Another surgery looms

For someone who enjoys relatively good health, I've had a lot of surgeries. And this month I will be going "under the knife" again, not quite six months after my hip joint replacement. This time, I will be undergoing a rotator cuff tear repair on my nondominant (left) shoulder.

The first question people ask is, "What did you do?" And how I wish I had a thrilling story to tell; one that climaxed with a dramatic injury necessitating surgery. Alas, my life is not that exciting. To illustrate just how NOT exciting my life is, here is how my doctor explained I came to have this rotator cuff tear:

"It's kind of like an old sock where, eventually, the worn-down area becomes a hole."

Old sock? Lovely.

The reality is, I've had tendonitis in my left shoulder for many years and, as my hip deteriorated--and I relied upon my upper body for balance and leverage--the pain (and the tear) have gotten worse.

Although considered "minor" when compared to hip joint replacement, I've been told that the recovery can be painful. One plus: we bought a new recliner, which is where I will be sleeping for awhile post-op.

Unlike a hip joint replacement, where the patient is urged to get up and move as soon as possible, a rotator cuff repair requires immobility to heal properly--and then physical therapy to restore range of motion and strength.

"Follow doctor's orders," those who have had this procedure tell me. Otherwise, more surgery will inevitably follow.

Point taken. After this one, my goal is to stay out of the OR for a long time.

Great resource

Happy New Year!

I've been spending a lot of time in orthopedists' offices so far this year--not for my hip or back--but for my upper extremities. More about that soon. But in the meantime, I wanted to share this website from the American Academy of Orthopaedic Surgeons. Very useful, easy-to-navigate site with lots of information. You can also search the membership directory to find a doc near you. Good stuff!

12 weeks on 12/12/12

It’s the holiday season and, for me, that means BAKING. In recent years, it also meant pain and limited energy ~ but not this year!

This is just one of the many tasks I am able to do – and enjoy – with my new hip joint.

As of today – 12/12/12 – I am 12 weeks post-op and moving right along towards a full recovery.

Physical therapy has been ongoing and, slowly but surely, my strength and range of motion are improving. The cane has been relegated to the back of my car and I am back on the treadmill, gradually increasing my speed and endurance.

I met with Dr. Wellman about six weeks ago and he officially released me from my precautions, noting that he was surprised to see that I was “on track” with my recovery. Given my unique situation, he had expected me to be lagging behind.

During that visit, I was shown my X-rays “before” -- depicting my tilted pelvis -- and “after.” Don’t ask me how, but Dr. Wellman succeeded in not only replacing my hip joint, but also leveling my pelvis!

The difference is dramatic. I can lie flat on my back with my legs extended – something I haven’t been able to do in a long time. I can carry things in both hands, out in front of my body, without struggling through each step. But most importantly, I don’t ache anymore.

Although I have resumed a normal routine, I still have work to do. The muscles in my right hip were inactive for years and it will take time to restore their strength and flexibility. But I’m headed in the right direction!

Getting busy ~ on a cellular level

Baby steps to a happy place. That's the mantra I've been repeating for the past four weeks since my total hip joint replacement surgery.

Despite all of my due diligence to find the right surgeon, I was completely unprepared for the slow but steady recovery I've been living during the past month. I have even lamented to Mark that -- maybe -- I shouldn't have gone through with the surgery. His response had been an emphatic "of course you should have ~ you were in pain!"

Good point. As Dr. Wellman promised, the joint pain is gone. But the surgical swelling and discomfort (and precautions) linger, hence my frustration.

Feedback from friends has been unanimous and encouraging. "You're so much straighter!" they exclaim. And that's good news for my flatback syndrome. The new hip will help loosen my hip flexors, which is key to minimizing my tendency to lean forward.

The most important thing, though, is that the surgery was a success. Dr. Wellman told Mark that my hip joint had been so worn down, he likely added about 1/4 inch of length to my right leg during the procedure. And, perhaps in response to my pre-op concerns, Dr. Wellman ensured that the new joint's placement was at the correct angle, moving it every which way prior to closing the incision.

So, I remind myself to be patient and, yes, each day things are a little better. I went upstairs after one week and graduated from a walker to a cane after two. Now I'm walking without the cane at home and, as of last night, can finally toss aside my TED hose. Consequently, last night was the best night's sleep I've had since before the surgery!

Yes, I'm bored. I hate being restricted to "light" activity and being dependent on others for the most mundane tasks -- like retrieving a fallen object, driving or making dinner for my family. But I need to allow time for my body to heal. My friend, Liz, said it best: "Sure, it looks like you're not doing much, but you're really very busy -- on a cellular level."

It is (almost) time

Early sedation.

What a wonderful phrase!

It means one less worry for me as I count down the final week before my total hip joint replacement surgery.

During my whirlwind of pre-op appointments last week, I learned that I will be “sedated early” – just as soon as I meet with my surgeon and he “signs off” on my procedure. As Tony, my nurse, explained, “I don’t know why it’s taken us so long to figure this one out. Sedate early, not for your sake – for ours. Because if you get anxious, we have to deal with you!”

This is huge. This means I won’t have to endure that gut-tightening gurney ride down the hall and into the OR where the combined assault of sights, sounds and sensations never fail to send me into a fit of uncontrollable shakes.

