Yesterday, my beloved Scott and I celebrated our 6th Anniversary of being together. Six beautiful years with this amazing man! We’ve been through a lot in that time: Scott’s retirement, his mother’s death, my father’s death, the death of two of our dear pets–Sam and Peanut, and two years of hip pain and surgeries for me. Never once has he wavered in his steadfast, positive happiness and generous love. He is truly my sunshine and the love of my life!
As my hips got worse, he encouraged me to go see a surgeon instead of continuing to hurt myself trying to rehab what wasn’t fixable, took care of me when I was totally incapacitated after the first surgery, cheered me on when I was discouraged, cautioned me to take it easier when I was pushing too hard, and worried about me more than I knew as I struggled with continuing pain and disability.
Sometimes we don’t know how our suffering impacts our partners and all those who love us. They go along for this ride too. Here’s part of the card Scott gave me for our 6th:
We are so grateful that at last this ordeal is over, and for the modern medical miracles and awesome surgical team that made it possible for me to walk and dance again.
I am grateful to you, dear Scott, for all the help, support and encouragement along the way. I know it hasn’t been easy for you and I can never express how much it means to me that you shined your sunny light on me no matter what. Here’s to the next chapter of our lives! I know we can face anything with each other.
Yesterday, I had my post-op with Dr. Shukla and Davis. I got to say goodbye to my “saddle bag” bandage and see the incision. It looks good (I’ll put photos and the xrays at the end, so if you don’t want to see them, don’t scroll down :-).
Yesterday was a celebration, a graduation, into a whole new chapter of my life. I finally have solid, strong, even hips under me for the first time and the cable that has held me back is gone! If I’m careful about what I do, these hips should last me for life. I hugged both Dr. Shukla and Davis and told them how very grateful I am to them for giving me my life and my body back. I couldn’t keep myself from tearing up, didn’t want to. For me, this is a miracle and I’m excited to see what I’ll be able to do as I strengthen my right leg and restore balance to a body which has never been balanced on a solid foundation. I can already do so much more than I could two weeks ago. It was fun to be able to show them! (I promise I’ll make a new video after my physical therapy so you can see too.)
I also talked with them about the cable. I saw Davis first and gave him a printout of my last entry on all the changes I’d seen within a few days of its removal. I pulled out the brochure for the Kinamed SuperCable, which I’d given him after my second hip replacement, when I knew it was the cable that had been my problem with the first replacement.
Then he made my day with a wonderful piece of news: “We found something even better–flatter, smaller and smoother.” He drew a picture for me of the small, flat clasp that holds the new cerclage cable together. He explained that the challenge he and Dr. Shukla face is convincing operating rooms and implant manufacturers to provide these superior cabling systems. He asked if he could use the information on the changes I had seen when it was removed and refer to my blog when they are advocating for the newer system. Absolutely! Then, I would feel like my suffering has not been in vain and that this blog could be of value in preventing suffering for others. These cerclage cables are used in many orthopedic surgeries, not just in hip replacements.
I asked how often they have to remove them. He explained that most people are not bothered by the older cables, except for people who are more slender, fit and body aware. “But, yours was the second one we’ve removed in 4 months.” He also told me my cable had loosened and that’s why it gave me more problems over time.
Then I saw Dr. Shukla and we also talked about the cable. I told him I was so happy to hear that they are using a new system and trying to make it more available. I said, “It’s an insult to your beautiful work to put this cable in on top of it.” He nodded, smiled and blushed. He too requested permission to use my blog as a case study to advocate for change and possibly create a link for other Reno Orthopedic Clinic patients.
We wrapped it up with hugs and good wishes for a Happy Thanksgiving. I have so much to be thankful for!
I went home and immediately felt a rush of relief. I realized I’d been bracing myself for the conversation about the cable. I wanted to express my concerns and implore them to change systems. But, more importantly, I wanted them to know how much I appreciated their skillful work which restored my body and gave me my life back.
