Almost Five Months

There's two or three of you who will receive this blog post as an e-mail. It's been a while since I posted last. Since there isn't much change day to day or week to week I'll start keeping some data points, via this log, monthly.

I saw the surgeon last month, got x-rayed, and got an A-OK review. My next appointment is for an annual check up. He says do whatever I want, let pain be the guide as to how much, see ya in a year. Cool!

It has been almost 5 months, since the surgery. I have been pushing the hip in the last month and it has pushed back. The result is that I am maybe, not sure, in a little better shape but I am walking with a limp again. The pain is most apparent after I have been sitting. When I stand up after being in a car, restaurant, or at my desk for awhile the pain is about the same as before surgery. After walking for just 100 feet it gets much better and doesn't start to hurt again until after walking over a mile. I've experimented with jogging on a treadmill and that still hurts immediately and leaves me limping for awhile. I'm going to keep intro-jogging the two days a week I am at the gym with Edsall for a total of only 1 mile per week and see how that goes. I hope things get stronger and I can do more pretty soon. I am also riding a stationary bike and walking or hiking about 2 to 4 days a week. I need to step up to every day but the hip has been getting too painful at the current rate.

I have not skied yet but there has been little snow. It snowed this weekend so I will probably go before Christmas while Nick is in town. I expect I'll feel a little better than the last time I skied before surgery, but not completely better. I'll make a post after the first time I ski.

Thanks for reading. Happy Holidays, y'all.

(Security) Theater

Kirsten and I just went up to Seattle for a romantic weekend. It was the first time I have been through airport security with the new hip. The surgeon's office had just promised that I would set off the metal detector. I asked them about some sort of card to get me through and they just laughed. If cards worked the bad guys would just get cards so the security guys wouldn't care about them anyway.

I'm not a big fan of all the money we spend on airport security. It is still so porous that most of the security measures are to make the honest people feel good and the government look good. The pundits I like call it security theater. The new part of my theater is the glass box. It goes like this. Strip down to no jacket, belt or shoes. Run it all through then step through the metal detector that hesitates, then goes off. The agent asks if you have anything in your pockets like a cell phone and invites you to step through again. You say no but you have a hip. Never mind the step through again in that case, please step into this glass holding pen. They then call a male searcher. The searcher lets you out of a glass back door after you have stood there for awhile in your stocking feet, stupidly facing the wrong way, holding up your pants, watching folks watch you. The cage, I presume, is to keep a higher level suspect such as myself from bolting. The searcher comes with a wand and goes over you very thoroughly including a lot of pat downs and reaching behind waist bands. It doesn't take much longer.
Do take off your belt. I wore one without a metal buckle but the dude still had me take it off and wait while he ran it through the scanner. There is a slight alternative I didn't have a chance to try. I didn't use it, but Salt Lake has some optional scanners that see through clothing but, I'm told, don't have a metal scanner. With a hip they can see you don't have a weapon that way and you can skip the pat down. The Salt Lake pat down guy told me about it. Seattle didn't have one so I haven't had a chance to try that route.
Sitting for a while still stiffens up my hip. But once I'm up and moving I can cruise the airport, and Seattle downtown, without a limp. As expected, I have to report that I still get museum back when on my feet but not moving much. I had slight hopes for that with a fixed up hip, but I think I still need to work on the ol' core strength and flexibility, and maybe go ahead and rent that wheel chair . . . !

Expectations, 104 Days

November. Until yesterday I was thinking that I was right about hip progress flattening out. Slow, hard to measure progress is surely to be expected and with low, and reasonable, expectations a person is not likely to be disappointed. I have been content to keep the big picture in mind. To think long term. In that sense I had been completely satisfied with hip surgery results.

For the last six weeks I have been trying to augment this satisfying progress by losing weight. I'm 5'11", almost, and 200 lbs, not almost. For my height an ideal and still realistic weight would be maybe 175. I believe that weight loss would help dramatically in the daily pain level. For instance, I can feel the difference in discomfort when I climb up a few steps while carrying a couple bags of groceries. For 6 weeks I tried to be aware of what I was eating and to stay a little hungry. But I didn't lose weight. So 11 days ago ( but who's counting?) I found Livestrong.com and their amazing, and free, website. Under "My Plate" one can count calories both in rather precise terms of intake and in exertion. One can put in their weight, age and activity level and how fast they want to lose weight and Livestrong gives you a target daily calorie amount. For these 11 days I have been scrupulous about maintaining the site and I am, according to them, more than 10,000 calories ahead of maintenance level and over 3000 ahead of target. I still weigh 200 lbs however. This time I let myself expect that I had been eating more than I thought, that counting calories would help me smoke that fact out, and that if I hit or exceeded their targets I would lose weight. I admit I am disappointed. Counting calories should count for something for all kinds of reasons, the least of which is how damned tedious it is! Anyway . . . I'm not sure what to do about that. I'm not really willing to put a lot more share of mind into weight loss or to be a whole lot hungrier. I'll go another week and see. This time without expecting as much.

