Authory stuff (achoo!)

A few developments in Interbet Book Land ... I have a really truly rooly Amazon Author's Page (which involves your publisher verifying that you really are you, and stuff like that).

And I've got a whole page on my web site about the book now, too. My son took the photo - didn't he do a nice job? Points if you can name the two hand-knit items I'm wearing! On this page there's also a free Secret Shape puzzle you can download, print out, and try.

Reviews are slowly coming in (thank you to all the wonderful people who have reviewed it!!). You can read them on Amazon and on Fishpond, as well as various blogs (MadMad, Five Ferns, and Roxie, for starters).

Wiley have recently offered me a second puzzle book, BUT it depends on how their puzzle book sales go over the next few months, so it's on the back burner for the moment. If you were thinking of possibly buying my book one day, doing it sooner rather than later would be really appreciated!! There are links to online shops on my web site, plus it's available in bookshops in the USA and Canada.

Am currently laid up with the worst head cold I've had in years ... it crept up on Friday, I managed to get through friends coming over for lunch on Saturday, and a few cups of tea with friends on Sunday, but by Sunday night there was no denying it. Have been in bed for 2 days now, and still suffering from SFB (Snot For Brains). Blargh.

Cuddles from Petal help a little, when she's not being Psycho Loony Nippy Puppy! Her sister Alexis came over for a Puppy Play Date last week, they barely stopped for 2 hours of dominance 'play', growling, running, tussling, and nipping! She slept all afternoon, afterwards!

Chihuahua Puppy Jumper

Here's Petal's Cabled Jumper. She's fairly happy wearing it, and it certainly keeps her warm on these chilly Canberra winter days! Chihuahuas are very barrel chested and tiny, which makes it difficult for them to fit standard dog jumper patterns.



This is an adaptation of the Need for Tweed Dog Sweater (Rav link) by Shiri Mor

Size : Chihuahua Puppy - 3 months old (chest measurement ~ 23 cm / 9")

Needle : 3.75 mm / US 5
Bendigo Woollen Mills Classic 8 Ply, 30 metres - machine washable

Back

CO 20 sts

Knit ~7 cm (2.5”), with garter st borders, cables or pattern as desired.

Pattern I did :
RS : k3, p1, k4 (cable twist every 6th row), p4, k4 (cable twist every 6th row), p1, k3
WS : k4, p4, k4, p4, k4

When get to desired length :
Decrease at each end of row, every second row, for 5 rows (k1, k2tog, k to last 3 sts, k2tog, k1).

Bind off loosely.

Belly strap

CO 11 sts
Knit ~3 cm (1”) in garter st
Decrease at sides (k1, k2tog, k to last 3 sts, k2tog, k1) in alt rows until have 3 or 4 sts left. Leave sts on st holder.

Put it together
Sew Belly band to Back piece at sides (see photo). The narrow end of the belly piece should line up with the widest edge of the back piece.

Pick up stitches around the neck section (20 sts from back, cast on 6 new sts, slip the 3 or 4 sts from end of belly band, cast on 6 new sts = 35 sts total).

Knit in the round for 4-6 rows. Knit a few short rows for the chest section to make it deeper, as you go around. This section isn't really wide enough in this first jumper, I'll experiment with the next version and update these instructions accordingly.

Bind off loosely, darn in ends.

The nice big leg holes mean it’s easier to get on, and more comfy for a pup who isn’t used to wearing stuff.

Final step : Get onto squiggly puppy, somehow!

What the Occupational Therapist Said

On to the last section of the Joint Replacement Information Session I attended earlier this month. This is what Christie, the Occupational Therapist (OT), had to say :

The OT is there to help you learn how to manage daily tasks at home - bathing, toileting, sitting, driving, and so on. They can help with training, equipment, setting up your house, and so on.

Hip precautions are set by your surgeon (they vary depending on whether the incision is done from the front or the back of the thigh). At Canberra Hospital they are prescribed for strictly 3 months, no exceptions. And possibly longer (I know of women with hip dysplasia who were given hip restrictions for as long as a year). 3 months is the minimum time for the ligaments that support the hip joint (and were cut / disrupted during surgery), to restabilise and repair.

