A farewell of sorts

I just realized it’s been over 6 months since my last entry. Work kept me busy over the summer and now into the fall. But the real reason for the lack of posts is nothing has really changed, so there hasn’t been a lot to write about.

Both Becky and Robbin decided I wasn’t progressing with their treatments, so I stopped seeing both of them. Since I began my appointments, I have improved, but not to the degree I had hoped. I still have the tightness in my right hip, although the amount varies by the day. Some days it’s very obvious, others it’s pretty subtle. I would still classify it as annoying more than anything. It’s not really painful, just a reminder of where I’ve been. I still have the clunk in my left hip too. The stretching and strengthening didn’t have any effect. I’ve started doing pilates on weekday mornings hoping to regain some of the core strength I used to have. The clunk is very apparent with certain pilates moves.

At my last massage appointment with Robbin, she suggested I buy and start using a massage aid device called a Thumbby. It helps to focus your force in a certain spot so you can massage longer and deeper. It cost about $20-25 on Amazon. Most evenings I try to work on my tight spots. It seems to help, temporarily. I’m still not making any lasting changes, but it’s nice to be able to loosen up some muscles.

Thumbby massage aid

Thumbby massage aid

Really, I don’t have that much to complain about. I am basically pain free. I rode my bike a bunch over the summer, working up to 35 miles with hills. I regularly walk 3 miles in my hilly neighborhood without problems. In September, Steve and I took a 2+ week trip to Paris with stops in London and Amsterdam. We didn’t have a car the whole trip, so public transit and walking got us everywhere. We walked a lot! At first, I would come home at the end of a day of sightseeing and have sore muscles, but I think that was just a lack of conditioning. As we walked more, I got more used to it. Before surgeries, that amount of walking, especially the sightseeing style of walk…stand…walk…stand, would have left me very sore and achy in my hip joints.

I saw Dr. Mayo in May for a 1-year check up on my left hip and a 2-year on my right. Everything looked good. He seemed pleased with how everything turned out. We discussed both the issues I was still having. Basically, if I want to pursue either further, I can (likely with injections first), but I don’t think I want to do anything else at this time. I can live with my hips how they are now and there’s no guarantee injections (or firther surgeries) would help. They could make things worse, so I’m content where I am now. Since there’s nothing urgent for Dr. Mayo to follow up on with me, I don’t need to see him for 2 years. I don’t think I’ve gone more than 6 months between either appointments or surgeries since I became his patient.

I will continue to check in here with any changes to my hips or any crazy adventures using them, but it will likely be a while until I write again. Thanks for reading and following along for this journey.

Slow progress and insurance woes

It’s been a while since my last post. That’s a result of 2 things: 1) there just aren’t dramatic changes happining any more and 2) I’ve been really busy with work. A quick note about #2, I am a self-employed graphic designer and web designer. As other self-employed out there will already know, work can be feast or famine. Weeks can go by with nobody calling and then everyone seems to need something at the same time. I made a short-notice trip to Ohio at the beginning of February to bail out one of my freelance clients. I used to work for him full time and he is a friend and good source of work for me. His one full-time employee quit right before their biggest job of the year. He flew me in to help out for about 10 days. Having me there meant that he could sleep every night. Just a quick moment of shameless self-promotion…if you’re interested, check out my website (www.brown-bag-creative.com), and I promise this is the only time I’ll mention it. This blog is about hip dysplasia after all.

Back to hips, during January I continued with 2 PT and 1 massage appointment a week. At massage therapist Robin’s suggestion, PT Becky started a new treatment called Graston. Here’s a brief explanation from their website:

“The Graston Technique® incorporates a patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively detect and treat scar tissue and restrictions that affect normal function.”

Scar tissue restrictions affecting normal function…sounds like me. Basically, a person trained in the technique, like Becky, runs the metal tools across the affected area to help break down scar tissue and loosen up “stuck” tissue. She has used the long handle-bar looking tool at the top and the bottom left tool on me. It’s not pleasant when it is happening, but it isn’t really painful. As the tool runs over your tissue, you can feel little bumps. It’s very odd and a little startling, especially at first. For about 24 hours after a treatment the area is extra sore and tender. So far I’ve seen improvements from Graston, so I’ll deal with any temporary unpleasantries.

Graston Technique tools

Graston Technique tools

To throw a wrench into the works of my recovery, in early February, I received my first ever bill from the PT office. We switched to a different insurance plan within the same company at the beginning of the year. Before switching, Steve asked somebody (he doesn’t remember whom) how PT would be covered and was told it would be the same as the old plan where we pay a $15 co-pay per visit and the rest is covered, with a max of 60 visits per year. After I got the bill and made a phone call to insurance, I learned that he had been given incorrect information. We are responsible for 100% of the cost until we meet a $3000 deductible. After that we’re responsible for the $15 co-pay plus 20% per visit.

