Bilateral THR Sue's double hip replacement

[Whitmore]

Had both hips replaced on September 27th 2019 in Naples, Florida. Should have been a 3 day stay in the hospital, but turned into 4 as I was waiting for insurance to authorise rehab. Both PT and doctor advised me just to go home, where my husband could be my caregiver, with a visiting nurse and physical therapist for support. I took their advice and am happy I did. So far, everything has gone smoothly, though I don't want to jinx anything!

On day 8, I was lifting up my walker while walking , transitioned to the cane the following day, and now use nothing when home, except at night when I take sleep meds.

I have always been a runner, but it seemed to be yoga that caused the rapid deterioration, with both hips having bone on bone osteoarthritis, It was when I noticed that my right leg was 1 inch shorter than my left and was told that I had significant bone erosion, that I knew I had to take action pronto. It was about 5 years since the original diagnosis.

I am British and have lived and worked for a number of years in the US. I spend most of my time in London now I'm retired, but was refused surgery by the NHS as I was 'too young'. Perhaps I could have challenged the decision, but being lucky enough to hold private US insurance, I was able to find a US surgeon who offered to do both hips at the same time and with prostheses of my choice.

The only problem so far has been anaemia from the surgery, insomnia and restless legs, possibly from the anaemia or the surgery itself--don't know. I dealt with insomnia pre-surgery by exercising vigorously, but that's off the table for now. I've been given low-dose Doxepin by my primary, and it did work last night, so hopefully that will tide me over the hump.

Anyone have any other advice on how to deal with insomnia and restless legs?

 

[Celle]

Hello Sue, @Whitmore - and

It sounds as if you're doing well.

@Mojo333 has also had bilateral hip replacements. I'm sure she'll be along soon, to talk to you.
Meanwhile, I can help you a little.

Anyone have any other advice on how to deal with insomnia and restless legs?

I'm afraid that insomnia is a very common problem during recovery. There's an article about it in the recovery reading I'm going to give you.

We do also have an article about Restless legs following knee replacement surgery . Although it mainly talks about knees, I think much of it also applies to hips.

Here is the recovery guidance and some helpful articles as well:
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.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.

 

[ForumUser]

Sounds like perfect timing ...

I think many get the twitches following surgery ... lots of stuff moved, cut, and then the always somewhat personalized random/unknown effects of various drugs.

I tended to sleep a bit fitfully, initially, gradually working back up to seven hours, but having bilat process, you probably can’t find that perfect spot

I found elevating and icing ... well after I returned to full mobility ... to be very helpful. With a bilat this probably just means finding that right location - mine was on sofa with two pillows under leg, elevating the knee, leg hanging over the end of the sofa, silicon pack directly to the outside of my gym shorts for good cold connection and with a towel over it to insulate and hold the ice pack in place. About an hour for the silicon pack to start warming, bathroom break, walkabout inside initially, then outside, then back to ice and elevate.

 

[Mojo333]

Hi @Whitmore and welcome to Bonesmart!
Congratulations on your two new hips...the esteemed Both at Once?!!! Club
Thanks to Celle's tag to come by and weigh in...in an attempt to refresh my memory regarding sleep and restless legs... I've been hung up reading my old recovery thread.
The link is in my signature if you care to read alot of early whining and later gushing exuberance as things improved.
I too transitioned from walking aids rather early...and returned to lots of activity much too soon.
This, I'm sure, played into just having antsy, cant-be-still legs along with normal recovery weirdnesses.
I'm sure this kept on until about month 4 for me...(yes. I know...not too encouraging)
Reminded myself many times that the discomfort and aggravation was better than the excruciating pain I felt preop...but is very frustrating.
It resolved and about the time I thought to possibly pursue medication...it began to ease and eventually subsided.
As I said, it seemed mine would be worse on nights after days I was doing alot.
It never hurts until we stop!

You sound to be doing very well so keep the faith.
So much of these these things just take time to resolve and do keep babying yourself as long as you can.

 

[Layla]

Hello and Welcome to BoneSmart. Thanks for joining us!
Another brave bilateral joins the ranks. It sounds like you're off to a good start and doing well. I have a suggestion for sleep and restless legs if you'd like to go a more natural route. It may be worth your consideration for both spasms and a good night's rest. It is Magnesium.

Magnesium Glycinate supports the following:
Bone health
Healthy blood sugar
Cardiovascular health
Muscle relaxation and nerves
Promotes healthy sleep (falling asleep and staying asleep)

An article on Magnesium from the BoneSmart Library -https://bonesmart.org/forum/threads/magnesium-is-a-star.20301/

Magnesium Glycinate is the preferred form as its more easily absorbed by the body and causes less intestinal issues than other forms may.
Possibly others will stop by who've tried it with success.

Come update often. We'd love to follow your progress. The support and encouragement found here is next to none.

A happy Saturday to you!
@Whitmore

 

[Whitmore]

Thanks for the kind replies. It's day 19 and all seems to be going well, except for the awful insomnia. I am just resigned at this point to sleeping in 1 1/2 hour chunks and napping during the day, though it is starting to make me depressed. I've been using the Magnesium since I got home, but it hasn't helped. Low dose doxepin helps a bit, but results in my dragging during the day. Once I can wriggle around in bed at the 6 week mark, hopefully this will improve.

