My GP Approves

Consulting with my GP

It is now nine weeks post surgery and I am feeling pretty good! Time to see my GP and assess whether I am ready to go back to work.

She seems pleased with my progress after checking me out.

I tell her that HR at work and the insurer need a letter saying that I am fit to start back on a graduated return to work.

She is happy to provide and away I go.

Physiotherapy – V

Now that my two doctors have signed off on me, it is over to getting my muscles to work properly again. More exercise, more stretching, more massage, and more movement is the ticket.

Physio Mark is thoroughly brutal. There is no easy way with him. If I can do the exercise then we need to add another one. If this massage doesn’t cause pain, then it is time to move to another area. There are lots of knots and adhesions to be dealt with.

I keep working hard on movement, particularly now that the joint and my general health have been approved. Some days it feels like no progress at all, but I know there is always a little.

The Paperwork

My insurer wants the letter faxed or a copy attached to an email. To do this I need to get to some technology. This took a couple of days to sort out and then that goes away. I am starting to feel impatient. I will just have to concentrate on my exercises.

Outside Activities

I am doing some dog walking, although my lower back and hip flexors are still very stiff and weak. Walking around Trout Lake has proved to be a good measure at about a kilometre around the lake. I started, needing to rest 3 times and have worked up to completing a lap in one go.

Gardening consumes me. I dig and pull weeds with a kitchen timer at my side. 12 minutes on, 3 minutes off, two cycles, take a break inside and catch my breath for half an hour. Rinse and repeat. Currently I can do three of these cycles a day.

Still taking a muscle relaxant with my acetaminophen and taking it as often as allowed. Sleep is very rocky and I wake up every few hours. I still cannot lie on the side of the surgery, but I am sleep enough and napping during the day.

This is hard but rewarding work that I know will pay off over time.

Eight Weeks On

Visiting my Surgeon

Two months after surgery and it is time to visit Dr. Dive. First a round of x-rays of the hip to see what has transpired. I get to see the x-rays and they look like the ones you see in textbooks or on the web as examples how things should look after the operation.
Then the consultation.

“Looking very good. How do you feel?
Now, let me see you walk without the cane.

Time to stop using the raised seats, but keep the 90 degree hip precautions!”

I have a question: “My hamstring on the right side still knot up. Is there anything that I should be doing beyond the exercises from physio, swimming, and walking?”

He checks the leg, smiles and says. “It will just take some ‘Tincture of Time’.”
I nod with a smile on my face. I am good with time and its passage.

His final comment was, “You are a poster girl for the procedure.”

All this is a relief as I had been concerned that the new joint and my old bones were going to get along. It appears that they have made friends and bonded.

Re Habilitation

Habilitation (from Latin habilis "fit, proper, skillfull") has many meanings, including: To impart an ability or capacity to. So now I am in the process of learning how to do again, that which I used to be able to do: Turning; Bending; and Walking.

The leg hip and back muscles are all very weak after a year (and more) of either limited activity or improper activity trying to compensate for the deteriorating hip. It is amazing how much my lower back aches just standing in one place.

Muscles that were Cut 

These are still trying to come back together. Now, it is not ants, but rather the ripply feeling of slightly larger critters moving around in there. Still, it is a little better every day.
I am so impatient!

Exercise Program

Lot of stretching, turning, bending (all while keeping the 90 degree hip precautions. Careful lifting and digging the garden is all part of this program. I now take a timer out with me and limited how long I can be doing this – 13 minutes activity, 4 resting, 13 minutes activity, take a half hour break.

Walking

How far and how many steps are the questions each and every day. My stride is getting longer, so the same number of steps inches up the distance. I am pushing on the steps, but still trying not to overdo it. Currently, I can do around 5000 steps (a couple of kilometres) over the course of a day. This leaves me very tired but still functional.

The Wall

There is a point at which doing about a kilometre at a time, my lower back just ‘locks up’. Nothing I did seemed to be helping. Time to get back to my physiotherapist for a session and some advice.

He said, “More stretching and some deep massage for your hamstring muscles.” Okay, that hurts so it must be helping. Actually, the stretching helps a lot and easing the hamstrings is making it easier to walk as well. 
More small adjustments.

