Cane-free but not yet Pain-free

A few days ago I left my cane behind. Not literally. It's still in my kitchen, getting in my way. But I decided to try walking around without it. My leg notices but I think I walk pretty well without it. I don't need to limp. As always, my concern is with my posture.

During the day I experience pain in little ways. When I put on my right sock and shoe (diminishing pain, happy to say). When I pull my leg into my car (just a little). Mostly I feel that tension that never goes away when I am on my feet. The therapist says we're gaining on it, on the straightness. I'm not sure; I think he may be delusional.

At night is where the pain rubber hits the road. I have trouble with restless leg - just the right leg - and often I awake with pain in my right knee. Sometimes it creeps down to my foot, sometimes the pain is more on the right side of the knee, sometimes the pain goes up the thigh. It is all the same, though, pain that is impossible to ignore. Oddly, if I sit on the edge of my bed for a few minutes, with my legs hanging over, the discomfort tends to go away. It doesn't usually stay away. If I get up and walk around that tends to help a lot. I just never feel like getting up and walking around. All I want is to get back to sleep. My resistance to what I know works knows no bounds.

In therapy I am still not entirely up to the former levels I used on the machines, but getting closer. I'm happy to wait. More often I find I have no pain on the hip machine, which is a really big deal to me.

Today's challenge is going to wear me out. I am going to Santa Barbara on a train with a bunch of other Aqua class members and friends. Once there we will walk around, do whatever we want, until the train leaves late in the afternoon. Many will shop. I see little shopping in my itinerary. The challenge for me will be to get through it. Finding enough places to sit down, making my way on the sidewalks to where I want to be. I am so often reminded that most of the things that are enjoyable to so many involve walking and standing. I admit I feel impatience that after three surgeries I am not there yet. I think back to the years when I could walk and walk forever. I want to do that again, to enjoy it, every step.

Life after

On March 26 I had my right hip replaced. I had heard so many glowing accounts from patients of hip surgery that I practically expected to walk out of the hospital with no pain at all. That may happen to some but it didn't happen to me.

I used a walker for most of the first week. Then I moved to the cane, which I am still using. I am hoping to set it aside in another week, but my therapist says not to rush. Take what time I need. It's a nuisance to use a cane all the time. It's like being one-handed.

But back to the last few weeks. I left the hospital on March 28, morning. I might have left the day before but the surgeon was out of town until that night, and I don't think that hospitals enjoy releasing patients at night. Hospitals are so intrusive and such rest-suckers. It was hard enough getting to sleep on that bed with my leg not comfortable, but then I'd be wakened for some blood pressure check or something else. Fortunately I was disconnected from the IV soon, and then the catheter, and finally the drain. When the hospital physical therapist came around I was ready ready ready. I was hardly pain-free but I wanted out so I hit the ground almost running.

I started outpatient therapy the following Monday, April Fool's Day. My friend Maryann had gotten me to and from the hospital, and on Friday we had driven together to pick up my daughter Elaine and grandson Elliott at the airport. So Elaine drove me to physical therapy.  After I did a limited number of activities there, the therapist had me on the table, where he tested my hip. He said I was doing very well, that all the time I had spent there working on my knees had paid off in strength, and that I was "about three weeks ahead of schedule". Of course that's an exaggeration, but one I was delighted to hear.

I have now completed three weeks of therapy. I have tried driving and found that I can do it. I am not yet pain-free. I am not yet healed inside, although the wound on my leg is completely closed and I am cleared for dipping in the pool again. The swelling on my hip has gone down some and is clearly not the issue swelling was for my knees. A hopeful result: the therapist says my knee is starting to get straighter! That my bad hip may have interfered with that. I remain hopeful that one day both legs will be straight and I will no longer feel tension in my legs when I walk or stand.

Hip Hip Hooray!

In the middle of January I returned to the ortho doc who renewed my knees. I told him about the pain in my hip and mentioned that he had taken an x-ray of it a couple of years ago. He tested it by having my lie down and moving it this way and that and pressing here and there. He asked me questions. Then had me get another x-ray.

He showed me what the x-ray revealed: the right hip is worn out, is bone on bone. The left is still looking good. The only solution he felt made sense was a hip replacement. I was all for it.

It's funny how I've changed. Years ago I wanted nothing to do with surgery. Now I have two new knees and am looking forward to a new hip. Part of me just didn't want medical intervention. I wanted to solve it myself, and I was embarrassed at letting my body get to this place (in my case, the wearing out of these joints can easily be attributed to my heavy weight, which I carried for so many years).

