Hip Replacement

How Long Does the Pain Last?

2011-09-23T05:50:00.001-07:00

A good friend of mine had his right hip replaced about three weeks ago by the same surgeon I used. A week after the surgery, I went to see him at home, and he was moaning and groaning "how long is this going to last?" He was very discouraged, and seemed to be in pain. It was difficult for him to get up even to go the bathroom or take a shower, and he was disgruntled by his own helplessness.

I went back a week later, and he was up and walking around. But he was still housebound and depressed, and still on the pain pills.

After the third week, he told me he was having to be awakened in the night for the pain pills. I asked him if he had any common sense, and if so, why wasn't he using it? If, indeed, he was sleeping, how bad could the pain still be? He lengthened the time between doses of the pain pills.

At the end of the fourth week, he went back to his office.

He's 81. Ritz, tell your dad to have a little patience. I'm in no pain, doing everything, I could sleep in a tent if I wanted to (I don't, but I've been trekking through India), I practice yoga, and everyone's body heals at its own rate:-)

Annual Update

2011-04-18T15:29:00.000-07:00

I've been to the ortho who says that after five years, I'm doing really well. I know that's true, because I do anything I want to do. I am still practicing yoga, walking 1-2 miles a day, lifting weights and doing Pilates when I can. I would still recommend this surgery to anyone in pain.

Does it solve other problems? No. I still have the same issues with my back. But because they are not complicated, they are something I can live with.

If you want to talk to me about hip replacements, just comment and I will answer to the best of my ability. It has been fun hearing from people all over the world.

Scoliosis

2010-05-07T14:47:00.000-07:00

Someone commented on this blog that her mother was afraid to have a hip replacement because she has scoliosis. I made sure my surgeon knew in advance about the scoliosis and adjusted so I was a bit less unbalanced after than I was before. It had absolutely no effect on my recovery, however, or on the severity of the operation.

I'm now 3.5 years out and I don't even remember I have it most of the time. Of course I still keep in shape assiduously, which was the way I was before.

Now I'm a Health Maven:-)

2008-11-24T17:17:00.002-07:00

I'm a patient, not a physician, but I have valuable advice to give because I have gone through something you are contemplating or have just experienced. Two years the other side of my hip replacement, my doctor told me my muscles were visible equal on both legs, which is a big deal, because then you don't limp and you can go back to athletics. I can do that. In gratitude, I've allowed Wellsphere to make me a Health Maven and agreed to continue to offer advice from the patient's perspective to you. Here's a pretty well-crafted press release about the program.

Recession Special: Free answers from doctors and expert patients who truly care

Wellsphere’s Health Mavens provide free answers to millions of health seekers

In these difficult economic times, it’s comforting to know there are medical and patient experts out there who care enough to answer health questions online for free. Dr. Geoff Rutledge, MD PhD, Wellsphere’s Chief Medical Information Officer, told reporters today about the new Health Maven Program, which connects volunteer doctors, psychologists, nurses, personal trainers, expert-patients and other experts with health seekers who are looking for answers. Anyone with access to the Internet can get their health questions and concerns answered quickly and at no cost at www.wellsphere.com/healthMaven.s.

Health mavens are carefully selected, knowledgeable, health experts who are committed to helping others live healthier, happier lives. Hundreds of Health Mavens have volunteered to join the program and answer questions, with new Mavens signing up every day. “We’re witnessing an incredible growth in the number of people using the Internet to find health information” said Wellsphere’s CEO Ron Gutman. According to an iCrossing research repot, for the first time in history people with health questions are more likely to turn to the Web for answers than to their doctor. “Recognizing this trend among our users, we assembled the world’s leading network of over 1,800 medical and patient experts to share their experiences and expertise with Wellsphere.com’s almost 3 million monthly visitors. We are humbled by the experience, expertise and genuine care these wonderful individuals share every day with people who come to Wellsphere looking for answers” said Gutman.

In addition to providing a wonderful service to people seeking answers to their health questions, the Health Maven program allows participating medical professionals and patient experts to broaden their impact by sharing their experiences and expertise with a much wider audience, and to get the recognition they deserve. Here are a few of their comments:

"Being a Health Maven gives me the opportunity to interact directly with the Wellsphere community. It's been a lot of fun and professionally it's incredibly rewarding." - Melissa McCreery, PhD

"Wellsphere has taken caring to a new level and I'm glad to be a part of it," - Kathleen Blanchard, RN

"I enjoy being a maven - it seems that doling out advice and answering questions seems to be my calling in life." - Lynn Dorman, PhD

To find out more about the Health Maven program, please visit http://www.Wellsphere.com/HealthMaven.s

If You are Thinking of Having a Hip Replacement...

2008-09-23T08:45:00.002-07:00

I am here to help. There's not much for me to update on my own progress, as I have returned, through Pilates and yoga, to "normal." (I've never been normal.) But I am here to help everyone else who is having a hip replacement.

If you are thinking of having a replacement, read this blog all the way through. I've tried to be as truthful as I can about the experience, from the day before the operation to the present, nearly two years later. Only by going back to how I felt at the beginning of the process can I remember how much pain I was in when I tried to register myself into the hospital, and when I walked down the corridors for the pre-op tests. In retrospect, I waited too long.

I thought I could cure myself through diet and exercise. I couldn't. But now that I've had the surgery, I see there are some times when surgery is clearly the best choice.

Summer Update

2008-07-30T17:35:00.002-07:00

So you may notice that these posts are signed by "Buppy the Puppy." His blog gets much more traffic than this one does, and it's written from his point of view, so signing them Francine Hardaway didn't seem logical, and Blogger doesn't seem to let you change your signature from blog to blog. Or if it does, I haven't bothered to learn.

But this is the latest and greatest on the hip replacement, which will be two years old in November.

I can now balance on my left leg. This is a big deal. Couldn't do it before the replacement, and couldn't do it for a long time after, because I also have a scoliosis that tilts me to the left. In fact, that's what probably threw the hip out in the first place. And then I have no arch on my left foot -- also a problem.

So now I recommend Pilates as a complement to yoga. Pilates has given me an even greater and more subtle sense of alignment, and how small muscles in strange places help you stand and walk. But if you are going to take Pilates, don't go to the gym or take a mat class. To get anything out of it, you have to use the Reformer, a wierd piece of equipment with an even stranger name. But the Reformer gives you the feedback you need to truly strengthen the correct muscles.

I probably should have known all of this before I trashed my hip!

Francine Left THA Meets Francine Left THA

2008-06-06T19:39:00.003-07:00

Left THA means total hip replacement of the left hip. I had that in November 2006. Today, at my 50th high school reunion festivities, I ran into another woman from my high school class, also named Francine, who also had a left THA. We compared notes and both agreed that the surgery had been fabulous for us. Like me, she had been a yoga practitioner. Like me, she's back in yoga.

Her recovery was remarkable, she said. And she told me she had read my blog, but that it was no longer available. So it reminded me to update it so Google would take another look at it.

I went to the Bronx High School of Science, and this weekend I'm walking all over Manhattan with my customary sprightly gait. No problems.

Tell Your Story

2008-04-09T17:56:00.001-07:00

The Future

2008-03-10T06:54:00.002-07:00

The future of this hip replacement is bright. I'm at South by Southwest (SXSW), which has been described as Spring Break for geeks. For the past three days, I've worn a pedometer as I walked around town and around the conference center, just so I can see how I am doing for exercise. Yesterday I walked 15,755 steps, all on concrete. That's the equivalent of 6-7 miles. Although my back is stiff (that's a whole other matter), my hip is fine. So exciting that I can do all this now.

Four Miles

2008-02-18T09:23:00.001-07:00

IMG_0588
Originally uploaded by hardaway.

So here I am, walking four miles (this was the half-way mark) on the Sawyer Canyon Trail with my daughter. The day after, I'm fine, if a little sore because I usually don't walk more than 2 miles a day. Now I think I can train for a marathon.

One Year Later...

2007-12-12T11:06:00.001-07:00

Francine Hardaway at Poplar Beach with Kodie
Originally uploaded by hardaway.

Here I am on Poplar Beach in Half Moon Bay with a golden retriever of my daughter's. The most important thing about this photo is that I am not in pain, not limping, and capable of walking three or more miles and doing a Power yoga class.

I went back for my follow-up with Dr. Whirlow, and she said I could do just about anything I wanted to, because I understood my body. She also said that the muscles in both my legs looked symmetrical from the rear, and that I had a done a good job of rehab.

She said most people don't get back to where I am because they are not willing to do the work to get all the way back. There's no denying it: it was work. If you read back through these pages, you will see that.

But I set an intention to return to yoga, and I wanted to be able to walk the goldens, and this morning I took everybody to the dog park and it was wonderful.

Ten Months Out

2007-09-22T16:31:00.001-07:00

Three Twitterers
Originally uploaded by Robert Scoble.

That's me on the left, walking with friends in Half Moon Bay. Walked a mile with them. Notice no leaning and no limping.

Summer's Gone, But I'm Back

2007-08-29T19:09:00.001-07:00

The long tail of the Internet forces me to keep adding to this blog in response to the people who are asking me online if I am "back yet." Indeed I am. In the photo on the left, I am with my two goldens (I am the photographess) on a hill far, far above my home. I walked up two large hills to get here, and then hiked on the POST trail. A year ago I couldn't have done this AT ALL. Two years ago, I could have done it with ease.

This year I did it, a little out of shape in the wind department, but with no pain in the hip, back, et. So yes, I am back.

On Balance

2007-08-16T11:26:00.000-07:00

This is a bad pun. I have, on balance, recovered from my hip replacement. That means I can hike, walk the dogs, do yoga, take Pilates, and sleep without pain. I have not dislocated. I dance.

However, my balance has been seriously impacted by the surgery and the lack of a piriformis muscle, the weakening of glutes, the reliance on my right side, etc. As a result, I am even worse at balancing on the left than I used to be, and I was never very good at it (probably because of the scoliosis).

So I think that's the next step in my recovery. I've gotten very "into" functional strength, with the help of Chip Weber, who was the final step in my physical therapy and the only one who gave me any real insight into strengthening and conditioning. The roller exercises he made me do are still the ones that I depend on, although I now do them through a Fletcher-based Pilates studio.

This is probably TMI for most of you, but I want full functionality, and I will keep working to attain it :-)

Pete Wilson

2007-07-23T07:57:00.000-07:00

Yesterday I read in the SF Chronicle that Pete Wilson, a famous local anchor personality, died after undergoing surgery for a hip replacement at Stanford. This reminded me that hip replacement surgery isn't something to take lightly. He had a heart attack during the surgery.

And he wasn't old. And he was at a major teaching facility. Stuff happens. But I wonder if he was thoroughly screened before the surgery as I was. I had to take so many tests, and I was in so much pain at the time, that I resented each one of them. Now I see how necessary they all were, and I once again give props to Janet Whirlow, MD, who made me go through all the correct preparation so that nothing bad happened to me (that I didn't cause through my own desire to do too much too quickly :-)).

As for me, I can hike a couple of miles on a trail, be pulled along by two large golden retrievers, do yoga, do Pilates, and go to the gym. I still don't rotate inward or take my left leg across my body. I don't cross my left leg over my right. I move more mindfully. But that's about it...

Camp Fluppy Puppy

2007-07-17T17:35:00.001-07:00

IMG_0854.JPG
Originally uploaded by chelsea hardaway.

The dogs at Chelsea's house in Montara.
L.to r. Kodie and Bodie, who belong to Chelsea, and Chauncey and Luckily belong to me

2007-07-15T17:17:00.000-07:00

Second Annual Arizona Entrepreneurship Conference

Agenda and Registration

PHOENIX AIRPORT MARRIOTT HOTEL

November 8, 2007 from 7:30 AM to 4:00 PM

Reception and meet-up starts at 4:30 PM

Looking for funding? Need a new go-to-market strategy or a partner all? Feeling the scarcity of tech talent? You can find them all at the Second Annual Arizona Entrepreneurship Conference – a must-attend for anyone in or contemplating an entrepreneurial venture.

The theme of this year’s conference is “Success” – yours and that of such Arizona superstars as Limelight Networks, Jigsaw Health, and Zenter. Don’t know them? You SHOULD…

PROGRAM HIGHLIGHTS:

Opening Keynote

Pat Sullivan, Founder of ACT and SalesLogix, currently Chairman of Jigsaw Health,

on why he started another company, and why Jigsaw Health.

