Unveiling

When I got out of the hospital, the lateral portion of my leg had about 100 one-half inch steri-strips holding my incision together. Up to this point, I had totally forgotten about the fact that the surgeon was going to have to cut me open at the hip to get in and fix my hip joint. I was worried about so many other things that had nothing to do with the actual appearance of my leg. When I saw my incision in the hospital for the first time, swollen and bruised, with a hemovac drain and what appeared to be hundreds of steri-strips and no staples or stitches, I was duly impressed by the verisimilitude of it all. 20 years ago, when I shattered my femur, the distal bone shot out the back of my leg putting a significant hole just below my right buttock. The orthopedic surgeon neatly sutured me back up with a "smile-shaped" sew job about 4 inches south of the lower layers of my ski-racing onion booty acquired by years of back squats and lunges and too many girl scout cookies. Of course, you don't fix a shattered femur with super glue and arthroscope. Nooooo.....you make an 11-inch incision that will accommodate a 7-inch plate, 13 screws and the power drill that drives those screws into what is left of the pieces. And, you don't get started until you paralyze the thigh muscles to relax, lengthen the muscles, and reposition the bottom half of the leg back in to position, a process that took approximately 3 hours. That 11-inch incision was closed with 25 staples and yielded a scar to be proud of. It was similar to a mini, railroad track and made for great conversation at pool parties. People would take note of the big scar and exclaim something along the lines of, "Wow! That's some scar! What happened?"

Whereupon, I would say something flip such as, "broke my femur......," while turning around, "....and that's where it popped out the back of my leg!" It was good for a wince or a grimace and depending on how many mint juleps I had on board, I would make up some witty response to the "how" question.

"My chute didn't open...."

"Shark."

as if the real story wasn't good enough....

"Hit a finish post at 60mph....on skis.....in a World Cup race.....in Switzerland."

"No really....what happened?"

When they removed the bandages after my hip replacement, I still couldn't see the extent of the scar because of all the steri-strips. When it dawned on me that it was possible to have yet a third scar on the same leg, my spirits dipped. Scars are tattoos with better stories. I would much rather have a really good story to go with my lateral dysmorphia, and something other than, I got drunk at prom and woke up with a disfigurement that is there to sag and fade along with my youthful pulchritude. If I am going to have a mark that will require the first layer of skin of my buttocks to reverse, than I hope that mark is accompanied by a prodigious story of "no shit, there I was....." and epic circumstances. Whatever the mark(s), one very long, very obvious scar is difficult to pull off for a short girl with stout legs and a small breast size, and a second scar in an unappealing place begins to call one's femininity into question. This notwithstanding, if it has a great story, even a small-breasted girl of average beauty and intelligence can pull this off as a the mark of a badass rather than the victim of an unfair circumstance or the mark of an idiot. Needless to say, I leave the part about being on the 1988 Olympic team and my accident happening six weeks before the Olympic games out of my story. It's a bit of a momentum killer. So when I contemplated yet a third scar on a leg with very little un-maimed real estate left, I was thinking my right leg would probably need to be shrouded in lycra for the remainder of my life. Flo-Jo's asymmetrical sports fashions came to mind. However, the physician's assistant told me something that made my day.

"Dr. Schmalzried was able to utilize your old scar for your incision."

"Um, yeah, but, my hip is up here," I said as I gestured to my obvious anatomy.

She replied, "Yes, well, now that scar is just a little longer."

A little? That's the understatement of the week! It wraps around my left cheek in the shape of a hockey stick. What was once 11 inches is now a healthy and astounding 17 inches! Yes, that's right. I am zippered from my knee to my rear. It is huge.

The other interesting thing is that the surgeon didn't use stitches for the last layer of closure. I am marginally astounded that on a portion of anatomy that has the most potential to 'spread,' especially on a short, stocky person of my stature, the physician simply "taped" my leg back together. I worried this was not going to be effective.( If you know me by now, you know me to be of little faith. ) This made for difficult wound maintenance.

I was informed by my medical team on how to care for my incision. 48 hours after surgery, they say you can shower. They recommend not submerging the incision in water for the first few weeks until the steri-strips have fallen off and the wound has healed properly. The reason for this is to prevent infection. Infection can have nasty results on a healing scar and a new hip implant. I was not about to test this advice. Rather than take any chances, I wrapped my leg and my butt in plastic wrap prior to showering. You can probably imagine how sexy dimpled skin on an atrophied leg looks when wrapped in plastic....NOT sexy by any means. I then, used white, athletic tape to seal the edges and keep it on my leg for the duration of my showering experience, which, by the way, was just short of heaven (the warm water, the clean feeling, the gentle massage of the water on my bed-ridden skin.....it was glorious). It almost made me forget about how much muscle mass I had lost. Afterward, I would remove the plastic wrap and clean around the edges with hydrogen peroxide or alcohol on a Q-tip. This process was cumbersome and time-consuming, so taking a daily shower was a bit of an ordeal. While I wanted to shower every day, it seemed that my bandages and my psyche benefitted from a bit of a break in between. Plus, I was slow with the undressing, getting in and out of the showertub, drying off, and being extra careful not to slip on our tile floor. I alotted half my day for this in the beginning. Luckily, I had no other plans most of the time.

At the two week mark, the steri-strips started to fall off. Being a nurse and a former river guide, I have learned a trick or two when it comes to bandaging in wet environments. There's this stuff called Tincture of Benzoin. It smells nasty and when applied to the skin, creates an incredibly adhesive surface that almost anything will stick to. About the time my steri-strips started peeling off, I applied a layer of this on my skin along the edges of my incision and re-applied another whole box of 1/2" and 1/4- inch steri strips, literally wallpapering the side of my leg. I was still bruised and there was still some dried blood so I never got a really good look at the new scar in its entirety. All I knew is it was bigger. I couldn't help but wonder how "old" skin was going to heal compared to the healing of the rest of the scar that occurred 24 years ago.

I remained steadfast in my scar maintenance. I kept it dry and clean for 4 weeks which is the recommended time it takes for a deep thickness scar to fully heal. At the five week mark, the last of the steri-strips had fallen off and my new scar was unveiled. It's quite big. My new scar is worthy of the mileage that my right leg has traveled. It is a testament to medical technology and the good people who have gone through years of medical school, residency and fellowship to put humpty dumptys, such as myself, back together again.

Summer parties should be fun this year. Strangely, my new, long scar, makes the scar on the back of my leg seem smaller and of less importance, which is weird for me because that scar has a better story. Dwarfed by the new scar, the small scar made by my bone tearing a hole in my flesh 20 years ago now seems impotent. Clearly, I will need to practice my new punch lines.

"I'm a government experiment gone horribly bad...."

"I fell for one of the 3 classic blunders....." (for "Princess Bride" fans)

"My leg was torn off by: (Shamu, the Yeti, on a recent NASA shuttle re-entry....)"

"No really, I hit a post at 60 mph on skis....."

The last one is still the most plausible, but a little embellishment in the telling of a good story never hurt anyone......

