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Getting Healthy and Stronger

By Todd Aalbu, MPT, CSCS, PES, CAFS 30 Jan, 2017
So, I start this entry at the finale of week 4 post-op, which concluded with a successful week in Physical Therapy where goals were met, and the 1-month post-op visit with Brad, Dr. Khalfayan’s PA.

I titled this entry as “Reality Bites” due to the fact that, again, unrealistic expectations often will lead to disappointment. I had the thought earlier this week that the definition of “Reality” should be “where Theory converges with Execution/Performance.” You might have the unrealistic expectation that you are going to be ahead of the average, but then the physical fact that healing occurs at a fairly set rate, and regardless of who you think you will be, there are only so many factors that can influence that rate of healing.

I have come to the realization that this is, in-fact, a very long road to recovery. Theory and knowledge of the healing process and Rotator Cuff function would have clearly defined that fact. But when you go into the procedure with unrealistic expectations of beating the “protocol,” it set me up for being unprepared for some of the typical ups and downs that occur with recovery.

So, my PT, David Dahl, has had the unfortunate task of having to “talk me off of the ledge” a couple of times this week. Bringing things back into perspective that we have met the goals of the protocol, as well as that this is only week 4 after surgery, of what Dr. Khalfayan has predicted to be a 10-12 month recovery to full function. With that perspective, I have to keep in mind that this is roughly 1/12 of the way in the process. Brad at my 4-week post-op visit drove this point home as well, stating that being at this point in the recovery process is exactly where they want to see me, not ahead of schedule, and not behind. In their experience, Brad included that the individuals who are ahead of the protocol and schedule often are more at risk for re-tear/failure of repair. The individuals who are way ahead of schedule often falsely gain confidence and push activities past what the repair can handle to which leads to the failure of the repair.

To re-focus on the positives, I am sleeping in bed propped up. As well as sleeping in bed, I am also now able to make it through a better part of the night sleeping roughly 3 hours at a time, before changing positions, and then going back to sleep. I have also been able to sleep a few hours without my sling on, with is a very welcomed change! I have been driving this week for short distances as well as spending a little time at work doing some light computer work and paper work. All of these seem minor, but feel like exponential gains from 1-2 weeks ago. Progress is occurring!!
By Todd Aalbu, MPT, CSCS, PES, CAFS 19 Jan, 2017

Day Eleven came with something completely unexpected, a state of depression. Now, I have said it plenty of times through the previous blog’s, I have seen many post-operative patients who will often talk during their PT sessions about how difficult it is being home injured and recovering. Many times I have talked patients through the process of keeping themselves busy, doing any and all things that are safe for their recovery of surgery, just so that they can feel “productive.”

 

I completely underestimated the mental debilitation that occurs when you are down-recovering. I feel like I need to call 16 years-worth of patients and apologize for any interaction that I may have had with them in the past years that may have come across as insincere when they have brought this topic up during treatment! I also have realized through this process how much I get-back from being a productive member of our Team at ProAction Physical Therapy. Treating patients, helping them achieve their goals, coaching them to a more improved functional state, leading our Team/Staff at the clinic, well, it has become obvious that it “Feeds Me” spiritually and emotionally. I know through this process that God is working on my Heart and Soul as much as He is healing my shoulder.

 

So, with the need to continue to drive myself personally and emotionally, I have found that it is important to me to contribute as much as I possibly can with one non-dominant arm, around the house with light chores. My wife, Tamsie, has accused me of being a “Norwegian Mule,” not paying attention to her requests for me to stay down and not compromise the repair. Still, I have to keep moving and feel like I am contributing something to the day-to-day requirements of the house.

 

This process has given me a completely new appreciation for reaching out to friends and family that have undergone surgery too. It has meant more to me than I can explain when a friend or family member has called to “check in” and see how things are going and how I am doing day-to-day. One of my ski-buddies, Ed, stopped in to visit the other day and share a quick cup of coffee. Another friend, Bruce, swung by the clinic during my PT appointment to check in and see how I was moving. Others have dropped multiple texts and phone calls, all just to say that they are thinking about how it is going. To this I am more than grateful, and as well has taught me the valuable lesson of how we contribute to each other in our World! Never underestimate the value of a phone call to someone that crosses your mind!

