January 21, 2015

The Latest on my Not-So-Zombie Arm: One Month Post-Op

Had a quick trip to DC yesterday (left Denver on Sunday afternoon, arrived home at midnight last night) and unfortunately, it took a bit of a toll on my arm. I haven’t talked about my arm much lately, because I don’t want to complain… and plus, everything is so much better than it was! But when a friend told me how great it was that I was all recovered and that it happened so fast, I thought I should post a little bit of personal detail to set the record straight.

(Apologies for not writing more in depth about this before; I was originally a little leery of posting my medical details since I was trying to not make a big deal at work about my surgery. I didn’t want anyone to think that I wasn’t capable of doing my job, or would require extensive time off to recover! But now that it’s (mostly) over, I figure there’s no harm in sharing.)

Basically, toward the end of August, my left hand started randomly going a little bit numb at times. It was never for more than a few minutes, and I just assumed that I might have been doing something weird with it – like when you wake up in the morning having slept on your arm and it’s all pins and needles-y for a bit. But it started happening more and more, and it started always going numb as soon as I stepped into the shower… and then one of my best friends told me that was a possible symptom of MS. I’m not really a hypochondriac, but that got my attention! I started keeping a log of my symptoms, and realized it was happening a lot more than I had thought – sometimes even a few hours a day, and always every day. Plus, I soon realized that I was losing strength in my left hand, and losing it very rapidly – to the point where I couldn’t squeeze a bottle of shampoo, and couldn’t cut my nails on my right hand because my left hand wasn’t strong enough to work the nail clippers. I hadn’t noticed it originally since I’m right-handed and don’t use my left hand for a lot of functions, but this was definitely not good!

So I made an appointment directly with a neurologist (thanks to 5280’s awesome list of best doctors); unfortunately, he wasn’t able to get me in for a month. But when that appointment finally happened in November, all it took was a quick motor skills evaluation and I saw exactly how bad things were… and I was scared. For example, he asked me to spread my fingers wide on my right (good) hand, and keep them like that while he tried to push them together – and I did fine. But then he asked me to do the same with my left hand, and basically I offered zero resistance, to the point where he was like, “no, no, I said, try to keep them apart.” Oops – but I was trying my hardest 🙁 We also tried a grip strength test, and while my right hand could easily squeeze 75 pounds per square inch, my left hand could only squeeze 45 – which was off-the-charts low.

My neurologist was pretty concerned about how bad it was, and managed to get me in that same week for a “nerve conduction study.” (Things that are really scary: when a doctor who is normally impossible to get an appointment with tells his receptionist, “clear my schedule for Wednesday morning so I can do this test on her as soon as possible.”) The NCS sucked a lot – the first part involves them hooking you up to an electric shock machine and seeing how long the shocks take to travel through your nerves, and the second part has them sticking needles into your muscles and then having you flex the muscles (yes, with the needle still in there) to see what kind of response there is. The shocks were the worst – my body literally jumped off the table a few times, and at one point, I was crying so much that the doctor asked if I wanted to take a break. No – I just wanted to get it over with! But on the plus side, it only took about an hour, there was no lasting pain, and we got a conclusive result: my ulnar nerve had somehow been damaged to where it was only conducting impulses at 10% of the normal speed. My neurologist told me I needed to get in for surgery as soon as possible – and that I might permanently lose function of my left hand if I didn’t.

By the way – I’ve asked my neurologist, my orthopedic surgeon, and my physical therapist what they think the cause of this sudden lack of nerve function was, and none of them really have any idea. They all agree that it progressed fairly quickly, but the best explanation they can come up with is my tendency to put my left elbow on my desk and then lean my head in my left palm while working on the computer. Which, um, doesn’t everyone do?? (Except me now that I learned how bad it is.) I am not really satisfied with that as an explanation for what caused these problems (though I guess it’s better than “well, Laura, you are aging”), but wanted to mention it to all of you in case this advice can help anyone else. Don’t prop your elbows on your desk! Sit with good posture while you work! Let me be a cautionary tale! Okay, PSA complete.

