THR Dorothy's 2nd hip recovery, June 22, 2012

[sharonslp]

Dorothy, you're sounding delightful!! I love it that you're approaching the annoyances at work with a different perspective. I remember how irritated my colleagues used to get at staff meetings...public education is full of idiocy!....I learned early on to view the meetings the same way I viewed television....as entertainment. Which administrator will say something stupid today? Tune in at 4pm for the latest blow-up between the 7th grade team leaders. Who will the wacky science teacher cuss out this time? Seriously....you can't make this stuff up!

Sharon

 

[Anniepops]

Hi Dorothy, I'm so pleased things are going in the right direction for you, as long as it's an improvement, no matter how small, that's a good thing

Interesting about the different rollers Cardie, I too didn't realise there were different densitys. Mine is a darkish blue one and very hard. It was the only one in the shop so no choice for me but it does seem to be the same as the one my PT had me use.

I was at the hardware store recently and seen the grey foam pipe thingies for lagging pipes.....I think, not very 'up' on DIY stuff.lol. And I said to hubby I could have just bought a length of that for my rolling, it was a lot cheaper than my roller but it wasn't as hard.Anyway, I am very pleased I bought one, it comes in handy for hubby and the boys too when they have sports injuries so well worth having.

Take care Dorothy, hope things continue to improve for you

Onwards and upwards

Ann.x.

 

[rider1960]

Sharon--TOO funny!! I love the way you wrote that--it had me laughing Problem is, I will probably fight to keep from laughing during my next meeting.

Annie--Thanks for the pipe thing suggestion. I'll have to check that out.

Dorothy

 

[Poppet]

What time is dinner Dorothy? .... Mmmmm! Sounds yummy.

So pleased you are slowly seeing progress and very glad that your pt understands and is gentle..

I had to smile about the animals, we do exactly the same thing as humans, most of us dislike the cold and look for comfort food?

Love the 'don't sweat the small stuff' at work.. THR does change us.. For the better I am sure, just takes a little longer now to work out
the new 'us'...

Hugs xx

 

[rider1960]

Poppet--dinner was yummy!!!! Wish I could have sent some to Oz.

Thanks for check in on me You are so sweet and caring.

Dorothy

 

[Poppet]

Hi Dorothy

Had such a craving this week...

 

[C Mac]

Hi Dorothy,

It's good to hear that the myofascial work is helping!! It is a great modality, and with that and continued time for your body to heal and adapt to your newest hip I hope you will be feeling much better as we roll into and out of the winter months. Flexors and adductors are common areas to have issues after THR, even without the "help" of overzealous PT....

I am glad that you are working on focusing on your own body and it's adaptation and getting past the feelings towards the hospital experience. I, too, have trouble with letting go of things sometimes but the passage of time does help with that as well

You can probably find rollers of all sorts of densities in a sporting goods store as well as Target and other types of department stores that have fitness/yoga related clothing and supplies. I got my roller at Kmart. One of the "core" exercises that I learned in PT was with the long foam roller and it might be something you could ask about for your back. It looks like this -- only keep BOTH feet on the ground.

As you rest upon the roller you bring your extended arms slowly over to the left of center, then back to center, to the right of center and back to center. During this movement you are keeping your tummy tight and staying in place on the roller. I also did the same movement bringing my hands towards the top of my head and back down to the center.


Hope you are having a good weekend and just, also, want to remind you that your new hip is ONLY a little over 4 months old -- still a whole lot of healing and adapting going on. Do give yourself permission to take it easy and factor in those rest periods that are so helpful in continuing to make progress. Don't mean to nag..... you are doing great, you just put a lot of pressure on yourself.

Take care,
Cardie

 

[rider1960]

Cardie, there is truth in what you say ... but ... but ... I hear of SO many other people here talking about having no pain after just a couple of months and being off pain medications even after just a couple of weeks, walking a couple of miles a day after just a 2 months or so, etc. Many people sound near normal within just 2 to 3 months. That's even faster than I was with my first hip, and I thought that went well. So, I know I'm in the minority.

If I walk even 1/2 mile two days in a row, I'm VERY sore in the hip adductors for the next couple of days ... and that's with still taking Percocet a couple of times a day and Naprosyn every day. I do think I'm lagging well behind the majority here. I'm not trying to keep up with the Jones's, but I do use others' experiences as a guide for my own.

