What's the Hip Fix?

Two Years Post-RPAO

2011-06-02T14:49:00.126-04:00

It has been a long time since I last wrote here, and an even longer time since I visited Dr. Millis. But today I made the old familiar drive up to Boston again.

The main purpose of my visit was to get a contrast MRI of my right hip now that it has been over two years since my March 16, 2009 RPAO. I am part of a study Dr. Millis is doing on cartilage regeneration post-PAO surgery -- the study will compare the MRI taken pre-RPAO with MRIs taken one year and two years post-PAO. Ideally, the MRIs will show that cartilage damaged by the poor alignment of the dysplastic hip will repair itself once the joint alignment has been corrected by the PAO.

One of my favorite qualities about Dr. Millis is that he will sit down and geek out with patients about the science of the surgery -- this time he sat with my mother and I and took us through all my MRIs, explaining how the contrast material indicates cartilage damage in the pre-surgery image, and then tracking the cartilage repair across the two post-surgery MRIs. Today's MRI showed no cartilage damage at all, indicating that my body has repaired all of the painful damage my hip had suffered prior to the surgery. It is an amazing result -- two-and-a-half years after my diagnosis, I am truly "cured" of hip dysplasia as well as the damage it caused.

Of course, today's MRI merely confirmed on a medical level what I already knew to be true from my own experience. For the last year I have been active with tennis and horseback riding and long walks around New York City, limited only by stamina and blisters. Most of the time I don't even think about my hips, but from time to time I am still struck with wonder and gratitude at the amount I can do, and the pain I don't feel.

No News is Good News

2010-09-07T07:56:00.003-04:00

No news really is good news. I haven't written here since April because I basically have not thought about my hips for months.

The entire summer I have been playing amazing amounts of tennis -- four times a week at my peak -- as well as walking up to five miles across the city at times. Through all of this, my hips have been completely pain-free.

I'd say my hips were "as good as new," except they actually are better than new. I never could have done this amount of activity with them pre-surgery. In the months before my first surgery I could barely play tennis once a week, let alone walk long distances.

My hips have now healed so well that in the midst of a tennis match I've actually forgotten that I even had surgery on them, or that they ever even pained me. Which is exactly how someone my age should feel about their hips while doing athletic activity, actually.

So thank you to Dr. Millis for re-aligning my chassis so that my hips can now carry me as smoothly as they should have from the beginning. My tennis opponents wish you'd left me as I was. :)

Eleven Hours of Tennis

2010-04-13T09:59:00.003-04:00

Every part of my body hurts -- except for my hips! This past weekend I went to tennis camp in the Catskills. Ideally, you play 11 hours of tennis over the course of the two-day program, but going into it I wasn't sure how much I would be able to do.

Prior to my screw removal, I was up to playing tennis three times per week, and I'd played two consecutive days in a row, but every time I'd played it had only been for an hour or two total. Tennis camp was a whole new level of intensity.

And it was fantastic. I played every minute of the eleven hours, not holding myself back in any way, and my hips did not hurt for one second. Not the bones, not the small muscles inside, not the incision. My hips felt like there had never been anything wrong with them.

The rest of my body is another story. I am pretty sore! But it is a good feeling of having worked hard and pushed myself, and my tennis definitely got a big boost from all the instruction and practice, so it is all worth it.

New York City tennis season has officially started now that Central Park is open, and I am ready for a great summer of tennis with my new, sensational hips. Thank you Dr. Millis!

Screw Removal

2010-03-27T07:07:00.004-04:00

I am now officially hardware-free! Yesterday I had the six screws from my LPAO removed in an outpatient procedure. It was relatively quick (I think it took an hour in OR) but I got general anaesthesia anyway. There was the option to just be heavily sedated but honestly I did not want to hear and feel the vibrations from the drill, no matter how much happy juice they were giving me at the time.

This time when I came out of general anesthesia I was strangely restless and impatient, like I wanted to get out of there, I was bored, I wanted to read, I wanted to move, want want want, I don't know what I wanted but it was everything and nothing. Strange. But better than shaking and freezing like last time.

I came to with several layers of bandages over the incision, and not a lot of pain in the incision area: maybe a 3 on the pain scale, which lowered to a 2 once they gave me some more morphine.

They discharged me relatively quickly; I was only in the PACU for about an hour and then we got on the road on our way home. During the three-and-a-half hour drive home from Boston I was relatively pain-free, but I was very nauseous the whole way and did get sick once on the side of the road. I hadn't even been nauseous after either of my other procedures, so I think this was more the result of a long car drive on top of the general anesthesia and morphine.

Today the incision site is quite painful; more painful than I expected it to be. I'm taking the oxycodone as often and as much as I'm allowed to and it doesn't seem to be making a dent.

Dr. Millis told me I shouldn't play tennis or really do any activity for two weeks after the screw removal, and I'd kind of hoped that was a conservative estimate and I could be back to at least walking to work and working out, if not tennis, by mid-week this week. But at the rate my incision hurts now, there is no way that is going to happen.

That is depressing, because tennis season starts on Thursday, and I've been playing more and more tennis recently to get ready for it. In the last couple of weeks it has been up to three times a week and my hips have been feeling great. So taking two weeks off now is a big setback.

But I suppose I shouldn't complain -- I'm lucky to be on the courts again so soon anyway, and at least now I am 100% done with all my surgeries. One year and five months after my initial diagnosis, both PAOs are done, all the hardware is out, and I know I'm going to be feeling better than I have in years as soon as this incision heals. And that is a good feeling.

Tennis!

2010-01-26T10:01:00.004-05:00

On Sunday I played tennis for the first time post-LPAO! It felt great to be back on the court, and both my hips felt great before, during and after.

I played doubles for two whole hours, and while I didn't go for any crazy gets, I didn't hold myself back too much either. Obviously I was a bit rusty, but for the most part I felt really good and like I am ready to start playing regularly again. Yippee!!

I have been doing a lot with my hip lately: walking to and from work (it is only 20 min. each way), Pilates, spinning, and seeing my trainer twice a week. All that work has obviously built up the muscles quite well, and the spinning has been improving my cardio quite a bit.

So fitness-wise, things are going very well. Tomorrow I am going up to Dr. Su's office to get my 12-week post-op xray of the left hip, so we'll see how the progress is going on the inside as well. Dr. Su is a hip specialist at the Hospital for Special Surgery here in New York, and the doctor who first diagnosed my hip dysplasia and referred me to Dr. Millis. I'm having my xray done there so I don't have to drive all the way up to Boston, and so that Dr. Su can see the end result of his initial diagnosis.

Eleven Weeks Post-LPAO

2010-01-19T15:50:00.003-05:00

My hip has been doing spectacularly well for the last week or so, with no significant episodes of pain or limitation at all.

Prior to that there was unpredictable, variable pain that seemed unconnected to my activity level. The pain would appear without warning, sometimes in the front of the hip, sometimes in the back, on the ischium, and sometimes, more rarely, on the outside of my hip. It would last for a random amount of time, and then it would disappear, seemingly without cause.

For example, one morning I woke up and had pain with every step I took with my left hip, for no apparent reason. I hadn't pushed the hip the day before, or done anything out of the ordinary. I rested all that day, hoping that would help, but the hip continued to hurt in what felt like the small muscles surrounding the hip, as if I'd overdone it walking or something. Which I hadn't. The pain lasted into the next day and then, as suddenly as it had appeared, it disappeared. For no reason. Frustrating.

The last episode of that inexplicable pain was about a week ago. Since then, my hip hasn't complained at all, despite an increase in my walking, intensification of my workouts with my trainer, and the addition of both swimming and spinning to my regimen. In fact, my hip has taken all these challenges in stride (pun, sorry) and has felt great.

So I don't know how to explain any of it. All I can report is that I've been doing more and more with my hip and it has been feeling good. My right hip, which is now ten months out from its PAO, feels great as well. My fitness level is improving markedly and I'm starting to feel like my old self again.

Next week I will get another x-ray taken and I'll have more to report once Dr. Millis has commented on it.

Nine Weeks Post-LPAO

2010-01-04T14:57:00.003-05:00

After my RPAO, I started my nine weeks post-op entry jubilant about finally being allowed to wean myself off crutches. Juxtapose that with today's entry, nine weeks after my LPAO and here I've been walking for three weeks already!

Well, that is a bit of an exaggeration. I only ditched the crutches totally about two weeks ago, but since then I've been walking more and more, trying to get my strength up. I went to Europe right after Christmas and although my hip tired easily, for the most part I felt pretty good through airport transfers, post-holiday sale strolls, and museum visits. I even took a 10 mile bicycle ride one ambitious morning.

I can't say my hip was pain-free -- when it got tired, it definitely got sore, but I was good about making sure I always had an "escape route:" a cafe to rest in, a subway to jump on, a cab to hail, etc. so I never got stuck anywhere having to push my hip past its limits just to get home.

Now I'm all moved back into my apartment in NYC, my office at work, my normal life. Well, almost normal. I still don't think I can make it far enough to walk to work yet. And I definitely need some time before I can play tennis again. But I'm progressing really fast and I'll get there soon enough. Who wants to walk to work in these sub-zero temperatures anyway?

Seven Weeks Post-LPAO

2009-12-22T20:39:00.003-05:00

I went up to Boston today for my second post-LPAO appointment -- a little early, at only seven weeks post-op, but that seemed apropos given the quick pace of this hip's recovery.

In the last few weeks, I've been mixing in more and more walking, but still keeping the one crutch with me for longer excursions or (given the current weather conditions on the East Coast) inclement footing. Needless to say, Dr. Millis and the team were pleased with my progress, my range of motion, my strength and my nearly-perfect walking.

I say nearly-perfect because, as physical therapist Jaime pointed out, I need to do some specifically targeted exercises with the thera-band to get back to 100% on the left side. So I've got those movements as an assignment. Other than that, though, I can continue with my bike riding at the gym, and continue to increase my walking as it feels comfortable and as my hip muscles strengthen.

Essentially, I am now where I was at the end of May with my RPAO -- which puts my left hip recovery about a month ahead of where my right hip recovery was at this stage. So there's my Christmas present!

Progress Report

2009-12-07T20:37:00.001-05:00

Officially five weeks post-LPAO now, and there is more good news to report.

I have been to the gym three times since I got the green light to start last Tuesday. Getting on that bike and moving my blood around feels so good after a month of basically being sedentary. I have fewer restrictions on my movement than I did at this point last time, plus I got started going to the gym the day after I got permission from the doctors, so the mood-enhancing effects have already begun.

At the gym I have been riding the stationary bike for 30 minutes on the "random" setting, with a highest resistance of about 6-8 (out of 25 available on the bike). It may not sound like much but after my RPAO I had to start at zero resistance for 10 minutes, and work up from there. Plus, my cardiovascular endurance totally disappeared during my month of the Couch Workout, so 30 minutes at level 6 has me breathing hard enough already! But I'm looking forward to improving on that front as well.

I've also done some upper body work at the gym (although with all the crutching, I don't think I've lost that much strength) -- lat pulldowns, rows, chest presses, etc., but I've been pretty lackadaisical about it so far; must step it up a bit.

Interestingly, I just realized that I -- completely coincidentally, without having gone back to check my post-RPAO entries -- quit my pain meds at exactly the same time post-LPAO *to the day*. Amazing! So yes, I quit my pain meds today, exactly the same way I did at the five-month mark last time: I woke up with very little pain, and figured, hey, why not give it a shot?

One of the reasons I decided to go off the pain meds now was that I wanted to feel pain as the warning sign it is. Now that I am putting more weight on the left leg, and using one crutch at times, I don't want to push things too fast simply because I've numbed the pain and don't know that I am putting too much strain on the joint. But so far, so good. What pain there has been is minimal and tolerable and subsides if I give my hip a rest for a while.

So now I am pharma-free, except for aspirin (allowed to quit next week), fiber, and calcium. I sleep well on both sides. My incisions look great. My only niggling problem is that tight spot on my spine where the epidural was, although I don't feel it nearly as often now. If it is not gone by next week I'll let the team know.

One Month Post-LPAO

2009-12-01T17:08:00.001-05:00

Today was my one month post-op appointment with Dr. Millis and the team. I already had a feeling my left hip was healing faster than my right hip had earlier this year, but my appointment today confirmed this.

I got the standard x-rays before seeing the team: supine AP and false profile. When I went over the films with Erin, she pointed out the areas of bridging -- where the bone had begun knitting to fill the cracks. My bones have done a spectacular amount of knitting in the past month! The cut in the illium was barely visible (except the big gap to fill caused by moving the acetabulum), and the other two cuts were bridging nicely. I'll try to get the films so I can post them. Both Dr. Millis and Erin were impressed.

I reported that I am down to two Percocet a day, one in the morning and one before bed; Valium occasionally as needed. That strange pain (that I thought might be a ligament) is completely gone now. I still take one Atarax at nighttime. I am sleeping much better now, able to sleep comfortably on both sides now, as well as on my back. I still have the strange pulling feeling at my epidural site, so Erin told me to let them know if it got worse or continued much longer.

Erin did my range of motion tests and they were good as well. My hip can bend below 90 degrees towards my chest now and rotation was good. My straight leg raise was high and strong, too, which I think is because I was in good shape going into the surgery. I think if the muscles around your hip are strong going in, it can only help in the recovery.

When it came to movement, I admitted that I'd been putting more weight on the leg this past week. Erin had me walk with one crutch and then a few steps without crutches. One crutch felt OK but without crutches I definitely felt that sinking feeling you get when the leg is not ready to take the weight yet. So I am officially allowed to start using one crutch, but always keep the other around in case I need support or my gait becomes uneven "like a penguin," to quote Erin. Great news, huh?

I am allowed to go to the gym now, with far fewer restrictions than I had post-RPAO. I can do the stationary bicycle at zero resistance to start, as usual, but I can increase duration and resistance faster this time. And I can do any upper body and core exercises I want, provided my hip feels fine when I'm doing them. This is great news because the faster I can start getting back into shape the better; I'd rather not lose as much fitness as I did after the right hip surgery.

It is amazing how much different this recovery has gone compared to my recovery in March. Other women have said that one hip is always worse than the other, but you never know which one will be the bad one. Imagine if this one had been worse than the RPAO! But luckily it is going fantastically so far, and I'm feeling really great. But I doubt I would have appreciated the speed and ease of this recovery as much if I hadn't had such a rough go of it in March.

So good news overall, but there's still a lot of healing to do. I am going to try not to get overexcited about this progress, and continue to take it slow and steady so I can keep knitting away as well as I have been. I return to see Dr. Millis and the team in four weeks (Dec. 29), but I'll update here before then, to report on how the new weight-bearing and gym visits are going.

Three Weeks Post LPAO

2009-11-23T09:29:00.004-05:00

It is now three weeks post-LPAO. At this point last time I had a giant leap in progress. This time, progress on the left hip is just steady and slow. I think the difference (again) is that Dr. Millis didn't have to go into the joint capsule on this left side. The first three weeks of horrendousness after my RPAO probably had a lot to do with the joint capsule having to heal up and stabilize. So while my first three weeks post-LPAO felt better than my first three weeks post-RPAO, I think the recoveries are pulling even now.

PAIN and its MEDICATION

My pain is generally very low. Most of the day I am in little to no pain. I usually wake up with pain around 4 or 5 in the morning, but once I take a Percocet I can make it quite a while until the next one. That ligament (or whatever it is) is still bugging me from time to time, but not nearly as much as it was last week, when it hurt at every step. Now it is just an occasional pinch from time to time.

Sleeping is still not fantastic, but is getting better. I still wake up a few times a night when I have to roll over. I can comfortably sleep on my right (non-op) side for long stretches at a time. The pain gets worse towards the morning when the previous night's bedtime Percocet has worn off. Last night, in a fit of madness, I tried to roll onto my left side. Ouch. I'm not quite ready for that yet.

I am gradually stepping down on the painkillers. This past week I discontinued the Oxycontin altogether and I have been averaging 4 Percocet/day (day being 24-hour period, in this case). I am still taking the Valium as needed.

I haven't stopped Atarax but I think I will this coming week. My hospital rash is long gone and the itchy-red-spots are pretty much gone as well. Just some residual itching here and there.

MOVEMENT

Movement is generally the same as last week. Now that the ligament pain (or whatever it was) has let up, I am less reluctant to crutch around. I have even left the house for dinner at a restaurant and other adventures. I am good on my crutches (after much practice!) and I am strong from my pre-surgery fitness level, so moving around is not a problem when the ligament is not bothering me. Some chairs are still uncomfortable, but I can find ways to sit to minimize the pain.

Because I seem to be healing so fast, I have been entertaining delusions of perhaps getting off crutches earlier this time. But I think that is probably not going to happen. I have been ahead in the healing game with this PAO because of the joint capsule -- but cut bones are still cut bones and they are going to take as long to heal on the left side as they did on the right. So I'm just going to be in this I-feel-fine-I-just-can't-walk limbo phase for longer this time. Great.

INCISIONS

Both my incisions look great: click the links for the pictures. The one that really matters is the right side, since that will be my permanent scar on that side. On the left side they will open the scar back up again to get the screws out in a few months anyway, so who cares what it looks like now.

MOOD

My mood is good; mostly stressed. I have had to work a lot during this recovery and it is leaving me with less time to read and relax than I had during my recovery this spring. It is also draining. In the evening I feel like I am going to collapse from exhaustion once I log off work. Another reason I am not getting as much reading done this time around. Happily there's the holiday weekend coming up so maybe I can get through a book.

Next week is my 1 month post-op in Boston. How the time flies as I limp along behind it.

Two Weeks Post-LPAO: Movement

2009-11-16T13:30:00.001-05:00

One significant difference from my recovery in March is movement. It is very obvious that this surgery was less invasive and less "destructive" than my RPAO in March. At this point in March I was still quite limited in my hip joint movement, much more so than I am now.

I have quite a bit of leeway in how I can move my left hip without pain. I can straighten it and bend it far more than I could at this stage with my right hip. Of course I cannot lean down to put on a sock on my left leg, or even smear Sarna cream on my itchy left calf, but I can make a more acute angle with my left hip than I could with my right two weeks post-RPAO. I can cross my legs at the ankles (right over left, of course). My left hip also still pops and clicks (painlessly), though more quietly than pre-surgery. (My right hip never popped again after my RPAO.)

The fact that Dr. Millis did not cut any muscles during my LPAO is also noticeable. Although it is weak, my left hip flexor does actually work. I can use my left leg muscles to move my leg around a little bit. At this point in March I could not move my leg at all without someone to help me lift it and replace it in a new position.

All of this should mean increased mobility, maybe even an excursion outside the house (!), but unfortunately the pain I have been having while crutching has been quite a deterrent to getting up and crutching around. So mostly I stay seated or supine, unless I really *have* to get up.

I still need help getting into and out of the shower, because there is a lip, but I can shower on my own. I have a shower chair but I use it more for support than for sitting while I'm showering.

I don't use a special toilet seat -- my right leg is strong enough to lift me from most seated positions even when there is not really enough support for me to use my arms to assist.

I am comfortable sitting in a soft armchair, as long as I can slouch a bit or put my legs up on an ottoman. Dining room and kitchen table chairs are less comfortable, mostly because they involve eating (therefore leaning over the table) and that causes overly-acute-hip-angle problems. Same problem with my office chair (and leaning over the computer). I try to solve the angle problem by sitting on the edge of the chair and angling my thigh down towards the floor, with my foot under my chair, but it is not very comfortable.

Sleeping is the one area in which I am actually doing worse than I was at this point in March. I can still only sleep on my back, with pillows under my left knee. It is not terribly comfortable and when my lower back (what I assume to be the sacrotuberal ligament) hurts, it is not comfortable at all. I am desperate to switch positions during the night, and I have tried, but I still can't sleep on my right side. My left hip and that spot on my back ache when I try to do that. In comparison, two weeks after my RPAO in March I could already sleep happily on my non-op side.

Two Weeks Post LPAO -- Pain & Itching

2009-11-16T11:56:00.001-05:00

Today is two weeks from the date of my LPAO, and I have been home from the hospital for a full week. It has been a bit different than my first week home after my RPAO, which you can read about here and here.

For one thing, my activity level my first week home after this surgery was much higher, and not by choice. After my RPAO, I spent the majority of my first week at home sedentary, reading or sleeping in a couch or bed, moving only when necessary. This past week, I had to work full time the whole week. I was, of course, working remotely from Connecticut, not going into the office. But still, that meant sitting upright in a chair at a desk most of the day, and moving around a lot more than I had done in March. Having to work couldn't be helped, but I do think I could have used a bit more sedentary reclining last week.

My pain has been generally well-managed, except for sometimes sharp pain in two specific places. In March, what pain I had would migrate, popping up in different places every time. This time, the pain is localized in two places: the back of my hip joint (it feels like deep inside where my left buttock meets the top of my thigh, maybe the cut in the ischium?), and above my tailbone, on left side, just above my left buttock.

