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Friday, March 28, 2014

4 Weeks Post Op

A WHOLE month!!!!!!!!!!!!!!!!  Woohoo!!!  And I ain't looking back!  This surgery is a brutal one from which to recover, but only brutal for the first 2.5 weeks for me.  Then after that it has been a slow but steady improvement.  I am totally self sufficient now (except for carrying things since I'm on two crutches).  It feels great to be able to do everything on my own.  Even shoes and socks are not an issues.  I am riding the bike 2 times a day for 15-20 minutes at a time.  I am hoping that doing this will reduce some of the atrophy and help me get off of crutches more easily. 

I got all of my records in the mail this past week as well.  The operative report was quite impressive.  They did SO MUCH during that surgery, cut lots of bone, muscles, and moved so many things around that it's mind-boggling to believe that it is possible to feel the way I currently feel.  As far as coverage, I gained 15 degrees of anterior coverage, 15 degrees of lateral coverage, and retroversion was fixed by 10 degrees.  I still have a posterior wall sign, but I now have an anterior and lateral hip joint!  This means that it is stable and that it shouldn't sublux out anymore.  The hip joint feels really great, much better than the other side.

I am trying to do everything I can to recover from this surgery as fast as possible.  I am taking all my vitamins (C, D, calcium, and multivitamin), riding the bike, doing all of my ROM exercises (flexion, external rotation, abduction, adduction), resting, remaining NWB.  I see my surgeon in 3 more weeks doe more x-rays.  I am hoping to speak with my surgeon sooner than this appt tho, because I need to submit for my vacation for the next year and I need to know when the best time to have my three weeks off as I hope to get the other side screwed as well.  I feel crazy to want to have another PAO, but I do believe that it is necessary and will help me attain the best function with the least amount of pain possible.

Sunday, March 23, 2014

3 Weeks Post LPAO

Turning the Corner

This past Tuesday was the day that I woke up and suddenly, I felt a change.  I felt better!  Every single day I am able to do more and more.  Functionally this includes: showering all on my own, ride stationary bike for 15 minutes at a time, crutch in one fluid motion with crutches and bad leg meeting the ground at the same time, cut my own toe nails (for the first time in a year and a half!!), bend down to get to the lower drawers in my room.  There are prolly many more, but I can't think of them right now.

Things that I still need help with: setting up for a shower, carrying things with two hands. That's basically it.  So, I can say with confidence that after the first two weeks, the PAO is not THAT bad.  It's not fun, but it's doable and not horrendous (after the initial couple of weeks).  It's as if somebody flipped a switch and pow--I'm feeling better.  Don't get me wrong, I still have pain and am still non-weight bearing, sleeping yucky, but if I had to do this again, I would (I'm calling tomorrow to discuss this topic with my surgeon as my location plans for residency have changed from what I had anticipated). To put this recovery into perspective, I feel like, overall, I am actually doing better than after several of my scope surgeries.  It's so weird!

Currently I am doing LOTS of range of motion exercises and stretches.  I make sure that I get up and crutch around the house very often, and make sure that I do one extended crutching venture (like 10 min or so) every day as I don't want to get too deconditioned and I want to be able to walk as soon as I get the clear to do so. 

As far as medications go, I have been able to significantly wean down my pain meds this week.  As of 6 days ago I was still taking Norco 10/325 mg every 6 hours, and since seeing my surgeon and obtaining Norco 7.5/325 mg, I have been able to wean over this week to, for the last two days, taking half of my Norco 7.5/325 mg once in the morning and once in the evening.  I add Tylenol during the day up to the maximum allowed dosage and take Robaxin as needed when I get muscle spasms (which is always my adductor muscles).

Wednesday, March 19, 2014

2 Week Follow Up

I saw my surgeon yesterday for my two (and a half) week follow up and everything looks like it is going according to plan.  He wasn't very descriptive of how the surgery went or what he expects the outcome to be, but he did say that the PAO was the right surgery to have and that my hip joint is stable now.  He is a wee bit concerned about my nerves:  my lateral femoral cutaneous nerve is completely numb laterally and I have a patch of tingling, pin-like sensation on my inner thigh (I am assuming it is the ilioinguinal nerve).  We are going to watch it for now and hope that it improves.  I would rather not have to start something like Neurontin.  He refilled my pain medication but reduced the dosage of hydrocodone to 7.5 with is fine with me.  I am allowed to ride the stationary bike without resistance fact, I have to since my atrophy is extensive already and it's just been 2 weeks.  I have to work on my flexion and external rotation lying down as it gives a better stretch on the hip.  He reiterated the fact that being aggressive early will help the overall outcome of the's be aggressive!

