Diary of a Tennis Hippie

                               by Percy

                     (email: percy@evcforum.net)


For those new to the hippie culture, hippie is slang for a person
who's had a Total Hip Replacement (THR).

I'm 51 years old and have been playing tennis since I was a teenager.

Entries are in chronological order (here's a link to the reverse
chronological version).

April, 2000

    On Barry's Java Jive Team Tennis team at Woburn Tennis Club, help
    win the spring version of the "A" league.

May, 2000

    Win 5.0 tournament at Nashua Swim and Tennis, though only average
    4.5 players like myself were entered.

June, 2000

    Notice pain at top of right leg during stretching when I lie on my
    back and try to bring the right knee up to my chest.  I've never
    been flexible, so I can't bring either knee all the way up to my
    chest, but now my right leg hurts a little at the hip when I try
    to do this.  Extra stretching does not reduce the pain.

    I start taking anti-inflammatories before I play (660 mg Aleve
    works best for me), but the hip problem begins to affect my
    tennis.  I occasionally "tweak" the hip.  This is a sudden pain in
    the hip joint that feels like a small jolt as if the joint
    temporarily dislocated.  For about 5 minutes immediately
    afterwards there is pain around the hip joint and I have to move
    gingerly.

September, 2000

    Thursday night doubles with Tommy's group resumes.  This is a
    strong group for me, but I'm still sort of holding my own.

    Also resume playing on Barry's Java Jive Team Tennis team down at
    Woburn.  We're not as strong this year because we lost a couple
    people, but we're probably still the 2nd or 3rd best team.

November, 2000

    I see Dr. Bill Mitchell at Longwood SportsMedicine about the hip.
    He takes X-Rays, says there's still sufficient cartilage, suggests
    swimming or riding a bike to reduce the problem.  I begin riding a
    stationary bike for 10 minutes before Thursday night doubles at
    Nashua Swim and Tennis.  I buy a stationary bike thing for home
    and ride that in the family room at night.  This has no noticeable
    effect, and by spring I'm no longer riding a stationary bike.  I
    still occasionally tweak the hip, it still hurts during
    stretching, and it seems to be getting worse.

Winter, 2000-2001
    
    I sit out maybe three weeks total on the Thursday night doubles
    hoping the hip will improve.  By Christmas I've stopped working
    with Rocky, the pro I take lessons from, 'till the hip is better.
    I do not resume playing on Barry's team for the spring.

Summer, 2001

    I've stopped playing tennis except on Saturday mornings with Jim.
    I'm taking it real easy, hitting without pace, Jim is keeping the
    ball down the middle for me.  If I move too aggressively I tweak
    the hip.

Winter, 2001-2002

    I don't join the Thursday night doubles, but continue to play with
    Jim on Saturday mornings.  I find I'm gradually able to pick up
    the pace.

    I start hitting pretty solid.  I've smoothed out my strokes,
    including my serve (where I used to land hard on my right leg,
    probably contributing over time to my hip problem).  This has
    involved changes to the basic mechanics, and my strokes are now
    more sound.

    I start feeling pretty good.  I rarely tweak the hip.  I'm hitting
    very solid.  In December I call Rocky and we hit for an hour.  I
    hit real well.  I decide I'm going to pick up the pace and begin
    playing more than once a week.  I call George and a couple other
    people and begin playing a few times a week.

    The increased activity lasts just a very short while because pain
    in the right hip increases.  It has long ago reached the point
    where it can hurt the next day, and if I play too much tennis it
    can hurt for a couple days.  Getting out of the car is becoming a
    little painful.  I'm having trouble putting on my shoes and socks,
    and especially tying my shoelaces.  I realize that while I've
    accommodated my tennis somewhat to the hip problem, the problem
    itself has gotten worse.  I return to hitting once a week with
    Jim.

    I begin thinking of finding another orthopaedist closer to home.
    Bob mentions a couple names, but I have trouble tracking them down
    (the names turn out to be close but wrong), and time goes by.

    I find out about Dr. Eric Benson from Regis, who has just had a
    hip replacement.  I schedule an appointment.

March, 2002

    First appointment with Dr. Eric Benson.  He looks at the X-Rays
    from Longwood SportsMedicine.  He knows Dr. Bill Mitchell.  He
    knows all the people down in Boston.  He studied under the team
    that conducted one of the evaluation studies for the FDA of the
    ceramic hip replacements from Europe, the same team that did Jack
    Nichlaus, and now he's the "major joint" guy at NH Orthopaedic
    Surgery in Manchester, NH.  He's young and energetic and appears
    to know what he's talking about.

    I tell him about my activity level.  He tells me tennis is very
    hard on artificial hip joints, but he doesn't discourage me.  He'd
    like to get some new X-Rays, but we can't do it today, I have
    afternoon meetings, so we schedule an appointment for the
    following month.

April, 2002

    Second appointment with Dr. Benson.  We get fresh X-Rays.  He
    confirms the problem, which he says is loss of cartilage (but
    thinks there's still sufficient cartilage left) and the presence
    of bone spurs.  I later figure out that the build-up of the bone
    spurs was what caused the restricted motion.  In fact, I later
    decide the bone spurs not only caused the restricted motion, but
    also the "tweaking" of the hip.  I figure that when bone spurs
    around the cup and bone spurs around the ball line up just right
    and attempt to slide past each other that that must be causing the
    jarring "tweak" that I occasionally feel during activity.  Later
    on, when the tweaking stops happening, I figure out that the bone
    spurs caused this, too, because they've grown too large to allow
    sufficient motion for them to collide anymore.  In other words,
    particular chance alignments of bone spurs were causing the
    "tweak", but as the bone spurs became larger and more numerous
    causing motion to become more restricted, these chance alignments
    simply could no longer happen.

    Dr. Benson strongly recommends against hip replacement.  If I
    weren't active in tennis (before the hip pain began, it was maybe
    5-7 times a week, about an hour to an hour-and-a-half each time,
    maybe 8 tournaments a year, one winter league and a weekly
    high-level doubles game in the winter) it would be okay, but he
    believes the current prostheses might not stand up to it over the
    long term, and that I'd likely eventually be unsatisfied with the
    result.  He gives me a little hope by saying that the FDA plans to
    approve ceramic hip replacements in April, 2003, and that he might
    feel more optimistic about a positive long-term outcome with them.
    He says he'd like to see me again in a year.

Summer, 2002

    I continue to play with Jim once a week on Saturday.  My
    conditioning, never very good (just bad genes, I guess - I stand
    up to cold weather better than anyone I play with, but hot weather
    wears me down fast), is getting worse, perhaps because I'm playing
    so infrequently, but I wonder if the hip problem affects
    conditioning, perhaps makes me work harder.  The left hip begins
    to bother me.

Winter, 2002-2003

    I continue to play with Jim once a week on Saturday.  Conditioning
    continues to worsen.  Right hip bothers me much of the time.
    Occasionally keeps me up at night.  Sometimes people ask me if I'm
    limping.  I grunt in pain at certain motions, like putting on
    shoes and socks, tying shoelaces, and getting in and out of the
    car, which is sometimes a struggle.  I can no longer just insert
    my right leg in to the car and climb into the seat.  I instead
    have to sit on the seat with my legs outside the car, then swing
    both legs together into the car because I no longer have enough
    flexibility to spread the legs more than a couple feet apart.

    Interestingly, tennis once a week (sometime more if I play with my
    son Jeff, but he doesn't pressure me at all) seems to keep me
    loose.  If I skip a week the hip joint appears to get stiffer and
    more painful.  I conclude that my hip is actually in worse
    condition than the amount of pain and external appearances would
    make it seem, but that keeping a moderate activity level is
    minimizing these effects.  I think about whether it's really
    appropriate to consider hip replacement as a solution, since I
    hear many stories of people who seem to endure years of
    debilitating pain and reduction of activity before finally seeking
    a hip replacement.  Am I some kind a pathetic wimp who at age 50
    already can't endure a much smaller amount of pain than a 70
    year-old feels?  Am I just being stubborn about accepting the
    aches and pains of growing older?  On the other hand, I know the
    hip cannot possibly get any better, that it will only get worse,
    so why not replace the hip while I'm young and still robust enough
    to enjoy it?

March 18, 2003

    A year has gone by, and I'm at my third appointment with
    Dr. Benson.  We get new X-Rays of the right hip.  I request of the
    X-Ray technician that she include the left hip (increasingly
    bothering me now, but still much less than the right hip), but she
    can't without a Doctor's order, and getting one would delay
    things, so we just do the right hip.

    Dr. Benson looks at the X-Ray, announces that the FDA has approved
    ceramic hip replacements as of April, 2003, says we could go ahead
    and do it, what do I want to do?

    I say that I can easily accept the pain and inconvenience, but
    that it's a quality of life issue.  Would it make any sense to put
    off getting glasses until you were legally blind?  I don't think
    this analogy with glasses is a very good one, but it does make the
    right point.  Modern medicine can fix this - why should I put it
    off?

    Turns out there are some reasons why I might not want to do it.
    There is the possibility of death, approximately .005% if I
    remember correctly.  I pay little attention to this possibility -
    compared to many hip replacement patients I'm young and healthy,
    and I'm pretty good at understanding and following instructions
    (not as good as I thought, as it later turned out).

    THR can also affect strength and leg length.  There's no guarantee
    I'll be able to play tennis as well after surgery.

    We decide to go ahead, the surgery is scheduled for Monday, April
    28th.  Oh, boy, I think, do I know what I'm doing?

    I tell my wife, Lois, by cell phone on the way back.  I don't
    recall the conversation, but she's supportive.

March 19, 2003

    I inform my boss of my decision to have the surgery, and that I'll
    be out one to two weeks (this turns out to be wrong, and I should
    have known that).  He says I should do what I think I have to do.
    I'm not sure if that contains any hidden message, but that's all
    the go ahead I need.  Over the next month or so I prepare by
    signing up for short-term disability and squaring away things at
    work.

    Somewhere along the line I realize I'll be out 2-3 weeks and let
    my boss know.  In my mind I'm thinking 2 weeks, with the 3rd week
    working from home.  Later this doesn't seem like such a good idea,
    it feels like rushing back prematurely.

April 14, 2003

    Pre-surgery checkup with my family doctor, Dr. Marshall.  Since I
    haven't had a physical in a couple years he does a full physical.
    Everything checks out okay.  He doesn't normally check hip joint
    flexibility, but checks it since I'm going in for hip surgery, and
    says the restricted motion is the worst he's seen in a patient my
    age.  Naturally he doesn't often check hip range of motion
    (henceforth ROM) in his patients, but this is still reassuring
    information that I'm not making a mistake.

April 15, 2003

    Pre-op appointment at Elliot Hospital in Manchester.  I'm
    introduced to people from all the groups that will be working with
    me during my stay in the hospital, which should be four days:
    admission and surgery on Monday and release four days later on
    Thursday.

Sunday, April 27, 2003

    The day before surgery.  Nothing to eat after midnight.  In the
    morning I can only have clear liquids.  I'm nervous.  I sleep, but
    not too well.

Monday, April 28, 2003

    I pack.  I've got three books and four books-on-tape, all of which
    I barely touch in the hospital.  I wear sweat pants and a tennis
    shirt.  Elliot Hospital calls.  Dr. Benson is ahead of schedule,
    can we come early?  We leave five minutes later.

    We find easy parking, register at admissions and are walked up to
    the surgical floor.  Lois and I are admitted to a screened off
    section of a larger room.  A nurse comes and tells me to change
    into a johnny, and she shows Lois out while I change and while
    they prep me.  I'm not following directions well and forget to
    take off my underwear and socks.  They install an IV.  They ask me
    if I've had anything to eat in the last 4 hours, I say only a half
    cup of tea.  Mistake, they say, but probably okay.  I must have
    misread the instructions.

    Dr. Benson comes by, marks my right leg with his initials.  He
    says they're ahead of schedule because the first surgery was a
    revision that was very simple, just an adjustment of parts, no
    wholesale replacement.

    They put TED socks on me (for circulation).  My belongings go into
    a plastic bag.  I give Lois my watch and glasses when she returns.
    We say goodbye, I think, and I'm wheeled through some doors.

    The anesthesiologist, a large nurse-looking person but obviously a
    doctor, asks me a few questions.  Other things happen, nothing
    significant, but I no longer remember them.  At some point I fall
    asleep.  No one asked me to count backwards from 10.

Later Monday, April 28, 2003

    I wake up.  I forget the first few words of conversation, but I
    start talking a blue streak.  "Is it done?  It went okay?  I'm
    awake!  This is good - I'm not groggy.  I didn't want to be
    groggy.  Yes, I feel a lot of pain.  On a scale of 1 to 10?  I
    guess 9.  But this is good.  This is great.  It's over.  It went
    well?  It went okay?  Yes, still pain around 9?  What's that?  I
    woke up saying, 'Pain, pain, pain?'  Oh, that sounds like me.  I
    did that last time I had surgery, only it was just moaning."  And
    so forth.

    As soon as the pain is reduced my entire bed is wheeled out of
    recovery, into an elevator, out of the elevator, down the hall and
    into a room.  I'm the only occupant for now, but it's a double.

    Nurses come by to introduce themselves.  I've forgotten everyone's
    name that helped me during my stay.

    I believe Dr. Benson comes by and tells me it went fine.

5 PM, Monday, April 28, 2003

    Lois stops by with Jeff.  They say I look good.  I feel good.
    Sure, there's pain, and I'm generally uncomfortable, but the worst
    is over, or so I think.  The only position I'm allowed is on my
    back with this pillow strapped between my legs to keep them at the
    proper angle to each other.  My feet have booties on that are
    connected to a machine that alternately squeezes each foot.  This
    is supposed to help maintain circulation to prevent blood clots.

    Lois and Jeff don't stay long.  I think a nurse may have asked me
    to try to slide my right knee up.  I can barely slide it up an
    inch.  I have no trouble moving feet and toes.

Tuesday, April 29, 2003

    I can slide my right knee up a little higher today.  I'm told to
    do the slide exercise several times a day.  Thank God they don't
    strap that stupid pillow back on my legs.  They leave that pillow
    sitting in a chair and just put a regular pillow between my legs.

    During the day I am gotten out of bed twice.  The first time I
    take the walker to the bathroom door and back.  The second time I
    take the walker to the hall and back, maybe 30 feet total.  No
    problem.

