Tuesday, April 22, 2014

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

Sunday, April 6, 2014

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

Wednesday, April 2, 2014

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." 


Tuesday, March 25, 2014

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

Friday, March 14, 2014

Walkers and Reachers

Well, I've been home a week. I'm told I'm more chipper this time, and have been spending more time on my feet and less in bed. It might be that things feel a little easier as I know what to expect this time around. 

I love my four wheeled walker! Last time I had the two wheeled version, as the 4 wheeler is deemed too unstable for hip replacement patients. The problem with the 2 wheeler was, as I got more mobile, I kept leaving it behind, and hobbling around. Not so good for the the 'symmetry, symmetry, symmetry' my favourite physio recommends. As before, I can walk a bit now, and in the kitchen I loco-mote leaning on counters to move in small spaces. The walker does get a bit in the way, especially when all four of us are in our tiny kitchen.

The 4 wheeled one moves so smoothly, with a swirly, gliding quality that makes me want to create a dance piece with it as partner. The wheels make a sound like distant thunder that makes the cats nervous, and I have my own comfy seat. It also has handy side zipper pockets, and a huge compartment under the seat that carries books and pens. I love it!

As last time, it's a challenge to walk slowly, though I try. I've heard more than once 'walking consciously is the best physio you can do', so I keep my steps small, my weight evenly on both feet, and press on the walker as little as possible, keeping my shoulders relaxed. I find it ironic that, though my job is healing, I often find myself rushing around the house, for no reason at all.

I told the nurse at the hospital that I hardly used the reacher last time, and she raised her eyebrows. The reacher has a handle on one end, and pinchers at the other, so you can pick things up. I realize now I'm back at it that I use the 'Golfer's Reach' instead. With my left the operated hip, I stand on my right, and reach my left leg behind me. If I were older, or less fit, I'd be using the Reacher more often. For me, it seems a bit finicky.

It's interesting to have this blog, so I can check in on how things went last year and compare. I didn't have the soreness in my upper back this time, but I think that came from spending more time in bed.  

It's seems I got back on the mat with Restorative Yoga a little sooner, which is feeling wonderful. It's easier to know how to move, as I spent three months staying within the same restrictions a year ago. I just have to transpose my body memory to the other leg. 

Today's quote: 'Smile, breathe and go slowly.' ~ Thich Naht Hanh

Monday, March 10, 2014

One Week Later

There! Surgery done on both hips, no third hip hanging around to require me to get this done again.

It was easier this time, knowing what was coming. I was much calmer the night before, and going through the pre-op steps. Maybe too calm. Last time I cried as I was being given my spinal on the operating table, and woke up just as it all finished. I think the tears earned me stronger sedation. This time, I was awake, though drifting. The spinal deadens any sensation from the waist down, and I was shielded from seeing by a blanket tent. There was a plastic covering over me, like a thin air mattress, with a vacuum cleaner hose constantly blowing warm air into it. Though my ears were full of the hum of the air, I could hear a rhythmic banging. In my stoned state, I called out a few times 'Hey! What're you guys doing? What's the banging?".  No one replied, and when I asked them before being wheeled out, they said they couldn't hear me either due to the noise of the machine. Good thing! 

My roomie, Flo
I got into the operating room, out of recovery into my hospital ward much sooner this time. I wasn't lucky enough to have a private room, or a great view, but I did learn a lot from my roommate. Her name was Flo, 91 yrs old with dementia and epilepsy. She doesn't always remember to take her meds, and this year, same as last, her husband found her on the floor having a seizure, in which she broke her hip. So, just like me, second time round of hip surgery. That's where the similarity ends. She doesn't remember where she is from one moment to the next. All she knew for sure is that she wanted to get up and go home. So if she wasn't taking off her gown so she could get dressed, she was removing her IV, or trying to sit up. Her husband and the nurses explained to her over and over, "Flo, you've broken your hip, you have to stay here and heal." To which she'd reply 'Ah!" as if she'd finally understood, only to to go back to trying to escape. I was impressed with the kindness of the nurses, and the fact that they never resorted to tranquilizers, or strapping her down, which I remember happening to my Grandma.

As before, I was complimented often on the speed of my recovery, how soon I was able to sit up in bed, swing my legs off the side and walker myself to the bathroom. With Flo as an example of the more usual hip replacement patient, I understood why. On my third day after surgery, I was practicing stairs, and checking out. On Flo's third day, she was lifted into a wheelchair, to practice sitting up for awhile. Poor Flo. I hope she's gone home by now. She really helped me to count my blessings!

