Arise! and Shine

 In the hope of helping others who may be facing this type of surgery, I am offering up details about my own recovery process.  Of course, everyone is different, so everyone’s recovery will be different. But, as a sixty-four year old, somewhat overweight woman, who suffered from bone on bone pain with increasingly severe mobility limitation for nearly a year before deciding to go under the knife, my situation is apparently not all that uncommon. I looked online for advice from others and discovered the information was either outdated or not very detailed so….I hope knowing some of the details of this journey proves useful to you.

 Day One 

My surgery began at noon and lasted about two and a half hours. My surgeon, Dr. Gustav Fischer, is one of the few certified and experienced in “minimally invasive, direct superior approach”, hip arthrospcopy.  A general anesthetic, not a nerve block or spinal block, was used.  No Foley catheter was inserted. I woke up in the recovery room to a kind nurse asking me if I knew where I was.  “In recovery after a surgery,” I managed to get out. My mouth was extremely dry and my throat sore from intubation.  Still, she seemed reassured.  She left, brought me some ice chips, and I sucked on them, one at  time while we waited for my room to be ready. I was very groggy and really just wanted to go back to sleep, but no, they like to keep you awake at this point.

After about 45 minutes (which is shorter than usual, I was told; waits can be up to several hours), I was wheeled to my private room (thank you, insurance!).  They transferred me to a bed, which involved me trying to coordinate my muscles a bit as “help”.  I was feeling no pain.

Once I was hooked up to all of the appropriate monitors and my tubes checked, I was left alone for a while. I drifted into a very psychic dream space, populated with healing angels.

It was lovely and very a form of lucid dreaming. I was annoyed to be awakened from it every hour for routine blood pressure, temperature, and other vital signs check-ups.  My blood pressure dropped very low at one point, setting off the bells so they rushed into my room, fiddled with things, added some ephedrine to the mix and brought me back to a level they were comfortable with.  I returned to my blissful, highly medicated state, doing personal visualizations directed at promoting my healing.

After a few more hours of the checking blood pressure, temperature and vitals routine, I began to experience a bit of discomfort.  They added pain medication to my IV line.  Shortly after that, a nurse came to get me out of bed.  Yep, within six hours I was sitting on the edge of the bed and being helped into the bathroom, where I peed a very, very little. However, the getting up proved easier than one might imagine. I was a little light headed upon sitting up and I definitely had to use the walker with a nurse assist into the toilet, but I was moving under my own steam.

I did not have an appetite but was happy to drink apple juice, water, and a cup of chamomile tea.

I passed a much-interrupted night of nurse checks, medication distribution, psychedelic dreams, feeling uncomfortable on my back, and having awareness of many comings and goings outside my room.  Mercifully, after I asked them to close my door, it was quiet between these interruptions.

Day Two

This was a whirlwind day. The surgeon’s PA came to check on me around 7:00 am.  Then, about an hour later, the surgeon himself came.  He reviewed my chart, asked me how I felt, told me the surgery had gone very well,

praised me for having gotten out of bed the day before and said he was sending me home in a few hours.

“But…but…I thought I might stay another night,” I began, “my husband works and is my only caregiver and it’s not really his forte’.  I still feel rather weak and a bit uncertain.”  I finished.

“Well, your husband is just going to have to get with the program.  You are doing very well and you will do much better at home, Nyla.” He pronounced, not unkindly, but in a tone that let me know there was no room for debate. “You don’t want to risk getting any of those nasty hospital based infections,” he added, a bit more compassionately.  Then left.

After that, an Occupational Therapist came in to show me how to maneuver my body in and out of bed, in and out of chairs, how to use the walker

hospital charged $200 for this. It’s available online for $30. Buy in advance.and various dressing aids.

 

 

I ate a small breakfast, enjoying the orange juice and coffee.  Then, a Physical Therapist came in to teach me some bed-based exercises which I would do twice a day for the next three weeks.  A couple of these were fairly easy, the others quite challenging due to my lack of muscle strength.

They switched my pain medications to oral, using oxycodone and Tylenol extra strength.  They told me to take baby aspirin twice a day to help prevent blood clots.  Then, they pulled out my various tubes and IVs.  The Occupational Therapist returned to take me on a walking adventure down the hall to a room where I proceeded to demonstrate that I could get up and down stairs, albeit very slowly, somewhat weakly, and

with the use of a cane.

 

 

 

They brought me a light lunch of soup, salad and juice.  I still had no appetite but enjoyed the liquid and a bit of the soup.  It was a bland cream of chicken thing.  The Physical Therapist interrupted my meal with her second visit and put me through my exercise paces to see what I remembered. Then, she helped contact the hospital pharmacy to fill my prescription orders so we could head straight for home upon discharge.

Peter (my husband), had come and gone during the morning routine and was called to come get me.  I got slowly and carefully dressed, then lay back down on the bed to wait.  I was definitely feeling tired after so much activity.

Peter showed up, they wheeled me out to the car, I managed to get in by using my right leg to lift my left (the surgical side) and my arms to help lift and pull me across the seat. The ride home felt a bit bumpy and I was feeling dizzy by the time we arrived, twenty minutes later.

I’d prepared the futon in my office on the main floor for a recovery room before the surgery

and it was to that space I headed immediately after negotiating the five stairs into our house.

 

 

My cat Rodney,

 

like a genuine familiar, came to sleep at the foot of my bed with me, which he continued to do for the first full week, night after night.

 

I was exhausted and fell immediately into a fitful sleep.  I missed my healing angels and that deep peaceful, place I’d experienced in the hospital.

The first night, I woke up every few hours. At four-hour intervals, I took oxycodone for the pain. Also, had to use the ice for numbing.

And I had to wake Peter in the middle of the night to come downstairs to help me to the bathroom.  Always a deep sleeper, he was not very awake, turned on all of the lights in the hall, bedroom and bathroom, waking me fully up, after which, it was hard to get back to sleep because I was so uncomfortable.  I finally did, sleeping for nearly ten hours.

