THR June 7, 2012

[Poppet]

Oh Linda, a shoulder issue now, I do hope that the PT can sort that out for you... Amazing these bodies of ours, we get bit by bit fixed and then something else shows up.

I wish you a quick resolution with your shoulder so that you can keep going with the wonderful progress you have made thus far

 

[Lgastreich]

I'm in the midst of my longest day back at work so far. I'm a pastor and we have two worship services on Sunday mornings and one in the evening. When I finished this morning, I told my husband I wasn't sure I could make it back tonight, but after a long nap, I feel so much better and know I will be okay. There were a couple of awkward-for-me moments this morning. The senior pastor closed the sermons with an invitation for people to come forward and kneel for prayer. The plan was that the pastors would move among the people, laying a hand on their shoulders and praying with them. These were beautiful and holy moments. But in the midst of the holiness, I realized that several people on "my" side of the chancel were not kneeling with straight backs but were more bent over--some very close to the floor. I couldn't think of a grace-filled way to nudge them and ask them to sit up, so I leaned into it and bent down--waaay past 90 degrees--and shared the moment with them. No problems--no pain and no one the wiser. My daughter told me later she wanted to come up and tap people on the shoulder and ask them to change positions. The same is likely to happen tonight, but we will probably have a third pastor with us. I think I'll ask him to keep an eye on the "crumplers" and I'll look for the straight-backed kneelers. No matter--it will be a good evening and I'm looking forward to it.

 

[tashia]

You are doing great. I would like to see you back up a little. I was pushed with my first knee and ended up paying a price. I know its good to feel out of pain and get back to all the things you miss but please do it slowly. If you go around and read many posts you will hear the same be careful. Riding a horse, how great. Its been years since I have ridden and hearing everyone talking about it brings such good memories. Now my PT was very unhappy when I mentioned I wanted to get back to horse riding. I also know I still needed more operations when I mentioned it before. Now I have both knees done and one hip so maybe I am getting there. Please keep us posted. You are doing so great but do take care. Tashia

 

[Lgastreich]

Thank you for the words of caution, tashia. I'm trying to monitor my energy--plan my days--and coming home before I reach the fatigue barrier. So far, so good. No horseback riding for me, though. Some other lucky folks on the forum have horses in their lives, though. I'm looking forward to getting back on my bike, but that's at least a few weeks off. I won't do it until I feel stable.

 

[Elle11]

Hey there Linda,

Thank you for expalinign what your PT does, as we don't have PT here.

How is your shoulder getting along?

That is fantastic that you were able to do your ministry at two services, wow! Interesting about the kneeling scenario with bent over backs. I am glad that when you went down to put your hand on people's shoulder, you did not hurt anything. Did you see the "golfer's reach" for picking things off floor? That might work in this situation as well.

Warm regards,
Elle

 

[VThereandnow]

Still sounds like you are doing great Linda, just be careful pushing past that 90 degree ting too much, you don't want to have some crazy event in the middle of your service. I can tell you are itching for that bike, but you are better off waiting till you are comfortable. , cathy

 

[Lgastreich]

elle Didn't think of the golfer's stance. It would have been helpful. But I was grateful that I was able to respond and didn't have any problems after. My surgeon is releasing me from my restrictions later this week--at the six-week mark. However, while that may mean I'm allowed to tie my own shoes, that doesn't mean that I will be able to tie my own shoes! Small steps continue. My shoulder responded well to the first few days of PT. The therapist suspects a bone spur, but without x-rays or more investigation, who knows? If it continues to respond to treatment, I'll be pleased. VThereandnow, I will indeed wait until the time is right to get on my bike. I'm trying to remain aware of what my body is telling me. In PT today, I was given a much more challenging exercise than I've experienced so far. When I told the therapist it was pushing me more than I was ready, he was quick to back down the number of reps. Wishing continued improvement for everyone on the site...Linda

 

[VThereandnow]

Good for you on letting your therapist know what feels right. Too many times I read on the thread a therapist giving someone more than they feel ready for and then they have have a setback. ...and you are obviously not someone who is going to shy away from excercise

 

[Lgastreich]

