THR My Hip Trip - Second Verse

[HollyB]

@Jamie you are correct on the Tramadol-- 50mg every 6 hours. I like your suggestion of increasing the Tramadol (not to exceed 400mg in a 24 hour period) because It appears that the culprit for my nausea was the oxy. I have a two week PostOp appointment with my PP and will see if she has any additional thoughts. I'll let everyone know if there is new news on this. Thank you for looking after me.

 

[copsham]

Hi HollyB you really had a tough recovery. I am glad you are coming through the worst. What would we do without brainsmart? The health system on any of our countries doesn't seem to provide answers to the frequent little questions which we are facing following such a big operation.
Fingers crossed that you will have a good sleep tonight.
Karen X

 

[Hoppy Nanny]

Hoping that the extra tramadol can help with the breakthrough pain x


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[HollyB]

Thank you so, so much for your support and kind comments, @copsham and @Hoppy Nanny . And, so true, what would we do without Bonesmart!

 

[LibraryLynn]

@HollyB I agree! Where would we be without Bonesmart!?

I'm so glad that you're feeling better. Now that I'm back full time and juggling doctor appointments, I don't get here as often as I'd like. I have been wanting to check up on you...glad you're doing better!

 

[HollyB]

Update at Two Weeks Post Surgery. At this point the nausea problems have settled down and I think I'm back on track although still a little weak from the experience. But, the big event today was my first visit from PT. In many ways I had been dreading this appointment because I just wasn't sure how my new hip and other bad hip would react. Here's what happened: I was doubled-teamed with two PTs. Very nice, gentle, and not going-ho to do every exercise in the book. So, thank goodness for that! They tested my strength and flexibility in both feet by having me do foot pumps against a bit of hand pressure (no pain); also checked strength in my quads by applying slight hand pressure as I attempted to raise my leg with other leg bent (no pain); also checked quads via that exercise where you push knee down from a lying position (no pain). The next thing I demonstrated for them was getting out of the bed, walking, sitting on the raised toilet seat, brushing my teeth, and then walking into our tv room and sitting down. They were pleased that I was following the posterior hip precautions with my activities but made a correction in the way I was turning with the walker when I had to turn toward my operated leg. This was very helpful. I was then timed on a short measured walk and then asked to walk 6 minutes straight and that was timed. That second walk exhausted me! Nothing was hurting but I was starting to get breathless. The final thing we did was practice going outside, down two steps, and getting into the car in preparation for tomorrow's visit to my PP. They worked with my husband during this part.

I was given two exercises-- single leg lift/ 1 set of 10 and the lying down quad squeeze/1 set of ten. In addition I was asked to walk 200 feet (they measured it off) once a day. They have contacted my OS's office to double check on my precautions particularly in regard to any abduction exercises.

They advised that I not do any exercises tomorrow in light of the appointment with my PP. And, they want me to take careful note about how today's activities make me feel. Further suggested that if I ever feel a sharp pain with any of the exercises I stop that exercise immediately. If there is just muscle soreness that goes away by the next day, then the exercise is probably o.k.

After this first session, which lasted 1.5 hours, I was one tired puppy. I was sore and a little shaky from all of the activity but nothing too bad. I was feeling muscles that I hadn't felt since the operation but again nothing too bad. I also know from past experience that my body will sometimes let me do things that don't hurt in the moment but cause undue pain later. I'm sitting in bed with a lot of ice packs and will report back re any pain. Oh, and I timed my pain Meds about an hour before the session ( 1 50mg Tramadol; 927mg Tylenol).

Of course, now I'm curious about everyone else's experience with PT. What was it like for you?

 

[Hoppy Nanny]

@HollyB Sounds like a good session and sensible PTs!
I didn't have any PT until 9 weeks post op...only was told to do as much walking as I wanted before that. Then I had hydrotherapy as had a limp but only gentle water exercises. I found that regime to be quite sufficient. Chrissie x


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[LibraryLynn]

I had very bizarre experiences with PT in the hospital. They have this program that they are quite proud of, but I think, especially in light of everything Josephine says, it is cruel and unusual punishment. The day after surgery they chase you down the hall and back. Then they chase you down the hall again to a big room where everyone suffers through an incredible number of exercises and an incredible number of reps. Josephine would have gone haywire. Plus, there are volunteers in there who seem to be a bit gung ho about them. I went along because I didn't know better, and I was pretty drugged up. (You better believe that will change for my next hip)

