One Hip Guy (Well, Two Actually)
The pain began about two years ago. I ignored it for the most part. As a man, when anything hurts you deal with it and keep it to yourself. My left hip was the first to manifest something akin to nerve pain. I recall taking a normal step on flat ground and almost falling over from the acute shot that coursed down to my toes. Within a week I was limping, but the shooting pain had subsided. What had replaced it was more of a soreness - something I could easily live with. Besides, I figured it was better than the alternative so again I pushed it aside. Before too long my right hip began to ache. There was some shooting pain, some soreness and a lot of swelling in my knee. Still I ignored it. It must be because I’m compensating for my left leg, I remember thinking.
One morning (I am unsure as to how much time had passed) I was getting out of the shower and caught a look in the mirror of the outline of my body. I was startled enough to call in my wife and finally admit the pain I had been hiding. My right hip had collapsed into my pelvic bone and the usual curve of hips had become concave. The amazing thing was that at the time the pain had all but subsided. This was not the case for my left hip but that was not as much of a wake up call as seeing the change in my body from what I came to find out was my completely deteriorated leg bone grinding on my pelvic bone. There was no pain because there were no (or very few) nerves left.
I went to several doctors to figure out exactly what the issue was and among the multitude of test results was one, positive, for rheumatoid arthritis. Numerous consults and many co-pays later the doctors and I put together a probable timeline of what had happened. The original sharp pain I felt was the beginning of the arthritis - and, long story short, so was everything else. The unfortunate part was that I ignored everything. Had I just gone to a doctor in the first place I probably would not be laying here on a couch, two new titanium hips later, typing this. Guess it just goes to show that you should always listen to your wife. (Not surprisingly she had told me to see a doctor in the first place.)
I found my way to an orthopedic surgeon who, upon seeing my MRI results, said, “Wow. Yeah. That’s not how thirty five year old hips are supposed to look.” I scheduled my first operation a week later, and then the second six weeks after. It really was that quick. Within eight total weeks I went from walking like I had just gotten off a horse to laying on this couch about ready to walk normally for the first time in more than two years.
It’s exciting, to be sure. But also to be sure it was anything but easy. I suppose some of the blame can be mine: I did not mentally prepare myself enough for everything involved with what is nothing short of life altering surgery. But there are plenty of things I simply was not informed of - or just did not know to ask about - before hand by those in the white coats.
I have given it a lot of thought and I have come up with nine things that I wish I had known before and tips on how to overcome the sometimes confusing and painful recovery process. As a thirty five year old father of four my situation is unique but recovery for the procedure is not. Here is what I learned.
1. Call your insurance provider before you schedule your surgery. Why is this a “recovery tip”? Because you are not going to want to fight with them when you are in the kind of pain that can only come from having a major joint ripped from your body. In my case it was an issue revolving around a brand name anti-blood clotting medication. Without this tiny pill one’s chances of developing a life threatening blood clot are around fifty percent. Pretty important medication, no? Not if you ask my insurance. They required a written reason from me, my surgeon and my rheumatologist before they would authorize payment. Granted the medication has a several hundred dollar price tag for thirty pills but when they are that important does it really matter? (There were other issues that popped up but none as serious as that.)
2. You will be getting something called a “block” - do not stand or sit up until this has worn off! I have punctuated this with an exclamation mark to drive home the point: this block thing will knock you down and keep you there. Literally. A block is basically an epidural. It goes in to the spine and numbs your entire pelvic area. For me it also numbed my legs and feet as well. When I was finally in my room and resting the nurses came in and out and see if I had “gone” yet, or “made water” as the charming Southern nurse asked. It was four hours out from surgery and I was feeling great. The drugs were doing their job and I had honestly forgotten about the block. I asked to sit up on the edge of the bed to help my body produce for them. The lovely Southern nurse must not have checked my chart to see what I had been given. I was able to sit up, use my arms to push myself to the edge of the bed and then I slid right off! Luckily the nurse was right there to catch me before anything horrible happened but her first question was about the block. I only used the in bed urinal form that point until…
3. You get up and out of bed the same day as surgery. This part surprised me quite a bit. I was up (as soon as I had feeling back in my legs and feet) and using the toilet before nightfall. Depending on the time of day surgery occurs some folks are even in physical therapy same day. My advice regarding this is simple but not obvious: Do not over do it. I was not the only person to fall into this mindset of “the doctors want me up the same day so the surgery must not have been as invasive and serious as I thought”. The surgery WAS AND IS as invasive and serious as you thought. You probably will not be pulling any staples or anything but the therapy while in the hospital is very intensive and will require a lot of energy. Do not waste all your energy on the first day - you will need it for the next two and a few weeks after that.
