A Year Later: Guess What?

Hard to believe that a year ago at this moment (surgery +3 days) I was one miserable puppy. No need to go into details - you can go back and read those entries if you want. Just revisiting this page - for the first time in a few months - reminds me of two things: First, that really was a life-altering journey. And, second, what a joy that it's no longer the center of my focus. The journey from Point A (a year ago) to Point B (where the joint-replacement surgery and its aftermath are just chapters in my life, not the center of my life) took longer than I expected. But it was survivable. In the grand, grand scheme of life, it was a very manageable chapter. And worth the pain. Yep, that's the big takeaway: The net result was good. I'm still a little stiff and a little sore; my outcome wasn't quite what I read about in the happy-golfer-guy brochures or former-tennis-pro online videos. I'm not totally pain-free and I didn't leap from my hospital bed to the first tee, but I'm a whole lot better off than I was before the surgery. The bone-on-bone pain is gone, of course (because the bone-on-bone joint is gone!) - and that's the big victory. I wish I could run (not advised) and I wish I didn't limp when I get up from sitting in the same position for a few hours. But all in all, I'm a happy camper. Life went on this past year. It seemed as if everything had to be put on hold for my surgery and recovery, but that only lasts for a little while. Then life begins to creep back in. And I guess that's a good thing. A year ago, if you'd have offered me "mostly normal" and "happy camper," I'd have taken that deal.

So if you stumbled upon this blog because you're trying to decide whether or not joint-replacement surgery is worth the effort, worth the pain, worth the time, worth the anxiety... my vote is yes. At least it was for me. If fear is holding you back, that's probably the one thing I can most adamantly address: Don't let it. The fact that you're considering this surgery at all indicates you have the choice. You're fortunate. You have an opportunity to improve your life. How many people in countless circumstances - right now and throughout history - have never gotten that opportunity? Don't let fear rob it from you. Don't let me, your surgeon, or anyone talk you into this... but don't you dare let fear steal it from you.

Seven Months Later: An Update

It's been more than seven months since my surgery and time for an update. The hip itself is fine, but I'm still having some issues with the nearby bursa and probably some tendons. I've had the bursa injected three times - the most recent was five weeks ago today. I'm hoping this one "takes." I've tried to really isolate the movement that causes me the most pain and I've developed a set of exercises - slow and quite painful - to work through the pain-motions and hopefully retrain my body to its modified anatomy. That seems to be helping a bit.

Bottom line, I'm still pleased I had the surgery - the bone-on-bone pain was certainly limiting my life significantly. And it was getting worse as time when on. But the hip replacement wasn't a one-stop-shop for eliminating my pain. Whether that will take more time or whether it's just something I'll have to live with remains to be seen. The surgery was necessary, for sure... no question about it.

21 Days: A Slow March to Freedom

It's been 21 days since I've had any pain medication. I'm amazed at how naive I was three weeks ago when I thought a single day would be enough to break the insidious, surreptitious "deal with the Devil" I'd unwittingly made. Indeed it's taken every minute of the past three weeks - and I'm not out of the woods yet.

I've known people who've abused narcotics intentionally. One, in particular, spoke incessantly of the withdrawal "cravings." I can't identify with that one bit. I don't crave the drugs at all. The only thing I crave is being rid of this awful feeling that had been 24/7 until just two or three days ago. It's no longer constant - thank God. Now it waxes and wanes throughout the day, getting worse around lunchtime, subsiding a bit, then rallying again in the late afternoon and early evening, making another stand around bedtime. I don't want to spend a lot of time detailing the past three weeks - it's just been awful - but the worst is behind me.

As tough as it's been, though, I need to point this out: Kicking the pain meds is eminently do-able. I was talking to someone recently who'd quit smoking this summer, only to replace chain-smoking with chain-snacking. He's gained probably 25 pounds in the past 90 days. He observed, "You just have to trade one addiction for another." I disagree. I could write another thousand words and not come close to describing the past 21 days - the physical symptoms, the awful pounding in my head, the crying out of my brain for something it's demanding and I refuse, the lack of sleep - but still, it's do-able. I have a bottle of hydrocodone at home. I still carried some with me the first week of this mess. And, yeah, I'm still feeling pain and a single pill would make that better - for a little while. But I'm stronger than all of that.

