What I Re-Re-Re Discovered

I have probably said this a hundred times but...when I do nothing I feel better! Since the airport/ Vicodin night, I have done nothing. I have left the house twice, once to go to Starbucks and once to go out to dinner. Zk has been really sick, so I haven't wanted to take him anywhere. He is feeling better, nothing like a round of Amoxicillin with a dose of Prednisone (really bad wheezing and probable ear infection). So for 3 days I have barely moved, and had almost no pain. Its amazing, Zk was finally a little better tonight and I had to try to keep up with him and I could feel soreness returning. Nothing of concern, I mean, I did have surgery 4 weeks ago, but what a difference the activity level makes. This is like after surgery #3, when I couldn't get out of bed for a week because I was so nauseous, my hip felt great!
I have been doing a lot of indoor activities with the other kids too, because I don't want to run around outside just yet. I have sat in indian style more than once, I mean, come on, how can I build a kick ass Thomas track, or a Lego city? I don't do it on purpose, it just happens. It is also hard to sit with Zk on the bed without ER in that hip. I am changing diapers, nebulizing, feeding etc.

I have been sleeping mostly on my non-op side, and I need a pillow in between my knees or else the op side hurts. Also, I am disappointed with the persistent swelling in my thigh all the way to my foot. I need it to go away, it is really uncomfortable.

My Fat Ankle

This morning I had a little incident, nothing really happened, but I will still refer to it as such. I was standing up, doing nothing, and I must have either very slightly turned my leg or turned my body and I felt this very sharp pain deep in the joint. It was a very specific point, and it was a reminder to me that things are still healing and I have a ways to go before things are normal again.

I had PT today and I felt the effects of the incident, I had to lower the weight on the leg press and eccentric SLR were painful and my psoas popped a lot. I stopped doing these.

We are now in Miami, its been a long day, between packing, getting to the airport, the flight... J talked me into taking one crutch since the gates are far, and I am glad bc I ended up using it. Now, I am finally in bed with extremely swollen ankles, heavy legs and a sore hip. Not too mention twice vomited on by an adorable Zk who is sick!

I emailed BK's PT to discuss my concern about the ER. He said obviously don't push it, and he said that I may be one of those people who don't scar down after the surgery...it seems I am always "one of those people"!

Ouch!

Ok, I need to back off a little bit, I can actually feel the inflammation in my hip making a comeback, with more swelling all the way down my leg. So far I've had 2 days off of crutches, and PT yesterday. Again, PT was great, she had me on the leg press at 75 lbs, doing wall squats, hamstring curls with a 2 lbs ankle weight, prone hip extension with my knee bent with a 2 lbs ankle weight, quadruped hip extension, eccentric SLRs, plus a lot of what we have already been doing. Not only was I exhausted last night but I was in pain, so I hit the Vicodin before bed. I am still in bed now and just feeling a lot of heaviness in my leg, soreness in the groin and butt.
We discussed my concerns over the excessive ER. She thinks that it is tight enough now to prevent it from sliding around in the joint now, but that I will have my full range, or close to it, since all the muscles are already stretched out. She is having me strengthen my internal rotators to try to help.

Just as a precaution, I emailed BKs PT about it too, I haven't heard back, but there was a nationwide blackberry outage last night so I hope it went through!

I think I would benefit from a daily anti-inflammatory, but this option is out, I am left with taking Tylenol during the day and if needed, Vicodin at night.

I Think I an Offiially Retire My Crutches

3 weeks to the day of my 4th surgery and I ventured out of the house sans crutches. It was super snowy and icy and I felt that given that I had been walking around the house without them for a while, they may become more of a liability outside. I went to the mall and did way too much walking. On top of that I did a little Target shopping too. Needless to say, I was exhausted by the time I was done. I did have some soreness and discomfort while I was walking, and my gait is definitely off one way or another. I almost feel like I look a little drunk at times, especially if I am really fatigued. I had pain last night but I managed without any meds. Today will be day 2 of no crutches. I have PT later this morning, I will share with my therapist my concerns over the excessive ER and see what she has to say about it. I will report back!

Turning The Bend

I just realized I haven't posted in a few days, my sincerest apologies! Things have definitely gotten a lot better since we last spoke! Thursday I had PT again. She had me doing some more standing exercises, including mini wall squats and hip flexion/abduction. The flexion/abduction was fine on the operated leg but the non-op leg was fatiguing quickly. She also added some passive adduction to stretch the ITB. It went well and I felt really good afterwards.

