Author Topic: Made My Decision-No Surgery  (Read 8256 times)

Offline tjtajo

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Made My Decision-No Surgery
« on: July 27, 2011, 07:40:16 PM »
Newbie to this forum.  I think I have read about every post on this site-ha!...

My backstory.  Male, 46, live in Dallas, active (competitive amateur golfer, avid tennis player, light weight training to keep in shape for golf, 1-3x per week at the gym) 
professional-sale, home office, lots of travel.   I have excellent insurance and can also afford the out of pocket expense for the surgery. 

Ruptured my Distal Bicep Tendon on 7/10/11 on my left arm (non dominant) waterskiing while on vacation in remote northern Michigan. (note: I use to waterski in my 30s but not skied since I was 40..this was more of "lets see if I can still do this and show my kids what dad can do" and I guess I know that answer!  ha!  Anyway,  I knew I tore the bicep from the sound (tearing but no pop) and visually...seeing my bicep roll up near the shoulder.  I had some pain but nothing like i thought based on what saw and heard (and read post injury).  Pain threshold felt more like a bicep "charlie horse".   I immediately began icing and had made a sling out of a towel to secure my arm.  Being at least a 100 miles from a hospital I called my sister who is a nurse and spoke to the ER doctor on staff at her hospital.  He told me to ice, rest, elevate (sling) and have my arm looked at immediately when I return from vacation.  He said my arm would probably need surgery and don't wait more than 3 weeks to see a ortho doctor. But also told me not abort my vacation as the arm would be fine until I get it looked at. I took ibprofin and followed his advice and rested the arm for the next few days.  Over the next 7-9 days my arm felt exceptionally fine despite the injury.  It did bruise in the forearm and near the elbow but only lasted 3-4 days.  We cut the vacation short a few days and flew back to Dallas.

I saw my ortho doctor for the first time on 7/20/11, 10 days post injury.  He examined my arm (no MRI) and visually confirmed the rupture.  He could feel the tendon against my bicep as could I.  At this point I was experiencing no pain and all of my bruising was completely gone.  He recommended surgery and referred me to 3 specialists (he is ortho but more of a knee specialist.  On 7/22 I actually consulted 2 of the 3 specialists and they both concurred the total rupture and suggested and agreed surgery was the preferred option to fix my arm.  Due to the timing of my injury they both wanted to get surgery dates set up immediately.  Both were also sports orthos. 

So at this point I am sure you are all thinking..."so why aren't you not having surgery TJ!!!??"

And a great question!  Further background.  I am not afraid to have surgery.  As a matter of fact when I initially injured my arm that was my plan of attack. I had knee surgery (miniscus tear) 2 years ago and my knee to this day feels incredible so I understand the results that surgery can bring. But when I got back home I researched my injury for hours.  I wanted to be knowledgable about my surgery options, types, rehab, risks, etc and ask pointed questions to the doctors  But during this time there was one thing that was starting to consume my thoughts about my injury...IT DIDNT BOTHER ME...IT DIDNT HURT!  In fact there were days where I totally forgot I injured my arm.  This got me to thinking...what can I do with my arm right now....so i started experimenting with my own little household strength test. Lifting everday things around the house.  Cans of paint, fertilizer bags, luggage, chlorine buckets, golf bag, trash cans, etc..things I touch everyday.  I was experiencing no pain!  There were heavier items that I wanted to lift but opted not to for fear of irritating the muscle but my strength tests got me starting to think about NOT having surgery.  My research started to focus on non surgery treatments and the long term prognosis and post injury treatments.  In my non surgery research the articles still focused on the surgery benefits and were always pointed out first but most every article i read talked about how this injury was manageable and very treatable without surgery.  I also recalled some old friends who had this injury...I sought them out and talked with them.  None of them had surgery for their injuries.  Then I found this website and I totally related to many of the posts that I read Kelly-(who was against surgery then had it), adamwallace?, SRB, Berbee (??) Brian J attached some great references about non surgery post injury studies.  But also read many posts from Big Joe, and Jeff who were huge supporters of surgery...all of it I read and took under advisement...thank you all for your input!

