Subscapularis

The good news after three hours today of sitting around in Fracture Clinic is that the fracture is healing well, you have to look hard at the x-ray to see the join, the metalwork is good and I have some movement and am allowed out of the sling when I’m sitting around watching TV etc. the Consultant said its basically over to the Physiotherapist now.

Looking good

However it’s still going to be a very long job, Mr Consultant signed me off for at least another two months and possibly longer. The problem is the Subscapularis muscle or more specifically the tendon that joins it to the Humerus, this is the muscle that got mucked about with during the operation. The arm can only move outwards by 20 degrees or so and not far vertically and ONLY the physiotherapist is supposed to do it with me passively laying there while she does it. I have to wait for her to tell me when I can do it myself and it won’t be for a while.

Subscapularis tendon that needs to heal ( photo taken from here )

The Subscapularis is essential for lifting and for overhead sports such as tennis or swimming or in my case lifting the arms in to Surya A or landing dropbacks and all the other fun stuff I miss doing.

I thought summer was at least coming, but the wind, hail and rain are back blowing the blossom off my trees. I’m keeping warm reading the prospectus of Abby’s TT, which she has asked if I was interested in doing. I’ve never thought about teaching, I once covered the beginners Ashtanga at the local place when the teacher was sick.

5 months later

Five months since I was last able to practice my full list and seemingly still nowhere near being able to do it again. And there I was thinking I was making progress in March at least going back to the Shala and feeling like I was doing something with Louise’s help.

The rehab is a very slow process, so far I’m allowed only very gentle pendular swings, sawing and chopping movements and the physiotherapist does passive abduction and elevation, where I just lay there and have to tell her when to stop. She tells me I’ve also lost movement/rotation in my wrist through all the time I’ve been in my poly sling.

The sling is also having a detrimental effect on my shoulders and neck as well, so she’s added in some posture exercises, though again these are very gentle movements.

Progress is necessarily slow for reasons, because of the muscle they had to remove/replace during the operation and the Physio doesn’t want to push this until she knows its at least beginning to heal, but how do you tell. Also she was sent information about the surgery and what needs to happen, but the handwriting is so appalling, yes I know I can’t talk, but its impossible to read what the Consultant has written and so the physiotherapist is reluctant to push my rehab. She has actually asked me to ask some questions at Fracture Clinic next week so that she knows what she is allowed to do.

I never thought that 5 months later I would still be nowhere near being able to work again or go to practice. As teacher Cat said there is still breath and Bandha, but everything else is turning to mush with a lack of meaningful activity and hours watching box sets while drinking tea and munching biscuits.

I had expected to be looking forward to a week in Spain with Dena at the end of June, but can’t see that happening, next on the list Kino in London in August, that could be too soon at this slow rate of progress or led primary with Sharath at the end of August. Looking like another year to write off at this rate. Christmas at Purple Valley is looking likely.

Metalwork

Three weeks since the surgery, the arm has settled down, the graft site still catches me out. I can straighten my arm, do sawing and chopping movements, squeeze a ball and move my shoulder blades together, but that’s all I’m allowed. I’m not allowed to move the arm outwards.

On Monday I finally saw the metalwork that’s joined my arm up, pretty impressive stuff. I expect alarms to be going off in Airports and tube stations with knife detectors!

At Monday Fracture Clinic they told me the reason the fracture remained non union was because the tissue between the two bits of bone had started to turn to fibre instead of bone. The Doctor also told me the reason I’m not allowed to move the arm outwards is because during surgery they had to undo a muscle at the front of my chest/shoulder and then put it back. It’s going to take a few months for this muscle to join back on to the tissue, tendons and bone and I could tear it off if I move it outwards. The sling has to stay on for another couple of weeks.

The stitches also came out, this wasn’t as stressful as I imagined, I only felt the last ones pull as the Nurse removed them. Though both the sites are still sore.

The Physiotherapist has given me a couple of extra things to do, next week she is allowed to do more, but this week she just tested the movement I have and used massage pressure to try and free up the knot in my neck caused by the sling. I was a guinea pig for the trainee physiotherapist who was shadowing her this week. What with the re attaching muscle and all the arm muscles that were moved she says it will be at least 3 months of rehab. I can’t really start any kind of yoga practice until the muscle is safely attached again.

This has turned into a long recovery road, but at least I’m now on the right road.

