February 9, 2016 The Surgery and Recovery
Getting to sleep the night before surgery wasn’t easy. I’m a night owl as it is, and I was anxious. I took a valium to help me relax. It didn’t touch it. At 3AM I considered taking an ambien, but decided it was too close to when I was going to have to get up. Eventually I got to sleep, but not for long.
January 19 I arrived early for my 10.15 check in for my 12.15 surgery at the Swedish Orthopedic Institute. After a few minutes wait I was called back. Questions were asked, vitals were taken. I changed into the most enormous hospital gown ever. Seriously. Two of me could have fit in that thing, and that’s with my weight gain. My nurse came back with a cup of pills for me to take, looked at something, and then asked “What time were you told to check in?”. It turned out that even though I had verified the time the day before my surgery was scheduled for 2.40. Crap. I could have slept more. I was told this happens at least once a day. The nurse brought me a portable dvd player and a few movies. I watched Panic Room. I played Candy Crush. I surfed the web.
Eventually the anesthesiologist came in, followed shortly by Dr. Pritchett. Then my whole little room was full of people. They had a hard time getting an IV line in. They finally went with my left hand, because the veins in my left arm kept collapsing. I took the cupful of pills, and shortly was off to the operating room.
My anxiety increased once in the room. They gave me something for it through the IV. I could feel it, but it’s tough to relax when you’re about to have major surgery. I had to sit up for the spinal. Something about it hurt, and the next thing I knew Dr. Pritchett and the others in the room were all holding me in a hug like position (not an actual hug, but like that), and then it was done. I laid down. There was a bit more conversation which I no longer remember.
I awoke as I was being wheeled into the recovery room. The clock on the wall in front of me read ten to four. I looked around and it still read ten to four. I talked to the nurses. It was still ten to four. I concluded something was wrong with that clock. It still read ten to four. A little later I noticed the clock no longer read ten to four. Hmmm. A nurse brought me ice chips. I munched them right down. She brought me more. They were welcome. I interjected into conversations among the staff. Now I wonder if my speech came out the way I thought it did.
Some time around five the nurse determined I was ready to go to my room. However, there wasn’t anybody to take me. It took a good hour before somebody was found, so I it was about a quarter after six by the time I arrived to my room.
As a result of my late arrival I never had the day of surgery physical therapy where they get you up out of bed and make you walk for the first time. It was just too late.
The nurse gave me a general diet menu (the kitchen later told me there is a meatless only menu and brought it to me). (note: Swedish has an a al carte on demand menu; you order what you want when you want during open hours, and they bring it to you 30-45 minutes later.) Since I hadn’t eaten since the day before I’m ravenous. I ordered a hummus/olives appetizer plate, a vegetable and tofu stir fry with rice, and some little cups of almonds for snacks during the night, and a diet Sierra Mist. I ate most of the food quickly.
Some people experience nausea after surgery, even though they administer anti-nausea drugs intravenously. I didn’t have this problem at all, but be be forewarned: you might be sick.
After eating I dozed off in front of the tv. Dr. Pritchett wiggled my right toe and woke me up. We talked about the surgery. I can’t remember the details anymore.
During the night I dozed off an on. I slept a fair bit, but was awake for long stretches as well. The nurse checked my vital signs a number of times.
I was offered pain medication, and was told to request it whenever I want it. I was actually quite comfortable, and turned it down. I knew that pt would no doubt hurt, and decided to have a pain pill with breakfast. That way I wouldn’t get nauseous from the pill, and it would be coursing through my veins for pt. The nurse agreed that this was a good strategy.
January 20 Day 1 post-op My physical therapy and occupational therapy times were written on the whiteboard. The plan was for 1 pt and 1 ot session with a discharge that afternoon.
The physical therapist came and helped me get out of bed. I stood up for the first time and …red and green spots appeared in front of my eyes. I broke out in a sweat. My blood pressure dropped to 87/50. I was on the verge of passing out. The therapist and nurse set me right back down. I did not expect this at all. It’s called orthostatic hypotension. I had never heard of this, but apparently it’s not unusual that when surgery patients stand for the first time their blood pressure drops dramatically. Later I found out it happened to nearly all of that therapist’s patients that morning. After a little bit they stood me up again. My blood pressure dropped again, but not quite as far as it had the first time. Still, it was too far down for me to walk safely. They have to lay me back down. I can’t do anything else for pt.
A little while later the occupational therapist comes. She is aware of my blood pressure issue. This time I get up on the other side of the bed. My blood pressure drops once more, but not nearly as dramatically as it did earlier. We walk to the toilet, which I’m able to use (a must before you are released), and back. I notice I have a great view of Mt. Rainier from my room. I took a couple of pictures with my phone. Because of the blood pressure issue I was still quite unsteady. She was not able to take me to the room where they teach you to walk on stairs and get in and out of a car. I have to go back to bed.
At this point the original plan of discharge this afternoon was in doubt. My blood pressure kept dropping too much to walk around and do the necessary pt and ot things to leave the hospital. It was determined that Dr. Pritchett would have to come see me later to make the final decision.
I had lunch and another pain pill.
The physical therapist returned for the afternoon session. This time my blood pressure only dropped about 20 points, leaving it on the low side of the normal range. I was to complete the pt, and do all the exercises. Things went well enough that another ot appointment was scheduled, and it was determined that I may be going home after all.
The occupational therapist returned. Again, my blood pressure dropped about 20 points. Everybody was pleased that the drop is stable and workable. This was the first time I walked out of my hospital room. We went down the hall to the ot room. It’s a long way for me. A wheelchair was fortuitously sitting in the hallway. I sat in it, and she rolled me the rest of the way. I was taught how to get in and out of chairs. Stairs are important. I live in a split level house, and have to go up 15 stairs to get to the main level. It turned out going up and down stairs was not nearly as difficult at I thought it would be. Getting in and out of the car mockup was trickier. This was awkward, but I managed it. The ot took me downstairs to the tub shower mockup. Dr. Pritchett arrived while she showed me how to get in and out of a tub shower.
Since I am no doing so much better than I was in the morning the verdict is discharge.
The therapist took me back to my room and showed me how to get dressed with the dressing hook and grabber. I later forget everything she told me. Drugs. Prescriptions are obtained, instructions are given, both oral and written. I forget the oral. I forgot a lot of things the first few days. My neighbor arrived to take me home, and I was wheeled down to his car and transferred in. We stopped at a Thai place on the way home and ordered food to go. I got fresh rolls and Pad Kee Mao.
Another neighbor came over and helped me into the house. Going up the stairs was not a problem. I’m a little bit slow, but not unsteady. I decide to lay on my (elevated) chaise lounge, and perhaps sleep on it. Once I am alone I eat dinner, watch tv, and am besieged by cats. I decide dto get up. It was more difficult than I expected. I nearly fell. After describing the chaise lounge and my bed the occupational therapist told me that it would be easier to get on the chaise lounge and out of the bed, and harder to get up from the chaise lounge and into the bed. She was so right. I didn’t eat the fresh rolls, so I put them in the fridge and took my plate to the kitchen. Using the toilet at home for the first time wasn’t as easy as it was in the hospital. I realize it’s too high, and getting on and off is a bit of a trick. I later solve this by putting one arm on the left side. I decided to sleep in my bed. It was really hard to get on it. It required the leg lifter on my right leg, a big lift, and hard shimmying to the right. It was quite a trick. I almost fell.
I decided to leave lights on throughout the house in case I have to get up. I left the bedroom tv on all night, too. I never do this, but decided I was better off under these circumstances. I naturally sleep on on my back. I stick an accent pillow between my legs as you are supposed to sleep with you legs apart. This turned out to be unnecessary as it doesn’t take long for one of my cats to sleep between my legs and feet.
Just like at the hospital, I woke up on and off throughout the night. Sometimes this was with an alarm. The nurses advised me to stay ahead of the pain by setting my alarm every three hours and taking a pain pill. They informed me that when people don’t and they wake up to go to the bathroom they are in horrible pain when they try to get up. I take the pills every three hours. I still experience some pain when I inevitably have to get up.
January 21 Day 2 post-op I got up around 9 or 10. It was difficult to get up. Using the leg lifter is essential, but I still felt pain in my inner thigh. When I made it to vertical I marched in place for a bit before emerging. I thought I felt ok. It turns out I wasn’t. I can’t remember if I tried to feed the cats. I planned on making myself a peanut butter sandwich for breakfast. I couldn’t do it. I dropped my reacher. I had a second one, so I got that. A few minutes later I dropped it, too. I got the bright idea that I could probably pull one of the reachers up with my long handled shoehorn. I dropped it, too. I couldn’t hang on to anything.
I still had my fresh rolls from the night before, and they’re wrapped in plastic inside their container (thankfully). I manage to get them and a drink and myself to the chaise lounge. If I hadn’t had those fresh rolls I wouldn’t have had anything to eat. I couldn’t prepare anything.
I felt crappy on this day. At the hospital I was warned that for most people the third day post op was usually their worst day, and the day they felt the most pain. This was only the second day. There was more pain. All the IV stuff had worn off, and now I just have the oxycodone. The pain was most intense in my inner thigh. Dr. Pritchett told me he gave me some injections there (I can’t remember what for), and I could see the bruises. The outside at the incision area hurt too, in a burning sort of way. None of this was beyond tolerance levels, but it was there.
