I feel so much better.
I am a little more than six months post surgery to replace
my hip.
There is a lot to be said for aftermarket (and in some ways
bionic) body parts: titanium, ceramic, and a little plastic. Like having
cataract surgery or adopting an adult black cat with one eye, I have found more
people have had the experience than I would have expected. The local
surgeon—ranked as #1 for his low complications rate in all of New York
state—had done 16,000 of them before he got to me, after all. What was new to
me was routine work for him. (He did great work, especially for the first
surgery on a January morning.)
There is nothing wrong with aftermarket body parts.
Looking back, it’s hard to say how long, one way or another,
I limped and gimped, but it was at least a year, probably more. I do know that
for a while my first steps every morning were like Frankenstein’s. And that gait became the
morning new normal. And sometimes I walked that way, almost, later in the day.
For months last year I thought the problem was my knees—which
it was to some extent and had been remedied by what I think of as medical WD-40
shots in my knees.
So before I agreed to the surgery, I got the knee shots,
took ibuprofen until my ears rang, took glucosamine-chondroitin, used a heating
pad, tried cider vinegar (too sour), turmeric/curcumin (too spicy), and fish
oil (too burpy). I rolled on topical magnesium and CBD oil for leg cramps. I
had perfect attendance in water aerobics three days a week for a semester
(which I now think of as athletic overachieving even as I still attend). The
pool was the one place where, almost gravity-free, nothing hurt for an hour. I
read everything I could find about hips online (there are about 206 bones in
the human body, by the way) and wished I had taken Anatomy and Physiology all
those years ago instead of General Bio. For better or worse, my sense was that
both knees and hips were too far gone for the experimental stem cell treatment
not covered by insurance. I went to
twenty sessions of physical therapy until finally I went to a second (this one
highly recommended) orthopedic surgeon for an opinion. On a scale of 1-10, what
is your pain? At least a 7, maybe an 8. And the pain was exhausting.
The verdict: I needed hip replacement surgery. Knees were
bone and bone, and so were my hips, one in particular. The physical therapy for
my knees had been helpful but not exactly the point.
The orthopedic PA and I also discussed alternatives to try
until I was ready for the surgery by a, well, genuine sawbones. Since I had
fortunately never been in a hospital before, I exhausted all the other
non-surgical possibilities first.
Until I realized the pain that was defining my life was not
going to go away. My life as I knew it had been interrupted slowly and
incrementally. I was no longer who I had
been, and not in a good way.
I hadn’t gone anywhere I didn’t have to. Pain tainted
everything. Sitting in theater seats hurt. Walking hurt. Carrying a cat to the
vet for a routine appointment was more difficult than I wanted to admit. Putting
a sock on my left foot was…. excruciating. I went upstairs slowly in part
because it was difficult to develop and sustain momentum, and stepping in and
out of the bathtub required slow, careful moves. Clean out the garage? Forget
it. I had a limited range of motion. I came to curse gravity and almost all life
out of the pool. My physical therapist had told me “Motion is lotion,” but
motion as often as not hurt. Still, I did my exercises at home twice every day
anyway. (I am told most people go to physical therapy in part because they
don’t do their prescribed exercises at home, but I certainly did them.)
I once was a walker, but no more. I trimmed the hedge, but I
was too sore to carry the trimmer into the garage afterwards. I had to take the
newspapers in small amounts out of the recycling bin to carry the bin to the
curb. Sitting didn’t hurt until I got up, so I spent a lot of afternoons lying
down on a heating pad even in the August heat. The other things I did not do: I
didn’t go to Maine even for a day trip for the first time in decades; driving
didn’t hurt, but walking afterwards did. I didn’t go downtown to protest Trump’s visit.
I didn’t go to any social event that required sitting in uncomfortable theater
seats. Or in restaurant seats. Or standing at a bar. Bending over to pick up a
penny in a parking lot? Forget it. Walking any distance was not possible.
My inability to function successfully in the world was
collateral damage from an arthritic hip that needed replacement.
My passport sat unused.
