Agnesian

We don’t do everything together,” says Carmen Bonlender, a Lomira resident and recent Agnesian HealthCare patient. “But we did both have our rotator cuffs repaired last year – and by the same doctor.”

That doctor was Joe Kemp, MD, a board-certified orthopedic surgeon with the Agnesian Center for Bone & Joint Health in Fond du Lac.

“Dr. Kemp talked to both of us before Carmen’s surgery,” said Randy Bonlender, Carmen’s husband.  “He made us feel like we’d known him all our lives.  In fact, it was just before Carmen’s surgery that I told him, half jokingly, that I’d probably be coming to see him soon.”

Carmen’s surgery was first, done in March at Agnesian HealthCare’s Fond du Lac Surgery Center in 2011.  Randy’s followed in September, done at St. Agnes Hospital.

Present for Carmen’s surgery, Randy said to Dr. Kemp, “I think I’ll be coming to see you soon.” He did – three months later – in July. A set of X-rays ruled out arthritis, so an MRI was scheduled.

“My shoulder concern came on pretty quickly,” says Carmen. “I just woke up with pain one day, and then it got progressively worse.” Avid campers, the Bondenders go about every other weekend in the summertime. In summer 2010, Carmen noticed she was having difficulties with her right arm playing swing ball and beanbag toss, and at work. Her sister suggested she might have frozen shoulder (also known as adhesive capsulitis), a condition characterized by pain and stiffness in the shoulder joint. 

Carmen had her shoulder checked that summer and a series of exercises were recommended, but her shoulder kept getting worse – and more painful. In January 2011, she first saw Dr. Kemp.  An MRI revealed a small tear.

“It was not a big tear,” says Dr. Kemp, “but it wasn’t going to heal on its own. Surgery was definitely needed.” He prepared Carmen for the prospect of surgery.

“He said I might have to take six to eight weeks off work, but then I could return part time for a few weeks,” Carmen says. “Also, exercises and physical therapy – lots of it. Dr. Kemp said I should expect about a 10 percent recovery per month.”

Carmen’s surgery was done by Dr. Kemp and Alan Roetker, MD, also a board-certified orthopedic surgeon, in March 2011 at Agnesian HealthCare’s Fond du Lac Surgery Center, just off the Highway 151 bypass. “I went in at 6:30 a.m. and went home at 1 p.m. The surgery itself took just 45 minutes.”

“Carmen’s shoulder was pretty inflamed,” Dr. Kemp recalls, “but the surgery itself was routine, and done arthroscopically. I only wish the healing were as fast.”

The rotator cuff is a group of muscles and tendons that cover the shoulder joint. In a typical rotator cuff injury, one or more of the four tendons involved either tears, or tears away from the bone. Surgical repair involves stretching the torn tendon(s) back into place, then suturing the torn ends back together – or re-attaching them to the bone.

“I do all of my rotator cuff surgeries arthroscopically now,” says Dr. Kemp. “I can’t even remember the last time I did an open procedure. Arthroscopic surgery is just so much quicker, less invasive and often less painful.

“That said, you can’t speed nature,” adds Dr. Kemp. “The tendons still have to grow back together, or re-grow to the bone. That takes time – it just does. A good analogy is when you put down a roll of sod. It’s there – where it needs to be. But it takes time for the grass roots to grow down and attach to the soil underneath. That’s just nature. Once it’s reattached, a rotator cuff tendon grows back together at about 10 percent per month.”

Initial recovery was “no piece of cake,” Carmen recalls. “The first three weeks were the worst. I couldn’t sleep in my bed or on my side, so I slept in a recliner. Also, it was my right shoulder and I’m right-handed, so all of a sudden I couldn’t do simple things – like brush my hair or tie my shoes. Randy was great, though – he helped me a lot.”

An admissions specialist at Moraine Park Technical College in Fond du Lac, Carmen had signed up for a work-related, on-line class before the surgery. “I was determined to see it through,” she says. “So, I went ahead and did the class, beginning a week after the surgery. Keyboarding one-handed was a bit of a challenge, but I did it.”

Simple range-of-motion exercises began a week after surgery. “Just simple bicep curls and a pendulum swing – back and forth like an elephant’s trunk, but with no weights,” says Carmen. After six weeks Carmen began physical therapy – twice per week until August, then once per week through August.  Carmen continued her own exercises at Club Olympia until the end of the year. She resumed work part time eight weeks after surgery, and went back to full time two weeks after that.