By Todd Aalbu, MPT, CSCS, PES, CAFS 18 Jan, 2017
The first week after surgery, especially shoulder surgery, is usually marked with the same complaint by all patients: “Everything is going fine, but I am really having difficulty sleeping and getting comfortable.” Well, even with the numerous post-op shoulder surgeries that I have seen through the years, and as many times as I have heard the complaints of “lacking sleep,” I have to say that I have been Humbled. I have found that I may get roughly 1-2 hours of rest at a time, with the need to then stand up, reposition, do a few pendulum exercises, and then try to get back to sleep. As most of us know, going with diminished sleep for a day or two, well, not preferred but you can power through. Going on 7+ days of interrupted sleep, not fun at all. I have a completely new appreciation for sleep deprivation.

Day 8 came, and so did my first post-operative visit to have the surgical dressing removed, as well as suture removal. Dr. Khalfayan’s PA, Brad, was able to remove all the sutures from the four orthoscopic sites, all without problem. We also reviewed how the original pain medication that was prescribed was not really taking down any of the pain, and I felt was actually “amping” me making it very difficult to sleep. They adjusted the meds, reviewed the next phase, including the precautions of limits of passive range of motion that will be in-place up through week 4 post-op.

Best part of the end of week one is the ability to start Physical Therapy. As much as I know how people often come in 10-14 days after surgery being limited in their range, I somehow thought I would be very different, having more mobility, less pain, and very unrealistically had the expectation to be WAY AHEAD of protocol and schedule. Well, I was Humbled, yet again. David Dahl, DPT, my PT, was able to get about 30 degrees (of the 90 degree ability per protocol) of forward motion, and approximately the same to sideward-abduction. Well…so much for being “way ahead of schedule.” My work, and as well the work of David, will be an up-hill battle. But, we will get there!

My word for this week that I have been impressed by is “Perseverance.” Nothing worth having comes easily…
By Todd Aalbu, MPT, CSCS, PES, CAFS 18 Jan, 2017
Surgery for my right shoulder repair was scheduled in Seattle at the Swedish Surgical Center at 10:30am. Traffic (unusually…) was a breeze, and we were down there with plenty of time to check-in to the surgical center, and relax a bit before being called back by one of Dr. Khalfayan’s surgical RN’s. Of course with going under anesthesia, you cannot ingest any food or fluids after midnight the day before surgery, so I was very thankful that we could schedule the surgery for earlier in the day. Still, it never fails, that morning the smell of espresso sure makes you consider what you know that you cannot have!

After all the vitals were taken, Dr. Khalfayan came in and met with Tamsie (my wife) and I to go over the last minute details, and was politely confident in all that needed to be done. After getting situated on the table, next thing I knew, it was 2-1/2 hours later, and I was waking up from a nice nap…just with a large sling and bolster on my right arm.

I will tell you this…the day of the surgery really was quite an easy experience. Having the Scalene block for surgery, after coming out of anesthesia, I really had no pain in my shoulder, as my whole shoulder and arm/hand were completely numb. Now, having seen a multitude of post-operative shoulder patients over the years of my practice, I knew what was to come…the Block will wear off! I was very fortunate as the Block lasted until around 8-am the day after surgery. That is when things become very uncomfortable. I had done as instructed and kept on my 4-hour dose of pain medication, but personally found the pain medication really didn’t do much to stop the persistent aching, it just alleviated the sharp pains that occurred randomly. I also found that the pain meds didn’t help me sleep, as they had a bit of the opposite affect and I found them to keep me very alert and awake. So, after 3 days of not really sleeping in the recliner, I tried changing to Tylenol, and changing back/forth between the recliner and propped on the couch, which allowed for 2 hours of sleep roughly at a time. As with most patients, the common complaint after shoulder surgery is not being able to rest/sleep very affectively. I now can personally attest to that statement; it is very difficult to find comfortable positions. Part of this is due to the aching, part of it is (I believe) due to trying to sleep somewhat sitting up in posture, and not being able to change positions due to the sling/bolster and the position of the affected shoulder. Most of us will change positions frequently as we sleep, so to try to sleep static is quite unusual. Still, with all of it, my wife has been a “trouper” and sleeping down on the couch near me…my “thanks” to her will not nearly be enough to show the gratitude that I have for all of the sacrifice she has made for me to go through with this procedure.

