the 3 B's

Brace. Booties. Barrel. This is the goureous contraption that keps me safe while I sleep. It's very helpful because it keeps my hip from externally rotating (turning outward). This motion stresses the stitches on the joint capsule.  The brace also keeps my hip from moving too much and it's quite the fashion statement! 

Here's the brace in all it's glory!

day 2 post op

After the first night at home I spent most of my day sleeping. The car ride home and the surgery itself can be incredibly exhuasting (and even more so for open surgery). I wasn't eating very much at all due to the medications what I did eat tended to be beige and bland. The first few days of recovery were so exciting!

The brace, boots and barrel!



close up of the brace and ice machine



10 things to do while you're on bedrest

1. flap your arms on the bed and pretend you are a velociraptor
2.eat yogurt
3.contemplate your future
4. paint your fingernails bright colors
5.convince someone to paint your toenails because you can't bend beyond 90 degrees
6. watch disturbing television shows about beauty pagents for small children
7. feel guilty about watching those shows; study for the biology SAT subject tests
8. play with play dough
9. watch videos of animals with British voice overs
10. take pictures of your feet

day 1

For the first 24 hours or so post-op I was in the hospital. During that time I would be awake for about 15 minutes then nap for an hour. Very exciting. I was also hooked up to a morphine pump (PCA pump) to keep my pain under control. When I woke up my hip/thigh felt like it had been hit repeatedly with a baseball bat, though everyone's experiences tend to differ. In addition to the pump, I was attached to and IV that kept me hydrated with fluids. I also got three infusions of antibiotic during my stay as this the norm for all surgery patients at my particular hospital.


relaxing on the inpatient floor

Due to the tendency of my hip to dislocate I had to keep my hip immobilized in bed until my brace was delivered that afternoon.

the lovely Pillippon hip brace!

In the late afternoon I was sent off to physical therapy to practice walking on crutches and using stairs. Most hospital won't let you leave until you pass those tests! Then I was drugged up and loaded into the car to head home.

The big day

After starting the day with my breakfast of champions (apple juice and water) we headed to the pre-op clinic around midmorning for general admitting and some basic pre-op testing. Not pregnant? check. Allergic to anything? check. Not wearing any jewelry? check. Vital signs? of course. After that we headed up to the pre-op holding area where I waited on a bed to meet with my surgeon and a whole bunch of other people. We got some hard news from the surgeon who told us that he didn't know what shape the cartilage would be in and that removing part of the labrum would be my best option. We all knew it would be a waiting game to see what was going on.

Let's do this!

The lovely anesthesiologist placed an IV and gave me something and I was out before we even reached the operating room.

so sleepy

It seemed like 10 seconds had passed and I was waking up in the PACU (recovery room). I was monitored closely and I drifted in and out of sleep. Soon my parents came in with good news. My labrum was perfect and we had the pictures to prove it! They mentioned something about my other surgeon coming in to talk to them, something about my femur and a brace. We were all so excited about my labrum that we didn't pay any attention to  it.



Ready to roll to the inpatient floor!

As we were getting ready to leave for the floor, the phone next to bed rang and the nurse answered it. Then she gave me a funny look and said "it's for you" and handed it to me. Apparently it is not standard for surgeons to call their patients in the recovery room.  He talked to me for close to 10 minutes. I was still quite sleepy and I think I understood about 30% of what he was saying. Every few minutes he would pause and I would say something like uh huh...really? oh jeez. yup. really? mhm... ok. From what he said this is the basic explanation of the wild shenanigan my left hip has decided to pull on me. After looking at the cartilage through the arthroscope he noticed that my femur was all dented, like a golf ball. (normally it should be nice and smooth). He then must have called in my other surgeon, the one who does open surgery, to come and help out. He imitated my walking pattern as the other one looked at my femur through the scope. As my leg was going though the motion of walking my hip was subluxing-coming out of the socket a little bit- with every step! I do have very very loose joints. (If you were wondering, we are looking into the possibility of Ehlers Danlos Syndrome at my post op appointment but more on that later). As a temporary fix he placed a few stitches on my faulty hip capsule. (known as capsular reefing). For my rehab we have to be super careful to prevent a full dislocation as my joint is compromised from the surgery. I am currently in a Phillippon brace-pictures soon! I am also on crutches, touch down minimal weight bearing, with the brace for 4 to 6 weeks plus 2 more weeks on crutches without the brace. The interesting thing is I am currently on bedrest without a CPM machine (constant passive motion) or ANY physical therapy as the goal is for me to make as much scar tissue on my capsule as possible!

