Patient Stories

Melodee v2

~Melodee Nugent~ My Updated Story

1-month post hip revision surgery (December 2018)
I already have had a previous Patient Story (click here) with the International Hip Dysplasia Institute in November 2015 regarding my hip dysplasia story and how well I had been doing. A lot has changed since then, and I feel I need to give my revised story.
First off, I encourage anyone with hip dysplasia to get in the water and swim. I know swimming is not for everyone, but it is one of the best sports out there that is easy on your joints. I am lucky to have chosen swimming as my sport (though I didn’t really have many options with my hip dysplasia). I have swimming to thank for helping to make me the person I am today. I can’t imagine myself without this sport I love.

I was born with hip dysplasia which was first noticed at a routine check-up soon after I was born. I had multiple surgeries as a young child; one to correct the angle of the hip and one to try and correct the difference in leg length as a result of the first surgery. I vividly remember one of my last appointments with my pediatric orthopedic surgeon when I was 18 years old. He told me two things: 1) “Watch your weight” and 2) “You will probably need hip replacement by the time you are 40”. His words have always stayed with me over the years.

I credit swimming 100% to my overall health and putting off the hip replacement by about 10 years. I was able to have three children without any complications for the hip. Swimming is a low impact sport and thus makes it a perfect activity for me and others with similar joint issues. There are many swimmers over the age of 40 because swimming is very easy on the joints. Unlike other endurance sports, specifically including running and cycling, wherein athletes are subjected to rigorous pounding of their joints, swimmers can continue to get better as they age.
My passion for swimming has been a gradual process; one that I would never have imagined when I started as an adult more than 20 years ago. I joined United States Master Swimming at the age of 27 (1994). I consider myself a marathon swimmer. I train in a pool all year long. I love the open water races (I have competed in 12 different US states and have traveled to the Caribbean as well). A marathon swim is considered any distance of swimming over 6.2 miles (which is the equivalent of a marathon run). To date, the farthest I swam was a 36-mile swim in the Red River in North Dakota in 2016 (a year before I had my hip replacement). That race took me 12 hours and 27 minutes to complete. I am always looking for new challenges.

Swimming never bothered my hip, probably because being a distance swimmer there is little kicking involved. At the end of 2016, however, my youngest daughter said, “Mom, you say owww all the time”. I knew I was slowing down with walking, doing stairs and bending. I was used to my slower lifestyle on land and learned to deal with it and thought that was just life. I went to the doctor in January 2017 and got the surprise of my life, the reason for the slowness was because there was little, to no cartilage left on my bad hip. Was I shocked….completely! It definitely explained how I had been feeling. I tried a cortisone shot, with hopes of it lasting long, but it lasted only a couple weeks. Then I had to make a major decision, should I go ahead with total hip replacement surgery? This was not quite the 50th birthday surprise I was expecting. I knew my situation was unique and made the surgery more complicated than a regular hip replacement. I really felt that was the best choice for me. The big bonus was that my surgeon would try his best to lengthen my short leg (one-inch leg difference). I was very excited about that possibility.

Hip replacement surgery went well, though my femur splintered, which I knew could happen. I had weight restrictions because of the splintered femur and the leg lengthening, which meant I had to use a walker for the first six weeks. Then I used a cane for another 6 weeks until I felt comfortable walking. I was told the recovery would be about one-year and then my doctor changed it to 6-months because he said he knew I would be tenacious about recovery.
I needed to wait 4 weeks post-surgery to hop in the pool. I really missed my athletic club during my month off from swimming. Not only am I friends with swimmers, but other members as well. They are my second family. I rarely miss a day in the pool. I started back gradually by swimming 1000 yards and slowly increased the distance. Not only was I swimming laps in the pool; but water walking, water jogging and PT exercises as well. It was early summer, and I spent many many hours in the pool (we have an above ground pool at home). I spent at times up to two hours a day of water walking, which involved reading a book that was on the float and walking in circles. I was also able to do my first open water race 2 months after the surgery. I still was not up to speed and needed assistance getting out of the water and walking to the beach but was thrilled to be able to compete. I was able to do 5 more open water swims in 2017. I knew the recovery would be long, but it was going so well. I truly believe that all my water activity shorted my recovery time significantly.

