Things I'm happy to say goodbye to.

Well, I had this beautiful long post all written, and it vanished into cyberspace. Has that happened to you? Kinda took the wind out of my blogging sails for awhile. I'll rewrite it - I think - but in the meantime here's what I've been simmering on lately. 

Welcome Post-Surgery Changes

1. No more tension in my right hip
When standing, I would often notice the external rotators of my right hip (aka my right butt cheek) clenched. I would relax them, only to notice them tense again moments later. I'm sure this was a holding pattern in reaction to pain. Now, though my hip still hurts a bit from the surgery, this butt-squeezing has melted away. When I check in, I notice myself standing evenly on both feet, with no extra tension. There is still a little tightness, but I'm thinking I need to do some hip-swaying dance to relax my hips, get them swinging with my stride again. Bellydance, anyone?

2. No more pain at front of my right ankle
The morning after dance class, and after karate, as well as during yoga practice, the corner where the front of my ankle joins the top of my foot was sharply painful. The pain would abate, only to return the next week. After surgery - gone.

3. My toes touch
My right leg has been outwardly rotated at 45 degrees for a few years now. I remember the moment of deciding that forcing it to stay parallel in yoga practice created more pain in my hip, and wasn't useful. The muscles in the inner thigh are weak, and I get a certain knotting of the muscles at the front of the right hip when I walk uphill, which is the proper muscles remembering to work. But it is a joy to stand with my feet in Tadasana, mountain pose, all 10 toes facing the same direction. I love setting up for Urdva Danurasana, a backbend, and just touching my toes together before I press up, to make sure both feet are parallel. Like rediscovering an old friend.

4. I'm taller!
I measured myself about a year ago, and I was 5'8". I couldn't believe it. I've been 5'9" since I stopped growing as a teen. I couldn't figure how I'd lost a whole inch. I think two things contributed. First, the compression in the hip joint with the deterioration of cartilage. Second, the pain was causing my hip flexors/psoas to shorten, making me stand with my pelvis tipped forward, my lower back arched. i realize how much, as I rehabilitate and stand straighter. There is a sweet, spacious feeling  across the front of my hips into my belly. So I measured myself just for fun the other day, and there I was 5'9" again! I feel like I was given something back I didn't know I'd lost.

5. I can run!
Well, not like I'm going to do a marathon anytime soon, but at least I could run for the bus if I had to. At some point in the last couple of years I stopped being able to run. It's hard to explain why. It was partly pain, but also I just felt to stiff to run. I spontaneously broke into a run the other day, just because I could. Only from the car to house. It felt wonderful!

6. More mobility = more enjoyable walking

Sashia on the pipeline

I realized on my walk today how much easier it is to walk up hills, and on uneven terrain. Before surgery, it was getting tough to step over logs, and I felt a bit unstable and scared of falling. The tightness in my inner thighs hindered my mobility, as did the limited range of motion in my hips. Last week I graduated from sticking to the pipeline (an old, unused pipe that's like a sidewalk behind our property), to following trails and deertrails up the hills and through the underbrush. I'm not completely healed up yet, but I'm so happy to be able to move again.


Isn't this an amazing journey? I feel blessed to have fallen into that hole of reduced mobility and pain, and be lucky enough to come back out again. It changes you, living with pain. It's different, learning to be a person who has to say 'sorry, I can't', instead of one who says 'sure, let me do that!' 

It's good to know both sides, to learn empathy for others. I have much more understanding these days of seniors, of others with disabilities. I am better at slowing down to help, to be patient, to offer a kind word. I know what it feels like not to be able to trust your body. To wonder whether or not to say how much you hurt. Sharing our pain, and our joy, is the way to empathy and compassion.


Today's Quote: There are no mistakes, no coincidences. All events are blessings given to us to learn from. - Elisabeth Kubler-Ross

Core Stabilization and Strrrrretching!

