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 hour...it 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. 

< 1 Week Pre-Op

I have waited 9 months and now surgery is less than a week away.  It feels surreal.  I think that the majority of this feeling is that I am nearing the ending of school.  THAT is super exciting.  And surgery comes along with a different kind of excitement.  An excitement...erm...rather, hope that comes with the thought that this surgery could be a huge improvement for my quality of life.  The hope that if I can get a stable hip, that I could have a reduction in pain levels and be able to do things on my feet again, like shopping, going out with friends.  When I write it down like that it makes me sound super pathetic and a hermit.  In all honesty though, being on my feet all day hurting so much is so draining, that I barely have the energy to do anything but come home, collapse on the couch with my beloved heating pad, ice packs, and Tramadol.  THIS is the reason I am doing this surgery!  So bring it on!

Anesthesia called yesterday and I think I got my point across on how sick I get after general anesthetic.  The nurse and I had a nice chat about the factors that increase post-operative nausea/vomiting.  Apparently non-smokers, obese, people who get migraines, and people who get motion sickness are the strongest predictors of nausea and vomiting.  Awesome.  I have all of those except the obesity.  The strongest predictor she said was motion sickness...which is so odd that I haven't ever stumbled across this before because I get so car sick that I can't even ride in the back seat of the car around town because I get nauseous.  In the past we have tried scopolamine patches, Zofran, Phenergan, all of which do not help.  The nurse has noted it and I will definitely make the anesthesia team aware of this issue.  This is one of my main concerns about surgery. 

Another thing that is stressing me is that the insurance company has been so kind as to deny my surgery.  I hadn't heard anything from the insurance company or the surgeon's office and I called last week to see if everything was okay.  Apparently the surgeon is doing a peer-to-peer review on Monday to get my surgery covered.  His nurse said that I should really, really NOT worry about it as he WILL get it covered.  All in all, it still makes me very nervous because there is still that possibility that the surgery won't happen if I can't get it covered.  I mean, what else more do you need than subluxed hips on standing to get approved.  So now praying for this as well.  I hope it gets all straightened out.  The insurance makes me so nervous after what we went through in 2012 :/

Pre-Op Appointment--Check

This past week I had my pre-op appointment with my surgeon.  It went fairly well....all things aside, it made me extremely nervous, but I'll get through.  I am very nervous about this approaching surgery and I obviously came across as a Nervous Nelly because he asked me what I was so nervous about.  In any event, the appointment started with him telling me about how my surgery and hospital stay was going to shake down.  There wasn't anything that I didn't know in his speech.  But he didn't go through everything in detail because I had said that I had a good understanding of what the surgery entails.  Fair enough.  He then went through a very limited list of risks (I know he did this purposefully because both he and I know that I am not the most enthusiastic PAO patient he's ever had and I betcha he didn't want me running for the door!)  While I was asking my questions, I decided that I would ask about my other hip since that side is painful daily as well.  Ultimately, my chances of it settling down after I cease to add the compensatory weight on it are....nil.  Awesome.  So, looks like a PAO on the other side during residency (sooner rather than later). 

We then discussed plan B.  I am extremely thankful for him creating a plan B incase my hip is not good enough for a PAO to be done.  The plan is for him to scope my hip and check my cartilage health and then he will make a decision on whether or not to proceed with the PAO.  He has done 1500 PAOs and has had to abort 3 of them.  My chances are that I will very likely get the PAO.  We are all hoping that it ends up this way as I am too young for a THR.  But, having said this, the PAO will simply be a bridge to get me a couple to several years before needing it replaced.  He can't guarantee that the PAO will remove all of my pain because I have had too many surgeries, but he can guarantee me a stable hip...one that is not subluxed out while standing!  I am hoping that the pain from the instability substantially reduces my pain levels.  I know I am making the right decision to go and try the PAO if possible, as then I can know I did everything I could before having the replacement. So if the PAO is a no-go, I will be closed up from the scope and will have a replacement two to three weeks later with his partner.  The risk of infection is too high if we do the replacement the same day.  During my pre-op I also met with the surgeon who will do my replacement if needed.  That is when it really set in that we really don't know how this is going to turn out and that a THR is a very real possibility.  He was very nice about describing it all to me and was straight up that its not a matter of if we will meet for a replacement, it's when.  I got his surgery scheduling lady's contact if it does in fact come to that.  (Please pray it doesn't)