Dr. W. gave me a booklet he had written, about hip replacements: the anterior approach. He has been practicing this minimally-invasive surgery for a few years now and finds that it is superior in every way to traditional hip replacement surgery. I have met some of his patients and they all say it is very easy to recover from and the pain goes away completely. The booklet has space to put all my appointments, list all my prescription meds (I still have one that I use occasionally: the Ropinirole), and other notes. So I don't have to make a folder as I did last time. The information is complete, down to "when can I drive?"  (the answer: when I feel okay enough to drive and am no longer on narcotics). A very useful booklet, which I read carefully over the next few days after my appointment.

I am scheduled for this surgery on March 26. I am excited!

It Varies

Since my juice fast, the sharp pains in my groin area have not returned. However, pain in my hip in general, the more generalized pain, has not been kind to me lately. Could be because I am trying out some new prepared foods and some have ingredients that are not helpful.

I have gone on hikes the last two Saturdays. The first Saturday I tried a new one that is on a dirt road and is two miles long. There are a couple of little hills, nothing big. Yet I found it took a lot out of me. I didn't have significant pain but my knees were tense, so I was not particularly enjoying it. I was still hurting the following Sunday all day.

The following Saturday I did one of my favorite short hikes: Stoneridge. This hike is not far from my house and involves climbing a small hill, affording views out over the city. It is a rocky dirt trail. The total distance is not long - I don't actually know how long - but it is steeper than the previous week's hike. I had a good time on this hike and did not feel any aftereffects on Sunday. I'm not sure what I learned here. It may simply be that I need to take my time, as I had to climbing those rocks. Others sail over this trail, run it. I'll never do that but maybe I'll speed up a little over time.

Reducing inflammation through diet

I just finished a ten-day juice fast last Saturday night. During those ten days I drank the juice of carrots, oranges, apples, kale, spinach, sweet potatoes, pears, grapes, cabbage, grapefruit, lemons, ginger, tomatoes, garlic, and there may have been one or two other fruits or vegetables. At about day 6 I noticed that the sharp pains in my groin area that had become a regular thing had disappeared. More, I found less pain in general in my hip.

I looked up the list of "safe foods" in Neal Barnard's Foods that Fight Pain. This is a list of foods that do not cause inflammation in anyone. Here is that list:

Pain-Safe Foods

Pain-safe foods virtually never contribute to arthritis or other painful conditions. These include

• Brown rice
• Cooked or dried fruits: cherries, cranberries, pears, prunes (but not citrus fruits, bananas, peaches or tomatoes)
• Cooked green, yellow, and orange vegetables: artichokes, asparagus, broccoli, chard, collards, lettuce, spinach, string beans, summer or winter squash, sweet potatoes, tapioca, and taro (poi)
• Water: plain water or carbonated forms, such as Perrier, are fine. Other beverages – even herbal teas – can be triggers.
• Condiments: modest amounts of salt, maple syrup, and vanilla extract are usually well-tolerated.

I noticed that most of the foods I had been drinking were on this list. A few I drank are potential "triggers" - foods that, for some people, do cause inflammation. It occurred to me that these potential trigger foods are probably not triggers for me. And if so, the improvement in my pain levels may be attributed to what I was eating - drinking.

There are three parts to Barnard's plan for determining which foods cause arthritic pain in you:

1. Eat primarily the foods on the "safe list".
2. Do not eat any foods from the Major Arthritis Triggers list. Not even a tiny bit.
3. Eat other foods that are not on either list, but be sure that the great majority are from the safe list.

Avoid Major Arthritis Triggers

1. Dairy products*
2. Corn
3. Meats**
4. Wheat, oats, rye
5. Eggs
6. Citrus fruits
7. Potatoes
8. Tomatoes
9. Nuts
10. Coffee
*All dairy products should be avoided: skim or whole cow’s milk, goat’s milk, cheese, yogurt, etc.
**All meats should be avoided: beef, pork, chicken, turkey, fish, etc.

This plan is to be followed for four weeks. By that time pain should be reduced. In many persons the pain will go away sooner, but for some it takes up to four weeks to get their bodies to stop reacting. After four weeks, introduce trigger foods one at a time, eating them frequently, for two days each. Monitor the body's response. This way you find out which foods are triggers for you. Barnard advocates getting rid of meat and dairy products entirely regardless (there are many reasons).

So here I am, a few days post-juice. I intended to follow Barnard's plan but I have already slid. I have eaten oats, potatoes, tomatoes, and wheat. I feel safe in continuing to eat citrus fruits because I had so many of them while juicing. I'm feeling some hip pain today, which suggests that I may have eaten a food that is a trigger for me (or it may just mean that my hip has gone beyond much hope). I'm considering backing up, staying with the safe foods for a while, then later introducing the triggers corn, wheat, oats, rye, potatoes, tomatoes, and nuts. Oh, and coffee.