The night before hip surgery 7/25/11

* This is the first part of a series of posts written (almost) everyday for the first few weeks while recovering from a hip arthroscopy. Hope you like it! *

Since we live about 80 miles away from the hospital where I have my surgeries, my family and I decided to spend the night before my surgery at the hospital's family housing complex. This was a complete godsend to us as my pre-op appointment was at 10:30 the next morning and we would have battled nasty morning rush hour. To help get rid of pre op jitters we went to a fun dinner and headed back to our room for some pre-surgery preparation...



chocolate milk, cookies and trashy magazines? yes.

Since you can't eat after midnight before surgery why not have your last meal be milk and cookies? We also borrowed the movie The Incredibles ( I know it's a kids movie, but it's pretty fantastic). Plus it turns out I have more in common with elasta girl than I might have thought...more on that coming soon!

I made it!

Tomorrow will mark one week after my fifth hip surgery. Whoah. Under the circumstances I'm actually feeling pretty darn good. I've got lots of pictures and I hope to start tomorrow on a day-by-day chronicle of my surgery and recovery. As you may know from experience it takes at least a week to beginning to feel "normal" after an arthroscopy. I'm taking it very slow right  now and it's a bit difficult to make my brain focus on writing right now so I'll keep the posts short and sweet!
Ty

getting ready for surgery

On July 13th I had an arthrogram (see the last post!) and though the metal anchors in my hip caused some blurriness (a.k.a. artifact) my surgeon believes that my labrum has become detached and that arthroscopy is our best option. This will allow us to see what's and fix it in a minimally invasive way. Last Thursday we found out that there was a cancellation for this Tuesday and they were able to fit me in! That's the day after tomorrow and I can't believe it. I've been getting ready this weekend (which apparently includes a lot of trips to Target) and I'm incredibly thankful to get this over with during the summer and have the chance to start my senior year without crutches! I hope to have lots of photos and in-depth posts about my recovery. To start things off, here's a pre-surgery list! Packing and getting ready for surgery is a huge part of my mental preparation and it really helps me come to terms with things and feel less anxious.
  
Things to bring:

• loose fitting pj or sweat pants (if you bring one thing, bring these!) You will want to wear jeans for a week or so after surgery.
• T-shirt
• slippers/grippy socks for slippery hospital floors
• magazines + music
• a thera band (if you have one and if your protocol includes it) to tie your ankles together to keep your post-op hip for rotating externally.
• toothbrush, toothpaste, hair brush, etc.

You're never too old for a stuffed animal and they're great at holding oxygen masks near your face.

MRI arthrogram- pictures!

I've already written about arthrograms once here (I go in to way more detail about the process of the procedure, flouroscopy and the MRI scan )Yesterday I had an arthrogram on my left hip to check for a labral tear. (a tear of the gasket-like rim of cartilage on the hip joint called the labrum. The contrast injected into the hip joint during the procedure makes the labrum much easier to see on the MRI scan that follows the procedure.) I sometimes feel like I've had so many hip procedures in the past three years, but when I thought about it I realized that this was only my second arthrogram. All I can say is that I was a ball of nerves before the procedure and there was nothing to be worried about. The initial injection of the number stings a bit but the best part was I couldn't even tell that the contrast needle went into my hip. If you've never had a hip injection before  I'll admit it can be scary. Everyone's experience will be different but the best thing to do is trust your radiologist. From start to finish it tends to only take about 20 minutes and if they inject some numbing agent into the joint with the contrast (which they usually do so you can lie still and pain free for about an hour in the MRI scanner) you'll be pain free for a bit after the procedure. It's a win-win. By all means I'm not saying it's a walk in the park, but it's best to look at things in a positive light. It also really helps to have something fun to look forward too after the procedure (for me, that's ice cream). Bring on the five inch needles!

hip strengthening and balance exercise

I've been given this exercise in physical therapy a few different times as it's a  great multipurpose exercise for practicing balance and strengthening the muscles around the hip. Plus it's pretty fun and you can join the circus once you get really good at it. It's a great thing to do pre- surgery to strengthen and also post -surgery if you have muscle atrophy (wasting or loss) from the surgery and recovery. Always check with your physical therapist first, of course! You do need a small exercise trampoline for this but to get stated you can always just do it on solid ground. The trampoline just adds to the balancing element of the excercise. As you can see in the video, I wobble a lot, especially on my left leg. This weakness, we think, is from those crazy six months on crutches after my last surgery. To do this stand on one leg and have someone throw you a ball. At first they can throw it straight at you but as you get used to it they should begin to throw it to the left, right and higher or lower. This forces you to move your body to catch the ball which in turn tests your balance. Depending on your tolerance you can switch legs every 30 to 60 seconds but you should stop if you have pain.

