Ups and Downs

Now past week six post-op, I can agree with my doctor that hip surgery recovery will be up and down.
On Wednesday I felt great.
On Thursday my hip ached.
On Friday the pain was almost constant, just aching and throbbing a little.
On Saturday the pain vanished, and I felt not a twinge the whole day.
On Sunday I felt mostly wonderful, but some aggravation after a long walk.
On Monday I was in pain.
Ugh!

I'm plugging away at PT, and can now do:
- Bridges
- Squats (not all the way down)

Leg lifts

- Lunges (!!!) - believe it or not, they do not aggravate the hip, and are a great mild stretch to the hip flexor, as long as you keep the back leg totally straight and directly below the hip.
- Balance moves on half-bosu (or at home, a stack of pillows)
- Side leg lifts
- Wall sits

The better I am about PT, the better I feel, so I have been trying to get it in twice a day, although I occasionally slack off.

Last week I got a chance to talk to another runner who was having the same surgery. She had it this Friday; I spoke to her Wednesday (I just met her, but I know her boyfriend well). She had a lot of questions prior to the surgery, but I felt like I had NO helpful info for her - there is just so little consistent information out there about hip labral tear surgery! She is seeing the other hip specialist in town, Dr. Suri, and his post-op instructions differ hugely from those of my doctor (like, wearing a brace for only 10 days versus 6 weeks from my doc!).

I'm being patient with the ups and downs, because I was told to expect that. I'm just hoping that in time (but not too much time!) the ups overtake and leave behind the downs.

Bay St Louis a few weeks ago

Seven years! Happy Anniversary to this guy, who got a pop quiz on the "in sickness and in health" part of the vows this year, as he waited on me hand and foot while I was on crutches. What a stellar guy!

I'm blessed to have a partner who shares my sense of humor and balances my personality. He's patient where I'm not; organized where I'm disheveled; smart about the things I'm dumb about; and serves as my go-to guide to movies and music since I can't be bothered to pay any attention to either myself. And besides that, he's the sweetest person I've ever met and adores me - so you can't beat that in a husband.

Here's to many more years!

Confession: the brace is history

No brace!
(Excuse the wrinkles -
I actually wore the
shirt tucked into a skirt
for church)

Our social calendar was packed the weekend before last, popular kids that we are. Saturday we had to juggle helping the church out with an errand to the dump, a birthday celebration downtown at the Bastille Day festivities, and dinner with friends. It was hot - in the 90's - and after putting on shorts and a tank top, I just could not, could not, could not wrap that hot and heavy brace around my waist.
I went without it. Carefully, but coolly!

And then for dinner I kind of forgot it. And for church the next day I definitely left it home on purpose. I'm just over it!

Now, this is the only point on which I have strayed from doctor's orders, so I think I'm probably not doing irreversible damage: especially since my doctor said, "Four to six weeks". I made it to four and a half weeks with the brace, so technically I'm ok. Lower end of the estimate, but probably no big deal.

And when I look at protocols for the same surgery at other facilities or with other doctors, I can't find any that recommend the brace for longer than five weeks at the absolute max. Most say 3 weeks. So I gave myself permission to ditch the brace.

And I'm posting this info over a week later because no way was I posting that I got rid of the brace, only to feel worse and worse as time went by! Instead I've been feeling better and better, so I am OK with publicizing my disobedience to orders.

Looking at the picture I just took braceless (with my handy phone camera timer app I just downloaded), I notice that I'm in my typical left-leg-not-engaged stance. I'm trying, guys, but I have to undo months, if not years, of poor posture, stance,and gait!

$22 at the Goodwill

It was a good weekend at the Goodwill.
I picked up these two matching tops with tags still on, which were sold from Anthropologie. I don't know which one I'm keeping yet, because I'm letting my sister pick one so we can be long-distance twins.

Then I got four tops: a yellow tank with sheer panels in the back (wore it to dinner); two serviceable T-shirts from Ann Taylor that are just dressed up enough to pull off at work, in tan with lace and black with ribbon; and a J. Crew button-down that also still had tags.

But the steal of the day were the Etienne Agnier pumps, clearly never worn, in navy snakeskin. They're a classic shoe and comfortable, since they are actually a wide size. I have been slowly replacing my shoe collection with leather shoes only. When I was a poor college student, leather shoes were an unthinkable luxury (unless they were a Goodwill find), but now I'm looking at the worth of comfort. My feet are so oddly-shaped that I rely on leather's malleability to get the shoes to even fit a little bit. At $3, I think these heels are a good investment!

I feel like a million bucks

So I'm backing off everything.
One of the discharge instructions I read from a prominent physician who performs hip labral tear repair mentioned that patients will often feel very good around 4 or 5 weeks post-op, and then they overdo it.  I don't want to be one of those patients! The last thing I want is a set-back of any kind. So when I woke up feeling like surgery was a thing of the distant past, I slowed down instead of speeding up.

