Frog lateral 6 weeks post-surgery. A dirty and poor quality scanner with lots of internal reflections and smudges, so read with care.
Same date, normal position. Same crummy scanner.
Drugs, Nutrition, and Bone Density
New Hip + 13 days
These first were the toughest days. My hip was very stiff. Very hard to find a comfortable sleeping position except flat on back, but I can't stand being on my back constantly. All the sliced/diced tissue made my hip underneath the 4" incision feel like a giant wad of old chewing gum. The first 3 days I was at the hospital, and the next 3 days I was at my friend Dave & Di's, where my good friends waited on my hand & foot. Good for the spirits! But no internet connection, and I'm an active stock trader trying to rebuild my plan for an early retirement from teaching and a return to full time research. So, when the stock market topped out in mid June I started losing money by not being on-line. And too, I wanted the comfort of a return to my familiar place and diet. So for the past week, I've been on my own at home. Each day begins with a self-injection of blood thinner. Today (day 13) is the last of them! Good riddance to that. My incision will be opened to the air tomorrow. The incision has looked good - or at least, as good as such a thing can look. No pain on the incision itself. Zero. Just a sense of stiff hard rubber there. No "foul discharge" and no fever - both would be signs of infection.
Here's my recommendations for others who live alone.
(1) Try to wait till after you're off the heavy drugs before flying home. My flight was a living nightmare.
(2) Go to the market and fill your 'fridge and cupboards with food before you head off to surgery.
(3) Get a small table-on-wheels, like one of those bar things, for home. It's really awkward trying to bring meals from kitchen to bedroom when you're using both hands on crutches!
(4) Include plenty of fiber-rich fruit early on; even bring it with you to the hospital. Buy plenty of calcium/magnesium/vitamin D supplements and get 2000 mg/day of calcium beginning right after surgery. Try to not eat the hospital food. It's awful, and nutritionally empty.
(5). Do plenty of torsional stretches before surgery, so that you are comfortable lying on your stomach and twisting around and changing your wound dressing. I could do it, but just barely, and I'm reasonably flexible. You don't want to hire a live-in nurse for that. Your incision (if posterior approach, as most surgeons do, including Dr. Gross) will be at about the 8am position (12 o'clock being your belly button and 6 o'clock being your cheeks crack), and about centered on the widest part of your hip.
(6). Of course, get your raised toilet seat set up before you arrive home. If you have a strong good arm and leg, it's not strictly necessary, but surely safer and more convenient. Use a 64oz empty fruit juice container as an in-bed urinal to minimize trips to the bathroom.
(7). A "picker" is useful, but if you have a good leg, it's quite straightforward to bend at the good hip while keeping fairly straight with the operated hip as you pick something up. It depends on your fitness and comfort with this. Don't risk a fall, if you have any doubts, and get a picker (they will supply you with one at the hospital if desired). It's pretty useful for putting on socks of your operated leg.
(8) Set up a wide table next to your bed before you leave for surgery. This table will rapidly fill with your med's, your used dishes, and with any/everything else as you learn to spend most of your new life in bed.
Week 2
It's "farmer's market" day, and I crutched my way from home, a half mile to the outdoor market where I filled my daypack with all possible fresh peaches, apricots, cilantro, kale, red onions, heirloom tomatoes, basil, nectarines... so gorgeous, after that hospital food! Hands feel mashed somewhat after returning home. A mile of crutching is at my outer limit in this regard. However, I note that this time I did not get any leg swelling afterwards. My first excursions, on Day 9 and Day 11 were similar in length, and I had hip muscle swelling, leading to a bit of sciatica afterwards (which dissipated by the next morning).
