A Note by Kani
Just a general response that has not been mentioned in Michelle's post. Michelle was released from the hospital on day 3 from a simultaneous bilateral done in under three hours! Dr. De Smet told me that this was the fastest recovery he has ever seen from a bilateral. She was immediately doing leg lifts without the pulley system the pt uses so you can exercise the leg. Michelle worked for three months with a pt prehabbing for the operation working on those muscles in the hip region the will really help in recovery. If I had known I would have done as much of this as possible but with my extreme stiffness in the hips it would have been impossible to build those muscles up. I exercised the large muscles only. I was out of the hospital on Day 5 two days earlier than had been scheduled.
Kani -Villa Cento Passi, Ghent, Belgium
December 23rd (Post Op Day 4)
In morning, breakfast then an hour of land PT with Marc at 9:30 am - ½ hour per leg. He has me lay on back in bed. He starts with a several minute light rubdown of thigh - not deep tissue or muscle, but designed to increase blood flow, using talcum powder. Next ankle flexes, then quad compressions - press back of knee into bed, hold for 5 seconds and release. Repeat. Marc then takes leg and works on range of motion. He bends leg, with calf parallel to bed and gently works thigh toward 90 degree angle with hip. No pain, but gentle stretching, increasing range of motion. Then, bending other leg at knee with foot on bed, I do a straight leg raise with leg he's working on, and push down against his resistance. He says most people cannot do that exercise this early. I move to other side of bed and he repeats with opposite leg. Next, I lie in middle of bed and move both feet toward outside in a V. Marc then gradually increases the base of the V, again working on increased range of motion, with incremental stretches - not to the point of pain. Then, sitting on edge of bed, raise lower leg against resistance Marc provides. Next walking in Villa with Marc watching gait - even strides, rather than little short steps with bad leg and longer steps with good leg (easier to do right with bilats, since there isn't a good leg), natural pace: one -- two, one -- two, torso straight, rather than hunched over, easy and limber, vs. stiff and constricted, movement. Most of this is coming pretty naturally - feels so natural, and great, to walk without a limp (as long as I have my crutches, that is.) Next stairs, up and down large entry way flight - probably 30 steps. Use one crutch and handrail, holding second crutch parallel to floor with crutch hand. No problem. Walk some more in hallway then back to room. Do abduction - holding door frame, extend one foot as far as possible to side. Back to center. Do other foot. Back to center. Repeat. Hard at first. Then calf stretch and back stretch. Last is groin stretch. Sit on corner of bed with one leg on either side, extend legs out, then lean back and raise arms over head. If any of those muscles are tight, you feel the stretch. Lunch, brief rest, then an hour of pool PT. Same as before, only I can do faster bicycling. Find out from PT that Kani cannot come today, but maybe tomorrow. Italian restaurant again with fellow patients for dinner. Koen says I can walk tonight, but Lynn brings wheel chair for backup. Walking goes fine without need for wheel chair.
December 24th (Post Op Day 5)
Breakfast, then PT at 9:30 am. Same as before, but today I get to do stairs one at a time. Right crutch and left foot down, then left crutch and right foot down. Very easy and natural. On the way up, it's right crutch and left foot up, while pushing off with the left crutch still on the stair beneath, then left crutch and right foot up, while pushing off with the right crutch. (This is a bilat technique, so don't use it if you're a uni.) Mark gets ice-bag to use at night to help with stiffness. Go for walk outside and find neighborhood pharmacy, grocers, bakers, then walk a ½ mile in small park down the street. Feels great. No pain. Still blows me away. Christmas eve buffet with the DeSmets tonight. Kani gets sprung from the hospital this afternoon. Good food. Good company. Good hips.
December 25th (Post Op Day 6)
Marc is here as usual at 9 am even though it's Christmas day. Same routine, but a bit more resistance and practice stairs without rails. Goes great unless you do same crutch, some foot, then bad things happen, especially if you're coming down. Note to self - opposite crutch, opposite foot. (Bilat note only - unis do it different!) Christmas lunch of goat cheese salad, roasted rabbit, roasted vegetables, warm cherry- applesauce, and individual assorted mini-desserts that defy description. Walk outside in the park. Left overs for dinner with the DeSmets.
