Great Forum! Wish I knew of it sooner...

[Shamrocker]

I did a lot of net reading before my left THR (9/11/08) but sadly, never came across this forum until afterward.

Firstoff, many thanks to moderator(s) and members for taking the time to offer information, hope and encouragement to folks like me. As others have said, it can't be stated enough how helpful that is to those of us anticipating or just out of this major surgery.

Some observations I've made whilst lurking around here:

• There are a lot more "young" people having THR's than I had realized - I don't feel so alone now!
• There is a huge variation on almost every aspect of this surgery and recovery amongst patients - from time in hospital, to different meds used to treat pain, to time before getting off walking aids, etc.
• Things are certainly done differently in different parts of the world with regard to THR. Still can't get over reading about the member from (I believe) Australia, whose employer provided taxi service to and from work, therapy, medical appointments, and a BED (!) for occasional rests when he/she returned to work after surgery!!!. Qantas, here I come!
• There is a LOT we aren't told by either surgeons or therapists (i.e. no one ever mentioned the awful heel pain to me, and I was left on my own to develop ways to alleviate it). Surgeons ought to give patients this website as standard practice!

As for my own experience, my surgery went very well and was without complications. From what I've read, my recovery has been maybe a tad faster than average (left hospital after 3 days, went home with help, off walking aids by 4 weeks, walking well with no limp, minimal pain by 6 weeks, just soreness near incision). The biggest problem is that I was under-medicated for pain, despite several pre-op conversations on this subject with my surgeon, and repeated assurances that I would be kept "very comfortable". NOT! This made those early days so much more unpleasant than they needed to be. When I read about the pain meds some folks on here received, it made me wish I'd gone to their surgeon. Mine doesn't believe in PCA (patient-controlled analgesia, where you can push a button and receive morphine through IV). I let him know I tolerate narcotic pain meds very well (from limited past experience), but I was never given morphine in the hospital. That would have been so helpful those first few days - I'm pretty tough about pain, but I'm not a believer in being a martyr and having unnecessary discomfort. All I was offered was Vicodin, which was not powerful enough and was never administered on time due to nursing shortages (that could be a whole other post!). I repeatedly told various medical staff that my pain was not well-controlled, but to no avail. In fact, I wound up feeling like a junkie begging for drugs. I was given a very short supply at discharge and had to use them extremely sparingly, leaving me with a lot of pain and difficulty sleeping or exercising. Not good for recovery! I pushed through the pain and did the PT anyway; otherwise I'm sure I wouldn't be walking so well at 6 weeks. I understand the dangers of narcotic pain meds and the risk of dependency, but the acute phase of recovery from THR is relatively short and, in my opinion, does not justify this ultra-conservative attitude (btw, no history of substance abuse here, nor any other reason to be over-cautious).

Sorry to rant, but that experience was so very frustrating, and may be enough to make me switch to another surgeon when I need the other hip done or need a revision. It's a shame, because he really is a fine surgeon - that's why I chose him (low complication rate, few dislocations, infections, transfusions, etc.). I think of myself as a fairly effective self-advocate, but I got nowhere on this issue. Then again, when you're post-operative, you're quite vulnerable so it's possible I didn't advocate as effectively as I do when I'm up to par. Has anyone else had this experience? I don't recall seeing any posts on this subject (my apologies if I missed it).

One quick question to close this obnoxiously long first post: I am 6 weeks post-op and experiencing persistent swelling and tenderness around the incision area. No discoloration, warmth, or signs of a clot or infection, and the incision itself looks good (well, actually I look like Frankenstein, but you know what I mean ; ). Icing doesn't seem to help much, but I'm doing it anyway. I'm pretty sure I'm not overdoing it with activities and exercise, and in fact, a few days I've tried doing next to nothing and it's still swollen and quite tender to the touch. Such a bad place for tenderness (posterior incision). The doc's office says not to worry. I'm not due to go back until mid-December. It's probably normal, but I wonder if others have experienced this and how long it may last. It's the last of my surgical discomforts and I'm impatient for it to be gone!

Thanks again for providing this awesome community forum!

 

[mvo]

Hi Shamrocker and welcome!

Like you I am nearly 7 weeks out from a left THR and I consider myself young (45). My sister had the same surgery, at the same time and she is 40. So both of us have had a lot of conversations with people along the lines of :
“What’s with the crutches?”
“Hip replacement.”
“WHAT? At your age?????”

