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[THR] Leg length discrepancy question

Discussion in 'Hip Replacement Recovery Area' started by Bellydansr, Jan 26, 2017.

  1. Bellydansr

    Bellydansr
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    Holy cow!! Who would have thought something like this would have happened. Obviously not me or it wouldn't have!! LOL

    My surgery was a week ago today. We had a huge problem in the hospital that first day. I got there at 5:30am for admission. I was the first surgery for Dr. Eilerman, so luckily we were on time. I have a medication I take for appetite control (when I think about taking it!!) and it's two meds that work together. Buproprion and Naltrexone. When I went in for my pre-op appt, 10 days before surgery, they had a question about the Naltexone and said they would look it up because the nurse I was talking to didn't know much about it. Well, they really didn't look it up until the morning of my surgery and only half-assed at that! They said there was a possibility that it might have an affect on my pain "cocktail", but since they use about 3 different drugs, it shouldn't be a problem.

    Well, it was bigger problem than they let on. We can't get a straight answer about what happened during the surgery, but I can tell you what happened afterwards. After surgery, and twice as long in recovery than expected, they had to give me another dose of oxy for the pain just before sending me up to my room.

    I get up to my room and am still in pain. It continues to worsen. They give me another 10 mg of oxy. My husband is watching me go from....My leg hurts. (duh...you just had surgery) to My leg really hurts....to My leg really, really hurts and My leg really, really, REALLY hurts!!!! :shocked: Now, he has gone out to the nurses station a few times and doesn't want to make a pest of himself, but the nurse just looks at him and says I gave her 10mg of Oxy and that is all I can do for the next 4 hours. He asks how long it should take to get into my system. She says 30 minutes. It's been 20-25, so he goes back in. He waits about 5 minutes.

    By this time I have gone from crying to bawling. :sos: Obviously, I'm not getting any relief at all. Instead of the pain getting better, it is getting much, much worse. Now, my husband is retired DEA and has decided to get a little hateful, while hoping they don't call security and throw him out.

    He goes to the nurses station and informs them that there is something very wrong with this situation and that he is not going back into my room until there is a nurse with him to monitor the situation. The floor nurse that has been hateful is nowhere to be seen. Another nurse comes up and Paul explains the situation. He also asks if they are aware that I am on a med that possibly blocks all effects of opiods...the oxy. It is apparently in the Narcan family.

    Her jaw dropped to the floor. He said he thinks this is what is going on. She said she had no idea! No one on the floor did. They just knew that I was apparently slow to come out of anesthesia or something downstairs because it took twice as long. So, they come in the room and she immediately realizes there is definitely a big problem. Apparently, I was not getting any pain relief whatsoever because oxy is the only thing prescribed for pain once you get upstairs.

    They go out in the hallway because I'm not in any shape to understand what is going on. She says they have a very strong liquid Tylenol, which is not an opiod, that she can give me once she gets the okay from the doctor. She immediately calls him and then gets the hospital pharmacist up in my room and things go from there. They don't use the liquid Tylenol a lot because it's so expensive and the Oxy usually works, but not for me.

    Paul said she hooked it up and ran it full force into my IV. He said within 4 minutes, it had knocked out the pain enough for my body to relax and I zonked right out. They all had a little pow wow outside at the nurses station and they told Paul that this was something no one had ever experienced before. He told them he understands completely...the problem he had was not with what exactly happened, but how it was handled (not handled) by the initial floor nurse. :censored::tantrum2: She just didn't want to deal with it at all. :no-fin:

    By the time I woke up again and was halfway coherent, practically the whole hospital had heard about what happened. They said everyone was brought in on what happened and that they were definitely making changes to all protocols over this.

    Needless to say, everyone was wonderful from then on. I'm sure they were concerned about being sued or something, but I was just thankful for not being in excruciating pain anymore! It took a good day for the naltrexone to leave my system and needless to say, I haven't taken it since surgery, so the meds they sent me home with would work.

    Because I was so behind the power curve, I ended up staying 2 nights instead of just 1. My PT the first day consisted of getting up and going to the restroom. I got a private session in the am and a group session in the afternoon the next two days. Soooo....that was my wonderful time in the hospital. LOL At least now, when the time comes for my left leg, I will know not to be taking the Contrave or the Narcan part of it!!!:loll:

    As for recovery at home, it sure seems a slow go. I walk a little bit with my walker and do some leg exercises. I have 16 stairs at my house and all our bedrooms and full baths are upstairs. I go up and down the stairs with my cane and my hubby either in front of or behind me about 4 times a day. Our Sheltie takes the other side of me on the stairs. LOL

    I have showered twice and my hubby changed my dressing after each time. The incision looks good. Well, as good as can be expected with staples....yuck! The constipation is not really a big issue thankfully. I have had trouble sleeping both downstairs in the recliner and upstairs in the bed. My lower back starts to really hurt after a while.