Violated

This week, I crossed the four week mark. My range of motion is excellent and I’m getting around pretty easily. Driving has opened up my world, although, getting in and out of the car still tends to be a bit of an issue. I feel like a Yogi trying to squeeze myself into a small box. My movements are slow and calculated and I am careful not to bump the steering wheel or emergency brake because my incision is still fairly tender. However, once I’m in, I’m on the road, and it’s quite liberating. I have been fairly excited about my progress and I am now back on the path of my life, running kids to school, doing the grocery shopping, managing a little house cleaning and even making my bed, which I don’t regularly do. However, since I’ve been spending so much time in it, I figured it looked better made because that meant that I wasn’t actually in it and had no plans to return to it until my regular bedtime. My attire has also changed. I am actually wearing pants on a daily basis instead of scrubs, pajamas or sweats. Because of the soreness of the skin near my incision, it was more comfortable to keep things loose. However, it exemplified the reality that I had no intention of actually getting out of my car when I drove the kids to school and had an empty reality that I was truly independent. Wearing pajamas and sweats also reduced the number of times I had to struggle with putting pants and socks on which up to this point, has been quite a challenge. Unable to bend my hip past 120 degrees, I was unable to reach my foot and therefore had very creative ways of hooking a pant leg or wiggling my sock on with my toes. It wasn’t that I couldn’t do it…..it was that I couldn’t do it “gracefully” and each morning was a lesson in creative biomechanics. Currently, my hip doesn’t like to flex but it’s getting closer and the wiggling and squirming isn’t quite so prevalent. God forbid my husband should walk in and find me contorting myself into strange body formations just to get my socks on. The litany of remarks regarding sexual positioning would abound….”Hold that pose!” is one that comes to mind. I am glad it is getting easier and it opens up my wardrobe possibilities nicely.

The other great milestone in this process is I had my last Lovenox injection last night. No more evening stick. I noticed I was starting to assimilate this experience into my routine by feeling anxious right around the 8:00 hour. When my 8 year-old daughter was trying to be helpful by reminding me to “take my shot”, I got more irritated than I was grateful for her helpful reminder (as evidenced by my low volume growl). It wasn’t the needle that bothered me as much as the fact that I don’t have enough fat on my abdomen. I know, it’s a terrible problem…..(sigh). It hurt because I kept injecting into muscle tissue. I am so glad to have that over with. Now, I take Aspirin twice a day. It’s a little easier.

I am down to one crutch and feeling like the world is opening up. My stamina is still not quite up to par though, and I tire easily. A three-hour session at the soccer field (two practices, one for each daughter) pretty much lays me out. My muscles get sore and my body does a nosedive. I spend more time in my carefully made bed the day after one of those. Despite this, the fact that I can do it is a small victory and those are to be celebrated as I have mentioned.

Dr. Schmalzried’s office called to schedule my follow up at the six-week mark. In two weeks, I will fly down and hopefully get the “all-clear” sign and start my new physical therapy program, a program that includes something other than stretching and watching movies. I can't help but wonder what the security screening will be like. First, I am still using a crutch. Do they take your crutch away? Second, I have an entire leg full of metal, so will they make me drop my pants? I'm thinking T-string underwear will not be a good choice of undergarments for flying. Maybe Marek has some boxer shorts I can borrow....

My reason for contemplating this goes back to an experience I had after flying home from Utah the week before Christmas this year. I came upon the security screening with plenty of time prior to my flight and was not anticipating any problems. I always get a little anxious that maybe I forgot to pull out my 4oz bottle of hand lotion, and an overzealous TSA agent might to tackle me and send me up the river for such a serious infraction. Upon arriving at the security screening zone, I had gotten all of my little gray bins, as usual and filled them with my many questionable items like my belt, my shoes, my jacket, my laptop (in a separate bin of course), and my purse. I was also carrying my ski boots because having been a World Cup Ski Racer, this is an old habit to break. I have always carried my boots on planes due to the fact that they are highly personal items that are specially fit to my foot and to lose them to the black hole of lost baggage was simply too exasperating to allow. Hours of molding footbeds, grinding plastic, adjusting buckles and redistributing liner foam would be lost because instead of my boots going on the plane, they would end up in some tropical climate while people tried to figure out what they were for. No, I never take that risk of losing my skiing slippers and this particular trip was no exception. Off they went on the conveyor belt in bin number 5.

On this particular trip, I noticed they had just installed the new body scanners. These scanners were causing a huge ruckus because no one wanted to be viewed in their underwear by TSA agents who had little or no higher education and might be seen giggling like elementary school children at somebody's "non-traditional" brand of skivvies. I didn't care one bit if it got people through security faster without compromising safety and if my Victoria's Secret cheetah undies elicited a giggle, so be it. So, when I was summoned to stand in the scanner, it seemed like no big deal. However, after exiting the scanner, you walk out into a glass enclosure that has a door. It's kind of like a man-trap, and looks like something out of Willy Wonka's Chocolate Factory, without the buttons. The TSA agent closes the door and announces on his walkie-talkie that he needs a "female" body check. Now, if I just went through a scanner that can see through everything, why do I need a body check? I am not carrying anything internally except a 4 year-old IUD which, last I checked, was still considered legal. However, I WAS in Utah and birth control is a hot topic in this particular "culture." I use this term loosely. I can see it now. "Woman arrested for smuggling an intrauterine device." Hmmm, note to self. Put phone number of the ACLU in my contacts list.

TSA guy asked me to identify my items from the conveyor belt. I pointed to all 5 and had a chuckle that a small army was going to be required to follow me as I was not allowed to touch my items or so I was instructed. I waited in the glass enclosure for awhile. I thought, good thing I am not in a hurry. Meanwhile, I saw a female agent with red, curly hair standing and talking to another agent right next to her. She was medium frame, slightly busty, wore her pants a little tight, and her makeup a little heavy. She made no gesture that she was coming over and appeared to be simply having a regular conversation (if not flirting) with her male TSA colleague, while making me wait in Homeland Security's version of a fish bowl. I assumed that perhaps she was not trained in the art of "patting down" and they were waiting for the real agent to arrive. Nope. After about 5 agonizing minutes of wondering what the hell they were doing, she finally walked over and told me she would be taking me to a room with my belongings. Now, I was starting to get a little nervous. This was a scene right out of the Midnight Express and red-headed Barbie was going to make an example out of me. They took me to a closet sized room with one of those bomb residue detectors that was barely big enough for the 3 of us (including the homely female agent assigned to carrying my belongings....with difficulty I might add). Barbie announced that she was going to pat me down with her hands, that I was to hold my hands straight out, and "part" my legs. I thought I was now the victim of some soft porn internet scam. The red-headed agent patted me down. As she patted down my stomach, she commented, "Ooooh, I wish I had a six-pack!" Really? I had just been objectified by a TSA agent. Wow. I was appalled. I wonder what she would have said if I had a "spare tire" or breast implants. "I see someone's been enjoying the holidays...." or "I wish I had a D-cup!" Seriously? Small talk during a body search. This was new and I found it totally inappropriate. Meanwhile, homely girl was now handing me my belongings quickly....I figured she was probably the senior agent assigned to monitoring Barbie and realized that Barbie was screwing this up every way possible. Barbie put the pat down glove in the bomb residue detector and thankfully, I was found to be clear of anything suspicious. Then, little Miss Bouncy-pants smiled and said, "See? That wasn't so bad was it?" There is nothing like being patronized by a child's toy. Is this the woman keeping me and my country safe from terrorism? I can just see her making disparaging remarks to the person who comes up positive on the bomb residue detector....."Uh-oh, somebody's been a very bad boy/girl....!" I swear this was right out of an Adam Sandler movie. If this is the best TSA has to offer, then we are in serious trouble. As I put on my shoes, my belt, and my jacket, I felt grossly violated. I got out of that room as quickly as possible and headed straight for the airport bar. I wondered about taking action. Who do you complain to? And if you complain, are you considered suspicious? Are American citizens truly free to speak out against an inappropriate TSA agent? My hops and barley were just the antidote to my patriotic temper tantrum. I decided that if the opportunity presented itself, I would say something, but so far it hasn't.

