It's now six weeks since the surgery to replace my right hip and I am finally feeling close to normal. I shook the Vicodin about two weeks ago and went through an uncomfortable week of withdrawal. Then about two days I ago I gave up Tylenol (I had been taking 3g per day). I've had only one 500mg Tylenol in the past 48 hours.
Today is the first day since my surgery that I can say I feel right. I am using a cane to assist the left hip but am quite ambulatory.
Physical therapy is helping quite a bit. Found a great therapist who spends about 15 minutes moving, pressing, etc., after a 45 minute routine of machine and stationary exercises.
So, the good news is I feel good. Looking forward to getting the second hip done and moving on with life.
Monday, December 28, 2009
Monday, December 21, 2009
Shook Off the Vicodin But It Was Not Easy
Last Tuesday night at 3:30 a.m. I took my last Vicodin (5mg Vicodin, 325 mg Tylenol). The last six days I've been feeling pretty poor. When I recognized that I was taking Vicodin to control feelings of malaise, chills, emotional downs -- symptoms of opiate withdrawal -- rather than to control pain, I knew it was time to get off the Vicodin.
Previously I had been trying to wean myself off the drug but successively longer periods of time between doses. But that only caused me to experience the repeated beginnings of withdrawal numerous times without acheiving my goal of Vicodin independence.
So, I stopped taking Vicodin altogether and determined to deal with the withdrawal over a period of days. And it did take several days -- days of feeling pretty crappy, poor temperature control (usually cold), feeling down. But I think I've come through it now, some six days into the process.
I've been dosing with 500mg Tylenol tablets, one every four or so hours. That's 3g per day total, versus a limit of 4g per day of Tylenol.
Previously I had been trying to wean myself off the drug but successively longer periods of time between doses. But that only caused me to experience the repeated beginnings of withdrawal numerous times without acheiving my goal of Vicodin independence.
So, I stopped taking Vicodin altogether and determined to deal with the withdrawal over a period of days. And it did take several days -- days of feeling pretty crappy, poor temperature control (usually cold), feeling down. But I think I've come through it now, some six days into the process.
I've been dosing with 500mg Tylenol tablets, one every four or so hours. That's 3g per day total, versus a limit of 4g per day of Tylenol.
Tuesday, December 15, 2009
4 Weeks Post-Surgery and Coming Along
Okay, so it's 4 weeks (today) since surgery to replace my right hip joint and I am more than pleased with my progress. Sure, it's been a bit difficult here and there, but it's not been painful at all (controlled largely by Vicodin 5mg, 4 times per day; needed mostly to deal with the left hip joint which is scheduled to be replaced in a little more than 3 weeks, on January 7, 2010. The difficulties have been diminishing, consisting mostly of limited mobility which, with exercise and time, have been steadily decreasing. And, I've not been able to drive. Getting in and out of our car on the passenger side is becoming easier each day.
A word on Vicodin. The positive is that it does work for me. I was able to cut down the initial dosage from 8 pills to 4 pills per day, about 6 hours apart. I find that anything less (or a longer time period between pills) rather quickly results in chills, malaise, and increased pains and stiffness in my left hip joint. The negative is that after the second surgery I am sure to experience withdrawal symptoms, probably about 6 to 8 weeks post-surgery when I hope to be coming off the pain medication (late February or early March).
Getting dressed is not a problem except for getting compression stockings on my legs. Renee has been diligent about that task each morning.
The surgical scar is healing nicely. The steri-strip covering the dissolvable stitches is coming off piece by piece. The wound looks good, no oozing, no odor. I have my physical therapist check it each time I see him (2 or 3 times per week). There is a slight red portion which the therapist attributes to a "pinch point" where the movement of my hip results in movement of that portion of the surgical site.
Also, keeping my legs elevated whenever possible has been a challenge. A new lift/recliner chair works well for that, particularly when augmented by a large triangular foam pillow under my legs which helps elevate my calves when the chair is moved to reclining position. Highly recommended.
Physical therapy also works well to combat the edema present in my legs following the surgery. That's my primary focus now -- reducing and eliminating the edema.
A word on Vicodin. The positive is that it does work for me. I was able to cut down the initial dosage from 8 pills to 4 pills per day, about 6 hours apart. I find that anything less (or a longer time period between pills) rather quickly results in chills, malaise, and increased pains and stiffness in my left hip joint. The negative is that after the second surgery I am sure to experience withdrawal symptoms, probably about 6 to 8 weeks post-surgery when I hope to be coming off the pain medication (late February or early March).
Getting dressed is not a problem except for getting compression stockings on my legs. Renee has been diligent about that task each morning.
The surgical scar is healing nicely. The steri-strip covering the dissolvable stitches is coming off piece by piece. The wound looks good, no oozing, no odor. I have my physical therapist check it each time I see him (2 or 3 times per week). There is a slight red portion which the therapist attributes to a "pinch point" where the movement of my hip results in movement of that portion of the surgical site.
Also, keeping my legs elevated whenever possible has been a challenge. A new lift/recliner chair works well for that, particularly when augmented by a large triangular foam pillow under my legs which helps elevate my calves when the chair is moved to reclining position. Highly recommended.
Physical therapy also works well to combat the edema present in my legs following the surgery. That's my primary focus now -- reducing and eliminating the edema.
Thursday, December 03, 2009
Home This Week, Physical Therapy
As you've read (below), my surgery was scheduled for 1:30 p.m., Tuesday, Nov. 17. I spoke with the surgeon around 11:00 a.m. and he said that he had one to do in a few minutes and that it should take an hour and a half; that I should be good to go around 1:30 p.m.
Evidently there were problems and that surgery lasted longer than expected. At 5:00 p.m. the anesthesiologist came to us to say that he had reviewed my medical information and that it would be medically irresponsible to do both hips during one surgery. Complicating factors include weight, history of atrial fib, elevated creatinine. So, they decided to do only one hip, the worst one.
