Long ago (1988) I moved to Berkeley and started sending a monthly "newsletter" to my Boston friends. When I returned to Boston (1993), I continued the tradition for about five more years (or until I had kids). Looking back, I realize that I was actually blogging. Each newsletter contained anywhere from a few to several blog posts. Having been silent for the past decade or so, I've decided to resume these activities. Don't expect anything profound -- I tend to focus on what I find entertaining or amusing and perhaps sometimes informative. We shall see!

Thursday, August 20, 2015

Week 6: Mobile at last!

I have been officially discharged from home PT, and I got the "all clear" from my surgeon (or more precisely, his PA). That means I can pretty much do anything I want except run (and by extension, I'm going to include soccer in that). And I can now legally drive again! That was very exciting (of course, the day after I was allowed to start driving, our family found ourselves with another licensed driver, but that's definitely material for a different post!). The next major milestone will be 6 months post-op when I see the surgeon and we discuss "the future" (what I can and cannot reasonably do). The X-ray was prety cool -- the part looks great (so much better than a normal hip). I will continue with PT to rebuild muscle, which I think is really addressing the year and a half I spent in pain and limping more than any post-surgical residue. So, 6 weeks post op, status is:
  • I can walk 4+ miles at a 16 minute pace.
  • I can (finally) work hard enough on the elliptical to get a heart rate up to 75-80% of max (which for me is way higher than any of the charts say). It feels good to be able to work up a real sweat (exercising as opposed to hot flashing).
  • Range of motion is quite close to normal.
  • Every once in a while I can tell that the abductor isn't 100% there on the right.
  • My walking posture is almost normal (I have to concentrate on walking straight, but this is left over from the pre-surgical mess I was).
  • Quad is still a tad weak (only noticeable if I'm thinking about it going upstairs), but we're getting there.
Overall, I am thrilled -- so much happier than pre-surgery.

Tuesday, August 11, 2015

Week 5: Definitely wrapping up here

I take it as a good sign that there is less to report each week. Again, changes happen, but are not as dramatic. So, this week's milestones were:
  • Wednesday: went for a walk in the woods. I wasn't up to climbing over felled trees (we had a hailstorm on Tuesday), but I was fine with the uneven ground and carried my cane, but didn't use it.
  • Thursday: So, based upon the walk in the woods, I shed the cane!
  • Friday: I hit the 3-mile mark on my walk.
  • Saturday: I hit 13,000 steps.
  • Monday: I upped my pace from Friday's 19 min/mile to 18 min/mile.
Tomorrow is my Xray and post-op appointment and next week's post will be my last!

Tuesday, August 4, 2015

Week 4: Slow and Steady

It's pretty clear that there is less big news to report this week, but progress continues. It seems that the major milestones this week have been:
  • Walking without the cane pretty much all the time except for long walks.
  • Long walks are approaching 2.5 miles (with the uphills and downhills of Tower Road).
  • The last day of week four I did about 3/4 of the walk carrying the cane as opposed to using the cane.
  • I can regularly hit 10,000 steps and have hit a max of 13,000.
  • PT is feeling more like a workout -- it's all about rebuilding muscle strength.
I'm thinking that there will be only two more posts in this series, as the beginning of week six will bring me to my post-surgical appointment, and I expect to be pretty much fully functional. And anyway, I will need to start on my next blog series: flipping a classroom of 150 students!

Tuesday, July 28, 2015

Week 3: Look Ma, No Hands!

It was another big week on the recovery front. Wednesday I had my last visit from the nurse and was discharged and, more importantly, relieved of having to wear dorky socks! Yippee!!!!! This also means I can now fully dress myself -- a wonderful feeling. Putting on socks is still a bit tricky, but doable.

At my Friday PT session, I discovered that I can actually use the brand new spiffy elliptical that my wonderful husband swapped in for the treadmill (since I really should not be running on a treadmill but I can go as hard as I want on the no/low-impact elliptical). I can also do the spin bike! Yeay -- I can start working out again -- my physical therapist doesn't want me doing either with resistance, but it's a start.

