Speaking of limping...

My brother Justin reminded me of this Monty Python skit. Sadly I'm not yet capable of qualifying for one of these government grants.

Week 8: full weight bearing, a speed bump

[Warning: long post]

Much has happened since my last post! Tuesday by chance we got to meet Terri, another of Dr. Mayo's PAO patients who has been super helpful. She was in for her pre-op appointment before having a PAO on her other hip--four months after a PAO on her other hip! She had the ideal recovery from her first PAO, the best recovery story I've read. She's recovering from PAO #2 as I write this, and so far it sounds like it's going as well as #1.

But I'm getting ahead of myself. An update on the last three weeks: relatively uneventful. My hip has felt solid the last few weeks, like the bone has fused enough for it not to flex when I move this way or that. I can roll onto my non-operated side in bed and lie on it for some time without too much discomfort. I can do just about everything myself, including getting in and out of the shower, getting all my clothes on (except for my right sock if it's tight). My right gluteus maximus is on vacation--it's just flat. My incisions have healed well; to the right is a picture from about a week ago. The pressure sores on my heels are basically healed.

Tuesday Krista drove me in for my eight-week follow-up appointment--eight weeks from my SDH, seven weeks from my PAO. It was good to see everyone in the office again.

First they sent me off to get a bunch of x-rays next door. One x-ray required me to spread my legs a bit and turn my toes inward, to rotate my femur inward as much as possible, but I wasn't able to rotate it at all. I was hoping that was just due to muscle atrophy, since I've been very careful to observe Dr. Mayo's restrictions.

Then back to the office. Sara came in with the x-rays and slapped them up on the light box for us to look at. All those bone cuts have healed well. There remains a little gap where the top cut above the acetabulum was made but it will close up. The trochanter cut for the SDH seems to have healed perfectly. Nine screws of varying lengths and seven suture anchors are visible on the x-ray. (I'd put up pictures but for some inexplicable reason the IT department didn't allow an orthopedic surgeon's office to run DICOM software which would allow them to view the x-rays!)

Dr. Mayo also patiently answered a bunch of questions about the repairs he made. If I understand correctly, the labrum was torn pretty much all along the front of the acetabulum, which is why seven suture anchors were required to sew it back. He's confident that it has/will reattach itself to the acetabulum. I'm guessing this was caused by the thickened neck of the femur impinging on the retroverted acetabulum. He also trimmed down the neck of the femur to minimize impingement (see the illustration at the beginning of this post).

There was also an apparent lesion near the top of the femoral head. One doctor diagnosed it as osteochondritis dissecans. It looked like it might be a little divot. But what Dr. Mayo found was a small bump on the femoral head that also scored the surface of the acetabulum. He performed an OATS procedure, removing a 10 mm plug of bone and cartilage where the bump was, and transplanting a plug of bone and cartilage from the edge of the femoral head, where the cartilage is less crucial. The plug is press-fitted and the bone should fuse with the surrounding bone. That should stop the damage to the cartilage in the acetabulum.

Dr. Mayo expects my hip should last at least 10 years, maybe more, but he thinks I'll probably need a hip replacement someday. I would be very grateful for 10 more years; it would definitely be worth it.

But the x-ray showed some bad news too: ectopic bone has formed in front of my hip socket, where I was opened up, enough to severely limit my range of motion--Dr. Mayo estimates I have a range of motion of about 20˚ before the ectopic bone starts impeding movement. As I understand it the bone is not what we normally think of--like a solid chunk--but is rather bone cells interwoven with the muscles. Evidently when these cells are traumatized by something like surgery they can differentiate either into scar tissue or fibroblasts, or they can differentiate into bone.

The treatment is another two or three hour surgery. The approach would be the same as for the PAO, and would require detaching a couple of muscles again. Dr. Mayo would hack out (he prefers the term "morselize," borrowed from spinal docs) the ectopic bone from the surrounding tissues. Recovery would be much easier, since I would still be able to bear full weight, but I would again be restricted from lifting my leg straight up while those muscles re-anchor. While he's in there, Dr. Mayo would remove most of the screws. By my count four would stay: two to reattach one of the muscles he detaches by chiseling off a chunk of bone (because bone-to-bone heals better than muscle-to-bone); and the two in the trochanter, since those would not be accessible through the PAO incision.

Shortly before surgery I'd get a single dose of targeted radiation to the area, to preemptively inhibit the cells that would want to turn to bone after this surgery. Evidently I'd need another CT scan before then to help the radiology/oncology guys do their targeting.

Surgery would happen sometime after the four month mark. The bone needs that much time to mature in order to be able to differentiate it from the surrounding tissues. In the meantime, I'll stay busy with PT, limited by my range of motion. Dr. Mayo said there's no point in trying to force it; I'd just make it "angry."

Before these surgeries Dr. Mayo told me that the likelihood of this happening was increased because we were doing two surgeries close together, so it wasn't a total surprise. Had we known how everything was going to turn out we might have done the two surgeries six months apart, but then I would have had two long recoveries rather than one.

But all this ectopic bone is just a speed bump (no pun intended). The important part is that the repair appears to have been successful.

So now I'm trying out my new hip. I'm limping around the house with one crutch reasonably well, better the more weight I put on the crutch. Without the crutch all I can do is lurch around, almost hopping on my good leg. I have PT orders so I'll need to find a physical therapist and get busy.

I'm very grateful to God for how he's working in all this. And I couldn't be happier with the care Dr. Mayo and Sara give.

Week 5 (SDH+5 weeks, PAO+~4 weeks): status

Progress continues, though usually not dramatic.

Last week I finally figured out what a 60˚ hip angle translates to on the knee CPM machine, and I hit that target, so I'm done with the CPM machine as well. Which is good, since it costs $25/day.


Two nights ago I slept in our own bed for the first time since surgery, and slept as well as in the hospital bed (which is to say about five hours), so today we returned the hospital bed. It's so nice not to have to sleep on the opposite side of the room from Krista! I'm now also able to turn onto my non-operated side, which is a very nice after a month in one position on my back. It's also better for my heels, since it takes all the pressure off them.

Today I worked a full day (telecommuting), the first since surgery. But that was sitting in the hospital bed; I'm not sure I'll make it all day yet on any of our chairs or couches.

I'm learning how to do more myself, such as getting into the shower, into bed, into the van. The main thing I need help with is changing my heel dressing.

Speaking of my heels, the left heel is fine now, but the right is slower to heal. We took off the dead skin part of the blister/sore and though it's ugly it seems to be healing better now. Krista cleans it at least daily and tapes gauze over it.

The crutches are taking their toll, making my hands a bit numb. Maybe I'm not using the proper technique.

I'm eagerly looking forward to my first follow-up appointment in three weeks. I'm guessing Dr Mayo will want me to wait longer before starting to walk on it.

All in all, it's going very well. We are very grateful to God for taking such good care of us!

Day 28 (SDH+27, PAO+22): Done with Fragmin shots

Today Krista gave me my last Fragmin (anti-coagulant) shot!

Day 27 (SDH+26, PAO+21): heel sores

While in the hospital my heels started getting very tender. Because I could only lie on my back, there was constant pressure on my heels. Plus the TED hose (compression socks) add a lot of pressure over the heels. Add to that a long hospital stay due to having two surgeries.