It was even harder than it was the night before to get up from my chaise lounge. I realized what the problem is: it was too soft. My hands keep sinking into it, and I didn’t have the strength to lift myself off of it. I nearly fell in the attempt, and felt sharp pain in my freshly resurfaced hip. I realized that I would need to get stronger before trying the chaise lounge again. I moved to my chair. The chair was much easier to get in and out of, although it’s not nearly as comfortable as the chaise. C’est la vie. Chair it was.
When my catsitter arrived she was concerned with my appearance. She told me I was deathly pale. (She used to be a nurse.) She made me two peanut butter and chocolate spread sandwiches. I ate one right away. (I later took the second one to bed with me.) I really needed that. She also retrieved all the things I had dropped.
When it was time for dinner I realized I couldn’t even nuke myself a frozen dinner. I called a neighbor who came over and did this for me. She could see that I wasn’t doing so well. I told her that tomorrow is supposed to be worse.
I dozed a fair amount this day. Because of the pain in my inner thigh I was not able to do all of my pt exercises.
This day was followed by another night of on and off sleep. I took my second sandwich, a couple of little cups of applesauce, and a bottle of water to bed with me. This turned out to be a great idea. Just being able to get a few bites of energy each time I woke made me feel better. I would recommend having snacks and water available during the night to anybody in the aftermath of hip surgery.
January 22 Day 3 post-op I felt better today. For me, at least, Day 2 post op was my worst day. I was able to prepare basic food for myself. My catsitter did get me lunch. I would have love to have showered. However, I have a tub shower, and there was absolutely no way my right leg was going over the top of that tub anytime soon. In the hospital they showed me how to get in and out of a tub. While I don’t recall exactly how (never give instructions to people on drugs), and I know I did it in the hospital, it’s not happening at home. My tub is taller, and the hospital drugs have worn off. I gave myself a very thorough sponge bath and changed into a fresh nightgown. This was almost as good as a shower.
The next few days Slow and steady progress. I did have one scary incident where I realized I couldn’t get up from my chaise lounge (too soft and no arms). I called a neighbor who came right over and helped me up. I decided not to try laying on the chaise lounge again until I’m stronger. The home pt exercises were still difficult, but less so. I started to back off on the drugs, but I still needed them. I continued with the sponge baths. On Monday January 25 I turned on my laptop for the first time since the surgery with the aim of doing some coding. I quickly discovered my mind wasn’t there yet. The drugs were definitely interfering with my higher mental abilities. Lesser ones, too. Example: A neighbor asked if I had any cousins. I do, and I realized that the previous night I had had a phone conversation with the cousin I am closest to. I had forgotten about this, and had absolutely no memory of anything we talked about. I started walking up and down the hall with my walker a lot.
This was also when the swelling in my leg really increased. I wasn’t surprised by this, as this is addressed on Dr. P’s web site, but it was strange seeing it happen. I even had a cankle. I’d never had a cankle. I don’t ever want one again. Besides the fact that all that swelling is unsightly, there’s only one way for that fluid to exit. I had to pee a lot during the recovery. Note: don’t wait for the commercial break. If you’ve got to go, just pause the tv. It takes a while to hobble down the hall. You can’t afford an emergency. I also expect that the swelling could make woven clothing tight or difficult on that side, but I alternated between nightgowns and sweats for the first part of my recovery.
January 27-29 I felt like I was really getting better here. While I had been getting better each day since the surgery in these few days I felt like my progress really amped up. I was more alert, stronger, and doing more for myself. I still couldn’t get into my shower, so on the 28th a neighbor drove me to my local community center. I’m a member there, and I swim there regularly, so they know me. The pool people all think I’m doing great for only nine days out. The community center has several “cabanas” which are large, private rooms with showers and toilets. In theory these are designed for families with children. One of them is a dedicated handicapped cabana. It has a large walk in shower with grab bars, a movable and adjustable stool, and a handicapped toilet. I take it over. This is the first time I’ve washed my (long) hair since the surgery. It felt so good to take a proper shower! But… I forgot my sock putter onner, and had to ask the pool manager to put my socks on for me. He didn’t mind. He put my shoes on, too.
January 29 I had my first follow up with Dr. Pritchett today. A neighbor took me, and we stopped for lunch at a local Vietnamese restaurant. I carried in my portable cushion to avoid breaking the 90 degree rule. I really wanted a bowl of pho, but then realized I couldn’t lean over the table to eat it. I couldn’t really move into the right position at the table, and if I did I would break the rule. I wound up ordering a noodle bowl and holding it up to eat from, just like when I’m sitting at home in my chair. Sigh. I realized eating in restaurants just wouldn’t be much pleasure for the next few weeks.
The good news is that according to Dr. Pritchett I’m doing well for ten days out. The x-rays look good, my walking is good, I’m ahead of the curve. I was cleared to drive as long as I am not taking any narcotics. I do still need pain pills, but not as intensely as in the first few days. I obtain a prescription for a less strong narcotic. I also got a prescription for physical therapy.
My big bandage was removed. Steri-strips were placed in a couple of places near the bottom of the wound. I was told not to put any creams of any kind on it. When the scabs fall off completely I am to email in a photo for approval to get back in the pool. No swimming until the wound is completely sealed.
January 30 I got in my car for the first time since the surgery. It was awkward. I had to sit on a cushion to raise myself high enough to not break hip precautions, plus I had to lean the seat back more than I liked. While I may be cleared to drive, as long as I am not taking any narcotics, there was absolutely no way I could move my right foot between the gas and the brake. I just didn’t have the strength yet.
The next few days I worked on my exercises, and I started to get some back and forth movement in my right leg. I continued tapering way down on the pain pills, only taking them on occasion. Every so often, usually at night, I felt an intense stabbing like pain near my incision. I had to take a pill when this happened. Otherwise, the need was greatly decreased. I was doing better mentally, too. I wasn’t forgetting things the way I was at first. While I was not yet up to coding I was able to start this blog. The history entries were all written during this week, as were the first few days of this entry.
February 4 I can finally move my right foot well enough to drive! I don’t know that I would want to drive a long distance, but at least I can drive myself to the community center for a shower, and to physical therapy.
I hadn’t yet made any arrangements for physical therapy as I needed to be able to drive to get to a pt appointment. This turns out to have been a major mistake. Getting a pt appointment in my suburb isn’t so easy. A therapist that I saw before, and was happy with, has moved her practice to Seattle. A clinic with an excellent reputation, that people I know have been pleased with, has no appointments available for at least a couple of weeks, and the therapist/owner of this clinic (who I’ve heard many positive things about) doesn’t have any openings until March. While I’m not really comfortable driving all the way to Renton (another suburb) I was happy with Olympic Physical Therapy, so I decided to contact them. I looked up their number only to discover they have been taken over by a national chain, and are no longer Olympic PT. So much for that. Said chain has also taken over another local chain that had a location in my suburb. I’m really not interested in going to the Mickey D PT chain. Unsure of what to do, I called my regular/local orthopedist’s office (not Dr. Pritchett) and asked where they are currently sending their hip and knee replacement patients. They recommend the outpatient pt at St. Francis Hospital. I am dubious about this. I called anyway, and got an appointment on February 11, which was sooner than I could get one at the pt clinic I would rather go to. This was still nearly two weeks from when I got the prescription, and I knew I needed the pt to really start making progress.
Between the time I saw Dr. Pritchett and started physical therapy I started walking – with the walker – around my block, and on the track at the community center. When I first started just making it to the top of the block was like running a marathon. It was amazing to me just how weak my right leg was post surgery. I know walking is helping to strengthen my leg. At home I rarely used the walker anymore, either the cane or nothing. This depended on distance and time of day.
The St. Francis Physical Therapy Rant Interlude So February 11 finally arrives and I’m able to start my physical therapy. Great. I go to St. Francis. All of their handicapped parking is along the curved driveway entrance. After a couple of loops I score one of the spots. I get out with my walker. I want to get on the sidewalk, but discover there are no curb cuts, despite this being a hospital. I walk in the driveway to the entrance.
When I get to outpatient services the receptionist hands me a pile of paperwork, and tells me to sit down and fill it out. I look around. Despite being a hospital, and a hospital that advertises its hip and knee replacements, they don’t have a single high chair for hip and knee patients. There is no place I can sit down. I point this out. The receptionist, to her credit, goes off someplace and comes back with a chair for me so I can sit down. I fill out the paperwork.
I’m called to go off with some other woman (I have no idea who she was or what she did) to her office to fill out yet more paperwork. She tells me to have a seat in the low chair. I state once again that I can’t sit in such a low chair, being as how I have just had hip surgery. After I’m standing for a few minutes she takes me to the physical therapy waiting room where they actually have high chairs.
I then get called back by the therapist for my initial evaluation and session. She takes me into a room and tells me to have a seat in the low chair. Seriously. In the past five minutes my hip precautions have not been removed. I was peeved. If you are a hospital, and you are performing hip and knee surgeries, and are offering physical therapy to this demographic, you should have the basic equipment to do so. This was ridiculous. I wanted to just walk out. When I have explained the whole hip precaution thing – again – to this therapist she decides to have me sit on the table. She adjusts it, and my interview takes place with my sitting on the table with my weight on my hands because, being a table, it is backless. This is not comfortable, or inspiring of any confidence on my part.
