9 days post op

For some reason I've been highly unmotivated to post anything here since my latest surgery. No idea why, all news has been good news! I had my right hip operated on last Tuesday, April 5, so I'm officially a week and 2 days out from surgery today. This time around, my labrum didn't need to be reconstructed - and it required only a repair with 2 (or 3?) anchors, some bone shaving, cartilidge clean-up, and some microfracture, but not in a weight bearning area. This operation has been SO much easier than my left hip in January. I've been off pain killers (except for one before sleeping) pretty much since last Thursday or Friday. I felt like my hip joint muscles were wrecked for only the first day, and was able to actually do a real stride, rather than shuffle my foot along the floor, pretty much by day 2. So, now its just waiting, and being patient. I think I got a bit overly ambitious, thinking that by the time I left Vail I'd be pain free. But, even though I started in a relatively good position, the recovery is still slow as molassas. Gotta give it time. In other good news - the left hip is holding up really well - it hurts here and there, but I'm really pleased and glad for that. It misses its own p.t. though, and it misses riding the bike outside. Soon :) The restrictions and instructions are very similar to last time - 4 hours a day in the CPM machine (3 weeks), as much as possible in the game ready ice machine (2 weeks) and no external rotation or extension for 4 weeks, which means wearing the hip brace and strapping my feet together in foam boots at night (least favorite restriction). I'm on crutches for 4 weeks with 20 pound max weight bearing, and the fifth week its 50%, then i get to wean off of them (hoping that process is easier and faster this time). Right now, i'm in PT twice a day which lasts about 2 hours each time and involves riding the bike with no resistance for 20 minutes, some passive motion, soft tissue work (some not so soft), and some very mild strengthening stuff, followed by game ready icing. I've gone to the pool twice as well - which means 3 pt sessions those days. The rest of the time is spent getting time in on the CPM, reading, eating, sleeping and movies. Very repetitive. It gets old. Once again my parents have been total rockstars. They've both been with me the entire time, cooking, chauffeuring, helping sherpa things here and there. But, they were shocked also by how much less help i needed this time. I think that is a relief, and means they are getting more time to read and relax too. They also have taken advantage of the opportunity of being in the offices of world reknown orthopedic surgeons to have their own aches and pains checked out and my dad may be returning in the not too distant future for his own knee repair. Good stuff. Other than that - I miss home. I'm anxious to be back, to be engaged in life a bit more, and have a little more variety in my day to day! I'm seeing the light at the end of the tunnel big time. In fact, i think its becoming super bright. I just need to make sure i take my time in getting there so I don't trip and fall and make this any longer than it needs to be. Patience. I think the reason I haven't been motivated to post is that its all pretty boring! But boring is good :) Thank you for your well wishes, calls, emails, texts, etc. Adds some light to my day. I am sure that all the good mojo sent my way has a large part in how well this has turned out. Thanks :) xxoo

Turning a Corner

Last weekend i had to take big jump backwards to move forward again. But, its working! Going back onto two crutches helped my hip settle down. The pain subsided and the loose feeling mellowed out. I'm back to alternating between one and two crutches - but I feel i'm close to losing the sticks completely. Yesterday in the pool i did some waist deep walking and felt incredibly different than I had just last week. I could take a full forceful stride without a lot of pain (just a small pain in the hip flexor, which is still weak). I could stand and balance on the one leg. TFL is getting stronger. I know, little things, but huge progress.

I also got back onto my regular road bike (on the trainer) rather than riding the stationary bike. Clipless pedals, bike shorts, my goodness, it feels strange. But so good to sweat. I only rode for under an hour, and if I had a power meter on i'm sure it would be laughable, but I'll take it. I'm hoping the sun will start shining around here and in the next week or so i'll be able to get out on the road and ride a few times before the next surgery.

Speaking of which, the next surgery is just over 3 weeks from now. I'll be driving from Denver to Vail in exactly three weeks. Boy am I ready. As I'm starting to do more, my right hip has started to have the familiar pains in the front, back, side, allover basically. So, any doubts or feelings of "i can just live with it" have left. Its going to be a long wait, but this wait will be sweet, because it will be the last wait. Enough with this year and all of my pieces falling apart.

I have a lot to rebuild in terms of strength. I did a plank yesterday, and I lasted about 10 seconds. I used to do those for minutes, repeats. I'm sore today too. But hey, I'm excited to just be able to do it and not have my hip or my clavicle limiting me. My biggest challenge will be to have patience, and not do too much too soon. Last thing i want is another injury.

