Recovering at Home!

With all the drama finally over I was able to relax and recover.  PT came Friday afternoon to do their evaluation and promised to start coming the following week.  I continued to take pain medication fairly regularly and didn’t try to be a hero.  I have told I don’t know how many patients, family and friends not to wait until the pain is a 10 and for once I took my own advice.

I spend most of my time reading, / crocheting and not doing much.  I continued my exercises over the weekend and started to do them standing, using the weight of my leg to make them harder by Monday or Tuesday.  Pt came twice that week and by the end of the week I was itching to go home.

I didn’t get to see the boys much when I was at my mom and dad’s because football practice had started and things were getting busy at home.  By then end of the week I was getting around well with the walker and able to come home on Friday of that week for the long Labor Day weekend.

I have continued to recover really well and faster than anyone thought.  By the end of week 1 I  was starting to use a cane around the house and by the end of week 2 I had pretty much given up the walker indoors and out.

When I saw my doctor for my post-op appointment right after labor day they removed the staples.  He was pleased with my progress and said the implant looks great on x-ray.  He did caution me about maintaining partial weight bearing, not bending or twisting and the rest of my precautions until 6 weeks post-op.  He said I probably should still be using a walker but said he was okay with the cane as long as I don’t overdo it.

I am now walking around the house without the cane and I take it with me when I go out in case I need it but I really don’t use it.  PT says they will discharge me next week and I am now walking pretty normally.

As for pain…After week one I started taking half the dose of oxycodone and every 6 hours rather than every 4, although I continued to take the larger dose before bed and woke up once in the night for the smaller dose.  I’ve had few nights here and there where I have been woken by muscle spasms and pain requiring more medication but those are also decreasing.  Mostly that’s after PT increases the difficulty of the exercises.  Now I am taking Tramadol during the day and the smaller dose of oxycodone at night.

The severe pain has been replaced by aching, muscle fatigue and spasms.  And I feel a little better every day.  I still limp when I get up in the morning and usually require the Tramadol and some time to get moving but the stiffness is getting better too.

Probably the most positive “side effect” of this whole experience is that my lower back pain that I’ve had every morning for several years is gone!  I haven’t woken up with a back ache once since surgery.  To me that makes it all worth it.  I guess I’ve been walking around with a hip problem for quite some time now.  I’ve had problems with my lower back for at least 10 years.

I go back for another follow up on 9/28 and I hope to be released back to work for 10/3.  I still have a ways to go and I still have strength and stamina to build but, with time, I know I will feel so much better.  I’m very glad I decided to do this surgery because I can now get my life back and do the things I want to do with my kids and family.

As with everything in life, it’s a give and take.  My skiing days are probably over and I won’t ever be able to run.  But I hate to run anyway!  The fact that I can hike, bike, swim and go through every day life without pain to me is amazing and totally worth the loss a few little things.

The decision to have such a big surgery at a young age is a deeply personal decision but for me it was the right decision.  I wasn’t willing to miss out on hiking, camping and being active with my kids for the next 10 years in favor of putting off surgery until I am older.  I decided I am willing to risk a possible second surgery in the future in order to get rid of the daily pain and misery I’ve been living with intermittently for years and daily for 6 months.  I did research on prescription anti-inflammatories and the effects of taking them long term and decided surgery was a better option than those effects.  40% increased risk of hearth attack and stroke?  No thank you!  I discovered that a chronic back ache that I had learned to live with is all but cured and I hope it will stay that way for a long time to come.

Also of importance were functional issues such as my leg collapsing, limping, and falls.  I wasn’t willing to risk falling down a flight of stairs because my leg buckled underneath me.  I was having a had time walking and just doing every day tasks at work and at home.  The surgeon was hesitant to perform the surgery on a person as young as myself but after hearing my reasons he agreed.

None of us knows what the future holds.  All we can do is make the best decision possible based on current circumstances.

Post Op Day 2-3

Each day things got a little better and by Post-op day 2 I was allowed out of bed and able to use the bathroom with assistance.   I got more rest the second night although I still woke in pain I slept for longer.  Don’t ever let anyone tell you the hospital is a restful place.  They wake you at all hours of the day and night to take your vital signs, blood etc.  Of course, I expected that.

After breakfast physical therapy came and talked to me and explained that I would be able to get up and move later with assistance. I was allowed up in the chair for longer that day and had my friend Kathy come from Columbia and my friend Charlotte come visit.  I set all this up before hand and asked people to visit me since I knew John would be working and I would be alone most of the time.

