Kirk M’s Hip Resurfacing with Dr. Su 2011

June 12, 2011

Well, things could not have gone better. Dr. Su said the bone density was good and he just had to clean out a couple of small cysts. The whole process was incredibly efficient and literally pain free. There was only one glitch in the whole thing, they had way over-booked the rooms and I had to spend 8 hours in recovery. There were some people who had to stay there overnight. That was the only place they dropped the ball, but they dropped it big time. It was rather surprising they were so poorly organized there when every other step of this experience was probably the most efficient thing I have ever seen. However, they did bend over backward to compensate for it all, which also shows that they are willing to be accountable for the entire process.

Dr. Su is so real. No God complex, completely straightforward and just a really nice guy. He spent time with me pre-op and allowed me to ask all the questions I wanted. All of the HSS staff here are incredibly nice and attentive.

I really haven’t had any pain, per se. The only discomfort is sitting in the bed on the wound. It doesn’t hurt, it is just annoyingly sore, like if you spent hours and hours sitting on a cement bench or something. They cut me off of the epidural this morning and gave me oral Percoset. That stuff ROCKS! No pain at all, not even sitting on the wound.

PT starts today later on in the morning and I am anxious to get up and move around. I really feel amazingly good. I am just getting tired of laying on my back all the time.

June 13, 2011

Dr. Su said I needed to be very careful the first 3 months and then SLOWLY build athletic activity back up during the period between 3 and 6 months. Barring any unforeseen complications, he said I can run at 6 months.

I have already decided to be on the conservative side and not even think about running until WELL AFTER the 6 month mark. My plan is to get past the 7 or 8 month mark and then, when I get out and walk, inject a minute or two of easy jog every so often. From then until the year mark, I will just do a little more running and a little less walking as time passes until I am back to running the whole workout.

I did a bunch of walking around my hospital floor today. It was really great to periodically get up and move. Learned climbing stairs with the forearm crutches too. I really like those type of crutches. For me, they are much more natural feeling. I should be released tomorrow and will spend another week at the Belaire. Truly, this has been much easier than i thought it would be. It’s not exactly a party, but my shoulder arthroscopy was more difficult as far as recovery goes.

And the staff at HSS is really incredible. I really couldn’t ask for more from them.

So, tomorrow they release me out into the wild.

June 20, 2011

Dr. Su has no 90 degree rule. Most resurfacing surgeons threw that out a while back. It was a relic from small-ball THR’s that tended to dislocate easily right after surgery so it doesn’t apply to large head MOM devices. The PT at HSS had me on a lifecycle with low resistance at day 5 and each session after that. It felt great. I am going for a 30 minute light spin again today at the gym. I will probably put my tri bike on the trainer this week and do more cycling at home. It is just easier to get on a step-through lifecycle right now as I am only on day 9. You will be surprised at how much you can do and how soon.

June 23, 2011

I got the OK from Dr. Su’s office to do 30-40 minutes on the trainer at very light resistance. They did say to stop if anything got sore or gave me warnings. I was 10 days out and did 30 minutes total. I rode for 10 minutes, did some light stretching and then rode for another 20. I then did my PT exercises in the gym stretching area. It all felt pretty good, although I was a little tired after that. I didn’t pay any big price for it the day after either.

Yesterday was 11 days out and I walked 2.3 miles in 1:02. Not as fast as I could go, but I think it is more important to focus on form and gait and also not strain things at this early juncture by pushing hard. I still always walk distance with two crutches (forearm type), even though I can walk very well with just a cane. I only use the cane for around the house and use the two crutches to practice even gait and balance when doing the “mileage”. It’s like anything, you don’t want to do a ton of mileage with bad form since all that does is teach you to do it improperly.

I would love to ride my bike, but at this point, I can’t see getting on it for many weeks. There is just too much at stake to get impatient and stupid. I will get on my road bike when I can do full sprint intervals on it when locked into the trainer. Again, I don’t see that happening for many weeks / months. Don’t know about your pedals, but with my speedplays, clipping out is the least of my worries. I can easily rotate my heal outward at more than 45 degrees with no pain or problems. I will be back in the gym today for the same routine as Tuesday and may kick it up to 40 minutes. My goal is to get to an hour and then put on very slow increases of resistance over time.