My surgery was uneventful, took 90 minutes and all went well. I had a nice semi-private room overlooking the East River and Roosevelt Island. Also, plenty of beautiful nurses caring for my every need, waiting on me hand and foot, 24/7 -- just like I'm accustomed to receiving at home.
On Friday, I was transferred to Helen Hayes Hospital, a sub-acute rehabilitation facility in Rockland County -- first class. I spent 8 days there and was discharged last Saturday, a couple of days after Thanksgiving. I am getting around with a walker and sometimes with a cane.
I began physical therapy in Rockland this week. And I'm doing exercises to strengthen my legs. Each day brings some improvement in mobility.
Unfortunately, it is now the un-operated hip that is limiting my movement and causing the most discomfort. I have been able to reduce my reliance on Vicodin from 8 pills per day (5 mg each) to 2 or 3 pills per day.
All in all, I feel better than I did pre-surgery. And by February, I hope to feel great.
Evidently there were problems and that surgery lasted longer than expected. At 5:00 p.m. the anesthesiologist came to us to say that he had reviewed my medical information and that it would be medically irresponsible to do both hips during one surgery. Complicating factors include weight, history of atrial fib, elevated creatinine. So, they decided to do only one hip, the worst one.
My surgery was uneventful, took 90 minutes and all went well. I had a nice semi-private room overlooking the East River and Roosevelt Island. Also, plenty of beautiful nurses caring for my every need, waiting on me hand and foot, 24/7 -- just like I'm accustomed to receiving at home.
On Friday, I was transferred to Helen Hayes Hospital, a sub-acute rehabilitation facility in Rockland County -- first class. I spent 8 days there and was discharged last Saturday, a couple of days after Thanksgiving. I am getting around with a walker and sometimes with a cane.
I began physical therapy in Rockland this week. And I'm doing exercises to strengthen my legs. Each day brings some improvement in mobility.
Unfortunately, it is now the un-operated hip that is limiting my movement and causing the most discomfort. I have been able to reduce my reliance on Vicodin from 8 pills per day (5 mg each) to 2 or 3 pills per day.
All in all, I feel better than I did pre-surgery. And by February, I hope to feel great.
Monday, November 23, 2009
Skyped with my Granddaughter
I had a special treat this evening. My daughter and granddaughter connected via Skype for a short video phone call. MY $300 HP Netbook worked perfectly. I sang my repertoire of nursery rhymes and was treated to my 20 month-old's punctuation, singing and rocking and rolling as I sang to her. Doesn't get much/any better than that.
And I received another special treat when my other daughter phoned to report my 6 year old grandson's delight at having been visited overnight by the tooth fairy. I understand that the going rate has risen but from what I remember, in my day one could have redeemed an entire mouthfull of baby teeth for today's price of a single tooth.
And I received another special treat when my other daughter phoned to report my 6 year old grandson's delight at having been visited overnight by the tooth fairy. I understand that the going rate has risen but from what I remember, in my day one could have redeemed an entire mouthfull of baby teeth for today's price of a single tooth.
Rehab Underway
Doing well in rehab. Arrived late Friday from NYC. Not much going on in the facility over the weekend but I did manage to get in some OT and PT sessions. OT teaches basic skills like dressing, washing, reaching for things, etc. PT involves strength training, positions to avoid while healing, practice walking, stair climbing, rappelling and mountaineering.
Today I received my schedule and I have 5 classes per day.
Pain is basically gone. The right side old pain (groin, quad, glute) is totally absent. Vanished. (Left side glute hurts a bit but possibly because aggravated by sitting too long on a hard wheel-chair cushion).
The surgical site is doing well. I get a low level of post-op pain from there but less than "1" on a 1-10 scale. I've been taking 2 Norcos (5mg Vicodin plus 325mg Tylenol) 4 times per day.
Eating relatively little but getting a bit hungry at 4:00am so I've been saving something from dinner for those times.
Lots of girls here. Average age 82.
Daily blood tests to adjust Coumadin dosage.
Staying at a magnificent facility owned and run by NY State. Terrific view of the Hudson River.
Surgeon used dissolving stitches and a steristrip to cover the 10" incision so I've been able to shower since I arrived at rehab.
I hope to stay as long as possible. This is a terrific facility.
Friday, November 20, 2009
Updated Contact Information
845-786-6287
Helen Hayes Hosp.
Rm 8, Wing 1A
West Haverstraw, NY
914-844-1571 | Cell
866-738-9412 | eFax
Helen Hayes Hosp.
Rm 8, Wing 1A
West Haverstraw, NY
914-844-1571 | Cell
866-738-9412 | eFax
"IBM" -- I've Been Moved (to Rehab)
I'm recuperating at Helen Hayes Hospital in the Hudson Valley where visiting hours are 11 to 9. My stay could be 5 to 7 days.
Two bronco busters cowboyed my ambulance up the East Side Drive this afternoon, across the GWB and onto the PIP where the road finally smoothed out. Not to be frustrated in his efforts to give me the world's roughest ambulance ride, driver Soto weaved constantly from lane to lane in what seemed like a concerted effort to put the truck into sinuous rhythm and me strapped inside on a hard bench into an asynchronous harmonic as I bounced into the wall with each swerve of the wheel. All this as his colleague Nicki entertained between strains of a heavy beat pouring from the radio sufficient to set all of 180th St. in motion. From time to time we'd roll over the cutouts lining the lane to protect drivers who stray too far from the road with a sudden bright staccato machine gun burst that wakes those dozing drivers so as to prevent an unintended rollover.
The ride was entertaining. Good thing I had taken my pain meds in advance of the trip.
The rest of the day has been uneventful as I get settled in for PT to begin tomorrow.