If you find yourself hooked on pain medication and you want off, I don't necessarily think my way is the right way. It's certainly not the only way. I should have tapered my dosage down over several weeks. I can easily understand that someone in this position might need some help, support - even active medical following or treatment. These 21 days have been tough - minute-by-minute it's been much more difficult than the three weeks immediately after my surgery. Honestly, at times it's taken all the courage, patience, toughness I can muster. And still there have been low-point moments where I thought, quite literally, "I can't live like this." I even thought about choosing not to live. That's how tough it's been. So, believe me, I'm not soft-selling how difficult it can be to kick the meds.

But today, day 21, my message to anyone facing this battle now or in the future is simply this: You can do this. Somewhere on this blog there's a link to my e-mail address. Send me a message if you need some encouragement. Call your doctor if you need some help. In fact, that's probably a really good idea. But you really can do this. Shoot, if I can, anybody can.

Did I mention my hip still hurts? I guess, sometimes, there really are no easy answers.

Breaking a Deal With the Devil

I never saw this one coming.

Just over a week ago, still fighting "considerable discomfort" - my code for "a lot of pain" - I met with my surgeon's assistant to figure out what to do next. Based on my description of the pain and what seemed to aggravate it, he diagnosed an inflammation of the trochanteric bursa - a small, fluid-filled sac on the bony protrusion of the thigh bone, just a few inches from where my old hip joint was sawed off and a titanium replacement was installed. All of this is thoroughly explained in the previous entry to this blog. Last Friday afternoon, T.J., the physician's assistant, injected the bursa with a dose of steroid and told me to give it a few days and see if that might help. I was encouraged he had a plan, because this nagging pain just wasn't going away. Even though it was different from the awful pre-surgery bone-on-bone pain, it was almost as limiting in its own way. Yeah, I'm very glad I had the damaged hip replaced with a new one, but extremely disappointed to have seemingly traded one kind of pain for another. T.J.'s diagnosis and treatment gave me hope. I headed into the weekend with more optimism than I'd had in several weeks.

By Sunday, the pain had begun to dissipate. On Monday, for the first time since months before my surgery, I needed only a single 5 mg. hydrocodone pain pill. By Tuesday, the pain had eased even more. It wasn't gone completely, but it had certainly eased to the point that I felt I could function without having to smack down the pain with narcotic medication. I took some Tylenol in the morning, some more Tylenol after lunch, and settled in behind my computer for the last half of the work day. And that's when it started.

At first, it felt like my insides were being tied in knots, like I might be sick to my stomach. Then I noticed I was clenching my teeth, almost biting my lips. My head started to pound. I looked in the mirror and saw wide eyes staring back at me, cold sweat on my forehead. I was shaking, if not visibly, at least on the inside... needing to get up and walk around, wanting to go somewhere, do something. The large muscles of both my legs began to burn. I thought of the three hydrocodone pills in my pocket. This was, after all "discomfort," so why not take one? But this was the day I'd wanted to go without any narcotics... not for any reason other than to convince myself that T.J.'s treatment last Friday had worked. My head pounded some more, my legs hurt more. I compromised and took half a pill.

Within 30 minutes, the mystery symptoms began to back down. And that's all I needed to know: It was the hydrocodone, the narcotic pain medication. It had me.

I'd needed every single dose I'd taken over the past year - the months of trying to nail down a diagnosis, the months of trying to see if I could avoid or delay surgery, the weeks of waiting for the operation, and the three months since the procedure. Never once did I take a pill for any reason other than I was in significant pain. I've known people who've abused narcotics - actually known three who died from narcotics abuse/overdose - so I've been plenty motivated not to abuse narcotics. I've been strictly business with my pain medicine - taking only what I needed to beat back the pain to a point where I could function at home, at work, walk the dogs, do things around the house, stuff like that. If I hadn't had the medication, I would simply not have been able to participate in life over the past year. I knew the risk of tolerance, dependence, even addiction - but I really didn't have much choice. The pain was all-limiting, all-encompassing, and I am a very pragmatic person. If there's something that helps, something that allows me to function, I'm certainly not too proud to take it. When I'd say my prayers, I'd even give thanks for pain medication and the doctors who believed me enough to prescribe it. I even thought about the generations of people who lived in pain before modern medicine, the people who live in pain today and can't get medication, the months I knew something was wrong and I did without medication. I really, really treated this stuff with respect and gratitude, as if that would somehow keep me out of harm's way. But it didn't.