Doesn’t help that we both apparently look a lot younger than we are.

Sorry to hear about your pain. Each facility does seem different. My sister was allowed the self administered morphine and I think she still has all the pain relief she needs – she hasn’t mentioned being rationed!

At our hospital they always asked each patient to rate their pain on a scale of 1 to 10 and I guess re-medicated (if that is the right term) accordingly. I always answered “zero” as it was just really a dull ache, but I suppose I got the standard dose of whatever I was on. (Sorry for the vagueness, but my brain was a little mushy. Next hip, I’ll bring a notebook and write down all the helpful things they tell me!) Seems I am one of those very lucky ones who didn’t have much post-op pain and haven’t needed any pain meds since. So I can appreciate my new hip all the better, because, pre-op, the pain was awful for years.

Last week was my first week back at work, and my incision is now a little inflamed and tender, but not sore. I put it down to more and different activity, I used a lot of stairs this week as I am too impatient to wait for the lift!

All the best for the rest of your recovery. You seem to be doing well in the mobility stakes. I’m still using one crutch, hopefully I’ll use it a bit less this week.

Regards,
Monica

 

[clwhit]

Welcome! Glad you found us. Better late than never, as they say.

Regarding the swelling, I am 4 months post RTHR. I still have swelling around my incision. My OS says it will go away in time. I'm not worrying about it. It was major surgery we went through!

Glad to hear your recovery is coming along. Keep us posted on your progress.

~Carol

 

[jaz]

Welcome to the board Shamrocker. Like you I didn't come across this board until after my THR but have found it a valuable resource.

Interesting, I was just talking to DP about the variation between us all. Here in New Zealand they seem to get you out of bed, walking up and down the hospital, showering yourself and weened right down to panadol within a few days of surgery. You get daily visits from the hospital PT and a photocopied booklet of exercises but once you leave hospital you are on your own.

In New Zealand we have Accident Compensation, a Government organisation that covers any medical care caused by an accident or medical intervention. They (ACC) are very focused on getting people back to work. As an HR Manager I've worked with them many times rehabilitating people back to work and they are very good at providing taxi's, paying for PT, home help, special equipment at work etc if it get someone back to work sooner. It is not actually the workplace that pays for much of this, but works with ACC to ensure a smooth transition. Also, if you employ more than 100 people in one location you must have a first aid room which must have, amongst other things, a bed for resting.

 

[Josephine]

Welcome, Shamrocker (Irish antecedents, I take it?). Your post is eloquence itself in describing the experience of under medication after joint replacement. Makes me think I should write a paper with all the similar stories posted on here.

As far as your swelling is concerned, remember you are ONLY 6 weeks post op which is still very early in the healing process. You'll not get to 'the top of the hill' until at least 12 possibly 16 weeks. Takes time for everything to settle back to normal. Sounds like you are doing fantastically well. All power to you!

 

[Laurie]

Welcome Shamrocker,
I too had THR, on Aug 26. Not young, 55, but in excellent health. Just finished my first full week of work and it was a very long week. Interesting you mentioned the swelling, as I brought this up a couple days ago on the forum. Except for some soreness around my incision, I thought I had completely recovered from surgery. Not so, as there has been some swelling around incision this week. I know it is because of my increased activity and not being able to put my feet up at work. So I plan to take it a little easy this weekend.

I didn't realize that the self administered pain medicine in hospital was not the norm in US. It is what I had here in northern NJ. Also had a prescription for percoset when I left the subacute place day 9 of recovery. I was fortunate in that I didn't need anything stronger than tylenol extra strength. Good thing cause the narcotics made me sick. What you described sounds close to barbaric.

But overall sounds like you are doing great. For me, during the weeks 6 to 8 I regained lots of strength, to the point where I now have the stamina to do my my usual gym routine. Better now as I have added power walking and treadmill to my workout--not possible before because of pain.

J0sephine, your idea of doing some kind of book with personal experiences, perhaps by topic and medical expertise, sounds real good. There are lots of us out there and there will be many more.
Laurie

 

[JudyS]

welcome Shamrocker,

Sorry about the pain you had to endure. I was lucky in that my surgeon totally is aware of all the pain a THR causes. When I went to the joint replacement class at the hospital I was given info on PCA because of the surgeon I had. Others were told their surgeons's did not use it.
I did have sub par care in the hospital and in tears did ask a nurse on day following surgery to speak to her supervisor or my priamary doc. She flat out told me NO.

