Hip Joint Replacement Surgery

My Hand, Festooned With A Needle and an Electronic Doo-Dad

Left the house at 5AM yesterday morning and got home around 7PM with a new hip joint. Dr. Elizabeth Lieberman from the Orthopedic and Fracture Specialists performed the operation at St. Vincent's Hospital in Beaverton. While I was there I was almost entirely under the care of women. I think I only had two guys dealing with me. Let's see how many I remember:

• the receptionist greeted me, collected $455, and started putting data in the computer,
• the nurse who guided me to the surgery preparation room
• Rosh prepared me, which seemed mostly to making sure she had the right person and the right operation, i.e. lots of typing on the computer
• a vampire to stick the needle in my hand so they could pump me full of drugs
• Dr. Li, the anesthesiologist came by and introduced herself,
• her assistant, a man, came by and talked to me,
• I think Rosh wheeled me and my stretcher to the operating room. I can't be sure it was her, but then lying flat on my back I couldn't see who was pushing my stretcher.
• Did Dr. Lieberman's surgery nurse come by before I got to the O. R? Probably, but once I was in the O. R. she got me on the operating table (carefully covered with a sheet) and got me in position so the anesthetists could stick c spinal tap needle in my back.
• And that is all I remember before I woke up in recovery, where another man checked my vital signs and entered more data in the computer. I was still pretty out of it, I don't recall anything else about that, I wasn't there long.
• Then it was off to Short Surgery Care Center / Unit (?) where I spent several hours sleeping and occasionally eating Kellogg graham crackers. That was a high point. I've been working on losing weight for a while and cookies are pretty much verboten. When you have been deprived of cookies for a while, even graham crackers are a treat. I ate at least six.
• Kathleen was my primary nurse in the SSC. Rosh also came by. She got to insert a catheter into my urethra to drain 560cc of urine out of my bladder. I had no sensation down there. Not draining the bladder could cause big problems.
• Around 3 or 4PM Jerri, the Physical Therapist came by and ran me through various exercises for the feeble, like getting out of bed, walking across the hall to the restroom where I was able to urinate by myself (only 250cc this time), walking down the hall with a walker, and climbing the world's shortest staircase (3 steps). She seemed to think I should remember all the rules from last time as it was only three years ago that I got my right hip joint replaced. I vaguely remembered going through the motions, but the rules? Not a clue. The big one is 'if in doubt, knees out'.
• While we were out of my room (number 7), someone came by and stole my stretcher, so they had to activate the movers, a crew of, I dunno, half a dozen lovely young women to pull a bed out of another room and wheel it into mine. I suppose there is some difference between a 'bed' and a 'stretcher' but the only difference I noticed was that the safety rails were chrome steel tubes on the stretcher and plastic panels on the bed,
• Next was the Occupational Therapist. I think the big deal here was getting dressed.
• Now I get one more nurse to go over my rules for when I get home. Fortunately my wife was there to absorb all that so all I had to do was smile and nod.
• Lastly, a cute young woman (a CNN maybe?) got me in the wheelchair and wheeled me to the Phil and Wife Nike Entrance where my wife was waiting with the car. She gave me a little help getting my feet in the car.

Every time I met a new person I had to tell them my name, birthday and why I was there. Then they collected my vital signs (pulse, blood pressure and temperature) and entered it into the computer.

That's all for now.

Fun with doctors and plumbing

Yesterday morning I went to see Dr. Schmidt, the urologist. Mom went with me. He listens to my tale of woe and prescribes Oxybutinin. I'm already taking Tamsulosin to cope with an enlarged prostate gland. When the prostate gets enlarged it becomes more difficult for it to relax enough to let urine flow, so the bladder, a muscular organ, has to work harder to push the urine out. The Tamsulosin lets the prostate relax so the bladder doesn't have to work so hard. Near as I can tell, after a long period of having to deal with the recalcitrant prostate, the bladder gets to be in a state of constant tension. So now I've got Oxybutinin which is supposed to relax the bladder. I took this once before, about a year ago, for a month, and it helped, but now the same problems have returned, so it looks like I will be adding one more drug to the handful of pills I take every day.

Get done with all that and doc asks me if I want a prostate exam, cancer screening you know, and mom says yes. I'm pretty sure I had one of these a year ago, but with the two of them ganging up on me I submit. It's annoying and unpleasant, but it only takes a few seconds and I should be good for a couple of years. I suspect the doc offered to do it because he knows that medicare will pay him $25 for the exam and it will only take a minute. $25 for a minute works out to $1500 an hour, which is pretty good pay in anybody's book.

