Guarding my thoughts

Today I didn't make it into the office.

I made it as far as Physio and to one of the venues to pick up invoices and then I went home to start work on them.  I wasn't up to going in today.  I'm not sure if it was the thought of the chair and table that I am using until the person using my desk full time moves into their new office or whether it was inevitable questions explaining how the work I was doing actually fits into the grand scheme of the businesses' future plans that kept me away.  Perhaps it was a combination of both.  

I started off the day with a headache and it didn't really ease until later this afternoon.  My range measurements didn't improve this week either, so not only was there pain there was also general grumpiness and a little despair at the plateau that I've reached.

I've been thinking a lot about that plateau today and have started wondering whether I ever had greater hip flexion than that.  I'm currently at a passive range of eighty degrees but I'm not sure when it was ever better than that.  Maybe it hasn't been since I was a child.  In that case, it's going to take a hell of a lot more than three months worth of stretching to bring it back.  I guess because the abduction range came back immediately, I expected the rest to follow suit pretty quickly.  Under the guise of pain, there were a few tears at Physio today.  You can kind of get away with it when you have your head in the hole and it you are involuntarily jumping each time the pain is sharp.  It probably helps that I'm a girl too.  A little more socially acceptable.   Not that anyone would say anything negative, I'm sure that they would be a great support, it's more that I don't really want to share some of these thoughts.  Not until they've been processed and I can decide how I want to deal with them.  The crazy thing is that is probably the place where how I'm feeling would be understood the best.  

I think the abundance of people who ask but don't want to really know have made me a little more guarded about discussing it especially when I am having a bit of a tough day.  I read a blog a while ago about a girl that had a total hip and wrote a blog.  She stopped blogging when someone made a comment about how that was all she ever spoke about.  It feels like that is where people are at now with me but they just haven't said it yet.  The thing is that this thing is still the central point in my life at the moment.  My whole world revolves around my rehabilitation and the distance there is still to go.  I don't have the energy for too much more than that.  It might seem like I'm projecting that all is good but this doesn't mean that I'm ready to take on anything more than I am right now.  As it stands, I think that I might have too much and I'm not making enough time for all my exercises, that somehow I should be doing more of them.  I worry that this could be part of the reason that I've hit the plateau.  These are just more things that people don't want to know.

I don't know why I thought that this would be any different than talking about the arthritis.  I didn't talk about that too often because those who haven't dealt with it before don't understand living with a chronic condition.  This is an extension of that.  Just because I want to talk about this massive change in my life, doesn't mean that others aren't sick of hearing about it.  I'm thankful for those that have been through this process and those spoonies that can understand.  Even when I have finished rehab and life is better than it has ever been, I'll probably still want to talk about them.  I guess I'm going to have to find some new people to talk to.  Ones that are interested in resurfacing, replacements and MOM joints.  I guess there will always be a place for me at Surface Hippy.  I'll also be able to blog.  People can choose to read or not.  If they don't, well they don't need to hear my hip talk and the important changes that are going on in my life. 

In an attempt to feel like I have achieved something today, I've increased the time on the elliptical today to nine and a half minutes and 500 metres.  I'm not sure how that will treat me tomorrow but I really needed to increase and improve something today.  I feel ok so far so hopefully it will be ok.  If I'm doing well tomorrow, I might try to add another minute and a half.  

Aside from exercise and Physio, I had a little bit of work to do today, though nothing was time critical.  It was more getting a bit of a start on the work that needs to be done this week.  Tomorrow is the time critical day which I already have a good start on.  As for the rest of the week, I guess I will work out as it progresses.  

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.

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.

Pain Management and Healing: Part I

I have touched on the issue of pain management in some of my other posts though the issue really does need a bit more attention as it really is a major issue in my history, decision making process, post operatively and even now as I am on the recovery path.  Since I've been asked recently about my current pain levels, I'll start with the present and work my way backwards.

Today, I'm taking Panadol Osteo at night before bed.  It's nothing really.  I've gone without it for a couple of nights in the last week or so as well.  Since I've been home, I've been choosing the level of medication that I require on a day to day basis.  After two decades of managing pain I get it right most of the time.  Throughout the rehabilitation process they tell you it's important to stay ahead of the pain as it's more difficult to fix the problem after it's gotten too bad.  Bad pain also restricts the amount of exercise that you are doing which can delay recovery times so it makes sense to manage the medication carefully.  On the flip side of this, I want to be off medication.  Being off anti-inflammatories was one of the hopeful outcomes for the surgery which I have now met so I've moved the goal posts a little.  It won't be the end of the earth though if I need to take two panadol at night for the rest of my life.  It certainly is better than the other meds that barely managed the pain pre-op.

