Monday, January 14, 2013

Total hip replacement -- special guest post by anonymous!

My bunion surgery posts still get many hits (people - just get your bunions removed!), and since someone I know had a hip replacement this past summer, I thought perhaps a few readers (or internet searchers) would like to read someone's perspective of a complete hip joint replacement because of arthritis. This person has graciously allowed me to share this person's story. (Lack of gender-specific pronouns purposefully done albeit awkwardly so, thank you very much.) So...without further ado....

Total Hip Replacement Surgery, My Story by Anonymous

Tomorrow at 6 a.m. I check in for the operation. Gonna get up at 4 a.m. and probably sit around and wait for time to go. Good luck, me.


I haven't written for the past four days since my surgery for obvious reasons. The number one reason is that this journal won't let me go back and pick up days I missed, which I don't like, or I would have cheated and filled in days one, two, and three to fool anyone who reads this. The last reason is that I didn't have my iPad to write with (on second thought, that should be reason number one). Anyway, here's how things went from Friday July 20, 2012, to today Tuesday July 24, 2012.

I checked into Kaiser Hospital in Fremont, CA. at my 6 a.m. scheduled time. My wife and I arrived early (as usual) and sat in the lobby across from a woman who was in a party of three and who stared relentlessly at our faces. It was like we were the fourth and the fifth people she'd seen in her life. Not a valuable detail but at the time it was very annoying.

Finally the door opened and we handed our home-prepared paperwork (medical directive and power of attorney type legal things) to the check-in lady.

We sat in another waiting area nearby while she copied my forms and did the computer "magic" check-in. We didn't know it at this time, but there was another woman sitting in a small office down the hallway who would later have me sign some release forms. The kind that say that if I were to die on the operating table, it really wasn't their fault. Eventually we talked to this lady and were then sent to the second floor to wait in another waiting room while the people there looked at my papers and prepared to guide me through pre-operation routines.

After a very short wait (they really don't give you enough time to start screaming and running out of the door) I was led to a small dressing room by a nurse to shed every stitch of my clothing (and, I might add, every bit of the dignity, ego, and self-control I ever had in my life landed comfortably on the cold tile floor) and I put on a one-size-fits-all surgery gown. They've improved these gowns over the years, and now they actually are big enough to cover your ass. (Just a fascinating side note.)

Here's a point that's burned into my memory: They give you hospital antislip booties to put on your feet. (I learned a few days later that the supervising personnel at Kaiser had better not see your very slippery little feet on their tile floors without these booties on. This is a major safety violation that allows them to surgically remove both feet at any time. I know, a little too facetious.) I found it humorless that I was given booties to put on a foot that I haven't been able to lift far enough to get huge hiking socks on in years, yet there I was with this dainty too-small booty to put on without assistance. I gathered everything inside me and slightly hooked the bootie on the tip of my right foot, while at the same time suffering for what I hoped would be the last tremendous pain that my arthritic hip joint would ever give me. I grabbed a very small piece of material at the heel of the bootie with my outstretched fingertips and pulled it on. I sat there for a minute to let my pulse subside and then took the next step into the unknown.

I pulled the call switch and the nurse returned. He took my personal items, which I had put into a hospital provided plastic ziplock bag, and he asked me whether I wanted to carry them and give them to a loved one later, or have them locked up while I was there and then the hospital staff would move them to my room after my surgery. Since I had no idea whether my wife had ran screaming from the building at this point, I told him to lock them up.

With that done I was walked down some hallways to an area where there were several curtained-off recliners with computers at each station. Each sectioned-off area was in  an open area where gurneys could be easily wheeled if need be. A nice lady in medical-looking garb came (I'll stop using the nice man and nice lady adjectives here, because they were all nice) and asked me  the first of many check/double-check times, "What are you  here to get done and where on your body?," and she took my vitals and punched in all the data she'd gathered into the computer. Another lady came in and inserted my brand new IV port into the back of my left hand. They put a computer-generated plastic bracelet on my right wrist, which I learned over my stay at the hospital that it would be scanned every time someone did anything to me or for me.

I have to confess what this whole process reminded me of: You know those death row scenes in movies where the guards have walked the prisoner down the Green Mile and are now going through all of the routine tasks to prepare the inmate to be put to death? Yup, that was my vision at the moment.