I can’t even express how angry I was when I learned this. I have been going 3 times a week thinking it was $15 per visit. After 5-6 weeks of 3 visits per week, I find out I have to pay either $65 or $75 per visit. Grr! If I had know the costs, I would have cut down the frequency of my appointments.

We’ve also learned of another piece of incorrect information about our costs for the new insurance plan, but at least this time the wrong information ended up in our favor. Steve was told we’d have to pay 100% of prescription costs until we met the deductible. The first time I picked up one of his 2 migraine medicines I was expecting to pay the cash price of $180 but instead I was only charged a co-pay of about $15. Maybe it all works out then, but I still wish I had known what I was spending when I went to 3 PT/massage appointments a week.

After getting the bad news about PT costs, I decided I needed to cut down to one appointment per week. In general, every few weeks I’d feel a bit of progress in relieving the tightness in my right side, but very minimal progress. Even before the insurance surprise, I was beginning to wonder if I was coming to the end of the road for what these appointments could do for me. Becky had wondered the same thing after discussions with Robin. They both asked me what I felt was helping and what wasn’t. I think the massage and the Graston are helping and the laser and EMS are not, so we decided to just do what’s working.

For the last few weeks, I’ve been alternating between massage one week and Graston and stretching the next week. Because Becky isn’t doing the laser on me, she is spending more time with the Graston tools. I think it’s helping. I’ll stick with this routine for a few more weeks and then reassess.

Progress, finally

Since about Thanksgiving, I’ve been going to 3 weekly appointments at the PT office, one for massage and two for laser and EMS. Right before leaving town for a week for Christmas, I finally started to notice a difference. The tightness and stiffness in my right groin is improving. I had a massage with Robbin the Tuesday before Christmas. Typically I’m sore the evening after a massage and I go back to usual sensations the next day. Well, the day after that massage I woke up without tightness. That is not uncommon, but I usually start to feel it within an hour of being up and moving around. I made it until dinner before I felt any tightness. Great news!

The next week we were in Ohio visiting family for Christmas. Getting to the airport involves walking about 1/3 mile to the bus stop, riding the bus downtown, walking 5-6 blocks then down stairs to the transit tunnel, taking the train to the airport, and walking another 1/3 mile just to get to the entrance of the airport, all of this while pulling a rolling suitcase and carrying a backpack. All of that walking would normally have angered my right side, but I made it almost to the airport before I felt anything. More great news!

We had a great time visiting family despite a bit of illness. The first night in Ohio I woke up in the middle of the night with nausea, thought I was going to vomit but my body was expelling from the other end. I think the airport sushi was a bad idea…never again. The next day, Christmas Day, I felt better but ate tentatively at first. By mid afternoon I felt back to normal. That’s how the trip started. It didn’t end too well either. The day we flew home, Steve had been up the night before coughing so he was exhausted and felt terrible. After a long day of travel, he collapsed on the couch at 5pm. I lasted a while longer, but between changing 3 time zones and getting up early for our flight I was done by about 9 or 10pm. That’s how we spent New Year’s Eve. The next day Steve had a fever and the chills. He had the flu. I lasted one more day before I got it too. We spent the rest of the week on the couch under blankets.

Between traveling and being sick, I didn’t exercise for 2 weeks. Boy, could I tell a difference. Both hips were more tight and sore. Both Robbin and Becky noted the same thing at appointments earlier this week. Thankfully, Steve and I are both feeling much better now, though we still have coughs. I’m working back up to 45 minute interval trainer sessions most nights. I guess the normal routine is good for me.

New therapies

First, a little bit about our Thanksgiving trip to Bend… as always, the trip was great. Because of Steve’s crazy work schedule, I was the designated driver for the 7 hour trip. My hips fared fine for the drive. By the end, my shoulders and back were a little sore but it was nothing a soak in the hot tub couldn’t fix.

Previous years I have enjoyed various outdoor activities. Before my dysplasia diagnosis I would run with others. Since I gave up running, I have been snow shoeing and cross country skiing. This year I didn’t feel up for any of it yet. I spent so long dealing with my right hip being overworked and angry that I didn’t want to push it too much. I’m finally back to normal.

My parents joined us in Bend this year and I wanted to spend as much time as I could with them. My dad had a hip replacement in August and he’s still recovering, so we couldn’t do too much for his hip. We were quite a pair. While Steve was cross country skiing, I took my parents to the High Desert Museum. The highlight was an animal show including a series of very impressive birds (hawks, falcons, owls) flying around the room over our heads. We could have reached up and touched them.

After returning from Bend I started a new regimen of appointments at the PT office. I had one massage before Thanksgiving and I’m continuing with one massage a week. I’m still impressed with Robbin. The first 3 meetings were an experiment in how my body responded to work on different areas. I think now she’s narrowed down what she things will have the most benefit. Last time she was working on some muscles on my upper thigh and across to where my hip bone sticks out. There are some very tight and tender spots especially where muscles meet and attach to bones. Robbin said she can feel where muscles seems “stuck” to the tissue below. After every meeting with Robbin, she sends me home with a new type of self-massage as homework.