3 weeks to surgery, 3 weeks in Vail, probably another 2-3 weeks until i'm where I am right now on the other hip. I'm expecting and hoping that the next surgery won't need a reconstruction and that it will be less difficult. If my timeline is right, that means in less than 10 weeks I'll be on my bike. That seems almost ok!!

2 Steps Backwards

Bad news. Back on 2 crutches and hip is feeling loose. Crappy combo. Its been a rough few days. Walking on one crutch was a stretch - but it was so much more convenient and felt like "progress" so i kept going. Only, it was getting more and more painful, which is not the goal. So, back onto 2 crutches based on the reality check from my PT. If I'm walking like a pirate with a peg leg, either get an eye patch or bring back the second crutch.

This week was also the first week of adding external rotation and extension. I hadn't been allowed to do that for the first 5 weeks in order to let the joint capsule heal up all nice and tight. This was because of the looseness I had been feeling after surgery. So, I'd worn the damn hip brace for 5 weeks. I hadn't taken a full stride for 5 weeks. And had slept in the damn foot boots with my feet strapped together for 5 weeks. All sucky annoying things that I did, thinking it would pay off in the end. Things seemed to be going well. Tightening up. Less and less incidences of looseness. Well, its been 3 days of freeing myself from those restrictions and the looseness is back. Wonderful. Very discouraging.

I have an email in to my dr. people to see what their advice is.

Meantime, icing and advilling and blogging :)

happy saturday folks.
v

Walking is hard

Yesterday was the start of "50% weight bearing". This means that if I'm standing still, i can put even weight on both feet. If I'm walking I need to still use the crutches so that when I step on the operated leg, I only get 50% of my weight. Well, standing is hard, walking is next to impossible. Everything in my hip screams when I try to walk with any sort of normal stride. Its sort of spooky. Get lots of crunching and popping to. None of this really worries me - I guess that says a lot about where I'm at with this mentally. I hope by the end of this week (i.e. 4th week post op), I can at least walk semi comfortably at 50% weighbearing. And, I hope the other hip is easier and faster to recover, because this is pretty slow. Mostly, I hope this hip just ends up healing up all nice and smooth and pain-free - even if it takes its sweet time.

3 Weeks post-op (tomorrow)

We left the cozy security of Vail and Howard Head and have returned to San Francisco - and I'll be going back to work tomorrow. Tomorrow, I also get to start weight bearing 50% weight on my left leg - still with crutches. A week later, I get to say goodbye to them entirely - assuming I can learn to walk with no extension past neutral, otherwise it'll be another week after that. CPM leaves me tomorrow or Wednesday. Already said goodbye to the gameready - which was sad. Unfortunately, some of my other restrictions ahve been lengthened - I'm still required to limit external rotation and extension - and that's been extended from 3 weeks to 5 weeks - to be sure that my joint capsule/hip heals all nice and tight. So, still have the damn bolster and boots at night, and the hip brace for another 2 weeks. It'll go by fast, no worries. Also stil have the calf pumps for another week. So, that should be manageable I suppose. I can bend over and put that stuff on and off myself at night - so its more just annoying than impossible.

Its been a rough transition - leaving a place where I spent most of my days either in PT or on the couch, and had two loving people around me to help me with everything (i can count on one hand the number of meals i prepared during the 2+ weeks we were in Vail). I now have PT 3 times a week - and I only have 30 minutes with my pt at those sessions. I'm thinking about upping it to 5 times a week (prescription says 3-5), but i'll see how this goes. I'm supposed to do constant passive motion for 20 minutes 1 to 2 times a day for the next 8 weeks. So, this gets done 3 times a week in therapy - the rest of the time, i suppose i'll go to the pool to do it, or beg my brother or some other poor soul to do it. Friends beware, I may show up at your houses asking you to move my leg around in circles... it'll be fun!

Janet - pool therapy was awesome. Basically, a bit of aqua jogging with the aqua jogger belt (totally new for me) and some kicking on my back. some mini squats and some side standing leg lifts, and then some walking, forward, backward, side to side. Today I actually swam a little - with a pool bouy between my legs. My upper body is finally going to get some muscle back (after 8 months of a weak/broken collarbone) - crutches and pool should do the trick.

I'm also supposed to ride a bike with no resistance for 30 minutes a day 2 times a day. My road bike on a trainer isn't working unfortunately (not comfy at all and very hard to get onto with my restrictions), so I'm scrambling to find a spin bike somewhere that I can have at home, rather than having to drive to the gym 2 times a day every day.

In between this will be work and catching up on everything that i've missed.

