Progress Report

Officially five weeks post-LPAO now, and there is more good news to report.

I have been to the gym three times since I got the green light to start last Tuesday. Getting on that bike and moving my blood around feels so good after a month of basically being sedentary. I have fewer restrictions on my movement than I did at this point last time, plus I got started going to the gym the day after I got permission from the doctors, so the mood-enhancing effects have already begun.

At the gym I have been riding the stationary bike for 30 minutes on the "random" setting, with a highest resistance of about 6-8 (out of 25 available on the bike). It may not sound like much but after my RPAO I had to start at zero resistance for 10 minutes, and work up from there. Plus, my cardiovascular endurance totally disappeared during my month of the Couch Workout, so 30 minutes at level 6 has me breathing hard enough already! But I'm looking forward to improving on that front as well.

I've also done some upper body work at the gym (although with all the crutching, I don't think I've lost that much strength) -- lat pulldowns, rows, chest presses, etc., but I've been pretty lackadaisical about it so far; must step it up a bit.

Interestingly, I just realized that I -- completely coincidentally, without having gone back to check my post-RPAO entries -- quit my pain meds at exactly the same time post-LPAO *to the day*. Amazing! So yes, I quit my pain meds today, exactly the same way I did at the five-month mark last time: I woke up with very little pain, and figured, hey, why not give it a shot?

One of the reasons I decided to go off the pain meds now was that I wanted to feel pain as the warning sign it is. Now that I am putting more weight on the left leg, and using one crutch at times, I don't want to push things too fast simply because I've numbed the pain and don't know that I am putting too much strain on the joint. But so far, so good. What pain there has been is minimal and tolerable and subsides if I give my hip a rest for a while.

So now I am pharma-free, except for aspirin (allowed to quit next week), fiber, and calcium. I sleep well on both sides. My incisions look great. My only niggling problem is that tight spot on my spine where the epidural was, although I don't feel it nearly as often now. If it is not gone by next week I'll let the team know.

One Month Post-LPAO

Today was my one month post-op appointment with Dr. Millis and the team. I already had a feeling my left hip was healing faster than my right hip had earlier this year, but my appointment today confirmed this.

I got the standard x-rays before seeing the team: supine AP and false profile. When I went over the films with Erin, she pointed out the areas of bridging -- where the bone had begun knitting to fill the cracks. My bones have done a spectacular amount of knitting in the past month! The cut in the illium was barely visible (except the big gap to fill caused by moving the acetabulum), and the other two cuts were bridging nicely. I'll try to get the films so I can post them. Both Dr. Millis and Erin were impressed.

I reported that I am down to two Percocet a day, one in the morning and one before bed; Valium occasionally as needed. That strange pain (that I thought might be a ligament) is completely gone now. I still take one Atarax at nighttime. I am sleeping much better now, able to sleep comfortably on both sides now, as well as on my back. I still have the strange pulling feeling at my epidural site, so Erin told me to let them know if it got worse or continued much longer.

Erin did my range of motion tests and they were good as well. My hip can bend below 90 degrees towards my chest now and rotation was good. My straight leg raise was high and strong, too, which I think is because I was in good shape going into the surgery. I think if the muscles around your hip are strong going in, it can only help in the recovery.

When it came to movement, I admitted that I'd been putting more weight on the leg this past week. Erin had me walk with one crutch and then a few steps without crutches. One crutch felt OK but without crutches I definitely felt that sinking feeling you get when the leg is not ready to take the weight yet. So I am officially allowed to start using one crutch, but always keep the other around in case I need support or my gait becomes uneven "like a penguin," to quote Erin. Great news, huh?

I am allowed to go to the gym now, with far fewer restrictions than I had post-RPAO. I can do the stationary bicycle at zero resistance to start, as usual, but I can increase duration and resistance faster this time. And I can do any upper body and core exercises I want, provided my hip feels fine when I'm doing them. This is great news because the faster I can start getting back into shape the better; I'd rather not lose as much fitness as I did after the right hip surgery.