I saw a lot of talk about ice machines in the forums but it was never discussed with HSS or Dr. Su. They ice you the whole time you are in the hospital and then you just get a couple of large, reusable ACE ice packs and use them all the time for the first couple of weeks out of surgery. I had virtually no swelling and the tiniest little bruise just below the incision that only lasted a few days. I went off the painkillers at day 3 and never took anything since, no Tylenol, Advil, nothing. ALWAYS ice for the first few weeks and ALWAYS after doing any walking or PT. It will make all the difference in the world.

July 6, 2011

I was walking without a cane or crutch around the house (with a limp) at a little before 3 weeks. That was just last week. I am walking 3.3 miles at a stretch with a cane but lift and carry it much of the time to practice walking squarely. Haven’t got the wobble out completely yet, but I do notice a little bit more strength and less limp every day.

Eitan is quite right, don’t really look at progress on a daily basis, just focus on working at things on a daily basis. I still get up every day hoping I will feel completely done and strong. Of course, that isn’t the case, and when I get frustrated by that, I remember how it was just a week prior and realize how far I come every week.

To me, the surgery is the easy part. Putting all the outdoor activities I love on hold during these perfect SoCal summer days is torture!

The good news is that the time does start to fly by the further out from surgery you get. And just to further repeat the refrain stated many, many times here:
DO NOT use any one else’s recovery as a standard for “normal”. Whatever timeline suits your body and your circumstances is normal for YOU. Be patient and be smart and you will soon be one of the people posting down the road that says they don’t even remember they have the thing when they are out doing all that they want.

July 13, 2011

 I always qualify my fast recovery by saying that I am a freakishly fast healer and, probably more significant, I was fully mobile and active all the way up to surgery. I think that is the biggest thing. Most people needing resurfacing aren’t so fortunate and are in so much pain that they can’t do much beforehand. I was keeping in what I call “Half-Ironman shape”. I was swimming 7500 meters per week, riding 100+ miles per week and (up until a few months before surgery) running 15 miles per week. The running was a bit painful for the last couple of years, but nothing that stopped me. It started to get worse late last year and so I stopped running on land and started deep-water running to prevent trashing the bone right out of being able to get it resurfaced.

Regarding the walking and stride – I could pick up both my crutches and take a few steps at a time by day 3. It was sore and I was favoring the operated side, but I could do it. I was tempted to push it, but decided to work with the two crutches and focus on walking dead even with them so I wouldn’t create a habitual limp from the start.

Two things about this I feel are important. First, use forearm crutches. You can walk much more naturally with them than the underarm type. Second, just like with good running form, push you pelvis under you and line up your shoulders with it. Do not hunch forward with your shoulders onto the crutches. Then you “walk light” on the crutches. You just touch them to the ground at your sides at the point of full bearing on the operated side and make sure you are walking dead even. It only takes just a tiny bit of weight onto your arms to help the operated side through the full step and takes just enough of the load off to allow you to walk straight and even. Then, as you get stronger each day, lighten the load you are putting on your arms to the edge of where you can still walk even.

I worked very consciously at this every day, every walk. After a couple of weeks, I went to one crutch or cane when I walked for another week. Same thing here except you are now bearing more weight on the operated side. I kind of transitioned during that week by using 2 crutches on long walks and the cane for everything else. When I was on the cane, it was the same drill. You walk with proper posture and make sure you give enough weight to the cane to allow an even step on the operated side, but not so much that you are leaning over to the side or depending upon the cane too much. If you can’t do that, go back to the crutches until you can. DO NOT FORCE YOUR RECOVERY. No one else’s timetable is the one for you. Feel what your body is doing and act appropriately. Your timetable may be 2 or 3 times longer or it may be shorter. Your body is sending you constant updates. Tune in and listen.

At week 4, I was using nothing. Long walks make the operated side a bit tired (3.5 miles), but I am up and down stairs without problem and completely functional without any devices. They are put in the garage rafters.

