Sunday, September 28, 2008

Packing Painfree

We are on our way out the door, for a trip to Miami for the Jewish new year. Packing was a pleasure this year. When my hip problems were running rampant, packing used to be a nightmare, the squatting and lifting and carrying etc. The only issue this year seems to be that kids are so excited to go they have been up since 6:45, asking when we can go to the airport!

The only issue I continue to occasionally experience is nerve pain on my anterior thigh. It has been 10 1/2 months since my revision, I don't think it will ever fully go away. And its not like I constantly deal with it, only some days, it seems to come and go. A small price to pay in my opinion.

While I was bragging about Jk last week, I forgot to mention L's astute comment about the baby! Have I mentioned that the baby has been named "ice cream"? So one day, L says to me "Mommy, is ice cream in your blood"? Hmmm, how do I explain this one, its not quite as simple as "the femoral head sits in the acetabulum". "No, L, ice cream lives in a pouch in my tummy". She started cracking up like it was the funniest thing she had ever heard. "Mommy, you're not a kangaroo", she said. To which I started cracking up. We ended the discussion with me pulling up a schematic on the computer of a pregnant woman's uterus, with the baby inside, "pouch" and all! Now she gets it!

An update on my brother: He has to go to PT first, I don't know if he has actually started but definitely has a bad attitude since PT did not work for me pre-op, and for many others.

An update on my patient: I am still a huge wuss!! She is off of crutches, went to Costco and Target in one day this week. She is painfree- she used to have debilitating back pain as well, she no longer does. I am so amazed. Pre-op, for many years, she walked with a cane, she no longer does. And she did not have cortisone injected into the joint during surgery (I witnessed it with my own eyes!)

Tuesday, September 23, 2008

My Kids Are So cute

A lot of my "bragging" has been about L, my 4 year old princess/anatomy lover!! Although this is in no way hip related, it was too cute to keep to myself.Jk is 2 1/2 (almost 3 actually) and sometimes I am not so sure if he understands the whole new baby concept. Boy did he prove me wrong on Sunday.

We were out for lunch and at the table behind us there was a little boy about Jk's age, and a baby in a carseat. The little brat, I mean boy, started teasing Jk and saying "hahaha, you don't have a baby, hahaha" (Imagine that being said by a 2 or 3 year old in a sing song voice). To which Jk turned around and (like a small genius) said "I do have a baby, its in my mommy's tummy"

How Cute!!!!

Sunday, September 21, 2008

Thinking of How Things Were 1 Year Ago

Today we went apple picking. It was our second time, the first was about a year ago. That put me about 1 month pre-revision. Apple fields around here tend to be rocky and hilly, with uneven terrain, and spread over many many acres. Last year I had a really tough time "navigating" the apple orchards. I was in a lot of pain, for some reason, I have very vivid images of the groin pain I felt that day. I don't generally remember the pain all that well (thank goodness for small favors) but for some reason, apple picking brought back memories!

I am happy to report that this year, there was no groin pain. There were other issues, which I will get into momentarily, but that achey, deep hip pain was no longer there! Yay!

I have been having a lot of swelling in my legs lately, and a feeling of heaviness. I haven't really had it with other pregnancies so I will assume it is related to having 3 hip surgeries. There are days I wake up and I cannot imagine how I will go to work and stand because I am having so much aching up and down both legs. I don't even remember if I blogged about my DVT scare a few weeks back (I will have to look back and check), but my legs have been sore and swollen, even on days I am not on them that much.

It is possible that there was some damage done to the lymphatic system, and now that it is being stressed things are "backing up". It was not an issue before I got pregnant.

There are also days that my "invisible bruise" pain comes back, these are the days I know I should have stayed in bed!!! I usually notice on my way to the car. My ankles feel fat, my thighs feel heavy, and I have pain over a large area on the front of my thigh. And that is only 7:30AM!
I still haven't seen a single patient!

Despite this, I am back to cooking! Over the course of the summer, I had resorted t serving the kids mac n cheese and hot dogs quite often because we were spending every afternoon at the pool, and these dinners were quick, easy and portable. Now I have no excuse. It is back to the kitchen for me!

