End of Financial Year Craziness

And so it starts.  It is my busy time of year and the craziness has begun.  The next two weeks will really be a test of how rehabilitated I really am.  The extra days of work that I picked up about two weeks ago were to start the setup of a new digital setup for cut over at the start of the new financial year. The work that I started a month or so ago has all of the end of year things to do like payment summaries and the like.  Between the two of them, I'm busier than I have been in a very long time.  I'm trying to keep work on just the three days a week so I have four days to make sure that everything else gets done.  I haven't done so well yet as little things are creeping into other days as I'm capping out at about five - six hours of work in a day and some days I really need a little bit more than that.  Mostly this is because of the amount of data entry that I need to get done at the moment to set up this new system.  I don't think that my brain was working properly when I estimated how long the task would actually take.  My brain is getting back into gear as I get back into things.  It's almost there (the setup and my brain!) and I will be going back in tomorrow to keep working on it.  Tomorrow is expected to be a big day so today was a work day reprieve so that I could get a few other things done.

Today's big activity was grocery shopping, which I managed on my own.  I also got all of the groceries into the house by myself, put them away and then organised dinner.  It wasn't a full shop as it is an in between week, so I've started off a little easier on myself.  The last time I went grocery shopping, I went with my husband and he brought everything in so even though it has been less, I still did it by myself.

I'm still at six minutes on the elliptical today.  I was supposed to go up to seven but by the time I had the groceries away and had cooked dinner, I hit the wall and the second session only went to two and a half.  It doesn't sound like much but it is for me at the moment.  My cardio fitness is pretty disgraceful at the moment and will take a little while to recoup.  I haven't been able to do any real cardio activity for quite some time so I'm not overly surprised at the level that I'm starting from.  On the plus side, even though the muscles are fatiguing quite quickly, they are holding up to a lot faster movement than I expected at this early stage.  I'm not quite sure how the speed equates to walking due to the differences in the stride length but for me I think that averaging between 3 - 5 km/hr is definitely a great start.  If I can maintain this speed and improve my stamina, I think I would increase the resistance and incline as part of the program before trying to speed it up anymore.

I'm not quite sure what my walking speed is like at the moment and can't really think of a great way to measure it.  I had thought about using a pedometer when I go out to get a rough idea but it didn't really work out.   I tried using it around the house to count steps but it looks like I still have too much sway as it is counting too many steps.  I had wanted to record the number of steps each day to see the increase in my activity but it looks like it will have to wait for a little while longer.

Trigger Pointing Day

Just a quick note about my knotted glutes (ok I'm being a little more eloquent the other day) and the  adductors that were also *really* bad.    Trigger pointing at physio today hurt like hell but it was worth every single little moment where I wished that I had a leather strap to bite down on.  I felt l the most amazing kind of awesome walking out of there and the nice feeling has stayed with me throughout the day.  

I don't think that my husband could have handled inflicting that much pain to release those pesky muscles.  Only a true professional can do that!  (I know comments like that seem like an open invitation for comment but I'm tired, so please read only read it in the manner to which I mostly intended!)

Arrival of our Elliptical

This morning our elliptical machine arrived and I have already added it into my rehab program.  I need to start off pretty slow and five minutes a day seems to be enough to begin with today since I was in at work as well.  I've started off at the bottom two levels of resistance without any incline.  To start with, the aim is to use it to increase the walking type of activity that I am doing each day.  Though exaggerated, the elliptical is a more natural walking movement pattern than how I am walking at the moment.  It also seems to help loosen the muscles up to help get through the longer days.  I'm hoping that this is not just a result of the movement but a reflection of how the effects of exercise like this will now affect my overall health and wellbeing.  Pre-op, something like this would have me in pain that lasted for much longer than the amount of time that I had spent on it.  The difference between the grating that my hip joints used to do compared with how fluidly they move now. I still can't help be amazed.  I hope that I don't forget this feeling.

I'm hoping that within a few weeks, I have built to a half hour walk and my gait pattern and strength have improved enough to be using my cane all of the time (well at least for a couple weeks after that and then maybe not at all).

Pain Relief

I put up with the pain for over a day before I realised that I could take some pain relief.  I took an ibruprofen before bed and it seemed to help enough that I got to sleep and slept well.  I don't know why I didn't consider pain relief as an option.  The pain that I had wasn't one that I was used to or can ever recall having.  It wasn't that sharp pain that I was used to but it was still able to stop me from doing things - like full weight bearing.  It wasn't as bad as the old pain, even though it did hurt a fair bit, I'd describe it more as irritating and limiting than bad pain.   It was irritating enough that I wasn't able to get comfortable enough to sleep on Friday night and I woke on Saturday morning feeling pretty rough.  As the day progressed, things were a little better but by the end of the day I was pretty much back where I started.  

As I contemplated doing this all over again today, I was a little upset that I had taken what seemed like two big jumps backwards when I had been doing so well.  Now that it's been so long, I don't get much feedback to help me determine the improvements that I don't see for myself either, so the little that I do see seemed to be stripped away which is ridiculous since it was solved with nothing more than a single ibruprofen.  I'm someone that has dealt with far more pain than this for a very long time and yet this little episode threw me for quite a while.  It was just a bit of a reminder of what was and how uncertain the future is.  It's representative of change that I don't quite understand and don't quite know how to deal with yet.  I'll get there in my own time and until I get there people are just going to have to wait.