Second Month Recovery

Shorter Posts

I am in the slogging stage of recovery now. My full time job is to get better and more mobile. It takes up all my time and energy, but will be worth it in the end. This covers my activities up to the end of week seven, post-surgery.

On Overdoing the Recovery

I do really want to be well again. So, I sometimes just run (walk, lurch) with the endorphins that come with exercising and then I have a tendency to do too much. This leads to a day (or more) of increased pain and decreased mobility. L

So, I am trying to count or time my movements so that I don’t do this. Still, my natural enthusiasm does whisper in my ear, “Sure you can do another 10 minutes.” And it is really hard not to agree. And when I do, I pay.

I am currently trying not to overdo it with swimming, and now with stationary bicycling. The latest step up sees me in the fitness centre on the days between swims. Again it is easy to get into a groove and keep going. The cycling is working my leg muscles, my knees and my glutes.

Garden

The weeds are being removed and the ground is being uncovered. Any extra energy after exercising has been spent here. The uneven ground is actually a very good exercise for my legs and balance, so it really is a win, win…and I get food!

Walking

This is harder than I would have ever imagined!

All the exercising that I have done just barely gets me up to the level where I can start to walk any distance at all. A single block is tough the first time, but after recovering, then it is to try two, three blocks. After a week, I can just barely do eight blocks and I am exhausted. It takes the rest of the day to recover.

Getting Ready to Drive

Off the Opioids for the last week. Can move my leg easily through the range of movements that I need. Reflexes are good.

First trip out is just a short one to pick up some more acetaminophen, It went well, and I can now get myself to swimming and the fitness centre. Nice to be independent again.

Current Pain Management

The acetaminophen is doing the job as far as pain in concerned. However, I am now taking Lyrica for the nerves that are screaming at me. This is not Pain pain, it is more like extreme irritation with lots of signals that something is not ok. The nerve meds help quiet them down at night so that I can sleep.

After the First Month

One Month Plus After Surgery

My right leg (the one with the incision and new hip) is waking up! It is not happy! The internal conversation sounds a bit like this:

Right Leg (RL): Just what did you do to me?!?

Me: Um, we had a little operation to replace the hip joint…

RL: Little!! My Ass!!! (RL does include my gluteus maximus muscle, after all.)

Me: You seem a little restless lately?

RL: I am trying to figure out all the nerve paths that your “little operation” has disrupted.

Me: Is that why I am having trouble sleeping?

RL: You bet it is, honey! You disrupt me and I am gonna disrupt you!

This is my imaginary discussion with my right leg and a possible reason why I am having major twinges and little electrical shocks (like tiny, tiny ants running around inside my leg). And, yes, it is making it hard to sleep. Is it ‘painful’? No, just annoying. It actually feels like a program of healing that the leg is going through as it re-finds the muscle and nerve connections that were disturbed (cut).

Swimming – II

Three times a week now and I am up to 300 metres in lengths. In a younger incarnation, I used to swim kilometres of lengths in a saltwater pool until I was bored. Right now, my little 300 metres seems like a major victory. My style and breathing cycles are all a long way out of whack, so I am learning to swim all over again.

Hoping to push to 500 metres (20 lengths) by the end of next week.

Gardening – II

Gardening, I mean, weeding, is interesting to without bending my hip more than 90 degrees. My other leg is getting much stronger as I lunge at the weeds that I have just uprooted with my hoe or loosened with my shovel.

The ongoing rain means that I sneak out between showers (deluges) and it helps me keep the time short so that I don’t overdo it.

Physiotherapy – IV

New exercises, again. Now the emphasis is on balance. Walking heel to toe is harder than it used to be! I can climb stairs one step for each stair. This is a major breakthrough. Still using various supports (walker, crutches, cane) but depending on them less.

Walking

Around the block and out grocery shopping for the time being. I know I need to walk more but am not quite there yet. I am managing to clock in at around 5000 steps a day on a consistent basis. More to come in the future.

Pain Management – VI

Since it is my muscles and back that are speaking the loudest, I am adding a muscle relaxant to my acetaminophen regime. Still taking the opioids at night since I need some sleep to continue the healing process.