Week 3.7
Progress is progressing! Pulled my steri-strips off at day 17 when they didn't fall of as expected. Scar looks "good". I've been pretty non-adventurous about stretching, but yet still the range of motion is increasing on its own. Can sleep on my un-operated side with no significant pain, especially with the pillow between the legs. The sciatica didn't come back. Leg swelling pretty much gone after day 18 or so. No leg pain or evidence of circulation problems. Main problem is just the restlessness of inactivity, and those damn crutches which hurt my hands. Crutching from Trader Joe's to home (1 mile round trip) with a ton of non-fat milk etc in my backpack really mashes the nerves in the palm of my hands. How did I crutch for 3 YEARS early on?! I don't know how I did that, now. Been taking 1 vicadin per day, but have this persistent ringing in my ears and wonder if it's drugs. So I stopped taking it on day 24. Pain levels OK, I think I'd already acclimated to the vicadin anyway.
Week 4.5
Each day is a little less painful and a little less stiff. I was cleared for bath and pool therapy at the 28 day mark, and at 28 days I took the bus down to the gym and had my first workout. I joined my Ironman-bound friend at the pool for a 2400 yard swim. I used a bouy between my legs so my hip did not do any work except a bit of adduction to hold the bouy. Felt good! On day 30, I did 3600 yards in the pool. All upper body. I also continue to crutch around for shopping and now for the bus; about a mile every other day. No significant swelling in my hip, but it still feels stiff and I am not pushing for much ROM yet; I continue to worry about bone bonding with the prosthesis and with the reattached tendons, given my severe osteoporosis. I'll take it slow. But I do want to encourage good blood flow and (if its possible) blood vessel re-routing to my femoral head, and so these pool and hot tub sessions I believe are going to be helpful. I've been taking no drugs now for over a week, and don't miss them. Sleeping much better, now about as well as before surgery (which is still not good compared to before my hip went).
Frog lateral 6 weeks post-surgery. A dirty and poor quality scanner with lots of internal reflections and smudges, so read with care. |
Same date, normal position. Same crummy scanner. |
Week 6.9
At the 6 week mark (day 42) I went to one crutch instead of two. Swimming about twice a week, 3000 yards or so. This past Saturday (day 44) I did my first race - the Lake del Valle Aqua Challenge 2-mile swim. Felt good, had a good swim (but no medals this year) and here's the story on that. At week 5, I had a slip on the walkway outside Spa Fitness and put my full weight on the operated leg. No fall or impact, but full weight. Don't feel any new pains so hopefully no damage. Trying to get a baseline of my morning urine pH. So far just two readings; 6.0 one morning and 7.0 another. Need more for some kind of pattern to emerge. My activity level is only going up very slowly. Still spend most of the day inactive. Going for a 2300 yd swim shortly, and will also do weights this time around, upper body only. Talked with Dr. Gross today on the phone. Here is a digest of the Dr. Gross information I got on my questions. Ringing in the ears has disappeared.
Week 9
I'm still on one crutch. At week 8.5 I had my first return to teaching - a one-weekend field class to the Sierra. I figured it would be very hard for me to do everything I needed to do during this field class all on one crutch - and I in fact spent a fair amount of time "walking" without aid. No ill effects. However, my hip feels very turned out and I cannot walk without a severe limp, even though there is no pain causing the limp. I'm just very tweeked out. My left (operated) leg feels longer than the unoperated leg, but this is most likely that my hip/spine connection is tilted due to 10 years adjusting to a shorter left leg so I am not yet worried about it. When my bones are stronger, I'll get some proper chiropractic and see how straight I am. For the past 2 weeks I've been carefully monitoring my urine pH, which ideally should be 7.0 to insure no bone calcium losses are happening for pH buffering. The 2000mg of calcium which Dr. Gross told me to take turns out to be necessary to insure this, even though I already have a reasonably alkaline diet (fresh fruits and veges, no soda, alcohol, sugary stuff). It's necessary for me to take a final 500mg CaMg-Vitamin D tablet chewed up before sleep to insure a good morning pH. Since according to Gross my bone is continuing to weaked for 3 months after surgery it is foolish for me to be putting stress on the hip. So, minimal walking, anything long (like a mile to/from downtown) I do on crutches but with reasonable weight bearing on the left leg. Around the apartment, I don't use crutches now. That's a week before I'm supposed to get off them, but I'm being very careful. Othewise, I continue to swim 2-3 times a week about 2,000 - 3,000 yards at a time. No particular pain in the bone, some soft tissue pain if I muscle around too much, but it goes away quickly. The "wad of bubble gum" feel to the hip surrounding area is less now, although the rotators are still painful to use at all, and I'm avoiding it till a bit later. Fracturing my fragile bone is the last thing I want to do during this period!
