How it stands

[kitanzi]

I just had that appointment with the specialist, bringing along my MRI photos. He showed me precisely on the photos where it apparently shows (to his eyes) that I have arthritis in the joint between the clavicle and the acromion. Apparently a small bone spur has also shown up after all, in spite of not being spotted on the x-rays, and it's digging into my rotator cuff. Given all else that's already been tried, he seems to think that surgery is the obvious answer. I know a number of you had suggestions of other things to try, but I wouldn't think any of those would help with actually removing bony build up from where it's not supposed to be, or forcing it to stop hurting me. Am I wrong? Anyone?

He asked if I wanted to make an appointment. Apparently it's arthoscopic surgery, on an outpatient basis. He seemed quite confident and routine about it, and of course he would be. It's very routine to him. I don't feel so damn routine about it, and it doesn't help that I'm about three or four hours short on sleep for several reasons. (Although I have to say, Serenity rocks!)

So I'm throwing this out at all of you hopefully clearer, more rested minds. There were several people with strong suggestions when I mentioned this before. Would any of those be appropriate for this?

UPDATE: My regular doctor left me a voicemail Friday saying they'd looked at the MRI films and I should call them for the analysis of what they showed. Since that was after hours, I called them today after I got to work (after my specialist's appointment) and left a voicemail asking for a callback with that information. I just got one... and they have a different answer as to what's wrong. They say I have a slightly torn labrum (I think that's what she called it) and a bony overgrowth, and should make an appointment ASAP with an orthopedic specialist to arrange surgery. Obviously, two different descriptions of what *needs* the surgery makes me nervous, which I explained to her. She immediately offered to fax their findings over to the orthopedic office, which I gladly accepted, and I will call back there later today to ever-so-politely say WTF?!? (On the plus side, here's a very good example of the value of a second opinion. I should remember that.)

UPPERDATE: (No, I know that's not a word. Humor me.) Finally got a callback from the specialist, and the detail that apparently reconciles them is that the labrum is irregular, which may indicate a tear or simply fluid from the inflammation, which is apparently what the doctor believes it to be. I can live with that explanation. I guess tomorrow I call the appropriate people and make an appointment for surgery.

Comments

[redaxe.livejournal.com]

The arthroscopic surgery for bone spurs is familiar to any baseball fan. (It also helps if two of your cousins are orthopedists, one specializing in arms and hands.)

At this point, it is indeed a fairly routine, outpatient procedure. I'm not familiar with the postop rehab routine required to put the shoulder back in shape, but it's probably slightly less strenuous if you're not planning on throwing 95 mph again :-)

(Disclaimer: I've been putting off my own orthopedist visit for chronic shoulder pain for months, now. So while I feel competent to advise you, both from an intellectual and empathetic viewpoint, please construe my not having acted on my own stuff as demonstrating cowardice rather than lack of faith in the state of the art or its practitioners.)

[kitanzi.livejournal.com]

The idea of me trying to throw anything at 95 mph reminds me of the old, old joke about the patient who asked his doctor if he'd be able to play the piano after his surgery. Having been told he would, he was remarkably pleased - "That's wonderful, I never could before!"

Thanks for correcting me on the spelling for the type of surgery, also, and I hope you manage to get yours taken care of. I'm a coward myself, and freaking out on and off, but the pain's enough to override that.

[grey-lady.livejournal.com]

For what it's worth, one of my sisters had a very similar surgery performed. She was home the same day, experienced very little discomfort, and was glad she'd gotten it done - even though, like you, she was really dreading the whole process. I seem to recall her after-surgery recovery was fairly straightforward and involved some basic exercises but nothing very strenuous or arduous.

[kitanzi.livejournal.com]

I appreciate the feedback - I am dreading it, I admit. I'm pretty well convinced it is what I need, though, but given the new information (I updated the entry since you replied) I am insisting first on getting an consensus from my doctors on precisely what they are operating to fix first!

[klrmn.livejournal.com]

i will ask my chiropractor if it sounds like anything he would be of use for. all in all, i would be a lot less woried about [somethingoranother]scopic surgery than what they *could* have proposed.

[kitanzi.livejournal.com]

Yeah, it sounds like relatively minor surgery as surgery goes. At the moment, my biggest concern is the conflicting descriptions of exactly what is wrong. I want to know what they're fixing before they start fixing it - as I told ACat, I'm just funny that way.

[klrmn.livejournal.com]

sounds like they may be using different words to describe the same thing. in any case they seem to agree that extra bone is painfull.

[kitanzi.livejournal.com]

They may, and they do. The part I want clarified is whether or not something's torn as well.

[klrmn.livejournal.com]

well, if the torn part is a sub-section of your rotator cuff, then all the peices would fit together.

[kitanzi.livejournal.com]

I suppose so, and that's probably what I'll hear when I hear back.

