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.

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.

PART 10: I COULDN'T DO THIS ALONE

I am incredibly grateful for all of the help I've been getting from my family and friends over the past week.  The recovery process is going to be challenging enough with a lot of help along the way; I could not imagine how hard it would be to deal with it alone.  So for anyone facing this challenge, or possibly something similar, I highly encourage you to reach out, ask for help, and let people in who do offer, because you will need it.

For perspective, these are the things that I currently cannot do by myself:

 - Change my shirt

 - Shower

 - Cook

 - Open a jar

 - Drive

 - Put my own socks or shoes on

 - Change my two year old's diaper

 - Put my two year old to bed

 - Change the cat litter

 - Take out the trash

 - Push a stroller

Some of these items I will gradually be able to do more and more throughout the recovery process, but many of them will require at least some help for months to come.  In our society that truly idolizes independence (for better or worse), this injury requires a healthy slice of humble pie to be able to get through each day.  

Fortunately, I am married to a truly wonderful woman and we live in the same city as both of our awesome families.   My wife was able to take two days off of work and then family was able to come over during the day so she could go back to work soon after surgery.   My parents, in-laws, sisters, and friends have all chipped in to bring us food, watch our son, or just keep me company.  

My wife has been amazing.  She wakes up early each morning to make me breakfast, get my medicine, and change the ice in my cryo-cuff.  One unexpected benefit of this injury is that I get to spend more time with her than usual.

It's times like this when life shifts a little bit off the normal path to allow you to see unconditional love in action, and it's absolutely amazing.  This time I'm the recipient of that love.

My chest does hurt still, but more importantly my heart is full.

 

PART 9: GETTING USED TO THIS

So I'm starting to get used to the brace and I'm not sure if that's actually a good thing.  What I mean is that as my pain has improved and I've been able to relax a bit, but I've caught my myself twice start to try to lift my left arm for an itch or slight discomfort.  Lifting my arm over the next three weeks is a huge no no for proper healing.  Fortunately the brace has restricted me from doing anything stupid.  

Through these little episodes I'm realizing that a moderate amount of fear will be healthy to remain conservative as I recover.  The fear of re-tearing my tendon and going through all this again is horrifying, so I hope to use that as a motivation to keep from trying to do too much, too fast.  

The one instruction I heard loud and clear from my PA and general physician is definitely don't do anything the dr. told you not to do.  Now that I'm on the road to recovery, I'm starting to understand that it will take a lot of focus and patience to follow those instructions for the months to come.  

PART 8: MY TV BROKE

Perfect timing, right?  Just when I get stuck on the couch for a while, the bulb on my TV fails.  Fortunately, I was able to find a new, inexpensive bulb pretty quickly.  I paid extra for overnight shipping and then my wife was able to successfully install it.  Crisis averted.

Wednesday - 3/26/2014 (2 days after surgery)

Tonight my wife and I decided to take an exciting adventure into the world of bathing.  One of the downsides of being locked in a brace with a bunch of stitches is how hard it is to stay clean.  I wouldn't be allowed to shower for at least 5 days after surgery so our options were limited to a glorified sponge bath.  Out of fear of re-tearing my tendon, I was extremely timid while I was out of my brace for the first time.  It made both my wife and I pretty tense during the whole ordeal, but I will say it was nice to be clean(er) and have some fresh clothes on.

Thursday - 3/27/2014 (3 days after surgery)

After being on strong narcotics for 72 hours continually, I was starting to get tired of taking them.   They were definitely making me feel slightly nauseous and light-headed.  I'd also get mild headaches in between doses which was a sign to me how quickly the physical addiction to the narcotics had been setting in.  Unfortunately I was still in enough pain that I wasn't quite ready to drop my dosage of pain meds quite yet.  Pain was still in the 2-3 range which was tolerable most of the time.

My ability to sleep was getting better but the pain and brace still woke me up every 45-60 minutes throughout the night.  Since I tried to eat every 6 hours before I took my pain meds, I haven't had a full night with no interruptions yet. However, today I was successfully able to take three 45 minute catnaps to remain relatively rested.  

Speaking of catnaps, being home has reminded me exactly how much my cat actually does sleep, which is somewhere around the twenty hour mark each day.  This is about the same amount of time I've been spending in my chair hooked up to the ice machine.  He's got a rough life.

PART 7: POST-OP CHECKUP

Tuesday - 3/25/2014 (1 day after surgery)

My wife took me in to see the physicians assistant (PA) the day after surgery.  The 15 minute car ride to and from the dr. were about all I could take in the pain department.  

The PA shared with us what they found and what they were able to repair.  The surgery was conducted by opening me up with about a 4" cut just above my armpit crease on the front of my shoulder.  When they went in, they had to move my deltoid muscle (shoulder) around to figure what was going on with my pec tendon underneath it.

Turns out I tore my pec tendon in between the bone and muscle junctions. So it wasn't the best case nor the worst case scenario and they were able do some surgical repair.  

