The Bum's Rush; or Welcome to the Machine Part Two

[Cal]

Had my RTHR @ 7:30am-9:30am Monday 11/19/12; spent the remainder of the day goofy due to the lingering effects of the anesthesia. Cognizance, memory & coherent/sensible conversation were difficult and required serious effort. Told the surgeon that since I lived alone (nearest relative >100 miles away) I felt I needed some time in rehab to be prepared for independent living. He agreed & passed that word on to the other involved staff.

Tuesday 11/20/12 - the OT/PT 2-girl tag team showed up & gave me preliminary testing in AM, which consisted of walking my 50' w/ a walker. They returned in the PM & did a retest, which consisted of my walking 100' w/crutches and going up & back down 4 stairs. After I did that, they advised me I was ineligible for inpatient rehab because of my extraordinary althletic prowess and performance. They told me their recommendation was one of no inpatient rehab for me & that owing to that recommendation, my (so-called) "medical insurance coverage" wouldn't cover any inpatient rehab despite the surgeon's recommendation. Apparently, some roving PT gypsy is supposed to visit me @ home someday. I truly hope the roving PT gypsy doesn't expect to be treated with any trust, respect or civility by me after the way I got treated in the hospital because needless to say, that won't be happening.

TheOT/PT girls gave me a bottom-end, cheap, folding aluminum walker, a pair of used aluminum crutches (from the PT room where they had their practice stairs & other stuff) and an aluminum "commode" frame for me to install over my toilet at home.

Having done that much, they gave me some prescriptions and post-op written instructions and discharged me precisely 48 hours after the surgery. The scope of their advice was "weight bearing as tolerated; anterior hip precautions." No explanation of what "anterior hip precautions" means was given.

My daughter drove me to the pharmacy and supermarket so I could get the prescriptions filled and fill my frig up with food.

I'm supposed to wear the 2 compression stockings for a month, & it was thoroughly obvious before I got thrown out of the hospital that I was incapable of putting one (or a sock or a shoe, either) on my right leg. Nobody addressed that issue & nor did anybody tell me how to roll over in bed or get into/out of the shower, a car, a chair or anything else, either. They were too busy tripping over themselves in a headlong rush to get me out the door. I've been figuring all that stuff out one thing at a time, sticking with what doesn't cause pain and not repeating what does cause pain.

I'm now home for about 30 hours & I've been wondering about what to do about the right leg stocking/sock/shoe quandary. Luckily, I had a lucid moment & decided to research self-assistance devices on Amazon. I found there's a world of them - costing from $8 to $50, with varying shipping fees & varying user reviews. Unfortunately, I don't know which are the dogs or which are the good ones. So... since today is Thanksgiving, I guess I'll take a cab to a WalMart tomorrow (since I need one NOW, not when UPS gets it here in a week or two) to see what they have in stock and what they recommend. I have to guess that going to WalMart - 4 days after a THR - on "Black Friday" should be quite the experience, if not bordering on suicidal. Hope I get through it without getting further injured by the crowd.

I'm confident I'll get more sympathetic, more and better medical advice from the staff at the WalMart pharmacy than I got from the hospital staff. I doubt anybody else could be as unconcerned, uninvolved and uninformative as the hospital OT/PT girls and the rest of the hospital staff were. However, I must admit their focus on getting me out of their sight was singularly intense and remarkably focused.

I'm scheduled for a follow-up appointment with the surgeon precisely one month after the date of the surgery. I presume that'll be the 3 minute-long "final kiss-off" appointment and so I'm not filled with reassurance about forthcoming help or support from that quarter, either.

Oh, well. Hopefully nothing major will go wrong and I won't have to impose on any of those useless cretins for any real advice or help...

 

[PlanetJanet]

Wow, I am so sorry! I can't help with anterior restrictions because I didn't have that, but I can tell you this : get a grabber, a dressing stick (nothing sadder than sitting and staring at your underwear, wondering how to get it on) and a sock puller. The shoehorn I could take or leave, but I don't use them anyway. And if the commode frame works, that's nice, but I like the raised toilet seat. Take care tomorrow, Walmart on Black Friday would have scared me at best, the only good thing now would be that I have a stout wooden cane (my father built it and I think he was thinking of a shilleleigh) to smite others with. Keep reading and posting and I'm sure there will be lots of help offered. I'll be thinking of you.

