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Sunday, December 28, 2014


I realize that my updating on my blog weekly has fallen behind.  I had a lot happen these last several weeks and have neglected to update.  I am working full hours now and am still trying to wean off crutches.  I am 12.5 weeks out and can do one crutch at work and no crutches at home.  Coming off crutches is difficult when I have such long hours on my feet.

My right hip pain is pretty good.  Though I still have surgical pain, my hip itself feels pretty darn good.  My left hip still is there and I think its here to stay until I get the hip cut out in a replacement.  I am thinking of asking for an injection when I see my surgeon next; hopefully it will settle things down decently and allow me to work with less pain.

My incisions are looking great though the screw heads stick out nicely on my right hip and I can't wait to get those removed.  I have a March 6th surgery date for those to get removed in the OR.  I am hoping that this is the last time I will have to go into an OR for a long while.  My hope is to get through residency (which is three more years) without having to have another surgery.  That isn't unreasonable!

Short and sweet.  I'll update more frequently in the near future.

Until then, Merry Christmas and Happy New Year!

Thursday, November 13, 2014

6 Weeks Post RPAO

I can't say that I'm depressed, but I can say that I am in a valley as far as life goes.  I have returned to work for the past two weeks and it has been more than difficult to get through.  Though I am working minimal hours (PTL) I am still finding it difficult to stay afloat.  I am struggling each and every day with pain and fatigue.  Currently I am more than exhausted.  I realize God doesn't ever give you more than you can handle, but this surely is a learning experience for me.  I am growing as a person, whether I like it or not.  I don't have a choice, I needed to have this surgery and I still needed to work.  So I did both (with a four week vacation).  I wouldn't recommend anybody in their right mind return to work at four weeks.

Currently my right hip is not terribly sore.  The muscles are sore, but the joint itself has been quite calm. I have not had any groin pain since surgery.  I still have pubic bone pain and my incision is very VERY tender still, but I manage.  I did go up on my Butrans patch this past week as my left hip is terrible having to accommodate the added weight of being the sole weight bearing hip.  I think the increase has helped but I don't intend on being on it for too long and hope to wean down slowly over the next couple of months.  I'm still on my Neurontin for my obturator nerve on my left side from my LPAO, I thought I could get down to 600mg at night, but I need one more dosage during the day to keep the nerves quiet.  I hope that I can also wean this medication over the next couple of months as well.  I am still non weight bearing on my right side and am totally sick of crutches.  I see my surgeon next week for my second post op follow up...hopefully then I will be cleared to weight bear.  I plan on starting PT next week as well.

Back to the mental, emotional, and spiritual aspect of recovery.  I am finding this surgery terribly difficult to press on with positivity and hope.  It feels like I'm a patient revolving through Operating Rooms over and over, never fully giving my body a chance to heal.  The longest I've gone without a surgery in 8 years was in 2013 when I went from September 2012 through to February 2014 without a single surgery. Now, it's been two very large ortho surgeries during 2014 and will be planning on screw removal in the spring of 2015.  I long for the day that I am wheeled back to the OR for one last time for a few years (when I get my LTHR bc we all know that the replacement IS actually coming my way).  I need to place my fears in the Lord, have faith, trust, and persevere onward, through pain, fatigue, and exhaustion.  I pray for strength, endurance, and peace; but most of all for strength to get through this difficult time.  This has been a major hurdle in life and I had always hoped I would make it through with grace and positivity, but currently, I'm feeling the opposite. 

Friday, November 7, 2014

5 Weeks Post RPAO

Ok, so like, yeah, things have been hectic; too hectic to be good.  I started back to work officially at four weeks, but unofficially at 5 weeks. So I had to do anesthesia for three days then the weekend off then start outpatient clinic. The anesthesiologist showed mercy and told me to not come in and to stay home and continue to recover.  Which was necessary since I wouldn't be able to do any intubations anyway.

I then started outpatient clinic at just shy of five weeks post op.  Eww. Yeah, it is absolutely no fun crutching into patients rooms and having to think about medicine at this point in time.  I'm exhausted.  Literally, by noon I'm ready for a nap.  It's not the pain that is a problem (though my left hip hurts tremendously from being the sole weight bearing leg), but the lack of stamina.  I have negative energy at this point in time.  Two days after I started in the clinic I got a sore throat and then, yesterday, viola!!!!  I have strep throat. No kidding this is horrible.  I'm still feeling gross from the surgery and then I have a disgustingly sore throat with exudate, a fever of 102F, vomiting, myalgias, lack of appetite, cervical lymphadenopathy.  All around a bad day yesterday. Phew.

Today is better though I still have a sore throat, I am not vomiting and my fever has broken.  It is a shame that I had to get sick because I am hanging on by a thread anyway, and to add this sickness on top of the massive healing I am doing, it just drains me.  Oh, and to add insult to injury, I am studying for boards (which are December I will be able to sit for 9 hours of multiple choice questions is beyond me) and the regular readings we are required to do for my residency.  It all is, well, EXHAUSTING. 

I hate complaining.  In fact, this entire post has been relatively depressing.  I am not depressed, I'm just drained.  Completely drained.  I should still be staying in bed, icing, and watching movies on Netflix instead of commuting 1 hour and 45 minutes a day, seeing patients, and studying.  It just is a very rough patch in life.  I like to think it will build character; but for now, I need a pick me up.

As far as the right hip goes, it is relatively pain free.  I still have soft tissue pain from the surgery but the groin pain has gone away. My left hip still has tremendous groin pain but the anterior pain from the screws is much better.  The incisions look great.  I had a piece of suture sticking out on the distal portion of my PAO scar and I was fiddling with it today and it kinda just fell off.  Meaning that there is a small hole at the distal portion of the scar where the incision is; I'm kinda freaked out!  I hope it closes soon. Sigh.

over and out.

Tuesday, October 28, 2014

4 Weeks Post RPAO

Today marks a month from my surgery, exactly one month ago I was in the OR getting sliced and diced.  I am happy that I will not have to do a PAO ever again.  EVER AGAIN. Never, ever, ever.  That sounds pretty darn good to me.  I realize that a LTHR will be in my future as well as right screw removal, but, no PAOs again.  If I can get through a PAO, I think a THR will be easier.

Overall I am self-sufficient.  I can't pick things up off the ground but can do everything else. I started driving a couple of days ago as well.  It's not too bad, I have enough control of my leg, just turning corners and the movement laterally of the hip by accident is what hurts.  I have stopped taking my Tylenol 3 all together and put back my Butrans patch and supplement with Tylenol Extra Strength and Tramadol 4g total in a day (yes, that is still max dose).  I appreciate the steady state of pain relief in my system, though I have lost my tolerance to the pruritis from when I was taking the Butrans pre-op so I have had to take some benedryl to prevent me from scratching off my eye lids in general.

Today also marks my last day off from work.  Yes, I am returning back to work at four weeks post-op.  I am not happy about this at all, but I don't have a choice and I have to try.  I was originally given three weeks but managed to get an additional week off without having to make it up at the end of the academic year.  I am going to try and return keeping in mind that if it's purely impossible then I will not hurt myself trying to work and will have to take more time off.  I am going to be miserable, I know that, I just hope I don't hinder my healing.  I hope I'm not stupid for going back so soon.

I had scheduled my return to a rotation in an outpatient clinic, but since there are three days more than four weeks in October, I have three days which need to be filled with my October Anesthesiology rotation (which I intended on missing completely).  I obviously can't go into the OR and intubate people, and that is the focus of this rotation, so I am not sure how or what I am going to do for the next couple of days.  Please pray that I make it through because I could cry thinking of just trying to get from my car to my locker to the OR area; I don't know how I'm going to do it.

I also managed to step completely down with all of my weight onto my right hip today...TWICE.  This is not an ok thing to do.  It hurt like the dickens.  I know that my surgeon did a solid job, but I can't help to worry.  Plus, with my osteomalacia, I have to be very careful since my bones are so soft. I hope this osteomalacia does not hinder my healing in any way, shape, or form.  So not looking forward to working this up in the future.

Friday is my birthday, so Happy Birthday to me: let's go back to work waaaay too soon.  Not.

Thursday, October 23, 2014

3 Weeks Post RPAO

Two days ago marked the three week post op date from my RPAO, right hip scope, left screw removal. I'm definitely getting better, just its really really slow compared to last time.  Last time, it was as if a switch was flipped at 2.5 weeks, this time it is not the case.  But I am getting better.  Showering is much easier, I can sit up without having to hold myself up on the shower chair.  I will continue to use the shower chair until I am fully weight bearing. I still have to sleep on my back as I cannot lie on my side (non-op nor operative side) yet, so sleeping is most uncomfortable.  The majority of the time I sleep in the recliner which keeps me contained and removes the urge to flip and flop around (it's like a tease to be in bed and not be able to turn over).  I still require the maximum dose of tramadol and supplement with Tylenol 3 when needed, but my pain is controlled now with the these as opposed to earlier, I was NOT achieving adequate pain control with these medications.  So things are getting better.  I am cleared to ride the stationary bike now, but have yet to do so.  I will try maybe later on today provided I'm brave.  As of now, the standard crutches with the Crutcheze pads are working well.  The purple ones I bought are very nice and I love the colour, though my wrists, elbows, and shoulders are achy all of the time. I have very loose joints and the upper body joint pain is definitely something that is expected given my hypermobility.

