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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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    8 Month Check in:

    I had my visit with my surgeon yesterday, and he has released me for a year. I also have been okayed to go back to work, as long as my job does not require me to lift or carry over 20 pounds. That can be modified as we go along, he said he wanted me to have the chance to feel comfortable doing something before an employer tried to force me to do it. So I am out of luck on returning to CNA work right now, as there is really no such thing as a light duty CNA unless you get hurt on the job. I was a little broken hearted at that, but there is still plenty of time to work up to that.

    We discussed my limp. I still have the Trendelenburg gait going on. We discussed me doing some more PT at this time, but since my insurance coverage has run out that is really not an option. He spoke with the on-site PT and gave me a couple of sheets of exercises to do at home, or anywhere basically. Clam shells, side leg lifts etc. He said not to push it just to try, and if and when I felt good about that to email him and he would set me up with more to do. He said at this point though walking is still the most important thing, walk and build stamina, and the limp would get less and less as time goes by. He said I may always have some degree of a limp, but he feels confident that it will be mild and not the lurch I currently have. He reminded me again that I am not the typical THR patient, this healing process could be several years, and just not to give up.

    The release for a year is pretty much due to my insurance coverage. But he told me that if I had any issues to call and they would get me in, and that I would never be turned away for inability to pay as long as he is at this practice. I also have his personal email to keep in contact too. He said he is very interested to see how my case turns out both short term and long term.

    So at this point, my plans are to start my new job on Monday and see how it goes and work on some higher education courses to be able to go back into the medical field.

    I just want to tell everyone here thanks for all the advice and support. Even though I am not a regular poster I still read and take comfort from everyone's posts and successes. This site is a tremendous help for anyone going through this joint replacement journey.
     
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  2. Krista

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    @YoungHippy, so sorry you couldn't go back to your job as a CNA, but it is good that you have a new job. Might I ask what a CNA is?

    And that's really too bad about the lurching Trendelenberg Gait that you have. I had that after my THR in July, 2015, and did not have it before. I also had pain accompanying the limp. It never went away, and I finally got diagnosed with torn gluteal tendons last February. Conservative treatment did not help, and MRI confirmed the tears, so I had surgery for repair 5 weeks ago. I'll know in a month or so if the surgery was a success, after I'm allowed to go back to full weight-bearing and have given myself some time to get strength back in my gluteus medius and minimus muscles that haven't had to do any work for the last 16 months.

    Have you had any imaging done of your hip area to see if there are any problems with soft tissue injuries that may be causing your limp? Those two tendons that I had repaired are vital for being able to hold your hip steady while walking, since each step requires that your body be held steady while balancing on only one leg for a short time.

    I sure hope this resolves for you. It seems to me that medical science should be able to diagnose why you have the limp.
     
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  3. Jaycey

    Jaycey Moderator

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    A true BoneSmart OS! As we always say - walking is the best PT for new hips.
    Refreshing to see this. A realistic surgeon. Yes, for some of us recovery is not straight forward. DO NOT GIVE UP. You'll get there!

    All the best in your new job. Don't be a stranger here!
     
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  4. gullimac

    gullimac Graduate

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    @YoungHippy good to hear from you. You truly are not a run of the mill Hip Replacement. Nice of your surgeon to reassure you and offer his personal contact. Good luck with the new job!
     
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  5. YoungHippy

    YoungHippy Member
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    @Krista CNA is a Certified Nursing Assistant. I have been certified for 22 years now and that has been my primary job in my adult life. My last job was in a Long Term Care/Rehab facility. I worked 3rd shift and helped my residents bathe, toilet, transfer, provide comfort care for the hospice patients, give hugs as needed and basically anything else I was needed to do. And contrary to what people think, just because it's night time does not mean the residents sleep :) For the rehab side my main duty was to provide ice to the joint replacement patients, and walk with them to the bathroom as needed, check incisions and change bandages as necessary.

