01 January 2014

Fun with Acromioplasty - part one

I have had trouble with my right shoulder for fourteen years.

I had fallen in college and ended up with a tiny fracture in my right wrist. At some point a few years later, my right shoulder starting popping and grinding. I went to the Kaiser Permanente medical center, where the general practitioner referred me THE ONE orthopedist. The orthopedist did some testing, told me I had a torn piece of cartilage hanging down in the shoulder joint from the fall, and needed surgery to repair it. The orthopedist then referred me to THE ONE orthopedic surgeon.

Before I proceed further, I should explain that I'm not making some kind of odd Frodo, M.D. commentary. I don't know if they still work this way but, a decade ago, Kaiser had a single medical building in my city of residence, in which they housed their medical staff and equipment. If you got sick, you went to that office and saw one of several randomly assigned general practitioners.That general practitioner would conduct a basic review and testing and, if they felt it appropriate, they would send you to see a specialist. Oops, I mean, "the" specialist, because they only had one specialist in any particular category.

So, I was shuttled off to Kaiser's ONE orthopedic surgeon. He came in, read the written MRI report, and then proclaimed without any kind of physical inspection of my shoulder or review of the MRI images, that I could not possibly have this particular injury because it was only found in little old ladies or people who had fallen. He wouldn't listen to anything I said. All he wanted to do was give me an injection. I asked what the injection was, and then he rolled his eyes and said that he would use the needle to inject "medicine" into my shoulder. When pressed for details, he started talking about "walking the needle along the bone." I bailed, not only because he was incredibly demeaning to me, but because I found the idea of "walking the needle along the bone" in my shoulder to be terrifying.

I followed-up once with the referring orthopedist who apologized and said that the surgeon was a jerk, but that he was literally the ONLY ONE at Kaiser who could perform the surgery. I gave up on treating my shoulder. I couldn't bear the thought of going back to the jerk doctor, and couldn't afford to go out of network. I subsequently ignored my shoulder for fourteen years.

This year, as a part of a general clean-up of my life, I decided to address all of my unresolved physical ailments and therefore sought treatment for my shoulder. It had degraded to the point that I had notably reduced mobility and constant pain. I could barely lift my elbow above my shoulder line and my shoulder would pop and cause shooting pain in my arm if I extended my arm to the side or picked up anything heavy.

I had new, non-Kaiser insurance and selected a new orthopedist based on positive Yelp reviews. He ordered an MRI with contrast which, as far warning to any of you out there on the interwebs going down this same path, is not your typical MRI experience. I have had a good number of MRIs - brain, ankle, spine, kidneys, etc. - and usually contrast involves injection through an IV in the arm or hand. For a shoulder, the injection is made directly into the joint.

First, we had a little snafu where the imaging center had booked my appointment with the MRI technician but had forgotten to book any time with the radiologist. This meant that I had to wait around for two hours while they tried to fit me in.  They said that I could come back on another day, but I had already taken the time off of work and didn't want to have to do so again.

I was then shuttled off to the radiology department where I got to put on a typical hospital gown. The radiologist suited up in his lead armor and his assistant then pulled out a tray filled with GIGANTIC NEEDLES. If you are needle shy - like me - for goodness sakes, don't look around the room, and close your eyes as soon as you get on the table. Once I saw the needles, I turned away and started crying, and continued crying for the entirety of this stage of the test.

I had to lay on a table, very slightly on my left side. They shoved a small angled pillow under my right shoulder. The radiologist said that this position helped separate the shoulder joint and make it easier to get the needle between the bones. While this information would be helpful to a normal person, for me all I could think was, "OMG HE IS THREADING A NEEDLE BETWEEN TWO BONES OMG OMG OMG OMG!!!"

Once I was in position, the radiologist injected a local anesthetic into my shoulder using a small needle, which was not so bad. It was several injections in different areas. Next, he put a very, very long needle deep in my shoulder, where it remained for about 5 minutes. This process takes a while because the radiologist is trying to position the needle so that the contrast material gets inside the joint, and reaches all of the tissues around the rotator cuff, including the labrum. This involves moving the needle a little bit, taking an x-ray and checking the position, moving the needle a little more, taking another x-ray and checking the position, etc. While not overtly painful, it was uncomfortable pressure. I also happened to be wigging out at the gigantic needle protruding from my body, which I could see in my peripheral vision.

