THR Anterior THR Aug 19, 2014 Home same day.

[HerbM]

Thank you for the THR emblem @bottomshollow

 

[bottomshollow]

 

[HerbM]

Perhaps I am the only one in the world who actually ACTIVELY ENJOYS a Total Hip Replacement.

All and all, I am having a lot of fun and very little to offset that.

 

[Chessie]

Perhaps I am the only one in the world who actually ACTIVELY ENJOYS a Total Hip Replacement.

No, you definitely are NOT. I think, with very few exceptions, We ALL are enjoying our new hips!! Congrats on you so-far-speedy recovery! It's so amazing when it goes exactly right, isn't it? Enjoy that new hip!

 

[HerbM]

I meant actively enjoying the process of replacing the hip, not just the new hip itself.

Nothing involved has even approached the pain that hit me while driving to the hospital despite my being on less painkillers now.

In fact nothing has even approached the pain I was feeling each time I sat in my easy chair pre-surgery.

I hope (some of) you guys are enjoying the WHOLE thing as much as me, but for me this is almost pure joy.


So far (at 60 hours post-surgery) either the Exparel is holding or there is no pain in my joint or wound. It is only touted as working for "up to 72" hours with the main peak at 36-48 hours, and then falling off steadily.

Energy is still high -- higher than pre-surgery. Temperature and BP nominal.

 

[bottomshollow]

@HerbM, I think it's just super that you are enjoying all the aspects of having your hip replaced. To be pain free and mobile is a wonderful thing.

Temperature and BP nominal.

I hope you meant "normal" .

Have a great day, Herb, and keep us posted (as if I had to worry about that). We care.

 

[Poppet]

It is a great feeling Herb when the bone on bone pain is replaced with our bionic hips.. Good for you!

 

[Chessie]

I meant actively enjoying the process of replacing the hip, not just the new hip itself.

I hope (some of) you guys are enjoying the WHOLE thing as much as me, but for me this is almost pure joy.

Absolutely. I was on cloud nine the moment I woke up from surgery! Who wouldn't want to be free of that pre-surgery pain? These days, recoveries from this surgery are much less an "ordeal" than of days past - thank goodness!

 

[HerbM]

FYI: Changed my avatar because my former avatar, the "hip x-ray", is no longer a part of me or my life. The little guy is my grandson, Andrew.

Had a small temperature excursion late last night (Day3) and early this morning; I had been cold and was covering with a lot of blankets and clothes so it may only have been this. (99.5 was the max). Had it kept rising I was going to call my support, but it also would go down a bit when I uncovered (maybe 99).

No redness, tenderness, swelling nor warm wound area so it merited observation but no real action.

My temp is back to normal this morning (98.4).

At just past 70 hours post-op, it is starting to be likely that the Exparel is not contributing very much yet my hip is totally comfortable.

The quads are still a bit stiff and sore like from over-exercise, but even that seems to be dissipating a little.

Still waiting for the 'inevitable' energy drop -- no sign of that so far.

Considering another walk but the lazy in me is probably going to delay until it gets pretty hot here.

Instead, I think I will go to the gym and see if a bike or elliptical machine is possible; the goal is to work out the stiffness. Walking puts a strain on my worn out knees so probably better to find an alternative that doesn't irritate the knees. They only have to last a few more months.

 

[HerbM]

@HerbM,
...
I hope you meant "normal" .
...

No, I definitely meant 'nominal': "performing or achieved within expected, acceptable limits; normal and satisfactory".

It is close to the same meaning as 'normal', but with slightly different nuances, especially the 'satisfactory' part.

 

[Chessie]

Take your time. I do think letting that incision heal properly is the most important thing this first week or so - and I am definitely one that pushes it! Not sure that so much exercise is needed at this point - make sure your doctor is okay with what you are doing.

 

[HerbM]

My doctor discussed it with me and he is just fine.

The PT was just here for our first session and the main thing he did was to mobilized the wound area with (gentle) massage. That's the biggest challenge to the incision that has occurred.

Walking is the best exercise for my hip at this point and the hip doesn't mind AT ALL. The knees continue to be the only significant limitation.

I assure you that no matter what it sounds like, I am NOT pushing it -- it only seems like it compared to the normal and typical hip replacement.

Pretty sure the Exparel has worn off -- I seem to have some more feeling inside my hip joint and area.

It's still somewhat uncertain, since there is no pain even if the Exparel is gone; it's more about seeming to feel the area differently.

 

[Chessie]

Walking is the best exercise for my hip at this point and the hip doesn't mind AT ALL.