Overdoing It

Last night I needed to use two crutches.  I felt like my right glute was a knot of muscles and it hurt more than I've felt pain in a very long time.  It really hurt when I put more than about 40% weight on it and when there was no weight on it, it just was a regular type of pain.  That's the strong side that I don't normally use a crutch to assist, so I ended up back with two for a while yesterday.

How did I get to this point?
Well, probably a little bit of stupid mixed in with a little bit of stubborn.  After so many years of 'managing', I really thought that I understood my body enough to have a handle on finding where the limits fall on a day to day basis.  I thought that I had learnt the lesson to listen to my body a long time ago.  I was pretty good at working out how many spoons I had each day and figuring out early if I've dropped any throughout the day (Check out the The Spoon Theory if you don't know what I'm talking about!).   With change happening every day, it is difficult for me to work it out with any accuracy at all and because I want to keep pushing forward, we have the ingredients for a 'stop work'.

Today has been a very slow day.  Muscles ache and I'm limping pretty badly.  I have done my stretches today and some of my exercises but now where near the level of activity that I have been doing over the last few weeks.  Slowing down is not really that great for my mood.  I'm going to have days like this where it feels like I'm going backwards when I am still moving forwards and just need a break.  The last few days have been the busiest that I have had since the op and I did ok.

The burst of activity started on Wednesday when I went back to the office for most of the day.  I ended up being in there for about five hours which normally wouldn't seem like a lot.  It's not that I didn't notice before how much activity this new office requires because I did. How far things actually are, how many steps I need to walk up and down, the distance to the bathroom, driving home in traffic and where the car was parked were all part of the considerations to go back.  I was ready and it was a full day.  I didn't really think about how sitting for that long would affect me and I was really tired by the time I was finished for the day.  By the time I got home I was totally exhausted but not sore.

I slept well and started early the next morning.  Life is getting back to normal and I had to do normal things like taking my car in for service.  I could have done with another few hours sleep to recover from the previous day and my muscles were still tired and a little tight from the previous day.  I felt pretty good though and we headed out after dropping the car off.  We ended up walking around a shopping centre and looking at elliptical machines.  The first place that we looked at was a no go.  The girl that was a manager couldn't seem to comprehend that I was looking at the elliptical for rehabilitation purposes not for burning calories.  I'm not quite sure whether there was a subtle underlying dig there or not as she kept going back to increasing the heart rate and a proper work out.  It seemed like she might have been in love with her own voice to, though that impression really could have come from my irritation at being told that I needed to burn some calories more than I need to build up my muscles and get my hips moving.  I'm still on crutches and I made it quite clear what my rehab requirements were and it didn't sink in.  It is possible that she was just a bimbo and meant nothing by it.

We went to another fitness store and tried out quite a few of them out.  The guy there was able to listen to our requirements and help out without being insulting.  He was actually pretty cool and helpful.  I probably spent 4 or 5 minutes on different machines which helped loosen everything up.  I wasn't using any resistance at all and that was enough to start out.  We made the decision to get one and it gets delivered on Monday. The rest of the day included finishing off some more of the work that I'd started the previous day, baking and some more chores around the house.  I was on my feel for most of the day and was really ready for sleep by the end of the day.

Friday started with a hydro session.  It went for about an hour and a half which is the longest that we have had so far.  I felt pretty good when I got out of the pool but by the time that I got home, I was pretty well wrecked.   Hydro can kind of sneak up on you like that.  It doesn't feel like you've done that much until later.  Sometimes it doesn't even hit until the next day.  I thought that I felt somewhat rejuvenated later in the afternoon so I figured that I would start on the to do list again and headed back to the shopping centre to go to medicare and MBF to sort out refunds for the surgery.  This involved a fair amount of walking and where at some point I hit the limit and ran out of spoons.

I'm not sure if it was a cumulative effect of the activity of a few days in a row or just that one day with the extended hydro session.  It could also have been one of those unexplained losses of energy linked in with something completely unrelated to the amount of physical activity that I have been doing.  My body may have just decided that it wants a break, just because.

Regardless of what the reason is for my enforced break, it's where I'm at today.  Using two crutches and going as slow as I was a few weeks ago.  I'm better than I was when I went to sleep last night but the muscles still aren't happy.  My husband was some what amused by my request to massage my ass to try and get the knot out.  Amused but he still assisted.  I would have just about asked almost anyone to massage my ass last night.  There is no dignity when it comes to pain.

Improvements and Progress

I had physio this morning and we measured my ranges, as we normally do once a week.  It has been a little over a week this time since we did two hydro sessions last week instead of the usual program.  Today was all about trigger pointing to release some muscles, measurements, review of the land program (as opposed to the water) and practice walking with the cane.

There have been improvements on both sides, with the biggest ones on my right side.  My passive range of hip flexion on the right side has increased 9 degrees to 80 which I am really happy with.  This measurement is made with the left leg straight and assistance to bring the right leg up as to isolate the joint.  If both legs are at table top, the range is greater but it isn't an accurate measurement as it isn't just hip flexion.  The passive range is less as I don't quite have the strength to bring my legs to a tabletop position on both sides which would improve the 'active' measurements.   This is the only way to improve them as my knees are close to becoming the limiting factor measuring from a heel slide.   On one of the measuring days, my knees and muscles surrounding them were really tight and before we used trigger pointing to release the IT band, my active flexion range was about 5 degrees less.

