Six Weeks Post-Op

Springtime has come to Connecticut, so at least now some of my sitting can be done outside in the sunshine, enjoying the slow colorful explosion of my mother's garden.

A week ago I discontinued painkillers entirely; since then pain has been minimal. A few times I have "overdone it," I suppose, but the pain has been manageable with just a few Tylenol rather than the hard stuff.

I still have not exactly mastered the 1/3 weight bearing, so I am contenting myself with an average of 1/3 weight bearing. Sometimes I step too hard, sometimes I don't step enough; so be it. At this point I don't think I'm going to come crashing down in a heap of shattered bones and bent screws if I happen to step on my leg with full weight.

By now I have been to the gym a few times to ride the exercise bike and do some upper body exercises, which has helped my mood considerably. It feels good to get some blood flowing, even if it is only for thirty minutes at zero resistance. That's right, I am up to thirty minutes on the bike. I asked my physical therapist if I can add resistance or some other leg exercises now, but she said I had to wait until I saw the doctor again before I could be cleared for any increases. So that means I am stuck at this level for three more weeks. ::Sigh::

This week I finally removed the shower chair from my shower. I probably could have removed it last week as I hadn't sat on it in a while.

My incision is still plagued by an open wound at the top. Erin (on Dr. Millis' team) said it is called a "suture abcess" and that I should just keep it covered by a Band-Aid until it goes away. Erin didn't seem worried but I can't say I am very pleased about having an open wound for weeks on end.

Last week's malaise hasn't entirely dissipated, but the lovely spring weather and the gym visits have certainly helped. And as always, I have plenty to do.

Work has been very busy these past couple of weeks, in a stressful way more than in a "happy industry" way. I'm very glad to be working from home; I would not be getting nearly as much done if I were in the city struggling to and from the office and trying to handle life alone in my apartment.

The office has kindly let me extend my "work from home" absence past my originally planned return date of May 1. Now I plan to remain in Connecticut with my infinitely helpful and supportive parents until after my next appointment with Dr. Millis, at which I will hopefully be switched down to one crutch or even a cane.

Off The Meds

It has now been five weeks since my surgery.

Today is the first day I have gone without any pain medication at all, and it feels fine so far. I had really been stepping down the dosage slowly prior to that, going by whatever pain level I felt. This morning my hip hardly hurt at all, so I decided to give the day a try without medication.

At this point I can sleep on my right (operated) side for long periods during the night. It feels a bit funny, but it is not painful. I sleep through the night with no problems. I am still clocking about nine or ten hours of sleep every night.

I can move my leg around quite a bit using the muscles near the hip; they are starting to recover nicely. All the exercises I got last week from the physical therapist are going very well; they are almost too easy. Only the hip abduction exercise is still difficult.

I have not been to the gym to do the exercise bike or the weight machines for my upper body -- I'm still trying to work out a membership with the YMCA up here in Connecticut. I really hope to get to the gym soon, as I feel that my sedentary lifestyle is affecting my mood as well as my body.

I am still working on getting my new 1/3 body weight weight-bearing allowance right, but the added weight isn't adding pain in my hip. Even when I've accidentally stepped on it with full weight it has not been painful, just obviously weak.

The numb spot on the side of my thigh is still there. It feels like it might be a little less numb, but it is hard to tell.

My incision has actually regressed and is not looking as good as it was in my last photo. One of the subdermal sutures has poked out at the top of the scar, creating an open wound, so I have to wear a Band-Aid over that part. The rest of the scar looks fine, but it is just redder and more noticeable than it was when I first took the Steri-strips off. I am not sure why. I am allowed to massage the scar with Vitamin E oil now, so maybe that will help.

So basically I am at the point in my recovery where I feel totally healthy, except I am on crutches. It is a very frustrating feeling. Progress was obvious before: less pain, more movement. Now everything just feels stagnant. Before I wasn't frustrated because it was very clear that I was injured and needed to rest and heal. Now it is easy to forget that all I have in those cracks is "fuzzy white stuff" and the bone needs time to heal together into a strong, solid unit again. And so it is easy to fall into the foul mood I have been in for the past three or four days.

