10 years
8 years ago
Saturday, December 18, 2010
A helpful tool for visualizing bones and muscles
My fellow hipsters will appreciate a new tool Google Body. It's even searchable, so you can just type in the name of a body part (e.g. "rectus femoris") and voila! You can control the transparency of the different layers (skin, muscle, bones, organs, circulatory system, and nervous system) so you can see only what you're interested in.
Thursday, September 23, 2010
One year hipaversary
One year ago today Dr Mayo surgically dislocated my right hip to clean up some damage (torn labrum, remove a sort of spur on the femoral head, and shave down the femoral neck). Five days later he performed a PAO to align my hip socket in order to make the joint last longer.
Much has happened since then, and now it's all done. PT ended in August, and I won't see Dr Mayo again for another year. When I left Mayo's office, I was saying goodbye to new friends.
Much has happened since then, and now it's all done. PT ended in August, and I won't see Dr Mayo again for another year. When I left Mayo's office, I was saying goodbye to new friends.
Everything looks good. I neglected to get copies of the x-rays from my last appointment a few weeks ago, but they look the same as the final x-ray from my cleanup surgery, so here you go: before and after. Notice the cloudiness around the joint is gone.
My range of motion is good--less than before, but pretty good. My hip flexion (bending forward) is still a bit limited, but it does bend a little more than 90˚ so it's good enough. The joint itself feels great, better than the left side (which recently has started hurting), but there is still some tightness to work out. I can sit cross-legged but not for too long. A patch of skin the size of my hand between the incisions is still numb. And thankfully that rash has not returned.
I've done quite a bit on my new hip since the cleanup: walked all around the San Diego zoo, hiked 5+ miles in a stand of old-growth fir in the Olympic mountains, and biked a few miles on the road and many more on the trainer. Driving feels mostly normal, but I do have a bit of trouble moving my leg to position my foot when switching between the accelerator and the brake, and I can't sit as long as I used to.
The next major thing I'll do with my new hip is move to Pittsburgh for my new job.
A lot of water has sure gone under the bridge in the last year! Thank you God for taking such good care of me--and Krista!
 |
| Before |
 |
| After |
The next major thing I'll do with my new hip is move to Pittsburgh for my new job.
A lot of water has sure gone under the bridge in the last year! Thank you God for taking such good care of me--and Krista!
Wednesday, June 16, 2010
PT
I'm going to a new physical therapist, one recommended by a friend who's been doing PT his whole life due to cerebral palsy. I really like this guy, because he's professional, no-nonsense, he seems to know what he's doing, and he pushes me. The last therapist I had just talked the whole time.
He currently has me doing a dozen or so different stretches or exercises, a couple of sets of each, a couple of times per day, which takes a while--in fact, I haven't been able to find the time to do them as much as he would like me too. But it's helping nonetheless. I'm finally able to (start to) cross my leg, and I can walk almost normally. I sometimes limp, but more out of habit, and when I realize that I can even out my gait. I need to gain a bit more extension because my heel's coming up a little bit sooner than the other heel.
My hip got a good workout a week or so ago when we took the kids to a logging competition (like the kind you'd see on ESPN). I ended up standing for standing outside for three or four hours. My muscles were tired, but I didn't have that deep ache in my joint that I would have felt before surgery, which is a very hopeful sign.
I still have some significant limitations in flexion and rotation. I'm getting 90˚ flexion, but I'd like more, as it's still a bit awkward putting on shoes and socks. My rotation is improving, but it's uncomfortable crossing my leg. But every week my hip feels looser and more normal.
I think my hip's better now than it has since the surgeries began.
He currently has me doing a dozen or so different stretches or exercises, a couple of sets of each, a couple of times per day, which takes a while--in fact, I haven't been able to find the time to do them as much as he would like me too. But it's helping nonetheless. I'm finally able to (start to) cross my leg, and I can walk almost normally. I sometimes limp, but more out of habit, and when I realize that I can even out my gait. I need to gain a bit more extension because my heel's coming up a little bit sooner than the other heel.
My hip got a good workout a week or so ago when we took the kids to a logging competition (like the kind you'd see on ESPN). I ended up standing for standing outside for three or four hours. My muscles were tired, but I didn't have that deep ache in my joint that I would have felt before surgery, which is a very hopeful sign.
I still have some significant limitations in flexion and rotation. I'm getting 90˚ flexion, but I'd like more, as it's still a bit awkward putting on shoes and socks. My rotation is improving, but it's uncomfortable crossing my leg. But every week my hip feels looser and more normal.
I think my hip's better now than it has since the surgeries began.
Monday, May 17, 2010
Ectopic bone
So you wanna see what ectopic bone looks like after it's been "morselized"? Here is a picture of what Dr. Mayo removed. He said there was actually more; some had already been taken before he told them to get a picture for me.
Looks like stew meat, or a tasty treat for Fido.
Looks like stew meat, or a tasty treat for Fido.
Wednesday, May 12, 2010
Post HO-removal two-week followup
Monday we went in for a two-week follow-up. Renee and Dr. Mayo checked my incision (looks good), peeled some of the glue off, clipped the ends of the sutures (Dr. Mayo used nylon instead of the dissolving kind this time, in case it was causing skin irritation), and checked my range of motion. I get close to 90˚ flexion, and rotation is improved, though significantly less than my left leg. I have a lot of stretching to do, to make up for almost eight months of relatively little activity.
To the right is a picture of the screws (or replicates) that Dr. Mayo removed. The two little ones were replaced (I think in my iliac crest), so counting the two in my trochanter from the SDH surgery I still have four screws embedded.
Since I'm active again, Renee said I could ditch the TED hose and the last three Fragmin shots. I'm still on meloxicam until I finish out my 30-day supply.
