Arthroscopy: The Day After

Here I am typing, one handed mind you, but I am typing! Day two was better than I expected based on my first rotator cuff surgery three years back. The seemingly clumsy attempt at administering the pain block by the anesthesiologist turned out to be a benefit, because the extra numbing agent that he used really deadened the pain for much longer than 24 hours. I lasted for all of Day Two as well. I was in no pain from the surgical site and experienced only soreness in the general area.

Now I did take the Hydrocodone as prescribed, but at this point I am starting to feel like I won't need it for the Day Three and beyond. I also used plenty of ice today, something that will continue for many more days. I moved about the house frequently today, getting the mail, fiddling with a new cordless phone system and programing a new remote for the living room television. Apart from that, I read and generally just hung out with my family and watched more of the basketball tournament. It's been a pretty good experience thus far, and much better than before.

I still must sleep in a reclined position again tonight, but I have a feeling that because I am not in much pain I may actually have a better chance to sleep tonight than in previous nights. I surely miss my bed, but it is not so bad. Tomorrow begins a new challenge as I remove the bandages and begin the first very light exercise of the arm. I can also finally shower as well!

Arthroscopic Surgery

I've been through this before. In 2009 I was rear-ended in an auto accident, resulting in a tear of my right rotator cuff tendon. I didn't discover that the injury had occurred until weeks later. The surgery in May of 2010 repaired the partial tear successfully and I recovered well from it, though I was surprised to find that sleeping was very difficult. I had to sleep for nearly two weeks in a recliner, because laying down created challenges. Also, owing to the fact that I am terribly right-handed, learning to use my left hand for daily functions those first two weeks post-surgery was definitely a challenge.

Physical therapy truly helped to strengthen my shoulder, but it was time-consuming. I recall going to therapy for eight weeks, two to three times a week. The good thing about all of this was that I was on summer break from school for most of this, so I had the time to get well. I was even able to sneak in a Jamaica trip during this period (though I was still in some discomfort at that time).

When I learned a few few months ago that I had suffered a full-thickness tear of my left rotator cuff, it was not terribly surprising. The shoulder has been painful and lacking complete range of motion for a long time. I used to lift heavy weights, foolishly I might add, and I had known that for quite a while that things were not quite right in either shoulder, but with these types of injuries people usually self-treat with an analgesic and go on with daily lives.

In the case of the auto accident, trauma changed my attitude that with respect to my right shoulder. What led to the re-evaluation of the pain in my left shoulder was a fall last September. I found that I suddenly could not lift my left arm more than a few inches without strong pain in my forearm. This was exactly the same pain that I had experienced in my right shoulder and I knew that it was time to see my orthopedic surgeon again.

The thing about the shoulder tendons (and there are four which controls arm motion) is that they don't get much blood supply to begin with, so damage in this area can be slow healing. The Acromiom bone, which is the bony extension which overhangs and protects the upper tendons is subject to developing a hooked appearance due to normal arthritic conditions. Even without much physical abuse, this bone can dig into the top tendon, the supraspinatus, and partially tear it. A fall or other traumatic occurrence can aggravate the existing tear and result in the condition that I am experiencing there. It is a common injury which is especially frequent with men in my age group. This diary is intended to help others going through the same thing that I am experiencing. Yes it is a little scary, but knowing what lies ahead is a great tool and preparing for this procedure. There will be several updates to this article as I work through this.

Day of Surgery

My last meal, per per-surgery instructions, was the night before, about 7:30. I have not taken any aspirin or NSAIDS for the last week prior to today. I was allowed Tylenol, which I needed last night. I felt some apprehension before going to bed, but my spirits were lifted by the Bulls beating Miami to stop their winning streak! This morning I woke early, had just a sip of water with my prescribed medication per instructions for my reflux condition.

After watching Sports Center, I drove with my wife, Linda, to the surgery center, where I checked in and paid what I owed of the surgeon's bill. They called me right away and I went on back to the prep area, where I was asked for the first of a dozen times my name, date of birth and the procedure and location I was there for today. The nurses wee very efficient in prepping me. I was all hooked up to the various lines in about twenty minutes. I was told that I had to take off my wedding ring. Now, I have not been able to get that ring off for about 20 years. When they said it would have to be cut off I asked for some ultrasound lubrication and presto! It came right off after a little bit of tugging effort. I'll have to get it stretched! My doctor came in next to diagram on my shoulder where he would be working and after a few jokes, he left to prepare.

