Theses: Piper (12) & Martin Luther (95)

In 1517 Martin Luther posted his 95 theses as a protest to the religious practices of the day. I had a similar occasion occur when I felt I was ready to be released from rehab following hip surgery. After 7 days in the hospital and 3 days in rehab, I tried to make as lucid an argument as I could for my release.

I posted these arguments, virtually, in my room. Had these arguments not worked, I was ready to take the next step of contacting the hospital ombudsman. But Dr. Govani, the doctor for the rehab wing, fully agreed with me, particularly on item #3, and I rolled past the frowning nurses on my way out.

Positive

1. I want to go home.

2. There is no medical reason for me to stay.
   
   
3. Medicare is the #1 entitlement cost. Let’s both do our part, today, to bring this cost down.

4. My wife needs to go home.

5. My home has all the necessary equipment for limited mobility.

6. I have had 4 previous orthopedic and 3 general surgeries, so I know the routine.

7. I have Visiting Nurses service.

8. I have done everything asked of me in PT and OT.

9. I have returned to medication levels prior to surgery, i.e., no stool softeners, no pain pills and no supplemental Lovanox.

10. Further stay has increased risks to me, namely:
    a. heart stress: BP went up to 157/77 last night just thinking about going home.
    b. cumulative risks from infections to myself and wife are getting significant
    c. my brain is starting to deteriorate
    d. my general overall mental outlook is declining

11. Dr. Nick Ting actually was ready to release me to home last Friday (11/26/10), but I declined.

12. I have met all my personal, post-surgical goals.

Contraindicated

1. Limited mobility. I have always improved in the past. I have a functional family (wife, son & daughter) for support

2. Swollen legs. This is improving daily now that I am getting out of bed.

3. Shorten stay. The ‘normal’ stay, while undefined, seems to be about 10 days. While I have been here only 4 days, I believe I am ready & capable of going home.

4. Temperature rise and incision bleeding. The temperature rise to 101 is a fluke (just my body getting ready to go home); the bleeding is minor and not unexpected.

I invite you to check out the history of my pre-surgery and post-surgery feelings by checking out our blog at:

http://cc-hip-redo.blogspot.com

Let’s aim for a 12/2/10 release, sometime around 13:00 hours.

Larry L. Piper

12/2/10, 01:30

(The bottom line is that I rolled out of the rehab ward about 15:00 hours on 12/2/10. The doctor said he had a flat tire, so that delayed his arrival about 1 hour. We got home about 20:30 hours with only two brief stops. I slept the last three hours of the trip, all of which was in the dark.)

A Christmas Letter

 We mailed the following letter (sans pictures) in with our Christmas card this year.

A reader of Dear Abby was making fun of the annual Christmas Letter. It went something like this: 'We spent the year traveling for world peace, our #1 son had an audience with the Pope and our #2 son won the Nobel Prize'. So with these caveats in mind, here goes our life in 2010.

We started the year by inviting two cats into our family, Mike and Ike. We had gotten rid of our last cat on 9/10/2001, so we took the events on the following day as an omen, and we had resisted adding anymore cats. The personalities of brothers Mike and Ike fit our family lifestyle, and we both get more from them than they get from us.

Larry took over the Presidency of the local computer club. It was not so much a position of honor or knowledge as it was to give the former president a break from his 14 year 'reign'. These presidential duties did temporarily sidetrack Larry from his main goal: to check into the possibility of a pacemaker. The story is long and convoluted, but essentially in mid-2009 Larry could tell he was NOT coming back from the back fusion surgery. His resting heart beat had dropped to 35, and a visit to the cardiologist confirmed that he was a candidate for a pacemaker. Unfortunately, the cardiologist 'forgot' about the office visit. But a new doctor had come to town. Officially she was an electrophysiologist, and she had a new $5 million operating room at her disposal. An appointment in March confirmed that a pacemaker was needed (bradycardia is the technical term), so on April 27 Larry had both a pacemaker installed and some cardiac ablation done. The two procedures were day surgery, and recovery was complete in two days except he could not raise his left arm for six weeks (to let the internal leads heal).