    Last night was the first night I truly got some decent sleep. I will stay downstairs in the recliner for a while. My biggest "pain" is this burning pain that shoots down the side and sometimes the front of my thigh. I usually get it when push off my right foot to step onto my left foot. Or if I stretch the quad too much (like when trying to stand up). I am having a lot of difficulty standing straight up. My right leg is a little longer now and I tend to stick my butt out and limp a bit when walking with walker.

    It is really hard for me to get a smooth gait with the walker. I had PT on Tuesday and they kicked my butt!! LOL I go back next week Tues and Thurs and do so for the next 6 weeks.

    I have yet to do the exercise where you lift your leg behind you a little. I don't think I can do that one because it hurts too bad to get anywhere near doing that. Hopefully that will change soon.

    My parents come into town on Tuesday and my mom seemed to think that we would be able to go the Farmer's Market with a friend that week. I am beginning to think maybe not. She is surprised I am having this much trouble with the anterior approach. My father had the posterior approach and even though he had the hip precautions that I don't, he was out and about by now and felt no pain from day one. I just hope she realizes that mine is completely different from his and doesn't expect too much from me. Because she probably isn't getting it!! :heehee:

    I am still on the Oxy, but not every 4 hours like before. Maybe every 6-8 hours. And lots and lots of ice!!! Ohhhhhh....and they wanted to send me home on Lovenox. That was fine, UNTIL I found out that it is an injection where you inject your stomach every day. WHAT????:bolt:Ummm...oh hell no!! When she saw the look on my face and the tears in my eyes, she said she would talk to the doctor about something orally. Thank God!! I was put on Eliquis twice a day instead. :phone:

    Today was the first day that my husband felt comfortable leaving me for an extended period of time to go do something for him. I told him GO!! I am fine. When I get up to go to the bathroom, it will be my first trip by myself...LOL!!! And I'm upstairs lying in bed because he wanted to make sure I was not going to try to go up or down the stairs by myself if the need arose.
     
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  2. newlybionic

    newlybionic FORUM ADVISOR Forum Advisor

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    I'm sorry to hear about all the problems you had in the hospital with appropriate pain medication. I don't understand how it was not picked up by your OS prior to your admission for surgery. I always have a list available to give to my doctors and whenever I go for an office visit or a hospital admission. I hope your recovery from here on out is a much smoother road.
     
  3. Bellydansr

    Bellydansr
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    Thanks @newlybionic !! I had my list of medications printed out for them at both my preop and the day of my surgery. The basic problem is that Naltrexone is a kissing cousin to Narcan. And of course everybody "knows" that the only thing narcan is used for is with overdoses. There is absolutely NO other use for Narcan other than that. Well, guess what? Bupropion and Naltrexone are the two ingredients in Contrave, which is a new weight loss/appetite suppressant that is out on the market. Commercials are just now coming out about it. Talk about a learning curve! I was a great teaching moment. :)
     
  4. Hip Hip Hooray!

    Hip Hip Hooray!

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    I'm so sorry to hear that this happened. Thank God your husband was with you and stepped in to help. Please take care of yourself and go slowly. There is plenty of time, and the patience and Bonesmart mantras will really pay off in your recovery.
     
  5. Bellydansr

    Bellydansr
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    Thanks @Hip Hip Hooray!!! I am very thankful he was there. Had he not been, I don't know what would have happened. I wasn't in any shape to "discuss" options. Lol No one else, obviously, could have understand what was going on. The good news is that once it was focus or, things were much better. Everyone was wonderful. I had great care and really didn't want for anything. Most of my questions come now that I'm at home with nothing to do. Haha! I keep going back and forth on icing. I keep my leg pretty well iced during the day, but is there a too much? I'm getting better sleep now at night, but I tend to wake up around 4 or 5 and I have had no ice on my leg all night and even though I'm uncomfortable, I'm not in total pain. So I wait for a few hours, go back to sleep and then ask for ice and pain meds when everyone is awake. I always wonder if the back and forth is okay.
     
