Rudrani Farbman Brown Yogini with LTHR
Your Name: Rudrani (Ann) Farbman Brown
Date of surgery: Oct 16th 2009
Surgeon: Dr David Mayman
Hospital: Hospital for Special Surgery
Prior to surgery
When did you first notice symptoms and what were they?
In 1984 I was a Siddha Meditation Teacher in residence in the Oakland Ashram. One winter, driving to LA on a speaking tour of the Southern California meditation centers, our car full of devotees somersaulted three times and landed upright in a ditch. We were all miraculously unharmed. Doctors at the local hospital at San Luis Obispo noted that my x-rays showed mild bone spurs in the cervical spine. This was my earliest awareness of having arthritis. I had no symptoms. Ten years later swellings at the base of the thumb joints appeared. They weren't bothersome though I dabbled in taking supplements and going off nightshades and citrus. These precautions didn't make any difference that I could see.
Over the decades, the well being of my yogic life style protected me. I did not really realize that the slowly progressing problem in my joints would one day become significant I tended to focus on soft tissue problems like torn menisci or rotator cuff issues working with them in asana practice. I had thrown out my left hip a few times, but didn't consider this might injure the joint structures. Though thinning cartilege was visible in occasional x-rays and MRIs, my approach to diminishing range of motion in hips, as well as knees and shoulders, was to rectify this with yoga alignment principles.
What forms of treatment did you seek before considering surgery (chiropractic, acupuncture, medications, bodywork, physical therapy, herbs, etc)?
Yoga therapeutics, chiropractic, supplements and the NSAID Mobic, (an anti-inflammatory).
What was your medical diagnosis (traumatic osteoarthritis, congenital hip problem, avascular necrosis, etc)?
How did you change your work habits, lifestyle to accommodate the hip problem?
The scope of asanas I could practice reduced little by little. I called this "losing poses". My teaching in courses trainings and classes remained the same though increasingly I used teachers and advanced students to demonstrate during class.
The specific problem in the left hip only became acute three months before surgery. Instead of thinning cartilege, the last round of x-rays showed an absence of any joint structures whatsoever. Unbeknownst to me, long bone spurs had grown out of the acetabulum over the femoral head to stabilize the femur --- the body trying to help itself. (My surgeon mentioned that bone spurs can damage joint structures. I recommend getting diagnostic tests done sooner rather than later).
In the last months before surgery getting around became painful. I climbed stairs with one leg, couldn't reach my left foot, and had difficulty getting in and out of bed, bath and car. I started to have discomfort sleeping. Walking bone on bone, my left leg no longer extended backwards and I didn't have an even stride. In class, I couldn't bend forward to adjust students on the floor in supine poses such as savasana. Standing up out of a chair and taking weight onto my left leg took awhile. In the very last week, I took taxis to the school to teach my classes only 6 blocks away.
Over the spring and summer of 2009, five months before surgery, I began to research THR. It was good to know what advancements were available. I began consulting orthopedic surgeons seeing a total of four, who unanimously agreed I was a "candidate" for THR.
One surgeon explained that if I experienced no compromise in my life style and was asymptomatic, it didn't matter what the x-rays showed, surgery was not necessary. This understanding freed me of medical pressure. I entertained the idea of living with my left hip as it was. I held off setting a date for surgery. Another two months passed by in discomfort. I became sure this was the only resolution.
I continued teaching, lead the WYC Fall retreat upstate and otherwise kept my schedule up to the day of surgery. I was in good spirits despite some over-study and periods of butterflies. Being in community and teaching kept me flying in a good space. The retreat group was exceptionally gracious. It was one of the best retreats in depth and Shakti.
What factors, physical, emotional, financial, etc. affected you after your final decision to have surgery?
Similar to anyone receiving a serious diagnosis, at first my mind traveled a course of denial, self blame and then finally acceptance I was curious about arthritis and asked the surgeons many questions. I examined my own history to see if the progression of joint troubles related to family issues or turbulent periods of my life. I wondered what I'd done wrong. Maybe I hadn't practiced enough, gone to doctors promptly enough, taken supplements enough. Maybe I'd relied too much on hatha yoga to heal everything. As a director of a yoga school, I felt shame, as if this wasn't supposed to happen to practitioners.
