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Tag: hip

Three faces of recovery

a #hip2point0 update: two weeks on the new hip, and…

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!

Nats Park panorama, 28 April 2017

six days left to go…

In six days, the new hip arrives – I can’t wait!

I have the clearance from my primary care doctor – my body is ready for new hip hardware. I have the surgical orders from my orthopedic surgeon – he’s ready to remove the last vestiges of #projectfemur hardware and put in shiny, new things. I had a nice call today with the admit nurse at the hospital – the hospital is ready to take me on as a patient.

But I’m not sitting idly by waiting for surgery day – I’m keeping busy!

My first Nationals Game of the season happened last Friday. The weather was perfect, and the Mets defeated the Nats (making sprite and me happy).

sprite and I went to the beach where I dipped my toes in the surf and received a wonderful natural exfoliation thanks to a wee bit of wind. We stopped at farm stands, ate fresh flounder sandwiches, tried out a new-to-us donut shop, and enjoyed Reese’s peanut butter Blizzards from DQ.

I’ve been cleaning The Burrow to make it more accessible in my post-surgical state. I’ve assembled a fairly large clothing donation for charity in the process (“I’m not half the man I used to be,” as McCartney once mused).

I just had my final pre-op dry needle and PT session – hip feels really great after that!

I’ll go on a few more bike rides with friends, to another baseball game (weather permitting), a meeting of the Pennsylvania Alpine Racing Association, and a few coffee and meal outings.

And Sunday I will eat like it’s going out of style – gotta for 12 hours prior to surgery, so I’m going to enjoy some of my favorite flavors in anticipation.

Like I said: I can’t wait for my new hip!

Calendar page

only four weeks from today (doo-wah!)…

Four weeks from today, around this time, I should be taking my first step.

On my new hip, that is.

Yup: mark May 8th on your calendar, as that’s the day I get #projectfemur a major upgrade. It’ll come in the form of surgical steel, titanium, industrial-grade ceramics, polymers, and cement.

It’s a monumental day, to be sure. On May 8th, 1429, Joan of Arc lifted the Siege of Orléans, turning the tide of the Hundred Years War. On the same date in 1861, Richmond, Virginia, was named the capital of the Confederate States of America. In 1886, the first Coca-Cola was sold by a pharmacist named John Pemberton as a medicinal tonic.

On May 8th, 1912, Paramount Pictures was founded.  On May 8th, 1945, V-E Day was declared, ending military actions in the European Theatre of World War II. In 1978, May 8th saw the first successful summiting of Mt. Everest without the use of supplemental oxygen.

Many famous people were born on May 8th: Oscar Hammerstein I, Harry S. Truman, Robert Johnson (king of the blues), Saul Bass, David Attenborough, Don Rickles, Toni Tenille, Melissa Gilbert, and Evgeny Lebedev – to name more than a few.

On the flip side, many famous people died on May 8th: two Popes, Gustave Flaubert, Harry Selfridge, Avery Brundage, Rudolf Serkin, and Dana Plato, again to name more than a few.

It’s the earliest day on which Mother’s Day can fall in the U.S. It’s Furry Dance Day in Helston, England.

And it’s the day of the arrival of my new hip.

So until then, I count down the days.

#projectfemur: my hip is now missing a couple of bits… for the better

My hip/femur is now a few grams lighter. There’s less pain and more mobility. #projectfemur – for now – feels quite a bit better.

Sixteen days ago, Dr. Faucett removed some of the hardware from my January 2014 reconstructive surgery. As I wrote about in my previous post, the screws that bound my femoral head to the rod that aligned my broken femur had made their way into my hip capsule, playing bundles of nerves like a guitar pick on a string.

It was painful, to say the least. Standing up, sitting down, lifting my leg, walking, running, skiing – it all hurt. In the weeks leading into this most recent surgery, even riding my bike was painful. The nerves were so aggravated on a ride one week prior to my surgery that my entire right leg went numb, and I had to ride 25 miles back to DC more-or-less on one leg’s worth of power.

No more screws

Look ma: no more screws!

The surgery was a laparoscopic procedure, minimally invasive. One screw came out without a hitch, while the other brought a bit of dead bone with it on the way out so I wasn’t able to keep it. There was a ton of post-operative swelling: laparoscopy requires a lot of fluid to be flushed through the working area to provide a view for the camera, so the incisions drained for the better part of 30 hours. It was painful at first, and awkward.

