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Monday, June 30, 2014

I'm so ready to move on!

I wish I could say that this recovery continued as smoothly as it began, but the last week has been borderline awful. I'm so ready to move on from this phase of recovery!

It kind of went like this:
Draining wound => Fever, chills, short illness => Bactrim DS prescription => Terrible oral ulcers, mostly under the tongue, a Bactrim side effect => Guyon's Canal Syndrome

Guyon's Canal Syndrome is basically a pinched ulnar nerve, thanks to pressure on the palms while on crutches. It's not the end of the world, but my pinky fingers are numb and my palms ache. It makes using crutches tough. Now I'm working with crutches I can't use, and I can barely speak thanks to mouth sores. Not exactly a picnic.

Oh, and finally my hip started complaining a little. I'm probably putting a little pressure on it because I'm struggling with the crutches, and it aches and pinches. I was worried that I'm feeling a pinch right where I felt pain before the surgery, but I think that's normal - after all, that's where the work was done! A really nice member of Varsity Sports, my running group, emailed me about her surgery last year. I've never met her before (we're a large group and I only run with them for Monday track) but she saw my post to the group about surgery and reached out to me. I asked her about the pain and she said she felt the same thing, and it takes a long time to return to normal. She's 9 months out and still in PT, although she's finally back to running, so that is a sobering lesson to me to not expect too much, too soon.

This weekend I had to go to a nephew's birthday party at that hell-hole, Chuck E Cheese's, and the theme was Transformers. I impressed by being the only grown up in a Transformer costume:
I transform into a wheelchair, I suppose.

Speaking of costumes, dressing with the brace has been a bit of a challenge. One look I like is a tight undershirt or camisole that stays put under the brace, then a boxy crop top over it. It sort of minimizes the brace. You can't really tell in this picture...which is the point. I just look a little lumpy.
Those are wedges, but yes, I have definitely worn heels while on crutches! 

I still feel like a blob in an awkward brace, but at least I'm a coordinated slob in a trendy crop top.

Friday, June 27, 2014

Everything was going fine until it wasn't

Man, I was KILLING this surgery thing! Back to work after the weekend, continuing with my busy social life, creating delicious meals (green onion sausage and mushroom ragu over polenta with fresh rosemary and creme fraiche), diligently completing PT, feeling not an ounce of pain. Just tired when I got home from work, that's all.
This is a picture of me diligently completing PT. 

Everything was fine!
Then the wound started to drain. And drain and drain and drain and drain. It was annoying and gross. But it wasn't infected, so I just skipped the antibiotic my doctor prescribed (DO NOT TRY THIS AT HOME). I thought the wound had finally closed up, but at PT last Tuesday, it opened up again and the draining started all over again. I was at work later that day when my doctor totally busted me. I was hopping on one leg to help a customer with a bulky bag - I needed both hands, so I put my crutches down - and in walked my doc. The look on his face was terrifying.
He just stared me down for a few minutes, while I sheepishly made up excuses about why I was hoppin gon one leg and why my crutches were 7 feet away, then he asked about the drainage. "But you're taking your Bactrim, right?" he asked. I had to admit that no, I wasn't, as it was clear discharge, no puss. "That's smart," he snapped. "You have an open channel communicating with your joint. How does osteomyelitis sound?"

I was rather filled with shame. I mean, I'm a pharmacist! I filled the prescription. And then I got sick. I swear, the minute my doctor left I realized I was flushed and warm - embarrassed by my doctor? Or...fever?

When I realized I had a slight fever, I rushed to check the wound. Luckily, they still look clean and there is no infection of the site. But my throat ached. The light hurt my eyes. I felt sore all over.

And now I feel like crap. I'm fighting some kind of infection (it feels like a mild late flu), trying not to topple over with exhaustion at work, and on top of it all one of my techs resigned. And it's poured rain every single evening for a week, and I can't exactly manage and umbrella and crutches. It's not fun anymore! I'm ready for the crutch and brace phase to be over!

Wednesday, June 25, 2014

The torture device I sleep in

At night, I lock myself into a CPM, or continuous passive motion machine, and set the timer for 4 hours. I plop an ice pack on my hip, and go to sleep.

The CPM makes a whirring sound as it cranks my leg from 0 to x degrees - "x" started at 45 degrees, and my doctor has me going up by 5 degrees a night until I'm at 90. I do not recommend enjoying the plush comfort of the CPM machine in the summer, as its fake fur lining reaches about 180 degrees F by midnight. Luckily, my body temperature stays pretty average, as my groin is being concurrently frozen off by the direct application of ice.

