A Tale of Endurance

Joe has many strengths and skills. One of them is the ability to endure and persevere through difficult times (this could be stressful periods at work, a never-ending long run, death of someone close, etc.). While the past week has gone extremely well, it is an endurance test of acceptance of limitations in the present. Here’s the week in review: Surgery leaves you more fatigued than you can imagine. Recovery becomes a full-time job. Wearing a sling 24/7 is a drag because the strap digs into the neck. Sleep in the recliner is elusive.  It’s tough doing everything with his left hand – time consuming, slow going – but Joe is quite adept already.  With his left hand Joe can put contacts in, button shirts, secure belts, write legibly (yes, it looks like a 3^rd graders writing, but still …), wash dishes, floss, and do push-ups (Ha! Just checking to see if you’re really reading this).  Joe had little pain post-surgery, took the minimal amount of Oxycodone for 3 days, and then discontinued it. The doctor and physical therapist love this (and research shows the faster you get off pain meds, the better your recovery). Joe has diligently used the Continuous Passive Motion (CPM) Chair (pictured above – moves arm laterally) for three 1-hour segments each day as prescribed, starting at 35° and increasing the range of motion daily, to bring him to 90° (140° is the max) as of today. The doctor and physical therapist love this too ♥

Yesterday was Joe’s week 1 follow-up with Dr. Vetter.  An x-ray taken prior to the appointment showed everything looks good internally. Stitches at the end of the shoulder were removed and a fuller explanation of the surgery was given. Rotator cuff surgery was once done exclusively as “open surgery” (cut open the shoulder), then arthroscopy was all the rage (4 little holes are made for instruments to go in via camera guidance) and now, they find a combination of the two surgeries, called a “Mini-Open” are the most efficacious. This is what Joe had. Arthroscopicly, they were able to trim his torn muscle and reattach it to bone with anchors. They were also able to remove a piece of his collarbone this way to create more space for his muscles/tendons (more on what this means in a second). The open aspect of his surgery occurred at the end of his shoulder where they shaved down his hooked acromion process.

The acromion process is the bony cap at the end of your shoulder – that round dome you can see and feel – and via tendons it connects to your clavicle (though the acromion process is born from the scapula). There are 3 types of acromion processes (pictured above). Type I is flat, and creates the most amount of space for your muscles and tendons to move freely.  This is the least common type, with about 17% of the population having it (I hope I’m one of them!). Type II is curved, creates a little less space for the muscles and tendons, and is implicated in some rotator cuff tears. Type III is hooked, creates a cramped space for the muscles and tendons (this is why some of the clavicle bone is removed in surgery – opens up more space), is found in 40% of the population and generates the highest risk level for a tear – especially in physically active people. This nasty hook may be responsible for 70-90% of all rotator cuff tears. Still with me? Now of these tears, there are 3 types: A, B & C based on the thickness of the tear. A = a tear of less than 8mm, B= a tear of 8-12mm, C= a tear greater than 12mm. Joe, always an overachiever, had a 15mm tear (1.5cm), so he wins the jackpot of having the worst of it all! And, if that isn’t enough to impress you, how about this: Most hooked acromion’s are anterior, BUT Joe’s hooks are lateral (this is rare). This means they perfectly slice into his supraspinatus muscles, and after 43 years of doing so, something had to give. If you’re reading closely, you’ll note I used the plural “muscles” in the previous sentence. This is because yesterday we learned from an MRI of the left shoulder, that Joe has a tear there as well thanks to his predacious acromion. What does this mean? More surgery. More to endure.

The good news is the muscle tear in the left shoulder isn’t complete – it seems the underside of the muscle may still be attached. There is no sign of muscle atrophy, which buys Joe time. If the muscles were atrophying, he’d need surgery within 3-4 months for the best outcome. Since there is no atrophy, as long as he doesn’t overdo it with that arm, surgery can wait 6 months until his right arm is fully healed. While we’re both glad Joe insisted on having the left arm MRI’d to check for this possibility, a second surgery is an exhausting prospect to entertain at this time. We’re doing our best to stay focused on the present. Joe’s tracking of daily/weekly progress should help with staying in the moment.

Today was Joe’s first PT session and it went swimmingly. He was given 5 exercises to do 5x/day. This on top of doing the CPM chair 3 hours per day, and icing the shoulder after each of these expenditures. For the next 5 weeks, Joe is not to lift or hold anything in his right hand that is heavier than a Kleenex. He is not to do repetitive movements. He is not to contract his shoulder muscles. The aim of PT for now is to begin getting the arm away from the body, getting some blood flow and range of motion (ROM) to the shoulder in a passive manner. In addition to his home PT exercises, Joe will see the PT every Tuesday and Thursday for a combination of massage, and PT manipulated ROM.