I am not bored: I've got plenty to do, especially where work is concerned. But I don't want to do any of it any more. I am tired of this variety of sameness. I move from book to magazine to work task to TV show, I move from bed to armchair to table to couch, but it is all the same. It is all still and slow and seated. And I am really tired of sitting.

One Month Post-Op Visit

Today was my first post-operative visit with Dr. Millis, one month after my surgery. I had x-rays taken, met with the doctor to discuss my progress, and met with Physical Therapy to discuss my "assignments" for the coming month. My next visit to Boston will be in another month.

Dr. Millis said my x-rays looked great, and that "all the fuzzy white areas" were new bone growing to fill the cracks. Honestly, the whole x-ray looked like fuzzy white areas of varied brightness, so I didn't really see what he was seeing. I will post the new xrays when I get them. Dr. Millis also tested my range of motion in extension, flexion and rotation. In all, he was very pleased with my healing progress.

I got cleared to stop taking aspirin (which I'd been taking to avoid blood clots). I was instructed to continue to wean myself off painkillers as I have been doing. I got cleared to drive a car.

I am still on both crutches, only now I am allowed to put one third of my body weight on the right leg. So not exactly throw-down-your-crutches progress, but progress nonetheless. The problem is that one third of my body weight is a hard weight to gauge when you are thinking about crutching. It is one thing to put just the weight of your leg down. It is another thing to put half your body weight down as you do during when walking normally. But one third body weight? That is two thirds of the normal weight I would put on that leg if I were walking normally. But how does two-thirds normal weight feel? I have no idea. This will take practice.

The meeting with Physical Therapy outlined the range of movement I am permitted and the exercises I should practice in the coming month. I am now allowed full extension of my leg, which means I can lay on my stomach and on my back with no pillow under my leg. I was given a set of starter exercises and instructions to do them at least once a day. I was also given permission to walk in a pool and ride an upright stationary bicycle at no resistance for 10 minutes, building up to 30 minutes.

I was specifically instructed not to do any straight-leg lifts using the quadriceps because the head of one of the quadriceps muscles was detached during surgery (hence my inability to slide my foot forward the first week, remember that?) and still needed time to reconnect securely.

I did a whole set of the exercises with the Physical Therapist and they were pretty challenging despite their simplicity. It is an odd feeling to be starting something so basic from scratch. Before this, I had been moving my limbs around without a problem since birth. It is a bit rough to have to re-learn it all when the limbs are so much heavier and there is far less naptime.

After three hours in the hospital going from appointment to waiting room to appointment again, having Dr. Millis move my leg around to test motion, having the Physical Therapist move my leg around and lead me in a set of exercises -- my leg hurt more than ever. Muscle pain as well as bone pain this time. I foresee a painful period ahead of me as I begin to practice my new movements this coming month.

I am looking forward to moving more and bearing more weight on the leg, but I am also disappointed that the healing process is not moving faster. Looking back over the last month -- or even through this very entry -- the sentiment seems silly: I have progressed so much from being flat on my back in the hospital a month ago. But I have swung back to the way I felt the first weeks after the surgery, when I was unhappily surprised that recovery was so hard and painful. This time, I am unpleasantly surprised that recovery is taking so long. And just like last time, I should be surprised, nor should I have naively expected that somehow, for *me*, everything would be easy and quick. It has all been and will continue to be just as painful and gradual a process it is for every other normal human being. What a surprise.

Three Weeks Post-Op

It is now three weeks post-op and things have definitely improved. Pain is down (as is pain medication), movement is up, and the incision looks amazing. Next week I go up to Boston for my 1-month-post-op visit and then we'll see how much progress I've made internally as well.

PAIN and its MEDICATION

I have far less pain now than I did a week ago, and I get by on far fewer painkillers per day. This past week I have been taking an Oxycontin twice a day, morning and evening, and filling in with Vicodin three times during the day; yesterday I dropped it down to only two Vicodin during the day. This past week I also stopped taking the Valium all together.

