Physio Visit

I went to see my favourite physiotherapist, John Manley, the other day. He asked me how I was doing, I responded that my hip's feeling good, but I'm getting impatient. He said I've been impatient as long as he's known me. Maybe it's just the changes I've been going through in that time...

Put a Pebble in my Shoe
I told John about the one leg longer thing, and he seemed unsurprised, and furthermore, unfazed. He left the room for a minute, and came back with a chunk of insole and some scissors. He asked me to cut it to fit in my shoe, and feather the straight bit close to the instep. He said to try not to make a mess. John has rather a dry sense of humour. 

So I cut it to fit, put it in my shoe, and we went out into the big room with the mirrors to test out my walking. I've been focussing on keeping my gait even and my feet mostly parallel. I've been encouraging my hips to swing side to side a bit, but they're not very willing - yet. Turns out I've been missing an important detail. 

Debutante Slouch

John says my pelvis still has an anterior tilt of about 30 degrees more than it should. It's how my body has learned to move to avoid the pain in my hips. He asked me to walk and tilt my pelvis. Then to tilt it more. It felt like I was tilting A LOT! As if I were Steve Martin doing the pelvis forward walk for his character in Two Wild and Crazy Guys on Saturday Night Live in the 70's. https://www.youtube.com/watch?v=dpFNC7puU2M  

As I walked forward and backwards up and down the room, tilting my pelvis and relaxing my shoulders, I could feel a subtle response in my lower back. John said this will open up the fascia at the front of my hips, and bringing the vertebrae into alignment at the L4, L5/S1 juncture. This will in turn bring my thoracic and cervical curves into line. Once I'm past my restrictions, he'll give me some exercises.

Range of Motion, Clamshell and Mini Bridge
After that, I lay on my back on his massage table, and he checked my range of motion. He says it's exactly as it should be at the moment. He checked the activity of my external rotators by having me lie on my side with my knees bent, and open the top knee. He suggested I do this exercise, gently, to strengthen them. I remember he had given me that exercise before, but I'd forgotten to do it. Damn! 

John also asked me to lie on my back and lift my pelvis, coming up to a small bridge. He invited me to lift my right foot a little off the table, which was hard to do. Then I did the same with my left. Not quite so difficult, but still challenging. In fact, after a few reps of each side, my left hamstring started to cramp up. I have been noticing when I walk uphill that my hamstrings and glutes are weak from my long recovery period, and they need work. After I walked up the long set of steps from the beach the other day, leading with right foot, the top of my right hamstring was sore for about a week.

On Patience
As for the impatience - yes! I am very impatient, and for good reason. Almost 4 years ago I moved back to BC from Montreal. A few months later, I met my now partner, Zack, along with his kids, Noah and Piper, then 12 and 9. At first, we were a very active family, hiking, biking, swimming, diving, boarding, skiing, etc. etc. But it was soon after I met them, that I was diagnosed with osteoarthritis. Over time, my pain grew, and the list of fun activities I could do, shrank. No more running, jumping on the trampoline, and playing Survival in the forest for me.

Also, with one hip surgery last year, and the second this year, that makes 6 months, or half a year of movement restriction. Last year, as I was rejoicing in the new movement potential of my right hip, my left hip started to give me trouble. Just as i started to rev up my movement potential, it slowed back down again. Compared to my old life in Montreal, where I rode my bike everywhere, taught three yoga classes each day, danced contact improv and attended regular contemporary dance classes, I live the life of a slug. 

So, of course it will be SO AMAZING when this last month is over. Which is still a long way from the end of the healing journey. John says it takes 18 months all told to heal up after THR. But, to be able to move for the rest of my life, or until old age slows me down, the wait period is short. On the other hand, it's been so long, and most of my time with my family I've been hampered by arthritis. To be able to stretch and bend, run and jump, turn cartwheels and stick handstands. To be able to teach, to dance, to ski, surf and bike with my stepkids -  I can't wait to have my life back!!!


