Tag Archives: PAO

Joy

It’s been seasons since I last posted.  The simple fact that I can say that would have made 2013 Me really happy.  2013 Me couldn’t even imagine getting to where I am today.  I haven’t written because I haven’t need to.  I don’t think about my hips all the time anymore.  Most of the time I don’t think about them at all.  They no longer rule my life, activities, thoughts and I am no longer in chronic pain.  I guess what I’m saying is that, cross my fingers and knock on wood, I’m better!

Sure, better is relative.  I am so much better than I was a year ago when I was being primed for the possibility of a hip replacement because of the persistent and exhausting pain.  I am better than I was after each of my four surgeries.  I can sit cross-legged on the floor and I am back to flying trapeze, aerial silks, the gym – everything but running (but I think I’ll get there). No – I’m not better than I was before all of this started. I do still have some pain, mostly aches if I sit too long or push myself too hard but at this point, who cares?  I sure as hell don’t.

I saw my surgeon Dr. Sink at HSS today for what was basically my 2 year follow-up from my PAO and my almost 2 year follow-up from my SDD.  EL with crests 3.5.15

To my surprise I was told that I don’t need to come back for three years, and then only if I want to.  We agreed that I’ll probably need a hip replacement (or two) sometime down the line but for now, I’m A-OK.  In fact, my x-ray weirdly looks like I never had a single surgery.  It took me twice as long as to heal as normal so yea, it was crazy how long it took – like molasses on a 10 degree incline slow – but I am pretty much there. I also know that Dr. Sink and everyone at HSS will be there if my hips falter, my stand-by support system.

IMG_2801

So as of now, the blog part of this site, as it is, is on indefinite hiatus. I’ve decided that I am going to maintain and improve the site so that people who are searching for information have a resource.  I still get between 50-100 hits a day, so clearly there are people out there who are looking for information and I’d like to help them.

For most of you it’s “until we meet again.” Thank you all, for the kindness you have shown me.  I was not alone through this – you were with me, reading along, and I am genuinely grateful.

 

Summer 2014

Holy macaroni has a been a while! 6 months since my last post is inexcusable so I have made a commitment that even if I do not have an impending surgery scheduled, that I will update my blog at least once per season. And this, dear readers, is summer.

Since I last posted, I completed the “plan of attack” I mentioned in my previous post — a combination of 2/week pilates, 1/week physical therapy, daily anti-inflammatories, and monthly meetings with my surgeon.  I still need to lose weight (for health reasons) but am hopeful that the regimented schedule required by part-time law school in the fall will help that along.

I am happy to say that my right hip, the PAO side, is doing really well.  In general, I have no pain unless I walk for a really long time and even then, the pain is mild (though I have to acknowledge that I haven’t pushed my hips beyond basic activities like walking).  Dr. Sink has been very happy with this recovery as well, although he did acknowledge that my recovery from the PAO was about 200% of the average.  I am the turtle of recovery but dammit, I think I pretty crossed the finish line.

The left hip continues to strengthen but unfortunately, the pain caused by activity – specifically any significant distance walking – has steadily increased.  As a result, my left hip is out of line and thus in pain.  Often, after sitting for a period of time, my left hip will ache just from standing up and I limp around for a while like a Weeble-Wobble.  I avoid stairs as much as possible because they cause the greatest pain.  On top of it all, I have maxed out of PT sessions because apparently I am ‘all better.’  All of that said, Dr. Sink and I agree that it seems possible that it will continue to improve, if slowly, so I am going to wait a bit longer see him around Christmas to discuss next steps and to have new MRI and X-Rays taken.  Based on my symptoms and the pain level, my guess is that I will have a total hip replacement within the next 9-15 months.

All of that said, I start back at my last semester in of law school in 2 weeks, followed by the Bar in late February, and then I’m DONE!  While it is unlikely I will ever run again, I’ve wrapped my head around that fact.  However, I continue to take pilates, bowl, golf, ride my bike (on occasion) and even take weekly trapeze classes — strangely, trapeze doesn’t bother my hips a stitch —  and here is video proof from my trapeze show on August 8th.    Onwards to Fall!

Dramatic Improvements

Just under 3 weeks post screw removal and I did something today that I had honestly believed I’d likely never do again. I ran!

I decided to try to go for a walk to see how my hips are really doing by testing them out. I’ll admit that and it was rough at first – the bursitis in both hips (especially in my left) is definitely still there and both psoas were a little crabby – but felt a little better after a while (or maybe I was just numb – it was pretty cold outside). So after I’d been out about 20 minutes and was feeling a little cocky, I figured what the heck and just jogged/ran a block. It didn’t hurt any more or less than walking and felt so incredibly freeing that it was like I was dreaming. I proceeded to walk/run for the next 40 minutes, mostly walking but taking breaks to jog a block or two. I smiled the entire way.