Because of the reduction in medication, I don't have the same skin reactions as I did before, so I have stopped taking the Atarax (although I still use the topical rash cream morning and evening in the relevant areas).

My pain is generally very low. Most of the day I am in little to no pain; towards the afternoon I start to feel an ache and that is when I take the Vicodin. If I am going out to something I usually take a Vicodin beforehand as protection, as Dr. Millis suggested, and then I am able to sit through dinners and events with no problem. I sleep well, not waking up too often, and I don't wake up with too much pain in the mornings.

Overall there has been a huge improvement on the pain front this week. Actually Dr. Millis predicted this would happen. When we spoke a week ago he said that I would probably notice a sudden lifting of pain over the next week or so; a disappearance of the constant aching pain that I'd had since the surgery. And so I did.

MOVEMENT

I have made great strides (sorry) in the movement department as well. With the reduction in pain, and the knowledge that I am not overly numbed with pain medication and am not likely to do anything that will "ruin" the surgery, I feel much less nervous about my right leg in general.

I can bend carefully in more directions and at sharper hip angles without the prior pinching; I can move my right (operated) leg out to the side or in across my other leg a little bit (not talking huge ballet swings here, maybe 20 degrees in each direction?); I can rotate my right foot inwards and outwards when my leg is stretched out before me. I can lift and move my leg more often now (which is still not that often) without using my arms to assist, but I can also tell that many of the muscles around my hip are (not surprisingly) very weak indeed and, once I get the go-ahead, are going to need some rehab work.

One thing I have not noticed with any of my increased movements is popping, grinding, clicking, snapping or any other Rice Krispies sounds or feelings coming from my hip. Perhaps that will come with larger movements, but so far so quiet.

I know that I have put a little more than the allowed weight on the operated leg at times (by accident) in the past week and I haven't had any pain result from those brief occasions. I am still under the hospital-discharge instructions to put no more weight on my operated leg than the weight of the leg itself (i.e. resting my foot on the floor), so that is what I do, but it feels like I am ready to put some more weight on the operated leg.

Honestly, with my pain so low and my movement so improved, sometimes this whole surgery/recovery/crutches thing feels fake. Like I could just throw my crutches aside and walk if I wanted to. I suppose that is a dangerous feeling because it could lead to me acting carelessly with a hip that, while feeling much better, is by no means even close to completely healed.

But it seems my naive pre-surgery superhero feelings have begun to resurface -- the ones that made me think this recovery wouldn't be that bad at all (at least not for *me*) and the ones that are making me think the doctor is going to tell me I can throw away the crutches and walk when I go see him on Tuesday. Thank God my parents never got me a Wonder Woman costume for Halloween as a child; I probably would have jumped off a building expecting to fly.

INCISION

One great reminder that none of this is fake at all is the five-inch scar across my abdomen. All the steri-strips are off and it looks amazing, see for yourself. Dr. Millis must have used skin glue or something because the incision has healed together so smoothly and so quickly. But I can't get too excited about it: he is going to reopen it to get the screws out eventually, and I don't know that it will heal up so nicely the second time around.

MOOD

I am in good spirits most of the time, especially now that the pain and itching have lessened and I've gotten more relaxed about the movement of my hip. I am not bored in the slightest: on the contrary I am relishing the opportunity to read voraciously in various media and keep up with my favorite TV shows and movies. This is the part of me that is hoping that the doctor does *not* tell me to throw away the crutches and walk next week. I'm not done with my pile of books yet!

Nevertheless, the bookworming has slowed down in the last couple of weeks as I'm back to working almost full days now during the week. I feel up to it mentally and so far I think I have been doing as good a job as I would be doing if I were physically in the office. Probably better, since I am comfortable and only have a 13-stair commute.

Venturing Out on the Town

Tuesday's big adventure was going out to dinner at a local restaurant. At the time it was my longest excursion out of the house since I got home from the hospital a week and a half ago.

I was already in a bit more pain than usual before we went, but I thought the pain was more from muscle cramping from sitting in one position all day than from hip ache, so I took a Valium instead of an Oxycodone. Wrong choice. I was irritable, sleepy, uncomfortable in my chair, not very hungry and climbing the pain scale throughout the meal. What a terrible dinner date I was for my poor parents!

