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. 

It's good to be home

The past week has felt like the slowest week in history- at times I would check my watch after what felt like hours to see that only a mere 15mins had passed. But on the other hand when thinking about my surgery it seems like this past week has flown and that I was only getting wheeled into theatre a day or two ago. I guess that is what happens when you are confined to a hospital room - days and nights merge together and the conventional measures of time loose their meaning. Hours and minutes are replaced by the time between the arrival of a meal, a visit from a doctor/specialist, or a nurse dispensing medication.

Since my last post I was moved into my own private room and started to become more independent with my care. I progressed slowly from moving with a pick up frame to using 2 forearm crutches. A short trip to the toilet and back still felt like a marathon and I continued to spend most of my day lying in bed. The physiotherapist visited each day and took me further, encouraging me to mimic a normal walking pattern but with a limit of 20% of my body weight through my right leg. The physiotherapists have also continued to place me on the CPM machine each day to help keep my hip joint moving.

Things I usually take for granted- such as having a shower, became my daily highlight. Surprisingly I have quite enjoyed sitting for my showers, but despite this I cannot see myself making it common practice going forwards!!

On Tuesday I was discharged from hospital and returned home. I say this after every holiday or night away from home but never with such conviction as now- Wow I do love my own bed!! I napped for 3 hours once home and was excited to spend time amongst the craziness that life is with a 3 and a 5 year old. I know it is going to be hard to be on the "side lines" of parenting for a while, listening to my husband deal with the madness of bedtime while I lay down feeling guilty, but I know it will not be forever. The key is to enjoy this down time- well as much as possible, because it will not be too long before life has picked back up where it left off and I will be reminiscing about the days where the hardest decision I had to make was what to watch on Netflix.

Day 2 post op

Yesterday afternoon the physiotherapist returned and got me up walking a short distance on a pick up frame. I managed well however by the time I returned back to bed (maybe completed a total of 15 steps)  I was exhausted and felt quite giddy. My blood pressure had dropped so I spend the rest of the evening lying down. My operated leg was placed in the CPM (continuous passive motion) machine for 2 hours at a time slowly freeing up my hip and moving it further into flexion range. Initially the machine was set to 50deg hip flexion but I have since progressed to 100deg flexion.

I woke today feeling refreshed as I managed to get 5 continuous hours of sleep however my pain was quite noticeable, making me a little scared to move. During the night I had slept on my left side with a pillow between my knees which I found more comfortable as I usually like to sleep on my side.

The nurses had taken down my pain blaster unit so I was now relying oral analgesics. Thankfully it didn't take too long for my morning tablets to kick in. I also had my IV taken down and my catheter removed.

This morning I was sent for some X-rays which show 5 screws in situ in my pelvis holding my socket in it's new position. It was quite confronting to see the images the first time and made it all feel very real. Considering the amount of work done during this surgery I am amazed by the relatively small amount of bruising I have on the surface. I think having ice continuously on it has helped a lot.

                  

Jit popped in again to see me this afternoon and sorted out some medication allowing me to stand up without feeling faint. Since then I have managed a shower (heaven!!) and have been to the toilet (those who know the hassle I had after my last PAO would appreciate how relieved I felt!) Ordering prunes as part of my breakfast was definitely worth while!

I have had a few visitors pop in including my beautiful girls. It is tough being away from them and I was concerned that they would freak out seeing me in hospital however they are quite resilient and just had lots of questions. However my husband Sam and I had to be on guard the whole time because they did forget quickly and would launch onto me for cuddles and kisses.

Only 3 more nights in at The Avenue Hospital and then home to my own bed and family.

Surgery time

Yesterday was the day.. I arrived at The Avenue hospital at 11am for check in where I was taken to my room. Unfortunately the hospital is very full so I ended up in a shared room but thankfully my "room-mate" is a lovely lady who had knee surgery the day prior and has been a pleasure to be around.

Prior to surgery I showered with a special antiseptic wash. I put on my attractive hospital gown and waited in bed (see picture below). I was collected at 2pm and taken up to the theatre holding bay where I was greeted by a lovely theatre nurses. I spoke to the anaesthetist and of course was visited by my surgeon Jit. By this stage nerves had started to kick in but Jit has a magical way of putting me at ease. Before I knew it I was being taken through to theatre.