Last week it snowed in the valley for a few days but by yesterday it was sixty degrees again with bright, fall-blue, cloudless skies. I went out for a road bike ride with Kirsten and our neighbor, Nancy. Both women are lean and strong. Nancy hasn't been riding much of late but she is a natural, tiny like a jockey, and like I said, strong. Surgery had sort of evened things up for all three of us on the road and it was fun to ride for an hour or so with them. I've been riding some on my own, not a lot, but some. Yesterday, however, the girls could not keep up or even close. In fact, I was reeling in other riders, something that never used to happen, ever, even before surgery and even when I was all trained up for Ride the Rockies last June. Kirsten has maintained that my arthritic hip was holding me back a lot, even on the bike. I'm still a little skeptical about that, but yesterday, hey, an upside, unexpected surprise! Something feels different out there. Perhaps not only does my hip not hurt as much but my whole leg works better and is stronger. Now that's more than one might expect.

90 Days

K and I went for another nice hike on Saturday up to Cohab Canyon on a spectacular fall day in Capitol Reef. The cottonwood trees were in full golden splendor, the day was cloudless and the slanting late afternoon light made me pull out the camera. The hike isn't quite 1000 ft in vertical but in places it is rough and there are a few 2 ft step ups. Before her knee surgery in 2006 and for 2 years afterwords she used hiking sticks. Up until my surgery I was using a hiking cane. We took neither and didn't miss them. I can still feel some soreness but it is better than before.

Yes, I do absolutely plan to ski this winter. Nick and I are all up to date with 20 days between us at Snowbird and I have a Silver Card at Alta. See y'all up there!

Week 12 - Hard to Stay a Curmudgeon!

I received a succinct nudge to check in on hip progress.

I am just about ready to declare that everything about the hip is better than it was before surgery. There's a couple of yoga positions I'm afraid to try just yet before I am sure, but I told myself I would give them a go after 3 months.

Otherwise, there is less general pain. I can sleep on either side for at least an hour before I need to rest my hip by laying on my back for a bit. I can get a sock off and on without pain. Riding a bike 20 miles doesn't cause much residual pain. Hiking up and down hill is definitely easier. This last I became aware of last weekend. Kirsten and did an uphill hike in Capitol Reef along the Fremont River to an overlook at sunset. Compared to the last time I did that hike early this summer my leg felt like someone released the friction lock on my left side. The leg seemed to swing and lift itself and even though I am not in as good as shape as then, the hike was easier.

There is still pain when I first stand up but it only lasts a couple of steps then things seem to get settled in. Friends of ours just brought over some ski poles they picked up for me at the RowMark ski swap. I think that if we went skiing tomorrow (besides being a bit hard on the skis), my hip would feel better than it did the last time I skied last Spring. Even the scar is starting to fade a bit. Modern medicine. I generally enjoy being a skeptical curmudgeon about it, but that is getting harder and harder.

9 Weeks

Entering week 10. I am starting to take the new hip for granted and therefore impatient when it gets in the way. I remind myself that I used to be amazed that people were running and skiing at six months and this is only two. So, I count the good things. I am sleeping better. The hip seemed to wake me up every 30 minutes, less if I were trying to sleep on my side, which I prefer. There is much less of that now and the rest is welcome. I can walk without a limp, especially after the first step or two. My back hurts a lot less. I was able to pull the airplane out the hangar and put it back when it didn't start. I can imagine sitting on the motorcycle for a bit before I sell it. I would like to use the bike and plane maybe this fall and next spring before selling them. The hip will help.

Trying to get stronger has been a bit of a yo-yo ride and I have slacked off in the last week as a result. My courage often slacks when positive feedback is lacking. Some miles, 10 to 20, on the bike means a couple of days limping and I am just not inclined, quite, for more limping. So between weather, flats and schedules I haven't been on the bike, sheesh, for 10 days now. I did some tentative squat thrusts at the gym yesterday and tweaked some muscles right around my hip, but I don't think I got the socket or related parts. I did not receive specific PT instructions but I think I will start inventing my own to see if I can speed things up.

Butt In

Another week where changes are small enough that it is difficult to identify them. I notice that I can get in and out of cars easier, almost normally. I've been on another couple of bike rides and like before, my left leg and hip are a little weak still but don't hurt more than a minor dull ache while I ride. Later I have more of a dull ache after riding for a day or two, one that is enough to wake me up at night. At night I can sleep on either side now but the hip accumulates an ache that wakes me up in a half hour or so. Putting on shoes and socks has now become less than arduous. And . . . I can hot tub.

Walking around there is not much of a limp left. Sometimes my left foot pigeon toes and particularly while I'm climbing stairs my left knee wants to knock knee in a bit. My back hurts MUCH less than it used too. I'm told that I'm more upright and don't quite stick my butt out like I used too.

So, butt in and butting out for now!

7th Week Notes

I am afraid there just isn't as much to compare and contrast on recuperation as there was at first. It's tempting to talk instead about the chipmunk that got trapped in the Torrey house for days or maybe weeks, dined on chocolate, slept on the feather pillows, chewed up a third or more of the window screens and apparently tunneled out by chewing through a wood window and squeezing through a quarter inch slot of aluminum. Or maybe something about the strange late summer flower bloom in Torrey. Or something about my first piano lesson. Or the new camera lenses I picked up, or the amazing $20 Galileo telescope developed by the IYA2009 Cornerstone Project (see https://www.galileoscope.org/gs/), or my other 2 telescopes, or even coping with the vigorous diet I'm trying to hold to while being dazzled by the ever more exquisite (cuz I'm hungry?) cooking of K. That would be more interesting, but this blog is not about that.

