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THR Wide Awake - Mailman Chases Dogs Away

I was told to, in the first couple of weeks, take a very short walk once an hour while awake.
Also that in the initial weeks (they were aware of my good health and fitness) "Less is Better!!!!"

The implant has damaged the bone but (hopefully!!!!) there's no fracture needing to mend, so the weight bearing is good for both helping the implant meld, so to speak, as well as general good health (deep breathing, circulation, muscle activation).
 
Mailman said:
What puzzles me though is that they get you up and walking hours after surgery and then shortly after that send you home, with no restrictions on movement and encouragement to walk as much as is comfortable. I expect that would not be recommended as the primary therapeutic following a crash.
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After most surgeries the patient is encouraged to get mobile quickly. The old idea of bed rest has been proven most detrimental to overall health. The need to move to prevent blood clots and overall decline is definitely of value. The gap in interpretation is the “as much as is comfortable” because we almost all end up overdoing it at some point. Our bodies send pain signals to warn us of possible damage. We need to be alert to evaluate these signs and take reasonable action.
 
Day 21 - 3 week recap.

Chart: Painkillers vs. mobility

Notes:
1. Only painkiller self administered wasTylenol Extra Strength 500mg tabs. However, anesthetic packed into wound allowed essentially pain free mobility for the first 3 days, hence the high miles. Blissful.
2. Meralgia paraesthesia then immobilized me for the remainder of week 1. Insofar as it only hurt when I walked, I chose to just sleep and rest rather than take the prescribed pain medication (gabapentin). Fortunately the Meralgia began to subside by day 8 and I was able to manage the pain by just moving around very, very slowly.
3. Until day 16, Miles is exclusively in simply walking (numbers taken from pedometer app). No PT or other exercises. Walking aids: 4 wheel walker first 3 days. Cane first 8 days. After that I get secure enough not to carry it around. From day 16 on mobility is not limited to taking walks. It's more everyday activity such as going to the store or out to restaurants, yardwork and house cleaning. However I'm not quite ready to say yet that short term recovery is complete. I'm still icing. I'm still not driving. My energy level is still not where it was before surgery.

Day. Tylenol in mg. Miles
1. 3000 0.87
2. 3000 0.49
3 3000 0.40
4. 3000 0
5. 3000 0
6. 3000 0
7. 3000 0
8. 1000 0.45
9. 0 1.00
10. 500 0.49
11. 500 0.25
12. 0 1.14
13. 0 0.69
14. 0 0.59
15. 0 0.42
16. 0 0.80
17. 0 1.52
18. 0 1.09
19. 0 1.51
20. 0 1.56
21. 0 0.83

I consider this chart as a helpful aid in staying out of the ODIC.
For example day 8 and 9 I stopped Tylenol too quickly while at the same time also doing too much walking and had to backtrack. The rest of the time has been smoother sailing.
 
I too tracked mileage and for activities like sitting (mine were knees, maybe more problematic for sitting in a chair), yardwork, etc I set a timer!
 
Some people seem to think that age is directly related to recovery time, that is, the older one is the longer recovery will take.

I think that physical condition (and mental/emotional attitude) is more an indicator of recovery time than age, and the optimum balance of adequate rest and efficient movement during recovery is the key to the fastest recovery.

Regarding recovery, when anyone says "we're all different" I hear "there's nothing you can do about it".

I think that's false, and also a disservice.
 
my OS said the exact opposite re: age and recovery time - ceteris paribus older patients recover quicker because they tend not to have as strong and severe an inflammation response as younger patients
 
Mailman said:
Regarding recovery, when anyone says "we're all different" I hear "there's nothing you can do about it".

I think that's false, and also a disservice.
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You are most definitely reading into it meanings that are not there.

Most people come here because they are frightened that there is something wrong. They have often been reading the absurd accounts online ("my neighbor's cousin had a hip replacement and was out playing golf a week later!").
Before we offer specific constructive advice, they NEED the reassurance that the norm is actually a pretty wide spread and that, yes, everyone does have a different recovery.