Two bronco busters cowboyed my ambulance up the East Side Drive this afternoon, across the GWB and onto the PIP where the road finally smoothed out. Not to be frustrated in his efforts to give me the world's roughest ambulance ride, driver Soto weaved constantly from lane to lane in what seemed like a concerted effort to put the truck into sinuous rhythm and me strapped inside on a hard bench into an asynchronous harmonic as I bounced into the wall with each swerve of the wheel. All this as his colleague Nicki entertained between strains of a heavy beat pouring from the radio sufficient to set all of 180th St. in motion. From time to time we'd roll over the cutouts lining the lane to protect drivers who stray too far from the road with a sudden bright staccato machine gun burst that wakes those dozing drivers so as to prevent an unintended rollover.
The ride was entertaining. Good thing I had taken my pain meds in advance of the trip.
The rest of the day has been uneventful as I get settled in for PT to begin tomorrow.
Wednesday, November 18, 2009
Surgery
Surgery went well, about 90 minutes, beginning at 6:00 p.m. Tuesday evening. Pain management is a high priority at HSS and that has been evident all through my experince here.
Unfortunately my anesthesiologist vetoed a bi-lateral about an hour prior to surgery which was a big disappointment. So I am hoping to get the second hip operated on in early January, if possible.
Where I go from here is up to Oxford, my health insurance provider. Best case would be Helen Hayes, an acute care rehab facility in Rockland county. I am hoping that Oxford will approve it.
I am resting comfortably and hope to be discharged Saturday. A big "Thank you" to everyone who wrote, called, expressed interest and concern, or even just thought about me. I am fine and will be as good as new soon.
This is my final entry in this blog. The rest will be merely rest and rehab. So I am signing off. This post is my 30.
Ellis is Recovering Amazingly Well
Just spoke with Ellis, who is recovering amazingly well after his one hip replacement. He is in great spirits, cracking jokes and feels great. They have already had him walking around and should be admitted into a semi-private room later today.
He made it a point to thank everyone for all the prayers and speedy recovery sentiments. For information as to where to send gifts/flowers, though he says they are unnecessary (the emails and phone calls have really touched him), please contact Edd Schillay at edd@trial.com
- Posted by Edd Schillay
He made it a point to thank everyone for all the prayers and speedy recovery sentiments. For information as to where to send gifts/flowers, though he says they are unnecessary (the emails and phone calls have really touched him), please contact Edd Schillay at edd@trial.com
- Posted by Edd Schillay
Tuesday, November 17, 2009
Ellis is Out of Surgery
I've been told that Ellis went into surgery at 5:00pm and came out three hours later with one of the two hips done. He is doing well and is in the recovery room at the hospital, where he'll stay until some point tomorrow.
The doctors stated that they didn't want to keep him under too long and will have to do the second hip after he recovers from this surgery - most likely two months from now.
Thanks to all for the phone calls and requests to send gifts/flowers. Once Ellis is assigned a room or moves on to a rehabilitation facility, I will be sure to post an update.
- Posted by Edd Schillay
The doctors stated that they didn't want to keep him under too long and will have to do the second hip after he recovers from this surgery - most likely two months from now.
Thanks to all for the phone calls and requests to send gifts/flowers. Once Ellis is assigned a room or moves on to a rehabilitation facility, I will be sure to post an update.
- Posted by Edd Schillay
Still Waiting
The surgery preceding mine was to have been completed by 2:30pm. It appears to have run over. Where's Edd with his electronic timing lights?
Surgery Pushed to 3:00pm
Just had xrays on a very cold table. Doc Bully initialed my hips.
Everyone is exceedingly polite and helpful.
Everyone is exceedingly polite and helpful.
In the Waiting Room
Arrived at HSS at 10:00 am and walked in as a matter of principle (as opposed to using a wheel chair). I figure "walk in, walk out". Let's hope so.
Family waiting room very nice with 4-story window onto NY's East River. The gently flowing massive olive green slug of liquid is, I am sure, water. I give it about 4 knots in the southerly direction. A Kings Point Merchant Marine ship just sailed by rapidly.
The sun-filled waiting room is packed with families and patients like me waiting to be called. Breaking the white noise din every so often is the voice of a hospital official politely calling out a surname. Each time that happens I get a jolt. Will that be my name?
Hungry. Haven't eaten since "dinner" (3 ounces of chicken and a baked potato -- no sauce). Yum! A small food service stand is serving breakfast. I'll deal.
A woman announces that visiting time (11:30am) had arrived for patients in the recovery room. She sets forth the rules: 20 minute visits, one patient at a time in the recovery room; extra visitors must queue up. The waiting room empties to about half the number of people earlier.
I am sitting, waiting, emailing and now blogging.
Family waiting room very nice with 4-story window onto NY's East River. The gently flowing massive olive green slug of liquid is, I am sure, water. I give it about 4 knots in the southerly direction. A Kings Point Merchant Marine ship just sailed by rapidly.
The sun-filled waiting room is packed with families and patients like me waiting to be called. Breaking the white noise din every so often is the voice of a hospital official politely calling out a surname. Each time that happens I get a jolt. Will that be my name?
Hungry. Haven't eaten since "dinner" (3 ounces of chicken and a baked potato -- no sauce). Yum! A small food service stand is serving breakfast. I'll deal.
A woman announces that visiting time (11:30am) had arrived for patients in the recovery room. She sets forth the rules: 20 minute visits, one patient at a time in the recovery room; extra visitors must queue up. The waiting room empties to about half the number of people earlier.
I am sitting, waiting, emailing and now blogging.
Switchover to Mobile Mode
It's Tuesday, surgery day, and time to throw off the teather and go wireless. This is my first post from my iPhone.
Slept well last night to the credit of some vintage Willie Nelson music that I find very calming and soothing. The Bose noise-cancelling headset was comfortable and delivered a you-are-there sound environment.