It's the muscles that are limiting the range now, not the actual joints.  My physio program aims to improve strength and flexibility over time.  The ranges that I have in all directions are better than I had pre-op, so the muscles that I am working to grain these ranges haven't been used for quite some time.  The only range we aren't measuring is adduction as I'm not particularly comfortable with that range.  I think this has a lot to do with 6 week restrictions not to cross the mid-line.  I'm not entirely convinced that it is completely muscle discomfort either, I think that my brain learnt during that six weeks that it didn't like that movement as my hip could pop out and it's taking a little while to get over that.  I didn't just learn this because I was told, for at least the first few weeks, if I accidentally moved my leg too close to the mid-line, it hurt and the hurt was a bad pain that was quite clear that it wanted to be avoided.   It still feels like it wants to be avoided though not with the same level of pain feedback so I am taking it slowly with exercises in this range.  I'm ok with that range taking a little bit longer than the rest.

Surprisingly, the muscles on my right side are starting to loosen up a little bit and it's the left side that's playing at being tighter now.  Maybe this has to do with the different muscles used while driving, since that's one big change since the last time we released everything using trigger pointing.  The clutch movement is very different from moving between the accelerator and brake.  It's not really a big deal, it's just interesting to try to figure out what is making differences.  The main reason that I know what side is tighter, is that is the side that hurts the most to release and so by contrast feels more amazing after the muscles are released.

Walking with the cane is a lot more difficult than crutches.  I practiced for quite a while today.  The movement is not natural at all yet and will take a little bit of time before I move to using outside of the house.  The cane shows just how much weight I am still putting through the crutch and at what point the pressure is being put through it.  Even though I can feel where I'm going wrong, I can't quite figure out what muscles aren't firing the way that they should.  To help correct, we are practicing with exaggerated movements and have filmed me walking so I can see what it is that I can feel so that I can try to link the two together and get things working properly.

It feels like I have had another big burst of improvement over the past week and it's spurred me on again.  Things felt like they were plateauing and I was having difficult staying positive and on task with everything that needs to be done.  From what I've read, it seems this is a normal part of the recovery process.  Some days are just harder than others and you need to just push through as some day soon there will be a massive boost which will restore your faith and move you a lot closer to your goals.

This is the first week that I'm going to pick up some more work.  Depending on how worn out I end up for the next few days will influence how many updates there are between now and the weekend.

My Walking Stick

After my conversation with Reese at Hydro last week about moving to a cane / walking stick, I figured that I would get one of the cool ones that I spoke of way back in March when I saw a girl about the same age as me with one.  She had the one called Poppies.  I liked Bubbles (like the picture here) and called around the retailers to find one in stock.  The company that makes them is called Switch Sticks and you can buy from them but they don't have an e-commerce site, it's the old school print and fax the form.  Besides, I really wanted it today so I could take it to physio with me tomorrow.

In the search I found that there was a little gift store just up the road from where I am doing some work at Milton called Michaela's Gifts and Homewares.  (Couldn't find a website but the link goes to the True Local Listing).  It's a great little place that I will go back to the next time I'm looking for a little gift for someone that is a little bit different from the everyday.  There are a few other gift type stores that stock these canes around the places that I travel, though none had the Bubbles design that I could look at as I was pretty sure that was the one that I wanted.

I have had a go walking with it and it is a lot more difficult than using the crutch and will take some practice and strength.  I can feel that it is the next progression from a single crutch before walking unassisted.

What the BMHR's look like / Where they are now

I have digital copies of xrays that were taken on the day of my surgical review.  I can open them in a piece of free software called OsiriX and export them into a format that I can open in photoshop to remove the pieces that I don't particularly want to show everyone.  I've also rotated the image so that the left is on the left (which probably doesn't make sense - but hey I'm new to this and am having fun playing!).  When I have a bit more time I'll have another go at getting some clearer copies up that haven't been cropped so tightly (that was to hide the outline of my body, which I'm sure can be removed with a little bit more work.  This process also had the side effect of darkening the detail of the femurs, so I need to go about the process a little bit differently).  In the meantime, I thought I'd upload something so you can see my new parts in place!

Back to work planning

Today I went into my old office to plan going back.  This is a little bit more complicated than just going back to work since I don't really have a full time job to go back to.  This was one of the reasons that we decided to have the operation now.  There may be some opportunities to increase my work load but it really will be a case of wait and see.  To start off with I am increasing my one day to three days a week and starting a new project.  In a lot of ways it's good because I can go back sooner than I would had I been trying to go back to a full time position.  I'm not sure I have the energy yet for a full time job as well as the rehabilitation exercises that I still need to do.  The positive side of this arrangement is that I have all week to get everything done.  About 25% of it needs to be done by Wednesday and ideally I would have it all finished by then but I do have some room to juggle things around a bit.  The juggling room will let me make sure that I get all of my exercises done.  I know that I have more activity on the days that I go out but this doesn't cover all of the muscles that really need to be worked each day.  I've heard stories of people that don't continue with the rehab and are limited because of it.

I'm at 10 weeks post op tomorrow.  Statistically 80% of the improvements happen within the first 12 weeks, so I really need to make sure that I follow the program and stretch it out.  I guess it is all averages out though and there are a lot of people's stories that I have read who are up an walking a few miles within a month.  Surely that has to sway things the other way a bit and I'm just on the other side right?  The ones that still see steady improvement over a longer period of time in the beginning.

