8 Weeks - Physical Therapy and Bye Bye Crutches

Well let's start with the most important part first, shall we? At my first physical therapy session (today) my therapist told me I did not need crutches at all. I've been using 2 for long trips and 1 for short, and nothing for really short/around the house. She said a cane was probably just fine and to let pain be my guide.

Woohoo! That's a recommendation I am happy to take to heart.

She measured a whole bunch of things, like strength and range of motion. I heard her say "normal" a couple of times. Normal! I've never been normal in my life, and now I'm becoming normal. Or normal'er.

That doesn't mean there isn't a lot to work on, and I have home exercises to do, but not overdo, as she was quick to warn me. I think these people are all on to me ... they realize that I will do as much as they will let me as soon as they will let me and that patience is not one of my virtues.

I am clearly limping but my gait isn't as bad as she would have expected. I walked up the stairs like a normal person (right foot up then left foot up) without crutches. She finally got a little scared and asked me to please hold the handrail, but I didn't feel I needed it. She said she would have expected my right thigh to be more atrophied (well hey, it was huge to begin with). My right calf is very atrophied.

We talked about flexibility, turnout or lack thereof, my ticklishness problem (caused perhaps by all the "guarding" my muscles automatically do, perhaps due to dysplasia), the limitations given by my surgeon, and how right now I am compensating all over the place just to be able to walk, which is normal. She does think I will see fast improvement and that this is going to be "fun."

Well, fun for HER.

Six Weeks: Swim, Swam, Swum

I know that I am blogging way too much lately, but so much exciting stuff is going down. Today was my first pool outing since surgery.

I am lucky to have a warm water therapy pool just a short drive from my house. They also have an olympic-sized pool right there for when I graduate from the baby pool. For now though I'm happy as a clam floating around in the 98 degree bathwater.

I wasn't really sure what to do when I got there. Not only was I the youngest person by at least 30 years, but Dr. Mayo did not give me any pool exercises and he actually seemed reluctant to even let me go in the pool when I asked him. He said I could go at six weeks (yeah, that's Wednesday, but come on ...) but didn't tell me what I could and could not do. So I stayed with my usual restrictions. No straight leg raises or abduction or weight bearing ...

Wait a minute. Weight bearing? If I walk in the pool am I really weight bearing? In theory I am allowed to put up to 44 pounds on my operated leg. How they came up with 44 pounds is beyond me, and it's not like I am able to tell accurately how much weight I'm bearing anyway. I have just stuck with the concept of "toe touch" until now. But in the water I did some actual walking in the shallow end.

It was very odd. My body is so used to NOT walking that every time I stepped on my right leg my torso would scrunch up in a futile attempt to not bear weight. Even in the pool I had a pronounced waddling limp. It got better over time, but boy, if this is any indication, real walking on land is going to be, um, rather challenging. I had hoped walking, which I've been doing for almost half a century, would be a skill I might easily reacquire. Now I'm thinking not so much.

Over the course of an hour I did lots of floating, some range of motion exercises, a little walking, more floating, and some paddling with just my arms in a feeble attempt to get my heart rate up (kicking my legs did not seem like a very bright idea even though it's not on my restriction list).

Today was the first time in almost six weeks that I've done any activity which resembles exercise. I am sure that I overdid it. Based on the pain that's just starting to become apparent in my right groin and buttock, I'm sure I will find out in the next 24 hours just how much.

Five Weeks

Here's a quick update on my hip status at five weeks post right PAO:

~The scar itself looks amazing; it's just a pink line. There are itchy red dots around it though - probably some kind of rash, definitely not an infection. I'm putting on neosporin/cortisone and will call the doctor if it doesn't go away soon.
~I have very little pain and have not even taken Tylenol in weeks. I still don't have anything that feels like bone or internal joint pain. It just feels like soft tissues adapting, and I have tightness in the muscles and near the scar, especially first thing in the morning or if I move suddenly or if I'm on my feet (well, foot) for too long. I hear an occasional click when I externally rotate. No other hip noises though.
~I wore fitted jeans and low-heeled boots to go out with friends on Saturday night. My scar did not hurt from the waistband and I did not have an issue walking in "real" shoes. I am not going to wear high heels any time soon though.
~I made zucchini bread this evening all by myself, thanks to the bar stool in the kitchen and my handy backpack for carrying stuff.
~I went in to the office Monday for 4 hours. My butt hurt from sitting in a real chair for that length of time, and when I got home I was tired and took a nap. I am going back in tomorrow and Thursday and will try to work longer hours as tolerated.
~I am sleeping a bit better but still not back to normal. I can sleep on my back and on my left side. I rolled over onto my right side just to see what would happen and it didn't hurt. I am not really supposed to do this so I have not made a habit of it.