Getting out of bed and walking for the first time was strange and scary.  I was taught how to get out of bed and rise to standing without putting weight on my left leg.  Then I was taught how to take steps forward with a walking while using it for support as I moved my left leg forward.  Next came moving backward and turning in order to sit in a chair, bed or toilet.  That day I walked a few dozen steps and was able to get to and from the bathroom with assistance.  I wasn’t allowed to get out of bed without waiting for assistance.  I also began some exercises in bed, moving my leg from side to side, lifting my leg up off the bed, sliding my heel up and down while bending my knee and kegel type exercises.  The more mobile I was the more the pain seemed to ease.

Later in the evening the Chaplain that I work with visited with me again for a little while again.

Overnight I slept better than I had the night before and in the early morning hours I moved, with help of course, to the chair and rested there for a few hours.  The following morning the doctor rounded as he had the other 2 days.  He commented that I must be an early riser since I was awake each time he came in.  I told him I am not but that I had to move frequently to be more comfortable.  I explained that I would rather re-position to relieve some of the pain than to take medication at such frequent intervals.

Things were progressing as expected and I was to be released from the hospital later that day.  Discharge planning had begun the day before and a walker for me to take home as well as a raised toilet seat were delivered.  The pharmacy came to ask who would be giving me the Lovenox injections that I had been receiving to prevent a blood clot and I told them I would be able to do them myself.  No on else was willing to do it for me and I was okay with doing it myself.

Physical Therapy worked with me on going up and down stairs to ensure that I would be able to get in the house once I arrived home.  Social work came to discuss my discharge plans and I told them I planned to go to my parent’s home for the first week or so since it is all one floor.  Referrals we also made to home health for PT after discharge.

That afternoon my parents  came to pick me up and I was given all of my prescriptions and instructions.  The dry bandage that had been in place since surgery was replaced with a waterproof bandage that could stay in place for  a week.

That evening one of my parent’s friends generously provided dinner for the entire family and John and the kids came over to eat and visit.  I was still very dependent on the walker but able to get to and from the bathroom and in and out of bed while using only oral medication to control my pain.  I was happy to be home!

After John and the kids left and I was ready for bed I noticed that I felt flushed and that my left leg had swollen to 2x the size it had been earlier in the day, red and warm to the touch.  I also noticed the incision was draining more than usual and that drainage was coming out from under the bandage.  Although it was late, I called the hospital orthopedic unit an asked what I should do.  They advised I go to the ER and said that they would call the ER and let them know to expect me.

I don’t know how long I waited to be seen, but when I was taken back they took the bandage off and the ER doctor examined me he said he was highly suspicious of infection.  He also ordered an ultrasound of my leg to rule out of blood clot.

I was taken to radiology where I met with the most unsympathetic ultrasound technician ever!  She didn’t really explain what she was going to do and began her exam.  She didn’t ask me how long it had been since surgery and didn’t seem at all concerned with my comfort.  She kept manipulating my leg and asking me to point my toes inward (which I told her I was neither allowed nor able to do).  Then when I told her that the position she had me in was painful and uncomfortable she simply said I would have to endure it so that she could do her job.  She offered to stop the exam a couple of times but obviously if she did that they couldn’t be sure that I didn’t have a blood clot!  Out of patience and in pain, I gritted my teeth and told her to just do what she had to do.  I was totally over it and pissed as hell.  After she finished the testing she asked me if I needed to sit up or change position.  I was so mad and in so much pain I was not nice.  I told her to “just leave me alone” and was in tears at this point.  The poor transport guy from the ER retrieved me and wheeled me back to the room.

As soon as I arrived back in the ER the nurse saw that I had my hands over my face and was extremely uncomfortable and the doctor, who had ordered morphine for pain, changed his mind and gave me Dilaudid(which is stronger) instead.  After that kicked in I was much better and felt a little bad as I could see the doctor was kicking himself for not giving me something for pain before sending me to radiology.

Next they removed the bandage and took a sample of the discharge to check it for infection.  The on call doctor with the surgery group saw me and agreed with the ER doctor and they started another infusion of Vancomycin.  The ER doctor seemed convinced I had an infection and wanted me admitted.  However, the on call surgeon did not want to admit me and really wanted my surgeon to see me before anything was decided.  I guess that’s what happens when you are operated on by the guy in the practice with the most experience.  The ER wasn’t pleased as they wanted to send me upstairs so they could fill that bed with someone else but they kept me for the 2 hours that it took for the Vancomycin to infuse and by then it was 6am and time for my surgeon to make his rounds anyhow.

When my doctor  came in he was great!  I found him to be compassionate throughout the entire process but especially so that morning.  He explained that he didn’t think this was infection but rather that the increased activity from the day before combined with the blood thinner I was receiving had caused the increased discharge.  To my relief he prescribed an oral antibiotic, just in case, and an anti fungal in case of yeast infection from all the antibiotics and sent me home.

