No MRI

Quick update; MRI is a definate NO. Dr. Z will be ordering a 3D CT scan immediately post op from the screw removal. Once I'm stable in recovery room, they'll transfer me to radiology, do the scan, then discharge me.

Injection relief

Why did I wait so long to get this hip injected again?! The cortisone has been a saving grace for me everytime! I forget how helpful it is, just sad it doesn't last forever.
I was seen yesterday for my right hip, complaints of continuing pain and restricted joint motion. Dr. Z first had me get xrays. They came back unchanged from September which is a huge relief! So we know it's not advancing arthritis. But when he did his physical exam on my hip, it wouldn't flex any further than 85-90 degrees. It was very painful at about 80 degrees and I was very unhappy letting my hip be pushed any further. I told him it felt like I didn't want him to go any further with it. He said there was actually something physically blocking movement. A bit perplexing, to be sure. I'm sure he hates this hip since it's had everything done to it already and still presents abnormal.
Anyway, he thinks I need to have the screws removed soon (March 30th), and then I need an MRI. I had to remind him I can't get MRI's anymore (I have an internal cochlear implant that the FDA will not ok MRI's) and then he was even more perplexed. So, my assignment is to try to get permission from my ear surgeon to ok the MRI, but if absolutely not, then Dr. Z said he'll just have to go with a CT scan. At that point we did the hip injection. The numbing spray is amazing! I like it so much more than the lido injection. While ultrasounding my hip he thought he could see a bunch of adhesions, so that could explain the joint restriction and pain. When he tested my hip after the injection, there was almost no pain, but still had hip flexion of about 85-90 degrees. While I don't know what the next step will be after the screw removal and imaging, my best two guesses are 1) scope to clean up scar tissue or other underlying causes of pain/restriction, or 2) do nothing and live with it as is. I have my follow up after screw removal in June, so I suppose I'll know more then.

The other issue discussed was my left knee/leg. I was finally diagnosed with miserable malalignment officially and left side is much worse than right. I really only have two options to consider for my left leg. 1) Do nothing and just put up with it. Continue to ice, take Mobic, and do activities to tolerance. 2) The only correctable option is a combination femoral and tibial osteotomy. He is very reluctant to go this route because it's a nasty surgery, I'd be off work for up to a year (not so long with my new office job now though), and according to Dr. Z the PAO would seem like cake compared to this. He said he wants me to wait as long as I possibly can before considering this route. One big thing to consider is that my knee is not in danger of being harmed with the miserable malalignment. I'm "functional" so why mess with that? It's really going to be up to me in the end (and we're talking back burner, a long time from now before this decision will be made. My criteria will be limitations from pain, if knee goes from subluxing to dislocating, and intolerance to Mobic long term). Basically, I'm focusing on right hip for now, since it is sooo close to being finished!

So roll on March 30th where I will really and truly be "just a few screws loose" one last time!

The hip book is finally here!

Due to an overwhelming amount of support and opinions I have decided on seeing Dr. Z over having my PCP inject my hip. January 23rd it is. It's great to bounce ideas off my fellow hippies and get their take on a situation.

I finally got my copy of the first ever written and published adult hip dysplasia guide! It was a great Christmas gift to myself:) Great read for those who haven't been through the gammut yet. Plus, for those of us who are a part of this original group that the book originated with, it's fun to read and review all our thoughts from when we were going through the initial stages. I feel a kinship with my hip sisters, and reading the book makes it even better. You can find the book here: www.Lulu.com or www.amazon.com

1 year post LPAO

Today is a great day in reflection of my left hip! I can't believe it's been one year already since my hip was realigned for the better:) I'm really happy with it as far as how stable it feels. For the most part, I'd say I'm 85-90% better now! I'll never be perfect, and still have occassional symptoms that bother me, but I love the outcome! At one year post op, I am able to withstand a full day of hard work, I don't have nearly as many giving out episodes, I don't feel as achy as I would have a year ago after any kind of activity, and my quad has full feeling in it again.

I do experience clicking in the hip occassionally, and the outside of the hip/leg pops or clunks which I think is the IT band? Anyway, whatever it is is pretty much the only thing that hurts my hip anymore. The problem is because the pop or clunk shifts all the way from my hip to my knee and it makes my knee feel like it's going to pop out of it's groove.