The big event of the year was our 50th anniversary. The manditory trip or family dinner was never on our radar. Judy concocted this plan to share our celebration with family and friends at the Loons baseball game. The Loons are a three year old, A-level professional baseball team in the Dodger's organization. So about 12 of our family and 18 of our friends were able to join us at a cookout at our house before we all enjoyed the game in prime seats behind home plate. Larry put together a PowerPoint show that contained over 100 photos from our married life.

The most visible accomplishments in 2010 were changes to our house. We did the changes with our checkbook rather than our own sweat, which was both a seismic shift in our philosophy and a boost to the local economy. The key was finding a good, local contractor. Mike first reroofed our 25 year old garage in May. When we saw what a great job he did, we turned him loose on new siding and windows for the house. Then we had a 55 year old spruce removed from the front lawn, and voila!, we had a new home. Checkbooks are a wonderful thing!

Larry had some adjustments made to his pacemaker and a second cardioversion done in late summer. Now his heart was hitting on all cylinders. But the hip pain had returned. The expert opinions said he should return to Cleveland Clinic for the redo operation after 22 years. Larry's original hip surgeon had retired in 2007, but a new surgeon even more capable than the first had taken over. The downside was a four month wait for an open surgical date. But then the gods smiled upon us and a date became available at Thanksgiving. The surgery took twice as long and the hospital stay was about three times as long as expected. The recovery period will be tougher than previous surgeries, but as Judy noted, 'if we had done the surgery at any place other than Cleveland Clinic, Larry might not have walked normally again.'

All in all it has been another good year. We have a lot to be thankful for. Life is good.

Pregnancy, Marathons and Orthopaedic Recoveries

Pregnancies, as we all know, take 9 months to reach fruition. And the process cannot be shortened to 1 month, as the joke goes, by putting 9 men and 1 woman or 9 women and 1 man on the job.

Running your first marathon takes a similar amount of time. I had a couple DNFs at the 26 mile distance before I devoted the necessary 9 months time and effort into training for the distance. I have talked with and coached other runners who have voiced similar feelings in conquering the marathon distance.

So that leads to an orthopedic surgery recovery. This is a subject on which I have abundant experience. The 'party line' on hip replacements is 1 year before you will be back to normal. My 1st hip took a little less than 9 months; the 2nd hip took a little longer. But the back fusion was a totally different matter. The bone paste used in the fusion takes a minimum of 3 to 6 months to 'set', and, like concrete, continues to harden up to 2 years later. During this first 3 to 6 months, one has fairly restrictive movements.

So this is the predicament in which I once again find myself. My left hip redo on Nov 23 will take 3 to 6 months to set because Dr. Muschler had to use bone paste to build up my hip area. During this time I must have absolutely zero weight on the left foot for 6 weeks. At this point we will make another trip to Cleveland Clinic where an X-ray will show the healing progress. I truly believe that Dr. Muschler will extend my non-weight-bearing restrictions another 6 weeks. This can be a depressing outlook. During the previous back surgery in Nov, 2008, I passed the time by writing a book about my life -- to give to my two children. What I will do this recovery period is unknown at this time. All I know for sure is that I have 9 months to do it. Any suggestions?

The photo above is from day 20. Tomorrow I expect the Steri-Strips to be completely removed (Day 22).


Larry

Routine Has Set In

The duties of blogger have fallen to me. Judy is busy taking care of both of us.

I gained strength rapidly after recovering from the 5 hour car ride home. I am into a routine that consumes most of my day. I see a visiting nurse once per week to who checks my general progress. A PT (physical therapy) nurse comes in two times per week and we work on exercises for about an hour. Throw in a 2^nd PT session, meals and a couple naps each day and it is time for bed.

I have been able to sit up for 20 minutes at a stretch for the last 3-4 days, so I can read a little email and type into my daily diary or this blog. My mind is starting to work again, and the reality of 6 to 12 weeks of this recovery routine is beginning to set in.

