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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 ...