THR Not going as planned

[upsman]

Hello. I actually didn’t find this site till after my right THR. I‘ve been creeping around the site ever since, reading other people’s stories to ease my mind. But now I’ve had some things happen that I haven’t seen addressed.

I had my surgery April 25. According to the doctors the surgery went good. Went home on the 26th. Post surgical protocol called for PT once a week for 4 weeks.

At my 1st PT, I informed my therapist that things weren’t going well because at one week, I thought I’d be off the walker. He informed me that my expectations were a little high. This is when I found BoneSmart.

Recovery from there has been ok. At 3 weeks I went to a cane full time. The night before my 4th visit, I woke up with mid-back muscle spasms on my right side. That next day I casually mentioned the spasms and that it hurt worse if I breathed deep. Long story short? Blood clot in lung. Another trip to the hospital and they found another clot in my right calf. My doctor was very surprised because he said I was such a low risk for a clot. The doctor called the clots “small.” I was prescribed blood thinner eliquis 5mg 2 pills, twice a day for a week, then 1 pill twice a day for 3 weeks. I’ve now been on eliquis for 2 weeks.

Now for the questions. The fatigue I’ve felt has gotten worse since week 2. Would a “small” blood clot cause fatigue? I don’t feel any difficulty breathing even though I seem to get out of breath really easy. Also, for the past couple days, I’ve had what I would describe as a low grade headache that I just can’t seem to get read of. I’ve never had a history of headaches. I'm trying to figure out if the eliquis is causing this or is it coincidence.

Another subject. I’m a delivery driver for UPS. It’s very physically demanding. My surgeon has me going back to work in 11 weeks. I’ve asked the nurse a couple of times about the chances that it would be too soon but they seem absolutely convinced that I’ll be ready. Her exact words were “we fully expect that you’ll be ready.”

I’m 6 weeks out right now and while I’m walking ok I can definitely feel the weakness in the leg and climbing stairs is difficult. I’m wondering if 5 more weeks is anywhere close to enough time for my hip to heal enough for me to be climbing in and out of a truck 140 times a day. Any thoughts?

 

[Pumpkin]

@upser
Welcome to BoneSmart, glad you joined us!
Sorry to hear about all you have been through.

IMO your surgeons expectation for you to be back a very heavy job 11 weeks after your THR and complications from a blood clot in both your lung and leg, is unreasonable. My best guess is you will need at least 16+ weeks to go back to a very heavy job.

We recommend people go back to work around 12 weeks, for less strenuous job, and a Phased return to work.
Members with very heavy jobs have found taking more time off to allow their joint replacement to heal, do much better that going back to work too soon.

Ask your pharmacist about your headaches and Eliquis, they should be able to answer your question.

Here are the Hip Recovery Guidelines, the articles are short and will not take long to read.

Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary
2. Control discomfort:

rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT

a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

BoneSmart philosophy for sensible post op therapy​

5. At week 4 and after you should follow this

Activity progression for THRs​

6. Access these pages on the website

Oral And Intravenous Pain Medications
Wound Care In Hospital​

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

 

[Eman85]

Can't give you any advice on clots or anything related, no experience and not qualified. I'd say going back to work is going to be tough. I know how demanding your job is and there is no easy days. Any chance they will allow you light duty of sorts? If you're a package driver what are your weight lifting requirements? Lifting and carrying weight might be a problem, it was for me.

 

[Newstart70]

@upser I am sorry to hear about your challenges. I had my RTHR done on March 7th this year.
Joint hip replacement patients are at high risk of blood clots after surgery. My OS prescribed daily self injections of Fragmin for 29 days following surgery.
It also sounds like you are going back to work too soon. I am retired, but I wouldn't have felt well enough to go back as soon as you are planning. The recovery is unique to every patient, but considering your vocation, 11 weeks seems too soon.
You are in the right place now though. There is so much valuable information and support here.
All the best to you in your recovery.

 

[Jaycey]

The fatigue I’ve felt has gotten worse since week 2.

Read the article on Energy Drain that Chris left for you (above). It's real and you just can't fight it. Nap when you can.

My surgeon has me going back to work in 11 weeks.

It is hard to say how you will feel at 11 weeks out. But in my experience new hips do not like any kind of lifting. I would have a discussion with your employer and see if you can have a phased return or lighter duties when you first go back.

 

[Layla]

Welcome to BoneSmart!
Sounds like you've had a bit of a rocky start. I'm sorry.

Look up the side effects for Eliquis. One of them is headache, so I'm guessing that's the cause of your headache. If it continues to bother you, I'd touch base with whoever prescribed it.

I agree that you're suffering Energy Drain.
Our body's energy supply isn't limitless. So when we're in healing mode after major surgery
our energy will be used for healing first, not leaving a great reserve for all the other activity of daily life. It is completely normal to feel tired for quite some time. How long....most likely relates to your body's rate of healing. Making our best effort to get adequate sleep and rest is beneficial.
Our body does it's best healing while we're sleeping.

As far as returning to work, you may not feel physically able at 11 weeks. But you may also be surprised at how much stronger you're feeling five weeks from now. Hopefully you're allowed some wiggle room in regard to your return.

Thanks for joining us. I think you will love the support and encouragement you'll find here. Stop back often.
Have a great day!
@upser

 

[Josephine]

Blood clot in lung. Another trip to the hospital and they found another clot in my right calf.

That would be usual because such blood clots start in the calf and then a bit of the clot travels up the major veins and into the lung. Glad you're feel better now

The fatigue I’ve felt has gotten worse since week 2. Would a “small” blood clot cause fatigue?

Partially but the Energy drain is also a primary culprit.

