Total Hip Replacement 10: Four Weeks, Over and Out

heelsThis will be my last report on the hip replacement saga, winding it up with the nice round numbers of 10 posts and 4 weeks.  From here it appears there will be nothing interesting left to say about the recuperation [insert gesture to avoid evil eye here].

This past week, I took only one nap, finding that 30 minutes of relaxation usually does the trick when I get worn out.  I went on a shopping trip with a friend, walking and standing around for three hours, and came away with only tired feet.  I walked with my dog for an hour, up and down some good hills, ending with only wind-stiffened cheeks to complain about.  I’ve started doing gentle yoga stretches, with which my hip complies politely, and am starting to feel a little looser.  Last night, I clambered around on a steep, rocky hillside, in the dark, pushing a herd of horses from one paddock to another, with no problem.  I ate a lot of iron-rich Total cereal and dried apricots and black beans and whole grains, regaining a girlish blush in my cheeks.

The only change is with my scar.  I know it’s important to massage and manipulate a big wound to break up adhesions and unnecessary scar tissue.  And I know it’s painful.  I’m getting professional help with this soon, but once I passed the three-week, fully-knitted point, I watched a YouTube video on how to work on a scar and started doing it myself.  Ouch.  But it’s working — instead of a big, rectangular patch of hard, immovable flesh, I now have a pretty normal thigh with a rubbery scar down the middle.

In another month, my bone should be solid and I’m allowed to get back to most activities (riding!).  Another month after that, I have my final follow-up with the surgeon.  Somewhere in the 6-12 month range, I should be fully certified to do everything I will ever be able to do.  There are more markers to come, but the progress is already just incremental and I think it’s time to, quite literally, move on.

Final lesson learned: the anticipation is often (always?) worse than the reality.  But did the angst help by setting me up to be underwhelmed by the reality?  I’ll ponder this on my next long, pain-free walk.

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Total Hip Replacement 9: Three Weeks Out

Less and less to report each week, which is probably how it’s meant to be.

At the end of last week, I peeled off my surgical dressing to reveal my scar.  About 3 inches long, looking raw and gross.  By the end of this week, it looks tidy and pink and tolerable.  The only pain I really have left is that incision — the doctor says the nerves will take a while to settle down, so it bites and stings at times.

I don’t remember where my cane is.  I have relieved my husband of almost all horse duty.  I walked my dog like a normal person for the first time in many months.  I climbed all the stairs to my fifth-floor office.  No biggie.

The complaint this week was on-going fatigue.  Not normal fatigue, mind you, but a head-punching, blood-sapping, thought-killing swamp of exhaustion.  The couple of times I resisted the need to fall into a coma during the day, I was rewarded with searing headaches, a brain that refused to form a thought, and a long night caught like a fretful baby between an intense pull toward sleep and the inability to let go.

I tried to go back to work this week, with varied results.  I knew that showering, dressing, feeding the pets, straightening the house and driving 45 minutes down the winding canyon would use up some energy, but I was surprised to learn how much more it took to sit up and think and speak coherently about professional things.  I dragged through three half days, doing a little better when I stayed home on the couch and did my thinking from there.  Daily naps of one to two-and-a-half hours are de rigeur.

The doctor says it’s certainly anemia.  She said most patients are anemic after surgery, a fact glaringly absent from all the volumes of information I was given before the procedure.  If I had expected it, I wouldn’t have asked friends to bring me light, vegetarian food to recuperate on!  She said I may be feeling it especially because my hemoglobin count was quite high to start with — a virtue of being healthy at high altitudes, I guess — and sank precipitously immediately after the procedure.  My current levels are just above the need for a blood transfusion, and the steep differential probably hit me hard.  Plus, I wonder if living at almost 9,000 feet makes it harder to get by with those low levels than if I lived at sea level.  The worst news was it will take 3-4 MONTHS for those levels to climb back.  Hopefully I’ll continue to feel better during that time, because I need to work and also need to get out and use this new leg of mine.

I can definitely tell that this new hip works way better than the old one, rest its soul.  I’m pretty excited to put that to use.  After my next nap.