When I got home, I got a call from Dr. Millis. He wanted to check up on me at the two-week mark. Obviously he was catching me at a low point pain and mood-wise, but despite how awful I felt during the call, I tried to give him a broader picture of how I have been doing these past weeks and the progresses I have made.

The highlights of what he told me were:

-- if I am to undertake anything adventuresome (ahem, restaurant visit), I should prepare by taking extra pain medication beforehand (in this case one or two Oxycodone instead of one Valium) and not torture myself by going poorly protected, painkiller-wise;

-- he did not seem to be concerned about the amount of pain medication I am still needing (I was concerned because some of my PAO peers seem to reduce and even quit their pain medication so quickly, and I just don't think I can do it that fast, nor do I think I am being wimpy about my pain level);

-- I don't have to worry so much about overdoing the angle or the weight on the operated hip -- it will take more than such small things to do damage to the hip and its healing;

-- any grinding, shifting, popping, or clicking I may have felt are normal the first few weeks (I have felt none of those things.);

-- the dressing can come off any time now, the incision will be healed shut by now;

-- the numb spot will continue to recede.

Today I took the dressing off -- it is still hard to tell what the incision looks like because of the steri-strips. Mostly it looks like a 4.5" long mountain ridge curving down from where the iliac crest sticks out in front. Here is a photo; one of the steri-strips has peeled off already so you can see the actual incision there.

For orientation, the grey fabric is my pants, the top of the incision is where my hip bone would stick out really obviously if I were skinny like a supermodel, and the right side of the photo is the right side of my body. The yellowish tinges are from Betadine solution.

[Note, I've also added a post-surgery x-ray photo here, and going forward photos will be easily accessible in the Quick Links section at left.]

Tonight was another big adventure, attending a three-hour fund-raising event with my parents. Again I was already in a bit more pain than normal beforehand, this time because I'd stepped on the dog while swinging my bad leg off the couch -- the dog obviously jumped up and away, wrenching my leg as she moved. It hurt -- me physically and the dog emotionally.

This time I applied the lessons of Tuesday night and took two Oxycodone beforehand and had extra medication with me. (The fact that the event was a trivia competition and I was able to vigorously compete does prove my point that the Oxycodone does not make me foggy at all.) Although my team did not win, the night turned out well overall. My pain stayed very low until the last hour, when it started to increase and distract me. So clearly I can venture out a bit more, but as Dr. Millis suggested, I should be prepared with extra pain medication to avoid self-torture.

Two Weeks Post-Surgery: Movement

I am more mobile than last week in the sense that I am more confident on my crutches. Other than that there is not a significant amount of progress. I am in good shape for crutching -- prior to the surgery I did a lot of step-ups onto high platforms, squats, lat pulldowns, rows, triceps dips and other "crutch muscles" exercises, so I actually have not felt much difficulty crutching due to fatigue/weakness of any of the supporting muscles. (That said, I don't do much crutching other than around the house for necessary tasks only.) The real difficulty is with the muscles that were affected by the surgery in my right leg, as I describe below in the bit about the stairs.

I'm concerned sometimes that I accidentally put too much weight on the bad leg, or that I create too sharp an angle at the hip by leaning forward in a chair, for example. I left the hospital with instructions to keep the angle between my torso and thigh between 80 and 30 degrees (with 0 being flat out as when you stand up straight or lie down flat on the floor, and 90 being your knee brought up so your thigh is perpendicular to your body). So my concern is that I might accidentally push the hip a bit too far with weight-bearing or the angle, since I'm protected by the painkillers.

Or I might just fall on my face, like I did yesterday. I was waking up from a nap, and clearly not really fully awake or coordinated. As I got up from the couch and reached for my crutches, I lost my balance and fell forward. I caught myself mostly with other limbs, but I did land moderately hard on the floor with my right (op-side) knee, jarring my operated hip. It hurt right away (even through the painkillers) and of course I instantly panicked that I had done some sort of significant damage to my hip or hindered the recovery in some way. It feels OK today so maybe I am not made of porcelain. But lesson learned: wake up, THEN stand up.

