Knowing how important focusing on recovery from a hip replacement operation is I went to great lengths to set up a supportive environment. Front and center was an electric bed with an overhead trapeze which my wife surrounded with shelves and tables – my command center for the next month. The rest of the hardware was close at hand; a wheelchair, walker, extra high toilet seat, a nighttime “pee without getting out of bed” system and various doohickeys. My wife was psychologically prepared for an extended period of caregiving and serving me breakfast in bed whether I liked it or not.
I moved through many stages right after an operation, some of them lasting only a few days. Looking back it is almost hard to believe that such simple tasks as swinging a leg on to my bed was a major production but that is what you are like in those first days of recovery. It is also easy to forget regularly monitoring temperature for signs of infection related fever, giving myself injections in the abdomen to reduce the risk of blood clots and wearing pressure socks as precautions against the dreaded deep vein thrombosis. I slept long nights, sometimes soaking my sheets in sweat and would suddenly nap after what seemed like minor exertion at any time of the day.
Take Some Time Off!
My surgeon said to plan on taking six weeks off 100%. This is, after all, a bilateral hip replacement. In my world of being an executive and a consultant that was much easier said than done. I did a prodigious amount of work in the run up to my operation, pushing through my then familiar level of pain to clear the decks as much as possible. Still the world kept turning so, while the phone calls and emails slowed they did not stop. On one level I am thankful that I have work but on another it would have been very sweet for me to turn it all off entirely and fully concentrate on my healing. Very quickly I began to feel an intense resentment around work. After one egregious day of being pushed from task to task at the cost of rehabilitation program compliance I realized I needed to draw a line in the sand. I announced I was going on medical leave by ending business activity at 1 PM every weekday. To make it stick I turned off my cell phone and ignored business email, one of the best executive decisions I’ve made in a long time.
The darndest things happen when you are laid up. A far away friend sent me a care package in the mail including a real hollow-eared chocolate Easter bunny. I realized it had been decades since I’d gnawed into one of them. I wonder how she knew chocolate was part of my healing diet.
One of my planned leisure activities was reading and to that end I got a stack of interesting books out of the library. Fatigue, pain and opiates don’t go well with reading, though. Two or three page sessions at 50% comprehension is not the way to enjoy that 900 page biography of what’s his name.
You always seem to find out about the scariest downsides after the fact. No screws or glues sounds great until you are told the pieces have just been laid in there attached to nothing. Your prosthesis is only as strong as the integration of the hardware into your skeleton, that is, your bones need to grow into the grooves in the titanium. Usually that happens but you never know. All you can do is hope. My paranoid self has been quick to freak out at strange feelings and odd twinges. Unfortunately, it will be some time before those can be safely relegated to the psychosomatic.
During my pre-operative research I was delivered generally uninspiring prognoses by surgeons about my future range of motion. They could fix the pain but don’t be surprised if you end up moving like the tin man. Muscles have memory and once lost some capabilities are not regained. My anterior surgeon was much more optimistic but even he wouldn’t provide a guarantee. I was bringing muscular atrophy, shortened and stretched tendons, twisted vertebra, adhesions and scar tissue to the (operating) table. Anterior hip replacement provides an edge, not a panacea.
Carpe Diem
Early on in the recovery process I noticed I was able to move my legs in ways I had not for years. That is to be expected considering my previous level of disability but still, to actually experience it is entirely different than understanding the concept. I was moving my legs around in bed one day when I realized what I was feeling in the hip was the incredible slickness of the joint. That ball and socket was gliding effortlessly, not creaking and grinding like my old hip. It was then that it dawned on me I had a radical opportunity.
A month ago, crippled and in pain, I moved like an old man. A flight of stairs required courage and grit. I would break out in a sweat from the effort of tying my shoes. The only way to lie on my side was to prop my knees apart with pillows. You get the picture. My congenital and developmental issues meant my hips never really worked right. Now, poof, all those old painful limitations are gone. In their place is this incredible opportunity to experience my body as it was originally designed. I could feel the obstacles melting away, the full potential opening. The strength and flexibility required for those activities I enjoyed so much in “middle age” were on the table as a fully achievable option. The ability to do things I found tough even as a kid, like standing solidly on one leg, were now possibilities.
Fortified by the belief, actually the certainty that I can enter this new territory, I’m now spending 2 ½ hours a day in physical therapy five days a week. I have access to brilliant staff, a Pilates table, exercise equipment, exceptional therapeutic massage, massive ice packs and a warm pool full of functional toys. I really work hard in there with non-grim determination. To fully actualize the potential of the surgery I’m having to work out from toe to head; you can’t fix the hips without straightening out the knees. On the most basic level I am learning how to walk again which is way cool. Waddling around sucked. Deep inside I’m experiencing the pleasure of new capabilities and the wonder of leaving behind all the old habits from my years of pain driven adaptation. I’ve even discarded my old footwear to break habits of muscle memory.
