Hip, Hip, Hooray!
The title of this post is generally recognized as a call for a toast or a cheer, and indeed there is reason to celebrate in our house today because my wife is now successfully recuperating at home after having had a complete hip replacement. Despite her constant working out and her rather healthy lifestyle, arthritis had managed to cathc up with her on one hip (but oddly, not the other) and while it was not yet bone-on-bone, it was painful enough to cause her a year of mild pain which grew progressively worse, a pain which eventually began causing her to limp for most of each day. Activities such as running and even a walk with any sort of incline became close to impossible for her without a lot of grimacing and determined effort; and since hiking was and is a part of our normal outdoor routine a decision had to be made...change her lifestyle or change her hip. Said one site: ...once the arthritic process begins, progression is almost always inevitable, a sentiment which was echoed by the different doctors (primary, hip/back specialist, ortho surgeon) who reviewed her symptoms and charts. So after a plethora of physical therapy, acupuncture, stretches, exercises, anti-inflammatories (from over-the-counter to prescription strength) and a cortisone shot (which the docs said to try but rarely works*) --basically anything to rule out surgery, and almost all of which provided only temporary relief-- she made the decision to proceed.
What was initially surprising was the almost nonchalant attitude of virtually everyone we talked to, from friends who had undergone the procedure to the docs and therapists. Yes, you're up and made to walk within hours (yes, hours!) of coming out of surgery (and by the way, you can choose to be awake during the surgery if you so desire). Climbing stairs? No problem. Higher toilet seat? Not needed. Big scar? About 4 inches. Full weight bearing? Pretty much. And after about 2 weeks you should be able to get around without crutches, they said, and return to all normal activity after a couple of months (minus running or other high-impact exercises). We were told that for most part, the hip was the most-practiced on and least-complicated joint to replace as compared to the knee, shoulder, and finger (I didn't even realize that they replaced finger joints). So it all sounded pretty darn easy...until we looked at the resin model. As seen in the graph above, the part that goes into your femur is quite large which means drilling out that portion of the bone in order to make room for the insert (today's surgeries tend to not "cement" the piece in but rather just let the bone grow around it). And the tendency now (if you're a candidate) is to do the surgery from the front (anterior) which is less invasive and provides less chance of the new replacement popping out or slipping (clicking on the graph's link will also take you to a video that shows a computerized version of the surgery). And the trend is for more and more of these types of surgeries to be robotically performed (as is happening to my friend's father with his knee replacement). It's all a bit dazzling to the average non-medical person...in other words, us, the patient.
Medicine of all sorts is a field that has fascinated me, from the anatomical to the experimental to the ethical. I would listen to lecture series on being an emergency room doctor or a pediatric doctor, the latter of which is something which must prove as silent and as challenging as being a veterinarian since there is little feedback on where it hurts or what one is experiencing. Add to all of that the difficulty of trying to distinguish between nicking a tiny capillary (not much residual damage) and nicking a nerve (possible paralysis) and how much room there is to move each of them before they might tear or break and lose their ability to transmit and function (the patient is asleep so for the doc there'll be no way to tell until they have awakened)...daunting to say the least. As one surgeon told me, there's no basic roadmap because each person is different and coming upon that one genetic deviation that has the nerve running down the right side instead of the left is always a possibility. My step-father's operation to remove an aneurysm was just such an operation, it all going quite smoothly until they realized his vessels were corroded and unable to take and hold the sutures (imagine darning a wool sock and having to go further and further up to find the threads that would hold). After nine hours of operating the surgeon emerged, exhausted, and said that he was close to running out of options; the next step was to shut off some of my father's organs and try to go even higher to find a blood vessel that would hold. By that point they had gone through 36 pints of blood. When do you make the decision to stop, I asked, to which he replied, "I'm almost there." Two additional hours of operating and there was mixed success he told us, the sutures had finally held but they were now having trouble "restarting" his kidney. We waited a day then another, each arriving with no change, then a call was made for dialysis but by this time his blood pressure had dropped too low to even implement that. The end result for all of us was that shock, that unexpected ending of life that comes to anyone when everyone, including him, went in confident and smiling and thinking that all would be okay as it had always been before.