So with all that said here is some of my rationale for my decision to not have surgery:

1.  I have been pain free since day 4 of the injury and my life has been very normal.
2.  I know several people who had this injury and did not opt for surgery.  Their quality of life was not impacted at all.  2 of them had their injuries in their 30s.
3.  My age and types of activities I enjoy are not bicep intensive and as of today do not bother me...
4.  It was my non dominant arm
5.  I am still able to use my bicep today for the things I regularly do on a daily basis...i am able to lift 10-20 lbs items w/ ease and without any pain right now.  Heavier items tend to irritate the bicep but I am being very careful what I try to lift for the next few weeks.
6.  I hit golf balls pain free today...thinking about playing this weekend.
7.  Medical studies that documented non surgical treatments with results that are very favorable in terms of arm strength and quality of life.  Some even provided better results than many of the boiler plate data associated with non surgery expectations related to muscle loss.
8.  I am not a body builder, my exercise is basically cardio and light weight training...for weight management and overall health maintenance. 
9.  I understand and can live with the fact there will be some muscle and strength loss but anxious to see what PT and new exercises to focus on to strengthen the surrounding muscles that will take up the slack of my bicep.
10.  I feel at peace with the decision


The comments/observations above were sort of my first level of thinking related to my non surgery decision....in short, my life as I know it today basically has not changed.  Yes my bicep looks different but the visual appearance does not bother me in the least.  Nor my wife.  So far I am able to live normally as I have been doing.  So what am I gaining with having surgery...yes my arm would be stronger and it would look better/normal but that was all I was to gain from surgery? If what I am experiencing now is acceptable...is the surgery even WORTH IT??  Is it worth the stress of having surgery?  Is it worth the rehab? Worth the minor risks involved (nerve issues, numbness, etc)? worth the out of pocket cost?..at this point I was saying..NO!

But what about the long term aspects?  Evaluated that as well.  Here is what I am calling my 2nd layer of thinking related to my non surgery decision.  I reached out to my acquaintances who had this injury. Two of them had no regrets and 1 did and his was more about the cosmetic appearance (he injured his bicep in his 30s and single).  But all of them felt that their lives were not impacted in the least.  Their arms regained strength and they all said they never really think about the injury or their decision.  The injuries dates range from 3 years to 15 years ago. (not sure of what options were available 15 years ago)  I also talked with my specialists who agreed surgery was the best option.  But in asking them what I am faced with if I DONT have the surgery and they both said what virtually everyone on this forum and all the literature i have read..."20-40% loss of supination strength, muscle atrophy, loss of flexion strength. etc., etc  I get that.  But they both said something that struck me.  That a non surgical decision is something you can definitely live with if you understand the reality of some muscle loss/strength.  One of the specialist said, "this is not open heart surgery"  You can live with this injury and you can recover quite well but you need to understand there will be some differences in your arm strength but its very manageable.  There is good PT available to help recovery but the arm wont be 100% and you need to be OK with that.  They both stated this is a personal decision and their position and recommendation was still surgery but it was their job to let me know the pros/cons.  The decision was mine, theirs was to fix my arm if that was my course of action.  That dialogue and exchange pretty much pushed me to opt for a non surgery recovery.  The specialists candid comments about the non surgery option put me at ease and ultimately swayed me to go the non surgery route.  I am very much at peace with my decision.

So I apologize for writing a "novel" but wanted to give an insight to my decision not to have surgery.  I may be a bit off here but I sense many people on this forum who strongly favor surgery need it as part of their job, are avid weight lifters, or have fairly high intensity recreational lifestyles/interests.  I am none of those...my life is about golf, tennis, photography, keeping in relatively good shape, hanging with my teenagers and wife. As I said i feel at peace with it and tend to provide regular updates and posts to this website about my progress and alike.  I know my decision bucks the trend to many of the posts on this forum but I think its important for future readers and posters who visit this forum for information and support to get both sides of the story.

Again I plan to commit to providing updates to my situation and feel compelled to do so..this forum was good for me.  I hope I can help someone else with my experience.


I welcome any and all comments and questions.  Thanks to all of you in advance for your posts and support!

TJ

 
  • Repair Method: Endobutton
  • Surgery Date: 8/5/2011

Offline BarryO

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Re: Made My Decision-No Surgery
« Reply #1 on: July 27, 2011, 11:46:08 PM »
5.  I am still able to use my bicep today for the things I regularly do on a daily basis...

Just one correction: no, you can't use your bicep for anything.  You've sustained a complete distal tendon rupture, so one end of the muscle is unattached.  Your bicep is currently useless, and will remain that way and will continue to atrophy.

You can still flex your arm right now because of you brachialis muscle; it's the primary arm flexor.  You'll lose more supination strength, as the bicep is an important muscle for that motion.  In my first visit with the ortho surgeon, he had me try to flex my arm against his resistance, and I did OK.  Then he had me make a fist, he held it firmly, and asked me to try to supinate the forearm; it wouldn't budge.  I think that's what tipped it over for me; now that I have a shop put together I really enjoy working on and maintaining the family vehicles; it would be bad not to have any strength in turning a wrench or twisting a screwdriver.

