Little big milestone

5 months/ 1 week PO

 

I finally reached walking one mile in the park, at 5 months PO hip fracture! I was very proud of it, did it quite well and when I told my PT, his very first question was “did you time yourself?” Huh? I am happy I could walk it, I could seriously not care less in what time. Weird.

In the past week I walked my precious mile three times. It goes a bit better each time but still takes a lot out of me.

 

At PT we increased the height for practicing doing steps. Now it’s an 8 inch height, which is pretty much the standard height for stairs.  I can manage my staircase twice a day now – the “normal” way. But twice is  MORE  than enough. I feel it in both hips pretty much right away and it takes a tremendous effort.

~~~

Tomorrow we are going on vacation. My PT told me to take the crutches along. Just in case my hips get angry. Makes sense but I was kinda hoping I was done with them, but I am a good patient and take them along.

 

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~~~

The Elliptical is up to 8 minutes on level 1, medium speed. I am happy with that. Lots of little improvements happening.

Pain is almost gone, the hips take turns in being achey and it of course depends on how much I do. Overall I feel pretty good and if it wasn’t for the lacking strength and endurance in my R op hip/ muscles; doing sports and moving faster on the staircases, I’d say I feel almost normal.

 

Girl drawing smiley face on to a wall

~~~

So now I can pack my suitcase.

Forget the cute shoes, it’s comfy sneakers with good support, icepack, Ibuprofen and crutches. Hooray. But I will make the best of it. I will have to choose wisely what I can do, judge walking distances and I will probably make friends with every single bench in sight. Hopefully this will be the last vacation with crutches.

As I said to my OS already, last time I saw him “the subject hips is not just getting old – it  WAS  old already five years ago” (when this “oh so fun journey” began).

 

See ya.

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4.5 months into the recovery

Yes, I am still at it.

Recently a lot of people acted very surprised to hear I am still using my crutches or I am still in physical therapy. Well – surprise!

 

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***

I saw this T-shirt the other day, maybe I should get it. Hmm…

 

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At 4.5 months PO I can:

  • crutch-walk around a pond which is a “good” half mile/ ~ 1000 meters
  • walk “without” crutches maybe 100 yards/ meters and then it is clearly enough
  • do stairs “Granny style”
  • walk without crutches “indoors” but for anything outside my home that requires more than 15 minutes of standing or walking – two crutches
  • drive a car again with nearby errands to run
  • stand longer at home (ironing, cooking etc.)
  • do about 4,000 steps per day
  • shower without a shower bench

 

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Since this week I have my PT’s permission to do “small community stuff” like go in the post office, grab a coffee or get some groceries without crutches. I do not have the okay for going to the supermarket and do a full weeks grocery shopping without crutches yet. Basically quick “in & out” errands.

I am still taking advantage of an online shopping service for getting my groceries. One orders online and picks it up curb side. Very convenient!

~~~

PT is going well. I continue to improve strength and when my range of motion was measured, I had gained another five degrees on all movements in the last six weeks.

My gait is also getting better. I am walking faster than two weeks ago and am keeping my upper body nice and straight. It still looks “robotic” though as my PT charmingly called it. My op side has good  ROM  but when I am walking it looks stiff and wooden.

(This is who my walk reminds me of…)

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~~~

Since a little while I also have clicking going on in the front of the hip and in the back. It does not hurt so I don’t think it’s the labrum getting stuck, but some tendons snapping over the hip. I am not too concerned about it, I think it will settle with time again when everything thing is more balanced.

~~~

In physical therapy we are working a lot on strengthening right now. Still doing the leg press, leg extension, hip machine, using the big ball for doing 2/3 squats along the wall and elastic bands for various exercises. (I really have to watch my PT closely, sometimes he tries to sneak extra weights on the machines without telling me and I can not do it.)

 

Sideways stepping. (Burn baby burn!)

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Walking like an “ice scater”.

 

 

Another exercise I am working on is trying higher steps. I am still doing my staircase at home “Granny style”, or “the hospital way” as my PT likes to call it but I am practicing  now a bit higher steps.

