Posts Tagged ‘surgery’

I’m still living with RA after being diagnosed in 2008. But like many patients, symptoms tend to rear their head prior to being formally diagnosed. For me, that was bilateral iritis (inflammation) in 2004. The ophthalmologist questioned me about joint problems and with nothing to note, we ignored possible autoimmune causes. In 2007 I had my first joint surgery – the left ankle. In 2008 I had surgery on the right ankle. Then other symptoms prompted my perceptive primary care doctor to send me to a rheumatologist. Since 2007, I’ve had multiple surgeries associated with RA – three ankle, both shoulders, joint replacement in both thumbs, cervical discectomy and vertebrae fusion, right elbow, and sinus surgery to treat persistent infections caused by RA meds. The 11th surgery was one week ago on the left elbow. The procedure was designed to clean up damaged tissue caused by ongoing RA related inflammation in the joint. The surgeon said that my elbow “was on fire” from RA and the MRI showed that the entire joint had inflammatory fluid around it. The sutures come out tomorrow (see pic below) and I start occupational therapy in a couple of weeks. Adding insult to injury, I just had thumb joint replacement on the left side six months ago and it’s making use of the left hand much trickier. At the same time, I’m in the midst of getting radio frequency ablation (“burning”) of nerve roots on the facet joints in both the lumbar and cervical regions of my spine. A future post will describe this process in more detail.

The scars of surgery are outward reminders of the permanent impacts of RA.



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It’s been 12 days since having a second Ligament Reconstruction Tendon Interposition (LRTI) surgery designed to replace the damaged carpometacarpal (CMC) joint at the base of the thumb. This procedure was on the left thumb – the right side was done in April. Today the cast and sutures were removed (see pic below). During the procedure, the trapezium bone is removed from the wrist and a tendon is harvested from the forearm and rolled up and secured in place of the trapezium. Artificial materials such as metal and plastics tend to be rejected as artificial joints in this area.

Instead of being placed in another cast for 3 weeks, the surgeon placed me in a splint with the notion that periodic, gentle movement of the metacarpophalangeal (MC) joint just above the CMC joint may prevent stiffness and freezing of the joint which would ultimately compromise and damage the replaced CMC joint. This is what has happened with my right thumb which my surgeon and rheumatologist suspects is from RA-induced inflammation since RA isn’t really under control at the moment. My occupational therapist spent considerable time attempting to “unfreeze” the joint to no avail. A procedure to either remove the synovial capsule and surrounding soft tissue or to permanently set the MC joint with screws at a 25 degree angle is being considered once the left thumb heals enough for everyday functioning.

This is my 10th surgery in 10 years since being diagnosed with RA and it’s pretty much a toss up as to the difficulty of recovery between this procedure and cervical (neck) discectomy and fusion surgery. My surgeon says the hands contain many nerve endings and it’s difficult to function without the grip of a hand for such a duration. Occupational therapy will begin around 8-10 weeks.


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It’s been so long since I posted here and felt that some sort of update was in store. I’ve been on short term disability (STD) since January 1st. I must be on STD for six months straight in order to move to long term disability (LTD). My workplace has been wonderfully supportive and has great benefits to aid in this process. All benefits remained in place during this time. Not working has been a real blessing in terms lowering stress levels and helping with rest. While being a tough decision, it was clearly the right decision. I walked away from a lifelong career of teaching that was very rewarding and was what I was made to do. Long term disability starts July 1 at which time I will officially be separated from my employer and will receive paychecks from the LTD insurance company and benefits through COBRA. I will continue to engage in some consulting work to supplement my income.

In the midst of the work transitions, a 7th joint surgery occurred a couple of weeks back. This was on my left shoulder and was basically a repeat of the surgery done on my right shoulder in January. The AC joint was damaged by RA to the point where there was no cartilage and bone was rubbing on bone. The surgeon cut off the end of the collar bone and shaved the shoulder bone to clean up bone spurs. The rotator cuff was in good shape on the left shoulder unlike the right side. Arthroscopic surgery is the way to go as the healing goes much quicker and pain is much less. The shoulder remains quite stiff and I can’t use it much for the next couple of months. However, the right shoulder is causing me more discomfort and that is because the surgeon repaired the rotator cuff which takes a long time to heal.