A couple of days ago I had my first post-op radiographs and appointment.  It was less than informative.  I had radiographs done which show a stable RPAO and left screw removal. I am allowed to ride the bike as mentioned above.  I have to remain non-weight bearing but can place my foot down with enough pressure so as not to break a graham cracker (which isn't much but does allow for proper gait heel strike and toe off) for another month when I go back for more radiographs.  Otherwise, I still have some symptoms and issues that cannot be explained.

First of all, I have significant numbness on my anterior and lateral thigh which cannot be accounted for solely from the lateral femoral cutaneous nerve.  My surgeon did not even see this nerve and thinks it could be from the retraction during the surgery or from the scope, but even if it was, it should not be so significant (as in I should not have complete lack of sensation from the surgery), he said it was not normal and could not explain why I had this for both my PAOs.  We will watch at wait.

Secondly, I have significant pubic pain which also should not be there.  It is swollen too.  I asked about it and he said that it could have been from the scope, but that he is not sure.  It doesn't make sense that it would be from the scope as it is tender anteriorly, not inferiorly.  So, I will continue to ice and hope that it goes away.

Thirdly, I apparently have soft bones.  Like really soft bones.  He had told my parents immediately post op that my bones were soft and my mum had asked about this during this appointment. He said that I did in fact, have soft bones, and that we will look into it later.  He wants to do a bone density test and we will investigate other possible etiologies. I am concerned as it likely isn't just lack of sunlight since I still have tan lines from tanning this summer, so if it is vitamin D deficiency, I really don't know why.  My surgeon took 5 different x-ray views of my right hip at my post-op visit.  The false profile view shows loose transformation lines which are essentially a linear fracture consistent with osteomalacia. I am taking high dose vitamin D right now  plus calcium and a gummy multivitamin for bone health.  I am not into taking vitamins very much, but this has me on alert and I will be taking vitamins the rest of my life since I am at risk for osteoporosis (if I don't already have it). I feel like this is just another blip in the road to recovery.  I just want this hip ordeal to be done, and just when I finish my last major surgery for a while, I have to go figure out what and why my bones are the way they are.  I don't want to dig up any more problems, but, I don't really have a choice, do I? 

Why can't things ever be simple? There is always something.

Friday, October 17, 2014

Hosptial Stay

I felt great considering I had just had my pelvis broken.  PT came by and got me out of bed and I crutched into the hall and back to a chair in my room.  This was no easy task.  I did shed a few tears, but I did not yell at the physical therapist, so that was good.  My pain was initially under control with a dilaudid PCA, which was stopped in the afternoon and I had a foley catheter, which was also removed in the afternoon.  I had not had a bowel movement but I was able to urinate.  My dad went and got me a pumpkin spiced latee with whipping cream from Starbucks too--which totally made my day!! :)  I used the CPM every time I was lying in bed.  The surgeon came by after his work day at a different hospital and told us that the surgery had gone very well and that the right hip was in much better shape than the left hip and he expects me to get like 20 years out of this hip.  That puts me at 50 years old! I can handle never having another right hip surgery until I am 50! (excluding screw removal which will happen in hopefully 6 months time).

Early in the morning (maybe even prior to midnight, things are fuzzy as far as chronological order goes), I started having extreme nausea. I was given Zofran which did not help and ultimately Phenergan which did help but not before I was puking my guts out.  I think I threw up like 6 times.  Vomiting after having your pelvis broken is very, very, very painful. I don't think I had ever experienced pain like that before. And, not to mention this vomiting was not the normal 'let's throw up in a bucket type', it was projectile. YUCK.  But after this occurred, things settled down.  I had my drain removed in the morning as well as my surgical dressing.  Ok, so obviously they just slapped that dressing on haphazardly and didn't even consider where they were placing the sticky bit of the dressing because holy crap it hurt to remove the dressing from the sensitive areas!! Like COME ON, if I had wanted a full bikini wax, I could have done it myself with less pain than when they removed the dressing. Ouch.  On this topic, (sorry if TMI, but if you were a gal having this surgery, you'd have these questions too!), I thought I had 'cleaned up' down there enough before surgery.  I was all trimmed and shaved the day of surgery laterally just to ensure they didn't have to shave in the OR.  Well, they shaved me anyway! I was so put off, like I was NOT messy and it was not in the way and they still removed a significant amount of hair. So, best piece of advice, clean up WELL.

PT also came by today, which again produced tears. I was able to get up, crutch out of my room, and then up the stairs.  It was funny, there were only two stairs this time.  Last time there were four stairs.  Having said this, I could be wrong (was on a lot of dilaudid) and am just exaggerating the number of stairs because it was so painful to move last time that the stairs were very daunting. I passed the PT and was moving well enough to have her sign off.  I didn't need OT this time either since I was "a pro at hip surgeries by now". Oof, sad....8 hip surgeries later, you would expect me to be able to navigate and move around alright s/p an operation.

Today, I didn't throw up anymore, I didn't poop, and I did pee.  I was still using the CPM.  My appetite had significantly decreased from my nausea that comes in waves throughout the day.

My night was uneventful, slept a lot as my nurse was incredibly paranoid about controlling my pain. We had chalked up the previous night's events to pain which had got out of control and lead to my nausea (well, when I say 'we' I mean me because when my surgeon rounded later on this day, he took off the dilaudid and wanted the resident to take off the Norco as well and just suck it up with Tylenol, but the resident refused to remove the Norco as he understood I had a big surgery and didn't want me to suffer needlessly). This night also was the start of my urination problem. If you've ever had urinary retention after surgery, you will know it is a big ordeal. So, I had to pee around 2am. The nursing assistant got me up from bed and into the bathroom where I sat for 20 minutes trying to pee. Absolutely nothing was coming out. But I thought I could feel the urge, just I couldn't get it out.  They bladder scanned me and found 500cc on the scan, so I got straight cathed for 650cc.  This was such a relief to have my bladder emptied, but not a fun experience to have to get that done.  I've only ever had a catheter placed in the OR when I am out stone cold. Not the most fun experience.

My surgeon rounded again today in between his cases in the OR. He told me that he wanted to take off all narcotics (as mentioned above) to reduce the nausea.  He asked if he thought I could do with just Tylenol, in my head I thought 'ARE YOU CRAZY!?!?!?! YOU JUST BROKE MY FREAKING PELVIS!!!!'....I politely told him no, I didn't think that would be a good idea, so I got Tramadol in addition to the Tylenol to manage my pain. Sweet, no narcotics after breaking my pelvis, a hip scope, and screw removal. Rolls eyes. Anyway, he was so nice otherwise.  I don't understand his drastic change in personality compared to my first PAO round.  First time he was literally kicking me out of the door with discharge orders in on POD#2 and now he told me to take my time, we were in no rush to get me out of here and that I should stay as long as I felt I needed so that I was comfortable to go home.  The only thing we were waiting for was for me to ensure I could urinate decently and my nausea.

After my surgeon left, I decided that I had to pee. Ok, so really, shouldn't be a big deal right? Lug my sore and swollen body to the crapper and pee. Nope. Honestly, there was no way I could get my pee out! Even if my life depended on it, it was NOT coming out. The nursing students were instructed to bladder scan me. The one nursing student had to be a fresh as they come as she didn't know anything.  So I had two nursing students trying to figure out the bladder scanner.  They were scanning and saw 700cc in there, they quietly whispered to themselves that this couldn't be right when I told them that it definitely could be right, and probably is because it HURTS. They got their preceptor and of course my nurse was on lunch, so I had the covering nurse who was a crazy woman come and fix this pee problem I had so nicely developed. She didn't have an order for a straight cath so she decided to insert a foley catheter just in case they wanted to put a foley back in, then she called the resident who didn't answer, then she called my surgeon! (In my head I thought, great, she's totally over reacting and she was all frantic when talking to him, and all he said was straight cath the freak who won't pee...ok, I bet those weren't actually his words, but I bet that was what he was thinking). Anyway, the foley came back out since they just wanted to straight cath me. It's a joy having catheters put in and out of your bladder every 8 hours. While on the pee topic, they decided that I should be bladder scanned 8 hours later to ensure I didn't have pee in there.  Well, 8 hours rolled along and I did not have the feeling of a full bladder. They scanned me and looky looky--600cc of urine in there, my fabulously gorgeous orthopedic surgery resident (yes, he was HOT) so graciously put in an order for a foley catheter to give me bladder rest. Sweet. Not.