The good news is I think we're wining the battle of the inflamed bursa. The bad news is I'm in the midst of another battle.

So that was last Tuesday. Today is Sunday. I'm still fighting this thing. I tried making it through Wednesday without any meds, but by the time I got home from work my brain was screaming, my eyes were as wide as ping-pong balls, my insides felt hopelessly twisted like a long-forgotten string of Christmas lights, my major muscle groups felt as if they'd be doused with lighter fluid and lit afire. It was only then that I told Hettie what was going on. Considering the whopping doses of medicine I'd been on just before and just after the surgery (30 mg daily pre-op and up to 80 mg immediately post-op), she encouraged me to try stepping down gradually from the narcotics. I'd made it through the previous day with just 2.5 mg - why not try that for a while? And so I did - one more time. I took half a pill and tried to outrun the demons as I hooked up the dogs and headed out for a walk. I had to keep moving until the medication reached my brain. The storm abated somewhat, but for the second consecutive night I got almost no sleep. My muscles cramped, my head felt as if someone had slipped a small inner-tube just inside my brain and slowly inflated it. Not exactly the recipe for a good night's sleep.

I knew Thursday would be the day I'd take no meds, no way, no how. As much as I needed the meds before, I knew I needed to get off them now. I may have had no problem taking narcotics, but once I knew what had to happen, I was determined to see it through. I went to work with one pill in my pocket. I guess that was my way of saying to myself the 1/2-pill option was still available if I needed it - but, truthfully, I was absolutely intent on not taking it.

And I made it through what was an awful, awful day. But I made it. Again, not much sleep that night, and I considered taking a vacation-day Friday...but I didn't. I also thought the withdrawal symptoms would be gone after one day of no narcotics - and I was way, way wrong about that. The battle was just as fierce on Friday. When my boss showed up at 3:30 with a project that needed to be finished in two hours - a project that I usually require 48-hours notice to complete - my raging brain just about departed my skull. But I hung in there. To my knowledge, neither he nor anyone else knew what was going on.

At one point I considered meeting with my staff, apologizing for what seemed like a lousy week of being a boss. I mean, how effective could I have been as a leader last week? But I didn't say anything, didn't want them to know, didn't want to make excuses. I just wanted to beat this thing - get it behind me.

I confessed to one friend that I was "going through a challenge this week" but that I wouldn't want to talk about it until it was behind me, until I was reporting the scenario from a position of strength.

It's Sunday morning as I write this. After consecutive 1/2 pill days (Tuesday and Wednesday), I'm now on the fourth day of no meds. And the battle still rages. But I'm bigger than this; I'm going to win. I unwittingly made a deal with the Devil having needed pain medicine for as long as I did. Last Tuesday he tapped me on the shoulder and demanded payment. That ain't gonna happen. This is where I draw my own line in the sand.

Almost Three Months: Some Unfinished Business

Nearly three months have passed since my surgery. I think I made excellent progress over the first month; in fact, I tried throughout that period to be way ahead of the curve in all respects. I met or exceeded just about all my goals in that regard. The one thing I haven't been able to overcome is lingering pain on the outside of my hip area, just an inch or so from the incision. Not only hasn't this pain improved, it's actually gotten worse in the past few weeks. I also think I've unconsciously adjusted my walking motion to accommodate this pain mechanism, leading to some additional discomfort in operative leg and my lower back. I thought some time in the water on our vacation, time away from my computer desk and everything else, would help - but it didn't. In fact, the pain has become even more intense since we got back from vacation. It's been waking me up at night, making even the dog-walks difficult, and limiting my ability to exercise. And, yes, I've been taking pain meds - something I thought would have ended a long time ago.