The former pain has lessened over the course of the week and by now is pretty much resolved. The latter pain is much more common and more severe than the former. That pain above my left buttock is almost constant when I am crutching (each time I take a "step" with my left leg, I feel pain there) and can ache while I am sitting in chairs or lying down, especially if I have just been crutching. I have no idea what it is, it doesn't seem to be located near the surgery site at all. I've got an email in to Dr. Millis asking about it.

My best guess is that there is something going on with the sacrotuberous ligament. That would make sense since one of the hamstring muscles originates from that ligament. Maybe when I step a certain way and activate that muscle, it pulls on the sore ligament? Now why the ligament is sore in the first place is a totally different question. Unless of course it is because that ligament connects the sacrum to the tuberosity of the ischium -- the ischium, of course, being the potential source of my other pain described above and one of the bones cut during a PAO. Gosh, surgeons must love it when patients play doctor using Wikipedia.

Moving on. Unlike on my right side after my RPAO, there is no numb spot on my left thigh after my LPAO. Probably because they didn't have to move the nerves around on the left side.

My incision on the left side is fine. The dressing itches sometimes but not too often. It is not generally tender, although earlier in the week it did feel a bit bruised if I pressed gently on my hip near the top of the incision. We have not changed the dressing on the left side. I imagine it will come off some time this week.

My incision on the right side (where the screws were taken out) does not bother me at all. Obviously it was a much shallower cut than the left side. Its dressing came off on Saturday, but the steri-strips remain.

In the hospital I did have some swelling in the hip area on the left side, and my left foot and lower leg swelled up like the blueberry girl in Willy Wonka for a while. But all that swelling is gone now.

My current pain medication regimen is:

-- 1 Oxycodone every 5 hours during the day
-- 1 Oxycontin twice daily
-- 1 Valium as needed during the day
-- 1 Oxycodone and 1 Valium kept at bedside if needed for pain during the night

It is more pain medication than some other PAO women have taken at this point in their healing, but as I wrote a few days ago, I am not being a sissy; I just seem to need more pain medication than most. I am not worried; I will step it down when I am ready, just as I did in March after my RPAO. But currently, especially with that frequent upper buttock pain, I need pain relief.

As I explained in March, the Oxy painkillers do not make me feel mentally foggy in the slightest. Only the Valium makes me a bit scatterbrained and sleepy, so I never take it when I am working, or trying to concentrate on something important like Gossip Girl.

My horrible skin rash has subsided. Probably primarily because I am not laying in those hospital sheets anymore. Earlier in the week I was applying the prescription steroid rash cream twice daily, but since the rash seems to have been vanquished, I've essentially stopped with them now.

Alas, when one itch dies, another is born. Again I am plagued with the itchy-red-spots problem I had in March, probably a side-effect of the pain medications. I am taking Atarax (thrice daily) to combat the itch, and I also try not to scratch. I carry around Sarna lotion and put that on every time I have an urge to scratch. Needless to say, I am very moisturized. It seems to be working because I feel like I have a few fewer itchy red spots than I did mid-week.

I still take aspirin, but I never wear my TED stockings. No one told me I had to. I wore them on the car ride home from the hospital but that was it.

Recovery Day 5 -- Homeward Bound

2009-11-07T22:29:00.001-05:00

Among the many uncomfortable things about sleeping post-PAO is the fact that you can only sleep on your back: still and straight like a mummy (with pillows under one leg). Last night I somehow got it into my head that I might be able to sleep on my right side for a while. Surprisingly, it did not work at all. Neither my left hip nor my right appreciated the change. My left (PAO) hip just ached and my right hip's screw-removal incision pulled and pinched. Position change fail.

Dr. Kim came to visit me in the morning. I had actually never met Dr. Kim, so that was a pleasant surprise. He checked my dressings and asked about pain and had me wiggle my toes and all the rest of the typical morning-rounds check up.

At 9:30 Michelle from PT came to get me. I remembered her from March, she is a great PT. She helped me out of bed (an activity which is going more and more smoothly each time I do it) and wheeled me to the PT room. I walked the parallel bars (without help moving the left foot this time) and then got on the crutches to show I could handle them on a flat surface and on stairs -- two prerequisites for my discharge. All of this went very well today. It is such a mystery why sometimes physical things can be so hard and then suddenly so easy.

Obviously I spent two and a half months practicing crutching earlier this year, so that could be the reason for the crutch success. It went well, except that I seemed to be favoring my operated leg a little too much. As I stepped with my left foot, Dr. Millis kept saying "more weight on that foot!" I'm supposed to have 1/6 body weight on the left foot as I step on it, but that is a hard thing to gauge.

Having passed the PT tests, there were just some loose ends to tie up before getting me out the hospital door. There was a humorous moment sizing my TED stockings -- first they gave me size large, regular length stockings. They were loose and too short, like mid-calf gym socks. My mother kept saying I needed LONG stockings because I am tall, and size medium, so they'd be tight enough. A couple of attempts later what I ended up with were tight thigh-high TEDs. They looked sort of trampy, in a way.

The drive home was much better than it had been in March. I was in less pain, perhaps because the surgery had been less invasive so the little bumps and swerves of driving were less disruptive? Or maybe I was just better packed in with pillows and pain pills? Who knows. Another mystery.

By the time we got home to Connecticut three and a half hours later, I was in a lot of pain. While driving, we'd overshot the timing on my oxycodone dosing and so the pain had broken through big-time. I was at 7 or 8 when we got home, just moaning and staring blankly until the pain came back down.

My parents helped me lurch myself up the 13 stairs to my bedroom, and finally I fell into a blessed night of sleep -- in my own bed, without wires, beeping monitors, vital sign checks or rude awakenings by crowds of interns.

Phase One complete. Time for the long Phase Two.

Recovery Day 4 -- Wireless!

2009-11-06T22:54:00.000-05:00

Last night was a terrible night because of the rash. Even though I finally got some steroid creams last night, the itching and discomfort was hardly vanquished, and I had to keep calling for Nubain and Benadryl in between my steroid cream applications.

This morning I wanted nothing more than to leap out of bed, have a shower (preferably stripping away several layers of rash-infested skin in the process) and then marinate myself in steroid cream. Last time I had this operation, I absolutely dreaded getting out of bed because it was so painful and logistically difficult. I think the rash is worse this time around, but I know that getting into and out of bed is somehow much less difficult, so it makes sense that I'm much more amenable to getting out of bed.

Nonetheless, I spent most of my morning in bed, working. So much for taking off from work for two weeks after surgery! Dr. LaReau stopped by to check on me, I ate some fruit salad, time passed.

At 10 my catheter came out. With that, I was wireless! No more leads, IVs, drains, nothing. Just me and my rash.

Finally Kimber came for PT, and it was time to get out of bed again. It went better this time; I was more confident with the limits of what I could do, and I also trusted Kimber more. Once up and in my wheelchair, I was taken to the PT room to try walking on the parallel bars. Again, I was pretty confident about it -- after all, this had been a less invasive surgery and I had already done this learning-to-walk-again thing before.

As all you proverb fans probably guessed, it went terribly. At least I felt it did. Just like in March, I couldn't slide my op-side foot forward to save my life. I was so disappointed and confused. This time they didn't cut that muscle! It is supposed to work! Why can't I move my foot?! Kimber helped me slide my op-side foot forward for each "step" but it just felt like cheating. I couldn't do it myself. The whole endeavor hurt my hip and my pride and I felt like a sad failure. I had thought it would be so much easier than in March and it wasn't.

At least when I got back to my room my sheets were changed. But I didn't get to take that long-awaited shower because (of COURSE) I got the only room on the floor with a bathtub instead of a walk-in shower. Perfect. So I had to wait for a new room to open up so I could switch rooms to take a shower. Which meant getting back into bed to stew in my own boiling skin for a few more hours.

I have been on oral pain medication since the epidural came out yesterday, but I still feel like they are not yet covering my pain properly. There are "gaps" where the pain comes through and when I ask if it is time for some more medicine I end up having an hour or more to wait.

Just like in March, I feel like I always have more pain than I "should" have. I know it is probably in my head, but I just get this vibe from people like they think I can't possibly be in pain when I am taking "so much" medication. But I am not exaggerating my pain. When I ask for medication, it is because the pain is at a distracting level, like 5 to 7. Actually, earlier today, when I told one of my nurses my pain had returned and asked if I could have some more medicine she looked at her watch and sort of sighed disapprovingly and said "you are already on a lot of medication..." It sucks to feel simultaneously like a sissy and a junkie.

At around 15:00 two doctors from dermatology came to look at my rash. They didn't take any photos so I guess they were "the deciders." After some chin-stroking they presented exactly no new ideas and no new solutions. So once again dermatology comes up a day late and a diagnosis short. Give me my steroid creams and go away now please.

In the afternoon I got out of bed again for a second session of PT with Kimber. Needless to say, I was not feeling positive about it, but since I had to get out of bed to get my shower anyway, I figured I might as well hit the parallel bars along the way. For some reason, this time it all went much better. Kimber still had to help me move my left foot forward, but at least it felt like I was contributing this time.

And so I earned my reward. Ahh, a shower and a steroid cream body mask. What a spa treatment. After that I was feeling (and looking) much better, so when Dr. Millis stopped by this evening he was happy to see me looking revived. He said everything is going so well that I might even get discharged tomorrow afternoon. The only things left on my to-do list are final x-rays and showing PT I can climb stairs on crutches. And we all know I can do that. Right?

Recovery Day 3 -- Dermatology Phones it In

2009-11-05T21:26:00.005-05:00

This morning my epidural was turned off at 6:00 and I was started on the oral medication cocktail of oxycontin, oxycodone (Percocet) and Valium.

At 7:00 Dr. LaRue came in to check my dressings and I showed him my growing rash. The itching had increased throughout the day yesterday and I could feel that the nubbly, swollen heat rash had begun again, just like last year. ::Sigh::

So far the itching caused by the pain medication has been treated with Nubain and Benadryl, and we've been trying to prevent any rash or further skin irritation with frequent sheet changings and sponge baths, but there is only so much that can be done. I think the rash was inevitable.

As soon as I mentioned the onset of the rash, I was given some over the counter anti-itch cream, but I couldn't get anything stronger until a dermatologist looked at the rash. My experience from last time told me that this would not be happening with anything resembling efficiency.

At 8:00 pain services came again (smartly this time with only one intern in tow) to check on my pain levels with the oral meds. My hips were holding steady between about 1 and 4, depending on movement and time since last dosage.

After all that frantic morning activity I fell asleep until 11:30. I ate a fruit salad for lunch. That is worth mentioning because back in March I had no appetite at all in the hospital and I barely ate anything other than broth until about Friday or Saturday of that week. This time I ate fruit salad the day after the surgery and have eaten a little bit each day since then. Not a lot of food, but a soup here, some fruit there, etc. And that must be good, right?

After lunch, I signed back on to work for a few hours to fight some fires.

Speaking of fighting fires, by early afternoon the monstrous red blotchiness was in full bloom across my back, flanks, buttocks, and down the backs of my legs from my thighs to calves. It had even begun creeping around the front of my left upper thigh and across my stomach. All the while itching violently in hot, angry welts. Although it was clearly the same rash I'd had while recovering in the hospital in March (and therefore my chart already listed all the appropriate steriod creams necessary to soothe it), a dermatology consult was requested.

Meanwhile, Kimber from PT came to help me get out of bed for the first time since my surgery. It went relatively well, despite being herky-jerky and a bit nerve-wracking, and so I spent most of the afternoon sitting in a recliner chair enjoying a break from my hospital bed and waiting for the dermatologist to show up. And waiting. And waiting.

At 18:00 Dr. LaRue stopped by to check on me and took a look at my rash, which was by then much worse than when he'd seen it in the morning. He said he'd personally order up all the dermatology meds that had been used on me in March, and would also make sure dermatology was on its way.

I literally sat in that chair for three hours waiting for dermatology to show up and tell me I had a rash (surprise!), and prescribe me the medications I'd already taken a year ago for the same condition, and that Dr. LaRue had already ordered. Not only was the dermatology consult disrespectfully tardy, but the person dermatology ultimately sent was an intern who just took photos of my rash and threw out a couple of inapplicable but complex-sounding diagnoses that ultimately translated into things like "blocked sweat glands." I suppose blocked sweat glands are what led me to be steweing in a pool of my own sweat for the last few days, right? Eventually the dermatology intern went into a back room to call her attending so she should get coached on what to say to us. Impressive. At least I should finally get some steroid creams out of the ordeal.

Overall, today was physically miserable because of the discomfort and frustration due to the rash, but from a strictly orthopedic perspective it was a great day with good pain control during the switch from epidural medication to oral medication, and a successful adventure out of the bed and into the chair for a few hours. Moreover, with the removal of the epidural, I also got to remove all the leads monitoring heart rate, breath rate, etc., so that means a night free of strangling wires and beeping machines and one more step towards wireless freedom.

Recovery Day 2 -- Awakened by Pain and PT

2009-11-04T18:25:00.001-05:00

After a calmer-than-usual night of sleep, I was awakened by Dr. LaRue at about 5:30, as he stopped by during his rounds. He took the drain out of my wound. The entire hip/flank area on my left side is hugely swollen and is making me feel enormously fat and distended. I don't recall my corresponding flank being so swollen in March. It almost made me wonder if the drain should stay in a bit longer -- isn't there so much more fluid in there to drain out? But I guess Doctor knows best.

My pain was still at zero this morning, which is even more impressive considering my epidural is set at 8.5 mL/hr this time as opposed to the 12 mL/hr it was at for my right hip in March. So everything is still coming up roses after this second PAO.

With my pain so controlled and my arms so strong, my nurse and I took advantage of the opportunity to give me another sponge bath and change my sheets again. Wow, the hygiene! I will say, though, despite all the prophylactic sheet changing we are doing, my back and flanks are still hot and sticky and pressed into damp sweaty sheets a lot of the time, so I worry that the heat rash may make a reappearance.

Dr. Millis stopped by to remove part of my dressing as well -- the thick ace bandage wrapped around my entire midsection and left thigh. Once he cut that thing off I felt fantastically better. The bandage had been the source of a lot of itching and discomfort so far, and removing it made me far more comfortable. I still had the two bandages over the incisions on either side, but at least the thick itchy girdle covering it all was gone.

After all that activity, I was exhausted, and so I napped from 10 to 12:30, turning away PT's attempts to rouse me into activity in the late morning. I already find PT's in-bed exercises a bit silly, and I am certainly getting tired of the way everyone in the hospital seems to think it is OK to rouse me from my most peaceful slumber for whatever little test (or intern lecture) they have in mind. I thought I read somewhere that adequate sleep (and hydration) were the absolute best medicine?

When I awoke from my healing sleep, I had another headache. (So much for "absolute best medicine, I guess.) I don't usually get headaches, and I don't remember getting any during my hospital stay in March, but this time around I've been having low grade headaches for a lot of the time. Tylenol has only helped about 50% of the time.

I also had another new pain when I woke up from my nap -- my left hip. The hip pain that had been held a zero this entire time had suddenly broken through, and now my left hip ached at about a three or a four -- enough to cause discomfort while lying still, and to cause me to avoid moving the hip if possible.

Nonetheless, I (grudgingly) went through the in-bed exercises with PT when they came back in the afternoon, and I had to postpone my pity party even longer by spending the rest of the day logged on to work (!) taking care of various crises that had popped up in the office since Monday. I was supposed to be able to take time off from work for this surgery, but unfortunately the schedules in my current cases, and the intricacy of my involvement in them, has made my complete absence from work impossible. I can't say that stressing over the projects (and our firm's shoddy remote intranet connection) is helping my healing, but there is not much that can be done about it, so I'm doing what I can, given the circumstances.

Dr. Millis stopped by in the evening to see how I was doing. I told him about today's hip pain and my in-bed PT, he checked my incisions and sensation. He thought all was progressing just fine, but just as a bonus he ordered me to be transfused with a pint of the blood I'd donated autologously pre-surgery.

Recovery Day 1 -- So Far So Good

2009-11-03T17:37:00.000-05:00

My first night in the hospital after the surgery was also a fitful, fractured one. Just as during my hospital stay in March, all my machines kept thinking I was dying in one way or another -- no heart rate, no pulse oxidation, no breath rhythm -- and so the beeping started and stopped all night and thus, so did my sleeping.

Every time I woke up I felt as if a large chunk of time must have passed since the last awakening... and yet the clock had hardly moved at all. I can honestly estimate that I woke up every half hour last night because of beeping, itching or a nurse taking vital signs.

One thing that did not wake me up was pain. The epidural has been handling my pain really well; I've been at a zero on the pain scale so far. This time I don't need a CPM machine, either, because apparently it is not necessary if the surgery does not go into the joint capsule.

My recovery so far is already going better than it did after my March surgery. Although I am still plagued with itch problems (as a side effect of the pain medication), having the use of both my arms to move my body around using the trapeze pole above the bed makes it possible for me to lift myself off the bed so my back can be cleaned, my sheets can be changed and towels can be laid underneath me. Hopefully all these precautions will help keep me cool and dry so I can avoid the heat rash situation that so plagued me in March.

So by midday today I was pretty content -- zero pain thanks to my epidural, clean sheets thanks to my two working arms and my lovely nurse, and itching suppressed thanks to Nubain. And so, contentedly, I slipped into a nap.

Only to awaken with a start some time later to find seven doctors crowded around the bed in my tiny room, staring at me, clipboards in hand. I fumbled for my glasses as one of them began to make introductions and ask me questions. Putting my glasses on did not help focus my thoughts; instead it only made me see in frightful clarity that I was indeed surrounded by doctors with clipboards staring at me, awaiting my answer to the pending question that, in my panic, I had not heard. I was paralysed and made idiotic by the surprise and my self-consciousness, and so when I did start talking, I answered most of their questions vaguely and certainly unhelpfully. By the time I regained (a scrap of) my composure, it was all I could do not to laugh when I realized six of the seven were obviously rigidly earnest interns trailing a resident on rounds. (Hey, I watch Grey's Anatomy, I know what's up.)

Not to be a diva or anything, but that bed-crowding scenario was NOT OK with me. I have no problem with a teaching hospital, or with a resident coming into my room with interns to use me as a learning example. But I do not want to be woken up from delta wave sleep to find seven people in lab coats clustered tightly around my bed, scribbling on clipboards. Once you get over the initial shock, it is creepy, and then plain rude. So I politely asked my nurse if in the future I could be warned, and if necessary, awakened, before a med school field trip took a tourist stop at my room.

Incidentally, the seven doctors with clipboards were from pain services, and after having a discussion that was ostensibly with me, but really amongst each other, they decided to put me on Narcan for my itchiness. Never mind that I was already taking Nubain and Benadryl, both of which were doing the job well for me.

A bit later, PT came by to do some exercises. This seemed as ridiculous to me this time as it had when they came the day after my surgery in March. What could PT possibly think they were going to get done with me one day after major hip surgery? Apparently not much: move your feet up and down, clench your buttocks together, etc. But I guess it is never to early to start moving again.

Unlike in March, this time I seem to have an appetite during recovery. Today I ate a fruit salad and a bit of soup, which seemed to make everyone happy. Drs. LaRue and Millis came in to check on me separately during the evening; both seemed satisfied with my progress so far. And of course Dr. Millis stopped the Narcan as soon as I told him it wasn't doing anything for me and that the Nubain had been working just fine, because he's logical like that.

Left Hip PAO -- The Surgery Itself

2009-11-02T21:20:00.000-05:00

For the most part, today* was much like Surgery Day for my right hip PAO. Same fitful night of sleep, same chilly walk to the hospital, same admitting and pre-surgery procedures.

This time, however, I had a cold. It seems like I never really got back to 100% healthy after that cold I had in late September after my first autologous donation. As you'll recall, I had a mild cold during/after the first autodonation, and an oncoming sinus infection during the second and third.

And then two days ago I began to have a sore throat. By last night I could tell that I definitely had a cold (or maybe even a continuation of that same unconquerable sinus infection? Please, don't let it be that!). I was very nervous that today's surgery would have to be postponed, which would have been a logistical nightmare.

Last night I tried to get a good long night's sleep (perchance to heal myself of the cold overnight?). Of course that was not to be, and I had a horrible, fitful night filled with nightmares about the surgery being cancelled, interrupted only by the frequent need to blow my nose.

This morning, the pre-surgery procedure was pretty much the same as it was with my right hip PAO in March. Mom and I walked over to the hospital. I had my vitals and other checks done at admitting. I mentioned there that I had a mild cold but the admitting staff didn't seem too concerned about it as long as it wasn't a cough/chest problem.