Total Hip Replacement 8: Two Weeks Out

As advertised, week two brought less dramatic change than week one did.  It started out with walking fine, doing my assigned exercises easily, using the stairs, and taking almost no meds.  It’s ending at pretty much the same spot.  I’m still using a cane or ski poles despite the ding to my pride because without support I limp just enough to make other parts of me sore.  But there were notable achievements in the last seven days:

  • took the 45-minute drive to town three times and did errands, ate out and went to a movie;
  • did some driving;
  • cooked a couple meals and cleaned up after;
  • went to the barn and did minor horse chores by myself;
  • started going up and down stairs like an adult rather than a toddler;
  • answered a work email that took a little thought;
  • took off my surgical dressing and examined my scar;
  • got on my stationary bike and rode for 10 and then 15 minutes; and
  • took just a couple naps.

The last real medication I’m taking is Celebrex, a strong NSAID.  I’m supposed to take it once daily for another week, but I’m experimenting with shedding it early because I haven’t had any swelling or swelling-related pain for a long time, even 23 1/2 hours after my last dose.  We’ll see how that goes.  Then I have my baby aspirin for another couple weeks, which I’ll take dutifully because blood clots are my major paranoia.

My only big concern of the next several weeks is the serious danger of falling down that is posed by January’s ice and snow.  My poor femur is so vulnerable, as is the brand new joint.  I got some Yak Trax for my shoes and will probably carry my ski poles around a lot.  And wait eagerly for spring and for that magical 8-week time frame when the bone should be more solid.

I’m happy to complain and be snarky about my limitations and how long it takes me to do normal things, even 14 whole days out, but actually I’m amazed at my progress and very grateful.  I can absolutely see big improvements from the new joint already, and imagine there are many more to come.  I’m grateful to medical technology and my surgeon, to myself for working hard to be strong and healthy going in, to the wonderful friends, family, and superlative husband who have helped me out, and to all my body systems that are pretty miraculous at this healing and adaptation stuff.

As I said at the start, I’ve been logging all this not purely out of an exhibitionist urge, but in hopes that it might be helpful to someone else facing the same challenges.  If there is such a person out there, here a couple pieces of advice from today’s vantage point:

  • make sure you use the best surgeon in your area and get your questions answered by that person or someone else if necessary;
  • schedule far enough ahead that you can make preparations;
  • do everything you can to be as strong and flexible, both in your muscles and in your overall health, before the surgery;
  • if you can, do it in a drier and more forgiving season than winter in the Rockies;
  • don’t schedule on a Friday — the first couple days out are the hardest and it’s nice to think doctors are in their offices during that time; and
  • expect to be tired and fragile for some time, even if you were a dynamo beforehand.

 

 

Total Hip Replacement 7: One Week Out

This is the seventh day since my surgical enhancement.  Here is a brief report.

Pain

The pain has receded at a standard 1:1 downward slope (except when you try to get too tough too soon and skip your NSAID and your leg blows up like a Ballpark Frank — they plump when you cook ’em! — and hurts accordingly and there follows a great gnashing of teeth abroad in the land).

Mobility

Day 1 (surgery): throw up

Day 2-3: Cruise around with walker

Day 4-5: Ditch walker for cane

Day 6: Ditch cane in the house; walk up and down hilly driveway with ski poles

Day 7: Zumba class (not really, Mom)

Other stuff

Day 1: throw up

Day 2: exhausted, sick

Day 3: exhausted, sick, grumpy

Day 4: really, really tired

Day 5: sooooooo tired

Day 6:  moderately severe fatigue

Day 7: Zumba class (nope, too terribly tired)

So we see the mechanics are out-pacing the spirit.  That’s OK — it’s 9 degrees and snowy outside, so the spirit can take a little time to catch up.  But not too much.

Total Hip Replacement 6: Surgery and Aftermath

Boy, what a relief to get out of the anticipation stage!  By the time I was in the prep room getting fussed over by nurses, I felt much more relaxed than I had in the preceding weeks!