Also at PT I discovered that I can now lay on my good side and lift up the leg with the new hip -- this is a huge step forward for the muscles on the outside of the hip, which were pretty much non existent last week. It turns out that phyiscal therapists rate strength on a Five point scale. prior to this week, the muscles in that direction were somewhere between a 1 and a 2; now they are a solid 3!

But perhaps the biggest shock was that spontaneously on Friday I could suddenly walk reasonably well without the cane. I was in my office and suddenly just felt stable and able to walk without a limp. Absolutely amazing!

Saturday, I went out for a 1+ mile walk and brought the two crutches as I'd been doing, but never actually used the second -- I did the whole walk with only one crutch, so Sunday, I both lengthened the walk (about 1.5 miles) and used the cane. And then Monday, I lengthened my morning walk to about 1.75 miles and over the course of the day hit 10,000 steps for the first time since surgery.

Today wraps up week 3 and PT was great -- we're focusing on building up the strength in the few muscles that are still weak, continuing to stretch the hip flexors, and beginning to start stretching the quads. All great news.

So, my week 3 summary is:

  • I can walk for 40 minutes at a shot.
  • I can now walk a couple of miles without stopping.
  • I can walk without a cane (way better than I was pre-surgery). I can't do this yet for my long walks, but around the house/office I'm good.
  • Strength is coming back.
  • I can do an elliptical for 30 minutes.
  • No more dorky socks!

Tuesday, July 21, 2015

Week 2: Big Strides!

It's been a fantastic week!

It started on Tuesday with a visit from the nurse, who removed my bandage, which warrants a bit of discussion. Every surgeon seems to have his/her own preferred method of closing you up: stitches, staples, steri-strips -- I've had them all. However, my surgeon used something I'd never seen before: glue and an aquaseal. The glue seals the wound and the aquaseal is a large (and I mean large) gel bandage that covers it. Among its most wonderful properties is that it's waterproof! This meant that I was able to shower from the day I got home (as opposed to the week or ten days I'd been quoted by others). I don't know about you, but showering is one of life's simple pleasures, and especially after a stint in the hospital, sitting in a nice warm shower is really high on my list.

Anyway, she removed my aquaseal, and we cleaned off a lot of the gluey, gummy adhesive to reveal my fine, six-inch scar.

Everything else looked good, so we left things that she'd come one more time, but we guessed that would be her last visit. Yeay -- everything looking good medically.

Then later that day, my PT showed up and we did a little bit of walking with only one crutch. I probably don't want to do that all the time, but I can, and that's exciting.

The next day (Wednesday), I ventured out for one of my short, but slow, walks all by myself. I now feel stable enough getting around that it doesn't concern me. This is another major milestone! We celebrated by going out for sushi that night -- I felt almost like a real person.

Thursday's big news was that I was able to lay flat for a full 15 minutes. Now, this might not seem like much to you, but one of the tightest muscles I have right now is my hip flexor, making it extraordinarily painful to simply lie in a flat position. In theory, I'm supposed to do this three times a day for 30 minutes; in practice, after about 10 minutes I want to curl up in a ball and cry. A long walk prior to the stretch helps a lot.

Ah yes, one other topic I haven't mentioned yet -- the dorky socks! A lot of post-surgical attention goes to avoiding blood clots (which I admit is a good thing to avoid). In my case, the avoidance protocols involve daily shots of blood thinner (which are getting pretty tedious about now) and what I fondly call, "The dorky socks." These are knee-high compression socks that have all the great features of a) looking ridiculous, b) being uncomfortable, and c) being really hot.

If it weren't for the dorky socks, I think I'd be able to dress and undress myself, but I still need help getting them on/off, because they are so tight, and I'm not quite flexible enough on the right side to deal with them. I am guardedly optimistic that they are about to become a thing of the past after my next/final nurse visit!

By Thursday, I also realized that the vast majority of the swellig was gone! I had been pretty bummed when I weighed myself coming home from the hospital -- I'd spent the past two weeks, eating lightly, and prior to surgery, walking a lot -- 15,000 - 20,000 steps per day, so I had expected to be a bit lighter than when I'd left for "Canada -- Part II" But the scale said that I was three pounds heavier, which was devastating. However, on Thursday, I ventured on the scale again -- 9 days post-op -- and I was a full ten pounds lighter than my "coming home" weight. Ok, I was much happier.