Spoke with all my children yesterday. A load of emails, and a bunch of phone calls, from friends.
Up early. Ready.
Slept well last night to the credit of some vintage Willie Nelson music that I find very calming and soothing. The Bose noise-cancelling headset was comfortable and delivered a you-are-there sound environment.
Spoke with all my children yesterday. A load of emails, and a bunch of phone calls, from friends.
Up early. Ready.
Monday, November 16, 2009
T Minus 11 Hours and Counting
Well today I received my hospital arrival time (10:30 a.m.) and surgery time (1:30 p.m.). I am very positive about this, very calm, looking forward to getting better.
Today's food intake was limited to non-fiber light eating: corn flakes, skim milk, cottage cheese, turkey and Cling peaches (reminiscent of Edith Bunker anyone?). Tomorrow will be clear liquids only.
I've downloaded "The Essential Willie Nelson" and some Willie Nelson and Johnny Cash podcasts to my iPhone, as well as a few new games, Scrabble (terrific) and iBowling being the best. Both allow interactive play with someone else on the Internet, so I ran a shakedown Scrabble game with my brother Steve. To say that I was thoroughly whooped would be an understatement. Despite a respectable mid-200 score on my part, Steve was bumping up against 400.
When I played the game alone against the iPhone's CPU, I noticed something quite unfair. The CPU has access to and uses every word in the dictionary, including many I never heard of. On the other hand, when I use words that the CPU never heard of, they are rejected. Now I ask you, is that fair? Hmmm.
I packed a small bag with some baggy p.j.'s, toiletry items, socks, a shirt and a sweatshirt (the latter two being TRIAL.COM logo products, of course). Tomorrow is the big day.
Today's food intake was limited to non-fiber light eating: corn flakes, skim milk, cottage cheese, turkey and Cling peaches (reminiscent of Edith Bunker anyone?). Tomorrow will be clear liquids only.
I've downloaded "The Essential Willie Nelson" and some Willie Nelson and Johnny Cash podcasts to my iPhone, as well as a few new games, Scrabble (terrific) and iBowling being the best. Both allow interactive play with someone else on the Internet, so I ran a shakedown Scrabble game with my brother Steve. To say that I was thoroughly whooped would be an understatement. Despite a respectable mid-200 score on my part, Steve was bumping up against 400.
When I played the game alone against the iPhone's CPU, I noticed something quite unfair. The CPU has access to and uses every word in the dictionary, including many I never heard of. On the other hand, when I use words that the CPU never heard of, they are rejected. Now I ask you, is that fair? Hmmm.
I packed a small bag with some baggy p.j.'s, toiletry items, socks, a shirt and a sweatshirt (the latter two being TRIAL.COM logo products, of course). Tomorrow is the big day.
Sunday, November 15, 2009
Getting Close
I've been limiting contact with the outside world so as not to catch a cold, or infection or do anthying else that might throw the schedule off. Today, though, my daughter-in-law Dara and my son Jason hosted my soon-to-be 88 year old Dad (who is in town from Boca Raton, Florida), and the rest of the Mirsky family for brunch. Jason used his new smoker to smoke salmon -- absolutely the best smoked salmon I have ever had. It was moist, almost fall-apart soft, and major league delish.
Spent the rest of the day at home nodding off between NFL football plays and switching the channel incessitantly unsuccessfully seeking something decent on TV to watch. I did the same thing yesterday while watching a non-stop succession of college football games. I think the college games were better than the pro games this weekend.
Had a lot of time to ponder just how lucky I am in so many ways. First I have a tremendous support base of really good friends all over the U.S. and Canada from my work with law firms over the past 17 years and The Network of Trial Law Firms that I set up. The messages I have received from scores of those friends are heartfelt and gratifying.
Of course my family and other friends have been in touch with support and encouragement. I am lucky and thankful for that.
But putting this thing into perspective, how lucky am I that within several months of diagnosis, I am to be operated on by one of the leading surgeons in the world at one of the best hospitals in the world, and as a kicker, most of the expense is expected to be covered by my insurance? Considering how many people there are in the world, how many of them must need this kind of surgery, and how many just cannot get it, I am more than lucky. Blessed is a better description. Makes me want to do something to help those less fortunate to get access to this kind of life-altering solution.
When I was an engineering student at City College of New York in the late 1960s we were just scratching the surface of bio-mechanical engineering. The kinematics I studied were based around railroad link drives and internal combustion engines. I'm glad that creative thinkers chose instead to devote their attention to designing mechanical and other medical prosthetics, for soon I will be a beneficiary of that work.
Spent the rest of the day at home nodding off between NFL football plays and switching the channel incessitantly unsuccessfully seeking something decent on TV to watch. I did the same thing yesterday while watching a non-stop succession of college football games. I think the college games were better than the pro games this weekend.
Had a lot of time to ponder just how lucky I am in so many ways. First I have a tremendous support base of really good friends all over the U.S. and Canada from my work with law firms over the past 17 years and The Network of Trial Law Firms that I set up. The messages I have received from scores of those friends are heartfelt and gratifying.
Of course my family and other friends have been in touch with support and encouragement. I am lucky and thankful for that.
But putting this thing into perspective, how lucky am I that within several months of diagnosis, I am to be operated on by one of the leading surgeons in the world at one of the best hospitals in the world, and as a kicker, most of the expense is expected to be covered by my insurance? Considering how many people there are in the world, how many of them must need this kind of surgery, and how many just cannot get it, I am more than lucky. Blessed is a better description. Makes me want to do something to help those less fortunate to get access to this kind of life-altering solution.
When I was an engineering student at City College of New York in the late 1960s we were just scratching the surface of bio-mechanical engineering. The kinematics I studied were based around railroad link drives and internal combustion engines. I'm glad that creative thinkers chose instead to devote their attention to designing mechanical and other medical prosthetics, for soon I will be a beneficiary of that work.
