A Joint Venture

Hi blog (he said sheepishly),

I'm sorry for neglecting you for the last couple weeks. To say things have been hectic would be putting it mildly. To say things have been stressful would severely underrepresent just how difficult it's been. A couple weeks ago I talked about my shoulder and my book, and really those two things have kind of taken over my life. Although to be fair, I don't really have much of a life to start with, having been busy trying to get this book done and going to school and not having a lot of time to spend with other people.  I miss other people, hopefully I can start hanging out again soon. It'll definitely be a lot easier to see my friends again once the rough draft is done and school is out for summer. But enough about that, I have some serious news to parse out. So let's get cracking, how's that sound blog?

Recap
Since my last post I've gone to see two other doctors. My general practitioner (who is a sports medicine doctor and does not specialize in any particular joint) told me he'd never seen a shoulder joint that degenerated in all his years of practice. This worried me for a bit until I realized he's not a shoulder specialist, so maybe it wouldn't be as bad as it appeared when I went to see the Sharp hospital doctor he recommended the following Monday (last Monday, a week ago).

Sharp Specialist
The Sharp specialist ordered a couple more x-rays so he could get an overhead view of my shoulder before I saw him last week. After a bit of a wait and a couple visits from his PA (physician assistant), the doctor came in and pulled up the x-rays. "I've never seen shoulders this degenerated before," he told my mom and I. Perfect, I thought bitterly to myself. It wasn't shaping up to be a good visit.

The doctor informed me that whereas the ball and socket joint normally forms a sort of ball and cup structure, my joints were so damaged that this structure had actually reversed to form a cup and ball. Due to this level of damage and because the bones were so worn away, he actually wasn't sure if he would be able to replace either shoulder at all. Normally the surgeon need a certain amount of bone in order for him to be able to do the replacement, but because of the severe degradation of the joints, the way it appeared from the x-rays, it would be next to impossible to do any of kind surgery. I can't say I was too pleased about that.

However, he did mention that (I don't know if "lucky" is the right word, because nothing about this feels lucky to me) there is a shoulder surgeon convention going on in San Diego in the middle of June, so the doctor would take my x-rays with him and "shop around" the images to see if anybody had any ideas. I didn't want to wait until June, that's two months from now (it's mid-late June). As helpful as it would be to have all those specialists taking a look, I'd rather get more information now.

Scripps Specialist
Before I saw the Sharp specialist, I'd already scheduled an appointment the following Monday with one of the top shoulder surgeons in California. I really wanted that third opinion to be a good one. Even more so after the less than pleasant visit the week before. It took nearly an hour to get to see him, but once he came in and started to look over my the x-rays and check my range of motion, he got right to work.

Again, as with the Sharp doctor, he told me just how bad my joints were and pointed out the structural reversal going on. He tossed around a few big words and drew some pictures on some paper and said most of the same things I'd heard exactly one week ago. However, the big different is that he didn't think it was unfixable. While the damage was extensive, there were ways of doing the surgery and getting the joints replaced.

The more damaged shoulder might be a candidate for a normal shoulder replacement, but the left one is shaped different and it would be extremely difficult to do a normal replacement with that. Instead, he talked about a surgery called a reverse shoulder replacement, which would, in effect, reverse the normal way the joint works, pivoting the head of the humerus (upper arm bone) around a shaped structure in place of the socket. The problem with doing this surgery is that it is a measure of last resort. Normally doctors like to use normal shoulder replacements first, and then use this when no other options is present. In fact, they don't really like doing this surgery on anyone under 70 because the joint wears out after 8-10 years and then it's iffy on what would be available to do next. The left one would almost certainly be a reverse, the right one too probably (although there's still a chance for a normal replacement).

In the end, he decided CT scans of both shoulders would give us more information to work with, which will allow for a more accurate assessment of what can be done for my shoulders. Those should be scheduled either today or tomorrow and then hopefully I'll get them done soon so I can get that information I so desperately need. The sooner I get the joints replaced, the easier it the surgeries will go. The longer I wait, the more degeneration occurs and the more pain I'm in, and the harder both the surgeries and life will be. I'd rather just get these done with, I don't like waiting. At least I shouldn't have to wait until June to get better answers, so there's that.

Next Time
I've been working a crazy amount on my book. Progress shall be updated. Stay tuned.

Your disintegrating master,
Andrew