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[THR] Compression stockings

Discussion in 'Hip Replacement Recovery Area' started by YoungHippy, Apr 4, 2016.

  1. YoungHippy

    YoungHippy Member
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    I agree with that. I feel like the first surgeon just didn't know what he was doing.
    Honestly, I don't remember where I read that. I do remember that at the time I was reading it I had no idea I was going to have a THR to correct my issues.
    No, I don't have any x-rays.


    I actually have 3 problem spots. From the first chart:

    E-R3F This is the one that wakes me up. Sometimes it can be alleviated by sitting up and letting my lower legs hang off the bed.

    From the second chart:
    R5B-B-C This is a constant ache. It's always there, how bad depends on how long its been since my last tylenol dose.

    R5B-F & R6B-F This one isn't so much a pain as a feeling of sitting on a foreign object. It doesn't feel great, but not normal either.

    Thanks @Josephine
     
  2. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    To start with I shall leave you a link to this How To as you need to know how to use the multiple quote tool
    How to use the quote feature
     
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  3. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Before I can proceed, what do you mean by 'first' and 'second' charts? There is only one that shows front and back of the body.

    But assuming these are what you are referring to (I hope!) I give it a go and see that these are your areas of concern

    younghippy.jpg

    All these areas are probably just post-op pain. This confirmed to me by this comment
    because it's the internal incisions and healing thereof that you are feeling.

    So now I'm going to ask you some questions if you don't mind, and 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)

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

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

    5. what kind of PT exercises and exercises at home are you doing? How much 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: (enter number) of sessions each day
    enter exercise + enter number of reps and sets
    enter exercise + enter number of reps and sets
    etc., etc.

    At PT
    enter exercise + enter number of reps and sets
    enter exercise + enter number of reps and sets
    etc., etc.
     
  4. YoungHippy

    YoungHippy Member
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    Yes, that's what I was referring to. I seem to be at a lack of words to say what I really mean these days.

    1. Posterolateral

    2. pain Right now I am about a 2. This is just getting up. The highest I get going through the day is about a 4 or 5

    3. The only pain med I am on is Tylenol. I take 1000mg every 6 hours.

    4. For housework I have been washing dishes, meal prep, microwave foods. Not at the same time, and I don't put up dishes since our dish cabinet is in another room. Laundry: washing, drying, hanging and folding. We don't have real closets just hanging racks in the laundry room. And for folding clothes I fold them and stack them on the dryer. My mom takes them from there and puts her stack up in her room, and takes mine to my room where I put them where they belong.

    For shopping: I don't do any grocery shopping at all. I have picked up prescriptions from the drug store. I have walked into stores just to walk around and pick up small things. I am still using crutches so trying to hold a basket or cart is tricky.

    Other errands: I accompany my aunt who has MR to her doctors appointments, mostly at the hospital where there is alot of walking. I get out and visit friends, usually at their home where we sit around and talk.

    I try to balance things out, if I have a high activity day I tend to rest and do little the following day. For example, the day of my check up with my surgeon I went out to eat and walked around in a couple of stores, so the following day I didn't go anywhere just did a little walking outside at home.

    5. I am a PT drop out. I had home PT for 2 weeks in the beginning, and then went for 2 visits at outpatient before quitting. Since then I have done none of their exercises. I walk and spend about 20 minutes every morning with the pedal exerciser. I try to repeat that at night, but it doesn't always happen if I am tired.
     
    Last edited by a moderator: May 23, 2016
  5. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    hmmm, I see
    Okay
    I see, well this is part or all of your problem. You are only 7 weeks out and assuming you've been doing this for a while, this is why your muscles and wound are complaining. I doubt there is anything actually wrong other than overworked and angry tissues. Is there anyway you can cut back on the household chores?
    Well good that you're not doing the official exercises but I suggest you stop using the pedalar completely. You're already doing enough/too much. I think you also need to take a stronger pain med if only last thing at night and days when you are home most of the time.
     
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  6. YoungHippy

    YoungHippy Member
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    Thanks Josephine! I will try and put off some of the household stuff for a little longer. I guess I was just excited to be able to do again after so long. Tylenol is the best I'm going to get as far as pain meds go though. My surgeon had me on oxycodone until my 2 weeks check up. Then he cut me down to Norco and only gave me 15 of those. Said that after that my pain should be adequately controlled by OTC meds.
     
  7. YoungHippy

    YoungHippy Member
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    No, we don't have that over the counter here. It's considered a narcotic and has to have a prescription.
     
  8. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Okay. But aren't you going to tell me the site of your pain?
     
