[THR] Zorro’s RTHR hospital experience. A LONG REPORT

Zorro’s RTHR hospital experience. A LONG REPORT<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p>
<o:p> </o:p>
I want to share my experience with my RTHR with my BoneSmart friends.<o:p></o:p>
<o:p> </o:p>
This site is a wonderful resource and has helped me get through a very difficult experience with poise and a greater sense of optimism. I hope that this write up of my hospital experience will offer hope to others who undergo this experience.<o:p></o:p>
<o:p> </o:p>
PRE SURGERY<o:p></o:p>
I am 56 year old, physically fit female. My RTHR was scheduled for Monday 3/26/12, 14 days ago. My hospital requested that I wipe myself down with antibiotic wipes (which they supplied to me) the night before the surgery, and the day of the surgery before going to the hospital. I did not sleep for three days prior to the surgery due to nervousness.<o:p></o:p>
<o:p> </o:p>
Friends drove me to the hospital for my 6 am check in. (Neither they nor I slept the night before.) Things proceeded well. All personnel were cordial and professional. I was pleased that I was asked several times what joint was being replaced. (We all have read the horrible stories about someone, usually a diabetic patient, who must have an amputation, and unfortunately the wrong limb is amputated!) <o:p></o:p>
<o:p> </o:p>
SURGERY<o:p></o:p>
Finally I was on the gurney and the anesthesiologist “Dr. B.” chit chatted with me a little. I confessed to him that I underestimated my weight by ten pounds and to please give me all of the anesthesia that I needed. He did something to my back and the next thing I know it is several hours later and I am waking up from the surgery with a dark haired nurse watching over me. My point here is to reinforce something that was said earlier on the BS boards: “You will go to sleep. You will wake up. It will be all over.” This really is true.<o:p></o:p>
<o:p> </o:p>
RECOVERY<o:p></o:p>
I was transferred from the recovery area to my room. As I was being transported I felt nauseous and requested a kidney shaped barf bowl. I was immediately given one along with some tissues. I did not have anything to barf up as I had not eaten in 18 hours. It was more like baby spit up. I did my little barf, wiped my mouth and was transferred to my room.<o:p></o:p>
<o:p> </o:p>
IN MY HOSPITAL ROOM – THE FIRST DAY<o:p></o:p>
I am pleased to report that pain management was NEVER an issue with me. I noticed that while I was under anesthesia they had attached a Foley catheter to me, thus eliminating my need to get up and peepee. My surgery was around 7:30 am and I was in my room by 11 am. The nurse immediately found a vein in my hand for the IV. I felt okay although I was slightly groggy and grouchy. When people spoke to me I was so tired I could not keep my eyes open, although I could speak in complete sentences. I attribute this to missing three nights of sleep prior to my surgery. I tried to watch TV with little interest. I had no interest in food and made no pretense at eating my lunch. I knew that I would have to try to eat better, as I would need nutrition and nourishment to heal. I dozed off and on during the afternoon.<o:p></o:p>
<o:p> </o:p>
I suspect that the hospital mattress was filled with gel pellets, and it forced my heinie to carve a little “well hole”, making it harder to get in and out of the bed. I made myself nibble at my dinner. The food service delivery persons were very personally concerned that I enjoy my meal, God bless them. I also had the option of selecting my dinner from a menu which was very nice. My IV pole kept emitting alarm noises because it needed a new battery. This was very annoying, but I consciously decided not to be irritated.<o:p></o:p>
<o:p> </o:p>
My body felt sore all over, like I had been beaten up. Even though the surgery was for my right hip, my left side was also sore. Go figure. A few hours later I felt well enough to watch “Dancing With the Stars” and to send an e mail to friends letting them know that I was okay. I also had the wherewithal to order the premium channels from the television provider, and thus was able to watch the repeat of the season five premiere of Mad Men, a very nice diversion for me.<o:p></o:p>
<o:p> </o:p>
I was massively dehydrated for the first two days. My mouth and vocal cords were almost sandpapery. Thus I advise others to start over-hydrating themselves three to four days prior to the surgery. It was not until two days post surgery that the nurses thought to offer me some popsicles and fruit ices for dehydration relief.<o:p></o:p>
<o:p> </o:p>
I slept well enough, probably because of the pain meds, but keep in mind that after the hip surgery you can only sleep on your back -- the least preferred position for most people. Basically I tried to soothe and calm myself as best as I could and I was able to sleep for stretches of several hours at a time. My sleep was routinely interrupted by the techs who would take vital signs every six hours. They would make me recite my name and birthday every time they took my vitals. My BP was always low, and I had a low grade fever most of the time in the hospital<o:p></o:p>
<o:p> </o:p>
The first evening post surgery was when I started itching. On a scale of one to ten the itching ranged between six-to-eight, two steps below poison ivy (which I have had the misfortune of having). The itching was so bad that I specifically kept my dinner fork so that I could scratch myself more efficiently. I tried to do more of a rubbing of myself versus using the edge of my fingernails to actually scratch myself. My nurse observed my scratching and suggested that he could administer injections at four places on my body to stop the itching. I declined this delightful offer. It was my later understanding that the itching was caused by either: a.) the antibiotic wipes that the hospital requested I use the night before and day of the surgery and/or b.) the anesthetic.<o:p></o:p>
