6 month check-up – all good!

On 1st Feb 2013, it was 6 months and 1 day since Mr Witt sawed and chiselled his expert way through my pelvis and pinned me back together during my RPAO.  And of course, the only way to celebrate this is with an X-ray at UCLH (apparently my second home).  One of the most exciting parts of this adventure was travelling on the London Underground – I haven’t been mobile enough to do that for years! Now I can cope with just one crutch, to support my left (unoperated) hip.

And the good news is, everything on the surface is healed (see below for non-gruesome scar pic) and on the X-ray everything looks fine!  One of Mr Witt’s registrars showed me just how much more coverage my hip socket has following the operation – no wonder I’m getting less pain on that side when I walk these days!  There is one fracture which had to be shifted so far that it’s unlikely the two sides will unite fully – and apparently this is quite common and not a problem as it’s a non-weight-bearing part of the pelvis.  But the hip is officially fixed.  Woop!

We discussed one niggle that has been frustrating me for the last few weeks – when I try to do certain yoga poses (bridges, clamshell exercises), I get an intense pain low down in my pelvis, kind of between my butt and my pubic bone (nice).  It’s impossible to point out without looking extremely rude, so that was kind of embarassing.  Anyway, it’s so sore that I have to stop whatever I’m doing, and it takes several days to recover again – during which time it hurts when I walk, go up stairs, do my physiotherapy, turn over in bed  – well, during everything.

Mr Witt and his team told me that this is reasonably common and can be caused by a tiny stress fracture in the pelvis – but on a non-weight-bearing part which is why I can’t feel it when I walk around (unless it’s after I attempt said bridges, clamshells etc). They inspected my X-rays thoroughly and found no evidence of a fracture, and so they’ve put it down to a muscle (probably hamstring) which is rubbing or catching on one of the fractured sites.    They gave me more hamstring stretches to do, and told me that if it doesn’t improve in 6-8 weeks, they can give me a cortisone injection under sedation, to ease it.  This is something that happens quite often post-PAO, and apparently cortisone tends to sort it out for good.

So, that leaves Hip Number 2 – the left one!  Mr Witt put me on the waiting list for my LPAO at the same appointment, so I just have to cross my fingers I won’t have to wait too long.  I suspect August will be an interesting month for the second year running.

In the meantime, here is a picture of my scar, on its 6-month birthday.

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Stripes – I’ve earned a few..

I’m quite proud of it – it’s fading to a pretty silvery colour, and sits right along the natural crease in my hip joint.  It’s invisible under my knickers or a bikini.  And it’s only about 4 inches long.  The little screw bumps above the incision are not really visible in this picture, but I’m rather fond of them too.  It’s nice to have a reminder of the operation that is helping me walk again.  Almost like people get tattoos to mark important times in their life.  Tattoos aren’t my thing, but I like to think I’ve earned this particular stripe!

PAO Recovery Week 10: A Setback.

Dammit – things were going so well!  Until a week or so ago, I was making great progress.  As I wrote in my previous PAO update, I was beginning to do some weight bearing physiotherapy , trying to move away from crutches, and generally enjoying being in much less pain and much more mobile.  So much so, that I think I got too confident and…oops.

*Sniff*

I was trying to do some one legged bridges (raising myself up on my operated leg) and it felt sore.  Well, I thought to myself, physiotherapy exercises do hurt.  Every physiotherapy exercise I’ve ever been given has hurt when I first tried it.  So I did a few more.  And that night, when I went to bed, I noticed a soreness down the side / back of my right thigh.  It hurt when I bear weight through my leg, when I squat, when I sit down, when I stand up – and over the next few days, it didn’t get any better.

After an uncomfortable hydrotherapy session I decided to take it up with my GP, who sent me to the Accident and Emergency Department for an urgent X-Ray.  Three different orthopaedic doctors compared the X-ray with the previous ones taken at my 6-week checkup, and decided that there were no changes between the two.  This is good news, because it means my adventurousness hasn’t resulted in a fracture.  Blood tests revealed nothing unusual so infection is also ruled out – hooray.   Unfortuately though, it has left me with a series of guesses as to what is causing the problem.  Sciatica?  Bursitis?  Iliotibial band?  I’m not sure.

