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Long Weekend

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I love nights like tonight. When it’s a little drizzly out and seems darker than it should be, and you open the window so that a bit of cool air creeps in while you’re snuggled under the blanket with the cat and the dog and a book and tea. Today is one of those days where I really don’t mind my limited mobility; in fact, were I not immobilized I might feel a little guilty. As it is I feel happily calm.

I am 16 days post-op and had my two week follow-up with my surgeon this past Tuesday.

Two-week follow-ups are less about checking angles or taking x-rays and more about making sure your pain is under control and that you are doing OK. I had all of the Steri-Strips removed from the incision, had the incision cleaned, and had a few placed back on to make sure that the stitches hold permanently. I was happy to learn that I no longer had to wear my DVT compression socks 24/7 (i peeled them off 15 feet from the office door) and could send my CPM machine back as I am mobile enough not to need it anymore (it was picked up earlier today).

This recovery has been going extremely well, my pain managed by Tylenol, and my surgeon was pleasantly surprised at how well I was doing. I mentioned that when I stopped my narcotic medication and switched to OTC meds, I had some unpleasant withdrawal symptoms including extreme irritability, insomnia, and two days of crying for seemingly no reason (must remember for future reference to avoid this medication). I explained how the pain in my left side is more of a deep muscle ache that is always noticeable but not severe or excruciating. The pain on the right side, the side in which I had the PAO surgery in December, is actually where I noticed the more striking and alarming pains. We had previously discussed, before the second surgery, that this would likely be the case . The right side still has problems though the extent is not yet clear. My doctor noted there is always a chance, unfortunately, that once one problem is fixed, another may become unmasked. For example, it’s possible that once the dysplasia in my right side was fixed with the December PAO surgery, impingement may have been unmasked and that may be causing the pain I continue to have in the right side. Similarly, it is possible that, now that the impingement on my left side has been repaired with the SDD surgery, the dysplasia related to my acetabular retroversion may become more prominent.

That said, neither my surgeon nor I are of the opinion that we need to rush to make any decisions, one way or another, on the effectiveness of either of my surgeries to date. These decisions can wait several months, until I am well into my physical therapy and have a better idea of how I’m doing.

As you can imagine, I am hopeful that I am finished with surgeries and that physical therapy will help take me to the finish line in terms of recovery. My next follow-up appointment is scheduled for mid June, at which point my surgeon will take x-rays of my left leg and hip to determine if the trochanter osteotomy he performed is healed and whether I can stop using crutches.

I’m happy to be back working remotely from my home. I like the structure it provides, requiring me to get up at a particular hour and having tasks to complete. I also really enjoy what I do and so it was almost a relief to be able to get back to it. I’ve gone out to a couple meals and to my surprise had no trouble sitting on a booth or on an un-cushioned chair. This is dramatically different than the last surgery and a welcome change. I am hopeful that I’ll be able to get back to law school in the fall, though that will depend on my recovery, any further surgeries I may need, and making sure that I have a safe balance between my work/school/recovery and personal lives. I figure I’ll know more about my Master Plan in a few months.

In the meantime, I hope you all have a lovely long Memorial Day weekend, whether you are enjoying the outdoors or snuggled under a blanket next to a cool breeze

Pain

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I am 8 days post-op and to my surprise, the severe pain that lasted weeks after my last surgery is already gone. I stopped all narcotic and prescription pain medications today and am only taking Tylenol for the more manageable pains and aches. I don’t have any idea why the pain is so much less severe this time around.

Pain is really kinda great for someone like me because it’s my protection. My natural instinct is to push until I break — either do everything or do nothing. I feel guilty if I don’t throw myself into things 110%. Throughout my hip drama, pain has been a fluctuating roadblock – a limit to my activity and energy that can literally stop me in my tracks and knock me flat on my ass. It’s not always in the same place and can change from day to minute. Pain has stopped me from doing more than I could or should have done; unlike every other barrier I try to artificially manufacture for myself, I have no control over pain. I listen to it and I abide.