Now that I have a leg full of metal.....I wonder what my trip to LA will bring. I better bring Ken along, just in case.

Driving

Initially, before having surgery, the medical team warns that it may be up to twelve weeks before you can drive. That's a long time to lose one's independence, especially if you live rurally, with no public transportation and have two kids involved in everything under the sun from elementary school to soccer practices to field trips and birthday parties. Then, there are the occasional errands that must be run to manage a household like filling the car with gasoline, taking the garbage to the end of the driveway, grocery shopping, bank visits and trips to the library to feed the insatiable reading habits of two kids without television.

Up to now, my husband has been handling all of this, plus his job, the cooking, the cleaning, the checking of homework and the monumental task of keeping the Science Fair projects on track. While I am grateful and he has done a fantastic job, I feel my life slipping away, the clutter creeping in, budgets swirling the drain, and dogs and cats suffering a sporadic feeding cycle. My husband is very good at crisis management, but no one can do the job of two people well for an extended period of time, not even me. I know this because every 3 months, I crack, and need some sort of girl's night out or physical activity that recharges my perspective. Eventually, something will have to give and I feel the seams of our life bulging as my husband's work projects are piling up. He is starting to drop behind and the stress is starting to show. He will have to return to being 100% focused on his job to keep his positive momentum going. With me out of work, we really can't afford a loss in his momentum as breadwinner of the family. However, the dropping off and picking up of our children from school is throwing two very big distractions into his day. There is the 8am curveball where he has to juggle a conference call while making two girls' lunches, two girls' ready and out the door, and driving 40 minutes to school and back. He has to cram most of his workday in between the hours of 9am and 3:00pm and then run to pick up kids and relay them to soccer practices, the library and the grocery store. His boss is very understanding, but in a down economy, record unemployment, and poor sales numbers, the landscape is ripe for my husband to be superseded by someone younger and willing to do the same job for less money. Therefore, my aspirant spouse is not overestimating the kindness of his employer nor conceding a reduction in his productivity.

The love of my life has announced that he must return to his rigorous travel schedule, which consists of him leaving on a Monday evening or Tuesday morning and not returning until late Thursday night. It starts tomorrow. I don't think I am ready. One issue with driving is positioning myself in the car. I can barely sit in a chair let alone having to navigate around a steering wheel. As it is with everything, I have to take extra time: extra time to move the seat around, and extra time to get comfortable. With pain, everything requires careful and meticulous movement, calculated ahead of time and one's abilities not overestimated. And in the event I overdo it while out in the world, I have to rest. Another important obstacle on the road to freedom is I am still taking narcotic pain medications. These medications take 6-8 hours to be fully metabolized. Driving on narcotics is a serious malfeasance especially for a registered nurse. I cannot, with any good conscience, allow myself to get behind the wheel of a vehicle knowing fully well that the effects of narcotics would not only endanger the lives of my children but my new hip implant as well. To assure that I drive safely, I have to stop taking them. This worries me because predictably, around 3 or 4 in the afternoon, which is the time I have to pick the kids up from school, my hip begins to ache and generally, continues until bedtime. I can't take anti-inflammatories because I am being anticoagulated with daily Lovenox injections and while Tylenol is an option, it is ineffective. I am irritated to have to bite the bullet two and a half weeks after hip replacement surgery. I feel like it is all moving too fast.

Necessity is the mother of invention though and sometimes, you just have to jump in with both feet. Today is Valentine's day and tomorrow, my husband leaves for Missouri and Oklahoma for the week. He has not arranged for transport of the kids ahead of time. As usual, my husband places unrealistic expectations on my abilities and the reason for this is because I traditionally meet them. I am really my own worst enemy. I own his lack of preparedness because it is my own fault for not recognizing and verbalizing my limits. I should just say no, and that I can't do it, but I have a hard time with making that admission. This little factoid about myself frequently gets me into trouble.

Pending tomorrow's change in care plan, I did not take my morning narcotic and by afternoon, I decided to take my first test-drive. My kids were adorably concerned.

"Shouldn't you take Papa with you?"

"That would leave you here by yourselves," and in the event I botch this driving thing, badly, it would also leave them to be orphans.

"We could all go with you."

(Another brilliant form of natural selection)

"That's not a risk I'm willing to take just yet."

I promised to drive just to the end of the driveway which is about 1000 feet. If I wasn't back by dinnertime, I agreed that they could send a search party.

My car is a 5-speed, stick shift. The clutch didn't worry me but the rapid change from brake to gas pedal was my biggest hurdle. What if a child ran out in front of me? What if a car I was following were to brake suddenly? Did I have the reflexes to respond? I was apprehensive after it took me five minutes just to get in the driver's seat. I played with the position of the seat until I found the least uncomfortable orientation. Once in position, and after a few gas-to-brake pedal practice runs, I started her up, backed out, and headed down the road.

It was incredibly liberating to be master of my own destiny once again. The driving, the shifting, the braking, none of it was problematic. I even fudged my distance and drove to the end of the street. I was free. I couldn't wait to take the kids to school the next day. Just to be sure I was safe, I practiced a few rapid brake tests. While my reaction time would not win any Olympic medals, it was still fairly good. It was at least as good as that of the little old man down the street who frequently tortured me with his driving when I got stuck behind him while in a hurry. I would just have to adjust to this change in reaction time by giving myself plenty of time to arrive at my destination. This meant breakfast would be earlier at the Diva house.

Upon my return from my test drive, I was met by my family who appeared relieved that I hadn't driven off of a cliff. My hip seemed fine as I extricated myself from my driver's seat and crutched into the house. I was emancipated from house-ridden, patient status. I was now ready to rejoin the ranks of society. Perhaps a little retail therapy was in order, in celebration of this post-surgical milestone. Since we wouldn't be hiring someone to drive the kids as originally anticipated, this would free up some available funding. Well, not really, but retail therapy sounded like fun anyway, and I was in need of recharging my own perspective.