Ouch…what have I done?

But still – meh.  In terms of pain and mobility levels I have regressed weeks.  I am back on two crutches, need serious amounts of codeine to help me sleep through the pain, and can’t sit, stand, walk or sleep for long. And I’m still at a loss as to what is causing the pain.  It isn’t localised to my joint – in fact the mobility in my hip joint is continuing to improve.   This pain radiates down the back and outside of my thigh, even as far as the outside of my knee.   And because I don’t know what the matter is, I don’t know how to try and fix it.  I’ve been told to lay off the physio and wait to see if things improve without any weight bearing or other kind of aggravation.  Grrrrrr!

Thankfully I have another physio appointment in two days, so I am really hoping for a) some answers and b) some exercises that can help me reduce the pain.  I feel like I’ve retreated back to a codeine-induced zombified haze, and I just don’t want it to be like this any more. Last week, I was getting excited about  returning to work soon, and now I’ve been signed off for at least another four weeks.

Are there any PAO-ers or ‘hip women’ out there who can give me some advice?  Does this sound like anything you experienced or have heard of?  I’d be so grateful if you could help me get rid of this pain and put me back on the track to becoming the bionic woman (minus one-legged bridges, which I may very well never attempt again.  Ever).

What a difference three weeks make – PAO recovery weeks 5 – 7

After week 4, the rehabilitation work begins. My time is now increasingly taken up with physiotherapy exercises and attending hospital appointments.

Week 5 sees the first of my physiotherapy appointments.  Having seen all the amazing feats of athleticism that other PAO-ers are able to achieve after 5 weeks, I’m rather nervous that my physiotherapist will be disappointed with me.  But no – in fact, she’s really impressed!  This is a big relief to me, as I was starting to wonder if my pain levels at this stage were rather high.   She suggests I add in an abdominal exercise to the exercises I was given when I left the hospital, and books me in for hydrotherapy in week 7 (of which more later).

Pleasingly, she also marvelled at the rate at which my scar is healing, and at how neat it is.  You can judge for yourself here!

I did not pick the glue off this scar at ALL. Definitely not. No.

This photograph was taken in week 4.  I think it looks a lot worse in the photo than it does in real life, actually. You can see that the glue covering the incision is starting to peel off, and it’s very difficult to refrain from helping it along.  The peeling increases after I discover that I can wangle myself into the bathtub at last.  This is heaven.  I spend a long time in the bath every morning.   It really seems to help with the achey feelings I get when I wake up.   There is still some weird numbness along the incision site and radiating down my thigh – but the area affected by this is decreasing every week.

Week 6 sees me head up to London for my check-up at UCLH – and the surgeon also seems really pleased with my progress.  ‘I did that!’ he says with a rather endearing level of smugness, as he checks over my incision.  He’s also happy with the new X-rays, which show that my pelvis is starting to heal.

So, now I’m expected to put full weight through my operated leg – although still using two crutches.  ‘Let’s give you a test’, says the surgeon.  ‘Stand on your left leg.  Lift up your operated leg.  Good’, he says, as I wobble about.  ‘Now, try the same on your right leg’.  I attempt to lift my good leg off the floor and put all my weight through my operated leg.  Ouuch – but I manage it for about, ooh, half a second.  The surgeon actually chuckles.

He gives me some new physiotherapy exercises which, at first, I find really tough.  I wonder if he’s overestimated my recovery level, even though my mobility and energy are continuing to improve.

The new exercises I have to do are:

1) Lying on back, keep operated leg straight and raise it into the air.  Repeat 20 times

2) Lying on back, bend the knee on your operated side and lift your leg towards your chest.  Hold your knee and pull your leg towards your chest.  Hold for 20 seconds, repeat 15 times.

3) Lying on your side (operated leg upwards), keep your operated leg straight and raise your leg, keeping it parallel to the lower leg.  Repeat 25 times.

