Thursday, October 31, 2013

A Hip Journey Through Photographs

A hip journey in photographs.
Here I am with my brothers Christian and Andrew. This is a good shot of my body cast. It went from my toes to my chest.

Here's me and my brother Jody. I'm young here, as you can tell. Another picture of my body cast. It went from my toes to my chest.

My daddy and I. You can see my body cast in this picture. It went from my toes up to my chest.

X-Ray 12-30-10. Extreme lack of coverage on right side. Center Edge angle is -11.
X-Ray 12-30-10. On X-ray Table, lateral shot.
Findings: Severe right hip dysplasia with uncovering anteriorly and laterally. Loss of joint space superiorly with lateral subluxation of the femoral head.

X-Ray 12-30-10. Standing X-Ray weight bearing.
X-Ray 12-30-10. Frogger position.
Findings: There is severe right hip dysplasia with lateral upsloping of the acetabulum end significant subchondral sclerosis along superolateral margin. There is narrowing of the joint space, early osteophyte formation, and mild later subluxation. Overall Impression: severe right hip dysplasia with early osteoarthritis and lateral subluxation.
3D CT 1-14-12. Top of joint looking down into it.
3D CT 1-14-12. Front of joint looking in.
Overall findings of study: Congenital  severe hip dysplasia. Subchondral sclerosis and cyst formation along superior acetabulum. Mild flattening and irregularity of the right femoral head.

Steriod Injection with contrast for imaging 1-23-12. Notice the needle coming in on the left-hand side. Yikes!

CT with contrast 1-23-12. Labrum images. There were many of these. I'm not a doctor and have no idea what this means! Just thought it was interesting.
Findings: Marked uncovering of superior and anterior femoral head. Posterior labrum normal. Superior labrum is moderately enlarged. Focal detachment of the superior labral base from 11:30 position anteriorly, with maceration of the anterior labrum to approximately 5:00. There is full thickness chondromalacia of the anterior-superior acetabular cartilage with cyst formation. Paralabral ganglion at 12:30 up to 12mm. At least partial tearing in ligamentum teres. 
Arthrographic photo (I think?) directly before surgery 10-26-12. 8:30 AM, right before starting!

X-Ray 10-26-12. 2:50 PM Directly after surgery in the recovery room. 

10-30-12. Enjoying Dunkin' post-RPAO on hospital discharge day. 
10-30-12. Up and ready to go on discharge day!
LOOT of prescriptions when I first came home.
Pillow fort we made so I could try and sleep at night.
X-Ray 11-8-12. Post-op appointment X-Ray.
Findings: 4 screws securing bony fragments. Two screws extend from acetabular roof towards sacroiliac joint and the third long screw appears to extend from anterior iliac crest towards the ischial spine. 
X-Ray 11-8-12. Post-op appointment.

11-20-13. My first real outing, taking my new wheels for a spin!
Thanksgiving 2012, recovering with a glass of wine.
PAO hospital bill

X-Ray 12-6-12 - RPAO-ed hip.
Findings: No hardware failure. Osteotomy defects are healing. 





12-9-12. Oh, the blasted scooter. And yes, we LOVE Target. 
12-12-12. Walking for the first time post-RPAO!
X-Ray 1-17-13.
Findings: Stable fixation screws with no complication. No definite osseous bridging of the right superior pubic rami defect. 






X-Ray 2-28-13.
Findings: Increased bone callus formation to suggest further healing.
3-18-13 Back under the knife! Arthroscopic surgery to fix torn labrum and microfracture to create cartilage.





3-2013. Incisions from Arthroscope.
Hospital bill from Arthroscopic procedure.

Scars from both procedures.

CPM-ing it!
My personal parking spot for recovery. Gotta love the handicap plate.
Relay for Life of Cumberland. Organized this event and had to spend nearly the whole 2 days on my feet coordinating with people and vendors. 5-31-2013

Walking down the aisle as a bridesmaid at my brother's wedding. 6-15-2013

A ~20,000 step day in San Francisco. 8-20-2013

X-Ray 10-31-13. Frogger.
Findings: Stable alignment of previously identified periacetabular osteotomy with intact hardware and no evidence of complication. Improved coverage of the femoral heads bilaterally. No evidence of osseous bridging of the superior pubic rami.

