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 yeah....wow. 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

xxoo

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.

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. 

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 it...it 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.

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

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.

Reminiscing....

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.

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.