This recovery, without the pain I feel rudderless. I know that my body needs to heal A LOT more before I start trying to get back to a normal routine, that I need to rest all the time because I just went through really major surgery. I should be sleeping constantly, taking large doses of meds and yes, I should hurt. But this time my body just doesn’t hurt so much. I’m missing the limit that tells me to stop, so I don’t. I can’t seem to justify a need to sit on the couch and get better, as much as I genuinely wish I could. I sleep a normal amount each night and I wheel myself most of the way to the Target (which was exhausting but didn’t hurt) and I try to tidy up around the house. In other words, I fail to take care of myself because pain isn’t there to remind me.

And so I feel agitated and sad and exhausted and crappy almost all of the things you normally feel like when you’re 8 days post major surgery. But I also feel guilty because I can’t blame the pain for preventing me from getting back to my life. I’m really struggling with this and it’s upsetting me a great deal. I expected to feel terrible – after all, someone sliced me open, broke and shaved bone, took my leg out of the socket, and on and on. I didn’t expect to feel ok (or the feelings that are going along with it).

I don’t know. It’s late and I’m tired. I have no insight or solution. And I don’t have to because this is a blog and I say so. Hey, I’m allowed to be difficult and irrational darn it – I am recovering from surgery, after all.

Flew the coop

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I was released from the hospital on Saturday at 2pm and was home in Brooklyn by 3:15. I am allowed to put up to 30% of my body weight on my left leg and the balance on my right / crutches / walker. My stay at HSS was very successful and the pain seldom reached beyond a level 3 or 4 out of 10. However, even with the strong medications I was on, the pain did occasionally spike to an 8 or 9 out of 10.

My left hip and leg muscles feel very achy and sore, while at the incision site (which is approximately 9″ long and runs down the outside of my left thigh) I occasionally feel a stabbing, burning pain. The pain is also noticeable in my gluteus muscles, as spasms in my middle and lower back, and as a slow burn around the top of my knee. Not surprisingly, I continue to have some aches and spasms in my right (previously operated on) leg as it has become responsible for carrying the majority of my weight.

To minimize the pain and to keep my hip joint moving, I use my continuous passive motion (CPM) machine for 2 hour spurts, 4 times a day (I have no idea who the woman in this picture is but it gives you reference as to what a CPM looks like).

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Sometimes when I’m not looking, my cat Fawn Adelle uses it as a cat bed.

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While in the hospital and initially at home I was taking two pills of Hydrocodone and Tylenol every four hours plus Benadryl since the Hydrocodone made my tummy, back and arms very itchy. I also take aspirin (for blood thinning to prevent deep vein thrombosis), Protonx (which help prevents acid reflux as a result of all the medications), Valium (as needed, for muscle spasms), and a variety of other pills that I was taking prior to my surgery. Although many of the medications make me very sleepy I can’t seem to fall asleep and seem like a zombie a lot of the time. I get around 7-8 hours of sleep a night. Boris has been my constant recovery companion.

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I’m happy to report that pain is definitely not as bad as it was after the PAO. I spoke to my surgeon’s office today and told the PA as much. She confirmed that although the initial recovery pains following a PAO are much harder, the length of time and long-term pain associated with a SDD recovery is far more difficult. Fantastic!

One noticeable difference between this surgery and the last is that I have definitely felt more emotional. It may be the change in medication or the fact that this is my third surgery in a short time but I have definitely been more blue. Whatever the cause I am trying to maintain my positive attitude and believe that I may have (hopefully) turned a corner today.

I finally got it together and took a shower yesterday which was a welcome change since it had been 5 days since I’d been permitted to take a shower. Today I even went so far as to shower, put on blush and curl my hair – a look I call ‘recovery chic.’ For comparison, it took me weeks to get to this point following the PAO.

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Starting today I reduced my Hydrocodone/Tylenol to 1 pill every 6 hours as I try to eventually ween myself off the meds. So far so good but I would not be disappointed if I needed to up the dosage a bit if the pain became overwhelming. I seem to be a little less fuzzy-minded but that changes minute to minute.

In general, recovering from surgery in May is a VERY different experience from recovering in December when the weather is dark and gloomy. However, like after my first surgery, my mom and husband have been incredibly helpful and I can’t thank them enough for doing basically everything for me. My first follow-up with my surgeon is scheduled for May 21st. I am hoping my wheelchair is delivered soon so I can get outside and enjoy the beautiful spring day. I hope you are all doing the same.