Day Three

I woke, did my bed exercises and resolved to get myself out of bed without help. Using the walker, I hobbled first into the bathroom to begin a daily, post surgery Senna supplement, then out to the living room, to a recliner we’d brought in for me to use during my recovery.  Peter was surprised to see me up and about. He kindly brought me coffee, refilled my water bottle, and then, fixed us both breakfast of scrambled eggs and toast, of which I ate a small amount while sitting in the recliner.

I spent the day drinking water, zoning out on my laptop, and going back to bed for naps.  We had not put the raised toilet seat I’d purchased on the toilet because we have an electric bidet which Peter is very fond of and seemed hesitant to lose, but had said he would, if necessary. I’d said we could wait and I’d give it a try as is.  I discovered that if I stretched my surgical leg out in front of me until it touched the bath tub, I could sort of get into a comfortable enough position on the toilet to pee. I secretly wished we’d installed the raised toilet seat and I highly recommend doing so.

I continued to take the oxycodone this day at four-hour intervals but I really didn’t like the way it made me feel. Woozy and sluggish. However, there was a deep aching in my hip joint and my left knee continued to hurt.  Also, I developed a kind of neuropathy in my right leg, which had had surgery eight years earlier.  Tingling, numbness from my hip to my knee in the front and outside right of my thigh, interspersed with sharp, icy, stabbing pains.

I did a fair amount of research about this. It seems that the dislocation of the hip sockets, the amount of physical abuse the body sustains during this kind of surgery, and the angle one sleeps in can contribute to nerve issues.  I read that the use of a raised pillow wedge might be helpful so ordered one for next day delivery.

I had a bit more of an appetite in the evening and ate some Thai take out.  I continued to make sure to drink water, working to get a minimum of 48-60 ounces per day, plus coffee in the morning and apple juice in the afternoon.

I felt very anti-social and didn’t want to talk on the phone to anyone or have any visitors.  I didn’t even write emails or post on Facebook. Just read, watched videos, and dozed.

I went to bed a little after 9:00 pm, did my bed exercises, then waited to fall asleep. I had a restless night, unable to get comfortable on my back, needing to get up to pee twice; however, I chose not to wake up Peter anymore but to simply struggle out of bed and use the walker in the dim light thrown by the nightlight.

It was hard going since my left leg and thigh were so weak but I was able to do so by sliding them together slowly to the edge of the bed, then pull myself to sitting, then use my hands to help lower them gently to the ground. I trekked to the kitchen for the ice pack and got up to pee twice during the night. Doing so in the almost dark helped keep me out of that fully awake place I’d experienced the previous night. Still, the need to take pain medication in the middle of the night pretty much prevented me from hitting deep REM sleep anyway.

Day Four

I did my exercises in bed before getting out.  I visited the bathroom, began the first of my daily sponge baths because I felt funky, and hobbled out to the recliner.  Peter woke up a bit later, made us both some coffee, and asked what I wanted to eat. I chose granola and yoghurt, with fresh blueberries and strawberries.

I still hadn’t had a bowel movement and decided it was time to up the fiber and fruit content of my diet. And to drink even more water.

While Peter worked in the other room, I spent another morning online, watching movies and reading the paper.  I decided to skip the oxycodone and move to just extra strength Tylenol for pain. The opioids contribute to constipation and I decided that it was time to help my body get back to its routine.

I asked Peter to get me a cabbage sesame salad that Trader Joe’s carries for my afternoon meal. More roughage.  And it tasted really good.  It gave me a burst of energy and I decided that I wanted to take a short walk to the pocket park next door to our house.  With Peter spotting me and carrying my walker, I used the cane and made it down the front stairs, switched to the walker, and began a slow, steady momentum forward.  Rodney joined us and we walked through the park, turned around, came home, and back up the stairs.  I estimate this to be a total distance of only about 150-200 feet but it felt like a big accomplishment and I was ready to rest afterward.

The raised pillow wedge arrived  

and I asked Peter to put it at the head of my bed.  I then rearranged the four pillows I’d been using in the hope that this would help reduce the pressure on my spinal column nerves.

Peter surprised me with a pint of Hagen Daz vanilla Swiss almond ice cream and I ate the entire thing.  I reasoned that the cream, on top of the cabbage I’d eaten earlier might help stimulate a bowel movement.  I was wrong.

We sat together and watched a movie until about 10:00 pm, then I went to bed.  I did my bed exercises again and discovered that I was hurting from the walk, so despite my hoping to have stopped the oxycodone completely, I had to take a tablet to kill the pain in order to get to sleep.

It was another fitful sleep, waking to pee.  Getting in and out of bed was still taking a fair amount of caution and energy and I still needed the use of the walker to get across the hall.  Sleeping on my back, even with the new raised pillow wedge, was definitely adding to the neuropathy of my right leg because I noticed that within ten minutes of lying on my back, it would begin to tingle and go numb.  I hoped that it wouldn’t get worse overnight and decided to write an email to the doctor the next day about it.

Day Five

Woke up early thanks to hungry kitty meowing. I had been forbidden to bend down by the occupational therapist who had stated firmly, “Do NOT try to feed the cat for a few weeks”, so I had to text Peter, who was asleep upstairs, to ask him to come feed Rodney.

Once awake, I couldn’t go back to sleep so did my bed exercises and got up.  Noticed that it was a wee bit easier to slide out of the bed. Also felt strong enough on my feet to use just the cane to go to the bathroom, though I did switch to the walker for the main part of the house.

I kept finding it annoying to try to negotiate the walker through the very small openings between furniture in our small home.  Also, Peter’s shoes on the floor in my path provided an obstacle which caused me to stumble.   Make sure your floor is clear of throw rugs and tripping hazards, and reposition furniture so that you have wide enough spaces to maneuver between.

I composed an email to Dr. Fischer about the neuropathy, stating I didn’t want to catastrophize anything but that I wondered if this was usual. I was very descriptive and exact about the progression, location, and timing of symptoms.

Drank a lot more water, then had a brainstorm and asked Peter to go the store to buy prune juice. Not my favorite, but people swear by it so I thought to give it a try.

Erinna, my daughter, came by for a visit.  My emotions seemed to be volatile and my endurance limited and I didn’t exhibit appropriately motherly behaviors. We ended up having a big argument. She left, I cried, turned back to my laptop for comfort.