[catalana.livejournal.com]

*sigh* And thus we see why medicine is an art, not a science, no matter what they say. *hug* Second opinions are good...but bear in mind that some of this stuff looks awfully similar, so it's easy to see how it might be confused. (Heck, I had x-rays, MRIs, and CT-scans of my back done and things only showed up on *one* of them! And that's before they even got into trying to read the films, which is apparently an art in and of itself...I'm so glad I never wanted to be a doctor.)

Anyway, hope you can get some kind of agreement on what the problem is...and most of all that they can fix it! Surgery sucks, but if it would get rid of the pain, it's probably worth it. *hug* I'm sending you good-thought vibes.

[kitanzi.livejournal.com]

Thank you, I appreciate it! I expect the specialist probably has more experience in reading the MRIs for his specialty, but I would like him to take a second look, just to be sure and perhaps explain why it might look like something else. He was in rather a hurry this morning to have me make an appointment for the surgery right off the bat. If it would fix things, and I'm willing to accept that it should if it's a bit of bone that needs removing, then I'm certainly willing to do it.

[folkmew.livejournal.com]

I think "upperdate" is a fine word. I intend to shamelessly steal it.

I have to admit that a "bony overgrowth" sounds like something that surgery is good for rather than other stuff. It might be useful to do something like Alexander afterwards to help um... thingy. I'm sure it helps something or other. Glad you are getting multiple opinions.

Mary Ellen "I'm not a doctor, nor do I play one on TV" Wessels ;-)
Hugs!

PS (just thought you needed the pink beaver of love tonight) (god, that really does sound... obscene)

[kitanzi.livejournal.com]

It suuuuuure does! *G*

Yeah, if the issue was just muscles and tendons I could see non-surgical alternatives being appropriate, but not for affecting bone where there should be none. I do appreciate the information everyone gave, though.

[quadrivium.livejournal.com]

*Big hugs* That's all. I have no platitudes. Just know that I'm thinking about you, Sweetie. :-)

[kitanzi.livejournal.com]

*bearhug* Thank you, I really do appreciate that.

[annonynous.livejournal.com]

"a small bone spur has also shown up after all, ... and it's digging into my rotator cuff."

I usually think of bone spurs as being a foot thing, but I guess not.

"in spite of not being spotted on the x-rays,"

Not surprising. MRIs are much more detailed.

"It's very routine to him. I don't feel so damn routine about it,"

Well yeah, he ain't the vic, er, patient now, is he? :)

"I can live with that explanation. I guess tomorrow I call the appropriate people and make an appointment for surgery."

I'm glad you're feeling less pressured about this. Or maybe just resigned? Surgeons can be like that,
especially if it's a fairly profitable surgery. It is a fairly common, straightforward surgery (good news).
On the other hand, it's bone surgery, not flesh or organ surgery, which means a longer healing time.
Did they say they were only going to do the bone spur removal, or also repair the labrum (if it is, in fact, torn)?

Ann O. (in consultation with Chosen One)

PS - Near as I can tell, the labrum and the rotator cuff are not the same critter.

[kitanzi.livejournal.com]

Mostly resigned, but I feel like I got enough response from the specialist on that concern that I don't feel like I was blown off, which is reassuring. They did say, during the callback, that if the labrum is found to be torn they will repair that too rather than have to do a second surgery, so that really seems to make surgery the consensus.

Frankly, their best advocate isn't anyone at their office, it's my shoulder. I'm so very sick of this. I feel like far too much of my life has come to revolve around whether it currently hurts, or might hurt, or when I took my last painkillers. It would be easier if it were consistent about what caused pain, or if the pain were even REMOTELY in line with what causes it, but I can be perfectly find with routine things or I can have a glass dagger that stops me dead in my tracks because I had the audacity to WIPE MY MOUTH.

[klrmn.livejournal.com]

okay, i talked with my chiropractor and tho he'd like to have a chance to treat you before you resort to surgery, it also sounds like he recognizes that chiropractic treatment probably isn't going to be able to solve the excess bone part of the problem. chiropracty would be indicated, however, as a part of rehab and as preventative medacine to keep you from developing similar problems elsewhere (and keep arthritis at bay).

i'd still be happy to take you with me to my apointment tomorow, if you like.

[kitanzi.livejournal.com]

Right, I think the surgery's going to be required for the bone issue regardless. I'm also going to have to schedule it fast if I want to have it done before OVFF, which I would love. I'll have to find out how much my insurance will cover for chiropractors, if any thing. Even if it does I may have to wait, because between missing work for this, and going to OVFF we're going to be painfully tight on money for a bit. I'm curious, though, how chiropracty helps arthritis? For rehab it does sound promising.

[klrmn.livejournal.com]

i'm not sure it's so much a direct link between chiropractic care and arthritis so much as the healthier you are in general, the less likely you are to get caught in a negative feedback loop.

i should shut up now and let a professional explain =)

in any case, you should definitely have my chiropractor check out your insurance to see if they'll cover treatment, because he's really good about not racking up all sorts of charges that insurance isn't going to cover and then billing you for them later.