I know I'm being a bit overly cautious, but I just really want to be very careful and treat my hip as properly as possible during this healing time, especially when it is so early and everything is so loosey-goosey in there; I feel like the slightest mistake (like clumsily falling) might cause some small setback or damage that would prevent the joint from healing as strongly and solidly as possible. I'm afraid that pushing oneself too hard and pushing the boundaries of healing too soon could create microscopic weaknesses in the healed joint that over time could cause pain, problems, and potentially more surgery. I want to heal this hip once, well, and for GOOD. (And then do the same thing to the other one.)

My current movement project is going down stairs -- as we know last week's breakthrough was sliding my right (op) foot forward using the hip flexor/upper quad when taking a step forward with my crutches. Going down steps is a slight variation on that, as I put the crutches on the lower step, place my right (op) foot on the lower step, then (with all my weight on the crutches) bring my left (non-op) foot down to the lower step where my crutches and other foot are. So the additional difficulty here is that rather than just sliding my right (op) foot forward, I also have to use muscles around my hip to support the entire weight of my right leg while the right foot is in mid-air over the lower step before I place it into position.

Previously I had either cheated by slithering my foot over the edge of the stair and down onto the lower stair (i.e. never losing contact with the ground) or having someone place my right foot on the lower stair with each step. But by now my hip flexor/upper quad muscles are strong enough for me to place my own foot on the stair below (sans slithering or assistance) for several steps in a row. This morning I made it down almost all of the 13 stairs down from the upstairs, so that was a pretty good achievement.

I still need help getting into and out of the shower (there is a high lip that I need help getting over with crutches, plus there are zero handholds to grab on to for support), but I can shower myself using my shower chair. Although a shower feels fantastic, the entire undressing/getting in/not falling off the shower chair/getting out/drying myself with all weight on left foot/redressing process is sometimes an exhausting ordeal, so the glee can be somewhat tempered.

I have been fine with using a normal toilet since I got home. I think this is due to my pre-surgery leg workouts -- my left leg has been doing quite well at lifting my entire body weight from various seated positions even when there is not really enough support for me to use my arms to assist.

Similarly I never got myself a leg-lifter to position my leg; I just grab it by the knee and move it around with my arms. To make small adjustments to the position of my lower leg I have been using an excellent trick I read in someone else's blog -- slip the non-operated side's foot under the ankle of the operated-side leg and use the good foot to adjust the position of the lower leg on the operated side.

I am perfectly comfortable sitting in an armchair with an ottoman for hours. I can sit in an armchair without an ottoman for a while as well, as long as I can slouch a bit. Dining room and kitchen table chairs are less comfortable, mostly because they involve eating (i.e. leaning over the table) and that causes greater-than-80-degree hip angle problems. I 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 as you can probably imagine, that is not all that comfortable for long periods of time either, so I prefer the armchair route.

The leg-under-the-chair solution is also helpful for getting up from armless chairs or other seating positions where there is not a lot of support nearby for using my arms to help me stand up. With my right leg under the chair and my right knee pointing 45 degrees towards the floor, I can lean forward to use my body weight to help me stand up using just my left leg, without creating an overly acute hip angle from leaning forward.

There has not been much progress in sleeping positions. As last week, I can sleep on my back (with two pillows under my right leg) or on my left side (with two pillows between my knees and one between my ankles) for long periods during the night. I can switch between these positions by myself, although it is not something I can do in a state of half-sleep, so I do still wake up several times per night to make these switches. Last night I must have been dreaming something topsy-turvy because I woke up in the midst of an attempt to turn on to my right (op) side to sleep. I did complete the turn, figuring I might as well try lying on the operated side, but that experiment lasted about one second, as it hurt immediately and not insignificantly.

Although I can't move all that much, my spirits are still high. I'm in a good mood most of the time, and I'm never bored. I have so much to read (books, magazines, newspapers, blogs) and so much to watch (Netflix! Hulu!) that the days pass quickly. I've also started to log back in to work this week, but so far I've just been responding to two weeks of emails and trying to get my inbox back in order.