My former quality of life was no more. (And when I used a
cane a month before my surgery to attend a Christmas concert, ushers offered me
a seat in the handicapped section, not with my family. I declined and hauled
myself up to the elevator-less second balcony. The Americans with Disabilities
Act goes nowhere near far enough.)
The pain just got so normal so slowly that I am not sure I
appreciated—for a long time—how out of commission I truly was.
And yes, I know there are far worse things, life-threatening
conditions, to have. But still.
And so surgery.
Approval from the insurance company happened overnight. Hip
replacement counts as “elective” which apparently these days does not mean a
nose job. I went to an hour of pre-op joint
camp. I went through the other required pre-op motions: my lungs were “unremarkable”.
Primary care review, PT consultation, admissions meeting, and finally meeting
with the surgeon. I chose to spend 23+ hours in the hospital rather than coming
home on the same day, and in that time, I had at least three different nurses.
New day, new shift, electronic records.
I discovered that I have very good health insurance. My
surgery cost me a $500 copay for my hospital admission. Period. (That said, the
current health insurance system in the US is criminally unfair. But thank you,
Excellus Blue Cross Medicare Blue PPO.)
After my $500 surgery, the first thing I did in the hospital
was stand up straight and without pain for the first time in I don’t know how
long.
But before the surgery, I bought a cane and a walker. I
cleaned even during the ten days pre-op without ibuprofen or aspirin at which
point I realized fully how seriously bad off I was. On a scale of 1-10, the
pain was pretty much a 10. And I came to understand the need—the urge--to
provide, provide as you move closer to an event that you have little control
over, after all.
I would have to stay
home for two weeks post-op, so I put up stores: easy-to-prepare food for two
weeks, cat food and littler, clean clothes, extra pillows to support my leg.
Boost and Zing bars. Flashlights. Motion-sensor lights so I wouldn’t have to
even reach for a light switch. I bought a reacher device, a tool to help me put
on socks, and a booster seat for the toilet. (Amazon was my good friend.) I put
up stores as if for The January Apocalypse (and I still have some of those cans
of soup). Despite the pain (no painkillers for ten days before surgery, remember), I
cleaned like there was no tomorrow just in case. Floors. The bathtub. I rolled
up the throw rugs and put them away so I wouldn’t trip on them. I got books to
read during the first two weeks post op when I was going to have to stay home: John
Irving’s The World According to Garp,
Jacqueline Suzanne’s Valley of the Dolls,
John Cleese’s Professor at Large. None
of which I read more than a few pages of. (Later someone told me that the meds,
especially the prednisone, makes for a certain lack of intellectual focus.) On the bright side, I
never had problems sleeping during any of this, not even the night before the
surgery.
So after 23+ hours—one night—in the hospital, I was home on
the new single bed in first floor dining room. I had ice packs. I had no
problems sleeping at night, but during waking hours I was supposed to elevate
my leg for 45 minutes and then move around for 15 minutes. (And I did.) My legs
were elevated on a pile of pillows and I did ankle pumps and more ankle pumps
to keep the blood flowing. I was to eat several small meals throughout the day,
take deep breaths and use a fancier than usual peak flow meter and monitor my
results. I hydrated and hydrated. As
pre-surgery PT taught me, I walked upstairs leading with my good leg and led downstairs
(as if to hell) with my bad leg. I hooked my operated leg over the good leg to
get myself out of bed. I lived in jammies and sweats. On a scale of 1-10, the
pain was maybe a 3 or a 4 at the absolute worst.
There are many ways to replace a hip, it turns out, and mine
was a minimally invasive one-hour robot- assisted procedure, anterior approach,
that required no physical therapy follow up. Muscles and nerves are stretched and contorted
but not cut, so healing time and risk of infection are minimized. I went home
with no restrictions. My body told me what I could do. That said, though, I don’t want to think about
how violent, how brutal cutting of the
hip and the pounding of the femoral stem into my bone was; I am just grateful
for the anesthetic. I mean, the sawbones really did saw bones. Years ago I would have been in rehab for weeks if
not months. Because of the anterior approach, there was little chance of
dislocation even when I did 90 degree moves. I bent over to clean the litterbox
two days after surgery. I was careful but not immobilized.