One thing I'm worried about is that I cannot bend my hip beyond 90 degrees, and it doesn't feel like tight muscles or scar tissue. Granted I've never before had surgery and may not be the best judge, but I can't help worrying that there is a mechanical limitation which won't go away as the tissues heal. I hope I'm wrong. If anyone else has first-hand experience from Dr. Gross surgeries I'd love to hear about it.
Week 10.0
Today's the first "official" day I should be off crutches altogether. Did a stretch session in the gym before a light upper body workout and then 1400 yards in the pool. For the gym stretch, I used the big box and lay down, propping my left foot against it and bending my knee and hip as much as possible for a passive stretch of the glueus muscles. Then, to the Santa Cruz Track Club where I walked for 3/4 mile, focusing intently on not limping. Very tough! Just trying to walk properly required lots of conscious muscle involvement around the hip, and the muscles had to really work. Got better by the 3rd lap, after a session of instructed stetching from Art, the race walk coach. So far, so good. Progress!
Week 11.0
I had my first appointment with an endocrinologist yesterday. Dr. Levine. He was not convinced my free testosterone was low, since the total testosterone was normal, and we're re-doing the test. There was nothing yet in my history or existing tests which shed light on my osteoporosis. He thought it suprising that even with my relative sedentary 10 years, that I would be so osteoporotic. He did feel it was possible that my lack of activity was the sole cause, given how dramatic is the bone loss in astronauts in prolonged weightlessness. However, he wanted to look for other causes. We're doing more tests, including parathyroid. His tentative suggestion is to try the new drug Forteo, which is a formulation of parathyroid hormone. This builds bone instead of merely inhibiting resorption as biphosphonates do. The effects are strong, but it is expensive and not always covered by insurance since it's around $10,000 / year (!). We'll see what my tests show. Here's a page on Forteo. Today I walked one mile at the Santa Cruz Track Club workout. Quite difficult, I'm relearning walking all over again. My hip feels like the nerves have been reconnected in a random way. Like the "wiring harness" has been disconnected, and reconnected with some random rotation. I can limp as per usual, but to concentrate and walk straight is just as hard this week as it was a week ago.
Week 17.0 (Oct 10, '07)
School's started. Still haven't had time to get the blood work etc and return to Dr. Levine. But been focusing on urine pH levels and diet, and learning a lot. My hip is slowly feeling less stiff. Pain hasn't been much of an issue at all. However I did hyperextend my knee 3 weeks ago, but this is mostly healed now too. Walking "normally" is now much much easier than at week 11. Still must mentally focus on walking properly and not limp / "duck out" with my left foot. Did the swim's on the Big Kahuna half Ironman triathlon, and also the Sentinel triathlon here in town, and did well. Last weekend (Oct 5-7) I did 4 miles of mountainous downhill hiking at my Astro 27/Geo 27 field course at Pinnacles National Monument. Felt fine! According to Dr. Gross' schedule, my bone should now be 3 weeks past it's point of minimum strength. I'm walking more and more with only the slightest limp. walking up stairs without matching feet is still hard. Had an appointment with my chiro last week and he's impressed by the proprioceptive performance on balancing tests. He's happy with my progress. No running or even thought of running yet. I want my bone confirmed strong and at least 9 months of healing before even thinking of that. I am beginning to think about ordering the Soloflex WBV unit. My bone should be ready for this soon, I feel.
Week 18.5 (Oct 22, '07)
Hip stiffness continues to get better. Sunday I did my most ambitious exercise yet - an 7 mile bike followed immediately by a 7 mile hike into the Santa Cruz mountains on trails. Felt fine, just a bit of extra soreness that night, which quickly went away. I'm able to walk virtually normally now. The knee pain has also healed. To hike for miles and feel normal, what a great feeling! Can't wait for winter and snows and a chance to get back on my cross country skis.