I got orders for PT, with the same no-straight-leg-lifting and no-active-abduction restrictions, until my next appointment four weeks from now. Dr. Mayo gave the OK to drive if I feel safe. Best of all, he said I could ride my bike on the trainer, but not to power with my right leg.
So last night, for the first time in about eight months, I set up my bike in the kitchen and went for a ride. It was a challenge to get on the bike, since it's a road bike (and therefore tall) and mounted on the trainer it's a couple inches taller. I ended up stepping on a chair to get high enough to get into the saddle. But once I got on, boy did it feel good! Very natural, enough that I had to be careful not to power through with my operated leg. I tried to take it easy and just spin, and ended up riding 11.5 miles in 45 minutes. My cardiovascular conditioning is weak; even though I was taking it very easy, after 30 minutes my stamina was dropping fast. I don't think I overdid it because today my hip feels about the same as it did before I rode. Very encouraging!
My hip is already much more flexible than before the HO removal. It feels tighter than before this surgery but is loosening more and more each day. I fit behind the steering wheel much more comfortably than before, but I'm not quite 100% because the no-straight-leg-lifting restriction and the corresponding weakness of that muscle make it hard to lift my leg to move it between the gas and brake pedals. But good enough that I'm driving the boys to school in the mornings.
The swelling has gone way down, to the point that my operated hip looks about the same size and shape as my other hip.
To the right is a picture of the screws (or replicates) that Dr. Mayo removed. The two little ones were replaced (I think in my iliac crest), so counting the two in my trochanter from the SDH surgery I still have four screws embedded.
I got orders for PT, with the same no-straight-leg-lifting and no-active-abduction restrictions, until my next appointment four weeks from now. Dr. Mayo gave the OK to drive if I feel safe. Best of all, he said I could ride my bike on the trainer, but not to power with my right leg.
So last night, for the first time in about eight months, I set up my bike in the kitchen and went for a ride. It was a challenge to get on the bike, since it's a road bike (and therefore tall) and mounted on the trainer it's a couple inches taller. I ended up stepping on a chair to get high enough to get into the saddle. But once I got on, boy did it feel good! Very natural, enough that I had to be careful not to power through with my operated leg. I tried to take it easy and just spin, and ended up riding 11.5 miles in 45 minutes. My cardiovascular conditioning is weak; even though I was taking it very easy, after 30 minutes my stamina was dropping fast. I don't think I overdid it because today my hip feels about the same as it did before I rode. Very encouraging!
My hip is already much more flexible than before the HO removal. It feels tighter than before this surgery but is loosening more and more each day. I fit behind the steering wheel much more comfortably than before, but I'm not quite 100% because the no-straight-leg-lifting restriction and the corresponding weakness of that muscle make it hard to lift my leg to move it between the gas and brake pedals. But good enough that I'm driving the boys to school in the mornings.
The swelling has gone way down, to the point that my operated hip looks about the same size and shape as my other hip.
I continue to be amazed at how little pain I've had. I haven't needed to take anything, or even thought about it, even in the hospital. I'm eager to get past all the post-op distractions so I can get a sense for what it's going to feel like long-term.
Thank you God for such a smooth recovery!
Tuesday, May 4, 2010
Day 9 post HO removal surgery
My hip feels great. I can do everything for myself. My range of motion is greatly improved. Flexion is pretty good, good enough that I can put socks on the normal way, even my TED hose. External rotation is excellent and unstrained; internal rotation while pretty good still feels a little tender.
The joint feels very stable, and if I'm not moving there's no pain. The muscles have healed up enough so that I need to remind myself not to overdo it. Every now and then I'll move a certain way and be reminded of Dr. Mayo's no straight leg-lifting and active abduction restrictions.
I'm using one crutch to even out my gait. I can walk without a crutch, but with a limp.
When I walk there is some muscle pain, which is probably related to the muscles Dr. Mayo had to detach, but it decreases every day.
At first it was painful to cough, but that pain is almost gone now.
I can comfortably sleep on my back or on my non-operated side. I can use a regular toilet without having to have my leg sticking out straight in front of me.
The bad:
My leg has started to swell and looks maybe 10-15% larger than the other leg. Also, it is bumpy and itchy at times. I remember going through a phase like this last time; I hope it passes quickly. I'm trying to go for walks more often to get that stuff broken down and pumped out.
My incision is red in places and my hip is swollen somewhat but not enough to prevent me from wearing pants. I'm hoping and praying that I can avoid infection and dermatitis.
One thing I've learned through these surgeries is that I have very sensitive skin. My belly has broken out with a rash where something was taped. It's possible that the itchiness and bumps on my leg are a delayed reaction to the nasty green stuff they scrub it with.
I do not cease to be amazed at how our bodies recover after being (carefully) hacked open and screwed, sewn, glued, and taped shut.
The joint feels very stable, and if I'm not moving there's no pain. The muscles have healed up enough so that I need to remind myself not to overdo it. Every now and then I'll move a certain way and be reminded of Dr. Mayo's no straight leg-lifting and active abduction restrictions.
I'm using one crutch to even out my gait. I can walk without a crutch, but with a limp.
When I walk there is some muscle pain, which is probably related to the muscles Dr. Mayo had to detach, but it decreases every day.
At first it was painful to cough, but that pain is almost gone now.
I can comfortably sleep on my back or on my non-operated side. I can use a regular toilet without having to have my leg sticking out straight in front of me.
The bad:
My leg has started to swell and looks maybe 10-15% larger than the other leg. Also, it is bumpy and itchy at times. I remember going through a phase like this last time; I hope it passes quickly. I'm trying to go for walks more often to get that stuff broken down and pumped out.
My incision is red in places and my hip is swollen somewhat but not enough to prevent me from wearing pants. I'm hoping and praying that I can avoid infection and dermatitis.