 

For the surgery I had a spinal block combined with a light anaesthetic. The benefit of this was complete numbness to the lower half of my body that remained after surgery - meaning I had no pain what-so-ever when I woke. What felt like a blink of the eyes I woke in recovery with my usual post-aesthetic shaking. With both legs numb I was feeling great. I was back on the ward by 6:30pm where my beautiful husband was waiting for me. Attached to me I had oxygen via a nose prong, a drip, a catheter and a "pain blast" which delivers pain relief directly into the surgical wound. I also had a pump at the end of the bed which is attached to a stocking like sleeve on each lower leg and every 20seconds one side inflates and deflates - squeezing my calf - helping to move the blood from my feet and legs to prevent DVT.

Over the next 5 hours the feeling gradually returned to both legs, transitioning from complete numbness --> to tingling --> to being able to move my toes --> then ankles --> and eventually normal sensation. I was given small sips of water but was not allowed to eat anything until the sensation had returned, meaning I went 19 hours without food. Boy did those sandwiches taste yum when I was able to eat at 1am.

I managed to get small cat naps throughout the night in between hourly obs (blood pressure, heart rate, oxygen saturation etc) and checking my sensation / movement of my right leg. Initially I could not settle because of the noise that the calf compression pump made however after a while that along with the drip pump acted like white noise and helped me drift off to sleep. Usually being a side sleeper (with my preference being my right side) it felt awkward lying on my back with my head slightly elevated. One tip that I have found to be a god-send is using a neck pillow. It allowed me to completely rest my head and neck while being slightly upright

This morning the physiotherapist came to check in on me. I was given some gentle exercises of moving my ankles up and down, squeezing my quadriceps (thigh muscles) and to start trying to slide my heel up to my bottom (this is the one I find the most difficult and a little painful so I will have to take my timed build on it over the next few days). As my blood pressure has been good (I have done my best to have little sips of water often to stop my usual BP drop after surgery) I managed to sit on the edge of the bed and even stood up with a walking frame for a few minutes. The nurses changed my sheets and helped me to have a quick sponge bath and I was able to put on some pyjamas. 

So here I am sitting up in bed writing my blog feeling quite good. This early on it is all about rest to allow my bone to start to heal. I will most likely have an Xray done in the near future so I will try and get a copy to post on here so you can check out my new hardware!! 

Take two... Here we go again

I have been very lazy with my blog over the past number of years and that is mainly because my hips have not really played a big role in my life and have not been as high on the priority list. Instead I have been keeping busy looking after my two beautiful girls (now 3 and 5 years old), running my physiotherapy & clinical pilates business, getting away and going for adventures in our caravan and mainly enjoying life.

The only time I would think about my hips is when I had my yearly check up with Mr Jit Balakumar. Jit has been monitoring my left hip while also keeping a close eye on my right (non operated) side by sending me for imaging when needed. Prior to this year I have never had any issues with my right side, and this is despite having severe dysplasia on this side also. It was the middle of the year when I first noticed a dull ache in my right groin at night time. It was a far too familiar feeling taking me back to early on with my left hip. Knowing my history I didn't put off making another appointment to see Jit and the outcome of that appointment was as I had predicted - time to look after the right hip and have a Periacetabular Osteotomy (PAO).

It has been a very different preparation for surgery this time compared to 6 & a half years ago. My main concern and focus has been around how are we (my husband & I) going to manage my rehabilitation with two young children who still very much depend on my help. My husband Sam is a superstar dad and he proves that daily, however we work best as a team. With me out of action and unable to drive for 6 weeks it means he has a lot more on his plate. Thankfully we have a wonderful support network and have not been short of people offering us a hand. I have spend countless hours forming spreadsheets that cover everything from who is picking up/ dropping off/ looking after the children /who is taking me to post op appointments and so on. This along with organising coverage and scheduling for my business while I am unable to work has helped keep my mind busy and as a result I have not really had any time to be worried about the actual surgery itself. I know it is a big deal but I feel strangely comfortable by the fast approaching surgery, even a tiny bit excited to have it over and done with. I guess having an idea of what to expect this time around is also putting my mind at ease.

So with only 3 sleeps to go until I go back under the knife I thought it was an appropriate time to put my blog writing "hat" (or should I say mum bun/top knot) back on and fill you in.

There are a few people who were not in my life first time around and have been asking what exactly is a PAO surgery and why would I be having such a big operation when I look perfectly healthy. Rather than trying to explain it to you here is a link to a fantastic video that explains all that you may wish to know -->

www.ypo.education/orthopaedics/hip/periacetabular-osteotomy-t148/video/?fbclid=IwAR1_0-CXGBT3PQTuOe-KVZayPIQWxR-QqzpeyOeYNM4UxilZ6Ax994XUg1c

(You may need to copy and paste if the link is not working!)