    Lois, Jeff and Kathy visit in early evening.  I'm not doing very
    well.  The medication has made me nauseous which has made me very
    weak, though I'm actually doing fine.  Family gives no outward
    sign, but they're concerned.  Nausea turns out to be a recurring
    problem.  Two of my days in the hospital are spent nauseous and
    mostly out of it.

Wednesday, April 30, 2003

    I can slide my knee up pretty high today.  I do this exercise, 10
    reps, a few times during the day.

    Physical therapy person asks if I'll be using a walker or
    crutches.  I say I'll follow their recommendation.  She suggests
    crutches.  She gets a pair, we adjust them and give them a try.
    It takes a few minutes to keep me from leaning my arm pits into
    the tops of the crutches, but after that we do fine.  First we
    make a circuit of the floor with two crutches, then a second
    circuit with one crutch.  One crutch is much easier.  We do a few
    stairs, too.  None of this is difficult.

    When Dr. Benson stops by I ask him a couple questions about how it
    went.  He said there was less cartilage than the X-Rays had made
    it appear - it was mostly gone.  The bone spurs were so bad that
    he had difficultly dislocating the hip.  The bone spurs on the cup
    had grown partially around the ball, and he had to spend 20
    minutes grinding some of them down before he could complete the
    dislocation.

Thursday, May 1, 2003

    Dr. Benson stops by, as he has every morning.  He says they'll be
    releasing me today.

    I make a circuit with a PT person with the crutch.  Seem to do
    okay.  I do it again later by myself, decide to adjust the crutch
    some more to be taller.  This works well.  The leg is supposedly
    full weight-bearing, but I can't put much weight on it without
    feeling too much pain to bear, so it can't really support me.  The
    quadricep is stiff everywhere, and there's one place on the side
    of the quadricep about four inches below the hip joint which feels
    incredibly bruised like it's been jabbed real hard by the end of a
    broomstick.  This is where I get a sharp pain if I try to stand on
    the leg.  Did they have to cut the muscle there?

    Around 1:30 Lois arrives.  I'm dressed and mostly packed.  We
    finish up and prepare to go home.  A nurse goes through some
    paperwork with us, mostly releases and instructions, and gives us
    prescriptions from Dr. Benson.  I'm wheelchaired down to the front
    door, Lois drives the van over (the nurses thought I'd have an
    easier time getting in and out of the van, but as we later
    discovered, and as I suspected anyway, the seats in the BMW go
    much further back, and the BMW was much easier to get in and out
    of), I'm loaded in and off we go.  We're going home.

    I spend the evening in front of the TV.  Leg between knee and hip
    seemed to swell up more around bedtime.  Later figured out that it
    was the coumadin (blood thinner, reduces possibility of blood
    clots) that I was to take every night, 10 mg one night, 7.5 mg the
    next.

Friday, May 2, 2003

    Weighed myself.  Gained 8 pounds?  How could that be?  Later
    figure out that the weight is the swelling of the leg.

    Darren, a physical therapy specialist from TLC, stops by around 10
    AM.  I'm feeling pretty good.  He takes a couple hours, copies
    down lots of information, checks out the house to see where
    difficulties might lie, goes through some exercises with me that
    I'm to do three times a day.  I walk to the end of the driveway
    and back.

Saturday, May 3, 2003

    Leg is still swelled up pretty good, though this doesn't represent
    a problem.  Had a medication problem, probably the hydrocodone
    Dr. Benson prescribed for pain.  I'm nauseous all day.  At the end
    of the day Lois calls and gets a prescription for anti-nausea
    medicine.  It works after an hour, but I've wasted the whole day
    immobile on the couch.

Sunday, May 4, 2003

    I feel great, but weight is up another half pound.  Leg still
    swollen.  I do all my exercises.  Lois and I walk out to the
    street, then a couple hundred feet in each direction, then back to
    the house.  Feel fine.  I'm using one crutch, of course.

Monday, May 5, 2003

    1-week anniversary of surgery.

    I get up early and clean up.  Darren comes by at 8 AM, we do the
    exercises, I'm doing fine.

    Rosalie comes later in the day to take a blood sample to measure
    the coumadin level.

    Mom arrives.  We try to walk around the block, but halfway around
    my right knee is starting to ache, probably from the swelling.
    The right leg down to the knee has been very swollen since
    returning home.  We luck out, Lois appears in the van on her way
    home, so we ride back home.

Tuesday, May 6, 2003

    Dr. Benson's office calls asking if I know where the blood sample
    went.  I'm having more nausea problems, I ask for an alternative
    pain reliever.  I tell her where to find the blood sample, she
    says she'll get back to me about the pain reliever.  When she
    calls back she says to take no more coumadin until the next blood
    test, which should be Thursday.  Turns out my coumadin level is
    way up, my blood is way too thin, and I shouldn't shave.  This
    probably explains why the swelling in the leg won't go down.  Sure
    enough, as soon as I stop taking coumadin the swelling goes down
    dramatically over the course of a couple days.  She also provides
    a prescription for darvoset, which works much better for me.  Not
    quite as strong as hydrocodone, but no stomach upset now.

    I walk around the block twice, probably too much, as I do no
    walking the next day.

Wednesday, May 7, 2003

    Darren comes by at 8 AM, we do the exercises.  I seem to be doing
    well, he gives me a couple new exercises to do.  I can walk
    without the crutch, but after a very short while it feels like I'm
    tearing myself down instead of building myself up.  I continue
    using the crutch.

    Didn't walk at all, though yesterday's over-walking contributed,
    but did the exercises a couple times.  Jeff had an away tennis
    match at Oyster River where the team bus was to leave
    Hollis/Brookline High School at 1:45 PM, so Mom and I had to pick
    him up at Brentwood at 1:00 PM.  Turns out he left his tennis bag
    in the school bus that morning and a madcap circus of running
    around ensues.  He hadn't told the bus driver he didn't need a
    ride today, which means the bus driver was on his way to pick Jeff
    up at the same time that we're already driving him back to the
    high school.  We tried to reach the bus company and the bus
    driver, but no luck.  We called back to Brentwood in case he was
    there, which he was (great luck!), but then my cell phone battery
    ran out.  I give Jeff my tennis equipment, he borrows a shirt from
    another boy, and off they go.

    Who needs caffeine when you have adrenaline?

Thursday, May 8, 2003

    I forget this day.  I don't think I did too much.  This may be the
    day where I ate enough candy to upset my stomach, didn't do as
    much as I should have.  Swelling in leg continues to go down.

Friday, May 9, 2003

    Had wonderful breakfast with Lois and Mom at Timeless Diner in the
    morning, then Mom returned to Vermont.  Shortly after arriving
    home became incredibly lethargic, no energy at all.  Couldn't even
    read email.  Did very little all day.
    
    Called Dr. Benson's office to tell them that we hadn't been
    contacted about a blood test for coumadin level.  They sent us to
    St. Joe's emergency room in Milford for the blood test.  Results
    were phoned to Dr. Benson's office, a little after 5 PM a phone
    call informs me that I should take 1 mg coumadin per day.  Just 1
    mg?  No wonder the level was elevated.

Saturday, May 10, 2003

    Did exercises, walked around block in morning.  Tired afterward.

    Can easily walk without crutch, but there's pain and it begins to
    wear after a short while so I'm sticking with the crutch for now.

    Instructions from NH Ortho say not to use reclining chair, but
    that's all I use.  They're easy, plus the leg is raised for
    improved circulation.  Don't see the problem.

    The rule against bending the leg more than the 90 degrees at the
    hip seems a little too strong.  Probably should be 75 degrees.
    Dr. Benson says the danger in doing this, and in bending leg
    inward or crossing right leg over left leg, is dislocation.
    There's so much discomfort involved in even getting close to doing
    these things that there's no danger of them happening.  I wonder
    if it's that if you keep doing it it takes the joint capsule
    longer to firm up, or if it never gets as firm, increasing the
    risk of a repeated dislocation problem down the road.  I'm mostly
    successfully avoiding doing these things.

    I think I'm way ahead of your average 70 year old, which is where
    the pamphlets I have seem targeted.  Probably average for a
    50-year old, but the difference from a 70 year-old is dramatic.  I
    should be able to discard the crutch shortly, and I won't be using
    a cane.  Though I'm not recovered yet, I feel like I have a good
    sense for how good I'm going to feel when I *do* recover.  When
    can I start tennis?  How long will my left hip joint last before
    it needs surgery, too?

    In the hospital Dr. Benson mentioned that some patients tell him
    the hip joint feels like it has a mind of its own or feels very
    strange sometimes.  After my walk I think I understand what he's
    talking about, but I don't think it has anything to do with the
    joint itself.  It has to do with the muscles during recovery.
    Some of the muscles in the right leg were unaffected during the
    surgery, some were affected a little, some a lot.  The relative
    strengths are much different than normal right now, and after my
    walk when the muscles were tired I had the sensation of the leg
    tugging itself off slightly in random directions under it's own
    volition.  I think once the muscles recover that this sensation
    will completely disappear.  This could be even more the case for
    people whose motion had been more restricted than mine.  But we'll
    see.
    
    Walked around the block again in the afternoon.

Sunday, May 11, 2003

    Can't remember clearly now a few days later.  I don't think I did
    my exercises or took walks, but I'm not sure.  However, it was
    Mother's Day, and me and the kids went to Wal-Mart and bought a
    couple presents.  We had pizza for dinner, I think.

    I'm walking around the house without the crutch, but anything
    further I use the crutch.

Monday, May 12, 2003

    2-week anniversary of surgery.

    First day back to work, but working from home.  Mainly read email,
    didn't make much progress.  Also did some bookkeeping-type
    activity, like filing my work/hour sheets.

    Darren came by at 8 AM.  Said to keep doing same exercises, but do
    them three times a day, two sets each time except only one set the
    middle time.

    Patty comes by to take what turns out to be the last blood
    sample.  She gets the vein on the first try!

    Walked around the block once, I think.

Tuesday, May 13, 2003

    Second day back at work.  Read John's randomization white paper
    and provided feedback.  Read some email, but only making slow
    progress.  Attended afternoon meeting, boring as usual, I didn't
    have much to contribute, but Josh is apparently 80% done with the
    Verilog model for the LAN card.

    Walked around the block twice, did my exercises twice.  They are
    so boring.  I'm feeling pretty good.  Lois bought me a cane, I
    used that for the second walk.

Wednesday, May 14, 2003

    Mammoth lovemaking session last night.  Whoa!  Hip held up fine,
    just have to be careful not to lie on right hand side and avoid
    the bad leg positions, which wasn't difficult.  Right side is
    getting less and less uncomfortable to lie on.

    Darren came by at 8 AM.  Gave me new more aggressive exercises.
    The one where I stand up straight and move the leg out to the side
    suddenly hurt sharply on the right side of the right buttock
    during the 2nd set and had to stop.  This is a place where it has
    felt like a deep bruise since the surgery.  What did the doctor do
    to it?  Still aches this afternoon, and I'm not walking as good as
    before, but I think this will take only a day, two at most, to get
    over.  I'll take it easy today.  I've already walked quite a bit
    since I just started driving today, and I picked Jeff up at school
    and took him to see Dr. Cohen and took him back, then went to
    library, then to D'Angelo's.  I'll let that be enough for today.

    Hampshire Hills Rehab called and left message, looks like I'll be
    going there - not sure when I start, I haven't called back yet.

    This should have been third day back at work, but I never logged
    in.  Spent most of day on couch.  No physical problem, but I
    couldn't get my mind to focus.

    Beverly called from Dr. Benson's office.  I don't have to take any
    more Coumadin.

Thursday, May 15, 2003

    Today for the first time I don't feel stronger than the day
    before.  Nothing dramatic, but I'm used to feeling stronger each
    day, so this is very noticeable.  Right buttock still aches, not
    painfully, though.  Hip joint capsule feels like an inert solid
    ball, I wonder if that's due to some returning sensation.  In
    other words, before there wasn't enough sensation to be aware of
    the joint capsule, and now there is.

    Did my morning exercises.  New exercises are tougher, but not
    dramatically so.  Took walk around block, clockwise today.  Going
    up the steep hill is tough, took 15:05, I think counter-clockwise
    only takes about 13:00.  But I also felt a little slow today
    because of the extra aches.

    I'm back to reading work email.  Boring.

    Did my evening exercises.  Took walk around block,
    counter-clockwise, took 16:30.  I'm slowing down even more.

    Major milestone: not a single darvoset today.

Friday, May 16, 2003

    Changing things up a little.  I'm going to rest today, no
    exercises or walking.  I'm talking three Aleve in the morning
    instead of one vioxxe, I'll take more in the late afternoon since
    it doesn't last as long.  And I'll ice the right rear buttock a
    few times, maybe there's some swelling.

    I'm still not walking as well as I did before Wednesday morning.
    Also did very little work today, my mind just couldn't
    concentrate.

    Bob called.  He had just found out about my RTHR.  We talked for a
    while, he told me Steve had had a rough winter healthwise, and
    that he passed out in his car earlier in the week and had a
    serious accident, ended up in the hospital.  He's home and
    recovering now.  They got Steve's tennis court (it's clay and
    takes some prep work) opened up for the season.  Bob volunteered
    to try hitting with me when I begin to try to resume playing.

    Still no darvoset today.

Saturday, May 17, 2003

    Did exercises in morning and walked around the block.  Leg felt
    much better for walking today, did it in 12:46 keeping just what
    felt a normal pace.

    Ran errands most of afternoon so skipped the evening exercises and
    walk.

    Helped Jeff restring a racket.  Had no trouble standing for the 30
    minute turn I took, but I probably spent most of the time with my
    weight on the left leg.

    Still no darvoset today.

Sunday, May 18, 2003

    Probably haven't mentioned, but I've never liked sleeping on my
    back, and so I've been sleeping on the left side for a while now,
    sometimes directly sideways, which feels a little uncomfortable to
    the new right hip until I get the leg positioned just right.
    Other times I'm almost on my stomach, but angled up a little with
    the right leg crooked out to the side a bit.  This is the most
    comfortable position.

    Starting a few days ago I began sleeping on the right hip, too.
    The incision area is too uncomfortable to sleep on directly, so I
    sleep tilted either toward my stomach or toward my back.  I think
    this causes a little swelling in the incision area, and some pain
    in the morning, but I need some variety in my sleeping position.