At home I sit up for large portions of the day, but I still have to lay on my back all night and during naps. And I'm supposed to wear the TED hose until my Fragmin (anti-coagulant) shots are done.

So my heels have gotten worse. My friend Scott who's a nurse considers my left heel to have a deep tissue injury. The dark spot is about the size of a nickel and is basically a deep bruise.

My right heel is worse. Scott calls it "an advanced stage two ulcer." It looks like a big blister and oozes a lot. For a few days my whole heel would throb when I would stand up.

Scott gave me a stern talking-to, telling me how fast these can get out of control, and told me to call my doctor for advice. He explained how pressure (the heel laying on the bed) and shear forces (the heel sliding back and forth on the CPM machine) and TED hose can restrict circulation, leading to this problem. He also helped me to adjust my CPM machine so it doesn't rub my right heel.

So I called Dr Mayo's office and emailed some pictures. It was a clinic day for him so his schedule was full, but in typical Dr Mayo fashion he still managed to shoe-horn me in the same day, calling me back around 9 pm. He told me to stop wearing the TED hose even though it's a bit early (yay!) and suggested getting off the CPM machine as soon as I reach my target (60˚, which I can probably hit but haven't gotten around to measuring yet, naughty me), and of course keeping pressure off my heels.

It's been nice not to have to wear the TED hose the last few days. My left heel isn't bothering me any more, with no swelling, though it still has that big round dark spot. My right heel no longer throbs when standing, so I think it's making a difference, though it is still red and swollen. Also, the last two or three nights I've not been sleeping in the CPM machine, which increases circulation because my right leg isn't elevated above my body all night. We're also going to try to experiment with lying on my side; having another sleeping position would help a lot. I'm trying to get up and around more, since movement and activity improve circulation.

Also, my sister sent me Herbal Ed's Salve which we apply every time I change my socks, which is a couple of times a day because of the ooze.

All this has made me realize how difficult it must be for people who are bed-ridden, and yet again how many blessings I take for granted.

SDH video

I found an SDH video, narrated by Dr Ganz who pioneered this particular technique. Dr Mayo did something very similar in my first surgery, except once the joint was opened the repair was much different (labral repair, 10 mm OATS, shave neck offset). The surgery itself begins about 8:20.

I purposely waited until after my surgeries to watch this.

Thanks

Krista and I both feel overwhelmingly thankful.

Thankful to God for sustaining us and blessing us through so many different people.

We are thankful for Dr Mayo, for his amazing skill as a surgeon and his top-notch care. Also for his cheerful PA Sarah, who checked on us frequently, and who had to field a 2 am call during the ileus adventure.

We are thankful to the nursing staff for their gentle care: Kim, Larissa, Stephanie, Martha, Nick, Karie, Ron, Chris, Rowenna, Shienna, Joy, Charlene, Margie, Pat, Ivonna, Sherry, Phyllis, Katie, Jesse, Joey, Christina, Jaeyoung, Louella.  I'm sure I've left some out. Their care was excellent, and often personal.

We are thankful to the physical therapists, David and Pam, for their encouraging, patient, and needful semi-torture.

We are thankful for drugs, technology, and anesthesiologists (particularly Drs. Robinson and Elder). Epidurals are amazing!

We are thankful to all the family and friends who helped with the kids so Krista could stay with me: Krista's parents, aunt Kay, and sister Kari, and our friends the Deffinbaughs, and for others who offered to help. Also my good friend Scott Matheny stayed with me a night and continues to give a lot of good advice.

We are thankful for all of you who visited, called, commented, emailed, or sent cards. Thank you for sharing our joys and burdens!

Day 22 (SDH+21, PAO+16): recovery at home

Today is the 21st day since my first surgery (SDH). We've been home a week now and are settling into a routine.

[Warning: lots of boring details follow that probably only other PAO patients-to-be would find interesting.]

I haven't had any pain medication since the morning of Oct 4th (PAO+6), two days before we left the hospital. The narcotics messed up my bowels so I'm trying to stay away from drugs. My hip feels tight and tender, and hurts if I move it certain ways, but the pain is now more at the level of significant discomfort rather than outright pain (as when, say, one is sent out of recovery without an epidural bag).

Speaking of bowels, mine are working fine now, for which I am very grateful. That ileus was no fun.

My incisions are healing well. The glue is starting to peel so it looks funny. My last drain hole has closed up so today we removed the gauze and Tegaderm for good. The skin on my thigh is red and bumpy, likely due to irritation from being shaved.

Because I had two surgeries close together, and probably because I had so much IV fluid pumped into me (somehow gained 20 lbs in the hospital, not by eating!) I had more edema than normal. Both thighs and my midsection were pretty swollen but that has subsided noticeably. My non-operated left leg is pretty well back to normal, and my operated right leg is getting closer to normal. What is amazing to me is how much my leg muscles have shrunk in just three weeks--they're puny.

Dr Mayo specified several restrictions for how I can move my leg:

• No straight-leg lifting. This is because he had to cut across some muscles, and until they heal only the stitches through the muscle sheath are holding the muscles together.
• No abduction (moving the leg from inside to outside, as when making snow angels). This is because for the SDH surgery he cut a slice of bone from the greater trochanter where a bunch of muscles attach (instead of detaching the muscles themselves), and then screwed the bone back into the femur. This chunk of bone needs time to re-fuse with the femur, and using the muscles that attach to it could hinder fusion by pulling on the bone fragment.
• Maximum 60˚ hip flexion on the knee CPM machine. This is for the same reason as the "no abduction" rule. Evidently the hip CPM machine puts an upward force on the trochanter, which can result in the trochanter fragment not re-fusing with the femur. Dr Mayo prescribed a knee CPM machine instead and told me to limit it to 60˚ of flexion at the hip. I still need to figure out what 60˚ at the hip translates to at the knee, since the knee CPM machine is calibrated for knee angles; one way is to get a goniometer to measure the angle.

These limitations mean that I can't lift my leg into the car, into the tub, out of the CPM machine, etc. I need either someone to lift it for me, or to somehow lift it manually.

The most disruptive effect of this is that when I need to go to the bathroom at night, Krista has to get up in order to get my leg out of the CPM machine (see picture at left). Because of all the IV fluid I'm still shedding, I sometimes have to get up three times during the night; it's like having a newborn again.

I'm training the boys to help move my leg in situations like this in order to free up Krista. They're doing a good job, super eager to help however they can.

Once my leg is out of the CPM machine, I'm able to crutch around the (single story) house by myself, and I can seat myself at the couch, kitchen table, or commode. I can sit for an hour or two with some discomfort. I'm able to get in and out of our minivan with someone lifting my operated leg. I sit in the middle row because there's more leg room.

I still have to wear the TED hose (compression socks) which, along with the anti-coagulant Fragmin shots, are intended to minimize the chance of blood clots. After two weeks of daily Fragmin injections are done I'll be able to stop wearing the TED hose. Krista gives me the shot every morning after breakfast.

My herbalist sister has been loving on me with vitamins and supplements to aid healing (E7 protein powder, oatstraw tea, plus a bunch of other things--so many that it's hard to keep up!). I need to work through her list and get a routine going.

I've managed to find a comfortable enough position to work a few hours. I'm definitely not ready to be back at the keyboard full-time, but it's good to know I can work some to stave off poverty.

