Two Weeks Post-Surgery: Pain & Medication

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

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

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

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

My current pain medication regimen is:

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

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

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

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

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

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

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

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

Staying Healthy

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

DIET

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

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

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

EXERCISE

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

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

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

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

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

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

Feelings

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


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

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

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

Artwork courtesy of and (c) Olle Söderström.