When the machine turns off, I wake up. Then I start the long, complicated process of extricating my leg, finding my crutches in the dark, crawling/falling over my husband or my CPM machine (depending on which side of the bed I choose to get out of), and crashing into the bathroom to throw my melted icepack into the sink.

When I get back in bed, having completely ruined my husband's night, I roll onto my stomach for the 2 to 3 hours of recommended tummy time. I'm supposed to lie on my stomach to gently stretch the hip flexors.

It's so fun. You wouldn't believe the wonders my sleeping habits are doing for our marriage.

Tuesday, June 24, 2014

Picnic at the park

Friday after surgery I was getting tired and bored.

Audubon Park and dear friends to the rescue! Our friends at Phillip's Bar called me and told me to stop by. I took my crutches down the block, and picked up a to-go dinner!
Those guys had made us a garlic and prosciutto pizza, Caesar salad, homemade pasta (swoon), and boxed it up with a bottle of wine!
Twenty-four hours post-op

We drove over to the park and enjoyed a delicious dinner as the sun set. I'll miss this beautiful park while I recover.

Monday, June 23, 2014

My track club is the best!

The New Orleans Track Club sent me a card! Aren't the they cutest track club ever?

My incisions have been steadily improving, although still draining, but the fluids are still creating a little swelling.

Once the swelling really subsides, I expect that I'll start feeling the pain from surgery as I mobilize. For now I'm still feeling excellent, with just a little awareness of aching and swelling, neither of which is bad to enough to classify as pain.

I expect that as PT progresses, I'll begin moving muscles that will put stress on the surgery site, so this week and next will reveal where there is pain. Until then, I'm enjoying lying around strapped in a cumbersome brace pain-free.

Friday, June 20, 2014

Physical therapy for hip labral tear

One of the nice things about my surgery is that I had it done within the Tulane network. I work inside Tulane Medical Center, and everyone has been incredibly concerned and helpful (one of the doctors actually called my cell from out of the country on Friday to check on me!).
Once I had the surgery done, a drove of helpful therapists started calling me or stopping by to see me at the pharmacy. Before I even had an Rx written for PT, one of my favorite physical therapists had set me up with a PT who normally works at sports medicine (Uptown clinic), but comes to the hospital (Downtown) twice a week to work with the Orthopedic clinic patients. He's willing to come in early for me and start my PT at 8 am, so that I can get in 45 minutes and be downstairs opening my pharmacy by 9 am. This is perfect for me, because now I can just get my PT done right where I work, just a few floors up!

Unfortunately, day one of PT had an inauspicious start. I hopped (literally) out of the shower and started getting ready when I realized that there was blood on my deodorant...and my face lotion...and the carpet...I looked down, and one of my incisions (the one that appeared swollen when I posted last) was draining heavily. It wasn't blood; it was bloody discharge. There had been a lot of swelling in that area, so I figured it needed to drain, but I couldn't control it! It was practically squirting out. I soaked through paper towels like nothing - but it wouldn't stop pumping fluids out. Fifteen minutes later, I was going to be late for PT if I didn't leave NOW, so I just started piling bandages and paper towels on top, holding it all in place with spandex shorts, which I layered under running shorts.
By the time I got to my car, blood had soaked through all the bandages and both pairs of shorts.
So I showed up to PT looking like I'd just been shot in the thigh. Luckily, several lovely therapists had me re-wrapped in layers of gauze and Tegaderm in no time, and I was ready to start PT.

Now, the first person to recommend Van Sice to me was a PT at Tulane, who worked with his hips, but she actually moved last month. I'm not going to lie; I was disappointed. The therapist I'm working with instead is brand new. He graduated last month, actually. That's fine, though. I like young, new health care professionals willing to try cutting edge nonsense. And to help him out, I provided him with a protocol from another doctor: Dr. Shane Nho at Rush Medical posts all his documents online, and all of them are extremely helpful. I brought the rehab protocol to Christian, my PT, and he will be working with it as a guide.
If you want more info on hip labral tear surgery, especially the rehab component, I highly recommend browsing Dr. Nho's website - it's full of info.

The PT session went incredibly well, although every time I moved my leg blood pumped gayly out of my wound. I have minimal pain with all movements, and excellent strength on both sides. The only strength score I got that wasn't a 10 was hip extension on the left, which makes sense since I've been prevented from that movement for a week. But my PT cautioned me that weakness could still develop: I'm only 1 week in.