Because I had waited around at admitting for so long, by the time I got up to the surgical floor, my medical team was waiting around for me. I didn't even get a chance to change into my surgical pajamas before Dr. Millis signed my hips, his resident Dr. LaRue introduced himself and talked about the surgical strategy, the nurses came to check various things, and the anesthesiologist gave his explanation of the procedure. I did tell them that I had a mild cold but they, too, said they'd be more concerned if it were a chest/coughing cold with fever than the nasal congestion cold I had.

Then the anesthesiologist injectected me with the loopy-loo sedation medication and I was wheeled in to the OR at 7:50. I do remember joking around a lot in the OR as the team prepped me and placed my epidural. I remember there was music playing in the background and I asked what kind of music they were going to play while they operated on me. He asked what I wanted and I told him definitely no heavy metal, as that might make him go overboard with the saw. I think I eventually settled on Händel's Water Music.

While I was in surgery, my mother got regular updates on my progress. At 9:30 Dr. Millis had started in on the left hip, and by 11:00 he was cutting bone. By 12:30 he was putting the screws in on the left side. At 14:15 Dr. Millis was preparing to take the screws out of my right hip. Finally at 15:30 Drs. Millis and LaRue came out to tell my mother that I was all done and the surgery had gone well. He also gave my mother a baggie with the five screws that had come out of my left hip. Souvenir!

Dr. Millis did mention that my superhuman bone density had surprised him once again -- this time he was prepared for how difficult my bones were to saw through, but he was not prepared for how tightly my bones would adhere to the screws in my right hip during the past seven months of recovery. Apparently they had a heck of a time getting the screws out!

He also explained that this left hip surgery was somewhat less invasive than my right hip PAO had been, since my left hip was in better shape going into the surgery than my right hip had been. This time they did not have to open the joint capsule or detach the head of the quadriceps muscle. Also the femoral head did not need to be shaved and shaped for better alignment this time either. Thus the surgery itself was faster and my recovery will likely be quicker and less painful as well.

While Dr. Millis was giving this auspicious news to my mother, I was in the recovery area, awakening from anaesthesia in what felt like the throes of death. I felt like I had hypothermia, and I was shivering so violently that it would be more appropriately termed convulsing. I was also gasping for breath, literally gulping huge lungfuls of air but still feeling as if I could not breathe, as if I was drowning. I was given oxygen and was covered in hot blankets over every inch of my body like a heated white burqa. I remember pleading with them to stop the shaking; they ended up having to give me a horse's dose of Demerol to calm it.

By the time my mother came into the recovery room to see me, I was breathing normally and my convulsions had been reduced to chattering teeth and an occasional body shudder. I was still covered in blankets as they brought me up to my room. I was given some Nubain for the itching and promptly fell asleep.

*Obviously, I did not write this post on the day of my surgery. I wrote it a few days later, but post-dated it for chronological consistency.

LPAO Pre-Op Appointments

2009-10-20T21:20:00.002-04:00

Today my mother and I were back in Boston for a combination post-op / pre-op visit. Seven months post-op for my right hip, two weeks pre-op for my left hip. Overall it was a long day with some confusion and scheduling mishaps, but everything got done and everything is great, at least with my hips.

I had my appointment with admitting, which was much quicker this second time around. I signed my various proxies and consents and I spoke to the anesthesiologist and the admitting nurse. My insurance pre-authorization is "in process," so hopefully I'll get the confirmation in the mail any day now.

I had my third and final blood draw at the hospital blood center, and then I went up to see Dr. Millis. The scheduling mishaps meant that Dr. Millis did not have my pre-op left hip MRI or my post-op right hip X-rays to view prior to me seeing him, but nevertheless he put me through my range of motion tests and discussed both hips with me. My range of motion was great; nothing hurt; my muscle tone and fitness were much improved since my last visit in July.

Finally, on our way back home, we stopped at Waltham so I could have my pre-op MRI and post-op X-rays. The nurses had a lot of trouble injecting the contrast for the MRI because my veins kept rolling away or blowing out, even when they used an infant needle. They had to stick me six times to get 30cc of contrast into me. Clearly it was a wretched experience, especially at the end of a long and draining day. Pun intended.

My biggest concern today was really my general health and the useability of both today's blood draw and my two prior blood draws. At the hospital blood center (unlike at the New York Blood Center), they told me to contact them if I got sick with a cold or flu-like symptoms within 48 hours of my blood draw. This was a concern because, as you may recall, I got sick after both my previous blood draws.

My first blood draw was September 25 and I believe I wrote that I'd woken up that morning with a raspy throat and immediately fell into a (relatively mild) cold after the blood draw. My second blood draw was October 5; I woke up that morning with pressure in my left sinus and was diagnosed the next day with a sinus infection. Obviously in both cases I was already sick when I gave the blood.

Today I asked the blood center nurse about both cases and she felt fine about the first draw but wanted to run the second draw scenario by my doctor. Dr. Millis was fine with it but said we'd use the October 5th pint last, if necessary.

The problem is that today was my third blood draw, and I am still not 100%. In fact, I finished a 10-day course of antibiotics for my sinus infection three days ago (on Saturday 17th), and unfortunately woke up yesterday with the realization that my sinus infection was back. It had not been vanquished by the 10 days of antibiotics. I have to admit I didn't take super-good care of myself during the course of the antibiotics; for example, my sleep schedule was messed up by a trip to Los Angeles.

So today I have a sinus infection and I had to give my third blood draw. This on-site (in Boston) pint gets separated out for its plasma so maybe that mitigates things? I don't know. It is worth noting that (without knowing about the sinus re-infection) the admitting nurse checked my general health, including lymph nodes, looking in my nose and throat, breath sounds, etc. and declared me healthy. If I was really really sick, she'd have been able to tell, right?

I told Dr. Millis about my sinus infection and asked him if I could get back on antibiotics and take them until just before my surgery and he said yes. So that is the plan. I am going to try my very hardest to take the best care of myself possible these next two weeks (which I already should have been doing, but anyway) and hope that this second course of antibiotics can kill this thing. Obviously if it doesn't, there goes my surgery date.

Autodonations

2009-10-05T21:36:00.000-04:00

Today was my second autodonation prior to my LPAO. This time my blood pressure was 120/80 and my hemoglobin (iron) level was 13.8. At my first autodonation (September 25) my blood pressure was 104/80 and my hemoglobin was 15.9. (Normal hemoglobin for women is 12-15 gm/dL of blood.) I'm taking iron supplements, of course, and trying to be as healthy and rested and hydrated as possible so my body can make more blood, but it can only work so fast. Luckily I have two full weeks until my next autodonation.

It is harder to stay healthy this time around, though. Maybe it is the season, but I have been a bit sick recently. The day of my first autodonation I felt fine, but my throat had been a little rough when I'd first woken up and I knew that I was on the verge of getting sick. And I did get a mild cold after the autodonation.

I hope the blood will be OK. When I woke up with a raspy throat the morning of the autodonation, I did some research; it seems the reason you can't give blood when you are sick is because you need that blood yourself to fight off the sickness -- not because your blood will be tainted with sickness. All I care about is that the blood I get post-surgery is not going to hurt me.

This morning I could tell that I was again on the verge of something -- this time it felt like I might have the stirrings of something in my left sinus (under the cheekbone). But again I felt fine going into the autodonation: no fatigue, aches or other signs of sickness. So we'll see. I will definitely ask Dr. Millis about this during my pre-op later this month.

It is hard to believe that I have less than a month left until my second surgery. I'm almost seven months post my RPAO and I've recovered so well -- I'm playing tennis twice a week, seeing my trainer twice a week, and I even did Pilates for the first time last week. I feel strong and relatively fit again (cardiovascular endurance is still not what it was). My left hip doesn't hurt at all, ever, and my already-PAO'd right hip is pain-free most* of the time. It is possible I've been pushing it a little too hard, though.

In a way, it is depressing that I have come this far and recovered so well, only to bring it all back to zero and have to start recovery all over again. But on the other hand, it is helpful that I now know the process of recovery, and the timing, and I know that if all goes as well as it did after my RPAO, I should be at this level of strength and recovery again by May. But then again, if I've learned anything from this process it is that recovery is impossible to predict, so really, anything could happen.

I am glad that I am having the second surgery in the winter. It is supposed to be a record-breaking cold and snowy winter this year, and now I have an excuse to sit inside by the fire for most of the winter. My parents' house in Connecticut, nestled in the snowy woods, is a great place to spend a winter.

I'm not there yet, though. I still have a month left. A month to tie up loose ends in NYC and at work, stay (get?) healthy and strong, and enjoy all the walking and tennis and Pilates that I'm lucky enough to be able to do in this brief interlude.

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*My right hip does hurt sometimes, and it is very confusing. I can't predict it or make sense of it at all. The pain is usually in the front, (which is where the labral pain was before), but the pain is not on impact like it was with the labrum. Instead it hurts when I lift my leg to step a certain way, or in a deep squat. I think it must be the muscles (especially the hip flexor) getting fatigued and sore. But what is taking it so long!? I have been working on my strength for months; all my other muscles are back in business. Why would the hip flexor keep hurting on and off for so long?

The other strange thing is that it doesn't seem to be correlated to my activity (as least as far as I can tell). Some days I step on the tennis court and am sore after 5 minutes of play. And some days (like tonight) I can play an hour and a half and not feel sore until the end. Why is that? Some days I walk to work and it is pain-free; some days I start to walk and it is sore as soon as I get out the door. Another question for Dr. Millis.

One reason might be that I am constantly pushing the envelope with my hip -- if I were not walking to work every day and playing tennis twice a week, it might feel totally pain free all the time. We'll see what Dr. Millis says later this month. Whatever it is, it can't matter that much, since I'm about to slow way down on the activity level for a couple of months.

LPAO Scheduling

2009-09-11T12:34:00.003-04:00

It is now a month and a half until my second PAO, this time on my left hip. Even though my left hip has not been in pain for almost two years now (overshadowed, I suppose, by the whinier right hip) I am still going forward with the surgery as planned. In the x-ray taken pre-RPAO, it is clear that my left hip dysplasia is equally as bad as my right hip's was, so I might as well get it over with. Even if the left hip isn't hurting now, it is structurally guaranteed to start hurting eventually.

The schedule I have finalized is as follows:

September 14, 2009 -- Begin rigidly healthy pre-surgery lifestyle: sufficient sleep, healthy and iron-rich diet, no alcohol, regular exercise. The goal is to avoid getting sick, to support my body through the month of blood draws, and be the healthiest and strongest I can possibly be going in to the surgery.

September 25, 2009 -- First autologous blood donation, at the New York Blood Center, with the blood subsequently shipped up to Boston. Begin taking iron supplements; take them up until the surgery.

October 5, 2009 -- Second autologous donation, at the New York Blood Center.

October 20, 2009 -- Pre-operative appointments at Children's Hospital. During this full day in Boston I will meet with Dr. Millis, the anaesthesiology team, physical therapy and admitting. I will also have my third autologous blood donation while I am there.

November 2, 2009 -- Surgery date. Here we go again!

Again I've arranged my absence with work, planning to be completely off the grid for two weeks after the surgery: one week in the hospital in Boston and one week sleeping and healing at my parents' house in Connecticut. During the third week (week of November 16), I plan to begin working remotely from Connecticut, as I did last time.

I plan to stay in Connecticut for about two months after returning from Boston, so I can have the help and supervision I would not have if I returned alone to my apartment in the city. Last time I thought I'd be back in the office in six weeks, but I decided I didn't want to go back until I was off crutches almost entirely, and that wasn't until eight weeks.

Six Months Post-Op -- Tennis Again!

2009-09-03T09:42:00.005-04:00

Six months after my RPAO I am feeling good and enjoying an active summer. At this point I feel pretty much 100%, except that my fitness level is still not as high as it was pre-surgery, especially my cardiovascular endurance.

The biggest news I have is that at 5.5 months post-op I was cleared by Dr. Millis to begin playing tennis again! Finally! I have only played a few times since then but I am looking forward to getting a little more regular with the tennis this month. Very exciting indeed.

Meanwhile, I've continued to work with my trainer and increase my overall strength and endurance. I've also stepped up the cycling cardio (on a real bike this time!) over the past two weeks. All of that has been going well and the only limitations I've felt have been my fitness level, not my hips.

My left hip is still completely pain-free; I wonder if it will stay that way all the way up to its surgery date?

Speaking of LPAO, it is only two months away! Sad. It will be such a bummer to have to do all this again starting from zero again. But I am glad I took the summer off and didn't have the LPAO in July or August. It has been really great to have an active summer and enjoy the weather and my vacations. I think it would have been really tough to go through recovery in the summer when all I would want to do is run around outside. Plus those hot flashes I got from the pain killers would NOT have been welcome on a hot summer day!

Five Months Post-Op

2009-08-04T07:40:00.005-04:00

At this point, my right (operated) hip is functioning at 100% for all walking-related activities. I no longer have any of the pain I described in my previous entry: no more twinges, no more aches, no more stripes down my thigh.

I can walk for long distances and durations without my right hip causing me to limit myself. Of course, I still get tired and footsore, but that is in a more general sense; I would have gotten tired anyway at some point!

I have now been seeing a trainer for about a month. My first training session was quite light and yet the soreness afterwards was wretched, mostly in my quads. I honestly had trouble walking and supporting myself with my quads for the first few days after the session, and I was in quite a bit of muscular pain. I suppose it was something I was just going to have to go through on the way to getting my quads back in gear, but I have to admit I wasn't aware that my quads were *that* weak!

Since that first session, my trainer has been stepping up the workouts in intensity and pace as my strength and endurance increase. I'd say my fitness is about 75% of what it was last year at this time, when I was playing tennis 5x per week and seeing a trainer regularly. I have some work to do, but obviously it feels good to be back on the path to fitness again.

For the time being, my trainer is being very careful with my (weak) hip flexors and with any impact exercises. So far my hip has not hurt during or after any of the training sessions. During one session my right hip flexor was definitely exhausted, but the joint itself did not hurt and the hip flexor in question was not even sore the following day.

On my own I am working on cardio on the exercise bike and to a lesser extent, introducing the elliptical machine. I am up to 45 minutes at about level 7 or 8 (out of 20) so that is still not hugely impressive on a cardiovascular level.

I am still not swimming. I know it is good for me but I just hate it and so I am still resisting it by making all sorts of excuses.

My numb spot still comes and goes but I never even notice it unless I am purposely paying attention to it.

My scar hasn't really made a ton of progress since the last time I posted a picture, and it still itches sometimes at the top, where that abscess was for a while, although the abscess has closed up and the scar is totally "healed" at this point. But scars do tend to keep that mauve look on me for a long time before they whiten up, so it is not surprising to me that it is essentially unchanged. And it doesn't matter anyway since Dr. Millis is just going to open it back up again in November to take the screws out on that side.

Speaking of November, my left hip (which is scheduled for surgery in three months, on November 2) still hasn't made a single peep of pain all summer.

Four Months Post-Op

2009-07-08T21:19:00.006-04:00

In my last entry six weeks ago, I was just starting to walk again; now I am getting close to 100% with walking. Right now, I'd say I'm at 80% of my pre-dysplasia-pain ability to walk, and probably 100% of my ability to walk just prior to surgery.

As I wrote six weeks ago, at first even going on a half mile walk was exhausting. My leg muscles were in various states of soreness for several weeks, and my cardiovascular endurance needed work after two and a half months of limited activity.

My gait stabilized soon after I began walking. Once I got steady on my feet, I tried to increase my walking bit by bit -- at first just starting with the basic walk to and from the subway on the way to work (a few blocks each way), then little lunch-hour walks that I stretched longer and longer.

Eventually I was able to walk from my apartment in the Financial District across the Brooklyn Bridge to DUMBO, one of my favorite walks and one I was very glad to get back to! My longest walk so far has been a five-mile walk through London the weekend before last -- but I did pay for that with exhaustion and soreness for the rest of the day afterwards, so I haven't repeated the feat since.

I have had pain as I've been increasing my walking. It is hard to explain -- a lot of the time it is clearly muscle pain -- in the quads, glutes, calves, hip muscles -- but once or twice it has felt disturbingly like the old pain: twinges when my hip hit a certain way; that old "blister" feeling. The twinging/shooting only happens when I am *really* spent, like after that 5 mile walk for example. In London, my hip felt great during the whole walk (I would have stopped immediately had it started hurting), but after I came home and had rested on the couch for a while, I got up and felt really stiff with twingy pain in the operated hip on each step. I don't know what that means.

At times I admit I've been concerned that the surgery "didn't work" and the pain was the same old pain I had pre-surgery. But unlike the pre-surgery pain, the twingy pain I have now goes away quickly. The old pain would linger for several days until I'd stayed off my hip long enough for it to fade away.

Other times when my hip has been tired I've sometimes felt an ache, sometimes with the ache reaching down in a stripe down the outside front of my thigh. Of course that stripe could be some inner quad muscle complaining. In fact, I am not sure that the twingy pain isn't muscle related, too. I just don't know. But no matter what the pain, it has usually not lasted more than a few hours and it has always been gone the next morning. I figure it is just all part of building up the strength and endurance of my hip, and to stick with the rule to ease up if it hurts.

Jaime (physical therapist) did give me some exercises and stretches during my May visit, which I was to do daily. I tried to do them every morning and evening but I definitely did not do them that often. The stretching was, and still is, the worst -- my hamstrings were tight anyway before the surgery and now they are just ridiculously tight. It is hard to tell if there is even any progress with the stretching, but I suppose it is good for me no matter what.

I have also ridden the exercise bike sometimes during the past weeks. I haven't swum and I haven't done any anaerobic exercise, but that is just because I am lazy. I have resolved to remedy those deficits in the coming weeks.

As it stands now, I am back to being able to get around in the city at least as well as I did just prior to surgery. I can walk to subways, around the office at work, to errands at lunch hour, in parks on weekends, etc., all without pain (for the most part). I can walk briskly and bustle up and down stairs at typical New York pace. The last couple of nagging range-of-motion problems (not being able to really bend freely over my operated leg to put on a sock, for example) have finally fallen away.

I still have the numb spot on the outside of my thigh, but it comes and goes. Sometimes it feels like it is almost totally gone and then sometimes it comes back a little bit. I guess it is possible there will be some sort of strangeness there for the rest of my life, but no matter; I rarely notice it and am never bothered by it when I do.

I went up to Boston yesterday to see Dr. Millis and the team. (My last visit was back in May, right before my last entry in here.) I got x-rays that looked (to me) exactly like the x-rays from six weeks ago. Screws straight, cracks filled in, etc. Dr. Millis was pleased with my gait, flexion and strength and all seems to be improving according to plan. Weakest links are the right hip flexor and hip abductor muscles. (They probably would have been stronger if I'd been more religious with my PT exercises, hmm?)

I asked Dr. Millis and Jessica (physical therapist) about adding back some activities. Sadly I'm not allowed to start up tennis again, but I'm now allowed to hit against a wall or against a ball machine, so that's a start. Jessica said I needed a month or so before I could start adding any impact on my hip, so "real" tennis is still on hold.

No horseback riding still because it is "too jarring." (I'm surprised they didn't also say "and you could fall off!")

Thankfully I am allowed to start back up with a personal trainer again, so that should help with my motivation to get back in the weight room. I've already set up my first session for this Friday.

Another bit of good news is that I don't have to go back up to Boston until my LPAO pre-op appointment in October! I will communicate with the physical therapists and Dr. Millis via email to give updates on how I'm doing, but basically I'm free to enjoy my summer and fall.

Speaking of LPAO, my left hip is still pain-free despite the increased activity. I haven't had even a twinge from it even during the longer walks. That doesn't affect my decision to put it on the chopping block in November, but it is definitely good news for the enjoyment of my summer.

Ten Weeks Post-Op -- Walking Again

2009-05-25T19:47:00.000-04:00

So now, ten weeks after my surgery, I am back in NYC and walking without crutches, two big steps towards getting back to "normal!"

Last Wednesday I packed up my things and moved from my parents' house in Connecticut back to my apartment in the city. On Thursday and Friday I worked in the office for the first time in over two months.

Thursday I used one crutch for pretty much any walking I did around the office, as well as to and from the office. I took a cab to work in the morning but I took the subway on the way home. On Friday I only used the crutch for getting to and from the office; all day long I walked around in the office without crutches. And on Saturday I went crutch-free all day!

At first I was not very steady walking without the crutch. I don't mean that my balance was off, I mean that my gait was strange and halting. It was as if I'd forgotten how to walk normally. I was overly conscious of my posture and my stride, and I had a sort of limp. I was not in pain -- my hip would get tired and uncomfortable, but it did not hurt in the way it did before the surgery. Mostly it was difficult to get my leg to move properly for the walking stride.

Interestingly, climbing stairs was one of the first things I was able to do "normally". Even a few weeks ago when I still used crutches for everything else, I could climb (not descend) stairs fluidly and without pain or discomfort of any kind. I wonder if this is because stepping up with the operated leg doesn't put the same kind of pressure on the joint as taking a step on flat ground -- and the stair-climbing muscles (hamstring and buttock) were already getting back in shape from my exercise bike riding.