    Took one vioxx this morning instead of three Aleve to see if I
    can tell the difference.  Before the surgery I had tried vioxx as
    an alternative to Aleve and found it lacking, but today at least
    the vioxx seems to be doing a very good job.  Pain in the
    incision area due to a little swelling seemed to diminish markedly
    in only an hour.

    Rate of improvement has decreased.  I thought I might be walking
    without a cane by today, and I give it a try, but in the end I
    only walk about 10% of the distance around the block without the
    cane.  But while walking around in the house during the day I feel
    like I'm almost walking normally, though I have to concentrate to
    pull it off.  I'll try without the cane again for the evening
    walk.

    Felt stronger for the evening walk.  Walked maybe 15% without the
    cane.  Discovered could actually reach the shoelaces of the right
    shoe without pain, so I'm tying my own shoes now.

    No darvoset again today.  I won't mention it again unless I find I
    have to take some.  Only six tabs left.

    I started this diary with an eye looking forward to when I could
    begin playing tennis again, but I guess there's going to be at
    least three more weeks of these rehabilitative summaries before
    tennis gets into the mix.

Monday, May 19, 2003

    3-week anniversary of surgery.

    First day physically back at work.  Discovered I can tie my own
    shoelaces this morning, though I still need the device to put on
    my socks.  Didn't do exercises or walk in morning, no time, plus
    didn't want to lose too much energy.  Energy turned out to be a
    factor.  After a couple meetings I no longer had any mental
    energy.

    Fortunately had to leave early for my first out-patient PT
    appointment at Hampshire Hills.  I'm as bad with names as ever,
    I've forgotten the therapists name.  She was good.  She removed
    the incision tape, said she could tell it was no longer adhering
    to the incision and she was right.  I guess I must have sticky
    skin and the stuff just didn't want to come off.  The bottom most
    pieces of tape also covered a couple inch length of suture thread,
    the kind that eventually dissolves, emerging from the bottom of
    the incision.  She cut this to about an eighth inch length.

    She also measured my legs, says the right is an 1/8 to a 1/4 inch
    longer, which is what Dr. Benson estimated it was before surgery.
    Forgot to mention earlier that on my second or third day in the
    hospital Dr. Benson said I'd have to be fitted for a lift for the
    left foot.  We didn't discuss it beyond that, but to me this
    implied that he'd had to lengthen the leg.  Now it seems that he
    didn't.  Maybe he had me confused with another patient when he
    said that.  I don't see the need for a lift for a 1/4 inch
    difference.

    She also checked flexibility, measuring how far I could move my
    legs to the front and sides.  15 degrees to side for right leg, 25
    for left.  Right knee cannot be raised to quite reach the 90 degree
    position.  I asked what holds it back, she said muscles, but this
    doesn't sound right to me, because I sense the resistance coming
    from the hip joint.  I wonder what it is in the hip joint that is
    holding it back.

    Lack of energy extended into evening - fell asleep on the lounge
    on the back porch.  Didn't do exercises and Mental concentration
    seems poor - I can't read in bed as long as I used to.

Tuesday, May 20, 2003

    Happy birthday 51-year old!

    Second day physically back at work.  This is too much.  With the
    commute time I feel too rushed to do my exercises and take my
    walk, plus I get tired too easily.  I park at the far end of the
    building to make the walk in and out of the building as long as
    possible, but it's still only a three minute walk.  Will work from
    home rest of week.

    Leg aches a little in odd places unrelated to the surgery today.

    During lunch I watched a net video of a hip replacement surgery.
    Found the link at TotallyHip, but here it is again:

        http://www.slp3d2.com/sfi_1013/broadcast_pre.cfm

    Unbelievable to watch.  Surgeon moves so fast it's like he's
    butchering a roast.  Isn't afraid of damaging a thing, just yanks
    muscles, tissues and bones this way and that.  I think the analogy
    is with watching a cartoonist draw - they draw their lines
    incredibly rapidly and casually, but the result is very precise
    because they've done it so many times.  It must be the same way
    with the surgeon, I just can't tell a good surgery the way I can a
    good drawing.

    But it's still more violent than I imagined.  The reamer for the
    acetabular cup looks and is wielded like a drill, and the reaming
    of the femur looks especially gross.  The acetabular cup is
    pounded into place with a hammer, as is the stem for the femur.
    The ball is pounded onto a rod on the end of the stem.  They test
    for potential dislocation by picking up the leg and moving it
    around.  The surgeon is fast - the surgery part of the video is
    over in about 30 minutes, though they skipped the opening.
    Patient appeared to be at least 70 gauging by the slackness of the
    skin, though that clue might be misleading.

Wednesday, May 21, 2003

    New record for walk around the block, 11:30.  Wasn't going to
    attempt such a fast pace, but it was starting to rain so I gave it
    a shot and felt fine.  Walked maybe 40% without the cane - gait
    became slightly more natural during the walk, feel good about
    that.

    Today put right sock on without the sock-device for the first
    time, though I was definitely pushing it and probably shouldn't do
    this again for a little while.  Could feel pressure in hip joint.

    Yesterday got rid of the commode, not sure ever really needed it.
    Made getting down and up easier, but all the bathrooms have
    counters and windowsills to grab onto, and probably would have
    done fine without it.  Was told the commode was so you don't
    violate the 90 degree rule, but a lot of the flexion when sitting
    on the commode comes at the waist, not the hip, and since my hip
    joint currently doesn't yet approach 90 degrees without a lot of
    resistance (can't seem to get it past around 100 degrees) I know
    I'm not getting close to 90 degrees.

    What is an IT band?  Saw it mentioned at TotallyHip.  Geoffrey
    said that bending the leg inward would strain the IT band.  I
    haven't been following this stricture very well while sleeping -
    am I doing myself damage?

    I just got the information about my components from the doctor's
    office:

        Howmedica Osteonics Accolade size 3 press fit prosthesis with
        132 degree neck, 36 mm and 0 ceramic head.

        Howmedica Osteonics Trident acetabular component size 16 mm
        w/60x36 mm ceramic insert.

    And I found a marketing webpage that describes these components -
    pretty interesting reading no matter what components you actually
    have:

        http://www.howost.com/ceramic-hip/

    It turns out that a 36 mm head is the largest available, which is
    good since I've heard that ROM is better with larger heads.  The
    webpage says they're also better for "joint stability", though I'm
    not sure what that means.

    Also found out what "IT band" is.  IT is short for iliotibial
    band.  It connects from the side of upper hip bone down the side
    of the leg to the top of the tibia.  It is one of the abductors
    that help pull the leg out to the side.  I think they go through
    the muscle of the IT band for THR, which is why abduction (moving
    leg out to side) is so weak after surgery - at least it was for
    me.  It also explains why crossing the leg over or turning it
    inward might stress the IT band, since it's been incised or at
    least severely stretched.  I have my legs modestly crossed
    right now (legs mostly parallel, but right foot over left), which
    is just what you're not supposed to do, but it feels fine.  It
    didn't feel fine just a few days ago.

    Hmmm - trying to actually cross right leg over left knee now...can
    almost do it.  Backed off at the first hint of pressure on the
    joint.  I'm relying on feedback from my body to tell me when I'm
    doing a bad thing because my experience since surgery is that this
    has been a reliable gauge, but for the benefit of anyone who might
    read this I've been told that some people get feedback in the form
    of discomfort and/or pain and some people don't.

    Did a bunch of walking when I picked up Kathy from horseback
    riding, so I didn't do my evening walk or exercises.  I love dogs
    but had never met Laurie's dog Cam, a huge rottweiler.  When I
    approached the ring Laurie had her hand firmly on his collar and
    he still dragged her all the way out of her seat and nearly to me.
    I kept coming because I hadn't been paying close attention to the
    dog and assumed it was the Hyde's friendly Newfie.  Hate to think
    what could have happened.  Turns out he doesn't like strange men,
    made friends with him later.

    Obtained a copy of the article Tennis After Total Hip Arthroplasty
    that appeared in the American Journal of Sports Medicine in issue
    27 in 1999.  It was originally presented at the American
    Orthopaedic Association Residents Conference in Baltimore, MD, in
    March of 1996, so this is actually a pretty old paper.  It's
    encouraging in the sense that there are hippie tennis players
    playing at a high competitive level, but the sample group was
    biased in two significant ways.  First, the group was
    self-selected - the respondents decided whether they would respond
    or not.  Second, only members of the USTA were sent surveys, and
    those hippie tennis players who found they were no longer able to
    compete after THR likely let their USTA membership lapse - it's
    impossible to know how large a group this is.  The article is
    pragmatic in that it says the likelihood of revision increases
    with activity level, though this conclusion is simply logical and
    not an outcome of the survey results.

    One thing that is becoming very clear - by far the dominant
    failure mode is loosening of the prostheses where they attach to
    the bone.

Thursday, May 22, 2003

    Put sock on without the device again - I know, I said I wouldn't
    do this again so soon.  Anyway, less discomfort today.

    Did morning exercises but didn't do my walk because I ended up
    walking up and down the basement stairs a bunch of times turning
    the water to the sprinkler system on and off so the plumber could
    fix the exterior backflow valve.  Must have overdone it yesterday
    because I'm weaker today.

    DSL went out - more trips up and down the stairs checking out the
    DSL modem.

    I think I've already done too much today - leg is weak even when
    just walking.  I have PT tonight, so I'll take it easy till then.

    At PT she applied rubbed lotion into the incision for while,
    stretched the leg out to the side, gave me some other stretches to
    do, said to continue with current exercises for now.

Friday, May 23, 2003

    Been a slug all day.  No exercises, no walk, no nothing.  But I
    needed this.

Saturday, May 24, 2003

    Did my exercises once, walked around the block once in 13:35, but
    with 75% no cane.

    Iced hip down once.  Tissue beneath the incision feels lumpy.

Sunday, May 25, 2003

    Did my exercises once, walked around the block once in 11:13, new
    record, and with 100% no cane.  Yea!

Monday, May 26, 2003

    4-week anniversary of surgery.

    For the first time I can walk normally.  Suddenly my right leg has
    passed a threshold of strength, and the right side no longer dips
    down as the weight descends onto the right leg.  The relevant
    muscle seems to be in the buttock.  Leg is still very weak going
    up stairs, but descending stairs is fine.

    Be interesting to see how long the strength holds up during my
    walk.

    Still putting my socks on without the aid, and it's getting easy.
    Just tried crossing right knee over left knee and I can do this
    comfortably - yea!  Interestingly, after 4 weeks of greatly
    diminished activity I can now cross my left knee over my right,
    something I lost the ability to do about a year ago.  Inflammation
    must be at a low in the left hip.

    New record for walk: 10:15, no cane.  Right buttock pretty tired
    at end.  Not able to maintain a completely normal gait for most of
    it, but still did pretty well.

Tuesday, May 27, 2003

    Overdid it yesterday, today leg was weak and stiff.  Could only
    walk with bad limp, wished I brought the cane with me to work.

    PT person's name is Jean-Marie - not sure the spelling is right,
    I've only heard it pronounced and not seen it written.  She
    loosened up the leg quite a bit, and I walked out much more easily
    than I walked in.

    No exercises or walk today - a rest is called for.

Wednesday, May 28, 2003

    1-month anniversary of surgery.

    Leg feeling much better this morning, but still sense a little
    weakness and stiffness.  I'll do exercises and walk tonight.

    Decided leg was too weak for exercises and walk tonight.

Thursday, May 29, 2003

    Leg still very weak.  Leg was very tired after 2 or 3 minute walk
    from car to office.

    PT was fine, gave me a new squat exercise.  Decided leg still too
    weak for exercises and walk.  But it *is* feeling a little better.

    Time for a useful note about where things hurt.  I feel no pain
    when idle.  The same two places that felt like there's a severe
    deep bruise and are painful when pressure is applied while probing
    with fingers still feel roughly the same as a couple weeks ago.
    One is below and anterior to the hip joint, but not on the
    quadricep.  I originally thought it was the quadricep, and I
    called it the quadricep in earlier entries, but Jean-Marie, my PT
    person, says it's not the quadricep (later I find out it's the
    iliotibial band).  I'll try to find out what muscle it is.

    The other muscle that hurts is one of the gluteus medeus, it hurts
    six inches above the hip joint and posterior, which is high up on
    the buttock.  It must be pretty near where the glut attaches to
    the upper hip.

    The guess from the PT people is that the doctor has to detach
    these muscles and then reattach them, and they take a while to heal.

    I'll modify this entry when I get the right names for all the
    muscles.  And I'll try to get more specifics from Dr. Benson when
    I see him on June 11.

Friday, May 30, 2003

    Did exercises for first time since Monday, only one set.  Tried to
    walk around the block, but had to turn back.  Leg started feeling
    very tired.  Maybe did 20% of the whole distance.

    Leg is feeling funny.  It has little aches that weren't there
    before that have gotten worse as the week has gone by.  Wonder
    what it means.  The leg doesn't feel more swollen.  Is it maybe
    because it's less swollen?

    I can sleep on my side on the operated leg, but it isn't too
    comfortable, and it usually begins to hurt after five or ten
    minutes.

    I've been putting my pants on without supporting myself with a
    doorframe, and when all my weight is on the operated leg and I
    maneuver to get my leg into the pant hole there are tiny but sharp
    pains coming from around the joint.  Wonder what it means.

    I don't think I'm making any progress lifting my right leg
    higher.  Wonder what the resistance is from?

    Had brief post-op meeting with my regular doctor, Dr. Marshall.
    He said it should take 6-8 months to return to my original
    conditioning before surgery.  Thinking about when I might return
    to tennis, just to stand there and hit the ball - seems more than
    just a couple weeks off at this point.

Saturday, May 31, 2003

    Did exercises, walked around block in 12:24 and felt pretty good.
    We'll see how the leg feels tomorrow.

    I'm having trouble with two of the stretches Jean-Marie gave me,
    the one for the quadricep and the one for the muscle on the inside
    of the leg.  I had Kathy manually pull the leg out to the side
    while I was lying down for the inside muscle, but I'm going to
    have to figure out something for the quadricep.  I feel like I'm
    wasting my time trying to put some stretch on it this way, with
    the right knee on the floor and the left leg out front and trying
    to push forward - I just don't get any stretch.  Of course,
    there's no much flexibility in the left leg, that could be part of
    it.