    I haven't had any scans done so far on my hip, only the X-rays to check placement. I have a bad gait, but it doesn't hurt to walk. Well, my back sometimes from the gait, but that gets less and less over time also. I occasionally have muscle soreness after an especially active day, or if I have a first. For example, I have trouble raising my right leg high enough to take steps like a normal person would. Steps like going into a house. Well I went to pay my rent and my landlady has these stubby little steps and I was actually able to climb them bad leg first. It was my first time doing any steps normally, and I did pay for that with some soreness, but after the initial soreness I can do it and it doesn't bother me anymore. It's like I have milestones, but pay for them with short term soreness, and after that I have my progress until the next first. My THR was after an auto accident that fractured my acetabulum and the ball of my femur. I sat with a dislocated hip from December to April totally non-weight bearing. So my hip is never going to be perfect, and I am actually pretty happy with walking pain-free at this point. My main goal is to build back up the muscle I lost and then see where I stand. With the damage I had I have already done better than I was ever expected to do. Before the hip replacement I asked my surgeon if I would ever be able to sit indian style again, his answer was maybe, but not to be disappointed if I couldn't. Well, yesterday when he came into the room I was sitting up on the exam table indian style and pain-free.

    @Jaycey Yes, very refreshing on the realism. I told him the first time I met him to please not sugar coat anything to placate me, just be real with it. And I won't give up. I'm going to keep right on working on this until that side is as close to normal as it can be :)

    @gullimac Read that you joined the double hip club! Congrats on all your progress :)
     
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  6. Krista

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    Wow, @YoungHippy, you had a dislocated hip from December to April? That must have been so painful. I'm very glad you have no pain now, except for the occasional lower back twinges. It sounds like your gait is slowly improving, and I hope that after you get those muscles stronger, that it will be better still. And sitting Indian style! That's something I'll never do again, I'm sure, so congrats on that. Your former job as a CNA sounds like a lot of physical work, so I understand your doctors saying you shouldn't go back to it. You must have been such a wonderful carer. I wish I had had anyone half that nice and helpful when I was in rehab. Don't get me wrong, they were all just fine, but I tried hard not to call anyone, unless I was really in need, especially at night. For the first 8 days I was there, I was required to call for help to get to the bathroom. And I did actually sleep fairly well while I was there, since I had the hospital bed that allowed me to control all parts of the bed exactly for my comfort level.

    Hope you get rid of that limp, and I am thrilled for your progress!
     
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  7. YoungHippy

    YoungHippy Member
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    Well, I have been working again for 7 weeks now. I actually have 2 jobs at this point. Between them I am pretty close to full-time employed. One of my jobs is at a tanning salon. There my duties consist of cleaning the beds, checking in customers, pushing the buttons to start the tanning session, and very light housekeeping. My second job is a nail salon that is run by the same lady that runs the tanning salon. There I am the greeter. I get customers signed in, help them select services and get them seated at the appropriate stations. I gather nail colors for the nail techs, collect payments, and anything else I am called on to do at the time. It is not a hard job, it is just a lot of walking. I wear my fit bit to work there and I am averaging between 7 and 10 miles just in the salon. The first week I was employed again I worked 4 10 hour shifts in the salon. By day 2 I was crying. The limp takes such a toll on the rest of my body. I have lower back pain, upper back pain, my feet hurt, and even the opposite thigh from my THR hurts. My boss is from another country, and is of the opinion that overweight people are just lazy. She says that all my aches and pains would be cured if I just lost more weight. I ended up telling her that I do everything she asks of me, and more. As in things are done before she even thinks to ask. And that from then on when I wasn't busy I was going to be sitting. It took her a little while to realize that I did my job correctly and that she always had everything she needed before she needed it, but I think we understand each other now. Since then she only requires that I work the salon on Saturdays or on special occasions. Like today is the Vietnemese New Year's eve, so I worked the salon so she would have more leeway on coming and going and taking care of her traditions.

    I bought new shoes, which was a whole adventure in itself due to the continued swelling in my leg. My leg is swollen most of the time now. From the thigh on down to the foot. Due to the swelling the foot on the THR side is often a wide rather than a normal width. But if I actually buy a pair of wide shoes, then they move around too much on the normal side. So finding a pair of shoes required 3 trips and many prayers, and even after that my feet still hurt after 2 hours at work. So then I moved on to finding insoles to fit into the shoes I had bought. 2 pairs of insoles before I found my match. I actually have to wear a different insole in each shoe. On the good side I can wear a full insole with good arch support etc, on the swollen foot I only wear the heel cup insole. If I wear anything more on that side then the shoe no longer fits. Then, after I had the whole adventure of getting all that down to a science, I lost a shoe. I had a cinderella moment, but I guess prince charming was nowhere around since that shoe hasn't been seen since. Went back to the store to buy the exact same pair of shoes (and an extra pair too) only to find they were sold out. So repeated the whole process again. The swelling leg makes jeans fun also. It's a contest to see which pair of my jeans will pull up over my thigh on any given day.