One less worry. And yet there are many more clamoring for attention: the possibility of post-op infection and blood clot(s); pain; dislocation of the new joint; mobility -- or lack thereof; preparing myself and my family for the recovery period (grocery shopping, bill paying, cleaning, gardening [yes, gardening ~ who knows when I’ll be able to pull weeds again!], etc.

And, of course, the biggie: will Dr. Wellman succeed in inserting my new hip joint at the correct angle? All the latest medical technology will be deployed to ensure he will, and he has assured me he will not leave the OR until he is satisfied that my new hip is stable. What more can I ask?

Until now, the whole idea of having this surgery has been a surreal blur as I’ve gone from one doctor’s appointment and/or imaging test to the next. Then one Saturday morning, at the ungodly hour of 5AM, I sat up in bed and thought, “You’re actually going to let someone replace a part of your body with a piece of metal and plastic? What are you thinking???”

“A part of your body that’s broken and doesn’t work anymore,” Mark clarified much later that day. Good point.

I replay that conversation with increasing frequency as these final days tick by. I still can’t believe I’m doing this. And I totally cannot imagine what life will be like with a pain-free right hip and a normal stride. But I am looking forward to finding out.

And the countdown begins…

My opinion of orthopedic surgeons is a matter of record. In a word: arrogant.

So it is with no small measure of surprise that I tell you how unconceited were the three orthopedists I have recently met in my quest towards hip replacement surgery.

In my last post, the first surgeon (Dr. David) admitted that he had no experience doing hip replacement in a “patient like me,” and he referred me to Dr. Bolognesi at Duke.

As often happens when I’m nervous, my anxiety had shifted into overdrive and, by the time I was in the exam room, I worried whether Dr. Bolognesi would recommend revision surgery before a hip replacement could be done. As usual, my anxiety was for naught.

Dr. B. immediately put me at ease.

“Hi, I’m Mike.” [he had me at “Hi”]

Both he and his resident (who had talked to and examined me before Dr. B. arrived) had obviously reviewed my X-rays, MRI and doctor’s notes before entering the exam room. Due to the forward tilt of my pelvis, Dr. B. said I would likely benefit from a new technology to help ensure the new hip joint was placed at the correct angle. He told me about his colleague, Dr. Wellman (great name for a doctor, don’t you think?), who was trained in Boston where the technology originated, and recommended that I confer with him.

Coincidentally, Dr. Wellman had had a cancellation and I was able to get an appointment for the next day [my friend Michele said that’s a sign from the universe, telling me it’s time to finally have this surgery].

Dr. W. proved to be as informed and thorough as Dr. B. Because he practices at Duke, Dr. W. treats some of the most complicated joint replacement cases -- often requiring reconstruction -- but in my case, the challenge is determining the correct angle. Therefore, my hip replacement surgery will require “more planning” than usual, specifically a CT scan beforehand. The results of that test -- entered into a software program – will give Dr. W. the guidance he needs to correctly place my new hip joint.

My parents and I consulted with three different orthopedic surgeons before agreeing to let the third – Dr. Hugo Keim – perform my spondylolisthesis fusion in September 1975. Although high-risk, that surgery was a resounding success.

Thirty-seven years later, I’m hopeful the third surgeon will again be “the charm” in September.

The downside of ‘unique’

Being unique is usually a good thing. Except when an experienced orthopedic surgeon examines your X-ray and admits he’s “never seen that before.”

But that wasn’t the worst news I received during my recent consultation with Dr. David Fajgenbaum.

After examining me and observing my gait he said that, because I have waited so long, the muscles in my hip joint are likely to be so atrophied that I may never walk without a limp – even after extensive physical therapy.

“If it’s as bad as you say, why am I not in more pain?”

“I don’t know.”

Then he recommended I get a bone density test because my bones appeared “thin” in the X-rays. [The results from my bone density test were normal, so maybe he’s wrong about my recovery too!]

Getting back to my X-rays, Dr. David pointed out the two views of my right hip: one of extreme arthritis and the other of a hip out of its socket. And for that reason he did something he does not routinely do – he ordered an MRI.

Although his candor surprised me (and sometimes reduced me to tears), I was ready to let Dr. David perform my hip replacement. I have met my share of arrogant orthopedic surgeons, and he is not among them. Throughout our meeting, he stressed that the decision to have the surgery – and when – is mine. “We treat patients, not X-rays,” he said. “We’ll do the surgery when you say you’re ready.”

The MRI confirmed “markedly advanced degenerative joint disease evident at the right hip with severe joint space narrowing…” among other ominous medical jargon. From the report Dr. David concluded that the discrepancy on my X-rays is likely due to my spinal fusions, which are causing my pelvis to tilt forward. As a result, I could be at a slightly higher risk of dislocation following hip replacement.

“Have you ever done a hip replacement on a scoliosis patient like me?"

“No. So I think you should get a second opinion.”

He recommended Dr. Michael Bolognesi at Duke Medical Center. Based on the volume of spinal surgery at Duke, Dr. David thinks Dr. Bolognesi is “more likely” to have encountered a patient like me. Here’s hoping.