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12 Sep 2018

The Road to Recovery

Six days later and it still aches a bit. The doctor explained that may be because he:
  • Did a 4-inch incision in the skin
  • Cut the tendon
  • Split the muscle
  • Cut the bone 
  • Dislocated the shoulder and worked on it outside the body
  • Replaced ball at top of arm bone with metal ball
  • Covered the socket with a new plastic surface.
Enough, you get the point.
All the surgeon can do is physically get the shoulder back in shape so that pain can stop completely and range of motion returns as close to optimal as possible.
The success and time of each is directly proportionate to the rigorous exercise program prescribed. 
In the week between the surgery and the follow up visit there are several very specific dos and don’ts.
Every waking hour ice is mandatory for swelling reduction.
Squeezing the ball 10 times each hour is required and easy.
The breathing machine also is 10 times hourly. It is tougher than it looks. Major lung filling is required for minimizing pneumonia and other breathing complications. It has an amazing calming effect and 3 major inhales would definitely reduce stress when tempers are escalating. Allyn has permission to invoke the breathing down the road when I might get a bit testy.
The sling only comes off three times daily, for exercise, bathing, and getting dressed. That is tough duty. The exercise is comprised of 1 set each of 10 curls (no weight), wrist curls, reverse wrist curls, arm hanging circles, and shoulder shrugs.
The purpose of the sling is to stop inadvertent shoulder movement. Many minor movements still hurt.
The sling stays on for six weeks, with serious physical therapy (the torture) starting in a week. 
The doc said that in four to six months I will be back on the golf course. That remains to be seen as I have been off for 20 years.
 








10 Sep 2018

Hospitals – Cant Live Without Them, But YIKES!!!

