Three tips for successful surgery

It happens to the best of us as we age. Sometimes, after a long walk, you have a little hip or knee pain. Then it starts happening more often. You get together with older pals and the first half hour becomes what one friend calls the “Organ Recital”: “my hip, your eye, her shoulder, his pancreas.” Pain starts waking you up at night like a nagging toothache. You join Team Motrin and start gobbling anti-inflammatory pills that eventually hurt your stomach. You buy the economy-size gel form called diclofenac to smear on the achy spot, thinking optimistically about the warning label precautions. You finally see a doctor, and there’s X-rays, ultrasounds, MRI’s, maybe a shot, and finally a diagnosis. Wear and tear, loss of cartilage, osteoarthritis, it’s “bone on bone.”

Maybe you are able to manage your symptoms with physical therapy, but maybe not. You become sadly fluent in the language of joint replacements.

The clinic schedules you for surgery, and they are busy, and it’s three to six months out. Is it time to get serious about bingeing on couch time, and taking stronger drugs — or are there other options? How can you prepare to increase the chances of a good outcome and a return to a more active life?

I’m looking forward to my second hip replacement in five months. Last April, I was a weepy mess with hip and back pain. My primary care doc sent me to rehab and we soon figured out that surgery on both hips was the needed next step. Surgery is scary. Besides picking a doctor you trust and following instructions, you have little control, and the outcomes are uncertain. I was lucky to find Dr. David Thorsett and the Total Joint Program he created at Santiam Hospital in Stayton. Dr. Thorsett is a huge fan of preparation and describes a three-pronged approach: 1. physical readiness; 2. mental readiness; and 3. emotional readiness. He says, “all three are equally important.”

Most people are familiar with the idea of rehab or physical rehabilitation, working with a specialist to recover after an injury or surgery. But Dr. Thorsett sends many people to “prehab,” or prehabilitation, to get ready for surgery by working with a physical therapist who can assess weak spots that could slow your recovery and help you regain a sense of control. Some people can do this with an athletic trainer or on their own if they have a steady program.

As we age, we all face the inevitable loss of muscle mass and strength called sarcopenia. If it hurts to move, and we become more sedentary, we become even weaker as muscles atrophy and shrink. But with careful work, the right diet, and managing stress we can build some of that muscle back and feel better.

Physical therapist Seth Wilkie at Redbird Physio in Sisters sees lots of people before and after joint replacements. He has his tricks that eased my pain but it was his role as a supportive coach that really saved me. An evolving set of specific exercises became a routine and gave me a sense that I could help myself.

As my rehab/prehab ended a couple months before surgery he recommended that I keep working with a coach and suggested I talk to Ivy Castellana at Core Connection Pilates in Sisters about improving core and hip strength. Pilates is a low-intensity muscle strengthening workout that targets the core, including lower back and hips, to improve flexibility, mobility, and stabilize the spine. Ivy is skilled at movement analysis and helped me notice and work on imbalances in my feet that were affecting my stride.

To help with mental readiness, Santiam Hospital requires a pre-surgery class that goes through how to prepare your home, what adaptive equipment you will need, what to expect on the day of surgery, and what happens after it’s over. Dr Thorsett calls the class “prehab for your brain”.

The emotional readiness piece is helped by meeting your support system in the hospital, including a surgery coordinator who answers questions and helps with problems, and the therapist that will teach you how to move safely. But your home support system is equally key, family and friends who will help take care of you, drive you to rehab, bring meals if needed, and ease the emotional ups and downs of healing. Mind/Body techniques such as restorative yoga and meditation can also help keep you on an even keel.

Dr. Thorsett explains that being kind to yourself is important, as well as being honest with yourself about your problems. Maybe we still think of ourselves as an athlete/skier/runner but in truth it has been several years since we moved that much, and instead, we have embraced the couch.

After months of preparation, I checked into Santiam Hospital in Stayton last Halloween and put myself in the hands of their surgical team. My surgery went well and I got a reality check to hear that despite all those squats, my hip muscles were still smaller and weaker after years of less activity. But I was climbing stairs the first day and within three days I was back at rehab. In a few weeks I was terrorizing shoppers at Oliver Lemon’s as I buzzed around with my walker. I’m now lifting weights and biking at Sisters Athletic Club, and back at Pilates with Ivy, preparing for the next round. My new hip feels great. I turn 70 soon and I still have many hikes and travels on my bucket list.

So friends, don’t despair. Your health is in your hands. Motion is the lotion. If it hurts, please see your doctor. Find out why and make a plan. Do the work to become as strong as you can in body, mind, and spirit — and get well soon.