THR Wide Awake - Mailman Chases Dogs Away

[Mailman]

@myglasshalffull : regarding drugs.. Good suggestion! Here in Oregon cannabis is legal and 4 plants can be grown for personal use without any tax or paperwork. So I usually cultivate one plant every year just because I can, and give it away to friends just like other produce from the garden.

I seldom use it myself but in my current situation, now that you mention trying natural remedies, I think that's an excellent idea.

After 5 days in the house, knowing that I needed to get moving again if I am to get my vitality back, and knowing I wasn't going to fill the prescription, yesterday evening I grabbed the rollater for security and headed out the door. Ridiculously slowly and carefully. But I did manage to go 4 blocks despite the pain.

The result was a sense of accomplishment, optimism and rediscovered confidence. These are like drugs with only positive effect.

 

[Mailman]

Day 10. Breakthrough .

Through the perspective that the opportunity to blog here at Bonesmart provides, the healing process is a marvel to behold. It chugs along all by itself. Despite my focus on the pain and discomfort that I still expect each day, overall it's the progress unfolding in the background that is of greater interest.

Recap:
Days 1 -3: Free pass from painkillers packed into wound at end of surgery. Unfounded optimism.
Days 4-8: 5 days confined to house by the intense burning nerve pain of Meralgia Paresthetica. Grave doubts about the future.
Day 9: Resume outdoor walking albeit extremely slowly and limited. 0.45 miles. I can do this.
Day 10: Over the course of the day, despite remaining nerve pain, I have traveled a full mile, at a slightly faster pace. I am on a roll.

 

[Mailman]

Day 11 : No more painkillers.
Need a more accurate reading of my condition so I don't join the ODIC. Painkillers mask that and disallow integration of mind and body and optimal recovery, if you believe that stuff, which I do.
1/2 mile walking daily appears to be my baseline now.

 

[Mailman]

Day 12: Reality Check

For pain I was taking 1000mg Extra Strength Tylenol.3X daily. I stopped completely but found, after skipping 5 doses, just how much the Tylenol was reducing the intense burning pain of Myalgia Paresthetica. Turns out quite a lot!

So I'm starting up again, seeking the optimal daily dose of Tylenol, not for maximum comfort but rather for optimal healing of the LFCN nerve damage. This damage results in numbness, burning pain, or both and is more likely after a THR using the anterior approach, because the nerve runs down towards the knee right over the front of the joint capsule.

It should be noted that burning pain does not necessarily indicate greater nerve damage than numbness alone.


Gemini AI adds:

"In Meralgia Paresthetica caused by LFCN retraction, the burning pain is likely due to abnormal firing in the damaged axons.

More studies are needed to fully understand the specific thresholds and how to modulate activity for optimal regeneration and remyelination.

While reducing the burning pain might seem desirable for comfort, it's not entirely clear if it directly translates to faster healing."

 

[myglasshalffull]

Are you adding icing to your regimen as well as the extra strength Tylenol?
Not sure that helps your particular situation or not but I've always found ice to really help.
Also love my heating pad on other days, so comforting!

 

[Mailman]

Yes. Icing more but limited to at rest while pain is only during walking. However come to think of it I suppose I could figure out some way to ice while walking. I'll try that today.

 

[Layla]

I'm sorry you're struggling with this pain, Mailman.
Do you think something like this may bring some relief?

Amazon.com

 

[Mailman]

I ordered it.

 

[Mailman]

Day 13 : Turnaround

Being the pain killer minimalist I am I decided to only take 500 mg of Tylenol the past 2 days and see if I could work with the pain while walking, which was 1 mile yesterday but only 1/4 mile the day before.

Today I'm much better. The burning pain while walking I have been suffering from for the past 10 days has finally given way to the normal THR discomfort that I remember from my first THR last October. I'm quite tired, continue to sleep on and off throughout the day, but I'm now comfortable enough to do without any Tylenol, perhaps for good.

I have been reading about neuroplasticity and how it applies to my recovery this time around. The LFCN takes time to heal itself physically but the brain is the other half of the equation and can adjust and recalibrate the new physical electrical impulses that it receives from the nerve endings relatively quickly. The two together determine the intensity and quality of the pain sensation. Naturally, with any abrupt change received from the nervous system from injury the brain responds with attention grabbing pain to alert the organism.

However, introducing painkillers into the mix longer than is necessary to insure the survival of the organism can inhibit the healing potential of neuroplasticity, slowing down recovery; directly when nerves themselves such as the LFCN are traumatized, but also indirectly in trauma to soft tissues, muscles and bones.

In extreme situations such as drug abuse, neuroplasticity can backfire and continue the perception of pain past the point when it is no longer there physically and instead is a misinterpretation of the nerve impulses being received.

 

[Mailman]

Day 13 : Bandage removed

Clean and dry. 3 inches long. Silver impregnated bandage shown still hanging at bottom. A few self dissolving stitches still visible.

 

[Mailman]

Perhaps you can tell me what it feel like when the patient overdoes it with too much activity to the point they are damaging themselves.

I've been dealing with Meralgia Paresthetica since Day 3, today on Day 14, so I have a really good idea about what that feels like, even now when it is subsiding and providing room for the rest of the pain and discomfort of recovery from a THR to become more noticeable.

