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Birmingham Hip Resurfacing
Patient Journals, Jim Duffy
Operation Day, Oct 20, 2006: Friday. Renee said the operating team got started on me about 7:50 a.m. and closed at 9:30. Both Dr. Rogerson and Renee said the operation went very smoothly due to easy entry (I assume because my hip area is skin and bone). Tall, thin hip stem with a 54 ml cap, relatively small. Today, I'm in a lot of pain. Can't move, roll over or get out of bed.
At 1:00, after recovery, I was taken to my hospital room, 909-2, in Meriter Hospital, where I met the day crew. I asked David to help me turn on my side, and then I yelled out in pain. No doubt he thought me a bit rude. Stayed on my back throughout the day and most of the night. Urinated in a bottle. (Sorry, gals, but this is one time I am thankful for my male plumbing).
At 3:00, my wife Kim came to visit and I threw up, probably due to the anesthesia and morphine. While I enjoyed using the morphine button liberally, I soon realized that it wasn't relieving the pain as much as it was giving me a great buzz. But what goes high soon comes crashing down, so I stopped the morphine after eight hours and wanted no more pain medication. But the nurses kept insisting, especially the 12:00-6:00 a.m. night nurse, who demanded that I take at least a couple of Tylenol when my fever spiked to 103. My bathroom duties were made easy with the bed latrine, so I didn't need to get up during the first 24 hours, even though I urinated every 2-3 hours due to the I.V. By morning, I could turn myself over on my right side, with great pain, with help from the overhead gurney.
On operation day, the pain is terrible, but it's never as painful again. Going forward, each day, the pain lessens significantly.
Day 2, Oct 21: Saturday. Sleeping irregularly, 2-3 hours at a time. Woke up early and asked for help getting out of bed, as I thought I might try to use the bathroom. The stool softeners (to counter the pain meds) gave me gas, but I was not yet ready. But the getting up and walking to the bathroom was instructive. The fact that I could get up and be mobile seemed impossible yesterday, but I did it and now know I can do it on my own (first mental hurdle). (This would be the only time I would depend on someone to help me get up and go to the bathroom.)
Dr. Rogerson stepped in to my room to visit and gauge my progress. He told me that Renee was so happy at how easy I was on the operating table. They got in and out without a problem. Later, Renee told me that she gets nervous when she sees a "muscle-y guy," but since I have no meat on my hips or butt, it was a snap.
Afternoon physical therapy was the second mental hurdle, showing me that I could start moving my leg through pain. The therapist at Meriter is first rate, A+. By evening, I could turn over in my bed at will. It was very painful to do so, but I was able to drive through the pain. (By tomorrow night at Meriter Heights, I could roll over on my side without pain!). Dreamt of orange juice and drank 3-4 large glasses of O.J. on Sunday morning. My body is craving orange juice and calcium (cheese).
Day 3, Oct. 22: It was still painful rolling over last night, but I made more rotations. Morning P.T. was great and I was able to walk all the way back to my room afterward. Kim and the girls came to the hospital about 12:30 and we moved over to Meriter Heights. The girls helped me to settle in and they left about 6:00. It was a bit scary being alone at night, but I got along okay. The hardest part was going to the bathroom. Green stools. Wished for a TV in the bedroom. Otherwise, I liked the apartment layout: narrow kitchen, high table chairs, great stools — these things made it easy to get around with crutches. Kim brought in lots of food.
Day 4, Oct 23: The third mental hurdle was experienced in the pool at Meriter Heights. Here I discovered that I can do things with my leg in water that I would be afraid to do on land. One hour in the pool was like an hour in heaven. Truly. Warm water makes the experience comfortable in the extreme. Because Kim wasn't there, I worked with the physical therapist. Bob and Susan Miller (one of my cohorts), when they discovered I was on my own in my apartment, offered to come and change my dressing after swimming, an extraordinary act of kindness. Kim arrived in the afternoon, in time to walk with us during land P.T. We walked the hallways and did exercises in my room. Also got a massage as Kim watched and learned how to apply massage techniques. About 5:15, Dr. Rogerson stopped by and told me I could shower, which I didn't know I could do with the stitches still in. Later, Kim and I walked up the street and had dinner at Tornadoes. It was difficult to sleep. For a while, I wondered why there was so much pain, then I realized it was probably fatigue from so much walking and exercise.
