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.