Saturday, May 30, 2009

Updated scar photo

Since I'm at 6 weeks post-op I thought I'd take an updated photo of my incision scar. It's amazing the progression from a week after surgery. If you can stand the horror, I made a collage. Click here.

6 weeks post-op report

I've been so busy working my job, working around the house and rehabbing lately I've neglected to post. I suppose that's a good thing.

Since the last post I've been to see the surgeon for a checkup and to do my first post-op x-rays. He said the x-rays looked great and was very pleased with how the implant set in.
He didn't lift all restrictions. Wants me to not ride the bicycle outside, play golf, go beyond 90 degrees, and other similar activities until 12 weeks. He did say I could slowly start working on the range of motion but he didn't want me testing it very much until 12 weeks. Otherwise, I'm free to do anything I want while using pain as a guidance. No more cane, which I haven't used much anyway.

I'm actually breaking the rules just a bit, because I can tie my shoes now but just barely. I stretch as much as possible with my arms and upper back trying to keep as close to 90 degrees as possible. Funny thing is, how I'm tying my shoes now is all I could do pre-op, so I know it's only going to get better.

I tried to be a really good patient and follow the rules to the letter, but that's difficult for me with this kind of stuff. I figure if you use common sense and let your body guide you things will be okay.

Saturday, May 16, 2009

Physical therapy

It was suggested that I note the steps of my physical therapy. That's a great idea. I'm sure I'll forget what I've done if I don't do this, so here goes.

First PT session was one week out from the surgery and then 2x per week for the following two weeks and then one final day on the fourth week post-op.

Session 1 (see attached photos)
1. sitting hamstring stretch
2. standing calf stretch
3. quad flexion (towel or pillow under knee with downward force)
4. knee extension (lying down will pillow under knee and extend lower leg upward)
5. hip adduction (squeeze pillow or ball with inward force)

6. hamstring strengthen (pull heel into surface)
7. heel slide (lying down pull knee toward chest close to 90 degree)
8. trunk stability (tighten buttocks)
9. standing heel raise (flex calves)
10. standing hip abduction (first session only move leg out 6-8 inches)

Session 2
1. Everything from session 1
2. standing knee raises max 90 degrees (use table for support if needed)

3. standing squats (use table for support and keep trunk vertical, squeeze buttocks on each stand)

Session 3
1. recumbent cross-trainer (10 minutes) (Click here to see the type of machine)

2. single leg press operated leg (10 minutes) (started with 60 lbs and moved to 75 lbs which is half my weight - was not to do more than half my weight)
3. recumbent bike (10 minutes)
4. hamstring strengthening (10 minutes) (this was done by sitting on a stool
(see picture) with 20 pounds of weight attached and pulling myself around the room - it really works well)
5. standing knee lift
6. squats
7. electrical stimulation on quads (15 minutes)

Session 4
1. Same as session 3 except no bike because I was doing that from home now
2. knee extensions on a weight machine (10 minutes - sessions with operated leg only and both legs)

Session 5
1. Same as session 4
2. Elliptical (10 minutes)
3. resistance backward walking (10 minutes - this was done by using a strap around my back that was attached on my front to a pulley weight system. I walked slowly backward and then slowly forward. I don't recall the exact weight but it was a comfortably hard weight, meaning safe but beneficial)
4. same as #3 except walking sideways
5. single leg step-ups (30 reps using the operated leg and holding a handrail for balance)

Session 6
1. Same as session 5
2. lying leg abduction (lying on non-op leg and raising op leg 6 inches - 10 reps x 3 - therapist told me to be very careful with this and not rush it - it was hard and painful, especially at first)

Session 6 was my last at the therapist's office, so I've been doing quite a few exercises each day at home. I generally alternate days on the harder exercises. Here are the examples of what I'm doing at home. I don't do each of these every day. I mix them up and alternate days with some, for example I won't bike ride and do elliptical in the same day.