Lovin' Ox

One of the many joys of having a hip replacement is the outside possibility that you will develop a blood clot which, depending on where it develops, can break off, travel to your lungs or heart and kill you. It is called a VTE or venous thromboembolism and usually develops in the lower leg due to "stasis" which is an extended period of decreased activity resulting in reduced blood flow. Types of conditions that contribute to this event are being bed-ridden following a traumatic event like surgery or sitting for long periods of time on planes or in automobiles without moving the lower extremities. There is a phenomenon known as "Virchow's Triad" which is the perfect storm for a VTE. Virchow's triad is characterized by venous stasis (caused by reduced activity and blood flow), vessel wall injury, and a hypercoagulable state, meaning an increased reason to clot. Generally, when the body senses that it is bleeding, it initiates a clotting cascade as a protective mechanism. When one has a vessel wall injury either due to trauma or surgery, this cascade is in full bloom. Therefore, it's better to increase movement and blood flow to prevent blood from pooling and subsequently clotting. Most of the time, small clots that form dissolve spontaneously. However, of the VTE's that develop, about 3% will travel to the pulmonary bed and cause disastrous results. When one has major surgery, there is a 40-60% possibility that a venous thromboembolism will develop if left untreated. Anything over 50% in my book means you have a better than half chance that you are going to have this complication. Hence, I was a nervous wreck before I had my hip replacement surgery. The good news is, it is treatable in many ways. My personal favorite is getting my lazy butt out of bed and walking around. Movement of the lower extremities increases blood flow and therefore blood can't sit around and clot. Lazy or not, I still need my 8 hours of sleep at night and that's a long time to let blood lay around. So, the next best treatment is anticoagulant therapy. Traditionally, patients are placed on a drug called Warfarin Sodium, known specifically as Coumadin. Coumadin is a good, effective drug. It is so effective though, one can become a little too "anticoagulated" meaning you could probably bleed to death from a paper cut or worse, suffer a life debilitating stroke. If you had a surgery such as mine where you may have minor bleeding in the area, coumadin therapy may turn a small bleed into a big one. Coumadin is a Vitamin K antagonist, meaning that patients must watch what they eat because there are many foods with Vitamin K that can affect the effectiveness of the drug. Coumadin is also very "touchy" and it is very difficult to assess the right dose as each person responds differently to it. For this reason, patients who take Coumadin have to have regular checks of their bleeding time to make sure that the medicine is working properly and not causing problems.

There is another anticoagulant therapy called Enoxaparin. Enoxaparin is a low-molecular weight heparin and it's effectiveness is based on the weight of the patient. It is not affected by foods ingested and generally works on everyone in a predictable fashion. The drawback is it can only be administered by injection. On either therapy, you are bound to get poked a few times.

I was deathly afraid of throwing a clot. Between that and infection, I was totally freaking out about my hip replacement. The problem with being a nurse is you know enough to be dangerous but not quite enough to be confident. After seeing many patients with blood clots and infections, I was not especially excited to have this happen to me. So when I was asked whether I wanted to take a pill or inject myself daily with my blood thinning agent, I chose the injection. It seemed like it had less to worry about and I was good at giving injections. After 12 years of nursing, I figured being able to inject myself was sort of a "perk". I'd save myself a visit by a home health RN (to draw blood to check bleeding time) and the nightmare of wondering if my Coumadin was therapeutic or if I'd eaten too many green leafy vegetables. I recently modified my diet to include green leafy vegetables and it was murphy's law that now I would be expected to limit them. No way. I'll take the injection instead and keep the worrying to a minimum.

Enoxaparin is the generic name of the drug that a company called Sanofi Aventis markets as "Lovenox." The dose is based on how much you weigh and is delivered via an injection into the subcutaenous fat portion of the skin. Most people are familiar with the traditional intramuscular injection which is the shot in the arm or the butt with a long needle. Subcutaenous injections or "SQ" injections are given with a tiny needle into a pinch of fat much like how diabetics deliver insulin to themselves. It's pretty easy, although I had an interesting dilemma.

I am a woman of moderate height and stature. I am small-breasted and thin in my mid-section and carry most of my weight in my legs and my rear-end. The contemporary description of "too much junk in the trunk" fits me well and I could pinch all kinds of fat between my hip bones and my knees. I also have a nice little fat deposit in the tricep region at the back of my arm. Trust me, I am not without a subcutaneous layer. However, when one self-administers Lovenox, they recommend pinching the fat of the abdomen and injecting the drug in this region. Ironically, I can barely pinch an inch here. I am having a heck of a time conjuring up a big enough pinch to stick the needle into. On more than one occasion, I have hit the muscle underneath which really hurts when you inject Lovenox. It stings like crazy. Everynight it's a new adventure trying to pinch enough fat on my stomach with the great irony being that if I injected it into my butt, I'd have no trouble finding enough fat. I tried using my tricep fat, but it's impossible to pinch and inject at the same time. And trying to pinch and inject into my backside was a comical display of me chasing my own tail.

I am not especially psyched about this injecting every night, but given that it will probably save my life. I stick with it. I also bought two pairs of compression hose that I wear every night to bed. One night, I woke up with searing pain in the back of my heel. I was convinced that I had a small clot. I pumped my foot back and forth as vigorously as I could, worried that this thing was going to either, get stuck and get worse, or break free and travel into my chest. After a couple of agonizing minutes, the pain went away. I waited for chest pain and shortness of breath that never came. I felt like I had dodged a bullet.

Another night, I asked my 8 year old daughter to give me my shot. She was so intrigued by the skin preparation, the pinching and the poking. I asked if she wanted to do it and she said "Sure!" The first night, after I used my syringe, I had her practice on a tangerine. She used the dirty needle and stabbed this poor tangerine over and over, injecting with varying speed. When it was time for my shot the next night, I must admit, I was a bit nervous after watching her anticoagulate a tangerine over and over. However, when it came time, she was quite nervous and a little subdued. She very, carefully cleaned the site with the alcohol wipe and then, on command, jabbed me in the small pinch of fat that I was able to muster with excellent aim. She slowly injected the medicine and did a fabulous job. It was the best injection I'd had in the last two weeks and she was so very proud of herself. I, personally, was happy to have the night off. She had a heck of a story to tell at school the next day.

So, you see? Lovenox is so easy even an 8 year old can do it. If you have the choice between Coumadin or Lovenox, take the Lovenox. And if you are skinny in the middle, you might want to hit the carbs a little harder prior to surgery. If you already have that spare tire, you will be happy to know that it is good for something. Lovenox therapy continues for three weeks total. After that, I get to switch to Aspirin. Even though my 8 year old can show me how it is done, I am running out sites on my abdomen. I will be happy when the injections are done.

Healing Hands

For the past 4 years, while trying to figure out what in the heck was going on with my hip, there was one treatment modality that kept me moving forward: Massage. Not the freaky kind that happens in seedy parlors behind closed curtains and shows up on your credit card statement as "Entertainment," but rather, the highly professional manipulation of body tissue by a licensed professional that helps release toxic substances and promote relaxation and muscloskeletal performance.

Since my days as a world class athlete, I have been a huge proponent of massage primarily because the average athlete is really good at flexing their muscles on command and in unison, but letting them go tends to be a challenge. A good massage therapist with knowledge of musculoskeletal and nervous system anatomy can greatly enhance the performance of the highly trained athlete. Massage, adequate hydration, and stretching are the appropriate prescription for overtrained, overtired, and overused body tissues and increase an athlete's ability to push the envelope at the peak of a long season.