I had another physio visit yesterday at the Royal Jubilee Hospital. With a lilting Irish accent, David watched my gait, and pronounced it 'goot'. He said, however, that I need to lengthen my hip flexors and energize my transverse abdominals. The pain in my hip flexors over the past years had caused me to increase the curve in my lumbar spine, relaxing my abs.

Core Stabilization
David asked me to lie on my back, knees bent. He put something slippery under my right foot, and his fingers lightly on my belly. He asked me to slide my foot away from me about a foot, then back. I told him I felt my abs working. David explained that my rectus femoris were working, when they should be relaxed. That my transverse abdominals aren't doing their work of stabilizing so I can move from the leg.

Then David offered a lovely image. To imagine my heart to be connected by a string to my diaphragm. As I inhale, the diaphragm bows downward, and the heart rises up, lengthening the string. With the exhale, the drum skin of the diaphragm  and the heart move towards each other, shortening the cord. He left me to breath like that for 5 minutes.

Then he asked me to picture the framework of core stabilization surround my core. The transverse abdominus as a girdle across my belly, and the multifidus winding through the erector spinae, stabilizing the back. At the top, the diaphragm, and at the base the pelvic floor. So ever since, I've been passing to check if I'm engaging, gently, this core support. 

As my core becomes more stable, my hip flexors and psoas are opening. Backbends feel awesome! I had not realized how omnipresent the sense of pain and tightness at the front of my hips had been. How when I lay on my back to stretch on leg, the hip flexor of the other leg was the first place I felt the stretch. 

Stretching
I can also feel the beginnings of how glorious it is going to feel to stretch my inner thighs. The first place I felt pain was the right hip flexor, probably in 2002. The second was the inner thigh of the same leg, after a workshop in 2007. It never healed, both adductors becoming tighter and tighter, until when I tried stretching, it felt like pulling a thick robe. Solid. Immobile. Now the feel loose, fluid, willing to let go and elongate. But not yet.

The day before my birthday, July 18th, I have my 12 week visit with the surgeon. I'm hoping I get the go ahead to start some gentle stretching. Can't wait!

Today's Quote: Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? You are a child of God. Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do. We were born to make manifest the glory of God that is within us. It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others. 

~ erroneously attributed to Nelson Mandela, actually written by Marianne Williamson. Let's send some healing thoughts to Mr. Mandela, hospitalized with a lung infection. He is 94 years old. 

Prepare for the long haul

I've been told more than once that I limp less now than I did before my surgery. Which makes me want to consider my healing finished. But it's a long process. In fact, as I move forward, I realize that my sore hip was affecting me more than I understood.

It's a weird thing, how chronic pain seeps into one's life. At first a few twinges, a pulled muscle that doesn't go away. Pain after a long, beautiful walk with the dogs. I saw most clearly how far things had progressed when I saw myself through the eyes of my brothers and sister last Christmas.

I still have pain in my hip, but it's changing every day, for the better. I walked the dogs today, and felt a familiar lightness slipping into my psyche like an old friend turning up for coffee. I realize now in coming out of the pain how much it was affecting me. Much as I do my best to accept what each day brings, each 'no' carries a little sadness. Each 'sorry, I can't jump on the trampoline', or 'I wish I could come skiing too'. Even 'sorry, I can't help you with that', doesn't feel so good. 

Surgeon Visit
So I'm excited to be on the mend, to be moving forward, though my visit to the surgeon on Friday was a bit anti-climactic. He and the nurse were happy with my progress, and after watching me walk agree I'm okay to walk without a cane. 

The sad thing is the precautions stay. The family was hoping to say goodbye to the tall toilet seat, that gets stinky quickly. Not yet. So I still can't bend past 90 degrees, cross my right leg past the midline of my body, or twist at my right hip. For another 6 weeks, and maybe another 6 months after that!

The Precautions Continue
Turns out the precautions are not just to avoid dislocation. It's important to allow the body to build some thick scar tissue around the joint capsule, for long-term stability in the joint. Sigh.