Range of Motion Illustrated:
Range of motion is much better than I thought it would be at five weeks, although I have no real basis of comparison. I can bring my right knee toward my chest (I can get it closer than shown in this photo, but not while taking a picture of myself!):



My external rotation has improved since my four week report; however, it's still not very good, as expected:



While lying on my stomach, I can grab my right foot with my hand and touch my butt with it. I can cross my right leg over my left. I haven't figured out a good way to stretch my hamstrings, which have been historically tight; I have a feeling they will be very tight when I'm able to really try.

I am very pleased with my progress, excited to get in the pool in a week, and anxious to start bearing weight and doing real exercises. I am curious how much my pain level will increase with additional activity and weight bearing since it feels like I'm doing a lot of nothing right now.

Four Weeks

Clearly I haven't spent the past 4 weeks working on my tan

I am halfway to my post-op appointment where, please God, I will find out that I can ditch at least one of the crutches. I am 2/3 of the way to being able to drive and go in the pool. I have stopped the insane sweating. I am done with the hospital bed. I am so done with the iron supplements.

I am starting to feel pretty normal, other than being unable to get the song "Tennessee Waltz," complete with Lawrence Welk-type orchestration, out of my head. It's been two weeks since I took any pain meds so I don't think this is opiate-related, but I have no other explanation.

I also have this overwhelming urge to go shopping. I don't have the stamina to shop or try a bunch of things on, and I don't even know what size I will end up being when all is said and done; I'm not about to actually go to the mall. So what is driving this shopping desire? I think I've been watching too many episodes of "What Not to Wear," which is shown in reruns two or three times each weekday. I think Stacy and Clinton would agree that a brand new hip deserves a brand new wardrobe, so if anyone wants to nominate me to be on the show you have my blessing. Shut up!

Sleeping is still not a sure thing, and before this I was a really good sleeper, so I'm perplexed and not quite sure how to fix it. I've ruled out heavy drinking and sleeping pills, for now. I am still unable to find consistently comfortable sleeping positions throughout the night, and often wake up long before dawn. But that's OK! I can take naps any time I want to.

Not that I'm just sitting around doing nothing all day in my jammies, although occasionally that happens. I confess that I have read my share of People magazines, although I draw the line at The Enquirer and I've avoided the most ridiculous daytime TV shows. (Note: "What Not to Wear" should NOT be categorized as crappy daytime TV.) Most days I try to be as normal as possible by getting up, showering, making an attempt to tame my hair even though blow drying is out of the question, and putting on "real" clothes from the loungewear family (i.e., sweats).

I attempt to sit upright each day for as long as possible. I try to get up and walk around throughout the day and/or get out of the house if someone is willing to come get me. I'm not yet ready to walk in my own neighborhood since our streets are not well paved and the terrain is hilly. I am able to shower standing up on one foot. I can do light housework, such as cleaning up cat barf, doing laundry, and washing dishes. Monday I even vacuumed half of the main floor (it is possible, just takes a while) and cleaned the upstairs bathrooms. I actually sat on the floor and scrubbed from there - it's easier than mopping upright.

Which leads me to ... I can sit on the floor and get up from the floor using my good leg. It's a neat party trick.

I have not yet tripped, fallen, or accidentally put my full weight on my right leg as so many PAO patients do. In some ways I wish this would happen so I could test out my hip, but I know it's not ready. Don't worry mom, I'm not planning to actually do this.

My upper thigh is still numb, lumpy and a bit swollen. The scar looks really good and doesn't hurt when I touch it. I occasionally feel odd twinges of pain in my outer hip which I imagine are screw heads poking me, but since I'm not sure what screw heads feel like this could all be in my mind. I feel odd pulling sensations in my muscles. Sometimes my knees hurt, especially at night. I know how important strong quads are to keep the knee joint stable; my quads are not just weak, they are pathetic after four weeks of atrophy. My hope is the knees will be just fine once I build the muscles up again -- I've never had knee problems and don't want to start now.

I actually feel like I could walk just fine without my crutches, but I'm not going to be a fool and try it. There will be plenty of time for walking. I'm sure I'll look back fondly on these lazy, boring days when I'm in the midst of physical therapy hell in September.

Three Weeks

Has it been three weeks? Has it ONLY been three weeks?

Time seems to be moving slowly; I'm focused on my 8-week "bye bye crutches" appointment and I’m not even halfway there.