My tendon tore about halfway across and then tore down the middle as well.  So essentially, at least how I envisioned it, I had a 1" by 1.5" flap of tendon hanging loose after my injury.  The dr. was able to suture the tendon to itself but no anchors were inserted since the tear was away from the bone.

Since it tore in the middle, the doctor's instructions are to do nothing but keep the arm still for three weeks to allow the tendon to begin repairing itself.  Then, I'll come back for a follow up evaluation and we'll begin to discuss physical therapy.  The PA did say that therapy would start by increasing range-of-motion, then slowly trying to add strength and finally endurance.  Again, I was reminded it will be at least a six month recovery timeframe until I return to normal activities and longer for full strength.  

At this point I was just glad the road to recovery had begun.

PART 6: THE FIRST 24 HOURS

We got home from the hospital a little after noon.  I was able to stand on my own with someone next to me for balance but I was in a lot of pain still.  My wife helped me get setup in my chair and hooked up the cryo-cuff to the cool water pump.  My parents stuck around for a bit to help while my wife went to get my prescription filled at the pharmacy.  

Over the next 24 hours my main focus was on pain management and getting used to having my arm immobilized.  I was allowed to take pain relief every six hours and my pain was varying between a 4-5 most of the time.  Getting and staying comfortable was a challenge, especially at night since I was sleeping in a chair in the family room.  

My wife was incredible making sure I was as comfortable as could be and seeing after all of my needs.  She would prep my food and medicine, adjust my pillows, take care of my ice machine, and most importantly entertain me.  

I couldn't wait to go back to the dr. the next day to hear what they did in surgery and find out about more about what I could expect during recovery.

PART 5: SURGERY

Monday - 3/24/2014 (9 days after injury and one month before my 36th birthday)

5:00 am alarm for the loss.  Surgery was scheduled for 7:30-9:00 so we were told to arrive at the hospital at 6:00 to get ready.  

The surgery prep started quickly with the nurses.  It took about an hour and fifteen minutes to go through it all: changing, shaving, cleaning, IV, and a meet and greet with the anesthesiologist.  Since my injury was on my chest, they were not able to give me a nerve block in my arm to help manage the pain.  I would be reliant on the narcotics they were offering that day.

At this point I was able to spend about 5-10 minutes with my wife and mother talking to the physicians assistant before they took me back for surgery.  This was an actual pleasant calm before the storm.  I had been trying to take moments throughout the morning to take long, slow breathes and meditate to calm my nerves.  Finally, when it was go time for surgery they pumped me full of something special because I was all smiles as they took me into the operating room.

About two hours later I came back to consciousness.   Unfortunately I woke to excruciating pain right where my procedure took place; about an 8 out of 10.  The nurse then began putting pain meds in my IV to help.  After 3 rounds of special stuff she was able to bring my pain level down to about a 5/10.  From my recollection that took about 10 minutes, give or take an hour.   

When I woke up, I had already been put in my shoulder immobilizer brace/sling device and also had my shoulder wrapped in a cryo-cuff for treating the inflammation.  

I was then wheeled back to the prep area and my wife and mom were able to join my side.  It was great to see loved ones, even amidst the continual pain.  Although my wife and mom may have felt a bit helpless thoughout the day, their presence and love comforted my spirit in ways that no drugs could even dream of. Times like this in life allow you to truly take count of your blessings and without a doubt I am grateful for my family.  

The nurses had me eat some crackers and juice to get something in my stomach before they gave me my first Percocet.  I almost got sick after taking it but was able to keep it down.  It eventually helped get my pain to a 'tolerable' level and before I knew it I was getting dressed and we were heading home.

PART 4: SURGERY PREP

Now that surgery is scheduled I realized I had a lot of prep to do beforehand.  I needed to wrap things up at work since I didn't know how long I'd be off, get stuff ready around the house for dealing with one arm in a brace, and then what caught me the most by surprise was the mental preparation I needed to do.

Since the ortho put me in a sling to wear before surgery, I was challenged to get work wrapped up so I could go on disability for as long as my recovery needed.  This required me to quickly come up with and execute a plan for all of my responsibilities and projects and then take the time to communicate and delegate these plans to staff, managers, and clients.  It would have been hard enough to do this before surgery while healthy, let alone with only one hand to type with and pain to manage.

Outside of work, I really didn't know what to expect during surgery, recovery, or physical therapy.  Since this injury is pretty rare there were only a handful of resources I found online that allowed me to understand what to expect.  This is when I got the idea to start this blog so that others can learn from my experience.

Around the house my wife and I had to setup a place for me to sleep since it's best to sleep in a slightly reclined position with a shoulder immobilizer on.  We ended up with a fluffy chair with lots of pillows in front of the tv as well as getting a wedge pillow for the bed.  The other main items we needed were comfy loose fitting clothes that would be easy to get on and off with my arm in a brace.

The last part for me was getting mentally ready for surgery and therapy.  This required me to do some reading on what to expect in the procedure but more importantly coming to peace with the decisions and put my faith in the hands of the care I was receiving.  Since my pain and bruise kept getting worse leading up to surgery, this actually became easier to accept over the weekend.