As for the occasional discomfort I've felt these past few days as I have been weaning off crutches, it is the muscles -- not just near my right hip, but throughout both my legs -- that are hurting most as they build back up. Physical therapist Jaime told me to expect this.

Today, for example, my right soleus muscle is quite sore. That makes sense since that muscle is critical for walking and standing, two things which I have not done with that leg in a while. If I am going to be really whiny, my entire right leg is pretty sore, but the soleus is the worst.

I should also mention that as I'm relearning to walk, my right knee is almost as jerky and confused as my right hip. I suppose it is because the right knee fell into just as much disuse as my right hip while I was on crutches and so all it's surrounding muscles need to shape up too. Now when I get up from sitting for a while, my knee is often stiffer than my hip! I can walk it off in a few steps, and it is not painful.

Unsurprisingly, I am exhausted by what used to be standard NYC walking. On Saturday I walked to the Seaport from my apartment (about a half mile each way) and felt like I'd walked a 10K. It gives me a new appreciation for what good walking shape I must have been in before!

My left leg has been quiet through all of this increased activity. I am just waiting for it to start hurting (but hoping it doesn't). Dr. Millis said I can get the left hip done in as soon as a month's time, but I am not anxious to leap back onto the gurney just yet. I'm hoping my left hip can behave itself until October, so I can do all the fun summer activities on my calendar without having to coordinate my outfit with a pair of crutches.

Finally, I should note that the numb spot on the outer thigh of my operated leg is almost entirely gone now. It still feels a little bit strange when I rub it, but much improved from immediately post-surgery. For the most part it is almost back to normal sensation.

Nine Weeks Post-Op -- Lose the Crutches!

2009-05-19T18:36:00.003-04:00

Hallelujah! I am now officially allowed to wean myself off the crutches!

Today I went up to see Dr. Millis for my two-month post-op visit (although it really was 9 weeks post-op). He took another x-ray (I'll post it as soon as I get the image from the hospital) and I met with Jaime, the physical therapist, again.

I'm sad to say that it is hard for me to see any difference between today's x-ray and my last x-ray, or even the x-ray taken 5 days post-surgery. But the doctor was very pleased with all the new fuzzy white stuff I have apparently added in the last month, and he said that according to the x-ray there was no skeletal reason I couldn't walk right away.

Dr. Millis had me "try" walking without crutches, and both he and Jaime were impressed that I was walking so well my "first time" without crutches. I didn't tell them I'd already been using one crutch a little bit and even doing some minor walking. Hey, they didn't ask, OK? I would have told them if they'd asked.

Even though I've now gotten permission to walk, I can't just toss the crutches aside like a Christmas miracle; my hip and leg muscles, after two months of general atrophy, need a little time to get up off the couch, dust the Doritos crumbs off their bellies, and get in shape. I am allowed to walk as much as is comfortable, but Dr. Millis and Jaime warned that I should always have a crutch with me for when (not "if") my hip gets tired or sore.

Weaning off the crutches means sometimes I'll be walking, sometimes I'll be on one crutch, and sometimes I may even need to go back to two crutches for a day or so, depending on what my hip feels like. But as my joint strengthens I should find myself needing support less and less.

Jaime tested the range of motion in my right (operated) hip, as well as my current ability to use various muscles around the joint to lift my knee up, abduct my leg, and bring my leg out behind me. She also had me stand on my right (operated) leg and lift my left leg off the floor, which felt unstable and a bit scary. But apparently having 100% of my body weight on my right hip is not a problem at this point -- everything is healed enough that I'm not going to damage anything. What I really need to avoid is impact. Standing with 100% of weight on operated leg = OK; jumping up and down on operated leg = not OK.

Jaime then had me stand on my right (operated) leg, with a hand on the table for balance, and do all the same movements with my left leg: lift knee up, abduct the leg, bring leg out behind me. Initially I thought this was to strengthen the muscles around my left hip, but it turned out that having to support my entire body weight on my right leg while bracing myself against the movement of my left leg was the actual point of the exercise. And it was hard. The same muscles that are used for leg abduction are used to support the leg when standing on one foot, so I felt the burn on the outside of my right hip/thigh rather than in the muscles around my left hip. I am to practice these leg movements bilaterally, adding the resistance of a thera-band as my strength increases.

In addition to the leg movement exercises, Jaime also gave me some more stretches (hamstring and hip flexor) to add to the quad stretch I was already doing. She cleared me to begin doing crunches, increase my resistance on the exercise bike and swim laps in the pool (gently). She said I could try the elliptical machine when I felt my balance was good enough. I am not allowed to work with a personal trainer or do Pilates until after she's assessed my progress at my next visit.

So all of this is fantastic news. I have a lot of new movements to work on now, so I finally feel like progress can occur again! I am very excited to get started.

My next visit with Dr. Millis will be at 16 weeks (four months) post-op.

Two Months Post-Op

2009-05-13T10:27:00.005-04:00

I was supposed to see Dr. Millis yesterday for my two-month visit, but I couldn't because of scheduling conflicts (mine, not his). So I was supposed to know by now whether I could ditch these wretched crutches.

I've unofficially been mixing one-crutch and cane usage (and even some walking) into my days for the past week and a half, even though I'm technically supposed to be on two crutches until I next see the doctor. My hip has been feeling OK with the increased burden: sometimes it feels a bit tired and achy but most of the time it feels just fine. Even when it does hurt after being on it too much, it is not very painful at all. Maybe a 2, at the maximum. Any time I've felt discomfort I've gone back to two crutches until it has subsided.

As I write this I am starting to feel more and more guilty about cheating with the crutches. Erin told me expressly not to cheat and to stay on crutches until I saw the doctor again, and even the physical therapist wouldn't let me increase the resistance on the bike. If I find out next week that there are negative consequences to my cheating, i.e. my x-rays show some setback due to my impatience, I will be really upset with myself.

This is just taking too long, though! Two months is too long to be limited like this, especially in the springtime. It is one thing when I am just sitting at home at my parents' house, but the instant I do anything remotely social or adventurous, I want so desperately to be off the crutches that I cheat (now that I can). For that reason it is good that I have kept myself up here in Connecticut and not returned to the city. I knew the sequestration would protect me from temptation.

Another cause of my impatience with crutches is shame. I've felt a bit ashamed about this whole diagnosis since the beginning. It is not like I had some glorious sports injury; I was born defective with a deformity commonly associated with DOGS. That alone is cringe-worthy, but in addition I am not a person who likes to be seen as weak, helpless, pitiable or needy. I don't like attracting attention such that people feel sorry for me. I don't like having to ask for help. And so I absolutely hate being in this condition. Another reason for hiding up in Connecticut is so people don't see me in this pathetic state.

The closer I get to walking, the more impatient I am get rid of these symbols of weakness and deficiency. And sometimes that impatience overrules the cautious part of my brain that says I should follow my doctors' orders.

None of this is offered as an excuse for my cheating, just as an explanation. I have a week to go until I find out how everything looks on the inside. You know what would be the most karmically appropriate result? If my imprudence has set back my healing and so I have to stay on crutches for another month. That would be just what I deserve, wouldn't it.

Seven (and a Half) Weeks Post-Op

2009-05-06T12:57:00.006-04:00

The healing proceeds apace. Pain is negligible, movement is good, abscess is on the mend.

I've been going to the gym several times a week (the goal being every day but sometimes it just gets away from me). I know my physical therapist told me I couldn't do more than resistance level 1 until I see the doctor again May 19, but... machines are different, right? Some go 1-10, but the one at my gym goes 1-20. So I have been squidging my way up on the resistance and am now up to 30 minutes at level 3, with no obvious ill effects. I have also been doing some upper body exercises and ab work.

Last month Erin warned me to stay on two crutches and 1/3 body weight until May 19, but it is hard to do that when I am feeling so much better and stronger. I have to admit that I sometimes put the crutches down when I am in the kitchen and just taking small steps around carrying a bowl from counter to counter or something. So technically that is the verboten full weight sans crutches. I know I shouldn't but it is so tempting, and there's no pain to tell me "no."

It turns out Erin was right about the abscess: it has been clearing up. It is still scabby but I don't wear a Band-Aid anymore. The rest of the scar is pretty much the same as it was -- like someone drew a line on me with a mauve-colored marker.

I am pleased with my range of motion, and I can feel that the muscles around my hip are getting stronger. I can lift my leg onto the couch now, or into the car, without using my hand under the knee to help it up. One thing I still can't do is put my socks on right (operated) foot, or tie my shoelaces on that foot. The angle when I bend over the right hip is too acute. I can do the left, but not the right.

Not really much else to report this week. I guess this is the long boring part of recovery.

Six Weeks Post-Op

2009-04-28T23:22:00.003-04:00

Springtime has come to Connecticut, so at least now some of my sitting can be done outside in the sunshine, enjoying the slow colorful explosion of my mother's garden.

A week ago I discontinued painkillers entirely; since then pain has been minimal. A few times I have "overdone it," I suppose, but the pain has been manageable with just a few Tylenol rather than the hard stuff.

I still have not exactly mastered the 1/3 weight bearing, so I am contenting myself with an average of 1/3 weight bearing. Sometimes I step too hard, sometimes I don't step enough; so be it. At this point I don't think I'm going to come crashing down in a heap of shattered bones and bent screws if I happen to step on my leg with full weight.

By now I have been to the gym a few times to ride the exercise bike and do some upper body exercises, which has helped my mood considerably. It feels good to get some blood flowing, even if it is only for thirty minutes at zero resistance. That's right, I am up to thirty minutes on the bike. I asked my physical therapist if I can add resistance or some other leg exercises now, but she said I had to wait until I saw the doctor again before I could be cleared for any increases. So that means I am stuck at this level for three more weeks. ::Sigh::

This week I finally removed the shower chair from my shower. I probably could have removed it last week as I hadn't sat on it in a while.

My incision is still plagued by an open wound at the top. Erin (on Dr. Millis' team) said it is called a "suture abcess" and that I should just keep it covered by a Band-Aid until it goes away. Erin didn't seem worried but I can't say I am very pleased about having an open wound for weeks on end.

Last week's malaise hasn't entirely dissipated, but the lovely spring weather and the gym visits have certainly helped. And as always, I have plenty to do.

Work has been very busy these past couple of weeks, in a stressful way more than in a "happy industry" way. I'm very glad to be working from home; I would not be getting nearly as much done if I were in the city struggling to and from the office and trying to handle life alone in my apartment.

The office has kindly let me extend my "work from home" absence past my originally planned return date of May 1. Now I plan to remain in Connecticut with my infinitely helpful and supportive parents until after my next appointment with Dr. Millis, at which I will hopefully be switched down to one crutch or even a cane.

Off The Meds

2009-04-21T11:52:00.003-04:00

It has now been five weeks since my surgery.

Today is the first day I have gone without any pain medication at all, and it feels fine so far. I had really been stepping down the dosage slowly prior to that, going by whatever pain level I felt. This morning my hip hardly hurt at all, so I decided to give the day a try without medication.

At this point I can sleep on my right (operated) side for long periods during the night. It feels a bit funny, but it is not painful. I sleep through the night with no problems. I am still clocking about nine or ten hours of sleep every night.

I can move my leg around quite a bit using the muscles near the hip; they are starting to recover nicely. All the exercises I got last week from the physical therapist are going very well; they are almost too easy. Only the hip abduction exercise is still difficult.

I have not been to the gym to do the exercise bike or the weight machines for my upper body -- I'm still trying to work out a membership with the YMCA up here in Connecticut. I really hope to get to the gym soon, as I feel that my sedentary lifestyle is affecting my mood as well as my body.

I am still working on getting my new 1/3 body weight weight-bearing allowance right, but the added weight isn't adding pain in my hip. Even when I've accidentally stepped on it with full weight it has not been painful, just obviously weak.

The numb spot on the side of my thigh is still there. It feels like it might be a little less numb, but it is hard to tell.

My incision has actually regressed and is not looking as good as it was in my last photo. One of the subdermal sutures has poked out at the top of the scar, creating an open wound, so I have to wear a Band-Aid over that part. The rest of the scar looks fine, but it is just redder and more noticeable than it was when I first took the Steri-strips off. I am not sure why. I am allowed to massage the scar with Vitamin E oil now, so maybe that will help.

So basically I am at the point in my recovery where I feel totally healthy, except I am on crutches. It is a very frustrating feeling. Progress was obvious before: less pain, more movement. Now everything just feels stagnant. Before I wasn't frustrated because it was very clear that I was injured and needed to rest and heal. Now it is easy to forget that all I have in those cracks is "fuzzy white stuff" and the bone needs time to heal together into a strong, solid unit again. And so it is easy to fall into the foul mood I have been in for the past three or four days.

I am not bored: I've got plenty to do, especially where work is concerned. But I don't want to do any of it any more. I am tired of this variety of sameness. I move from book to magazine to work task to TV show, I move from bed to armchair to table to couch, but it is all the same. It is all still and slow and seated. And I am really tired of sitting.

One Month Post-Op Visit

2009-04-14T23:23:00.000-04:00

Today was my first post-operative visit with Dr. Millis, one month after my surgery. I had x-rays taken, met with the doctor to discuss my progress, and met with Physical Therapy to discuss my "assignments" for the coming month. My next visit to Boston will be in another month.

Dr. Millis said my x-rays looked great, and that "all the fuzzy white areas" were new bone growing to fill the cracks. Honestly, the whole x-ray looked like fuzzy white areas of varied brightness, so I didn't really see what he was seeing. I will post the new xrays when I get them. Dr. Millis also tested my range of motion in extension, flexion and rotation. In all, he was very pleased with my healing progress.

I got cleared to stop taking aspirin (which I'd been taking to avoid blood clots). I was instructed to continue to wean myself off painkillers as I have been doing. I got cleared to drive a car.

I am still on both crutches, only now I am allowed to put one third of my body weight on the right leg. So not exactly throw-down-your-crutches progress, but progress nonetheless. The problem is that one third of my body weight is a hard weight to gauge when you are thinking about crutching. It is one thing to put just the weight of your leg down. It is another thing to put half your body weight down as you do during when walking normally. But one third body weight? That is two thirds of the normal weight I would put on that leg if I were walking normally. But how does two-thirds normal weight feel? I have no idea. This will take practice.

The meeting with Physical Therapy outlined the range of movement I am permitted and the exercises I should practice in the coming month. I am now allowed full extension of my leg, which means I can lay on my stomach and on my back with no pillow under my leg. I was given a set of starter exercises and instructions to do them at least once a day. I was also given permission to walk in a pool and ride an upright stationary bicycle at no resistance for 10 minutes, building up to 30 minutes.

I was specifically instructed not to do any straight-leg lifts using the quadriceps because the head of one of the quadriceps muscles was detached during surgery (hence my inability to slide my foot forward the first week, remember that?) and still needed time to reconnect securely.

I did a whole set of the exercises with the Physical Therapist and they were pretty challenging despite their simplicity. It is an odd feeling to be starting something so basic from scratch. Before this, I had been moving my limbs around without a problem since birth. It is a bit rough to have to re-learn it all when the limbs are so much heavier and there is far less naptime.

After three hours in the hospital going from appointment to waiting room to appointment again, having Dr. Millis move my leg around to test motion, having the Physical Therapist move my leg around and lead me in a set of exercises -- my leg hurt more than ever. Muscle pain as well as bone pain this time. I foresee a painful period ahead of me as I begin to practice my new movements this coming month.

I am looking forward to moving more and bearing more weight on the leg, but I am also disappointed that the healing process is not moving faster. Looking back over the last month -- or even through this very entry -- the sentiment seems silly: I have progressed so much from being flat on my back in the hospital a month ago. But I have swung back to the way I felt the first weeks after the surgery, when I was unhappily surprised that recovery was so hard and painful. This time, I am unpleasantly surprised that recovery is taking so long. And just like last time, I should be surprised, nor should I have naively expected that somehow, for *me*, everything would be easy and quick. It has all been and will continue to be just as painful and gradual a process it is for every other normal human being. What a surprise.

Three Weeks Post-Op

2009-04-08T09:02:00.001-04:00

It is now three weeks post-op and things have definitely improved. Pain is down (as is pain medication), movement is up, and the incision looks amazing. Next week I go up to Boston for my 1-month-post-op visit and then we'll see how much progress I've made internally as well.

PAIN and its MEDICATION

I have far less pain now than I did a week ago, and I get by on far fewer painkillers per day. This past week I have been taking an Oxycontin twice a day, morning and evening, and filling in with Vicodin three times during the day; yesterday I dropped it down to only two Vicodin during the day. This past week I also stopped taking the Valium all together.

Because of the reduction in medication, I don't have the same skin reactions as I did before, so I have stopped taking the Atarax (although I still use the topical rash cream morning and evening in the relevant areas).

My pain is generally very low. Most of the day I am in little to no pain; towards the afternoon I start to feel an ache and that is when I take the Vicodin. If I am going out to something I usually take a Vicodin beforehand as protection, as Dr. Millis suggested, and then I am able to sit through dinners and events with no problem. I sleep well, not waking up too often, and I don't wake up with too much pain in the mornings.

Overall there has been a huge improvement on the pain front this week. Actually Dr. Millis predicted this would happen. When we spoke a week ago he said that I would probably notice a sudden lifting of pain over the next week or so; a disappearance of the constant aching pain that I'd had since the surgery. And so I did.

MOVEMENT

I have made great strides (sorry) in the movement department as well. With the reduction in pain, and the knowledge that I am not overly numbed with pain medication and am not likely to do anything that will "ruin" the surgery, I feel much less nervous about my right leg in general.

I can bend carefully in more directions and at sharper hip angles without the prior pinching; I can move my right (operated) leg out to the side or in across my other leg a little bit (not talking huge ballet swings here, maybe 20 degrees in each direction?); I can rotate my right foot inwards and outwards when my leg is stretched out before me. I can lift and move my leg more often now (which is still not that often) without using my arms to assist, but I can also tell that many of the muscles around my hip are (not surprisingly) very weak indeed and, once I get the go-ahead, are going to need some rehab work.

One thing I have not noticed with any of my increased movements is popping, grinding, clicking, snapping or any other Rice Krispies sounds or feelings coming from my hip. Perhaps that will come with larger movements, but so far so quiet.

I know that I have put a little more than the allowed weight on the operated leg at times (by accident) in the past week and I haven't had any pain result from those brief occasions. I am still under the hospital-discharge instructions to put no more weight on my operated leg than the weight of the leg itself (i.e. resting my foot on the floor), so that is what I do, but it feels like I am ready to put some more weight on the operated leg.

Honestly, with my pain so low and my movement so improved, sometimes this whole surgery/recovery/crutches thing feels fake. Like I could just throw my crutches aside and walk if I wanted to. I suppose that is a dangerous feeling because it could lead to me acting carelessly with a hip that, while feeling much better, is by no means even close to completely healed.

But it seems my naive pre-surgery superhero feelings have begun to resurface -- the ones that made me think this recovery wouldn't be that bad at all (at least not for *me*) and the ones that are making me think the doctor is going to tell me I can throw away the crutches and walk when I go see him on Tuesday. Thank God my parents never got me a Wonder Woman costume for Halloween as a child; I probably would have jumped off a building expecting to fly.

INCISION

One great reminder that none of this is fake at all is the five-inch scar across my abdomen. All the steri-strips are off and it looks amazing, see for yourself. Dr. Millis must have used skin glue or something because the incision has healed together so smoothly and so quickly. But I can't get too excited about it: he is going to reopen it to get the screws out eventually, and I don't know that it will heal up so nicely the second time around.

MOOD

I am in good spirits most of the time, especially now that the pain and itching have lessened and I've gotten more relaxed about the movement of my hip. I am not bored in the slightest: on the contrary I am relishing the opportunity to read voraciously in various media and keep up with my favorite TV shows and movies. This is the part of me that is hoping that the doctor does *not* tell me to throw away the crutches and walk next week. I'm not done with my pile of books yet!

Nevertheless, the bookworming has slowed down in the last couple of weeks as I'm back to working almost full days now during the week. I feel up to it mentally and so far I think I have been doing as good a job as I would be doing if I were physically in the office. Probably better, since I am comfortable and only have a 13-stair commute.

Venturing Out on the Town

2009-04-02T23:49:00.001-04:00

Tuesday's big adventure was going out to dinner at a local restaurant. At the time it was my longest excursion out of the house since I got home from the hospital a week and a half ago.

I was already in a bit more pain than usual before we went, but I thought the pain was more from muscle cramping from sitting in one position all day than from hip ache, so I took a Valium instead of an Oxycodone. Wrong choice. I was irritable, sleepy, uncomfortable in my chair, not very hungry and climbing the pain scale throughout the meal. What a terrible dinner date I was for my poor parents!