Sunday, June 1, 2003

    Leg feels okay this morning.  Maybe I'm back to where I was about
    a week ago.  Even though I feel okay I decide not to overdo it and
    I do no exercises and take no walk today.

Monday, June 2, 2003

    5-week anniversary of surgery.    

    Leg feels good today.  I ask Jean-Marie at PT which muscle it is
    that hurts when I try to go upstairs, and she says it is probably
    the iliotibial band, even though it has little or no muscle.  She
    does deep massage on the leg, and afterward and I am able to go up
    and down stairs with no pain.  Amazing!

    During lunch I was catching up at the hip site, and the resident
    expert, Geoffreyf (don't deny it, Geoff, you are), who
    unbelievably happens to live in Lowell, was responding to a
    question about abductor muscles (muscles which move leg off to
    side), and he said that the iliotibial band (connects from upper
    hip bone down side of thigh to top of tibia) is the seam of the
    Fascia Latae, which is a ligament-like sub-skin surrounding the
    thigh.  It in turn connects to the Tensor Fascia Latae which is a
    muscle that maintains tension in the Fascia Latae by pulling up on
    it.  I think that explains my pain when I climb stairs.

    Also ride stationary bike for 5 minutes with no problem.
    Jean-Marie says increasing circulation aids healing.

    Jean-Marie also says I should be able to get a copy of the OR
    report that details everything they did, including which tissues
    were cut, moved, stretched, etc.

    A couple times today I found myself absentmindedly skipping
    rapidly downstairs - had to catch myself and slow down.  Didn't
    want to trip and fall.  Felt fine doing it, but I know I'm still
    pretty weak and probably not too able to recover from a stumble.

    I don't know if it was the small amount of aerobic exercise, but
    am tired and lethargic tonight, do no exercises.

    Thinking about returning to tennis, doesn't seem so far off now.
    Would be nice if I could, because maybe I could substitute tennis
    for some of the boring PT exercises that I understand are in my
    future, especially the EXCEPTIONALLY BORING STATIONARY BIKE!

Tuesday, June 3, 2003

    Leg feels good.  Did exercises but took no walk since I walked in
    and out of work and then went to the Nashua library on the way
    home, and that's a fair walk, too, from the parking lot, plus I
    must go up and down stairs between 5 and 10 times a day.  Don't
    want to overdo it again.

    I think I forgot to mention the time a few weeks ago, and it was
    the only time, that I ran errands while using my cane.  Couldn't
    believe how differently I was treated.  Everyone was holding doors
    open for me, making sure not to jostle me.

Wednesday, June 4, 2003

    Leg feels *real* good!  Walking out of work found myself walking
    fast.  Normally I'm a slow walker, and I was trying to figure out
    why I was walking fast.  I wasn't in a hurry, I didn't feel in a
    hurry, it just felt natural.  Found myself walking fast again when
    I went to the library (forgot yesterday that I had books at home
    that were due).  Did I develop into a slow, deliberate walker
    because of my hip, and now I'll be a fast walker again?  Or was
    today an exception for some unknown reason.

    Even more incredible, I stepped into the car!  Wasn't thinking
    about it, just did it, almost didn't even notice what I'd done.
    Normally I have to sit on the seat with both legs outside on the
    ground, then rotate into position.  I always used to step in, but
    had to give that up a year or two ago.

    Didn't do any exercises except for the side lifts (lie on left
    side, raise right leg into air).  The exercises just feel so
    trivial compared to going up stairs, getting in and out of car,
    etc, hard to get motivated.  Should have done the stretches,
    though - my bad!

Thursday, June 5, 2003

    Leg felt slightly weaker today.  Rode bike for 6.5 minutes at
    beginning of PT.  Skipped evening exercises.  My two setbacks were
    relatively minor, but they've made me fearful of overdoing it.

    Tennis seems at least a couple weeks off.

Friday, June 6, 2003

    Did all exercises, increased my walk distance because I'm walking
    faster and I should be walking at least 20 minutes a day.  Walked
    around the block twice in about 18 minutes.    

Saturday, June 7, 2003

    Did no exercises, no walk.  Leg felt slightly weak today, didn't
    want to push it.

Sunday, June 8, 2003

    Did exercises, walked longer route that has two tough uphills,
    took 20:22.  Really pushed it.

Monday, June 9, 2003

    6-week anniversary of surgery.  Appointment with Dr. Benson in two
    days.

    Leg is tired and weak this morning.  Pushing it yesterday was a
    mistake.

    Am concerned that strength of leg isn't returning more
    quickly.  I know I'm ahead of many people, but the strength in
    going up stairs doesn't seem that different from 3 weeks ago.

    Had Kristen at PT today (again, I'm bad with names - I'll correct
    it later if it's wrong).  She helped me with some stretches, then
    she took me on my first visit to the exercise room.  Hampshire
    Hills has revamped their exercise room.  Many, many machines.
    With TVs.  And wireless headphones.  Maybe should consider
    rejoining.  Five minutes on the bike, two reps of 10 of leg
    presses, one rep of 10 of leg curls using just right leg.
    Adductor/abductor machine was in use, but we were out of time
    anyway.

Tuesday, June 10, 2003

    Leg feels even more tired and weak.  Do no exercises, take no walk.

Wednesday, June 11, 2003

    6-week post-op appointment with Dr. Benson.  He said things look
    excellent.  Appointment was short, but he talks fast.

    We talked a little about the anterior and posterior approaches.
    He uses the anterior, and I guess to be more accurate it should be
    called the anteriolateral, meaning lateral entry to the body and
    anterior (front) entry to the joint capsule.  Posteriolateral is
    what they do at New England Baptist under Dr. Bierbaum, where
    Dr. Benson was previously.  I believe posteriolateral means
    lateral entry to the body, but posterior (rear) entry to the joint
    capsule.  Dr. Benson learned the anterior approach, which is
    apparently a little more complicated, while in Connecticut during
    his residency.  While at New England Baptist he did mostly
    posteriolateral, but said he did do a few anteriolateral with
    Dr. Bierbaum while there.  He said the dislocation rate with the
    posteriolateral was about 5%, and so after arriving at NH
    Orthopedics he decided to use the anteriolateral because
    dislocations are a burden for patients, as emergencies they're
    disruptive to schedules (especially if surgery is required), and
    there isn't a large residency staff to respond to dislocations in
    Manchester.

    He said he does around 100-120 total hips each year, around 400 so
    far at NH Ortho.

    We talked about flexibility.  He says in the years prior to
    surgery as people's range of motion (ROM) decreases that the joint
    capsule loses flexibility because it is no longer being stretched
    as much.  A tight joint capsule is actually good post-op because
    it helps prevent dislocation.  He can correct a tight joint
    capsule during the surgical procedure, but this increases the
    possibility of dislocation and so it isn't generally done.
    Stretching should gradually loosen the joint capsule over time.
    It is the tightness of the joint capsule that currently limits my
    ROM, the bone spurs no longer being an issue.

    He said that with the anteriolateral approach combined with my
    large acetabular cup and ball (60x36) that dislocation after
    surgery was very unlikely.  I'd have had to work at it.  The
    precautions aren't really that important with this approach.  He
    says he's had only one dislocation in his 4 years at NH Ortho.

    In contrast, the posteriolateral approach apparently leaves the
    patient slightly more prone to dislocation, often with no feedback
    that dislocation is about to occur.

    Just like everyone else has been telling me, he told me I really
    shouldn't expect the Gluteus Medeus or the Tensor Fascia Latae
    muscle that connects to the Illiotibial Band to have healed much
    to this point.  In fact, he says they should only be beginning to
    heal now, and should take another 4 to 6 weeks before I see
    significant strengthening.

    He agreed with PT that the leg length difference was about a 1/4
    inch.  He asked if I wanted to try a lift for the left leg and I
    said no, especially since a 1/4 inch was the difference before
    surgery, so I'm already used it.

    He said I can resume tennis, but recommended that I not play
    competitively for a couple more months.  My leg still feels so
    weak I wouldn't consider it anyway, and I told him that for now I
    just wanted to try tapping the ball against a wall and see how the
    leg and hip feel when subjected to the twisting forces.  Anyway,
    that's a big HURRAY!  Will probably try tapping against the wall
    later today if it doesn't rain.

    Leg has mostly recovered from my aggressive walk on Sunday - I
    could almost walk without a limp.  I'll do my stretches and let my
    tennis activity be my exercise.  Forecast is for rain, though, and
    it *does* look dismal out there.

Thursday, June 12, 2003

    My son Jeff, 15, started tennis lessons with Jason today.  Jason
    has to solve the puzzle of how to untangle Jeff's backhand.  A
    couple years ago Jeff insisted on switching to a one-handed
    backhand, but he's still using the two-handed contact point.  In
    trying to fix it I've only made Jeff mad and discouraged, so we'll
    give Jason a chance.

    During Jeff's lesson I hit against the wall for maybe 7 or 8
    minutes.  The leg felt great.  In fact, it felt better after than
    before.  I would have hit a few minutes longer, but I got a phone
    call which gave me a chance to figure out that maybe I shouldn't
    push it.

    Hitting ground strokes, which is all I did, is absolutely no
    problem.  I was able to easily clock ground strokes off both
    sides.  Hitting to myself quickly became boring, so I began moving
    the ball back and forth between forehand and backhand, forcing
    myself to first skip to the left, then the quickly skip back to
    the right.  I was able to stay light on my toes and everything
    worked great, but as soon as I placed the ball too far away the
    weakness of the right leg became apparent and I couldn't get there
    in time.  There was no pain in either hip, but of course this was
    pretty mild stuff and tougher tests lie in the future.  I did get
    slightly winded very quickly, but in my defense with three balls
    and not missing much there weren't any pauses.  Overall
    assessment: FANTASTIC!!!

    At PT told Kristen (still not sure that's her name - I can't
    believe I'm this bad with names) what Dr. Benson had told me
    yesterday.  She did a deep massage on a tight little knot in a
    muscle in the buttock, I'll get the name of the muscle at my next
    visit.  She wasn't sure what might have caused it.  I've never had
    a deep massage before - it occasionally hurt, but overall it felt
    wonderful and I was walking more easily afterward.  I haven't had
    a woman "touching" me there since I met my wife, and that was a
    strange feeling.  No embarrassing reactions to report, but a very
    odd and unexpected feeling nonetheless that didn't occur at other
    times when they've massaged the incision and thigh.

Friday, June 13, 2003

    First day after my little tennis hit.  Leg feels pretty much as
    before.  The weakness in the leg is still there, and I've begun to
    notice an accompanying ache in the joint area when I walk.  This
    has been there but wasn't very noticeable when the muscles were
    weaker.  I'm not sure what is causing this.  It doesn't feel
    muscular, and it definitely isn't the joint itself.

    When I put my pants on and balance on my right leg, it aches from
    the joint down the thigh that continues for a few seconds after
    I've taken my weight off the leg.  The sharp little pains I used
    to feel seem to have mostly gone away.

    Was going to hit again at end of day.  Rain held off all day until
    I was done working.  Didn't do exercises or stretches.  I'll try
    to be good tomorrow.

Saturday, June 14, 2003

    Forecast is for rain, rain, rain.  Those of you in the northeast
    of the US know what I'm talking about - this has been an
    unbelievable spring.  The best weather we've had this year was a
    few days in early March.

    Later: Well, it didn't rain, so I did my stretches and went down
    to the courts and hit against the wall for about 20 minutes.  Leg
    was really weak.  I wasn't anywhere near as agile as Thursday, or
    at least it didn't feel like it.  I could stand in one place and
    hit with ease - turns out this takes almost no leg strength.
    Running myself back and forth showed how slow I was, and there
    were many times when I had to compromise my footwork and simply
    reach.

    I also tried a few serves.  This proved to be really easy, too,
    but I used almost no knee bend.

    Both legs felt achy afterwards, the walk to the car was really
    uncomfortable.  But now a couple hours later both legs feel
    GREAT, better than earlier today.  We'll see if they feel the
    same tomorrow.

Sunday, June 15, 2003

    Leg felt *very* good this morning.  I was able to walk up stairs
    with no major aches, though naturally the leg is still weak.  So
    since anything worth doing is worth overdoing I decide to try
    tennis again.  I do my stretches at home (the adductors are
    stretched further than they've been in a couple years, but the
    right quad is still short, can't touch my heel to my butt yet),
    then go down to the courts and hit against the wall for maybe 10
    minutes.  Bob happens by on his bike, so he borrows one of my
    rackets and we hit on the court for maybe 20 minutes.  I try the
    net but make the mistake of jumping to reach a high backhand
    volley but stumble and fall.  No damage done, but we stop there.
    Still, a very successful outing, and a couple hours later the leg
    feels better than ever.

    The fall confirms my suspicion that I won't be able to rein in my
    instincts all the time.  Wall is safer for now.

Monday, June 16, 2003

    7-week anniversary of surgery.

    Leg feels closest to normal that it's felt since surgery.  Feels
    stronger today.  The ache when I balance on just the right leg
    while getting dressed is still very much there, but a little less
    today.

    Something I haven't mentioned before, should have asked the doctor
    about this, but the swelling has gone down enough now to be
    certain that the right hip has been moved from between a half inch
    to an inch further away from my body center.  This means the
    angles of the prosthesis are different than originally.  Looking
    about on the net I see three angles mentioned: flexion, adduction
    and exension.  (Geoffrey, help!)  I don't know what mine were
    originally or what they are now.  I believe this is something the
    doctor mentioned before surgery when we were talking about post-op
    strength stranges.  He said the changes he would make in my angle
    should increase my strength, or at least increase the leverage my
    muscles have.

    I have PT this afternoon at 5, and afterwards I plan to stop by
    Steve's and hit a little on his clay court.

    Well, PT went fine and I went over to Steve's for a little tennis.
    Steve, Charlie and Bob were there, so we hit two singles on one
    court.  I hit with Bob and Charlie hit with Steve.  Hit for about
    40 minutes.  Had a lot of trouble if I had to move too far left or
    right, but I was able to easily rip forehands when I had time to
    set up.  I've decided to focus on getting more topspin in my
    backhand, so the backhand wasn't as good, though I did hit a few
    good ones here and there.  Changed to the western grip for the
    backhand.

    Afterward tried to sweep the court, but only finished half of one
    side before letting Bob finish.  I did the lines.  Legs were
    pretty tired and achy afterwards.  Went to bed way early, fell
    asleep early.

