Getting Out and About

Tools

I have my reacher and my long shoe horn, both quite long and awkward when they are not being used for their designed purpose. Where do I put them??? I need the reacher all the time to ensure that I don’t break my ‘hip precautions’ of not bending my hip more than 70 degrees from vertical. We found a piece of the thin walled PVC pipe that we had used to plumb the house for our central vacuum system. After cutting off a two inch / five cm section and making a cut down one side to remove a .5 cm strip, we drilled four holes and used a couple of nylon straps (nyties or zapstraps) to lash it to the right side of my walker up near the top and towards the front. A little work with a half round file and there is a notch for the shoehorn handle and the reacher fits nicely on top of this. Everything is in easy reach and I am good to go.

We also fastened a pouch to the front of the walker so I can carry my pill box, a cordless phone, and a water bottle with me as I move around the house. Saw a number of patterns for sewing pouches for walkers out in my internet search, so anyone who wants to go custom will have not lack for inspiration.

Getting out of the House

I am scheduling some sort of walking every day, starting with several laps of the floor that I am on. I now wear a pedometer and amongst the walker, crutches, and cane, I am up to almost 1000 steps a day.
To get more walking in, I need to get out. The late winter rains are not making this easy, but since we shop in a variety of small stores, each time we need something for dinner, I am eager to go out. I certainly don’t feel up to the supermarket crawl yet, but a trip to the green grocer or the deli is manageable and makes me feel more social/human than endless laps around the house.

Expedition Planning

My goal is to make it around the block. I figure that I may take me another week to do this.

Physiotherapy

I attended as scheduled, 2 weeks after the initial surgery. Assessment is that I am doing fine and am on track. New exercises to do twice a day. So currently my life if focused on exercising, walking as much as possible, occasional outings, and napping. This is still the punctuation to everything that I do. I am much more appreciate of the term "nap attack" than ever before.

Pain Management – III

Getting back down to only taking Over the Counter medications is now my goal. Every few hours, I ask myself about what level of pain I am experiencing and then look really hard at the medications that I have available. Early in the day, I can use less, but after working out and just before the next nap, I need a bit more. The 'hard' drugs are being consumed less often but they are still with me. Without them I do less movement and it is the movement that will get me back to normal, faster than anything else.

Staples Be Gone

Staple Removal!

I’ve been home for a week and it is now 10 days after surgery; my leg is getting seriously itchy under the dressings. I have an appointment to get the staples out in the afternoon. A simple procedure, really. It took very little time and pain as Dr. Lee removed the 30+ staples that have been holding my incision wound together. She pronounced that it should leave very little scar by the time everything is healed. A few applications of Polysporin for good luck and I am on the way to being whole again.

Pain Management – II

Large holes in your leg really do require more drugs than I had imagined. When you can’t sleep at night and can’t find a comfortable spot during the day, it is finally drilling into my thick skull that I still need the some pain relief. Over the counter Tylenol is not quite enough and I am cut off the Non-steroidal anti-inflammatory drugs due to the danger of internal bleeding, blood clots and the attendant consequences if they move around in my body. When I had the staples out I also got a new prescription so that I can start stepping down from the opioids when I need them less. That will be a welcome relief. I do not like the clouding and physical side effects that they bring. It will still be awhile before I can get back to ‘normal’.

Crutches

I am slow but steady when it comes to going up and down stairs. I need to do this a couple times a day to get from my bedroom to the living room and kitchen. Each trip is easier, but I still need my walker to get around on the floor that I am inhabiting. I am concentrating on walking as straight as possible, speed be damned at this point.

Using a cane

I am taking a few steps now, indoors only, on the side opposite the new hip. The cane has a history as it was owned and used by my Father in Law (gone now). It is a marvelous piece of natural wood that has been steamed and bent. It is very light and strong. Quite suitable as an assistant.

More Naps

My sleep patterns have changed a bit with the surgery. I never get into a really deep sleep as I am always a bit uncomfortable. Still, I seem to be getting what I need for the time being. Lots o catnaps seems to smooth my resting out.

First Shopping Trip

A sunny Saturday and I really want to get outside. With the dogs loaded in the vehicle, it is off grocery shopping. I concentrate on a parking spot and one is waiting for us right in front of our regular green grocer (Norman’s) on The Drive. It feels good to be leaning over the produce and discussing what will go well for this week’s menu. Vegetable bought, and I am ready to be sitting again. In fact, by the time I make it up the back steps at home, I am ready for another nap.

