Caffeine Sensitivity

WHAT?!?  How did that happen??

I had a coffee yesterday afternoon at my sister's kitchen tea and I had a really restless night last night.  I don't understand where the girl that went out in the evening and drank 5 flat whites and went home to bed. I know that was some years ago now and I don't drink as much coffee as I used to but, c'mon, it was 4 o'clock - not even dark!

Though most of today was in a little bit of a lack of sleep haze, I felt good.  I saw Reese first up this morning for physio and my body did quite well considering the demands that I put on it over the weekend. My muscles turned out being no where near as tight as what I thought they'd be and there were actually a few parts of today's session that felt relaxing.  (Note:  Only a few! Sounds a little crazy I know.  Maybe I was too tired to feel pain!  No, really, some of my lower body muscles are starting to behave normally, it really is amazing)  I have a new exercise to add to the plan.  I love the new challenges.  This one could be a little bit interesting 

I came home and played with Jack for a while.  I still love the little guy.  He smelt a bit like dog today which I wasn't overly enamoured with but he is a dog and this will happen from time to time.  I played for an hour before I came home.  Not all of his family is home yet so I still get to visit so that he isn't alone too much.  He's taken to help me stretch and move and expects me to follow him around.  If I don't, he'll sit and look at me like he's waiting for me.  I guess he has decided to be a part of my rehabilitation programme.  You don't say no to a little face like that spurring you on!

I'm getting a little bit of work done tonight so tomorrow isn't as busy a day.  It will likely to be a big one since I have a lot to catch up on from last week so anything I can do now will take the pressure off a little bit.  I don't exactly know what happened but somehow I got behind in a few things.  I'll be back in bed in a couple of hours and relaxed and ready for tomorrow.  

Six Week Surgical Review

I went to visit the surgeon on Monday for my six week post-op review. I was a little nervous the night before and while driving back into the hospital. Realistically, I know I've done well and my progress has been steady, so there was no real reason to be nervous. I'm not quite sure what started up the butterflies but they were quickly squashed.

On the way in, we were a little early and managed to get a 15 minute parking spot just in front of the coffee shop so the day was starting off well.

When we arrived in the surgeon's office, we were sent upstairs for new x-rays. Q-Scan uses the new digital machines so I have a nice little CD with the three views showing the perfect placement of my two BMHRs. I had to download a view for the Mac (it came with a windows viewer - the one I downloaded is free and pretty cool. It's a DICOM viewer called Osirix) and now when I have a few minutes I will be able to upload some clearer images. It still amazes me that they are in there. The joints don't feel anything but natural. I guess after so many years of crunching and ROM limitations my idea of normal is a joint with smooth, fluid movement. I know that my limiting factors at the moment as far as mobility goes are to do with muscle strength and tightness not the actual joints themselves.

We headed back to the surgeon's office and saw him pretty quickly. He's pretty happy with my progress and gave me the all clear to lift the hip restrictions. We had a quick chat about my progress, the improvement of the left side foot drop (all better now) and other bits and pieces. The Four Corners piece was raised, which I commented that I hadn't seen though I had heard that it was quite biased and that kind of led into a general conversation about acetabular cup placement (mine is perfect, having an awesome experienced surgeon is crucial), the number of resurfacings he has done (700+) and the success he has had with the BHR (The BMHR is still new though the data is much like the BHR's early data and is promising).

I asked about metal testing and pregnancy for when we get to that point in a couple of years. I was asked if I would supply test results when we go down that path and I said I would happily volunteer results for data for a study on the MOM devices.

[Side Note: I really believe that they are the best option for a lot of people, not just people like me. Some articles still suggest the MOM devices are not suitable for women of child bearing age as there is some evidence that the metal-ions pass through the blood barrier, however, there is no evidence that it will cause any problems. This may get a lot of negative comments and I challenge the naysayers to find hard data before name calling. I am open to an open dialogue of the issue, however, comments with rude remarks will not be accepted. I trust my surgeon and the data that he has researched as an expert in this field. The research I have done supports my belief in him. The decision to have the procedure was not one made without great consideration of a lot of factors. I will eventually write more on the topic of making this decision, so at some point the label 'Decision' will have more posts. Just like this part of our lives, we will do due diligence to any big decisions that we make. Anyway, back to the topic at hand.]

