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Friday, May 30, 2014

13 Weeks Post Op

I entirely missed my 12 week post due to being out of town and crazy busy with graduation. I suppose it is around this time that life starts to return back to being able to do normal things. It's a great thing! I am very VERY thankful to be completely off of crutches. That happened around 2 weeks ago. At 11 weeks I was able to make it through the entire day without crutches, but then a couple days after that I had to travel alone in an airport and I obviously couldn't do that without one crutch. It was basically brutal getting through an airport with a roller carry on and one crutch. I wouldn't recommend traveling alone yet. But I managed. And I was out of town for a week and only used my one crutch twice the entire 12th week: once the day after I traveled to go out to dinner and after my graduation ceremony because that invoked standing for two hours and walking a lot. That was my goal: to be able to walk across the stage at graduation without any crutches and without a limp and I totally did it! I remember being in my last appointment with my surgeon and he said that walking across stage without crutches would be a good goal, and I laughed saying that I would most certainly be off crutches before then. Little did I know how close I would come to actually needing them on graduation day.

All in all, my left hip is doing well. Realistically, I know it won't be pain free. After having 5 surgeries on it (4 of which were the wrong type and actually were just de-stabilizing my hip), and having the amount of arthritis in the hip, I have to expect some pain. But, having said this, I can't really feel a difference in this hip. It's hard to explain, but I feel like I'm now walking on top of my hip. It must be the feeling of stability? I'm not sure, but it does feel tremendously different than ever and I quite like it. I can absolutely feel a difference in, what I am assuming is this stability feeling people talk about, between my PAO'd hip and my non-PAO'd hip. In addition, I can now say I feel better than before my surgery (on my PAO'd side only). It is absolutely in sane to think that anybody could feel so much better after voluntarily having their pelvis broken with 5 cuts and screwed back together with 4 screws.  It was.a horrendous surgery, and it cussed me to experience pain like I've never experienced before, but I feel as if it was very much worth it (and I realize I am very early in the healing process, but I am confident it will only get better from here on out). And now, I desperately want my left hop PAO'd. Sounds crazy but not crazy.

At this point, there is very little I can't do because of my LPAO. And I moved into my own room upstairs earlier this week!!!!! :) That side still has adductor and hip flexor weakness, but I do exercises every day for these muscle groups: 3 sets of 10 adductor squeezes and 3 sets of 10 straight leg raises. I ride the bike for 10 minutes on days I do my full set of exercises (strengthening all of the muscles around the hip and core and balance exercises). I only do 10 minutes in the bike because the entire exercise set takes 1.5 hours to do everything properly. On odd days, I will ride the bike for 30 minutes and then do my adductor and hip flexor exercises as mentioned above, and then also stretch and do some balance work, all the while, letting pain be my guide. But the pain is mostly muscular at this point. I realize that I am not on my feet much these days so my left hip won't hurt as much. The true test will be when I start working in a month. A test for both hips.

I got my MRA CD in the mail this past week. I was gonna share a couple snap shots of the study, but I'm typing this on my iPad and, since it's new, I don't know how to add from my camera roll yet. Sigh. New technology :)

I see my surgeon in just over three weeks. I hope he is happy with the progress because I know I am. And I hope, even more, that he says let's do the RPAO in July! Fingers crossed.

Sunday, May 18, 2014

New Things

Today marked day two of using no crutches.  I didn't even touch them once!  Mind you, I didn't walk very far at all, but still:  11 weeks out and I have officially ditched them (I'll be taking them away when I have to navigate airports tomorrow traveling to graduation), but those long walking distances don't count as technically being on crutches.  My goal was to be able to walk across stage without a limp:  and I'm a week ahead of schedule.  My surgeon, PT, and ATC all agreed that walking across the stage would be a reasonable goal, I can confidently say that I have already met it :)

This past week I did a straight leg raise, but today I did 10 of them!  SLR are my nemesis (along with adductor squeezes), but I can officially say that I can do a SLR or two or ten...they aren't exactly pretty, but can be done.

And now I officially can say that my recently operated hip hurts less than my other hip.  I didn't think that I would ever say that given this left hip hurt so much before the surgery.  Gosh, I want my right side PAO and scoped like yesterday.