  9. YoungHippy

    YoungHippy Member
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    We did that already above. After a couple of days of taking it easy things are a little better. I was rushing things. After so long not doing I was ready to live again. Now I see that just because I can do something doesn't always mean I should.
     
  10. YoungHippy

    YoungHippy Member
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    Well, just when I thought I was getting through this I started having issues.

    At some point after I became fully weight bearing I started having swelling in my op leg. I would notice this after a day of heavy activity, but it wasn't painful and usually the swelling went away after I elevated my leg for an hour or so. Day before yesterday I accompanied my mom to her Dr appointment in another town. I went into the dr office with her, stood and talked for a friend for about 20 minutes, sat the rest of the time we were there. I noticed my leg swelling while we were there. We left there and went to get some food at Sonic. While we were there the back of my thigh started aching. Other than that everything was normal. Went back home after that to get my leg propped up. Figured the swelling would go down like usual. The swelling never went down, and actually expanded into my foot once I took my shoe off.

    I didn't do anything yesterday except sit around with my feet up.

    Today I went to my PCP where they sent me for an ultasound to make sure I didn't have a blood clot. That was ruled out, thankfully. The swelling isn't painful, it's more uncomfortable than anything. My incision area is tender. Today for the first time I noticed that any pressure on that area is just not good. My clothes don't bother me, other than the legbands for my panties, but in the truck I noticed that the seat belt buckle and side of the seat made things really uncomfortable. As of now my PCP hasn't done anything other than send me for the ultrasound, she is supposed to call me in the morning. I also left a message on my surgeons answering service after the results showed it was not a blood clot.

    On an interesting note. My PCP was asking about my arthritis pain. I just looked at her in confusion. I had only been to see her one time until today, basically to get refills for my allergy meds, so she isn't that familiar with me yet. I explained to her that as far as I know I don't have arthritis. The notes in her system, which links into the hospital where I had my surgery, stated that the reason for my THR was osteoarthritis damage. Her system only shows the newest results and she hadn't gone back any further until after I told her about the car accident and subsequent surgeries. This kinda makes me wary about my OS. I sure hope he is a better surgeon than he is at getting information correct. O.o
     
  11. gullimac

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    Hoping this was just a momentary set-back @YoungHippy . How are things today?
     
  12. YoungHippy

    YoungHippy Member
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    Thanks for checking in on me @gullimac Still have swelling. Basically anytime my feet are down for more than an hour that leg swells. The thigh is always swollen. The tenderness comes with more swelling so my goal in life is to keep my feet propped up as much as possible. Idk if it's a coincidence or not, but after 2 days of the huge swelling, I couldn't seem to fall asleep, I took a benadryl, the following morning my foot was a normal size for the first time in 2 days. I keep hearing to expect swelling for a period of time after THR. But this seems excessive. My PCP told me not to start PT again at this point, and not to do any exercises at home other than heel slides and ankle pumps.
     
  13. YoungHippy

    YoungHippy Member
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    My swelling finally went down almost completely. My thigh is still a little swollen but not the overwhelming swelling that I had been experiencing.

    I began PT again yesterday. My goals are to walk without a crutch and strengthen those hip muscles. PT noticed that I have an awkward lean going on when attempting to stand from a seated position and when walking. She asked if my legs had ever been measured to see if they were the same length. The surgeon came into my room at the hospital and compared length with me laying down with my ankles side by side. I learned yesterday that is not an accurate measurement. PT measured and said that I have a half inch lld.

    She suggested that I go to a local shoe store and get an insert for my shoe. Spoke with the people at the shoe store and they said for anything over a 1/4 inch the bottom of the shoe had to be built up rather than using an insert. My problem here is cost. They will build up my shoe for about 50$. Which isn't bad. But I don't have any real shoes yet. When I had my accident I was wearing my work shoes (the only real shoes I owned as I prefer barefooted unless I'm out of the house). My work shoes were the rocker bottom sneakers, can't remember what they are technically called, maybe shapeup? Needless to say that I can't wear those anymore until my stability gets alot better. I purchased a cheap pair of slip on shoes after surgery, mainly to avoid having to tie shoes for awhile. I really don't want to purchase new shoes that I can have built up until I am walking properly. So my question is, is there any temporary alternative that would help me make due until I can get a shoe built up?
     
  14. gullimac

    gullimac Graduate

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    My question is will you be able to get to the point where you "walk properly" without being in a built up shoe? You may not be able to wait until you are walking correctly. You may need the built up shoe in order to return to a normal gait. Kind of a chicken vs. egg argument in some people's minds.

    You could try a generic insert first, even though it wouldn't build it up enough, to see if you get some relief. But I have also seen that sometimes inserts initially can make a problem worse (or just plain feel very awkward) before it gets better. It is kind of like your body has adjusted to work with the abnormal mechanics and then when you correct things it feels totally wrong and makes you sore in places you have neglected for a while.