What I hadn't bargained for is the constant anxiety around infection. I was convinced my incisions were infected, though it was probably just irritation caused by the staples, since it's all calmed down now they are out. Now I have what looks to be a cold sore at the corner of my mouth. I have no temperature and the surrounding area doesn't look inflamed. I've dabbed some oregano oil on and see if that contains it. I did ask my home health nurse about it yesterday(day 2) , and she just advised me to contact my primary, but I'm hesitant to do that just yet, as I'm frankly too tired today to go in to their office. I'm wondering if all these anxieties are reasonable or just a symptom of my having too much time on my hands!

 

[Layla]

@Whitmore
I'm sorry you're having difficulty with sleep. It's a fairly common complaint and it does seem to resolve pretty quickly. If you haven't already, check online to see if you're taking the safe maximum dose of Magnesium. Possibly it will take a little longer to notice the positive effects.

Try not to worry about infection. If you don't want to go to have the lesion on the corner of your mouth examined, consider calling your Primary asking if you can send a photo from your phone they can enlarge and advise on. Possibly they'll give you a nod to do so and they'll offer you the reassurance you're seeking.

I do think many experience anxiety over different aspects of recovery. The likelihood of complications is actually rare. Naturally having too much time on our hands does allow the imagination to run wild. Try to stay busy. There's a lot more that you can do than you'd imagine. Crossword puzzles, Adult coloring books, research and plan your next vacation, Pinterest, Houzz, start a recipe collection, online games, call an old friend, catch up on emails etc. Check out the Social Room here also. There are some fun threads to read as well as games to participate in with others . Here is a link - https://bonesmart.org/forum/view/social-room.11/

I believe busying yourself will ease some of those anxious thoughts while your body continues to heal.

Stop by often with updates, we'll keep you company!
Wishing you a peaceful rest of the day!

 

[Whitmore]

Thanks for the suggestion. Contacted doctor re lesion and she prescribed a day's worth of Vaclovir(4 pills). If it clears up, great. If not, then we'll have to try something else. I'm actually wondering if it's a side effect of the anaemia that I have as a result of the surgery. We'll see.

On the plus side, drove today(day 21) to pick up meds(doctor approved on day 18). Just a short distance, and getting the car seat adjusted to get out /in and drive a bit of a pain, but a milestone!

And walked outside for 20 mins unaided. Only anxious moment was an enthusiastic dog who wanted to jump up on me. I was lucky that my husband was with me and could get between me and the dog!

Still sleeping in 1.5/2 hour chunks. If I could just roll on my side instead of having to get up, I think the problem will go away. Roll on 6 weeks!

 

[Mojo333]

You sound to be doing very well.
Nice to know you can get yourself somewhere.
I, too, was so anxious to get some good sleep and back sleeping wasn't helpful.
Took quite a bit to transition to my side even after all was healed and be comfortable too but it finally does get there.
Hope your weekend is restful and happy.

 

[Jaycey]

@Whitmore You are doing great for so early out from BTHR! Driving already - well done! Keep up the good work. You are well on your way to pain free living.

 

[Layla]

Hello and a Happy Friday to you! Congrats on walking unaided.
Driving is a milestone also and a fulfilling one at that. It's so nice to regain the independence it affords us.

Hopefully the meds clear up the lesion and it's just a tiny blip on the screen.

Following is an article on side sleeping that may interest you. Whether or not you're ready, something that helped me immensely, and I now find invaluable, is a Body Pillow. I purchased mine at Target for only $10, so it's not a costly investment if you find it useless. It's approx 52 inches long and 20 inches wide. I began using it by laying on my non op side and putting it between my legs running mostly the entire length. There is enough length left over to wrap your arm around. Personally, I find it comfortable and use it to fall asleep nightly. Something to consider if you don't have one already -

THR: lying on my side - when can this be done?

To answer this question - it depends upon any restrictions such as don't bend past 90 degrees which will make a difference to this 1. if you have restrictions, then you cannot/should not try sleeping on your side until these have expired. Maybe 6, 8 or even 12 weeks - it depends upon the...

bonesmart.org

Another article that may be of interest is one on sleep deprivation. If nothing else, in reading it you'll realize you're in good company.

Sleep deprivation is pretty much inevitable - but what causes it?

Time and again members complain about not being able to sleep and after a while, that it gets to making them feel frustrated, despairing, depressed and even ill. I thought perhaps a short treatise on the reasons for disturbance of sleep patterns was long overdue. It won't help you to sleep but...

bonesmart.org

You're on your way and doing great! Keep up the good work and stay in touch.
@Whitmore

 

[Whitmore]

28 days out now. Looks as if the 'cold sore' was not a cold sore after all, but a fungal infection. It cleared up with Lotrimin. I actually self diagnosed it as angular cheilitis, which is usually fungal and strongly associated with iron deficiency. Now my gums are no longer a scary white colour, I assume the anaemia is getting under control and I can fight off the fungus.