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  6. Cherdonnay

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    @Bellydansr. I'm so sorry you had to go through all that pain but glad you seem to be doing well now. When I go in to my OS for last pre-op visit, I'm going to be sure he writes up extra orders for pain medicine in case one doesn't work, another would be available. Scarrry. Sleep well


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  7. Jaycey

    Jaycey SUPER MODERATOR Moderator

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    @Bellydansr so sorry you had a bit of a rocky start to this recovery. Great that your hubby was your advocate. Now the healing begins.
    No, ice is a natural pain killer. I iced around the clock post RTHR. Just be sure you alway have a cloth or towel between your skin and the ice pack.
    At this stage you need to stay ahead of the pain. Take your prescribed meds around the clock.

    I'll leave you with a bit of reading. The articles are very short but might answer some of your questions about this recovery.
    First are the BoneSmart mantras ....
    - rest, elevate, ice and take your pain meds by the clock
    - if it hurts, don't do it and don't allow anyone - especially a physiotherapist - to do it to you
    - if your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again
    - if you won't die if it's not done, don't do it
    - never stand when you can sit, never sit when you can lie down, never stay awake when you can go to sleep!
    - be active as much as you need to be but not more than is necessary, meaning so much that you end up being in pain, exhausted or desperate to sit down or lay down!

    Pain management and the pain chart
    Healing: how long does it take?
    Chart representation of THR recovery
    Dislocation risk and 90 degree rule
    Energy drain for THRs
    Pain and swelling control: elevation is the key
    Activity progression for THRs
    Home physio (PT)
    Post op blues is a reality - be prepared for it
    Myth busting: on getting addicted to pain meds
    Sleep deprivation is pretty much inevitable - but what causes it?
     
  8. Tweetybrd

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    OMG!! I can not believe your story!! That is so awful! So glad your husband was there and made sure they got you something that worked for the pain. I am sure that added a huge amount of stress to your body and you will need to take some extra time to rest and heal. So glad you are doing better now. Don't let your mom pressure you to do more then you are ready to do. Everyone heals from this surgery differently.
    I have been icing all the time, just swap out when they get warm for fresh ones from the freezer. I put ice on when I go to bed and then I usually wake at 5 to 6 and move to the couch and my husband gets me fresh ice before he goes back to bed. :ice:
     
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  9. Hip Hip Hooray!

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    Can you have your pain meds at your bedside, so that you don't need to wait for someone to wake up and give them to you? They really make a difference when taken on time. I did have to get up and ice my hips at 3:00 a.m. at times. It always helped, and I went back to sleep. The Bonesmart mantras really work.

    I live alone, but I don't have any stairs. Using the walker really helped me. It gets better with time.
     
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  10. jp4199

    jp4199

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    @Bellydansr
    I wonder also about heel pumps, and just gentle knee raises. I found that my pain was of a crampy type and that movement was the answer. Very small rocking gentle movement, and it was nearly constant it felt through the early weeks, often while the pain Meds were settling in if that makes sense. Ice is lovely, but my other suggestion, especially at the groin muscles, is a small heat pad. I promise it gets better!
    Be gentle with yourself. Healing takes time!



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  11. Bellydansr

    Bellydansr
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    Is a 1 inch leg discrepancy normal? I'm 5'2"" and my surgical leg is now a full 2.5 cm/1 inch longer than my other leg. My PT said it could cause back and knee problems. I got an orthotic to put in my winter shoes, but it only goes about 1/2 an inch or so. Problem is, I have like 50 pairs of summer sandals and insets won't work there. The dr said when I have my other leg done, years down the road, they will even out. Not real thrilled at the moment.
     
  12. Jamie

    Jamie ADMINISTRATOR Administrator

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    @Bellydansr ... you'll notice that I have merged your latest thread with your original recovery thread. We prefer to keep each member's recovery updates, questions and concerns in a single thread. That way we can more easily go back and review what all you've been through. And...my dear....you certainly HAVE some history! I'm so sorry to read that your first days of recovery were so stressful and painful. I hope things have calmed down a bit for you.

    Please remind your dear mother of all you went through and the fact that everyone's recovery is different. Just because your dad was up an at 'em in a few short weeks, you may not be. In fact, I'm thinking that rocky start may just slow you down a bit.

    I'm concerned that your therapist may be pushing you a bit too much. Frankly, you don't really need a lot of therapy with a hip replacement. Usually some stretching and simple walking around does it. Even with that, you don't want to overdo the walking either. Your body needs time to heal.