I still feel like my left hip is my strong, or dominant, hip. I tend to stand with most of my weight shifted onto my left hip. The good thing is that I can completely withstand the weight now without the hip getting sore.
I am definitely glad I had the LPAO. Even if I have to have other work done in the future, it will make my coming years much easier being without as much pain and uncertainty about my hip.

I have noticed my anteversion has gotten more pronounced since the PAO's were done. I guess it would be due to the new hip alignment? This has made my knees more painful, but I'm working on ways that will help them to feel less stressed.

My right hip is 6 months post RPAO and just shy of 2 years post RSDD. Unbelievable!! I don't feel good about my right hip at all. It really hurts after a day at work, and at night, forget it. I have a really bad time trying to sleep due to pain and aching in this hip. I still need pain meds to be able to sleep and this makes me really upset. I really love heat and always go to bed with my heat pad. I also need to ice quite a lot. I don't regret having the RPAO done since it puts my joint at a more normal alignment, but I wish it would have been done in the first place instead of the SDD. I can't change the past though, and can only hope that the future holds something that agrees with my right hip. I would be thrilled if I could get it to be around 85-90% like my left hip! I am looking for less demanding physical work (as a nurse) due to my right hip. I can't handle hard, long, crazy days anymore. At least it's only my right hip that I have to blame it on!

I'm so glad I had a great outcome first with the left hip. It makes everything a little easier to deal with and to know that maybe one of these days I will feel that way about my right hip too. Here's to hoping the one year post op entry about my right hip will be just as good!

And I am back!

I'm around 18 weeks post op and just finished what seems to have been the longest, most exhausting week of my life so far! I was cleared for work with no restrictions finally (!!!) and started on Monday. My new position is in ACS, or "same day surgery". I am responsible for admitting patients for surgery, and then recovering them when they come back, along with endoscopies and infusions. Lots of IV starting and LOTS of running up and down the halls and a lot of standing. I feel really overwhelmed with the new job, and undoubtedly I miss being back in the OR, but I like this job too. It's still surgery related and working with a lot of the same crew!

Left hip: doing really well. Stiff if sitting too long, still rely on it for placing most of my weight on this hip. Some snapping both medially and laterally. More "gross" and annoying but occasionally painful.

Right hip: again, not really sure what to think about this hip. Flexion still sucks. I can't put on socks or shoes "normally". I have to sit and put my ankle up on my knee to reach my foot. I can't flex past 90 degrees still and it really hurts if I try. I also am feeling the hip catch again. And my psoas snaps or catches painfully when I rotate my leg. I also have psoas snapping when I turn in bed. What I think might be the worst though is laying on my right side while sleeping. I wake up with hip pain in the anterior/medial region and have to turn off of my right side. This started about 4 or 5 weeks ago. Being at work is aggravating my hip and leg but I know that it's just the first week back and I'm sure that I will feel it for awhile.
For my home PT that I do now I use a theraband on both legs and do 30 reps of three different kinds of adduction and abduction exercises. I'm trying to strengthen the hip and core. Doing so should relieve a lot of my pain. That's the theory anyway! I'm thinking since my left hip is doing the best out of all my joints that it is a good example of success!

3 month follow up RPAO

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

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!

12 weeks post RPAO and 9 months post LPAO

I'm still in PT for the right hip. I don't use crutches anymore. I still haven't done a whole lot of walking distance wise but I will build up to that.
In PT I'm still struggling with straight leg lifts on the right side. It just does not want to do it. My left knee also still hurts, especially on stairs or with a wrong move while turning.

But I am able to lead up steps with my right leg and I can do abduction exercises pretty well, so that is a good thing. I think in my next PT session I'll be getting my ROM measured again so we can see where my hip flexion is at this point.

I am being choosey on jobs as well, trying to find something that isn't as physically demanding, so I am not working yet. Which is ok, since Z said I wouldn't be 100% ready to go just yet anyway. Squatting down and getting back up still bothers my quad on the right and that will be important to get back. Pain is kind of in the background now, like a familiar old ache. It's usually worse after sitting awhile from stiffness or if I'm up doing an activity for too long. But if I rest, it goes away. Icing and heating still do well for me too.