I think we all would agree with that. :iagree: I was simply stating that you really don't NEED that much, at this point. But of course it is an individual thing; I rode 15 miles on the bike 13 days after surgery and was totally comfortable with it, but I know that isn't normal for most people.

Carry on and enjoy!

 

[HerbM]

The Exparel has definitely worn off (sometime right around the advertised 72 hour mark, but by 80 hours is was absolutely certain.)

No pain but I can definitely feel the surgical wound pulling and puckering a little, especially around the incision and more especially after sitting and then needing to straighten up to stand and walk.

The Exparel bought me the full 72 hours post-op when surgical pain is supposed to be at its worst. None of that was an issue for me; missed it completely.

STRONG RECOMMENDATION: If you are having joint replacement of any kind, or surgery of any other type, ASK YOUR SURGEON if Exparel is appropriate and available for you!!!!!!!

This stuff is near magical (as far as I can tell with my limited experience of surgery.)

So far, the hip replacement is FAR less painful (almost 0 literally) and far less trouble than my wisdom tooth removal -- and that wasn't so bad.

And the recovery is LIGHT YEARS beyond the pain and discomfort of my week before surgery or the first week the hip went bad and before the doc put me on analgesics and effective NSAIDs.

Immediate relief.

Today my wife did drive me to the gym. I tried the elliptical but the reach was too long (for my knees) to allow me to warm and stretch the quad. Then we both tried recumbent bikes, but my OTHER knee couldn't tolerate the cycle reach for very long either.

I could have continued but it wasn't fun.

So the really nice "Health & Wellness Directory", Collette, saw me staring around looking for something that would work and with a confused look on my face. When told that my quad needed stretching gently, she took me to the Leg Extension machine and set the stops so that it wasn't possible for the machine to take me too far.

We moved it a little further after careful testing so that since the push bar would itself go to vertical my knees could go 100+ degrees. At first we went with the machine minimum of 10lbs, but quickly upped it to 20lbs.

20lbs was just enough provide resistance so the bar would 'fly' on extension.

With this light weight I did 15 minutes of slow reps and the quad(s) were quite happy, while the knees didn't mind.

This wasn't even boring because, Collete kept me company and chatted with me until my wife collected me (we had agreed on 15 minutes of 'work' and her bike timer finished.)

To be fair to Collette, I did NOT tell her that my surgery was 3 days ago until my legs were comfortably working the machine. (I conveniently forgot to mention it was a joint replacement too, until she asked.)

Just the right amount for today; I could have done more but wanted to keep it well within the safe envelope and ensure that my energy doesn't deplete.

Afterwards we out to dinner at Red Robin for the first time since the surgery. (The other night we went to Chipotle but brought that food home.)
h to
I was by this time of day incredibly hungry but ended up only eating about 1/3 of my usual order. No problems, just felt satisfied and brought the rest home to have for lunch tomorrow.

Needless to say, I am off my zero carb diet, but all in all eating pretty sensibly. I will give myself another day or two and get very serious about more weight loss while still feeding my rebuilding body. My weight is up about 5-7 lbs since the surgery; some might be fluid retention; but my BMI is staying down (we have a special scale that shows BMI.)

No matter what, it is really important to lose 30-40 lbs for the double knee replacement in 2 months -- might have to settle for 25 but shoot for the moon and be satisfied with what you reasonably get. ;)

The leg extension maching was perfect today because my lower quad needs strengthening but is also strong enough to easily straighten my knee against body weight.

Tomorrow, I will look for a straight leg extension machine where it is possible to use a resistance LOWER than my leg weight since right now my upper quad and other leg lifters won't let me raise my right leg in an ordinary leg raise. (I probably COULD get it up, but that might be beyond what is prudent so I am only using about 75% of my strength to try.)

My wife says she thinks they have such a machine.

[EDIT] Almost forgot to mention (it was such a non event), today the PT guy came by for the first hands on session of Home Health. He briefly massaged and mobilized my wound by direct manipulation (after I asked him to explain how this was safe), and had me do about 5 reps of two exercises that I was doing before getting all the way clear of the anesthesia for surgery.

That was LITERALLY the sum total of the 'therapy'. This coupled with his previous absolutely NOTHING visit (we met and shook hands) and their nurse came by only to get signatures and take my BP and temperature (not quite a worthless visit for anyone without the knowledge and means to self-check vitals.)

He promised to call me after my post-op visit to the on Monday to learn how the surgeon wants to proceed. Likely I will cut the Home Health Care folks loose as a waste of time. Not sure whether their rehab facility is worth the effort to visit -- if not, it will make sense to cut the entire company loose.