    I still cannot sleep on the THR side. That's just a big nope. Most of my sleep is done on my belly with my feet hanging off the end of the bed. I cannot walk distances. In the nail salon, I can walk miles back and forth, but walking distances is an issue. I still have my handicapped placard until next month so I get to park closer to the stores I need to go in. But once I get in I have the option of walking without a cart and the muscles on the good leg screaming because of the limp, or getting a cart and walking normally except then my wrist hurts from using the cart. It's a catch 22, something is going to end up hurting either way. Recently we had an issue with our driveway being impassable. I had to park the car at the highway and walk up. It's a half-mile dirt lane. It took me about 30 minutes to walk it because of having to pause every 20 feet or so. It's like I can walk until those thigh muscles start acting up, then pause for a minute or 2 to relax, and then go on. I don't have to sit or anything when that happens, just stand still for a moment. I still cannot do clam shells. I can raise the op side about 2 inches to the side and that's it. I can stand on the op leg alone for about 30 seconds at a time.

    The strange thing: I still cannot take regular stairs normally. I cannot lift that leg enough to make a step. I can however assist that leg by tugging on my pants leg to get it on the step, and once I get it there I can use that leg to pull up. I also have to use the pants leg method to get into my truck. Once I raise it up there I can use that leg to pull the rest of my body up. In a seated position I can raise that leg with no problem. I actually without thinking about it was sitting in my chair at work the other day, and noticed something stuck to my shoe. I raised that leg right on up and picked off a gum wrapper from my shoe. Think knee to chest, like the picture only without any hands guiding the leg. Standing straight up I cannot do that. For example, undressing at night, you drop your pants and then step out of them, I can't do that standing upright. But I found that if I lean forward a little I can raise the leg high enough to step out of my pants with no problem. I am not sure what the difference is there. Maybe someone with more knowledge of how the body works can help with that?? @Josephine

    Overall, I feel like I am stuck in a rut. I have emailed and called my surgeon's office about the swelling. They said at this point it is nothing to be concerned about. It still worries me. The leg is swollen and is always colder than the other. I am in the process of establishing primary care, but they are having issues getting my records sent over from the surgeon's office, and will not even schedule an appointment for me until they have those in hand. In the meanwhile, I am just hanging around waiting for answers from people who don't seem to be taking me seriously. I realize that I had an accident and experienced major trauma, I realize that this may be my new normal. But atleast someone reassure me that it is my new normal and not some other underlying issue. My grandmother was a little older than me when she broke her hip and had to have a hip replacement. She had similar issues with swelling afterward. Turns out there were some damaged blood vessels in her legs caused by the initial fall or the multiple surgeries. She ended up having a stroke before anyone took her seriously. You would think that 30 years later Drs would take this kind of thing seriously. The surgeon's last email to me said that from the onset his goals were to have me reasonably pain-free and walking, and that he feels like he met those goals. I really think that those goals should have included me being a functioning human being and holding down a job without crying.

    Sorry this is so long, I just don't feel like anyone else understands me. People who have been around me since the accident are all like " well, its been over a year now, why aren't you any better than this?". I get the feeling they think I am dragging this out. In reality, I wish it was like that and that I would just wake up tomorrow and be my old self.
     

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  8. YoungHippy

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    I was finally able to see a primary care physician last week. She diagnosed me with venous insufficiency in my op leg. Said there is nothing she can do for me other than have me wear compression stockings until I have an ulcer, at which point she will refer me to a specialist. She did not actually prescribe compression stockings, just suggested I pick up some knee highs from the wal-mart. I bought the Dr Scholls travel compression socks. I have been wearing them for 4 days now and can tell a big difference in the swelling in the lower part of my leg. My foot doesn't swell as bad, I can actually wear a full-length insole in both shoes without that side being too tight. Unfortunately, because they are only knee highs they do nothing for the thigh swelling. I noticed that wal-mart does sell the compression leggings, and may eventually try a pair of those, but leggings are not something I would wear every day.