Speaking of Torrey, however, coming down here yesterday about 18 days after leaving here does profile some progress. I take all the stairs one at a time, that is normally, even with a load of luggage in my hands. The low couches aren't quite as low. I am faster in and out of bed. I am not using a toilet riser. I feel again that another disclaimer is needed. I am not writing this because it is so damned fascinating, but just to keep track of how recuperation goes. Anyway.

I have yet to be able to sleep as well as before the operation. After 10 minutes or so of trying to sleep on my side, and I can lay on either side now, an ache builds up to the point that if I have fallen asleep it wakes me up. But that is getting better slowly. On the upside, on Friday in the gym, with Kirsten and Brian there to keep tabs on me, I let it rip on the elliptical machine to get my heart up near its max of 170. I did that several times. On the downside, the last time I quit because my hip was aching too much and it continued to ache like that for a day and a half. I think I ended up stronger. Tomorrow we want to do a 17 mile bike loop around Torrey that has some pretty good hills. I don't think that will be hard on my hip. It feels like I am getting past the point of tending to the healing cuts and getting to the point of buidling muscle and regaining some flexibility. I am not as flexible as before the surgery yet, but getting close.

My nurse points out that while my pain level hasn't changed a lot lately, my pain management regimen has changed. I am not taking any prescription meds and not even ibuprofen or Tylenol some days. They were getting hard on my stomach and I generally feel better without them. Onward!

6 Weeks

It has been 6 weeks post op and I am now free to sit in water. Can't beat that!

First Bike Ride

After going to the gym again on Saturday and riding the stationary for bike for 20 minutes I felt ready to give the real road bike a try today. Kirsten and I went out for a warm, breezy 11 mile ride. After a little fiddling with a new bike seat, we settled down into a slow but steady ride. I could feel a little bit of pressure in the hip, right in the socket, but it is not painful. At this point in recuperation it is more painful to lift my leg at the knee than it is to put weight on it. I thought that might be a problem on the bike, but it's not. Gentle peddling pressure is no problem, pushing harder starts to cause a little pain, but it's a gentle ache of a pain, not a sharp one. And I can start to see that it won't be long before I can throw my leg over the seat to get on the bike instead of stepping over the crossbar as I have been doing for the last few years. Cool! Not quite yet, but soon.

I was surprised that it was my heart and lungs that were the limiting factor in getting up the hills rather than than my leg and hip strength. My legs felt great. I couldn't do Ride the Rockies again any time soon, but the legs and hip felt great. Kirsten has been riding a bit while I've been recuperating and I wasn't quite able to keep up with her. I think that is terrific. Hopefully if we both ride and train together at this point we can continue to do so from now on.

I don't want to get too gushy about medical technology. Grandpa always said that God sends the cure and the doctor sends the bill. But, it is less than 6 weeks since a total hip resurfacing and I'm out on a fun 11 mile ride! Wow. And, as a friend of mine says, I mean that forward and backward.

Sweet Spot

My lovely and impossibly busy sister says she enjoys taking time to check in on my ramblings every day. Perhaps, contrary to previously stated intentions, I ought to go ahead and make more frequent entries than just once a week. You are sweet, Cami! Flattery will get you anywhere.

I went to the gym today for the first time post surgery with my buddy of 30 years, Brian. I could brag that we were there from 10:30 to 1:30, and we were, but it was much more a function of two old retired buds catching up on any and everything than of the effort we put in. None-the-less, I did turn the crank on a spinning bike for 20 minutes or so and then did a resistance circuit with Brian. He asked me if the bike hurt. I thought about it and said yes and described the general, dull ache. Then he asked how it feels when I am not on the bike. Oh. Hmm. Yes, there is a general dull ache. Good point! Cool!

In fact, the hardest effort of the day was putting on a sock and gym shoe. Bending over far enough to put on a sock and tie a shoe is still getting to where the hip pain starts to get sharp. There was nothing like that on the bike. And after 20 minutes on the bike I could walk with less limp than just before, particularly if I was conscious of trying to do so. I realized, in trying, that to some extent my limp is a habit reaction from before the surgery to hip pain . But limping no longer helps, in fact it makes things a little worse.

Shucks. There is a big sweet spot between somewhat painfully putting on a shoe and using it with exertion almost pain free, one that I can fine tune a steady recuperation into. No excuses!

5 Weeks

Not much new. I feel about the same as last week. There is still pain and limited motion but a little better all the time. I'll try to check in weekly with any objective updates.

New Parts

I asked on Wednesday about getting copies of the X-Ray just for fun. Rob, the PA pictured, said their X-ray copier died 6 months ago but that we could snap a pic. I made him pose as a consequence while I snapped a pic with my phone.

Checked Up, Checked Out

Went into the surgeons office with Kirsten on Wednesday morning for the followup visit. We met with the nurse and then the PA; we knew the surgeon would be out. It seems, as I expected, that all has gone as well as it can. The TED's (surgical hose) use was lifted, the 90 degree movement precaution was lifted, I'm off the narcotic meds and can now use ibuprofen or acetaminophen and/or naproxen in the approved combinations. I'm still taking an aspirin a day for blood thinning. All the news was good news.