The anesthesiologist was right — as soon as he gave me some kind of anti-anxiety medication, my memory gaps open.  I was in the prep room and then I was in the recovery room.  Crazy stuff — he told me I was totally awake when they wheeled me into the OR, gave me a spinal block injection (!!) and did whatever else they do before actually beginning, but I have only the vaguest memory of the OR ceiling and a rush of activity.  Later, at home, I kept finding electrodes stuck to me in odd places and wondered why, since no one had ever hooked them up.  “That you know of,” my husband quipped, reminding me how much happened to me without my knowledge.

The doctor was also right about my waking up alert, without a long groggy climb.  In the several hours after waking up, I had a dose of fentanyl and, later, oxycodone, even though the spinal block was still keeping me partially numb.  At first, I didn’t feel the notorious  effects of those meds that I had dreaded.  Bu when I first tried to sit up, and later when PT tried to stand me up, I was overcome with dizzy, sweaty nausea and my blood pressure tanked.  That was the worst experience thus far.  But by evening, I was able to stand up and move around and then I graduated to walk back and forth a few times in the night.

The pain has been off and on.  Sometimes the actual incision site stings, sometimes my whole thigh throbs.  The thing that really knocked it out was the muscle relaxer flexeril, better than the opioids.  In the morning, OT came to help me figure out how to put on socks and deal with the shower and such.  She told me the pain would increase for the next 24-48 hours, which was definitely not what I had been told before.  But she was right, the most intense part thus far was Saturday evening, 30 hours after surgery.  Both kinds of pain were bad and I had a hard time getting into bed.  Oxy didn’t really help but flexeril again saved me by easing the pain and pushing me into deep sleep.

On post-op day 2, the pain was fading enough that I took only Tylenol all day.  I was able to walk and do my PT exercises without too much agony.  But I felt woozy and light-headed and very weak all day.  I walked around the house numerous times and did my PT three times as directed, snoozing and grumpy the rest of the time.  I was not looking forward to many days like that.  But on the other hand I started to get handy with the walker and figured out how to carry things around so I could let my husband leave the house.

It’s post-op day 3 and I’m much better on all counts.  No narcotics last night so I feel more like myself.  The pain is really fading fast — I took half my Tylenol dose this morning and did my exercises with very little pain.  I braved our awkwardly-designed shower and got clean, which felt great but also tired me out.

I guess I’m now at the base of the long, gentle slope to get up to better than I was before.  That’s pretty good for day 3.  I’ve been warned that it will take longer than I expect, and longer than I want, to recover my energy and strength.  I imagine I can shed the walker within a day or two, but that doesn’t mean I’m going hiking.  Aside from pain, the PT at the hospital said overdoing it too soon could cause tendonitis, which doesn’t sound good at all.  So my real challenge from here is probably to take it slow enough.

Total Hip Replacement 5: The Countdown

Two days until the big slice.  Three prescriptions filled (anti-inflammatory, muscle relaxer and the dreaded oxycodone).  Three OTC drugs obtained (Tylenol for when I can shed the oxy, baby aspirin for a blood thinner, and a laxative because everything else will stop me up).  Quick recap: for the woman who balks at taking a pain reliever, six kinds of medication are lined up on my counter, for after the three or four or more other kinds they give me at the hospital.  So, to make me feel better, a million natural remedies also procured (electrolytes, probiotics, immune stimulator, liver support, digestive aids, arnica pills, arnica linament, etc.).  One walker, one cane (borrowed from my mother, something poignant in this), and two ski poles, stacked up and waiting.

People keep asking me if I’m ready.  Well, I’m pretty healthy — working out and physical therapy have my muscles feeling loose and relaxed.  I’ve been eating well and sleeping surprisingly soundly.  I have all the aforementioned junk.  Friends have graciously offered to bring food and visit me.  So yes, I suppose I am prepared in the material sense.

I scheduled this thing a long time ago, which has pros and cons.  There has been a lot to do and arrange for, so that’s good.  It’s given me a lot of time to worry about what I’m facing, so that’s bad.  At this point, more than anything, I want to fast-forward to waking up in the hospital.  I actually don’t dread going through this; I’m quite sure I’m going to do fine.  But by now I’d rather be in it, facing it squarely, than sitting here wondering and imagining how miserable I might feel in any number of ways.  I hope I don’t regret saying that.