In another thread, VThereandnow said, "Yes, when fatigue sets in, it is suprising sometimes. I always thought of it, especially early on, as my body getting ready for another burst of something good." The words are helpful today. Especially the suggestion that the fatigue could be an indication of something good to come. I'm not surprised that the past few days have been tough--over and again I've read the mantra, "Two steps forward and one step back." I've been tired and experiencing a bit of pain that reminds me of early days of recovery. Because of this forum, I'm not worried. I sort of expected something like this would happen as I ramped up my work schedule and PT. Yesterday in the midst of a necessarily long day, I was able to phone a friend who lives near my office and crash at her home for a bit. After a nap, I felt sooo much better and was able to get through the evening responsibilities without any problem. Today is a writing day, so I can spend nearly the entire close to home. I haven't walked outside in a few days because of the pain and the heat. But I think I'll be able to get to the pool later on for some water-walking and more relaxing. Thanks again for the forum. It helps me keep things sorted out.

 

[VThereandnow]

How very wise of you to call a friend and take a rest. It really is true our bodies are doing so much healing early on that they need more rest than we realize. Glad you are taking care of yourself. You seem to have been doing a lot, so rest is ultra imp for you to get so the body has time to do what it needs to do.

 

[Lgastreich]

I meant to ask my surgeon or the PA, but forgot. Josephine, were any muscles cut in this surgery? I know that may seem obvious, but I've been told both "yes" and "no" by a physical therapist and a chiropractor. I had posterior approach, uncemented, and a Smith & Nephew device if that makes any difference. Just curious! Thanks.

 

[Elle11]

Hi there Linda,
You sound liek you are doing so well!! Amazing that you are off all restrictions already-YAY! Little by little, you will be able to get down there to your shoe. This is another example how each surgeon's advice is so different. Mine said "3 months" beore restrictions lifted, altough he alos indicated this is more a precaution becaus ethe sixe of the new femur is pretty large.
I also wanted to to know EXACTLY what muscles was cut etc. and although I think it might be different for each surgeon, this was the general bit I found (from this site) for posterior:

The piriformis muscle and the short external rotators (tendons) are taken off the femur. All of this gives the surgeon excellent access to the acetabulum and preserves the gluteus medius and gluteus minimus muscles (which are responsible for hip abduction – when the leg moves outward).​

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Sorry I am did not cite the exact source (I would have a hissyfit my students if they did this!!!)​

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So, anyways, it does not look like anything was cut, just moved a bit. Tht still sound OUCH! Now the interesting thing is the connection of the piriformis with the sciatic nerve. I would do some looking up of this on line, becasue it is so interesting. (I was glued to my yoga anatomy book on this very topic all morning!)​

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I know you are a spiritual person, Linda. Doesn't this whole body mechanism bit just wow you out? I've been in tears a few times to think how marvelous we are and feel so uplifted my the gradeur of anatomy.​

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Oh...if you want to tag someone you have to do the @ followed by their user name and THEN a semi-colon. I was forgetting the semicolon until Sandy showed me what to do. EXAMPLE, I'll do you now: @ + Lgastreich + ;​

Lgastreich; ​

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Have a beautiful Sunday service! ​

Warmest, Elle​

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War​

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[Jamie]

This link has a description of the various approaches that may help you understand what was done in your surgery:

Surgical approaches

 

[VThereandnow]

When I talked to my doc he said he cut the piriformus and did a cross cut in the middle if the iliofemoral ligament. Cathy

 

[Lgastreich]

Thanks, everyone. When I look at Jo's lovely graphics, I want to say I had the antero-lateral approach, but the surgeon said it would be posterior. (How has that table not been featured as an instrument of torture in a James Bond movie?) I guess I need to ask the surgeon, if I want to know for sure. I've strained a hip flexor and when the PT was explaining what likely happened, he mentioned muscle being cut. The chiro who referred me to the OS said they would separate, rather than cut muscles and now I'm just curious. Yes, Elle, I am in awe of how our bodies are put together and how they function. Psalm 139:14 describes us as "being fearfully and wonderfully made," words that have come to mind many times as I've considered this process.

I'm preaching for the first time post-surgery this morning. Kind of excited. A little nervous. It will mean a bit more standing and a bit more of "being on" for the three services. There's a several hour break between the morning and evening times, so I'll have time to rest up this afternoon. Peace to all of you--LInda

 

[Josephine]

You need to remember that incisions aren't mechanical engineering! The descriptions in that article are just general ideas of how a certain incision will look. Surgeons each have their own versions which even then invariably are adapted to the patient's anatomy and that particular procedure's needs. And though he might prefer and antero-lateral or a posterio-lateral, when you take three patients of his, each varies quite a bit for no particular reason other than that was where he made the cut! See? (No I don't either but I promise you it's a fact!)

