It's so close

I can feel it.  I'm almost there.  It's not going to be today or tomorrow but maybe another month.  I'm not quite sure which is more difficult to deal with, feeling like it will never end or feeling like it's so close but it still so far away.  I still get tired and needed a really quiet day yesterday to recover from the week.

Today I'm going out to lunch when I could probably would be happier staying at home getting ready for tomorrow.  I picked up some work on Thursday so that I wouldn't have such a big day tomorrow but I haven't even looked at it yet and I'm really not sure I feel like looking at it at all.  I suppose that's a pretty normal reaction to real life and weekends.  

When I get home, I'm going to cook for the next couple of days so at least I don't have to worry about that.  I'm not quite sure what I'm going to feel like only that it has lots of vegetables.  I haven't really had my share in the last couple of days with too many other things going on.  

On Friday, I had physio and we practiced with the cane again.  It's starting to look a lot better but the action of walking doesn't feel natural at all.  My arms don't really know what they should do and my left one just likes to stay still.  Apparently this is quite a normal reaction to injury as the body holds the arms in and it is something that you have to learn again.  When I do concentrate on it and get the pattern right, reduce the hitch in my stride as my left leg moves forward in a straighter line instead of coming around.  I'm not sure why I do this or why this incorrect pattern feels more natural than a proper gait pattern.  

I have to go finish getting ready to go and will finish this post when I get home.

I've made it home and back to the couch where I spent a great deal of yesterday.  I'm still worn out, just with a belly full of Grill'd burger and chips now.  I've still got to get up the energy to get some cooking done for tomorrow as I'm unlikely to have the energy.  I've only clocked up 4 minutes on the elliptical today so far and I'm not convinced that I could step back up onto it to finish of the rest of todays minutes.  I might have a go a little later on, maybe after I've had a small nap.

Before I went out to lunch, I started off with the rest of the activities that filled last week and wore me out.  Friday was a pretty long day.  Aside from Physio first up, I also spent a few hours working at the computer and then went out to the movies in the evening.   I still managed to fit in 8 minutes and 400 metres on the elliptical, so it would have been the longest and busiest day that I have had so far.  On the tails of a full week, I deserved my rest day yesterday. On the plus side, I didn't wear myself so much so I that I couldn't walk without the two crutches like the day that I overdid it.

Tomorrow is Physio day and a measuring ranges day.  I haven't decided if I am going into work tomorrow or Wednesday.   I guess I will just see how I feel in the morning.

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.

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.

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.

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.

26 Days Post Op: I'm Boring

I've got nothing.

Today was just a day.

I woke up, went to rehab, had lunch, went back to rehab, rested, had dinner and now I'm online for a while before I go to sleep.

I'm pretty worn out from a big day and I guess there will be a few more days like this until I am back on top of things.

One more full day to go tomorrow and then the next day I go home.

23 Days Post Op: 5 Days to go in Rehab

I am pretty wrecked this afternoon.  I did a big session at the gym this morning back onto my terms and with my goals.  There seemed to be a little bit of back tracking which might be because I was more forceful about what needed to be achieved today or maybe she realised the normal comment was out of line.  I'm not sure but the positive side of things was that it went better and I achieved what I needed to achieve.  The next time I will be in the gym is Tuesday afternoon as the morning will be my home visit with my OT.  Tomorrow is yet another public holiday and I will be doing my exercises on the ward and going for walks. I have friends coming in with real food and they can take me for a walk (like a puppy *smirk*).   

The big 'I did it moment' today was getting my feet into bed twice today.  I'm not quite sure I could manage it now as everything is ready to fall asleep but I got them in - twice.  Out is pretty easy now provided the rails are down.  I'm not quite sure why they want the rails up still when I go to bed as I'm not rolling anywhere yet.  I guess it might just be one of those safety requirements that they need to follow for certain patients.  It just means that I still need to buzz the nurses when I wake up between 3 and 5am for a bathroom break so I can get out bed.   