After 30 years the stopper in the sink in the upstairs hall bathroom bit the big one. Found one on Amazon for $5 and had it delivered. In the drawing above, note how the Pivot rod goes through a little ring at the bottom of the stopper. The ring had broken loose from the stopper but was still on the Pivot rod. The Pivot rod goes through a hole in the side of the drain pipe and is held in place with a nut. Unscrewing the nut allows the Pivot rod to be removed, but when you do that the ring is going to fall off into the P-trap. If might get flushed down the pipe and out the sewer, but it might just hang around there collecting other bits of trash and eventually block the trap. 

P-trap

Best to get it out. Normally, the P-trap can be easily removed, but because our custom cabinets have drawers underneath, there is a shelf directly under the P-trap, so in order to remove it I had to unscrew the down pipe that contained the Pivot rod access hole, which slid into the P-trap and allowed me to pull the whole thing out. Of course water pours out when you open the P-trap, but my brain was operating so I had an old towel on hand to mop up the spill. The back of the shelf had water stains that appeared to come from the shut off valves, but the valves were dry, so I just put everything back together. 

I'm working blind getting the Pivot rod into the hole in the new stopper, but must have I got it right  one because it's working.

This morning we drove out to North Plains to let the shutter man into our old neighbor's new house. They decamped for Palm Desert, and the shutters hadn't yet made it to shutter man, so we got to be the good neighbors. The shutter man got the worst of it. We had a ten minute drive from our house, but he had an hour and a half drive from Oregon City. Morning rush hour through some of the most congested highways. Normally that drive would take half that time.

We stopped at McDonalds and got a couple of breakfast burritos and coffees and it cost like $10. You order from a big flat-panel touch screen. Tap, tap, tap, tappity tap, tap, tap. Every item takes at least 3 taps, and final check out takes several more. It seemed a bit ridiculous, but we got through it. The only people we saw was one person behind the counter, one person mopping the floor and the person who delivered our order to our table. I don't know if I like this, but the food was fine and the price was excellent.

Now we head over to Providence Hospital on the east side where the striking nurses are out in full force. The parking garage was fuller than usual today. We parked on level F and took the elevator down. Sign by the elevator says level D for the skybridge, level C for walkway to main entrance. Get down to level C and find we have to take the stairs down one more level to get to the street level.

Mom gets checked in and the fire alarm goes off. Very loud and very obnoxious and everyone has to leave the building. Me, fearing the worst, suggests we start walking. I mean, who knows how long we are going to be stuck outside, and it's freezing. Maybe we can find a coffee shop. We walk two blocks and indeed we find a Starbucks where we order a couple cups of coffee and a couple of the smallest scones in the world for $15. Meanwhile, mom gets a message from her doctor in the same building, so she calls her back and finds that the fire drill is over and we can go back inside. Seems that was the third fire drill this morning, and it's only ten o'clock. If we hadn't gone to Starbucks we would still be standing outside, freezing, because god hates us.

The dexascan reports that mom's bone density has gone up, which is good. It looks like that her expensive personal training regimen is paying off.

I stop in the bathroom on our way out. I'm sitting on the toilet thinking I ought to send a note Providence to compliment the janitor for keeping the restroom so clean. Then I lean over, the toliet flushes and squirts me in the butt. Dang it! Apparently I leaned over far enough to trigger the automatic flush trigger. Bah. 

Wash my hands (at the sink) and reach for a towel. There is an automatic, wave-at-me towel dispenser. It  rolls out six inches of paper towel. Wave again and I now I have two pieces of paper towel, each six inches long, barely enough to qualify as one sheet. Try the other dispenser. It rolls out a nice long sheet, at least fifteen inches. So not all automatic gadgets are junk.

Back home we head to Walgreens to pick up my drugs. It looks like there are half a dozen spaces in the parking lot, but they're all allocated for special people. There is the requisite handicapped double spot, a spot to pick up online orders and two spots to charge your electric car. Is there an ordinary empty parking spot? Oh yes, there is! One. Bueno.

We go inside, I go to the pharmacy to pick up my drugs. They have some, but not the whole order. Serrrano tells me that the rest will be here this afternoon. I know his name is Serrano because he has it written in big letters on his forearm and when I asked him about it he told me.

I'm done and go look for mom. She's waiting in line to buy toothpaste. The only reason we're buying toothpaste here is because because Medicare or our health insurance gives us $25 a month to spend on stuff, presumably health related. Shoot, if you're gonna give me money, I'll take it. You'd have to be in pretty bad shape to need money for toothpaste, but I imagine there are scads of people who have been driven into the ground by effing Biden and his commie cohorts. The line is long, and I'm gonna have to come back anyway, so we head home, eat tuna salad for lunch and write this story.