Cast Off
Remember, kids, if you don’t want a nasty scar and crazy bruising, don’t slouch over your computer!

My surgeon performed an ulnar nerve release and transposition – basically, pulling the ulnar nerve out from behind the back of the arm where it belongs, and moving it to instead run on the inside of my elbow. As a result, it now works the opposite way of most people’s ulnar nerves, in that it’s stretched to its tautest when my arm is straight and to its loosest when my arm is bent.

I should note that while I was sitting in my hospital bed and they were going over the surgery plans for the hundredth time and having me sign at least two dozen consent forms, I told my surgeon that while he was in there, he was free to make any other improvements he thought necessary – like giving me a bionic elbow. He told me he would take that into consideration, but laughed while he said that… so I don’t know if he took me seriously. However, my (disgustingly expensive, why-did-I-choose-the-high-deductible-plan) health insurance bill does show an extra $2000 charge for “arm tendon lengthening”, which wasn’t part of our discussed plan, so perhaps that was a little bonus he added in there for me. I’ll let you know if I discover any newfound contortionist abilities or if my arm grows like Pinocchio’s nose when I lie.

In the two weeks after surgery that I was stuck home, I wrote a lot having my arm immobilized, but I haven’t talked too much about the details since I got the cast off. Things aren’t totally hunky dory, but they are so much better than when my arm was all bound up and unusable that I just feel silly complaining. Plus, Pollyanna as this may sound, I just don’t feel like wasting time dwelling on some pain that will eventually go away when I could focus on all the other great stuff happening in my life right now! But this morning’s PT session was kind of frustrating, so I thought it might be a good time to explain what’s been happening.

Ever since surgery, I have been going to physical therapy twice a week in order to regain strength and flexion in my arm. When I first got my cast off, I couldn’t bend my arm more than about 30 degrees. I couldn’t touch my head to put my hair in a ponytail, or scratch my shoulder when it itched. Over the first week or so, I made a ton of progress to regain the flexion, and it’s kind of been slow and steady ever since… until the last week and a half, when it feels like two steps forward, one step back.

I mean, I still have much better mobility than I did after surgery, don’t get me wrong. But it’s frustrating that my elbow is so ridiculously swollen; my PT has been using the ultrasound machine a lot to try to get the blood vessels going and bring that down. (He says it’s the scar tissue from where the surgeon had to cut through the muscle, and that mine is a bit dense, but not abnormal.) Plus, beyond the swelling, there are a lot of things that are downright painful. As I learned going to Dallas last week and DC this week, flying hurts a lot – the cabin pressure makes my scar throb like crazy, and it’s really hard to find a position where the armrest isn’t pressing on the sensitive spots on my arm. (Had an extremely bitchy comment here that I’m now embarrassed by and have since deleted – apologies to those of you who already read it. Remind me not to blog after drinking enough wine to make the Bachelor solid entertainment.) Furthermore, no matter how much time I spend putting cocoa butter/Vitamin E on my scar, it dries out like crazy in flight and ends up being really itchy as a result.

However, what is frustrating me the most right now is my inability to really get back to the gym. (Doesn’t that sound pathetic? But it is really bothering me.) Over the last month, I was at first excited to see my body weight dropping on the scale. Hooray! Unfortunately, while I dropped 6 pounds in the last month since surgery, I’m now coming to terms with the fact that, actually, my clothes aren’t fitting better. It sucks, but I’m realizing that perhaps what I lost in the last month was not fat but muscle. (You would think I would have figured this out after writing/researching an article on preventing muscle loss for Greatist a few years ago… but I was blinded by the optimism of thinking I had finally lost the weight I’ve been trying to lose for years. It’s amazing what you’ll believe when you want to believe it’s true!) So much for me feeling proud of myself – although I weigh less, I’m actually less fit than before! Just goes to show that when you are figuring out how to measure your success, you need to carefully choose the right metric.

