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.

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.

Staples Be Gone

Staple Removal!

I’ve been home for a week and it is now 10 days after surgery; my leg is getting seriously itchy under the dressings. I have an appointment to get the staples out in the afternoon. A simple procedure, really. It took very little time and pain as Dr. Lee removed the 30+ staples that have been holding my incision wound together. She pronounced that it should leave very little scar by the time everything is healed. A few applications of Polysporin for good luck and I am on the way to being whole again.

Pain Management – II

Large holes in your leg really do require more drugs than I had imagined. When you can’t sleep at night and can’t find a comfortable spot during the day, it is finally drilling into my thick skull that I still need the some pain relief. Over the counter Tylenol is not quite enough and I am cut off the Non-steroidal anti-inflammatory drugs due to the danger of internal bleeding, blood clots and the attendant consequences if they move around in my body. When I had the staples out I also got a new prescription so that I can start stepping down from the opioids when I need them less. That will be a welcome relief. I do not like the clouding and physical side effects that they bring. It will still be awhile before I can get back to ‘normal’.

Crutches

I am slow but steady when it comes to going up and down stairs. I need to do this a couple times a day to get from my bedroom to the living room and kitchen. Each trip is easier, but I still need my walker to get around on the floor that I am inhabiting. I am concentrating on walking as straight as possible, speed be damned at this point.

Using a cane

I am taking a few steps now, indoors only, on the side opposite the new hip. The cane has a history as it was owned and used by my Father in Law (gone now). It is a marvelous piece of natural wood that has been steamed and bent. It is very light and strong. Quite suitable as an assistant.

More Naps

My sleep patterns have changed a bit with the surgery. I never get into a really deep sleep as I am always a bit uncomfortable. Still, I seem to be getting what I need for the time being. Lots o catnaps seems to smooth my resting out.

First Shopping Trip

A sunny Saturday and I really want to get outside. With the dogs loaded in the vehicle, it is off grocery shopping. I concentrate on a parking spot and one is waiting for us right in front of our regular green grocer (Norman’s) on The Drive. It feels good to be leaning over the produce and discussing what will go well for this week’s menu. Vegetable bought, and I am ready to be sitting again. In fact, by the time I make it up the back steps at home, I am ready for another nap.

Home Sweet Home

The Great Escape

I was so ready to get out on the third morning. I wanted to be home with my critters and partner. I wanted some (not a lot) real food. I wanted to be out of the hospital bed.

There are lots of bits of paper to be collated. That folder that you brought in with you comes in handy. Descriptions of your drugs, your wound dressings, your exercise program, and more are provided and you do want to keep them handy.

Fill your prescriptions on the way home if you can, or have your support person fill them for you. This may require you to send them out with your ID and a note. I double checked what would be needed before I left the hospital as there was no public pharmacy on site. In BC, the person who fills the prescription must have the CareCard of the person for whom the prescription is written. I clarified this at the hospital before leaving and it worked out just fine.

I was accompanied to the car by an Occupational Therapist who was there to coach me on getting in safely. The ride home was bumpy, even though I know my dear driver had checked out the smoothest route between hospital and home.

Homecoming

While my driver checked out the smoothest streets for the trip home, it was still one bumpy ride. I kept doing my deep breathing and just held on. It took a few minutes once we had come to a halt behind the house for me to be ready to disembark. Speaking of barking, I could see both dog noses under the back gate as I was approaching. They seemed as happy to see me as I was to see them.
It was an adventure using my crutches to come into the back yard and, slowly, up the back stairs. Really glad I had practised before going into the hospital. I was also happy to lie down on the couch when I am inside.

Pain Management - I

I never really noticed the post-surgical  convenience of having a nurse come by every few hours and say “Take these pills, now.” Serious luxury! Now that I am home, I can see that you need a virtual nurse when you get home to do these reminders.

When I got home, I let my pain control slip a couple of times. When the pain gets high it is hard to climb out of that well and get back on top of the big exercise ball that is your pain control program. A short consultation before I left the hospital would have been useful to even out the bumps.

I need a Meds App! Every 2 hours during the day, the app asks: What level of pain are you at, currently. Given you current pain medication it may offer a med to take, tell you that you have had meds recently, suggest that you wait another hour before trying again. I went looking but didn’t find anything quite like this. It wouldn’t have mattered, really, as I don’t have a cellphone, much less a smart one.

What I actually have is a spreadsheet that allows me to set up my meds for a day and then I fill up a 7 segment pill box that is labelled with the times that I need to take them. This is now working well.

Constipation

Let’s talk about this because it is real. All those lovely painkillers have the side effect of bunging up the digestive system. I normally eat a fibre rich diet anyway, but I now need more. The balance seems to be 1 dried fig (which I love) for every constipating pill. Taken with lots of water. This is on top of my normal diet. It is a relief to be regular! (Never thought I would be saying this.)

Incontinence

One of the other side effects of the anesthetic has been decreased bladder control. Sigh  Not the most fun I've ever had. However, it is controllable with frequent visits to the washroom and that requires more walking, which is a good thing for my recovery. I am using a heavy flow menstrual pad for overnight. The good news is that control is returning.

Rugs

We removed all the small throw rugs during the pre-surgery prep to avoid tripping hazards. However, the large area rugs also proved to be impediments to the walker. Rolled up and tucked under various pieces of furniture now. Glad that there isn't any wall to wall carpet in the house.

Hip Precautions

The preliminary documentation talked about "90 degree precautions" i.e., the operated hip must not go beyond 90 degrees. I found out quickly from the physiotherapy team on day one that this was actually "70 degree precautions" for the first month. Keeping that leg as straight as possible at the hip is a tricky piece of business as all of my reflexes have it bent. With help from others, "Watch your hip!" I am getting the hang of it and keeping positioned so as not to dislocate my new hip joint. 

Wouldn't want to go back into surgery any time soon or have to explain it to my doctors.

New Routines

Everything takes a lot longer. Double or triple the time that you would normally spend on a task and you might be in the ballpark.

Putting on a sock is a 3-4 minute sequence now rather than 20 seconds. I need help if the ‘sock aid’ doesn’t release. I am thinking about cutting it down for my smaller than average feet; should be able to do this with scissors quite easily.

Getting dressed is good to help (re-)build skills and feel like you are ready to take on the world. I am still wearing my sheepskin slippers most of the time, though, and they are so cosy.

Sleep

As much as possible! Cat naps and catlike behaviours abound. Sleep, stretch, snack, walk around, back for another nap. I could become a cat quite easily.

End of Week One

I am exhausted! I do a gentle round of exercises every day and it wipes me out!

That said, I can see miniscule improvement every day.

I can use the crutches for a limited time each day and am moving longer distances each time. Of course, longer, in this case, means a few more metre increments, not even up to a block at a time yet. That will be next week, I hope!

I will try doing my exercise round once in the morning and once in the afternoon.