The second type of appointment I had a referral for was iontophoresis, where medicine is forced deeper into the tissue with ultrasound. The evening before my ultrasound appointment the PT reviewed the referral and realized they don’t have the equipment to do iontophoresis (I had made the appointment for ultrasound). So, I wouldn’t be able to get iontophoresis at that office, but I decided to keep the initial appointment and find out what kind of benefit I could get from regular ultrasound. When I showed up for the appointment with Becky (she had treated me initially, before I was diagnosed by Dr. Downer) she explained that iontophoresis requires a special type of equipment that they don’t have. They do, however, have a special, fancy laser called an LCT-1000, which heats up the tissue at a cellular level. She stretched my hip a little bit and then used the laser on the scar tissue area for about 15-20 minutes.

After the laser, Becky hooked me up to an Electronic Muscle Stimulator (EMS). She placed 4 cold, wet pads on my back, 2 on each side of my lower back next to my spine, and had me lie on my back. Then we experimented with the settings on the machine. As she turned knobs, I started to feel a very weird tingling sensation. As she continued to turn up the power I was supposed to feel the muscles contracting eventually, but I just started feeling stabbing pain. Becky said sometimes it’s hard for the patient to feel the muscle contractions, especially when used on the back muscles, so we backed off until I wasn’t feeling the stabbing. Once the setting was determined I was instructed to engage my core muscles and with my knees bent and feet flat on the table, slowly raise my thigh up to 90º one at a time. She called it marching. The EMS is on for 10 seconds and off for 10 seconds. While it’s on, I march…while it’s off, I rest. After 10 minutes of that, I was done.

I’ll continue two appointments a week with Becky and one with Robbin for the next few weeks and see what happens. As of now, I’ve had 3 massages and 2 laser treatments. Overall, my hips do feel different. I’m probably a bit more sore on both sides. The tightness in my right side is less intense but it covers a larger area. I’m hoping after a few more weeks of this, I’ll start to feel more significant improvements. Still feeling hopeful.

Encouraging appointments

Last Tuesday I drove to Tacoma for my 6-month check up with Dr. Mayo. The appointment was very similar to previous ones. I arrived about 15 minutes early and had 3 x-rays taken, one lying on the table shooting anterior (front) to posterior (back), one standing anterior to posterior, and one standing of a false profile (shooting through the right hip to the left hip).

After x-rays I waited for a few pages of my book and was then taken back by a nurse. She took vitals and asked some basic questions, then I waited for a few more pages of my book. Normally Kenda would come in first, so I was surprised when the next face I saw was Dr. Mayo. He slammed the x-rays into the light box and asked how I was doing. I told him the left was still gaining back strength but doing well. I mentioned the continuing tightness on the right and said my PT had a theory about the cause. When I told him Dan thought the tightness was because of scar tissue, he seemed to think that was very possible. He explained that there’s not a good diagnostic measure to see scar tissue, so it’s a guess that it’s there, but it’s a good guess.

He also it could be tendonitis. I asked about trying massage therapy and he was agreeable to that. I also asked about Iontophoresis, or Electromotive Drug Administration (EMDA), which is a technique using a small electric charge to deliver a medicine through the skin. This can be done by a PT with ultrasound. Dr. Mayo was agreeable to that too and gave me a prescription for an NSAID gel called Voltaren.

He mentioned a few other possible treatments also. One is an injection of a steriod into the area. I might consider that if massage and ultrasound don’t work. Another option is a psoas tendon release. That is a surgery to cut a tendon. I’m not sure I’d want another surgery. He also didn’t seem too positive about that either. I don’t think the success rate is great. I think I’d rather live with it how it is than go through another surgery that might not help.

After discussing that, Dr. Mayo watched me walk and didn’t see any problems. I hopped up on the exam table and he did a quick physical exam to check my range of motion. One thing he and Kenda always do during exams is roll my leg side to side to see how far the hip socket rotates. You can sometimes diagnose a labral tear by doing this. He mentioned something about me having loose joints. It was the first time anyone had mentioned that to me. Being too loose-jointed can be a bad thing, but in my case it just means I have a high but acceptable amount of rotation in my hips. He thought it was a good thing.

Overall, the appointment went well. I expected to get a good report on my left and I was happy to leave with the massage and ultrasound referrals and the prescription for iontophoresis. After Dr. Mayo was finished with me, I went out to the nurse’s station to say hi to Stevi and Kenda since I hadn’t seen them as a part of my exam. At the previous appointment, Kenda had shown me and Steve a video taken during the first surgery. I had come armed with a thumb drive this time, so she copied videos and x-rays during both surgeries for me.