I think I am officially done with painkillers, yay!!! I am also pretty much done with crutches, I have been taking one with me when I am out of the house but think that starting tomorrow I will ditch it. My external rotation is a bit too good right now, which is my only concern. I don't think there is anything that can be done, but there is almost no tension when I accidentally, without thinking, externally rotate. I like to do this thing where I will half indian style sit on one leg when in a chair, I have done this on the op leg and had no pain or restriction. I also wake up with it externally rotated sometimes. I hope this is ok. I don't see BK until 1/20 and don't think this is an issue that I have to call or email about. I will run it by my PT though, just in case.

My thigh pain is getting better, finally! As is the bruise on the side of my hip. An issue that I am not happy with s that my ankle swells, and my hip still feels swollen. I don't remember this much swelling in the past, and although the ankle swelling is minor, only noticeable to me, and probably not seen by anyone since I usually wear boots when I am out, it is still concerning.

I don't plan on leaving the house today since we are basically snowed in. On the bright side, I finally was moved up on the waiting list and got an indoor parking spot (trust me, in NY, this is huge), especially since I have been getting really fed up with my outdoor lot, but have not had any issues with them since the infamous "hell" issue!

In The Blink Of An Eye

The rest of my day didn't go as well as the beginning. I will fast forward to the end of the night which featured me back on 2 crutches, then in bed with Vicodin.

My day did get a bit hectic, Jk had a doctor's appointment which involved me picking him up at school and walking to the appointment, probably a total of 7 blocks. Then giving the kids dinner, which involved a lot of whining, and "I don't want that". We had a leaky diaper incident, some bratty shower moments, and lots more whining.

I was not happy! Luckily J came to the rescue and took over bedtime responsibilities.Hoping for a better day today!

Crutching Away

I have been going back and forth between 1 and 2 crutches these days. I use one in the house for the most part, unless I am in a lot of pain, then I use 2. Or, if the kids are being especially needy, then I use none. Like when I 'lost' zk only to find him splashing around in the toilet. So I had to give him a bath! We have been ok so far, J came home at a decent hour last night to get everyone into bed.

I had PT today, and am progressing slowly but steadily. I am very happy so far with my PT, and especially happy with her conservative manner. I don't feel the need to rush this at all, and everything will come back with time. I was feeling a little discouraged with my flexion ROM, but she measured it today at 113', so I am pretty happy. She did a little bit of passive extension, to 15', and measured my ER at 30', we won't be pushing that anytime soon. I have been concerned about having excessive ER at this point but this made me feel better.

We are going to Miami next week, I hope to be done with crutches by then!!!

Back On Narcs

I can't seem to win. Every time I think I have turned a corner with the pain, I end up doing too much and needing to go back on narcotics. I woke up this morning and I knew there was no way I was managing with one crutch, and no way I was managing without meds. Incidentally, it is a pretty gross day out. I also did a lot of walking in the city last night (ok, not a lot, but a lot for me) and a lot of stairs at a night club where we went to a concert. I did really well last night, just got a little stiff from sitting too long.
This morning I had a lot of quad/ thigh pain. My entire thigh still hurts, all the way to the knee now. It is most likely a side effect of the traction, I just hope it goes away soon. I also had pain deep, deep in the groin, near the adductor insertion, only deeper. I started with an Aleve, hoping to get away with just that. 20 minutes later I couldn't take it any more and ended up with half of a Vicodin. I feel better!

Warning: Graphic, Read At Your Own Risk

No, this is not a sex post!

Now that that is out of the way, I can begin. I have been having a lot of pain on the outside of my hip, it is swollen and ugly and bruised, and tender to the touch. The sutures came out Wed. and have been covered with steri strips, but one of them has felt very hard and had a huge lump around it. I decided that this may be scar tissue so began working on it earlier in the week. It didn't change much. Last night I decided to take off the steri strips (even though I had been told to keep them on for a week) and see what was going on. Indeed, there was a hard lump around one of the incisions. I began once again trying to work on the scar tissue when suddenly, a gush of blood shot out from a small opening at the bottom of the incision. As this happened, I felt a release around the incision. As I squeezed the lump, blood oozed from the tiny opening. It was very dark blood. The lump got smaller and smaller as I squeezed. I suddenly had less pain in the area and the lump was disappearing. Last night I was able to sleep on my operated side for the first time since surgery. It seems I had a pocket of fluid collecting under one of the incisions. I had a similar issue after my c-section with L, a pocket of fluid collected under the incision.