As for the drainage, it was so heavy for so long that I called my doctor. His nurse made me check for warmth, pus, etc , but I had no signs of infection. They recommended Bactrim DS for 7 days, but I actually didn't fill it; the draining stopped by late afternoon and I think it's ok now. Very annoying, though. I easily lost about 6 ounces of fluid. If it continues to drain today, I'll start the antibiotic.

Wednesday, June 18, 2014

Post-op visit

Today I ...
1. Drove myself for the first time since surgery. I didn't have any driving restrictions, but David's car has been in the shop (actually, we dropped it off at the mechanic's on the way to surgery, just running errands, lalala). It's nice to have my freedom, but it's a pain parking far away from the walkway in the garage at work, and clomping around on crutches for half a mile.
2. Got caught in pelting, pounding rain and had to slosh through it with crutches. I'm soaked.
My street, right before I took 5 minutes to get out of the car, wrap my bags all over myself, get my crutches out, etc
3. Had my first post-op appointment! I got my stitches taken out, except for one incision, which isn't healed yet. I'll probably snip that out myself this weekend.
Swelling is way down, except the far-left incision; bruising is healing nicely; almost as good as new! 
My doctor went over my surgery photos with me, which are still incomprehensible to me, but this one is important:
Or these are NASA images. I have no idea. 

Because it shows damage being removed, AND an intact labrum. Because the tear went around the very edge of the labrum, even after removing the damage, I was left with a minimum of 2mm of labrum all the way around! So this is very, very good news! I was worried about not having ANY labrum in the surgery area, so this made me happy.

A few comments from my doctor - damage was much worse than he expected based on my symptoms, but he was pleased that he was able to both remove the damage and preserve the labrum around. In fact, he expects this to be one of his most successful hip surgeries and predicts a full recovery. Since he is a very honest person, he told me, he rarely tells his patients that they'll probably recover completely, but he is quite happy with the condition of my hip. However, if this thin area of labrum fails, there is still hope - you can do a labral graft using a piece of the IT band. He would prefer that to just removal in a worst case scenario (Good to know there are options if this doesn't work).

I got a timeline from my doctor, too:
- Time left sleeping in the CPM machine: One more week
- Time left on crutches: Two more weeks. Dr. Van Sice leans toward the conservative side with weight-bearing, so even though many doctors recommend two weeks total, he wants that extra week. I am flat-foot weight bearing 20lbs.
- Time left wearing this brace: OMG minimum three more weeks. Seriously, I think I'll die. He likes 4 - 6 weeks in the brace.
- Time left before I can lift my leg up: Restriction lifted. It's time to use those flexors just a little bit! But within range of brace, which is locked at 90 degrees flexion.
- Time left until I can run....Well. My doctor actually gave me an answer to this. In fact, he announced it first thing. But I'm keeping it to myself until I hear from my physical therapist, who may have a different view. But it was good news  :)

So far, so good!

Tuesday, June 17, 2014

Back to work I go!

Yesterday was my first day back at work. It wasn't that bad - just nine hours perched on an uncomfortable stool while wearing a brace tucked under my shirt for appearances, with no place to prop my crutches in my tiny pharmacy.

But really, it was not bad at all. I have another pharmacist right now, which is an enormous help, especially since she can run to the register instead of me (I'm not running anywhere).

I'm still feeling just fine. The area is, of course, still swollen; thankfully I was able to replace the huge, bulky bandage with a small pad or I'd have trouble fitting in my clothes. The weakness I was complaining about is completely gone as far as I can tell, but I can't actually test it because I'm not allowed to lift my leg at all for three weeks.

Yesterday I mostly just spent the whole day catching up on emails, so today I'll try to actually get some work done! Luckily I only took Thursday (surgery day) and Friday (recovery day) off work - Wednesday is my "short" day and I got some work done while fitting in my pre-op, so I wasn't too overwhelmed coming back to work. Plus my technician is amazing and did everything for me. Today I'm buying the crew pizza to say thanks!

