THR Wide Awake - Mailman Chases Dogs Away

[trailrunner]

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.

I told this anecdote on my pre-surgery thread, but it's appropriate here, so I'll tell it again:

When I met my surgeon for my first visit, we concluded that a hip replacement was the best course of action. He was patient with me, and when we were finishing up the discussion, I said: "Well, that's it then. I guess the next I'll see you will be in the operating room. Please be gentle on me." He said: "There's nothing gentle about this procedure," and smiled.

I really liked him.

 

[trailrunner]

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

"Overwhelmed" is a common feeling.

Before my surgery, a friend had her hip replaced a few months before me. She was a calm and optimistic person. She described the first week as "overwhelming."

I was blissfully asleep during my procedure, but I also found it overwhelming for the first week or so. It's pretty hard to understand that our body can be unzipped and then undergo all the things that happen during surgery, then zipped back together. We can be given chemicals so we don't feel it, and don't remember it. I was there, but I wasn't. I was there just until they told me to go to the side of the bed and curl up in a ball. That this is routine and that I was one of a dozen patients in the center that day (if not more). That the doctor and nurses have already forgotten about me, but to me it was one of the biggest days of my life.

Objectively I understand all of that. But in some ways it's still difficult to comprehend.

 

[Freyagirl]

It certainly sounds like you are having a somewhat different experience with your second surgery. It’s hard to predict ahead of time what each recovery path will be like. I agree that a positive attitude can help with recovery and a defeatist approach may slow recovery. I feel very fortunate that I mostly was able to keep a positive mindset and recovery has gone well. I did NOT have 2-3 days of pain relief packed into my surgical site. My pain right after surgery was high for a few minutes and then relieved by IV pain killers- so not everyone will have a couple days of delay. It’s always good to have multiple viewpoints for folks seeking a path that works for them. I hope that recovery continues to go smoothly for you.

 

[Mailman]

Thank you @trailrunner . I needed to hear that.
I must be pretty dense. It took not only being ON the table but also AT the table for me to be so deeply affected.

 

[Mailman]

@Freyagirl I'm very surprised you didn't get the free pass for day 1 and 2. I thought everyone got that. Maybe someone more knowledgeable than I can explain why that pain relief is not universally applied?
Damn shame. I hate unnecessary suffering.

 

[Jamie]

@Mailman….in answer to your question about pain management, the injected pain medications are a relatively new procedure (within the last 10 years) that has proven to be very good for patients to help manage post-op pain. But unfortunately some surgeons choose to stick with their “tried and true” procedures and either not keep up with or maybe just not adopt newer ideas. We recommend that pain management is one topic BoneSmarties should discuss with their surgeon during their initial consultation for just this reason.

I do recall reading your recovery thread for your first hip and I appreciate that you are taking time to tell your story of having surgery while awake with both your hips. While not for everyone, I can understand and appreciate the reasons behind your decision and the work you put into finding the right medical team to work with. While I personally would not want to have surgery without being asleep, I can relate to your concerns about the effects of some of the medications on older people. I, too, watched my mother come out of her hip surgery as “different” and she never recovered from that mental loss. My experience with her was back in the late 1990’s and I know that MUCH has changed in the world of anesthesiology. So, I was not concerned about it as I had my discussions with the doctors in preparation for my joint replacements. I believe the medical world has learned a lot about how to better use the drugs that are available today.

For decades I never took any numbing agents for dental work. I was fortunate to have two dentists during that time who agreed to this for fillings and crowns. To me, the pain was short-lived and just barely uncomfortable. And my reward was not having a numb mouth for hours when it was over. I hated that! One of the dentists who agreed to work this way told me the process was actually much harder on him because he was always concerned that something would happen to cause me great pain. Maybe it made him a bit more careful in how he worked….I don’t know….but I never had a problem. My current dentist did this for a while, but then talked me into trying the newer numbing medications. Wonder of wonders, it actually was much better than I expected and the numbness is actually very short-lived. So, I guess there have been advances in the world of dentistry too.

I respect you for your approach to your surgery. I’m glad you didn’t wait with your second hip. Please know that this recovery may be a bit different than your previous surgery for no other reason than it happens that way sometimes. It sounds like you’ve got the recovery process under control, though, and I think you are wise to listen to your “gut” feelings that you need a little extra down time right now. That’s the one bad thing about the injectable pain meds…..people tend to feel so good right after surgery, it’s easy to push the activity a little too much sometimes. It will be interesting to hear how things go for you in the coming weeks and months. Hopefully you’ll be back to full speed quickly. All the best to you.

