What can you do one month out of surgery?

Before surgery I found it very helpful to hear what others were able to do in the weeks post-surgery, rather than always focusing on all that you can't do.  I haven't yet set up my TRX as I had planned but I am still planning on adding that in at some point.

At four weeks, here is my standard workout/PT session:

20 minutes on the arm bike

Bridges

Lateral leg raises

Adductor work (on my back on the floor, knees bent, feet on the floor - gently drop the knee outward to the ground)

Prone leg lifts

Hamstring curls

Mini-squats

One leg balance, eyes open and closed

Calf raises

Hamstring stretch

Hip flexor stretch

That's all my PT work at the moment, then I move on to:

Planks

Modified push ups (I did these and the dips on the stairs when I was not up for going to the gym early on)

Modified dips

And then since I'm not cleared for free weights yet:

Chest press machine
Back row machine
Tricep/bicep machine

One month and will I run again?

Today is my one month surgeriversary.

They've started weening me off crutches in PT.  So I've had days of some increased pain, which they say is normal as I start using the crutches less.   Tuesday was particularly painful, to the point where I had convinced myself that I had injured myself somehow.   Things are better today but I'm still constantly worried about something being wrong whenever something feels "off".

I will be having my last pool therapy session next week and then we will move to all land-based therapy.  My pool work right now is 5 minute sessions each of:

• Walking, forward and backwards
• Lateral walking
• Marching
• Lunges
• Squats
• Calf raises
• Step ups
• Leg raises

By the end, my legs are pretty tired... and that's with the assistance of buoyancy!  I've noticed that my surgery leg is a good 1/2" smaller in diameter than my other leg.   It looks... scrawny.   We'll be adding in more strength work in the next few weeks and things should improve.

I've done a lot of thinking about my running future over the last week.   I have been having pains in my "good" hip.  I know I have poor body mechanics and chronic issues.  I have yet to have one year of running in four years without some sort of injury and time on the DL.   I had cartilage peeling off the bone in my hip, which is a step away from arthritis... which isn't that far from needing a hip replacement.

I have to wonder if my body just cannot handle running.

Is it worth the risk?

Did fixing the impingement solve some of my body mechanics issues and maybe I'll have a better track record going forward?

Will I know the difference between normal post-op-resuming-to-running aches and pains from something-is-wrong-I-should-stop aches and pains?

Will I be happy if I don't ever run again?  Will I regret the decision to not give it a try?

Sigh.

This is what happens after four weeks of nothing much to do but overthink things!

Part of the reason why this is such a struggle is that most of my social circles and "fun" activities center around running.  It's hard to let that go.  Because then... what would I do?  I think I would be happy riding my bike more, but I won't do bike races so I would still miss out on the competitive part that's a lot of the fun.  Can I deal with that?

Sigh.

The unexpected cost of surgery

I'm sure everyone realizes that surgery is an expensive procedure.   What I didn't appreciate beforehand though were all the things that surround the surgery itself that seem to put a drain on my wallet.

Physical therapy.  First, the copays... I will have approximately 25-30 physical therapy appointments post-surgery.  At $45 a piece, this is a serious drain on cash.   If we include all the sessions I had for this injury before surgery, it would get close to another 25.   Don't do the math.  It's scary.

Physical therapy is also a 55 mile round trip for me.  That would be my typical commute mileage for an entire week and now I do it 2-3 times a week.   And have you noticed that gas is not cheap?  Yeah.  Thankfully, my car gets 40MPG but ugh.

Internet shopping.  I may or may not have been on Amazon Prime post-surgery.  A lot.

Food.  We are going out to eat or picking up food more often, either on the way to/from physical therapy.

Work time off.   By the end of rehab, I will have blown through all of my sick leave and vacation time.  While this is not a cash issue, it still sucks.   "Vacation time" has a certain image of beaches and mai tais.  Not crutches and a pill sorter.

Race entrance fees.  I had signed up for several races before I was diagnosed, not realizing that I would be heading into surgery.  So now that I can't race, I effectively purchased a very expensive t-shirt for a race I didn't run.

Various purchases of "surgery aids".  I ran through what I purchased before surgery in this post.   Not for nothing, but most of that stuff will be useless shortly.  Glad I had them, but it still added up.