When I got home, I got a call from Dr. Millis. He wanted to check up on me at the two-week mark. Obviously he was catching me at a low point pain and mood-wise, but despite how awful I felt during the call, I tried to give him a broader picture of how I have been doing these past weeks and the progresses I have made.

The highlights of what he told me were:

-- if I am to undertake anything adventuresome (ahem, restaurant visit), I should prepare by taking extra pain medication beforehand (in this case one or two Oxycodone instead of one Valium) and not torture myself by going poorly protected, painkiller-wise;

-- he did not seem to be concerned about the amount of pain medication I am still needing (I was concerned because some of my PAO peers seem to reduce and even quit their pain medication so quickly, and I just don't think I can do it that fast, nor do I think I am being wimpy about my pain level);

-- I don't have to worry so much about overdoing the angle or the weight on the operated hip -- it will take more than such small things to do damage to the hip and its healing;

-- any grinding, shifting, popping, or clicking I may have felt are normal the first few weeks (I have felt none of those things.);

-- the dressing can come off any time now, the incision will be healed shut by now;

-- the numb spot will continue to recede.

Today I took the dressing off -- it is still hard to tell what the incision looks like because of the steri-strips. Mostly it looks like a 4.5" long mountain ridge curving down from where the iliac crest sticks out in front. Here is a photo; one of the steri-strips has peeled off already so you can see the actual incision there.

For orientation, the grey fabric is my pants, the top of the incision is where my hip bone would stick out really obviously if I were skinny like a supermodel, and the right side of the photo is the right side of my body. The yellowish tinges are from Betadine solution.

[Note, I've also added a post-surgery x-ray photo here, and going forward photos will be easily accessible in the Quick Links section at left.]

Tonight was another big adventure, attending a three-hour fund-raising event with my parents. Again I was already in a bit more pain than normal beforehand, this time because I'd stepped on the dog while swinging my bad leg off the couch -- the dog obviously jumped up and away, wrenching my leg as she moved. It hurt -- me physically and the dog emotionally.

This time I applied the lessons of Tuesday night and took two Oxycodone beforehand and had extra medication with me. (The fact that the event was a trivia competition and I was able to vigorously compete does prove my point that the Oxycodone does not make me foggy at all.) Although my team did not win, the night turned out well overall. My pain stayed very low until the last hour, when it started to increase and distract me. So clearly I can venture out a bit more, but as Dr. Millis suggested, I should be prepared with extra pain medication to avoid self-torture.

Two Weeks Post-Surgery: Movement

2009-03-30T17:20:00.003-04:00

I am more mobile than last week in the sense that I am more confident on my crutches. Other than that there is not a significant amount of progress. I am in good shape for crutching -- prior to the surgery I did a lot of step-ups onto high platforms, squats, lat pulldowns, rows, triceps dips and other "crutch muscles" exercises, so I actually have not felt much difficulty crutching due to fatigue/weakness of any of the supporting muscles. (That said, I don't do much crutching other than around the house for necessary tasks only.) The real difficulty is with the muscles that were affected by the surgery in my right leg, as I describe below in the bit about the stairs.

I'm concerned sometimes that I accidentally put too much weight on the bad leg, or that I create too sharp an angle at the hip by leaning forward in a chair, for example. I left the hospital with instructions to keep the angle between my torso and thigh between 80 and 30 degrees (with 0 being flat out as when you stand up straight or lie down flat on the floor, and 90 being your knee brought up so your thigh is perpendicular to your body). So my concern is that I might accidentally push the hip a bit too far with weight-bearing or the angle, since I'm protected by the painkillers.

Or I might just fall on my face, like I did yesterday. I was waking up from a nap, and clearly not really fully awake or coordinated. As I got up from the couch and reached for my crutches, I lost my balance and fell forward. I caught myself mostly with other limbs, but I did land moderately hard on the floor with my right (op-side) knee, jarring my operated hip. It hurt right away (even through the painkillers) and of course I instantly panicked that I had done some sort of significant damage to my hip or hindered the recovery in some way. It feels OK today so maybe I am not made of porcelain. But lesson learned: wake up, THEN stand up.

I know I'm being a bit overly cautious, but I just really want to be very careful and treat my hip as properly as possible during this healing time, especially when it is so early and everything is so loosey-goosey in there; I feel like the slightest mistake (like clumsily falling) might cause some small setback or damage that would prevent the joint from healing as strongly and solidly as possible. I'm afraid that pushing oneself too hard and pushing the boundaries of healing too soon could create microscopic weaknesses in the healed joint that over time could cause pain, problems, and potentially more surgery. I want to heal this hip once, well, and for GOOD. (And then do the same thing to the other one.)

My current movement project is going down stairs -- as we know last week's breakthrough was sliding my right (op) foot forward using the hip flexor/upper quad when taking a step forward with my crutches. Going down steps is a slight variation on that, as I put the crutches on the lower step, place my right (op) foot on the lower step, then (with all my weight on the crutches) bring my left (non-op) foot down to the lower step where my crutches and other foot are. So the additional difficulty here is that rather than just sliding my right (op) foot forward, I also have to use muscles around my hip to support the entire weight of my right leg while the right foot is in mid-air over the lower step before I place it into position.

Previously I had either cheated by slithering my foot over the edge of the stair and down onto the lower stair (i.e. never losing contact with the ground) or having someone place my right foot on the lower stair with each step. But by now my hip flexor/upper quad muscles are strong enough for me to place my own foot on the stair below (sans slithering or assistance) for several steps in a row. This morning I made it down almost all of the 13 stairs down from the upstairs, so that was a pretty good achievement.

I still need help getting into and out of the shower (there is a high lip that I need help getting over with crutches, plus there are zero handholds to grab on to for support), but I can shower myself using my shower chair. Although a shower feels fantastic, the entire undressing/getting in/not falling off the shower chair/getting out/drying myself with all weight on left foot/redressing process is sometimes an exhausting ordeal, so the glee can be somewhat tempered.

I have been fine with using a normal toilet since I got home. I think this is due to my pre-surgery leg workouts -- my left leg has been doing quite well at lifting my entire body weight from various seated positions even when there is not really enough support for me to use my arms to assist.

Similarly I never got myself a leg-lifter to position my leg; I just grab it by the knee and move it around with my arms. To make small adjustments to the position of my lower leg I have been using an excellent trick I read in someone else's blog -- slip the non-operated side's foot under the ankle of the operated-side leg and use the good foot to adjust the position of the lower leg on the operated side.

I am perfectly comfortable sitting in an armchair with an ottoman for hours. I can sit in an armchair without an ottoman for a while as well, as long as I can slouch a bit. Dining room and kitchen table chairs are less comfortable, mostly because they involve eating (i.e. leaning over the table) and that causes greater-than-80-degree hip angle problems. I solve the angle problem by sitting on the edge of the chair and angling my thigh down towards the floor, with my foot under my chair. But as you can probably imagine, that is not all that comfortable for long periods of time either, so I prefer the armchair route.

The leg-under-the-chair solution is also helpful for getting up from armless chairs or other seating positions where there is not a lot of support nearby for using my arms to help me stand up. With my right leg under the chair and my right knee pointing 45 degrees towards the floor, I can lean forward to use my body weight to help me stand up using just my left leg, without creating an overly acute hip angle from leaning forward.

There has not been much progress in sleeping positions. As last week, I can sleep on my back (with two pillows under my right leg) or on my left side (with two pillows between my knees and one between my ankles) for long periods during the night. I can switch between these positions by myself, although it is not something I can do in a state of half-sleep, so I do still wake up several times per night to make these switches. Last night I must have been dreaming something topsy-turvy because I woke up in the midst of an attempt to turn on to my right (op) side to sleep. I did complete the turn, figuring I might as well try lying on the operated side, but that experiment lasted about one second, as it hurt immediately and not insignificantly.

Although I can't move all that much, my spirits are still high. I'm in a good mood most of the time, and I'm never bored. I have so much to read (books, magazines, newspapers, blogs) and so much to watch (Netflix! Hulu!) that the days pass quickly. I've also started to log back in to work this week, but so far I've just been responding to two weeks of emails and trying to get my inbox back in order.

Two Weeks Post-Surgery: Pain & Medication

2009-03-30T16:27:00.006-04:00

My pain is generally well-managed but there is a lot of it still lurking below the painkiller block. When the pain does break through, it has usually moved to one or another of its favorite places to surface -- sometimes over the incision, sometimes on the outside of my hip, sometimes deep within the joint, sometimes at the top of my iliac crest (where I think there is a screw head), sometimes in the back of my hip joint (deep inside behind the bottom of my right buttock), sometimes shooting itself like a racing stripe down the outside of my thigh, knee and calf.

There is still a numb spot about the size of my hand on the outside of my thigh, right below where the greater trochanter of the femur sticks out to form the widest part of the hip. The numb spot is normal; Dr. Millis said they have to move a significant nerve aside when they are doing the surgery, and this causes some damage to the nerve that gradually repairs itself over a few months. But there will be a steadily receding numb spot there until the nerve has completely healed.

My incision is usually the least of my problems. It is not generally tender, but it itches sometimes under the dressing, and as I mentioned above, it does sometimes hurt. We changed the dressing two days ago, so I saw the scar (through the steri-strips, which means I didn't see much). Not much to report until I really see it when the dressing and the steri-strips come off. The dressing is set to come off this Thursday.

There does not seem to be much swelling at all in the hip area or the leg on my operated side. I am not even sure there was that much swelling in the hospital.

My current pain medication regimen is:

-- 1 Oxycodone every 5 hours during the day
-- 1 Oxycontin twice daily
-- 1 Valium at bedtime
-- 1 Valium kept at bedside if needed for pain during the night

Some PAO bloggers I have read have been on less medication (or less frequent dosing) by this point in their recoveries, so I'm not sure why I'm still needing such high or frequent amounts of pain medication. I have, on occasion of missing a dose or taking a dose too late, had breakthrough pain, and it is not at all tolerable -- about a 5 on my pain scale if I let it get too far. Since leaving the hospital I have stepped down to one Oxycodone every five hours instead of two every four hours, and have switched to taking Valium at nights instead of Oxycodone.

Unlike others, however, I don't find the painkillers make me feel mentally foggy in the slightest. Only Valium makes me a bit scatterbrained and sleepy, which is why I take it at nights now and leave the Oxys for the daytime. But on the current regimen I have been reading varied, mentally stimulating books and magazines, playing (and winning) fierce games of Trivial Pursuit and staying generally awake and alert all day, save an afternoon nap. So I'm in no rush to get off the pain killers for any philosophical or mental acuity reasons, I just find it interesting that others have weaned off them tolerably so much more quickly than I seem to be doing.

Of course, one must consider that my surgery took seven hours rather than the four and a half hours Dr. Millis had originally predicted, and my bones were, according to him, incredibly strong and difficult to cut. I have five screws rather than the usual number of three most often used in these operations. Also, I came out of surgery with an elbow injury on top of the hip situation (and then there was the heat rash!), so maybe my body's healing department has had a lot a lot of balls in the air and that is why my pain has been persisting longer than that of my PAO peers. Or maybe everyone is different in their healing and it is what it is.

Speaking of heat rash, I've been applying the prescription rash cream twice daily since I left the hospital. The dragonhide that formed after the fiery welts I had in the hospital has completely flaked off by now and the marks of the rash are reportedly looking much better and almost dissipated.

The itchy-red-spots problem (which apparently is a side-effect of the pain medications, although I have not read of similar reactions among any of my PAO peers) persists, but seems to have been lessening steadily. For that I try (usually unsuccessfully) not to scratch at the spots and I apply Gold Bond lotion twice daily. Mostly it feels like I have a mild but chronic case of chicken pox.

I am also still taking the Atarax pills (twice daily) that I was taking when I left the hospital for the itching/spots. I think I will reduce the Atarax as the pain medications are reduced.

I was never given Lovenox or even Coumadin at the hospital, just aspirin, so I keep taking that once daily to keep my blood thin and clot-free as I'm healing. I stopped wearing my TED stockings after a few days at home. Even in the hospital they weren't very tight and didn't seem to be doing anything that a pair of drug-store knee-highs couldn't do. Plus, no one told me I had to wear them when I got home.

First Week Home

2009-03-26T11:44:00.005-04:00

I've been back at home for four days now. The routine is really one of keeping me comfortable, clean, and as pain-free as possible. I would not say I have been progressing in leaps and bounds.

The pain is variable. At times it is quite bad and I am unable to focus on anything else until the medication kicks in; at other times it is more manageable. Sometimes the variation seems to be related to movement (crutching around, showering, etc.) but sometimes not. I suppose that is how it is these first weeks when things are shifting and mending and moving about in there.

When I was first taught to crutch by the PT tech at the hospital, the instruction was to put all weight on the left (non-op-side) foot, move the crutches forward a foot or so, slide my right (op-side) foot forward (toes slightly up so as not to snag on the carpet) until it is even with the crutches, then lean almost all my body weight on the crutches (only bearing 1/6th of my body weight on my op leg -- basically the weight of the leg itself) and follow by bringing my non-op-side foot even with my op-side foot and the crutches.

At first I couldn't slide my op-side foot forward at all. The muscle just wasn't there. I would stare at the foot and try to THINK it forward but I just couldn't get any muscles to respond to slide it forward. I had to get the foot where it was going by leaning forward so the weight momentum would swing it forward to meet the crutches, or by creeping forward along the floor with the toes, or some other cheat.

But by now whatever hip flexor/quad muscle was not firing before is working to slide my right foot forward as I crutch. So that is progress! I can slide my op-side foot forward six inches across the floor. Trophy please!

Crutching is very tiring. Standing on one leg is also very tiring. Pretty much everything I do that is movement requires so much effort by every single part of my body except my right leg that I am exhausted after the smallest feats. A shower, a staircase, a switch of positions... all of it requires a rest period afterwards, and sometimes some Valium if the movement has caused muscle cramps or extra pain.

I can sleep on my left side for long periods (i.e. more than an hour = long) during the night and switch from lying on my back to lying on my left side on my own. It is neither easy nor comfortable to do so, but I can do it. There are times when sleeping on my left side is far more comfortable than sleeping on my back, but combining the words sleeping and comfortable is still an exercise in oxymoronism.

I have not made any progress at all with the itching, however. I must be reacting to one of the medications, but I just itch all the time. Not the same as the heat rash, but just like itching little red bumps everywhere. I am still taking Atarax (which I was taking in the hospital for the heat rash) so the itching is supposedly being controlled, but you could fool me.

Another strange thing I have noticed is wild temperature fluctuations. I swing from freezing cold to complete hot flashes in what seems like fifteen minute intervals. Makes dressing very difficult but I'm learning to love layers. I think this must also be some some sort of medicine reaction.

My dressing is beginning to peel off so I've got an email in to the doctor to find out when that can come off. It is pretty much deciding the timing itself at this point, but I don't want to just rip the rest of it off without his permission.

Other than that, no news from the home front.

Transitioning Hospital to Home

2009-03-24T12:06:00.006-04:00

Saturday involved more physical therapy, now including walking with crutches, as well as in the parallel bars. All of it is still very very tiny amounts of movement -- 3 stairs here, 12 crutch-steps there. Nothing like what I'm going to have to be prepared to do when I go home. They train you "how" to do the motions but they don't work on strengthening you to handle how much your muscles are going to have to be doing by the time you are moving. It is all well and good to practice 3 stairs, but my house has 13 to get from first to second floor. But I suppose form is most important; I'll have plenty of "on the job" training as soon as I get out of here. I was not sent home with any PT "prescription" or any discussion of types of exercises I should focus on at all.

Today (Sunday) I go home around noon, after having spent seven days in the hospital (including the day of surgery). By now my pain is pretty well managed with oxycontin and oxycodone. My PT is progressive in the sense that I can now walk more steps and even handle some stairs, up and down. But the heat rash itching has not gotten any better despite the creams and powders.

Last night I managed to fall asleep on my left (non-operated) side for about an hour, but had to be rescued like a beached whale when it was time to be rolled over onto my back again. Of course when I woke up I had that same strange "where am I" feeling I always have had in the hospital, and the concern that I'd woken up in a dream (rather than FROM a dream), if you know what I mean. That has happened to me more than once while here at the hospital, like there must be some other alternate reality that I am missing just before I wake, and in that other reality I don't wake up every day in a gown on a gurney scratching my back raw. Also -- and this must be the drugs -- every time I wake up I feel like I'm in a different room. Very similar to my other hospital room, but a different room nonetheless.

The doctors came by early this morning on rounds (as usual) and I was completely out of it and falling asleep in the middle of conversations (as usual). That is so very embarrassing. Patients are never nodding off like junkies in the middle of coversations with Dr. Gregory House, for example. Unless it is important for their differential diagnoses.

I am ready to go home. I don't think this hospital bed has much more to offer me (other than the trapeze, which I will sorely miss).

All the paperwork has been done for my release; Dr. Millis himself wheeled me to the door and wished me well (I'll see him in three weeks for follow up anyway) and was very sweet about everything. Some of the nurses seemed genuinely sad to see me go, and say that they have requested me as a patient for next time (which I have to think is a lie, can you even do that?)

My mother and I got on the road about 1pm and stopped for a coffee/restroom break at McDonald's on the way. It was my first time in public on the crutches and it is just a joke how slowly I move on crutches. People must think I'm kidding -- I look healthy and strong enough, and yet I'm heaving like a cast Clydesdale and I'm moving about 6 inches a minute. I couldn't make eye-contact with anyone at the McDonalds because I have to study the ground for each step and think so hard about my muscles, so I don't know if anyone was staring or not, but this one poor kid did have to hold the door for me for like 5 minutes as I snailed my way through. Bet he regretted that one.

The drive home was about three and a half hours; my leg kept jiggling or bouncing with the car's movements, plus I missed a painkiller while I was asleep during the journey, so needless to say I was in a world of hurt and exhaustion when we pulled in the driveway. It was all I could do to make it up the back steps to the den and pass out on the couch. After a while I had mustered enough strength to make it all the way upstairs to my room to sleep again.

Recovery Day 4 -- Exit Wounds

2009-03-20T23:12:00.005-04:00

This morning I was up by 7:00am, which is pretty much the earliest I have woken up and stayed up since I got here. I was still furious about the back issue when I woke up, which is never a sign of rationality or an omen for a positive day. My lower back and flanks were still raw and itching terribly, damp and nubbly feeling when I scratched them; I could feel the angry rash forming. This discomfort was keeping me distracted and furious, like a six on my pain scale. I'd never intended the pain scale to apply to more than hip joint pain, I tell you that.

The nurses arrived and got me back in my CPM machine (which itself is not annoying or uncomfortable). I let them know that overnight my back had continued itching as if I'd been sitting sat naked in a poison ivy beach chair for three days. I'd tried shifting position, having sponge baths and salve creams applied but nothing seemed to ameliorate the horror. Only the IV-administered itching drugs could (temporarily) keep me from trying to claw off my own skin.

The other thing that bugs me about being so uncomfortably itchy is that I know I am moving my operated hip too much and putting it in non-optimal positions while trying desperately to talc, salve or sandblast my back and flanks. I can feel that I am causing my hip extra pain and I worry that I am delaying its healing because I am unable to focus on protecting the joint in the face of eliminating the raging discomfort on my skin.

Dr. Sankar came to see me at around 7:15am. I am just so so angry today; everything is making me furious. Before I was sad and pathetic and self-pitying, but now I'm just pretty much pissed off. Pissed off at how much I am itching and really pissed off at having to use the bed pan. I'm pretty sure I have already explained properly how f'ing pissed off I am about the bed pan.

At 8:45am the physical therapist came to help me practice getting from the bed to the recliner chair beside my bed. That was an ordeal which involved me supporting myself on the trapeze and swinging my good leg to the ground, followed by the physical therapist supporting my bad leg, following my lead to keep my bad leg in the correct alignment to the good leg all the way to the floor, so that eventually I would be sitting on the edge of the bed with both legs hanging off towards the floor. Or at least that was the idea.

What actually happened was that I swung my good leg to the ground but the the PT-held bad leg lagged behind and so was shifted from its usual angle and caused a painful bursting feeling within the joint. It honestly felt like a small water balloon had burst within my hip joint. I gasped and swore and instantly began crying hysterically. Partially because of the pain and surprise, partially because of the fear, and partially because of the (probably unwarranted amount of) hatred and blame I immediately directed towards the PT-tech who had ruined the whole maneuver (in my opinion). When I finally got settled into the chair, I refused to work further with the PT tech and refused to move from the chair until 11am. Which behavior is probably why I was appropriately sent to a children's hospital to have this surgery.

By 11 my tantrum had run its course and so I moved to a commode chair (basically a chair made of a high toilet seat with arms and legs with wheels), which could be rolled into the bathroom for me to shower in. The commode chair could also be rolled over the toilet to allow me to use the toilet like a normal person without the cursed bedpan scenario.