Today's quote: "Life isn't about waiting for the storm to pass; it's about learning to dance in the rain."  ~ Vivian Greene

Last Post Post-Script

After writing my last blog post, finishing up with the surgeon saying my left leg is now a bit longer than my right, I went out to the village. I was wandering around in a gift shop, looking at cool stuff, when I realized my left leg felt significantly longer than the right. More than I had ever noticed before. It was disturbing, having just been thinking about living with different leg lengths, and not being so pleased about it.

Then I looked down at my feet, and saw that I was wearing two different shoes. I must have slipped them on without looking. They clogs feel similar enough that I hadn't noticed while, but the red one has a slightly thicker sole. No wonder that leg felt longer! I felt rather silly, yet relieved at the same time. I continued with my errands, telling the part of me that was concerned about embarrassment with the reassurance that people mostly just look at faces, not at feet.


Today's Quote: "They say 'put your best foot forward' but which one??" ~ Rolf Harris

Six Week Surgeon Visit

I went to see the surgeon last week for my six week visit. I parked, walked in then realized I'd forgotten my cane. They recommend you keep using walking aids, to allow the muscles to heal evenly, and avoid creating bad movement habits. I can walk easily without my cane, though I usually take it with me for longer walks, as my hip starts to get sore. My walker has become and extra seat for visitors, and a rack for drying towels. The crutches I borrowed from the Sooke Loan Cupboard languish against the wall beside the door. I haven't used them once!

I spoke with the nurse, Colleen, for a long time while waiting for the surgeon. She checked my incision and said it was healing well. She wasn't thrilled I cane-free, but watched me walk, and said it looked good. I feel like a bit of a rebel, but I have been doing my physio, yoga, and taking care to walk evenly. I'm working on getting my pelvis in line and my hips swinging. Hoping to join a Zumba class for fun, fitness and mobility.

Getting Moving
I asked her about impact, once I've finished my three months of restrictions and am onto getting moving again. Turns out she's an ex-pro skier, maybe a bit older than me. She said it's the impact that creates the damage, and that her knees were starting to go from too much 'mogul-munching'. She likened my new hip to a Ferrari. If I 'drive' it carefully, I'll get a lot more miles out of it than if I grind through the gears and race it on bumpy roads. Makes sense. I'm still hoping to get some jumping in on the dance floor, but I won't be running any marathons. I'm fine with that. 

I've been itching to get moving, and thinking of taking my bike for a ride on the Galloping Goose. The Goose is a former railway bed, now a nice, relatively flat and wide path through the woods. The nurse said it would be okay to ride it, the only danger being falling off my bike, tearing my healing muscles. We agreed the wise choice is to wait until my three months are up. Sigh. 

Heredity vs Lifestyle
We also talked about heredity as the cause of arthritis. She felt it was a large factor, but that a lifestyle including lots of impact was also a contributor. My younger sister, who has not had such an active life, has recently developed hip pain. We're hoping it's a result of a fender bender, not the first step on the path to hip replacement. Only time will tell. 

Colleen asked how my hip felt. I replied that my left leg feels a little longer than my right, but my physio had said it was probably a result of the healing in the joint. It does feel rather full and stiff in there. She said it might feel like that for up to six months, and that it takes at least a year for the various clicks and pops to fade away. 

Revision Surgery
I asked her about revision surgery. She told me that it involves chipping the prosthetic out of the femur. She brought me a demo prosthetic to show me the small holes that the bone grows into, one of the reasons for the restrictions in the first three months. I have heard of cemented versus non-cemented prosthetics. The cemented version could have more risk of dislocation, but be easier to remove for revision. The nurse, Colleen, said that hopefully by the time I need revision, in 20 or 30 years, they'll have some fancy new technology that will make it easier. 

