Stop Sign

This is the next stage of my journey and describes the initial stages of recovery from hip fracture and pinning.

Saturday morning (29 October), the PA (physician assistant) visited me for his sign-off for my discharge from the hospital.  During this visit he made the following comment: “For injuries like yours, we often need to encourage the patient to get up out of bed.  But for you, we need to hold up a big red Stop sign to remind you not to do too much.”

I was happy to note that my discharge instructions included the indication “weight bearing as tolerated.”

I was to return in 2 weeks for follow-up x-rays to verify that the repair looked like it was supposed to.  Meanwhile I learned that I would receive home-based physical therapy twice a week for up to three weeks.  What a terrific idea!

My first home-based PT session was the following Monday: day 4 after surgery.  The physical therapist watched me walk – with the walker, of course – and corrected my gait: no limping allowed.  She looked at a number of areas in the house and made suggestions primarily related to safety.  She also recommended getting my laptop moved from a temporary setup on a card table to the desk area in the office.  She gave me a half-dozen exercises to do twice a day, sitting or lying on the couch.  Finally she took me out the front door to show me how to safely go up and down the 3 very shallow steps leading to the front walk.  To my amazement, she then pointed to the corner on either side of the house and told me that I could walk the full length of the block, all 7 houses, and back, twice a day.

This was incredibly exciting: it was heavenly to be walking outside already.  A friend happened to call the house later in the afternoon while I was doing my second walk, and was shocked when my significant other told her I’d stepped out for a walk!

Earlier that afternoon I’d moved my laptop and various papers to the office, as suggested.  I was using a day pack to hold things while I walked from one room to another with the walker.  During this process I suddenly realized that I’d walked from the other room to the office, carrying a few light items, and left the walker behind!  I was already starting to graduate.

The next day I changed the dressing on my incision and was surprised to find that I actually had 3 small incisions in a line, perhaps 1.5 inches from end to end.  I knew I’d been closed with surgical glue, so there would be no sutures to remove.  I am still amazed that the screws could be installed with such small incisions.  This surely contributed to the ease of my recovery.

By the next day, day 6, I was starting to leave the walker behind while walking around in certain rooms, such as the kitchen which has multiple countertops I could use for stability.

On day 7 I had my second PT session at home.  I got several new exercises and instructions on increasing my walking distance: add 1 house per day, which I incorporated into that day’s walks.  The following day I could go all the way around the block!  So what if it’s a small block?!

By my third PT session (day 11) I was still taking the walker with me for the walks, but for the most part I was just carrying it in front of me for looks rather than weight-bearing support.  So my physical therapist graduated me to using a cane.  I was told it was ok to increase my distance by 2 houses per day.  I was starting to identify several different short loops and out-and-back walks I could do in different directions from the house, so I wouldn’t get bored with the same itinerary.

And I started to get more grandiose in my thinking about my walking distance.  The two-house-a-day increase was in the 10-15% range, and I simply projected that percentage to see where it led.  I’d been seeing TV ads for a Thanksgiving Day 5k Turkey Trot.  According to my projection I actually would get to 5k in time – the power of compounding, for sure.

On day 14 I went in for x-rays and an appointment with my PA.  I asked what he thought about walking 5k on Thanksgiving and quickly explained how I came up with the idea.  To his credit he maintained his composure, and then replied with a reference to the big red Stop sign he’d mentioned prior to my discharge from the hospital.  The 5k would be too much too soon.  What I had not realized is that the first 6 weeks are critical for the initial stages of bone healing: so-called fixation.  So, even though I felt great and could certainly tolerate more walking, it was not the right thing to do.  I really only needed enough weight-bearing to stimulate bone growth.  In fact, he instructed me not to increase my distance any more until my next appointment 4 weeks later.  Although I was deeply disappointed, I knew I was going to do exactly what he recommended.

In response, my physical therapist suggested the next day that I divide my 2-walk distance into 3 walks: shorter, more frequent walks were better.  So I did.  I had also been carrying the cane, more or less like a fashion accessory rather than a weight-bearing assistive device.  She recommended that I make a point of using the cane to bear some weight.  This had the (probably intended) effect of slowing me down, since I was not very adept at using the cane.  After this session I was discharged from home-based PT: no more new exercises, increases in repetitions or complexity, or increased walking distance.  It had become a waiting game, and I needed to exercise my patience.

I had also gotten to see my x-rays for the first time since the surgery.  The picture in the header to these postings is copied from a Wikipedia article and is of a left hip, but otherwise looks generally similar to my x-rays.  I thought the screws were pretty impressive, as well as hard-to-miss.

It is perhaps amusing to note that, other than feeling like I was on an enforced plateau for 4 weeks, my biggest frustration was getting socks on and off.  It was simply hard to reach my toes, no matter which way I tried.  The other frustration was not being allowed to drive.  Even though I had numerous offers from friends, and my significant other was very helpful, I am used to having independence and this was a real limitation.

I was grateful every day that my recovery was progressing so well.  I am sure that things had gone so well because I was in good physical condition at the time of my injury.  On the one hand there was the irony that, barely 10 days after walking a marathon, I had my hip pinned.  On the other hand I recognized that the marathon – or, more precisely, my training for it – was a silver lining with respect to the baseline condition for my recovery.