I will try to write another blog tomorrow; it will be more philosophical than medical.

Larry

We're Home

Eat, Sleep, Rehab

Today was Larry's first big PT and OT day. He did very well.....you know Larry....he's there to do more than necessary and as usual he charmed them all. He seems to be getting stronger now. The therapist put him thru the usual PT moves but now 30 reps each. Of course, he did 31. After seeing him morning and afternoon, she has him pegged. He told a couple of jokes and while waiting for transportation back to the room, one of the lady patients said tell us some more in case I am not here tomorrow when you are.

He is sleeping soundly right now. My head nodded a couple of times while catching up on my emails. We solved a couple of problems today having to do with computer related renewals. We did not anticipate being here this long……optimistic souls that we are. So we have lots of good check marks for the day.

Larry's lack of strength is the main factor in getting out of rehab and loss of flexibility from his back surgery. Since the surgeon did so much rebuilding in the hip, the new bone has to heal solidly. So we may very well be trapped in the house this winter as much as we were with his back surgery. It will be so nice to get home we won't mind. It's hard to remember that you are almost 72; you think you will spring back as you have always done. And he will be back; it just takes longer.

Oh yes, I am doing all this computer work from Larry's room. It took some persistence to get on the Cleveland Clinic wireless here at Lakewood, but it works. It’s so nice to be able to communicate with family and friends easily.

Over and out.

Judy

Monday-Tuesday Recovery Report

Yesterday (Monday) was a big day, almost as big as surgery day. Larry was transferred from Cleveland Clinic proper to one of Cleveland Clinic’s associate hospitals with a Rehab Unit for those not ready to go home. It is one of two recommended by his surgeon.

A new phrase added to our family sayings is “Poking the bear”. His surgeon used the reference from childrens literature. You poke the bear once, no problem, you poke him twice, three, with little response. By the fourth time he will come after you. He was using this to tell Larry not to push himself to fast to get back on his feet or he would pay a penalty.

Scot and Laura came Sunday afternoon to be here Monday when Larry was transferred. It was a tremendous help to me to calm my nerves for the transition. I have a good hotel to stay at and daily shuttle to the hospital. So we are back to a routine.

Tomorrow (Wednesday) Larry begins 2/day PT and 1/day OT. He is ready to prove how quickly he can improve. Up until a couple of days ago, he did not have the strength to stand and support himself on his walker. Now the effects of 6 hours of surgery and the more complicated surgery than expected are behind him and it’s on to the challenge of recovery. And you all know Larry; he will put his all into the effort.

He’s hoping for a return home in 5-6 days but we will see how fast he can improve enough to get the physical therapy department to release him. I am helping every day with the exercises and learning all the moves. Haven’t even gotten to reading anything I brought “to fill my time.” Larry does that. Recovery is hard work!

Thanks for all your encouragement.

Judy

Sunday Report

There have not been many changes lately. Larry is getting stronger and his internal blood loss has been replaced with all his transfusions. Damn coumadin complicates everything. He’s down to Tylenol for pain. Physical therapist work with him yesterday (Sunday) went well. He made it out the door again, rested in a chair in the hall for a few minutes and made it back to bed again. Sat in the bedside chair a few times also. You just can’t build strength and energy lying in bed.

Today the case manager is working on getting everything in order for transfer to a Cleveland Rehab hospital. The discussion has been about a 5-10 day stay for intensive 3 hr/day rehab sessions all the while with doctors and therapists whose job it is to deal with those who are motivated to get home but have the expertise to deal with the medical issues also.

Scot and Laura arrived yesterday evening to check on their dad, help with the transfer to Rehab and give me some moral support. It helps at this point to know I am not the one totally responsible for watching over him. Got too many years invested in this guy to turn decisions totally over to someone else, even if it is a nurse or doctor. I know him and can read him better than anyone else.