That's not " fated to one result." It's the reality. My second knee was MARKEDLY different from my first. Same me. Same surgeon.
Yet I immediately saw differences in the incision line and the dressing; the difference in patterns of inflammation and stiffness were apparent within a week and continued; and the two could have easily represented different people altogether. My attitude if anything was BETTER second time round (I avoided a repeat of a horrible drug reaction!) yet my results have not been overall as wonderful as the first, because, yes, every one is different.
 
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@Mailman You really are misinterpreting the statement, "we are all different." What we mean is simply this: every recovery is unique, so don't compare yourself to anyone else!

We each go into this surgery with different sets of challenges -- from how damaged the joint is, to our overall physical condition, to our mental health, to other medical problems and, yes, even to age.

Not only are we all different, but every joint is different -- even two hips/knees in the same person. My second knee was a much easier recovery than my first -- despite the fact that I was several years older and in slightly worse physical condition.

So yes, we really are all different when it comes to recovery.
 
@mendogal you wrote:
"Most people come here because they are frightened that there is something wrong. They have often been reading the absurd accounts online ("my neighbor's cousin had a hip replacement and was out playing golf a week later!").
Before we offer specific constructive advice, they NEED the reassurance that the norm is actually a pretty wide spread and that, yes, everyone does have a different recovery."

All very true no doubt. And moreover
I recognize and greatly appreciate the empathy and effectiveness of the care provided by staff here at this site.. knowledgeable bordering on angelic. Thank you! Being here has been a huge help in my own recovery and yes my two THAs have also been different, which has been instructive.

That said, it's all the suffering which I have a hard time accepting. It's difficult for me to believe that there is no room for improvement to be gleaned by looking at the very wide range of difference between one recovery and the next. Its difficult for me to believe that it's just the luck of the draw.

I know much of what I have said in this regard is dismissed as irrelevant or even annoying but I remain hopeful that someone has benefitted, that words I have written have reduced someone's suffering.

I started out by sharing my experience of being wide awake during surgery in large part to show that it was possible to not only overcome fear of the procedure but to turn it into a peak experience. At this point that seems mostly irrelevant even to me. The main event is the struggle through recovery which we all share.

I do wish that more people would share positive outcomes, not to judge or compete but to inspire with their account and perhaps find some very practical ways to achieve better, more joyful experiences.
 
Mailman said:
I started out by sharing my experience of being wide awake during surgery in large part to show that it was possible to not only overcome fear of the procedure but to turn it into a peak experience.
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I am so glad that it all worked so well for YOU. it was possible for YOU to turn it into a peak experience. Each one of us has different physical and mental resources to draw from. My surgery was smooth and recovery was steady and ok for me to manage with the support of my family and medical team. Others here struggle with anxiety, depression, lack of financial resources and support. I admire their determination to keep moving forward. I don’t believe that trying harder will get them past all these difficult challenges and turn it into a “peak” experience. It was interesting to hear your story and understand another path that can be taken.
 
@Freyagirl I'm not advocating for being awake during surgery. In describing my experience I'm trying to point out that reducing both the fear of surgery and the stress of unmet expectations during recovery are not only both possible but will actually speed up recovery. That is my lived experience. The mind is that powerful in determining physical outcomes.

​

 
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Happy One Month Anniversary, Mailman!
I hope you have a nice weekend. :)
@Mailman
 
Mailman,
Trust me on this, if I could have been back at my normal lifestyle quicker I sure would have been & it had nothing to do with my mental outlook.
I was a very strong & active 70 year old woman when I fell.
I left the hospital BELIEVING in 30 days I would be running around with the dogs again & back at my job.
But it wasn't like that for me.
Not for lack of trying that's for sure.
There were days I was downright mad at the world for my situation & then had to learn to accept my "new normal" for next few months, and now I am totally fine but it was a longer road for me.
I appreciate all your additions to the conversation here because it gives others the opportunity to see there are choices when heading into surgery. I've had quite a few surgeries in my 72 years & I'm never afraid of the surgery. I was awake for birth of my 2nd son by C-Section cause had a spinal block.
Just never gave being awake for anything else a consideration.
But by you sharing your experience we now have an entirely new perspective & I thank you for that.
 
