Sunday, January 27, 2013

The Patient

Greg has taken to referring to me as "The Patient" ever since my hip surgery on January 15th. And, it's true, I have needed a full time caregiver for the first two weeks post op. I'm slowly regaining my independence now, but there are still plenty of things I can't do and that I won't be able to do for several more weeks and, in some cases, months.
Post Op Day 9 - going to PT by myself for the first time
Greg only took the day of my surgery off work. Thankfully, he is able to work from home and that is how he has been able to take care of me without burning all of his vacation days (he hasn't been with this employer long enough to be eligible for FMLA). He also took a few hours off to accompany me to my first two PT appointments.

My last post covered the day of the surgery in excruciating detail. Now I'm going to bring you up to speed on the new version of my daily life.

When Greg gets up in the morning, usually around 6am, I make sure to carefully roll onto my stomach to spend my last hour in bed as "tummy time." I have to do two hours of tummy time every day as part of my physical therapy regimen. This strengthens the back & abdominal muscles and is essentially a lazy version of the locust pose in yoga.
As soon as I get up, typically around 7am, I start popping pills. Thankfully, I have only been taking 5mg oxycodone (pain medication) at night to help me sleep, and have gotten through the rest of the day by frequently applying ice to the surgical area - my right hip. Even when the femoral nerve block wore off after 36 hours, the pain was very tolerable. I do have to take two other pills (to encourage proper healing) and two more (to offset the side effects of the other medications). I also take several vitamins (B-12 & D-3 which were prescribed by my general practitioner due to low levels in blood tests) and other drugs (niacin & L-arginine for Raynaud's disease).
Post Op Day 10
In the past few days I have regained enough flexibility to bend over far enough to put on my underwear, pants, socks & shoes by myself. Before that, it was Greg's job! Once I'm dressed, we begin the at-home exercises that currently make up a large part of my physical therapy regimen. Greg helps me with 40 minutes of passive stretching & range-of-motion exercises, then I do another 20 minutes of exercises on my own. We have to do all of these exercises twice daily.
my week-by-week physical therapy schedule
I then move over to the couch and place my right leg in the CPM machine. It continuously flexes my leg at the knee from 0-90 degrees (relative to my hip). I have to spend 6-8 hours every day in this machine for the first two weeks post-op. I typically break it up into three 2-hour sessions, and get up at the halfway mark of each session to encourage more blood flow to my feet.
Post Op Day 5 - quality reading time in the CPM machine
Due to my Raynaud's disease, I've been having an especially tough time of keeping my feet warm since the surgery. The tips of my big toes are deep red to blue and very sensitive, alternating from burning to tingling to almost completely numb throughout the day. This is in spite of taking all the prescribed medications, wearing Heat Holders socks & a warm hat (even indoors), and covering up with two blankets any time I'm sitting/lying down. This is about the extent of what can be done to alleviate the symptoms of this disease and it sure is frustrating (and painful)!
Raynaud's flare up on my left great toe
Between the tummy time, exercises, and CPM machine, I am occupied for 10 hours every day. While I'm in the CPM machine I usually read, or, at night, stream videos on Hulu. It was too painful to sit upright for any length of time for the first week after surgery, so I also ate most of my meals while reclined on the couch. This week I am able to tolerate 30 minutes of sitting in a chair so I am eating with Greg at our dining room table. We even went out to eat at a neighborhood Thai restaurant last night!