My surgeon (and most of the Canberra surgeons) use the posterior approach (closer to the back).

Hip Precautions (posterior THR) :

1. The operated leg must not cross the mid-line of the body - not when sleeping, standing, or sitting. No crossed legs!

2. No internal rotation. Do not let the leg turn in towards the mid-line (ie pigeon-toed) - and no twisting of the upper body towards the operated side.

3. Do not bend the operated hip less than 90º - so you can't bend forward for anything. This one has the biggest impact on daily functioning. I won't be able to sit on anything lower than my knees. There are some diagrams here.

Daily tasks

Showering

• Have your toiletries in easy reach, on a shower caddy or shelf. Don't leave shampoo on the floor, for example.
• Use soap on a rope, or liquid soap in a dispenser (tick)
  
• Use a long-handled brush &/or sponge (tick, tick)
  
• Use a shower stool if you're wobbly! (tick) They can be borrowed from the hospital - I got one from Aldi
  
• Not quite sure how to dry my legs yet ... my feet may get very good at grabbing towels for this!
  

Getting Dressed

• Use long-handled aids such as a reacher, grabber (tick x 2), long shoe horn (tick), sock putter-on-ers (tick) etc
• Have the items to put on in easy reach
• A long-handled shoe horn is extremely useful when away from home, as the curved end can be used to hook and grab things that slip out of reach (like undies when in the loo!)

Toileting

• Be very careful how far forward you bend
• Place the toilet paper forward, so you don't have to twist to reach it
• Use an over-loo chair at home for 3 months (will be lent to me from the hospital)
  

As for going to the loo when you're out ... this is a problem! Unfortunately all the disabled toilets I've checked so far have low seats - including the ones at the hospital!


After asking around on Hipwomen, several women mentioned using devices that allow women to wee standing up - I decided on the brilliant (Aussie invention!) Whiz Freedom. I know it only takes care of 'Number Ones' - but it's a great start (and great if you're into camping too!).

Cooking

• Have all equipment at waist height, easy to reach
• Temporarily store your crockery on the bench, or in some higher location

Cleaning and Gardening

Don't do it. Well, you can possibly do a little, with a great deal of caution. But there's to be no vacuuming, sweeping, mopping, digging, weeding, mowing, or raking. Any excuse to drop the housework, and get the kids and hubby to take over!

Work

Most people need 4-6 weeks off work - the main thing if you go back to work within the 3 months, you still need to do your hip precautions. I should be okay, since I work from home, and just so long as my brain is functioning (debatable at times!), I can work on my laptop in bed, or at my desk.

Driving

Driving after a joint replacement is illegal in Canberra for 6 weeks post-surgery. 3 months of no driving is recommended for THR.

As a car passenger : tilt the back of the seat backwards, so the angle is very wide when sitting down.

Setting up the house

• Check what steps & stairs you have to deal with.
• Grab rails in the bathroom can be very helpful. The suction cup sorts are not strong enough!
• Use a toilet seat raise for 3 months
• Low lounge chairs are out - look for more suitable seating around the house - they must be knee height or higher
• Foam wedge cushions are good (tick)
  
• Get in and out of bed on the same side as your operated hip
• Sleep on your back for 4-6 weeks
• Check the house for mats, cords, and ensure you have a clear pathway for your crutches - reduce the risk of tripping and falls!

Goals before admission

• Assess what might be difficult to do at home, so you can get help from the OT
• Organise your home environment
• Buy the small aids you need
• Finish any necessary tasks (pay bills, pre-cook meals, etc)

Walking Aids

After surgery you start out on a forearm support frame, then move to a pick-up frame or a wheelie frame. Finally, crutches and walking sticks, which you'll need for quite some time at home. I've got walking sticks and elbow crutches of my own.

NB : It's normal to get an increase in pain when you go home from hospital, as you're being much more active.