Possibly the surgeon has in house rehab and clinic, or I will just use the YMCA.

 

[HerbM]

Unassisted, unmonitored shower -- unlimited hot water, that felt really nice.


Ok, it got me finally, I finally felt a pain -- when I sneezed my leg under the tissue at the incision objected with a brief burst of actual pain.

It lasted for only a fraction of a second, like a bolt of lightning, and was gone. Due to the brevity it is impossible to say where it was between 3 and 6, call it 4. It did leave me trying to figure out how to prevent further sneezes. ;)

To be complete, there had been two small and even shorter 'burns' along my incision when rolling over after lying on the side with the wound.

The burns seemed to be my body was complaining about the thigh spreading out and repositioning when the procedure leg reached the top and the weight of the muscle and other tissue sagged a little due to gravity. Only 2 or 3, and very quick. Pulling off the band-aid will likely hurt more.

 

[PuppyLove]

@HerbM you sound like you're doing great! I had a similar experience with home health. After the first nurse then PT visit, I called the OS and told him I'd prefer outpatient PT. I went to a center my hubby used after shoulder surgery. What I found really helpful was that they tailored the routine around my bad knees and gave me exercises to strengthen my muscles in anticipation of TKR. The PT even made up a list if exercises to do in the pool, so I could do more rehab at home. It sounds like you're more physically fit than I was, but it may help to have some experienced folks to guide your rehab.

 

[HerbM]

@PuppyLove @PuppyLove your Golden puppy is gorgeous and actually looks quite a bit like our Golden, Trooper. When I saw your puppy lying in the bluebonnets, I immediately had to look to see if you folks were in Texas (yes). Although we will likely never get to meet you and your husband, if you folks are ever in the Austin area, get in touch.

@HerbM you sound like you're doing great! I had a similar experience with home health. After the first nurse then PT visit, I called the OS and told him I'd prefer outpatient PT. I went to a center my hubby used after shoulder surgery. What I found really helpful was that they tailored the routine around my bad knees and gave me exercises to strengthen my muscles in anticipation of TKR. The PT even made up a list if exercises to do in the pool, so I could do more rehab at home. It sounds like you're more physically fit than I was, but it may help to have some experienced folks to guide your rehab.

Sounds like you and I have similar thoughts on this.

The only reasons for even allowing them to come, were that it is free (insurance co-pay is maxed out), everyone encouraged me (including my Aetna INSURANCE nurse) to get all the help you can, and finally in the spirit of doing all that is practical.

As to fitness, I have some issues:

• Weight (but my my BMI is only about 25 right now and BMI doesn't really come out correct for either big boned and athletes with lots of muscle.) Muscle or fat, my knees still need to haul it around (225 lbs.)
  
  
• System wide osteoarthritis at a moderate level (almost all joints).
  
  
• Tight ligaments and tendons -- even with stretching and yoga (which I am not doing much right now) my flexibility and mobility are always something to deal with. (I am actually surprised that my knees weren't sore from the surgery and that the quads aren't MORE sore.)

Beyond that I am still very strong (even at 62) and have a lifetime of playing most sports and doing many martial arts, as well as the mental attitudes developed by these sport, MA, Army Airborne, and special forces training.

Please don't misunderstand this last, I am not a believer in "no pain, no gain" but rather always try to follow the directions that pain gives us about what we should do and not do with our bodies.

In general, pain is NOT a "Bad Thing" and those without it seldom survive for very long.

Pain is INFORMATION and a message from our bodies that we should change our behavior.

Like any message or information, pain can however be misleading, wrong, or just outdated (e.g., the problem is already noted and being corrected.)

Pain beyond the point where the information is accurate, useful and necessary IS a "Bad Thing" however.

Another item that has not so far been mentioned by me is my extensive training an experience with hypnosis and pain control.

Note: A key with hypnosis is to never turn off a pain unless you have dealt with the source or you are working to get proper medical treatment.

This is both good ethics & good sense AS WELL AS critical in making these methods of reducing pain more effective. If your unconscious 'knows' you are doing the 'right thing' it is far more likely to reduce or turn off the pain.

[I strongly suspect that the severe pain that hit me while driving to the surgery was my unconscious dropping its pain reduction efforts (ongoing for weeks or months) to remind me why the surgery was so necessary.]

Our Y is very close to the house and has a therapy pool with waist deep warm water for walking and mobilizing joints. They even teach arthritis workout classes in there.

The idea of prepping the body with exercises before the TKR/THR seems extremely important for those that can do that.