I enjoyed the appointment. I think I'm an interesting topic to talk about! Actually it's the shiny new hips that are interesting as well as the progress that's been made and will be made and all things relating to the new parts that the surgeon knows that I don't. The summary of the appointment is that all is good and I am due for review again in September.

In the meantime, HIP RESTRICTIONS ARE LIFTED! Not that I can really exceed 90 degree hip flexion, but that isn't the point. The point is that the risk of dislocation has reduced and I have passed that first hurdle. (There are other things that I don't have to be as concerned about either - though the seat height is probably the one that functionally is the most difficult to deal with.) It's nice to be able to be able to stretch a bit more, to reach down to at least try and touch my toes - still a few inches off and my hamstrings are squealing! They need a lot of stretching out just like pretty much everything else. I can't reach as far as I could pre-op yet, though it has been almost seven weeks since I've done that stretch so I guess it isn't too surprising that it isn't the easiest thing to do.

So the plan for the coming week is as much stretching as possible and keep on top of the exercises. I have a little bit of work to do tomorrow so I'm going to have to figure that into my day as well to make sure everything gets done. I feel like I should be doing more by now but I am still tiring easily. It's getting better as each day passes though there is still a little way to go yet.

With that in mind, I really need some sleep. It's way past the bed time I have gotten used to. Even though I've always loved sleep, I need even more these days. I guess that's an indicator that my body is still investing a lot of energy into the healing process.

Til next time!

Coffee Break and The Week in Review

Last night my husband got home from being away for a few days for work.   No matter how much he wanted to be at home, there is work to be done that cannot be delayed forever no matter the desire to do so. The deciding factor was more to do with how I was going and whether I could confidently do what I needed to do on a day to day basis.

I am pretty self sufficient now with the only thing that I really need help with being getting the compression socks on for day and TEDs for night.  These special socks are knee high and not the nicest things to get on and off.  They are used as a blood clot preventative recommended by the rehab doctor for at least six weeks post-op until my mobility increases and is a little closer to normal.  There are differing opinions as to the duration required, the time that it will take for mobility to return to normal and what activity level will prevent the development of clots.  The time frame recommended is at least the six weeks while I am on the clexane injections (aka lovenox, a blood thinner, daily self-administered injections).  My GP suggests that after the six weeks are up that this is a decision that I need to make based on how mobile I think I am as to whether I continue wearing them.  At this stage, it really doesn't hurt to be cautious, though a little time off from them each day since that the clexane finishes today will be most welcome.

I had some awesome sock helpers come and stay through the week to help me out with this and keep me company through the week.  Special thanks for the help and the company!  Even though I know I would be fine home alone, it is nice to have someone around to chat to (and overdose on chocolate or apple crumble with as it really is no fun to moan to yourself that you ate too much and can't move!)

Physio this week was great and there were increases to the measurements that we made for the range of movements last week.  I'm expecting another change when we measure again next week.  Amazingly it is the hip flexion that is lacking over abduction.  The reason I find this a little odd is that it was very much the reverse pre-op and I had really expected them to return and strengthen in the reverse order.  Hip flexion equates to more of my functional goals at the moment.  Stairs without compensation vaulting being the big one.  Once the hip precautions are removed, it will be an important part of building the strength to drive again as well.   The exercises to strengthen these muscles are becoming more manageable since I have been able to start leg lifts using my own strength.

Today was a big sleep in day.  It was awesome to have no where to be and nothing to prepare for this morning.  Coupled with a late night last night chatting with my husband and a big week, the extra sleep was welcome.  I can sleep on either side now quite comfortably so even though I wake to move, I am able to move into different sleeping positions safely (ie not breaking hip precautions) and getting a reasonably good sleep each night.