The pain I have now is only muscular.   The joints don't hurt.  They move freely and don't grind or stop me from moving.  I'd say that the pain that is left is probably similar to work-out pain (without straining anything).  If the worst pain I had pre-op was a ten, I'd say today was only one or at most a one and a half. (I'm sure that there are things more painful that my worst flare but for the sake of the scale, I'm putting the worst one up the top end and working down from there)  I'm completely worn out and everything feels fatigued but it isn't real pain.  There is the friendly muscle ache going on letting me know that I did work hard today and my body really has had enough for the day.  Every now and then it's a little sharp if I sit too long and stretching and moving will help release it out.

A lot of the exercises that I am doing are to build the hip flexors and hip stabilisors.  To work these a lot of other muscles are getting a work out as well.  Pretty much everything around that area needs to be stretched out as it gets tight.  The adductors are some of the worst offenders.  Gluteals, quads and hamstrings are pretty close behind.  The muscles that are above the top of the pelvic bone on the right side are getting a bit of a look in at the moment too as I am practicing walking on one crutch. Knees ache and are swollen a bit more than normal.  They are getting a work out too given my gait has changed as I'm straightening up and not compensating as I used to pre-op.  As the muscles strengthen, I'm able to do more before things get worn out.

Over the years of working with Paul at Body Leadership, I have learnt a lot of skills to help relieve muscle pain.  Squeeze, Stretch, Trigger, Move are the four tenets of body maintenance and when applied make a massive difference to how my whole body feels.  I probably won't explain this anywhere near as well as either Paul or Reese would but I know what I'm supposed to do and they check in regularly to make sure that I'm doing everything properly and add in extra stretches and exercises to my program. Trigger pointing myself isn't anywhere near as effective as when either of those guys are doing it either, though it does make a huge difference.  Pain is more easily managed with the help of these guys.  I can't wait until I can comfortably lie on both sides on the beds at the clinic so that I can get all my connective tissue released.  The thought of all the muscles all loose and nice feels like floating which would be awesome right now!

When I'm in bed I can lie on the wound on either side. The time limit before I have to move is a couple of hours so I am waking to move still and as time goes on, I can stay mostly asleep to move so my sleep feels less interrupted and I wake feeling like I have actually slept.  It's probably close now as I can comfortably rub a moisturiser into it and put quite a bit of pressure into it.  Apparently this is good thing to do while the scar tissue is still pliable to try and minimise it.  I've only really just started this in the last week or so as I've been pretty tentative with it until I was sure it wouldn't hurt.  I don't think I'm going to end up with a really big scar anyway as it looks like the surgeon has done an awesome job putting me all back together again.  The line is quite a fine line and a lot less than I would have expected when you consider how deep the incision would have been to get down to the femur.

When I arrived home from hospital, I was taking the maximum dose of ibrupofen and panamax.  The dose of codeine that I was taking had been cut down to 60mg at night and three lots of 30mg through the day.  30mg is what is in a single Panadeine forte tablet.  Codeine is an opiate and it isn't one of the common ones they use for pain management for this surgery apparently.  The narcotics usually prescribed are oxycontin and endone which I couldn't take as I had a bad reaction to them.

I hadn't really thought of Panadeine Forte as a stong pain killer.  I guess that's because if I had used them pre-op to handle pain and I thought that post-op the pain would be so much worse and I'd need something so much stronger.  Surprisingly I didn't.  The surgical pain really wasn't that bad.  Don't get me wrong, I wouldn't have wanted to put too much pressure on the wounds in the early days but mostly the site was numb around the wound.  It isn't completely back to normal yet but it isn't numb like it was then.

Every now and then there was a quick sharpness but it didn't last.  I like to think of it as the point where the nerves that were healing were first taking the electrical impulses through them and that first sharp pain is the first one as it pushes through the damaged piece the first time to forge the new pathway.  I'm not sure how it really works but the visual of that made the whole thing a bit more positive in my mind.