How great it was to hear that they had already changed! This is how good medicine and strong doctor-patient relationships should be. We work together towards better and better outcomes. Every time I have a surgery, they have some new innovation which has made my life easier. For example, the DVT icing/compression unit I received for my second replacement and the Prevena bandage system used on this incision. I feel so fortunate to have doctors who listen and make changes based on what they hear from their patients.
Feeling heard is truly a salve for heart and soul. I cried and laughed and danced with joy and relief for the rest of the afternoon. I’m BACK! (Well, mostly, still have some rehab to do… I’ll keep you posted on that as I go along.)
Ok, here’s show and tell:
The end result of my 3 surgeries Perfect, stable, even hips! New scar on right hip after cerclage cable removal It’s a little longer, but very fine stitching. Davis did beautiful work, didn’t he?A wider-angle view of right hip scar Left hip scar Now at 6 months post-opWider-angle view of left hip scar
I thought you might like to see photos of my amazing surgical team…
Dr. ShuklaDavis J.P. Ayers II, MSPA, PA-C
God Bless the two of you! Thanks for saving my butt! See you in a year!
Today is Election Day and it’s an important one. Please vote–let your voice be counted.
The other day, I found this op ed I wrote in October of 2008 and re-read it. It was published in the Denver Post’s Online Guest Commentary on October 31, 2008. When I read it again, I was disheartened by the fact that our country has become much more divided rather than united in the last 10 years. Over the last 10 years, I’ve also changed my political affiliation to Independent, as it feels more in alignment with my own truth.
A Purple Nation By Rhonda Ashurst
I am a Democrat and my husband is a Republican; my father is a Democrat and my mother is a Republican. The bipartisan nature of my families, of this nation, fascinates me. Political maps show red Republican states and blue Democratic states, as if we can be so easily divided. I have long suspected that there are many purple families like my own, and that we also more blended individually than our party affiliations might indicate. I vote for Republican candidates when I think they are better suited for the job. I know many people, including my family members, who regularly cross party lines. We have informative, respectful debates and sometimes we sway each others’ opinions and votes. We can agree to disagree, and still have dinner together and get the dishes done. My curiosity about partisan politics led me to George Lakoff’s book on The Political Mind. Dr. Lakoff is a cognitive scientist who studies the underlying differences in how conservatives and progressives view the world. In a nutshell, Lakoff defines progressive thought as empathic and protective and conservative thought as strict and authoritarian. He makes the excellent point that we are all bi-conceptual, using both types of reasoning in different circumstances. Like good parenting, good governing requires a balanced perspective between nurturance and accountability. A current example is the $700 billion bailout of the mortgage crisis. A bi-conceptual solution would include helping people to stay in their homes, as well as offering assistance to financial institutions to keep our financial system from collapsing as it did during the Great Depression. In addition, there would be accountability to the American people in how this $700 billion was going to be spent and a return on investment when the markets recover. We would question the wisdom of laissez-faire free markets and increase regulation of financial markets in the future. As individuals and as a nation, we would take an honest look at our spending habits and resolve not to spend beyond our means. Getting out of this mess requires a bipartisan, bi-conceptual solution that is both supportive and accountable and involves all of us, as well as other nations. This global crisis has underscored the fact that we are all inter-connected and when a stone is thrown, it causes ripples in worldwide pond. In times like these, we need a nurturing parent who says, “Don’t panic, we will find a way through this. Here is what I can do to help.” We also need a strict parent who says, “If I’m going to help you, we will have to agree on a plan for how you will do this differently in the future. I will hold you accountable to the plan and I expect you to do your part.” After reviewing information on the current plan, I’m not convinced we are there yet. When we go to the polls on Election Day, we must consider which candidates and ballot measures represent the balanced perspective we so desperately need to meet the challenges we face as a nation. We cannot afford to let partisan polarities immobilize this great country. It is time to unite towards common goals, utilizing the strengths of our different views, and honoring that we all have a role to play in the recovery. Republican or Democrat, red or blue—we are all united in the common dream that we may pursue life, liberty, and happiness from a place of security and stability. We all want our children to have these same opportunities and not to be saddled with our mistakes and a mountain of debt. As a long-time member of purple families, I know we can rise above our differences and be a purple nation.