I really needed to write this post about my more positive achievements because today was, overall, a generally bad day: right hip hurt a lot, I have started my period, my GI system is just outta whack (upset tummy, constipation, gas), and heartburn that felt like my heart was literally on fire 75% of the day.  Hopefully tomorrow will be better!

Friday, May 16, 2014

11 Weeks Post Op

Today marks my 11 week post op update.  Things are progressing very nicely with respect to physical therapy.  I am going three times a week and am working a LOT on my strengthening.  I have the hardest time with aDduction and hip flexion, but they are coming along....slowly but surely.  My nerve pain has decreased some since starting to take Neurontin 200mg BID.  I don't feel like it is quite high enough dosage, but it does alleviate the lava feeling on the inner thigh.  I assume that once I can find a PCP, that I will ask for them to increase the dosage as my surgeon seems very hesitant to start any medication for a chronic use. 

I am sleeping fine now and can lay on my op side (with pillow between my legs because my other hip hurts).  I am walking around the house, as of this past week, without any crutches and no limping.  But I do use the help of the walls and counters sometimes, so I use one crutch outside.  I feel like I'll be able to ditch the crutch all together in the near future.  For my walking goal, it was to be able to walk across stage at graduation without limping and I have already met that goal a week early.  This next week will be a test for my hip as in a couple of days I will be traveling back to school for graduation alone (meaning, I will be navigating airports alone).  I think that I'll bring one crutch to be safe because I still need if for long distances.

I got my MRI/arthrogram result on my online chart today:

There is intrasubstance degeneration and multifocal tearing
involving the anterosuperior quadrant of the acetabular labrum the 12:00
position superiorly to the 3:00 position anteriorly. There is short axis and
longitudinal tearing of the labral substance throughout the anterosuperior
quadrant. There is focal chondrolabral junction separation, there is focal
labral detachment from the 2:00 to 3:00 position. No paralabral cyst is noted.
 There is mild thinning and fraying of the articular cartilage along the
extent of the labral tear.
So I am not impressed at all, yet the results completely justify my pain.  I have significant labral tearing when I had an autograft AND an allograft done on this side in Sept. 2012!!!  That entire surgery seems to be a waste of all resources possible.  I've obliterated the labrum because the stupid dysplasia was not fixed. Obviously if my hip is clunking around and putting pressure on the labrum it's gonna retear.  I can't say that I am surprised, but finding out that my labrum is all torn up again makes me very sad and mad.  My previous surgeon was completely negligent by missing or choosing to ignore my dysplasia.  My lateral CE angle was measured as being 3 degrees less than on the side that I just got fixed, but these are the radiologist's surgeons readings are always different (usually worse angles), and I tend to trust my surgeon and not the radiologist's measurements.

Thursday, May 15, 2014

10 Weeks Post Op & Athrogram

Oops!  I totally missed my 10 week post op post.  I was in no mood to update as I had had my right arthrogram done on my 10 week post op day and it kinda made me miserable the rest of the weekend and then the entirety of my week has been consumed with running around.  So, I will update on my arthrogram and MRI and then will do an 11 week post tomorrow or so.

I was extremely nervous about the arthrogram/MRI as last time it took one hour to get the needle into the joint, and even then the majority of the contrast had extravasated out of the joint.  It was a terrible experience that I dreaded having to do again.  So after ensuring that I did not take any NSAIDs for three days prior, I had my mum come with me and we spent a lovely Friday afternoon in the hospital.  I usually don't have my mum come with me for these things, but the MRI at this particular hospital is very small and I didn't exactly like being stuffed in there last time and figured I would take a valium to relax me for this portion of the test.

After getting changed into the hospital gown and scrub pants, I was brought back to the fluoroscopy suite.  The physician assistant was really nice and after I reminded her she did my last arthrogram, she said that she hadn't forgot me and my case because being allergic to chlorhexidine and having such a difficult time to enter the joint was hard to forget.  But after cleaning off my hip, feeling for the femoral pulse, and injecting lidocaine into the skin and subcutaneous tissues (which kinda burned), she had the radiologist come in, and they ensured that the dye was in the joint.  With one small adjustment to the needle placement it flowed into the joint nicely.  She seemed quite attentive and almost nervous about doing this procedure by herself.  She had said that the radiologist and herself had discussed my case prior and that we would be observing the entire procedure.  Fair enough, because I did not want to have a repeat of her performance similar to my previous experience.  But it all went smoothly.