You can read more about arthritis and food at the Physician's Committee for Responsible Medicine site.

Shooting from the hip

This morning I walked into the physical therapy office feeling no pain in my right hip. This has become unusual. I almost always am in pain there, and took to using my cane while in Las Vegas. I had just returned from my holiday trip there last night.

While in Las Vegas I did not exercise every day. I went to the gym four or five times in about two weeks, and I did some walking on some other days, but mostly I was not being especially active. Perhaps the extra rest was good, after all, for my hip. I can never tell, really, because I avoided exercise altogether on my November trip and was in a whole lot of pain the entire time.

Nevertheless, here I was, feeling good! It is always nice to start a new year feeling good. I don't do resolutions but I do like to take stock a little.

My time on the Nustep crosstrainer went well; no extra hip pain. I like to meet certain goals on some machines. In the case of the Nustep I like to get to .75 mile in the fifteen minutes I'm on. Today I sailed to .80, which is quite a bit more than usual. I really was feeling strong.

I then moved to the hip flexor machine and had little trouble there. Usually that's one of the machines I just like to get done with. I did start feeling the pain again on the leg press; I do four sets of fifteen with both legs, then four sets with just my right leg, and that's when it tends to set in.

The leg press is similar to this photograph (above). Different from most leg presses at gyms because you lie flat or nearly flat. I completed the rest of my workout continuing to feel good, and when I walked out of the place one of the other clients remarked that I seemed to be walking better. I knew that I was. 

I have had so much pain in my right hip that I have wondered if I would ever have another day like today. They are getting father and father apart. This may be the Year of the Hip for me. Fortunately, recovery from that operation is easy for most people. I should be able to fly through it and get on with my life. I need to make an appointment with the orthopedist and see about setting a date. Assuming that there is no other fix that would make sense. Yes, I know about the injections. If he suggests that, I'll go ahead and get one, see how it works for me.

I am still, obviously, working on getting my legs straight. The therapist says we "just have to outlast it". I am glad he has that attitude because most would give up. I don't want to. The tension in my legs prevents me from using them as often and as long as I'd like. Getting them straight should relieve that tension.

And so I enter my 67th year full of hope, feeling good.

Still Keeping On

Proof of the rack. Here I am, as of last Wednesday (October 24, 2012), on the diabolical stretch machine at the physical therapist's office. Weight on my right knee: 20 lbs; left knee: 25 lbs. I haven't been able to increase the weight for quite a while, but I do feel a slight softening, a little less pain over the 10 minutes I am stretched. I am thinking of adding just a teeny weeny bit next time.

It has been over a year since my second surgery. Being in therapy this long is NOT typical. Most people are out completely within about three months. So please do not take my experience as an example of typical. Further, everything works well except for one thing: the extension. Getting the knee straight is the whole point of my being there. Yes, I also have hip pain but that is a separate situation.

In some ways it seems like I have gone backwards lately. I have had a lot of restless leg issues, in one leg or another and sometimes both, making getting to sleep very difficult. Many nights I am restlessly trying to get some sleep unti as late as three or even four in the morning. No longer the morning person, me. My hip has also made a lot of everyday activities difficult. I give in to it too easily. I start to do something around the house and the pain makes me want to sit down. I sit down. Getting up again isn't fun. I need to turn this around, just get out and do. Get out, get up, get around.

Related to the pain is the eating. Clearly I have been gorging. It is hard to stop. Overeating is the story of my life, nothing new. I have managed to control it at times but am not doing so well right now. Nobody needs to tell me that extra weight puts more strain on the joints. I do know this.

But hey! I have a nice haircut. It makes me feel more "professional", in a way, more "legitimate". I can't quite explain this feeling. But I'll take it. I am also getting out with various groups of photographers more often, always a challenge. There is a lot of walking, standing, and hauling involved in photography, although one pro told our club that he never goes far for a good photo. He finds them not far from his car! Not a bad example for someone like me, who gets a little afraid of doing lengthy hikes to get to the right place. It really helps to be learning, to be working on getting that photo, on doing better this time than the last.

Food: for those of you who have been suggesting various diets or supplements and possible allergic reactions, believe me I have been there. I make no bones of my not being a fan of supplements. Don't get me started on that. But I have also done elimination diets to determine if there are certain foods that increase inflammation. So far I have not found any that made any significant difference. I continue to eat a vegan diet, but unfortunately I do have these long-term issues with food, and unfortunately there are many foods that are vegan and not healthy. At least I am avoiding animal proteins. Give me that.