December 26th (Post Op Day 7)
Morning PT, with more reps, more resistance. Walk in the park in later morning - maybe a mile. Lunch, then a walk on the sidewalks where my crutch sunk on one of those uneven cobblestones and I felt a sharp painful pull. It seemed OK later although there was still a trace of strain, so I iced it when I got back. Pool PT added in straight leg raises, where the PT supports you laying lengthwise in the water, holding onto the bar, and you go down with your leg, then do a straight leg raise, alternating legs for bilats. (Unis do operated leg only for most of these exercises.) I asked Gaetana, Koen's wife and the Villa nurse this week, about the muscle pull that evening when she came to change my bandages (it's so hard to know what's 'normal' and what's a potential problem...) Gaetana got Koen who was roaming around the Villa somewhere, and he spent a half hour with me. Koen said that I was doing more than he wanted me to do and said I needed to slow down. He spent a lot of time teaching (when you stumble 800% or 8 time your body weight can go onto your hip; unused muscles also have unused proprioceptors that have a poor sense of where the hip/body is in space; the only thing that rebuilds bone strength is time, the highest risk of neck fracture is the first 6 months and some ways to decide what is ok to do or not - listen to your body, if it hurts, don't do it; do less, not more; etc. He explained that the need to slightly shave the neck of the femur on both hips to allow full range of motion in my surgery, also increases the risk of femoral neck fracture. He then explained that because of this he wanted me to use two crutches for 6 weeks to minimize the fracture risk. (I was the only one with this protocol in my group.) Hip looked fine he said, but slowing down is most likely to keep it that way. Koen reminded me I was only 1 week post op. So.... I took easy the remainder of the day. Note to self - less not more.
December 27th (Post Op Day 8)
Normal routine. Breakfast, hour of individual land PT, walk, lunch, rest, pool PT. Sleeping in 2 hour stretches by now. Sleep fine in all positions, although using the pillow between legs can be time consuming if you want to switch positions. Stiffness tends to wake me up. Can put on support hose by laying on my back in bed, sliding heel to butt, slipping hose onto foot and pulling up to ankle, then I'm set to sit up and pull it up without breaking 90 degrees. Bilats have a harder time with autonomous functioning initially, as there is no good leg. Bilats are only 2.9% of the total procedures done by Koen, with the vast majority single hips, and the initial days are a bit intense. It's great to have a fellow bilat, Kani, to share experiences.
December 28th (Post Op Day 9)
Continue with gradual increase in reps and resistance in individual PT. Walking is easy and natural and stride is good. Very little weight is on crutch - mainly for balance and to protect hip. . I went into the city center today on a sunny, clear, blue skied day and was able to see much of the old city. They have newer trams, so access on crutches wasn't problematic. I walked through the most famous church in Gent which is huge with all marble floors and many stairs. I never would have made it pre-surgery and except for needing to rest once due to a bit of residual weakness, I had no pain or soreness. I continue to be amazed at the lack of pain. Pre- surgery, if I was standing or walking for any length of time, I was always scouting out the nearest bench or chair. Now, I need to get up and walk every half hour or so in order to stretch out the stiffness. I use two crutches all of the time - it's an easy rhythem now, don't rush, and rest when I'm tired. My stamina is surprisingly good.
December 30thd (Post Op Day 10)
The 3 hour excursion yesterday was fatiguing, but I had only minimal stiffness this morning which was remarkable. Koen and Marc both say to listen to your body, if you are sore, do less. Koen says do 75% of what you think you can do. I slept for a 4 hour stretch last night. If I walk a bit when I wake up, the stiffness goes away and it is easy to fall back asleep. No stiffness during land PT, and I took it easy during more strenuous parts of pool PT due to yesterday's excursion and mile plus walk today. Meds consist of Clexane (40 mg injection daily for 21 days, with 80 mgs. the day before, day of and day after flight home), Biofenac (anti- inflammatory used to prevent/reduce heterotrophic bone growth), and pain meds as needed. I used only morphine epidural first 36 hours post surgery and two Tylenol tablets since then. No swelling or bruising of incision or of hip or leg. Incision is almost healed, although Gaetana or Koen check the incision daily. I do injection myself.
