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Post Surgical Musings, Days 4-5 (Post 3)

Day 4-5: Music Therapy
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Day 4-5: Music is Medicine

Post Surgical Musings, Days 4-5 (Post 3)

Post-Op Day 4

Today is post-operative day 4 for hip preservation (ahem: reconstruction) surgery.

If you missed my first posts, find them here:

Hip precautions and movement limitations are quite intense – so focus on other parts of the yogic biopsychosocial (BPS) model are necessary. This means focusing on everything (psychosocial, emotional, spiritual, intellectual, and energetic) but the physical due to hip precautions and post-operative protocol.

My mobility is limited, and for the first week, only passive motion in the hip is recommended. Protocol also suggests many hours on the CPM (continuous passive motion) – so much so that I am opting to sleep in it all night versus staying in it most of each day. The positive thing is – I had such severe psoas hyperactivity that the CPM is key for allowing the psoas to calm down, which will minimize reinjury and improve post-operative healing (since the psoas lies directly above an anterior labral repair).

Several hours of prone lying are also a part of protocol, but realistically, rolling over is difficult and requires significant assistance, so I have set up my massage table on the same floor as my bedroom. I need assistance to lay prone (face down) on the table, but from there, I read or practice deep breathing and yogic pranayama (breathing) for 30-45 minutes at a time. It’s fantastic and does wonders for pain management and stress regulation.

Back to the yogic BPS model, I am focusing on self-care through meditation, yogic breathing, and music – all of which aide in pain management and neuroendocrine (hormonal and nervous system) regulation.

Today was a first – I practiced the violin, my first real activity outside of reading and doing the necessary assisted stair climbing I must do to get to the kitchen. I also listen to music, mostly instrumental and classical, which is the incredible spiritual and energetic medicine for me. The support of my in-laws and husband are giving me the psycho-social-emotional boosts I need to remain positive amidst lots of acute pain and impairment.

Post-Op Day 5

A bit of a delicate discussion, at the top of my list is getting off pain meds. I have a laundry list of prophylactic meds for GI protection, prevention of post-operative bony proliferation, and blood clot prevention, and those are non-negotiable. However, there is a two-fold reason to get off of pain meds. First, the GI motility slow down that happens post-surgically is terrific. I have heard this from countless patients and from family, friends, and colleagues who have had major surgery. However, in my previous experience I had always mostly flown through this phase of post-op recovery relatively unphased.

Not this time.

Constipation combined with what feels like a deep bone pain is terrifically uncomfortable. Coupled with remarkably stubborn edema, which shows no signs of relenting, I am in a sad state of discomfort. I am certain that the required lack of mobility that comes with this surgery is as responsible for my systemic woes as much as the polypharmacy and surgical anesthesia.

Armed with knowledge of happy GI function though, I send the troops out to fetch some fresh probiotics, psyllium, and magnesium. In addition, I have determined that pain meds and muscle relaxers (which have been essential for the involuntary psoas spasms that have caused more pain than the surgery itself), do no more than make me groggy and borderline unconscious, not to mention amazingly dizzy. As a result – I am happy to announce that my new goal for day 5 forward is to stop those soon, perhaps even today.

Sitting is also unbearably uncomfortable, of which I am supposed to spend no more than 30’ daily doing. Reclining is the only option, and I realized that the only place to do that, in the entire house, is in bed. I have to remedy that by buying a new chair. The “cushy” sofa allows more than 90 degrees of flexion, and the seat pain is too deep to properly prop myself up and manage post-operative edema.

IMG_1055
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Game Ready was a great manager of edema for the first month

Also, stair climbing is incredibly difficult, and I live in a 3-story house. Essentially, traveling anywhere means ascending or descending stairs multiple times a day. Doing that is causing edema to be remarkable, which means I must spend more time in isolation from my family. Fortunately, I did invest in renting a Game Ready ice machine – and that has been invaluable for managing edema on those days when climbing multiple flights of stairs is unavoidable.

Complete Rehab

However, staying true to the yogic model I preach, I am attending to all aspects of care – physical, psychoemotional, intellectual, energetic, and spiritual.