What made me happy was doing underwater dolphin kicking and when I looked at my feet, it was so cool to see my toes line up evenly. It made me appreciate what I went through. Plus, I could buy any shoes I wanted and did not have to examine shoes to see if a shoe lift would work. I was the happiest about that because I thought I would always walk with a limp.
I continued to do well after the surgery. I was even written up in the Froedtert Today magazine a year later. I had a great swim season in 2018 and did very well in my open water events. I did a 15-mile swim called “Border Buster” in Vermont in July 2018. Lake Memphremagog is on the border of Vermont and Canada, so we swam across the border into another county. In August, I went on an 8-mile walk with my girlfriends along Lake Geneva (Wisconsin). I would have never done this prior to the surgery because I would have never made it. I also went to a big Milwaukee festival called Summerfest that summer. My girlfriends and I were talking about why it has been so long since we came, and it was because I could not have walked that much before. I didn’t think of the hip issues anymore, I had put that chapter of my life behind me…….or so I thought.

I had my follow-up the next month (September 2018), this was actually 16-months post hip replacement surgery. I was asked questions about my physical activities and I explained all was good. Then my doctor pointed out his concern, there was a shadow on the x-ray showing that the implant has moved. I didn’t notice any pain associated with the hip (though upon reflection there may have been some red flags). He told me to be aware of thigh pain and not dismiss it as something else.
I was surprised and concerned after that appointment. It never occurred to me that it wouldn’t work out for me. We discussed coming back in 6 months to see how the x-ray looked.
I went on a trip soon after that and returned to notice the start of thigh pain. After a couple friends asked me about how my hip was doing (no one asked in so long, but apparently, I was limping again), I made an appointment with my doctor one month after I last saw him. I am glad he mentioned to be aware of thigh pain because I would have dismissed it as something else and I am sure it would have taken me awhile to figure out it was related to the hip. The x-rays didn’t change, but it was apparent that something needed to be done. Three weeks later I had the revision surgery on November 5th, 2018. Prior to surgery, there were uncertainties on the recovery. It all depended on how the hardware came out, if it came out easily, then a quicker recovery. If he had to break the femur to get it out, then it would be a longer recovery. Of course, there were problems getting out the old stem and the femur had to broken to get it out (he spent 2.5 hours trying to get out the old stem).

The surgery was over 5 hours long and I now have a longer stem (about 8 inches long instead of 5 inches). With the femur broken, I was not able to weight bear for 6 weeks and used a walker again.
The recovery from this surgery was different than before, the scar was almost double in length (higher and lower), which meant sitting was difficult. I spent most of the first 2-3 weeks laying down with the couch only slightly reclined. Pain was mostly in the lower femur (because the new stem was longer). I went back to work part-time at 5-weeks, which may have been a week too early because I still was not sitting comfortably yet.
I was extremely happy to be back in the water 1-month post. Everyone at the club who knows me noticed the smile on my face to be back. For me swimming is not only a physical activity but is also a part of my rehab. I started out gradual again with the swimming. I would use the pull-buoy for the first 2 weeks (which is foam piece you put between your legs) to work on the upper body (this prevents me from kicking). I actually showed the doctor a video of me swimming with the pull buoy prior to surgery so he wouldn’t have concerns about me back in the pool. I was back to my normal distance of 4 miles a day in about a week. Of course, I was not breaking any records, not doing any timed sets and not doing flip turns. That will all come with time. At my 6-week appointment, everything looked good so far and I am hopeful at 3 months it will look good too.

After having two hip surgeries in a year and a half, I would encourage others to look at “weekly” improvements, not daily. It is difficult to see daily changes, but easier to notice the weekly changes. Each week I would see improvement in my sitting, moving around, walking and bending. I was often asked how I felt about having another surgery so soon. Of course, it was not what I had planned in life, but I feel there are much worse things out there that people struggle with daily. This for me, was only a bump in the road of life. My husband did mention to me recently how proud he was for how hard I worked at the recovery and how well I took this second surgery.

Swimming has taught me lifelong lessons, not just in the pool, but outside of the pool as well. The water will always be my “happy place” where I can escape the real world, clear my mind and push my limits to train for those crazy marathon swims. Those mornings where it would feel great to stay in bed, swimming teaches dedication and hard work. Most non-swimmers can think of something else they would rather be doing than follow a blue line in the pool for hours. I never get bored of that line in the pool; it will always be there for me. Swimming taught me discipline, commitment and goal setting. Commitment that can sometimes be obsessive at times. I love to have a big swim planned and have months to prepare for it. Without the many hours spent to meet these goals in the pool, I wouldn’t know what hard work feels like and to go after something you really want to accomplish. These characteristics will carry me through the rest of my life and helped me with the recovery of my hip surgeries. I am not sure if I chose swimming or swimming chose me. I think it goes both ways, but whatever way it is, I am lucky!