t2.bmp (300054 bytes)  Lou's Hip Story

 

I want to start by thanking Judy Fredenberg.  Her story motivated me to finally scheduling my total hip replacement (THR) surgery.  Without her story, courage, and encouragement, I would have postponed my surgery until the pain became excruciating.

I've had Osteoarthritis for 11 years now.  The joints in my hands have become deformed.  However, I found that Glucosamine and Chondroitin have reduced the aches in my hands significantly.  The swelling has been reduced substantially with the exception of one joint.  Although my hands have improved, I was unaware that another part of my body was deteriorating.

Although I have arthritis in both my hips and they are both THR eligible, my story here is regarding my left hip.  My right hip looks worse on the x-ray.  However, it is my left hip that is giving me pain and suffering.

Although I am not extremely active, I did exercise regularly.  I walked for an hour a day and went to the gym 3 times a week.  I go on an occasional hike and generally love to walk.  As of August, 2006, all that has come to an end.

Aches and pains in my left hip began in March 2006.  At first it was a snap in my mid left quad.  It felt like someone was using a rubber band and snapping it on my quad.  The sensation was unpredictable.  I kept walking and exercising as usual.  At this point, the snapping was an annoyance, but not debilitating.  The Chiropractor concluded this was due to my posture and skeletal structure.  She prescribed some stretching exercises.  I wish I didn't listen to her.  I knew I had arthritis, but didn't want to even think that now it was in my hips.

After a month, the snapping decreased and was replaced by an ache in my inner quads down to the upper knee.  This continued for 3 months.  The Chiropractor continued to insist it wasn't a joint issue because the pain was in my quad muscle.  I continued to see her for therapy.  The therapy and stretching exercises were not helping.  I didn't want to admit it to myself because the alternative was not something I wanted to accept.

In July the pain in my quads began to diminish and was replaced by stiffness, aches, and pain from my hip down.  At first the pain was manageable although very uncomfortable.  I was able to go to Europe for 2.5 weeks.  However, after several hours of walking, the pain was absolutely horrible.  I had to take 800mg of ibuprofen and lie down for an hour.

In July and August, we move cross country.  Moving heavy boxes up and down stairs made the situation even worse.  It got to the point where I was only able to move a few boxes before having to stop, take Ibuprofen, and rest.

I finally admitted to myself that the Chiropractor was not working.  So I went to a physical therapist.  Their conclusion and treatment was similar to the Chiropractor.  However, the physical therapist did apply a sonic treatment that helped relive the pain, but only for a short period of time.

In August it became more difficult to transition from a sitting position to standing.  It is difficult to straighten the hip.  Sometimes it is a matter of a few seconds.  Other times it can take about a minute with pain levels measuring 6 on a scale of 10.  During the past month, walking has become more and more difficult.  I no longer walk an hour a day as I did for many years.  Recently the area just below and just above my knee has begun to ache.

Before moving from Seattle, I went to see an Orthopedic.  He took some x-rays and there it was.  What I didn't want to know.  The x-ray showed arthritis in both my hips.  Complicating the issue even more was the fact that I had waited so long.  Now I moving a week later so I could not do anything about it until the cross country move was done.

In late August, the aches and pains vary from lower back, along outer left side, and down to my knee.  The pain level is less in the morning.  The afternoon and evening pain levels depends on level of physical activity. Sitting or lying down for a 30 to 60 minutes helps alleviate the pain.

After the move, I went to see another Orthopedic.  Another x-ray and an MRI were taken.  The MRI showed conclusively that both hip joints are diminished by the affects of arthritis.  My right hip looks worse than my left although it is my left that is painful.  The Orthopedic recommended shots of cortisone in my hips.  As I would later find out, this is a bad idea at my age of 44.

Still not convinced and hoping to find another answer I liked better, I went to Duke Medical to see Dr. Attarian.  What a difference.  This doctor has excellent patient skills.  He explained the issue, cause, and options to me in detail and with great patience.  He allowed me to ask as many questions as I wanted.

Unfortunately for me, my options are not good.  I can either stick it out as long as I can with pain medication, or have THR.  I am 44 years old.  I don't want to live on pain meds for any length of time.  However, the thought of THR was horrific.

Frankly the idea of THR just terrified me.  Maybe because I've seen the procedure on the Discovery channel.  Maybe because when I was a child I an operation where my heart stopped for a while due to anesthesia.  This is a case of knowing to much.

So the past month has been spent taking doses of Ibuprofen and Tylenol.  Now the doses have increased because they just don't help.  Sitting in my recliner is uncomfortable.  Sleeping has become difficult due to the pain.  I force myself to walk a mile a day, but that is very difficult.  Getting up out of any chair is a painful ordeal.  I am constantly tired since my body is fighting the pain.  I was so looking forward to our new home.  Anxious to explore the new area.  Excited about living in a new place.  Yet, I am unable to do any of the things I wanted to do without pain.