I haven’t been on any RA treatments since last December. I’ve run the gamut of most available RA treatments and it’s evident that they either haven’t worked or the side effects including migraines, GI issues, and infections were unbearable for me. I can say that not taking meds allowed me to avoid fighting the side effects – this has been pleasant. But the RA disease process has picked up during this period. Joint swelling, pain, and fatigue are on the rise and I know that this can bring more damage from the RA processes. I see my rheumatologist next week and we’ll develop a plan for the future.

In the midst of the craziness, we are moving from Seattle to San Luis Obispo County, CA this summer. This decision was primarily based on our desire to help some friends start a new church in the city of San Luis Obispo near Cal Poly State University. One of our Associate Pastors at our home church in Seattle will be leading the church and there is a team of people going along to help. The new church is called Vista Church. Some people wonder why we would do such a move but this is how churches get started – they are planted by people. Not only will we be able to help with the new church, but the move to the Central California coast will allow me to enjoy sunny and warmer weather and hopefully this will make my body feel better. Our house already sold in a couple of days (the market is nuts in Seattle) and we are currently looking for a house in Cali.

Transitions are a part of life. It’s much easier to sit back in your cozy chair and avoid changes. But getting on the roller coaster and enjoying the ride instead of fighting it makes the journey much more enjoyable. I’ve learned to trust that God will take care of you no matter what transitions life brings.


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It’s been six weeks since right shoulder surgery was performed in order to resect the acronomim and clavicle joint (AC joint) and remove rotator cuff tissue that was damaged by bone spurs. At a follow-up with the surgeon today, he indicated that patients tend to talk about still having pain but of a different quality. This is true for me in that the joint pain is much diminished but dull aches remain. He said this is primarily from healing bone and surrounding soft tissues. He cleared me for stepping physical therapy up from gentle stretches to strengthening exercises. Given my battle with RA, he said that recovery is likely to be longer than normal.

We then turned attention to my left shoulder as it’s been bothersome for quite some time as well. The surgeon gave a steroid injection into it about 8 weeks ago but there was only about a week of relief. He got an x-ray during the visit and discovered that there was acronomim bone rubbing on clavicle bone with no joint space visible. He attributed this to inflammatory arthritis (RA) and said that the cartilage between the bones was damaged but there were no large bone spurs visible. Like with the right shoulder, surgery would be needed to repair this joint and he suggested waiting at least three months after the other surgery. This would be good timing as my insurance out of pocket costs are met and will be until the end of June. We will schedule surgery at another follow-up appointment in six weeks.

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It’s been a little over two weeks since I had arthroscopic shoulder surgery. At the post-op followup visit with the physician assistant (PA), an x-ray was done and the steri-strips placed across the small incisions were removed. The incision scars are quite small FullSizeRender (3)compared to other surgeries (see photo). There remains a large area of bruising around the front incision where fluids pooled up after the surgery. I was told that the sling was not necessary except to provide relief and to send a message to others not to grab my hand or hug me!

The PA showed me 24 photos of the procedure and explained what was going on in each one. One showed a grinding tool right above the rotator cuff which had some damage from a bone spur right above the tool. The tool was


bone spur above and rotator cuff below

used to remove both the damaged rotator cuff tendon tissue and the bone spur. In the next photo, the tool is shown working on removing some bone tissue on the end of the clavicle. Finally, a space between the acromium and clavicle is visible after removing about 1/2 – 3/4 inch of the clavicle. The x-ray shows an that there is an open space where the AC joint used to exist. Bone will no longer grind on each other. The x-ray technician asked who did my neck surgery as she “sees all” on the image. The screws and plates are visible on the image.

