THR Buttock pain 3 months post op<

[gwenc]

@Rkeilb I feel so bad for you with your continued pain and your surgeon apparently not taking any interest in your situation. Are you sitting on the ice pack every time you sit for more than 10 minutes? I found it made a huge difference when I sat on the icepack rather than using it on top of the thigh or on the side of my hip. Just know we are all thinking of you and praying for answers and healing for you. Blessings!

 

[Rkeilb]

Good morning
Yes sitting on ice pack when possible. Sometimes I just hang that cheek off the side and sit on 1/2 my butt. This morning I got up and didn't feel too bad but once I started walking around the pain builds on the side below my incision and down my outer thigh even without sitting. After a couple hours at work it's bad.
Therapy place says all soft tissue and should subside but geez it has been way longer than normal for this amount of pain.
I will feel better once the new Dr checks everything I keep thinking that when I went through that too aggressive PT back at 9 weeks they messed up something with the implant, but I hope not!!!!!!!
If I get another injection in a couple weeks (they make you
wait that long)
they are gonna do the Piriformis which they probably should have done last time but my Pain management Dr thought different??
He's the Dr but my body
I know I will get through this but much harder road than I thought
Yes very displeased with surgeon
Looks at MRI and nurse said no need to come in because he will just tell u everything is fine
Horrible after care
Thank you for caring I wish my surgeon had your compassion and maybe I would be better by now
Anyway hate to be a complete downer so
Happy Friday

 

[gwenc]

You probably shouldn't be back at work full time if you are in that much pain - maybe you can work half days for a while? I know I always feel good when I wake up too, but by the end of the day I am pretty sore. But it's manageable, not anywhere near the level of pain you are experiencing. More like stiffness, with some achiness in the joint area. I still get frustrated though, wanting to be "normal" again. I hope tomorrow brings even a little bit of improvement. And I hope you find a better doc to help you through this!

 

[Rkeilb]

Half days sound much better but I would have to go back on STD again or use up a lot of vacation time.
Gonna give it a try but you can only do what you can do.
Take care

 

[gwenc]

How are things going @Rkeilb ? Have been thinking about you! Please give us an update.

 

[Rkeilb]

First let me say I saw your post in your thread and I'm glad you're getting better and had a great time.
I wish I could say I was but I'm not. I will probably be back on STD starting next week working 4 hour days if I can even do that.
I don't understand what went wrong with my recovery but I feel I'm actually getting worse instead of better.
My 2nd opinion fell through after 2 weeks of waiting for records to get there they called and said they declined to see me. No reason given just won't see me so that was devastating at the time.
I guess my good news is Friday I have an appointment with my surgeon so at least they can see the shape I'm in for themselves.
I was better months ago then I am now.
I get the feeling after talking to the nurse they don't think it's a big deal and are downplaying it which makes me mad.
I go to the myofacial therapy later today and talking with pain center again about another injection so God knows I'm trying.
I just want someone to figure out what's wrong and how do I move toward getting better.
I'm having a hard time staying positive without any improvement but I will keep trying
Thank you for asking and I truly am glad for you or anyone who's getting better but at the same time it makes me think why not me??
I refuse to give up I will get better!

 

[gwenc]

well that just plain sucks. I hope you get some answers soon. Make sure they take an xray when you go and make sure you look at it with your surgeon, and ask for a copy of it so @Josephine can look at it too. She is very good at reading x-rays. And I have heard quite a bit of chit chat about "defensive" surgeons who just automatically say everything looks great even when its not (like the prosthesis is loose, or whatever). So be your own health advocate and demand answers and then challenge them.

 

[Josephine]

I just want someone to figure out what's wrong and how do I move toward getting better.

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Rkeilb]

Of course I would welcome it

 

[Rkeilb]

Thanks gwenc they told me they would do an x-ray so that's for sure and a copy is smart.
I'm making my list of questions and concerns.
Just got home from myofacial appointment and butt pain does seem a little better.
I'll take any improvement I can get

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are

1. what approach did you have for your surgery? Anterior, posterior, lateral? You can look here to see the various types THR approaches or incisions

2. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

3. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

4. are you icing your painful area at all? If so, how often and for how long?

