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:

I thought you might like to see photos of my amazing surgical team…

God Bless the two of you! Thanks for saving my butt! See you in a year!

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.

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!

Today was my third surgery in 13 months to remove the cerclage cable placed around my right femur after my hip replacement on that side. It has done its job of holding my femur together while the bone knitted and formed around the stem of the implant. But, it has caused me a lot of pain and disability for these 13 months and it became very clear it had to go. 

Here’s the email I sent out this afternoon (I was actually able to comfortably sit in my chair at my computer and do it all by myself!):

Hello All!

I am so happy to report a quick, successful, pain free surgery and I was home by 9:30! We couldn’t believe how fast it all went, and easy, compared to hip replacements.

I went in at 7:00 and was out by 7:20. By 8:00 I was conscious and by 8:15 clear. They had me dressed and out the door by 9:00. Unbelievable!
I’m taking it easy at home, but feel well enough and can actually sit to write this email, so thought I’d do it myself. This also works well for Scott :-). 
You cannot believe what a nasty thing I’ve had around my femur for the last 13 months! No wonder I was having so much trouble and pain. It is large, with square rough edges. The end where they cut it after cinching it tight post-hip replacement (imagine a metal zip tie) is very sharp and frayed. If you aren’t careful while handling it, it can cut your finger. And that was rubbing on my soft tissue all this time! I started to cry when I touched it and felt how sharp and rough and bulky it is. I attached photos so you can see it. Scott, thought to add the quarter to show the size. I took one close-up of that sharp, frayed end. I’m so glad I decided to have this surgery to get that nasty thing out of there!

I don’t have pain, though I am taking 1/2 a Tramadol every 4 hours to make sure I don’t get any when the blocks wear off… The really cool thing is that my muscles seem to be unaffected. I can walk, touch the floor, sit, bend my knees, reach my toes in a chair–all the things which are impossible for awhile after a replacement. I attached a photo of me doing tree even, on the surgical leg!

I came home with a new bandage (there’s a pic of that too). It comes with a battery/suction device that draws fluid out of the wound, so there is less chance of infection and improved healing. the surgeon explained that when he goes into the same incision a second time, there is greater risk and that this bandage system seems to ameliorate that significantly. The bummer is that I have to have this attached to me for the next two weeks! That means no pants and it’s getting too cold outdoors to be without them. I’m also not sure how I’m going to shower… May have to get creative with that! But, if it keeps me from getting an infection, I’m all for it in spite of the inconvenience. 

My sense is when that bandage comes off, I’ll be doing awesome. I’m already noticing that the snap is gone when I flex my muscles. It is now fluid and easy like the other side. I also discovered that I’m already standing more on that leg than I have been. I usually favor it and list to port when standing. I have had to consciously remind myself to stand on both legs, but already that is changing! Isn’t it amazing what our bodies can do?

Thanks to all of you for reaching out and keeping me in your prayers and thoughts. I always feel swaddled in all your love when I go in for a surgery. I dearly hope this is my last.

Much Love and Gratitude,
Rhonda

We decided to take a trip to the Redwood Forest and the Trinity River to soak in nature and all its good energy before my cable removal surgery. It was such a needed sojourn! 

Here are some of my favorite photos:

I came back renewed, yet still having difficulty psyching myself up for my third surgery in thirteen months. But, hiking through the hills of the redwoods, I had so much pain that I knew there was no option. It was the first time I’d done hills since my hip replacements, and even with hiking poles, it still hurt. I really don’t want to live the rest of my life with this kind of pain and disability. I want to be able to hike moderately in beautiful places and not fight this anymore. So, it has to go.

One more day. Tomorrow I spend half the day in pre-op appointments and then, at 7:00 a.m. on Wednesday, the cable will come out. Happy Halloween! Pray for me. 

I’ll let you know how it goes on the other side, when my head clears.