Tuesday, June 17, 2003

    I overdid it yesterday.  Both hips ache in the same way they used
    to before surgery - I assume this means I've inflamed both hip
    joints.  Both legs feel like they've been used to jackhammer
    through concrete.  I have non-muscular aches here and there in
    both legs.  Right leg does not feel weak today, but neither does
    it feel strong.  I can walk fine but I feel it as I walk, and
    especially as I get up out of a chair.  I'm going to work from
    home today and see if moving as little as possible helps.

    Tonight the leg feels great!  Stronger than ever.  Pain during
    walking is less than it's been in a few days.  I'll return to
    stretching and tennis tomorrow.

Wednesday, June 18,2003

    Geoffrey convinced me I was overdoing it.  Thanks, Geoff!  I
    decided to take another day of rest.

Thursday, June 19, 2003

    Leg feels fantastic this morning.  Assuming decent weather, will
    do stretches and tennis later today.

    Did my stretches, then played tennis with Jeff and Tyler for about
    30 minutes.  Tyler's a friend of Jeff's from the tennis team.
    Warmed up, then played 2-on-1 to 11 about six times before I
    quit.  Both boys have down-the-middle-itis - it was great fun
    using my ability to place the ball to tie them in knots.  Tyler
    figured out I had trouble reaching drop-shots, though.  He also
    figured he could sneak in to net while I was playing the ball.
    After passing him several times in a row I finally shouted to him,
    "Tyler, I'm crippled, not blind!"

    Iced down the right hip afterwards.  It felt swollen and achy, but
    nowhere near as bad as Monday.  The boys aren't much for keeping
    the ball in play.

    I've been trying to stretch out the joint capsule.  When I do my
    standing leg raises (while standing, lift knee as high as
    possible) after the leg reaches it's limit, which is the thigh
    horizontal, I grab it with both hands and lift it as high as it
    will go for a couple seconds.  Today I was almost able to put on
    my right sneaker by simply lifting my leg while sitting.

    Also try to stretch out joint capsule side to side, which involves
    turning the leg both the inside and the outside.  Turning to the
    inside merely meets resistance.  Turning to the outside causes a
    sort of burning sensation in the joint, but not the burning
    sensation associated with stretching nerves - it's definitely the
    joint capsule or something near it.  PT says I'm not doing any
    damage by doing this.

Friday, June 20, 2003

    Right hip joint slightly achy this morning, right leg still strong
    but weaker than yesterday before tennis.  Looks like another day
    of rest is in order.

Saturday, June 21,2003

    Did stretches, then played tennis at Steve's with Bob.  Bob's
    having more trouble with his right arm and had to hit left handed,
    but he did alright - much better than I'd do.

    Iced down the right hip afterwards.  Hip felt pretty good -
    swollen but no major aches or pains.

Sunday, June 22, 2003

    Day of rest.  Just did the stretches.

    I have to remember to ask PT why when sitting and I rest my right
    ankle on my left knee that it hurts.  It feels like its coming
    from the back of joint, but then when I probe a bit it feels like
    a lot is coming from the buttock area.

Monday, June 23, 2003

    8-week anniversary of surgery.

    Went to PT early and rode bike for 7 minutes, level 3 manual.
    Then used abductor machine for 10 reps.  That's all I had time
    for.

    At PT Kristen and I talked quite a bit.  I've been having my
    doubts that the tennis is doing me any good, and it just doesn't
    feel like a good substitute for the exercises.  So I'll put the
    tennis on hold for a while.  New set of exercises to be done twice
    a day:

     - 10 stomach crunches
     - 10 straight leg raises while lying on floor
     - 10 straight leg raises while lying on side, 2 sets, increase by
       1 every day
     - 10 squats, it's a funny kind of flat footed squat, but it
       really causes my leg to hurt in the IT band area about halfway
       down the thigh on the outside
     - 10 butt lifts (probably wrong name) using just the right leg
       placed on top of an exercise ball (I bought one)

    Kristen also answered the question about the pain in the buttock
    from crossing my right leg.  I've forgotten the muscle names, but
    there are buttock muscles that attach to the Greater Trochanter,
    and the clockwise rotation of the right leg stretches this
    muscle.  While she couldn't be certain, she said it was likely
    that one or more of these muscles was in some way damaged by the
    surgery.

Tuesday, June 24, 2003

    Did my stretches and exercises in the evening.  Feel okay.

Wednesday, June 25, 2003

    Leg felt achy and weak today.  I'm not feeling any forward
    progress.  Am a little discouraged.  Skipped exercises today,
    don't want to overstress leg.

    One great thing about the stretching - I can now spread my legs
    further apart than in a couple years.  The adductor muscles had
    just gotten tighter and tighter because they were never stretched
    very far because the hip joint just wouldn't go very far, but now
    that I stretch them every day the improvement is very obvious.
    While standing I can get my feet about a foot further apart than I
    used to.  The separation used to be so narrow that I couldn't ride
    a horse.  This isn't something I do very often, but since my
    daughter takes riding lessons it does occasionally come up.  I
    wonder if I could ride a horse now?

Thursday, June 26, 2003

    At PT talked with Kristen some more, and combined with what I've
    learned at the hip support site I've concluded the rapidity with
    which I no longer needed a cane was due more to my strength going
    into surgery, and not to a fast recovery rate.  The muscles most
    disabled by surgery are coming back as slowly for me as they do
    for anybody, it's just that my other muscles are strong enough
    that it doesn't matter for simple things like walking and climbing
    stairs.  But for running it's another matter.  I won't be able to
    run until these other muscles come back.  My decision to
    deemphasize tennis stands.

    Let still felt achy and weak, didn't do my exercises again, but I
    should mention an improvement.  When I put on my pants while
    standing up on one leg, the right leg no longer has any problem
    with this.  The muscles seem strong enough to keep the leg
    perfectly stable, either that or I've merely learned how to
    balance with the muscles I *do* have.  But I *do* have a feeling
    of confidence now while doing this that I didn't have before.
    When I'm done the leg aches for a few seconds.  This doesn't feel
    like a muscular ache, but it's similar to the ache from the
    squats.

Friday, June 27, 2003

    While rough housing with Kathy last night I did something to a
    muscle near the hip joint.  Nothing major, but it's a little
    swollen today, and it feels pretty stiff.  Doesn't seem to have
    affected strength, though.  Perhaps I pulled a small muscle.  Or
    perhaps enervation is returning to a muscle.  Anyway, though I
    don't know what muscle is involved, it only actually hurts in
    certain very specific situations.  For example, if I lie on my
    left side with legs below me but bent at the knee and with right
    knee on top of left knee, then lift the right leg into the air, it
    hurts just a little below and to the front of the hip joint.
    Rolling over in bed hurts a lot.

    This hasn't affected my strength.  I was able to do all the
    exercises, and the leg feels pretty strong today.  I was able to
    do the lying-on-side leg raises with no problem, in fact they were
    easier than they've been, but this is with a straight leg, not a
    bent leg, and seems more to stress muscles in the buttocks.

    The leg *does* feel a little weaker for the lying-on-back leg
    raises, but this was a small enough difference that I might be
    mistaken.

Saturday, June 28, 2003

    2-month anniversary of surgery.

    On vacation.  Hip joint still aches.  Have decided to take the
    easy approach while on vacation and not exercise, we'll see if
    rest helps.

    Three hour drive in car was no problem.

Sunday, June 29, 2003

    On vacation.

Monday, June 30, 2003

    9-week anniversary of surgery.

    On vacation.

    Three hour drive in car again was no problem.
    
Tuesday, July 1, 2003

    Hip joint still aches.  I'll take the exercise approach now.  Did
    my stretches and exercises.  Leg strength feels the same, except
    it still feels weaker for leg raises while lying on back.

Wednesday, July 2, 2003

    Played tennis for maybe 35 minutes with Jeff.  I'm still really
    slow, slower than ever, in fact.  But I think that's because I'm
    learning where my limits are - I didn't push the leg to the pain
    point at all.

    Went to PT.  After massaging the incision and leg did a couple
    exercises.  One was on a balance board on just the right leg and
    moving it back and forth, forward and backward, then in a circle.
    The other standing on was on a piece of foam on just the right
    leg, which was easy, until Jean Marie started giving me little
    nudges and I had to maintain balance.

    Did my exercises.  I'm starting to think that maybe water exercise
    is a better answer.  I'll call Hampshire Hills and see if my PT
    pass gets me into the pool.  Or maybe I won't ask, I'll just go.
    HH is better than the YMCA because the pool is heated, I think.

Thursday, July 3, 2003

    I can run!

    I can run!  I can run!  I can run!

    I can run fast (for a 51 year old).

    And I still can't play tennis.  Here's why.

    Tennis requires many small quick motions of the feet for proper
    positioning.  I don't run to the ball, I use a series of small
    very quick skips so that when I arrive at the spot my feet are
    already in the proper position for striking the ball.  At present
    the leg is still too weak to execute these skips.  Perhaps I
    should try some "bad footwork tennis".  Maybe this would even be a
    good longterm project.  As I've gotten older I've found the effort
    more and more tiring, and perhaps it's time to develop less
    strenuous footwork.

    Took a 20 minute walk with Lois this morning.  We were 3/4 done
    with the walk and were talking about muscles recovering and why I
    can't run even though walking is easy, and it suddenly occurred to
    me that if walking straight ahead is easy, then running straight
    ahead should also be easy, and that if it wasn't then
    understanding why should be informative.  So I started a short
    jog, then stopped after 30 yards.  It felt fine.  So I started a
    longer jog, then picked it up into a genuine run, covering
    maybe around 60 yards altogether.  It also felt fine.  Then I
    tried imitating my tennis motion to the ball - couldn't do it.

    Ended up doing more walking than originally planned.  Lois and I
    went out to lunch with our son Jeff (Kathy's visiting a friend for
    a couple days), and on the way back Jeff and I stopped at the mall
    to buy him a WarCraft III expansion pack.  We parked next to Sears
    for easy access to Electronics Boutique, but do they have it?  No!
    So we have to walk clear to the other end of the mall to
    Babbage's.  I had to slow way down about half way there as a
    muscle in the buttock began to give out.  The muscle recovered
    during the purchase and I was able to walk half way back before
    having to slow down again.

Friday, July 4, 2003

    Happy fourth of July!

    Attempted a morning walk, but turned back after just a couple
    minutes because the buttock muscle fatigued rapidly.  However, had
    no problem doing my stretches and exercises.  That kind of
    clinches it - walking is a pretty good exercise.

    Played tennis with Jeff a little in the afternoon.  I've pretty
    much figured out my range, didn't overdo it for even a single
    shot.  Of course, this isn't really exercise, as it was much
    easier than the attempted morning walk.

Saturday, July 5, 2003

    Attempted to take walk in morning, but turned back after 4 minutes
    because buttock muscle fatigued again.  Did stretches and
    exercises.

Sunday, July 6, 2003

    Took 22 minute walk, but buttock muscle became very tired and I
    had to slow down for much of the walk back.

Monday, July 7, 2003

    10-week anniversary of surgery.
    
    Kristen tried new exercises at PT.  The two-leg board balancing
    exercises were very difficult as far as balancing, but were easy
    as far as hip muscles.  The two-leg bouncing on the trampoline was
    also easy, though I fatigued after a while.  It was the one-leg
    exercises that got me:

     1. Stand on right leg, touch left leg consecutively to three
        points marked in front of me on the floor, one to the left,
        one straight ahead, and the last to the right.  The one to the
        right was very tough.

     2. Stand on right leg, catch 3 pound plastic ball that Kristen
        somehow never managed to throw to me.

    Leg feels tired and achy tonight.

Tuesday, July 8, 2003

    Leg is tired and achy today.  Jeff needed someone to hit with
    this evening, so we hit for maybe 40 minutes.  Played 4 games.
    Jeff, like most juniors, has down-the-middle-itis, so I'd just put
    the ball away on my first shot.  I was about to go up 4-0 when I
    missed a placement at 40-30 by just a couple inches.  Now it was
    deuce.  Jeff hit my next serve straight at me and I couldn't get
    out of the way.  The next serve he hit for a winner straight down
    the line.  Amazing what you can do if you move your feet, but I
    wish he'd move them all the time.  Sometime he's like a statue out
    there, reminds of Drew Bledsoe.

    Leg is even more tired and achy tonight - I overdid it.  I iced
    the hip down, it felt a little swollen.

Wednesday, July 9, 2003

    Leg is very tired and very achy today.  I need rest, no exercises
    today.

    Anybody reading this who's recovering from THR and thinks they're
    doing well, try some tennis.  Or soccer.

Thursday, July 10, 2003

    Leg *hurts* this morning.  First few steps after rising to my feet
    are very painful, and a large part of the pain doesn't feel
    muscular.  Have I hurt the prosthesis?

    Now, at noontime, the leg feels great, better than at any time
    over the past few days.

    At PT I told Jean Marie about how bad the pain had gotten and how
    suddenly it abated.  She said patients like me always do very
    well.  I think they're getting tired of my paranoia.  After soft
    tissue work (massage) we did some fairly aggressive exercises,
    including hamstring curls.

    Jason couldn't make it for Jeff's lesson today, so I hit with Jeff
    after PT.  Took it very easy by hitting out of the bucket and
    didn't chase any balls unless they were real slow.  Nonetheless,
    leg hurt a lot afterward.  I iced it down.  Legs started cramping
    later in the evening, mostly the hamstrings, probably due to the
    PT exercise.

Friday, July 11, 2003

    Leg feels great this morning.  Continued resting it.


Saturday, July 12, 2003

    Continued resting the leg.  Feels great again today.

Sunday, July 13, 2003

    Continued resting the leg.  Started to ache a little toward the
    end of the day, time to begin exercises again tomorrow.

Monday, July 14, 2003

    11-week anniversary of surgery.

    I don't think I'm any stronger now than at week 5.

    Did exercises in bed in the morning.  Discovered the weight of the
    sheets and blanket on the leg is pretty much the right weight
    right now.  Did four exercises:

     1. Leg raises while on back
     2. Leg raises while on side
     3. Butt lifts with one leg, but with foot positioned close to
        butt.
     4. Leg raises while on side, but with knee bent to 90 degrees.

    Overstrained the leg walking 23:00 in the evening.  Why do I keep
    doing this?