While I'd been off pain-killers (including tylenol) for the past week, I was still using ice at night to go to sleep, but Thursday night was also the first night where I never put the ice pack on! Things just keep getting better!

But Friday was the big day! During PT, she let me try a cane, rather than one or two crutches, and we walked around outside on bumpy ground, and it was OK. So, I've been promoted to a) a cane, and b) reciprocol stair walking (i.e., "walking stairs like a big girl"). This is huge as a cane means I have a free hand and can actually carry things! This means I can do things, which is rather exciting!

I also managed a 30 minute walk (still with the crutches), but probably over did it a bit during the weekend between insisting on making dinner Sunday evening and walking too much. I need to give the muscles more time to get stronger, but it's such a relief to be able to do stuff.

So the report after two weeks is pretty darned amazing.

  • I can comfortably walk for 30 minutes (albeit with crutches and slowly).
  • I can get up and down stairs pretty normally using the cane lightly to give added strength to the leg with the new hip.
  • My sleep is better than it was pre-surgery; I'm probably sleeping better than I have in a year and a half.
  • I'm no longer napping at all.
  • Pain level is pretty much always sub-3, unless I just do something I shouldn't or am doing a couple of the exercises that are still challenging.
  • Bruising is pretty much gone:
    Last Wednesday (8 days post-op):

    Monday (13 days post-op):

Tuesday, July 14, 2015

Total Hip Replacement: Surgery and the First Week

Warning: amazing bruise pictures below.

Everything went pretty much according to plan. There were a few slight hiccups -- I tested positive for Staph, so they put me on an antibiotic for five days coupled with daily Hibiclens showers. In my experience, Hibiclens is pretty standard for the three days prior to surgery, so this just meant a longer run.

Pre-Surgical Appointment

This was mostly routine, although it was my first experience with NEBH so it was kind of interesting to compare and contrast (I have now had surgeries at St. Elizabeth's, Emerson Hospital, MGH, the Brigham, and NEBH.)

NEBH was the farthest ahead electronically (or at least relative to what I'd seen other places, which was admittedly a few years old now). Every document was shown to you on paper, but you provided an electronic signature, so they had the entire file digitized, including things like your Health Care Proxy. So, no searching for random pieces of paper at future moments. Other than that, checkin was pretty typical -- sign lots of forms.

If you are "of a certain age" (over 50), then you also get the bonus ECG (they would like to make sure that you're not going to keel over during surgery). So we did that, we drew some blood, I met with physical therapy, I think we may have taken another Xray (although I am not entirely sure), and (new to me), they did nasal swabs to test for both MRSA and Staph. I don't know if this is NEBH standard for everything or something special for joint replacements. It is pretty clear that infection is a huge concern for hip replacements (e.g., from here on out, before every dental appointment, I need to get prophylactic antibiotics. Who knew?), so this might be standard everywhere; I don't know.

Surgery

Then I went gallavanting off to Canada knowing that some time between 4:30 and 8:30 PM on the 6th, I would get a phone call with my surgery time. So, I'm sitting on the runway in Denver, waiting for them to close the door and my phone rings. My surgery is scheduled for 7:30 AM with a checkin time of 5:45 AM. Oh yeay; I land at 10:00 PM. My wonderful husband books a hotel room about 15 minutes away from the hospital, picks me up at the airport, and spends the night before surgery with me (isn't he a great guy?).

I show up at 5:45 expecting a pretty quiet/empty place, but au contraire -- there are already a dozen people in registration when I get there (and what time did they get there?). Checkin is reasonably efficient and then a nurse comes to get me for pre-op.

Pre-op is an interesting experience -- a (long) parade of doctors and nurses come by, introduce themselves, tell you what their role in your surgery is, and get on with their business. I'm sure I will leave out a bunch of folks, but I remember: pre-op nurse, surgical nurse, anesthesiologist, hematologist, a second anesthesiologist, and, of course, my surgeon. Everyone is pretty friendly and chipper. You get used to stating your name, date of birth, and what procedure you're having -- a lot! And, in good form, the surgeon initials the hip on which he's working. You may think this double checking is excessive, but I still remember being wheeled into the OR at MGH and seeing the board displaying RIGHT ACHILLES REPAIR. Only problem was, I had a LEFT ruptured achilles. I pointed this out pretty adamantly and they assured me they knew which side was having surgery, but let's say that the error on the sign did not instill great confidence.