It’s amazing to see how far Joe has come in 7 days. It’s crazy to think that surgery was just a week ago – the time feels both longer and shorter. When does he return to work? That’s hard to answer. He’s participated in some conference calls this week, but since he can’t use his right hand much (no repetitive motions), and since his job is primarily on the computer, he’ll have to play this by ear.

All Done

Joe in his sling and Ted Stockings

I knew it was a good sign when surgery was scheduled for May 24th. The 24th (of January) is Joe's birthday. If you  break 24 down to one number (2+4), you get 6, my birthday. I knew it was a good sign when surgery was scheduled for May 24th, because this is the 16th anniversary of the passing of Joe's beloved cat, Tippy ("Tippy-Cat!"). Surely, Tippy-Cat would be watching over Joe. I knew it was a good sign when surgery was scheduled for May 24th and I learned that is the day of the full moon.

I knew today was a good day for surgery when I drove to the gym at 4:30a.m. and saw a fat nectarine-colored moon sitting on the Western horizon. I knew it would be a good surgery when we were checking in and Dr. Stekiel (Dr. S), the anesthesiologist, intercepted us at the desk with a friendly warmth and casual confidence. Ditto for nurse Sherri and Dr. Carole Vetter. I knew it was a good sign when Dr. Vetter was ready for Joe 30 minutes ahead of schedule. All of these signs did not lie.

Now to back the story up. Yesterday afternoon the anesthesiologist called Joe to discuss procedures and mentioned the option of having an interscalene brachial plexus nerve blocker to aid with pain management. This has to be given before surgery to a nerve in the neck. The risks could include nerve damage, infection, adverse reactions, and no response at all. This was a big decision to make in the 11th hour and weighed on our minds until we got to Froedtert. More on that in a minute. 

Crisp air and bright blue skies - perfect running conditions - greeted Joe this morning. Joe had toyed with the idea of getting a final run in the day of surgery, but was hesitant to do so knowing he could not have any food or water - not even a teeny sip, after midnight last night. But knowing he would have to put running on hold for 12 weeks was enough to drive him out of bed for his last hoorah - a demanding hillacious 3-miler clocked at a blistering 7:40 pace! This made me smile, as well as the surgical staff. Joe was noted to be an official hardcore badass, and as a reward was given a litre of IV hydration before surgery.

While the water dripped through his vein, Dr. S explained that the nerve blocker, if Joe chose to have it, would be guided into his nerve via ultrasound. This virtually eliminates the risk of nerve damage. Knowing Joe could not have the standard anti-inflammatories others get due to his colitis, we decided the nerve blocker made a lot of sense. I stepped out of the room, Versed was administered to prep him for the nerve block, and within 10 minutes of receiving the block, Joe literally could not move his right arm, could not feel his right arm.

Prior to the nerve block, Nurse Sherri had Joe initial his right shoulder in his own writing, and I have to say that those printed initials made with his non-dominant hand, writing upside down on an angle, were more precise and clear than my own print job on paper with my dominant hand. I think it's the engineer in him. Sherri also had Joe put on full length Ted Stockings (covers him from toes up to the top of his thighs) to be worn all day as a precaution against blood clots.

At 8:55a.m., we said our goodbyes, as Joe was wheeled to the operating room 35 minutes ahead of schedule. He had won the staff over with his quiet humor and graciousness (and of course the rumors of his pre-surgery run), support staff telling me, "Your husband is so sweet. So interesting. So nice." I was dispatched to the comfortable waiting area where I alternately sat or paced (not out of nervousness, but out of restlessness with just sitting) while reading Gone Girl. At the end of the waiting room, windows overlooked a large park that hosted a gaggle of geese. I enjoyed taking breaks from my book to watch them peck and socialize.

At 10:25a.m., Dr. Vetter came out to report the surgery was over and a success. She described it as "easy and simple", as she showed me a series of images taken during the procedure. She said Joe's shoulder was just being dressed (this means she literally came right out to see me after closing his shoulder), and I would be brought back when he awakened. An hour later, I found a groggy, smiling, slinged Joe with a sore throat and jaw from the breathing tube, and an unquenchable thirst. By 1p.m. we were headed home with a prescription for Oxycodone. Joe won't need the Oxy until later tonight. The key is to stay ahead of the pain. As the nerve block wears off, his arm should begin having sensations again starting with the fingers. Dr. Vetter advised taking the first dose of Oxy when sensation reaches his elbow. The Oxy is to be taken 2-3 times per day as needed. In addition to that, Joe is on Tylenol every 4 hours, as well as using ice paks for 20 minutes every hour. Not one for taking meds, and having a high pain tolerance, it is unlikely Joe will be on pain meds for long.