I am allowed to get a pass out of here now to go across the street for lunch or a coffee or whatever provided that I go in the wheelchair.  My husband suggested we do this for lunch today but I wasn't keen  as I think it is already going to be hard enough to come back on Tuesday after actually going to the house.  It's probably a little backward, but I figure that if I just stick to my routine here, the days go quickly and the five days left will be over before I know it.  As it stands it's not quite even five really as I should be kicked out in the morning.  That will probably depend a lot on whether we still go for patient transport or not.  That is going to be decided on Tuesday as the getting in and out of the car thing hasn't been attempted yet.  I don't care if I have to go home in an ambulance so long as I get there and get there this Friday coming.   

14 Days Post Op: Good Friday

Public Holidays mean that the rehab gym is closed.  I still have exercises to do, though it is a little more difficult without some of the equipment.  I have four days of this to work through and hope that the schedule that I am on sees at least some improvements.  Up until now I have seen a change every day and I hope to continue to see these things happen.  I'm a little worried that it won't run as smoothly and as quickly while the physios are away.

The big improvement today was being able to shower and dress independently.  Thankfully I have had my husband to assist me with this, so it hasn't been as much of a big deal as it could have been. (I'm not particularly happy with the idea of someone other than my husband help me with this.   Hopefully by being able to do this myself now, I can be a little more independent and put less pressure on him to be here first thing in the morning to assist with the getting ready process.

Between being out of bed at 7:30am and getting ready and sitting out of bed until my husband arrived around eleven, I was pretty much wiped out for a while.  It sounds strange but sitting out of bed requires significantly more energy than sitting up in bed.  I'm not quite sure why.  I had a bit of a sit back in bed and took advantage of my husband being available to give my feet and calves a bit of a massage with some moisturising cream.  It is ridiculously dry inside here and my skin is peeling.  It's truly disgusting.  It might also be some of the cleansers and tapes that have been used over the past couple of weeks that have assisted in this process as I do have quite sensitive skin.  I probably should have started this moisturising process a lot earlier to prevent this, however, it wasn't something that I'd really thought about happening.  I don't think that the compression socks are helping much with the skin they cover either.

After lunch, I actually went outside for the first time in a week.  It was a bit strange to be out in the open.  We didn't go too far, just out of the front door of the building.  I went in a wheelchair as I'm not quite up to that walk yet especially since there isn't any seats downstairs that are the right height for me to sit on while I've still got hip precautions.  I'm not sure how people do this when they are out of hospital but haven't yet had the precautions lifted.  I don't know too many places that actually accommodate for the higher chairs and toilet seats that are required.  I guess by the time I get home, I'll still want to be in going through my own physio program, working on the strength and ability to hopefully ditch the crutches at six weeks so there won't be a great deal of time to be looking at spending too much time out and about.

After getting back to my room from downstairs, I got stuck into the first set of exercises for the day.  This pretty much tired me out again and put me back into bed for a bit of a rest a chance to catchup with a friend that came to visit and to post for today.  I am still planning to do another set today to hopefully replicate the level of activity that I have been doing in the gym for the past few days.  This might wait until I've had a short siesta though :)

Human Again

Nine days post-op

Today is the first day that I really feel human again.  I had an early start this morning waking at 6am, then had the usual hospital interruptions each half hour as I tried to doze back to sleep to have a bit of a sleep in. I started off rough, though through the span of time between 6 and 9:30 the little naps seem to have done the trick.  I've just started to get a little weary (it's 2:30pm) which isn't too bad at all really considering that this is the first day I've really been awake and alert for five hours straight.  In that time I also went for a walk and had a small physio session, gotten up two other times, showered and had lunch which are activities that usually require nap time after them.  It looks like improvements are starting to come more quickly, so I hope that I'm on that upward swing with the strength in my legs as well.

Best of all, the depression waves seem to be staying away today.  I am still a little all over the place emotionally and this may well just be hormonal (yes - freaking unlucky I say), though a small amount of depression when things aren't working the way that they are supposed to would have to be quite normal I should think add the hormones in and hey presto, a recipe for a crazy woman.