Friday, June 13, 2014

Surgery: Hip labral tear

Howdy folks!
Sorry, no late-Thursday loopy drugged up post from me, because I staunchly refused any pain medications and wasn't loopy. Aaaand if I tried to maneuver over to the computer, I would have either thrown up or fallen on my head.
So, the surgery is over with, and I'm in recovery mode. I went in at 7:30 am Thursday. My doctor scheduled me last on the list because hip surgeries are long and complicated. Prep for surgery was fine. I talked to the anesthesiologists about my problems with general anesthesia (last time, I had severe nausea and threw up for weeks). We agreed to do a combination of gas and Diprivan, with Decadron and Zofran added to the IV. Unfortunately I got that nausea party started early. While they were taking blood, I started feeling ill. I suggested they go ahead and get some Versed now or I'd probably throw up on them, and the nurse anesthetist laughed at me. And that's the last I remember!
I woke up incredibly nauseated. Dr. Van Sice was talking to me. He told me that unfortunately, the labrum was in very bad condition, very frayed and full of old damage, and could not be repaired. This was something we both felt was important, so I'm pretty disappointed about that. Instead he had to remove the damage. I just hate taking parts of your body out, you know? The good news, though, is that he did a little PRP (platelet rich plasma) injection in the joint while he was there. Woo hoo! I've always wanted PRP! He said he's been trying it for his hips with good results in shortened healing times. My insurance doesn't cover PRP, so it was a freebie.
Then I rudely waved my doctor away so I could gag pathetically.
Now, I am very good about not actually throwing up - I hate it so much that I learned as a little kid to resist it at all costs! But I can't do much for the nausea. And even with zofran and decadron during the procedure, and zofran and phenergan IV post op, I was in bad shape. I was in the recovery room for several hours trying to feel well enough to transfer to a wheelchair. Because the surgery took a lot longer than expected, I wasn't ready to go until 5:30. The problem with that is that the physical therapist left at 4:30! So - no one fitted me with my crutches. That meant, that after a ride home that I only survived thanks to a ginger ale,  I got home to discover that my crutches did not fit AT ALL. They have forearm grips, but guess what? My arms are too small for the smallest setting, so I can't use them at all. I have no support! I had to send David to Walgreens to buy crutches so I could go up the stairs to the bathroom!
My view: ice, brace, useless crutches.
It was about 8 pm when my nausea finally subsided to I could eat. Thank goodness. Things have since settled down. I'm wearing this big, bulky body brace, an ice wrap over that, and using crutches. I slept in the CPM machine, which was a tad awkward, but I was fine.

What's better than I thought:
1. I have not taken anything for pain, and I didn't in the hospital, either. Pain just does not bother me. I'm fine. Yes, it hurts, but heck, it hurt before surgery, too! I heard horror stories about the pain from this procedure, and it's not half as bad as I thought.
2. My throat and mouth are a little sore, but nothing like the last time I had surgery. Turns out that I had a laryngeal mask airway instead of intubation, which is much more comfortable.
3. I was clear-headed and with-it an hour after surgery. Since I didn't accept any morphine or anything for pain, the only drug I had to worry about was phenergan, and it cleared my system pretty quickly.
Friday night: brace is from waist to thigh, locked at 45 degrees. Ice over that. And yeah,  I'm pale and puffy!
What's worse than I thought:
1. I am so weak. My leg is useless. My brain is telling it to move, and it isn't.
2. My get-up is horrendous. My bandage is huge and bulky, my brace is huge and bulky, and my ice is huge and bulky. Plus, I am huge and bulky. All those IV fluids are puffing me up to the point that my rings and shoes don't fit.
3. I am stuck all over. I don't know what happened in that OR, but I went in with one nice, tidy IV and came out with FOUR, two of which were still accessible. The one in my hand was put in before I went under, and they took blood for the PRP (probably what made me start feeling sick). It seemed fine. Then I came out with three arm sticks and one failed stick... I expect to be pretty bruised on my right arm.
After I took the bandaids off, I found a botched stick as well! Five IV attempts?! Was it training day?!
All in all, I'm pretty pleased. I am glad I had the surgery done before damage had worsened any more, and glad my doctor did the platelet rich plasma. Some of my questions before surgery were about whether the procedure was necessary, and it seems it was: continuing to pull and tear the very damaged labrum would have caused cartilage damage and eventually bone-on-bone contact.
Thanks for your kind words, thoughts, and prayers - I appreciate every one!

Wednesday, June 11, 2014

Pre-op for hip labral repair

Today I spent all day in pre-op. Work has been very busy lately, and we're short pharmacists (new grads mostly have not taken their licensing tests yet, so they can't help out). So I could only get one day off before surgery, and I had to fit all my pre-op into one day.
First off, early in the morning, was my goodbye to running. Just one short loop in the park, knowing it was probably the last one for six months!
Lacing up for the last time in a long time! 

