Post-surgery Day 2

This morning Dr Mayo came by to check on Matt.  He thought Matt looked really good, ordered the nurses to remove his catheter and IV.  If he needs any pain management he'll take some pills orally.

Physical therapy came around 10:30 am and got Matt on his feet.  His blood pressure is on the low side and he struggled with light headedness so only stood for about 5 minutes.  They'll come again tomorrow.

Later this afternoon I helped Matt sit up and he walked to the bathroom and felt great!  He then proceeded to wash his hands in the sink, wash his hair, and brush his teeth.  He was very encouraged.

Matt is doing well on the CPM.  He's already almost up to 90 degrees flexion with no pain!

That's all for today...

Day of surgery (to remove ectopic bone)

We arrived at the hospital at 5:30 this morning.  We went through admittance and Matt received a small dose of radiation to help prevent ectopic bone from forming again after today's surgery.  We happened to pass Dr Mayo in the hall and said hello.  Matt yelled back, "Save the screws!"  He's hoping to get the screws that Dr Mayo will be taking out from his PAO in September.

Matt was rolled away for surgery at 8:30.  It was a long wait and I didn't hear anything from Dr Mayo until 3:40 in the afternoon.  The surgery went well but took longer than expected because there was a lot of ectopic bone.  He removed about an equivalent of 1 1/2 cups of bone and also cleaned out some scar tissue.  Dr Mayo was able to enter through the same incision spot from last surgery so Matt won't have any additional scars.  He lost a bit of blood but they reused what blood pooled and siphoned it back somehow.

Matt awoke from the anesthesia feeling a bit nauseous and threw up once.  The nurses graciously changed his bedding and then gave him some anti-nausea medicine which helped.  He's on an IV for pain medication and can control it himself.  So far he hasn't taken much.  He wants to do all he can to avoid having an ileus again.

They put him on a hip CPM in bed and he's doing well with it moving his leg up and down.  It's currently set at 40 degrees flexion and Dr Mayo wants him to work up to 90 degrees in the next two weeks.

Again, Matt has a catheter and also a hemo-vac to drain the excess blood from his surgery sight.  He's on oxygen and has an IV with saline to keep him hydrated as well as some antibiotics.

It's been a long day.  But we're doing well and are thankful for how God has brought us through.

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]

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!

Dermatitis gone, next steps toward surgery

Dr. Mayo sent me to a dermatologist to check on my dermatitis just in case. He prescribed the same treatment as Dr. Mayo--topical steroid cream a couple of times a day. I continued to do that and the dermatitis has finally cleared up.

Last week I had a follow-up appointment with Dr. Mayo. He's satisfied that my skin has cleared up enough to take the next step toward getting the ectopic bone out. He checked my range of motion: it's still around 50˚ flexion, 5-10˚ internal rotation. He doesn't see a point in continuing to see a physical therapist at this point until he cleans that ectopic bone out.

The next step is another CT scan to map out the ectopic bone, a month from now. I'll also have a consultation with the radiation therapy folks regarding the single, low-dose of radiation they'll give me at my next surgery. Then I meet with Dr. Mayo to see what the CT shows. Thankfully, all those appointments are scheduled for the same day.

Then a month or so after that--likely sometime in April--Dr. Mayo will go back in and remove the ectopic bone and most of the screws. I have nine screws in my right hip, and seven suture anchors. The anchors stay, but I think he can remove as many as five screws through the PAO incision; two will be replaced as he'll need them to secure a chunk of bone that he needs to remove and replace again. If he needs to reopen the SDH incision to get all the ectopic bone then he'll remove the two screws in my trochanter. So best case I end up with two screws remaining.

Keri located some more x-rays (intra-op from the PAO), but we have yet to find the digital photos for the SDH. Evidently the machine that handles those doesn't talk to Multicare's network, so a radiology person has to upload them manually. She's doing her best to track them down. I'm very curious to see them.

My hip feels pretty good, considering. The joint doesn't hurt, just the tight muscles, and of course my range of motion continues to be limited. I still can't drive comfortably. But some things that hurt before surgery don't hurt now, and my hip no longer aches when I lie in bed at night. It really is amazing to think that the body can sustain such trauma and heal so well. Of course it helps that the trauma was intentional and therapeutic.

I can't say enough good about Dr. Mayo. I'm very grateful to have such a capable, conscientious hip virtuoso working on my hip.

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.