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!

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 swelling 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):
  
  

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 completely 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 therapist 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 walk-in 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 in research -- he has a herd of goats prancing around Scotland (I think) with artificial 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.

25 days and 13 games later: The USA vs Japan

The day arrived!

I had planned to do a boat trip up the Indian Arm this morning with Beth Martens (fellow chuck) and her family (Omar, Katie, and Cassie). I figured it would be a lovely and welcome distraction as we awaited the big game. It was a good plan -- I didn't start to get antsy until about the last 45 minutes of the trip.

But enough preamble -- the environment was everything you could expect -- overrun with Americans, it was almost entirely a pro-American crowd. It was a joyous, festive, albeit nervous, atmosphere. And unlike any of the other games, we had a bit of a pregame show -- Canadian Maple Leaves, the FIFA banner, mounties, and flags saluting all the teams who played in the tournament.

From the first moment, the USA made it clear -- they were out for redemption -- the heartbreaking PK loss four years ago was a bitter memory, and they were out to ensure there was no repeat this year. Japan started with the ball, passed it back, took a long kick, and the USA gained possession and immediately started pushing into the attacking third. And then, two and a half minutes in, Rapinoe sends a beautiful corner kick into the middle and Carli Lloyd runs in and just buries it in the back of the net! The stadium went completely wild!

And then, only two minutes later, it's Holiday taking a penalty from the same side. Julie Johnston flicks it on and again, Lloyd tips it in! USA 2-0 and we haven't even had five minutes of game time! The whole team ran over to hug their bench and the crowd cheered for a good solid minute.

Japan could not seem to muster the long sequence of passes that so characterizes their play -- they would make three or four good passes and then send a long ball to nowhere, kick it out of bounds, or otherwise lose possession. And when they did, the US attacked ... and attacked ... and attacked. In the 14th minute, Tobin Heath launched one into the box. The Japanese defender flicked it high in the air, but still in the box ... and this time, Lauren Holiday raced onto it and volleyed it into the back -- 3-0!!!!!

But perhaps the most stunning play of the game came just at the fifteen minute mark -- Carli stole the ball at midfield, the Japanese goalie is way off her line, and Lloyd sends the ball in from midfield just over the outstretched hand of the Japanese goalie. USA 4-0 and a hattrick for Lloyd in the first fifteen minutes!!!

In the 18th minute, Lloyd almost made it 5-0 off a beautiful cross from Klingenberg. At this point, Japan finally settled down a bit; their possession improved and they began controlling the ball. And when Japan does that, they are dangerous and one makes mistakes at their own peril. Sure enough, a misstep by Julie Johnston in the 27th minute gave Ogimi just the opening she needed to send the ball soaring into the corner of the goal past Solo's outstretched hand. USA 4-1.

This is about the time it's important to remember that in 2011, Japan came from behind not once, but twice, to take the game into overtime and PKs. So, even with a 4-1 lead, it's natural to become a bit nervous.

Perhaps an even more salient reminder of 2011 was the 32nd minute Japan substitution, bringing Homare Sawa into the midfield. Sawa is arguably the soul of the Nadeshiko in the same way that Abby Wambach is for the USA. She's a tad slower than in 2011, but her ability to calm the team down, establish order, give Japan hope, and attack the goal is unmatched. And that's exactly what she did.

In the 39th minute, surprisingly, Japan made its second substitution. This is somewhat unheard of -- using two subs before half time -- but Sasaki (the Japanese coach) clearly needed some tactical changes to avoid being completely thrashed. And that's how they ended the first half: USA 4-1 and Japan having used two of their three subs.

And then it was the second half!

Rookie Morgan Brian, who has played wonderfully as the holding midfielder, had a beautiful shot in the 50th minute that forced the Japanese goalkeeper to make a tipping save. And then in the 52nd minute, the US scored again -- unfortunately, it was an own goal, by Julie Johnston. As mentioned earlier -- the Japanese take advantage of every misstep; a slight defensive glitch gave them a shot on goal that Johnston tried to divert with a header, but instead of diverting it, she sent it into the corner of our own goal, just out of Solo's reach. USA 4-2 -- and those who remember 2011 are started to get a bit twitchy.

And then, just a minute later, a Holiday corner kick goes to the far post, where Morgan Brian is perfectly positioned to set it up into the middle where Heath redirects it into the goal: USA 5-2!

Before the 60th minute, Japan used its last sub, replacing forward Ohno with Iwabuchi, who scored Japan's only goal against Australia. And only moments later, the USA made its first sub: Rapinoe is subbed out to a standing ovation, replaced by Kelley O'Hara.

It's a bit sad to say, but the remaining excitement of the match was the entrance of the team's two senior members: Wambach for Heath in the 79th minute and Rampone for Morgan in the 83rd minute.

And then it was all over ... the USA were world champions and Japan was in tears. There is a lot of genuine respect between the USA and Japanese teams, but it's always difficult to lose and have to stand around waiting to get those silver medals.

And then, there is the golden ball -- to the best player in the tournament -- Carli Lloyd!