ProYogaTherapy Model of Assessment
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This is the Yogic Biopsychosocial Model I use to assess and treat all patients who work with me. And of course, I will use it to direct my own integrated physical therapy recovery.

In each limb of the BPS model:

Physical – I am spending an extensive amount of time attending to my early rehab, starting PT as soon as I can postsurgically. Right now, rehab includes passive range of motion in and outside of the CPM, prone-lying, and working basic muscle groups in isolation through isometric contractions. Nutritionally, I am sticking to my usual anti-inflammatory diet to help with post-surgical recovery, management of systemic inflammation, and maintenance of a good gut microbiome.

Psychoemotional – I love supporting women and their work, so I am doing something I never would have time to do normally. I read a book just for fun! Call the Midwife, by Jennifer Worth is a poignant and timely memoir, which more than 5 decades later, can still teach us so much about compassionate, modern, mother-centered prenatal and postpartum care. I followed it up with watching the BBC series, and I have to say, it did my soul good.

Intellectual – I am still pursuing my doctorate, even at 4 days post-op. I am enrolled in 2 classes this semester, and in hindsight, I realize I should have fully taken the semester off. However, it did do me good to keep my brain active, because my part of the semester’s work was researching hip labral special testing!

Energetic – Breath, nutrition, pain management, neuroendocrine function, and joint nourishment are so inter-connected. I use breath to facilitate sleep and to ease pain, primarily, and in doing so, I am arriving at a better place energetically. Systemically, I know my mind and body are thanking me.

Spiritual – Prayers, meditation, and time spent in gratitude are perhaps most important. I am thankful for being able to choose the timing of my surgery, for the skill of the surgical team, for my amazing and supportive husband and in-laws for their consistent presence and round-the-clock support. I could not manage a household, our three children (all under age 8), my job, school, and my own physical condition without their support. Also, I have received a literal flood of support – cards and well wishes – from friends and church family. Dozens of cards have arrived already, and I am savoring each one.

CLINICAL PEARL REVIEW

Sketch up a presurgical plan of what your biopsychosocial support system and self-care would look like. How will you address physical, psychoemotional and social, energetic, intellectual, and spiritual needs?

Here are a few ideas to get started:

  • Physical – Find a PT that specializes in hip preservation rehab. This is very important. A general PT won’t cut the proverbial mustard. Schedule your first post-operative PT appointment as soon as you get your surgical date. PT should begin within days of surgery for optimum recovery. Total rehab time usually takes 4-6 months of formal PT, and another 6 months of follow up and home based PT. Read up on your post-operative protocol, including pharmaceuticals. Anti-clotting meds, such as aspirin, anti-spasm meds, such as muscle relaxers, and anti-inflammatories (for reducing the chance of bony proliferation post-surgically), are not always prescribed. DO discuss with your surgeon whether or not these medications may be necessary for your recovery. Additionally, read up about anti-inflammatory eating, because what you eat DOES matter in orthopaedic recovery. Also, what you eat and how you move, including medications, can impact digestion, and digestion predicts overall health.
    If possible, plan for family members and friends to start a meal train at this website: Meal Train You can also plan ahead by freezing meals prior to surgery. However, nutrition is so vital to recovery, I would suggest cooking fresh daily by having meals delivered, if possible.
  • Energetic – Your breath also predicts your health. Start here to learn how to breathe properly and efficiently.
  • Psychoemotional and Social – I would highly recommend making a plan to have at least 3 weeks (preferably 4 if possible) of outside support if you are considering hip labral surgery and have heavy family or work obligations.
  • Intellectual – Read everything you can about your condition, including surgical protocol, and reliable information online. My hip blog, The Informed Patient, is a great place to start, as well as my closed FB page for hip labral injury.
  • Spiritual – Meditation, prayer, devotion, solitude for introspection – are important ways to nurture your spirit, mind, and body. If you do not have a spiritual belief system or faith, yoga offers a wonderful non-religious way to practice meditation. If you do have a spiritual belief system – consider combining that faith practice with yoga. Yoga enriches your belief system and intensifies your faith. Read my post here to learn how yoga is for every body and every faith.

Resources

Need help finding a good hip PT?

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