I get my IV and I have to admit that I don't even remember being wheeled out of pre-op and into surgery. It seems that they must have left me under for quite some time, because I went in for surgery at 7:30 (in theory) and while I have a few vague recollections from post-op, my first real recollection was getting taken to my room right around noon. And here is the truly amazing thing: they handed me a pair of crutches and I walked, bearing weight on my brand spanking new hip from the stretcher to my bed. How totally unbelievable is that?

In-hospital Rehab

The plan was to put me on accelerated rehab so I could go home the next day instead of staying a second night. (Part of accelerated rehab is the walking to bed thing.) So they got me settled and before the afternoon was out, I had Laura, the physical therapist come by and take me for a walk. This rebah was the oddest thing I had ever experienced. While I could walk on the thing, it was still remarkably difficult to move it around and get myself into and out of bed. It's a rather different experience from any of my prior injuries.

Keith and Teagan came by that afternoon/evening to visit, which was quite nice. Mary Riendeau also came by with a bunch of balloons and a bucket of goodies. I think I was pretty cognizant that evening, but I was, in fact, on narcotics, so who knows. I asked about food and almost miraculously a tray appeared moments later -- clear liquid diet. Yuck. I drank some bouillon and called it a meal. Unfortunately, this didn't actually settle terribly well and just as Mary was leaving, so did the boullion. Oops.

The night was the first I'd spent in a hospital since Teagan was born. And I was feeling pretty great then relative to this time (even with a C-section and a terrible close). So the night was rough. I got at least one shot of dilaudid (narcotic pain killer), but it was still a pretty rough night.

I felt much better the next morning. OT showed up early (before 8) and went through my stepping into/out of a shower, getting to the bathroom, etc. She cleared me to go home! PT showed up later in the morning (after another tray of clear liquid diet and another attempt at bouillon). We mastered the stairs -- I can't tell you how much easier crutches are when you're weight bearing. With non-weight bearing, stairs are always a bit terrifying. With weight bearing, they are a piece of cake. Cleared by PT. Unfortunately, on the way back from PT I got a bit nauseous again and I experienced the return of the morning's bouillon.

Then things got bad: they decided to give me reglan for the nausea. Unfortunately the reglan started giving me the shakes -- so bad that my muscles started clenching and I was in agony. In what seemed like forever, they tried some adavan to help relieve the shakes. Eventually I calmed down, but within a couple of hours, I felt the shakes starting to come back on again. I alerted the nursing staff, but it seemed like it took forever for anyone to do anything -- this time they tried demerol. Finally the shaking stopped and didn't come back.

But this ended up torpedoing any chance I had of going home that day. I would have been OK with the nausea if we could have skipped everything else!

Keith came by that evening to visit again, and we planned to get me out of there as early as possible the next day. I had one more PT session that evening, walking further, doing stairs again, etc. Hemotology signed off on my status. The surgeon came by and he seemed happy.

So, on day two post-op, I had one last PT session, another visit from the surgeon, another hemotology checkout, and then got myself cleaned up and dressed and went through the endless pile of paperwork. I think we finally got out of the hospital around 11:30 AM. The PT was completley accurate that the day right after surgery was the worst and that the second day after was considerably better. It may be that staying in the hospital both days was really all for the good.

Home Rehab

Part of the discharge process includes setting me up with both home nursing service and home PT. It seems that the home healthcare service spent a large part of Thursday trying to reach me, but they kept calling my cell, and I wasn't really paying attention to it (I also don't get great cell reception in the house). It turns out that I was going to be getting weekly visits from a nurse and PT three times a week for awhile and then twice after.

This bout of rehab has been rather different from anything else I've experienced. On one hand, I can walk -- I'm pretty much fully weight bearing and just using the crutches to make sure I'm balanced and I take fairly normal strides. Put another way, the goal is to make sure I don't develop any bad walking habits. So that is quite amazing. But then there are stupid little motions (sliding my right leg off to the side) that are exhausting and painful. The exercises I'm supposed to do seem so trivial, but man do they knock it out of me!