    Just my 2 cents. Glad the swelling is getting better.
     
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  15. Krista

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    Just some thoughts I had while reading your post! If I were you, I would make sure I was completely certain what my LLD is. Surgeons measure for LLD while you are still in the operating room. Did the surgeon say you had one? How confident are you that the PT's measurement is accurate? I'd want an excellent orthopedist to determine any LLD by the most accurate method available. Then when you are 100% sure that you have one, and what it is exactly, you can work on adjustments with inserts or built-ups. It has been a bit more than 15 weeks. Many people feel like they have a LLD after surgery and it takes awhile for things to settle and many of them end up not having one. I don't know how long that takes, but I wouldn't be using inserts if there was any chance of things evening out on their own.
     
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  16. YoungHippy

    YoungHippy Member
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    Thanks for the input @gullimac and @Krista

    I called the surgeons office yesterday and spoke with the nurse, she said LLD would be something they would cover on my next visit, which will be next month. She also said she had received PTs notes on that. So basically wait until then to get an official measurement on that. She did suggest I could get a small heel insert to try out until then to see if it made any difference in my walking.

    So I made a trip to my local shoe store, the one PT had suggested to get my shoe built up. Talked to them, told them I just wanted to know more about what was involved etc. They have one guy that specializes in the shoe inserts and building up soles, and he is 2nd generation at the shop. While we were talking we realized that we are related, and that he had also done the buildups on both my moms and my grandmothers when they needed them. I told him what PT had told me, and what the nurse had told me. His suggestion after watching me walk was to try an insert. He made a 1/4 inch heel insert and I tried it right in the store. It really does help, took care of most of the leaning and I noticed I wasn't depending quite so heavily on the crutch with it. He didn't do any kind of measurements, but says that he agrees with PT based on the way I walk. Another lady that was in the store mentioned that he had told her about her LLD before her surgeon ever did also. So atleast I have a starting place now.

    I wore the insert for all of yesterday and today and haven't noticed any additional aches and pains. It seems my balance is a little better too. I had been noticing that when I bend over I tend to sway towards the right, that is not so pronounced now. And it doesn't seem as tiring to walk now. It's not official, but at this point anything that makes me steadier on my feet is a welcome addition.

    It has been interesting though. I was house/pet sitting this week for an older dog, he has issues walking also and tends to sway a little to the left when he walks. So between us we were pretty much going in circles when we went out to walk. :rotfl:
     
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  17. YoungHippy

    YoungHippy Member
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    So this happened when I logged in today. Trying to figure out when I became Jennjones ? wut.png wut.png wut.png wut.png
     
  18. YoungHippy

    YoungHippy Member
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    So this happened when I logged in today. Trying to figure out when I became Jennjones ? wut.png
     
  19. YoungHippy

    YoungHippy Member
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    Here is my latest update:

    I started back in PT a couple of months ago now, and that seemed to be going well. It's been a lot of work, but I do think it has helped. It was PT who mentioned an LLD of ½ inch. I started out with a ¼ inch heel insert in my shoe, which really did seem to help with the lurch. I figured I would wait for any extra lifts until after I had seen my surgeon again.

    I had my follow up appointment with him last Wednesday. My concerns were that I still have swelling in my op leg, my gait, and of course the LLD. He took x-rays and made his usual comment about how everything is still where he left it. Which of course I asked where did he expect it to be? That's when he showed me my x-rays and pointed out that my THR is angled slightly different than my natural hip on the other side. He said that because of my previous injuries there wasn't sufficient bone to have them angled the same, hence the offset, and the worry that things could possibly shift during the healing process. He advised against using the lift, saying that it could aggravate more things than it helped.

    He used computer software with the x-rays and says that I have a .5cm LLD, which should not even be noticeable, and that he really hates when PT acts like they know what they are talking about on those types of things.

    The swelling he explained as that after 3 surgeries there could be some scarring to vessels that will take a while to heal, and that he would not be concerned about it at this point.

    He says my gait issue is Trendelenburg gait, and the only fix for that is more PT to build the muscles that I lost during my months of non-weight bearing.

    I did request copies of my x-rays that day and am still waiting for them to come in the mail. I did get my hospital x-rays of everything from the day of the accident until the THR. So I have my complete timeline from original break until THR. Would love to post some, but for some reason, the file is not a format that I can upload here?

    I was pretty satisfied with my visit, and with my progress to that point. I'm not anywhere near where I was before the accident, but feel that I have come a long way from where I was before the THR.