I do think I'm in considerably more pain day to day than most others here. I have good strength and coordination in the hip/leg just because I've pushed along best I can, but my adductor muscles, particularly the adductor longus, are still like a thick extremely tight rope and moving my leg around can feel like a knife is cutting through that area. Ouch!

I was probably 85% back to normal at the 6 month point with the first hip ... and that was even with being extremely weak all over by the time I had that hip replaced. I'll get there eventually with the 2nd hip, but it's been a very long haul with the adductor muscles that were injured especially.

Thanks for the info and picture of the foam roller exercise. I definitely need to get a softer roller with more give. I get bruises so easily with my current roller. I made a huge one on the inside of my thigh (about 6 inches in diameter). My PT commented on it, and I teased him, telling him I was going to tell everyone that he beat me up in therapy, lol.

Well, I'm off to have a pre-Thanksgiving turkey dinner at a diner that we frequent often. Yumm!

Gorgeous weather here. Hope everyone is doing well and enjoying their day.

Dorothy

 

[VThereandnow]

Hey pal, finally getting back to the forum. If I am correct after reading back a bit on your thread, though you remain positive as always, it sounds like a bit of a mixed bag - am I correct? ...and so it goes right? All we can do is keep trucking along, trying things, trying to be gentle with ourselves (which is one of the biggest tasks, at least for me). You talked about trying not to compare and OH don't I know that one haha. In fact when I was visiting my mom I saw a 7 month update from someone and immediately was comparing (though I know it does no good). For me dealing with the early darkness is a bit of an emotional adjustment also.

So just a quick note as I do a Check in on everyone. Amazing how a bit of a time off ( and it seems my notifications were not working for a bit) gets me soo behind on the site. I'll post an update soon, right now I am sick of "me" and want to hear about others . Cathy

 

[rider1960]

Hi Cathy, I have to admit that I was definitely doing some of the comparing myself with others in my last post. (bad me!!) A little bit of "woe is me!" was going on. I'm over that now and back to "I wish I were further along ... but I'm not, so I need to just keep moving at whatever pace I can." I think that is the healthier way to live, for sure. It does get pretty frustrating though, as I'm sure you know.

I saw the back clinic people yesterday and we discussed possible options for my back other than medications. We decided on trying a radiofrequency ablation of the SI joint. I don't know of anyone who has had it at this joint, but I do know of two people where I work who have had it done for neck pain and headaches stemming from a head and neck injury, and they are doing very well. One woman has had it done several times through the years, and it usually lasts a year or two before the nerves regenerate. I read about it more on the internet after I got back from the appointment, and I still don't know if it's the right thing to do, but I have to do something and it might as well be that, I guess. A regular SI joint injection didn't help me that much after the local wore off. The PT thinks most of my back pain is coming from the right SI joint, with piriformis to a lesser degree. It's only on the right--been that way for about 4 years, with increase in pain after the rioght/2nd hip surgery--probably because of all the manipulation, altered gait in early recovery, and the too aggressive post op PT. I'm glad they are willing to do something about it to relieve the pain other than prescribe medications.

Oh, BTW, some info for people who are worried about narcotic pain medication addiction: I had a long talk with the nurse practitioner about that yesterday. I have taken Percocet/oxycodone pretty much every day ranging from 1 pill, to a lot around the time of the hip surgeries for at least a year. I get concerned about drug dependence, of course, like everyone else. She wasn't concerned at all. She said there is the possibility that my body can get dependent on it but if that happens, they can give me something like Valium, Klonopin, Ativan, etc. to deal with the withdrawl symptoms and they have very good success with getting people off them. And, then they switch people over to something else if they continue to need chronic narcotic pain medication. This is a large pain/back clinic with about 10 doctors and 30 NP/PA's and they've probably seen it all as far as pain medication management. So, I hope this eases fears others may have. Her advice is TAKE THE MEDICATION SO YOU CAN KEEP MOVING; IF YOU DON'T AND THE PAIN KEEPS YOU INACTIVE--THAT IS MUCH WORSE. Just an FYI.