All in all, it was an informative appointment.  I am less than thrilled that I am still on my surgical journey towards functioning hips and have, obviously, become semi-jaded.  I think that my attitude during my appointment came across as being rather fed up and a bit sarcastic.  He knows I am less than excited to have to have surgery again.  I made it VERY clear to him.  Which, isn't exactly how I wanted to come across during our pre-op planning.  He is a very good surgeon, and I think I trust him totally.  My issue with trusting surgeons is that I actually trusted my previous surgeons!  And all they did was make me worse by performing the wrong operations on me.  I think that it is only human nature to be hesitant on the trusting bit once you have been let down so many times in the past.  I hope that my surgeon understands this, because this is one of the hardest things for me at this point in time and I really don't mean to be snarky with him and all of his surgical suggestions.  And my surgeon is such a sharp shooter--whoa!  He doesn't sugar coat anything and just tells you the way it is.  Which is good in a way, but kinda threw me off guard as I have heard from other patients of his how he jokes and has great bedside manners.  With me, it was all business.  Which is fine, I really don't want him to be my bestie, I just want him to fix my hips so that I can start to live a semi-normal life.

I am now in the process of organizing the crap in my life before the big day.  I organized my clothes so that my parents can find things in my closet (I do not keep the most tidy of rooms), started to move my junk into the spare bedroom (since I will be staying down on the main floor post op...no sense in lugging my sore body up 15 narrow stairs post op if I can avoid it).  I also got my pre-admission information all set up with the hospital too--they called yesterday.  So, it is really happening!  We are beginning a major turning point in this hip journey.  In 11 days I will have a better idea of what is in store for my hips.  This is exciting in an oh-my-gosh-I'm-gonna-barf-I'm-so-nervous kinda way.

T-Minus 25 Days

I seriously can't believe that this dang surgery is coming up so quickly.  It's crazy.  I have waited 9 months to schedule and have this surgery (I could have had a baby in that time for crying out loud!...scary thought).  So now, less than a month and I'll be all fixed up.  And I'm ready!  I am at a point where I know I need something done as I need my life back and if the PAO is what is needed to get it back, then BRING IT ON!

Pre-Op:  February 13th
Last day of school:  February 27th
PAO:  February 28th

February's gonna be a busy month.

Yes Sir--Countdown is in the 30s.

I keep a countdown on my phone to keep me on track as to how many days left of school, which has now also become my countdown for surgery since both lie on the same day.  But I have officially got down to the 30s....39 days to be exact, with only 29 of those days being at school on rotation.  The END is finally nearing!  After 25 years of formal education, I have 29 days left.  It is actually surreal.  I am super, uper, duper pumped to finally be coming up on my end of being a "student."  I keep it in quotes since becoming a physician actually requires lifelong learning and I never really get out of being a student, but at least I'll be getting paid starting in July.  This is exciting. 

So I didn't pick my surgery date very intelligently.  I should have chosen a week later since it would have given me a chance to do something fun for a week.  Perhaps go on a vacation somewhere for a couple of days, relax, hang out with family, have a small celebration to conclude my formal education.  All would have been very much enjoyed.  Instead, I chose to hop up on the operating table ASAP...which means I get to conclude my medical school rotations getting bones broken, hip socket formed, and a stay in the hospital.  As if I didn't get enough hospitals during medical school...I get to spend 3-5 consecutive days after school is done...what a way to finish off with a bang, eh?

All in all though, I am very thankful things have fallen into place and that I am able to have my surgery done at the most convenient time possible.  I realize that having surgery is never convenient, but this is the best possible scenario.  The thought of trying to do the other side during residency may be another beast in its entirety....but let's focus on the task at hand: finish med school, get left hip fixed.  I can do this!

Now I just need to stay positive for the remainder of school until the surgery.  I'm trying so very hard and it goes in cycles of "I can do this" to "Holy crap...why?"  I believe this is normal but it doesn't make it any easier having to control the roller coaster of emotions and doubts whilst keeping up with life.  Soon enough though, I will be able to leave school behind and focus on healing myself up.  I am, in fact, excited to turn this next page and begin the recovery process (and yes, I know it will SUCK post op....I ain't naïve...although sometimes I wish I were as there may be less pre-op anxiety). 

There are a couple things I promise myself as I approach surgery: 
Stay Positive
          Eat Healthy
               Be Patient
                         Obey my surgeon
                                          Don't be a hero
                                                       BE THANKFUL
                                                                    Embrace the experience
                                                          

Putting these up here now so that somebody can rifle these at me in about 8 weeks time.

A Post For Newbies

I was reading cancer blogs recently as my friend has had a recurrence of her Hodgkin's Lymphoma and was interested to read about other's struggles with cancer, and realized that many of the blogs were very informative and gave advice rather than always wallowing in their despair of having to deal with cancer.  Now, I am not comparing hip dysplasia with cancer, but I thought that the idea of trying to give a bit more information versus simply keeping this blog self-centered and yes, sometimes a place to throw a pity party, would be a better way of approaching things.