25 reps?  Oh please! The first time I tried this, I could barely do one.  After a week or so, however, it gets easier.  My hip starts to feel more stable, and I feel as if the movements are more controlled.

By week 7,  I’m used to the pain of carrying out the exercises and reassured that the hurt is not making my hips worse.   Of course, I’m still not improving as fast as I’d like, but my physiotherapist rolls her eyes at this.  ‘What do you want?’ she says.  ‘I’m amazed you can do those exercises and that number of reps.  Your pelvis was broken in 3 places!’.   She tells me that the pain is due to the inflammation still present and to the fact that the muscles and ligaments are being pulled and stretched differently now that my pelvis is screwed into a different position. She seems genuinely impressed with how I’m getting along, and tells me not to overdo it.  Nonetheless, I persuade her to let me try a few minutes on a stationary bike, and she gives me a new set of exercises that I can do at home with a gym ball.  So I have plenty to work on!  I also start hydrotherapy this week – and in chest-deep, warm water I discover I can walk without pain and without a limp.  It feels heavenly.

And finally – all the lounging in the bath and hydrotherapy sees off the last of the glue surrounding my incision.  Here it is – again, I think it looks rather more graphic in this photo than in real life, but what a difference from the photo above!  The ridge above the incision line is partly caused by the heads of the three screws holding my pelvis together – they do stick out a little, but that’s probably more to do with the fact that I’m quite slim.  I’ve been told that all the screws will be removed one my second PAO is done.  In the meantime, I’m starting to feel that I’m getting my life back!

Incision at 7 weeks.

Day 6 – homeward bound!

Today is the first day that I actually feel ready to go home. I am less disorientated, and I feel confident that the painkillers (codeine and paracetamol) are on top of my pain. So when the smiley physiotherapists arrive (my ward roommates and I have named them the physio terrorists – a name they are strangely proud of), I am ready to tackle the stairs. This is important because once I can demonstrate I can manage on stairs using crutches, I can go home. Bring it on!

Disappointingly, my enthusiasm does not actually extend to being able to walk to the stairs – a distance of about 20 metres. Dammit, not the most impressive start. However, on being wheeled to the stairs, I find it easier and less daunting than I had imagined. Stairs, it turns out, are easier for me than walking on the flat. Hooray! This means I’ve passed the test! The smiley physio terrorists seem very pleased.

Walking back to my bed, I can’t wait to get back in it. I feel immensely vulnerable, shaky and stumbly. Every little wobble hurts. It’s hard to go in a straight line, it’s hard to go around corners. It’s sore and frankly difficult to move my right foot forward, and well, that’s rather an essential part of walking isn’t it! I am relieved and exhausted once I’m in bed, but resting helps a lot. Learning to walk again is turning out to be quite hard work, but this is normal and it’s early days. I keep being told by doctors that I’m doing very well and to take it easy, and I’m so tired I don’t answer back once! This is rather shocking for Irish, I think he’s not used to a placid wife!

It turns out I get a looong rest after that, because it takes about 6 hours for the pharmacy to put my meds together so that I can be discharged. This was the only part of my hospital stay which was underwhelming. Hospital pharmacists are slow – I’m very glad I was allowed to keep my bed and not sent to sit in the discharge lounge for this time (thank you nurses).

So, at peak rush hour in London, we head away from UCLH on the five hour journey back to Devon. The traffic is kind to us and once we work out how to get my useless legs into the car, it’s relatively comfortable. It feels AMAZING to be home!

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Bonus side effect of major pelvic surgery: beautiful flowers.

Home at last! Here are some good tips for managing the journey home.

1) Bring pillows to add height to your car seat. Once you’re in, push the seat back to give you as much legroom as possible.

2) Audiobooks are great to use in the car when you dont feel like talking and when music feels too grating. You can borrow them from your library for free. I liked the detective story ones. I could follow the plot, but I also found the ‘being read to’ element really soothing and soporific. I snoozed a lot on the way home.

3) Loose, jersey trousers (like yoga pants) in a size too big are the easiest thing to wear.

4) Don’t even think about wearing underwear! Going commando is better than uncomfortable seams stretching across your swollen and over sensitised skin. In fact, I may never wear underwear again!