But the pain soon subsided (I was off of the opioids within a couple of days, save for a few nights’ worth to aid sleep comfort during the heat wave), the swelling went down, and mobility returned to my leg rather quickly. I’m on a prescription NSAID (Celebrex, FWIW) that’s keeping any latent pain in check, but there isn’t a lot of pain to be found. I was cleared to bear full weight on the leg from the get-go, and graduated from two crutches to one within a week.

So things are better, much better.

However, the nerve pain being greatly reduced shows me how much biomechanical compensation I’ve introduced into my walking over the past year. My right hip flexor, gluteus, adductors, and hamstrings are very weak, and my right abductor is smaller than its left counterpart. In fact, my upper leg is one inch smaller in diameter than the left, and both legs are very lean right now. Below the knee, things are just about equal.

Two legs, two sizes

My legs as of August 31, 2016: one is smaller than the other…

So I know what work I need to do in the next two months: get the right leg back into shape and try to get back some of the flexibility it had before necrosis set in. I know not to expect 100 percent pre-injury mobility, and that even 100 percent pre-injury strength is tough given the femur is still eroding. But getting things into shape, and closer to equilibrium, is key, whether I’m heading into a full ski season this winter or a total hip replacement just after Halloween (the timeline depends on how pain levels even out over the next 4-6 weeks, but I’m optimistic).

Dr. Faucett says it’s now entirely my own timeline to write, and I have a prescription for physical therapy to help along the problem areas. The muscles are already saying “thank you” to me in anticipation.

I’ll be researching orthopedists to do my total hip replacement. I have two primary parameters: the orthopedist must be well versed in revisions of previous hip replacements (i.e. compensating for already-compromised and rebuilt joints), and must be good at rebuilding the hips of impact sport athletes. I will leave no stone unturned in finding the right surgeon and the right replacement hardware for my needs.

Until then, I’m back on the bike, starting tonight at the penultimate “Downtown Breakaway” for the year. It’s a ride I organize every year, and I’ve missed the last two weeks due to the surgery. While I won’t be at 100 percent, it’ll be good to be back out there on two wheels with my friends.

Stay tuned…

#projectfemur turns 2.0: osteonecrosis

I know, I know: it’s been a long while since my last update on… well, anything. For this, I apologize.

Heck, two years ago this week, I went on one of my first club bike rides after my surgery.

First club ride after surgery, August 9, 2014.

It was awesome – as was the 2015 riding season!

During the 2015-16 winter season, I had a really successful alpine ski coaching experience, helping my athletes qualify for elite regional championship competitions.

Coach Rudi at Sunday River, March 2016

That rocked!

But there was a specter lurking in the background. It is a single word:

osteonecrosis

Also known as avascular necrosis, it’s a condition where blood supply gets cut off within a bone, causing the bone to die. It is caused by any number of things, and I’m not sure how I happened to develop it, but it’s there, clear as day, in my femoral head.

Avascular necrosis has taken over my femoral head - not good.

Avascular necrosis has taken over my femoral head – not good.

How did my discovery of this come about?

Let’s do a quick recap:

After my one year surgery anniversary, things were good:

My femoral head, one year after its repair.

My femoral head, one year after its repair.

See that nice, round femoral head? See the clean mending of where I was once broken in two? All good!

I skied in 2014-15. I rode my bike a lot once I was free to ride outdoors. I hiked. I ran.

But then things went off the rails.

Back around Thanksgiving of 2015, I started to feel a bit of pain and catching in my right hip. It was here-and-gone stuff, and while my hip had always been a bit stiff in the morning, until then it had been able to get into the swing of things rather quickly on most days.

But by late November, the pain was more intense, sharper, and sustained. Sure, it would go away after a little while, but sometimes it would just stay there all day. Ibuprofen would calm the pain most of the time, but not all of the time. And I’d get a real nerve pinch down my adductor (I believed this to be a lingering side-effect of tearing said adductor a few years before my femur break).

As the ski season commenced, the pain continued to intensify. When I flew out to Utah for a USSA certification clinic, some of the on-snow exercises were tough to pull off. I noticed a decreasing ability to lift my right leg laterally. Every afternoon after the skiing was over, I’d spend time in the hot tub at my hotel, then stretch to try and loosen my hip, often to only semi-successful levels.