I continue to go to my PT, who is doing some good manual work on my muscles and tendons messed up after hip 2. I highly recommend this work for anyone after surgery. He does at least 30 minutes of hands on work with me--usually more like 45 minutes--split between my hip flexors/adductors and my back. He's been a wealth of information too because he is so used to feeling around there to know what parts are worse than others and how things are progressing. It's different from the PTs who do a quick exam here and there and very little soft tissue work.

Gorgeous and sunny here today ... but chilly. Well, it's November in upstate NY, so that is to be expected. At least it's not cloudy, as it is for much of the winter months.

Dorothy

 

[C Mac]

Hi Dorothy,

I hope you are doing well and still getting some benefit from the PTs massage work on your flexors and adductors.

On the SI joint, I don't remember if I mentioned this little exchange I had with the pain management doc that I saw a few months back. I, also, have a spot on my right SI joint that is sore and swollen and has been so since I returned home from my surgery. The Doc expressed that when we have a THR surgery it does change the alignment of the pelvis and most of that change manifests at the SI joint because that is where the bones of the pelvis come together (also the pubis symphis in the front of the pelvis, the other spot the bones come together). His example was that if we went out on the street and give a bunch of "normal" people a small heal cookie to wear in their shoes for a few weeks they would all (or most) come back and complain of SI joint pain. So, I guess I wonder if your team is also looking at the muscles of your low back and pelvis -- maybe checking how your spine and pelvis line up on a standing x-ray, evaluating for pelvic tilt or LLD issues?

I realize that you've been coping with SI and back issues for years before the hip replacements, just wondering if now that you've had the two replacements they have introduced changes that your body is trying to adapt to as best it can. Maybe with more time to continue to work the soft tissues and experiment with different movements, exercises and activities there will be improvement. I hope there will be improvement!! I have seen some in my case, it has been a slow slog...

Lastly, I have a family member that had the radio frequency ablation of a nerve somewhere in his lower back. He reported that it lasted for about 3 years. He saw a doc at Fletcher Allen Hospital in Burlington, VT and is now working with a Dr. Charles Argoff at Albany Medical.

That's all, don't mean to be a cyber nag just trying to share something that might be helpful in some way.
Have a nice weekend,
Cardie

 

[rider1960]

Oh Dear Cardie, you are no where near a "cyber nag". I appreciate every bit of information and advice you give me

I think you are right about the SI joint getting worse after the second surgery because of all the changes that take place with a hip replacement. I also think the rough post op hospital PT I had threw it out of whack and got it more inflamed. I suffered some pretty extensive damage to my body because of those 2 days in the hospital. I probably would have been better off if I had left the morning after surgery before they had a chance to screw me up!!! I felt fine until PT got ahold of me.

My leg lengths are very near the same. The PT I'm currently working with thinks the right is slightly longer to the eye than the left, but it's so insignificant that it isn't measureable. I had a pelvic tilt for a month or so after surgery that made my right leg feel longer, but that went away some time ago, and I've walked and stood pretty straight since then. My pubic symphysis is fine and lined up in my xrays.

I do think the chronic inflammation that I've had in the right side SI for years, combined with the surgery and the post op PT from "you know where" has made it much worse. I also notice I walk in a guarded manner because of the muscle and tendon injuries I suffered. That has to put a strain on things some as well.

The good news is that I had an adductor longus corticosteroid injection Monday 11/19 and it's helping a lot. I think that's the biggest offender. I had my first post injection PT session this morning and he said a lot of it feels much better to him since pre-injection. I still have significantly inflamed areas throughout the hip adductors and flexors (they really suffered a hit with that awful PT I had), and I'll likely have to have another injection done in a month in the same muscle or another muscle. My surgeon can only pump so much steroid into me at one time and has to space them out. But, I would say I feel 50% better since the injection has started to work--significant difference just over the course of days. Celebration time, for sure!!! But, I've been warned by both the surgeon and the PT to really go easy for the first couple of weeks to let the steroid settle in and do its work and don't get it flared back up again by thinking I can go out and conquer the world just because some of my pain is gone.