Doctors and surgeons (hospitals in general) have to cover themselves and warn you of that possibility --that things could go wrong-- and often (as was the case for my wife) pretty much require you to bring in your advanced health directive or the optional POLST or Physician's Order for Life Sustaining Treatment. For older people or people prone to serious medical conditions, such a list of your treatment preferences are recommended as something to be very visible in your home, often recommending that they be placed on the back of your front door or taped somewhere close to your entryway. It may sound morbid but place yourself in the shoes of emergency personnel who may have to decide whether to break down your front door just to enter; they find you unconscious on the floor, frail and thin with your heart now stopped and know that the CPR they are required to do will likely break or crack your ribs and cause you a long and probably painful recovery; BUT if your POLST has a DNR (Do Not Resuscitate) order which they can easily see or access, then that is that. Your decision and wishes are respected and honored...if you have decided that you do not want to live that way, to be kept alive at any cost and to have machines blaring indefinitely and you be probably drugged out in a haze to control the pain, then the emergency personnel will honor your written wishes (which are additionally witnessed and signed by a doctor) and will let your resting heart simply stay stopped. However in the hospital, things grow a bit more complicated...some of those types of forms are legally binding and some are not and the possibility that your wishes might be overridden is very real, even if it's a request by a distant family member who has had little contact with you but is indeed related by blood...states and countries differ in what they feel they must honor to avoid possible litigation so it becomes important to check with your own area (a physician, whose job is to "first do no harm," should not be the one to be placed in this position as this should be your personal decision but only if you've taken the time to fill out the legal forms...in this country a verbal request often isn't enough, at least for the courts). Family squabbles are bad enough at home, much less in an emergency medical situation. Keep your mom alive, even against her wishes? If there's no form, then it will indeed become your call overriding hers, and the hospital has to honor that. In other words, despite all the time spent in surgery, it can become even more complicated afterwards.
But I am getting way off the subject here, delving into some philosophical questions of when it is that we come to that point in our lives when we laugh off hearing those words of "there's a risk, a small one but a risk nonetheless," and when it is that we begin to pay a bit more attention to those words and perhaps notice our heart racing a bit more with the thought that we may indeed have the possibility of not emerging from this final stretch. But my wife is home and we've "dodged a bullet" once again, a phrase we should probably stop using (at least here in the U.S.) because it is indeed growing more and more difficult to do so these days. And none of this makes light of her situation for this operation involved moving muscles and cranking knees into positions and all the sorts of things that come to be quite evident once the pain pills begin to fade away. "An open wound," is how she described its feeling, and I think she meant open wound as in a gunshot wound and not open wound as in a paper cut. Sleep, right now, is a blessed event for her.
The movie First Man** showed astronauts Neil Armstrong and Ed "Buzz" Aldrin walking at night in their quiet Houston neighborhood caused my wife and I to comment how we remember our own childhood days being similar, carefree and void of any fear or threat of danger even when walking along the darkest and most deserted streets. And perhaps our younger days in general were like that even if we unexpectedly had to enter the hospital. We always felt that we would emerge, perhaps a bit pained and a bit sore, but we would indeed make it through and we would recover. My wife now has a new hip and so far it appears that medical progress has done it again and that she will make a full and speedy recovery (although gauging by her agony tonight, not speedy enough). We can laugh about it later but for now even she would have to admit that it's one heck of a way to celebrate a birthday.
*If you are close to deciding to have surgery, one reason not to have a cortisone shot (which is basically a steroid shot meant to quell your immune system and dull the pain but little else, meaning that you could be causing more damage if you're actually wearing out your cartilage or bone and would thus be continuing to do so) is that surgery has to be delayed 2-3 months to allow the cortisone to exit your body and reduce the chance of infection.
**If you have the chance, catch the extras of how the film First Man was made (many features such as the huge LED screen and the depiction of the creaking spacecraft were things which had never been done in Hollywood before), why such a historic tale had never been told before and why there was no interest to do so even in a book version...all were fascinating to watch and proved almost as interesting as the movie itself.
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| Image of total hip replacement from HSS |
Medicine of all sorts is a field that has fascinated me, from the anatomical to the experimental to the ethical. I would listen to lecture series on being an emergency room doctor or a pediatric doctor, the latter of which is something which must prove as silent and as challenging as being a veterinarian since there is little feedback on where it hurts or what one is experiencing. Add to all of that the difficulty of trying to distinguish between nicking a tiny capillary (not much residual damage) and nicking a nerve (possible paralysis) and how much room there is to move each of them before they might tear or break and lose their ability to transmit and function (the patient is asleep so for the doc there'll be no way to tell until they have awakened)...daunting to say the least. As one surgeon told me, there's no basic roadmap because each person is different and coming upon that one genetic deviation that has the nerve running down the right side instead of the left is always a possibility. My step-father's operation to remove an aneurysm was just such an operation, it all going quite smoothly until they realized his vessels were corroded and unable to take and hold the sutures (imagine darning a wool sock and having to go further and further up to find the threads that would hold). After nine hours of operating the surgeon emerged, exhausted, and said that he was close to running out of options; the next step was to shut off some of my father's organs and try to go even higher to find a blood vessel that would hold. By that point they had gone through 36 pints of blood. When do you make the decision to stop, I asked, to which he replied, "I'm almost there." Two additional hours of operating and there was mixed success he told us, the sutures had finally held but they were now having trouble "restarting" his kidney. We waited a day then another, each arriving with no change, then a call was made for dialysis but by this time his blood pressure had dropped too low to even implement that. The end result for all of us was that shock, that unexpected ending of life that comes to anyone when everyone, including him, went in confident and smiling and thinking that all would be okay as it had always been before.
