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.

My Aching Hip: Preparing to Go Under the Knife

I’ve been touched by a surgeon's 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 I’ve been given about 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, are designed to reduce 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 are 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.

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/