Then on to my doctor's appointment. Much to my chagrin, today's imaging showed a small bone spur on the femoral head. I was hoping not to have any osteochondroplasty done, since it seems to have poor results and long recovery, but looks like I can't avoid it. Because of that, I'll have to take two types of NSAIDS to prevent heterotopic ossification (after bone is removed, the body wants to replace it and heal, and rapidly lays cells down. NSAIDS reduce bone growth). I took those prescriptions, and my prescription for narcotic pain meds, to the pharmacy, where I bossed everyone around and pretended to be an expert.
Kidding. I try not to be the drug or insurance "expert" (aka jackass) on the rare occasion when I'm the patient.

I continued on to my pre-op at the hospital. I'm having the surgery at a different campus from the hospital I work at, but the same entity. Wouldn't you know - I ran into a good doctor friend I know, who directs neuro rehab at both campuses. I can never get away from work!
Pre-op didn't answer as many questions as I'd hoped. They didn't have the surgery schedule yet, didn't know what type of anesthesia I'll be under (it will be general, but I prefer IV to gas), and didn't have my crutch order yet. Hm. My blood pressure, pulse, temp, and labs all checked out, so I'm good to go for tomorrow.
Depressing, in-depth post-op info, which goes out to 16 weeks and does not promise sunshine and rainbows

Before heading to pick up my rxs, I swung by Target. I'm rarely in this part of town, so I took advantage of my proximity to do some retail therapy. Honestly, I needed it. The pre-op was quite discouraging. No one is promising any pain relief or a high chance of success. It's a little disconcerting, especially since I was already hesitant to have surgery at all. I'm not looking forward to the long (and apparently very painful) rehab, and no one is sugar-coating that for me.
Plus a jillion pairs of super cheap underwear, which you don't need to see. 

I picked up my prescriptions and met the guy supplying the immobility brace.
Yeah, this looks fun. 
By then it was three, and I called Outpatient Surgery, which told me to check in at 7:30am for a 9:30 surgery time. Ha, ha. I think we all know how backed-up surgeries get (often hours).
Then, minutes later, my CPM machine arrived. It's a beauty. I'm supposed to get 6 hours on this thing. Are you kidding me?! Where am I going to find 6 hours? I suppose I can sleep in it.

Yay, warm fuzzy fake fur in the dead of summer. 

All that I'm missing now is crutches, which will have to show up tomorrow. I hope.
Maybe if you guys are lucky I'll log on tomorrow for a totally loopy post-anesthesia post!

Monday, June 9, 2014

I'm not a hypochondriac or, pre-surgery thoughts

It's time for a serious post about my injury, a hip labral tear.
Last summer, I was coming back from a long-misdiagnosed femoral stress fracture, and everything was peachy until a vague, diffuse pain appeared in my left thigh. I did what any good runner does who feels pain - stopped running, called my doctor.
My doctor shrugged off the pain, saying I didn't need a doctor - I needed a coach. Nice, except resting didn't help the pain. A coworker sensed my frustration and recommended a different sports medicine doctor.
This doctor did some x-rays, and there was a lump on my bone: a wide area of sclerosis along the fracture site. He prescribed rest and calcitonin. But when I returned at follow up with unchanged pain, he gave up on me. He told me that my injury was in my mind, that the lump on my femur was part of the normal healing process, and that maybe I just didn't like running and should do something I enjoyed.
He told me I was a hypochondriac, and when I insisted the pain was real, he snapped, "Don't bully me into a diagnosis!"

I left the office in complete frustration and confusion. How could I be imaging this injury? Had my recent injury just made me a worry-wart? But I love to run. Why would I find excuses not to do it?
Was I a big wimp about pain? I thought back to the 40:59 10k I ran earlier that Spring. I saw my doctor four days later for pain that just wouldn't go away, and it was a complete fracture of the femur. I ran two 10ks and a half marathon with a broken leg. But now I was making up pain in my thigh?
I kept a little quiet about this non-diagnosis on the blog, half out of skepticism, half out of embarrassment.

And now? Now I'm going into surgery to repair a torn hip labrum. It's torn, it's frayed, and it's probably been there for awhile. It's not an incredibly common injury, and it's hard to diagnose because of the relative rarity and the ambiguous symptoms (like, surprise, pain radiating down the leg). And my non-specific symptoms, referred pain, and tolerance to groin pain (I've had osteitis pubis symptoms for so long that I don't ever report groin pain; it's normal to me) made the diagnosis harder. So I give my doctors a little break. But a simple MRI showed the tear, and a doctor who took me seriously would have tried to dig a little deeper.

Don't let this happen to you. You deserve a diagnosis, and you deserve to be taken seriously. If your doctor keeps shrugging you off when you have a legitimate injury, find someone else! You have to take charge of your own health and healthcare, because no one else will do it for you.