I'm not sure if it is my imagination or whether there are some real changes in the last few days.  I'll ask Reese when I see him at hydro in the morning.  Today I felt good so I know that I can push a little bit more in the session tomorrow.  The knot in my shoulder has almost worked it's way out and my burn doesn't hurt anymore so it's been a good day.

Back to Hydro

Now that I am back driving, I've started hydrotherapy again.
The weather is cold but the pool is inside and the water is heated.

The session was awesome.  The feeling of walking in the water is amazing.  The movement is fluid, there is no joint pain and it really does give me an idea of what things will be like on land very soon.  I'm due to go back again on Friday.  I'm going to have a break from the pool tomorrow and head into my office and organise when I'm going back to work a few more hours each week.  I'm hoping to soon be strong enough to go to the pool each morning for an hour and then head into the office for a few hours each day.  

I think that the pool exercise will help get to the next level of strength and ability pretty quickly.   We started off pretty slow with marching laps forward, backwards, sideways.  There was also bicycle like exercises and heaps of stretching.  I also got to jump which was pretty cool.  I was in the water for an hour today and felt really good when I got out.  I'm not sure if the muscles will be a bit tired still tomorrow but they are doing pretty well at the moment.

I have managed to get a knot in my shoulder which I am trying to work out using a trigger point ball.  That's pretty much the only thing that hurts and I have absolutely no idea how I've done it.  Between that knot and a burn on my finger (stupid cooking accident) it really does look like things are getting back to normal!

I can drive again!

Today my sister came and picked me up in my car and we went to the ring road on the Griffith Uni campus which is pretty flat and very quiet on non-uni days (it's a public holiday here today).  I wanted to get behind the wheel on a flat road with little traffic to see if I could drive.  I figured that the low speed limit and the speed bumps would give me a chance to change gears quite a few times if I did a few laps.

When I got behind the wheel and started to drive, it felt normal and I didn't even do a lap, we just left the campus and headed out for lunch.

After we got home, I called a friend and headed out again.  This trip I went on the freeway with the music up loud.  It felt like freedom.  It felt like life was pretty much normal again.  Ok, so I still need at least a single crutch (and two if out in public) but for those few moments when I'm driving, I'm in control of my life again and its starting to seep into my general mood.

This could be the start of the next step of the rehabilitation process.

How did you get here and did I answer your question?

An interesting side effect of blogging has been checking my statistics.  I find it interesting to discover where you are all coming from and how you managed to get here.  I have been involved in Internet and associated businesses (starting out in dial up sales and support) and though I've always had an interest in all things Internet, this is somehow more interesting to me.   I think mostly because it's personal.   I'm actually curious about the people that are visiting my site and the reason that they were here, what they were looking for and if I was able to help them.  The personal reason for this blog is to share information about my hip replacement with people who are maybe thinking about getting one or have had one and are looking for other people out there and how they are going.

Looking at the search terms and the pages that are viewed, I can get an idea of what people want to look at and address some of these areas in more detail in later posts.  Right now I think I am missing out on a post about recovery time and a few other topics that I haven't really gone into great depth about my thoughts or feelings on the topic or really where I think I might end up and when.  Stats aren't the only way that I've realised that there is a lot more of my story to tell.

I've had some awesome emails with a few suggestions which have helped me think a bit more about a few things relating to how I feel about where I 'm at.  It's true that I have tried to be probably a little too positive with some of my posts and this isn't always exactly how I'm feeling. Some of the people who know me well have been able to easily read between the lines, where other visitors don't have the benefit of that insight.  I have wanted to make this blog a fair representation of the process and how I have worked through it to get my 'better life' and there are some things that are missing.

One of the things that I've been asked is if I ever get into a rut because my posts seem a little 'too positive'.  I'm going to just paste part of an email I wrote in here as it sums it up pretty well:

I do get into a rut sometimes and get sick of the whole thing.  [......]  Things are up and down and I find that when I start to write it out, I become more even which is probably why things read more positively.  When it's still all in my head, I kind of get into a bit of a downward spiral sometimes where I can't actually think about anything good that has happened.  When I go to write, I'm forced to think of at least something that has changed or improved or I'd have nothing to write about.  In a lot of ways, having the blog has helped me get through this process.  

I think that I have written some rather insightful emails to my blog visitors and my friends since I've had the operation and I think that maybe my blog could benefit from some of these personal insights that I had on days when I haven't blogged.  I'm not quite sure yet about the best way to add these in.  I'm thinking that maybe I'll summarise their questions and post my responses.  I'm thinking that I might tag as "Correspondence" and if it ends up being interesting, adding a page for these posts.

There have been a couple of reasons why I have tried to phrase things a little more positively at times.  One part is that some people know who I am.  Who I am or who I think I am often contradicts some of the thoughts and feelings that I have had throughout this process.  Sometimes I think I made a mistake in publicising where I would be telling my story because I have edited some of the things that I have said and tried to make my thoughts sound more positive than I was really feeling.  On the other hand, the Internet is forever and editing those thoughts that will be around forever may not necessarily be a 'bad thing'.  I can always come back later and tell the parts of the story that were too difficult to tell at the time with the insight that a few more days or a few more weeks has given me.  Since I received the question, I have thought a bit harder before editing my thoughts as much.