Fortunately, the day after I returned home from surgery I had my first appointment with my real PT. I had Nikki as a student, and I've worked with her a lot with fibro and breast cancer. Nikki was able to answer my questions, explain away some odd aches and pains and be my counselor when I gave up. Anyway, she laughed when I told her how many exercises I was doing. She cut me WAY back, and if anything hurt at all, I was to stop immediately.
Then, my PT experience changed because I was going way too slowly for regular PT...we worked a great deal of my muscle stretch in the early days. Once my incision healed after week 2, I started in the pool. That was a godsend, and I've been there since.
We are hoping to move me to the parallel bars now at 8 weeks. I'm just finally showing enough strength to start working out of the water.
Slow and steady, and do not let them do anything to you that hurts or that you're unsure of. I'm lucky to trust Nikki 100% because I've known her for 20 years.
Lynn

 

[HollyB]

@Hoppy Nanny your exercise program makes perfect sense to me especially since I suspect you would be motivated to walk on your own and sensible enough to know how much was too much. Thank you for sharing that. And, good grief, @LibraryLynn , your hospital experience sounds like the PT From Hell. And are you ever right about going along with an approach like that because you just don't know any better. It happened to me in an earlier context. Ironically I had sought the first OS opinion which was hip was bad and you need surgery -- your body will tell you when. So I asked for PT referral for "prehab". This particular OS (not the one I later chose) seemed surprised at my request but referred me to his practice's in-house PT Program. I worked with a fitness trainer, not a PT, a fact I didn't realize until later. This guy was so gung-ho and I was so dumb as to go along with his program that I injured my back and the leg that hadn't been giving me any trouble. But my wonderful PP gave me a referral to a terrific PT and I worked with her for about a year and have great confidence her abilities. In fact, she told me that her approach to THR rehab was to do very little for the first six months. She said that her experience from watching the Home Health PTs is that their programs are very gentle. So here's hoping. I will return to her whenever I am released for outpatient PT. But I'm very leery of the PT exercises in part from my own experience, from @Josephine's advice, and from various threads and articles here on BoneSmart.

 

[LibraryLynn]

I will definitely go into hip 2 with Josephine's admonishments about hips not needing muc PT to recover ringing in my ears! I am now well armed with more information! That's one of the pluses to doing this twice.

 

[HollyB]

@LibraryLynn Ditto on that!

 

[NuMe2014]

@ HollyB I happy to hear that you have your nausea problem under control. It's so hard to get any good rest when you are struggling with that. Your PT sounds wonderful! I really have a great team that I work with too. A lot of what they have me do are stretching exercises and a few strengthening exercises but not to any excess. They stress the walking but not to over do it and to concentrate on my gate. Now that I have TWO good hips it is so much easier this time around !

 

[HollyB]

Thanks @NuMe2014 and you are so right about the nausea and how it just messes with your rest. Glad that seems to be done! You know, your thread has been so helpful to me as I consider the timing for my second hip. You really give me the inspiration and courage to move forward with #2. Take care.

 

[NuMe2014]

@HollyB how do you feel today after having your physio yesterday?

 

[HollyB]

@NuMe2014 thank you for asking. Yesterday after PT I collapsed into bed with a good supply of ice and when I got up a few hours later I was none the worse for wear. I felt the odd muscle ache and twitch but nothing that seemed to want to "settle in". There was a little bit of swelling in my ankle and knee (anyone get those ankle swellings?) so I continued to ice all evening while my husband and I watched the recently ordered from Netflix "Band of Brothers". I slept amazingly well although I did get up for a 3am Tramadol dose. Today I was pleasantly surprised to find that there were no aches and pains from my first adventure with In Home PT.

 

[HollyB]

Update of First Visit With PP and Second PT Session. On Wednesday (11/01/2015) I had my 2 week appointment with my PP. Because of the practice session the day before with the PTs we were able to negotiate the steps and the car smoothly. It was a brilliant idea on the part of the PTs to have that practice session and I told them so when I saw them at our next appointment. The PP's office had a supply of wheelchairs so I was able to transfer out of the car, sit in the wheelchair, and get rolled into the waiting room. I was called back to my PP's exam room quickly and the exam was very positive. We discussed the nausea and the Meds and she advised ( as did you, @Jamie ) increasing the Tramadol before considering the Oxy. Incision looked good -- it was closed with glue (?)/ no staples. My PP cautioned me not to rub,scratch, or otherwise touch any of the little scabs that had formed even if they itched, which so far they haven't. She was very pleased with my progress and hugged me before she left -- this woman is amazing and I'm lucky to have her for my PP.