Home Sweet Home

The Great Escape

I was so ready to get out on the third morning. I wanted to be home with my critters and partner. I wanted some (not a lot) real food. I wanted to be out of the hospital bed.

There are lots of bits of paper to be collated. That folder that you brought in with you comes in handy. Descriptions of your drugs, your wound dressings, your exercise program, and more are provided and you do want to keep them handy.

Fill your prescriptions on the way home if you can, or have your support person fill them for you. This may require you to send them out with your ID and a note. I double checked what would be needed before I left the hospital as there was no public pharmacy on site. In BC, the person who fills the prescription must have the CareCard of the person for whom the prescription is written. I clarified this at the hospital before leaving and it worked out just fine.

I was accompanied to the car by an Occupational Therapist who was there to coach me on getting in safely. The ride home was bumpy, even though I know my dear driver had checked out the smoothest route between hospital and home.

Homecoming

While my driver checked out the smoothest streets for the trip home, it was still one bumpy ride. I kept doing my deep breathing and just held on. It took a few minutes once we had come to a halt behind the house for me to be ready to disembark. Speaking of barking, I could see both dog noses under the back gate as I was approaching. They seemed as happy to see me as I was to see them.
It was an adventure using my crutches to come into the back yard and, slowly, up the back stairs. Really glad I had practised before going into the hospital. I was also happy to lie down on the couch when I am inside.

Pain Management - I

I never really noticed the post-surgical  convenience of having a nurse come by every few hours and say “Take these pills, now.” Serious luxury! Now that I am home, I can see that you need a virtual nurse when you get home to do these reminders.

When I got home, I let my pain control slip a couple of times. When the pain gets high it is hard to climb out of that well and get back on top of the big exercise ball that is your pain control program. A short consultation before I left the hospital would have been useful to even out the bumps.

I need a Meds App! Every 2 hours during the day, the app asks: What level of pain are you at, currently. Given you current pain medication it may offer a med to take, tell you that you have had meds recently, suggest that you wait another hour before trying again. I went looking but didn’t find anything quite like this. It wouldn’t have mattered, really, as I don’t have a cellphone, much less a smart one.

What I actually have is a spreadsheet that allows me to set up my meds for a day and then I fill up a 7 segment pill box that is labelled with the times that I need to take them. This is now working well.

Constipation

Let’s talk about this because it is real. All those lovely painkillers have the side effect of bunging up the digestive system. I normally eat a fibre rich diet anyway, but I now need more. The balance seems to be 1 dried fig (which I love) for every constipating pill. Taken with lots of water. This is on top of my normal diet. It is a relief to be regular! (Never thought I would be saying this.)

Incontinence

One of the other side effects of the anesthetic has been decreased bladder control. Sigh  Not the most fun I've ever had. However, it is controllable with frequent visits to the washroom and that requires more walking, which is a good thing for my recovery. I am using a heavy flow menstrual pad for overnight. The good news is that control is returning.

Rugs

We removed all the small throw rugs during the pre-surgery prep to avoid tripping hazards. However, the large area rugs also proved to be impediments to the walker. Rolled up and tucked under various pieces of furniture now. Glad that there isn't any wall to wall carpet in the house.

Hip Precautions

The preliminary documentation talked about "90 degree precautions" i.e., the operated hip must not go beyond 90 degrees. I found out quickly from the physiotherapy team on day one that this was actually "70 degree precautions" for the first month. Keeping that leg as straight as possible at the hip is a tricky piece of business as all of my reflexes have it bent. With help from others, "Watch your hip!" I am getting the hang of it and keeping positioned so as not to dislocate my new hip joint. 

Wouldn't want to go back into surgery any time soon or have to explain it to my doctors.

New Routines

Everything takes a lot longer. Double or triple the time that you would normally spend on a task and you might be in the ballpark.

Putting on a sock is a 3-4 minute sequence now rather than 20 seconds. I need help if the ‘sock aid’ doesn’t release. I am thinking about cutting it down for my smaller than average feet; should be able to do this with scissors quite easily.

Getting dressed is good to help (re-)build skills and feel like you are ready to take on the world. I am still wearing my sheepskin slippers most of the time, though, and they are so cosy.

Sleep

As much as possible! Cat naps and catlike behaviours abound. Sleep, stretch, snack, walk around, back for another nap. I could become a cat quite easily.

End of Week One

I am exhausted! I do a gentle round of exercises every day and it wipes me out!

That said, I can see miniscule improvement every day.

I can use the crutches for a limited time each day and am moving longer distances each time. Of course, longer, in this case, means a few more metre increments, not even up to a block at a time yet. That will be next week, I hope!