For my next Blog, I will go through the 1-week follow-up visit, as well as into week 2 post-op.
By Todd Aalbu, MPT, CSCS, PES, CAFS 13 Jan, 2017
Ok, I first have to disqualify my opinion on this topic as with my profession as a Physical Therapist, it often leads me to the thought, “why not try conservative treatment for a defined period of time, then see if it makes a difference.” If you read my first Blog, I finished with the knowledge from the second scan/Arthrogram, with a noted 1-inch by 1-inch tear of my Supraspinatus, two Labrum tears, an Adhered Capsule/frozen shoulder, and some arthritic noted changes in my Glenohumeral Joint.

With these results in hand, I scheduled my follow-up appointment with my second Orthopedic Surgeon, Dr. Khalfayan with OPA-Seattle. Between the Corticosteroid injection by Dr. Khalfayan (Injection #3), a few weeks of aggressive PT for the Frozen Capsule, as well as the Arthrogram and scheduling the follow up, it is now the beginning of December, 10 months after the original injury. Upon the previous visit to review the first MRI from earlier in the year, Dr. Khalfayan was rather frustrated that an Arthrogram was not done initially by my previous Ortho during the earlier part of this journey. Dr. Khalfayan stated, “Straight MRI’s often do not show the details of what is really going on regarding shoulder injuries, and thus I rarely will order an MRI when an Arthrogram will often show the details missed with an MRI.” I had the Arthrogram results e-mailed to me before this follow-up appointment, as I had wanted to read through them as soon as I could (my curious nature and lack of patience would not allow me to wait!). Knowing the details found in the Arthrogram, I wasn’t at all surprised to see Dr. Khalfayan walk into the room with a large grin on his face. First words from his mouth were, “Well, this is why we do the Arthrogram!” As he pulled up a chair, he looked me directly in the eye and said next, “I see why you think that your shoulder hurts!” All kidding aside, Dr. Khalfayan took about 10 minutes going over the results, and finishing with his conclusion that “this is not an IF you do surgery and correct this, it is more of a WHEN do you wish to do surgery?” As we talked about the Arthrogram findings, Dr. Khalfayan outlined what his plan was with surgery, indicating that he would repair the Rotator Cuff tear, debride the SLAP and Posterior Labrum tears, take down part of the anatomical bone impeding on the joint space (Acromioplasty), as well as manipulate the shoulder while I was under anesthesia to break up the adhesions in the capsule, and possibly do a Capsulotomy as well.

With full trust in Dr. Khalfayan’s opinion and surgical outcomes, I scheduled surgery for December 29th. In my next blog, I will take you through my experience with the day of surgery.
By Todd Aalbu, MPT, CSCS, PES, CAFS 05 Jan, 2017
Not being a person who enjoys being the “center of attention,” I am stepping out of my comfort zone to document my journey through some of the details of my rehabilitation of my right shoulder. It has been a long time in coming, as my injury occurred in January of 2016, in which I had an unfortunate pre-release of my front binding while I was slalom skiing (waterskiing). As I was crossing into the first wake, my front foot literally stepped out of the binding, to which with my forward momentum, I came down into the water leading with my right shoulder. It happened quick enough without warning, and I cannot recall if it was the handle, or just the force of the water, that then threw my right arm up over my head with enough velocity to cause the injury.

At the time, I knew that this injury was “more than the typical fall” that with some time, some rest, and usually some ibuprofen, I would get past the inflammatory phase and move on. Within a few days, as the acute phase was calming down, I was able to understand that I had some hallmark signs of instability of my shoulder, which lead me to seek out an Orthopedic consult with a local Ortho surgeon. A MRI was ordered and results found a tear of my Posterior Labrum, as well as what was thought to be a small tear in my Supraspinatus Muscle/Rotator Cuff. A cortisone injection was administered, with little relief, which lead to another injection approximately 4 weeks later.