 

[Damn!]

Cal, I'm not sure where you are located, but you might want to shop at Walgreens or CVS tomorrow instead of WalMart. I have found that Walgreens has more assistive devices then WalMart. Additionally, some of those types of stores actually have online ordering and a home delivery service. Worth a shot. I hope this helps..

Please take care. Don't be afraid to call on friends or neighbors if and when you need help.

Happy thanksgiving and please let us know if you have any questions.

Tammy

 

[sharonslp]

Cal, I bought the cheapest sock aid I could find ($10) at my local Meijer store (which is like a K-Mart/Target/etc), and it worked just fine. Also, I was discharged the next day after surgery, which was fine with me. The hospital was overcrowded and understaffed, and as long as I could get out of bed on my own, I knew I'd be fine. So will you. If you can even think about going to Walmart now, you are absolutely able to take care of yourself.

With an anterior approach, there aren't really restrictions. Most of us who weren't anterior are told not to cross the midline of the body and not to bend more than 90 degrees. If you have any questions or concerns, call your surgeon's office tomorrow (hopefully they are open on Friday this week) and simply ask. Listen carefully to your body. If something hurts, don't do it. Get lots and lots of rest. Use ice, elevate, and stay ahead of any pain.

You are already over the worst, and in a week or two, you will be amazed at how far you've come.

Sharon

 

[Jamie]

Damn! is right. Try Walgreen or CVS (I'm assuming you're in the USA). Also, look to see if there are any home health agencies in your area. They make home visits and help you with recovery and therapy. They will do a home assessment and make recommendations as to what you might need. If your city or county has an office that assists "older" residents, try that as well. YOU CAN GET HOME CARE!!!

Since you are 66 years old, I'm assuming you are covered by Medicare. Contact your GP or surgeon and tell them you need an order for this home care assistance. That way Medicare will pick all or most of the cost. They will also cover some of the aids you need, but not all.

Your hospital should have had a social worker who helped you with this before you were discharged. You also can contact the hospital and ask to talk with the Social Worker. That person should be able to help you too. Don't give up. There are resources.

 

[Poppet]

Sorry cant help you with advice re the US system Cal, but just dropped by to lend some support from down under!

 

[Jaycey]

Cal, so sorry you had a bad experience in hospital. But the good news is it's all done and dusted and you can now get on with recovery. Jamie is right - get in touch with your GP and get help with arranging for some home assistance.

Having said that - I was alone for most of my recovery. A good grabber and some frozen meals are all you need. You can already move around on your own. And you approach "if it hurts don't do it" is exactly right. Ice and elevate when you can to keep the swelling down.

Take care and do let us know how you are getting on!

 

[nerdgrrl]

Hi Cal- I had a RTHR by anterior approach about two weeks ago, so I'll try to help you out with protocols. These are my surgeons preferences. Not all surgeons have the same protocols, but they are pretty similar.

As Sharon said, for anterior approach, There basically aren't any restrictions, but if it hurts don't do it. My surgeon prefers I don't sleep on the operated side until further out, nor does he want me to sleep on my stomach or hyperextend my right hip. Basically, let all those muscles and tendons on the front of your hip get some rest the first week or two. I found I didn't need the elevated toilet seat, so if you are able to get by without it, don't bother installing. If you have installed it, it will probably make your first week a bit easier.

You will probably need to assist yourself with lifting your right leg into bed for the first week or so. They gave me a special strap, but really if you have a sturdy bathrobe belt that will work. You kind of fold it in half and flip the loop over your foot, then use that to help lift your leg. Alternatively, hook the foot of your good leg under your operated one and use the good leg to help lift the bad one into bed.

For the first few days to a week ish, you probably want to elevate your leg and ice your hip as much as possible. The times you have to get up for food and toilet will probably be plenty of exercise. I can't help you with the dreaded TEDs since I struggled with those as well. Since I had the luxury of help with the TEDs, I took advantage of it.