I am actually having a mild obsession with Panko breadcrumbs. I have a friend who manufactures the brand I use and I jokingly offered to be her "recipe blogger"....she is now expecting recipes! I will share with her as well as you...coming this week, Teriyaki Panko Oven Baked Onion Rings.

My other obsession these days is childbirth. Mostly, that I CANNOT have a c-section. This baby seems to enjoy being breech, but I WILL NOT have a 4th surgery right now (hear that kid). I have been doing breech turning exercises (anything that involved having your hips higher than your chest) which does work, but gives me a massive headache! I have an ultrasound on Thursday, and based on the position, I will decide if I will start the Webster technique for turning a breech.

Don't worry, once the baby is in in proper positing, I will be obsessing about how to deliver it without messing up my hips!!!

PS- I have about 15 lbs of apples in my kitchen...anyone have good (and easy) recipes???

Friday, September 12, 2008

Things Can Never Be Simple, Can They?

I am now 22 weeks pregnant. The hips seem to be holding up just fine, yay!
I had a scheduled OB appointment 2 weeks ago, but it was cancelled at that last minute bc of some scheduling issues. There was no other time for me to come in until 2 weeks later, but I was concerned about the 20 week ultrasound. This is how the conversation with the receptionist went:
R: Sorry, we have to cancel your appointment, can you reschedule for...
S: No, I can't make it, but what should I do about the 20 week ultrasound, I am 20 weeks now
R: What 20 week ultrasound?
S:Umm, THE 20 week ultrasound!?!?
R: Oh, you mean, like, to find out the sex of the baby?
S: Umm, no, like, an anatomical scan at 20 weeks
R: Well, do you want to find out the sex?
S: No
R: Well then why do you need the ultrasound?
S: Um, to make sure my baby doesn't have 2 heads (ok, I wasn't that snotty, but come on, everyone knows about THE 20 week ultrasound. And this is a receptionist at an OB office)
S: Can you please put someone else on the phone

This person assured me I was not crazy and that there is indeed a 20 week ultrasound that EVERYONE gets.

So yesterday I had the 20 (22) week ultrasound. The baby (who has been named ice cream by L) apparently does not have 2 heads and looks good (I asked if the hips are checked during the ultrasound...I have become slightly paranoid about genetics and hips lately...I was told no, but they will check for dysplasia after birth). But the baby is breach. OMG. L was breech and it was a disaster that ended in a c-section. I do not want to re-visit the world of c-sections (or any other surgery for that matter). I was reassured that it is too early to worry, but I reminded my doctor that L was breech at 26 weeks and never flipped. I am on the verge of a breakdown. I have already begun breech turning exercises, contacted a chiropractor who does a technique to turn breech babies and am awaiting a co-worker to return from vacation to give me the name of an acupuncturist who specializes in this too. And you thought I was only anal and crazy about hips!!

Tuesday, September 9, 2008

Holy $hit, I Am A Really Big Wimp

A few things I wanted to share with you but have been falling asleep each night before I get a chance to blog.

The first is that my patient, the one who had surgery last week, the one I observed, is doing awesome. I asked her for permission to write about her. She is 40, with many many medical issues, including chronic back pain, foot and ankle problems, fibromyalgia. Dr K wasn't even totally convinced she would do great with the surgery. I was really nervous for her as well, it is a tough recovery, plus, she had some minor dysplasia so everything was up in the air. She also takes narcotics on a regular basis for her back, so the pain relief made me nervous. She ended up being home 2 1/2 hours post-op, in her bed, on the cpm, resting comfortably. I told her to call me in the AM if she didn't feel up to coming to PT that day or if she had any issues/ problems. When I arrived at the office, she had already called. "Shit, she must be having a lot of pain" I figured. I called her back. She was feeling great, just couldn't remember how to go down steps with crutches!

She arrived in my office looking amazing, only 15 hours post-op, in NO PAIN. I figured the marcaine hadn't worn off yet. She kept saying that her back no longer hurt and she had no internal hip pain. Her biggest complaint was that the incisions hurt and the spinal bock site hurt. I kept waiting for the drugs to wear off, but kept my fingers crossed as I held my breath over the next few days.

