Four Weeks after Bicep Tendon Surgery

Yesterday marked four weeks since my Bicep Tenodesis. The picture above pretty much sums up where I am: physical therapy and lots of it.

I have PT exercises I do twice daily (10-15 minutes) and actually go in for therapy twice weekly. Up until last week, almost all of the exercises were assisted in some way, but most of the exercises now are under my own power. For instance, I do an exercise where I slide my hand up the wall; I used to employ my good arm to push it up and now I no longer do that. This is progress.

I have noticed that my mobility has increased as well. I’m not near 100% yet, but it is a vast improvement over the first few weeks. There are some exercises that my therapist introduced that when I started caused me a lot of discomfort and my range of motion was very limited. Little by little, the ROM has increased and the pain has subsided.

The one thing that has surprised me the most is just how sore I still am, and its a pretty constant companion at this point. Some of it is a result of the PT exercises and pushing myself. I suspect that some of it is that as much as I try not to lift anything over 1 lb. with my right arm, that gets violated pretty often. Nothing over 5 lbs. for sure, but I do find myself not being as careful as I should. I wonder if the PT folks know that this happens in general and therefore give patients an untenable restriction with the hope that we might limit ourselves just enough–kind of like putting a 70 mph speed limit on a highway knowing full well that no one will observe that, but hoping that at least we’ll go under 80! In any case, I’m using a fair amount of acetaminophen.

My PT folks tell me that my I’m on track. I know that I am impatient. I’d like to get back to running and biking, and eventually doing resistance exercises. It is pretty boring to just walk briskly, or get on the bikes at the gym. I will just have to stick it out.

Earlier in the week, my therapist asked me if I felt the surgery was worth it. Good question. I hope to know the answer over the next month or so.

Body Image…According to Genesis

Society places a great deal of emphasis on body image. Advertising tells us that we must look a certain way. If we want to be appealing to a partner/spouse/lover, we have to be in great shape, have a perfect smile, beautiful hair, no wrinkles….

From the very beginning of the Abrahamic traditions (Judaism, Christianity, and Islam), the idea of body image is quite different. The first chapter of the Book of Genesis gives the biblical account of the creation of the world over the course of six days, including the creation of human beings on that final day.

The text is quite difficult in the original Hebrew…and it’s not much better in the English. Here are the verses from Genesis 1.

26 And God said: ‘Let us make man in our image, after our likeness; and let them have dominion over the fish of the sea, and over the fowl of the air, and over the cattle, and over all the earth, and over every creeping thing that creepeth upon the earth.’

27 And God created man in His own image, in the image of God created He him; male and female created He them.

First off, to whom is God speaking? What is the difference between image and likeness? In verse 26, it seems as if only one being is created but in 27 it is not so clear; the object goes from singular to plural. The classical commentators wrote many good interpretations to try to explain it all, but it still remains enigmatic that the very verses that describe our creation are so muddled.

One thing that is notable is that nowhere do the verses specify that this body was a physical specimen that had to look a certain way. All we know is that human beings were created in the Divine Image (whatever that means). What we can interpret from this is that our bodies (whatever shape they are in) are holy vessels given/created by God. As such, we can imply a responsibility to care for that gift; it is, according to many religious traditions, the container in which our souls are kept.

What does this have to do with fitness? Certainly, if we receive a valuable and unique gift from a beloved “friend,” it would behoove us to care for it. This gift–our bodies–is not just a trinket to put on a shelf either. Our bodies have a purpose; they allow us to do what it is that we are supposed to do in this world. Jewish mysticism–in particular, Kabbalah–tells us that the soul can only be perfected when it is inside a body. Our experiences in this world have an influence on the nature of our souls and we can use those experiences to rise to higher levels of holiness (kindness, understanding, love, too). Caring for our bodies is essential, for if it is broken or broken down, we cannot accomplish what it is that God has put us here to do.

By the way, there are those who are born with disabilities–mild to severe. Even so, those individuals have an obligation to keep their bodies in the best condition possible–or if they are unable to do so themselves, it is up to us to assist. Everyone has a role to play in God’s creation…and only by being healthy and strong (in its many forms and to the best of our abilities) can we do that well.