I was saved at that time by a wonderful nurse who walked by and recognized me , she came in to see what the heck I was doing there again. She took over for the nurse and had my drug problem fixed in minutes.

I left the hospital with percocet . My doc had no problem giving me another prescription each time I saw him. At my 2 week apt he asked if I was ready to shoot him due to the pain.
Seems like I progressed similar to you, except I overdid it at 4 weeks.
I had my surgery on June 6th. At 3 months I was told I could go back to my trail (hiking) adn I have been enjoying it since.

Good luck with your healing. Definately find a different doc if your other hip needs to be replaced. I am now being treated by mine for my knees.

Welcome again.
Judy

 

[mvo]

Welcome, Shamrocker (Irish antecedents, I take it?). Your post is eloquence itself in describing the experience of under medication after joint replacement. Makes me think I should write a paper with all the similar stories posted on here.

Go for that paper Josephine!
Monica

 

[Josephine]

A thought - I've been reading through all the posts in this bit of the forum adding tags (that orange bar with a list of words in small red font - try clicking on a word and see what happens!) and have been most concerned at the number of people complaining about sore heels.

Various explanations were put forward from nerve damage to something that happened during the surgery but the plain simple fact is that they are pressure sores!! The risks of these being caused occures at significant points along your journey.

In theatre (OR): if the approach is anterior or antero-lateral, then the patient lays on their back throughout the procedure. Good practice demands that specially shaped foam blocks are placed under the patient's Achilles tendon to lift the heesl off the table and thereby prevent it.
If the approach is posterior then the patient lays on their side but can still get a pressure sore on the outer ankle protruberance. In this case, even a small piece of foam or soft padding will be sufficient to protect the bone from the hard table surface.

In recovery: hip patients, as you know, are always nursed on their backs. Most recovery rooms, in my experience, have the patients transferred to their beds on arrival but even so, prolonged and uninterrupted pressure even on a supposedly pressure friendly mattress can cause a pressure sore to begin. Preventative measures include a small pad under the Achilles tendon and/or regular movement and massage of the heel at least every 15 mins. Memory foam is an excellent material to use in these situations.

In the ward: although the vast majority of pressure sores begin in the theatre/OR, they can still start in the ward and the simple answer for this is that the patient be encourage to move regularly when in bed. If early signs of a sore are present - redness and discomfort or pain - then anything from a small pad foam to a sotfly rolled up pillow case placed under the ankle will relieve the pressure and the symptoms. Memory foam is an excellent material to use in these situations too.

What saddens me is how few nurses nowadays actually understand or even care how a pressure sore develops. So often it is assumed that the sore begins when the redness and/or pain becomes evident when in fact, the damage causing such symptoms occured anything up to 48 hrs before. At that stage, the first thing that happened was the heel became numb and only when that numbness wore off was the discomfort experienced.

In essence what I am saying is that sore heels = poor nursing care.

End of lecture!



(guess you can tell this subject makes me sooo mad!

)

 

[Shamrocker]

Thanks to all of you for the lovely warm welcome. This forum is blessed with such kind, articulate and well-informed people! I'm so glad I found it, and will hopefully soon have occasion to offer some helpful words to someone else.

In essence what I am saying is that sore heels = poor nursing care.

(guess you can tell this subject makes me sooo mad!

)

Josephine, you are absolutely correct about the heel pressure sores resulting from poor nursing care (along with lack of patient education). My nursing care in a renowned facility (whose advertising slogan boasts "WORLD CLASS CARE") was sadly sub-par the majority of my 3-day stay. However, I find myself wanting to defend the nursing staff, as I truly believe they had the best of intentions but were simply understaffed. They were constantly apologizing about the length of time it took to respond to calls, late meds, etc. and I believe they sincerely felt bad about it. But each of them had more patients than they could manage, many of them requiring considerable care and assistance. My poor 78 year old roommate was left stranded in the restroom for nearly an hour and a half, despite repeated calls from both of us. The results could have been tragic. I made sure I let my surgeon know about this and was quite critical in the post-discharge patient satisfaction survey. For whatever that's worth.

I hope you do publish the paper you mentioned. I'd be more than happy to contribute my two cents ; ) Very best of luck to all of you joining me in this recovery journey. I wish you good health and comfort. Thanks again for making me feel so welcome here!