Soon the anesthesiologist whizzed in with his smock waving behind him and sat down in a real whirlwind of a doctor way. I knew it was him because he had sent me a picture in an email a few days before to introduce himself and to supply me a PowerPoint presentation on the different ways to be put under. I already knew what I wanted, but I was surprised that he actually gave me a choice. I said I wanted general anesthesia and that I didn’t want to remember anything. As we were talking about lifestyle choices I was making  that could affect me while in surgery,  he asked if I drank and how much in the last six months. I told the truth and said about six beers was all I've had. He said, "So, just special occasions like New Years, birthdays and waking up in the morning?" I liked him from then on. Then the whirlwind left while saying that he'd see me in a few minutes.

My orthopedist (great guy I might add, and I didn't know how great until things were all over. He has a decent sense of humor, which is number one in my book, and he answered anything I needed to know) came into the recliner area and looked at the monitor. Using a Sharpie pen, he marked my right leg with a  "yes" and his initials. I believe I sent my wife home soon after this (I forgot to add that she sat with me during this process) because it was getting close to 8 a.m. and everything was wrapping up in pre-op. 

They gave me a relaxation pill, and I walked to the OR on my own in my little-half sock antislip booties. The whirlwind,—my orthopedist—and everyone else were there doing their getting ready activities. I was helped onto the operating table, and the anesthesiologist soon came into my view of the OR ceiling. He told me that he was going to give me oxygen through a mask, slipping the mask  on as the words left his mouth. My doctor walked up (with his game face on) and pulled my gown up and asked me which hip they were operating on, I replied, "Right one."

With all this confirmed, I looked at the fluorescent lights in the OR…and then I was being woken up by a voice from somewhere far away from the planet I was on. I tried to get my thoughts together about what just happened and what I was doing there, then I realized that my throat was feeling awful. I began coughing and pointing at my throat and the voice from somewhere outside reality said it felt that way because of the tube they put down my throat and it would pass. (I thought I was going to pass.)
When I got half my senses back I realized I was in no pain, which is something I did not expect since I'd just gotten my hip hammered on, sawed on, and ground on for an hour and a half. This was a pleasant surprise. They moved me down a bunch of hallways to my room where there was another beehive of activity. A bunch of words were said and I was hooked up to the feeding tubes and morphine drip.

In all honesty, the next three days were the same things over and over. I was asked every two to three hours if I had pain. People (supervisors) came in and introduced themselves and said to call them if I had any problems with anything at all. My doctor popped in at all hours of the day or night to check on me. I guess the biggest moment of the three days was when the physical therapist stood me up for the first time. This was a moment that I'll never forget because, to my total hip replacement amazement, I had no pain. Other than a tightness in my hip, I was standing like I had in the years before I had gotten arthritis. It was so shocking that it still doesn't seem possible. This painless feeling has pretty much been the case since Friday afternoon. I am told that it happens, but not that often.

I am very lucky. 

My personal key events during the hospital stay are the following.

1. The catheter removal on the morning of the second day.
I had no idea what to expect, and the truth is, I was so grateful to have the catheter in the first place because I didn't have to move. It was a very scary proposition at this point in my life to move at all, so I never wanted it to leave my body. My nurse of that shift (7:30 p.m. Friday to 7:30 a.m. Saturday— can you believe that?) was nice enough to tell me on Friday night, with a smile and a glint in her eye I might add, that I wouldn't feel any pain when she did it, and she'd wait until late in her shift to do it. I have proof of this too because my wife was there when she uttered those soothing words. Now, I really don't want to scare anyone, but I'm sworn to tell the truth here, and to say that the catheter removal hurt is totally incorrect. The removal of a catheter is three seconds of staring at the sun, being on Omaha Beach on June 6, 1944, being drafted, losing your favorite pet, and putting your hand on a hot burner (don't try this at home) stinkin' pain all rolled into one. Eeeyaweeee! That hurt! I'm just sayin'.
I had already read that it burned to pee after the catheter removal, so I decided to never have pain again by never peeing again. My urinary tract was now officially closed for business until further notice, or until I popped, which I almost did. After gathering pee for a few hours it became imperative that I pee.
2. Peeing after catheter removal.

