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.

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!

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.

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.

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.

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.

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!