Wednesday, January 23, 2008

Recovering from hip surgery

Things were going so well for me health wise. My transition from a vegetarian to a low fat vegan diet were paying tremendous dividends in sustained weight loss (now 3o pounds), much lower cholesterol, better sleep and a feeling of well-being. I was approaching 8,000 miles of cycling for the year and I never felt better.

Then, on December 12th, I had a freak accident on my bike. I was riding with a buddy in the North Georgia mountains. While climbing a steep hill, I misjudged the grade and hit too high a gear for the terrain. My bike slowed too much and as I started to fall over, I couldn't get my cycling shoe (right) unclipped from the pedal. I fell directly on my hip and was in great pain. My buddy used his cell phone to call 911 and 45 minutes later the EMS arrived. I was in terrible pain as they hoisted my on the stretcher, deposited me in the ambulance and took me to Chestatee Regional Hospital in Dahlonega, Georgia. My wife took the 2 hour drive from Atlanta and met me in the ER. The x-ray showed a spiral fracture the the subtrechanter hip bone and the top of my femur. The Orthopedist judged it a "nasty" fracture.

We had a very difficult decision to make. The Orthopedist on call wanted to operate that evening. My wife and I were concerned about such a critical operation being done in a hospital we knew nothing about by a surgeon we had no familiarity with. Due to the pain, and the prospect of a long ambulance ride back to Atlanta we agreed to have Dr. Hochschilder do the repair. Turned out we made a great decision. Dr. Hochschilder is a military surgeon trained at Army Medical Center and has done hundreds of similar hip surgeries. All indications are that the repair was done very well. I am recoverying well now six weeks after the surgery. During my last visit to the doctor he showed me the xray. The fracture was now 80% healed. The doctor had put a titanium rod from the top of my hip down to the close to the knee and a titanium nail through the subtrechanter. There were some wires around the top of the femur at the break site to secure the bone around the rod.

I love titanium bike frames, so why not titanium through my femur and hip?

I can't say the rehab thus far has been easy. There have been plenty of depressing, fearful times when I have not been sure whether I would regain full use of my right leg. My wife has been great providing me with support and lifting of spirits. She has been at me side almost continually during these first difficult six weeks.

I will say that the lifestyle improvements done before the accident have paid real dividends. The 30 pounds that I lost will certainly help my recovery. Better to rehab a hip at 170 pounds rather than 200 pounds. I have religiously stayed with the low fat vegan diet during the rehap and my weight has stabilized between 168 and 170 pounds. Nice not to have to worry about weight gain during this long (probably 3-4 months) period of relative inactivity.

I asked the surgeon the condition of my hip bones and he gave me very good news. He said that I had no arthritis and that my bones were very strong. He said that my upper leg muscles were strong and thick which made it difficult for him to do the surgery, but will serve me well during rehabilitation. Hooray for recumbent cycling.

I have my goals set to return to cycling outdoors by mid-March or early April. I am committed to complete at least two Century rides before the end of the year. My physical therapist says that is a realistic goal as long as I do not rush things. I am very impatient and my tendency is to try to move rehab along too fast.

The first two weeks of rehab were the worst. There was tremendous uncertainty about recovery and the pain was rather intense. I had lots of trouble sleeping so in addition to the constant pain I was chronically sleep deprived. I started home physical therapy December 17, five days after the surgey. I had been walking on a walker for 4 days prior to beginning PT. The therapist gave me a set of leg exercises to do on my bed and standing at my walker that I was to do 3 times per day. I have done that religiously.

On January 4th I took delivery of a Vision Fitness Recumbent stationary bike. This bike has been a wonderful add to my rehab. My leg almost always feels better after 15-20 minutes of easy spinning on the trainer. I can adjust tension so that I can do increasingly longer and more intense workouts. After six weeks I am doing 30 to 40 minutes five-six times per week on the trainer. The psychological benefits of this cycling can't be over-estimated. I also am fortunate to have a well equipped home gym that has been invaluable in my rehab.

Each day of my rehap I can see little improvements. But, on three occasions I have worked out too hard and created so much pain in my leg that I was set back a couple of days. I have now learned, by trial and error, how to just enough work, but not too much.

After two and 1/2 weeks I transitioned to crutches and ventured outside on New Year's Eve to dinner in a restaurant with some friends. Getting out for the first time was terrific. The transition to crutches was difficult and there was quite a bit of pain in my leg for the first week or so. I have been on crutches since December 31. Last week I tried to transition to a cane, but it was too soon and I ended up creating a lot of pain in my leg that took three days to recover from.

My home physical therapy lasted five weeks and now I have moved on to outpatient PT. My therapist is a triathlete who has completed the Ironman twice. She is very inspirational. She feels very confident that I well have a full recovery as long as I have patience and don't try to rush things. She has suggested that I do my exercises in a pool three or four times per week. Today I signed up at the local Jewish Community Center to use their pool and had my first workout in the pool. It really felt great to get out and to fool around in the pool. My leg felt great doing the exercises with help of the buoyancy.

I can get around pretty well now and look forward to moving to a cane soon and resuming driving my car within two weeks. My crutches walking is almost entirely pain free at this point. I work out every day and feel very optimistic about my future. I will have much more to say about my rehabilitation in the coming weeks and months, but here are some of the key lessons learned thus far:

  • It is important to keep a very positive attitude and to create realistic goals to shoot for. My goals are to be back on my bike outdoors in March, to ride regularly and finish two Centuries during 2008. I hope to be walking independently by March 1.
  • Patience is key. Trying to rush things and being macho is counter-productive. I have set myself back three times by overdoing. I do my exercises moderately and stop when a good burn turns into pain. There is nothing wrong with backing off a little and working your way back. I have set my goals long term and hope to beat them. But, I know I have to be patient.
  • Family and friends are very important. My wife has provided tremendous support and the calls and visits from friends have been an important part of my psychological rehab.
  • Try to live as normal a life as possible. When I can I go out with friends and I have continued to do some client work at home. I can't travel yet, but I have tried to stay reasonably active professionally and socially.
  • The human body has a wonderful capacity to repair itself. I am in awe at how my leg has progressed over the past six weeks.
  • Once the surgeons job is done, 90% of the job of rehab lies with the patient. I have had to work very hard doing exercises, riding my stationary bike, and doing upper body weight training to have reached this point. I know I have at least another 6 weeks to go before I am walking without aid and several months before I am back to normal. But, the results lay mainly in my hands. The physical therapist provides valuable guidance, but the outcome is up to me. This is hard work both physically and psychologically.
I have a lot to be thankful for and I look forward to continuing my recovery over the next several weeks.

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