So, here are the things you get good at in the looooong recovery from hip replacement.


1. Golfer's Reach
Since you can't bend forward at the hip 
without going past the recommended
90 degrees, one leg trails out behind 
when you bend down to give the dogs 
their bowls, sweep fluff into a dustpan 
or...pick up a golf ball.

2. Sock Pulling

I have borrowed this ingenious contraption, called the sock pull. It makes it easy to put a sock on my right foot, since I can't bend towards that leg. 

3. Uneven Downward Dog
This is how I get up and down from the floor, through a downward dog with my right leg extended. It makes me think of older students, who have looked at me with disbelief when I asked them to sit on the floor.

4. Asking for Help
I can't reach forward from sitting to pick up a cup from the coffee table. So I ask for help a lot. It's a good thing.


I'm doing my best to stay patient, to be in each day, and not look forward to the day the precautions are off and I can stretch my muscles out. It's going to feel sooo good! But I'm not looking forward to it or anything. Not at all. ;)



Today's Quote: There is no way to Happiness. Happiness is the way. ~ Buddha

Six Week Update

Six weeks later
It's six weeks ago today that I came out of surgery. I'm walking without a cane, and have stopped taking pain meds - mostly. I still waddle a bit when I walk, but it's getting better all the time. I'm feeling great, full of energy, and ready to take up my life! There are so many things I've been held back from because of my hip pain. I'm excited! 

GP Visit
I saw my GP earlier in the week, and she said I'm doing great! I asked for her approval for me to drive. She asked what I thought. 'I'm fine.' I countered. So I'm driving again, which makes getting around much easier! 

My GP, Vanessa, showed me before and after X-rays. It was strange to see the x-ray of my hip and leg with the prosthesis in it. It was like looking at a picture of someone else. Vanessa showed me the X-ray of my hip before the surgery. You could see there was no space. It was, as they say, bone on bone. She asked me to describe the difference between the pain before, and now. 

The quality of pain
I remember it was sharp, I could feel the lack of cartilage. The amount of pain increased directly with the amount of heavy lifting I did - or walking on a hard surface. This pain is different. Rather than in the joint, I feel it in the muscle. It feels like if I could do a looooong held pigeon pose, it would feel much better. Exactly what I can't do right now, with my 3 precautions. 

Not the left hip too??
I also saw the x-ray of the other hip, and Vanessa checked its range of motion. She says I'll need to get the left hip done too, but to wait a bit. I have some ideas around that. I'll share them with you in another post. Can you say 'Lectins'?

Physio
At my physio visit yesterday, John manipulated my right leg. He says there's old stuff from the years of pain mixed up with trauma from the surgery and recovery. But he assures me plenty of movement in the future.

John asked me to stand, then tuck my pelvis under a lot. He had me stand up taller, then untuck two thirds. When I walked forward, I felt taller, and there was less pain. He also had me walk backwards a bit, which was uncomfortable, but switched things up so when I walked forward again it felt smoother. As suggested by John, when I remember to, I float forward from my lumbar, which smooths it out.

Surgeon
All in all, I'm very pleased with my recovery so far. Today I drove down to the hospital to get x-rays for the surgeon to look at before our meeting next Thursday. I'm looking forward to hearing what he has to say! 

Second Physio Visit

Second Physio Visit
I saw a physio here in Sooke yesterday. Having practiced physiotherapy and acupuncture for 20-some years, John is compassionate and knowledgeable. An unassuming man with the soul of a healer and a monk-like, puckish grin.

John asked me about the history of my hip, noticing that I sat with my weight on the left. After a few gentle questions, I found my eyes tearing up. I remembered an ex-dancer in his early 50's who told me of his grieving following his double hip replacement. He'd waited until he could barely walk before getting surgery. John mentioned holding space for a natural grieving process. I realize it's a necessary part of my healing. I don't like having to live with a porcelain hip. I liked my body just fine as it was - before the pain. I think I need to play me some cryin' tunes.