- I was given a whole list of new PT I can do now that it's been over 4 weeks, but instead of introducing it all all at once, I just added one new activity a day.
- I completely skipped a walk in the park, knowing I might have to park far away for a birthday party/Bastille day celebration later in the day.
- I actually reduced the number of reps in PT
- I wore heels to a dinner party but made sure I either stood correctly (with weight evenly distributed to both legs) or sat.

At the city's Bastille Day celebration on the River

I was glad I made those choices, because I accidentally hurt my hip yesterday! Don't laugh, but I was cleaning the bathroom and was trying to put a new mophead on the mop. As I fiddled with the screws, I sat down on the toilet seat while I was working on it...except I forgot I had just cleaned the toilet bowl, and the lid and seat were up. I expected the seat to be higher than it was, so I CRASHED down that extra two inches, catching myself squarely on the injured hip. It did NOT feel good! Luckily, the pain was short-lived, and I was fine after about five minutes, but I would have been frustrated if I wasn't. If I had done too much, and it hurt all day, I'd keep wondering if I hurt it accidentally or by overdoing it.

I didn't just feel good physically yesterday. I felt good mentally and emotionally, too, because I got some quality time with good running friends! My running group, Varsity Sports, has more or less kept tabs on me via Facebook, but a couple in the group, Jon and Janell, invited us to dinner this weekend. We joined them at their lovely home, along with several other group members, and it really was wonderful to see everyone again. Jorge was there - he and I were probably the closest in speed on speedwork Mondays, so he's sort of a training partner; also several of the members who've been with the group for years, and Andy, who I ran with for the Greek Fest 5k. It was so nice to see everyone, especially Jon and Janell, whom I really look up to. Jon is a cancer survivor and I would like to tell his story here once I get his permission.

It did suck a little to hear everyone's racing and running stories, but that mild pain was worth the pleasure of good company, good food, and good wine.

P.S. to yesterday

I should add to yesterday's post that $55,000 is only what the hospital charged for the surgery and my outpatient hospital stay. 
I got separate bills for:
1. My pre-op hospital visits
2. My anesthesia
3. My doctor's charge for actually doing the procedure (he charged over $5000)
4. X-ray and imaging during surgery
5. PT while in the hospital, which consisted of a therapist not fitting my crutches to me

All in all, the surgery bills were close to $70,000.

Money is meaningless

You know what's all wrong with our whole medical system? Money is meaningless. Really. It means nothing.

For example, I might dispense a prescription for quetiapine, a generic drug that costs me $11 for 30 tablets. I bill the insurance $302. That's because the other options I could bill - like the brand-name drug, which retails for nearly $600 - would cost the insurance company much more. So they are willing to pay me a little extra for this generic. But they don't pay me what I ask for. They pay me a $4 dispensing fee, and $271.80 for the drug, which is 90% of the average wholesale price of the drug. Because they set their own pricing, and if I don't like it, I can just jump off a cliff. I like the $264 profit, though, so I stay on top of the cliff.

Or, I dispense a bottle of insulin that costs me $88 to a patient. I bill the insurance company a reasonable $96. They reimburse me $82.50, because the drug is the wrong brand. They prefer a different brand of insulin that costs $79.50, so they only reimburse me based on that drug, even though I don't have the authority to substitute it for the other brand. I lose money, but I can't do anything about it, because my contract with the insurance company says I can't turn patients away based on reimbursement. I'm considering jumping off the cliff.

Or, you go to the emergency room with a fever. They give you a tylenol, and you go home. You read your (whopping) bill later, and see that you were charged $9 for a tylenol. That's because you weren't paying for the tylenol. You were paying for the boxed lunch the hospital provided a Medicare patient who came in to the emergency room because she was too busy on Friday to go to her scheduled dialysis appointment, and now she's trending toward acute kidney failure. That, and she likes the box lunches that the hospital provides but Medicare doesn't reimburse.

Or, I have an outpatient surgery. The hospital bills my insurance $55, 000.

My insurance company disallows $45,000 of it and, between United Healthcare and I, pay the hospital $10,000.
Was the surgery worth $55,000? Heck no. That's stupid. They didn't give me a platinum implant, geez. Is it reasonable to reimburse just 9% of the bill? No, that's stupid, too! Of course the hospital can't bill the actual cost of the surgery, and the insurance can't just pay them back.

Ludicrous? Yep. Money has absolutely no meaning in the world of medicine.

Influencing weather

I have a very spooky talent. Whenever I'm injured, I'm somehow able to make the weather gorgeous, so I can not enjoy it running. As usual, I'm not running, and the weather has been unseasonably cool and beautiful.

Rains have lowered the temperatures, and also caused the overnight growth of this huge weed in my backyard:

While I was back there, I watered my herbs, which are also flourishing in the more moderate weather. My mint even came back from a totally dead and empty pot. You cannot kill mint - proven fact. It's very scraggly, but I had actually cleaned that pot out for replanting when I noticed some tiny shoots, so I just let it grow in.