It's been just a month and it is nice to have the restrictions removed. There is still background pain and pain when I get to the 90 degree point or too bent. The background pain is enough, it seems, to make me a little more tired than I would be otherwise. I'm still stiff and move slowly when I first get up from sitting or sleeping. I tried the toilet without the riser and that seems a little soon. But yesterday when I got up in the morning and walked to the kitchen to start the copy I thought for the first time that I feel better in many ways than before the surgery. The furthest I have walked is 3 miles and that was over rough ground in Capitol Reef. I was a little stiff but it wasn't too far.

Time to start getting stronger again. I specifically asked about the gym, a bike, weight bearing and the answer was to let pain be the guide at this point. The only continued restriction is to stay out of tubs and pools and such for another couple of weeks. So, meeting Edsall at the gym tomorrow.

Riding the Plateau

Kirsten and I are still in Torrey, probably until this coming Tuesday. Hip recovery has slowed down and evened out. I'm still taking some meds, about 1/3 the originally prescribed dose of Lortab. Going for a mile walk without that amount would be more painful than fun. Initially I thought the doc might have prescribed too much, but now I think it might turn out to be about right. I keep myself on the edge of being uncomfortable and that has me slowly and steadily cutting back.

I am still just walking a little over a mile a day, most days. Getting around is a little easier but that has resulted in me tweaking the hip a bit too much a time or two getting off a low couch or just getting up or down in general. The over-tweaked pain lasts a day or so. I walk down steps now one step/one foot at a time but still generally two step going up with the good leg going first. Raising my left knee more than about 30 degrees is still the most painful movement. The pain of walking is getting back to the same point as before the surgery. Most of the pain is the familiar hip pain I had before, but some of that is just starting to go away and there are some new sensations, mostly of tightness. There is a sense that my leg isn't quite in the same place as before and that my left foot is, for the time being at least, a little pigeon toed. It feels better when I walk to try and turn that foot out a bit. K says I land a lot more on my heel now than before, when I used to step flat footed on the left. Progress!

My body is starting to feel the lack of all around exercise. I see the surgeon's office next week and I hope to get some go ahead to hit the gym a little for some upper body resistance work. I'll get a better idea then of when the 90 degree restriction will be lifted and a bike, or a push up or sit up starts to be possible.

Dark Leafy Greens Never Hurt No One

Day 19

Last Tuesday another new nurse named Sue came in to run the blood test via a finger prick. Basically she is measuring for the speed of coagulation and shooting for a measurement between 2 and 3 on a scale of about 5. The result determines the amount of blood thinner to take. I had been right at 2.0 which was making them happy but Thursday's measurement came in at 1.5. A little too low, no big deal, the meds would just need to be adjusted. As Sue picked up to leave she reminded us of the precautions to take along with that of eating no dark leafy greens and the like (with vitamin K). Eh? We asked her about the diet restrictions and as she described it in more detail like that of no cranberries and vitamin supplements, Kirsten and I both had kind of a déjà vu reaction that maybe once we had heard this before. In fact, I had enjoyed a couple of great spinach salads over the weekend. Turns out the vitamin K thickens your blood! But, like I said, your veggies never hurt no one. By this weekend, citing how much more active I seem to be than the usual patient (I am? oh good.) they had me drop the Coumadin and go to one regular aspirin a day. They also cut me free of the home health care. To boot I have dropped the crutches and have used a cane only for outside walks. Today I plan to walk without the cane as well. I'm sleeping ever better, according to Kirsten and, while still taking Lortab we are continually cutting it back. Without it I still get too uncomfortable to be very interested in walking. We're back in Torrey for 8 or 9 days so it is nice we don't need to go into the local clinic for a blood test. Finally, on the medical front, my blood pressure was slowly creeping back up, presumably from no bike riding and we went back to a half my formerly prescribed dose of Lisinopril. The BP obligingly dropped right back down. Still got the lovely surgical hose. Yesterday I drove for the first time, hose and all, just the mile into Torrey for a general store run. No problem including the new relative ease of getting in and out of the car.

The bills have started coming in. No drama, but I'm finally glad to have been paying those insurance premiums. The hospital, not including the surgeon or anesthesiologist was around $35k but the amazing thing is that the prosthesis alone was about $25k of that. Zowie.

Ramp up and down

Thanks for comments. I've hit a little bit of the recovery doldrums. Travel yesterday left me with a bit of a flat tire and I begged off on the Chicago concert last night. Kirsten went with 3 others for a girls' night out. Maybe I'm not the only curmudgeon.

One mile is the most I have walked at one time so far. The PT urges me to be walking more often instead of further. Given the relative comfort of doing that and my desire to get off the meds I think I will do that for another week or so. I walked .4 miles early this afternoon and will try to round it to a mile tonight. I've been completely off the oxycontin since Friday and have pared back the lortabs to 2 at bedtime then one every 5 hours or so. But even on that I took a long nap today that didn't feel very natural. Yet there is still a constant background pain. It's there but not too bad. K and I are going to try less Lortab during the day and see how that mixes with stepping up the mileage. I'm trying not to count days until no orthopedic stockings and the 90 degree restriction is lifted (20? 30?). The 90 degree is particularly tricky at my desk when I am already sitting quite upright with my feet on the floor and want to reach forward on the desk to get something. So far my hip is still in the socket. Separately, I think I'm getting close to being able to sleep on the incision side.

