I saw Z on Monday for my 3 month check up (technically I'm 14 weeks post op) and things went relatively well. He had me walk down a hall and back so he could assess my gait, which he said was getting a lot better. Then came the leg strength tests. He was not too pleased with how weak my right hip is. I wasn't able to resist against his hand pushing on my leg at all. Even I was surprised at how little strength I have! So he really stressed to work on side leg lifts and hamstring strengthening exercises to build up my muscles. He said the muscles are still pretty atrophied looking. And here I thought I was building them up pretty well! The joint space is still narrowed but holding it's own, so we're still observing that. As far as pain, I'm no better than prior to the PAO. Z isn't going to worry too much yet because it's still quite early in healing and he recommends that most people won't feel even halfway better til at least 6 months have gone by. He offered up three opinions of why I might still be in pain. 1) weak muscles (it takes over a year to heal)
2) capsul impingement/scarring
3) recreated FAI from the PAO. I have only 85 degrees hip flexion now, which is worse than before the SDD even. He said that with the strange anatomy of my hips, getting the right hip to fit together was a challenge. He explained that the femur is anteverted and valgus (meaning points too straight up in the socket, or the angle of the neck is greatly increased) which causes it to bump against the acetabulum which was retroverted but now more lateralized and anteverted. He basically told me that's the trade off for being able to walk without pain. I hope so! But if my pain doesn't go away, I don't know what the next step is. I will be seeing him again in 6 months unless I have problems and need to be seen sooner. I am diligently working on my hip strengthening side leg lifts now. My verdict is pool therapy is nice and gentle but it doesn't do anything for strengthening! I won't go that route again if I have to. PT finished officially last week against Nicky's wishes. She didn't feel I was ready for discharge but I'm done. I can do this on my own now.
Screw removal to be decided at a later date. Dr.Z really wants to give my body a break from surgery/invasive procedures for awhile and that's why I will have 6 months til I see him again. So far the left hip is still doing well!
At this point in time I can drive about 2 hours straight, I can walk mostly limp free for half a mile to a mile, and I'm able to cycle for 20 minutes with moderate resistance. Verdict for left hip is PAO was amazing! Jury's still out on the right although I don't regret it one bit!
Z is an amazing surgeon and he gave my hips a fighting chance! I'll forever be grateful!
"I got great reZaltz!" :)
Keep up the hard work fellow hipsters! So happy to have had all your support and love over the last couple years! xoxo
Wednesday, September 14, 2011
Saturday, September 3, 2011
The skinny on life after PAO's
I received some questions regarding what it's really like after having a PAO done and I'll do my best to iterate what is really achievable post pelvic reconstruction in the early stages (think under one year).
Walking without crutches:
This was able to happen for each PAO right around the 11 week point for me. On average most surgeons will give you the 8-12 week range and that's pretty spot on. I technically could have come off walking aids altogether at 8 weeks except that my limp was too pronounced after walking only a few minutes. There was really no pain, per se, just fatigue. Once the muscles became stronger it became easier to walk further. At 8 weeks I dropped both crutches indoors but still used one for outside or going to the store until right around 11 weeks.
Being off the crutches completely now is still on the tiring side. I can't walk far still. The grocery store is still a lot for me and I notice I do walk slow and begin to limp on the right side (most recent hip done). The left hip is doing really well though, and it is now 9 months post op.
Cycling:
I was given the thumbs up to use a stationary bike with no resistance after my two week follow up. It went just fine each time. I would only be able to do a minute in the beginning but have worked my way up to 15 minutes easily and fairly quickly. At three months, as long as everything is healing as it should, resistance isn't an issue to add into the routine. Probably even at 6-8 weeks it would be okay.
Flexibilty:
This is a big one. While most people will lose a lot of natural flexibilty post op, I can't say that I lost very much. It all varies on your body. I am more flexible than average although I have lost some ROM. If flexibility is important to you, don't be too upset if at first you can't do what you once could. It may came back if you work at it, but remember, the whole hip is in a new position now.
Use of pain meds:
I have been using different pain meds for awhile. I don't know that I would classify myself in a category of "high pain tolerance" or "low tolerance" or anything like that but I just plain hate feeling bad or being in pain, which I am the majority of the time. But it's not just my hips that hurt. I have "polyarthralgia" (multiple joint pain) and a few other conditions and for me meds work. I took vicodin for about 5 weeks after the PAO's and then got back on my antiinflammatory, Mobic. I also have a script for Tylenol #3 for breakthrough pain. However I do try to use heat, ice, and massage as well so I'm not totally depending on meds. I honestly can say the left hip doesn't need pain meds anymore, that heat and ice are enough, but it's too soon to tell with the right hip yet. All my other joints I have issues with still need help though, so I will probably be on meds for the rest of my life.
Intimacy:
After having PAO's on both hips, especially close together, it is somewhat different finding positions that work and are comfortable for you to remain in. It is possible to pretty much go back to what you were used to though. For me it doesn't feel completely natural just yet, because abduction is hard to keep up. It really puts a lot of uncomfortable pressure on my inner thigh/pubic area. I was told that it's mainly due to the pubic cut made during the PAO and this is the slowest cut to heal.