<o:p> </o:p>
The itching issue concerns me because I endured a moderate amount of distress that might have been easily addressed by a sponge bath wipe down and/or some soothing lotion. My hospital and healthcare pros are good, but they dropped the ball on this aspect of my care. (FYI, my hospital is a “Major International/American Healthcare Institution” and indeed, likes to consider themselves to be “The” Major International/American Healthcare Institution.) The itching finally abated in Day Two.<o:p></o:p>
<o:p> </o:p>
Another area where the healthcare pros dropped the ball is with my meds. I was given an antihypertensive med that I do not normally take. This med lowered my BP to the point of syncope (fainting). I worked for a good part of of my career as a pharmaceutical sales rep, and I know the drugs that I should be taking. When I asked the nurse about the new antihypertensive med she implied that this drug was part of my normal regimen, when it is not. I offered the phone number of my primary care physician to confirm this, but she dismissed me. Somewhere there was a miscommunication and the unneeded hypertension med became a part of my orders. The result was that on day two when my PT tried to start therapy I passed out from low BP.<o:p></o:p>
<o:p> </o:p>
It did not occur to me request it (this was my first time ever being in a hospital) but for my first two days I was not sponge bathed, nor did they assist me with oral hygiene, nor was my linen changed. This is not a good reflection on my hospital or on the staff who cared for me during this time. I write this in hindsight, and as I have said, this was my first hospital stay; it did not occur to me to request assistance with these issues. I hope that others who read this will/can be more assertive in requesting the help and accommodations they should have to be comfortable.<o:p></o:p>
<o:p> </o:p>
During my stay everyone who entered my room introduced himself or herself -- a very professional thing to do. Everyone also announced aloud “Knock, knock” as they stood at the door, as my bed was behind a curtain. I estimate that I was introduced to about 40 people during my four days in the hospital (nurses, assistant nurses, food service staff, housecleaning staff, respiratory pros, techs, physicians, social workers, PTs, OTs, and others for every eight hour shift). I was lucky that I was the only patient in my room and thus had extra privacy. I was introduced to a “Patient Advocate” who was pleasant and accommodating, although I did not know/understand how to best use her services. As far as I could observe all visitors who had direct contact with me washed their hands prior to engaging with me.<o:p></o:p>
<o:p> </o:p>
DAY TWO<o:p></o:p>
Early in the morning my surgeon stopped by. The room was dark and I was half asleep but I managed to identify him, say hello and state that my goal was to be his fastest healing patient. <o:p></o:p>
<o:p> </o:p>
My PT was young and wanted to be aggressive with me. (She was aware that I work part time as a group exercise instructor, and I wanted to heal and recover as fast as I possibly could). Ordinarily I would have happily participated with her agenda, but my hypotension would not permit me to be as aggressive as normal. I could tell that she was disappointed. I was walking in a “Wedding March” fashion with my walker, whereas she wanted me to simply place right foot in front of left and continue on thusly.<o:p></o:p>
<o:p> </o:p>
I had my books and my laptop, but I was not really interested in reading anything. <o:p></o:p>
I managed to brush my teeth, a very good feeling. I have acne and I had to specifically request a washcloth to wash my face versus using the pre-moistened personal cleaning towelettes (loaded with who knows what kind of industrial strength disinfectant) that are used to wash patients. The face washcloth was of a texture similar to burlap (!), but at least I was able to wash some of the oil/sebum off my face.<o:p></o:p>
<o:p> </o:p>
I emphasize again that I was not in pain and the nurses kept me supplied with ice bags.<o:p></o:p>
<o:p> </o:p>
DAY THREE<o:p></o:p>
My syncope (fainting due to low BP) was finally under control and I was fully able to work with my PT. We worked with the walker some more. I get the feeling that she wanted to do more with me but that due to my low BP she changed her plans to be more conservative. I was able to eat more of my meals. For some reason while in the hospital I decided I no longer like to eat meat, but I ate all of my veggies and sides.<o:p></o:p>
<o:p> </o:p>
In the morning a foreign physician examined my incision and pronounced it good. I thought he said that my incision was three inches long; this did not sound correct but I was hopeful that I was some kind of an exception. Well this was wrong; I either misheard him or he misspoke. My incision is six inches. But he was right in that it was good and healing nicely.<o:p></o:p>
<o:p> </o:p>
At some point during the day my nurse removed the Foley. A few hours later I rang for his assistance to go to the bathroom to urinate. We managed to do it slowly and carefully. This felt like a real victory! (It was hard to soap up and rinse my hands with the IV connectors still taped to my left hand.)<o:p></o:p>
<o:p> </o:p>