Let's face it, my world class athletic performance days are OVER and I am now in the midst of a new challenge: My 40's. The unfortunate reality of my world is my brain still thinks it's driving an 18 year old body with all the benefits of fast recovery, sinewy strength and limitless recoil. My 44 year-old body begs to differ. Despite pushing my muscles and connective tissues to their limits, there are many moments when they scream "uncle" by forming little balls of toxic waste in the fibers of my overused muscles. I am therefore unable to recruit those fibers. Instead, I am often sore, stiff and left for dead. It used to be that I could pack myself in ice, throw down some vitamin I (a.k.a. Ibuprofen) and recover in a short time period, but being 44 years old ups the ante. Without stretching, hydration and excellent nutrition, returning to a max effort with stiff, sore muscles puts an "old girl" at risk for a major injury. Unfortunately, I have learned the hard way. I need more recovery time and if I have any hope of staying active and not destroying my body in one foul swoop, I better start being a lot nicer to it. My friend Eva refers to this revelation as trying to make a U-turn with an 18-wheeler. Old habits die hard and are more than likely to get you jack-knifed on a residential street. This is why one must turn to the professionals.

In our sleepy little town, there is a pocket of peace and tranquility known as "In-Depth Massage" and it is attended by a small, unassuming woman of immeasurable strength. She is firm in her beliefs and practices yet respects the differences of others. She is attentively contemplative as you share your physical woes and it is almost as if she knows your issues better than you do. She is guru- or llama-esque when it comes to ascertaining your pertinent physical problem and she frequently surprises you by starting in exactly the opposite part of your body that you just told her was bothering you. For example, if I tell her my lower back is giving me trouble, she digs in to my shoulders. It's almost as if to distract me from the real issue which is rooted in the fact that my life is far too busy and I am too stressed out. I am thankful she refrains from pointing out this obvious fact despite my poor efforts to change it. She is not a large person despite the force she is able to generate. She is quiet, peaceful, receptive, and kind and I presume that she is often underestimated. She goes by "Alice" and I am selfishly reticent to share her gifts for fear of losing my appointment slot.

Over the last few years, Alice has dug in to the mysterious maladies of my right lower extremity. Once thought that my issues were related to a prior broken femur, or multiple broken vertebrae, she helped me to isolate my aches and pains to my right hip by means of deductive reasoning. For example, after digging in to my psoas muscle (painfully and effectively), reducing my quadriceps to a puddle of mush and transforming my quadratus lumborum into a submissive servant of my body's core, it slowly became obvious that my issues of pain, dysfunction and weakness were, in fact, coming from my hip joint. Of course, I had consulted primary care physicians with my groin pain complaints but the process was the same: A right hip X-ray was taken. The joint space was present. There was no visual evidence of degeneration, and the true story of the joint was not told. I was sent home without a diagnosis. My hip was declared to be that of a "healthy" 44 year old woman and hypochondriasis was added to my list of maladies. I questioned my own assessment skills. Was I imagining it? Was I being a weenie? Perhaps I needed to work harder at getting stronger? Alice said no. Something was going on but neither of us knew what.

Perhaps piriformis was acting up? We suspected some sort of soft tissue thing given that the X-ray appeared normal. Maybe something was disconnected from my crash of 1987 and was never recognized? Over the long time it took me to find answers, one thing remained consistent. Massage therapy was effective in supporting the muscles and connective tissues that were splinting my hip joint. Despite my insistence on abusing these tissues, Alice magically kept them in operation while we played detective.

One thing was for sure: there was no way I would ever challenge this woman to a thumb war. For anywhere from 60-90 minutes, Alice dug in to the little balls of muscle that popped up in a session in a manner that resembled the "Bop-a-Mole." No sooner would she get one little muscle ball to release, than another would pop up on the opposite side. It was like chasing gophers. Yet calmly and serenely, Alice was never thwarted by my muscles' attempts to derail her focus. She was determined, and persistent and would not let my pesky muscles have the last word. I often felt guilty that she went the extra mile. I enjoy movement and pushing my body to its limits whether kayaking or climbing or playing soccer with my kids. I'm always confident Alice can fix just about anything, along with an extra liter of hydration and a well-placed ice bag. Hey, at least I'm making SOME effort to take care of myself....

When it came to my hip and groin pain though, we were both stumped. I was often frustrated and even slightly pessimistic from time to time. I would go see Alice and the calmness and the patience she exuded would reform my outlook. Her healing hands gave my musculoskeletal system a boost and built me a bridge that kept me from falling into the abyss of despair.

One week after my surgery, Alice came over to my house to pick me up and take me to her studio. Despite the swelling in my right leg, a fairly nasty-looking incision, and my lack of cat-like reflexes, Alice agreed to revitalize my traumatized limb.

"Are your kidneys working properly?" she asked prior to my appointment.

This is just another example of her expertise. Had my kidneys not been working, putting a significant volume of interstitial fluid back into circulation could have very dangerous effects on my post-surgical heart and lungs. "Woman drowns in living room" would read the next day's headline. I did not wish this to be my epithet and was thankful that Alice had this base covered.

Alice performed a 60-minute massage, focused on increasing lymphatic drainage. I was somewhat skeptical that there would be actual "drainage". I was there because I needed an outing and the rest of my body was in shambles. Massage is not only effective but it feels REALLY good. I should have known better about the effective part though. After molding my back, arms and legs like putty with her iron thumbs and unforgiving elbows, I crutched out of her studio feeling 4 inches taller and vertically straighter. When my husband brought me home, I felt like my bladder was going to burst. As it turned out, that lymphatic thing was the real deal! I must have unloaded an entire gallon of fluid! Most importantly, I felt great! I felt like whatever toxic substance was making me feel like a slug was now gone and I was renewed once again. That, and I felt about ten pounds lighter. Another small victory to celebrate and a rekindled desire to jump back on that stationary bike (thus requiring more massage therapy later.....but I digress) Plus, the muscles involved in walking and moving seemed far more capable to continue the job while those that had been traumatized by surgery were left to heal.

I feel like the Holy Grail lives just down the street, and that Alice is my fountain of youth. Alice heals. Not just my overrun musculoskeletal system that I neglect on a regular basis, but also my soul. Every two weeks, I invest in musculoskeletal massage because I am convinced that Alice's healing hands and shared perspective bring me back to center when my world starts to spin out of control with playdates, soccer practices and kid's homework. Alice reforms my physiological systems and my conscious ability to deal with the challenges that present themselves by being a role model of peace, kneading my connective tissues into submission, and reminding me that it's okay to trade in my physical pursuits for more introspective ones. Because of this, I am a better wife, a better mom and a better member of my community. It seems so simple.

At 44, change is similar to recovery: it takes longer and requires more adjuncts for success. In my attempt to change my hammerhead ways, I am frequently unsuccessful and self-critical for falling into old patterns and therefore must rely on others to keep me focused and resolved. Despite my desire to conform to the way of the peaceful warrior, it is clear the process does not occur overnight. I am thankful for healing hands at my time of greatest need, whether they be those of a capable orthopedic surgeon, a professional massage therapist, a caring husband or a precocious daughter. The return of my capabilities seems like the best way to say thank you to the people who go the extra mile for me. The real test will be when it is my turn to return the favor. I can only hope that the lessons of my recovery will not be lost on a short-term memory.