Overall the appointment went fine.  He is less than talkative and is rather quiet.  I have to drag information out of him.  I did get him to show me my scope pictures and radiographs.  The scope showed cobblestoned and yellow cartilage on a large portion of the femoral head, mostly the weight bearing portion, and some smaller areas of smooth cartilage  And the xrays look fine.  I have four nice screws holding things together.  I took a picture of the AP and false profile, but only the AP saved to my phone.  The AP doesn't show the significant correction I received anteriorly.

As far as pain right now, it is rather constant and I need pain medication every six hours.  I have stretched it out to eight hours once, but since going to see the surgeon, the pain has been more severe.  Crutching to the office, going to get x rays, getting on the exam table, him examining my hip (resistive adduction hurt like the dickens....i'm not sure I have much muscle activity there), and ROM testing, followed by a crutch back to the car....adding a total of 1.5 hours of driving made for an EXTREMELY painful day yesterday.  Today was better though. 

I am doing passive flexion, external rotation, and resisted adduction like A LOT (feels like all day), I lie flat on my OMM table frequently to stretch out the hip flexors.  And I did gather enough courage to ride the upright bike today at 18 days post op.  It wasn't as bad as I thought it was going to be.  It did hurt my ischial tuberosity, but I was able to unweight myself with my hand on the seat, which made if much more tolerable.  I did five minutes without resistance and that was enough for me!

Otherwise I just get up and crutch every so often so as not to get too stiff and lounge around.  My existence seems extremely boring.  I'm used to being busy at the hospital or clinic on rotation and now I'm lying around like 100 times more than usual.  BOOOOORING.  I find I text some of my friends a lot more often.  When they are out being productive and Im at home distracting them and decreasing their work productivitiy. I bet they will be happy when I'm done recovering too!

So, I have another month of recovery before I see the surgeon again.  I hope that the nerve pain decreases some and I get some more feeling on my lateral thigh because it is totally numb from greater trochanter to knee and about four to five inches in width, plus the medial thigh burning and pin sensations.  Boo.  I'm also going to work on my bone growth :)  I need to fill in that lovely gap with callous, cartilage, then bone...and that seems to be like a heck of a job!

I will put pictures up, but I think I may wait until I get a false profile at my next visit to the surgeon, as the AP isn't that dramatic.


Sunday, March 16, 2014

Hospital Stay

So after my surgery I had to stay in the hospital for a couple of days.  Needless to say, it was an experience that was painful and I don't wish such a stay for anybody.  The first night after surgery was a blur, I remember swearing that the PCA pump was not working because when I pressed it, it did not relieve my pain.  I remember lots of people telling me that my light was green and I could press the button again (I guess I was drugged and couldn't remember when to press it).  I also remember the resident coming in and asking if I needed higher pain medication dosage, and I remember saying that I am squirming because of the pain and needed more if he wanted me to sleep at all.  Other than those three things, I don't remember much. 

The first day post op was a blur, I remember the PT coming in and trying to get me to stand and walk.  But this was not going to happen because of the pain.  I basically got three steps out of bed and that was it.  I was unable to get to the bathroom so they got me a commode.  Which was nice, but I don't remember when it was taken away from me (it wasn't there long, that's for sure).  The foley catheter was removed this morning, so I had to make trips out of bed to pee.  Other than that, I don't remember anything else.

Second day post op, I had my drain removed bright and early by the ortho resident.  This was fun as it bled all over my bed when it was removed.  He had to come back thirty minutes later to change the dressing as it was still oozing a lot of blood.  It wasn't the most painful thing to be removed.  It didn't tickle, but it was odd and hurt a bit.  My surgeon rounded on me soon after, and his two minute swing by was less than helpful.  All he said was that I needed to get up and walk since most people are walking by now, and that he put the orders for me to be discharged that day.  He tested my sensation and motor function.  I was definitely strong enough, but my sensation on the lateral and medial portion of my thighs were not right.  The lateral femoral cutaneous nerve distribution was completely numb and the medial was almost completely numb.  The PT then came was very, very persistent and I was going to walk out of my room and down the hall a bit.  Walking this far (10-15 feet) took approximately 45 minutes.  It was horrendous and the worse possible pain that I could imagine.  Every single step hurt so much that it made me cry, sweat, and feel nauseous and like passing out.  I was given dilaudid beforehand, but this didn't matter.  I did do this, but it was REALLY painful.  Needless to say, I did not pass my PT and was there for another night.  My day nurse was bent on me having a bowel movement and ordered me a bowel protocol.  This caught up to me this night as I had horrendous diarrhea and made a trip to the bathroom every 30 minutes.  Which meant that I didn't get any sleep at all.  And every trip made me more and more sore.  It was really not fun at all.