After a lazy start, we headed out to have coffee with friends of ours.  This time when we arrived, I used the stairs and not the elevator.  I wouldn't have contemplated that week.  I'm not sure if the stairs weren't even and smaller than normal but I was able to step up without compensation on just over half of them.  When I arrived at the top of the stairs, I walked the long way around to the front of the restaurant and arrived at the same time as our friends.

This afternoon has been rest, catching up on email and reading some of the blogs that I frequent.  The feet on the recliner are up, the tv is on in the background and as I think of it, there are foot pumps or muscle contractions or little leg lifts, just something to keep moving while I kick back.

First Real Post-Op Outing

Today was the first real outing and my husband and I went for coffee and brunch at La Dolce Vita at Park Road, Milton with friends.  (I know I went to the hospital to see the social worker on Tuesday but that really wasn't a 'real' outing after being there for four weeks)

The trip was part of the 'Project Awesome' goals that I worked out with Paul from Body Leadership for my recovery process.  Reintegration into the real world is a little scary when you have been in safe places since a major operation.  I'm also very comfortable in my own space and am not getting cabin fever, so there it is easy for me to let time pass making the prospect of going out a bigger issue than it actually is.

The main reason that I had been a little scared about going out in public are all of the falls hazards that are outside of my control.  I also worried about available seating and whether toilets were going to be available that were accessible and the right heights.  (The toilets for some reason were a really big deal which is strange considering that when they weren't a problem - at the hospital - I didn't even need to use them and we were out for about two hours that day.  Surely I could manage a quick outing without having to go?)  I also worried about being stranded somewhere without being able to sit and not able to walk any further (highly irrational considering that was a) unlikely to happen and b) I wasn't going to be left alone).  All of these things were probably becoming bigger deals in my own head as I put off facing them.

I got to chose where to go out to and the conditions of my 'release' to help make me more comfortable about what we were going to do today.  I chose La Dolce Vita Restaurant because I am comfortable there.  I have spent a lot of time there and I know the staff well and also know the terrain well.  I knew how we could get in there without having difficulties getting me out of the car even though my disabled permit hadn't arrived yet.  About the only thing that I wasn't sure of was toilets.  I knew that the ones upstairs were a no go as there was a massive step to get into them that I had little chance of clearing on my own and the height of the toilets was probably too low especially without bars to assist in correct positioning to maintain the hip precautions.  I knew there were some downstairs (accessible by lift)  as well, but I wasn't sure what they were like either.  Google for once, let me down.  I didn't find what I was looking for.  It may not have been google's fault as the resource just might not be available.  How do people who have permanent conditions find out this kind of information?  Trial and error?  That seems absurd.  Is it even possible that one of the most popular coffee/dining areas in Brisbane doesn't have disabled toilets?  Surely they do somewhere?  I figured that they must and if they didn't, there was always McDonald's across Milton Road (After all of that worry, I didn't even use them and stupidly I didn't even check to find out exactly what was available).

We made it there around the time that we said that we would be there.  It takes me a lot longer to get organised at the moment.  Part of the problem is that it is easy to sit in the shower for long periods of time rather than have a quick shower to get ready.  The second issue are the Venosan socks that I still need to wear during the day.   I should have organised a 'sock helper' before now to assist the assistant helping me get these things on.  It's on my list to do over the weekend so that I can hopefully get something delivered early next week.  As they are heavy duty compression socks, they aren't the easiest things to get on.  With hip restrictions, they are even more difficult.  They are for a very good reason though, to reduce the likelihood of blood clots and for that reason we persist with them.  The third issue is trying to figure out all of the things that we needed to take with us that may or may not be required.  I reasoned that this was somewhat similar to trying to get a child out of the house and all of the things that they require.  It might not be as bad, though there were still a lot to consider.  We needed a pillow and a towel to try and adjust seating height so that I could sit and not break hip precautions, the wheelie walker in case this solution didn't end up being viable, another set of shoes in case the ones I decided to wear but haven't worn since the op didn't work out, tissues (yep I have managed somehow to get a freaking cold), medications, jumper and then the regular day to day items that you don't leave the house without.  In the end we made it and we had everything that we needed.

