My Hip Replacement

Hip Replacement in Latvia

It has been four days since I had my left hip replaced at the TOS (Traumatoloģijas un Ortopēdijas Slimnīca) hospital here in Rīga, Latvia. I wanted to take some time out of my busy sick leave to write about the experience for anyone interested in a European socialized medical system or about hip replacement and recovery in general.

At age 53, I may seem a bit young to be having a hip replacement, but when the joints go, they go. My brother, the marathon runner, had his hip replaced a few years ago, so I like to think I take after him. I remember when I had some injury and we were both in Berlin limping around together. It was a good time. Now he rides his bike 50 miles a day, and I hope to be doing that soon!

But first things first.

How did I know?

How did I know I needed hip surgery? To be honest, I am still not sure if it was necessary, but it came down to the fact that I am not an “old man,” but I had been walking like one for a few years. I have been suffering from this mysterious pain on my left side for over 10 years. I had been seeing a physical therapist in Omaha who thought it was a problem with my Piriformis muscle, but no amount of training or massages seemed to be helping.

I knew I had tight hips, especially on my left side because I was doing yoga at my rock climbing gym, and I had no flexibility. But I thought it was just a sign of age or neglect.

However, before leaving the United States, I had an MRI and it showed that I did have arthritis in my left hip, but it didn’t seem serious. So 6 years ago, I had back surgery which took away a lot of the pain I had been having on my left side. I had these shooting pains that made it impossible to walk long distances, and just made life miserable, so I went through an arduous spinal fusion surgery. This helped with a lot of the pain, but after a few years, the hip was still giving me problems.

About a year ago, I had been taking general arthritis pain medication prescribed by my family doctor, but it didn’t seem to help. I was going on long walks with Baiba, and after about 9,000 steps, I could feel the bite of my hip. I would lie in bed at the end of the day, struggling to sleep because there was this burning pain on my left side.

So finally, my doctor said I needed to go to a traumatologist, which is a doctor that deals with bodily injury. I saw one, and he said I needed to see an orthopedic doctor, so I booked an appointment with Dr. Yu. It was a late afternoon appointment, and he just did about 3 tests and asked me some questions. The thing that made him certain was when he tried to manipulate my left hip, and I just screamed out in real pain.

The Process

From that point on, I was in the System. As a Latvian citizen, I am covered by the state healthcare system, but it is a bit confusing, and I still don’t fully understand how it works. The idea is that anyone can get coverage for healthcare, but it isn’t easy, and it isn’t completely free.

To get on a list for a procedure, like hip surgery, I had to be referred by my family doctor to a specialist. The specialist then has the power to put me on a list to receive the procedure itself at a state hospital. In this case, he said it would take from one to two years. The problem was, that there was no receipt or paperwork involved. He just said I was on this list in October of 2024, and I just put it on my calendar each month, that I was on a waiting list for a new hip.

Of course, one major barrier in all of this is my lack of Latvian language. I have been taking lessons and trying to learn, but it is a real challenge. Even after 9 months of lessons, I still can’t walk into a hospital and understand the questions they are asking much less offer a response. This is important because the way they were to inform me of the surgery was to give me a call. Some random person from the hospital called me up, but didn’t speak any English, so I finally had to make sure that when she called a Latvian was nearby.

In September of this year, I got the call and they told me that I had to come in for a preoperative check. My doctor helped me understand this and sent me a list of all the documents I needed to bring to the hospital on that day. It felt like I was doing side quests in some video game. I had to go to a dentist and have them write a letter saying I was healthy enough for surgery. Then a urologist, an x-ray, the dagger of Azkaban, and a scroll of Ritual.

By the end of the quest, I spent half a day in the hospital getting poked and prodded with no update as to the date of my actual surgery. The only person who spoke any English was the anesthesiologist, but the only thing he was sure of is that it would be a local anesthetic and not a full knock-out.

The Decision

A few days after the tests, I got a call at work from the hospital. Again, I was lucky to have a Latvian nearby who could tell me what was being said. I was given a day and time of check-in, but no details. I was to show up at the hospital on Sunday, October 12 for my October 13th surgery. It was happening!

And that is when the fear and doubt set in. I would be missing work. I would be in the hospital. How long would it take to recover? What if something goes wrong?

I had over a week to process all of this and I kept going back to a survey I did on Facebook last year when I asked people about their joint replacements and not one of the regretted it. All of them wholeheartedly said it was a great decision and their quality of life improved. And, as I understood from my brother, he was walking shortly after surgery, and back to his full self in just over a month. I am thankful for all of these people who gave me words of comfort and advice.

Checking in

The Sunday of check-in came quickly, and I wasn’t really ready. I wasn’t sure how long I would be there (they said 4-5 days, but I didn’t want to stay that long.) I wasn’t sure how to pack, but I threw some loose clothing and slippers in a bag with my toiletries and some snacks packed by Baiba, and to the hospital we went.