The fact that you have no pain is not unusual; most people with a complete rupture have no pain after the first few days.  The objective of the surgery is to restore function, not to alleviate pain.

In any case, it's a personal decision, and good luck with your outcome.  The other muscles in your arm will compensate somewhat.

Offline Jeff

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Re: Made My Decision-No Surgery
« Reply #2 on: July 28, 2011, 12:28:13 AM »
I confess...I didnt read your whole post.  But read enough.
And Barry O is 100% correct.  Your Bicep is doing nothing. 
To add to the point it will NOT heal on its own.

I did want to point out one thing,  the 20 30% stregnth loss is misleading.
IF you are a couch potato and do office work...then ya..20 30 % loss youre not even going to notice.
BUT if you are a power lifter tossing around 700 pound truck tires is strongman competitions...you are going to lose 90%.  ( I went from 65# curls to under 9#)

If youre an advid golfer...tennis....you should really reconsider surgery.
And although NO BODY likes surgery... its very safe. the anesthesia is better than even 10 years ago.  and somthing I personally found comforting..
THIS SURGERY HAS EXCELLENT RESULTS.

just hought you should know)

Offline bitterguy

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Re: Made My Decision-No Surgery
« Reply #3 on: July 28, 2011, 05:39:42 AM »
We all have to do what is best for ourselves.  Sounds like you have considered the pros and cons and know what your limits will be with injury.  You are right, vast majority of people here are into MMA, weightlifting, or other sports that really require 100% strength.  If you are aren't, I could see why you would opt out of surgery.  Keep updating, be good to see how things go for you.  Good luck.
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Offline tjtajo

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Re: Made My Decision-No Surgery
« Reply #4 on: July 28, 2011, 06:36:38 AM »
Jeff and Barry O thanks for the reply...I am not a body builder by any stretch and in my strongest days I never powered lifted..only lifted to keep muscle tone and be healthy overall.  I am not a couch potato either but my activities and interests will not be super intensive on my injured arm either.  Golf wise I am a lefty so my right arm is the dom arm in my swing.  I actually played yesterday and played quite well.  Tennis i play right handed.  Weird I know. 

My ortho did the resistance test with both arms and the fist and said my bad arm is weaker but not that much.  He seemed somewhat surprised. 

I understand the bicep is not doing anything.  But I can still lift many things today post injury that I was able to do before.  If I can do that now I will be able to do it in future as I begin to build up the surrounding muscles. 

My decision not to have surgery was not based on not liking surgery or being afraid.  I believe surgery works and have had it before very successfully (knee).  For me it was more about what I am gaining or not gaining from the surgery based on my lifestyle from what I had prior to the injury.  This decision has kept me up nights so I have not taken it lightly. 

Today I am 18 days post injury and my arm feels fine, ROM feels the same.  I am functioning normally in my life.   Does anyone find this abnormal for a complete rupture?  I know that may be difficult to answer because my lifestyle seems to be different than many on this forum.
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Offline King Joe

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Re: Made My Decision-No Surgery
« Reply #5 on: July 28, 2011, 07:00:29 AM »
Hi tjtajo
thanks for the dissertation...it was a good read albeit a bit of a fiction.  I do believe, despite you saying you are not, that you do fear the surgery.  You say you researched it  and the options but in your cited facts, you cite only 'conservative' treatments.  tjtajo...THERE IS NO TREATMENT for a DBR.....there is bridging the gap and ALTERING your lifestyle to fit a deficient limb.  You truly are kidding...even lying to yourself if you believe less is better than whole.

BE absolutely logical....something NOT there can't work.  No way, no how.  YOU are not unique and many of us here have been in your shoes.  Myself, 4 days after...I was teasing my kids pushing my playdoh bicep around my arm.  I hunted for a week immediately following my injury including loading game into the truck...I thought (and I am a heavy lifter) breifly how could this be?  I can virtually do everything...till I tried to twist and lift....and had an out of body experience as I watched 'somebody elses' arm not be able to lift something that days before, I threw around like a rag doll.  NO pain don't mean its right.

As said by others here.....the estimate of strength loss is a way conservative under estimate.

Bare with me for a story (hey, you told yours, I'm telling mine...hah).