It’s not the body image we are told to project on TV, in magazines and in movies that is ultimately our concern. Our focus should be on maintaining and strengthening our bodies so that we act justly, love mercy and walk humbly with our God [Micah].

Eating Differently in a Pandemic

The most recent issue of AARP Magazine (August/September 2020) featured an article by Ruth Reichl entitled “The Changing American Table.” In it she discusses how food tastes, the taste of food, shopping habits, and eating habits have changed over the last 50 years. It is a fascinating look at the major events and trends that helped to define American cuisine. Here is the link: https://www.aarp.org/health/healthy-living/info-2020/changing-food-trends.html.

What was most intriguing was her take on the effect that the COVID-19 Pandemic has had in the last 6 months. The pandemic disrupted (and still does) our food chain. Packing plants became COVID-19 hot spots, restaurants shut down (some temporarily, others permanently), some food went to waste, and other food simply wasn’t produced. For many Americans, it was the first time that we actually began to fathom all the steps that take place from the farm or sea to our tables.

Americans (you should pardon the expression) are a little late coming to the table on this one. Judaism has always emphasized an appreciation of food–what we may or may not eat, how it is prepared, and how it must be sanctified through blessings before and after the meal. An observant Jew at each meal is reminded through all these steps exactly where the food came from…and the many miracles that accompany its journey to our stomachs.

Reichl noted that during this pandemic many people turned their attention back to the sources. People planted gardens and grew vegetables. Others began cooking and baking from scratch. Many in rural areas did what the norm was a half century ago and went straight to the farm to purchase produce and meat. If there may be one silver lining to COVID-19, it is that it reconnected us to an awareness of the sources of our food…and to the fragility of the system.

Personally, I have been a cook and bake from scratch kind of guy (although not exclusively) for a long time. There are still a lot of processed foods in my diet. Even so, during the last several months, I have found myself trying to go back to the basics. We even planted some basil, tomatoes, peppers, parsley and cilantro!

Whether COVID-19 will have a long term impact on how we view the food we eat is unknown. Certainly there are encouraging signs that we will think more about where our food comes from. On the other hand, we know that many of us have put on a few pounds, simply because we are sitting at home more surrounded by food and because our gyms and other ways in which we are active are not as accessible.

My hope is that our society will learn from the Jewish approach to food. It is a blessing and it is to be enjoyed–but always in the right context and as a way to fuel the human body (not destroy it). A good lesson for a pandemic…and afterwards too!

Two Weeks After Bicep Tendon Surgery

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Today was liberating. I got to ditch the sling and was also able to drive. Today was also my first day back at the gym training clients in person. Of course, it will be another 4-5 weeks before I can lift anything heavier than 1 pound with my right arm, but it feels great to be getting back to a normal routine.

It’s been 14 days since the Bicep Tenodesis surgery and I feel like we’ve made some good progress.

The last week was up and down. The stitches came out 2 days ago and I good a report from the doctor. The assistant showed me the pictures that the arthroscope took (they actually sent me home with a set but I really couldn’t interpret them). She explained what I was seeing, where the problem had been, and how it was corrected. The good news was that the rotator cuff is looking awesome and there didn’t seem to be any other issues. She did say that the area that was causing the discomfort that led me to PT and eventually surgery was not actually that bad, but that they could see where the issue was.

Was the surgery unnecessary then? No. This was not going to get better and would probably have gotten worse. Taking care of it now just means an easier recovery and less time dealing with the mobility and pain issues. It’s kind of like when your check engine light comes on; you can go right to the dealer/mechanic and it won’t usually be such a bad problem…or you can drive on it for another couple of months and then find out that you’ve got a serious repair that will cost a lot more. I’d rather be proactive.

There were times over the past seven days when my arm felt fairly pain-free and others when the it was a little more intense. One night it even woke me up in the middle of the night twice; I fell back asleep with an ice pack on. Yesterday at PT, the therapist told me that this is actually quite normal. She said to expect it to continue for a while; I may even want to ice each time I do my PT exercises at home and before bed. So far, that hasn’t been necessary but we’ll see how things proceed.

