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!