Surgeon Says!
The surgeon arrived, he said my x-rays look perfect. He checked out my gait and pronounced it good. He re-iterated the three month precautions, and chatted a bit.Then just before he left, he dropped the bomb. He said my left leg is 1/2 an inch longer than my left! That if it stays like that, I can just wear a lift in my shoe. Not the best news for someone who spends a lot of time barefoot. He talks so fast, and I was so surprised, that I didn't manage to ask him anything more about it. I will when I see him again, in about 2 months. 


Today's quote, to celebrate Shakespeare's 400th birthday: How poor are they that have not patience! What wound did ever heal but by degrees?  ~ William Shakespeare

Unexpected Drawbacks

Just passed the six week mark, and all is going well. I'm walking in the house a lot without cane or walker. Doing my best to stay slow and symmetrical. 

Though the pain is still there, I'm taking Tylenol less and less. Mostly just when I bump my activity level ahead too much all at once. When that happens, I do some lying around the next day. I have some tension in the upper left quad, a result of new or overworked muscles...or both. Yoga always helps!

I'm looking forward to my visit with the surgeon on Thursday, although I have a feeling it's going to be short and sweet. I'll let you know how it goes.

In the meantime, here's a list of some unexpected drawbacks of THR recovery. 

1. Say goodbye to the foot on your operated leg
Since you can't bend more than 90 degrees for 3 months, you can't get up close and personal with the foot on your operated leg. So, cut your toenails before you head into the hospital, or give yourself a last pedicure.

2. One wet shin
For the same reason, you can't dry all the way down your operated leg after the shower. I just wave it around a bit before I put my pants back on.

3. Limited cat petting or lifting
It's  not easy to reach down to cat level standing on one leg with the other behind you, though it's possible. What's really a challenge is picking up the cat, as usually I use two hands, and that requires expert balancing skills.

4. Bye bye fancy boots (sniff...)
I have a new pair of boots I adore, but the left is inexplicably tight, and they zip up on the side. I have worn them a few times with my loving partner's help, but I usually clop about in clogs. If I have to take my boots off when I'm out, at the physio for example, I'm forced to ask for help to get that left one back on.

5. Looking like a disabled person
It is interesting to be out in the world using a cane or crutches. People look at me sidelong, or ignore me. I know this state is temporary - but they don't. It gives me a little window into how it feels to use walking aids every day, for the rest of your life. My three month flirtation with sticks and wheels and small steps is really nothing to complain about. 

6. Getting nowhere fast
Do you remember the old man character Tim Conway used to do on the Carol Burnett Show? If you don't, he has this slow shuffle of small steps. Tim Conway Wheelchair Sketch It feels a bit like that when I walk. Walking down the hill after the bike race the other day, I kept having to step aside to let people pass. I guiltily remember striding ahead of my ex in the snow, leaving him and his aching knees struggling along in my footsteps. I am humbled.


Today's Quote: “There is nothing noble in being superior to your fellow man; true nobility is being superior to your former self.” ~  Ernest Hemingway

Four Weeks Down, Eight to Go!

Saw my favourite physio this week, John Manley out here in Sooke. I can go at no charge to the Adanac Clinic at the 'Jube' (aka Jubilee Hospital), but it's a long drive, and they didn't do much for me last time. John was happy with my progress. He ask me to let my hips swing side to side with my walk, which hurt a bit in the outside of my right thigh. He also suggested a slight pelvic tilt, as my pelvis is tipped quite a bit forward, to avoid the pain.

Don't overuse your arms
John also encouraged me to just 'tap' my cane, and to rest my hands lightly on my walker. I was rejoicing in my upper body strength early on in my healing. It makes it easier to get around, the fact that I can propel myself with my arms, connecting to my back when i need to, without any ache in my shoulders. Turns out at this point, though, the idea is to let the legs do the work, keeping my steps small, my gait slow and steady. Sigh.