Peter and I went for another walk to and through the park later in the afternoon.  I asked him to go buy some spicy curry for dinner.  It’s always been a real “cleaner outer”.  When he came back, it was to report that the Indian restaurant hadn’t been open so he’d gotten Thai chicken wings and rice instead.  Not exactly curry, but a noble effort for substitution.

I drank more prune juice, ate more fruit, ate another pint of ice cream.  I felt guilty about eating the ice cream again, but it tasted so good and it seemed I deserved something enjoyable. Plus, I reasoned that the combination of things I’d eaten would surely assist my body. I was beginning to worry about not having a bowel movement and believed this should do it. By bed time, still nothing.  I went to bed feeling discouraged.

Well, in the middle of the night, my system kicked into gear.  I woke with a churning, roiling in my gut and barely made it out of bed and onto the toilet.  My body was trying hard to pass what was in it but things had become so hardened and compacted that it couldn’t.  I was blocked up.

As embarrassing as it is, I share this next part as emergency  strategy: I ended up having to stick my finger up my butt to dig out impacted fecal matter until I’d loosened enough of the blockage that things could move on their own.  This was NOT an easy or pleasant task.  And after that, oh God, things began to move.

I had explosive diarrhea, time and time again.  My body was cramping, I was sweating and I felt faint.  The toilet was uncomfortably hard on my poor hip joint since we hadn’t put that damned raised seat on. I ended up weeping in pain.  I felt like I was having a grand mal seizure at one point, kind of blacking out.

Finally, I managed to clean myself (found myself grateful for that bidet after all), dragged myself up onto my feet, and hobbled into the bed, where I collapsed.

Day Six

I woke up dehydrated and weak. Finished off the water in my water bottle and went back to sleep for another hour.  Finally got myself up and out of bed (skipping my morning bed exercises in the process) and made my way to the recliner in the front room.  I was definitely feeling the effects of my nocturnal adventure and my joints were all hurting.  I asked Peter to get me some Tylenol plus because I couldn’t even get myself out of the chair to get my own medication, as I had been doing every day before.

I ate a small amount of scrambled eggs and toast, courtesy of Peter.  Drank my coffee. Drank a lot of water.  Got up the courage to share what had happened. Not sure why I did, I think I just felt like someone should know.

Peter doesn’t like this kind of talk and asked me to please not discuss it while we were eating our breakfast.  I don’t understand that kind of squeamishness but said, “fine”.  I was irritable and unhappy and feeling powerless and tired of hurting.  I lashed out at him over some small thing, we had an argument, and he left the house to go to work, leaving me alone to take care of myself for the day.

I managed to feed myself, refill my water bottle, waste some time watching videos, then took a nap. When I woke up, I felt a bit better, so I finally did my PT exercises.

Peter came home from work and I asked him to go pick up Chinese take-out.  Not usually a big fan of Chinese food (so bland), I decided the vegetables and some chive dumplings would be easy to digest so my body might resume some normalcy.  I stayed off the pain meds during the day.  Fifth day after surgery and I was doing it on extra strength Tylenol, 500 mg.

Except at bedtime. Damn, but my hip was aching, my knee was still hurting a lot, my right shoulder was now hurting, and I was having even worse neuropathy.  I brought out the ice again but in the end, I resorted to one Oxycodone to get  through the night.

 I was worried because I definitely didn’t want to block things up again.

Another fitful night. Insomnia. Tossing and turning.  Unable to get comfortable.  Tried to sleep on my non-surgical side with pillows between my legs for support but this only worked for an hour or so.

Day Seven

I woke up, did my bed exercises, noted that today marked one week since my surgery and gave myself credit for having given up the walker, for having gotten myself up and down without help all week since that one first night, for having gone for two walks and a car ride, and for having mostly cut out the Oxycodone (except at bedtime). All in the first week. I celebrated by making my own coffee and fixing my own breakfast.  Woo hoo!

Peter seemed grumpier than usual in the morning.  I had to ask him for help at times, though I was trying very hard to be as independent as possible.  Still, on this day, he seemed a touch annoyed.  When I asked him if he would go to the pharmacy to buy me some stool softener before he left for work, he said, “right now?”

I’d done my research and figured out that I should try this for a week or so during the days of any pain killer use. I recognized that I had developed a small hemorrhoid from all of the sitting, dehydration and trying to pass a stool. A stool softener seemed an excellent idea.

He became agitated because he’d arranged to meet his new assistant and he didn’t want to be late.

“I’m sorry but I can’t very well get there myself,” I said, “or I would.  Just text her and let her know you will be ten minutes late because you are running a medical errand for your wife.  It’s the only one you’ve had to do all week.”  I added this last a bit spitefully, I’m sorry to admit.

I think having one’s significant other being the only person you depend on after this kind of surgery is not ideal for either party.

He left and returned, no more than ten minutes late as I’d promised. I added taking one stool softener per day to my regimen.  Which was now down to one baby aspirin morning and night, one extra strength Tylenol in the morning and usually in the afternoon.  And I decided that I was going to go Oxycodone free at bedtime from now on.

My friend, Lynn, called to ask if she could come visit and bring me dinner that night.  I was ready to see a friend and grateful for the food offer so said, “Yes, please. I will be so happy to visit with you.”

Spent the day getting up and down, walking around the house with just the cane, added some standing balance exercises (the Horse—Tai Chi) and an old ballet stretching thing I could barely do to my exercise regime.  I noticed that the movement helped lessen the right thigh neuropathy. Spent the day reading and watching movies.

My son, David, came by in the late afternoon and we visited awhile.  Then Peter showed up, and the three of us went for another walk to and through the park.  After David left, Peter asked me if I wanted to check on my garden (he’d taken over weeding and watering duty for me), so I hobbled, using only the cane, around the yard, checking on things and approving,

making sure to give Peter many compliments for having  gotten involved in the gardening.

Some new neighbors came by, we ended up chatting for close to 40 minutes, and by the time they left, I was feeling  shaky on my feet.  We went inside and I said that I needed to lay down for a while.  I ended up sleeping for nearly two hours and missing my friend’s visit entirely.

