Muscle Repair - My Perspective

10.5 months since I had my abductors re-attached to my leg.  I'd like to say that I had wild dreams of strutting down the street in high heels by now, but I think we all knew that wasn't going to happen!  My more modest dream of just walking without my stick is yet to materialise too.  I'm still hopeful though.

I think the recovery from the muscle repair took much longer than any of us thought.  Six weeks on two crutches and then a further few weeks on one crutch did nothing for my residual muscle tone (and metabolism!).  If possible, I seem to have lost a little more function as my quadriceps muscle has taken to doing EVERYTHING and now I can't stop it from taking over.  After 10.5 months I cannot lift my operated leg from a lying position and I was just able to do so prior to the muscle repair.  So.... I don't know what happened there?

The way I see it, right now, I am no better or worse than I was prior to the muscle repair surgery.  I'm hoping that in time, with continuous exercise, something might improve.  I've already accepted my stick as one cool accessory (I can get the last packet of pasta from the back of the massive supermarket shelves with that bad boy lol!).  My funky walk is something else - I'm disappointed that it doesn't seem to be evening out, but as long as I don't catch my reflection in a window or mirror, I'm mainly okay with it.

Anyways, as is becoming my mantra - I am still in NO PAIN.  That I am so so thankful for!

I have heard that some muscle repair surgeries can actually induce pain in the muscle due to scar tissue formation.  I either have massive nerve damage and just can't feel it (possible considering my (in)ability to notice how far advanced my osteoarthritis was?) or the repair did go well and scarring was minimal.  I'm going to go with the latter, psychologically more optimistic... ;o)

Related posts of interest:

• Ultrasound Results
• Injection fun
• 6 weeks, now walk

Article by Mr.O'Hara

Very excited to see an excellent article online in the surfacehippy community by my favourite orthopod himself addressing the recent negative press surrounding hip resurfacing....

http://www.surfacehippyinfo.com/index.php?option=com_content&task=view&id=543&Itemid=108

and this is why I trust him so much :o)

Even my eyebrows hurt!

Okay. Swimming and gymming. I have been 7 times in the 10 days since I joined up and its been great! Even though parts of my body are reminding me of their existence! My hip on the other hand is getting stronger and stronger, and its the one body part that doesn't ache.

I'm doing about half an hour on the gym bike and an hour in the pool, including hydrotherapy exercises in the pool. Mr. O's letter (for me to give to the gym is they're worried about my using the machines in recovery) does sorta say I could be doing a lot more, but honestly, I don't think I'd be able to move the next day if I did all that!! I mean, I have the physiotherapy exercises to do at home too! I figure if I include one more machine each week then I might actually be able to function. I went to work last monday and couldn't use my upper arms and shoulders after all of the swimming last weekend!! My hips were fine! I don't know if I can keep up with this bionic hip...

A couple of other completely fantastic side effects from these workouts - I have a lot more energy and I'm sleeping very well. I'm sleeping more and more on my op side now, not for long periods but I find I'm just rolling over onto that side naturally in the night.

My ROM is still increasing. I still can't get my sock on my right foot yet without my putter-onner but I can get my knee almost to my chest so I can reach to the underneath of my foot....but its still not quite enough to put a sock on or clip my toenails yet. It's getting there. It'll be 7 weeks post-op on monday so all of this is remarkable.

I am, of course, still using one crutch for walking any distance. The limp is still prominent but I can tell its beginning to get better. I've started to use a cane indoors, I haven't quite transitioned to using it outside yet as I've never had to use one before and it takes some getting used to! It was a suggestion by Mr.O to get myself a collapsible cane so as I get stronger I can walk for longer periods of time unaided and I can just take the cane out my handbag to use when I get tired. So I got myself a funky purple spotty one from http://www.switchsticks.com/ , if you've gotta use one, make it stylish!

Anyhoo, I've just come back from the health club and I need to scrape myself up off this sofa (again) so I can go make some dinner ..... ;o)

BHR versus THR

I decided I should highlight the differences between hip resurfacing (BHR) and total hip replacement (THR). Many people have asked me what BHR is and what are the differences to THR. This will also be a prelude to the next blog post.

Hip resurfacing is NOT where the orthopod goes into your hip and smoothes everything out, as the name might suggest. BHR is actually a metal-on-metal (MOM) hip prosthesis. It comprises a metal acetabular cup and a metal femoral head cap. The metal used is chromium cobolt nickel. THR's to date can be composed of metal and plastic, ceramic and ceramic, and the newer ones are large-head MOM. The biggest difference between a BHR and THR is in the femoral component of the prosthesis. In a THR, the head of the femur is amputated and a metal rod/spike is inserted into the femur which has a ball on the end acting as your new femoral head. In BHR, the femoral head is maintained, it is only reamed down ready for a metal cap to be firmly inserted over the top of the head.

Just for comparison here's a great image from the Mayo Clinic (http://www.mayoclinic.com/health/medical/IM03868):

BHR is therefore more bone conserving and is proving more beneficial to younger people with hip disease as it has allowed many to go back to more higher impact sports and activities compared to a traditional THR. However, it should be noted that the newer MOM THR's are allowing all ages to do exactly the same. The survival rates of BHR prosthesis have shown to be significantly higher than traditional THR at 10 years. But THR surgery has been around a lot longer than BHR (~15 yrs for BHR in UK; only since 2006 in the US), plus there is a skew in the age groups recieving either. So far the data falls in favour with BHR for younger people, but only time will tell.

I don't want to get bogged down with the pro's and con's here, I merely wanted to describe the main anatomical differences between BHR and THR.