One thing I've learned through these surgeries is that I have very sensitive skin. My belly has broken out with a rash where something was taped. It's possible that the itchiness and bumps on my leg are a delayed reaction to the nasty green stuff they scrub it with.
I do not cease to be amazed at how our bodies recover after being (carefully) hacked open and screwed, sewn, glued, and taped shut.
Days 1-3 post HO removal surgery
For those of you who are interested in all the little details:
My time in the hospital was uneventful (if you can call being flayed and chiseled, then screwed, sewn, glued, and taped back together uneventful). The most remarkable thing to me was how relatively little I hurt. I didn't take any pain medication by choice during the four days I was in the hospital, and other than during the surgery itself I was only given pain medication three times: one hit on the PCA to test it after they hooked it up (2 mg dilaudid), two Vicodin the next day before PT came at the insistence of the nurses, and two more Vicodin the following day at the nurses' insistence (though PT didn't end up coming until nine hours later, when it was probably no longer effective). The next day I insisted I didn't want anything, so I haven't taken anything since the third day.
So what did it feel like? Of course right after surgery I was in a fog with all sorts of sensations, including nausea for a few hours (puked once). But after that wore off, I didn't hurt much just lying in bed. When I had to move I felt very sore but I didn't have that bundle-of-dry-sticks feeling of fragility inside my hip like after the PAO. Standing up I could feel a lot of muscle soreness and exerting the muscles was somewhat painful. But the muscle pain diminished noticeably every day.
The first time PT came they sat me on the edge of the bed for a few minutes, then stood me up. Cumulatively I was upright for about five minutes before I began to feel light-headed, which was a big improvement over last time. Opting out of the epidural was a good call, since the epidural made me very light-headed (it results in the blood vessels in the legs enlarging, causing blood to pool in the legs, with the result that not enough blood is left in the head). I experienced some light-headedness one other time, but that was all. I think it was the second day that I got up to use the toilet, and felt so good that I went to the sink to wash my hair and generally wash up, 20 minutes or so, all under my own power. We were very encouraged by that.
Lying in bed got to be uncomfortable. The second or third night I got tired enough of lying on my back that I worked my way out of the CPM machine and onto my non-operated side, where I slept for an hour or so. That made a big difference.
The regimen is very much like for SDH and PAO:
My time in the hospital was uneventful (if you can call being flayed and chiseled, then screwed, sewn, glued, and taped back together uneventful). The most remarkable thing to me was how relatively little I hurt. I didn't take any pain medication by choice during the four days I was in the hospital, and other than during the surgery itself I was only given pain medication three times: one hit on the PCA to test it after they hooked it up (2 mg dilaudid), two Vicodin the next day before PT came at the insistence of the nurses, and two more Vicodin the following day at the nurses' insistence (though PT didn't end up coming until nine hours later, when it was probably no longer effective). The next day I insisted I didn't want anything, so I haven't taken anything since the third day.
The first time PT came they sat me on the edge of the bed for a few minutes, then stood me up. Cumulatively I was upright for about five minutes before I began to feel light-headed, which was a big improvement over last time. Opting out of the epidural was a good call, since the epidural made me very light-headed (it results in the blood vessels in the legs enlarging, causing blood to pool in the legs, with the result that not enough blood is left in the head). I experienced some light-headedness one other time, but that was all. I think it was the second day that I got up to use the toilet, and felt so good that I went to the sink to wash my hair and generally wash up, 20 minutes or so, all under my own power. We were very encouraged by that.
Lying in bed got to be uncomfortable. The second or third night I got tired enough of lying on my back that I worked my way out of the CPM machine and onto my non-operated side, where I slept for an hour or so. That made a big difference.
The regimen is very much like for SDH and PAO:
- green leg from surgical scrub (including Margie washing it off herself again, surprised that no one else had)
- TED hose
- Plexi-pulse
- CPM machine
- two surprisingly long drains hooked up to a Hemovac (came out the third day, I think)
- catheter, out when you're ready (the second day, I think)
- IV drip
- PT once a day
- blood draws in the middle of the night
- daily Fragmin shots
- no straight leg-lifting and no active abduction
- Dr. Mayo and/or his PA popping in once or twice a day
I did lose a fair bit of blood, enough so that they hooked up a cell saver during surgery and recycled 600 ml of my own blood, but I did not receive a transfusion. I ended up getting three bags of IV fluid (3 liters) before they unplugged me, which was enough to make me puffy but not to the point where I felt like my eyes were bulging, like last time. I felt a quart low or so; the first few days after surgery my blood pressure was low (90s over 50s) but eventually came up to 110 over 70 or so.
Even though I wasn't using the IV the last two days, the nurses still wanted to keep it in for quick access should the need arise, so I ended up having it in until the morning we left.
Dr. Mayo said that normally after re-opening an incision he would excise the scar tissue before suturing it up again, but he decided not to. Perhaps my skin was damaged somewhat by using steroid creams for months on the dermatitis. In case my skin was reacting to the kind of suture he used last time, he used nylon, the ends of which are hiding under the tape. So maybe I'll end up with a killer Frankenstein-style scar.
(You can see the effects of the dermatitis in the brown, pigmented splotchy area near the visible drain hole in the picture to the left.)
Dr. Mayo had me on a hip CPM this time, which I liked much better than the knee CPM. It was much easier to get in and out of, and it didn't rub my heel (last time I got an especially nasty pressure sore on the heal, in part because of the rubbing). My hip felt tight as the machine approached 90˚ but it was not painful.
In addition to radiation therapy I'm on Meloxicam, in pill form once a day after breakfast. It can have some nasty side effects and needs to be used carefully in conjunction with anti-coagulants like Fragmin. I'm eager to get off both. I've been having headaches the last few days and am wondering if the Meloxicam might be to blame.
