3 weeks/11 weeks

3 weeks post op hernia repair & 11 weeks post op hip revision

This has been a week of me trying to gain some endurance in preparation to return to work next week.  On Tuesday it hit 75 degrees in Ohio, so I picked up my 3 1/2 year old nephew from daycare and we went to the zoo for a few hours.  We had a good time and it was good to get out and enjoy the weather.  After walking around the zoo my butt hurt so badly.  My glutes are being used because I don’t have the strength in my other muscles yet!

Today at PT was interesting!  I started out on the bike for 8 minutes.  Then we dry needled my glutes (I have never wanted someone to stick a needle in my butt so badly!) and quad.  After needling we went out the gym to check my back and pelvis….surprise surprise I was a hot mess!  This created a challenge because the typical way to correct this couldn’t be done because of my hip/hernia surgery.  My PT was able to creatively fix it!  Yay.

Next my PT decided that since we weren’t “technically” allowed to start rehab until 4 weeks that she was going to “passively aggressively” rehab me.  So, she worked my shoulders with the body blade, punch-outs, rows, and other monotonous exercises until I was unable to move my arms.  I was exhausted!!!  Last thing was ICE!  My favorite.

After PT I had to go by work for a few hours and by the time I got home I was exhausted….next week is definitely going to be a challenge!  I have to be very cautious not to overdo it!!!

Surgeons appointments…

I saw both Dr. Ellis and Dr. Leff today.  My goal for today was to figure out how we are going to progress with therapy with my 10 week post op hip revision and my 2 week post op inguinal/sports hernia.

First appointment was with Dr. Ellis.  Dr. Ellis was at the front desk when his nurse was taking me back to my room.  As we walked past him I said hello and kept walking with his nurse, but he stopped me to ask if Dr. Leff found a hernia….his nurse jokingly said she’s your next patient if you’d like to come to her room.  We all laughed and he came to my room.  He came in and we discussed what Dr. Leff found and he read the surgical report.  My biggest question for him was rehab.  He watched me walk and said I’m restricting my extension (due to post op pain). He went and grabbed Dave (his PT) and we discussed what my rehab should look like.  I asked about treadmill…..definite no go!  In his opinion I can start the elliptical at any point (slowly…starting with 5 minutes with gradual increases).  Then for dad I asked about sailing…he is fine with me sailing this summer.  We discussed me returning to work in a week.  He said to take it slow and easy.  He wants me to see Dave and Tiffany in 4 weeks to re-evaluate where we are with therapy and how we can progress.  (I know I’ve said it before, but I LOVE Dr. Ellis)

I then headed over to Riverside to see Dr. Leff.  He was fitting me in between surgeries so I didn’t have to drive up again.  He came in and checked my abdomen and had me turn my head and cough.  He was very happy with my progress.  I asked about the pains I’m having.  I still have the pressure/fullness and he thinks it’s related to my adductor compensation and will take time.  All my other pains and sensations he said he isn’t concerned about and will improve with time and rehab.  I wasn’t able to ask all of my questions and I’m still confused by what he wants me to do in regards to rehab (he mentioned a specific Sports Hernia Protocol that I tried to find googling, but couldn’t so I’ll call the office tomorrow for clarification).  In regards to sailing…he said I could, but my core is very weak and hiking out could be a challenge.  He doesn’t need to see me again unless I need him.

I am allowed to walk and start the bike.  No core exercises or swimming until 6 weeks.  I will start PT up tomorrow….gentle PT.  I’m just excited be doing something!

We’ll see how I do with activity progression!

1 week post-op

I’ve made it to a week post-op.  It has been harder than I expected, but I am getting a little better each day.  I am still staying at my parents house and haven’t done much other than sitting in the recliner and watching Netflix.

I still get pain when standing and sitting upright, but each day I can tolerate a little bit longer each day.  I haven’t been able to taper the ibuprofen/tylenol.  I thought I would be able to drive at a week post-op, but not being able to tolerate sitting upright has prevented that.

I am so sick of sleeping in the recliner.  I so badly want to sleep on my side or stomach, but I can’t tolerate the pain.  For the last two nights I have started out in bed (it was nice to try and lay flat), but I didn’t last.  I ended up in the chair around 2:30am.

My post-op hip has really started to bother me.  It has been very achy, stiff, and sore.  I’ve also had some sharp pains right over the femoral vein (like pre-op).  Walking up stairs is difficult.  Being that this is my third surgery on this hip in less than a year I am very paranoid.  I messaged my PT last night for reassurance.  She said it all needs to rest another week and I should be ok in the long run.  She keeps telling me that the third time is the charm….that this time it worked.  I told her I don’t have her optimism yet, but I’m hopeful.

So, I have one more week until I see Dr. Ellis and Dr. Leff.  I need to get a copy of my surgical report to take to Dr. Ellis, since I see him before I see Dr. Leff.

Missing my mobic….