Week 21 (Nov 7, '07)
Hip stiffness is now mostly gone, just a little bit left. Last Saturday I got on my Serrotta racing bike for the first time in 10 years. No problem doing an internal rotation to get in/out of the clips. Felt good! Sunday, a 26 mile ride to Sand Point. I walk most times I go downtown now. Also in the past 10 days, my first session of boogie boarding, up at Waddell Creek - an hour long. Stretching session; lying on my back, still can't bring my operated leg any closer than about 70 degrees (~10 degrees meaning I'd be touching my chest) angle. Also hard to get a standard piriformis stretch to actually stretch the piriformis. I'm still worried that there may be limitations to my hip articulation aside from scar tissue. But, I don't have anything to back up that worry except the way it feels.
Week 29 (Jan 2, '08)
Dec 30 I was at Yosemite, and for the first time in 11 years I tried cross country skiing. Just 1 mile, and a little up/down on the bunny slope as well. My muscle memory was sketchy and my 3-pin boots are more than sketchy - they disintegrated! So it was a short experiment and I need to get new boots. But it felt great. Then, Dr. Gross said I should be able to run by sometime "next year". Well, Jan 1 is next year and I felt ready to do just a bit. I ran for a half mile on the beach in my running shoes, keeping my stride very short to allow me to use my calfs to extra-cushion the impact. Felt great to run again. No hip or knee issues arose, just some unsteadiness in my ankles. Jan 1 was a glorious day, and I got on my Serrotta and did a challenging 40 mile ride up the coast to Swanton Loop. Pure joy, and no hip issues! Jan 6: I ran again, this time a full mile; first half with shoes, and second half mile barefoot, in the rain on the hard sand of the beach. Felt so delicious to run through the surf again for the first time in over a decade! No complaints from anywhere in my body, but it'll be a long way back to real running. I've re-joined the Santa Cruz Track Club, and have a Soloflex WBV platform on order now as well. I'm doing more significant stretching, hurdler stretches inside the hot tub at the gym to help support my body weight and give maximum flexibility via heat.
6 months (Jan 13 '08)
Got my Soloflex WBV platform and have used it for 20min each of the last 3 days, set at 0.4g, standing with most of my weight on my operated leg. Feels quite gentle, and no problem.
8 months (Mar 14 '08)
Since my last entry I continue to get more fit (slowly) and am doing harder exercises for my hip at the gym. Glut machine, standing donkey calf machine, leg press added to the routines with ab- and adductor machines. Cycling now up over 50 miles per training ride. Last weekend I decided to start regularly doing the Santa Cruz Sentinel Triathlon cycling course (23 miles), since I have several recorded competition times on that course (dating back 10-20 years ago) for which I can compare. Sobering! My times in the early '90's were 1hr 08min. Last weekend, 1hr 33min. Yow! But I felt good and had no hip issues. Just undertrained (and 10 years older). I'm motivated to cut that gap. Now one thing that continues to bother me is a "clunking" or "snapping hip syndrome" on the operated hip. I didn't think much about it early on, figuring it would go away on its own. Nope. It's only gotten a bit worse. So I clearly need to focus. Thanks to a lead in Surfacehippy, I found this link on "snapping hip syndrome" and will re-double my training and stretching exercises. I will say that my left hip is still nowhere near as flexible as my normal right hip. I can't pull my hip anywhere near my chest as I can with my right, much as I try and stretch it. Stretching elsewhere in my body feels like stretching normal tissue, but stretching my hip feels like trying to stretch a wad of old chewing gum stuck underneath a school desk. Doesn't hurt so much as it just doesn't want to budge very much.