Krista and I both really enjoyed seeing our old friends from last time: Kim, Stephanie, Pat, Margie, and many others. Thankfully I was a lot less work than last time, and we didn't have to share so many awkward and uncomfortable moments.
And of course Dr. Mayo and his new PA Renee were excellent. Dr. Mayo is careful and meticulous, two excellent attributes in a surgeon, which is why surgery was 5.5 hours (incision to suture completion, according to my chart). We always enjoy talking to them. Again, everybody in the hospital had good things to say about Dr. Mayo.
Thursday morning both Renee and Dr. Mayo came by to check on me one last time and gave the thumbs-up to go home, and by 11 am, after a stop at the hospital pharmacy, we were on the road.
Day 1 radiation therapy
[Flashback to the day of surgery, to fill in details on radiation therapy for those interested]
After 20 or 30 minutes we finally arrived. The radiation tech was clear, concise and assured us that we're in good hands because she's been doing this 20 years. She briefly showed us the plan on a computer monitor and then wheeled me into a large, open room with a concrete floor, various machines, and green laser beams criss-crossing in places. The machine they were using on me was much less intimidating than a CT or MRI machine, but way more dangerous.
Seeing a sizable chunk of lead on the platform I'd be lying on, I chuckled, and the tech said she'd explain that.
She told me that I would be receiving a single dose of radiation, a blend of five kinds of photons, X of something else and Y of something else, 700 centiGray's worth (absorbed, I think).
Next I get up on the platform while the tech and her assistant graciously give me the room while I employed the lead cup in the fashion they described (though I suppose they were watching on camera). They return, propping up my knees with a slab of foam, hooking my feet together with a rubber loop so I don't slip out of position, and then they line me up under their laser crosshairs. Satisfied with my position, they tell me to hold still and depart the room to run the machine.
First the machine does some calibration, taking a quick image from above and then one from below to make sure they align properly. Then the actual radiation bath began, bathing my front and then the rear. I think this stage was only a couple of minutes. While this is happening I could see these metal shapes inside the emitter head (or whatever it's called) shifting themselves into the shape that I saw on the computer monitor earlier.
And that was it. I freed myself from the lead prison (let's hope it worked) and then was wheeled back to the fifth floor for surgery.
Tuesday, April 27, 2010
Post-surgery Day 2
This morning Dr Mayo came by to check on Matt. He thought Matt looked really good, ordered the nurses to remove his catheter and IV. If he needs any pain management he'll take some pills orally.
Physical therapy came around 10:30 am and got Matt on his feet. His blood pressure is on the low side and he struggled with light headedness so only stood for about 5 minutes. They'll come again tomorrow.
Later this afternoon I helped Matt sit up and he walked to the bathroom and felt great! He then proceeded to wash his hands in the sink, wash his hair, and brush his teeth. He was very encouraged.
Matt is doing well on the CPM. He's already almost up to 90 degrees flexion with no pain!
That's all for today...
Physical therapy came around 10:30 am and got Matt on his feet. His blood pressure is on the low side and he struggled with light headedness so only stood for about 5 minutes. They'll come again tomorrow.
Later this afternoon I helped Matt sit up and he walked to the bathroom and felt great! He then proceeded to wash his hands in the sink, wash his hair, and brush his teeth. He was very encouraged.
Matt is doing well on the CPM. He's already almost up to 90 degrees flexion with no pain!
That's all for today...
Monday, April 26, 2010
Day of surgery (to remove ectopic bone)
We arrived at the hospital at 5:30 this morning. We went through admittance and Matt received a small dose of radiation to help prevent ectopic bone from forming again after today's surgery. We happened to pass Dr Mayo in the hall and said hello. Matt yelled back, "Save the screws!" He's hoping to get the screws that Dr Mayo will be taking out from his PAO in September.
Matt was rolled away for surgery at 8:30. It was a long wait and I didn't hear anything from Dr Mayo until 3:40 in the afternoon. The surgery went well but took longer than expected because there was a lot of ectopic bone. He removed about an equivalent of 1 1/2 cups of bone and also cleaned out some scar tissue. Dr Mayo was able to enter through the same incision spot from last surgery so Matt won't have any additional scars. He lost a bit of blood but they reused what blood pooled and siphoned it back somehow.
Matt awoke from the anesthesia feeling a bit nauseous and threw up once. The nurses graciously changed his bedding and then gave him some anti-nausea medicine which helped. He's on an IV for pain medication and can control it himself. So far he hasn't taken much. He wants to do all he can to avoid having an ileus again.
They put him on a hip CPM in bed and he's doing well with it moving his leg up and down. It's currently set at 40 degrees flexion and Dr Mayo wants him to work up to 90 degrees in the next two weeks.
Again, Matt has a catheter and also a hemo-vac to drain the excess blood from his surgery sight. He's on oxygen and has an IV with saline to keep him hydrated as well as some antibiotics.
It's been a long day. But we're doing well and are thankful for how God has brought us through.
Matt was rolled away for surgery at 8:30. It was a long wait and I didn't hear anything from Dr Mayo until 3:40 in the afternoon. The surgery went well but took longer than expected because there was a lot of ectopic bone. He removed about an equivalent of 1 1/2 cups of bone and also cleaned out some scar tissue. Dr Mayo was able to enter through the same incision spot from last surgery so Matt won't have any additional scars. He lost a bit of blood but they reused what blood pooled and siphoned it back somehow.
Matt awoke from the anesthesia feeling a bit nauseous and threw up once. The nurses graciously changed his bedding and then gave him some anti-nausea medicine which helped. He's on an IV for pain medication and can control it himself. So far he hasn't taken much. He wants to do all he can to avoid having an ileus again.
They put him on a hip CPM in bed and he's doing well with it moving his leg up and down. It's currently set at 40 degrees flexion and Dr Mayo wants him to work up to 90 degrees in the next two weeks.