The trouble came when the anesthesiologist began to administer the nerve block in my neck. It seems that my anatomy is not textbook on the left side; it took him four attempts using an ultrasound guided needle to find the correct nerve to stick. After the second attempt he asked me if I would like something to "take the edge off" through my IV line. Of course I did! After that I didn't care much what he did.

When I was appropriately numbed up Linda was brought in for final hugs and kisses and I was wheeled into the operating room and transferred to one of the most uncomfortable, narrow beds I've ever been on. I remember scooting onto it and being asked to push myself a up little higher. I heard the anesthesiologist say "nite-nite" and the next think I knew I was propped up on another bed, bound up in a bandage and the fitted sling we had to buy days prior to the procedure. Linda was sitting by my bedside and I slowly came to consciousness. There was no pain whatsoever from the site, but my calves were very sore. Apparently they had to flex my legs in an awkward position on the surgical bed during the procedure.

I was told that the surgery went as planned and that it took about 40 minutes. I went into surgery on time at 1 pm, and was out in recovery by 2:00. I was given some cold water and applesauce and I noticed that my throat felt very raw, from the tube they ran down my throat during the procedure. I was told to cough once or twice per hour throughout the next couple of days to help keep my lungs clear. I was able to stand very quickly, Linda helped me to get dressed and the nurse went over with us the doctor's post-surgical instructions once more. Linda is a Registered Nurse, so I had no concerns about not understanding directions. She always maintains charts of blood pressure, meds and so forth on a regular basis, so I knew that I was in good hands with my wonderful wife.

I was home by 4:30 and ready to dine, since I had fasted since the night before. I opted for breakfast - eggs, coffee and a slice of toast, which I was able to palate just fine. Dinner was equally light - soup. Much of the night I was troubled most by the bindings that I was in. They don't want my arm to move too much these first three days, so I find it awkward to sit in chairs or rise cleanly from the sofa. I was given hydrocodone and 600 mg ibuprofen to take every four and six hours respectively, but the pain block they gave me was still working well, as it did throughout the might. As I say, I don't sleep well in a recliner and tonight was no exception. I am not allowed to lay flat for several days so that the repair can set without complications. I was not in pain, but I was uncomfortable, napping on and off all night long. The first two nights are always the worst.

More to come!

New Car Update

A little over three months in and I'm still enjoying my new Mazda CX-5. It is comfortable, safe and getting excellent gas mileage at close to 33 mpg in an even mix of highway and street driving.

It did get a jolt of real world experience recently though; someone backed into the car at a local mall, resulting in about $1500 in damage to the rear bumper and quarter panel. The person who damaged the car drove off. That was frustrating, but the repair was done expertly and the car is a good as new.

I've owned (and financed) many new cars in my life, but few have been as satisfying as this car; the only the exception was the Ford Explorer Sportrac that I replaced with this car. I'm amazed at how much technology is now going into even "economy" cars these days. Hands free Bluetooth connections, rear back up cameras, navigation, blind spot warning systems, satellite and HD radio, multiple air bags, leather power seats and more are all often standard equipment. And the power and gas mileage these cars are getting is amazing. It remains to be seen how these engines will hold up in the long run though with the heat and high compression they produce.

White Bean Soup

I am always looking to cut down on meat-laden soups and other main dishes. I experimented with this one recently and it came up a winner in my book! You can cut the bacon if you want to go totally vegetarian (and add a few drops of Liquid Smoke at the end, or use turkey bacon for that smoked flavor. This one is easy and tastey.

Directions:

1 14 oz. can white beans (Great Northern is fine)
4 cups low sodium chicken stock
2 bacon slices, minced
1 tsp Liquid Smoke (if skipping the bacon)
1 tbsp olive oil
1 cup fine chopped onions (about the size of the beans)
1 cup fine chopped celery
1 cup fine chopped carrots
1 clove garlic, minced
1 tsp dried oregano
1 tsp dried basil
2 bay leaves
salt and pepper to taste
2 tbsp grated Parmesan cheese

Chop vegetables and bacon. Heat old in a medium stockpot over medium flame. Add bacon and saute until rendered. You can pour off some of this oil if you are looking to cut fat, otherwise dump in the vegetables and cook until the onions are clear. Add the beans, with the liquid and the stock and season with the spices. Bring this mixture to a boil and then simmer covered over low flame for thirty minutes, or until the vegetables are soft. Test for salt and pepper and adjust if needed. Drizzle in the Liquid Smoke at the end if meatless.