Lunch Keynote

Surprise Guest

Workshops, Panels, and Case Studies

Being Green in Arizona

Real Estate 2.0 – Technology Changes Ahead for Arizona’s Major Industry

Exit Strategies by IPO or Acquisition, featuring the CEOs of Limelight Networks and Zenter (acquired this year by Google)

Women as Entrepreneurs: Some Surprises About How Successful They Are, and in Which Industries

Access to Capital in Arizona

The Process of Innovation: How You and Your Company Can Innovate

Recruiting and Keeping Talent in an Era of Free Agents

Social Entrepreneurship: Making Money and Making a Difference

Social Media Connection: An open invitation to Arizona Social Media Mavens to Come and Meet-up

Evening Reception

With Michael Gerber author of “The E-Myth” and world-renowned entrepreneurship advocate, host of “In the Dreaming Room

No-host Bar

Full conference, $99 before 10/15/07, $125 (regular registration), $150 at the door

Lunch only - $75

Reception only - $50

Social Media Pass - $50

Student - $50

Remainder of copy is exactly the same as last year, except omit TIE and NAWBO as partners

Me and Jeremiah Owyang

2007-06-29T21:04:00.001-07:00

Picture 014
Originally uploaded by jeremiah_owyang.

At the Under the Radar Conference in Mountain View, CA with the new hip.

Penang, Phuket, Bangkok

2007-06-18T07:28:00.000-07:00

I just got back from three weeks in Asia. The details of the trip are here; and the photos are here. The point of this post is to tell you that I climbed to the top of a 7-story Buddhist temple in Penang, and walked all over Bangkok. Also went on lots of walking tours in Phuket.

At the end of the day, I would be tired in the hip, and a little achy, but I was keeping up with people anywhere from ten to 30 years younger than I and with their own hips. I also did a yoga class a day. I notice I'm having trouble with step-throughs in flow, but not on the side of the new hip :-)

I think one of the reasons I was able to do so much walking and touring is that I also had a massage almost every day. One of the big under-reported and underdiscussed issues in the tightness in muscles after the hip replacement. part of the problem is from favoring one leg for a period of time before the surgery; the rest of it is probably from cutting and moving of muscle tissue during the surgery.

So when you pop back into your regular activity level, if you were active before, you are definitely going to have muscle spasms and tightness. I noticed on my trip that my IT band, which had been bothering me before the trip and which I had been using a body roller to release, was not a problem at all. The problem was in the glutes.

And of course I'm not you, because I also have a bad back, and the erector muscles deteriorated as a result of the surgery, too, and I had to get them back. There are many yoga poses (backbends like locust, sphinx cobra and flying cobra) that help this, and my back got better during the trip from the daily practice.

What don't I do now? Complicated twists on the left, cowface pose on the left, pidgeon on the left, and that's about it. I am careful about internally rotating, but not THAT careful. I still have occasional twinges when I move into certain positions, and I use them as indicators.

Francine in Malaysia

2007-06-03T00:08:00.001-07:00

Francine in Malaysia
Originally uploaded by hardaway.

Here I am in Malaysia six months after the hip replacement. never mind how I look, but I just got finished travelling for 48 hours. Not bad, huh?

Update after six months

2007-05-27T14:13:00.000-07:00

All of you contemplating a hip replacement out there will be happy about this one! Six months have gone by and I am almost totally back to normal. By that I mean I'm doing every yoga pose I used to do except headstand (because I haven't got the core strength yet to get up into it), pidgeon on the left side (will probably never do that, as it violates ALL of the hip precaution), and certain intense twists with crossed legs. I am also walking a half hour a day with 150 pounds of dog (2) on leashes.

I have to admit that:
1)I don't have the prettiest walk
2)I probably will never have, because
3)I was right about my back. I have moderate to severe scoliosis, which probably caused me to lean into my left hip in the first place.

But, folks, it's all eminently doable, even for an athlete. The misleading part is how they tell you that you will be walking the day after (you are), but how different that is from feeling like yourself (takes more than six months).

On Thursday I leave for a yoga retreat to Penang, Phuket, and Bangkok. I've been bringing the cane to the airport with me simply because it gets me to the front of security lines, but I think I'm finished with that, as well.

Power Yoga

2007-04-22T14:01:00.000-07:00

First time back at Power Yoga since the surgery. It showed me how tight I am on the left(operated) side compared to the right. Not in the hip joint, ironically, but in the hamstrings, calves, etc. By the end of the class, I had stretched to the point where I felt equal on both sides, but I must admit as soon as I sit down I tighten up again. I can see that I can stretch it, though.

Yoga is such a gift. You learn so much about yourself. The sense of community is awesome. And the stretching and strengthening seem so much more interesting than just doing exercises in a gym.

2007-04-22T12:21:00.000-07:00

2438 E. Whitton Avenue Phoenix Arizona 85016 240 Coral Reef Ave Half Moon Bay, CA 94019	602.910.5622(V) 602.218.5272 (F) Francine@stealthmode.com Francine Hardaway, Ph.D
Objective	Entrepreneurship Coach and Mentor Chairman of a Small Business Group Corporate Board Appointment
Experience	1998-Present Stealthmode Partners Phoenix, AZ CEO Started and grew a company that is the market leader in Phoenix for startup company acceleration (fee-based) 1:1 counseling for five private clients in technology, construction, and environmental markets. Facilitated and administered ten successful FastTrac entrepreneurial training programs through the Ewing Marion Kauffman Foundation (applied for and received grants from the Cities of Phoenix and Tempe) Facilitated a monthly Founders and CEO Roundtable dinner attended by hundreds of local entrepreneurs Ran a highly successful First Annual Arizona Entrepreneurship Conference with 500 attendees and a bottom line profit Currently facilitating ENT 250, Networking and Public Relations for Entrepreneurs at Grand Canyon University Writer of a blog that is a resource for entrepreneurs Started a chapter of the Social Media Club in Phoenix Facilitate Social Media Club meetings monthly
	1997-1998 Innovative Environmental Products Tempe, Az VP MARKETING Negotiated NASCAR license for environmental cleaning products Introduced company to online marketing Created web site Created marketing strategy and plan 1:1 counseling on business strategy for CEO
	1996–1997 Intel Corporation Santa Clara, CA MANAGER, WORLDWIDE PRESS RELATIONS, Computing Enhancement Group 8 direct reports Introduced digital imaging, Internet phone (VOIP), USB, and Intelligent I/O to both b2b and consumer markets Supported Intel’s appearances at Comdex, CES, and Semicon West trade shows Delivered and participated in 360 feedback process
	1980-1996 Hardaway Marketing Services Phoenix, AZ Founder and CEO P&L Responsibility for $2m annual budget Became largest PR and marketing agency in Phoenix 15 direct reports President, Arizona Commercial Real Estate Women Counseled 1:1 clients of all sizes on networking and public relations
Education	1968 Syracuse University, Ph.D. 1963 Columbia University, M.A. 1962 Cornell University, B.A. high honors Bronx High School of Science
Community Organizations	National Business Incubator Association, Phoenix Community Alliance, Churchill Club, Silicon Valley Association of Startup Entrepreneurs, National Network of Commercial Real Estate Women, Social Media Club, Arizona Technology Council

Hostess with the Mostess

2007-04-09T11:49:00.001-07:00

Hostess with the Mostess
Originally uploaded by chelsea hardaway.

Chelsea's Bo, part of the Golden Retriever nursing team,. welcomes me back to Half Moon Bay after the surgery

Grief

2007-04-08T14:31:00.000-07:00

I have had a horrible week. Although when I went to the doctor she told me nothing was fractured or loose, and that I was still healing well, it didn't cheer me up. In fact, very little cheered me up. I managed to make everyone in my life angry with me, because I was so self-absorbed that I wasn't "there" for any of them, although I thought I was running around trying to help everyone.

Finally I began to think that, four and a half months out from the hip replacement, still in (some) pain and still limping or leaning, I am mourning the loss of my youth. Or at least that part of my youth represented by the ability to walk gracefully without shifting and leaning from side to side or limping. When I was younger, no one could notice I had scoliosis. Now my right shoulder is visibly raised all the time. And no amount of exercise that I've done so far has been able to impact this.

I have tried very hard to embrace wisdom, age gracefully, etc., but I think I must be fooling myself.

Concerns

2007-04-02T18:47:00.000-07:00

More clunking in the hip joint when I raised my leg today, so I was told to get X-rays, which I will do tomorrow.

Meanwhile Chip, the trainer, came over and tested me. He was pretty worried for a while that the joint was unstable, but after he tested me, he thought maybe the issue was just a tight ileo-tibial band and an unconscious external rotation that turns the wrong muscles on and off.

I must say that after he massaged me, my hip joint didn't make the same hollow clunking that it had before. But there is still a chance that I will have to have a revision, which means going through all this stuff all over again -- another surgery, another anaesthesia, another rehab. I was close to tears when Chip was telling me about it.

It is, however, only during flexion, so maybe it's okay.

Clicking?

2007-04-01T14:22:00.000-07:00

After two weeks of yoga without consequence, this morning I went to the gym to do the exercises Chip gave me. When I finished the series of exercises, I decided to see whether I had gained strength (although I knew I had), so I went back to some of the exercises I used to do with the physical therapist. When I got to the marching, I noticed that when I raised my (operated) leg, there was a painless catch or click that I could feel, rather than hear, and I wonder if that's normal.
It's almost as if the joint is catching up somewhere, and maybe it's on a muscle, tendon, or ligament that surrounds it.

I'm gonna ask the experts. Better safe than sorry.

Flow

2007-03-24T13:31:00.000-07:00

I can flow! This is very important because...well, because I could always flow before. So now I feel "normal." When I went to Dr. Whirlow she told me I should stop when I felt things pulling. This morning in the flow class, I could tell when it was overstretching either the hip tissue or the groin tissue, so I just backed off. I also didn't do anything that involved crossing my legs. Oh, and I didn't really try to balance on one leg without a wall next to me.

But that was a surprisingly small part of the practice, and again I realize how important yoga is for both stretching and strengthening. And how, because it is also a breath exercise and a mental/spiritual exercise, the fact that you have done twenty pushups in an hour doesn't even occur to you.

So what's left now is some tissue healing and some scar tissue that has to be stretched and moved gingerly. But I have just had my four-month anniversary, so there's more improvement to come.

Cleared for Yoga!

2007-03-18T07:27:00.000-07:00

Dr. Whirlow cleared me to go to yoga! This is news so good that it immediately caused all my remaining aches and pains to vanish, which tells you how much of all this is psychological. When you think you're a patient, you feel sick. When you feel like you are in training, you feel like a strong athlete. Go figure.

I went to a yin class, where you hold the poses for a very long time. I asked the teacher to watch me to make sure I didn't internally rotate (the only real restriction), and she actually structured the entire class without internal rotations. The good teachers like to do that, because it makes them think, and the entire class can learn from it. However, by now I am pretty sure I know what's an internatl rotation.

Dr.Whirlow also gave me a little card to carry in my wallet saying I am her patient and I have a metal implantable device. Not that I've ever had any trouble making myself understood at the airport; you get wanded either way. I'm going to volunteer to be one of the people who try the new scanner, which I've sure will be much faster. They are testing one at Sky Harbor Airport right now.

I feel so much better.

She also told me that I had a 36" head on my replacement so it fit right and I would have very little chance of dislocating -- except with a lot of force. That's for the woman from Harvard who has been reading this before her own replacement. I hope yours went well. Now you start the tough part, climbing back to full functionality. But it can be done. I did it! I blogged it. I'm here to tell the tale.

chauncey in bed

2007-03-11T12:46:00.001-07:00

chauncey in bed
Originally uploaded by hardaway.

So this is one of the dogs I can now walk on a leash. He's Chauncey, he's five, he weighs 85 pounds and he accompanied me through the surgery. Notice that he is a male, and he therefore thinks he controls the remote :-)

He now has a baby brother, a one-year-old golden I rescued and named Luckly Puppily. Although I didn't get Luckily P. until New Year's Eve, I was only about six weeks post-op, and I absolutely couldn't walk either dog on a leash. Ever try to leash train a puppy that you can't tak on a leash? I had to defer the job until very recently.

Just an update on me...

2007-03-11T12:30:00.000-07:00

It has been a while since I posted to this blog, because I've been at a standstill in my recovery. But I've been working with my gaiting coach, and I'm getting there -- wherever there is. My daughter still says I'm "leaning," and last night someone told me I was limping. However, I can do everything I used to do, and the only pain I have is when I arise from a sitting position and take the first step. I wonder if that's even the hip, or whether it's all the underlying back problems.

I also feel very strong. I walk two golden retrievers short distances on leashes.

I've been back to yoga, even to Vinyasa, although I didn't flow on the left side. I also don't hug my knees to my chest (going through 90 degrees), do certain ab exercises, or do plow pose or twists. Or pidgeon on the left.