I will try doing my exercise round once in the morning and once in the afternoon.

Hip Replacement Surgery

Night Before Surgery

The house and myself were are ready as possible, so this was the last sleep before the operation.

The hospital that I was going into required a night before ritual of bath/shower, a dry off period, and then a wipe down with Sage wipes. Those things are cold! Take the package advice and gently warm them in your microwave for 30 second (or less depending on power) or lay them on a hot water radiator for 20 minutes before using them. Air Dry yourself and then to bed with clean sheets, and then a good, or at least reasonable, night’s sleep.

Hospital Admitting

The Day of the Operation dawns. Don’t forget to bring a folder for the papers you have and the papers that you will receive as you go through your hospital stay. A book is also useful for the inevitable “Go over there and wait.” times and then later when you are resting.

There was more taking of samples, another swabbing down, changing into your hospital gown and getting a dressing gown for the back (Thank You!, Hospital).

I am now deep in the hospital; in a hospital gown; the doctor has signed the hip that is being replaced; I have been asked about allergies many times; I have had a thorough briefing and testing on the 10 point pain scale (https://www.google.ca/search?hl=en&site=imghp&tbm=isch&source=hp&biw=1063&bih=637&q=pain+scales&oq=pain+scales&gs_l=img.3..0j0i24l9.9073.9073.0.9709.1.1.0.0.0.0.166.166.0j1.1.0...0.0...1ac.1.3.img.kkLAClQ5Vcc);then an interview by the Anesthesiologist; and the admitting nurse has started my IV. It is all pretty inevitable now.

Surgery

I get to walk into the Operating Room, where a team is ready, just for me. Just follow the direction: Sit here, Lean forward, wait for…

The next thing I remember is coming to, as the team moves me onto a hospital bed and I am rolled out into the recovery room. I know that only a couple of hours have passed and that the surgery is over now.

Recovery Room

My Recovery Room nurse is chatty, I suspect at least partially to see how awake I am. The big question is when is the chest down anesthetic wearing off? They use a bag of ice to see what you can feel. Sensation comes back steadily over the next hour or so. First the non-operative leg, then the side that was operated on. Once that is feeling the cool of the ice it is time to be sent to the ward.

Ward

This is home for the next few days. I was sharing a room with a woman who had her surgery two days before. This was her second hip replacement as she had the other one done three months previous. She was working hard to get out of there as soon as she could. In my dazed stupor, she seemed like a little dynamo and I thought, “I hope I can do as well.”

Meanwhile, I am feeling a bit of nausea and, fortunately, there is a drug for that.

Day One Post Op

Overnight is a balancing of nausea, pain management, and a need to sleep. This floor is a busy place with soft dings and gongs going off all night long. The bed pan is there for relief and now I am grateful for the extra strength in my arms so that I can pull myself up and be able to use it.

This is not the best day of my life. I feel like someone has removed my right leg and then reattached it after replacing the joint. Oh, right, they did! The leg is not a happy camper, but the various miracles of modern chemistry are working to keep me under six on the pain scale.

Hospital – Personnel

There was a never ending parade of people traipsing through.

The nurses (and the student nurses) were all very competent, well identified and had massively different personalities. They cycled every 12 hours, so it was a bit hard to get a handle on who you were trying to connect with. Primarily, they all spent a fair amount of their times taking my vital signs and getting me to take pills of various sorts and to drink water. “Drink more water!”

Other personnel were not as clearly identified. It was often hard to understand what they were supposed to be doing. So, I didn’t worry much about it.

Cruel to be Kind

One clearly identifiable group was the Physiotherapists. Physiotherapy is an instant-on process after this surgery. You are being watched to make sure you align your operative side correctly. Than they show you how to roll up into a sitting position on the side of the bed.

“Can you stand up?” (If you can do that you can walk!)

“Can you come down to the Physiotherapy Room?” If you can you can start your exercises. Yes, they will hurt but it is all worth it.

I was eager to get started and despite the pain of doing the exercises, I was never pushed past what was doable. Lovely people who were always paying attention to what you were doing with that body of yours.

Hospital – Food

Scary, Scary stuff, kids. There is nothing that arrived, other than one boiled egg, that I would consider wanting to eat before or after my stay here. The first day, I had no appetite for any food. The second day, no appetite for whatever it was that they were serving. It had names, but no particular flavour or interesting texture (library paste?). I completely balked at eating something described as “SS Meatballs”.