So I called and made an appointment with my surgeon's Physician's Assistant, T.J. I could have made an appointment with Dr. Mokris, the excellent surgeon who actually did my procedure (with T.J.'s assistance), but I opted not to - and here's why: Sometimes big-picture thinkers really are, well, big-picture thinkers. When I saw Dr. Mokris for my six-week post-op checkup, he looked at my x-ray and said I was doing perfect. I told him I was still hurting - much more than I'd expected to - and he assured me I was fine. And, in the big picture, I was and I am. The new titanium pieces are exactly where they should be, everything's lined up perfectly, the bone is knitting to the metal, and life is good. Big-picture. That's his job, that's what he does, that's where he thinks. Think of someone who is, say, a bridge architect. He designs a bridge, oversees its construction, declares it perfect because the loads are distributed properly, the structure is sound, and you can now get from Point A to Point B without a boat. Perfection. So if there's a pothole in the pavement, this guy is probably not going to get too concerned about it. At least, metaphorically, that's how I've come to look at big-picture thinkers, and this has seemed (to me, at least) especially true in the medical field. The bridge is up - all is well.

I have no doubt Dr. Mokris would have given me his full attention and taken my complaints seriously - I just didn't want to go to the bridge-builder this time around. I wanted to go to the guy who fixes the little things. So T.J. listened carefully last Friday, gave me a thorough exam and found all the movements that caused great pain (he's good at that!), and came up with a reasonable theory: Trochanteric Bursitis. Here's a description from some website:

A bursa is a small sac of fluid, and bursae are present wherever moving parts occur, helping to reduce friction. They are normally found around joints and where tendons, muscles, or ligaments, pass over bony prominences. The trochanteric bursa lies over a part of the femur (thigh bone) called the greater trochanter (a bony lump at the top of the outside of the thigh bone). Its job is to prevent friction between the greater trochanter and tissue called the ilitibial band. The condition known as trochanteric bursitis refers to a situation where the bursa has become irritated and inflamed. This can be caused either by a direct blow to the area or by repetitive friction of the iliotibial band on the bursa, as occurs in long-distance running.

Well, I haven't been doing any long-distance running (darn it!), but there were some mallets and other tools banging around within an inch or so of my left trochanteric bursa - so that all made pretty good sense. (In the edited image, above, the smiley represents ground-zero of the hip replacement operation - pretty close to that bursa. Another note about the image: It depicts a right hip - mine was the left hip).

Anyway, T.J. decided to do a corticosteroid injection directly into the bursa. Did I mention he's very good at doing things that hurt? Yeah, that sucker really did hurt - a whole lot, in fact - but the early indications are he may have made the correct call. It's now about 48 hours after the injection and the pain has eased considerably. It's not totally gone, but it's a lot better. I can walk better now, too - with my operative leg moving straight forward and back, not swinging out to accommodate one kind of pain while creating another type of pain. I like that; it's something I can get my mind around as being a good sign, beyond just some pain relief.

My advice to anyone dealing with any challenging medical issue is pretty much this: Be your own strongest advocate. Keep pushing for answers. Don't stop just because the first doctor, or even the eighth doctor, can't find the problem. If the bridge-builder doesn't do potholes, find a guy who does. Keep pushing. Whether this latest round of treatment will do the trick or not, I feel a lot better today than I did two weeks ago when I was just sitting around waiting for things to get better, feeling grumpy because they hadn't, reading other peoples' reports about being back on the golf course three months post-op. I'm scheduled to see Dr. Mokris for another follow-up in six weeks... and I'm hoping I can cancel that appointment because the pain will be gone. If not, well, I guess it will be time to sit down with the bridge builder.

I'll keep you posted. Meanwhile, I'll keep doing what I can do to get from Point A to Point B.

Alert the Media: I Mowed the Lawn

Two-and-a-half months post-op, last night I mowed the lawn. Alert the media.

I'd like to report I undertook such an activity after carefully evaluating my rehabilitation status and reviewing my progress with my treatment team. Truth is, I've had a rotten week on so many fronts and yesterday turned out to have been an absolutely terrible day. By the time I got home, I just wanted to go somewhere and hide from people, telephones, and other assorted stressors -and an hour behind a noisy Lawn Boy seemed like a pretty good escape. Hettie was working late, so there was no one around to throw a penalty flag. The lawn mower promised sixty minutes of moderate effort with the cares, concerns, and tugs of the world being drowned out by a 5.5 horsepower Briggs & Stratton engine as I attempted to make fairly straight lines in the whithering fescue.

The good news is the yard looks decent and I woke up today no more stiff and sore than any other morning. The bad news is I was unable to mow away the world and all its assorted problems.

