12th August 2012

Hip Replacement Cont’d – ‘One Day to Get on Track’

Account of ‘The Day After Surgery – One Day to Get on Track’ (Aug. 1, 2012)

New Day – New Crew – New Perspectives

OK – just the highlights – not a minute by minute account …
Starting with the usual vitals (6:30 am) – blood test, blood pressure, pulse, … visit to the washroom “Can I get something out?” – whatever that might be – NOT!

New nurse arrives, gives her name and assures that I am weaned from the PCA and morphine and gives me ‘pain killing pills’, etc. – not exactly made clear what I’m getting – she is in and out in a hurry – I hardly got her name.

Breakfast arrives in very short order – wheat toast w jam, milk, coffee, cream of wheat, grape juice, water – I ask the food carrier to get out of my night-table drawer the red-currant scone my wife had brought the night before (‘good stuff’ – whole wheat flour, flax, w buttermilk). As I was into my breakfast (drank the milk, almost finished the toast) and just drinking some of the grape juice, the day nurse charges into the room, grabs the grape juice cup and hollers “don’t drink that stuff – you are going to throw up if you do!” I try to respond, “I’m only consuming what’s on the breakfast tray.” Seeing the red-current scone, she carries on “and don’t eat that”. I try to object, “the scone is really healthy and why shouldn’t I drink the grape juice, it’s part of the hospital breakfast?” “If you want, what’s good for you, you listen to me”, is her line.
WOW! What a put-down.
Then she explains that as far as she is concerned, she is trying to keep me from ‘throwing up’ and that’s that.
I back off and quietly finish my scone – what a start to the day with my nurse for the day.

Quickly, the morning fills with activity. The capable physio-therapy team arrives, followed by the occupational therapist, a very professional and amicable young woman. I’m out of the bed and performing basic physio-exercises by using the two-wheeled walker for support and progressing to demonstrate ‘good walking posture’ with the walker. There is a promise of more physio that afternoon – great – I love physical activity.

The latter part of the morning, I feel a bit dulled and nauseated. I ask about it and recognize that the oxy-codin is probably doing it to me. I don’t exactly get excited about lunch with feeling a bit queasy.

Following lunch, my day nurse impresses upon me that I’m still facing the challenge of eliminating from my filling bladder. I try several times to get going to the toilet without success. She is stern now, “If you don’t eliminate by 2 o’clock, I’ll have to put the catheter in”. I can’t foresee that to be a gentle process, unlike the night before. I give it a couple more gallant tries and finally, at 10 minutes to two, I can demonstrate success by showing the plastic bottle with an appropriate amount of liquid. What a relief.

More physio and OT in the afternoon – walking with crutches, demonstrating correct usage of the assistance tools (reacher, etc). I’m very encouraged by the assessment that my general muscle groups are handling my movements and mobility rather well.

The afternoon is also brightened by the visit of the Nurse Practitioner, ‘the eyes and ears of the surgeon’ – she is terrific and most encouraging in her discussion of many aspects of the surgery and recovery process. I also discuss my pre-operation pain killer with her and how I felt after the oxy-codin. I’m assured that I will be given the same prescription for my pain med, Tramadol (tramacet). Later in the afternoon, I turn down the oxy-codin when offered by my day nurse and elect some alternative pain tablets.

My roommate and I discuss the day’s activities and express mutual encouragement – we are both doing very well – he is in his forties while I am sixty-eight. He reflects on my patience with the day nurse – he says, “I wouldn’t have put up with her.”

After the evening meal, a follow up with some texting and calls with Ruth to alert her, that there is talk by the physio staff, that I would likely be encouraged to leave the premises the next morning – that’s based on the day’s performance and the prospect of demonstrating ascending and descending stairs with crutches the next morning.

With the usual regular vitals measurements and other activities, I don’t find a good sleep coming easily. I’m successful in going to the bathroom several times during the night – sounds like we’re really dealing with the very basics of life.

I’m awake very early, about 5 am. I look forward to the next day and feel that I need a shower to get that fresh feeling to face the day. As I think about that, it dawns on me that when the shift change comes at 7 am, no staff would have any time to assist with my desire to get cleaned up – they have too many vital tasks to complete. So … I push my Help Button at 5:30 am and am most fortunate to claim the help of a very nice Care Aide who is willing to assist me to take a shower. It’s a bit of an adventure to take the first shower – issues to be concerned about: stability, not getting the wound dressing too wet and disturbed, not bending beyond the 90 degrees rule, not twisting at the hip, etc … Done with the shower – I feel like a new man and happily await the day in bed.