We've made a few small trips, to an apple farm with the kids, and to Walmart. I crutched around at the apple farm and then found a seat while everyone else walked around. At Walmart I used an electric cart; it worked fine but was somewhat uncomfortable, especially going over bumps. But it's good to be out!

We got a commode that perches over the toilet. It's very helpful for me because it effectively raises the seat about a foot, saving me from having to bend my hip too much, and it has handles on the sides so I can raise and lower myself in a controlled fashion. We only have one bathroom, so we just leave it set up and everyone uses it. The kids think it's fun to be perched a little higher.

We're renting a shower chair, which is necessary for me to be able to shower. Our bathroom has a tub shower, so the chair we got is taller and wider than our tub, allowing me to sit on the chair with my legs outside the tub and then rotate into the tub. I'm very glad to take showers again; during the two weeks I was in the hospital I had only one shower.

We're also renting an electric hospital bed from Apria which can raise or lower the head and feet separately. It has a trapeze which helps me to get myself in and out of bed. The mattress sleeps hot and sweaty without a mattress pad, but is reasonably comfortable with one.

So that's life at week three.

Rating Pain

Periodically the nurses would come in and ask me to rate my pain on a scale of 1 - 10. I found it difficult to rate it, as I could easily imagine more intense pain than I was feeling at the moment.

Courtesy of my brother Justin and my good friend Paul Martin, here are Brian Regan's thoughts on rating pain:

Updates

I updated some past posts, tweaking the titles to include the number of days since the particular surgery, added tags, corrected typos, added some links (e.g. Wikipedia links to "ileus"), etc.

Synopsis

We've given lots of details so now I think a synopsis is in order.

Wednesday the 23rd Dr Mayo performed the SDH to clean up my socket. It was messier than expected, requiring a major labrum repair using a record seven suture pins, and a 10 mm OATS plug. The labrum repair also involved shaving off some bone, temporarily increasing my degree of dysplasia.

Dr Mayo had hoped to do both surgeries at once, but the amount of work the SDH required made that not possible. Plan B was to do the PAO on Friday but my platelet count was low so surgery was postponed to Monday. The PAO went well and Dr Mayo was able to almost completely correct the dysplasia. He expects no problems with it.

So the surgeries went very well. There was one major problem, an ileus in which the narcotics I began taking when they transitioned me off the epidural put my bowels to sleep. Perhaps the chances of getting an ileus could have been reduced had it been possible to do the second surgery sooner, so that I would have needed the epidural and narcotics for a shorter period of time. But I think it's worth it even the way it's happened because I'll only need one recovery.

I hope to ask a bunch more questions (when I'm not on drugs) at the next follow-up appointment about the nature of the damage, the repairs, and his prognosis for my hip. Also Sarah his PA said I'll be able to get pictures of everything. I'm eager to see what the damage inside the joint actually looked like.

Day 14 (SDH+13, PAO+8): going home

We had one more visitor Monday night around midnight. We already had the lights off and were just settling in to sleep when the privacy curtain by the door started to open. Krista sat up and said, "What?!" and lo and behold, there's Dr Mayo, just returned from a business trip out of town. I said, "What are you doing here? You should be checking on your wife, not me!" "She's asleep already," he replied.

So we talked about how I'm doing and when I could go home. He said that once I met the last couple of PT benchmarks (e.g. traverse stairs) I could go home, maybe the next day or Wednesday. We talked a bit more about limitations, and he decided I shouldn't exceed 60˚ (instead of 90˚) on the CPM to reduce the chance of non-union of one of the bone cuts he had to make for the SDH. Other than that I basically have no PT to do until I can start bearing weight in 8 or 12 weeks, except a couple of simple exercises intended to maintain some muscle tone in the operated leg (quad, glutes, hams).

Krista and I went to sleep excited for the next day. We got going the next morning determined not to miss PT and therefore delay our departure. (PT is good but seems understaffed; if you miss them when they come for you, chances are they won't have time to get back to you that day.) PT Pam worked with me again teaching me how to do stairs ("up with the good, down with the bad") and on proper crutching technique. Then we went over some paperwork with a nurse (care instructions, sign a few things), Krista went to the pharmacy to get my Fragmin shots (an anti-coagulant I'll take for two weeks to minimize the chance of blood clots), and we worked on getting a walker. (We ended up returning the walker yesterday unused, as crutches are working fine.) At one point while Krista was packing I choked up at the thought of going home, I think for joy of being reunited and for remembering all we'd been through.

Krista called Kari to ask her to bring the van and the kids around 1 pm. They gingerly loaded me into one of the middle seats in the van since those have more legroom than the front passenger seat. All together again, we drove happily away on a nice sunny day. On the way home we got some real food for lunch and Jamba Juice, picked up a part for the minibike, and finally arrived home. I was somewhat uncomfortable due to all the driving movement and the long sit, but it was bearable. Maybe I should have taken some pain meds before the trip, but I didn't want to risk bowel trouble again.

So here we are, two weeks later, home and very happy to be together again! Thank you God!

2 weeks (SDH+13, PAO+8)

Lots happened today.....we're home!
More later.    :)

Day 13 (SDH+12, PAO+7)

Matt's doing awesome with physical therapy.  He's learned how to walk with a walker and crutches, how to pivot into a bathtub to take a shower, how to put on socks and pants, etc.

He had his catheter removed for good today, and was able to pee normally.  He also doesn't have to be hooked up to an IV anymore.  He's able to drink liquids and eat solid food again.  And the last time he took any pain medication was yesterday morning. 

He still needs more gas to be emptied from his bowels.  The nurses want to see several regular bowel movements before he's safe to go home.   We were hoping to leave tomorrow, but I think more realistically it will be Wednesday at the earliest. 

Since Matt's been completely off of pain medications today, his skin is rapidly clearing up from the rashes.  He also hasn't had as many muscle spasms.  His speech is clearer and he's not sleeping as much during the day.  His face isn't pale and has some color in it again.  It seems all the problems have been due to his body not liking the pain medications.  At home he rarely takes anything for pain so his body just isn't used to them.  Thankfully, things are gradually returning to normal for him now.

We had a visit from Howard and Doris Spear today.  And my sister, Kari, is coming to see us tonight.  It's nice to see friends and family and be reminded that this isn't our life here.  We'll sure be glad to return home.

Day 12 (SDH+11, PAO+6): feels like 3 weeks

We're making some progress!

Matt's been motivated and has been doing a great job walking.  He's been given more Miralax and suppositories and little by little he's been making small deposits into the commode.  He feels a little better and has been getting more sleep.  He still has occasional muscle spasms that are irritating, but not painful.  

Dr Mayo's assistant came to visit us this morning.  She said he's doing an awesome job with physical therapy and is amazed at how little pain medication he's needed the last couple days.

Matt's rashes are slowly diminishing and his skin is gradually looking better.  His incisions look really good too.

Our friends, the Blackstads, came by today.  I told them it's strange being in the hospital for so long.  It's like I've started another life here.  I have a certain routine such as going for a walk two times a day to get fresh air and exercise.  I've figured out the best food to get from the cafeteria, food that balances tastiness with nutrition and often get the same thing to eat every day.  Getting Matt in and out of bed to sit on the commode or go for a walk has its own routine that takes quite a lot of time.  He's not allowed to use the muscles in his right leg, so he can't lift it or move it himself.  When he's in bed he keeps his leg in the CPM machine which helps to keep the hip from tightening up.  Also, he still wears the compression socks, all of which I put back on him and turn on. 