P.S. Yes, Josephine, my antecedents hail from Cork and Galway. Might explain my loquacious nature ; )

 

[Josephine]

P.S. Yes, Josephine, my antecedents hail from Cork and Galway. Might explain my loquacious nature ; )

Yayy!! Me Mam was from Sligo!

 

[Stanj]

Hello Hippies
It is interest that the only pain I had for from the moment I woke up after the procedure to, well, now was sore heels. I never told anyone, it is irritating so I just lifted my knees so my heels were flat on the bed and all was fine until the next time I laid flat. That lasted for 3-4 days and never returned.
Several mentions of overworked staff and lack of attentiveness was just the opposite of my problem. I had the nursing supervisor, an MD looking in on my several times a day, and the RNs were visiting often, sometimes just to visit or read some document to me that I was having problems with due to its formal Russian language. As it turned out, alone time in my private room was about the only thing I could have used more of.

I often read how the progress is steady and eventually all is fine. I really have not much thought about my THR lately, never really took any precautions or limited my activities after discharge from the hospital in June 2008. It dawned on me how long ago it's been last week when vacationing in California, I went to Lake Tahoe to stay at my mother's condo at Incline Village. I spent most a week hiking and climbing various mountains with crests in the 9000-10,300 foot range. I met a girl on a trail and struck up a long conversation and eventually headed off together. On the second day, at the 9,100 foot level we came across a beautiful little snow melt lake and went swimming....mostly bathing it was much too cold to swim, hours before the water was ice or snow. Not planning on traveling with anyone neither of us had any swim appropriate clothing so we naturally "skinny-dipped". When getting out of the water Donna asked what was wrong with my leg. "Nothing, why?" "the long scar"..."huh?" "that one...on your right hip"
I was as surprised as she was, I had completely forgotten about the THR. I realized I had not even thought about it for months.
I was equally surprised that my leg was not the limiting element of my endurance, it was my lungs. I had not been above 1,000 feet for several years. I felt no difference in leg strength between the "normal" leg and the "brand new bionic" leg. During my recovery period the only exercise I did was dancing and walking, lots of walking since I have no care in St Petersburg. Daily walking long distances, stairs and a fully "manual" life not only is simpler but keeps one in shape naturally while having major expense savings. My friends in SPb never exercise but are all fit and trim with lots of energy. Walking a mile or two with groceries or climbing stairs every day many times a day results in never having to watch calories or worry about portion size and not needed health club memberships. The idea of driving through traffic to use a machine to exercise seems strange to me, considering how much effort is put into seeking out labor saving appliances etc.

 

[Josephine]

LOL you have a good point here, Stan. But skinny dipping? Oh wow! Are you and this lady still in contact? I was hoping there was going to be a nice romantic ending!

 

[JudyS]

Stan
I just love Lake Tahoe area. I have been hiking and biking here in socal and don't really think about my hip either. If it wasn't for my knees........

My Italian grandmother never learned to drive. I grew up in a small town in Rhode Island. My grandma walked everywhere for all her errands, the bank, to buy fresh bread each morning, and did a lot of gardening.
Never had any health problems. One sad day in her late 80's as she was walking, a car hit her, she fell and banged her head, which resulted in her death.

The town I live in now is very unique . There is a real down town about 1/2 mile from my house. My kids hanb out there after school and walk home. I easily walk into town for the pharmacy, bank, coffee etc. I love living like this.

The new hips are great
Judy

 

[Stanj]

Hello Judy and Josephine. I am sorry to hear about your grandmother's demise. You got a taste of her small town life and pleasure plus health(mental and physical) benefits of slower pace and living at a human pace. I find that the small town nature of even large cities where walking and no-stress transportation exist, the benefits multiply. The reduction in stress living simpler for routine activities allows much more time for socializing, intellectual stimulus, and nurturing relationships. I've lived both ways, high speed and intense versus simple and low impact, and can say the latter is better for mental health and adds greatly to personal and financial security.

