Time goes by

Things are getting better. My surgeon recommended a body mechanics specialist who understands that it's stretching I need. As I knew they would, lots of muscles have gotten weak and tight without yoga. He gave me a new series of exercises.

I have also been going to a different PT who seems to have given me better strengthening exercises. Although I still get tired and limp, I've been taking the dogs to the golf course and loving it. And today I was practically dancing in the pool. I don't limp at the beginning of the day.

But I will say this, as I've said before: the surgery was nothing compared to what I expected. It was much easier. The rehab was nothing compared to what I expected. It is much harder. I think it depends on what your expectations are for yourself at various time periods. I'm almost nine weeks out, and I think I should be finished with all this rehab.

That's it for a while...

I'm almost eight weeks out, and I'm pretty much back to my old life, give or take a little discomfort, a limp, and continuing physical therapy. Nothing that happens to me and my new hip is interesting; today I went to the gym and divided thirty minutes of cardio into ten minutes on the upper body ergometer, ten minutes on the bike, and ten minutes on the elliptical cross trainer. This is not the stuff that needs to be written about every day -- nor is the fact that every morning I march on the Biltmore golf course with the dogs to practice picking up my feet when I walk.

I'll come back to this blog when there's something worth reading. Off to the dog park.

I had the greatest trip to California. Big difference walking through airports now that I have the hip replacement; I no longer look to see how far away things are -- I just set off like I used to. And I feel as though I am getting more and more stable. My back is loosening up, too, now that I'm doing some yoga. One thing I see I cannot do:sun salutations. They violate the hip precautions when I step my left foot forward and put my arms on the floor.

I'm about to blow off the physical therapy and get on my own program. I know which muscles are weak, and I know what to do to strengthen them, and I feel silly lying on the table with a heating pad, because I'm always already warmed up when I get there. yesterday I went to the gym and walked the treadmill/rode the bike for 30 minutes.

Stay tune! This is 8 weeks and I am getting much better again.

Update: went to a physical therapy when I went home and got some good standing exercises that build strength. No more of this heating pad stuff.

Pilates

Once again I have come to the conclusion that physical therapy is a poor substitute for some of the kinds of body work I have done in the past.  Today I went to a Pilates class, the first clase of any kind I've been to since the surgery.  It seemed great to be in a class.  I modified a few things to deal with the hip precautions: bent my knees and pointed toes out when I folded forward, and didn't hug my left knee into my chest.  But otherwise I had a great time and I think it made me feel much looser.

And then this afternoon, I had a deep tissue massage, after which I wasn't even limping.  The massage therapist told me to go home and take a bath for a half hour in Epsom Salts, which have just re-surfaced in my life.  They were a part of my childhood, and then I somehow forgot about them.  But they do take out toxins and prevent soreness, so I did it.

And I realized I've spent the entire day without the cane.

Golf course

Before I had hip problems, I always took the dogs to the golf course in the morning so they could blow off some steam and not want to tear up the house. This morning, for the first time since the hip replacement, I loaded them in the car and took them up there alone. The part of the golf course I used to walk is about a mile and a half, and I wondered if I was going to be able to do it. Answer: yes!!! It was so much fun to be out where I used to go and also so much fun to watch the dogs run and cavort that it really didn't feel like any distance at all.

One problem: at the end of the walk when I had to put them both back on leashes (one weighs 58 pounds and the other 84 pounds), Chauncey -- the heavier one -- decided to pull on me. Only when he did that did I realize I'm still not fully recovered inside. I was sore.

New PT

I'm working with a new physical therapist who puts a heating pad on me and gives me ultrasound before making me walk around and watch myself. She explained that I am not transferring weight to my left hip, probably because I have bad habits, and that's why my walk looks so pathetic. She makes me walk thoughtfully on the basketball court while she watches. And then I go to the pool to try to emulate the walk by myself in water, where it's easier because I only weigh ten pounds.

I heard that a (male) friend of mine had a hip replacement on December 7 and is already walking without a cane. Made me feel bad. But I bet he had the minimally invasive kind, and doesn't have my back issues or my bad walking habits. It's not a competition.

Onward and upward, working those muscles.