So here this post goes: providing information for newbies to the hip dysplasia/FAI world.  I know if can be overwhelming.  I remember the first time finding out I had a labral tear:  I was sitting on my bed 7.5 years ago taking a study break when I decided that I would pop my CD of my images from the arthrogram/MRI and, after fiddling through stuff that I didn't understand, I found the written report.  My heart immediately starting pounding and I felt light headed:  anterolateral filling defect consistent with labral tear and associated CAM boney prominence.  Meaning labral tear and impingement.  I didn't tell a single soul and kept this information to myself until I went to the orthopaedic surgeon as I didn't want anybody to freak out, nor did I really know what I was reading.  In any event, my point of telling this story is that I would have loved to stumbled across a blog post from somebody who had been through a similar situation very early on in my hip journey, because maaaaybe some of the mistakes I have gone through could have been prevented.

• Always get a second opinion.  I know this is hard with socialized healthcare, but seriously, wait to get re-referred to another surgeon because having two or three opinions is enough to make a sound decision.  I went ahead with surgery after one surgeon told me I needed a hip scope.  In hindsight, I should have waited the additional months to see yet another surgeon, because turns out my hip should have never been scoped in the first place.  In places like the US, second, third, and fourth opinions are easier to come by compared to that in Canada, UK, etc.  But still, pleeeeease, get a concurring opinion.  It will be worth it to ensure you get the proper diagnosis and proper treatment.
• Don't let any physician tell you that your pain is in your head, or that you should be all healed by now so you won't need to come back.  I've had two separate doctors tell me this, and I know I'm not cray cray, my hip does in fact hurt me.  I ended up forcing the first doc to tell me this to please refer me to another doctor because this is obviously not working out and the second doctor I kinda dropped like a hot potato and never returned.  Case in point, don't let doctors tell you you are crazy and that you don't hurt.  You are a patient and know your own body the best.
• Weigh risk vs. benefit..  If you are deciding whether or not to have surgery you must be willing to risk getting worse or staying the same in order to gain what function/ROM/pain you have lost.  I initially had my first two surgeries because I was having a hard time fully working out and participating in all my activities to my potential.  Well, 6 surgeries later, I can no longer stand well, nor can I work out at all.  Just seriously weigh the risk versus benefit.  And I'm not trying to scare you out of surgery, just make sure it's really the right thing to do.
• Research. You need to be an informed patient.  Plain and simple.  You can't believe everything your surgeon tells you.  You need to be able to question his/her thought process to make the best decisions for you and your hips.
• Make contacts with fellow hipsters. I could not have asked for a better cyber-support network of gals that totally get it.  There is always someone out there who has done what you are going through, pick their brain, ask questions, make friendships.  The contacts I have made through the Internet have formed into relationships that are closer than some of my physically present friends simply because they 'get it'.  Its a great bond and makes you feel less alone in trying times.
• Listen to your body.  And don't let things get too bad before seeking an opinion.  I did this with my left hip and it has snowballed into a mess of sorts.  You should not hurt doing physical activity, sitting, standing, walking, jumping, etc.  Don't be afraid to go to the doc, maybe there is something out there to help! And this point can be related to recovery too:  don't overdo things when recovering (MUCH easier said than done).  Slow and steady wins this race!!
• Find a place to vent.  I have three main outlets: my mum, my hip-friends, and my blog.  Each of these serves as an area in which I can freely discuss my feelings, fears, difficulties, and successes.  It's so important to not keep it all bottled up inside!
• Do your exercises.  Keeping a strong core with strong glutes is important with hip pain.  I will admit was better at this in the past, being with school is so busy and all, but there is no excuse: some bridging and planking will do wonders for the body and hips.
• Keep your weight in check.  This is MUCH MUCH easier said than done.  It's a vicious cycle for many people who can't fully exercise properly (as with those who have hip pain), but portion control is important: the kitchen is where the money is at for us hip folk!  I like Myfitnesspal to record my daily intake of food when I am feeling on the fluffier end.  I know that every pound of body weight = 3-9 pounds on a hip.  That's a frigging lot of weight on the hips.  It's hard.  I know.  And I'm not trying to offend anybody who is overweight, but simply making a point that it is something to think about.

Obviously I could continue to go on and on, but it wouldn't be helpful to read a novel in one posting.  Maybe I'll add to this list in a future post.  Until then, peace!!!!

54 days until surgery.

Long Hours

I know I'm in medical school and it is expected to work hard and long hours, but working roughly 69 hours this week on one bad hip and one iffy hip made my week miserable.  I feel like I am expected to function like this:

 

 

 

But what I really feel like is this: