Wednesday, March 27, 2013

Recovery 101

I realize now that I really didn’t give any information on my recovery at home after the surgery. I have to apologize for that. Let me go over what it was like for me after coming home from the hospital. 

The first day I came home my hubby had to fill my prescriptions…which came in a giant paper grocery bag. I had to give myself morning injections of Lovenox for blood thinning, I had pills for inflammation, I had pills for stool softening (really?), and I had pills for pain management. I also had to take calcium pills for bone health. It was ridiculous. Besides the medications, I had to have the CPM machine and the wheelchair delivered. I also had to schedule the Visiting Nurses home care company to come and assess my home and help me learn how to live in my environment with my condition.
Being home was hard. Not because it was painful (it really wasn’t very painful), but because I wasn’t able to do a freakin’ thing on my own. My discharge instructions were as follows: “Activity as tolerated: Not Allowed, Housework: Not Allowed, Strenuous Activity: Not Allowed.” To make things worse…the discharge instructions also stated that I had to keep my body at an angle less than 70 degrees at all times. This was, BY FAR, the most frustrating part of recovery. I had to sit in a recliner, in the fully reclined position, every, single, day. It was infuriating. Anytime I had to do anything, sit in a chair, get out of the chair, sit in the bathroom, anything…I had to be angled. It was the winter of perpetual slouching.
What’s worse is that even if I wanted to do something on my own…there was no way I could. My leg was so weak that I couldn’t move it on my own. I wasn’t able to get into or out of bed by myself…I couldn’t get dressed by myself…I couldn’t even put socks on by myself. It was an incredibly eye-opening, and humbling experience. My husband had to help me every second of every day when I needed something. That guy’s a champ and he deserves a medal for dealing with me. I was not the best patient at times…I’ll admit it.
The first week home was the hardest, as expected. The visiting nurses came and helped my hubby and I figure out how to do things like go up and down the stairs, get into bed, get onto the toilet, get into and out of the shower, etc. (we had to buy a shower seat, but it was totally worth the investment). The nurse (whose name was Harmoine, loved that) checked my bandage while I still had it, and my incision once Dr. S. was able to take the bandage off a week after coming home. She also took my temperature and my blood pressure when she came. I was given a series of exercises to do three times a day every day. The nurse came twice a week for the next few weeks to help me with these exercises, and to add new ones or tweak old ones. The visiting nurses were really great. It was helpful for me, as I was really lost for the first few weeks. I had to really re-learn a lot of things.
I needed 24 hour care until Dr. S. said otherwise. So, to help with my care until early December, my hubby recruited some of my wonderful family members to stay at the house and take care of me so he could make into the office a few days a week. For the first three weeks or so after surgery, I pretty much slept all the time. I was tired constantly as my body tried to recover from the trauma. Also, it would take a couple weeks for my body to completely get back to normal after the blood transfusion reaction. After the first three weeks, I really started to feel pretty good, and we got into a good routine.
I kept doing my home exercises until Dr. S. cleared me for physical therapy (PT) about 7 weeks after surgery (early December). This meant a couple things for me: Once I started PT, I no longer needed 24 hour care, and I could start weaning off the crutches at PT. I started PT twice a week in the facility, and worked out once at home on my own. That was when the frustration really began. I wanted to go from 0 mph-100 mph and had a very rude awakening when I started PT. My right leg was a mess. My thigh muscles, and some of my calf had atrophied, and the spot where Dr. S had to re-attach the rectus muscles in the thigh to the iliac crest was extremely painful. It was still healing. I lost feeling in the outside of my thigh, and during exercising it twitches and can be an uncomfortable feeling. Even my calf and my foot were really, really fatigued, I had no balance.
Slowly and surely I regained movement and flexibility in my leg. The day that I could put socks on by myself, I did a little victory dance. That was a big day for me. After starting PT, it took another two and a half weeks until I was off the crutches completely…but I resorted to using my cane for a while. It’s winter here in New England and the snow and the ice create an obstacle I wish I didn’t have. Once I finally did get off the crutches, and was back to walking “normally,” the hip itself felt really great. There’s no pain in the hip joint at all. The pain that I’m feeling during physical therapy is all thigh muscle pain and pain from where he had to detach and cut through the muscles to get to the hip joint.
