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Straight from the hip

Dotti's Hip Replacement Story

One Tired Step After Another
    By Al Coon

September 17th, 2011 Fifth Day after Surgery
Five years ago this very day, Dotti and I were very excited. One thing that day shared with the day of Dotti's surgery was that we spent time with our best friends, Jim and Tammy.

I got up at about 6:45 a.m., and finished packing. We had been very busy right up until the last minute before Jim and Tammy showed up, and I hadn't really had time to get everything finished. But things came together quickly that morning.

Before long, Dotti, Jim, and Tammy also got up, and shortly we were all dressed and ready to get started. Jim did most of the loading, using his packing skills learned in the Navy when he was a plane captain, loading cargo.

We wanted to be at the ship by 12 noon, and the drive should take about three hours. So, our departure time from the house was set at 9 a.m. We made it out the door about 10 minutes ahead of schedule.

We hopped in the van, and stopped at Starbucks on our way to the freeway, to get some caffeine for the trip.

The hours it took to get up to Seattle passed quickly as we discussed our cruise. It seemed like very little time had actually passed when we reached Exit 165, and soon we were cutting over to the waterfront. A final left turn put us on Alaska Way, which seemed very appropriate; because that road took us right to where our ship was waiting for us.

     From Embarkation!

Yes, 5 years ago today, we set off on Our Alaska Cruise with Jim and Tammy. We had no idea what lay in store for us, and that is something that I hold in common with the Al of 5 years ago. The potential today is far more expansive, in that the life that Dotti and I will share together is under renovation. We don't stand merely waiting for a visit to a few ports along a fixed cruise route, no matter how beautiful the ports, or the route itself might be; we are pressing forward to an entire world of possibilities, with health and an active lifestyle working their magic like an enchanted flying carpet.

When you set off to sea, there are certain dangers involved as well. There is an ocean all around your vessel that you can fall into. You go up and down stairs and ladders that are moving under your feet in unpredictable ways. The nearest full hospital can be a bit of a trip away. You are living around strange people, and visiting cities as tourists, which many locals view as fair game for pocket picking of various types. Generally, the risks are low, but they are there.

After surgery the risks are at least as real as they are for a cruise. Blood clots can form, infections can set in, and falls can be devastatingly harmful, not only to the hip itself, but to your brain and other body areas, as the blood thinners can cause serious bleeding, or even death. There is more than enough to worry about. Sure, the odds are good that nothing like that will happen. Every precaution is taken. But that isn't enough to allow one to sleep soundly without worry, at least one who is like me.

Another difference with our situation today, versus the one we were in 5 years ago, the joys and benefits that we are most eagerly looking forward to are in the future, not today. On the day of the cruise, we were excited about everything. Checking in was exciting. Working our way past the hawkers trying to sell us things was exciting. Walking out to the gangway, and then up it, towards the ship, was exciting. Even stopping to let them take a picture of us so they could sell it to us later was exciting. And stepping onto the ship was definitely exciting. We were having fun before we even really got started.

Of course we are having some fun moments as Dotti works her way forward, but that is not primarily what this is about for us. Today we are mostly trying to get past what is going on right now, so we can reach out to what we will be doing weeks, months and years from now. It is almost like a pregnancy in a way. From the moment a baby is conceived, even as a single cell, he has his own personal DNA. He is a person of unique genetic makeup. He will be an old man one day who will die of old age, if nothing shortens his life from its natural course. Time makes all the changes, as a human moves through all the steps of life, from a single cell right through to old age. At first the dangers are many, and everyone breathes easier when the baby is able to breathe outside for the first time. He has made it past the first hurdle. Then comes the infant stages where many more things can go wrong, but the potential is incredible that he carries with him. If only he can get from the starting gate up to the place where he can use his potential to full advantage. It is exciting watching that happen for any parent who has gone through the process.

Today, Dotti is in the situation of having great potential but not yet ready to use it. First we have to go through the "womb" phase, as things heal and gel into a working unit once more. At some point, Dotti will be taking her first step alone, no help, no walker, no cane, just her own two awesome legs carrying her forward on their own. Then there will be many steps, and there will be climbing and running (short bursts, but no jogging, by doctor's orders), and the horizon will broaden with each step to a wider and wider vista of possibilities. It is that image that keeps me hanging on to the positive, when Dotti is in pain and things seem to be overwhelming.