Pull out the bay leaves and serve with a sprinkle of the Parmesan cheese.

EASY BEEF ROAST

One of my favorite comfort meals is a good beef roast. It’s hearty and flavorful, and afterwards you can use the leftovers (if there are any) to make a nice soup. The problem with this dish lies in the cut and method of preparation.

In terms of the cut, I prefer the boneless crosscut rib roast. It’s a little more expensive than the eye of round, but the extra fat marbling will ensure tenderness and flavor. I’ve found that in order for round roast to be as tender you have to either slow cook it eight hours or use a pressure cooker. Those methods can turn the meat into a stringy mess, to me unpleasant result.

Rib roast usually comes with a bit of a fat cap; trim off as much as you can, but I do like to retain a little on the meat for flavor. The key is low and slow oven cooking. I set the oven temperature to 275 degrees - and I don't peek!

INGREDIENTS

4-5 lb. beef crosscut rib roast
1 tbsp. olive oil
1 medium yellow, onion, chopped not too fine
3 cloves garlic, chopped
2 stalks celery, chopped
2-3 carrots, sliced
2 beef bouillon cubes
2 cups water
(You can substitute 2 cups low sodium beef stock for the bouillon)
2 tbsp. Worcestershire sauce
1 tbsp. Montreal Steak Seasoning
1 tbsp. dried onion flakes
Salt and black pepper to taste

Preheat the oven to 275 degrees. In a Dutch oven or large stockpot heat the oil over medium heat. Season the trimmed beef with the spices, pressing into the meat and brown on all sides in the hot oil. Add the chopped vegetables, water and bouillon to the pot, season with Worcestershire sauce and cover tightly with the lid.

Place the meat the oven and roast for three hours and thirty minutes. Avoid opening the door of the oven during this time to ensure heat does not escape. At the end of the cooking time, carefully remove meat from oven and let rest 15 minutes before slicing and serving. A serving size would be three to four ounces, with a nice side salad!

My New Car Buying Experience

I am a fairly frugal person with few excesses, save such tech items as smartphones, iPad, iPod, computers and camera; it’s a big reason why I drove my last car 8 plus years. I want to stretch my dollar as far as it can go, as most people do.

When I bought that 2004 Ford Explorer Sport Trac (in 2003) though, I wasn’t quite of that mindset. The vehicle, after all the add-ons, was over $31,000 when it was all said and done. That vehicle was the most extravagant that I’ve ever owned; all power, satellite radio, leather seats, security system, the works. And it was faithful too. It was never in the shop for mechanical issues, other than the two times that I was rear-ended at stoplights by inattentive teens.

But despite all of that it had begun to show its age at 142,000 miles; its tires needed replacing, the transmission had begun to slip at speeds above 75 miles per hour, and various rattles and squeaks were evident throughout the cabin. I was also getting much less than Ford’s rated 18 miles per gallon; a weekly fill up during the recent height of gas prices cost me $72, and that didn’t last the entire week. But the main question was whether I should throw $3700 into new tires and transmission repairs, or use that money as a down payment on a new vehicle. I had enjoyed four years of blissful car note free existence up until that time, after financing the truck 66 months (I had paid it off about a year early by making extra payments). I knew what I had to do, but what type of replacement was definitely a top question in my mind to settle.

I am a band/choir director in a smallish school district. I had needed the truck to haul equipment over the years, but my place of employment has also grown over these same years. I now had at my disposal a department truck to carry all of the stuff I needed the truck for initially, so there went my overriding need for a pick-up truck.

I have never been a sedan fan, so the obvious answer to me was a crossover. Let me state that I have been a Ford person for many years, owning – trouble free I might add – a 1997 Ford Ranger and a 2001 Ford Escape prior to purchasing the Sport Trac. Prior to that, I had owned a 1985 Nissan Stanza wagon (good car), and a 1987 Hyundai Excel and a 1991 Chevrolet Lumina. Those last two cars were dogs.