The payoff for this came yesterday when I went in to get my follow-up x-rays to send to Dr. Su. I am at 4.5 weeks and the tech was asking me all about the device and procedure. As we walked a very long hallway back to the front of the facility, she was about 8 feet behind me and said she couldn’t believe that it was just over 4 weeks and I had absolutely NO limp at all. She said there was no way to know I had this done last month by the way I walked.

August 28, 2011

I just rode a hard, PAINLESS (well, no hip pain, my legs were screaming for mercy) 40 miles for my 10 week anniversary and can’t even remember the couple of weeks of recovery anymore. The only pain I have now is my body begging me to give it a break since I can do all the athletic things I love. I can’t wait for my 6 month mark so I can start running again.

April 16, 2012

** Disclaimer: I am not a doctor, I don’t play one on TV. My statements are a combination of personal pre-op research, my own rehab and a HUGE dose of opinion based on my own deductions. I think there is a lot of interpretive gray area all over the theories of proper rehab.

That said, there are certain constants I believe hold true for all patients:

1.
Fact: The acetabular cup has been press-fit into the hip bone. There is no glue. The knurled back allows for bony in-growth over time. This is the “glue” that will hold it in place so that it can withstand the pressures of activity. The key phrase here is “over time”. Bone growth is slow. During the first 6 months to a year (depending on what surgeon you ask), this bony in-growth is not complete and, therefore, not a completely solid bond.

My Opinion: Significant pressure on this cup (what I have referred to as “torquing”) early on can make it move in the socket. I think of it as gluing something and then twisting the parts before the glue is dry and it comes loose. Not only is the glue probably not going to ever permanently bond the two pieces because of this movement, they are now misaligned, and probably going to continue to move around, preventing any future bonding. You now have a permanent failure of the mechanism.

2.
Fact: During the surgery, the femoral vascular system is temporarily disrupted. Over the next (approximately) 3 months, the bone density of the upper femur, including the femoral head, weakens as the body rebuilds the supply damage within the femur. The theoretical peak of this weakness is supposedly at the 3 month mark. From month 3 to month 6 (or month 12, depending upon what surgeon you ask), the density slowly gets better and better. Some of the research documentation suggested that in many cases, the density after one year was actually better than before surgery. I believe that they attributed this to a higher level of activity post-op than pre-op for those who were significantly immobile before surgery. Moderate impact (AFTER THE HEALING PERIOD) keeps bone density up.

My opinion: Pretty much the same as #1 – Any high pressure on the femoral head when it is in this weakened state could subject it to breakage. This danger is two-pronged. You also can engage in activities that risk trauma (falling off a bike or while skiing) during the “weak” period that will snap the femoral head off like a toothpick. This I know as a good friend of mine did exactly that. A very light fall from a bike at about 3 months and it snapped.

So, what exactly is the right amount of effort to get the muscles and body back while not risking the device or the femur? From what I can gather, nobody knows. And I am sure we have all heard the tired cliche “Listen to your body.” It’s not the body I don’t trust, its the mind drowning it out with a lot of “I want, I want, I want” whining. Face it, we are all a bunch of overgrown, spoiled 5 year olds who want what we want…NOW!

I think there are obvious no-no’s of high impact that we have all heard. If you don’t know what these are, you haven’t done your homework and need to stay after school to catch up with the rest of the class.

Personally, I didn’t do anything that put a high resistance on the joint: leg weightlifting, hard bike resistance, any upper-body weights that put twisting leverage on my core. I strongly feel you should not put either hard pressure nor leveraged twisting on the joint in the healing period.

There are two points I’d like to make here:

1. I know from over 30 years of strength training that you can fully work you soft tissue (muscles) without having to use huge weights that put a lot of pressure on the joints. High reps with very low weight taken to muscle fatigue is very effective.

2. YOU ARE NOT TRAINING, YOU ARE HEALING. I think that this point is being missed by many. Yes, this operation is so you can get back to doing everything – AFTER YOU HEAL. Nobody said you can do everything as soon as you check out of the hospital. If you insist on acting like a spoiled 5 year old and do something impulsively stupid, your hip will punish you like an angry nun in catholic school.