As for how the hip feels. So far so good. Much harder recovery than last time - I think last time I felt great a few days post op, and would have been happy walking less than a week later. This time, I'm only now starting to think that going to 50% weighbearing sounds like a good idea. Hip is still quite tender some days, other days/times it feels pretty good. I think my adductor is working overtime and sometimes just screams at me - as does the graft site. My IT band and everything that connects with it will need a lot of love in the coming weeks. All in all though, I think I have a more realistic idea of the trajectory of recovery. I don't get all cocky and over confident on good days, and I'm more able to take in stride the bad days. I do also feel like my hip is slowly tightening up (which definitely helps me take things more in stride). I don't care if my hip still still hurts - so long as its not falling out of the socket, i'm happy. I'm hoping that the next week of increasing the work the hip has to do won't cause any major flare ups - but I won't be suprised if I'm in for a bit of pain here and there. I'm very excited to get to walk crutch free again soon - its just a pain in the arse.

Next surgery has been pushed back a couple of weeks - and is now scheduled for April 5. I originally was scheduled for exactly 7 weeks after the first surgery, and now it will be 10 weeks. I think that will make it a bit easier on my recovering hip to deal. Counting down the days!

Thank you thank you thank you for everyone who has been there for me through this time - and the past 8-9 months. It means so much. what's important in life has certainly become more clear to me in this process.

I can see the light at the end of the tunnel. I CANNOT wait to be riding my bike one day and think - my hips don't hurt! doesn't seem too far off now.

Groundhog Day

Tonight marks the one week anniversary of my hip surgery. In some ways, the past seven days have flown by. In other ways they have crept so slowly by. Every day I feel a little better. My least favorite thing about the recovery time are the restrictions while I sleep - I despise having to sleep flat on my back with my feet strapped in to the foot bolsters - unable to move. I'm counting down the days til that is no longer required.

Every day is somewhat the same. It starts like this: I wake up in bed, flat on my back, feet strapped to a bolster, calf pumps strapped around my calves, game ready machine strapped around my thigh and hip. Stiff, sore, a little sweaty. (nice, yes). I call out, as nicely as i can "help" - and my mom, who usually hears me on the first or second shout, comes in to undo all of the contraptions. I grab the crutches, hobble to the kitchen, and have coffee and enough food to give a little cushion for the pain killers and all the other medications I'm taking to help my hip. I shower - which is tricky and interesting balancing on one foot - and get dressed in some baggy shorts, slip on vans, a tee shirt, and fleece. Then we head out the door and down the elevator into the car, and drive into vail where I crutch into the Howard Head PT and plop myself onto a bike.

I have PT at Howard Head 2 times a day - usually lasting 90 minutes to two hours each session, along with a 20 minute driver there and back. The PT is great. It consists of about 20 minutes no resistance on an exercise bike. Then, I work with a PT for the next 40 minutes to one hour - doing passive circumduction, some soft tissue massage, and some very mellow exercises to get the muscles firing again. So far, both of the PTs I've worked with specialize in hips and are intimately familiar with what was done inside mine. It is reassuring. I wish I could pack one up and take her home with me.

My parents, who are my everything during this time (cook, chauffeur, nurse, psychologist), wait in the lobby for me - chatting with the other 'regulars', writing emails, doing stitchery and reading. After my PT is over, we head back to the condo, eat and I spend whatever time I have in some combination of the cpm machine, game ready, and calf pumps. Then its back to PT to do it all over again.

Evenings usually involve some reading, a movie and food. Luckily I've had a few visitors to mix it up - which as been lovely. Then its off to bed - where I strap into the game ready machine, the calf pumps, and the bolster, take a few pain pills, and drift off to sleep.

I'm still on pain pills - every 4 hours. This surprises me, since last surgery I was off pain killers about one day post op. I'm also still very limited in movements due to pain and restrictions. Also, a new thing compared to last surgery. Each day seems to get a little easier, and the swelling goes down just a little bit. My hips were about 2x as wide as normal for the first 4 days or so - but they are slowly decreasing in size. Along with the decrease in size, there is a decrease in swelling.

In PT I see lots of other hip patients - at all stages of recovery. It does seem like those who had labral reconstruction have a harder the time first few days than the others. I'm told by the PTs that, in time, this all equalizes and recovery time ends up being about the same.