Heading home mañana

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Significant improvements! Since yesterday’s post I have been moved to HSS’s 10th floor, and moved again once on the 10th. The numbness in my left (operated) leg is totally gone and 90% gone from my right leg. I have gotten up and walked down the hall with a walker and then crutches – both times incredibly slowly. I am able to get myself out of bed without too much difficulty and transitioned to a regular solid food diet. Best of all? Baring any traumas I get to go home tomorrow!

Unfortunately not all my news is quite so rosy. My pain continues to be well managed; however the drugs are making it difficult for me to focus and I notice that I’m easily distracted and frustrated (it has seriously taken me about 7 hours to write this little post). My right leg has started to spasm from lack of use. Historically, at about 3 days post-op (relative to when I receive anesthesia) I normally feel pretty depressed. This surgery is no exception and today I’ve been feeling quite blue. You’d think that with everything my body has gone thru in the last few days I would be asleep all the time but instead I can barely sleep an hour at a time and am not sleeping nearly enough – only a few hours a night. Also, I have apparently developed an allergy to the adhesive in medical tape + the oxygen that they put up your nose when you have an epidural makes my nose crazy itchy. Fun!

Guy is renting a car to pick me up at HSS and I hope to be home by 2 or 3pm on Saturday. I took a photo of my wrapped incision (with a pen for size reference) but won’t get to see its full gruesome beauty until they rewrap it tomorrow morning. I’m guessing that its about 10″ long but soon i’ll know for sure. I’m gonna try to get some shuteye. Hasta mañana!

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Maybe Actually Good News!?!

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Quick update.  I had my MRI yesterday at HSS.  If you haven’t had an MRI, imagine laying on a too-narrow super firm bed, having your hips locked into place with a brace, your feet taped together, under a sheet with a light breeze blowing over you, while you slide into giant, thumping, magnetic sardine can.  Some people freak out — I’ve had so many done I literally fell asleep.

So, I got a preliminary “heads-up” from my dr’s office that there are no significant areas of concern in my right hip, that the labrum looks good, but that I have tendonosis in my abductors and iliopsoas muscle.  This may be caused by use or may be related to the fact that I previously had an arthrscopic procedure and my hip may just need extra time and TLC to bounce back.

The reason I am cheerfully optimistic is that 1) the protocol for getting over tendonosis is typically RICE (Rest. Ice. Compression. Elevation) — and once I have my surgery on my left side all I am going to be DOING is resting!, and 2) physical therapy.  Know what’s missing from that list?  Surgery!  I may be able to get away with not having another surgery on my right side!  I didn’t realize how much the fear of another surgery was getting me down until I felt the stress literally float off my body since I got the news.

Again, all of this is preliminary and I still need to meet with my Dr. on Monday to go through the full MRI results.  BUT, it looks like I will be under the knife on my LEFT side come May 8th — and maybe, just maybe, that will be it for a while.  Yea!!!

Here we go again

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Nuts. I’m anxious. I’m also 9 days away from surgery which makes sense that I would be anxious but last time, I was utterly zen. Totally calm. You’d have thought I didn’t care that I was about to be broken and put back together. Admittedly, before my last surgery I only became zen in the final 2 weeks leading up to my surgery — prior to which time I was a paniced freak. This time, though, I have totally ignored the impending surgery so I never had a chance to panic. Apparently now’s the time.

As I type, I am at HSS in the midst of my surgical pre-clearance, including a physical exam, blood work, EKG, chest x-ray, and a meeting with the hospital GP that is assigned to me for the surgery. The day started at 9am and should be done by 2pm. I’ve been through this before so unlike last time, I knew what to expect (and to bring something to read – there’s a decent amount of down time between appointments).

Most importantly, I already had my appointment with my surgeon. We briefly discussed my impending surgery (the Open SDD) but the majority of the appointment focused on my (still crabby) right hip. I still have pain in the joint and around the greater trochanter but the majority of the pinchy pain is in the area between the hip and my groin – likely caused by the psoas tendon and break in the pubis. So, I am scheduled for an MRI tomorrow, an Active Release Therapy session on my tendon on Thursday, and a follow-up with my surgeon next Monday to see if the pain is caused by a torn labrum, nonunion or seething else. My surgeon has never had to go back in to repair a torn labrum after a PAO so, lucky me, i’d be the first. As of today, we are still moving forward with the left hip but the final decision will be made next Monday – 2 days before my surgery on my left. Apparently it is gonna be a busy week.

