3 surgeries at 30

X-rays of my shoulders after surgery.

30 is one of those milestone years people tend to dream about having done certain things like climbing a mountain, or buying a home, or even just getting that first tattoo. It also happens to be an age that your body starts invoicing you for all the damage you did to it in your later-teens and twenties. The latter was certainly the case for me.

The day I turned 30 was day number 15 of a month-long liquid diet prescribed to me by my doctor after wiring my jaw shut. You see, two weeks earlier I had what was to be surgery number 1 of 3 over the next 14 months. To sweeten the deal, I would also get to enjoy braces for ~2 years. If I had to write a Haiku about what my 30s were looking like, it’d go something like this:

High-school mouth once more,

And geriatric shoulders,

So, this is 30

That’s right, at 29 years old I was starring down the barrel of jaw surgery, 2 years of braces, and 2 shoulder reconstructions. Not a great hand, but if 2020 has taught me anything, things could have been much, much worse.

ASIDE: I really don’t want this post to be some whoa-is-me thing about how my life has been really difficult because the truth is relative to the majority of people on the planet—especially in the last year—it hasn’t been; and to be even more truthful, the things I endured were 100% elective—albeit to prevent further damage and issues down the road. One could even argue that having the option to have surgeries in the first place is a whole other story of my privilege—not to mention my attributes for skin tone, gender or sexual orientation. I’m sure you can guess…

The fact is, part of my experience these last 2 years has been struggling through recovery but also feeling guilty for struggling because I know that relative to most, things are still sooooo good for me. I have a partner who loves me, a job that pays me, a non-threatening skin tone and I live in a place that has—to date—done a really good job at “flattening the curve.” As far as 2020 is concerned, that’s some 1% shit. Scratch that. As far as history is concerned, that’s realllly good.

However, shit friggin’ sucks sometimes. People get defeated in all sorts of ways and It’s ok to express how you feel no matter what your situation is. Nobody has the right to police your emotions and me writing this piece is a reflection on it being ok to talk about my shit. That and it’s just cathartic as hell.

So, I was turning 30 and my body was a hot mess…

For my jaw/teeth, I was told I had an underdeveloped upper jaw which created an underbite, leading to pretty bad jaw pain and a slow wearing down of my front teeth. It also made for more musical eating as most of my chewing was accompanied by a fairly annoying sound of squeaks. My girlfriend really enjoyed this aspect of our meals together (she didn’t).

Now, I had had braces once before—at 21—to try to correct my bite. Unfortunately though, my lower jaw continued to grow and since I had a permanent retainer, my teeth did not shift to accommodate. This meant that they slowly began to sit edge-to-edge. Imagine if the only teeth that touched when you bite down were your two front teeth—that was me. As a result those teeth are now much smaller and seriously blunted from the constant wear and tear.

After meeting with a couple orthodontists I was given two of options: braces for 2-3 years (and it may not be a permanent fix) or surgery first and then braces for 12-16 months. With 30 steadily approaching, I opted for the more expedient—or so I thought—and invasive approach. Like my teeth at the time, I was going to live life on the edge.

Enter stage left: Lefort 1 Maxillofacial Advancement—aka jaw surgery. The procedure was described to my by my surgeon as, “we’re going to cut straight along your gum line, pull your teeth forward like a dresser drawer, screw in some plates to keep it in place, and stitch you back up. I suggest you get a really good blender.” I admit I wasn’t the most stoked about the idea but after talking to some colleagues who had had similar procedures in highschool, a lot of the unease I was feeling began to dissipate.

At 10 AM on the morning of November 7th, 2018, I received the first cuts of this story. Surgery went really well and I spent the night at UBC Hospital where the nurses there took really great care of me. Pumped full of drugs, the pain was surprisingly manageable. In fact, the worst thing of the experience was the “Nasotracheal intubation”—a.k.a nose tube. If the worst part of my experience was when the nurses removed my nose tube, considering what my surgeon had just done to me, I’d say the whole thing went really smoothly. Now it was just surviving liquids for a month…