Real good advice

Last night one of my favorite yoga teachers read my blog. Here are the comments of Jeff Martens:

The good news, if it can be called that, about not having a pirifomis is that you probably won't ever get sciatica on that side as many times this results from a pinching of the nerve around that muscle. The pirifomis is one of the major players in outer spiral of that leg. You still have your glutes and tensor fascia lata (don't order this at starbucks).

When standing, or if the femur is in a fixed position, flattening out your lower back on that side will be more of a challenge now as might pelvic medial rotation - swinging that side of the pelvis (and raised flexed leg) outward. (yep --Francine) That old exercise of laying on non-surgery side and raising other leg upward very gently and consciously could start to build supportive synergistic muscles. You are also going to want to find ways to keep groins and adductors on inner thigh flexible as that side adductor muscle complex is losing a good antagonist and could just atrophy a little or shrink without that constant antagonist action helping to keep groins toned and stretched. (Already happening --Francine)

You might also want to explore your sartorius muscle which flexes and rotates knee and hip in relation to psoas. The sartorius is very sensitive to trauma in the form of adrenal exhaustion.

Here are some unsolicited pointers for the poses you do:

1)child's pose: isometrically press knees together and then isomentrically feel like you are moving them apart every once in a while without moving knees to gently activat enervous system and retrain to move w/o piriformis.

2)cat/cow -- really work pelvis and sacrum gently through full range of motion.

3)downward facing dog -- work tailbone up without collapsing kidneys

4)warrior II -- use glutes to draw front kneestraight over foot instead of collapsing inward. Do this dynamically, bending and straightening knee, but very small motions and knee not bent much at deepest for now.

5)triangle -- use arm of chair to support and activate quadricep strongly. Then work on "wagging" tailbone from side to side gently in the pose, as if there were a broom attached to tailbone. This will keep fine abductors and adductors toned and balanced.

6)half moon (a standing pose in which you link your hands over your head, lean left, lean right. -- This version of ardha chandrasana is good. Draw tops of your femurs in and fire legs deep into ground. This will also be good for sartorius and IT band.

7)any good backbend. I do Camel. -- It would be good to do a backbend where the femurs are fixed by standing or keeling and another where the sacrum and legs are free, as in locust (lift back legs one at a time while on stomach, then both) "airplane" and cobra.

Along with Supported bridge pose, this will keep sacrum freer yet seated "into" body (perifomus inserted on inner sacrum). you can alter knees in and straight for couple minutes each in supported bridge and breathe healing into area.

Been doing the pool since Dr. Whirlow told me to. Today's the first day of my new physical therapy, so I hope things will be better. Here's a sequence of yoga poses that help stretch the back body after all the strengthening exercises physical therapy asks you to do:
1)child's pose
2)cat/cow
3)downward facing dog
4)warrior II
5)triangle
6)half moon (a standing pose in which you link your hands over your head, lean left, lean right.
7)any good backbend. I do Camel.

These are probably not in an order that facilitates flow, but that's not what I'm after :-) After I do those, I find I can walk painlessly without the cane for a while.

Type A Rehabber Forced to Face Facts

Dr. Whirlow gave me my wings back today. I can fly, as long as I wear a compression sock. I can do many familiar yoga poses, including pose of the child, because I am externally rotated in the hip when I do it (everyone is). I cannot: touch my toes with my legs straight, internally rotate my hip joint, pull my knee into my chest, cross my legs at the knee. This may be forever. This means I can't do "cow-face" pose.

I asked why I still limp and have some pain. She told me I ought to watch a hip surgery so I could see and understand what I have gone through. She said I was "cerebral" enough to understand.

Short version: I am doing too much. What a surprise. As more and younger Type A people have hip replacements, the doctors and PTs are going to see this again and again -- people who are not just thrilled to be out of paibn, but want to be NEW.

I guess I can't expect to walk perfectly at six weeks after collapsing into my hip for the better part of a year. And at this stage of the rehab, I should be doing more pool and less treadmill and bike. (This comes on the heels of a morning in which my new puppy ate the waterproof MP3 player that I was using to listen to podcasts while walking in the pool. It was a Christmas gift from Chelsea, but since we both love dogs we pardoned the puppy and I ordered another one.)