Again, Matt has a catheter and also a hemo-vac to drain the excess blood from his surgery sight. He's on oxygen and has an IV with saline to keep him hydrated as well as some antibiotics.
It's been a long day. But we're doing well and are thankful for how God has brought us through.
Wednesday, April 21, 2010
Four tattoos and ectopic bone
But the lingering dermatitis on my skin has been threatening the April 26 surgery date. It finally started to go away, so I stopped using the steroid cream, but the dermatitis returned so I'm back to using the steroid cream twice a day. The big question around here the last month or so has been, will it clear up enough for surgery?
Monday before my CT appointment Dr. Mayo carved out a few minutes from his schedule to take a look at my skin. I definitely did not want to absorb the extra x-rays for a CT if we weren't going ahead with surgery on the 26th. But thankfully it has cleared up enough for him to cut. He thought surgery was scheduled for the following Wednesday two days later, but was relieved that he'd have another week to think about how to get at all the ectopic bone. He's hoping to get it all through the PAO incision, but that may not be possible, so he might have to make yet another incision. I'm glad that in a situation like this that's not cut-and-dry he has three decades of experience to draw from.
So I went ahead and did pre-op with Dr Mayo's new nurse Renee and then had the targeting CT done.
The targeting CT gives the radiation oncologist the information he needs in order to plan how to administer the radiation. The tech marked the outside of both hips with crosshairs, plus another in the center near my waistline, and another near my belly button. Then she gave me four tattoos in the center of each crosshair--just a dot made by needle prick. She next taped BBs on each crosshair so the reference points would show up on the CT. Once that was done it took another five minutes or so to get the CT.
So everything's in place. The insurance company pre-approved the surgery. I won't need to bank any blood this time, nor do they have me taking iron. I also won't need to shower with that nasty hex-something-or-ever stuff the night before and morning of. I'll be on a CPM machine at the hospital, will leave on crutches, wearing TED hose and two more weeks of Fragmin to minimize the possibility of clotting and stroke, but when I return home I'll sleep in my own bed instead of a rented hospital bed, and won't need a CPM machine at home. I don't know yet whether I'll need a commode or shower chair again. I'll be on a no-straight-leg-lifting restriction for four weeks, and then I can resume PT.
I'm skipping the epidural, as wonderful as it was last time, in favor of PCA in hope that I'll be able to get back on my feet sooner, which will help the swelling to subside quicker and keep my bowels moving, unlike last time. I'm guessing it'll hurt more than the perfect epidural I had before.
Krista will stay with me for the three or four days I'll be in the hospital. We'll try to update the blog as things progress.
Thanks for your prayers!
[update: added photo]
[update: added photo]
Thursday, March 18, 2010
I'm all screwed up
Three appointments this week: CT scan, consultation with the radiation oncologist, and an appointment with Dr. Mayo.
The CT scan was so Dr. Mayo could see how extensive the ectopic bone formation is. The consultation with the radiation oncologist was to prepare me for getting zapped around the time of the surgery to prevent new bone growth. And the appointment with Dr. Mayo was for him to analyze the CT scan to decide how he wants to go about harvesting all the extra bone. ("Harvesting" is an appropriate word considering I'm what they call a "bone farmer.")
I also brought home some pictures. First is an x-ray (taken probably in January) that shows some of the ectopic bone. All nine screws and five of the seven suture pins are visible. If you mouse over the image you'll see the ectopic bone highlighted in red, the small suture pins in green, and the screws that Dr. Mayo is going to remove in blue.
The other picture is a slice from the CT scan which shows a chunk of bone blocking the front of my hip. Mouse over to see the ectopic bone shaded red.
There are more images, but they're harder to read. The CT scan shows the extent of the ectopic bone much better than x-rays, and it turns out it's more extensive than was evident from the x-rays. It's going to take some doing to get at all the bone. Dr. Mayo is hopeful he can get at it through the front PAO incision, but it's possible he might need to go back in through the SDH incision (including slicing the trochanter again, etc.) or even a posterior incision, and possibly open the hip capsule.
So instead of this being a shorter surgery scheduled in the afternoon to fill out the day's surgery docket, this will have to be the main surgery for the day.
I'll probably be in the hospital three or four days, which seems a breeze after almost two weeks last time. Although I had a perfect epidural last time, I'm going to forgo it this time in order to get back on my feet and moving quicker. Epidurals cause the blood vessels in the legs to open up, with the effect that blood washes down and pools in the legs, which made me pass out when sitting up. The sooner I'm up and moving, the better to help the swelling go down and to avoid another ileus.
Speaking of ileus, Dr. Mayo said that mine was the first true ileus he's seen in a decade. He thinks it was likely caused by having an epidural for so long (I think it was eight days, starting with the SDH and continuing to three days after the PAO).
Next up is another CT scan April 19th for the radiology oncologist to use to craft his radiation plan, followed by surgery on the 26th. For four weeks or so I'll be back on the no-straight-leg-lifting restriction, and then I can start physical therapy for real. I can't wait to get back on my bike! And Krista's probably ready for me to start driving again.
My dad's praying for a bone-eating enzyme to clean things up so I don't need radiation or surgery. That'd be nice!
The CT scan was so Dr. Mayo could see how extensive the ectopic bone formation is. The consultation with the radiation oncologist was to prepare me for getting zapped around the time of the surgery to prevent new bone growth. And the appointment with Dr. Mayo was for him to analyze the CT scan to decide how he wants to go about harvesting all the extra bone. ("Harvesting" is an appropriate word considering I'm what they call a "bone farmer.")