Taking a shower (even with the unwanted and what I considered unnecessary assistance of a nurse I did not particularly like) was quite a lovely experience. Getting back into bed from the commode chair was quite the opposite. The same logistical problem of launching a good leg onto the bed while balancing body weight on the trapeze and having a bad leg guided by a PT tech made me nervous and irritated. The PT's approach to this maneuver was not making logistical physical engineering sense to me, nor did she seem nearly strong or reliable enough to trust with lifting and guiding my injured leg in sync with my good leg. Again, I was not wrong, and she ruined it (in my opinion) because the approach she was suggesting required superhuman strength and accuracy from me and there is no way any patient could have done it. So that did make me like her any more at ALL.

So I had my horrible exit from the bed, my excellent shower and chair nap, a relatively productive 12 shuffly steps between the parallel bars and a horrible reentry to the bed. Getting into and out of bed were so scary and horrifying that it almost made everything they facilitated, including the shower, the steps, the chair, the non-bedpan urination, and the easy salving of my back, not worth the fear and panic of exiting and reentering the bed.

The whole experience made me ruthlessly dislike the physical therapist and her every appearance. Luckily the next person to arrive in my room was my friend Josh, and then Dr. Millis, who said I should be able to get out of here by Sunday noon.

And the doctor told me to drink my milk of magnesia. All everyone wants me to do here is drink milk of magnesia, drink miraplex, consider suppositories, blah blah blah. I haven't eaten a thing since Sunday night, so whatever is in my intestinal tract is not exactly a Hoover-dam type blockage. But clearly the whole team is freaking about my GI tract so I'm drinking my f'ing magnesia people, relax.

Friday night I got my second blood transfusion along with what turned out to be an accidentally overly high dose of oxycodone, so the entire experience was a end-of-Pinocchio-like a nightmare of blurring memories, alien-invasion-dreams, tubes of blood going into strange machines, stretched out time, slurred words and confusion. The back/flank rash was still horrible and itchy, and I kept waking up in what seemed like a different sci-fi dream. And I don't particularly like sci-fi.

Recovery Day 3 - My Back is Covered in Magma

2009-03-19T22:00:00.000-04:00

Today my linens were changed again, but this time Dr. Millis himself was smart enough to be there for the actual changing -- I think he knew I'd throw a fit (because last time I was so nervous about the moving around and the sea-mammal-lifting scenario) and that my pride would probably cause me to suppress my panic in front of the head of the orthopedics department and therefore allow the deed to be done. Again I question why my linens needed to be changed less than 24 hours since their previous change. But anyway.

There were a lot of people around (male and female nurses); Dr. Millis was distracting me by talking about various unrelated things and giving me various meds while others were messing with the bed around and beneath me. So it all went far less terribly this time than my apprehensions had suggested. It also helped that my left elbow had healed enough that I could lift myself with its help from the trapeze, unlike last time.

My epidural was also taken out today, which was far less painful than I'd anticipated it would be. I suppose the epidural itself inside my back was quite small -- although I will say that it did affect how you could lean back in your seat, it had to be just right or it dug into your spine in quite the wrong way. A bigger coersion to removal was the tape around the epidural site and wires -- it itched crazily (a trend, you will see). But all went well and the epidural came out just fine and left almost no mark, as the hole in my spine had been so tiny. The epidural delivery system itself had been off since the morning anyway (meaning no medicine had been flowing through) as I was transitioning from that delivery system to my new oral meds.

The real, very distressing concern I had with removing the epidural had nothing to do with pain. Without an epidural (the wires for which had kept me in bed since the surgery), I no longer had any need for a urinary catheter, and without a catheter, I'd have get out of bed to use the toilet. (Sorry, I'm going to have to discuss catheter territory here...) So far, I hadn't had to get out of bed for anything, and, because I had a the luxury of a catheter, I'd kept myself very hydrated, drinking tons of water in addition to the IV fluids I was receiving on a 24 hour basis. I happened to be on the phone when the nurse who was sponge-bathing me mentioned something in passing about removing my catheter and began fussing around down in the catheter area. (Red flag just on its own.) Hold the phone, literally. I was not about to fall for that little she's-distracted-by-the-phone diversion trick. So I got off the phone and launched into a little whining parade, asking why I couldn't just keep the catheter until I learned to get out of bed safely. But I guess catheters are often the source of infection and so they should come out as soon as possible. Given the fear I'd already acquired about moving (even just enough to change my linens), and the amount of fluids I'd been drinking (consequence-free due to the catheter), I was actually prepared to accept the risk of a UTI (everyone likes cranberry juice, right?) over a constant (one-legged) Tigger-like bed to bathroom bouncing cycle. Alas, mine was the minority opinion and so the catheter too came out.

This meant that by Thursday afternoon I'd become almost totally wireless -- no leads, no epidural, no catheter, no IV-drips (although the IVs were still in place should they need to be hooked up to something or other).

This would all have been excellent progress except that Thursday also suffered from a timing problem. The day was supposed to have gone like this: get wireless, get a pint of my own blood transfused (for extra pizzazz!), get out of bed with PT's help, learn to use the rolling commode chair to get to the bathroom, rest on laurels. But instead, something got delayed with the blood and the schedule went more like this: get wireless, wait for the pint of own blood, inevitably have to go to the bathroom but no more catheter and no training in how to get out of bed (because PT wouldn't come until after I've gotten my pint of blood, of course, which makes perfect sense in Nonsense Land). For bathroom breaks I was forced instead to choose between pissing myself or using a bedpan, both choices I had planned to put off until at least my mid-80s.

The bedpan required me to hoist myself up on the trapeze, a nurse to position a plastic bowl-type thing beneath me, me to lower myself onto it and try to pee in it without missing and pissing all over my bed (which of course, could have been an option on its own, as you recall). Lots of people have to help set this bedpan scenario up for you and so you are not exactly left with any modesty while performing the task. It is mortifying and disgusting beyond belief, and honestly should be someone's episode of Fear Factor. Personally, I chose to add in the optional pre-bedpan temper tantrum (which does not lessen the bladder's needs) before succumbing to the bedpan option. I did, however, maintain what I thought was a shred of dignity by countenancing a complete, unabated, immature and utterly satisfying fury for the remainder of the day, and going on a water strike. All of which, I'm sure, showed them.

When you think of fury, you imagine, perhaps, Yosemite Sam's ruddy, seething face beginning to shake, or the way Acme characters' faces fill up red from the bottom until the very pate is reached and "TILT" begins to flash in their eyes. I am not going to say that in a similar manner my bedpan humiliation fury was physically manifested by the pulsing, hot, Habanero-like heat rash I was to suffer for the remainder of my hospital stay, but I'm not going to deny the metaphoric coincidence either.

As you may recall, during my feverish period described yesterday, my back would pour sweat and feel like an inferno, and I would stuff as many ice packs as possible back there to try to alleviate the situation. All that heat and pressure (despite the ice packs) eventually lead directly to a horrible, spreading, angry heat rash that inspired absolute insanity in me, removing my concern for hip pain, consideration of others, desire for food, drink, life, liberty and the pursuit of happiness and replacing it with a frantic desire to rip the skin off my back with any available shredding and/or rending type object(s). This frantic heat rash condition could be controlled slightly with various anti-itch medications, but would become a background tenet of my mood for the remainder of my stay.

So needless to say, Thursday was an angry day. Not only were my linens changed again in some sort of spasm of sadistic cleanliness, my back began to boil like a hot, itchy pool of magma, my catheter was removed before I knew how to get out of bed, and my dignity was stolen and beaten and ridiculed and tossed into a bedpan in front of male nurses.

On the plus side, I did get to have a shower.

Recovery Day 2 -- Fail Whale

2009-03-18T23:34:00.002-04:00

After a good night's sleep last night, I continued the Sleeping Beauty trend through most of the morning, confounding many of the various medical team visitors that came by in the morning intending to work with/on me and finding some sort of hibernating, mumbling creature in my bed.

My lucky epidural/Valium/nubain combination certainly did treat me well through the night and this morning, but when I finally woke up midday I had two problems. One was that my shoulder muscles, having been kept in the same position for two days and nights straight (because of IV lines and injury), were stiff and very sore. The second was that Phlebotomy had not been deterred and was waiting for me to wake up. Seriously? Are they playing some sort of sick darts game with me? Didn't I just give them blood samples yesterday? I was unable to feign sleep well enough to discourage them, so they stuck me again and again and again until they they finally found a vein that could give them what they wanted.

By now all the evil forces amassed against me had noticed that I'd awakened and so I was cheerfully told it was time for my bed linens to be changed. Last time I had checked, I had been lying quite immobilized on my bed linens, tangled up to several types of wires, hooked to a CPM machine, and basically inextricably attached to my bed and, therefore, its linens. I also did not particularly care that my linens were at this point a day-and-a-half old. I don't even change my sheets at home every day and a half. But the hospital cared, and so I was -- strongly against my will, I note for the record -- forced to have my linens changed.

The linen change operation can best be pictured if one imagines how one moves a large sea mammal -- an orca, say, or a manatee -- from one tank to another at Sea World. A big sling is positioned under the enormous beast and then is hoisted; the animal is lifted, fins flopping out to the side, pulleys straining, as the tank is hurriedly changed or cleaned beneath the teetering mass of blubber. Finally, thankfully, the hovering sense of disaster is abated as the humiliated and panting celaphopod is lowered back down to its bed -- I mean, tank.

My CPM machine was not replaced after the linen change, since I'd had the machine on and constantly running since immediately post-surgery. This meant that my operated leg was in a new position and that a pressure sore that had, gradually and, at the time painlessly, been created by the support bar of the CPM machine against the underside of my thigh, had begun to make itself known as the sedation masking it wore off. Quickly and excruciatingly.

Physical therapy came and did some mild exercises with my legs and feet; I ate some broth. All the while the pain from my new positioning increased, the pressure sore began to liken a red-hot poker pressing into my thigh, and, somehow, the epidural began to decrease in effectiveness (despite being raised from 8 to 10 by Dr. Millis last night.)

By late afternoon I was probably at a seven or an eight on my pain scale, moaning and crying and repeatedly pressing the nurse call button to beg hysterically for help or a shotgun. Unluckily, my mother was out taking a walk at this point, so I was literally alone, sobbing into the abyss and the nurse call walkie-talkie.

The pain began above my hip, probably where the screws entered my iliac crest just below my waist on the right side. The pain widened and deepened at the hip joint itself, illuminating all the different moving parts aching inside the joint and around it, including the muscle along the outside of the hip joint. The pain then shot down the right side of my thigh and flared out again near the lateral tibial head, narrowing and dissipating down the lateral side of my right calf. This pain was steady and totally consuming, and I couldn't figure out why it would radiate out so far from the hip itself.

I cried and moaned and hit the call button again and again. Finally, FINALLY, a nurse came and brought Pain Services, who discussed my pain and did some sensory tests to determine the coverage area of my epidural. The Pain Services team eventually decided to raise my baseline epidural to 12 and to give me a jump start on pain relief by injecting a small dose of lidocaine directly into my epidural line. Although it was not instantaneous, the lidocanine did the trick and provided me with possibly my first (and only) pain free 90 minutes while in the hospital.

Once the lidocaine kicked in and my biggest crisis was resolved, some of my smaller irritations could be addressed. I'd been feverish all day, so my body temperature had been fluctuating between chills and hot flashes. When I was hot, I was dripping sweat and had to be packed around with ice packs all over me; when I was cold, I was swathed in blankets and chattering my teeth. When I was hot, my back would itch and drip and feel like an inferno pressed against the pillows and the bed, and I would stuff as many ice packs as I could between myself and the bedding. My fever hit 102 at its highest. My back itched and overheated horribly, only worsened by the enormous ace bandage dressing wrapped around my incision as well as my entire abdomen.

Needless to say, this was an incredibly uncomfortable day. I was in pain and/or discomfort almost constantly, as well as woozy for long portions when I was on Valium to help me relax and Nubain to help relieve the itching.

At 6:30pm Dr Millis came by to remove the large ace bandage dressing and replace it with much smaller dressing over the incision alone, which relieved some of the abdominal discomfort, but not the horrible itching and damp heat on my back. I saw my incision through the stitches and steri-strips -- it looks about five inches long and not horribly disgusting. Dr. Millis said my fever was normal. He looked at the pressure sore from CPM machine but declared it didn't look that bad, which was annoying since it certainly continued to *feel* that bad.

I ate my first food (some bites of scrambled eggs and a few crackers) so I'd be able to start switching to oral medicines in the next day or two.

I would have to say that today, Wednesday, was one of the very worst days so far, and that I am surprised and disappointed that I was so very uncomfortable and painful several days after the surgery. I didn't expect the recovery to be pain free, but I certainly did not expect the seemingly increasing level of durable, multivalent misery that I would be still be experiencing several days following the surgery.

Recovery Day 1

2009-03-17T20:42:00.001-04:00

Last night -- the night after my surgery day -- was rougher than I thought it would be. Despite being exhausted after the surgery, I kept being snatched from the edge of sleep by various distractions, both human and electronic. Nurses came often to check my vitals, and oversensitive monitors periodically became convinced that I was no longer breathing, which of course sounded an emergency alarm that brought people running to my unnecessary rescue. My sleep was fitful from all the interruptions, and uncomfortable because of the itchiness brought on by the epidural medications and the all the contraptions stuck to and moving on me.

In my bed, I was sleeping with two IV lines, three monitor leads, a pulse oximetry meter, rhythmically inflating compression leg wraps on both lower legs and my entire right leg in a continuous passive motion (CPM) machine cycling my hip constantly between 30 and 70 degrees. Cozy.

The 11pm nurse shift change brought relief in the form of a wonderful nurse who gave me Nubain (for itch) and Valium (for muscle relaxation and sleep) among other delights. I slept much more comfortably after that but I wouldn't call it cozy.

This morning Dr. Sankar came to see me as I awoke, and he said I looked very well for someone the morning after surgery. Phlebotomy followed Dr. Sankar, which caused me to mar my fine looks with a considerable scowl, as they pincushioned me for some blood tests. The scowl deepened when I found out these would be daily blood tests.

Then the physical therapist arrived, which I honestly thought was a joke. Seriously, how much physicality did they think they were going to be able to get out of me in this state? A toe wiggle? Well, that was pretty much the answer. Wiggle your toes, move your ankles, etc. They did ask me to isometrically tighten the quadriceps muscle in my right (operated) leg as much as I could. It was a strange sensation to be sending my leg muscles signals that simply did not seem to be received. The therapist laid her hand on my thigh and said she could feel my muscle contracting, so my efforts were not unheeded, but I was still numb to any response at all and the non-feeling was quite bizarre.

I spent most of today sleeping, probably making up for my poor night's sleep last night. In the evening the anaesthesiologist checked on my left elbow injury -- I still couldn't use it to help lift myself using the trapeze (the pole above my bed that can be used to lift and adjust the body using the arms) and I still did not have full extension or flexion. The pain was tolerable if I kept the elbow relatively still, but it was obviously a concern for the surgery team.

Dr. Sankar also came by in the evening to remove my "drain," a pair of tubes that had been left in the wound and led out to a collection pouch outside the body to drain away blood and fluid from inside the surgery site. The drain reduces swelling and aids in healing, and had been emptied several times since I'd gotten to my room on Monday night.

When Dr. Millis came up at 7:45pm, my last visitor of the night, he asked what my pain level was in my hip. I told him honestly that it felt like I had a machete driven through my groin. He thought this a sufficient enough reason to increase my baseline epidural from 8 to 10. The machete became a steak knife and the night passed relatively peacefully.

The Surgery Itself

2009-03-16T20:40:00.005-04:00

My mother and I made the chilly, five minute, pre-dawn walk to the hospital. Right on time at 6:00am I made a point of bounding up the hospital stairs towards the Admitting department, ticking off my last "last" before surgery. In the Admitting area there were three other patients with their families checking in for surgery. All of them were kids, except for me, which I guess is to be expected at a children's hospital. They were, alternatively, sniffling and clutching a teddy bear, silent and affectless, and moderately cheerful. I was actually a bit jocular and excited, which seems an utterly inappropriate mood with which to approach major surgery.

By 7:00am we were all in the pre-op holding area, a room lined with curtained off alcoves, like stalls in a barn. In my "stall" I changed into my surgical "johnny" gown and met with the anaesthesia team. They reiterated everything that had been discussed about anaesthesia during the pre-op meeting in February.* In some PAO blogs I'd read that some patients had experienced problems with their epidurals where the wrong leg was numbed, or the epidural did not work at all. When I mentioned this to the anaesthesiologist, his answer seemed to be something like: "yes, that happens sometimes; it is tough to pinpoint the right spot; we are actually working blind in there because we are not going to bring in a fluoroscopy for a simple epidural, but we do these all the time so it should be fine." Oh, OK, now I feel better.

Dr. "Woody" Sankar came to sign my hip and Dr. Millis, sporting a green St. Patrick's Day bow tie, stopped by to answer last minute questions. He estimated he would be done with the surgery by 1:00pm. After the doctors left, the anaesthesiologist gave me "something to relax" through my IV -- I don't know what it was but it hit me almost instantaneously.

Quickly thereafter, at 7:45am, I was wheeled into the operating room and my mother was taken into the family waiting room. I didn't have my glasses on anymore, but through the fuzz I saw that the OR was full of a lot of people, a lot of tables and a lot of stuff on the tables, everything in the blue/steel/white color palette that looks so good with my complexion. I also remember thinking Dr. Millis' surgical cap was not at all like the caps the surgeons wear on Greys Anatomy.

My gurney was wheeled close to another bed, which had been piled with pillows or cushions of some kind, and I was told to swing my legs around so I was sitting on the side of my bed resting my shoulders, forearms and head on the cushions. "Try to make your back into a 'C' shape," the anaesthesiologist said.

Wait just a minute, I thought. This is the procedure for getting an epidural. I am not supposed to be conscious while getting an epidural. I am not supposed to remember this part. I am way too conscious for this. Meanwhile people behind me are telling me what a great spine I have and what a wonderful "C" shape I've made with it, and Dr. Millis and his strange surgical cap are right in front of my face talking about things completely unrelated to how overconscious I am during this epidural placement. Dr. Millis is holding my hand and the man behind me is saying "this is some local anaesthetic, just a small pinch," and I recoil from the not-small pinch and am told to hold still. At which point I think, oh God, this epidural thing really going to blow and I am far too conscious!!, but then it just a bit of pressure and it is done. The man behind me asks me if it tingles on the right side or the left side of my spine and I tell him it is the right side and I am conscious enough to know and be relieved that the right is the correct side for this epidural to work.

So then many hands help put me on my back on an operating table, and Dr. Millis puts this fleshy plastic face mask over my nose and mouth and I remember he was talking to me and holding my hand and I was frustrated because I wanted to answer but I couldn't because of the windy face mask. And then I was gone.

Since seeing me off by the operating room door, my mother had been waiting in the family area. At 9:30 she was told that all was going well and that my surgery had begun at 8:45. By 11:00am the doctor had begun making cuts into the bone but had not inserted any screws yet. By 12:30pm the doctor had discovered the superhuman bone density of my skeleton and was still cutting bone and was now estimating two more hours of surgery. By 3:20pm the doctor was almost finished and was closing the incision, but the nurse said he would not come out to talk to my mother until I was awake and moved into my bed in the Post-Anaesthetic Recovery Unit (PACU).

Meanwhile, I was coming to in the PACU in what should have been relatively pain-free awakening from general anaesthesia. Unfortunately, during the surgery my left arm had been placed in a position that normally would have been comfortable but in my case was not. The left arm had two IV lines, an arterial line and a blood pressure cuff on it, and was stretched out straight across a table, supported with pads and gel packs. Despite all those protections, my left elbow somehow hyperextended, causing straining or microtearing of the tendon attaching my biceps muscle to my radius.**

I can't even remember if I had any hip pain at all when I woke up because all I remember is excruciating pain in my left elbow. My cries utterly confounded the PACU staff who were (understandably) under the impression my hip was my most likely pain locus. All I recall from this period in the PACU is whimpering and moaning and leaking tears as people tried to figure out what was wrong with me. No conclusion was ever really reached, but I was given morphine anyway, which helped a little.

At 4:10pm Dr. Millis came out to the family waiting area to speak to my mother. He said the surgery had gone well, and that I was out and awake and feeling no pain in the hip, but that I was feeling pain in my elbow. He also mentioned that I had very strong bones, which was why the surgery took longer than expected. Dr. Millis showed my mother films taken during the surgery as the bone was cut, moved and after the five screws had been inserted. The doctor showed a comparison of my pre- and post-surgery hip socket angles -- my pre-surgery angle was 90 degrees and the goal for the surgery had been to increase the angle to at least 110 degrees. The post-surgery angle was actually 114 degrees, so Dr. Millis was obviously quite pleased with that outcome.

