12 weeks postop - hydro, physio, pain

I am now exactly 12 weeks postop and not seeing big improvements yet.

I had my first session of hydro last week, lovely to get in a hot pool and move more freely, but very easy to overdo it and end up extremely sore afterwards. I have lots of exercises to do in the water, particularly working on flexion (as it is still limited to about 95 degrees, despite me pulling my knee towards my chest lots). I am doing the exercises for both legs, to try and strengthen the right up and loosen off any scar tissue which might be causing the ongoing discomfort I have that side. I get 6 sessions in the pool and then will be reassessed to see if more would be beneficial.

I am still using the fentanyl patches and my GP did warn me that I would probably need to increase the dose as my body gets tolerant to it over time. I am quite against this, as it's making me quite tired generally. I have been topping up when needed with tramadol instead, and that seems to be working out ok for now. I am hoping I can cut down perhaps over this weekend and see how I go back on a lower dose tramadol only instead.

I am doing half days at the hospital at the moment and went into theatre for the first time on monday. Unfortunately I am unable to scrub in as I can't be clean with crutches or stand for even short periods, so I just get to sit at the edge, not very exciting really. I did do 5 hours today, but managed to sit down for half of it, although still came home very sore so it was probably a bit much. I think I will need to stay on the reduced schedule for a few more weeks yet, as I do find as the week goes on, my pain builds up and I feel worse and worse. I have two assessments at the end of this week so I have to be functioning for those!

My next appointment has been moved to next thursday, just to check everything is ok as I am still in loads of pain and struggling with range of movement. I'm sure it's that I am over doing it still and have been since 6 weeks postop, rather than anything major that is wrong, but the reassurance would be good. I also want to discuss screw removal and perhaps a steroid injection (particularly as I needed both these last debridement at 12 and 14 weeks postop).

On a plus note, me and Rich found out we are both in Torbay hospital for our foundation (junior doctor) two years, yay, so we have already started house hunting!

10 weeks postop - struggling

I have not had a very good week this week. I have been really struggling with pain and nausea. I have still been pushing myself to go into the hospital and did a couple of 7 hour days, msotly on my feet, which ended up with me in agony and crying lots. Once you get to that level of pain, its very hard to get it back under control again. I also have to confess I stupidly decided to go a bit cold turkey on the tramadol too, so on wednesday night I stopped taking it (don't try this at home..). I then did a full day in clinic, where all the consultations are done standing, so I was not in a very good place by thursday evening and had to relent and go back on the tramadol.

Although I would love to be off painkillers, this was a very stupid way of doing it and was just going to go badly. I saw the GP on friday, after another morning of awful nausea meant I couldn't go in. She was wonderful, very supportive and has put me on fentanyl patches to help with the pain as they have less nausea and stomachy side effects. I have also got half dose tramadols to wean off slowly. She told me I was doing waaaaaaay too much for someone 10 weeks postop and that I absolutely had to cut down. I was worried that I had hit a bit of a plateau with regards to the pain, but as she pointed out, I am doing loads more than I was two or three weeks ago, so its no wonder I am more sore. She wanted to sign me off for at least a week, but I can't afford to miss anymore time with the med school this close to qualifying, so we agreed I would do half days at most this week and see how I go. She even rang the consultant I am under to let him know I was pushing myself too hard and to stop me and that I would be in when I could!

I have now had the patch on for almost 2 days (it takes 24 hours to get into your system and start working), but my pain is better and combined with a lower dose tramadol, I slept really well last night - yay! So I think we might have it cracked. Now I just have to stick to this regime for a bit, then maybe try cutting it down slowly as my pain improves.

Unfortunately, hydro was cancelled last week due to chlorine problems with the pool. So my assessment and first session is tomorrow, which I am really looking forward too - particularly as me and Janet are doing it together, so we can compare notes and leg sizes (Janet had her PAO 9 days ahead of me) and have a catch up over a cuppa afterwards. I am hoping to get in to see physio this week as well, I was meant to do a few weeks of hydro first to get increased range of movement in the joint as my flexion is still stuck at 90 degrees, despite me pulling my leg towards my chest lots. But as I only have the basic five exercises I had from my first session, I want to expand those really so I can get moving forwards a bit more.

I am going to ask Mr F about having my screws removed sooner rather than later, as I can feel them in my trochanter when I do abduction exercises and when sitting (groin) and walking, it is really rather uncomfortable there. I'm not sure if my pelvic screws can come out as well or if they have to stay in a bit longer, as they are visible at the top of my pelvis - ew.

Let's hope this week is better than the last! xx

9 weeks postop - exercises, exercises and more exercises

I was exactly 9 weeks postop yesterday. Not much has changed since the last post. I went to physio again at the beginning of last week, luckily I saw a different physio who was much better. She did a complete assessment of both hips and took a detailed history. My left hip flexion wasn't even 90 degrees yet, so that really needs work. She recommended that I still sit on chairs that are higher and be careful not to force the flexion by leaning over my leg to write etc. On the plus side I do have a little bit of internal rotation, which I had 0 degrees of before the op! She has referred me for hydro, which should be starting on monday, provided the pool has reopened as they have been having some trouble with it. I am still doing the same exercises as in the previous post, as the plan is to get some more ROM with the hydro before pushing the dry land stuff. My abductors are getting stronger, although it is very sore to do that exercise and I think thats the abductors moving over the trochanteric screws.

I am walking around the house without any crutches. Initially from sitting, I do limp quite badly, but once the hip is loosened up after a few steps I can walk with a pretty even gait, although I am having to concentrate on that still. Plus when I get tired in the evenings, its a lot worse. But I have seen definite improvements there as my leg gets a little stronger from the exercises. Outside the house, I have been using two crutches. I tried to use just one on monday, but after a couple hours on the ward round, I was in a lot of pain and had to leave. It wasn't the walking that was a problem, it was the periods of standing still which really hurt. So I have gone back to using two, at least I can attend more then, even if it is annoying not to be off the crutches yet, I am doing a lot more than anyone should be at this stage of recovery, so it is going to take me longer to get rid of them fully.

Pain wise, its much the same. I have trochanter and flexor pain on walking, groin pain on sitting and flexion and ischium/bum pain randomly. I tried to drop the nighttime tramadol on saturday, had a very uncomfortable night so will stick with it for now. I would love to be able to come off all painkillers, but I wouldn't be able to work then, which unfortunately I have to do! Hopefully I will see some improvements in the pain soon, as its pretty static at the moment, rather than decreasing.

I am now lying on my operated side, it is initially painful, but after a couple of minutes, its bearable. It really hurts to roll back onto my back and straighten out the leg though, but its nice to be able to change sleeping position.

I have now moved onto my orthopaedics 6 week block. They are going to let me into theatre with a "clean" pair of crutches to use, although I really can't stand for very long without getting extremely sore and you have to wear lead aprons much of the time, so I am not sure if I will do too much theatre time in the next few weeks. Other than that its just ward work and clinics, so that is manageable on crutches, though practicalities of carrying equipment and moving is interesting! They are all understanding and I have said that I am only coming in until around 2pm for now. Hopefully I can increase that over the coming weeks, particularly as I will be missing time going to hydrotherapy.