    Has anyone else had this issue after their THR? Is this something that will work itself out in time as I get closer to normal? And if not how does one make it through a hot summer wearing these things? They are ok now as it is still cooler here, but I don't see these going over well with shorts in the summer time.
     
  9. Krista

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    How good it is that you have a diagnosis. I don't understand why you can't get the referral to a specialist, since you have negative symptoms now. But you have to wait to get an ulcer. Darn. Hope the swelling in your lower leg stays down, and that if you try the leggings that that will help your thigh swelling, too. Wishing you the best!
     
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  10. Jaycey

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    Let's tag @Josephine and see if she can give you any input on this problem.
     
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  11. YoungHippy

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    @Krista The lack of referral is because I am currently without insurance. My plan is to get through my round of dental work and then save up to go to the specialist on my own if things aren't looking better by then.

    Another interesting note: When I saw my PCP she started me on antibiotics for a sinus infection. After a week of being on those, my leg does not swell nearly as bad. Example: I have been up since 7am at my computer. It is close to 9am now. Usually, after sitting this long without my stocking with my feet down my whole foot would be swollen. I have a little swelling around the ankle, but nothing compared to what it was before.

    I will complete this round of antibiotics tomorrow, and then start another round on Saturday morning for the dental work. The dentist after seeing my medical history says he will not do anything more than x-rays on me without an antibiotic for atleast a year and possibly more. The plan is to convert my upper partial to a full set. But for right now that is on an "it needs to go basis". As in he is extracting 3 that are giving me problems, but wants me to be a little farther out from all of my surgical stuff before he does more. I'm not sure if that is the norm or not for after these surgeries, but I am good with playing it safe. It would really suck to finally have a pretty smile only to wind up with infection issues. Some of this work probably should have been part of my preop stuff. I am thinking it was because I wasn't able to walk at all that they didn't enforce the dental work ahead of time. My uncle had to be cleared by the dentist before he was able to get his hips done, as well as several other people I know.

    Also, currently looking for a new job. Found out that we are getting a major fitness chain in my town, that offers unlimited tanning as part of their 20$ membership. That will put the tanning salon I work at out of business. So, I am looking into other options to keep the salon open, like maybe learning how to do the spray tans since nowhere else in my town offers that, or offering other salon services. Offering other services would mean having another technician working with me, and I really like the fact that I work independently there, and having 2 techs would get confusing on who gets what commission. Does anyone have any good leads on work from home companies? I feel like that may end up being my best fit until I am moving better.
     
  12. Krista

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    @YoungHippy, it must be so scary, not having health insurance. Is there anything that can be done about that?

    Glad the swelling is going down. May you get through all the dental stuff without problems. I have bad teeth, and worry that things will really start to go south for me in that department at this point in my life.
     
  13. YoungHippy

    YoungHippy Member
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    @Krista Currently I can't do anything about the insurance thing. I am trying to straighten out some stuff from the ACA insurance as we speak. Hoping I can have all that fixed and reenroll this year during open enrollment. If we still have ACA by then :( It is scary not having it with all that is going on, but having a PCP makes me feel a little better.

    I apparently hit the genetic lottery on both teeth and hips. My teeth have been messed up for years, and the name of the game has always been "Oh, let's save the teeth". Well now I am about done with that game, and realize that life is too short to hurt. By all means, let's get them pulled and get me some dentures. The dentists have been putting that off for years because of my age. I finally told this one that I wanted to enjoy things again, like ice cream or a cold soda on a hot summer day, and I didn't want to wait anymore. Here's hoping for better luck for both of us, both hip and teeth wise :)
     
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  14. Krista

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    Yes, best of luck to you with the teeth and leg and job and insurance, @YoungHippy! I feel very fortunate already, and I got some good advice yesterday from my PT about what I can do to keep improving the strength in my surgical leg and lower back to get my gait where it should be.
     
  15. YoungHippy

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    Figured I would check in since yesterday was my anniversary. It is now 1 year and 1 day out from my RTHR. I have to say that I am not impressed. Mine was a complicated case and is still having a complicated recovery. I can walk, for which I am very thankful, but still have the lurch going on.

