Surgery and the immediate aftermath
We left from Chicago and took what was called cheerily the Hip Express by the airline crew. It seems that the direct flights to Birmingham are often filled with people going there for this procedure.
We stayed at a nice bed and breakfast, me, my wife and oldest son (a tender 9 years at the time). I went to the Nuffield. In the UK health care system, that is one of the more expensive hosptials (remember they have eeeevil socialized medicine). In contrast to the $40,000 that JRI wanted, along with an armload of waivers, they charged 9,500 UK pounds total for everything as a package deal and it came with a 30 day guarantee, viz, if anything went wrong with the surgery within the first 30 days, they would pay for follow-up. For what it is worth, my insurance company covered it without question, since it seems that the official position is only someone would go outside of the US healthcare system in the direst of emergencies, therefore, any foreign procedure is approved without question. Of course it saved them a wad of dollars (it came out to $13,500 or so at the then current exchange rate).
I met McMinn the day before the surgery. An ruddy-complexioned and completely affable man, I felt an immediate sense of relief. He knew his stuff cold and fielded every question to my satisfaction. That was the first time I felt utterly confident that this was the right choice. Oh, in an analytical sense I knew that all the evidence pointed to him as the man, but it’s different to feel that way. He cautioned me that the bone was thinning around the hip. An inability to load it properly with weight for years causes the body to simply slowly to remove the bone there. Another year and I simply wouldn’t have had enough bone to attach the implant.
Tip: The implant is only as good as the bone it attaches to. Get this done earlier rather than later.
I got a nice room in the Nuffield at the end of the hall. The nursing staff was like a well-oiled machine. They always magically appeared with whatever I needed just as I was starting to form the question. Normally I would have found that eerie, but now it was comforting. The food wasn’t bad either. For the stay, my family really didn’t have much in the way of downtime. They went to the railway museum, the Cadbury Chocolate Factory (my son still talks about that) and tooled about town.
As for surgery itself, the first memory I had was in the recovery room. Remember, I twisted up like Quasimodo pre-op, so while I was groggy, my first sensation was the oddest. I was lying flat. This pretty much convinced me I was in some strange dream. On top of that, someone was talking to me and since I did not speak their language, I ignored them. It turns out the woman on duty had a magnificent Highland brogue, but I was too addled to process it in English (she was actually really sweet and the perfect person after surgery). I’m afraid I made her life more difficult than I should have, since by not responding they assumed there was something wrong with me. Once I started chatting though, all was set right. Still it was a singular experience. The surgery required quite a bit bone grafting. McMinn told me that while the bone was better than he expected, the surgery dragged on much longer than he expected. I can thank running for accelerating the deterioration and for giving me strong enough bones to make a comeback.
The way it is supposed to work is that for the first 24 hours post-op, you get a morphine pump, so that every 5 minutes you get to give yourself a small dose. Weirdly enough, it hurt less. I didn’t need any pain killers for the first week post-op. Only later when I was walking a lot did I get demonstrably sore. Almost as soon as I was wheeled back into my room my wife asked me if everything was ok. I replied
“Considering that in the last day I’ve been nuked, gassed, drugged and had a real pro come after my ass with power tools, just fine.”
Needless to say, just fine has become a standard expression.
The first 24 hours post-op are miserable and there is no other way to put it. I was fortunate that pre-op I made it a point of working out (swimming), so I had enough upper body strength to move myself. That night was terrible. There is no way to describe it. Oh, I hadn’t had a complete night’s sleep for years, so I was used to that part of it. A large part of the misery was the bruising since there was no position that was even remotely comfortable as well as being really dry from the oxygen tube too. That made my throat hurt awfully. I lost a fair amount of blood, but declined a transfusion. This probably made it a bit harder too. Normally I would have donated my own blood, but at that time (and probably still) transporting blood across international boundaries was not allowed and there wasn’t enough time to recover from donating it pre-op.
The next day
The morning after surgery the put me on my feet at exactly the 24 hour mark. This, I opine, is along the lines of hopping back on the horse that just thrown you: if you don’t get back on immediately, you might not ever. Again, the fact that I swam made all the difference. You see, the hip itself is pretty well anchored by that point, since McMinn uses a type of cement. A lot of people have a blood pressure drop when they stand. Passing out has happened, but I experienced only a brief moment of light-headedness. I was off with my walker for a couple of steps to the chair opposite from the bed where I sat for a bit.
Now, the next several days were filled with lots of tiny trips with the walker. One also must wear compressive stockings to keep swelling to a minimum since the threat of thrombosis is rather higher after hip surgery. I also was put on standard THR restrictions (no leg crossing and such), although by this point all the bruising had taken hold and I had no interest in that. I graduated to a pair of arm crutches and was told to use them for 6 weeks. The next 3 weeks after that I was to use a pair of canes, then the final 3 weeks just a single cane. At the 12 week mark I was to be free of all walking aids. This was an unusually long time on these and it was attributed to mediocre bone quality, the amount of grafting and the extreme weakness of the muscles.
A lot of people on surface hippy write and wonder if they can’t toss the canes sooner than the doctor says. I just remember what my grandfather told me once. He said to do it right if you can’t do it twice. I have no regrets I followed the doctor’s advice to the letter. The only exception was around the house. Pre-op I had handholds set up all over the place, so I used those rather than crutches, but note that I did still use support.
To finish off the English end of the story, I stayed for the balance of the first week in the hospital. Since there is a very real possibility of thrombosis if you take a plane ride lasting more than a few hours (it’s a 6 hour flight), they strongly suggest you remain in country for another week. This gets you up to the point that they can pull the staples (ouch). We went to Stratford-upon-Avon, Shakespeare’s birthplace, and stayed in a Bed and Breakfast there. The choice was made because the old part of town, which was almost out our front door, is small, quaint and highly navigable. There are benches regularly too. This gave me quite a headrush. I could take my crutches and actually go out all on my own, walking. I went to coffee shops, did a little window shopping and basically was a completely boring tourist. But I was doing it alone! I didn’t need a vehicle, my wife didn’t have to hold me up, I could just walk where I wanted. Oh it was slow going and I had to rest, but for the first time in years I could go to a bookstore, buy something fun then sit down and read it over a cup of java. I almost couldn’t believe it….
One other oddity was that I found post-op when I was finally off pain killers that I had a badly infected tooth. The symptoms had been masked for some time (on the x-rays of my head you can see where it had eaten some of the jawbone). So in the month post-op I ended up getting a couple of root canals. Not my idea of fun, but I had no choice.