Now is not a bad time to be sick if you have to be sick. Some
things can be fixed. Although there
is a certain Zen to all this DIY figure-it-out but in its way highly structured
recovery, for me it was a good match. I took an opioid pill only three times,
and looking back, I don’t think I really needed those pills. My leg never
looked like the telephone pole I was told it would; it was a little swollen and
sensitive, certainly with dark purple and black bruises, but I was not completely disabled, really, and the black and purple turned to green and yellow as my leg
healed. By taking the opioids I was trying to get out ahead of the pain,
something which I did not need to do and which, actually, is standard medical
thinking of a bygone age, or so I have been told. Off the major meds for seven months now, I
still monitor what might be too much and, equally importantly, too little
movement. Sloth is not my friend. Motion is lotion; rest is rust.
I folded up the walker and put it away ASAP before it became
a clothes rack. I was just loopy enough most of the time during those early
weeks from the prednisone (steroid), the meloxicam (atomic NSAID) and
acetaminophen for the swelling to know I was pleasantly but not dangerously
loopy.
I was walking without a cane in the house three days after
surgery but kept it close anyway. I went up the stairs on the third day, too.
I shoveled out the car after a blizzard six days after
surgery. Most of the driveway I left as it was; sooner or later, all the snow
melts.
I got in and out of the car, just to see, five days after I
got home.
These days motion is lotion as long as I don’t overdo. Limpy
and gimpy no more.
The staples were the worst part. As prescribed, I took the
bandage off five or so days after surgery, but I could not believe the staples.
Think of tiny staples used on carpet but that caught on the inside threads of
my sweatpants; the nurse who later removed the staples (and there must have
been 20-30 of them) told me my leg muscles were sewn together at least twice
below the top layer, but that was not the point. To me they looked too much
like carpet tacks (well, staples) to belong on my body.
The cats Dr. Swishy and Moonbeam Nightingale served as furry
caretakers, probably welcoming the hours of warm body heat at home 24/7 during a
January blizzard. Granted, they had to learn not to sit on my left leg. They
were good sports in the solid two weeks of kitty time-sharing. Swishy snoozed next
to my pillow, Moonbeam next to my hip (not on it). Never have I felt as bonded
to any pets. Anyone who discounts the power of purring/feline nursing and even
a badly timed nose touch just doesn’t know enough. (And even now when I think
it might be time to adopt cat #3, I have to remind myself how attentive and
caring they were and how a devoted middle aged and a loving geriatric cat would
react to a stranger cat, and I set that adoption idea aside.)
I spent two weeks answering texts from friends and family. I
did not want or need anybody hovering. The internet can be a helpful and
successful time-suck when you need one. Not surprisingly, there is no shortage
of hip replacement t-shirts available, none of which I have bought although I
have to grant some credit for their predicable cleverness: “Real Hips Are So
Last Month.” “I Make This Hip Replacement Look Good.” “Hip Hip Hooray.” “Got
Titanium?” ”Hippy.” “I Just Had a Joint.” “Bionic Custom Parts.” (My parts are
made by DePuy Syntheses, part of Johnson and Johnson.)
I grant you that staying indoors for two weeks even in
January might not have universal appeal. In fact, it is not an overstatement to
say that in the history of the world, there may never have been anybody better
qualified than I to spend two full weeks in solitude—in comfy sweats, no makeup, no
small talk.
I just wanted to be home alone to heal. Plus, there wasn’t
much for anyone else to do, really. I
slept. I iced and iced. I watched British mysteries on my iPad. I remembered to
hydrate, hydrate, hydrate. I walked around for 15 minutes every waking hour and
then iced, iced, iced. I read very little and I wrote even less except to keep
the required written record of what pills I took when and what exercises I
completed during every waking hour.
My renewed after-hip surgery philosophy: comfort is good. Convenience
is vastly underrated.
That said, I was more eager than I expected to get the evil staples
removed two weeks after the surgery. Outdoors! A car ride! Fresh air! In-person
company! After the staples were removed and I got the okay to drive, I drove
myself to the grocery store—and then came home and slept for a solid two hours.
Another week later I got into the pool for water aerobics (and ditto the nap).