I did eat the boiled egg, some overcooked vegetables, a bland vegetable soup, and some instant oatmeal. Fortunately, hunger was not an issue and I will not be starving any time in the near future.

Clothing

You will be told that you should have ‘loose clothing’ to wear after surgery. They are NOT kidding! Get out your ‘Fat’ clothes and then figure that you will need something even looser. I borrowed sweat pants from my nephew and although they are a bit long, they have accommodated the extra 10+ pounds that the swelling has added to the leg that was operated on.

After the first week, the swelling starts to come down. I am now back into normal sweatpants and feel somewhat lighter.

Getting The Call

Getting The Call

I suppose this was The Wait – III, but it all happened very quickly. I had barely told the folks at work that something was up, saw my GP with the news (we were both very happy), and started to review the company policy for sick leave when the phone rang on January 29. Dr. Dive’s office, “Can you be ready for surgery on Feb 5?”

“Yes, Yes, I can!”

“Okay, stop taking this drug right away. Do these things now (a bit of a list). You will be called in for more lab work, an education session, and other things shortly.”

No, I couldn’t get up and dance around, but I sure felt like it! I really had won the lottery and I didn’t bump anyone to get there!

Preparation

Read this Book (and/or the one that they give you) http://vch.eduhealth.ca/PDFs/FB/FB.130.B393.pdf

This is the big overview, with pictures and diagrams. You need to start here to get a sense of will happen and what you need to do.

Preparation – The House

You will get lists of equipment and modifications. Some of them will look strange, but trust these people, and be aware that these lists are the bare bones. http://oasis.vch.ca/surgery/classes-to-prepare-for-surgery/prep-for-surgery/

While it differentiates between equipment that you will need in the hospital and equipment that you need at home, you will need ALL of the equipment for the 12 weeks after surgery.

·         4-inch raised toilet seat (with or without armrests)

·         Tub transfer bench or shower chair

·         Non-slip bathmat

·         A standard (no-wheel) or 2-wheel walker

·         Crutches

·         Long-handled shoe horn

·         Long-handled reacher

·         Sock aid

·         Extra-firm cushion (4” x 16” x 18”) for the drive home

In addition, we removed the base on the dining room chair that I would use and put a new plywood base that took the 4" foam piece. We then raised the table by an inch so that I could get my legs underneath. This went a long way to ensuring that I didn’t feel awkward trying to eat.

Another great change was to replace the legs on the bed, the living room couch and my recliner chair so that they were at the right height and I did not need to wrestle with cushions to get into the safe positions. This would be hard to do in a short period of time, but easy enough if you have several weeks to prepare.

Preparation – The Mind

The education session with an Occupational Therapist through OsteoArthritis Service Integration System (OASIS) in Vancouver is a good bit of public education about what to expect and what to prepare for. http://oasis.vch.ca/surgery/hip/  It is ‘sanitized’ but that is quite reasonable as the needed information comes through.

Talking to relatives, friends, and colleagues yielded a nice cross section of the population who had gone through this procedure. The uniform message was, “Life is better after surgery.” I can work with that!

Preparation – The Body

Exercise! Yes, You! You will need more upper body strength than you think in the weeks after surgery. Some useful exercises that I did (and should have done more of):

Walking, cycling, and others exercises that moved my hip joint were right off the menu, but are lots that you can do.

Push Ups

If you haven’t been doing these, start by placing your feet about a foot apart and a foot away from the wall and lean towards the wall until your nose almost touches and then push away from the wall back to upright. Do ten of these. No need to rush, the slower you do them, the greater the benefit. Keep moving your feet away from the wall a few inches each time, until you are at a doable distance.

You can also do these from lying face down on the floor, but I was physically long past the point of being able to get up off the floor by myself.

Curl Ups

My hip was not up for much movement but limited Curl Ups – raising the head and shoulders and curling the back while tightening the stomach muscles were just fine for me. Do them with your knees bent and again, slow is good.

Upper Body Stretching

Reach Way up! Crunch back down! Keep moving what will move without pain.

Ankle Pumps

Moving your ankles back and forth works the calf and thigh muscles without stressing the hip. 

Mostly it is all about movement. Do you own favourite exercises, but do them!

You are trying to be as ready as possible!

The Diagnosis

The Diagnosis

I knew it wasn’t going to be good news but it still arrives with a jarring thud.

“Bone on bone with the joint collapsing.” Dr. Dive delivers this in a very neutral but kindly tone of voice. No doubt he has had to say this many times, as he is a prominent complex joint surgeon with the experience to know exactly what he is talking about. People ask who my surgeon is and when I tell them, they all say things like, “Lucky You! He’s the best.” My GP was very impressed. A quick Google finds that he is a well-respected academic in addition to his creds as a great surgeon. This has been quite reassuring.