Wow, it’s hard to believe I’ve reached the one year mark with my right hip! Unfortunately, I am still struggling with that danged cerclage cable around the femur (aka The Zip Tie). I did a new video which demonstrates the problems I’m having functionally because of it. You can see it at this link:  Rhonda’s Hip Adventure Videos.

So, I went to see my surgeon for the one-year follow up appointment on September 18th. Both he and Davis watched me demonstrate for them what is on the video. Dr. Shukla had me stand next to him, so he could touch my thigh as I contracted my muscles. You can both hear and feel the snap of the muscles over the cable. I winced with the jolt this always gives me and he winced right along with me. I will always remember him looking up at me with his cherub face and telling me he was sorry, but he had to do it. I could tell by the look in his eyes that he understood how much pain and difficulty this cable has caused me over the year. I looked down and said, “I know you had to do it. We always agreed the structural integrity was the most important thing, and you nailed that. You told me the cable might bother me and if it did, we’d take it out. So, let’s just take it out.”

It was one of those sweet moments you never forget, when compassion shines through and you realize why you trust this man to help you function again with your legs under you and without pain. I know we are getting there. One last surgery to go. 

On October 31st (Halloween), they will take out the cable. It will be about a 20-minute operation. They will cut a 2-inch incision into the bottom of my current scar, part all the muscles to the bone, clip and remove the cable, and put me back together. I’ll have a different bandage this time that has a battery-operated catheter in it to remove fluids and help it heal faster. I’m looking forward to getting that thing out of there and seeing what I can do then!

Leftie is doing very well at four months, getting stronger and more flexible all the time. I occasionally get a little stiff and sore if I overdo, but mostly I can’t even tell I had a hip replacement on that side. I can’t wait to feel the same way on the right side!

I am at that magic 90-day mark when they say you are over the biggest hump of your hip healing. It’s WAY BETTER with this hip and I continue to be very grateful for this. My walk is back to normal, though I am still working on the stamina to go longer distances and to stand longer. Here’s the latest video of my walk (the last one):   Rhonda’s Hip Adventure Videos.

As you can see I no longer have a limp or stiff hip. Yay! I can do a mile pretty easily now and 2 miles once a week. I did learn this month that doing 2 miles three times in one week was a bad idea and I set myself back and had more pain and stiffness as a result. It’s taken a couple of weeks to get over that. I was just so excited to get back on all my familiar trails and favorite places… But there is nothing like pain to encourage you to return to your Goldilocks Zone!

My new routine includes swimming three times a week, walking a mile once a week and 2 once a week, plus short walks around the neighborhood more frequently. I also do Tai Chi and Qigong every morning for 30 minutes to wake up and warm up. I do yoga 3-4 times a week in the afternoons to stretch, keep up my core and upper body strength and work on my one-legged balance poses which strengthen my legs and improve my balance. 

I tend to move from one activity to another (sitting, standing, moving) at least every hour. This seems to keep me from having too much pain and stiffness by overdoing any one activity.  I can sit for 2+ hours if necessary (e.g. to watch a movie or performance). I do some stretches and flex muscles around the hips in my seat when I sit that long. 

I am down to taking 1-2 ibuprofen at night and one dropper of CBD oil for sleep. This is working well. 

I continue to have problems with bearing weight and really contracting the muscles in my right leg. At this point, I am solid in my plan to request the cable be removed at the end of October. I see my surgeon to discuss this on September 18th, so I’ll include the result of that conversation and some video footage of the problems I’m having with the cable in my next monthly update. 

Until then, I’m cruising along, staying in my Goldilocks Zone and listening to what my body tells me. It’s amazing how smart it is! You would think by now I’d be better at listening to it instead of what my head’s agenda is. But, the tricky thing is I still don’t know when I’m overdoing it until I’ve done it and then it’s too late! My advice to my fellow hipsters is take it easy and slowly build up your stamina and strength, even if it feels like you could keep going.