This contrast injection process, for me, was truly horrible. I would say that 10% of the unpleasantness was discomfort (not pain), and 90% was my being utterly terrified of needles and freaked out at the gigantic needle protruding from my body for an extended period of time.

Once the injection was made, they took me off to the MRI wing. The  walk down the hallway felt exceptionally long, partially because I was emotionally exhausted after all of the needles, and partially because I was concerned that the gown was insufficient to cover my tush. The MRI itself was easy. They give you earplugs, hand you a panic button in case you freak out or need to pee, and stuff you in a narrow tube that makes lots of loud noise. At various points, they told me to inhale or exhale and then hold my breath. 

Once the test was over and I met my husband in the waiting room, got a hug, and then proceeded to cry off and on for the next hour, while I decompressed from the terrifying needling I had received.

The MRI showed wear to the rotator cuff, pockets of inflammation, and a type III acromion, i.e., a little piece of bone in my shoulder was curved down and poking into my rotator cuff. The orthopedic surgeon said that surgery was necessary to clean up the joint and perform an acromioplasty, i.e., shave down that piece of bone so that it stopped chafing my shoulder tissues. He said that if surgery was not convenient in the immediate future, that I could delay and try physical therapy. He warned me that physical therapy was only a short term solution to reduce pain and improve mobility, but that surgery would be required to correct the problem. I chose to do the surgery immediately.

My next post will discuss the entire surgical procedure and recovery, including photos of the incisions and bruising, for any prospective acromioplasty recipients who want a very forthright idea of what to expect!

20 August 2013

When being a plus is really a minus, part two.

Somewhat surprisingly, I received an immediate response from Target. It was signed by a specific person and seems to be a unique letter, so maybe I can actually help make a tiny change in the right direction for other plumpies, like me.  Come on, Target! <waves pompoms> 

As an aside, my Dad told me yesterday that I needed to lose my "flab" for health reasons. None of my medical conditions are weight related, but he is still right. However, the fact that what he said was true didn't make it hurt any less. Why does being told that I am fat carry such tremendous emotional weight?

Target's letter follows.


Dear <Pocketlesspants>,


I'm sorry to hear you're disappointed with the current availability of plus-size clothing at your local Target store.


Your comments are important because they help us learn more about what you're looking for at Target. We've partnered with many different designers so we can bring you the latest styles. To help us serve you better in this area, I've shared your comments with our buyers for further review with our design teams.


We appreciate the time you've taken to share your thoughts and feelings with us.



<Specific Polite Person>

Target Guest Relations

19 August 2013

When being a plus is really a minus

gained weight when I was diagnosed with epilepsy and started taking pills that controlled seizures but fucked up my metabolism and appetite. I had a horrible time adjusting, and then developed a series of additional illnesses and injuries that threw me into severe depression and limited my mobility. I ballooned. It is hard to eat well when (a) you are sad, (b) your pills turn off the receptors that tell you when you are full, (c) you spend every waking moment in pain, and (d) food tastes good. Be honest. We all know that pie is good for stopping uncontrollable tears, and that a cookie can put a little pep in your step to get through a rough day.

I am working hard to get my life in order. I am currently seeing six different doctors with different specialties. I take six different prescription medications which cost more than the rent on my first apartment. I have had four surgeries in three years and accumulated more scars than the rest of my immediate family has, combined. Each surgery brings me one step closer to a life without pain. I cannot exercise yet because of physical injuries but I am trying to diet until I can get back on my feet. Nothing official, but I try to eat half portions, have stopped drinking soda at home, don't snack before bed, eat more fruit and veggies, etc. I have lost 45 pounds and dropped from size 20 to 18. My size 18 pants are even baggy now everywhere - waist, butt, legs - so I think its time to test drive a 16. My shirt size also dropped from a 2, to a 1, and now just a plain ole XL. I want to buy new clothes, but...

Here is where it gets tricky. I hate clothes shopping. It makes my limited self-esteem flush down the toilet. 