When I woke up it was 7:00 pm.  Peter had eaten some  excellent Jambalaya she’d brought over and told me they’d had a pleasant, short visit.  I texted an apology to her, ate some of the food, and finished it off with fresh watermelon, which tasted wonderful.

We watched Netflix shows for a while but then I went to bed, I still felt so weary.  I also was hurting a lot, having overdone the day. Neither ice nor extra strength Tylenol helped so, despite my desire to avoid taking any more of the oxycodone, I ended up having to take one in the middle of the night.

 

Day Eight

I woke up before Peter again, made my own coffee, and noticed I felt much stronger on my feet. I started dropping the use of the cane indoors and began instead using furniture to balance my way around the house.

I also took a shower! I got myself into and out of the shower (luckily, we have a shower grab bar) but did have to sit on the shower chair to get through the whole thing.

But oh, wow, did it feel good to wash my hair and get truly cleaned up. I had to make sure not to soak my water-resistant bandage, so I took the shower nozzle down and hand held it and turned the water off and on several times during the process.  I recommend making sure to install a handheld shower nozzle for your after-surgery recovery.

I finally got a reply from the surgeon who said that it was impossible for him to offer any diagnosis on my non-surgical leg but that if the neuropathy continued to concern me, he recommended I contact my primary care physician.  I’d learned more online.

Day Nine

Getting in and out of bed became less work.  I noticed that I was able to slide my legs over and off the edge with no discomfort and able to lift them back onto it without having to use my right leg as a support for my left.

I told Peter that I felt up to going out for breakfast. I decided we both needed something social and positive to do together, however small. I managed to get myself into the car and we went to Elmer’s, which we often make jokes about but which I knew we could get into and out of easily.  Used my walker to negotiate through the restaurant and asked for a booth rather than a table so that I could stretch my leg out on the cushioned seat.  Made it through breakfast, then made it back in and out of the car, up the stairs, and into the house.

I continued to walk around the house mostly without my cane today.  I noticed that by evening, I felt less secure and wanted to use it.

Day Ten

Inspired perhaps by my outing yesterday, Peter asked if I wanted to go for a Saturday drive. The answer was, unfortunately, “no”.  The idea of sitting in a car for an hour or two just didn’t appeal. Not yet.

My friend, Eva, came for a visit, and, using my cane, I led her outside to the deck where we sat and visited for about 90 minutes.  Afterwards, I felt a bit tired and was glad to sit in the recliner with my leg and hip elevated.

Later, walked to and through the park using only my cane.  Also, was happy to cruise around the garden to check on my plants.  I was very happy to see the heirloom tomatoes were ripening.

 

Days Eleven and Twelve

These days kind of blended together in their sameness.  Each involved waking up, doing bed exercises, getting myself out of bed, eating breakfast, zoning out while watching Netflix, reading, doing stretches, practicing going up and down the stairs outside, sitting on the deck for a short while in the evening, and feeling very bored. Very restless.  I noticed I was feeling a bit depressed in the evenings, wondering if this whole experience was really worth it.

Some aches and pains continued, particularly the development of a new one on the right inside of my groin, opposite the surgical site. Still, I took no more oxycodone, managing my pain with just the Tylenol, twice daily and one more at bedtime.  My bowels didn’t regulate fully, but with the help of the stool softener, I didn’t experience anymore debilitating constipation.

Day Thirteen

I dumped the raised pillow wedge.  It just seemed that it was placing pressure on my spine and neck, and the neuropathy was not getting better with it. It may work better for you, particularly if you haven’t had any surgeries on your other leg.

Day Fourteen

First session of outpatient PT today.  I realized that my shorts were upstairs in my dresser drawer so while Peter was at work in the morning, I decided to do the stairs.  14 of them, counting the landing. I went slowly, following the post-surgical precautions, good leg first going up, recovering leg first going down. No problem.  Made me feel good.

Also had another carefully orchestrated shower.  Lifting my surgical leg high enough to clear the bathtub created a sort of low level, inner groin pain, because the muscle group was being tested.  But it was bearable.

It took the use of the sock aid to get my socks on and an extended length shoe horn to get my shoes on.

I had to ask Peter to adjust my surgical leg sock because it bunched up.  Unable to bend that leg or bend down at the waist is frustrating. I also noticed my toenails are getting long. Sigh.

Peter drove me to the clinic and back.  I met with my provider, Steven, who turned out to be a kind of sports medicine guru on loan to the clinic to mentor the permanent staff.  A really likable guy who laughed many times at my attitude and jokes while he was doing the assessment and writing up a “plan”.  When I told him that we were going to Maui Sept 20^thfor two weeks and I wondered if I’d be able to snorkel, he was kind of quiet for a moment.

“Nyla,” he began, “I don’t like to tell anyone anything is impossible. I say, work for it!  And you have made really excellent process up to this point.  I mean, you are ahead of the curve in your recovery. Still, even a person half your age who had this kind of full hip replacement would be hard pressed to manage snorkeling six weeks post-surgery.  You may want to temper your expectations a little.”

I was silent, a bit disappointed. Mulling things. Finally, I asked, “What about swimming? I can swim in a pool, right?”

“Well, if you are just thinking about playing in the water and not doing vigorous laps or stuff, yeah, that should be okay.  You might even feel strong enough to swim in the ocean if the waves or current aren’t too bad.  Let’s see how it goes. I want to make sure you don’t drown.” He said.

So, I found myself realizing that hiking five miles through the bamboo forest to the waterfalls around Hana probably was no longer on the agenda, either.

Also, Peter had purchased us tickets to see Lionel Ritchie at the Moda Center tonight.  I explained that there simply was no way I could navigate all of the stairs and levels of that huge auditorium.

I had suggested the day before my surgery that he might want to exchange our tickets for accessible seats but he hadn’t done so. He drove to there, went to the box office, and they said that they would accommodate us at the door by bringing in a wheelchair for me. Very fair and right of them.