You can see the increased coverage of the femoral head ("ball" of the joint) in the image to the left. Compare my left and right hip socket coverage and it is obvious how much more of my right femoral head is in the socket compared to the left femoral head. Obviously all my new hardware is quite visible as well.

The doctor also mentioned that he had not used all of the pints I'd autologously donated prior to surgery, since most of my blood replenishment during surgery came from the cell saver system. But he would probably be using some of my donated pints to ease my recovery in the next few days.

At 5:30pm my mother came to see me in the PACU. I was already on morphine for the elbow pain, so my hysteria had lessened slightly at this point. She fed me ice chips while I kept trying to clear my throat of the breathing tube feeling. While she was there Dr. Millis and Dr. Sankar were adjusting my CPM machine, which I would use for the next few days.

At 7:00pm, twelve hours since I'd first hit a gurney, I was wheeled into my room on the 10th floor. Luckily, I had a private room with a lovely view. I didn't spend much time enjoying the view, though, as I was exhausted -- from the surgery, the sedation, the pain, the morphine, everything. I think I was asleep by 8:00pm.

* All quotes and dialogue attributed to medical staff at Childrens' Hospital are taken from the memories of my mother and my(drugged)self, and should not be considered direct quotations or perfectly correct paraphrasing.

**This is my diagnosis, not a doctor's. But I still think it is right.

Surgery Day - Morning

2009-03-16T05:45:00.005-04:00

My surgery time is 7:30 this morning; I have to be at the hospital at 6:00am.

Yesterday my mother and I drove up to Boston; we stayed in a hotel last night. My mother will be staying there for the week. (For others having Boston surgeries, it is the Best Western Longwood, a block or two away from most of the Longwood Medical Area hospitals, including Childrens', Brigham & Women's, Beth Israel Deaconess, etc. There is a special rate for relatives of hospitalized patients.)

I did eat a smallish dinner last night. The pre-surgery eating guidelines allow you to eat up until midnight the night before the surgery, but they recommend having only a light meal. Post-midnight I can drink water until three hours before the surgery, i.e. until 4:30 this morning. Which is basically when I woke up from a night of pretty fitful sleep and could not fall back asleep. So I did get about a liter of water in me just under the wire.

I did not bring very much with me for this hospital stay -- I can't imagine I will need much that won't be provided by the hospital or available on site. (There is a CVS/pharmacy in the lobby of the hospital, and since Longwood is a neighborhood of hospitals and medical facilities, anything I could need is probably available within a 5-block radius.) My packing list included:

- glasses, contacts & solution
- my favorite sheepskin slippers
- cardigan sweater
- reading material
- laptop
- gym shorts
- pyjama pants
- bathrobe
- crutches (which I had leftover from a sports injury a couple of years ago)

Even that seems like a lot given that I'm not going to be able to get out of the bed for several days, much less change out of the hospital-issue gown I'll be in through and after surgery. The shorts/pants, bathrobe and slippers are really for later in the week when I'll be out of bed taking my first steps with the walker and then crutches.

This morning my first stop will be Pre-op Admitting to finalize my admission to the hospital (most of the admitting paperwork was done in February at my Pre-op visit). The nurse there will take my vitals, confirm that I have complied with all the appropriate medication/food/liquid restrictions required in the weeks and days before surgery, and get me changed into my surgery attire.

Next I will go up to the surgery floor, where I will meet with Dr. Millis and the anaesthesiologist. Dr. Millis will sign my hip to indicate which surgeon I belong to and which hip he is to operate on. (I suppose all patients look alike when supine with surgical bathing-caps, breathing tubes and billowing pastel gowns, so one must take more basic measures for identifying one's patients -- like writing on them with Magic Marker. You know there must be a lawsuit or two behind that rule.) Next the anaesthesiologist will start the IV, and hopefully that is the last thing I shall remember.

So now it is time to head over to the hospital. I feel tired and hungry and cold, and everything else you feel at 5:45am on a March morning. I have a bit of a headache; my right hip is at about a 1 on my pain scale. My left hip is at a zero today.

I am not nervous per se. Mostly I sense the culmination of an odd feeling I've been having all week, ticking off my "lasts" before the long period of recovery I will have ahead of me. Last tennis match, last day in the office, last subway journey, last night in my own bed in NYC, last walk with the dogs at my parents', last time driving a car (although the 3.5 hour drive up to Boston may have lessened the blow of that particular "last"). Today I will walk into that hospital feeling healthy and strong, carrying my own things, pushing through the revolving door myself, and bounding up the stairs to admitting in what will be my last "bounding" for a long while. It is quite a juxtaposition with how I'll be in half a day's time.

But my hips are built the way they are built; this surgery is a necessity. People have more complicated, emergent, painful, dangerous, experimental surgeries every day; some come out with outstanding results, some come out with complications, some don't come out at all. I have done what I could to prepare for this, I have chosen a fantastic surgeon and an excellent hospital; there is nothing more for me to do now other than trust the experts. The ball (of my hip)* is in Dr. Millis' court now.

*(Sorry, I just couldn't resist.)

Pain Scale

2009-03-12T14:14:00.000-04:00

There is, apparently, no objective pain scale to be found on the Internet. Instead there are many angry nurse blogs complaining that there is no objective pain scale. And that patients who are clearly not in agony still say "10" when asked what their pain is on a scale from 1-10.

In order to avoid confusion on this issue, below is the pain scale I will be using throughout this blog.* Maybe I will post it by my bed in the hospital so the nurses tending to me can also benefit from its clarity.

0 - No pain.

1 - Conscious of occasional discomfort in the affected area, but discomfort is tolerable and does not inhibit daily activity.

2 - More steady discomfort in the affected area, however still tolerable and not inhibiting of daily activity.

3 - Some pinching, throbbing or sharper spikes of pain in the affected area, perhaps causing a brief wince. Discomfort still tolerable but beginning to make you think about favoring that area while moving/bearing weight on it.

4 - Overall higher level of pain. Activity of the affected area limited in an effort to lessen pain. Mildly distracting but non-strenuous daily activities like talking and reading are still possible.

5 - Pain level has become distracting, causing irritability when talking, inability to concentrate on reading or other activities. You are definitely not moving/bearing weight on the affected area. Mild sporadic profanity begins.

6 - Now you are getting pretty pissed off about this pain. Where is the f'ing nurse?!

7 - Tears, gasps and desperate mewing in between sobs. Mommy evoked.

8 - Wailing and white knuckles. God(s) evoked.

9 - You begin to think you have chosen the incorrect hospital for appropriate pain management. Lawyer evoked.

10 - Someone has lit your body on fire and is now attempting to put it out by beating you with track shoes. (Flip-flopper.)

*I reserve the right to alter or amend this pain scale if it turns out that writing it while not in pain, pre-surgery, on a Friday afternoon after lunch, has led me to grossly underestimate and/or mischaracterize any or all of the aforementioned pain levels.

Last Tennis Match

2009-03-11T23:29:00.003-04:00

Five days to go.

Tonight I played my last tennis match before surgery. This time last year I was playing tennis two or three times a week, and was in the process of signing up for the three leagues I played in last summer, including one that I captained all the way to Sectional finals.

In the last couple of months I've played tennis maybe once every two weeks, with mixed results in terms of post-match pain. The decrease in my tolerance for a vigorous tennis match has definitely been one of the most saddening manifestations of my hip problems. I am hoping this surgery will bring me back to the courts as frequently and as capably as ever.

That said, of course I played some of my absolute best tennis tonight. Always good to go out on a high note.

My preparations for surgery are pretty much complete. I am on track to tie up all loose ends at work by Friday; I am on my way to being packed for what I expect to be six weeks away from my apartment in the city. I have not bought any of the equipment recommended by many other bloggers -- the grabbers or the sock donners or the bath chairs. I figure I will get (a parent to get me) what I need if I need it. I already have crutches from hurting my knee two summers ago. So my bag is mostly full of books and lounge pants.

My hip pain has been pretty minimal these last few weeks. It comes and goes, sometimes not seeming related to my activity level. During tennis yesterday I felt discomfort in the back of my right hip, or maybe in my lower back on the right side as a result of some compensation for the right hip. I also felt a sort of soreness on the outside of my hip, which is unusual. And afterwards of course the anterior labrum (basically the front of my hip, right at the crease when I lift my thigh) gave me some pain, which was to be expected.

My left hip has also piped up with a few twinges in the anterior labrum a few times this week. But none of this pain has been at all severe -- usually about 1 to 2 on a pain scale -- so it hasn't inhibited my activity more than to warn me that I should think about easing up.

Mentally I've been mostly unaffected by next week's events, other than a gradually receding paranoia that I will suddenly be felled with a cold and all my preparations and planning will be tossed out the window as my surgery is postponed for months and months. But as the days count down and I remain healthy, even that worry is fading.

Two Weeks to Go

2009-03-02T20:55:00.004-05:00

Today was my third and final autologous blood donation prior to the surgery. I was glad to see that my iron-rich diet and iron supplements had raised my hematocrit level to 13.4 for this donation. My blood pressure was low, though: 90/60. My blood pressure has been lower and lower at each blood donation. I'm not sure why, or if I should be worried about it.

In any event, today's blood donation was much better than my donation during my pre-op visit to Boston. Today I was at the New York Blood Center again and I had the same technician, Skip, as I'd had during my first autologous donation -- the guy knows what he is doing. The whole process is as quick, efficient and painless as puncturing a vein and draining a pint of blood can be, I suppose.

I have also learned my blood type as a result of these autologous donations -- I have B+, just like my mother. And my secretary, for that matter. Strange to think I have gone 29 years of my life without knowing my own blood type. Only 10% of the U.S. population has B+ so it is even better that I have three units of my own blood standing by during the surgery.

Today's autologous donation was the last preparatory appointment I had on the books prior to surgery. Now I just wait two weeks, continuing to keep as healthy as possible, and continuing with iron-rich foods and iron supplements to get my hematocrit back up in time for the surgery.

I also found out today that my insurance (Anthem Blue Cross) has authorized the surgery as "medically necessary," which is an important step in having the entire expensive procedure and inpatient costs covered. All the contact with the insurance company was handled by the hospital, so luckily I was spared much of the wrangling that some women have had with their insurance companies over this surgery. At least for the time being.

Staying Healthy

2009-02-25T21:55:00.002-05:00

Now, in last few weeks before surgery, the most important thing for me to do is remain healthy. I have heard too many horror stories of girls who have gotten a cold right before their surgery date and have had to have the whole thing postponed. Best to avoid that if at all possible.

DIET

Of course I am eating a healthy diet. Lots of fruit, vegetables and lean protein, very little sugar and starch. I have completely cut out alcohol. I am also focusing on iron-rich foods, to help my blood bounce back between autologous donations. So that means dark green leafy vegetables, red meat, beans, etc. A quick Google search can bring up a more comprehensive list. Liver anyone?

I am also taking iron supplements in addition to my usual multivitamin, omega 3 and calcium. There is a lot of information out there about what supplement to take (or avoid taking) with what food to increase absorption, but I just can't be bothered with taking it all in and regulating myself so much. So I'm just eating as healthily and ferrously as possible, taking the supplements, and hoping it all comes out in the wash. Or absorbs in the wash, as it were.

I have to mention that iron supplements will unpleasantly affect your digestive system. And I will leave it to you to look up why that is and what you can do to ameliorate some of the problem.

EXERCISE

Since my hip has significantly been increasing in pain over the past six months or so, I have been decreasing my activity level to compensate. I can no longer walk for long periods around the city (like to and from work) or play tennis at the frequency I used to. I can eke out a match here and there, but I will pay for it the next day (or even towards the end of the match).

For the most part, I am not usually in much pain on a daily basis, but that is because I have curtailed my activity level so much to avoid aggravating my hips. I don't take (and have never taken) painkillers when my hips begin to hurt -- not because I have anything against painkillers, but because I just figured the pain was a signal that I should stop. This kind of hip pain is not pain you can "work through" like having sore muscles that warm up and loosen up; this is pain that gets worse the more you do. So I figured if I mask the pain to allow myself to do more, I am just going to pay for it in the end (or cause so much damage that I would need painkillers to do even routine things in life). So basically my "painkiller" is to stop moving around until my hips stop hurting. Which has meant I don't move around much anymore.

So with that backdrop comes the challenge of getting myself into surgery shape without causing myself pain.

For cardio I have been doing the bikes (seated and stationary). Elliptical hurts my hip. I also swim, since I am lucky enough to have a pool in my building. I usually hate swimming laps, but since I got a swimming armband and earphones for my iPod, the boredom is gone!

For strength training I have been doing weights (both general circuit training and a specific focus on the crutching muscles: lats, pecs and triceps) and some Pilates mat exercises that focus on the muscles around the hip. I also do some of the hip muscle exercises in the pool after swimming my laps.

To be honest, I've only really gotten serious about this pre-surgery health-nuttery since last week -- most of the PAO women whose blogs I have read started much earlier. But I was already in decent shape, with good muscle tone from regular visits to the gym prior to this pre-surgery frenzy. So I'm not starting from zero. I'll just have to do my best for the remaining 2.5 weeks!

Pre-op Appointments

2009-02-20T10:39:00.004-05:00

Yesterday I had my pre-op appointments in Boston with the various hospital departments and Dr. Millis' team. Everything is now go-for-launch.

It was quite a full day, especially since my mother and I drove up to Boston and back to Connecticut the same day. Seven hours in the car plus five hours at the hospital minus one pint of blood equals exhaustion.

ADMITTING

First appointment of the day was with Inpatient Admitting. I met with a nurse who did (another) full history and vital signs, and discussed the surgery process with me. Not the actual surgical procedure, but the process surrounding the surgery.

On the day of the surgery I am to arrive sans jewelry, colored nail polish, tampons... basically nothing foreign on or in my body. Last meal must be 8+ hours before surgery (so basically dinner the night before). The nurse advised me that one should make sure one is not constipated coming in to the surgery because one gets more constipated from the anaesthetics. Also best not to have a big meal the night before because you will regret it when you wake up after surgery and throw up everywhere because you ate too much the night before.

After the surgery I will go to recovery and then my room. They can't promise me a private room since I am a low priority for a single room (i.e. I am not carrying an infectious disease or something of that nature) but they told me they would not put me with a child. Even though it is a children's hospital they do treat adults (obviously) and so I'll get an adolescent or an adult roommate, if I have one.

Admitting is the department I go to for check in on the morning of my surgery. Since my surgery is scheduled for 7:30am, I will get to admitting at 6am and they will make sure I have followed all the guidelines above. They will also check vital signs and blood before sending me to the surgical floor.

ANAESTHESIOLOGY

I met with a member of the anaesthesiology team, but he is not necessarily going to be my anaesthesiologist on the day. We discussed my options, which were basically general anaesthesia and a) epidural or b) PCA ("pain pump," where you administer your own pain medication by clicking a button on your IV line). I chose epidural because I'd rather have a steady flow of medicine from pre-surgery through recovery than having to pump my own medication and get "behind" on the pumping while sleeping, etc.

The epidural is inserted pre-surgery (but post administration of sedation and pain medication such that I am not really conscious of the epidural insertion). After the IV line is put in and I'm on relaxy meds, I will have to lean forward and make my back into a C, like in Pilates. That opens up the spaces between the vertebrae and makes it easier to get the epidural in. They assure me it won't hurt very much at all, but if the actors on Grey's Anatomy are anything to go by, that is a big fat lie.

Once the epidural is in, I will be put completely under with general anaesthetic, my breathing tube and urinary catheter will be inserted and the games begin.

After the surgery I will come to in the recovery area and will apparently be very thirsty and dry of mouth, due to the breathing tube having let my entire mouth/throat system dry up throughout the surgery. I will also apparently be nauseous (hence the light meal the night before).

The epidural stays in for three days, after which I will be switched to whatever oral cocktail of painkillers works best for me for the remainder of my stay. The hospital has a "pain service," as the anaesthesiologist put it, so my medication can be increased/adjusted 24 hours a day, whenever I need it.

INSURANCE

In pre-op admitting, you sign most of your necessary consent forms so you don't have to do it the day of the surgery. Consent/understanding of risks for anaesthesia and the surgery itself, naming of a proxy in case you can't make decisions on your own (gulp), acceptance of financial obligation if insurance doesn't pay for your surgery.

Insurance itself is, for now, a non-topic. My insurance (Blue Cross) has covered everything so far, and apparently the hospital's insurance department has already begun the process of getting my surgery approved and covered. They'll get in touch if they need me. So no news is good news in this department, I suppose.

BLOOD DONATION

During pre-op admitting, one is usually sent to the phlebotomist for some blood work, but because I was also doing an autologous blood donation yesterday I only had to get stuck once for both pint and vials.

On February 9th I gave my first autologous blood donation at the New York Blood Center in New York. I'd never given blood before because I always feared that my horrible, very bad, no good veins would be even worse if you tried to squeeze a pint of blood out of them. At the New York Blood Center, I was wrong. The guy found a vein somewhere in the marble blankness of my arm, got the line in with minimal pinch, and the blood came out so fast that I felt quite unwell and nearly passed out.

At Children's Hospital blood center, it was a different story. When I got to the blood center, my blood pressure was apparently 80/60, which is pretty low (standard is 120/80), and my nurse was concerned and told me to pound a bottle of water and try again. The next measurement was higher, though, and so the attempts with the needle began. The girl got a line in, but the blood was coming out SO slowly. And she had to keep moving the needle in the vein to restart the blood flow when it waned. Needless to say it was highly uncomfortable. Although the plus side of blood dripping out of me slowly is that I didn't practically pass out from the blood loss like I did in New York.

I have one more autologous donation on March 2nd in New York and then I am done. Hopefully I will get Mr. Expert again; I'll take a little syncope over a needle-wiggling drop-by-drop eternity any day.

When I donate in New York, it is shipped up to Boston. I had to donate at least one of my three pints on location in Boston, because it needed to be separated into platelets and plasma right away for concentrated injections during surgery. Shipped blood apparently cannot be separated in the proper way.

At my first blood donation, my iron was 14.6. In Boston yesterday it was 12.5, even though I'd been taking iron supplements in between the donations. Twelve is a normal reading, so I am not low, I just need to continue with the supplements and the iron-rich food through the next blood donation and up until the surgery.

PHYSICAL THERAPY

I met with the physical therapist who will be working with me during my week in the hospital, and monitoring me during my recovery. She taught me how to walk on crutches, which was not really new considering I was on them for a month just a year and a half ago for the tennis injury. I remember them all too well.

The physical therapist said I should expect to be on crutches for three months after the surgery. I have heard varying reports from other women who have gone through this surgery, so it is clear that the length of time one is on crutches (as well as every other variable in this process) is highly individual and contingent, and so difficult to predict with any useful accuracy.

I was also told I needed a special raised toilet seat, a shower chair and a wheel chair. Honestly, I can't see myself ever using the wheel chair, since my parents' house and environs are not very conducive to wheeling rather than crutching. I am most likely not going to have a CPM (continuous passive motion) machine unless there is work done on my femoral head. I will do a more complete list of "things I need" in another entry.

SURGICAL TEAM

Last but most importantly, I met with the surgical team, which is to say Dr. Millis, Dr. Prashant (who I'd not met before but I assume will be scrubbing in) and Erin Dawicki.

We went over the whole morning-of-surgery procedure that I'd discussed with admitting and anaesthesiology earlier in the day. Dr. Millis explained that depending on how it all looked in there when he opened me up, he might need to fix any tear there might be in my labrum or do some shaping on my femoral head if it is needed to help the (newly aligned) joint fit together properly.

Dr. Millis also discussed my left hip. It seems we are going to have to do the left as soon as possible after the right. I recently had some significant pain in the left hip (only) during a walk, which was unusual because it is usually my right hip that hurts first, most, or at all. And when I was on crutches a year and a half ago, my left leg was my "good" leg and took most of my body weight for a month, resulting in severe pain. I am quite certain that as soon as I start crutching around after my right hip PAO, my left hip is going to start complaining loudly. But we shall cross that bridge when we come to it.

Pre-Op Scheduling

2009-01-22T00:36:00.008-05:00

Now that I have a surgery date, I have had to schedule all my pre-operative appointments. Before surgery I need a complete physical with blood panel, kidney function and liver function tests; autologous blood donations (giving my own blood for use during/after my surgery); and pre-operative appointments at the hospital.

The challenge is not only in coordinating schedules, but in planning dates that allow for proper hemoglobin replacement between blood draws and prior to surgery. My first blood donation cannot be earlier than six weeks before the surgery (February 2) and my last donation cannot be later than two weeks before the surgery (March 2). Moreover, one must allow seven to ten days between blood donations to allow the body to replace the missing pint of blood each time.