September 20th, 2011 One Week and One Day Since Surgery
Thirteen years ago today, Dotti kicked off her web page. She called it Dotti's Weight Loss Zone. These past 13 years have been eventful to say the least. And here we are living through yet another "interesting time."

A week ago we were at Holy Family Hospital, and Dotti was having her hip replaced. It was her right hip, and it was 91 days exactly since she had her left hip replaced. For the past year Dotti has been suffering almost constantly with hip pain, and today she still is suffering, but there is a difference. This time, we have every reason to believe that it will end, and end fairly soon.

In the last update, we left Dotti in her hospital room on Monday, the day of her surgery. One of the critical things that I didn't mention was that they tagged her as a "MRSA carrier," an asymptomatic bearer or Methicillin-resistant Staphylococcus aureus, the increasingly common antibiotic resistant strain of the staph bacteria. When Dotti first found out about it, she was naturally quite distraught. The hospital staff, and even the doctors, were caviler about it all. They put Dotti into a isolated room, and people entering the room had to wear yellow gowns over their street clothes. But otherwise it made little difference. Apparently there were several patients down the hall in this situation. (They placed a cart with gowns in it at the door of each so designated room.)

With so much else going on, and with the lack of real concern from the hospital people, I put my worry about MRSA on the back burner for the time being and focused on the other things that were obviously real and pressing. Most of my worry was aimed at the more distant future anyway, since she was not symptomatic. Then on Tuesday morning, after they brought in a special team for testing and evaluation, to check Dotti out, they said it was a false alarm and she was NOT a carrier of the bacteria! No more special gowns, and Dotti was treated just like the rest of the patients at the hospital, except they let her keep her private room, as a sort of "I'm sorry present." It may have been on the back burner of my mind, but it was apparently a heavy load nonetheless, because I suddenly felt much lighter and freer than I had before I got the good news! No MRSA after all. Thumbs Up!

When Dotti first checked in, and they placed her in the prep room, she asked them to put the IV into a vessel on the side of her arm, rather than in the top of the hand this way. Unfortunately, the nurse was unable to get it in, and ended up putting it into the top of the hand as you see here. This was a continuing problem, and finally, as Dotti was in the middle of receiving her last bag of saline solution, they had to stop, remove the IV and move it to the place where Dotti had requested in the first place. (You will see later on, when she left the hospital the IV was being removed from the side of her arm.)

Just like with the first hip, Dotti's blood pressure was low and her blood counts were down. We were once again worried that they were going to press for a blood transfusion. But, that didn't happen, and we were glad.

Back to the good stuff! The food at this hospital was excellent. "Hospital food" used to be used as a descriptive term for bland, tasteless, cardboard like food. Both times Dotti was in this hospital the food was super. Amazing! Also, not only did they serve good food, but they allowed me to go down to the cafeteria and buy a voucher, so I could order a meal off the menu and have it delivered to the room, where I could eat with Dotti. On Tuesday I ate two meals there! Dotti would call up the kitchen and order her meal and my meal at the same time.

I showed Dotti the update I had written on Monday on her iPad. She liked the Mount St. Helens picture that you see here.

Catherine, Dotti's twin sister, went in on a joint venture with me, and we got Dotti some flowers and a balloon, and we also got her this cuddly little dog, dubbed Killer. Killer and Dotti were best buddies in the hospital, as you can see.

Dotti grew restless one time, and she decided that she wanted to take a walk. There wasn't any of the staff around at the time and so I put the safety belt onto her, and she grabbed her walker, and the next thing you know we were walking down the hall. We were half way to the far end before we ran into anyone, and the staff were overjoyed to see her being so active. (We weren't sure if they would be upset for not following protocol or quite what to expect.)

Later, Jessica, the physical therapist, took Dotti for another walk. Jessica is a weight loss success story! She lost 60+ pounds and is doing very well at keeping it off. So, naturally, some of the conversation of the walk centered around this vital topic. Jessica is friendly and very attentive to her patients' needs. Dotti was walking very well, with her steps being even, and with no limp. Jessica kept the IV pole moving along, so Dotti didn't have to concern herself with it.

Dotti has the safety belt on, which was never brought into real service, although on our little walk with just the two of us, I had my hand on it the entire time, without ever needing to actually use it.

The shirt Dotti is wearing is a special one, because it was given to her by Catherine, and it means a lot to Dotti. It is a Reno (Nevada) shirt, with bear tracks all over the front of it.

