All I want for Christmas... Part 2: BTHR Surgery

It seems that there is an acronym for everything, and so there is for my December 13th bilateral total hip replacement (BTHR) surgery using the anterior approach. The anterior approach is important, because other methods damage a lot more muscle and other surrounding tissue, which makes recovery tougher than it is with the anterior (front) approach. I will stop short of telling you about the materials and machines involved, because it can make my head spin, so probably does not interest others much (except maybe engineer types like my hubby).

After a lot of preparation, I was about to head to the hospital at 5am on Tuesday, December 13th to make the picture on the left look like the one on the right, only I got a bonus prosthetic hip by doing both at once.

Now, make no mistake that this is a major surgery. It is something that many people put off for years, even decades, if they can. But I was ready to get back to a normal life, even if it meant weeks or even months of recovery after a major surgery like this.

My biggest worry before surgery was that they might find a reason to delay. I was told in advance that any kind of infection or fever of 101 or greater would mean that they could not proceed, and I really couldn't comprehend how I could wait longer or go through an additional week without NSAIDs (ibuprofen-type medication) in preparation. For three days leading up to surgery, I had to shower with a special antiseptic wash and use a fresh towel and wash cloth and wear freshly laundered clothes and pajamas each day. So, with a 5:30 a.m. arrival time on Tuesday, December 13th, I was up just after 4am for that one last shower before surgery.

We arrived at the hospital in advance of the first real snowfall of the year, and they called me back for prep at about 6am. Darrell was soon able to come back to join me. I was a nervous wreck, but I typically hide that well, so I suspect I looked calm until they took my blood pressure (reading high). Then, my temperature reading was 100.5 at first, and then the dreaded 101. The nurse was asking me how I felt, and I answered honestly that I didn't feel sick at all, just nervous and worried that they would send me home. At about this time, I even started developing a rash on my stomach and back. I'm convinced it was because of the overwhelming worry that they would delay my surgery, and I knew I would likely have had to wait until at least January if that were the case. The nurse was looking worried, too, but suggested we try an under-tongue thermometer instead of the forehead one. Thankfully, it registered 98.8. Whew!

Since they were operating on both hips, I got IVs in both arms, always a joy since my right arm usually causes more issues when giving blood or inserting IVs. I had to swab the inside of my nostrils with huge Qtip like things with nasty smelling antiseptic on them, also a (not) fun surprise. I was told I would get something in the IV to calm me, have a spinal block for pain, and then something to put me out since most folks don't seem to like being aware of the sound of bones being sawed during the operation. Who couldn't agree with that? I was wheeled off to surgery a little after 7am.

In the surgical room, a few folks were already prepped in what looked like space suits. I'm told joint replacement is one of the most sterile surgeries they ever perform, hence the strange looking outfits. A few nurses and the anesthesiologist looked normal at this point though, and they prepped me quickly for the spinal block. Much like an epidural, which I'd had with the birth of each of my two kids, you sit up and hunch over so they can insert the needle in your spine. The bonus here is there weren't contractions to deal with as there had been with my epidurals, so it was relatively easy. At about the same time, they said they were pushing something into my IV, and the last thing I remember is being helped back down onto the bed.

While I'm sure the surgeon, anesthesiologist, and others in the operating room were quite busy, it seemed to me like I just took a deep 3-hour nap. Sometime soon after 10am, a nurse was talking to me as I was blinking awake. I was told it went well, and then I was in and out of sleep for a while. I honestly can't remember if Darrell met me in the recovery room or up at my hospital room where they took me just a bit later. I think he arrived just after they wheeled me into the hospital room. Through early afternoon, I just remember a jumble of medications and fluids going into my IV, nurses checking my vitals regularly, and Darrell looking still a little worried about me.

Within 4-5 hours after surgery, the physical therapist came by for the first time with the objective of getting me out of bed, into a chair, and if things went well, to the bathroom. Since I felt the urge to go by this point but didn't want a bed pan or who knows what other option, this was kind of a relief and I was determined to make it to the bathroom. I'm happy to report that it wall went well. The nurse was checking my vitals at each step of the way, with the only problem being that just before I got back into bed, my blood pressure dropped pretty low and I felt kind of woozy. However, every time getting back up after this point went well. One good thing about me is that I don't seem to get sick ever on anesthesia. I can't imagine adding that to the mix of recovery just after surgery, so I'm grateful for a strong stomach.

I was at some point told that a few unexpected things came up during surgery. One was that my blood pressure and heart rate dropped enough at some point that they had to give me medication for that, but apparently that sometimes happens in longer intense surgeries like this, so the doctor didn't seem too concerned about this. Another is sort of a good and bad situation. I apparently have very strong, healthy bones. The same running that sped up my hip joint deterioration gave me strong bones that shouldn't break easily. However, that actually makes it tougher to insert the prosthesis into the leg bone. On my right side, the surgeon had to use two screws to help anchor due to this. Again though, he said this shouldn't cause me any added problems down the road. Also, my hemoglobin levels had fallen kind of low during surgery, and were going to have to be checked the next morning to see if I'd need a blood transfusion. And lest I or anyone else think this surgery wasn't yet necessary, my doctor assured us that there was no cartilage left in either hip joint, the balls were completely misshapen, and the hip bones on top were starting to collapse. I'm hoping to see some of this in my X-rays at some point, as I know they took a few just before surgery.

