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Straight from the hip

Dotti's Hip Replacement Story

Father's Day Setback

By Al Coon
June 21, 2011

This morning my computer popped up with a reminder that I programmed in many months ago, that the Summer Solstice occurs today June 21, at 10:16am. (That is 5:16 pm GMT on June 21, or 2:16 am June 22 where our son Glenn is in Japan.)

We have been having some special days go by, but they are not being celebrated in traditional ways. When we had our 35th anniversary, Dotti was hurting far too much to enjoy going out to eat or playing miniature golf, or any of the things we usually would do to celebrate out of the house. So, we sat and watched family videos at home. Three days later Dotti went in for surgery and we have been focused on trying to get back to normal from that. And of course that is what this email is about.

My last report left off where Dotti was home, and we had a nurse and physical therapist visit us in our home. Dotti was just under 4 full days from her surgery, and progressing as well as could be expected, or better. The physical therapist had her pushing harder than before, and showed her how to use her right foot under her left foot to give support when she got into bed. She coaxed Dotti into sitting a recliner, rather than the solid chair we had brought up especially for her convalescence.

On Friday night Dotti went longer than usual between medications, and when she woke up Saturday morning, it was the worst she had felt so far. However, 30 to 60 minutes after she took her meds, she was doing fine again. She was soon up and typing on her computer! At lunch we did her first set of exercises for the day.

I have been changing her dressing over her wound and it has been getting drier and drier each day. Yesterday there was nothing on the bandage at all! Nothing had seeped from the wound and it looked dry and very well on the way towards healing. She still has 6 days before the staples are removed but if healing continues as it has so far she will be ready for that for sure.

I have two more shots to give her (anticoagulant). That is part of our daily routine that I will be happy to be finished with! She has little dots on her stomach where I have been sticking her, and I am running low on new places to hit. The doctor is swapping her over to aspirin to keep the blood clot threat at bay after that.

I wrote the following on Saturday morning (June 18):

It is hard to believe that 5 days ago Dotti had just woken up in her room and started the road back to health. Six days ago I was all knotted up inside with worry about what the next day would bring. In two days one full week will have passed, and that will leave 3 more weeks before her first regular scheduled doctor's follow up appointment. (The doctor sounded very confident that all was well and he was expecting nothing to require his attention before that time, although it was made clear that if anything did, we should call his office immediately.)

Dotti's temperature has been 98.6 or less the entire time she has been home! (Increased temperature would be one of the first indications that infection was brewing.) Her blood pressure was pretty close to normal when the nurse checked it the day after Dotti came home. So, it is not falling off, which is very good!

Her spirits are up. She is making meals and even smoothies for us, to keep active. And here is a big deal: she got both of her legs up into the bed without assistance once yesterday. I had to lift her legs to get them in every time before. At first, I had to lift them a long ways. The physical therapist showed her how to put her right foot under her left foot (something that would not be allowed if those old precautions were mandated) and use that to assist in the lifting. That was not a magic bullet sort of solution. She couldn't immediately lift her leg up that way, but it helped a bit. Then she simply shocked me by getting both legs up onto the bed all by herself. (Our bed is extra tall, a good foot or more higher than a normal bed would be. If Dotti sits on the bed, her legs do not reach the floor, unless she slides well over to the edge, almost sliding off, and even then, they just barely make it.)

This morning I was helping her put her stocking/slippers on, and she was lying on the bed cross ways on her back, with her legs dangling. I was standing beside the bed facing her. To help me, she suddenly lifted both of her legs up and hit me in the chest with both feet, and held them there. My jaw dropped. This is very new ground! Getting the legs up to my chest was perhaps not all that impressive, since the bed is so tall, but getting the legs to swing from all the way down, upwards to reach that position was a very big deal, and she did it without thinking about it. There was no preparation, or swinging back and forth to build momentum. She just thought to herself, "If I put my feet up on his chest it will make the job of putting on my socks easier." She didn't pause to consider how she would do it, or even if it would be a challenge. In typical Dotti fashion, she thought of me, and wanted to make my job easier, and moved to make it happen. That's my Dotti!

