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

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.

4.5 Months Post Op

I almost can't believe its been 4 and a half months since I had surgery on my left hip. I thought I'd be all good by now, alas, I still have 2 surgeries to go. But, putting that aside...

This weekend was almost like a normal weekend for me - woke up both mornings and went and rode my bike for 3+ hours. Yes, I was slow, but it left me with that good exhaustion. It was awesome. Then we ate, went to the farmers market, ate some more, saw a movie (scott pilgrim takes on the world is great), lounged on the couch, played with the kitties, cleaned bikes, caught up with friends, etc. pretty basic weekend, and it was lovely :)

If it wasn't for the looseness in my left hip, I would feel very happy with the results of the surgery. That is good to keep in mind going into the next couple of surgeries. I think if it weren't for my collarbone, i could have started riding outside at about 6 weeks post op. As it turned out, I was off the bike for a bout 4 months - but that was due more to the collarbone than the hip. I think riding has been helpful for the hip - and it feels better than it did 2 weeks ago. It feels stronger, fewer tweaks, etc. Before I was able to ride, I was doing a lot of hiking - which was harder on my hips for sure. Last night i had a burning feeling in my joint/hip area - but I would guess that is just muscles/tendons - and just due to the nearly 100 miles i put in on the road this weekend. It is heavenly to ride without pain in the left hip. I hate that my right hip hurts and aches and grinds, but at least it is a remider of where Iused to be on my left hip - so I have something to compare.

I'm ready to start moving forward - to start building endurance, strength and speed, and to start losing the extra 10 lbs I've put on through all this. But, not quite yet. For now, I need to just be happy that i get to ride my bike. Enjoy the sunshine where I can find it, and just maintain a level of sanity until the next surgery arrives... and then the next one. MUCH better than doing that waiting from the couch!! :)

Kitties, etc.

We got some kitties! Their names are grimace and igor, they are sisters, from the spca. They are awesome. Little purring and snuggling machines, but also quite frisky. They are good at knowing when to use the claws and when not too - which I appreciate. We have had them a week as of today. Levi has not quite adjusted...
We're working on it... Any suggestions are welcome.

More big news... I have finally returned to the gym and to the bike. YAY YAY YAY! I'm not doing anything near what I used to do in the gym, but i'm at least getting some strength in. It is shocking how weak I am. Like doing a single leg bridge is REALLY hard. I'm doing mostly core work, a bit of lower body, and as much with the left arm as I can do. PT stuff for the hips and the right arm as well. I had some major sharp pains in my hips as a result of the gym work (usually a few hours or the morning after), but it goes away.

My first ride was on Saturday and I've ridden twice since then. I have to say I was very pleasantly surprised at how well both my hip and my clavicle held up. It is funny though - my strongest limb is my left arm. I feel a bit gimpy. The most pain during the rides comes from my right hip - the one I haven't had any surgery on yet. Its the loudest for sure. I'm trying to not put weight on the handle bars much - so going up hills and descending is tricky (and slow), but generally fine! I'm getting the rhythm back. My left hip has felt generally excellent on the rides in terms of pain level. Some strange little squeaks here and there, and some mild achiness at times, but generally quiet and strong feeling. I definitely feel the left glute engaged and like the right glute is impossible to access - its like the pain and mis-aligned structure just prevents me from using it. The only remaining real complaint I have on my left hip is the looseness (I think the pains and squeaks are normal for 4 months into recovery - so don't concern me really). If it werent for the looseness I'd be feeling very happy about the surgery. so....

about that looseness. I finally spoke to Dr. Safran about Dr. Philippon's idea that labral reconstruction is needed to fix the looseness issue - as opposed to just closing/tightening the joint capsule. I asked a ton of questions, we had a good discussion. And, he called me back multiple times with additional thoughts. It was reassuring to have his attention and brain power on this. His suggestion, which I think is a good one, is that I get one or two more opinions, since he and Dr. P. are telling me such different things. Dr. Safran is quite confident that the joint capsule is the issue and he can fix it. He doesn't suggest reconstruction. For many reasons, which I won't go into. My primary take-away from what I've learned is that reconstruction is new, its results not proven, and that the cause of my issue is not really pin-down-able. I hope I can get at least some sort of consensus from the group of docs. The two people he recommended I contact for second opinions are Dr. Byrd and Dr. Sampson. So, I'm going to get on that.

Another piece of good news. I went in and had another xray done on the clavicle today and it shows that there has been some bone growth!!!!!!!!!!!!!!!! YAY!!! YAY!!!!! its only on the lower part of the bone (the top part is still a nice gap), but it is something - and it means I'm healing, which is so fantastic. He thinks in a month I should be able to use crutches - so, if I decide to have surgery with him, we'll do that in mid-september. Second hip could be done in Nov (assuming all goes well) and I could have this largely behind me by 2011, which is a very appealing idea. But, I still have research to do, so i'm not going to get ahead of myself.

In the meantime, I'm gonna ride my bike :)

Ciao,
v

Bend! (and hip and collarbone...)