I also had a "come to Jesus" talk with my surgeon about the hospital PT, what they did to me, what I've heard from other patients, and my wanting something changed to prevent this from happening to others. It's clear to me that the hospital PTs don't have the professional judgment to know when it is safe to push people and when to back off. They just push even when people are struggling and in pain, and don't seem to get it. The people like me who hunker down and do it regardless of the pain may get injured; others that are smart enough to say no still get pressured "oh come on, you can do it--try harder" and stuff like that--a good friend of mine recently revealed to me that she remembers their pressuring her to do an exercise that was severely painful and she had to basically tell them to leave her alone, and she was in tears over it. But, she never told anyone about it--"I just thought I was a wimp."

I don't know what is going to come out of this, but I did get reassurance from my surgeon that he has informed them of my situation and has been asking patients about their experience since my hospital stay. Some patients are saying they thought it was too much, but they aren't giving him the details I'm hearing, heard while I was there, or read on an internet blog from a patient who went through her own bad time in PT there a couple of months after I did. I told him I doubted anyone was going to complain as loudly as I have (although he did say there has been one other patient with similar complaints since the time of my last hip). He's a nice guy and he naively thinks patients will tell him if they have any concerns or complaints, but many people just don't like to complain--The PTs and physicians are elevated to god-like status by many people. Some patients have told him they didn't have a problem with the exercises--if they can do it without a problem, fine. But, the exercise program is so intense and the therapists who are so pushy that I believe it's another accident waiting to happen.

I never had anything like this happen after my first hip replacement at a neighboring hospital. No one was suffering through the exercises any more than what would be expected after a procedure of this magnitude. I always looked forward to my PT so I could see what my new hip/leg could do. I had obtained a written copy of my first hospital's post op PT protocol and my surgeon made a copy of it and is going to forward it over to the joint replacement program folks at the second hospital.

I know I got him thinking, and I wouldn't be surprised if he makes some significant changes for his own patients, even if the other docs decide to stick with the way they are doing things at hospital number 2. I've pretty much told him like it is, but many patients won't discuss things like this as openly and honestly with their doctors. He's a very nice, approachable surgeon, but many people still view physicians as gods and don't want to speak their mind. I was pleased with our talk overall, though, because he assured me he will do everything he can to get my problems resolved and is taking it very seriously. He's also very kind and caring and listens to everything I say without acting like I'm a PIA. I can see and feel genuine "I'm so sorry you are going through this." coming from him.

I'm also going to increase PT to 3x week, rather than 2x. I'm digging out of the financial hole I got into when hip number two caused me to be out of work longer than expected and need more PT and doctor's visits than I had planned, so I think I can afford to pay for an additional weekly PT visit. And, they told me today that they will continue to treat me after my insurance cuts off payment for just my co-pay--very kind and generous of them. My insurance loves to cut people off PT, so that was a real relief to me. I don't think this will be a quick fix, but I like the hands on stuff my new PT is doing and I think he is the right man for the job to get me up and running, if anyone can. I liked the last PT I worked with too, but this new guy does hands on work that the other one didn't, and that's what I need now.

Dorothy

 

[Poppet]

Hi Dorothy

The good news is that I had an adductor longus corticosteroid injection Monday 11/19 and it's helping a lot. I think that's the biggest offender. I had my first post injection PT session this morning and he said a lot of it feels much better to him since pre-injection. I still have significantly inflamed areas throughout the hip adductors and flexors (they really suffered a hit with that awful PT I had), and I'll likely have to have another injection done in a month in the same muscle or another muscle. My surgeon can only pump so much steroid into me at one time and has to space them out. But, I would say I feel 50% better since the injection has started to work--significant difference just over the course of days. Celebration time, for sure!!!
I am so happy for you Dorothy... about time honey...

 

[VThereandnow]

Hey there,
I am so glad the injection is helping some. Ack, besides everything else for me, the SI joint is the worst so I hear you on that one sister. Really glad you will be able to continue with PT and that they made $ arrangements, very nice. 50% better? That sure is something to celebrate Let's hope the PT moves you well beyond that soon. Glad to hear some good news, Cathy

 

[rider1960]

Thanks Cathy and Poppet. I really appreciate your support.

So far, I'm still feeling pretty good after the last injection. I've been able to back off on the Percocet some, but I'm aware my body might be dependent on it, so I'm tapering it slowly ... while giving myself permission to continue to take what I need to stay comfortable. I'm not playing a hero.