Week Four

Week Four

My daily routine is exercise, get up, breakfast, exercise, nap, lunch, exercise, nap, exercise, break, dinner, relax, bed time. It is an up hill push to get back to the level of fitness that I had even a year ago.

Movements as still slow and sometimes tentative but I am moving for the most part. Everything is so much better than before the surgery!

This is my last week of 70 degree hip precautions. I think I must be healing because they seem restrictive at this point. I want to move around more, but remember that I am not completely healed up each time I forget to take pain killers on time.
I am still being very careful about how I position the hip. The very last thing that I would like to be doing is trying to explain to my surgeon why I am back in the hospital. I think it would be...awkward.

Swimming

A number of people have recommended swimming as good exercise. With my long hair, a chlorinated pool leaves me walking in a cloud of chlorine for days after a swim, which is one of the reasons that I have not been swimming in years. A little searching and I found a pool nearby - Killarney Community Centre - that uses ozone instead of chlorine so off I went.

What a wonderful feeling of being un-weighted in the water. There is extra resistance to movement, but you float. I did all of my standing exercises and most of the lying down ones with ease. It won’t replace my other routines but it sure was a nice way to work out. And my hair does NOT smell of chlorine. I bought a month pass and we will see if I get my money’s worth.
I also came out of the pool feeling like I had been working hard. It is easy to overdo the exercises because they become so easy to do. I have to watch my time and count. Next week, I will start swimming laps and see where I get to.

Bicycling

What I really want to be doing is bicycling on the street, but this is not an option on my current drug program and the late winter weather, so I will try and be patient and build up my stamina so when I can get out, I will be able to actually get somewhere.

Since the pool that I am swimming in is located in a Community Centre, the Flexipass that I purchased can also be used for various Fitness Centres in other locations in Vancouver. I found another close one - Trout Lake - that has stationary bicycles. It was recommended that I use these as well to help my leg muscles get back in shape. It is tricky to get to the Community Centre for a short stint of bicycling since I am not driving yet. It will be easier when I can get myself there on my own.

Tool Upgrade

Had to buy a folding reacher so that I can put it in my swim bag. The rigid one doesn’t fit and is really awkward to care around. 

I have also repurposed a nice piece of driftwood with a crook in one end as a garden cane. With a crutch tip added, it is actually quite stable and stabilizing for me out in the back garden.

Gardening

I have been doing a small plot at a time every day that I can get outside. The creeping buttercup, ground ivy, and various other weeds are doing quite nicely since I didn't get them dug out last fall. Lots of catching up to do. Besides being necessary, the gardening is another good workout for my whole body.
Garlic is up and happy, purple sprouting broccoli is almost ready to eat, I have self sowing parsnips up and getting a head start on the season. I have potted up 12 clay pots of  wood strawberries for my planters off my back deck. There are buds on them now so blooming will happen in a couple of weeks, then little strawberry snacks after then as long as there is some sunshine.

Orange Marmalade

The time for Seville oranges is passing and I am running out of marmalade, so I located a case of oranges and sent out a message to the other members of the Canoe Creek Community Kitchen, for a get together last Saturday to make some orange marmalade. One member of the group asked "Is this on your care plan?" and I answered that as long as I keep my hip at 70 degrees or less, it is.
Five of us managed to make 25 litres of jam over about four hours. That felt good! I was able to do everything, although I needed to sit down frequently. This was my full exercise program for the day and I spent the afternoon napping on the couch.

Pain Management - V

End of the week but not an end of the opioids. I still need them on a decreasing basis. The more I move, the more muscles get involved and have something to say about the process. My lower back is protesting now as it has been mostly immobilized by the lack of hip movement and has become weak. I am adding exercises for this area as well to build it back up. A heating pad for my leg and lower back seems to help as well. 

I am back to a cup of coffee in the morning, which also seems to help with the pain and allowing me to start moving after my get out of bed exercises. Hope to be on strictly over the counter pain relief in the next week or two.

Week Three

End of Week Three

There were a couple of days where it seemed like a step forward and then a step backward. Still, I am staying optimistic as nothing is as bad as before the surgery.