There are more images, but they're harder to read. The CT scan shows the extent of the ectopic bone much better than x-rays, and it turns out it's more extensive than was evident from the x-rays. It's going to take some doing to get at all the bone. Dr. Mayo is hopeful he can get at it through the front PAO incision, but it's possible he might need to go back in through the SDH incision (including slicing the trochanter again, etc.) or even a posterior incision, and possibly open the hip capsule.
So instead of this being a shorter surgery scheduled in the afternoon to fill out the day's surgery docket, this will have to be the main surgery for the day.
I'll probably be in the hospital three or four days, which seems a breeze after almost two weeks last time. Although I had a perfect epidural last time, I'm going to forgo it this time in order to get back on my feet and moving quicker. Epidurals cause the blood vessels in the legs to open up, with the effect that blood washes down and pools in the legs, which made me pass out when sitting up. The sooner I'm up and moving, the better to help the swelling go down and to avoid another ileus.
Speaking of ileus, Dr. Mayo said that mine was the first true ileus he's seen in a decade. He thinks it was likely caused by having an epidural for so long (I think it was eight days, starting with the SDH and continuing to three days after the PAO).
Next up is another CT scan April 19th for the radiology oncologist to use to craft his radiation plan, followed by surgery on the 26th. For four weeks or so I'll be back on the no-straight-leg-lifting restriction, and then I can start physical therapy for real. I can't wait to get back on my bike! And Krista's probably ready for me to start driving again.
My dad's praying for a bone-eating enzyme to clean things up so I don't need radiation or surgery. That'd be nice!
Tuesday, February 16, 2010
Dermatitis gone, next steps toward surgery
Dr. Mayo sent me to a dermatologist to check on my dermatitis just in case. He prescribed the same treatment as Dr. Mayo--topical steroid cream a couple of times a day. I continued to do that and the dermatitis has finally cleared up.
Last week I had a follow-up appointment with Dr. Mayo. He's satisfied that my skin has cleared up enough to take the next step toward getting the ectopic bone out. He checked my range of motion: it's still around 50˚ flexion, 5-10˚ internal rotation. He doesn't see a point in continuing to see a physical therapist at this point until he cleans that ectopic bone out.
The next step is another CT scan to map out the ectopic bone, a month from now. I'll also have a consultation with the radiation therapy folks regarding the single, low-dose of radiation they'll give me at my next surgery. Then I meet with Dr. Mayo to see what the CT shows. Thankfully, all those appointments are scheduled for the same day.
Then a month or so after that--likely sometime in April--Dr. Mayo will go back in and remove the ectopic bone and most of the screws. I have nine screws in my right hip, and seven suture anchors. The anchors stay, but I think he can remove as many as five screws through the PAO incision; two will be replaced as he'll need them to secure a chunk of bone that he needs to remove and replace again. If he needs to reopen the SDH incision to get all the ectopic bone then he'll remove the two screws in my trochanter. So best case I end up with two screws remaining.
Keri located some more x-rays (intra-op from the PAO), but we have yet to find the digital photos for the SDH. Evidently the machine that handles those doesn't talk to Multicare's network, so a radiology person has to upload them manually. She's doing her best to track them down. I'm very curious to see them.
My hip feels pretty good, considering. The joint doesn't hurt, just the tight muscles, and of course my range of motion continues to be limited. I still can't drive comfortably. But some things that hurt before surgery don't hurt now, and my hip no longer aches when I lie in bed at night. It really is amazing to think that the body can sustain such trauma and heal so well. Of course it helps that the trauma was intentional and therapeutic.
I can't say enough good about Dr. Mayo. I'm very grateful to have such a capable, conscientious hip virtuoso working on my hip.
Sunday, January 24, 2010
Four-month check-up
After the usual x-rays Dr. Mayo checked me out. He says I have about 40˚ of hip flexion (instead of a normal 100-110˚) and still almost no internal rotation. The x-rays don't show the ectopic bone to have spread much more than before, but it doesn't show up that well with this kind of x-ray. A CT scan will be necessary to determine its extent.
But he said no CT scan, bone-cell zapping, or surgery until my skin clears up, which it now mostly has.
This time I got a copy of the SDH x-rays, of which one is posted here for your viewing pleasure. This x-ray was taken at the end of the SDH surgery, before the PAO. You can see the two long screws he used to hold the slab of my trochanter in place, and seven small dark spots around my joint marking the suture anchors he used to tie my labrum back into place. In the course of repairing my labrum he had to trim back a few millimeters of my acetabulum, temporarily increasing my degree of dysplasia.
They didn't have the digital photos from the SDH surgery at hand, so I wasn't able to get a copy of those. Hopefully at my next appointment, as well as x-rays post-PAO showing all sixteen pieces of metal.
Meanwhile all the travel and stairs I climbed in Colorado have helped strength my leg alot. I'm limping much less, and I can almost entirely hide the limp by cheating with my toes to raise my leg up a bit. I still don't fit comfortably in the front seat of the van, so I'm still keeping the kids in the back. After reading about the PT other PAO patients are getting, I'm going to try a more rigorous physical therapist.
This year for Christmas I got...cellulitis!
For a couple of months I've had a small patch of scaly skin on my hip between the two incisions. Seeing that it wasn't going away and knowing that another surgery is coming up I decided it was time to do something about it. Hoping it was just dry skin, I gently picked at one spot--just enough to draw a tiny drop of blood--but it wasn't peeling off like dry skin, so I left it.
The next day I went to my primary care doctor to get his opinion. He diagnosed it as dermatitus and he prescribed a topical steroid cream to apply twice a day, to get my immune system to stop overreacting.
The following day we set off on a Christmas trip to Colorado Springs. All my side of the family was meeting up at my sister and brother-in-law's, the first time in four years we've all been together. That morning I started to get congested, and by the time we got off the plane in Denver I had a full-blown sinus/altitude headache.