Tuesday, July 15, 2003

    Rested.  At some point I figured out that a large part of the
    weakness in raising the leg is a muscle that in the front goes
    from the hip to the femur.  It's called the ilio-something.

Wednesday, July 16, 2003

    In the morning the leg really hurt when I put weight on it,
    especially diagonally across the front from hip to knee.  Didn't
    go away during the day.  Was limping so badly a couple people
    commented.
    
    Was able to do exercises during PT, but didn't do anything extra.

Thursday, July 17, 2003

    Leg hurt all through the night.  Felt a little swollen, so iced
    hip joint and upper right quadricep.  By afternoon leg was feeling
    much better.  Hope to resume exercises and walking tomorrow.

Friday, July 18, 2003

    Took Jeff shopping for a few things for camp, so ended up walking
    the length of the mall and back.  Buttock was hurting before we
    were done.  That was my walk.  Iced hip down later.  Leg felt
    tired, no exercises.

Saturday, July 19, 2003

    Took walk around block in 11:00, which was about all I could
    handle.  Slowed down quite a bit near the end as buttock began to
    ache.  Reading back through this diary it seems I'm going
    backwards.  This is where I was about 2 months ago.  I can only
    guess that as more muscle becomes enervated that it is very easily
    strained because of a couple months of not flexing at all.

    But that's an optimistic interpretation.  In my darker moments I'm
    wondering if the buttock muscles are ever going to come back,
    specifically the gluteus medeus that seems completely dead though
    other muscles are probably involved, too, like the peri-something
    that PT mentions.  The gluteus maximus is fine.

Sunday, July 20, 2003

    Drove Jeff to camp.  He's been so looking forward to this.
    His been in contact over the Internet with friends from prior
    years, and he seems really excited.  He somehow lost his
    cellphone, so he'll have no phone at camp, but that shouldn't be
    much of a problem.

    The small amount of walking I did while dropping Jeff off, maybe 8
    minutes total with a long break in the middle while at the
    registration desk, made my leg tired.  The upper hamstring toward
    the outside was stiff and sore when I arrived home, for no real
    reason.  Iced it down.

Monday, July 21, 2003

    12-week anniversay of surgery.

    Thought I'd be much further along by now.  Before surgery I was
    guessing I'd be playing tennis in July, now August only looks like
    it *might* be possible.

    The recovery is not progressing the way I expected at all.  I
    haven't told PT how little I've been able to do recently, though
    last week might have been a little early to report it.  I seem to
    mostly decide not to do the exercises so that I don't risk hurting
    something, but when I go to PT they're talking about increasing
    the reps and the difficulty of the exercises.  Obviously they
    expect some progression, and so do I, but it just isn't there.

    Leg feels much better today.  Was going to do morning exercises in
    bed, but first went to the kitchen to make coffee, and though
    there was no real pain anywhere, I did receive a few minor little
    "feelings" that made me decide not to do the exercises this
    morning.

    Should have mentioned this long, long ago because it is useful
    data, but I'll mention it now.  If I put my hand on my butt while
    walking, the good butt flexes as I walk, the bad butt stays
    completely flaccid.  This doesn't appear to have changed one bit
    since I first noticed it around maybe week 4 or so.  My guess is
    that the gluteus medeus is important for walking.

    Upper hamstring was stiff and sore all day.  Iced it down, and the
    hip, when I got home from work.  Did stretches.  Didn't do any
    exercises or walk.

Tuesday, July 22, 2003

    Leg has no stiffness or soreness this morning, feels pretty
    strong, too.  I hereby resolve to not overdo anything from
    hereon out.

    Though the leg continued to feel strong, even short walks, like
    the three minute walk to my office, made it tired, particularly in
    the buttock.  And the hamstring stiffness and soreness came back
    later on after I went to the library.  I seem to be so fragile.
    Over the past six weeks I've spent most of my time resting to feel
    good enough to exercise again.  I guess this is just something
    I'll have to work through.  Maybe the muscles that hurt are ones
    that are just starting to come back.

Wednesday, July 23, 2003

    Did exercises in bed in the morning.

    At PT Jean-Marie did a deep massage on the buttock muscles, the
    gluteus medeus and the periformis and whatever else is in there.
    Also checked muscle strength.  I walked out limping.  I had
    planned to do a walk when I got home, but leg ached too much.

Thursday, July 24, 2003

    Leg still ached today, so didn't do any exercises or stretches
    again.  I may have to reconsider whether PT is doing me any good
    or not.  They seem to be good at keeping me focused on the need to
    do exercises, but at this fragile stage exercise seems to hurt me,
    and what's the point of going to PT if you can't exercise?

    Buttock muscles were extremely stiff and sore in a narrow vertical
    arc from top to midpoint roughly in the horizontal center.

    Iced down the leg - that helped a little.

Friday, July 25, 2003

    Leg still achy and weak.  Buttock still very stiff and sore.  Did
    exercises in bed in the morning, but nothing else.  I'll see later
    if the leg feels stronger or weaker from the exercise.

    Later on, leg felt a little more achy, so I'll take it easy on the
    exercises for another day.

    I literally can't believe what is happening.  I'm way behind where
    I was a month ago or even two months ago, and every time I make
    the slightest bit of progress I hurt the muscles again.  PT has
    hurt me the last three times I was there, so I'm going to cancel
    next week's appointment.  I'm determined to ease back into this so
    I can walk a mile again, and I'll go real easy on the exercises
    until I can do that.

Saturday, July 26, 2003

    2-week vacation starts today!

    Buttock still stiff and sore, but feels slightly improved.  We're
    going to do some shopping, so I'll be doing some walking.  We'll
    see how it goes.

    Shopping excursion went fine, but it illustrated just how weak the
    right side is.  Even with conscious effort it is very difficult
    disguise a rolling tendency on the right side while walking.
    While waiting for Lois I tried to walk in front of some shop
    windows to see how bad it was - didn't look terrible, but it was
    noticable.  Sometimes the right side is strong enough to hold me
    up and I walk evenly, but mostly not these days.

Sunday, July 27, 2003

    Did exercises in morning in bed.  Went shopping a little, not as
    much walking as yesterday, but I was walking much better, little
    to no rolling.  Did more exercises at night, trying to concentrate
    on the areas of greatest weakness, the leg lift and the buttock
    lift, both while lying on back.  Forgot to do stretches.

Monday, July 28, 2003

    13-week anniversay of surgery.
    3-month anniversay of surgery.

    Went to Nashua and Hollis libraries, felt okay.  Got onto a coding
    roll later in the afternoon into the evening (this is coding for
    my website, not for work) and didn't do exercises or stretches,
    and by the time I went to bed the hip was very achy and felt
    swollen.  Had trouble walking on it first few steps every time
    after getting up.  But I'm attributing this to yesterday's
    exercises - as I've said before, I believe you don't find out that
    you overdid it until the next day.  So it was appropriate that I
    took it easy to day relative to exercises.

Tuesday, July 29, 2003

    Hip was achy and bothered me much of the night.  Got up early and
    iced down the hip, the buttock and the quadricep, took 660 mg
    Alleve.  Going to Shaker Village today.

    My weight goes up and down unpredictably independent of diet, but
    I think I notice a correlation with swelling, which would make
    sense.  I've even had days where I lost a couple pounds during the
    day, which never happens.  Recent low correlated with least
    swelling, recent high was yesterday when swelling was pretty bad.

    But the question is, why am I having so much trouble with swelling
    and pain 3 months after surgery?  This is an especially
    significant question since I was experiencing much less pain a
    couple months ago.  I am mystified and concerned.

    Later on: it's amazing!  I iced down the leg one more time before
    we left for Shaker Village.  Walked all over the place.  I even
    walked past the gardens and all the way down to the pond and
    around to the peninsula to take a couple wild geese pictures, and
    I was the only person to do this.  Only trouble I had was the leg
    got tired walking back up the hill, and I had to stop briefly a
    couple times.  And now tonight the leg and hip feel great!

    What does this mean?  I can only guess, but I think my troubles
    over the past couple months are due to a minor injury or injuries
    to one or two muscles, or perhaps to the joint capsule, or some
    combination.  Who knows?  But exercise causes fluid leakage, in
    other words, swelling.  Swelling causes pain and reduces
    circulation, slowing healing and making walking more difficult.

    So I'm going to stop exercising altogether for a week or so.  I
    will only do stretches and walks with lots of ice.  This will
    hopefully give whatever it is a chance to heal and allow me to
    begin exercising again without having setbacks every other day.

    The important question is why didn't PT help me through this.  Did
    I not tell them the right information?  I tried to keep the
    complaining to a minimum, but I *did* frequently mention my
    concern that I wasn't progressing very fast.  I *did* mention
    aches and pains.  But I only mentioned them, I didn't emphasize
    them.  Anyway, I've cancelled this week's appointment.

Wednesday, July 30, 2003

    Hip felt pretty good today, but got carried away with coding and
    went to bed without doing any stretches or any walk.

Thursday, July 31, 2003

    Today a day trip to Boston for a couple museums.  Iced down the
    hip and leg in the morning, it felt achy around the joint and
    above the knee in front.  Parked in the lot for the Museum of Fine
    Arts, then walked to the Gardner Museum a couple blocks away.
    Visited all three floors without problem.  Then walked down
    Huntington Avenue to Au Bon Paine for lunch.  Then walked back to
    the Museum of Fine Arts and walked through the Thomas Gainsborough
    exhibit, then through the adjoining area with some Rembrandts,
    Rubens, Van Dykes, Degas, Monets and even a Picasso or two.  Then
    walked through the Egyptian and Greek areas, then through the gift
    shop, then back to the car.  Leg felt a little tired much of the
    time, but had no problems.  Feels good tonight.  The sharp pain on
    the outside of the greater trochanter where I suspect one of the
    muscles was stapled back on seems to have gone away.  Will do
    stretches then ice it down later.

Friday, August 1, 2003

    Friday morning leg was fine, but I coded all day in front of the
    computer, and as time went by the leg ached more and more.  By the
    end of the day it hurt quite a bit, and it was so late I only had
    time to go to bed.

Saturday, August 2, 2003

    Leg hurt so much that I had to get up in the middle of the night
    and ice it down.  In the morning when I woke up it still felt
    pretty achy, and I iced it down again.  By afternoon it felt
    pretty good.

    Went out to dinner with Carol.  Wait was so long we went next door
    to the mall and walked around for 45 minutes.  Leg got tired after
    a while, but held up okay.  Buttock got the most tired, and there
    was some achyness in the upper hamstring.

Sunday, August 3, 2003

    Leg felt pretty good in the morning.  Iced it down before taking a
    short trip to the mall.  Leg felt pretty good walking around.  We
    keep stopping in shops, so I couldn't tell if it would have gotten
    tired on a continuous walk.

    For first time in a while I did the stretches and exercises, added
    a 2 lb ankle weight.  I think now that I wasn't injuring myself -
    I was just causing swelling and inflammation that hurt a great
    deal, to the point where the exercises hurt too much to do.  I
    can't believe the amount of icing I'm having to do, but as long as
    I do it regularly the leg seems to feel pretty good.  I'm going to
    become more aggressive on the strengthening.

Monday, August 4, 2003

    14-week anniversay of surgery.
    
    Leg didn't feel too bad when I first got up, but after a couple
    hours it is achy.  The pain doesn't feel like inflammation pain or
    muscle pain, but bone pain and joint pain.  I'm going to take 660
    mg Alleve and ice the hip and leg down and see how they feel in a
    few hours.  If they feel much better then I have solved the
    problem where I keep thinking I've injured myself.

    A couple hours later the leg feels much the same - hip joint pain,
    bone type pain in the a couple places in the leg, including the
    outside of the calf.  I'll try another round of icing.

    Even after the second icing the pain in the leg was only slightly
    diminished.  Went to library and discovered that after a minute of
    walking the pain seemed to go away, so went for walk around block
    upon return home.  Took roughly 14:00 - pretty slow.  Had to stop
    several times because buttock got too tired, but only had to stop
    for 10 or 15 seconds at a time.  Will ice leg down again - this is
    ridiculous - if I weren't on vacation there's no way I could do
    this much icing.

    I suspect the pain may be caused by the squats - they put a lot of
    stress on the leg.  Even when healthy I didn't do squats like
    these, though the left leg doesn't seem bothered.  I won't do any
    squats tonight, then I'll do one additional one every day, so
    tomorrow I'll do 1, Wednesday I'll do 2, and so forth.

    I should also note that I believe I can occasionally detect some
    contraction in the gluteus maximus during walking.  Usually it is
    completely flaccid for a normal paced walk.  It's too early to be
    certain of this, though.

    After icing the leg down it feels pretty good.  I think the walk
    actually helped.  Perhaps I should have been pushing through the
    pain when I started having these problems.

Tuesday, August 5, 2003

    Leg is very slightly achy this morning, only hurts when I walk on
    it, but otherwise feels good and strong.  No pain at all while
    sleeping last night.  I'm going to write a little more code and
    then check into a TiVo upgrade, but after that I'll ice the leg
    down again.  I should stretch and exercise this morning, got
    caught up in things last night and it got too late.

    If it dries up a bit more outside I might go down to the courts
    and hit against the wall a little.  It's been a long time, July
    10th I think, and I should try to gauge if there's been any
    progress in that respect.

    Just got back from maybe 15 minutes hitting against the wall.  The
    bad news: I'm out of shape.  The good news: movement was much
    improved.  After warming up for a couple minutes just hitting
    straight ahead I started to move the ball back and forth from
    backhand to forehand, gradually extending the range.  I found that
    when I needed to move fast I could pull the leg through
    the necessary movement.  This is a big improvement from four weeks
    ago when the leg wouldn't respond with anything but pain.  Will
    ice leg down soon.  Plan to do exercises and walk later.

    One more thing.  After hitting for five minutes or so I needed a
    break and so walked around the fence to get a ball I'd hit
    through.  Decided to check buttock flexion and it was flexing
    bigtime, even when I changed to a very slow pace.  Now, a half
    hour later, the buttock is completely flaccid while walking.
    Hmmm, not sure what this means.

Wednesday, August 6, 2003

    Went to bed last night with an achy leg, woke up with leg feeling
    just great!  So I did my exercises in bed, and an hour later the
    leg felt very achy.  So I took 660 mg Alleve and iced it down.  If
    the pattern holds, within a few hours the leg will feel pretty
    good.  If not, I'll ice it again.  I have PT today, I'll have to
    ask them about this.  If the leg starts feeling better I'll hit
    against the wall a bit.  I might anyway even if it doesn't.