The physios have been a really positive influence on my mood.  I wasn't expecting that.  Not that I have anything against physios - I love mine that I have been seeing for years, I was just wary about the hospital system and just how much support would be provided to me.  I think the biggest issue I've had so far is my own expectations and how these were influenced pre-operatively.  I really thought by day 9, I'd be learning crutches, not still how to get out of bed with one assist (rather than the two I was using yesterday or when tired and ready for meds at 6 this morning).  There is absolutely no way on earth that I was only going to be in here 7 - 10 days.  Maybe that was always just the rehab component and I got something wrong, but I don't know.  I'd over estimated it to two weeks, though in reality it will be three weeks or just over.

I'm having some visitors for a little while this afternoon and then hopefully I'll get a restful night sleep tonight.  I think that really is the big thing that is missing and causing most of the issues now - lack of good sleep.  The big issue is how difficult it is to move to get comfortable and not being able to sleep on my side which is how I have slept for the last twenty years.  Apparently the restrictions will reduce at some point, hopefully once I can actually get into that position as I'm not quite sure how to stop myself doing that in my sleep.  It's pretty easy right now as there isn't any way to get into that position without rolling assistance and I'm sure someone will tell me once it becomes a concern.

8 Days Post Op

There is lots to fill in, though I'm still not up to spending much more than a few minutes at a time focused on any one thing yet so I'll have to come back a bit later on to fill in the gaps of what has happened in the last week.

I arrived in the rehab ward yesterday afternoon, which was a few days behind schedule.  I was held up in the ortho ward in the main section of the hospital that deals with people in a more acute state of illness.  Basically I had some problems getting on the right types of meds and also required three units of blood over the space of a couple days.

It looks like I am going to be in this ward for about two weeks depending on my progress as there are some clear goals that must be achieved before I can go home.  Specifically I need to be able to get out of bed on my own, upgrade from the rollator to crutches to assist with walking and be able to get upstairs.  I'm not sure if the first one or the last one seems like a harder goal to achieve.

Overall, pain levels are a lot lower than what I was expecting.  I didn't think that I would be fine with a brufen and panadeine forte cocktail, though that's what I am able to take without hallucinating (hard drugs were evil - more about that another time) and I seem to be doing ok in that regard.  What is killing me is the weakness.  I didn't expect that all these muscles that had been worked hard in the months leading up would suddenly be so tired.

Two days to go

I woke up sore and tired again this morning after a restless night.   I think that it may well be a conspiracy to take you off medication before an op like this.  Maybe it has nothing to do with blood thinning properties, more that they want you to remember how bad it can possibly get before they put you in and fix it up.  Kind of like under promising and over delivering.

At least I woke up mentally positive.  There are two days to go and then the physical stuff will at least be on the mend, permanently and I'll have much better pain management meds too :)  A little nervous about how much I might need them but overall positive.  I'm hoping that the visible improvements that I will see and knowing that there is an actual end date for the surgical pain will be enough to help overcome the pain hurdles.  I've been told that you shouldn't be a hero with pain meds and don't let it get to the point where you can't handle it anymore as it takes time then to get it under control.  It's very different from the 'tough it out' attitude that many of us learn and live with.  The other tip that I got was to use pain meds about twenty minutes before the physio arrives.

I had hydro this morning and that helped loosen things up a bit and I felt a bit better after that.  It was the last session before surgery and was a little bit slower than what we were doing last week.  I'm generally just a little bit slower at the moment.  Thankfully there isn't really a need to speed it up - so it isn't too much of an issue.  Not sure that I could have handled another full work day today so it's just as well that I finished things yesterday.   Being finished and not completely up to my regular activities on Wednesday, I had changed the hydro until today from Monday and am skipping the last pilates slot as I really didn't think I'd be up to it today.  Unfortunately I was right, though at least I was prepared and got to make the most of the time and feel better for it.