But that doesn't mean yoga is not helpful or possible. What it does mean is that before you go back after your hip replacement, you should demonstrate to a knowledgeable person (surgeon, therapist, or yoga therapist) the asanas you would like to do, but have safety questions about, in order to get an educated opinion.

Or, I supposed you could just wait a year, when almost everything is probably safe.

Progress!

2007-02-23T06:37:00.000-07:00

I have about twenty pages of exercises to do from the trainer. After a month of working with him personally once a week and doing the rest of the stuff completely three times a week and partially on other days (I also have a life) I am beginning to see some real progress.

The exercises range from curling the bottom of my feet to get my arches to develop, to things for making my ankles stronger, to lat pulldowns and stabilization exercises. I am amazed at how complex the act of walking truly is. I knew not many other animals did it, but still...

The good news is that Chip Weber, ths gaiting specialist, knows what he's talking about and I am really making progress. I've graduated from a limp to a trundle (or a waddle), and I can actually make that go away, too, if I concentrate.

This rehab has been harder than I thought, but still is working so I feel good about it.

Three months out (and still limping)

2007-02-15T12:50:00.000-07:00

I am still stiff on the left side and limping. It has been three months. I don't have the patience to do much more rehab, although I've been doing the latest trainer's exercises every day. I've lost muscle mass, and therefore gained body fat was well as pounds. I'm beginning to lose my optimistic attitude. And I don't even have any complications.

The health care system still doesn't tell you the truth. Although Janet Whirlow tried, she can't compete with the minimally invasive procedure's rehab results. Well, I really don't know that, because I didn't have one. But there seems to be a lot of tissue healing still going on, and the fact that I still have pain when I get up from a seated position and have to force myself to walk without limping or leaning bums me out.

Amazing how long it takes to re-establish that glute, and how the other muscles compensate and cause you discomfort while they're doing so.

In the meantime, I'm also bummed because I have other medical issues: just had a squamous cell carcinoma removed from my nose and need to have a small skin graft tomorrow which will take up the entire afternoon; have been told by my eye doctor that I have cataracts on the way to needing treatment. One thing after the other. Growing old is, indeed, not for sissies.

2007-02-09T06:14:00.000-07:00

I didn't really "get" this before, but tissue is still healing after three months. I just didn't know that until I saw Dr. Whirlow yesterday for my three month visit.

I'm not going to remember the technical terms, so I'm not even going to try, but Dr. Whirlow told me yesterday that the first new cells are the kind that let you bear some weight, and then those that let you go about your everyday activities. The last kind to form are the kind that help grow the new hip joint into the bone--bone cells. And if you go back to weightbearing exercise too quickly, you won't form those bone cells correctly, you will form fibrous tissue instead, which is weaker and deteriorates more quickly.

Okay, that's the best reason I know not to over-exercise. Finally, she gave me an explanation that gets through to me. It's not only about making the muscles stronger; it's about making the new bone grow properly around the joint.

No wonder they don't want you to give up the cane too quickly.

So I was right to give up physical therapy, where they were making me do exercises that hurt. Stepping up on a 6-inch step for 45 repetitions and shifting my weight completely over to that hip is probably not what I am ready to do yet in my body.

Ironically, this makes me feel better and not worse. Why am I still waddling? Because I have to grow the new bone; I can't just support myself on muscle, no matter how much I work to develop it. Didn't I just find that out before the surgery, when I went to all that physical therapy? At least now I'm waddling, rather than limping.

It's the rehab, stupid!!! I was focussing on the surgery.

I have released myself from physical therapy. I'm now working with a kinesthesiologist who also works on horses, and is helping me with my gait. He has given me, among other things, a foam roller to massage my ileotibial band, which tightens up when I talk.

Time goes by

2007-01-27T17:23:00.000-07:00

Things are getting better. My surgeon recommended a body mechanics specialist who understands that it's stretching I need. As I knew they would, lots of muscles have gotten weak and tight without yoga. He gave me a new series of exercises.

I have also been going to a different PT who seems to have given me better strengthening exercises. Although I still get tired and limp, I've been taking the dogs to the golf course and loving it. And today I was practically dancing in the pool. I don't limp at the beginning of the day.

But I will say this, as I've said before: the surgery was nothing compared to what I expected. It was much easier. The rehab was nothing compared to what I expected. It is much harder. I think it depends on what your expectations are for yourself at various time periods. I'm almost nine weeks out, and I think I should be finished with all this rehab.

That's it for a while...

2007-01-19T07:32:00.000-07:00

I'm almost eight weeks out, and I'm pretty much back to my old life, give or take a little discomfort, a limp, and continuing physical therapy. Nothing that happens to me and my new hip is interesting; today I went to the gym and divided thirty minutes of cardio into ten minutes on the upper body ergometer, ten minutes on the bike, and ten minutes on the elliptical cross trainer. This is not the stuff that needs to be written about every day -- nor is the fact that every morning I march on the Biltmore golf course with the dogs to practice picking up my feet when I walk.

I'll come back to this blog when there's something worth reading. Off to the dog park.

2007-01-15T20:44:00.000-07:00

I had the greatest trip to California. Big difference walking through airports now that I have the hip replacement; I no longer look to see how far away things are -- I just set off like I used to. And I feel as though I am getting more and more stable. My back is loosening up, too, now that I'm doing some yoga. One thing I see I cannot do:sun salutations. They violate the hip precautions when I step my left foot forward and put my arms on the floor.

I'm about to blow off the physical therapy and get on my own program. I know which muscles are weak, and I know what to do to strengthen them, and I feel silly lying on the table with a heating pad, because I'm always already warmed up when I get there.Â yesterday I went to the gym and walked the treadmill/rode the bike for 30 minutes.

Stay tune! This is 8 weeks and I am getting much better again.

Update: went to a physical therapy when I went home and got some good standing exercises that build strength. No more of this heating pad stuff.

Pilates

2007-01-13T19:34:00.000-07:00

Once again I have come to the conclusion that physical therapy is a poor substitute for some of the kinds of body work I have done in the past. Today I went to a Pilates class, the first clase of any kind I've been to since the surgery. It seemed great to be in a class. I modified a few things to deal with the hip precautions: bent my knees and pointed toes out when I folded forward, and didn't hug my left knee into my chest. But otherwise I had a great time and I think it made me feel much looser.

And then this afternoon, I had a deep tissue massage, after which I wasn't even limping. The massage therapist told me to go home and take a bath for a half hour in Epsom Salts, which have just re-surfaced in my life. They were a part of my childhood, and then I somehow forgot about them. But they do take out toxins and prevent soreness, so I did it.

And I realized I've spent the entire day without the cane.

Golf course

2007-01-11T07:48:00.000-07:00

Before I had hip problems, I always took the dogs to the golf course in the morning so they could blow off some steam and not want to tear up the house. This morning, for the first time since the hip replacement, I loaded them in the car and took them up there alone. The part of the golf course I used to walk is about a mile and a half, and I wondered if I was going to be able to do it. Answer: yes!!! It was so much fun to be out where I used to go and also so much fun to watch the dogs run and cavort that it really didn't feel like any distance at all.

One problem: at the end of the walk when I had to put them both back on leashes (one weighs 58 pounds and the other 84 pounds), Chauncey -- the heavier one -- decided to pull on me. Only when he did that did I realize I'm still not fully recovered inside. I was sore.

New PT

2007-01-10T16:50:00.000-07:00

I'm working with a new physical therapist who puts a heating pad on me and gives me ultrasound before making me walk around and watch myself. She explained that I am not transferring weight to my left hip, probably because I have bad habits, and that's why my walk looks so pathetic. She makes me walk thoughtfully on the basketball court while she watches. And then I go to the pool to try to emulate the walk by myself in water, where it's easier because I only weigh ten pounds.

I heard that a (male) friend of mine had a hip replacement on December 7 and is already walking without a cane. Made me feel bad. But I bet he had the minimally invasive kind, and doesn't have my back issues or my bad walking habits. It's not a competition.

Onward and upward, working those muscles.

Real good advice

2007-01-09T06:25:00.000-07:00

Last night one of my favorite yoga teachers read my blog. Here are the comments of Jeff Martens:

The good news, if it can be called that, about not having a pirifomis is that you probably won't ever get sciatica on that side as many times this results from a pinching of the nerve around that muscle. The pirifomis is one of the major players in outer spiral of that leg. You still have your glutes and tensor fascia lata (don't order this at starbucks).

When standing, or if the femur is in a fixed position, flattening out your lower back on that side will be more of a challenge now as might pelvic medial rotation - swinging that side of the pelvis (and raised flexed leg) outward. (yep --Francine) That old exercise of laying on non-surgery side and raising other leg upward very gently and consciously could start to build supportive synergistic muscles. You are also going to want to find ways to keep groins and adductors on inner thigh flexible as that side adductor muscle complex is losing a good antagonist and could just atrophy a little or shrink without that constant antagonist action helping to keep groins toned and stretched. (Already happening --Francine)

You might also want to explore your sartorius muscle which flexes and rotates knee and hip in relation to psoas. The sartorius is very sensitive to trauma in the form of adrenal exhaustion.

Here are some unsolicited pointers for the poses you do:

1)child's pose: isometrically press knees together and then isomentrically feel like you are moving them apart every once in a while without moving knees to gently activat enervous system and retrain to move w/o piriformis.

2)cat/cow -- really work pelvis and sacrum gently through full range of motion.

3)downward facing dog -- work tailbone up without collapsing kidneys

4)warrior II -- use glutes to draw front kneestraight over foot instead of collapsing inward. Do this dynamically, bending and straightening knee, but very small motions and knee not bent much at deepest for now.

5)triangle -- use arm of chair to support and activate quadricep strongly. Then work on "wagging" tailbone from side to side gently in the pose, as if there were a broom attached to tailbone. This will keep fine abductors and adductors toned and balanced.

6)half moon (a standing pose in which you link your hands over your head, lean left, lean right. -- This version of ardha chandrasana is good. Draw tops of your femurs in and fire legs deep into ground. This will also be good for sartorius and IT band.

7)any good backbend. I do Camel. -- It would be good to do a backbend where the femurs are fixed by standing or keeling and another where the sacrum and legs are free, as in locust (lift back legs one at a time while on stomach, then both) "airplane" and cobra.

Along with Supported bridge pose, this will keep sacrum freer yet seated "into" body (perifomus inserted on inner sacrum). you can alter knees in and straight for couple minutes each in supported bridge and breathe healing into area.

2007-01-08T07:09:00.000-07:00

Been doing the pool since Dr. Whirlow told me to. Today's the first day of my new physical therapy, so I hope things will be better. Here's a sequence of yoga poses that help stretch the back body after all the strengthening exercises physical therapy asks you to do:
1)child's pose
2)cat/cow
3)downward facing dog
4)warrior II
5)triangle
6)half moon (a standing pose in which you link your hands over your head, lean left, lean right.
7)any good backbend. I do Camel.

These are probably not in an order that facilitates flow, but that's not what I'm after :-) After I do those, I find I can walk painlessly without the cane for a while.

Type A Rehabber Forced to Face Facts

2007-01-06T11:19:00.000-07:00

Dr. Whirlow gave me my wings back today. I can fly, as long as I wear a compression sock. I can do many familiar yoga poses, including pose of the child, because I am externally rotated in the hip when I do it (everyone is). I cannot: touch my toes with my legs straight, internally rotate my hip joint, pull my knee into my chest, cross my legs at the knee. This may be forever. This means I can't do "cow-face" pose.

I asked why I still limp and have some pain. She told me I ought to watch a hip surgery so I could see and understand what I have gone through. She said I was "cerebral" enough to understand.

Short version: I am doing too much. What a surprise. As more and younger Type A people have hip replacements, the doctors and PTs are going to see this again and again -- people who are not just thrilled to be out of paibn, but want to be NEW.

I guess I can't expect to walk perfectly at six weeks after collapsing into my hip for the better part of a year. And at this stage of the rehab, I should be doing more pool and less treadmill and bike. (This comes on the heels of a morning in which my new puppy ate the waterproof MP3 player that I was using to listen to podcasts while walking in the pool. It was a Christmas gift from Chelsea, but since we both love dogs we pardoned the puppy and I ordered another one.)

When I went this afternoon for the six week checkup, Dr. Whirlow looked at my still-swollen leg and told me it might be swollen for a year. Who knew? She looked for a clot as the cause, couldn't find one (she made me tense my calf muscle and asked it if hurt), and decided the swelling fell under "normal." She said it should be treated. Was I elevating it? No, no one really told me to do that. Was I receiving lymphedema massage from the physical therapist? No. I told her the physical therapist was working on helping me stretch my piriformis, which the PT thought was the source of some of my pain.