There's not much I can do to help out around the house while I'm on crutches, but at least I'm able to stand up by myself. For the first few days, Greg had to lift me up from any sitting position plus he had to move my right leg when I changed positions. Now I've learned to hook my good leg under, and use it and my right arm to control the right leg so no additional stress is put on my hip. This also helps for taking showers, which is particularly difficult because we have a deep claw-foot tub.
Post Op Day 4 - I have a visitor!
I am supposed to be on crutches for two weeks post-op so hopefully will start to wean off them this week. But I'm very lucky because even though Dr. Herzka did microfracture the top of my femur, the damaged area (where the cartilage was completely worn down) was small enough that they only drilled two holes in the bone. Anything more and I would have been on crutches for six weeks!
Post Op Day 2 - first trip to physical therapy
In addition to all of our daily rehab activities at home, twice weekly I travel to OHSU for physical therapy. I go via public transportation, and depending on what time I leave, that requires two buses, or two buses plus the streetcar (and a lot of extra time for getting to & from the bus stop on crutches). Unfortunately, the first day I went to physical therapy, January 17th (two days after surgery), the streetcar we were riding on broke down. We were instructed to get off and board the next streetcar, which arrived within five minutes. However, the "broken" streetcar had not been able to get far enough ahead to not block the tracks, so we had to get off the second streetcar, as they were now going to use it to tow the broken one back to the garage. We ended up having to walk a few blocks and then Greg picked up a Car2Go to drive me the rest of the way to PT. Thankfully, the other two times I've been to physical therapy since, I've not had any transportation-related issues.
Post Op Day 7 - I'm riding a bike (kind of)!
As I mentioned in my previous post, I have also been to one post-op doctor's appointment. I received a printed summary of the surgery and got to see photos that were taken with the endoscope. The doctor did a basic exam, checking my range of motion and the appearance of the surgical site. She also removed the sutures and replaced them with a few pieces of surgical tape. She was very happy with my overall condition. My next follow-up appointment is on February 28th with the surgeon, Dr. Herzka.
Post Op Day 9 - sutures removed, rash & bruises starting to subside
As I mentioned before (in reference to not taking oxycodone), the pain has been pretty manageable. Yes, I am in constant discomfort, but, on a scale of 1 to 10, it's typically around 2 or 3. Initially it seemed to arise from the swelling around the surgical site and the sutures pulling on my skin. Now I am experiencing more muscular aches as I progress in physical therapy with some occasional acute pain associated with the areas that were repaired during surgery. I'm also having an issue with the second nerve block not wearing off completely and thus I have numbness in part of my upper thigh. Hopefully this will go away within the next week and should not be permanent.
pre-op CPM machine practice
The only other real negatives to speak of are that I had a reaction to the adhesive they used to cover the surgical site and broke out in a rash that still hasn't completely disappeared; and I've had a sinus infection for the better part of this past week and have gone through a box of Kleenex.
Post Op Day 6 - bad rash, sutures, bruising
So that's my life for the past two weeks. It will evolve as I continue to heal and progress through six months of physical therapy. I particularly want to say thank you to my sweet husband, Greg, who has played many roles in the days since my surgery including cook, waiter, dresser, bather, lifter, physical therapist, cleaning/laundry man, escort, and general "fetcher" of things. I can't imagine going through this without you and I love you very much!
Post Op Day 10

Saturday, January 26, 2013

Going Under

It actually snowed in Portland the day before my surgery. I got out to run a few last minute errands (pick up prescriptions, buy a few groceries, get a haircut) and enjoy total freedom & mobility one last time. I even cooked steaks (it's a rarity for us to eat red meat at home) for dinner knowing that I wouldn't be able to eat again for almost 24 hours.
video
The hospital had called at the end of the previous week to let me know they were pushing my surgery back from first thing in the morning to midday due to some necessary equipment not being available. So we left our apartment around 9am on January 15th to catch a bus & then a streetcar to the OHSU Center for Health & Healing. We checked in on the 4th floor, paid a deposit, signed several consent forms, and were escorted to an exam room by 10:30am.
the first tall building to the right of the bridge is the OHSU Center for Health & Healing
I was immediately issued a wrist band (name, date of birth, drug allergies) and changed into a lovely purple hospital gown & socks. I got onto the gurney and the nurses covered me with blankets and connected a hose to a hole in my gown which then inflated with warm air.
Next, they began a battery of tests (temperature, pulse, blood pressure) while answering multiple questions about my medical history and confirming my identity and the surgery I was there for. We also reviewed post-op instructions & medications. They gave me an IV (I convinced the nurse to put it in my arm versus the back of my hand) and then the anesthesiologist came in to discuss general anesthesia.
Greg was allowed to stay with me until they wheeled me to a pre/post-op room just before noon. There I was greeted by multiple doctors who continued the prep work by adding some drugs to my IV, prepping the skin (I had also showered with Hibiclens the night before and that morning), marking the surgical site on my leg/hip, and using an ultrasound-guided needle to administer a femoral nerve block.