It is amazing how much different this recovery has gone compared to my recovery in March. Other women have said that one hip is always worse than the other, but you never know which one will be the bad one. Imagine if this one had been worse than the RPAO! But luckily it is going fantastically so far, and I'm feeling really great. But I doubt I would have appreciated the speed and ease of this recovery as much if I hadn't had such a rough go of it in March.

So good news overall, but there's still a lot of healing to do. I am going to try not to get overexcited about this progress, and continue to take it slow and steady so I can keep knitting away as well as I have been. I return to see Dr. Millis and the team in four weeks (Dec. 29), but I'll update here before then, to report on how the new weight-bearing and gym visits are going.

Three Weeks Post LPAO

It is now three weeks post-LPAO. At this point last time I had a giant leap in progress. This time, progress on the left hip is just steady and slow. I think the difference (again) is that Dr. Millis didn't have to go into the joint capsule on this left side. The first three weeks of horrendousness after my RPAO probably had a lot to do with the joint capsule having to heal up and stabilize. So while my first three weeks post-LPAO felt better than my first three weeks post-RPAO, I think the recoveries are pulling even now.

PAIN and its MEDICATION

My pain is generally very low. Most of the day I am in little to no pain. I usually wake up with pain around 4 or 5 in the morning, but once I take a Percocet I can make it quite a while until the next one. That ligament (or whatever it is) is still bugging me from time to time, but not nearly as much as it was last week, when it hurt at every step. Now it is just an occasional pinch from time to time.

Sleeping is still not fantastic, but is getting better. I still wake up a few times a night when I have to roll over. I can comfortably sleep on my right (non-op) side for long stretches at a time. The pain gets worse towards the morning when the previous night's bedtime Percocet has worn off. Last night, in a fit of madness, I tried to roll onto my left side. Ouch. I'm not quite ready for that yet.

I am gradually stepping down on the painkillers. This past week I discontinued the Oxycontin altogether and I have been averaging 4 Percocet/day (day being 24-hour period, in this case). I am still taking the Valium as needed.

I haven't stopped Atarax but I think I will this coming week. My hospital rash is long gone and the itchy-red-spots are pretty much gone as well. Just some residual itching here and there.

MOVEMENT

Movement is generally the same as last week. Now that the ligament pain (or whatever it was) has let up, I am less reluctant to crutch around. I have even left the house for dinner at a restaurant and other adventures. I am good on my crutches (after much practice!) and I am strong from my pre-surgery fitness level, so moving around is not a problem when the ligament is not bothering me. Some chairs are still uncomfortable, but I can find ways to sit to minimize the pain.

Because I seem to be healing so fast, I have been entertaining delusions of perhaps getting off crutches earlier this time. But I think that is probably not going to happen. I have been ahead in the healing game with this PAO because of the joint capsule -- but cut bones are still cut bones and they are going to take as long to heal on the left side as they did on the right. So I'm just going to be in this I-feel-fine-I-just-can't-walk limbo phase for longer this time. Great.

INCISIONS

Both my incisions look great: click the links for the pictures. The one that really matters is the right side, since that will be my permanent scar on that side. On the left side they will open the scar back up again to get the screws out in a few months anyway, so who cares what it looks like now.

MOOD

My mood is good; mostly stressed. I have had to work a lot during this recovery and it is leaving me with less time to read and relax than I had during my recovery this spring. It is also draining. In the evening I feel like I am going to collapse from exhaustion once I log off work. Another reason I am not getting as much reading done this time around. Happily there's the holiday weekend coming up so maybe I can get through a book.

Next week is my 1 month post-op in Boston. How the time flies as I limp along behind it.

Two Weeks Post-LPAO: Movement

One significant difference from my recovery in March is movement. It is very obvious that this surgery was less invasive and less "destructive" than my RPAO in March. At this point in March I was still quite limited in my hip joint movement, much more so than I am now.

I have quite a bit of leeway in how I can move my left hip without pain. I can straighten it and bend it far more than I could at this stage with my right hip. Of course I cannot lean down to put on a sock on my left leg, or even smear Sarna cream on my itchy left calf, but I can make a more acute angle with my left hip than I could with my right two weeks post-RPAO. I can cross my legs at the ankles (right over left, of course). My left hip also still pops and clicks (painlessly), though more quietly than pre-surgery. (My right hip never popped again after my RPAO.)