Since I had owned an Escape in the last decade I was eager to see what the all-new 2013 revision had brought to the car. This was where my odyssey began. My wife, who drives a company Ford Fusion hybrid, had picked up the car at Holmes-Tuttle Ford here in Tucson about ten months back. She had a great review of one of the sales staff, Scott Patty, who was especially helpful. He happened to be the internet sales manager there. In her experience dealerships are not very accommodating to pharma drug reps who have ordered replacement cars through their company’s fleet websites. The dealerships don’t make much money on these sales so they usually don’t spend much time with the reps either on the test drive or the delivery of the vehicle. But her salesperson did and she remembered him when I announced that I was ready to buy a new car.

I called Scott in November and set up a test drive appointment for the Ford Escape. He quickly remembered my wife and had a car ready for me when I arrived. The new Escape has been totally remade from its earlier version, with all new engines, sheet metal and technology. I was initially interested in the top of the line Titanium version of this SUV, which comes with Ford’s 2.0 liter Ecoboost engine, and a convenience package the includes an automatic rear lift gate (pass your foot under the rear bumper), all power leather front seats, keyless entry with exterior touchpad, and MyFord Touch/Sync. There is an amazing amount of new auto technology in this car, but not without some problems. The Ecoboost engine, especially the 1.6 liter, has been subject to recalls, and the MyFord Touch system has been finicky.

The car I drove was in perfect condition and I had no problem with the touch screen technology (which includes a backup camera, voice commands and navigation). I was bothered by two issues though; the windshield had a tunnel effect that I was not overly pleased with, and the front seats were very hard. Ultimately, the price would be the main source of my displeasure, however. With all of these amenities the price of the car is over $34,000 list. It’s a steep price.

I kept all this in mind as I saved money for the down payment. In mid-December I was ready and returned with my wife to test drive again the car and start negotiations. She drove it and was displeased with the seats, the handling and the price, all legitimate concerns. Additionally, we were not pleased with the dealership’s offer of only $2500 for my trade. We needed more and they did come up $500. But it was still not enough.

The main problem was the cost of the car, which was too high for the money I wanted to put down ($3000) with my trade. I wanted to keep monthly payments around $550 and no more than 48 months. That was not going to happen with an Escape Titanium. Other models in this series were not as appealing and I felt were still overpriced. I also did not want that troublesome 1.6 liter engine, which at last account was subject to four recalls in 2012 for fires and other issues.

We went at this for three hours and we would not budge; there was no way that we were going to go down this road again without a car equipped the way we wanted, so we finally walked out. Scott was great in this whole process. I have no ill words to say about the salesmanship or professionalism that he exhibited. Both were top notch. We just could not agree on a price and terms.

I had also been watching reviews on line of the Mazda CX-5, a new model from the tires up. Mazda had been a longtime partner of Ford, and had in fact re-badged the former Ford Escape as the Mazda Tribute. Mazda though stated that its new CX-5 shared no components with any Ford products. My blood was up, so I visited the Mazda dealership (all in the Holmes-Tuttle/Jim Click companies) a few days later and drove the car.

I came away very impressed with the handling and the controls; while it came with a touch screen and backup camera (which I wanted), the package was simpler and easy to use on the go. Hands free telephone and voice commands were standard, as well as keyless entry, power driver seats and blind spot warning system. Seats were a high quality cloth in the mid-level model that I was interested in (Touring), and they were prepared to cut me a teacher’s deal of $1500 off the sticker price, which was $27,500 and change). There were no rebates offered at the time I bought.

The car only comes with a 2.0 liter 155 horsepower four, mated to either a six-speed manual or 6-speed automatic (which can be shifted manually). Most car magazines have not been extremely happy with the power, but Mazda calls this engine SkyActive, meaning that weight has been shed as a concept from the ground up to make this engine quick enough and fuel efficient, at 26-31 mph in an even mix of driving.

My wife had been worn out by the negotiations with Ford earlier in the week, so she told me to handle it on my own. We did have a lively text-conversation through this negotiation, but essentially she said stay with our original requirements, if I could. My trade still brought me only $2500 but they threw in a Sirius/XM radio and installation at cost ($140), allowing me to buy this add-on in cash rather than financing, so I finally said yes with her blessings.

I took delivery on December 15th and have been nothing but pleased with the CX-5 since. It is not overly powerful, yet it is quick. If I need the transmission to shift faster I can always throw it into manual and it scoots. Above all I am most pleased with the gas mileage, a main reason for ditching my old Ford. I’m getting 30.4 mph on regular at this writing. I’ve only had to fill up once since buying the car. I can’t beat that with a stick.

