When Health Advice Collides

One of the upsides of aging is that you know that doctors are humans — not gods. You know that the advice they offer is often generic and based on large data bases that are not specific and tailored to your particular needs. You know that their goals don't always align with your own. But you also know that they know a lot more about disease and body mechanics than you do.

All of this can make navigating a health issue tricky, as I've been reminded these last two months as I recover — far more slowly than I'd hoped — from a hip replacement.

During the six months between the first x-ray that indicated my left hip was in bad shape and the surgery that installed a new titanium joint, I've learned that, for people in their late sixties, hip replacements are a dime a dozen. That recovery from a hip replacement is easier than from a knee or shoulder replacement. That when I'm done recovering, I'll wonder why didn't I do the surgery sooner.

Great! But before I can begin this love affair with my new hip, I have to re-learn how to walk. And, for me, that's where progress is proving tricky.

From the get-go, I've been bombarded with unsought advice, often as not from people who have never had a hip replacement. (Don't even get me started. After having accompanied a husband with leukemia and a sister with colon cancer from diagnosis to burial, I know that people's well-meaning but uninformed advice is not — not — helpful.)

One of the few people I listened to with acute interest is a Pilates pal who was my age when she had a hip replacement five years ago, and has since returned to her Pilates practice without incidence. Our bodies have similar strengths, given the training we've shared for years. I also signed onto the same medical practice she used, though I used a different surgeon.

Her advice: "Just follow the doctor's instructions and you'll do great."

That sounded good until my surgeon, pre-op, responded to my question about how soon, post-op, I should begin physical therapy, with a dismissive, "You won't need PT." Nevermind that the hospital where we were scheduled to do the procedure had already sent me packets of pre-op and post-op exercises that stressed the importance of physical therapy. "All you'll need to do is walk as much as you can," he said. If I insisted on PT, however, he said that he would provide a prescription.

Uncomfortable with his answer, I checked in with two physical therapists I respect, each of whom said PT should begin one-to-two weeks after surgery. Having had several successful experiences with PT, I chose to go with their advice instead.

Still, during that first post-op week, I took the surgeon's advice to heart and pushed the walking. Five days out, I walked a mile … then woke up the next morning hobbled with aches and an acute awareness that I was an idiot for pushing so hard. (Hey, I miss my Pilates regimen. I want to move this thing along!)

My recovery progressed smoothly until the day before my two-week post-op check-up when I was seized by pain worse than on Day One. Had I done something to provoke this? Maybe dislodged the new hip?

At the check-up, an x-ray showed that the new hip was just fine. The physician's assistant never actually looked at my hip or my gait. She did, however, trot out statistics gathered by surgeons that she said indicate people who do PT recover more slowly than those who forego PT. "Therapists always want you to do 30 reps," she said. "Sometimes that can cause damage."

The 30-repetitions part is true. Physical therapists have their own gathered statistics that indicate that for an exercise to be effective, you gotta do it, yep, 30 times. Urrrgh. Now what??

When I took my conundrum back to my physical therapist, he was unfazed. Reassured by the clean x-ray, he said that the pain I'd experienced was probably the result of my gradual progress transferring weight back to my formerly arthritic left leg. I'd been favoring my right leg and the exercises he'd given me to correct that imbalance were, only now, beginning to put real pressure on the new hip.

That made sense. As I did sideways steps across his studio's hallway and carefully repositioned my left foot with each forward step, making sure not to swing my leg to the side, I could feel how I'd been compensating to pamper the injured leg.

That left me wondering what would have happened if I'd followed my surgeon's instructions and focused solely on walking — walking that I now know I was doing incorrectly. Would my body have self-corrected my awkward gait? Or would I have created a problem, beyond healing from surgery, that would then need addressing?

Now into my seventh week of recovery, I remain diligent about both taking walks and doing my PT exercises. But I've fashioned my own goals, based on what my body is telling me. I walk at least a mile each day, unless my hip says, Knock it off, go home and ice. I do the 30 reps each exercise requires unless my body says, That's enough, you can stop now.

Based on the recovery experiences of fit friends who had hip replacements, I'm a bit disappointed that my walking remains uncomfortable. And given my 12 years of Pilates diligence, I'm frustrated that I'm not bouncing back faster. (My physical therapist says all that Pilates may have masked the arthritis, allowing it to build up and worsen over the years.)

Hey, whatever. At least I'm no longer parsing or worrying about the conflicting advice I've received from the medical and physical therapy communities. Having done my research and made my choices, I am now tuned into the most important expert of all — my body.

Jill Smolowe is the author of "Four Funerals and a Wedding: Resilience in a Time of Grief." To learn more about her book and her grief and divorce coaching, visit jillsmolowe.com. Read More