Two Years Post-RPAO

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.

Eleven Hours of Tennis

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

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.

One Month Post-LPAO

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.

Two Weeks Post LPAO -- Pain & Itching

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

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!

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 2 -- Awakened by Pain and PT

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

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

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

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.

Four Months Post-Op

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.

Nine Weeks Post-Op -- Lose the Crutches!

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.

One Month Post-Op Visit

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.

Venturing Out on the Town

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.

Transitioning Hospital to Home

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 1

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

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

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.)

Pre-op Appointments

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.