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.

Look no hands!!

At my 6 week review Jit was really pleased with my progress. Scans which were taken a few days earlier showed initial stages of bone growth and he was very optimistic that the bone would continue to grow over the next 6-8 weeks restoring strength to my pelvis. From a functional point of view he seemed surprised.. He did mention at one stage during the review that he has never seen anyone move as well as I do at the 6 week post op mark before.. so I was extremely chuffed!! I believe that being fit and healthy prior to my surgery has played a large role in the speed that my muscles have switched back on, that and the fact that I have a super physiotherapist who has guided me through which exercises to do and so on.

At the appointment I told Jit that I was mainly getting around on a single crutch but occasionally I would hobble a few steps at home without any support. He gave me the all clear to progress to full weightbearing and told me to use pain, fatigue and limping as a guide to when I am over doing it and when I should return back to one crutch. The first day after my post op appointment I felt like I was "breaking the rules" when I rocked up to Physio... It felt foreign to have the use of both arms while walking.. I could now do simple tasks such as tie my hair up in a pony tail while on the go.. little things like that which had really frustrated me over the previous 6 weeks! The more I walked the more my hip freed up however I still fatigue very easily, needing my crutch in the afternoon and evening to stop me from looking like a penguin while I walked around the house. Slowly over the past week I have progressed to being 100% gait aid free. The only time when I notice the hip changing the way I walk is first thing in the morning when I am a bit stiff, but after the initial 10 steps the hip loosens up and I'm off walking without any hassles.

My dog Jessie is loving the fact that I am now free to walk. Being a Labrador she loves her walks and the past week I have ventured to a local lead free park on a couple of occasions much to her delight. She he still however looks back at me while on the lead with a sad face until we arrive at the park where she is allowed off the lead - almost like she is saying "come on mum... why are you still walking so slow?!? You no longer need to use those sticks to help you walk so lets pick up the pace a little bit!!".

The past week I have also started back up at the gym, being able to increase the load through my legs and hip. I feel great being back in the gym environment, it really is a stress release for me. My program consists of low impact cardio such as bike, stepper or cross trainer and then weights training aimed at improving the strength of my muscles, not only around my hip - but throughout the body. In just over a week I can feel and see a big difference in my strength. My left thigh is now only 1cm smaller than my right (no longer a 2.5cm difference) indicating hypertrophy (which is the increase in the volume of a muscle or organ due to increased size of the cells, often as a result of use). I can now stand on my left leg without dropping the right side of my pelvis and my balance is improving so that I can close my eyes without falling over.

Although I am moving around without crutches and exercising at the gym I am still far from my destination. Rehabilitation from a surgery such as a periacetabular osteotomy takes place over years and not months, but I am willing to maintain my drive and hopefully reap the rewards with a strong and functional hip in the longrun.

Change of pace.

I have been a bit slack with keeping you all posted with how I have been travelling the last few weeks but my days of lazing on the couch watching DVDs have been limited!! I now attend physiotherapy three times per week: on Mon, Wed and Fri. After my hands on treatment session (or should I say torture session) I spend a good hour completing my strengthening program in the gym and then in the pool. Although my exercises are still relatively basic and gentle, I can already feel a huge difference in my muscle strength, and my chicken leg is starting to get some meat on it again!!

Being a physiotherapist I love that I am able to assist people in many different ways and often through a difficult time in their life.. For example I may be able to help reduce a retiree's back pain which allows him to return to his love of gardening, alternatively I might watch a new mum being able to lift her son or daughter for the first time without grimacing following treatment. I believe it is these small "wins" which give me job satisfaction and keeps me loving what I do. But unfortunately as many of you would be able to relate to, in this day and age of faster passed work with higher expectations and pressures, sometimes the daily grind and work demands shift the focus purely to getting the job done and moving onto the next thing without ever being able to "stop and smell the roses".

The last 5 weeks have forced me to slow down and really step back and observe the world from a different perspective. Prior to the surgery I was concerned about being bored with nothing to do and feeling like I had no purpose because I was used to having a long to-do list for every day. However I have surprisingly enjoyed the change of pace, especially having the time to spend with friends and family. Feeling the physical and mental changes after each physiotherapy session has also reinforced the impact that treatment can have on someones life. refreshing my love for physiotherapy and restoring my belief that I am lucky to work in the health industry.

I have my 6 week review with Jit next week so fingers crossed that my xray shows good bone growth around the screws. I have signed up to a gym with a hydro pool for 3 months which will allow me to continue my rehabilitation while progressing from hydro exercises to harder land based exercises.