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Epilogue

Almost eight months have now passed since my hip replacement. I am back to report on my recovery. This chapter will sound like I am blowing my own horn. I suppose that I am, but I am hoping that in doing so I am providing encouragement to those of you who have trepidations about your life after surgery. As any thinking person would, I had thought quite a bit about what would happen in the aftermath of surgery; I wondered whether I would be able to do everything that I had not been doing prior to surgery because of hip pain. Thus far, I can say that—within reason—I can!

Before I chronicle some of my exploits, I would like to thank the many people who have sent me e-mails after reading this book. Their hip replacement sagas have been very positive and uplifting. If I never find that publisher with deep pockets, I will have been rewarded many times over by knowing that I have helped others who have reached the hip replacement decision point. Thanks for writing and thanks for all the kind comments about my meager work.

One, two, buckle my shoe

Doing things with your feet is one of the major problems after hip surgery. One is cautioned not to bend too far, but doing anything with feet requires such bending. The fear of dislocation becomes ingrained to the extent that I did not even try. I had bought shoes with Velcro closures prior to my surgery, so that I would not have to concern myself with how to tie shoes thereafter. For six months, I wore them and other slip-ons in my shoe collection. (I am an aspiring male version of Imelda Marcos.) However, I can now bend down and tie my shoes. Each time I can do something new with my feet, I rejoice.

For example, there was the time I forget to take the sock helper along when I was visiting my family in South Florida for Thanksgiving. Oops! I could have cheated by wearing no socks to Thanksgiving dinner—things are that casual in Florida—but I decided to live dangerously, putting the sock on unaided. It turned out to be no problem. However, I still could not help thinking that I must have come close to dislocating the hip. I had been cautioned that a dislocation could occur with no warning whatsoever, and I envisioned myself being carted away to the hospital with my sock half on. No such drama occurred. I still use the sock helper at home, because I do not want to take silly risks. It is here, so I use it.

The toenails on my left foot were getting a little long when I visited my cousin Paula in New York in October, four months after surgery. I intended to do a lot of walking in the big city. Walking with long toenails can be painful. Paula offered a pedicure, and who was I to refuse. She did a wonderful job, for which she should receive hazardous duty pay and a government pension. The next time I needed to cut my toenails, I was back in Florida, and Paula was in Japan. Thus, I could not call her for a rush job. (Her employer never would have understood.) Toenail clippers in hand, I steeled myself for the inevitable dislocation and gingerly initiated the task. It was over in a flash—far too easy, and with no dislocation!

I mentioned in the previous chapter that I had been doing a little gardening, but could not stoop to pull weeds. I am now proud to say that I can actually pull weeds, but I still prefer to let somebody else do it.

Three, four, travel some more

I like to travel. My wanderlust even existed when I had so much hip pain that I paid dearly for even short, domestic trips. Whether traveling by car or by airplane, there was pain; whether I was traveling for business or pleasure, that pain would get in the way. I could drive only a few hours without having to make a pain stop. I also had to wonder whether the massive doses of anti-inflammatory drugs were impairing my reaction times, making me a dangerous driver. When I traveled by air, I had to bring along a folding cane, which enabled me to hobble through airports. Standing up after a long flight was an exercise in how much pain a person could endure. Yet I dragged along carry-on baggage and battled for position with the other frequent flyers. A day of travel wore me out so completely that I was worthless the next day. One of the big lifestyle improvements I was hoping to derive from the hip replacement was the ability to travel painlessly, and to be fresh and ready for action the next day.

The first out of town trip was a few days after the September 11 tragedy. A friend, Georgia, who was moving from Florida to California, planned to drive her car there. Another friend, the now infamous Dr. Margie from Louisville, had planned to meet her in Orlando to make the drive with her. Visions of the movie Thelma and Louise entered my mind when I learned of the grand plan. In any case, air travel was disrupted by the terrorists. Margie could not get to Orlando. She worked out a plan whereby she would take a Greyhound bus to Birmingham, Alabama and meet Georgia there. In the meanwhile, a hurricane was churning in the Gulf of Mexico. I did not want to let Georgia drive alone in the rain all the way to Birmingham, so I volunteered to do the driving. I did not know how my hip would react. I now know that there was nothing to worry about. Not only was I able to drive twelve hours, half of which was rough going through blinding rain and tropical storm force winds, but also I was able to maintain an even disposition throughout, not once getting upset at Georgia or her two dogs, not even when she broke the clip on my radar detector. I might have been able to accomplish the drive before surgery, but I would not have been able to avoid being an angry sourpuss.