As I write this, it is 105 degrees in Portland; we’ve had record high temperatures the past few days. I still have trouble regulating my body temperature, and coupled with the heat this has been difficult. We don’t have air conditioning because our house is up on a hill and surrounded by trees; it never gets hot enough for us to need air conditioning (until now). We do have a basement which is cool, but I'm at the point in my recovery where I want to get out of the house and be more active. I can’t really do much outside without dissolving into a sweaty tired mess.

Today my parents took me out to lunch at a nice air conditioned restaurant. Then we went to the grocery store (also cool) and pharmacy (not bad). I did a lot of walking in the stores and felt pretty strong on the crutches. I didn’t realize how tired I was until I got home and took a two-hour nap!

So here is my three week update:

~Scar looks good and I’ve started massaging Vitamin E oil into it. I’ve heard that Bio Oil works well but also heard that any oil is fine, and since the scar already looks so good I see no reason to buy the Bio Oil because I have some Vitamin E.
~I try to sleep in my regular bed but still bail out in the middle of the night to the hospital bed. The mattress on the hospital bed is horrible, but I can change the settings and get more comfortable. Plus I hate waking Perry up with all my tossing and turning. I did spend one night early on sleeping in the recliner but did not repeat it because the hospital bed is better. I can usually sleep on my non-op side with a pillow between my legs but sometimes that just hurts. It’s hard to move the pillow and my leg around to find the sweet spot but when I do, it's great.
~My pain level is usually a 1 and I’m not taking any pain killers. The pain I do get feels muscular and not like it’s inside the joint or in my bones. It’s hard to tell for sure, but I don’t think I feel anything where the bones were cut. I feel sharp pain if I move my leg too abruptly. I am trying not to actively lift the leg as I was told not to, but occasionally I do by accident. I’m able to do it, but I feel sore in my hip flexors and my inner thigh when this happens. I’m trying to be more aware so as not to do it accidentally.
~I’m trying to do things around the house like laundry, cleaning, etc. I carry things around the house in a tote bag around my neck, in my teeth, in a backpack, tucked into my waistband … whatever is handy. It takes a while to bring all the clean laundry in to the bedroom and put it away – several trips with the tote bag – but I feel productive. My house is a mess – we have a long-haired cat shedding everywhere and the vacuum cleaner is just not going to happen with crutches – but I have learned to live with it. Laundry, of course, is not optional.
~Thanks to the CPM machine, my range of motion seems excellent. I can bend over to pick things up from the floor, reach forward and touch my toes, tie my shoes, paint my toenails, bring my leg in to my chest (not all the way by any means, but darn close), sit on the floor, and pull my operated leg up over my head with my hands a la Biellmann. OK, OK, I can’t do the last thing, I was just seeing if anyone was still reading.
~I have gently tried external rotation (e.g., sitting cross legged). My external rotation (turnout) has always been limited and it’s exttremely limited now because of post-surgical stiffness. This surgery did not correct my anteversion (my femurs are rotated inward) since that would be an additional surgery (femoral osteotomy) and my surgeon did not want to do it. (I didn't really either, although the thought of better turnout almost made it worth it.) I don’t know how much my external rotation will improve once I am able to stretch and work on it. I hope to have external rotation that is no worse (and if the stars align, better) than before. Otherwise returning to ice dancing, with its requirement for turnout in order to do even the easiest turns, may be challenging or impossible. This was my biggest outcome fear going in, and it’s too early yet to know how this will turn out (pun intended) in the long run, because I’m not allowed to do any real stretching or rotating yet.
~I’ve lost 12 pounds. I’ve been eating very healthily and I’m definitely not starving myself or dieting. Everyone says my formerly muscular legs are looking wimpy. So we can safely assume that’s 12 pounds of muscle gone to hell.
~Sneezing and coughing aren’t as excruciating as they were earlier in my recovery, but I still feel them in the joint/incision.
~My hands still hurt when crutching but I’m getting used to it and it rarely bothers me.
~I can still see the bruise from my first Fragmin injection, given to me in the hospital by Nurse Ratched. I can still see the bump where the IV needle was inserted. I can just barely still see the bruise from my autologous blood donation! Needles and I just don't get along.
~I am going to have a glass of wine before bedtime. I haven’t had an adult beverage since before my surgery. I have a feeling I will sleep quite well tonight.

2 weeks post-op

I am a couple of days late with this post as my two week post-op day was Wednesday and it is now Friday. I don't have scar pictures (the post-op photo I took with my phone is pretty blurry), although it looks good. I'll have to get Perry to take a photo tonight because this just wouldn't be a PAO blog without scar photos!