Aorta

Aorta
The Aortic valve is the exit valve from the heart

Twenty odd years ago I ended up in the hospital because of atrial fibrillation*. Doc prescribed some meds, things calmed down and I went home. I've been taking the drugs ever since and my heart seems to be pumping along just fine. Doc also discovered I had an enlarged aorta. The risk is that a larger blood vessel is at greater risk of bursting due to high blood pressure**, so I take drugs to keep my blood pressure under control and I go in for an echo-cardiogram to make sure the aorta hasn't gotten any larger.

I had an echo-cardiogram today and the exam seemed a little more extensive than usual. She's running the probe over my chest, but then she goes around my left side, up to my neck and down towards my stomach. I always thought the aorta was only a few inches long and adjacent to the heart, so now that I'm home I gotta look it up and I find that the thing is a monster. Huh.

The first part of the exam was to check on a specific area, but the rest of the exam was 'protocol'. It makes sense, I suppose, if you are going to all the trouble to set up the scan, may as well make it complete. Who knows what kind of other potential problems you might encounter, especially on an old dude.

Old is relative. A friend of my wife went to work for a guy 20 years ago. The guy is 88 now. Who'd a thunk that starting work for a guy who is 68 years old could turn into a career? Still going, I dunno how strong, but still going.

* as opposed to ventricular fibrillation which is generally fatal.

** if the aorta ruptures I would be dead within minutes. Good way to go if you are going.

Oxycodone

It's been five days since I've had a shower and my wife tells me I'm getting a little ripe, so we're going to try and get rid of some of the stink this afternoon. I've had very little energy which is not surprising given the second round of surgery, but I also haven't been getting much sleep. Pain is negligible, but sleep is elusive. Two nights I tried going without an oxycodone, but it didn't work. I finally gave up around 3 AM and took one of these prescription opioids. That allowed me to sleep but I wonder what's going on. Am I getting hooked on this stuff? Insidious is what it is.

I suppose I'll need to keep taking it until my hip has healed properly just so I can get enough sleep. Then maybe I'll be able to tolerate going without sleep for a couple of days until I relearn how to sleep without it.

Revisit Hospital

Went in for surgery Friday afternoon to correct the misaligned hip joint. Is misaligned the right word? Seems appropriate. Didn't go to the Operating Room till around 4PM. Last time I was here they sedated me as well as given me a spinal block. I remember a whole lot more about the pre-op and post-op this time. For instance, I remember scooting off of the gurney and onto the operating table, and then sitting there while they started sticking a needle in my back. That was it until I woke up in post-op.

KCI's Prevena Incision Management System

$4,000 - Disposable

Saturday I was pretty much in limbo, just kind of lying there, dozing now and again. Since I only spent one night here the first time I expected the same this time. All was fine until we get to the occupational therapy (last step before discharge) and we notice the incision is bleeding, not gushing, but more than a couple of spots. They apply pressure with a big fat elastic bandage but that doesn't quite do the trick, so they hooked me up with a portable vacuum pump to suck the excess blood away and call it good.

Well, good enough. Here it is two days later and there is no sign of blood in the tubing, but this electronic leech is supposed to stay attached to my hip for a week. I would have been better off spending another night in the hospital.

Emergency Room Visit

Two weeks ago I had surgery to replace my worn out hip joint. Wednesday morning I was supposed to visit the doctor for a routine follow up visit, see if everything is progressing okay. At 4:30 AM Wednesday morning I felt a muscle spasm around my new hip joint and a clunk-a-bunk sound and all of a sudden I couldn't move. Well, I could move my hands and feet but that right leg wasn't going anywhere. What do I do? I could holler for my wife, but she's sleeping, she's had a rough couple of days with her own problems, and I am loathe to disturb her. I can scoot down the bed until my lower legs are hanging over the edge, but that's as far as I can get.

About 5:30 AM I hear rustling noises so I know the boss is awake and I start hollering. Eventually I get her attention and we start figuring out what to go. I call the clinic and talk to the on-call doc and he advises me to call 911 and get an ambulance ride to the hospital, so we put that in motion.

Ambulance and fire truck arrive about 6:30 AM. I always wondered why they always seem to send a fire truck along with an ambulance, now I know. It's for the man power. For the ambulance crew to be able to deal with the patient, first they need to extricate them from wherever they are. In my case you wouldn't think it would be too bad, but they still had to get 240 pound dead weight out of bed and down the stairs. The six of them carried me in some kind of blanket. It was a bit snug going down the stairs, but we all got down without incident.

