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Sunday, January 25, 2015

Update: L & R Hips

So a couple weeks ago I had my three month follow up with my surgeon. It went good and bad. My right hip is on track and I am planned to get my hardware removed March 6th. I am currently trying to arrange my work schedule so that I can take the day of surgery and the next day off. That gives me enough time to get my brain cleared of the anesthesia enough to take care of patients. I hope I don't need a walking aid, but if I do, no issues bc the weekends are pretty light anyway (provided I am not on call). He was extremely happy with my right hip and it is a bit ahead of schedule. I don't have any joint pain anymore, just muscular pain that will go away with time. It's too bad I'm on my feet so much bc I think that I could really be even further along in my recovery if I wasn't working 80 hours a week.

My left hip is another story. I continue to have groin pain and catching just the same as pre-op. In addition, I have obturator nerve palsy from the PAO. My surgeon said he has only had one other patient have this nerve palsy after a PAO. He said that I am to do two more months of physical therapy and then we will fully discuss whether or not I need a nerve decompression or not. He believes the nerve is either stuck in the acetabular bone from when he did the bone rotation during the PAO or the nerve could be twisted in fascia in the pelvis. The thought of another surgery is completely shattering. I essentially shot my surgeon down when he said that I may need another surgery. He said he understands my hesitancy, but we will discuss it at my next appt. He said usually he doesn't follow up too closely after the screw removal, but he wants to see me bc if my nerves.

I understand why he wants to do surgery. I had a nice conversation with my physical therapist. She said that I am only 30 years old and do I want to take neurontin for the next 60 years? Do I want to have inability to adduct my legs for the next 60 years? The obvious answer is no! But I've just had two major surgeries within 7 months this past year. Add that with the previous 6 hip surgeries over the last 6 years, and it makes for a chick who is less than enthused to need to make another return trip to the OR. Quite frankly, this is unbelievable. The chances of this happening are almost nil. With such luck, I should go buy a lottery ticket. My current plan of attack is as follows: get an EMG (if my surgeon thinks that is a good idea), get my screws out on the right side, then discuss with him what and when we should do based on the EMG at my next appointment in March. I am not sure how involved the surgery is, but he did mention that it is not a small surgery. But if I can keep working post op, then maybe, just maybe I'll agree to it? Deep down I wanna just live with it for another three years then get it fixed after residency. Who knows? All I know is, this is an unfortunate place to find myself: post scope, post PAO, and possibly needing nerve decompression surgery. I should write s book or something!

Sunday, December 28, 2014


I realize that my updating on my blog weekly has fallen behind.  I had a lot happen these last several weeks and have neglected to update.  I am working full hours now and am still trying to wean off crutches.  I am 12.5 weeks out and can do one crutch at work and no crutches at home.  Coming off crutches is difficult when I have such long hours on my feet.

My right hip pain is pretty good.  Though I still have surgical pain, my hip itself feels pretty darn good.  My left hip still is there and I think its here to stay until I get the hip cut out in a replacement.  I am thinking of asking for an injection when I see my surgeon next; hopefully it will settle things down decently and allow me to work with less pain.

My incisions are looking great though the screw heads stick out nicely on my right hip and I can't wait to get those removed.  I have a March 6th surgery date for those to get removed in the OR.  I am hoping that this is the last time I will have to go into an OR for a long while.  My hope is to get through residency (which is three more years) without having to have another surgery.  That isn't unreasonable!

Short and sweet.  I'll update more frequently in the near future.

Until then, Merry Christmas and Happy New Year!

Thursday, November 13, 2014

6 Weeks Post RPAO

I can't say that I'm depressed, but I can say that I am in a valley as far as life goes.  I have returned to work for the past two weeks and it has been more than difficult to get through.  Though I am working minimal hours (PTL) I am still finding it difficult to stay afloat.  I am struggling each and every day with pain and fatigue.  Currently I am more than exhausted.  I realize God doesn't ever give you more than you can handle, but this surely is a learning experience for me.  I am growing as a person, whether I like it or not.  I don't have a choice, I needed to have this surgery and I still needed to work.  So I did both (with a four week vacation).  I wouldn't recommend anybody in their right mind return to work at four weeks.

