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Tuesday, April 29, 2014

PT Assessment

Yesterday I had my first PT sesh.  It really wasn't a full treatment or anything since she did an assessment.  She seemed like she kinda knew what she was talking about.  I'll have a better idea after we start working together.  We are planning to do three times a week in order to maximize my recovery and get strong enough to have a fighting chance to be strong enough to get the right hip done end of July.

I have a lot of work to do:  my adductor and hip flexor strength is only 1/5 and my extension is zero degrees.  A lot of this is expected since they did essentially break my pelvis, inserted four screws, and I've been walking with crutches for two months. 

Speaking of crutches, I want off of them!  I can do one crutch alright, but very slowly, and when I'm tired it hurts too much.  If I could have one wish right now, it would be to not need crutches to walk :)

Friday, April 25, 2014

8 Weeks Post Op

Two whole months!  Dang.  I want this recovery to keep a rolling on :)

I am feeling pretty well these days.  I had my second post op appointment this week.  Things look good.  I had an xray of my left hip and there is enough bone there to begin to weight bear but my muscles are not strong enough to walk properly.  My surgeon had me take a few steps without the crutches to prove his point that I need to get my muscles back.  After my appointment I was allowed to put full weight on my hip with two crutches.  I am to do this for a week and then graduate to one crutch for as long as it takes me to walk without a limp.  I can easily do one crutch already, so I do that in the house, but when I am out, I still use two crutches at the moment.  Monday, I plan on not needing two anymore, but I am to just listen to my body and go from there.

The remainder of my appointment went well.  He started me on Neurontin for the nerve pain.  Albeit, a VERY small dosage, so I am not sure that I will see any benefits from it, but I'll keep taking it and see.  The burning proximal, medial thigh is less than cool!  Speaking of nerves, my LFCN is still dead.  Absolutely no feeling.  No change or improvement either.  Ok, back to the appointment.  He tested my muscle strength and it seems it is all good except my adductors are almost non-existent.  He asked me if I had been doing my adductor squeezes (uh, yeah, I have been, too bad it doesn't show).  We then discussed my right hip and agreed that it must be done.  I explained how I wanted to do it before August first as it would save me a lot of money in insurance, but he said that it would be cutting it pretty close and that there would be like a 50/50 chance I could do it at the end of July.  The other option is doing it in December since it would be slower in the hospital and my absence would be less of a burden on my resident team.  I really hope that it can be done in July.  Hobbling around for another half year would suck.  He said that we would decide when I see him next near the end of June.  If he decides that I am strong enough, we can do surgery near the end of July, if not, then I must wait until December. Fingers and toes crossed I get my muscles into gear and get strong enough by end of June!!!!!

I am now cleared to do PT as well.  I had to call up several places to see if they were familiar with hips and PAOs.  I called two places and one place seemed confused on what I wanted and didn't make me feel like they knew what they were talking about, so I ended up going with the second place I called.  I made a huge ordeal about needing somebody who knew what they were doing.  So I got the head PT at this place.  I start on Monday with an evaluation.  And then will schedule appointments from there.  The script says 2-3 times per week for 4-6 weeks.  I will do whatever it takes to get strong enough to have my other hip done so that these major surgeries are out of my life!! I am actually excited to begin physical therapy!  Until I get my butt in to see the PT on Monday, I have been trying to slowly start strengthening my hip, butt, and core muscles.  But having a professional opinion and guidance will be helpful as well. 

As far as mobility goes, I am doing alright.  I am able to easily use one crutch and can hobble along without anything as well.  The first day cleared to weight bear, I was able to walk fairly well with just a small limp, but since I have been trying to activate more muscles, they have become very sore, and I now have a sweet Trendeleburg gait going on.  It's kinda pulling on my SI joints and lower back when I do walk without assistance, so I best be careful. 

And, last but not least, I definitely forgot to ask my surgeon during my appointment if I needed an MRI/arthrogram for my right hip.  I only wanted to know now because I would prefer to have it done prior to beginning work.  So I emailed his nurse and asked to see if she could find out anything.  I feel bad for bugging them so much, but I really do want to know.  It would make life so much easier to get it over and done with when I am off, instead of trying to schedule it when I am working at my new job. 

Thursday, April 17, 2014

7 Weeks Post Op

Not much to report, but today marks my 7 week mark since my LPAO.  I have not needed a single Norco for the pain since last weekend (just had one bad evening of pain).  I'm really itching to walk.  That may come on Monday when I see my surgeon for xrays and hopefully get the clear to bear weight and start weaning off of crutches.  I'm not gonna lie, I've tried standing with 50% when I brush my teeth and in the shower.  I would be hard pressed to find a single PAO patient who didn't "test their hip out" slightly ahead of schedule! 