I’ve had what I would describe as a low grade headache. I'm trying to figure out if the eliquis is causing this

Could be. Apparently the side effects can include

• Easy bruising.
• Unusual bleeding or bleeding that won't stop, including nosebleeds and bleeding gums.
• Pink, brown, or red urine.
• Black or bloody stools.
• Coughing up blood, or vomit that looks like coffee grounds.
• Trouble breathing or wheezing.
• Severe headache.

My surgeon has me going back to work in 11 weeks. I’ve asked the nurse a couple of times about the chances that it would be too soon but they seem absolutely convinced that I’ll be ready.

Looks to me like they are forgetting that you had a thrombosis which in itself can cause fatigue. I suggest you mention this to them and tell them you don't feel ready and would like another 3-4 weeks off. This on the basis that if you don't ask, you don't get!

 

[upsman]

Thanks for the responses. This is taking longer than I expected. My surgeons exact words at consultation were, “you’ll be back to doing pretty much what you want in 3 or 4 weeks.” Lol. It’s 6 weeks and I haven’t been fishing a single time.
My biggest fear is not being able to go back to work. I think I’ll take Josephine’s advice on that work postponement, because there’s no such think as “light duty” as a package driver.

 

[Mojo333]

Agreed.
I have a job that requires ALOT of loading and unloading...I went back in a supervisory capacity...because y new hips didn't appreciate the extra load.
However I now do it all!

 

[Mojo333]

It’s 6 weeks and I haven’t been fishing

Super sad.
Do get that situation rectified!

 

[Eman85]

I hate to break it to you but your OS is wrong. I was a linehaul driver for a different company. You can read my thread and see how it worked out. At 3 mos you might be able to go back but lifting and carrying will most likely be a problem. My OS made it very clear before surgery the limitations and the time line. I can honestly say it was 1 year to see real "complete" recovery. I still baby it as far as lifting and carrying, I'm not screwing this up.

 

[Debru4]

After a back surgery 9 years ago I went back to teaching elementary school part time at 3 1/2 weeks. My teaching partners took my duties and I was able to sit a bit during the first couple weeks back. I had to do no lifting, so the main thing I dealt with was standing and walking.

I am retired now, and following this hip replacement I could maybe have done something similar but there is NO WAY I could have handled lifting and carrying things. I was doing very well early on, and walking a great deal.

But I did not lift and carry things, and still am very careful when doing so---I am trying hard to maintain the health of not only my hip, but also my back and knees, as all have been stressed by dealing with the severe osteoarthritis in my hip.

Is part time work at 11 weeks an option? I would suggest a gradual return to your job, whenever you decide to do it. After a couple/few weeks parttime your body and mind will be far more able to handle th job, in my opinion, than jumping in full time!

 

[Bfam85]

Hi @upser...it is very typical for surgeons to cavalierly say that you will be fine in a very short period of time...I have found that to be a fallacy whether it is a joint replacement, hernia repair, etc., etc. I sure wish they would be honest. A patient would be better prepared for recovery. Perhaps they are afraid we wouldn't do the surgery if we knew how long it would take? Just my opinion....hope you are feeling better soon.

 

[Layla]

Surgeon's really do a disservice to their patients in making such statements.
Check out this article -
http://bonesmart.org/forum/threads/healing-how-long-does-it-take.5424/

Hopefully you're able to take more time off and do a Phased Return.
Week by week you'll regain strength, but it's still early days in the whole scheme of things.
Wishing you all the best as you continue to heal.
@upser

 

[upsman]

Lol. Not fair mojo.
I almost tried to take my kayak out today, but decided against it. The leg would not take it.

 

[upsman]

I hate to break it to you but your OS is wrong. I was a linehaul driver for a different company. You can read my thread and see how it worked out. At 3 mos you might be able to go back but lifting and carrying will most likely be a problem. My OS made it very clear before surgery the limitations and the time line. I can honestly say it was 1 year to see real "complete" recovery. I still baby it as far as lifting and carrying, I'm not screwing this up.

Yeah I believe he’s wrong NOW. I don’t think any of them have a clue about the requirements of the job. I’d be working right now if I had a desk job.

 

[upsman]

I’ve started walking more to start building up endurance. 1/2 mile and my leg starts hurting. PT says it’s just weak muscles. I hope he’s right. I used to be into running a lot. Even now my resting pulse is 55-60. After walking 1/2 mile at the speed of pond water, my heart rate was 76 the first day and 80 today. Good grief. Have I gotten this out of shape from 6 weeks of doing nothing?

 

[Layla]

You're funny!
Give it time, you'll get there. I'm leaving the Activity Progression for THR for you to read -
http://bonesmart.org/forum/threads/activity-progression-for-thrs.13187/
Check it out and you might not feel as discouraged. It's only a rough guideline. Some will be a bit ahead, some will lag behind. You're still in early recovery and it takes a full year, even longer for some, to make a full recovery. So chin up...there are brighter days ahead
I hope you have a great weekend!
@upser

 

[Eman85]

You do realize what was done to was worse than being hit by a truck? The drain on your body from being disassembled, having parts lopped off and pounded in and then reassembly is like a scheduled car wreck.
Sounds like you're about to discover that forcing things won't make it happen faster, it will put you further behind. I brought in all of the paperwork my HR dept gave me including job description and the Human Performance test they required me to perform because I was out for 3 mos. I think my OS is still laughing at what they expected.

 

[upsman]

Surgeon's really do a disservice to their patients in making such statements.
Check out this article -
http://bonesmart.org/forum/threads/healing-how-long-does-it-take.5424/

Hopefully you're able to take more time off and do a Phased Return.
Week by week you'll regain strength, but it's still early days in the whole scheme of things.
Wishing you all the best as you continue to heal.
@upser

Thanks for that article. I never realized the WHOLE story to surgery recovery. Of course, if you’re like me you think, “I’m in good shape, I’ll heal quicker.” Nope.