I’m giving myself another six weeks of medical leave by which time, hopefully, I’ll be pretty close to new normal. It may take six months for all the little hitches to work out but after three months of physical therapy I should be able end my intensive. Doctor’s orders are I cannot get on a bicycle or do anything “risky” for at least three months after the operation. August 3, four months out, I turn 60. I’m planning on looking a lot more like I was at 50 than at 59. Even deeper than my looks I am projecting into the idea of feeling my newly regained youth.
What a time to be alive.
Sensitivity or Paranoia?
Three month check in time. Saw my surgeon yesterday. He said I’m a success, a calling card for him and I’m free to do whatever I want. Head to knee, half lotus, ride a bike, run – it is all absolutely fine. Sure there are months more before the rehabilitation process is complete but at this juncture it looks like a full recovery to my pre-osteo self is in the cards
That being said, my paranoid side and hypersensitivity have sometimes combined to occasionally bring me waves of fear. What was that popping feeling? Does that pain mean I broke something? Once I was sure the prosthesis was sliding inside my femur. Thank god for email and my surgeon’s blackberry. Very quickly I get reassuring notes back. It is amazing what a note from your doctor can do. My regular physician once solemnly wrote on his prescription pad “stop worrying about your heart”. You know – it really worked – and I never felt bad about chocolate cake again.
One noticeable difference is that my walk is now so much straighter. I used to sway side to side like a drunken sailor sometimes startling strangers as I whacked into them. Now there is no wobble in my shadow. A really interesting bit of feedback came from my daughter, now 30, who said even when she was a little kid I was swaying into her. My osteo was a long time coming with subtle warning signs decades in advance. Being aware of such things I am now hyper aware of disturbances in people’s gaits – I see those bad hips everywhere.
The New Me
I wondered what it would be like to have all that metal inside me. What I can report is it doesn’t exist. I don’t feel a thing, my bones are happily bonding with their new friends, thankful for the support. The body wants to work and apparently it is less stuck on the purity of being all biological than some parts of my mind were. Rather than denigration or rejection I get the feeling of celebration. The least I can do is work my buns off giving those selfless bones the soft tissue support they deserve.
I have been marveling at my new self, or maybe it is remembering my old self. I am capable, I can do things that most of us take for granted but they were so far out of reach for me that I could not imagine doing them ever again. For instance take stairs. Stair climbing for me, years ago, became a one step at a time ordeal leaning hard on the banister. I would look up that flight of steps and nod to the inevitable pain then go for it slowly and gently. Occasionally, wearing a suit and needing to look strong I would push out of my comfort zone and grind my bones in an attempt to keep up with a group. Sometimes a flight of stairs like that would reverberate for hours. Today I was with a group of people and we all went up step over step with none of us putting a hand on anything. Nobody else noticed a thing. I was exhilarated.
It was at least five years prior to my operation that I lost the ability to squat. It simply got too painful to get down on my haunches. I developed other habits, like bending over. Well squatting is back. Want to see the bottom shelf of the grocery store? Want to pick that thing up off the floor. No problem!
I’ve started a bit of hiking. This activity is challenging because of the many positions you get into where you need to apply power for the next step, especially uphill and on rocks. It is here where my years of atrophy meet my months of rehab in the form of limitations. The cure is continued challenges supported by continued strengthening. I got on my bike for the first time after months off. Felt a bit woozy up there and I was too scared to go on dirt. That will come.
I have a favorite short hike to a hot spring. It is a steep and rocky 15 minute jaunt. In my “youth” I used to enjoy running up and down. The last time I hiked it very slowly two years ago, I said to my wife it felt like I was on the Bataan death march. Being alone on the path I was able to cry out as loudly as I wanted in pain and made a horrible sight. Today I’m looking forward to another visit, not running but at least comfortably navigating the obstacles.
Why not running? Shock. For now and maybe for the rest of my life I need to be concerned about inducing shock to the metal-bone boundary. When you break a bone the resulting calcification can result in a stronger section than what you had before. Metal and bone makes a much less robust connection and enough force can sheer off the most exquisitely constructed fusion. My tolerance for shock will go up over time, it might be a year before the process is complete. By then the normal shocks of life like running will be fine. Just how much I test my fusion hardiness is up to me. I do want to go skiing and need to be able to take a fall. That’s ok, apparently, but it is not without risk. I can play tennis but there is some edge where the side shock can cause things to become undone. I have to feel into the risk of various activities because there is no bright line. I do not want many enjoyable activities to be relegated to distant memories based on extreme risk aversion but I also do not want to end up trying to re-heal the gruesome mess of a broken bionic body.