Next, I had to walk around for 10 minutes to distribute the dye around the hip joint.  10 minutes is a lot of walking when still on one crutch (for the opposite hip).  I had several employees stop me to ask about which hip was injected and which hip I needed the crutch for.  Kinda bold if you ask me, but whatever. One of the employees was nice enough to bring tape to tape my gown shut because I was walking with the HUGE hospital gown and was worried about showing too much.  A funny thing to think about is how I was not concerned about maintaining my modesty when I was originally post op and attempting to walk in a hospital gown.  I know that the nurses and therapists were good at ensuring I kept covered (I mean, I'm assuming this because I don't recall ever worrying about it...I simply worried about not passing out/throwing up/saying mean things).

The MRI portion was the easy part.  Since I was relaxed from the Valium, I didn't mind the MRI tube.  My surgeon likes to use the 3T MRI.  It took approximately 45 minutes to get full images of my right hip.  They had attached an intensifier (?), or some special cage thingie on my hips that centralized over my right side.  It wasn't too tight and was totally fine, even with my screws sticking out on my left side.  After the hip images were done, I had 15 minutes of right knee images taken.  I asked if it was for a study, and the tech told me that it's just what they do now.  (I appreciated the thorough explanation. Ha!  I suppose if I remember, I will ask my surgeon at my next appointment). 

Afterwards, I needed to get a CD of the images for my surgeon and I convinced them to make me one too.  But they said that they would mail me the CDs since it would take a half an hour or so to get the images processed.  And on a Friday afternoon at 4:30pm, I was fine with waiting for it to come in the mail.  My mum and I then had to go get gas, stop to see if my Neurontin had been called in to the pharmacy (getting my Neurontin called in turned into an 8 day ordeal....something that I could rant on and on about, but will spare the details), and then obviously I needed to treat myself to something yummy--and I got a McFlurry at McDonalds.  I am not an ice cream person (kinda lactose intolerant), but this was exactly what I needed!  I gobbled a Reece's peanut butter cup McFlurry down in a matter of minutes and enjoyed every second of my calorie laden treat!!!!

So now I am awaiting the results online (they post the reports to my online chart) and for the CDs to arrive in the mail.  It's not going to be earth shattering news because we already know I have dysplasia on that side and we already know that I need a PAO on that side.  I suppose it will show us if there are any abnormalities that we didn't expect, but I would be willing to put money on it that it will show post-operative changes and dysplasia.  But, I'll update when I receive the results.

6 days ago marked my 10 week post-op date.  I was still using one crutch outside and could hobble around inside the house alright.  I still had trendelenburg gait, but nothing too terrible.  No hard narcotics have been needed for several weeks now:  Tramadol PRN and Tylenol does the trick.  I had talked with my surgeon earlier in the week about my nerve pain as medially it still feels like boiling water had been poured on my skin and had severe allodynia when my pants/shorts touched my inner thigh.  After convincing my surgeon to increase the Neurontin dose, it felt like pulling teeth to get the script called in by his assistant.  Now I am taking 200mg BID. 

Saturday, May 3, 2014

9 Weeks Post Op

Yesterday marked my nine week post op from my left periacetabular osteotomy.  I can't say that I'm so thankful that I have done it yet as I am still too fresh out of surgery to be able to consider it a success.  I do know that my good ol' hip pain, deep ache, and catching is less pronounced than it was prior to surgery.  But this has been replaced with generalized achiness all over the pelvis.  My pubic symphysis has gone mad on me as it still hurts to touch lightly.  All this said, the hip is definitely more stable and I don't have the fear of it sliding/clunking around (although this only happened occasionally pre-op). 

The nerve pain continues.  I am still completely numb laterally but this doesn't hurt, its the medial/proximal thigh up into my crotch that really hurts.  I'm still taking Neurontin 200mg QHS but it might as well be a sleep aid and nothing else as it does help me fall asleep but it does not help with the nerve pain.  I intend on calling the surgeon in a week or so to increase my dosage.  You know what I really need is a primary care doctor!  That way I could eliminate the need for my orthopedic surgeon to write me scripts.  I will definitely do this, but the timing isn't great as I need to find one close to my hospital and I don't know that area very well, nor do I know who is good out there. 