I contacted my surgeon’s PA to hear thoughts on going. My friend, Lynn, had said, “Don’t be foolish. Please, Nyla, don’t put yourself through that.”

In truth, I was doubting my endurance, but I didn’t want to disappoint Peter so thought hearing from my medical team would help me decide.

I was told in no uncertain terms that it was too soon for such an outing. What if someone knocked into me?  What would happen if I had to go to the bathroom? The crowds and noise were not conducive to healing.  So, I chose to stay home while Peter went with our friend, Eva.

It was the right choice because I was in bed, asleep, by 9:00 pm, and didn’t even hear him come in.

Day Fifteen

Same old, same old. Except that Peter and I went out for dinner to a restaurant and I used only my cane. Also, I celebrated being opioid free for several days by having one gin and tonic.

Day Sixteen

Erinna collected me to take me to my follow up appointment with my surgeon, then onto my second PT appointment. She came early so we could go out for lunch first. I’d managed the shoes and socks all by myself this second time, before she arrived, because Peter was at work.

My surgeon was pleased with my recovery, removed the dressing and said that the wound was clean and healing nicely.

 

 

Told me I could take a shower now without fear but to wait another week for bathtub.  Said I could begin sleeping on my surgical side “whenever it feels comfortable to do so”. Told me to still not bend down to feed the cat. His strongest words were, “Take it slowly, Nyla.  You are an overachiever.  It takes longer to recover from a setback so better to just take it slowly.”

The appointment ended earlier than I expected, so I had Erinna take me home so I could rest alone a bit before PT.  I was feeling weary after both the restaurant and doctor.  I texted Peter and asked if he could collect me in 20 minutes, then put my legs up in the recliner and closed my eyes until he arrived. Then, it was off to second PT session.

This time, Heather, Steven’s assistant, worked with me. She had me work on a seated Stairmaster kind of thing for as long as I could, which was nine minutes. Then had me walk while she did a gait analysis.  Stopped me, said my cane was adjusted way too high, and took it down four notches. That was why my shoulder had been hurting at night.

She put me through my exercise paces and grew concerned when I was doing a side motion called, “the Snow Angel”.  Turned out that my left patella was slipping off to the side and I was hyper-extending, which was causing me pain, which was why my knee had been hurting at night in bed.

She told me to stop doing that one, replaced it with a set of bridges and belly lying quad stretches using a strap. Said I was ahead of the curve still in most areas but that from the year of overcompensating for the pain when walking prior to surgery, I was behind in the soaz and quads arena.  “And,“ I added, “I have no core strength anyway because I’ve gotten got fat.”

“Let’s shift our thinking a bit about that.” She said. “Let’s just say that you’ve lost your preferred state of being but that you are heading back toward it.”

 

Peter collected me when PT was over and we stopped for sushi on the way home.

I continued to experience fitful sleep, discomfort in bed, and following my second PT session, some additional aches in newly waking muscle groups, which I was able to manage with Tylenol.

 

Day Seventeen

Very tired all day but determined to stay awake, believing it might help me sleep better at night.

Bowels seemed to have finally returned to a nearly normal schedule so I stopped taking the stool softener.

Didn’t have the energy to do my bed exercises in the morning but did them at bed time.

Did have the energy to cook for the first time, though I chose a rather ambitious recipe to start with: lemon blueberry bread.

We had blueberries and lemons which were in danger of spoiling if they weren’t used so I thought, “Go for it”.  Forty minutes of zesting lemon rind, juicing lemons, measuring ingredients, and then folding then together, plus cleaning up after myself as I went along.  When I finally put the bread into the oven I needed to sit down and elevate my legs. Luckily, the bread had to cook for an hour so I got a decent respite.  It was delicious, which felt like the reward.

Continued to walk without the cane as much as possible.

In the late afternoon, Peter worked in the other room while I made a Caprese salad with my homegrown heirloom tomatoes, and prepared French bread with brie for a side.

I was definitely feeling like I’d had a busy day at the end of it all.

Neuropathy lessened a little bit as I became more active, but was still present.

Peter went out with his friend, Eddie, for an evening of fun, food and drinking and I stayed home (obviously) alone watching movies.  I was quite tired so went to bed before 10:00pm.  Another tossing and turning night of sleep.

I decided the discomfort in bed is the worst side effect of the surgery.

 

Day Eighteen

Peter went to work at his new office to catch up on things.  I did my PT, made my own breakfast, and later, after feeling kind of trapped and depressed, I decided to drive myself out to lunch.

My surgeon’s PA had told me that since I was no longer taking oxycodone and since the surgery was on my non-dominant driving hip, I could begin driving again, if the car was an automatic, whenever I felt ready. I decided I was ready.

My car was parked in the driveway, which is a bit of hill.  It made it difficult to get in because the door kept wanting to swing shut on me as I was navigating my legs inside. I didn’t realize until after I was seated that it would have been easier if I had simply pushed the seat all the way back first and then adjusted it once I was in.  Hint: do that.

After I was safely inside and driving, I realized that I really didn’t have a whole lot of energy, so the idea of getting in and out, walking into a restaurant, etc. just felt daunting.

I knew I could do it but I thought, “Why push myself so hard? Remember, take it slowly.”, so I ended up getting a turkey burger and milkshake using the drive thru at Burgerville.

While I’m not a big fast food fan, it was so nice to feel mobile and no longer trapped and dependent, that I was fine with my food. Besides, that milkshake was made with fresh blueberries and it tasted pretty damn good.

 

 

 

 

Drove myself home, out of the car, and back inside with minimal struggle.  The stairs were starting to feel quite navigable and I even put weight on my surgical side going up to see how it would feel. No pain, for the first time in a year.

My friends, Eva and Karl, came for a brief visit.  Peter served them some of my lemon blueberry bread, which everyone liked a lot.  That felt nice.

Day Nineteen

Did my bed PT, got myself up, enjoyed another shower. Peter and Eddie went to play golf for the day, so I was alone again.

Was definitely feeling off all day.  I had a headache, my neck hurt, my hip was achy and I had no energy.  I realized that I had probably been overly ambitious on the weekend but didn’t take a nap, determined to sleep better one way or another. Was able to manage the discomfort with the Tylenol.