Saturday, November 14, 2009
How Am I Feeling?
I feel like I am about to enter a 6-story water slide. Confident it will all be fine but a bit apprehensive about taking the plunge. However, almost constant discomfort and pain continually remind me there is no alternative.
Pre-Admission Case Management
A pre-admission case manager phoned with a few questions relating to post-surgery rehabilitation:
1. Does my home have stairs to get in?
2. Does my home have stairs inside?
3. Is anyone at home to help me?
She told me that screening nurses from two of the local rehabilitation centers (Helen Hayes in Rockland County, and Burke in Westchester County) are on-site daily at HSS.
Admission to one of those facilities will depend on approval by my health insurer (Oxford) and availability (room at the inn).
I understand that, from a patient's perspective, rehabbing at one of those facilities is much preferred to rehabbing "at home" or even at a nursing home with rehab capability because of focus, expertise and frequency of rehab exercising.
However, sometimes (?) a health insurer case manager might have a different view as to "medical necessity". In my case, with both hips being replaced, HSS' pre-admission case manager is of the opinion that I should have no trouble getting insurer approval. I'll let you know.
I am told that sometimes advocacy is called for. I'll have to see if anyone I know is skilled at that. ;-)
1. Does my home have stairs to get in?
2. Does my home have stairs inside?
3. Is anyone at home to help me?
She told me that screening nurses from two of the local rehabilitation centers (Helen Hayes in Rockland County, and Burke in Westchester County) are on-site daily at HSS.
Admission to one of those facilities will depend on approval by my health insurer (Oxford) and availability (room at the inn).
I understand that, from a patient's perspective, rehabbing at one of those facilities is much preferred to rehabbing "at home" or even at a nursing home with rehab capability because of focus, expertise and frequency of rehab exercising.
However, sometimes (?) a health insurer case manager might have a different view as to "medical necessity". In my case, with both hips being replaced, HSS' pre-admission case manager is of the opinion that I should have no trouble getting insurer approval. I'll let you know.
I am told that sometimes advocacy is called for. I'll have to see if anyone I know is skilled at that. ;-)
Friday, November 13, 2009
Pre-op Medical Screening Complete
Completed pre-op screening this week and received clearance for bi-lateral hip replacement surgery this coming Tuesday. I met with an anestheseologist and was examined by a doctor.
HSS also conducted an hour of patient education where we learned about the upcoming surgery and handling post-surgery everyday things like sitting, standing, turning, walking, putting on socks and using a toilet.
Also I stored a pint of blood for possible use during surgery, or donation if not needed.
HSS also conducted an hour of patient education where we learned about the upcoming surgery and handling post-surgery everyday things like sitting, standing, turning, walking, putting on socks and using a toilet.
Also I stored a pint of blood for possible use during surgery, or donation if not needed.
Tuesday, November 10, 2009
Bringing You Up to Date
Many Years in the Making: Now that I have had a chance to think about it, I have been having hip joint symptoms for many years but I never associated the symptoms with the source. My symptoms were groin pain, PITA, and quadricep pain (all both sides). (Most patients think that their hip is in the region of the buttocks and are surprised to learn that true hip pain is most commonly experienced in the groin. Source: The Hip and Knee Institute) The cause apparently was arthritic deterioration of my hip joints. But what was the cause of that? Many theories, but overload, too much weight on those weight-bearing joints appears to be the primary culprit. My weight at least contributed to and possibly accelerated the development of the problem. But there were other causes as well.
Some Congenital Contribution Also: I have been overweight all of my life. That led to a variety of leg and foot problems (principally swelling, insufficient circulation, pain). But, thinking back, about twenty years ago a friend (Bobby Zelin) pointed out that I was walking on the outer edges of my shoes. That was probably a precusor of things to come. And, interestingly, when my surgeon Dr. Buly threw my hip x-ray onto a light board, the second thing he noted was that one of the sides of my femur was convex rather than concave. He said that apparently my femur continued to grow after my young adulthood, when growth should have stopped (eventually leading to impingement with the pelvis). (That was the second thing he said. The first thing he said, when he saw the degree of arthritis that has resulted in bone-on-bone contact in both hip joints, was "oh, you must be in a lot of pain". Thank you. Yes, a great deal of pain and constant.)
Some of the exercises and activities I engaged in during my life probably contributed as well, including those mandatory standing broad jumps in the 7th grade, jogging when that was the craze during my 40's (I was actually jogging 6 miles), as well as inattention to the condition of my shoes and sneakers which I tended to wear well beyond their useful lives.
Relieving or Living with the Pain:
The clues were there for a long time. About a year ago I began noticing groin pain. I mistakenly attributed that to a slip and partial split in the shower. Then my gluteus maximus (buttocks) began aching along with my quadriceps which would become rock solid tight. Walking anywhere became a chore. Walking over uneven surfaces was worse.
I found some comfort with an occasional dose of Advil. Aleve didn't do squat for me. UltramER was prescribed but ineffective at the dosage given. I began to need regular rub-downs with a "Thumper".
Finally, Dr. Brian Israel, D.O., my primary care physician, guitarist and guitar collector, prescribed 5-500 Vicodin-Tylenol and that worked.
Physical Therapy Ineffective: Early on I started treating with a physical therapist. The warm moist heated blankets were soothing, the light back massages too light, the laser heating comforting, but nothing lasted. Eventually I stopped treating because nothing was working to relieve my pain long-term.
Weight Loss with Purpose: At the same time I had re-embarked on an on-again, off-again long-term program of weight loss under the guidance of a nutritionist with Phelps Hospital in Tarrytown, New York. I have tried many different diets, and have been somewhat successful, but my middle initial, "R" doesn't stand for "Richard", it stands for "Recitavist". I was a recitavist dieter. No matter how well I did on a diet program, I always gained back the weight I had lost, and more. I was a Duncan® Champion Yo-Yo dieter. Eventually, I essentially gave up, resigned myself to being big, and kept purchasing ever larger clothes.