I'm sure I'm forgetting something.  It's probably best if I just stop doing the mental math now!

A very big thing happened today

Three weeks post-surgery.... and I drove myself to the gym.   That would be the first time I was behind the wheel of a car in 21 days.  When was the last time you went a full three weeks without driving?   Have you ever? 

At the gym I did:

My physical therapy work

Planks 2x1 minute (alternating 10 seconds on my feet 10 seconds on my knees because I am so damn weak at the moment)

Arm bike for 18 minutes - according to the machine that was a whole 3 miles!  

Then I did the back/chest/shoulder machines, since I am not cleared for free weights

This week I also went to work for 4 hours, which was the longest I'd been out of the house since surgery and I also was allowed to drop down to one crutch while in the house.  

This week I had more ache/groin pain but less of the "sharp" pains.  I can now twist on my hip (not that I actively try to do this) without a zing in the hip.    I can also now activate my hip flexors without pain, though they are incredibly weak.  

A big week all around!

Surgery is now two weeks in the rear-view mirror

I'm at the two week mark from labrum tear repair, femoral osteochondroplasty, acetabular osteochondroplasty, and psoas tenotomy.  (I know, big words!)   This surgery has about an 80% success rate, which makes it a mental as well as physical recovery, because with every little pain or nag I'm asking myself if I am in the 80% or the 20%.   We're just going to have to keep the faith. :)

A recap of recovery over the last two weeks:

For about 3-4 days after surgery, I had an intense, sharp pain in my groin whenever I would attempt to move my leg.   This completely resolved, and thankfully I was able to stop the narcotic pain killers.  This was mostly from the psoas release.   Now if I attempt to lift my leg (i.e. use my hip flexors),  my leg mostly just doesn't move.   If I keep at trying to lift my leg, I will start to get a nagging pain in the groin, but nothing sharp like after surgery.   

I've been told it can take up to three months before you can engage the psoas fully and it's certainly the most challenging part of rehab so far.   For instance, if I am standing on my crutches, I can move my foot about 1-2" off the ground.   So I can walk OK, but if I need to put on a pair of pants, I need to sit down, physically move my leg up and into the pants leg.

My lower back was seriously irritated from like day 5 to mid-second week and eventually I needed to start up the pain killers again.  It's calmed down a lot, with much less sciatica involvement, but still not 100%.   This is not uncommon post-surgery but given my history, I would have been more surprised if my back didn't react somehow.   Now that I am able to walk in the pool, things are better.  As I've mentioned before, sitting for long periods is just not good for low back issues.

I started physical therapy three days after surgery.  I had my first check-in with the surgeon's PA at the one week mark and the stitches came out then.  As soon as the stitches were out, I was able to start pool therapy and the rest of my sessions for May will be in the water.

My pain right now in the operated hip is just about zero.  After PT, I will have a little groin soreness but it never lasts too long.   Today was one of those stormy days that I would have felt in my hip and I felt nothing, so for now, things are going in the right direction!

You are what you eat, or something like that

When I am not exercising, my ability to eat well goes right out the window.  I don't fully understand why that is, because you'd think that if I am not exercising I really should be better about what I am shoving in my pie hole.   Today I downed an entire package of dried mango.  We're talking like 600 calories and 130 grams of carbohydrates in about 15 minutes.  OK, so there are worse things than binge eating mango, but if any of those worse things were within reach, I'd have eaten that too.

I have been wearing sweat pants or gym shorts for the last two weeks.   I fear the day I need to put on pants without an elastic waist.

It also doesn't help that my husband is in charge of preparing our meals while I am on the DL.  Not that he's a bad cook, but he's not as strict as I am about what it is that we eat.   Like, we probably wouldn't have had pizza three times in the last two weeks.   At least it was homemade pizza, I suppose.   And we also eat very late because he still needs to get his workouts in.  Dinner at 8pm means that I am snacking constantly until he can get a meal ready.  Thankfully, the meals I had prepped ahead of time and froze have gotten us out of a few way-too-late-to-cook jams... but we're already through most of it now!