Hip Dislocation

You'll know if it dislocates! Go straight to Casualty (by ambulance if you can't sit up), and get them to call your surgeon - they can fix the joint, pulling it into place, but it will require anaesthetic. Possibly surgery. Urk.


Your Miss Petal photo reward. She's wearing a little jumper I designed for her.

She's a TINY thing

Just so you can see how tiny Petal is - this is her in the kitchen with Dotter, having a little chat ...

Baking Soda Poultice

My sports physician Dr Rob Reid (who knows everything there is to know about joints, tendons, bones, and such) recommends using a baking soda poultice on swollen and inflamed joints. I find this quite soothing on my sore knee.

He says : "A poultice using bicarbonate of soda is used to decrease the swelling in and around a joint or draw out fluid or oedema from under the skin. The joint swelling may be because there is fluid within the joint, or that the covering of the joint (the synovium which holds the fluid in the joint) is "waterlogged" and this produces a boggy swelling of the joint."

Here's how to make one!

1. Gather your equipment : a bag of baking soda, some water (warm or cold, up to you), a mixing spoon, a bowl, and a piece of scrap fabric (old shirt / t-shirt etc).


2. Mix roughly 2 cups of the baking soda with enough water to make a firm paste, roughly the thickness of bread dough. It should be soft and moist, but not runny.

3. Place the lump of baking soda onto your square of fabric.

4. Tie up opposite corners, to make a neat little bundle like so. There should be just one layer of fabric under the poultice.

5. Sit or lie down for an hour, with the poultice sitting or lightly strapped onto your swollen knee, ankle, wherever ... I usually keep a face washer or towel handy, as it can drip a bit.

After the hour is up, put the baking soda mix into a lidded container, rinse and dry the fabric, and reuse the next day (just add a bit more water to get the paste consistency again).

Dr Reid says you should refrigerate the poultice, and replace the baking soda after about 3 or 4 uses, but really, I don't see how that would be necessary, as it's never going to go off ... I've used the same batch of un-refrigerated baking soda for more than a week without problems, it still fizzes slightly when I add water.

He goes on to say : "The bicarbonate of soda poultice will draw the fluids out of the joint over a period of time, and this commonly takes 7 to 10 days, especially for a joint that has a boggy swelling for more than 1 or 2 days. The poultice can be used in association with any other treatment that is being used, and does not cause any skin problem."

More delays

I called the Surgical Bookings at hospital this morning ... and they're saying August/September for my THR surgery. Sigh. I will still have my Pre-Admission Clinic soon, but that's 'valid' for 6 months. I reckon I'll be lucky to have this thing done by the end of the year.

This is the disadvantage of being a public Medicare patient - private patients and more urgent cases take precedence, and push you further down the waiting list. Canberra has the worst / longest waiting lists in the country, too.

The advantage of being a public patient is the operation and hospital stay don't cost me a cent. So the wait is worth it! I'll keep posting about my preps and stuff now and then, but don't have to think about it quite so seriously just yet. The waiting is the hard part!

What the Physiotherapist Said

Part 2 of the Patient Information Session

Physiotherapist - Christie

This is the physio program after THR, at the Canberra Hospital. If you're having this operation, your own hospital and physio may have different guidelines.

Day of surgery (Day 0)
Deep breathing / coughing exercises, to help expand the lungs after surgery
Ankle/foot exercises

Day 1

• 1 physio session : start on exercises
• Get out of bed with 2 people assisting
• Walk 10 metres
• Use large walking frame
• Sit out of bed 1-2 hours
• Discuss hip precautions (next post)

Day 2

• IV pain relief comes down, onto oral analgesia - take it regularly!
• 2 physio sessions, morning and afternoon
• Progressively more difficult exercises
• Out of bed with 1 assistant
• Walk further than 10 metres
• Sit out of bed morning and afternoon, 2 hours
• Use smaller walking frame
  

Day 3

• 2 physio sessions
• Be independent with your exercises
• Get out of bed independently
• Get into bed (harder than getting out) with help from only 1 person
• Progress to small walking frame or crutches
• Walk at least 30 metres
• Looking at discharge options, and discussing home environment
• Moving around frequently
• Walk to toilet, no bed pan
• Sitting out of bed morning and afternoon
• Need to change position hourly.

