MD Confessional

Making the Move

2009-06-21T11:18:00.001-07:00

We've made it to Minnesota with few, if any casualties. The family is doing well with everything and My hip has held up remarkably well, too. I'm still walking with my cane and waddling if I don't, but I can cruise around the house and even carry things for short distances without it.

I am very tired of the cane. I wish I could say that I was ready to go without it, but by about noon, I start limping and it becomes obvious that I need it. Honestly, I would be closer to getting rid of it if I were working harder on my rehab. With the move, I have become That Patient. I've done my exercises three times this week, instead of every day (or even multiple times a day.). I don't have physical therapy starting for almost another week. I only worked out twice this week.

That doesn't mean that I've been sitting around, of course. I've been up and moving and walking through airports and around the neighborhood and chasing Nora and unpacking and...well, just not what was prescribed. Things have just been so busy.

At this point, I think that I'm going to manage this with spin. I helped move a household of three people and three hundred pounds of dog 1,500 miles. I am acheiving more in a day than at any time since surgery and I feel ready to start work. I have had very little pain and have not needed any narcotics or muscle relaxors. I fatigue much less easily than even a couple of weeks ago. I haven't been in a wheelchair in over a month.

How's that?

Flying Solo

2009-05-26T11:48:00.000-07:00

After 9 weeks of being with my mom or my mother-in-law, I am alone. Now, I am normally someone who needs time to myself at the end of the day. I like to curl up with a book and not be talked to. Maybe it's all that talking that you do as a doctor.
This is something different. I haven't been by myself for more than a few discrete hours since surgery. Now, I am suddenly responsible. For me, for Nora, for laundry and dishes. "Overwhelming" isn't the right word, but "disorienting" might be. It hasn't been that long since I was a grown-up, but it's easy to allow someone else to pick up the slack.
I certainly think that I'm ready to pick up the slack. It's not like I can't walk or cook. Cleaning may be challenging, but we'll just have to see.
In related news, I took the bike off the trainer and into the out-of-doors. Yesterday, Eric and Nora went with me and today, I went by myself! Hooray! Even in the pouring rain, riding outside is more enjoyable than staring at the wall of my basement. The trainer is convenient, but um, uninspiring.
On the other hand, my first ride of the year was a breeze, which certainly was not the case last year. I distinctly recall being relatively crippled after a similar ride last Memorial Day. So maybe it's too soon to malign the poor trainer.

Sitting, walking and riding (Post-op week 9)

2009-05-22T05:05:00.000-07:00

I still do a lot of sitting these days and I still get tired pretty fast. But things are looking up.
Since I started physical therapy, my strength is improving immensely and I've started walking on the parallel bars while I'm there. My gait is still what I like to call "Quasimodo gimpy" without support, but it's getting better, too. I asked the therapist if I can drop down from the crutch to a cane and I got a big negatory. Can't win them all, right? But I'm really pretty done with the crutch.
I'm still riding my bike on a trainer for an hour a day. I've started giving myself one day off a week, because well, it seems to help. I'm doing some intervals with more resistance or speed, but I really just want to get out on the road. I'm worried about what happens if I blow a tire, though. I can't exactly walk my bike home.
I bought a new saddle for my bike yesterday. It's supposed to be better for butt pain and sciatica, but it is so granny, I'm embarrassed to be seen on it. Maybe it's a good thing that I can't get on the road quite yet.

Therapy (Post-op week 7 1/2, FYI)

2009-05-13T12:34:00.000-07:00

Today, I began work with the physical therapist. I was all proud of my progress and thought that I was doing pretty well until I got there. After all, I've been doing leg lifts of all kinds daily, riding my bike for an hour daily, stretching multiple times/day and swimming 2-3 times/week. Also, I'm walking with one crutch, driving, making dinner...
Bah.
I expected my quads and hip abductors to be weak. Give them a break, right? They were disconnected not too long ago and forced into 6 weeks of inactivity thereafter.
Likewise, I knew my hip adductors were weak. There was some talk of a nerve stretch injury of the obturator nerve during surgery when I had so much spasm in those muscles post-operatively. It's hard to miss it when you can't get your leg onto or off the bed, in and out of a car, etc. I was expecting that.
The calf weakness knocked me down a peg. Here I am, working my ever-loving ass off (Not really, it's as big as ever.) and my calf has the unmitigated gall to be weak? Well, I never.
As it turns out, I have some mild sensory loss as well. OK, so I actually have many areas of sensory loss. That happens when someone opens up your hip and begins to disconnect all the things that like to be connected. But the one that's important for you neurology geeks out there runs down the back of my thigh and into my calf and the outside of my foot, corresponding with the pain.
So, that freaking piriformis has been spasming hard enough to do more trauma to my sciatic nerve than I thought. Either that or this whole hip dysplasia thing has been a total farce and I just have a sacral nerve impingement. Possible. Unlikely.
So, I have a bunch of exercises and instructions to perform piriformis release and to ice my ass. That's right, ice my ass. Awesome.
At least having a cold butt will be good preparation for moving to Duluth.

Inertia

2009-05-05T06:51:00.000-07:00

Maybe it's the weather. Or lingering anemia. Or laziness. There are a million things that need to get done in order to move in a month. But I can't seem to motivate myself to do them. I write a few emails each day, do my rehab and that's it. I'm proud of myself today because I got up with Nora and got her dressed. She was delighted, until I handed her off for Nana to take her to school. She desperately wanted me to come.
I can't say that I can't. Because I can. But I have a shallow pan of stamina these days and if I take her to school, I might not make it through the rest of the day.
Yesterday, I did my biking and leg lifts, I went to the pool and swam longer than I have since surgery. Then, on our way to K-mart to pick up diapers and other miscellaneae, daycare called. Apparently, Nora was ill. Errands were cut short and we went to go get her. Once we got her home, she was not even remotely sick. But that is another (rage-inducing) story. So, when I had planned on crashing on the couch, I was entertaining a rambunctious toddler. She managed to get 7 time-outs last night. Each of which I mandated, but had to be executed by Nana, due to my inability to pick up the limp, tantrum-obsessed child.
Maybe it's not so surprising that I'm tired this morning. I just wish that things like this didn't set me back so far. I feel like I've been hit by a truck, not a two-year-old. She only weighs 29 pounds. How can she knock me out so effectively?