Day 5, Oct. 24: Up early, 5:30 a.m. Kim had been sleeping on the sofa and moved into the bedroom so I wouldn't disturb her. She's not a morning person. I made a lovely breakfast of salmon (Kim's leftovers from Tornadoes), cream corn and rice, which was leftover from Sunday night. After breakfast I did some sitting exercises, used the bathroom, brushed teeth and sat down to write up these journal memories from Operation Day until now.
I am now only 96 hours removed from surgery. Recovery has been truly remarkable. I can walk with crutches for several city blocks. Desiree, my physical therapist, pointed out that most progress going forward is mental, including not limping. I count this insight as the fourth mental hurdle and I am more conscious now of trying to put more weight on the leg, walking more naturally and fighting through the pain.
Time in the pool was terrific, again. Afterward my leg was extremely swollen around the knee and in the lower extremities. This scared me a little and I thought maybe I should call the Dr.'s office in the morning if the swelling hasn't gone down. Kim went home to care for the girls. The World Series Game 3 is on TV to help keep me entertained. By 7:00 p.m. I am tired, but feeling good. A slight headache persists. Don't know the cause but assume it's something to do with the anesthesia and/or operation.
Day 6, Oct. 25: Woke up and the leg is still swollen, but not as much as yesterday. I'm still concerned. The leg is sore from yesterday's one-hour land, one-hour pool and one-hour walk around the capitol. It's 7:00 a.m. and I'm already up and ready for the pool at 8:15. So I have some time to write. Kim says she will arrive before pool time. First she has to get the kids ready and drive them to school, then drive here from our home in Fort Atkinson. The St. Louis Cardinals won last night, now 2-1 versus the Tigers. Game 4 tonight. Yesterday in the pool we met a gal who had the operation 2 weeks prior to mine, Oct. 6 versus Oct 20. She had only one crutch and came bounding down the steps. She was so upbeat but said she had had her problems the first week. Another gal we met as we were leaving the pool had had her operation on Oct. 9 and she said she wasn't doing as well but didn't specify. Perhaps her expectations were too high and she thought she would be much further along at this point. What I'm learning is that every one proceeds at their own pace. My progress seems much slower than some others, but I couldn't be happier at the progress when I look back only five days ago. Phenomenal. Sometimes I think we expect way too much, way too soon.
Today, during land therapy, I learned how to walk using just one crutch. This was my fifth mental hurdle, and a big one, because I learned that I can train my hip and leg muscles more accurately (at this point) with one crutch. Immediate realization. The World Series game was rained out, so I walked up to the Capitol at 7:00 p.m. in the cold. An amazing leap, just when I thought I had hit a wall, suddenly I was walking faster and with less limp (still with crutches, of course). Dr. Rogerson called at 8:30, still at the hospital. We chatted for a few minutes. It was a good day all around, and my last night at Meriter Heights.
Day 7, Oct 26: Going home today. Woke up this a.m. realizing speed. That is, yesterday's walks included speed, walking with confidence at a good clip and walking all the while through pain. Once I was assured by the physical therapists that I could walk with pain, and that the pain is okay (muscle fatigue equals progress), that the pain is not bad pain (hip gone bad), then yesterday's workouts start taking a progressive, positive turn. I feel blessed to have stayed here at Meriter Heights and having use of the pool. But I'm ready to go home and start exercising on my own. This program was just right: We didn't stay too long, and we didn't get pushed out too fast. The timing is just about right, I think.
