5 Weeks Post Op

I should have been better about updating as my days came and what milestones I reached on what particular days so as to have a decent account of my recovery so I can compare it to the opposite side.  Sucks I didn't think to do that after this PAO.  I will promise to be better after the next one!

Yesterday was my 5 week post op date.  I am totally self sufficient now.  I can drive easily given that it is my left leg that was operated on. I can shower standing up and sitting down (the shaving of legs still needs to occur sitting and I just feel more comfortable with the chair in there still).  I can, shhhh, stand on two feet without any real pain and yes it feels weird.  One day I just looked down and holy crap, I was standing on two feet equally.  I know I am not supposed to do this until I see my surgeon again in two weeks, but it just happened.  Now I brush my teeth on two feet...I can't see how it can hurt too much because it is not as if I am walking around on it (although I feel like I can walk on my hip!)--which I would NEVER do at this point.

As far as pain levels goes, it is up and down.  For instance, yesterday, I had to take Tylenol and tramadol on board all day but then today I just took a half a tramadol and Tylenol the rest of the day.  I still take my muscle relaxant at night, but I was taking that pre-op too and am content to keep that on board until I get my other side screwed.  Quite honestly, I am taking these pain meds mostly for my non-operated hip.  My left hip is feeling really good, its the muscles and nerves that hurt on that side, but my right hip aches that deep sickening ache all of the time.  Suffice it to say, the right hip is less than happy to be supporting me fully these days. 

I am not sleeping well at all.  If I sleep in a bed, then I wake up every time I move.  Just this past week I have been able to roll over onto my stomach.  This is a welcomed position change from my back, but I can't stay like that too long.  I am still unable to roll and stay on my non-op side as my adductors spasm if I do that.  Those adductors have really taken a hit with the new bone positioning--right from day one they were sore.  Most night, sleeping in the bed keeps me awake bc I move, so I usually sleep in the recliner, which prevents me from moving too much so I can sleep longer than the usual four hours.  But I can't stay there every night as my back hurts there too much.  Complicated.  So, I rotate between bed and recliner. 

I am doing all of my exercises, including riding the bike. This week I have seen a great improvement in my atrophy as it is visibly less!  I am biking between 25-35 minutes total every day.  I hope that it helps me so I can get off crutches quicker.  My ROM is okay: flexion is about 100 degrees until I get the groin pinch, and I can do the figure four without too much discomfort, external rotation is good--I can get it to be equal to my right side now without any stretch, it is the sharp joint pain that is limiting me from full external rotation.  I am happy with my ROM, but I do believe that I should be able to do more.  I am unsure if it's my arthritis that is limiting my motion or if it is just the inflammation from the surgery, either way, I hope that I am doing as well as can be expected.  I will know more when I see my surgeon for my follow up in two weeks.

My incision is looking nice, all healed up, but the subcutaneous sutures are still extremely palpable with all 10 knots still able to be easily felt.  Two of them feel like they have some inflammation inside. I will keep an eye on it because I feel like they all should be dissolving a bit faster than they are.  My screws, all four of them, can be felt easily on days that the incision is not too swollen.  Lately, I haven't been able to feel them too easily, but I do feel them pinch when I flex up.  As my surgeon told me, I will be "begging to get my screws out!"  Maybe I need to fluff up a bit?  I sure am trying by drinking two high calorie Boost drinks daily...not necessarily to beef up, but to maintain my current weight, which is VERY difficult for me right now. Healing from major surgery uses us so many calories!!!

All in all, I am doing pretty darn well. 

4.5 Weeks Post Op

Time flies yet drags on.  It's just so weird.  These last four days or so have been icky.  My pain level has increased again and I am needing Tylenol and Tramadol during the day and half a Norco at night (along with the odd muscle relaxant here and there).  I wish that I could will myself to feel better.  It's just so hard to keep up the energy after having this surgery.  I definitely do my best to remain positive and hopeful.  After two and a half weeks I was on fire, totally killing this recovery and now it's a bit harder.  My pain is hard to pin point, but I do know that the joint pain has decreased significantly.  I have a lot of adductor muscle pain and spasms still, plus the nerve pain.  I would really appreciate if the numbness, hotness, and hypersensitivity would start to improve!  I'm over freaked out nerves.


I seriously can't believe I am considering it, but I have contacted my surgeon and my residency coordinator about how we can arrange for me to have my right hip PAO'd within the next several months.  The right side is especially painful know with the added pressure of being on crutches, but it did hurt prior to my LPAO and it was subluxed on radiographs. So, it's basically inevitable at this point.  My surgeon said 6-12 months before I can do the other side.  So I'm trying to figure out when it will be best to get this surgery done as I only have three weeks of vacation during my intern year of residency.  That is gonna suck....returning at 3 weeks!  :-O

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.

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).

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 now...in 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 hip...so...let'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.

HERE"S TO HEALTH AND HEALING!!!!

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.