I was cleared to start physical therapy and was given a prescription. I went upstairs to the PT clinic run by the surgery group and scheduled PT starting February 17 with two sessions each week for six weeks. The goal is the begin stretching and moving to strengthening.

For the present, I’m careful with the shoulder and avoid moving it too much as any movement can cause it the tire easily and become painful. But without being immobilized, I find myself going into usual movements and paying for it later. Overall, recovery from arthroscopic surgery has been much easier compared to open incision surgeries and I’m thankful for this technology.

In the meantime, I still can’t start my new RA treatment, daily Kineret injections, as I’m battling a thrush fungal infection. I see an ear, nose, and throat doctor tomorrow to address the ongoing cough and the thrush infection.

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grinding tool removing bone tissue on clavicle








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opening between acromium and clavicle after removing bone tissue








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X-ray showing end of clavicle removed. Screws and plates are visible in neck from previous surgery

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Comparing our RA Scars

There’s a great scene in the classic 1975 movie Jaws where Fisherman Quint, Police Chief Brody, and Scientist Hooper are sitting around on a boat during the evening. The three are drinking and loosening up after a stressful day of chasing the shark. (Robert Shaw, the actor who played Quint, was reputed to have been wildly drunk during the filming of the scene.) Hooper and Quint are playing a clowning game of one ups-man-ship comparing their body scars. They pull up clothes to show their various badges of honor – some from school and bar room fights, some from burns, and others from clashes with various sea creatures. Brody feels like the odd man out as he only has an appendectomy scar to share. He lifts up his shirt, looks at his medical-induced scar, and then lowers his shirt deciding not to participate in the game…

photo-e1424322927354Rheumatoid arthritis is much like this script. Some of us may have physical reminders – scars so to speak – of our RA. These may come in the form of disfigured joints or as actual scars from surgeries intended to repair the damage done by RA. These outward signs are constant reminders to us about our condition.

Read the rest of the article at http://rheumatoidarthritis.net/living/comparing-ra-scars/.

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photoLast Friday brought a 6th surgery in the past seven years. This is remarkable given the fact that the first 46 years of my life were relatively healthy with no major medical procedures. All surgeries have been connected with rheumatoid arthritis. Friday’s surgery was an outpatient procedure on the right elbow designed to remove damaged tendon and bone and to reattach tendon to the joint. It’s been an ongoing battle with both elbows for the past 18 months but other RA issues, primarily neck surgery and recovery last spring, took precedence.

The orthopedic surgeon who conducted the procedure specializes in hands and elbows. He said that he’s done numerous surgeries on the elbow and my tendon was one of the worse cases he’s seen. Healthy tendon tissue is typically smooth, white, with parallel lines. He characterized mine as mushy, gray, and undefined. After clearing out the tendon and removing damaged bone tissue, the remaining tendon was connected to other nearby healthy tendon. Holes were drilled in the bone to hold suture anchors that were used to reattach the remaining tendon to the joint.

The procedure was scheduled for early afternoon. After a long wait where drinking and eating were not allowed since the previous evening, a nasty migraine began to set in. The nurses stated that this is common due to dehydration. Lack of coffee probably didn’t help. They increased the saline drip line and provided a bag of ice. After waking from anesthesia, the migraine completely vanished. This was the easiest postoperative recovery in that there was no nausea or pain at the surgery site. The anesthesiologist said that he would just use infused anesthesia and avoid gases and narcotics that cause nausea. The surgeon used local injections of anesthesia to block pain. These lasted for at least 12 hours. Percocet, a combination of oxycodone and acetaminophen, is helping keep pain in check.

photo (1)The arm was immobilized from above the elbow to the fingers. The dressing was changed after three days and the stitches will be removed after 10 days. Occupational therapy will begin at two weeks to slowly regain movement and strength.

There’s never a dull moment with RA and this episode is just part of the ongoing battle. After knowing that the surgery will be infection free, I will begin another part of the battle by adding a new drug called CellCept alongside current Rituxan infusions.

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