I smile, a bit blankly, “Any options with injections?” I was hoping that the lab made synovial fluid injections might buy me some pain relief and time before surgery.

“I’m afraid that you are well beyond that.” Was his answer in the same tone of voice.

Sigh and a nod on my part.

“We are looking at four to six months to get a surgery date.”

I nod again, with some relief, as this means there actually is an end in sight. I have been in limbo for the past year as I have been on waiting lists and increasing painkillers to deal with my decreasing mobility.

Dr. Dive is gentle and efficient. He recites the diagnosis into a digital audio recorder and I get to hear it again in medical language as he spells out just what is happening to my hip and what needs to be done.

Afterwards, I make sure to let his office know that I am interested in any cancellations that might come out and would be very flexible with my schedule. I am pleasant and accommodating with the very efficient assistant, while silently hoping for that slim chance that an opening that I could slip into would appear.

How Did This Happen?

“You are too young to need joint replacements yet!” My GP, Dr Lee (a wonderful woman) was surprised when it became increasingly clear that I was losing mobility. I was less surprised, coming from a family with a long history of osteoarthritis. My knees had been deteriorating for years and I am one of the fortunately ones that benefit from the lab made synovial fluid injections. But, this was different. I had been gardening one Sunday afternoon in April and when I got up, something catastrophic happened. I had tear-inducing pain all throughout my right side, running from back to toes.

“Sciatica is a possibility, but we need to take a look at that hip.” (It had been feeling ‘funny’ over the past month) she said, and sent me off for x-rays.

The Radiologist decides that there is nothing evidently wrong with the hip, and there is some disc bulging  in the lower back. Initial diagnosis of sciatica, and I go onto my first waiting lists. One for an CT Scan of the lower back and the other for the Spine Clinic with its attendant surgeons.

The Wait – I

Time Passes. Dr. Lee ups my pain killers and now nerve medications as I wait. I continue to go to work because not working would be boring as well as painful. There is always lots of work to be done.

My CT Scan happens at the end of May. Nothing exciting to report except that there is no bone to nerve impingement in my lower back. This is very good news, but I am still in severe pain.

I take my vacation in July and spend part of that time with a massage therapist who eases the tensions in my leg muscles. This balances out my walking, but I cannot lift my right leg and all I can do is mark time by observing the slow loss of mobility. I went from walking at least 12,000 steps a day, down a couple hundred each week until it was no more than 5000 in a day.

I continued with my Community Kitchen Activities and everyone is very good about letting me organize the activities. I spend a lot of time sitting on the side watching the action as we can up 500 pounds of tomatoes, 150 jars of salsa, litres and litres of pickles, and two sessions of the famous “Apple Pie in a Jar” canning at the Copley Community Orchard.

Then a phone call in October! I have an appointment with the spine specialist at the end of November. Having a location, date, and time on the calendar brightens up

First Specialist Visit

I am finally in at the Spine Clinic for my consultation. I’m also down to 4000 steps a day before I hit serious discomfort and disability.

“Hi, I’m Dr. Hunter. What seems to be the problem?” I explain how I ended up in his office; give him a quick rundown of symptoms and actions. He asks a few questions, has me walk back and forth across the room, and examines my spine…and hip.

“I may be wrong, but I don’t think that your spine is your biggest problem. You have almost no mobility in your right hip. Let’s get a new set of x-rays right now.” The Lab is right there around the corner in the building. New x-rays are taken and I wait for a few minutes before being called back in.

My hip x-ray flashes on the screen. “See this side?” pointing to the left hip “This is fine. Now, the other side...” And it becomes completely obvious that the right hip is not fine at all!

“I am referring you to the Complex Joint Clinic. You should expect to get in within four to six weeks.” I thank him for a clear picture about what is happening and leave in a bit of a daze.

Okay, another round of hurry up and wait.

The Wait – II

I won’t say too much, except that I am very good at waiting now. I keep busy. I work at controlling my pain and that includes breathing techniques along with medications. By the end of January, it was taking two days’ worth of energy to do one day’s work. I am grateful that I could do half of my work remotely and/or online.

With Christmas in the offing, I guess (correctly) that it would be more like six to eight weeks and was not surprised to get an appointment with Dr. Dive, a noted hip surgeon, for the 25^th of January.

The visit with Dr. Dive was informative, concise, and direct. I now just needed to wait…again.