I called her Friday, honestly expecting her to tell me that she was in a lot of pain...Nope. No pain. She was completely off of all narcotics (Including pre-op ones), still with no back pain either. I think she was also shocked that the back pain went away, this was totally unexpected, but a nice added bonus.

I saw her in the office yesterday again.She was feeling amazing, so happy that the pain was gone, and thrilled that it was such an "easy" fix! She wants to do PT 3x/week instead of one lose the CPM and resume life! I am so thrilled for her.

Looking back, I was (am) a 26 year old healthy, with no other issues, simple hip patient who ended up with so much post-op shit. It just goes to show you how we are all so different.

Another thing....Jeff, my brother, was here this weekend and had his appointment on Fri with Dr K. Yes, he has FAI, seen on x-ray.And the OS in Miami swore up and down to me that there was none. He went for a CT scan Fri as well, to make sure there is no more FAI than what was seen on x-ray, as well as an intra-articular injection. Weirdly enough, since his hip problem started, his foot has been bothering him,once he had the injection, the foot pain went away. He is not too clear on whether the injection helped or not, but once the CT results are in, decisions can be made!!

Tuesday, September 2, 2008

Hip Arthroscopy is SOOO Much Cooler When You Are Not The Patient!

So today I had my day in the OR. Of course things did not go as planned. On Friday, I was supposed to hear from the surgical coordinator regarding where to go, who to meet etc. He never got back to me. Luckily, I knew the patient and she let me know what time the surgery was at. I sent another email this morning to the coordinator.The surgery was scheduled for 2pm. He sent me an email at 2:38 letting me know it was at 2. Gee, thanks!

Basically all day I was a nervous wreck since I hadn't heard from him, and texted Amy all morning about it, but decided to just show up and figure it out when I got there. The paperwork was done anyway. I was also waiting for the PA to email this AM about the time, but she didn't either (added to my anxiety) but it turns out there were major scheduling snafus.

I made it to the surgery reception area where without much question, they took me back to get scrubs, in the meantime, the PA emailed me to let me know they were about 2 hours behind on scheduling (thank goodness for blackberry). So I got changed and hung out with my patient for a while.

At4:00 we were in the OR. I have to say I have observed 2 other surgeries and been a patient in 4 (3 hipscopes and 1 c-section), this was the first time that no one has yelled "Don't touch anything". I guess I looked more authoritative this time!!!

She had a spinal block with some sedation and we were ready to roll. I did have to step out of the OR at times bc they use fluroscopy and I didn't want to take a chance with the radiation and the baby (pregnancy + x-ray does not mix well). So I watched the portal placement through a window, as well as the tractioning, which I would have loved to watch (Hopefully this patient will do well, but she will probably need the other side done so it should be after I have the baby and I can come back.) When I came back in, he showed me the large labral tear, looked like it was from a cam lesion. there was also a bunch of synovitis.He did a synovectomy and then debrided the tear. There was no evidence of a pincer lesion there as well as on x-ray, MRI and CT. THE PSOAS WAS LEFT INTACT!!!! Whohoo!!! They then released the traction to look for the cam lesion. Again, I stepped out for some x-rays, they had to cut into the capsule to access the bump. He performed a cam decompression and then approximated the edges of the cut capsule and put in some sutures. This is a newer procedure (I don't think I had it done) but apparently it decreases the stress on the anterior structures and decreases tendonitis during recovery and rehab. I will let you know how she does.

I stood right behind Dr.Kelly the whole time and got to see the screen as he did. He explained what he was doing, showed me the anatomy and the damage, and the pre an post x-rays.

That was it. It was 2 hours from the time we entered the OR until she was resting comfortably in the PACU. It was incredibly awesome for me to watch, I feel like I learned a lot and have now been on all sides of this! She looked great in recovery, much better than I ever did. I think they used less sedation on her. She was already beginning to wiggle her toes before I left, she was on the CPM too. She received PT prior to the surgery because of the long wait time, which was nice, they fitted her with the brace and taught her to use the crutches before she was all drugged up!

I am just about in seventh heaven! I need a life!!!!