Tonight I think I'll encase myself in construction-grade concrete and see how that works out.

Attitude Adjustment, Island-Style

Last Saturday, just over seven weeks post-op, we hopped a flight to Freeport, Grand Bahama, then drove to the western-most tip of the island for six days at Old Bahama Bay. What follows is a quick recap of that trip in the context of my continuing recovery from a left hip replacement and some lingering discomfort related thereto.

Two important things before I forget: First, I am happy to report they now offer extra icing free at the Cinnabon inside Charlotte airport - a fact that in and of itself makes air travel much more pleasant. Second, I can unequivocally report titanium joint replacements set off airport metal detectors - a fact that only makes air travel more pleasant if you enjoy the full body pat-down by large men who look as if they can break you in two without much effort at all. I certainly prefer extra icing to the pat-down experience, but maybe that's just me.

Some context on this year's vacation plan: I like going to very remote out-islands in the Bahamas, renting a small house and boat for a week, snorkeling, discovering beaches where there are no footprints, and staring up from a limestone rock at the Milky Way splayed fully across the night sky. These are places about as far from Nassau or Freeport as you can imagine - where grocery stores aren't much larger than my one-car garage, the produce market is a stack of melons outside someone's home, and the nights are so dark the heavens shine brighter than any planetarium show. The stars alone are worth the trip. There aren't really tourists in these places and there usually aren't doctors, metal detectors, or wireless networks. We go for the colorful people, the even more colorful fish and coral formations, and the sense that everything about our routine lives is far away and - for a week, at least - largely irrelevant.

This year, mostly because of my recent surgery, we opted for a much more tame approach to vacation. We chose a small resort with a laid-back attitude, a helpful staff, phone service, and cable TV. And we bought travel insurance that included on-site medical treatment and air ambulance service, just in case I did something stupid and messed up my new hip. I missed my true out-island experience, but I know this was the right choice for 2008.

So how'd the new hip fare? Well, I'm happy to report it didn't rust. It did hurt, but it most certainly didn't rust.

Two activities pushed my new hip to its less-than-two-months-post-op limit: Climbing the dive ladder back into the small boat we took on a snorkel adventure and pushing the 14-foot Hobie Cat sailboat up onto the beach after an afternoon sail. I mean, those two things really, really hurt, they were really, really difficult, and afterward I was really, really sore. But I could do 'em - and that's pretty remarkable. No question, upon reflection, that having our own boat for the week would have been too much; just climbing the dive ladder twice was plenty. Trying to get leverage when all you're standing on is water is extremely difficult with two good legs; it's almost impossible with one good one and one weak one. And digging into the sand to push a little sailboat is hard under any circumstances. In this case, it was really a teeth-gritting experience.

As a result, I had a pretty good limp for most of our time on Grand Bahama. But true to my commitment beforehand, I wasn't stingy with the pain meds. I took 'em when I needed 'em - and I needed 'em a lot. At night, especially, I was pretty uncomfortable. Sleep just wouldn't have happened if I hadn't been able to beat back the pain with a couple rounds of hydrocodone. A few times I found myself thinking, "Aw, c'mon, it's time to get off the pain meds." But, honestly, I would have spent most of my time stuck in our hotel room if I hadn't been able to dial back the pain.

I did notice this positive development on the rehab highway: The pain wasn't idiopathic - fancy medical term meaning "we don't really know what causes it." I could definitely tell what was causing my pain: Pushing, shoving, bending, yanking, dragging, climbing, digging in soft sand, climbing the steps to our hotel room - stuff like that. I wasn't hurting just sitting around - and that's a significant sign of progress from just a couple of weeks ago when it hurt just sitting around. I really gave my new hip a workout this week - and (mostly) it rose to the occasion. Of course, it's not really the hip itself that hurts - since it's titanium and has no nerve connections. The pain is mostly in the top of my thigh, where they cut off the old hip ball, and the socket, where they dug out some bone and stuck in a new metal socket. But, honestly, just a little under eight weeks after surgery, I think it's pretty remarkable I was able to do what I did.

I would like to have gone on more snorkel trips - and I would like to have done more sailing in the Hobie - but I could tell I was pushing the limit and (against my nature!), I listened.