It turns out I am supposed to have specific “goals”. Recovering from the surgery and getting back to my old life does not count as a goal. Nothing is going to progress with this visit unless I can come up with three pat little answers. I can’t remember what all three were, but one was getting in and out of my tub shower. Satisfied, the PT starts moving my leg around, and asking about the exercises I have been doing. I tell her, and show her a little. She has me walk a bit. She agrees that I should start transitioning to the cane. She decides I should keep doing what I am doing, and add three more. The first is squeezing a pillow between my legs (10X 3x per day), the second is what she calls “mini-squats”, and the third is marching while standing. And that’s the end of the session. Seriously. This whole thing was maybe half an hour or so. I felt like I got nothing out of it. I asked if I would see her every time. She told my yes, except that sometimes I might see someone else.
At the pt front desk a schedule of twice a week visits was made. This was difficult. The scheduler told me that they were very busy and booked because they’re so good. In fact, they have a waiting list of people wanting their services, and they were only seeing me at all because I was a surgery patient. I had a hard time holding my tongue and suggesting it was more likely because the doctors at the hospital were referring all their patients there. She handed me the schedule, and sent me off. I wondered how much they were billing my insurance company for this. When I got back in my car I looked at the schedule. It was with a different person each time. Two of the appointments were with PTAs, and not PTs. I knew that my dubious feelings about St. Francis were correct. I called the place with the good reputation and scored an appointment on February 19, which was sooner than when I had tried calling before.
Since I still had two more appointments scheduled before my first one at the new place, I decided to keep my Tuesday appointment and give them one more try. It only seemed fair. This time I don’t score a handicapped spot along the driveway entrance. I have a hard time finding a parking spot at all, and finally wind up in a handicapped spot at one of the medical office buildings (still part of the St. Francis campus, but not the main hospital building). To get to the sidewalk there are no curb cuts. I have to take a step up, and walk on wet, uneven grass. This is a little bit scary with the cane. When I need to cross the street, really the main drive of the hospital, there is a marked crosswalk, but no curb cuts. Seriously. They have curb cuts at the mall. But the hospital??? I’m dumbfounded.
This time I only have to wait in the pt waiting room, where they do have high chairs. The PT du jour called me, and took me into their main exercise area and asked me to sit down. I could not freaking believe this. Once again I had to explain the hip precaution thing to the PT at a hospital where they do hip and knee surgeries. I wind up on a table again. I think that for their staff meetings St. Francis should make all their people sit on exam tables with their legs hanging off and their weight back on their hands. Really people, this isn’t comfortable, and it’s not respectful of a population you claim you serve (I don’t expect every place in the world to have chairs, etc. for hip and knee patients, but hospitals, orthopedist offices, and pt clinics that serve them should). The PT du jour goes over the copious notes from before, and has me do a few of the same exercises. Then she takes me over to the parallel bars and has me kick my right leg to the side a few times, and then to the front a few times. She decides I should add these to my routine. And that’s it. Since I have mentioned my fondness for swimming on the way out she shows me their Aquacizer, which is basically a contraption that fills with water that you then walk in. It’s like a water filled treadmill. I think it looks interesting, until I realize I will get the same benefit walking in the walking channel at the community center pool. The time from when the PT du jour called me back to the time I exit the building is between 20-25 minutes. When I get home I call and cancel all of my remaining appointments.
To say that I was unhappy with the St. Francis physical therapy experience is an understatement. From start to finish it was unsatisfactory in every way. It was bureaucratic in the way hospitals are. Despite advertising hip and knee surgeries, they lacked sufficient facilities for dealing with hip and knee patients, from sufficient handicapped parking, to curb cuts, high chairs in waiting areas, high chairs in physical therapy areas, and a staff that understood this. Both pt appointments, with both therapists, were horribly disappointing. The therapists were concerned with paperwork and notes. They did very little work with me. A different therapist each time means no continuity of care.
To anybody that finds him/herself in an unsatisfactory pt (or other medical) situation, do what I did: pick up the phone and find someone else.
At this point it’s been nearly three weeks since I saw Dr. Pritchett. While he thought I was ahead of the curve then, at this point I’m falling behind because of the lack of proper physical therapy.
February 19 I had my first appointment at the preferred physical therapy clinic. This was a much better experience. I was a bit suspicious when they didn’t have a chair for me to sit in (I can’t be the only restricted patient they have ever had), but they promise to have one for me on my next visit (they did). This therapist is way more on the ball than either of the ones I saw at St. Francis. My appointment also lasts a full hour. My assessment is much more thorough, and the exercises given are far more helpful. If I could go back I would have made an appointment here while I still couldn’t drive. It was worth the wait.
His surprise was not my weakness, which is typical for hip surgery patients, but my stiffness and range of motion. I’ve been so good at protecting my hip from violating the 90 degree rule that I’m losing ROM. This is not good, and is now a pt goal.
While I’m quite capable of walking without an assistive device, the therapist wants me to use the cane anyway. He points out problems in my gait without a cane, and that I walk more correctly with one. This is true, and something I had been struggling with for the past four years. I haven’t walked correctly since my accident in 2012. His opinion is that I should walk with the cane for a while, and cut back some of my walking, so that I learn to walk correctly NOW instead of walking poorly now and having to relearn proper walking technique later. I agree to go along with this for a while. I’m interested in long term success, even if it means taking a baby step back.
Late February I’m so much better now. The frustrating thing for me are the hip precaution restrictions. I feel like doing certain things, but not being able to bend over and the whole 90 degree thing is really a pain. Not only am I restricted in my seating, but chores like vacuuming, cleaning the cat box, doing laundry, changing bedding, loading/unloading the lower level of the dishwasher, etc. are all but impossible. There are ways to cheat a bit, by sticking my leg out and leaning over on the good leg, but it’s not effective for everything. These things are probably not a big deal for those with live in partners, but as a single person it’s a problem. I managed to rig together a long handled cat litter scooper with a painting extension pole, the scooper, and duct tape, and am able to reduce my dependence, not to mention the expense, of my catsitter, but I still have to have her take out the weekly litter, my garbage, etc. A neighbor from across the street comes over and helps me with the dish situation a couple of times. When she does my sink is full of dirty dishes. I don’t mean just from one meal, but with a good 2 -3 days worth of dishes each time. Nasty. She also takes pity on me one day and vacuums my upstairs (after a few weeks of no vacuuming and six cats it was bad) and helps me change my bedding. This is the longest I have gone without fresh bedding in my entire life. My sheets are just nasty. My surgical leg has been plagued by dry skin, and it has been flaking off onto the sheets. It’s visible. I’m grateful for the help. I knew going into this that I wouldn’t be able to do these things while restricted, but living through it is a different thing entirely.
March 1 My six weeks of 90 degree restrictions are over. Joy! I can do household chores! Tie my shoes! Shave my legs! Well, I’m not restricted, but that doesn’t mean I can actually do everything. I tried to shave my legs in the shower. This doesn’t work out at all. I can’t lift my right leg high enough to do the job, I can’t reach down low enough to do the job, and I can’t stand on my right leg securely enough to shave my left leg. Sigh. I either have to live with the fur and wait until I can physically do so, buy one of those long handled razor extensions, or have my legs waxed. Tying my shoes isn’t happening, either. I went to a technical meetup to celebrate. People that didn’t know I’d had hip surgery were amazed that I had, and those that knew were amazed at how well I was getting around. I drank a lot of bourbon. It was good.
March 3 My last tiny little bit of scab finally fell off. I’ve been waiting for this. Most of my scab has been gone for a while, but there’s been this tiny little bit, no longer than the width of a little toenail, that has been hanging on. It falling off means I can finally get back in the pool. I took a picture with my phone and emailed it as per instructions, only to get on out of office response as both Dr. P and his assistant are at a conference in Florida. Grrr. I called the office to see if somebody else could give me the ok. They told me no, but insisted that emails were being answered in a timely manner. Indeed they were. I got the official ok at about 1.50pm, and was in the pool by 2.15. My pool has a lift. I call it the “dunkerator”. This name has caught on with some members of the pool staff. As I was being lowered I noticed my legs are all too closely resembling those of a gorilla. It looked even worse wet.
I was nervous at first. Could I really still swim? I had a pull buoy in case my hip couldn’t take it. It was a little awkward at first, but then it was fine. I was slow, which wasn’t a surprise given that I hadn’t been swimming since before the surgery. I didn’t want to overdo it on my first time back, so I only swam about 20-25 minutes. It was still enough that I couldn’t get to sleep until well after 3AM.
March 4 I had my legs waxed and my toes done. They are now a luscious shade of lavender. My PT suggested I might try sitting to shave my legs. There’s no way to sit in my shower, and why? Salons have been invented now, and waxing lasts longer. Besides, I haven’t been able to cut my toenails since October. Might as well add waxing to the salon visits.
March During March I made a lot of physical therapy progress. My gait improved greatly, so no more cane, strength and ROM improved, I relearned how to get up from chairs, and I learned to walk up and downstairs like a normal person again. Strength is still a bit of an issue going upstairs, and I really need the rail, but I can go up using both legs.
March 25 I have an pt assessment/report with a new physical therapist at the same pt place (my previous one, who had just started, up and quit after just a few weeks on the job). While I’m still weak, I am greatly improved. When I started pt I could barely raise my right leg while lying down. Now straight leg lifts are easy.