Also don't cross your legs. That is not for hip restriction but for blood clot prevention. That restriction is for as long as you are on blood thinner.

You are only a couple of days out of surgery, so this will be the worst part of it at home. You will start to improve every day, but you might not notice it so much at first. Oh, also, you will see it all over the place here - keep the pain under control, it will help you heal better.

I hope that helps. I'm so sorry you had such a terrible experience!

 

[Cal]

Thanks to all for your inputs. One question, though -- what are "TEDs"?

 

[Poppet]

Hi Cal,

Ted's are anti embolism (to prevent clots) stockings specifically designed to speed the blood flow by providing graduated compression at the ankle and gradually diminishing the pressure up the calf. They come with or without toes.

Some surgeons order them, some don't for post surgery.

Before I went to theatre, the nurses put them on me, but when my surgeon saw them he made them take them off. Then post surgery, he said to me that I didn't have to wear them because I was having blood thining injections for 6 weeks and that was sufficient..

There are lots of different opinions with Teds.

 

[sissy46]

Good grief, Cal, I am shocked they threw you out like that. When you add your surgery date to your signature, it might be helpful to others in your area if you add the name of the hospital and surgeon. Just saying....

TEDs are compression stockings. If you can't get them on, be sure you elevate that operative leg as much as possible, toes above nose, to keep the swelling down.

I also had the anterior approach and I had TEDS for the first day in the hospital, but once I got them off to shower I never put them back on again. I had no restrictions at all, was told I could sleep on my operative side once it was comfortable. OT tried to give me a grabber, a sock helper, and a shower chair but I turned them down as I didn't need any of that stuff---could put my socks on and also reach the floor to pick up anything, but I was pretty flexible to begin with. I did go home with a walker, which I used for a couple of days, then had a friend drive me to Walgreen's for a cane and I never used the walker again.

It doesn't sound like your case manager did an adequate job for you. I also live alone and in a second floor condo, and did not want rehab, and based on your experience, probably wouldn't have qualified for in-pt rehab anyway. But PT and a home health nurse (from Gentiva) came out the date after I got home, which was a Saturday, to evaluate me. Do you have the phone number for your PT company? You should, and you could call and see when they're coming.

Please don't go to WalMart today! Even able bodied people get stomped to death in WalMarts on Black Friday! Anyway, you need to be resting, staying ahead of your pain, elevating and icing.

I think you're going to be surprised at how much you're able to do in a very few days. Of course you're frustrated---who wouldn't be after the way your were treated. But you've come to the right place for support and information. Yay, Bone Smart!

 

[nerdgrrl]

On the other hand, I found the grabber pretty useful for about the first week and a half. I guess I am less flexible than sissy ;). See what you pain level is when bending down to pick stuff up. If it is not too bad, then you could skip it.

I hope you can get in touch with your in home PT/OT soon. They didn't provide me with any of that, but I felt they did pretty well in hospital explaining things, plus they knew I had help for the first week.

 

[dede62]

Sheesh your hospital stay and instructions were as helpful as Foggymama's emergency entrance and exit! I am so sorry that you didn't get the care you deserved after this major surgery. I would definitely contact the hospital administration and let them know how poorly things were arranged (or not) for you.

I didn't have the anterior approach but several others have. Nerdgrrl's assessment is very thorough and on point as she is doing great yet not overtesting herself 3wks out. There are several others that had that approach so you should find some good reading in some of the recovery posts.

I certainly hope you are getting some in-home visits of some sort - at least a nurse to deal with the blood thinners and wound/dressing changes. I wouldn't hesitate to contact my insurance company as well for things that are covered and should be offered post-op.

Best of luck with this, and keep in touch here on the board. You will find that we are a kind, supportive bunch and only wish you the best. Ice, elevate, and keep to the pain med schedule.

 

[Cal]

Many thanks to all for your inputs, support and well-wishes...