5. are you elevating your leg. If so how often and for how long?

6. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Rkeilb]

1 Posterior

2 when at rest I can get down to a 2
After I am up and moving it escalates fairly quick, I have been working 4 hours lately and by the time I'm done I'd say an 8 easily
Standing and walking the pain is just below outer butt cheek and runs down my thigh I best can describe as soreness and burning
Sitting pain is stabbing but to the point of being extreme, putting any pressure on that cheek even for seconds is painful. I feel muscle spasms back there occasionally.
I think you probably nailed that with the Piriformis but it has been since surgery
from the get go not just since I overdid the PT
Pain along incision site- soreness
Slight groin pain in the last few weeks but minor in comparison to other pain

3 Ibuprofen 400 mg twice a day morning and evening
Norco 5 mg one in the AM around 8am and 2 around 1 pm when I get home from work and lay down
Also am using Voltaren Gel once a day usually afternoon to early evening

4. Icing 3 times per day for at least 20 minutes per time

5. Elevating when icing and at night during sleep

6. Working 4 hours a day and then around the house chores mowing, laundry, yard work has been mostly out of the question last month and half. Earlier in my recovery I was doing more as far as chores go.

7. Stretching exercises hamstring, Piriformis type from your link once a day for 10 minutes at most
A Leg lift called leg fights 2 sets of ten (myofacial exercise)
Hip swivels 2 sets of 20 a myofacial thing that is supposed to level my pelvis
Stationary bike 10 minutes
Myofacial therapy twice per week at 1 hour each

I went through that crazy PT at between 9 and 12 weeks where they had me doing pretty much every exercise that your link said not to do but I ended that around the fourth of July and have not done anything like that since. Paid a high price for that mistake.
There is no doubt that was detrimental to my recovery.
Just not sure if all this pain can be attributed to that? I expected the first 12 weeks or so but I will be 5 months pretty soon.
I will get a copy of my xray if you'd be interested in giving it a look? As time goes on and you don't get improvement you start to think the worst.

Thank you very much!

 

[gwenc]

"Leg fights"? Hmmmmm - that doesn't sound good! I will let Jo respond but it does sound like you are still doing a lot. Do the exercises hurt while you are doing them? I agree that an 8 pain level 5 months post op is pushing the bounds of a "normal" recovery, but, I have also learned not to set any expectations. Hard, I know -- you want your life back, as we all do. For what its worth, I'm rooting for you @Rkeilb !

 

[Rkeilb]

They are a kind of leg lifts where you bend your other leg and use it to push down on the leg your lifting. Just started doing those last week after starting new therapy. Can't say that it causes any immediate pain.
Thank you for your support it does help.
I just need to turn that corner and I should be fine. At least that's my hope

 

[Josephine]

when at rest I can get down to a 2, 8
I think you probably nailed that with the Piriformis but it has been since surgery
from the get go not just since I overdid the PT

Ah - okay

buprofen 400mg twice a day morning and evening
Norco 5mg one in the 8am and 1pm
Voltaren Gel once a day

Norco comes in a variety of strengths - which one are you taking? I did ask "how much are you taking (in mg please) and how often?"

5 milligrams of hydrocodone, 325 mg of acetaminophen
7.5 mg of hydrocodone, 325 mg of acetaminophen
10 mg of hydrocodone, 325 acetaminophen​

I seriously wouldn't bother with the gel as there is strong evidence that they don't work because they only penetrate about 2-3mm below the skin

Icing 3 times per day for at least 20 minutes per time

You accomplish little or nothing in 20 minutes. Ice for at least 40-60mins and more than 4 times a day if you think it helps.

Elevating when icing and at night during sleep

okay

Working 4 hours a day and then around the house chores mowing, laundry, yard work has been mostly out of the question last month and half. Earlier in my recovery I was doing more as far as chores go.

