Learning to Walk Again

I have a number of drugs in my arsenal that don't seem to be doing their magic anymore, so I've been struggling with insomnia. It's nothing new; I've struggled with insomnia to varying degrees for my whole life, or at least as long as I can remember. In a bout of insomnia a while ago, I started reading through this blog, and I was really happy I took the time to write out all that I did. It inspired me to try to start writing again. If for nothing else, for me. Writing has always been my outlet, something cathartic for me, but lately it has just seemed like such a chore. So many things that used to give me pleasure just seem like such a chore. I've mentioned that since my surgery, I've just felt so... blah. I need to bust out of that. I think I'm finally ready. So here we go.

Fortunately, I actually have something to write about that's relevant to this blog. I (FINALLY!) had my first PT session on Friday. Dr. Terminator told me that he wanted my first PT session to be with one of his own PTs; however, his assistant (an athletic trainer) hinted to me that she didn't think it was necessary, especially since I live a few hours away. So I ignored Dr. Terminator and set up an appointment with a physical therapist in town my husband had seen for his knee and highly recommended. 

I LOVED him! I think he is going to be a godsend in terms of my recovery. He was extremely thorough and knowledgeable, and spent the entire appointment with me. No aides, no assistants, unlike the last time I did hip PT and spent most of my time with girls straight out of college who know a lot less about physiology than I do. (Though, to be fair, the PT in that case was so mediocre that I actually enjoyed the aides and assistants more than him.) Anyway, I feel confident that Jerry will be able to make up for whatever shortcomings Dr. Terminator may have, and help me get through this rehab. I really, really, really needed this boost right now, and cannot tell you how happy I feel after this appointment. When I finally got a date for my surgeries, I wrote this post, about how I was revved up to kick some ass. I feel so disappointed in myself that I've been sooooo... blaaaaah... during this recovery, and that I've squandered two months of my life doing pretty much nothing. But that's water under the bridge, and it's better late than never, I guess. I really am revved up to kick some ass now. 

I told Jerry my #1 priority right now is walking. I'm so embarrassed that I cannot walk at all without at least one crutch, not even a few steps. I told him I'm not sure if it's that I CAN'T or that I'm too afraid to. My hip feels like this weird body part that isn't mine, that I don't trust. It's totally weird. It's not that it hurts, it's just weird. I was prepared for pain, but not the weirdness. Fortunately, Jerry completely understood what I was talking about and said that walking is a very complex movement involving hundreds of muscles. That's why it takes babies so long to figure it out. Because of the amount of changes that took place during the surgery, I will essentially have to learn how to walk again. And that's no simple task. It is not just a question of regaining strength in my muscles and getting them all to fire at the appropriate time, it's also that the trauma of the surgery has changed the connections between my brain and my muscles, so my proprioception is off, and my brain needs to be retrained. The fact that I don't feel like I can take even one step without crutches could be as much about lack of balance as lack of strength. Of course, I do have significant weakness as well. Jerry told me that it takes twice as long to regain muscle mass as it does to lose it. Also, because even before surgery, I wasn't walking normally, it's even harder. It's not just like getting back up on a bike and riding again; it's like learning to ride a bike and then a unicycle. That made me feel better.

I did a little bit of walking for him, with crutches, and told him that I think my surgeon has a philosophy of two crutches or no crutches; he doesn't like the one crutch thing. (He's never actually told me this, but someone else from my PAO Facebook group informed me of this.) Jerry said he could understand this, as walking with one crutch usually makes you lean toward the crutch side, and can lead to bad habits. However, realistically, there are times when it's just more practical to use one crutch so you can carry things around. I told him my concern was that with two crutches, I was putting less weight on my right side than I actually COULD (enter the literal and metaphorical crutch). He showed me a different way to walk with crutches, where you don't bring both crutches forward at once, but alternate one crutch at a time - so when your right leg goes forward, only the left crutch goes with it, and when your left leg goes forward, only the right crutch goes with it. This helps balance your gait and allows you to put a little more pressure on your weak side without the potential complications of using a single crutch too much. He emphasized that I didn't have to use one technique all the time; I should use a combination of all of them as needed. 

