Another ten years, another hip

 I am eight days away from an operation on my left hip. Same operation as the left, a total replacement, anterior. It has been a long and often painful journey (and boring too) but finally I got into that operating room and here I am, eight days later.

Lately I have perused my notes from my first hip replacement, to remind me how it went. It was not a case of immediate pain relief. I did not expect that it was, but my memory was that it was so much easier than the hip replacements that it seemed instant. 

Today I drove for the first time since the op. I had been taking some narcotics (oxy) so could not drive even if I felt up to it, and I did not feel up to it. I stopped the oxy yesterday afternoon and today I felt ready.  In fact, there was quite a change between yesterday and today, both in the level of swelling I see and in the pain I am experiencing. 

Here are my feet yesterday. Notice that the left foot is very puffy. My leg was similarly puffy.

And here are my feet today. They look almost identical. You can't see my thigh, where the swelling from the operation is most noticeable. But the difference in my feet is reflected in how much better I feel.

I had the hip operation because the hip is worn out. The doctor thinks that the hip was causing the knee pain I had in my left knee for the last few years. I have been cautiously optimistic. It is still too early to tell for sure because I still do have pain and swelling to work on, but I am gaining in hope. I met with the physical therapist today and he had me climb some stairs. He said just to try stepping up with the left foot, just see if it hurts too much. He didn't want to pursue it if it did hurt too much. But it didn't. In fact, I think it may have been less painful than it was before the operation. That's what is giving me hope.

Life after

On March 26 I had my right hip replaced. I had heard so many glowing accounts from patients of hip surgery that I practically expected to walk out of the hospital with no pain at all. That may happen to some but it didn't happen to me.

I used a walker for most of the first week. Then I moved to the cane, which I am still using. I am hoping to set it aside in another week, but my therapist says not to rush. Take what time I need. It's a nuisance to use a cane all the time. It's like being one-handed.

But back to the last few weeks. I left the hospital on March 28, morning. I might have left the day before but the surgeon was out of town until that night, and I don't think that hospitals enjoy releasing patients at night. Hospitals are so intrusive and such rest-suckers. It was hard enough getting to sleep on that bed with my leg not comfortable, but then I'd be wakened for some blood pressure check or something else. Fortunately I was disconnected from the IV soon, and then the catheter, and finally the drain. When the hospital physical therapist came around I was ready ready ready. I was hardly pain-free but I wanted out so I hit the ground almost running.

I started outpatient therapy the following Monday, April Fool's Day. My friend Maryann had gotten me to and from the hospital, and on Friday we had driven together to pick up my daughter Elaine and grandson Elliott at the airport. So Elaine drove me to physical therapy.  After I did a limited number of activities there, the therapist had me on the table, where he tested my hip. He said I was doing very well, that all the time I had spent there working on my knees had paid off in strength, and that I was "about three weeks ahead of schedule". Of course that's an exaggeration, but one I was delighted to hear.

I have now completed three weeks of therapy. I have tried driving and found that I can do it. I am not yet pain-free. I am not yet healed inside, although the wound on my leg is completely closed and I am cleared for dipping in the pool again. The swelling on my hip has gone down some and is clearly not the issue swelling was for my knees. A hopeful result: the therapist says my knee is starting to get straighter! That my bad hip may have interfered with that. I remain hopeful that one day both legs will be straight and I will no longer feel tension in my legs when I walk or stand.

Hip Hip Hooray!

In the middle of January I returned to the ortho doc who renewed my knees. I told him about the pain in my hip and mentioned that he had taken an x-ray of it a couple of years ago. He tested it by having my lie down and moving it this way and that and pressing here and there. He asked me questions. Then had me get another x-ray.

He showed me what the x-ray revealed: the right hip is worn out, is bone on bone. The left is still looking good. The only solution he felt made sense was a hip replacement. I was all for it.

It's funny how I've changed. Years ago I wanted nothing to do with surgery. Now I have two new knees and am looking forward to a new hip. Part of me just didn't want medical intervention. I wanted to solve it myself, and I was embarrassed at letting my body get to this place (in my case, the wearing out of these joints can easily be attributed to my heavy weight, which I carried for so many years).

Dr. W. gave me a booklet he had written, about hip replacements: the anterior approach. He has been practicing this minimally-invasive surgery for a few years now and finds that it is superior in every way to traditional hip replacement surgery. I have met some of his patients and they all say it is very easy to recover from and the pain goes away completely. The booklet has space to put all my appointments, list all my prescription meds (I still have one that I use occasionally: the Ropinirole), and other notes. So I don't have to make a folder as I did last time. The information is complete, down to "when can I drive?"  (the answer: when I feel okay enough to drive and am no longer on narcotics). A very useful booklet, which I read carefully over the next few days after my appointment.