The fact that Dr. Millis did not cut any muscles during my LPAO is also noticeable. Although it is weak, my left hip flexor does actually work. I can use my left leg muscles to move my leg around a little bit. At this point in March I could not move my leg at all without someone to help me lift it and replace it in a new position.

All of this should mean increased mobility, maybe even an excursion outside the house (!), but unfortunately the pain I have been having while crutching has been quite a deterrent to getting up and crutching around. So mostly I stay seated or supine, unless I really *have* to get up.

I still need help getting into and out of the shower, because there is a lip, but I can shower on my own. I have a shower chair but I use it more for support than for sitting while I'm showering.

I don't use a special toilet seat -- my right leg is strong enough to lift me from most seated positions even when there is not really enough support for me to use my arms to assist.

I am comfortable sitting in a soft armchair, as long as I can slouch a bit or put my legs up on an ottoman. Dining room and kitchen table chairs are less comfortable, mostly because they involve eating (therefore leaning over the table) and that causes overly-acute-hip-angle problems. Same problem with my office chair (and leaning over the computer). I try to solve the angle problem by sitting on the edge of the chair and angling my thigh down towards the floor, with my foot under my chair, but it is not very comfortable.

Sleeping is the one area in which I am actually doing worse than I was at this point in March. I can still only sleep on my back, with pillows under my left knee. It is not terribly comfortable and when my lower back (what I assume to be the sacrotuberal ligament) hurts, it is not comfortable at all. I am desperate to switch positions during the night, and I have tried, but I still can't sleep on my right side. My left hip and that spot on my back ache when I try to do that. In comparison, two weeks after my RPAO in March I could already sleep happily on my non-op side.

Two Weeks Post LPAO -- Pain & Itching

Today is two weeks from the date of my LPAO, and I have been home from the hospital for a full week. It has been a bit different than my first week home after my RPAO, which you can read about here and here.

For one thing, my activity level my first week home after this surgery was much higher, and not by choice. After my RPAO, I spent the majority of my first week at home sedentary, reading or sleeping in a couch or bed, moving only when necessary. This past week, I had to work full time the whole week. I was, of course, working remotely from Connecticut, not going into the office. But still, that meant sitting upright in a chair at a desk most of the day, and moving around a lot more than I had done in March. Having to work couldn't be helped, but I do think I could have used a bit more sedentary reclining last week.

My pain has been generally well-managed, except for sometimes sharp pain in two specific places. In March, what pain I had would migrate, popping up in different places every time. This time, the pain is localized in two places: the back of my hip joint (it feels like deep inside where my left buttock meets the top of my thigh, maybe the cut in the ischium?), and above my tailbone, on left side, just above my left buttock.

The former pain has lessened over the course of the week and by now is pretty much resolved. The latter pain is much more common and more severe than the former. That pain above my left buttock is almost constant when I am crutching (each time I take a "step" with my left leg, I feel pain there) and can ache while I am sitting in chairs or lying down, especially if I have just been crutching. I have no idea what it is, it doesn't seem to be located near the surgery site at all. I've got an email in to Dr. Millis asking about it.

My best guess is that there is something going on with the sacrotuberous ligament. That would make sense since one of the hamstring muscles originates from that ligament. Maybe when I step a certain way and activate that muscle, it pulls on the sore ligament? Now why the ligament is sore in the first place is a totally different question. Unless of course it is because that ligament connects the sacrum to the tuberosity of the ischium -- the ischium, of course, being the potential source of my other pain described above and one of the bones cut during a PAO. Gosh, surgeons must love it when patients play doctor using Wikipedia.

Moving on. Unlike on my right side after my RPAO, there is no numb spot on my left thigh after my LPAO. Probably because they didn't have to move the nerves around on the left side.

My incision on the left side is fine. The dressing itches sometimes but not too often. It is not generally tender, although earlier in the week it did feel a bit bruised if I pressed gently on my hip near the top of the incision. We have not changed the dressing on the left side. I imagine it will come off some time this week.