When we finally arrived at my sister's I looked at my hip--it was bright red halfway down my leg and halfway around my backside, hot and much more sensitive to touch than normal. I assumed it was due to all the activity of the day and figured I'd give it some time. Besides, it was the sinus headache that was making me the most miserable.
Two days later my sinus headache was diminishing but my hip was not improving, so we found a doctor nearby. The doctor and his nurse were both very interested to see me, saying mine was "the most interesting case of the day." The doctor looked at my skin and said very seriously, "I don't want to alarm you, but this could be very serious," diagnosing it as cellulitis, a skin infection. He proceeded to lay out the various options, from just oral antibiotics at best to IV antibiotics in a hospital to surgical intervention if infection collects around the hardware. But first he wanted to give me a big shot of Rocephin to see if the infection would respond to antibiotics. And he instructed me not to use the steroid cream (which I hadn't used yet anyway) on my dermatitus, as the steroids would inhibit the fight against the infection.
So after a warning about it hurting like an injection of peanut butter they jabbed two syringes of Rocephin into my backside (the good side), took some blood, and sent me home with an appointment for the next day.
The Rocephin worked--the skin seemed less hot to touch and the redness seemed to decrease somewhat. The doctor thought the antibiotics were working so he prescribed a combo oral antibiotic for 10 days. My blood work showed a CRP of 145 (with an annotation saying that a value greater than 3.0 was an indication of a future cardiac event), and my sed rate was 40.
Thankfully nothing more invasive was required. I did not want anyone except Dr. Mayo to cut on my hip, so I traded email with Sarah, his PA. She was the first todiagnose call it cellulitis, from a picture I emailed her. She was a superb help throughout the whole ordeal.
(Make a too-long story less long: leave out half a dozen visits to my surgeon, primary care doctor, an urgent care doctor, and a dermatologist...)
Now, after 20 days of Augmentin and about two weeks of using a steroid cream, the redness is almost entirely gone, and the dermatitus is almost entirely gone, leaving behind somewhat darkened pigment.
My surgeon won't operate until my skin's "pristine," which it will hopefully be by my next appointment in a couple of weeks.
The next day I went to my primary care doctor to get his opinion. He diagnosed it as dermatitus and he prescribed a topical steroid cream to apply twice a day, to get my immune system to stop overreacting.
The following day we set off on a Christmas trip to Colorado Springs. All my side of the family was meeting up at my sister and brother-in-law's, the first time in four years we've all been together. That morning I started to get congested, and by the time we got off the plane in Denver I had a full-blown sinus/altitude headache.
When we finally arrived at my sister's I looked at my hip--it was bright red halfway down my leg and halfway around my backside, hot and much more sensitive to touch than normal. I assumed it was due to all the activity of the day and figured I'd give it some time. Besides, it was the sinus headache that was making me the most miserable.
Two days later my sinus headache was diminishing but my hip was not improving, so we found a doctor nearby. The doctor and his nurse were both very interested to see me, saying mine was "the most interesting case of the day." The doctor looked at my skin and said very seriously, "I don't want to alarm you, but this could be very serious," diagnosing it as cellulitis, a skin infection. He proceeded to lay out the various options, from just oral antibiotics at best to IV antibiotics in a hospital to surgical intervention if infection collects around the hardware. But first he wanted to give me a big shot of Rocephin to see if the infection would respond to antibiotics. And he instructed me not to use the steroid cream (which I hadn't used yet anyway) on my dermatitus, as the steroids would inhibit the fight against the infection.
So after a warning about it hurting like an injection of peanut butter they jabbed two syringes of Rocephin into my backside (the good side), took some blood, and sent me home with an appointment for the next day.
The Rocephin worked--the skin seemed less hot to touch and the redness seemed to decrease somewhat. The doctor thought the antibiotics were working so he prescribed a combo oral antibiotic for 10 days. My blood work showed a CRP of 145 (with an annotation saying that a value greater than 3.0 was an indication of a future cardiac event), and my sed rate was 40.
Thankfully nothing more invasive was required. I did not want anyone except Dr. Mayo to cut on my hip, so I traded email with Sarah, his PA. She was the first to
(Make a too-long story less long: leave out half a dozen visits to my surgeon, primary care doctor, an urgent care doctor, and a dermatologist...)
Now, after 20 days of Augmentin and about two weeks of using a steroid cream, the redness is almost entirely gone, and the dermatitus is almost entirely gone, leaving behind somewhat darkened pigment.
My surgeon won't operate until my skin's "pristine," which it will hopefully be by my next appointment in a couple of weeks.
Saturday, January 9, 2010
Physical therapy
(Yes, I've been delinquent in posting updates. Terri's excellent posts on her PT reminded me that I needed to post about it too.)
Since I've been given the go-ahead to bear full weight, I've been doing physical therapy to loosen and strengthen my hip muscles. For the first few weeks I went into the PT office twice a week, but now I'm just doing the exercises he gave me at home.
At first it was all I could do to bear enough weight on the operated side to quickly drag my good leg forward a little bit in time to take my weight before the other leg gave out. And was my hip ever tight! I tried to be super careful not to violate any of Dr Mayo's straight-leg lifting and abduction limitations, since it would be a Bad Thing™to tear one of those muscles free. That, together with the ectopic bone mass in front of my hip socket made for a very tight joint, with virtually no internal or external rotation. But I could get around reasonably well with one crutch.
So I began PT. My physical therapist gave me several exercises to do: abduction (a sort of standing one-legged snow angel), extension (holding the leg extended backwards), and rotation (while lying flat wearing an ankle weight with the knee bent 90˚, lower the foot to either side).
He recommends holding the muscle in the stretched position for a minute or so because after about 45 seconds or so the stretched muscle "melts" and begins to relax, thus helping the muscle to stretch.