    Later in the day, hit against the wall for about 30 minutes, but
    took maybe 6 one or two minute breaks.  Leg did not feel as strong
    as yesterday, and it left a little stiff along the outside, but
    there was still no pain associated with trying to move fast.

    Went to PT directly from tennis.  It had been two weeks since my
    last visit, and I told Jeanne Marie what I had learned about icing
    down the leg.  She agreed that causing inflammation so easily
    didn't seem expected and suggested I call the doctor and ask about
    it, so that's what I'll do.  She wants me to try pool therapy, but
    I resisted.  I agree it's a good idea, but I don't think I would
    reliably do something I'm so averse to.  So she suggested that
    I do my walk or vigorously ride a bike with no resistance
    immediately after exercising or playing tennis to see if the
    increased circulation helps the inflammation.

    So when I got home I did my walk.  I originally planned the 3/4
    mile walk, but felt so good that I took the turn for the 1.5 mile
    walk, then turned back after a minute as I felt the buttock begin
    to tire.  This turned out to be the right thing to do since I ran
    out of gas a minute or two from home.  Still finished in 13:55,
    pretty good time.

    Iced the leg down for 20 minutes as soon as I got inside, and
    right now the leg feels *really* good, which it usually doesn't
    after this much activity.  Perhaps I have turned a corner?

    Should I do my exercises later tonight?  Haven't decided yet.

Thursday, August 7, 2003

    By the time I went to be last night the leg hurt like sixty.  By
    morning the pain was greatly reduced, so I did the exercises in
    bed, and a couple hours later the leg hurt like sixty again.  So I
    iced it down once, then again later, and while the pain diminished
    the leg never felt good enough to think about doing exercises or
    taking a walk.  I was already limping, and just a trip to the
    grocery store was plenty.

Friday, August 8, 2003

    Leg still has pain this morning, but it is better.  Feels pretty
    strong today, but I can't use the strength for doing things like
    going up stairs because of the pain.  Did a long icing of the
    upper leg while watching the 2nd half of the Patriots/Giants game
    on TiVo.  Have to pick up Jeff at tennis camp later today,
    probably spend about 3 hours in the car, so I'll see how the leg
    feels this evening.

    I called Dr. Benson and left a message about the inflammation
    problem I'm having, hopefully I'll get a callback later today.  I
    feel at this point that the leg would respond positively to some
    aggressive exercise if it just wouldn't hurt so much.

Saturday, August 9, 2003

    Leg didn't hurt very much today, but it didn't feel strong,
    either.  Going up stairs was harder than usual.  The Tensor Fascia
    Latae felt stiff through the whole day.

    Did my stretches and exercises, then completed a 1.5 mile walk in
    20:55.  Not a record, but the buttock didn't get tired, not even
    close.  In fact, it was my calves that began to get a bit tired.
    Will ice the leg down soon.  It'll be interesting to see how much
    inflamation I get later.

    Inflammation wasn't too bad, but got a little too aggressive with
    the icing, almost gave myself frostbite.

Sunday, August 10, 2003

    A routine emerges?  Iced down leg, allowed it to warm up, then did
    stretches, then exercises, then 1.5 mile walk in 22:17 the hard
    way, two steep uphills.  Buttock muscles got tired last 20 steps
    of 2nd uphill and had to slow down, otherwise okay.

Monday, August 11, 2003

    15-week anniversay of surgery.

    No, a routine does not emerge.  Leg was very weak, felt like the
    Tensor Fascia Latae, which felt stiff again.  Decided to give the
    leg a day off.

Tuesday, August 12, 2003

    Did not do the exercises, but did do the stretches and the walk
    the hard way in 25:25, very slow.  Had to stop maybe 8 times for
    about 5 to 10 seconds because of weariness in muscles immediately
    adjacent to the greater trochanter.  Tensor Fasia Latae was very
    stiff and weak today, I was limping, but the walk and icing down
    afterward made it feel much better. 

Wednesday, August 13, 2003

    Went to PT early and used some of the machines in their exercise
    room.  Bike for 10 minutes at around 85 RPM with almost no
    resistance, the abductor machine, then leg press machine.  At PT
    only had soft tissue massage and discussion of where I am.

Thursday, August 14, 2003

    Took the day off.

Friday, August 15, 2003

    Did the stretches and exercises, then the long walk but with only
    1 steep uphill instead of 2 in 19:45.

    Dr. Benson's office finally returned my call about the
    inflammation.  Beverly talked to me a little, then said she'd talk
    to Dr. Benson about it.  She suggested I wear the ted socks again
    for the inflammation - I said okay but won't do it.  In my opinion
    their effect is minimal to non-existent for those with no
    circulation issues.  I'm not letting the nursing staff make me
    uncomfortable just because they had a bright idea.  She also asked
    if I was taking Vioxx or Celebrex, so I told her I was using
    Alleve.  But since she mentioned it and since I have a bunch of
    Celebrex left over from a couple years ago I'll try it.  It says
    once a day, I'll try two, once in the morning, once at night.

Saturday, August 16, 2003

    Did stretches, exercises, and the long walk the hard way in 21:58.
    Had to slow down when buttock near upper trochanter began to
    weary.  Still a good showing, iced it when I got home, and there
    appears to be no inflammation several hours later.

Sunday, August 17, 2003

    Skipped the exercises because felt some strain in back and
    buttock, but did stretches and the long walk the hard way in
    21:13.  Decided to try stopping for 5 seconds when muscles began
    aching instead of slowing down, seemed to work well.  Switched
    from Celebrex to 660 mg Alleve, didn't have to ice afterwards.

Monday, August 18, 2003

    16-week anniversay of surgery.

    Did stretches, exercises, and the long walk the hard way in 19:27.
    Tried experiment, 660 mg Alleve in morning, 660 mg Alleve when
    returned home in evening.  Leg felt stronger than it ever had
    during the day.  No icing necessary so far.  That's good, hope it
    stays that way.  I don't have time for 20 minutes of icing and 20
    minutes of warming the leg back up every day, not when added to
    the time for stretches, exercises and walks.

Tuesday, August 19, 2003

    Leg felt slightly inflammed, particularly along the outside
    between the quadriceps and the hamstring.  But I did stretches,
    exercises and the long walk the hard way, taking it easy figuring
    I couldn't do two fast days in a row, and I was right.  Had to
    stop maybe five times, eventually did it in 26:58, a new record in
    the other direction.  Iced down the leg when I got home.

Wednesday, August 20, 2003

    Leg still feels slightly inflamed, again particularly along the
    outside between the quadriceps and the hamstring.  Took the
    Alleve, we'll see if that helps.  I'm taking 1320 mg a day, hope
    that's okay.  I won't do the exercises today, I can feel the
    bridges in my back.

    Amy from Dr. Benson's office called back (I had a call in asking
    about the inflamation) and said to cut back to 880 mg a day with
    the Alleve.

    Just soft tissue work at PT.  Cut back to once every three weeks.

Thursday, August 21, 2003

    Leg still feels inflamed.  Took a leisurely walk, only one uphill,
    same long distance, which I recently measured at about 1.1 miles.
    Probably took me around 22 minutes.

Friday, August 22, 2003

    Did stretches, exercises, walk in 21:59.  Inflammation in leg
    seems to be creeping up.

Saturday, August 23, 2003

    Had guests for weekend, skipped everything today, but not a bad
    idea to take a rest, inflammation is increasing.  Lower Alleve
    level probably isn't helping.  I'll call Dr. Benson's office on
    Monday and ask to try vioxe.

Sunday, August 24, 2003

    Inflammation a little worse today.  Did stretches and exercises,
    but decided to try riding bike instead.  My bike was new in 1981,
    and I haven't ridden more than the tiniest bit since then, but
    other than inflating the tires and adjusting the brakes it did
    okay.  Hope it doesn't fall apart on me.  Anyway, rode around the
    block 4 times, probably took about 11 minutes.  Iced leg down
    afterwards.

Monday, August 25, 2003

    17-week anniversay of surgery.

    Did stretches, exercises and bike ride 4 times around block in
    about 10 minutes (that's all I can handle, I'm not in good shape
    right now).  Inflammation felt noticeably better afterwards.
    Hopefully I'm on to a good thing.  I can't increase my activity
    level until I'm able to exercise without causing inflammation.  It
    seems incredible that a set of 4 exercises that takes 5 minutes
    can cause inflammation that takes 20 minutes of icing and 880 mg
    of Alleve.

Tuesday, August 26, 2003

    Didn't want to mention this in yesterday's entry in case things
    went south later, but my leg felt awfully good after the bike
    ride.  Today, same routine, but 5 laps instead of 4 in about 13
    minutes.  Some pain at the very top of the leg at the crease where
    the leg meets the body in front is starting to get annoying, but
    leg feels pretty good.  Not as good as yesterday, but pretty
    good.  Since I'm going a little downhill, I'll make tomorrow a
    rest day.

    Switched to Vioxx today.  One a day, with Tylenol if necessary for
    pain.

Wednesday, August 27, 2003

    Took the day off, but the leg felt *really* good.  It's never felt
    so good.  At work I was going right up the stairs with no weakness
    or pain, while last week I was pulling myself up using the railing.

Thursday, August 28, 2003

    4-month anniversary of surgery.

    Followed normal routine, 5 laps in about 12 minutes.  Leg felt a
    little achy on last lap so didn't push it.  I usually walk off the
    ride for a few minutes afterward, but I didn't this time because I
    wasn't that tired and leg started to feel inflamed, so I started
    walking.  Leg felt better, but not all the way better.

    Even though I've only been riding the bike a short while, my
    conditioning has improved to the point where my legs aren't
    getting that tired in 5 laps, but I'm pretty out of breath.  I try
    to keep a high RPM rate, not a high speed, but my RPM rate keeps
    increasing and so now I'm ripping around the block in a short
    period of time.  I'll try to do 6 laps tomorrow, assuming it isn't
    raining.

Friday, August 29, 2003

    Leg felt a little achy when I went to bed, but feels great this
    morning.  There's some tennis in my future soon.

    Did normal routine.  Leg feels great.

Saturday, August 30, 2003

    Hit against the wall lightly for 5 or 10 minutes.  Did a little
    moving back and forth.  I'm able to move faster now, but I have to
    be careful to move the right leg smoothly or it hurts.  Was able
    to work up some inflammation in that short time.  Didn't do
    stretches, exercises or ride.  Leg felt okay by evening,
    but there was still inflammation.

Sunday, August 31, 2003

    Hit against wall lightly for maybe 20 minutes.  Did some moving
    back and forth.  Leg felt same as yesterday.  Rode bike 4 laps in
    about 10 minutes when returned home, then walked it off indoors
    for 5 minutes.  Leg definitely became inflamed after hitting, the
    ride definitely helped, I won't be able to tell how much for
    another hour or two.

    Leg felt pretty good later, but could definitely tell that it had
    been under greater stress than the usual exercises.

Monday, September 1, 2003

    18-week anniversay of surgery.

    Followed normal routine, 4 laps on bike in about 10 minutes.

Tuesday, September 2, 2003

    Followed normal routine, 4 laps on bike in about 10 minutes.
    Kathy (age 14) rode with me, I tried to pass her at the end of the
    last lap, legs so enormously tired afterward they hurt.

Wednesday, September 3, 2003

    Day of rest.

Thursday, September 4, 2003

    Another day of rest.  Didn't need it, but stayed late at work and
    then had to pick up Jeff after driver's ed class, so didn't have
    any spare time.

Friday, September 5, 2003

    Followed normal routine.  Kathy rode with me again, tried to take
    it easier this time, still very tired afterward.    

Saturday, September 6, 2003

    Followed normal routine.  Kathy rode with me again, but managed to
    take it easier.

Sunday, September 7, 2003

    Followed normal routine.

Monday, September 8, 2003

    Unexpected day of rest.  Trying to get a release out, worked
    through the evening.

Tuesday, September 9, 2003

    Another unexpected day of rest.  Had to do both dropoff and pickup
    of Jeff at Driver's Ed class.

Wednesday, September 10, 2003

    Played a set of tennis with Jeff.  Inflammation came back big
    time.  Riding bike upon return did not help.  I'm going to try ice
    next.

Saturday, September 13, 2003

    Leg felt pretty good, did regular routine, 5 laps around the
    block.

Sunday, September 14, 2003

    Hit the tennis ball a little with Lois for maybe 45 minutes.
    Didn't do anything stenuous, felt fine later.

Monday, September 15, 2003

    Day of rest.

Tuesday, September 16, 2003

    Day of rest.

Wednesday, September 17 2003

    Day of rest.  I know, this is too much rest, but the hip flexor
    seems to be getting worse with exercise, not better, so that's my
    excuse.

Thursday, September 18, 2003

    Did normal routine, except 6 laps.  Started icing the hip flexor.

Friday, September 19, 2003

    Was so focused on trying to complete a functional spec didn't even
    think about exercises.

Saturday, September 20, 2003

    Hit with Jim for about 40 minutes.  Felt pretty good.  I wasn't as
    slow as I thought I'd be, I wasn't very fast, though.  Temperature
    was 80 degrees, my conditioning wasn't as bad as I thought it
    would be.  Leg did not go crazy with inflammation afterwards,
    didn't even have to ice it down, except for the hip flexor.  I
    have a feeling this hip flexor is going to be a long term
    annoyance.

Sunday, September 21, 2003

    Did exercises, then did a 5 lap bike race with Kathy, age 14.
    She slaughtered me by at least 1/2 a lap, and I was on a racing
    bike and she was on a mountain bike.  We bet $5 against she has to
    play tennis with me in an Anna Kournakova outfit (the outfit part
    is fine with her, I added the outfit part to the bet to make it
    interesting for her because she likes clothes, she just doesn't
    like sports involving balls).

    I noticed she was pulling away from me on the downhills, which
    mountain bikes shouldn't be able to do against racing bikes, and
    back in the garage I noticed my rear tire is only half inflated,
    so maybe I didn't do as bad as I thought.  Also had trouble with
    gear shifting.  I have the little levers that are hard for me to
    hit the gears in a hurry, while she has the automatic handlebar
    shifts.  I'll think of more excuses later, right now I have to
    rest.

Monday, September 22, 2003

    Did stretches and exercises, but by the time I was done it was too
    dark.  Tried cycling in the dark once already, it was too scary to
    repeat.

