Another ten years, another hip

 I am eight days away from an operation on my left hip. Same operation as the left, a total replacement, anterior. It has been a long and often painful journey (and boring too) but finally I got into that operating room and here I am, eight days later.

Lately I have perused my notes from my first hip replacement, to remind me how it went. It was not a case of immediate pain relief. I did not expect that it was, but my memory was that it was so much easier than the hip replacements that it seemed instant. 

Today I drove for the first time since the op. I had been taking some narcotics (oxy) so could not drive even if I felt up to it, and I did not feel up to it. I stopped the oxy yesterday afternoon and today I felt ready.  In fact, there was quite a change between yesterday and today, both in the level of swelling I see and in the pain I am experiencing. 

Here are my feet yesterday. Notice that the left foot is very puffy. My leg was similarly puffy.

And here are my feet today. They look almost identical. You can't see my thigh, where the swelling from the operation is most noticeable. But the difference in my feet is reflected in how much better I feel.

I had the hip operation because the hip is worn out. The doctor thinks that the hip was causing the knee pain I had in my left knee for the last few years. I have been cautiously optimistic. It is still too early to tell for sure because I still do have pain and swelling to work on, but I am gaining in hope. I met with the physical therapist today and he had me climb some stairs. He said just to try stepping up with the left foot, just see if it hurts too much. He didn't want to pursue it if it did hurt too much. But it didn't. In fact, I think it may have been less painful than it was before the operation. That's what is giving me hope.

Checking in and checking up

It has been way too long since I have written here. Much has happened or changed, even though right now I feel like I'm treading water.

Leading with the hips was good advice. I still follow it. I still have to tell myself, though, consciously. My physical therapist says I am walking much better, my back is straighter, and my knees are "softening". He says they no longer bounce back when he presses down on them. It's been a long time, this straightening. Most people do not have to spend so much time doing this. On the other hand, my therapist told me of another woman who has not put the time in as I have and who is now bent over and whose knees are bent more than before. He compliments me on my persistence.

Hip pain is a distant memory. I never have it any more, either during the day or the night. My experience is much like others who have had this surgery. Easy and done.

My main complaint when I walk is lower back pain. This is largely because I still don't have the best posture, and I know my weight makes it worse as well. Nevertheless, I have walked across the Mackinac Bridge in Michigan two years running - that's five miles across, and last September was cold and windy - and while I did feel back pain it was not enough to deter me or even cause significant discomfort. I felt like I managed it better in 2014 than in 2013. Not as tired, not as hurt, even though I had not done much to get ready for it.

Still in therapy. Still working on getting my knees straight, but also working on my right shoulder. I developed a constant ache in my arm and finally went in to see what was up, got referred to the physical therapist again. Actually, this turned out to be a good thing, because Medicare was no longer paying for my leg therapy. The therapist was "carrying" me. I didn't want that to keep happening so now I go in for rotator cuff damage and the knees get thrown in, so to speak. The tendon is not torn, I am happy to say. At this point much of the pain has gone away. The therapy is working. It's a delicate area, though, and one must be careful not to put too much weight or strain on it too soon. I also am working on elbow damage, different from the rotator cuff.

What with the shoulder, knee, elbow, and hip work I am in the therapy office for 1-3/4 hours each time now, three times a week. I use weights, a roller thing, and eight machines and do a total of 23 different exercises.  I have a rubber band to use for shoulder exercises when I travel. I tell people I am working my way through all my joints. I sure hope that isn't actually true. I look forward to getting out of physical therapy.

Lead with your hips

The other day, in physical therapy, one of the assistants happened to watch me walk from one machine to another. She told me that I was walking much better but was still leaning too much, humped over. She said to "lead with your hips".

I am sure that this is advice given to many. Yet this is the first time I had heard it. One of my physical therapists, back in 2011, was intent on helping me walk straighter and I really tried and continue to try literally years after, yet I keep catching myself walking hunched over. When I see myself reflected I try to straighten myself out but clearly I needed another way to approach this. When Carmen said "lead with your hips" I knew she had given me a gift that might make a huge difference in my life.

Remembering this simple bit of advice really has helped. I straighten up naturally when I do this. My whole body, not just my shoulders, for example.

Other news on the home front: my hip feels completely normal now, except that there is a tiny bit of discomfort when I put on my right shoe. Less and less, though. I no longer sleep with a pillow between my legs. My legs rarely are the cause of a sleepless night. I use restless leg medication rarely now. My knees are just the tiniest bit straighter. Still working on that.

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!

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.

One Year

It has been one year since my second knee surgery. It seems hard to believe that I have been in therapy for that long! On the other hand, it really has been getting old. Yet I plug through the routine three times a week, occasionally upping the weights or number of reps.

It is frustrating to me that my hip pain causes me to limp sometimes. Others usually attribute this to my knees, and I feel like a broken record saying "no, not my knees, my hip", and having to explain that yes, I see hip surgery in my future. I bore myself just getting the basic info out.