At the moment, I’m not allowed to lift anything heavier than five pounds with my left arm. However, as I go through PT exercises, I’m trying to also do them with my right arm, for balance – and it is crazy to me to discover that doing dumbbell rows using 5 pounds is actually slightly challenging for me with either arm. I used to use 40 pound dumbbells for those! It’s also really frustrating that I can’t do a pushup, plank, burpee, or any other exercise where I have to put weight into my left arm – those used to be the staples of the bodyweight workouts I would do in hotel rooms or otherwise on the fly when I couldn’t get to a gym. I’ve been skipping group exercise classes and also most everything except cardio lately, and while running is great, it just doesn’t help you prevent muscle loss and stay in optimum physical condition.

So now, I’m working really hard with my physical therapist to try to get my strength back. The flexion and weight bearing I know will come with time, and after rereading that Greatist article I wrote so long ago, I’m heartened to remember that muscle memory makes it easier to regain strength than it was to build that muscle the first time. On the minus side, the loss of grip strength is something that according to my surgeon may take up to a year to come back, if it ever does. (In the meantime, it is a terrible horrible necessity that I “must” book manicures since I can’t cut my nails myself. Woe is me.) Either way, though, I know the next few months are going to require me to step it up in the gym and focus on strength-building in order to get back to where I was before surgery.

Anyway – all this is to say that while my arm is back to a level where I am so thankful for it’s basic functionality, it’s also not 100%. Whenever I get frustrated in physical therapy at my inability to do something stupid (like, play with Silly Putty for longer than 90 seconds without wearing out my strength), my therapist reminds me that I did just have majorly traumatic surgery a month ago, and that all strength is relative. I am really grateful to my amazing surgeon for doing a fantastic job and helping me to heal this quickly (plus giving me a scar that’s much less noticeable than I expected!); however, I also wanted to make sure that I’m not presenting an unrealistic view and discouraging others who have to undergo a similar procedure. I read a bunch of blogs prior to surgery (Jenna’s was most helpful, though her post about the nerve conduction study scared me to death); it generally made me feel better, and much more prepared, to hear from others going through the same thing.

Any questions? Any beginner-level weight lifters out there who want to join me for a back-to-basics program instead of those Pinterest workouts titled “FOREARM KILLER” or “BICEP SHREDDER”? My arm has already been through enough, thankyouverymuch.


8 thoughts on “The Latest on my Not-So-Zombie Arm: One Month Post-Op”

  1. glad you’re on the mend! leaning on your arm could definitely have been a major factor–my former boss had the same thing happen…he was a jeweler and was in a wheelchair from his mid-50s on, and to set stones and carve rings, he’d rest his elbows on the arm rests of the chair so he could hold things steadily–after 10 years of that, he ended up with pretty bad ulnar neuoropathy in both arms and ended up retiring to avoid permanent damage. seeing that has made me really adamant about not leaning on my elbows!!

    1. Just surprised me because I didn’t think I do it more than most people! I am really paying attention now though to make sure I don’t do it anymore 🙂

  2. I can’t put my elbow on my desk and lean because I broke it 10 years ago and it’s now held together by metal. I do have a bionic elbow and sadly, it does not set of metal detectors and, yes, I’m quite disappointed by it.
    I also had one of those annoying elbow casts (for 3 weeks, I think?) and it does take a long time to regain range of motion. PT is great for it, even when it sucks.
    I’m so glad you’re doing better and you got the nerve problem solved before it became an ever bigger problem.

  3. Wow, the whole concept of the nerve damage is bizarre. And scary. I’m so glad you went to the doctor before you lost use of your hand! I totally understand how frustrating it is to start back from scratch, but you’ll get there!

    Also… how freaking cool is it that you wrote an article for Greatist?!

    1. I used to know the crew at Greatist pretty well – they are awesome people! I wrote a few articles for them and got REALLY excited every time I did 🙂 They were fun to research and write!

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