December 31st (Post Op Day 11)
Marc did hour of land PT. He added resistance to the abduction exercise (moving each leg out to the side from a standing position, then back to center.) Koen came to change bandage today and spent a ½ hour reviewing x-rays with me. Wow. I see now why he wants me to take it easy. He basically rebuilt the acetabulum cups so that they are where they should have been in the first place, but it involved a lot of bone removal from my pelvis. The slight shaving of the femoral neck corrected any chance of impingement, so that full range of motion is achieved. No wonder everything feels so different - my hips are normal for the first time ever in my life. Kani gets outdoor roaming privileges today and we go for a walk to the neighborhood store to celebrate. Tonight, a New Years Eve buffet with the DeSmet family - great food and company as usual, but neither Kani nor I last until midnight. He heads for bed at 10 pm and I last all the way until 11 pm. Wake up briefly at midnight to the New Years Eve fireworks - takes me a few minutes to remember it's not Beirut and there's no war, and a few more minutes to settle my heart rate back down. I wish my hips Beste wensen voor het Nieuwe Jaar, change position and go back to sleep.
January 1st (Post Op Day 12)
Marc has a well deserved day off today, but Koen lets Kani and I use the pool to do the water therapy routine which feels great. Kani and I go for a walk in the park, then later after a New Years Day luncheon, I take a tram to the Old City to see the city lit up at night. It is spectacular, but a lot of walking. I feel like I can walk forever, but I don't because I'm doing less than I think I can. Back for left overs with the DeSmets and an enjoyable round of family games. Kani and I try the cork toss into the bucket, but pass on musical chairs. New Year. New Hips. New friends. Life is very, very good.
Take care, Michelle bilat 12/19/06
BHR DeSmet Madison, WI writing from Villa Cento Passi, Gent, Belgium
Bilateral – 12 days out
I am a 51 year old woman, small framed (5'2", 115 lbs.) with congenital dysplasia and arthritic deterioration secondary to the dysplasia in both hips. My right hip was worse than my left on x- ray and had more limited motion. My left hip had more pain. Both hip sockets were too shallow and angled problematically for my anatomy. I was referred to Dr. DeSmet from a US surgeon due to the complexity of my hips and the need for simultaneous bilateral resurfacing. I spent the 3 months prior to the surgery pre-habbing with a PT that had some experience with resurfs and during that process, through a combination of pool work, Pilates, core training, upper body conditioning, carefully orchestrated lower body land strength work and balance work, went from being unable to stand at all on my right leg, to standing easily (if painfully) on either leg.
December 18th (Day minus 1) Spent yesterday recovering from jet lag from the flight from Madison, WI to Gent, BE. This morning, went to the Villa Cento Passi for pre-surgery work-up. Had blood drawn (5 tubes), chest x- ray, hip x-rays on brand new, state-of-the art x-ray equipment, fitted for post-op surgical hose, pre-op blood thinner administered – Clexane (enoxaparinum), EKG, meeting with cardiologist reviewing EKG and health history. Spent ½ hour + with Dr. Koen DeSmet discussing all results. He sketched out for me on the x-ray what the plans are and answered all my questions. (At this point of pre- surgery jitters, the basic question could be summarized as, "Are you sure this is really a good idea!?!") Entire process took 2 hours, with no waiting for anything. Amazing. Then lunch at the Villa, unpacked in my room (able to just leave things as they are as I'll return to same room once released from the hospital. The room is spectacular). I am #3 on the surgery schedule.
