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After 35 years in public education as a high school English teacher and university administrator, I began my second life as a freelance writer, winning San Diego Society of Professional Journalist awards for my opinion columns in the former San Diego daily North County Times and the San Diego Free Press.

Monday, November 5, 2018

My Aching Hip: Under the Knife Day and After


October 30, 2018


Karen and I arrive in the lobby of the Palomar Medical Center at 9:00 to check-in for my 11:00 surgery. As I approach the front desk, a receptionist asks, “What can I do for you?”
“I need a new hip.”
“Okay. They come in orange and black. Which would you like?”
“Black, please. More stylish.”
Nice to discover a sense of humor upon my arrival here.

Karen is asked to remain in the waiting room, while I’m escorted down the hall to meet a tall Nurse Ratched. Not her real name, but descriptive of her manner, which mirrors a character from Ken Kesey’s, One Flew Over the Cuckoo’s Nest. A shorter woman, clad in a Harley-Davidson tee shirt, stands in Ratched’s doorway, looking down at the large suitcase standing beside me. She looks up at me with a smirk.  “Planning to go to Europe?” Karen packs heavily for overnight trips.

Nurse Ratched asks biker girl, “Does he have a significant other?” Biker girl replies, “Yes. His wife is in the waiting room.“

Ratched scowls, “I want her in here.” Biker girl bows, heads back to the waiting room. It was then I understood she's probably a medical assistant, not someone off the street. It’s Halloween Eve. I must expect the unexpected, even here.

After Karen arrives, the anesthesiologist enters the room. She explains the advantages of a spinal block, what women get to make childbirth more enjoyable. She doesn’t offer any of the other options listed on the sheet Nurse Ratched handed me earlier, like general anesthesia, all of which carry risks, ranging from awakening during the operation to death. So, I sign up for body piercing.

I’m being rolled into the operating room now. I see seven individuals in white, my surgical team, moving busily around the room. I recognize my surgeon’s voice. The man next to my gurney looks down at me and asks, “Hip replacement?” I answer, “Yes.” He continues, “Right side, right?” I assume he must be joking or testing my awareness. But I take no chances. “Left, please,” I say firmly.

My good-natured operating room companion advises me the best way to prepare for the needle about to be jammed into my back is to sit on the edge of the gurney and slump forward into a posture that would cause a mother’s rebuke.

I do so and feel only what amounts to a doctor’s familiar warning of a “slight pinch” before sailing off into unconsciousness.

I’m lying on a bed now in Room 768. It’s 2:30 p.m. A physical therapist asks me if I’m ready to take a walk. Spotting a four-legged silver walker standing by, I readily agree. After one lap around the bed I’m tired and ready to take a nap. The physical therapist explains the 1 to 10 pain scale, least to most, that will enable her to decide which exercises will be tolerable. I tell her my pain level, to my surprise, has not exceeded 2 to 3 after the operation, no doubt due to medication. Before surgery the pain in my left hip often hit 8 to 9. So far, so good!


October 31

After a pain-free, but twilight, sleep overnight, it’s going-home day. I’m scheduled to be discharged in the afternoon, little more than 24 hours after going under the knife.

The physical therapist takes me for a couple of long, walker-assisted, strolls up and down the hall, followed by mini-workouts in the rehab gym, where I practice getting into and out of a shower/tub and stepping up and down a single stair. Still very little pain, just an ample amount of stiffness.

My PT warns me never to cross my legs or ankles during recovery, nor to bend too far forward from my waist, nor to pull my knee up past my waist to greater than a 90-degree angle. Each of these positions risks the dislocation of my new hip and a return to the operating room for a repair job.

I tell my PT there’s no danger of absent-minded leg crossing with me. As a kindergartner I discovered I could not sit cross-legged. When the teacher asked us to sit that way, to my embarrassment, I could manage only to keep my legs together and lean over to one side, propping myself up with my arm to keep from falling over. To this day I’m unable to do what the teacher ordered.

Understanding my new limitations, I order a 3-foot long grabber device from Amazon, so I can pick things up from the floor without bending down, together with a device to allow me to put on my socks independently. We thought Karen could do it for me until we discovered her own body position limits from spinal stenosis.