Photos from pre-surgical screening – I like to get dressed up for my HSS appointments!

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Thrill Rides

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Spring is officially sprung and in the spirit of renewed activity, my hips have been busy little bees the last week!

As I previously noted, I had been having an increased amount of pain in my right hip (really, the space between my right hip and groin) in the last few weeks. I was able to walk short distances but longer walks and lifting my leg definitely made things worse. Climbing stairs was mildly painful and I had been using my cane everyday for support but in general, the pain never exceeded a loud grumble…until this past Tuesday.

I felt fine at lunch but as I walked up several flights of stairs and out of the subway the pain in m right hip (the hip that had the PAO surgery) became utterly excruciating, like the most awful ache with moments of stabbing pain like mini ice picks! I only had my cane with me and nearly sat down on the sidewalk since I could barely drag myself the 1 block down the street to my office. I leaned on my cane, pain shooting into my hip with every step, and dragged myself back. By the time I made it I was in tears (this is only the third time I have cried since the PAO in December). I frantically called and e-mailed Dr. Sink who was able to get me in the next day (which I was so incredibly thankful for – he fit be in between surgeries). Luckily the pain mostly went away when I sat so I either sat or reclined the rest of the day. I started using crutches again that night, for the first time in 6 weeks. I started to worry that I would never actually get better, that I would always be in pain, that my next surgery would have to be postponed indefinitely.

At my appointment the following day, they took 4 x-rays and determined I did not have an new stress fractures. They also determined that the non-union of the pubis bone had not repaired itself (although a tiny bridge of bone, maybe 1/8th the width of the break, appeared to be growing). The pain was thought to be caused by one of the tendons (the rectus femoris or iliopsoas) — either that it was aggravated or that it had become stuck in the osteotomy site (basically, that the tendon rolled into the space where the bone was supposed to have grown and got stuck there). I was prescribed anti-inflammatories + the anti-inflammatory patch I have been wearing on my hip. I was sent for an ultrasound (with contrast) and injection of lidocaine and cortisone (into the sheath of both tendons). The ultrasound showed that although the tendons were not in the break that moment, they were each sitting right on either side of the break (and the pain could have been caused by the tendons rubbing on the edge of the break or they could have been stuck for a bit of time).

The cortisone injection took several hours to kick-in but by 10pm I noticed that my hip was feeling better. The next morning it was WAY better — honestly, it hadn’t felt so good since my surgery. For the first time in months I could put on my socks without pain. And walk? Back to normal – if not better! The pain had decreased about 90% and has since settled to a decrease of about 80%. I slept a ton and took it very easy the rest of the weekend – even let my sweet husband GK push me around in a wheelchair at the auto show. I was feeling so ‘normal’ today, though, that I let myself take a short bike ride today (bike riding is one of the few activities that doesn’t hurt if you have hip problems).

I have to be evaluated by Physical Therapy at HSS before I can get back to working with my physical therapist again. I may also need another cortisone injection before or after the surgery. It’s also possible/likely I will need another surgery on the right hip to fix the torn labrum (another pain) and non-union but not until the Open SDD is healed.

Oh! And on that note – the Open SDD is set for May 8th (1 month from today). My sinuses are healing wonderfully (follow-up with ENT this Wednesday) and my BIRTHDAY (my 36th) is this Thursday, April 11! Time to start revving up — it’s gonna be a busy busy spring!

Living Life on Hold

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I am very pleased to report that sinus surgery this past Thursday seems to have been a success. At the very least, I haven’t had any significant pain or discomfort following the surgery and I was able to work from home the day after the procedure. The nasal stints are scheduled to be removed tomorrow – those puppies are BIG!  I feel sorta stuffed up and sleepy but apparently it’s normal and resolves itself within a few days. I can’t do any lifting or bending for the time being but should be 100% within a few weeks. Yea!

