Winifred and Me: A Five-Week Report

Back at the stove!

A couple of weeks ago, when I introduced the new friend who lives in my hip*, Winifred, I promised a blow-by-blow report of what I experienced in my first experience with joint replacement. I hope none of you Lovely Readers take it as an insult when I guess that many of you are either already at or approaching this event yourself. I mean, you are reading a blog. If you were cool and young (and I started to add "hip" to this list but, too soon) you would be reading this in Substack or as an Instagram post. 

The bottom line is that although my road to recovery has not been that of those who told me it was a piece of cake, and that within three weeks I'd forget I'd had surgery at all (nope, nope, nope), I'm making excellent progress. Last week, in fact, I cooked my first full meal since mid-August and it was not particularly onerous or exhausting. (One Pot Chicken With Rice and Caramelized Lemons, if you're curious, and it was delicious.)

So welcome, fellow limpers and groaners! I have two disclaimers to make before I dive into the nitty-gritty of my own personal hip replacement. 

The first is that surgery was five full weeks ago, and I was under anesthesia part of that day. Except for the moment I was emerging from anesthesia and was told that not being able to move my toes was perfectly normal (it is not), I remember virtually nothing of that morning, and only bits and pieces of the rest of the day. 

The second disclaimer is the most important thing I have learned in the past four weeks, and if I could write it in italics and boldface and a shockingly large font, I would. It is this: 

My experience is mine, and mine only. Yours, should you need joint replacement, may include two things that I have experienced, or several things, or nothing at all. It's like falling in love: You can prepare all you like but you won't know what it's like for you until you go through it yourself. Also like love, be aware that it can hurt but this isn't inevitable. 

Also, I am not a doctor. None of this, not one word, is intended as medical advice. Again, it is what I experienced and your own doctor may roll his/her eyes in horror at what you are reading. 

So. Let's dive in.

My surgery was the first of the day at Big City Hospital, and I highly recommend this prized spot. As the first of the day, I knew it would start on time and that I would have a few more hours of lolling around before the physical therapy crew came in to get my lazy new butt out of bed. Husband was not as thrilled about the schedule, since it meant we had to be on the road by 4:30 a.m. to make the 5:45 a.m. check-in time. Pffft. He had all day to nap. We arrived at the hospital on time, with the required walker and comfy clothes in tow.

As for the surgery itself, here is what I remember about it: (Crickets.)

That's it. Nothing at all. I assumed my (excellent) surgeon was doing the work, and had not subcontracted it to a first-year medical student, but honestly, he could have raffled off the opportunity in an NPR fundraiser ("Use cool power tools! Say STAT and mean it!") and I wouldn't have known the difference at the time. Because anesthesia is wonderful, I did not see him until I was mostly conscious several hours later.

Fortunately he checked in with Husband in the waiting room when I was still snoozing away in the recovery room. Husband was most impressed that (excellent) surgeon took all the time necessary to answer any of Husband's questions. Husband also remembers that I waved as I was rolled down the hall from the recovery room to the orthopedics wing, another moment I do not remember. The orthopedics wing, by the way, was an excellent place to spend the next 24 hours. (Some fake-joint patients leave within hours; my clotting issues won me an overnight stay even though this is still considered an out-patient procedure.) All of the personnel on this hallway only deal with zippered hips and knees so they truly know their art. They knew what is run-of-the-mill and what makes them say "Hmmm..." They have the best advice on pain meds. In my case, they were total sweethearts.

The physical therapy folks I would not describe as total sweethearts, but they know their job and their job is to get me up and moving when that was pretty much the last thing I wanted to do. (We had been pre-warned about this--"You're going to love everyone you meet there," our joint replacement class leader told us about the orthopedic wing staff. "Well, not the PT people," she added. "You're not going to like them at all.") Surgery was in the morning, and by early afternoon I was out of bed and walking down the hall. There is an up side to this seemingly-cruel forced march: No need for bedpans. If you can walk 100 yards, you can get that hip over to the bathroom.

I was hoping that the 3:30 a.m. alarm would mean I would sleep well that first night, but apparently the good nap I had in the operating room caught me up on all the sleep I needed. As always, hospital sleep is the worst. The mattress is the worst. The pillows are the worst. The long, long night watching the digital clock on the other side of the room is the worst. On the advice of the nursing staff I had taken pain meds before I "went to sleep" (ha!), but even that did not help.

Speaking of pain, I will make all veteran joint replacement patients jealous by reporting that I had almost no pain. I believe I took three pain pills, total, and those were prophylactic before PT sessions. I know; I've just destroyed all the sympathy I had built up by having a complication but this is to reassure y'all that pain is not necessarily the worst thing every replacement patient will face (see also: foot drop, as discussed in a previous blog post).

But morning comes! And with morning comes more PT. This time I walked 300 feet and climbed up and down a fake four-step stairway. I learned the phrase "Good foot first going up, bad foot first going down" and have repeated that phrase a minimum of 7,000 times since. Then the physical therapist gave me a photocopied sheet of exercises to repeat at home, and a warm good-bye hug (ha! Physical therapist, remember?) and I was cleared to go home. 

