Hopefully the last surgery for a while...

On Monday 7th October I had surgery at The Avenue Hospital on my right hip to remove hardware (the screws that were put in during my PAO last year) and an arthroscope where Jit repaired my labrum and shaved off a CAM lesion. 

The preparation for surgery was familiar: fast from early in the morning --> arrive The Avenue --> admission nurse --> admitted to the ward --> shower with special wash --> fashionable gown --> right hip/groin/thigh prepped by nurse with further microbial protection --> taken upstairs to a theatre waiting bay --> speak to nurses / anaesthetists / assistant doctor --> Jit pops in and confirms the surgery and signs my right thigh --> taken through to theatre --> put to sleep.

Even though I have been through it all before I am still amazed when I wake up what feels like only a few seconds later in recovery! Still a bit groggy I was told all went well and I was given the screws that came out of my pelvis. Despite seeing them on X-rays many times, when I held them they looked HUGE and it felt surreal that they were only that morning inside my body!!! 

I stayed in overnight and was discharged home the next morning after a reasonable good nights sleep. My post operative orders are to remain partial weight bearing (20% body weight though my right leg) using 2 x forearm crutches for two weeks. I will see Jit's nurse back at Melbourne Orthopaedic Group at the 2 weeks mark for the dressings to be removed and then progress to walking with 1 crutch - hopefully just for 1 more week. I have been taking it easy and watching a lot of TV. 

Here are the pictures taken during the arthroscopy for those who are not grossed out:

Climbing mountains

When I had surgery at the end of last year I was worried about my rehab as I wanted to be fit for our families' adventure around Australia this year. At the beginning of our travels in April (just over 4 month post op) I was still experiencing a lot of altered sensation in my right thigh especially after prolonged sitting - which was of great concern with lots of sitting in the car planned as we sight see our way around Australia. 

 I had diligently been doing my strength program prior to leaving home but on the road our routines were new and it was easy to forget about my rehab. After a few weeks I felt weak and less confident with my right leg. I also started to feel some pain in my groin similar to the pain I had experienced previously when I had a labral defect. I made myself a promise that I would make more of an effort to keep up my strength work so I commenced daily squats and got on my bike more often. I managed a 23km bike ride throughout Cape Le Grande National Park- it was a great way to see the park however I didn't realise how hilly the area was!!

I am happy to report that my hip has not been a bother on our trip since those early days. We are 3 months in and I have tested the hip out on multiple grade 5 hikes while also lifting / carrying children at times. The best past is that since I got back to my strength work I have hardly thought about my hip and have not needed to take anti inflammatories. I am glad that it hasn't stopped me from running around on the sand at the beach, swimming / snorkelling in the pristine turquoise water, climbing into gorges at Karijini and getting on the floor with my kids to play / muck around. 

I have booked in to have the screws taken out a week after we return from our 6 months away (October 2019). At this time Jit may also look at and repair the labrum.  Until then I will continue to enjoy our holiday and not fall off the exercise wagon!! 

10 weeks

It ticked over 10 weeks yesterday since my surgery and I feel like I have turned the corner. I am now walking without an aid and over the past week my gait has improved a lot. I am able to stand on my right (operated) leg however my balance needs to improve. I have started some small single leg squats with a focus on improving my deep gluteal activation. The times where I momentarily forget that I have had surgery are becoming more frequent, and I am now often pain free. It is time for me to ramp up my rehabilitation and get stronger as there is only 9 weeks until I leave with my family on a 6 month trip caravanning around Australia. Life is gradually returning to normal.

Attached are a couple of video clips of me doing my rehab last week with a focus on quads control and balance on my right leg.

A literal pain in the ass

Yesterday I had some x-rays taken prior to my review with Jit. The X-rays show good early bony healing to 2 of the 3 cuts that were made to my pelvis during surgery. Unfortunately the fracture line in the ischium (the sit bone) is still apparent and therefore not stable enough for me to completely come off crutches yet. Jit explained that during surgery he injected a bone stimulant to promote bone growth. As the ischium is so deep it would not have had the benefit and needs more time for bone to develop and close the gap between the two edges. It does explain why I get a sharp pain in my right buttock if I put too much weight through my right leg so it's at least a couple more weeks with a single crutch for me. 

I spoke to Jit about the altered sensation in my right lateral thigh and he confirmed that it is a result of some damage to the Lateral Cutaneous nerve of Thigh, which is unfortunately a common side effect of the PAO surgery. He is pleased that the sensation is slowly returning even if it causes me sharp pain and discomfort at times. 

Otherwise Jit is happy with my progress and I am allowed to gradually increase my loading with exercise, focusing on building quadriceps and gluteal strength. I have started to ride my bike and it feels great to be out and about and no longer stuck in my lounge room on the exercise bike. My fitness has taken a big hit with doing minimal exercise over the past two months, and it did feel as if my heart was going to explode while riding up a small incline. But I guess I need to start somewhere. I am not one to focus on things such as weight and a number on a scale however I have recently been more aware of my appearance and have felt self conscious. I figure it is probably because I am currently the heaviest I have ever been. I can pretend that it doesn't matter but I do feel disappointed in myself. My rational brain tells me "it's okay.. you have had major surgery and you needed to take some time out" but being someone who prides myself on being healthy it is very hard to keep the negative comments out of my head. I am writing this, not for your pity, but to highlight that surgery is not just a physical thing and there is an emotional rollercoaster that goes with it. I will continue to take small steps towards my goal of being "me" again with another layer of resilience added. 