My night was uneventful. In fact, I actually slept through the night. My pain was worse since I was only on Tylenol & Tramadol, but I was managing alright.  My appetite was not there at all, and I was just simply exhausted.  I still used the CPM and was basically just waiting for my bladder rest to finish so I could go home.  The plan was to keep it in until tomorrow morning when they would take it out and see if I could pee.  There was a possibility that I would go home with a foley and then follow up in the urology clinic the following Wednesday to try and remove the catheter. This totally stressed me out as there was no way I was gonna go home with a foley! I came in for hip surgery, I did not want to leave with a freaking foley. UGH.

I basically chilled all day.  I got up with the help of my parents and crutched down the hall a few feet (maybe 10?) and then didn't do much. My appetite was completely gone, all I ate was cottage cheese and Jell-O.

I was determined that I was gonna go home today.  I got my tank top on under my hospital gown, put on my favourite Lululemon headband and sat up in the chair to eat breakfast.  While eating the resident came by and was all happy that I was eating and we would remove the foley for a trial of void.  I told him that I wasn't hungry but I was eager to try to pee. Not 10 minutes later, I was extremely nauseated.  I had the nurse and aid help me to the edge of my bed.  That's when the puking started.  But this time, it wasn't going away. I threw up over and over until I was just retching with nothing coming up (sorry for the disgustingness of this, but it is what happened). The hot resident came back in and was flabbergasted that I was like this, he was gonna tell me I was going home and now I was throwing up. He waited outside for this to stop and every time he came in, I started retching again.  At one point we were talking when I had to interrupt him to dry heave into the cute rose coloured barf bucket. He kept trying to talk to me while I threw up, but I couldn't pay attention to him.  Ended up the nurse, kinda sternly, told him that this was not the time to try and talk to me and he agreed to come back later. Before he left he told me that I would likely not be going home today.  Really?! I can't go home like this? Ugh. He didn't come back later that day.  All I was instructed to do was stay in bed and minimize movement.  I slept all day thanks to the Phenergan they kept giving me. What a waste of a day.  In the hospital another day. 

My surgeon was off this day and could not come in so he sent one of his covering partners to come in. Which was awkward. I was still puking and a strange man without a name tag wearing a plaid shirt and jeans came into my room and stood there staring at me. I turned to him (between pukes) and asked him 'who the heck were you?' In retrospect, I was kinda mean to him :/ He explained who he was and then was like 'Oh! You're the one with the urinary retention. We've had a lot of discussion about you with the residents and your surgeon." At this point I was writhing in pain because, again, that much pressure on the pelvis after having it broken was horrendous.  All this doc said was that I had to relax! RELAX?! You try throwing up after a PAO! He said he was gonna take a look at my medications and try to figure something out for me.  His solution: Valium for anxiety.  I wasn't anxious, I was in pain.  I didn't get any Valium during my stay.

I slept the rest of the day after the vomiting was controlled.

The night was uneventful again. Thankfully. I just chilled in bed with my buddy the foley catheter. In the morning they were gonna remove the catheter and then I was gonna try and pee.  The foley came out at 6:00am. The resident was by at 8:30am and I still hadn't peed, but we were gonna send me home with or without a foley, didn't matter because I needed out of here.  He got all of my medications ready and left me to do my thing.  I made it to the bathroom and...wait for it...I peed!!!!!!! Praise The Lord! As I was in the bathroom, the resident came by and was checking to see if I peed, and I told him I had.  Always nice having a conversation with a hot resident about peeing through the bathroom door.

Everybody was happy I peed. 400cc  And no big post void residual either! I got my medications and was discharged.  Though, I was instructed to stop my birth control pills for risk of clotting. Ugh, not that I'll be engaging in activities requiring birth control in the near future, but my periods will now be all messed up. Two months without birth control.  But at least I didn't have to go home with a foley.

So FINALLY is was discharged home. Nearly a week after my surgery.  What a crazy ordeal which I was glad I was over.

Wow, that was long.  I detailed this more for my own records than for your enjoyment because who really is gonna read a play by play account of my hospital stay? Ha, not many.  But, there you have it: a 6 day stay after a periacetabular osteotomy. Boom.

Over and out....

Wednesday, October 15, 2014

2 Weeks Post PAO

I have neglected to properly update my blog.  Shame on me. Hahahaha.  In any event, I will, in the future detail my hospital stay, but today is my two week update.

All I have to say is this is one beast of a surgery. Check out the following link.  There is a surgical video under the Supplementary Data section that is not for the faint of heart but most certainly justifies my perpetual pain post op.

As of now, I am still requiring pain medication on a constant basis.  I alternate 2 Tramadol and one Tylenol #3 every three hours.  I also take Robaxin every 8 hours, then the regular Neurontin and laxatives/stool softeners.  All in all, I'm still pretty unhappy from the pain. The majority of my pain is located in my pubic bone laterally and deep as well as in the pubic symphysis.  I also have one part of my abdominal muscle near my incision that is definitely angry.  Otherwise, I still have that deep aching pain and SI joint pain.  Basically, everything hurts still.  The only numbness I have is my lateral femoral cutaneous nerve on this side too. (which actually surprised my surgeon in the hospital since he didn't even see this nerve during surgery--he attributes this numbness from the scope).

Functionally I can crutch around pretty well.  Very slowly and methodically, but I can get around decently.  Yesterday was the first day that I can easily and safely get up from a seated position by myself.  Prior to this, I had been able to do it on my own, but it was not safe and one of my parents would hold the crutches for me in order to stabilize things as I stood up.  This adds a lot of freedom as I can go to the bathroom as I please, go get dressed as I please, etc.  I have no problem putting on socks since I have been trying to do this since my hospital stay.  My main issue right now is pain control.  Functionally, I feel like I am right on track.

I have good and bad days.  Today was a decent except I had one incident of sympathetic response.  Which was weird, because, yes it hurt, but it wasn't ridiculous--all I had done was get up and put some lipstick on.  I had to then sit down, put a cold washcloth on my neck, and take a Zofran. Things are so unpredictable with this recovery.  But I suppose this goes for any surgical recovery.  Our bodies are strange and mystifying organisms sometimes.

The screw removal site it healing nicely. In fact, both hip incisions are healing nicely. But the screw removal surprised me as it hurt more than I expected.  I definitely still have some throbbing in the area at night.  But this is nothing compared to my PAO'd hip. I know it will get better, it just needs to be sooner rather than later.

Another very real source of my stress is returning to work.  I was scheduled to return back to work next Wednesday (a week from today), which would put me at three weeks post op.  This obviously is NOT happening. I have another week scheduled to be off as of now, but there is a very real possibility that I will need more time off.  This would completely screw up my schedule and would shift my completion of graduation from internship, getting to my advanced residency position in another city for Physical Medicine & Rehabilitation, which would shift me all the way through for the next three years after this year.  It is a big ordeal and a big decision.  One which I will not make until the time comes. But, I realize that I cannot be superhuman and if I can't return at four weeks post op, I simply can't return and would take time off.  But, as it stands now, I'm gonna try to return.  It's just so stressful; having a timeline to recover.

Friday, October 10, 2014

9/30/14: Right Hip Arthroscopy + Right Periacetabular Osteotomy + Left Hip Hardware removal

The day prior to my surgery date, I got a call stating that I was scheduled for an OR time of 3:45pm. When I had called earlier the previous week, they stated that I was scheduled for 5:30pm, so the earlier time was much appreciated.

I woke up very nervous on the surgery day.  I was allowed to drink clear liquids until 11:45am.  I tried to drink some black coffee but, due to the nerves, it made my tummy upset.  I opted to drink some ginger ale (which I nursed until 11:45am).  I decided to shave my legs nice and carefully, took a shower, did my eyebrows, and then looked online at jewelry (what doesn't settle a girls nerves more than online shopping for earring and necklace sets?!).

When my parents got home from their half days of work, we left for the hospital. We arrived just on time! I checked into the south surgical waiting area and we were given a ringer (like the ones used in restaurants) and it went off after five minutes or so.  I was then brought back where I took a pregnancy test, got changed into the hospital gown, and then waited.  The nurses then started an IV in my left hand, I signed the consents, signed my right hip. There was confusion as the left screw removal was not on the consent.  This was settled when the surgeon came in.

We waited, and waited.  The anesthesiologist came in and discussed that he would try to mimic the previous regimen from the last PAO, I got a scopolamine patch, and then waited some more.  The surgeon came in and he signed my right hip and he agreed to take out the left sided screws as well.  Though, he was surprised as he thought that we were going to take out all of the screws (on both sides) at once.  He seems a bit put off by the fact that I wanted them out, but he ultimately agreed to take them out.  After another hour of waiting, the room flooded with the CRNA, OR nurse, and a bunch of people.  They didn't give me Versed until I was getting on the OR table (at my request).  I said my goodbyes and then was wheeled into the operating room.  Of course it was cold, and I waited on the bed for a few minutes until they were ready for me to slide over to the operating table.  I was then given some Versed which didn't do much. While I was arranging myself on the table I could hear the surgeon telling people the order in which things were going to happen: right scope, right PAO, then screw removal.  I wish I had my glasses on while in the OR because I really couldn't see anything other than the black boots attached to the OR table that were going to be used for the scope.  After I got settled down, a mask was placed over my face and then I was off to sleep.