My sage, unfortunately, was eaten up by caterpillars.

My visit to the PT yesterday went well, although as I expected, he didn't have a whole lot of information for me. I did notice that I felt better with more stretching, so we're adding some stretches - but not a lot, since I still have range of motion restrictions in place. He was very happy with my walking, which is completely normal, and he testing my strength again and both sides are strong, and - more importantly - equally so.

Two more pretty nice things happened yesterday. One, I went to a boring all-day meeting at the district office, where I found out that my little pharmacy was the most profitable department in the district last month. Yeah, me and my two technicians, raking in the dough, not creating any drama, just quietly working! I have to toot my own horn - we're a huge asset. We don't require much, if any, local or corporate support. My pharmacy basically functions as an independent. So who wouldn't want a quiet, unobtrusive, drama-free money-maker?
Two, one of our neighbors was at Bible study last night (he's actually friends of the hosts, but we recognized him from the house around the corner! NOLA is so small). I hadn't seen him in a while, and he asked about my brace. As it so happens, his sister had the same surgery from Dr. Kelly in Boston ten years ago. She tore her labrum in a car accident, and no one could give her a diagnosis or pain relief until she saw a specialist. He had a lot of good information for me - how she hurt for about 6 months post-op, then rapidly improved; how she needed PT for about a year; also how wonderful she felt after recovery! It's nice to have that resource and I like hearing the success stories of others.

Oh, and one last thing - I was cleared to get on the exercise bike for short periods of time at low resistance (1 or 2 - just to prevent bouncing, which can yank on the joint)! So I'm off to go stare at the wall and pedal in place. Woot!

First steps

I'm off the crutches and on my own two legs again!
After  rough couple of days last week, it feels good to make some progress and have something to place in the "pros" column of my recovery pros and cons chart (Cons: brace, CPM machine, drainage, crutches, antibiotics, crutch chafing, Guyon's canal syndrome, near-miss with fatal skin reaction).
The first day I felt a little weak and awkward, and I discovered that walking normally in the brace is difficult (it's still set at 0 degrees extension, so all my walking has to be done ahead of my body).
The good news: the pain I felt prior to surgery is no longer there. It was a very distinct feeling, and I'm glad it's gone.
The bad news: I have some groin aching and pinching and hip flexor pain. I've been doing my best to avoid or minimize hip flexor tendinitis, but I appear to have a little.

I'm not sure what to make of the situation right now. I assume that the pain I'm feeling is normal, and it hurts because labrum was cut at that area and bone shaved down. I don't think it's a sign of failed surgery, because the pain I felt before is gone. I also don't think it's a sign of damage to the surgical site or weight-bearing too soon, because the pain is not really on impact. It grows after use (like, it hurts more after a long walk than after a night in bed resting), but pain is more related to internal rotation of the leg or adduction than weight-bearing. I think it's just pain because work was done in there, and it's still healing. I see the PT this morning, so I will check in with him and watch him Google it on his phone (his new phone - he upgraded with his first paycheck. This guy is an infant.).

Right now the pain isn't bad at all, but I don't want to do anything I shouldn't do, so I'm trying to take things easy. I know that it's my tendency to shrug off pain, and look where that got me? In a brace for 6 weeks!

What are you wearing this weekend? Happy 4th of July!

Because July 4th was a Friday, but family celebrations were Saturday, I got to wear two patriotic outfits!
For the holiday, I dressed the theme up a little:

Red and white tailored shorts and navy T-shirt

But for Saturday picnics, I wore a more casual shorts and T... with my scarf that looks like I got tangled up in bandstand bunting.

Ridiculously obnoxious flag scarf

Too much flag in this picture. 

What red, white, and blue did you wear for the fourth?
PS - ok, so I took the brace off for the pictures. So sue me. I put it on right after, I promise.

Thank you for your patience

Last day, if all goes well. 

All I can do is type

I now cannot walk or speak (which is putting my husband at a distinct advantage over here).
I ended up discontinuing the Bactrim on Sunday secondary to a severe reaction, but I'm still dealing with the effects. My mouth and throat are almost completely covered in ulcers, blisters, and inflamed areas. If this happens to you when taking Bactrim (or any drug, but especially a sulfonamide), call your doctor! It could be a sign of a potentially fatal reaction. PSA over. 

I just mixed it up in the half-empty antacid bottle. 

I made myself some Magic Mouthwash when I got to work on Monday, but eating, drinking, and speaking are still hard. I've been subsisting on ice chips and ice cream (not a bad diet, I must admit) and completely confusing all my patients with my garbled speech.
At least the "sickness" and "flu" symptoms vanished when I stopped the Bactrim...looking on the bright side!
Off to PT to see how my brand, spankin' new physical therapist spent his first paycheck ever. I like this guy, but boy, he's so young and new at this job...makes me a little nervous.