Goals for Days 3-5

• Practice stairs with crutches / walking stick
• Standing exercises
• Independent with exercise program and transfers (in/out of chairs, beds, car etc)
• Able to walk over 50 metres
• Able to negotiate 5 steps
• Sit out of bed most of the day
• Perform physio outcome measures
• Good understanding of hip precautions

Generally go home around Day 5

After leaving hospital
The hospital offers 2 free physio sessions a week, for a month, to progress your mobility, functioning and self-care for hip and knee replacement patients.

Ongoing physio is vital!

What the Occupational Therapist said is next .... :)

Your Petal Photo reward for today :

LOLs

If you click on the pic, you can give it a vote (use the cheezburgers above the image)!

Impatient Information - What the Nurse Said

This is the basics of what I was told about THR at the 2 hour Patient Information Session on Joint Replacement (Hips and Knees) last week. There is a ton of info, so I'll break this into several posts. Keep in mind that this is what is done at Canberra Hospital (see the piccie? That's where I'll be!). This may give you some idea of what to expect for your THR, if you're in the same boat as me, but obviously each country, hospital and surgeon has their own way of doing things.

Hubby came along with me. As expected, I was one of the youngest at the info session - 3rd youngest out of about 20 patients. There was a young girl who looked like she might have rheumatoid arthritis, poor thing, and a man in his 30s with a degenerative joint disease. Everyone else was roughly aged 65-85, at a guess. No-one else had CDH, no surprises there!

The Nurse - Hanna

Some days before surgery there will be a Pre-Admission Clinic, where I'll meet with the nurses, anaesthetist and surgical registrar etc. Blood tests, urine tests, ECG, yet more hip x-rays, and other baseline observations will be made. This is my chance to tell them I have PTSD associated with my childhood surgeries, and that I'll need some help when coming in for surgery (knock me out, please!). More on PTSD later (another post).

The general plan is to come in to hospital on the morning of surgery (not the night before, which is what I've always experienced before). Nil by mouth from midnight, of course. Go to Admission, then into the glamorous "Theatre Gear", and into a Holding Bay until it's my turn off the rank.

I'm actually feeling very anxious about this, it is triggering a lot of my PTSD stuff. I will be sobbing with fear the whole time ... it upsets me even just thinking about it. I really wanted to be sedated in my room beforehand, and oblivious when leaving for the operating theatre. I may be able to change this, I'll discuss it at the pre-admission clinic.

After the operation, it's off to the Recovery Unit, and then Ward 11B, which is for joint replacements only, so all the nurses are very experienced. I'll have a urinary catheter in (put in during surgery), a drain in the wound, and a Charnley Pillow between my legs.

I'll have PCA (Patient Controlled Analgesia) with delicious morphine or fentanyl. You press the button, and you get the nice happy drugs! It's not possible to overdose, as it can only deliver one dose in 5 minutes, no matter how feverishly one presses the button!

There will be either a femoral nerve block in, or an epidural. I really would prefer the femoral nerve block, don't want people mucking around with my spine! Still, don't suppose I'll have much, if any, say. Either of these would be in for about 48 hours, and will numb my leg/s, but I'll still be able to move them.

I'll also be attached to an Alaris pump (IV) and have a canula in my arm, to give fluids and prophylactic antibiotics. This, the catheter, and the wound drain will probably be in for about 48 hours.

On return to the ward, the nurses will check my dressing, make sure I can move my toes, and take my "vitals" (blood pressure, pulse, temp etc) every 30 minutes for the first 2 hours, then hourly for a while, then every 4 hours, tapering down over the days. They'll also give me a bed bath to try to help remove some of the almost indelible bright pink antiseptic paint Canberra orthopedic surgeons favour of late!