Another important observation for someone who might be considering this procedure or who may recently have had it: The water was wonderfully therapeutic. If you live on or near the water or if you have a pool or hot tub, get in the water as soon as your doctor says you can. And keep getting in the water. I don't do swimming pools, but I spent as much time as possible in the ocean - and it was the best therapy I've had so far. I'd trade pain medicine for ocean therapy anytime. Shoot, I'd trade food and shelter for ocean therapy!

Other miscellaneous observations:

1. Don't cut it close at the airport. Setting off the metal detectors and going through the whole pat-down thing takes extra time. Plan accordingly. 2. Consider the travel insurance option I mentioned. Two or three times on Grand Bahama I had "uh-oh" moments where I wondered if I'd done something bad to my new hip. Accidents happen and when they do, you want to get the help you need without having to take out a second mortgage. I felt good knowing if I did hurt something, I could afford to get where I needed to go for treatment. 3. Go for it. We considered not taking a vacation this year, given the recent surgery. I am so happy we went. My attitude about everything is so much better today than it was just a week ago. No matter how I've painted the whole hip-replacement experience, it's a pretty big deal with its share of pain and life disruption. We save and do without a lot of things to take a vacation - and I'm so glad we took this one. As a couple, we've both been through a lot leading up to my surgery and in the weeks since then. We needed a break. 4. As "limited" in scale and scope as our 2008 vacation was in light of my hip surgery, it would have been much, much more limited if I hadn't had the surgery. Everything hurt with a terrible bone-on-bone, sickening pain before this surgery. I'm on the other side of that pit now, climbing out, and I'm so glad to be here.

Another miscellaneous vacation story: We saw a shark while we were snorkeling. Well, I saw it - heading toward Hettie, in fact. It wasn't exactly in attack-mode, but there it was, about three or four feet beneath the surface, looking about as intimidating as anything I've ever seen in my life. It was a big shark, too, maybe five or six feet, and I could tell in an instant it didn't care about my new hip or anything else. There we were, splashing around on the surface looking a lot like lunch - and there it was, looking for lunch, about 15 feet away from us. That's all I needed to know. I had my underwater camera with me but never for a moment thought about taking a picture. Instead, I splashed, spit out my snorkel and tried to say "Shark!" to Hettie, and we got the heck out of there. I'm very happy to report the shark did the same thing. Last I saw, it turned away from Hettie, briefly looked in my direction, and then veered off into the open water. The very thing I feared the most - the thing I've wondered and worried about in twenty years of snorkeling - happened. A shark showed up. A big shark. We weren't in a group of people, either. It was just the two of us. And after the encounter, there were still two of us. I'll call that a victory any day.

I always come back from vacation, look at the 200 or so pictures I've taken, deem none of them anywhere near capable of capturing the wonder of the experience I've just had, then wish I could just go back and do it all over again, this time trying to do a better job documenting what I've just been through. So when we got home last night and I transferred two cameras worth of photos to the computer, that same thought process started in me again. The pictures just aren't that great, in my opinion; I should have done a better job. The experience was unique and no one I know has done exactly that, but it all happened so fast, and now suddenly it's over. Did it really even happen? Will I do a good job trying to share what it was like with anyone who asks?

It's kind of that way with the journey I began several months ago when I went to my doctor and said I just couldn't take the pain in my left leg, or back, or hip, or whatever it was any longer. I needed to do something about it or I'd just end up sitting around watch life go by. When we found out where the pain was coming from and what we needed to do about it, I decided to document the process to the best of my ability - so when someone contemplating a similar journey might ask about it, I could point them to my record of the experience. That's why I've done this blog. And like my vacation photos, I don't feel as if I've done a very good job of recording the experience. Unlike the vacation, however, I don't want to go back and do it again. Once is plenty - and this imperfect record will just have to stand on its own.

I'll add more to the record when I have something new to report... when the pain goes away entirely or I hit another significant milestone. Now eight-weeks post-op and one vacation under my belt, just over a week before Hettie returns to her teaching job, I'm still glad I had the operation, still generally pleased with my progress, still a little disappointed with the level of discomfort I'm still experiencing. Like the momentary shark encounter, though, there really was no way to be fully prepared for the experience - no perfect way of handling it. I do the best I can with the challenges life throws my way, as I'm sure you do, and most of the time things work out.