December 19, 2010 I’m 6 days post-op, RBHR, with Dr. Robert Gilbert in San Francisco. The surgery apparently went really well — Dr. G said my 45/50 BHR was a totally perfect X-ray in terms of optimal positioning — which I was VERY glad about because I’m female and was worried about the metal wear problems from problemmatic placements.

Dr. Gilbert isn’t listed among the expert resurfacing docs, but he is one…. When I first saw him, he’d done 280 BHRs, and has been doing so many that now he’s surely over 300. He said he’d had two failures (both fractures, I think) and they revised to THR with keeping the acetabular cup from the resurfacing. He’s known at California Pacific Medical Center as a very talented senior surgeon, and he and his team were top-notch.

I’m recovering very well in terms of weight-bearing, ROM, strengthening overall, etc. I’ve had two problems, one expected and one not. The unexpected (I’ll admit this here among all of you): initial poor continence. For about 3 days since they took the catheter out, I would have urgency to urinate and barely be able to hold it, or to start losing it just before reaching the toilet. I was dismayed about this until I realized that of course the bladder sphincter and related muscles are in the groin area, and my groin was bruised and swollen from the surgery, so (duh) these muscles and reflexes might not yet be online. It’s gotten better, but it made the first few days rough because I would suddenly, very suddenly, have to go to the bathroom and yet had to stand up (the transition in what’s difficult) and hobble to the bathroom. I can’t quite yet sprint…. So, I’ve gotten a portable commode that I stand near my bed, and though I don’t 100% need it anymore, it’s very useful for nighttimes.

I hadn’t read about this problem anywhere, and I wonder if other resurfaced women have had it.

The second problem is PAIN. I had a spinal, and though I was standing up (weight-bearing!) four and a half hours after surgery with no pain, the spinal soon wore off… and I haven’t not had at least level “5” pain since. I was prescribed Vicodin, and though I’ve been taking slightly more than the Rx directions (which were a 7.5/325 ever four hours), the pain level sometimes creeps higher (to 7 or even 8, when I start to cry), especially in early morning and in late evening. It is exhausting. The home nurse told me on Post-Op Day 5 that a “5” level was not good enough, that it’s better for healing not to have so much pain, and that I should call the doc. He was out, but another doc in the practice prescribed Percocet. Not much difference at all.

Part of the issue is that I’ve had on-and-off chronic migraines for many years, and my body is both very familiar with narcotics (unfortunately) and, since pain breeds greater pain sensitivity, I have a lower threshold. So they don’t seem to be having enough impact. I’ve taken a lot more opiate meds for my migraines than I’m taking now for the hip, but I still don’t just want to ratchet up without guidance.

I’m using ice nearly all the time, and that does help some, and my spirits are generally very good (I live alone but have had lots of friends visiting to help). I just wish I could have even a break from all this pain. It’s Saturday night right now, and I won’t be able to reach my doc til Monday.

I’m exercising reasonably, haven’t injured it, generally doing everything right, it seems… and yet. The pain is in the bone and soft-tissue area, plus down the entire leg and also in the groin.

Sigh.

And I dropped my i-Phone into a bowl of chicken soup, but that was kinda funny. After fluttering through a bunch of screens (like fluttering wings), the phone seems to have survived….

BC

December 20, 2010 I’m only 8 days post-op, so I don’t know much, but I’ll pass on what my surgeon, Dr. Gilbert (San Francisco), advised that could be relevant to your situation. He said the worst thing people do after resurfacing is sit in a regular chair. He said we should recline when not walking. I don’t know if this is tissue healing, hip joint healing or blood clot avoidance, or maybe all three.

A couple days ago I tried sitting at my kitchen chair for 15 minutes or so, and I felt a kind of numbing in my lower legs, which made me nervous. I went to the sofa and put my legs up, which helped.

I too have a desk job. My main concern won’t be getting to/from work but the length of time just sitting. I had my surgery on 12/10, and I’m scheduled to return to work half-time on Jan. 10; I’ve left open the possibility that this could be working from home. I’m supposed to return full-time as usual on Jan. 17. If sitting is still uncomfortable, I’ll get one of those big plastic chair-balls, or rig some pillows and foot rests or something.

I want to recommend Dr. Robert Gilbert at the California Pacific Medical Center in San Francisco. When I first met him a month ago, he said he’d done 280 HRs, all BHRs, and he’s been doing a few a week, so rapidly growing this part of his practice. He’s known as a senior surgeon at CPMC and has won a “patient choice” award. I think he has been the head of orthopedics at CPMC. He hasn’t advertised resurfacing operations as some docs do, but now he’s doing LOTS of them. Right away he told me the number he’d done, the failures (2), the reasons why (femoral neck fractures, women), and what he did about them (both revised to THR successfully, keeping the acetabular cup). He uses spinal anesthesia, which worked very well for me.

He’s no-nonsense — precise, clear, concise, very focused in his demeanor, just what you want in a surgeon — but I wasn’t intimidated; he was friendly and available for questions. In fact after my first appointment he told me to call him because surely I’d have more questions after I reflected on everything. We ended up talking one evening, and though he’s a busy man (he had done a few resurfacings that day) and I didn’t want to dally, I felt I could ask all my questions.

He also told me how the operation itself worked, for instance how the bruising and swelling in my groin and inner thigh were from the machine that essentially squeezes my body when it’s lying on its side so I’m held absolutely still as they do the operation. Afterwards I saw all kinds of lines drawn on me… this surgery is like geometry.