Later that day I called Dan to update him about my appointment and the referrals. I had talked to him before about massage. His office doesn’t offer massage but he recommended a woman at his previous employer, Peak Sports and Spine, which is a lot closer. I figured since I’d be going back to Peak for massage, I’d go there for the ultrasound too. Dan initially said he would recommend his boss, who is a woman, for the ultrasound. He understood if I didn’t want him rubbing a device around in my groin, but if I was okay with him doing it, I should just make sure I’m wearing my nicest underwear and he’d cover me up with towels as much as possible. That made me chuckle. I would have felt a bit uncomfortable with that. I told him I was thinking about going to Peak and he immediately rattled off a few names of women therapists there.

I called Peak to make an appointment for a massage and was able to get in a couple days later. I talked to the receptionist about the ultrasound referral too but decided to do the massage first and then make an appointment for ultrasound when I was there in the office. I wanted to see how the massage went before planning anything else.

The massage was Thursday. I had only had one massage before, so I wasn’t exactly sure what to expect. I was hopeful that someone working at a PT office as apposed to a salon would be highly skilled. I was immediately impressed with Robbin. She started with a quick assessment and noted some tightness in the soft tissue in both hips, more in the newest surgery side, which makes sense. She also said she was impressed that I didn’t end up with internal rotation of my legs after the surgery. She said my surgeon must be really good. I couldn’t agree more. Later she commented about how good my scars looked. I changed into shorts and she got to work.

The massage lasted about 45 minutes. She worked on my feet, calves, and thighs a little to start but spent most of the time on the area of my scars and into my groin a little. She showed me a technique for loosening up the tissue around my scars. She also suggested I start stretching my hamstrings because she felt they were a little tight. Overall, I liked her and felt she was very skilled and knowledgeable. I’ll continue to see her weekly for a while. Thanksgiving week, next week, is out for me because we leave for a trip to Bend, Oregon, on Wednesday and Monday and Tuesday will be filled with work and preparing for the trip. I have another massage scheduled the week after. I also scheduled with one of the women PTs for  ultrasound earlier the same week. I have the Voltaren gel and have been using it for a couple days. It smells like a mix between arthritis cream and bug spray, but the smell goes away after a little while. I’ll bring that with me to the ultrasound appointment.

Overall, I’m hopeful and encouraged. I haven’t been able to say that for a while. Aside from the multiple appointments, the one other change is I’ve started to ride hills on my bike. I’ve had a few dry days to test out the climbing legs the last 2 weeks. I’m starting slow, riding on gently rolling roads instead of always having to be on the bike trail. The one challenge in my rides is I’m now riding the hills to my house instead of changing into flip-flops and walking up the hills. The first time, I was quite sore after, but I’ve done it 2 more times and it gets a little better each time. I think riding hills will help rebuild my weak iliopsoas muscle on my left side.

I’m not good at being patient

Since my last post I had another appointment with Dan. I had gotten back to “normal” with the tightness with my right side and the pain from the bursitis in my left had mostly gone away. The appointment started with a discussion about what I was able to do and how it made me feel. I still wasn’t back to where I was before messing with the scar tissue, but I’d found a new baseline.

Next Dan did another assessment. He thinks I have one muscle, the iliopsoas or inner hip muscle, that is still weak. That’s the muscle you use to raise your leg straight in front of you. It makes sense that it would still be weak because per Dr. Mayo’s directions, for the first several weeks of PT I wasn’t allowed to use that muscle. One good thing about the weakness being in this muscle is that it is strengthened by walking and cycling. I don’t need to do any specific PT exercises for it. All the muscles not strengthened with every day activities have returned to normal. That’s great!

After the assessment we talked again about long-term goals and concerns. Dan asked what I was most worried about for the future. I have no doubts that the weakness in my left side will be resolved. I had this same weakness last time and I think all of the strength has returned. By far, my concern is the tightness in my right side and fear that it will develop on the left side.

As always, Dan knew exactly what he wanted me to try next. The previous stretches and strengthening exercises were obviously too much because they inflamed the area. The goal is to very gently stretch the front of the hips and strengthen the back. We started by finding a baseline for the tightness by walking down the hall, first at a normal walking pace and then at a fast walk. Then I tried the first stretch, variable 1 (lie on the floor on your stomach, straighten arms to lift upper body off the floor while keeping your legs on the floor, hold 5 seconds, repeat 5 times), and did my walk test after. I didn’t notice a change when I walked. Next I tried the first strengthening exercise, variable 2 (lie on the floor on your stomach, lift one leg a couple inches off the floor, hold 5 seconds, repeat 5 times on each leg). Again I didn’t notice a change when I walked.

After the second stretch, variable 3 (stand with front leg bent and in front and back leg straight, it’s a calf stretch but also stretches the hip, hold 5 seconds, repeat 5 times on each leg), I felt more tightness in my hip. Next we tried strengthening #2, variable 4 (with stretchy band in the door, loop band around your calf and pull backwards 10-20 times, repeat 2 times on each leg). Again this one produced more tightness in my hip.