I'm also pleased that since I had the talk with my surgeon about the hospital PT, I don't feel as angry about that topic. I had discussed it with him briefly before, but this time I said everything I wanted to say, the way I wanted to say it. It was kind of funny looking back on that discussion. I was on the table all prepped for my injection when he walked into the room. In his usual "let's get down to business style" he came over to me with the syringe, and I said "Wait! We need to talk." And, then I let 'er rip (nicely, but very firmly).

I may be coming to a place where I can let go of it and move on. I wrote email to my surgeon yesterday saying that I certainly welcome a chance to discuss this further with the hospital people, but if they contact me, they do ... if they don't, they don't. It's not worth continuing to put so much energy into this fight. I did tell him that even if I never bring this up again, my feelings about what they do over there will never change--it's still a bad program and it's an injury waiting to happen. I'm just not going to discuss it any more. It feels good--probably a form of a grieving process I had to get through--grieving the loss of the opportunity to have an easy hip replacement recovery for hip number 2.

I also have to be sure to thank PT Mike when I see him on Tuesday. He has been so instrumental in helping to identify the most problematic areas. Everything has felt like one big mass of pain and it's been difficult to separate it out. He's really good, but it took him 2 weeks of working with me to be able to determine the back was primarily the SI and the adductor longus was the primary hip muscle problem. SO many things are sore and inflamed. I'm very grateful to him. He's really a great PT and knows his stuff. His wife also has horses, so I get to talk "horse" with him while he is working on me--an extra plus ... well, at least a plus for me who loves to talk horse ... him?? ... well he's just the husband being dragged along on his wife's horse crazy life adventure

Cold here in NY state. We have a little dusting of snow. I guess winter is really here. It's OK though. I'm kind of liking having nothing better to do than relax and hunker down in the house. So other than going out to take care of the horses I've been being pretty lazy this weekend. And, I have another excuse--I was told by the surgeon and the PT to take is very easy for 2 weeks post injection. I think I have a pretty good game plan of excuses, don't I???

Dorothy

 

[dianemarie]

Hi Dorothy,

You sound like you are really doing well and in a good place regarding the PT at the hospital. We may never know why we had to go through certain things but look at the bright side. We got to meet each other and many other wonderful people on the forum. And thank goodness we've had both hips completed so won't have to go down that road again.

Cold and snowy here also, we had the wonderful lake effect yesterday and got a few inches of snow. it is pretty but darn, it always brings cold along with it. So glad you have a wonderful PT, wish I could find one like that around here. Maybe will check things out and possibly I can.

Take care, talk soon.

 

[rider1960]

Thanks Diane. PTs vary (check out my comparisons on Cathy's thread if you want to know what I've experienced along the way). Some times you have to try a few to find what really works for your particular situation.

Dorothy

 

[C Mac]

Hi Dorothy,
I hope you are doing well and still finding benefit from the PT.
Hope the farm & animals are all ready for the winter months -- and you too of course!
Take care,
Cardie

 

[rider1960]

Hi everyone! Thought I would just give a quick update (although ... are any of my updates really "quick"????? lol lol)

The first hip (left) 1 year anniversary is coming up soon, and that couldn't be better. The hip and leg feel wonderful, have great strength, etc etc. It is my "super hip"!! I love it so much It can do anything and does it well.

The second hip (right) replaced in June has some problems. The hip joint/prosthesis itself seems fine and feels fine. The soft tissue/muscle/tendon injuries that I suffered in physical therapy post op at the hospital still affect me. I've had a bunch of testing and treatment--testing for infection in the joint, EMG/nerve conduction studies to rule out nerve impingement, injections into the offending muscle and around the tendon, lots of PT iwth a focus on massage and trigger point release, and a few acupuncture treatments until my spare money ran out. I have tried about every conservative measure I and anyone else working with me can think of. Amazingly, the hospital and even my surgeon still have a hard time admitting that this problem is the result of too aggressive PT while I was there (rolling my eyes in disgust). I have tried to make them see the light, but it's clear I'm not getting anywhere with that, so I've had to just accept the fact that those responsible are never going to admit their fault and take any responsibility and let it go--that ship has sailed as far as it can go. And, as much as I love my surgeon in general, even he doesn't seem to be able to totally accept that this is what caused the injury and spent a lot of time ruling out other things like the infection and nerve damage. I think he just has a hard time wrapping his head around the fact that this could have been done by exercises days one and two post op. He definitely agrees something is wrong and needs further investigation and/or treatment--he's not doubting that I'm in pain. I guess that will have to be good enough.