I asked if years of yoga practice where misalignments or even specific alignment principles had impacted my body could be the cause. The doctors said yoga had nothing to do with it and that yoga had most likely kept me out pain despite the wear and tear of forty years of teaching yoga. They said greater yogic diligence would have added only a few more months of time. They said it was a mix of genetics, injuries and wear.
It was hard for me -or the doctors- to reconstruct exactly how this particular joint had gotton destroyed.
I hesitated at first to share with students who were used to seeing me as indestructible and invincible. There was a great learning in this as I ended up discovering just how many people in our community were ready to hold me up, shower me with grace and put themselves out to give support.
Facing surgery increased my awareness of my mortality and the teaching on Impermanance. I got that my body was not here forever. Major surgery was definitely raising the ante as a life lesson because there were risks involved. Though I was not facing a fatal illness, this brought lessons that come when one feels one's life is on the line.
Were there other yoga teachers and students that you spoke with that helped you?
One of the most invaluable preparations was to talk to others who'd had THR keeping notes of their stories in a file and going over the details. Eight yoga students shared with me.
Naomi's dancerhips.com website, with her own and others' stories was also a valuable guide. I found her site through an Anusara yoga student with bilateral THR. Naomi's supportive answers to my last minute questions right before surgery via e-mail, though I have never met her, was a blessing.
What influenced your choice of surgeon?
I chose the surgeon first of all, who showed the most humanity. I could feel his love for his work and his confidence. Some surgeons were arrogant, some condescending, some paternal and some brusque. Dr Mayman was free of these qualities. He had warmth. He allowed e-mail correspondence and answered my questions. The clarity of his answers and his calm contributed to my choice. He was of the philosophy that educated patients make the best patients. His assistant and office workers were kind, patient and never harried or impersonal. The orderly atmosphere of his office and the good cheer of the office "girls" all contributed to a gut feeling of trust.
I originally heard of Dr Mayman from one of my students who had his hip replaced by him and had been back in a yoga workshop after three weeks! My student and I discussed the choice of prosthesis the different companies that manufacture these, the use of computers in surgery, the uncemented method where the bone grows over the prosthesis, the pros and cons of ceramic metal or plastic for lining the femoral head and he shared his own correspondence with Dr Maymans with me, full of information.
My surgeon discussed my choices of prosthesis with me in e-mails and in consultations. His assistant also spent time with me on the phone. I liked both his conservative approach and at the same time, the fact that he had had extra training in Computer Assisted Surgery (CAS), which a new generation of orthopedic surgeons at HSS has adapted. By using x-ray and computer image during surgery, the placement of the prosthesis is extremely precise. This prolongs its life, reduces wear and tear and decreases particles released in the blood stream. Experienced surgeons I interviewed with forty years of surgical experience didn't use computers.
I feel I made good choices. I healed with very little pain and was off meds in ten days -- just taking Tylenol -- and was off walker and cane in 14 days, walking without even mild soreness. It was a miracle. Some like to say it was due to years of yoga, but I think it was the accuracy of how that prosthesis was placed by that very brilliant young surgeon!
What was your pre- op care ?
Exercised ankles, quads, knees, gluts, biceps,triceps and hamstrings as much as possible.
Lost 15 lbs to reduce impact on joints by going on the radical anti-inflammatory diet ---no diary gluten meat/fish/ poultry, caffeine, alcohol and sugar, night shades and citrus-- found in Dr Bernard's book. The diet eliminate foods known to trigger inflammation. (I modified this diet when needed not being allergic to any of these foods).
Banked two units of my blood for the surgery, an option offered by my surgeon's office. I ended up not needing it during surgery and it was returned in recovery.
Rested, slept well
Did a pain free modified Hatha practice with plenty of Pranayama and Meditation
Took supplements that fight inflammation and preserve joint health (Zylammand, Joint Medic crème)
Was aware of what supplements to must stop a few weeks before surgery such as omega threes EPA/DHA, Vitamin E, (stop one month before surgery ) green tea extract
Borrowed post-op props from my student who had this surgery
Listened to the experience/stories of those who have had this surgery
Took 1500 mgs calcium and 1000 units Vit D Got a bone density scan, over-all checkup, mammogram, dental check-up, etc.