I'm continuing with my 1000+ mg/day of Ca/Mg/Vit D supplements, going very easy on the cod liver oil to avoid getting too much vitamin A (bad for osteoporosis), lots of fruits and veges, especially calcium rich kale and green leafy's. I don't get on the Soloflex as much as I should. It's excruciatingly boring. Instead I am doing brisk long walks barefoot on the hard sand at the beach near my home several times per week. I try to run but my knees hurt and my first running in January, after a week of pure joy, I got an overuse injury of my ankle on the my good leg which lasted for well over a month. Got to be smart and measured about this, Nolt!
1 year (June 13, '08)
The gym work has paid off. I can now run again. Whereas when I first tried to run, in January, I felt like an "old man", now I feel like a "young man, who's never run before". OK, youngER man. Meaning, I feel the stress in my muscles, I feel slow, and my flexibility is not quite back to where it was, but not the pain in my joints as earlier. I'm enjoying walk/run's on the soft and hard sand at the beach several days a week. I just hop on my bike for the mile ride to the beach and it's a very nice break. My swimming is going well. I plan to enter an Ironman distance open water swim in a month. And, I plan to enter my first triathlon in 12 years - the Sandman Triathlon local here.
My hip is much less stiff, hardly noticable except when I focus. Stretching is now more pleasant, more like I'm stretching tissues that welcome it, instead of the earlier feeling like I was trying to stretch old stuck-to-the-bottom-of-the-desk chewing gum that complained. I continue to take cod liver oil only very sparingly - just a sip once every day or two, in order to limit my Vitamin A intake (more than 2x RDA hurts bone density), continue to take my Ca/Mg/Vit D supplements from Trader Joe's, 1000-2000mg/day, in addition to the minerals I get from my pretty decent diet rich in veges and fruits. I continue to monitor my urine pH and use the alkalizing supplements Potassium and Ca/Mg/Vit D to help insure it stays neutral or slightly alkaline. I continue to stretch, often in the hot tub at the gym. The "clunking" I complained about has mostly gone away with the strengthening and stretching (usual runners stretches you can find in many places). I have not had a bone density scan but may get one (depending on out-of-pocket) later this summer. I'm really doing all I can to help my bone density, so if the density scan is not good, I'm not sure what I could do about it anyway (aside from drugs - and I'm not a fan of drugs).
14 months (Aug 3, '08)
My return to running continues to be slow. However, I passed a milestone today - my first triathlon since Ironman Canada '96. I did the Sandman Triathlon in Aptos (.75 mi swim, 15mi bike, 4.5 mile beach run). My swim was strong (not affected by my hip), my bike was OK, and my run was.... well, I did run the entire course w/o walking, and that's the biggest challenge I've put to my new hip, and it seems without any trouble. Photo's of my race day are here. Again, Dr. Gross says that there's a small chance of AVN under the cap developing between 1 and 2 years post-surgery, so I will continue to monitor closely the sensations in my hip. For today's race, I did feel soreness, but it was on the outside of the hip and consistent with soft-tissue being stressed. Any pain in the groin side and I'd have immediately stopped been concerned. The "clunking" I earlier complained of... seems to be entirely gone. Been a while since I can say I noticed it. Guess the stretching and weight room work did the trick.
14.5 months (Aug 24, '08)
Two days after my triathlon, my operated hip was sore when I'd put weight on it, much like pre-surgery. It worried me, and I even spent one day getting around on crutches just in case I'd actually hurt the bone in some way. But the symptoms got much improved over the next few days. Then, I used a gizmo my triathlon buddy Dave showed me, from tptherapy.com. You use your own weight to do deep massage on muscles around the upper leg and hip. It was quite painful, in a good way. I used this for about half an hour, while watching the Olympics Opening Ceremonies. Next morning, my hip felt great! I ran on the beach and did 42 miles on the bike and felt no pain. Went to my local running store and bought my own. Kind of expensive - $69 for the roller you see on the right on the page linked above. But, worth it in my opinion. Those rotators and insertion points around the hip after surgery are going to need lots of deep tissue work to minimize scar tissue tightness. Now, I'm upping my biking quite a bit and plan to do the Big Kahuna Triathlon in 2 weeks - a half-Ironman distance race. But I'll skip the run; I'm just doing the swim and bike. Can't run 13 miles yet.