Two Weeks Post-Surgery: Pain & Medication

My pain is generally well-managed but there is a lot of it still lurking below the painkiller block. When the pain does break through, it has usually moved to one or another of its favorite places to surface -- sometimes over the incision, sometimes on the outside of my hip, sometimes deep within the joint, sometimes at the top of my iliac crest (where I think there is a screw head), sometimes in the back of my hip joint (deep inside behind the bottom of my right buttock), sometimes shooting itself like a racing stripe down the outside of my thigh, knee and calf.

There is still a numb spot about the size of my hand on the outside of my thigh, right below where the greater trochanter of the femur sticks out to form the widest part of the hip. The numb spot is normal; Dr. Millis said they have to move a significant nerve aside when they are doing the surgery, and this causes some damage to the nerve that gradually repairs itself over a few months. But there will be a steadily receding numb spot there until the nerve has completely healed.

My incision is usually the least of my problems. It is not generally tender, but it itches sometimes under the dressing, and as I mentioned above, it does sometimes hurt. We changed the dressing two days ago, so I saw the scar (through the steri-strips, which means I didn't see much). Not much to report until I really see it when the dressing and the steri-strips come off. The dressing is set to come off this Thursday.

There does not seem to be much swelling at all in the hip area or the leg on my operated side. I am not even sure there was that much swelling in the hospital.

My current pain medication regimen is:

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

Some PAO bloggers I have read have been on less medication (or less frequent dosing) by this point in their recoveries, so I'm not sure why I'm still needing such high or frequent amounts of pain medication. I have, on occasion of missing a dose or taking a dose too late, had breakthrough pain, and it is not at all tolerable -- about a 5 on my pain scale if I let it get too far. Since leaving the hospital I have stepped down to one Oxycodone every five hours instead of two every four hours, and have switched to taking Valium at nights instead of Oxycodone.

Unlike others, however, I don't find the painkillers make me feel mentally foggy in the slightest. Only Valium makes me a bit scatterbrained and sleepy, which is why I take it at nights now and leave the Oxys for the daytime. But on the current regimen I have been reading varied, mentally stimulating books and magazines, playing (and winning) fierce games of Trivial Pursuit and staying generally awake and alert all day, save an afternoon nap. So I'm in no rush to get off the pain killers for any philosophical or mental acuity reasons, I just find it interesting that others have weaned off them tolerably so much more quickly than I seem to be doing.

Of course, one must consider that my surgery took seven hours rather than the four and a half hours Dr. Millis had originally predicted, and my bones were, according to him, incredibly strong and difficult to cut. I have five screws rather than the usual number of three most often used in these operations. Also, I came out of surgery with an elbow injury on top of the hip situation (and then there was the heat rash!), so maybe my body's healing department has had a lot a lot of balls in the air and that is why my pain has been persisting longer than that of my PAO peers. Or maybe everyone is different in their healing and it is what it is.

Speaking of heat rash, I've been applying the prescription rash cream twice daily since I left the hospital. The dragonhide that formed after the fiery welts I had in the hospital has completely flaked off by now and the marks of the rash are reportedly looking much better and almost dissipated.

The itchy-red-spots problem (which apparently is a side-effect of the pain medications, although I have not read of similar reactions among any of my PAO peers) persists, but seems to have been lessening steadily. For that I try (usually unsuccessfully) not to scratch at the spots and I apply Gold Bond lotion twice daily. Mostly it feels like I have a mild but chronic case of chicken pox.

I am also still taking the Atarax pills (twice daily) that I was taking when I left the hospital for the itching/spots. I think I will reduce the Atarax as the pain medications are reduced.

I was never given Lovenox or even Coumadin at the hospital, just aspirin, so I keep taking that once daily to keep my blood thin and clot-free as I'm healing. I stopped wearing my TED stockings after a few days at home. Even in the hospital they weren't very tight and didn't seem to be doing anything that a pair of drug-store knee-highs couldn't do. Plus, no one told me I had to wear them when I got home.