1. stretch hamstrings and calves
2. standing knee lifts with 10 lb ankle weight
3. standing reverse knee extension with 10 lb ankle weight (works hamstring)
4. knee extensions using ankle weights or a bench/weight machine
5. standing side adductions using weight machine for resistance
6. walk 1-2 miles
7. lying leg abductions
8. core and upper body work (arms, shoulders, abs, back)
9. elliptical (up to 20 minutes per session now, increasing intensity and hope to be 30 minutes soon)
10. bike riding indoor on a trainer (essentially a stationary bike, up to 45 minutes now - working on increasing intensity and hope to be to 60 minutes soon)
11. leg press alternative (i don't have a leg press on my home machine so I simulate a leg press by holding onto a surface with my hands and squatting on one leg - I can control the weight/force with whatever I'm holding onto with my hands)

That's about it. I will modify and evolve as my body lets me.

Friday, May 15, 2009

4 weeks post-op

I can't believe it's been a month since the surgery. It has been quite a journey so far, from barely being able to move the first day at home to doing multiple exercises per day.

The first week post-op I was spending the vast majority of my time on the couch, even working with my laptop. I was barely able to sleep and was running a fever every night. I also developed a rash on my back, which appears to have been a heat rash due to spending so much time on my back. Also had my first physical therapy session and there wasn't much easy about it.

By the second week things were getting better each day. The fever was gone. The rash was finally clearing up (thanks to cortisone cream). Two more trips to therapy and new exercises. Got the staples removed and the surgeon said I appeared to be healing well.

Week three saw much increased activity at therapy and at home. I had moved to just a cane at this point. Most of my walking around the house was without any assistance, but any longer distances still required some help. I was able to ride my bike indoors on a trainer, like a stationary bike, and also work on the elliptical machine. For the first time I started to feel somewhat normal again. Certainly felt good to sweat with a workout!

The therapist turned me loose after my first session in week 4. It was nice to be able to start doing my exercises at home. The improvements continued to get better and better each day. Still stiff and sore after extended periods of sitting or sleeping but even those moments are improving.

So, that brings me to today. I've yet to have a really good night's sleep, but I am at least getting a few hours a night with the remaining hours being fairly restless. It's just still difficult to get comfortable.

The days are pretty darn good. Once I get the day started I don't experience much pain or discomfort. I'm getting in good exercises and try to do a little more each day. Today, for example, my exercises have consisted of leg extensions with ankle weights focusing on the quads and a different move focusing on the hamstring, 20 minutes on the elliptical, walked 2 miles and upper body/core work.

I can't wait to see what the 4 weeks brings.

Thursday, May 14, 2009

I can drive again

As of today I can drive again according to my surgeon. I've actually already driven some due to necessity and there was no issue whatsoever. I guess the doctors are understandably nervous about patients being able to react quickly to the demands of traffic. Perhaps I've healed quicker than most but other than some discomfort getting in and out of vehicles I've had no trouble driving.

I work from home so I don't have to drive a lot but it's nice to be able to go somewhere when I need to and not be dependent on others.

Tuesday, May 12, 2009

45 minutes on the bike

A new milestone today for me. I did a 45-minute workout on the bike (indoors on a trainer). I have been doing 30 on the bike and 15 on the elliptical but now that I'm going to be doing all my exercises at home I wanted to change the days when I do the elliptical and start working more on riding the bike.

Luckily, I do have a TV to watch while I'm riding on the trainer, so I won't get extremely bored. Also, I keep the workouts interesting by starting in an easy gear and riding for X minutes and then going through harder gears and so on and finally work back down to easier gears to cool down.

Hopefully by the time I actually get cleared to ride outside I'll have a good feel for how the gears work and understand what gear to ride in based on the situation. The thing I love about the trainer is that it simulates the road well and allows me to use all the gears and feel what they would really feel like on the road.

One thing I've got to get used to is the sore butt. Dang! I do have a couple pair of padded cycling shorts but I need some more, since I'm riding almost every day. So, some days (like today) I wear running shorts and fold a small towel to sit on. That only helps so much. I may have to look into a more comfortable seat.

Yet another thing to buy.

