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Thanksgiving Day was my 1 year surgiversary and my first Thanksgiving since the surgery.  I had a day of relative moderation.  I made a point not to drive myself crazy over my choices, and I ate a small amount of everything.  That still turned out to be a little bit much, though, and at the end of the meal, I had to sit quietly by myself for 15-20 minutes waiting for the fullness to settle -- I wasn't sick, but a little uncomfortable.  I never deal with this on a daily basis -- I manage my intake very well -- but special events remain a bit of a challenge.  Ah, well.

I've been losing and gaining the same 5 or 6 pounds since early October.  I even hesitate to call it a "stall", since it's been a crazy 6 weeks of regular up-and-down yo-yos; never the same weight from day to day.  _Finally_ on Monday, I broke the stall, losing 2 pounds from my lowest, and -- get this -- today, the day after T-Day, I'm even a pound lighter: 181 (no decimal point!!!)  When I consider the dietary deprivation I've been putting myself through, it's a cruel joke to find that I reached my nadir on the day after I ate from-scratch green-bean casserole and chocolate mousse cake!  (No, I don't dump!)

This is a good point to take stock.  Depending on my mood, I can wax half-empty or half-full.  I started out on my initial consult at 5'3" and 315 pounds.  I lost 25 pounds over the next two months, reaching 290 pounds on my day of surgery.  Today, I'm --let's call it -- 180.  There are many OHers who started at a similar weight who've lost more and faster than I have, but I really don't see how I could have done any better.  All things considered, 70-75% of my EWL is pretty good at 1 year, even if it's also nose-on average!  We all wish (and assume) that we're above average: HA!

I really _can_ notice how much progress I've made.  I'm typing this on my laptop, and the laptop is sitting on my _lap_, with lots of room to spare.  I've gone from 56" pants to 36'', from 3X shirts to L (and a few M).  Luckily, I'm a pack rat, so all of of my pre-Reagan-era clothes were waiting, scarcely worn and still mostly in style (hey, I'm a guy) for me to finally fit into them!  I can even convince myself that my silhouette now looks normal rather than oval.  Maybe "George Constanza normal", but no longer Humpty Dumpty or rounder.

One curse of being so short (2" shorter than I believed, and what my driver's license claimed), is that it screws up your BMI terribly.  I can't believe that I'm a year post-op, and I'm still 2 BMI points and 10 pounds from being classified as overweight -- technically, I'm still obese!  The nerve!  I'm about 35-40 pounds away from a normal BMI.  Hey, I'm sure I'll manage to reach overweight in a few more months, and maybe if I'm lucky, approach normal.

/Steve

Everyone feels like August disappears in a flash as summer comes to an end, but having a project like hip replacement surgery for the month really underscores this.  Last Tuesday, it was a month since the surgery, and today (Friday), it's been a month since I came home from the hospital.

This past week, I officially "graduated" from my outpatient physical therapy sessions.  I started driving again on my last day of PT, and it felt fine.  I no longer use a cane in the house or for short distances, and I climb stairs normally.  My only concession is that I still use the cane for my daily walks around my neighborhood, just to minimize stress on the new hip, at least for a few weeks longer.

My right hip pain disappeared the day of my surgery, but it's taken the past month to gradually resolve any lingering surgery-related stiffness.  Now, everything "feels" normal.  I've almost forgotten the previous two years of hip pain!

It sounded strange to be described as "young" (for a hip replacement candidate), but there must be something to this, because my rapid post-op progress has impressed everyone, including myself!

A year ago today, I started filling out the paperwork to have WLS at Boston's Beth Israel Deaconess Medical Center.  I looked back at that form today: I was 315 pounds (I'm only 5'3"!)

9 months ago today, I had RNY surgery @ 290 pounds.

And today, I *finally* got below 200 pounds: 199.8 !!  I'm not even sure how long it's been since I've weighed so little; probably the early 1980s!  Whoo-hoo!!!

Sometimes I think the past few months have been like watching paint dry; on a day-to-day basis, the weight loss has been slow, constantly interrupted by stalls and fluctuations, and I've only recently been able to acknowledge the results when I look in the mirror.

As short as I am, I am still approx. 65 pounds away from achieving a "normal" BMI; whether I reach that isn't clear (30-odd years ago, when I hit 130 pounds -- for about a millisecond -- I looked skeletal), but I hope and expect that I'll continue to lose at least 45-50 more pounds, and then strive to maintain it.