I’ll be honest, prior to surgery I was not at all phased by the notion of a month-long liquid diet. Maybe it was my previous experimentation with things like Soylent or my love for smoothies, but the reality is I was grossly underestimating what lay ahead. The first couple of weeks were alright. I was using MyFitnessPal to track my caloric intake each day to ensure I was getting enough nutrition and I was getting creative with smoothies and soups. Week 3 and 4 (especially) were a bit of a struggle though. Sometime during week 3 I was getting really tired of the same old potato soup and fruit smoothy combo and for some very strange reason was craving some spicy-sour Tom Yum Noodle soup. Now again, I couldn’t chew anything, so after grabbing takeout from our favorite Thai spot, my girlfriend did the honors of blending it up for me. Huge mistake. Do you know what blended shrimp, mushroom and rice-noodle in a spicy-sour sauce tastes like in liquid form? Vomit. I think I managed one sip. I’d say in hindsight this was a terrible idea but I think anyone could have guessed how this would have turned out. Delusion was clearly beginning to take hold. After that experience I decided to just stick with what I knew and muscle through the remainder of my sentence. Oat smoothies became my ride-or-die.

Aside from the new eating habit, this also kicked off my social-distancing—before social-distancing was cool. I spent some time reading, playing (losing) Fortnite and watching a bunch of TV and Movies. Between my sedentary lifestyle and restricted diet, I lost about 10 lbs. In fairly lackluster-fashion, my first meal after getting my elastics removed was scrambled eggs and rice. As much as I was allowed to chew, I wasn’t exactly ready for a steak just yet.

One of the consequences of cutting my upper jaw and sliding it forward is that I couldn’t feel the roof of my mouth or top teeth/gums. This certainly took some getting used to but over time, feeling began to creep back in. As far as my mouth was concerned, now it was just standard orthodontics for what I had thought would be 12 months. It was time to start prepping for my shoulders. At this point I was just waiting for a date from my surgeon.

My shoulder issues were the result of years of recurring dislocations and neglect on my part following a snowboarding accident (left) and a weird hockey fall (right). It was one of those things where I didn’t realize the damage I was doing because the pain, although excruciating in the moment, was surprisingly fleeting. Stupidly, I would frequently dislocate, relocate myself, take a quick breather, and continue doing whatever I was doing in the first place. The worst example of this would have to be when I was tree planting in Northern Ontario one summer during undergrad and in one day alone I dislocated my left shoulder 4 separate times—all by myself in the middle of the bush with nothing else to do and no access to medical attention, I decided to work through it. The reality is that even if I was next to a hospital at the time I probably wouldn’t have done anything about it. Apparently I have a high pain tolerance—pluses and minuses, clearly.

Now you may be asking, how the hell do you dislocate a shoulder 4 times in one day? And it’s a great question. Essentially, after you’ve dislocated once, it becomes easier and easier to do it again. The technical term for what my shoulders did is actually called a “subluxation”—this is when the ball rolls out of the socket, gets stuck for a bit and then rolls back in after very awkward body manipulations (picture Elaine Benis dancing). In my case, a dislocation could be triggered by something as simple as putting on a jacket, reaching for a car door, or pointing at something on a whiteboard—all real life examples. On the 4x day, The trigger was reaching down to plant a seedling in the ground many thousands of times. It’s the full extension of a reach is where shoulders are most vulnerable. For someone with bad shoulders, tree planting was a less than ideal match. I didn’t plant again after that season.

Over the years, I’ve had multiple X-rays and the results always came back with “only minor damage, which should be easily fixed with a labaral repair and physiotherapy.” Now I was never really great about doing my physio but It wasn’t until I got CT-scans done when the reality of the damage I had been doing sank in. Viewing the fully rendered 3D model of my shoulders on my surgeon’s screen with full pieces of my shoulder missing really helped paint the picture for me: I had eroded about a 1/4 of my left shoulder socket and about a 1/3 of my right. Put simply, labaral repairs weren’t going to do shit. This was going to require some bigger cuts and some new hardware. I was thinking some I, Robot, Will Smith type procedure but unfortunately for me, that wasn’t in the cards—yet—and I didn’t want to wait.