The first few days after surgery, my biggest concern was that my hip still felt loose. I've talked to the surgeon about this, as well as the fellow, the Surgeon's assistant, both of my PTs and a few other patients (yes, I like to talk when I'm worried). One thing I heard from another patient was the most reassuring thing anyone has said. Apparently Dr. Philippon lets people view the surgery - both the fellows and the PTs on occassion. At the end of a labrum reconstruction, he forcibly attempts to distract the femur from the hip socket at various angles in order to make sure the new labrum has created the suction seal he wanted. The femur does not come out. I believe everyone's confidence that my hip is not loose is based on this fact. I think the looseness I'm feeling is a looseness in the joint capsule, and I am hopefull that this will tighten with time and with the reactivation/strengthening of the muscles. In any event, knowing that my femur is secure in the socket is reassuring - I don't have the feeling of the bone clunking around in the socket as I did before. I am so glad I chose to do this surgery with Dr. Philippon. I feel that I'm in very good hands.

Today I could go to the Pool to start aquatic therapy - which they have every tuesday and thursday. Today's conflicts with my PT, so I'm going to go to PT instead. Maybe thursday I'll go to the pool. I have some fear of the pool - only because that was the first place where my hip subluxed after my first surgery - 10 days post op. So, that's a little hurdle I need to make it over.

We originally were planning to go home this Friday - me back to SF and my parents back to LA. But, we've decided to stay another 6 days - mostly because I can't go back to work at this point anyways, and I also wouldn't be able to do most of this on my own. It is so important to me that I comply with all of their instructions as much as possible to do the most I can do to make a full recovery.

Most of the restrictions are lifted at week three - including the despised bolster. At that point, I can sleep however I want! that will be lovely.

Til next time...
Virginia

coolest crutch accessory

Crutch crampons!



Who knew?! Now I just need some chains for my vans.

Time flies

Its Friday, I had surgery on Tuesday, which means this is post op day 3. Seems like it has been forever and at the same time its flown by. This surgery has been much harder than the original hip surgery was. I remember that time, i was off pain killers by day 2 and feeling very mobile and good by day 3. Right now, there is no way i can imagine not being on pain killers - and have been taking them conisistently about every 4 hours. I am guessing this is because they did more work in the joint. I've also been told that revisions are usually harder recoveries than first surgeries.

Dr. Philippon used a graft from my IT band to reconstruct my labrum. It required 7 anchors - which is apparently a large reconstruction - it looked like it was about half of the circumference of my hip socket. Apparently, my joint capsule had scarred to my labrum which is part of what he thinks was causing me pain. He also did bit of cleaning up rough cartilidge and trimmed additional bone off the femur. He also tightened the illiofemoral ligament and did a plication on the joint capsule to try to get rid of the loose feeling I have. He said the cartilidge looked really good and he was pleased - and I didn't need microfracture - so that is good!

I expected to feel an immediate lack of looseness in my hip when I awoke from surgery - but the unfortunate truth is that my joint still feels very loose. It is a terrifying thought that this surgery may not solve that problem, but I'm trying not to worry and to give it time. I know that there is a lot of fluid in my hip and a lot of inflammation, and he did do things to tighten the joint - so hopefully once everything settles down a bit, it will be snug. I hope.

Here's how it went - Tuesday, we showed up at 12:30 pm at the hospital and got checked in for surgery. I got changed into the hospital gear, got the IV going, had blood taken to create PRP than would be re-injected, and got the epidural going to keep me feeling nothing from the hip down (creepy!). I don't even remember being put under by the anesthesiologist, but I woke up around 8:30 pm in recovery - feeling pretty good. No nausea and not much pain because of the epidural. I was already in the cpm maching (constant passive motion machine ) and a version of the game ready ice shorts around my operated hip. My parents came in and said hi and hung out til about 10:00. I had some gingerale and saltines, and texted with people - probably a little incoherently. That night i dozed in and out of sleep - with nurses coming in here and there to adjust this or that. At around 2 am, they took out the epidural and started me on regular oral pain killers - it was a pretty mellow transition. Then, to the bathroom by wheelchair to brush my teeth and rinse my face, and then down to physical therapy where they put me right onto a bike to pedal for 20 minutes. All of the previous day's surgery patients go to PT together early the following morning - so we all got a little class on how to use our own cpm machines, how to operate the game ready, and how to use all of the other random equipment I have to be using for several weeks. Then there was a bit of passive motion with my PT and back to the condo.

At the condo, I showered, got back into the equipment I have to be in (i.e. game ready, CPM, calf pumps) and then headed back to PT for a couple more hours. Craziness. Meanwhile, I should mention that once the epidural faded away completely, my hip began to hurt quite a bit. Worst thing is moving having to use my leg to step forward - it feels horrible. Its getting to be less and less bad though, so that is encouraging.

