Hey there! It’s been a fortnight since #hip2point0 happened, and a lot has changed – primarily for the better!
The surgery went well. My previous post was thumb-typed in the pre-op prep room on my smartphone. I hadn’t yet had any pain meds or anesthesia, but I was confident about the surgery. My prep nurse had wonderful bedside manner and a great sense of humor. My anesthesiologist was similarly nice and friendly. My orthopedist initialed my right hip, and I was ready to go.
I waited. As the last surgery of the day, I had to wait for my doctor and his team to have lunch – a good thing, I’d say. That said, I hadn’t eaten since midnight, and my stomach was growling a bit (and not out of nervousness).
My surgery lasted almost four hours. My surgeon, Dr. Hanna, had to remove some of the #projectfemur hardware, which proved tough as the still-good part of my femur had grown around the titanium rod running down the marrow channel of my femur. I lost a lot of blood during this (“a sign of a healthy bone,” per a doctor friend), but after the hardware came out the installation of new hardware was fairly routine. Best of all, Dr. Hanna didn’t have to dissect any gluteal muscles to get to the surgical site, which meant a quicker recovery was possible. (All credit to pulling off a 45 mile bike ride the day before surgery, as it made my glutes limber enough to be moved without cutting.)
As was the case in 2014, I awoke from anesthesia in a great mood, though I can’t remember this as there is a period of unconscious awake state before actually waking up (thus why you sign a contract stating you’ll make no major life decisions while on anesthetic drugs). I do remember waking up in my room at Shady Grove Adventist Hospital, a bit nauseous but otherwise OK.
And my hip felt great!
And my right leg was now back to equal length with my left – woohoo!
The blood loss took its toll on my original plan to go home the next day. When I was sat up to transfer to a chair for PT, I turned white as a sheet, my blood pressure dropped, and I almost fainted. I was very anemic, and it showed. So I ended up getting four units of platelet-rich plasma over the next two days, and it did the trick, getting my hemoglobin numbers moving in the right direction.
My inpatient PT and OT went well once I had the blood, and I was walking with crutches – fully weight bearing on the new hip – two days post-op. I easily passed all of the occupational tests, including climbing and descending stairs, getting onto and off the toilet, into and out of a shower, a car, and bed. The therapists credited my pre-surgical shape for being so capable.
What was really remarkable was the overall lack of pain in my hip. Sure, the muscles were sore – moving them out of the way, while less invasive, is essentially pulling them, so I felt like I’d been kicked in the butt extremely hard – but the pain level was so low that I was off of opioid medication less than 30 hours after surgery. The docs and nurses were pleasantly stunned, as was I – but best to avoid those things, I don’t like the side-effects.
The nurses and techs at Shady Grove were really caring and affable. It took me until Wednesday night (the night before my discharge) before I got a good night’s sleep, but that’s to be expected. On discharge day, the ward doctor said I had one new prescription: Coumadin, an aggressive blood thinner. This was due to the pulmonary embolism risks I had, my history from 2014 being the driver in this decision.
Coumadin is a samurai sword of an anticoagulant: it doesn’t mince words in its treatment, for better and for worse. The latter aspect is what really hit me hard. It meant: limited use of sharp knives (I could bleed a lot without clotting); blade shaving was out of the question (so I’ve grown a scruffy beard, drawing comparisons to Roger Waters‘ current state of upkeep); basically cutting iron-rich, green, leafy vegetables from my diet (they are rich in vitamin K – i.e. the clotting vitamin); and cutting my daily alcohol intake to a single drink. Given I live in a mostly vegetarian household, gutting green veg from my diet has been really limiting on what I can eat. And given I’m recovering from blood loss, I crave iron-rich things – and the vitamin K veg have the most easily metabolized iron of all foods!
But it was worse than that. I happen to suffer from a rare side-effect to Coumadin and warfarin: I get hypersensitive teeth, to the point where anything not pH neutral and/or room temperature causes my entire jaw to engulf itself in waves of pain. I cut my daily dose from 5mg to 4mg to make things less intense, but it only did so much.
I wanted to be on Xarelto, which was my anticoagulant after the PEs in 2014. It worked great, with no major side-effects, no dietary restrictions, etc. But my doctors insisted on Coumadin as it wouldn’t interfere with platelet production – a reasonable concern.
So I went home and since then, it’s been awesome (save for the Coumadin side-effects). I’m ambulatory, walking a lot, doing household things. I’m doing in-home PT with a great therapist from MedStar’s Visiting Nurse Association, and I’ve quickly graduated from crutches to a cane, and now only use the cane for longer-distance walking – I can walk unassisted and without a limp!
The nurses from MedStar VNA have taken blood samples, confirming my hemoglobin and hematocrit numbers are recovering nicely – so well that my primary care doctor switched me from Coumadin to Xarelto today! I’m already feeling my mouth returning to normal, which is a big relief!
I see Dr. Hanna on Wednesday to have my surgical staples removed, get some X-rays, and discuss PT and post-op consultations moving forward. I’ll still be in hip precaution territory for a while (to prevent dislocating my new titanium, ceramic, and polymer joint), but it should be a fairly smooth, linear trajectory back to normal life by mid-summer.
Thank you to Drs. Hanna, Olsen, Baxi, and Hofmann in helping drive this crazy ship called me through surgery and recovery. Thanks to all the nurses, physical therapists, and occupational therapists who helped me take the first steps on my new hip. Thanks to my friends for being there to cheer me up and keep me company. Thanks to my mom and dad for reaching out to care from afar. And special thanks and love to sprite for being there for me, helping me through rough patches, and keeping me grounded when I needed it.
In summary: the new hip is great, I can walk, I see a bright, pain-free future ahead. Yes, there’s work to be done, but I’m good for it – allons y!