THR Wide Awake - Mailman Chases Dogs Away

[Mailman]

Yes. The plan is to be wide awake from start to finish, just like last time.
Knowing now from experience how little there really is to fear, and having even greater trust in the surgeon, anesthesiologist, staff, I have relatively little anxiety about the procedure.
I'm looking past the surgery to as quick a recovery as last October. I'm not only more prepared psychologically this time but also in far better condition both physically and mentally having taken full advantage of having one new hip already.

 

[Pep]

Just read through your recovery journey from your first THR. Inspirational!

Godspeed for round two starting tomorrow!

 

[Mailman]

Surgery this morning went well! I'll be headed home before sunset.

This time my view during the procedure was not obscured. They used clear plastic instead of a sheet as a shield from my chest up, so I had a ring side seat and was more directly involved.

The procedure was already familiar from my prior THR and from YouTube videos. OHSU is a teaching hospital , so I had a 1 hour surgeon narration in details for the benefit of a fifth year resident, most of which was way over my head.

Since I was not strapped down as securely as last time I could raise my shoulders and head enough at times to see the area more directly. For instance I was able to clearly watch the hammer blows, see the retractors being placed, and the suction tube between me and the person directly in front of me using it to capture my excess bleeding, and also the final stitching. I was surprised to see how forcefully the surgeon hammers to set the cup in the pelvis and also stem inside the femur. Also how much the PA stretched the wound open so as to limit the incision to only about 3 inches.

Relocating the new head on the femur into the new socket was only a visual thing, there is no bodily sensation in that but I could see someone freaking out at any of these junctures, just the idea, if they were not prepared. But after my previous hip replacement, the experience of which continues to be a lifetime high, I had complete trust. I felt like a trusted member of the team myself, as they gave me much more liberty this time and included me directly at times, so there was never any room for fear or even concern about what was happening or going to happen during the entire procedure.

I'm looking forward now to another quick recovery. I know what I need to do to achieve that and will do it.

 

[Layla]

For instance I was able to clearly watch the hammer blows, see the retractors being placed, and the suction tube between me and the person directly in front of me using it to capture my excess bleeding, and also the final stitching. I was surprised to see how forcefully the surgeon hammers to set the cup in the pelvis and also stem inside the femur. Also how much the PA stretched the wound open so as to limit the incision to only about 3 inches.

Ugh...
Don't know how you do it, but you did. Safe travels home and best wishes as you begin healing.
Please keep us posted.

 

[trailrunner]

Geez, you are a brave person. As an engineer, I am fascinated by the process. As a person, I can't imagine watching this being done on someone else, let alone me. I am impressed. I don't use drugs, but I am thankful that we have anesthesia and I'm happy to take advantage of it when it's available.

Supposedly one of my relatives was awake during her hip replacement. This was about 10 years ago, and she joked with me about it. She worked in medical sales, or some related field, and she said she wanted to make sure they used the right product. She joked that she wanted to make sure that she received her commission for the sale.

 

[Mailman]

I'm not a particularly brave person. I was a severely degraded and weak person after 5 yrs avoiding a needed hip replacement diagnosed in 2019. I tried every alternative I could find to avoid surgery but by last October I could barely walk across the room with a cane and nowhere without. Mentally I was depressed. I couldn't stomach the thought of having my leg cut off and put back together but nor could I handle being a decrepit old man at 74 much longer.

After consultation I had a very low regard for the local orthopedic clinic (Slocum, Eugene OR) and the surgeons there. Basically I didn't trust them to be particularly concerned about anything except the money. But I was backed into a corner so I applied for a date for a THR. This was last Fall. In February they wouldet me know when they could schedule me for sometime in April, May or June.

I would likely be in wheel chair by then. But I also feared the possibility of cognitive decline from general anesthesia, even propofol, in older people already experiencing memory loss. There are legitimate studies about that. Slocum would not commit to a spinal so I went looking for and found a very empathetic surgeon at OHSU in Portland, which does 90% of surgeries with spinal anyway and agreed to not even using propofol aka 'Twilight' if that's what I wanted. Seeing the condition I was in he scheduled me in on a cancellation he received during that first consultation. Instead of 4-8 months I then had 10 days to do the research and decide whether to be awake or not during the surgery on October 18.