The Small Victories

“She’s doing what??!!!”

Apparently, this was my doctor’s response when my physical therapist ratted me out on the activities I was doing. This does not worry me as this is not the first time a doctor has made this exclamation on my behalf. My response is that if the doc hadn’t done such a great job, then why am I able to do stuff I’m not supposed to be doing? OR, if you didn’t want me maxxing out my range of motion, then why didn’t you put me in a body cast? The answer to this is that they don’t really expect you to get close before the six-week time frame is up. The other part is I think they are so used to putting new hips in people with no flexibility, that the expectations of full range of motion at 2 weeks are pretty low. Being approximately 20 years premature for this surgery, my tissues are responding pretty well, and a lifetime of beating the crap out of myself has gotten me used to pushing limits a little early in the process. So when my physical therapist told my doctor I was walking with one crutch and pushing my hip flexion past 120 degrees, the response was a little incredulous.

Not only was my PT supposed to impose a writ of cease and desist, but my doctor’s office threatened to call me and give me the what-for. I got a very funny telephone message from my PT when I was unable to successfully make it to the phone on time due to my slow crutching.

“This is a message for Tori. Tori, I talked to your doctor today about pushing your range of motion. The general consensus was ‘she’s doing what?!” Anyway, they said they might call you and I just wanted to let you know that I wasn’t trying to rat you out, but rather trying to clarify the doctor’s order....,” (which was written for 140 degrees of flexion, by the way. )

Her tone was one of professionalism and worry. While she and I both knew that no damage had been done and that all was well with my joint, we were both a little sheepish for stepping out of the doctor’s parameters. I think we both felt like a couple of kids who just got busted for staying out past curfew. No harm, no foul, but we were both anticipating the safety lecture. I had to giggle. Even at 44, I am still pushing limits and defying authority. Some people just never grow up.

Fortunately, my doctor didn’t call me at home despite having my defense rehearsed and ready. However, I spent the next few days in bed, resting and doing basic range of motion exercises just to put a little karma back in my karmic trust fund. Yawn.

It takes healthy tissues at least six weeks for healing to be complete. Two essential components comprise the healing process: Regeneration and Repair. The regeneration phase is characterized by the proliferation of surrounding undamaged specialized cells that replace damaged tissue. In repair, granulation occurs and granulating tissue matures and forms scar tissue. In the repair process, 4 broad and overlapping stages are taking place: Bleeding, Inflammation, Proliferation and Remodelling. Bleeding is often short term and is usually done 6-8 hours after injury or surgery. Next is the inflammatory phase. This phase is critical for release of chemicals that promote healing. It’s onset is immediate and peaks within 2-3 days. However, the whole process lasts over the next couple of weeks. The Proliferation phase is the generation of repair material, i.e. the production of collagen. The peak of the proliferation phase doesn’t occur for 2-3 weeks post injury (or surgery). The remodeling phase, often underestimated, is the phase where the healing tissue starts to behave like the tissue it is replacing. The remodeling phase begins when the proliferation phase peaks and goes another 2-3 weeks. These processes of healing are well-designed and there are no drugs or therapies that enhance this process. The best way to survive these healing components is to be patient, to rest, stretch, and let the body heal the way it is designed.

For someone like me, this can only spell one thing: B-O-R-E-D-O-M. No running, no jumping, no stretching, no playing. Just rest. A person of boundless energy such as myself has great difficulty with the patience required to simply “heal”. Try telling a 4 year old to lay down and rest. Yeah, it’s like that. Sure, after 1 or 2 weeks, I think it’s great. Motherhood is insanely busy and we could all use a little ‘down” time, but take it to the next level, and soon, it becomes a prison sentence. What’s a girl to do?

Well, today is the day I rode the stationary bike for the first time. It was on the Physician’s "approved" activity list, and it was like heaven. I set the bike up on our porch with the magnetic trainer and started riding. My unaffected leg did the work while my leg with the new hip went along for the ride. It was heaven. I felt semi-normal. The sun was out, the air was crisp and there was just enough breeze to make it seem like I was actually moving. I had my iPod nano cranking out the motivational tunes and I spent palpable minutes pedaling my way to normalcy. It’s funny how the small victories are so important in the recovery process. Whether it’s meeting your range of motion goals (however minimal they may seem), spending time on the stationary bike, or walking from point A to point B, it is essential to celebrate these micro-victories. The funny thing about these small affirmations of progress are that they are so subtle, and you, the healing person, are the only one that can truly appreciate them. No one celebrates them with you, and some people may think you have actually lost your last marble, but the truth is that the small victory is the spark to the fire. It’s as if you have a special secret that no one else knows, and it leads to big changes down the road.

Time flies when you celebrate the little things., and it creeps exponentially slower when you wallow in misery. It is very important that you surround yourself with happy, inspirational people and entertainment. For example, you should only rent motivational movies and listen to inspirational music while recovering from surgery. DO NOT UNDER ANY CIRCUMSTANCES, watch sappy, tear-jerking chick flicks, especially while taking pain meds. Time will literally stand still and that is a deep psychological hole for which there is no shovel big enough to dig one out. Stick to the funny stuff or the uplifting sports dramas. Some of my favorite movies include, The Replacements, The (New) Karate Kid, The Blind Side, Gladiator, The Shawshank Redemption, Miracle, Remember the Titans, and any movie where the underdog overcomes the bullying protagonist with witty one-liners and clever insolence. Movies such as these have all the elements of successful recovery: sarcasm, winning against unbeatable odds, satire, wit, did I mention sarcasm? Laugh your way through the sporty comeback movie and your own recovery will zoom by. As a bonus, you’ll have a less likely chance of doing something stupid.

Needless to say, I found my groove listening to old AC/DC tunes while pedaling a stationary bike in the crisp, outdoor sun and before I knew it, 20 minutes had zipped by. This being my first day, I thought 20 minutes was taking it easy. However, as you may guess, it was just over my limit….. I love the whooshing sound my limitations make as I whiz right by them. In a moment, I went from celebrating victory to being spanked by reality. I got stiff and sore and resorted to wrapping my butt in ice. Looks like two more days of rest lie ahead. It was worth it, because along with celebrating the small victories, there is hope. Seeing a glimpse of your future, uncrippled self does wonders for your bored, healing soul despite the minor consequence. Six weeks is no longer an eternity or a sentence. It’s merely a matter of time, and patience, and a really good movie.

Can't Sleep

I’m a sleeper. I can sleep through almost anything; parties, rock concerts, lights on, TV blaring, vicious poking, none of it wakes me, and if it does, I usually come up swinging. My husband hates that I can sleep through anything. I sleep like I am dead. It is a gift derived from being the daughter of two young parents of the 60’s, who partied on into the night with frequent guests long after they put their only child to sleep. It was the gift of a mother who worked late nights and had to bring me along, putting me to sleep in a back office while she worked behind the bar. It was a gift given by a father whose apartment was over a bar that he owned that played loud music well into the wee hours of morning. I have slept through many alarms including very important ones that meant the difference between ski racing in Europe or going back to college.