I took my last dose of narcotics just after midnight Thursday night and stopped all painkillers at that point. I hate how the narcotics make me feel, and the tylenol doesn't seem to do anything.

Friday was one of those days of sitting around, napping, not eating much, changing positions, napping, etc. Both the nurse and physical theraphist came by around two and checked me out to make sure all was going well. Immediately after I had to do a qualifying exam via Skype. I was pretty good for the first hour, but could feel the fatigue setting in by the remaining half hour; after I just crashed for a couple hours of napping. I think the combination of 1) not feeling like eating much, 2) still recovering from surgery, and 3) the exertion required to move around was combining to make me extremely tired.

That night as I went to bed, Teagan commented on my bruising. It is all in the back of my leg, so I couldn't see it, but I decided to start photographing the progression of the bruising. We didn't save the Friday night pictures, but the Sunday night pictures looked like this:
Wow. I had no idea.

Saturday and Sunday were much of the same -- moving around, sitting around, icing, getting stiff, walking around, napping, etc. While the pain isn't too bad, I would also say that I'm pretty much constantly uncomfortable. At the same time, I can feel that things get just a touch easier each day. Another physical therapist came over on Sunday, and she pushed me through all my exercises and reminded me to get a few real walks in each day. So, I decided that I would make sure I did three sets of each of the three types of exercises I had and take three walks. Although my walks were slow, I was able to do a 5 minute walk, an 8 minute walk and a 12 minute walk. That felt pretty satisfying.

Unfortunately, the laying down exercises were so extraordinarily painful and difficult (the PT assured me that they'd be a lot easier if I were still doing painkillers) that they left me kind of whimpering by the time I went to bed (honest).

I decided to take it much easier on Sunday -- only a couple of sets of exercise and one 15 minute walk. But I did get a lot of work done around the house -- mostly paying bills. This ended up exhausting me in new and different ways! My back was really, really sore -- essentially, my hip flexors are super tight and this puts strain on the back. Stretching the hip flexors is the most painful thing I have to do, with abduction a close second.

Monday wrapped up my last day in the first week of surgery -- I managed to stay awake all day, until about 5:00, including a few sets of exercises and a 15 minute walk. My appetite had pretty much returned to normal (although I have no sweet tooth, which is OK with me). I'm trying to eat as much iron-rich food as possible in an effort to combat the fatique. In other situations, I've found it pretty effective.

So my week one summary would be something like this

  • Walking is remarkably easy.
  • Tightness in the hip flexor is the single biggest problem leading to stiffness and an unnatural gait.
  • The muscles that got damaged in the surgery (hip abductors, in particular) are the most troubling in terms of what I can do. My guess is that this would not be the case for the anterior approach -- something I haven't discussed. The traditional hip replacement takes place from the rear buttock. There is a new approach that comes through the front. In theory, it's supposed to preserve more muscles. My experience is that the anterior is more common on the west coast; on the east coast, every surgeon I spoke with was much more comfortable with the posterior approach, particularly because it provides better visibility. The tradeoffs are nicely summarized here. In theory, the anterior approach leads to faster recovery, but the numbers I see and what I expect don't fully support this and to the best of my knowledge there are no conclusive studies.
  • I was bathing independently by day 5; day 4 was mostly independent. That said, we have a walkin shower with a built-in seat, which makes things easy. I have an extra chair next to it that mostly gets used for getting out of the shower, put also provides some leverage to keep that right buttock off the toilet.
  • Appetite has pretty much returned to normal by day 6.
  • By day 7 I was reasonably functional in terms of phone calls, conversations, balancing my checkbook, paying bills, etc.
  • The bruising is really quite amazing.

Total Hip Replacement: The History

When last you left this blogger, I was riding the high of the recent women's world cup championship. Good thing too -- I definitely needed something good before embarking on my next journey -- after flying home from Vancouver on Monday, I had to be at New England Baptist at 5:45 AM Tuesday morning to get a new (right) hip.

I suppose a bit of background is in order.