So all the nitty gritty about what goes in and what comes out seem to be going well. His resident and surgeon will both be in for a final discussion this morning. They both have said that they know he is a “motivated” patient.

More later. Thank you all for your interest and concern. Email if you want; we are reading them every day.

Judy

Saturday Day 5

Things change so quickly from day to day, always keeping us on our toes. Today started at 3 a.m. with two more units of blood because of low hemoglobin. I couldn’t sleep so went back over to Larry’s room at 4 a.m. I slept in a chair until the hospital came alive.

The dressing was changed today, somehow it was overlooked yesterday with all the ins and outs of nurses on a holiday. There was a lot of bruising at the top area above the incision. As usual, I took a picture of the wound. Later when the resident came in, he wanted to see it but hesitated to remove the fresh bandage. When he heard I had a picture and showed it to him, he said that gave a new meaning to the term “Kodak moment”.

In the end he decided to cut back on Larry’s coumadin and Lovanox and use a pressure Ace wrap in that area. This is quite a guy. He had been on 24 hour duty that night, came in to see Larry as he had promised at about 30 hours. After that he was to be found working at the computer after showering and shedding his doctor’s coat. He went out of his way to contact Larry’s surgeon and work up a plan.

Therapy was good for the first time today. Larry had more energy so was able to get up from the bed, sit up for a half hour, stand up and walk 15 yards on a 4 posted walker without putting any weight on the surgery leg. His therapist today was great – an athletic young woman with just the right amount of modifying exercise so that Larry was successful.

He sat up on the side of the bed a second time later in the afternoon. And the every important BM took place. Some hospitals make a big deal out of BMs before going home but Cleveland Clinic does not seem to be that concerned. Nevertheless, just one more checkmark for the day. (Larry thought this was important information but I think it just might be TMI. :o)

Patient load census this weekend was only 11 on the orthopedic floor tonight. The nurses all seem to want upbeat optimistic Larry for their patient.

To quote a line from the movie “Overboard” with Goldie Hawn……. “It’s a great day at sea, sir”……our version is “It’s a great day at Cleveland Clinic.”

To be continued…………..

Judy

Day 4 at Cleveland Clinic

Hospital life is a list of unending changes depending on the latest doctor or therapist’s visit. Both the surgeon and resident agreed that Larry could go home today as far as surgery and vitals were concerned.

HOWEVER, the physical therapist said that Larry is not ready and he would not recommend that he leave the hospital. The difficulty of the surgery and effects of past recent surgeries have left him weak in the upper bodystrength area. So it has not been possible for him to use enough muscle strength to stand and walk with the walker, while not putting any weight on his surgery leg. He has 3 months ahead of him doing just that, not putting any pressure on the surgery hip area while the new bone forms and heals.

So since insurance companies frown on staying in the hospital “only” for therapy reasons, they have been trying to arrange a transfer to one of the Clinic’s Rehab centers for a 5-10 day stay. There are 2 here that are used by Larry’s surgeon, but this being a holiday week there are difficulties contacting insurance people and lack of staff at the rehab centers until Monday.

To all our friends in our computer clubs, you shouldn’t be expecting to see Larry as soon as he planned. Although this time the drugs do not seem to have affected his mind as much as other surgeries, so you will hear less complaints about forgotten passwords.

Family and friends who want to communicate with us can email me (you know my email address) as I read my email daily. The cell phone reception is iffy in some parts of this enormous place, so that really is not an option.

Finally, I cannot say enough about the excellent care Larry has received here. His surgeon is a genius, his main physical therapist is a young Nigerian man who is also remarkable. The nurses are all excellent and caring, and of course Larry has charmed them with his banter.

5:00 p.m. Update…..they could not find an opening at the Rehab Center, so unless Rehab calls over the weekend that they suddenly have an opening and doctors on staff for admittance of a new patient, we will be here at Cleveland Clinic at least until Monday. What an exciting and nerve wracking week this has been so far!