I tend to be a determined, goal oriented person and I hate hospitals. I could go on about how difficult it is to sleep in hospitals and tell you about the lady who decided 5am was a great time to clean up in my room. But if you've ever spent the night in a hospital yourself, you probably already know all of this. If you tell me I might be able to go home the day after surgery, that is exactly what I will be expecting and working toward. The physical therapist came in the morning after surgery, and I did well enough with him to get the green light to get out of bed and go to the bathroom all by myself (before that, including all through the night, I'd had to call one of the nurses and couldn't even let Darrell help me get just over to the bathroom). Occupational therapy came in soon after to see how I managed getting dressed, to make sure I was all set with a walker to take home, and to see if I needed anything else.

The doctor came in with the blood work results, and while my hemoglobin had dropped a bit more, that wasn't unexpected and it wasn't quite low enough to require a blood transfusion. So, I would just be sent home with instructions to take iron in addition to several prescriptions and other post-operative care instructions. My doctor also agreed that I would get to go home after one more visit from the physical therapist.

Finally, the physical therapist came back. This time, the goal was to walk the halls for a while with the walker and to learn to get up and downstairs. I passed with flying colors. My physical therapist said I was the best bilateral hip replacement patient he'd ever had. If, like me, you assume that I was also probably the youngest, he assured me that wasn't the case as he'd had several in their 30s and even younger.

And then, the answer to my prayers - I was going home! Plus I knew that soon after getting home, Hunter would arrive home from college with my best friend Shara and her daughter Amelia. It was wonderful to know that the rest of my recovery would be at home, and to know I'd have plenty of help once there.

And, since this is already quite long, I think you'll get a Part 3 soon to describe my recovery, which is going quite well so far.

All I want for Christmas... Part 1

I received an early Christmas gift on December 13, 2016. This gift is something that I will never actually see, but it replaces something that wore out much too quickly. I am 45 years old. I am not overweight. Until 2015, the only chronic condition I had ever experienced was mild asthma. But due to rapidly destructive osteoarthritis, by July, 2016, it was evident that I would need two new hips. By August, my surgery for BTHR (bilateral total hip replacement) using the anterior approach was scheduled.

I am a runner. I ran track and cross country as a teenager, but only ran sporadically throughout my 20s and early 30s. In my late 30s, I wanted something to get me back into shape, something just for me now that my kids were a little more self-sufficient. And in the back of my mind, I had a goal to run a full marathon someday, even though I'd never run more than about 6-8 miles at a time even as a teenager. So, I did all that. I built up mileage slowly and only had one minor injury in about 6 years of running. I didn't take more than a week off running whether work was insane, I was traveling, sick, or anything else. I would run on vacations, I learned to run in sub-freezing temps. I ran 2 full marathons, about 10 half marathons, and countless 10ks and 5ks. I convinced my son to train for and run several 5ks with me. We got a dog soon after I really got into running, and she was my constant running partner, willing to go up to 10 miles with me. For one of my marathons, I trained with Team in Training to raise money for the Leukemia & Lymphoma Society. That was especially fitting because my husband Darrell had recovered from Hodgkin's Lymphoma early in our marriage.

I guess all this makes it easy to assume the running caused my hip osteoarthritis. But when I first began seeing my orthopedic doctor in July, 2015, his first words to me were, "Bad genetics, huh?" followed soon after by the then shocking news that I would need hip replacement surgery by age 50. If I really think back now, there were some subtle signs that my left hip was causing me problems now and then years before. I like to think I have a high pain tolerance, as long distance runners typically do. Running did not cause my osteoarthritis. Running gave me 6+ years of better health, stamina, and a sense of accomplishment than I'd really ever had before. But yes, running did accelerate the damage to my hip joints, especially when I kept running (with the doctor's ok) even after diagnosis.

In 2015, my running was already starting to suffer. I had gone from 9-10 minute mile half marathons previously to being lucky to run 11-12 minute miles. But what does a runner do when she is told her running days are likely numbered? She of course schedules a bucket list running item, which in my case was the Disney Coast to Coast challenge where you run a half marathon in the same calendar year in both Disneyland and Disney World. In February 2016, I completed the Disney Princess challenge (adding a 10k the day before the half marathon) with my non-runner but Disney loving, senior in high school daughter and with my running and best local friend who I had done one leg of the coast to coast with a few years before. Then on Labor Day weekend, I completed the Dumbo Double Dare (again adding a 10k the day before the half marathon) with the same friend and our teen/preteen sons. By that weekend, I was really just able to walk, typically with a limp, and even then, the last mile of that last half marathon was really tough to complete. But I did it. To round out the year, I even somehow managed to convince Darrell to walk a half marathon with me, the Indy 500 mini-marathon in May, 2016. If it came down to giving up running, I at least went out in style and by completing events with each of my kids and hubby.

I'm a firm believer that God only gives us the challenges we can bear, even if things seem nearly impossible at the time. So, when things get tough, I tend to just try harder and pray (although admittedly I sometimes get the order wrong, because I think sometimes God is trying to tell me I need to go to him rather than toughing it out on my own). The saner thing to do would likely have been to get surgery scheduled for early fall. But, I had plans to see my daughter, now a college freshman in West Virginia University's color guard section of the marching band, perform at both a football game in October and then march in the Macy's Thanksgiving Day Parade in November. Plus, I had also had steroid injections in August, and my surgeon stressed that he could not perform surgery within three months of those injections. I also planned to work right up until the day before surgery and only take two weeks off completely. All this while limping worse and worse... and worse, and experiencing more and more pain.



Somehow, someway, and with a lot of support from Darrell and prayers from family and friends, I made it through to the day of surgery...