I take Tylenol and the occasional Tramadol for pain relief.  But this is mostly due to my pain in my right (non-op) hip.  SO sick of hip pain. Speaking of pain, I have noticed that my pubic symphysis is extremely painful to palpate.  I accidentally leaned on the island in the kitchen today and nearly jumped out of my skin because it hurt so much.  Maybe I just irritated it's just odd that it would come out of nowhere.  It kinda caught me off guard.

I got my surgeon's bill today. It was a lovely $18K.  The breakdown of procedures was as follows:
  • Periacetabular osteotomy
  • Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman type procedure)
  • Arthroscopy of hip, surgical with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty and resection of labrum
  • Bone graft; major/large
I hate hate hate insurance because of past experiences, I am so careful with these types of things because of traumatizing experiences after previous surgeries.  It makes me nervous just looking at the bill.  But it all looks like it has been billed properly and I have to pay just over $1000 for the surgery itself.  I am still waiting on the anesthesia and hospital fees.  I know that I will hit my $5000 OOP and $200 deductible.  I just would love for it to go smoothly without any hassle or hiccups.  For insurance purposes, I hope to get my right hip PAO'd before August 1st as it would be covered under my current insurance and essentially be no additional charge.  I could definitely handle the copays and that is it.

Sleeping is still sucky.  I got some melatonin and tried that last night and it seemed to work.  It's hard to be fully confident in this supplement as it is usually used for circadian rhythm disturbances.  But, it worked, and I fell asleep last night very quickly.  I was extremely tired though since I had been out and about yesterday.  I convinced my Mum to go to Applebee's for their $6 burger Wednesday.  YUMMY.  And then we went to The Dollar Store and then to Walmart.  I crutched all over each of these stores.  It wasn't exactly fun, but it also wasn't terrible.  What irked me was that I have a handicap parking pass for an entire year and at each of these stores there was not one single open handicap parking space available.  Which, whatever, it's busy because of Easter weekend approaching, but when they don't have a handicap parking pass displayed makes me think that they just parked there because it was close and don't actually have difficulty getting into the store.  So, I STILL haven't used my handicap parking pass to date since I a) always forget it or b) all the spots are occupied.  First world problems...I know.

Saturday, April 12, 2014

6 Weeks Post Op

I feel like these weekly updates are coming rather quickly.  I feel like I just wrote my 5 week update and now it's already 6 weeks!  Dude. Whoa.  So things have basically stalled as far as healing goes.  The next step is beginning to weight bear and learning how to walk again.  But none of this can happen until I see my surgeon in a week and two days.  So, I just go around on crutches feeling as if I should be able to put weight on my operated side.  It is VERY hard to not test it out with just a few steps.  One of my friends in my surgeon's PA and I distinctly remember her telling me about the stupid girls who walk on their hip before cleared by my surgeon and how stupid that is....I remember agreeing with her, but now that I am feeling as if I can walk, I could see how people test their hip out prematurely.  The only thing that I have been doing all week that is pushing the limits is standing equally on two feet while doing things like brushing my hair and brushing my teeth.  Shhhh....but it doesn't hurt to put weight on it :) 

I am not taking any Norco anymore.  But do take the max dose of Tylenol during the day and the random Tramadol interspersed.  This is mostly for my right hip and not my operated hip.  I'm really happy with this not needing heavy narcotics anymore.  I need my right hip fixed so badly because it hurts so much.  I knew this would happen as it was sore just from compensating a little more with the left being the most painful hip.  But now that the right is the sole weight bearing side, it is extremely angry.  The timing of my next PAO will be discussed during my next appointment and hopefully we can schedule surgery for the end of the summer (end of July) as my residency needs to know when I am going to need surgery so we can plan accordingly. I do feel bad about needing to have special considerations in the scheduling.  I feel like it's the story of my life: the one that needs to have things rearranged all of the time because of my surgeries.  It makes me really happy that after this next PAO and then the subsequent screw removal, that I could potentially be done with needing special scheduling considerations and done with major surgeries for a few years.  My hips and surgery and doctor's appointments have been thought and time consuming for so many years, that I'll have to take up a hobby or something to fill all of this time and energy that I have put into my health for the last 8 years.

Sleep continues to be an issue.  I can sleep on my tummy all night now and can lie on my non-op side for a couple of minutes with a pillow between my legs.  Both of these things happened this week.  So that rocks!  Even with these new found positions, I am sleeping terribly.  I think that mostly it is because of my lack of schedule and activity.  I'm not expelling a lot of energy so, naturally, I'm up until one or two in the morning and don't sleep in much either.  Thank goodness for Benadryl and muscle relaxants!  I expect that the sleeping will become better once I being to walk without my crutches and increase my home exercises in a few weeks.  Oh how I look forward to ditching the crutches!!!!!!!! :)

Saturday, April 5, 2014

5 Weeks Post Op

I should have been better about updating as my days came and what milestones I reached on what particular days so as to have a decent account of my recovery so I can compare it to the opposite side.  Sucks I didn't think to do that after this PAO.  I will promise to be better after the next one!