Today I looked at images for anterior approach hip replacements.  I was wondering where and how big my scar will be.  That was probably a mistake.  But there were two pictures I will hold on to: an older guy standing in his hospital room looking a little wobbly but genuinely alert and happy and untroubled a few hours after his surgery; and a young woman reclining in bed with her surgical dressing showing, giving the camera a relaxed and sardonic look free of misery.  Somewhere in between is where I expect to be.  Wobbly and sardonic.  Alert and free of misery.  So be it.

 

Total Hip Replacement 4: Pre-op Insomnia

It was pre-op week.  I had a two-hour “total joint replacement class” at the hospital, got my blood drawn, and had a pre-op visit with the surgeon’s medical assistant.  And I lost a lot of sleep this week, any possible connection?

The class was led by a nurse and a physical therapist.  Very nice, energetic, knowledgeable women.  They elaborated on the pamphlet my surgeon gave me, talking about exactly what we can expect from check-in through discharge.  They were positive and upbeat and clearly very caring, and I left the class with a cold clot in my stomach.  In the course of giving the day-in-the-life description and warning us what to do and not to do, they referred to so many miseries that can ensue.  Unchecked nausea, dizziness and fainting, unrelenting pain, drug reactions, falls.  They couldn’t help but tell a few war stories, like the guy who dropped his phone as he was preparing to leave the hospital the morning after surgery, bent over for it, fell and broke his femur.  Or the lady who threw up on the nurse or the one who fainted trying to walk.  I was the youngest in the audience by far and tried to console myself that I would have it easier than many, but on balance it was at least as alarming as it was educational.

The blood draw was thankfully quick and easy.  People often have trouble getting into my veins but this young woman was smooth and expert.  No one has asked me my blood type, presumably they’ll figure it out themselves.

Then came the pre-op consult.  Again, a very kind, cheerful PA.  Again, leaving with a chilled feeling.  Was it the talk of possibly coming out with my legs at different lengths?  Or her comment that the channel down the center of my femur–where the prosthesis inserts–isn’t very big?  Or her warning that I can never put my left leg in the Warrior yoga position again, but that I “should be OK” with positions needed in riding?  The list of 6 medications I need to have at home, including one that is only to fix the effects of another one?  Her comment to my husband that I may feel depressed during all of this?  Maybe it was my own visions of my slender femur shattering when they try to stick the implant in, or when I trip and fall over my cat.  “That would be a whole different story,” the PA said, shaking her head and making her best gloomy face, “not an outcome we want at your age.”

I’m all for informed consent and generally like to know more rather than less, but I’m ready for a sales pitch on this.  Where were the recent patients to tell us how great they feel, how they wish they had done it earlier?  Everyone I talk to who has had a hip replacement, or knows someone who has, says only great things.  It’s time for a few more of those conversations.  And a good night’s sleep.

Total Hip Replacement 3: Preparing for Surgery

I’m scared of this surgery.  I’ve never had surgery before, I’ve never even been in the hospital.  So it feels like a big deal.  And they’re not just removing a little something, they’re chopping off a hefty chunk of bone and replacing it with artificial pieces.  Makes me a little queasy thinking about it.

I’m mostly scared for two reasons.  First, I had a co-worker many years ago, fit and in her early 40s, who went in for a routine knee surgery to fix her ACL.  Two days later, a blood clot went to her heart and she died almost instantly.  So that freaks me out.  Second, I’m very sensitive to drugs in general and hardly ever take anything.  NyQuil once made me hallucinate.  So I’m scared of the effects of the onslaught of anesthesia, pain killers, antibiotics, blood thinners and whatever else I’m going to get.  I’m afraid I’ll be sick or unhinged for some time after.

And then there’s the joint replacement itself.  Will it take?  Will it work?  How will my body integrate it?  Will everything work right afterwards?  Will I be one of those few whose legs are noticeably different lengths?  At a dinner party, a nurse kindly informed me that sometimes the sciatic nerve gets damaged and you can never flex your foot again.  These things are not pleasant, but my functioning is impaired enough now that ending up slightly wonky doesn’t actually worry me too much.