Tomorrow, or whenever I get around to it: First days at home.

*That sounds kind of creepy, but the alternative to thinking of Winifred as a friend would be thinking of her as a foe, and that seems counterproductive.

Meet Winifred!

 

My surgeon apparently favors the button-and-zipper incision.*

What a cliffhanger! 

When I left you three weeks ago with a photo of Tom Walz's Award-Winning Tater Tot Casserole, I had intended to be back within hours with news that I was an award-winner as well, having earned the prestigious A+ Hip Replacement Patient Stellar Recovery Award. 

Spoiler: I am not an A+ Hip Replacement Patient Stellar Recovery Award winner. But I also have not failed hip replacement recovery--maybe a solid C shading toward C-? 

The good news is very, very good. Here are the things I feared most, in descending order and warning my sons that this list contains TMI:

1. Death. I probably had a higher awareness of this possibility than most hip replacement patients, given my clotting disorder and the distinct shadow that passed over my (excellent) surgeon's face when we talked about this. I distinctly remember our conversation: "You won't even be aware of it if things go wrong," he said. "I'm the one who'll have to tell your family you didn't make it through." Well, alrighty then.
2. Anesthesia-prompted dementia. My mother, the Best Woman Ever, went into her second knee replacement with slight signs of dementia but came out of the anesthesia fighting the IV and catheter and convinced President Lincoln was in the next room. She never completely recovered. I had discussed this with the surgeon and anesthesiologist and they assured me that if I were not already showing dementia symptoms this was unlikely to be a problem. Still...
3. (TMI AHEAD) Post-surgery constipation. I know. But IT'S A THING!

I was able to rule out two of those three things within moments of waking up post-surgery. I was alive! President Lincoln was dead! And...well, the third concern was still concerning but a few days later, checked off the list.

What I had not known enough to fear was emerging from the procedure with a dropped foot. In fact, I didn't even know what a dropped foot was. As I foggily emerged from la-la land in the recovery room, my first words to the nurse were "I can't move my toes. Is that normal?" And she looked me straight in my still-slightly-crossed eyes and lied through her teeth: "Oh, yes, that's perfectly normal." 

Mmmm...not so much. 

As my dear Lovely Girl #2's orthopedist brother was able to explain, dropped foot is a known complication of hip replacement, and happens when the sciatic nerve is stretched or damaged. This long nerve runs from the base of the spine to the foot, and when it is mad it can stop talking to the foot. In my case, that means I can push my toes and foot down normally (think of pressing on the accelerator) but I can't lift the toes or foot (think or lifting the foot back up off the accelerator). It's a very weird feeling: I tell the toes to lift, and nothing at all happens. 

Think of how you move your foot when you take a step--you lift up the front part, hit with the heel, then the front part lands. In my case, walking is more like having a raw pork chop attached to my ankle. To take a step in the first few days after surgery, I basically lifted my knee and kicked that pork chop out in front of me and watched it go SPLAT! on the floor. 

So, LG2's brother told me, this is a known complication even though it only happens in about 1% of cases because I am super-duper special. The silver lining is that it almost always resolves, but the attached cloud is that nerves are the slothful turtles of recovering cells and this could take a long time, that I should think in terms of many months. 

My (excellent) surgeon also reassured me that the pins-and-needles I was feeling were an good sign--the nerve is trying to fire, it just hasn't gotten its act together. 

A few days later I was fitted for a carbon fiber AFO (ankle-foot orthosis) brace that slides into my shoe and gives my foot enough substance that I walk with a fairly normal gait, or as normal as one walks three weeks post-hip replacement. Sadly, the brace means that I had to order shoes a size larger and wider than my already-substantial feet normally require. When they arrived I burst into tears. "It's progressive degradation!" I wailed to Husband. "Now I'm having to wear clown shoes!" I do believe Post Partum Depression might also apply to hips.

There is good news on the recovery front. A few days ago I noticed that I can lift my toes a tiny, tiny bit off the floor. And by tiny, I mean you can barely slide a sheet of paper under them, but that's progress from three weeks ago. And the nerve firing continues to be intense, and has ramped up from its original 10 decibels to about 500 decibels. (I know, I know. Pain isn't measured in decibels, but this has very much felt like something that can be heard.) Again, that's good. My (excellent) surgeon was quite sure that the nerve wasn't cut, but hip replacement is not a delicate operation and he believes the nerve was stretched.

So I am here, and healing, and getting better every day. Tomorrow (or soon) I'll write about the "normal" parts of hip replacement I've experienced and the positives, of which there have been many. 

I just wanted you to know that Winifred is installed and working great. See how beautiful she looks? 

*The surgeon did not actually use a button-and-zipper incision. That is not a thing. This is my denim skirt making its presence known in the X-ray from my post-surgery check-up. But if button-and-zipper incisions do become a thing, remember that you read about it here first!