That's when I heard about and joined bonesmart. I only found very brief mention about being awake in two blogs but it was a start.
Layla asked how I could do it wide awake. Here is how.. I was forced into it by my fear of memory loss after seeing my mother decline decades earlier after a shoulder replacement under general. She never really recovered from that. I was afraid of ending up like her.

So I set to desensitizing myself by watching all of the bloody gory YouTube THR teaching videos for surgeons that I could find, over and over again. After maybe 20 hours of watching it was easy to watch (done on someone else!) but I was still undecided until the last minute in pre-op. I would have an IV and the anesthesiologist beside me to talk with. If I wanted to lose consciousness during the procedure then she would make that happen.

Turns out I didn't need that and had an experience of a lifetime.

So basically I avoided one fear of memory loss by overcoming another fear of surgery. A two for one.

The personal benefit of all of this has been enormous. I have better mental clarity now than before surgery. With the removal of the decrepitude and lack of mobility I have the body I remember from decades ago. In overcoming both fears I have increased my ability to use my mind for other more uplifting things. Like gratitude and compassion for the suffering of others I read about here.

Everyone likes to be told they are brave. I know I do. But I'm not especially brave.

In this blog I just want to demonstrate what is possible so that anyone who is as motivated as I was can have a better THR and recovery. That's all. With the right preparation anyone can experience a THR wide awake. The two I've now experienced have changed my life dramatically. I'm convinced that being fully conscious also improves recovery.

More about that if there is any interest but you should know that with a spinal the actual level of physical pain wide awake is no greater than getting a filling at the dentist wide awake. In fact what is injected into the spine is very closely related to novacaine and lidocaine but longer acting. To overcome the mental and emotional aspect, the fear, you not only need to desensitize your ideas about what you will experience and the reaction you think you will have but also should have established sufficient trust with the service provider. You will be an active participant not just a piece of meat that needs repair. Unfortunately, I believe that this level of trust is not deserved by most providers outside the public healthcare facilities such as state University Medical centers and teaching hospitals. Once again, not convenient or easy, but worth it.

This can all be daunting, but the reward, for me at least, someone with sufficient motivation, has been enormous; plus your wife will brag about you and people will tell you that you are brave, even if you're not. LOL.

 

[mendogal]

@Mailman
Just so you know, there ARE options besides propofol or awake.

My anesthesiologist for my second knee not only wouldn't use propofol, due to my age he wouldn't use the versed (short acting benzo) alongside the fentanyl - a combo I've had before for surgeries.

So I had the spinal plus nerve block in my thigh plus the iv fentanyl; I was totally out but the fentanyl clears so quickly and without residual that I was up and walking and headed home in no time!

 

[Mailman]

Good to know.
I try to avoid any kind of drugs at this point in my life. I probably have a high pain threshold and tolerance as I've been able to tolerate minor dental fillings without novacaine/lidocaine and two colonoscopies without anything to alleviate that discomfort.
I don't welcome pain and suffering of any type but also recognize that this is the stuff that, in large degree, our lives are made of. So I'm always looking for ways, not to avoid, but to transcend the inevitable.

 

[Layla]

Here is how.. I was forced into it by my fear of memory loss after seeing my mother decline decades earlier after a shoulder replacement under general. She never really recovered from that. I was afraid of ending up like her.

So I set to desensitizing myself by watching all of the bloody gory YouTube THR teaching videos for surgeons that I could find, over and over again. After maybe 20 hours of watching it was easy to watch (done on someone else!) but I was still undecided until the last minute in pre-op. I would have an IV and the anesthesiologist beside me to talk with. If I wanted to lose consciousness during the procedure then she would make that happen.

