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Chapter IX. Going Home

I was home a mere eight days after surgery. As I mentioned in the last chapter, before leaving the rehab, I had arranged through them to get the necessary equipment for my convalescence: walker, commode chairs, shower chair, and so on. Further, I arranged for home nursing care and physical therapy. The rehab personnel recommended one specific local firm to provide all those things. Unfortunately, they bungled it.

The first problem was that between the time I specified which equipment I needed and the time the equipment was delivered, somebody changed the order. I still do not know who changed it. When the delivery person arrived, all he brought was a gigantic commode chair that was much too wide to fit over any of my toilets. He said it was designed to support 400 pounds. Now, mind you, I am overweight, but not that overweight! The order I had given to the rehab outpatient coordinator specified a particular three-in-one commode chair, the same one that had been installed in my bathroom at the rehab. I wanted two of them, one for the upstairs bathroom and one for downstairs. The other items in my order were the walker, which had been delivered to me at the rehab, and a shower chair. Fortunately, the delivery person had the proper three-in-one commode chairs in his truck—at least he thought he did. I needed at least one and I needed it that night. It turned out that one of the two he thought he had was broken, but he gave me the other one. I told him that I could use the giant commode chair for a shower seat, just to simplify matters. The delivery person said that would deliver the second three-in-one first thing in the morning. I was beginning to have my doubts about his company.

In the morning, I received a call from the same man, telling me that he had an emergency in a distant town, which would cause a delay in delivering my equipment. I did not blame him, for obviously his schedule was being stretched too thin, but I was developing a very negative attitude toward his employer. He eventually arrived with the equipment at around 7:00 PM.

Additionally, the same company was supposed to contact me within 24 hours of my discharge from the rehab hospital to arrange for my home nursing and physical therapy. I had been discharged on a Friday, so I waited through the weekend and all day Monday, but I heard nothing from this outfit. On Tuesday, I called the rehab to speak with the person who had arranged for the equipment and at-home care. I told her what had happened and strongly asserted that I did not want these people handling my at-home care. She said that she would call them to find out why they dropped the ball but I told her that regardless of the response, they were fired. I discussed the possibility of changing to the Visiting Nurses’ Association for those services, which the coordinator agreed would be a good idea. As it turned out, I was completely happy with the VNA personnel who eventually served me.

This experience of mine should illustrate the need for you to be assertive throughout your experience with the surgery and rehabilitation. There is no excuse for such poor performance on the part of a health care provider as I received from that company. I did not accept it and neither should you. Your hip might be temporarily compromised, but as long as you have functional set of vocal cords, make certain that you open your mouth at appropriate times and use it to obtain the best possible care from all providers.

What equipment will you need at home?

Walking support

You obviously will need a walker, crutches, or both. Your health insurance will probably pay for one or the other. A walker is better for stability and using one is not as fatiguing as is using crutches. The choice between the two will be personal preference, but you should get help from your physical therapist in making this decision.

You might want to think about buying a cane to use when you are past the walker or crutches stage. Perhaps in your case a cane will not be necessary. Canes are typically used for balance, not support. I find a folding cane handy for travel and attending sporting events. If you feel that you might be a little unsteady on your feet in these situations or in general, investing in one or more canes is a good idea.

Toilet equipment

You are no doubt aware by this time that in order not to bend your new hip joint past the 90-degree limit, you will have to elevate your toilet seat. The “three in one” commode chair is a piece of equipment that fulfills this need. It fits over the toilet such that the seat is elevated, and it has arms for supporting your weight as you lower yourself onto it. As I have mentioned, I bought two, one for an upstairs toilet and one for a downstairs toilet. Of course, my insurance only covered one.

Shower equipment

The rehab gave me a cheap long-handled shower “sponge,” which was actually a piece of foam rubber on a plastic stick. It is the right idea, but you could do much better by investing roughly $10 on a nicer one. A shower chair with handholds is a good idea but you might have to fork over the money for it. I am told that health insurance companies consider shower chairs a luxury. Alternatively, you could have grab handles installed in your shower or shower/tub. It is a good idea to have a shower hose instead of a fixed head. One final tip: it might be hard to find these days, but “soap on a rope” is a great thing to have. Bar soap kept slipping out of my hand; then I had to go get my grabber to pick it up.

Dressing aids

Three aids are standard for the hip surgery patient: a long-handled grasping device, a long-handled shoehorn, and a sock helper. In my case, these were supplied to me by the rehab, but I had also bought a grabber and a shoehorn on my own, so I could have them both upstairs and downstairs.