Judy

Thanksgiving at Cleveland Clinic

Thanksgiving Day at Cleveland Clinic was pretty quiet, fewer patients and visitors. The parking lot at the Guest House was only about half full. There was a skeleton crew on duty when I left at 10 this evening.

Last night, Wednesday night, Larry’s second night after surgery was a tough one. We heard today from the nurses and doctors this is not unusual as the body begins to wake up and react to all the insults over the last 24 hours. He was not able to stay on top of the pain, so I went back over to the hospital about 4 a.m. The Clinic Guesthouse is just across the street from the main entrance.

To top it off, his roommate had many issues which brought quite a number of personnel to the room during the night. Eventually this led to the roommate being transferred to a different floor this morning. The nurse aide came in this morning and jokingly said “hear you had a perfect night last night.” Everyone at Cleveland Clinic seem to go out of their way to be pleasant and listen to what you have to say. Nice! So for the time being, Larry has a “private” room.

The orthopedic resident told Larry it is expected that he would be weak after 6 hours of surgery. The resident was happy with how Larry's surgery looked. Physical therapy this morning -- Larry was still very weak and struggled to stand with a walker. Work with the Occupational Therapist this afternoon went better, able to get up from the edge of the bed and stand with some help from the therapist. Succeeded again later with Judy’s help. Each effort makes it a bit easier.

Just as a measure of how he is feeling, he wasn't even curious about the Black Friday ads in the enormous Cleveland paper.

We both sneaked in several naps during the day. We are not pushing the docs to let Larry rush home, trusting their judgment. Just making the 5 hour drive home will be a challenge, followed by a lot of hard work.

Judy

Hip Re-do Day 2

A picture is worth a thousand words.

This morning when I arrived at the hospital the nurse had begun a blood transfusion.  Larry’s blood pressure had dropped very low.  Eventually he received another unit later in the afternoon, which raised his blood pressure and his oxygen levels.  His endorphins were still high from yesterday’s big day, as were mine…..relief that the surgery part was behind him.  So he was feeling good.

The surgeon and his PA arrived at 11:45 and gave details of the surgery.,. most of which I reported in yesterday’s information.  He reported that he did use 300cc from the bone bank for the graft.  Since the hip and surrounding pelvis were rebuilt, the recovery time is going to be almost as extensive as his back surgery.  Larry will be on a walker for a minimum of 3 months, not putting any weight on the surgery leg, in order for the bone to grow together and strong.  From there on, his recovery protocol will just depend on his progress.

Physical therapy today with a very bright young man from Nigeria.  He said he was in the operating room during Larry’s surgery and commented on the surgeon's precision and meticulous work on forming, fitting and refitting the “cage” to make sure it fit perfectly.  This therapist was just as attentive to detail, helping Larry to sit on edge of bed and stand with walker the first time.  It took a tremendous amount of energy and strength for Larry to do this and he was somewhat discouraged that he didn’t move well.  They reminded him that it was only 24 hours since his surgery.

So I left at 7:00 this evening to come back to the room.  He was sleeping and would probably be sleeping most of the evening.  I think tomorrow might be another tough day as his body awakens more and he begins to feel the effects of 6 hours under anesthetic, plus a lot of “poke holes”. 

At this point, it looks like we will be coming home Saturday but there is a lot to be accomplished before then.  And lots more recovery work to be done when we get home.

Larry is one tough guy.  Where does all that inner strength come from?  In case it isn't obvious, I'm quite in love with this guy.

Judy

Surgery Day

After an early call to report to the Clinic at 9:30, Larry was taken to Pre-Op.  At 10:30 I spent an hour with him until the “limo” aka Cedric arrived to take him to the Operating Room.

At Cleveland Clinic there is a large electronic board listing all the patients there that day for surgery and their progress.  It reported that Larry went to the Main OR at 11:57.  However surgery did not begin until 1:15.  Our discussions with the surgeon indicated that the surgery was a 2 ½ - 3 hour surgery but eventually it was 7:15 before he was released to the Post-Operative Recovery.  It was finally 9:45 until I was able to see him; he was transferred to his room shortly thereafter and midnight before I got back to the hotel.  Hence, the reason this is being posted this morning.