But if you do not have time to check the above link out then I guess in a nutshell the surgery is moving my hip socket (cue using one hand as a socket and other as a ball to represent the hip joint) and moving it into. better position to make it fit together better with a goal of preventing degenerative changed to the hip joint.

Hit me up if you have any questions as I will be checking and updating my blog a lot more over the coming months.

Another year on

I cannot believe how time has flown since I posted on here last. Great news is that my hips have been doing fantastically. I guess it is much easier to forget to post on here when I am not in constant pain and bother like in the past and instead I have been keeping busy with my beautiful family and work.
Recently I had another deGEMRIC scan (it was due to be done much earlier but I had to wait until I had stopped breastfeeding). This time I had the scan done on both of my hips and thus I was in the MRI machine laying still (or doing my best to be still) for over 1 and a half hours. The good news is that I spoke to Jit recently who told me exactly what I was hoping to hear. That there was no evidence of further degenerative changes within my left hip (the PAO'd side) and that my right hip (which has dysplasia but no pain) currently has no signs on degenerative changes within the cartilage. Yippeee!!
However unfortunately I have recently been getting a little bit of lower back pain. I understand the close relationship between the hips and the lower back and I guess the increased demand on my body when it comes to looking after a 15month old has started to take its toll. But saying that, the pain is only gentle at this stage so I will try and keep it under control with some physiotherapy intervention and massage. It would also probably help if I was a little bit more strict with my gym core strengthening but I cannot always be perfect.

I guess the main reason I wanted to post on here is to give you hope that if you are going through a PAO recovery or something similar at the moment there is light at the end of the tunnel and hopefully you will have some fantastic news down the track which makes you think "I am so glad that I had that surgery!!".

Keeping it in the family.

On the 17th of October 2013 my husband Sam and I were blessed with a gorgeous little girl who we named Willow Maree. As for most children born in Australia Willow's hips were tested soon after birth for the presence of clicking which could indicate possible developmental hip problems. The paediatrician who tested Willow's hips explained that they felt fine however due to my history of a missed hip dysplasia and the fact that the condition is congenital (an abnormality which is present from birth or hereditary) she would refer her to have an ultrasound done on her hips. Having gone through a lot of drama with my hips both Sam and I decided to play it safe rather than risk letting a problem go undetected and we took Willow for her ultrasound at 6 weeks of age. The imaging procedure was very gentle and Willow tolerated it with nothing more than a slight grizzle when I unwrapped the blanket and woke her from her sleepy state. Willow was positioned on her back with one side of her nappy undone and the ultrasound probe placed on the outside of her hip. The radiographer was fantastic with Willow and made every effort to keep her comfortable - she even made sure that the ultrasound gel was warmed slightly and not freezing like when I had ultrasounds on my growing belly during pregnancy. The whole process for both sides took a total of 30mins, with the only pitfall being the cost of the ultrasound being a few hundred dollars - but I think this is not much to pay for peace of mind! At the paediatrician review we were told that the ultrasound showed that Willow's hips are just within the normal range and there shouldn't be anything to worry about. I had my surgeon Jit Balakumar also look at her scans and he also completed a few tests on her hips. He agreed that they looked and felt good but he has asked that she have one more ultrasound at 12 weeks to ensure that development continues on track.

 

Speaking about family; my dad has recently undergone a total hip replacement after a sudden onset of hip and groin pain. Dad reports not experiencing any previous hip or groin pain. He has however a long history of lower back pain which referred down into his leg, but this was much reduced after back surgery over 20 years ago. Dad's hip and groin pain worsened quickly causing him to limp, so he was referred for an Xray and then an MRI. These images showed that he had severe osteo-arthritis and would need a total hip replacement. Unfortunately the timing of this news was not ideal as my dad was planning on walking my sister down the aisle at her wedding that was only a couple weeks away. Dad went to see the same surgeon who completed my PAO surgery. To help dad get through he underwent an arthroscopic clean out of his left hip to help reduce the debris in the joint cavity and was prescribed medication for his pain. During the arthroscopy Jit was able to get a closer look at the integrity of dad's hip joint and he was surprised by the amount damage that was present especially considering that pain had only recently commenced.