I had a mild case of anxiety as we were crossing the Captain Cook bridge and arriving at our destination.  As I got out of the car, someone I knew was walking through the car park and was a nice reminder that I was in a safe place.  I felt a little calmer as I got out of the lift and started to walk around the front past Alegria and saw more people that I knew having brunch.  The friends we were meeting with had already arrived and seating wasn't an issue once we had topped it up with the pillow and towel.  Quite comfortable actually!  There was no requirement to bring the wheelie walker out so I just used crutches which are not only more comfortable for me to use, but I feel better using them.  I know that there is no shame using a walker and if I had to I would, I just wanted to look like I was more well than that.

Brunch consisted of real coffee and a bacon and egg panino for me and was awesome.  Meds were taken with a sparkling mineral water chaser.  We were out for a few hours and then headed home.

On the way home I spoke to my sister who was in the city and asked her to go into the pharmacy for me.  She called while she was there so I could talk to the pharmacist to confirm what I could take to get rid of this cold.  Thankfully the blood thinners weren't an issue and hopefully I can stop suffering with the congestion and associated tiredness and step it up a little in the rehab.  She picked up some things for me and I had some cold tablets still at home that had the all clear so I had one of those and pretty much feel asleep straight away.  A few hours later, I woke up and felt a million times better.  I even did another round of step ups on the single stair outside (10 each side no vaulting) and feel pretty proud of that at the end of a big day.  My walking distance will be a bit lower today even with the outing as I haven't done as many laps around the house.  It probably balances out as far as energy usage goes and each day I do get a little more stamina to do more.

Spilled Milk

There is no use crying over it, right?

Even if there is coffee in the milk?

Probably not.

But that's where I was at this morning when I managed just that when I arrived at Physio today (all over towels and pillows....  sorry!)

Now, it was good coffee, but probably not quite good enough for a cry, it wasn't like the last cup of coffee that I would ever drink again and it really wasn't the problem.  The day just didn't start off well.  I woke up tired and sore having not been able to sleep that well.  Panadol Osteo really doesn't cut it to replace the anti-inflamatories that I was on until last Friday.   This is probably the longest I've ever gone without something stronger and sleep is hard to come by at the moment.  I think that naps may be in order when I feel that I might actually be able to sleep for a little while.  There were a few other little things that managed to fray the nerves before I actually got to the point where the coffee was a really big issue but even so, really not a proportionate emotional response.  It's probably just as well I was somewhere where people know me well, as it really was quite an episode, one that I really wouldn't want to have out in the real public.

The day turned around and I got over the weepies and felt a lot better after an hour of Physio and another cup of coffee.

I caught up with an old friend for that second cup of coffee and got a chance for a bit of a sit down and breather to keep the physio calm and relaxed mood going on.  The pain subsided for a bit and I got a chance to get stuck into the last few work tasks so that I can handover to the person taking over.  I pushed through til about 10:30 tonight to get everything done so I won't have to work again before the op.  I finished up about the time that my husband arrived back home after being away for a while.  He wasn't definitely coming home today as he was still in exile but after my little episode this morning.  

I need nap time and relax time now that my husband is home and we are this close to game day.

Busy Day

I started out late today and managed to get an unmetered parking spot at Spring Hill on the first pass and made it to my appointment with my dentist a little early. I have no cavities :), so it was just a scale and clean today and another item off the checklist.   I spoke to Dr Tom about the surgery and about the report I read in relation to taking an antibiotic an hour before any procedure and apparently these precautions are more commonplace than I thought.  It seems that these precautions are taken by other people with different fixed items aside from joints.  I guess it stands to reason that those with a higher risk of complications due to infection should do what they can to avoid them.  It is just something that I hadn't really considered until now.  Poor dental health is even worse news than not taking antibiotics so making sure that I go for my regular checkups will be important.  I've booked in the next one for six months time (which I did after I got home as the new receptionist forgot to ask if I ever wanted to come back again), by which time I should almost be able to walk there :)  Maybe a little toooo far - a ten minute drive would equate to a pretty long distance, though I could catch the bus which would be a new thing for me.

