What I Wish We Had Known About Hip Replacements Before My Husband’s Surgery
When my husband’s hip and thigh pain prevented us from taking walks together, and then confined him to reclining on the couch watching TV all day, we knew he needed help. After an x-ray showed his ball and socket bones grinding against each other, hip replacement surgery was recommended. To prepare, I talked to everyone I knew who had undergone hip replacement and read everything I could on the subject. My husband watched YouTube videos of the process to see what was going to happen from the first cut to the last stitch (or staple).
What no one told us was what happens emotionally after hip replacement surgery. In addition, nothing was said in the handouts or hospital class we took to prepare for the surgery about the narcotics prescribed post-surgery.
As a caregiver, you will be told about helping the patient stand and sit, providing physical support with using the bathroom, showering, grooming, dressing, shopping, cleaning, cooking, doing laundry and errands, your duty to manage the finances, keep track of medical appointments and medications, and encourage physical therapy exercises daily. But no one will say your spouse may experience a roller coaster of moods or withdrawal symptoms coming off pain meds. These tips are a heads up for patient and caregiver as a team.
Depression can be triggered by the anesthesia from surgery, pain medications, pain itself, and restricted movement. Add to this the universal desire to get back in shape as soon as possible. Many people assume if they do everything the doctor and physical therapist say to do – and then some – they will get better faster. When that doesn’t happen due to a variety of individual factors, the caregiver may have to deal with massive disappointment and their spouse’s feelings of inadequacy. Even though my husband was ahead of the curve in recovering skills, it didn’t happen as fast as he thought it should. Bottom line: bodies heal at different rates and no one should compare their progress to other people’s experiences unless perhaps that person is your genetic twin.
Action: Inform your doctor
Inform your surgeon you are feeling depressed. Surgeons generally don’t receive or react well to feedback that is “nonmedical.” But the brain is a medical organ that controls the rest of the body and must be considered in any invasive surgery. If your surgeon is not responsive, tell your general doctor. You may be prescribed an antidepressant. If already on one, your dose may need to be altered temporarily, especially given the amount of pain medication in the mix. Post-surgical depression is not abnormal and it will pass; but it may need to be tempered by medication. Also, surf Internet forums on patients’ experiences and you will likely find you are somewhere in the middle of the extremes.
Each day can be a roller coaster ride. At first my husband wanted to do everything himself so he could be independent faster. Then he would have more pain from his activity level and feel anxious that it was too much pain and something must be wrong. Some days he even questioned the wisdom of getting the operation as it seemed to be taking too long to feel better. This happened at two weeks, three weeks, and so on. It also turned out that he had a strong reaction to his pain medication: Oxycodone with Acetaminophen. His reaction was the opposite of what we expected. As an opiate, one would think it would calm you down, but it made him more anxious and aggressive.
-Action: Inform your doctor
As with depression, medication may need to be prescribed for anxiety, or adjusted, in order to deal with both the trauma to the body and the alarm bells going off in the brain. The body was not only sliced open, but bone was replaced by metal. It would be great if patients could have a week by week description of average pain levels and skill progression.
Oxycodone with Acetaminophen is probably the most common pain medication prescribed post-hip surgery. A strong narcotic pain reliever, Oxycodone does not stop pain but increases tolerance to pain. Acetaminophen is non-narcotic and relieves pain by elevating the threshold to sensing pain.
My husband was prescribed 80 325mg pills for the first two weeks, 80 for the second two weeks, and 60 for the third two weeks, taking one to two pills every four to six hours. We both freaked out a little watching a news program targeting addiction to opioids, and reviewing the coverage of Prince’s death, which was allegedly caused by an opioid addiction due to severe hip pain.
Dr. Jim Duffey, an orthopedic surgeon and partner at Premier Orthopedics in Colorado Springs, says the body does develop a dependence on the narcotic and will go through withdrawal when that amount of opioids are used post-surgery. He uses a combination of pain treatments to avoid overreliance on narcotics, one of which is implanting a catheter within the incision under the skin that steadily releases a regional anesthesia that numbs the site (he uses ON-Q Pain Relief System). In addition, Tylenol (Acetaminophen) can be effective, particularly when given intravenously, which is more potent.
A Harvard Magazine article by John Lauerman points out that not enough recognition is given to post-surgical depression and the effects of stopping opioid medications. At that point, there is often more residual pain than the patient realized, and withdrawal can include trouble sleeping, anxiety, and dark thoughts.
Action: Talk to your doctor before surgery
“Most MDs (especially surgeons) are horrible at discussing these things with their patients,” says Dr. Jeffrey Foote, cofounder and director of Center for Motivation and Change, which specializes in substance abuse treatment. Side effects and complications of pain medications should be explained prior to surgery. Ask about the possibilities of addiction. How many pills are too many? Ask about withdrawal and how to taper off or about the possibility of opioid substitutes.
We knew constipation is a side effect of both opioids and anesthetic and has to be treated aggressively. We had been told to use over the counter medications, to try warm prune juice, to drink lots of liquids – but nothing worked, not even suppositories. During this time, my husband ate less and less and I worried he was getting inadequate nutrition for healing.
Action: Ask a nurse (or trust me)
Nurses, who are perhaps more aware of dealing with constipation in patients, are a great resource for details like this. Get a laxative with Senna (Sennosides). That, finally, did the trick.
Note: At seven weeks post-op, my husband alternates between using a cane and walking tall and going without the cane and limping. The surgeon said the limp generally resolves between four and six months post-surgery. He is off all narcotics but takes some Tylenol every day. We are excitedly planning activities we could not do for the last two years because of his hip pain. The one thing that surprises him is how clearly he feels the rod and cup, the new bionic parts in his body.
Judy Kirkwood writes articles for print and web publications – national, regional, and local; is a contributing writer to Simply the Best and Boca Raton Observer magazines in South Florida; and plays on the beach and in the pool year-round. Visit her on Facebook @JudysFlorida and please visit www.JudysFlorida.com.