According to Dr. Kemp, recovery can be challenging, even under the best of circumstances. “We put a lot of emphasis on helping patients understand what to expect. There can be pain and soreness, and at first, the shoulder is just not capable of bearing weight. Mostly, though, patients need to understand that recovery and healing just takes time.”

Emotions can run high, too. For many rotator cuff patients, the injury is a first brush with age or vulnerability. “Suddenly, they realize they can’t do it all anymore, or they can’t do the things they want to do,” says Dr. Kemp. “So, they’re dealing with those issues – while they’re rehabbing.”

Carmen could relate. “We have three grandchildren – a three-year-old boy, a two-year-old girl and an eight-month-old girl. I couldn’t lift them, or play with them.”

Being removed from the activities one loves can be difficult for recovering patients, says Dr. Kemp. “Imagine a baseball pitcher. Playing baseball is what he has done his whole life. But while he’s healing and doing his rehab, he’s at home, or in a therapy center or a gym. He’s not with the team. All of his support – his teammates and coaches – are all gone. He’s not part of the team, and he’s not playing baseball.”

Regaining confidence can also be an issue, for athletes and non-athletes alike. “You wonder - can you really throw hard, or lift, or shovel or swing?” says Dr. Kemp. “Some patients end up making permanent lifestyle changes – even after they’re 100-percent healed.”

This was true for Carmen. “I started exercising again - at home - after physical therapy. Now I’m going back to the gym,” Carmen says. “That’s a good thing. But no more bowling. Randy and I bowled for 25 years. But I think we’ll just do Wii® bowling from now on.”

Randy Bondlender’s shoulder concerns had been going on for some time. “Probably two years or more,” he says. Randy, also 51, had been a farmer earlier in his life. “I figure I just wore it out.” He remembers having difficulties lifting and moving his arm to the side, and having concerns sleeping. At first, he thought it was arthritis. 

Finally, in July 2011, Randy made good on the prediction he made just before Carmen’s surgery, and went to see Dr. Kemp.  A set of X-rays ruled out arthritis, so an MRI was scheduled.

“I remember when the nurse brought in the MRI results, they were attached to the same colored sheet of paper that Carmen had on hers. So, I kind of figured I was going to need surgery.”

Indeed, Dr. Kemp says the MRI revealed a significant rotator cuff tear. Surgery was the only real option.

“I didn’t argue with him,” says Randy. “I was tired of living with the pain, and tired of being tired – I wasn’t sleeping.” Surgery was scheduled for September.

“Dr. Kemp told me the same thing he told Carmen: six to eight weeks off work, no lifting at first, simple exercises, physical therapy, and about a ten-percent-per-month rate of healing.”

Randy’s surgery was performed at St. Agnes Hospital by Drs. Kemp and Roetker. His surgery took longer than Carmen’s, though – about two-and-a-half hours – because the rotator cuff tear was more significant. “It was a little trickier,” Dr. Kemp recalls.

Nonetheless, Randy’s post-surgical pain subsided quicker than Carmen’s. “I took pain medication for three or four days – that was it.” Also right-handed, Randy’s surgery was on his left shoulder. “I know – it was easier for me than it was for Carmen because of that.”

Randy returned to work a week after surgery, although Dr. Kemp was leery. He cautioned Randy to do no lifting for a full year. A logistics manager, Randy does only a small amount of lifting at work anyway. He did commence physical therapy four weeks after his surgery, going twice a week through the end of 2011. He also exercised at home, using the same rubber bands and weights Carmen had used. 

Although the Agnesian Center for Bone & Joint Health has full physical therapy facilities at both St. Agnes Hospital and the Fond du Lac Surgery Center, Randy and Carmen both went to the surgery center. “We even had the same physical therapist – Brooke. She was great.” 

Just like Carmen, Randy’s therapy consisted of range of motion exercises and slow, steady weight training. “Especially when the shoulder is healing, exercises should be done slowly,” says Dr. Kemp. “Tendons don’t like sharp, violent motion.”

“I’m still not fully recovered,” says Randy. “At first I slept in a recliner – just like Carmen. Then I slept in bed but with extra pillows. Now the extra pillows are gone, and I have almost a full range of motion.”

Randy says his shoulder sometimes gets tight at the end of the day, but exercises help. He does shoulder exercises at home, and goes to a gym to use an elliptical with light weights.

Both Carmen and Randy say they would highly recommend Dr. Kemp to anyone. “In a heartbeat,” says Randy. “He’s a great surgeon, and a great person. He made us both feel like we’ve known him our whole lives.”