Normally, I would do all the cooking.  I do what I call a "Sunday cook up" where I will prep as much of the week's meals as I can on Sunday. Sometimes I will even cook full meals so it's just a quick reheat for lunch or breakfast.  Sunday also includes getting some good snacks ready, so that when I am hungry, I don't devour 600 calories worth of dried fruit.   I keep track of everything I have in the fridge and the weekly meals with a magnetic white board.  I can get dinner on the table quickly during the week, so that I can get a workout in and still have dinner at a normal-ish hour.  I am anxious to regain control of my kitchen!

My basic rules for what I eat (you know, when not on the DL and eating everything in sight):
- Eat mostly fresh things that need refrigeration or have a quick expiration (i.e. not indefinitely shelf stable Twinkies)
- Limit things that come in packages
- And if it does come in a package, avoid gluten, dairy (ok, this one I cheat on too much), corn, soy, fake sugars, processed/added sugar

I tend to use paleo recipes because I know they will be gluten- and dairy-free.  I can't really call my diet paleo though since I have no real issue with rice or potatoes.

In June, our CSA will open and we'll have lots of fresh local veggies every week.  I love going to the farm!  It's a beautiful spot and it's nice to see where our food comes from and visiting with the cows and chickens.

CSA haul

Some of my favorite recipes:
Belly dance beet salad
Stovetop pork carnitas
Tricolor pepper steak - I make a few substitutions in this one, (like coconut aminos for the soy sauce) but the basic recipe is good
Pork medallions with cherries
Ginger beef with mango salsa
Southwestern frittata

My post-op bucket list

These are the things that I want to do when I'm done with this hip stuff:

1.  Put my socks on myself.  (figured I'd start off with an easy one)
2.  Bay to Breakers.   I love San Francisco and a race that needs to actually ask that people wear clothing sounds like it would be a fun time.
3. The San Francisco Half Marathon.  Mostly because I had to DNS this year because of surgery.  I basically bought a $100 t-shirt for a race I didn't run.
4.  A kayak-bike-run triathlon.  There aren't that many of these around, but I'd love to do one.
5. To be able to use my standing desk.   It sounds silly, but the standing desk has so dramatically improved my health, I don't know what I am going to do if my hip doesn't allow me to stand while at work!
6. Ten Penny Duathlon. Every.Damn.Year. I am injured for this race.  Last year was my first year doing it, but it was coming off an injury so I really hadn't trained at all. I think I had two or three bike rides before race day.   I'd like to be able to do this race healthy.
7. Steeple Chase Bike Tour.  I've done this bike ride several years, and it's one of those events I love doing over and over, mostly because the rest stops are all churches who bake goodies for the riders  (calories in > calories out for this event!).  I've had to miss it the last few years.
8. Soapstone Mountain Trail race.  It's local, it's put on by a great group and it has this warning:  The courses include a number of steep, rocky, slippery or otherwise treacherous areas. Though injuries have been few and minor during the races history, a serious injury is possible. Because parts of the long course are relatively inaccessible, it is possible that an injured runner might have to wait an hour or more for emergency medical care.
9.  Bolton XC Summer Series.  For 7 Wednesdays in the summer, $3 will get you entry into a tough 2.9 mile XC race.  No electronic timing, no t-shirts, no frills, but loads of fun.

I think that's all doable, right?  :)

Pool Physical Therapy

I've been in and out of physical therapy for many years and this was a first!  My session today was in a therapy pool from Swim-Ex, like this:

The water was probably about 90 degrees, so it felt very nice on the muscles and joints.  They also have an integrated water treadmill, which I will get to use later in the program.  Way cool.

Today's pool therapy consisted of 5 minute sessions of each of the following, in chest-deep water:
High knee walking in place
Walking - forward and backward
Lateral walking
Stepping up  (forward)
Stepping up (side)
Straight leg raises - front, back, side
Calf raises
Squats

My legs were jello after.  This is the first time since surgery that I've stood for that long, period, let alone that I was standing without crutch assistance.  No groin pain at all, which is the point of doing this sort of work in water to start since it's low impact and joint friendly.

I was so exhausted that I napped as soon as I got home.  Same thing on tap for Wednesday's PT!

One week check-in!