A few hours later I rang again for assistance to go to the bathroom to urinate. After ten minutes with no response I managed to slowly and carefully get myself out of the bed, grab my walker and toddle slowly to the bathroom (the commode had a high seat adjustment). Twenty minutes later when my nurse showed up and scolded me I was absolutely unapologetic about my initiative. I continued to go to the bathroom unassisted for my remaining stay in the hospital.<o:p></o:p>
<o:p> </o:p>
During the afternoon I had more PT, and OT with a delightful healthcare professional. We practiced getting in and out of cars, washing hair and other ADL. Later the plans for my discharge for the next day were communicated to me.<o:p></o:p>
<o:p> </o:p>
The need for me to purchase and take Lovenox, an anticoagulant was reinforced to me for the second time. This news was very unpleasant on two counts: 1.) It is extremely expensive, between $500 and $600. (for most people this expense is probably picked up by insurance, but for me, not). 2.) It involves self-injecting a one inch needle into a fold of skin in the lower abdomen every day for 20 days post surgery. I was not a happy camper. Ugh!<o:p></o:p>
<o:p> </o:p>
Still, I realized that it was in my best interest to maintain an “attitude of gratitude,” and so I made a conscious decision not to dwell on the Lovenox unpleasantness.<o:p></o:p>
<o:p> </o:p>
When asked if I wanted pain med, I would think about it and decline! I started taking regular Tylenol to control any discomfort. I suspect that my lack of pain was due to my surgeon’s skill in wielding his scalpel.<o:p></o:p>
<o:p> </o:p>
DAY FOUR<o:p></o:p>
I woke up excited about being discharged later in the day. I was a good girl and ate my breakfast. PT did some work with me, reinforcing how to walk up stairs with crutches (“Good leg, surgi leg, crutch…”) and the OT reinforced our ADL work from the day before. <o:p></o:p>
<o:p> </o:p>
Before the shift change my female nurse inquired about my bowel movement. I shared that I felt like I was on the verge of one and I suggested that if I drank some coffee I could do it. God bless her, she made sure a cup of coffee was delivered to my room. Within the next hour I had my first post-surgical bowel movement – another victory! I saw this as another sign of success and healing, and I was grateful for my nurse’s attention to this aspect of my well being. I find that many healthcare pros are skittish about talking about this aspect of health. Unfortunately the shift changed and she was off duty before I could share this victory and thank her.<o:p></o:p>
<o:p> </o:p>
I ate my lunch and was surprised by a visit from my pastor. My spirits skyrocketed! His visit was brief but heartfelt. After he left I began to gather my belongings. I then had enough energy to use my walker to walk around the floor, smiling and waving at all of the Healthcare professionals who had assisted me. It felt great! After lunch there was some confusion about whether I would meet my friend at the hospital entrance or whether she should come to my room. Finally I was discharged!<o:p></o:p>
<o:p> </o:p>
I had called a home healthcare supply store and ordered my personal walker and some other equipment. My friends and I stopped to pick this up and then we were on to my home.<o:p></o:p>
<o:p> </o:p>
RETURN TO HOME<o:p></o:p>
I had arranged and prepared my home well, and once my friend left me I functioned pretty well alone. I had plenty of DVDs and books to divert my attention.<o:p></o:p>
<o:p> </o:p>
My first night alone at home was slightly rough. I still was not dehydrated and experienced severe dry mouth at night. I also was forming mucus in my nose and had trouble breathing through my nose, yet my attempts to remove the mucous led to nose bleeds.<o:p></o:p>
<o:p> </o:p>
My surgeon insists that I wear compression hose to minimize the event of blood clots. This is mildly unpleasant, but I manage to comply. Injecting myself with the Lovenox was another hurdle to overcome. I appreciate my surgeon’s conservatism, as it is to my benefit. As I wrote earlier, paying for and injecting myself with Lovenox was unwelcome and unexpected, but I got over it and I am managing to capably inject myself each morning and get on cheerfully with the rest of my day. Friends, biting unpleasant but necessary bullets is just a part of life.<o:p></o:p>
<o:p> </o:p>
My biggest problem upon returning home was getting comfortable in my bed. It was hard to get the surgi leg onto the bed and then to move it to the center. Slowly I managed to get all of myself in bed. The first night I did not sleep restfully, but each night since has been better and better.<o:p></o:p>
<o:p> </o:p>
ON GOING IT ALONE<o:p></o:p>
The situation I am in is that I do not have direct relatives to care for me. I knew this ahead of time, and was able to prepare myself accordingly. The good news is that I had a small core of friends whom I could depend upon for help, kindnesses, small favors and services. I tried to rotate my use of them so as to not deplete any one person’s goodwill. This is all you really need. I am very proud of myself for being a big girl, and having a good attitude about this, versus having a “poor me” pity party.<o:p></o:p>
<o:p> </o:p>
It is great to have someone to “be there” for you, and it would be my preference. But I also love the way I have grown tremendously by facing this situation squarely and using the resources at my disposal (prayer, meditation, positive thinking, research, intricate planning, etc.) to ensure the best outcome I could plan.<o:p></o:p>
<o:p> </o:p>
SUMMARY<o:p></o:p>