Yesterday was my 5 week post op date.  I am totally self sufficient now.  I can drive easily given that it is my left leg that was operated on. I can shower standing up and sitting down (the shaving of legs still needs to occur sitting and I just feel more comfortable with the chair in there still).  I can, shhhh, stand on two feet without any real pain and yes it feels weird.  One day I just looked down and holy crap, I was standing on two feet equally.  I know I am not supposed to do this until I see my surgeon again in two weeks, but it just happened.  Now I brush my teeth on two feet...I can't see how it can hurt too much because it is not as if I am walking around on it (although I feel like I can walk on my hip!)--which I would NEVER do at this point.

As far as pain levels goes, it is up and down.  For instance, yesterday, I had to take Tylenol and tramadol on board all day but then today I just took a half a tramadol and Tylenol the rest of the day.  I still take my muscle relaxant at night, but I was taking that pre-op too and am content to keep that on board until I get my other side screwed.  Quite honestly, I am taking these pain meds mostly for my non-operated hip.  My left hip is feeling really good, its the muscles and nerves that hurt on that side, but my right hip aches that deep sickening ache all of the time.  Suffice it to say, the right hip is less than happy to be supporting me fully these days. 

I am not sleeping well at all.  If I sleep in a bed, then I wake up every time I move.  Just this past week I have been able to roll over onto my stomach.  This is a welcomed position change from my back, but I can't stay like that too long.  I am still unable to roll and stay on my non-op side as my adductors spasm if I do that.  Those adductors have really taken a hit with the new bone positioning--right from day one they were sore.  Most night, sleeping in the bed keeps me awake bc I move, so I usually sleep in the recliner, which prevents me from moving too much so I can sleep longer than the usual four hours.  But I can't stay there every night as my back hurts there too much.  Complicated.  So, I rotate between bed and recliner. 

I am doing all of my exercises, including riding the bike. This week I have seen a great improvement in my atrophy as it is visibly less!  I am biking between 25-35 minutes total every day.  I hope that it helps me so I can get off crutches quicker.  My ROM is okay: flexion is about 100 degrees until I get the groin pinch, and I can do the figure four without too much discomfort, external rotation is good--I can get it to be equal to my right side now without any stretch, it is the sharp joint pain that is limiting me from full external rotation.  I am happy with my ROM, but I do believe that I should be able to do more.  I am unsure if it's my arthritis that is limiting my motion or if it is just the inflammation from the surgery, either way, I hope that I am doing as well as can be expected.  I will know more when I see my surgeon for my follow up in two weeks.

My incision is looking nice, all healed up, but the subcutaneous sutures are still extremely palpable with all 10 knots still able to be easily felt.  Two of them feel like they have some inflammation inside. I will keep an eye on it because I feel like they all should be dissolving a bit faster than they are.  My screws, all four of them, can be felt easily on days that the incision is not too swollen.  Lately, I haven't been able to feel them too easily, but I do feel them pinch when I flex up.  As my surgeon told me, I will be "begging to get my screws out!"  Maybe I need to fluff up a bit?  I sure am trying by drinking two high calorie Boost drinks daily...not necessarily to beef up, but to maintain my current weight, which is VERY difficult for me right now. Healing from major surgery uses us so many calories!!!

All in all, I am doing pretty darn well. 

Tuesday, April 1, 2014

4.5 Weeks Post Op

Time flies yet drags on.  It's just so weird.  These last four days or so have been icky.  My pain level has increased again and I am needing Tylenol and Tramadol during the day and half a Norco at night (along with the odd muscle relaxant here and there).  I wish that I could will myself to feel better.  It's just so hard to keep up the energy after having this surgery.  I definitely do my best to remain positive and hopeful.  After two and a half weeks I was on fire, totally killing this recovery and now it's a bit harder.  My pain is hard to pin point, but I do know that the joint pain has decreased significantly.  I have a lot of adductor muscle pain and spasms still, plus the nerve pain.  I would really appreciate if the numbness, hotness, and hypersensitivity would start to improve!  I'm over freaked out nerves.

I seriously can't believe I am considering it, but I have contacted my surgeon and my residency coordinator about how we can arrange for me to have my right hip PAO'd within the next several months.  The right side is especially painful know with the added pressure of being on crutches, but it did hurt prior to my LPAO and it was subluxed on radiographs. So, it's basically inevitable at this point.  My surgeon said 6-12 months before I can do the other side.  So I'm trying to figure out when it will be best to get this surgery done as I only have three weeks of vacation during my intern year of residency.  That is gonna suck....returning at 3 weeks!  :-O