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I should  NOT  try my whole staircase with the new technique yet, it’s too early and too much for my hip still.

~~~

So, that’s about it at this point, let’s finish with a laugh. I saw this picture the other day and thought, “hm, I guess my ski injury is so uncommon, it did not make the cut. Lucky me.”

 

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Slow but steady

17 weeks PO and still in the slow lane.

 

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No PT last week, I just did my home exercises and went for small walks. I am supposed to practice walking crutch free every day for short distances inside my home; from room to room is okay but my op hip tires quickly.

Preparing a meal in the kitchen for half an hour feels like I spent about three hours on my feet or changing bed sheets sucks real energy out of me for example and I need a break.

The simple task of “standing” a little bit longer like for ironing or cooking is not all that simple. I do see improvement to a few weeks ago but I am surprised how still simple things can throw my hip off and present me a crappy night in return.

I try to stay below 3,500 steps per day, anything over I am asking for it.

 

Crutch free I can walk about 50 yards/ meters by now, then it is clearly enough for my op hip. It’s a tricky combination, to have massive atrophy and a major weight bearing bone that needs to get used to bear weight again. Why easy if you can have it difficult?

This recovery puts a new definition to the word “slow” but this week my PT is back and I am back on track.

 

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Mini progress!

7 weeks PO and two physical therapy sessions down.

That place is hopping! A constant flow of patients coming and going, whereas I am by far the youngest. The average age there is 65 and somehow I always get stuck with some old guys who work out right behind me, making weird noises. Eeeeeek!

To warm up I was told to do the stationary bike for 10 minutes without resistance. I swear, among all the high tech equipment they have, this was the wimpiest bike there.

 

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I was there for almost 1.5 hours and did all of my home exercises. My PT also did passive movement with my hip, to gain ROM.

He also did massage the scar tissue and the hip flexor. That needs major attention and I need to see an ART therapist for that, when I am more mobil again. It seems like I have quite a bit of really hard scar tissue in my thigh and of course adhesions.

He rolled out the TFL band too since it’s tight and I still have swelling in my upper thigh from surgery.

~~~

The only movement I should avoid is deep flexion with internal roation. Also, still no green light for going in the bathtub. Requires too much flexion of the hip.

 

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My PT was happy with my exercises and we both could already see improvement. He gave me very specific exercises to target different muscles. Muscles that were in the sleeping mode for the last seven weeks and they need to be woken up again.

The home exercise program I was given takes me a good hour right now.

~~~

I am definitely walking better than last week too. I had people with walkers pass me in the hallway, but better is better.

 

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I do get the feeling though that my PT rushes things a bit. Already at my first visit he told me about doing the anti gravity treadmill “ next time”. I am not a fan of the idea of doing it so incredibly early on.

 

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After all, I have not formed bone or even reached 25% weight bearing yet. So when he suggested it at my last visit,  I told him no.

 

Maybe later on, when I am more weight bearing and stronger but at the moment my fracture is still there and is only being held together by three screws, and the middle one is “too short” as it is, according to my local OS.

In his opinion it should reach more/ longer into the femoral head and even though I am not a radiologist, looking at the Xray, I see what he means.

~~~

I asked my PT if he had patients my age with this kind of fracture before and was told “not too many”, which could also translate to “none”…. Hm.

He suggested to “put weights on the ankles” next time I do prone hip extension with a bent knee. (What part of me telling him that “I am a slow healer” did he not get??)

 

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There won’t be any weights on my ankles next time!! It is plenty to work with my own body weight, especially so early on.

 

I have read one should avoid “too much too soon” since it’s a very delicate recovery. If one pushes things one can end up with a stress fracture in the femoral neck and that on top of the still fractured hip would have me headed straight to a THR. I need that as much as a hole in my head.

Already from the exercises we did I was in pain afterwards. My night was miserable and my hip was very angry. It also did not help to have me double my time on the stationary bike within two visits.

 

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~~~

The verdict for this week is a good one. I am walking better, pain is in general low and PT is already paying off.