Another reason is that I still believe that when I get through this rehab process, things will be better than they have been for a long time and this perspective looking back will benefit others.  I have a number of drafts from earlier posts that I have kept shelved for the time being, that I hope that I will gain some insight or perspective or just some point for them so that some day this blog is a full accounting of how this chronic disease has affected my life and how hip replacement has changed it for the better.

Going out for Lunch

Today and yesterday, I went out for lunch.  It was good to be out, even in the cold.  A change of scenery for a little while has been good for my mental health.  I'm becoming a little too comfortable staying at home and need a little nudge in the direction of living life on the 'outside' every now and again.

Today was a bigger day with a lot more walking.  We headed to Garden City for lunch and after eating, we went for a walk for the length of the centre and back.  I'm not quite sure what the distance that I walked was but it was pretty decent amount for a single trip. I was tiring about two-thirds the way back to the car but we had planned a stop for cake and coffee on the way back and it was just about at the right time.   I think that I could have done another trip about the same distance after a bit of a longer break.

I also had a go at an elliptical machine and a recumbent bike to see what was possible at this stage of the rehab process.  The bike is out for the time being as the flexion range isn't comfortable and it is difficult to get my feet in the pedals without assistance.  The elliptical was really good.  It is a little difficult to get on to, though possible and no more difficult that getting in and out of the car.  The movement is smooth and could be a good way to increase my activity levels.  Walking is cheaper and just as good an option, though I'm not really confident enough to go out walking on my own especially with how hilly it is and how few pathways there are around here.   I have been thinking about it for a little while and still not sure which way is the best way to go from here.  I need to up the activity a bit more but I don't think that I can walk around the house anymore than I already do.  It takes a lot of loops around a house to do the distance that I did today and I'm not sure I can do that around the house.

Tomorrow I'm going to try to drive.  My sister is coming to take me to a parking lot so that I can learn to drive again.  I'm not too keen to try and take the car out of my driveway here.  I'm just a little bit concerned that if I'm not ready, I might end up rolling into the garage door or maybe the house at the end of the street.  I'm sure that it won't be that difficult, I think that I have the range, reflexes and strength to use the pedals and once again it's just confidence.  It seems to be that's what is lacking at the moment to take things to the next level.  I'm just not quite sure how to get that back.  As the weather cools, I seem to becoming even more comfortable staying at home which really isn't a good thing.  Everyone is busy getting on with life, it's just seems easier for me to stay here.  This really isn't the right attitude to move forward but right now that's just how it is.  There needs to be some change or catalyst to get me out of this slump.  I'm just not sure what it should be.

What else happened on Game Day?

After I posted my Game Day post, I was called into one of the offices to have a final meeting with the nurse who was organising the last few details that needed to be covered before I went in for surgery.

This was mostly administrative.  All of my details were checked and I was given a red hospital band for each wrist that had all of my personal details on them.  It was red to indicate that I had allergies (alcowipes and fabric bandaids).  Apparently I had one for each wrist for easy access to my details while I am in the operating theatre.

I was then given a bag to put my clothes in and was told that I needed to have a shower with special soap and get into a hospital gown, booties and a cap and moved into a waiting room bed.  My husband was allowed in this room with me and we had a few minutes to chat before they wanted to wheel my bed to the theatre waiting room.

In the theatre waiting room, I was introduced to the anaesthesiologist and her assistant.  The next level of prep was to put me underneath a 'huggie blanket' that pumped hot air around me to raise my body temperature.  With the longer surgeries one of the things that they need to keep a close eye on is body temperature dropping.  Apparently by starting warmer, the risk drops.

As I lay waiting, slowly getting more toasty warm, people would come past and put different things on the end of my bed.  There were leg gutters and the foot pump machine and another blanket.   I didn't know what the gutters and the foot pumps were about until some time later.  It all seemed a little bit surreal.

The surgeon came in to have a quick chat too.  We talked about which side I wanted him to do first, the one that was causing me the most pain and went through the reason that we needed to make this decision before going in.  After the first one is completed, the surgeon and anaesthesiologist make the decision to continue making sure that I am doing well under the anaesthetic and any additional risks or concerns are assessed at this time before they cut the second side and get started.  He marked both legs with a marker pen indicating that I had chosen the right one to be done first and said he'd see me soon.

The anaesthesiologist came back and put a arterial line in and told me that we wouldn't be too much longer.  Not long seemed like a very long time for me.  I didn't have any of my personal belongings so I couldn't read, my husband hadn't been allowed in this area, so I had no one to talk to.  I was too wired to sleep so that was out.   I wasn't nervous, just ready to go in and get things going.   I resorted to eavesdropping on the nurses conversations to keep myself occupied.  Not the most ethical activity but my brain was buzzing and there wasn't much more in this sterile environment that I could do to pass the time.

After cooking for what seemed like forever, it was time to be taken into theatre. I was wheeled in and shifted over to the theatre table.  Everyone seemed happy and cheery and I took that as a good sign.  The operating table was covered with an air mattress type thing making it strangely squishy.  The thing that surprised me was how small the table seemed.  I still haven't figured out how the whole process went as far as how I was positioned for the surgeon to work on me and whether I actually lay on one operated side as the other was completed.  It's another of those questions that I really wanted to ask the surgeon but think it's probably a little silly to want to know these kind of things and keep my mouth shut.

