My Arm

A medical and musical journey in 5 movements

(With a happy ending)

By Ted Rosenthal

© 2016 

3^rd Movement

The physical therapy plan – significantly less playing, ultrasound heat treatments, massage and anti-inflammatory medication – was working.   And more importantly, now that I had successfully performed Gershwin Concerto in F at the 92^nd St. Y, the Lincoln Center performance December 6^th seemed very doable.  I went back to see the hand doctor, Glickel, and he seemed even less impressed with my tendonitis symptoms than the first visit, no need for a cortisone shot.  He thought it was time for an MRI of my upper arm to confirm my Popeye Deformity.  I agreed. They were quite booked up but I was able to schedule an MRI for three weeks later.  In the meantime I did my “Texas Trio Tour,” a concert and a workshop at North Texas State, followed by concerts in San Angelo and Midland/Odessa.  I was pleased that my arm, while not perfect, seemed to be getting better.  And that this intense playing did not seem like it would set me back.

I had my MRI on November 30^th, six days before my Lincoln Center concert.  Three days before the concert Dr. Glickel called to give me the results – they found a tumor in my arm, a lipoma, almost certainly benign, but said he’d like to take it out.  I received the call on my cellphone as I was getting ready to teach a class at Manhattan School of Music. Of course the halls were noisy, the reception bad, and I was certain there were questions I forgot to ask.  But he did offer a follow up appointment to discuss my options, which I took.

December 6^th was a memorable day performing with the Park Avenue Chamber Symphony, David Bernard conducting at Rose Hall, Jazz at Lincoln Center.  The performance went well and I felt I had navigated a very tricky physical situation to a successful outcome.  After the post-concert euphoria, Dec. 7^th was back to “reality.” I went to see Dr. Glickel.  I assumed that my tumor was small – the bottom bit of my big Popeye muscle.  To my surprise, I was told that the tumor was over 6 inches long.  Further, they weren’t sure I had both the Popeye Deformity tendon rupture and a large lipoma, but they would know for sure when they did the surgery which they encouraged me to have.  When I seemed incredulous that I wanted them to know exactly what I had before they opened up my arm, they followed up with the chief radiologist to reread my MRI.  He confirmed that in fact I didn’t have the Popeye Deformity at all; the large lump was all just the tumor.  They told me they could remove it and I’d be back to playing lightly in a few days and be back to playing gigs in 2 weeks. I told them I wanted to “sleep on” having an operation.

On December 8^th I went to see Caryl for my physical therapy appointment.  She had attended my concert and was very complimentary of my performance.  I was interested to know if she saw anything I was doing physically at the piano that needed adjusting or that might have caused the tendonitis.  She replied that she hadn’t and reiterated her praise of my musical and physical approach.  I thanked her and instead of rolling up my sleeve for her treatment, I started taking off my shirt.  “Do you mind?” I asked, “I have something to show you.”  I pointed to my bicep area and explained that the MRI results came back and in fact I had a large lipoma, not the Popeye Deformity.  I told her the doctor would like to remove it.  She looked a bit skeptical questioning the need for surgery unless it was absolutely necessary.  In the 24 hours since my doctor appointment, I spoke to friends, family and colleagues to hear their opinions about whether or not to have the operation. Caryl wisely suggested getting a real second opinion, from a qualified doctor, and gave me her recommendation for another specialist.

As a teacher at Manhattan School of Music and Juilliard, I feel lucky to work with some of the top young talent in the world.  I also have a few adult students who, while not professional musicians, are highly accomplished in their chosen fields.  One such person is David Burstein, a semiprofessional jazz pianist on the side and a doctor at Mt Sinai Hospital in his professional life.  In addition to being my student, David is also a good friend.  At my request David asked his medical colleagues for a recommendation. I watched the planets align as his colleagues came up with the same name as did Caryl:  Dr. Edward Athanasian at the Hospital for Special Surgery.  Although David’s colleagues also recommended another respected surgeon at Mt. Sinai, Dr. “A.” was described as (no pun intended) a cut above the rest.  Because I couldn’t get an appointment with Dr. “A” for almost one month I decided to see the Mt. Sinai surgeon as a 2^nd opinion in the interim, reserving my 3^rd (and hopefully final) opinion for Dr. A.

Dr. Iofin at Mt Sinai showed me my MRI, pointed to the tumor, commented on its size, and pointed to the median nerve near the tumor, which controls 3 fingers in the hand.  He told me because the tumor had grown so close to the nerve, there was a very small chance that he would touch or nick it during surgery.  “It almost certainly won’t happen, but nothing is 100%…”  I explained that being a pianist, if the surgery caused nerve damage to my fingers he might as well cut off the whole arm.  Despite my new knowledge and concerns, he thought there was no doubt the tumor should be removed.  His take on recovery time was about 4 weeks.  Things seemed to be getting more serious with each opinion…

(to be continued)