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.

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!

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:

• 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.

Four tattoos and ectopic bone

Monday I had a CT scheduled for the radiation oncologist to use for targeting the radiation treatment he'll administer on surgery day. (This single dose of radiation is to suppress additional ectopic bone from forming after this next surgery.)

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]