Bonnie Bainbridge work with Roxlyn Moret
Took Infusions: Boiled fresh ginger with honey, Nettle Tea and Cat's claw (anti inflammatory)
How long were you in the hospital?
What kind of prosthesis did you get (e.g., ceramic ball/ceramic liner? poly liner? highly-crossed linked poly liner? all metal?)?
Highly crossed linked polyethylene liner with metal ball (chromium, titanium and cobalt.
At first, I wanted to restore my hip joint to full range of motion, which is only possible with a metal on metal (MoM) prostheses. These are the same size as your natural femoral head and have minimal risk of dislocation. However they put 30% more metal ions into your blood stream, which the kidneys have to eliminate. . After 12 years of using MoM in this country (16 years in Europe), there are still no definitive studies on the long-term effect of metal ions on our blood chemistry.
The cross-linked polyethylene (highly durable plastic) liner has been greatly improved over the last ten years. It releases a somewhat higher percentage of particles into the blood stream than metal-on-metal. The liner's size reduces the size of the femoral head which means the joint's range of motion will be less than the original . Alot depends on how shallow or deep the socket is and the unique shape of your pelvis.
I went back and forth on this because full range of motion was so desirable. It finally got clear when one of the HSS surgeons I'd met with, said he'd give me a 28 mm ball. My surgeon said a 36 mm ball would fit me and that the metal on metal (MoM) ball would only be 4 mm larger, a minimal difference in terms of joint movement. Wrapping my ankles around my neck was not a priority. 36 mm with plastic liner was the solution with which I felt the safest.
Medical advancements in THR are rapidly emerging year after year. One day, stem cells will no doubt re-grow our cartilege, and having metal joints that set off warning sensors in airport security will become a thing of the past!
Anything else to say about your in-patient experience?
The best help I got right before surgery was from the president of the Ojai Foundation in California a community where practices are based on council and who do great work for peace in the world.
Her letter was as follows:
Although there was not a lot of time remaining conscious in the operating room, this is exactly what I did try to do,. The gurney was wheeled over to the special THR table (which was in three separate parts) and then they approached me with the IV. I had maybe only 15 seconds before I lost consciousness but I saw the OR in detail and many people in their light blue caps and masks. I saw Dr Mayman, scrubbed and ready, seated on a little low stool looking relaxed and confidant with his mask pulled down from his nose. He waved briefly. I suddenly saw in the very back of the room, as if real, the statue of my Guru's Guru a beautiful large idol typical of Indian temples that sits in the middle of the meditation temple of the South Fallsburg ashram. It is one of the most powerful places to meditate that I know of. (For those of you interested in the life in ashrams of Siddha Yoga, read the middle section of Elizabeth Gilberts Eat Pray Love bestseller). In front of this marbled, pillared niche was my Guru presiding over the Operating Room and standing by his own teacher, not especially protecting me, but rather presiding over the cosmic dance alongside him.
It was an incredibly beautiful sight. I felt at ease in that moment.
I awakened in the recovery room with no sense of where I was - staring at a football game on a monitor overhead with no sound. I wondered if I was now in heaven, which was perhaps an eternal football game, which we all watch throughout the eons. My first words of new life were to please turn it off.
I remember watching the units of the blood I had donated before surgery being returned to me through the IV drop by drop, entering my blood stream rhythmically like a mantra revitalizing me.
In the hospital after surgery, high on opiates, my brain had felt absolutely no pain. However, my body had been through the shock of a femoral head sawed off, acetabulum reamed, a 6-inch spike and ball put into my thigh bone. Both my body and psyche registered this as a near death experience despite being pain free. It brought up feelings similar to when one comes to that line between life and death. In the days that followed, my soul felt the joy and sorrow of life more keenly than I have ever felt. Small things like the sight of the morning star out of my window at dawn over the East River, or a big Russian oil tanker with the captain clearly visible on the bridge at the helm, his ship churning the waters right outside my window, filled me with joy and a sense of the mystery of life. At the same the slightest word that took me way from pure love with a relative sent me into grief and loss. Anything that felt karmic and patterned left me broken hearted. I believe this was due to the wounds in my body even though I was miraculously free of pain.