It was 1999 the last time we were in Reno, and Dotti and I went there, with Dotti's Reno Bowling League, as part of the league package. We had several days in Reno, a trip to Carson City, where we had this old style photo taken, and on to Lake Tahoe, before driving back home. It was a wonderful trip. And while Dotti's walk down the hall was a very impressive and important trip, I have to admit the one to Reno was more fun. Smile

There have been many times over the past few years, when things have piled up, and made me wonder if such fun and wonderful events are never to come our way again. Often it has felt like standing on the other side of a glass wall, and being able to see what should be, what could be, but not being able to actually touch it. Today, we are on the path to discover whether that glass wall can be shattered or not. Either we can get our weight down and our activity level up to where it belongs, or the wall will win. Well, I brought my hammer along and that wall will have a fight on its hands this time. We will get through it, or die trying.

The hip surgeries are only the beginning if we don't fix this. Next come the knees, and then diabetes. Our life will continue to spiral downward and there will be less and less to delight us, and more and more suffering and trying to cope. It is up to us to choose a door. But, unlike the old fable—where great rewards lay behind one door, and pain and death behind the other, and a choice had to be made without knowing which door was hiding which reward—our doors are labeled for us: Thin and Healthy; and Overweight and Suffering. So, here we go!

One of the major differences with this surgery from the last was the level of tiredness that Dotti had. She was exhausted this time. She would be talking, and then, right in the middle of a discussion, her eyes would close and she would be asleep. When she was on her computer, she would drift off to sleep very quickly when she started reading. I was worried to be honest. She was a lot more tired. And I wasn't sure why. Sure, she had a lack of sleep before surgery, but she hadn't slept all that well before surgery the last time either. I was reminded of the Cognitive Assessment Monitoring that I saw going on the last time (and I saw the CAM sign up again this time as well), as if there might be something to worry about with their anesthesia, and full recovery by the patients.

But when things were going on, Dotti was okay. She walked fine, and in the physical therapy sessions she was alert and bright, just like she normally is. That made me worry less. And fortunately, as time has gone by, although there is a ways to go yet, Dotti has returned more and more to her normal bubbly self.

Misty's balloon was over Dotti's head whenever she was sitting in her chair. It was a sweet reminder of how our niece had come to see Dotti and brightened her stay.

One of the treats that the hospital gave her really hit the spot for Dotti. She loved her graham crackers.

On Wednesday, I took this picture out Dotti's hospital window. The windows did not open, because the hospital had a sealed system where all the air inside was sent through filters to keep it clear for anyone suffering from allergies. That was unfortunate for the time Dotti was in the room, because she was too hot all the time. The room thermostat was set all the way down below 60 but the room temp was well over 70 for her entire stay. This probably contributed to her tiredness. The shame was that just on the other side of that window the air was fresh and cool. At night it was down in the low 50s and most of the day it was cooler than her room was.

Out the window you can see our car parked in the lot. It is the silver Honda, the third car beyond the white truck. The little roof extending out from the lower left corner of the picture is the cover for the walkway out the front door of the hospital, where we were going to be taking Dotti that morning. I would pull the car around by the covered walkway, and Dotti would be moved from her wheelchair into the car. (When it came time to do that, the attendant who pushed the wheelchair down commented on how well we did it. I told her we had lots of practice. For a year I have been helping Dotti get into the car. We have it down pretty good.)

I got to playing around with my camera and took this picture of myself looking at Dotti. She always puts a smile on my face. And this morning I was especially happy, because I was going to be able to bring Dotti home. No MRSA, no transfusion, and no known complications. All systems were GO, and I was happy as I had been for many a day!

This time Dotti brought along some shoes/slippers that were comfortable and more to her liking than the hospital sock slippers she had to wear last time. They went on easily and were good for walking in the halls. Of course with the hot room, she didn't wear them at all except when she got up.

One very happy surprise for Dotti was this bouquet of flowers from our friend Vikki. She and her mother had stopped by for a quick visit on Sunday, the day before surgery. We had no idea they were in town, down from Canada, and so it was a surprise. Then, on Monday, these flowers arrived at the room. Thank you Vikki!

