Recovery Day 2 -- Awakened by Pain and PT

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

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

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

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

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

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

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

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

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

Recovery Day 1 -- So Far So Good

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

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

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

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

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

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

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

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

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

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

Left Hip PAO -- The Surgery Itself

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

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

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

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

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

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

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

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

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

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

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

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

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

LPAO Pre-Op Appointments

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

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

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

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

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

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

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

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

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

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

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.

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!