As the last act at Meriter, my stitches were removed and we got ready for the drive. At home, I walked to the gas station and back, about a half mile round trip. I threw the Frisbee for the dog, walked around the yard cleaning up after the dog. Later I walked the half-mile wooded loop in the park. The leg hurt through the night. Also, because I had two beers in the evening, I had a slight reaction with the meds. which gave me an instant headache. I was up four times during the night to go to the bathroom.
Day 8, Friday, Oct. 27: Slept in today. My leg hurts. I could use more massage. The pain is pretty constant now, but part of the healing process. I don't have the physical therapists to rely on for mental pep talks, so I give myself the talks regularly. The pain is fatigue, part of the process. The leg's structure is sound, the muscles are atrophied, trying to refire after the operation. Takes time. Be patient. Push, not too hard, but don't sit idle. Work.
In the morning I got into the car and drove over to the grocery store. Did some light shopping with one crutch and a basket. Bought some vitamin E to rub on the incision, aspirin, toothpaste and soap. The girls are still in bed at 10:30 as I write. I'm keeping the leg up whenever I sit. I will try more periods of exercise/walking today than yesterday. More periods at shorter distances, perhaps. Don't want to overdo it, but don't want to underdo it, either. I want to keep pushing the envelope. My leg muscles are sore and I remember what Desiree said about the unnormal position of the leg during the operation, when the muscles experience prolonged contraction. I wonder also about the big ligaments and hamstring in the back of the leg, which are all tender still to the touch. Desiree commented that many patients "hit the wall" on or around the ninth day, tomorrow. Maybe that's when there seems to be no change in muscle pain, followed by significant healing? We'll see.
Walked around the neighborhood this afternoon with Krista and Kaylie and Aspen. Rested at the rock while the girls exercised Aspen in the field. My air is getting better, not so much huffing. Did more leg exercises in the afternoon.
Day 9, Oct 28, Saturday: Determined to up my walking time today, from 2 short walks of a half-mile each, to three, plus more time on my feet, and lots of P.T. exercises, of course.
In the a.m., Kim and I walked the dog in the park, on the wooded half-mile loop, came home for a short rest with feet up. Got up and made chili, a long process, maybe an hour, which I completed in two shifts, with rest in between. After a half hour rest, I walked with Kaylie to the grocery store, roughly a half mile including walking the aisles at the store. We purchased candy for trick-or-treaters. At home, put my feet up. The leg was tired/fatigued by this point, 2:00 p.m.
For the next couple of hours I did sitting exercises and standing exercises whenever the opportunity presented itself. It's a beautiful fall day. Kim cut the grass under clear skies, though a bit windy. Took the last bandages off this morning and showered. Was a bit dizzy after my shower and had to get into bed to lay down. I notice that whenever I sit too long between half-mile walks (half hour or longer without getting up and moving around), the leg stiffens up. Now I'm determined to rest in shorter increments (15 minutes or so) and move around more. I'm not always successful at implementing these off-the-cuff plans when the leg is tired/fatigued.
Today I was able to lay on my side and lift the leg straight up for the first time, about one inch. This was a huge sixth hurdle for me. I won't call this one a "mental" hurdle because I physically was unable to move the leg. Here's an example of something that many patients are able to do during the first few days, but it has taken me much longer to conquer this action. I don't get frustrated because I know that everyone's physiology is different. I'm very happy with my progress in walking and other exercises, and I realize that this particular movement is going to take time.
Day 10, Oct 29, Sunday: Yesterday, because I took three walks instead of two, each at a half-mile distance, I was sore all night long. But there's no swelling today. My gate has been pretty good during these walks, at least until fatigue sets in, then I detect more of a limp. Today (trick or treat), I'll try to do four short walks, and more constant exercises, with less sitting time. Beautiful, sunny day, up to 57 degrees.
Grandma and grandpa surprised us with a visit that lasted more than four hours, so I was able to walk only three times. Still had muscle pain at night. Felt little progress. Could this be "the wall" that Desiree observed?