March 28 I saw Dr. Pritchett for my scheduled follow up. I’m doing well. My bone has grown into the implant. It is a permanent part of me now. He is pleased with my progress. I questioned him about the leg length issue and the arthritis in my left hip. He told me my right leg is 10mm longer than the left. He doesn’t see this as a problem in the long run, and doesn’t think I’ll notice it in a few months. He says that my left hip is about 50% worn out. Since I have hip dysplasia, it’s not a matter of if it will need surgery, but when. We discussed scenarios for when that might happen, but it’s a difficult thing to predict. My next follow up is one year from now. I’ll be asking about the condition of my left hip then.
April 6 General thoughts about where I am now after surgery: I am not at 100%, but I am greatly improved. All of my pre-surgery pain disappeared with the surgery. It’s hard to explain if you’ve never experienced it. Before the surgery I was in 24 hour a day pain, from my back to my hip down the iliotibial band and all the way down the side of my calf. It was jarring. It was sometimes better, sometimes worse, but it was always there. No more.
However, I am still sore from the surgery, particularly in the groin/abductor muscles area, and in the incision area. The muscles are also still weak. I can do plenty of straight leg raises now(40), but not the sideways ones from a lying position. Although I can walk up an down stairs like a normal person, I still need the handrail going up. I just don’t have the strength to hop up them yet. I also can’t quite reach my feet to tie up shoelaces on the surgery side, although many people can at this point. I almost can. I can touch the top of my socks, and almost my foot, but that hurts. I’m told this is all normal, and that it will resolve over time. Dr. P told me that most people finally feel like they’ve put it all behind them by about six months. This seems realistic. I’ve had injuries that were more difficult to recover from than this (for example, see the injury described in the bottom entry; that was a far more difficult and lengthy recovery).
I do get better every week. Every week I realize there is something more I can do that I wasn’t doing the week before, and I don’t even think about it. I’m walking for exercise again, typically about 1 1/2 – 2 miles at a pop, and hope to be hiking by this summer. I’m still sticking to gentle, mostly level or gently sloped trails, but you have to start somewhere. I’m up to about 40 minutes straight of crawl stroke, followed by a series of pt exercises in the pool, and then about 15 minutes of water walking. I finish with a 10 minutes boil in the hot tub. My speed has increased quite a bit as well, but it’s not quite back to where it was. I never claimed to be Missy Franklin, so that’s fine. I like to increase my duration by about five minutes every one to two weeks, so shortly I’ll move up my time to 45 minutes.
Really, though, the recovery is nothing compared to what I experienced before the surgery. I’m glad I had it. I wish I had known that my real problem was arthritis all along. I would have had my hip resurfaced much earlier had I known. A century ago I would have wound up in a wheelchair at an early age, and probably turned into a blimp and died of heart disease in no time. So, yay! for modern medicine.
April 8 I had my toes done today. Now they are a nice vivid shade of blue.
April 11 Last week was unusually nice weather, so Wednesday through Friday I spent time walking in local gardens and parks. I’m walking around a couple of miles each time. Saturday I went swimming for 35 minutes plus pt exercises, and also took a walk for half an hour. Yesterday I did 10 minutes on the bike and then a two mile walk. I’m still weak. I really don’t think I could walk more than this, even though before all the hip problems this would have been nothing for me. My muscles tell me later that this is quite enough, even on the left (non surgical) side. While this is disappointing, it shouldn’t be a surprise. Except for my six weeks on the cortisone shot I was unable to walk even a fraction of this distance prior to surgery, so the muscles are coming back from almost nothing on both sides. I may not be where I was a few years ago, but I’m light years from where I was at the time of surgery. Plus, now it’s just sore and weak muscles. Sore and weak muscles can get stronger. The joint was never going to get better, and the muscles were only going to deteriorate more as I used them less as the hip hurt more, so I’ll take the weak muscles that can get stronger over the bad joint any day.
You may have seen those commercials advertising (the cure for) opioid induced constipation. At the joint replacement seminar I attended we were warned about this. They advised us to buy laxatives in advance. The hospital may even dose you with laxatives while you’re there.
A piece of advice: buy the laxatives and take them. In my entire life I cannot recollect ever being constipated. I thought the warnings were overblown. Uh, no. I was given plenty of painkillers in the hospital, and sent home with oxycodone (1-2 tablets every three hours as needed). This brought my bowels to a dead halt.
After I had been at home for a couple of days it occurred to me that I had eaten plenty of food, but there had been no output. I wasn’t uncomfortable in any way, but I did notice my belly was a bit distended. I decided to try some Miralax. Nothing. The next day I downed some more Miralax. Again, nothing. The next day I took even more. At this point I’m realizing it’s been an unhealthy amount of time since I let loose. So I took another dose.
Finally, late in the evening, I began to have the sensation that my time was a comin’. This turned out to be a marathon session. Years ago a friend of mine told me that giving birth was like “shitting a football”. Yeah. I kinda get that now. The whole process took so long I can only compare it to labor (it wasn’t labor long, but still). It was exhausting. I developed an appreciation for the phrase “ripping a new one”, because I was pretty sure I was doing that to myself. It was a workout of a type I hope to never have again. And then….holy crap! I truly shit a brick. I had never seen a single turd so huge. That thing could have been used as the cornerstone of a new skyscraper. The density must have been on a par with lead. Or even osmium. I had to plunge the toilet after that thing. And every fart for the rest of the night hurt.
So take those laxatives.
I had about three weeks to prepare myself and my house for hip resurfacing surgery. This is not much time at all. It was like preparing for a trip, but without going anyplace (except the hospital).
Dr. Pritchett’s assistant told me she would send me a packet. I expected an email attachment. Uh, no. It was a giant binder. There were a lot of things I was required to do. There were physical therapy exercises before the surgery. I had to schedule a pre-op physical. I was required to attend a joint replacement seminar at the Swedish Orthopedic Institute. (Note: I was easily the youngest person at said seminar.)
Because of post-surgery physical limitations, most notably no bending beyond 90 degrees for six weeks, there was quite a lot I had to do at home.
I live alone, which is something that neither the doctor’s office nor the hospital like to hear. They want to believe everybody is in some blissful 1950s nuclear family, with lots of people at home to care for you 24 hours a day. This is the modern world. It doesn’t always work that way. Some of my preparations were in consideration of solo living.
Many people like a recliner after surgery. Some people even sleep in them for a few days. I get this. Being two weeks post op as I write this I can see how I would have enjoyed a recliner. However, recliners just don’t fit with my decorating style. The piece of furniture I lounge on in my living room is a sofa with a chaise lounge on the right side (it can be switched to the left). This is My Spot, and is directly in front of the tv. You need to sit high up (restrictions) so I knew this wouldn’t work. I went shopping for a chair. I couldn’t custom order anything, so I had to take something in stock AND that would coordinate with my existing furniture. This was not easy. I finally found a chair that would do at Macy’s furniture clearance center. It wasn’t ideal, but it would do. If you are planning hip surgery I recommend seriously giving thought to what piece of furniture you will be spending most of your time in afterwards. It’s not like just anything will do. The chair I got was ok – I’m sitting in it now – but if I had had the time I would have ordered something different.
There are miscellaneous things you need to buy. Do a search for a “hip knee replacement kit”. There are various versions, some with more stuff than others. At a minimum you must have a reacher, a sock putter onner, a clothing hook, a long handled shoehorn, a long handled sponge, and a leg lifter. I use all of these things every day. Bungee shoelaces might be nice. I got some of these in my kit, and found them useful, but this will depend on your shoe situation. On thing I didn’t buy that I wish I had: something called the long handled comfort wipe. It’s for reaching toilet paper to the places one uses it. I have managed without it, but if I could go back in time I would buy it.
Pillows are another item you may need to buy, depending on whether you have an excess of pillows in your house. Pillows are helpful for raising the height of chairs. I bought something called the Seat Assist Deluxe Seat Lift Seat Riser Car Cushion Pillow with Black Cover. This is handy. It fits perfectly in a car seat, better than a regular pillow. It has handles, so you can take it into a restaurant. The exterior is some sort of black vinyl material so it can easily be wiped off. For my new chair in the house I’m using a cheap feather pillow I bought at Target. I bought a fiberfill stuffed pillow, but since it doesn’t conform the same way feathers do it has been useless. YMMV.
I bought some frozen food, and all sorts of snacks and soft drinks. I placed all the snacks on my kitchen counter. The key is to have as much stuff available at a reachable level. You will not be able to to reach all that far up nor down, so it’s key that you have as much stuff as possible where you can just grab it. I own cats. Knowing that there will be weight restrictions, I stocked up on cat litter. I bought a good 2-3 months worth of cat food and stacked it on my dining room table. Again, a reachable height. By the time I was done arranging everything my countertops and dining table looked hilarious.
I bought the toilet seat with removable arms. Having both arms on it didn’t work for me. I didn’t want anything touching my surgical side. I wound up leaving the left arm (non surgical side) on and have used this arm with my right hand on the back of my toilet for getting on and off. In retrospect the toilet seat I purchased adds more height than necessary. This is something you should check more thoroughly than I did.