@myglasshalffull you wrote:
"Trust me on this, if I could have been back at my normal lifestyle quicker I sure would have been & it had nothing to do with my mental outlook...
I left the hospital BELIEVING in 30 days I would be running around with the dogs again & back at my job.
But it wasn't like that for me.
Not for lack of trying that's for sure.
There were days I was downright mad at the world for my situation & then had to learn to accept my "new normal" for next few months, and now I am totally fine but it was a longer road for me."

@myglasshalffull , What I am trying to communicate about the influence of mindset on healing has nothing to do with either believing or trying harder. Instead, it is a prescription for simple observation of, and acceptance of, a recovery devoid of expectation, judgement or competition, especially competition with oneself.

This prescription has a basis in the body biochemistry. Here's how::

Stress Hormones: Stress elevates cortisol and other body chemistry which can suppress the immune system, hindering the production of beneficial cytokines needed for tissue repair. Additionally, these hormones can prolong inflammation, which while necessary initially, can become counterproductive in the long run.

Positive Chemicals: Positive emotions and a strong recovery mindset with more easily achievable expectations, can promote the release of endorphins, natural painkillers that improve mood and pain tolerance. Endorphins can also indirectly contribute by improving blood flow, which delivers essential nutrients for healing.

By managing stress and maintaining a positive outlook, you can influence the biochemical environment in your body with a positive feedback loop instead of a negative one.

Fight or flight and the release of adrenaline and cortisol will seemingly be an appropriate response to the severe attack on the body that must occur during the surgery. More so if completely unconscious during that. But it is not helpful to continue in that mindset during the recovery that follows.

Again, I'm not advocating for anyone else to experience a THR awake. But for me the actual surgery was not an assault, and certainly not a mystery I would have to wake up to, or a nightmare to imagine. It was a rescue from chronic pain, a rescue that I contributed to as a team member in real time with enormous gratitude and appreciation, made possible by mutual trust.

So no need at all to fight or flee. Leaving the OR, victory was already mine.
 
Thanks @myglasshalffull. I must admit I like watching it too but more than that I hope it inspires others to ask what contributed to a faster recovery. After all, if I, as a 75 year old man can do this, than perhaps others should not so easily settle for less?

Here is what I believe has contributed to my recovery..
1. Surgeon care, as in care taken to have the least impact on the body, from size of incision to retraction of muscles and especially nerves, specifically the LCFN so as to minimize Meralgia Paraesthesia (during anterior approach), minimum application of reaming, drilling and the pounding required for press fitting, avoiding unnecessary mishandling of the leg during dislocation relocation of the ball and socket. All surgeon care is not equal. Some surgeons are more motivated by empathy and some more by money. I was very fortunate to have the former.

2. Surgeon skill, as in technique and accuracy, from knowledge and experience. Manual dexterity. Some surgeon hands are more talented than others.

3. Team members too!- their skill and care as well as teamwork, rapport and respect for the surgeon as team leader (my own observation during surgery).

4. The patient going in- Relationship with surgeon, staff and facility; optimum weight, muscle strength, balance and tone; degree of degradation of the joint being replaced. A positive attitude as well as a larger before and after difference due to a larger degradation of the joint can make up for a more badly degraded joint and poor muscle tone.

5. Type of anesthesia. Short term affects, length of hospital stay, immediate post op experience, blood loss, complications, according to peer reviewed studies indicate that spinal is significantly better than general, which thankfully is used less and less as time goes on. GA is clearly used now for the benefit of the surgeon to the detriment of the patient.

