Legs To Stand On: A Psychological Journey Continues:
Part III: One year later
How fast it's gone. Too fast. As though I've been away in some foreign land or strange place in myself, and I've come back to find other people's lives moving forward: marriages, births, geographic changes, professional decisions, publications, productions. And what have I done in the meantime? Well, I've gotten better.
This may sound strange coming from the lips of someone who went back to her practice thirteen days after surgery and who was in the gym a week later. Since my surgery I've have been in full time private practice, written articles, revised a play I'd been working on before surgery-and started a new one! I'm talking about what my preoccupation has been, what the leitmotif of my life has been...
I've been getting better.
I'm grateful. I'm pleased - AND I now feel as though I have a lot of catching up to do. I 'm tired of thinking of myself as someone that has to wait to live fully. I want to do it all full out. Now.
I want to have adventures. Like the trip Allan and I took to St. Lucia last month: my official "hip" vacation. A celebration of physicality. It was warm. We swam with exotic fish in a clear, turquoise sea. The sun was comfortingly warm. I had bought a new bikini for the occasion. Screw the scars. They were a badge of courage - but not what I wanted or want my life to be about...
I'm learning to ignore the fuss that's made over me at airport and museum security checkpoints. Just get through it.
Physically, I have done extraordinarily well. If you saw me walking down the street you would never imagine that I'd ever had any issues with my hips. I am utterly pain free. I walk at a good clip. My old confident stride has returned. I am back to all my old gym activities: cross trainer, lifting weights, stretching (I'm better at the barre than I've been in 2 years.), starting yoga again. Allan and I have vowed to resume tango lessons.
Before surgery I worried that my hips wouldn't be the same shape afterwards. I'm a bit vain, but it is more likely that this was a displacement of what I was really worried about!. Well, my hips DO look the same, the indent at the point of articulation is perhaps even more pronounced.. And the scars continue to recede - greatly helped, I should add, by BandAid Scar Therapy. The important point is that I simply don't care as much.
I have a few minor complaints: my balance has not quite returned, I still can't sit cross-legged like a guy (Why do we always want to do what we can't do?), and every once in a while I am aware of the parts of my prostheses moving over each other. It feels creepy, not because it hurts but because it reminds me of the "not me" in my body. Otherwise, I am rarely aware of being any different.
I am infinitely better than before surgery. I've had a great result.
It was when the surgeon's work was done,though, that mine really began. I had anticipated that I would need to be rigorous in my physical rehab. What I was unprepared for was how much of the work I had to do would be psychological.
Here is what the year of "getting better" has been like.
At four months I hit a trough. I had been going like a house on fire since my surgery: exceeding all expectations - even my own. People marvelled that I moved so well. No hint of a limp at eight weeks. And I looked healthy. Maybe a little skinny.
My disposition had been sunny. I had felt optimistic and on top of it all. Suddenly I had little energy, I felt fatigued, discouraged., even morose.
If I had given birth to a baby instead of acquiring and learning to use a new set of hips, I would surely have been diagnosed with post-partum depression. I explain this depression to myself in the following ways. First of all think I went out too fast - like a runner who moves immediately to the front of the pack and then can't maintain the pace. Part of the adrenalin rush that gets you through surgery. But this was at the very time that metabolically much of my energy was going into healing. I simply didn't have the resources that my athletic stance in life and my denial of limitations was demanding. I pushed, didn't pay enough attention to the "no" that my body was screaming at me. Now my body was claiming it's due.
A second reason for my depression was that, on another level, I was beginning to face what had actually happened to me. A certain degree of denial had been necessary to get myself through the experience. Survival mode. After all, you can't keep saying to yourself, "I'm about to have my femurs amputated"! You'd never let them near you. I describe in Part Two how I consciously by-passed details of the surgery itself by focussing on visions of my recovery. It worked splendidly. For the surgery. But there's a price to pay for everything.
I notice this frequently an my practice: most behavior - even defense mechanisms - have functional and non-functional aspects. I had used denial functionally to get through surgery, but I now had to deal with what I had denied...
At four months, then, I had a delayed trauma reaction... It hit me suddenly that I didn't have joints any more in the usual sense. Sometimes my legs didn't even feel as though they belonged to me. At these times I would see visions of the x-rays taken at six weeks: titanium rods hammered down into what was left of my femurs. I would feel nauseated.