Day 11, Oct 30: During my morning walk I tired quickly. In the afternoon, I took Aspen to Skuppernong State Park and walked a long way on the trail, surprisingly, without any fatigue. The evening walk with Kim hurt, though, but after dinner and a good long rest (two, three hours), I felt rejuvenated. Got down on the floor for the first time. Did some pushups, some sit-ups. Wow! Stepped outside and surprised myself by accidentally taking a step without the aid of a crutch. Repeated it again later. Truly a seventh mental hurdle day!
More importantly, all the physical work is paying off handsomely, dramatically. The pain at night is well worth the rapid recovery. I'm continuing with exercises all through the day. My boss sent a card with a Steelers video and work called about a project. In the evening, I felt the best mentally, physically and emotionally that I have felt since the operation. My appetite has returned. I was even able to put on my TED stocking this morning by myself (with some struggle, of course). Also, I was able to lay on my side on the floor and lift my leg straight up over the stool, remarkable considering two days ago I could lift it no more than one inch!
Day 12, Oct. 31: My muscles and tendons behind the knee are extremely sore. Faced with a dilemma: move forward with rigorous physical activity, which could cause pulled or injured muscles/tendons, or slow down today and slow progress with fewer walks today at shorter distances, to allow the muscles a chance to heal/recover. A beautiful sunny day, 40 degrees (about 25 degrees cooler than yesterday!) and windy. P.T. continues, with pain.
Much sitting and reading today. Good for the soul. Talked to brother Dennis and Norman in the a.m.
The wall — one walk, instead of three, and much slower pace than yesterday. But I'm feeling muscles up around the butt and hip beginning to work that I haven't felt working until now. So while today fells like two steps backward, there is progress.
Day 13, Nov. 1: Still troubled. Not sure yet how to proceed. Do I fight through the pain behind the knees and risk tendon problem by aggravating them, or do I pull back on the amount of physical therapy I do? Pain at night keeps me awake after 2:00 a.m., or is it just insomnia (it's 4:00 a.m. as I write)? At any rate, I will proceed today with my exercises and activities, but keep the long walks short and continue to nurse the sore muscles.
6:30 a.m. Kim gave me a massage. Felt great. Wish for more and take whatever I can get! Discovered bruising behind the knees outlining the ligaments. Went to parent/teacher conference this morning and stood in the gym a long time. Had lunch in Lake Mills followed by a slow walk (still with crutches) around the town park. At 3:00 took Aspen for a short walk in the park. Both knees hurt, especially after bending them. More exercises throughout the day.
Day 14, Nov. 2: "The Wall" continues. Last night, deep pain in hip, but seems to have subsided. Maybe my legs got crossed during sleep? Not sure. Will call Dr. Rogerson's office and Desiree today. Continue with P.T. exercises and walking today.
11:00 a.m.: A whole new rhythm today! Huge mental hurdle No. eight. Progress again developing quickly (it just seems not quick enough). Using more and varied P.T. tools available to me in my home gym, tools that I haven't been able to use until now.
Day 15, Friday, Nov. 3: It's been two weeks today since the operation. Quite the journey. Pain and stiffness occur mostly at night. Still getting up every two hours during the night to pee. Leg hurts terribly then, and also when I roll over from side to back, and vice versa.
Today is my last Lovenax shot in the stomach. Hurray! We'll see if that has something to do with the urinary issue at night. Maybe it's the Indocin, which I have to take for another week.
4:30 p.m. Today, and really for the first time, the big thigh muscle on the front of the leg is attempting to work, as well as the butt muscle (hurdle number nine). These two really propel the leg and, apparently, these two had atrophied most, further weakening them (along with them getting snipped and cut during the operation). They are the last to kick in and, as they begin to work, I can feel my body attempting to realign back to where it was two or three years ago, before bone started grinding on bone more or less full time. Reflecting on this, it's amazing how the body compensates and adapts when something goes wrong, like osteoarthritis. Equally amazing is how the body readapts when corrections (done well) are made. Progress with these muscles will take time, I now know, patience and hard work. So be it. I'm grateful for the opportunity.
