Journal Starting at Day 6 post-op BHR Dr. Ure

[Pat Walter]

Hi Kevin

I have your story posted on my Hip Stories. Here is the link
http://www.surfacehippy.info/kevin07.php

Let me know when you have any updates.

Pat

[kriyamon]

3 week update:

Well, days seem long when you don't have to work and small things seem larger.  Overall I'm stoked with my progress.  I just have to ignore the little stuff and give it to the bigger power of the universe....and of course to my surfacehippy support group.

Dr. Ure was kind enough to reply to my email of two weeks ago regarding leg length....as we already figured out...it is most likely perceptual. 

I had some interesting questions for Dr. Ure regardng his view of PT.  He really doesn't recommend it for 6-8 weeks post-op but when you leave Mercy Medical they give you a a set of exercises to do 5-7- times a day.  I'm going to my PT once a week and I find that he really helps my stay right with the exercises and explains healing and the muscle stuff which is very reassuring.  So I'm waiting for a response from Dr. Ure on this issue.  It's so great that he is accessible by email.

Also, I've had a really bad time getting a much needed forearm PLATFORM crutch.  I need it because I have a bad right wrist and the regular crutch is causing pain and swelling, and probably screwing up the little bone I have left in there.  Apria health care tried to deliver a Forearm crutch to me....NO WAY....this has been a constant problem.....no one seems to uns=derstand that a PLATFORM crutch supports you weight with your elbow, not wrist.  Anyway, after a lot of research, I've found that there are safety concerns with the PLATFORM crutch....but I think it's BS.  They are available on the market for about $170, but I can't get my insurance to pay and I can't afford.  None of the local loan pools have one.  If anyone out there has one, please let me know.

So I ordered some trekking poles today for $35...maybe that will help.

I'm getting around pretty well. Able to walk a couple of steps with no crutch.  Walked about a mile today with the walker.  It's better than the crutch..I just kinda push it in front of me and only touch it on part of my stride.

I've cut the tramadol in half but still taking 200 mg celebrex.  I'll be happy when I'm able to get off that crap.  The pain level in my wrist is as bad as the hip at times.  The pain in my hip is mostly around the groin..and down to the knee...unfortunately some of the same pain pathway I had before surgery...It will take some manipulation (massage, accupuncture, yoga) probably to get my body to forget that pain channel.

[momzer2]

Kevin:

Have you had a follow-up xray since your surgery?  I'm a little concerned when you say you still have groin pain.  I was told that groin pain could signal a serious problem.......   ???

Karen

[kriyamon]

Thanks Karen...only the film that was taken post op at the hospital.  I'll email Dr. Ure and see what he thinks.  I appreciate your concern and knowledge.  I'm probably a bit complacent at this point with pain..I just think it's natural and willl come and go.   Thanks for waking me up a little.

Kevin

[momzer2]

Kevin:

I was a little suprised to hear that your doc doesn't want PT for 6-8 weeks.  Is there a specific reason why he would have you wait so long?  Did I miss something in your bio?  Anyhow, my doc had me start at 3 weeks post-op.  At first I really didn't see the point to having PT, but after my first visit I couldn't believe the exercises and balance things that I was shown.  (I also had the 'exercises' to do at home from my discharge after surgery.  These were a great help, too.)  However, I have had 7 PT visits now and I feel that they have made a HUGE difference.  Shows that even us nurses can be wrong!!!  I also walk 2-4 miles a day, depending on my other activities.  I have only had limited PT in the past for a back issue so I wasn't familiar with all the 'cool' equipment they have and use with me now!   :D   I am currently 6 weeks post-op.  I have been walking without any cane for the past 3 weeks.  We all progress at a different rate and you had extraneous issues prior.  However,  I really can't believe that you should prolong PT this much.   ???   Are you doing major balance and range of motion stuff at home?  I would especially be concerned with exercises that retrain the abductor and adductor muscles in the thigh.  These are really critical to hip stability.    Hope I'm not being too nosy....

Karen

[kriyamon]

Don't be concerned about nosey Karen, we're all on the same boat trying to help each other.