As far as yesterday went, I was really getting depressed. Today wasn't too much better so I put myself on a low dose of Zoloft, leftover from my first 2 postpartum weeks. It did the trick then and should do the trick now!

I have a lot less pain today, I haven't taken any type of pain medication (including OTC) in 24 hours. I can walk in the house almost all the time with one crutch, when I fatigue I need 2, usually I feel it in the IT band first and then I know its time for 2 crutches. I am going to a concert tonight...wish me luck!

My Breaking Point

It seems as if I am hitting a rough patch this morning. I am beginning to feel frustrated and sad at the same time. It just doesn't seem fair. As I sit at my computer, holding back tears, I wonder what I could have done wrong to end up back in this situation, 3 small children to care for on crutches. Up until now, my mom has been here and has been doing pretty much everything. She went home today and I am feeling extremely overwhelmed. I am using 2 crutches for the most part, I am able to get around the house a little bit on one crutch, but the pain in my ITB gets worse when I do this, so I know it is not a good idea. Jk wants me to take him to school, L is concerned about how I am going to dance with her at her school Chanuka party next week, and Zk just wants me to hold him.

I know this is temporary. I have been here before. I am almost positive that I can read back to another post and I will have written the same thing at around this point post-op. It is just so hard to have to rely on others for just about everything.

If I continue to mope, I start to wonder why I was destined to have 4 surgeries, in less than 3 years? I try to be positive, I guess this is not the worst thing to have. It is not life threatening, more of an inconvenience. But as I am living with the reality of it, it is hard to be positive. And just like in the past, I know that this too shall pass.

Fourth Op- Report

Preliminary Diagnosis: right hip labral tear status post instability episode, status post prior hip arthroscopy with re-tear of labrum

Postoperative Diagnosis: right hip labral tear status post instability episode, status post prior hip arthroscopy with re-tear of labrum

Name of Operation: Revision right hip arthroscopy, labral tear debridement, synovectomy, debridement of ligamentum teres, and capsular shift procedure with revision decompression cam and rim side.

Indications: The patient suffered from persistent right hip pain 2 years status post a prior hip arthroscopy after she had been in a forced external position after she had a baby. She had a stretch of the anterior capsule with persistent pain, re-tear of the labrum, and also tearing of the ligamentum teres. She had failed non-operative measures and given the persistent pain and lack of improvement, she was indicated for right hip arthroscopy and associated procedures.

Procedure: After the patient was correctly identified in the holding area, she was brought into the operating room. Spinal epidural anesthesia was administered. She was placed in the supine position on the traction table and approximately 10mm of distraction were achieved across the acetabular joint. The right hip was then prepped and draped in the standard surgical fashion.

A lateral portal was established under fluroscopic guidance using the Seldinger technique. Then a mid anterior and additional anterior lateral accessory portal were both established. Arthroscopic examination demonstrated a labral tear anteriorly with evidence of a defect in the anterior capsule. There was some residual mild bone spurring bone spurring on the acetabular rim as well as mild superior lateral cam impingement lesion. Residual remaining aspects of the decompression were in good condition. There was synovitis adjacent to the capsular rent, and there was synovitis in the fat pad in addition to a partial tear of the ligamentum teres.

At this point the labrum was debrided of non viable tissue. The capsule was elevated off the residual rim impingement and then a rim decompression was performed. The ligamentum teres was then debrided of non viable tissue and a fat pad debridement was performed. The cartilage on the femoral head was in excellent condition as was the remaining aspect of acetabulum.

The scope was then placed in the peripheral compartment where a T capsulotomy was performed for good visualization of the superior lateral aspect of the cam lesion. There was some extension of the cam superior laterally. Cam decompression was completed up in the superior lateral 11 to 1 o'clock position with good visualization and protection of the retinacular vessels during this period of time. There was some irritation and erythema around the labrum in this position consistent with the residual impingement. At the completion of the residual cam decompression, no further impingement was present.

