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.