Dotti's positive attitude is one of her greatest gifts. If there is nothing bad lurking in the background (infection, blood clot, etc.) Dotti is going to be off her walker (not to be confused with being off her rocker :-) ), and onto using a cane by the time she goes into the doctor. I will insist she wait until then to make the full transition (as per doctor's orders), but she will be practicing before then I am sure. And then she will be off the cane in short order, and walking all on her own. We still can't determine whether her right hip is going to force her to use a cane regularly or not after the left hip comes fully around. It may be that only when she is very tired will she have to use it, or it may be that the hip will start to hurt more as she becomes more active. Only time will tell.

As long as Fate doesn't drop a nasty bombshell on us with one of the complications that can happen, I am sure that Dotti will be walking far better than she has in years by Christmas, and we are going to be out hiking long distances not long after that. (She may even try out our snowshoes with me this next winter; you never know.) I will continue to believe all will be well, until I know for sure it is not. So far it has been like a miracle, and frankly, Dotti has been happier much of the time since she has been home than she has been for many months.

Dotti has been running through the range of emotions of course, but she has been smiling a lot lately, and that has cheered my heart a great deal! Barring something unexpected happening, I am counting on Dotti and I being far healthier and more active next year. We will give it our best effort and that is all we can do. But the possibility is very great that 2012 will be a much better year for us.

Back to the present...

In the afternoon on Saturday, Dotti was feeling upset, and it was an emotionally tough evening but that is part of healing. One of the things that has cheered Dotti up was flowers. Here is a picture of some of the flowers that Dotti received.

Dotti and flowers. I can remember when the first flowers arrived at our door. I was in the middle of changing out the kitty litter for our cat Frostbyte, and a knock came at the door. I cleaned up enough to answer the door, and there was a box of flowers. The frustration of having to scramble evaporated instantly and I smiled at the thoughtful gift. Dotti was sound asleep, so I set up the flowers for her to see when she woke up. Then later a flower arrangement of fruit showed up, and that was another very welcome arrival. (When someone is watching his weight, a fruit basket is a wonderful treat! And this was creatively done up to look like flowers.)

Father's Day, Sunday Morning, Dotti woke up feeling very positive. We ran through most of our morning routine, meds and shots, she did her sponge bath and we decided to wash her hair in the kitchen sink. So, Dotti set off walking down the hall from our bedroom to the kitchen, and about halfway down the hall, on one of her normal, nothing out of the ordinary steps, POP!

I was standing behind her about 4 feet and I heard it. It sounded a lot like her hip used to sound before the surgery. It wasn't a "rifle shot" sort of noise, but it was impossible to miss. And suddenly her hip hurt right where the surgery had been done. Oh no!

Emotionally, both of us have depleted reserves. We have just about had all we can take, after months of suffering with Dotti's crippling hip pain, worrying through her surgery and hoping nothing more will go wrong. Then POP!

Dotti tested the hip. She waited a bit and then tried putting pressure on the leg. It hurt, so she waited some more and tried again. There was pain but it was not unbearable. She tried walking, but using her arms to take most of the load off that left leg. She walked to the kitchen sink. The shampoo session was out of the question at this time, she was sure. So, she turned around and walked all the way back to the bedroom, using her walking, and placing minimal weight on the left leg. I got her safely back into bed and hit the phone.

I called the home nurse organization and they checked and called back to tell us to call the surgery doctor. His office was on an answering service of course, and they gave me a number for the on call orthopedic specialist. I tried that number and got another answering service who took my number and told me the doctor would call back. When he did he said that fractures of the femur were common and Dotti should go into the Emergency Room and get it x-rayed.