Meanwhile, back @ my end of the stick... The roving PT lady came by @ 10am on Black Friday. She was actually OK; did an extensive analysis/eval, gave me 4 exercises to do & actually put me through the paces, showing me how to do them instead of just handing me a printout and bolting. She also told me what my "PT goals" (i.e: the level of accomplishment @ which they'll discontinue the @home PT) were, set up appts for next week & left a msg for the roving OT lady to stop in to see me also. She and the surgeon have been the only 2 truly helpful people I've dealt with so far - all the rest have been a string of pretty much non-positive experiences.

Well -- at least it appears that this experience has bottomed out, leveled off & isn't continuing to worsen. That's the single happiest development yet.

One comical aspect... I don't need the costly commode that was provided (& is therefore being taken back). But - owing to my overall stiffness & the pain caused by reaching for my R foot, putting a TED/sock/shoe on the R foot is impossible & I truly do need a sock aid & a grabber but those (of course) aren't provided. Fortunately, I can make a sock aid from materials I have @ home & the grabber isn't expensive. It is nonetheless typically asinine of Medicare (i.e: Govt) to automatically stick the costly, unrequested & unneeded item in my face but then refuse to give me the low-cost items I really do need when I ask for them. It boggles my mind. The Director of Medicare must be Groucho Marx and their executive mgmt team must be the old Monty Python troupe.

Oh, well... I look forward to next spring, when this whole thing will hopefully be a rapidly fading memory.

 

[oldyellr]

Cal, before I went in for my operation I had a thorough pre-op consult at the hospital where I was provided with a booklet and instructions on everything I'd need and where to get the items. In my small town of 38,000 there are half a dozen such medical stores. Much of the stuff was loaned to me by friends, but I did have to buy a sock aid, reacher and cane. I was advised not to get the cheapest sock aid because it was a bit flimsy and would tend to twist sideways. You could probably make one out of a piece of PVC pipe.

My discharge from hospital was not as traumatic as yours. However, our first stop was the drug store to get my prescription pain and blood thinner pills. I waited in he car while my daughter went in. When she finally got back, I was shocked that the meds had cost $185 and she had to use her bank card. I realize that's not a lot on a doctor's salary, but it floored me. We joked about selling the pills on the street to recover the cost.

 

[dede62]

John,

Funny my hubby said the same thing. And my refills for the anti-nausea are more expensive than the actual pain meds..

Only joking folks. Don't report us to the DEA or anything...

 

[Cal]

I guess I'm missing out on at least some of the fun, good times and laughs here because I'm using buffered aspirin and nutritional supplements for blood thinning, no anti-nausea drugs and my prescription coverage picks up the good majority of prescription costs. The only hole in my prescription coverage was the program exclusion of Celebrex but I'm using the CVS generic equivalent of Aleve, so my cost there is pocket change. Overall, I definitely can't complain about prescription costs.

 

[oldyellr]

My pain pills were Tramacet (37.5mg Tramadol/325mg Tylenol) and blood thinners tiny little pills called Xarelto. After deciphering the receipts, it appears that my drug plan only covered the latter. The actual cost for 26 of those little suckers was $257 and I had to pay $100 of it (my deductible for the year). That's crazy when maybe a couple of bucks worth of aspirin may have done the same job. It's also crazy that my drug plan would not have covered the pain pills because they're certainly not an over-the-counter drug, but an opioid. Anyway, there's a whole lot of information on this site about all the various pain killers and muscle relaxants.

 

[Kev's wife]

Just wanted to chime in with kudos to the hospital where my husband had his surgery. In the gift shop, they sell a "hip replacement kit" which contains all the tools necessary for your recovery: grabber, sock aid, etc. And it wasn't any more expensive than buying them elsewhere; possibly cheaper. We had already purchased a grabber elsewhere, but it never hurts to have more than one. Otherwise, it's always in the other place that you last used it rather than near you.

 

[Poppet]

Great that the 'roving PT' has turned out to be informative and helpful Cal, waiting to hear how the OT is?

I loved your following statements:

Well -- at least it appears that this experience has bottomed out, leveled off & isn't continuing to worsen. That's the single happiest development yet.

Oh, well... I look forward to next spring, when this whole thing will hopefully be a rapidly fading memory.

Next time you post, could you pop a signature in with your surgery details please, it helps us staff heaps, ta here is the link for instructions.

How to create a signature