Joint Camp

Memorial Hermann Hospital, like other major hospitals in a medical center city like Houston, has a special operation they call a Joint Center through which “Experts … carefully plan every step of your care to help ensure a speedy and successful journey to recovery.” They assured me that I “would be in excellent hands every step of the way.” To further illuminate their holistic services they host two-hour educational sessions, aka “Joint Camps,” twice a month.

Even though I would be attending one of these sessions less than a week before my surgery I was curious about various pieces of the joint replacement puzzle and did have a few questions. Even though my doctor tells me to “feel free to call with any questions you may have,” in my experience actually calling has tended to make me feel as though I was disrupting the smooth flow of their practice. Plus, I liked hearing the answers to other participants’ questions. So I attended a Wednesday morning session.

My Joint Camp was run by the Center’s very capable director, Rhoda, a nurse who had been around for awhile. There were ten of us prospective patients in attendance plus eight spouses or significant others. Half the audience would be knee replacements and half hip. Of us hip cats, half would be getting the anterior technique (like me) and half posterior. After her introductory comments she showed us a video of each procedure.

Now I know enough about orthopedic surgery to know that I certainly didn’t want to watch a video of it being done. An old neighbor of mine from a previous life was a highly paid representative for Stryker medical devices, and he told me enough stories to keep me throwing up for days if I’d been a barfing kinda guy, but Rhoda assured us these were merely innocent animations of the procedure that would leave us better informed and not sick tour our stomachs. The four minute vids were fine, but still brought home that this was a major event not to be taken lightly.

We reviewed things to do and things to be concerned about before surgery.

We discussed what to expect as we checked into the hospital, prepped for surgery and slept our way through to recovery.

Coolest thing was was we would have our own section of the hospital. We would each get our own private room and private bath. I could see in my mind’s eye the rope line to get into the V.I.J. (Very Important Joint) section complete with a big bouncer in a pale green lab coat and extra dark Ray Bans checking his list and waving through the chosen few. (I would end up a wee bit disappointed that we didn’t get special designer-logoed hospital gowns.)

Of course we would get room service. If the operation went as expected we would be on our feet the same afternoon and walking to our in-crowd-only V.I.J. physical therapy the next morning.

An anesthesiologist (an incredibly handsome cuss who might have just stepped off the set of a television drama) spent 20 minutes talking about how critical it was to properly dope us and to be on the alert for any negative post-op side effects. The most likely side effect would be nausea and vomiting although one of our post op drugs would (one would hope) help prevent the worst of it. We would all get a prescription (mine was for Zofran) to deal with this problem at home.

After the movie star left, the lead physical therapist for the Joint Center (a very attractive lady in her own right) went through her speil. She indicated that in addition to straight physical therapy we would also get a little occupational therapy. Someone would be stopping by our room to reiterate certain activities we should avoid and to offer instructions on how to perform tasks we didn’t even have to think about now – like getting into and out of bed, chairs and motor vehicles; using the toilet; bathing; picking up items from the floor; and getting both dressed and undressed. There were tools we could purchase or maybe even borrow that could make each of these things easier. Heck, I was thinking I’d be too cheap to even buy a walker – which they made sound mandatory – much less buy a shower stool or toilet booster seat.

All the speakers stressed how important it would be to have an involved, active coach with us as we recovered. (I think they misspelled “servant.”) I can tell you with total confidence that my wife of 49 years was EXCITED to assume this role!

My number one takeaway from this two hour session (which lasted only the promised two hours) was how important it was to stay ahead of the pain. The hospital would take this so seriously that they promised to wake us at the appointed hour to keep us on schedule. A corollary lobbed out by one of the significant others present was to not underestimate the importance of ice to help minimize swelling and pain.

My number two takeaway from Joint Camp was to give thanks was that I was getting re-hipped rather than re-kneed. The knee replacement surgery sounded more complicated, painful and extended in terms of recovery and rehab.

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Bobby Gets a New Hip

This is the story about how I came to purchase and have installed a new hip joint. But I should first offer a brief explanation of how and where I believe it all started.

