In July, Marilyn Nienhuis took the first step of a long and painful journey on the last step of a Crested Butte hotel.
She simply tripped. “The force of the fall was just tremendous,” said Nienhuis, who was 69 at the time. So forceful, in fact, the ball of her shoulder socket had been torn out.
After surgery in Denver a few days later, Nienhuis’ entire left arm and shoulder were immobilized in a massive pillow sling. She was unable to drive, cook, dress herself or do any of the outdoor activities she had shared with her husband, Glenn. The pain was often overwhelming.
She thought she’d be laid up for a short time. Instead, her surgery was followed by a series of complications — and six surgeries. The intensity of the pain, which would sometimes prompt her to go to bed and just be still, and the physical challenge of each surgery and rehabilitation became a mental-health challenge.
“I was so weak I couldn’t even hold a book or a magazine.” Deciding she needed some relief, she asked her doctor for “a happy pill,” she said. Lexapro helped.
That inactive post-surgery time can present mental-health hurdles that weren’t included in the rehab program your surgeon mentioned prior to your surgery.
“Post-operative depression is a real thing,” said Kim Aseltine, Nienhuis’ physical therapist at Conifer Physical Therapy. “You’re doing all these fun outdoor things — endorphins are your drug of choice. Suddenly an injury takes that joy away.
“For some people who lose that joy, it’s easy to go to the dark side.”
While information regarding post-operative rehabilitation is readily available, there is little information available to patients about post-operative depression, said sports psychologist Lisa Lollar, who has a private practice in Denver.
“It is very difficult to find information post-surgery versus post-injury,” said Lollar, a clinical psychologist who shifted her area of expertise to sports and has been working with the mental-health side of athletic injuries since 1996.
Surgeons are trained to fix the problem, she said, but not the patient’s post-op mental state.
“When an activity or sport is so integrated into a person’s life, and suddenly you remove that activity or sport, it can be incredibly frustrating,” said Lollar. “For many athletes, sport is their stress release, and suddenly their stress valve is gone. If they really identify with being an athlete, they lose their identity as well.”
Douglas Wisoff, a physical therapist and owner of Radiant Running in Lafayette, has worked with the mental-health post-op challenges both in his practice and personally. A lower-back injury sidelined him from ultrarunning for three years.
“You have this energy,” Wisoff said. “Getting injured is like hitting a wall. You’re getting your joy and sense of self worth out of the thing that you do, and now you’re separated from that thing that gives you joy.
“If your sense of self-worth is tied to that thing, you can totally freak out about your external loss. You have to decide whether this injury is a game-changer, or is it a waiting game.”
Working with the emotional challenge
However, not every athlete facing surgery needs to worry about this.
Dr. William Cooney, a orthopedic surgeon at Front Range Orthopedics and Spine in Lafayette, is careful to make a distinction about mental states after surgery. “There’s a difference between post-operative blues and post-operative depression.”
“Depression is a medical issue, and blues an emotional issue,” Cooney said. “Sometimes they overlap. Typically, depression involves sadness, loss of interest, difficulty sleeping, thoughts of helplessness, difficulty concentrating. Depression really needs treatment. Blues can pass.”
Cooney performs joint replacement and repair on a variety of people. Chronic sufferers generally don’t get the blues or become depressed, he said. They’ve chosen to have surgery and have time to mentally and physically prepare for it.
When surgery isn’t elective, often without any kind of preparation, a person is forced into something they didn’t plan and don’t want to do, Cooney said. “Their life has changed.”
“I talk to people about getting their joy from other areas of their lives while they’re injured,” said Wisoff. “Get into the family scene. You have to develop a self-contained happiness that doesn’t need anything from the outside. You have to really understand the word ‘patience.’ When you become patient, that’s when you start to heal.”
That can be tough — athletes want to know whether they are ever going to be as good as they were, Lollar said.
“Athletes who are faster healers take responsibility for their healing,” she said. “They have more social support. While rehabbing, they continue to pursue other interests and remain motivated in other ways. They set small goals so they can see progress and keep moving.”
Faster healers also have a lot of trust in the medical and rehabilitation staff they work with, and they reach out to people within their support systems, she said.
After a long year and a half, Nienhuis feels the end is finally in sight. Enjoying some unseasonal good winter weather recently, she and Glenn went to the golf course, where she chipped a few shots for the first time since the injury.
“I’m a strong person,” she said. “A positive person. I could be angry, but it’s not going to do me any good. Something good will come out of this. I’m stronger. My faith is stronger. My husband and I are closer. He’s my doctor, my nurse, my chauffeur, my cook and my lover, and he hasn’t complained once.”
FOR MORE INFORMATION about post-surgery depression — how to prepare for it and how to handle it — go to .
