Speaking of limping...

My brother Justin reminded me of this Monty Python skit. Sadly I'm not yet capable of qualifying for one of these government grants.

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.

Week 5 (SDH+5 weeks, PAO+~4 weeks): status

Progress continues, though usually not dramatic.

Last week I finally figured out what a 60˚ hip angle translates to on the knee CPM machine, and I hit that target, so I'm done with the CPM machine as well. Which is good, since it costs $25/day.


Two nights ago I slept in our own bed for the first time since surgery, and slept as well as in the hospital bed (which is to say about five hours), so today we returned the hospital bed. It's so nice not to have to sleep on the opposite side of the room from Krista! I'm now also able to turn onto my non-operated side, which is a very nice after a month in one position on my back. It's also better for my heels, since it takes all the pressure off them.

Today I worked a full day (telecommuting), the first since surgery. But that was sitting in the hospital bed; I'm not sure I'll make it all day yet on any of our chairs or couches.

I'm learning how to do more myself, such as getting into the shower, into bed, into the van. The main thing I need help with is changing my heel dressing.

Speaking of my heels, the left heel is fine now, but the right is slower to heal. We took off the dead skin part of the blister/sore and though it's ugly it seems to be healing better now. Krista cleans it at least daily and tapes gauze over it.

The crutches are taking their toll, making my hands a bit numb. Maybe I'm not using the proper technique.

I'm eagerly looking forward to my first follow-up appointment in three weeks. I'm guessing Dr Mayo will want me to wait longer before starting to walk on it.

All in all, it's going very well. We are very grateful to God for taking such good care of us!

Day 28 (SDH+27, PAO+22): Done with Fragmin shots

Today Krista gave me my last Fragmin (anti-coagulant) shot!

Day 27 (SDH+26, PAO+21): heel sores

While in the hospital my heels started getting very tender. Because I could only lie on my back, there was constant pressure on my heels. Plus the TED hose (compression socks) add a lot of pressure over the heels. Add to that a long hospital stay due to having two surgeries.

At home I sit up for large portions of the day, but I still have to lay on my back all night and during naps. And I'm supposed to wear the TED hose until my Fragmin (anti-coagulant) shots are done.

So my heels have gotten worse. My friend Scott who's a nurse considers my left heel to have a deep tissue injury. The dark spot is about the size of a nickel and is basically a deep bruise.

My right heel is worse. Scott calls it "an advanced stage two ulcer." It looks like a big blister and oozes a lot. For a few days my whole heel would throb when I would stand up.

Scott gave me a stern talking-to, telling me how fast these can get out of control, and told me to call my doctor for advice. He explained how pressure (the heel laying on the bed) and shear forces (the heel sliding back and forth on the CPM machine) and TED hose can restrict circulation, leading to this problem. He also helped me to adjust my CPM machine so it doesn't rub my right heel.

So I called Dr Mayo's office and emailed some pictures. It was a clinic day for him so his schedule was full, but in typical Dr Mayo fashion he still managed to shoe-horn me in the same day, calling me back around 9 pm. He told me to stop wearing the TED hose even though it's a bit early (yay!) and suggested getting off the CPM machine as soon as I reach my target (60˚, which I can probably hit but haven't gotten around to measuring yet, naughty me), and of course keeping pressure off my heels.

It's been nice not to have to wear the TED hose the last few days. My left heel isn't bothering me any more, with no swelling, though it still has that big round dark spot. My right heel no longer throbs when standing, so I think it's making a difference, though it is still red and swollen. Also, the last two or three nights I've not been sleeping in the CPM machine, which increases circulation because my right leg isn't elevated above my body all night. We're also going to try to experiment with lying on my side; having another sleeping position would help a lot. I'm trying to get up and around more, since movement and activity improve circulation.

Also, my sister sent me Herbal Ed's Salve which we apply every time I change my socks, which is a couple of times a day because of the ooze.

All this has made me realize how difficult it must be for people who are bed-ridden, and yet again how many blessings I take for granted.

SDH video

I found an SDH video, narrated by Dr Ganz who pioneered this particular technique. Dr Mayo did something very similar in my first surgery, except once the joint was opened the repair was much different (labral repair, 10 mm OATS, shave neck offset). The surgery itself begins about 8:20.

I purposely waited until after my surgeries to watch this.

Thanks

Krista and I both feel overwhelmingly thankful.

Thankful to God for sustaining us and blessing us through so many different people.

We are thankful for Dr Mayo, for his amazing skill as a surgeon and his top-notch care. Also for his cheerful PA Sarah, who checked on us frequently, and who had to field a 2 am call during the ileus adventure.

We are thankful to the nursing staff for their gentle care: Kim, Larissa, Stephanie, Martha, Nick, Karie, Ron, Chris, Rowenna, Shienna, Joy, Charlene, Margie, Pat, Ivonna, Sherry, Phyllis, Katie, Jesse, Joey, Christina, Jaeyoung, Louella.  I'm sure I've left some out. Their care was excellent, and often personal.

We are thankful to the physical therapists, David and Pam, for their encouraging, patient, and needful semi-torture.

We are thankful for drugs, technology, and anesthesiologists (particularly Drs. Robinson and Elder). Epidurals are amazing!

We are thankful to all the family and friends who helped with the kids so Krista could stay with me: Krista's parents, aunt Kay, and sister Kari, and our friends the Deffinbaughs, and for others who offered to help. Also my good friend Scott Matheny stayed with me a night and continues to give a lot of good advice.

We are thankful for all of you who visited, called, commented, emailed, or sent cards. Thank you for sharing our joys and burdens!