The most pain I ever had was the second night in the ortho ward and it wasn't in my hips or legs.  It ended up being my back from being in one place for so long without moving.  The first night I still had the PCA to help out but the second night it was gone (I think the PCA is the name for it.  It is the button that you can press to self administer drugs straight into your drip.)  The night it was gone things weren't as comfortable.  I'd also lost the air mattress thing that I had in ICU and they don't roll you in the ward to help relieve the pressure.  The next day I managed to get the air mattress back and that made all of the difference.  Over the next few days I could move a bit more, they got my haemoglobin under control and sorted out meds that worked and I was starting to sleep for a couple of hours at a time which helped.  I think this is the main reason that the goal is to get you up and moving the day after surgery.  Unfortunately when that doesn't happen, muscles start to tighten up and within two days muscles start to weaken.  So I guess the moral of the story is to at least try to get up the first time the physios come in.  If it works out, you'll be so much better off.

When I moved to the rehab ward, the back pain moved to further up the back.  I'd lost the air mattress topper again but the pain was likely from poor posture while using the rollator.  The muscles across the middle were really tight and difficult to stretch out.  I found that the solution was a rolled up towel that I lay on as it ran down the length of my spine and my shoulders could fall back over it and get a good stretch.

12 Days Post Op: Progressing Well

I am progressing reasonably rapidly at the moment.   I still require some assistance to survive the day, though the amount of effort required from the 'assistant' is reducing as I am starting to be able to use more of my own strength.  I am still a little way off being a superstar of the rehab process but I think I at least deserve a gold star for effort!

The main area where help is required is to get in and out of bed.  My legs are still too heavy to move around from a laying ore reclined position in bed around to the side of the bed without a little help.  It still astounds me as to how much weakness that there actually is.  I understand the concept that I was cut open, bone sawed off, extra pieces put in and all sewn back together again, however, I just can't seem to grasp how this makes all the muscles go to sleep.  I understand that muscles will waste if they aren't used but still it hasn't been that long since they were used properly.  I guess that I have underestimated the amount of activity that I actually did do in a regular day even if there were a few lazy ones back to back sometimes.

It really is a vicious circle that needs to be broken out of as quickly as possible as when you are weak, activity is difficult, slow and you do less of it.  The less you do, the less you can do.  As an example, Pre-surgery simple activities like going to the bathroom aren't a planned and executed event, you just go and think nothing of it.  Post-surgery they are. In addition, middle of the night trips become a major exercise so returning to sleep isn't particularly easy.

I don't think that I started down that path of doing less and less, which is extremely positive.  I was lucky that even though I was ill for the first week post-op, I had the encouragement and assistance that I required to get started on the path to recovery.  (Even when I was high on oxycontin the first time I had it ever and was freaking out and throwing up, I still tried something.)  Each day I get stronger and have both more ability and more endurance to complete the exercises and add new ones in.  I'm hoping that this continues for a while yet as I still have a number of old skills to remaster.

The big one is walking.  I am currently using a rollator/gutter frame that looks like this to walk.  I am using significantly less pressure through my arms and walking is slowly becoming more fluid.  It is more difficult to walk in the rehab gym on the bars, though this too is getting easier as time passes.  The bars are a prelude to crutches which I will need to be an expert on before I am allowed to go home.  My left side is still recovering from a bruised nerve and is weaker than my right side.  There may have also been a pre-existing weakness in this side that I wasn't aware of as it was the side that had the most joint damage.  Thankfully I was still able to have the BMHR on the left and it didn't have to be changed to a total hip.  Surgeon's skill or luck or likely a lot of the former and a little of the latter, I don't know, I am just grateful as it will make revision a little easier.  As I walk without pressure through the arms, I fall into the left side as the hip stabilisers aren't there yet.  I have added in other exercises to start to encourage these guys to fire and work a bit harder.  The residual numbness in the left side is almost gone, so hopefully we will soon see strength returning a little quicker than it has on this side so far.

Sleep is still difficult and is likely to continue to be for a little while yet.  I have started to get into a little bit of a routine in which I am able to get about 3 hours before waking to get up and move around for a bit and then back to sleep again a half hour later for another 3 hour stretch if I am lucky.  There is always further little sleep time depending on waking times, though this can be as little as an hour.  I manage a nap in the afternoons before the afternoon rehab session or in the early evening before my 10pm meds.

I am spending a higher than normal amount in bed and suffering muscle tightness in my mid and lower back.  The periodic muscle pain is pretty much all there is as the actual hips themselves are pretty much pain free.  There is still a lot of swelling left and ice is one of my best friends.  As I understand it, this is pretty normal and will continue to be this way right throughout the rehabilitation process.