There is a minor mystery. Right after surgery the surgeon referred proudly to a 3 inch incision. The one on my hip looks like 8 to 10 inches. Makes me wonder if he mixed me up with someone else. The follow up visit with the surgeon is in two weeks. There will be X-rays which I hope to get copies of, just for a souvenir, and we'll discuss what incision was 3 inches. In the meanwhile I guess I'll have to give up on my bikini swimsuits.

The Stretch

Day 13. On Friday we went to a Diana Krall concert at Red Butte Garden with Doug and Dona et al. Doug took advantage of the Americans with Disabilities Act, to a minor extent, when we drove up to the gate and went in with two friends through the VIP/handicap entrance. The concert was sold out and the main gate line was a thousand people long waiting for the 6 o'clock gate opening. We went right through. Amazingly by 6:10 the main lawn was already full, but the wheel chair access is a cement strip all the way around the top of the lawn where there was plenty of room for my higher chair and for all of us. I sat, very comfortably, in a standard portable canvas sling chair. The opening act was a pleasant surprise, K and went for a walk between acts, then Diana crooned to us until about 10. Doug slickly parked the car nearby in the VIP lot so the walk out was short. Very smooth.

Saturday we got up to meet with some friends, pick up some books, get Sock-eye Salmon at the mini mart, back home to pack up and headed down to Torrey. By the time we got here, I was getting a bit tired. I'm tired, but care-giving is a maybe more of a strain than recovering. My nurse is coming out of a long Sunday afternoon nap as I write.

D and D came down to Torrey today. While they were driving down K and I went out, with my new Garmin 305 gps watch, for a desert stoll. K keeps singing, "If you're a nerd and you know it, check your watch . . ." We figured it might be about a half mile out to the neighbor house. I set out with two crutches then asked K to carry one on the way back. Even though the road is uneven dirt the walk was pretty easy. Sure enough, 1.02 miles round trip. Good thing I had the watch.

I'm weaning off the meds. In the morning my back hurts as much as anything, a pain I am familiar with and that I hope goes away as my new functioning hip kicks in. The 90 degree bending limit keeps me, in the meanwhile, from stretching out my leg and back the way I would like. But I don't need meds for that. So I quit the oxy as of Friday and going to half strength on the Lortabs. I imagine I'm off the Lortabs in a week. I can't take Ibuprofen or any other anti inflammatory while on blood thinner, so I will have to see how Tylenol does. Tylenol isn't usually much help, but the pain is diminishing fast enough.

I think I am in the middle phase where I am not yet better than I was before surgery but am getting better every day, slow but sure. There may not be much to report for awhile. Joe asked about the mental aspect. I feel happy and satisfied with how it is going, but with my usual impatience to get it done and be able to get back to normal workouts, no crutches, no toilet risers, no handicap parking, less dependent, able to sleep on my side, yada, yada. The stretch.

Inspiration

Friends who had various surgeries before mine warned that the pain meds often made them itch. I have found that between my beloved hose and the meds and maybe surgical steri stips and or whatever, I do get itchy. The recommendation, ok'd by the doctor's office, is simply Benadryl. I have always found Benadryl to work for an itch, and one of the ways it always works is to make me sleepy. K bought some spray on anti-itch antiseptic that also seems to work. I think I will stick to that tomorrow.

My sister commented that she is deathly afraid of Oxycontin. Until my experience with recovery from alcoholism I had not paid much attention to prescription painkillers and their abuse. But the stuff and it's misuse is prevalent. Yesterday I met the nurse who will be calling on me a couple of times a week for the next few weeks. She looked to be about my age and as she unpacked some gear I noticed her look at the pictures of K's kids and my kids on the mantle in the living room. I was hoping she would ask. She did. Asking about someone's kids is always, always a terrific thing to do. I was delighted and asked in turn about hers. She has 5 and is a widow. Perhaps brazenly I also asked how her husband died. She looked at me, paused for just a second, and still watching me said he was a prescription drug addict. Home health care gets intimate pretty fast. I told her I was sorry, that I thought I had a glimmer of understanding, that my AA anniversary is 11 months. She smiled and relaxed and, while pricking my finger told me a bit of her story. It's sad but she obviously has a mature grip. On her life I mean, as well as my finger.

K came in and we shared notes on the availability of pain meds and the medical community's stance. It seems to me, based on my current experience and on that of stories I hear in AA of recovering addicts, that the docs routinely prescribe plenty of pain pills for various maladies. For some it is too much. In my case I would guess they gave us more than I will need. In AA land folks are very leery of the docs propensity to prescribe. The take from the professionals in recovery is that you take what is prescribed for pain and as long as it goes to the pain, you are ok. When it starts to make you feel good it's time to stop. As soon as anyone takes the stuff because it makes them feel good they are on a slippery slope. Presumably a very slippery one. Oxy is simply synthetic heroin. So K is in charge of the drugs around here, I don't know where they are and don't need to. We have found that taking them as prescribed for the first week has been just about right. If I take less the pain starts to get too big. More and I get unnecessarily woozy. I'm happy to report that none of them make me feel particularly good. That probably indicates they are going to the pain and all is according to plan.