While waiting for his total hip replacement surgery Dad completed a gentle exercise program which I like to call a "pre-hab" or "pre-habilitation" (rehabilitation before the surgery takes place). It allowed for reduced muscle atrophy (wasting due to disuse) and also gave him an idea of what to expect following the surgery.

 

Dad underwent a total hip replacement at the Austin Hospital on the 5th of December. Jit completed the surgery via an anterior approach meaning that he entered the hip through the front rather than cutting through the muscles behind the hip joint. Dad is progressing well following the surgery and is due to see his surgeon again in a fortnight.

long overdue update.. pregnancy following a PAO

I cannot believe how quick time has passed. It has been almost a year since I had my screws removed from my left hip and I am happy to say that my hip has been fantastic these past 12 months!! Following the removal of my screws I continued to attend the gym and complete my core strengthening program with a goal of maintaining the strength around my pelvis. This was a high priority for me as my husband and I knew that we wanted to start a family and I was concerned about how I would manage being pregnant. After a few months of trying my husband and I were super excited when we discovered that we had fallen pregnant in Feb this year. Initially I had grand plans of eating only healthy things and continuing my exercise routine while pregnant so that I would look after myself and the tiny little human who was growing inside.. Oh how things changed when morning sickness arrived!! Unfortunately I suffered from severe morning sickness that even landed me in hospital on IV fluids, so when it came to food I had the motto "if I could get it down and keep it down for at least half an hour then I would eat it".. and as for exercise I did not attend my gym for almost 3 months.. longer than I had off following major pelvic surgery!! But eventually as I started to feel more human again I was able to reintroduce my active lifestyle with obvious changes due to being pregnant.

One thing that had always been in the back of my mind following my PAO surgery was the impact it would have on labour and giving birth. I have read multiple articles about natural birth after pelvic osteotomies and was hoping that I would not need a medically assisted delivery. After much discussion with my fantastic obstetrician we have decided that it is wise to have a medically necessary C-section delivery. The reason behind this is because I have a very narrow pelvic outlet to begin with which has been further reduced in size following my PAO surgery. If the baby was to become distressed or "stuck" during the birth my obstetrician would not be able to take my hips into the position that he would need to assist the baby to be born. This combined with the fact that my husband is much larger than me pretty much made the decision for us!

So far throughout my pregnancy my hip has managed really well. Now being 33 weeks pregnant there are many physiological changes associated with pregnancy which are placing added strain on my body in particular  my hip including:
- increased body weight. So far I have put on just over 10kgs since falling pregnant. At the end of a days work (still managing to work full time) my knees and ankles are achy as they have never had to carry this much weight around. But "touch wood" my hip is coping with the extra weight so far without any complaints!!
- the hormone relaxin is preparing my body for labour by softening the connective tissue which would allow the pelvis to open up and allow the baby to pass through. This can often lead to pains around the pelvis as it is not used to having movement at these joints. So far I have not experienced any of these issues, however it is nice to have a little bit more pelvic flexibility than usual!!
- postural changes due to having a basketball shaped bump tucked into my top can lead to altered pelvic position and lower back pains. I have tried to be very aware about my posture to protect my lower back however as I get tired towards the end of the day I do catch a glimpse of myself in the mirror and realise how poorly I am standing / holding myself!

Overall I think my hip is doing great so far throughout this pregnancy. The next 2 months will really test the hip and the rest of my body as baby continues to grow and prepares to meet us. I am so very excited about becoming a mum and the best thing is that I really do believe that I would not have been able to be this active and enjoy my pregnancy if my hip had been sore throughout, so I am really happy that I decided to have the PAO after getting married and before starting our family!

The PAO community

When I decided to start writing this blog almost a year ago I could never have imagined the number of people that would read it, let alone contact me to ask questions and or share their own hip experience. To be honest I thought that maybe my mum and a handful of friends would read this out of obligation, but it has been fantastic to hear that people have enjoyed what I have written and gained something from it.

 

The idea of a blog had never really appealed to me before this but when I found myself making the hard decision of whether or not to have the peri-acetabular osteotomy surgery I found it a fantastic way to organise my thoughts into some sort of order and assist me with the decision making process. 

 

My specialists were pivotal in providing me with the relevant information about my hip condition and the proposed surgery, however I still found that curiosity got the better of me, turning to "Dr Google" to see what had been written by others going through a similar experience. I found myself wanting to know about the simple things for example such as how others coped at home alone during the day. Therefore while writing this blog I have made a conscious effort to include both positive and negative experiences about not only about the surgery itself but also the less obvious seemingly smaller things including the emotions associated with such a large surgery.

