To All My Friends and Lovahs

What two surgeries in 21 days gets you

I have received a number of comments and emails acknowledging my return from the PUP list to somewhat more active publishing of Curly R, thanks to everyone that has welcomed me back and sent well wishes the past eight weeks...

...ago was when I took a spill off my bicycle on an evening commute home from my Washington DC office and separated my right shoulder, really ganked it up, grade five separation, all three ligaments and the tendon, torn. Six weeks ago I had the surgery, an orthopedic surgeon unzipped me and sewed my acromioclavicular, or AC joint back shut using a dead guy's hamstring tissue.

All was going well in recovery for two weeks... when I developed a post surgical infection in the incision, although no one ever said it was staph or MRSA, because of the legal and hospital compliance requirements and possible implications and consequences hospitals and doctors never do say the forbidden words unless they are damn certain with a specifically grown and identified culture.

They never said it was staph, but it was and I probably got it in the operating theater from a piece of gear that was however briefly in contact with my open shoulder.

After identifying the infection two weeks after surgery and deciding to quote treat it like it was staph unquote the sawbones put me on Bactrim, an antibiotic specifically for treating staph, it worked, the streaks and gnarly boil shrunk, but not fast enough, when he saw me a week later he took one look at the infection and OH YEAH WE'RE GOING TO NEED TO OPERATE ON THAT LIKE NOW. So four hours later I was back on the table undergoing a debridement, which is medically defined as

The removal of a patient's dead, damaged or infected tissue to improve the healing potential of the remaining healthy tissue.

Nice. By now it was and seeping pus and had an odor and it was fucking gross.

The cause for this second, unscheduled, surgery three weeks ago was principally to protect the graft, the dead guy's hamstring in my shoulder. If that were to become infected then we would have to do a reverse surgery to remove the graft, putting me back at worse than square one, with a still separated shoulder and having undergone three surgeries.

So the sawbones put me back under, unzipped the top half of the original incision, where the infection was localized, and cleaned the shit out of it, cut out all the infected tissue, took a bunch of cultures and irrigated it with six liters of saline which I gather is a lot for this type of surgery.

Oh did I forget to mention that this surgeon, experienced and highly recommended as a shoulder and knee specialist, had never had a post surgical infection before? So even he was freaked out?

The day after the second surgery, the surgeon sent me to an infectious diseases specialist which was a thrill, a shrunken old crone with a strong resemblance to Witch Hazel from Looney Tunes, when I said I was worried about staph or MRSA she cackled and said oh I had that and judging from her hobble and gallows laugh I instantly believed that she had at some point or another contracted every malady she had ever treated.

Even without firm results from the infection lab this doctor recommended I have a peripherally inserted central catheter, or PICC line installed in my left arm so I could begin a three week course of antibiotics delivered intravenously at home, the hardcore MRSA killing antibiotics that are basically like straight chlorine in the bloodstream. A PICC line is inserted semi permanently into a vein your upper arm and threaded gently up the vein and into the chest cavity. I had zero interest in that action.

Thankfully my wife talked Witch Hazel down until we could get some results from the lab, instead we went with a similarly harsh course of oral antibiotics, doubling the dose of Bactrim and adding Cipro, the stuff they gave the Postal Service and Capitol Hill workers after the anthrax attacks in 2001. That tore my tummy up pretty good, I am done with the Cipro but will be on Bactrim for another week.

For the first week after the second surgery I saw the sawbones every day, after hours, on weekends he came and opened his offices to see me, looked at the incision and evaluated for signs of return infection. So far there has been nothing and all signs are that he got it all.

Last week I returned to physical therapy, my range of motion is returning rapidly, the strength and resistance reps begin next week and my biggest concern now is the upper edge of the incision scarring on the bone of my shoulder, reducing the skin flexibility. This can be fixed over time with a scar therapy I like to call the rubba rubba. It will still be eight weeks minimum before I can get back on my bike for the 22 mile daily round trip to work and back. The longer term prognosis is for full return of strength and mobility in my right shoulder.

Now I have an awesome five inch scar, and a great deal more insight into medicine and the body, and a new appreciation for what these professional athletes have to go through in surgery and recovery from serious injuries that because of the state of medicine and the nature of the sport on the outside we often view as pedestrian.


Apropos to this discussion is Redskins tailback Clinton Portis, as you may recall he suffered a dislocated shoulder in preseason game one of 2006 against the Bengals, looking back at that injury now and comparing it to mine, Clinton had a dislocation of the glenohumeral joint, the ball of the humerus which is the upper arm bone separated from the joint cup, or glenoid fossa, the bone slipped out of the joint and put stress on the ligaments and joint capsule, but there was no separation of the collar bone from the acromium or tearing of ligaments. That injury can come back if the sufferer comes back too early and the tissue around the ball has not sufficiently tightened back up, which is what happened to Clinton later that season.

Clinton's injury was a dislocation, mine by comparison was a separation, where the joint itself is injured and in my case, basically disintegrated.

Of all the shitty experiences to have to go through this one has been enlightening. Now back to regular football programming.



Photo of my right shoulder by me.