As far as my function goes these days, it is slowly (SLOWLY) getting better.  I am still on one crutch almost all of the time inside the house.  Although I do manage to hobble around to cook myself my meals and when I need to carry light things I am able to do so without any crutches - it is just very trendelenburg in nature.  I can't say that it is only weakness nor only pain that requires me to use the one crutch because sometimes it doesn't hurt to place weight on my hip and it is just muscle weakness, while other times it downright hurts to put weight on my hip.  When I wake up in the morning, it hurts to put any weight on it for approximately an hour and then things settle down.  I am also showering without a shower chair (started last week!) and basically am completely independent.  I am still sleeping in the spare bedroom because my room is up 14 steep stairs and the fact that I am so sleepy due to meds in the middle of the night and still on crutches, it is just safer to remain in the spare bedroom.  It's a comfy bed and I don't mind it at all.  We still have yet to remove my own bed from the living room.  That was a Godsend post op, the bed in the living room, but I don't need it anymore and I've just been using it at night to watch TV, but only because it is there, not because I need it--the couch will do perfectly fine.

I can't wait to get back to a routine.  I have nothing to do all day and basically lounge around, watch Dexter, make earrings, answer emails, do paperwork.  Fairly boring, but this will all change once I start work July 1st.  Things will start to pick up starting next week. I received a lovely script in the mail yesterday for an arthrogram and MRI on my right hip, so I have that scheduled for Friday of this upcoming week.  Then on Monday have another doctor's appointment, followed by a physical/drug test/TB test at the hospital on Tuesday.  All of this plus PT on Monday and Wednesdays. 

Speaking of PT, I had another therapist on Thursday.  Well, actually, I just worked with the ATC.  It was helpful but I didn't feel as comfortable with her knowledge (she didn't realize the surgery I had nor had no idea that I actually kinda knew what I was talking about).  So, I will remain with the PT/ATC that I originally began with last week and go just two times.  I can totally do the home exercises and plus, I'll save some money!!

Thursday, May 1, 2014

First Physical Therapy Sesh

Yesterday was my first session with my physical therapist (and her athletic therapist).  It was, overall, painful.  I really think that they got muscles that haven't been used in like two months.  We worked mostly on the hip flexors, adductors, glutes, quads.  Although I could only do three separate exercises because I got one of those amazing (not) sympathetic responses from a) trying so hard and b) pain.  It just kinda hit me and I got all sweaty, clammy, lightheaded, etc.  It was not fun.  So we decided that three exercises would be enough.  The PT adjusted my pelvis a bit as well since my pubic symphysis is like super tender to touch and crooked. 

I showed her my xrays on my phone and she said that it's no wonder my pubic symphysis hurts bc it's all arthritic.  Well...I knew it was sore to touch and it looks all jacked up on the, yeah...obviously it's gonna be crappy.  But she is going to work on leveling the pelvis out a bit too.  I appreciate her outlook:  she isn't focused on just my hips, but also my pelvis, and core.

I haven't worked with an athletic therapist in conjunction with my physical therapist on a regular basis, but it seems as if the ATC helps with the exercises and the physical therapist helps with the manual stuff.  I'm not sure how I feel about this, as I can do the exercises at home (once they show me what to do).  We will see how this works out.  I am going three days a week for the first couple of weeks, and then we will see how much I need.  I have unlimited PT visits with 10% co-insurance for a medically necessary condition.  So that is in my favour! :)

Me having such a response yesterday to the few exercises we did, they told me to anticipate being really sore.  Last night after therapy, I was beat!  I had to have a bath to wash all the sweat off since I was so scuzzy.  And then did end up taking a Norco (first one in weeks).  It helped things and I actually slept all night without waking up hurting (yay for pain pills when you need them)  I have PT today, but was told that if I woke up hurting a lot that I could call and cancel if going to PT was not going to be worth it.  So today, I am not too terribly sore.  The hip flexors and adductors feel like they've run a marathon, and my other hip hurts a lot, but overall, it's not too bad.  So I guess I should go to PT today.  Maybe they can stretch me out and release some muscles?! That would be amazing!