Again – New Day, New Nurse, New Horizons … (Thursday, Aug. 2)

Following breakfast, the physio team and the OT come by to talk to my roommate and I to tell us that we will be good to go, as soon as we the the ‘Stairs Test’ and have our mobility (range of motion) measured. I called Ruth to give her notice, “As soon as you get here, I’m out of here”.

By the time, all is done – discharge details, paper work, etc., the Occupational Therapist takes me out to the car with Ruth and gives the final demonstration and scrutiny over my proper entry into the car. It’s 12:30 pm and I’m on my way home, 44 hours after entering the hip surgery process.

Wow – a bit of a whirlwind but also a revelation how efficient and effective modern medical procedures have become. I leave the UBC Hospital with gratitude, great respect and appreciation for the professionalism I was privileged to experience and observe.

Now, I am pursuing New Horizons – the lengthy period of strengthening the disturbed muscle groups (physio therapy – mostly based on self-discipline) and forcing myself to walk without a limp. It’s looking good at this point – the promise of returning to normal, pain-free movement with a new hip opens new horizons, new opportunities that only exist because of undertaking to have a Hip Replacement.

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8th August 2012

Hip Replaced – First Night in Hospital – NOT a Slumber Party

Follow Up to the Hip Replacement Surgery – Evening of July 31 to Morning of Aug 1, 2012 (Day in Hospital)

‘ Life at the Ward’

Arriving at the ward the evening of July 31 (Surgery Day) was a totally new experience to me. I was fortunate to be settled into a semi-private room to join another fellow who also had his hip replaced (his right – my left). His operation was earlier than mine, giving him opportunity to settle in and have a head-start on the recovery process.

My first observation was a recognition of being cared for by an excellent, highly professional nursing staff – can’t say enough about the quality of care being provided.

Of course, everything starts with the all important intravenous hook-ups, including a computer-aided dispenser of pain-killing morphine that can be triggered by the patient to manage coping with different pain levels (Patient-controlled analgesia (PCA)).  Blood testing and vitals monitoring is still carried out at a more frequent rate during the early hours of settling in after the surgery.

One aspect of the monitoring includes ultrasound measurements of urine volume in the bladder. Several measurements were taken during the night hours and it was after midnight when I was confronted with the unpleasant truth – unless I could urinate myself (either in bed into the plastic urinal container with volume measurement markers or make it into the bathroom to do the same), the unappealing alternative would be a catheter insertion to drain my bladder. Although a bit shaky on my legs, I desperately maneuvered myself into the bathroom a couple of times with the unfamiliar two-wheeled walker to try and comply with doing the all-important ‘pee job’. Unfortunately, my specifically-called upon organ was too ‘dulled’ by the spinal anesthesia and the various pain-killing meds to give any kind of response – ‘it’ had shrivelled into the proverbial Seinfeld-referenced cold water specimen that just would not cooperate. I couldn’t avoid the inevitable – it was time for the catheter insertion. Although an extremely unpleasant sensation, I give great credit to my professional nurse who dealt with this challenge compassionately, matter-of-factly, and most expertly. She did an outstanding job and we successfully drained the bladder. Since the catheter stayed inserted for the remainder of the night (until 6:30 am), no further trips to the bathroom were a positive. However, with an inserted catheter that keeps draining the bladder, I had this unpleasant and constant sensation of ‘wetting the bed’ all night long – along with pain management, a definite hindrance to ‘pleasant dreams’.

Thus endeth the first night – saying Good Bye to the terrific Night Shift.
7:00 am brought renewed monitoring activities, blood tests, vitals, etc.
A new day (Aug 1) and a turnover in nursing staff.

Continued with Aug 1 Account of One Day to Get on Track.

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5th August 2012

The Surgery — In and Out in 44 hours – Part 1

Hip Replacement Surgery – Surgery Day (July 31, 2012)

Continued from August 3rd Posting

Here it goes – Be Prepared.

Scheduled Time to appear at the UBC Hospital: July 31, 2012 (12:30 pm). The night before (July 30) – NO food after midnight – just water or clear liquids (e.g. apple juice) before check-in time (12:30 pm next day). Since this is the big day for the big event, my wife and I leave early so as not to be late – good move, as the UBC Hospital is undergoing major construction and a different back entrance has to be found and driven to. We arrive on time and are checked off by the receptionist – “Please take a seat and wait until called”.  My wife wisely used the wait time to bring in the required items a patient must bring to have on hand after surgery: (items were obtained after participating in an OASIS orientation session – most insightful and helpful – the ‘Must Have Equipment List‘ is provided)

  • two-wheeled, collapse-able walker
  • a pair of crutches
  • high-density foam cushion
  • Dressing equipment (long handled reacher, long handled shoe horn and sock aid)