The procedure they had pegged for me is called a “Latarjet”—named after the French doctor who first performed in 1954—and it involves cutting a piece of bone that your bicep attaches to and repositioning it to the front of your shoulder socket with two screws. This creates what they call a “boney block”, preventing the head of your arm to slip out; as it was doing so frequently before. If you’re curious, here’s a 3D animation of what they do. It took me some time to wrap my head around the mechanics of it and to also accept the fact that there was no better alternatives for my situation in the 21st century. We have come a long way as a species but unfortunately for me a lot of our advancements were not in the realm of shoulder reconstructions. To think they first did this procedure 70 years ago is absolutely mental. Supposedly it’s quite common amongst New Zealand All Blacks players which, for someone who spends 8 hours a day at a desk, is either really cool or very concerning. But hey, If it works, it works—right?

If timing isn’t everything, within days of me giving notice to my job of ~5 years, I received a call from my surgeon—they had an operating room booked for me in 3 weeks time. As my health benefits were set to expire and I was planning to contract for the foreseeable future, I rushed to get my own health and disability insurance set up—as my risk-averse, accountant father always says, “it’s better to have it and not need it, then not have it and need it.” Fortunately, I managed lock down a work situation that was willing to be flexible with my current health situation and my private benefits ended up come through—sans anything pertaining to my shoulders or a laundry list of things related to mental health and anxiety.

Quick aside: depression and anxiety are things I’ve always dealt with and took medication for years ago. The fact that my coverage falls short of an array of things because I got help for this stuff when I was much younger is kinda fucked IMO. Thankfully I’ve developed tools and habits to combat these feelings but who the hell knows what help I may need in 5, 10, 20+ years. The system needs fixing.

On the morning of February 20th, 2019, I had shoulder surgery number 1. I remember entering the OR, chit chatting with the doctors and nurses about my tattoos, counting down from 10, 9, 8—black. I woke up post-op and was feeling surprisingly greaaat. The nerve block they had put in pre-surgery was still very much in effect and my pain was almost non-existent. If you’ve never had a nerve block before it’s essentially like when your foot, hand, arm, etc. fall asleep. Now multiply that by 10. You have no feeling, no control, and basically the effected appendage has become deadweight—flopping around, completely subject to gravity’s will. To occupy myself, I played “lift and drop” a few times before being rolled into the OR.

Getting home, I setup camp on the couch, as you do post-surgery, and waited for the nerve block to wear off with meds at the ready. I wasn’t allowed to lie on my back as I needed to keep my shoulder/arm elevated to reduce swelling so it took a few nights of trial-and-error to get the pillow-pyramid just right. A cocktail of Tramadol and Hydromorphone every 4-6 hours made dreams come a little easier. I think by day 5 I was completely pill-free, taking the odd Tylenol to take the edge off. Living in Vancouver, I’m especially fearful of opiods so I wanted to get off them as soon as I reasonably could—that, and they absolutely ruin your stomach. CBD oil was a welcome companion that I can’t recommend enough.

At this point in my journey I had to wear a not-so-subtle sling for 24 hours a day with my good arm completely immobile; my face was still slightly swollen from the previous surgery; I had braces that were regularly well-stocked with food from my previous meal (one handed flossing with braces is hard); and I wasn’t allowed to do any physical activity aside from walking. Let me tell you, the body dysmorphia was real. Not only did I not feel like myself, but I didn’t recognize the person in my reflection. Needless to say, I wasn’t in the best of places mentally and tried my best not to think about the fact that I was only 2//3 of the way through it all. Again, I socially-distanced myself. Had I only known what was coming in 2020 I probably would have done otherwise.

After 2 months in the sling I was given the ok to start light-physiotherapy. Eventually I got back to biking, and running, and slowly started weight training again. As my physical health improved, so too did my mental health. I got to enjoy most of the summer with my friends and even got to go skiing in the winter with my girlfriend and her family—albeit I was very guarded not to fall.

As soon as my surgeon was feeling confident with my recovery I was booked in for shoulder surgery number 2. The date was set for January 11th, 2020. I was equally excited and nervous—excited for it to be done, but nervous to go through it all again. Thankfully, I at least knew what to expect and it was going to be on my non-dominant arm this time round.