Flashback to September 20, 2013

Near the end of my working life I had chucked the white collar life and started driving 18-wheelers over the road. I was starting with my third trucking company in a little over a year and had just completed their company orientation in Arlington, Texas.

I climbed into the International ProStar I had been assigned as my instructor walked back to the office. This would be my home for the next … who knows how long? I fumbled the key into the ignition, depressed the clutch, and turned the key. The dashboard lit up, but otherwise, NOTHING! They gave me a truck that wouldn’t even start!?!?

I ran into the office to snag my instructor before he left for the day. “Oh, yeah,” he said. “You really have to push the clutch to the floor. Internationals are touchy like that.” Hmmm.

I went back, and after five minutes of increasing pressure I had the seat moved all the way up so I could exert maximum leverage. Finally, using all my strength – literally – I pulled on the steering wheel and mashed down on the clutch pedal to the point at which the engine finally fired. Phshew!

Present Day

I point to that incident as the origin of my chronic hip pain, and while I was only in that truck for a year, the repetitive stress of starting that truck, on top of all the work of clutching a big rig through traffic jams all across the country, planted the demon seed that grew into a full-blown pain in the pelvis. Toward the end of that year I was experiencing pain walking more than a hundred yards. It kept getting worse through the next 15 months until I pulled the plug on my regular work life and retired.

A year later I finally went to an orthopedic surgeon and had it checked out, for real. An MRI revealed some osteoarthritis and ligament trauma, but I wasn’t bone on bone yet.

It kept getting worse even as I got into a physical fitness regimen. My thrice weekly workouts made me as fit as I’d been in 30 years and didn’t specifically hurt my hip as I was working out, but the pain got worse.

A coworker told me his wife had gone through a total hip replacement and was exceedingly happy with her surgeon. He added that there were new treatments available that might provide relief short of cutting me open. Turns out this surgeon was in the same practice as the doc who had done my shoulder.

Eventually I got to the point where I would get a jolt of pain – at least 8 on a scale of 1 to 10 (with ten being able to bite an arrow clenched between my teeth in two) – simply twisting my left leg wrong or adjusting position in my La-Z-Boy. So I returned to my orthopod. In his defense, he had told me the first time that I would be needing a full hip replacement. I told him I was “tapping out” and was ready for the titanium replacement part.

“Not so fast,” he said. There were steps we’d have to take first, mainly, get a “simple” cortisone injection.

A hip injection isn’t like getting one in the shoulder. I’d had a shoulder cortisone injection before – to minimal benefit – and ended up getting arthroscopic shoulder surgery anyway. Hip injections had to be done using a flouroscope under a moderate general anesthetic. So I scheduled myself in for this outpatient procedure. The copay ended up being less than $50 and the mark the nurse left on my hand from sinking the line was the ugliest thing about the whole exercise. The actual injection site was less noticeable than most bug bites.

While it seemed to help after a day or two, it stopped helping after 10 days, and my condition started deteriorating again. At my follow up orthopod appointment I reported these facts to the doc’s PA. He said keep on keeping on and to report back when I thought it was time. A week or two later I was back to my original levels of pain and then some.

I reached my personal breaking point after I spent a Fourth of July hobbling around a community festival followed by a trip to Minute Maid Park the next evening to catch an Astros game. I couldn’t walk more than 50 yards without stopping to let my hip recover. I felt like – heck, I was – a cripple. So I scheduled myself in for what I hoped was a final consult. We set a date, and I started jumping through the hoops:

  • Blood test
  • EEG / EKG
  • Primary care physician clearance
  • Cancer doc clearance, in this case my dermatologist since I suffer from perpetual basal cell carcinoma. (Personally, I thought this was overkill and after a brief phone call the two docs agreed that basal cell didn’t rise to the level of more virulent forms of the disease.)
  • Multiple conversations with the hospital
  • Reading the voluminous pre-surgery instructions (Cliff notes: no drugs, extra protein, lotsa water, shower ‘til your skin is raw, stop living after midnight the night before the carpentry begins)
  • Etcetera, etcetera