Ectopic bone

So you wanna see what ectopic bone looks like after it's been "morselized"? Here is a picture of what Dr. Mayo removed. He said there was actually more; some had already been taken before he told them to get a picture for me.

Looks like stew meat, or a tasty treat for Fido.

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!

Day 9 post HO removal surgery

My hip feels great. I can do everything for myself. My range of motion is greatly improved. Flexion is pretty good, good enough that I can put socks on the normal way, even my TED hose. External rotation is excellent and unstrained; internal rotation while pretty good still feels a little tender.

The joint feels very stable, and if I'm not moving there's no pain. The muscles have healed up enough so that I need to remind myself not to overdo it. Every now and then I'll move a certain way and be reminded of Dr. Mayo's no straight leg-lifting and active abduction restrictions.

I'm using one crutch to even out my gait. I can walk without a crutch, but with a limp.

When I walk there is some muscle pain, which is probably related to the muscles Dr. Mayo had to detach, but it decreases every day.

At first it was painful to cough, but that pain is almost gone now.

I can comfortably sleep on my back or on my non-operated side. I can use a regular toilet without having to have my leg sticking out straight in front of me.

The bad:

My leg has started to swell and looks maybe 10-15% larger than the other leg. Also, it is bumpy and itchy at times. I remember going through a phase like this last time; I hope it passes quickly. I'm trying to go for walks more often to get that stuff broken down and pumped out.

My incision is red in places and my hip is swollen somewhat but not enough to prevent me from wearing pants. I'm hoping and praying that I can avoid infection and dermatitis.

One thing I've learned through these surgeries is that I have very sensitive skin. My belly has broken out with a rash where something was taped. It's possible that the itchiness and bumps on my leg are a delayed reaction to the nasty green stuff they scrub it with.

I do not cease to be amazed at how our bodies recover after being (carefully) hacked open and screwed, sewn, glued, and taped shut.

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.

Day 1 radiation therapy

[Flashback to the day of surgery, to fill in details on radiation therapy for those interested]

The morning of surgery, after checking into surgery pre-admission and changing into the lovely gown, we waited for radiation therapy to call. Finally about 7:30 they were available so a couple of nurses wheeled me and Krista down to radiation therapy--the long way. Neither nurse was sure how to get there with all the construction and rearranging that's been going on, with misleading signs thrown in for good measure. 

After 20 or 30 minutes we finally arrived. The radiation tech was clear, concise and assured us that we're in good hands because she's been doing this 20 years. She briefly showed us the plan on a computer monitor and then wheeled me into a large, open room with a concrete floor, various machines, and green laser beams criss-crossing in places. The machine they were using on me was much less intimidating than a CT or MRI machine, but way more dangerous.

Seeing a sizable chunk of lead on the platform I'd be lying on, I chuckled, and the tech said she'd explain that.

She told me that I would be receiving a single dose of radiation, a blend of five kinds of photons, X of something else and Y of something else, 700 centiGray's worth (absorbed, I think).

Next I get up on the platform while the tech and her assistant graciously give me the room while I employed the lead cup in the fashion they described (though I suppose they were watching on camera). They return, propping up my knees with a slab of foam, hooking my feet together with a rubber loop so I don't slip out of position, and then they line me up under their laser crosshairs. Satisfied with my position, they tell me to hold still and depart the room to run the machine.

First the machine does some calibration, taking a quick image from above and then one from below to make sure they align properly. Then the actual radiation bath began, bathing my front and then the rear. I think this stage was only a couple of minutes. While this is happening I could see these metal shapes inside the emitter head (or whatever it's called) shifting themselves into the shape that I saw on the computer monitor earlier.

And that was it. I freed myself from the lead prison (let's hope it worked) and then was wheeled back to the fifth floor for surgery.

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.