So, I had to stop all over the counter medications and NSAID’s after my appointment with Dr. Leff last Wednesday in preparation for surgery tomorrow.  I didn’t realize how much relief I was actually getting from the mobic.  Mobic is an anti-inflammatory medication (Naproxen) that also prevents bone regrowth.  Dr. Ellis prescribes it for 6 weeks post-op (but writes for refills up to 3 months).  I’ve been on Mobic almost the entire time since my first surgery (minus a month or so) because of it’s anti-inflammatory properties.  The pain and feeling of fullness is off the charts.  Tylenol is not cutting it.  I am so ready for tomorrow.

Tomorrow is surgery day.  Dr. Leff plans to do a laparoscopic inguinal hernia repair with adductor exparel injection and needle tenotomy.  He feels that I have developed some of the compensatory changes of a sports hernia with left adductor tendinopathy.

After talking about this in depth with my PT and doing a lot of research….this is the best possible course.  My PT is very happy that he is going to do the needle tenotomy.   We’ve been doing dry needling regularly, but this will be more intense- the area is repetitively needled to disrupt pathological tissue and induce bleeding. This turns a non-healing chronic injury into an acute injury with enhanced healing capability.  And to quote my PT, “So basically they are going to shoot you up really good and needle the heck out of the tendon, like dry needling to facilitate healing.”

I had PT this morning (my last visit for 2 weeks).  We have cut back on exercises, but today my PT did some strength tests to know where I stand before I get cut into again.  She wanted to know what my hip can handle now.  We did bird dogs and she tested my core so she will know what to focus on post-op.

Just got my phone call about surgery time….arrival time 8:30am with a planned surgery time of 10:30am.   We are going to wait and go to Columbus tomorrow morning rather than tonight.  I don’t sleep well the night before surgery anyway and would prefer to sleep in my bed one more night.  I’ll head up to my ‘rents tomorrow morning and we’ll leave around 7am.  More to come after surgery!

6 week follow-up

Yesterday was a crazy day for me!  I had PT with my local PT first thing in the morning (7:30am).  We continued on our limited treatment plan until I saw Dr. Ellis.  She did some mobilization and once again dry needled the heck out of my leg!

I then headed to Columbus for my 6 week appointment with the surgeon in which I very anxiously waiting for….!  Needless to say it didn’t go as I had anticipated.

I first had an appointment with Dave, Dr. Ellis’ PT.  We discussed my symptoms and he manipulated my leg through complete ROM.  He was very happy with my ROM, especially my straight flexion.  He was able to cause symptoms with internal rotation.  He watched me walk and noticed I still have a limp.  We discussed my current therapy plan and exercises and he was very pleased.  He said he wouldn’t change a thing in regards to current exercises/plan of care.  He suggested we hold off on increasing to weight bearing exercises until I am able to complete all ADL’s without causing pain (basically a pain free day).

After I saw Dave I had x-rays.  They completed a series of three x-rays.

Third and final part of my fun in Columbus…Dr. Ellis!  Can I just start off by saying how much I love Dr. Ellis?!  He is so compassionate and caring and really takes the time with his patients (you never feel rushed with him).  He had already talked to Dave, but he wanted me to describe my symptoms for him.  He then took me out to look at my x-rays/images.  He showed me my six week post-op x-rays from my original surgery to compare with the one’s they just took.  He showed me the AIIS and what he shaved off.  He did remove a lot of bone (left only enough for the rectus femoris to attach to) and that is why my straight flexion is so good.  We then headed back to the room for Dr. Ellis to manipulate my leg.  He was very happy with ROM and didn’t think my hip was causing my problems.  He started testing a few other things and then he thought I could potentially have a sports hernia.  He wants me to see a specialist in Columbus (Dr. Leff) to rule out the sports hernia.  He said that while we wait we could try a predisone taper and see if that helps with my symptoms.  If it helps great, if not we’ll have the process to see Dr. Leff started.  He then asked me if I had any other questions (which of course I did :)).
-Did he find an actual tear/how did that happen?!  He said that it was technically a tear, but it was more of an unstable area that required additional anchors.  He said it was very red and inflamed and pulling away from the socket.  He felt that I had scar tissue that was compressing the labrum every time my femur hit the AIIS.
-What about hip popping/clicking?  He’s not concerned.
-What about swimming?  YES!!!!  Just no aggressive kicking!
(I think he knew how badly I needed some type of activity!!!)
-Work?  When can I return?  What about going back PT?  Definitely not yet (and Dave agreed with him).  He said I need to be off 6 more weeks.  He wants me to see Dr. Leff and then see him again before he’ll clear me to return to work.

I started doing some research last night about sports hernia’s and FAI.  It’s pretty common.  I found some articles on PubMed and starting reading up so I can be more knowledgeable…I also shared them with my PT and she and I will talk about it more at my next appointment on Tuesday.  So, I started the prednisone today.  I’m working with Dr. Ellis’ Care Coordinator to coordinate an appointment with Dr. Leff as soon as possible and then I’ll see Dr. Ellis again.  I did go swimming today….which was amazing for my mood (I was really starting to get down)….it’s amazing how much working out helps me!!!

Articles I found (I’ll add more as I do further research):
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931344/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568531/