The excellent pain management was due to the miracle of Dilaudid that wonderful opiate in the epidural. The drug left me feeling enlightened! I could see the hidden love in people's heart. It was visible in all the staff, their need for love and approval and recognition as they played out their various roles and their desire to do good for others.
I often felt moved to tears. My helplessness and dependency on others placed me in a state of love in a way I had not ever known.
At times a deep melancholy, a clinging to life would come over me. I dreamed intensely of my parents, grandparents and my ancestors who were gone and my place in the generational stream that was so transient. The yoga scriptures call this Abhinivasha, attachment to life -- one of the Kleshas or afflictions of the mind. The wrong notion that my voice in the world was perhaps silenced permanently or that my frailty and inactivity were perhaps irreversible came in the vulnerable late night hours. I counteracted this with the CDs full of wisdom.
My husband did a five-day vigil there with me, sitting silently and unstintingly protecting me like a lion. He deserves an award.
From the hospital dieticians I asked for the best diet possible they had of fresh fruit, salads and "vegan bowls" of brown rice black eyed peas and vegetables, a meal I had twice day the whole time I was there! They gave me a large container of rice milk and an organic rice cereal for my breakfasts, which were kept in the patient's refrigerator. They gave me fresh lemon for water and chamomile tea. In this way I almost avoided the food of hospitals, although there were the usual high fructose sugary juices, jello and fruit cup, packets of nameless powdered broths and the erstwhile- overcooked broccoli, grey and falling off the fork.
The hospital staff was dedicated, but the noise and coming and going in and out of the room and my roommate's loud conversations with her nurses and orderlies, (whom she called upon morning noon and night) were very hard on the body. Late at night my roommate watched TV, headphones on, her ceiling lights on full blast even at 4 a.m. Her cell phone conversations during the day were also loud. I had one night of real sleep deprivation. She demonstrated how a person overwhelmed by her own needs becomes blind to the needs of another - (isn't this how we all hurt each other?). I recoiled from her and over the last night, felt aversion for her. Aversion is another of the five afflictions of the mind called Dvesha Klesha. I tried to overcome it. I wanted my energy only for growing my bones. I reconciled with the roommate on the last day, showing up for her with an open heart, forgiving her oblivion of my needs though mine had been every bit as urgent as hers ---In short, it ended well.
I had good PT sessions during the hospital days.
I used the late night awake-time for listening to CDs. I used the Pranayama CD of Rama Berch called Life's Breath for the Yoga breathing practice of Ujjayii Pranayama I would often fall asleep in the practice. I also used the guided deep relaxation in savasana (a resting pose) found on Thich Nhat Hanh's CD Meditations on the Earth. This CD has the five prostrations which is a part of a traditional Buddhist practice but made for modern students of any spiritual practice. These guided prostrations helped me stay in a high state of surrender in the hospital. I also read Swami Muktananda's Play of Consciousness. It is his account of the unfolding of the Kundalini Shakti, an autobiographical story of the path of a great saint who was my teacher.
CDs from the Hospital for Special Surgery offered by the holistic nurse practitioner, Laura Jasphy are available if you are a patient there. She can be reached through HSS patient information 212-774-2053. The hospital tries to be up to date. The CDs are for pre-and post op healing to manage fear, pain and post-op depression through guided meditation and imagery. Jon Kabott Zinn instituted this program of mindfulness in hospitals in 1979.
Did you have any complications, especially unexpected difficulties, after you got home?
None. After just ten days, walking for the first time I was aware that my operated hip extended back freely and that I could walk with an even stride--- a miracle.
What steps did you take toward recovery? (Physical therapy, chiropractic, acupuncture, medications, bodywork, herbs, etc.)
I had pre-stocked my freezer full of good meals and also stocked the pantry well Crystallized ginger was helpful for nausea from meds.
I needed someone there in the house for the first week after my return. Although I was able to shower and walk around slowly with the cane, I needed help with meals, errands and keeping order. I was sleeping a lot during the day. I was often up during the night listening to my portable CD player. Talks and music in the late night hours became treasured solitary time. By day, I tried to institute a rhythm of study and retreat to give the day some shape.
I supervised a project of giving away belongings. Bags of stuff went to Goodwill making a deeper order in the house. This generated a healing and serene atmosphere.