I am scheduled for this surgery on March 26. I am excited!

No pain no gain

I think I have to accept that old saw when it comes to the knee therapy. Again and again nurses and others say one has to keep pain meds in the system so that therapy will not be very painful and therefore make progress. I used to want the pain to be blocked altogether and would be impatient when it did not happen. Of course, in a perfect world, I would get that. I have personally observed four people who have had knee or hip replacements and all of them have had trouble finding pain meds that worked for them. The first days are usually the worst but in my own case I struggled nearly until I went off the meds altogether. I am trying to take more deep breaths and reduce my expectations in this department. Today the therapist - Ron this time - had me do some tiny leg lifts, then ankle bends and the pulley lift, and finally he struggled to get all the cables put aside soi could get up with the walker and walk down the hall and back. It got easier and much better than yesterday. Yesterday my knee buckled whe I tried to stand straight up. I stopped at the bathroom on the way back, to my great relief. My one attempt to use a bedpan this morning was not encouraging. Little by little I am regaining independence. Perhaps it is a good thing that I am so impatient.

In the grip

The surgery went well. I woke,however, in a lot of pain. The nurses gave me all that they could over the period of time that I was in the recovery room, and then when I went into my regular room I got still more. I woke up at about 9:30 am and it is now 2:10 and I am embarrassed at how much pain relief I have been given. It's better but far from comfortable. I had some trouble adjusting pain meds the last time but I do not recall waking up in such pain and having it continue as it has. This is not entirely unusual, of course. People have different experiences, even the same person at different time. I am in a room with a woman I met in the waiting room, just like last time. Only this time she had hip surgery and she will not be going to Transitional Care. She has a husband and daughter to help her at home. I was right when I remembered how dark these rooms are. Finally I have some light. I could not figure out where the light was until the nurse showed me and hooked it to the pillow like last time. Between the two of us and our machines there is some kind of beeping going off practically every few minutes. IV bag empty. Malfunction of something or other. There is also room for a third patient in between us, so I'd say the room is spacious. I wish I could get up right now and walk around it, but the pain makes that seem impossible. When the physical therapist arrives I hope I will be able to stand up. That might even help, once I get past the initial pain of moving off the bed. Oh, yes. The good news is that there is no full-length brace on my leg this time! I hope this means everything will proceed a little bit more easily.

I'm Excited

The day is almost here. Tomorrow I get knee surgery. And after several days of uncertainty and then nervousness I am now excited. I am thinking about how it will be to have one straight leg, for example. Miracle!

This afternoon I visited the transitional care center. I went there mainly to check on the food - as I am vegan I wanted to be assured that they could feed me. The answer was a reserved "yes". They try to accommodate all kinds of diets. I am now working on a list of simple vegan dishes to give them. No recipes, just ideas - veggie chili, spaghetti with marinara sauce, peanut butter and jelly, mushroom and barley soup, and so on.

While I was there I saw the therapy room (small and not a lot of equipment) and the break room and living room and a typical bedroom (two beds with a screen between).  It's a small, homey kind of place. I expect I'll be able to do some reading there easily enough, along with the therapy. The patients I saw there were older than I am, which suggests to me that I may be able to get through the therapy more easily. We'll see.

As always, getting ready to go somewhere takes a lot of work. I bought two more bags of kitty litter (I blend two types), I washed lots of clothes, I cleaned this and that and now I think I am reasonably ready. and I am getting excited.

The Stress Test

Today was my stress test. I went to sewing class in the morning and left at about one to get to the cardiologist's office. I spent more time filling out papers than doing the test - or at least it seemed that way. It actually did take over an hour for everything.

First they did an ultrasound of my heart. This meant they plugged pads with cables on various parts of my chest, then I lay on my left side while the technician moved the instrument around a little, first on about the center of my chest, then on the lower left side. She got pictures of my heart beating away nicely. Then another person came in and put an IV in my right hand. It hurt! Another person plugged more cables in different places on me for an EKG and finally they hooked me to the drip bag and the test actually began.

They started with a low dosage of this stimulant and gradually increased it. By the time they hit my target heart rate I could hear my heart and feel it thumping away, and I felt a bit dizzy. After topping out the cardiologist said my heart is fine and left the room. It was a few minutes before my heart beat came back to normal. The results were faxed to the surgeon's office so I should be hearing about the surgery date for sure soon.

