About six weeks ago, I was in the Loop just leaving the international Lyme disease conference, briefcase in one hand, shopping bag filled with I-don’t-remember-what in the other, when my foot caught an irregular sidewalk crack and down I went, hard, landing full force on my left shoulder.
(Permission to cringe.)
I was immediately helped up by what felt like a busload of high school students visiting the big city. Knowing immediately that I’d either broken or dislocated my shoulder, I got into a cab home, where I grabbed my wife and my Medicare card and headed to the emergency room.
“Not broken, just dislocated” I was told when the x rays came back, though I’m hugely skeptical about all sentences containing the word “just.” After an injection of something to put me to sleep for five minutes, during which time a husky resident popped my poor shoulder back home into its socket, I found myself wearing a sling and was told to follow up with an orthopedist.
Studying shoulder dislocations
I went online to learn something about shoulder dislocations (like you, I use Dr Google for situations outside my scope of expertise). Reading that I’d be wearing a sling for anywhere from three to four weeks, after which the shoulder sort of heals itself, I thought I’d postpone the surgeon and get an MRI instead, to gain a better picture of what was going on.
I got the name of a top shoulder surgeon from two orthopedists and scheduled a visit. He certainly seemed to know shoulders, but I was less than delighted when he informed me this would never heal on its own and that without surgery I’d have severe limits on my left arm’s range of motion for the remainder of my long life.
He recommended that I undergo something called a reverse shoulder replacement as soon as I could schedule it. I’d never heard of this procedure. In fact, while I knew shoulder replacements existed, I’d never known anyone who’d actually had one. I asked about his experience doing the procedure. He chuckled competently and said he was doing six of them next week.
Back to Dr Google
I must admit he made the whole process sound like a walk in the park. The procedure would take less than an hour, require just one overnight hospital stay, and I could be back at work within three days at the outside. It flashed through my mind that all surgeons, regardless their specialty, play down recovery time, probably because being honest can impair business.
When I looked into reverse shoulder replacement online, I got some goosebumps, and remembered, too, that surgery follows the 1/3, 1/3, 1/3 rule. After surgery, a third of people are better, a third worse, and a third pretty much the same.
Then, over the next couple weeks, though I was agonizing over having the surgery I actually felt I was getting better, with less pain and a somewhat better range of motion. It was then I began having real misgivings about the whole undertaking.
Checking various physician websites, I began to suspect my surgeon had been less than candid. The procedure was listed as taking three hours, with a five-day post-operative rest period and weeks to months before significant improvement.
In addition, I didn’t fulfill the main criteria for actually having a shoulder replacement. Pain was number one and after a couple of weeks, I really wasn’t in much pain unless I moved my arm beyond its range of motion, in which case a painful jolt stopped me in my tracks. At first, moving a couple of inches was painful. Later, I could examine patients, type notes, etc, without too much discomfort.
Diminished range of motion was the second criterion. Physical therapy works on improving range of motion, half inch by half inch. I never gave this much of a fair shake, wimping out with an MRI and an orthopedist instead.
Thoughts in the night
Then, tossing and turning one night, worrying this decision like a dog with a bone, I remembered a book I’d read some years earlier, The Healing of America by T.R. Reid, subtitled “A Global Quest for Better, Cheaper, Fairer Health Care.” The author himself had some sort of health issue and had travelled the globe to explore how physicians in different countries would treat it.
“Omigod!” I said aloud at 2:30 AM, sitting up. I remembered that Reid had a chronically bad shoulder from an old injury.
Now wide awake, I pawed through my library (remember, I’m still in a sling), found the book, and opened it to Chapter One. The very first physician Reid visited was an orthopedic surgeon in Colorado who recommended (you guessed it) that he schedule a shoulder replacement as soon as possible.
Ha! And double ha!
I flipped to Chapter Two in which he heads to Asia. There the physicians don’t even consider surgery. “Begin with acupuncture,” he’s told. There’s also some massage and physical therapy.
In India, it’s Ayurvedic medicine and in France, Canada, and the UK it’s physical therapy. No one suggests surgery except the US orthopedic surgeon.
The next morning, I called and cancelled my surgery, explaining I was getting better on my own, promising to check back if things took a turn for the worse.
Physician, heal thyself
I then went to the WholeHealth Chicago office and talked to Mari Stecker about the situation. Now you should know that Mari and I and the late Kirk Moulton founded what would become WholeHealth Chicago just about 25 years ago. This means Mari and I have worked together for close to a quarter century. And while I personally do look older, Mari is ageless and looks pretty much the same as she did when she first contacted me all those years ago.
Some of this is good genes, but she puts a lot of credence in a Chinese anti-aging technique called facial guasha, which she teaches here at WholeHealth Chicago.
But I digress.
If the voice of a perfectly sweet, competent individual could drip contempt, Mari’s did just that when I explained my situation. I believe I even saw a hint of a sneer on her upper lip.
“David,” she began, “I simply can’t believe you’re telling me this. Haven’t you learned anything in our 25 years of working together? You actually would have gone to surgery without trying acupuncture first? I’ve lost track of the number of torn rotator cuffs and torn labral tears I’ve treated. You’ll be fine.”
Well, Mari was as confident as the surgeon and let’s face it, acupuncture is a lot more pleasant that having someone hack away at your flesh and bones.
During my first acupuncture session I climbed onto the table and started unbuttoning my shirt to expose my shoulder. “Leave your shirt on,” Mari said, “I’m not needling your shoulder. Don’t you remember anything about the meridians?” (Apparently not.)
She then placed needles along the energy pathway (the meridian) affecting the healing of my left shoulder. To my surprise, this turned out to be my right foot and ankle.
Now comes the best part. Before inserting the needles she asked me to demonstrate for her my limited range of motion. Lying on my back, I could move my arm no more than 10 to 15 degrees away from my body. You can try this yourself if you stand up, arm straight down at your side. Ten degrees is a motion maybe three inches outward.
Needles in place, she said “Okay, finished. Listen to your music and I’ll be back in about 40 minutes.”
I popped Billy Holliday into my cassette player (no comments, please, about my old technology) and dozed off. When she returned to withdraw the needles she said to me “Okay, move your arm” and lo! up it went, from ten to a full 90 degrees.
“Good heavens!” I expostulated, “That’s magical! That’s…witchcraft.”
“It’s just acupuncture, David. And I can’t believe you got yourself scheduled for surgery.” She snorted irritably but good-naturedly and said, “Come back in three days.”
The way forward and a word on surgeries
Although my shoulder isn’t perfect, I can certainly live with it as chiropractic physician Cliff Maurer guides me through physical therapy and I continue acupuncture with Mari two to three times weekly. Mari also recommended glucosamine/chondroitin and bone broth.
I don’t have full range of motion, but I can raise my arm to shoulder height. What I also don’t have is anxiety over surgery I didn’t necessarily need that wasn’t necessarily going to produce better results that I have right now.
I want to add one final comment. This last year, I had as a patient an anesthesiologist who works at a well-known medical center.
A question for him had been nagging me and I phrased it as follows. “Look, you don’t have to answer this, but I’m really curious. Since you watch surgeries being performed all day every day, in your opinion what percentage of them are probably unnecessary and are being performed just to “do something.”
He didn’t hesitate. “Oh, at least half, probably more. I’d say 60% are really not needed.”
David Edelberg, MD