I’m gonna ask my physical therapist if there is any reason I really shouldn’t run a bit but I think that as long as I’m careful and take time to strengthen and stretch they’ll be on board. I was never a very good or fast runner but I really loved it. I am so happy to imagine that it could someday be a real part of my life again!

Oh, and I had my 2 week post-op last Monday and all went well. Dr. S. was really happy with my progress and pleasantly surprised that I wasn’t using any sort of walking aid, either a cane or crutch. My scars are healing quickly and I’m not due for another follow-up until April. I got my operative report which did note that they’d had to repair my bursa when they removed the screws and that I’d had a lot of bursitis in my left hip, a fact that came as no surprise to me based on my previous levels of discomfort. I am meeting with PT before that so they can give me guidance on what I should focus on.

Onward and upward!

Sleepy Saturday

It’s been 4 days since bilateral hardware removal and today I was finally allowed to remove my bandages and take a proper shower. I saw the new incisions on each hip for the first time and truthfully, they’re not as bad as I’d anticipated. At about 4″ long, they’re each approximately half the length of the incisions from the original surgeries. They are healing nicely (although they look a little gory with dried blood and steri-strips) – I decided not to post pictures of them until they look a little bit better (you’re welcome). I can’t yet tell if surgery fixed my remaining issues – it’s just too soon to tell. I probably won’t know for certain until the inflammation goes down which might take a while. That said, I am cautiously optimistic.

Earlier today I made the exact same mistake I’ve made after pretty much every surgery – I acted like I had not just had surgery and tried to do a couple things around the house. I paid for it with a serious bout of nausea and exhaustion. I know this was a “minor” surgery but it still involved somebody cutting into me and my body feels the need to remind me of that fact. In general I’m worn out most of the time and get so sleepy that I can doze off at the drop of a hat. I’m sure it’ll take me several weeks or even a month or two to really get back to feeling normal.

I’ve started to pull back on my pain meds since the pain has lightened a bit. I haven’t had leg cramps in the last day (a huge relief) and the itchiness has gone now that I’m off the Percs (a definite downside to opiate medication). That said, I wouldn’t be surprised if I have to kick them up for a period of time since recovery is all ups and downs.

I’m hoping to try some PT exercises at home once I feel up to it, starting with mild things like bridges, clamshells, squats and the like. My next appointment with my surgeon is January 13 when he will clip the ends of the dissolvable sutures and will likely discuss formal PT and steps moving forward. For now, I’m falling asleep. Goodnight and sweet dreams.

(Mostly) Hardware Free 2014

Happy New Year! I hope everyone had a fantastic time celebrating the end of 2013/start of 2014.  I spent last evening at home, recovering from yesterday’s removal of 7 of the 8 screws that were installed during my PAO and Open surgeries. Here’s a (rather long) recap of how surgery went and how recovery has gone so far.

Before surgery...

Excited pre-op

Surgery was initially expected to take about an hour and a half; it ended up taking closer to two and a half hours. Anesthesia consisted of a spinal and sedation. Dr. S started by removing the 3 screws from the left side which had bursitis that he had to clean-up and then removed 4 of the 5 screws from my right side (1 of the screws was positioned too deep to be easily removed).

I woke up in the PACU in a lot of pain in my left side, a burning ache from my left hip down my left side into my knee and cramping my left calf, pain at about a 7 or 8/10. The pain in my right side was not nearly as bad, about 3/10.

...after surgery

Exhausted post-op

The nurse injected liquid Motrin into my IV (which basically had no effect) and then injected Dilauded which worked right away (thank goodness). Dr. S stopped by to check on me (I only vaguely remember that he was there, I was still drugged from surgery) and talked to my husband about how the procedure went. The nurses in pre-op and the PACU were very warm and helpful (another great experience at HSS).

I was in the PACU for 2-3 hours, had 1/2 a cheese sandwich and some ginger ale, and my first dose of Percocet. I got to the point where I felt ok enough (pain at about a 4/10) that I managed to dress myself and was released last evening.

The evening was uneventful and I faithfully took my Percocet every 4 hours, even through the night which was restless and insomnia filled. Unfortunately, this morning I made the mistake I tend to make the day after surgery – I felt so OK, pain wise, that I thought I could wait 5-6 hours to take my pain meds. Bad, bad idea. The pain in my left side, which had been at a steady 3 or 4 out of 10, spiked to 8/10, and I was suddenly in tears. Just then a nurse from HSS called to check-in with me (perfect timing) and reminded me that I MUST take my pain pills every 4 hours on the dot. So I’m on it, the pain’s down to about a 5 or 6/10, and we’ll see how the next few hours go.