A bit of a blur

I was thinking this blog should be renamed “The Journey of no practice”, but at least I’m hoping there is at last an end in sight of the fractured proximal humerus saga.

Nil by mouth from midnight on Tuesday , admitted to Hospital at Noon on Wednesday, just after 3pm the last words I remember from the polish Anaesthetist were “sweet dreams” zzzzzzzzzzzz. Vaguely with the world again at 8pm, though not really sure, it was all a drug induced blur of slipping in and out of consciousness until the Sister came to stick the anti clot injection in to stomach, she just did it, probably a good thing as if I’d been more with it I would have tensed from the memory of that needle 2 years ago. It’s still a bloody painful 10 seconds, she did at least bring me a cuppa afterwards.

Thursday I was supposed to go home, but the nerve block on my shoulder had worn off and the pain in my Pelvis from the graft was too much, god knows how much medication by tablet, oral liquid and finally when it got to much a morphine drip, sending me back into the zombie semi conscious zone. So being still there another evening stomach jab, owww. Stings for ages after.

Finally Friday enough lucidity and pain stability to talk to the Consultant, who showed me the spectacular x-ray of pins holding it all together. He said not only had he pinned the fracture but separated all the muscles that were glued together after 4 months. The Physiotherapist told me what I can and can’t do. Surprised she got me out of the sling then to be able to almost straighten the arm from day one, though warned I may not get full movement back. I can’t do much until all the stitches come out in 2 weeks time.

Got home at 6pm Friday, without the strong hospital painkillers to knock me out, not a lot of sleep, no position seems comfortable.

Ani, a Nun at Bylekuppe near Mysore bought my download Mysore map a while back and we have been chatting about Mysore, she sent me this lovely Get Well card PDF

Ani in Mysore, click the PDF to see her lovely get well message
kevin.pdf

NHS U-turn

After a tortuous journey, 2 trains cancelled and a car ride I walked through AYL’s door to find it very busy. Spot in the corner by the mat cupboard would do, but as I practised I realised I didn’t feel right, sodding infection. Louise squashed me in Paschimottanasana and I thought I was going to explode, I plodded through to Baddha Konasana then decided to abandon the project, heading off in to the Closing room to lay in Savasana while I plotted how to get home. I must have felt crap, I didn’t even stop for a croissant!

There’s been a turn round, since I complained about the interminable delay in getting my fracture treated. I obviously hit a nerve somewhere in the NHS, as Monday morning I was woken by the noise of my silently charging cell phone vibrating its way off the bedside table. The call was from the head honcho Consultant’s Secretary asking me to attend that mornings Fracture Clinic, despite not having an appointment and not the Clinic in 6 weeks time as they had told me the week before!

Checked in and whisked straight through by the Nurse to see the man himself, who was grovellingly apologetic, saying I’d slipped through the cracks and how he was going to put it right. The upshot being he had now actually looked at the x-rays and CT scan and agreed that after 15 weeks it wasn’t going to heal on its own and does now need the plate and screw surgery and would next week be ok?

So I’m on the Trauma list waiting for the call. The ops a bit more involved than I thought, 3 hours long and involves not only rebreaking the 25% that has united, filing up the edges to get a nice fit, before plating and screwing the fracture back together. To help the join they are also going to “harvest”, don’t you just love that word, some bone from the top of my Pelvis, so by the time it’s done I probably won’t be able to stand up as well as not be able to use my arm again. But at last we have a light in the tunnel, even if this does mean starting the rehab again.

When they get their arse in gear it’s amazing, no sooner had I got home hardly from the Clinic than I was summoned for my Pre op assessment the next day.

Lunchtime today the phone rings again, it’s the Trauma Nurse to say next Wednesday is the big day, bring on my bionic arm!

NHS frustration

Practice is where it is, at least i managed to get to AYL this week, standing is mostly doable and quite a lot of seated up to Navasana, but still no way is the Bhujapidasana through to Garba sequence possible. Baddha Konasana is good, especially with Louise squashing me down followed by a superb assist in Supta Padang squashing the bottom leg to the ground at the same time as stretching the hamstring of the vertical leg. Louise and Emma have worked out how to assist me now, deep twist in Parsvakonasana and deep bending me in the Prasarita. After Salabhasana I’m getting away with adding in Ustrasana in lieu of backbend, before I get assisted cross arm half way drop backs, feels so nice to get that deep bend, roll on the day when I can do it on my own again.

Nonunion – Why won’t they just do it?

