Thursday, April 24, 2014

Around Our House: The Shoulder Incident Bankart Repair Part 2

A few hours after surgery.
On March 3rd, 2014, I had a Bankart Repair to my right anterior glenoid labrum. For those of you who know me, you may remember me having the same procedure done four years ago on my left arm. Here is the post I wrote about that repair:

I wanted to write about this repair because the recovery was so much different.

To start, my right shoulder was not as bad as my left. My left shoulder was coming out so easily which was scary and unpredictable. After the surgery and PT, I worked very hard to strengthen both shoulders to keep the muscles strong, therefore reducing the chances that dislocations would happen again, particularly to my unrepaired right shoulder.

The history on my right shoulder is that it would dislocate when I was in my early 20s. I specifically remember it dislocating while playing air hockey, getting up off the couch, and swimming. I had a capsular shrinkage done on the shoulder in 1999 which stopped the dislocations, and since I was NOT active, the surgery worked fine for me. This type of surgery did nothing to repair the labral tears that were a result of the recurrent dislocations.

The labrum is a ring of cartilage that sits atop the scapula where the head of the humerus connects to the body. Its function is to add surface area to the joint to stabilize an otherwise very unstable joint. Attached to the labrum at the top is the biceps tendon and off the edge surrounding the entire shoulder joint, the capsule. When shoulders dislocate, the humerus slips past this ring potentially tearing the cartilage away from the scapula. The more often the shoulder dislocates, the worse the tear and the weaker the cartilage become. The head of the humerus can bump up against the scapula and damage the smooth soft surface of the humeral head (known as a Hill-Sachs defect) and wear the cartilage off of the backside of the bone. Labral tears can lead to recurrent dislocations or in my case significant pain.

Fast forward 15 years, After my last surgery, I started swimming, lifting weights, and running. My left arm was strong and I could tell the different between the two. My right arm couldn't keep up. I was experiencing pain with certain movements (like front crawl, triceps dips, push ups, etc). The more I worked my arm, the weaker it became. Being in my mid 30s, I wasn't ready to stop doing these things. Dr. Honkamp did a contrast dye MRI on the joint and discovered a labral tear. There was also some fraying to my rotator cuff due to the inherent instability caused by the tear. It was a hard decision this time because is was NOT dislocating again, but my activities were being limited, and I decided to go for it.
My inner shoulder before. The pen marks on the labral tear photo indicate how tall the cartilage SHOULD be.

The After. The penmarks show how the labrum was gathered up and reattached to the bone with anchors and sutures.
The stitches. There is another matching hole on the back.

Going into the surgery, I was working out 4-6 times a week. Typically running at least 5 miles at a time, swimming for a hour, or taking weight lifting classes like Body Flex at the gym. I was in really good shape and my arm was as strong as it could be.

I had the surgery. During my surgery, they completely detached the labrum from my scapula and anchored it back with four sutures. It was painful as expected for a few days. Then, I became allergic to the Vicodin (severly itchy skin, hallucinations, and urinary problems) so I stopped taking it. Unfortunately, this was a weekend, so I went the whole weekend only using Advil for pain (I also tried Tramadol which made me CRAZY so I couldn't sleep). I spent a few awful nights, but by early the next week, I was doing ok. The doctor gave me a Percocet prescription which I used sparingly at night. Once I switched off the Vicodin, my head was clearer, which allowed me to get to the gym.

One week out, I went to the gym. I took it easy, did some walking, rode a recumbent bike, did some more walking. A few days later, I went back. This time, being completely pent up and unable to sleep (keep in mind I had been exercising very regularly, so my body wasn't used to resting so much!), I did a few test laps at a very slow easy jog. I had been grilling my doctor and physical therapist regarding running. The verdict was that running would not damage the repair so long as I was tightly restrained in my sling, but that it would likely hurt so bad that I wouldn't want to do it. The running did not really hurt. I ran about a quarter mile, and then finished up on the elliptical ( this was about a week and a half past surgery).
One challenge: how to tie a shoe when you can't reach it... I ended up pulling my foot in to my chest and tying it upside down.
All strapped in and ready for a run. My hand had an unfortunate resting spot!
The more attractive/comfortable immobilizer I wore at night and during the day, allowing my forearm to move freely while pinning my upper arm to my side to protect the repair. My pain was worse if I kept my forearm bent all day long.

Each time I went to the gym I did a little more. I found that if I strapped my arm in tight with my immobilizing sling, I could run ok. The body mechanics were off, but it felt good to sweat. At two weeks I ran two miles. At three weeks I ran three. I was running once or twice a weeks with strength training exercises and elliptical in between. I could do lunges, high knees, frankensteins, butt kickers, speed skaters, and squats. I was occasionally taking Advil at night to sleep, but nothing during the day. Since I had started running and exercising, my pain tolerance has significantly improved, so I am not sure how I would have handled this pain four years ago.

I decided to go ahead an sign up for Dam to Dam on May 31st, 2014. It is a half marathon that was happening exactly three months post surgery. My goal was to be running six miles at the six week post surgery mark. I made it. At six weeks out, I stopped running in my sling. At 6 weeks, we also started working on my range of motion in PT. This made my shoulder sore, but I found that running actually made it feel better.

I am currently about 7 1/2 weeks post surgery. So far this week I have done two 4 milers, a 2 mile tempo run, an 8 mile long run, and an hour long session on the high school bleachers. I can do a very slow one armed breaststroke in the pool (which I do to keep my hips happy). My pain is manageable. My range of motion is about 75% back, my proprioception is good, and I JUST started using weights in PT. My therapist thinks the running has significantly helped me bounce back from the surgery.
7 weeks post surgery, i can raise my arm!!!
Most information on the web says NO RUNNING for 8-12 weeks, so if you are facing this type of surgery, definitely talk to your doctor before taking off. If I were going into this again with the goal of running in the first six weeks, I would look into getting a sling from this website: They are designed to hold the arm in tight to avoid jarring the joint.