    I consulted with my surgeon at the beginning of march about the swelling in my leg. It had worried me as the swelling became almost nonexistent after a round of antibiotics for a sinus infection. He took fresh x-rays and said that everything looked good. That while at first the bone growth was slower than what he expected that now everything looked like he would expect in that department at 11 months out. He thinks that getting my vitamin D levels straightened out helped with that. (although since it has not been tested since the day of surgery I am not sure what the levels are now)

    On the swelling, he pretty much just said that it happens. That in his experience some people swell for a period of time after a THR and that in most cases the swelling just stops one day. He did recommend I get full-length compression stockings rather than just the knee highs recommended by my PCP. I have not done that yet, and don't know that I will at this point.

    I asked him again about the limp. Before when I asked this he said that it may always be present, but should get better. This time I specified that while the limp does not hurt in the hip area, it does make other parts of my body hurt, such as knees, feet, lower back etc. He pointed out that my hip was actually dislocated for 4 months, and that because of that the muscles had shortened, and that when he did the THR it stretched all those muscles back out, and that it was bound to take time to recover from that. Then he said with the extent of damage I suffered I may always have these problems. He went on to suggest that I get a cane and make some "lifestyle" changes. By lifestyle changes, he means get a job that does not require me being on my feet all day. Now what bothers me about this is A. my job is not a lifestyle change. Lifestyle change would be things like lose weight, quit smoking, exercise more.( Although, if I quit my job I most definitely would lose some weight on that no food diet. :heehee: ) B. He keeps referencing damage vaguely, but cannot seem to give me a specific answer as to what kind of damage. What exactly is still damaged that is causing me problems? Why can't we figure that out and fix the problems? The attitude seems to be that now that I am walking, however awkwardly, that his job is done. :skep:

    I did end up quitting part of my job, or getting fired, not sure which. :what: My boss owns a nail salon and a tanning salon. I work the tanning salon during the week, and used to work the nail salon on my days off. Found out that I could not handle 10 hours of continuous walking. My boss decided that by then end of the day I was not moving fast enough for her and replaced me with a younger girl who could move faster. She does still allow me to work at the tanning salon, which is a better fit for me anyway. I walk alot at the tanning salon cleaning the rooms and such, but I also get to sit a bit in between, and that makes all the difference. I am also in the process of creating an office at home where I can do home-bound customer service/tech support. One of my college professors transitioned into that once he could no longer work on campus. In his words, the pay really sucks but they have awesome health insurance. Maybe insurance will make doctors more interested in finding out why I am the way I am.

    Through my job I met a PA that works with a local orthopedics office, and he has taken an interest in my limp. He said from what he has seen in his office, no damage is really considered as being damage until after 18 months from the THR. He said that is the window when they stop thinking "body getting used to new hip", and start thinking "lets see what else is going on". Of course the hold up on actually being seen at this practice is lack of insurance. Hoping to be able to change that soon and figure out what is going on.

    On a kind of funny note though: the salon I work in is in the same strip mall with a grocery store, pharmacy, and a few other stores. I have the cart pushers from the grocery store trained to leave me a shopping cart for errands after work. They have learned that even if I walk in the store for one item that I am still getting a cart for help with walking. So most days about 20 minutes before closing time, one of the cart pushers will pop his head in and ask if I would like a cart left in front of the salon so I can shop after work. With that, I can do all my errands in the strip mall without worrying about being able to make it back to the truck at the end of the day.

    So, that is my year. Things are definitely better than they were a year ago, but still more progress to be made to get back to real life.
     
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  16. Jaycey

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    @YoungHippy Thanks for checking in and the update. I had the same experience with my left hip. The joint was collapsed for the whole 6 months I waited for surgery. Muscles atrophied quite a bit. Post LTHR I had major issues with my back due to walking differently. Physio and an osteopath helped me regain strength and ease the back issues. Can you get a referral to someone who can help you correct your gait issues?
     
  17. YoungHippy

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    @Jaycey I will be able to do that once I get some health insurance again. I was on the ACA insurance last year, but because I wasn't able to work until December I lost my subsidy that helped pay for that. This year I don't make enough money to qualify for ACA. I fall into that gap where the states were going to expand medicaid coverage to cover. Unfortunately, North Carolina opted out of expanding coverage. My current job doesn't offer any benefits. Hoping to get started working from home with a company that offers benefits. It may take a bit, but I will get there.
     
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  18. YoungHippy

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    Just wondering who else has to wear compression stockings on a regular basis and how do you handle this during the summer heat?

