Showing posts with label mood. Show all posts
Showing posts with label mood. Show all posts

Tuesday, April 13, 2010

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!

Saturday, March 27, 2010

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.

Monday, December 7, 2009

Progress Report


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.

Tuesday, December 1, 2009

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.

Friday, November 6, 2009

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?

Monday, October 5, 2009

Autodonations


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.

Thursday, September 3, 2009

Six Months Post-Op -- Tennis Again!

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!

Tuesday, May 19, 2009

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.

Wednesday, May 13, 2009

Two Months Post-Op


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.

Wednesday, May 6, 2009

Seven (and a Half) Weeks Post-Op


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.

Tuesday, April 28, 2009

Six Weeks Post-Op


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.

Tuesday, April 21, 2009

Off The Meds


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.

Wednesday, April 8, 2009

Three Weeks Post-Op


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.

Monday, March 30, 2009

Two Weeks Post-Surgery: Movement


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.

Tuesday, March 24, 2009

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.

Thursday, March 19, 2009

Recovery Day 3 - My Back is Covered in Magma


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.

Wednesday, March 18, 2009

Recovery Day 2 -- Fail Whale


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.

Monday, March 16, 2009

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.)

Wednesday, March 11, 2009

Last Tennis Match


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.