We never did figure out for sure whether we were supposed to use the top or the bottom of the cylinder on the left, to measure the quality of the rate of air flow, when Dotti pulled air into her lungs through the tube. I am assuming it is the top, since it is wider and seems logically to be right. The label says Best, Better, Good, and it is interesting that, no matter whether you use the top or bottom of the indicator cylinder, the Best category is a lower rate of air flow. But at the same time, you are supposed to move the large "Inspired Volume" indicator up to as high a level of milliliters as possible. Clearly they are looking for sustained, deep breathing, rather than a quick burst of air into the lungs. The important thing is that Dotti used the device often, which is what they want, in order to keep pneumonia away.

I thought this was an interesting image. It shows the day Dotti was to check out of the hospital, Wednesday, September 14, 2011, along with a stethoscope hung over the calendar by one of the nurses.

Reading the small print, you see that it was the 257th day of the year, with only 108 days left of 2011, and that meant there were only 102 shopping days until Christmas! And don't think they won't run by in a hurry either. Big Smile But seriously, I am very, very much counting on things being a lot better by Christmas this year, than they have been for a very long time for Dotti and I. We have a lot of room for improvement, but we now have a lot of opportunity to move into that space and make things better.

Unfortunately, the balloon I picked up at the gift shop didn't match the quality of the flowers from the same place. The balloon started sagging soon, and finally had to be put on the shelf because it couldn't float any longer. But it was still bright and still carried the intended message, and the flowers were just fine. Between these items and "Killer" Dotti was very happy with the joint venture that Catherine and I entered into.

A very special treat for Dotti and I was having Catherine up for a one-week visit just before this surgery. We were very thankful that Ed, her very understanding husband was willing to spare his lovely wife for the week, and like me he is overjoyed to have a reuniting of the twins once more. Twins share something that is deep, and connected in ways that the rest of us can only wonder at. They need each other and they help each other to flourish. It was a great week!

Before Dotti could leave, there was one last physical therapy session to attend. This safety belt supplied a very good method for insuring Dotti would not fall as she was walking. It could be grasped, and would sustain her entire weight if necessary. Fortunately it never was put to the test, but it was there just in case.

This shows the walking path that Dotti took on the day of the surgery. Her room number is on the right, and I stuck the camera out from the door of her room. Looking down the hall, you can see on the left, after the double doors, and the two doors on the left beyond them, the corner of the nurses' station, with a potted plant sitting on the railing. Dotti walked right past the nurses' station that first day, then turned around, and she walked all the way back! After what they had done to her leg, that is frankly a miracle. No, it wasn't supernatural, but it was darned impressive nonetheless!

The white chair on wheels was beside a computer station and as Dotti was walking that first day, she was joking with a nurse who was sitting in that chair, that if the nurse didn't get out of the way, Dotti would run her over. It was things like that, where Dotti's sense of humor and bubbly personality came out, that made me feel everything was going to be okay after all. She may have been tired and not feeling quite right just yet, but she was still inside there, and she was scrapping to get out.

Here is Jessica the physical therapist, come to pick up Dotti for her last session. Dotti was trying to close off a phone call so she could leave. (Notice that her cell phone is plugged in trying to charge up, after all the use it had been getting.)

Jessica and Dotti hit it off very well, and both Dotti and I were very impressed with Jessica's Journey and how well she is doing. She has a super personality for her job, and in the group session that followed, she had the participants smiling and laughing and generally having a good time, despite the fact they were exercising and at times fighting through pain. She is definitely in the right profession!

Jessica handed this artificial hip to Dotti, so I could take her picture with it. While it is not exactly the same as her two new hips, it does give you a feel for what they had to do to her in surgery. The semi-sphere at the top gets mounted into the pelvis. Then the rest of it goes into the femur. Cutting off the head of the femur, and then pounding that spike down into the bone, and then popping this part into the pelvic part, to create a working joint, seems like something that would take weeks to heal up from, before you could even think about standing on it, but they had Dotti walking just hours after doing all of that. It seems impossible, but it happened, twice!

Jessica had Dotti go up and down these practice stairs before the group session. After all the practice she had with her left hip, as it was healing and then lately with her right hip, because it has been hurting so badly, Dotti had no trouble getting up and down these stairs with a cane.

The only issue is really doing the swap for which leg is the "good" leg and which is the "bad" leg. The memory aid goes "up with the good leg to heaven, and down with the bad leg to the other place." So, you are supposed to go up the stairs using your good leg first, and bring the bad leg up afterwards. Going down you lead with the bad leg. In all cases, you keep the cane planted on the step below to lean on. Now we just have to remember that the left leg is the good one! (Isn't that wonderful? Just a few months ago the left one was an agonizing mess. Now it is the GOOD leg!)