"You don't have a piriformis anymore," Dr. Whirlow responded. " I sent it to pathology. That's where I insert my chisel (or some tool like that)." What a revelation -- no piriformis on the left side!

So I am changing physical therapists. This is good news to me, because I thought the PT wasn't helping. And I am starting to go to a trainer who will help me work on my gait. I feel like a dog going through agility training.

Dr. Whirlow also said that it takes a year and a half to regain all function if you don't do the physical therapy. The therapy speeds it up a lot, but you can see where she's coming from. It's not a simple rehab.

Oh, and I need to walk more slowly.

And we will collaborate on a pamphlet of yoga poses for people who have had hip replacements. This is long overdue.

The X-Ray

2007-01-04T13:49:00.000-07:00

OMG, I got the X-ray of my new hip yesterday. There it is, gleaming in there like the solid citizen it is, in sharp distinction to the other side of my pelvis, where my own right hip languishes in shadows and shards. There's nothing wrong with my right hip -- it's just not titanium and ceramic. It's pretty amazing to get a glance at a foreign body in your body, especially since I don't FEEL anything different now that the incision has healed.

Yesterday I read the blog of a football coach who had both hips replaced and blogged about the second one at www.geezerjocks.com. When he described his exercise routine after the surgery I almost fainted. He lifted heavy weights almost immediately, which amazed me. And he was walking long distances, too. Eeek. So I went to the gym twice in twelve hours, last night and this morning. And I'd better take the dogs somewhere tonight, too. Gotta catch up!

It's the Psoas, stupid!

2007-01-03T14:41:00.000-07:00

Before I had my hip replacement, Jeff Martens (one of my favorite yoga teachers) , came to visit me. He brought with him a book about the muscles involved in yoga, and somehow we got into a big discussion about the psoas. In yoga, the psoas is known as the place where people hold unpleasant emotional memories. Clearly, before my surgery, my psoas had gotten so tight that I couldn't extend my left leg flat on the ground while laying on my back. Jeff's thought was that the holding in my psoas represented a failure to deal properly with the grief from both my mother's and my husband's deaths six months apart --which I tried to shove under the rug because I was working for Intel at the time.

But after my surgery, I'm still in pain when I try to bear weight on my left leg. And where? At the site of the psoas.

I had asked my physical therapist why I still limped when I tried to walk without the cane, and she merely dismissed me as too early in the process. However, I disagreed, and today when I went into the PT place I saw a different therapist. This therapist tagged it immediately: my psoas was still contracted. She spent most of the therapy releasing it, and at the end of the session, I walked with almost no limp! This is promising.

I see a difference (again)

2007-01-02T17:28:00.000-07:00

Every once in a while I make a leap (well, figuratively) forward and I'm re-energized for rehab. This morning I walked almost effortless up the steps to the main gym floor, and I left my cane in the car altogether. Now it wasn't pretty, but it worked.

The gym had an after-New Year's special: free body fat calculations. All my life I've thought of myself as muscular, so I submitted to the test. Lo, I was declared to be 33% body fat. Damn! I know that's not a really accurate measurement, but it's not far off what my fancy Tanita scale says, so I must be in worse shape than I thought after this surgery. That's something we never think about: what a couple of months of relative inactivity can do to all those calculations.

So I went to the Internet and looked up what someone my age should be. First of all, they stop calculating after age 55. Everybody 56 and up is lumped into the same group. Ideal for women my age is 26.5-31.3. Average is 31.3-36.3. So I'm on the low side of average, only the average American is overweight and overfat.

As soon as I see Dr. Whirlow and she lets me, I'm gettin' a trainer. These goldens aren't doing it for me :-)

Luckily

2006-12-31T18:48:00.000-07:00

First Shot of Chauncey's Baby Brother, Luckily

2006-12-31T18:41:00.000-07:00

He came to us today from the golden rescue folks -- between 1.5 and 2 years old, 55 pounds, and a littl furball. They call him Red in their system, but then they found out his real name was Lucky(he answers to it). I've morphed it a little into Luckily: Luckily, I found you! Happy New Year!

Gym

2006-12-31T07:40:00.000-07:00

At the gym yesterday I took the water aerobics class, up to the point where the instructor started doing things that violated the hip precautions (jumping with bent knees,bringing knees to chest). It was fun and easy. Today I go to the gym to walk the treadmill and ride the bike -- I'm doing different things every day. Very, very slowly, my walk without the cane is improving and putting my full weight on the joint is hurting less.

Just in time. The Golden Retriever Rescue people called me yesterday and they have a new golden for us! I think we get him today. He's two years old and his name is Red. I'll have to change that.

What's perfect is that I always stay home for New Year's Eve, and it will be Red's first night. He won't think he has a mother who eats in the restaurant every night :-)

How long IS the rehab?

2006-12-29T07:27:00.000-07:00

I'm on the way to the gym. I can now do the leg press and the abductor machines in addition to the bike and the treadmill. But I'm losing patience with this physical therapy stuff.

Yesterday when I went to physical therapy, I gave Kate, the PT, a piece of my mind. I told her I wasn't getting better fast enough, and I wondered if there was anything wrong.

She sat me down and, while stretching my hip flexor, gave me a piece of HER mind. She said I was on the fast track, and that many people at my stage weren't even working on their abductor strength yet; they were still working on ADLs (activities of daily living). She told me that most people were not shown how to get down on the floor or how to pick things up off the floor by putting one leg up behind them, because they weren't agile enough to do it. And she told me it would be about three months before I could even tell how my walk would look. Basically, her message was "don't complain; you are far ahead of everyone else."

While Dr. Whirlow didn't tell me it would be the easiest rehab because of the weakness in all my muscles, she didn't really EMPHASIZE the length of the rehab. She did say it would be work. But somehow I had the idea that after six weeks, something magical would occur and I would BE HEALED.

Actually, this isn't so. I can walk miles with the cane, and I have lost most of my pain, but when I try to walk unaided, I can see how far I am from finished with rehab. This makes me impatient, because I was willing to give it six weeks, but not six months.

So here I go, over to the gym. Today I will not walk in the pool with the underwater MP3 player I got for Christmas, but I will ride the bike with my regular IPOD. I vary these exercises in case one works better than another :-) And I will continue my magical thinking: one of these days, I will be healed.

Not about my hip replacement, but...

2006-12-28T06:52:00.000-07:00

The Stealthmode server was moved yesterday, and the link to my Stealthmode blog is down. I'm frustrated, which doesn't contribute to my recovery from surgery, so I will post my business blog post here and cross-post it when my blog comes up again...

John Edwards has chosen to announce his candidacy on YouTube, and Paul Kaputzka has covered it for NewTeeVee, part of Om Malik's blog.
Because of my advanced age and non-technical background, I'm careful which blogs I comment on, for fear of being considered a little old lady with a cane. But if it's one place where I'm experienced, it's politics, so here goes.
I can't let my friend Scoble, one of the most honest and open journalists on the planet, get excoriated for leaving his wife Maryam and son Patrick over Christmas vacation to go to New Orleans' Ninth Ward,, Iowa, and New Hampshire -- not exactly top winter vacation destinations.
This is ridiculous. I am as pissed at reporters who are in the pocket of politicians as anyone, but just because someone rides on a campaign plane does not put them in anyone's pocket. For Edwards, who strikes me as an earnest man, this is a way to reach out to new constituencies who don't vote (young people) and should. For Scoble, it's a way to document how social media is influencing politics. It wouldn't matter who the candidate is.

The Cane Collection

2006-12-27T06:27:00.000-07:00

I should probably mention that I treat my cane the way I treat eyeglasses; I don't use the Walgreen's $20 special. Instead, I make it part of my wardrobe and my fashion statement. This probably comes from my yoga practice of acceptance.

So I found a web site that sells fancy canes and I bought replica of a cane that's in a French war museum, and one that has flowers and greenery, almost like cloissone, trailing up and down the shaft.

The historical French cane cost a couple of hundred dollars, but the other one was quite reasonable, and when I wear them people comment on how cool they are.

I am doing warrior and triangle poses now, for all of you who practice yoga. And for all of you who don't, you probably should start before the surgery, because yoga poses are a much more pleasant way to regain your muscle strength and flexibility than 10 reps of something at the physical therapist. There's something about repetitive motion that eventually makes me mad, whereas two or three warrior poses, perhaps because the stretch and strengthen at the same time, feel GOOD.

And now for an update on me

2006-12-25T06:32:00.000-07:00

Merry Christmas! Five weeks ago today, I was preparing for surgery. Waking up hungry and not being able to eat because of the anaesthesia. Today I get to eat all day long, going from party to party.

I'm weaning myself slowly from the cane, but it isn't easy. I still can't bear all the weight on the operated leg without bracing the other leg against it. For you yogis, I can do tree pose, but not king dancer. And when I walk caneless, I limp. So I can see it will be a long haul to develop these muscles again. On the other hand, I've gotten up quite a head of steam on the cane, so I am walking fast again. I'm beginning to think a lot of this is the problems in my back, which haven't been able to be fixed by yoga in two months. This deserves more investigation.

But not today: it's Christmas.

This blog makes the news!!!

2006-12-25T06:28:00.000-07:00

Club shows firms how to use the Net's social side

Sonja Haller
The Arizona Republic
Dec. 25, 2006 12:00 AM If podcasts, wikis, blogs, and vlogs sound like sci-fi movie characters to you, you are not alone.

Yet even the handful of the 40 or so attendees at a recent Social Media Club-Phoenix meeting who could not define these Internet communication methods saw the value in learning about them.

"It's where things are going," said Rex Reynolds of HQ Quotes LLC. He said he attended to learn how to market his business and receive more immediate public feedback through online communication like blogs or online journals.

He said he saw the meeting as a free tutorial. "The intellectual capital in this room is amazing," he said.

The alphabet-soup names represent a shift in the way business, from issuing corporate news releases to generating clients for a home-based business, will be done in the future.

Pioneers in the Valley's new media enterprises, along with teachers, life coaches and professionals in non-profit groups, public relations and marketing, attended to explore using Internet tools to find customers and compatriots.

Making new communication methods a part of a marketing plan has become increasing important to businesses that want to more closely monitor and understand their target markets, Sheila Kloefkorn, president of the Phoenix chapter of the American Marketing Association said in a telephone interview.

She noted that social-networking sites like MySpace.com and Facebook.com provide opportunities for businesses to learn more about what makes their target customers tick.

"I think the real opportunity is that more and more people want to control their media, so you hear a lot about consumer-generated media, meaning we all want to go on and have our own little community of just the things we care about," Kloefkorn said in an interview last week.

She also is president of KEO Marketing Services in Tempe.

The power and perks of social media were illustrated in a story told by club organizer Francine Hardaway, president of Stealthmode Partners, a business consulting firm in Phoenix.

During hip-replacement surgery at Scottsdale Healthcare Shea, she began blogging about her recovery. Word spread that she was writing about her experience as a patient for all in Internet land to read.

"They started treating me like a VIP," she said. "The thing about social media for me is its raw power."

At times, the group conversation steered toward geek-speak, but facilitators refocused the conversation on layman discourse.

Marketing and public-relations practitioners like Amanda Vega see the potential for big opportunities for clients who use blogs, social-networking Web sites and other online venues to tell the public about their company.

Companies that don't incorporate such outlets into their marketing efforts, she said, run the risk of disenfranchising potential customers, especially younger ones.

"There are a lot of younger audiences that will not buy from people who do not have a Web site, specifically if you can't buy online," said Vega, owner of Amanda Vega Consulting in Phoenix and a club participant, "They don't trust you. You have to have some sort of online presence."

Vega noted that some of the public companies her firm represents have turned to online forums such as blogs to disseminate U.S. Security and Exchange Commission filings, which can help garner more attention than the traditional news release.

The Phoenix chapter of the Social Media Club had its first meeting in November and is still in the early stages of defining its agenda.

"The water's warm. There aren't any sharks in it," said attendee Steve Epstein, chief technical officer at Media2Eye.com. Epstein's comments were aimed at people interested in aspects of social media but perhaps intimidated by the terms and their lack of knowledge.

The Social Media Club's headquarters is in San Francisco. Since it began a year ago, clubs have also launched in Miami, Seattle and New York.

Staff reporter Andrew Johnson contributed to this article.

Reach the reporter at sonja.haller@arizonarepublic.com or (602) 444-8998.

Christmas Eve

2006-12-24T09:41:00.000-07:00

Tomorrow will be five weeks since the surgery. I was really sore (muscles) in the quads and glutes from the walking on the treadmill yesterday, but it taught me that there's no exercise to substitute for walking itself, so I will do more of it.