The surgery was more than just a simple replacement of the cup the ball joint rides in.  The bone was lodged around the cup and the bone was paper thin.  The regular jumbo size replacement cup did not fit so the doctor did a 300 cc bone graft in the area, put in a larger “cage” with 9 screws.  This will take longer to heal.  The femur bone had pulled away but was not loose, so he cleaned out around it and decided it was not necessary to do more. 

The surgeon was very happy with the results and said it was just a normal re-do surgery.  This extra will require 3 months on a walker.  There was talk of going to a rehab center but we already have the “rehab” set up at our house.

We will probably be going home Saturday.  We will get more info today when we see the doctor.

Off to begin another day at Cleveland Clinic.  High praises for their expertise and care of patients.

Judy

2 1/2 days and Counting

Family Thanksgiving today at Laura's.  Tying up loose ends tomorrow.  38 hours til we head out to Cleveland.  22 hours til surgery on Tuesday.  We'll know the time for sure when we do the usual "evening before" call to the hospital.  We're ready!!!

Judy

Pills: To Take or Not To Take

Besides all the Pre-Op tests (blood work, X-rays, heart, anesthesia and financial checks), one of the major requirements is to stop certain medications at certain times prior to surgery.

For Larry, the major concern of all surgeons is blood thinner (Coumadin). The standard answer is to stop Coumadin 5 days before surgery -- which he will do. This gives his blood a chance to return to a normal coagulation state. The risk of a stroke for heart patients NOT on Coumadin is 1/1000, so missing 5-6 days is a negligible risk increase.

But surgeons worry about other drugs which can affect blood clotting. So here is a more complete list of DO NOT TAKE items:
NSAIDs (like Motrin, Aleve and Naprosyn) should be stopped 7 days before surgery.
Aspirin should be stopped 7 days before surgery.
Vitamin E, multivitamins and fish oil (all oil soluble) should be stopped 10-14 days before surgery.
All herbal preparations should be stopped 7 days before surgery.

On the other side of the coin, iron has been added into Larry's medications. This is a form of blood-doping; it worked very well on Larry's back surgery two years ago.

So I am elevating everything in the house so Larry can get up and down when he returns from the hospital. This includes the bed, the toilet seat, a chair and the davenport.

Our B.S. lists (that's Before Surgery) are shrinking in size. One more social commitment of the 'blended' family Thanksgiving dinner at Laura's in Chesaning this Saturday and we will be ready to head for Cleveland.

No pictures for this post.

Judy

6 Days and Counting

It is Nov 17, and I have set up a blog for you to track Larry's hip surgery at Cleveland Clinic.

We have made two preliminary trips to Cleveland to take care of all Pre-Op details, so we are good-to-go.

On Nov 2 we made a fast, 13 hour round trip to Cleveland Clinic to get cleared by a Cardiologist. Surgeons get up tight about ones heart condition, especially if you have had previous surgery like a triple by-pass and a pacemaker installed. We saw Dr. Michael Faulx (pronounce that one!), and he passed Larry with flying colors (that was after getting the usual high BP of 150/90 when in any doctor's office). After running the manditory EKG and listening to his heart, he gave Larry a 9 on a scale of 1-10. (This rating was somewhat tempered by a subsequent comment that, since Cleveland sees the very worse cases, anyone with a half-way normal heart beat would be rated high!)

On Nov 15 we had our second visit to Cleveland Clinic. We saw 8 different departments over an 8 hour period. Again, they could find nothing to rule out Larry's surgery. I may write more details in a subsequent blog, but for now I want to make sure this baby is working.

So on Nov 23 Larry will go into surgery. Surgery time is estimated at 2.5 hours, recovery time about 2.0 hours and hospital stay is 3 nights. So we will be eating turkey in the hospital and return home on Black Friday.

The above picture is the entrance to the hospital, one of about 20 buildings.

Much more details to follow.

Judy