    I currently wear knee highs and have been recommended to upgrade to thigh high. My swelling is only in my right leg. I work in a tanning salon and it's usually close to 90 degrees inside. I have been wearing my knee highs with jeans to work in. It is just too flipping hot for all this. Any ideas? I have thought about just finding some really funky design and just wearing the one with some shorts. Think it would still be warm, but I guess one cool leg is better than none.

    Also, any good ideas on where to find some that are more cost effective? I was pricing some and they were like 63$ for a pair. Sure they were pretty and all, but I would have to wipe alot of other peoples sweat off these tanning beds to afford that.
     
  19. Jamie

    Jamie Administrator

    Member Since:
    Mar 24, 2008
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    @YoungHippy .... you may notice that I merged your latest thread with your original recovery thread. This is the place where you should post updates and ask questions about your recovery as it keeps all your information in one place. That makes it ever so much easier for us should we need to go back and review things. Plus you had posted in the pre-op forum which is not a good place at all to get responses for a question like this. You'll see I changed your thread title to reflect your latest question. Just post here if you decide you'd like a new title at some point.

    About the hose....I do remember seeing a website (although I can't recall the name of the site now). But type in "inexpensive leggings" into a Google search and you'll find plenty of places to look!
     
  20. YoungHippy

    YoungHippy Member
    Thread Starter

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    Mar 4, 2016
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    I had some type of episode night before last. I call it an episode for lack of a better word. I really don't know what that was, but I really don't want that to happen again.

    For a while now I have had this vague ache at the top of my incision. Not a constant ache, only when I make certain motions. Like sitting up from a lying or reclined position, reaching in certain directions while in a reclined position. You know how all those sleeping pill commercials show an annoyingly happy person that sits directly up and bed and smiles? Well, that person is so not me. Sitting up has actually become a quite painful experience. I used to be able to sit directly up from a lying position with no issues, up until the last surgery for my hip. After that, it was a little twinge at the top of my incision. I found that using my arms to support some of my upper body weight took the pressure off. Then once I was able to move that leg on my own again, either bending the leg or sliding it slightly to the side while using my arms to support helped the pressure. It's one of those things I have accepted as my new normal. It doesn't impact my sleep normally since I am a side or a belly sleeper.

    Well fast forward to this past weekend. I spent my days off trying to clear the clutter out of my house. I was pretty much living in an episode of hoarders from my time of not being able to do anything. I didn't do anything heavy duty, as in no real lifting. I did slide a chest of drawers from one side of the room to the other. It glides fairly easily on hard wood floors. I would work for a little while and sit back for a few minutes. I had the TV running as background noise, so during my breaks, I would sit back and watch for a few minutes. After one of these little breaks, I attempted to get up to do something else. When I went to sit up the ever present ache at the top of my incision flared to new levels. Neither helping with my arms or trying moving that leg helped. Normally this ache is a mild thing. This time it was like "oh holy mess this is bad". My leg also didn't move as effectively as it usually does. As in I thought I was moving my leg, but it wasn't doing anything. I managed to get in a fully upright position on the side of my bed and the pain stopped. So I thought it was over. Then I stood up and tried to walk. Weight bearing was extremely painful on that side. I haven't had to use any walking aids in months, but at that moment I wished for my walker. I managed to get moving using the furniture in my room and doorways as I walked. After a few feet, I was able to move as gracefully as I ever do these days. (which is about as gracefully as a drunken monkey) The ache lost its sharpness after a few steps but was still there.

    All day yesterday I didn't have any out of the normal problems. I still couldn't sit up from a lying position without using my arms to push up, and still can't reach to my left while reclining without a sharp pain, but that is pretty much normal for me. What isn't normal is the constant low-grade ache while sitting and walking. It's like you stub your toe on something and it aches for a little while after, that's how my hip was yesterday and on into this morning. It doesn't even hurt bad enough to slow me from my normal activities. I still went to work and ran errands before and after. But that brief period of painful weight bearing was enough to scare the heck out of me.

    I did call my surgeons office yesterday and left a message with his nurse. But she warned that he was in surgery and I wasn't an emergency I was unlikely to hear anything for a couple of days. Not that I am expecting much out of him at this point.

    Does anyone have any ideas on what could be going on?
     

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