Upon returning from the hospital this afternoon, we discover it’s not too late to attend the Halloween Party Dinner here at the Chateau. I’m moving along, quite pain-free, with my new walker. Karen’s dead tired from spending the night near my bedside on the tiny little couch in Room 768. But she can’t resist dressing up as Charlie Chaplin, nor can I resist going to the party as a hospital room escapee, still wearing the wristband with my name and birthdate on it.

I discover that was a bit of a mistake. After dinner I can hardly rise without pain. By the time we walk to our home across the street my new hip is complaining of an 8 to 9 pain level. Fortunately, I find my Oxycodone prescription, take one pill, and fall into bed to a sound sleep.


November 5
I’m strong enough now to limp around, without assistance, in our house and outside with only a cane. I no longer need pain medication. I try sitting in the driver's seat of our car today. Tomorrow, I plan to drive the three miles on neighborhood streets to my doctor’s appointment.

Today I have a shiny new hip.

Life is good.

Saturday, October 27, 2018

My Aching Hip: Preparing to Go Under the Knife


I’ve been touched by a scalpel only three times in my life: to remove a cyst from my wrist, to repair a hernia, and to get rid of a couple of cataracts. As a newbie to major surgery, I must admit to a little anxiety. Well, maybe a lot of anxiety. Ok, I’m scared.

Kaiser Permanente seems to understand this. The description of how the surgery is done verges on a do-it-yourself guide. A graphic slide show removes the mystery of the procedure, the meditation, visualization and affirmation tapes I can listen to before, during, and after the operation, serve to reduce anxiety and promote healing. Click here for a sample:  http://74.62.111.169/kaiser/files/successfulSurgery/02_Imagery_For_Surgery.mp3

The one I’ve found most helpful thus far has been a firm, but gentle, voice inviting me to place myself in an operating room that features a skilled surgery team, expertly going about their work, while exchanging comments about how well it’s going. In the room with me are Karen, the rest of my family, and a circle of good friends, looking on with smiling faces, admiring my courage.

Yesterday Karen and I attended a 2 ½ hour hip replacement surgery class. There were nine of us at tables in the conference room at the Kaiser medical offices three miles from our home in San Marcos. At the front of the room a screen had been set up for a slide show presentation.

While awaiting the teacher, we quietly filled out forms asking us about our current physical activity, our daily pain level, and our scheduled surgery date. Filling the silence, recorded piano music softly played a melody fit for a funeral home viewing room parlor. An unfortunate choice, I thought, given the audience. I was relieved to see smiling Nurse Sofia enter the room, carrying her clipboard and a cheerful greeting.

After Sofia led us through the steps of how best to prepare for the 1.5 to 2-hour operation, as well as what to expect during and after surgery, she underlined the importance of preparing an Advance Directive, naming someone to make health care decisions in keeping with your written wishes if you’re unable to do so. Karen and I both have Advance Directives, specifying our wishes to donate our bodies for medical science. Here’s how and where you can do that:  http://www.biogift.org/body-donation-faq.php

A physical therapist followed Nurse Sofia’s presentation. She described how to keep your new hip from popping out of its socket. It comes down to avoiding crossing your legs for a couple of months. That will be easy for me. As a kindergartner I discovered, much to my embarrassment, I was unable to sit cross-legged. To this day I have been unable to do so. A lotus position has been only a fantasy throughout my life.

Our last speaker was a discharge agent who reviewed what to expect upon leaving the hospital. I was delighted to hear that a physical therapist will visit us at our home twice a week for three weeks.

During recovery I’ll listen to that tape of affirmations intended to lift my spirits while I cope with the challenges of returning to my old, but nimbler, self.

I now feel well-prepared for surgery on Tuesday. I can do this thing. Watch for my next blog, My Aching Hip: Under the Knife Day, to see how it went.

Tuesday, October 23, 2018

My Aching Hip: Deciding to Go Under the Knife


Five years ago, I complained to my primary doctor of a lingering pain in my left hip, causing me to use a cane on our daily walks. After having x-rays taken, he referred me to a surgeon, who told me osteoarthritis had caused cartilage deterioration in my hip. She offered cortisone shots to ease the pain, explaining the shots had to be repeated over time. They were not a permanent fix.