    Please read this article from our BoneSmart Library regarding your leg discrepancy. It's common for therapists to get this wrong, but I'm surprised at your surgeon. Your new-hip leg is most likely not actually longer than the other leg, it just feels that way because your pelvis is tilted from years of compensating for your bad hip. This is something that improves with time. You are so early in your recovery, it's important not to worry about this feeling right now. Concentrate on getting more mobile so you can practice walking with a good strong gait. You'll need to use your walker for a while to enable you to really stride out with your steps (not immediately, of course....you must work up to this).

    Please do not put lifts in your shoes. This will prevent your hips from adjusting properly and you'll continue to have that feeling of leg discrepancy. This is something that can take months to resolve, so please be patient. In most cases, the feeling will go away completely.
     
  13. Clipper

    Clipper

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    I have a diagnosed leg length discrepancy. My LLD is 2 cm and the angle of tilt is 3.7 degrees. I bought a device that fits around my shorter leg shoe called "evenup" which was suggested by my PT. It costs about $35 (free shipping) and is well made. I've worn it on my shorter leg walking shoes (crocs) for over 2 months and it has worked very well. I walk 2 or more miles / day, so it has survived over 150 miles so far and looks to go much further. It can elevate your shoe by 1/2" or 1". I use the 1" setting. The company is easy to find on the net and they ship very fast. I've also had several shoes for my shorter leg elevated by a shoe repair shop. These changes have leveled my gait and made walking much smoother. Good luck!

     
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  14. Bellydansr

    Bellydansr
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    Thanks y'all. My surgeon looked at my leg length the day after surgery and said there is definitely a discrepancy and said that he had forewarned there could be a small one. I thought maybe 1/4 inch. Never dreamed a whole inch from the anterior approach! And now I worry about all my summer shoes and the 3 pairs I just bought. My surgeon was the first to mention lifts for my shoes. I don't mind my orthotic in my winter shoes bc you don't see it, but I have to find something for my sandals that isn't noticeable. I hate the thought of having it redone by sometime else, but that will be my last option.
    I never had much hip pain at all except intermittently. Never had a problem with my gait either. I'm really concerned now. I have a follow up appt on the 27th with my surgeon and will see what happens there.
     
  15. candace

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    Jamie - what a great explanation of still feeling a leg length discrepancy! Thank you! I do notice my posture is better since both hips were fixed. I had the on check leg lengths when I was last there and all is good!


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  16. Jamie

    Jamie ADMINISTRATOR Administrator

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    @Bellydansr ..... Even if your surgeon has indicated you have an actual leg discrepancy, I strongly suggest you discontinue use of any lifts until your hips have an opportunity to level out. It takes up to 6 months for this to happen. You may find at the end of that time you have little or no discrepancy if you just give your body a change to normalize.

    The approach the surgeon used to perform your surgery has no impact on your perceived or actual leg length.

    We do recommend purchasing new shoes no matter what your situation is after surgery because your old ones have wear patterns reflecting your old hip misalignment. This can affect your gait and even result in pain in other areas of the body. It's usually a good idea to purchase one pair of sturdy supportive shoes for the first 6 months of recovery while your body is readjusting and then see where you are before buying more.
     
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  17. Missyhippy

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    I have a very similar story back 8 years ago.but this surgery was done in Australia. I had a knee replacement after being looked after by 4 different nurses prior to surgery and my telling of chronic pain history so that this knowledge would help them understand my issues as I take OxyContin 20 mg twice a day, for severe back problems.
    From surgery to recovery no pain due to nerve block and stayed in High Dependancy overnight. Back to the ward very early 830 am no pain so comfortable, until 10am when all of a sudden the nerve block wore off and it got worse and worse so bad that I was screaming with little notice from any nurse which for me was terrifying, thankfully or so I thought, my husband turned up and he immediately went to see the nurses. He is a rather tall man and sometimes people can be a bit overcome by his size, but in my life has never ever lost his cool. He was upset though seeing me like this in a modern hospital.
    Because the nurse got upset and emotional she was sent home From then and til discharge I was treated in the most vile way. The medication finally got to a stage that it relieved my pain and it was given three hourly but no nurse had been allocated me on their list that morning , and there never was any apology. and so no one took responsibility for me. It was only three days later I discovered that my leg from thigh to toe was black with severe bruising and the reason I had pain was that I had been having a slow bleed.
    What distressed me more was that of my treatment gave me nightmares for years and I was terrified to get further surgery done until this year. I was sent home without any pain medication.
    As I said before this surgery to my hip this year was amazing and so different and having read the previous story I wonder if this happens frequently for any reason and is never reported.
    I should have done something about this but did not. I started to think it was my fault even though it wasn't I think it is a responsibility of each patient to make sure care is the most important part of the start of recovery, pain being the something that allows healing successfully.
     
