Surgery Consult and Decision Making

On 6/27, I went to see the orthopedist for a surgery consult. Of course, the first thing I asked him about was the recovery time, and he told me that I would need to be on crutches for a month. One month! That's a long time. It's a long time no matter what, but it's a really long time considering I have a two-year-old who isn't potty trained, can't dress himself, live in an almost 100-year-old house with insane stairs, etc., etc., etc. I really didn't think I could do that, so I sort of got hung up on that aspect of the recovery and decided against the surgery right then and there. (I later reconsidered, obviously.) Unfortunately, because of the crutches hang up, I didn't really use the rest of the appointment to ask other useful questions that would have helped guide my decision-making. After a few days of going back and forth in my mind, I e-mailed the surgeon a bunch of questions and he ended up calling me back and going over them with me on the phone.

Some considerations:

1. Interestingly, while the one month on crutches thing seemed very long, the rest of the recovery didn't seem as grim as I had imagined. I asked the doctor if I had surgery, theoretically, within the next few weeks, if I could be off crutches and completely ambulatory by August 13th. I am teaching a one-week course, a semester's worth of material in five days, starting on 8/13. This course meets 8-5 for five days, and is physically tiring for me even when I'm not recovering from surgery. However, it is worth noting that I did teach this class when I was 33 weeks pregnant, which is probably just as bad as teaching it one month after hip surgery. (Then again, my son was born right after I finished, six weeks early, so maybe it wasn't the best idea.)

The doctor said this was doable, as long as I would be able to take breaks. I also might not be able to walk around too much, but standing would be fine. I tend to walk around a lot when I lecture, but I can modify this. And I'm sure none of my students will cry if I give them more breaks than normal.

2. I asked how long it would be before I could drive. If you Google 'driving after hip arthroscopy,' you get a wide range of responses from 'once you're off pain meds' to 'once you're off crutches' to 'six weeks if it's your right hip' (which it is). While I eventually came to the conclusion that one month on crutches was doable, one month of not driving was really not doable for me at this point in my life. I live in a city with limited public transportation, and the nearest bus stops are three blocks away. This wouldn't normally be a big deal, but is a big deal on crutches and with kids in tow. Plus, you have to consider the distance you have to travel from where the bus drops you off to your final destination. (For example, it is a trek from where the bus drops you off at the university to the university daycare.) Not doable. I mean, I'm sure I could make it happen if I HAD to, but this is elective surgery we're talking about.

However, after a brief discussion about what type of car I drive, my doctor was in the 'once you're off pain meds' camp. Who needs pain meds anyway? LOL. The big consideration for driving is that you cannot flex your thigh past 90 degrees, so I guess this rules out things like fancy little sports cars. Fortunately for me, I drive a hand-me-down from my grandparents, which I inherited eight years ago, along with their cat.

3. Speaking of no flexion past 90 degrees, probably the biggest bummer of all of this is, for me, is not being able to garden. Gardening is my one big hobby, and I actually really enjoy weeding. There is something oddly satisfying about sitting in my garden, yanking out weeds, and feeding them to my chickens. (I'm somewhat of an urban homesteader.) I can go to my Happy Place in my garden.

Unfortunately, the doctor did say that gardening was pretty much out. I believe the exact words were: 'Uh, yeah, there's not going to be much gardening after the surgery.'

4. I asked if I would be able to ski by ski season. This is not totally necessary, but merited strong consideration. My daughter finally learned how to ski proficiently this last spring and my son will be old enough for ski school in the winter, and I was looking forward to skiing with my family this year. I wasn't willing to give up the rest of my summer PLUS winter recovering from surgery.

