Reverse Humeral Replacement

November 22, 2015

As I have already mentioned in my last post I had the operation at the very end of September, once I had completed 5 out of 8 VAC chemotherapies. It was time for operation ‘make me Iron Man’, AKA a ‘reverse humeral replacement’ for all the medical types. The aim was to remove the diseased bone (humerous) and surrounding tissue and replace it with a new titanium prosthesis. This was a huge mile stone in my treatment and I had mixed feelings about it. I was so glad and relieved to be moving forward and finally getting the bastard that started all of this out my body. Nevertheless I was losing a part of my body. And possibly the ability to do a lot of the things I was good at, the things I love and I felt gave me my identity like rugby, Olympic lifting and some of my best dance moves. Would I ever be able to lift my future children onto my shoulders, get something heavy down off of a shelf, swim or do a straight arm bolt right handed ever again? I did everything I could to stay positive and looked at the sports and other things I could do, but I still couldn’t help but be frustrated about the ability I was losing. It would be strange if it didn’t affect me after being so able and active my whole life. Still, being alive and healthy is far more important!

The operation was at The Royal National Orthopaedic Hospital in London where I had the biopsy in January. It felt really weird being back because the last time I was there I had just been told I had cancer. Apart from needing a big upgrade, as it was built in 1905, the hospital is fantastic and such a high standard. The staff are all so friendly, professional and helpful. I had an amazing surgeon and got on very well with him. He was also the man that had the rotten job of telling me I had cancer 8 months before. Luckily I have private healthcare through the company I work for, and this made a huge difference. Although the wards are more sociable and lively, I preferred the thought of my own private room with wifi, TV and a shower/toilet. The main benefit of this was that I could watch the Rugby World Cup. I checked into the private patient suite the night before my operation and was due to stay in hospital for 7 days.

The plan was to make the incision at the front of my shoulder and cut through all the muscles and connective tissue. The humerus bone was dislocated from the ball and socket joint and they sawed through the healthy part of the bone below the diseased area. From looking at the pre operation scans they were confident the tumour had avoided the main nerve and blood vessels which was some much needed good news. It turned out my bicep tendon went straight through the tumour and my subscapularis (rotator cuff) was also involved so it had to come out along with some of my pectoral muscle. They reattached my bicep to the pectoral tendon which is very awkward. They drilled down into the remainder of the humerus bone, filled it with medical cement and inserted the prosthesis. Once the other end was drilled into the scapular (shoulder blade), the muscles and connective tissue were reattached to their new fixings and I was sewn back up, jobs a gooden!

I am interested in this stuff when it involves someone else so when it’s about me I am ultra-attentive and asked the surgical team about everything. One thing I asked was about the tumour itself, and how they cut it out. They told me they use the scans and don’t actually see the tumour itself because they cut out a margin of healthy tissue around it. The tumour was sent off to the pathology lab for tests and a few weeks later mine came back. It was great news, the tumour was mostly dead after all the chemo and the margins around the tumour were all intact, this news put a big smile on my face for the week. There were still cancerous cells inside the tumour which they removed, so it was good that I was still carrying on with chemo after the op.

My operation was originally first on the list but got delayed until 2pm, and I wasn’t allowed to eat after 2am! I was lying in bed, starving and waiting to be collected for the operating theatre with a big black arrow indicating which arm to operate on. Sporting some sexy stockings, net pants (don’t ask me why) and a hospital gown, I had a realisation that this was probably going to be the last time I would ever lift my right arm above my head and have a full humerus bone. But it had to be done. There was no going back and no other option. I felt like I should continuously fist pump while I still could. The operation was expected to only take 2 hours, which amazed me. However it ended up being 5 hours. My parents arrived ready to greet me from general anaesthetic at 4pm and had a worrying 3 hour wait, pacing up and down the corridor. It turned out they had never come across bone so hard and that resulted in 4 blunt drills. The surgeon also said he had never operated on a patient with so much muscle to get through. He either says that to all of his patients or only ever operates on children and old ladies. No offence if you fall into either of those categories! Nevertheless, it put a smile on my face.

Coming out of general anaesthetic was very strange. I felt like my limbs were made from lead and I could barely lift my head. First thing to do was eat! For the first time in about 24 years my mum had to feed me my dinner. Sadly there was no choochoo train or aeroplane. My arm was immobilized and I was high as a kite on pain killers. Apart from the obvious, it was great! I was attached to an oxygen machine and also had a tube coming out my shoulder for a few days which drained off excess fluid. I had to carry the pot of blood around with me everywhere. I wasn’t allowed out of bed for the whole first day which felt extremely unnatural to me. Now every man will know the hardship of peeing with a morning glory. However peeing into a cardboard bottle, while lying in bed high off drugs, pulling down my net pants (still don’t know why) and aiming, all of this using only one hand, was nigh impossible. There was some overflow, bad times. I can imagine it’s even harder for females, so respect to anyone that has nailed that skill! Luckily by the time I needed the toilet again I was up walking. I recovered very fast so ended up spending only 4 days in hospital, which was very pleasing.

It’s been almost 8 weeks since the operation and things are looking really positive. I was told by the surgeon before the operation that we were aiming for a 90 degree range of movement sideways/forwards and good movement backwards. This was fantastic news as it meant I could run normally! Up until this point I had images in my head of me running with one arm by my side. He mentioned about getting my hand to my mouth, possibly to the top of my head and holding a shopping bag/10kg weight…..I’ve done shits bigger than that! This was very disheartening at the time but I think I was told what the expected outcome in general was, rather than the extreme best outcome (which is what I would be aiming for). I’ve already got to 90 degrees sideways, 130 degrees forwards and although it’s far too early to do any weighted exercises, I’m confident it won’t be weak for long. Although I am so weak I struggle to even lift the weight of my arm yet, that’s my 1RM! The movement is assisted but the strength will come that’s for sure. It feels amazing to get some range of movement back in the joint. I didn’t think I would have this much, even if it is a little awkward at the moment with having everything reattached in new places and recruiting different muscles.

I’m currently a week away from my very last chemo!! Thank f*ck for that. With everything going on and the chemo knocking me back, it has definitely slowed down my healing and rehab. I cannot explain how much I am looking forward to being free of these 3 week cycles I have lived my life by this year. I am frothing over the thought of getting my life back, smashing rehab and getting back on the gain train in the gym next year!