 

At my review appointment which was almost 2 weeks ago I was completely surprised (and a little embarrassed) when my surgeon Jit informed me that he himself had been reading my blog. He said that a few of his patients had mentioned the blog so he started to read it and found it interesting and insightful to see it from the patients perspective.

 

Jit was happy with my progress at the review appointment, checking that the scar from the screw removal had healed well and informing me that unless I have any troubles I won't need to see him again for another 2 years where the plan is to have further MRI scans. Therefore at the moment I am going to continue to build strength up around the hip and improve my fitness. I will continue to update you with my ongoing progress and I look forward to hearing from more of you.

Screw Removal

Last Thursday I was admitted to The Avenue Hospital for my screw removal surgery with Jit Balakumar. Leading up to the surgery I was surprisingly calm, almost looking forward to getting in and having the procedure done. It is funny how things can change so much purely from past experience and knowing what to expect. I remember back to 7 years ago before my first hip surgery - I was terrified. Waiting for my surgeon I felt like I was going to be sick, so scared because I didn't know what what going to happen. This time around for my 4th hip surgery it was like going through the motions- fast from 7am (which is always a struggle as I love my food and continuously graze throughout the day), arrive at hospital to go through the pre-admission paper work and the financial side of things, get admitted where the nurse runs through your forms and takes baseline measures of heart rate and blood pressure etc.. and then they come and take me through to the waiting bay ready for my anaesthetist and surgeon to chat to me.

From behind the curtains of the waiting bay pops in a familiar face.. It is my anaesthetist Doron who was also my anaesthetist for my PAO surgery. He asked me about my last experience with a general anaesthetic and I informed him about my body's tendency to get "clogged up" as a result of the GA but also from the analgesic medications. He informed me that he would administer something along with the anaesthetic which should help prevent that this time. Like a well oiled machine as soon as Doron is done talking to me in pops me surgeon - Jit. As per usual he has a friendly smile on his face which automatically makes me feel further at ease. I was keen to ask whether he was going to go through the same scar as the PAO or if a new inscision was needed. He told me that he would only need to use the top half of the PAO scar due to the position of my screws in my ilium. I was happy to hear this as I think I have enough scars as it is already!!

 

For this surgery I was wheeled into the theatre where I transferred onto the operating table prior to being put to sleep. As I woke I could feel my body trembling, one of the side effects I experience after a general anaesthetic. I remember my surgeon coming to talk to me about how my surgey went however I cannot remember what he said, and more frightening I cant remember what I said!

 

That evening my family made the trek into the hospital to visit. My hip was feeling great - tender to touch and covered with dressings. I on the other hand was tired and felt lethargic. My blood pressure was very low and I was encouraged to drink a lot of water that night. The only problem with increased fluids is the increased number of times I had to buzz the nurse for the pan.. not the most elegant parts of being in hospital!! I was discharged the following morning after being visited by the physio and given the all clear to mobilise.

 

Still feeling nauseous, the car ride back to my dad's place near by felt like a journey across Australia. I was glad to get into bed and stay there all day. That evening I returned home via another painful car trip to my husband who was ready to once again look after me. He is definitely up for Husband of the year award -  again having to put up with me and my moods after surgery, especially being that we have only been married for 6months!! I came to the realisation that I do "pain" ok but im not very good at "sickness". I am not looking forward to the day I become pregnant and have morning sickness!!

 

I spent most of the weekend lying in bed due to the fact that every time I sat up for too long the world would start spinning. It took a few days for my blood pressure to return to normal and gradually I have been able to do more. Throughout the past week my hip has not bothered me much - occasionally I have felt tender through the operation site and I am lacking the final degrees of flexion due to this tenderness however it has only been a week so I'm not expecting a miracle. I have managed to work this week however I have been conscious not to over do it and take rests as I need to. I have a post operative appointment with my surgeon on Wednesday where the stitches will be removed.

 

Back on track

Today I received the paper work for my next hospital admission where the hardware will be removed from my left hip. I am really pleased that the screws will be coming out after only being in for 5 months rather than the expected 12months. Initially I thought I was going to be admitted to The Epworth Hospital for this surgery however I found out today that my surgery is going to be at the Avenue, so I get to experience the 4th hospital for my 4th hip surgery.

