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.