Tuesday, September 23, 2003

    Did stretches and exercises, then cycled 5 laps around the block.

Wednesday, September 24, 2003

    Rest day.    

Thursday, September 25, 2003

    Did stretches and exercises, then cycled 6 laps around the block
    at a slightly faster clip than normal.  I had found a pretty good
    rhythym and was applying pressure through most of pedal rotation
    and would have gone an extra lap, but I looked up to find the road
    joint that marks rising from easing incline and lost it, so I
    stopped.

Friday, September 26, 2003
    
    Rest.

Saturday, September 27, 2003

    Tennis with Jim.  Felt like real tennis.  I was slow moving to the
    right and moving forward, but moved pretty well to the left.
    Footwork on shots I had to chase forward was pretty sloppy, not
    sure if it's lack of practice or lack of strength, but I was
    running through the shots.  Little to no inflammation afterwards.

Sunday, September 28, 2003

    5-month anniversary of surgery.

    Rest.

Monday, September 29, 2003

    22-week anniversay of surgery.

    Rest.

Tuesday, September 30, 2003

    Did stretches and exercises, then cycled 4 laps around the block.
    Hip flexor is getting more painful.  This is starting to worry me.

Wednesday, October 1, 2003

    Rest.

Thursday, October 2, 2003

    Tennis with Bruce.  He hadn't played in a while and was pretty
    inconsistent, plus it was windy.  I felt slow.

Friday, October 3, 2003
    
    Hit against the wall steadily for about 20 minutes, trying to use
    it as an aerobic activity.  Unfortunately my back and arms and
    trunk began to tire and I had to slow it down, so it wasn't as
    aerobic as I would have liked, but still good exercise.

Saturday, October 4, 2003

    Played a set of doubles before the rains came.  I again felt slow.
    I basically sat back and did nothing.  I think changing my
    instincts for doubles is way overdue, and this is the right time
    to make the change.  I used to be the wild man charging around the
    court, making the poaches and the gets, but even before surgery I
    had slowed down to the point where I just wasn't a threat anymore,
    and in fact was a liability at net as I made moves for balls I
    once could reach, throwing off my partner as I would fail to get
    there.  I've got to change my doubles game to rely more on
    thinking than athleticism.

    So, what did I learn?  Maybe just one thing.  I tried to provide a
    variety of looks by hitting drop shots and lobs mixed in with
    normal shots, and this has potential.  Low shots to net men
    probably also have potential, but I didn't get much opportunity to
    do that.  I didn't hit but one hard ground stroke, and that was a
    backhand into the net.  After hitting the shot I decided it was
    the wrong one anyway.  The opponents were in the backcourt, I
    should have hit a deep drive with moderate pace.

Sunday, October 5, 2003

    Rest.

Monday, October 6, 2003

    23-week anniversay of surgery.

    Mark's in town, had a small group dinner.  Rest.

Tuesday, October 7, 2003

    Rest.

Wednesday, October 8, 2003

    Rest.

Thursday, October 9, 2003

    Rest.

Friday, October 10, 2003

    Rest.

Saturday, October 11, 2003

    Rest.

Sunday, October 12, 2003

    Rest.

Monday, October 13, 2003

    24-week anniversay of surgery.

    Played tennis with Jim.  Good long hit.  Hip flexor seems to be
    getting worse, pain from it gave me more trouble than anything
    else.  I'm still slow.  I think I'm getting a little faster, but
    it's hard to tell with the hip flexor holding me back.

    Why all the rest?  I could have exercised, but inertia caused me
    to see if rest might be best for the hip flexor.  I guess not.  So
    back to ice and exercise.

    I'm very tired, including my arms.  Why the left arm?  Very weird!

Tuesday, October 14, 2003

    Rest.  Leg felt inflamed.  I should ride the bike, but it's cold
    out.

Wednesday, October 15, 2003

    Rest.

Thursday, October 16, 2003

    Tennis with Bruce.  Leg felt okay, but isn't improving.

Friday, October 17, 2003

    Rest.

Saturday, October 18, 2003

    Tennis with Jim.  We had a good hit, but my leg grew increasingly
    inflamed, near the end I was considerably slowed.  In fact, by the
    time we finished my movement was nearly as bad as it was a couple
    months ago.  The inflammation has a dramatic impact.  All the time
    that I thought I was waiting for my muscles to recover it was
    mostly just inflammation.  I know I've made this observation
    before, but what is new is that I'm realizing that the degree to
    which my muscle weakness was due to inflammation was very large,
    probably 70-80% of the problem, maybe more.

    It's gotten too cold to ride a bike.  10-20 mph at temperatures
    below 50 degrees for more than 10 minutes is numbing on the face.
    I'm going to have to move the bike indoors.  God, a stationary
    bike again - I gonna go crazy!

Sunday, October 19, 2003    

    Rest.  I haven't done anything about the inflammation.  It's been
    nearly six months.  I guess I'm just tired of the whole routine.

Monday, October 20, 2003    

    24-week anniversay of surgery.

    Rest.
    
Tuesday, October 21, 2003

    Rest.  Leg felt inflamed.  I should ride the bike, but it's cold
    out.

Wednesday, October 22, 2003

    Rest.

Thursday, October 23, 2003

    Tennis with Bruce.  Leg was feeling pretty bad today.

    Set up my bike as a stationary bike indoors.  Rode for 10 minutes.

Friday, October 24, 2003

    Stationary bike for 15 minutes.

Saturday, October 25, 2003

    Leg felt pretty strong today, though it was achy in the area above
    the knee.  Stroking was extremely good, especially on the backhand
    side.  Was able to generate power *and* spin.  Had trouble with
    stamina.  Hip flexor a growing problem.  Inflammation in leg
    pretty bad later.

Sunday, October 26, 2003

    Iced leg down pretty good, feels better.  Rest.

Monday, October 27, 2003

    25-week anniversay of surgery.

    Rode bike for 4 sets of 3 minutes with maybe 45 seconds rest
    between each.

Tuesday, October 28, 2003

    6-month anniversary of surgery.

    Rode bike for 4 sets of 3 minutes with maybe 45 seconds rest
    between each.

Wednesday, October 29, 2003

    Since I had to play tennis at 8 AM tomorrow, decided to skip the
    bike.  Wasn't sure if this was the right thing, but didn't want to
    overdo it.

Thursday, October 30, 2003

    Tennis with Bruce.  We had a good hit.  I was hitting very strong
    off both sides.  We did some simple drills.  I was moving my feet
    extremely well and getting well positioned for shots.  Stamina an
    issue, but I was working very hard.

    Played a few games at the end, won all 3, but Bruce played some
    good points.  Attempted to work the points rather than just
    hitting out on every shot (my pre-surgery approach) and felt I was
    fairly successful.  Points didn't become too long, I didn't feel
    like there were more than a couple balls I didn't reach because I
    was too slow, though I'm still not fast.

    I haven't been concerned at all whether we use new balls, but
    perhaps it's time to always use new balls.  I hit with such power
    that the time the ball stays on the strings is critical, and I
    know that with new balls a lot of my shots that sent balls to the
    opposite baseline would have popped out by a couple feet.

    Backhand is the best it's ever been.  I've been wanting to hit
    with more topspin on the backhand, but maintaining pace while
    adding spin and still hitting under control isn't easy, but I seem
    to have worked it out.  Watching Justine Henin has helped.  I
    don't go western as far as she does, but otherwise our backhands
    are pretty similar.  She develops a lot of power from her shoulder
    turn, and that's what I've tried to develop.  The key is to load
    up the tension as the racket and shoulder turn back.  The torso
    should *not* turn back with them, except as forced to.  You must
    try to maintain the torso in allignment with the direction of the
    shot, and let the shoulder turn push against it to build up
    tension.  The shot is working great, and this is fun!

    Leg felt extremely good later in the day.

Friday, October 31, 2003

    Leg feels extremely good this morning.  Looking back over the
    diary I see that when I first resumed tennis that I was making
    similar comments about how good the leg felt afterward.  I think
    that's why I was so hopeful that tennis could become my exercise,
    instead of the hated PT exercises.  I've just finished reading
    those diary entries more carefully trying to detect where tennis
    become debilitating rather than strengthening, and it really isn't
    clear.  Just suddenly on June 23rd I decided that tennis was
    hurting more than helping, even though the prior days had comments
    like "leg feels better than ever", though interspersed with "leg
    feels achy today".  I think it was that even though the pain and
    leg strength off the court were slowly improving, on the tennis
    court I was getting slower instead of faster.

    Even so, up to that point I don't think the slowness and pain on
    the tennis court were associated with the severe inflammation
    problems I experienced later.  In the diary I see a few days later
    on June 27th I comment that I hurt the leg while rough housing
    with Kathy.  Even though this was minor and it felt like I
    recovered from it within a week, I think it possibly marks the
    point where inflammation became a problem, though it could have
    been about a week later on July 3 where I ran a short distance for
    the first time, though there was no pain at the time or shortly
    after, so I tend to doubt this possibility.  But anyway, it was
    within a couple weeks after this that 5 minutes of exercise began
    causing increased weakness and pain that would last a few days.
    Only after I discovered that 20 minutes of icing would fix it was
    I able to resume more regular exercise.

    Does this help me understand what is happening more recently?
    After a couple weeks of tennis with no bike riding the leg became
    weak and painful, then after just a few days of riding the bike
    the leg became very strong and felt very good after tennis.  Do I
    still have to ride the bike?  Or should I only ride the bike when
    the leg doesn't feel good after tennis?

    The correct answer is that I should continue riding the bike no
    matter what.  It is very good for stamina, and I need that, and it
    is very good for the leg, even when the leg is feeling good.  I'll
    try to keep up the bike riding, but stationary bikes are BORING!!

    Rode bike for 4 sets of 3 minutes with maybe 45 seconds rest
    between each.

Saturday, November 1, 2003

    Great hit with Jim.  I was hitting strong topspin shots as hard as
    I could yet still maintaining control off both sides.  We played a
    few games, for some reason Jim kept serving to my forehand and I
    was just punishing the ball.  I hit a number of shots that were just
    too hot to handle.  I was up 4-1 when we stopped.  I should
    qualify this by saying I think Jim is having trouble getting out
    of the habit of being nice to me, plus he doesn't see that well
    inside and the ball was moving pretty good.

    Stamina was still a problem, but I seem to bring it on myself.
    The better shape I get in the more effort I put into my shots.
    Today I just couldn't let up, the shots were just too beautiful, I
    just had to keep nailing them.  Jim shouldn't insist on only using
    balls that have already been used once with me.  It *does* slow
    them down, but I can just hit harder and since they're not as
    lively they stay on the strings longer and have more topspin and
    so they stay in, where new balls would be more likely to pop long.

    Ran into Regis, the guy who recommended Dr. Benson to me.  I asked
    if he had had an inflammation problem and he said he never had
    anything like I had.  He said he resumed tennis at 6 weeks and
    never looked back.  Two years later he's still doing the exercises
    3 times a day.  He was surprised when I told him I had dumped the
    exercises and am just riding the stationary bike and playing
    tennis.  He had the left hip done, while I had the right, but he
    said that just like me he had had more trouble moving to the
    forehand side - try to make sense out of that (no, he's not a
    lefty).

    My legs are tired, the hip flexor is a little sore.

Sunday, November 2, 2003

    Rest.    

Monday, November 3, 2003

    26-week anniversay of surgery.
    
    Rest.    

Tuesday, November 4, 2003

    Rest.    

Wednesday, November 5, 2003

    Rest.    

Thursday, November 6, 2003

    Hit with Bruce.  Slowed it down some as I needed to run some
    errands through the afternoon.  Since I hadn't been riding the
    bike the leg was slow anyway.

Friday, November 7, 2003

    Rest.    

Saturday, November 8, 2003

    Last hit with Jim, he's moving to Florida.  I'll miss him.

Sunday, November 9, 2003

    Rest.    

Monday, November 10, 2003

    27-week anniversay of surgery.
    
    Rest.    

Tuesday, November 11, 2003

    Rest.    

Wednesday, November 12, 2003

    Rest.    

Thursday, November 13, 2003

    Hit with Bruce.  Kept it slow.  Conditioning was bad because I
    haven't been riding the bike.  Why not?  Personal issues plus work
    is busy right now, I'm just too busy, but I hope to get back to it
    soon.

Friday, November 14, 2003
    
    Rest.  Iced the leg.

Saturday, November 15, 2003
    
    I guess I'm not ready for old-guy doubles.

    Played nearly three sets of doubles with Jim (a different Jim),
    Paul and Dick.  They're all older gentlemen between 65 and 75, but
    Jim and Paul are both pretty strong players, both still playing
    singles.  Dick is the oldest at 75 and had a hip replacement back
    in '98, so we traded a few stories.  Like Regis, he also had no
    inflammation problem like I am having.

    I hit politely in the warmup, but once we started it was like
    someone turned on a switch.  I was mashing groundstrokes and
    volley winners all over the place.  I was hitting serves and
    groundstrokes so hard that very few came back.  The server's
    partner stopped playing net in order to avoid being a target.  I
    was ripping groundstrokes from both sides, especially on return of
    serve.  Before hip surgery their serves had managed to hold me
    off, I guess because I wasn't mobile enough, but now I was teeing
    off on them, justing eating them up alive!  It felt great,
    orgasmic even!!  I thought I was going to have to learn a new
    style of doubles, more lobs and dropshots, etc, but I guess I can
    put that off for a few more years.

    My upper operated leg began to tire and ache in the middle of the
    3rd set.  Suddenly I realized I wasn't getting to balls at the net
    anymore.  Poor Dick was diving for balls I was letting go by me,
    and I suddenly realized that what happened after my hip first
    began hurting had just happened again in miniature, and now I knew
    what was going on.  When you're feeling okay you just react, but
    as soon as the body starts hurting it somehow stops the brain from
    reacting.  The only way I could react was consciously, which is
    too slow.  This is why before surgery I was having so much trouble
    maintaining my level in doubles, where quick reactions are
    important.  No matter how much I consciously wanted to, somehow my
    body and mind were conspiring together to prevent quick reactions.

    This is very good news.  I've got to get back in the habit of
    riding the bike on non-tennis days, but I think I'll call Barry
    and see if there's a spot open on his team for the winter Team
    Tennis league session that starts in January.