As far as room and comfort is concerned, I find it as roomy as my old truck up front, though I wish the arm rest was just a little be higher and longer. I can still get a tissue box, sunglasses, keys, pens and miscellaneous items in there. There is also a USB port, aux jack and DC power port in the storage bin, all nice to have.

Rear seating is about average for this class; there is more leg room than the Escape, but other SUV’s do boast slightly more. I don’t carry many passengers, so it doesn’t matter much to me. The rear seats fold flat for carrying cargo without much trouble.

Most of the materials up front are high quality and soft touch, though there are a few hard surfaces. I really wanted leather seats, but the cloth in my new car is very excellent quality and should hold up. Leather seats in Arizona are a mixed blessing. They look great, but they are also very painful after sitting in the 100 degree heat and sun a full day in the summer. Interior temps can reach 130 degrees. Try sitting on leather with shorts on after your car has been outside all day in those conditions!

I had the option of buying a car with a moon roof, but those have never appealed for me. Besides they tend to rob a bit of headroom. What I am missing most is a rearview mirror with auto dimming feature, as well as ambient lighting in the foot wells at night, as my old vehicle was equipped with, and a cargo cover. It’s no big deal though, because I can add them as accessories very easily during the coming months, and I will.

The bottom line here is that I paid less and at a lower rate and term for this vehicle than my Ford Explorer Sport Trac 9 years ago. I’ll conclude by saying that my buying experience was protracted, yet ultimately far less stressful than what I expected. You can get mostly what you want if you resolve to hold out and not give in to the ‘falling in love” syndrome that many car buyers do. If you do, you’ll be taken. Most professional car sales people are truly trying to help, even if they are looking out for their best interests. Shop around for the best rates (as we did) and stick to your guns!

A Lighter, Healthier Chicken and Shrimp Gumbo

I absolutely love shrimp gumbo, but it doesn’t love my waistline because of the heavy oil and flour based roux that is the basis of the dish. I mean without the roux, what do you have? You have soup, of course. But what can be done to simulate the silky texture of that roux without all of its heaviness?

If you are a purist when it comes to Gumbo, probably nothing can be done. But without feeling guilty about it (and paying the price with a scale going in the wrong direction) I wanted to taste something approaching this great food without worrying and fretting, so I tried this take recently. Note that there is no sausage in my version. Smoked pork sausage would add too much fat, and to me smoked turkey sausage only adds bulk, but not much flavor, so I left it out. You may of course use these meats as an option. In Weight Watchers point values, my version is only 6 quality points, so it’s a win for me.

PREP TIME: 15 minutes COOK TIME: 25 minutes

INGREDIENTS

1 cup cooked, roasted skinless chicken breast, medium dice
4 oz. raw shrimp shelled and deveined (or other shellfish if you have it)
1 14 oz. can diced tomatoes, low sodium
½ cup tomato paste, low sodium
1 cup chicken stock, low sodium
1 cup water, divided
1 tbsp. corn starch
1 tbsp. olive oil
1 stalk celery, chopped
1 medium onion, chopped
1 medium green pepper, chopped
1 cup okra, chopped
2 cloves garlic, chopped
½ chop fresh parsley, chopped
1 tbsp. your favorite Creole spice
1 tbsp. Worcestershire Sauce
1 tbsp. Liquid Smoke
1 tsp cayenne pepper
1 tsp Louisiana hot sauce (optional)
Dash salt and pepper to taste


DIRECTIONS

In a medium heavy pot, heat the oil over medium high heat, until it begins to shimmer. Pour in the chopped vegetables, except the parsley and sauté until the onions are clear. Season this layer with salt and pepper. Add the tomato paste and stir for an additional minute, then add the canned tomatoes, chicken stock and half the water. Now add in the cooked chicken and make slurry with the remaining water and cornstarch, pouring it into the pot and stirring. Season with the creole spices, cayenne pepper, and Worcestershire sauce, and hot sauce if desired, reduce heat and simmer until mixture begins to thicken. At the end toss in the shrimp and chopped parsley, stir and turn off heat,letting it rest covered for 10 minutes. Serve immediately afterward.

The dish can be served over brown rice, but that will add calories without necessarily enhancing taste. It’s hearty and filling as is, and won't throw your diet all out of whack. Give it a try!