My high school class, in preparation for its 50th reunion in 2008, has started a Yahoo group. One of the women on it has read this blog and asked for more information about my decisions. Because I spent some time replying to her, I'm going to re-post my answers, sanitizing them for privacy's sake:

Where do I begin?
My X-ray was so obvious that I never had an MRI. And I already knew that I had scoliosis, spondylolisthesis, and stenosis in my back. But I wasn't in pain from my back after I started to do yoga. Naturally I tried first to treat my hip with yoga. It didn't work at all.
That being said, anyone else might want an MRI. Some symptoms are slightly different from mine; I couldn't get my legs straight out on the floor because I had compensated for the hip for so long that my psoas and quadratus lumborum had tightened and weakened, even with the yoga. I was also losing strength in the gluteus medius. I had lost a lot of muscle strength of which I was unaware. All I knew was that I couldn't balance on my left leg. I never bothered trying to figure out why :-)

Why I chose the procedure I did:
I knew I wasn't a candidate for a resurfacing. My X-ray said my femur was literally jammed into my acetabulum; I had collapsed into the hip on that side. This did happen within a six month period.

I went to a doctor who does the minimally invasive procedure, and he was very cavalier about the impact of a hip surgery on the delicate balance of my back -- he said it wouldn't matter. Ten years of yoga study told me it would. Everything's connected.

So I went to a doctor who does the normal procedure -- a woman. She said that to position the joint correctly so that it didn't throw my pelvis/back out of line, she had to see into the joint space more clearly than the minimally invasive procedure would allow. She said I wouldn't have a large incision, however, because I wasn't fat. That was on the first visit.

She sent me for pre-op physical therapy, and the PT there told me that she had one surgeon client who did nothing but revisions on minimally invasive surgeries that didn't work, and that the failure rate was higher than one would like.

In further discussions with Dr. Whirlow, I cried over the possibility that I could no longer do yoga after the surgery because I needed it for my back. She then told me that there was a new theory that if you put a larger femoral head in, there was greater range of motion and the patient could do more activities afterward, and that she thought since I was an athlete I would want this. That's how I ended up with the big incision. I could care less.

I have had a lightning recovery. I was out of the hospital in three days, out to dinner after 5 days, driving after ten days. Yes, my muscles were cut and I am walking with a cane, but I have almost all my strength back after less than five weeks and I am doing many asanas already. I plan to go to a gentle class on Christmas Day now that I can get down on the floor. It's because of the Pilates and PT I did before.

I delayed the procedure to get mentally and physically ready. I never expected to become infirm. It scared the shit out of me and I had to come to terms with it. I have consistently denied the amount of pain I was in. I took the pain meds for four or five days after the surgery, but I find I can deal with a fair amount of pain and would rather have my wits about me.

I think I tried not to feel sorry for myself and to be unattached to the outcome. I had been to India twice, I understood a lot about Buddhism, and I summoned my yoga training.

Downward Dog

2006-12-23T10:46:00.000-07:00

Well, not quite, but yesterday the physical therapist, after a series of exercises designed to show me just how week my abductors are, also showed me how to get down and up from the floor without breaking the 90 degree rule. This involves going into a standing split, which I easily can do, with the operated leg out behind me, and then sinking on to all fours on the other knee.

90% of the hip replaced population wouldn't care about this, but for me it means I can go back to most of the yoga poses I did before the surgery, with the exception of forward folds and twists. That rocks.

She also had me walk on a treadmill, so this morning I walked on the treadmill for ten minutes in the gym and then rode the bike for twenty minutes. I am back to a half hour of cardio, albeit at a lower intensity, which is where I was before the surgery.

And you are asking why I don't talk about going into the pool? Because the PT told me I weigh the equivalent of ten pounds in the pool, and I determined will never develop walking strength by just walking in the pool.

I went to the dog park with Chauncey today, too. Man, was he happy.

Muscles I don't have

2006-12-22T10:55:00.000-07:00

Here we are almost at Christmas and I'm still on the cane. But walking better. Nothing hurts. And what I've learned from physical therapy is that I've probably been walking wrong for years. I've always had a very fast, purposeful walk, but it doesn't tuck my tail under me and it doesn't use my hips correctly. I don't wiggle. So I probably haven't had the right walking muscles in many, many years.

Worse, I didn't walk -- I POWER WALKED. Miles and miles. Do I need to know this now--that something I've been doing since I was a year old I've been doing wrong?

I doubt I will ever look like a picture perfect walker. But I can definitely cover some ground.

Four weeks out

2006-12-19T16:46:00.000-07:00

OK, I'm four weeks out and I am beginning to draw conclusions about this surgery that I can share. First of all, the American Acadamy of Orthopedic Surgeons has good information about the surgery itself. But it doesn't really have the patient perspective, or the emotional point of view of someone contemplating the hip replacement.

I was terrified. I had never had surgery, indeed never had general anaesthesia before, which baffled my surgeon because I have two children. But I had them during the womens' movement in the '70s and Lamaze (husband-coached childbirth) was getting voguish. I had two natural childbirths. And I left the hospital after a day each time.

But there was no reason to be terrified. It is an easy procedure for the patient, the anaesthesia wears off almost immediately, and if it weren't for the fact that the surgeon carves you up like something out of a bad episode of Nip/Tuck, there wouldn't be pain. There IS, indeed, pain, but it is under the paitent's control because you are given the morphine pump. That's for the first couple of days, and then you get the cocktails of oxycontin and Percoset or Vicodin.

The pain is from muscles, and how much you have is determined by how badly they cut through muscle to do the surgery. Some surgeons don't cut through at all, but I had a procedure where they put a larger femoral head in so I could have greater range of motion and do more things in the future, and so I have a bigger incision. The other pain is from the incision as it heals. Anyone who has had stitches has had this pain.

The pain goes away by the day, and your strength comes back by the day. It's always discernible (or at least every day I could tell I was stronger). Today I went to the gym and got in the pool by myself, and I did my whole workout that I used to do before.

Now, that's because I wasn't afraid of the pain and I left the drugs behind (except for Tylenol) two days after I left the hospital. To me, that made it easier to see where I was at, to resume driving, and to see where I needed therapy (glutes are firing now, and it's time for the abductors).

I attribute my speedy recovery to my preparation. My advice: don't become a couch potato when your hip starts to hurt. Find a stationary bike, or a pool. Make sure you do a half hour of something every day that mobilizes the joint. Go for physical therapy, and learn what muscles help you walk. Develop them: they won't all be cut. Make sure you have upper body strength so you can walk on the walker and the crutches and get yourself out of bed. And take Pilates or some other core strengthener, again so you can get out of bed.

All this makes the recovery shorter. You don't want it to be longer. The physical therapy afterward is tedious and un-fun. And sometimes it hurts. So you want to get through it asap, trust me...

Floyd Landis and Me

2006-12-18T11:18:00.000-07:00

Yesterday afternoon I got bored so I went to the gym. I got on the exercise bike and rode the full 22 minute cycle and cooldown on level three, with absolutely no pain. Now, was I sore this morning? Absolutely, but who cares? I wasn't any more sore than I was after this morning's physical therapy, because my abductors are really still asleep. Also having an interesting problem levelling my pelvis, because my proprioception is off.

Also saw an article in the paper that Elizabeth Dole is recovering from hip replacement surgery. Like me, she scheduled it for the interstices between appointments :-)

I feel I am almost at full strength. Fewer naps. Less unsteadiness. Easier to climb steps. And I can do a lot of yoga asanas that fall under the hip precautions: half moon, chair pose, camel pose, tadasana, tree, king dancer. Can't turn my left foot in, so I can't do triangle and warriors yet. Also doing wall clock and wall pushups :-) The worst is not being able to get down on the floor.

Walking

2006-12-17T05:30:00.000-07:00

Whooo-hooo! Yesterday I met my running buddies (we used to run 60 miles a week together and do marathons, and now we're all around 65 and walk together) by the Biltmore with Chauncey and we walked the canal. Although I had the cane and we didn't go too far, it felt great just to get out there with them again.

For those who wonder how well I walk after less than a month: not the way I want to. I have a limp, which I am trying to correct as I practice walking. It comes from having weak muscles on the left side that don't allow me to change legs the way you need to when you walk. But I have almost no pain -- only a little every once in a while when I move incorrectly--and it is a pleasure to walk.

Today I will take Chauncey out again. Good thing he orbits around me and I don't really have to have him leashed, because I can't really control him on a leash yet. You have to hold the leash in the left hand, the cane in the right, and if he pulled, I be in a face plant immediately.

One sad thought: there's a former Microsoft employee, a friend of a friend, dying of cancer. He was blogging until a few days ago, and now his family is continuing his blog as he is in hospice. His decline is taking place over almost the exact series of days of my recovery.

technorati tags:francine+hardaway

Physical Therapy

2006-12-16T06:00:00.000-07:00

Got on the exercise bike today for the first time. It was really painless and I see I can go back to the gym, which is good. I've been procrastinating on the swimming, because it's cold. Also because I don't want to fall getting in or out of the pool.

In physical therapy I am working on the transfer of weight from one leg to another that's involved in walking. Because I had pain before the hip replacement, and because I'm still sore now, I have a terrible hitch in my walk that makes me look like a limper. I don't want to have this, so I am going to have to practice walking big time.

However, if I walk any length of time, I still am in pain, so I will have to wait until all the walking muscles get stronger. This morning I am going out with my old walking buddies to walk on the canal, and I'm going to see how far I can go.

Around the house, I can walk without the cane. On the outside, I still need it because my leg gets tired where the muscles are week. Also because I don't want to reinforce the bad walking

Chickened out

2006-12-14T12:54:00.000-07:00

Spent my first night alone last night, and didn't sleep very well. I'm not sure why, because I didn't have any pain. Just woke up and stayed awake for two hours. So this morning I found myself unwilling to take the chance to go to the gym by myself and get in the pool. I thought perhaps that, being tired, I might have an accident. Instead, I am hanging out on the computer and getting up every hour or so to practice walking.

Off restrictions

2006-12-13T19:54:00.000-07:00

I saw Dr. Whirlow yesterday and she decided I could take off my TED sock (yay!) and begin to ride motorcycles again :-)

No, that's a joke. Actually the patient before me in the office was Pat, an acquaintance of min who had her surgery the same day as mine and told Dr. Whirlow "wait until you see Francine and she tells you how she rode the motorcycle." Poor Dr. Whirlow didn't know what to believe, and came in half expecting to be told that I had committed some major violation of the hip precautions.

No such thing: I'm no dope. The most dangerous thing I've ridden in the past two weeks is a barstool. And now that my sentence over, I will admit that I have violated my home imprisonment repeatedly to go to Houston's and to have lunch with clients.

I also walked in the pool and am going to outpatient PT. I have some really bad walking habits, so I will be staying on the cane until I can train my muscles to support my left leg again. This doesn't bother me, as I'm pretty fast on it by now. But I am determined to learn how to walk without a limp.

After three weeks, I am really thrilled by my own progress. Except for the fact that I still don't sleep through the night because I'm uncomfortable after a while in any position, or I accidentally turn on to the incision side, I'm fine and on no pills. I get tired at about 3 PM, but if I take a short nap, I'm good to go again. My next visit to Dr. Whirlow is at six weeks, with another X-ray.

For the first time yesterday I asked what she did, and she assured me that she put in a large head so I could have greater range of motion and more ability to do things like yoga. She told me the implant was made of ceramic, titanium, and one other metal, and that unlike pure ceramic joints, it wouldn't Squeak!

I'm a happy girl. A long three weeks to me, but no one else thinks it was long...I sent the rest of the golden retriever nursing team (Temple, Bodie and Kodie) home to California today. Now I have to nurse my dog out of the depression has has fallen into since they left.

The Pool

2006-12-12T09:49:00.000-07:00

I went yesterday to the outside physical therapist, who looked at my walk and said she didn't like it. However, when I told her I was only three weeks from surgery, she said I was remarkable. But that doesn't change the fact that my gluteus medius is dead, my quadratus lumborum is tight and not working, and a bunch of other things need work. She gave me a list of exercises and told me I was okay to go in the pool.

So this morning I went to the pool at the gym for the first time in three weeks. I cannot tell you how good it felt! And now a word of thanks to Temple, Chelsea's boyfriend, who got up at dawn to drive me over there and stand by the side of the pool for a half hour reading me the pool exercises, making sure I did them right, and also making sure that I can negotiate the gym and the pool without violating the hip restrictions. We did beautifully! Temple is a born caregiver. And in the pool I do not limp!

Me and the Nursing Team

2006-12-11T10:22:00.000-07:00

Three weeks

2006-12-11T06:12:00.000-07:00

My three week anniversary. As I evaluate the pain, I realize I have no more hip joing pain (of course), but I have lots of other pain: muscle spasms in my glutes are the worst, probably because I exercise and use them all day long. But there is also a burning sensation in my groin that reminds me I've got stitches inside me that are probably still not all healed.