Hello again!

I apologize for the complete lack of posts for the past months, I simply wasn't able to  as junior year really took almost all of my time and energy. But now I'm back! Yay! I'm excited to be able to do this again because I enjoy writing about this (and hopefully you enjoy reading about this too!) I hope to have more physical therapy videos and more explanations about surgeries and more general thoughts about this whole hip surgery experience.
Ty

getting stronger!

We've got a plan! Sort of. It's been decided that my time at physical therapy is better spent doing isometric exercises to strengthen my muscles. I had never heard of isometrics until I had hip surgery but they can be very useful. In a nutshell  isometrics strengthen major muscles groups (ex: quads and glutes) without joint movement. This important for me (and many FAI patients too) because I may damage my joint if I do typical strength training on exercise machines. Isometrics are mainly done by contracting that muscle group for a few seconds. After spending a good portion of the last few years recovering from surgery or being on crutches my muscles have taken an extended vacation. Strong muscles can help to reduce tendon pain (when muscles are "lazy" tendons have to do more work and can become sore and inflamed with tendinitis).

breaking up (scar tissue) is hard to do

The current plan of attack for my hip pain is to break up the scar tissue from my various surgeries. Scar tissue can build up quickly and cause all kinds of problems not the least of which is pain. I can't give a particularialy scientific explaination to why it forms but it can do all sorts of damage. When scar tissue breaks up naturally (with movement) it can be very painful. I was also told I might even have scar tissue on my labrum causing pain. Having a physical therapist break it up for you isn't fun but it can help.Right now I'm having  graston tools used on my hip. It's much more effective that manual massage and I can even feel the scar tissue breaking. (it feels like bubble wrap is being popped under my skin) It's pretty rough on my hip and I have the bruises to prove it! My physical therapist  suggested that my my Mom can do this at home on the days I don't go to PT. Graston tools are quite pricey but we've found a great alternative: a point turner. It's a sewing tool you can find at a craft store for less and $5. Use the rounded end with a little bit of massage cream. It works well to draw "circles within circles" with the tool on the outside of your hip if you've been having iliotibial band issues.

my story

It's been a while since I wrote a post about what's going on with my hips, so here it is!  I believe I last wrote that I was going to start a physical therapy program to "restart" my poor psoas muscle. I have been having groin pain since August and despite steroid injections it kept getting worse. After starting a PT program for my psoas, which was believed to be the source of my pain, my pain continued to get worse. We decided to switch to massage which didn't help either. Right now I'm going to PT twice a week for treatment with Graston tools to hopefully break up my scar tissue. I can't say that it's helping but it does leave me pretty sore...and black and blue! We're in contact with my surgeons and we're trying to decide what The Next Step should be. It's looking like another arthroscopy to make sure my labrum isn't torn...oh boy.

warming up

Massachusetts is currently digging itself out of an enormous amount of snow which makes me want spring. It also makes icing my hip not too appealing when it's 10 degrees outside. Thankfully at PT recently I've been getting heat instead of ice. It's pretty wonderful to be wrapped up in two enormous heat packs and four towels in January. Getting good, deep heat on a hip can be difficult but my physical therapist has come up with a method that I am a very big fan of. I think this could be pretty easily done at home with two hot water bottles or two microwaveable heat packs. It doesn't fall off, it gets heat around the entire hip AND it's great for bilateral hippies like me.

1. Take a flat sheet and fold it into a rope and place it across the bed
2. Place two heat packs of the sheet with their ends touching so they make a big rectangle
3. Take bath or hand towels, depending on how big your heat packs are and layer them on top of the packs. (The number of towels depends on hot your heat packs are and how much heat you can tolerate)
4. Do your best princess and the pea impersonation and lie down on the towels
5. Tie the sheet around your waist (you can put a wedge or some pillows under your knees if you like) 

ice is nice

Maybe it's the weather outside or maybe it's because I've been having more pain lately...who knows, but ice seemed like a good topic for today.