Years ago...many...years...ago...in my crazy hyper martial arts days....I always worked my styles hard.  I had developed my kung fu in my hands so that I could literally drive single fingers through dry wall.  Single finger push ups were the mainstay of training...man, I had weapons for hands....EXCEPT my pinky fingers.  I had torn the ligaments in the tips so many times that the tips basically had no 'strength' at all and could be pulled backwards almost to touching the back of the finger...and in knife thrusts..>THEY would snag and pull...and hurt and swell and...and....  As a devout (and crazy) warrior, I actually considered surgery to remove these weakest links (hell, if you every study Chinese history about the Shaolin Monks, THIS is not a strange thought).  I was close to that final decision....when a student of mine simply stated....what if there is some advanced technique that REQUIRES pinkies?
     My brain 'got that'....and today, i have pinkies still...and it aint so bad....there was advanced techniques...they were called "a full life".

What if, tjtajo, you 'need' to lift and twist one day?  What if, you needed to lift twenty-FIVE pounds but because of your 'justified' choice years before...you can only lift 20?  What if it meant saving a life?

Again, life is to be lived fully.  I know there are many in the world that HAVE NO CHOICE but to live 'less than'.  By your own admission, you have a full choice....the means and the capacity.  You slap the faces of those that can't....and for that, I pity you.

Good luck with your choice...and I truly hope...What if...? never happens to you.

Me, I got some healing to do (7 months PO)...its nearly football season and I got heads to crack..>WOOOOoooooo!

King Joe Outa Here!

Offline Nathan

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Re: Made My Decision-No Surgery
« Reply #6 on: July 28, 2011, 09:11:23 AM »
good post tj. im with the king on this one.  get it done! its only 4 - 6months outta ur life, then once ur healed up u can hit the lake again and try some wake boarding :)

nathan

Offline MarkJF

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Re: Made My Decision-No Surgery
« Reply #7 on: July 28, 2011, 10:58:45 AM »
Me too, I'm with Joe.

Sorry tjtajo, I injured my injury was 10 days ago and I am super keen on surgery, I want to be "as I was" and I can be too, it'll just take a while. I read and re-read your post but still can't see a logical reason not to have surgery considering it's (in the scheme of things) a relatively straighforward operation, not a complicated or dangerous one where you run the risk of losing, say, losing your sight, or, god forbid, your dick...................

Hopefully I will have had my operation by the next time I post on here. I'd urge you to re-consider.
  • Repair Method: Suture Anchor
  • Surgeon: Dr Wattens (BRI)
  • Surgery Date: 30-08-11

Offline tjtajo

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Re: Made My Decision-No Surgery
« Reply #8 on: July 28, 2011, 01:34:12 PM »
King Joe..thanks for your thoughts and sharing your story... but would appreciate it if you turn down the sarcasm related to my decision not to have surgery.  Your comments "you pity me" and "I am slapping people in the face" that are less fortunate than me is totally out of line and BS!  What does that have to do with anything!?  It's my decision, my life, my circumstances!  Since you are such a staunch supporter of the surgery let me ask you this..are you offering your financial backing to someone on this forum who is unable to fund the surgery or lacks insurance???  I am thinking probably not! 

My decision is mine.  I am not trying to advocate to anyone on what corrective direction they should or should not take related to this injury...just trying to seek information, facts, insight, and share my experiences and feelings related to my decision in case someone else now or later has similar circumstances.   I believe that is how forums like this one are started in the first place.  As I said this was not an easy decision and something I have thought about very seriously. 

You sound like a hell of guy and from other posts i have read and seem very passionate about the surgery benefits and about sharing your story and beliefs.  Nothing wrong with that.  Just don't make it personal or be derogatory to those who choose a different path than what your believe in. 

Also...Nathan...i actually was wakeboarding not skiing when I hurt my arm...

Speedy healing to all...

TJ


  • Repair Method: Endobutton
  • Surgery Date: 8/5/2011

Offline davez

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Re: Made My Decision-No Surgery
« Reply #9 on: July 28, 2011, 05:42:35 PM »
TJ, thanks for your detailed input to the forum.  Good luck to you.

I had surgery 17.5 weeks ago.  To sum up my experience, the first 7 weeks after surgery my arm was a burden. But starting the 8th week it came around fast and felt like my arm again and every day thereafter it feels stronger. I am lucky I hurt my non-dominant arm. I have been told not to golf for 6 months. 

dave

Offline Jeff

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Re: Made My Decision-No Surgery
« Reply #10 on: July 29, 2011, 12:48:51 AM »
Tj...sorry if it sounds like were picking on you.  Not our intention.
We have ALL been where you are.
And we hate to see misconceptions and false hope lead to a decision that effects the rest of your life.