X-Ray 10-31-13. Front of hips.

X-Ray 10-31-13. False profile. 
10-31-13. Dr. Schiller and I at my 1 year appointment! What a difference a year makes!

It's amazing to see the time lapse, for me. I can relive each of these moments as they happened and remember where I was in my journey.

Hope you enjoyed. I'll post later on my 1-Year appointment with Dr. S today.

Thanks,
D

Wednesday, October 30, 2013

Breaking Bad (Habits)



Now that I’m a year on, I find myself really focusing on the little things. I don’t walk with a limp anymore, and I don’t even hesitate to do anything at all with my hip throughout the day. Now, I mostly just focus on all the ridiculous bad habits I didn’t know I had. It’s amazing what the human body will do to “protect” itself over time. I’ve been in pain for so long, that my body developed these coping mechanisms I didn’t even know I had. You change certain things about how you move, and how you position yourself so that you don’t trigger that horrible pain. 

I don’t think I realized how many bad habits I have, until I started trying to break them. For instance, I still have a hard time walking straight upright. I still have somewhat terrible posture. Before PAO, my labral tears were so bad that I couldn’t take a full step across the top of my hip without buckling pain. If I ever even tried it, I would end up bent over cursing at myself. I also couldn’t stand up straight when I walked because the full pressure and stretching on the joint hurt immensely. So, I walked just a little bit hunched over with my shoulders slouched in, and leaning forward to alleviate the stretching in the front of the joint. I took small, half steps on my right side, limping so that I didn’t have to move across the top of the joint. Tom (my PT) used to call this guarding. I was guarding my hip from any motions that would cause pain. 

Another bad habit I learned over the years, to protect myself from my hip pain, was to walk down the stairs facing sideways. So, instead of facing straight down the stairs and putting all of my emphasis on walking down straight onto my hip, or over my hip, at some point I started walking down stairs with my body facing to the side. Usually, I face the left side. Most of the time, now, I catch myself doing this mid-flight of stairs and I think “What the heck am I doing?!” Well…when I really think about it...I was protecting my joint from full pressure and movement. 

I still physically pick up and lift my RPAO-ed leg into the car with my hands after I’ve sat in the seat, and then do the same and lift my leg out when I’m attempting to get out of the car. I don’t have to do this anymore…it’s just a bad habit. This was a habit I learned post PAO. The psoas and rectus muscles were so damaged that I couldn’t even lift my leg up with my own muscles, I had to lift it with my hands and move it into the car. Even today, over a year later, I still have a little bit of trouble doing this on my own…so I still lift my leg with my hands. 

I still sleep on my left side. Every night, always. This one is the worst. I can’t seem to break this habit. The problem is that sleeping on your left side for a million years is not good for any of the other joints…like, let’s say, your shoulder. My poor left shoulder and my left side of my neck are constantly aching because of this. Problem is, I can’t get comfortable any other way! I’ve been trying to fall asleep on my back or right side, it’s been a bit of a battle…but hopefully I’ll get used to it over time. 

These are just the ones I catch myself doing on a regular basis. Now, breaking myself of these things is what I have been focusing all of my “recovery” on. I make myself walk straight up, with good posture. I force myself to go down the stairs correctly. I am trying to remember not to lift my leg into the car, and every night I continue to try and sleep in another position. I’m finding it’s very difficult to change something your body has been doing for years and years. It’ll take some time, but I’ll get there.

Now that I’ve got other hip-y’s thinking about it, I bet you’ll start realizing that you’ve got things you do to “guard” against your pain. Whether it’s before your surgery, if you’re recovering from a PAO or other surgery, or you’re years separated from a recovery…I hope that you and I will both be able to live without guarding for pain.