6 Weeks Post Op

Wow the past month has flown! Christmas is usually a busy and  hectic time of year however this year was very different. Being out of my usual routine I was able to take a bit of a back seat and enjoy Christmas from a different perspective. Yes there were moments where I freaked out about being prepared enough however a little bit of online shopping seemed to do the trick. Overall I was still able to part-take in multiple Christmas catch ups and enjoy all of the festivities. 

Jit had mentioned at my 2 week check up that I could start driving from around 4 weeks if I could actively flex my hip comfortable in sitting. Feeling good I started to drive short distances just prior to Christmas - much to my husbands delight who could finally have a couple of drinks at Christmas parties as he had a driver. I guess it is a small price to pay after the running around he had done since my surgery!

I have managed to come off all of the pain medication, having Panadol Osteo available if I over to it. I have seen my physiotherapist a few times since I last wrote. He has mainly worked on my adductors and the anterior hip region assisting me with improving my hip range of motion. After each session I completed some exercises in the hydrotherapy pool- such as walking laps, marching on the spot, side leg lifts, pushing a pool noodle down int the water with my right leg, balancing on my right leg etc. It feels great the in the water as I can move more freely without the need to use crutches. Both Physio and hydro has really helped get me moving better, I no longer need to assist with my hands when lifting my right leg up (into hip flexion - ie getting into or out of a car). I am at the point that when I am sitting down I often forget that I have had surgery and almost go to get up and walk before remembering to use my crutches. 

Most years after Christmas my little family head away camping. This year I was a bit hesitant as I worried about on how I would manage camping (saying that we are fortunate to have a caravan with a few luxuries and therefore are far from roughing it). I finally committed as we could always come home early if I was not managing. I am so thankful that we decided go as the new environment has done wonders for my soul. There have been a few things that have been tricky, such as using the crutches on the softer sand, but overall I have been able to sit and laugh with good friends and watch my children really enjoy themselves. I have also been able to do some exercises in the river and I feel with the added difficulty of the current pushing me downstream it has helped to strengthen my right leg. 

Being 6 weeks post op today I am due to see Jit for a review. I will see him next week once we are home from out camping adventure. I have started moving around with a single crutch at times (increased my weight bearing) however I still I need to focus on moving well and not limping therefore I go back to using two crutches when I fatigue. There are still times that I worry if I will ever walk normally again or be able to do simple things like sit on the floor comfortably but I know I am still only at the start of my journey and if I continue to progress as well as I have so far I am sure I won't look back! 

2 weeks post op

Last Thursday marked 2 weeks post op and I had a review appointment at The Melbourne Orthopaedic Group. Before my appointment I had some standing X-rays done across the road at The Avenue to ensure that everything was still sitting in the correct position and that some bone has started to form. The first part of my appointment was with Jit's nurse who removed the dressing that was covering my scar and cleaned it up. The scar looks fantastic and the nurse told me to start doing some gentle scar massage to help the collagen fibres align, ensuring it acts and moves as well as the skin around it. 

I then had a brief consultation with Jit who was very happy with my progress. He told me that I can stop wearing my TED stockings (YAY!!) but to continue daily aspirin up until 6 weeks post op to prevent possible DVT. I am to remain partial weight-bearing (max 20% body weight) for the next month while my bone continues to grow and fill in the gap created in my pelvis during surgery when they repositioned my hip joint. Jit reminded me not to overdo things at home especially as I start to feel better as the bone is still healing. He also encouraged me to continue to reduce my pain medication so now I am only taking 1 x Palexia (sustained release opioid analgesic) tablet and Panadol as needed. I will see him again in the new year at 6 weeks post op. 

I am looking forward to starting some formal physiotherapy this week and getting in the hydro pool where I can start moving more freely without crutches. 

The price of over doing it

It is great being at home, sleeping in my own bed and lying on my comfy couch watching Netflix. However there is also a downside to being back in my natural environment. The temptation to attempt basic household chores such as picking up toys or folding and putting away clothes is challenging to fight. Being a creature of habit I easily fall back into my usual routine and I struggle to sit back and watch the household run without my input. Even the most simple task of taking my dishes to the dishwasher now requires thought and effort. I use a 4 wheel walker with a tray table on top to allow me to do such jobs as I cannot carry anything while partial weight bearing on crutches. 

When booking my surgery I knew that there was never going to be a perfect time. In order to have time to heal I was always going to have to make sacrifices. Especially coming into the silly season there will be events that I will have to overlook. One thing I really did not want to miss out on was my eldest daughter's kindergarten concert which was last night. 

In planning for my first real outing since surgery I took some of my stronger pain medication (Endone) and my husband placed my short-term disabled parking permit in his car. In spite of the permit it was still a minor-feat for my upper body and left leg to get me from the car into the venue. I really enjoyed being out of the house. While sitting on the hard plastic chairs my pain was barely noticeable and I was easily distracted by the adorable children acting out their plays and singing songs on stage. Once home last night I iced my right hip and went to bed with no more pain than I had been experiencing this past week.

Unfortunately I woke this morning with lots of pain and stiffness. So much so that I was scared to move as the pain in my groin would take my breath away. At that moment I realised that I had definitely overdone it yesterday. Looking back it was not a great idea to introduce some home exercises yesterday knowing I had plans in the evening. Although the exercises I completed were very gentle and appropriate for my stage of rehabilitation (exercise bike for 5mins with no resistance and light reformer leg work lying down) the accumulative effect created a sore and sorry Meghan today. Therefore I have learnt my lesson and I have a very lazy day on the couch planned for today. Hopefully back on track on the bike and reformer again from tomorrow.