One thing that I often will counsel my clients on is that “you often have to be your own medical advocate,” leading you to make decisions or determine the best course of treatment for your own benefit. It is interesting how I can often recognize that need in my own clientele, but that it is so often ignored when YOU are the CLIENT. I say this only because that during the months after my initial injury, my “gut” told me that there was more going on, even though the course of treatment suggested was fairly routine and very conservative. None-the-less, I continued on the conservative trail, trying to manage my symptoms with rest, stretching, and avoiding activities or positions that seemingly were aggravating my inflammation. All the while I was avoiding what was truly staring me in the face, and that was the fact that I was getting weaker, having tremendous difficulty sleeping at night as well as working, limiting my skiing frequency significantly, and growing more and more frustrated with my condition. It was upon seeing the Ortho again one time in May that I expressed my frustration at my lack of progress, to which they said, “Well Todd, you are really just dealing with an inflamed bursitis, nothing more.” I was very perplexed by this statement, as I had a confirmed Rotator Cuff tear, as well as a Labrum tear from the MRI. But, I did not want to be confrontational with the MD, so I walked out of that appointment knowing that I would be needing to seek a second opinion. Finally, I started to wake up and follow my gut instinct. Be that as it may, it only took me 8 months to figure it out…

Fast forward to September, and my consult with the second opinion. I chose an Orthopedic Surgeon in Seattle who has a great reputation, and a surgeon that I have seen phenomenal outcomes from their surgical decisions and techniques. He took one look at the MRI, and noticed more involvement that had previously been noted by the first Ortho, as well as the need for further testing involving a contrast dye Arthrogram to indicate the full involvement of the injury. After a few weeks of aggressive PT for what was now an adhered capsule (aka “frozen shoulder”), the Arthrogram was conducted. What was indicated was a 1-inch tear (2.5 cm) in one direction, as well as another roughly 1-inch tear (2.2 cm) in another direction of the Supraspinatus. It also showed not only the tear in the Posterior Labrum, but also a tear of my Anterior Labrum (SLAP), as well as some other “43-year old shoulder” arthritic changes. In the next blog, I will further go into the next step, “To do surgery or continue the conservative route.”
By Todd Aalbu, MPT, CSCS, PES, CAFS 31 Mar, 2016

Have you ever had one of these moments?

You’re on the treadmill at the gym, and prompted to enter in your age to calculate your optimum heart rate. And you can’t believe the number you just keyed in. Where did the time go, and weren’t you just rocking out at that Fleetwood Mac or Rolling Stones concert?   Your kids and grandkids see graying hair and age spots, but you walk around feeling like you’re the same rebel you’ve always been. 

Yes, it happens to everyone!

If you think about it, aging is a gift. Racking up birthdays is a privilege denied to many. So the real fountain of youth isn’t found in skin creams, hair dyes or pills. Health is the real wealth in life, the real key to vitality and energy and the spring in your step. And a healthy attitude goes a long way in building a healthy body!

Aspire to be a “Super Ager”

At one time, popular wisdom held that disease and disability were a natural part of aging. It’s true that getting older does increase our risk of health issues. But many people live active lives full of purpose well into their older years. Look no further to those scientists call, “super agers,” people in their eighties and nineties with brainpower and physical attributes that seem far younger than their advanced years.

Live Long and Prosper: Take these Steps and Go the Distance

Get regular exercise. Older adults who exercise regularly report fewer problems with overall health and mobility. They also report lower health care costs than seniors who aren’t physically active. Water activities like swimming can be great options for older adults. Water exercise has been shown to help with disabilities and improve quality of life. Exercise can maintain or improve older women’s bone health. And it can be beneficial for people with arthritis and chronic illnesses. You don’t have to join a pricey gym, just get out and walk.

Eat healthy foods.   Be sure to include whole grains, fruits, vegetables (fresh, frozen or canned), lowfat dairy and lean protein such as beans, peas and fish in your diet. Limit foods that are high in sugar, salt and fat. Limit alcoholic intake and drink plenty of water.

Stay connected with others.  People who stay active with their family and community show symptoms of Alzheimer’s disease later than those who have less outside contact. Join a club, attend a new church, or invite new neighbors to dinner to make new friends.