However, the doctor said skiing by ski season was totally doable, and that after three months there would basically be no restrictions on my activity. He said that he has gotten NHL players playing hockey again after three months. I assume that was in a previous lifetime considering he must be, like, 20 years old, lol, but nevertheless, I was happy to be put in the same category as NHL players. :)

5. I explained my concern over getting around my house on crutches. I live in a house that was built in 1920 and has a horrible stair case. Granted, I am a little phobic of stairs, perhaps overly so. However, between my knee that randomly gives out on me and a highly uncoordinated daughter who trips no fewer than ten times a day, the fear isn't totally irrational - and I have actually fallen down the stairs at a colleague/neighbor's house while holding my son, when he was an infant. (That was fun. Not.) The main problem with our stairs is that there is no rail, so all those instructions on the web about going down stairs on crutches don't apply. (FYI: This is a very useful site if you have normal stairs: http://www.upmc.com/patients-visitors/education/rehab/pages/stair-climbing-with-crutches.aspx.) Our house is also difficult to get into and out of. When we bought the house, the back entryway was almost a deal breaker for me because there is a real possibility that you can fall down the stairs into the basement if you aren't careful. Since I'm not planning to move anytime soon, the stairs will always be an issue. However, when you add a two-year-old into the mix, it makes the issue a little more difficult. I can't be going up and down the stairs all the time like I usually am, following my son from inside to outside and then back in, getting things for him, putting him down for his nap, changing his diaper, etc. (The diaper changing is another issue.)

The doctor asked if I would have to go upstairs to sleep -  i.e., was my bedroom upstairs? All the bedrooms are upstairs, although I can always sleep downstairs. He agreed that might be a good idea, but said if I had to go up the stairs, I might want to consider going up backwards and coming down on my butt (which is what I make my kids do; they call it thump thumping down). It wouldn't necessarily be easy, but it was doable. He also said he had done this surgery on other people with young children and they managed; that even after a few days it was likely I'd be feeling pretty good and would be able to get around pretty well. You just need to stay on crutches for so long to allow the cartilage time to heal properly.

So that was that.

* * * * *

After a lot (A LOT) of thinking and thinking and OVERTHINKING, I decided that the surgery was going to have to happen at some point. I can't live another 40+ years like this, and I do hope to live another 40+ years. I also hope that some of these future 40+ years are more active than the past year has been for me. Thus, I came to the conclusion that sooner would be better than later, just because if I'm miserable, and surgery can make things better, which I hope with all my heart it can (otherwise why would I do it?), then why should I wait? As one of the doctors told me, there is no 'good time' for surgery. 

The thing is that if I wanted to do the surgery this summer, it needed to happen soon if I was going to be ready to teach by 8/13. Considering it took me seven months from the time my pain started to actually see an orthopedist, that seemed rushed.

Other options:

• Have the surgery later and recover during school year. When I started this job, I was having trouble with my knee. I was worried I would need surgery and wouldn't be able to recover before the school year started. My brother told me not to worry, that students would feel sorry for me if I were on crutches, and be nicer. LOL. He recently had had surgery on his foot and interviewed for jobs on crutches and had gotten a job. (He is a federal prosecutor.)
• Have the surgery during the winter break. This would mean giving up the ski season, but at least not the end of summer.
• Have the surgery at the end of May next year. If I could do it early enough, that would leave most of the summer for at least semi-fun. Honestly, this would be my first choice, but I was worried about whether or not I could make it that long. I was soooo miserable the past year, and definitely felt I couldn't handle another year like the previous year. The cortisone shot made the pain much more manageable, and ideally I would have waited it out to see how long the effects lasted, but I didn't want to get to the beginning of the semester and find out the effects had worn off. Looking back, I think the chronic pain really took a toll on me. For one, it kept me from sleeping well, and I already have trouble sleeping, so I was basically crazy from lack of sleep. Ordinary pain relievers did nothing, and when I tried the more heavy duty stuff my PA prescribed for me, those made me crazy. (I almost had to cancel class one time because I felt so crazy.) I also stopped doing my favorite exercise, which is going on walks and walking to places as a mode of transportation, which made me crazy from feeling all gross and sedentary and put me in a bad mood for most of the semester.

So, I decided to go forward with the surgery ASAP. It was so unlike me to make a decision so quickly, but I felt like I was at a point where I couldn't go on the way I was. I also really liked the surgeon, and felt like he was competent and trustworthy (hopefully my instincts will turn out to be right), and that was an important factor, too. He was also available on 7/7/14, so I scheduled the surgery and did not look back.