It is getting a bit old, all this walking slowly. Though I am doing better, walking more often and smoothly without my walker, I still ain't goin nowhere fast. Though I can use my golfer's reach to lean forward, it's pretty awkward getting down to the floor. When I washed the windows the other day, I did all the top half, then laboriously got down to the floor to do the lower windows on my knees.

It's very one-sided
When I do yoga, I have to roll from my back to front, or vice versa, via the right side, pushing off the left foot before the knee comes too low.  As for sleeping, only on my back, or my right side, often with an icepack. At least this time, it's easier to get in and out of bed, as my operated side is the left side. Much easier than when my right hip was sore.

I asked the physio if I should try lying on my left side, even though it hurts. He says it could bother the incision, and it would be best not to.

Torsion
 I asked if was okay how I've been leaning forward, keeping my hip at less than 90 degrees by tilting my pelvis. John replied that we're trying to avoid torsion, which I understand as moving too much at the hip socket. There's a longer definition here: http://www.hss.edu/excessive-torsion-hip-pain-center.asp#.U0G4F61dUmc, along with plenty of other useful info about various types of hip pain. So I need to be more cautious about my angles. It feels from the inside that part of the problem is pushing off with the operated leg to stand up.

Book!
I am going to write a book about all this. Collect about 10 stories, meld them together with useful information, and e-publish it. There is a lack of information out there, and, though the system here in BC is efficient and helpful, I know I would've loved to read some other people's stories of hip surgery, before I went through it myself.

Today's Quote: "Walk as if you are kissing the earth with your feet." ~ Thich Nhat Hanh

Choices

Three weeks plus, and the pain is abating. Less Tylenol. I started the week with walking up a flight of stairs on Monday, followed by a very small series of even smaller standing poses on Tuesday. Wednesday it felt like a very large fist in a steel glove had pounded my left hip. Did some more lying around, watched The Moulin Rouge. I'm feeling better.

I keep meeting, or hearing about, people for who THR has been recommended, who are putting off the surgery. For some, it comes from a doctor's recommendation. There was an ex-dancer I spoke with in Montreal who was told by his doc to wait as long as he could, and could barely walk by the time of his operation, 8 years later. He wished he hadn't waited so long. There are others who choose to live with the pain, than go through the operation and recovery.

It took me awhile to get used to the idea of having surgery. I remember the phone call when my doc told me I needed a hip replacement. I cried. A lot. Somehow I thought there would be a less drastic solution to the growing pain I'd been living with.  I think it was a good 18 months, maybe two years before I was ready to go on the list for hip replacement surgery. When I finally did, I wished I had done it sooner. I was lucky to be able to go on the cancelation list, and both times jump to the front of the line through someone else's misfortune. Though going in for surgery with only a week to get used to the idea is a bit intense.

For sure it's an intense surgery. The recovery period is long. But it could be worse. Brain surgery, for example. Chemotherapy. Some kind of 'ectomy where you have something removed that you'd rather not. It's true that this surgery is elective. You can choose to live with severe arthritis. Many people do, by choice, or by necessity. Just pop pain meds all the time. Don't depend on being able to run for a bus, or get down on the floor to play with the kids. For a physical person, getting the procedure done seems to me a no brainer.

I was told I'd have a 6 to 12 month wait, and I've heard of longer. It can take time to find just the right surgeon. I'm so lucky here in Victoria. We have a pool of excellent surgeons grouped in a new 'Rebalance' centre. The Joint Replacement Clinic guides you through the pre- and post-op process. And it's all covered by our health insurance - unless you get ceramic hips, which I did. Worth every penny, though, for longevity.

Against the 80 or so (if we're lucky) years of a lifetime, 3 months, or even the full recovery period of a year to 18 months is tiny. It feels long from here, but short on the other side, I remember. Right now, the little steps of improvement are exciting, but underwhelming. Each week passes slowly. I still have two months to go, as of tomorrow, and it seems interminable.

My memories comfort me. Last time, once the three month mark was over, it was so liberating to slowly stretch out my tight muscles. The only thing holding me back was the degeneration in my left hip. The endless recovery became short as it receded into memory. This time, I'll be able to pull out all the stops. It's going to be so good!!

