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.