The PT came before the nurse left and we compared notes on the question of the tradeoff between taking enough meds to exercise more or quickly weaning off of them. It is not a question they had pondered a lot but they quickly concluded that sticking to the Doctors recommended dose then letting pain be the guide to how much to exercise is the way to go. That seems reasonable to me for the first several weeks. After much more than that I would like to be tapered completely off. I expect I will be able to. The only reason not to switch to Ibuprofen or any other NSAID right away is that they have a blood thinning aspect and my blood is being carefully controlled and monitored via the Coumadin and the finger pricks. The Celebrex, which doesn't have the blood thinning effect, should do the same. Blue Cross won't cover the Celebrex because they want to try something cheaper, like Ibuprofen, and aren't concerned with the off label reasoning. So we just bought some of the expensive stuff anyway.

I went for a .3 mile walk this eve after about a .2 mile walk this morning. It's a lot of work to try and keep up with K's languid pace. I get nice smiles from the neighbors out walking. I'm sure it's the tights. One older dude last night said in greeting, "Hip surgery, huh?" He said he had his first in '03 and his second last year. His wife patted him on the back looking at him in the face with a big smile and said, "Look at him go. And he's 80!" Inspiring. I said I want to be like him. I told K afterward I want us to be like them. I've been getting around the house all day on one or no crutches but took two on the walk. Two are still prescribed by the PT in or out. I'm a little stiff now, an hour after the walk, but I expect to do fine. I've got inspiration.

Finding a pace

Yesterday I read through a number of blogs and web postings from others who have been through hip resurfacing and was struck by a few common themes. People, their recovery and their attitude go hand in hand. And that reminds me of any kind of survey outcome. For instance, the finding that people who go to church are happier doesn't tell us if happy people go to church or if people who go to church are happy. My finding that people who have obvious upbeat attitudes were also having upbeat recoveries doesn't tell which is the cart and which is the horse, but I think it is safe to let intuition make the call.

Another theme was that people who recovered the quickest were up and at 'em the quickest. So I decided I would be, if not the fastest, amongst the quickest to walk around the block. I didn't see anybody claiming to quite do that in the first week. It seemed easiest enough to me so I got K to join me for a short trial hike up the street. As I reported yesterday, we only went about 4 or 5 houses before she said it looked like I was starting to tire. I felt okay, but figured we could go out again that evening. But even that small hike, while never hitting me all at once, made for a more restless night and for the pain meds not being able to quite keep up for the next 16 hours or so. The PT was here today listening to my story. She asked, "What is the last thing I told you when I left on Friday?" Hmm, I couldn't quite recall. She smiled and said, "You will keep recovering fast as long as you don't try to go fast." She said that again today when she left. The little cutie. Tonight, after the sun sets and it starts to cool off I think K and I will stroll about one house less.

Maybe then I can still make the block by 10 days!

Next time I'll pontificate on the tradeoff between weaning off the drugs quickly and ramping up the activity quickly. Also so more thoughts on addiction, pain meds and the medical industry. The nurse that came by today has some interesting Al Anon experience to share.

Easy Sunday

If you read this, try to make a comment. I have not mentioned the blog to many people, and I am enjoying the new experience of blogging, but I can't help but be a little curious about whether I am writing just for myself. I think you can just click on the word "Comments" at the bottom of each blog and then if you have an AIM account or Google or Yahoo or some such, you can log in and say hi.

Still getting better without complications, knock on wood. It seems to me that I am recovering as fast as anybody else who has blogged on hip surgery. Today K and I walked about 4 houses up the street. It was more effort than I expected, using the two elbow crutches, but I felt like I could go around the block. In fact, just so I can say I did it in the first week, we may try to go around the block tomorrow. Now, post shower and post Lortabs, and a few hours later I feel fine.

We had a couple of visitors today, men my age or a little older. One of them, at least, thought I looked so good he wanted to go out and get his joints x-rayed. It must be the Ted hose. They are truly killer.

I can't remember what I have blogged about the drugs. There is the largest prescription bottle I have ever seen, by 4X, of Lortabs. Also Oxycotin, Celebrex, Coumadin and Colase. The Lortabs seem like terrific Ibuprofen and go straight to the pain without much side effect. The Oxycontin, a synthetic heroin, makes me feel a little goofy and K and I may decide to skip a dose of that tomorrow morning. I took Celebrex years ago and didn't think it did anything for me. It feels about the same now. The Coumadin is closely monitored blood thinner and seems to be working fine -- I'm not too bruised up nor have I died of a blood clot. The Colase is a stool softener and I'm happy for it. I'm happy for the meds for now and can imagine that as the next week goes by I will be able to start weaning off quite quickly.

The drugs do help me sleep, which is good because I spend most of the night on my back. I normally like to turn from side to side during the night, so a little help sleeping on my back is nice. Otherwise I feel like I am getting plenty of sleep. Recovery on.

Some Pictures

The Factors

Recovery on day 5 is going about like I expected. There are a couple of factors that I didn't know of that tend to dominate the show more than others. One is the precautions. There are 3 of them: 1) don't cross your legs 2) don't go pigeon toed and 3) don't bend the knee/hip/shoulder angle past 90 degrees. The third is the most limiting. That means don't bend over to pick up something on the floor, to put on a shoe or sock and the like. It means the toilet needs a riser. It means it's hard to get your underwear up when it is slumped around your feet on the floor. The second precaution is limiting mostly while sleeping. They want my legs to not go past parallel toward each other. So sleeping on my side needs to be done with a sturdy pillow. It may not sound too hard, but the maneuver to get on one's side can be tricky.