My surgeon has done a bunch of things, and says it's getting out of his area of expertise. He is referring me to a sports medicine specialist in the practice--he finally believes it's a muscle/tendon problem. I also have scheduled an appointment with another sports medicine doc in another practice associated with a teaching hospital. Both docs are very experienced and well respected, so it will be interesting to get their assessment and recommendation and compare notes.

My surgeon thinks I may be headed for a adductor longus (muscle on the inside of the upper thigh) surgical tendon release where they cut the tendon to release the tension on the muscle, and therefore relieve the pain, since it just won't calm down any other way. The rectus femoris muscle more towards the front, a hip flexor, is also sore, but not as bad as the adductor longus. Although he is willing and able do the surgery, he's a hip surgeon is not a muscle/tendon injury expert (he's a hip specialist and says he's never run into this problem in his many years of doing hip replacements), so he wants input from the guys specializing in this area. I think that's a good idea because I (and my hip surgeon too) don't want to undergo any more surgery unless we are sure it's the best thing to do.

The muscles are still weaker on the second hip side because I haven't been able to exercise them much because of the adductor and hip flexor muscle/tendon pain. That's very frustrating because I think the hip could handle regular exercise if it weren't for that. It feels like a knife with sandpaper wrapped around it stabbing me in the upper groin, with additional pain spreading a few inches down the muscle when I raise the leg to dress, get in and out of my pickup truck, pretty much anything that requires those two muscles to work. I can walk short distances (only 500 feet tops) without the pain increasing too much, but I'm still taking Percocet 2-3 times a day depending on the pain and max doses of anti-inflammatories to even be able to do that and general day to day life activities. I've been dealing with this so long that I've learned what makes the pain worse, so I have adapted some of the ways I do things to keep the pain from getting worse.

My back also didn't like the last hip surgery either. I had pre-existing back problems on that side, and they are worse now, either from the manipulation done during surgery or the weird way I walk and "guard" the leg from pain. Probably both. I've been in treatment for that too with my back/pain management clinic giving injections, and the PT is also working on that. The SI (sacroiliac) joint appears to be the primary culprit and I'm pursuing a radiofrequency neve ablation procedure that will basically fry the nerves in the area so they won't transmit pain signals. It's temporary, but it's a long temporary--could be 6 months to a year of relief, which sounds pretty good at this point.

As far as my life, I'm still consumed by my horses, dogs, and cats, lol. I'm able to take care of the horses, but I'm careful how I do things and I get help with the heavy work. I wish I could take my dogs for a walk, but that's just not going to happen. I have a large fenced yard and we play ball and Mike takes them for walks on the weekends, so they are doing OK. I keep praying that I can ride my horse and hike with my dogs in the near future. I also design and make jewelry as a hobby and small home business. I've been recently getting back into that more and I really enjoy it.

I try to keep positive about the complication I'm having, but I have to admit it gets very difficult. I'm almost 7 months post op and still have severe pain that I didn't have before the surgery. I do have high hopes that the sports medicine docs will have more to offer and I'm looking forward to their input and plan of treatment. At this point, I think I've tried every conservative treatment I can, so I really do think surgery is the only remaining option. I'll do whatever it takes to get up and literally running again.

Overall, I'm very grateful to have the gift of new hips. My way of looking at it is that my soft tissue problems can be repaired, but my hip arthritis was only getting worse and worse as time went on. I only wish I hadn't let them push me so hard in PT. I tell everyone DON'T LET THEM PUSH YOU--if it feels like your leg is being ripped off, then it's too much. Unfortunately, I was too out of it to have the good judgment to "just say no", and they didn't have the professional judgment not to do it. I hope my situation can help others avoid this problem in the future.

Dorothy

 

[Jaycey]

Hi Dorothy! Thanks for the update but I am SO sorry you are still struggling with that hip ! Sounds like you are exploring all the options though. And well done that you are still getting on with life despite all this. Please do keep us updated!