Jon and I decided to get away for the 4th of July and make a road trip up to Bend, Oregon. I've been wanting to go for a long time, and had it in my head as a place I'd maybe like to live. I fully expected it not to meet my expectations (sort of like 10 years ago I dreamed of living in Boulder and then I went there and it was less than I imagined). I was so wrong! Bend was all that I had thought. Beautiful and amazing scenery. From town you can see the snow covered peaks of the cascades in the distance, all of the surrounding area is covered by huge pine trees, and the deschutes river runs right through town. In town the river is peaceful and manicured, but just out of town it becomes wild again - roaring between huge walls and over big boulders. The path leading around the river is also manicured around town but it continues with a small dirt train winding over wooden foot bridges and around the river's edge for miles and miles out of town. If I could run, this would be the spot for me. Houses in town are my favorite kind - old 1920's bungalows, with some done up modern, with metal roofs and solar heating, and cool landscaping. The people were friendly, the pace slower, the weather perfect (except for the 9 months out of the year where it is cold and snowy! but even then apparently it is sunny 300 days of the year). Even the town has enough going on that we were more than entertained in the evenings - good food, good wine, a "first friday" with shops and galleries opening their doors and people milling about, and even a small 'critical mass' with a few cruiser bikes running through town. We loved it. Now I just need to get a bunch of friends and my family to move up there... and find a source of income up there... must begin plotting that move...

I know there has been a lot of backlash up there against the growth they've seen in the last 10-15 years, and all of the monied californians cashing out of the bay area and moving up there - inflating the price of homes and the cost of living. so, further investigation is definitately needed. Maybe another trip! :)

In other news, this past Thursday was my follow up appointment with my surgeon - 3 months post-op on left hip, and 6 weeks post-op plate removal and clavicle break. First the clavicle. He took an xray and said the break showed no bone growth. He also said that is normal (?) for collarbones, and bones may not begin to grow in until week 6. that said, he was surprised I couldn't shake his hand - or at least that is how I read his reaction. He didn't say anything about more surgery to install a new plate, and in general, I got the sense he wanted to wait and see it heal on its own. He also said it would take 6 months to fully heal, and for the swiss cheese holes to fully fill in. Strange how this all seemed so minor before I had the surgery. I am actually starting to get mad about this.

My own research on the internet suggests that it can take a long time for breaks to heal without fixation. It could be another month or two before the clavicle feels good. For now, I can move my arm all over the place passively - no problem. I take it out of the sling quite a bit to let it move and not be stiff. carrying anything of weight in that hand puts a strain on the clavicle that I can feel - and it doesn't feel good. The same is true of reaching my arm up in the air unassisted - can't do it without pain in the spot where its broken. Mostly I am still sleeping only on my back, in the sling. so OVER that. I can turn now on my left side - but sometimes it feels like even that pressure pulls on the collarbone and it puts bad pressure on the spot with the break. I have been using a bone growth stimulator for the last 3 weeks. Its basically a large blackberry looking thing, connected to 2 electrodes that I have taped on either side of my collarbone - one on my neck and one on my breast plate. 24 hours a day, seven days a week. I get a lot of funny looks and it is a huge pain in the ass - but if it helps it is worth it.

As for the hip... he was not happy that I'm still having looseness in the joint and said that he recommended we go ahead with surgery to go in and tighten the joint capsule. He said the sugery would be arthroscopic, and I'd be in a hip brace for 2-3 weeks and on crutches for 2-3 weeks. He would either sew up the capsule if it simply hasn't healed, or if it has healed, he would create another hole and sew it up tighter (by overlapping it). He would also clean up any scar tissue or other damage.

Of course, we can't do any hip surgery until I am able to put my full weight on crutches with my right arm - which I definitely cannot do right now. AARRRGH. So frustrating. We picked a date to go ahead with that surgery - one month from now - August 6. He said if the collarbone is still not strong by then we can push the date back. He also moved the leg around to test range of motion and says that I'm tighter than I should be - so I'm loose and tight at the same time. I'm also still having pain - sharp and achy. He said by 3 months he'd expect me to be 60% of normal and he doesn't think I am there. So, even apart from the looseness, this is not going as well as normal. Funny, in every other recovery in life I've felt like i was ahead of the curve, and now i'm behind it. Sucks for sure.

I want the surgery that is going to FIX me ASAP. However, another surgery that is just going to butcher me some more is totally unwelcome. So, in the meantime, I'm trying to get a second opinion on the hip issue. I have pretty much accepted that a second surgery on my left hip is going to happen, but I want to make sure that this surgery actually works. If my joint capsule needs to be sewed up or tightened, fine. But if the real problem is that my labrum is no longer good enough to seal the hip, then I want to address that. I have sent my films to another doc(in Vail) who sees lots of FAI patients. Hoping to hear next week. I am also considering going back to the doc in SF who will do two hips at a time - but is not covered by insurance. I am so done with all of this and it may just be worth the $20,000 out of pocket to have them done together. Only thing is, I'm sure I won't be happy having that $20k bill hanging over my head for the next few years. Of course, the longer this gets dragged out, i'm into 2011, and another out of pocket maximum to meet on my insurance. Plus all the time off of work, various contraptions that I have to pay for out of pocket, etc. Realistically, its not a choice between $20,000 or free. Its probably more like a choice bewteen another $5000 or $20,000. Something to consider for sure.
I am also getting a second opinion on the clavicle. I do not want surgery to replate it, but I also do not want to be waiting in vain if that is inevitable.

Who has time for work and life when you have all of these doctor's appointments and p.t. appointments? its insane. Luckily I was working a flexible schedule to ride my bike - now I just use that time for doctor stuff. Don't be jealous!

Today we are seriously considering a kitty. I'm sort of scared! but i know i'd love to have a kitty running around...