I was at the gym today for an Aqua class, but the class was canceled because not enough people showed up. It was raining, and rain tends to keep a lot of people away. I went upstairs to the weight machines instead. I did fifteen minutes on the bike, six on the elliptical, and fifteen on the treadmill. I devise my own little intervals on the treadmill, upping the level three or for decimal points for thirty to sixty seconds, then upping it again, and then taking it down twice. I do that a few times during the total fifteen minutes. I felt mild discomfort in my hip when on the treadmill today, but nothing I could call pain. That's an improvement over when I first took to the treadmill some months ago.

After doing the above cardio exercises I did several exercises on machines, strengthening my upper body, core, and back. I think I should head for the gym after physical therapy M,W, and F, to fill out the workout with these upper bod and core exercises. Making for an all-around effort.

At times I do wonder if I will ever see that light at the end of the tunnel. Did I mention in my last post that other clients at physical therapy have told me they suddenly hit the straight leg? That after a long time working on it, their knee finally went straight and there was no more pain? God, I want that so much. Will I be that fortunate?

I continue to take meds for restless leg syndrome and a recurring rash, but nothing else most of the time. Sometimes my leg (usually the right) aches to the degree that I cannot sleep and I end up taking some sort of pain killer, usually tylenol. Just to take the edge off. Sometimes I resort to Tylenol PM when it looks like it's going to be a LONG night. But I don't make a habit of it.

I have been doing a lot more work with photography in the last many months, partly because I upgraded my camera. But one difficulty I have faced is that photography field trips offered by photo groups in the area tend to involve standing and walking and not much chance to sit. Depending on how my hip is doing this can be quite a problem. I brought a "shooting stick" - also called a seat stick or something like that - to an outing at the Oceano Dunes not long ago. I found it a bit difficult to put the stick in the sand and lean against the seat, though. Other places should not present as much of a problem. Photography is usually a physically demanding activity for those who are really good at it. Well, sigh. I am doing better than I was before surgery. That is the point.

One year down. What will I say next year?

Revenge of the Right

Today I went to the Strawberry Festival in Arroyo Grande, about 13 miles from home. This is a giant street fair, covering many streets up and down and back and forth in the "Village", which is the older commercial part of town. I parked on a dirt lot some distance away and took the shuttle to the festival. I spent about an hour walking up and down and around and finally back to the bus pick-up spot so I could return to my car, carrying strawberries of course.

Lately, and especially today, my right leg has started to complain when I walk. My hip hurts, my knee hurts, I feel twinges in different parts of my leg. My last therapist warned me that this would happen, that the change in alignment of my body would start to aggravate the pain in that leg. The ultimate solution is the right knee replacement, but for now I have one straight and one crooked leg and I have to figure out how to deal.

I thought maybe if I just walk longer it will ease up. It did seem to ease, just a little, but not much. I'm fretting about this a bit because I don't want to be limping on that side, I don't want to be just as gimpy as I was before surgery. I want to walk as normally as I can and feel as good as I can. So I will continue to work it very slowly and carefully, and when I see Paul on Tuesday I will ask about it.

The Left Leg, the Right Hip

Sometimes, out of the blue, I feel a sharp twinge in the area just below my left knee. It is pain combined with a stiffness, that odd kind of arthritic stiffness that I associate with an arthritic "flareup".  It usually eases off a bit but not always.  It has happened a couple of times lately when I was in the middle of doing leg presses, and continued through the rest of my gym routines.

Sometimes I wake with right hip pain. Sometimes it eases off soon, but other times it just won't. Today, for example, it caused me difficulty getting around the house. I hoped that the Aqua class might actually help it but it didn't. In fact, the frantic water-walking we did today had me almost biting my tongue as I kept hoping it would ease up. It never did and it still hasn't.

These are the two pain issues that most affect me right now. Even when I start off feeling good, going to the market for example, in no pain, one or another of the two will often slip in and make my feel-good time not so feel-good.

It's been a while

It's funny how common these machines have become. The machine on the left is a hip abductor-adductor machine. I use the abductor part, pushing my legs from closed to wide open.  The machine is open in that pic, about as wide as I am able to push it actually. I use it to help my hips, which have arthritis, to strengthen them so that I do not feel as much pain from the joint disintegration.

The first gym I joined was Jack LaLanne's, in Alhambra, California or somewhere near there, in the late sixties, early seventies. It had, along with various machines, one of those belts that were supposed to jiggle the fat off you, and the trainer recommended a high-protein, high-fat diet - was Jack the first to promote that? I tried it and lost weight but felt so weighed down I gave it up. I did not feel healthy, just a little thinner. I've been in and out of gyms since then.  I have been on this current kick since April and am making less frequent posts about it now that I have settled into a routine and not a lot changes.