Should have taken the nap because sleeping through the night was still not happening.  The pattern seemed to be waking every two hours to shift position, which required moving the pillows and adjusting the sheets to accommodate, plus one trek to the toilet around 4:00 am or so.

Day Twenty

I woke up at 6:00 am.

Getting out of bed was much easier so long as I moved slowly and didn’t twist my body at the waist while twisting my hips.  I carefully leaned down, picked up the cat’s dish, and fed him.  Gave him fresh water.  Made my coffee and settled down for awhile in the recliner to read.

Peter woke up a little after eight, made himself coffee, and went out onto the deck.  About twenty miutes later I decided that I wanted to go to the Cadillac Café for breakfast. Asked Peter if he wanted to join me.  He did.  We found a parking place right in front, which was nice, but I was feeling like I could have walked a full block easily if necessary.

After breakfast, Peter dropped me off and went to work.  About five minutes after I sat down in the recliner I realized that I was actually feeling rather tired.  I got up and went to bed, without thinking about it.

I fell asleep and slept for two and half hours, waking one hour before my PT appointment.  I recognized that I could have slept longer even as I was getting out of bed to shower and get dressed.

I decided to use a new knee brace I’d gotten after Heather had told me last week about my patellar subluxation.

I was able to slip it on using the grabber and tighten the straps after pulling it up. I used the sock aid and shoe horn and got my shoes on.

Drove myself to PT, where Steven added two more exercises to my routine, analyzed my sitting and standing postures, and then added a third. “Lift off your heels, not the ball of your foot,” he said, “it will engage your quads and make it easier.” I immediately felt the difference. After the first set of 10 I was able to stand without holding onto anything.  I did another set of 10 and finished with 8 minutes on the seated Stairmaster thing.

Steven had me describe my week and after congratulating me for all the growth and hard work said, “Nyla, sleeping is as much a part of recovery after surgery as physical therapy and regaining your independence.  Sleep is your body’s friend. Take those naps. You’ve still got quite long way to go.”

Stopped for sushi on the way home because I hadn’t eaten since breakfast and it was 4:30.

I was more tired than I realized for my full glass of water literally slipped out of my hand when I was lifting it to my mouth for a drink. The friendly woman who works there was very kind but I was deeply embarrassed about the mess I’d made.

I left immediately after that and drove myself carefully home, where I relaxed into the recliner.  I called Peter at work to check on him and he shared that he’d lost a lot of time by driving Eddie to SW Portland and having lunch with him so would be working late again that evening.

Laptop time, movie watching, and working on this article, then to bed.

 

Day 21

Three weeks!  I made it– so can you.

The good news is that in three more weeks, if I keep up with my PT (and I will. Highly recommend you do, too) I will be able to swim again;  even in the ocean if there are no big waves or tidal pull.

They say three to six months for resuming “normal” activity levels.  It’s feels like a slog sometimes, but hey, being free of  debilitating bone on bone pain is a blessing and an encouragement.

If you are experiencing osteoarthritis, degenerative joints, and pain, you have the opportunity to learn from my foolishness.  Do what needs to be done sooner. Don’t suffer needlessly for months and months and months.

As this three week timeline hopefully demonstrates for you, there is truly hope on the other side of full hip replacement.  And the posterior, “minimally invasive” approach is definitely worth pursuing.

Happy new hip from your once old school, now modern world, “hippy!”

 

 

 

 

 

 

 

 

 

 

 

I am shepherdessing 

baa baaa baa

My La la la

ladylove

through the valley of death

To her home.

Her manifestation:

 

J

So, let’s say that you are a person with good intentions, trying to live a socially responsible life.  You recycle more faithfully than ever before, you take your own bags to the grocery store, you trade your old gas guzzling vehicle in for an energy efficient car (or even better, you walk or ride your bicycle or take public transportation everywhere),

you replace all your light bulbs with LED high efficiency ones, and you decide to do the right thing, which is to buy those carbon offsets so you can continue to fly without guilt

.up up and away

Okay. Good on ya!

Now, let’s say that you take your commitment to live your socially responsible life to the next level: your diet.

You give up on single use plastic packaging, you buy only organic, locally sourced food,

you stock up on bulk goods (which you wisely choose to store in glass, NOT plastic), you sign up for one of those food share delivery programs, choking back your shock at the costs as you do but hey, local farmers!

You find yourself looking with envy at your neighbor’s chicken tractors

and even begin to consider the feasibility of getting your own chickens. That would be cool.

Or, maybe you are even thinking about going the whole way. You are going to give up meat altogether and become vegetarian or vegan.

That’s one option (but please, don’t become a self righteous boor about it).

Still, you still need that cup of coffee, or tea, in the morning. And you happen to like it with milk.

 

If you’re like most people who make the decision to live responsibly, you have already figured out just how devastating cattle and their waste are to our planet. Livestock create 18% of the world’s green house gas emissions and cattle are the source of nearly 80% of that total. You don’t want your cup of coffee, or tea, or hot chocolate to continue to play a part in that ongoing pollution.

Chances are that you will simply pick up a container of almond milk next time you are at the store and call it good. Or, maybe you’ll go with coconut or soy or cashew. Or even oat, flax, rice, hemp, macadamia, etc.

The list of plant based milks goes on and on.

Here’s the thing: just substituting non-cow’s milk for one of the above doesn’t automatically make it a more socially conscious, or even healthy, choice.

Take almond milk, the most common substitution with the most marketing dollars behind it: while one cup of almond milk may only contain 30-35 calories (the unsweetened kind) and have half the fat of cow’s milk, it takes 1.1 gallons of water to grow a single almond in California’s desert climate (where 80% of the world’s almonds are grown) irrigating almonds

and a full two cups of almonds for one half gallon of the liquid, which means an additional 48 ounces of pure water will be used. That doesn’t even take into consideration the processing, packaging and distribution impacts of that package you just picked up. Given California’s severe drought status, purchasing almond milk from a market comes close to being an environmental crime.

Yes, you could make your almond milk at home if you have a blender, cheesecloth, and the time, but the environmental impact of using all of that water

is not going to go away.