Day 16, Nov. 4: Slept through another painful night, but only needed to get up and go to the bathroom twice. Maybe it had been the Lovenox that made me have to urinate so much at night. Yesterday I made the switch to aspirin, as prescribed by Dr. Rogerson. The lasting pain is in the back of the thigh when I roll over at night or switch from a reclined position to a leg-down position, as if the circulation suddenly goes from "off" to "on."
Today I will continue with P.T. all day long and add a couple short walks. Overall, the leg is improving and mobility is getting better each day. Pain remains the same. Yesterday, when I moved the leg side to side while sitting (as prescribed by P.T.), I felt popping. Also, my left elbow is taking a beating from bearing my weight on the crutches.
1:30 p.m.: Two things: First, in the shower this a.m., looking down, I see clearly a body realigned for the first time in two or three years, a big tenth hurdle. Weight is shifting back to balance on both legs. Secondly, I took a step without crutches yesterday, and I took 10 steps today. Measured THAT way, progress is good. Pulled a back muscle, or something in the upper-mid back/lung area, slightly when lifting light weights. Took an aspirin.
Day 18, Nov. 6: Another painful, sleepless night. Sounding like a broken record. The entire leg was in pain (not the hip). Too much P.T.? Probably. Yesterday was remarkable in that I walked for the first time without crutches. Ten steps in the morning. Later, I walked from the front curb to the back fence without crutches. Did P.T. at least five times during the day and many short walks around the yard. The leg hurts all the way down through the knee and below into the calf and shin. I intend to back off a bit today (but once I get out of bed I feel compelled to work at P.T.). Also, I pulled something between my stomach and chest yesterday. Also, I'm quite constipated, probably from the iron supplements. Also, yesterday I worked light upper body (only from the sitting or lying position without putting any weight or strain on the hip or legs). So I might have pulled my stomach/chest lifting a barbell from the ground while I was in an awkward sitting position.
4:30 p.m.: found 7 lb ankle weights I can use for additional leg strengthening during my regular P.T. exercises. Started using my leg machine with light weights for knee strengthening. Upper body workouts are lengthening in duration, rotating with P.T. leg exercises. Today I was unable to walk without crutches but walked further and faster than previously. A good day overall.
Day 19, Nov. 7: 11:30 a.m. Still hurting at night, mostly when I turn over in bed. Ate oatmeal before bed and again this a.m. to relieve constipation. It worked. Feeling a lot of popping in the hip. Not sure what that means. Keeping my legs busy. Voted this morning. Yesterday I prepared a mean that required two hours of non-stop standing. Continuing with my P.T. and walking. Bruising still behind my left knee and upper left calve.
3:30 p.m.: Two long walks today, perhaps 50 yards of which I used no crutches. Shot basketball in driveway without crutches. Definitely crossed a big No. 11 hurdle. Boredom is setting in. Ready to get back to work and on with life after hip surgery. Thank God for the opportunity for this new life! Now it's just a matter of working/weaning my way off the crutches! In terms of my story, perhaps the time sequence might apply to persons of similar age and body build: tall, think limbed, little to no butt, no meat on the thigh/hip area.
Day 20, Nov. 8: Walked the half-mile wooded loop in park, going about 2/3 of the way without crutches. Took a second walk at Dorothy Carnes Park, about a half mile. Shot some baskets in the driveway, worked out in my gym downstairs, including leg exercises, and did P.T. all day long. Progress has been rapid and, hopefully, will continue to be. Circulation pain continues; hopefully will get better the more I exercise the leg.