So about this business of cutting muscles, the same things apply. One surgeon will do it different to another and one surgeon will do it differently from one patient to another. As for the position of your wound, it's a bit like the sailor's compass - you know, direction might be south, south-south-west, south-west-west or south west! Get my 'drift'?

So when a surgeon is doing any surgery, things are rarely exactly the same every time.​

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As for muscles being cut - well this is a bit of an issue too. Obviously if you are having surgery, things have to be cut else how is the surgeon going to get to where he needs to be? But the surgery definitions of cut and divided, split and opened up often escape the general public. They are fine degrees of the same thing ranging from using a scalpel to cut skin to teasing apart two muscle bodies to go in between them to get to the other side! Fact is, once the skin and superficial layers are cut open, the rest is by what we call blunt dissection, meaning we tease the muscles apart in the line of their natural separation. You can see this for yourself next time you cook a chicken. When you get into the carcase, you find that different muscle bodies have separated themselves from adjacent ones and you can almost pick them apart with your fingers! Surgeons use these natural pathways between muscles to get to the deeper places so there is no cutting done in this situation.​

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As for dividing (or cutting) structures like the piriformis, they can be divided and when they are, we usually we put a stitch in the distal end with a long thread and a clamp on the end so we can locate it easily and repair it at the end of the procedure. But for many years, I never saw a surgeon do this. It's convenient for a surgeon to do it in the posterior approach but not essential. If he's always been accustomed to doing it, then he might find it very difficult to dislocate the hip. But surgeons who preserve the piriformis manage so why can't they? Who knows? It's surgeon's preference again - some do, some don't. I doubt many of them feel obliged to explain their choices to their patients! ​

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Hope this all helps.​

 

[Lgastreich]

Thanks, Jo. I sincerely appreciate the information. I'm finding it helpful to know as much as I can take in about what has happened and is going on internally. It helps me gather my patience for healing. I also look at the diagrams and have any more appreciation for the people like you who have taken the time to learn the details of our how our bodies work--not something I would have ever been able to do. So again, thank you.

 

[thegiftlady]

Hi Lgastreich,
You are too funny. Go get those slouchers! They will all look like angels in no time. But remember, you are still in early recoup, and God knows and will totally understand if a of your angels are a little crooked, so long as their songs and words are in his spirit .

Glad you discovered the Golfer's Reach. It was, and continues to be my savior. We are conditioned to think we have to bend forward at the knee and squat to pick up, tie, etc. I learned with my THR that bending at the waist/bad leg straight back is not only perfect for hip recoup, it's better for your back. I use it now all the time to avoid a reoccurance of sciatica/ to avoid other back issues.

Tying Shoe laces was a biggie for me too. If you still have this challenge, or for those reading who do, try this.
Put the lace shoe on you op leg. Stand with your butt facing the bed. If needed, hold on to the bed table.
Bend the operated leg back at the knee and wiggle your foot up on to bed. Goal: Instep flat on the mattress with your heal facing the ceiling.
Bring in your toes a bit to lift your instep up and release the laces.
Lean down as if to sit on your foot but do not sit. Lean just enough so you can grab the laces with your two hands.
Tie.
This stance maintains the 90o and worked like a charm for me.
I started with the elastic curlie laces that do not need to be tied (just need a pull to tighten). Gradually I learned how to tie regular laces backwards.
If you just don't have enough flex, stick to the elastic laces = just pull to tighten. They look like curlie cues, sold as kids laces. Found mine at Payless.
... and then, there's always slip-on sneaks (lace less).
Hope it's clear to you and all posters!

 

[Lgastreich]

New question: Does the challenge of staying hydrated continue weeks after surgery? I probably wasn't drinking 64 ounces of water pre-surgery; but if I fail to do so now, I think I can feel the effects. Of course, the 100+ degree heat could be contributing, but I'm only outside for a few minutes at a time.

 

[rider1960]

I've found that I drink almost constantly. If I go for more than an hour without something to drink (while I'm awake, of course), my mouth gets dry and I just don't feel as good. I keep some water or iced tea in front of me all the time.

It was like that with the first hip too. I don't know what causes this "constant need for hydration" but it seems to be very big in the world of hip recovery.

Dorothy