Four-month check-up

Right after we got back from Colorado I went in for my four-month appointment with Dr. Mayo--a bit early to check up on the cellulitis. By chance we got to see Terri again, and she seemed to be recovering swimmingly, as usual. She ought to be the PAO poster child.

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 to diagnose 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.

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.