The ride to the hospital was uneventful though a bit bumpy. I always thought ambulances would have a soft, cushy ride, but they don't. They must have rocks for springs. I felt every bump in the road. It wasn't painful, just annoying. The ride on the stretcher into the Emergency Room wasn't much better. I think the hospital must get the wheels for their gurneys at the scratch and dent sale. Bump, bump, bump, bump all the way down the all. It would all be tolerable except that all the floors in the hospital are glass smooth. You'd think with all the pristine floor they could spend an extra quarter on getting some ROUND wheels.

Once they got me ensconced in the ER they hooked me up with an IV (Intra-Venous line) and gave me a dose of dilaudid, also know as hydromorphone. That gave the whole ER thing a warm, fuzzy glow.

Clay from the clinic came by and introduced himself. He was there to assist Dr. Wang with getting my hip joint back together. That was the last I saw of him. A bit later I'm wondering when they are going to get going and the nurse tells me they're getting ready to take another X-ray to make sure the joint was back together, and I'm like what? When did they do that? While I was knocked out, apparently.

My wife drove me home. We stopped and picked up a couple of cheeseburgers on the way and were home by 2:30 PM.

My surgeon was a bit distraught over this turn of events, but evidently thinks she has identified the problem, so I will be going in for surgery again tomorrow (Friday) afternoon.

Hip joints becoming dislocated is a rare but not unknown event, but usually when these rare events happen, the ball part of the joint goes backwards. In my case it went forwards which makes it double rare. My wife wants to know why. I tell her it's because I'm a Martian and we're just weird.

P. S. I hoped to include a video of me being carried down the stairs, but it hasn't been dropped into my grubby little hands yet, so you'll just have to use your imagination.

Hospital Visit

Meet Adventist Health Portland's Dr. Elizabeth Lieberman
OHSU

Tuesday I had my right hip joint replaced by Dr. Elizabeth Lieberman and the crew at St. Vincents Hospital in Beaverton, Oregon. This is typically an out-patient procedure and I would have been sent home that afternoon. However, something went wrong in between closing the incision and when they took an X-ray in surgical post-op - the joint came apart (dislocated), so they took me back to the operating room and put me under once again. No cutting this time, just Doctor Lieberman getting rowdy and twisting me into a pretzel or some kind of wrestling take-down, and the joint reassembled itself. Because I had proven to be troublesome patient, she decided to keep me confined overnight. She's done over a thousand hip joint replacements and this is the first time she has encountered this problem.

Doctor's initials on my right thigh
Right thigh, not the left

I had no objection, I was fully doped up and having plenty of pleasant dreams. In the middle of the night when it's pretty quiet, I heard this noise. It sounded like the tune Mosquito by Gustavo Bravetti, it wasn't very loud, but it was definitely there. Every now and again I would hear giant dump trucks rumbling by, but that was probably just the service carts the crew was pushing down the hall.

I probably saw upwards of two dozen people in my private room and only three of them were men. One of the men was a vampire who came to suck my blood around 3 AM in the morning, He tells me that he had his hip joints replaced, which I thought was a little odd because he looked like a kid, maybe 35 years old. Turns out he is 45 and had his hip joints replaced when he fell out of a helicopter in Iraq. He was 22, the helicopter was 20 feet off the ground and there was an RPG (Rocket Propelled Grenade) involved.

The ambiance of the of the operating room was noticeably different than any other place I have been. It wasn't any one thing, it was a combination of whole laundry list of small differences. Bunches of machines I had never seen before, the tone of the people speaking and the direct action and lack of waiting. I suppose that's what this is all about. Getting all the ducks in a row may take hours, but once you are there, it's 'once more into the breach' my friends. Kind of like going to war or staging a theater production or making a movie.

Discover the CARESTREAM DRX-Revolution Mobile X-Ray System
Carestream Health

I noticed several new machines. Usually X-ray machines are like permanent installations with their own room. Here they had a portable one that they rolled up to my bedside, slid some kind of imaging tablet underneath me and boom, picture. It took just a couple of seconds. They showed me the image after they got my hip joint back in its socket. There is a small display screen on the back of the machine head. They just swung the it over to where I could see it. I don't recall seeing the one they took immediately after surgery. They may have, but I kind of doubt it, you never want to show the patient ominous images.

Exergen TAT-5000 Temporal Artery Professional Thermometer
This is only one I found that looks like it fits the bill.