Bless your heart! This was very emotional for me to read. I hate to think of anyone being fearful enough go through the process of desensitizing themself from what I’ve heard described as a rather brutal surgery. I can’t imagine watching someone cut into my flesh, dislocate my hip and use instruments to saw and pound something in place of my natural hip. However, I certainly understand your concerns given your explanation. I guess you were comforted by the escape clause pre planned with the anesthesiologist to fade out if it became too much.
I still find it extremely brave and a wee bit crazy, lol, but we all have some of that in us throughout life. Thanks for documenting your surgery / recovery stories here. I am sure many will follow your progress with interest. Have a great evening and weekend, Mailman!

 

[Mailman]

Having been there yesterday morning watching firsthand unobstructed, I can tell you it is MORE than rather brutal. With all the cutting, drilling, reaming, pulling, pushing, prying, twisting, joint dislocation, hammering and pounding there is no more brutal procedure that I can imagine calling medical unless for some reason a new improved hip joint replacement technique also required drilling holes in someone's head and plugging them with jelly beans. It's almost that over the top. It's a lot rougher handling of the body than shown in the YouTube videos.

Considering the brutality of the procedure I would rather be present as one more active team member, as conscious observer, at a not for profit teaching hospital, rather than as an unconscious piece of meat at a profit driven business.

 

[Mailman]

At the end of two days in, for second hip I can foresee a faster recovery this time around. I have an easier time getting in and out of bed and have slept relatively well both nights. Unlike before, when I could only be flat on my back with the lounge doctor, which I'm not accustomed to, I am already able to sleep on both side and even stomach, which I prefer. So I'm getting adequate rest.
Out of bed I can test walk without even a cane in the house but of course use a cane for safety and front wheel walker when going out. Yesterday I logged a total of a half mile, broken up to no more than about 3 blocks at a time. No more than 500 feet at a time was recommended by the PT at discharge, but beyond that no limit beyond not being stupid and overdoing it.
So now comes the dreaded day 3. Last time, in October, I got no sleep on night 2, became extremely and uncharacteristically agitated and angry the following day and was visually hallucinating spider webbing on all surfaces in my field of vision, which I could touch and move around with the tip of my finger. Not fun.
I don't expect a repeat of that this time around.

 

[Hessian]

wishing you all the best with these peak inflammation days!

 

[Mailman]

(continued)
I attribute the difference between last October 18 when I had the first THR, and now, to being in much better physical shape. That first hip was 5 years degraded after diagnosis, to almost complete lack of mobility. I was seriously considering procuring a wheel chair. I was in sad shape not only physically but also emotionally and mentally.
In October, after surgery I got the news that although the second hip was not yet symptomatic, the xrays showed it was eligible and should be replaced as soon as I was completely healed on the first side.
With the first hip restored and the other still fully functional I've spent the past 3 months rehabbing our rental house, the sale of which is now pending.
I did this as much to rehabilitate my body as to rehabilitate the house.
It's working.

 

[Sohowarrior]

I’m astonished and also intrigued by this. You answered my first concern, which was having a back up plan with the anesthesiologist. I know this would not work for me at all. I also eschew Novocain at the dentist but this is not a filling! I guess my other concern would be watching if things go awry during surgery. A broken femur, for example, during implant insertion. Unanticipated excessive blood loss. Does that warrant going to plan B for sedation? Even if the surgery is relatively quick and seamless, I find the prospect mind blowing. And curious about how many surgeons are willing to perform surgery under these conditions. But thank you for posting. Super interesting. And here’s to a speedy recovery!

 

[amab]

You have an amazing story and I hope this second replacement continues to be easier than the first. Best of luck on your journey!!!

 

[Mailman]

@Sohowarrior:
The time in the OR both times was right around an hour and a half but the first half hour was setting up prior to incision and the last 15 was stitching up. So 45 minutes for the heart of the procedure. Not much longer than some dental appointments, and any pain and sensation completely blocked. Time in the OR went by quickly both times, but the experience was very different.

The first time was, well the first time. For me, not the surgeon. He had done at least a THR or maybe it was a TKR on one of the nurses at the hospital, maybe more who requested spinal but no sedation. I don't imagine many surgeons would be willing. It's much easier for them if you are under, but vice versa for the anesthesiologist.