Hospitals in general are labyrinthian in nature, and old hospitals like this one are especially confusing. I took Baiba to the entrance that I had used when I was having my tests done, but it was a Sunday and no one was there. We asked a few people where to go, and finally we learned we had to go to the main entrance, which was more of an emergency room than a hospital check-in.

We took a number, and I gave my details. We waited until a man with floppy hair and tattoos came to lead me back through the secret doors that Baiba was not allowed through. We said goodbye, and I started my journey.

The first stop was some kind of administrative office with paperwork to sign. I showed my i.d. signed my name, and then I was following the floppy-haired man to the elevator and up to the 4th floor to room 306 which would be my home away from home for the next 3 days.

Room 306

Across from me, sitting on the edge of his bed, was an elderly man with grey hair and a polite smile on his face. I wanted to make conversation, so I tried some Latvian asking how he was. He just looked at me blankly, saying nothing. I tried again in English, but he made no reply.

The room was large and designed to be shared by four people. There was a closet for my coat and shoes as well as a toilet and a shower. They provided no towels, nor any way to dry one’s hands. I found this odd.

I chose the bed opposite from him next to a window which gave me a nice view of the trees changing color outside. I unpacked my things and set up camp with my computer and phone on my bed. No one had told me anything, so I just decided to sit and wait as patiently as I could.

Soon, another older man came in with his family. I was a bit surprised because Baiba said no one was allowed in, but here he was with maybe his son and/or daughter being helped to the bed next to mine.

After they left, he shouted his name, and the man across from me said his, so I threw mine into the pool. But it dawned on me very quickly that these two were speaking Russian and only Russian, so I wasn’t a part of the conversation.

Some kind staff members brought lunch which was some unrecognizable meat with macaroni and a soup. The soups there were nice. Then they brought dinner later which was some unrecognizable meat mixed with rice. I will say that it was better than what I had in Venstpils, or my taste buds have adapted.

Finally, in the evening, a nurse came and said I would either have surgery at 8 a.m. or 11 a.m. It seemed strange that they didn’t even know yet.

They gave me some pills to take before I went to sleep. I read, played Civilization VI, Scrabble, read, and just waited. I imagined that this is what prison must be like. Just sitting in one room most of the day doing nothing.

I looked over at the smiling Russian man across from me. He seemed to just sit on his bed, legs dangling over, and looking around doing nothing. I kind of envied him.

The Operation

I was a bit nervous, but I had slept well, and I woke up before 6 a.m. with no alarm. The nurse came in and told me that I would be going in at 8, so it was GO time!

When you have an operation, everything leading up to that moment is slow, but then it just happens really quickly. They wheeled me to the elevator and up one floor to the OR. I was happy to see that the operating room looked very modern and there were lots of people bustling around doing lots of things. I did not see Dr. Yu. I had not seen him since a year before when he put me on the list for this operation. I was hoping to have at least a quick word with him, but it wasn’t going to happen.

I had done some research on the procedure, and I wanted to know if he was going to do an anterior or posterior incision, and maybe get some details about the exact type of prosthesis.

The anesthesiologist (not the one I had interviewed with), was a nice woman who said they were going to do an injection in my back. Another nurse gave me the stint in my hand for the IV, and then she tried to stick a needle in my back. She apologized and tried three times, but she wasn’t able to find whatever she was looking for. It was likely because of my previous back surgery. “We’re going to have to knock you out.” Thank God! I thought to myself. I couldn’t imagine being awake and watching them work, wondering what they were doing for an hour or more. How stressful!

I felt the anesthesia flow into my blood stream. It is this numb sensation, cool in the arm, and you can kind of feel it slowly spreading through your body. The oxygen mask was put in place, and I was out.

I woke up a few hours later in the recovery room feeling really good, aside from the post-op taste that still hasn’t gone away. I don’t think I have slept that well in awhile.

Post-Op Drama

I lay in a haze of ether and mist for a little while. Thinking strange thoughts about things that don’t exist.

I think that in that time, the surgeon came in with some nurses because I had said I wanted to talk with him. I wanted to know how the surgery went, what he did, was it necessary? What did he see inside of me? But he was not interested in the conversation. He gave me a few one-word answers, and left as hastily as he had entered.

A PT named Agnese came to show me exercises to do and what I could and couldn’t do. She was my favorite of the people there. She seemed to genuinely care, and was helpful with answering my questions. She gave me my neighbor’s walker so I could practice walking. I didn’t realize that I was supposed to bring my own crutches, so I was kind of stuck. Luckily, my neighbor had been taken away for his surgery, so he wasn’t there to complain.

After she left, I had to go to the bathroom, and I was excited to try walking by myself. I was not feeling much pain, just a mild pressure in my hip area. So I carefully turned out of the bed and stood up, putting my weight mostly on my right leg. I used the walker and slowly made my way to the bathroom.