HOSPITAL STAY: December 19th (Surgery) Taxi waiting for 5 minute ride to Jan Paflijn hospital at 7am. By 7:20 am, I am admitted and looking for ward 2-B. I have a 2 bed room. I get gowned, scrubbed (they used to use special soap pre- surgery night and day, but no longer do as results of study showed no difference in infection rate. Infection rate for Koen at this hospital is a very low ½ percent (0.5 %) with zero percent (0.0 %) antibiotic resistant, MRSA, or C-diff infections. ) Next, shaving and blood draws (x2). I'm feeling protective of my blood – seems like everyone wants some these last 2 days. I hang out, getting nervous with the waiting, reviewing the question of the day, "Is this really a good idea? Maybe I should have just done one?" I have no hesitancy about my surgeon as I have nothing but excellent recommendations for him and the connection feels good. He appears highly confident without arrogance – a nice combination for a surgeon, explains clearly and without hurry, smart with a sense of humor and skilled hands. I remind myself that pain level and limited mobility necessitates surgery, everything has been carefully researched and I'm in the best shape I could be, so I need to just relax and trust. I don't actually relax, but I am impressed with my reasoning. At noon, they come and wheel me away. In the pre-op area, they insert an IV, then to the pre-op part of the recovery room, where the anesthesiologist puts in an epidural morphine device into my back for pain control post surgery. Hurts a little, but not bad, and it's over quickly. He tests it out and exchanges the morphine pump for a less finicky variety but the epidural tube stays put, so no problem for me. I ask about pre-op antibiotics for mitral valve prolapse (a benign heart condition that increases potential for heart infection) as instructed to do by the cardiologist, and they confirm that I have a broad spectrum antibiotic in my IV. At 1 pm, they wheel me into the frigid (think Alaska in mid-winter) operating room. (Koen has been studying bone temperature and infection rate – he keeps the operating room cold to lower potential for infection.) Bart (Koen's nurse assistant) says hello. They transfer me to a operating table and everyone works on a limb – putting TEDS on right leg (left hip goes under the knife first), disinfecting things, checking IV flow, then anesthesiologist says my hand will sting and I'll gradually feel sleepy, both accurate predictions. I wake up cold. People sliding x-ray films under both of my hips. Sit up to help them. Bad idea. Everything goes dark. Wake up again to blood pressure cuff. Move to look around. Everything goes dark again. Wake up to more blood pressure taking. Warmer now. Special blankets with a heat hose underneath. Much better. No pain. I wonder if Koen didn't do the surgery. Then I see the inverted V shaped wedge pillow strapped between my thighs and I think that is only used for total hips, and sit up to ask if they did a total hip on one or both hips. All dark and wake up to more blood pressure taking. 65 over 45 – they don't like the reading. Everyone else, one by one, leaves recovery. I don't sit up anymore, or I figure I'll never get out of there. Finally, at 9 pm, they spring me from recovery as BP is up to 70 over 50. Dr. DeSmet said that surgery was very difficult, as the anatomical complications were more severe than they appeared on x-ray, but successful bilateral resurfacings. No need for blood transfusion. I'm happy, in an out-of-it sort of way.
December 20th (Post Op Day 1) Wake up early, early morning, believing I am in Beirut and hospital is being attacked. Nurse assures me that I'm in Belgium -- no war. Good news. (I was an exchange student at American University of Beirut in 1976 - 1977 when Israel attacked and civil war was in full swing and was in hospital for short time after injury during an attack – surgery/morphine/different country must be triggering those memories.) Drink lots of water – supposed to stay hydrated. Wake up an hour later. Throw up lots of water. Not so good. Sit up. Fall back. More blood pressure taking. Pillow strapped between my legs is a hassle. Nurse says it stays where it is until Dr. DeSmet says it can go – maybe 2 or 3 days. Bad news. Night passes with intermittent dozing, nausea, dizziness, vomiting, nightmares and war dreams. Nurses excellent – kind, competent, reassuring. Nurses say no more water until stomach settles. Good plan – the hell with staying hydrated. (Forgot that IV was taking care of hydration anyway.) In morning – no breakfast, can't even keep fluids down yet. Bed bath with nurses. Tubes are a hassle – oxygen, epidural with morphine pump in back, IV, catheter and drain in left hip (single hips don't have tubes – only bilats.) Throw up as rolling back and forth activates nausea. PT comes with pulley and thigh band to raise leg to bent position, then lower, flex ankle, press back of knee cap into bed and hold for count of 5, then release and repeat in sets of 10. ½ hour per leg says PT. Dr. DeSmet comes. Removes evil pillow – yes! My hero. Says surgery was even more complicated than it appeared on x-ray, but everything looks great. Required slight shaving of femoral neck to insure full range of motion on both hips and extensive restructuring of acetabulum. Says nausea/dizziness is probably due to either anesthesia reaction or morphine reaction and it will pass -- eventually. He leaves. I throw up after 3 more leg pulls. PT takes away pulley. Says tomorrow will probably be hardest day as they remove epidural with morphine drip. Bad news -- today is no picnic. Oh well – nothing to do, so might as well just deal. Alternate dozing, vomiting and dizziness for several hours. Fall asleep. Wake up at 3 pm. Sit up. No problem. Feel good. Drink Belgium version of 7 up – no problem. Live dangerously and eat saltine cracker – no problem. Life is good. PT comes back with pulley. I start hauling leg – watch my room mate and realized I'm doing it wrong. Must have gotten instructions wrong this morning. I do what she does. Haul up leg. With knee in bent position, extend leg fully and point toe up and lower for 5 repetitions. Lower leg. Flex ankle. Push back of knee into bed for 5 seconds. Relax. Repeat. Do 1//2 hour each leg. PT come back – says those are advanced exercises – room mate is 3 days ahead of me and only had one hip. Oops. PT says I can't try walking until all the tubes come out tomorrow morning. Room mate teaches me Dutch – says I should be able to say Merry Christmas in Dutch understandably by Christmas 2007. Dutch is not easy. Her English is excellent, and we have a fine time together. Arm is swelling. Doctor arrives and examines arm. Says IV has infiltrated. New IV is inserted. That one infiltrates too. Note to self – next life, get bigger veins that don't roll. I suggest we just leave the thing out and I'll drink lots of water. No go. Third IV installed. So far, so good.