Started PT at a center this week. Three sessions mostly focussing on balance and correction of my waddle. The therapist had me 'walking the tightrope' along a tile edge to try to get me to bring my legs closer together and stop the waddle. Easier said than done, though improving. I now have no problem driving, but still plagued by insomnia, which gets me down periodically. Still, a couple of naps during the day, mean I can get through it. Trying to stay positive, but this is getting old already!

 

[Mojo333]

Good to see your update and see your anemia is resolving so you can hopefully start feeling more like yourself.
Yes, one month out almost and it does get old waiting on healing to happen and things to improve.

The sleep part was the last piece of the puzzle to fall into place for me.
I won't depress you with how long that took before my legs settled down and my circadian rhythm fell back into line, as we are all different.
I, too, was a chronic napper.
Get it when you can.
Keep the faith, my double hippy friend.
It keeps getting better and better.

 

[Layla]

Hello, Happy Friday and weekend to you!
Thankfully you successfully treated the lesion and got to the origin of the issue.
It's so wonderful to be driving again after taking a break. It's nice to have that independence back. The Energy Drain you're feeling is due to your body using energy first for healing, not leaving much else for the activities of daily living. Try to embrace it as healing time because while sleeping our body does it's best repair work. Happy nappy time!
@Whitmore

 

[Layla]

Happy One Month Anniversary!
Wishing you a great week as you continue healing.
Stay in touch.
@Whitmore

 

[Whitmore]

Thanks for the well wishes.

Things were going well...until I stopped taking Mobic a week ago, as I felt is was leading to insomnia. Though walking is still good, all of a sudden(last 3 days) I can't do stairs unaided without tremendous difficulty. My legs feel like they have lead weights attached to them. My left leg was my 'good' leg and now is much worse.

Freaking out as worried this is a sign of an infection.

I've got a fungal rash on my neck(post surgery) at the moment that the local doctor has prescribed a one-dose deflucan for, which I'll pick up from the drug store tomorrow. No redness over incisions or fever.

Could it really be the Mobic that made the difference? I'm hoping so. As I say, I'm freaking out.... help!

 

[Layla]

Hello @Whitmore
Are you taking a probiotic? I can only say if it were me, I'd begin taking one... if you're not already. Is this fungal infection related to the lesion you had earlier?

I've learned through reading that fungal infections can be the result of antibiotic usage as well as a weakened immune system. Please do your own research, but my understanding is that 70% of our immune system lies within our gut. Probiotics improve gut health.
An article from our Library -

Probiotics

Dr. Selman Waksman [1964] coined the term antibiotic which he defined as any substance produced by a microorganism that kills or inhibits the growth of other microorganisms. Probiotics are bacteria that interfere and kill pathogens but the mechanisms employed by these agents in preventing...

bonesmart.org

What about instead of Mobic, you try Extra Strength Tylenol at 1000 mg 4x daily (every six hours) not to exceed 4000 mg within any 24 hr period. You must calculate in anything else you're taking that contains Acetominiphin so you stay within the safe range of no more than 4000 mg every 24 hrs.
An article on NSAID'S which Mobic is -

Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

Acetaminophen - also known as Tylenol and paracetamol Drugs.com Acetaminophen (Tylenol, Extra-Strength Tylenol, generics) is a safe choice, and is often one of the first treatment choices in osteoarthritis. However, acetaminophen can be toxic to the liver when used in excessive doses. It is...

bonesmart.org

You may want to touch base with your surgeon on all of this. I'm sure through a few questions a member of his care team will either offer you reassurance, or advise you to schedule an appt. I think it would give you the peace of mind you're seeking.

Please stay in touch and let us know how you're doing.
I hope your evening is a peaceful one.

 

[VSlowLife]

@Layla, @Whitmore I just read some published research from a collaboration between Cornell University and The Hospital for Special Surgery regarding healthier guts and less risk of infection in knee and hip surgery, in mice. I could not believe I read this, but they did knee replacements in mice!

They hypothesize, if they could fix poor gut health before surgery, the rate of infection would be even less than it currently stands.

This is an easy to read summary of the research:

Link found between gut bacteria, successful joint replacement | Cornell Chronicle

Having healthy gut flora – the trillions of bacteria housed in our intestines – could lower the risk of infection following knee and hip replacement surgeries, while an unhealthy intestinal flora may increase the risk of infection.

news.cornell.edu

 

[Layla]

Thanks @VSlowLife
While I find this very interesting it will need to be vetted by Admin.
I'll report it and we'll see if it stays.

 

[Whitmore]

Thanks so much for taking the time to respond.

I do believe it's all related to the angular cheiiltis---I have some vaginal itching too. I'm eating natural yogurt and have Florastar but am not sure if I should take it or not as it's a yeast, though billed as a probiotic. Will need to check with doctor.

I did pick up and take the single Diflucan pill and will call the orthopedist first thing tomorrow to discuss these various issues.

Thanks again. It's good to have others' to talk to who have been through the same process.