The nurses had a thermometer that they used to check my temperature. I never did get to see it. They ran it across my forehead and the down the side of my head behind my ear. It felt like a ball point pen with a a tip the size of a child's marble.

Scanning Technique: Bladder
Clarius Mobile Health

They also had a little ultrasonic machine whose sole purpose was to measure the amount of urine in my bladder. My bladder apparently has a capacity of about 250 cc (1 cup), which kind of explains my frequent trips to the bathroom.

I've been home for a couple of days now and things seem to going okay. My hip is still plenty stiff. I'm taking 5 mg of Oxycodone every five hours and the pain is negligible.

Aches and Pains

Since my back flaked out on me, I am not as effective at getting things done. Shoot, hiking to the back of beyond (the far corner of Home Depot) is enough to justify taking a nap. But I can drive, and since there are always errands that need to be run, I do. I drive my pickup truck and it seems to be comfortable enough but I suspect all the bouncing and jouncing over the Portland potholes puts some strain on me. A couple of days of driving around town and I am flipping exhausted. I got a massage for the first time last week and it was an experience. I suppose intense is the best description. I felt a whole lot better afterwards.

I wonder if a car with a more car like (softer) suspension might make driving less draining. I do hate it though when a wheel drops into a pothole and whole car suffers a big jolt. I never used to care about potholes, they were a nuisance, but what are you going to do about it? If you're driving a truck you don't care, you just drive right over them.  A friend of mine, J. R. Montgomery, used to drive trucks for a living. He told me about the time he drove a Cadillac from Ohio to New York City, a distance of about 400 miles. He said it was the most comfortable ride he had ever taken. It was like sitting on your living room couch. Bet there weren't any potholes back then.

Previous posts on the subject.

Steroid Injections

Lumbar Epidural Steroid Injection
Mayfield Brain & Spine

I went to the doctor yesterday morning to have steroids injected into my lower spine. Didn't even have to get undressed. Unfastened my trousers and lay face down on the table. Started with a couple of lidocaine injections that got my attention, but didn't notice much after that. There were three people there: the doctor, her assistant and an X-ray technician. They had an X-ray machine in there so Dr. Linda could see what she was doing. The whole thing took about half an hour: 15 minutes to go over the paperwork and 15 minutes on the table. Walked out. It may be two weeks before the full benefit is felt. Right now the only difference I feel is some pressure in my lower back. That and I'm not sleeping. I went to bed at midnight but I couldn't get to sleep. I'm still awake and blogging like a madman.

Stenosis

I am brought by the lee. I don't know just exactly what that means, but from context I conclude it isn't good. Too much Patrick O'Brian I suppose.

Turns out it wasn't over exertion that was causing my legs to hurt. One of my vertebrate has seen fit to escape from its duty bound place by a fraction of an inch and is impinging on the spinal cord resulting in a myriad of false signals being transmitted both up and down the spinal column. Upwards I get pain, mostly controlled by a single tablet of Naproxen taken twice a day, and downwards I do not have all the control I could wish. It takes considerable determination to overcome the feeling of weakness and climb the stairs at a cheerful pace. Fine control is lacking as well. I now need to sit down on the bed in order to put on my trousers without risk of toppling over.

It's been three months since this started up and I have made half a dozen visits to medical people of one sort or another. The last one was a back specialist and she avers that an epideral injection of steroids may bring some relief. I hope so.

Jack went through something similar. I vaguely remember him mentioning it occasionally. He underwent surgery a few months ago and it seems to have helped. On the other hand I have a cousin who also underwent surgery on his back recently and his outcome wasn't quite so good.

Still, compared to some other bloggers I follow, I am in pretty good shape. One fellow reported that doctors want to take his legs. Another lost both legs and an arm in Afghanistan, so maybe 'lee' just means a slight inconvenience.

Groan

CAT scan image of sinuses

I can't drink cold water anymore. Actually, I can drink it, I just can't hold it in my mouth. If it comes in contact with my upper left teeth the pain is forthright. I thought it was a sinus infection getting ready to make my life miserable (there are sinuses in your cheekbones, well, in my cheekbones anyway), but then my wife pointed out that my dentist has been telling me that one of these days I am going to need a crown. Oh great, just what I want. I'm not sure if that is better or worse than a sinus infection. But it's only November, so my sinuses still have plenty of time to make my life miserable before the end of the year. Not that you care, it is, after all, a personal problem. I'll just go crawl in a corner now and curl up with my blankie.

The image is from the WebMD website, which has a pretty good slide show as well.

Update January 2017 replaced missing image.