In contrast, the last surgery, it took me six weeks just to get back to the gym to WALK!

Thursday, March 27, 2014

DIY Cat Hotel

The kitties giving it a good sniffing!
 So last summer, my girls (6 and 9) and I started to volunteer once a week at the local animal shelter, Furry Friends Refuge. Furry Friends is a local non-profit no-kill shelter that deals with all sorts of small animals but we specifically go to see the cats. It's been a wonderful thing for both of my girls, especially my oldest who was having problems dealing with her OCD all last school year (long story short, she was terrified to go to school because she was afraid she would get sick). When she would start to worry, we would change the subject by talking about the cats at the shelter. We are happy for the cats when they get adopted, and we do what we can to help the animals at the shelter to feel happy, safe, and comfortable. The girls brush, pet, hold, play with, and talk to the cats, and occasionally, I can get them to help me clean up their litter boxes. What I never realized is how happy it would make ME to go to the animal shelter. Nothing will wipe away your worries like sitting in a room full of fuzzy purring baby kittens, or to be greeted by a furry friend with a good solid head butt.
Seriously, kitten therapy works EVERY TIME!

To be fair, Juniper LOVED this. So did Beatrice.

Sylvia and Valentine with his stylish lion haircut.
With Spring Break approaching, we were looking for a fun project that we could do together. Both of my girls are in Girl Scouts so we thought it would be fun to earn one of their badges over the break. They chose to earn their pet badges. Most of the requirements they had already filled with our visits to the shelter and by caring for our two cats. But one requirement remained, make a comfy place for an animal to sleep. So we decided to make a comfy place for a BUNCH of animals to sleep!

Here it is as we found it at the thrift store.
We thought of way we could make a structure that the cats could sleep and play on. Initially we wanted to find a second hand bookshelf, but we ended up finding a small TV entertainment center. It was sturdy, it had several cat sized openings, but it had a big center area we needed to think about. We did a little searching online and found the perfect solution, cat hammocks!

Before we could add the hammocks and paint the shelf, we needed to make a few adaptations to the original shelf. I had just had shoulder surgery on my right (dominant) arm, so we needed to call grandpa Tom for some help.

He helped us to cut some cat sized holes in the sides, on one of the front doors, and one on the top. We removed the narrow door to open up the small side nooks, and he helped us add two posts to the center of the large opening.
After we cut some holes, removed a door, and added two posts.

He used a hand jigjaw to cut the circles (it's exactly coffee can sized if you notice). He added a few screws to stabilize one of pieces that stops the large doors from pushing in, and he helped us to add the posts to support the hammocks. Luckily, grandma Sandy was there to help us carry the shelf back to our van, since I was out for the count.
The Carry-Van, because they carried it to the van...
Once we got it home it was time to figure out paint colors and the pattern for the hammocks.

We found an article online written by Oakland Animal Services that showed the hammocks they use in their shelter, we modeled ours after theirs. I found some small carabiner clips on ebay for 90 pc for $23.00, and had the fabric on hand. The eyehooks we bought at the hardware store when we bought the paint.
The hammock test.

Once the hammock test was complete, we started to paint. We sanded it lightly since it was a finished wood veneer, and then we applied a spray on primer coat.
Yes, I let my kids use spray paint with supervision. They are really quite capable! 

After the white coat dried, we rolled and brushed on the base color. The girls chose light green.  We masked off the area we intended to put carpet for climbing so the carpet glue had a better chance of sticking.
Be prepared to say good-bye to whatever clothes your kids paint in... 

Once the green coat dried, we penciled in the drawings and started to paint the cute designs. My girls are great little artists so the cat drawings are theirs.
Working on the details.

The finished art with the paper mask removed. 

Once we removed the paper, and the painting was finished, we applied the eye hooks where we wanted them, then we applied the scratching rope on the posts (we used 3/8" sisal rope attached with carpet glue), and remnant carpet with carpet glue on the sides. To start the rope, we tacked one end at the bottom with two carpet tacks, spread the carpet glue up the posts about four inches and started wrapping our way up. I tacked the rope each time I stopped to apply more glue.  It took two packages of rope, one for each post. To adhere the carpet, I first cut the piece to the approximate size we needed and then spread a thick coat of carpet glue on one side, stuck the carpet, and then laid the shelf down on that size to press the carpet into the glue. I did the same on the otherside only I used my folding tables to weigh down the carpet. We waited 24 hours and then trimmed the carpet and cut out the holes with a box cutter.

We cut small pieces of carpet to go inside each of the animal cubbies, but left these so they could be removed in case they got dirty. We had an old neglected pet bed that fit perfectly inside the large cabinet space at the bottom, so we donated that with the Cat Hotel.

When we brought our cat hotel to the shelter, it was an instant hit! The cats were so curious (perhaps because the remnant was our old living room rug that smelled like toddlers and cats). They tried every cubby and Mustard immediately got cozy in one of the hammocks. The girls were absolutely thrilled! If you would like to go see our Cat Hotel in action, it currently resides at 9 Lives Boutique and Thrift which is a fundraising thrift store for Furry Friends Refuge.

Pumpkin, Poinsettia, Beatrice, Mustard and Sylvia take a moment to pose with the Cat Hotel.

Mustard had dibs on this hammock. Just so you know. 

Mustard, Butterscotch, and Pumpkin give the Cat Hotel a good sniffing.