My first air trip after hip surgery was a football weekend in Pennsylvania. I wondered whether I would be up to traveling at all at that point in September, a mere three months after the operation. I would never know until I tried it, so this was to be the perfect opportunity. I would be with friends who could take care of me in the unlikely event that anything bad happened. I made travel arrangements in such a way that my hip would be pampered. Being a frequent flyer, it was easy to get first class upgrades so that I would have some room to stretch out and exercise the leg. (Of course, the danger of deep vein thromboses (DVTs) had been drummed into my head.) I also rented a car that was large and luxurious. The weekend turned out to be an uneventful success, although my alma mater, Penn State, lost the football game to Wisconsin. I did a lot of walking around the campus and in town, feeling only minor soreness.

As I mentioned when I was talking about toenails, I went to New York City for a weekend in October. By that time, I knew that I could accommodate the air travel. Things were settling down a bit after September 11, anyhow. I had not visited New York for about 10 years. The reason for this was my fear that the big city would beat me up. I had lived in New York for five years earlier in my life, and I knew that a lot of stamina is required to succeed in just about anything in the big city. I was afraid that I would not be able to handle the walking, the taxis, the crowds, and just about everything else. This time, though, I was laden with optimism. My cousin and I went to theaters, to a basketball game at Madison Square Garden, to restaurants, and to parks. We walked, we took taxis, we rode buses, and we took the subway. Not once was there any pain. Not once was there any fatigue. Walking forty or so blocks in midtown Manhattan was probably the first big test of my walking ability. The results were excellent.

I was ready to test the hip for a longer flight. I made plans to visit friends in Jolly Old England. This eight-hour flight would surely test my mettle, especially because I was unable to get the first class upgrade on the eastbound flight. There again, in the past, I would have been in agony because of the small seats with little legroom. Worse, sitting in a rows immediately in front of and behind mine, in the center section of a jumbo jet with 2-5-2 seating, were families with several infants and toddlers with small mouths that belied their ability to shriek loudly. I did not get even a minute’s sleep on that flight. Yet I arrived at Gatwick at 9 AM in a good mood (no doubt relieved that “it” was over), and was even able to handle the announcement from my friends that there would be no toilet facilities at my destination until the following day because the septic tank had overflowed. I could only imagine what my response might have been if my old hip had been in control of my emotions.

One more pleasure trip is worthy of noting here, especially because it involved heavy use of the artificial hip. In December, six months after surgery, I went to California and Nevada for a two-week vacation. My plan was to do a bit of hiking in Southern California, and do a bit of gambling in Las Vegas. My hikes in California were generally five-mile day hikes over moderately hilly terrain. Aside from some huffing and puffing when ascending the hills, due to my being out of shape from so little exercise while the hip was hurting, I was able to accomplish the five miles easily. That Saturday, I was supposed to be visiting some friends for what I thought would be a lazy afternoon barbecue. When I got to his house, my friend David let me know that he wanted me to take a walk with him through his gated community—another three miles up and down hills. I find this commonly now. People, who have known me during the old days of moaning, groaning, and not being able to walk very well, now wish to see me walk. I am glad to oblige them.

The Las Vegas part of the trip was good, but it really did not serve to prove anything about my new hip. Thus, I will not comment much on it here. I will say that I was involved in a minor traffic accident in which I was hit from behind by an off-duty topless dancer. Even traffic accidents can be Las Vegas style entertainment!

There has been only one other trip between then and now (end of January 2002). I successfully completed a one-day trip to Pittsburgh to handle some family business. I started with the 5:35 AM flight out of Orlando and returned on one arriving shortly after 8 PM. In the snowy streets up north, I walked through salty slush, kept my balance, and froze my tush. It was a long day, but there was no pain, little fatigue, and I did not lose my temper even once!

Some of you are no doubt wondering about metal detectors and your new, metal hip. I have to say that not a single metal detector has yet detected my hip. This was surprising to me, because the hip prosthesis is a big piece of metal. Nine different airports since September 11, and one sports venue (Madison Square Garden) failed to detect it. I had prepared my speech and had my card ready, but never had to use either.

Five, six, pick up sticks?

I have not yet picked up my golf clubs, which have been silently rusting for about 10 years. It has been that long since I played my last round of golf. I definitely want to get back into something competitive, and golf seems to be the best sport for me to accomplish that. My surgeon told me that basketball was definitely out of the question, not that it would matter. I once played a respectable game of golf, and perhaps I will be able to do so again. My clubs are 30 years old, though. If I find that I can actually swing them whenever I finally get the motivation to do so, I will have an excuse to spend some money buying a new set.