The actual process of PT is changing as well. For the first 10 days or so almost everything I did was passive or assisted. Now that we’re past the two-week mark, we will begin to build up the muscle while continuing to work on mobility. I am happy about this even though I know that I might experience some aches and pains. I looked in the mirror yesterday and saw that my right bicep is definitely looking sad compared to my other arm. The rebuilding process will be a long one, but I have lots of reasons to want to get myself back in tip-top shape.

Next report when we hit the one-month mark. In the meantime, it is great to be back to doing the things I enjoy…within limits!

That’s what You Get for Exercising

Emergency Sling Demonstration (AMM 721) National Museum of Health and Medicine

I was on a Zoom call on Thursday when someone noticed that I was wearing a sling. I explained that I had bicep surgery and she said something along the lines of “that’s what you get for exercising.” I politely (but firmly responded) that I had overdone it at some point which is probably how I got injured, but that I would take exercising regularly over sitting on the couch any day as a strategy for healthy living.

It amazes me the “excuses” people come up with for not taking better care of themselves. Can you imagine someone having accidentally burned the dinner they were preparing at home and then declaring, “that is why I always get fast food?” (Actually, I can.) Ruining a meal is bound to happen once in a while; we either misread a recipe or get distracted and forget that something is on the stove top or in the oven, etc. Most of us just chalk it up to a learning experience and figure out what to make instead. The alternative–eating out all the time (even pre-Covid-19)–is simply not healthy or sustainable.

The same is true with exercising. It is true that those who workout/run/bike do get the occasional injury, and that many of us more susceptible as we age. Even so, the alternative of becoming sedentary is not an acceptable option. Sports injuries are usually repairable. Heart disease, diabetes, obesity and other maladies associated with a sedentary lifestyle are much more difficult to correct. As we live longer, it is all the more important to not only have quantity of life, but quality of life as well.

A large part of my “business” as a personal trainer is working with older adults. These are often those who are most afraid of injury, and rightly so. My clients understand, however, that being active (cardio, resistance, and mobility training) is a recipe for more energy and greater independence. Being able to keep up with grandchildren, hiking the Galapagos Islands, and staying in their own homes are “what they get for exercising.”

Looking at my should in a sling, one could correctly state: “that’s what you get for exercising,” but that misses the point. The fact that I am 57 and am able to run, bike, hike, and pretty much engage in whatever physical activities I desire (once I am recovered from my surgery) is also “what I get for exercising.” I’ll take my calculated risks knowing that in the long run the payoff is worth it.

One Week after Bicep Tendon Surgery

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It’s been a whole week since my surgery. Here’s the update!

This surgery has been a lot less difficult than I feared. Last year, when I had foot/leg surgery it ended up being a much bigger deal than I expected. I haven’t taken any painkillers since Sunday…which isn’t to say that I haven’t had pain. Rather, it is not severe enough to warrant taking something that has an addiction risk.

A few annoyances that I can live with: It is hard to find a comfortable way to sleep while wearing a sling so my sleep patterns are off. The support hose I have to wear to prevent blood clots are not the least bit attractive; not going to be wearing any shorts for another week. The sling and restricted mobility in my arm are an inconvenience, making it hard to brush teeth, eat, write, use a keyboard, etc. These are all things that will go away (God willing) in a week and, in the meantime, are not life altering.

I started PT on Monday and have been doing a number of exercises twice daily: pendulum circles, assisted lateral arm extensions, assisted forward arm extensions, assisted eccentric lateral rotations, assisted forearm extensions and hand-pumps. The “assisted” means that it is either supported by my arm or a prop like a table or cane. Not too taxing and I definitely can tell the difference; things are not nearly as stiff as they were. I will be going to PT twice weekly for the next five weeks.

The big news was that I went back to Personal Training today–virtually. Just one client, but it is a good way to get back into it. Tomorrow, I’ve got two clients and then–after clearance from my doctor–I should be able to start in-person training with some limitations next week. I still cannot lift anything heavier than a coffee cup with my right arm, so any demonstrating I do will have to be with my left arm. (My client today kept starting single-arm exercises and I had to reminder that she needed to use both arms; in other words, do as I say, not as I do!).