It's hard to sleep, because I have to take precautions not to get into the real fetal position and not to turn over on the unoperated side without a pillow between my legs and not to put my legs in a scissor pattern. Lots of lower back pain as well. When I was on Coumadin, I took two tylenol arthritis for this, but now that I'm on an aspirin that I take every night with dinner, I'm not anxious to take Tylenol as well. I think when I get in the pool this will all get better.

I went to a wind-tasting last night and there was a man there who had had a hip replacement four months ago. He was off the cane and walking well, seemed to be in no pain, but he said the socket was moving around his hip because he didn't grow enough calcium to knot it together. He said he could feel it moving. His surgeon put him on Fosamax to grow calcium. Eeek! That's a complication I had never even read about.

I also spent my first night alone on Saturday night, at Temple spend the night with his family. I was fine, and in the morning I got up and went to Starbucks. Just like old times. I think I am almost ready!

Pilates

2006-12-10T07:05:00.000-07:00

By the end of June, Bonnie and I were close friends, and I had much more range of motion but no less pain. I began to read about what I'd need in order to recover quickly from the surgery, and there were a lot of references to core strength and upper body strength. So when I left Phoenix for my summer in California, I decided to go for the core strength rather than find another physical therapist.

Somewhere between Bonnie and Pilates I also tried Rolfing. I actually loved it, because it released all the muscular tightness I kept having from trying to walk on my bad hip. Here's what I learned about my particular situation: I don't stop. I will keep going through almost any pain, and probably without meds. That means I will use any muscle or body part necessary to keep me going, whether it's the right one or the wrong one. By the time I got to Bonnie, I had developed a bunch of alternative muscles for walking, while the "real" ones were short and tight. Both Bonnie and Rolfing helped me learn what muscles I needed to develop and what muscles I needed to stretch.

So a big part of keeping comfortable and keeping going was keeping stretched out. I did this both on land through Rolfing and yoga (where I finally quit going to classes and practiced on my own, only poses where I was sitting or lying down), and in the hot tub at the gym, where I could do the standing yoga poses I couldn't do on land.

I also learned to use ice packs on my butt and groin when I had done something really stupid, like walk my dog up a hill near my house.

But the coolest thing I did all summer was Pilates. I found a great studio near my home in California and I spent a fortune on private sessions three times a week on the Reformer. Pilates also taught me new things about my body, especially how to identify all my core muscles and isolate them.

In a way, all this was a gift; I had spent years being an athlete without knowing very much about anatomy and physiology, which was probably how I injured myself in the first place. Because I am very strong for a woman my size, I just powered through things.In all my years of running, even marathons, I never stretched. And even in my yoga teacher training, I did not concentrate on understanding how the muscle groups worked.

Of course I have made up for all this now. I was destined to get these lessons one day, whether I wanted them or not :-) But I think I could actually teach yoga now, because I have come to a greater appreciation of how its early inventors and practitioners came to it.

Oh, I almost forgot: one other little component of my preparation was to stop my other joints from becoming arthritic. To accomplish this, I practiced something my yoga teacher, Jeff Martens, showed me-- the joint-freeing exercises of Mukunda Stiles. These are an excellent series of easy movements that awaken the range of motion in every major joint. I got down on the floor and did these every morning,

Did I have a life apart from exercise and therapy? I guess not, but I got into it and began to enjoy it. I thought it was a wonderful summer. I even managed to keep my business going. Luckily, I work from home and control my own time!

Pre-Op Physical Therapy

2006-12-09T06:51:00.000-07:00

Bonnie Kurth is a physical therapist who specializes in hips. I went to her for three months, and I learned several things from her: less is more, walk with a cane to minimize pain, and the key muscle for gaiting is the gluteus medius.

Because my hip joint had been collapsed for a long time already,my gluteus medius had gone to sleep, along with a bunch of other muscles that work with it. Before I could strengthen them, I had to stretch them, and Bonnie and I spent a month stretching, which did a lot to relieve my pain. I refused to take drugs, so I was always in pain.

But the anti-inflammatories didn't really do much (and Celebrex carried an increased risk of heart attack) and the idea of taking pain killers and messing with my mind didn't appeal to me. So no drugs.

Bonnie convinced me, while I was laying on her table and she was trying to do trigger point release on me, that I should walk with a cane because she was going to hurt me in order to help me. While I didn't like it, I found a web site called Fashionablecanes.com and ordered a couple of great canes -- one was a replica of an 18th century Royal French walking stick, and the other a spring floral pattern. They made a fashion statement that I wanted to make.

Like me, Bonnie had two dogs, and we were drawn to each other by our understanding of how dogs think (or how we think they think). Because of this, I let Bonnie do some really strange things: for example, she would put a belt around her own waist, and around my leg, and try to dislodge the femur from the acetabulum to give me more range of motion. She was pretty successful in doing that, and I regained much of the range of motion I had lost.

I also switched from painfully walking the canal with my girlfriends in the morning for exercise to water aerobics and walking with the Aquajogger belt. And Bonnie made me aware that I was causing myself more problems by exercising through my pain, because I was compensating too much, This meant I was using all the wrong muscles to do things, and letting the "right" muscles, the ones I'd need after surgery if I had it, atrophy.

Not a big surprise; I've always been partial to outcomes rather than process. I had never studied the process of walking and running, just gone for the outcome. Now, I got to learn what goes into walking--all the little muscles that influence gaiting, like the ilio-psoas, the gluteus medius and miminus, the adductors and abductors. Throw into all of that the functions of the spinal erectors and the core, and you get to realize how complicated this process of walking on our hind legs truly is.

How Our Bodies Age

2006-12-09T02:59:00.000-07:00

http://www.washingtonpost.com/wp-dyn/content/graphic/2006/12/04/GR2006120400761.html?referrer=emaillink

free at last!

2006-12-08T06:50:00.000-07:00

The nurse and the physical therapist came yesterday and discharged me. All my vitals are stable, I'm off the drugs, and I can do all the exercises without help. Except that now she has given me balancing poses: walking forward on my toes and heels, semi-lunges, and balancing on one leg (tree pose). Can't do tree pose yet, but that's a good multi-task for while I brush my teeth.

Ed and I celebrated by going to dinner in the bar at Capital Grille. Tip: barstools are easier to get in and out of than chairs. I've always loved to eat in the bar anyway.

More about how I prepared.

I am on the board of a private school in Paradise Valley. We had a nominating committee meeting one day after my Tucson visit, and one of the women on the nominating committee was a retired orthopedic surgeon. She told me she had practiced many years ago with a woman named Janet Whirlow, and that Janet was the kind of doctor who would look at the interconnectedness of body, mind and spirit, not to mention the interconnectedness of hip and back.

So I made an appointment, and when I got into Janet's office I felt like I was home. Disclaimer: remember I am 65 and grew up in an era when men dominated medicine. Although I actually have had two wonderful female internists, I've NEVER seen a woman surgeon before,and I thought I was going to have to make a mental leap to trust Janet. She's about 5'3", weighs about 100 pounds, and looks -- well --pretty. I have a hilarious mental image of her in the operating room standing on a box to get above some 300-pound guy strapped to the table as she takes the saw, hammer, and drill to his hip. Hip surgery, after all, is carpentry. Period.

Janet took my X-rays and put them up on her light board. She didn't dismiss the idea that a hip surgery could screw up my back. She didn't tell me I should forget about yoga. And because she took the time to talk to me, I began to cry in her office. I told her the other surgeons really treated me like a disembodied hip, that I had never had surgery with general anaesthesia before, and about my fears. She told me she had left a large practice because she wanted the time to talk to people like me.

She also told me that I should train for the surgery, and that I'd have a better result if I didn't rush into it, but took the time to get ready properly. She told me that I would have to donate my own blood, that I would need about six weeks to recover because my surgery would not be minimally invasive, and that minimally invasive surgery wasn't really appropriate for me, because in order to equalize my leg lengths, straighten out my pelvis to protect my back, and position the hip properly so it wouldn't dislocate if I went back to yoga, she would have to open me up enough to actually see the joint. It made sense.

Then she told me I wasn't mentally ready for surgery and probably would be better off waiting until I was, and she recommended me to a physical therapist. And not just any therapist, but a hip expert.

This was May. My birthday was the 14th, and I had scheduled the Tucson surgery right after, so it would be covered by Medicare. By this time, although I was limping pretty badly, I was still terrified about going to the Tucson surgeon, even though he was minimally invasive, so I bailed. I called and cancelled. This meant I could not have surgery again until Thanksgiving, because I was planning to leave Arizona for the summer, and then I was going on a cruise to the Italian Mediterranean in September, and then I was producing the First Annual Arizona Entrepreneurship Conference in early November. So I put off the decision, and instead decided to try everything else in a wild effort to avoid surgery.

And that's how I met Bonnie, who loves dogs.

How I Planned

2006-12-07T06:28:00.000-07:00

Last night I realized that I started this blog in a moment of pique about the admissions process at Scottsdale Healthcare North and its pre-admission process. That, however, does not help the person planning a hip replacement. So I'm going to back track a year, to when I got back from China and realized I was limping. Or rather, people told me I was limping.

I ignored it, powered through the pain, and was determined, at least, to wait until I was on Medicare to do something about my hip, because I had the kind of health insurance that entrepreneurs have -- very little. So the first part of my plan was to wait until May, when I turned 65.

To do that comfortably, I switched my yoga practice to a less strenuous one from Power, after which I used to emerge really trashed. I also began to exercise in the pool at my gym. I didn't want to wet my hair every day swimming, so I walked in the water. And I did pull-ups on the ladder. At first I hated it. But then as always, some really nice people manifested and I formed a new community of pool exercisers -- a man with MS and his caregiver, an older woman who hiked first and then walked, and some Europeans who just believed water exercise was good for you.

By May, however, I was in considerable pain. So I started asking around for people with experience. One of my yoga teachers had a friend in Tucson who had had a new, minimally invasive procedure and was up in seemingly no time with a tiny scar. Ed and I went down to see him. He had learned the procedure in Europe. He had done a lot of them. He acted like it was NOTHING. I asked him a lot of questions about my back and its relationship to my hip, all of which he dismissed with the "don't you worry little lady" attitude of the guy who does 50 surgeries a week, and then he fobbed us off on his office staff.

We did schedule the surgery (same way I put deposits down on new real estate projects as long as they are refundable), and then I went home and started to talk to friends and family.

The logistics of having surgery in Tucson weren't optimal, but they were doable. One of my deal breakers was not to have to go to a rehab facility, however, and we quickly learned I couldn't drive or ride home to Phoenix until I had the staples out. Hmmm. Ten days in a hotel. Or go to the rehab and have Chelsea stay in the hotel.

So I began looking for surgeons in Phoenix who might do that same procedure. At the same time, I had two nagging fearsL

1)the hip surgery would aggravate my back issues, which are not trivial, but which I have always controlled with yoga. After all, when you are a yoga teacher you learn that the "hip bone's connected to the thigh bone, the thigh bone's connected to the knee bone, now hear the word of the Lord." (Old folk song) Often, if you change one thing that relates to the spine, everything else also changes (often for the worse).

2)I would never emerge from the anaesthesia with all my marbles. My mother didn't, so this wasn't just idle anxiety.

...more tomorrow

Dawn in the blogosphere

2006-12-06T06:16:00.000-07:00

I have been trying to write every day about the hip replacement, for others who might have to have one. I do it when I get up in the morning, before everything else intervenes.

I'm now more than two weeks out, and I feel as if I am in the same amount of pain I had before the surgery, but for different reasons. Now the pain is not in my hip, but in my back from general lack of exercise, I feel like I can take care of that problem in a couple of weeks when I am allowed to do things again.

In the mean time, I am now at the point where I am walking with just the cane, and even bouncing off the walls of my house without anything, I feel very steady, and I am going to start driving, since this is my left hip. In week three I can legally go out without losing my Medicare benefits (the home nurse and the therapist) and I will be thrilled to resume my life just in time for all the Christmas parties, Not that I haven't been walking around on my block and in my yard :-)

The scar is healing beautifully, It's big: probably over a foot long. I had a lot of staples. I think that's because Dr. Whirlow had to really look at my pelvic area and back to see how to place the new joint so I could go back to all my previous activities. When I see her on Tuesday I am going to ask her how she did it, and what muscles she cut. I'm getting them back slowly, but I can see now that I will be going to therapy for a long time. I guess that's why people say the rehab is difficult. It is.