Find a purpose.  Taking part in productive activities also builds emotional and physical health. Studies show that volunteering can help a person feel happier and more confident about life. It is especially helpful in older adults. If transportation is an issue, find another way. Consider volunteer work that you could do by phone or computer in your home.  

Get help.  For both mental and physical ailments.  Mentally, depression is common among older adults. Don’t ignore the signs. A loss of interest in favorite activities, feelings of worthlessness and lack of energy can mean you may need to talk to someone who can give some direction. Be sure you have a strong support system for times when you’re feeling down.  Physically, things do have a tendency to break-down as we get older, do not ignore symptoms and warning signs.  Consult your physician about your concerns and seek treatment if necessary.

Serving the Snohomish county area, ProAction Physical Therapy helps people stay active and enjoying the life they want...and deserve.  


By Todd Aalbu, MPT, CSCS, PES, CAFS 30 Mar, 2016
I have finally decided to take the plunge and add a blog to my site. I always wanted an easy way to share information with visitors and I’m super excited to start this journey. Keep coming back to my site and check for updates right here on the blog.
By Todd Aalbu, MPT, CSCS, PES, CAFS 30 Mar, 2016
Whether from chronic tension, a whiplash injury, interverbral disc disease or progressive arthritis, the neck can be a hidden and severely debilitating source of headaches.  Such headaches are grouped under the term "cervicogenic headache", indicating that the primary source of the headache is the neck.

There are well mapped out referred pain patterns of headaches.  Even headaches located mostly in the forehead or behind the eyes are often "referred" pains coming from restricted areas in the upper cervical spine.

the cervical joints connecting the top two or three levels of the neck to the base of the skull handle almost 50% of the total motion of the neck.  Therefore, this area absorbs a continuous amount of repetitive stress and strain.  Furthermore, the cervical joints bear the main weight of the head.  Fatigue, poor posture, injuries, disc problems, join degeneration, muscular stress and even prior neck surgeries can all compound the wear and tear on this critical region of the body.



Todd Aalbu has treated me over the years for a severe neck injury and a possible career-ending lower back injury. When life was against me, Todd wouldn't let me give up. His ability to treat my ailments and keep my mental and spiritual attitude in check were unfailing. If it were not for his consistent care, physically and emotionally, I would not have made a full recovery!

Danny Evanger, Fire Fighter
Eastside Fire & Rescue


Getting Healthy and Stronger

By Todd Aalbu, MPT, CSCS, PES, CAFS 30 Jan, 2017
So, I start this entry at the finale of week 4 post-op, which concluded with a successful week in Physical Therapy where goals were met, and the 1-month post-op visit with Brad, Dr. Khalfayan’s PA.

I titled this entry as “Reality Bites” due to the fact that, again, unrealistic expectations often will lead to disappointment. I had the thought earlier this week that the definition of “Reality” should be “where Theory converges with Execution/Performance.” You might have the unrealistic expectation that you are going to be ahead of the average, but then the physical fact that healing occurs at a fairly set rate, and regardless of who you think you will be, there are only so many factors that can influence that rate of healing.

I have come to the realization that this is, in-fact, a very long road to recovery. Theory and knowledge of the healing process and Rotator Cuff function would have clearly defined that fact. But when you go into the procedure with unrealistic expectations of beating the “protocol,” it set me up for being unprepared for some of the typical ups and downs that occur with recovery.

So, my PT, David Dahl, has had the unfortunate task of having to “talk me off of the ledge” a couple of times this week. Bringing things back into perspective that we have met the goals of the protocol, as well as that this is only week 4 after surgery, of what Dr. Khalfayan has predicted to be a 10-12 month recovery to full function. With that perspective, I have to keep in mind that this is roughly 1/12 of the way in the process. Brad at my 4-week post-op visit drove this point home as well, stating that being at this point in the recovery process is exactly where they want to see me, not ahead of schedule, and not behind. In their experience, Brad included that the individuals who are ahead of the protocol and schedule often are more at risk for re-tear/failure of repair. The individuals who are way ahead of schedule often falsely gain confidence and push activities past what the repair can handle to which leads to the failure of the repair.