The surgery took 2.5 hours. And it went really well.  Although there is some arthritis in the hip, it wasn't nearly as bad as the left hip, and I should be able to get 20-ish years out of the hip before I need a replacement.  My labrum was intact (not all shredded like the last time), and everything went smoothly.  Thank goodness!!

I remember waking up in the PACU this time. (which is actually quite unusual for me as I'm usually zonked for hours).  I woke up very confused and frightened.  I couldn't understand where I was or what was happening to me or if the surgery was even done. After I got my glasses I settled down a bit.  They had set up a morphine PCA and morphine boluses.  Problem was morphine wasn't working! They quickly switched it to Dilaudid and I got immediate relief.  I was then transferred to my hospital room (which I remember as well....crazy how different things were this time).

Once in my room, I of course, made a big deal that the PCA wasn't working well enough. They increased the dose and then I dosed in and out of consciousness until the morning.  I ended up getting to my room around 11:00pm. Once I was settled in, my parents left and the rest of the night was history.

I survived my second (and LAST) periacetabular osteotomy.  Praise The Lord!

...detailed hospital stay is to follow in subsequent posts

Wednesday, October 8, 2014

Pre Op

This is terribly delayed as I have had my surgery and am back home, but I thought thst updating chronologically would be most useful. I will update the surgery and hospital stay later, but for now I'll  remember the pre-op appointment.

Three weeks ago I had my pre-op appointment for my upcoming right periacetabularosteotomy and left hardware removal. I had my mum come with me so that everybody felt comfortable going into the surgery and if it came down to choosing between a PAO and a hip replacement, both my surgeon and my parents would be more comfortable. 

The appointment itself wasn't terribly informative; there was no new information that was learned. On imaging my right hip is exactly the same as my left.  The surgeon will be sticking a scope inside to look and check the cartilage to ensure a PAO can be done. We discussed my left hip as well.  He asked me if I was happy that I did the PAO. I can't lie and say I am happy because, I'm bit sure if I'm happy I did it.  It was a huge ordeal healing from such a larger surgery and I still hurt.  I do have more range of motion on the left hip, but it's terribly painful to weight bear. After telling him this, he hesitated on even doing the right PAO because I'm "between a rock and a hard place: my right hip needs fixing but my left hip is less than perfect". The fact that he hesitated doing the right side really concerned me.  I can't say I am surprised that he hesitated, but it just worries me because I'm heading into the same major surgery on the right hip after a less-than-stellar result on the left.  It's hard to place faith in a surgery and commit to doing the same surgery again when the initial surgery didn't provide much pain relief.

I also got some radiographs of my right hip.  I will figure out how to add pictures into the blog from my iPad at another time.  But I promise to add them in! 

After pre-op, my mum and I went to Lululemon. I initially wanted to get some yoga pants, but they were waaaay too $$ for me.  Not to mention, they were SKIN TIGHT. I like to leave a bit more to the imagination than what those pants were allowing. I wouldn't consider myself a chunky person, but those pants definitely accentuated my lumps and bumps. Having had so many hip surgeries has made my hips lumpy and bumpy. I decided against yoga pants and opted for an adorable Lululemon scarf. Which made me very happy :)
Aug 28, 2013 - Uploaded by lululemon
We designed the Vinyasa Scarf with snaps on either end so we can wear it done up or undone ...

Thursday, August 28, 2014

Pain Management

I had finally broke down and decided to try some low dose narcotics to help me get through my days more easily. Late last week I saw my PCP who is more than supportive of me getting the proper pain man't with me having hip dysplasia, very large orthopedic surgeries, and working 80 hours a week.

I was very reluctant to go the opioid way. This is almost entirely due to societies stigma on narcotics and chronic pain. Many people often believe that people who take pain medications are the people who want to go through life numb. People have a tendency to look down on people who take narcotics daily as wimps who automatically want disability, social security, etc. I will admit, many healthcare professionals think this way as well. I see it day in and day out:  residents and attendings automatically writing off patients when they see they take opioids. It is an absolute shame. What is also a shame, and what I believe has made it (the daily use of narcotics) social taboo, is those chronic pain patients who rely solely on medication to help their pain.  It's those people with chronic pain who neglect to try to be participating members of society. Some people cannot work due to chronic pain, but when one fails to even try to take care of themselves, when they refuse to so physical therapy, refuse to ice, and refuse to do anything that may help their pain except to take pain medications; it is this group of people who ruin it for the rest of the people who legitimately need pain medications.

Personally, I have tried my very hardest to avoid going this route in fear of being seen as the girl, the doctor, the daughter, the friend who is on narcotics. I have been really struggling with this for a long time. I was thinking the other day, if I had a friend, doctor, patient, collegue who was in my particular situation, I would encourage that individual to seek proper pain management. Why was I withholding this relief from myself? It made absolutely no sense whatsoever. I had a doctor willing to write me the script, I had a supportive family, I had significant pain, what was holding me back? Stigma. I should have known better than this, I am a healthcare professional. In any event, I went to my PCP last Friday and agreed to try the Butrans patches. It was such a big step for me, I was so proud of myself for taking this step. And when I went to fill the script I had been debating over for the last several months, the unthinkable happened: the pharmacist refused to fill it!

I am not joking, the pharmacist looked at my script, looked into the computer, and said that they don't carry this medication and that he would not order it in for me, I had to go elsewhere. Talk about a slap in the face: I had been so brave to actually ask for the patch and now the pharmacist was saying he refused to fill it. He made me feel like I was asking for heroin or something outrageous. I politely retrieved my script from him and went to my hospital's pharmacy. They ordered it in for the next business day, no questions asked.

I started my butrans patch on Monday. Immediately I didn't notice anything. I went to bed and slept relatively decently, but nothing I could attribute to more than being exhausted and sleeping well. It wasn't until I was at work the next even when I realized that it had kicked in: I could walk relatively quickly to retrieve my pager and not limp! I worked 16 consecutive hours and barely had to limp at all. My pain isn't 100% gone but I can stand, walk, bend easier because I have significantly less pain. And my mind is not all gorked out. I feel mentally sharp.  I may even feel more energized because my mind isn't totally consumed by pain. I can't remember feeling like this before. I anticipate being on this patch for a while since I will be working a lot all year and will be having major surgery in a month. And I am OK with that. Which is a huge thing.

Wednesday, August 6, 2014

Stupid Crazy Hips

It gets to a point, during such a long and arduous surgical process, where one wants to throw in the towel, call it quits, be done and over with the entire ordeal. I won't lie, I feel like that often. I'll out on a happy face and go about my normal activities, but deep down, it truly is frustrating.  I have had so many surgeries on my left hip, the last being the most brutal, and it still hurts. Which is disheartening. The left hip may actually still hurt more than my non-PAO'd hip.  It's scary. I am hoping when I get the screws out in September, that it will alleviate some of this pain.  The fact that it hurts to weight bear is worrisome bc I know it will need a THR, just when?

As for my right hip, it's been alright. The deep ache is constant, but I've been lucky as it hasn't slipped out in six weeks or so. Now that I've jinxed myself....

Medication-wise, things are still so-so.  My new PCP was more than supportive to help manage my pain.  During my original appointment, he was pushing for Butrans patches and I was hesitant.  I chose the Tramadol ER. Which kind of does work, but I wouldn't disagree that I need more pain relief to properly function at work. In hindsight, I wish I had taken him up on the Butrans patch offer, but hindsight is 20/20. I suppose I should call to see if he would write a script for me prior to my next appointment with him on August 22nd. I will have to gather up enough courage to call. I have no problems calling for other people, or dishing out advice to people, but when it comes to me and my own health and doctors, I hate it.

But on a happier note, the proper Neurontin dosage has done wonders! I can touch my inner thigh skin and not cringe. I don't get those sharp electrocuting pains down my leg anymore. Thank goodness. Hopefully I won't be needing 300mg TID for too too long, but I'm expecting to need it up to and through a while of my right PAO recovery.

Speaking of which, the RPAO is coming up. In 54 days I'll be getting ready to go to the OR for my (hopefully) last big operation for a while.  I know it needs to be done, it's such a daunting task. And the fact that I have only 3 weeks scheduled off is worrisome. I know that is almost next to impossible, but the fact I will be returning back to work shortly after the surgery has me stressed.

Saturday, July 26, 2014

80 Hour Work Weeks are NOT ok

I simply cannot believe how much I am working. Don't get me wrong, I am thrilled to finally be making money, but working so much is very difficult. I think, rather, I know that my pain is getting in the way.  I will keep it brief tonight since I have to get up at 5:15 tomorrow morning, but Both my hips hurt now.  I am hoping that the left is just hurting from the screws. But I'm not sure if screw pain can manifest as groin pain.