Hope all are well,
Talk soon,
D xox

Saturday, October 26, 2013

365


What an interesting day it was. I felt a strange tugging on my psyche all day. I felt like I was in a strange vortex of time where I was living my current day…but I was constantly thinking about the day in regards to where I was one year ago.  I’d look at the clock: “Oh, it’s 7:45, they were just pumping me with happy juice to head to the OR.”
Or: “12:45? I was about an hour away from being out of surgery.”
Or my favorite:
“2:30? Ugh…I was VILE in recovery at 2:30. Mint green and all sorts of pukey”
And in case you’re wondering, at this time last year (6:40 pm) I was high as a kite on morphine and zonked out of my mind.

Anyway, I wanted to make this a post of reflection. One where I answer the questions I get often from people…and some I know I’d ask someone else if I had the opportunity. So, here goes nothing!

Did you feel like you were fully prepared for surgery and recovery?
Absolutely. We thought we were perfectly prepared…had prepared for weeks.

Were you actually prepared for surgery and recovery?
Absolutely not. But, the thing is, you really can’t be totally prepared. You can’t know how debilitating the surgery is, until you’re debilitated from the surgery. We figured it out as we went…it was a lot of learning on the fly.

What is the last thing you remember before surgery?
The very last thing I remember is looking around the operating room and seeing my surgeon standing around with his surgeon buddies oogling my x-ray.  I remember thinking various thoughts like: “I hope he slept well last night.” “I hope he had a great big cup of Joe.” And “Boy, I hope he’s feeling dapper today!”

What is the first thing you remember after surgery?
Dry heaving! I remember a lot of awful, terrible dry heaving. And I remember my lovely recovery nurse, Sarah, telling me I looked like the ceiling tiles (which were green). I remember she was a rebel and gave me my blood transfusion before she was supposed to…and I remember thanking her profusely because it made me feel so much better. Then I remember drinking a ton of ginger ale (only to later puke it up).

What were the first three weeks after surgery like?
This was the most trying/worrisome/painful/difficult part of surgical recovery. I spent the first 5 days in the hospital. This was both good and bad for a lot of reasons. First of all it was good because I was really nervous about how fragile I was. But…it was bad because you really don’t sleep in the hospital. For a place that wants you to rest, they sure do LOVE to wake you up every chance they get. I also had a little bit of a hard time because I reacted to the transfusion and had a high fever for three days. Once I broke the fever, cleared PT in the hospital, and got my surgeons’ blessing…I went home. I was so thankful to be home with my family…but petrified at the same time because I didn’t have nurses there for my every need. My husband (who became known as Nurse Matt) had to do EVERYTHING for me. We had visiting nurses come to teach us how I could get around in my house. I still to this day tell myself: Good goes to heaven, bad goes to hell. That is what the nurse taught me to remember which leg to use each way when you’re going up or down the stairs with the crutches. Good up, bad down. It was a difficult time. I had to relearn everything, and while it wasn’t particularly painful in the hip joint at this point…it was painful when I had to do my physical therapy.  Overall, it was physically and emotionally taxing the first two weeks at home. I had a hard time realizing and accepting all of the help I needed. I had a lot of moments that felt like a let down. I felt really helpless…and I hate that feeling. It took a few days for me to accept the condition for what it was…and to realize that I needed the help if I was going to get better faster. After those first three weeks, we were in a great rhythm. I was feeling stronger, starting to get my appetite back, and feeling better about myself.

What was the best tip or trick you learned to help you recover?
While I was non-weight bearing, the best trick I was taught was to put a plastic garbage bag on the reclining chair before I sat down. This plastic allowed me to slide easily onto and off the chair. It also helped me reduce friction when I was doing my physical therapy. I know that seems ridiculous…but I was so weak I couldn’t even move my leg at all because of the friction between my sweatpants and the reclining chair fabric.

What was the most painful part of the recovery while you were non-weight bearing?
The Rectus muscles. I had a LOT of pain my thigh muscles for a long time. When Dr. S did the surgery, he had to cut these muscles off of at their attachment point to access the hip joint. After he put them back, it took a LONG time for them to recover. I still have weakness in these muscles. The nerve pain was pretty prevalent for the first few weeks as well.