Also important is the overall surgical team. The nurse who pre-admitted me over the phone spent a ton of time was me and was so friendly. The anesthesiologist spent lots of time with me the morning of the surgery. The PA (?) who held my hand and steadied me as they did the spinal anesthesia was calming and gentle. The nurses during my 4 days post-op (at my request and surgeon’s recommendation I stayed an additional day for more PT) were extremely attentive. I never had to wait more than a moment after ringing the call button. Really, every CPMC person I dealt with — and there were a lot — was terrific.

Two days ago, on a rainy Friday, Dr. Gilbert’s assistant, Alisha, personally brought me a new prescription (for narcotics, so couldn’t be called in) on her way home since she was driving to Berkeley to get her kids, so I wouldn’t have to find someone to drive into San Francisco or wait the entire weekend for a different pain med.

When I walked into the operating room and looked around at the blinking machines, equipment, and several people preparing for the surgery, I thought WOW… I can see why this operation costs so much, and it’s worth it… and I realized I would be so nervous if I didn’t trust the surgeon and team. But I felt quite calm because I DID trust them all.

December 22, 2010  I’m 12 days post-op. I had the self-absorbing stitches/glue, plus Steri-strips that I was told just to leave on til they fall off. They’re still all on. I’ve been keeping them covered very loosely with gauze. Two days ago the incision area started to get very itchy. I thought that was just healing, and though sometimes I would rub slightly AROUND the incision (not even as close as the Steri-strips), I haven’t touched the incision or Steri-strip area. Today when I went to take a shower I saw the skin around the incision, both under the Steri-strips and around, is raised and red, a little shiny, and very itchy. The home PT looked at it and said it didn’t seem like an infection per se in the wound (no drainage or extra pain), but definitely a skin reaction. Both she and my sister, who is a Physician Assistant, said I should go into see the doctor since we don’t want to have ANYTHITNG going into the prosthesis. And a holiday weekend is coming up.

December 28, 2010 What would do we do without this website? I’m so grateful. Today is one of those emotional days. I’m 18 days post-op, RBHR, and getting around quite well (one crutch or cane), but sometimes the whole thing — the whole blow to one’s health, youth, etc. — feels overwhelming.

I’m still having quite a bit of pain, and taking Percocet though about to run out; I suppose the pain is an underlying drain on energy. Then today I got a call from my general practitioner that she’d received my labs from immediately before the surgery and the hospital stay, and that I’m severely anemic. No one had told me that before, though I did end up needing a blood transfusion the day AFTER surgery because the hematocrit (?) count and blood pressure dropped so much. Also, the bone density scan I had before surgery showed that while my hip bones were strong, I had early osteopenosis (sp?) in my lower back. The surgeon was surprised when I said that I didn’t take calcium or vitamin D supplements, though I’m a 47 year old woman.

I’ve hardly ever taken supplements of any kind, only fish oil occasionally, because I’ve been so active and eat very healthily. I live in the SF Bay Area, what has to be one of the food capitals of the world for healthy food. I starting taking iron two weeks before surgery, but I’ve been nervous about starting calcium and Vitamin D3 because of the risk of calcification around my new BHR. (I wasn’t given Indocin post-op.)

Is this something to be worried about? I have an appointment this week with my general practitioner, and I suspect she’ll give me an Rx for combatting the anemia. Do any of you take Fosamax or any of the prescription bone-health meds? How do you know if you start to have calcification? What does that mean?

I suppose what’s really going on here, emotionally, is feeling out of control of my health, and overwhelmed at having to add a variety of supplements to a regimen of already taking various meds daily to prevent and sometimes treat regular migraines. Life already is complicated; I have a really demanding job, plus relationships, plus writing a book, plus just the stuff of life that we all have, like finances and paperwork. I’m really tired, and I know that when I’m feeling stronger I’ll be able to see meds and supplements to build up my blood and bones etc. as simple and positive things, which of course they are. At this moment I just feeling like crying and lying down… I’ll do the lying down part….

December 30, 2010 Yesterday, 19 days post-op, I walked up and down my block MOSTLY WITHOUT CRUTCHES AND WITHOUT MUCH LIMP! I carried the crutches, of course, but found it quite easy just to walk. I tired quickly, and tiring means sloppiness in gait (my operated leg tends to roll in without its old hip-capsule musculature), so I mostly am using a crutch or cane as it continues to strengthen. Still, very encouraging!

Pain definitely still there — still wakes me at night aching, and is worst by far in the morning — but there’s a gradual lessening. This really is a long recovery; I can tell I’ll be working on strengthening abductors etc., and very carefully improving range of motion, for many months ahead. And of course taking extra care to prevent falls… I’ve never really liked downhill skiing anyway…! But beginning to see a light at the end of the tunnel.

I’ve studied Buddhism on and off for years, and I’m trying to use this experience of facing limits and mortality as a “practice” for appreciating the things of life even more. I’ve always been very strong and carefree, seeming much younger than I was (47), traveling everywhere, kind of like a 20-something guy in some ways — the “live forever” attitude. Welcome to reality. My father’s death last week has added to the sobering note. It’s been quite a year.

I’ve also experienced a great increase in community — friends helping me out post-surgery in my newly-adopted Bay Area region, sisters coming together around my father’s death, and these online forums as well as offline connections through them. The stuff that life is made of.