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I’ve been thinking more about the nonunion of my pubis bone and the pain in my hip and front of my right leg that seems not to be getting any better, even though I can walk. As  I understand, nonunion is normally asymptomatic but in my case, it may be causing the pain and may be the reason my recovery is stalling (even though I am able to walk). I learned from other ‘hip women’ that I could request copies of my x-rays from the hospital, which I did. I figured I’d post the x-ray of the nonunion so that everyone can understand what I’m talking about.  For perspective, imagine that the camera is facing me and I am turned 90 degrees to the left.  My left leg is placed facing forward, in front my body, and my right leg is turned out 90 degrees and placed back and to the right.  That’s why it looks like my pelvis is torqued.

I’ve also learned that as part of my May Open SDD surgery on my left hip (which is 6 weeks and 2 days away and which will require more recovery time than my PAO), the surgeon breaks off a small portion of the greater trochanter bone from the femur to gain access to the joint and later reattaches that section of bone at the end of the procedure with two or three screws. Sometimes (I’ve heard up to 40% of the time) the screw heads catch on muscles or tendons in the leg and the screws have to be removed in yet another surgery.

So, if you’re counting, which I am, I had a right hip scope surgery (January 2012); right PAO (December 2012); sinus surgery (March 2013); and will have Open SDD on the left side (May 2013). Add to that the possibility of a surgery to fix the nonunion of the right side AND, if I’m lucky (said sarcastically), screw removal. Between all these surgeries, there is recovery and pain and holding patterns. I know that I can’t expect to have all the answers but COME ON!!! I just want to take my life off hold and start living again! Ride my bike, take a walk, NOT watch TV like an obsessive, go back to school, lose some of the weight I have gained from sitting around all the time.  I have tripped down the rabbit hole and I would like to find a way to climb back out.

I don’t wanna be whiny but man, it’s spring, almost April, the days are getting longer and soon the weather’s gonna be nice.  Let’s get this show on the road!

Surgeries and Surprises

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First, Happy slightly belated St. Patrick’s Day! Hope you were out drinking green beer and eating corned beef and cabbage!

It’s been a little while since my last post and I have lots to report. For those who don’t want to / have time to read the full post, here are the bullet points:

1. One of the bones in my right pelvis that was broken during the PAO surgery (the pubis bone) did not grow back together. Dr has prescribed a bone stimulator / increase protein to make it grow. If it doesn’t work I may have to have ANOTHER hip surgery on my right side to bridge the gap.
2. We are a go for my Open SDD surgery on my Left Hip on May 8th (pre-op April 30th).
3. Sinus surgery is set for THIS week (Thursday, March 21st). Basically, Dr is creating a straight shot out of my sinuses / removing bone and tissue / fixing my deviated septum. Same day surgery, home Thursday evening, around a week of recovery.

THE LONG VERSION
I met my hip surgeon for my 3 month RPAO follow-up / 2 month pre- Left hip Open SDD appointment on March 15th. The appointment started with x-rays. I met with my Dr. and mentioned that although PT (physical therapy) was going well and even though I am able to walk unaided, I was concerned about a new sort of pinchy/burning feeling that I’ve been noticing in the front of my hip. It also sometimes feels like the tendon is rolling over the joint, almost like it’s catching.

During my hip evaluation, my Dr. had me sit at the end of the table and try to lift my leg up off the table (really hard to do) while he pushed down. It was excruciating and I squealed in pain, not a normal reaction at 12 weeks post surgery. The Dr. then pulled up my x-rays. The x-ray showed that one my the bones had not grown together, possibly at all. The two sections of bone appeared to be about a centimeter apart, not even touching. This is called nonunion (when the bone does not grow back together following the surgical break) or slow union. It is one of the complications that can result from PAO surgery, normally only in about 1% of cases. Oh, lucky me. Even when it does happen, is typically asymptomatic and therefore does not require further medical intervention. Unfortunately for me, it may be the reason that I’m having pain in the front of my hip and, it’s possible that the tendon is getting stuck in the break. Gruesome.

The Dr prescribed me a bone stimulator which is a machine I will have to wear every day at home and will hopefully stimulate the bone to regrow. His staff also recommended I increase my daily intake of protein and calcium as much as possible so unfortunately for the animals, my efforts toward vegetarianism are taking a break. Hopefully the bone stimulator + increase in protein works. If it doesn’t, and if I continue to have problems, I may have to have a further surgery on my right hip after my SDD surgery in May. I should know more after my next appointment. In any event, it doesn’t sound like it will prevent me from moving forward on my left hip surgery which is good.