I bought a few pairs of slipper socks with the non-skid rubber dots on the bottom. I’ve found these helpful. First off, putting on regular slippers, even ones you slide into, is not easy for the first several days or longer following surgery. Second, I have a wood floor in my bedroom. I was concerned that my bare feet would slip out from underneath me while I was getting in and out of bed. Let’s not forget they keep your feet warm, too.
I made arrangements with a cat sitter not only for the day I was in the hospital, but after my return as well. My litter boxes are downstairs, and getting to them, not to mention leaning over to scoop them out, is problematic for the hip surgery patient.
I cleaned, vacuumed, and mopped to the best of my reduced ability. Because of the post-surgery hip precautions you won’t be able to do any of this for a good long while. This means your house will soon turn into a pig sty. This is something you just have to accept, unless you have someone around to clean up after you, or you can hire a maid. My house is turning into a pig sty. Sigh.
A quick rant (and rave) for Joann Etc: I decided to buy a piece of foam to raise the level of my chaise lounge. I carefully measured it. The arm is curved, so I knew it wouldn’t be exact, but I figured that would be close enough. Foam comes in 24″ wide by 90″ long pieces. I needed one piece cut to 60 inches, and a second piece about 8″ x 30″. This is not a problem if you buy the whole piece. You cut one big piece, and then you take the other one and cut it the other way. The only problem is Joann has a corporate policy that they will only cut foam in one direction. There seems to be no logical reason for this policy. I could understand if you were leaving them with some odd shaped piece they could never sell, except I was buying the whole piece. I could also understand if there was some weird nap that made it emit some toxic chemical or something. But there isn’t. This is just one of the dumbest, most unfriendly customer service policies one could think of. The cutter wouldn’t do it at all. I had to get a manager, and plead with her for several minutes. Seriously. How does this policy make any sense at all??? I spent more time arguing over it than cutting it would take. The manager finally relented, and directed the cutter to cut it. I thanked the manager profusely. I really needed this second piece. The cutter pointed out the cameras in the ceiling, and told me that they are always being watched for things like this. Fascinating. Corporate management at Joann has nothing better to do than make sure these poor (and probably not well paid) employees don’t cut foam in the wrong direction? Excuse me while I roll my eyes to the heavens. Note to Joann: This is a stupid, customer unfriendly policy. Change it, and move on to more important things.
A big rave for Lowe’s: The Thursday before surgery my microwave died. I knew that after surgery this was going to be my major cooking appliance. I had to have a new microwave. Now. What I really needed was an over the range microwave, preferably a Samsung to go with my Samsung range. Over the past few years I’ve replaced every appliance except my OTR microwave. My previous OTR microwave had died on Thanksgiving a number of years back (great timing again). It was replaced with a Black Friday countertop special. This was what died, so now I had two dead nukers. At least it didn’t die after I had the surgery. That would have been a disaster. I knew my choices would be limited to whatever was in stock, and that getting it installed on short notice could pose a problem. First thing Friday morning I headed for Lowe’s and announced “I need a microwave stat”. At first they didn’t think this was possible, but the guy called, and the installer was just making up the Monday schedule, and they had one spot left. Now all I had to do was hope they had a decent nuker in stock. What I really wanted was the combination convection/microwave. It wasn’t even on display. Bummer. The guy (salesman who helped me; don’t know his name) went into the back, and wrote the stock numbers of what he did have in stock and came out and pulled them up on the computer. They didn’t have much. The first one was so plain and basic I would have been better off buying another cheap countertop model. The other one had more features, and was a lot more money. It was ok, but it wasn’t what I wanted. I told him I wanted the convection/microwave, and he said the only one of those they had was another brand. I looked at it, and it wouldn’t have coordinated with my range. At this point he plugged another stock number into the computer. It was a microwave that they were supposed to put on display, but it was still in the box so he had no idea what it was. It was the Samsung convection/microwave I wanted! Yay! Sold! It worked out perfectly. I got the microwave I wanted, and I got it installed the day before my surgery, and they hauled away both of my dead ones. That was excellent customer service, and I was a very happy customer.
I think this is about everything I did at home.
By the fall of 2012 I was finally recovering my injury back in February. Prior to the injury I had been an avid walker, hiker, and swimmer. I walked for an hour or so in the woods near my home on alternate days, and hiked in the mountains or out at the ocean during good weather. On the other days I would swim. My preferred routine was about 1/2 hours of breast stroke followed by 45-60 minutes of crawl. All that disappeared once I was injured. I was forced into the couch potato world, and gained about a clothing size over the next several months.
While I was able to resume some swimming several weeks after the accident, I had not initially been able to use my legs, but had used a pull buoy until I was able to kick. Around October/November I started to walk (for pleasure) again, and by November/December had built up to the 45-60 minute range. My swimming was getting stronger, too. I felt I was nearly recovered.
One December day I went for a swim. I did about 30 minutes of breast, and then switched to crawl. But during that first length of crawl something went horribly wrong in my right hip. I felt intense pain. It was like nothing I had ever felt before. I wondered if I needed to stretch it more. At the end of the pool length I tried stretching it, shaking it, everything I knew to do to get it to relax. Nothing helped. I swam, barely, back to the other side. I couldn’t continue. I got out of the competition pool and walked over and into the recreation pool (there are two pools at the community center where I swim). My leg got worse, not better. I didn’t know what was wrong, but I knew it was serious.
By the next morning I was completely incapacitated. I couldn’t really walk at all. I hopped. Badly. I could not figure out what I had done wrong. I decided to wait a day. No improvement. My regular orthopedist was on leave at the time (yes, I have had enough injuries I have a regular orthopedist), so I made an appointment at my local Virginia Mason with a hip specialist. She had recently started at VM, was focused on hips, and hip preservation surgery (this is her big thing). This seemed like the right sort of doctor for my problem.
My appointment was a few days later. I was feeling a little better, but not much. It started with a painful series of x-rays. I was told she was very particular about how she liked her x-rays. After x-rays I went to a room upstairs to await her presence.
A few minutes later her PA entered to take my history. I walked for her and told her what had happened to me. I also told her that I had previously sore groin/abductor muscles, like I didn’t stretch them enough. She made a comment like, “Yeah, back to your teens, even.” or similar. Well, yes. She wasn’t surprised at all, but I was surprised to hear her say that.
After another wait the doctor came in. She pronounced that my searing, debilitating pain was caused by bursitis. She prescribed an anti-inflammatory, and extolled the virtues of physical therapy for bursitis. She saw no reason to give me a cortisone shot for it, even though that may have immediately relieved the pain. She didn’t really like giving shots unless pt was tried first, and in her opinion if I just did the exercises I would be all hunky dory in another 3-4 months.
She also informed me that I had hip dysplasia, and that this would result in arthritis in about another ten years, and I would eventually need my hip replaced. I was shocked. I had only recently heard of hip dysplasia, and only knew about it in cats and dogs. I didn’t know that much about it. I most especially didn’t know humans could get it. I didn’t get much of an explanation, either. Her emphasis was that this was way off in the future, nothing I needed to worry about now. For my immediate problem I just needed some physical therapy, and to do the pt exercises on the paper she gave me. That was it.
After I got home and got over the shock of the hip dysplasia diagnosis, I did some research. This turned out not to be so simple. If you search for hip dysplasia most results are for animals, not people. Those that are for people are usually for dysplasia in children and adolescents, not so much adults.
I quickly discovered that I had been experiencing dysplasia symptoms for decades without knowing it. The big thing was the groin muscle pain. That had been a problem for years, sometimes worse, sometimes hardly at all. Since I was always so active I attributed it to improper stretching. It never occurred to me to go to a doctor for sore muscles that were indicative of something I had never heard of. I also experienced some weakness in the leg, occasional limping, some clicking and cracking. Again, all symptoms. Nothing was so serious I would have gone to a doctor for it. I doubt I ever even mentioned these symptoms when at the doctor for other reasons. And if I had? Would it really have made any difference? In any case, the eventual arthritis problems wouldn’t happen for about another ten years. This was December 2012.
I dutifully did the exercises. There was some improvement, but I never got all the way better. I had my good days, I had my bad days. I continued with the Celebrex.
Despite the pain, I decided I needed a vacation. I went to Costa Rica and Nicaragua for a few weeks. I had been to CR before, but not Nica. Since I had lingering “bursitis” pain I decided to make this a low activity trip. I mostly did ok, but there were about three days when the pain kept me from doing much at all. One of the highlights was a morning hike through the Reserva Biológica Indio-Maíz in Nicaragua. I expected it to be mostly flat. It was not. It was rolling hills. This was hell on my hip. I needed extensive help on this walk. My mind said yes, but my hip just wouldn’t move. A year earlier this would have been easy for me. Now, it took everything out of me (and quite a bit from the guide, too). It was frustrating and humiliating to not be able to manage this little hike. The good news was I saw a coral snake, and I’ve always had poor luck at seeing venomous snakes in the wild.
Not long after I got back, say around April 2013, I went back to the hip specialist. I explained that I had done those exercises religiously, but the pain persisted. I insisted on a shot. She once more extolled the virtue of physical therapy, and again insisted I would be better soon, but she did go ahead and give me the shot.
I received some relief from the shot, but nothing like what I was expecting. I wondered if I hadn’t quite directed the doctor to the correct spot. I did the exercises. I never got better. In fact, the pain grew worse.