The grabber is somewhat like those long-handled devices grocers used to use to get items from high shelves. (I am barely old enough to remember corner groceries.) I found that the “extra-long” grabber that I bought was better fit than for picking up objects from the floor the shorter one given to me by the rehab. Apparently, the rehab takes a “one size fits all” approach. I am of average height, 5’10”, so the too-short grabber might be a point of considerable concern for somebody much taller than I am. It would be appropriate to ask the rehab if other sizes were available, but I was not astute enough to ask.

The sock helper is an interesting device. You will need to use it for quite a while after you go home, so learn it well. It is basically a rigid, hollow, semi-cylindrical, plastic form with a rope attached. You stretch your sock over the form, insert your foot, and then pull on the rope. It pulls the sock up your leg, then pulls the form out of the sock. You can make minor adjustments with the grabber.

Living alone

If you live alone, you will find that there are small things that might have to be left undone until friends, family members, or household employees are available to do them for you. In my case, it was important for me to effect a gradual increase in my commitment to performing the usual chores around the house. However, the first night at home, I had a small crisis. I was eating a bowl of rice, which I clumsily knocked to the floor. In a brief moment of panic, I did not know what to do. Not being able to bend over became a big thing. Should I call someone to clean up the mess? No, that would make me look stupid and helpless. Should I leave the mess for the next day when I would have visitors who I could ask to clean it up? No, that would be too kind to the bugs. As I calmed down, I realized that I could just clean it up myself by using my grabber—the longer one that I had bought—to hold a dustpan while wielding a broom in the other hand. Alternatively, I suppose I could have gone for the shop vac, but that would have been overkill. Where there’s a will, there’s a way. The grabber approach worked fine. (Perhaps I should have stuck around at the rehab long enough for the occupational therapists to show me that maneuver!)

Like Clint Eastwood’s character, Gunnery Sergeant Highway, in the movie Heartbreak Ridge would say, “You adapt, you overcome.” You will be fighting small battles every day, but with enough determination, you will be winning most. As the victories pile up, it will become apparent that you are winning the war. It only took me about a week at home to realize that I was not handicapped. I was only slowed down for a while. However, if I had not undergone the surgery, I surely would have been handicapped. This thought inspired me to work even harder at rehabbing myself.

One difficult solo maneuver was strapping the abduction pillow between my legs without bending excessively. After a couple of nights of struggling with it, I determined that using my long-handled shoehorn in conjunction with my extension grabber, I could fasten the Velcro straps easily enough. The whole procedure would eventually require less than a minute to accomplish. Undoing it in the morning was a little more difficult due to the grabbing power of Velcro. At that time of the day there is a great incentive, because I am usually on my way to the bathroom. I likened the experience of sleeping with this abominable thing to having a small dog that likes to share my bed. The difference was that unlike the dog, if I kicked the pillow, it would not get out of the way. Moreover, it surely was not going to bring me the newspaper. This was another of the inconveniences that would have to wait for the six-week follow-up before I would be able to ditch it. In the meanwhile, I had to continue strapping myself in for a good night’s sleep.

By the way, I mentioned that I was not a back sleeper, which I thought would make it difficult to get any sleep. Actually, like the venerable Gunny Highway, I was able to adapt. However, one weird thing I noticed is that I sometimes woke up talking in my sleep. This might have been more attributable to the narcotic I was taking for pain control than to sleeping on my back. It is a good thing that I know no state secrets!

One thing you will not be able to do by yourself is change your compression stockings. They are just too constrictive at the ankle to enable you to get them over your feet without bending too far at the hip. Perhaps your surgeon will give you a different timetable, but mine has directed me to wear the damn things straight on through to the six-week follow-up exam. These dastardly hose might well be impossible for even an unimpaired person to don without assistance. You will need help. Make the best of it.

You will be pampered. Friends and family will do what they have been taught since early childhood: bring food. Did I ever get a great pot of chicken soup from the neighbors one Friday night—it was just like my grandma used to make! You will receive so many offers of help that you will have to disappoint some of the helpful folks by telling them that all your needs have been accommodated. Alternatively, you might want to do as I learned to do. Keep a list of little, non-urgent things you need, from which you can assign items if somebody absolutely insists on doing something to help. You can avoid hurt feelings and have some additional company, besides.