We were racing World Cup in Waterville Valley, New Hampshire. On the last night, we all went out dancing and ended up going to bed late. I know what you are thinking, but I was 18 and drinking at a World Cup party was not a good idea given that all my coaches and many of the U.S. race organizers were present. I was perfectly sober when I went to bed. I set two alarms and promptly slept through both of them. I missed the bus to Boston where I was to catch a plane that would take me to Zurich, Switzerland with the U.S. Ski Team. As I mentioned, I was 18 years old and I was in a world of trouble. Luckily, a very nice person that worked with the race committee took pity on a desperate teenager and agreed to drive me the 127 miles and two and a half hours to Boston. I remain repentant for this deviation of responsibility even 26 years later and forever indebted to the person that saved my budding ski career. I enlisted my future roommates to make sure I was awake by encouraging them to throw things at me. I set multiple alarms and set them earlier than anyone else’s using my friend’s alarms as backups. I was mortified of making the mistake of missing a ride to a World Cup race or crucial airplane connection for most of my career. And on the days I got to sleep in? I slept until lunchtime……while my teammates threw stuff at me.

This all changed when my daughters were conceived. Pregnancy was unkind. I was either too sick to sleep or too hypoxic. I couldn’t breathe when I was pregnant due to the shortage of real estate in my abdomen and frequently woke up gasping for air. Once the girls were born, I woke easily with every squeak. Of course, skunks mating under our porch didn’t wake me, but when one of the girls made even just a little sound, I was up with a start. The girls woke frequently throughout the night, needing to be breastfed or changed or both every two hours. Once they were toddlers, they were little nightwalkers, trying to come sleep in our bed with us, with me eventually having to walk them back to their own beds. Later, they had nightmares and would cry out in their sleep and when these resolved, it was time for potty training and the complimentary nighttime bed-wetting. I swear, I didn’t sleep for seven years, until last year, whereupon I finally returned to sleeping like the dead.

When you have a hip replacement, it is vitally important that you do not allow your affected hip to rotate inward. This is why they want you to sleep with the “abductor pillow’ between your legs at night, in case you roll to the unaffected side. Rolling to the surgical side is possible from a range of motion standpoint but with a gigantic, painful incision along the affected side, this side isn’t really an option for sleeping on either, which leaves only one viable sleeping position: flat on your back. I don’t sleep well on my back. I sleep, and I sleep deeply, until it’s time to move to another position, which is usually somewhere in the neighborhood of four hours. If I am unable to change position effortlessly, I wake and then, I don’t sleep anymore. Instead, I become painfully aware of my restless muscles.

Two weeks post-op means I haven’t done anything in the realm of exercise. My muscles are antsy, stiff, and sore and want to move. It is midnight and walking with crutches in the dark is not necessarily the best plan. I try to do my range of motion exercises but they are quite painful and make me no more tired than the 438 sheep that just jumped over the bed. As I lay awake, I think of all the things that need to be done that aren’t getting done with me laying around waiting for my tissues to heal. The girls have book reports, science fair projects, soccer, and homework. I have a mountain of projects like organizing photos, contacts, managing one daughter’s soccer team and photographing the other. I have big plans for PT and workouts of non-hip-related parts. I need a shower.

My mind won’t turn off and sleep is not coming easily. Non-essential thoughts are taking over like where did I put my pocket knife last week and I wonder if we have any zip ties. Which day are the library books due, Monday or Tuesday? Oh crap! Wednesday is Zoe’s share day, which means two food groups for 37 kids. I’m trying to remember what we have in inventory. Graham Crackers and apples will have to do. She’ll want something obscure like black olives. Please let this not be the usual battle with six year-old drama. Can Marek cover all these bases? And work? He’s already making me look bad by being better at mothering than I am…….

In an instant, it’s 2am. Daylight is an eternity away. I readjust my pillows and blankets and pray to drift off into peaceful slumber. I consider Benadryl and decide that if I haven’t gotten to sleep by 3am, I’ll do it. Drugs are such a slippery slope when it comes to sleep. They are more of a crutch than a strategy and lead to rituals of sleep that are impossible (or dangerous) to sustain over time. I worry that this whole ordeal is going to turn me into one of those pill-popping, desperate housewives with the jeans and the hooker heels and the diamond, bedazzled, rodeo belt. Soon I’ll be indulging in pedicures and lipsticks in multiple shades of red and wearing those stupid slippers with the feathers while petting my little Yorkshire terrier or Shih tsu puppy with the little bows around their ears. I try to conjure my inner badass to get my mind off of my tiara fate. I am so tired. My body is exhausted and my legs ache. All I need is sleep but my mind keeps racing away with desperate housewife thoughts and this week’s to-do list. 2:44am. It’s still black as black outside. I reposition again, trying not to wake my husband all the while cursing him for not helping me get to sleep. I am on my own, praying for the Sandman’s visit. I try to remember what life was like with my husband without the kids. The kayak safaris, the travels, the love affair……..

I awake at 6:50am with first light coming in through my bedroom windows. As it turns out, my husband helped me get to sleep after all. Only 4 more weeks of sleeping on my back. Less, if I can tolerate sleeping on my healing incision, or if I’m careful, on my left side with two pillows between my legs for safety. For now, I am glad that I did not resort to the Benadry, but I don’t see an end to the pain meds anytime soon. My incision still feels sharp and raw and my right leg muscles feel like they have been run over by a tractor. It’s getting better, day by day. I feel like each week, I take 4 steps forward and 3 steps back. I’m still going forward, but the idea of slipping backwards even slightly, taunts me. If I can fall asleep on my back for awhile, it serves me well. The restless legs, the aching and the sore, right side are somewhat diminished enough that I feel I can walk around our porch an extra time or push my PT regimen. However, I feel a sense of dread as the day ends, wondering how long I will be awake with my thoughts before drifting off. Necessity is the mother of invention. I figure out a way to turn on to my stomach. Perhaps one position change is enough to get me back to sleep sooner. I remain hopeful that I will one day sleep deeply, unstirred and undistracted, with the possibility of sleeping through an alarm or two and possibly breakfast…….

Too Young

“Hip replacement? You’re too young to have a hip replacement!”

I have heard this over and over in my daily excursions and in the telling of the story over and over again to people who are wondering why I am crutching around with my two kids in tow. I am often amazed at how perfect strangers have absolutely no inhibitions about stopping a person in the grocery checkout line to ask about why one is using crutches.

“Surgery,” I say, as I unload my overfilled cart with one hand and no help.

“What kind of surgery?”

Most of the time I think to myself, “None-of-your-beeswax surgery,” but given that my energy levels have not yet returned, I avoid the urge to fight this battle publicly.

“Hip replacement surgery.”

“BUT YOU’RE TOO YOUNG TO HAVE A HIP REPLACEMENT!”

It’s almost as if you can anticipate the rhythm of the stanza and dance to it.

I’ve tried to come up with clever retorts in the moment, but half the time, my school-age daughters are with me, and unfortunately, none of my brilliant comebacks are rated G.