Let's be honest. I don't like being fat. Society doesn't like my being fat either. I am not sure which one hates my fatness more. I am happily married but notice time after time how men will connect with thin women and avoid making eye contact with fat women. Shopping is another example of how plump women are shunned. For example, I went to Nordstrom Rack with my husband to find formal wear for a party. The men's section had plus sizes but the biggest size in the women's department was, literally, a size 12. Not a single garment existed in the entire store for a plump lady. We went to three other stores that day looking for plus size dresses, to no avail. TJ Maxx had a single dress in my size, but it was short and sleeveless and I wanted something more modest. The lack of clothing in my size at stores makes me feel angry, ugly, and unloved. The average American woman is a size 14-16. Why would retailers shun such a huge portion of the market?? The only rationale I can come up with is that designers and/or retailers are disgusted by fat women and don't want them wearing their brand, so they intentionally only make skinny sizes. The recent Abercrombie & Fitch debacle supports this theory. I felt so incredibly ugly after that shopping spree that I have not been to a clothing store since.

I do, however, urgently need new work clothes that fit, which is forcing me to address my loathing of clothes shopping. My compromise is that I am willing to look at Target because (a) I like them, (b) I like my husbands clothes that he gets there, and (c) we are already there once a week for groceries, so it is super convenient.

Unfortunately, even though Target does have a ladies' plus section, all they have in stock are sleeveless low cut blouses, a "bag" blouse with no shape whatsoever, a deep V-neck tee in two dull colors, and a single style of nondescript spandex pants in black and khaki. So, while I CAN get plus sized clothes at Target, the selection is dreary. 

I genuinely wish that I weren't fat, but I am and I would like to not be constantly punished for it!!! All I want to wear are simple, pretty clothes. Even if someone can't say that I am pretty, they should at least be able to say that my shirt is. So, I decided to send the letter below to Target today. I really really REALLY want them to have stuff I can wear. 


Dear Target,

I love Target. I shop at Target every week for groceries, entertainment, and my husband's clothes. I wish that I could buy clothing at Target too, but I am a plus size woman and your garment selection is terrible.

It makes me sad. I walk through the skinny women's section on my way to the plus size area and say to myself, "ooh pretty" or "wow look at those patterns." Then I get to the plus size area and hang my head in shame.  

(1) The plus size women's section is a tiny half aisle in the back of the store, and usually has a selection of two blouses, a tee, two pants, and a sweater. When the skinny section wants to put things on clearance, they put racks of skinny clearance items in the plus size area. Couldn't the space being used for skinny clearance items be used to offer additional plus items instead?

(2) The plus size women's clothing has the following common features: (a) Spandex pants, (b) Ankle pants, (c) Squares of cloth with arm holes, (d) Low-cut necklines,  (e) Super short sleeves, (e) black, white, brown, and snore. 

What is wrong with this, you ask? (a) I prefer straight leg pants that offers a more flattering silhouette than pants that cling to my badunkadunk. (b) Capri-pants are not flattering on plus size women. (c) Muumuus and potato sacks are not flattering on anybody. Please stop selling squares of cloth with arm holes as "shirts." (d) Just because my bosom is ample doesn't mean that I want to show it off.  (e) If it doesn't touch your bicep it is sleeveless, not short. Sleeveless shirts are not flattering on plus size women. (f) Target is known for having FANTASTIC patterns and color selections everywhere in the store, except the very drab plus size section. 

My husband buys most of his clothes at Target and he looks good in them. Not only does he have a huge selection of styles to choose from, but each style comes in a delicious array of colors. Also, as noted above, you guys have a great selection in the skinny women area. Why don't you offer larger sizes of your regular clothes? If you insist on having a completely separate line for plus size women, could you try to bring it up to par with the rest of your store by offering flattering styles and terrific colors and patterns?

I want clothing that complements my body. Monochromatic sleeveless low-cut bags aren't good enough. Moreover, being overweight is depressing. I don't like my body and I know that the world doesn't either. I am losing weight (45 pounds so far) and look forward to the day that I achieve a healthy weight. In the meantime, though, I would like to be able to go shopping and feel EXCITED about buying beautiful clothing, or at least look in the mirror in the morning and know that I look the VERY BEST I can, in spite of my weight. 

Please help me and the rest of plus size America look the very best we can, Target. Please upgrade your plus size women's clothing section!

Very truly yours,