The MyoFascial Web
John placed me in front of a mirror and looked at my posture. He asked me to notice how my pelvis was shifted to the left, my ribs and shoulders to the right. John described the fascia as a net that weaves through all the tissues of the body. Put your fingers into the net, and twist it. The twist will carry through the rest of the net, creating pulls in other places. 

Symmetry, symmetry, symmetry!
To correct my posture, John asked me to root through my feet, still allowing my right foot to rotate outwards about 45 degrees. Then to do a Kegel (like yoga's Mula Bandha) and engage my core (Samanha Vayu), keeping the upper abdominals soft. He encouraged me to lengthen, to reach up through the crown of my head. Through creating length in the spine, taking the slack out, everything slid into alignment. 

My hip flexors have been shortening, and my lumbar curve deepening. John recommended that rather than a walker, I use crutches. These will enable me to walk evenly as well as continue to lengthen instead of leaning forward over the walker. Crutches for a bit, then a cane. I'll be walking unaided in no time.

Fears
I was already feeling impatient with 3 - 6 months of precautions. When John said 12 - 18 months for total recovery, I almost burst into tears. I realize he means until everything's all aligned, no limp, etc., but that's a long time!!!

He asked me what I am afraid of. These are my fears:

1. That I'll need to get my left hip replaced too. Johns says it's likely.
2. That when it's all healed up, I'll have a squeak, or a clunk, or one leg longer than the other.
3. That my range of motion continues to be very limited.  

With this surgery, I am forever changed. Irreversibly. Even now, I'm not so sure it was the right decision. Yet I am at the same time very sure. Does that make sense?

It's about the journey
How often do I have to be reminded?? John suggested I enjoy this process of healing. Which started me thinking that it's kind of like a reverse pregnancy. My surgery could (with much less required from me) be likened to the trauma of childbirth. I need to spend more than nine months caring well for my body. Each month will bring more ease, rather than less. My work is accepting each day for the challenges it brings, and having faith in the process. 

Being reborn into a body that moves fluidly, painfree - I think that's worth waiting for. For that, I can do my best to live each day consciously. To eat well, move well and rest well. To care for my spirit and my soul, opening space for emotions to flow. I can choose patience, with that shining light at the end of the tunnel. 

Today's quote: “Life is a journey, not a destination.” ― Ralph Waldo Emerson

Hip Replacement Video

I just found this very nicely done video of the workings of the hip joint, and what happens during a hip replacement. I love the capabilities we have we computer graphics to look inside the body for a deeper understanding of how it works.

Check it out! 

http://www.nhs.uk/conditions/Hip-replacement/Pages/Introduction.aspx

Three Weeks Post-Surgery

Friday May 3rd marked three weeks since my surgery. My time on the operating table seems so long ago, as with every day I have less pain, and more movement. I'm not so tired anymore, and am feeling able to return to giving bodywork treatments. I'd like to balance my receiving practice with offering others the health and wellness of Clearheart Bodywork. Besides, much as I love my home, it's time for me to get out in the sunshine!

Physiotherapy
I was very pleased to have my first physiotherapy session yesterday. It was a treat to have some outside input on my healing journey. It's a bit weird hanging out at home, wondering whether I'm doing things right, or not. As the physio said, they give the same 3 precautions to everyone, regardless of personal requirements. It is nice that at 50, technically middle aged, (or old, according to my step-daughter), I am in the 'young' category. Most people who've had this surgery are much older than me. 

I went to the Royal Jubilee Hospital physio department. My physio, Jason, was easy-going and knowledgeable. One of his first questions was "So - about the driving thing...?"