I had sent my parents home a few hours before he came to get some rest and thinking they were going to admit me.  My dad came and got me and I was glad to go home though it had been a rough night.

 

Surgery Post Op Day 0/1

When talking about my inpatient surgical stay they speak in terms of Post-op day numbers.  The day of surgery is considered post-op day 0, the day after is considered post-op day 1 etc.

The night after surgery I guess would still be post-op day 0.  This was challenging night to say the least.  I expected pain after surgery and I also expected to be heavily medicated.  What I did not expect, however, was that that pain would not be relieved and I would told be that I could receive no more medication.

Being immobile is a funny thing.  Not using my surgical leg and being bed bound for the first 24 hours was expected.  But you often expect that being immobile will prevent pain from movement, but immobility causes pain of it’s own also.  What I failed to factor was pain caused by the trauma of surgery.  Never having had surgery I had no idea what to expect.

I can’t really provide a reliable time frame due to all the mind altering substances I had running through my body but I can provide an approximation based on what I was told.  After I was moved to the floor I was given IV and Oral medication every couple hours for pain.  It wasn’t until after my husband had left for the night (about 3:30pm) that the spinal really wore off and I began to experience what I would classify as the worst pain of my life.  Worse than natural childbirth in severity and duration.

I required medication for pain about every 2 hours and this was to be expected.  I was receiving Dilaudid in my IV and Oxycodone by mouth alternating so that I received one or the other every 2 hours.  Both were effective but neither lasted the full 2 hours.  At least twice throughout the night I was in so much pain that I was in tears and one of those times I was crying out in pain and trying to stifle my cries with a pillow over my face.  I pushed the call button and asked for pain medication several times and was told that it was too soon for me to receive anything else for pain.  The nurses gave me my medication as often as they were able but it was a miserable night.

Several times I asked the nurses to turn me to take the pressure off my hip, which in an of itself was intensely painful and almost unbearable.  This only worked for an hour or less.  I slept in 30-60 minute intervals and each time woke in intense pain.  My instinct was to re-position myself which of course was impossible due to the immobilization device I had been placed in while I was under anesthesia and the pain that made me afraid to try to move. I was unable to pull myself up in bed despite the trapeze device over my bed.

At about 6am the doctor made his rounds and was friendly and sympathetic.  He saw the exhaustion and pain on my face and I told him it had been a very difficult night.  Other than the pain everything looked good and was progressing as expected.

Some time later that morning 2 people from anesthesia came in to talk to me and I told them that my pain had been poorly controlled overnight.  Apparently for the first 24 hours pain control falls under the anesthesia department.  They told me that the nurses should have called them so that they could have adjusted my medications accordingly.  Of course, as a nurse, I should have asked that a doctor be contacted in regard to pain control but it was never offered and I was not thinking clearly enough to ask them to do so.

Thankfully, Tuesday was a better day.  I was able to get cleaned up with the help of one of the Aides, the chaplain I worked with visited with me in the morning and I was able to start eating a little.  Later in the day, with better pain control now in place, I was able to get up to a chair for a time and the change of position was welcomed.

Tuesday afternoon my pain management was put back in the hands of the orthopedic surgeon and the Dilaudid was changed to Morphine which  allowed me to be more clear headed and alert.  I remember the nurse saying the the dosage of Oxycodone had been increased so that I was not getting as much Tylenol with it.  The reason for increasing the dosage has to do with the Tylenol contained in the medication.  The Percocet(Combination of Oxycodone and Tylenol) comes in different strengths.  Tylenol can be toxic to the liver if too much is taken in a 24hour period, generally 3000-4000mg max daily.  So by increasing the amount of Oxycodone in each dose and having the Tylenol amount remain the same the risk for liver toxicity is reduced because less Tylenol is being given.  While this wasn’t lost on me I could have cared less and to be honest I’m not sure why they even bothered using Percocet vs. just Oxycodone alone.   I assume due to the anti-inflammatory benefits of Tylenol but I’m sure they were minimal.

My friend Zupash visited with my in the afternoon for a little while and it was very nice to see her.  I hadn’t seen her in some time due to our crazy schedules with kids and work etc.  She was also kind enough to make dinner for the boys, as were a few others that week, which was greatly appreciated.

Tuesday evening my parents brought the kids to see me after dinner and I was glad to see them.  It was also important for them to see that I was okay.  My older son Aidan was a bit upset when I told him he wouldn’t be able to see me the day of surgery because I would be very tired and not feeling well.  Both of the kids were worried about me I’m sure but Aidan being older and more sensitive than his brother was particularly worried.  They didn’t stay that long and that would be the only time I saw them during my hospital stay.