"Does the PAO really help?":
If I got a quarter for everytime I heard this asked I'd be rich! In short, yes, it does work. But I think that you really have to think about why you're doing the PAO. Pain? Giving out/instability? Unable to walk or run because of fatigue in hips? Just because the xrays show the dysplasia and your surgeon says to do it? These are all things to consider. If you have pain from your hip and giving out episodes, it's a miracle! My left hip was terribly unstable, now it feels really good. If I had to rate it 1-10, 1 being horrible 10 being wonderful, I would say it was a 3 before surgery and is now an 8 after surgery and will probably continue to improve. The right hip was completely different. I felt fatigue pain and something like a deep bruising pain after short distance walking. It never gave out on me but it sure did have some breath taking stabbing pains. It is harder to judge this hip due to the previous 2 surgeries on it, but I suppose I would say maybe a 2 to begin (before FAI/SDD surgery) and now after the PAO I would say I'm at about a 5-6.
I have a way to go before I'll be all done recovering from my hips but there is hope. I see more improvements than set backs and hear similar stories from fellow bilateral PAOers so I know that it's all normal.
I'm a little tentative to test out my hips doing strenuous activity such as tennis or running but I need to get over that. This is the reason to have the surgery done so I can enjoy those activities without premature wear and tear. I think that might be my biggest hurdle to face, not babying the hips. It's a mental thing and I think the mental aspect of the PAO's is much more difficult than the physical aspects!
Walking without crutches:
This was able to happen for each PAO right around the 11 week point for me. On average most surgeons will give you the 8-12 week range and that's pretty spot on. I technically could have come off walking aids altogether at 8 weeks except that my limp was too pronounced after walking only a few minutes. There was really no pain, per se, just fatigue. Once the muscles became stronger it became easier to walk further. At 8 weeks I dropped both crutches indoors but still used one for outside or going to the store until right around 11 weeks.
Being off the crutches completely now is still on the tiring side. I can't walk far still. The grocery store is still a lot for me and I notice I do walk slow and begin to limp on the right side (most recent hip done). The left hip is doing really well though, and it is now 9 months post op.
Cycling:
I was given the thumbs up to use a stationary bike with no resistance after my two week follow up. It went just fine each time. I would only be able to do a minute in the beginning but have worked my way up to 15 minutes easily and fairly quickly. At three months, as long as everything is healing as it should, resistance isn't an issue to add into the routine. Probably even at 6-8 weeks it would be okay.
Flexibilty:
This is a big one. While most people will lose a lot of natural flexibilty post op, I can't say that I lost very much. It all varies on your body. I am more flexible than average although I have lost some ROM. If flexibility is important to you, don't be too upset if at first you can't do what you once could. It may came back if you work at it, but remember, the whole hip is in a new position now.
Use of pain meds:
I have been using different pain meds for awhile. I don't know that I would classify myself in a category of "high pain tolerance" or "low tolerance" or anything like that but I just plain hate feeling bad or being in pain, which I am the majority of the time. But it's not just my hips that hurt. I have "polyarthralgia" (multiple joint pain) and a few other conditions and for me meds work. I took vicodin for about 5 weeks after the PAO's and then got back on my antiinflammatory, Mobic. I also have a script for Tylenol #3 for breakthrough pain. However I do try to use heat, ice, and massage as well so I'm not totally depending on meds. I honestly can say the left hip doesn't need pain meds anymore, that heat and ice are enough, but it's too soon to tell with the right hip yet. All my other joints I have issues with still need help though, so I will probably be on meds for the rest of my life.
Intimacy:
After having PAO's on both hips, especially close together, it is somewhat different finding positions that work and are comfortable for you to remain in. It is possible to pretty much go back to what you were used to though. For me it doesn't feel completely natural just yet, because abduction is hard to keep up. It really puts a lot of uncomfortable pressure on my inner thigh/pubic area. I was told that it's mainly due to the pubic cut made during the PAO and this is the slowest cut to heal.
"Does the PAO really help?":
If I got a quarter for everytime I heard this asked I'd be rich! In short, yes, it does work. But I think that you really have to think about why you're doing the PAO. Pain? Giving out/instability? Unable to walk or run because of fatigue in hips? Just because the xrays show the dysplasia and your surgeon says to do it? These are all things to consider. If you have pain from your hip and giving out episodes, it's a miracle! My left hip was terribly unstable, now it feels really good. If I had to rate it 1-10, 1 being horrible 10 being wonderful, I would say it was a 3 before surgery and is now an 8 after surgery and will probably continue to improve. The right hip was completely different. I felt fatigue pain and something like a deep bruising pain after short distance walking. It never gave out on me but it sure did have some breath taking stabbing pains. It is harder to judge this hip due to the previous 2 surgeries on it, but I suppose I would say maybe a 2 to begin (before FAI/SDD surgery) and now after the PAO I would say I'm at about a 5-6.
I have a way to go before I'll be all done recovering from my hips but there is hope. I see more improvements than set backs and hear similar stories from fellow bilateral PAOers so I know that it's all normal.
I'm a little tentative to test out my hips doing strenuous activity such as tennis or running but I need to get over that. This is the reason to have the surgery done so I can enjoy those activities without premature wear and tear. I think that might be my biggest hurdle to face, not babying the hips. It's a mental thing and I think the mental aspect of the PAO's is much more difficult than the physical aspects!
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