Say 'no!' to Driving?!
A few days ago, I'd started helping drive our kids to various activities. I tossed my cushion on the driver's seat to keep my hips at less than 90 degrees, and proceded with care. At the Joint Replacement Clinic (JRC) they had said not to drive while on the heavy painkillers, which I'm long past. They also said there's a danger of clenching muscles in reaction to an intense driving situation, and perhaps do some damage. My pain is not so bad these days, and I'm pretty relaxed, so I reasoned, with a little luck, I'd be fine.

But Jason said if I have an accident, and ICBC found out I'd recently had a hip replacement, they'd have a field day. Usually you don't start driving until you get your surgeon's permission. Who knew? So, back to being chauffeured until I wangle a visit with my GP. 

Jason checked my healing, and watched me take a stroll with a walker. He said I move like my surgery was two months ago, not a scant three weeks. He did recommend that I keep using the walker, to retrain my muscles effectively. He suggested a 4 wheel, rather than the 2-wheeled one the JRC told me to use. It's tough to stay behind the walker, when I can walk pretty well without it.

He says my incision looks good, and showed me some cross-fibre massage, that will keep it from adhering to the fascia. I got the definite okay to get back in the hot tub - yay! He gave me some simple exercises and stretches, which I'll incorporate in my yoga practice. 

Visit to the Surgeon
I see the surgeon in three weeks, at which I can find out more about how long I continue with the three precautions. Jason reminded me that the ligaments around the joint capsule have been cut, and since there is little blood flow in the joint, they will take a long time to heal. If I do accidentally dislocate my hip, it will dislocate easily forever after. Yuck! So no pigeon pose for me for three, maybe even six months. It's going to feel sooo good when I get there!

Since the surgeon has been up close and personal with the head of my femur and my acetabulum (hip socket), he'll be able to tell me how great my risk of dislocation is. If the femoral head sits deep in the socket, I can probably get moving sooner. If my acetabulum is on the shallow side, I'll be cultivating more a lot more patience. 

I'm Doing Great!
Generally, Jason was very positive about my progress, and said I was doing great. These are the things I attribute it to:

• healthy diet, with lots of greens, raw juices and smoothies
• Arnica, Traumeel and Vitamin C
• RESTORATIVE YOGA PRACTICE!
• Nettle Tea
• lots of water
• plenty of conscious activity and rest 
• positive attitude and visualizing healing
• icepacks 3 - 4x/day
• the love and support of my family and friends!!!

Asana Practice - Standing Poses!

I busted out a few standing poses this morning, which felt wonderful. Much as I love my restorative practice, it's been a month since I've done any standing asana. I warmed up with a few modified Sun Salutations, along with some squats to bring back the strength in my quads.

For balance poses, I did a very tiny tree pose, holding a wall when I stood on my right (operated) leg. I very gently practiced Triangle pose (Trikonasana), Revolved Triangle (Parivrtta Trikonasana), and Intense Side Stretch (Parsvottanasana). I did a nice standing quad stretch Jason showed me, supporting the foot of the stretching leg on a cushion rather than holding it. This allows the quad to be passive, and stretch more effectively.

It was interesting and a bit of a brain twist to remember not to fold more than 90 degrees at the hip in all postures. I focused a lot on engaging my leg muscles, and especially on drawing the head of the femur into the hip socket. After a very short time, I felt the muscles in my hip had had enough.

I opened, as usual, with Supta Baddha Konasana, and closed with a variation of it. An interesting side note from Jason, is that the hip and leg can relax best when supported in a slightly bent, and outwardly rotated position. No wonder this posture feels so deeply healing.

Today's quote: A journey of a thousand miles begins with a single step.

~ Lao-tzu, Chinese philosopher (604 BC - 531 BC)   

This is the popular form of this quotation, a more correct translation from the original Chinese would be "The journey of a thousand miles begins beneath one's feet." Rather than emphasizing the first step, Lau Tzu regarded action as something that arises naturally from stillness. Another potential phrasing would be "Even the longest journey must begin where you stand." [note by Michael Moncur, September 01, 2004]