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.

The good, the bad ...

You know the rest.

I woke up this morning feeling really good. Sleeping is usually an issue. I can't sleep on my right side since my right hip just can't take the pressure. I can't sleep on my left side because my left knee generally hurts if I do so (I am sure my left knee problems are related to my hip problems, but that is another story). And if I sleep on my back, well, my back starts to hurt.

But I usually do sleep on my back anyways, with a few tosses and turns during the night, and get 6 hours of sleep. I have good and bad nights but never pain free, until last night when I slept the entire night and woke up with nothing hurting. It was a great feeling! I should have known that it wouldn't last.

I went to the rink and all was OK until we did our first lift, and I felt my left inner hip socket pop. We tried a couple more times but I could not support my weight with my left leg as I have to do in this lift. The left hip is my "good" hip, or "better" hip anyway. We continued skating for the two-hour session.

Now here I sit with ice on both hips and inner thighs. The pain has radiated from the inside of the left hip to the outside and all the way to the right hip. It's as bad as the first time this all started hurting, when I was off the ice for 3 weeks and went to the doctor the first time. It hasn't been this bad since then. Shoot, what have I done? That is an easy lift and hasn't given me any problem until now.

I am seeing a surgeon to discuss periacetabular osteotomy next week. Perhaps I've taken a turn for the worse, I don't know. Tim is gone on vacation for a whole week starting Friday and I was going to work on my Cha Cha Congelado while he was gone, but it sounds now like I will be "resting."

Damn, damn, damn. Shit, shit, shit. I was hoping to put off any surgery for a while (a year, maybe two?) because things were going so very well for so very long. Maybe this is just a minor setback and not the start of my downhill slide into arthritisland. I'll find out tomorrow if I can skate, or walk, or not.

And I'm feeeeeelin' ... good?

Strangely, yes. After several days feeling like someone had beat me up in the parking lot, I woke up this morning feeling almost quite normal. I did my usual routine of sleep for 5 hours and wake up, but I think that was more from habit than pain, and I fell back to sleep.

This morning my hips barely hurt, my back doesn't hurt, and my knees don't hurt. It's amazing. AND, I skated for 45 minutes yesterday, working on Novice Moves since Tim is out of town. I skated at medium intensity and so I figured I'd pay for it today, but somehow I'm not.

The past 3 nights I've had trouble sleeping and it has felt as if someone kicked me in the pelvis by morning. My back has hurt almost as much as my hips but I think that is from standing at my desk all day vs. sitting. And my knees have started to bother me, probably because I walk funny and that puts additional stress on them.

I think that I can attribute this episode of feeling good to stretching last night. I didn't stretch overly hard or long, but I did it. I hate stretching and always have. It has always been painful and I've seen very little progress with it. I've always been inflexible even when I've worked hard at it. This has caused me to hate ballet class where they keep telling me to do things I can't, and to hate stretch class and yoga class where I am the only one who can't touch my toes or bring my knees to my chest.

I even hired a personal trainer once to work on stretching with me. She said I was "the least flexible young person" she had ever seen. Stretching for me has always been a losing battle. Now in middle age I'm only going to get less flexible, so while stretching won't improve me, it may keep me feeling better than I would without it. So I need to make time for it even though it hurts and I hate it.

Other things that I'm learning about myself:

I have very overdeveloped glutes. This is called a "skater's butt," but I have more than the usual amount of it. I have the mega butt, which contrasts enough with my very small waist that I can't find clothes to fit. I always thought the butt was due to skating, even though it persisted during those two decades when I wasn't skating (although I was doing other athletic activities). I wondered why I got so much of it even though as a kid I really wasn't training heavily compared to many and I wasn't an elite skater. I had no body fat either back then so it was just very, very strange and oh, so ugly.

Now I think it's the mechanism my body has used to compensate for the weakness in my hips. I think the muscles around the hip joints have atrophied and the glutes always made up the work load. This is also why I found that I was very weak doing certain exercises that everyone else found easy. I just didn't have the structure for it and the muscles couldn't get strong no matter what. The biggest muscles in my lower body picked up the slack for all the rest.

This is all amateur science and conjecture on my part, but would certainly make sense if it were true. I can't find anything in the medical literature stating that people with acetabular dysplasia develop large glutes, but perhaps it depends on which athletic activities they pursue. My body has been trying to do the things I ask of it, skating-wise, with a structure that is more suited to couch potato-hood, and since I insisted, it compensated.

Well, all this aside, today I am feeling good so I plan to take advantage and paint the closet in the bathroom.

A bad day and a good day

Yesterday I experienced the worst hip pain yet. At work, I couldn’t sit down, so I stood up. However, if I stood too long my back started to hurt, so then I sat down. After about 10 minutes of sitting my hips ached. I kept putting my heat pack on but the pain was all over so it was hard to do anything useful. I stood up, then I sat down, all day long. It was frustrating and unproductive.

I went to a friend’s dinner party in the evening and again, couldn’t sit for long and couldn’t really stand, so I “mingled.” I walked around and around and talked to everyone several times. Walking helped my pain if not my social life.

Sleeping was a major problem for the first time ever. I have been sleeping OK, although I can’t lie on my right side for long (the right hip is more painful than the left). Last night I couldn't lie on my back or on either side, and I can never sleep on my stomach. So I really got about 4 hours of intermittent sleep, tossing and turning. When the alarm went off at 5:30 I was ready to go directly to the hospital and sign up for the earliest possible THR surgery.

Instead I went to the rink for practice, figuring it was a lost cause due to yesterday’s pain and my lack of sleep. However, nothing hurt from the time I got in the car. I had an almost pain-free practice despite one fall on my butt (which I’m sure I’ll feel tomorrow in my lower back) and now I’m sitting here in my chair at work with not a single problem. While yesterday the only thing I could think about was how painful everything was, today I am able to go about my activities without giving my hips a second thought.

If I were an optimist I’d say perhaps I’m cured, but unfortunately I know better. For now though I plan to enjoy this, and maybe even get some sleep tonight.