PART 3: THE DOCTORS AND MACHINES

Monday - 3/17/2014  (2 days after injury) 

I had my father take me to see my general physician today.  Since I needed to keep my arm ROM very limited for pain management I figured it would be best to not drive myself.  

My general physician had a quick look at my bruise and swelling and then followed up with handful of questions.  She also thought I had done some significant damage to my pec even though the bruising was on my arm.  Due to the apparent severity of my injury she wanted me to see my orthopaedic as quickly as possible so she scheduled it for me and got me in the next morning.  I knew I hurt myself pretty bad but her urgency caught me a bit off guard.

My general physician elected not to conduct the full suite of physical tests knowing it would cause me great pain and that the ortho would be conducting them tomorrow anyway.

Tuesday - 3/18/2014  (3 days after injury)

Tuesday was a long day of machines and the doctors office.  It started at the ortho at 10 am with paperwork and x-rays.  After another hour I the waiting room I was finally called back to see the dr. around noon.  He came in with a resident, assistant, and a physicians assistant (PA) and within 5 minutes of tests and questions he concurred that I had likely torn/ruptured the pec tendon off the humerus (upper arm) bone.  

He then shared the news that this would require surgical repair and that it would be at least 6 months before I would even attempt bench press again and I would spend the first six of those weeks in a sling. He tentatively scheduled surgery for Friday to get the repair done quickly before any scar tissue set in.

This was not the good news I was expecting.  Ok, I wasn't expecting good news but I didnt think it would be this bad.  Obviously this bummed me out and I quickly started thinking through how this was drastically going to affect my life in the near future.  From work, to taking care of my two-year old, and helping my 4-month pregnant wife around the house.

The Dr. scheduled an MRI for me later that afternoon to get confirmation on his diagnosis.  I had to go to Paul Brown stadium to get it done as that was the only place nearby that could get me in on the same day.  My dad and I went to lunch and then headed downtown to get the MRI.  For those who haven't had the pleasure of an MRI before, it is essentially 45 minutes of being told to remain incredibly still in a very small and loud enclosure.  It wasn't any fun but I figured it was worth the peace of mind to have confirmation of the diagnosis before having surgery.

So my dad and I then went to pick up my son and head home.  I will say that the only good things about this day was I got to spend most of it with my incredibly loving and patient father and then end it by putting my beautiful son to bed.

Thursday - 3/20/2014  (5 days after injury)

Fortunately my wife was able to cut her work trip short and come home to accompany me to my follow up appointment with the ortho.  It turns out that the MRI confirmed there was a major pec tear with lots of swelling but it wasn't clear enough to see exactly where the tear was along the tendon.  

The dr. explained that best case was if the tendon pulled of the bone which would be fixed by anchoring the tendon back to the bone with a couple of screws.  The worst case would be if the tear was at the muscle/tendon junction because that often can't be surgically repaired.  The middle case is if the tendon tore in between the bone and muscle, in which case the would sew the tendon back together.  

Since he couldn't determine what exactly was going on with the MRI, he recommended we proceed with surgery and hope there is something to repair.  My wife and I agreed so we then scheduled the official surgery for Monday morning since his Friday schedule had filled up.

PART 2: WELL THAT SURE HURT

After we got we home, I was quickly in bed with miserable pain in my left chest and shoulder.  Even the most minor of movements that engaged my pec muscle sent me wincing in pain.  After 3-4 hours in bed and ibuprofen I moved to the couch to spend the rest of the day resting and watching TV.   

Sunday (3/16/2014) was a little better in the pain department but I needed help to get my shirt off to take a shower.  When my wife helped pull the shirt over my head she gasped.  That's when we first saw the bruise on my upper arm.

At this point my wife and I both agreed I should seek medical care on Monday to figure out the extent of the damage.

Pain became manageable with ibuprofen, rest, and ice but my range-of-movement (ROM) was very limited without wincing pain.

PART 1: OOPS, I TORE MY PEC

So last Saturday, March 15th, 2014 I tore my pec.  Or for the medical nerds in the room, I ruptured my pectoralis major tendon. The injury is pretty rare so yes it confirms that I do belong in the "special" status as many of you have been lead to believe.

How it happened:
So I was trying save a cute kitten from a grizzly bear attack when all of a sudden...
Ok.  Ok.  I was bench pressing as is the case with many of these injuries.  In hindsight I believe my hands were too wide on the bar so fellow weightlifters take note.  I had warmed up my body by doing jumping jacks for 2-3 minutes followed by light stretching.  I warmed up my chest with a set of 135 for 12 reps before moving of to my workout of 205 lbs. for 3 sets of 12.

My normal workout routines almost always are comprised of circuits so on this day I was alternating between flat bench press and raised rear leg lunges.  The injury occured on my 3rd set during the tenth rep.  I heard a pop and tear and immediately my left pec started spasming.  I immediately racked the weight, before my spotter could even react.  There was no doubt something major was wrong.  I went and told the wife and kid who were in the pool that it was time to go home.

So we left, but the pain had just begun.