Inspiration

I found a patient video online earlier that just makes me want my BHR tomorrow. I hope its even half as good for me:

http://www.surfacehippyinfo.com/index.php?option=com_content&task=view&id=350&Itemid=30

I did winch a little watching the part where he gets out of bed for the first time as that still evokes the strongest memory for me after my PAO. The physio's came round that morning, after 3 days of lying flat in bed being pumped full of morphine and goodness know's what else. They manhandled me into a sitting position (well, I couldn't do it myself) and lowered my legs over the side of the bed. I wasn't in any pain, the epidural was still in and morphine was still swimming about my system. I couldn't feel anything below my waist on the right hand side and I was completely freaked out by it - and the zimmer frame right in front of me (!!). At that point I promptly threw up and started crying. Apparently this is normal and in hindsight, thats the worst part, not the surgery, but the first time out of bed.

I am being honest when I say I'm not nervous about the surgery. But until now, I just haven't mentioned that I'm nervous about the first time out of bed. I survived once, I'll survive again!! And if this patient is anything to go by, it's not going to be 3-4months on crutches! :o)

4 weeks to go - reflection

Of all the random things to do on a sunday morning, I decided to watch an entire BHR surgery online on the McMinn Centre website (http://www.mcminncentre.co.uk/flash/). Derek McMinn is the founder of the BHR and I feel so lucky to be having mine in Birmingham where it all started. As far as I know, he only works at the ROHB part-time to do knee surgeries now and all his hip patients are private.

I should say that the surgery video is graphic and watch it being warned thus! It's fascinating though and despite it being a specially recorded surgery, it still only took him 50mins to complete the entire thing. If I hadn't already been through a triple pelvic osteotomy (TPO or PAO) I probably couldn't have watched it. I remember my orthopod telling me how they checked how secure the pins were in my pelvis - which basically involved him bouncing me (!) on the table by shaking one of the pins on a metal rod.....yum! It almost seems too comical to believe, if it weren't for the bruises.

So aside from becoming slightly obsessed with researching 'all things hip' (or 'hip porn' as one of my friends referred to it!) I've begun to start thinking about getting organised. I have 4 weeks to go. Next friday, 29th Jan, the ROHB has arranged for me to have my pre-op assessment at my local GP surgery. That's really nice of them as it saves me a 4hr round trip for something that will only take 30mins. It also means I can pop down on my lunch break and not have to worry about being off from work.

I'm slowly accumulating a shopping list of essentials. This is in part due to the fact that I'll be recovering at the family home in Scotland and not in Leeds. So I need to organise myself not only for the hospital stay, but a few weeks away. I'm going to think on that more in a couple of weeks time. Next weekend I think I'm going to have a mini-spring clean of my apartment and sort out a lot of stuff. My thinking on that one is this - my job is ending at the end of may, and at this moment in time I have no job to go to after that, therefore I might be moving. If I have to move, it makes sense to have the apartment in order when I'm less mobile or if I need some kind soul to help me.

So really I'm just in psychological organisation mode this weekend. I'm not nervous about the surgery (yet!), but I did have a moment yesterday where all I could think about was infections post-op. And I'm not talking about from the surgery, I mean getting a throat infection or from a small cut etc. Apparently you have to be super careful about such things with a metal prosthesis as bugs like to grow where blood (and thus antibiotics) can't get to them and they can cause havoc. I had visions of antibiotic spacers and then THR's. But enough, its all about choices and what I can live with. I cannot live with the joint the way it is, so BHR is the way to go and I will just have to make sure I look after myself.

I think I'm going to go draw myself a nice hot bath and remove myself from the internet 'hip porn'!

2010 - The Year of Deja-vu

Happy New Year!

I love the turn into the new year, it inspires me and I feel more confident about things. After making a long trek back to the family home in Scotland in this freezing cold weather for christmas, having a very relaxed and stress-free holiday, I'm home again and making plans for the coming year.

I should just name this year 'deja-vu'. It was exactly 5 yrs ago that I was awaiting hip surgery and looking for a new job. This is precisely what I face now in the first half of this year. Remarkably, I'm not stressed or worried about any of it - having been through it before and finding that everything works out, I know that if I continue to work hard at my current job before the end of my contract, job hunt and keep as healthy as possible before my op then everything is going to fit into place.

I've had very few aches and pains these last few weeks, despite the cold weather. I've taken care to keep as warm as possible, sometimes wearing as many as 5 layers when outside! Can't say I've been cold!! I've donned my walking shoes for the snow and ice which have some serious tread on them. I even have some Yaktrax (http://www.yaktrax.co.uk/) for the seriously icy weather. I mean, nothing can 100% guarantee that you won't slip and fall, but you can seriously reduce the risk with sensible footwear.

Now, I say I've had only a few aches and pains, I should add that its chiefly down to getting the pain management correct. Diclofenac once every 12 hours and 15-30 mins with the TENS machine in the evening (once in for the night) seems to work very well for me at the moment. I have been stiffer in the hip due to the cold, but its not painful, it just slows me down. I'll be getting my hip block a week on monday so I'm going to have to alter the routine - hopefully I won't need the diclofenac for a long while, which will give my poor stomach and liver a rest! I've also taken some non-medication pain relief advice from Jan Sadlers website http://www.painsupport.co.uk/. I've always been a great believer in meditation as the best relaxation but it does take some practice getting it right to work for you.

I'm going to break this year down into two - pre and post op. This also encompasses old and new job too as I'll be pretty much finishing one job, having surgery, and starting new job - fingers crossed the dates work out, but I've been told the surgery is likely to be in April at the earliest.

So my goals for the first half of the year are to stay as healthy and fit as possible for the impending op, managing any stress that might arise, and seriously pursue a new job. :o)