The second PT Session was on Friday (the 13th!). I was able to do 2 sets of 10 leg lifts without any pain. However, I think this is a bit aggressive and plan to only do 1 set of 10 on a daily basis and slowly build to a second set. We did standing toe raises and standing heel raises -- no pain at all. I was clocked for 30 seconds of standing without holding onto anything -- no problem with that and I was a little surprised that I wasn't shaky or wobbly but I wasn't. We did side leg lifts ( and the PTs had cleared this with the OS). The only exercise that bothered me was The Bridge. I was afraid of it because I had had difficulty with that exercise before surgery. But I tried it and the PPs told me that I didn't need to raise up high just raise up to my comfort level. I had no pain with it but , like the Leg Lifts, it seems a little aggressive to me at this point. I walked, using my walker 200 feet. In addition, I asked the PPs for a few gentle upper body stretches that would keep me limber in light of the work this part of my body is doing with the walker. So, I now have several stretches to do that I hope will keep this part of my body "on board". All in all, it was a good session. Afterwards I iced, elevated, and rested. There was no particular pain that day or the next so I'm keeping my fingers crossed about the PT Sessions.

Here is a question that has arisen from both the Home Health Nurses and the PTs: both have cautioned me against over doing the icing. The Nurses mentioned it first and told me that I should only ice for 15 minutes at a time. I showed them my gel packs which cool pretty quickly and they thought that was probably o.k. Just to leave the packs until they warmed up (about 20 minutes or so I would estimate). The reason I was given is that too much icing could interfere with blood circulation and that the blood circulation was needed for healing. The PTs advise icing for 15 minutes after exercises and not icing before exercises, which makes sense to me. But the PTs also warned against over icing. So, BoneSmart Gang, @Josephine , @Jamie could you help clarify this one for me. Thanks everyone and here's hoping that today is a good day for everyone.

 

[craftdee]

Hi @HollyB All sounds like good progress

My Physio told me much the same as yours... she said even to heat BEFORE exercise then ice after, but not to ice permanently. I found that I was too antsy to sit and ice for extended periods and was up and about after 15 minutes or so anyway... I never had a problem with swelling and did find the ice REALLY helped in the very early days - but many others here swear by icing a lot and for a long time (in terms of weeks out). The other thing my Physio said was "it's an individual event" you've just got to try it out and see what works for you

 

[Jaycey]

I have no idea why your PT is pushing all those leg raises. Sounds pretty aggressive to me. Please don't over do these as it will only lead to soreness.

Regarding icing, I iced several times per day and then took a gel pack to bed at night. As craftdee says, it really does help control the pain and swelling.

 

[HollyB]

@Jaycey thank you. My gut reaction is that 2 sets of 10 reps for the Leg Lifts is a bit much. I have three other exercises in addition to the Leg Lifts: 5 bridges; 10 seated knee extensions (I've always thought knee extensions were dicey on a good day!); 10 standing leg lifts to the side. Then the 200 foot walk. All of this is to be done once a day. Any sharp pain, I am to stop immediately. Any lingering pain, muscle or otherwise, I am to report.

I'm setting up a chart of the exercises and plan to note how I'm feeling while I'm doing the exercise, immediately after, later in the day, and then the next morning. Obsessive, probably. But, I figure it will make me focus a lot better on the task at hand.

Oh, and I won't be doing all of those Leg Lifts. I'll pause at 5 and maybe go further if it feels comfortable but certainly not 2 sets.

 

[Josephine]

The PP's office

For us ignoramuses across the pond - what is a PP please?

plan to only do 1 set of 10 on a daily basis and slowly build to a second set.

I'd stick with doing one set of 10 and never increasing it. Did you forget the advice that hips actually don't need much exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We did standing toe raises and standing heel raises -- no pain at all.
The only exercise that bothered me was The Bridge
I had no pain with it but , like the Leg Lifts, it seems a little aggressive to me at this point.

Ouch! You may not have pain at the time but as days go on, you will risk developing tendinitis and other aches and pains. These are very punishing exercises, especially for 2½ weeks out.

The Nurses mentioned it first and told me that I should only ice for 15 minutes at a time. I showed them my gel packs which cool pretty quickly and they thought that was probably ok. Just to leave the packs until they warmed up

I think this is pretty much what we preach here except that little or nothing is accomplished in 15 minutes. 40-60mins about 4 times a day is better.

but not to ice permanently

When have we ever promoted icing permanently? Certainly not me.

I never had a problem with swelling and did find the ice REALLY helped in the very early days - but many others here swear by icing a lot and for a long time (in terms of weeks out).

Do they indeed? Well if they do, it's not by BoneSmart's recommendation. Only if they have significant pain/inflammatory issues.

The other thing my Physio said was "it's an individual event" you've just got to try it out and see what works for you

Exactly!