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It is up to each of us to look for our common threads of humanity, our shared dreams. If we look under the surface of our differences, we may find we have far more in common at the deeper levels than we realize. It is time to stop feeding the fire of division and nurture our unity as a nation and a people.
When we are divided, we are challenged to think of where our unity exists.
Before I forget, as my body returns to normal, I want to make sure I note some of the changes I’m observing now that I have my right leg back under me:
When I wake up in the mornings, I no longer have the achy, arthritic stiffness I’ve grown accustomed to. I thought I’d have to live with that for the rest of my life. Since my right hip replacement, I’ve felt like I was 80+ when I got out of bed in the morning. I did 30 minutes of Qigong and Tai Chi to be able to move and dissipate the pain. Now I don’t have pain anymore. (I even removed the ever-present bottle of ibuprofen from my night stand!) The really odd thing is that pain affected most of my body: legs, glutes, back, shoulders, neck. Now it is suddenly gone and I feel my old self again! Could it be possible that my whole body was reacting to that cable? Maybe it was just a lot of muscular contraction and holding of tension? I don’t know, but it’s a very welcome relief!
The soreness from the surgery is already mostly gone. I actually have less pain now than I before the surgery! It’s Day 5 and I can hardly tell it ever happened.
I can do lunges and squats, and hinge from my hips. The pain which caused me to favor the right side and shift my weight to the left, is gone. As a result, I am much more balanced and stable when doing these movements. As of Day 5, I can squat all the way down to the floor, sit on my heels, and come back up. I would have screamed doing this before the surgery, or collapsed on the floor.
Because of the increased balanced stability in my legs, when I bend down to pick something up, the familiar twinge going up the right side of my back (QL) is gone. I no longer fear throwing my back into spasm every time I reach for the floor. I didn’t realize the contortions I was going through trying to avoid engaging the right leg and hitting the cable. As a result, my back is looser and I feel much more confident using it. I can effortlessly touch my palms on the floor again.
This morning, I reached over the right arm of my recliner for something on the floor. I didn’t even think about it. I could never do this without a lot of pain before, so I avoided it. This motion requires me to shift my weight onto the outside edge of my right thigh and it always caused so much pain once my flesh hit the sharp edge of the cable that I stopped. I’d get out of the chair and bend over my left leg instead.
I can lift my leg to put on and pull off pants without needing additional support. I trust my balance and can control the right leg.
It is much easier to get up from a sitting position.
I can tighten my glutes and not feel an aching pain in my right hip and outer thigh.
I vacuumed yesterday and caught myself extending the right leg and pushing from there. I’ve been doing left-leg-leading vacuuming for probably 2 years!
I’ve stopped continuously massaging the outside of my right thigh.
I am no longer constantly aware of having a foreign object in my leg. Now both my implants feel like an integral part of my body and I cannot even tell they are there. It was like this on my left side by about 6-weeks. But the right has always bothered me until now.
From my first walk on Day 4: My full, even stride is back! I can walk uphill and step up stairs and onto rocks without pain and with confidence. I was able to lift my leg over a fence, which I couldn’t do before. Uneven ground is no longer a scary negotiation. Hey, maybe I won’t need to always use hiking poles on a trail! My back isn’t stiff and my legs don’t ache when I get home.
From my second walk on Day 5: I expected to be sore, because I did a lot yesterday! I was having too much fun exploring what I could do! I figured I’d pay for it today, which is what usually happens, but instead I am only a little sore. I was able to come back home and do some yoga without feeling wobbly on my legs and having a tight back and achy legs.
I can do belly dance moves which have been impossible since the replacement, these moves require me to shift all my weight onto the right leg and engage the gluteus medius. For example, I can now do hip drops, figure 8’s and the 3/4 shimmy. I can also push the right hip out to the right side, as if I were bumping a car door closed, and not get bit by the cable. I might actually dance again! This is one of the great joys of my life and I realize I haven’t even put the music on to tempt me, because I simply couldn’t do it without a lot of pain and awkwardness.