I sat on the side of the operating table as the theatre assistant stood in front of me explaining that soon I would be given something that would make me feel a little drunk and not too worry, he would make sure that I didn't fall off the bed.  The fluid was injected via the drip on my left arm and I started to feel a bit more than a little drunk.  The feeling was quite pleasant and they spoke to me, keeping me in the loop about what was going on.  The spinal was next and I recall leaning forward with the theatre assistant making sure I didn't fall forward in my drunken state.  I don't remember it actually being put in.

The next thing I remember is waking up in ICU.

Best Wishes to Tony for his total hip today!

Just a quick message to send best wishes to Tony who has had a total hip today.  He should be safely tucked in after a successful surgery earlier today and getting ready to start rehab to get his life back starting tomorrow.

Hey, I think that my blog Has MADE IT!!

I have recently received my very first SPAM COMMENTS!!

The spammers are praying for my recovery and if it doesn't go well they'll apparently help me out with a lawsuit with a click the link for all my visitors to help them out as well.  Isn't that nice of them.  They had gone to the trouble to create a blog with lots of information to scare the beejezus out of anyone considering hip resurfacing and MOM implants on one hand and the offer of legal help on the other.

Now obviously my blog does not support these scare tactics and have deleted the comment.  I support McMinn's conclusion that the ASR was not a well designed device and it shouldn't be a reason for people not to consider MOM implants as well designed devices installed by excellent surgeons are long lasting and change lives.

I understand that some people have had horrible experiences with this surgery, though these are relatively few compared with the number that have successful outcomes in the longer term.  I feel for those that have had difficulties and wish them well with their revision surgeries and their futures.  I am sure that they have the information that they need to do what needs to be done without the ambulance chaser posts that my blog is attracting.  I am curious to know how they found me.

The novelty of spam comments has worn off now.  I don't want anymore, please.

GP Checkup, Bad Seats and Regular Days

The last few days have seemed busy even though I really haven't achieved a whole lot.  I couldn't even tell you when the last time was that I wrote a blog update without checking.  Hey, it was that entry Pain management: in the beginning - that still needs to be finished!  There is so much more to add and it seems like most days I'm just too busy to sit for a few hours and get the details down.  It's a little odd considering that I haven't really been anywhere for ages.  The every day bits and pieces haven't really been covered for a little while either and there are a couple of things that have happened that rate a mention.

Physio on Friday was good.  It wasn't much of an exercise day as we focused on releasing some of the very tight muscles that had been driving me crazy.  Even though I had been trying to release them myself, I hadn't quite gotten to where I needed to be and needed some extra help to get there.  I felt a hundred times better by the end of the session.

When we did the range measurements for hip flexion, it was actually my knees holding me back in the active range.  Once we released these, I ended up with an extra 5 degrees more than the previous measurement.  (If you need a visual on this one to understand what on earth I am talking about:  Laying on your back, slide your heel up towards your bottom making sure that your pelvis stays straight - so other leg straight and level on the bed.  The active hip range is measured in this position.  The passive range is measured by having your leg lifted to table top and moved towards your chest.  For me, there is a few degrees difference between the two)

So while all this was going on, the landline rang in the lounge room which is a fair way from the bed where I was getting measured.  I elected to ignore the phone as the only people that have it are the hospital, the red cross and the alarm company and I could see no reason why any one of those would be calling me since I've been to my post op appointment, spoken to the red cross in the last week and I was in the house so the alarm can't have been going off.  After it stopped ringing, my mobile rang.  It was the alarm company.  They were just checking to make sure that the alarm was still working since it hadn't been armed in such a long time (maybe two weeks).  We had to go outside the house and arm and disarm while I was on the phone so that they could confirm that it was all working properly.  How very embarrassing.  A reminder that I hadn't gone anywhere in two weeks.  Hopefully I'll be driving myself soon and will be a little bit more independent.  Even though I am quite comfortable at home and can fill the days, I think that getting out a bit more would probably do me some good.

I didn't really do anything out of the ordinary on Saturday.  It was a day for sleeping in, getting my exercises done, making sure that I did a few extra trips up and down the stairs and I watched some tv.  My husband was at home but unfortunately he had to work most of the day so I was pretty much left to my own devices.  

Sunday we went out to lunch at my mums place.  It's the longest car trip I've had since pre-op and it went ok.  The seat that I sat on for lunch wasn't really that great though and I came home a little bit tired and tight.  This probably wasn't just a bad seat for me but more that since I went out and it wasn't an activity where I had to walk very far that I didn't have the same level of activity on that day.  I am used to doing a far bit now, even if it is just around the house and a day where the activity levels drop seems to make more of a difference than I thought.  I still only needed a couple of Panadol Osteo to sleep, so I guess it wasn't too bad.  I'll have to make up for the lack of walking today.  

Today I had a GP checkup.  Primarily it was to sign some paperwork so that I can get some extra physio rebates from Medicare as I have a chronic condition (I'm sure you've figured this out by now!). While I was there I checked on my blood work (all good, inflammatory markers a little high but nothing that wasn't expected), got a flu vaccination and went through the changes / improvements since my last visit.  The doctor seemed really happy with my progress.  He has seen some bilaterals before so I guess he has some basis for comparison.  The main changes to report were the lack of medication required, using one crutch most of the time, hip restrictions gone and improvements in ranges.  