It has been hard to accept the idea that I need THR.  After all, THR are mostly for older people.  I can't really need THR, right?  Wrong.

Thursday, September 28, 2006

I have scheduled my surgery for November 8.

My in-laws are coming from Arizona to help out for 3 weeks.  They sure are nice people.  It will be a lot easier to rehab with them around.

Tuesday, October 3, 2006

I seem to get more and more tired.  Seems like I wake up tired.  Last Friday I started sleeping with a pillow between my knees.  This helped alleviate the aches that were preventing me from sleeping all night long.  Nonetheless, I still feel some discomfort which is why I am always so tired.

It continues to be more and more difficult to stand.  I've had a few episodes now where I've just had to sit back down because it was too painful to stand up.  I have found that stretching my leg before attempting to stand does help somewhat.

I am looking forward to the surgery just to get this over with.  At the same time, I'm fairly apprehensive.  The idea of being put under does not thrill me.  When I was 7 years old I had an operation on my eyes.  My mother told me the doctors had a tough time bringing out of consciousness.  Apparently my heart stopped for 2 minutes.  I wish I didn't know that.  Even though I know that was almost 40 years ago and modern medicine has come a long way, it still scares the heck out of me.

Monday, October 30, 2006

Duke Medical requires a heart stress test before undergoing major surgery.  I had my heart stress test last week, October 24.  I passed with flying colors.  At first I was really nervous about this.  After all, raising your heart rate to 150 is nothing to sneeze at.  It turned out to be pretty much a cake walk.

Having the heart stress test has actually relieved some of my apprehension regarding my upcoming surgery.  I know now I have a strong heart - one less thing to worry about.  I also know now I will have a spinal tap with a sedative.  I no longer need to be concerned about general anesthesia since I will not be going that route.

It continues to get more and more difficult to stand up.  Sometimes now it takes 10 to 15 minutes.  Sometimes I just give up and stagger over to the recliner where I recline for a while before attempting to stand up again.

Saturday we bought some post surgery supplies.  I got a couple of reachers, a leg lifter, and a raised toilet seat.  Yahoo!  I did not get the sock puller basically because I am currently working out of the house.  I don't need to put socks on everyday.  If I do, I have my wonderful wife Karen to help.

I had to catch up on some yard work the other day.  I spent about 2 hours working on the yard.  I paid the price in a big way.  I was in a great deal of pain.  It took about 2 hours for the pain to subside.  Fortunately it was Sunday and football was on.  What a terrible way to live.

Ibuprofen and Tylenol really don't help very much.  I'm thinking about not taking them anymore.  I've noticed my stomach is getting upset lately.  I might as well stop taking them and just rest more.

9 days to surgery.

Thursday, November 2, 2006

What a tedious day.  We spent almost 6 hours at Duke Medical for the pre-op.  I'd say about half the time if not more was spent waiting.  I had another x-ray taken of both my hips.   Apparently the doctor will use these to customize the prosthesis for my body.

I spoke to the doctor for about a half an hour.  I asked him several questions.  I brought a sheet of paper with 14 questions.  I also asked him a few more that I thought up.  The questions were, as you would think, about the surgery before and after affects, medications, physical therapy, and length of stay in the hospital.  He did tell me that I would be able to sleep on my side as long as I had a pillow between my knees.  This was a relief.  I don't do well sleeping on my back.

After waiting some more, we did some Duke Hospital paper work, paid our deductible, and then waited for the pain management nurse. 

The pain management nurse was a 65 year old man who was rather eccentric.  He was the first person I've talked to who said I would be in severe pain after the surgery and for up to a couple of weeks.  I'm not sure what to make of this because no one else I've talked to has described the after surgery pain as such.  I understand there will be pain and some discomfort, but nothing so severe as what this nurse said.  We didn't care much for him.  I hope he's wrong.

After waiting for another hour, we met with the nurse practitioner.  She was a very pleasant lady.  We talked a lot about cruising - my favorite subject.  She asked a lot of health questions in preparation for the anesthesia team. 

I have a choice of 3 types of anesthesia - general, spinal tap, or regional.  General anesthesia is much more risky than the other types and not necessary.  Apparently they do use general anesthesia much anymore unless it is the only way to go. 

Spinal tap would keep my lover half mostly numb for about 24 hours.  However, I may feel a little bit of pain.

With Regional anesthesia they somehow find the nerve around my hip and numb it completely for 12 hours.  Apparently my entire leg will be completely numb.