So, back to the hip specialist for another shot. She refused to give me another shot. She said if it didn’t do the trick the first time, it never would, so it wasn’t worth another treatment. She pushed PT again. She gave me a prescription for a gel. She told me that she didn’t want to see me again, as I wasn’t a surgical candidate, and all I had to do was the PT to get better. I would be better within a few months. If I wasn’t getting better, then I wasn’t doing enough PT. I did not leave happy.
Looking back at how I felt I believe I had already developed arthritis by this time. Maybe I had bursitis in December, and maybe I didn’t, but by this time – early summer 2013 – I don’t believe there was a trace of bursitis in my right hip. This doctor should have listened to my pain. She should have realized something else was wrong. Instead she gave me the brush off.
I’m not naming this physician, but it’s not too difficult to figure out who she is. I have often thought of writing to her to discuss her treatment of me. Perhaps she didn’t realize the negative impact her attitude and diagnosis had on me. For the next couple of years I kept thinking it was my fault I wasn’t getting better. I wasn’t doing the right exercises, or not enough. I now know this wasn’t true. NO exercise would ever “cure” me. If she had recognized the arthritis the ultimate outcome may well have been the same, but the path could have been easier and shorter. Instead, her diagnosis left me with the delusion that I wouldn’t get arthritis for another ten years, and I truly believed that.
Needless to say, the pain never got better. No walking or hiking for me that summer.
Around August 2013 I started acupuncture. I had never considered acupuncture before. I am no fan of needles, but by this time I was desperate for relief. Acupuncture was listed as effective for bursitis pain. The acupuncture was no cure, but it did help with the pain. I don’t regret the acupuncture at all.
My acupuncturist noted my poor gait. He suggested I consider more PT just to work on that. My gait was indeed poor. Between the injury in 2012, followed by the bursitis, and no doubt compounded by the (in my mind anyway) dysplasia, I had a distinct limp. By this time, whenever I was standing most of weight was on my left leg. My right leg felt unstable. I was quite conscious of this, but there was nothing I could really do.
In early 2014 I started more physical therapy, this time with Olympic Physical Therapy. Again, there were times when things would get a little bit better, but the hip always got worse in the end.
After I ran through my physical therapy benefit for the year I enrolled in what Olympic calls Athletic Engineering. I refer to AE as group physical therapy, although this is not how it is advertised. The exercise circuit is core oriented, and many of the exercises were the same or similar to the exercises I was doing in PT. I liked the instructor. I kept on believing that if did the exercises I would get better “in a few months.”
By this time my walking had deteriorated quite a bit. I was slow, and I couldn’t walk long distances. However, I would have good days, and on good days I could walk a certain amount. Hiking was still out.
In August 2014 I had the opportunity to go rafting through the Grand Canyon. I had always wanted to do this. With my hip there were times when it was difficult to get on and off the boat, but I managed. Unfortunately I wasn’t able to hike much. I really wanted to do this, but my “bad hip” just wouldn’t let me. Too much instability, too much pain. It killed me to miss out on one of the key parts of the GC experience, but at least I could keep my ever expanding ass on the boat.
Aah, yessss, the other downside of the sedentary life: since my hip precluded the walking, hiking, and diminished the swimming, I continued to gain weight. When I saw pictures of myself from this trip I was appalled. I couldn’t believe I had gotten so fat.
In late September 2014 I went to Hong Kong. Again, hip pain prevented me from doing everything I would like to have done. There were a couple of days where I just went to the movies because I just couldn’t do anything else.
I continued with the AE. I never got better. I got worse. The Celebrex wasn’t cutting it anymore. In the spring of 2015 I quit AE. I liked the instructor, but my hip just wasn’t getting better. If my hip wasn’t getting better then what was the point?
Throughout the first half of 2015 my hip continued to deteriorate. I really couldn’t understand why. I did the stupid exercises. I lived for Celebrex Even though it wasn’t as effective as it had once been, if I stopped taking it within a few days I would be in agony. With it I still had good days. Unfortunately, my good days were quickly becoming like my bad days, and my bad days were getting worse.
What struck me as odd is that there were times I would be having a good day, and then I would move, and I would be in horrible pain and suddenly it would be a bad day. Or vice versa. While the pain was on a downhill slope, it wasn’t consistent.
One lovely spring night in 2015 I went to a meetup downtown. I knew I would be looking for a job soon, and I wanted to give taking the bus a trial run. I am not much of a bus person. However, I did understand the logic of taking a bus for a job downtown. From my local park and ride there is an express bus directly downtown. I discovered that even late in the afternoon it was pretty full heading downtown, but this was not a problem. I had to walk 2-4 blocks to the meetup location. I was slow, but I had time.
The meetup started fine. I ate and socialized, and then there was a presentation. Then something happened. I don’t know what I did, but my hip went out. Searing, horrid pain. I could barley move. Each step was so agonizing I felt like crying. It didn’t get better. Getting from that building to the bus stop was hell. I don’t know how I did it. I wished I had driven. I sat on a bench until the bus finally came. I crawled up the stairs, paid my money, and looked for a seat. To my horror I discovered that even at 9 o’clock at night the express bus was standing room only. I knew I had to get off that bus because I could not have stood on a moving bus for the nearly half hour ride home. The pain must have shown on my face, because a gentleman got up and offered me his seat. I was incredibly grateful. I stopped at Rite Aid on the way home and bought myself a cane.
That incident scared me. With my hip in that degree of pain I was dangerously close to being stranded or having to take a very expensive cab ride. At this point I realized that I couldn’t take the bus downtown. I couldn’t risk being without my car. Even on a good day my hip lacked the stability to risk having to stand on a bus. I needed to drive every place I went. I couldn’t consider a job anyplace that lacked parking or an elevator. My possibilities were becoming limited. This was not a good sign.
I took a trip to Turkey in June 2015. Again, there were random days when I couldn’t do much, if anything, because of hip pain. Other days I did quite well. My first day in Cappadocia was a bad day. It started out ok. I went hot air ballooning. I thought the baskets opened and one then walked in. Uh, no. There are footholds. You use them to climb over the basket. Crap. This didn’t work for me. There was not enough stability or strength in my hip. It took strong Turkish men to haul my ever expanding carcass over the top of that basket (and back out again). I’m sure this looked comical from afar. It felt embarrassing. I tipped well. I spent a good chunk of the rest of the day not doing much except lounging around my hotel. I went to the Goreme Open Air Museum. I was in so much agony I could barely walk into any of the churches. So many required walking up steep staircases I just gave up. By the next day I was doing better, took the Green Tour, and managed a lovely walk, albeit slowly. The last day I walked through the Rose Valley. While getting down into the valley was quite a trick, once in it I had no problems. I was slow, but it’s not like I had to be anywhere. I had built some rest breaks into this trip, knowing I was likely to be incapacitated on random days, so it mostly went ok.
It was obvious by this time that my hip had become substantially worse over the past several months. I had long since given up on the whole idea that if I just did more exercises I would be all better in “a few months”. I knew I needed to break down and go to an orthopedist. Needless to say it wasn’t going to be the hip specialist again.
My usual orthopedist was back from his leave at this time so I made an appointment to see him. I got my records from VM. Of all the x-rays taken they only gave me one, and it was so marked up as to be useless. Fresh hip x-rays were obtained. My ortho showed me the x-rays. It was at this point that I found out that my real problem was arthritis. I was shocked. I had been told that I wouldn’t get arthritis for several more years. My ortho was surprised I didn’t know I had arthritis. It wasn’t new. It was a fairly advanced case. He pounded on my bursa sac. No pain at all. All the pain and instability were from the arthritis, and the arthritis was a direct result of the hip dysplasia. All that PT had pretty much been a waste of time and money. It was never going to make me better. The hip specialist had sold me a bill of goods. I was truly living under a delusion.
My ortho recommended a shot, this time directly into the joint under fluoroscopy. He suggested that this could potentially last a good six months, and then I could have another one. I was also to continue on the Celebrex, and it would help if I lost weight. Sure, if only I could walk again.
I debated about the shot for a bit. It was going to cost me $ 800 out of pocket, and I was looking for a job as I was unemployed. On the other hand, who wants to hire someone with a painful limp? It might be illegal to discriminate on such a thing, but face reality: it happens, and it’s just one more reason for someone to say no to you. I figured if I got six months out of each shot, I could continue with them for a couple of years until I could move into a single level house.
I had the procedure in August 2015. OMG. This was the best I had felt in years. I kid you not. It was a taste of normalcy after years of pain. My gait returned to normal. I started walking for pleasure and exercise again. I bought two new pair of walking shoes in anticipation of autumn walks. The only pain I ever felt was when I started to incorporate HIIT training in my swim routines. The extra intensity brought twinges into my hip. I laid off the HIIT, and things were fine. I would say that I was about 95% of my previous self. After about six weeks I had built my walks up to about 45-50 minutes, and increased the average intensity of my swims. I even managed to drop a couple of pounds.
And then it was all over. I started to feel pain again. At first I hoped it was just the change in the weather. But no. The shot had worn off.
The pain returned with a vengeance. It was worse than ever before.
At this point I knew my options were limited. The so called conservative treatments were at an end. The Celebrex was barely touching my pain. Wonderful though the shot was, it didn’t last long. And at $ 800 per shot out of pocket it wasn’t a viable long term solution.
The only long term solution for hip dysplasia and arthritis is surgery. The standard procedure is total hip replacement. The problem with hip replacement is that they only last so long, and at my age I would eventually need another one, or revision as they are referred to.