 

[myglasshalffull]

Congrats on Hip #2 & doing it "your way." I commend you, I'm not that brave.
I can definitely go the absence of Novocain for dental work, but major surgery, give me the drugs! LOL!
I had nerve block for my ankle surgery 5 years ago, it was delightful. Everyone kept telling me to use the oxy I was prescribed and "keep ahead of the pain." A term I wrestled with. If I'm not in pain, what am I keeping ahead of. I did oxy a day or two but it made me nauseous. It was a fairly pain free surgery even with 3 fractures in ankle & screws, pins & rods. However, not being able to walk & having a cast was not fun.
Fast Forward to my hip which was not scheduled, a fall on ice & fact I went on vacation thinking nothing was wrong & just bruised badly my hip surgery ended up 1700 miles from my home. Fortunately I was in US territory & had US doctors. But no time to ask questions or prepare. I remember getting fentanyl & mask over my face & asked to breath in deeply & off to never never land I went.
I woke up in pain so I'm guessing no pain reliever was issued into area before closing.
I was up & walking & happy about that & pain I was experiencing prior to the surgery was much less, a bonus. I walked the halls of that hospital relentlessly so I could get discharged & back home, I just wanted to be home. I flew home 4 days after surgery. It was tough sitting on plane for 4 hours but one of the flight attendants was aware of my situation and he told me if I needed him to use bathroom or anything else he'd help. Then one hour drive home, I was so stiff & sore when I finally arrived at my door.
I remember crying & saying I was afraid.
Good nights sleep in my bed & next day I was up making a pot of coffee & enjoying my kitchen. I couldn't sit for long periods but I could stand at counters in my kitchen & even make a pot of chicken soup with store bought rotisserie chicken!
I found BoneSmart after a few days, Thank goodness cause I probably would have thought I was one crazy lady. What comfort this site has given so many of us. We all have different experiences but by sharing them here we all have a commonality like no other. Whether you recover in 3 months, 6 months, a year or still on recovery highway, this is the place to be.
I wish you another amazing recovery & thanks for your very honest contribution on both experiences.

 

[Freyagirl]

@Freyagirl I'm very surprised you didn't get the free pass for day 1 and 2. I thought everyone got that. Maybe someone more knowledgeable than I can explain why that pain relief is not universally applied?
Damn shame. I hate unnecessary suffering.

My surgeon said that it gives a false sense of recovery and folks overdo it rather than rest. I used low dose Oxy for the first week and then was only on Tylenol. The pain was very manageable within a few minutes of waking up from my spinal.

 

[Pep]

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.

I have this pain and burning too. It is called Meralgia Paresthetica. My experience is recounted on my thread.

Sounds like you eschew many meds but if you are willing to take Gabapentin, it is helpful. I'm down to 1 or less 300mg tablet per day- usually in the wee hours of the morning and it tides me over through the waking up stiffness.

I'm two weeks out. PT knows about the symptoms and recommended desensitizing massage. So I have been in the hot-tub at the strongest jet for the past 3 days since my scar is healed enough now.

And I bought compressive thigh sleeves from Amazon which I am wearing along with a knee brace (since my knee is also kicking up since the surgery- I think that is d/t gait changes). The constant light pressure of the thigh compression relieves the symptoms entirely while I am walking.

Lidocaine patches, and icy hot from dollar tree are relieving. Icing and elevating is helpful. The condition is caused by compression of the lateral femoral cutaneous nerve (the surrounding tissues are traumatized). My doctor said the vast majority of anterior THR patients have this symptom for awhile after surgery. It is a sensory nerve and does not affect mobility.

 

[Mailman]

@Jaime I was both sorry and surprised to hear that we share similar stories from the 90's about our mothers. Dementia was the concern motivating the character on that episode on "The Resident" I mentioned. She opted to do surgery awake instead of not at all (and die), the indication being that general anesthesia and dementia remains a public concern.

My aim at bonesmart is getting through my own THR as successfully as possible, by putting that experience on record for anyone who might benefit it, for any purpose whatsoever including general interest.