Two of my blood donations will be in New York at the New York Blood Center, which will ship my blood up to Boston. One of my donations must be on-site in Boston, as they need a very fresh on-site sample to separate into plasma and platelets for concentrated infusions during surgery. A shot of platelets in various areas can boost clotting during a bloody surgery (which any surgery involving bone-sawing necessarily is).

The schedule I have finalized is as follows:

February 3, 2009 -- Complete physical, including blood/liver/kidney levels, just to check everything and know my baselines. I'm getting this from a regular internist here in Manhattan and having the records sent up to Dr. Millis' office.

February 9, 2009 -- First autologous blood donation, at the New York Blood Center. After this appointment I am to ensure my diet has iron-rich foods and am to take iron supplements for five days.

February 19, 2009 -- Pre-operative appointments at Children's Hospital. During this full day in Boston I will meet with Dr. Millis, the anaesthesiology team, and admitting. I will also have my second autologous blood donation while I am there.

March 2, 2009 -- My third autologous donation, at the New York Blood Center, with the blood subsequently shipped up to Boston.

March 16, 2009 -- Surgery date.

Meanwhile, I have a more general goal of getting myself as strong and healthy as possible prior to the surgery. I have read that other women have experienced faster recoveries when they have gone into the surgery strong and fit. I also must try to eat a nutritious, iron-rich diet during this period of blood donations, as well as keep myself generally free of colds and other sickness. If one is sick one cannot donate blood; if one is sick in the days approaching surgery, the surgery will be postponed.

I've arranged my absence with work. I plan to be completely off the grid for two weeks after the surgery: one week in the hospital in Boston and one week sleeping and healing at my parents' house in Connecticut. During the third week (week of April 6), I plan to begin working remotely from Connecticut, although start day and hours per day are going to be contingent on how my recovery is progressing at that point.

I plan to stay in Connecticut for at least five weeks after returning from Boston, so I can have the help and supervision I would not have if I returned alone to my apartment in the city. Manhattan is NOT a friendly place for people on crutches, so ideally I would like to be almost off them before I leave Connecticut. Right now I anticipate physically returning to the office the week of April 27, but again that is contingent on my recovery speed.

Meeting Dr. Millis

2009-01-08T18:35:00.000-05:00

Today my mother and I drove up to Boston to meet Dr. Millis and discuss my potential surgery. I say "potential" because it still was not guaranteed that I was an appropriate candidate for the PAO surgery, much less that I would have the renowned Dr. Millis as my surgeon. If Dr. Millis felt I was not a good candidate for a PAO, or if he opted not to take me as a patient, I would have been frustratingly back at square one. So my biggest concern heading into this appointment was getting everything nailed down, and most importantly, getting a surgery date inked into the calendar.

Prior to meeting Dr. Millis, I had to get additional X-ray and MRI imaging at the Children's Hospital's Waltham facility. I must admit that getting procedures done at a children's hospital is really kind of wonderful. For example, there is fun, whimsical decor in the waiting room, including fish tanks! I remember fish tanks in my pediatrician's waiting room when I was six years old. Nothing bad can happen to you in a place with fish tanks, right?

Additionally, the staff at children's hospitals are cheerful, patient and comforting. My X-ray tech was joking around, making sure I was comfortable and breathing, etc. I'm not particularly scared of X-rays but there is something to be said for treating sick and hurting adults like they are frightened children. Maybe all our hospitals should be like children's hospitals.

At the very least hospitals should always have a fun dragonfly mobile above the table when they try to inject contrast medium into you for your MRI. It was at least somewhat soothing to glare at the swaying, cartoonish insects, clenching my teeth as two nurses tried their hands at finding and piercing a vein in my superhero body. Apparently I have such good elasticity in my veins that they flatten out or roll away at the sight of a needle. Elastigirl indeed. Finally after five excruciating tries they got the contrast medium injected and so into the clanging doughnut I went.

After my Innerspace photo shoot at Waltham, we headed over to Boston to meet Dr. Millis at the Children's Hospital's main campus in Boston. While waiting for the doctor, I filled out a couple of questionnaires about my hip pain. It was a bit tough to know how to answer the questions since I wasn't in a lot of pain today. I am not usually in a lot of pain, but mostly that is because I limit my activities so much and stay off my feet if I begin to have any pain. This has especially been the case in the last six months or so, when my pain threshold has dropped such that I have had to carefully mete out my hip usage to keep myself pain-free most of the time.

My mother was concerned I was downplaying my pain but I really was not. I know the threat of severe pain is always there but I try to keep myself out of pain by preventing it rather than treating it once it has started. So for me the real pain is in how limited my physical activity has become in my efforts to avoid aggravating my hips.

That is not to say I have not had severe hip pain in the last couple of months: there are several times I remember being almost unable to walk and gasping in pain when I'd "overdone it". I put that term in quotes because overdoing it in my current state is doing activities that normally would be completely manageable for someone without my hip condition. Things like a tennis match or a long walk of a few miles. A healthy 29-year-old should not be felled by an afternoon at the museum.

I was still filling out the questionnaires when the doctor came in with his associate Dr. Brighton. Dr. Millis is an affable man with an enthusiastic air. He took a conservative approach, initially saying "if we decide this surgery is right for you" and similar flirty statements. Needless to say, this was annoying. I wanted him to say "OK, you need this surgery, and I'm doing it for you. Now let's talk logistics." But I guess he wanted to ease into it. Or maybe most new potential patients are not as decided, determined and dispassionate as I am about this whole thing. I've accepted the diagnosis and the need for the surgeries. Now I just want to get them over with. Right, recover; left, recover; done.

I truly think Dr. Millis had decided I was a good PAO candidate and that he was going to take me as a patient before he entered the room today, maybe even before I got to Boston and had the second set of images taken. I don't think he would have even had me come up to Boston if he hadn't, and I seriously doubt he would have spent so much time with me during the appointment if he was unsure.

The doctor watched me walk in various ways: normal, on tip toe, on my heels. He did some range of motion tests on both hips. I have no gait problems and have very good range of motion in both hips. We looked at the images from Waltham and the images I'd taken in October at HSS. The doctor drew the various angles on the X-rays to show where my socket edge was and where a normal socket edge should be. In the false profile view, it was even clearer that my sockets were far too shallow on both hips.

In the images, there doesn't seem to be that big a difference between my left and right hips, so it is a bit odd that the right usually hurts so much more. When I was off my right leg last summer, on crutches for a right knee injury, my left leg took all the weight and hurt more than it ever had before. So it is clear that my left leg has the same capacity for pain as the right. I guess the right is just quicker to pain because of the chronic labral tear and so I end up getting off my feet before the left hip even starts to hurt.

Dr. Millis confirmed that I am going to have to have the left hip done pretty soon after the right PAO. It will depend on the healing rate for the right hip, but it could be as soon as three months after the first surgery. That is faster than I expected, but honestly, the more I can compress this disability and recovery period, the better it is.

"Can we talk dates?" I asked, finally. Dr. Millis got his scheduling coordinator on the phone and offered me February 9. One month away! That was a bit too soon, even for me; I need to coordinate with work and other commitments. I took the next available slot, which was March 16. So there it is. Right hip PAO in two months. Giddy up!

Consult Scheduled

2008-10-31T20:36:00.000-04:00

Sharelle Davis from Dr. Millis' office called me on Thursday morning to let me know that Dr. Millis had reviewed my file, and to schedule my first consultation appointment with the doctor.

When I had first begun talking to Sharelle last week, collecting my records and films for Dr. Millis' review, the doctor still had consultation appointments open in December; by now his first available appointment was in January. Dr. Millis sees new patients on Thursdays only, and with Thanksgiving, Christmas and New Year's Day all falling on Thursdays, the holiday season is not a scheduling cornucopia.

As an alternative, Sharelle offered to put me on Dr. Young-Jo Kim's track. Dr. Kim is on Dr. Millis' team and has worked with Dr. Millis for quite some time. The advantage is that Dr. Kim's schedule is lighter -- I'd be able to get a consult with him in early December. But if I chose Dr. Kim for the early consult, I was also choosing him as my surgeon -- one can't switch between the two.

It seems from his bio, resume and publications that Dr. Kim is younger and less-reknowned but by no means incompetently skilled at PAO surgery. That said, this was a choice I didn't really know how to make. How to choose between the doctor referred to you specifically by name as the "best" or his similarly qualified, yet unrecommended, understudy?

I called Dr. Su's office to ask for help with the decision. What had Dr. Su heard about Dr. Kim? Would he recommend him as an alternative to Dr. Millis? Dr. Su never got back to me with any answers, which I found disappointing. He might get back to me next week, I suppose, but I did not want to stall on the scheduling. I wanted to secure an appointment and have something concrete in the calendar right away.

I surveyed the message board about Dr. Kim and found no negative comments and one first-hand comment: a woman who has a surgery scheduled with him in the spring and who found him to be knowledgeable with a good bedside manner. In the absence of an answer and affirmative recommendation from Dr. Su, however, it seemed prudent to go with the doctor he had initially recommended by name. After all, Dr. Su hadn't recommended Dr. Millis' "team" or "program," he'd recommended Dr. Millis himself.

I took Dr. Millis' earliest available consult appointment, January 8, 2009. The appointment consists of an MRI at the hospital's Waltham facility in the morning, followed by a 12:30 appointment with the doctor at his Boston office. Sharelle could not estimate my surgery date based on the consult; she said it was something the doctor would discuss with me at the consult.

While I am glad to have an appointment in the books, the sluggishness of this process is very frustrating. Ideally I would have been having the actual surgery in early January. But I suppose I have unrealistic expectations for a busy, reknowned doctor and a major surgery. And I could always have gone with Dr. Kim if it was so important to me to race through this.

To her credit, Sharelle has been very kind, patient and responsive with me despite my many questions and phone calls. I have tried not to be an annoying patient (as I have had enough annoying clients myself to know how it is on Sharelle's end of the phone) but my impatience is difficult to suppress.

A woman on the message board told me that Dr. Millis' surgery lead time is typically three to five months from the consult. Since I am under 35 years old, I can have my surgery at Children's Hospital where the doctor has more operating room time available, so that should help. Even if we assume best-case scenario, I won't have anything earlier than a March surgery date for the right hip.

I suppose all this speculation is silly, though. There's nothing I can do now except carry on until January, doing what I can when the pain is minimal, taking it easy when the pain is worse, and enjoying the holidays until the dawn of 2009, the Year of the Hips.

Ready for Review

2008-10-27T16:55:00.008-04:00

As of today all my imaging and office records from my visits with Dr. Su and the HSS Radiology lab are collected at Dr. Millis' office and ready for his review. Dr. Millis reviews potential new patients on Wednesday afternoons. So now I just have to sit around and wait for Dr. Millis' office to call me so we can begin scheduling my consult and hopefully my first surgery.

Meanwhile, my right hip is hurting a moderate amount. I stayed off it most of the weekend, but last night I played three hours of tennis. Perhaps that was a decision made with questionable judgement. Both my hips felt exhausted by the last half hour of play -- I could actually feel the exhaustion in the muscles in and around my hips, most likely because the muscles and soft tissue structures are pretty much all that hold my hips in place. The pain didn't really begin until today.

Today I can really feel the pain in the front of my right hip, where the labrum tear is. I've tried to limit my walking today and save all my hip use for tennis tonight. I probably shouldn't play, I know. But I have cancelled tennis for Wednesday so at least my hips will get a few days rest after tonight.

I honestly am not sure what I should be doing about my hip nowadays. Am I supposed to stay off it as much as possible? Or am I free to do my normal activities until surgery? I definitely don't want to cause damage that will jeopardize my surgery prospects, but I'd like to stay as active as possible if I may. I am going to start swimming for more low-impact cardio exercise, and keep up the weight training as well.

More when I hear from Dr. Millis' office later this week.

Feelings

2008-10-23T14:27:00.009-04:00

So far I have only written about the chronology and science of this new circumstance. Along the way, my feelings about the diagnosis and surgeries have run from astonishment to acceptance, denial to determination.

When I first got my diagnosis, I was completely taken aback. As I mentioned in my first post, I had expected to be told to take painkillers, or do some stretches. I did not expect to be told I'd need one surgery, let alone two. When I left Dr. Su's office that day (a perfectly normal Tuesday, which seems to be when all shocking and bad things happen), I was distraught. It seemed my entire life would be taken away: days in the hospital, weeks barely mobile, months on crutches, half a year before I could play tennis again.

In the days between my diagnosis and my MRI, I researched my condition and the surgery. I read several blogs written by young women uncannily like myself, struck almost as if on cue, in their late twenties. It is because of those blogs that I began this blog -- in an effort to add to to the well of personal experience with PAOs, for current and future dysplasia sufferers.

Now my feelings have shifted from panic, self-pity and denial to resignation and motivation. I am convinced I need the PAO surgery in both hips and I am actively trying to move the process along to get started as soon as possible for the right hip. After 15 years of pain, it is time to get this fixed, hopefully once (ok, twice) and for all.

Artwork courtesy of and (c) Olle Söderström.

Bones and Cartilage

2008-10-23T06:39:00.003-04:00

The xrays I took in July 2008 (right) show the faulty structure of my hips. Notice how the hip socket does not cup the femoral head on either side of body -- the sockets are shallow and thus all the upward, weight-bearing force of my femur slams right into the very edges of my hip sockets. You can see that the space there is much narrower than the space between the ball and socket in the rest of the joint. That is because I have spent 29 years pounding away at the cushioning of my hip joint in that one spot.

Dr. Su noted that my right hip is worse than my left, and therefore would need surgery before my left hip. One can see from the xray that more of my left femoral head ("ball" of hip) is inside the socket than my right. (In the xray, my right hip is on the left side of the film, as if you were looking at me standing in front of you.)

The next step was to ensure that I had enough cartilage left in my right hip to perform a successful PAO. If I'd worn away too much cartilage, even a PAO wouldn't necessarily keep me from having to have a total hip replacement relatively soon. Damaged cartilage has a limited ability to repair itself, and is very slow to repair. For this reason, humans suffer arthritis from a lifetime of wearing down the cartilage in their joints; if cartilage could quickly and effectively repair itself, arthritis would not be so prevalent. If I didn't have enough left to cushion the joint even after it had been reconstructed into the correct alignment, the PAO would not be an appropriate surgery. It would be too late.

Ideally, a dysplastic (dysplasia-afflicted) patient has a PAO -- reconstructing the natural joint -- rather than a hip replacement -- replacing the natural joint with a prosthetic joint. It is preferable to keep the natural joint since the body has the ability to dynamically maintain the health and function of the natural joint throughout life, whereas a prosthetic joint will wear out like any mechanical device and need to be replaced. A natural human joint generates less friction than even the most perfect ball bearing; in other words, we have never invented an equal substitute for a natural joint. Cartilage has not even been recreated in a lab yet, not via stem cells nor via synthetic materials. A prosthetic hip can only be expected to last 10 to 15 years in someone with my age and activity level, meaning the prosthetic would have to be surgically replaced one or more times over my lifetime. Clearly, one PAO in each hip now is preferable to several hip replacement surgeries for each hip over my lifetime.

On October 17, I had an MRI focusing on my right hip. An MRI is much more effective at showing the soft tissue of the body, and therefore could show the amount and state of my cartilage, as well as the other soft tissues in and around my joint, such as ligaments, tendons and musculature. It is worth reading the description of the MRI linked above -- I never really knew how the technology worked or why the machine had to make all that clunking throughout the procedure.

The MRI experience itself was not terribly scary if you don't mind napping in a farrier's shed. The scan took about an hour, with no physical effects other than an odd tingling from time to time. The lab had special MRI-compatible headphones so I could listen to the music of my choice during the scan. The clunking managed to drown out The Doors from time to time, but having music was better than listening to my thoughts.

On October 21, I went to Dr. Su's office for the MRI results. I was pretty worried that I might not have enough cartilage and would not be able to have the PAO in the right hip, but would instead have to have a replacement. As I discussed above, that was not the preferred option. My anxiety was fueled by the fact that my right hip had been hurting almost constantly since my xray-follow-up appointment earlier in the month -- it certainly didn't feel like there was enough cartilage in there!

Thankfully, there was. Dr. Su said I had a good amount of cartilage, but that it was beginning to "fibrillate," meaning soften and weaken, the early stages of arthritis. This just underscored the need to have the surgery as soon as possible.

My MRI report also explained why I felt so much pain in the front of my hip socket. There is a ring of cartilage called the acetabluar labrum that surrounds the lip of the hip socket, like an o-ring. Its function is to deepen the hip socket, keeping the head of the femur from popping out of the socket. Given my shallow hip sockets, it makes sense that my labrum was being put under intense strain holding my hip joints together.

The MRI report read: "The anterior [front of the body] labrum is chronically torn and degenerated, appearing hyperplastic [enlarged, stretched] and generating ganglion cysts [fluid-filled cysts caused by repetitive wear on the joint] that dissect outside the confines of the fibrocartilage, deep [into] the iliopsoas muscle-tendon junction." This means the cysts are intruding into the muscle-tendon junction of my iliopsoas, a muscle triad that are the strongest of the hip flexor muscles. This is causing "mild insertional iliopsoas tendinosis without tear," meaning degeneration without inflammation but damage to the tendon on a cellular level.

In short: ouch.

Once upon a time...

2008-10-22T17:50:00.002-04:00

...I walked into a doctor's office expecting "take two asprin and call me in the morning" and walked out needing two surgeries instead.

But I guess this all really begins in high school, when I vaguely remember my hips hurting from time to time and eventually going to our local orthopedist. He told me I had "growth bursitis," but I don't recall what he suggested I do about it. He certainly did not suggest I had defective hip construction.

On and off during the fifteen years since that visit to Dr. Suburbs, my hips continued to hurt, sometimes badly, sometimes not at all. I don't recall it being one hip more than the other. I didn't mention the pain to many people along the way, partly because it was transient and so seemed less chronic in my mind, and partly because it was so chronic that I was used to dealing with it.

The pain is best described as feeling like a blister on the inside front of my hip socket; when my femoral head (the "ball" of the ball-and-socket hip joint) hit the "blister" in a certain way, there was a sharp pain. Sometimes it was enough to make me gasp; sometimes the pain shot down the front of my thigh. Sometimes my hips would ache when I was still, too, and I would feel the shadow ache down my thigh during the worst times.

The pain was exacerbated by certain types of exercise, mainly walking. I walked a lot -- around college campus, around my neighborhood when I lived in Los Angeles, almost everywhere once I moved to New York. If I did too much, the blister was irritated and then I had to stay off it for a while until the blister subsided. So that is how I played it.

I never took anything for the pain; if my hip hurt, I stayed off it until it felt better. In retrospect, I think this may have been wise.

In July 2007 I was seeing an orthopedist who specialized in sports injuries for an tennis-related knee injury, and I had him look at my hips while he was at it. "Mild to moderate trochanteric bursitis," Dr. Sports said, and offered me a cortisone shot. Beyond the fact that sticking an enormous needle into my hip to administer the shot sounded shudderingly awful, the treatment of just numbing the pain seemed short-sighted. There must be a reason my hips hurt, I thought. If I just numb the pain, won't I hurt myself more just pounding painlessly on a subdued injury? So I just carried on as usual.

In July 2008, my mother convinced me to visit Dr. Edwin Su at the Hospital for Special Surgery ("HSS") here in New York City. Dr. Su had done my mother's hip resurfacing earlier in the year and was "the best," she said, so I should really have him take a look. At the time, my hips were not hurting very much and I kind of blew it off. I went to Dr. Su's office to take the x-rays in July but didn't wait around to look at them with him. I figured he wasn't going to tell me anything different from what the other orthopedists had said.

Finally in October 2008, I went to see Dr. Su to view the xrays I'd taken in July. The only reason I was spurred to action was that my firm's New York office was moving downtown and I would no longer be close to HSS, which is on the Upper East Side. I figured I might as well get the follow-up appointment over with while I was still close enough to make it a short trip from the office to the hospital. If not for the office move, who knows how long I would have put off the follow-up visit?

Dr. Su took one look at my xrays and told me I had bilateral hip dysplasia. You may have heard of hip dysplasia in dogs, but it is basically the same thing for people -- hip socket is too shallow, putting strain on the joint and grinding away cartilage at the edge of the hip socket. I won't explain too much more; click the link if you want more details. The link above explains dysplasia as well as the surgery I need to have on both hips.

The surgery is called Periacetabular Osteotomy ("PAO") and essential involes chopping apart my hip and putting it back together in the appropriate postion, securing it with screws, and letting the bone fuse together in the new alignment. Pleasant thought, isn't it? And I have to have the surgery twice; right hip first, then the left within a year after the right, most likely.

In this blog I will detail my path from diagnosis through recovery. In researching this surgery I found several women who wrote blogs about their PAO experiences and I found the information and personal stories helpful in preparing myself mentally for this serious, and surprising, diagnosis and the surgeries it requires. I hope my story can be similarly enlightening, heartening, and informative for others.