So the plan was to do variables 1 & 2 for 2 weeks. If things were going well, add variable 3 for a week, then a week later add variable 4. I was allowed to keep walking and cycling. I was even allowed to add hills to both as long as I didn’t do it at the same time I added a new variable. If I have any problems, he wants to know for sure what caused the troubles. That makes sense to me. I also asked him about adding massage. He was fine with that, as long as I didn’t do it at the same time as adding something else to the regimen.

I went home encouraged about the new plan, but sore from the experimentation. I felt like I should allow myself to return to my normal amount of discomfort on the right side before starting the new plan. The next day I had a sore throat which turned into a full cold within a few days. I decided to start with just the first stretch, and because of the cold I didn’t feel up to cycling. After a few days the cold got a little better and I added the first strengthening exercise. It didn’t go well. I was more sore on the 2 days I did it. After 2 failed attempts to add that exercise, I knew I needed to stop it but I wasn’t sure if I should add something else.

I decided to call Dan again. This time he was with a patient when I called so I got his voicemail. He called back at the end of the day and told me to try variables 1 & 3. If that goes well try variable 4 for a week then try variable 2 again. It’s been a week. I’m doing 1 & 3 every day and 4 every other day. After a recurrence of my cold, I’ve finally kicked that and I’m riding on the bike trainer most days. It has started raining so I’m less motivated to walk or ride outdoors. So far this attempt at the new exercises has gone well. I’ll try variable 2 again sometime next week. I might also look into massage.

Things are going well, but I’m used to seeing obvious results from my efforts. I asked Dan when I should notice a difference with this plan. He said within a month or two. Yikes. That’s kind of ungratifying. And what if I do this for 2 months and see no changes? I am not good at being patient, but what choice to I have? None. I do trust Dan. Now it’s time to work on that patience.

More setbacks

Warning, scar photos at the bottom of this post.

Being the obedient PT patient that I am, I did exactly what Dan suggested. I rested 3 days and then started back up with my activities. Two Saturdays ago I started by doing some yard work. I sat for a while collecting kindling in a crate. I trimmed back some ferns leaves that had died. A little while into it Steve joined me and began tackling the horrible hillside of ivy (I hate ivy). I’d been avoiding that task because it involves climbing up on a steep hillside, so I was very glad when he decided to take on that task. As he threw down bunches of ivy, I would collect them in the yard waste container. Later that night we were both a little sore. I had used my arms more than I realized and my hamstrings/glutes were sore, but that seemed reasonable considering what I had done.

Sunday I did some strengthening exercises on my left leg in the morning and went for a 45 minute bike ride in the afternoon. I was still sore from the yard work the day before, but my hips felt the same after the exercise as they did before. Monday morning I did my bridge exercises and felt fine after. I felt good enough that I cancelled the PT appointment I had scheduled for the following morning. That clearly jinxed me. Later that afternoon I was standing and milling about in the kitchen as I made dinner and noticed that both hips started feeling more and more sore. Ugh, not again. After we ate dinner I sat on the couch for a while and gradually the pain returned to “normal.”

The following day I called the PT front office first thing when I woke up hoping to get my appointment back. Of course the slot had already been given to someone else. After I ate breakfast and got ready for the day, I called Dan to tell him what was going on. Despite how booked up he gets with appointments, I’ve been pleased with how easy it is to get him on the phone. Either I’ve been lucky and caught him between patients, or he takes calls during appointments. I told him the whole series of activities for the previous few days and how I felt after them. I could tell he was taking notes. My fear was that he was going to tell me to take a longer break, so I was actually pleased with his directive. He told me to stop all strengthening exercises (a foreign concept…I’d been doing strengthening exercises a couple days a week up until surgery #2). He thought walking and cycling were still okay, but he wanted me to cycle in 15 minutes increments (which means on the trainer, can’t get anywhere on the roads in 15 minutes). If I felt okay 2 hours after trainering, do another 15 minutes, up to 3 times a day.

Starting the next day, that was the new regimen. Trainer 15 minutes, rest 2 hours, repeat. The goal was to get to the point that I could do that 3 times a day for 3 days straight and feel pretty good after. Cycling has always made my hips feel better. I think the bent over position on a road bike helps the scar tissue not to interact with the muscles underneath as much. Starting out the first day, I had a typical amount of pain from the scar tissue on the right and from the bursitis on the left. As I cycled I would feel better and within 30 minutes after riding I would return to that typical pain. This remained the case for several days. I tested myself out a couple days by adding walking along with the cycling. I reverted to shorter distances, 2.5, then 3.5 miles, and felt okay until I had to go uphill. The tightness would increase as I was ascending but once I returned home I would go back to typical. Good signs I guess. At least I wasn’t getting worse.

By last Saturday, I started to notice a slight improvement in my typical pain. At the same time, I started using ice on both hips after every time I exercises. I also began taking more anti-inflammatories. I’m not sure if it was the ice that helped or if it was just time. Sunday I felt a slight bit better. Same thing on Monday and Tuesday. Today, I decided I would trainer for 2 25 minutes sessions instead of 3 at 15 minutes. So far so good. I’ll do that a couple more days and then try one 45 minute session, maybe outside.