After I left Dr Tom's office I went up a level to check at my old GP's office to see if all was sorted with the insurance company that was requesting my health information (which it has been so hopefully that will also be something that is checked off the checklist).  The issue was the insurance company not wanting to pay for the time to collate my medical history (which is hardly light reading even though this GP only covers the last four or five years).  I guess this is what happens when you have to search for someone to actually want to insure you.  I would have thought that with the prevalence of arthritis in the community today that it wouldn't be such a big deal, however, it is apparently and there are few insurers that want to touch me (other than the really bad catchall, no medical questions type covers which don't do much for you anyway - don't get me started on that one - just know that I wasn't happy with them).

Next it was coffee at my old coffee shop, Two Cups, which was next door to where I used to live.  That would have to be the big thing that I miss about living in the city - crossing the street for an awesome cup of coffee.  The closest coffee near where I live now is a five minute drive.  I'm not quite sure what the coffee options are when I am in hospital and this might be where I end up in trouble.  Though I've cut back to a cup a day - I make sure it is the best possible cup of coffee that I could possibly have so that I can really enjoy it.  It might be my husband's job to scout coffee before he arrives to visit in the mornings which will be somewhat reflective of what life was like for him on Saturday mornings when we did still live in the city :)

Next it was off to Milton to drop off some paperwork and then out to Coorparoo for physio where I actually arrived early again.  This is highly unusual behaviour for me as things usually don't line up as well as I plan them so today was a bit of a surprise.

I had a bit of a break after physio and caught up with Paul and had a chat about all kinds of stuff.  Ultimately it ended up with the big issue in my life at the moment - surgery - and what I want to eventually write about here that I am going to probably need some help with to make sure that I get it all right.  It's a bit of a pet project that I have to work on when I have some time after the surgery.  I might be crazy to think that I will feel like doing too much in the early days but I do have a lot of little projects planned for those few weeks.  I'm not really starting on a lot of this until after as there is a fair amount that needs to wait until I am going through the rehab process as the work I've been doing to prepare is really to improve the surgical outcomes and reduce the impact of rehab.  These are things that I really can't comment on until I actually am there and going through it.  I'm not going to know what needs to be worked and where I feel weakness until later.  Some of the focus of the pre-op preparation has come from comments made by others on discussion boards as to what things they found difficult in the rehabilitation process while the rest has come from discussions with my physios as to the things that they know that I will need to deal with.

Home again and getting some work done.  There are a few reports that I need to organise and just little bits and pieces that fall due when I am away.  Unfortunately most of them needed March to finish before I could get right into it so the bulk will be done tomorrow on the weekend.

Eight sleeps to go.

Lack of Motivation

Today was a day for a complete and utter lack of motivation.  I did manage to get to pilates today though the rest of the afternoon I did very little.  I totally corrupted my good influence :)  This either means that I have accepted that I can't control everything and have finally relaxed or I'm just tired.  Sometimes I over analyse things though today I won't - I'll enjoy the relax I had and take it at face value - I just must have needed it.

I started a course of antibiotics this afternoon and promptly fell asleep.  Hopefully after a few more good nights of sleep I will be able to completely kick the germs well in time for the final countdown until game day.

I've started to have a think about what I want to do that morning before we check in at 11am.  I can eat until seven, so I'll get my morning coffee which is a good start :)

With those happy thoughts of morning coffee, I am going to go back to dreamland.

Nine sleeps to go.

Late to Pilates

I was late this morning to pilates...  I swear that I set my alarm a whole hour earlier than it went off - someone must have changed it in the middle of the night!!