The T capsulotomy was then shifted for solid clossure of the anterior capsule. The medial limb was brought lateral with 5 sutures passed side to side using ideal suture passer and a bird beak penetrator with good secure fixation of the capsular repair. at the completion of the capsular repair, no residual defect was present. the head was well contained with the socket. At this point no further pathology was identified.

The instruments were removed from the hip joint. It was drained of fluid and the arthroscopy portals were closed with 3-0 nylon sutures. A marcaine cocktail was placed in the joint. The wounds were cleaned, dried, sterile dressings were applied, and the patient was awakened from anesthesia and brought to the PACU having tolerated the procedure well.

Sutures...Gone!

I don't know if I have mentioned that sutures really gross me out. Yes, I see them all the time but it just seems so unnatural to have them in your skin, and my PT thought they may be part of the reason I feel so tight and pinchy.

It was no surprise to me that I showed up for my appointment today, which was scheduled the day I scheduled surgery....with a whole discussion on whether it would be ok to have them out 9 days post-op...and I had no appointment. The same thing happened with surgery #1. At least this time I hadn't thrown up in the car on the way down, and was in the correct office. And just like last time, there was no way I was coming back another day!

I think from now on I just won't make appointments because I get seen a lot quicker this way, no waiting in the waiting room, little waiting in the room! J/K

So the incisions look good, except for one which is still good but needs some time with the steri strip. My flexion ROM is good, and I have decent ER, I can stop wearing the @###$$%&$ boots at night! The bruising and swelling is probably bleeding from the capsule. He had to do a capsular shift, so he cut the capsule and instead of just approximating the edges together and suturing, he overlapped the edges and folded over the extra tissue, I now have a tighter capsule with a REALLY strong repair. He showed me the scope pics, the psoas looked great and is "unscathed" (guess he knows who he is dealing with). He was really impressed with the quality of the cartilage, I am thrilled about this.

I am very concerned about the repair and the ER so I spent some time discussing this with his PT. He said stick with gentle ROM for 6 weeks, it will come back. No joint mobs for 6 weeks. He said treat it like a shoulder with a repair, you want the mobility but you also need the stability. I feel better but still nervous about it. I see him again in January, I hope the ROM is good by then.
I have the op report and will post is as a separate post.

Swollen Swollen Swollen

That is the best way to describe my thigh right now. It is so gross! I really feel like it will burst open any minute, I feel like when the sutures come out tomorrow, the leg is going to explode. My bruise is getting more purple each day. I also have a faint black and blue line around my shin, must be from the boots in traction.

I had PT today and was complaining about tightness and tenderness to the ITB. My PT worked on it, and kept asking if I was ok, if it hurt, could I tolerate more etc.....it was basically numb. She could do whatever she wanted and I barely felt it. Its not numb numb bc I feel something, so we will refer to it as parasthesia, or decreased sensation. The front and lateral aspect of my thigh have decreased sensation. Hopefully once the swelling goes down it will get better.

I am afraid to put on anything other than sweatpants, I don't want any material rubbing on my thigh, or anything tight around it. So I am going into week 2 of sweats only!

I have my post-op appointment tomorrow, I plan on asking why I look like I had the crap beaten out of me (i.e. huge purple bruise on the side of my thigh) and if I should possibly go back on an anti-inflammatory for a while to bring down the swelling. I will let you know what he says...

My Frustration

My goal at this point is to be pain free and no longer need to take narcotics. Unfortunately, I have not hit this goal. I would also really like to be able to ambulate in the house with one crutch, this too is not happening. Usually, the reason I can't go down to one crutch is weakness and a horrible limp. I don't think I am that weak this time, I actually have pain if I put too much weight on that leg...except if I take Vicodin. so I land myself in this situation, I can do a lot more with Vicodin on board, but it is just masking the pain. Once it wears off, I have a lot of pain. I don't remember having this much pain any other time. I will have to go back and read my old posts again, but I am pretty sure I didn't.

I am also exhausted beyond belief. I can't sleep at night bc I am limited to which positions I can get into. I can't sleep on the operated side bc it is really painful, still swollen, and still has some bursitis. The bruise on that side continues to get worse, it looks awful.