More Matt quotes:

• Matt was getting ready to go for a walk.  I usually follow him with the wheel chair in case he needs to sit down.  This time he asked, "Will you bring the wheel barrow?"

• Matt requested some clean socks for walking down the hall.  He asked, "Can I get some more non-stick socks, I mean, non-slip stocks?"  

We heard the word "discharge" for the first time today.  Because Matt's doing well with physical therapy and his wounds are healing well, it looks like we just need to finish emptying his abdomen of gas and then we can begin thinking about returning home.

My mom and dad brought the kids by to visit again today.  Micah really wants us to come home.  Of course we are anxious to be a whole family again.

Day 11 (SDH+10, PAO+5)

Just a quick update...

We're still waiting for Matt's bowels to wake up and get moving.  The x-rays showed that his abdomen is mostly full of air, not much stool.  We've tried different laxatives, suppositories, stool softeners, enemas, walking, etc.  The doctors and nurses keep emphasizing that movement is the best solution right now.  We continue to pray and wait.

Today my Aunt Kay brought the kids to visit us for the first time.  Riding the elevators seemed to be the highlight.  Matt was pretty groggy so wasn't able to participate in much conversation.  I'm so thankful that the kids are doing well.  My sister, Kari, has been able to spend a lot of time with them and carry on with home education and "parenting".  The rest of my family as well as some friends, the Deffinbaughs, have helped to carry the load too.  It's a huge blessing to know that our children are in good hands, that I've been able to stay with Matt at the hospital and that we can focus our attention here. 

The symptoms of Matt's pain medications haven't been all bad.  My sister, Kari, came to stay with us last night and the two of has had some fun laughing at Matt.  You know how carefully Matt thinks and how modest he is:

• He was reading on his iPhone and said that the groups of words were turning into trucks and driving away off the screen.  (Just so you know, he recognizes the fact that his mind is playing tricks on him.)

• He was asking the nurse about some seepage from his wound site.  He asked, "Should my website be dry?"

• Randomly Matt asked me, "Where did you put our keys this time?"  I clarified, "Our car keys?"  "Yeah."   I answered, "The valet attendant has them."  "Oh", he said.  Curious, I asked, "Why did you ask me that?"  "I don't know," he said. 
  

• Referring to his catheter, "It's kind of fun to pee in bed!"

Obviously, it's not all funny here, but I was glad for my sister to be here and for us to have some laughs together.  Thankfully, Matt's pain is under control and he's been able to get out of bed and walk some.  We've also been able to get more sleep, which goes a long way.

By the way, I guess I didn't ever write that Matt's PAO surgery went well.  Dr Mayo was pleased with his work.  He was able to correct the hip angle to almost normal.  He doesn't expect there to be any problems with it.

The status summary is that there have been two good surgeries.  But recovery has been very difficult and not normal.

Day 10 (SDH+9, PAO+4): post PAO surgery

We didn't get any sleep last night.  Most of the time I was just standing by Matt's bed watching him moan in pain, or I was praying or crying.   I know that my lack of sleep is making me more emotional.  I've been here with him at the hospital for ten days now.   I've never seen Matt in this much pain.  On occasion he would cry out, "Help me Jesus!"   The pressure in his abdomen was so intense he couldn't imagine how it could get any worse.  We were very concerned for his health and feeling frustrated with a lack of information from the nurses.  We couldn't go forward with any plan until we heard the results of the x-rays.  But the nurse who would fill us in wouldn't be coming to see us until the morning.  We felt helpless.

At 5am the nurse finally came and said that Matt has an ileus, basically his guts are asleep from the shock of surgery and all the pain medications.  He's mostly full of extra air, not necessarily constipated.  The game plan now is to get him moving as much as possible to get things moving around in his abdomen.  That gave us a little hope and I think it was motivating to Matt because I awoke to him doing pull-ups on the trapeze bar in his bed.

The nurse also prescribed some valium which helps relieve spasms and causes drowsiness so the pain isn't as difficult to manage.  After that I think he got a little sleep.  I slept from 6-8am this morning and awoke to the nurses saying it was time for Matt to get some more x-rays of his chest and abdomen.  This time Matt used a walker to get into a stretcher bed that they used to roll him down the hall.  He did a great job with his hip and wasn't in too much pain.  I'm just glad he's able to move around a little now.

The nurses have changed his oral medications to an IV med called dilaudid.  They don't want him putting anything else into his stomach until the pressure has been relieved and he's been emptied.  So no food or drink for him today.  He's still on an IV with fluids, however.

Thank you all for your prayers and words of encouragement.  It's a huge blessing when we hear from you via email or blog comments.  I do read them all to Matt too.  It's wonderful to know that we're not going through this alone.  And most of all we are made keenly aware of our dependence upon God's mercy.  Yesterday when Matt was moaning in pain he said, "God is so merciful to us all the time."  That is true.  He is our sustainer in every way.

Day 9 (SDH+8, PAO+3): post PAO surgery

Please pray for Matt.  I'm really concerned for him.  I think today was the most eventful day so far.  Matt has a lot of discomfort in his abdomen and lots of pain in his hip when he moves.  Today's events were primarily attempting to deal with these two problems.

He's continuing a routine schedule of taking two primary pain medications oxycodone (every 3 hours) and oxycontin (every 12 hours).  He's also given vistaril (every 4 hours) to help amplify the effects of the pain meds.   To keep on top of this schedule we're using our iPhone to set alarms so we or the nurses don't forget, especially when we're trying to get a precious few moments of sleep during the night.  Our iPhone has been a wonderful thing to have here on a long hospital stay.  I've used it to take pictures, check email, make phone calls, look up information, etc.  These medications make Matt very groggy and sleepy.


The nurse gave Matt an enema today.  We hoped it would loosen his bowels to bring some relief from his huge bloated belly.  He must have sat on the commode for an hour but there wasn't much to show from it.  All that sitting cut off the circulation a bit to his legs and as a result caused red blotches all over his legs.

Matt's diet today has been mainly clear liquids.  He's afraid to put anything else into his stomach and add to the discomfort.  He's also been a little nauseous and is afraid he'll chuck it all up.  

Dr Mayo is going out of town so he asked a general surgeon to come look at Matt's abdomen.  Dr Lynch ordered chest and abdomen x-rays.  Matt is in so much pain from his hip that we talked the technician into letting him come get his x-rays on his bed instead of having to get in and out of a wheel chair.  I helped a man wheel Matt down and around the hall in his bed.  Again we heard someone rave about Dr Mayo.  The technician who took the x-rays said that Dr Mayo is a phenomenal surgeon and does precision work.  We're waiting for the results of the x-rays.

Matt had his catheter removed this morning, but hadn't urinated all day.  I guess it's quite common to be unable to pee afterward.  The nurse decided to do a bladder scan to determine if Matt was full of urine.  He was indeed.  They inserted a straight catheter to empty his bladder.  They measured about 975 ml of urine.  That helped to relieve him a little.

Matt has developed a new rash on his stomach.  When Dr Mayo came to visit us this morning he said it looks like some sort of chemical reaction.  Thankfully neither the rash on his stomach nor the rash on his back is bothering him.