The other encouraging news is that I’ve communicated with a few other people who had the same surgery and who were really pleased with the results. The are working out, have rebuilt the muscle, and have no limitations. I don’t pretend that I’ll be there in a couple of months, but it is good to know that there don’t seem to be any long-term negative effects.

Next week, I’ll go back to some regular posts, but we’ll also have a 14-day update. Thanks for all the good wishes in the meantime!

72 Hours after Bicep Tendon Surgery

Well, it is 72 hours after my surgery, and today I was finally able to take a shower. It was with great joy that I was finally able to bathe but the effort definitely wiped me out for most of the afternoon. I have had a few surgeries over the years, and I always forget how much effort and energy it takes to heal.

As you may recall from my previous post, the anesthesiologist went above and beyond. In fact, it wasn’t until Friday evening that I actually had the opportunity to ask my wife what the surgeon said about the procedure and what he found when he finally got in there. Of course, all of this had been explained to me earlier, but I was too high to either process it or remember it. The good news is that my case was somewhat rare for a good reason; the surgeon explained that it is quite unlikely that the MRI gives a complete picture of what will be found once they get inside. Often there are little surprises that pop up during the procedure. In my case, however, the MRI did an excellent job of predicting exactly what was going on. This meant that the surgery was rather “ordinary.”

So far, the pain has been less than I expected. It has been mostly controlled with prescription strength ibuprofen and acetaminophen. On Friday, I took a short walk and found that my stamina was pretty good. Later in the day I took another walk and discovered the same thing. I was pleasantly surprised until the pain block wore off. Since then I’ve had to back off quite a bit.

Tomorrow, I will begin physical therapy. My post-surgery instructions already have me doing pendulum swings with my right arm, but I am sure that new exercises will be added. In the meantime, it is quite an adventure learning to do things with my non-dominant arm like brushing teeth, eating, and opening and closing doors. I have a lot more respect for folks who are missing a limb or are in some other way limited in their use of an upper extremity. And for the record, this voice recognition program is not as helpful as I would have hoped.

Overall, I am grateful that I am doing as well as I am. These inconveniences are only temporary. I will keep you posted on my progress.

24 Hours after Bicep Tendon Surgery

Yesterday I finally had my bicep tendon surgery. After 18 months of on and off physical therapy and 4 cortisone shots, this was the next step. As I wrote in a previous post, I see this procedure as regular maintenance–just as I would do for a car. As long as I take care of my body, I hope that it will last me a long time.

Over the next few weeks, I’ll talk to you about my progress so it might be of some use to others who may be in need of similar surgery.

On Wednesday, I got a phone call to arrive at the surgery center at 11 AM. I would estimate that surgery actually began around 12:30. Once the anesthesiologist got involved, there isn’t a whole lot that I remember. The last thing I can recall is getting some Versed, after which the doctor began to do an ultrasound of my neck to figure out the right spot in which to do the nerve block. I remember eating some graham crackers in recovery; I remember getting into a wheelchair to be wheeled out to the car; I have zero recollection of the ride home or how I changed into my pajamas or how I got into my bed… Which is, frankly, how I prefer it.

I will admit that I am not exactly sure what the procedure entailed. It is called bicep tenodesis. I tried to watch a video on YouTube, but after about 20 seconds, I decided it was probably a better idea to just let the doctor do his thing. What I do know is that my rotator cuff was in good condition and required no attention.

And now, the recovery. I have a sling that I have to wear for 2 weeks; on top of that sling is an ice pack that I will need to use for the next 24 hours or so. I have to wear compression hose for 2 weeks to prevent blood clots; let me assure you, it is quite a look. No shower until Sunday morning (ugh!). On Monday afternoon, I have physical therapy with my favorite therapist, Megan, at the Cleveland Clinic. Originally I thought I would be missing one week of work, although now it appears it could be 2 weeks. I won’t be able to do any lifting with that arm with anything heavier than a coffee cup for the next 6 weeks.

