My story of surviving a ruptured aneurysm in Amsterdam in 2019 makes me a poster kid for “Better In, Better Out,” a concept trademarked by Holland’s Maastricht University, TNO and Care IQ on preparing patients for hospitalization: The more fit the patient is before a medical confinement, the more quickly the patient will get out of the hospital and back to civilian life. 

Here’s a “Better In, Better Out” story about a friend of mine in Albany, NY, who discovered this happy approach on her own. When Deb was faced with hip replacement surgery in December 2020, she set about building the physical, emotional, and mental strength she would need to recover and rehabilitate from a very serious surgery. 


Deb was already fit. For years, she has worked with a strength trainer three times a week. She didn’t let the pandemic stop her, moving online when his private studio was shuttered by COVID in the spring, and returning to her private sessions, wearing a mask and practicing social distancing, when he re-opened in June. 

When the hip pain hit last July, Deb added a couple of weekly sessions with her physical therapist. As “essential workers,” the PT practice was open and had adopted the same COVID safety protocols. The two practices had long consulted with each other to ensure they were on the same page in Deb’s treatment, a rarity in the often siloed approach to care. She highly valued the coordinated, holistic approach, which gave her confidence that she was doing everything she could to get better. 


However, the pain did not diminish. Finally, an October MRI revealed the problem: Deb had a stress or insufficiency hip fracture, a torn labrum (the cartilage surrounding the hip joint), and bone-on-bone contact. “My trainer took a look at the report and said, ‘You’re a hot mess,’” Deb recalls with a wry laugh. She scheduled hip replacement surgery, getting a valuable new member on her team: the surgeon’s case manager, whose background in physical therapy gave Deb additional insights into what lay ahead.


Armed with this new knowledge, Deb and her team began a five-week countdown to surgery. “You learn how your body will need to work during recovery,” she says about working on her abdominals to support her torso, her arms to lift her, and her legs to support her.

When time came for the operation, Deb was ready. “I went in very confident and ready to plow through.” Despite the case manager’s advice that she plan on resting at home for two weeks after surgery, Deb was committed to getting back to life ASAP, and she convinced her case manager that she was up for it. “I’m not a patient patient, and I knew that down time would be harder on me than anything, leaving me bored at home, with the potential to overeat and get discouraged.”


On a Monday morning in December, just days before elective surgeries were cancelled and barely six months since the onset of pain, Deb underwent surgery. Three hours later, she was on a walker doing a lap down the hospital corridors. She ditched the walker for her second lap, using the railing for support. “By my third lap, I was moving unassisted, doing what the happy nurses called ‘a hospital jog,’ telling me that I was almost as quick as runner patients.” She did not take narcotics for the pain, managing with Tylenol. She was discharged on Tuesday. Although the hospital made her take a walker home, she never used it. 


Because she wasn’t on narcotics, Deb could get behind the wheel right away (a big bonus, in her book!). On Wednesday, she drove herself to her first post-op physical therapy session, and then to her first post-op strength training workout. By the time she arrived at her trainer’s, her PT had called ahead to discuss his assessment and planned exercises. Her trainer began customizing her sessions accordingly, focusing on hip strength and weight-bearing status. Deb’s Movement Team was back on the job. 

Three training workouts and two physical therapy sessions every week kept Deb busy and focused on her recovery. Being goal-oriented helps, she said. “You grit your teeth and know that the end is in sight.” She celebrated hitting each marker of her progress with her trainer and physical therapist — driving herself (a bonus!), getting into bed without pain, climbing stairs normally, even putting on her gym socks unassisted.

When Deb walked into her surgeon’s office for her six-week checkup, the staff were amazed. “They said they wished all of their patients were as prepared as I.” 


Deb is feeling very much back in the game of life. She has officially graduated from physical therapy — with honors! She’s back at Zumba, on Zoom. And she semi-jokingly tells her trainer that he can retire when she turns 100. She is now 66. 

Deb is aiming for a remarkable feat just six months after hip replacement surgery: finishing the June 5 Freihofer’s 5K Run for Women. “Even if I have to walk it, although I’m shooting for my normal ‘turtle jog.’”

I’m betting she will hit her goal. Better In, Better Out! 

Deb’s Movement Team

Chris Mann, MS, CPT, at Kinetic Training [click here] and Cody Csontos, DP, DPT, at Choice Physical Therapy [click here].

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