Great. Just great. I was hit with a feeling that if I were to drop dead that moment it would be an improvement. Would Dotti have to go back in and get cut on again? She is on anticoagulants, could they even do it? If so, they would be pouring blood transfusions into her. And how major would the procedure be? If it were not a fracture, what caused that pop? The unknowns were building up in my head. I asked the doctor how to get her into the car by myself. Going up the stairs to get Dotti into the house had been difficult, but she could use her left leg. Now, if there was a fracture, she couldn't. I felt that the doctor became completely unhelpful at that point. He had no suggestions, and when I asked what an ambulance might cost, he said it was not his field, and had no idea. After a pause he then hazarded a guess of somewhere around $1000.

When I got back to the bedroom to tell Dotti what was going on, she asked who I had been yelling at. I had no idea that I had been yelling at all. That was a complete shock to me. Had I been?

I suddenly thought of LeRoy. Was he off work? Was he awake (he works nights)? Dotti and I both hate to ask for help. It is against our nature, and self-sufficiency is something we have always striven for. But when you have to cry for help...I dialed LeRoy's number.

He was sleeping, but said it was okay that I woke him up, even before he knew why I had called. As soon as I said I was taking Mom to the ER and needed his help, he was scrambling to get ready and on his way, not a moment's hesitation. I hugged Dotti and we both shared a moment of emotional release.

I got Dotti dressed while we were waiting for LeRoy to arrive, and he was there before we were all done. He had wasted no time! Between us two men, her walker, her cane and some problem-solving on the fly, we got Dotti down the stairs and into our car. I kept slapping thoughts of how bad this might be into the back of my mind, but the darned things wouldn't stay put. Off we went to the same hospital where the surgery had been done.

Emergency Rooms. I hate them. When Dotti was in her car accident a few years ago, she sat for 5 hours before she was seen. It seems that a long wait is guaranteed at the ER, always. If I can go to urgent care, or just live with something, I will do all I can to avoid the ER. I hate going there. That is just a bit of personal background, so you can get an idea where I was at when the doctor said, "Take her to the Emergency Room," multiplied by the fact that we thought Dotti was on her road to recovery from this whole mess and suddenly she was heading back to the hospital.

Enough about me. Dotti was of course distraught with worry, and the unknown was hanging over us like a thundercloud. So, we drove to the hospital. As we arrived I was reminded of how happy I had been just a few days before, when Dotti was coming home. Now what?

LeRoy was a great help, sitting with us and he even made a run to Starbucks when he found the hospital coffee shop was closed. Dotti looked out of the window and said, "I think I just saw LeRoy out in the parking lot." I said, "Maybe he forgot something in his car." Then he walks in with coffee. We didn't expect that. We should have, because he is just that kind of guy, but we had no idea he had even left the building until Dotti saw him at the car.

Well, they finally took Dotti back to a room, and then wheeled her off for her x-ray a little later. There were little adventures along the way, with a bed pan that didn't work out, a doctor taking off her bandage for a look, only to realize she had no new bandage to replace it with, which left the wound on the sheet with the other issues, and if it were in a movie it would have been quite hilarious I am sure. But in real life, no.

Dotti and Al In ER. Here is Dotti trying her best to smile for the camera, and yours truly wishing we were both somewhere else under different circumstances. The swim we took together out hundreds of yards from the beach at Midway Island, and still, we could touch bottom in the warm waters. That would be a good trade I think. But alas, this is now and this is where we are. But, we are together, and that is always the best place to be at any time.

Poor Dotti was trying to explain to the nurses and doctors how she was on the way to wash her hair when this happened. How her hair looked was the last thing on my mind. But seeing that smile was worth millions.

Here are Dotti and LeRoy and his effect on Dotti is quite therapeutic. His sense of humor lightened the load on his parents' heart greatly. Dotti and LeRoy In ER.

Well, the ER doctor pointed out a few artifacts on the x-ray, where lines were present, but obviously were not the problem. The only one she could see that might be an issue was the item I have marked as "1." It is a white line that looked odd. I was scratching my head as to how it happened, but at the same time thinking, that would be very good if it were it, because that is not a particularly heavy load bearing location, to my layman's eyes. But the doctor said she didn't know for sure and she called the orthopedic specialist at the hospital that day to have him look at it. So, we waited for him to get out of surgery to come down for a look.