Anytime I try to do exercises the leg feels so stiff and swollen, almost like it wants to burst at the seams. Occasionally, I will get this funky kind of pain in the front of my thigh and then down in my foot, I assume this is some sort of nerve irritation and hope it resolves quickly. My ITB is still very tight and tender.

Today I have PT again, hopefully I will leave feeling better this time!

I keep forgetting to mention the good news...the left leg is holding up beautifully, no pain or soreness. Occasionally a bit of fatigue but that is it!

I Want My Life Back

I always seem to over do things post-op and always end up regretting it. I have been looking through old posts and seeing what I was doing when. I seem to have a knack of trying things too soon.
So, just an update, I tried to walk with 1 crutch around my bedroom last night, this was after a party where I spent about 30 minutes on my feet, then sat for almost the rest of the time. I was pretty excited because I was able to do it. Unfortunately, I woke up with a lot of pain today. I am trying to avoid pain killers so ice is my best friend. The leg also feels more swollen today and the incision sites are painful.

One thing I have been looking back in my blog for is this business about an invisible bruise. My entire thigh hurts in the front, almost down to the knee. There is nothing there. Just pain, almost an aching. I am also very bruised on my lateral thigh, close to the greater trochnater, I had ugly bruising like this last time. This bruising developed a few days post-op and seems to get a bit worse each day. It is painless, but ugly.

I have very good flexion ROM but IR feels pinchy, I hope and pray that this is temporary. ER is still restricted, and if I accidentally go into it, it HURTS.
I have been doing my exercises and can do a sidelying straight leg raise (abduction). I have been practicing in bed, abduction (gravity eliminated) but get a lot of ITB pain. The ITB may have a touch of tendonitis so I am definitely sticking to 2 crutches and being super careful.

I have my next PT session Tuesday and see BK on Wed., hopefully I will be able to do more next week!

Not a Good Morning

Again, I woke up feeling very un-rested. I "kicked" off the boot sometime in the middle of the night and slept on my left side with pillows in between my knees. L woke me up at some point and wanted me to take her to the bathroom. I was in horrible pain so I took a Vicodin (at least I hope it was a Vicodin, it was pretty dark). This morning the pain was better but I woke feeling slightly dizzy and lightheaded. I don't know if it is from the Vicodin or just a combination of all the drugs I am taking. I had to fill out some paperwork yesterday at PT, and I had to write down the meds I take, it looked like this: Vicodin PRN, Indocin (anti-inflammatory), Prilosec (to prevent "issues" from the Indocin), Zofran PRN (nausea), Pentasa (Crohn's) and Xifaxan (Crohn's). Between that list, and marking the hip on the body chart, you would never guess that I am 29, more like 92!

I will take lightheadedness over nausea any day, but I really hope it goes away soon!

Let The Rehab Begin

Have I ever mentioned how much I hate PT? Ironic, I know, I guess I should clarify and say I hate being the patient in PT. Today was my first PT visit.

The day started off pretty crappy, I woke up nauseous, which made me panic. The first thing I did was run (ok, not run, but limp) to the Zofran. Next I put the Vicodin out of reach. This can not be happening. I also quickly called my OS office to have a new Scopolamine patch called in. I don't really know if it is working or not, but the placebo effect is powerful enough for me! The Zofran helped and my pain wasn't too bad today, so no Vicodin all morning. For whatever reason, the Zofran made me very lightheaded.

My PT appointment was at 2, so my mom and I decided to go out for lunch. I wore my oh so gorgeous brace since I am trying so hard to be compliant with my restrictions. It definitely helps me, but on the flip side, people stare like you are from outer space. It makes me really think twice about wearing it again, except when the possibility of ruining my newly repaired capsule comes to mind. I don't have plans to leave the house again until Saturday night so I will re-evaluate the brace situation then.

PT was simple today. My old PT P has left the practice, I chose C to be my new PT because she has helped me a lot in the weeks leading up to surgery, and she is significantly older than the other therapists I work with, so I figured she has a lot more experience. The rehab for this surgery can be tough, if I feel like it is not going the way I want it to, I will see one of the PTs my OS recommends.

My exercises for now are: heel slides, glut sets, bridges, hip abduction in supine, trying to perform hip abduction in side lying, seated long arc quads, standing hamstring curls. She also did some gentle PROM into flexion, abd and a hamstring stretch. She also had me do ankle exercises to help with the swelling.