• Be well educated and well researched in advance. Reviewing BoneSmart and other sites is a good move. Forewarned is forearmed.<o:p></o:p>
• Do not rely exclusively on the hospital to address all of your needs and to “know” what you need because “they are the experts”. The healthcare system is too unwieldy and cumbersome. Get into the habits of a.) Speaking up for yourself pleasantly and without apology, b.) Double checking any assumptions, and of c.) Politely, assertively and firmly asking questions.<o:p></o:p>
• Go into the experience being a warrior for positivity; be vigorous and proactively have positive expectations.<o:p></o:p>

<o:p> </o:p>
Friends, I hope you find this recounting of my hospital stay to be helpful, and that my recollection of my experiences will make your experiences more positive. We are all members of the same club (I am referring to the human race AND the joint replacement club) and it is my privilege to be of assistance. Thank you all for your encouragement to me.<o:p></o:p>
<o:p> </o:p>
Sincerely,<o:p></o:p>
<o:p> </o:p>
“Zorro”<o:p></o:p>
United States<o:p></o:p>
April 9, 2012<o:p></o:p>

Glad to hear that you are doing well Zorro, but a few of those hospital "oversights" sound like they could have been even more unpleasant (and dangerous) than they were. But you survived and are doing great!

Now you should look forward to taking it easy and having a SLOW and UNEVENTFUL rcovery....

Z

Would you mind giving a broad indication of what part of the country you are in? I'm trying to figure out which institution you might be alluding to...you can feel free to ID if you are ok with that...

Well Zoro

That certainly was a long report glad you have a few friends to help out and try and take things easy doing the sensible thing, It always works in the long run.

Billy

Congratulations. I love your "life is that which we make of it" attitude! The story of your preparation, willingness to bite the bullet, and resourcefulness has been a joy to read.

I'm glad the surgery was successful and that you are home and doing well.

keep up the good work!

Dorothy

Dear Zorro,
Congratulations on handling your surgery so well. A hint about the lovenox (sp ??). I had to inject myself for a month after I fractured my pelvis. Make sure that you do not inject into the same spot twice-it burns a lot. After I did this once by mistake I divided my stomach into quadrants and kept track of where I had injected by marking with a pen. Best wishes.

Zorro, what a wonderfully detailed report. This is so helpful to everyone going through this for the first time. I find it fascinating to see how experiences have certain commonalities and yet many differences.

I hear your concern about the Lovenox. I had to do it too, and was really apprehensive. However, it turned out to be simple to self-administer, and I quickly grew cavalier about it. But I was relieved to be done at the end of TEN days. I wonder why you have to do twenty? I suspect your surgeon is simply more conservative about it. Interestingly, when I have my other hip done in July, I won't be using the injections at all. My surgeon informed me that there is now a pill med available that is considered superior to the Lovenox. Imagine that. I am extremely fortunate that my meds are all covered by my insurance...otherwise I would be asking about alternatives.

