Shoulder Injury IV

Physical Therapy
with Pulley
AREMENIA, Colombia
November 22, 2019

Surgery will have to come much later. Last Friday's consultation with the orthopedic shoulder specialist didn't end with the operating room referral I'd anticipated.

Evidently, my arm muscles have become so atrophied since the accident that the range of where my arm can reach has frozen. I had mistakenly ascribed those limitations in movement solely to the torn tendons. However, it seems I need to exercise the arm back to a minimal level before the operation can take place. The doctor prescribed 20 sessions of physical therapy prior to the next consultation--let alone the referral to surgery he says will further be necessary.

As he spoke I could see my onward travel timeline unraveling. Before, I had presumed that I could keep to my plans to use my ticket back to the US. With my flight one week before Christmas I had hoped that managing to schedule a mid-November surgery might have allowed ample time to recuperate post-operation. But, this unexpected three weeks of physical therapy throws all my plans into disarray. I'm certainly not going to be backpacking throughout South America over the latter part of this trip, as I'd planned.

David with Gladys, Diógenes,
and their Friend, Lily
Fortunately, when the doctor delivered his orders for physical therapy Gladys was again alongside to translate and comprehend all the finer details that I would have missed had I been alone. Hearing the prescription for 20 sessions of PT put me in a funk. I realized how I'd likely need to revise my flight home possibly leaving Colombia some date after Christmas. Gladys had the presence of mind to go right to the main hospital building where the PT room was located. She spoke with a therapist working the Physical Therapy wing who showed us what services they could offer. The PT wing seemed like a depressing room with old equipment and not a lot of staff on-hand. However, the therapist we spoke with also moonlighted at a private clinic. She gave us her calling card with the address of her other job. Gladys and I walked straight down there to compare the private clinic to the one in the public hospital.

Physical Therapy
with Ball of Sand
The private physical therapy clinic was much nicer than the PT wing of the public hospital. I don't know what the difference in cost would have been but even I, in all my frugality, am happy to spring 21,000 Colombian pesos per session to have therapy at the private clinic. That's roughly $6 USD at current exchange rates. I've been going every weekday for the past week and replicate the same exercises at home on the weekend.

Most of the exercises are simple movements that wouldn't challenge a toddler but become excruciatingly painful after an injury. I bend my hands down behind my head while holding a large rubber ball filled with sand. I move my arm from side-to-side while clutching a small dumbell. I pull one end of a leash up above my head in my one good arm and clasp the opposite loop dangling behind the small of my back to raise up my gimpy arm. In both hands I extend a broomstick out: as far to the left, as far above my head, and as far behind my neck as I can. Each exercise is repeated 30 times.

PT Liliana
Demonstrates Exercise
There are advantages to following this regimen of exercises in the clinic rather than just doing them at home. Each session opens with technology I couldn't replicate in my bedroom. For the first 15 minutes I sit with electrodes gummed onto my skin. Those allow an electrical current to pulse through the injured part of my arm. The buzz feels nice, but there were a couple times when the attendant initially set the voltage too high causing my entire arm to spasm and flail wildly until the current was lowered. Every other session one of the therapists rubs my arm down with a clear gel and wipes it all about my skin with an ultra-sonic wand. Every so often I receive a massage that helps to relieve tension in the area around my shoulders and my torn muscles.

Liliana Torques Arm
to Painful Point
The most painful part of this regime--though I assume the most helpful toward my recuperation--is Liliana, the main physical therapist on duty over the morning shift when I have my regularly-scheduled appointment. She demands that I follow exercises that stretch my limits. Occasionally, she lays me out on a table then torques my arm into positions where it might not have extended even before my accident. I'm no masochist but do assume that this painful pulling is all along the road to recovery.

I've realized how much my problem, aside from the torn ligaments themselves, stems from the initial misdiagnosis and further delays in getting to the next stage of treatment: the delay of over a week in having the MRI read, the delays in scheduling follow-up appointments with qualified doctors, and now these three additional weeks of physical therapy. I'm taking a couple steps to try to cut through the waiting:

Post-PT Reward: Hookah
Pipe and Mango Milkshake
First, I've signed myself onto some sort of a yearlong HMO subscription. It strikes me as a colossal racket and the benefits don't save me any money. Rather, enrolling has bought me time. For example, the consultation with the orthopedic shoulder specialist cost 47,800 pesos at the public hospital. I had to wait nine days for that appointment. To consult with that same doctor at his private practice normally costs 120,000 pesos. But, being in-network that fee is halved to 60,000 pesos. That discounted rate still costs 25% more than seeing him at the public hospital would but allows me to fix an appointment at his private practice for the very next day. Signing onto this year-long medical plan--through some outfit called "Sentir Humano"--cost me 75,000 pesos: about $20 USD. I figured that sign-up fee would be worth it if it saves me a single day of medical limbo.

My second step to try to accelerate the process will come tonight when I take coffee with Ianalen, Gladys's physical-therapist friend from the gym. Both she and PT Liliana from the private clinic have said that it would be legitimate to double the frequency of those 20 therapy sessions to twice a day. I'd like to confirm that's not going to over-strain my arm and perhaps make my condition worse. If Ianalen agrees, then maybe, just maybe, doubling up the pre-surgery exercise sessions and having appointment strings pulled by the HMO will allow me to schedule the rotator-cuff surgery for sometime in early December.

David, Gladys, and Diógenes
But, even with this potentially expedited schedule I have realized how long all that is to come post-operation will need for a proper recovery. At some point I'll have to have stitches removed. There will be further sessions of follow-up physical therapy for several more weeks, post-surgery. My arm will be bound up in a sling for over a month.

My ticket has me flying out of Bogota on December 17. But with only one hand free then, just strapping my belt around my waist--let alone packing for an inter-continental flight--will be time-consuming and difficult. I should probably start steeling myself to miss Christmas in Seattle. Worse, it sounds like everything closes up in Colombia over Christmastime. I may well not leave this country until sometime well in 2020.

At least I'm in a very good place for recovery staying with a kind couple--Gladys and Diógenes--who are actively bringing me about town to appointments and playing translator for the important points. I may be in a bad situation but am in a good place staying with caring friends. The silver lining might be that the whole incident has certainly been good practice for just what I came for: acquiring conversational Spanish.