Third day post op, the resident came by and told me that no matter what, I was going home today.  The PT and OT came in and said that my surgeon had told them that I am going home and that I was going to do what I needed to get done to be discharged.  So, I struggled, but did 3 stairs and walked to and from the bathroom.  I put my own socks and shoes on and got in and out of bed by myself.  All in all this was again an extremely painful experience and one that I hope never to repeat. But I ended up getting it done and was discharged home.  After a 45 minute drive home, it took 35 minutes to get into the house, up 5 stairs into the kitchen and into the living room where my bed was.  I think that it was a bit too soon to come home, I mean really, 35 minutes to get from my car to the bed? 

The next couple of days all blur together because of the constant narcotics and anesthesia brain.  I do know that my first trip to the bathroom from the living room took 35 minutes and it was almost impossible for me to crutch in our bathroom because it is so small.  So my parents ended up renting a commode to put in the living room for the time being and as I get stronger, I can use the regular bathroom.

Wednesday, March 12, 2014

February 28th, 2014: First look Arthroscopy + Left Periacetabular Osteotomy

Despite this being VERY delayed, I thought that I should finally start up my blog and record my experience of my first PAO.  Until now, I've basically had almost zero concentration or motivation to do anything.  I have a lot to update on here, but I figured that the best place to start was on surgery day and make up the lost time in later posts.

Friday February 28th, 2014:  SURGERY DAY.
I had received a call the day prior that my surgery time was 4:45pm so I was to be at the hospital at 2:45pm.  This meant that I had a LONG time to wait before my surgery on that day.  Phew.  It gave me a lot of time to be nervous.  But I felt like I handled it pretty well.  No dry heaving or throwing up! ;) I got to drink clear liquids until 12:45pm.  So I drank up all morning in hopes of feeling a little less empty.  I was very very nervous, but I had waited such a long time for this day, that I just needed it to come and be over with. 

We left for the hospital nice and early as I had to show my parents how to get out of the hospital easily (the roads around the hospital are quite confusing and I was worried about them being lost late at night), and I had to return my pager and ID badge from my Radiology rotation.  It was nice to not be rushed and get there with plenty of time.  When I got there, they almost immediately took me back and got my IV started, I peed in a cup for the pregnancy test, and basically sat and waited.  They were concerned about my temperature since it was so high, but the room had the heat blasting on and I was almost on the verge of sweating.  They ended up retaking it a couple of times and then just decided to tell my surgeon that it was the room and that I didn't actually have a fever. 

The anesthesiologist came in and we discussed that I would get general anesthetic.  I made it very clear that I had got EXTREMELY sick in the past despite using Scopolamine patch, Zofran, Phenergan.  He said that they would pump me full of all antinausea medications before I woke up and do their best.  An hour later he came back and said that he had been thinking of me and had discussed my concerns with his colleagues and they wanted to do the Scopolamine patch still and that they would really be alert to my nausea levels.  This anesthesiologist was not the one on my case, when I met the one on my case she happened to be a graduate from my medical school.  It's too bad I don't remember this bit of information as the Versed had already kicked in at this point, but my parents told me because it was kinda ironic.

The surgeons resident came in and asked me a bunch of questions, I signed my leg, then my surgeon came in and signed me leg.  He was very brief (as expected).  And told my parents that if they saw him come out in half an was a bad thing as this could indicate that the arthroscopy to check the cartilage health showed more arthritis and that the PAO was not an option.  Next thing, everybody flooded my room, I got some Versed (which is a pretty fast way to feel high), I said my good-byes, and vroom off to the OR.  I don't remember going to the OR, but I remember transferring over to the fracture table for the first portion of the surgery.  They gave me a mask to take deep breaths and that was it.  I don't even remember waking up really.  I remember being in my room on the ortho floor and complaining that my PCA wasn't working.  That's about it.  Nothing too extraordinary from my end as I had the easiest job there...simply being present while everybody else did the work.

As far as the surgery went, my surgeon actually stopped operating after the scope because apparently the cartilage was worse than he thought and he didn't know if he should do the PAO or if I should get a THR in a couple of weeks.  He went out and talked with my parents about each of the choices they had, and it ended up that he and my parents decided that the PAO would be the best bet, even with the arthritis, because it could give me a few to several more years with my own hip and would make the THR last longer if the dysplasia was fixed.  So he took another hour and a half to do the PAO portion of the surgery.  I'm not sure how long this PAO is supposed to last or how much pain relief I am supposed to get from this surgery, but I think I would have made the same decision had I been awake and able to decide what I wanted for my hip.

I will elaborate on my hospital stay in another post.