To give some idea of how labor intensive the equipment is - here is a list of all the equipment I have been instructed to use:

Crutches - with flat foot 20 lb weight bearing for the first 3 weeks and one additional week 50 lb weight bearing. Not a big deal really.

CPM machine for 4-6 hours per day, every day, for the first 3 weeks.

Game ready ice machine - as much as possible for the first 3 weeks. In the photo below, his compression ice pack is for a knee - mine is like a hockey short and fits around the hip. I think I mentioned at my last surgery - the gameready is awesome. Helps deal with pain and swelling - which there is a lot of. I do ususally find myself shivering with teeth chattering by the end, unless I'm in a down jacket, hat, and wool socks and covered with lots of blankets.



Calf pumps - for the first 3 weeks i'm supposed to use these any time i'm sitting around or lying down.

Bolster and foot holders - basically straps feet to this cylinder which prevents external rotation of the operated hip while sleeping. Means that I have to sleep flat on my back. I'm supposed to use this for the first 3 weeks. I couldn't find a picture of this one, but here is a photo of me wearing part of the bolster the morning after surgery. oh joy!

Hip brace - a large black contraption that straps around my waist and left thigh - which is supposed to prevent me from moving my hip in ways it shouldn't go. This I believe is every day all day (except when lying or sitting down) particularly when walking.

The hardest thing about this equipment is that all but the crutches and the brace, i need someone's help getting set up. Its very time consuming, and once you are set up, its an ordeal to get out of the contraptions to go to the bathroom, get something you forgot in the other room, reach the phone, or whatever. Thankfully I have both parents here doing all of this for me - including driving me back and forth to p.t. and various dr appts every day. And, bringing me food and drink while i'm strapped into my various equipment. It is really a 2 person job at this point. Only today did I start being able to do some basic things myself - like getting my operated leg up onto the bed, or off of the bed. Quite a feat.

On top of all that, there are medications to remember - all with their different schedules, the PT i'm supposed to be doing multiple times a day at home, and the 2 hours I'm supposed to be lying on my stomach. gaaah, it is overwhelming! My mom has put together a spreadsheet to keep track of all of that needs to get done. Thankfully I have my parents here to help me - or this whole system would have fallen apart.

Christie, my cousin who lives in Colorado Springs came up for a visit last night - so my entourage got even bigger for a minute! It was so nice to have some distraction and to chat with her in between all of the other stuff. Thanks Christie :)

P.s. my clavicle is holding up nicely, and has really been almost a non-issue. So, that has been a big relief.

Heading back to the clinic for more PT in about an hour and then back to my spot on the couch.


Thanks to everyone who sent me encouraging and thoughtful emails and texts and phone calls over the past few days. It means so much to me!! Made he whole thing a lot less scary too.

I'll update soon.

Bring It

A little late to start the countdown, but tomorrow is the day! I'm in Vail (well, Avon) and am all set for surgery tomorrow at 12:30. I'm having it done by Dr. Philippon. His best guess is that I will need labral reconstruction (using a graft from my IT band) as well as plication of my joint capsule. He gave me a 90% chance of success - given my age, etc. He thought the biggest concern would be cartilidge damage - which could mean continuing pain - but he was happy with what the MRI showed - good joint space and cartlidge looked better than he had expected, so fingers are crossed on that.

Pre-op day was pretty packed without a lot of waiting around, which was nice. 7:45 am I checked in for MRIs for both hips - since I was still deciding which hip to do. Shortly after, I was brought into the PT for a stress test. Lots of jumping around on one leg with strong elastic attached to my waist. I underestimated this test. I was sweating and breathing hard -especially at 8000 feet. One of the highlights of my day was chatting with a guy next to me on the exercise bike during my little warmup in PT. He was there for a 3 month follow up after having his labrum reconstructed using his IT band. First success story I've seen in the flesh and it could not have come at a better time. He was so happy with the results. It was a revision operation for him too - having had surgery back in 2006 to correct impingement. He said it was like night and day. Only good things to say. Seriously, just what I needed to hear. The Physical Therapist I met with also had positive things to say about the reconstruction, the recovery time, and based on what I told him he thought it seems like the left hip should be done first too. Stars aligning.

After PT. I had some lab tests and then I went out with my parents for a quick lunch in Vail fillage. Then it was back to see Dr. Philippon and his fellow. Lots of great info on what they saw in the MRI and confirmation that it seemed like the left hip should be done first. Then it was off to surgery check in and meeting with nurses. Now 'home' on the couch where I'll be spending quite a bit of the next 10 days.

Last night I was scared and undecided. Tonight I'm scared, but I'm decided and feeling good about the decision. I have high hopes for tomorrow.