 I am so blessed that I can go in to surgery with a week's notice. That I don't have to go back to work, and sit in a desk all day with an aching hip, or use my crutches to clump around a sales floor. When I broke my elbow twenty years ago, and had to register for college wearing a soft cast, my left arm in a sling. Every little thing was so difficult. A day that was already intense, with endless forms to fill out, line-ups to navigate, and decisions to make brought me more than once to tears. I was in pain, and one hand short for things like carrying books and opening doors. It was hell.

Today Zack drove me up to the platform on the hill to meditate. We sat in a patch of sunlight, looking out of the Sooke Basin, and were serenaded by spring birds. This afternoon, I might repot some plants on the deck. If I get tired, I'll chill on the couch and read 'Tiny, Beautiful Things' by Cheryl Strayed. (You can find her here: http://therumpus.net/sections/blogs/dear-sugar/) I am truly blessed with a supportive and loving family. I am so grateful also to you for coming with me on this journey. Namaste.

Today's Quote is from the very inspiring Cheryl Strayed: "Your life is here and now. And the moment has arrived at which you’re finally ready to change. I know it. The thousands of people reading these words right now know it. And you know it too.. We have the power to heal what needs to be healed. We get to give ourselves that." 

Two Weeks!

Today is the two weeks since my surgery, and I can't quite believe how well I'm feeling.   I can stand, and hobble a bit without my walker, and am having lots of fun scooting about on it. Then I wave admonishing finger at myself, mentally. Slow down, Anthea. 

When I look back on my the two week mark on this blog (It's a Rollercoaster!), I remember the frustration. It's a long haul, that's for sure. As before, I ran out of Dilaudid, and went back to Celebrex topped up with Tylenol. The pain is always there in the background, even with painkillers. Without them - too much!

This time around, I had a two week follow-up call from Colleen at the Joint Replacement Clinic. It was very useful in answering a few questions I had.

Off with the bandage!
I mentioned to a nurse in the hospital that I'd only changed my dressing once last time. She said that people often mess around with their dressings too much. So this time I haven't even pulled it up to take a peek. Colleen said I could peel it off, and take a shower without it. 

Some people get staples, but my surgeon used steristrips, which will eventually fall off. The drugs make me sweaty and stinky, so showers feel extra wonderful. The only slight drawback is that if I don't have help, my left leg has to airdry.

Restrictions
Last time I was waiting for my 6 week surgeon visit, hoping that he'd lift my restrictions. That was before my physio explained the reasons for them. Besides the outside incision, the inner joint capsule is also cut. It needs to grow thick scar tissue to keep my new, ceramic femoral head in place. 

My restrictions, if you remember are:
1. don't bend at the hip past 90 degrees
2. don't twist at the hip
3. don't cross the operated hip over the midline of the body

I have to keep these restrictions for three months, so everything heals up tight and strong. During the operation, the surgeon dislocates the hip, so he can get at the acetabulum (hip socket) and femoral head (the top of the thigh bone). With too much range of motion, the new hip is in danger of re-dislocating, again and again. We wouldn't want that!

As with most things, it's easier the second time around. It works for me to keep the alignment between my pelvis and my thigh bone from going past 90 degrees. So if I turn, I turn with my whole body. If I bend forward, I keep my pelvis upright, rather than tipping it forward. I feel like I live in a pelvic tilt. 

I remembered another reason I don't use my reacher much. I don't need it for getting dressed. When I put on my pants, I hold them as low as I can without tipping my pelvis forward, and lift my operated foot up as high as I can without going outside of my restrictions. This allows me to (just barely) hook my foot into the top of my pant leg, then squirm it up to the top of my thigh. Then I put my other leg in, pull my pants up, and... Voila!

Today's quote: 'Slow and steady wins the race.' the Tortoise and the Hare