Turned loose from physical therapy

I've been improving every day. I'm really pleased with my progress and apparently so is my physical therapist. At 3 1/2 weeks post-op (yesterday) he gave me one final new exercise and said he trusted me to continue working hard but he also trusted me not to over-extend myself (literally and physically).

The latest exercise he is having me do is a lying leg abduction, which is just like the standing one I've already been doing, except (obviously) lying down. I lay on my non-operated leg and with both legs fully extended raise the operated leg a few inches and then bring it back down.

I've been doing this standing up since the first week post-op and have been getting better at it each time. There really is no pain doing it when standing and I can extend probably 60-70 degrees now.

Doing this lying down is a totally different story. There is so much more leverage against the hip and muscles on the outside of the leg, such as the IT band. This is where the bulk of my incision is so it's no surprise that it hurts.

I'll just keep working it and it will get better.

Friday, May 8, 2009

A bike tire beat me

Speaking of the new bike. I'm new to cycling so I'm learning a lot. One thing about me that can sometimes be a curse is that I over-research just about anything I'm going to do or purchase. When I was researching trainers I read about how they just eat tires. Because of this there are special tires created just for trainers. The one that gets the best reviews is the Continental Ultra Sport Hometrainer tire. I knew this would be a necessity given the amount of time I'm going to have to spend on the trainer before I'm allowed to ride outside. I did ride with my stock tire once while I waited for the Conti to arrive and I was shocked how much rubber came off the stock tire.

Of course I didn't want to keep changing tires when I rode the trainer, so I had to buy a cheap wheel and a cassette (that had to match the stock one). I was so excited when the tire arrived because I wanted to try it out. Did I mention cycling is expensive? Even with high-end running gear it wasn't nearly as expensive.

I haven't changed bike tires or fixed a flat since I was a kid. It's probably been over 25 years. Of course I watched some videos online to make sure knew how to put on the new tire correctly. Boy do they make it look easy! What a nightmare.

So I tried to do a test first without the tube. I should've realized right then and there that this was not going to end well. I got my trusty multi-tool which has two tire levers with it. I finally coaxed the tire on and was already frustrated.

I worked and worked and got the tire off. I was really worried about getting the tube and tire installed without creating a pinch-flat, which is caused by using a tire lever. There is an art to this.

Before trying to put the tube in I wanted to check the wheel for any abrasions, then I noticed something. All the spoke holes were uncovered and the edges were sharp. I thought to myself, "won't those cause a flat?" So I did what I do best - hit google. Sure enough, my new wheel doesn't have something called rim tape. What? Why in the heck did the wheel not come with this.

Of course I had never heard of rim tape so I surely didn't have any lying around. Surely I can use some other tape, like electrical tape. I got some and put a couple of layers on the wheel, being sure to stretch it a bit to fit the narrow wheel correctly without covering the bead.

I did some more research after getting the tape on and found out that electrical tape wouldn't work very well and I needed real rim tape, which is most common in the form of a cloth tape. So, my tire would have to wait. I went to the local shop and picked up some Velox tape, which I read repeatedly was the best.

I installed the rim tape and gave my first shot at installing the tube. I got the tire and tube on about 80% and then had to resort to using the levers. I knew to be careful not to pinch the tire. Sure enough I promptly pinched it and heard "hiss." Yep, flat #1.

I removed the tire and got to practice using the tire patch kit. Test number 2. I got the tire on and it seemed to have worked. Sweet! It appeared to be holding air, so I installed it on the bike and did a test ride. It worked great.

The next day I went out to do a ride. Yep. Flat. Dammit!

I did not want to be defeated by this thing, so I gave it another shot with a new tube.

I worked and worked to get this new one on right. In the process I broke one of my tire levers. Crap, this is not going to turn out well. You pretty much can't do this with just one, so I found some little flat tool in the garage that was shaped like the tire levers. Only problem was it was all metal, so it would do some damage to the wheel. So, I wrapped some tape around it and gave it a shot.