What was the most painful part of the recovery while you were walking?
The psoas. It is STILL the psoas, as we’ve all read in several posts. This has been painful from the very first few steps I took post crutches.


What was the most rewarding moment of your PT? 
The high hurdles! There was an exercise that Tom had me do with these little hurdles that he’d line up on the floor. I’d have to step up and over them and walk over all of them with both legs. The hurdles had a low and high setting. The high setting was only about knee high…but it took me MONTHS of Physical Therapy to be able to lift my RPAO-ed leg high enough to be able to do all the high hurdles without a ton of pain in the psoas. The night I did the all the hurdles on my own, without stopping…I nearly cried. I was so proud of myself.

What was the worst part of recovery?
It is easy to think of a lot of these! Staying at an angle less than 70 degrees! That was AWFUL. Having to sit in the recliner for WEEKS, in the reclining position. Another is that there was a day where my psoas was hurting so bad I had to leave PT early and I limped really badly for the rest of the day. That day, I really thought my psoas would never get better. The first day home from the hospital was really, really hard. Those are the three that stick out in my mind the most.

What is the best moment of your recovery so far?
Walking down the aisle unassisted as a bridesmaid at my brother’s wedding. That was a great feeling of accomplishment for me.

What was the hardest part of recovery?
Everything. But the most difficult part of recovery was constantly finding the patience that was required to get fully “better.” There were times where I just wanted to RUN away from my crutches…or to SCREAM because my stupid psoas was acting up. There were times where I would literally cry because I was so frustrated with how long it was taking. PATIENCE is the most difficult part of the recovery process. They say it takes about a year…because it takes about a year. Recovery is SLOW. Now, repeat that a hundred times when you’re just out of surgery…because you’re going to need to remember that.

What was the most frustrating part of PT?
There were days where I lacked the patience I needed to continue on with PT and recovery. These days I often got frustrated at PT and either pushed myself too hard or didn’t try hard enough because I felt like I was always doing the same thing and it wasn’t making a bit of difference…even though it was. The nagging issues like the psoas, the nerve pain, the pinching in the joint…they were frustrating because they took so long to get better.

Do you wish you changed anything about your PT?
I wouldn’t have changed anything, per se. I think that I may have like to have added massage and hydrotherapy. I hear a lot of people talk about these things and they were not a part of my physical therapy/recovery process. I bet the hydro would have been heavenly for my little hip-y. And who doesn’t love a massage? One of the biggest surprises post surgery has been how screwed up my body has become because of the different (read: correct) hip structure. My back hurts often because my hips are now correctly aligned and it’s not used to that. My sacro-iliac joints on both sides hurt occasionally, my left more so than my right. My core is all messed up because I’ve got a whole different posture. It’s been hard to get everything back where it’s supposed to be. No more slouching over when I walk, no more short steps. Massage through all of this would have been very beneficial, I am sure.

Was it all worth it? 
YES. Yes, yes, yes. It was 100%, no doubt about it, absolutely positively worth it. I am a new woman. I am rejuvenated. I sleep better, I walk better than I ever have in my life. I am living a life doing anything I want without ever worrying about pain. That’s something that I just couldn’t have fathomed before. I feel amazing…like really, amazing.


That’s it! If there’s anything else you’d like to know…or want to add, please feel free! Having input from readers has been so great. I hope that I can continue to be helpful for all of you hip-y’s out there. I’ve had a lot of fun with this, and I hope to keep it going!

So…in closing, let me just say “Cheers!” Cheers to a year that was filled with pain and healing, with hard work and dedication, with small bouts of depression…and big moments of accomplishment, with exhaustion and with rejuvenation.  There was some sadness…followed by elated joy. A year filled with highs and lows, a year of reaching goals only to set more, seemingly unattainable ones. It was the hardest thing I’ve ever had to work through, and now that I’m out the other side…I just cannot believe how lucky I feel. I feel lucky to have had fantastic friends and loving family to support me every step of the way. Lucky to have had a relatively easy, breezy recovery. Lucky to have found a surgeon who cares about me, and what I’ve been through and am still going through. A surgeon who’s skilled at what he does, and provided me the opportunity at a new take on life. One without daily pain and aggravation, a life without constant decision making based on levels of pain and fatigue.  A life where I can get up in the morning and just do whatever I want. I never have to worry about how many pain relievers to take before my day starts. I never have to worry about whether I can run all the errands at the end of the workday, or if I’ll have to save some for the next day when I’m not in so much pain. One where I don’t have to ice or heat my hip to try and alleviate the debilitating pain. I never realized how bad it was, until it was so, so good.