Hanna advised wearing nighties (for the women!) for the first few days - it's not really possible to wear PJ pants or undies, with all the tubes and stuff. Dignity goes out the window with this sort of surgery, that much is a given!

There will be 'pressure area care', where I get rolled around in the bed (wheeeee!) to avoid pressure sores. Carefully and slowly, one hopes!

Once the pain machines are taken away from me (why?! WHY?!), the Acute Pain Team (great name, hey?) will come around to see me. They make the decisions about pain control, check me daily, and can prescribe whatever I need. One thing Hanna stressed was to KEEP ON TOP OF YOUR PAIN MEDS. Don't let them wear off before asking for more. This ensures you'll be covered when your physio sessions happen (which are on short notice), as well as helping recovery in general.

Some of the oral pain meds on offer are :

• Endone (narcotic)
• MS Contin
• Good old Panadol - which can enhance the effects of narcotics, and is very effective for bone pain
• Meds for nausea, if needed

Another tip about pain relief is that the nurses will give regular meds, but if they're not cutting it, and you're still in pain, you need to ask for the strong stuff. Hanna really emphasised how important it is to let them know.

There is a high risk of Deep Vein Thrombosis (DVT) after joint replacement surgery, so there are several things that will happen :

1. Early mobilisation - ankle & foot exercises right away, and up and walking, even just a little, by the day after surgery
2. Clexane injections (anticoagulant)
3. TED stockings (possibly)

I will be on Clexane for a month after surgery. It's an anticoagulant medicine, which helps avoid DVT, as mentioned. It's given by injection, and we have to learn to inject ourselves at home. We were given a CD with a video on how to do this, plus we'll be shown in the ward. Oh joy.

Here's your Petal piccie. She's reading a card sent to her by a friend in the States. One clever puppy, no?

THR Time

My blog is going to veer somewhat away from knitting in the months ahead, and limp into Total Hip Replacement Land. I'll go into a fair bit of detail, as I hope this information may be helpful to others with dysplasia who are heading down this THR path too (hello to all my friends over at Hipwomen!). Never fear, there will still be puppy piccies!

As you may know, I've always had crap hips.

To summarise (skip this if you've heard it all before!) : I was born with a congenital dislocated hip (CDH, left) which was picked up when I was 20 months old. By the time I was 7 I'd had a failed tendonectomy, two failed open reductions (all done in Australia in 1966-67), one successful and experimental open reduction (by the rather fabulous and innovative Professor Wayne Southwick at Yale University Hospital in 1969), and a (minor) femoral osteotomy in 1973.

I've spent months in hospitals, years in double hip spica casts (full body plaster from under the arms to the toes, with a metal bar between the legs to keep them in position), and even longer in uncomfortable braces at night, and traumatised my poor parents, as well as myself. In those bad old days, there was no physiotherapy or much rehab after surgery (something which surprises me in retrospect!).

Because my pelvis was so damaged by my surgeries, my pelvic outlet is distorted, and I needed two caeserians for my children, as no baby was ever going to get out - so one emergency in 1988, and one planned in 1991. My pregnancies were difficult, with a great deal of hip pain because of the softened ligaments and so on. After my children had been born, my mum remembered that Prof Southwick had said my hip joint 'mightn't survive pregnancy' - it certainly felt like it came close!

I have been able to function fairly well, though, thanks to Professor Southwick, despite my short and turned-out left leg (I was never a sporty type, hardly surprising).

As expected, arthritis set in around 12 years ago. With CDH you're generally looking at an early hip replacement. I am not a candidate for hip resurfacing. Professor Southwick said my hip might last for around 40 years, and he was spot on - I'm nearly 45, and it's exactly 40 years from my last major hip surgery.

Last year I was persuaded by my physiotherapist and sports physician - and I was extremely reluctant - to see a surgeon to start the process for a total hip replacement. I chose Dr Damian Smith, a lovely young guy who is a specialist in CDH as well as hip replacement, and I've been very happy with him so far - he's made time to see me when I had questions, and has been approachable and sympathetic.