I've had pretty constant hip pain for about 16 months at this point, but being smarter than I was before, I'm guessing the hip problems started several years ago. Every once in awhile, perhaps every second or third game, I'd notice that my hip would spontaneously kind of buckle. It was a quick thing, not terribly painful, and it was fine immediately thereafter, so I ignored it. This may not have been my most clever move.

Then, starting early last year, the hip started getting sore after games. It wasn't unbearable, just annoying. I figured it was a sign of aging, but didn't think a lot about it. Then in the late spring I ran into a woman who had just returned from a hip replacement and I asked her about early warning signs. She pretty much described my buckling sensation. This got me pretty scared, but I had some other medical issues to attend to, so I ignored it for a bit longer.

Finally in November I sought medical attention. My normal orthopedist doesn't do hips, so they sent me to a specialty I'd never heard of: physiatry. Initial diagnosis was bursitis. That sounded pretty good! That would be treatable and completely fixable. The only problem was that the cortisone shot made things considerably worse. Next step: MRI and XRay.

The results of that showed a torn labrum, a 3 cm cyst, and "mild to moderate" arthritis. This was the end of my run in physiatry and I went off to the area specialist in minimally invasive hip repair (thinking that this torn labrum must be the culprit). However, within moments of seeing him (we're now at December 24), he said that the labrum and cyst were the least of my problems, but I had pretty severe arthritis (flattening or destruction of the cartilage) in the hip. It didn't take a trained expert to see what he meant -- a well functioning hip is a ball joint, nicely centered in the pelvic socket with a nice fat layer of cartilate between the two. My ball socket was only millimeters from the pelvic socket and definitely not comfortably surrounded by cartilage. He sent me off for a slow-acting shot of cortisone into the hip joint and then PT three weeks later.

My Physical Therapist, Clare Safran-Norton, at the Brigham is awesome! I'd been trying to find someone to help me figure out why I'd been having repeated injuries on the left side and no one would take a holistic view, but Clare did. She immediately started to work with me to bring some flexibility back into my spine (it had become practically flat after so many months of compensating for hip pain), she got me working out in the pool, but most of all, she treated me like a partner and we worked together to see how far I could get. If you need a PT, I can't say enough good things about her. She is just terrific.

By the time I had my follow up with the doctor/surgeon, I was still in pretty constant pain and he broke the news that a replacement was really my only option. I wasn't thrilled, but swallowed the answer. He gave me the number of his scheduler to schedule surgery, but when I finally got through to her, she said I had to come back for another appointment and XRay. When I found this second appointment almost an identical rehash of the previous appointment, I decided to shop around a bit more for doctors.

I worked my network and got recommendations, did a bunch of searching online and decided that I probably wanted to get this done at New England Baptist, because it's an orthopedic hospital and they do more of these than pretty much anywhere else. So I started looking for someone who was both a sports physician and a hip replacement surgeon. It turns out that several of the NEBH (New England Baptist Hospital) crew practice out of an organization called Pro Sports Orthopedics and that they see patients in Cambridge, Brighton, and Waltham -- three terrifically convenient locations.

So I narrowed my list and decided that I wanted to speak with Anthony Schena The good news is that I liked him a great deal; the bad news is that he doesn't actually do hip replacements. Oops -- turns out "Joint reconstruction" is fundamentally different from "Joint replacement. My bad. He directed me to his colleague, Michael Mason. Liked this guy a lot. Instead of, "Well, we'll have to see when we can get you in." I got, "Oh, early July? That should be no problem." He took the time to draw pictures of the pieces that went into a hip replacement. He gave me a good sense of where the technology is, what we know and also what we don't know (I find this trait particularly attractive in physicians; it is all too rare). He was encouraging, and he's clearly active both clinically and I research -- he has a herd of goats prancing around Scotland (I think) with artifical cartilage. The research is going to take a long time to complete, because for the next step, the FDA requires that the goats be slaughtered and no one is keen to do that. And actually the clincher was when I asked him what brand he uses for replacements, he named two and said that he picked the one that fit me best. Very different from earlier interactions, which devolved down to, "I use this part."

OK, so the plan was set: I spend most of June in Canada (see previous blog sequence), during my trip home in the middle I do my pre-surgical appointment, and then I land on July 6 and get a new hip on July 7.