I’ve been quite fortunate through the years as I don’t recall spending even one overnight in a hospital. What a surreal experience it was. They did so many things wrong, inappropriate, inefficient and ineffective that I was shocked as a patient and just shaking my head as a businessman. Yet when I left, I felt so good about the people involved!  At least I can say that Included in all the errors was NOT putting wrong drugs in my IV.
It all started when we were told to show up at 5:30am on at least three different occasions but at the last minute I received yet another call CONFIRMING we would be there at 5:00am. Okay, little did I know how typical this type foul up happens around there. I still don’t know what was right, but we showed up at 4:55am and they weren’t even open. The operation was at 7:00am and it does take over an hour to prepare – especially since we had to fill out so many forms.
For the record, I have no problem that several nurses and the anesthesiologist, himself, asked numerous times if I had allergies and confirmed what medications I am on.  I am a big fan of the double check. 
It didn’t seem like a big deal being there so early because I was under the impression I was going to be sleeping most of the day. Wrong.  I had no sleep whatsoever after waking up from surgery.
Also, I know in our world, that each doctor, the hospital, the other staff and seemingly every other person around needs me to sign a release saying something along the lines that if they kill me that I am OK with that. Maybe they should have had me sign those releases earlier with many of the other forms. I was a bit anxious already. It was not a shocker to see that my blood pressure was high when they checked my vitals.
The pre-op people were just fine. They wheeled me into surgery precisely at 7:00 and I felt like a head of state. There must have been 10 – 12 people in the surgery room and each had jobs to do just to take care of me. It was very comforting. About three hours I was out of it and at 10:15am.  I woke up in post –op and was informed everything went perfectly.
The doctor called Allyn as scheduled and spoke positively and in-depth about the operation. He said I needed some recovery time, as per usual, in the post-op and then they would take me to my room where the nurses would call her when I was no longer out of it and in my room.
Then the problems started. They had no rooms quite yet. An hour later, they still had no rooms. This reminded me of trying to check into a hotel. I figured we had a real problem when they wheeled in a regular hospital bed to get me off of the tiny uncomfortable gurney. Then they allowed Allyn to come in to post op even though visitors are usually not permitted there. It wouldn’t have been too bad except another recovering patient was speaking inappropriately and yelling about his catheter and his penis and invading my audible space. I am not sure if the nurses even asked him to try to keep it down.
Bottom line- we waited over 6 hours for a room while every half hour a more senior staff member would come in and apologize and then shrug their shoulders.
At 3pm they agreed to get me a sandwich because I had not had a bite since dinner, the previous day. We had to remind them twice and still no food came. Finally, when I was rolled into my room about 4:15pm, I immediately told the nurse that I needed my sandwich that had been ordered. She wanted to start the process all over to get permission for me to eat, to check my diet, allergies, the doctor notes etc. It took another 30 minutes before a dry white bread sandwich arrived.
Speaking of food, all three meals were totally wrong (and terrible as anticipated). The protocol if you are not on a special diet is like room service but at a specific time. Never once did I receive close to what was ordered, although each time they changed it and apologized.
Earlier when Allyn had arrived, she pulled up a chair and let out a gasp saying the floor and machines are filthy. She looks around and the entire place is disgustingly filthy. That was shocking.
They made a huge deal of getting help walking to the toilet which was just four steps away even though I was not drugged up. OK I rang for and requested the nurse. 5 minutes later I rang again. Then finally on the third ring, she showed up. She was quick to inform me that she had other patients to attend to. Boy was I glad it wasn’t an emergency.
She said an assistant next door would be right in and handle the 4 step walk. It must have been below her pay grade. Nobody showed yet again. I called again and finally the assistant came in and said no one told him. I said I would be maybe one minute.  He said to pull the cord when finished and he would be right in.  I’m not kidding when I tell you that 3 calls and 15 minutes later, I just walked back to my bed.
Later when I asked the nurse about the delay in helping me back, she said she saw the helper was busy so she didn’t bother to tell him and just went on her way.
During the night, there is absolutely no concept of sleep. When they aren’t doing rounds, they are taking blood pressure, temperature, checking oxygen and pulse. Other times they are giving meds. I’m sure there is a good reason why they have different staff work on the roommate, but it seems like they stagger everything to maximize lack of sleep for both of us. I loved not having a private room – N O T!
The thing that was most offensive though was that in the middle of the night the staff had no problem chatting right out in the hall about both business and personal items.
If you stand way back it is easier to see that my problems were aggravating and not life threatening. I’m sure the operating room was totally sterile and probably if I had a real emergency and could say HELP then my roommate would have intervened. And I can get some sleep this week.
In the morning, Allyn and I worked with occupational therapy three times for quite a while. Of course, there was the hospital’s normal miscommunication as to the hours. Occupational therapy is how to do things like bathe and put a shirt on. The give several things to do during the 6 weeks the sling is on (part 3). We worked with four different ladies and they were all terrific.
During the off times in the morning I had a veritable line of senior staff, nurses, and administrators visit to hear first-hand about the problems. The word was out. They all seemed legitimately concerned and plan on taking action. Several took photos of the dirtiness and showed personal disgust. 
We walked out feeling the operation was a big success. Clearly the hospital system is a mess, but it is the best we have. Just don’t expect sleep or rest and bring an advocate with you (like Allyn) who doesn’t allow them to accidentally kill you.