My incision on the right side (where the screws were taken out) does not bother me at all. Obviously it was a much shallower cut than the left side. Its dressing came off on Saturday, but the steri-strips remain.

In the hospital I did have some swelling in the hip area on the left side, and my left foot and lower leg swelled up like the blueberry girl in Willy Wonka for a while. But all that swelling is gone now.

My current pain medication regimen is:

-- 1 Oxycodone every 5 hours during the day
-- 1 Oxycontin twice daily
-- 1 Valium as needed during the day
-- 1 Oxycodone and 1 Valium kept at bedside if needed for pain during the night

It is more pain medication than some other PAO women have taken at this point in their healing, but as I wrote a few days ago, I am not being a sissy; I just seem to need more pain medication than most. I am not worried; I will step it down when I am ready, just as I did in March after my RPAO. But currently, especially with that frequent upper buttock pain, I need pain relief.

As I explained in March, the Oxy painkillers do not make me feel mentally foggy in the slightest. Only the Valium makes me a bit scatterbrained and sleepy, so I never take it when I am working, or trying to concentrate on something important like Gossip Girl.

My horrible skin rash has subsided. Probably primarily because I am not laying in those hospital sheets anymore. Earlier in the week I was applying the prescription steroid rash cream twice daily, but since the rash seems to have been vanquished, I've essentially stopped with them now.

Alas, when one itch dies, another is born. Again I am plagued with the itchy-red-spots problem I had in March, probably a side-effect of the pain medications. I am taking Atarax (thrice daily) to combat the itch, and I also try not to scratch. I carry around Sarna lotion and put that on every time I have an urge to scratch. Needless to say, I am very moisturized. It seems to be working because I feel like I have a few fewer itchy red spots than I did mid-week.

I still take aspirin, but I never wear my TED stockings. No one told me I had to. I wore them on the car ride home from the hospital but that was it.

Recovery Day 5 -- Homeward Bound

Among the many uncomfortable things about sleeping post-PAO is the fact that you can only sleep on your back: still and straight like a mummy (with pillows under one leg). Last night I somehow got it into my head that I might be able to sleep on my right side for a while. Surprisingly, it did not work at all. Neither my left hip nor my right appreciated the change. My left (PAO) hip just ached and my right hip's screw-removal incision pulled and pinched. Position change fail.

Dr. Kim came to visit me in the morning. I had actually never met Dr. Kim, so that was a pleasant surprise. He checked my dressings and asked about pain and had me wiggle my toes and all the rest of the typical morning-rounds check up.

At 9:30 Michelle from PT came to get me. I remembered her from March, she is a great PT. She helped me out of bed (an activity which is going more and more smoothly each time I do it) and wheeled me to the PT room. I walked the parallel bars (without help moving the left foot this time) and then got on the crutches to show I could handle them on a flat surface and on stairs -- two prerequisites for my discharge. All of this went very well today. It is such a mystery why sometimes physical things can be so hard and then suddenly so easy.

Obviously I spent two and a half months practicing crutching earlier this year, so that could be the reason for the crutch success. It went well, except that I seemed to be favoring my operated leg a little too much. As I stepped with my left foot, Dr. Millis kept saying "more weight on that foot!" I'm supposed to have 1/6 body weight on the left foot as I step on it, but that is a hard thing to gauge.

Having passed the PT tests, there were just some loose ends to tie up before getting me out the hospital door. There was a humorous moment sizing my TED stockings -- first they gave me size large, regular length stockings. They were loose and too short, like mid-calf gym socks. My mother kept saying I needed LONG stockings because I am tall, and size medium, so they'd be tight enough. A couple of attempts later what I ended up with were tight thigh-high TEDs. They looked sort of trampy, in a way.

The drive home was much better than it had been in March. I was in less pain, perhaps because the surgery had been less invasive so the little bumps and swerves of driving were less disruptive? Or maybe I was just better packed in with pillows and pain pills? Who knows. Another mystery.

By the time we got home to Connecticut three and a half hours later, I was in a lot of pain. While driving, we'd overshot the timing on my oxycodone dosing and so the pain had broken through big-time. I was at 7 or 8 when we got home, just moaning and staring blankly until the pain came back down.

