The Two-Pound Rule: Replacing an Elbow and Accepting Limitations John Goettsch

For years, Jon Goettsch regularly joined his friends on the green, clubs in tow, easily extending his arms to swing. He lifted weights and took walks on the beach close to his home in South Orange County with his wife, Valerie. That all changed in 2018 as his right elbow, worn by rheumatoid arthritis and osteoarthritis, deteriorated, causing him excruciating pain.

By mid-2021, at 79, Goettsch’s longtime orthopedic surgeon in Orange County, John Morris, MD, referred him to John Itamura, MD, renowned shoulder and elbow orthopedic surgeon at Adventist Health White Memorial. “There’s only one Itamura,” Morris has said. “He’ll take patients that no one else will.”

Itamura’s initial diagnosis was direct but compassionate. “Your elbow’s toast,” he told Goettsch. “There’s nothing in there. It’s all fluid. No bone, no cartilage… this guy has to get replaced. But I just want you to know, two pounds.”

Itamura referred to a two-pound weight restriction Goettsch would have to adhere to post-surgery, which was necessary due to the rarity of elbow replacements and the subsequent lack of advanced research. Lifting more than two pounds with his right arm would damage the new elbow. This restriction would be in place for the remainder of Goettsch’s life.

This physical limitation was too much for Goettsch to accept. A carton of milk, about two pounds, was okay to lift. A bag of oranges, about three pounds, was not. He likened it to losing his arm completely. He opted to continue taking his anti-inflammatory medication, Celebrex, instead.

For another year, he endured the pain, but it wasn’t without significant costs. Valerie became his right hand during meals, slicing his food. He was forced to buy lighter bath towels, the usual ones now unbearably heavy. He never slept for more than two consecutive hours at night because the pain would jolt him awake. And the prolonged Celebrex use gave him an ulcer.

By November 2022, Goettsch, now 82, finally decided that the pain and misery outweighed the 2-pound weight restriction. “When you’re 82, you go, I’m sick of this, I got to change this stuff. I don’t know how many years I’ve got left, but I want to live to be 90, 95, and I don’t want pain.”

Itamura successfully replaced Goettsch’s right elbow this past June. On the day of the surgery, Goettsch was in pain, but happy this ordeal would soon end. Months after the procedure, his arm is finally pain-free.

“He’s one of a kind,” Goettsch said about Itamura. “I have high regard for him. His approach is really good, he’s very sympathetic to me, the patient, and he’s very sympathetic to [Valerie].”

Goettsch is still adapting to his new physical limitations. His greatest adjustment? Getting used to the two-pound rule and no more golfing. But he is in good spirits.

“I’m going to become a very good putter,” Goettsch joked about the future.

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