I waited 12 weeks after surgery before going back to work. This brought me t0 a mid-January return date. This was doctor’s orders…but looking back I’m so glad I did what he said to do. My family and I laugh about it now because, under normal circumstances, I really can’t ever sit still. I’m almost always doing something, somewhere. So, to be a captive audience at home for 12 weeks nearly drove us all crazy. I did invest in Netflix and Hulu, though, so I watched a LOT of TV. I actually tallied up everything I did while out on leave: During my 85 day medical leave of absence I watched 9 seasons of Grey's Anatomy, 2 seasons of Lost, and 2 seasons of Dawson's Creek. I completed 5 mystery solving games on my iPad. I read five books, knit two scarves, and taught myself how to crochet. I also learned how to walk again, how to lean on people when I really need them...and how to ask for help. I pushed myself to the max, and it was entertaining, informative, exhausting, and revitalizing all at the same time. Going back to work was a huge step for me, and I was so excited.
I was walking really well by about 10 weeks into PT (mid-February). I could walk short distances without much problem, and if I had to walk long distances, I took it slow and used my cane. I certainly wasn’t winning any races. The biggest obstacle for me was the pain at the reattachment point. I had a really hard time overcoming that. I couldn’t lift my leg into a marching position, or move my leg out forward. It took me probably 3-4 weeks to be able to walk over short hurdles at PT without a lot of pain. Once I was able to walk well, I started to notice that if I walked too quickly…or too normally (read: without a limp), my hip would buckle with pain. The same pain I had prior to the surgery. This was because of the labral tears. I knew it was time to start thinking about my next surgery. So, about 18 weeks after PAO surgery, Dr. S and I scheduled my second procedure (which I covered in my previous entry).
So, here are some overall thoughts and major points to take away from the PAO surgery:
-          Prepare as much as you possibly can beforehand. Practice using the crutches, figure out where you’re going to be when recovering (upstairs, downstairs, what chair will you be in, etc.), and align people in advance to help you.
-          Get the handicap plate. I am a stubborn person and if you’re like me you won’t want to get the plate…but this is not the time for that. That plate has helped me significantly.
-          Take time out of work to heal. Every doctor has a different protocol for recovering from this surgery. My doctor’s protocol appeared to be (in comparison to what I’ve read elsewhere) a fairly conservative recovery protocol. Taking time out of work wasn’t an option for me. The doctor asked me to stay out of work. However I have heard of people going back to work a couple weeks later. This is a big surgery, and the healing process for me was complex and challenging. I’m sure it differs from procedure to procedure…but personally I suggest taking at least 3 weeks out of work.
-          Prepare for the fact that after surgery, you may have a large area without any sensation. This area may or may not ever regain sensation. For me, it is a large part of my thigh to my right of the incision (about the size of a football). I knew this was a possibility before the surgery, but I always said “so what if I don’t have feeling?” Well…it’s not that simple. I have odd muscle spasms, and a lot of nerve tingling and pain. The feelings that I get because of the numb area are uncomfortable. It’s a small price to pay, and I’m certainly not complaining. Just something to prepare for.
-          Do ALL of your home PT as OFTEN as they tell you to do it. If they say they want you to do it three times a day, do it three times a day regardless of how tired or sore you are. I can’t begin to explain how much easier this made things. And if I missed even a day, the next time I did the exercises I could feel the setback. It matters. Do it every single day.
-          Expect a setback or two. It more than likely won’t be smooth sailing. I pulled several oblique muscles on my right side three weeks post surgery. That actually hurt worse than the surgery pain. I couldn’t move at all without severe pain in my side. I could hardly even breathe. I had to rest for a few days without any home PT, and when I started up again, I could feel the setback.
And here’s the most important thing:
-          BE PATIENT. Patient, patient, patient. Recovery is frustrating, and sometimes discouraging. You will have setbacks…you will get mad…you’ll want to rush through things…but just always remember to take a deep breath and be PATIENT. This surgery is a big deal…and your body is going to take a LONG time to get back to “normal.” Cut yourself some slack here and there. Try and learn how to focus on the now. I am one week post-op for the arthroscopic procedure. I’ve been on crutches/rehabbing/dealing with hip issues from the PAO for just about 22 weeks. And now I had my hip cut open AGAIN. This just added 7 more weeks of crutches and another 3.5-4 MONTHS of PT to my recovery. You can imagine my frustration. But, I have learned over the past couple months that this isn’t something that you can rush…even if you try. It’s SLOW. Every single day I have a moment where I get frustrated and aggravated and quite frankly just sick of this crap. But I just keep telling myself…in the long run I’m going to be in a way better place.
So, overall, recovery has been trying. It has been tough, and slow-going. It’s been exhausting. And now I’ve gone backwards another few steps because of the surgery last week. However, in the grand scheme of things, I feel really good about what I’ve been through. I’ve had to work really hard, and it’s going to have to continue…but in the end it will all be worthwhile. I’m on the road to having a really great biomechanical hip, a hip that could last me and be pain free maybe even for the rest of my life if I treat it well. I haven’t taken a step without pain in about 9 or 10 years. The first time I do, I will know this was ALL worthwhile.