Tomorrow, Joe can begin using the Continuous Passive Motion chair, which will gently and safely move his arm for him. By tomorrow the "cob webbs" of anesthesia will clear out. The shoulder dressing stays on until Monday, at which time Joe can take a shower. Anytime he removes the sling, he needs to let his arm dangle like an elephant's trunk. He must be keenly aware of not engaging his muscles in any way. Thursday we have a follow up appointment with Dr. Vetter. At that time, more direction will be given about the rehab process. Joe will also learn the results of his left shoulder MRI (done to see if a similar problem is likely to occur). Friday, Joe will begin physical therapy.

Warp Speed

The date of Joe's surgery set a deadline for completing a lot of small-medium home projects while he still has use of both arms (i.e, installing the rain gauge on the roof, re-stringing a broken honeycomb blind, rewiring a light socket, etc.). Fortunately, the weather has been cooperative, allowing Joe to sand, prime and paint several weathered areas on the house that were slated as a summer project. With new neighbors moving in in July, there was extra pressure to finish the side of the house that faces theirs - the side that was ravaged by woodpeckers in the fall - because first impressions are everything ☺

While the past 2 weekends have equaled house project time for Joe, it's been my opportunity to practice taking over some of his usual chores, such as mowing and general yard work. It seems I'm a slower mower than Joe, as I've run out of gas both times in the middle of the job, while Joe says he never runs out. I'm going to attribute this to our pie shaped lot, coupled with the obstacles along the way (Bruce, Dora, Basswoodia & Guido), which creates a lot of weird triangular angles, meaning you can't just mow back and forth in a straight line. To get all the little areas, my OCD kicks in, and I believe I become so thorough that I go through more gas. I've designated Sunday as mowing day (weather/schedule permitting), because I've found it's a great way to get steps and light activity in on my one non-exercise day of the week. My FitBit is telling me that I walk 2.5-3.0 miles while mowing, and and additional 1-2 miles walking around doing yardwork. This is light activity that will not tax my body or negate my Sunday recovery day, yet offers me a chance to stay limber and get natural Vitamin D!

The surgery deadline has also established a frenetic pace to get one last (fill in the blank) done. This has included many pit stops after work for Joe to stock up on various supplies for us from Menard's, SAM's Club, Farm & Fleet and miscellaneous stores (i.e., a jaunt to Payless Shoes to find work shoes that he can put on with one hand). The mad dash also means cutting his hair (he cuts his hair himself), finger/toe nails, making one last loaf of bread, one last batch of hummus. Some of these things he's doing in an effort to make my life a little easier once I take over both of our home duties.

And lastly, he's pushing to reach 425 miles run before his 12-week hiatus. He is on course to meet that goal before Friday's surgery. We haven't been told what time he needs to report yet (they schedule the time a few days prior), but if there's any time before we need to leave Friday, you can bet he'll get one last run in. And speaking of running, and to address the title of this blog (which is meant to refer to both the busy-ness of life to prepare for surgery, as well as my running), I am happy to report I have finally had a break through with my running fitness. In the weeks since the Wisconsin Cheesy, I've been consistently clocking faster runs with lowered heart rates. Most notable is the improvement in my trail running. I'm covering the same miles as last year 20-25 seconds per mile faster, with a heart rate 10 beats lower than last year at the slower pace. It's taken nearly a year to build back to this level after my knee injury fully healed. Running progress takes patience. As a reward, I bought myself a new pair of Gore-Tex Trail runners! My next post will share the outcome of Joe's surgery.

Shoulder Surgery

There was no audible pop, no one incident, nothing acute. Instead it was the degenerative process of wear and tear through an active lifestyle, coupled with a Type III Acromion Process (This is a bony point on the top of the shoulder that muscles and tendons cross over. There are three types of acromion processes - a flat one, a curved one and a hooked one - Joe has the hooked kind, which likely cut through his muscle like a knife on rope) that led to a "full-thickness tear of the supraspinatus" muscle in Joe's right shoulder. This is a rotator cuff injury that will require surgical repair to restore Joe's arm to a full range of strength and motion for the long haul. The rotator cuff is comprised of 4 muscles that taper into tendons that connect to bone. The shoulder joint (actually made up of more than one joint) is the most complex joint in the body, allowing us to move and rotate our arms in a plethora of ways. It's an easy target for injury through repetitive use or age - doctors say beyond the age of 70, most people will have some kind of tear in their shoulder even if they don't know it.