 

The next big hurdle is my 12 week PO follow up appointment. In a perfect world, the Xray should show hard callus and ideally, some new bone already. If not, then it means I am taking the scenic route in this recovery again and more quality time with my mobil legs.

 

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The countdown is on!

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In 48 hours I have my big six week follow up appointment with my OS. It will be then decided how Majesty hip is doing.

~~~

My head is buzzing with potential diagnoses and all different kind of “what if…” scenarios and the individual domino effects.

I read up about AVN, malunion, nonunion and don’t like any of those but it also will be decided how much my bone has healed already, if I can start with PT or I have to give it more quality time on crutches and continue the waiting game. A little bit more weight bearing would certainly be nice, not just for my other hip, but also for my hands, elbows, shoulders and SI joints.

 

I “should” get good news though. I have my age working in my favor, except for my drama queen hip I am fit and healthy, my bones are strong without any sign of osteoporosis ; I eat a clean diet and no junk food, I don’t smoke and I don’t drink.

Plus I “feel” like some healing has taken place already. Fingers crossed for good news.

 

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I continued making research and started thinking outside the box a bit and voila, I found a whooping four young people, with a complete hip fracture!

It was comforting to see others having the same questions and going through the same thing but their protocols but recovery timelines could not have been more different from each other.

  • Some were partial weight bearing right after surgery whereas I am toe touching for six weeks.
  • One guy was outside on his bike three weeks after surgery – I can do 5 minutes on my stationary bike every other day without resistance and so slowly, the monitor does not even bother to turn on, at 5 weeks PO.
  • Another fellow started partial weight bearing after 10 weeks on crutches and it took him 1 year to come back.
  • And one crazy guy started jogging (!) after six weeks PO already.

 

Interesting read but not really helpful since they vary so much. Since there is NO way I will start biking outdoors anytime soon or start running on the treadmill next week, this was the most helpful and realistic tip…

 

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It will be what it will be. I’ll update when I know more.

 

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1 month PO!

Finally! 1 month post operative. Another hurdle tackled.

Lots has happened in my momentary small world last week. For example, I got my operative report from the hospital. Was an interesting read.

It also stated “no complications.”

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I was lucky that day anyways, the orthopedic surgeon on call was specialized in “trauma and hip”. I could not have had a better OS than that.

This was her and her physicians assistant, “the morning after”.

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We also got the bill for my little adventure.

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Holy smokes!!!! For sure our most expensive three days ever, anywhere, but thank god the insurance paid. Three amen for that.

The bill was two pages long and listed absolutely everything. Cost of the ER, the operating room, anesthesia, all the meds I was given; the screws in my hip are over $ 4,000 and so on.

~~~

Most of it made sense, two things didn’t.

Not sure how they ever got to $ 1,095 for PT services and over $ 300 for “occupational therapy”.

I had exactly four PT sessions. On PO day 1 I was given non weight bearing exercises to do with my legs in my bed and I sat on the edge of my bed. The whole show lasted 20 minutes.

My PT came back the same afternoon and I crutched a few minutes around in the hallway and showed her, I can manage stairs on crutches. 20 minutes.

Same the next day with the differences that my PT put me in a wheelchair to eat my lunch, left and didn’t come back. It was not very nice to sit all alone in the room, trapped in a wheel chair and you depend on peoples mercy. I had to ask for her several times to come back. Pissed me off.

And in the PT room, I almost fainted after doing the steps.

Except for that I had the same 20 minutes four times. How can that end up as $ 1,095??

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And to list the “occupational therapy” with $ 300 is a joke as well. She came in and said, she just wants to be sure I know how to dress and shower by myself. I gave the shower a go and (fainted almost again towards the end) and that was it. I showered without assistance.

(Thank god. That would have been too much for me. It was one thing to have your clothes cut off your body by two guys , to have to use a bed pan was also something I could have skipped but at least I could shower by myself!)

Her whole speech and existance in the room was five minutes.

I find it odd but I am not making a stink about it since the insurance is covering it.

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I am getting very interesting comments regarding being on crutches these days by the way.