Thankfully Tuesday night was a little better than Monday night and my pain was far better controlled.

Left THR 8/22/16

I recieved my phone call on 8/19/16 informing me that I was to report to the heart and vascular side of the hospital at 7:15am on Monday August 22, 2016.  It was a long weekend with all the anticipation and to be honest I really don’t remember what we did.  I know we cleaned a lot in an effort to get ahead of the cleaning that I would not be able to do for the next several weeks.  It was all hands on deck.

On Monday morning I went with John to the bus stop and then we headed to the hospital.  It all went fairly quickly from there.  They made me put on a gown and there was a steady flow of people in and out of the room.  First came the nurse to talk to me and then another nurse to start an IV, they were followed closely by the anestesiologist explaining my anestesia options.  I opted for the spinal with sedation as I had planned.  Next came the CRNA and she was entertaining, bubbly and kind of funny.  Last of course came the surgeon, who discovered my tatoo and said he would have to avoid it, I told him I really wasn’t concerened with my 15 year old tattoo.

After that everything gets very fuzzy.  The CRNA ordered a dose of Versed (midazolam) which I knew would hit me hard.  There is a reason they used to call it midazo-slam when I was a paramedic.  Within minutes I was totally out of it.  I don’t know how long I waited but I don’t think it was long at all.  I don’t really even remember kissing my husband before they took me down to the OR, although I must have.

I remember being confused as they asked me to slide over to the table, the room was cold.  I can recall the anestesiologist starting to tell me what position he needed me in to place the spinal and I also remember him saying “nevermind you know exactly what I want you to do”  I vaguely remember saying I had an epidural with one of my kids and the proceedure is the same.

I honestly have no idea how long I was in the OR or what they gave me to keep me knocked out.  The only thing I can vaguely recall is the sound of the saw and the sound of the hammering.

Once I was out of surgery Dr. Lehman talked to my husband and I woke up in the revocery room being told that I had lost 240ml of blood and that I would be transfered to the floor as soon as I woke up a little more.  My BP was 90’s over 50’s, not surprising given the ammount of drugs they pumped me full of.  I began to feel my legs again, recieved at dose of pain medication and was take up to the floor where John was waiting for me.  He left about 3:30pm to go get the kids and I was alone the rest of the night.

 

 

Pre-op details

I realize that I mentioned my pre-op but I feel I need to elaborate on that subject a bit more.  The appointment was on a thursday and my mom went with me for moral support.  I had a good feeling about Dr. Lehman at my 2 previous appointments.  I found him personable, easy to talk to and reasonable.  He seemed genuinely interested in improving my quality of life and seemed to understand my concerns.

On this day the feeling was completely different!  He was rushed and was in and out of the room in less than 5 minutes.  He didn’t seem concerned with my 15lb unintended weight loss, didn’t explain where the incision would be, what materials he would use, nothing.  He only asked me a few questions about pain, function, how long I have had a hip problem and if I had history of falls from my hip problem. He answered one question I had about whether he would recommend outpatient rehab.  The answer was no, 90% of more go home after and do just fine.

His nurse/medical assistant must have heard me sniffling and came in.  I asked her about the incision and told her I wanted to know what kind of hardware he planned to use.  She told me where the incision would be and told him he needed to come back in the room to explain the hardware.

He came back in for less than 2 minutes only to give me a web site to look at and told me he didn’t have any models that had the same type of material he was planning to use.

I left discouraged and wondering what the hell I was getting myself into.  This group recently changed over to the Carolinas Healthcare System and is in the process of transitioning into that system and leaving the Piedmont System behind.  I have no idea if it was a buy out or a decision made democratically.   But I could certainly tell that he was rushed.  Perhaps without his usual transcriptionist in tow he was overworked that day.

Next stop was the hospital for pre-op testing and to pre-register for surgery.  That was fairly easy, a few questions from a nurse, register for my stay and pay my inpatient fee, and have some blood drawn.  Almost painless except that we were called back to the office for a set of x-rays they forgot to get.

I told my boss about this experience the following day and she said “why are you letting this guy operate on you?”  I figured he was so personable the other times I saw him and everyone is entitled to a bad day.  He’s been doing orthopedic surgery since the year I was born and is the most experienced surgeon in the practice.  Plus he may very well be the only surgeon in this practice or any other close by that accepts my insurance.

I’m glad to say my instinct was right and my experiences going forward have been nothing but positive and he’s been wonderful!  I would highly recommend him to anyone!  Dr. Lehman and a compassionate and caring doctor who really listens and he proved it several times over the past 3 weeks.