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]
Matt - I heard from a woman who had ectopic bone removed post PAO that it was a "piece of cake" compared to her PAO. She was out of the hospital the next day. Knowing our Dr. Mayo and with your past issues, he probably will keep you a bit longer just to make sure you are OK, but I think this will be MUCH easier and you should feel loads better when it's over and you can move your leg correctly, drive, etc.
ReplyDeleteI'm also curious - how do they administer the radiation?
Sending you happy healing vibes! Terri
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ReplyDeleteTerri,
ReplyDeleteI'm not sure of all the particulars of how they administer the radiation, but I do know that I'll be mostly covered with lead blankets and a sort of lead clamshell around the reproductive organs to protect against the scatter. The linear accelerator, which emits the radiation, is positioned and the beam is shaped using lead cones or wedges. If I recall correctly the actual exposure is about a minute and a half.
One question I've asked a couple of the radiology/CT techs is whether they track the amount of radiation a patient receives. One CT tech gave me the lame "you wouldn't understand" non-answer, and the other didn't seem to know the answer. What are the units used to measure the radiation, and how much is safe to absorb? They ought to record that info with all the imagery, and track the total.
According to the radiation oncologist I saw at the hospital the important part is for the linear accelerator to be properly calibrated; that's his answer to the Jan 23 NY Times article on the subject.
The radiation therapy people will come get me from the pre-op waiting area, wheel me down to their office and zap me, then wheel me back.
The treatment is effective from six hours before to 48 hours or so after. Dr Singh said that the chance of HO forming again after radiation therapy is something like 3-5%, vs about 60% without.
Somewhere I read that HO forms in something like 57% of hip surgeries. You and I both rolled the dice twice, and proved the odds.
There are lots of comparative studies between radiation and NSAID treatments here:
http://en.wikibooks.org/wiki/Radiation_Oncology/Heterotopic_ossification
Looks like radiation is more effective. This statement is comforting: "Carcinogenesis theoretical concern (no documented cases after HO prevention thus far)."
Thanks for the encouraging story. I'm glad to hear the PCA was adequate. I'm guessing it won't hurt as much, especially as much as two surgeries five days apart, plus no epidural coverage for a couple hours the one time, with an ileus thrown in for good measure. I'm just hoping he can get it all through the PAO incision, which might be wishful thinking since two separate surgical approaches are involved. I'll find out soon enough!