Before I had this surgery, I never realized how many things fall to the floor as a matter of daily life. Now, since I have to go find the grabber to go pick anything up, I am acutely aware. Sometimes the cane falls over. Last night I dropped a package of applesauce out of the refrigerator, And feeding the dogs is a logistical challenge; if I leave their bowls on the counter I can load them with food and feed the boys on the banquette in the kitchen. Then no one, even them, has to bend over. But last night Temple fed them on the floor, and didn't pick up the bowls. This morning, when I went in to feed them: GET THE GRABBER, BOYS!!! They don't understand all this complexity, which is why I love them.

My head and my hip

2006-12-05T06:48:00.000-07:00

No one talks about the emotional side of the hip replacement. But believe me, there are issues.

No one likes to be helpless, least of all me. But I realized I couldn't do this alone, so I asked one of my children to help. We did our best to pre-plan, especially for the fledgling businesses she and her SO own. All of us are self-employed and decided that a good time for us would be between Thanksgiving and Christmas when our workloads typically slow down. She brought her family so she could stay for a long time without missing them.

We all had the best intentions. And we thought we had planned.
But from the very beginning, there were problems.

Minor: My house wasn't set up for visitors: no TV in the guest room, small bathrooms, and problems with thick plaster walls and wireless Internet. Rental car too small for dogs.
Somewhat major: She got a request from a client for a project just before the surgery. Another client also wanted her to work with him before Christmas.
Very super ultra major: Neither of us was used to the role reversal of mother being waited on by daughter.

After two weeks of me desperately trying to be a manager and make the house more hospitable for her business from my hospital bed (endless calls to Cox, purchase of a TV,etc) and two weeks of her trying to work in between fetching bottles of water for me, emptying the garbage, bringing me food, and helping me dress, our relationship was completely frayed.

She was desperate to get home to an efficient work environment and some quiet time to work on the projects. I was tired of hearing her complain and watching her (after all, she's my baby) be miserable. Her SO wanted to stay in Arizona and be with his family for Christmas. The dogd were still busy nursing me. We had serious agenda conflict.

After more yelling and screaming than has ever gone on in our family before (we are usually not disfunctional) the obvious solution emerged:
last night, she flew home. The SO and the wonderful boys are here making my life easier.

This was all devastating to me until it resolved, and it gave me a glimpse of what old age, with its increasing dependence on others, will bring. The good news is that this is not a serious illness, and by next week I can go out. The other good news is that I have had a few epiphanies about how I ought to plan for my future ( or rather, THAT I have to plan for my future :-) Just in time.

frustration

2006-12-04T09:07:00.000-07:00

I've reached the point in my recovery where I am still grounded but too energetic to be happy at home. It's after 1 AM and i have been up for a hour. I'm just simply not tired because I was in bed most of the day. I've graduated pretty much in the house to the cane from the walker, and I've done all my exercises.

I'm sure once I am allowed to go out and do daily activities I will be exhausted, because I feel my energy levels varying during the day. But right now, I am sitting bolt upright in bed, typing away. It's not even that there's something on my mind that's keeping me awake, or any pain to speak of. Today I did so little that I didn't even have to take a Tylenol. After a day or two of doing a new series of exercises, I can do them without pain. Although I notice that I still have weak glutes, quads and abductors in the operated leg.

There is also no Internet in the house. We bought a new TV, plugged it in, and destroyed the broadband signal. Cox sent someone over who got it going temporarily, but as soon as he left the house it quit again. I called again, but they couldn't get a technician over until Wednesday. This is Sunday. So I have been calling repeatedly, telling them I am bedridden, telling them I have no home phone without broadband (I have VOIP) and hoping someone cancels an appointment.

Cox has tried to improve its customer service, but it still sucks. One tech on the phone was nice enough, but when I told him I really needed the Internet, he told me to read a book or watch TV. Another tech who I told I didn't want to be housebound without a home phone asked me if I could have someone come over and stay with me. He said,
can't you call a family member to come over? What a jerk! Could never have thought of that myself. And of course a family member is here. But what if she weren't????? The phone company used to be mandated to supply service to elderly and handicapped people living alone, but I don't think the Internet has that kind of mandate. I guess it shouldn't, as a regulation, but perhaps the customer service reps should be trained to make different answers when someone tells them they are homebound, just had surgery, live alone, and are also trying to support themselves on the Internet.

Tomorrow I will see if I can have a Verizon broadband card delivered.

saturday

2006-12-03T08:41:00.000-07:00

Today I walked around the house a little on the cane. When I do it, I can see how weak my left leg is. Some of my muscles have just atrophied, while others were cut or moved in the surgery. It won't be long before I am up and about on the cane and back out in the world, but it might be while until I can hold tree pose for 60 seconds on the left leg. But I couldn't before, either.

Resting Up

2006-12-02T11:32:00.000-07:00

Yesterday was a busy day, and I had to take Tylenol to get the three series of 18 exercises in comfortably. But I am feeling like I could get off the walker -- in fact, I walked from the bedroom to the bathroom on my cane in the middle of the night twice. The only reason I wouldn't try it all day long is that I can feel that the left leg is still weak, and there are four large doggies running around my house. I don't want to fall.

I'm less than two weeks out from the surgery, for those who are contemplating having it, and I have very minimal pain today -- almost none. Without even Tylenol.And I didn't have a minimally invasive procedure. My large scar is pink.

Every time your do those exercises, they get easier, and the advance from day to day is phenomenal.

I am also self-sufficient for dressing, showering, and calling out for food :-) My family and I are beginning to have our customary fun together!

I cannot say enough for a good surgeon.

Pizza

2006-12-01T06:00:00.000-07:00

Much better day. The physical terrorist gave me 18 exercises, each to do 3x a day, so that takes up the day right there. Then Olivia, a housekeeper I have had for over ten years who has also taught me Spanish, came in and cleaned the house from top to bottom. What a great feeling! What a dear friend she is, like my landscaper Rafael, who brought me the sweet bread and pear nectar from the Guatemalan grocery.
And then my friend Steve came by with pizza from La Grande Orange!

Better yet, here's a link to someone who has written in his own blog about my hip replacement blog:

http://elearndev.blogspot.com/2006/11/another-caring-story-and-power-of.html#links

Bummer

2006-11-30T01:41:00.000-07:00

I went to the doctor. She took out all my staples and pronounced me doing beautifully after she lifted and swung my leg around. She was pretty surprised that I was off my pills, and told me most people were still on them after nine days. She told me that I could put all my weight on my leg as tolerated, and take off the TED sock on my unoperated leg.

Then came the bad news. No, I could not go to the movies or out to dinner or, indeed, hardly anywhere because I would lose the home health benefits, including the valuable blood tests she needed to figure the Coumadin dosage. She grounded me until Dec.11.

I cried. I said, "it's about having a social life and going out to dinner."
Dr. Whirlow looked at Chelsea and said, "you are going to have to entertain her."

Even while I was crying and saying this, I felt like a jerk. At my stage in the surgery, most people are still fighting the pain. It's very hard to complain when you are doing as well as I am: you don't get any sympathy. But the better you do, the more you want to do, and the more frustrated you get when obstacles appear.

Dr. Whirlow continued helpfully,"have a dinner party." Chelsea and I looked at her as if she had suggested we give birth to an aardvark. Neither of us cooks, and I lived in my house for almost a year with a gas stove that didn't work --without knowing it. Chelsea is juggling the three retrievers, her business, being away from home, her SO, my TED socks and my personal concierge tasks. Dinner party????????

As a last effort to be helpful, she said, "you can drink a glass of wine while you take Coumadin."

I admire her. She was really trying. I think she was telling me to get blitzed at home until Dec. 11. I am a lucky person to have her...and Chelsea...and the constant parade of people who come to see me and call me all day long.

Tuesday

2006-11-29T07:11:00.000-07:00

Another physical therapist showed up today and told me that, as a recipient of home health services, I had the right to go to my doctor's appointments, my place of worship, my hairdresser (that's quite an interesting one) and that is all -- or I quit receiving services.

She also told me that if I pushed it too hard, blood would pool in the wound and I might get a DVT. This is a direct contradiction to what the nurse said the day before: that more active people had LESS risk of DVT.And another therapist had told me that a lot of the doctors thought there was very, very little risk of DVT unless you had a famly history.

I do know two people who have had them, and I don't want one. But I'm not sure what to do, so I spent most of Tuesday doing what most patients would do: shuffling around the house a little, and mostly laying in bed.

By the end of the day, I was in a big depression, and had to send out to Houston's for dinner. Then, because I didn't do anything all day, I couldn't sleep last night. Fortunately, today is my doctor's appointment and I will get some decent advice about what to do next.

Resting

2006-11-28T02:59:00.000-07:00

The big concession I made to my wild weekend was not to go to Starbucks on Monday. , Chelsea brought it back for me. We've got those TED socks and the plastic bag thing knocked, so I got dressed and hung out for a while with Mark Salustro, who I asked to walk me. I was practicing walking on the walker without a limp.

But by Monday afternoon, after Rob Dunaway came by with seven excruciatingly tasty bars of chocolate, and Paul Bendheim brought me a software program to test, and I wrote a BizAZ column, I once again felt like going out to dinner. The visiting nurse had come, and changed my dressing, showing me my incision. Lo, I am healed (almost). Seriously, I feel pretty good about how the scar looks. It still has the staples, however.

This time I chose the Chinese restaurant in the neighborhood, the dinner went off without incident, and I celebrated with my friend Fred and a glass of Chardonnay. Reminder: couldn't have had a pain pill if I needed one, because I drank, so I made sure I didn't need one.

Still have high blood levels of Coumadin, and took only 2.5mg today. I doubt I will have DVT, because I'm up and around a lot.

One week out

2006-11-28T02:47:00.000-07:00

What a bunch of days. You would think that after the EMT Party I would rest. But I woke up on Sunday and went to Starbucks again with Chelsea. After that, the physical terrorist came to the house for the first time to show me my exercises and check out my walking. Of course she said I was getting along fine, threading my way among the retrievers. She gave me a series of quad, hamstring, and glute exercises. The only things she gave that I can't do with ease are the abductor exercises, because I had an abductor contracture from years of using the wrong muscles to walk. Because my hip hurt, I didn't use my abductors and they got tight and weak. I guess she had to move or cut them and disturb a lot of tissue to release them so my legs would be the same.

I did not have a resurfacing or a non-invasive procedure for two reasons: first,I have scoliosis, spondololithesis, and spinal stenosis, and I wanted to make sure the new hip didn't aggravate any of those, which I now control through exercise; and I love yoga and wished to go back to it. So Dr. Whirlow opened me up wide enough to see the joint and position it correctly. I am thankful for this. I doubt you will ever be looking at my thigh to see my scar, but you may be seeing me in tree pose in a few months.

After the pysical therapy, Ed came over and we had a party in my room. At about 6 PM I decided I couldn't eat another night of turkey or another meal in the house, so we all went to Chelsea's Kitchen. Unfortunately (for us, not them) it was crowded, and we ate at a small uncomfortable table outside in the bar. Lots of atmosphere, but low on ergonomics.

By the end of the meal I was in enough pain towant to pass up dessert, but didn't.

In the middle of the night, I had to punish myself for my bad girlness by taking a Vicodin to relieve the most intolerable pain I had experienced since the surgery.

Sunday

2006-11-26T07:41:00.000-07:00

We had a bit of a hiccup in the stellar recovery process last night. Belle rented some movies and we watched 'Jesus is Magic" (Sarah Silverstein) and "Wordplay." I didn't think Sarah was as funny as she's supposed to be. I really enjoyed "Wordplay," though, because I grew up doing the NY Times Crossword Puzzle.

Somewhere at the end of the second movie I drifted off to sleep. Remember the Coumadin that I have to take to thin my blood? Well, I guess it has been doing too good a job, because in the middle of the night I woke up spitting blood. I had watched a video in the hospital about Coumadin and understood that one of its side effects was bleeding, so I called 911 and my doctor. The doctor answered her own phone on Saturday night after midnight, and told me the blood was probably from my nasal passages from the intubation. It was a big-ass nosebleed and not terribly dangerous, although she stopped the Coumadin for a while.

When the EMTs came, they checked out the color of the blood and concurred. They were terrific: a bunch of young firemen accompanied by a female medical student. I was a little embarrassed, but not as much as I would have been if I had not called and had bled to death :-)

On the positive side, I ambulated with the walker into Starbucks yesterday and had coffee with Greg. Then my friend Mary called, and met me there to take me back home. While she was visiting, Gillian showed up, and Dan came over with Bluey. When we opened the door to let in the fourth dog, all of them got out and started running down the street. Apparently my next door neighbor had the gate open into his backyard, and they all went in to visit his dog. When Kodie saw that the man had a pool, he apparently belly-flopped right in! (I didn't see it because I was home entertaining mere humans).