Peeing after catheter removal obviously makes you have to shift toward your side to get at an angle to pee (I mean us males of course) and you're wearing this hard foam rubber wedge shaped thing between your legs to protect from leg crossing, which makes this more difficult. With the help of the male nursing assistants, I was on unceremoniously rolled onto my unoperated side and then supported with some pillows behind my back. I told them to shoo away because I'm a shy pee'r, which they gladly did. As I was getting things ready I noticed that I'd bled some when she shot the caterer through my urinary tract. My sense that this was going to burn was now at 1000%. That thought coupled with lying in a position that made my stitches feel as if they were about abandon this ship and the fact that I'd now held my pee three hours too long, made me not pee that much more. But finally—tada—it flowed and flowed. Without much pain I might add. Before I started to pee and during my long and slow pee, the assistant would pop his head in and ask if I was done. I'd say no and he'd close the door. Soon I really was done, lying there tilted on my side in a painful balancing act and guess what? He'd given up and left for break or lunch. I was now a human domino waiting to split open. Finally, he returned to empty many, many ounces of urine. So much he was shocked (yep, I'm the proud holder of the peeing championship trophy).
3. The drain removal.

This was an event, but not a significant one. My orthopedist did it at the first dressing change and it turned to be a small tug and it was gone.
4. Blood thinner shots in the belly.

Doesn't sound fun does it? Well I have to say, it was almost painless and the fastest shot I've ever received.
5. Physical therapy.

I have covered my first PT (physical therapy) in the body of this writing so you're aware that I had no pain during it. I was warned in the class I went to two weeks before this operation and by my nurses many times after the operation, to shoot some morphine before PT starts so it wouldn't hurt so much. That was a great idea, in theory, but the fact was, you never, ever, ever know when the therapist was going to arrive, which means you never get the chance to slap that morphine in you thirty minutes before. Like I said, luckily I had no pain when I walked and that's what the therapist had me do. He had me walk as far up the main aisle as I felt comfortable, reminding me all the way that I had to walk back. The last day he had me go up some fake stairs and back down. Bing, bam, boom, dun. It really wasn't bad. He sent me home with exercises to do and that was it.
6. Side note event.

When anyone in a hospital tells you something will happen in ten minutes, rest assured that person is using a different time measurement than the rest of planet earth. Ten minutes in hospital time equals one hour in your time zone.
7. Occupational therapy.

Remember the whirlwind anesthesiologist in the beginning? Well his counterpart is the occupational therapist. My goodness she is full of info. Most of it was covered in the two hour class I took before the operation, so it became an "I'm aware of that" conversation. Very nice person though. She popped in twice, first time to educate, and second time to make sure I could dress my half self with the dressing aids. Actually, I've been dressing myself for three years using variables to these devices, so I was a star on her occupational therapy stage. She got all excited and released me to in-home therapy.
At this point I must step back and describe a nursing assistant (NA) whose shift was Sunday afternoon and evening. You know the guy that you work with that everyone knows can't do his job but somehow he gets by without being fired? I think every work group has one, and this particular NA reflected that description perfectly in the mirror of ineptitude. He was the only employee at the hospital that I would say needed to find another line of work before he kills someone.
I was already getting hints that he was clumsy and accident prone by small things he did on the first few visits into my room. Unlike all the other NAs he'd take my vitals and never tell me what they were unless I asked, he'd move things around that made no sense, and he'd bring in three boxes of gloves when there were already three boxes on the shelf. Then two incidents happened that really sealed my opinion of him.
I was lying in bed half asleep when I heard a crash/bang/smash against my door and someone muttering like he'd screwed up. Yep, it was him trying to roll the $25,000 worth of equipment in to take my vitals, all the while coming very close to tipping the whole shebang onto the floor. I told him that that was some entrance he'd made and he mumbled that he hit the door. Yep, I can confirm that.
The other incident happened when I asked him to bring another chair into the room so I could sit with my wife when she came that evening. They had been bugging me to sit in a chair so I figured that would be a good opportunity to comply. When I told him what I wanted, he just looked at me like I was crazy. I re-explained and then it sunk in. He banged around and got the chair in the door. He crammed the chair between the bed and the wall so that it was ten feet and a hospital bed away from the other chair that my wife would be sitting in. During this process, that he was not at all happy about, he kicked and tripped over the foot of my operated leg. Then he acted like it never happened. Scary dude.
One small thing happened that I'll mention here just because it surprised me so much when it did happen. On Friday after I was in my room and had eaten chicken noodle soup for lunch, I punched the morphine drip to relieve whatever little pain I had. My mouth started to water like I'd never experienced in my life. I swallowed several times to keep from drowning and it subsided. You know the old adage about listening to what your body is telling you? Well, my body had warned me that the next time I hit that button I was going to projectile vomit and I didn't listen. I hit the "make me feel good" button about an hour later and my mouth flowed once again for about two seconds before I had to raise up and over the bed rail to throw up. I don't know if the dose was too high or not, but after I did throw up my chicken noodles it never happened again, so I suspect that they lowered the dosage.
So this brings us to this first week at home, accompanied by the dreaded ride home in a bumpy car.
I was very anxious about the drive home. I didn't know how the incision would handle the bumpy ride, and I didn't like the idea of getting in and out of the car for fear of doing major damage to my new joint. My mind always prepares for the worst and hopes for the best.
The attendant wheeled me down the halls toward he elevator. I saw quite a few people on my way and almost none looked at me. It must be some sort of hospital etiquette that we all observe. I know I do it out of respect for their privacy when I see people wheeled around a hospital. We reached the elevators and the doors were already open so whish in we went. As we were going down I was still preplanning my entrance into the car. As we crossed the automatic doors threshold, I saw my wife wheeling our car toward the curb. My sphincter was getting tighter now. As it turns out I had forgot one key yet positive ingredient in my preplanning: Our car has a sturdy handhold above the door that allows me to pull up and shift into the seat. I knew at this point that my body removal would work out okay at our house.
I wasn't sitting in the car seat quite the normal way you should, so the ride home shifted my butt weight from left to right with every turn. My wife couldn't have turned any more carefully, but I still felt as if the incision (that I'd never seen) would pull open at any second. I held my breath and the overhead handhold all the way to our garage.
After getting out of the car I made my walker way inside to begin the next step of this twilight zone I was in. I greeted our dogs by sitting and protecting myself with the walker in front. It was good to feel some normalcy in my life again.
My wife and I got me to the bedroom and in bed without too much trouble. My wife had cleaned and set everything up for my recuperation and it still took a few days to gather all the things I wanted around me. Now I could pretty much leave her alone except for the things I needed to survive.