    When I returned to PT on Monday of this week I was wearing sandals. And one of the women was asking where on earth did I get a lift that wouldn't show with sandals. I told her that my surgeon said that I did not have a noticeable LLD and shouldn't be using a lift. Went ahead with PT as usual. My usual routine there is 15 minutes on the nu-step, some exercises at the parallel bars, and some more exercises on the mat.

    It was during the mat session that one of the other PTs came through and said that I should get my surgeon to check my LLD. Which of course led into the discussion again about how he said that I did not have one etc. So I had 3 PT people standing around me, having me adjust the way I was laying and saying that one of my legs were definitely longer than the other. During this time one of the Drs for the clinic came through also. And they were telling him they thought I had a LLD but my surgeon disagreed. So he asked did I mind standing and walking for him. Of course I didn't mind. So he watched me walk and said the same thing as my surgeon did about the Trendelenburg gait. He watched me both with the crutch and without, and with shoes and without. He had me stand with my hands on my hips, feet shoulder width apart. He said he thinks there is more of a degree of LLD than my surgeon is telling me. And that I need to go back and question that.

    He asked me to lay back on the mat again so he could check a few things since he was there. He was asking me about pain, and I told him that I was a little sore after PT, but that ice and Tylenol helped with that. He started pressing down around my hips, around the joints as well as the bony area at the front of my pelvis and asked did any of that hurt. And the bony area at the front did hurt when he pressed down. PT stepped in and did this thing where I laid flat on my back and they bent my leg at the hip to a 90 degree angle and held it for 90 seconds, they did this to both legs, and when they were done the point that was so tender wasn't tender any more. It was like an 'aha' moment. So then they had me lay on my stomach and the Dr went back to pressing down on different areas and said for me to tell him if anything hurt. Nothing hurt, but it wasn't really comfortable either. He ends up by saying that he thinks that my pelvis isn't aligned correctly. He said that my left side seems to be higher than the right, and that my sacrum sticks out more on one side than the other. As in on one side it's level with the surrounding bones, but that on the other side there is a noticeable difference. He ended by saying that I should probably have some x-rays done that focus on the entire pelvis and not just the new hardware.

    That same day, directly after the PT session, I had my first visit with my new PCP. I mentioned to him what the other Dr had said during my PT session about needing x-rays. He basically said that with my accident and THR status that anything dealing with my pelvis was out of his range of expertise, and suggested I call my surgeon and discuss this with him. He checked my vitamin D levels and sent me on my way said to return in a year.

    After the appointments I went home. In public I still walk with one crutch everywhere. It controls the lurch and helps out with unlevel surfaces. At home I sometimes go without it for short distances. As in if I need something from 3 feet away I am going to get it without the crutch, it's just quicker that way. Well I noticed that when I walked without the crutch after the PT session that I had less of a lurch than I had been having. So I thought, great, I am making progress. Fast forward to the next morning. I could barely get out of bed, my lower back hurt so bad. When I did make it out of bed it seemed I felt something shift and I was back to my usual lurch only worse. So it basically seems that whatever adjustments they made unadjusted themselves and left me with pain.

    I called my surgeons office and left a message with his nurse. She called back and I told her what PT and the other Dr had told me, she said she would speak with the surgeon and see if he wanted to see me again and maybe do some more xrays. She called back later and said that he said I should quit worrying over every little thing PT told me and that he would see me in 3 months.

    So now I am sitting here like now what? If something is out of alignment that needs to be aligned, by all means lets get to it. On the other hand, I cannot allow PT to do any more of this alignment because it hurts to bad the following day. Is that normal? Where do I even start to get answers to what is going on now? Hoping maybe @Josephine will chime in here.
     
  20. Josephine

    Josephine NURSE DIRECTOR, BONESMART Administrator

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    Oh my! What an amazing conclusion! Has nobody told you that about 85% of LLD is caused by the pelvis being out of alignment. In other words, the LLD is apparent rather than real. Read about those definitions here Leg length differential - LLD.
    As you will have read, apparent LLD is due to pelvic alignment which in other words, means posture. There's more in the article.
    The alignment correction will improve and correct itself over time by walking. Simple as that. You don't need and exercise regimen or adjustments, certainly not from a PT. You're only 4 months out which, for this particular problem is very early days. You might not be aware of improvement until a full year has elapsed. Until then, I totally agree with your surgeon. Stop allowing the PTs to obsess about this and to leave it alone. And you don't worry about it either. Certainly let them help you with the Trendelburg gait but that really doesn't need a lot of intervention either as it will correct itself over time.

    It seems from what you've said, you only get problem after the PTs have worked on you. So the answer there is self-evident. Good luck!
     
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