For those of you who are recently post-op and discouraged by comparing your progress against others, who wonder whether you'll be the first exception to the success promised by these procedures: I was just like you.  Be patient!  Even modest progress, seemingly invisible as you're living it, accumulates as time passes, until one day you look back and can't refute how far you've come.  Keep this in mind along the way!

Preamble:

I never had any serious orthopedic issues until Nov 2006, a year before my RNY surgery.  At that time, I was close to my highest pre-op weight (5'3", 315+#).  I started limping due to pain in my right hip seemingly overnight, which still surprises me because of its sudden onset.  I saw my PCP, who ordered X-rays and prescribed a month of physical therapy along with NSAIDs and a cane.  My response to this was remarkable: before the month was out I was pain-free, no longer limping, I'd placed the cane in the back of my closet, and I imagined that if I weren't "cured", at least I'd deferred more serious interventions.  Oh, as it happened, I continued taking the NSAID prescribed.

This "cure" lasted for approx 7-8 months, at which time a slight degree of hip pain reappeared.  But by then, I had already decided on WLS, and started the process with the bariatric program at Boston's Beth Israel Deaconess.  I stopped NSAIDs 2 weeks before my RNY surgery, had the surgery (11/27), and came home (12/1) 4 days later ready to embark on my new post-op life!

Before my surgery, I never fully understood how much my daily NSAID contributed to my lack of hip pain and general well-being.  It turns out "quite a lot", which is unfortunate, since had I appreciated this, I might have chosen a different WLS such as a sleeve gastrectomy.

Post-RNY, I began to have a severe flare of hip pain, enough to discourange me from exercising.  I really wasn't sure what was happening -- was I just being lazy?  Did the onset of winter prevent me from walking?  Or was I suffering from some sort of psycho-somatic "pain" so that I wouldn't have to exercise?  Anyway, by March 2008 my hip pain was out of control, even though I'd lost more than 75 pounds.  I finally saw an orthopedist, who took one look at my X-rays and told me flat-out that nothing other than a total hip replacement would relieve the pain.  Strangely enough, knowing that my hip was completely shot liberated me to embark on a daily exercise program: I dusted off my cane and proceeded to ramp up to a daily 90 min walk around my neighborhood.

I then met with an orthopedic surgeon and scheduled my surgery for July 29, 2008.

The hip replacement surgery itself:

You know, there's not all that much to say!  The actual surgery was nowhere as stressful as my RNY or my gallbladder removal.  With both abdominal surgeries, I woke up feeling that I'd been hit by a truck, but after this hip surgery, I felt remarkably fine.  I progressed steadily day by day and I was discharged to home on Friday, August 1.

I was walking with crutches the day after surgery, and was climbing stairs with crutches on the day or my discharge.  I'd describe myself as a model patient; I guess my relatively young age (52) helped me in this regard.  Once home, I set up outpatient physical therapy sessions, and have been doing pretty well.  In fact, I've been chomping at the bit to see when I can switch to using a cane.

I've posted at length on the OH boards about the weight gain I've experienced since the surgery: 8 pounds gained when discharged from the hospital, and 4 additional pounds gained in the 4 days at home.  You can tell this is all water weight: both legs look like sausages, especially my right leg, where the hip replacement occurred.  Some of this has already disappeared, and I expect that the rest of it (plus the true weight I'd have lost anways) should come off over the next few weeks.

A slight (?) setback (8/9/2008):

Last night (8/8/2008) when I tried to get into bed, I lifted my right leg (the bad hip), whereupon I experienced a blinding pain that I'd never experienced before, and it seemed to be located right in the hip socket.  It scared the sh*t out of both of us, especially because until then I'd been a model post-op hip replacement patient.  I could still put weight on the leg, so my new hip hadn't dislocated, and I really didn't want to trek out to the ER at 1AM on a Saturday morning.

The next morning, I was still sore and scared to move my leg the "wrong way".  Though I didn't experience a repeat episode of pain, that's only because I was immediately gun shy, and made every effort NOT to have it happen again.  My hip itself  felt vaguely sore, as if something had happened last night, and it seemed very easy to move the hip into a position where this would happen again.  I called the hospital and spoke to the orthopedic resident who'd been seeing me in the hospital, and he felt that it wasn't a dislocation, and it was unlikely that it was a broken bone around the implant, simply because I could stand on it (plus, my bones are VERY dense, which is typical of people who have been obese most of their lives!)