So there we have it. I’ve had better reasons to be knickerless, but I’ve never been happier to be home.

It’s PAO-time!

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Ahhh, morphine!

So, as you can see from the picture, I was PAO’d (right hip socket) by Mr Johan Witt on 31st July at 9am. We arrived early at about 6.30 and I was the first into theatre. I can honestly say that the last hour or so before surgery was far worse than the ones that came after! I was so frightened. But all the doctors and nurses I met were so reassuring, I felt in very good hands.

When it came to the surgery, I was brought, shaking, into a kind of surgical ante-room, where they checked my details, and put a cannula in my hand. A very nice anaesthetist said ‘this might make you feel a bit woozy’, as he injected something into it.

‘I don’t feel woozy’, I said. ‘Oh well’ says lovely anaesthetist, reassuringly, ‘breathe into this mask’. He places a mask over my mouth, and that’s the last thing I remember.

The next thing I remember is a nurse calling my name to wake me up, and telling me the surgery was over and I was in recovery. She pointed out that I had a tube delivering local anaesthetic to the site of the surgery, and a pump that I could control which delivered Fentanyl (like morphine) when I pressed a button (this is called a PCA – patient controlled anaesthesia). She also told me that I’d had a spinal epidural which would wear off over the next few hours. She told me not to pull the oxygen tube out of my nose. The lovely nurse gave me some water and asked if I felt nauseous or in pain. I didn’t. I felt happy and relieved it was over. I dozed.

Then Mr Witt came and told me the PAO had gone really well, and checked the wound, which already looked so small and neat – a thin line of about 4 inches in length, along my bikini tan line. I was very excited by this. I felt quite high. He went over the various drugs and told me that my urinary catheter would be removed soon. I was happy about this – before surgery thoughts of the catheter had made me feel quite squeamish. I went back to sleep, with a smile on my face.

Then Irish arrived, having some how managed to bribe / kidnap the recovery staff into letting him in – this is not really allowed. I was so excited to see him and apparently revealed my entire naked lower half to the whole room in an effort to show him my incision.

I ended up having to wait several hours in recovery because there were no beds available on the relevant ward. This wasn’t a hardship, I was very drowsy and lovely nurse sat by my side all the time, giving me sips of water. She took my catheter out at some point – she asked me to cough as she removed the tube and it was out in less than a second. This was a huge relief, I had been inordinately worried about the catheter and was happy to use a bedpan instead. Once I put dignity to one side, the bedpan wasn’t an issue. I used my good leg to lift myself off the bed in a kind of yoga shoulder bridge (not unlike my blog photo!), and slid the bedpan under me. This hurt – but I topped up with morphine before and after and just got on with it. The nursing staff were great at giving me as much privacy as was safe. A girl’s gotta do what a girl’s gotta do.

When I did move to the ward, it was lovely to see Irish and my parents waiting for me. I couldn’t stop smiling. I was unspeakably glad it was over. It was painful, but not unbearable. I was very conscious not to let people jerk my bed or approach me from my right side, because it hurt to press on my foot or move my leg. But I could wiggle my toes without much pain. I tried out the physio exercises I’d been given for post-surgery. They hurt, but it was rewarding to know I could start this straight after surgery. I started to feel a bit nauseous from using the PCA and yet another lovely nurse gave me a tablet which helped. The epidural wore off, but I had absolutely no increase in pain as a result.

I spent the evening dozing, watching a bit of TV, holding my mum’s hand and having a first cup of tea (heaven). My family left about 8pm and I dozed on and off through the night. I didn’t sleep much because I was woken regularly to have my blood pressure / oxygen / temperature checked (all fine), and because I needed to use the bedpan a lot because of the fluids going into my arm. I guess a catheter would have avoided that, but I didn’t really care.

Looking back, my memories of this day are quite sketchy, but more than anything else I had the sense that the wait was over, and that I was in the best place. My advice for the day of surgery for any PAO-ee is to just go with it, put your trust in the experts, and know that in a very few days you’ll be seeing improvements every day…

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