There came a time when the only thing I felt good about buying was an extra-long tie. Even my shoes weren't fitting. My feet had swollen as well as my legs.
Recommittment to Weight Loss: So, I started losing weight again, cutting back on portion size, making better food choices. Wight loss, for me at least, is sporadic. I loss weight, then I plateau. I had plateaued at about 50 pounds down from my all-time high. With a renewed the assault, came another 10 pound weight loss. But I got stuck again. And now, with impending hip surgery, I knew the time had come to get down.
I consulted Dr. Louis J. Aronne, a weight expert whom I had consulted many years ago and with whom I dropped 10% of my weight. Down 60 pounds, Dr. Arrone reviewed my blood work and history and prescribed a low dose (500mg) of Metformin, a drug with an off-label use controlling blood sugar and appetite.
Metformin has been good for me so far. I've lost another 10 pounds, bringing my total to 70 pounds lost. When and if I plateau again, we might try Welbutrin, an off-label use for which is weight loss.
Currently I have very little appetite. That's good. It's especially good because the pain-killer I've gotten to, 5-500 Vicodin-Tylenol, has one very nasty side effect -- constipation. Let's leave it at that, except the calcium blocker is also constipating. Needless to say, when one experiences so much difficulty eliminating, one's food choices narrow considerably. Granola, fruit, prunes and other good-for-you stuff are now staples in my diet.
When I go out to eat, I order less and generally eat less than half of what I order. My appetite is greatly reduced, sometimes non-existent.
With my recent weight-loss I went shopping -- in my basement where I had saved two or three wardorbs worth of smaller clothes from earlier times. I am now wearing clothes I haven't fit into for 15 years. And yes, still in style (my style).
Back and Leg Pain: But the pains in my back and legs were not diminishing. I was referred to an anesthiologist, Dr. Vinoo Thomas, who concluded that my pain was emanating from my sacroiliac ("SI") joint. Under minimally invasive fluoroscopy, I underwent two cortisone injections into each SI joint which provided me with some relief -- enough that I was able to trek around Israel this past May with occassional resort to ibuprofen. (If you like the photos of Israel, you might want to see my photos of Africa.)
The pain continued to escalate in scope and intensity. I couldn't sit for long, especially on hard surfaces. I was referred to Spine Options in White Plains, New York where I was seen by Bradley S. Cash, MD, FAAPMR who examined me and set me up with a course of physical therapy in his office. My therapist, Hemalatha Ramraj, PT, MS, was wonderful. But there was little marked improvement in my condition after several months of treatment. Eventually my insurer came to the same conclusion that I did -- the sessions were not working to improve my condition which was, in their words, "chronic" -- PT was not going to improve my condition.
Hema, my physical therapist, suggested that I have my hips x-rayed and her supervisor, Dr. Cash, ordered the x-ray. Bingo! Finally we had gotten to the problem -- advanced osteoarthritis in both hips. An earlier MRI of my lower back revealed disc herniation at L5 and T12 and the easy conclusion would have been that the disc problems were causing my leg pain. Not so. It was the hips.
And the pain was escalating. On a 10 scale, it had gone from a "3", controllable by Advil, to a regular "6-8", sometimes a "10" (when my hip would essentially hang up on a spur when I would sit a low couch in my TV room. That caused my hip joint to get stuck out of position, putting me in "catch-your-breath" agony). The only relief for me when that would happen was to wiggle to the floor and thrash about until my stuck hip joint fell back into place. I don't sit on that couch anymore and hope someday to see it at the curb awaiting my town's next bulk refuse pickup.
Confirming Diagnosis: I consulted with a friend of mine (Dr. Adam Levine, Associate Professor of Anesthesiology at Mt. Sinai) who recommended that I see Dr. Harry Spiera, a terrific diagnostician and rheumatologist. Dr. Spiera confirmed the diagnosis of advanced osteoarthritis. He said that surgery was definitely in my future.
At that point Anne Grundstein, my sister-in-law, an occupational therapist, arranged for a heavy duty cane to be delivered for my use. I have been using it daily since I received it.
My condition has continued to deteriorate markedly, and especially within the last 2 months. A couple of months ago I was able to hobble through airports in Newark and Atlanta for a dinner meeting with attorneys celebrating the 10th anniversary of their firm's founding. Last week I needed a wheelchair in Newark and Orange County airports to get to Laguna Beach, California for a CLE program that my Network produced. And while at the hotel I used an electric powered three-wheeled Lynx-3 (which I found a bit too short in length for my 5'-11" frame for me to be comfortable -- my feet hung off the front of the vehicle, but it beat trying to walk around the hotel). The decline in my hip condition has been rapid and irreversible, but for the upcoming hip joint replacement surgery.
Humor Even Under These Conditions: It took 6 weeks just to get an appointment with Dr. Buly. A number of other fine doctors were recommended to me, but Dr. Buly had operated on my neighbor who had a particularly challenging problem -- she needed to replace a hip prosthesis that was installed many years ago. She was referred from one doctor to another, each declining to operate, until she got to Dr. Buly. Her surgery was successful.
The moment Dr. Buly punched my x-rays up on the light board, he remarked, "you must in a lot of pain". Yes, I certainly was.