Sometime around 12:30 I was wheeled to the OR and transferred to the operating table. I remember saying hi to my surgeon, Dr. Herzka, and then the anesthesiologist put a mask over my nose & mouth and told me to take seven deep breaths. I made it to three...

I woke up a few hours later in the recovery room and immediately felt intense pain in my hip. The nurse gave me some opioids through my IV which quickly made me feel nauseous. So they decided to give me another ultrasound-guided nerve block, but in a different location than the first one (which was still working). My throat was also very sore & dry from the breathing tube so I started sipping some water. Eventually I was stable enough to be wheeled back to the exam room where Greg was allowed to join me around 3:30-4pm.

I was still nauseous from the pain meds so the nurse brought me some apple juice. Within an hour I was feeling well enough to get dressed and transfer to a wheelchair. Greg went outside to pick up a Car2Go while a nurse wheeled me down to the lobby. We met Greg at the building entrance and barely squeezed my leg (which was encased in a full leg brace to immobilize my knee since I couldn't feel anything due to the nerve blocks) into the tiny Smart car along with a giant bag of ice.
Luckily, even though it was rush hour, the traffic coming home over the Hawthorne Bridge wasn't too bad and we made the just-under-four-mile drive in about 20 minutes. It also helped that it wasn't raining. I took my time getting up the eight steps to our apartment (on crutches, which I had practiced prior to surgery) and quickly settled in on the couch.
more crutches + steps practice just before we left for surgery
Once he was sure I was okay, Greg walked to Safeway to pick up my post-op pain medicine (5mg oxycodone) as it was out of stock when I dropped off the prescription on Friday. The nurse had told us my femoral nerve block would probably wear off in 10-12 hours and that I would need to pre-medicate to avoid feeling any severe pain. When Greg got back home he heated up some soup for me (my first food in 24 hours). I was still suffering from a sore throat and could barely speak so I was also drinking lots of water and sucking on cough drops. I took one oxycodone and went to bed around 9pm (over the previous weekend we rearranged furniture and inflated the Aerobed so Greg could still sleep in the same room and help me if I needed anything during the night).
on the couch with full leg brace & ice bag after we got home from surgery
I will write about my first two weeks post-op in my next post, but I did want to include the information from the surgeon's report (which I received at my first follow-up appointment on January 24th) in this post.

These are the procedures that were performed with my "translations" in parentheses:
  • Diagnostic hip arthroscopy (get in there with a camera to see the extent of the damage)
  • Acetabular chondroplasty (trimmed the loose cartilage around the hip socket)
  • Labral repair (used three suture anchors to secure the torn labrum back to the acetabular rim)
  • Femoral neck osteoplasty (used a burr - a tool that looks like a long drill bit - to recontour my pelvic bone & the top of my leg bone to increase range of motion)
  • Focal acetabular microfracture (drilled two small holes in the bone to encourage new faux-cartilage growth in an area where the entire thickness of the original cartilage was worn down to nothing)
  • Capsular repair (sewed up areas they cut to allow movement of surgical instruments)
Credit: OHSU
Click on the Credit link under the above illustration to read more about hip arthroscopy and my surgeon, Dr. Andrea Herzka. They did take photos with the scope during my surgery (I saw them during my follow-up visit on the 24th) and I have requested a copy which should be delivered sometime next week. Fascinating! ;)