Is it more than the blunt sensations of traumatized soft tissue, the familiar sensation of recovering from a deep wound, some muscles readjusting to new demands? Sharp or shooting pain perhaps?

With the Meralgia no longer dominant I am still moving slowly and if I do too much the additional discomfort lslows me down even more, and that seems like enough to keep me out of trouble.
But if I knew more about what to watch out for as a warning signal, I think that would be helpful towards achieving a better recovery.

 

[Mailman]

I had my 2 week followup this morning and asked about pain indicating that I was pushing a return to normal activities past the boundary of best practices.
He said that for me, as someone who avoids taking pain meds, to even consider an increase in pain medication was the only indicator I needed.

 

[Jamie]

Your incision looks great!

I know you are eager to return to a more normal life, but please remember that you are VERY early in this recovery process and you need to watch your activity levels for a while longer, building up to more activity gradually. As your surgeon said, you'll know when you try to do too much. If you experience increases in pain or swelling during the activity or within the next 24-48 hours, it means you did too much. There is no specific type of "overdoing it" pain. It can be anything and almost anywhere within your hip, leg, or even your spine. Listen to your body's messages and you'll know when you do it. That's your signal to scale things back for a couple of days until it goes away. Then you can start to introduce more activity gradually.

 

[mendogal]

Increased discomfort or pain and increased swelling are the main indicators.

With my knees, if I overdid it, I would take a rest day during which I'd ice and elevate 45 minutes at a time three times.

Then moving forward I'd reduce my activity to about 2/3 of the time or the distance, depending on the triggering activity.

After a few days, I would increase it by a very small increment.

 

[Mailman]

Day 15:
@mendogal Only smallincrease in swelling. No increase in pain or discomfort, only different pain and discomfort. No thought of any pain medication either so I probably have a good level of activity, which is becoming more normal day by day. I do still need more sleep than usual and it is still irregular but not much else better to do these days and I can do that in any position except laying on the incision side.
So I'm pretty happy now that the Meralgia Paresthetica pain is dissipating.
I appreciate your and @Jamie advice. It clarified what to look for. I am very intent on having as quick a full recovery as possible.

 

[mendogal]

This is a handy guide for what we can expect based on healing at a cellular level....
It means that it's still quite possible to "overdo it" at several months out.

 

[Mailman]

@mendogal The staff cautions not to "overdo it", I assume because this will unnecessarily increase discomfort, just like getting carried away working out at a gym will result in discomfort in a day or two as the body adjusts to the unusual demand put on muscles and joints. It may even sprain or break something. At best it may prolong getting to where one desires to be. Slow and steady wins the race.

Is this a useful analogy?

Can damage that may be difficult to resolve be caused by pushing too hard during recovery?

 

[mendogal]

Short answer to your last question: Yes.

Longer explanation....

There's a palpable difference, to those of us who have done athletics, between the feeling of muscle ache of a workout and the feeling of a joint overdoing things after an athletic injury, right?

That muscle ache is familiar and reassuring; it tells us we have challenged the muscle enough to create the impetus for it to grow stronger. A day of relative rest from that exercise is a good thing, but no damage has been done.

With a garden variety athletic injury - sprain or strain - the pain and inflammation is enough to warn you to back off, use RICE.
The cellular level healing takes about 6 weeks and those who persist in continuing the activity during this time risk having an acute injury become a chronic problem. I have see this in scores of impatient martial artists over the years.

Well, a hip replacement is way more traumatic than a sprain or strain. Regardless of the "approach," the femur is essentially dislocated in order to drill out space and hammer the stem in. Muscles, tendons, and ligaments might not be cut in some approaches, but they are hugely disrupted. Small nerves and blood vessels take a beating. It's more like... Um... a bad car accident?

So the pain and inflammation are commensurately worse in both severity and in scope of affected area than a sprain or sprain.

Overdoing things before healing is complete creates inflammation, thus requires prompt application of rest, ice, and elevation PLUS heeding the clear message the joint is giving to "back off!"

Most of the time, our bodies respond to rest, ice, and elevation within a day or two, and there's no permanent damage.

Yes, we HAVE had members sustain severe damage, requiring further medical intervention - knee replacements probably more often than hip replacements - it's usually at the hands of aggressive PTs, but now and then it's self-inflicted.

 

[myglasshalffull]

Mailman,
Perhaps your very speedy recovery with Hip #1 now baffles you with recovering from Hip #2 & has you wondering if you pushed too far too early.
We all just need to listen to clues from our body, it took me forever to get on the patience train.
And I can see by your posts that patience is not your virtue!
I also understand how excited you must be to be mobile after all the time you spent in agony.
You will get there, this trip might take a little longer than the first but you have an amazing attitude & have educated yourself so I can foresee nothing but great success for you.

 

[Mailman]

Day 18

@mendogal your longer explanation is excellent, especially the analogy to a car crash compared to a simple strain or sprain. It provides the perspective I was looking for.

What puzzles me though is that they get you up and walking hours after surgery and then shortly after that send you home, with no restrictions on movement and encouragement to walk as much as is comfortable. I expect that would not be recommended as the primary therapeutic following a crash.