During a bike ride over the Christmas holidays in Connecticut, my right adductor would lock up in a painful way, and my hip would mis-track, causing my entire pedal stroke to degrade into spasmodic chaos – no fun. And a ski camp that occurred immediately thereafter was equally pain-laden, though skiing wasn’t too difficult to pull off without pain.

However, as the ski season continued (I was coaching four days per week all season long, sometimes more during intense racing times, from January through mid-March), the pain grew, the pain medications were less effective, and certain activities required in my work (e.g. having to drive long-ish distances to racing venues, skiing with large, heavy bundles of slalom gates, etc.) became downright excruciating. I’d demonstrate skills to my racers, trying to mask the pain in my expression. I even fell on the screws that attached my femoral head during the initial healing time, which was not pleasant at all, smarting for weeks.

Every day was masked in hip pain that would, at times, radiate down my leg. My walking gait became so labored and awkward that everybody could tell something was wrong. At least on a bike, I could be more-or-less normal, my December pain eventually subsiding as I began to ride more in the spring. But my range of motion in my right leg was compromised, catching in painful ways and making me feel like an old, helpless man.

Eventually, I had to clear things up with my orthopedist. X-rays happened, finding that one of the screws in the femoral head had been knocked through the head, the tip impinging my hip socket and possibly dragging over nerve bundles that travel down my leg. My doctor thought this could be part of the cause of the pain, and said that the screws should come out – a simple outpatient procedure.

My femoral head as of June 2016.

My femoral head as of June 2016.

Worrying both my doctor and me, though, was a random bone fragment that showed itself on another X-ray. As X-rays don’t show things in three dimensions, he ordered a CT scan for my right hip. I had it performed at GW Hospital, in their latest CT scanner (a very quiet machine).

When my doctor called me two days later from an out-of-town conference, I knew things were not good.

He kept it simple: I had osteonecrosis, and am facing total hip replacement.

Fuck. Damn. Shit. Why? How? Fuuuuuuuuck!

I received this news a few days before departing for a week long family vacation at Cape Cod, which left me plenty of time to digest this news and start researching my options. There is a lot to learn about hip replacement, that’s for sure!

The long and short: I’ll get back my leg length and range of motion with any hip replacement method, which is a big plus. The minus is that anything other than basic cruising on alpine skis is highly discouraged, as it can displace, dislocate, or fully break the replacement hip. I hope to speak with some elite ski coaches who have had THR to get their perspectives on living with a replacement hip as a high-level skier.

I’ve since seen a second orthopedist to get a second opinion – major medical things like this should get a second opinion – and he confirmed the same diagnosis as my original doctor. He did, however, recommend having the hardware from #projectfemur removed first (the same thing my original orthopedist recommended), allowing the femur to adjust to a non-titanium-enhanced state and to prevent possible infection of the marrow channel if I get a total hip replacement during the same surgery.

And that’s what I’m going to do this coming Monday, August 15th, with my original doctor, Dr. Faucett, doing the honors. It’s a short, outpatient procedure, and recovery should be fairly quick. Hopefully, getting the screws out of my hip socket will alleviate much of the leg pain I have these days – and it is a lot of pain, lemme tell ‘ya!

But I look forward to this next chapter of #projectfemur – and yes, it’ll need a new hashtag. I’ll figure that out sometime soon.

Once the incisions heal and swelling subsides from this upcoming surgery, I’ll assess my pain levels. And I’m going to keep riding my bike – something that’s encouraged by both doctors to maintain strength and cardiovascular health (trust me, I don’t want another pulmonary embolism or similar issue). I’ll be on crutches for a few days, then a cane, then just plain walking again.

And then the bike – definitely the bike.

It’ll be a minimum of two months before I dive into the more major procedure of total hip replacement. Hopefully I’ll get enough pain relief to delay this until spring of 2017 – and thus will be able to ski and perform my coaching duties more-or-less as usual. If not, surgery will likely happen later in the fall, and I’ll be coaching from a lawn chair. I’m up to the challenge, either way.

But right now my focus is on Monday’s surgery. And I apologize in advance to the ski team’s board of directors: I may be a bit groggy during the evening conference call that evening. Heheheheh…

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