Josephine; the girl I met on the mountain was not a romance interest, I have a great GF and would not do anything to interfere with that relationship. My GF is not jealous at all because I have never done anything to generate such a reaction. All my buddies are young women, we are all very close but after seeing the nature of our various relationships, Marina, my GF, has become their friend also. Since I have been gone to the US she and my girl buddies got together to socialize together regularly. I return to St Petersburg a week from this coming Sunday. Hurray!! It has been 7 weeks and that is too much time from "home". The weather here HAS been perfect however, and it has been fun to drive again, I miss my adopted home and my GF too much. She has a 14 y.o. daughter who is my real buddy, we talk by email or Skype several times a day. She lives with the grand parents 175 miles away in the oldest city in Russia, V. Novgorod, where she is enrolled in a special Total Immersion English school where all the classes, even Russian, are taught in English. Belinka is going to be 6' tall when she stops growing in a few years, slim and graceful. Marina and she share all their clothes except shoes where there is a big difference in size. Marina likes flashier clothes, shorty crop tops and rhinestones and shorter skirts and tighter pants(favorite stores are Georgio and BeBe) than her more casual daughter(who likes Espirt types of designs). As a result, when I go shopping for them, I have to visualize how it would look on both of them before making a purchase. That is one of the main errands I have been spending time with this last week. I really enjoy shopping for women's clothes, the design options are so much greater than men's clothes which are pretty boring, besides, I hate trying things on.

 

[JudyS]

Stan
I did not realize you were still in Ca. Had I known that and that you like to shop for women's clothes I would have found you. I totally dislike shoppping for clothes and trying them on. I have lost about 14 pounds since my hiking days began again and literally my clothes fall off. I was out last nite and came home with nothing!!! I am on a low budget which does not help with choices I am sure!!

I am living that small town outside a big city life and it is awesome. In town I have a small town pharmacy, where the pharmacist greets you by first name, kids come in after school to by candy. Tables outside for coffee drinking , eating and socializing. Many little stores have dog treats. Lots of random water bowls for the furry friends. And our wonderful mountain trail with a stream only 1 1/2 miles up.
Can't afford a house here, but so far the benefits outweigh the property ownership!!!

Have a safe trip back. I hope you have more comfortable accomodations!
Judy

 

[Laurie]

Judy, This forum is so interesting--over and beyond the joint replacement discussion. I am sorry to hear about your grandmother. But wondered where you grew up in RI. I graduated from Middletown (RI)High School many moons ago. My mother lives in the Narragansett area so we go up there a few times a year. RI still has alot to offer and is very diverse for a small state.

Sounds like your hiking is going great. I am mending well from my hiking spill last weekend--bruises are now green. If weather is good (rainy here in NJ today) may venture out tomorrow. Went to baby shower today and folks were amazed at my walking. Glad I seem to walk straighter to others as I feel I am not leaning or limping like I used to but hard to tell about yourself.

Happy weekend.

Laurie

 

[JudyS]

Hey Laurie,
I grew up in Bristol. The home of the 4th of July parade. Just the other side of the Mt Hope Bridge from you in Middletown.
When my oldest brother moved to Florida with the rest of the family I stopped going to RI. Last trip was 12 years ago. I keep having Bristol dreams in the last year. I think I need a visit!! I had one planned a few years ago when I lived in Georgia. My parents were driving up and I was going to hitch a ride. They arrived the day I took my older daughter to the Dr. and found out she had mono. My parents still thought I was coming. They were quite mad that I stayed home with her!!!

I went on a long hike to the top of a mountain today. The hip was fine. I hope you get to go tomorrow. Here in southern california the weather is pretty much good every day.

Happy rest of the weekend
Judy

 

[Laurie]

Judy, Now I am really intrigued. My Dad's cousin owned/lived in a house (139 High St?) in Bristol. She died a few years ago but her friends still live there. My parents and other members of my family have attended the July 4 parade and visited at that house for years. Now my Mom and whoever is up there continue to go to this day. I haven't been but have seen pictures and have heard about the big deal this event is along that street. Small world.

l also have a sister in law who lives in the San Diego area. Her husband works with an orthopedic group out there -- I think at Scripts Hospital???? That area is beautiful but so crowded....I do remember though the last time we were out there in April 07, left a rainy New Jersey in a.m. and by the afternoon I was sunning myself in her back yard enjoying the beautiful flowers and warm weather. Nice.

Looks like it will be a good day to get out and walk.

Laurie

 

[JudyS]

Yes Laurie it is a small world!! I had dreams last nite of visiting R.I ,probably due to our conversation.
You must let me know if you head to San Diego again.
It is another gorgeous day here. I will go for a short hike today!!
Enjoy your day
Judy