The other option is hip resurfacing. Hip resurfacing is a similar procedure, but the top of the femur is left (they chop it off in a standard THR). There’s more to it than that, but one of the chief advantages is that bone is left behind. Hence, if there is a need for a revision later you have a lot more bone to work with. The lack of bone from a traditional THR is part of what leads to them being less successful. Hip resurfacing typically allows the patient more intense athletic activity as well. The problem with hip resurfacing is that there have been problems with them, especially the metal-on-metal implants, and especially in women. Not everybody is a candidate. So I had my doubts about whether this was an option for me.
In the meantime I couldn’t weed my yard. I never did fall yard cleanup because I just couldn’t. It got harder and harder to clean my house. Carrying up groceries, especially heavy items like water and cat litter, would just wipe me out for the day. I would run a few errands, planning on coming home and doing some coding. But just walking around and doing basic stuff was so painful and difficult that when I got home I would take a break in front of the tv, and still be parked there six hours later. The pain was that exhausting.
By late October/early November my hip started to hurt when I drove. It started to hurt when I would flutter kick while swimming. My daily living was being more and more affected. I’m sure it affected how I came across to people, too. Not just because I was limping, but I’m sure the pain affected my mood on a subconscious level.
I was also still looking for a job, and the job search wasn’t going as well as I expected it to. I still had this idea that I would get a job, and at some point in the future I would have surgery. I figured it might take me a year to build up enough sick time to have surgery, and I would just have to put up with the pain in the meantime.
The pain got even worse. I sleep on my back, but I sometimes roll over to one side or the other to take the pressure off, especially if I’ve been reading in bed a while. When I would roll to my left it would feel as if my right hip were being torn apart. I couldn’t roll to my right at all. I couldn’t cross my legs or ankles because, again, it felt like my hip was being ripped apart. The pain didn’t just stay in my hip, either. It would radiate all the way down the side of my leg. The right side of my butt would hurt. On bad days even my right lower back would hurt. I was miserable.
Chronic pain is exhausting. It is debilitating. It is difficult to understand if you have never experienced it. I was in chronic 24 hour a day pain.
As November 2015 passed I realized I was now defined by my pain. It was a part of my identity. It was ruining my life.
I would sit in front of the tv and the pain would be so bad I just wanted someone to reach into my hip and rip it out. I didn’t see how I could wait a year.
I didn’t want to have surgery, but I didn’t want to be in pain anymore. Not having surgery and not being in pain was not an option. It was one or the other.
Since discovering I had arthritis, I had researched doctors and approaches to hip replacement. I had decided that if I were going to have THR I was interested in the anterior approach. I wanted to meet with James Pritchett as a possible surgeon. First, I decided to meet with my usual ortho to see if he could offer me any other options.
So I met with my ortho on December 9. We had a long talk. There were no miracle drugs he could offer me. I was down to another shot, or hip replacement. I asked about hip resurfacing, but in his opinion they had been nothing but disasters. He was of two minds for advice. On one hand he thought I should continue with shots and suffer with the pain for at least another five years before hip replacement. The problem was my age. I’m too young, and I would need a revision. He also admitted that he wasn’t the one in constant pain. Or, I could go ahead and have THR, knowing full well I would eventually need a revision. He said I would be happy. I could have an active life again. Of course, the more active I was the faster the new hip would wear out. He felt that I was an excellent candidate for the anterior approach (he only does posterior). He agreed that I should get a second opinion, and that Dr. Pritchett would be an excellent surgeon for me (he was familiar with him, and had had dinner with him on a previous occasion).
By this time I no longer considered that waiting for surgery was a viable option. The pain was getting worse. This was fascinating to me. At the start of 2015 I was in pain, but I was still functional. By the middle of the year the pain had intensified, but I was still functional. Between July and December, excepting my six weeks of shot fueled glory, the pain shot off the charts. The acceleration of the pain was insane. I was hardly functional at all. Just a few months earlier I would not have believed I would be in this position. I didn’t even know I had arthritis until July. By this time I had gained a good four clothing sizes since my troubles began in February 2012. This was not a good path for my long term health. I knew that surgery was the medically sound decision.
This was a financially risky decision, as I was (am) living off of savings as I am currently looking for a job. I knew that realistically having this surgery would knock me out of the job market until mid February or early March at the soonest, depending on the surgery date and recovery time. OTOH the pain would be gone. I would be fixed. The hobbling wouldn’t be that extra reason for a company to say “no”. I wouldn’t have to worry about building up leave time. The whole pain nightmare would be over. I would have my life back. I knew I needed to take the risk. I stopped applying to jobs.
I met with Dr. Pritchett at 10AM on Christmas Eve. Practically the first words out of his mouth when he walked into the exam room were “You need surgery”. We talked a good 30-45 minutes. In his opinion my arthritis was quite advanced. He wasn’t surprised at all that the shot had only worked for six weeks. When I told him I hoped the shots would work for six months a pop so I could continue them for a couple of years until I could move into a flat house he laughed at me. He said there was no reason to plan and live my life like an old person. I was too young. I could get this fixed and have my life back. In his opinion stairs in the house were a good thing: going up and down them would help me recover sooner. He thought hip resurfacing would be a good option for me. I questioned him about problems with them, especially in women, plus the dysplasia problem, and he talked at length about this, citing various studies, his history, and the implant he uses from Synovo, which is not metal on metal. I liked what I heard. He completely allayed concerns that I had about resurfacing. We also discussed THR, its various approaches, and the longevity of the prostheses. The benefits and risks of resurfacing vs. THR was part of this conversation as well. His opinion was that either resurfacing or THR was appropriate in my case, and that he would perform whichever procedure I would prefer. It was completely up to me.
When I left I pretty much knew I was going with resurfacing. It was the procedure I was initially interested in, until I learned about the problems with them. Those problems would not be an issue with the Synovo implant. Resurfacing also left open the possibility that I might never need a revision. Their ultimate longevity is not yet known because they haven’t been out forever. However, if I do need a revision in the future there is the possibility of revising to another resurfacing implant, and the top of my femur is preserved in case I need to go to a THR. And one other thing: Dr. Pritchett is The Man for hip resurfacing. He has done 4400+ of them. He’s what you call anyou’re going to have major surgery, go with the expert. I discussed the options with a few select people over the weekend.
When Dr. Pritchett’s office opened after Christmas I arranged my surgery for the first available date: January 19.
February 25, 2012 was my last pain free day. I had no idea when the day started that it would end with an injury that sent me on a downward spiral that I have only now arrested.
The next day was the Academy Awards, and I wanted to see the last two movies with major nominations that I had not yet seen, The Artist and The Iron Lady. After playing with theatres and times I determined my best strategy was an early evening showing of The Artist at Westfield Shoppingtown Southcenter followed by a late show of The Iron Lady at a Regal Cinema a few blocks down the street.
Saturday night at the mall was busy. Lots of people were cruising for parking. I finally found a parking spot on the skybridge level of what was then a fairly recently built parking structure. I don’t think I had parked in that structure more than a couple of times, and in those instances I had parked on the ground level.
After The Artist I was hungry, and had just enough time to grab a quick bite at the Vietnamese restaurant before heading off to the next theatre.
After my meal, I crossed the skybridge and headed for my car. Perhaps ten feet from the skybridge I was no longer walking, but flailing midair and heading for the ice cold concrete. I didn’t know why, but knew I was screwed before I hit the ground. Searing pain shot through my right foot, ankle, and leg. The nausea was so intense it was all I could do to keep my food down so that I would not be writhing in my own vomit. There was no possibility of getting up. The mall was closed. It was a good long minute or two before anybody came by. Fortunately the first arrivals were mall employees, and one went off and got mall security. By the time they arrived I had become the evening’s entertainment for passersby. People: think twice before you stop, stand in a circle, and point and stare at the person writhing in pain. It’s not pleasant for the victim.
By this time I managed to figure out what had gone wrong. You know how when you come off a skybridge it is level with the garage? Well, the moron that designed the skybridge and garage at Westfield Shoppingtown Southcenter decided that several feet after the skybridge it would be just a grand idea to have an extra stair down to the garage. No warning, no rhyme, no reason, just a needless stair where one shouldn’t be. Since I wasn’t expecting a stair there as at no other time in my life have I experienced a stair several random feet after the end of a skybridge I missed it and went over the edge. Security informed me that I wasn’t the first person who did this. Bet I wasn’t the last, either.
Let me make this clear: I have nothing nice to say about Westfield Shoppingtown Southcenter, the moron who designed this parking structure and skybridge, their insurance company, or the idiots at the city of Tukwila who thought this was a great design, and up to code. It’s a horrible design and it should not have been allowed. It has caused injury and pain not only to me, but to others as well (as told to me by not only mall security, but other mall employees). If they were to suffer the level pain that I and others have I would bet my bottom dollar that the design wouldn’t have been allowed. At the very least this design flaw should be corrected. As long as it isn’t I suggest spending your shopping dollars elsewhere. I’ve never set foot in this mall since.
Security called in a meatwagon. The paramedics took one look at my foot and determined I had a broken ankle. I obviously wasn’t driving home. I had to go to the hospital. Here’s another design flaw in that parking structure: Ambulances can’t go above the ground floor. They had to bring the gurney up, move my carcass onto it, roll me to the elevator, take me down to ground level, and shove me into the waiting meatwagon. Yeah, can’t say it enough: very poorly designed parking structure at Westfield Shoppingtown Southcenter. Avoid this mall at all costs.