Joe's tear is a little over 0.5". It most likely occurred in late January, which is when Joe started having shoulder pain/discomfort manifested in difficulty lifting his arm laterally (i.e., putting his arm into sleeves, lifting arm to the side and then up), and with finding a comfortable sleeping position. When his arm didn't improve after a couple weeks of rest, he saw our orthopedist who ordered physical therapy (PT). After 6 weeks of PT, Joe hadn't progressed as much as hoped for, so he was referred back to the orthopedist who ordered an MRI. The results of the MRI led to a referral to the highly qualified surgeon Carol Vetter http://www.mcw.edu/orthopaedicsurgery/faculty/CaroleSVetterMD.htm. Joe had to wait 2 weeks to see Dr. Vetter, during which time we crossed our fingers that surgery could be delayed until fall so our August vacation to the Canadian Rockies wouldn't be impacted.

Joe saw Dr.Vetter earlier this week. She indicated that surgery was necessary - sooner rather than later. If a tear of Joe's nature is not addressed within 3-4 months the muscles and tendons atrophy, reducing the success rate of surgery. With our active life, as well as all the ways Joe needs his arm to function well (i.e., running, work, guitar playing), he needs to have full use of that shoulder. Surgery has been scheduled for Friday May 24th, the start of Memorial Day weekend.

SURGERY: We don't have a time yet for surgery - the office will call Joe about 3 days before surgery to give him a time. It will be outpatient arthroscopic surgery lasting about 1 hour. During surgery the muscle tear will be fixed, the acromion process will be shaved down and some arthritis will be cleaned out. Joe will be sent home with pain meds, but cannot partake in the standard anti-inflammatory meds due to his colitis. His arm will be placed in a sling that has a tubular pillow attached to it, resting between his body and his arm to hold his arm in a precise position for recovery. He will also receive a special chair to sit in that will move his arm in a prescribed pattern for circulation and range of motion in healing. Joe will be motivated to get off pain meds ASAP (he hates taking any meds) - most people are on them for at least a week. Joe is not most people☺

IMPACT ON LIFE: No driving while on pain meds. Joe will not go to work the week following Memorial Day, though knowing Joe, he will try to do as much work from home as he can with his left hand. Joe will need to keep his arm immobile for 6 weeks. It is his right arm, his dominant arm. Imagine what you couldn't do with the loss of your primary arm. He will have to learn how to put contacts in with his left hand, or wear glasses. He won't be able to put socks on, or tie shoes - good thing we're entering sandal weather. I've already told him that I won't cut his toenails - he'll need a pedi or he can let them tap on the floor! He won't be able to wash or tie back his hair (this is where I practice being a hairdresser). He won't be able to use chopsticks - may have to downgrade to a spoon. I'll take over some of his activities, such as mowing the lawn, washing dishes (I usually cook and he washes), making bread by hand, etc. He will need to sleep in a recliner until it doesn't hurt to sleep in bed. He won't be able to play guitar - suspending his lessons until further notice. He will not be able to run for 12 weeks. This means missing the Rock-n-Sole Half Marathon on 6/15, and likely having to walk portions of The North Face Trail Half Marathon in September. And our vacation? We can still go, but whether or not we can do the short backpacking portions of the trip are unknown right now - we may have to do rigorous day hikes instead.

RECOVERY: The first week or so, Joe will be lying low, resting and tapering off pain meds. Within a week of surgery he will begin PT twice per week. In the beginning weeks PT will be passive, meaning only the PT will move Joe's arm, but as time goes on, Joe will be given exercises to do at home. He will be in the sling for 6 weeks, as this is a critical time period for letting the surgical changes gel and take hold. PT has been booked out until August. Mid-August Joe can start running again. Full functioning should return in 6 months.

Time Flies...

... when you're with the right person. Joe and I are one day away from celebrating our 20th anniversary. You never know what twists and turns life will take. On May 8th, 1993, I had no clue I was one day away from meeting the person I would share the rest of my life with. I never suspected that just 24 hours later, on May 9th, 1993 I would find someone with whom together we would become lifelong vegans and fitness nuts, mastered degreed professionals, home owners, parents to awesome kitty cats (some wise, some snarly, some pure goodness), avid backpackers, mountain climbers and stranger yet, runners (in fact if you had told me we'd be future runners, I'd laugh in your face and say "never").