This week I saw a new PCP who is very willing to help manage my pain. We have increased my neurontin to 300mg this and then added tramadol extended release 200mg. I haven't taken the entire three doses of neurontin yet as I have to introduce it slowly as it makes me sleepy.  I have taken the tramadol and it literally does nothing. Well, it does do something: makes me constipated. But that's it :( I was hoping that it would do the trick. I know my PCP wanted me to start on butrans patches, but I was a bit hesitant so wanted to try the tramadol first. It doesn't look like the tramadol ER is gonna cut it. It's hard to make this decision: hurt or take low dose narcotics at work? I'm not sure which is better.

I also got my tens/e-stim unit this week. The tens is for pain relief and the e-stim is for daily contraction of my adductors. Since the obturator nerve was damaged during my LPAO, we are trying to stimulate the adductors as much as possible to get them strong enough to stabilize the hip while it takes up the slack during my RPAO in September.

I have some things I wanna elaborate on in the near future, but this is (albeit briefly) where I am at the moment.

Needing prayers


Friday, July 4, 2014

Back To Work

I guess I can't say 'back to work' because I never really worked, but was in school.  Nonetheless, I'm back into a tiring routine that is in fact work because now I am getting paid. I am not gonna sugar coat this, working approximately 12 hours a day right now (with the odd 14 and 16 hour shift in the upcoming weeks)...SUCKS.

Not only is my stamina and physical endurance down, but my left hip is 17 weeks post op and my right hip is still pre-PAO.  My left hip is still painful, mostly in the anterior portion of the hip with a nagging ache that is hard to localize.  I hope that it are the screws.  One thing I noticed since I have started being on my feet all day is that after I sit for 10 or more minutes, my hip hurts when I weight bear for the first couple of steps, then it goes away.  It is quite odd, again, I hope that it are the screws. 

I've officially scheduled my RPAO for September 30th, 2014:  RPAO, R hip scope, L screw removal.  I just put the countdown onto my phone and saw that it is only 87 days until surgery.  I am closer to my RPAO than my left! (since I am 126 days post op from my LPAO).  The thought of doing this again makes my stomach hurt, but I have no choice.  I do believe that my right side will have better results than my left side given it hurts less than the left side. I'm so sick and tired of feeling so tired and sore all of the time.  I can barely do anything that requires significant standing and/or walking.  Just shopping around a couple of stores requires me to sit down and rest some bc I hurt.

Friday, June 20, 2014

16 Weeks Post Op

I am amazed that I have kept this weekly update thing up for so long.  I guess I'm just not busy enough.  That will come starting next week.  I start orientation in 6 days and then start working July 1st.  I'm extremely nervous for this on so many different levels.  I'm worried I don't know enough Internal Medicine to actually function as an intern physician (I hope I have an understanding team), and then physically I am also worried (my right hip hurts and I have yet to use my left hip for any significant period of time). 

On the hip front, things are going well.  I resumed physical therapy this week and have been working on the adductors.  They just don't want to work in the middle of the muscles (distally and proximally they are ok, but middle, they don't contract).  We've been the using muscle stimulator during my ball squeezes and leg slides to try and get it contracting properly.  This is something I need to ask my surgeon about at my upcoming appointment.  I have also been able to use the elliptical in addition to the bike at PT.  The left hip held up nicely, so I am thrilled about that since before the LPAO, there is no way that I would have been able to do the elliptical due to pain.  I'm hoping this LPAO was a success, without having used my hip all day, it's hard to tell, but it looks promising.

The right side is, well.....the right side.  It's yet to be fixed properly, so I will be eager to hear how soon my surgeon will want to operate.  I'm game for anytime, so long as my residency is cooperative with my surgical plans (they said they would be, but I've learned to not take anybody's word until I actually see it happen).  I know that the surgical scheduling lady at my surgeon's office said that due to my situation, they could have me in an OR within two weeks of the surgeon deciding to operate.  Last appointment my surgeon said that there was a 50% chance he would do it in July, and my PT thinks I'm ready for it.  Needless to say, I do have my hopes up to get this surgery done and out of my life.  But, ultimately, my surgeon makes the call, he is the expert and knows when it is safe to do the other PAO. 

Sunday, June 15, 2014

15 Weeks Post Op

Even though I'm a few days past, I'll still consider this my 15 week update.  It's almost four months!!! I can't believe has flown by yet dragged at the same time.  Generally speaking my PAO'd side is doing well.  It definitely gets tired, but it holds its own.  I had over done it on the PT exercises this past week and took a few days to recover from that.  But, at 14.5 weeks post op I tried: walking for 20 min, biking with resistance for 20 min, then 1.5 hours of exercises.  Not brilliant.  So after three days of recovery, I then had my graduation party which involved me standing and walking around for several hours.  I sat when I could, but with the number of people at my party, I had to socialize and walk around my yard from 4:30 until 10:00pm (which was after helping with decorating, cooking, etc).  So I now need to recover from that. 

Overall, my right side is not doing well.  It hurts a lot and I don't see how I'll be able to work disgusting hours with a right hip that is as sore as it currently is.  D-day is next Monday.  My surgeon will see if he feels I am ready for my next PAO.  What gets me is that my general energy is still not normal.  I realize I had my pelvis broken, but I also feel like any form of physical stamina has been sucked out of my body.  And this is still at almost four months out.  I can't imagine how long it will take to get my umph back if I go back to the OR in July.  Ha.  And I can't believe that I'm begging to do it again.  Call me crazy, but desperate times call for desperate measures. 

My work authorization should be here tomorrow, which will be awesome because then I'll be able to head back to PT hopefully this week, get my medications (I've completely stopped my Neurontin and birth control pills bc I can't get to the US to pick my scripts up).  So, if my card arrives tomorrow, I'll be heading over to CVS ASAP to pick my meds up and hopefully get a PT appointment in.

Saturday, June 7, 2014

Milestones for LPAO

Surgery:  February 28, 2014
Post Op Day 1:  walk few steps, sit up in bed
Post Op Day 2:  walk 15 feet
Post Op Day 3:  walk 30 feet, 5 stairs, discharged from hospital
2.5 Weeks Post Op: Decrease pain meds from Norco 10mg to Norco 7.4
2.5 Weeks Post Op:  Begin riding upright stationary bike 10 minutes, no resistance
3.5 Weeks Post Op: Stop taking narcotics around the clock, only at night
7.5 Weeks Post Op: Cleared to walk without crutches, instructed one week full weight bearing two crutches, then one week full weight bearing one crutch, then completely off as tolerated
8 Weeks Post Op:  Begin formal physical therapy
11 Weeks Post Op:  Completely off two crutches, no limping
12 Weeks Post Op:  Move to my bedroom upstairs
13 Weeks Post Op:  Can appreciate the stability in the joint, pain better than pre-op

Friday, June 6, 2014

14 Weeks Post Op

This last week has been relatively plateaued.  I can't say I've made any significant gains or losses.  So, I guess that is good.  Everybody keeps asking me how it feels, did the surgery work.  And I know it did, but as far as the amount of pain relief I am actually going to get, that will be determined when I am back on my feet all day working in the hospital.  Right now I am not doing much of anything on my feet.  I know my surgeon isn't telling me exactly how much pain relief I can expect, he is very cautious in giving me any sort of promise, especially since he operated and saw the inside of my hip.  The best we can do is hope and pray that the left hip survives the next couple years.  It would be amazing to get through residency with my own two hips!!

I see my surgeon in two weeks (hopefully, as long as my immigration stuff to work in the US comes through in time....long story of major stress).  It will be interesting to see what he thinks of my healing and when he thinks I could handle another PAO on the opposite side.  I truly think that my left side could hold me up, even if it was tomorrow.  I don't think that the left hip would be happy, but it quite possibly could be possible in another month or so.  I'm keeping my fingers and toes crossed.  Having said this, if he didn't feel that I was strong enough, I most definitely won't go ahead with something that is unsafe.  But leaving the surgery until December (the timing my residency wants me to have surgery) is seeming more and more unrealistic.  Unrealistic in the fact that it would be unrealistic to work until then without being completely miserable.  I did the entirety of my fourth year of medical school with one (which turned into two) very sore hips, I was, in fact, horribly miserable, and if July isn't going to work, then we have to swing something sooner because life is too short to limp around and miss out on activities because of hip pain. All of these scheduling possibilities are simply ramblings of my thoughts, what it actually comes down to is when my surgeon feels I am ready to have the surgery, which will be determined next appointment.

So I've been doing some reading on femoral/acetabular version since receiving my MRA report.  I have 6 degrees of femoral anteversion which means that I am actually retroverted.  Now, femoral version issues have never come up in any conversation with any surgeon in the past, nor with my present surgeon.  After some reading, I have learned that my measurements put me into the severe category.  Mind you, my acetabular version could offset the femoral version abnormality, so that it may not have stability ramifications, but this is definitely something that I need to bring up my next appointment, because if this needs to be fixed, I want it fixed during my PAO.  We haven't discussed what my right hip is doing other than the fact that we have established that it is painful, it won't get better without surgery, and it has dysplasia.  Again, next appointment will hopefully clarify what the surgical plan is for this right hip.