Range of motion came back. Stamina increased and I no longer wondered if I were
anemic. The surgeon said the operated leg is a teensy bit longer than the
other, but I can’t tell the difference. The scar has faded more than I thought
it would.
For the most part during surgery and recovery I have let my
introvert flag fly and fly. I did my best to pace myself, maybe going out for
lunch and running a few errands. A walk around the neighborhood is still—but
only sometimes--a preface to a nap. But then I have always been a napper. And I
have certainly always been an introvert. All this is not a bad way to live. Now
and then I still ice. On a scale of 1-10, maybe some days for a short while the pain is almost a 1; if I
am sore after working out in the pool, it’s a different kind of pain than
before surgery, and I know it will go away after some ice and a little rest.
Medically the verdict was out on the value of post-op new
shoes but since my gait has changed, I decided to give myself the benefit of
the doubt and bought some new ones: Ryka, Easy Spirit, and a pair of Tevas to
replace my sandals that had been worn for years in tropical monsoons. My brain
was fried for longer than I want to
remember by the meds (and by the pain before the meds), but that has ended, and I do what I can to help the healing along.
I eat well enough (what I think of as The Healthy Shit Diet). Right before the
surgery, I was given a 6 month handicapped parking tag for my car which I did
use; it’s the kind of thing that it is nice to have if only on principle. I
didn’t use it often, but I liked having it anyway even if the other people who
have them seem to drive around with them hanging from the rear view mirror and
I have to wonder in many cases what stupid driving move they made to result in
that parking permit. I still try to avoid people who seem to be coming down
with something if only so my energy can be spent on healing.
At first I was wise enough to try to accomplish one thing a
day: a trip to the pool OR to the grocery store OR to lunch. Since then I have
increased what I do, so much so that most days I don’t even tally what I am
doing: I just do things until I need a nap. I pace myself. Not having to think
about—focusing on—lifting one foot from the street to the sidewalk, for
instance, means I have more energy.
Touch wood, my new hip is fine, fine enough for me to dance
in the kitchen when the spirit moves. I am not expecting to do cartwheels and
backflips—skills few people need, after all—but I am no longer limpy and gimpy.
My other hip is far from perfect but doesn’t hurt yet. (The surgery was a
positive enough experience that when I went back to see the physician’s
assistant a month or so after the surgery, I asked when I could have the other
hip done. “Does it hurt?” he asked as we looked at the x-ray. No, I told him, but
we both saw the bone-on-bone on the x-ray.) My knees still get medicinal WD-40
shots every six months and they do still pop and crunch every once in a while,
but I have had crunchy knees since I was a teenager. Back to normal, mostly—but
I still keep the cane in the back seat of my car just in case. For now. I still take glucosamine and chondroitin, and
calcium, magnesium and zinc, and I still go to the pool water aerobics class to
bounce around to “The Eye of the Tiger”. Other students in the class complain
about the temperature of the pool, but I am grateful and more grateful, as I step
off the ladder into the water, for the comparative weightlessness (15%) the
pool affords me for an hour three times a week: blessed chlorinated
weightlessness. I stretch and stretch some more and then we bounce around.
Walking to and from the parking lot to the pool doesn’t hurt any more.
A body in motion tends to stay in motion. This is all still
novel enough that I think of my life as BH and AH—before hip and after hip
surgery. I still like having big chunks of time to myself and the cats are
still often in Full Cozy Mode. Strength and range of motion are returning.
These days, uninterrupted by pain and with most of my marbles back and
functioning post-major surgery, I am back to following an idea where it will
go. I am long back to making lists and starting to get things done. I like
living in a way that does not require me to move (or do anything) on a
prescribed post-op schedule. I have never bounded up stairs like a mountain
goat and I don’t care if I do. But I can go up and down stairs with no pain
even if I am still a little more tired at the end of the day than I remember
being, say, a couple years ago.
For now, the new bed stays in the dining room just in case.