Cashew milk, meanwhile, appears at most progressive grocers, fighting for shelf space with that almond milk, so it must be okay, right?

Well, it has one third the calories of cow’s milk, logging in at only 25-50 per cup, it has half the fat of cow’s milk, which is great, but it has negligible protein, meaning you are going to need to supplement with a higher protein source if you struggle to meet your daily protein levels.cashews

Like almond milk, cashew milk can be made at home if you want to avoid the packaging and transport dilemma. But sadly, cashews use almost as much water per nut to grow as almonds, and then you’ve got that processing problem.

Okay, Coconut milk. Surely it is a more sustainable and nutritious choice?

Well, it’s not an easy answer. Coconut milk is creamy, which is why some folks like it so much. It only has about 45 calories per cup and 90% of those calories come from saturated fat, which should be a good thing—it’s just that recent studies show that coconut oil raises bad LDL cholesterol levels and has no protein.

Furthermore, our increasing love affair with coconuts is leading to destruction of traditional farming methods in the tropical countries where they are native

as well as an alarming increase in monoculture farming (bigger $$), both of which are bad for the environment.

According to the World Watch Institute, food transportation is quickly becoming one of the world’s fastest growing sources of greenhouse gas emissions. Sadly, getting that delicious, creamy coconut milk to you means long journeys across the planet, leaving clean air left fouled by every load.

Okay. Then going back to locally produced soymilk is probably the thing to do. Yes?

soybeans on the vine

In terms of nutrition, soymilk is a close nondairy substitute for cow’s milk. It contains a similar amount of protein, but around half the number of calories, fats and carbohydrates. It is also one of the few plant-based sources of high-quality “complete” protein, which provides all the essential amino acids. These are the amino acids that cannot be produced by the body and must be obtained from the diet. But it contains no natural calcium at all.

Plus, wait an important minute!

Soy contains a frighteningly large number of isoflavones.

Isoflavones impact the estrogen receptors in our bodies, affecting our hormone levels, thereby increasing our estrogen levels. And study after study has linked high estrogen levels to increased breast cancer. Too much soy is a bad thing for babies and other humans.

Additional issues to consider with soymilk includes the fact that the vast amount of soybeans grown today have been genetically modified, it takes huge amounts of electricity to process those soybeans and turn them into a liquid “milk”, and in South America, farmers responding to the rapidly increasing demand for soy,

have taken to cutting down or burning immense tracts of the rainforest to turn it into a soy producing monoculture. Damn.

Moving on.

Rice milk has the highest levels of carbohydrate of all the alternative milks (but it also tastes watery). It has a high glycemic index, thereby raising blood sugar levels, which is not great for people with diabetes, the elderly and those with compromised immune systems, and rice milk has been shown to have worrying levels of inorganic arsenic, linked to cancers and heart disease.

We won’t even bother with discussing the production, packaging and distribution issues, which are comparable to those of coconut, soy, cashew and almond milk.

Macadamia milk has shown some promise in terms of sustainability.

A company called Milkadamia is especially focused on the sustainability of its product. The nuts are sourced from Jindilli Farms in Australia, which, according to the company, boasts “abundant rainfall, ample sunshine, rich soil, and low-impact farming.” Milkadamia claims its focus is regenerative farming, which aims to rebuild soil health. Its macadamia nuts grow on so-called free-range trees that do not require irrigation.

Macadamia milk is creamy and apparently only has a subtle taste of the macadamia nut itself, which you will either like or you wont. Still, transporting this nut milk all the way from Australia to your neighborhood means those nasty greenhouse emissions have to be taken into consideration..

Hemp milk comes on strong for those who care most about footprint of their edibles (pun may be intended) and least about flavor. The good news is that hemp grows quickly,

does not use a lot of water, suppresses weeds naturally, and resists disease. The not so good news is that most people who have tried it complain about its weedy flavor and the fact that it curdles when poured into hot drinks.

Oat milk also comes on strong.

It’s been my personal favorite for awhile and it’s both easy and inexpensive to make at home.

If that’s not your style, a Swedish company, Oatly, seems to have cornered the market on the really good ready made stuff, even perfecting a recipe which leaves their “barista brand” so that it foams like dairy.

Oatmilk is creamy and works really well in things like Golden Milk Tea and lattes, though your typical coffee drinker may find the fact that the homemade, and most sustainable version of the beverage, doesn’t turn their coffee that creamy shade of tan.

Oat milk has about the same amount of calories as cow’s milk (140-160) and has up to 5 grams of protein per cup. Due to its high fiber content, it helps lower LDL cholesterol (the bad kind) and can contribute to lowered blood sugar levels. These are good things!

Oats only use 1/6 the amount of water that it takes to grow almonds and the other nut milks, they are a nitrogen “catch” crop, which means farmers often plant them as a cover after their legume harvests are in to protect the soil.

When comparing all of the plant based “milks”,

most environmental experts agree that oat milk is the most sustainable and socially responsible choice, particularly when you make your own.

So, there you have the good news:

if you want to have your latte, your milky tea, your coffee con leche, your hot, frothy cup of cocoa on a cold day AND stay consistent with all of the other choices you are making to live a conscious, socially responsible life, oat milk is  your number one choice.

You’re welcome.

When I was a young single mother, I read every night at bedtime to my two children, David and Erinna.  This was always a precious and special time for me: just the three of us, away from the chaos and noise of the day, saying “goodbye” to what had been done, letting go of what might still need doing. Simply sharing a story, coming together, soothing ourselves through the magic of the words. 

Edmond Lear’s, The Quangle Wangle’s Hat, is one of those  soothing and happy stories.  We loved the musicality of it, the resolution found within the heroes journey, the fun of the colorful and exotic characters.

I don’t have a recording studio so I am here, just reading the story aloud, as I would have done for David and Erinna, all those many years ago. It may be unpolished, but it’s real and from my heart.  

I hope I manage to create just a bit of soothing escape from the noise and the chaos of the day for you.  

click audio, adjust sound, scroll down with the words

I am grateful for the beautiful artworks and photos used in this telling.