I have had quite a bit of free time lately and had a look back at my old blog posts.  All of my previous surgeries have been documented here (not my first one, though I wish I had that one on here).  It made my heart sink.  Every single surgery I was so optimistic that that surgery was going to work, it was going to take away my pain and be my last surgery.  I refuse to now say that this one is going to be the last surgery.  Not only has it been false in the past, I don't believe that it will actually ever end, there will always be the possibility of another surgery until my hips are replaced.  My hips are essentially THR ticking time bombs.  And the day I get my new hips, then will be able to relax and stop worrying about surgeries.  It sounds pessimistic, but I can't help myself, after 7 hip surgeries, one becomes jaded and skeptical to believe that they could actually be done with regular surgeries.

Friday, May 30, 2014

13 Weeks Post Op

I entirely missed my 12 week post due to being out of town and crazy busy with graduation. I suppose it is around this time that life starts to return back to being able to do normal things. It's a great thing! I am very VERY thankful to be completely off of crutches. That happened around 2 weeks ago. At 11 weeks I was able to make it through the entire day without crutches, but then a couple days after that I had to travel alone in an airport and I obviously couldn't do that without one crutch. It was basically brutal getting through an airport with a roller carry on and one crutch. I wouldn't recommend traveling alone yet. But I managed. And I was out of town for a week and only used my one crutch twice the entire 12th week: once the day after I traveled to go out to dinner and after my graduation ceremony because that invoked standing for two hours and walking a lot. That was my goal: to be able to walk across the stage at graduation without any crutches and without a limp and I totally did it! I remember being in my last appointment with my surgeon and he said that walking across stage without crutches would be a good goal, and I laughed saying that I would most certainly be off crutches before then. Little did I know how close I would come to actually needing them on graduation day.

All in all, my left hip is doing well. Realistically, I know it won't be pain free. After having 5 surgeries on it (4 of which were the wrong type and actually were just de-stabilizing my hip), and having the amount of arthritis in the hip, I have to expect some pain. But, having said this, I can't really feel a difference in this hip. It's hard to explain, but I feel like I'm now walking on top of my hip. It must be the feeling of stability? I'm not sure, but it does feel tremendously different than ever and I quite like it. I can absolutely feel a difference in, what I am assuming is this stability feeling people talk about, between my PAO'd hip and my non-PAO'd hip. In addition, I can now say I feel better than before my surgery (on my PAO'd side only). It is absolutely in sane to think that anybody could feel so much better after voluntarily having their pelvis broken with 5 cuts and screwed back together with 4 screws.  It was.a horrendous surgery, and it cussed me to experience pain like I've never experienced before, but I feel as if it was very much worth it (and I realize I am very early in the healing process, but I am confident it will only get better from here on out). And now, I desperately want my left hop PAO'd. Sounds crazy but not crazy.

At this point, there is very little I can't do because of my LPAO. And I moved into my own room upstairs earlier this week!!!!! :) That side still has adductor and hip flexor weakness, but I do exercises every day for these muscle groups: 3 sets of 10 adductor squeezes and 3 sets of 10 straight leg raises. I ride the bike for 10 minutes on days I do my full set of exercises (strengthening all of the muscles around the hip and core and balance exercises). I only do 10 minutes in the bike because the entire exercise set takes 1.5 hours to do everything properly. On odd days, I will ride the bike for 30 minutes and then do my adductor and hip flexor exercises as mentioned above, and then also stretch and do some balance work, all the while, letting pain be my guide. But the pain is mostly muscular at this point. I realize that I am not on my feet much these days so my left hip won't hurt as much. The true test will be when I start working in a month. A test for both hips.

I got my MRA CD in the mail this past week. I was gonna share a couple snap shots of the study, but I'm typing this on my iPad and, since it's new, I don't know how to add from my camera roll yet. Sigh. New technology :)

I see my surgeon in just over three weeks. I hope he is happy with the progress because I know I am. And I hope, even more, that he says let's do the RPAO in July! Fingers crossed.

Sunday, May 18, 2014

New Things

Today marked day two of using no crutches.  I didn't even touch them once!  Mind you, I didn't walk very far at all, but still:  11 weeks out and I have officially ditched them (I'll be taking them away when I have to navigate airports tomorrow traveling to graduation), but those long walking distances don't count as technically being on crutches.  My goal was to be able to walk across stage without a limp:  and I'm a week ahead of schedule.  My surgeon, PT, and ATC all agreed that walking across the stage would be a reasonable goal, I can confidently say that I have already met it :)

This past week I did a straight leg raise, but today I did 10 of them!  SLR are my nemesis (along with adductor squeezes), but I can officially say that I can do a SLR or two or ten...they aren't exactly pretty, but can be done.

And now I officially can say that my recently operated hip hurts less than my other hip.  I didn't think that I would ever say that given this left hip hurt so much before the surgery.  Gosh, I want my right side PAO and scoped like yesterday.

I really needed to write this post about my more positive achievements because today was, overall, a generally bad day: right hip hurt a lot, I have started my period, my GI system is just outta whack (upset tummy, constipation, gas), and heartburn that felt like my heart was literally on fire 75% of the day.  Hopefully tomorrow will be better!

Friday, May 16, 2014

11 Weeks Post Op

Today marks my 11 week post op update.  Things are progressing very nicely with respect to physical therapy.  I am going three times a week and am working a LOT on my strengthening.  I have the hardest time with aDduction and hip flexion, but they are coming along....slowly but surely.  My nerve pain has decreased some since starting to take Neurontin 200mg BID.  I don't feel like it is quite high enough dosage, but it does alleviate the lava feeling on the inner thigh.  I assume that once I can find a PCP, that I will ask for them to increase the dosage as my surgeon seems very hesitant to start any medication for a chronic use. 

I am sleeping fine now and can lay on my op side (with pillow between my legs because my other hip hurts).  I am walking around the house, as of this past week, without any crutches and no limping.  But I do use the help of the walls and counters sometimes, so I use one crutch outside.  I feel like I'll be able to ditch the crutch all together in the near future.  For my walking goal, it was to be able to walk across stage at graduation without limping and I have already met that goal a week early.  This next week will be a test for my hip as in a couple of days I will be traveling back to school for graduation alone (meaning, I will be navigating airports alone).  I think that I'll bring one crutch to be safe because I still need if for long distances.

I got my MRI/arthrogram result on my online chart today:

There is intrasubstance degeneration and multifocal tearing
involving the anterosuperior quadrant of the acetabular labrum the 12:00
position superiorly to the 3:00 position anteriorly. There is short axis and
longitudinal tearing of the labral substance throughout the anterosuperior
quadrant. There is focal chondrolabral junction separation, there is focal
labral detachment from the 2:00 to 3:00 position. No paralabral cyst is noted.
 There is mild thinning and fraying of the articular cartilage along the
extent of the labral tear.
So I am not impressed at all, yet the results completely justify my pain.  I have significant labral tearing when I had an autograft AND an allograft done on this side in Sept. 2012!!!  That entire surgery seems to be a waste of all resources possible.  I've obliterated the labrum because the stupid dysplasia was not fixed. Obviously if my hip is clunking around and putting pressure on the labrum it's gonna retear.  I can't say that I am surprised, but finding out that my labrum is all torn up again makes me very sad and mad.  My previous surgeon was completely negligent by missing or choosing to ignore my dysplasia.  My lateral CE angle was measured as being 3 degrees less than on the side that I just got fixed, but these are the radiologist's surgeons readings are always different (usually worse angles), and I tend to trust my surgeon and not the radiologist's measurements.

Thursday, May 15, 2014

10 Weeks Post Op & Athrogram

Oops!  I totally missed my 10 week post op post.  I was in no mood to update as I had had my right arthrogram done on my 10 week post op day and it kinda made me miserable the rest of the weekend and then the entirety of my week has been consumed with running around.  So, I will update on my arthrogram and MRI and then will do an 11 week post tomorrow or so.

I was extremely nervous about the arthrogram/MRI as last time it took one hour to get the needle into the joint, and even then the majority of the contrast had extravasated out of the joint.  It was a terrible experience that I dreaded having to do again.  So after ensuring that I did not take any NSAIDs for three days prior, I had my mum come with me and we spent a lovely Friday afternoon in the hospital.  I usually don't have my mum come with me for these things, but the MRI at this particular hospital is very small and I didn't exactly like being stuffed in there last time and figured I would take a valium to relax me for this portion of the test.

After getting changed into the hospital gown and scrub pants, I was brought back to the fluoroscopy suite.  The physician assistant was really nice and after I reminded her she did my last arthrogram, she said that she hadn't forgot me and my case because being allergic to chlorhexidine and having such a difficult time to enter the joint was hard to forget.  But after cleaning off my hip, feeling for the femoral pulse, and injecting lidocaine into the skin and subcutaneous tissues (which kinda burned), she had the radiologist come in, and they ensured that the dye was in the joint.  With one small adjustment to the needle placement it flowed into the joint nicely.  She seemed quite attentive and almost nervous about doing this procedure by herself.  She had said that the radiologist and herself had discussed my case prior and that we would be observing the entire procedure.  Fair enough, because I did not want to have a repeat of her performance similar to my previous experience.  But it all went smoothly.