Jolly good!


Stretching exercises hamstring, Piriformis type from your link once a day for 10 minutes at most
A leg lift called leg fights 2 sets x10 (where you bend your other leg and use it to push down on the leg you're lifting) - sounds like a jolly goos way to get pain!
Hip swivels 2 sets of 20 a myofacial thing that is supposed to level my pelvis - you mean like this?

Stationary bike 10 minutes - okay
Myofacial therapy twice per week at 1 hour each - well, can't say much about that!!

I went through that crazy PT at between 9 and 12 weeks where they had me doing pretty much every exercise that your link said not to do but I ended that around the fourth of July and have not done anything like that since. Paid a high price for that mistake. There is no doubt that was detrimental to my recovery. Just not sure if all this pain can be attributed to that? I expected the first 12 weeks or so but I will be 5 months pretty soon.

Oh indeed it can!

I will get a copy of my xray if you'd be interested in giving it a look? As time goes on and you don't get improvement you start to think the worst.

Yes, that would be helpful

 

[Rkeilb]

Hello @Josephine
The Norcos are 5/325 and they are giving me 4 per day. I take 1 in the morning along with 2 ibuprofen 400 mg
Then 2 mid-day and sometimes one at night but if I'm just laying around I don't take it because the pain is less than when I'm active. Then 2 ibuprofen 400 mg in evening.
I can lay off Voltaren Gel
The hip swivels are something different
You just lay on your back and swivel your hips a few times than hold the left side down for 5 seconds. Myofacial therapist said they want your pelvis even and I was high on left side. I'm not sure what I think about this therapy yet, it's not a strenghthing type thing they are just doing tissue massage and hold it to release pressure from the facia.
I can lay off the leg lifts just started them recently.

I did have my appointment today with the PA and here is a summary of what I was told.
Did x-ray which I will post but walked off without it today. He also looked at previous MRI from a month ago through different Dr. (Good thing I have good insurance). He said surgically he does not see any problems.
He also ran some labs just to be sure for anything with infection. Should have results early next week

He said that since my surgery was due to avn that he is not surprised my recovery is being slow. Also I have been on the Hydocodone for pain for around 2 years 7.5 mg/325 from my GP not surgeon. He thinks that lends itself to a worse recovery. He wants me to get off it as soon as I am able.
I probably never should have relied on that for the avn pain but it is what it is now.
Also he said I have severe atrophy of the glute on that side and I need to start slowly building it up or I'll be stuck in the rut I'm in.
I really don't understand how it atrophied so much but my question is how do I properly rebuild that muscle?
Obviously I don't want to make things worse.
Good news is they say everything looks good
bad news is I still hurt.
Thanks in advance and I will post that x-ray when I can.

 

[Josephine]

The Norcos are 5/325 and they are giving me 4 per day. I take 1 in the morning along with 2 ibuprofen 400 mg

OKay, so why don't you enhance this by taking 2 regular Tylenol each time - making a total of 975mgs which is about the max per 24hrs. I'll bet you find that an improvement!

Then 2 ibuprofen 400 mg in evening.

Well if you're finding it helpful I would just say two things:
1. NSAIDs are rubbish pain killers!
2. You need to be aware of the dangers of NSAIDs Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers

He thinks that lends itself to a worse recovery. He wants me to get off it as soon as I am able.

I'd tend to agree - have you considered making a switch to a totally different medication. Tramadol, for instance?

Also he said I have severe atrophy of the glute on that side and I need to start slowly building it up or I'll be stuck in the rut I'm in.

I really don't know where these people get such weird ideas! Of course it won't!

 

[Rkeilb]

@Josephine
Are you saying that I shouldn't worry about building up that muscle at this point?

 

[Josephine]

Yes. You've plenty of time to get to that. Months

 

[Rkeilb]

@Josephine
I will stick with the walking and stationary bike then.
I'm considering an injection in that Piriformis if that doesn't settle down
Thoughts on that?
Then I will leave you alone for time being
Thank you