I see Dr. Z again September 12th for my 3 month follow up, so I'm looking forward to hearing good things when I'm there.

10 weeks post op and this thing called patience.

10 weeks seems like a long time when you're analyzing days but it's really not that much time when you look at it in terms of recovery from surgery. I'm starting to get impatient with everything and it's probably because I have technically been recovering since November 30th when I had the LPAO. In a way it's really nice I had the amount of time off (8 months now) but it's also been a little challenging on the lifestyle I am used to.

So at this point in recovery I am no longer using the shower chair (actually wasn't using it since week 8, but kept it in the shower til now). I don't need a chair to sit in to dress now that I can put full weight on my hip. Driving is an independant activity with very little issue and I'm now walking around crutch free, even outside. I have brought a crutch with me if I know I'm going to be walking a lot, but otherwise am doing well enough without it!

As far as pain goes, I've been on Mobic (prescription NSAID) for 3 weeks now and it seems to take the edge off the aches I get in my lower body but it's not the miracle I was hoping for. It does work better than motrin at least. I'm still getting occasional sharp pains in the front of the hip, it gave out once recently, but right now it seems managable. The screws are not bothering me as much either. They will have to come out at some point, but I'm not in a rush like with the left side. The knees to my feet are progressively getting more and more painful. I'm told strengthening is key. I'm really trying and being faithful to my PT workouts.

Speaking of PT, I'm back in the pool. The incision looks good after a week of antibiotics. Pool therapy was nice. I do like it and am thankful for it. My PT measured my hip flexion ROM yesterday and it decreased by 23 degrees. So it went from about 100 degrees to about 77-80 degrees. That's not good and we'll be monitoring that as I progress. Part of the decrease was
pain related but part was also stiffness, as in I could not get it to go any farther no matter what. Hopefully this improves!

Yesterday Z called me to check up on how I was doing regarding the incision and the hips in general. We discussed them briefly and I also explained that I have a procedure coming up soon that will make MRI's no longer an option for me and would this be an issue regarding the right hip? He told me that an MRI would really not be sufficient for me anymore anyway and he would prefer to go in with a scope instead. So, there you have it. Looks like my MRI days are finally over! Thank goodness!

All in all, I think I'm doing relatively well considering the circumstances. It is do-able to have PAO's close together. Other than a little groin pain in the left hip, I'm not having many problems there. And the right hip is still in early stages so we'll just have to be patient and see.

Post op week 9 - incision infection

"You're enjoying your day, everything's going your way, then along comes Debbie Downer!"
This, fellow blog readers, is me, and I apologize because I have yet more bad news to share...
This weekend I began noticing my anterior scope incision to be puffy and way more tender than usual. I also noticed it looked a little red around the incision. I pushed at it and pus and blood came out, followed by a mix of serous (clear, blood tinged) drainage. I called the OS on call for my surgeon's practice and was placed on Keflex 500 mg 4 times a day for a week. I'm also to stop pool PT until next week. Today the site looks much better. Not red, no swelling, and no drainage. The OS thought the drainage might have been a suture that didn't dissolve and acted as a wick.

I did land PT today. We took it easy because Nicky would prefer I stick with water therapy but what can I do? It all worked out well regardless. So I'm a little sore in both hips. I've woken up muscles in the left that must have deactivated and the right hip is struggling with the hip flexor, but doing surprisingly well with the glutes/stabilizers.

I'm starting to try to walk in the house without my crutch and it goes well enough as long as I take my time getting up from sitting awhile. The most I've walked is only a minute or so though. I suppose I should try walking for timed intervals from the front of the house to the back. Work up some stamina. Driving has finally gotten easier! It's back to feeling like an automatic gesture again, although I occasionally still feel like I have to think about moving the foot forward from the thigh. Other things I've noticed is a lot of clicking and popping is going on inside the right hip when I'm in bed and rolling over or changing positions. It isn't painful, just annoying.

What I'm really ready for is going back to work. Not really physically ready, but I need the interaction with people again! Not to mention the checking account could use it too!