I have noticed recently that I am having hip pain less often. I used to feel it almost every time I got out of bed in the morning, and definitely every time I walked down the hall after getting dressed. Less so now, and less so throughout the day. That machine up there may in part be a reason. I also do simple "clamshell" exercises every morning and every night, and in our Aqua classes we often do things that require that I open and close my legs similarly. I think it's all adding up.

My knees, not so much. Still stiffen when I sit for a few minutes, still cause pain when I walk more than a short distance. It is hard to see any difference. "Alignment, alignment, alignment," says the physical therapist. And the alignment of my knees is where there is so much damage it is hard for me to imagine that I can make a marked change through exercise alone. But I am trying to do so.

I met with the physical therapist for the first time July 21. He suggested that I come back after two months. So in about three weeks I will see if there have been any measurable changes.

I got what I wanted.

I scheduled an appointment at my doctor's office for today. My regular doc doesn't have any openings until the end of August so I took a chance on a Physician's Assistant. I came in with my disabled parking placard application, wanting to be sure to get a signature on that, at the very least.

I told the PA that I'd been having increasing pain in my hip and whole right leg and foot and I wanted to confirm that it's arthritis and not something else. I also said I thought it might be helpful for me to connect with a physical therapist who can evaluate where I am and help me with the exercises I need to be doing to get stronger where I most need to. The PA agreed that this would be a good idea and arranged for x-rays of my hip, saying we already know you have arthritis in your knees so no new info would be gained from doing that. (saves me money too)

The x-rays confirmed arthritis and did not show anything else of interest. A radiologist will look at them, too, and I should get a call about what is found. Therefore, the PA gave me a prescription for six sessions with a physical therapist and she signed my parking placard app. So I got what I wanted! Now I just need to choose a PT in this area, perhaps not the easiest thing to do. I may ask Clara.

gone again

The pain in my right leg - hip, I guess- has been gone for a few days now. I've been paying attention. It didn't take long for it to leave again, which is a good sign.

I do think my little workouts are helping here.

Today I did new one. It is called Strong and Safe or Safe and Strong, I forget. I will look it up.

Safe and Strong at 50, by Cindy Kozacek (pronounced Kozak). It is a strength training workout for us older folks. It isn't specifically for arthritics and I found I could not do one of the exercises. I could do the rest. Cindy offers us three different versions of every exercise, including one that's seated. She is excellent at cueing and explanations without wasting time. And she's generous in her understanding of where we may be at. The workout requires weights and resistance tubes. It is the first time I have used resistance tubes and I like them. I can see why people would like to bring them when they travel. They are versatile and lightweight and inexpensive.

I recommend this workout. I will be using it "in rotation" with others and with my wii workouts.

I am also now keeping a little notebook in which I jot down how I feel each day and any other notes that may be relevant to my health and state of mind. It's good to keep track.

A new pain, new understanding?

Several weeks ago I started to have sharp pains in my right hip area, descending to the top of my right thigh. It made it difficult to walk without limping. At first I had trouble getting out of bed in the morning because the pain was so great. Over time, the pain has diminished at least to where I don't fear getting up. At times it goes away, I don't feel it when standing or walking, but it is usually just around the corner, waiting to come back.

My suspicion is that the arthritis has simply spread to my hip. My sensitivity to my left knee has placed additional strain on my right leg, and on my hip especially, which has caused the arthritis degeneration to accelerate in that area. I have no scientific proof of this situation, but it makes logical sense.

My hope is that the severe pain will diminish enough over time that I can manage things like longer hikes without much pain. It's probably what they call an arthritis flareup, and the first time it flares up the pain is much worse and longer-lasting.

When I speak to my doctor about arthritis pain all that he offers is pain relief, and we have had a struggle with that. First, I do not want to become dependent on anti-inflammatory drugs because they do not cure anything and they can cause more cartilage disintegration down the line. Interestingly, when I search for more information on this link, I find it more easily in articles on arthritis in companion animals than in humans. Yet we are all animals and we often respond similarly to the same treatments. The wikipedia article on osteoarthritis mentions damage to the articular cartilage related to the use of one of these drugs (presumably studies have not been done with the others or results have been inconclusive).

Another problem for me with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) is that they go right to my stomach. I had a serious ulcer, caused by ibuprofen, in 2000. I have been sensitive to these drugs since then so I must avoid them. Acetaminophen is an alternative I use now and then that doesn't seem to offer much help either.

When I was in the hospital in Scotland in May, for another ulcer (this one caused by the H. pylori bacteria) I was given acetaminophen with codeine and did not experience side effects. I therefore mentioned this when at my regular doctor's office recently and he gave me a prescription for it that I can use when I need it. I have found that when I take two it sends me into that floating place that usually means I get nauseous as well, so that isn't a good thing. I have found I can take one with little ill effect so I do have that available for when I feel desperate.

Although this hip pain has been very bad for an exercise program I try to follow, I have rarely used that drug. Instead, I look for signs that the pain is diminishing, signs that this is indeed a flareup and eventually it will calm enough to allow me more movement with less pain.