After four weeks had passed since my surgery, I had crossed all of the personal milestones that my mind feared long before the surgery. I'll list them in no particular order.
1. Sitting on a raised toilet for the first time with a newly stitched incision.
For obvious reasons and for fear of the unknown, this was scary the first time. I had no idea how the incision would feel being pressed against the hard plastic high chair while making sure that my operated leg didn’t bend 90 degrees at the hip. So I lowered myself as gently as I could, and to my extreme happiness there was only a small discomfort in the new hip joint. Mission accomplished.
2. Getting in and out of bed.
Swinging your legs over the edge of a bed and lifting them back in is a thoughtless process in your normal life. When you've got a leg that is hanging on by a clump of glue and a couple of screws it becomes a whole new world. Of course I never attempted to do it without help for the first week or so. Then it became obvious that when I was left by myself there may come a time when I'd have to get up on my own for safety sake. I tried swiveling out of the bed with my legs pressed together and sitting up as my feet headed toward the floor and it worked. My wife still helped me reverse the process by lifting my legs as I swiveled back into bed. After a couple of days of getting out of bed and getting assistance getting back in, we came to the conclusion that she was hardly lifting at all anymore, so I tried it on my own and it worked. Now I had the freedom to save myself, if the need arose.
3. Somewhere to sit at home.
Wow, this one turned out to be a biggie. Before the surgery my thoughts were, I've got bigger fish to fry after I've returned home, so I'd man-up and sit in a couple of different chairs in the house and live with that. That case was closed until I actually got home. I found that I had to sit with my leg pushed out away from me and at the same time I had to slightly twist to protect the incision that was still a little raw. You guessed it, this position throws the back into a misalignment that only allows it to be that way for a few minutes at a time. That concluded any hope of comfortably sitting and watching TV or just visiting away from the bedroom. Can you say "bedridden"?
If I had it all to do over again I would make sure that there was a very comfy chair to sit in in my living room. I would even have bought one just to allow me to join the outside world inside my home. Also, I would've built a 3 1/2" high platform for this chair to sit on until it was okay to sit at a lower angle. If I have to have another hip done (oh please, never let that actually happen! ), I will make sure I have a place to sit. Never, ever, ever do what I did.