4. Stairs. Stairs. Simple. Obvious. Stupid. Bane of my existence. Sure I felt some pain, some discomfort before the surgery but after…well, now I am in a whole new world of hurt. For the in hospital physical therapy they walk you up and down a small, well gripping set of fake stairs in a controlled environment. You may even develop a false sense of security in your ability to climb the stairs there. I will warn you now: do not get cocky. There is little in the way of similarity between those and the stairs in your home. Or worse: the stairs leading up to your home. In my case I have five steps leading to my porch. Here are the three things I had working against me: I had my first surgery in December, I had my second in January and I live in Chicago. No grippy stairs here. And no controlled climate. And there lies my tip: you will be climbing stairs in much different situations than what they have in the hospital. If possible practice your stairs before you go and make sure you have a good muscle memory of the height and depth of the steps. This way, even if it just snowed ten inches, then got warm then the temperature dropped so it all iced over again like it did for me, you can at least have a good recollection of where your feet should go.
5. You will be encouraged to sit - not lay. I was shocked when I was told this. I figured that doing exercises while laying down would be the best thing. As it turns out that is great and all but sitting is a much more natural position for your hips. It makes sense when you stop and think about it. That all said do not underestimate the importance of laying down. I sit, on average, for forty five minutes per hour, walk for at least five and lay for the other ten. No one told me to do this but I have found it to be most beneficial. There are muscles in your thighs that you just can not stretch properly standing or sitting. There is also the strain that is constantly on your lower back that needs to be relieved and, again, laying is the best way I found for this. (As with any form of recovery please check with your physical therapist and/or doctor to make sure this is safe for you.)
6. Movement restrictions seem strange and arbitrary. Do not move your leg out to the side. Do not sit in a position past ninety degrees. Do not lift your leg to put your socks on. And there are so many more. Granted these differ from doctor to doctor and probably from one situation to the next but there are a million little strange things that you may want to ignore. Take it from me: DO NOT IGNORE THEM! I almost popped my new hip out of its new socket because I was convinced I could change my pants by myself. I would try to describe the pain but I do not think I would do it justice. Then there is the amount of danger I put myself in. Had that joint popped out of place there is a possibility that I would have to go under the knife again to fix it. It just is not worth it. Listen to all the minuscule little things they tell you to watch.
7. You will not be able to do anything at all for the first few days after being home. So be nice to your wife. Or friend or partner or mom or whoever you have who so graciously accepted broken old you to nurse back to health. The first few days being home you will most likely be half asleep for most of your day. It takes a saint to put up with this and schedule your meds and food and in my case tend to the four children running around the house. On the same token make sure the person who is helping you is not someone you have any sort of problem with. Tempers will flare and patience will wear thin - best to have someone compassionate with you.
8. The transition from walker to cane to nothing is very quick. One week from walker to cane and no more than two from cane to nothing. At least that is the goal. (Again, depends on the situation but this is the norm.) I have a very simple tip here that I was not warned about: do not rush this part. You will want to, I assure you. After a few days with a walker anyone in their right mind would want to throw it out a window. Canes are barely better. But walking unassisted is a feat unto itself. It is not comfortable at first. It can cause unbalance and missteps and possibly send you back to square one. So do not rush this part. Just go with the rehab and see where you are day to day. No doctor or physical therapist is going to force you if you sincerely do not think yourself ready.
9. Bouncing back is much easier than you think. I was told at the beginning that the surgery and in home physical therapy was going to be daunting. And that it was. That said, after three weeks of rehabbing I was up and walking with cane. A week later I was driving a car again (so long as I was not taking my meds for pain). In fact I felt great by the time my second surgery rolled around. I did not believe anyone who said the pain would subside so quickly but for the most part it did. This is not to say you can expect the same but from what I understand it is the normal experience. There is a light at the end of the tunnel. And trust me: you are going to want to remember that.
So there are my nine tips. I know I am a strange case given the fact that I had full double hip replacement at thirty five years of age but my experience seems to be in line with many other folks I have been able to talk to. A few of them were able to warn me of things I did not include here and others had slightly different outcomes. What remained the same regardless of who I spoke to be it a doctor, nurse or patient was the feeling of awe that science has come as far as it has. Ten years ago a double hip replacement meant the better part of a year in and out of physical therapy and several trips to the hospital. Today you can be in and out of the hospital in three days with no need to go back. The hips I have should last another thirty years. If I need them replaced again I will be sure to update this writing with what will no doubt be an even brighter outcome.