Surgical Precision

This image could be subject to copyright, not held by me. If I get arrested, we’ll know why.

Thirty-some years ago, just about this time of year, I dislocated my shoulder. It was a two-part injury, started on the ski hill one afternoon and finished around 11 p.m. when I lifted a 10-pound weight over my head and felt a distinct pop.

This was back when Gunnison was macho and it was, no foolin’, 30 degrees below zero (about the same on either scale). I couldn’t get my coat on or zipped, so I threw it over my shoulders and walked the two blocks to the hospital, where they summoned my general physician, asleep at his house, who put me under and put it back in place.

I woke up around 2 or 3 a.m. and they discharged me. A couple of police officers had just been in, probably getting warm and relieving the tedium of driving around Gunnison in the wee hours, and one of the nurses said, “Oh, we should have had them take you home,” but they didn’t summon the cops back and so I walked the two blocks home, still with my coat around my shoulders, still at -30, and went to bed.

The next morning I threw my skis away (and haven’t been on a pair since) and began the recovery process. At some point I started physical therapy, at the hospital since that was the only option, with my therapist careful to keep away from the back of my shoulder, since that’s where my doctor said I popped out, even though 85 percent of dislocations go out frontwards.

But then my rehab stalled. My shoulder wasn’t bouncing back the way it was supposed to. My doctor declared this to be beyond him and shipped me off to an orthopedic surgeon, the nearest of which was in Montrose. Here the surgeon summarily announced I had popped out forward, and that I had adhesions, which I assume is a fancy way of saying scar tissue, and if they couldn’t be worked free in physical therapy he would put me under again and literally rip my arm above my head, yanking the adhesions loose and starting the rehab process all over.

I took my x-ray to my therapist, a woman named I liked very much, and while I’m quite sure she could read it, she was circumspect enough to know what I didn’t: the therapist doesn’t correct the doctor(s). And then she and I worked and worked and worked, and we successfully managed to avoid the anti-adhesion surgery that I was never going to subject myself to anyway.

Now, 30 years later, we are dealing with another shoulder, Lynn’s this time, and not as the result of any one accident. There are other differences, too — huge differences.

Starting with the doctor. Lynn bypassed the general physician altogether, and this is easy to do because orthopedics is now a booming business here in the Gunnison Country. Between Gunnison and Crested Butte there are at least three free-standing clinics with I don’t know how many surgeons, and although I’m not sure there’s one now, the hospital frequently has one on staff.

Your physical therapy choices are wide-open too. There were three clinics in Gunnison alone, although one closed and was taken over by our absorbent hospital. It is, truly, a whole new world out there.

Lynn, who had a bum foot before she had a bum shoulder, is on her fourth surgeon and her second, maybe third, physical therapy clinic without ever leaving Gunnison. And what we’re really learning is that medicine appears to be much less of a science than an art.

The first surgeon completely missed the stress fracture in her foot that another doctor in the same clinic saw right away, a mere four weeks later when nothing was improving, and not having had a stellar experience with that clinic, Lynn tried a different one when she had a foot flare-up. She liked that surgeon, but we think he’s moved on and his expertise was feet, not shoulders. But she stayed with that clinic for her shoulder, where she’s had a fairly positive experience.

And we both really like “our” physical therapist, where I learn how to move Lynn’s arm around at home. She’s at the hospital, and she came recommended to us by a friend. But while she’s competent and easy to work with, and the surgeon seems competent and quite confident (quite confident), they don’t appear to be particular fans of one another.

They’re being professional about it, more or less. The therapist asked for a more comprehensive prescription; when this was relayed to the doctor, he complained rather volubly about how the therapist already has this more complete prescription and he sends it over all the time. Her retort (this argument took place in slow motion, with Lynn and I as the go-betweens whether we wanted to be or not) was that every patient is different and no, he doesn’t have a universal prescription he always wants followed, as he seemed to indicate.

One of the first things the therapist said to us was that this particular surgeon is very aggressive with his rehab, and even though she didn’t say it out loud, the subtext was there: more aggressive than he ought to be.

The really interesting part of this is that we have a friend who underwent this same surgery (rotator cuff and biceps tendon) here in Gunnison about a month ahead of Lynn. She used a different clinic for the surgery and is seeing a different physical therapist, one not at the hospital.

Her doctor has only just now authorized some of the things Lynn was told she could do nearly right away. Lynn was told she could do all the walking she wanted, as soon as she wanted; our friend was told to wait six weeks. Lynn started dangling her arm down, sans sling, on the first day of therapy; our friend waited more than a month to start that. Clearly, different strokes for different docs.

Lynn’s therapist has been pumping the brakes on this exuberant “Do whatever you want” allowance from the doctor. It was interesting to hear a different friend (hip this time), the one who recommended this therapist, say that the therapist would like her surgeon to be a little more aggressive in his prescription, because this same therapist isn’t about to let Lynn do everything the surgeon said she could.

I think — and I can think this because I’m not the one in the sling — that the pace Lynn’s therapist is setting seems to be a good compromise. Even though the surgeon told Lynn she could go back to work if there was something she could do without pushing, pulling or lifting weight, she keeps falling asleep and wondering why she does that (answer: you just had surgery), and so even in her own impatience it sounds like the surgeon’s fast track is too fast.

Even though the therapist is not going to come right out and contradict the doctor, she does have her foot off the throttle, and that’s okay. We can just motor along, slowly, and see where that gets us.

But it is funny that this “science” has so many approaches in one little town that three decades ago barely had any approach at all.

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