Some Congenital Contribution Also: I have been overweight all of my life. That led to a variety of leg and foot problems (principally swelling, insufficient circulation, pain). But, thinking back, about twenty years ago a friend (Bobby Zelin) pointed out that I was walking on the outer edges of my shoes. That was probably a precusor of things to come. And, interestingly, when my surgeon Dr. Buly threw my hip x-ray onto a light board, the second thing he noted was that one of the sides of my femur was convex rather than concave. He said that apparently my femur continued to grow after my young adulthood, when growth should have stopped (eventually leading to impingement with the pelvis). (That was the second thing he said. The first thing he said, when he saw the degree of arthritis that has resulted in bone-on-bone contact in both hip joints, was "oh, you must be in a lot of pain". Thank you. Yes, a great deal of pain and constant.)
Some of the exercises and activities I engaged in during my life probably contributed as well, including those mandatory standing broad jumps in the 7th grade, jogging when that was the craze during my 40's (I was actually jogging 6 miles), as well as inattention to the condition of my shoes and sneakers which I tended to wear well beyond their useful lives.
Relieving or Living with the Pain:
The clues were there for a long time. About a year ago I began noticing groin pain. I mistakenly attributed that to a slip and partial split in the shower. Then my gluteus maximus (buttocks) began aching along with my quadriceps which would become rock solid tight. Walking anywhere became a chore. Walking over uneven surfaces was worse.I found some comfort with an occasional dose of Advil. Aleve didn't do squat for me. UltramER was prescribed but ineffective at the dosage given. I began to need regular rub-downs with a "Thumper".
Finally, Dr. Brian Israel, D.O., my primary care physician, guitarist and guitar collector, prescribed 5-500 Vicodin-Tylenol and that worked.
Physical Therapy Ineffective: Early on I started treating with a physical therapist. The warm moist heated blankets were soothing, the light back massages too light, the laser heating comforting, but nothing lasted. Eventually I stopped treating because nothing was working to relieve my pain long-term.
Weight Loss with Purpose: At the same time I had re-embarked on an on-again, off-again long-term program of weight loss under the guidance of a nutritionist with Phelps Hospital in Tarrytown, New York. I have tried many different diets, and have been somewhat successful, but my middle initial, "R" doesn't stand for "Richard", it stands for "Recitavist". I was a recitavist dieter. No matter how well I did on a diet program, I always gained back the weight I had lost, and more. I was a Duncan® Champion Yo-Yo dieter. Eventually, I essentially gave up, resigned myself to being big, and kept purchasing ever larger clothes.
There came a time when the only thing I felt good about buying was an extra-long tie. Even my shoes weren't fitting. My feet had swollen as well as my legs.
Recommittment to Weight Loss: So, I started losing weight again, cutting back on portion size, making better food choices. Wight loss, for me at least, is sporadic. I loss weight, then I plateau. I had plateaued at about 50 pounds down from my all-time high. With a renewed the assault, came another 10 pound weight loss. But I got stuck again. And now, with impending hip surgery, I knew the time had come to get down.
I consulted Dr. Louis J. Aronne, a weight expert whom I had consulted many years ago and with whom I dropped 10% of my weight. Down 60 pounds, Dr. Arrone reviewed my blood work and history and prescribed a low dose (500mg) of Metformin, a drug with an off-label use controlling blood sugar and appetite.Metformin has been good for me so far. I've lost another 10 pounds, bringing my total to 70 pounds lost. When and if I plateau again, we might try Welbutrin, an off-label use for which is weight loss.
Currently I have very little appetite. That's good. It's especially good because the pain-killer I've gotten to, 5-500 Vicodin-Tylenol, has one very nasty side effect -- constipation. Let's leave it at that, except the calcium blocker is also constipating. Needless to say, when one experiences so much difficulty eliminating, one's food choices narrow considerably. Granola, fruit, prunes and other good-for-you stuff are now staples in my diet.
When I go out to eat, I order less and generally eat less than half of what I order. My appetite is greatly reduced, sometimes non-existent.
With my recent weight-loss I went shopping -- in my basement where I had saved two or three wardorbs worth of smaller clothes from earlier times. I am now wearing clothes I haven't fit into for 15 years. And yes, still in style (my style).
Back and Leg Pain: But the pains in my back and legs were not diminishing. I was referred to an anesthiologist, Dr. Vinoo Thomas, who concluded that my pain was emanating from my sacroiliac ("SI") joint. Under minimally invasive fluoroscopy, I underwent two cortisone injections into each SI joint which provided me with some relief -- enough that I was able to trek around Israel this past May with occassional resort to ibuprofen. (If you like the photos of Israel, you might want to see my photos of Africa.)
The pain continued to escalate in scope and intensity. I couldn't sit for long, especially on hard surfaces. I was referred to Spine Options in White Plains, New York where I was seen by Bradley S. Cash, MD, FAAPMR who examined me and set me up with a course of physical therapy in his office. My therapist, Hemalatha Ramraj, PT, MS, was wonderful. But there was little marked improvement in my condition after several months of treatment. Eventually my insurer came to the same conclusion that I did -- the sessions were not working to improve my condition which was, in their words, "chronic" -- PT was not going to improve my condition.
Hema, my physical therapist, suggested that I have my hips x-rayed and her supervisor, Dr. Cash, ordered the x-ray. Bingo! Finally we had gotten to the problem -- advanced osteoarthritis in both hips. An earlier MRI of my lower back revealed disc herniation at L5 and T12 and the easy conclusion would have been that the disc problems were causing my leg pain. Not so. It was the hips.
And the pain was escalating. On a 10 scale, it had gone from a "3", controllable by Advil, to a regular "6-8", sometimes a "10" (when my hip would essentially hang up on a spur when I would sit a low couch in my TV room. That caused my hip joint to get stuck out of position, putting me in "catch-your-breath" agony). The only relief for me when that would happen was to wiggle to the floor and thrash about until my stuck hip joint fell back into place. I don't sit on that couch anymore and hope someday to see it at the curb awaiting my town's next bulk refuse pickup.