Twenty years have passed with astonishing quickness. I don't feel old enough to be celebrating "china" (the traditional gift for 20 years). In two more years, I'll have spent half my life with Joe and in another 30 years, people will be asking for our secrets to relationship longevity, but I can give you some insights on that right now. Share the same fundamental beliefs (it's helpful that we have the same politics and philosophies on life - it's another thing to unite over), share similar interests and hobbies (everything does not have to be the same, but more in common is better than less), make plans for new experiences and follow through on them (in fact, I think it's growing through new and exciting shared experiences that is key to not stagnating), pick your battles, always express gratitude and love (don't grow complacent and expectant - if Joe brings me a fresh water on his way back from the kitchen, I say "thank you" because it's not his job or a given that he serves me water☺), surprise each other with unexpected acknowledgments (could be a note, a sweet email, a gift just because), take care of yourself (in all ways - don't let yourself become fat and unhealthy, retain your independence - don't expect your partner to take care of you), keep learning and growing so you have something to bring to the table, and laugh!

Now, to provide you with a laugh ... here we are 20 years ago. I'm rockin' the spiral perm and thick eyebrows, while Joe sports his shorter poofier hair and a Fu Man Shu mustache☺But we sure had a beautiful east side apartment, didn't we?!


December 1993 - 7 months down and 233 months to go to reach 20 years!



Birthday Boyz

The Boys turn 3 on this Cinco de Mayo!

In human years they're about 28 years old.

 

Say Cheese!

We had a great race! A redemptive running of the Wisconsin (Cheesy) Half Marathon. Up at 4a.m., race morning began with the usual drills - multiple trips to the bathroom, oatmeal, filling of the Camelbaks, one more trip to the bathroom, and on the road by 5:15a.m. to Kenosha. Fully anticipating rain, we were excited to witness a beautiful deep flourescent pink sunrise amidst a thinning striated cloud cover. Though we allotted plenty of time to get to the race, we spent much time trying to find a parking space - eventually securing a spot about a mile from the start - and had to hustle to get to the start, check our gear and use a bathroom (yes, one more time!). By the time my gear was checked, we had 6 minutes before the 7a.m. start gun would sound, while long lines still waited for the Port-o-Potties. Anxious and stressed, I made the executive decision NOT to go one more time, telling myself that it was only nerves, not a real need to go.

About 4,000 runners for the combined full and half marathon took off in perfect conditions - upper 40's, filtered sun, gentle breeze. Already familiar with the course, I was not disappointed seeing the same scenery, and enjoyed the roadside crowds cheering us on. There was an exceptional K-9 presence today - people bringing their amazing and beautiful dogs to watch the race (gorgeous breeds like Huskies, German Shepard's, Golden Retrievers, Labs, and many big dog mixtures), and some fun homemade signs that weren't the norm, such as "Run Faster. I just farted" ,  "May the 4th be with you", "Keep running, Random Stranger, Go!" and "It's a hill. Get Over It."

Last year, my knee injury began acting up by Mile 3, and by Mile 8, I was interspersing many walk breaks. This year as I hit Mile 3, and later Mile 8, I noted how strong I felt and was grateful for no pains (except for that callus that was starting to develop a blister!). At 10 miles I glanced at my watch, and saw that I would come close to PR'ing (2:14:33 is my best), but reined myself in, reminding myself to "run the mile your in". Too many times, I've gotten carried away in the moment of a decent looking time, only to bonk 5 minutes later, so back to the very moment my mind went. At Mile 12, with just 1.1 miles to go, I developed strange rolling cramps in both achilles - this has happened to me before. I decided to walk through the last aide station to give them a quick break, and pushed through to the finish line with my second best race time ever - 2:17:00 (10:28 pace). This was a 9+ minute PR from last year, so a massive course PR!!!

And Joe? Well, despite sleeping poorly, feeling tired enough on the course to briefly walk a bit, he hit an all time PR, finishing in 1:39:11 (7:34 pace). Out of 2300+ half marathoner's, he placed 151 - that's in the top 6%! We collected our very groovy medals that have eyes that glow in the light, and listened to a Blues Brother cover band as we made our way, slowly, back to the car.

But wait, the day doesn't end there. With energy to spare, and a warming day with parting clouds, once home, it was 2 hours of fairly heavy yardwork and house chores, before showering and having a visit with my niece. As the day winds down, we're feeling chilled, despite temps in the low 70's - we suspect we got more sun than we realized. Windows have been shut, while the oven's been fired up for what else? Pizza! Very soon, we will become one with the couch☺ And based on my FitBit stats, I need it!

Steps Taken (so far): 35,991

Floors Climbed: 18
Distance Traveled: 18.51 Miles
Calories Burned (so far): 2603

Is it too soon to talk about what lies ahead? Nah. Since this was our second half marathon within one month, we will take a full 2 week recovery period with lower mileage before we amp up for race #13 - Summerfest's Rock-n-Sole Half Marathon on 6/15/13.