Occupational therapy was finished with Dotti quickly. She knew how to function at the sink and brush her teeth and all of that. Now she did her last session at the sink, and got set to change into her going home clothes, while the nurse did the paperwork.

Dotti packed things up and I made several runs to the car with her things. What a happy errand it was for me! Dotti was coming home. Yes!

Perhaps one day they will have a cell phone implant they can do. Smile It was getting close to leaving time now.

Of course the IV had to come out before we left. Pam, the nurse, pulled it out professionally and with minimal pain, and we were ready to go. Each day Dotti was doing a bit better and I was so happy that they were getting her out the door in just two days again, rather than keeping her that extra day.

Just outside of the hospital door they had a statue that suited the hospital name: Holy Family. The statue has Mary, Joseph and Jesus and I saw it each time I went in and out of the hospital. I thought it was well done, capturing the essence of the intended idea very well.

As the attendant wheeled Dotti down to the "loading zone," I ran over and got the car and had it waiting by the time they arrived. We quickly got Dotti into the car and we were on our way. There is a special feeling of freedom whenever I am able to drive Dotti away from the hospital and back home!

We had a few prescriptions to fill before heading home, and they took longer than I had counted on. (Insurance dickering over money I think was at the root of the delay, and that was unnecessary, since I would have paid the extra money myself rather than make Dotti wait in the car for so long. They just assume you don't want it if costs money, and don't bother talking to you.) By the time I came running out to the car, Dotti had a splitting headache. But I had water and the meds helped. By the time we got home, she was feeling a little better.

Our two "welcome bears" were ready to greet her, and welcome Dotti home.

Looking through the window, past my reflection, you can see Dotti looks tired, and Killer is in her lap comforting her. He sat there all the way from the hospital.

Dotti gave me a big smile as I opened the door and got things ready to get her into the house. We were finally home, and everything was okay!

I let Dotti borrow my hat for a moment and there she was, standing up in our driveway, on two new hips, and smiling!

Walking at this point is not as easy as standing and Dotti had her full attention set on taking each step correctly, while leaning on the walker.

Back home things have gone very much like they did the first time. I have to give Dotti a shot each morning to help avoid blood clots, and she does her exercises. Saturday she did a physiological "crash and burn" where she slept almost all day and all night, but it really helped. She has been much better since then. I love this picture of her on the phone. She looks so happy!

And this brown blanket has been her constant companion. It has two different surfaces to choose from. When she is cold there is a "furry" side, and when she is comfortable, she prefers the smooth, sheet-like side.

Sunday, we gave a lot of thought to the first Sunday after her first surgery. As you may recall, Father's Day was a scary setback. But this time nothing bad happened on Sunday and the recovery continued on its way, thank goodness.

Here Dotti is enjoying one of her favorite breakfast foods, Chobani yogurt. While things have been tough, and Dotti has had to put up with a lot of pain and she has to work hard to get back to her old self, she still tries very hard to keep an upbeat attitude and gives me a lot of smiles, which keep my spirits up as well.

Something new this time, we picked up an electric recliner, which will go from full recline (as it is in the photo) to a nearly standing position, where it pretty much lifts Dotti all the way up onto her feet. There is no dangerous straining or bending involved with getting up for her. It is much better than the chair she was in last time. And the cost was more reasonable than we expected.

Even more than the chair, I love those pink pajamas. Big Smile

A week has come and gone, and Killer is still keeping a watch on things. Dotti's wound has healed very well so far. It is even better than last time. I am sure all the staples will come out at the same time this time around. There is no oozing at all. Dotti is hurting still, but it is getting less each day. One week is done, and in just a few weeks she will be feeling like a new woman. In a couple of days, autumn will officially begin, which is my favorite time of the year. By the time the ice sets in, I hope Dotti will be well enough to be walking without a cane. We will see.

In any case, I am thankful that Dotti is home, safe and sound. We have a lot of reasons to feel optimistic about the future. The door of opportunity has just opened. It is up to us to walk through it, and as a bit of serendipity, walking just happens to be getting easier every day!

Let's Do It Again   /   Hammer and Tongs   /   One Tired Step

Part One: Straight From The Hip