The Story So Far

I checked with my insurance company and they verified that I do not have a pre-existing condition clause in my supplement. Thus my supplement is effective now. So that takes away one worry. I was scheduled for April 4 and I was ready for it:

* I got the EKG and the chest x-ray on March 12.
* I got the blood and urine tests the following week.
* My daughter made a reservation for a plane ticket to be with me for the first three days.
* I arranged to put a hold on my gym membership starting April 4 (that's today).

But then came the glitch.

I was scheduled for a pre-op appointment on March 30 with the doctor, and with a rep from the hospital on March 31. When I went to the doctor appointment the nurse told me she had been trying to reach me. There was an abnormality on my EKG and they were trying to get clearance from my regular doctor. The surgery may have to be postponed. But because I was already there the doctor came to see me. I told him I really wanted to stick to that original date if we could. He said he would go ahead with the pre-op appointment and I should go ahead with the hospital pre-op appointment and he would do what he could to keep it on schedule.

At the pre-op at the doctor's office they took my temp and blood pressure, then the doc came in to explain what I would need to do from that point:

* Get prescriptions for one oxycontin tablet, to be taken the day of the surgery, plus a special kind of antibiotic to take on days I had dental work done (after surgery for the rest of my life), plus another type antibiotic ointment which I would dab into each nostril twice a day until the day of the surgery.
* Pick up a cleanser called Hibiclens. I would clean my leg, from armpit to toes, twice a day, using this formula.

The ointment and Hibiclens have been shown to reduce chances of infection significantly. The use of the antibiotic before dental work reduces the chance of infection in the knee.

The following day I went to the hospital, got shuffled from place to place, finally met with a couple of reps there. Lots of papers. They did the filling out, asked me questions. Essentially I was pre-admitted so I would not have to fill anything out when I came in for surgery.

The following day I learned that no, the surgery can't go forward on April 4. The cardiologist who looked at the EKG could not, in all conscience, clear me for surgery. I took a lot of deep breaths, could hardly blame them for this decision. The doctors both talked to me at length, both worked hard to get this issue cleared up as quickly as possible. I ended up with an appointment for a stress test for this Wednesday, April 6.

And so my daughter changed her plane reservations, I changed the hold on my gym membership, and I have been explaining and explaining to those I meet that no, no surgery yet.

No Longer a Matter of If, but When

I met with a surgeon Feb. 23. He took more x-rays and told me that my left knee is plumb wore out (not in exactly those words). He said surgery should have been done several years ago. Not only is the cartilage gone but there are bone spurs all over the joint. When I asked if there were specific exercises I could do before surgery he said not really, ride a stationary bike if you can, do some leg lifts, but until those bone spurs are gone there is not much to be done.

He asked when I wanted it done and I said as soon as possible. But when I got home and started thinking about it I realized that I had not taken all things Medicare into account. I learned that hospital coverage ("part B") does not cover the doctor's costs - or, in fact, the anesthesiologist's. I would have to pay 20% of those costs in addition to a "hospital deductible". There is a difference between in-patient and out-patient status as well, so the transitional care might also require a 20% co-payment. I got to thinking that maybe I need a Medicare supplement after all.

I hunted around and found a supplement that looks right for me and signed up. As I understood what I read, this first surgery would not be covered if I have it done right away. I will probably have to wait a few months. I am going to call the agency tomorrow to find out if I read that right.

I am definitely having this surgery. My knees are too far gone for any other program to help them now. The surgery will be "minimally invasive" so I should be on my feet the day of the surgery, which is a relief.

Obviously this changes this blog. I really wanted to manage this arthritis without surgery but it has become so disabling that I am accepting the need. I am continuing to go to the gym because I am sure that the more flexible and strong I am the better.

Changes ahead

Two days ago I had an appointment with my regular doctor, to discuss options for my arthritis. I told him that I am living about 1/3 of the life I would be without arthritis, that I am in pain when I walk and when I stand, that this pain prevents me from doing many things alone and with my children. I told him about my efforts at the gym and beyond, and said I don't normally take pain relievers because of the effects on my stomach.

He said the only solution that makes sense for me is knee surgery. It's a "no-brainer", he said, and then sent me to get some x-rays of my left knee. When he came back in the room he said it hurt just to look at the x-rays, and he prescribed some Tramadol, a narcotic, for the short-term, and made a referral to an orthopedic surgeon. The appointment will be made when I get approval from Medicare.

In the meantime I went to get the Tramadol. I started taking it at about noon yesterday. It makes me fuzzy, as narcotics usually do. I do feel some relief from the pain, though, so I am going to keep taking it, to see if the fuzzy effects go away and the pain relief remains.  Right now I just feel like lying down.