Monday, March 25, 2013

A labral tear here, and a labral tear there.

Hello again! I just wanted to catch you up on a few things. On February 28, I had a follow-up appointment with Dr. S. regarding my PAO surgery. This was my 18 week appointment! Woohoo! I had been up and walking for weeks (I wasn’t winning any races…but I felt okay). Physical therapy was going so well, and I was kicking butt. The appointment with Dr. S. went very well; he was pleased with my progress. At this appointment we decided to go ahead and schedule the second procedure (arthroscopic hip scope). The most important thing I took away from that appointment was that I had literally no idea what to expect from the second procedure. Unfortunately, when it comes to cartilage and the labrum, he couldn’t know what he was going to find until he got in there. This means that he may only have to fix a couple small things on the labrum…or maybe just clean up some scar tissue. Or, worst case scenario, there’s a lot of cartilage damage and he needs to do what’s called micro-fracturing. This is where he picks at the femoral head with a little ice pick-like tool and makes it bleed. This blood then heals and turns into a type of cartilage called fibro0cartilage. Really what mattered to me in all of this information is healing time. I wanted him to do whatever he needed to do to get me into tip-top shape. So it came down to this: if he only had to fix labral tears? That’s about 2-3 weeks on crutches. If he has to micro-fracture quite a bit? That’s 12 weeks on crutches. That made me crazy…the not knowing. There’s a big difference between 3 weeks and 12 weeks on crutches. Anyway, I digress.
 Dr. S said I’d have to call Hilda (his assistant…who has probably made it onto our Christmas card list by now) the next week and make the final call on what day to do it. We were all on the same page that the last week of March, first week of April time frame was best. My family and I have a lot of exciting things going on this year…and I wanted to be sure I’d be up and running before them so I don’t seem like such a party pooper. When I called Hilda the next Monday, she told me that Dr. S didn’t have an opening until April 26th. I almost fainted. That’s a whole month after what I thought it was going to be. Hilda and I talked about what I had going on this year, and why the timing was so important. She said that she was going to try and figure some things out and call me back. She called me back a couple days later and told me she had finagled some operating room time for March 18th. This was less than two weeks from when we were talking…but I immediately said it was fine and booked it.
So the surgery day came, and everything felt like a scene from the movie “Groundhog Day.” We recognized a lot of people at the hospital, and they recognized us. I had the same exact surgical team as the first surgery, and it was nice to see some of those faces again. The thing that was different this time was the atmosphere. Everything was far more relaxed, including myself. After getting everything all set and I was  wheeled into the operating room, I got to look around for a few minutes and really take it all in. Last time they gave me loopy juice BEFORE going to the OR…so by the time I got into the operating room I was high as a kite. This time I got to see everything. What a fascinating thing…it’s really crazy to me. They wheeled me right next to what looked like some kind of torture device. It was the device the surgeon uses to create space between your hip joint ( I won’t describe it here….let’s hope you never have to see it!). I saw all the giant tool chests with my doctors’ name on them, and all the crazy lighting. It was pretty neat. Then I had to sniff the funny gas and about 30 seconds later I was in la-la land.
After the surgery, I woke up feeling pretty nauseous again. However my wonderful anesthesiologist Lexi made sure to give me a great cocktail of drugs so I didn’t feel a thing. Except tired. I got out of surgery around 11, and I slept until 2. I was WIPED. After that I started to come out of it and I recognized Sarah who was my recovery nurse from the first surgery. I loved her last time. She was so amazing. The nurse I had this time, Dina, she was great, too. But it was so nice to see Sarah and have the opportunity to tell her how much I appreciated her help the last time. After a while they got me up and moving, Matt came to see me and before I knew it I was in the car heading home. I slept most of the day.
So, the outcome of the surgery was pretty good. Dr. S. did a fantastic job with everything (obviously…he’s amazing). I had a couple really big tears in my labrum…they were so big that he ended up just having to cut part of it right off. That wasn’t a huge deal; he assumed I would have some pretty significant tears. There was some softness and wearing in my cartilage…and some areas where there was very little bit of cartilage left. So in these spots he did some micro-fracturing. Not a whole lot, though. The issue was that a part of my femoral head was slightly pointed…causing extra wearing on the cartilage against it. To fix this problem, Dr. S. had to shave down and smooth out that part and create bleeding to fill in the area with the fibro-cartilage. The last and most important thing we took out of this procedure was the discovery that there is only a small amount of arthritis in the joint. That is huge news. Because there’s so little arthritis, Dr. S thinks I may be able to put off hip replacement surgery until my late 60’s or even 70’s (if I treat my new hip well). In contrast…my hip was so crappy before all this that Dr. S. said he’s sure I would have needed total hip replacement in my 50’s (if I could make it that long).
So…all in all, it was a great outcome. However, because of the work he had to do with the femoral head, he wants me on the crutches for about 7 weeks. This is a bummer because I’m super sick of the crutches…especially as I was just on them for so long prior. However, I can’t tell you how happy I am to be DONE with surgeries. This has been such an interesting few months…I’m so tired from all the rehab. But, I feel so good to be moving forward with this chapter of my life. I’ve put if off for about 10 years now…it’s nice to not have it hanging over my head anymore.
I start physical therapy back up tonight, and I will have to keep going until probably mid-July. It is the best feeling knowing it’s only going to go up from here!
Ready, set, go!