Health Update #8: Post Op for Humerus Implant

April going out like a lion.

WEEKEND SOCIAL

First off, it was a fabulous weekend with friends from OU and a full house. We were grateful to have a space that could accommodate so many friends and a friendly canine. We were left with a fridge full of tasty treats and a plate of Jim's butter bars. We also scored a much needed recliner from Tim for helping to sleep through the night with the bum shoulder. 

Since we're all Writing Project people (shoutout to NWP and MBWP), of course there was a writing prompt based on a FB post from our neighbor Ingrid, and on Sunday, we shared our own memories of parents' bedrooms. It was a fascinating divide between those whose parents had bibles on the nightstands and those who had Playboys or Joy of Sex stashed in the closet (or Our Bodies Our Selves displayed openly on shelves for curious pubescents). Or those with swinging 70's newly divorced dads who wallpapered the bathroom with centerfolds. Not naming names.

I was able to figure out a rhythm of actively visiting and interacting vs napping or doom-scrolling quietly in my bedroom while the party raged on. Between the excruciating pain in my shoulder and the mind-wiping effects of the Oxy, I'm sure I wasn't much of a host, but Corrine made up for it as she always does and Ingrid took over my role of reminding Corrine now and then what original question had been posed to her.

Actually I think Liam is reacting to one of Corrine's stories

On Sunday, Corrine and I headed down to Grand Rapids to check into a hotel room near the hospital since we had to arrive at the hospital before dawn on Monday. Neither one of us got any sleep Sunday night. I fixated on the fear of going under sedation with four limbs and waking up with three. I also managed to fall out of bed in the middle of the night and scraped my knee.

Surgery itself had no complications.

OPERATIVE REPORT

The patient was brought to the operating room, placed in well-padded supine position, where general anesthetic was administered.  The right upper extremity was prepped and draped in sterile fashion.  Following time-out procedure, a longitudinal incision was made in line with insertion point.  Meticulous hemostasis was obtained as we dissected through skin and subcutaneous tissue down to the deltoid musculature.  The musculature was split and the fascia was transected with Bovie electrocautery.  The rotator cuff was approached and we made a T-type tendon incision that allowed exposure of the insertion site.  Starting pin was inserted and followed by the starting reamer.  We then passed a ball-tipped guidewire and placed an 8 x 5 mm x 240 mm rod in unrelieved fashion.  The rod was inserted gently to avoid over pressurization of the canal.  Once the rod was in place, the proximal interlock screws were placed under orthogonal C-arm views.  Briefly, the cannula was inserted.  Using blunt dissection, the bone was drilled.  The screws were measured and inserted by hand, 3 screws total.  

The proximal fragment had extensive bone loss in the metaphysis [area of the humerus between the shaft and joint] and a largely unstable reduction, but we were able to reappose the bone in adequate fashion. 

Once the proximal fixation was intact, we then assessed our rotational reduction and placed a distal interlock screw in similar fashion.  The screw was inserted by hand to 2 finger tightness and confirmed to be in good position based on orthogonal C-arm views. 

Final x-rays confirmed good hardware placement and adequate reduction.  The wounds were irrigated and closed in layers with 2-0 Vicryl and surgical staples.  The rotator cuff was closed with 0 Ethibond.  Sterile dressings were placed.  He was taken recovery room in stable condition.

When the surgeon talked to Corrine afterward he said that the area of metastasis had dissolved the bone essentially into a cancerous goo. That's why I was in so much pain. They were able to scoop out the goop and send it off for further biopsy to adjust the DNA targeting of immunotherapy. She asked what the cancer looked like and he said a blob of half cooked fish. The post operative pain shouldn't be nearly as bad as the pre-operative pain. I should have full use of that arm within 2 weeks.

We were discharged from the hospital by noon and at home by 1:30. The nerve blocker pretty much kept the pain at bay but the after effects of the anesthesia were pretty hard. I felt like I had a difficult time catching my breath especially with lying down. By evening I tried walking around some and doing deep breathing exercises to get the anesthesia out of my lungs. It was a little rough getting to sleep that night but we were able to piece together a few hours at least. This morning some of the sensation in my arm has returned and it is a little painful but not like before. And I feel like the anesthesia is completely out of my system.

I have radiation therapy this afternoon on my lung and then again tomorrow and Friday. I'll meet again with the surgeon in two weeks to see how the arm is healing and then finish radiation on that arm afterward. We will begin chemo and immunotherapy in mid May. We are still feeling optimistic about the prognosis.

I am very grateful for all the support and kindness from my friends and colleagues and family during this time and especially grateful for all the care that Corrine has given to me, and her family for the support that they've given to both of us.