Instead of pilates, I went visiting and took cake with me.  It's nice to be free to do things like that when the mood strikes you.  I got a chocolate cake from the bakery down the street that I haven't been before and it was truly awesome.  I haven't had a huge amount of sugar lately so the sugar rush was a little weird but also awesome.  (I must admit after my long haul work day yesterday I did have a Coca Cola in a glass bottle which was freaking amazing - though I think that it may well have unlocked the sweet tooth as I also had a little hallow easter egg tonight too which hubby brought back with him from Melbourne - it was awesome too.  There are still five left which I am trying to stay away from so I can have some later but they looooook at me saying eat meeeeee!  We did have lots of veges for dinner and I'll need to make sure I eat lots of good nutrients tomorrow to prepare for fast healing and healthy red blood but chocolate today is all good since I've been getting all the good nutrients for a while now when I started the prep about a few weeks before the blog :)

The day didn't step up a notch at all.  It stayed at the same cruisey pace and culminated in an afternoon nap which was awesome.  Think I managed to be completely out for about an hour and a half which is probably a longer stretch than I managed all night last night so I was pretty happy with that.

The evening was pretty low stress too.  Visit from my sister and her fiance and I got presents :)  Not sure what is in there, they are special ones marked with different times during my hospital visit to keep me occupied .  Very sweet and very cool (and oddly heavy so I am quite curious) :)  I'll keep you posted on that one.

The big decision of the day is whether or not to upgrade from my beloved kobo to the kindle for my hospital reading.  The reason that I am seriously considering it is the fact that the books that I want to read while I'm recovering are twice the price in the format for the kobo than the kindle and the kindle has access to more books and it has the wireless and 3G access so doesn't need to connect to a computer to get new books to read.  The new kobo does the wireless thing (but not 3G so probably just as useless as not having it in hospital) so it really comes down to the cost of books.  With the Aussie dollar as strong as it is at the moment it's even better for me as a consumer.  (Apparently its not that great for our economy as predictions have us getting to $1.10 USD, though there is always something that isn't good for our economy, mostly lately it has been natural disasters but I digress)  I do have some books to read while I make the final decision on this one.

Pretty much ready to attempt sleep again.  Hopefully I'm exhausted enough to just pass out regardless if I'm comfortable or not.  Wish me luck :)

[edit:  The kindle is on its way! 7 April, 2011]

Swollen Knees and Fatigue

My knees are revolting...  as in revolution revolting..  not disgusting revolting (though some might see that the melon like shape is revolting but it really isn't that bad.)  I think they might already be missing the femoral head that is about to disappear and crying in sympathy.  I told them quite sternly that if they didn't start behaving, they would be next on the list to be replaced with a newer, younger and more attractive model!  No not really - not keen on knee replacements, apparently they *really* hurt, rehab is harder, the satisfaction levels are lower (than hips) and I really don't have a need for those.  I do hope that once the hips are done the knees will calm down.

For the last few days I have had mildly sore, majorly swollen knees, likely a result of overdoing it last week, ending up with compensating by rolling in on the femur and putting extra stress on the knees as they weren't being used properly, causing inflammation.  There was no heat (like there was in my right hip last week) so hoping it is just a reaction to the alignment issue rather than the RA flare.  I got an 'it's possible' that this has caused the inflammation from my physio so stuck with that.  Post-treatment I came home with tubigrips that I left on until this morning and like magic my knees are the normal swollen kind not the extra swollen kind.   (Since I was a kid and first had the onset of the JRA, there has been thickening of the synovial fluid. In the beginning there was also inflammation.  Now, my normal range CRP and ESR indicate that it isn't inflamed and causing joint damage which is good!)  I was pretty worn out yesterday and slept a lot longer than normal last night and could still do with a nap this afternoon.  Fatigue is reasonably typical for me when things start to hurt.   I think a lot of it is to do with restless sleep and last night I got to catch up a bit :)

While I was at the physio visit yesterday I followed up the 'what have I done to myself now questions'   with a bunch of alignment questions.  Specifically I am curious as to whether the anterior tilt of the pelvis can be corrected.  As my body has accommodated for the lack of joint spacing in the hip, parts around have moved to give myself more spacing in the joint making it more comfortable to walk.  This was evident pretty early in the piece with a slight lengthening obvious when I started regular physio and regular pilates.  ( I swear I am taller when I come out of physio - and no they don't put me on a stretching rack :)  I don't think that I can get it back to a proper neutral position, though it will be interesting to see how things change once the hip spacing issue is fixed.