So I’ve been preparing.  I figure the stronger and healthier I am before this trauma, the better.  So I’m exercising more (luckily I can ride a bike without much pain).  I’m faithfully doing the strengthening and releasing exercises my physical therapist has recommended for all the outraged muscles around both hips.  I’m doing gentle and therapeutic yoga to make sure I don’t freeze up, even though my range of motion is limited now and will be worse for a while.  I’m eating healthy and drinking lots of nourishing and anti-inflammatory teas and things.  Turmeric root and ginger root, for example.  Maybe I can even lose a few pounds.

I’m worried about my horses.  For the first week after surgery, my husband is taking off work and will be around to help me and do horse chores.  After that, it gets sketchier, and I have to do what I hate the most: ask friends and neighbors for help.  I don’t know how long before I should be walking around the muddy paddock carrying feed buckets and climbing through fences, but somehow I think it will take more than a week to get there.

I wish I knew better what to expect in that first week or two.  They tell you generally that you have to walk a lot right away, do your PT exercises, ice your leg.  There will be some pain and swelling.  You’ll have drugs to choose from.  You may need a raised toilet seat, maybe a shower chair.  But what will it actually be like for me and for how long?  I live in the mountains and I don’t know that the walker they recommend will go over bumpy dirt roads, so will I be confined to walking around the house for a while?  All I can do is pile up books to read, collect the equipment they recommend, and stack my Netflix watch list.  And wait to find out.

Total Hip Replacement 2: Diagnosis

I had an MRI on my left hip at the suggestion of my physical therapist.  I also made an appointment with an orthopedic surgeon specializing in hips.

I got a written report from the MRI people.  Here’s what it said:

  • joint effusion with synovitis
  • degenerative osteoarthritis
  • joint space narrowing and chondromalacia
  • subchondral cystic change
  • exuberant osteophytosis

OK, then.  I spent a lot of time with the online dictionary and learned that my joint was inflamed, there were cysts forming in the fluid parts of the joint, I had bone spurs forming, and greatly reduced space in the joint.  All of it was “moderately severe.”  At least my bone spurs were feeling exuberant.

My tendons were all intact, so the pain I’d been having was not an injury there, but some part of the arthritis complex.

I pretty much freaked out.  I was hoping for a nice little tear to the labrum fluid sac that could be fixed with a micro-surgery.  Or maybe just some inflammation that would respond to more PT and dietary changes.  This sounded much worse.

After fretting over the list of ugly words, I finally got in to see the orthopedist.  Of course I’d been on Google, so I had a list of treatment possibilities to ask him about.  PRP injections, where my own plasma would be concentrated and injected into the joint.  Arthroscopic surgery to do tiny touch-ups.  A thing called a partial hip replacement, that simply put a smooth metal helmet over the femur.

I’m sure doctors love patients who have been on Google.  I know I love it when my legal clients come in knowing all about the law applicable to their case.  Luckily, he was very patient, and luckily he showed me the X-rays first.

I don’t spend a lot of time looking at X-rays, but my left hip looked awful.  There was no visible space between the femoral head and the hip socket.  Everything looked jagged and chaotic.  He showed me another angle, where a bone spur the size of my fingertip was sticking out.  My questions about non-invasive measures dried up in my mouth as the doctor said there was nothing to do but replace the whole thing.  I believed him.

I asked him why this was happening.  I’m young for this.  I have not been an intense athlete.  I am a medium-sized person of healthy weight.  He showed me around the X-rays a little more, pointing out that my hip sockets are too shallow, and more vertical than they should be.  Hip dysplasia.  It was inevitable, he said.  It may have come a little faster because you’re an active person and have fallen from rollerblades and snowboards and horses.  But it was unpreventable.

I left in a bit of a daze.  I had still been hoping for some minor procedure.  I made an appointment for a second opinion.  Doctor two said the same things and reached the same conclusion.  I had few options but the total hip replacement.

The modern technology on this is called the anterior approach.  The incision is made in the front of your hip and your muscles are just pushed aside, rather than being cut.  This makes healing much faster and less painful.  He showed me the prosthesis — a very neat contraption with a titanium stem that gets inserted into the center of the femur and a ceramic ball on top that sits into a nice smooth cup made of plastic and metal.  They are expected to last upwards of 30 years, although there are some failures sooner than that.  If I’m lucky I’ll get into my 80s doing OK and then deal with what comes next in a new era of medical technology.