Day 21, Nov. 9: Started the day with a good half-hour workout downstairs: legs, P.T., arms. Less pain last night, but still hurts to roll over. After each roll, the blood seems to rush down the leg and cause pain. Today (9:30 a.m.), I walked up the basement stairs without crutches, a first and another big mental hurdle (No. 12). Planning a good long walk in the woods today. As progress is good and steady, this will probably be my last journal entry because I definitely see the end of the tunnel from here.
Nov. 13: Back on a recumbent stationary bike for the first time since the operation. Twenty minutes, no problem. Went back to work today and, during lunch hour, went to the gym for P.T. Put on a sock for the first time without the aid. While my knee hurt a little bit, my hip felt fine. Have broken the 90-degree rule slightly, without incident.
Nov. 14: After half an hour of activity (walking, biking, etc.) the leg is pain free. If stiffens up at night, and while sitting at my desk. A half-hour walk in in the morning, before work, is the BEST medicine (as well as 5-10 minutes of P.T. warm-up prior to walking).
Today I noticed that I can sit at my desk with my feet down without circulation pain.
Nov. 15: 8:00 a.m.: 30-minute walk, 1.2 miles plus 15 minutes of P.T.
12:00 noon: 30-minute stationary bike; 20-minute P.T. (put on socks, no pain)
4:00 p.m.: 55- minute walk, 2.3 miles up and down wooded hills
Nov. 16: In the morning: 2.3-mile walk (48 minutes); 10 minute P.T.
At noon, one-hour upper body workout, 3 minutes on the elliptical machine, 15 minutes P.T. Put on socks without aid or pain.
Nov. 18, Day 30: Pivotal. Using crutches less. Standing without aid.
Nov. 20, Day 32: This morning, while walking the steep hills at Skuppernong Park, I realized that I wasn't using my crutches at all. In fact, I walked the entire half hour, up and down hills, carrying the crutches in my hands.
Update Six Months Later
April 20, 2007. It's been six months since I've had the hip resurfacing operation. It's been an incredible journey and a most miraculous experience. For the first time in many years, I am living pain free again, walking five miles through wooded trails, playing basketball in the driveway with my teenage kids, shoveling snow, cutting grass, taking long walks in the evening with my wife and dog.
The deep lines of pain that had grown on my face over the past several years are slowly being replaced by new (albeit contrasting) smile lines. At work, I'm able to chase through airports again along with my co-workers. During my lunch hour I often leave the office to go to the gym where I get on the treadmill for 30 or 40 minutes. In short, I'm back to my old self from five or 10 years ago. Physically, I am able to do everything I want to do without restrictions.
I am eternally grateful for the skill, competence and care of Dr. Rogerson and his most excellent team, and for all the folks at Meriter Hospital and Meriter Heights who take extra special care assuring hundreds of small details before, during and after the surgery. They all seem to know that hip resurfacing, like completing a complex algorithm, only works when every computation is perfect.
Dr. Rogerson is a rare physician who expects precision from himself, his assistants and physical therapists, and his processes. On my post-operative x-rays, the screws are remarkably centered in the femoral stem. Dr. Rogerson is a stickler for details and watches over the post-operative processes with as much concern as he does during the surgery. While I am naturally a slow healer and a bit prone to infections, I had no post-operative infections or setbacks of any kind. On the contrary, my recovery time was remarkably short. After only one month, I could walk two miles without crutches through wooded hilly terrain. Today, I can walk as fast and as far as I want. I can even run if I want to.
Dr. Rogerson has fine-tuned the smallest details of hip resurfacing to ensure the best results for his patients. I especially appreciate his professional integrity, good cheer and friendly temperament. These days, I hardly remember that I once suffered debilitating pain. My only reminder is a surgical scar that is fading with time. It's surprising how quickly my life has been returned to me. I have only high praise and thankfulness in my heart for the terrific care I received from Dr. Rogerson and his team.
Best regards,
Jim Duffy (Hip Resurfacing Patient No. 44)
5/5/2008
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