Going in this second time I was thinking it would mostly be somewhat routine, just a rerun. I had been up since 2 am. It was 7:30 am. I was thinking I might just sleep through it.

Wrong! Not a rerun at all.

The first time the anesthesiologist was the head of the department. I don't know if the surgeon requested she attend or that was coincidental but she was great. Though she had very little to do, she sat by my side and kept me company pretty much the entire time. We had a good time talking. She answered all of my questions.

That first time I was securely strapped down across the chest, and with my arms out to the side, at my wrists, so that if I panicked and suddenly tried to move I would not interfere with the procedure.

There was also a sheet placed from my chest towards me to over my head. So I could only hear, not see.

Limited exposure for me and limited risk for the team.

This second time was completely different. The anesthesiologist was not even an MD, much less a PhD and department head. He administered the spinal but once in the OR I only saw and talked to him briefly at the start and one time during. He was there if needed but I think was mostly occupied doing other unrelated things.

I was again strapped across the chest and wrists but lightly with some wiggle room. Most significantly there was clear plastic for the drape. So I could not only hear everything this time but also see, including the area around the incision if I raised my head and chest up as far as possible.

I already had so much trust in the surgeon, his team, and even the hospital itself, for what they did for me last October, that these changes, demonstrating their trust, interest, and willingness for me to be so completely present there with them in our shared experience, really touched me deeply. It gives me a chill ( in a good way!) just writing about this now.

 

[Mailman]

@Sohowarrior:
If I haven't yet answered all your questions I'd be happy to answer them. I'm just starting day 3 now so it's all still very fresh in my mind, and I have plenty of free time.

 

[Mailman]

Day 4 begins.

Day 3 was a big increase in pain and discomfort but I was still able to get out and walk around the block. Once I got moving I felt better, but the painkillers packed into the wound when I got sewn back up have definitely worn off and reality has reasserted itself. At least I avoided crashing like with the first hip last October.

Being able to get adequate sleep and drinking lots of water to flush the bi-products of those painkillers I think has helped me to avoid the visual hallucinations and uncharacteristic anger I experienced last time on day 3.

Although I have severe burning pain right now at a spot halfway down my thigh on the outer side when I walk, I still have no pain at rest.

So I'm still optimistic that I will have a better recovery this time as I'm in much better shape after having regained mobility after October THR on hip 1 and for pain relief I'm only on 1000 mg extra strength Tylenol every 8 hours, as prescribed.

 

[Mailman]

Psychologically, now that my feet are back on the ground I'm reevaluating my experience being wide awake during the surgery. I'm not at all sorry I did it that way. I was prepared for the first round, and by the first round for the second, but the added visibility this time was perhaps a bit too much.

The experience of seeing ones body being pried open with retractors, strenuously beaten with hammers, pushed around and manhandled and finally being sewn up while the spinal was just starting to wear off was here and now real yet otherworldly. Like other peak experiences it took me out of my day to day existence in a way that will take time to absorb.

Ultimately the goal is to enhance healing and health so I will continue to evaluate it that way.

At the moment I am a bit overwhelmed by the whole thing.

 

[Mailman]

Day 5 begins

Day 4 was another down day. No pain or discomfort at all when at rest but when trying to walk there is intense burning pain localized at one spot mid thigh, near front facing and a second spot a little higher and more to the side. This just started yesterday. Before that I could get out of the house for short walks. Now I can hardly take even a few small steps. Would this be a traumatized nerve that decided to wake up? I have been following prescribed pain protocol of 1000 mg extra strength Tylenol 3x daily.

Yesterday while binge watching 'The Resident' , I reached the episode near the end of Season 1 that includes a surgery while awake story in the story line. Having just gone through that myself, the synchronicity was delightful. The reason for being awake was supportive of mine, so that was validating and it also brought up some issues surrounding awake surgeries that carried particular interest.

Though I'm eager to get out and walk, something is strongly advising me to spend another day in bed icing, elevating and watching Netflix.