I didn’t wait very long before scheduling the surgery.  I couldn’t accept the grave limitations on my life.  And if I did it before the end of the year, it would cost me very little as I’d met my deductible and almost my out-of-pocket maximum.  Once I had absorbed the reality on those X-rays, why wait?

 

Total Hip Replacement 1: Symptoms

About two months ago, I learned that I need a total replacement of my left hip joint.  About one month ago, I scheduled the surgery.  In about one more month, it will happen.

I want to blog about it because I was totally confounded by my symptoms for a very long time and could not find any helpful information.  I also found very little specific information on what to expect with the surgery and the rehabilitation.  If these posts can help anyone else going through this procedure, I’ll be happy.

So how did I know my joint was failing?  I didn’t.  For a few years (a bunch of years if you go back to the very first unidentified twinges), I’ve had mysterious, shifting pain in both my legs and hips.  First on the right, then the left, then both sides, then the left again.  At first it was just now and then, until it slowly (over three years or so) became almost constant.  Sometimes my IT band was cramping, then it was my hip flexor, then an adductor, then the glutes.  I mostly noticed it on occasion when walking and, slowly, it got to be reliable on any walk over 30 minutes or so.

At the same time all this was going on, I noticed strange things happening with my left leg.  I did yoga regularly, and all of a sudden, I couldn’t do certain poses on the left side.  Anything that brought my left knee toward my chest or armpit, or anything that twisted my left knee toward my right hip or shoulder, was suddenly impossible.  And it hurt.  Instead of the expected muscles hurting — those on the outside of my left leg and hip that were being stretched — it was my left adductor on the inner thigh and groin that cried out when I tried to twist in its direction.  The adductor is supposed to relax when the leg moves toward the midline, but mine was screaming.

I also felt awkward and clumsy.  My left leg felt strangely weak and unreliable.  Sometimes it would suddenly give and shoot me a twinge of pain.  Standing up and making my way through a crowded restaurant or down the row in a theater was an ordeal — I didn’t trust myself not to fall into people.

This was all very strange.  I never felt anything resembling a swollen or stiff joint, only very angry, sharply complaining muscles.  So I got massage and acupuncture.  I had private yoga lessons.  I saw a Rolfer and checked with my chiropractor.  No one could explain my bizarre symptoms or why stretching and massaging weren’t helping.

It got bad.  I could no longer walk more than 20 minutes without a lot of pain.  I had pain after yoga class, pain after sweeping the floor.  I still thought I had strangely tight muscles for some unknown reason, but it was impairing my life too much.  And besides, I was healthy and in my early 50s, how could it be anything else?  Finally, a physical therapist I’d consulted said it reminded her of a labrum tear.  The labrum is the fluid cushion in the hip joint, like the meniscus in the knee and the bursa in the shoulder.  She suggested an MRI.

I’ll get into the details in another post, but suffice it to say by the time I had the MRI and took it to an orthopedist, he said I did have a labrum tear but that was the least of my problems.  Many of those confusing symptoms were part of the quickening failure of my joint.

I Googled my symptoms several times and never got anywhere.  If you know to look up hip arthritis you might find something, but if you have no idea what’s going on with you and you just put in hip flexor pain, you’ll get a mess back.  So here is my personal, unscientific list of symptoms that I think signaled the demise of my hip, in the hopes someone could find them and be helped.

  • loss of range of motion — your knee will not fold upward or cross-wise like it used to
  • instability — you feel wobbly standing on one leg or taking a step on one leg after first standing up
  • weakness — one leg is a lot weaker than the other; very obvious when climbing stairs
  • pain — unexplained pain and throbbing in any of the muscle areas surrounding the hip joint, like the hip flexors, glutes, piriformis, IT band and quads
  • groin pain — sharp or throbbing pain in the inner thigh or adductor muscle, especially up near the groin

Now that I know what’s going on inside, a lot of this makes sense, but it has been both confusing and discouraging for a very long time.