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!

Week 8: full weight bearing, a speed bump

[Warning: long post]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Synopsis

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

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

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

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

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

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

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

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

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

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

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

2 weeks (SDH+13, PAO+8)

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

Day 13 (SDH+12, PAO+7)

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

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

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

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

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

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

We're making some progress!

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

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

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

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

More Matt quotes:

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

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

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

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

Day 11 (SDH+10, PAO+5)

Just a quick update...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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]