When I finished, I started to slowly walk back toward my bed, but I felt really nauseous and dizzy. It was like I had a terrible hangover, and I was going to throw up or pass out, or both. I didn’t want that, so I just started breathing deeply, and I must have been flushed and sweating.

A new Latvian guy had joined us in the 4th bed, and he asked if I was okay. I assured him I was fine, and then made it back to the bed where I crawled in and just closed my eyes trying to make the world stop spinning.

In a few seconds, a team of nurses and doctors came rushing in the room. They put the oxygen mask on, checked my vitals and asked me questions. I said I felt fine, and that I had just overdone it.

I guess I scared them, but I was actually fine.

The rest of the day is a bit of a blur with dinner and reading and scrolling.

Going home

After a terribly and confusing night’s sleep, even though they original said I would need to stay for 4 days, I wanted to go home the day (Tuesday) after the operation. I woke up feeling strong and with a very small amount of pain. I just had to find out what I needed to do to get discharged.

The nurses seemed to be in disbelief when I said how little pain I felt. I said it was a 2/10. Eyes wide, they would look at me as if to say, “Are you sure?”

Dr. Yu stopped for about 30 seconds. After some terse explanations of the surgery, he said I could go home after I had an X-ray. He said everything went well. That was about as much detail as I was able to get.

I was visited by another PT who spoke really good English. He showed me how to walk up and down the stairs using my neighbor’s crutches. I asked him how I could leave, and he said I would need crutches. There happened to be a crutch store on the first floor. This gave me hope. I was given a pamphlet!

A new nurse came in, and I mentioned that I needed an x-ray to leave. She and her supervisor seemed surprised. Most people looked at me with surprise and disbelief, so this was no different.

Eventually, the surgeon came back and gave me a discharge paper with some instructions. I said I still hadn’t had the x-ray. Again, surprise.

The two nurses came in again, and asked me if I had insurance. I said, no, but I am a citizen. Again, surprise/disbelief.

When lunch came, they kind of snubbed me because they new I was leaving, so they only brought me soup and bread. This was fine.

Soon a man came in with a wheelchair to take me to get an x-ray.

After the x-ray, I checked with my friend Renars (the hero of this tale) to see if he could come pick me up with the extra catch of buying me some crutches.

At some point that afternoon, they brought my smiling roommate back with his new hip. He seemed to be doing okay as well. They took away the Latvian man for his hip replacement, and the other Russian man was getting ready for his knee surgery. It felt like a good time to go.

Renars showed up with my stylish crutches which he had just purchased from the hospital store. I gathered up all my things, and he offered to carry my heavy backpack. I signed the discharge paper with the 51 euro statement, payable now or within 15 days.

We went to the confusing elevator and went down together. I was walking well on my new crutches. I paid my bill at the front counter, and we headed for the door. But as we were leaving, I realized I had left my hat in the closet, so I had to make my way all the way back up to room 306 where I retrieved my hat.

Getting into the car was the most pain I had experienced over the whole procedure. I had what felt like a cramp in my thigh, and I couldn’t quite straighten out my leg. This same pain would be repeated later whenever I tried to put on pants or sit in a chair. Other than this pain, the surgery was pretty easy.

As soon as I got home, Renars was surprised to see me walk (with crutches) into the Livi coffee shop next to my house. I said that I just had to have a cup of coffee to feel normal again before going up the 4 flights to my flat.

Final thoughts

For 51 euros, I think I got very good care, and Dr. Yu said the implant would last more than 20 years, so I feel pretty good about the whole situation.

Prior to the surgery, I had been having lots of flare-ups on my right foot with what seems like plantar fasciitis. That pain was mostly gone when I came home, but now it seems to be coming back. I have not had pain in my left knee or IT band since I got home, and this is a blessing.

I walked about a thousand steps on day 1, then 2000 on day 2 and over 3000 on day 3. Today is day 4, and I had some swelling and pain last night, but today, I feel very good. I am going to try to take it easy today to let my leg rest a bit. Yesterday, a home healthcare nurse came by to change my dressing. Next week, he will take out my stitches. It cost 20 euros to get him to make a house call.

As far as sick leave goes, my surgeon wrote a note that gives me 9 days off work for the surgery. My doctor offered to write more, but I said that I can work from home, so it is fine to go back to work. It is hard for my American brain to comprehend the idea of just getting time off to recover. After my Achilles surgery in the States, I was back ASAP on a scooter in the snow. Here, I would have a month off.

Side note:

I have the greatest admiration for nurses and other health professionals. One of the people who cared for me was a young nurse in training. I told her that she was doing a great job. I cannot imagine a more difficult profession. Underpaid. Overworked. And they have to deal with so many people who aren’t feeling well. Cleaning up wounds. Taking care of people all day long. I want to express my sincere gratitude for putting up with my Latvian and for taking care of me!