Why have I been dawdling on this issue? Aside from the fear that I have lost my swing completely and will have to compensate for the hip such that I will hit the ball even more cockeyed than before, I have not yet worked golf into my routine because I am filling the time with a many other things for which there was a pent-up demand. Eventually, I will give golf the place it deserves in my schedule.

Seven, eight, this is great!

Recreation aside, I am able to do everything I need to do around the house now. I have been up and down ladders with no problems. I have been down on the floor. I am up and down stairs many times a day. I can use normal bathroom equipment, handling even low toilet seats with ease. I am elated. Six months ago, I was happy to be able to get out of a chair without feeling that awful blast of pain. Now, I do things that I could not even do at all in the months before surgery, and I do them painlessly. Total hip arthroplasty made all this possible. I cannot even imagine how badly my life would have deteriorated had I not gone through with it.

Fun with medical bills

I am going to shift gears for a moment to one of my pet peeves. No book of mine would be complete without a few parting shots at the sorry state of the health care industry. This time the subject is billing for medical services. Most of the bills for services relating to the surgery were paid by my insurer and by me within two months. However, the two biggest bills, from the hospital where I had the surgery and from the rehab hospital, have taken a while to straighten out. My insurer was the first culprit. The insurance company sent me an explanation of benefits for the hospital stay claiming $2000 was my responsibility, but it was done in such a cursory, lump-sum way that it made no sense to me at all. It took me at least two months of irritating telephone calls to get them to revisit the matter. Finally, they did. In December, six months after surgery, I paid the hospital what I actually owed: $825. The other bill, from the rehab, is still outstanding. This time, both the hospital and the insurance company agree on the amount, which is $552. However, I have been asking for an itemized bill to support that amount for three months now without success. Again, I have been through the wringer of aggravating telephone calls and bi-weekly dunning letters. Every time I manage to speak to someone at the billing office, she tells me that she will take care of the matter. I have been making this simple request since November. It is now the end of January, and I have received nothing. I have even told the billing people to go ahead and turn the bill over to their collection agency, because I know I will get what I want if they do. The collection agency will get me a copy of the original bill, because it will be an easy way to make a quick buck.

The reason for this stupidity is something that is increasingly common in the health care industry. Hospitals have found that billing and collection is something they can effectively “outsource,” so they do. The particular hospital system that runs the rehab facility in which I spent three days is a large, regional, supposedly non-profit organization. I can recall a major dispute I had with them over a mere $36 several years ago, where all they would have had to do was submit the claim to Blue Cross as they were originally instructed to do and, in fact, they were contractually obligated to do. Instead, it wound up going to a collection agency even after I had fully documented the case. The collection agent, upon hearing my story, communicated with the hospital, getting the problem fixed. That was perhaps 15 years ago, when the hospital organization was doing its own billing. Now, they employ a billing service in Atlanta, some 500 miles away, and they are even more screwed up than ever. Now that the function is not being handled internally, we add one more, communicative dissociation, to their long list of problems.

I have no doubts that I owe them some amount, for indeed I had a private room while my insurance pays only for semi-private accommodations. The detailed bill is necessary for me to confirm that the $552 for which they are billing me is the appropriate amount. When I check out of a hotel, I resolve any difference with the cashier at that moment because he or she presents the detailed bill to me. I am not accorded that same opportunity in a hospital. Hospitals must think that because they are supplying necessary services and because they are being paid largely by insurance companies with whom they have special deals, they are immune from the need to be courteous and accommodating when billing patients. They sling threats of collection and of damaging one’s credit rating without even taking the time to determine whether anything is wrong. I ask you this: In what other industry do suppliers of services have the audacity to expect that one pay their bill without having any notion of what it represents? If a dealer repaired your car, then told you that the warranty covered all but $552, would you not ask for substantiation of that amount?

They can send me to collection. I do not care. Let them take me to court. There, I will make them look like the disorganized, uncommunicative dolts that they are. This is silly. Just send me the itemized bill and I will pay the damn $552!

There you have it. Not even three quarters of a year have passed since surgery, and notwithstanding some hassles with medical billing, I am enjoying life as I once never thought I could. If you still have any doubts about whether this surgery is right for you, read the books I have recommended in Chapter II, talk with others who have had their hips replaced, and talk with your orthopedic surgeon. This operation has proven itself over time, having helped many people lead normal, pain-free lives. I have no regrets.

I would again like to thank all of you who have read my story. I wish you all well with your surgery and recovery. Once again, if you have any comments or questions, I am happy to answer any e-mail directed to me at goldfarb@mrbig.com.

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