The motion sensor lights still make a lot of sense: ease and safety in the
dark. My housekeeping has returned to
its standard: good enough. I can haul
around big bags of kitty litter when I have to, but right now I can’t imagine
running with a backpack from one end of an airport to the other end (and
somehow this is always necessary, no matter how carefully I schedule my
flights) or hauling a suitcase up two flights of stairs in a beach hotel in
Maine--but eventually I will be able to. I am still in the pool and I’m back
functioning in gravity, too. I go for leisurely walks. I try not to sit any
longer than I have to. I remember to stretch.
I am easing myself back into the world. I do care that I can
walk and not worry about walking. I can look around. I went to the movies. I
went to an Elton John concert. I go out to lunch, and if I haven’t driven to
Maine yet (too much sitting makes for stiffness), I have almost gotten there. I
don’t feel immobilized any more, but I am smart enough to be careful even
though I have risked tempting fate and have moved the surgery-related pills (even
ibuprofen and acetaminophen) from the handy top of the microwave to the back of
the medicine cabinet. I use the hip surgery ice packs on my pulse points in the
summer heat.
For the first time in a year and a half I got Chinese
takeout.
I mean, this was major surgery, and the surgeon said it
would take eight months to completely recover, which means mid-September. Even
though that rule of thumb comes with a lot of it-depends-on-the-person caveats,
I think it will prove to be right. Fingers crossed.
Looking back, I like to think that I already a brain and a
heart and courage, and the surgeon gave me a new hip. Other people pay for tattoos, but I have a four-inch
scar, a fading decoration that I am proud of. (Thank you again, Excellus Blue
Cross-Blue Shield Medicare, which yes, I do pay for.) I have learned that yes, really and truly motion
is lotion and if you snooze (so to speak), you fuse—or at least get stiffness,
not pain, in the morning.
The one thing I did not realize until very recently is the
extent to which the surgery itself is just the beginning. What happens after is
just as important: a matter of a way of life. And time.
And my new hip was a little more than a year after the gods
gave me new eyes via cataract surgery that made my vision 20/20 without
external lenses for the first time since maybe third grade. Yes, my eyes were
always correctable. But really, a lens on your eye is not the same as one in
your eye. It just isn’t. I had my cataract surgery right before Christmas 2017,
and at odd moments I still find myself marveling at how much I can see even
though I don’t mention all that I am amazed to see the way I did that first
Christmas. (So much so that I was told to shut up, a very unfestive response.) I don’t know if I will ever be able to take my vision for granted
the way most people do.
And maybe not my new hip, either.
I know that in January I will celebrate my hipaversary just
as last December I had a glass of wine to celebrate the one year mark of my new replacement
lenses—“my new eyeballs” as I think of them.
The gods gave me new eyes but then made it difficult for me
to go anywhere without pain. And then there was a stretch of too-easy
exhaustion despite a pain level of basically zero.
Hmmm.
One morning during the first week, maybe the third day after
the surgery, I tried sitting in a kitchen chair and moving my operated leg as
if to depress a clutch. I could move my leg kinda sorta but it had little
strength. I went back to bed.
A week or so later, though, I tried again, and my leg had more
strength, enough that I decided that I could probably depress a real clutch. A few
days later I went outside in the January cold and into the car to see if I was
right.
I could depress the clutch. And so I was certain that I would be able to
drive again, maybe sooner rather than later and maybe not, and all I had to do,
was…well, live long enough.
As I said, I still try not to sit very long if only because
I feel stiff when I get up. I still hydrate and hydrate. I can tie my shoes and
put on socks with far less pain (and the seconds of pain are lessening). I get
in and out of the bathtub/shower without even thinking about it. Standing, I
write on a yellow pad on the kitchen counter. Moonbeam sits on her chair near
the refrigerator and Swishy is stretched out on the floor. My passport is
stashed in its usual place; it replaced the one that I had to have extra pages
put into a few years ago (a practice now discontinued, by the way) since there
were just too many visas and stamps in it.
To answer the question I have been asked again and again,
more than any other, especially since in retirement my time is finally in many ways my
own: I don’t know exactly where—what places at any distance or even nearby--I
am going to next in this world of gravity, but I know that sooner or later, after
a little more time passes and assuming things go as I expect, I am going to be
back to going.
And so yes: hip hip hooray, indeed.
Copyright Sandra Engel
July 2019