In a while a man in hospital greens walked in and introduced himself as the the assistant to the specialist who would be coming. He took my photo of the x-ray and used a pen to circle the area that appeared to be the problem. (I marked that as number 2 in the photo.) He said that he had compared this x-ray with the one they shot on the day of the surgery and that was the only change he could see. Dotti's x-ray closeup.

Okay, that one would have been loaded by weight as Dotti was walking. (I was thinking to myself as he was talking, It is still high up the femur and maybe wouldn't be too bad.

He went on to point out that all of the prosthetic device is intact, and has not shifted. (He also pointed out that our doctor is a very good one and he did a good job here.)

Looking at the entire x-ray image it looks great. The acetabular component (the cup mounted on the pelvic bone) looks solid, and the head is clearly properly in place in the cup and attached to the femoral stem component. Everything looks solid. The femur doesn't show any vertical, horizontal, or spiral lines of fracture. (Thank goodness!) The assistant physician said the specialist would be in shortly to give more information.

Dotti's x-ray. I had been involved with some cleaning up task and had just washed my hands really well, and was just starting to dry them when the specialist came in. He was the doctor I had spoken with on the phone earlier. He was friendly and extended his hand to shake mine. I said, "I just washed my hands and they are still a little wet." He said, "I don't care, go ahead." I don't know, but that made me feel good that he was that kind of guy.

The earlier information we had received was sound and he asked Dotti if she wanted to go home. If Dotti paused a microsecond before saying yes, I missed it entirely. Going home was what she most wanted at that time. So, the instructions were that she should do 50% weight bearing on the leg, and no more than that. Other than that, nothing was to change, but we were to contact our doctor the next day. My Father's Day just got better when I heard that.

Dotti in wheelchair. LeRoy and his girlfriend Rachel had gone off to get a bite to eat, thinking that discharge from ER takes forever, and there was lots of time. However, they had the paperwork ready and in our hands very quickly and I wheeled Dotti out to the curb and ran to get our car. As I was pulling up I snapped a picture of Dotti waiting for me.

Since we knew Dotti could put some weight on the left leg, and going up stairs is easier than down, at least that is the way it seems to us, we felt confident we could get Dotti back home and upstairs by ourselves. And we were right. We were very careful and very slow, but it was quite safe, and so very happy that they didn't have to go in and operate, or anything else nasty.

Dotti back home from ER. Now Dotti doesn't look as happy as she did on Wednesday when she was coming home but she is far happier in this picture than she had been a few hours earlier. That walker has become such an everyday fixture in our lives we hardly notice it anymore. And those bands on her wrist seem like they are far too common as well.

Dotti with her laptop. We both are feeling positive, like we are back on track again, after a setback. We feel as though we are moving forward again. Dotti is moving around well (and she still is today!) with the weight restrictions being followed. Yesterday I got her all set up in bed so she could be left alone for an hour, and I took a 3-mile walk. Here she is with her laptop as I was leaving:

When I got home, I went out and mowed the lawn and Dotti came out on the deck to watch. She moved things around on her own out onto the deck. She is a little more active each day that goes by. Tomorrow we go in to see the surgeon and our hope is that he will be pleased with her progress and keep her on the same track she is on today. It was only 8 days ago that she was coming out of recovering and moved up into her hospital room. If she improved as much this next 8 days, she will be finishing up a marathon run! Okay, that is not going to happen, but we are very optimistic that Dotti will be feeling much better when another week has passed by.

Father's Day was scary, but having LeRoy drop everything and come running when I needed his help was a very, very special Father's Day gift to me.

By the way, if you would like to see a computer animation (no blood or gore) of what Dotti went through in surgery this is very close to it:

Tomorrow, Tomorrow  /  The Knife  /  Homecoming  /   Setback  /   Back on Track  /   You Go Girl!

Part Two: The Next Step