At this point I think the bursitis is getting better. I am noticing the pain less often throughout the day. I’ll keep up on the anti-inflammatories and ice and hopefully that will completely go away in a few weeks. The tightness in my right side is not back to where it was before Dan and I started treating it, but it is better than it has been the last 2 weeks. I am less discouraged, but I’m not to the point of being encouraged quite yet. My next appointment is Tuesday and I’m anxious to hear what the next step might be for the scar tissue. I think if I didn’t have that issue, I would probably be discharged from PT already.

An aside here: I learned an interesting tidbit at a dentist appointment on Monday. He is aware of my hip surgeries and asked if I was taking any medicines currently. I mentioned I was taking Ibuprofen for inflammation with the bursitis. He told me that 400mg (2 Advil pills, the recommended dose) would only help with pain. To have an effect on inflammation you have to take 600mg. I happened to have a physical with a new doctor today, my old doctor left the state. She confirmed what the dentist had said. I find it interesting that you have to take a higher dose to deal with inflammation.

It has been a while since I posted scar photos. It’s actually been a while since I’ve taken any photos. At this point there is not a lot that changes week to week. My first scar, left side of the photo, is now 1 year and 5 months old. It still has some red at the top and it’s a little thicker there. Of course that’s the part most likely to be seen because it’s above the waistband of some pants. The second scar, right side of the photo, is 4 months old. It is starting to turn white in a few spots. Dr. Mayo’s PA Kenda told me during my pre-op appointment for #2 that they do their best to make a new incision match an old scar. She said they even get out tape measures. She mentioned that Dr. Mayo has daughters, so he’s sympathetic to a woman’s concerns about vanity. I’d say they did a pretty good job of matching old to new. I’m becoming less self-conscious of the first scar since it is mostly white and blends in. The redness of the second one still bothers me. We’ll see how I feel about them a year from now.

scars at 1 year 5 months and 4 years

Setbacks

Since I wrote last week, things had started out good. At my PT appointment Dan and I had angered the area on my right hip where he thought I had scar tissue. He thought it would calm down within 3 days and I went home with new a new stretch for my right hip and different strengthening exercises for both hips. I diligently did my exercises and continued walking and cycling. By day 3, I was not back to where I had been before that PT appointment. I didn’t feel terrible, but the tightness was still there just a bit worse than before. Also, on my left hip the bursitis was a little worse. I ached in a much larger area than before.

None if that was enough for me to really worry. I was hoping that I was just talking longer than expected to settle down. Dan had told me to call him if things weren’t going as expected. I considered calling him Monday or Tuesday morning but I didn’t think a little extra soreness warranted the phone call, so I carried on with my new exercises.

Tuesday afternoon I went for a bike ride. This was always the activity that made my hips feel the best. I had completed 4 rides of 45 minutes, so I graduated to an hour. Starting out I was aware of the tightness in my right hip. As I rode longer, the tightness went away and I felt great. I finished my ride at Log Boom Park downhill from my house, switched into flip flops and started my walk up the hill with my bike. As usual, the tightness returned as I ascended. The bursitis soreness in my left also got worse as I walked. Usually after I return home and rest for a little while, drinking the rest of my water bottle, my hips return to “normal.” This time both hips remained angry. It was bad enough that I iced both hips on and off for an hour that night and knew that I needed to talk to Dan.

Wednesday morning I called Dan. I wasn’t sure how that process would work. The only number I had was the one to schedule appointments. So I called the appointment number and asked for Dan, expecting to be told he was with a patient and he’d have to call me back. After a short wait, to my surprise I was actually talking to Dan. He assumed since I was calling that things weren’t going as he had expected. I told him about the extra pains I’d been experiencing and the lingering pain after cycling the night before. He told me to stop everything I’d been doing since our last appointment. He wanted me to rest for 3 days. No PT exercises, no walking, no cycling. That is not an easy thing for me. I enjoy being active. I’m also trying to lose a few pounds. Being on crutches for 8-10 weeks doesn’t do good things for the waistline. Stopping cardio doesn’t aid in this.

I knew that he was right though. I’m on rest day #3 today. Tomorrow I will walk or ride and see how I feel after. Dan also wants me to go back to just a few of the older exercises, specifically bridges lying on the floor on my back and sitting hamstring curls and kicks with the stretchy band in the door. He wants to get me back to where I was before the change in exercises. My body doesn’t seem to like the changes.

I am so discouraged. Up to this point, both of my recoveries have had upward trajectories. I always got better with some very minor issues. I don’t know what to do with backsliding. I don’t like just sitting around. I’m very anxious to test out my hips tomorrow. My best hope is that things will be fine and I can continue improving, but I fear that it won’t go well tomorrow. I fear that my right hip won’t improve. I have a lot of fears when it comes to my hips, including some future surgery. I’m so done with surgery. Just yesterday, I cleaned and put away my raised toilet seat and shower seat. I hope I never need them again, but I’m not so confident that I’ll get rid of them yet. They’ll stay in the guest room closet for a while longer.

