A Human on Stall Rest, Vol. III: Risk Assessment

The subject of an Amateur’s Corner interview in 2021, Elena Perea is an Emergency Room physician who balances work, family life, and competing in Area II. In her latest blog, she brings us an update on her recovery. If you missed it: Vol. 1, Vol. 2

Hacking yesterday with me. Photo by Elena Perea.

At 6 weeks and 5 days post-op from the Biggest Should Repair Ever I saw my surgeon.  I was doing well—“almost too well.”  He looked me in the eye and said “you can’t screw this up because I can’t fix it again.”  It was sobering, as we discussed the literature that includes a 50-90% chance of repair failure, and the fact that the failure risk is greatest in the 3-to-6 MONTH postoperative period. I couldn’t stress the bone anchors with lifting more than a pound of weight until the scar matured.

“Why didn’t we talk about the risk of failure being so high before I had the surgery?” I wanted to know.

“Because you didn’t have any options.  None,” he replied.

He’s not wrong.  I couldn’t lift my arm from my side when I had the surgery, and it wasn’t going to get better.  At this appointment, I was able to hold it at about 45 degrees from my body, although I was so weak, I was trembling instantly.  So.  I can’t screw it up.  Fear installed.

At 7 weeks and 1 day, when I was officially liberated from the sling, I hooked up the trailer, put Beezie on it, and drove to Aiken for the Busiest Horse Weekend EVER in which I Did Not Ride.  Saturday started early, with my friend riding with William Fox Pitt at 7:15 (who was kind and signed an autograph for my kid).  I went and watched Beez do a short jump school so she could be perfect for Sporting Days the next day.  We saw the inimitable Kathy Viele ride a beautiful Grand Prix dressage freestyle at Stable View. We watched the Grand Prix of Eventing Showcase at Bruce’s Field.  After I pulled myself together after Annie Goodwin’s horse won it all (and Boyd waved at my hero-worshiping son with his million-dollar smile–thanks man), we walked Beezie’s Cross Country course for the next day.

Sporting Days Preliminary with John Michael Durr. Photo courtesy of Elena Perea.

Sunday, Beezie completed her second Preliminary, although my 60-pound spawn just wasn’t cutting it as a substitute for adult-male-sized JM at home, and she came home with a fatigue-related stop.  It was apparent we were going to change things up with her conditioning work.  I spent the drive home thinking I needed and wanted to get back on a horse.  Early in the 8th postoperative week, I convinced myself I could do it.  My physical therapist had ramped up my exercises and declared me ahead of the curve.  She gave me exercises that included pulling on bands like you would on reins.  You can’t hurry tendon healing.  I still couldn’t get my arms above shoulder height, and definitely wouldn’t be lifting more than the aforementioned pound, but felt like I could do it.

Life is about risk assessment, and I’m literally a professional at it.  Every time we make decisions, we weigh the potential benefit against associated risk.  I know the donuts could potentially make me fat; the pleasure of the sugar outweighs that risk almost every time.  There is real fear that I will ruin the repair, and need another big surgery with a less desirable outcome.  The likelihood is a non-zero number.  However, I’m not pitching a baseball or bowling or playing tennis.  The risks associated with riding include ruining the repair, although there isn’t any real direct stress to the shoulder.  My horse is quiet, has a soft mouth, doesn’t pull, I have help tacking up.  I am pulling on “reins” for physical therapy.  I could fall off and ruin my life, but that risk is unchanged today, a year from now, and in a decade.  The benefit of regaining some joy and independence, and of helping my horse be prepared for the next Prelim, far outweighed the risk when I did the math for myself.  The same risks might be present for another person who makes a different decision than I did, and that’s ok too.

And so, 8.5 weeks after having my shoulder pieced back together, 13 weeks after I took it apart, I got back on my horse.  It felt like coming home.  I did a 12-minute trot set and could not walk the next day.  I’m taking it slow, and mitigating risk by riding only my horse in only controlled settings with supervision.  I am not lifting my saddle, and am bridling with my left hand (which, by the way, is very strange).  I’m not jumping, and I’m giving the arm a lot of breaks.  It’s not “normal,” but it’s keeping my head in the game.

I’ll tell the surgeon when I see him again in 4 weeks.  As with most things, it’s better to ask forgiveness than permission.