After the first week, I was fine to be home alone. People came for brief visits, bringing a healthy lunch, taking me for walks in the gardens downstairs, meditating with me, cooking a meal or keeping me company doing PT exercises which are quite boring. The graciousness of everyone was incredible.
In three weeks at home resting and recovering, healing was steady and better and better each day.I had no hip pain whatsoever after ten days though I still had discomfort in other joints. I followed the movement restrictions carefully. I tired very easily but was able to move around my apartment normally in just two weeks. I greatly marveled at how I could extend the left leg back and walk with an even stride --- amazing!
The PT came three times a week as part of the post-op homecare plan. I did my exercises twice a day refining them with yoga alignment. I also used a print out of Naomi's list of exercises from this website.
After ten days, the inner circle of students and teachers from the WYC come over for an evening together bringing bag suppers and filling the room with beautiful energy with a long and deep meditation. We stayed to talk about my experiences from the viewpoint of seekers on the path of Yoga. Some of our topics were how we interface with institutions like a modern hospital, where there is not the same atmosphere of transformation we are used to, and how to bring who we are everywhere, even in the midst of our own vulnerability.
We also spoke as yoga teachers learning to serve our students who have prostheses. We discussed asana sequences suited to those with anterior incision who are more vulnerable to back bends and students with posterior incision more vulnerable to forward bends This is because muscles and ligaments of the joint capsule were pushed aside or cut in order to get at the bones of the hip joint either from the front or the backside of the joint. Whichever side was used to enter is still destabilized and dislocation is therefore a risk bending in that direction.
These were a few of the topics of that night.
I shared my gratitude. The grace of the WYC community was with me throughout and I never felt alone It was like a magic carpet of love and energy. The presence of everyone's intentions and prayers kept me aloft. I experienced how the power of love overrides everything and carries us in its current, an awareness major surgery can bring.
At home now, I researched the protocols and bodywork modalities I would need to heal and take care of my joints for the future.
The four supplement companies that I have found that make top- of -the -line products with cutting edge research are Life Extension Fellowship, Vitamin Research Project, Metagenics and New Chapter.
Dr Neil Bernard 's book Foods that Fight Pain inspired my anti-inflammatory diet and from that I also lost weight which helped reduce post operative pain.
I hope not to go back on NSAIDS to fight joint inflammation in the future (I had to go off them before surgery and the withdrawal included acute muscle pain, elevated blood pressure and moodiness - a reaction which apparently not all doctors realize.
I am still experimenting with products such as Zyflammand Joint Medic (a transdermal cream with Glucosamine Chondriotin Sulfate and MSM) and Metagenic's Kaprex and UltraflamX.
Home visits of healers helped me. I set up a massage table taking this idea also from Naomi. The table was set up in the afternoon sun in front of the living room windows. I had appointments for Massage, Acupuncture, Reiki, Chiropractic, Alexander technique, Bonnie Bainbridge Cohen healing work with Roxlyn Moret (hands on embryologic movement and cellular awareness) and Anusara Yoga therapeutics --all this wonderful imput on the sun lit massage table. This was very healing.
CDs of these healing modalities can be ordered on line if there are no practioners to make house calls.
I could feel my body healing in a specific rhythm changing each day. It knew how to grow back bone, marrow, skin and muscle. Resting was the best way to help the process. The body is totally amazing.
Anything or any practitioners that you would highly recommend?
Acupuncture: Kymberly Kelly
She will make house calls and is excellent. She is also a Chinese herbalist.
(From Naomi's institute: Turning Point Acupuncture)
Yoga therapy: Roxlyn Moret
Roxlyn does hands-on healing work on the pliability of bones and body fluids. (From the perspective of the work of Bonnie Bainbridge Cohen)
Roxlyn rents space for a class at WYC 4:30 pm Tuesdays.
Chiropractor: Dr Louis Angulo
He made house calls
155 West 72nd Street, NYC
Alexander Technique: Alan Bowers
Came to my home
Since it is only four weeks I will update later
Submitted November 16, 2009
Rudrani Farbman - Brown
Director, World Yoga Center
265 West 72nd Street
New York, NY 10023
World Yoga Center
Back to top