Anyway, I hope you continue to progress each day and remain problem-free in your recovery. Thanks for sharing this.

Sharon

Regarding itching due to opioids. I have had this reaction before to oxycodone. At home I took diphenhydramine (Benadryl) which is an OTC antihistamine. This was also given to me in the hospital after my THR. When they exceeded the amount of Benadryl they felt comfortable giving me, there was an injection that I was given to relieve the itching. Sorry, I don't remember the name. This helped me to be more comfortable.

Sharon, how pretty you are.
Thank you for your comments. Yes, I specifically posted my (long) recollection of my experineces in order to help others.
Thank you for your caring and patience in reading my post.
This is day 14 post op and I continue to feel better each day!
I am so glad to have this behind me, and the experinece has given me a new lease on life.

Thank you all for your responses to my post.
Special thanks to HomeschoolingMom.

This site provides a terriffic sense of community and I was particularly anxious to share my experiences with you all.
Sincerely,
Zorro

Well your experience seems much worse than mine, I was in and out of hospital in a day. Mind you I have a wife who helped with all over washing, putting on those rotten socks etc., N.B. I left off those socks after 7 days, they seemed to make my legs swell even more as they cut into me, but I know I would have had problems on my own.

I have to inject daily too and was given 35 doses, (have 15 left), that and having to sleep on my back are currently the only real problems I have .

You seem to be on track to a good recovery now take it easy.
John.

John WD
Yes, like you I have ten doses of Lovenox left, and sleeping on my back continues to be a struggle although I managed to get a full six hours of uninterrupted sleep last night. Glad to know that you are doing okay and that your wife is taking good care of you.

SIncerely
Zorro

Another observation about my experience:
If I had to do it again I would bring a stash of hard pressed, long lasting mints or fruit flavored candies to suck on during the day and help address dry mouth and dehydration.

Zorro,
Thanks so much for your detailed experience. I am 59 in otherwise good health, but am looking at LTHR. I also live alone and will be counting on friends to help out after the surgery. Please continue to post how you are doing. I am nervous that they will make me go to rehab post op since I live alone. That is something that I do not want to do.

Looking forward to your posts. Thanks.

Glad to hear you are home and doing so well. You have a great attitude

Thanks for the info , have only had good experiences of hospitals I have private healthcare in the UK and my maximum on NHS drugs is about £110 no matter how much I have. I have used the Clexine injections after Op and will probably be on them this time until the warfarin levels out.

Not sure if I'm getting a catheter, easier with one but the idea is you get up and move about having one would just give you an excuse not to

The only thing that I was concerned about last time was was being released after a prostate Op without having a bowel motion on day three and it took two further days for it to happen with the help of Senokot when I got home
It was annoying being woken every six or so hours to have blood pressure taken but I just lived with it and whilst the nurses knocked I did end up mooning at the woman who just walked in without knocking to collect the dinner tray.

To MollyM and others: 13 days post op and I am doing well and feeling fine. I am being as conservative as I can with my movements.
A little info about me: I am a marketing consultant and have been a group exercise instructor for 20 years. I suspect that my need for RTHR is due to being an overagressive instructor and exerciser. I have never been married and have always lived alone.

What I want to communicate is that I have been able to do everything I need to do using my walker: going to the bathroom, going to the basement to do my laundry, walking around my one story home, preparing food.

I get socialization from friends popping by, phone calls and from the Internet.

I hope that my story provides inspiration for others who must go it alone. If you and your healthcare providers deem it best you might be able to go right home. Going directly home, even alone, has worked okay for me and I have been home for the last ten days. Be optimistic, but realistic. Good luck.

Dingbat7 I had my right hip replaced nearly 5 weeks ago. This was done privately in the UK. I have been on rivaroxaban tablets to prevent DVD since beeing discharged. No teds or injections but the tablets were very expensive and my insurer would not pay or them or any other meds I was issued by the hospital.

Sounds like you have an annual per paid prescription card so you may want to try and get your take home meds issued by your GP.

As for the catheter, I would recommend it but have it inserted/installed while you are sedated if possible. I had to have one arranged in a hurry the evening after my op and it was not a fun experience - but it was a blessed relief:biggrin: it was removed the next morning.

Cive