The nurse removed Matt's hemo vac (tubes inserted near his surgery incision to expel extra blood) today.  It's nice to have less tubes and contraptions to deal with now.

Today the physical therapist came to see Matt while I was down the hall for a little break from the hospital room.  They got him into a wheel chair and he came down the hall to surprise me.  The excitement didn't last long though because of intense pain in his hip.  Matt said it felt like his hip was made up of little sticks that were breaking.

The nurses often ask Matt to rate his pain on a scale of 1-10.  I think he's rating his pain too low.  He said a ten on his scale would be for someone to rip his femur out of its socket and beat him with it.  I think the lady next door has a different scale.  I overheard her say that her pain was at a five or six, as she explained to the nurse with a cheery and enthusiastic voice.

At 9pm we were notified that Matt was to be taken to get an ultrasound.  Evidently this is routine for Dr Mayo's patients.  He wants to make sure there are no blood clots in Matt's legs. 

When we arrived back from the ultrasound, the nurse gave Matt some Miralax, a laxative formula.  We're hoping it will get his bowels moving to bring him some relief.   It's already 11pm and nothing has happened yet.  I think it's going to be a really long night.

Day 8 (SDH+7, PAO+2): post PAO surgery

Krista here.  Matt's a bit foggy headed due to a change in medications.  I know he enjoys giving all the technical details but for now you get a female perspective.  A lot has been happening.

The physical therapists have been trying to get Matt up out of bed but he's having trouble with fainting and black-outs whenever he sits completely upright.  Yesterday they gave him back his two units of blood that have been refrigerated for a couple weeks.  They thought that would make a difference.  Dr Mayo came by this morning to check on Matt.  He's pretty sure it's due to the epidural which dilates the blood vessels and causes the blood to rush from Matt's head.  He really needs to get out of bed and get moving.  So today they removed his epidural and started him on some strong drugs.   Hopefully tomorrow physical therapy will be a bit more successful.


Matt has been concerned with his right foot.  He says it feels cold and has a stinging sensation.  The nurses are keeping an eye on it, confirming a pulse, putting on warm blankets, etc.  It may simply be due to continuous elevation on the CPM machine and a change in medications.

In preparation for Matt's surgeries, the scrub technician used some sort of green sterilizer to rub down Matt's right leg.  Earlier, when he was also bloated from the IV fluids, I told him he looked like the incredible hulk.  Today a nurse came and washed all the green stuff off.  So between that and decreased IV fluids, Matt is beginning to take his normal shape again....except for his stomach.

Matt is very uncomfortable in his abdomen area.  He feels really full and bloated and his belly is big.  The nurses say it's due to the medications and constipation.  Earlier today they gave him a stool softener and say that as soon as he's able to get moving, that will also help aid his relief. 

Matt has had a bad rash on his back and bottom for quite a while.  It's probably due to some irritation from the tape holding firm the epidural and from laying on his bottom constantly for over a week.  It looked better today since we applied some topical cordizone.  And the tape was removed when they took out the epidural, so hopefully the rash will decrease rapidly now.

One of the drugs they are giving him is an antihistamine.  It has affected Matt's alertness, clarity of speech and sight a bit.  Matt's boss requested the pleasure of giving him a hard time if he was ever in this condition.   So Matt put himself in a vulnerable position and called Tom today so he could have a bit of fun with him.  I'm so glad they have such a good relationship.  They have been so supportive to our family during this time.

Day 6 (SDH+5, PAO+0): PAO surgery, recovery

Dr Mayo decided to go ahead and do the surgery. My platelet counts were still low, but he was sure they'd come around. And indeed they did--they were 150 this morning.

I said goodbye to Krista a little after 2 pm as they wheeled me off to OR room #12. There I got to chat with some of the surgical team, including the anesthesiologist. Normally they don't keep epidurals in longer than five days, but they decided that this one was in good shape so they reused the same one.
The OR looks like a clean mechanic's shop, full of computers, bright overhead lights with digital cameras mounted in them, lots of power tools and other stuff made out of stainless steel. Also there's a whiteboard on the wall with about a dozen labels with highly technical names like "boats" and "peanuts." During surgery someone keeps a tally of what things are used, and then at the end they account for each item to make sure they don't leave anything inside the patient. I definitely wouldn't want boats or peanuts left inside my body.

Somewhere along the line they slipped some kind of cocktail into my epidural, and I vaguely remember my mind getting very sluggish.

Next I remember waking while being wheeled to recovery, passing in and out of consciousness. The main problem this time was not vomiting but shortness of breath--I was breathing really fast, almost gasping for breath. They told me to breathe deeply and slowly which I tried to do, but it took awhile before that stopped.

I shivered like last time, but less. This time, instead of piling warm blankets all around me they laid this plastic skirt (like the skirt on a hovercraft) over me that had a blow-dryer sort of thing blowing warm air all over my body. This seemed to be more effective. Seemed to, but as I was in and out of consciousness, it's hard to tell.

It's hard to describe the overall feeling of coming out of general anesthesia. It's like gravity is nine times stronger, pulling at your whole body, your mind even. It's hard to focus your eyes and difficult to compose thoughts and speak them, even simple ones like "I'm shivering." The pain and pressure from having one's hip chiseled, sawn, drilled in seven different places added to the distraction. It took strenuous effort to reply to questions. I also tried to listen to the nurses talk to get an idea of how I was doing.

The first time I remember seeing a clock it was a little before 7 pm. A little after 8 pm they wheeled me to my room and I remember seeing Krista and her mom Ginger waiting for me in the hall. I was still very uncomfortable. Probably I was still feeling the effects of general anesthesia, but one major reason was that they sent me from recovery to my room without an epidural bag (an IV bag filled with epidural meds), so for a while I had no pain coverage and could tell. My nurses were frustrated about this, and did what they could to get one, and by 9:20 or so they had it hooked up. Around 10 pm I began to experience pain relief.

And also bowel relief. Evidently the laxative we had used in the morning wasn't finished acting, because around 11 pm I messed my bed. My poor nurses--shift change starts at 11, so cleaning up me and my bed added a good half hour to their work day. They were great and didn't complain about having to do such a nasty job. It was a challenging task to do on a patient right out of such a major surgery, because any kind of movement is so difficult.

The nurses monitored my vital signs every hour for the first four hours. Finally around 1:30 am Krista and I went to sleep, Krista on a hospital cot/chair. They woke me several times to draw blood, take my vitals, etc. etc.

Around 3:30 am something weird happened that concerned me somewhat. I suddenly woke from sleep, but in a way that felt very much like waking after passing out. It felt like a vein in my neck was overpressurized, like when an IV line gets plugged. I touched it with my finger and it felt hard. Right away the hardness subsided. I was imagining a clot in my neck causing all the pressure.

I told the nurse what happened and she checked with Dr. Mayo's PA, Sarah. Because I didn't feel disoriented or confused Sarah thought it was not a clot. It did not happen again. Later when I told Dr. Mayo he thought it was probably a muscle spasm, which makes sense because my head was turned entirely to one side and likely my chin had dropped to my shoulder--that uncomfortable position kids sometimes assume when they fall asleep in a car seat. Thankfully, it has all turned out OK.