4. Showering
I just smiled thinking about the first time I did this five days after the surgery. I am lucky to have a shower stall that is low enough to step into. I can't imagine how someone with a tub/shower combination can get over the tub’s edge to stand inside the shower without causing some harm to his/her new hip joint. Anyway, here's how showering went:
First of all, I had to decide whether to use the walker inside the shower or not. After checking to see if the walker would even fit inside the shower, which it did, I came to the conclusion that the shower stall handhold/towel rack would do the trick as far as stabilizing myself. As long as I didn't get too goofy, or slip, I thought that it would be okay to go ahead and shower.
So here was my setup: One towel on the floor in front of the shower and one towel hanging over one of the walker rails to use to dry off. I moved the walker sideways in front of the shower opening so that the back of it faced the shower. I could then turn around and face the shower and simply step inside. While stepping in, I held onto the towel rack on the opposite stall wall. Once inside, the shower was pretty much routine except that I quickly realized that I was very weak in my upper body. I don't know if this relates to just me or it's something that is common with surgery of this magnitude. I found myself shaking from weakness, and I hurried to get done so I could sit down.
After washing, I turned the water off and slowly turned to face the door again. I slid it open and reached for the towel on the walker and dried as much as I could reach. I grabbed the upper shower door track and used it to take the weight off my operated leg while I stepped back out into the walker. At this point I had assistance drying my legs, but I can say that if you are by yourself, I found that you can move the towel around you enough to get relatively dry.

So, in a nutshell, I'd say that the first shower was mentally a very thought-provoking challenge, but it turned out to be not so bad, other than the weakness in my body. As the days went on it was easier and easier. Today I have no more weakness and showering is as routine as it used to be.

5. Sleeping

During my hospital stay I slept and slept. I'm assuming that they were giving me a sleeping pill; plus the surgery knocked me for a loop because just being able to sleep on my back is not natural for me. When I got home this pattern continued for a week, and then insomnia hit. My guess would be that I had so much rest and sleep that my body didn't want anymore.
Insomnia isn't very pleasant when all you can do is lie on your back. It is normally difficult to get back to sleep when you can twist and turn to get comfortable, but to lie there and stare at the ceiling…you feel so unbelievably uncomfortable that sleep is fleeting. When sleep did come it was for about two hours and then I'd be awake for eight hours. Actually, the loss of sleep wasn't so bad compared to the fact that without rest, I never felt like getting up to walk or exercise, and both were things necessary for my recuperation. This added to all the thoughts I was having while lying awake.
At my first visit to the orthopedist, my wife asked for some kind of sleeping aid, so the doctor prescribed a pill to take. The short story is, I took the pill only two nights and it didn't work. It ended up working against me because it was the type of pill that requires you sleep for eight hours and if you don't, you feel horrible. As for myself, I slept about two hours and woke up the two nights I took the pill and  felt so awful that I didn't even want to talk, much less exercise.
Then the first night after I stopped taking the sleeping pill I slept for seven hours. The insomnia was over and it hasn't come back since. I hope it never does.


Summing this journey up.
Honestly, I had no fear going into the days and hours before the surgery. What happened was my mind saved my worries for after the surgery. Because of all the things I had read and was taught, I knew that I came through it so much better than I had ever expected. I think more than anything, I didn't want to screw things up by doing the wrong thing in the weeks after the surgery. Also, this is a very humbling experience because so many things can go wrong. Once you survive the surgery, you still can be struck in other ways, such as, pneumonia, blood clots, infection, or the thing I feared most, the dislocation of the new implant. Again that was due to the many, many warnings about never exceeding the movement limitations they'd drummed into my head. I could visualize my new hip with almost nothing holding it together because whatever was holding my hip was sliced lengthwise. I knew that it needed to heal to be safe, but I had no idea how long this healing process would take. There's no book on that.

Don't think that I feel that this operation was more serious than others that are performed. I know it isn't just because of the fact that no major organs are involved. What I do know is that the concerns are the same, prior to the surgery and certainly after. After a week or two you know that you have most likely passed the likelihood of ever having most of the complications that could have affected your recovery. The one remaining concern is the chance of hip dislocation. I can't truly put a timeline to it, but as the days pass you know you are able to move easier and easier, and your fear of messing up the surgery lessens. The one feeling that is continuous is the feeling directly under the incision that all the muscles are like a twisted rubber band or it's under spring tension with each step. I have since looked on the Internet to see what is happening to make it feel this way, and it is caused by the iliotibial band that is opened in order to reach the hip joint. This fibrous band connects the hip to the knee and stabilizes you when you walk. It's my feeling that once this band is healed and the tight feeling it causes is gone, I will be able to walk without a cane.
So, those are all the milestones and concerns that I experienced. I tried to cover the things that I wish I'd known prior to the surgery and the things I wondered about while lying in the hospital. I have to say though, time does fly afterwards, and before you know it weeks have passed and it's hard to believe that the surgery date is so far behind you.


Any questions? Anyone? Post them below and I'll funnel them through.  

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