08 Sep 2018

The Road to Shoulder Replacement Surgery and Surgeon Selection

Not my normal JetSetWay blog. 
Recently I had a total shoulder replacement aka total shoulder arthroplasty.  I am going to chronicle the steps that lead up to it, the procedure itself, the hospital experience, and the long tough recovery process. 
The steps leading up to the surgery were many and taken over several years. Arthritis in my left shoulder has caused my cartilage to disintegrate overtime and the pain increased in direct proportion. Picture a tire losing its tread and then losing the rubber itself and driving on the wheel itself against the road.  Ouch.  Every night the excruciating pain woke me up.  The day was worse depending on the activity.  
I must admit I had a built-in bias against going to an orthopedic surgeon from the beginning as I wanted to explore and eliminate all other possibilities before having surgery. And in total fairness to all four orthopedic surgeons that I ultimately spoke with, not one of them tried to push surgery; each one of them said it was a last step and even then, it was not mandatory. It is always an option in proportion to how much you want to deal with the existing pain.
Before I went to any surgeon I had been in close contact with my terrific concierge doctor, J. Corey Brown, and we tried so many alternatives.  Prior to the surgery decision, I tried using a chiropractor, then physical therapy, then acupuncture, then went to a local orthopedic surgeon who tried a Cortisone shot. That left the surgery option.
The issue was simple.  Was I willing to have temporary pain and discomfort in order to regain my mobility? For me it was an easy choice because the pain kept escalating.
Dr. Brown referred me to the Southern California Orthopedic Institute, a huge well-respected organization of orthopedic surgeon specialists who also do a considerable amount of the training for other orthopedic surgeons. We just don’t have those options in Las Vegas.
Fortunately, one of the gentlemen who started the institute actually was an intern with Dr. Brown. All the information I received from that doctor and my research came to the same conclusion; have surgery or simply deal with the pain.
He suggested I use Dr.  Joseph Burns who is the ultimate specialist on total shoulder replacement.
It turns out that there are about 900,000 knee replacements performed every year in the U.S. and only 50,000 shoulder replacements.  The shoulder replacement is a more difficult type surgery. Unfortunately, the vast majority of the orthopedic surgeons who perform shoulder replacement surgeries only do one or two a year. Dr. Burns does about 50 of these surgeries annually and often is called in as the person to repair previous surgical problems. That notwithstanding, I got a second opinion from a family friend who is also a very highly respected orthopedic surgeon. He knows the group well and gave a total thumbs up.
Dr. Burns said this is a relatively good time to have the surgery, if there is a great time, because I am at the age where it will last my entire life and there is new technology that allows him to know exactly where to put in all the replacement items rather than just in the general area because of recent CAT Scan advances.
I have a personal theory that a lot of orthopedic surgeons are sports fan. It turns out that Dr. Burns did his undergrad at Yale and was actually a ballplayer on two varsity teams.
I particularly like Dr. Burns. Not only does it seem that the operation was an entire success, but he spent time speaking to my wife, Allyn, after the surgery in a manner that made her feel I was in good hands and the surgery was a success. No CYA.
I did not feel like just a number.  When he came to the hospital the next day on his rounds and chatted with me, he spent an inordinate amount of time explaining things.   It was important to him to go over post-surgery requirements that will help with my recovery over and above just basic shoulder items. He even went so far as to put me on a special low sugar diet because of my diabetic tendencies. He cares about his patients not just about his narrow surgical area.
Stay tuned for Part 2.
 








24 Aug 2018

London, England, UK 2018

 

If the raison d'etre for our Madrid trip was the visit to The Prado Museum, the prime purpose for London finally was to be able to see Matilda the Musical. Wow!
In 2012 it won seven Laurence Olivier Awards (London's version of Tony Award), the most ever for a London production.
 We had dinner overlooking the Tower Bridge. 
Having been to London so many times, we decided to stay in a totally different part of town, actually across the River Thames at the Shangri-La which is on top of The Shard, the tallest building in Wester Europe. It is gorgeous with amazing views. The three photo above are from our room.
We spent an afternoon at Tate Modern, one of the world's best contemporary art museums. As usual it was good that I had a guide to have some clue as to what I was looking at.
We were very lucky in that they have a major Picasso exhibition on now that is over in just a few days. We liked it way better than the rest of the museum.

Picasso was a guy who always had sex on his mind (or hers in this case).

 

 

 

 

 

 

 

 

 

 

 

 

 

 
 
 
 
 








22 Aug 2018

Maspalomis, Grand Canaria, Canery Islands 2018

We needed a break from our vacation. Mission accomplished. We flew down to Maspalomis, a resort town in south Grand Canaria Island in The Canary Islands. We chilled for four days. It is a long ways away, but worth it. We shall return. Notwithanding the location it is definitely Spanish in all respects. They have been in control for over 500 years.
 
The Seaside Grand Hotel Residencia is considered by many to be the best in The Canary Islands and we were not disappointed. The room, service, ambiance and food all were excellent.
 
Whether you look up the beach or down, people were always coming or going. We managed to score a couple quiet lounges and umbrellas. The beach is over two miles long with gigantic sand dunes.
Of note is that the sand is the hottest I ever have experienced; way hotter than Hawaii. It required wearing flip flops to the water's edge.
 
One day we took a tour across and around the island. Being volcanic, it rises 6,000 feet and was quite windy, but with open beauty. There is lots of hiking, 4 wheeling, and cycling.
This particular cactus is known for its laxative powers.
They even have camel rides available.
Las Palmas, the main city, is across the island. We had lunch there overlooking the beach.
 
Last night we walked to town and loved that we ventured out.
We have had many great meals around the world and Las Rias adds to that list. Even more striking was that neither of us could get over the beauty of the restaurant and the A+ ambiance looking over the water. The only thing close for me for ambiance is probably Michel's in Honolulu.
Spain is such a breath of fresh air for us versus France. It so much less hectic, the people usually are nicer and the prices are dirt cheap by comparison. Having said that France still has a certain something going for it.