Currently my right hip is not terribly sore.  The muscles are sore, but the joint itself has been quite calm. I have not had any groin pain since surgery.  I still have pubic bone pain and my incision is very VERY tender still, but I manage.  I did go up on my Butrans patch this past week as my left hip is terrible having to accommodate the added weight of being the sole weight bearing hip.  I think the increase has helped but I don't intend on being on it for too long and hope to wean down slowly over the next couple of months.  I'm still on my Neurontin for my obturator nerve on my left side from my LPAO, I thought I could get down to 600mg at night, but I need one more dosage during the day to keep the nerves quiet.  I hope that I can also wean this medication over the next couple of months as well.  I am still non weight bearing on my right side and am totally sick of crutches.  I see my surgeon next week for my second post op follow up...hopefully then I will be cleared to weight bear.  I plan on starting PT next week as well.

Back to the mental, emotional, and spiritual aspect of recovery.  I am finding this surgery terribly difficult to press on with positivity and hope.  It feels like I'm a patient revolving through Operating Rooms over and over, never fully giving my body a chance to heal.  The longest I've gone without a surgery in 8 years was in 2013 when I went from September 2012 through to February 2014 without a single surgery. Now, it's been two very large ortho surgeries during 2014 and will be planning on screw removal in the spring of 2015.  I long for the day that I am wheeled back to the OR for one last time for a few years (when I get my LTHR bc we all know that the replacement IS actually coming my way).  I need to place my fears in the Lord, have faith, trust, and persevere onward, through pain, fatigue, and exhaustion.  I pray for strength, endurance, and peace; but most of all for strength to get through this difficult time.  This has been a major hurdle in life and I had always hoped I would make it through with grace and positivity, but currently, I'm feeling the opposite. 

Friday, November 7, 2014

5 Weeks Post RPAO

Ok, so like, yeah, things have been hectic; too hectic to be good.  I started back to work officially at four weeks, but unofficially at 5 weeks. So I had to do anesthesia for three days then the weekend off then start outpatient clinic. The anesthesiologist showed mercy and told me to not come in and to stay home and continue to recover.  Which was necessary since I wouldn't be able to do any intubations anyway.

I then started outpatient clinic at just shy of five weeks post op.  Eww. Yeah, it is absolutely no fun crutching into patients rooms and having to think about medicine at this point in time.  I'm exhausted.  Literally, by noon I'm ready for a nap.  It's not the pain that is a problem (though my left hip hurts tremendously from being the sole weight bearing leg), but the lack of stamina.  I have negative energy at this point in time.  Two days after I started in the clinic I got a sore throat and then, yesterday, viola!!!!  I have strep throat. No kidding this is horrible.  I'm still feeling gross from the surgery and then I have a disgustingly sore throat with exudate, a fever of 102F, vomiting, myalgias, lack of appetite, cervical lymphadenopathy.  All around a bad day yesterday. Phew.

Today is better though I still have a sore throat, I am not vomiting and my fever has broken.  It is a shame that I had to get sick because I am hanging on by a thread anyway, and to add this sickness on top of the massive healing I am doing, it just drains me.  Oh, and to add insult to injury, I am studying for boards (which are December I will be able to sit for 9 hours of multiple choice questions is beyond me) and the regular readings we are required to do for my residency.  It all is, well, EXHAUSTING. 

I hate complaining.  In fact, this entire post has been relatively depressing.  I am not depressed, I'm just drained.  Completely drained.  I should still be staying in bed, icing, and watching movies on Netflix instead of commuting 1 hour and 45 minutes a day, seeing patients, and studying.  It just is a very rough patch in life.  I like to think it will build character; but for now, I need a pick me up.

As far as the right hip goes, it is relatively pain free.  I still have soft tissue pain from the surgery but the groin pain has gone away. My left hip still has tremendous groin pain but the anterior pain from the screws is much better.  The incisions look great.  I had a piece of suture sticking out on the distal portion of my PAO scar and I was fiddling with it today and it kinda just fell off.  Meaning that there is a small hole at the distal portion of the scar where the incision is; I'm kinda freaked out!  I hope it closes soon. Sigh.

over and out.

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....