Confirming Diagnosis: I consulted with a friend of mine (Dr. Adam Levine, Associate Professor of Anesthesiology at Mt. Sinai) who recommended that I see Dr. Harry Spiera, a terrific diagnostician and rheumatologist. Dr. Spiera confirmed the diagnosis of advanced osteoarthritis. He said that surgery was definitely in my future.
At that point Anne Grundstein, my sister-in-law, an occupational therapist, arranged for a heavy duty cane to be delivered for my use. I have been using it daily since I received it.
My condition has continued to deteriorate markedly, and especially within the last 2 months. A couple of months ago I was able to hobble through airports in Newark and Atlanta for a dinner meeting with attorneys celebrating the 10th anniversary of their firm's founding. Last week I needed a wheelchair in Newark and Orange County airports to get to Laguna Beach, California for a CLE program that my Network produced. And while at the hotel I used an electric powered three-wheeled Lynx-3 (which I found a bit too short in length for my 5'-11" frame for me to be comfortable -- my feet hung off the front of the vehicle, but it beat trying to walk around the hotel). The decline in my hip condition has been rapid and irreversible, but for the upcoming hip joint replacement surgery.
Humor Even Under These Conditions: It took 6 weeks just to get an appointment with Dr. Buly. A number of other fine doctors were recommended to me, but Dr. Buly had operated on my neighbor who had a particularly challenging problem -- she needed to replace a hip prosthesis that was installed many years ago. She was referred from one doctor to another, each declining to operate, until she got to Dr. Buly. Her surgery was successful.
The moment Dr. Buly punched my x-rays up on the light board, he remarked, "you must in a lot of pain". Yes, I certainly was.
My Surgeon, Robert L. Buly, M.D.
My surgeon is Dr. Robert L. Buly"Dr. Robert Buly is one of New York magazine's "Best Doctors in New York" (2002-2009) and one of Castle-Connolly's "America's Top Doctors" (2003-2008). He specializes in joint-preserving surgeries for both hip and knee - including arthroscopies and osteotomies to correct anatomical problems like dysplasia and impingement that impair movement, cause pain and ultimately lead to arthritis. Dr. Buly has pioneered novel techniques to treat hip impingement arthroscopically, rather than through conventional open procedures. In complex cases, Dr. Buly works in concert with bio-engineers to design custom implants that solve unique problems. Dr. Buly is invited to lecture around the world to teach other surgeons about his techniques.
"Dr. Buly is on both the Surgical Arthritis Service at HSS as well as the Orthopaedic Trauma Service in combination with New York Hospital."
Source: http://www.hss.edu/physicians_buly-robert.asp
The Hospital for Special Surgery
My surgery will take place Tuesday, November 17, 2009 at the Hospital for Special Surgery ("HSS") in New York City.
HSS has an interesting history having been founded during the American Civil War in 1863 as the Hospital for the Ruptured and Crippled (R&C). It was the first and only orthopaedic hospital of its kind in the U.S.HSS performed 22,666 surgeries in 2008.
During a pre-surgery familiarity class I attended yesterday, we were told that HSS performs 3,500 hip surgeries each year.
Why Am I Writing This Blog?
INTRODUCTION: I thought it would be good to make a diary of my experience having my hip joints replaced. A friend of mine, Steve Meyers, kept notes during the process of his hip joint replacement process and I found those notes to be immensely helpful.
I thought that this blog might be of some help and comfort to others who will experience hip joint problems.
Also, so many of my friends have asked me to keep them posted on my progress that the prospect of periodically writing dozens of emails became daunting. A blog seemed the perfect solution.
So, here it is, to be updated from time to time as I have the opportunity.
I hope that it answers your questions.
Best regards.
Ellis
I thought that this blog might be of some help and comfort to others who will experience hip joint problems.
Also, so many of my friends have asked me to keep them posted on my progress that the prospect of periodically writing dozens of emails became daunting. A blog seemed the perfect solution.
So, here it is, to be updated from time to time as I have the opportunity.
I hope that it answers your questions.
Best regards.
Ellis
Sunday, August 02, 2009
Physical Therapy Not Working -- Surgery Needed
[I found this note to my primary doctor and thought it would make for good reading as to my condition months prior to surgery.]
"I stopped treating at Sleepy Hollow Physical Therapy as I did not see any improvement in my hips/back/gluteus area. A friend recommended Spine Options (Dr. Cash) at 244 Westchester Avenue in White Plains. After a short physical examination, I began a series of physical therapy treatments that included deep tissue massage of the gluteus muscles (both sides) which brought some relief but temporary; and electrical stimulation of the lower back and gluteus area while covered by a warm wet blanket.
"After about 4 weeks of treatment, Oxford determined to stop covering those treatments on the ground that my condition is not improving and is considered chronic. Nice after 20 or so years of paying premiums. I’m working on getting that decision reversed.
"Dr. Cash prescribed a hip x-ray (2 views) which was performed at Phelps last Friday. The radiologist’s report: bilateral (both hips) advanced osteoarthritis at the hips. Mild lateral sublaxation of chronic nature at the right hip."
"I stopped treating at Sleepy Hollow Physical Therapy as I did not see any improvement in my hips/back/gluteus area. A friend recommended Spine Options (Dr. Cash) at 244 Westchester Avenue in White Plains. After a short physical examination, I began a series of physical therapy treatments that included deep tissue massage of the gluteus muscles (both sides) which brought some relief but temporary; and electrical stimulation of the lower back and gluteus area while covered by a warm wet blanket.
"After about 4 weeks of treatment, Oxford determined to stop covering those treatments on the ground that my condition is not improving and is considered chronic. Nice after 20 or so years of paying premiums. I’m working on getting that decision reversed.
"Dr. Cash prescribed a hip x-ray (2 views) which was performed at Phelps last Friday. The radiologist’s report: bilateral (both hips) advanced osteoarthritis at the hips. Mild lateral sublaxation of chronic nature at the right hip."
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