An interesting case

I received the following email recently:

Hi Steve
I came across your blogpost about your second hip replacement when trawling the internet and found it both interesting and comprehensive – so I followed up and found the info on your first one as well.

How are you going now, a few years down the track?
(I ask because it’s now 10 years since my last replacement0.

Kind regards,
Nik Macdougall

Here is some more information Nik supplied in a followup email:

Hi Steve
Thanks for the reply – and I’m delighted to hear that your hips are in great shape 🙂

Your site is very informative and should really be promoted as a resource for prospective THR patients. An awful lot of literature out there is highly ‘medicalized’ and, as such, often hard for people to come to grips with. Personal experience – stories – are what make an impact. Well done all round.

I’m 58 and my personal hip history spans 44 years, although only one hip. I’m not sure what sort of thing you might consider putting up on your site, but would be happy to provide any info you feel appropriate.

I hadn’t thought of setting up a website, in fact I initially set out to produce a simple THR self-help booklet. However, since I’m not a medical professional I decided that was probably an unsound choice. So, after much contemplation, I wrote the story up as a memoir. It was a lengthy process – and I had to quell my internal critic from time to time, but I’m glad I did it. I finally self-published on Kindle a little while ago.

I do have a blog, but the topics are more broad ranging than my hip story. However, if you’re at all interested, the book’s called Girdle of Bones.

All the best,
Nik.

http://nikmacd.com/teacup/mission-accomplished/

From her blog:

Hi , I’m Nik Macdougall.

I fell off a 100 foot cliff and had 9 hip replacements over 35 years. AMA

Pretty interesting, huh? I haven’t read her book, Girdle of Bones, so can’t recommend it directly.

It’s been a long time; Is everything okay?

It has been more than two years since I posted last. Someone emailed me to see if everything was okay, so I’ll answer the question. The hips and legs and knees are just fine. Right now I finished mowing the lawn. It takes about 4 hours walking behind my self-propelled mower. The legs and buttocks tell me I’ve done more walking than they would like, but that’s just fatigue, not hip replacement problems.

I have a FitBit and an iPhone both measuring my steps. On an active week I average around 8000 steps. On a less active week I average around 5000. I’d like to always do 10,000 steps but that only happens occasionally.

More Physical Therapy

The outside of my right thigh just never got better. I was worried that my IT band had been damaged. So I went to Berkshire Physical Therapy in Lee for more physical therapy. Rachael listened to my story and watched me walk. Her diagnosis was that my gluteus medius and lateral quad were weak. They couldn’t support my weight when, during walking, all my weight was transferred to my right leg. So the IT band had to take over and it was stressed.

So the good news is that my IT band is fine but overworked. The gluteus medius is split during posterior hip replacement and sewn back together. The lateral quad was probably stretched too far when they were manipulating my leg during the surgery.

Rachael gave me a series of exercises that strengthened those muscles and, after a few months everything is much better. Still not perfect. If I stand on my right leg for an extended time or stand on it and bend over, for instance while trying to put my left leg into my pants while standing, it cramps up.

I do what I can to force the right quads to work hard. For instance, while walking up stairs, my body tends to push off with my left leg to spare my right quads. I work hard to overcome that tendency.

Hard to tell how much of this problem is because of the THR and how much is caused by my abusing my body by sitting in front of my computer for hours on end.

Knee

Three days ago I went to see Dr. Tomford about my knee. He looked at the x-rays and said my knee looked great. It must just be a problem of the knee adjusting to the new mobility of the hip.

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I was using the cane in my left hand and it seemed to relieve the pain in the knee when walking. He said I should be using the cane in the right hand for a problem with the right knee. Using the cane in the right hand was less comfortable, but I did it anyway.

Now I don’t need the cane any more. Was it just a few hours using the cane in my right hand that did the trick? Was it all in my head and all I needed was to be told by Dr. Tomford that my knee was fine? I don’t know.

The knee is still weak. I can’t balance on my right leg. There is pain along the outside of the thigh. I think that is the iliotibial (IT) band. Dr. Tomford says it is split during the hip replacement then sewn back together. IT band syndrome is a pain like I’m experiencing that is caused (among other things) by a sudden increase in activity. Well, that certainly fits.

That part of my thigh has always hurt since the surgery. If I lay on my left side and raise my right leg, it hurts. When I switched the cane to my right hand, that is the part of my leg that hurt. I am icing it now and icing my knee.

Interestingly, I had (and still have to a lesser degree) a similar problem associated with my left hip replacement in 2004. I wound up with “snapping hip” which is a juddering caused by inflammation where the IT band slips over at the top of my femur. So my IT bands are a problem.

I have ordered copies of the x-rays taken and will post them when I get them.

Now it’s the knee

About 10 days ago my knee started acting up. A sharp pain low and inside on my right knee, which is the side of my new hip. So I’m back on the cane after a a week or so free of any encumbrances. Using the cane seems to help avoid the load on the knee that it doesn’t like. But it is not getting any better; in fact, seems to be getting worse.

It is at its worst after being inactive for awhile, like in the morning or after sitting at my computer. I suppose I should stay off it, but it’s hard to do all my exercises and get in my 10 minutes of walking every day if I can’t use my knee.

I’ve made an appointment with Dr. Tomford for next week. Maybe it will be all better by then.

From Two Crutches to One

I can now officially walk with just one crutch or a cane. It has been one month since my operation. Don’t tell Dr. Tomford, but I have been walking with one crutch occasionally when I needed to carry something. I’m down to two Tylenol Extra Strength per day. My recovery is going very well.