In my opinion ice is great for hip pain and really great for post-op hip pain. Lots of people swear by the  Game Ready ice machine. It plugs into the wall and requires no pumping and allows you to adjust the temperature. pretty nifty. After my arthroscopy I was sent home with a low tech version of the game ready. You fill the cooler with water and ice cubes and squeeze the bulb to get ice water to flow into the the pad which is strapped to your hip. Pretty good relief for being very low tech! I also have a big therapeutic gel ice pack that I bought from a physical therapy place. It's very helpful but not as good as a machine for post op when you need around the clock ice. ( they can be a bit pricey and a bag of frozen peas does the job too!)

post-op ideas

My family and I went into my first open surgery not knowing what to expect. We had gone to a long pre-op clinic beforehand and learned that it would be rough and  got the basic concept of surgery and recovery. Beyond that we weren't too sure what little problems we might encounter and other little details. Having to experience the same exact surgery three months later was sacry (we knew what would be hard) but it was also reassuring not having there be any unknowns. I try to keep track of the things that made my recovery easier knowing. Some of them apply only to open surgery but most of them are for hip surgery in general.

• If you are the kind of person who wears nail polish (like me!) remove it before you go to the hospital. Most hospitals require this because the OR team needs to check circulation during surgery. They do this by looking at your toenails. who knew.
• If you'll be spending a few nights at the hospital bring a lightweight blanket (fleece is good). It can keep your legs warm in  the wheelchair, prop up an air mask so you don't have to hold it and if you roll it up it can keep your "good" leg from roatating inward when your "bad" leg is in CPM
• Have your CPM and any other rented supplies delivered before you go to the hospital
• arrange for sleeping arrangements on the first floor for at least a few days. pain meds+crutches+stairs=very bad
• If you've had open surgery please have someone shift your position slightly every couple of hours while you're not able to get out of bed. Prevention IS the best medicine. I am assigning absolutly no blame, my hospital is fantastic, but I did it a pressure ulcer/bedsore on my heel after my first surgery. Healing was a huge process that I wouldn't want anyone else to go through.
• If you live more than 1/2 hour away from your hospital, stock your getaway vehicle with at least three pillows to prop your leg up with when you're going home after surgery.
• If you know you'll be on more than a few medications after surgery have someone make you a med chart while you're in the hospital. It's helpful to have a chart with times and dosing on it so you don't forget anything.

Got any other suggestions? Let me know please!

IT band rolling

The iliotibial band or ITB runs from past your greater trochanter (the bump you feel on the side of your hip) all the way down to the side of your knee. Foam rolling is a great way "massage" the IT band if it's tight, snapping or painful. Though it's quite painful at first foam rolling is a great way to get some relief ( if your doctor and physical therapist give you the ok first!) I've attempted foam rolling many times and each time I end up in a twisted heap on the floor because my arms couldn't support my weight on the roller. Because I have been having IT band problems lately my surgeon suggested a rolling pin. brilliant. Even though I might an IT band release surgery in the future this provides some relief! It's much easier to have someone else do it for you, just tell them how much pressure to use.
P.S. tell me if you like these videos, I can do more physical therapy videos if you like!

muscles ligaments and tendons oh my

I do not have a good relationship with my IT band. In fact I think it may borderline on an abusive relationship. Oh  well. Since I've had hip surgery I've learned quite a bit about hip anatomy. More than sometimes I'd like to know. The biggest thing I've learned is that there are a lot of muscles, tendons etc. in your hip that you might not even know exist until they decide to go on strike. About 1/2 of my hip problems caused by FAI have bee joint (bone or cartilage) related. The other 1/2 have been muscle and tendon problems related to FAI. In fact I spent 6 months on crutches due to muscle atrophy and tendinitis. Pretty crazy to think that even though now my joints are now normally shaped (yay!) the various problems related to being on crutches, having surgery, suddenly changing the shape of my bones and simply growing are tremendous and that I still deal with them today. The iliotibial band runs from your low back to the outside of your knee. It's pretty darn big. Because of many causes mine (left only) is much too tight to the point of needing surgery to release it. The moral if this little story is that you should never take your muscles and tendons for granted. I would only think about my bone and cartilage and labrum but it is equally important to take care of all of your hips. Ice and physical therapy are great but sometimes rest is the best. Happy New Year!