Yes, this is an odd thing with Dr. Ure.  When I say he doesn't prescribe PT for that period, I mean he doesn't recommend you going to the professional.  Now, when you go through the Mercy medical center pre-op and post-op routine, the PTs are ever-present..They meet with you prior to surgery and give you a set of exercises to do (actually to start way before surgery if you're there in time), and advice the same set of exercises post surgery 5-7 times a day.  Each session takes about 15 minutes...so that's a lot.  I end up with about 3-5 times a day to keep my pain level where I want it.

So even though Dr. Ure doesn't send you to a PT for several weeks, you start PT exercises in the hospital on day one and continue from there.  In the hospital, a PT comes in twice a day to help you.

So, as I explained, there is a disconnect here.  I have asked the Mercy medical PTs and Dr. Ure's surgical scheduler about it and they are both now aware of the disconnect, but until we hear it from the horses mouth (Dr. Ure), we aren't sure what's up.   Anyway, upon my request, Dr. Ure wrote me a script for PT once a week.  Like I said, my PT helps me with stuff and explains things in laymans terms, and that helps.  I also go in there every day and ride the sitting eliptical exerciser for 10 minutes.

Sounds like you are getting much more aggresive PT.....I don't know if that's cause you are healing faster or if the PT is actually causing healing....Chicken or the Egg thing.

You are inspiring me to ask for more PT....I'm sure Dr. Ure would probably go along with it...although I wrote him about the groin pain this morning so he may come back and say to rest more again.

When you say balance stuff, what types of things...I'd like that..as I'm a surfer anyway.

Thanks a million for your input.

[avid]

Kevin,

I am going to see Dr. Ure tomorrow, as you know. I will ask him about delaying PT. Does Melissa have the same restriction?

avid

[kriyamon]

Cool, Thanks David...that's a great idea.  Denise is supposed to ask him for me too, but I know how busy they get.  I'm sure he'll get to my email eventually.  TO tell you the truth though, I wish I was going to PT a little more now that I'm more "on the mend".  See if you can find out what his logic/strategy are.

  I don't know about Melissa..she has been out of touch...hope she's OK. 

[avid]

Cool, Thanks David...that's a great idea.  Denise is supposed to ask him for me too, but I know how busy they get.  I'm sure he'll get to my email eventually.  TO tell you the truth though, I wish I was going to PT a little more now that I'm more "on the mend".  See if you can find out what his logic/strategy are.

  I don't know about Melissa..she has been out of touch...hope she's OK. 

Check on all that and will do! Actually it is not till Thursday. :-[ I have been a little concerned about Melissa as well. Didn't want to write until after I saw Dr. Ure. Hope she is doing well.

[momzer2]

Kevin,

For balance my PT has what looks like a fatter 'noodle' (like the ones used in swimming pools). It's about 3 feet long and it's cut down the middle, so that it's flat on one side and rounded on the other.  She had me balance with both feet the first time--now I'm up to balancing on my operated foot only while bouncing a ball off of a mini tramp. that is tilted to 45 degrees.  This is a really good balance exercise!  Also, have you tried just balancing on your operated foot?  The first time Terra had me try this I couldn't balance for more than 5 seconds (3 weeks post-op).  Yesterday, (6 weeks post-op) I balanced for more than a minute (I could've gone longer, but she said 60 seconds is the 'norm' for people).  For variety sake, she also will have me balance while playing catch with her.  She tosses the ball to the left, right, higher, lower, etc. while I balance on one foot on the noodle.  Sounds easy, but it actually is pretty tough.   :o     They also have a round piece of wood that's about 12-14 inches across with some sort of ball in the middle (underneath).  You balance on one foot (holding on at first) and rotate your foot to the right until the wood meets the floor then to the left.  Then forward and backward.  I had to stop doing this particular exercise cuz it was giving me foot pain (plantar fasciitis).  I've had trouble with this in the past when I used to power walk. 

Most of my pain now is still in the middle of my left butt cheek and outward.  Does anyone else have this type of pain?  The quality is not stabbing, it's like a slow burn the longer I exercise.