The Hospital is another matter, I finally saw the CT scan, which still shows the fracture not uniting, I was supposed to see the Consultant this time, but yet again got fobbed off with an underling, the Underling concurred with the last one saying its time for surgery to pin it together. I agreed to it, went through the fitness for surgery Q&A and he went off to get a confirmation.

However on his return he changed his story (obviously under orders from above) to say they want to give it yet another 6 weeks, it’s already been 15! If its still not united by then another CT scan (add another 3 weeks) taking us to 24 weeks, which is bloody ridiculous, considering how uncomfortable and at times down right painful it still is. I was not amused and have now complained to the Trust, see where that gets me, no hum won’t hold my breath as these people seem to be unable to make a decision.

A trip to Oxford was fun.

At least the Pilates sessions are good. Her weekly photo and assessment show my shoulders are lowering, especially the left one, despite the ongoing fracture situation. Interesting physical and breathing exercises, I didn’t realise it was possible to breathe more into one lung than the other, all aimed at undoing the clump of shoulder muscles and opening the thoracic spine. Every session adds a couple more exercises to do during the week. It’s also proving educational, she explains the anatomy and what needs to happen or change. I didn’t know I had a Acromion or what or where the brilliant for Scrabble Xiphoid is!

At least all the Pilates, Physio and what yoga I can do passes a few hours each day.

Full schedule

Despite having more free time than I can fill with box sets, I still seem to have a never ending schedule of things to do, just as well really, anything that takes my mind away from the intermittent pain and the will they won’t they operate saga.

I seem to have reached a plateau with what yoga I can do, so a friend suggested I talk to her Pilates rehab therapist. It just so happens that the Therapist has an offer on of a course of 6 one to one sessions at a huge discount, so I decided to see what she could do for me. It turned out the first session was free, mainly consisting of an assessment of my posture with regard to the fracture. No surprises there, left shoulder higher and forward and neck more lopsided than it usually is. She certainly seems to know her stuff, working out how she could help me and explaining the anatomy of what is wrong and needs to happen. Only about 30 minutes on the mat doing physical movements, getting me to put my thumbs on my ASIS and rotate the pelvis. Breathing in to my back to help get the shoulder blades back and down my back. All small subtle movements but very effective. Looking forward to the next session.

The local Mountain

The monthly Meditation & Realising Dreams workshop teacher decided we needed an outing, so last night we headed off to what passes for a mountain round here, Ivinghoe Beacon is nearly 800 feet above sea level after all. Luckily a nice mild evening as we silently walked to the top in the pitch dark, at the top is a stone Kern around which we made a circle as Susan led her meditation in competition with the wind and the jets descending in to Luton.

Back to reality today with Physiotherapy, that certainly made me be in the present as she manipulated my arm. She told me the x-ray shows that unless a miracle occurs it is time for surgery. She has given me a new blue stretchy band that I can hardly pull and a particular exercise to get the shoulder as loose as possible in preparation for the possible surgery. She said if the shoulder isn’t moving before surgery, getting it to move post surgery will be difficult.

So with the yoga I can do, plus the physio and Pilates exercises half the day is already gone

Actual sweat!

It could just have been that Louise had cranked up the heating, but for the first time in 10 weeks I practised and produced some sweat! Much more help this week, Louise has worked out how to assist and help me. Trikonasana A and B and Parsvakonasana A and B, instead of trying to stretch the left arm forward she got me to put it on my hip before bringing the shoulder back, just as the Physiotherapist ordered. All of standing is doable, just about.. UHP help, but an unbound or bent Ardha Baddha Padmot. My arm just won’t lift up, despite the physio pulley, so Utkatasana and Virabadrasana look a bit strange, but at least my legs and Bandhas are there.

Nothing weight bearing and no vinyasas, I still have to miss out the Bhujapidasana through to Garba Pindasana section. Mari A assist after Louise saw i had bound the first side, deepening the twist but not pulling on the arm. Definitely no pulling allowed now I know the fracture has stopped joining. Baddha Konasana assisted again this week and even a one toe grab Supta Konasana up and over. Ubhya etc no chance and a dodgy Setu B, a struggle to get up and balance.

Salabhasana A and B this week, well B very carefully putting not too much weight in to the left hand, but a nice bend. Louise did the cross arm backbends with me this week, that felt sooooo good, supporting the bend and taking my shoulder blades down my back, I couldn’t quite see the floor, but it was a much deeper back bend than I’ve managed in 10 weeks, it was worth the trip to AYL just for that along with the heat, energy and enjoyment of practising with others. I’m amazed how long this very modified practice takes still, but going back has been what I needed.