Things feel like they are going so very slowly at the moment.  It feels like the improvements are slowing down.  It's hard for me to see the differences between each day as it is taking more than a day for the differences to add up to something substantial.  The last big one was being able to balance on my right leg.  I'm not sure that there has been anything new since then.  

I suppose I could say that sitting on a regular toilet seat and managing to get back off it was an achievement.  I'm not sure if I could have done that a few weeks ago (I wasn't allowed to try until I got off hip restrictions anyway).   I thought I would give it a go on one of my trips downstairs to practice stairs.  Since it has been two months since I sat on a regular low toilet, I really had forgotten just how low they were.  I'm not sure who came up with that idea but it truly is crazy.  The height I have now (with the over toilet height adjustable seat) seems far more reasonable.  I guess I will have to practice and get used to it the more I am gong out in public though.  I wonder if getting on an off the toilet could be classed as adding an exercise to my day?  I suppose it could be if I drank a lot of water, right?  Anyway, it was just as well I had practiced before we went out on Sunday as I was prepared to use a regular height toilet and it all went fine.  Sometimes I really do wonder how it is that everything seems to end up a conversation about toilets these days.  

I fit into my regular size jeans again.  This means that the swelling has gone down and my thighs have returned to their normal size which is positive.  The knees are still swollen and really should be iced but it's too cold! I know I'm a wimp.  Strange really that I get through a massive surgery like this and what I want to complain about is that it is too cold to ice my knees!  Some would also say that it really isn't cold in Brisbane but it is to me as I've lived here for many years and am well adjusted to this climate.  I really should do it in the mornings when I'm sitting out the front in the sunlight drinking my coffee.  It probably wouldn't be too bad then.  Maybe I'll try that one out tomorrow and let you know.

The big exercise for today will be grocery shopping this evening.  We need fresh food.  There is half a lettuce and two carrots left in the fridge and I really feel like a big salad for dinner.  Even though we really only need to go to the fruit and vegetable section, I think I'll need to go down as many of the aisles as I can because I need to know if I can get any further than I did last time.  I think that I'll still take the wheelie walker in case I need a seat.  There are some seats in the centre of the complex, outside of the supermarket, so maybe I could take my crutches.  The crutches are definitely more comfortable to walk with but I'm not sure on this one.  I might have a chat to my husband and see what he thinks.  As in, if we take both and I use my crutches and I think I need the wheelie walker will you go downstairs and get it?  or can we take both and you push the wheelie walker until I need it? Not sure how this will go down.  It's worth a shot though, right?  If I'm not completely wrecked by the time we get home, I'll update this post.

My History and Pain Management: The Beginning

In the beginning, the pain was bad.  In my eleven year old experience, there wasn't anything comparable.  Not even when I needed seven stitches and they had to scrub the gravel out of my knee when I was ten was that bad.  It started off in my right hip and soon after I wasn't able to bear my own weight on my hip joints as it hurt too much.  When I was first hospitalised, I was put on high doses of asprin as even though they had a fair idea of what was wrong with me, there were a number of things that needed to be ruled out before they could treat me with arthritis drugs.  I guess the asprin helped to some degree but it also put trains in my head.  I could hear them above all else choo chooing their way past my ears.  Over time, a diagnosis was made and I was put on prednisone and Voltaren.   Other drugs were trialled in the first year.  I don't remember all of them.  The one that I do remember was something called Intragam that was a blood product that was supposed to help fix whatever was wrong with my immune system.  It was a series of infusions that I had to go back to hospital to have.  I don't think that any improvement was associated with this treatment as I only had one series of them.  My condition was pretty nasty for about a year.  Prednisone and Voltaren were prescribed.  For the first year I relied on a wheelchair.  In the very beginning and for the first six months or so I couldn't bear my own weight.  I could take a few steps but I would need to be supported or learn on walls or other things to help take some of my weight.   After then, things started to get a bit better.  After about a year I had the strength to walk again.  I'd never run any marathons (or any race really) but I could get around.  At about that time,  the meds managed the pain reasonably well.  I had good days and bad days and over time the good ones outweighed the bad.  I don't remember any really bad flares after then.  I didn't miss out on much at school except for sports and I can't say with any certainty that I was disappointed.  It just isn't something that I remember.

I ended up on Voltaren as the longer term solution.  The next decade went pretty smoothly and the meds dropped to 50mg once a day.  I knew when I missed them but otherwise there was nothing to really complain about.  I misbehaved like most 17 - 19 year olds (Actually this probably went on until at least 21 if I am going to be completely honest).  I think that the Voltaren did it's best work with the sore muscles and bruising on my shins from being pushed up against the speakers on the stage on Friday and Saturday nights in the mosh pit at Her Majesty's Bar (only when Blah Blah Blah and Alimony were playing - was almost my whole 18th year out on the town).  I wasn't any worse off the next day than my healthy flatmates.  Sometimes I think I even fared up a little better.

You can't be 18 forever but life really didn't change noticeably until I was about  22.  It was about then that I started to need to increase the Voltaren to 100mg a day every now and then to accommodate for the times when things went wrong and I didn't pick where my limits were.  It only really occurred if I overdid it and mostly I was pretty good at managing my days so that I didn't push it too far and ended up in pain.  My range of movement had started to slowly diminish and the limits that I had were slowly decreasing.  It wasn't anything that caused any huge disruption to my life and the things I wanted to do, I just new that things were changing.