Acknowledgements to Helen Oxenbury, Shelly Perkins, Roxy Cheltenham,  the 4th Grade students of Hawkhurst School, Huichol Elders Unnamed, E J Babcock, and John Vernon Lloyd.

I love Madrid.

It is a vibrant, colorful, melting pot of a city filled with friendly, warm, talkative people; people who seem to balance being busy with the pleasures of life.

They seem to do this much better than most Americans I know.

Café society is a way of life,
though it is not limited
to the usual “fashionable” crowds.

Instead, I observed people from seemingly every walk of life, age bracket, class and/or ethnicity mingling together.

I even recognized a conscious effort to bring accessibility to fruition.
-smooth escalators at Atocha Station-

lifts like the one in our apartment building. Most old buildings have already been, or are being, retrofitted

sign in Plaza del Sol

In a city this old, such an effort is noteworthy.

Night times are active, happy times, filled with the sounds of conversation and laughter spilling into the streets.

Neighborhoods boast a wealth of tabernas and restaurants, each overflowing with customers.

Tapas, vermouth, excellent Spanish wines, and even micro-brews, are served until the wee hours of the morning.

Still, the mornings are peaceful and quiet. I could hear birds singing long before I could hear the sounds of traffic picking up.

In Madrid, centuries old architecture is loved and preserved,

synagogue

not torn down like in my own city of Portland these days.

Given limited geographical space to work within, developers in Madrid have instead focused on preservation and creative re-utilization.Galeria de Intermediea Matadero

Art and culture flourish. Theatres are discovered in twisting, narrow lanes

producing innovative, Avant Garde works while the bigger houses deliver popular and modern pieces or dedicate themselves to the classics.

Galleries and workspaces spring up and then stay. Artisans practice crafts that go back hundreds of years. The Opera is magnificent, Flamenco is alive, and music clubs seduce as they always have. Museums…..well, as is known, Madrid’s museums are some of the best in the world.
Museo del Prado, one of my favorites

Franco’s reign of terror, ugliness and evil has left its scars, but those scars become harder and harder to see, thank the Goddess and the people of Madrid.

-a kinder police presence-

Streets once named after “the Generals” are being reborn daily as part of “movida madrileno”, the people’s cultural reclamation, which continues moving proudly forward.

And unlike America, Madrilenos have chosen a left wing coalition to govern them. One that values public dignity by promoting a basic income for everyone and isn’t afraid of levying stiff fines against corporations and business that do not pay their fair share of taxes.

Madrid has committed to healing the environment. Public transportation is excellent, quiet, and not fossil fuel based.

Alternative fuel development is highly supported, including utilization of both wind and solar. And the streets are clean.

Let me repeat that:
the streets are clean.

Unlike poor, beautiful, mishandled Paris, in Madrid the garbage is collected and recycled nightly. The air does not smell like open sewer. You do not have to worry about dodging piles of smeared dog shit wherever you go. And I did not once see a man use a building or wall as a pissoir. The level of pride in the environment, both built and natural, is impressive.

On the other hand, like Parisians (or Portlanders), Madrilenos do love their dogs.

I saw dog after dog in every neighborhood I walked through–and I walked through a lot of them–
trotting or ambling along on their leash, being guided by, or guiding, the people who accompany them.

Many of these dogs, interestingly enough, seem to be simply well loved mutts rather than interbred designer dogs like the ones I see all over Portland.

It seems that the socialist spirit extends to the canine universe as well. Podemos? Woof woof.

Oh, important side note: though I saw hundreds of dogs in the course of three days, I did not see a single pile of excrement on the street. Not one. People clean up after those dogs. As they should do, everywhere.

We sheltered for our far too limited time in Madrid in a lovely little flat in the neighborhood of Anton Martin,
named after the man who founded several early hospitals to serve the poor.

Across the street from our building, you will find the amazing three story
Anton Marin Mercado, where one can buy serious gourmet quality food along with their bread and veggies.

The venerable Cine’ Dore’,
an Art Nouveau masterpiece,
was also across the street from our digs. The Dore’ houses the Spanish National film archive, is a lively neighborhood meeting place, and in a bit of serendipity, was hosting a Gus Van Sant retrospective
in honor of Pride month, while we were there. The opening film was my very own Mala Noche, which played the week before we arrived. Kismet.

Yes, I love Madrid. I would gladly have stayed weeks, even months, longer. Madrid is a city that speaks to my soul.

However, the Grand Masters World Cup of Hockey in Barcelona, where Peter is coaching and leading Team USA, is the reason for this particular trip to Spain, so onward we pressed, at 118 miles per hour, thanks to RENFE high speed train.

(Inside the beautiful Atocha Station, waiting to board)

But Madrid, you beautiful city, I intend to return.

Anthony Bourdain, a successful, wealthy, highly respected, celebrity, committed suicide.

Kate Spade, a successful, wealthy, highly successful celebrity of a kind, committed suicide.

Both of those deaths are sad.

As a result, social media goes bonkers with people’s comments and platitudes.

You know what is even sadder?
The frighteningly high number of GLBTQI youth committing suicide every day in relative obscurity.

Also, unbearably sad?
That young men of color are still being shot down daily by our racist police forces.

And unfathomably sad? That we have an administration which has gutted mental health and crisis services for those who, unlike wealthy celebrities, do not even have access to quality treatment, despite the U.S.Centers for Disease Control report just released

which shows that suicide has increased in all but one state since 1999 and that more than half of the people who have done so had no known mental health diagnosis.

Finally, you know what is absolutely tragic? That things are so desperately wrong in our world that people believe that killing themselves may be their only choice.

If only folks would take the same amount of time they spend writing publicly about and/or lamenting over the unfortunate deaths of those with privilege and/or fame and use it to write Congress demanding corrections to the ongoing erosion of our healthcare and mental health and law enforcement systems.
https://www.ucsusa.org/action/phone-calls.html#.Wxrr2S_MzBJ

Or, mightn’t you become actively engaged in working against the rising tide of oppression and economic inequality we are seeing every feckin’ day?

Just a thought, my friends. Offered, with love, from a formerly suicidal person who knows the dark places.