After the bad news of probably going back to the surgery plan, at least returning to the Shala has been good, Louise encouraging me to return has come at the right time. The sudden call to give another Mysore talk with 2 days notice has also given my mind other things to focus on. So many people came up to me afterwards to say how much they had enjoyed it, the hour flew by for me and for them by the sound of the feedback.

Finally being the first Sunday of the month means the monthly “meditation and realising your dreams” workshop with Susan Earl. It’s mentally hard work, we certainly get to think about the reasons we have for not realising whatever our own personal dream is and this week Susan discussed “obstacles” that we perceive, those obstacles that stops us making the changes and doing what would make us happy. I’d never heard of neuroplasticity until today, but Susan explained that the brain can constantly make adjustments, not just in response to injuries, but also in relation to life changes.

At least the workshop, going back to practice and giving talks stops me getting too fed up with the seemingly never ending fractured arm. Two weeks to D-day. I need a rest now, it’s been a pretty busy few days.

Raisin Danish to the revolving Donut

Sunday was great, practice at the Shala followed by a Raisin Danish yogi breakfast.

3/4 still to go

Then Monday came round. Monday meant a new X-ray and Fracture Clinic. I thought it had been a month of getting a little stronger and more movement with the Physiotherapy, but the x-ray showed the fracture appears to have stopped knitting together by itself, this is NOT good. Three quarters of the fracture is still a gap, by week 10 it should all be pretty much united.

Non sugary Donut

The Doctor prescribed a visit to the Donut, aka a CT Scan to confirm the non knitting and the likelihood of surgery. Todays CT scan was a new experience, laying on a trolley that moves through the Donut ring scanner, I tried to watch it spin above me, but realised that wasn’t a good idea, as I got dizzy! Now I need to wait 2 weeks for the next Fracture Clinic appointment to find out the result.

Meanwhile it’s back to doing the physio and doing what practice I can, but we could be back to square one in a couple of weeks. 2 Shala Sundays to D-day.

In the mean time I have been asked to give another talk on Mysore this Saturday, I hope the next time I’m off work for 3 months I’m in Mysore and not stuck at home with a broken arm.

Good to be back

Since last Monday I have started to practice again in a more meaningful way, as opposed to the odd stretch added on to the physiotherapy. Each day was better, though much is still restricted or totally impossible. L had said to come back when I was ready, so I figured after emailing her that it was as good a time as any to return to the Shala.

I’ve missed walking through the door and my glasses steaming up immediately, I’ve missed Louise and the other Assistants and missed the people I practice alongside, the nods to those you nod to, the smiles with others I know better. I’ve missed the laughs, like today’s, when the Shala toddler ran (she was only crawling last time i saw her) up to a student in Downward dog shouting “dowwndoggy”. Home alone practice just isn’t the same.

Louise just said “take it easy, no pressure”! They left me to my version of sun salutations, trying to warm up and a one hand downward dog(gy) to stretch the Calfs and hamstrings. Most of standing seems to be possible with a bit of thought about arm placement, though my Trikonasana probably looked a bit ugly and unaligned. First help came in UHP, Emma assisting both sides.

Seated has to be vinyasa free, a forward bend in between had to suffice. Super squash in Paschimottanasana and help in Tiriang Mukha. The Marichyasana’s with some decent heat were good, binding A & B on the first side and C on the second, Mari D is just a kind of twist on both sides. Baddha Konasana hasn’t changed, I just needed the squash to put it back in place, L turning up right on cue. I think Louise mostly just observed today, working out how she can best help and assist, so long as any pressure is not on the fracture site or pulling on the arm then it’s no problem.

Closing via Salabhasana A and almost B, a bit of cross arm hanging back. Enough bend to do Matsyasana and Utana P for the first time and a ten minute Savasana. Despite all the necessary omissions, Bhujapidasana, Kurmasana, Supta Kurmasana, Garbha Pindasana, Sirsasana Urdva Dhanurasana and Uth plutihi practice still managed to take 90 minutes.

Until the fracture knits properly and I get back some muscle and i can actually put weight through the arm, it’s going to be a while before I get back to where I was on 5th December, the last time I practised at AYL, but it was great to walk back through that white door.