Right hip

Screw removal -- Right hip (gauzed) (2)Here are some photos of the surgical coverings (and a peek at a few of my tattoos).  My left hip is on the left side, my right hip on the right.  I can’t take off the gauze or take a shower until Friday so I won’t know how long the incisions are until then. Bathing in the sink until then — Yippee!

My next appointment with Dr. S is Jan 13th when the stitches will be clipped and the steri-strips replaced.  For now and the next few weeks I plan to take my pills and take it very easy.

Surgeries and Surprises

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.

6 week follow-up – NEWS!

So much to report! This is going to be fact / text heavy but I want to make sure I get thru all the details.

On Thursday, I met with Dr. Sink at HSS (full disclosure, I asked – he was cool using his last name on the blog) for my 6 week follow-up, although it had been exactly 7 weeks since my surgery. I took a cab to the appointment since I was not yet comfortable with the idea of taking the subway (and would have been exhausted since HSS is about the length of 7 avenue blocks from the subway).

When I first got there, I had 2 x-rays taken and was immediately whisked into an exam room. Dr. S’s nurse and PA came in to talk to me initially, to see how I was feeling and how recovery had been going. I was in a really good mood — in fact, I’ve been in a really good mood for most of my recovery (which likely has more to do with not being as hyper-stressed [from trying to juggle school / work / social life] than with recovering from an invasive operation). In any event, we had a good chat and they seemed pleased with how I was doing.

Dr. S. came in a few minutes later and we started talking about how my healing was going. I told him that I felt really good, that I was using the crutches when I went short distances and a wheelchair for long distances (walker when at home). He looked at the x-rays and confirmed that 1) the bone was filling in really nicely along all of the breaks, 2) that the head of my right femur is now sufficiently covered by my right acetabulum, and 3) that the angles (between the center of the head of the femur / hip) created the perfect 90% angle that he was looking for. He seemed really psyched about that and I was pleased to know that the surgery appears to have turned out really well. He also confirmed that I have 5 screws (I had only noted 4) and that I was ready to move onto physical therapy 1/2 x week x 8 weeks. More on that later.

We then started talking about my left hip, what type of surgery we would be looking at, especially since the surgery is scheduled for May 8th. As a reminder, although my right hip had dysplasia (which can only really be solved by a PAO), my left hip has acetabular retroversion, mild femoral retroversion, cam and pincer impingement, the neck of my femur (between the ball and trochanter) is too short, multiple labral tears, a hairline fracture of the acetabulum and what appears to be a hypertrophic (overdeveloped) labrum. We had always discussed an SDD for the left hip but at my last few appointments, Dr. S suggested that the left hip might need a reverse PAO so I was curious what he would say, having now reconfigured my right hip. After some discussion about the coverage of my femur (which looks good, side to side), he feels that an SDD is the best way to go. What this will mean is that the incision will be on the rear side of my left thigh, 8″-10″ long, and during the procedure Dr. S. will literally remove my femur from the socket, shave down the impingements on the femur and acetabulum, repair the labrum, break the trochanter and either move or remove a part of it, remove and reattach muscles, and I don’t know what else, but not necessarily in that order. As much of an invasive procedure the PAO was, this actually sounds worse. But strangely, I am totally not concerned.

The plan is that I will meet him in 6 weeks, after my PT, to see how I’m doing. Things may change and the surgical plan is fluid but at this point, an SDD is the plan. Dr. S was great, explaining all of the reasonings for doing this procedure and showing me the x-rays and MRI scans. I was at his office for about and hour and fifteen minutes and he was in the room talking to me and my husband for the majority of the time.

After my appointment I met with a physical therapist who gave me some initial exercises to perform at home. I was shocked to be told I could be full weight bearing on my crutches (and am permitted to use only 1 crutch or a cane when at home). Some of my exercises require that I stand on only one leg – the operated leg – and I was really surprised that I was able to do all of it with no pain (although my muscles are way weak). I’ll start PT in Brooklyn next week.

Finally and un-hip related, I went and had a CT scan of my sinuses / maxillofacial bones to see if there is any reason I am permanently congested / have terrible allergies in spite of allergy shots + major pills. My ENT thinks it might have more to do with the fact that I have a very small nose and that the sinuses are so small that there’s simply no space to move around. There has been suggestion of sinus surgery to see if there is some space to be opened up. I seriously need a break from surgery, not more! We’ll see what shows up those reports.

I feel like you seriously deserve a prize if you got all the way to this point in the post. I hope my honest to goodness gratitude is prize enough, but seriously, thanks so much for reading. Onward and upward (or, actually, downward since I need to do my PT exercises before bed). G’night!