The Three R’s of Hip Dysplasia Part 3: Recovery [Patient Story]
October 10, 2017
This is the third of a three-part personal account detailing the inspiring story of Nicole Mullins, exercise professional, advocate, and enthusiast, who met her greatest challenge within her own body.
Written by by Nicole Mullins, PhD, ACSM EP-C, NSCA CSCS
The Toughest Day
Surgery down, recovering to go. Several people told me that I am brave for having both hips resurfaced in the same week. Bravery had nothing to do it. I worked so hard, yet futilely, to feel some pain relief for over a year. At this point, I looked forward to surgery. I could not wait for treatment that would enable my efforts to lead to progress, instead of only further decline. The most difficult part of my entire treatment experience was securing care from a skilled surgeon. So… two days after resurfacing my right hip, the expert team of Dr. Thomas Gross also resurfaced my left. I expected pain. Again, I even welcomed it, knowing that it was part of the fight for my active life. However, the day after the second surgery was… very tough.
When I stood for the first time on Thursday morning, I felt a little bit dizzy and nauseated. I sat back down, to see if the feeling would pass, which it did within a few minutes. As I sat, though, and became more alert, I was having a very hard time getting comfortable. I felt like I NEEDED to walk… to get moving and promote some blood flow. I got help, walked just a short distance down the hall, and returned to my room. I felt fine, until I got back to my bedside and stood still. Then, I got very dizzy again, sat a little more quickly than intended (ow!), and rested awhile, over breakfast.
My sister Michele, who had flown from Massachusetts to be with me for the whole week, came to my room at about 8:30 am.
I am so fortunate to have had my sister’s company. It was great to spend time with her each day, and to have her witness and share my surgery experiences. We had a lot of laughs and, if not for the IV in my arm, the compression sleeves around my legs, and the ice packs on my hips, it could have looked like any other time in which two sisters were just hanging out, having a good time.
My OT, GeJuana, came around 9:30. I was feeling better, so we started the shower process. I needed a little more help than on Monday, but got in the shower ok. I was aware that I might again begin to feel lightheaded, standing relatively still in the warm shower. Sure enough, I soon began to feel a little dizzy and said so immediately, knowing the dangers of falling. GeJuana and three nurses were at my side in a flash. GeJuana is quite strong, and I just hugged her as she carefully dragged me out of the bathroom and onto a chair.
The nurses quickly placed me in a head down tilt position, began monitoring my blood pressure (BP), and started administering IV fluids. My first BP was 88/40. Yikes! Within 30 minutes, however, I was sitting up, replete with fluids and maintaining a higher BP.
Over the course of the day, my nurses diligently took my BP about 20 more times, to ensure that I would have no more dizzy spells. It eventually got back to a normal-for-me 110-ish/70-ish.
With my BP stabilized and anesthesia fully worn off, I had no more lightheadedness. Nevertheless, my morning had been taxing. I was put on the disabled list for hip class, but still carried out my PT in-room. When it was time for standing X-rays, as much as I wanted to walk, I did accept the offer for a wheelchair ride.
I would have to say that standing up on Thursday was near a 9 on the 1-10 pain scale. Everything from my hips to my knees felt… dysfunctional. Thank goodness for arm strength and great help.
Two Special Visitors
I had two special visitors on Thursday, Dr. Gross in the morning, and Father Bernard Kyara in the afternoon. Dr. Gross checked on me, as he had done Tuesday morning, showing me my surgical X-rays and offering to answer any questions. I think I asked him a few about the surgery itself, because I like medical detail, but I had no pressing concerns. Regardless, I liked that he checked on me.
In the afternoon, Michele and I were in my room, when Father Kyara made a brief visit. I had listed Catholic as my affiliation, so he stopped to check on me. He recited some very appropriate passages about pain and healing, inserting my name, which provided a moving, personal touch. He invited Michele to read a passage (which she did beautifully), served us communion, wished us well, and went on his way. He was lovely.
At about 5:45 pm, it was time to go to the PT/OT room, to see if I could walk up and down stairs with crutches. My care team needed to ensure that I could safely get into my home, before discharge.
“Up with the good leg?” Which is that?!
“Up with the good leg, up with the bad leg,” then… time to bear my full weight on my legs, without support, to lift the crutches up.
While “can’t” is not a word I use much, I could not negotiate the stairs that day. I just could not do it. I felt as though my legs would crumple if I lifted the crutches.
None of my caretakers present (Jason, PT; Cynthia, PT; GeJuana, OT) felt comfortable with me being discharged the next day, nor could I imagine making the trek to Ohio in fewer than 24 hours.
However, extending my stay would involve managing some logistics, which seemed very daunting at the time. The thought of changing our flights and rental car agreement, extending our hotel stay, managing our rides in Ohio and Massachusetts, and paying more money, felt quite overwhelming. Of course, in the grand scheme of health, those changes are not ‘big deals,’ but considering how frustrating it can be to change travel arrangements when feeling fine, imagine doing it at the end of this exhausting day.
I agreed that we’d try, and one of my PTs put in a call to Dr. Gross and Ms. Webb. Team Gross quickly OK’d my extension, and Michele and I managed to handle our changes. It was a wise decision, but it was not as simple as saying, “OK.”
