Tuesday, April 8, 2014

PART 17: BABY STEPS REVISITED

What a difference a week makes.  I was just starting to get active a week ago. I was still on lots of Percocet.  I was still very dependent on folks.  A week later and I'm grateful to say I've been able to gradually increase my activities, decrease my pain meds, and I have started to fend for myself on some of the basics around the house.

I've been able 'accomplish' the following items over the past couple of days which may not seem like a lot to most people, but to me it feels like an incredible jump forward in progress.

 - Make my own sandwich
 - Change the ice in my cryo-cuff
 - Shower almost independently
 - Walk for fifteen minutes, mostly pain-free
 - Go out to a restaraunt with the Fam
 - Sit upright in a chair without ice for an hour before pain kicks in
 - Sleep through the night
 - Empty and load the dishwasher
 - Clean the cat box

Given my left arm is still completely immobilized, a lot of these tasks take twice as long as usual, but right now that is ok since time is on my side.

Other progress that I've been noticing is I've been able to reduce the overall time I spend on the cryo-cuff machine.  My daily routine has become alternating a 20-45 minute activity with a 30-60 minute rest and ice session.

I never thought I'd be so excited about taking baby steps.

Sunday, April 6, 2014

PART 16: GETTING USED TO GETTING BETTER

As I start to feel better, I try more things, which then make me hurt again.  I feel like I'm chasing the ever changing line between pain, activity, rest, and medicine.  

Fortunately, I'm noticing the overall trend of my healing is going in a positive direction, but my days often have moments filled with pain, fatigue, and frustration.  I fell that this is a good example of trend (overall general improvement) and noise (daily ups and downs).

The challenging part to me is the ever-changing noise that requires me to rest, revisit, and adjust before progress appears again.  

For example, late last week after a few days of being a little more active around the house (i.e. emptying the dishwasher one handed), I started to get some very isolated pain directly where I tore my tendon.  Obviously this was frightening and discouraging, so I had to take it easy for a day to rest and figure out a way to improve my approach.  I decided to adjust the strap on my brace a bit, and the next day I was able to do those few activities around the house without too much pain.  Two days later I started getting sore in my outer shoulder muscle due to the adjustment I made in my brace.

So in general I'm very grateful that I'm beginning to get better, but I've just started getting used to process of handling all of the noise along the way.

Thursday, April 3, 2014

PART 15: GREAT RESOURCE

For those who may be reading this and also have this injury, I wanted to share the most useful resource I found while searching on the web.

pectear.com

When my injury happened and the severity of it was settling in, I started to ask a lot questions.  These were questions I felt that I needed to ask my doctors to help make sure I was getting the best treatment.   They also helped me start preparing for what I was about to go through.

The most important questions I started asking were:

What happened?  Did it tear? Where did it tear?
Do I need surgery?
What surgeons have experience performing this procedure?
What is the success rate of surgery?
What is the recovery time?
What is the recovery like?
How long will recovery take?
What is physical therapy like?
How long will I be off work?
How much will it hurt?

As I started searching online, I quickly noticed that I often would circle back to pectear.com.  I was able to find the following types of information and many great links to additional resources which answered most of my questions.

 - Description of the injury and types of tears
 - Links to professional medical journal articles
 - Photo gallery
 - Links to personal stories (like this blog)
 - Links to physical therapy guidelines
 - List of doctors with experience performing this surgery

So for anyone unfortunate to be in a similar situation asking the same questions, start here:

pectear.com


PART 14: LESSONS LEARNED

One of the great things about the company I work for is that it has a very strong safety culture.  For example, whenever there is an accident or near miss they go to great lengths to conduct an extensive lessons learned to help prevent repeating any mistakes.  

I decided to take this approach to my current personal injury and identify some of the potential causes so that others may learn from my mistake.  Warning: I'm not even close to being an expert on sports medicine, so take my thoughts below with a grain of salt.   They were formed from a combination of information I've read, talking with my doctor, and personal experience.

Weight Lifting Form

I started lifting weights 20 years ago and was taught about proper weight lifting form and technique primarily in high school.  Since then, I've sought out very little additional information on the matter which I believe could have been problematic on two fronts.  1) The scientific body of knowledge most likely progressed and discovered new techniques or safety precautions that I wasn't aware of, and 2) I most likely forgot some of the proper techniques over the past 20 years.

In hindsight I believe one of the main causes for my injury was that my hands were too wide on the bar during the flat bench free weight exercise.  As the hands move closer together on the bar, the shoulder and tricep muscle groups share more of the load with the pectoral muscle and the pectoral muscle range of motion isn't as dramatic.

In addition to having your hands closer together on the bar, I've read that not bringing the bar all the way down to your chest may also help prevent this injury.

Warm Up and Stretching

In my first post on this blog I described what I did to warm up before I was performing the bench press exercise.  In hindsight, I realize I could have done more to further warm up my body and pectoral muscles.  

First, I think that it is probably more appropriate to spend 10 minutes warming up the entire body instead of the 2-3 minutes doing jumping jacks as I did that day.

Secondly, I think I could have added a few more sets of warmup during the bench press exercise.  For example: 135x12, 165x12, 185x12 and then move up to 205.  This is an approach that I've read a lot of bodybuilders take in their workouts although it appears to be more common with lower rep routines.

Finally, when looking back, I don't recall doing any stretching specifically of my chest before benching that day.  I regularly stretch my lower back due to a previous hip injury but it often ends there.  I also have realized that stretching my chest was not something I regularly performed.