Finally I got tired and repaired back to the bed, where the nurses kept me company all afternoon.

Saturday morning=5 days post op

2006-11-25T04:42:00.000-07:00

There is a magical quality to recovering in the presence of animals. At least two members of the golden nursing team are with me all the time on the bed.Once again, this experience has given me the opportunity to learn about how incredibly sensitive dogs can be. No one has even stepped into my path or brushed up against me since I have the walker. Everyone is extremely helpful, laying in positions that don't make me uncomfortable. Last night Chelsea and Temple went out for a drink, and for three hours all three dogs stayed with me. Nobody even moved! They were working away, guarding me and making me feel safe.

I have cut out the Vicodin, although I'm still on the oxycontin. I don't have a lot of pain, but my leg is still swollen around the surgery and thus everything feels tight when I walk.

The home health nurse came today and drew blood for my INR levels (how much clotting propensity is in my blood). Thank goodness my level was 1.9, a number only significant because it means I don't have to give myself shots of Lovanox(another anti-clotting drug) in
the stomach all weekend.

I've gotten pretty good at picking things up off the floor with the grabbing tool: socks, phones, pieces of paper. The only thing I can't pick up is the tool itself, which falls over constantly if I stand it next to the bed.

I have also gotten good at dressing myself. If you lay on the bed, throw your panties up in the air with your good leg and raise the bad one slowly and carefully to meet them in the air (only lift about 30 degrees), you can dress unassisted. Here the grabbing tool is also useful.

Also got a good piece of advice about wrestling with the TED socks (another anti-embolism precaution) that I have to put on every morning. The socks have a hole in the front by the toes. What you do is put a 1-qt freezer bag over your foot, start the sock by sliding it over the bag beyond the foot and pulling the bag off your foot through the hole.

It is amazing how much we do by bending over more than ninety degrees or raising our legs more than ninety.

Golden Retriever Nursing Team

2006-11-24T05:30:00.000-07:00

Upperleft is the patient. Then clockwise, Blu, Bear (aka Kodie), Boda, and Chauncey

shower!

2006-11-23T10:16:00.000-07:00

I am going home for sure, and I get to shower first. In fact, I was supposed to have been bathed every day and was usually only given a cloth to wipe my face. I really didn't get cleaned at all after the first day, When Dr. Whirlow, my elfin surgeon looked at me she was surprised and ordered the shower. I think the care at this hospital goes from very good to incompetent depending on the moment.
.

photos

2006-11-23T08:35:00.001-07:00

I have uploaded some pictures of my hip replacement recovery at Flickr . Probably TMI unless you are having one yourself.

small details

2006-11-23T06:33:00.000-07:00

I have been getting in and out bed on the week leg side. What a jerk I have been! It is so much easier from the other side.
I am on vicodin now, and it seems better than Percoset, although they both make me know I am on drugs.I feel like I have spider webs in my brain.a nice nurse finally came in last night and assured me things would get better because the floor had been overwhelmed when one male patient went bad.

thanksgiving

2006-11-23T00:29:00.000-07:00

The nursing is really bad tonight. John never gets here. Neither does the chubby male aide who doesn't know anything anyway.these guys are more cavalier, especially since the Monday surgeries are off morphine and catheters:that means we have poorer pain management and it is in their hands.for the first time, I am scared of the care.I have no control.. Ed and Chelsea are gone. A moment ago, I sat at the side of my bed waiting an eternity for one of the boys to take me to the toidy.I rang and rang and no one came. Then this nice kid came and I asked him for tylenol because I thought percoset on an empty tummer was not good. Haven't seen him since.
Now feeling bummed out, vulnerable and depressed. Time to meditate.

disconnected

2006-11-22T19:34:00.000-07:00

I'm going to go home tomorrow! I can get out of bed and go to the bathroom with only minimal oversight and all my catheters and tubes are gone.
Nothing has changed with me and pain pills; as always, I hate the way they make me feel--foggy and wiggy, as though one more would send me over some edge.
Today I could see the hospital get ready for the holiday: none of the usual nurses will be on tomorrow and I don't feel as safe.Tons more people came in today, though, timing their surgeries over Thanksgiving.
I had my hair washed today, because I realize I won't be able to shower until the incision heals.
I also try to get an appointment for a manicure in the hospital spa, but they are booked.

This hospital is like the cruise ship, but with bigger rooms. It even has room service. After all, it is Scottsdale! It act a lot like a resort.
I walked twice around the floor today and each time got easier, but remembering not to bend forward and not to raise my leg when I get home will be a study for a while.I see why they say it is a long recovery. No matter what shape you are in, the tissues take just as long to revive. But I feel blessed.
I am strong.

Wednesday

2006-11-22T04:33:00.000-07:00

Yesterday I went flapping down the hall trailing catheters and IVs behind
me, for 100 feet.learning to walk again-walker'nad leg,good leg,walker,bad leg,good leg.I loved it.today I lose the catheter and the IV and the morphine pump. And more walking so I can go home tomorrow.
Let's see how this goes.
Yesterday'too, was party central in my room as ed, Marc, Mark, Marilyn,chelsea'temple and fref came by.the funniest was when Marc and Jlein appeared almost simultaneously with frappacinos.
So the worst thing is the catheter and the embolism socks. The best is the morphine. And I had Houston's take out for dinner.
The nursing staff here is head and shoulders above others I have seen. The indicator is that I felt okay sending Chelsea and ed home and staying here over night.

i walked!

2006-11-21T11:01:00.000-07:00

When the physical therapist came today, I walked and it was not painful at all. It was, however, complex because of all the rules:don't bend forward, don't put all the weight on the new leg..a lot to learn.
As bad as the preop process was, the nursing care is admirable. And everybody has read my blog, so I get awesome care.
They have also
Asked to use my blog for training.
Blogging turns out to have been very useful.

day 2

2006-11-21T06:07:00.000-07:00

This is really cool, blogging from the hospital on the BlackBerry.
Had a great night with no pain. If I don't move I have no pain.
Will you believe this? My blood type is B positive!
Is that perfect for me?
Today I get solid food and get up more and get Starbucks!

up and at em

2006-11-20T21:18:00.000-07:00

Sort of. Surgery went well. On big drugs! Stood up already and living on
chocolate pudding. It is uncomfortable with catheter, etc but I did it!

The Day!

2006-11-20T04:45:00.000-07:00

4:45 A.M. Up early to go to the hospital. Two hours of pre-op procedures, including positioning me correctly on the table and conferring with the anaesthesiologist. Now I'm excited, because I know that by noon I will be in another place, in a new beginning. I know I've made a good decision, and I'm going down the right path.

I know I will be frustrated after today by the lack of wireless in the hospital. I'm bringing my Blackberry, but I know I don't have the patience to write long pieces with my thumbs.

Slept beautifully, given the pain in my hip, with my dog on the bed. Got up to meditate and do some pranayama breathing to inflate the lungs and slow the heart rate. Might as well give the anaesthesiologist something to work with.

Party the night before

2006-11-19T21:20:00.000-07:00

It's the night before the surgery, and I've been to dinner at Wildfish and had scallops and red wine. I've already taken off all my jewelry, shaved the leg that will be operated on up to the waist, and raced out to buy a bathrobe for the hospital because I didn't own one. I also tried to buy a night gown, but when I went to Target I found out that night gowns must be out of fashion: they didn't have any. Only pajamas! Who knew...

I've been hyper-hydrating (forcing fluids) all weekend, and I've also been drinking cranberry juice because the surgeon told me to do it. She called me this afternoon to ask if there were any "surprises," (am I sick or something) or do I need anything. I found that touching. It's also good marketing.

I've been beautifully supported today by the arrival of my daughter and her SO with their 2 golden retrievers. My friend Dan also brought his golden over, and then he began to throw balls to them in my (big) backyard. When he threw out the opening pitch, four goldens took off after it, falling over themselves and looking as silly as goldens can. It was a LOL moment.

Now I go to bed, stop drinking at midnight, and only take essential meds with a sip of water in the morning. I have to be at the hospital at 6 AM for the pre-op; the actual surgery is at 8. Because I won't remember anything of tomorrow (according to the surgeon), I probably won't try to write anything. If I did, it would be like dialing drunk...

I've Claimed this Blog for Technorati

2006-11-18T15:18:00.000-07:00

Technorati Profile

That means anyone who wants to read about hip replacements can search Technorati and find mine.

Scottsdale Healthcare North

2006-11-18T14:33:00.000-07:00

It's not easy to be the patient these days. This week, it has taken every IQ point, every yogic mantra, and every ounce of emotional intelligence I have to get through the preop procedures and actually make it to the surgery without strangling someone.

Gone are the days, of course, when you checked into the hospital the night before surgery and had all the tests necessary to determine whether you were "good to go." Now those are all done in different places by different people whose systems don't communicate, and as a patient you feel like a rat on a grid by the time you get finished preparing.

Months ago, I chose the surgeon and the date, and began an exercise program geared especially toward hastening my recovery: Pilates, water aerobics, glute-strenthening exercises, and meditation on the positive outcome.

I chose the surgeon because she was willing to show me my X-rays, explain the procedure, and answer my questions. Before her, I went to see one who pooh-poohed my fears that what was done to my hip might influence my spine and make my back problems worse. He told me he had done 30,000 hip replacements, and I shouldn't worry. He said he didn't know much about backs. He said minimally invasive surgery was the way to go. Then he left the room and his staff began telling me the realities behind his hard sell. That was Dr. Maltrey. I'm sure he's a fine surgeon, but he scared the hell out of me. I like to think of my body parts as connected.

I left unconvinced. When I found Dr. Janet Whirlow, I cried in her office because she actually began to answer my questions. Later I came to find out she also answers her own phone and calls her patients personally to explain things.

So I scheduled the surgery, and planned a trip to China for the week before. I figured jet lag would be a good accompaniment for surgery. When I told Dr. Whirlow this, she laughed. It turns out I would have to give blood, in case I needed it, and have all the pre-op testing in the week I had planned to be in Guangzhou.

So I revised my plans. In the past two weeks, I have driven the 40 miles to and from Scottsdale Healthcare North a dozen times, mostly to act as my own courier, bringing my X-rays, tests, etc. from one place to another. Three times to receive "blood doping" shots I should have been able to get much closer to home.

My family doctor was on vacation, so I saw his nurse practitioner for my pre-op exam. She didn't have a rcent stress test in my chart, and told me I had to take one. I told her I had had one less than six months ago, and where to get it. She then told me there was no record of it at the hospital I told her to call. I had to go to Banner Samaritan, to the bowels of the basement, and pick up my own records, hand carrying them back to her office. Like a breathless retriever, I arrived in her office with the envelope in my teeth. She smiled: "you're good to go."

Then she never faxed my medical clearance to the surgeon. Last Friday, five minutes before I was to go on the air as a guest on a radio talk show, I got a panic call from the surgeon's office saying she was still missing the clearance. I made an emergency call to the doctor's office and made them promise to fax it within the hour.

When I got off the air, the surgeon's office called again. Yes, they had the clearance, but the lab had lost my UA. Would I mind going out to the hospital lab and peeing in a cup? Can I do it at the lab around the corner? No, because the surgeon can't get into their records.

I hop into the car (if you have ever needed a hip replacement, you know that hopping into the car is a metaphor) and drive out to Scottsdale. I present myself at the same outpatient lab that drew my blood the day before. I ask for the cup. They say I have to be admitted before they can take my sample. I proudly flash the hospital bracelet they had given me the day before at PreAdmission and Testing, and say I was already admitted. Hand over the cup, please.

The lady behind the desk said that was a hospital admission bracelet, not an outpatient bracelet, and I had to be admitted to the outpatient department. But the admitting lady was not working there on Friday afternoon, so I would have to walk around the entire hospital to the main admitting area.

I am walking with a cane, the hospital is under construction, the hallways are long, and I am pissed. I know I am already in their system, and that I have filled out the same forms about ten times in the past two weeks. I walk around to admitting.

The admitting lady laughs, and prints out another piece of paper for me to carry back to the lab. Can't you just email this to the lab? Or can't they see it on a screen, I ask? Nope. You have to bring the piece of paper. I ask why.

HIPAA, she answers. For the past two weeks, as I fetched and carried all the films and pieces of paper from place to place, I amused myself by asking "why is this process still done with paper?" The answer is always "HIPAA." I've begun to believe that everyone relies on HIPAA as the universal excuse -- it's code for "we're too lazy to figure out how to change our work flow."

No one working on the business side of the health care system cares a fig for the patient. They care only for the process. They do not care that patients may work, and be trying to get some things accomplished before checking out for surgery. They do not care that orthopedic patients may be uncomfortable walking and driving. And they certainly do not care that the inept processes they follow must cost billions of dollars a year.