Mostly good…a little bad

We don’t usually travel this much, but we have just returned from another trip. The latest was a shorter and easier trip. Steve’s summer office party was on Lopez Island last Saturday. Lopez is a 90 minute drive and a one hour ferry ride from home. Since we were traveling all that way for the party, we decided to make a weekend out of it. We left the house Friday morning and arrived on Lopez by lunch time.

relaxing on Lopez Island

We wandered around the shops at Lopez Village for a while (I had brought my cane but didn’t use it) and then checked into our B&B on the south end of the island. They had a great deck facing the water where we spent a couple hours relaxing. We went out to dinner and then hooked up with some other work friends also on the island that night and hung out at their rental house for the evening. I typically only see Steve’s co-workers at work functions every couple of months. There was a silent auction benefitting a food pantry when I was still on one crutch. That was the last time I had the opportunity to see these folks. During the evening I got lots of questions about the surgery and recovery.

The next day was the party, which consisted of two parts. Part one was an outdoor gathering on a large farm including a light lunch at noon and dinner of grilled salmon later. The second part included tours of two homes designed at the office (super cool, but that’s not what this blog is about). The timing of the party was decided so that it could be done in one day. Many took the ferry over that morning and took another ferry back that evening. Lopez is known for 2 things, being the “friendly island,” everyone you passed waved, and being very bike friendly. Quite a few co-workers left their cars at the ferry terminal and rode bikes onto the ferry and then to the party.

So far, my story has been all good. So here’s the little bit of bad. At Steve’s office, he’s known as the bike guy. Since Lopez is the bike-friendly island, everyone assumed Steve would ride there. He did bring his bike and rode in the morning before the party, so he did arrived at the party on his bike. When he was riding, I took the car to explore some sights on the south end of the island. I went to a couple parks. They both had hiking trails but no distances or difficulty ratings were listed. I didn’t want to get into anything too challenging for my hip since i was alone, so I wasn’t able to do too much. It wasn’t really that much fun for me. It reminded me of what I’m still not able to do.

Later at the party, I can’t tell you how many people asked us if we rode bikes there. At this point, I don’t look like I’m still recovering, especially if I don’t use my cane. I can understand why so many people asked the bike guy about riding. It was kind of disheartening to tell person after person that I’m not supposed to ride hills or more than 45 minutes. It was a repeating reminder that I still have a lot of work to do. I told this story to my friend Sarah over Skype the other day. I was scolded (with love), complete with finger wagging, and told to give myself some grace. She’s so right!

Despite the bike comments, the party was fun. Steve works with a great group of people. I got many comments from people who knew about the surgery about how good I looked. That’s always nice to hear. One guy had seen me laid up in the hospital bed at week 3. I believe I got a, “hey, look at you!” from him. I have come a long way in a relatively short time period considering what I’ve been through. (I know I’m contradicting myself, but one minute I am reminded of my accomplishments and he next my shortfallings.) By the end of the day, after touring the two office projects and a lot of standing around at the party, I was pretty tired. I got to the point where I had to sit down. That was another reminder of the work I still have to do.

Changing focus, I saw PT Dan on Thursday. I wanted to address the tightness I’d been experiencing in the first hip since about 6 months post-op. Because of the distance to the office, I’ve only been having appointments every 2 weeks. At my last appointment, which was initially scheduled with Dan, I had been switched to his assistant Katie. Normally that would have been fine. I like Katie. She’s perfectly capable of showing me the next round of exercises. But I had wanted to talk to Dan about #1. I was a bit annoyed they had switched my therapist without letting me know. I made sure I would be seeing Dan this time.

So at the appointment, he started by doing a full assessment of both sides. This involves measuring range of motion for every direction you can possibly bend your hips. I measured within normal ranges or just below normal for everything. The other test is strength, which is measured by me pushing against Dan’s hand in every direction you can possibly move your hip, knees and feet. I still have some weakness in my left quad but other than that I’m doing well. I noticed while Dan was measuring my ROM he had some big smiles as he was recording the numbers. After completing the strength tests he said other than the quad weakness I was basically normal. He said I was doing “damn good” especially considering the extent to which my insides were relocated. That made me smile too. If it wasn’t for the issues on #1 he said he would be confident to send me on my way to manage the strengthening on my own. He knows me well enough to know I’ll do the work necessary.

But I am still having some issues. On #2 I started having classic bursitis pains above the trochanter (the bump you feel on the outside of your hip). I had this on #1 in the spring but it was below the trochanter. I confirmed with Dan that we have bursa in the location I was having the pain. He agreed with my self diagnosis. The way you can tell if you have bursitis and not a ligament or tendon issue…if you press on the bursa sack it hurts in a very small area.