The concern is the capsule. As I understand it, some explained to me by a PT-rehab cohort, who like me was leaning back in his orthopedic, wheeled, jacked-up recliner working his new grabber device to put on his socks, it gets rather physical on the operating table. The surgeon makes the incision, (which looks more like 8" to me than 3", hmm) then the PA bends your knee, puts his shoulder to your thigh, and wrenches your femur out of the hip socket. Reminds me of carving the turkey at Thanksgiving. Then, to dress Acetabulum, or the hip socket to us laymen, and to get the prosthesis in, he cuts the capsule. Once the prosthesis is in he sews it back up. While the capsule is healing there is a heightened risk of dislocation and thus the precautions.

The second factor, which is not as predominate, are the surgical hose and the swelling. The first couple of days I didn't notice much swelling. The last few days my hip has ballooned up a bit and along with the bloating of laying around and the general pear shape makes me want to throw a tent over my head. The hose are white and as my leg swells up pretty much act like a tourniquit. The concern is blood clotting and the word is I will wear the things for 6 to 8 weeks. But Kirsten and I are already starting to plot a shorter path.

Back Home

OK, that was a little different. On Tuesday, where I last left off, Kirsten and I motored downtown on what was promising to be a triple digit temperature day. I soaked in the contrast between the midsummer outdoor scene and the institutional florescent environment we were about to enter. K drove carefully around the hospital block plotting out her parking and return strategy. The parking terrace was a half block or so away from the North Entrance we were directed to and I took my last stroll with her on the arthritic hip.

We checked in at a kiosk and picked up a pager, no TSA or full body scans. The waiting room had about 30 people in it including babies, a family of 8 or 10, lots of older couples. After a few pager beeps and a few forms we were taken to a small exam room where I donned a complex yet classically undignified hospital gown and a orthopedic white full length surgical stocking for my right (good) leg. Bobbi the nurse did the bracelet and drew some blood, put in the IV port and after about 45 minutes an orderly came and wheeled me toward the operating area. In quick succession we met the chief operating nurse, the surgeon and the anesthesiologist. They all looked great, cheerful, energetic, lights all the way on. The anesthesiologist came in asking me how I "wanted to do this." Curious question I thought, but I had just been thinking about that and asked if a general was necessary. He said absolutely not and described an epidural that was about a tenth the strength required for childbirth with a little sedative chaser. He said I would be numb and dysfunctional from about the belly button down (!) and that the sedative would probably cause a little amnesia. I'll say. They wheeled me into the open, laminar air flow operating room where about a half dozen folks in scrubs were scrambling around looking competent. The anesthesiologist handed me a hairnet head booty to put on . . . and then I opened my eyes in the recovery room. The only thing I could tell or feel that was different was that I now I had white full length surgical socks on both legs.

I felt great, not tired, not "hung over" and even, I thought, a little refreshed. However, it might be a little telling that 3 days later I can't quite remember how long I sat in recovery, but it seemed like just long enough for the radiologist to get an x-ray then I was wheeled into my private room for the rest of the hospital stay and reunited with my sweetie.

We stayed pretty busy with a little room service (I think hospital food is just great and the coffee at LDS was delicious) the various nurses coming in and out with their big healing smiles and a few texts and phone calls. Kirsten was fighting hard to hide the fact that she has a raging summer cold and wasn't feeling all that energized herself while I basked in constant affirming attention. The surgeon came by and said he was proud of himself, the that procedure "went pretty much perfect." He said he even made a smaller incision, 3 inches instead of 4. He described my left hip as "horrible" and, from the x-rays, my right hip as great. I have to say I am impressed by the guy. Later the next day one of my patient cohorts said Hickman had performed 11 surgeries that day!

At this point I was describing the surgery as less demanding than an eye exam. And at that point the epidural had not worn off. That night, when it had, I suffered a little episode while trying to go to the bathroom where my bp dropped to about 90/50, lots of sweating and nausea and having to holler out the door a couple times for help while I white knuckled the bathroom grab bar to keep from fainting. Back in bed one of the now swarming team of people clipped something into my IV and I slept for an hour or two. I haven't felt any where near that bad since.

Time to pee. I mean now, as I blog this. Later on I'll describe the hospital PT, the on time trip home and what recovery has been like here with beautiful and attentive Kirsten at my side. Except for the as predicted no BM as of yet, everything great so far!

Surgery minus 2 or 3 hours

We are back in Salt Lake from 4 days in Torrey. In two or three hours I am in for surgery. Kirsten has the coffee going and it smells great but that is as far as that can go. No food or drink, even water presumably, after midnight the night before. We are to check in at LDS at 7:30 A.M., north entrance. Bring loose clothing, no valuable, living will. Check, check, check. The call forwarding from the home phone worked just like it is supposed to. The call from the hospital yesterday rang K's cell yesterday afternoon around 2:30 pm while we were just emerging back into cell service on our way back from Torrey. The nurse was letting us know what time I had been scheduled. I thanked her for the decent 7:30 time. She laughed, "Not too early, not too late!"