The past week I have returned to doing my regular classes at my gym - RPM (which is a cycle class) and Pump (a weight lifting class). I was shocked to discover how unfit I was.. and during the RPM class I literally thought I was going to die!! But when my breath finally caught up with me I felt great that I had completed my first class back. After my Pump class I couldn't move for 3 days without a reminder of the burn I felt during the class... The challenge now is to continue going on a regular basis so that I don't have to start back at square one again.

Last week was also the first time I have stepped on the scales since my surgery and despite expecting to see a higher number than usual I was still shocked. I have put on 5kg and I am the heaviest I have ever been. Initially I was angry and disappointed at myself as I have always been one to maintain a healthy weight range, however I took a step back to really appreciate the bigger picture. Being less active for the past 4 and a half months along with comfort eating on the couch is of course going to lead to a little bit more insulation around the middle. So I have decided that it is time to be a little more focused on eating good foods and less baking in the kitchen otherwise putting on my bikini's this summer is going to be challenging!!

Imaging at 12 weeks post op.

As promised here are the xrays taken at the 12 week post operative mark. Healing can be seen through the osteotomy site in the ilium with callus forming around the pubis and the ischium.

Almost 100 days on...

So it has now been 98 days since my PAO surgery... Although it seems so long ago, at times it also feels like yesterday. In the past 14 weeks I have been challenged, surprised, frustrated, bored, impressed and proud. I had thought about what my recovery would be like every since I started researching what was involved with the surgery... I guess it's human nature to expect the worst but I never could have imagined that I would feel this good.

At the 12 week mark I had a review Xray to look at how my bone was healing at the osteotomy site. With my surgeon being overseas he accessed my scans online and was in contact via email where he told me that he was impressed with the healing around where the pelvis was broken, and that we could plan my next surgery to remove the screws. So only 56 days until I will have come full circle, being back at the Epworth Hospital preparing to go under the knife again, hopefully for the last time ..well at least for the next 25 years!!

At the start of this month I started a new chapter of my life.. I opened up my own physiotherapy & pilates business. It feels great to be back working again, I feel like I can use the experience of the past 14 weeks along with my physiotherapy skills to really help people. I decided to start back gradually so I am working 3 days per week. This still allows plenty of time to rest after a long physical day at work and it also gives me time to continue my rehabilitation at the gym.

At this stage of my rehab each week I am completing an aqua aerobics class, gym based weights and cardio workout and I complete my core strengthening program to work on the control in my lumbo-pelvic region (stability in and around my lower back and pelvis).

I will endeavour to take a photo of my 12 week xray films and post them shortly so you can see the healing.

Back in high heels.

Recently I have been contacted by others who have been through or are currently going through a similar thing with their hips and a common question which I have been asked is what about my right hip.. will that need to have the periacetabular osteotomy surgery also? Luckily for me I have never experienced any symptoms on my right side and that is despite favoring the right leg to compensate for my "dodgy" left hip. Scans which were taken to assess the integrity of my left hip also show dysplastic changes on the right side, however these changes are very minor compared to my left side. At the most recent post operative review with Jit he did mention the right hip, confirming that it was outside normal ranges indicating hip dysplasia and therefore using values stated in recent literature I am definitely a candidate for the same PAO surgery on my "good" side also. It is a difficulty thing to get my head around - having surgery on a joint that has never given me trouble but I can understand where my surgeon is coming from. Cartilage has no nerve supply, and therefore it does not transmit pain. Therefore there could be damage within the joint without my knowledge, and once the cartilage is worn the eventuality is a total hip replacement. I discussed my concerns with my surgeon and we decided that we will monitor the right hip with scans every few years and if the deGEMRIC scan shows that the cartilage integrity is at risk then we will reassess.

I have continued to travel along well with my rehabilitation. Being 10 weeks down the track I am at the stage now where I forget that I have even had surgery. The weekend just past I wore high heels for the first time and danced the night away. Much to my delight I had no pain or discomfort from my hip on that night or the following day. My friends told me that by looking at the way I was "busting a move on the dance floor" they would never have known that I had surgery and if it wasn't for my scar they would think I was lying!

I am still working hard at the gym, trying to improve my fitness and overall strength. I have started water aerobics classes where I get to do quicker dynamic exercise. In 2 weeks time I will have another Xray and I am hoping to see lots of bone growth around the osteotomy. If all goes well I may be scheduling my screw removal in the next few months.