Lastly, I am thankful. I am thankful that I had the opportunity to have the surgery, thankful that I have had such a great recovery, and thankful (every second of every day) that I have had an extremely successful PAO experience.

But mostly, I am thankful for every one of you: all the people in my life who have supported me (silently or loudly). I am thankful, and grateful, and forever honored to have had such amazing people by my side throughout all of this. It’s amazing, what good help will do for a recovery. Most of all I can do today is owed to all of you out there who have been with me this whole journey.  I really couldn’t have done it without you. So, thank you. <3

Thursday, October 17, 2013

Psoas-asaurus



That title is for my eldest brother. He suggested it a while back and at the time I chuckled. As time goes on and it continues to bother me, it really has become a bit like a big, annoying dinosaur. So now, I find it appropriate.
I’m writing this post for a hip-y friend of mine who is currently 10 months post-PAO (go you!) and is having issues with their psoas. I wanted to just give a quick synopsis on what my journey with the psoas has been like.
Oh, the psoas and I…a somewhat tumultuous journey.
I’ll start by saying that (as of lately) my psoas pain has not been bad at all. It’s now more of a range-of-motion thing, as opposed to before when it was actually limiting my mobility. And also, overall, the pain has never been to the point of needing treatment (other than PT), I’ve always just worked through it.
So, the psoas pain really started after I was walking again in May and I first posted about it on May 24th (Snappin’ Snappin’Snappin’). It happened, for me, after my second surgery. At first it was so tight that I would feel it pulling and rubbing over the front of the joint as I took a full step. It was so tight that it hurt to the touch. It was awful.
For a long time, it kept me from taking a full step and I’d have to limp as a result of it. I worked with Tom (my PT) to loosen it up and get me walking normally. We did a lot of focused stretching and several exercises to try and strengthen the area to help stabilize everything. Overall, it took me about 2 months to work this issue out. This included PT twice a week and working on it on my own as well.
For stretching, Tom had me do these stretches the most:
Stand with bad psoas leg in the back, make sure to tilt pelvis forward.

This one is really awkward...but it's so helpful. Bad psoas leg down, good up.


The exercises I did to help stretch it and also strengthen it were these:









 And also this exercise with the ab dolly:
 I would stand with RPAO-ed leg on the floor and my good leg on the dolly, I used my good leg to move the dolly forward in front of me as far as I was able, and then I would swing it out to the side and behind me in a circle. Then I would pull it straight forward into its starting position. This creates a big circle. While doing this, you’re obviously bending your right knee a little and you’re in the ever-popular “athletic position.” I also would go in only one direction as well. So, move the dolly back as far as I could, then bring it back forward, then to the front and back, etc. This one worked my psoas really, really hard.
Good leg on the dolly, foot in the center.

Just so you can see the way the dolly moves.




So, that's really it! I never called the doctor or considered having anything done for it. Personally, I just wanted to try and work on it on my own and try and address it with PT.  

Now, about a year after PAO, I still have some residual psoas issues. I have some range of motion issues some days, when the psoas is really tight. I still have to stretch it from time to time...but it's certainly come a long way over the last 5 months. 

I can't say that it really bothers me regularly anymore. I do feel it almost all the time. If I have to lift my leg for anything at all, I feel the soreness. But it is light-years better than it was. It is tolerable, and mostly just annoying at this point. I will say that I still, definitely, have weakness in the leg, and the psoas issues contribute to that.

Let me know if you have any further questions on how I addressed my psoas issues...I'm always happy to help!

Thanks guys!,
-D xox