I am in a lot of pain now and went back to the Vicodin. I may have overdone it with the abduction because I am having a lot of ITB pain, even when I am in bed. I feel like I have to put even less weight on my foot now and have to be super careful when I move. I may also have a touch of bilateral greater trochanteric bursitis.

Any advice on sleeping? The boots are killing me. This is how bedtime goes for me: J puts me into the boots. 10 minutes later I begin to feel claustrophobic. At 12 minutes my heart begins to race and I begin to be on the verge of a panic attack. At 12 1/2 minutes the left boot is off and I feel better. J then has to move the bolster that goes in between the boots to the outside of the right boot. I will fall asleep on my back for a little while. Then I wake up and NEED the right boot off. The boot comes off and the pillow comes back. I then sleep on my left side for a bit with pillows in between my knees, until the bursitis on the left begins to act up. So as you can see, sleeping is no fun for me!

The Weightbearing Restrictions Really Do Make Sense Now

I still feel like I am doing really well and the nausea is non-existent. Unfortunately, I remember it once or twice starting day 2 or 3. I spoke with the PA at my OS office yesterday, my biggest concern is the nausea, since I am pretty familiar with how the hip will heal. I left the hospital with a scopolamine patch which is good for 72 hours. I am nervous about what will happen after the 72 hours, even though I don't have even a bit of nausea. He assured me that if I want, he will call another one in for me. Its a good thing I am a junkie on anti-naseau meds and not narcotic painkillers!

Again, I spent a good part of the day in bed with ice packs, I got out to shower (whoops, still early to shower I think), rode the bike 2 or 3 times (vicodin makes me forgetful and dumb) and my friends came by with lunch for me. Sitting is painful sometimes so I avoid it as much as possible. I also had an "outing" today, well, more like an outing out of my apartment! I went down to the lobby twice, once to get L off of the school bus and once to get Jk as he was being dropped off from a playdate.
I am going to blame this one on the Vicodin, being that it is such a good pain killer for me, and that it makes me stupid, when I got out of bed earlier, I accidentally put all of my weight on the operated leg...holy shit...I literally saw stars. And here I was thinking that I don't really need crutches! Now I see that I really do! Since I haven't really ventured into the real world yet, I haven't put on my lovely bledsoe-philippon brace. In the past I have been pretty non-compliant with it, I think this time I will use it to avoid going into ER or extension, since I am supposed to avoid it anyway, and when I forget, the pain quickly reminds me.
Tomorrow is my first day of PT, again, I am breaking the "rules" since I was supposed to go yesterday. I took the liberty of making my own PT schedule this time since the last 3 times I was not at all happy to have to get dressed and out of the house so soon. I am also not looking forward to eventually having to get my ROM back.

I am not having any of the pre-op groin pain. I have butt pain and a lot of surgical pain anteriorly. I am really swollen too, not just my right leg, but all over, my ankles are swollen, my calves...I just look and feel puffy!

Thank you to everyone who has written to me, or posted comments on my blog. Once I can sit at the computer, I will be able to respond to the comments, for now I am blogging with my blackberry from bed!

Day 1...for the 4th time

Post-op day 1 has been pretty uneventful. My pain is pretty mild, I took a Vicodin this morning when I woke up, and one just now (7 hours later) There is absolutely no nausea, the anesthesiologist was great, he said we would give me lots of drugs to help me and I went home with a Scopolamine patch to wear for 3 days. I rode my bike twice already, and am spending the majority of my time in bed with ice packs.

My hip feels incredibly tight, it is hard to move it, but it does flex easily and I can do heel slides. I am also trying to remember to do ankle pumps, just to keep things moving. I am keeping a pillow on the outside of my leg to prevent external rotation.

I showered this morning (shhh...don't tell) with water proof band aids, I just felt really gross and dirty, and "hospital smelly". I have 3 incision sites, I can't tell if they are in the same place as the old ones or not, my thigh is pretty swollen and ugly right now. I am experiencing pain down my thigh and into my ITB, I guess it is to be expected after this surgery. What I don't have this time is the horrible bruising I had last time, which lasted a month. I can't yet tell if I have any numb patches or not, when the swelling goes down I will be able to tell more.
Overall I am pleased with day 1, I have had worse day 1's before!