The transitioning pain continues to get longer.  There are many times now that I can't seem to transition from sitting to standing.  It takes several attempts and several minutes to do so.  I find that if I can get to my recliner and just lie there for 10 minutes or that then I can transition more easily.

5 days to surgery.

Monday, November 20, 2006

I had total hip replacement surgery on my left hip on 11/8/2006 @ 8:45 am ET at Duke University Hospital.  I arrived at the hospital at about 6:30 am.  I was feeling ok.  I thought I would be a bit more worried, but after all the research, pre-op tests, and discussion, I felt pretty confident.  Needless to say, just before going under I did feel a last minute waive of terror.

I received an epidural for the surgery and then a "depodure" shot, which is long-lasting morphine for the pain for about 36 hours (it could have lasted as long as 48 hours).

I did feel some pain when I first woke up from surgery (and got some oxycodone in the recovery room) was probably due to a tiny window of that occurred after the end of the epidural and the start of the depodure.

The surgery went off without a hitch.  The doctor said I have very hard bones and so it took him longer to cut through.  So now I am fully equipped with a titanium-chrome prosthesis.

I stayed in the hospital Wednesday 11/8 through Saturday 11/11.  The pain level was more than tolerable.  No worse than a 5 on scale of 10.  The biggest issue for me was trouble with my intestinal system.  This turned out to be a huge problem as you will see.

I complained of constant discomfort in my stomach.  I had pain and felt enormously bloated.  The staff at Duke Hospital gave me Mylanta.  Yep, one of the best hospitals in the country decided all I needed was some over the counter remedy.  It didn't seem to matter to them that I was hardly eating and the discomfort in my stomach continued.  This did not improve substantially prior to leaving Duke Hospital.

I started receiving physical therapy on Friday.  It should have been on Thursday, but since I was not feeling well, it was delayed until Friday.  PT was pretty simple exercises.  One set could be done while in bed.  Basically moving the ankle back and forth, tightening the knee, and tightening the butt muscles.  The therapy called for one set per hour with 15 reps.

The second exercise is while standing up.  Essentially moving the leg in 3 directions and raising the knee.  Step back 10 times, then forward 10 times, to the side 10 times, and finally raising the knee 10 times.

My blood count did drop Friday morning.  I think this was due to the continued intestinal difficulties.  So they gave me my 2 units of blood that I had previously donated.

Saturday morning Duke Hospital decided to discharge me.  Even though my intestinal problems persisted.  So I cheerfully went home.

When I got home Saturday from Duke Hospital I was not feeling all that great. Then again, what can you expect from total hip replacement. It became apparent rather quickly that something was not right. I was not hungry at all. You know that is unusual for me! I was unable to keep any food down. The pain in my stomach continued to worsen throughout the evening. Nothing helped.
We went to the emergency room at Wake Medical in Cary, NC Sunday morning around 5 am. This as it turns out was probably a life saving a decision.
I had 3 issues:
1. Ileum - my intestinal system was not functioning.
2. My sodium level was at 119. Bad for your heart.
3. My blood count was at 21. Should be around 40. Um, not good.

Sunday 11/12/2006 was one of the worse days of my life. I felt awful. The hospital declared me NPO which meant I could not eat or drink anything. Good thing since it had no where to go. They gave me plenty of hardcore drugs for the pain. So I spent the day hallucinating. I saw some amazing things. I'd rather never ever again go through that.
I spent the day on an IV. The plan was to see if my plumbing would restart itself. The alternative was surgery.
Fortunately for me, by Monday morning I felt much better. I thought for sure I would go home. My plumbing did restart. That huge bubble in my mid section that literally made me look pregnant was all but gone. So they removed the NPO status and resumed food and water. Yahoo!
Unfortunately I was not out of the woods yet. My blood count was very low. So the new plan was to give me 2 units of blood and see if my body maintained the additional blood count. After the 2 units of blood, I was unplugged from all the machines. Blood was taken and a benchmark was set. If Tuesday morning my levels were the same or better, then I was clear. Tuesday morning came and the levels were the same. Time to pack.
Unfortunately you can't go from a blood count of 21 to 40 overnight. I went from 21 to 26. The doctor said it would take a couple of weeks to regain the remaining blood count and sodium. So for 2 weeks I will probably be very tired. You know what? He's right.

It is now Monday 11/20/2006 and I'm much better.  The hip is wonderful. I've been putting full body weight on it since Friday.  I'm off the walker and on crutches.  I get around pretty good.  Not much problem walking around.  I've gone for a few walks outside already.  Stairs are a breeze but slow.  I am scheduled to start physical therapy next Monday 11/27 - a full 3 weeks ahead of schedule.  I hope to be off the crutches and onto the cane in a couple of weeks or so.