This last week seemed like a million years, honestly.   I had a physical therapy session and my one week check-in with the surgeon today (they are in the same office).   Physical therapy went fine - I'm now cleared to ride a bike for 10 minutes every other day with no resistance.  I'm sure that will work up a sweat. :)

The physician's assistant went through my surgery and surgery photos and explained everything that was done.  I knew pretty much all of it already from the post-surgery meeting, but this was in a little more detail.  Other than the one spot where it had started to delaminate near the labrum tear, my cartilage was pristine- no blemishes or defects.  Yah!   And they anchored the cartilage back down, so effectively that's been "fixed".

This is a picture of my labrum prior to being fixed (note the red, irritated look, red arrows).  It also shows my psoas tendon (blue box) which was the major cause of the irritation.

This series of shots shows the labrum after it had been fixed and anchored - the red arrows mark the anchor points.  In total, I had three anchors into my acetabulum to fix the labral tear. The smooth white surface on the righthand side is the ball of my femur.

This is what the neck of my femur looked like after they shaved off the rough ridge that had formed and that was hitting the labrum.

And finally, once they were done with everything, they stitched up the hole they needed to make in the joint capsule.

There are some photos of the acetabulum trimming, further labrum damage and whatnot, but frankly, I can't quite remember which is which!

To give you a sense of how small the space is that they are working in, here's a good visual:

Here's a photo of my stitches earlier today.  Some minor bruising, but nothing too bad.  

Day 6 Post-Op and First gym trip

Today was pretty uneventful, which is fine with me.  I am off the vicodin completely, thankfully.  On Monday that seemed impossible!  I am still on the NSAID, per doctor's orders.  Pain overall is maybe a 1 or a 2 out of 10, certainly nothing notable.

I went to the gym today and worked on my physical therapy and then did 10 minutes on the arm bike. This is what it looks like:

I didn't use the foot pedals because I am not yet cleared for cycling, but the arm work was hard enough.  Ten minutes was about 1.5 miles according to the read out and then I thought about the hand-bike folks who do a marathon with their arms!  Impressive.

In other news, I also have acquired a post-surgery cold.  Nothing terrible but annoying.

Tomorrow is my one week check up at the surgeon's office.  I am pretty sure he will be in surgery tomorrow, so I believe I will be seeing his physican's assistant.  I'm most interested to get all the details of what they did in surgery and hopefully some pictures as well.

Day 5 Post-Op and PT Session #2

Amazing what a few days can do!  Today's physical therapy session was much better than Monday's.  I didn't feel like I was fighting against my hip the whole time.  I was in better control of my leg and could do all the exercises without needing to use my psoas/hip flexors at all, avoiding the dreaded hip flexor spasms from hell.

In fact, I was doing so well, she had me put almost full weight-bearing on my op leg for a few seconds, then shift weight back to my non-op leg.   I was shocked, but it really felt OK, so I did a few more.   Then she had me do some "mini squats" - just bend my knees a little bit, with my weight distributed evenly on both feet.   Again, no issues for a set of 10.  I felt pretty awesome, especially after the miserable first PT session.

After therapy, my husband and I went out to lunch.  I can sit up for about the length of a lunch comfortably, but anything longer than that and I need to stretch out.   I've heard that some have issues sitting up post-surgery, so I am thankful that I can sit up for meals without too much trouble.

Day 4 and first day home alone

All in all, things are improving.  I have the process for getting on and off the couch down so that I don't need any assistance.  Crutch walking with partial weight on the op leg is getting easier and is pretty much painfree.   I slept solidly last night and pain only woke me up once or twice.

However, it's not all positive.  I still struggle pretty consistently with psoas pain.  If I activate my hip flexors even a little, the pain is very sharp and intense.  Like, seeing stars sort of pain.  And then I am pretty sore for an hour or so after until things calm down.  I am still on pain killers and anti-inflammatories but the psoas pain easily breaks through all of that.  It's about 100x's worse than any pain I had pre-surgery, and that sort of messes with me mentally since you want to feel better after surgery, not worse.  I know I just need to give it time.   But, argh.

The most difficult part of this surgery is all the soft tissue issues - not the joint itself, but all the muscles and tendons that are attempting to compensate for the joint.  I totally understand this now.  I can feel all the muscles around my hip starting to ache and spasm.  It's why staying off your feet as much as possible is important.  Doing too much too soon just results in fatiguing the soft tissue, causing tendinopathies and trigger points.  I cannot wait until I am cleared to get a massage!

