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.

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.

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.

LPAO Scheduling

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

The schedule I have finalized is as follows:

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

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

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

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

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

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

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

Recovery Day 4 -- Exit Wounds

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

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

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

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

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

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

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

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

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

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

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

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

Two Weeks to Go

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

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

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

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

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

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.

Pre-Op Scheduling

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

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

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

The schedule I have finalized is as follows:

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

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

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

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

March 16, 2009 -- Surgery date.

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

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

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