The main issue I wanted to talk to Dan about was the tightness in #1. My hope was that the source was soft tissue and not joint. Joint issues = surgery. I’m so done with surgery. Dan had me do various different stretches to see what angered the problem area. Some stretches engaged just the joint, so if those movements produced pain the issue was coming from the joint. None of these movements produced pain. Other stretches engaged the muscles, so if these produced pain the issue would be coming from the soft tissue. These movements did cause pain. Good news. All indications are that my issues are not coming from the joint.

Going forward I have completely different and many fewer exercises. I am doing one exercise, a step up on the stairs, to strengthen my left leg. On the right leg Dan wants me to strengthen the back of my leg and stretch the front. This should show improvements in about 3 weeks. Dan thinks I have a band of scar tissue running across and binding against the muscles in my inner thigh/groin. Every time I engage those muscles I feel that tightness because there’s actually something there. The stretch should gradually break down the scar tissue. I’m very encouraged.

Plane trip and x-rays

Warning, x-rays included at the end of this post.

It’s been quite a while since I last posted. That happens for one of two reasons. Either there’s nothing to write about, or I’m too busy to write. My excuse is the latter. I started 2 big projects for work at the same time and in the middle of them, Steve and I were gone for 4 days. It was not the best time for a trip, but my dad was turning 70 and we wanted to surprise him and my mom with a visit. I don’t think either of them would have thought me able to travel yet, so it made the surprise that much better.

My brother and sister conspired with us. My brother and sister-in-law picked us up and we stayed the night at their house. My sister and brother-in-law had the challenging task of making sure their 3 boys (ages 6, 10, and 13) did not spoil the surprise. Everyone was having dinner at my parents’ house the day of my dad’s birthday. A few minutes after the others arrived I showed up. Both of my parents were floored and so happy. There were tears welling up in eyes, mine included. It was great.

Because of work, we had to keep the trip short. We left the house at 7:15am, took a bus downtown, then light rail to the airport, all while pulling wheeled suitcases and lugging laptop bags. It was probably a couple miles of walking including the 4-hour layover. I used my cane and managed okay. I had slight concerns about the metal detector with my 13 screws, but I sailed right through. I did note some handicap accessibility failures with security, such as they assume you can stand and take off your shoes. There are no chairs until after you get through the checks. I can do that now, but I probably would not have been capable a few weeks ago, at least not shoes that lace. We took advantage of having my cane and boarded the planes first. It was much easier to get luggage stowed without feeling rushed.

Our time with family was great. We each were able to spend some time a close friend too. Steve spent an afternoon visiting job sites with his former co-worker and best friend Rob, and I was lucky enough to have my best friend Sarah in the same country, much less the same city. She lives overseas but spends summers in the US. We met for breakfast. Steve’s parents drove down for a day to see us too. They joined us for dessert with the birthday boy and had breakfast with Steve the next morning. The trip was too short, but really great. Here is a photo from dinner our last night there. Starting in the back with me (in front of the bunny ears) and going around the table is my 6-year-old nephew Jake, my mom, my 10-year-old nephew Luke, my sister Kathy, my brother Michael, my sister-in-law Deb, and my dad. Absent from the photo are Steve, who’s taking the picture, and my brother-in-law Chip and 13-year-old nephew Chet, who were both at cross country meets, coaching and running.

most of my family

Other than the trip and working a lot, I’ve also been working hard at PT. Since I have a longer trip to the PT office now, I’m only seeing Dan every other week. He gives me new exercises and I go home and do them on my own. I’ve also been gradually building up my endurance with cardio exercises. I’m walking 2.5 miles on the bike trail and I’m up to 45 minutes on the bike trainer. The most exciting part is that I’m allowed to cycle outside now. Initially Dan had wanted me to work up to an hour on the trainer before moving outside. I mentioned at an appointment that I was anxious to ride outdoors and he said to give it a try, 30 minutes flat. So I’ve done that 3 times now and it feels great. I’ve missed working hard physically. And honestly, I still miss running.

As I mentioned in the title, I finally have x-rays. I went home from my 8-week check up with all of my hip scans on a CD but the .exe file needed to view them doesn’t work on a Mac, the only kind of computer in my house. Steve took the CD to work but had issues with the software crashing before he could extract anything and then needing to leave to catch a bus home. He was finally victorious over the buggy software and emailed screen grabs to me. This is what I look like as of my 8-week appointment. In this x-ray I am standing. The new hardware is in my left hip, which is on the right side of the x-ray.

8-week x-ray

This one is called a false profile and it’s a bit hard to see what’s what. Hopefully the labels and arrows help out a little bit. While this was taken I was standing with my left hip against the plate. My pelvis was rotated slightly back so the left hip wasn’t completely behind the right one. My right foot is angled out too. I think it’s an angle Dr. Mayo came up with himself.

8-week x-ray, false profile