Next, I had to walk around for 10 minutes to distribute the dye around the hip joint.  10 minutes is a lot of walking when still on one crutch (for the opposite hip).  I had several employees stop me to ask about which hip was injected and which hip I needed the crutch for.  Kinda bold if you ask me, but whatever. One of the employees was nice enough to bring tape to tape my gown shut because I was walking with the HUGE hospital gown and was worried about showing too much.  A funny thing to think about is how I was not concerned about maintaining my modesty when I was originally post op and attempting to walk in a hospital gown.  I know that the nurses and therapists were good at ensuring I kept covered (I mean, I'm assuming this because I don't recall ever worrying about it...I simply worried about not passing out/throwing up/saying mean things).

The MRI portion was the easy part.  Since I was relaxed from the Valium, I didn't mind the MRI tube.  My surgeon likes to use the 3T MRI.  It took approximately 45 minutes to get full images of my right hip.  They had attached an intensifier (?), or some special cage thingie on my hips that centralized over my right side.  It wasn't too tight and was totally fine, even with my screws sticking out on my left side.  After the hip images were done, I had 15 minutes of right knee images taken.  I asked if it was for a study, and the tech told me that it's just what they do now.  (I appreciated the thorough explanation. Ha!  I suppose if I remember, I will ask my surgeon at my next appointment). 

Afterwards, I needed to get a CD of the images for my surgeon and I convinced them to make me one too.  But they said that they would mail me the CDs since it would take a half an hour or so to get the images processed.  And on a Friday afternoon at 4:30pm, I was fine with waiting for it to come in the mail.  My mum and I then had to go get gas, stop to see if my Neurontin had been called in to the pharmacy (getting my Neurontin called in turned into an 8 day ordeal....something that I could rant on and on about, but will spare the details), and then obviously I needed to treat myself to something yummy--and I got a McFlurry at McDonalds.  I am not an ice cream person (kinda lactose intolerant), but this was exactly what I needed!  I gobbled a Reece's peanut butter cup McFlurry down in a matter of minutes and enjoyed every second of my calorie laden treat!!!!

So now I am awaiting the results online (they post the reports to my online chart) and for the CDs to arrive in the mail.  It's not going to be earth shattering news because we already know I have dysplasia on that side and we already know that I need a PAO on that side.  I suppose it will show us if there are any abnormalities that we didn't expect, but I would be willing to put money on it that it will show post-operative changes and dysplasia.  But, I'll update when I receive the results.

6 days ago marked my 10 week post-op date.  I was still using one crutch outside and could hobble around inside the house alright.  I still had trendelenburg gait, but nothing too terrible.  No hard narcotics have been needed for several weeks now:  Tramadol PRN and Tylenol does the trick.  I had talked with my surgeon earlier in the week about my nerve pain as medially it still feels like boiling water had been poured on my skin and had severe allodynia when my pants/shorts touched my inner thigh.  After convincing my surgeon to increase the Neurontin dose, it felt like pulling teeth to get the script called in by his assistant.  Now I am taking 200mg BID. 

Saturday, May 3, 2014

9 Weeks Post Op

Yesterday marked my nine week post op from my left periacetabular osteotomy.  I can't say that I'm so thankful that I have done it yet as I am still too fresh out of surgery to be able to consider it a success.  I do know that my good ol' hip pain, deep ache, and catching is less pronounced than it was prior to surgery.  But this has been replaced with generalized achiness all over the pelvis.  My pubic symphysis has gone mad on me as it still hurts to touch lightly.  All this said, the hip is definitely more stable and I don't have the fear of it sliding/clunking around (although this only happened occasionally pre-op). 

The nerve pain continues.  I am still completely numb laterally but this doesn't hurt, its the medial/proximal thigh up into my crotch that really hurts.  I'm still taking Neurontin 200mg QHS but it might as well be a sleep aid and nothing else as it does help me fall asleep but it does not help with the nerve pain.  I intend on calling the surgeon in a week or so to increase my dosage.  You know what I really need is a primary care doctor!  That way I could eliminate the need for my orthopedic surgeon to write me scripts.  I will definitely do this, but the timing isn't great as I need to find one close to my hospital and I don't know that area very well, nor do I know who is good out there. 

As far as my function goes these days, it is slowly (SLOWLY) getting better.  I am still on one crutch almost all of the time inside the house.  Although I do manage to hobble around to cook myself my meals and when I need to carry light things I am able to do so without any crutches - it is just very trendelenburg in nature.  I can't say that it is only weakness nor only pain that requires me to use the one crutch because sometimes it doesn't hurt to place weight on my hip and it is just muscle weakness, while other times it downright hurts to put weight on my hip.  When I wake up in the morning, it hurts to put any weight on it for approximately an hour and then things settle down.  I am also showering without a shower chair (started last week!) and basically am completely independent.  I am still sleeping in the spare bedroom because my room is up 14 steep stairs and the fact that I am so sleepy due to meds in the middle of the night and still on crutches, it is just safer to remain in the spare bedroom.  It's a comfy bed and I don't mind it at all.  We still have yet to remove my own bed from the living room.  That was a Godsend post op, the bed in the living room, but I don't need it anymore and I've just been using it at night to watch TV, but only because it is there, not because I need it--the couch will do perfectly fine.

I can't wait to get back to a routine.  I have nothing to do all day and basically lounge around, watch Dexter, make earrings, answer emails, do paperwork.  Fairly boring, but this will all change once I start work July 1st.  Things will start to pick up starting next week. I received a lovely script in the mail yesterday for an arthrogram and MRI on my right hip, so I have that scheduled for Friday of this upcoming week.  Then on Monday have another doctor's appointment, followed by a physical/drug test/TB test at the hospital on Tuesday.  All of this plus PT on Monday and Wednesdays. 

Speaking of PT, I had another therapist on Thursday.  Well, actually, I just worked with the ATC.  It was helpful but I didn't feel as comfortable with her knowledge (she didn't realize the surgery I had nor had no idea that I actually kinda knew what I was talking about).  So, I will remain with the PT/ATC that I originally began with last week and go just two times.  I can totally do the home exercises and plus, I'll save some money!!

Thursday, May 1, 2014

First Physical Therapy Sesh

Yesterday was my first session with my physical therapist (and her athletic therapist).  It was, overall, painful.  I really think that they got muscles that haven't been used in like two months.  We worked mostly on the hip flexors, adductors, glutes, quads.  Although I could only do three separate exercises because I got one of those amazing (not) sympathetic responses from a) trying so hard and b) pain.  It just kinda hit me and I got all sweaty, clammy, lightheaded, etc.  It was not fun.  So we decided that three exercises would be enough.  The PT adjusted my pelvis a bit as well since my pubic symphysis is like super tender to touch and crooked. 

I showed her my xrays on my phone and she said that it's no wonder my pubic symphysis hurts bc it's all arthritic.  Well...I knew it was sore to touch and it looks all jacked up on the, yeah...obviously it's gonna be crappy.  But she is going to work on leveling the pelvis out a bit too.  I appreciate her outlook:  she isn't focused on just my hips, but also my pelvis, and core.

I haven't worked with an athletic therapist in conjunction with my physical therapist on a regular basis, but it seems as if the ATC helps with the exercises and the physical therapist helps with the manual stuff.  I'm not sure how I feel about this, as I can do the exercises at home (once they show me what to do).  We will see how this works out.  I am going three days a week for the first couple of weeks, and then we will see how much I need.  I have unlimited PT visits with 10% co-insurance for a medically necessary condition.  So that is in my favour! :)

Me having such a response yesterday to the few exercises we did, they told me to anticipate being really sore.  Last night after therapy, I was beat!  I had to have a bath to wash all the sweat off since I was so scuzzy.  And then did end up taking a Norco (first one in weeks).  It helped things and I actually slept all night without waking up hurting (yay for pain pills when you need them)  I have PT today, but was told that if I woke up hurting a lot that I could call and cancel if going to PT was not going to be worth it.  So today, I am not too terribly sore.  The hip flexors and adductors feel like they've run a marathon, and my other hip hurts a lot, but overall, it's not too bad.  So I guess I should go to PT today.  Maybe they can stretch me out and release some muscles?! That would be amazing!

Tuesday, April 29, 2014

PT Assessment

Yesterday I had my first PT sesh.  It really wasn't a full treatment or anything since she did an assessment.  She seemed like she kinda knew what she was talking about.  I'll have a better idea after we start working together.  We are planning to do three times a week in order to maximize my recovery and get strong enough to have a fighting chance to be strong enough to get the right hip done end of July.