December 21st (Post Op Day 2) Wake up often in night. Whisper to room mate. She's awake too. We commiserate. Sit up - - get dizzy. Nurse comes. More blood pressure taking. Feel like I have to go – can't be -- have catheter. Sensation builds. Nurse examines catheter. Bag is blocked. Works on it for a half hour. Bag fills with 1 liter. Relief. At 7 am, all tubes come out. Amazingly easy and no pain. Takes 5 minutes. PT arrives with leg hauling equipment. I ask her about walking to bathroom. She says after exercises I can try. I haul happily away for an hour. Discover I don't need pulley – can lift and extend leg without help. Do exercises without pulley. PT says that's not usually possible. I keep waiting for pain to come – never does. PT lets me sit up – no problem, no pain, no dizziness. Stand up – no problem. Then walk with walker to chair – maybe 6 feet. No problem. Life is good. I eat lunch sitting up in chair. After lunch, we make grand bathroom excursion with walker. Then back to bed. PT comes back at 3 pm for more leg hauling. Do exercises without pulley for an hour. PT lets me try crutches. Right foot wants to turn inward a little – she says concentrate on keeping it straight. Left crutch with right foot, right crutch with left foot – a rhythm develops. Walk to end of hallway and back. Right foot is behaving itself. Back to bed. Dr. DeSmet comes. I ask about leaving hospital tomorrow. (I was scheduled to stay 4 more days.) He inquires about dizziness. I say I haven't had any in a long time. He smiles and says 3 am last night isn't so long. Seems long to me – must be a matter of perspective. He says if I keep progressing, no dizziness and can do stairs tomorrow, I can go to Villa tomorrow morning. Alright! Life is very, very good. PT takes me for another walk before dinner. Up and down hall without problem. No pain. Simply amazing. No pain. After dinner, walk down hall with Dave to visit Kani who had surgery one day after me – good to see him. As I'm standing at end of bed talking to Kani, I realize I need to be in bed – now. Maybe earlier than now. Bed seems to be a long, long way away. Tell Kani I have to go and head out, cross country, to my room. Make it. Life is good.