Believe me, all of these will be needed – some immediately after surgery. Ruth and I kiss ‘Good-Bye’ – parking the car for Drop-Off is very temporary and I will be the one facing every step hereafter. After a half-hour wait, I am called in to be ‘booked in’ for the surgery – first of many reviews of the basic details – identity, what’s the procedure, confirm the type of room I will be in post-surgery, etc. The pleasant young lady then takes me to the Surgery Waiting Room (initially, it was intended to have the surgery at 3:00 pm with the Surgery Prep prior to that). Of course, my personal details are double-checked again and I am told to wait until called – “in about 15 minutes of so” – well – NOT so. This wait stretched on and on and on … No one really came to make it clear that my surgery would be delayed considerably. I did get up from waiting and asked – “the surgeries are running behind schedule”.  That’s fine – I can understand that – things change along the way, especially with surgeries. Finally, at about 4:00 pm, I am ushered in to the Surgery Prep area. An experienced and jovial nurse directs me to a curtained area with a special prep chair with many adjustments for initial medical pre-surgery steps. Time to strip down and employ a set of special anti-bacterial wipes to clean different body parts (a similar pack was given to me and I used it at home in the morning). After the wipe-down, I put on the typical hospital gown and seated myself into the ‘pre-surgery throne’. The nurse came and reviewed a long list of personal medical details prior to getting started. She also inserted the intravenous tube in the left wrist – this will stay until the person is discharged. Of course, blood tests are taken frequently – pre-op, and daily while in hospital. Other individuals were also being prepared for various surgeries – each in a separate small prep-area with the special chair. The intravenous flow was started and I would later wheel my tree with the bag into the operating room. I was visited by another very experienced nurse, one of the assisting nurses from the OR, to go over my personal medical details again – wow – what a lot of checking and re-checking details. While waiting, Dr. Michael Moult, the anesthesiologist, came to review some medical details about me and to brief me on the anesthesia process that would be used on me – spinal anaesthesia. Although I knew beforehand that would be the method, anytime ‘spinal’ is mentioned, my brain reacts just a bit – “it just sounds a bit dangerous to me” – but Dr. Moult reassures me – it’s very much a routine to him. Dr. Duncan comes by briefly and with his wonderful and reassuring tone, he confirms that Ruth is my emergency contact and that he has the correct phone number. Another brief visit by one of the Resident doctors who would be assisting Dr. Duncan that day. He reviews vital medical details again and marks my left hip with a pen – we want to be sure to replace the correct hip – BTW – my right leg (the good leg) is identified with a very long green sock that I had to put on earlier. He mentions that this is the last Hip Replacement they are performing that day – I believe Dr. Duncan was responsible for ten that day – going between two ORs and assisted by Residents. So … about 4:30 pm or so, I’m asked to walk into the OR … WOW! It is impressive and a bit overwhelming – this whole team is assembled, waiting for me –  of course all specially outfitted with their OR suits – it is quite a scene. A warm welcome it is but brief and the team jumps into action immediately. On the operating table, I bend forward to receive the spinal injection and the administered sedation and … … and … … Walter – Wake Up! And –  just like that, an hour and a half later, I am awake and I am wheeled into the Recovery Theatre with recovery specialist nurses monitoring my vitals, checking with me several times whether I am gaining sensation back in my pelvic area by touching ice-bags against my skin and slowly moving downward to test recovery of sensation. They keep me until proven stable and having regained sensation down my leg. It’s time to be wheeled into my ward. I am being settled into my ward bed in a semi-private room with great attention being given to many details to make everything as comfortable as possible. It’s about 8 pm – I’m just settled into bed and my loving Ruth appears to raise my spirits. What a Day!

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3rd August 2012

Reflections on Getting a New Hip – Life Changes in 44 Hours

Hip Replacements are rather common medical procedures these days – I thought to write some personal reflections on the process. My reflections will be posted in several segments – I’m writing post-surgery – my length of sitting time at the computer will be limited – movement and physio-therapeutic exercises take precedence to writing a blog.

First, a short introduction to the medical procedure to become informed.

Basic Hip Replacement Procedures:

Anticipating the medical procedure:

As with any major invasion of our bodies, I don’t think, I’m unique to have some pre-operation concerns and feelings. It is very assuring to review the success rates of this specific operation. Although I had some unease as I went in for the surgery, I had great confidence in the expertise of a highly renowned surgeon (Dr. Clive Duncan – Vancouver, BC Canada) and also my personal conviction of faith that our “days are numbered” and in “God’s Hands”. I also had great comfort, that many people prayed for me while undergoing the surgery – an added benefit by belonging to the ‘Family of God’.

The Surgery — In and Out in 44 hours

The next posting provides some insight into the hospital surgery experience – it might be helpful to others to be prepared.

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