Everyone must do what they feel is right for them. Personally, I gave up some overall fitness and did a very conservative rehab to give myself the best chance of success with the device. I realized that all I had to do was face the fact that it is all ego. I have been in Ironman shape for over 20 years, and I didn’t want to lose that. Boo Hoo. Once I got over myself and this whole B.S. about tying a good deal of my identity to my fitness lifestyle, I realized that I wasn’t losing that lifestyle. I was moving through a phase of my lifestyle that required the same amount of discipline it took to get there in the first place. And I would work with both my body and my common sense so that I could achieve this goal just like all the other goals that came before.

If ever a cliche fit this situation I think this one does:

“Train smarter, not harder.”
 

July 8, 2012

I have been out getting on with life. I just wanted to post this photo of how I celebrated my 1 year anniversary. It wasn’t fast and it wasn’t pretty, but it was great to get back out there. This distance is a bit much for only running again for 5 months prior but I also did an Olympic Distance race a couple of weeks later that went very well.

I don’t really recommend doing half-iron distance (half-marathon run) so soon as my soft tissue was pretty sore for a couple of hours afterwards. All was fine that evening.

I had pretty much no pain or soreness after the short race, so I will stick with that until year 2.

Going for 1 year follow-up xrays and blood tests this week. I am keeping my fingers crossed but have no worries since things seem to be going so well.

July 12, 2012

I guess you could call it conservative in the “6 months to run” camp. In the “one year to run” camp, it is aggressive. Just depends upon your surgeon’s protocol.

After starting to “run” at 7 months and now being right at 13 months, I understand a bit better both sides of the coin.

I went EXTREMELY easy for the beginning. First, you have to understand that up to that point, I had gotten my long walk up to 6 miles at a very brisk pace every couple of days and was also swimming 2500 meters a couple of days a week and cycling up to 50 miles per ride a couple of days a week. That is all fine and good for general health, but, for me, did NOTHING to prepare the soft tissue for the stresses of running.

At 7 months, I ventured out to try to start running. I would warm up with a walk of a mile to mile and a half and then jog for only 50 yards or so. Then back to walking for a few minutes. Then another short jog, and so on for a total of around 5 miles.. In the beginning this was long walking and just some occasional light jogs for a VERY short distance.

Over the months, I would bring the running distance up a little every couple of weeks. At a couple of months into the running, I started doing 1 minute run, 1 minute walk (after a long warm up walk) for a couple of miles. That would push it. Every time, it would get sore, but some days it would be just the soft tissue complaining and some days it was pretty bad and refused to cooperate. I iced my entire bum, and upper thigh by wrapping big ice packs all around it EVERY TIME. ICING IS CRITICAL FOR RECOVERY!

Since I needed to stretch out the distance for the upcoming event and there was no way I was going to run the whole thing (I couldn’t run over a quarter mile at a time without walking), I simply walked a lot more and ran a little more in the sessions.

I had days where I could hold an easy run during the sessions for up to 3 miles, but these sessions were irregular and unpredictable. There were good days and there were bad days. By 11 1/2 months out from surgery, I got the whole thing up to a long distance of 13 miles once a week and 6 mile short sessions in between. The 13 at that point was WAY TOO MUCH. Although I did have some good sessions right before the race where I ran a lot of 1, 2, and 3, mile segments in the long session, there were some really bad ones in there too. I could feel that I was just pushing too much too soon and resigned myself to doing mostly walking in the event run portion and allowing another year of working on it before I could go out and really push.

In retrospect, I would definitely do the first 7 months of my rehab exactly the same way. The difference would be that when I started running again, I would have stretched out the very short jog period for at least another 3 months. I would have then doubled the time to gradually slide up the distance and run segment intervals. To simplify, what I did in 5 months (7 through 12) I would stretch out to 12 months (7 through 19).

The one other thing is that I have read from other hippies that the illopsoas and psoas can be very painful after this surgery when pushed to come back and will cause exactly the deep tissue soreness that I keep getting. A deep tissue expert / specialist in resolving this is reported to help tremendously. I blew off PT because I could tell they weren’t specifically knowledgeable about this operation and were appying a template treatment that was going to actually do damage (like those leg lifts early on which are a big NO NO).