On a side note--I also went to the rehab people in the hospital both BEFORE and after surgery.  I actually got a 3-ring binder with tons of info and lots of exercises.  We were all instructed to do them in the 7-10 days PRIOR to surgery so that we would be familiar with them.  I also did them at home twice a day until I had outside PT.  In addition, I had a visiting nurse PT gal who came to the house twice after discharge to be sure all was well and to work with me.

Let us know what the doc says about your groin pain.

Karen

[kriyamon]

Wow  Karen thanks for opening my eyes to real PT.  Of course you are a few weeks ahead of me and my PT may be waiting for more strngth build first, but I want some of that balance stuff.    I used to live in a town where the PTs were mostly kids right out of school working for big business and so it was an in and out factory experience.  Now I live in a smal town with a PT and his wife who have 30 years experience, are very personable, but have little equipment.  I'm going to print this out and take it with me...I feel confindent Joe will fix me up...he's very good at improvisation to.   The board with the ball sounds something like a surfer's toy called an Indo board, bbut it is a board with a cylinder under it.

Funny, started trying to balance on my operated leg yeserday after I read your post.  I can do it for a while. 

Thanks for your great input.  Oh I have the same type of pain you do...it's kinda near the incision so it seems very normal.  Worse after exercise and when I'm tired.  Don't forget the ice!

I may have been a little off when I called my pain groin pain.   It is near the groin but when I reallly feel it it stays on the inner thigh and doesn't cross that bridge.   It is just so much like the pain I had pre=op, which was in the groin at times, that my brain just thinks it's the same old thing.  I wrote my Dr. anyway and we'll see what he says.   I had a really strong feeling day yesterday.  I was able to do the laying down leg lifts for the first time.  THey were so painful at first the PT said don;t bother but had me doing them standing up.  Yesterday I got through three sets of them....maybe only a couple of inches but what the heck.  I thought three weeks ago my thigh muscle would never triggeer again!  .can't wait to get my trekking poles.

[momzer2]

Kevin:

Doing much out of house PT before 3 weeks post-op probably is not worth the trouble since your muscles are still not 'talking.'  I remember the first few days post-op when I couldn't lift my leg (out straight position) AT ALL.  Felt really bizarre.  Of course, the rehab people told us this would be the case, but until you experience it.....  I'm sure your PT guy can 'fabricate' something quite easily.  Just make sure if you do it at home that you have something stable to grab if you lose your balance!  Falling would be a disaster. 

Had my 6 week post-op today.  Dr. Barba was very pleased.  Took off all restrictions--well, except for high impact like jogging, tennis, etc.  I have to wait til I'm 6 months post-op to run safely.  That's mid April which is fine cuz the weather is really cold here until April anyway!!   :(

Keep up the good work, but listen to your body..... don't overdo it!! 

Karen

[kriyamon]

Great for you Karen!!!!!!!  6 months to running, huh.   mmmm, I guess I read about someone who was abnormal who was surfing in 3 months....I guess I better not count on that.... although it's not really high impact, it seems risky,except on smaller good surf.  I  guess I'll wait and see.

Thanks for all your great advice.

[momzer2]

Kevin:

Surfing aye!  I've never had the opportunity to surf, but I wanted to try water skiing again.  We took my daughter and her friend skiing this past summer on the lake.  Of course I couldn't attempt it, but then I thought next summer after surgery I can.  But now that I have my 'new' hip, I'm not sure I want to risk skiing.  When I think of how you wipe out, get thrown around.....  I think I might just have to skip it.  I really don't want to dislocate or fracture my femur.  I sound like a chicken, huh.  Being the lookout and taking the video/pictures may have to be fun enough....   Be careful with the surfing!!   :D

Karen

[coskater]

I am 4 weeks out plus a few days and I also don't do any PT, my doctor (Treacy) said I could go back to pilates and ballet at 6-8 weeks.  I have a set of 10 exercises that I do that work all the major muscle groups around my hip, I do simple knee bends of 50 degrees with my bum tucked under my hips for 10 seconds and the go up and balance for 10 seconds on my tip toes no holding on to anything while I do 10 sets of these.  I walk about 2 miles a day with 2 canes and my doctor says no more than 2.5 miles.