TO THE VILLA: December 22nd (Post Op Day 3) Stiffness during night wakes me up every hour or so, but most times can fall back to sleep. Heels hurt even with heel protectors. Use pillow under calf as well, and all is well. Crutch to B/R for teeth cleaning and washing. Change into real clothes and pack. PT comes right after breakfast. More leg exercises. Room mate says stairs are easy compared to first hallway walk. PT comes for walk and stairs. Right leg behaves normally now without any effort. My knees are next to each other and my feet point straight ahead. Amazing. Stairs are easy. Up one flight. Down one flight. Back up again. Life is good. 10:30 am – Hugo arrives to take me back to Villa. Use crutches pretty easily now. Back to Villa, settle in, then 3 course meal for lunch. Short rest, then pool therapy. Special waterproof bandage keeps wounds dry and sterile. Forward walking, large step forward walking, 90 degree knee raise step forward walking, 90 degrees with large steps forward walking, sideways walking. Backwards walking (harder for me initially). Then exercises – 90 degree leg raises, side abduction against water pressure then pulling back to center, soccer kicks. Running in place, then running in place with some bounce. Stretches – calf, quads, groin muscles. (Bilats do both legs, unis operated leg.) Bicycling holding onto rail at side of pool, with legs straight out, using cycling motion to keep body at water surface, slow, then gradual increase with some 1 minute intervals of hard cycling (they don't let me do hard the first day.) Koen stops by pool to check on how things are going. Bandage change and shot (Clexane – blood thinner) after pool. Plan to go out to dinner with brother and other patients. Run into Koen in the elevator – he stays OK for dinner out, but wheel chair is better than walking. After dinner, say goodbye to Dave (my brother)who heads back to his home early tomorrow morning. On my own now, but a couple from my town and Kani are here, which definitely adds to experience.
Part II to Follow.
Take care,
Michelle bilat 12/19/06 BHR DeSmet Madison, WI writing from Villa Cento Passi, Gent, Belgium
Bilaterals: Gear Reviews and Other Tips
Kani and I are two weeks out from simultaneous bilateral hip resurfacing courtesy of Dr. Koen DeSmet in Gent, Belgium. We are set to spend tomorrow night at the Sheraton located 30 steps from the Brussels Airport, with flights to our respective homes (Madison, WI and Hood River, Oregon) scheduled for the following morning. We both were on our own most of our surgery time. So while we still remember them, here's our tips:
* By far the most useful, in fact imperative gear item, is a good grabber, essential if you are on your own, but very useful even if you have a companion. If you have to travel, buy a folding one. Walgreens has a folding grabber for $9.99. You'll use this thing to dress, pick things up, reach for things, pick up dropped crutches, and many, many other things, especially your first few days to few weeks depending on your recovery process. Grabbers rule.
*The next most useful gear item, is a sock putter-onner. Both Kani and I preferred the 3 fingered variety with blue nylon on the inside and terry cloth on the outside. We even managed to put TEDS on with this model.
*A long handled shoe horn is a good thing if you have shoes where the heel gets caught going on. My variety was plastic with a horses head on the other end ($2 at a local shoe store.) In addition to it's duties with shoes, the stiffness of the plastic shoe horn let me get the TEDS OFF again. Bring shoes you don't have to bend over to adjust.
* If you're doing surgery alone, or returning to being on your own, practice putting TEDS on and off with your gear and make sure the gear works for that purpose if your surgeon has a TEDS protocol. An extra pair of TEDS is a good thing if the protocol is a 24 hour one or you will find people studiously avoiding being around you and your TEDS.
* A Leg Lifter isn't much use for a bilat. When you need it is during the time you can't lift either leg and the legs need to move in unison, which the leg lifter isn't able to do. Neither Kani nor I found the long handled washer much use either. Neither one of us had a dressing stick and we didn't miss it.
* Next in the Gear Reviews, we cover crutches.
By all means, if you are going to be on crutches for a while, try to get forearm crutches with forearm circles. Don't use armpit crutches. You may need to put a lot of weight on your arms for a bit and the forearm crutches are much more stable and don't mess up your shoulders. The model with forearm circles are way useful, don't fall, and just hang nicely from your arm when you go to open a door, use a key, wash your hands, etc. The "Euro Style" open back elbow crutches are not nearly as useful for longer use. Most bilats use crutches for 4 to 6 weeks, so the arm band ones may be well worth investing in. I got mine on Ebay for $30.
* The frequency with which you drop items is inversely proportional to your ability to easily pick up the items. You will drop a lot of things early on.
* You will never have your grabber and will need to go find it. Consider attaching it to your crutch as you won't forget your crutches early on.
* Don't ever drop both your crutches early on if you are alone, like say in the bathroom. You absolutely cannot pick them up again. One crutch dropped is usually recoverable using crutch number 2. You will also get good at picking up a wide variety of things with your crutches since you won't have your grabber with you. (See above)
* Everything takes longer – dressing, eliminating, walking, bathing, tooth brushing, etc., etc., etc. Just roll with it and don't get frustrated.