The pain seemed worse this time. There is a screaming entry in my journal from the day after, saying, "It hurts too much!". Though I haven't experienced it, I suspect it's like childbirth. The pain recedes into a distant memory, with other happier details plastered over top of it. Already, I don't remember how badly it hurt that day, less than a week ago. 

Drugs
On that note, I've been juggling meds, to manage the pain. My first night home from hospital was a bit intense. First, the hospital bed that changes positions at the push of a button really helps with getting into a comfortable position. Second, there are more drugs at the hospital. Every four hours or so, I got 2 tylenols, 1 celebrex (anti-inflammatory) and two dilaudids - and 2 stool softeners. They send you home with a prescription for Dilaudid, and no advice other than '1 - 2 every 4 hours'. The next morning, I decided to supplement a bit with Tylenol, which has helped a lot. 

On the stool softeners, there is some pain I do remember from last time - wicked constipation from the drugs! I thought my healthy, high fibre, home diet would kick it out, but it wasn't enough. So this time I'm taking a couple healthy scoops of natural fibre in water every morning, and everything's moving smooooothly. Sorry if that's TMI, but I thought you'd like to know if you're going into surgery too. 

Same as last time, I have to take an anticoagulant for a month, the same time every day. The change was that this time each does was a little needle in its own packaging, that I had to stab myself in the belly with. I'm not afraid of needles, but I've never had to self-administer. I was not keen! Luckily, when the surgeon came to gave me my walking papers, he said I didn't have to use that method. In fact, I can just take 325mg of Aspirin every day. Phew! Also preferable as those needles were worth about $25 each, ringing in at a few hundred dollars for the 28 days.

Today's Inspiration is from Pema Chodrun ~

There is a story of a woman running away from tigers. She runs and runs and the tigers are getting closer and closer. When she comes to the edge of a cliff, she sees some vines there, so she climbs down and holds on to the vines. Looking down, she sees that there are tigers below her as well. She then notices that a mouse is gnawing away at the vine to which she is clinging. She also sees a beautiful little bunch of strawberries close to her, growing out of a clump of grass. She looks up and she looks down. She looks at the mouse. Then she just takes a strawberry, puts it in her mouth, and enjoys it thoroughly. Tigers above, tigers below. This is actually the predicament that we are always in, in terms of our birth and death. Each moment is just what it is. It might be the only moment of our life; it might be the only strawberry we’ll ever eat. We could get depressed about it, or we could finally appreciate it and delight in the preciousness of every single moment of our life.

Monday, March 3, 2014

My Left Hip!

Well, it's been awhile since I've checked in. My right hip has healed up really well. I still need to do some work on strengthening the external rotators, but other than that it feels better than new. Even the torn hamstring I've been flirting with since I overstretched jumping a hurdle at 13 has vanished. Better living through surgery!

The fly in the ointment is the left hip. It has been getting stiffer and sorer. To the point that, on Thursday morning at the end of yoga, I said to Zack that I'm ready for my next surgery. That we should manifest it to happen soon, so I can get it over with and move forward with two healthy hips. And what happens? Just got a call from the Joint Replacement Clinic, there's been a cancellation, and I'm booked in for Tuesday, March 4th. Needless to say, I'm a bit overwhelmed, but excited!

It's a little easier this time, having gone through and come out the other side. I remember how last time I just went to sleep, woke up, and it was done. How the pain after that was the pain of healing. I do notice in reading through my blog a hint of impatience, a soupcon of frustration. I'm going to try to meditate this time, to help with the acceptance part of my healing.

I've jumped through my hoops - got my lung, heart and hip x-rays, a blood test, talked to the pre-op nurse and pharmacologist. I've collected my sock pull, walker, reacher, high seat, crutches and toilet seat from the Sooke Loan cupboard. I've had the Last Hot Tub, the Last Yoga Practice, the Last Supper and the Last Glass of Red Wine and Square of Dark Chocolate. I have my pink sponges ready to go for the Last Shower. 

My bag is packed, the mattresses in the living room for the Last Family Sleepover. Tomorrow I have to be at the Royal Jubilee Hospital (the 'Jube') at 7:40am. Guess I'll be going into surgery at 9:30 or 10. Wish me luck!