Nursing and physical therapy at home

Your doctors (and, of course, your insurance company) will determine how many home visits you will need from nurses and physical therapists. Your surgical dressing will need to be changed daily, assuming that you have come home before the stitches or surgical staples have been removed. A visiting nurse if necessary will complete the unstapling task, at home. The nurse will monitor your vital signs and look for evidence of infection or other emerging problems. Assuming that everything goes well and that you are generally capable of taking care of yourself with assistance from friends and family, you will only need a few nursing visits.

Physical therapy is of paramount importance in the recovery from hip surgery. A visiting physical therapist will set up a program for gradually increasing strength building, range of motion, and aerobic exercises that you can accomplish in your home. He or she might bring some aids that will permit exercising against resistance, such as Thera-Bands, which are large, calibrated elastic bands. As you stretch them, their resistance increases, allowing a reasonably good workout without expensive equipment. You will probably want to purchase some ankle weights, which will give you a more strenuous workout as your leg strength increases. The physical therapist will evaluate any exercise equipment you already have for use in your program, making sure that it is set up properly to not exceed the limits of motion set by your surgeon.

In my case, the insurance company sprang for six visits from the visiting physical therapist, Ann. This was broken down into three visits per week for two weeks. Ann used the time wisely to guide me toward self-sufficiency in continuing the program she created for me. Ann also performed hazardous duty beyond the call of duty by changing my compression stockings several times.

Once Ann completed her stint, I would take over the physical therapy program she had established for me on my own, increasing repetitions and duration regularly. Later, when I was better able to get around town, I commenced outpatient physical therapy. In this manner, I had the benefit of the amalgamated ideas of many different physical therapists, with the corresponding benefits to my rapid rehabilitation.

A humorous aside

Now that you are a bionic woman or a bionic man, you should prepare yourself to be an object of curiosity and the brunt of some innocuous humor. You will almost certainly be asked if you will trip the airport metal detectors with your new hip. (The correct answer is “sometimes.” It depends on the sensitivity of the individual detector. Your surgeon’s office will give you an explanatory card to show the security people. So do not worry.) You might be asked if your hip clicks or creaks when you walk. (Mine is quiet as a mouse, unlike the natural one it replaced.) No doubt, you will find these questions and jabs as humorous as I did. None of them, however, was quite as humorous as the telephone conversation I had with my well meaning, worrywart mother several weeks after the surgery.

We were on a non-hip-related subject when she hit me with the following non sequitur.

“Could you be struck by lightning?” she asked.

I was not even thinking about the hip. I was momentarily taken aback by the impertinent question.

“Well,” I responded after pausing to think about where this line of questioning was going, “I live in Central Florida, which is the lightning capital of the United States, where people are struck fairly often, so I guess I could at some point become a lightning victim, too.”

“No,” she said. “I meant because of the metal in your hip.”

She said this in all seriousness. I had to laugh, but I eventually told her that it really would not make much of a difference because it really does not significantly decrease the electrical resistance of a path lightning would take through my body to ground. I should not be any more vulnerable than a non-bionic man should. However, I have been formally educated in physics and my mother has not. She was laboring under the misconception that metal objects attract lightning. Lightning is not fussy. It just takes the path of least resistance to the ground.

Progress at home

If you create mildly ambitious goals you can look forward to achieving, your convalescence will seem to proceed more quickly, and you will accomplish more. There will always be things to look forward to, some of which will seem mundane to those around you. For example, that first shower I was permitted to take 48 hours after the staples are removed was a delight. I could not wait when the time finally came, timing it almost to the minute. Being able to run a load of dishes through the dishwasher and get them back in the cabinets was another happy accomplishment, as was doing a load of laundry. Stripping and changing the bed, taking out the garbage, and sweeping off the front sidewalk were all minor goals that I accomplished easily in time.

I have heard from other hip patients at this point in their recovery that they feel fragile and fear moving and bending too much. Of course, the restrictions that have been drummed into your head all along must be observed, lest you dislocate something. The temptation is to be very safe, sometimes to the extent of compromising the patient’s rehabilitation. If your surgeon gave you a 90 degree restriction, it does not mean that you should stay in bed all day lest you put yourself in a situation where you might potentially exceed 90 degrees. In my case, I felt that if I could get to 90 degrees, I should.

Stairs (the hard way)

It would have been possible to rent a hospital bed to allow me to sleep on the first floor of my house, but I am a stubborn guy. I insisted all along that I would use my entire house during my recovery, and I meant it. Getting up and down the stairs would be a major obstacle, but I was up to the challenge. At the least, I wanted to go downstairs in the morning and back upstairs at night. This would not be too bad, or so I thought. It was not easy. The first day or two, before I refined my stair-climbing technique, were replete with major stair struggles. It took several minutes to get up or down the stairs. It was bad enough that I stuck with a single ascent and descent for the first couple of days.