To re-focus on the positives, I am sleeping in bed propped up. As well as sleeping in bed, I am also now able to make it through a better part of the night sleeping roughly 3 hours at a time, before changing positions, and then going back to sleep. I have also been able to sleep a few hours without my sling on, with is a very welcomed change! I have been driving this week for short distances as well as spending a little time at work doing some light computer work and paper work. All of these seem minor, but feel like exponential gains from 1-2 weeks ago. Progress is occurring!!
By Todd Aalbu, MPT, CSCS, PES, CAFS 19 Jan, 2017

Day Eleven came with something completely unexpected, a state of depression. Now, I have said it plenty of times through the previous blog’s, I have seen many post-operative patients who will often talk during their PT sessions about how difficult it is being home injured and recovering. Many times I have talked patients through the process of keeping themselves busy, doing any and all things that are safe for their recovery of surgery, just so that they can feel “productive.”

 

I completely underestimated the mental debilitation that occurs when you are down-recovering. I feel like I need to call 16 years-worth of patients and apologize for any interaction that I may have had with them in the past years that may have come across as insincere when they have brought this topic up during treatment! I also have realized through this process how much I get-back from being a productive member of our Team at ProAction Physical Therapy. Treating patients, helping them achieve their goals, coaching them to a more improved functional state, leading our Team/Staff at the clinic, well, it has become obvious that it “Feeds Me” spiritually and emotionally. I know through this process that God is working on my Heart and Soul as much as He is healing my shoulder.

 

So, with the need to continue to drive myself personally and emotionally, I have found that it is important to me to contribute as much as I possibly can with one non-dominant arm, around the house with light chores. My wife, Tamsie, has accused me of being a “Norwegian Mule,” not paying attention to her requests for me to stay down and not compromise the repair. Still, I have to keep moving and feel like I am contributing something to the day-to-day requirements of the house.

 

This process has given me a completely new appreciation for reaching out to friends and family that have undergone surgery too. It has meant more to me than I can explain when a friend or family member has called to “check in” and see how things are going and how I am doing day-to-day. One of my ski-buddies, Ed, stopped in to visit the other day and share a quick cup of coffee. Another friend, Bruce, swung by the clinic during my PT appointment to check in and see how I was moving. Others have dropped multiple texts and phone calls, all just to say that they are thinking about how it is going. To this I am more than grateful, and as well has taught me the valuable lesson of how we contribute to each other in our World! Never underestimate the value of a phone call to someone that crosses your mind!

By Todd Aalbu, MPT, CSCS, PES, CAFS 18 Jan, 2017
The first week after surgery, especially shoulder surgery, is usually marked with the same complaint by all patients: “Everything is going fine, but I am really having difficulty sleeping and getting comfortable.” Well, even with the numerous post-op shoulder surgeries that I have seen through the years, and as many times as I have heard the complaints of “lacking sleep,” I have to say that I have been Humbled. I have found that I may get roughly 1-2 hours of rest at a time, with the need to then stand up, reposition, do a few pendulum exercises, and then try to get back to sleep. As most of us know, going with diminished sleep for a day or two, well, not preferred but you can power through. Going on 7+ days of interrupted sleep, not fun at all. I have a completely new appreciation for sleep deprivation.

Day 8 came, and so did my first post-operative visit to have the surgical dressing removed, as well as suture removal. Dr. Khalfayan’s PA, Brad, was able to remove all the sutures from the four orthoscopic sites, all without problem. We also reviewed how the original pain medication that was prescribed was not really taking down any of the pain, and I felt was actually “amping” me making it very difficult to sleep. They adjusted the meds, reviewed the next phase, including the precautions of limits of passive range of motion that will be in-place up through week 4 post-op.

Best part of the end of week one is the ability to start Physical Therapy. As much as I know how people often come in 10-14 days after surgery being limited in their range, I somehow thought I would be very different, having more mobility, less pain, and very unrealistically had the expectation to be WAY AHEAD of protocol and schedule. Well, I was Humbled, yet again. David Dahl, DPT, my PT, was able to get about 30 degrees (of the 90 degree ability per protocol) of forward motion, and approximately the same to sideward-abduction. Well…so much for being “way ahead of schedule.” My work, and as well the work of David, will be an up-hill battle. But, we will get there!

My word for this week that I have been impressed by is “Perseverance.” Nothing worth having comes easily…
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