Report from the Surgical Trenches: Total Shoulder Replacement in NYC

July 2, 2011; 10 Days Post-Op

Having had my initial follow-up visit with the surgeon and seen the x-rays, I can now say that I underwent successful surgery on Wednesday, June 22 and am the proud possessor (bearer? wearer?) of a titanium and polyethylene left-shoulder joint, plus a plastic ID card to show TSA screeners should I set off their security alarms.

The surgery was carried out by Dr. David Dines at Manhattan’s Hospital for Special Surgery, a short distance from my apartment. After consuming copious amounts of Jello and cranberry juice (who knew fasting meant eating like a kid?), I met my friend Ellen at the hospital at the civilized hour of noon, and was duly admitted for a 3-pm-ish surgery. An astonishing number of people, from the surgeon through the anesthesiologist & his assistant (an auntish-woman in granny glasses and a mob cap who called me “dear”) to several I could not identify but who were full of questions, visited me in the prep room, after which I took the proverbial gurney ride into an extremely businesslike operating theater. I was greeted by the auntie (“Hello, dear”) and promptly checked out of my consciousness.

While I was out, Dr. Dines removed the badly deteriorated bone of the ball and socket of my left shoulder joint (I had read the MRI report—sounded dreadful) and replaced them with implants of his design. The “ball” is the top of the humerus, or upper arm bone. The “socket” is a cavity at the end of the shoulder blade.

The Hospital for Special Surgery only does orthopedic surgery. Dr. Dines, who replaces up to 150 shoulders a year there, developed his first implant back in the late ‘80’s and has been improving on it since. Nowadays, it’s apparently custom-fit. The ball is attached to a piece that extends down into the upper-arm bone, securing it; the polyethylene socket (invisible in the X-ray) is attached to the shoulder blade by a small titanium piece into and through which, Dr. Dines, assures me, my own bone will grow. The whole thing should last 30 years, by which time I will be 100. (If necessary, Dr. Dines’s son Joshua, now in practice with him, could presumably do another at that time, should I once again find my yoga practice seriously compromised.)

I woke up easily in the recovery room, through what turned out, alas, to be only a dream of the operating team clapping and cheering. Great way to wake up, though, and I was told that they did think the surgery had gone very well. A couple of friends appeared at the end of the bed, but no one could tell me when space in a regular room would open up. As late afternoon slipped into evening, I was told that I might have to spend the night in the recovery room. I realized that sustained sleep would be impossible due to the constant beeping of monitors, and spoke to a nurse, who told me a dirty little secret of hospitals; just like the airlines, they overbook. In midweek, there is no guarantee of a room space opening up that first night.

However improbably, though, someone decided to check out of the hospital in the middle of the night, and by 2 AM my bed and I were ensconced in the inside space of a double room on the 5th floor. (What a great improvement over the old system, in which you were transferred from bed to gurney to another bed! Now they just zip you around in the same bed, and a very comfortable one it was, too.) I slept soundly until 4 AM, when staff came around to check vitals—heart rate, BP, temp. Amazing that I registered any vitals at all, but it was a lovely 2 hours’ sleep.

In a hospital dedicated to orthopedics, everyone knew what to do, and there was plenty of staff to do it. During my one full day there (Thursday) I found them very responsive  and unfailingly cheerful. I was never bored, and ate well—from Face Greek Yogurt to—at dinner—decent grilled chicken. Ice bags made of some kind of material that doesn’t sweat were continually replaced, and, on a combo of pain meds from IV drip and oxycodone pills, I was feeling no pain. Charming Dr. Sam Taylor, the 5th-year resident who had assisted in my surgery, came around and had the very bulky protective dressing covering my left shoulder removed, to reveal an astonishingly small incision in the front of the shoulder. It was covered with short, overlapping vertical strips of plastic tape; I wouldn’t have to change this real dressing!

Friday morning, the great man himself—Dines—came by, and told me that I didn’t have to wear my sling at home (only when out) and that I would be able to do the few PT moves I had been taught in the hospital on my own—apparently not always allowed—until I was ready to start formal PT.  So I came home, with a copious supply of oxycodone pills to keep me going. Friends generously turned out to bring whatever supplies I had not laid in before the surgery and, for a couple of days, to help me bathe. By Monday I could shower on my own and took my first little walk outside, across 2nd Avenue to the tree-and-bench-lined, brick-paved pedestrian mall that is 91st Street between 2nd & 3rd Avenues. (This was once the famous Ruppert Brewery and is now the main street of Ruppert Towers apartments. It was also once Jimmy Cagney’s neighborhood and the block is officially named after him.)

So: ten days along, the arm continues to be somewhat sore and a bit swollen, probably because I’m using it, which is ultimately good. I’ve got lots of multicolored bruises. But the long top incision stitch has been removed, I’m on the mend, and I start official PT on Wednesday. The surgeon swears that, eventually, I’ll be able to do headstand again.

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2 Responses to “Report from the Surgical Trenches: Total Shoulder Replacement in NYC”

  1. Chiropractor For Shoulder Pain Says:

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    Anyways, just wanted to say superb blog!

  2. mariyanu Says:

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