* The taller you are, the more important it is to pre-prep your house, putting lower things up where you can reach them without breaking 90 degrees, getting a toilet extender, etc. If you're 5'2" or below, that's not much of a problem. Small and light is an advantage initially with bilats.
* Never, ever go down stairs using two crutches (i.e. going down stairs without a handrail) using same crutch, same foot. Bad things happen. It's opposite crutch, opposite foot. Once you get the rhythm of this, it goes well.
* Use crutches as long as you need to in order to walk without a limp. If you are still limping, you still need crutches. Give it time. It's easier to not develop a limp than to get rid of one.
* Try to work with a good physical therapist before surgery working on balance, strengthening your weaker leg (if you're a bilat, you'll have one), and on upper body strength. Also, try to lose weight if you need to -- it will help a lot.
* In the elimination tip department, the Rowland/Moran team offers three tidbits for your consideration: (1) Kani says, if you're using the urinal at night, make sure that the bottom end of your bed is lowered first or things slosh over, (2) Also from Kani, during your first bowel elimination attempt, don't strain too hard – it makes you faint, and (3) from Michelle, if you feel like you have to go when you have a catheter in and the sensation gets stronger, have someone check your bag to see if it's filling. If it's not filling, the bag is probably blocked.
* If you're not any good at asking for or accepting help, either practice a lot before surgery, plan on a crash course after surgery or don't do bilateral surgery. You simply cannot do this one without some help.
* Bilats often get the triangular shaped pillows (JEFs) used for total hips. Do not panic. It does not mean you had a total hip. It means you're a bilat. They are, however, a drag, so ask your surgeon about getting rid of the thing ASAP.
* Do not compare your recovery with unis or even with other bilats. EACH RECOVERY IS DIFFERENT. Say that over and over to yourself. Each recovery is different. Slow and steady wins the race.
* Also do not compare one hip to the other. One hip/leg/foot will always be worse than the other in some way. This does not mean that your surgeon screwed up the worse hip/leg/foot. It means that each hip is different. Love them as you do your children for their unique strengths and problems.
* If your epidural pain relief is only working on one side, do not keep pushing the little pain button, thinking that some will eventually slosh over to the other side. Epidurals do not slosh.
* When the nurse says, this will sting a little, do not believe them. Substitute `a lot' for `a little'. However, it's always over soon.
* Post bilateral surgery, you will notice a slight change in the way that days and nights are structured. Each day will continue to have 16 hours. However, nights, for the first few days post-op, have 32 hours apiece. If they offer sleeping/pain meds, take them. You'll still have lots of hours to lie awake.
* If you have very, very small veins that roll, see if you can get them replaced before your surgery. It will save you a lot of hassles.
* Bring extra IPOD batteries and/or ear plugs in case your room mate snores loudly.
* Eat a lot post surgery. It takes a lot of energy to heal.
* Speaking of healing, take care of your heels. Put a pillow under your calves with your heels hanging loose, and consider a piece of sheepskin or something soft under them (if you have a helper who can keep adjusting the damn thing, since you won't be able to reach it.) Heels tend to get quite sore from the pressure of being on them and your back.
* Drink alcohol lightly.
* Get a lot of rest. Do less not more. Do 75% or less of what you think you can do. Listen to your body. Expect fatigue initially.
*Even if you have no swelling and no bruising and no real pain, you will have lots of stiffness. Ice is great for stiffness.
* Bring a really good, very, very gentle and hypoallergenic lotion even if you do not have dry skin or allergic reactions. The disinfectants they use are strong in surgery and it does things to your skin that you wouldn't believe. And normal lotions just irritate it more.
* If at all possible, find another bilat to have surgery at the same time you do. The mutual encouragement helps a lot, and definitely makes the experience more enjoyable.
* And finally, PICK YOUR SURGEON VERY, VERY CAREFULLY. Simultaneous bilateral replacements are not easy, nor short, surgeries and the more experienced your surgeon is in this specialized type of hip resurfacing, the better off you will be. And the more relaxed you will feel. Being certain that you picked the best surgeon FOR YOU, does more than anything else to give you piece of mind going into surgery and through the recovery process.
Hope this helps.
Take care,
Kani and Michelle,
Hood River, Oregon and Madison, WI, From Villa Cento Passi, Gent, Belgium
