A second opinion

In my last post, When Injuries Attack, I documented the MRI that I got of my back and shoulder and the scary results that the scans revealed. Here’s an update.

After my MRI results came in, decided to I get the anti-inflammatory injection in my back just before I went on vacation. After I returned, we would be able to talk more about other surgical interventions if I wanted to. I supposed the shot provided a little relief, but then again, I wasn’t doing anything gymnastics related and I usually don’t really feel pain symptoms unless I aggravate it with activity or sitting for long periods of time. There was a lot of walking, some trips to the fitness center, swimming, and rest, so there wasn’t any big flareup whilst at the beach.

When I came back for a follow up PT appointment, I asked about the surgical procedures that were suggested to me (spinal decompression and clean up the shoulder mess). That’s when the provider got squishy. We knew that a mid-year change in my insurance coverage was coming down the pike. Once it became clearer that they wouldn’t be paid their regular rates, they pulled back from their suggestions of treatment. Even the PT was something of an issue, because in their practice, PT is considered massage therapy and while it was once unlimited, now it is not and there would be a heftier copay with each visit. Let’s just say, they are an out-of-network provider and my insurance is much more straightforward with in-network facilities. I’ll leave it at that.

Now that the discussion suddenly seemed to shift away from the initial treatment plan, I was a little frozen about what to do next. I knew I needed something, but I didn’t know what would be most appropriate. When in doubt, call my athletic trainer friend. I trust his expertise and guidance implicitly; he has helped me many times before, has connections to all sorts of docs and lots of knowledge about orthopedic stuff. Talking to him helps to give me some much needed perspective. After reading him the MRI results, he explained that my back issues may not need surgical intervention, but the shoulder might. Best to get a second opinion.

He made a phone call and connected me with a sports orthopedist that he knew. He knows that one of my conditions in seeing a doc is that they mustn’t question my life choices, aka: my status as an adult gymnast. I need healing, not criticism. I documented that story in Chapter 4: Keeping the Bones Strong. Boy, did he come through big time. The next day, I got a phone call from the new doctor’s office and they had an available appointment later that day. (I guess it pays to have good friends with medical connections.) I brought my MRI results and went to the appointment.

When I walked into the exam room, by MRI imaging was up on the screen. This doc had privileges at the radiology facility where I got the scans done. I was seen by the doc’s assistant who listened to the whole story: how it started around the time I was getting the PT for my back, how we decided to get the MRIs to see what was going on, and what my expectations for healing were. I explained that I had no intention of quitting the gym. The doc came in next, I repeated the story, including my expectation of continuing my Geriatric Gymnast habit. Fortunately, being a sports doctor, he didn’t flinch. He seemed to understand and did not criticize. That’s a win.

We went forth with some manual checks of both shoulders and we went over the MRI results one issue at a time. He pointed out the tears (there, but not drastic or irreparable on their own), the bone spur (there, but small and not likely causing the pain), and the labrum, which looked “appropriate” for someone my age. There was a lot of “for my age” in the discussion, but he made it clear that it was not an insinuation of anything negative, rather an acknowledgement of how well I was doing in comparison with with other people “of my age.” I think he was impressed, actually. Something about “I can’t believe I’m talking to a 50-something about doing handstands.” That was also encouraging and validating.

Basically, he said that my MRI results for someone over 40 would normally trigger a surgical discussion. I was mentally prepared for it, and if he suggested it, I would have made the appointment that day. This doctor (a surgeon) however, said the opposite. He would not recommend me for surgery, at least not at this time, given my high-functioning status. What was most likely causing the pain was the subacromial bursitis, where there is a fluid buildup in the shoulder joint. That fluid (inflammation) is creating the problem for me and he showed it to me on the MRI. Mind. Blown.

In short, the treatment would include a three-step plan:

• STEP 1: Two weeks on an anti-inflammatory once a day and 6-8 weeks of physical therapy twice a week. If that helps the pain go away, and I don’t aggravate it more with motion that causes pain, we are done. If not we go to…
• STEP 2: Steroid injection. I am very uneasy about steroids, because I have heard it tends to damage soft tissue. He explained that it can cause cellular and cartilage damage, but not with one injection. Also, he would not inject into the joint itself, so the concern was even less warranted. Either way, he said it was my decision whether or not to go the cortisone route. If I do, and that is not enough, then we go to…
• STEP 3: Surgery.

Thankfully, he is not a proponent for surgical intervention. I have responded well to PT in the past (for my right shoulder years ago) and he was encouraging of that route. This is not a problem for me – if I can avoid surgery, all the better.

So, I will add PT to my healing activities. I have been religiously doing stretching, strengthening and mobility work every day. This will be a piece of cake compared to the rehab I’d have to do post-surgery. I feel a lot better (mentally) about this decision. I can keep training at the gym, conservatively. I’ll pull back on the movements and gym locations I know will hurt. At the same time, I’ll work on improving my technique to prevent further damage. My goal is to be pain-free in my shoulder by or before September.

As far as my back is concerned, I still haven’t figured that out, but I think I may need to get a referral for that too, eventually. My friend told me I may have to do exercises to manage the existing back pain. Maybe the discs will heal themselves, maybe they won’t. I’ve been living with it for so long and I’m still pretty high-functioning, “for my age.” I say that with a wink and a smile because I am proud of what I can do “at my age.” #Thisis51, baby.

For now, I’m taking one thing at a time. The plan for shoulder rehab is in motion.