These conversations are fine when I’m having a great day, but as I recover from hip replacement surgery, there are good days and bad days.

On bad days, I ache or I’m more tired than usual. When I hurt or ache and I am trying to accomplish some simple task like filling my car with gas, or picking up a take-and-bake pizza, almost predictably some large, overweight person with no personal boundaries will start with a line of questioning about why I am on crutches, finish with the “too young to have a hip replacement” thing, and then start in on some family member’s medical menagerie that has no parallel whatsoever to a hip replacement. All the while I am gritting my teeth, just trying to get through the moment and not be terribly rude. I just want this person to please stop talking to me about their horrific healthcare experience. It is at this time, that I must bite my tongue or go to my “happy place” and refrain myself from speaking my mind. After 12 years of emergency room nursing, one tends to be creative. The litany of one-liners that I have collected abounds. It’s really all about choosing one in the moment. Since there are so many possibilities, I am reticent to choose one, and therefore keep my mouth shut….., but a few of them sometimes slip, shrouded in sarcasm.

“I can see that you are taking much better care of your hips by not doing much at all. ”

“Perhaps I wouldn’t be in this mess if I had watched more TV. Clearly, it’s working for you!”

“Really? What exactly is the recommended age for a hip replacement? Do you think I should have waited? Oh Please! Tell me more! Because really, I’ve got nothing better to do with MY day.”

“Because smoking and drinking and having sex with multiple partners would have been a much healthier way to have spent the earlier years of my life…..Ski racing?…..what was I thinking?”

I cannot tell a lie. I have had all of these thoughts at least once and yearned to use them as a response. Sometime, I feel like a circus attraction.

Respectfully, I tell people that I have successfully worn out my hip in half the allotted time, that I have triumphantly used my hip so much that it simply could not keep up, and that modern medicine is now taking a stab at seeing if it can produce a better product for my very demanding physical lifestyle. I, either, lose my audience to complicated mental calculations of why anyone would be proud of this fact, or people just laugh and nod and that’s the end of it.....unless of course they are Raiders fans. Raiders fans get it and usually give me a fistful of solidarity and a hearty “Hoo-rah!”

Most of the people who ask are laypersons who have no prior medical knowledge, nor personal boundaries (or discipline for that matter). Then there are people who look at me with pity and tell me how sorry they are that I had to have surgery. I feel compelled to set them straight about the fact that surgery actually fixed me and once healed, I will have an opportunity to live another 15-20 years without hip pain. Unless of course, I get hit by a bus tomorrow which is an entirely different conversation……

These social interactions that I have been having have stimulated my brain to wonder certain things.

“How young is too young?”

“What is the median age of the hip replacement patient?”

“Is there an increase in incidence of joint replacements and if so, why?”

Any nurse worth her salt will tell you that obesity is the root of all evil. While I make bad jokes and terrible, stereotypical suppositions about people who carry extra weight, the fact is that the American diet is really to blame. Combined with a sedentary lifestyle that includes a desk job and a television, the American diet contributes to the top five killers of humans today. Obesity is a major risk factor associated with Heart Disease, Stroke, Some Cancers, Diabetes, High Blood Pressure, Osteoarthritis and Disability. The American diet is a total travesty. Even if you have money to burn and hire a chef or nutritionist, the fact is, our food supply is tainted with hormones and bacteria, lacks the nutrients we need, and is full of stuff that we don’t need at all. Our bodies are rebelling the American diet via the inflammatory response, which eventually manifests as joint pain and other incurable disorders.

We humans are also living a lot longer than we used to and doing more activities. According to the CDC, in 1900, the life expectancy for males and females respectively in the United States was only 46.3 and 48.3 years. If that were the case today, I’d be retired and living large at 40! In 2006, it was 75.1 for males and 80.2 for females. In 106 years, our life expectancy almost doubled. In 2007, life expectancy reached an all-time high of 77.9 years (total population). Our structural makeup, however, hasn’t changed too much. Technology has provided us running shoes, bicycles, skis, skateboards, scooters, skates, (and helmets!) and other mechanisms we use to hurl ourselves across the planet, self-propelled. Given the higher speeds, the increased impacts, and the ability to do more over a longer period of time, it is no wonder that we are wearing out our parts.

The most common reason for joint replacement is pain and decreased quality of life from osteoarthritis. With an aging population and one-third of Americans obese, prevalence of osteoarthritis is expected to increase (CDC 2009 Health Summary**). Demand for joint replacements will grow an estimated 175 percent for total hip replacements and six-fold for total knee replacements by 2030. While most joint replacement patients are older, longer-lasting joints make the procedures a viable option for younger and more active patients. (“Ten Statistics & Facts about growth in Joint Replacement”, Becker’s Orthopedic & Spine Review).

Sooooo essentially, I’m a trendsetter. Technically, I am not too young for a hip replacement. Rather, medical technology has finally caught up with the needs of my cohort who have spent most of their lives hurling themselves down mountains and across vast expanses of turf and asphalt. Humans are not the only ones with increased life expectancies. New body parts are lasting longer and longer, and surgery is becoming more tolerable with faster recovery rates. So now, a trip to the joint doc is like a trip to jiffy lube or In-and-Out burger. This means that the prior median age of 65 for hip replacement surgery is dropping…..fast. Young, active people are getting wind of this and when they realize that they can get 10-20 more good years out of their young limbs, they are going for it. According to Wikipedia, 97% of patients who have their hip replaced, report improved outcomes, and spend a large portion of their latter life asking the question, “why didn’t I do this sooner?”

If you had a 97% chance of improving your life, would you do it? Surgery is still risky business. But there comes a time when one weighs the status quo against the risks. Living in a constant state of pain and inflammation compromises a healthy immune system among other drawbacks, so it’s not necessarily “risk-free”. Basically, you are throwing the dice in consideration of either direction.

Being on this side of the recovery room, I have decided that I am definitely NOT too young to have a hip replacement. However, I AM too young to be sidelined by hip pain. I am way too young to be morbidly obese because an arthritic hip keeps me from healthy exercise. I am too young to suffer from an inflammatory disease or a cancer that is caused by the stress of joint pain and I am far too young to be on disability because I can no longer work as an RN. I AM too young to watch my life swirl the drain prematurely, especially if a smart, smooth-talking and fabulously persuasive Doctor in LA says he can fix me and has the resume to prove it. With a life expectancy of 80.2 years, I am only halfway done with my life, and the best is yet to come.

…Unless, of course, I get hit by a bus tomorrow. However, if I DO get hit by a bus tomorrow, I sure hope today was not wasted sitting around, complaining of hip pain.

**Health 2009 CDC (http://www.cdc.gov/nchs/data/hus/hus09.pdf#executivesummary)

Health, United States, 2009 is the 33rd report on the health status of the Nation and is submitted by the Secretary of the Department of Health and Human Services to the President and the Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was compiled by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). The National Committee on Vital and Health Statistics served in a review capacity.

The Health, United States series presents national trends in health statistics. Each report includes an executive summary, highlights, a chartbook, trend tables, extensive appendixes, and an index.