I did get there, yawning most of the way through the session as I didn't have time for my one cup of coffee a day or breakfast before I took off out of here in a hurry to actually make it before the session ended!  I was only about 10 minutes late and thankfully so was the person after me, so I got most of the program in before I raced of to get coffee.  (There is a new place almost half way home that is awesome - try it out if you are near Holland Park - it's called Stomp Espresso)

My husband was with me today to see what I have been up to (really it was that he needed a good stretch out and tagging along to pilates certainly does that for you).  He does some different exercises than me given that I have range of movement issues that make some pretty impossible.  This prompted me to remember something that I had been meaning to tell my instructor for a few sessions now.  There was finally one thing that I thought 'oh shit' about for after the op.  I would have to use the fitness circle at pilates.  I've never used that thing, but in all the shared studio sessions that I have had with people, no one likes it.  Every one has the exercises that they love and hate and they really do differ from person to person with, it seems the exclusion of the fitness circle, of which I have never personally met anyone that likes it.

The good news that I found out today is that I won't be able to use it for 'a long time' as it puts too much pressure on the femur and/or femoral head (depending on the excercise) - yippee!

As far as the ones I have love and hate relationships with:
So hate:  Reverse Knee Pulls

  I'm not sure why I really hate these.  It could be that I can't really kneel with the front of my knee comfortably on the shoulder rests (hip range in that position) and end up kinda squished or that as I look down to the floor I visualise face planting.  I'd say it's more likely to be the face plant

So Love: Feet in straps exercises like: Hinges (kind of like the first two positions of the long spine, the long spine and basically everything except for the ones I can't do which are pretty much any abduction stuff which upsets the hips
 Long Spine:

The pictures above I found in google, which lead to google books, which actually had an embed link (which is very cool).  I would have thought that would be something frowned upon - but hey if Google wants to let us :)  To give the author kudos, the book that they both come out of is:

Pilates

No, I have never tried that and though it makes for an impressive cover shot, I think that it leads people to believe that they can't do pilates.  I had someone who didn't know me at all (met a few times during a business transaction once when I was on my way to a session) comment that they are not strong or flexible enough for pilates.  I replied that you work to your own level and slowly increase your ability - that I am not flexible at all, in fact I'm going in for two hip replacements in less than a month, so anyone can do it.  Pilates helps lengthen and strengthen, promotes good posture and is exercise that you don't feel sore from the next day.  Sometimes the muscles feel 'worked' the next day and sometimes the day after that, though I've never had the gym type can't walk the next day done too much (and probably incorrectly so ending up putting excess pressure on all of the wrong places) from going to pilates.  There is still the muscle burn when you are there and not everything is easy but there still is visible results when you go regularly.  I always feel good after a session which makes it a lot easier to go.  People who disagree with me just haven't found the right class or instructor.  There is a lot more to pilates than matt classes or watching a DVD.  A good instructor coaches, makes sure that your alignment is correct, the right muscles are being worked and the program is customised to your ability and has a plan for improvement and progression.  If for financial reasons you are going down the class path (yes they are a lot cheaper), try finding one where the instructor also runs studio sessions so that you can go a couple of times on a one-on-one basis and discuss going to the larger classes with them.  This way the instructor can see what level you are at and suggest some alternatives when things come up in class.  You can also become more familiar with the exercises and the techniques so that you get the most out of the class.  If you find the right person, it will certainly help that they know you individually before rocking up with ten other people.  Also if you are one-on-one, be good to your instructor, they'll appreciate it.  If you have a scheduled session, don't cancel late.  Pilates generally isn't something that has a high demand rate for casual sessions so there is a good chance the spot won't easily be able to be filled and will leave them sitting around the studio for the hour waiting for the next session to start.

The extra session a week has made a big difference to abs and core - I actually am starting to have some dints now :)  (Much to the exasperation of a friend of mine who regularly does lots of sit ups - lots more than I ever do - and isn't getting the same dints).  I know that the dints aren't necessarily the goal here but it is kinda cool to have a visual result.