Last night I took a bath. Shhh, don't tell Dr. Mayo, because I don't think I'm supposed to. Some hip chicks are allowed to do hydrotherapy when they are still in the hospital for crying out loud, so I didn't think a bath would kill me. I was careful not to get the scar wet. I am a Pisces. We fish like to be immersed in water. I can't swim until week 6 per doctor's orders, so this is the best I can do. It felt really good to sit in warm water.

Here's my progress at the two-week mark (as of this past Wednesday):
~I am off all prescription/narcotic drugs. Had a bit of withdrawal for a couple of days (headache, nausea, sweating, inability to sleep) as I probably came off them too rapidly; I don't recommend that. Next time I'll taper more gradually. I'm just taking occasional Tylenol for pain. I think I've had just one dose of Tylenol.
~CPM is at 90 degrees, meaning I can get rid of it
~I can sleep on my non-operated side for about an hour and can flip on to my stomach (but can't sleep that way)
~I can shower (sitting down) by myself
~I can shave my legs
~I can get dressed by myself without any helpful devices. Hardest part is to put on socks and shoes, but I can do it.
~I can get in and out of the car without assistance (passenger side - can't drive for 4 more weeks)
~I have been working from home up to 4 hours per day (but not on a very regular schedule; usually about an hour per day).
~As mentioned, incision looks very good. It looks too good, in fact. Who would believe I had major surgery with this wimpy scar? It lacks the necessary gore factor.
~I did laundry while sitting on a stool last night.

Problems I'm still having:
~Sleeping through the night now that I'm off narcotics; usually I get 4 hours of sleep and then another 2-3 during the day. Despite this, I'm not really tired.
~My hands are killing me from crutching. I could crutch for miles if it weren't for that. I have padding for the handles and I have padded bike gloves, but still.
~Regulating my body temperature. I thought this was related to taking the opiates, but it's still an issue. One minute I'm sweating and the next I'm freezing.

Daily Routine

I picked a great time to have surgery. It had been really hot here in Portland with beautiful sunny days. Our house is in a forest and very well insulated, so it stays cool. I love sitting in the living room watching the hummingbirds and squirrels. I can wear shorts and tank tops around the house and don't have to worry about trying to stay warm. Best of all, I don't have to put socks on (something which I don't think I can do on my right side by myself yet).

I have been waking up at 5:30 AM to have breakfast with Perry and sit in a chair for a couple of hours. Our new recliner is being delivered today and I can't wait for that as the chair I'm sitting in is a bit uncomfortable. I usually check e-mail and read the news in the morning. I am a bit obsessed with checking other hip chicks' blogs to see what they are up to, especially those that are a few weeks ahead of me in the recovery process. We all heal differently, but it's good to know what to look forward to.

I've been leaving comments on other hip chicks' blogs with more regularity because I can empathize about both pre- and post-surgical issues. I am trying not to make a career of reading and commenting on blogs, but it's hard not to be obsessive about it since it's what I am living every day.

I have noticed that most peoples' blog entries tend to taper off or stop just about the time they are allowed to ditch the crutches and start walking. This makes sense because at that point people pretty much go back to their normal lives. I would like to hear more about the physical therapy experiences people have at that point, but I'm sure I'll have the experience myself soon enough.

The only "complication" I've had is that my hands are sore. I'm using padded bike gloves, but they aren't helping much. The crutches are a bit more cushy than the walker so I'm using those more, but it's easier to carry things with the walker. I put a bike basket on the front -- the same kind of bike basket that used to go on my pink Schwinn when I was 10 years old -- only this one doesn't have plastic flowers on it. My Mom's friend had it hanging in her garage and donated it to the cause, and it has been invaluable.

I am allowed to walk as far as I'm comfortable with the crutches as long as I don't put any weight on my right leg, which means most of my weight will be on my hands. The doctor made it clear that it's a good thing to walk and exercise but I haven't ventured out very far yet. I think my hip could go miles without a problem but my hands might not make it that far. Since we live on a steep hill, I think I'll try going to a flat neighborhood to see if I can crutch a block. Someone can follow me in the car in case I poop out.

(Speaking of, yes I did, on Wednesday. My sister Linda won the betting pool.)

Most days, after sitting in a chair for a couple of hours I go take my meds and inject myself with Fragmin, the worst part of my day. Then I usually get tired and take a nap. When I wake up I work for a few hours each day on my laptop. I don't want work to think they can survive without me for too long! Usually I read a book in the CPM machine in the afternoon. When Perry gets home he helps me take a shower. A shower chair is invaluable and Perry installed a hand-held shower head as well. I strongly advise everyone to have those things to make your life easier.