After a couple of visits he gave me a length of Theraband (a piece of colored surgical tubing) to add resistance for building up strength. I tie a loop in one end, stick it around my ankle, and anchor the other end by closing the other knotted end in a door. Then I do three sets of 10 reps of abduction, adduction, and extension exercises.
For a while a muscle deep on the inside of my leg felt very tight, so I worked on isolating that muscle and stretching it frequently. I think it's stretched out (as much as its neighbors anyway) since I'm not able to "find" it anymore.
Sometimes it feels like one of the muscles that attaches to the outside of my leg bone (to the trochanter) is more of an inflexible strap rather than a pliable muscle. It's a weird sensation. I'm not sure if it needs stretching, or whether that's a side effect of the ectopic bone tissue, or what.
After a week or so of PT I was able to waddle around with a severe limp when not using my crutch. My operated side would dip down so much when I shifted my weight to that side that I wondered if my leg were now shorter than before, but my physical therapist said it's all due to muscle weakness. (Besides, physiologically it was impossible that the surgeries I had would have that effect.) I was surprised to learn how much our muscles support us; before I assumed that muscles just move our bones, but evidently they do a lot more than that.
Now I walk with a mild limp with no crutches. What seems to have helped the most (but it could just be coincidence) is climbing stairs the two weeks we spent at my sister and brother-in-law's house over Christmas. At first it was almost impossible to step up using my operated leg, but by the end of the two weeks I was able to walk up normally without using the handrails, except for the wobbling and grunting. It feels strangely good to go uphill now, healthy, as if the exertion is getting everything all properly tightened up and aligned. I need to make sure I'm not violating Dr Mayo's limitations; I hope not because it feels good.
The rotation stretch seems to have helped a lot, and is the stretch that's the most uncomfortable.
My major limitation is still hip flexion (i.e. bending the hip into a sitting position). The ectopic bone tissue in front of my joint severely restricts how far it will bend. Every few weeks I try to sit in the front seat of our van but it just won't bend enough, which means I sit in the middle row with my daughter Eden (thankfully I don't need a car seat). I can sit in the driver's seat for a few minutes, but it's such a cramped position I can't easily move my foot from the accelerator to the brake pedal, requiring me to use my left foot for the brake. Also after a few minutes it becomes very uncomfortable. So until we can hack out that ectopic bone, I'm just a passenger.
More on that in a bit.
Since I've been given the go-ahead to bear full weight, I've been doing physical therapy to loosen and strengthen my hip muscles. For the first few weeks I went into the PT office twice a week, but now I'm just doing the exercises he gave me at home.
At first it was all I could do to bear enough weight on the operated side to quickly drag my good leg forward a little bit in time to take my weight before the other leg gave out. And was my hip ever tight! I tried to be super careful not to violate any of Dr Mayo's straight-leg lifting and abduction limitations, since it would be a Bad Thing™to tear one of those muscles free. That, together with the ectopic bone mass in front of my hip socket made for a very tight joint, with virtually no internal or external rotation. But I could get around reasonably well with one crutch.
So I began PT. My physical therapist gave me several exercises to do: abduction (a sort of standing one-legged snow angel), extension (holding the leg extended backwards), and rotation (while lying flat wearing an ankle weight with the knee bent 90˚, lower the foot to either side).
He recommends holding the muscle in the stretched position for a minute or so because after about 45 seconds or so the stretched muscle "melts" and begins to relax, thus helping the muscle to stretch.
After a couple of visits he gave me a length of Theraband (a piece of colored surgical tubing) to add resistance for building up strength. I tie a loop in one end, stick it around my ankle, and anchor the other end by closing the other knotted end in a door. Then I do three sets of 10 reps of abduction, adduction, and extension exercises.
For a while a muscle deep on the inside of my leg felt very tight, so I worked on isolating that muscle and stretching it frequently. I think it's stretched out (as much as its neighbors anyway) since I'm not able to "find" it anymore.
Sometimes it feels like one of the muscles that attaches to the outside of my leg bone (to the trochanter) is more of an inflexible strap rather than a pliable muscle. It's a weird sensation. I'm not sure if it needs stretching, or whether that's a side effect of the ectopic bone tissue, or what.
After a week or so of PT I was able to waddle around with a severe limp when not using my crutch. My operated side would dip down so much when I shifted my weight to that side that I wondered if my leg were now shorter than before, but my physical therapist said it's all due to muscle weakness. (Besides, physiologically it was impossible that the surgeries I had would have that effect.) I was surprised to learn how much our muscles support us; before I assumed that muscles just move our bones, but evidently they do a lot more than that.
Now I walk with a mild limp with no crutches. What seems to have helped the most (but it could just be coincidence) is climbing stairs the two weeks we spent at my sister and brother-in-law's house over Christmas. At first it was almost impossible to step up using my operated leg, but by the end of the two weeks I was able to walk up normally without using the handrails, except for the wobbling and grunting. It feels strangely good to go uphill now, healthy, as if the exertion is getting everything all properly tightened up and aligned. I need to make sure I'm not violating Dr Mayo's limitations; I hope not because it feels good.
The rotation stretch seems to have helped a lot, and is the stretch that's the most uncomfortable.
My major limitation is still hip flexion (i.e. bending the hip into a sitting position). The ectopic bone tissue in front of my joint severely restricts how far it will bend. Every few weeks I try to sit in the front seat of our van but it just won't bend enough, which means I sit in the middle row with my daughter Eden (thankfully I don't need a car seat). I can sit in the driver's seat for a few minutes, but it's such a cramped position I can't easily move my foot from the accelerator to the brake pedal, requiring me to use my left foot for the brake. Also after a few minutes it becomes very uncomfortable. So until we can hack out that ectopic bone, I'm just a passenger.
More on that in a bit.
Subscribe to:
Posts (Atom)