Today was my first day home alone for most of the day.  Basically, it sucked.  My husband accidentally took my lunch to work with him, so I had no food to reheat.  I attempted to put some sort of meal together for lunch.  Talk about mission impossible.  The dogs were happy because I probably dropped 40% of what I was trying to prep.

I have to do my physical therapy twice a day and all but two exercises require me to be on the floor.   Uhhhhhh?  Mission impossible #2.   Eventually, I figured out that I can sit on the stairs and then using my arms (tricep dips anyone?), I can slide myself down the stairs onto the floor.  Then it's just the reverse to get back up.

Tomorrow is another physical therapy session in the morning.  I am no where near being able to drive yet, so thankfully I have a lift and will have company for the rest of the day!

Hip Arthroscopy - Day 3, PT Session 1

I saw the physical therapist for the first time.  Within minutes of starting, she had me almost in tears from the pain.  Off to a great start!  She backed off the rest of the exercises, thankfully, and I was able to get through the rest of the session without any further near crying episodes.

She said that folks who have surgery on Friday and then PT on Monday start off with a little bit of a disadvantage.   The dr. likes to get people in the very next day to PT so that they can start working on range of motion and flexibility. Those who wait a few days after have already started to have some limited ROM, so the first session is typically a little harder.

I asked her about the psoas pain and she said that it will take a while to be fully healed - like on the order of two months or so.  My goal for most of the exercises is to not engage the psoas, which is easier said than done.

I was given a series of exercises to do at home - heel slides, hamstring stretches, hip bridges, ankle raises, hip extensions and shifting weight onto my op leg.   I need to run through this progression twice a day.

Heel slides

Hip bridges

Hip extensions

We set up the rest of the therapy schedule for May.  As soon as my stitches are out (which should be at Friday's check-in with the orthopedic surgeon), the rest of my PT will be in the therapy pool.  So that's pretty neat.

Hip Surgery Shopping List

A few items have come in really handy post-surgery!

The first is the grabber tool.   This saves me from having to get up off the couch, so long as all critical items are within the grabber reach.   I have a water bottle on a table near by that I can snag, and it's good for picking up my cell phone, a bag of snacks, etc.  It also helps when you are trying to get pants on and you can't bend over!

Next - this ice pack.   Some people will get an ice machine (like Game Ready) for post-op icing, but my doctor just has us use ice packs.  This wrap has adjustable velcro and the ice pack can be placed anywhere with velcro as well.  This means you can put the ice on and still get up and move, without it falling off or moving.

This laptop stand lets you keep your screen at a good height to avoid neck strain. It's fully adjustable and I can use it sitting up or more horizontal.   It works for kindles and tablets, as well.

The leg pillow will keep your leg raised comfortably, without fighting with multiple pillows. (Adjusting pillows when you can't really reach your feet is not trivial, I've found!)

I purchased a backpack-style handbag so when I leave the house, I don't have to deal with a purse and the crutches.  It's called a "mini-backpack" and it fits my tablet and wallet and such.  I also have a larger backpack for around the house, so I can put stuff in it and carry it back to the couch.   Not having a free hand makes it tough to bring anything with you from Point A to Point B.

I already have blisters on my palms from the little crutch walking I've done.  Crutcheze are added padding for the standard issue crutches you get from the hospital.

I haven't yet had a chance to test it out, but I also purchased a stool for the shower.  I'll update once I've had a chance to shower with it (I can't wait!).

The first 24 hours after surgery

It's amazing how many things change in just one 24 hour period.   Two days ago I was riding my bike, today I can't do anything without assistance.

The pain is still not totally controlled, even though I am on vicodin and anaprox.   It's fine if I am sitting still, but when I move - especially if it's an attempt to lift my leg in any way - it's a strong, sharp pain in my groin.  I am pretty sure it's from the psoas release because of the type of movement that triggers it.  I'm hoping it passes soon because it's kind of a bummer!

Getting around on crutches are taking some time getting used to and I'm still not quite comfortable up and moving, so that makes getting around a very slow process.  I have mastered getting on and off the toilet, however.  And I also managed to get underwear on.