Anyway, the discussion with the resident reassured me; he just told me to take it easy over the next few days, and to call if this recurs.  I have my fingers crossed!

Staples out! (8/15/2008):

Well, It's been a week since my scarey spasm of pain, and it hasn't recurred.  I was terribly gun-shy all last weekend; I never walked anywhere without the crutches, was really pretty bad with doing my hip exercises, and all in all just took things easy.  By last Monday, I could tell that whatever happened was behind me, and even the leg position which caused it was significantly less "twitchy".  All good news.  But I've run out of the good drugs, the weather has been lousy for most of the past week, and I've been itching to dump the crutches and switch to using a cane.  It's funny, they really don't tell you very much between office visits post-op, so I've just been conservative, lest I risk doing too much too soon.  (One problem is that the books and literature on hip replacement surgery are all addressed to 65-85 year olds, so their recommendations are, as expected, pretty conservative.)

Sooo, I just got back from seeing my surgeon's PA.  She took the staples out, was amazed that I was seeing her only two weeks post-op, and was surprised that I was still using crutches!  (!?!?!?)  So, I'm ready to hang these up at Lourdes, and have switched to using a cane.  Gad, I feel so much more mobile -- I can actually carry stuff across the room now!  Everything from now on is "as tolerated", which is great news.  Plus, I got another 10 days of Percocet, no questions asked.  By now, I could probably just rely on Tylenol, but it's good to have something in the house just in case.

I don't come back for a follow-up for another two months, in October.   With any luck, I won't have cause to update this entry until then!

PS: My right leg is still sausage-like, but I've managed to lose all but 4 of the 13 pounds of water weight I gained in the hospital and in the first few days at home.  I feel like I've lost an entire month of WLS progress!

Still on a mobility high!  (8/16/2008):

My God; the sun is out and I can walk!  It's amazing how liberating an "all clear" response coming from your care provider can be.  Last week I was hypervigilant, much too careful not to bend too far, not to shuffle around the house too far without crutches, but the moment I put the crutches away yesterday after my visit with the PA, I was walking around with much more confidence; for the first time since the surgery, I no longer felt like I was a "patient" first and a "person" second.  With the crutches, I always had to calculate whether it would be worthwhile to climb the stairs up or down (since we have no 1st floor bathroom, this was a real hassle).  My partner was blown away by the difference in how I carry myself.

When I was at the PA, I asked for a copy of my operative notes.  It was quite interesting.  Apparently, my surgeon commented on my "extensive body habitus from having had gastric bypass several years ago."  Well, it was only several months ago (8 to be exact), but the loose skin is definitely there, and it's only going to get worse!  I love that term: habitus.

Another revelation from the notes is that my premature hip wear-n-tear could not be ascribed solely to my history of obesity.  Apparently I had a "dysplastic acetabulum", a hip socket that was abnormally shallow, leading to early degenerative joint disease.  This could have been congenital OR due to an injury in childhood, though I honestly don't remember anything that might have caused that, either inside the womb or outside!

Hey, they just finished the pathology report on the condition of my femoral head (the ball joint of the hip, which they remove).  It makes for some interesting, albeit grotesque, reading:

SPECIMEN SUBMITTED: Right Femoral Head & Acetabular Reamings.

Procedure date	Tissue received	Report Date	Diagnosed by
07/29/2008	07/29/2008	08/01/2008	DR. L. BROWN/axg

DIAGNOSIS: 

Femoral head, right:

Bone and cartilage with degenerative and reactive changes.

Clinical: Right hip osteoarthritis.

Gross: The specimen is received fresh in a container labeled "Dyer, Stephen" and the medical record number. It is additionally labeled "right femoral head and acetabular reamings". It consists of a misshapen femoral head with a portion of the femoral neck that measures overall 6.0 x 5.0 cm with femoral neck measuring 1.5 cm in length. The articular surface is irregularly eburnated and numerous osteophytes are present. The femoral neck margin is smoothly resected and reveals tan bony cut surface. The specimen is cut along its length perpendicular to the articular cartilage. The cut surfaces reveal thinning of the articular cartilage to less than 0.1 cm in greatest thickness. Soft tissue is received with the specimen and measures 4.0 x 3.5 x 0.4 cm in aggregate. The specimen is submitted for softening and decalcification by histology in cassette A.