That you are planning a BTKR for November is going to put us in the same (or near) cohort. Right now, I am tentatively targeting October 19th (2 months from my THR this week ) -- my surgeon said he could do it in 2 months after the hip, but we need to see how good my health remains and make the final decision on bilateral or single (maybe you and I should chat).

But we already did the BioMet Signature MRI so that the custom instrumentation (jigs and cutting guides) can be made. The main thing I want to talk to my surgeon about on Monday is what makes the most sense for the knees

Updated: I remembered we had on of those "barber massage devices" that fits over your hand and just finished 20 minutes of working on that quad soreness.

Should have done that 3 days ago -- I actually found the massager in the week before surgery while clearing up clutter; we hadn't seen that thing for years. We also have a big "chiropractor's massage machine" that takes two hands to hold like a portable sander.

Tomorrow I am going to see if Carol is able to work on my thigh some more with the BIG machine.

Here is a 35 second video from my 10 minute combatives (slow flow) workout the evening after my surgery. I am the guy in the dark shirt. Remember most of the stiffness in my legs is the KNEES not my brand new hip.




I am in NO pain there, and though not moving very gracefully on my feet, that is not interfering with me smoothly and effortlessly taking away the attackers' knife each time. (Nor in attacking my friends )

Remember this is a SOFT FLOW DRILL and not actual fighting -- they were doing that when I arrived and that was exactly the drill I had planned to ask the to work with me.

The big guy was using too much strength at times, but that is because even though he is a VERY experienced martial artists -- he teaches unarmed methods to his local police force -- he is also a newcomer to this method of disarming knives with little or no real effort.

I just avoided his strength when he did that with me. (That is part of the secret.)

 

[whatthe2]

Here is a 35 second video from my 10 minute combatives (slow flow) workout the evening after my surgery. I am the guy in the dark shirt. Remember most of the stiffness in my legs is the KNEES not my brand new hip.

That is fantastic!!!

 

[HerbM]

4 days since surgery​

Back to the gym today: 2 sets on the leg extension (low weight, 15 & 30 lbs, about 10 minutes each) and about 10 minutes with a "stretchy strap" for forward straight leg pulls. The cable machine was too heavy for me even on the lowest setting and currently leg lifts with just the weight of my leg, except as raises from the knee where I am on the leg extension with increasing weight) for time & ROM rather than weight & strength.

Went house hunting (accidentally): Carol and I have been hoping to switch to a one-story house in our same neighborhood or nearby. On the way home from the gym saw an open house sign for just down the street and went down to check it out. It was close to what we want so after my walk through I went home for Carol, and we both went back to look at it again.

[We made an offer on the house -- which was rejected and countered so we will pursue this next week. My next offer may be LOWER even.]

After this I went for a massage by a Meridian Stretching practitioner. I have worked their stretching program a little, read the book, but never experience one of their massages. Wow!

This was perfect -- I didn't know how much it would help. My only real thought was loosening the procedure side quad a bit and maybe getting a little bit of KNEE ROM.

He was surprisingly able to work all of my procedure hip without interfering with my wound or my prosthesis. There was some residual tension and issue with the right glut from the months of the sciatic nerve being inflamed. This meant walking (from the same type of walker we might use) on my glut which would have been impossible with a posterior incision.

After taking care of my procedure leg and both knees he balanced both legs, noticed how jacked my shoulders are (likely from osteophytes and doing much of the work for my legs while knee and hip are damaged), he also worked each shoulder and did a quick general all over for back, chest, etc..

He made more progress on just my shoulders as an afterthought than several doctors, chiropractors, and masseurs had accomplished in 5 years of odd attempts to fix the shoulder.

This far exceeded my expectations and I would recommend it were this a popular modality likely to be available near you. If you are in the Boston area, definitely find Bob Cooley. https://www.thegeniusofflexibility.com/trainer-locator/

If in Austin and in pain then find my friend Jay Lyons. https://www.bodyinconcert.com/

A great day even if my hip were not still improving as fast as it is.

By the way, driving is no problem for me even though it was my right hip THR. (and I took no narco today so it was safe.)

 

[HerbM]

It has been a big day (#5 counting surgery day*), productive personally for my wife and I, as well as for my hip recovery and there wasn't time nor need for a nap so with this last item it's likely my bedtime:

Below is the link to my Surgery Day Video on returning home from the Anterior THR:

​

BTW, I was a little bad today: no ice, no narcotics (2 tylenol early morning), and less time elevating since I was out of the house quite a bit.

* Does anyone know for sure if Day 2 Post-Op or Post-Op Day 2 is "2 days after surgery" or "the day after surgery" (i.e. the 2nd day)???

Officially what does the medical community use or how do they say it avoid confusion?