The real challenge is learning to do the things that are necessary for daily living with my left hand when I am righty. Believe it or not, I found a way to dictate text on my laptop and that is how I wrote this blog post.

Of course, this is not the best way to spend my summer, but I am confident that in the long run, the pain will be worth the gain. I would rather have this taken care of now so that I can continue to enjoy an active lifestyle and be the best personal trainer that I can be.

In the mean time, wishing everybody Shabbat Shalom, and a good weekend! I will keep you posted on my progress.

Losing Track of Time During the Pandemic

We have all seen the memes highlighting the difficulty in keeping days of the week and months of the year straight during this pandemic. For most of us, our regular routines (often decades-long) have been interrupted and each day seems the same as the one before sitting in front of a laptop at home. Others have been luckier (?) and have jobs that require them to be out of the house which may provide more of a rhythm. Even so, the almost non-existent Memorial Day weekend and July 4 celebrations downplayed these markers in our annual calendar. What day is it anyway?

In Chapter 41 of the Book of Genesis when Pharaoh was searching for someone to interpret his dreams, his cup-bearer says “Today I mention my sins.” The cup-bearer remembered that there was a man, Joseph, he had met in prison who was good at interpreting dreams. The only way the cup-bearer could bring this up, though, was to remind Pharaoh that at one time the King of Egypt had put him in the slammer. Today, this is an idiomatic expression in Hebrew used when someone must admit as part of a conversation something unpleasant that they had done earlier.

In today’s blog post, I mention my sins. Yesterday, Wednesday, was Rosh Chodesh Av–the beginning of the new Hebrew month of Av. And I completely forgot about it. It wasn’t until after sunset last night that I realized that they entire day had passed without me noticing. Not such a big deal, right? Actually, the day is marked with special prayers (Ya’aleh v’Yavo, Hallel, Musaf, Psalm 104) and I said my daily prayers (all three times) in the regular fashion. This hasn’t happened since I began doing thrice daily prayers over 30 years ago.

How did this happen? Typically, the New Moon is announced in synagogue the Shabbat morning beforehand. A Torah Scroll is held, everyone rises, and the prayer leader recites the special prayer including the name of the month and when it will begin. Since the beginning of the pandemic, my synagogue has not had in-person Saturday morning services, so the prayer was not recited. Even so, I still knew it was on Wednesday but I simply forgot. I’ll blame it on the pandemic.

It seems to me that a similar thing happens with our fitness regimen. Many of us before the pandemic were in the habit of going to the gym on certain days of the week. Certain days might be lifting days and others cardio. Regular gym-goers have a routine, a rhythm…and I have seen that erode with many of my clients. Not wanting to come into the gym, and not excited about a virtual workout time passes. It may seem like it’s only been a few days or maybe a couple of weeks without a workout…but for many it has been since mid-March–over 4 months!

I am working on a strategy so that I don’t miss Rosh Chodesh next month (the following month is Rosh Hashanah so I won’t miss that!). I am also encouraging my clients to form plans to get them in that fitness routine that means so much. It won’t be easy. This pandemic has really messed with us.

Time is too precious. It is holy. Let’s make a commitment to not lose track of it.

The Power of Negativity

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And the results are in….NEGATIVE!

Yesterday I had to take a COVID-19 test in preparation for a surgical procedure on Thursday. I was pretty sure I’d be negative. I’ve had no fever, have worn my mask, maintained 6′, etc., but you never know.

I think for many of us over the last few months, even a sniffle or a tickle in the throat is cause for worry. Is it allergies or the plague? Do I need a ventilator or a Ricola? There is a pervasive anxiety that only a test can allay.

It is nice to know that I do not have the virus, but I realize that the test yesterday is only one snapshot in time. I could be exposed today (God forbid) and not even know it. The anxiety does not disappear. What is the case to be made for repeated testing?

As I said, although I expected it to come back negative, it is still a relief. Here’s hoping that many more of us follow the CDC recommendations so that we can turn this thing around. Let’s hope for as much negativity as possible!