When I went this afternoon for the six week checkup, Dr. Whirlow looked at my still-swollen leg and told me it might be swollen for a year. Who knew? She looked for a clot as the cause, couldn't find one (she made me tense my calf muscle and asked it if hurt), and decided the swelling fell under "normal." She said it should be treated. Was I elevating it? No, no one really told me to do that. Was I receiving lymphedema massage from the physical therapist? No. I told her the physical therapist was working on helping me stretch my piriformis, which the PT thought was the source of some of my pain.

"You don't have a piriformis anymore," Dr. Whirlow responded. " I sent it to pathology. That's where I insert my chisel (or some tool like that)." What a revelation -- no piriformis on the left side!

So I am changing physical therapists. This is good news to me, because I thought the PT wasn't helping. And I am starting to go to a trainer who will help me work on my gait. I feel like a dog going through agility training.

Dr. Whirlow also said that it takes a year and a half to regain all function if you don't do the physical therapy. The therapy speeds it up a lot, but you can see where she's coming from. It's not a simple rehab.

Oh, and I need to walk more slowly.

And we will collaborate on a pamphlet of yoga poses for people who have had hip replacements. This is long overdue.

The X-Ray

OMG, I got the X-ray of my new hip yesterday.  There it is, gleaming in there like the solid citizen it is, in sharp distinction to the other side of my pelvis, where my own right hip languishes in shadows and shards. There's nothing wrong with my right hip -- it's just not titanium and ceramic.  It's pretty amazing to get a glance at a foreign body in your body, especially since I don't FEEL anything different now that the incision has healed.

Yesterday I read the blog of a football coach who had both hips replaced and blogged about the second one at www.geezerjocks.com. When he described his exercise routine after the surgery I almost fainted.  He lifted heavy weights almost immediately, which amazed me. And he was walking long distances, too. Eeek. So I went to the gym twice in twelve hours, last night and this morning.  And I'd better take the dogs somewhere tonight, too.  Gotta catch up!

It's the Psoas, stupid!

Before I had my hip replacement, Jeff Martens (one of my favorite yoga teachers) , came to visit me. He brought with him a book about the muscles involved in yoga, and somehow we got into a big discussion about the psoas. In yoga, the psoas is known as the place where people hold unpleasant emotional memories. Clearly, before my surgery, my psoas had gotten so tight that I couldn't extend my left leg flat on the ground while laying on my back. Jeff's thought was that the holding in my psoas represented a failure to deal properly with the grief from both my mother's and my husband's deaths six months apart --which I tried to shove under the rug because I was working for Intel at the time.

But after my surgery, I'm still in pain when I try to bear weight on my left leg. And where? At the site of the psoas.

I had asked my physical therapist why I still limped when I tried to walk without the cane, and she merely dismissed me as too early in the process. However, I disagreed, and today when I went into the PT place I saw a different therapist. This therapist tagged it immediately: my psoas was still contracted. She spent most of the therapy releasing it, and at the end of the session, I walked with almost no limp! This is promising.

I see a difference (again)

Every once in a while I make a leap (well, figuratively) forward and I'm re-energized for rehab.  This morning I walked almost effortless up the steps to the main gym floor, and I left my cane in the car altogether.  Now it wasn't pretty, but it worked.

The gym had an after-New Year's special: free body fat calculations. All my life I've thought of myself as muscular, so I submitted to the test.  Lo, I was declared to be 33% body fat.  Damn! I know that's not a really accurate measurement, but it's not far off what my fancy Tanita scale says, so I must be in worse shape than I thought after this surgery. That's something we never think about: what a couple of months of relative inactivity can do to all those calculations.

So I went to the Internet and looked up what someone my age should be.  First of all, they stop calculating after age 55. Everybody 56 and up is lumped into the same group. Ideal for women my age is 26.5-31.3. Average is 31.3-36.3. So I'm on the low side of average, only the average American is overweight and overfat.

As soon as I see Dr. Whirlow and she lets me, I'm gettin' a trainer.  These goldens aren't doing it for me :-)