As said...there is NO non-surcial treatment for a Ruptured Biceps.
Surgery is the ONLY way.

And Yes...you can still lift things.  The Biceps Supinates, Not lifts. The Brachialis Lifts the arm.  Lifting with the Thumb UP has little stregnth loss.  Lifting Palm UP loses the stregnth.

There are secondary and thirciary muscles that pick up the slack.  And you can stregnthen them...but the Biceps is a major muscle group that cant be replaced.

Just things to consider.

Offline Gus

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Re: Made My Decision-No Surgery
« Reply #11 on: July 29, 2011, 05:29:22 AM »
Hi Tj,

I read your post and see your lifestyle is still of an active person.  I have read of people on here older than you swinging a bat in a softball game have ruptured their bicep, I would imagine the same could happen in a golf game but I guess it would be the opposite position of the arm you are swinging that was hurt?  

Also to note I was at a point where I almost could not have the surgery in time because of cost not because I did not want to and was weighing the options.
 The one major think process for me was is that you are now using your brachialis muscle, now that you are only using this very thin muscle aren't you afraid of rupturing that now that it is not being supported by a bicep? Reflexes have gotten many of us to rupture our bicep, not knowing of the need to perform the lift and hurting ourselves.

Good luck Tj, I do hope it works out with your decision.  ;D
« Last Edit: July 29, 2011, 05:30:59 AM by Gus »

Offline King Joe

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Re: Made My Decision-No Surgery
« Reply #12 on: July 29, 2011, 06:47:04 AM »
Hi tjtajo

"that" is what you got from my message....that I was sarcastic and perhaps hard on you? 

READ TJ!  Not my stuff....its crap.  Read the stories of the people here.  EVERYBODY has a story...and sadly, some have no choice but to do nothing.  YOU have the choice and choose what to MOST seems absolutely illogical....to NOT correct a situation that is near 100% CORRECTABLE so that you can live whole! (man, I feel like I'm talking to a smoker trying to convince them to quit).

You mention nothing of "What If...?"  You talk nothing of loss of strength, form and function?  You also sound like a "nice guy" (thanks for that) and perhaps even educated (despite your love of golf....HAH).....so it behoofs me that this discussion occurs.

Really, I would have expected, given the preamble above...."hi, was wake boarding with my kids...blew my bicep....looked funky and while it hurt only for a while, I know it aint right.  And while I have friends that also had this type of injury, for me being an active guy and am a semi-pro golfer, I made an appointment to get done soon.  Glad I found this site for the resources here are awesome.  Stay tuned for reports on my recovery.  OH, and that King Joe guy, is awesome!"  (ok, maybe you wouldn't say that last bit).

Good luck with your decision....I'm done here.  Maybe in the future, we can meet...and we can arm wrestle...HAH!

BtW TJ....as a trainer and medical practioner....I spend more hours (and $$$) than I can count (my wife says so anyways...hah) in volunteer service trying to arrange for services for those that can't.  Like your accusation of me responding to you, YOU don't know me.

King Joe, Outa Here!

Offline kungfusifu

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Re: Made My Decision-No Surgery
« Reply #13 on: July 29, 2011, 09:32:33 AM »
Hi TJ,

Sorry to hear about your choice not to have surgery. As you might expect I disagree.

If you severed a finger or a toe, would you have it reattached?  Sure you could live with it. Many disabled people in this world live perfectly fine working around their disabilities.

Right now- you are not complete. Your missing a tendon that is supposed to be there. It is not a redundant body part.

What if a beloved family member needed you to rescue them and you were 30% strength deficient in succeeding. Can you live with that? 

As you get older, physical strength and wellness govern the quality of your life. You will need that tendon down the road and you may not have someone standing next to you to ask for help.

"If its not broke don't fix it". Dude, its broke- fix it. You are not really thinking ahead.

 
  • Hospital: Phelps Memorial Hospital Tarrytown NY
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  • Surgeon: Dr. Howard Luks
  • Surgery Date: February 3, 2011

Offline markoc

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Re: Made My Decision-No Surgery
« Reply #14 on: July 29, 2011, 01:21:44 PM »
This injury totally sucks.......gone through it twice now. It is sort of "scary."
When you need your arm to provide for your family, it RE-HE-HEALLY sucks.....But, I couldn't imagine not being able to use my biceps at all again......and that's the way it is without the surgery.
Surgical procedure : Endobutton with Tenodesis screw