I really, really needed my husband around after surgery.  If I needed to get up for everything that wasn't within reach of the couch, I would have been in a lot more pain.  I do think though that I need a bell of some sort. :)  The intubation tube left me without much of  voice, so sometimes he doesn't hear my commands wishes, so the ringy dingy of the bell would be helpful.   I can't imagine living alone and trying to cope with this!  I can't really move my operated leg well on my own without intense pain, so he's been having to lift my leg for me, like when I want to get up from lying down on the couch or getting into bed.

Today we also start some range of motion exercises.  My husband needs to lift my leg and move it around in a circle, three times a day for I think the next few weeks.  I'm pretty sure this is what is meant by "in sickness" in our vows!

The wrap the have me in is enormous!  I couldn't get into real pants even if I wanted to.

Hip Labrum Repair - Surgery Day!

Last night, I was pretty anxious. My massage therapist had given me a CD to listen to so I decided to give it a try. I'm not usually one to do mediation or even much in the way of alternative medicine, but I found it really calmed me down and I was able to fall asleep without much trouble. I liked it so much that I might try it more often - I definitely felt relaxed and zen.

The relaxation didn't last long and I was up at 2am.  When the alarm went off at 4:45, I had only dozed off a few times.   So needless to say, I was tired.   But I figured I was about to get a two hour nap!

We arrived at the hospital a few minutes early at 6am.   I got all checked in and my husband snapped this photo:

I was not on any meds at this point, btw.  That cheeky grin is au natural.

I spoke with the surgeon for a few minutes and he signed my hip.  At about 7:15, the anesthesiologist came in to tell me what to expect.  I explained that I get nausea from just about anything that can possibly make someone nauseous so he decided to go ahead and give me a scopalamine patch.   Good call, as I didn't feel any queasiness at all.

At 7:30, right on time!, I was walked back into the operating room.  There were probably 6-8 people, buzzing around.  And it was about 60 degrees in the room so I immediately started shivering!  The gown I was in didn't offer much in the way of warmth.

They had me climb onto the traction table (do yourself a favor and do NOT google image hip traction) and covered me with a warm blanket.   Ahhhhh.  I was out cold pretty soon after that - a few breaths of the happy juice and it was nap time.

I was wheeled out into the recovery room around 9:45, so I think surgery took just about two hours or so.

I was in recovery until about noon, mostly because they were having trouble getting my pain in check.  I ended up getting a GRAM of tylenol IV.   A gram....  of a pain med that has questionable safety margins?  Oy.  Then fentanyl.  Then oxycodone.  And it still wasn't quite enough.  :(

The surgeon came in and explained all that happened.  He said my hip was "the real deal".  He commented "I see this sort of thing in college athletes.  Usually in people approaching 40, it's more wear and tear type degradation.   This was  a traumatic athletic event."    I took this to mean that I am as fit as a college athlete.  Right?  RIGHT.

He was a little surprised/impressed by how big the tear was, especially since it didn't look that bad on the MRI.   It was a large tear and spanned three of the four "quadrants" of the hip socket.   

In addition, the cartilage around the edge of the hip socket had started to delaminate from the bone.  He was able to anchor that and labrum to the acetabulum, so it should be functionally repaired.  In total, he needed three anchors to reattach everything.  The rest of the cartilage looked to be in great condition.

I  had a triple impingement - meaning, I had a cam, pincer and psoas impingement on my labrum.   He took down the bone on my femur, hip socket and cut the psoas tendon partially to give it more length.  I think the psoas is what is driving most of my pain post-surgery.  It is a sharp pain right above the groin.  The meds have it to the point where it only hurts if I move and not constantly bothering me.  But it sure makes getting up and to the bathroom fun.

My back made it through surgery without any major worsening, which was a relief.  I sure I would have some sciatica issues.  Of course, I am still numb from the top of the leg down due to a femoral nerve block (I think), so when that wears off, it may be a different story.   For now, it seems fine.

My throat is SUPER sore.  Like, I'm losing my voice, sore.  

Otherwise, I am so glad to be on the other side of this and can now focus on getting better. :)  First PT session is Monday!   And tomorrow and Sunday I have some moves to do to keep the formation of scar tissue down.