6. Patient mindset- level of fear, trust, expectation, victimhood, gratitude. Mindset produces body chemistry, for example cortisol, dopamine, and endorphins. Affects healing in a positive or negative feedback loop at the physical level. Also, integration of mind and body, that is, if I consider body as something other than 'me', the result is unhelpful to recovery as this sets up competition in which both sides can't help but loose. Also realistic expectations, ability to accept what is with grace, ability to observe what is without judgement, ability to be playful with the challenges as they arise, all contribute to a better outcome.

7. Social support, emotional support. Like being here! Also post op care and caring and support from surgeon and surgical support team.

8. PT- degree of, competency of, necessity of. Avoidance of. Usually more harm than good. My only exercise was walking, even when I really didn't want to, as much as I could, without ever overdoing it.

9. Painkillers- type and amount of. The less the better. In dealing with Meralgia Paraesthesia I found that neuroplasticity requires some exposure to tolerable levels of pain in order to reduce it to a more tolerable level. In other words, during MP for about a week I took only about 80 small painful steps a day and resisted opioids. The brain adapts better and quicker to unadulterated experience.

10. Exercise and activity- in an optimum balance with pain medication and restful sleep and relaxation. Exclusively, or at least primarily, at least until well into recovery only 'exercise' is simply walking and moving around, while continuing to develop the muscle strength and posture required for optimum gait and general movement. Especially important for quick recovery is optimum gait which must be learned. Gradual, consistent increase of activity to as much but not more than the body can handle without having to send the mind pain signals that say 'Stop!'. The best day is the day that is better than yesterday no matter how small the difference.
 
I really LOVE your statement, “The best day is the day that is better than yesterday, no matter how small the difference.”
 
my jaw dropped seeing your flexibility in the video, amazing!
 
@Mailman, I've enjoyed reading your observations and the documentation of your experiences.

I definitely balk at opting to watch my own surgical proceedings. Your tenacity to do so, for the reasons you expressed concerning your mother's cognitive decline years before due to anesthesia, are understandable.

My way too long delay in opting for THR's was due to my 56-year old sister's passing within a couple days of her first elective THR. A post mortem wasn't performed, so the cause will remain unknown. A blood clot was guessed. But the facts surrounding her demise, may point towards more of a breathing stoppage due asthma and perhaps opiates; so, NOT something that the general population including myself, should be concerned about.

Along the same lines and related to you, my dad had an elective THR over 40-years ago with a positive outcome. As you, he didn't want to be anesthetized and talked about watching the precedings reflected in the overhead lights.

I've re-read your first and then 2nd. THR sojourn, specifically viewing your medication (or lack of it) regime.

For my 2nd. THR scheduled Sept., 9, my goal is to NOT "stay ahead of the pain" per the generalized mantra, by unnecessarily overmedicating. This go around, I’m more interested in medicating only if I need it!

With my June, 17 THR, I mindlessly heeded the conventional "stay-ahead-of-the-pain advice". I was given 10-mg Hydrocode and advised to take it every 4-6 hours. Thus, as soon as I got home the day of surgery, I began taking 10-mg of Hydrocodone every 4 to 5-hours. Doing so, told me nothing about the pain that my body was experiencing.

The opiate left me in a fog and a daze, which is a state not to my liking. I prefer to be me. With opiate induced GI motility slowing, Colace and Miralax became necessary. Upper digestive issues also ensued and were compounded by esophagitis, probably because a couple of my daily pills stuck before entering my stomach. This was because I was limiting my liquid intake because of far too frequent (every 1 to 1.5 hours) urination runs to the bathroom. Nexium at 2 per day, came to the rescue for the upper GI issues.

Thus, with your noted minimal medication regime and with a nurse friend’s mentioning having her THR patients ONLY on Tylenol (which sounded like your plan), I plan to delve into the specifics of how she handled her patients, before my next (LTHR) surgery on 9/9.
 
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