And it's just as well, my physio and doctor were perfectly right - 8 months after going on the waiting list for a THR, my left hip is giving me nearly constant pain, I need extra pain killers at bedtime, and I'm back to using a walking stick most of the time. I can't walk far, and stairs, shoes and socks are increasingly a problem.

It's impacting on my right side too - my right knee is very painful and often swollen, and my right hip is painful too. This is mostly from the stress of taking over from the left side. My right knee needs to be strapped by my physio several times a week (taped to support it), and I have a slight lift at the outer edge of my right shoe to ease the strain on my right leg. I can't kneel on the ground any more.

THR when you have dysplasia is more complicated, in general, than for if you've 'just' got osteoarthritis. In my instance, my bones are unusually small, and deformed, so getting a secure replacement joint is going to be quite a challenge for Dr Smith.

However, last time I saw him, dear Dr Smith said some words which I really didn't want to hear, when he was looking at my latest x-rays : You do know your right hip isn't normal, either, and is going to require surgery?

Argh! I'm a bit worried that he'll recommend a PAO (periacetabular osteotomy) which is a major and rather bloody awful operation, where sections of the pelvis are cut and repositioned with screws, to create a better hip joint. Very long recovery. But it can get many years out of your own joint / bone, without needing a joint replacement.

Still, I'm trying not to think on that part too much, and just get through Leftie's stuff first.

I attended the compulsory Information Session for Joint Replacement at Canberra Hospital last week (which I'll detail in my next post), and they can now book my surgery date. Don't know exactly when yet, but should be within a month or two, most likely, and possibly with not much warning.

And your reward for getting through all those words, I give you : Petal - 12 weeks old - all together now - aaaaaawwwwwwww!


PS I meant to schedule this to be posted tomorrow, so you'd have time to enjoy my Good Luck Cowl (below) as well, but Blogger went all stupey-poopey on me. Never mind :)

Good Luck!

Aaah, knitting weather! It's been a good time to finish things, what with the hiatus between projects that I'm in at the moment.

Here's my Good Luck Cowl. Knit with qiviut (musk ox), kindly sent to me by Abbey! I cast this on for Knitting Camp in late April, and finished it a few nights ago, just in time for some really cold weather.

This is the cowl pre-blocking ...


... and post-blocking.


A close up of the stitch pattern :


Here's its Ravelry project page. The qiviut really is beautifully soft and super warm! Are you surprised to hear that Petal likes to snuggle in to it, too?

Ribby Jacket

This is the pattern booklet I got at Knitting Camp in late April ... it was a simple knit, all 2 x 1 ribbing, knit flat. I finished it in a month, and must admit I hurt my hands by knitting all that ribbing, too quickly.

Anyway. Here's the end result!


Knit with Cascade 220. Delightful stuff! It's pilling pretty quickly, but I'm willing to forgive it, for its softness and warmth!

I've done the button / buttonloop twice now - once too low, and it's currently too high - so hopefully I'll be third time lucky! But it's a very comfy cardy, I really love it. Petal loves it too, and keeps pulling and chewing at it. Hmmm.

Errata

Thank you everyone for your lovely kind and heartfelt wishes on Uncle Tony's passing. His funeral was last week, in Albury, and everything went well. It was great to see my aunt and cousins, and other family, despite the very sad occasion. My SIL (who is a celebrant) ran the event beautifully and thoughtfully as ever. I did a slide show of around 80 photos from Tony's life was well received, too, at the wake. Our photos of the event are here, if you're interested.

I've just finished reviewing my copy of Word Searches for Dummies, and found (with some help from others, thank you Five Ferns!) various errors, damn it. I guess it's inevitable. There is now a page of Errata on my web site. And if anyone else spots mistakes (that aren't already listed), please let me know! All these will be fixed in the first reprint.

And now, some gratuitous puppy piccies, because I know that's what you really came over to see! Petal is 11 weeks old, and cuter than ever. Her ears are definitely up!


She loves playing with balls, and cracks us up when she chases a full size tennis ball, and then picks it up! Her tiny teeth catch onto the fuzz - the ball is bigger than her head!