The other day I was in the supermarket. I was asked what happened and answered  “I broke my hip”. The first lady asked “if I am in a cast” (how do you put a hip in a cast???) and the second said “did you at least have fun doing it? “ People are weird.

Being on crutches gets two reactions, either people are super kind and help you out with doors ect  OR  they make weird statements. Not a whole lot in between. I am sure I have more comments coming my way as I progress in my recovery, but I have gotten the alien look a bunch of times already when the hip fracture came up.

~~~

Talking about crutches… my mobil legs arrived!

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They are much better for the arm pits but the shock absorbers took a bit of getting used to. They are louder than regular crutches, pretty light but I found the grips very hard on the hands. Not sure why the reviews said, “there is no more fatigue and one can crutch on them forever”. Not me. Crutching is tiring and I am in good shape.

I put my crutcheze pads on the handles  PLUS  got special weightlifters gloves. They have build in cushioning and it helps too.

The gloves are comfortable but made me laugh.

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To me they look like gorilla palms…don’t they?

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The instructions for the crutches were awesome too. Quote “Walk as naturally with them as you can”. Hm, last time I checked there was nothing “natural” about it when you are toe touching!

~~~

My op side thigh keeps shrinking away, atrophy starts on day 11 according to my OS. It’s scary to see it getting skinnier and skinnier every week. Will take me many months to build up again.

I remember this from my last hip surgery rehab. “For every week you are on crutches, your body needs six weeks to build up muscle mass again.” (Fun little spring and summer project right here…)

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Pain wise I am doing pretty good. It’s around 2/10 during the day, the hip  WILL  start throbbing quickly though if I do too much and end up like a 4/10.

Nights are mixed. Not really bad but some nights I can’t find comfortable positions for my op leg or I am aching. I can sleep on my back, my left side is okay, tummy feels great but the right is not there yet.

~~~

Taking a shower is still an achievement. Not so easy if you are toe touching only and have to balance on wet tiles. The shower bench helps out tremendously even though it looks a bit different than this scene…

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…it’s more a matter of “fifty shades of purple”, looking at my op side foot. During the day I rest and ankle pump away or crutch around for keeping the circulation going but in the shower that foot looks creepy.

~~~

People keep asking my why I even went skiing after two hip surgeries and want to know if I will go skiing again.

I went skiing already 10 months after hip surgery and had a great time. The endurance was still not there but I skied!

And yes, I have full intentions of going again. Why not? I live for winter,  love to zip through the powdery snow and feel the cold, fresh air on my cheeks. This is freedom and happiness to me.

I took this picture last year in Colorado. How can this not look perfect?

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Of course it is “safer” not to, but I am not the slave of my hip. I will do whatever it takes to get strong and healthy again and then, I am back on the slopes.

~~~

To finish up, I want to quote an orthopedic surgeon, talking about recovering from hip fractures and why recovery can be challenging.

“It takes a vast amount of energy for a young person to break normal, healthy bone – some estimate as much as 1,700 pounds per square inch or more – compared with the significantly lesser amount of energy required to fracture osteoporotic bones.

The direction that the energy takes as it enters and exits the bone, as well the position of the limb when the trauma occurs, results in the fracture pattern and the type and severity of the fraction.

Despite the fracture patterns sometimes appearing the same in healthy, strong bone versus osteoporotic bone, it’s a very different injury because the energy and trauma needed to break healthy bone is much greater.

The increased energy also imparts significant injury to soft tissues that surround the bone and result in tissue tearing and bleeding.

When I care for a patient with a fractured hip, young or old, I always explain that the recovery is often more difficult than it is for someone who undergoes elective hip or knee surgery or replacement. This is due to the greater damage to the soft tissue and bone in a trauma patient compared with the elective hip or knee patient.

While the hip fracture patient is an energency, the elective patient can be optimized both mentally and physically prior to surgery.

Also, the patient with a broken hip often has a more difficult rehabilitation after surgery. The broken bones and injured tissues must heal and frequently the fracture pattern dictates that the patient delay full weight bearing on the injured lower extremity.”

Just some food for thought from a surgeons perspective.

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