For myself it's been a big help to have it all saved for recall and comparison while going through this second round. Responses from other perspectives have also been a big help in understanding and processing the experience. So I really do appreciate everyone who has supported my story telling, especially the dedicated and knowledgeable staff such as yourself @Jamie who make bonesmart.org possible.

Because it's so not normal, I recognize that I may be perceived as advocating for having surgery while awake as somehow intrinsically better than being sedated. I'm not. It's nothing more than this is what worked for me.

I do want my experience to be understood for what it was and not what someone might be afraid it would be for themselves, so that the option of being wide awake can become more readily available. Knowing how both stubborn and fearful I was, if I didn't have the choice, I might still be suffering, with no mobility other than a wheelchair.

 

[Mailman]

@Pep
THANK YOU SO MUCH FOR THIS !

 

[Mailman]

,

My surgeon said that it gives a false sense of recovery and folks overdo it rather than rest.

That makes perfect sense. Having no pain at all the first 2 days was deceptive and I did take advantage of the free pass to walk quite a lot but that's what I was encoutaged to do. So I guess there are two opposing views on this and it comes down to being able to judge what overdoing it means in each particular case.

 

[Mailman]

@Pep : you caught my attention and lifted my spirits with this solution for the intense burning thigh pain of Meralgia Paresthetica..
"The constant light pressure of the thigh compression relieves the symptoms entirely while I am walking."

Unfortunately I've spent the afternoon looking everywhere for thigh compression sleeves or wraps and can't find any locally. Order delivery is 3 days out.

But I came up with this. Still testing but seems to be working adequately well.

DIY Thigh Compression Sleeve:
1. Ask your wife to sacrifice a pair of tights.
2. Get a pair of scissors to cut the feet off if necessary.
3. start with 1 leg of tights and raise it entirely to your thigh.
4. Raise further and arrange folds for desired compression and placement.
5. The other leg can be used to wrap around for additional compression. Or you can start all over with one leg of the tights placed inside the other to double the compression from the beginning.

 

[Mailman]

Day 6:

Day 6 was third consecutive day mostly resting in bed with no pain but unable to hardly walk due to what I now know, thanks to @Pep is called Myalgia Paresthetica, a localized, very intense burning nerve pain on the front of the thigh that is caused by a compressed nerve, the lateral femoral cutaneous nerve (LFCN).

Apparently this is very common during recovery from a THR.

Not fun! but it just means another day of inactivity.

Now starting Day 7, instead of creating conflict between mind and body with the sword of impatience, as if there are two me's, I'm going to focus on gratitude for the life I have.

 

[Pep]

...I'm going to focus on gratitude for the life I have.

Great attitude, Mailman!

 

[Layla]

Sorry to read you're struggling with pain, Mailman.
An article from the BoneSmart Library that you may not have read - Meralgia Paresthetica
I hope you have a peaceful evening.
@Mailman

 

[Mailman]

Read it.
Fortunately there is only pain when walking.

But I'm in a catch-22. Previously, for an optimum recovery I balanced amount of pain medication against amount of walking, gradually reducing the first while increasing the second without joining the overdoit club. That was my entire method for my recovery and it worked really well.

That is not going to work now when just about all the pain is directly caused by irritation and inflammation of the nerve from walking.
I probably need to find alternative exercise and include A NSAID, same as prescribed last time, but I'm still waiting for a call back from the PA before committing to a plan other than staying in bed all day.

@Layla or other experienced staff, I would be happy to hear your thoughts on this.

 

[Layla]

I’d wait on the advice of the PA. Hopefully you hear from him soon and get a plan in place that brings some relief. Staying in bed all day is not beneficial to recovery…as you know. Keep us posted…
@Mailman

 

[Mailman]

End of week #1:

@Layla: PA sent in a prescription for gabapentin this morning but I'm not eager to fill it.

I would prefer to figure out a way to desensitize myself to the pain. I remember reading about a Holocaust survivor. He became so adept at handling pain that after the war when he told his story he would demonstrate his super power by piercing himself straight through with a needle without hesitation.

I know. Just take the damn drug.

 

[myglasshalffull]

I so love your attitude Mailman.
My partner hates taking any type of medication, detests doctors, blood work, etc.
He "heals" himself holistically. You can laugh here.

I'm not one to take a lot of meds either, even Extra Strength Tylenol has side effects. If you watch TV & see all the drug commercials everyone is singing & happy until you start reading all the side effects!