Frequency of Bench Press Exercise

As I also mentioned in my original post, I like to vary up my exercise routine in part to prevent boredom and in part for muscle confusion.  Additionally, I have a chronic problem spanning the last decade of not being very consistent with regular exercise.  The norm for me consists of 3 weeks of exercise, 2 weeks off, 2 weeks on, 1 week off, 3 weeks on....  ...you get the picture.  Therefore, I probably end up flat bench pressing one or two times a month at most.  Occassionally I'll go 6-8 weeks without bench pressing, although I do push-ups and dumbbell flys more frequently.  

Supplemental Muscle Strength

As I mentioned earlier, the bench press exercise relies on the shoulder and tricep muscle groups in addition to the pectoral muscle.  If these support muscles had been stronger, it may have helped share the load as the pectoral muscle became exhausted.  I rarely performed exercises isolating the tricep or shoulders since my routine strategy usually focuses on exercises that utilize multiple muscle groups.  Strengthening those muscles seperately on a regular basis might have added enough additional strength to prevent or reduce the severity of my injury.

General Health

Although prior to this injury I didn't have any major health issues but I would like to point out I was not in optimal health.  I most likely was 40-50 lbs. overweight, had a moderately poor and inconsistent diet, and definitely could have been more consistent in overall exercise but especially cardiovascular exercise.

Age

I'm almost 36 years old and there is no doubt that over the past 4-5 years my body's ability to physically recover has slowed.  Maybe it's time my exercise and activity intensity adjust to that reality.

Tuesday, April 1, 2014

PART 13: BABY STEPS, MY FIRST ADVENTURE

Tuesday - 4/1/2014 (8 days after surgery)

Tuesday was a big day as I took my first walk in the neighborhood.  My parents came over to help for the evening since my wife had to work late.  I decided I would join them for a walk to go pick up my son from school.  

The walk is short, about 5 city blocks from our house so I didn't think it would be a big deal.  I was wrong.  I wasn't expecting us to power walk to the school or anything since my parents are about 70, so it was a surprise and a bit of a disappointment when a block from our house I had to ask them to slow down because my surgery area was beginning to hurt.  I didn't know if the pain was due to a slightly elevated heart rate or from the slight jostling around, probably a bit of both.  The pain didn't acquiesce until we got back home 20 minutes later and I was able to rest and get on the ice machine.  

I was really hoping that I could start walking around the neighborhood since my activity options are very limited.  I can't lift, drive (to the gym), run, cycle, swim, or do yoga so walking is about the only option I have.  I'd take a comfortable stroll to the coffee shop to get a cappuccino right now.   I guess I will just have to take baby steps, both figuratively and literally.

Sunday, March 30, 2014

PART 12: BRACE FOR COMFORT

I never expected to think that I would appreciate the comfort of my arm brace.  I thought it would just be an annoyance that I couldn't wait to shed.  Don't get me wrong, I'm absolutely looking forward to getting past the point where I need this brace, but since I'm incredibly fearful of re-tearing my pec I've come to appreciate the peace of mind that the brace gives me.

Just to be clear, I'm not discussing a physical comfort that this brace provides.  It's actually just the opposite: annoying, itchy, and quite ugly to look at.  I'm referring to the security it provides by preventing me from doing anything stupid.  Although I would say that physically my arm has gotten used to the brace I would not call it comfortable.

I started to become aware of this unexpected comfort the first time I took the brace off to take a bath.  Actually, to be honest, bath is a generous term.  It was more like a half- body wipe down by wife.  More on that never.  

As soon as I took my brace off I immediately tensed up and couldn't relax the entire 15 minutes I was out of it.  This made it challenging to communicate with my wife who was helping me, and also made me want to hurry things up so I could get back in the brace.  I'm sure it didn't help that there was added risk in me having a slip and fall since we were in the bathroom.   

During the few times I've been out of my brace since then, the fear has gone down but it is still a tense experience.   Knowing that my tendon is likely only 3% repaired at this point, the fear of moving my arm in an improper way and re-tearing the tendon is a strong motivator and minimizes the inconveniences of wearing the brace all of the time.  

So for now, the comfortable brace wins.

Saturday, March 29, 2014

PART 11: PAIN TOLERANCE

I really did not know what to expect with regards to pain after the surgery.  I knew things would hurt for a while but I didn't know if that was going to be a few days or a few weeks.  And what about intensity?

After never having a major surgery like this, I was not quite ready for pain management to be the number one item on my mind for the entire first week after surgery.

There were two sources for the pain, one is the direct injury/surgery area and the other comes from the inflammation.  Percocet and acetaminophen were prescribed for the former and a combination of ibuprofen and ice for the latter.  

Since pain was constant the entire first week, and pretty intense the first few days, my schedule and activities all quickly revolved around managing it.  Since I was taking strong narcotics every 6 hours my meal schedule quickly followed suit to prevent nausea.  Since ice treatment was required to control the inflammation, I spent most of the first week stuck in a chair.

After 3-4 days of the strong narcotics I knew I wanted to reduce my dosage as quickly as possible.  I was tired of the constant side effects of nausea, light-headedness, and slight headaches.  So on day four after surgery I decided to cut one of my doses of Percocet back.  Near the end of that six hour cycle between doses, the pain worsened and I knew it was still too early too cut back on the Percocet just yet.

A few days later, on night seven after surgery, I woke at 4 am and felt awful.  The nausea and light-headed ness were more than I could bear.  As I got up I noticed I had been sweating and my balance was off more than usual.  At that point I knew it was time to cut back, the side effects were too much.  

So now it's 18 hours later, some constant pain is back, but it's manageable and I'm hoping I've turned the corner and can start focusing my attention elsewhere.