Physiotherapy – III

On my second trip to physio, I am checked out for walking with a cane. Good, I get a pass and encouragement to do more. New exercises to do as well, and they all seem to flow nicely from how I am moving now. Need to keep the muscles around the incision massaged to stop them from cramping on me.

Upping the Movement

More, but not too much was the idea. Unfortunately for me, I need to really watch out for overdoing it. I have taken to timing myself so that I stay within a reasonable amount.

I exercise in the morning before getting up and again before going to bed at night. I have morning and afternoon sets of standing exercises and then I slip in a stretch every now and then as I am doing tasks around the house.

Counting my Steps

My pedometer is my friend. It lets me know, before I overdo it, how much I have moved my body and my new hip.

I have been edging up every day and am now at 3000 steps. That was the number I had fallen down to before the surgery. I figure that if I can do 500 extra each day, I will be doing well over the next month.

Gardening

The Garden has been screaming at me for months. The creeping buttercup in starting to overwhelm parts of it and there are many plants that need moving or at least repotting. My current activity is to go out and do no more than 15 minutes of gardening. So I am clearing very small patches but I know they will add up over time.

Getting Out and About

Every day, I plan a trip somewhere. Doesn’t matter where as long as it is a short trip with about a block length of walking. This has been working well and I can monitor it with my pedometer. With the weather being later winter rains, I need to step carefully so that I don't slip. As long as I take it slow, I am doing fine.

Tools of the Trade

Continue to use all the mobility tools at my disposal. The walker is my second floor companion now and makes sure I don’t fall over in the dark when I get up in the middle of the night.

I now spend a lot of thought on what movements I make and what tools I should use instead. It has made me hyper-aware of where my body is located in time and space.

Pain Management – IV

More Tylenol, less opioids. I have a new plan that I adjust daily so I can monitor my intake. I am showing small decreases in my need for painkillers and this is good news.

Still, I take them as needed because otherwise I would stop moving.

Getting Out and About

Tools

I have my reacher and my long shoe horn, both quite long and awkward when they are not being used for their designed purpose. Where do I put them??? I need the reacher all the time to ensure that I don’t break my ‘hip precautions’ of not bending my hip more than 70 degrees from vertical. We found a piece of the thin walled PVC pipe that we had used to plumb the house for our central vacuum system. After cutting off a two inch / five cm section and making a cut down one side to remove a .5 cm strip, we drilled four holes and used a couple of nylon straps (nyties or zapstraps) to lash it to the right side of my walker up near the top and towards the front. A little work with a half round file and there is a notch for the shoehorn handle and the reacher fits nicely on top of this. Everything is in easy reach and I am good to go.

We also fastened a pouch to the front of the walker so I can carry my pill box, a cordless phone, and a water bottle with me as I move around the house. Saw a number of patterns for sewing pouches for walkers out in my internet search, so anyone who wants to go custom will have not lack for inspiration.

Getting out of the House

I am scheduling some sort of walking every day, starting with several laps of the floor that I am on. I now wear a pedometer and amongst the walker, crutches, and cane, I am up to almost 1000 steps a day.
To get more walking in, I need to get out. The late winter rains are not making this easy, but since we shop in a variety of small stores, each time we need something for dinner, I am eager to go out. I certainly don’t feel up to the supermarket crawl yet, but a trip to the green grocer or the deli is manageable and makes me feel more social/human than endless laps around the house.

Expedition Planning

My goal is to make it around the block. I figure that I may take me another week to do this.

Physiotherapy

I attended as scheduled, 2 weeks after the initial surgery. Assessment is that I am doing fine and am on track. New exercises to do twice a day. So currently my life if focused on exercising, walking as much as possible, occasional outings, and napping. This is still the punctuation to everything that I do. I am much more appreciate of the term "nap attack" than ever before.

Pain Management – III

Getting back down to only taking Over the Counter medications is now my goal. Every few hours, I ask myself about what level of pain I am experiencing and then look really hard at the medications that I have available. Early in the day, I can use less, but after working out and just before the next nap, I need a bit more. The 'hard' drugs are being consumed less often but they are still with me. Without them I do less movement and it is the movement that will get me back to normal, faster than anything else.