  18. Bellydansr

    Bellydansr
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    Oh my gosh @Missyhippy !!! That is awful! You poor thing. I just can't understand how a nurse can let their patient be in such pain. I know it's very few that do that, but it still amazes me. My husband's told them she needed to be in the ER where she can just say "I know you hurt, but I'm more concerned with saving your life/limb at the moment." That is okay there, not up on the floor. We got a survey in the mail that we still have to fill out.

    @Jamie ...Thanks. I really do appreciate your advice, but it's just not practical for me. I have a month long vacation in June...2 weeks in Italy, with lots of waking tours, and then 2 week cruise. I just bought 3 different pairs of walking sandals to go with one other pair I'm taking. I can't wear the same pairs of shoes for 6 months. That's like having 3 outfits for the next 6 months. Yes, I may be vain, but I have many shoes bc they match my clothes.

    I just spent all weekend buying outfits for my trip. I have already been told by numerous people that if I keep walking with a 1 inch discrepancy it will really hurt my back and possibly my knees. I also have a belly dance workshop in 6 weeks that I've already paid for with several shows coming up in a couple of months. I don't have time to sit and wait to see what happens. I have several other friends who had a THRs done and they have all been very active right after. Fortunately, they didn't have a leg length discrepancy, so they had no problem. I know everyone is different, so I just have to do what works best for me.

    I never really had "bad hips". My hips never hurt. I had a labral tear and the groin pain I would have occasionally over the years is why I went to the Dr. I have been a high school cheer coach for the past 10 years and have always worked out, taught cheers and dances and stunted with my squads. So really no compensation needed. I just noticed that my right leg was not as flexible as my left for once and I struggled doing a split and straddle. I was a competitive gymnast in high school and cheerleader through college. But it was due to the labral tear. Unfortunately, I'm not sure the Dr fixed it during my surgery. I will find out in the next couple of days. So, my case is a bit different because I just wanted the groin pain fixed. Other than that, my hips were fine.

    Thanks @Clipper ! I found sone inserts that work well for now and I took one pair of shoes in to be worked on to see how well a heel adjustment works. $80 to cut and add to the middle of the heel, but we'll see what happens. :)
     
  19. Clipper

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    @bellydancer - Good luck with the heel inserts. I tried them at first and ended up getting full length 2 cm lifts added to the bottoms of my shoes. That has worked much better! Inserts inside the shoes were of little help. There's not enough room left inside the shoe for the foot with a 1" insert. Don't ask me how I know. And just adding a heel lift does nothing for the rest of the foot.

    My surgeon explained that when he does the anterior hip replacement, he increases the leg length on purpose by using the right selection of stem and neck sizes. Not much, about 3/4". This is to stretch the muscles which then act sort of like rubber bands to better hold the hip joint in place. If one of your legs is longer, your two legs will not even out over time. Your shorter leg bones will not just grow to match your longer leg bones. Instead your pelvis and spine will tilt which could lead to future problems.

    You probably need to decide the price you're willing to pay to be fashionable with your new outfits and matching shoes. Short term I'm sure you can deal with it, but your comfort will suffer. The lifts I had added to bottoms of my shoes were well done and are hardly noticeable (hey, I'm fashion conscious also!).

    If you get your other hip replaced, the surgeon can better equalize the leg lengths. That was not possible on my 2nd hip due to other problems.

    It's exciting to read about your upcoming vacation and about the outfits you've assembled for it. Best of luck!
     
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  20. Bellydansr

    Bellydansr
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    Thanks @Clipper ! Yes, fashion is important to my family and friends. Lol the doctor did inform me that when he does my left hip everything will be evened out. I figure once I get my shoes done and everything then things will be fine for a while. When I get the other hit done, that is when I can buy shoes and not have anything done to them. But when you have a whole closet full of shoes, that's a lot of money to be throwing away and try to start all over again. :) once the trip finally gets here I'll have lots of pictures. :)
     

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