Off to the hospital I went. The doctors looked at it and went “Oooh! You broke that ankle.” Then they x-rayed it. Not broken. Everybody was shocked. My ankle had managed to roll both in and out and not break. I sprained/strained/generally messed up every muscle on each side, but no bone broke. I toasted my Achilles tendon, too. It was so bad (“profound” was the word they kept using) that they wanted to hard cast it. I decided against the hard cast, and went with a soft cast.
Going up the stairs to get in my house was one of the most painful things I have ever done.
For the next week I slept on my couch because I couldn’t make it down the stairs to my bed.
For the next month I wore sweats every day.
I was in physical therapy for months. I maxed out my yearly benefit.
At the end of physical therapy I still wasn’t healed. When I stood on two scales I was putting most of my weight on my left leg. In retrospect, I now know this was a Bad Sign.
April 28, 2016
I’d been feeling so good lately that I decided to drive down to California to visit my cousin. This is a bit more than 900 miles, depending on exactly which route you choose (and this is one of those cases where more miles equals less time). Since I hadn’t taken a pain pill in months I didn’t bring them, but did bring my cane. I should have brought them both. I’ve driven up and down the west coast countless times, so I didn’t think I’d have any problems this time. After I’d been behind the wheel a couple of hours I realized I’d really stiffened up. I sit at a desk much of the day, but I do pop up and down quite often. You can’t do this in a car, especially if you’re driving. I stopped at a rest stop and it was difficult to get up. I was stiff. I spent a few minutes walking around to loosen back up. This pattern continued. I stopped for dinner. Once again it was hard to get moving, but once I did I was ok. After dinner I never got out of the car again until I stopped for the night. I knew this was a mistake, but I just didn’t want to take the time, especially after dark. I could feel myself stiffening and getting more sore. When I stopped at my hotel (the Shilo Inn in Medford, where I will never ever stay again; seriously, the Super 8 in Medford is nicer) I was so stiff I needed my cane to get out of the car. I had only brought it as a ‘just in case’ deal, but I was glad I had. My hip did not want to move at all. To top it off they only had one handicapped space, and it was occupied. It took a lot more than just a few minutes of walking to loosen it up.
April 29 The painful stiffness of the night before was gone. I left about 8 and vowed to stop more frequently and for longer. I first stopped in Shasta City, and then Corning. I can’t pass up the Olive Pit. I had this idea I would have lunch before Sacramento, but I never did. I started to stiffen up and get sore again, this time increased because of the day before. By the time I stopped for something to eat I stood to eat it. I needed to get off my butt to feel better. By the time I got to the ranch (my cousin grows almonds and grapes outside of Fresno) I was hurting. If I had had my pain pills I would have taken one. I was surprised at how hard the drive was on my surgical leg. While I couldn’t take a pain pill, my cousin plied me with margaritas and time in the hot tub. I felt so much better.
April 30 All my pain from the drive was gone. I did all my PT exercises and walked around the vineyards and orchards. No problem.
May 1 Went to Sequoia NP. This was lovely. Mostly good weather, and I saw a bear quite close. According to the iPhone I walked over five miles while I was there. I didn’t do a concentrated hike, this was just walks at the various sights and viewpoints and in the forest. I felt no pain at all. The one thing I chose not to do was ascend Moro Rock. It’s 400 steep stairs, with not much of a handrail, to the top for the view. It was late in the day when we got there, and I decided it would probably be too much for me at that point. Had it been earlier I might have gone for it, but not after walking all day. Finished the day back in the hot tub.
May 2 Went to Yosemite. Another good day. My iPhone said I walked over four miles. Again, this is just walking around sights and viewpoints. I would love to go hiking – real hiking, not just sights and viewpoints – in both of these parks, but I’m fine with what I did. Three and a half months post surgery and I was able to walk over five and four miles on successive days. This is a success. Had I not had my hip resurfaced I wouldn’t have been able to do this. Both parks will be there when I’m ready for some serious hiking.
May 5 I drove back home. Considering how the drive down went, I knew the key for the return trip was to stop often and move around, and that I should break the journey at a reasonable point and move my operative side. Sigh. I just can’t take my own sensible advice. I was making such good time – much better than on the way down – I realized I could do it all in one shot. It was still light when I passed Roseburg. I couldn’t bring myself to stop, even though I knew better. The last few hours my right leg throbbed. It hurt. It told me to stop. I ignored it. When I arrived home I hurt so bad I expected I would need my cane to get out of my car, but I didn’t. I left my luggage in my car and just crawled into my own bed, accompanied by my cat herd.
May 6 I was still sore, and my right leg was visibly swollen. Had I had the good sense to stop and walk around more frequently, and spend the night instead of driving straight through, I doubt this would have been the case. I elected to drive down because I had been feeling so good. However, the prolonged sitting combined with the constant low level pressure of my foot on the gas pedal (I suspect if my left side had been my operative side it would have been easier) proved to be more difficult than I expected. This is something to consider if you’re planning a road trip soon after hip resurfacing. I know some people leave the hospital and need several hour long drives or flights to get home. I guess that’s what drugs are for.
May 12 My toes are now this really cool iridescent color someplace between fuchsia and purple.
May 23 I made the mistake of kicking off the end of the pool too hard with my operative leg. I did this a couple of months ago, and had to take the rest of the week off from swimming. I was concerned I had done something wrong. This time I had to cut my workout short, but the pain is gone before the end of the afternoon. So I’m still a little sensitive in the surgical area, but it’s nothing compared to before.
June 8 I finally did some yard work. My yard looks like crap. I never did fall clean up last year because I was in too much pain. Since I had the surgery in January I haven’t been quite ready for serious work. I’m leery of getting on the ground, and then not being able to get up. In PT we have been working on ground transfers, and I can get up from the floor, but that depends on me having something to hold onto. That’s not the case outside. There is nothing for me to grab onto. Sooo… I decided the best way to tackle the containers (where I grow my vegetables and annuals) is to sit in a chair and lean over. This is what I did but if forced me to bend more than my hip has been doing. I also leaned over a lot from a standing position. I was quite aware that I was bending my hip far more than I had previously, and way past comfortable. I worked as long as I could. I was hurting afterwards. My lateral hip muscles knotted up so bad they felt like a lump with a concave side next to them. I even felt pain down the back of my leg all the way to my foot. Clearly I went beyond what my hip was ready for.
June 9 Went swimming. My leg was still sore and visibly swollen from the yard work. It felt ok when I was swimming, but worse when I got out of the pool. I skipped walking in the channel and went straight to the hot tub. I sat in it a good twenty minutes or so. It did not help. I left limping.
This was the most pain I felt in months, much worse than the road trip. I was especially bothered by the cramped up muscles. I couldn’t do my side clamshells or leg lifts at all. I decided to take a flexeril to relax them. Problem: I couldn’t find my flexeril. I knew I had a few, but the bottle was nowhere to be found, and I looked all over. I gave up and took a prescription pain pill. It helped with the pain, but not with its cause.
June 10 S till hurting from my yard work. I broke down and emailed Dr. Pritchett’s office for some flexeril and Celebrex (for the inflammation). He was out of the office. Sigh.
June 12 Feeling a bit better from my ill advised yard work I do it all again. I transplant some flowers and squash, and sow some beans. I do more weeding, hack on some blackberries, etc. This time I take a lot of breaks and am more careful of the positions I contort myself into.
June 13 The day after I am feeling sore, but not as sore as last week. There is once again pain down the back of my leg to my foot, but it is not as intense. There is still some general swelling in my right leg. I can both feel it, and see it in the mirror. Good news: Dr. Pritchett is back, and has approved prescriptions for me for flexeril and Celebrex. I pick them up after my swim. I don’t feel the need for the flexeril now, but will take the Celebrex for the next few days for the inflammation. I intend to do a lot more yard work in the near future, so I suspect they’ll both come in handy.June 14 It’s been 21 weeks since I had my surgery. Overall I would say I’m doing really well. I can walk for miles at a time. I can swim better than most people who have never even had hip surgery. The soreness that I experienced post surgery is all gone. The stiffness upon standing after sitting for long periods is gone. When I tell people I had hip surgery just a few months ago they’re shocked. They can’t believe how well I’m getting around. However, I’m still not 100% yet. My right leg is still weak. I notice this on hills, and I live in a hilly part of the country. As I mentioned, I can walk for miles, swim for 45 minutes, do loads of leg lifts, and still my right leg is significantly weaker than my left. I still have range of motion issues. I still can’t quite tie my right shoe. This is driving me crazy. I’m probably about an inch away from that. I still need to be cautious with the amount of pressure I put on my right side. I wouldn’t forcefully hop on a shovel, for example. Unexpected things cause me more problems than I expect. I didn’t expect the road trip to be so difficult, and I didn’t expect the gardening to cause the problems it did, either. Both of these are self-inflicted misery, however, and not a result of the surgery per se. It’s like some things have healed quickly, and others are lagging behind. There doesn’t seem to be any rhyme or reason to what’s better and what’s lagging. I suspect everybody has their own quirks with their recoveries. So, altogether much improved, but still some physical therapy goals to meet.