Last night K and I went up to Dan's (the grocery store) and got some Coumadin, a blood thinner I was instructed to take with dinner. Other than that, this seems too easy. Just bring a picture id, insurance card and my hip, they will do the rest. I am strangely not anxious. A little excited, but not anxious. In fact, I slept better than Kirsten last night. I told her that I realized I was glad this was me going in for surgery and not her or one of the kids. It's a lot easier, a lot, to have to only worry about oneself.

Brian called last night and left a nice message about Tom Watson almost winning the British Open at 59 going on 60. Last year he had a hip replacement! Yeah baby!

Next entry maybe Wednesday some time. And I'll already be back from the hospital.

Set to go

K and I are heading down to Torrey today and we think all the bases are covered.

I've triple checked the insurance. It's a trip dealing with these behemoths. A woman named Ashley answers the Regence Blue Cross customer service 800 number and asks if she can help. I tell her who I am and what I am doing and ask how I will be covered. I have two procedure codes for her. There is not yet an existing government code for a hip resurfacing so I give her codes for a total hip replacement and the code for an unspecified hip surgery. Then I tell her that it is neither of these, but that there is not a code. She can't find the procedure but says that yeah, it should be covered. ??? I say, Ashley, honey, I don't believe later when I get turned down that it is going to help me to say that I called and talked to Ashley and she said she thought I should be covered. Ashley sheepishly agreed. In the meanwhile, while still on the phone, K and I look up on the internet where Blue Cross has accepted the procedure and with the help of Google taking us right into the Blue Cross site go on to help Ashley find the procedure in her system. Then she says, oh yeah, here it is, and yes you are covered.

I have an insurance plan that coverers both my kids and me. Kirsten has been turned down for individual coverage and remains one of the great uncovered. For what is now running $8000 per year, Kristen, Nick and I have a $2500 deductible per person, then 80/20 up to a $4000 out of pocket maximum with a total individual lifetime coverage of $2 million. It took another call to find out about the $2 million. On that call I asked what is the maximum payout per individual on my plan. The rep asked do you mean the deductable? I said no, what is the insurance company's max payout? She said you mean your max out of pocket? I said, no . . . Anyway, you get the picture. Then, this morning I noticed while paying bills I had just missed the last premium mailer which is now 2 weeks late. I called again, this time very well helped by a rep who made a note in my file that the check was in the mail(!) and assured me I had a 30 day grace period anyway.

As my buddy Brian says, these premiums are huge but all you need is one procedure like this and they start to make more sense.

K went today and got the blood thinner script I take the night before surgery, the land line is transferred so when the hospital calls the Melony house line Monday to tell us when to check in we'll get the call on her cell, I've been off ibuprofen for a few weeks (because it also is a blood thinner), K got recommended stool softener for post op, and other than that there isn't much else to get ready. Insurance, will, meds, Hippy Tie Yi Yo!

The procedure to fix my cartilage free hip is called a total hip resurfacing instead of total total hip replacement because it keeps my femur intact. Instead of lopping off the top of the femur and putting a long stem/spike down the remaining leg bone, the top of the femur will be conditioned and the ball/cap above placed on it with the small stem shown in the picture. Instead of the prosthesis bearing the weight my bone will which promotes greater bone strength and, I expect, will decrease the chance of having to do the operation again in 10 or 15 years and will vastly improve my bone situation if I do need it. The surgeon's office had a sample prosthesis for Kirsten and me to check out. I held the socket in my palm and twisted the stem of the ball like a top. The ball noiselessly spun and spun and spun. I asked if they had a spare I could take home for a paper weight. No luck. The physician assistant joked that the part cost more than the surgeon will make.

The surgery is a little more involved than a hip replacement because of the need to dislocate the hip, by cutting the cusp, and work on everything intact. All the same, it only takes about a 4 inch incision and the surgery only takes about an hour. The cusp is cinched back up with stitches and there is a little "cement" used on the bone side of the hip socket, but beside the cusp healing and the bone growing into the socket surface, the hip is ready to go. It's ready enough they will have me stand on it the first day. I don't think I quite have to get off the operating table myself, but they want me using the leg, some, right away. If all goes as planned I will be in the hospital for one night and then home. Typically two crutches are used for a week, one for a week, then a cane or just hobble a bit after that. The main hip resurfacing web site out there, the one I used to find my surgeon, http://www.surfacehippy, has numerous testimonials of 40 -50 year old guys playing soccer, skiing, even finishing iron man competitions 6 months post op.

Blood clots are one concern. I'll take a blood thinner at dinner the night before surgery which they expect will kick in some time soon after the surgery. There are also some funky white stockings that fit tight that I will be wearing for awhile. The incision needs to stay clean and dry so no hot tubbing for 6 weeks.

. . . I wouldn't have thought to make this part of the blog, but I am heading over to my estate attorney – pre surgery – to make sure will all in order. Tell me I'm not a thoughtful guy! More later.

Pre-op thoughts coming

Before I go into surgery I'll enter a little background on hip replacement vs hip resurfacing, why I'm choosing the latter and what I'm expecting. I'll talk a little about K and my visit to the surgeon's office, what they saw and their reaction, recommendations and expectations including hospital time, procedure, recovery, pain pills, weight bearing, hygiene, bone healing time, when able to drive, and ??. Also, this reminds me I need to double check on insurance. More on that too.

Now is the time to check and see if hippy tie yi yo is going to work.