With the new tool and the one remaining unbroken tire lever I was eventually able to get the tire and tube on. I was as careful as I could be but the fit is so tight it's dang near impossible for me to do this right. I just hoped it had worked.

I aired up the tire and let it sit for a few hours. It seemed to be okay. Maybe it worked?

I got up the next morning. Yep. Flat. Son of a ...!

Well, I know when I'm beaten, so I gave up and took it to the local shop. Even the guy at the shop had a hard time with this tire. He said it was a really tight fit but he felt like he got it installed correctly. He also commented that I was smart for getting that tire for my trainer. Hey, the googling paid off :-)

Ever pessimistic, I didn't install the tire until it had made it through a night holding air. I woke up this morning and it still had full air in it. Yeah! Went for a 30 minute ride today and it worked great.

It's the little things in life that make you happy.

Better every day

Work is kicking my butt right now, so I haven't even had time to update this blog in the evenings.

I am now officially 3 weeks post-op and my hip feels better each day. I'm walking with just a cane now, although around the house I rarely use anything. I am careful to try to walk properly without a limp, because I'm wary of muscle memory causing a permanent limp.

I've also just been taking one pain pill a day, but there have been times where I should've taken another. Unfortunately I'm falling a bit into my pre-surgery habit of dealing with pain and soreness. I've got to learn to take medicine when I'm hurting - at least for these first few weeks.

I did use ice for swelling for the first time this week. I've done it a couple of days. Don't know if it's helping any or much but it's the right thing to do. I'm sure it's going to take several more weeks for the swelling to go away regardless.

The workouts at PT have been kicked up a notch each time. This week was a recumbent cross trainer, leg press, leg extensions, elliptical, stationary bike, hamstring pulls, step-ups, and resistance side steps. It is wearing me out! ... but totally worthwhile. It feels great to get in these good workouts.

Also, I've been riding my bike on the trainer almost every day plus some elliptical after. Today I did 30 minutes on the bike and 15 on the elliptical. I felt incredible afterward. I can't wait to get out on the road.

Looking forward to continued improvement.

Saturday, May 2, 2009

Rode my new bike for the first time

As mentioned earlier, my OS cleared me to start riding a stationary bike for rehab. The only caveat was to use pain as a guidance for how much I could do.

Last week I purchased an indoor trainer so I could use my own bike as a stationary bike. I got a Kurt Kinetic Road Machine fluid trainer. This thing is awesome.

I also purchased the cadence sensor for my Garmin Forerunner 305 so I could track my workouts. I used this heavily when I was running, so I thought it would be easiest to continue using it instead of buying a whole new computer for the bike. It won't track watts (power) but it will do speed and cadence, and when I ride outdoors it will map my rides, so I'm sure this will be more than adequate for a while.

The first hurdle was figuring out how to get on the bike, given that I have certain rotation and angle rules I have to obey on my right leg. I was able to get my right foot into the pedal clip and use the bike top bar for leverage and swing my left leg over the seat. That worked fine and kept my right leg correctly positioned.

I also had to tilt the handlebars back toward the seat so I wouldn't have to lean over too far to hold onto the bar and change gears. This enabled me to not break the 90 degree rule between my hip/thigh and torso.

I wanted to take it easily (obviously), so I figured 10 minutes, 15 max would be more than sufficient for the first time. It felt great starting off. These fluid trainers are cool! I started off in a mid-gear, big chain ring and 14 or 15 on the cassette.

After about 5 minutes, I figured I would be able to do 15 minutes. I wanted to move to a slightly harder gear for 2-3 minutes just to see how it felt. At about 8 minutes I was starting to sweat. This was great! I love working out and have really missed it. Even though this wasn't a big workout it certainly got the endorphins moving.

At 10 minutes I switched to a lower gear, don't even remember which, but definitely harder. My speed increased a little but the cadence felt about the same. I did that for 3 minutes and then cooled down.

This felt like a major accomplishment to me. Not only giving a good workout for my hip but being on a nice ride on my new bike for the first time. Bikes are much better than when I rode them years ago!

I was grinning ear to ear.