Thursday, January 3, 2013

Hip Op

I started having hip pain in January 2012. I remember feeling a sharp pain in my right hip while I was maneuvering storage containers at my grandmother's house in Nashville (in preparation for our move to Portland). I assumed I had strained a muscle so I took an anti-inflammatory and sat on a heating pad. I was pretty sore for a few days but then it seemed to be getting better.
Was this the cause of my injury?
Fast forward a few months. I joined a gym in Portland and, besides working out regularly (elliptical, treadmill, weights), Greg & I were pretty active walking around town and riding our bikes. I noticed that certain movements hurt my hip more than others but the pain was still tolerable. However the bursitis in my right shoulder (diagnosed in Italy in 2011) had really flared up so I was more focused on dealing with it.
power-generating elliptical machines at Green Microgym Belmont
As the summer progressed and we were volunteering at beer festivals, going on longer bike rides, and out & about often, the pain in my hip became more severe and it was hurting pretty much 24/7. Since we now had health insurance through Greg's employer (we had private insurance previously but had set an extremely high deductible), I was more willing to see a doctor to figure out the cause and, hopefully, get some relief.
I couldn't let the hip pain stop me from riding my bike!
I went to an orthopedist at Oregon Health & Science University in late August. X-rays didn't reveal the source of the pain so my doctor ordered four weeks of physical therapy. Unfortunately, that only made it worse and I had to stop going to the gym plus, no matter what I did (walking, sitting, lying down), everything was painful, sometimes excruciating.
This is the view from the 12th floor of the OHSU South Waterfront complex.
I returned to the orthopedist in October and he immediately ordered an MRI Arthrogram. A week later, the results came in and, when the doctor walked in my exam room, all he said when I asked how he was doing was "I'm a lot better than you are." He handed me a printed copy of the results where I read the words "extensive tear of the anterosuperior labrum...measures up to 3mm" as he said he would try to get me an appointment with the surgeon who specializes in hip repairs that same day.

I met Dr. Andrea Herzka a few hours later. She spent at least 30 minutes discussing the surgical procedure with me and even sketched it out on a piece of blank paper.
Here's what else was revealed by the MRI:
  • I have always been at a higher risk of having hip problems because I have deep sockets (where the femur/upper leg bone fits into the pelvis) and also because the femoral neck (the part of the leg bone that moves around by the hip) is not shaped the way it should be. Mine are almost flat across the top and they should be curved to allow more room for leg movement at the socket. Part of the surgery will include shaving off some of the femoral neck in order to re-contour it. This is called osteoplasty.
  • Where the labrum is torn there is also damage to other cartilage in that area (categorized as focal delamination of the anterosuperior acetabular cartilage). They cannot be sure of the extent of the damage with the MRI and won't know until they get in there with a scope (during surgery). If it is just rough from wear & tear they can smooth it out. This process is called chondroplasty. If the entire cartilage has separated, then they have to do a more extensive procedure to repair & replace it.
  • The torn labrum will be reattached to the hip socket with sutures and/or anchors. This is called labral refixation.
Bottom line: The surgery is outpatient and will take around 2.5-3 hours. It is minimally invasive (arthroscopic) but because of the multiple issues that are being addressed plus the fact that they have to use traction (physically pulling my leg bone away from the hip socket for an extended period of time), there is some risk of damage to the sciatic nerve and other surrounding tissues.
It's going to be a long time before I can crouch down like this again.
I will be on crutches for the first two weeks (six weeks if the cartilage damage is more extensive and a microfracture is necessary to stimulate growth of new "fibrocartilage"). I have to wear a Continuous Passive Motion machine for six hours daily for several weeks. I will start physical therapy immediately: 2x/week for three months then 1x/week for another three months. I also have to do exercises at home. Thus total recovery time is a minimum of six months.
CPM use
Yes, the news is worse than I expected, although it's not like I have to have a hip replacement (yet). And, clearly, my body is starting to catch up to my age and that sucks! But I'm tired of the pain and want to get this over with so I can enjoy the nice weather when it returns to Portland in June.
I want to be able to do this!
The surgery is scheduled for 8:00AM on Tuesday, January 15th, the earliest date available after I got insurance approval (which took several weeks). To help me manage the pain in the interim, I had an ultrasound-guided steroid injection on November 12th. After the initial discomfort from the injection wore off, I was almost completely pain free for about 2 1/2 weeks. It has gradually increased since then but I continue to stay as active as possible, knowing that my life is going to change drastically in a matter of days.
Christmas Eve bike ride
Since the surgery was scheduled in mid-December I have been preparing for the weeks ahead. Greg will be able to work from home while I recover and I hope that I can be independent enough to keep him from having to taking too many days off. He has had plenty of practice washing dishes, doing the laundry, and cleaning in general, but I'm the cook. So I've made a bunch of hearty soups to put in the freezer and I've stocked up on the things that we use the most. We usually don't keep much food in the house as I prefer to buy everything fresh, but our pantry and freezer are overflowing for now!
Do you think we can survive on beer & beef jerky?
And the countdown begins (11 days remaining as of today)...