I can do the high kick in Tai Chi 24-short form and control, extend and straighten the leg. In Snake Creeps Through Grass, I can step onto the right leg (which is extended out in a lunge) and pull the rest of my body and my left leg up to join it. Before I had to sort of hop my left leg up, using it more than my weakened right leg.
From the yoga mat: Poses that engage the right leg no longer hurt, e.g. Warrior I and II. I still can’t do Warrior III or Dancer, which require full extension over the right leg, while extending the left leg back. But, I am finally able to begin tentatively shifting weight onto the right leg and extending the left leg back while leaning forward. I was totally unable to do this before. While lying on my left side, I can lift, circle and hold the right leg with control and without pain which I have not been able to do, particularly holding the leg up and forward while scissoring my left leg up to meet it. I can do a supine twist to the left without the catch in my right side and back. All poses which open the right side are easier and my range of motion is back. It honestly felt like my whole right side froze up every time I asked the muscles to stretch over and rake that cable. And I can certainly see why! It was like pulling them over a piece of barbed wire. I’d say that most of my practice (and daily life) has been affected by the cable and my body struggling to work around it and avoid pain.
Last night I realized I’ve been depressed. I feel like my life has been on pause and now I’m back! Scott told me last night that he can tell I’m happy again. I feel so sad for him–he’s had to live with my pain, disability and depression all this time. I’m sure he felt like he’d lost his partner, and he did.
Scott and I were trying to pinpoint when the depression started. He thought it was two years ago. That’s when I started aggressively working with physical therapists and body workers in a vain attempt to heal my hip pain. This, of course, only aggravated my condition and increased my pain and disability. Then, I was diagnosed with dysplasia in July, 2017. My right hip was replaced in September, 2017 and the cable was installed to support my femur. It took me 3 months to walk without a limp and walking was never easy or pleasurable again. Then my left hip went and it was replaced in May, 2018. No cable was required. I could walk without aids in 4 days and had no limp within 2 weeks. It was then that I knew my problems on the right were caused by the cable and it had to go. Turns out, it was true!
But it wasn’t just the leg that was affected. Now it seems my whole body was affected with all the aches and pains I suddenly had. And I was depressed. Life had lost its luster. I no longer had the strong body I’d always counted on. Now I feel like my old self again on all levels. I’m 40 instead of 80!
There is no way to express how wonderful it feels to be able to do all the things I love to do with my body without pain. I am indebted to the miracles of modern medicine which have allowed me to walk again, and to my awesome surgeon, Dr. Shukla and his equally awesome assistant, Davis. They are truly masters of minimally invasive hip replacement and surgery. I can hardly tell they were in my leg to the bone 5 days ago. I will be forever grateful to them for my ability to walk, dance, do yoga and Tai Chi, and live my life again. The only thing that could have been better would have been a kinder, less invasive cerclage cable system. Hopefully, that can be corrected in the future, so others don’t have to go through what I have for these last 13 months.
This morning, while doing Qigong, the Prevena started to squawk. I turned it off and on a couple of times, hoping it would reset itself. When that didn’t work, I got online and looked up the alarm code. It indicated that my pump was full, but when I looked in the window, I didn’t see anything and had never noticed any drainage in the unit itself. So, I was puzzled. The instructions said to call my doctor if this happened.
Of course, the Reno Orthopaedic Clinic is not open on Sundays. I called and got the answering service. They took down all my information and my issue and said the on-call nurse would call me right back. And she did. She asked if I could see if the pump was full and I told her it didn’t look like it. She said the pump often stops around day 5-7 and the alarm can simply be part of it shutting down. She asked if I had any swelling , heat or pain and I told her I hadn’t since the surgery. She instructed me to cut the tubing flush with the bandage and put a piece of tape over the end, and then throw the unit in the trash. So, I did. Seems a shame to waste a medical device like that, but I guess they make them that way…
Once I cut the tube, the bandage puffed up. Davis had told me it would do that. Here’s what it looks like now:
Alas, I have lost my farty little friend! I am no longer tethered to the Prevena pack. All I have left is a poofy saddle bag on my right thigh! I’ll take it. No more worries in the grocery line.