Not fond of needles, I told her I’d prefer surgery. After showing me the x-rays revealed the cartilage had not deteriorated to bone-on-bone contact, she explained Kaiser Permanente’s policy, which was driven by the Affordable Care Act: avoid surgery when other means of pain management are available. She prescribed Ibuprofen, taken daily.

The pain medicine worked well for a while. I told myself, nobody dies of a little pain in the hip. I’d just continue taking those pills. No need to go under the knife for a cure.

Fast forward five years, to when the pills stopped working. The pain and stiffness in my leg had grown to the point where I could no longer put on my socks unassisted. The last time I needed help doing that was from my mother sometime in 1948.

After a visit to my new primary doctor, and more x-rays, I returned to see the same surgeon, who told me the new x-rays qualified me for surgery. She told me someone named Carlos would call me to schedule the operation. She said the current waiting list ran two to three months.

Ever the optimist, I emailed my surgeon a week later to ask when I might expect a call from Carlos. Her nurse wrote back he would call six to eight weeks before the scheduled date. My primary doctor gave me a prescription for Meloxicam, a stronger painkiller. It worked well enough to give me the patience to await Carlos’s call.

To my surprise he called within a week, offering me a November 6 surgery date at Kaiser’s Zion hospital in San Diego, 25 miles from the Chateau. With my pain under control, I told him I would prefer to await an opening at Palomar Medical Center in Escondido, just 11 miles away.  A few years ago, I published a column about the place. I dubbed it, The Palomar Hilton Medical Center, with its rooms with a view and a dream team of nurses. You can read it here: https://www.osidenews.com/2015/07/26/the-palomar-hilton-medical-center/

A week after Carlos’s call I regretted turning down his offer. Awakening that morning, I got out of bed to head for the bathroom. The pain in my hip returned with a vengeance. I managed to make it down the hall only by clutching at the walls and hopping on my right leg. After retreating to bed, and Karen’s insistence, I emailed both my primary doctor and my surgeon, pleading with them to save me from having to spend months flat on my back, awaiting another call from Carlos.

The pain returned to a manageable level after I spent most of the day in bed. Within two days Carlos called again, this time with an offer of surgery at Palomar Medical Center on October 30. I gladly accepted.

Now, as I await my appointment to go under the knife, I’ve had the time to second-guess my decision. What is the operation’s history? How risky is it? Can I trust my surgeon? What will it cost?

What’s the history of hip replacement surgery?
The earliest recorded case of attempts to perform hip replacement procedures dates back to 1891, when Themistocles Gluck tried to use ivory implants to replace the femoral head. In 1940, an American surgeon, Dr. Austin Moore, performed the first metallic hip replacement at Columbia Hospital in South Carolina.

What are the risks?
According to the Mayo Clinic, the two most common risks are blood clots and infection. My surgeon told me the mortality rate for those undergoing the surgery was less than half of 1 percent. The Arthritis Foundation cites a 2011 research report setting it at .029. Looks like my odds of survival are pretty good.

Can I trust my surgeon?
One of my favorite authors, Malcolm Gladwell, wrote a book titled “The Outliers,” in which he explains the 10,000-Hour Rule: the key to success in any field is practicing a specific task for 20 hours a week for 10 years. I, of course, looked up my surgeon’s bio, discovering Amy Steinhoff, MD, has been in practice for more than 12 years, exceeding Gladwell’s standard, and has five-star reviews from her patients.  

How much will it cost?
According to a January 22, 2015 report by California Healthline Daily, the cost of a hip replacement in San Diego County ranged from $24,000 to $47,000. But as a member of Kaiser Permanante Senior Advantage (HMO) we’ll pay nothing for room and board, surgery, anesthesia, x-rays, laboratory, tests and drugs.

Those are the reasons I’m now confident of my decision to undergo surgery at the Palomar Medical Center on Halloween Eve. To see how I’m preparing for that surgery, watch for my next blog entry: My Aching Hip: Preparing to Go Under the Knife, which will appear here:  http://theriehlworld2.blogspot.com/