I didn't sleep much more the rest of the night, but I did get to see the west-end of a sunrise on the clouds.

Day 6 (SDH+5, PAO+0): PAO surgery

I walked with Matt as they wheeled his bed down to the surgery ward around 2 pm today.  I reminded him to ask the anesthesiologist for a different general anesthesia.  Hopefully he won't have as much vomiting this time around.

While we were waiting in his hospital room earlier today, I asked him if he was nervous.  He said he wasn't.  He was quick to remind us both of all of God's mercies we have seen so far:  good nurses, an excellent doctor, my noticing Matt's epidural IV disconnected and lying on the floor, Scott's suggestion of getting his bowels cleaned out yesterday in preparation for another surgery today, an effective epidural, a rise in his blood platelet count (150), etc.  On my drive to the hospital this morning I was also reminded that I can find comfort in the fact that Matt is in God's hands, just like every other day.  We are trusting Him that He is good and has our best in mind no matter the outcome of this whole event.

It's been fun watching Matt interact with all the people that are taking care of him here: the nurses, doctor, physical therapists, CNAs, janitors, etc.  They may think his curiosity and playfulness is due to being a cage-fed-hen as he recently termed himself (working alone at home and not getting out much).  But I know that it's also due to the fact that he just loves people and the world God has made.  He's so interested in others' lives and loves to hear about people's experiences and learn whatever there is to learn about.   I love his curiosity and joy about life.  There's a definite void in our family when he's gone.  I know the kids and I would be different people without him in our lives.  I am so very thankful for Matt.

Dr Mayo expects today's surgery to take about 3-4 hours.  He'll be in recovery for about 2 hours after that.  I'm anxious to see him tonight.   I told him I had the hardest time I've had so far when I saw him after surgery last Wednesday.  He was completely enfolded in blankets, including around the top of his head, his skin was a bit bloated, and his face was somewhat yellow.  He looked half dead.  In typical Matt style he asked, "Oh, will you take a picture of me right after I get out of surgery this time?!"  Knowing he was just curious what he looked like, but also a little disgusted, I responded, "I suppose.  But people will probably look at me weird, like I'm being morbid or something."  He said I could wait until everyone leaves the room before taking his picture.  That's Matt.

Day 5 (SDH+4)

Matt got a good chunk of sleep last night, from about 12 midnight to 6am.  He felt pretty good today.

They put his leg on the CPM machine bending his knee up to 40 degrees which results in his hip being flexed to 50 degrees.

His epidural was turned down to a 6 so he hasn't been as light headed.  His physical therapist had him stand up today.  He supported himself with a walker for about a minute.  Later he worked his way to a chair where he sat for an hour and a half to eat lunch.  His leg has to be either stretched out forward or pulled in next to his other leg.  That was big progress since he didn't pass out.  The only time he felt a little light headed was while talking, since it uses up a lot of oxygen.

Today he got his hair washed, his face shaved, and new linens put on his bed. 

His blood platelet count is still at a low of 114.  The doctor can't explain the low count but says it's not in the danger zone so they are going ahead with surgery scheduled for tomorrow, Monday, at noon.

This afternoon, he was given prune juice to get his bowels moving.  They want him cleaned out before heading into another surgery and additional days on the epidural.

They did a doppler scan (ultrasound) of his legs to make sure there are no blood clots. Evidently this is not normal practice for most doctors.  Dr Mayo, again, is taking extra precautionary measures to care for his patients.  Thankfully, Matt's x-ray result was good.  He will get another one before leaving the hospital next week.

Tomorrow morning they'll test his blood platelet count again and get a current x-ray of his hip for the doctor to refer to in preparation for surgery.  The anesthesiologist may replace Matt's epidural with a new one to help prevent possible infection.  Right after last Wednesday's surgery Matt responded with much vomiting.  The anesthesiologist said it was most likely due to the general anesthesia.  Evidently they gave him about every known anti-nausea drug to try and stop his vomiting.  This time they'll try something different, maybe tweak what they gave him to help diminish his nausea.  Dr Mayo said Matt has a good epidural and that it's doing a really good job blocking the pain for him.

Several weeks before his first surgery, Matt gave two units of blood to have on hand in case it was needed.  Thankfully, they haven't had to use it yet.

Today Matt heard even more stories about Dr Mayo.  He seems to have his own distinct way of doing things and is very good at it.

Thank you all for your emails, phone calls, blog comments, prayers, and thoughts for us.  We appreciate them all and are encouraged when we hear from you.  Matt will be out of commission for a couple days now, but feel free to call or come visit starting Wednesday.  Most likely he'll be in the hospital (Tacoma General Hospital) until Friday or Saturday.

Day 4 (SDH+3)

Last night Scott Matheny came to stay with Matt at the hospital so I could go home, see the kids, and get some sleep.  We are so thankful for family and friends who are willing to help care for the kids while Matt and I are at the hospital.  The kids have developed some colds, so hopefully that will be short-lived.  Otherwise, they're doing fine.  I'm told they've been playing surgery the last few days.  (Titus' idea of surgery is cutting off heads and arms and sewing them back on.)

Thankfully Titus wasn't the one doing Matt's surgery.  The doctor didn't cut his leg off but he did make an incision about 15 inches long lengthwise down the side of his thigh.  Dr Mayo stitched it together underneath the surface skin and then glued the outer skin together.  It is a rather clean wound area. 

Matt started some physical therapy yesterday.  They taught him how to sit up on the edge of the bed.  The first time he made it for 20 seconds before he needed to lay down.  The second time he made it a little longer but had a black out and nearly passed out.  We learned that this is due to the effects of the epidural dilating his blood vessels.  When he sits up, all the blood rushes to his lower extremities and that's why he has felt nauseous as well.  The doctor said his epidural could be turned down so that he can gain more feeling and move around more.  That should help decrease his nausea too.  They just turned it down to a seven.  We'll see what happens. 

Thankfully, Matt's appetite has returned and he has been able to eat more substantially today.  The doctor wants him to get more protein to aid the healing of his wound.

The physical therapist put Matt on the CPM machine yesterday and he slept with it last night.  Matt said it feels really good to be moving and there hasn't been any pain from using it.

He got a couple good blocks of sleep last night.  Since it's the weekend, things have toned down a bit and there aren't quite as many people bustling about.  He does have new nurses and even they continue to make positive comments about Dr Mayo's work. 

Matt's blood platelet count has risen from a low of 119 to 124.  We're glad to see some improvement.  Dr Mayo will decide on Monday morning if he should proceed with the PAO surgery.  If all goes well, we hope for Matt to come home on Friday or Saturday of next week.  

Matt has enjoyed all the people here at the hospital.  I suppose it would be refreshing for someone who is basically a shut-in, not seeing his boss but every 8 years, having no co-workers, working out in the country from a bedroom closet using his wife's childhood vanity table as his desk.

Matt has a great view of the Port of Tacoma from his hospital room.  We've enjoyed some beautiful sunrises and sunsets here.

Day 3 (SDH+2)

This morning we received the news that Matt's platelet count has fallen.  Dr Mayo has postponed Matt's PAO sugery until Monday.  Today's plan is to get him onto a CPM (continuous passive motion) machine and get him moving a bit.  We're anxious to talk with the doctor more to learn what may have caused Matt's platelet count to go down as well as how we will attempt to bring it up in preparation for surgery. 