Other highlights, in no particular order:

• He asked what type of exercises, if any, I was doing at home. I told him I hadn't been able to do much because of my restrictions, but that I had started to ride the stationary bike about a week ago, and that I was constantly wiggling my feet around and flexing my leg muscles because I'm naturally fidgety and I can't help it. Even Dr. Terminator and Christian made a note of this when I was still in the hospital, saying it was a good thing. Jerry encouraged me to continue riding the bike with little to no resistance for 20-30 minutes a day, and suggested that I try riding backwards as well, just to use slightly different muscles. He also gave me more specific exercises involving isometric contractions of not just my leg muscles, but also my glutes and my abdominal muscles, to strengthen my core.
• He asked about my pain levels, and I told him that I was happy with them; I'm not in a lot of pain. I do have some pain, but it feels like it is from the incisions and muscles and not from the joint itself. (On a side note, this seemed like Dr. Terminator's top priority - that regardless of all else, the pain from within my joint should be gone, which it is. Which is amazing.) However, I also mentioned that I think I have a fairly high pain tolerance, which has led me to have problems in the past. I told him I've made a conscious effort to exaggerate my pain levels when asked to rate my pain on a pain scale, but sometimes I'm not really sure about my own perceptions. He said he would definitely make a note about that, but that this clinic was definitely NOT a 'no pain, no gain,' clinic; that pain is a message that should be taken very seriously. He said that in the past, pain was viewed only as a sign of damage, but research now shows that there can be pain with no damage, or damage with no pain. The current view of pain is that it can not only be a sign of damage, but also the body's warning signal of impending danger. Either way, he said it was a good thing I have little pain, because many of the people he works with are limited by pain, and that won't be a major issue with me. At the same time, we need to be wary of my higher pain tolerance.
• I told him that one of my biggest sources of pain is on the lateral side of my thigh, where my nerve got messed up. As the feeling comes back, I get weird pains. Christian told me that this was normal, and would likely last for a while, because nerves regenerate at a rate of 1 mm per day from the spinal cord. Jerry said that contrary to what might seem logical, damaged nerves are actually hypersensitive, because as they repair themselves, they are seeking input. So the more I can touch the areas that hurt from nerve pain, the better it will be in the long run in terms of helping to calm down the neurons. They just want attention. The same goes for my itchy scars. I should not hesitate to scratch them, as they are seeking input, and the more 'attention' I can give them in their healing phases, the more they will chill out later. He said it was thanks to a bunch of studies done on rats that we know this. Unfortunately, one of my scars is on my butt, so he agreed I'd have to set time aside for a private scratching session of that one, LOL. He was very excited that I teach biology and he could geek talk with me, and I was very excited that he was knowledgeable enough to geek talk with me.
• We talked about managing what pain I do have and whether or not I should be icing or heating. I never know, and as far as I can tell, there is no strong evidence one way or another. He concurred, and said I should do whatever feels the best. He said current research suggests that no matter what - ice or heat - blood flow to the area will increase after 20 minutes, so you should do what feels best. He said that our own bodies are smarter than any research that is out there. :) 
• I also let him know that my left side is also bad, and that we will need to protect it while rehabbing my right side. I said my left side was not as severe as my right side, and had been asymptomatic until PT messed it up. I told him I would be getting the left side fixed soon, and that I wanted to make it as functional and pain-free as possible. 

So, I left feeling energized. I've been riding the stationary bike as much as I can and practicing walking the different ways we talked about. I have been mostly using just one crutch because freeing up one hand to carry things is amazing. However, I have been very conscious about not leaning into the crutch and mostly just using it for balance. As much as I can, I practice walking in front of the full length mirror so I can be confident in my posture. In just the past 24 hours, I'm amazed at the progress I've been able to make, and am feeling far less anxiety about returning to work in just over a week.