I got a bedside commode because my surgeon told me to, but I've never used it. I don't have a raised toilet seat either. I know those things can be helpful but I haven't found the need. I would advise people to buy the raised toilet seat and have it available. Try the toilet without it. If you find you don't need it, return it.

The only other assistive devices I have are a grabber (invaluable - things fall on the floor all the time and I can also use it to help get my pants on my "bad" leg). I have a sock putter onner but haven't tried it yet as it has been too hot for socks. Usually people buy a "hip kit" which has a long shoe horn, a sponge on a stick for washing, a grabber, and a dressing assistant device. I didn't think I needed all of that and the grabber was on sale, so it was cheaper to buy just what I needed. However, usually it's cheaper to buy everything as a kit and some people may want the other items. I can reach my lower legs to wash them and can put my shoes on without a shoe horn so I didn't need all of the items.

I try to do my isometric exercises about 5 times a day, 20 reps each time. Those consist of the following exercises done lying on my back:
~Glute squeezes
~Pointing and flexing my feet
~Hamstring exercises in which I pull my heels down and toward my butt
~Quad exercises in which I tighten my quads and push them down into the bed

I try to get up 5 or 6 times per day just to stroll around. I'd do this more often if my hands hurt less.

I spend 20 or more hours per day in the CPM machine and I'm up to 75 degrees. I need to get to 90 degrees before I can stop using it.

My IV site is still sore and tender. Obviously anything having to do with putting a needle in one of my veins is a problem. Not intolerable, but something I've learned about myself.

I put my pants on today, and other exciting news

It has breen almost a week since I (or Perry) posted. So much has happened that I don't really know where to begin. I've been meaning to post but kept putting it off because I was in the middle of a very good book ("Memoirs of a Geisha") and just couldn't put it down. When I did put it down it was usually because I fell asleep, or someone was taking my vitals, or a physicial therapist was torturing me. So I apologize for no news, but in this case it's good news.

I'll go back and discuss my experience day by day in a second, longer post after this one. For those of you without hip problems (my friends and family), reading this longer post may not be necessary since it's really just a lot of boring and gory details. For those of you awaiting PAO, I hope the details of my experience will help you prepare for your own surgery and recovery.

So here's all the good news in a nutshell for those of you who won't be reading post #2:

1. My surgeon said everything went really well. He is not a demonstrative person but he had a big smile on his face and I am certain that I will have the best possible result based on his positive attitude about the outcome. Of course, much of my success is now up to me ... and how hard I work at rehabiliation. But I know that Dr. Mayo did all he could for me surgically. He not only did the PAO, he shaved the top of my femur (the ball of the hip) which had a knob that was catching when my hip flexed. Now it's round and should work better. (Yes, that's probably why my hip hurt every time I tried to do a mohawk or a choctaw!)
2. I am in a lot less pain than I expected.
3. I had great pain management in the hospital, and most of the procedures I'd been dreading were not nearly as bad as I'd imagined.
4. The nursing staff at Tacoma General was mostly kind, caring and competent, with a few exceptions who were not. Overall the standard of care from the nursing staff was better than most hospitals, for which I am grateful.
5. I got to come home on the 5th day after surgery (yesterday), which is probably the earliest they would have let me come home in any case. I was very ready to leave!
6. The drive home was 2.5 hours and pretty uneventful.
7. It is great to be home. I have my hospital bed set up in my office and from the windows I can see beautiful green tree tops outside. It's very quiet here (not so much in the hospital of course) and I'm getting lots of rest.
8. Although my mom and sister checked in on me today, I'm home alone and able to get from bed to couch to bathroom using my walker just fine. I'm able to get my operated leg in and out of the continuous motion machine and on and off the bed myself (something I had trouble with in the hospital). My bed at home is much lower than the hospital bed and thus easier to get into and out of.
9. I am SO EXCITED that I was able to put my pajama pants on BY MYSELF this morning without any assistive devices. As expected, I was al fresco all week in the hospital and the first day home; this morning I wanted pants. My non-op leg is very mobile and strong so I was able to maneuver the pants onto the bad leg using the good one. You have no idea how exciting this is until you've had hip surgery.
10. I still haven't pooped. My family has started a betting pool called, "when will Terri poop." Estimates range from tomorrow at 7 AM to Friday at 8PM. I'm eating prunes and hoping it's sooner rather than later!
11. Spinal Tap fans --- the control on the CPM machine goes to ELEVEN. Of course, that means it's LOUDER.
12. My scar looks great. I could post a picture but will save that for later since I'm not sure where the camera is.

Thanks to all of my friends who've been such great support for so long. I am very grateful to have you all in my life. Terri