We're feeling a bit disappointed right now.  Matt has been anxious to get this second surgery over with and get on to recovery.  However, again we are thankful for a good doctor and that he is cautious and is doing what is best for Matt.

The nurses have shown enthusiasm that Matt has been passing gas.  Little things are a big excitement around here!  It's a good sign that his bowels are waking up and working. 

Matt has been struggling with nausea off and on.  We're not sure if it's due to the epidural itself or the Nubain they give him to amplify the effects of the epidural.  He hasn't felt like eating much.

Please pray that:

• Matt's blood platelet count would rise to a safe level to go forward with surgery on Monday.
• Matt's nausea would subside so he can eat and regain some energy.

Day 2 (SDH+1)

Things have been eventful around here.

We didn't sleep much last night because the nurses came in every hour or two to check Matt's vitals.  Also, Matt kept feeling like he had to go to the bathroom, when he shouldn't since he has a catheter.  The nurse noticed that his urine hose wasn't draining into the bag properly.  She adjusted the bag, moving it lower so gravity could help out, and suddenly Matt was relieved depositing 1500 mL (1.5 liters) into the bag. He had no idea his bladder could hold that much.

The epidural is working well....well, as long as it's connected to him.  This afternoon, an anesthesiologist came to check on Matt and everything looked good.  After he left I happened to notice an IV hose lying on the floor. I traced it up to the epidural machine and we quickly became concerned.  The nurses, doctor, and friends had previously warned us to make sure we stay ahead of the pain and never let it get out of hand because it's hard to get it back under control.  Right away I called a nurse and they called the anesthesiologist back in to repair the hose.  My guess is that while he was here previously, he accidentally stepped on the hose and it became disconnected.  Matt was relieved when it was taken care of.  He was beginning to feel the epidural wearing off and thought he could tell where his bone had been cut during surgery yesterday.  Thankfully the epidural started flowing before there was too much pain. 

Matt's fluid IV line in the back of his hand had started to swell and puff up.  For some reason the fluids were going into his hand instead of into his vein.  The nurse hadn't seen that happen for a while and rated it a 3+ for those of you who know what that means.  She removed the line and had Matt elevate his hand.  The IV line has been moved to his other arm and we're waiting for the nurse to hook up the fluids again. 


Dr Mayo dropped by this evening to check on Matt and discuss tomorrow's surgery plan.  The only concern is that Matt's platelet count is on the low side, 133.  If it drops much lower by the morning, then surgery will need to be postponed until Monday.  At this point, surgery is planned for 8am tomorrow, Friday.  Please pray for Matt's platelet count to rise so that we can go forward with surgery.  

We've had some really great nurses as well as some sketchy ones, but invariably, whoever we talk to, they have really good things to say about Dr Mayo.   We're confident that Matt's in good hands, and for that we are very thankful.

Day 1: SDH surgery

Wednesday Matt went into his first surgery for the dislocation of his right hip.  The doctor's intent was to clean out the socket and to get a better idea of what has been causing Matt's hip pain.  What he found was a bit different and much messier than what he expected.  The labrum, the cartilage around the rim of the socket, needed much repair and Dr. Mayo ended up using a record number (seven) of suture pins to fix it.  He also took a plug of bone and cartilage and transplanted it into the top of the femoral head to smooth out the surface.  In the end, the repairs made his dysplasia worse, which is why the PAO surgery on Friday is crucial. 

Matt is doing well.  He's very glad for the epidural which will be ongoing through Friday's surgery and into the next couple days.  The epidural IV is taped up his back and over his shoulder.  He said it feels like his stomach muscles are constantly tense as if he's doing half a sit-up.  They've got him on oxygen to make it easier for him to breath, but he's not needing it as much right now.  His left hand is hooked up to an IV and they're pumping liquids and sugar through him, mainly to keep his blood pressure up and keep him hydrated.  He felt pretty bloated, like his eyes were bulging.  The nurse toned it down now and he's feeling much better.  Those are the gadgets on the top half of his body.

On his lower half he has a catheter as well as a tube inserted into his surgery wound to drain out the excess blood.  They've got him wearing TED socks on his feet, tight knee socks that help prevent blood clots.  In addition, his feet are in wraps that are hooked up to a machine that intersperses pressure on is feet, again to help circulation and prevent blood clots.  

Matt seems in good health, considering what he's been through.  The only concern is that his blood platelet count is on the low side, but not low enough that they're making a big deal out of it.  Beginning tonight at midnight, he won't be able to eat or drink anything as they prepare him for another day of surgery tomorrow.

Hacking Day: surgery

We're on our way out the door. We report at the hospital at 5:30 am, and surgery is scheduled to begin at 8 am.

My cold is a bit worse so we'll have to see what the anesthesiologist says. If he thinks it's going into my respiratory system we'll have to postpone.

How to pray for us

What's the most important thing to pray for us? Right now I'd say pray that we would think like Jesus about this whole situation, regardless of the outcome. This has loomed large in my thoughts the last few weeks. Spare me a few moments if you would and think about what he said and did in John 11:

    Now a certain man was ill, Lazarus of Bethany, the village of Mary and her sister Martha.... So the sisters sent to him, saying, “Lord, he whom you love is ill.” But when Jesus heard it he said, “This illness does not lead to death. It is for the glory of God, so that the Son of God may be glorified through it.”

    Now Jesus loved Martha and her sister and Lazarus. So, when he heard that Lazarus was ill, he stayed two days longer in the place where he was. Then after this he said to the disciples, “Let us go to Judea again.”

Two things stand out about his thinking that I want us to think as well. First, Lazarus' death was not pointless, was not merely tragic. The outcome wasn't merely death, but something great: "it is for the glory of God." God would be glorified--seen as amazing as he really is--not in this case merely by showing his power over disease, but over death itself. Disease and death take their best shot but fail. For Lazarus it was like getting to carry the torch for the opening ceremony of the Olympics--a great honor. Certainly not easy, but a great honor nonetheless.

The second thing to notice is that Jesus loved Lazarus and his sisters. He was not heartlessly using them as pawns to advance an egotistical agenda; a few verses later when Jesus arrives at the tomb he weeps. Even knowing the outcome he was moved. He didn't just force a stiff upper lip and stoicly ignore the pain of the moment. No, he directed the sickness, pain and death in that way precisely because he loved them. Read it again slowly and see. It was because he loved them that he didn't return immediately. Jesus could have come back right away and healed him. Lazarus' sisters knew that, believed that. But he stayed two more days, on purpose. Why? Because Jesus knew that seeing God's glory in raising Lazarus, triumphing over death, is better than merely living. And Lazarus had a front-row seat--he didn't just see the God's power at work, he felt it, experienced it. I wonder how many base-jumpers or other thrill seekers would pay money to have the experience of not just coming near to death but actually dying and coming back to tell about it!

My point in all this is to say that we want to think the same way. We don't take for granted waking up from general anesthesia or not suffering a stroke or anything. We know that the rubber meets the road in the midst of illness and death, and we want to be ready for it, ready to reflect what God is like in our lives and in our deaths, in our joys and in our tears.

(I'm not saying we should love death--far from it! but to show how loving it is for Jesus to show God at work as only he can.)

All that to say that we'd love for you to pray that we would be glad to be mirrors of God's glory and to trust God especially when it hurts, that we'd say with Jesus, "Not my will but yours."