Virginia – an awesome, spry, impressive older nurse – was with me for a significant amount of my time at Providence. The other nurses called her a “rock star” and she sure was. Petite, with short silver hair and super cool Vibram sneakers, she was impressively skilled and fit. I loved seeing her in action. She is an awesome role model.
Conquering the Stairs
Friday was MUCH better. Mahesh, a very vibrant and engaging OT, thoroughly reviewed my lessons, and then I took a shower, got dressed, and put on my socks and shoes with my tools. I next went to PT, with Jason, to tackle the stairs that bullied me the day before.
Before I took my first step up, I started to pitch forward. Jason made a major save, wrapping his arm around my belly to stop me from falling. Jason is 6’3”, strong, and alert, and thank goodness for that! “Thank you, Jason!” With a few deep breaths, I braced up for the stair challenge and… this time… success! Whew.
After conquering the stairs, I walked some more, with Jason in close proximity. Michele joined me during this session, then stayed with me for several hours, while I got my IV removed and returned again to PT. I practiced the stairs again, along with bathtub rim navigation and more crutches walking. In 24 hours, with some rest, a higher BP, and an anesthesia-free bloodstream, I was a different person in terms of pain tolerance, coordination, and balance.
Discharge: Better late than sorry
Saturday was discharge day, but not before some morning work. I had a final OT session, with yet another adept and amiable therapist, Olivia, and then a final PT session with Jason. After PT, my nurse for the day, Kelly, went over my discharge papers and instructions with me. I was impressed with her respectful listening and advice regarding the ‘stickier’ issues, such as wound care and opioid-induced constipation. Finally, Donald helped me to the car. Although I only spent a few minutes with Donald, I found him to be very cool. He was a very fit, retired Army guy, still wanting to help people. Lucky me! He not only helped me to the car, but saved me from leaving my cell phone charger in my room. He said he always checks to see if patients have them because, “We have a whole drawer of them.” Now, that is thorough patient care!
The staff at Providence Health is adept at more than medicine. The nurses responded, quickly and kindly, to my many requests for help, no matter what time of day or night. The OTs and PTs all radiated warmth and friendliness, gave me their full attention, and provided very reinforcing repetition of my lessons. Everyone who worked with me was professional and hard-working, and I felt as though they truly cared for me.
Michele and I were on our way by 12:30 pm. We stayed that night at the neighboring Courtyard Marriott, and then flew to our respective states the next day. Special note for any bilateral resurfacing patients, who may end up staying a night in a hotel after surgery: Be certain that you request a room with an accessible restroom. The accommodations at the Courtyard were very nice, but being unaccustomed to my new needs, I had not requested an accessible room. The restroom had no handrails and using the regular toilet (vs. one with an elevated seat) was very, very difficult. My sister had to use a lot of strength to help me each time and, because of all the fluids, she had to help many, many times.
Home Sweet Home
The next day, my birthday, I traveled without incident back to Ohio, thanks to great help from my dear sister, Delta special assistance, and my spectacular parents. Before and after each of two flights, I got wheeled to the aircraft and I was able to walk with my crutches down the airplane aisles. No problems.
In Ohio, my parents (who had arrived two days earlier, on my original discharge date) picked me up at the airport and drove me home. At home, they treated me to what, under the circumstances, was the best possible birthday gift: a very high, bedside commode, with arm supports. Oh, how perspectives in life can shift! It was a great gift!
My parents worked tirelessly to help me through the initial post-surgery weeks, as I worked to gain physical independence. On my first full day at home, I went on four short walks down the driveway. I added more distance every day, as my pain decreased. After two weeks at home, I had weaned off all prescription medications, except for once daily meloxicam (anti-inflammatory) and once weekly alendronate sodium (for bone density). I was walking considerable distances, without crutches and getting in and out of bed with less difficulty.
Now, at 10 weeks, post-surgery, I have come a long way. I am teaching a three-hour long summer class at the university and, of course, working hard to continue to heal well. I am walking, swimming, cycling, rowing, and lifting weights (lighter loads, higher repetitions), and I have competed in two pistol shooting competitions. I still have some pain – in one hip more than the other – but I am also still improving and I know that tissue remodeling takes a long time. All patients must work wisely and diligently to stimulate adaptation in healing tissues, without overstressing them. My background as an exercise specialist has helped me progress at a relatively rapid rate, but everyone can help themselves, by remembering that exercise is medicine.
Dr. Nicole Mullins is a professor of exercise science, in the Department of Kinesiology & Sport Science (KSS), at Youngstown State University. She earned her Ph.D. and M.A. in exercise physiology from Kent State University, and her B.S. in exercise science from the University of New Hampshire, where she competed in gymnastics. She is certified by the American College of Sports Medicine (ACSM), as a Certified Exercise Physiologist (EP-C), and by the National Strength and Conditioning Association (NSCA), as a Certified Strength and Conditioning Specialist (CSCS). She is a lifetime competitive athlete and physical activity enthusiast, with a mission of educating as many people as possible on the essentiality of regular physical activity and sound nutrition for making the most out of life.