My parents helped me lurch myself up the 13 stairs to my bedroom, and finally I fell into a blessed night of sleep -- in my own bed, without wires, beeping monitors, vital sign checks or rude awakenings by crowds of interns.

Phase One complete. Time for the long Phase Two.

Recovery Day 4 -- Wireless!

Last night was a terrible night because of the rash. Even though I finally got some steroid creams last night, the itching and discomfort was hardly vanquished, and I had to keep calling for Nubain and Benadryl in between my steroid cream applications.

This morning I wanted nothing more than to leap out of bed, have a shower (preferably stripping away several layers of rash-infested skin in the process) and then marinate myself in steroid cream. Last time I had this operation, I absolutely dreaded getting out of bed because it was so painful and logistically difficult. I think the rash is worse this time around, but I know that getting into and out of bed is somehow much less difficult, so it makes sense that I'm much more amenable to getting out of bed.

Nonetheless, I spent most of my morning in bed, working. So much for taking off from work for two weeks after surgery! Dr. LaReau stopped by to check on me, I ate some fruit salad, time passed.

At 10 my catheter came out. With that, I was wireless! No more leads, IVs, drains, nothing. Just me and my rash.

Finally Kimber came for PT, and it was time to get out of bed again. It went better this time; I was more confident with the limits of what I could do, and I also trusted Kimber more. Once up and in my wheelchair, I was taken to the PT room to try walking on the parallel bars. Again, I was pretty confident about it -- after all, this had been a less invasive surgery and I had already done this learning-to-walk-again thing before.

As all you proverb fans probably guessed, it went terribly. At least I felt it did. Just like in March, I couldn't slide my op-side foot forward to save my life. I was so disappointed and confused. This time they didn't cut that muscle! It is supposed to work! Why can't I move my foot?! Kimber helped me slide my op-side foot forward for each "step" but it just felt like cheating. I couldn't do it myself. The whole endeavor hurt my hip and my pride and I felt like a sad failure. I had thought it would be so much easier than in March and it wasn't.

At least when I got back to my room my sheets were changed. But I didn't get to take that long-awaited shower because (of COURSE) I got the only room on the floor with a bathtub instead of a walk-in shower. Perfect. So I had to wait for a new room to open up so I could switch rooms to take a shower. Which meant getting back into bed to stew in my own boiling skin for a few more hours.

I have been on oral pain medication since the epidural came out yesterday, but I still feel like they are not yet covering my pain properly. There are "gaps" where the pain comes through and when I ask if it is time for some more medicine I end up having an hour or more to wait.

Just like in March, I feel like I always have more pain than I "should" have. I know it is probably in my head, but I just get this vibe from people like they think I can't possibly be in pain when I am taking "so much" medication. But I am not exaggerating my pain. When I ask for medication, it is because the pain is at a distracting level, like 5 to 7. Actually, earlier today, when I told one of my nurses my pain had returned and asked if I could have some more medicine she looked at her watch and sort of sighed disapprovingly and said "you are already on a lot of medication..." It sucks to feel simultaneously like a sissy and a junkie.

At around 15:00 two doctors from dermatology came to look at my rash. They didn't take any photos so I guess they were "the deciders." After some chin-stroking they presented exactly no new ideas and no new solutions. So once again dermatology comes up a day late and a diagnosis short. Give me my steroid creams and go away now please.

In the afternoon I got out of bed again for a second session of PT with Kimber. Needless to say, I was not feeling positive about it, but since I had to get out of bed to get my shower anyway, I figured I might as well hit the parallel bars along the way. For some reason, this time it all went much better. Kimber still had to help me move my left foot forward, but at least it felt like I was contributing this time.

And so I earned my reward. Ahh, a shower and a steroid cream body mask. What a spa treatment. After that I was feeling (and looking) much better, so when Dr. Millis stopped by this evening he was happy to see me looking revived. He said everything is going so well that I might even get discharged tomorrow afternoon. The only things left on my to-do list are final x-rays and showing PT I can climb stairs on crutches. And we all know I can do that. Right?