Any suffering will be unspeakably worth it!

In addition to that, please:

• Give thanks with us for providing such a skilled surgeon, for help with the kids, for health insurance to help pay.
  
• Pray for strength for Krista as she juggles caring for three little kids and one big kid while under the influence of home schooling. (Especially as the onset of fall brings shorter days. I think she's half-plant; maybe chlorophyll injections would help make Northwest winters more tolerable for her.)
• Pray for wisdom, skill and stamina for Dr. Mayo and his crew. If he decides to do both surgeries tomorrow, it could take 10-12 hours, which is an awful long time to be hunched over and focused.
  
• Pray for the kids that they would be a blessing to those friends and family that are helping to care for them.
  
• Pray for healing and many more years of service out of this joint.

Thank you all for your love and prayers! SDG

Pre-op

Today Krista and I spent several hours doing pre-op stuff. After we showed up for our appointment at 2 pm they sent me off to get another x-ray, and then we met with Dr. Mayo's nurse and then Dr. Mayo. He wants to try to do both surgeries tomorrow for various reasons; he'll decide once he gets in the joint and sees exactly how much damage he needs to fix. We're hoping he can do it all at once since it will be easier on my body.

Dr. Mayo was very patient with my questions and answered them all. We both really like him and feel confident in his judgment and abilities (as if we were qualified to judge a surgeon). He's done a couple hundred surgical dislocations and 600-700 PAOs, which is an awful lot of experience. A 21-year old man and his family we met in the waiting room was another testimony to his reputation, as they flew all the way from Ohio to consult with Dr. Mayo after three or four surgeries to his hip. The previous time we came to the office he had just performed a fix-it surgery on a woman who flew in from Michigan after two failed hip surgeries by another doctor.

I asked Dr. Mayo for souvenirs, such as before and after pictures of the joint, or a chunk of bone or cartilage. We'll see what happens.

From there we bounced around from station to station, getting weighed, an EKG, answering numerous questionnaires, signing several forms, drawing blood, etc. A nurse gave me a couple of packets of some kind of disinfectant that I'm supposed to use on my body from the neck down, in the shower, once tonight and once in the morning. An anesthesiologist asked numerous questions, particularly about my cold; as long as it's not a respiratory infection it needn't interfere with the operation.

I got to ask a nurse why I'm not allowed to eat or drink anything after midnight. The answer is that if I were to vomit while intubated (i.e. while I have a tube stuck down my throat) the vomit could go into my lungs and cause serious problems.

It's all so very interesting to me--the way our bodies work, the rationales for doing X or Y, how anesthesia works, etc. So interesting that Nurse Keri told me I was maxed out on questions and not allowed to ask anymore.

Updates

A picture is worth a thousand words, so I added some images to the two surgery posts. Check out the second post describing PAO especially for a couple of good illustrations.

Recovery

Recovery will be long. I'll be on an epidural for the first four or five days until they transition me down to "lesser" drugs like oxycontin and oxycodone. They'll get me up and moving as soon as possible (to prevent blood clots, scar tissue, etc.) but I won't be able to bear weight on that leg for likely 12 weeks while the bone fuses. So a walker at first until I have enough strength and balance for crutches. Also, many hours a day in a continuous passive motion (CPM) machine to get the hip bending again, and doing little "exercises" to try to work certain muscle groups.

Oh, and it'll be a few days (perhaps a week or more) before my bowels wake up. Fun!

After 7-10 days I'll be able to go home, where I'll continue with the CPM machine and exercises. I'm renting a hospital bed with a trapeze handle for the first few weeks until I regain some mobility.

I'm hoping that within a month I'll be able to start working again. I was considering setting a recovery goal of doing the Seattle-Portland ride next summer, but that might be a bit too ambitious. More likely is to ride the Colorado mountains with my brother-in-law if/when we visit them next summer.

Surgery #2: periacetabular osteotomy

The second surgery is called "periacetabular osteotomy" (PAO), which translated to the vernacular means, "we'll chisel your hip socket out of your pelvis and realign it." It requires completely cutting through the pelvis in three areas to free the socket, after which it will be realigned and screwed into place; see link above for more illustrations. The benefit of this procedure over a hip replacement is that it preserves my joint. A hip replacement would not be durable enough to last the rest of my life (assuming average life expectancy); if I were to get a total of 25 years out of a hip replacement and then a second after the first wears out, I'd be in a wheelchair with no options by age 65. A PAO helps me to get at least a few more years out of my own joint, possibly many more (some have gotten 30 more years).

Typical surgery time for this surgeon seems to be five or six hours. Right now the plan is to do this surgery two days after the first. If the first surgery goes quickly and the surgeon feels up to it, he may go ahead and do this second surgery at the same time. I'd rather do them at once, but a 10-12 hour surgery is a lot to ask of a surgeon and his crew, and the chance for error increases with tiredness.

Below is a picture of a typical PAO tool set. I think the curved tools at the top left are the bone chisels used to cut through the bone.

These three images were obtained from a Smith & Nephew tools brochure.

[UPDATED: added PAO and tools images, minor clarifications]

Surgery #1: "surgical dislocation"

I'll be having two surgeries, scheduled for the 23^rd and the 25^th. The first surgery is called "surgical dislocation." Basically they'll dislocate my right hip so they can get a good look at the hip socket and the ball on the top of my femur and fix whatever damage they find. The surgeon will suture or remove torn cartilage, and possibly transplant plugs of bone and cartilage onto the ball if necessary. Also, he'll shave down the front neck of the femur near the ball because it impinges on the rim of the socket (see image to the right).

Gory details for the surgical dislocation: first they'll unzip the skin and separate some muscles to get to the juicy parts. Then they'll temporarily cut off a slice of bone where a bunch of muscles attach, along the bold line in Fig 1. The sliced-off part of the bone can then be pulled out of the way with the muscles still attached. The idea is to disturb as few muscles as possible; and since bone heals easier than muscle detachments, it's better to make this cut rather than detach and reattach all the muscles. This bone will get screwed back on at the end.




With those muscles out of the way, the leg can be rotated out of the socket for inspection and repair:




I'm grateful for bodies that heal, doctors and nurses that can do this stuff, and for the promise of a fully warranted replacement body in the future!

Update: watch a surgical dislocation narrated by Dr Ganz.

Why Hip Hack

My hip's been hurting for at least four years, particularly when getting up after sitting for long periods. Three years ago I started going to doctors to figure out what's wrong; five doctors later I think I found a good one with a good plan and some good success stories. Dr Keith Mayo has been doing these surgeries for many years and also is a hip trauma specialist. His diagnosis is that there is likely some damage and premature wearing of the cartilage, with the root cause being dysplasia--inadequately aligned and shaped hip socket(s) resulting in my weight being borne on a smaller area of cartilage, thus wearing it out sooner.

Dr Mayo will treat the symptoms (pain) by surgically dislocating my hip to open up the socket in order to fix whatever damage is there. Then he will treat the root cause (dysplasia) by performing a periacetabular osteotomy to reorient my hip socket in order to distribute my weight over a larger surface.

This blog will chronicle the experience so interested family and friends can keep up. No promises on how often it gets updated, but hopefully when it does it'll be worthwhile, complete with gory pictures.