About ten years ago now, a friend of mine had been telling me about this fantastic Physio that I just had to go and see.  He and his wife had fantastic things to say about this guy.  I was skeptical.  I had been to see physios before.  They were there to make sure that things didn't get worse.  There to make sure that my range of movement didn't decrease anymore by doing one boring exercise after another.  Physios meant splints to make sure my joints didn't get anymore deformed. It was the same thing over and over.  It almost seemed like giving up.  I did have some lovely physios when I was in hospital as a child but I didn't see positive results.  Or at least not positive enough to remember when things were so horribly painfully.  Unfortunately, at that time in my life, there probably would have been very little that brought positive relief to me.  Managing my condition at that time was about making sure that the active disease left behind as little disfigurement and damage as possible.

I don't even remember what prompted me to actually get over my preconceived ideas to make the phone call to make that very first appointment.  I guess to some degree I was curious as to what could possibly be different about what this guy did that was any different to make so much of a difference to my friend.  The concept of life being better for my friend was enough of a lure to at least try.  I wasn't completely convinced that anyone could do anything to help me feel any better.  I was living the best life that I could.  There was pain and limitation and I did need to make accommodations but life was good.    Besides, it wasn't my muscles, it was my joints and the damage left behind from it's earlier activity.  What good could more exercise do since I was fairly well adept at managing myself to the limits.  Oh hell, what was the harm in trying.  Even if it didn't work out, at least I'd tried.

I don't even remember that first appointment at all.  Something must have made me trust that this was something worth doing.  Something must have at least dented my preconceptions about what physio was and what more it could possibly do for me.  Over the space of the next ten weeks, Paul worked on releasing the muscles and connective tissue.  I'd walk out feeling like I was floating or walking on pillows.  I didn't realise until then how much of my pain wasn't actually my burnt out joints, but the muscles surrounding them that were so tight, a tight that couldn't really be stretch out due to joint limitations and the limitation of my knowledge of my own body.  By that point, I too referred to him as magic.

After a few weeks, inspired by some pretty amazing improvements in my range of movement, posture and overall positivity and feeling of wellbeing, I decided that it was time to check up on everything and I went in search of a new rheumatologist.  I'd booked an appointment soon after my trip to Melbourne for a conference.

By the time I went to Melbourne, I had been to about six extended sessions with Paul.  Coming back, I happily reported at how much more free I felt, how much further I could walk without pain, how far the 'limits' of my days had been reduced.  In just six weeks of treatment.  I wasn't ever going to get all my range of movement back as the joints were just too damaged but some of it was returning.  The most I could get out of life was so much more than I thought it was.

This really was the beginning of a whole new story.

To be continued....

Pain Management and Healing: Part II

After the abysmal failure of oxycontin and endone, a solution of ibuprofen and panadeine forte was suggested (all at the highest possible daily doses).  I was a little scared of the ibuprofen as some of the nurses had gone on about it upsetting my stomach again.  I was already on maxalon to stop vomiting and I didn't want anything that could start that again.  I asked the doctor if I could take the Voltaren again instead.  One said yes, one said that the Voltaren was more harsh on the stomach.  The reason that I had asked is that I new that I didn't have any adverse affects to it and while I was still in a paranoid sick state, I really didn't want to take any more risks.  In the end I tried it and it was ok.  I was still on the maxalon for a while as I still had nausea problems when I ate (though that very well could have been a problem with hospital food - not actually meds or illness).  Together the ibruprofen and panadeine worked out and there weren't any further adverse reactions.

There was some other drug that I could try if this didn't work out though from what I can gather the back up plan wasn't a favourable one.  In the beginning as I got closer to the times when I was due to have medication, I would wait on it.  I knew when it was due as the discomfort was increasing.  I never waited so long that it was unbearable, though there was one day when they were just over an hour late and I was stuck in a chair in my room when I really was ready to press the buzzer again almost at the point where I thought I couldn't handle it anymore.  I still wouldn't say that the pain was high on the pain scale, maybe a five, but I was exhausted and I felt like I didn't have the strength to hold my body up any more and everything was uncomfortable and I wanted to move but I couldn't.    I had learnt the hard way that the doctors were right, staying on top of the meds at that point was important to my rehabilitation.  There was no way that I was doing anything that afternoon for at least three or four hours while I rested and got on top of things again.  Normally I would have done another set of my physio exercises.

In the last week or so we started to cut down the amount of codeine that I was having, so the panadeine forte was changed to panamax and codeine tablets.  I didn't notice a huge difference.  During a big rehab day, I'd say I was more aware of the joints but overall I wouldn't say that the pain had increased.  There certainly wasn't any sharp pain anymore, just occasionally a dull ache which was only a one or two on the pain scale and significantly less than what I was used to pre-op.  I had started to be able to stretch some of the muscles a little and as my overall wellbeing improved, my confidence in my body also started to improve.  I think that this was the turning point for getting results as I was less tentative in trying to trigger point tight areas (obviously within reason - I wasn't digging into the wound just yet) and moving more (within the range of restriction).  As muscles loosened, I felt that I could do more and it felt like the joint was moving more freely and with more control.  Exercises like heel slides on the left and abduction were still difficult to start off but I could do a lot more without assistance and I could now visibly see some definite results.   The more I could do, the better my body felt.