For the most part, shoulder surgery/recovery round 2 was fairly straightforward. I dealt with the same pain, limitations and struggles I had in round 1, it was all just a little more mild. It was like Groundhog Day in that it was familiar but also different. Instead of doing everything with my left hand, I now used my right. In stead of reading a ton of Asimov, I watched all four seasons of The Expanse. One thing I was conscious to change this time around was making a solid effort to go the gym and get on the stationary bike a few times a week. I’m acutely aware of how physical activity impacts my mental health so I wanted to nip that in the butt from the outset this time. It certainly helped.

Everything was looking good. I was 6 weeks post-surgery when I had my second follow-up with my surgeon and was given the ok to stop wearing my sling after another week—thank God. I had received a date from my Orthodontist to get my braces removed—thank God 2x. My girlfriend and I had two weeks in Bali coming up to celebrate being done with all of my “upgrades”—thanks MasterCard points. The promised land of strong shoulders and a straight bite was starting to come into focus just above the horizon. Unfortunately this was also the end of February 2019 so if you’re a human alive right now, you know exactly how this plays out.

For the most part I get my news from Twitter and Reddit so my curated feeds of mostly technology and design were keeping me sheltered from a lot of the developments at the time—this was still before VC and CEO Twitter began peppering us all with their “expert” viral growth insights. Each time I went to the gym for my semi-regular bike rides I began noticing the TVs there were becoming more and more focussed on the developments of a novel coronavirus that originated in China. As the days past, the promised-land I had in my sights began to fall back behind the horizon as more and more things were either postponed or cancelled. I did manage to get in to see my surgeon before serious restrictions were put in place but our Bali trip was cancelled and my “braces-off” date of May 11th was postponed indefinitely. Luckily though, we were part of the first cohort of travelers that received full refunds for all of our bookings.

I’m not going to go into detail of my Covid experience because I think it’s the last thing anyone needs right now—TL;DR: it sucked—but needless to say, after a year and half of self prescribed social-distancing, more distance was the last thing I needed. We struggled a bit with our celebratory vacation being cancelled and I tried to come to terms with the fact that I had no idea when my teeth would be free from their shackles. We developed coping mechanisms. Our first was to tackle the Marvel movie marathon—10/10 would do again. Unfortunately, once Thanos was “snapped back” and Tony Stark was laid to rest, so too was our temporary distraction from the realities of our current situation.

In addition to our celebratory vacation, we also booked a half-marathon as something to train for and help me get “back to healthy again”. It was no surprise though when it, too, was cancelled. Although at first I felt relief I wouldn’t have to put myself through the grueling training, or the run itself, I knew it was something that would have been really good for me. That, and it was something my girlfriend Rebecca was really looking forward to doing together. Acknowledging that it was in my best interest to get healthy again and that having an event to work towards would be good, we committed to running the race anyways. This was a key turning point for me and my recovery.

Running has always been something Rebecca enjoys and I tolerate and after almost 2 years of mostly couch-sitting, I was not exactly in peak running condition. Slowly though, my 5km runs became easier and easier. 5km became 7km, and 7km became 10km. I began to feel better and better and even started to look forward to our long Sunday morning runs together. Each week we would increase our distance by 2 or 3 km so that we were ready to tackle the full 21.1 km come race day.

As each week passed and our running distances grew, so too did my outlook and postive feelings of self-worth. Sure, my teeth were still trapped and I couldn’t see my family or friends, but my shoulders were mostly recovered, I had a great partner to quarantine with, and overall, my health was on the up and up.

Aside from avoiding doing more damage, the main reason I decided to take on shoulder surgeries was that I wanted to be able to get back to the active lifestyle of my younger years. I stopped playing all of the sports I loved because overtime the risk-reward of injury to fun just wasn’t worth it anymore. Now, as I continued to work through physio and also started running and biking more, the idea that I could play basketball, volleyballl, or even hockey again started to become more and more realistic. I was starting to feel like everything I had gone through was going to be worth it. That’s not to say I didn’t think it would be during recovery, it’s just that when you have trapped-in-your-own-body type feelings the way I did, you tend to forget the reasons why you put yourself through everything in the first place.

Jan 6 2021

Hello, world!

Aug 24, 2020