My proprioception was off: I would scuff my feet on the ground when I walked, misjudging the distance from my hips to my feet. And sometimes walking felt rough, jolting, as though my new hips lacked shock absorbers.
I remembered suddenly that I now had to take antibiotics before routine dental procedures - the tissue surrounding the prostheses was prone to infection.
And the day I excitedly attended my first museum exhibit since surgery, Modigliani at the Jewish Museum, I ended up setting off the security system.
It had to be faced: I was not the same person any more. A third reason for my depression was that now that the critical period of surgery and its immediate aftermath was behind me I had to confront the rest of my life. Where was I going to take my practice? How could I make time to research my new play? Were Allan and I going to buy a house or fix up his? I'd been getting a lot of attention for being a good and brave patient, a fast healer, even an awesome example.
Now I was no longer a whiz kid accomplishing remarkable feats- just a regular person doing her life.
I see in my notes of October 4, 2004, or six months after my surgery, the words "return of the repressed". At six months the depression had deepened. As far as the outside world was concerned I was doing brilliantly. Allan knew, of course, and my closest friends. I had little energy, cried easily. I found myself in mourning for all sorts of things: for my amputated and discarded femurs, for moments not savored, for actions not taken.
For my youth.
I was acutely aware of my mortality, of the brevity of all life. I was also aware that I had committed an "irrevocable act" in having this surgery, an act that signified that part of my body had already used itself up and needed replacement.. Age. Decrepitude.
I was able to put all this aside when working with patients. In my practice I felt creative and on the ball. I could forget myself. But with those closest to me I was variously argumentative (more than usual!), self pitying, angry, sullen. I pushed hard for life changing action in other people - but couldn't initiate any myself.
And when I discovered on Labor Day, swimming for the first time since my surgery, that my competition flutter kick had disintegrated, I was inconsolable.
Naomi and I would have lunch every six weeks or so. "Did you ever feel that...? Did you ever notice that...? Did you have trouble with...?" I would ply her with questions and her responses were always reassuring and normalizing. It turned out that she had experienced many of the same physical symptoms and even the same emotional travail. And since she was nine months ahead of me I could get an idea of what was coming next and where I could expect to end up. I wasn't a freak after all. I was just... getting better.
I continued my own psychotherapy. It was invaluable. I could talk about how angry I was that this had happened to me, how everyone else expected too much of me, (Projection! Projection!). how the best part of my life was over, how it just wasn't fair. Beverly didn't let me get away with that stuff for very long.
I also continued to work with my wonderful physical therapist, Rocky, at Westside Dance Physical Therapy until Thanksgiving. (seven months post op). Of all the healing influences of my postoperative period, it was Rocky's that I could put to immediate practical use.
Rocky's process with me and my body was much like my process with my patients and themselves and/or others. Don't generalize. ("I NEVER get ANYWHERE with these exercises!") State things in terms of specific problems. ("When I do this balance exercise my left knee buckles.") And then find solutions to the specific problems. If, in the course of this, you discover an unproductive mind set, so much the better. ("I realize that before surgery I favored my painful left leg. It is a bit weaker now than the right, so I get scared when I have to depend on it alone. Both physical weakness and fear make me lose my balance."
Solution: accept that my left leg is weaker, do strengthening exercises. Reassure myself by recognizing that I have isolated and am working on the problem.) Rocky was far more patient with me than I was with myself, and her knowledge and intuition are extraordinary. I will surely go back to see her for fine tuning.
Allan has been steadfast throughout. His usual way is to be quietly attentive and optimistic about what lies ahead.. But occasionally, during this past year, he has had to resort to such subterfuge as.: "Think you could make it to the top of Sleeping Giant?" (a good steep hike of three miles or so) "Bet you couldn't." I've a;ways found it hard to resist challenges like that. Off we'd go Loving well demands creativity. Then one day, as suddenly as it had descended, my depression lifted. I stopped feeling sorry for myself. This corresponded to a surge in the healing process: suddenly I could do new things,. I wasn't bothered any more by many of the troublesome symptoms. Which came first, which caused which, I will never know.
It had been a couple of months.