My leg is having a party, celebrating being free at last! It is truly amazing how fast this recovery is going. I feel my whole body breathing a deep sigh of relief. It’s like I’ve been all crunched up on my right side, drawing the leg protectively into my body and not using it fully because of the pain. I can already do things pain-free that I haven’t been able to do all year. For example, I can do belly dance hip drops and figure 8 moves that have been impossible. I can lean forward on the leg, though not very far yet. I’m starting to get my forward and side lunges back, and was able to do 24-short form Tai Chi this morning and sit cross-legged for meditation!
I had a couple of tired days on Thursday and Friday, which is pretty normal and often more about getting over the anesthesia and all its various effects. Today I feel great! I have had virtually no pain since Wednesday, so I stopped all the pain meds. So far so good. I’m not even using Tylenol. In fact, the leg is less painful now than it was before the surgery!
Physically, my body has already moved on. It’s over. Emotionally, however, I go from anger to sadness to relief to gratitude to joy and sometimes back again. I’m angry that this brutal piece of hardware was placed in my body and it hurt so much that it really set back my recovery. I’m sad about all the pain and disability I suffered for the last 13 months. Every time I’m able to do something which has alluded me all this time, I cry all over again. When I touch the cable, which I keep on the kitchen table, I tear up. When I notice how much better I feel as I move, that I’m not off balance and favoring the leg, I feel relieved. I don’t feel like I’m 80-years-old anymore. And then there are those ever-increasing moments of gratitude and joy. It is finally over and I am whole again. There were times in this process when I wondered if that would ever happen.
I do want to say in support of my most amazing surgical team, Dr. Shukla and Davis, it wasn’t your fault. You did the right thing by putting a cerclage cable around that femur. I was the one who stubbornly kept walking on a totally destroyed hip until I stressed my femur. It already had bone spurs when you started. The wise and prudent thing was to support the femur until it could knit around the implant and repair any micro-fractures that might have occurred during the replacement. On this end of it, I have two solid replacements that are holding perfectly and I have equal leg length for the first time in my life. I also noticed, looking at my wet footprints at the pool the other day, I am no longer duck-footed! I have real hips for the first time in my life and I can walk again. For me, this is a medical miracle! I will be forever grateful to the two of you for the magic you’ve worked in my body. Without you, I would be in a wheelchair.
What I do want to say is that this piece of hardware does not belong in the human body. I realize that this is the cerclage system that comes with my Smith & Nephew implants. Why they are still using this cerclage system is beyond me. But there is a better one that uses a polymer system and a connector that lies flat against the bone and doesn’t have sharp ends, both for the safety of the patient and the surgeon. Here is a link (which may be helpful for my fellow hip people, or any of you who have to have orthopedic surgery): http://www.kinamed.com/products/orthopedic-products/supercable. I think I could have tolerated this cable better and might not even have had to have it removed. I found this site when I was Googling problems with cerclage cables.
I do plan to discuss this with Dr. Shukla and Davis at my follow-up appointment. But, I also want to share it here, especially for my fellow hipsters. From my perspective, Dr. Shukla and Davis are gifted in their ability to perform minimally invasive replacement surgery, which causes very little disruption to the muscle tissue. I had the benefit of experiencing this on my left side–I was able to walk unaided in 4 days! It took 3 months to walk as well on my right side, because of this cable. It seems a shame to ruin the amazing work they do with a piece of hardware like this! My hope in talking with them, and in sharing this here, is that others might be spared the pain I have gone through.
On a lighter note… Me and my new friend, the Prevena pump are figuring out how to better live with one another. Scott discovered that it could be disconnected from the bandage for showering, which I did yesterday and it felt wonderful! I also found two pairs of pants I can put the tubing in and still get around. I located my old western belt, which the pump case belt loop fits over, thankfully. So, I am mobile and can drive! In fact, right now, I’m going to the store to go grocery shopping for dinner.
Good to go with my little Prevena buddy
I must say that this unit is pretty amazing. There is absolutely no swelling, bruising or pain in or around the incision. But, it does have one little quirk… It farts. That is the sound it makes about every other hour when it suctions. So, pray for me that it doesn’t do that in line at the grocery store!