My next appointment on April 30 is my pre-op for my Open SDD surgery scheduled for May 8. It’s so strange to think of going through all of this again when I feel like I’m not even through the first surgery but I have to just keep moving forward, partly because I don’t really have any other choice.

In other news, my sinus surgery is scheduled for this Thursday, March 21. It’s a same-day surgery so assuming that the surgery requires that I get there at 7am, I expect to be home by 3pm or 4pm. The doctor is performing a septoplasty, turbinectomy, balloon sinuplasty and I don’t even know what else. The goal is to create more space in my sinuses so that when I have allergy problems, my sinuses don’t get so inflamed that they completely block and get infected. I also started back to allergy shots, 4 shots 1-2x week.

This year is already wearing me out and it’s only March. It feels absurd to me that my hip problems have so taken over my life. I am really looking forward to getting though the next 9 months and getting back to my life (surgery free!). Until then, the saga continues.

The Nose kNows

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My immune system decided that my hips have been getting WAY too much attention in the last several months and that another body part should receive above the title billing once in a while. Apparently it was my sinuses’ time to shine, to take center stage so to speak.

For this reason, I found myself at the ENT doctor today at 8 AM, ready and raring to go for my balloon sinuplasty, a “simple” in office procedure that takes no more than an hour and with “minimal” pain or discomfort. Seasonal AllergiesThe idea was that the procedure would help alleviate my persistent sinus infections as well as calm my extraordinarily severe level of allergies for which I had taken shots weekly prior to my recent surgery (and for which I continue to take 5 different medications daily). I wanted to get it out of the way before the spring allergy season kicked into full force since I am already having frighteningly bad allergy symptoms even in the absence of all of the normal seasonal triggers. I hadn’t thought too much about the ballon sinuplasty in terms of pain – after all, I had my hip broken four times in December and bounced back pretty well so how bad could a balloon be? Also, everything I had read online indicated that it might be a bit uncomfortable but certainly not painful. So I assumed that today’s procedure would be a simple one. I should realize by now that no medical procedure in my world is ever simple.

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Some of the tools. No fun at all.

The doctor started by placing cotton balls coated with numbing agent in my nose. After my nose was sufficiently numb came the two syringes and eight+ mini shots in each nostril. it sucked but was over pretty fast. I figured that once they’d injected the anesthesia into my nose the pain would be pretty much done and anything that happened after might feel like a little bit of pressure but certainly not painful. After a few minutes of waiting for the anesthesia to take hold I was taken to another room and they started the procedure. I got as far as having the camera placed in my nose and up to the point where my sinuses began when I started to think that my head was actually going to explode.

Puppy wave
I want to be born, THROUGH YOUR FACE!!!

I have never given birth but I imagine that if I tried to give birth to a puppy through my sinuses and out my nose having a balloon sinuplasty is what it would feel like. Also, because there are sinuses near your teeth, it was like when that little puppy realized he wasn’t getting out through my nose, he was would literally have to push my teeth of my mouth and escape through the empty cavities. I literally thought I was going to cry – oh wait, I did.

Popped balloon

After the doctor removed to the scope I asked her if that was as bad as it would be and she said that she’d only gotten into my nose, that she hadn’t gotten into my sinuses yet nor inserted the balloon yet nor inflated the balloon yet. So yeah, it was going to get worse. The doctor was very kind and took her time but after two tries it was apparent that this was never going to work. I asked her and she said that only about 1 in 50 patients are unable to complete the procedure and that it’s likely that I just have hypersensitivity in my sinuses. I want to meet somebody that’s gone through this procedure and shake their hand.

So now I am stuck. My only option to get rid of this persistent and really awful sinus/allergy problem is to have a full endoscopic sinus surgery which involves general anesthesia and outpatient trip to the hospital. I have a email into my hip surgeon’s office to find out if it’s even viable to have the surgery performed before my SDD in May. I’m actually afraid of going through the spring allergy season where I’m trapped inside, recovering from my surgery and having constant allergy attacks. At this point I don’t even of its possible to do the endoscopic procedure and I am too raw, literally and figuratively at this point, to make a decision one way or the other. I figure I’ll get more information and decide in the next week.

Bravo sinuses! You really stole the show today but for now you are relegated to be an understudy and my hips the star of the show.