My stomach is better, but definitely not there yet.  Still have some discomfort.  Over all though, quite tolerable and manageable.

Next Monday I go to get my blood count.  I think it is doing well.  My energy levels are increasing.  On Sunday I felt restless and definitely felt a touch of cabin fever.  Today I worked for 5 hours.  I felt pretty good but definitely need rest breaks here and there.

Saturday, December 2, 2006

I am happy to report that I continue to get much better.  It has now been 3 and a half weeks since my surgery.  For two weeks since coming home my energy levels and over all health have improved.  I went to see my PCP on 11/27.  The results of the blood work show my sodium is back to normal and my blood count is nearly back to normal.  All other tests are normal.  Ya-stinking-hoo!

My hip is doing absolutely fabulous.  I started physical therapy on 11/27 - a full 3 weeks ahead of schedule.  PT so far has been excellent.  No pain whatsoever.  I will continue to go to PT twice a week for four weeks.

I have been off crutches and on a cane since 11/27.  So far, so good.  When I go for long walks however, I switch to one crutch for additional support.  When I say long walks, I mean about half a mile.  I plan to increase that to .7 of a mile this week.

I have been able to go out to restaurants with no problem.  It is important to keep that 90 degree restriction in mind when sitting at a restaurant.  I am very cautious not to break any of the rules.

I keep doing my exercises as instructed by my doctor and my PT.  They do not cause any pain.  If anything, just some mild aches.  It is important to keep up the PT in order to rebuild the muscles that were abused during the surgery.

We have booked our first getaway in our new location.  We plan to go to the coast for three nights.  We have also booked a recovery cruise for January.  Can't wait.  It is an enormous relief to be able to plan activities in your life.  I can't wait to do them.  I can't wait to walk all over creation like I used to do.

I go see my orthopedic on 12/11.  I hope and expect at that time to be off the cane if at all possible.  Right now, I don't know if that is realistic since I still limp when I walk without the cane.

Thursday, December 14, 2006

Progress continues to go very well. I had my second checkup on 12/11 and all is very well. I don't need to go back to the Orthopedic until mid February for the final checkup and x-ray. I expect to be off restrictions next Wednesday 12/20 - 6 weeks post surgery.

My physical therapy continues to go very well. Kim, my physical therapist, marvels at how well I'm doing. I can walk now with a slight limp. I hope to be off the cane in another week. I can stand on one leg on my operated leg without any pain and with slight wobble. I'm doing all sorts of PT exercises such as leg lifts, side walking, steps forward, backwards, and side ways, squats, and several more. I'm very happy at my progress. My endurance is getting better although I wish it would go faster. I will be done with PT on January 10.
 

Here are some questions and answers I had.


Q: I am a computer programmer. So I sit in front of a computer for 8 hours a day. After I leave the hospital, how long before I can sit for 8 hours so I can return to work?

A: Probably within 3 weeks provided you can get up and move around for 5 minutes every hour (to prevent blood clots in leg)...

 

Q: I live in a traditional 2 story house. My bedroom and shower are on the second floor. Although I can sleep on the first floor, showering is not possible. How long after coming home will it be before I can go up and down the stairs?

A: Should be able to negotiate stairs safely within 1-2 weeks (the wound needs to stay dry until the staples come out around day #10.)

 

Q: I have read a little bit about "hip resurfacing". Is that something you do? Is that a procedure suitable for me?

A: Hip resurfacing is an off-label device in the US except for the Smith Nephew resurfacing... Many insurance companies do not cover this procedure, so it may be out of pocket... (whereas hip replacements are covered).

 

Q: I am much more concerned about anesthesia than anything else regarding the procedure. Please provide as much information about the anesthesiologist as possible.

A: The risk of a major complication from anesthesia is extremely low... the options are: regional (spinal, epidural, or nerve blocks with sedation) or general anesthesia.

 

Q: Regarding physical therapy, how long will that take and where will the therapy occur?

A: Initially in hospital the days after surgery; then at home or as an outpatient depending on how you do... Hip rehab is generally pretty easy for someone in your age group, and usually completed in 4-6 weeks.

 

Q: How long will my movement be restricted? That is, how long do I need to be careful of accidentally dislodging the new hip.

A: About 6 weeks postop to follow hip precautions, which you will be taught.

 

Q: Regarding getting back to work.  I am currently working from home.  I do not need to travel outside the house to an office for work.  Given that, would I be able to sit at a computer sooner than 3 weeks if I'm at home?

A: You could be working at a computer at home within a few days, as soon as your mind was "clear" from the anesthesia and pain medication...

 

 

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