Of course we all have different issues regarding our surgery, I have a very large scar and apparently had a difficult surgery due to my dysplasia and cysts on the femoral head.  I only do my exercises 2-3 times a day and walk 2 x a day 1 mile each walk.  The pain in my glute has gone away over this last week as I work on having an even stride and ballet like posture, shoulder back, head up looking up not down.  Ballet and pointe prior to this were very helpful. As a figure skater I don't worry about balance, my right leg is weaker due to another surgery last year, I am focusing on getting both legs equally strong.

Suffice it to say taking it easy seems to be helpful.  I stop doing my exercises if the pain breaks to high a level and while it is great that some get to walk without a cane at 3 weeks I will listen to the doctor and stick it out for 6 weeks.

So just listen to what your body says, I have a cadillac and reformer in my basement and have done pilates for years I actually just use them to stretch gently which seems to make things better.  Just don't twist too much.

Take care,


Leslie
R BHR
Treacy
10/2/07

[kriyamon]

Interesting..did Dr. Treacy actually not advise or prescribe PT?  I mean, we're doing all the exercises at home, which IS PT, but are our doctors actually not wanting us to? The exercises I was given were from the hospital PT group and they are for THR.   I'm confused.  I was talking to my PT this morning about it...his guess was that there is no established approved criteria for PT post re-surfacing, so to CYA, the Drs may be shying away from saying anything except what the restrictions are.   He's older and he said the same thing happens when any new surgical technique gets approved.  The PT exercises we are doing are actually for a total hip replacement.  He could be on to something.  I hope we get to the bottom of it.  I have a friend going in to see Dr. Ure today for pre-surgical evaluation, and he said he would be sure and get his opinion of post surgery PT.

I'm tired today..did too much yesterday...unfortunately life has granted me the opportunity to move in the next three weeks...uuuggghhh.  Moving is rough enough when you're well.  Tell you one thing...all those friends who offer help are going to be surprised when I sign them up for an 8 hour shift!!!!!!!!!!

Rest today....a little anyway

[avid]

Hey Kevin,

Just got back from Mt. Shasta and my visit to Dr. Ure. I asked about PT. His thinking is that everything in there needs time to heal. That needs to come first. He said the exercises you are given is PT and you get PT in the hospital. Once the major healing is over (six to eight weeks) then it is time to slowly begin with stretching and strengthening. I asked if PT would be prescribed and I believe his answer was no or it wouldn't be needed. When I was ready I could return to Yoga gently to begin with. Insurance companies are really down on PT; at least mine is. I wonder if that is one of the benefits of this surgery as the Insurance industry sees it, no PT.

I had a good meeting with Dr. Ure and he explained everything completely and answered my lengthy list of questions. He said a Smith & Nephew BHRS for an active 55 year old is a "no-brainer." The waiting room was full of Dr. Ure Patients or Patients to-be. One man who had his done a week ago was walking amazingly well and pushing his walker in front of him. There was a woman on one crutch after two weeks. There was a guy with the 500th hip that Amstutz had done. He now lives in Mt. Shasta and is a skier. He wanted to have Dr. Ure available in case he had a problem. Dr. Ure said the x-ray of his hip looked great. He said he hasn't been gentle to it either.


Edit: Re: PT

IIRC Dr. Ure said that after six to eight weeks the chance of dislocations goes to zilch. That is more of his reasoning for not prescribing PT in the first 6-8 weeks.

[coskater]

My PT received a note from Mr. Treacy saying my PT should match that of a total hip.  I was warned about walking too far and given a limit.  I did go to Mr. McMinn's site and added a few of the 0-6 week exercises which looked like they would balance the others, I have quickened the pace of my walks so a mile started at a half hour and now takes 20 minutes and I get a slight cardio benefit.  I did conact Mr. Treacy at 4 weeks and he said I could go on the bike.  All of this is very minimal for me at my peak I would skate 3-4 hours a day and then do an hour of either pilates, ballet or weights depending on the day. I am currently looking forward to just 20-40 minutes on the ice 2 days a week in January.  Slowly, no impact for me until about 9 months to a year out.