However, we learn from adversity. After those first two days, I taught myself to get up and down those stairs in less than 15 seconds. Using my folded-up walker as a support on my left side and the hand rail for support on the right, I would ascend or descend one step at a time. Going up, I led with my good leg; going down, I led with the operated leg. (A memory aid for this is “good leg to heaven; bad leg to hell.”) Three days after coming home, I was able to get up and down those stairs four or five times a day.

Meals

One of the major inconveniences of my recovery involved meals. In order to observe that 90 degree restriction, I would have to eat in one of three places, none of which resembled a dining table and chair. Standing up was one way. Of course, I would have to be balanced on one foot the whole time, which made it difficult. Another way was seated on a high stool next to the counter between my kitchen and family room. This is where I had most of my meals. It was pretty cumbersome to eat there, particularly when I had to serve myself. It took too long to maneuver my walker through several trips back and forth. The last alternative was dining while sitting in my recliner. This worked well if the food was something that did not involve much manipulation with utensils, such as a sandwich. Carrying the food there was a multi-step procedure with the walker. I had to use ingenious methods to carry things while using both hands for the walker. Accordingly, I could only carry one plate of food or one drinking glass at a time. If you have someone who can serve you, as I did when I was fortunate enough to be visited by friends, you can sit and relax while somebody else does the work.

The first meal seated at a proper dining table was something to look forward to, not unlike the first shower. It was about five weeks into my recovery when I felt I could attempt that. I have been dining at the table ever since.

Laundry

Doing laundry was another adventure. As I have mentioned, my house has two floors. The bedrooms are on the second floor, as is the laundry room, which is actually a closet with a washer and dryer. Between the master bedroom and the so-called laundry room is a long hallway. My biggest problem was moving a basket of laundry down the hall. I determined that a rectangular, plastic laundry basket would fit nicely between the two hand holds on my walker, which had wheels on its front legs. Thus, it made a nice laundry cart that served to allow me to wheel the laundry basket from the bedroom to the laundry room. The only real problem was bending down to pick up the laundry basket. I had developed a technique for bending down to pick things up off the floor without using the grabber. It involved bending at the waist while extending my operating leg behind me and balancing on the other leg. This maneuver should not be attempted by anyone who has balance problems, but it served me well.

Driving

Later in my recovery, I stepped up the magnitude of the goals. I began to drive the car for short trips to the bank or the post office at about four weeks post-surgery. This is about the same time as I decided to curtail the use of the walker. At first, I used a cane, but by the middle of the fifth week, I decided that it was not necessary. In a major test of my self-sufficient capabilities, I drove to Sears, walked in with no cane, no pain, no limp, and no sweat, bought a washer and dryer, walked out, and drove home. Yes! I was almost there. A friend called on Friday of that same week, asking if I wanted to have lunch with her. It would be about a 16-mile drive each way. I said, “Sure! Yeah, let’s do it!” I did, and another milestone was surpassed.

The following day, I took my car to the regular Saturday free car wash at my dealer (they do it to keep us coming back). Then I went to the supermarket to buy a full load of groceries. I accomplished both with no problems.

Stairs (the normal way)

Two days later, I was able to walk up and down stairs in the normal, foot-over-foot fashion. The first instance of doing this occurred spontaneously and accidentally. I was upstairs when I heard the doorbell ring. Without thinking and without I my cane, I ran down the stairs to answer the door. It was only when I was downstairs that I realized what I had done. Then I had to try going back up. I was able to do that, too.

Do not try too much too soon

I felt that I was ready for my six-week assessment, and for subsequently stepping up the rehabilitation. I had lost over twenty pounds in the aftermath of surgery and I felt good. Perhaps too good, as I will explain later. All of this sounds very good and encouraging, but in my follow-up with Dr. G., he told me very clearly that I was moving too fast. More about this in the next chapter. In the meanwhile, I would caution those hip patients reading this that my extraordinarily rapid progress should not be used as a guide against which to measure their own progress. Some might progress even faster; others might need more time. Indeed, I grew overconfident and soon had to be reeled in by Dr. G. The proper, personalized plan for your own rehabilitation must be developed in consultation with your doctors and physical therapists, augmented by your own motivation and perspiration. Nevertheless, remember to keep it within the limits you were given in your instructions by the surgeo

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