I have a lot of work to do:  my adductor and hip flexor strength is only 1/5 and my extension is zero degrees.  A lot of this is expected since they did essentially break my pelvis, inserted four screws, and I've been walking with crutches for two months. 

Speaking of crutches, I want off of them!  I can do one crutch alright, but very slowly, and when I'm tired it hurts too much.  If I could have one wish right now, it would be to not need crutches to walk :)

Friday, April 25, 2014

8 Weeks Post Op

Two whole months!  Dang.  I want this recovery to keep a rolling on :)

I am feeling pretty well these days.  I had my second post op appointment this week.  Things look good.  I had an xray of my left hip and there is enough bone there to begin to weight bear but my muscles are not strong enough to walk properly.  My surgeon had me take a few steps without the crutches to prove his point that I need to get my muscles back.  After my appointment I was allowed to put full weight on my hip with two crutches.  I am to do this for a week and then graduate to one crutch for as long as it takes me to walk without a limp.  I can easily do one crutch already, so I do that in the house, but when I am out, I still use two crutches at the moment.  Monday, I plan on not needing two anymore, but I am to just listen to my body and go from there.

The remainder of my appointment went well.  He started me on Neurontin for the nerve pain.  Albeit, a VERY small dosage, so I am not sure that I will see any benefits from it, but I'll keep taking it and see.  The burning proximal, medial thigh is less than cool!  Speaking of nerves, my LFCN is still dead.  Absolutely no feeling.  No change or improvement either.  Ok, back to the appointment.  He tested my muscle strength and it seems it is all good except my adductors are almost non-existent.  He asked me if I had been doing my adductor squeezes (uh, yeah, I have been, too bad it doesn't show).  We then discussed my right hip and agreed that it must be done.  I explained how I wanted to do it before August first as it would save me a lot of money in insurance, but he said that it would be cutting it pretty close and that there would be like a 50/50 chance I could do it at the end of July.  The other option is doing it in December since it would be slower in the hospital and my absence would be less of a burden on my resident team.  I really hope that it can be done in July.  Hobbling around for another half year would suck.  He said that we would decide when I see him next near the end of June.  If he decides that I am strong enough, we can do surgery near the end of July, if not, then I must wait until December. Fingers and toes crossed I get my muscles into gear and get strong enough by end of June!!!!!

I am now cleared to do PT as well.  I had to call up several places to see if they were familiar with hips and PAOs.  I called two places and one place seemed confused on what I wanted and didn't make me feel like they knew what they were talking about, so I ended up going with the second place I called.  I made a huge ordeal about needing somebody who knew what they were doing.  So I got the head PT at this place.  I start on Monday with an evaluation.  And then will schedule appointments from there.  The script says 2-3 times per week for 4-6 weeks.  I will do whatever it takes to get strong enough to have my other hip done so that these major surgeries are out of my life!! I am actually excited to begin physical therapy!  Until I get my butt in to see the PT on Monday, I have been trying to slowly start strengthening my hip, butt, and core muscles.  But having a professional opinion and guidance will be helpful as well. 

As far as mobility goes, I am doing alright.  I am able to easily use one crutch and can hobble along without anything as well.  The first day cleared to weight bear, I was able to walk fairly well with just a small limp, but since I have been trying to activate more muscles, they have become very sore, and I now have a sweet Trendeleburg gait going on.  It's kinda pulling on my SI joints and lower back when I do walk without assistance, so I best be careful. 

And, last but not least, I definitely forgot to ask my surgeon during my appointment if I needed an MRI/arthrogram for my right hip.  I only wanted to know now because I would prefer to have it done prior to beginning work.  So I emailed his nurse and asked to see if she could find out anything.  I feel bad for bugging them so much, but I really do want to know.  It would make life so much easier to get it over and done with when I am off, instead of trying to schedule it when I am working at my new job. 

Thursday, April 17, 2014

7 Weeks Post Op

Not much to report, but today marks my 7 week mark since my LPAO.  I have not needed a single Norco for the pain since last weekend (just had one bad evening of pain).  I'm really itching to walk.  That may come on Monday when I see my surgeon for xrays and hopefully get the clear to bear weight and start weaning off of crutches.  I'm not gonna lie, I've tried standing with 50% when I brush my teeth and in the shower.  I would be hard pressed to find a single PAO patient who didn't "test their hip out" slightly ahead of schedule! 

I take Tylenol and the occasional Tramadol for pain relief.  But this is mostly due to my pain in my right (non-op) hip.  SO sick of hip pain. Speaking of pain, I have noticed that my pubic symphysis is extremely painful to palpate.  I accidentally leaned on the island in the kitchen today and nearly jumped out of my skin because it hurt so much.  Maybe I just irritated it's just odd that it would come out of nowhere.  It kinda caught me off guard.

I got my surgeon's bill today. It was a lovely $18K.  The breakdown of procedures was as follows:
  • Periacetabular osteotomy
  • Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman type procedure)
  • Arthroscopy of hip, surgical with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty and resection of labrum
  • Bone graft; major/large
I hate hate hate insurance because of past experiences, I am so careful with these types of things because of traumatizing experiences after previous surgeries.  It makes me nervous just looking at the bill.  But it all looks like it has been billed properly and I have to pay just over $1000 for the surgery itself.  I am still waiting on the anesthesia and hospital fees.  I know that I will hit my $5000 OOP and $200 deductible.  I just would love for it to go smoothly without any hassle or hiccups.  For insurance purposes, I hope to get my right hip PAO'd before August 1st as it would be covered under my current insurance and essentially be no additional charge.  I could definitely handle the copays and that is it.

Sleeping is still sucky.  I got some melatonin and tried that last night and it seemed to work.  It's hard to be fully confident in this supplement as it is usually used for circadian rhythm disturbances.  But, it worked, and I fell asleep last night very quickly.  I was extremely tired though since I had been out and about yesterday.  I convinced my Mum to go to Applebee's for their $6 burger Wednesday.  YUMMY.  And then we went to The Dollar Store and then to Walmart.  I crutched all over each of these stores.  It wasn't exactly fun, but it also wasn't terrible.  What irked me was that I have a handicap parking pass for an entire year and at each of these stores there was not one single open handicap parking space available.  Which, whatever, it's busy because of Easter weekend approaching, but when they don't have a handicap parking pass displayed makes me think that they just parked there because it was close and don't actually have difficulty getting into the store.  So, I STILL haven't used my handicap parking pass to date since I a) always forget it or b) all the spots are occupied.  First world problems...I know.

Saturday, April 12, 2014

6 Weeks Post Op

I feel like these weekly updates are coming rather quickly.  I feel like I just wrote my 5 week update and now it's already 6 weeks!  Dude. Whoa.  So things have basically stalled as far as healing goes.  The next step is beginning to weight bear and learning how to walk again.  But none of this can happen until I see my surgeon in a week and two days.  So, I just go around on crutches feeling as if I should be able to put weight on my operated side.  It is VERY hard to not test it out with just a few steps.  One of my friends in my surgeon's PA and I distinctly remember her telling me about the stupid girls who walk on their hip before cleared by my surgeon and how stupid that is....I remember agreeing with her, but now that I am feeling as if I can walk, I could see how people test their hip out prematurely.  The only thing that I have been doing all week that is pushing the limits is standing equally on two feet while doing things like brushing my hair and brushing my teeth.  Shhhh....but it doesn't hurt to put weight on it :) 

I am not taking any Norco anymore.  But do take the max dose of Tylenol during the day and the random Tramadol interspersed.  This is mostly for my right hip and not my operated hip.  I'm really happy with this not needing heavy narcotics anymore.  I need my right hip fixed so badly because it hurts so much.  I knew this would happen as it was sore just from compensating a little more with the left being the most painful hip.  But now that the right is the sole weight bearing side, it is extremely angry.  The timing of my next PAO will be discussed during my next appointment and hopefully we can schedule surgery for the end of the summer (end of July) as my residency needs to know when I am going to need surgery so we can plan accordingly. I do feel bad about needing to have special considerations in the scheduling.  I feel like it's the story of my life: the one that needs to have things rearranged all of the time because of my surgeries.  It makes me really happy that after this next PAO and then the subsequent screw removal, that I could potentially be done with needing special scheduling considerations and done with major surgeries for a few years.  My hips and surgery and doctor's appointments have been thought and time consuming for so many years, that I'll have to take up a hobby or something to fill all of this time and energy that I have put into my health for the last 8 years.

Sleep continues to be an issue.  I can sleep on my tummy all night now and can lie on my non-op side for a couple of minutes with a pillow between my legs.  Both of these things happened this week.  So that rocks!  Even with these new found positions, I am sleeping terribly.  I think that mostly it is because of my lack of schedule and activity.  I'm not expelling a lot of energy so, naturally, I'm up until one or two in the morning and don't sleep in much either.  Thank goodness for Benadryl and muscle relaxants!  I expect that the sleeping will become better once I being to walk without my crutches and increase my home exercises in a few weeks.  Oh how I look forward to ditching the crutches!!!!!!!! :)