And the golden glove for the best goalie -- Hope Solo.

Then the Japanese get their silver medals.

And finally, the new World Champions take possession of the trophy!

It's been a great month. I can't wait for France 2019.

Reporting from beautiful Vancouver, it's the Consolation Match: England versus Germany

England enters the match having never defeated Germany in 20 meetings. Germany enters the match having lost to the USA in the semifinal. And they're off!

The opeining 10-15 minutes saw Germany looking confident and dominating. They had opportunities in the box within minutes of the opening whistle. In contrast, England did not look so good. They were able to keep Germany off the scoreboard, but they just weren't smooth or organized -- they didn't look like the team who had deserved to win over Japan. Until, that is, they settled down. About fifteen minutes into the match, England settled down and we were in for a good tight game. Something about the English play made it seem like they wanted it more.

Germany was more precise and better at putting together the passes and combinations, but England were putting themselves out there in a way Germany wasn't. Nevertheless, the game was end to end and relatively evenly matched, with the Germans looking perhaps a bit stronger. They went into half time 0-0.

The came out of half time with renewed energy and Germany looked particularly dangerous. They threatened the English goal, regularly, but without success; England had fewer opportunities. In the 75th minute we saw perhaps the best opportunity of the game with Jill Scott pulling Nadine Angerer out of the box, but somehow the ball went backwards instead of into the goal. It had looked so promising.

The battle continued and the final whistle blew on a game still tied at 0-0! Into overtime.

The frenzied battle continued throughout the first 15-minute period with neither team successfully creating a threatening attack. Then we went into the second overtime. I did not want to see this game end in PK's. Both teams deserved better.

And then...it happened: Leanne Sanderson (former Boston Breaker) in the box; Tabbe Kemme appeared to have her around around Sanderson as she went down; was it? could it be? Holding in the box? Well, the referee did call it, awarding a PK to the English. The replay we could see on television was interesting. While still standing, it was pretty clear that Sanderson had grabbed Kemme. It was equally clear that Kemme did hold Sanderson, but it was almost as if Sanderson made it happen. I think without the replay, the call was completely valid; with the replay, it was much tougher to decide. I wouldn't say it was the wrong call, but I can't exactly say it was the right call either. I wonder if soccer will ever use instant reply to rule on these things?

Anyway, Fara Williams stepped up to the line and nailed it.

The rest is history. Germany lost a stunning two in a row; England had their best finish ever; this fan was exhausted!

Back in Edmonton: Japan versus England

It was a beautiful day in Edmonton as Japan and England met in the second semifinal match. Many of the Canadian fans had purchased tickets to this game, hoping it would be a Canadian match on Canada Day (the Canadian Fourth of July Equivalent, celebrated on the first of July). But, England squelched that plan, so it was an interesting crowd - a lot of Canadian jerseys, a lot of American jerseys, and many, many fewer English and Japanese jerseys (I wore my Boston Breakers Sameshima jersey). As the people behind me were overhead to say, "No one really cares who wins; they're just here to watch soccer." I was cheering for Japan, because I would like to see another USA / Japan final, with a different outcome than we saw in 2011.

The crowd was a bit larger than I expected (31,000). We only got 19,000 for the USA round of 16 game in Edmonton.

And our seats were quite nice.

Japan got off to a bit of a rough start -- they weren't connecting cleanly on their passes as we've come to expect from them. England, on the other hand, got a decent chance on their opening possession -- a rocket launched just left of the goal. Japan collected themselves somewhat, but I was shocked to see how different the 2015 Japan team was from 2011. In 2011, Japan connected passes like a pinball machine; amassing some ridiculously high pass completion rate. Today, they were missing passes, sending balls into wastelands of space, and simply not looking like Japan. And England was loving it! England seemed to have the speed advantage on both offense and defense. But they too struggled to put together a significant attack.

Then the game started feeling eerily familiar -- in the 31st minute Japan's Ariyoshi was fouled -- the referee called it in the box, awarding Japan a PK. And like last night's foul on the Americans, instant replay showed that the foul was just outside the box. Oops. Japan's captain, Miyama, struck net. Japan 1-0.

And again, eerily similar to the Germany USA match, less than ten minutes later, England's Houghton also drew a foul; Fara Williams nailed it, and we were back to a tie game (which seemed more apppropriate given the tenor of the game). The teams went into halftime at 1-1.

Only somewhat reminiscent of the previous evening's match, second half play continued with Japan dominating the possession game, but England dominating the attacking game. And still, this was not the Japan of yesteryear. The final ten minutes saw subs coming in, play becoming frantic, and when the clock reached 90, and the 4th official showed three minutes of extra time, most of us were anticipating another thirty minutes of soccer.

But then -- heartbreak for England. Japan raced towards goal and sent a low cross into the box; while trying to clear the ball, England's Laura Bassett knocked the ball into her own goal. Some of the crowd went wild, but most of us groaned, "No!" This was not how this game should have ended. England's losing the game seemed not quite right, but losing in that particular fashion was simply devastating. If ever I wanted a "do-over" this was it.