Healing continues One of the real surprises of this experience is that just when I think I've gone as far as I'll ever go, something new happens. Frequently it's after I've given up trying. One day I forget what I can't do - and I just do it! Like bending down over a straight knee to tie my shoe...
Naomi assures me that healing continues strongly in the second year after surgery. All right, then!
I've learned something important: sometimes you can push yourself but sometimes you have to wait for your body. Good healing involves a little pushing and a little waiting. Your body will tell you which one.
In rereading my last installment I see that I worried about becoming a fearful person. Well. I must say that I'm still more careful than I'd like to be. I don't run down flights of stairs that way I used to. I didn't go sailing in St Lucia when it was so rough I might have been slammed around a bit. I commonly watch the ground for patches of ice. In January I retreated from a walk that Allan and I were taking along a paved linear park in New Haven. There was a lot of ice. I was afraid of falling. I hope this is a reaction that will fade gradually and finally disappear. A friend of ours who had a hip replaced several years ago skies regularly. Maybe I'll rollerblade again. I like to think of myself that way...
We have to decide what's important in life.
One Year Exam
This morning was my one year follow-up exam. with Dr. Pellicci. I was exuberant, grateful. I hugged members of the office staff and showed off shamelessly.
Questions to Paul Pellicci, MD:
Here are the questions I asked Dr. Pellicci followed by his responses. I hope they are helpful.
How do my xrays look? Am I making bone? (I had had non-cemented surgery.)
They look great. The bone has almost completely filled in.
I have forgotten what my protheses are made of. Could you remind me?
The acetabulum has a titanium shell and is filled with highly cross linked poly. The ball is ceramic, the rod titanium.
Will I continue to improve? For how long?
You will. I don't know for how long.
Will I ever find it easy to sit cross-legged?
Sure. Practice the stretch. Hold for 10 seconds. Release. Repeat.
Will I always have to take antibiotics before dental and other medical procedures?
Better not to take chances. The rate of infection is only one in one hundred thousand. But you don't want to be that one.
Every once in a while I feel a twinge under my left buttock. Is that normal?
Probably a little scar tissue. Give it some more time.
Sometimes I feel the parts of my prostheses moving over each other. Is that normal?
Yes. They telescope in certain positions.
Are there still movements I should NEVER attempt? Stretches I shouldn't push?
You never want to do these three movements at once: flexion, adduction, AND internal rotation. Al least for now, don't be passively stretched.
Is there a limit on how much weight I should be lifting with my legs? Carrying when I walk?
Never lift more than you can control. You never want to be shaking. In general, use lighter weights, more reps. As for carrying, use common sense.
Am I more prone to fracturing my femurs now that they have rods in them?
No. What you are prone to is popping the ball out of the socket. So when skiing, for example, make sure your skis are set to release .if you fall. You want to avoid accidentally getting into a flexion/adduction/internal rotation situation.
What about rollerblading, biking?
If they are important to you, do them.
How long will my new hips last with normal use?
We really don't know. We don't have long term studies on these new materials.
Will running shorten the life span of my hips?
Don't jog as your sport. You can run enough to play tennis, though.
If I should need another replacement, let's say in twenty years, will another surgeon take me on?
Yes, I'm making arrangements for that. On the other hand, your hips could last and last.
What is the hip replacement surgery of the future, arthoscopy?
Do you mean fluroscopy?
I'm not sure what I mean.
There's been a lot of hype about these tiny incisions. The newest Mayo Clinic research suggests there could be more not less muscle damage and longer, not shorter, healing! We need much more information. Is it likely that they'll perfect artificial cartilage in the near future?
Definitely. Stem cells can grow into cartilage as well as into other kinds of tissue. With a little luck our grandchildren, certainly their children, will go to a cartilage bank.
If it were available now would I be eligible? Now that I'm bionic?
I'm afraid not.
When all is said and done It never is, of course. As long as we're alive, fully alive, every day brings new possibilities, a new chance to do it right: live a little better, create a little better, love a little better...
My new hips have given me new life. I certainly feel younger now than the poor creature who was hobbling around diminished and in pain only a year ago.
And here's how I know that times are still "a changing". Until recently when people I knew asked how I was doing, I answered wryly, "Not bad for a girl with new hips." No more. I talk about other things.
My hips, while still relatively new, are no longer the most important thing about me.
Lois Meredith, Ph.D.
March 28, 2005
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