Doctors and surgeons (hospitals in general) have to cover themselves and warn you of that possibility --that things could go wrong-- and often (as was the case for my wife) pretty much require you to bring in your advanced health directive or the optional POLST or Physician's Order for Life Sustaining Treatment. For older people or people prone to serious medical conditions, such a list of your treatment preferences are recommended as something to be very visible in your home, often recommending that they be placed on the back of your front door or taped somewhere close to your entryway. It may sound morbid but place yourself in the shoes of emergency personnel who may have to decide whether to break down your front door just to enter; they find you unconscious on the floor, frail and thin with your heart now stopped and know that the CPR they are required to do will likely break or crack your ribs and cause you a long and probably painful recovery; BUT if your POLST has a DNR (Do Not Resuscitate) order which they can easily see or access, then that is that. Your decision and wishes are respected and honored...if you have decided that you do not want to live that way, to be kept alive at any cost and to have machines blaring indefinitely and you be probably drugged out in a haze to control the pain, then the emergency personnel will honor your written wishes (which are additionally witnessed and signed by a doctor) and will let your resting heart simply stay stopped. However in the hospital, things grow a bit more complicated...some of those types of forms are legally binding and some are not and the possibility that your wishes might be overridden is very real, even if it's a request by a distant family member who has had little contact with you but is indeed related by blood...states and countries differ in what they feel they must honor to avoid possible litigation so it becomes important to check with your own area (a physician, whose job is to "first do no harm," should not be the one to be placed in this position as this should be your personal decision but only if you've taken the time to fill out the legal forms...in this country a verbal request often isn't enough, at least for the courts). Family squabbles are bad enough at home, much less in an emergency medical situation. Keep your mom alive, even against her wishes? If there's no form, then it will indeed become your call overriding hers, and the hospital has to honor that. In other words, despite all the time spent in surgery, it can become even more complicated afterwards.
But I am getting way off the subject here, delving into some philosophical questions of when it is that we come to that point in our lives when we laugh off hearing those words of "there's a risk, a small one but a risk nonetheless," and when it is that we begin to pay a bit more attention to those words and perhaps notice our heart racing a bit more with the thought that we may indeed have the possibility of not emerging from this final stretch. But my wife is home and we've "dodged a bullet" once again, a phrase we should probably stop using (at least here in the U.S.) because it is indeed growing more and more difficult to do so these days. And none of this makes light of her situation for this operation involved moving muscles and cranking knees into positions and all the sorts of things that come to be quite evident once the pain pills begin to fade away. "An open wound," is how she described its feeling, and I think she meant open wound as in a gunshot wound and not open wound as in a paper cut. Sleep, right now, is a blessed event for her.
The movie First Man** showed astronauts Neil Armstrong and Ed "Buzz" Aldrin walking at night in their quiet Houston neighborhood caused my wife and I to comment how we remember our own childhood days being similar, carefree and void of any fear or threat of danger even when walking along the darkest and most deserted streets. And perhaps our younger days in general were like that even if we unexpectedly had to enter the hospital. We always felt that we would emerge, perhaps a bit pained and a bit sore, but we would indeed make it through and we would recover. My wife now has a new hip and so far it appears that medical progress has done it again and that she will make a full and speedy recovery (although gauging by her agony tonight, not speedy enough). We can laugh about it later but for now even she would have to admit that it's one heck of a way to celebrate a birthday.
*If you are close to deciding to have surgery, one reason not to have a cortisone shot (which is basically a steroid shot meant to quell your immune system and dull the pain but little else, meaning that you could be causing more damage if you're actually wearing out your cartilage or bone and would thus be continuing to do so) is that surgery has to be delayed 2-3 months to allow the cortisone to exit your body and reduce the chance of infection.
**If you have the chance, catch the extras of how the film First Man was made (many features such as the huge LED screen and the depiction of the creaking spacecraft were things which had never been done in Hollywood before), why such a historic tale had never been told before and why there was no interest to do so even in a book version...all were fascinating to watch and proved almost as interesting as the movie itself.
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