The Appointment

2009-05-04T07:44:00.000-07:00

It went, um, well. I guess.
We arrived at 1:00 and found out that the doctor was running behind. Very, very behind. As in, we finally left at 5:00. And I had neglected to take any pain medication beforehand. It was not a pleasant experience.
The X-rays showed that the PAO and the femoral osteoplasty look fantastic. Everything is healing well. In fact, I am forming bone much faster and better than expected.
That's sort of the problem. They saw a couple of things other things on the X-ray as well. There is a large callus (hunk o' bone) projecting into the pelvic inlet. It may be an issue with future childbirth. We'll just have to wait and see- we just won't know if it's a problem until the baby that is still a twinkle in Eric's eye is trying to come out.
The other problem is some heterotopic ossification- bone formation where there shouldn't be bone. In this case, it appears to be anterior to the hip joint and maybe in the rectus muscle. They would ignore it if there was no pain or problems. Unfortunately, on exam, I had a loss of range of motion. It didn't really hurt. It just felt like my leg had hit a doorstop. A large, bony doorstop.
The doctor told me to start taking naproxen twice a day to try to limit more bone formation. He also recommended stretches to try to get the motion back. He said that if this doesn't work, he would recommend waiting for the ossification to mature in 6 months or so and removing it. He also mentioned that this would require detaching the quads again and staying in the hospital again.
After I stopped dropping F-bombs, I agreed. I've been stretching my cotton-picking heart out. It sounds so nice and relaxing, doesn't it? As it turns out, if you try to push past that doorstop, it hurts. It reminds me strongly of labor pain, except that it doesn't stop hurting afterwards for about 24 hours. Then, it's time for me to do it all again. Let me rephrase that- it's time for Eric to do it all again. Because I am just not capable of inflicting that sort of pain on myself.
So this feels like a set-back. I know that in the long run, it's probably progress, but I'm discouraged. I was taking an aspirin in the morning as a blood thinner and a Vicodin at night. Now, I'm back to taking aspirin, four naproxen, and about four Vicodin, as well as Prilosec, Tums, Senna and Colace to treat the bowel issues caused by all of the above.
But on the bright side, I can start bearing more weight. That doesn't mean off the crutches, but it is a step in the right direction. Now, I mostly need the crutches for weakness and instability. And in two weeks, I can go to one crutch. Two weeks after that, a cane. The doctor said he's progressing me faster than usual. He normally doesn't allow dropping one crutch before twelve weeks. This will be at eight weeks.
Also on the bright side, I can drive. When I'm not on pain pills. And I got a prescription for physical therapy. Starting any day now.
So things are looking up. And down. We'll just have to see where this goes.

Back to Rehab

2009-04-28T13:09:00.000-07:00

It's not the new Amy Winehouse album. It's just me in the swimming pool. And on the bike. And on the mat. And now, on the couch.
I can't seem to remember if I was this wiped out before we went to Duluth. If I recall clearly, I think it was actually much worse. Of course, I'm not back up to working quite as hard. But I'll get there.
On the plus side, I haven't taken any pain meds all day. And I only took one all day yesterday- at bedtime. This is a huge improvement and I think it has a lot to do with not pushing it quite as hard as I was last week. I think I have to focus my energies on the prescribed exercises first. Then, whatever I have left that day, I can use to my discretion. But I have to be a good little patient. I can't expend all my energy on other stuff, no matter how much I want to go to the library, get my CME done for the year or cook dinner.
Two more days until my six-week check up. I'll have X-rays done and they will tell me if I can walk, drive, start physical therapy, and eliminate some of the restrictions. I'm a little excited. With the recent decrease in pain, I'm having a hard time believing that things are not healing as they should and I'm very hopeful that I'll be taking the next step forward this week.
Keep your fingers crossed for me!

That which doesn't kill me...

2009-04-27T07:03:00.001-07:00

And it didn't.
I'm very tired and my rehab fell by the wayside to a large extent. Even on the days when I did still have the time and energy to ride the bike, etc. it was pretty minimalist. I was pushing myself in so many other directions that I didn't imagine that I wasn't working hard enough.
Now, I'm back home and getting back into my routine and let me tell you- I wasn't working hard enough. Apparently, the progress that I had made was so very tenuous that skipping 2 days of leg lifts is still a major setback. Weird, huh?
On the other hand, I was out of bed and dressed by 7:30 every morning. I ate all my meals out of bed, if not exactly at a table. I went through seven houses in one day, all of which had stairs. We bought one of them. We visited four daycares and chose one for Nora. We drove and drove and drove and drove.
I am exhausted.
I feel like once I get rested up, my baseline will be significantly better than it was before I left. Or at least, that's what I'm telling myself. For now, just let me sleep.

Riddle me this

2009-04-17T12:58:00.000-07:00

How do you get two sound adults, one gimpy adult, one wheelchair, two crutches, multiple carry-on bags, and a two-year-old through security at an airport? After security, how do you get them onto a plane? On the plane, how do you keep them from biting off each other's heads to get to the chewy center? These are only a few of the questions rattling aorund my brain as I try to comprehend that we are going to attempt this feat tomorrow.
I suddenly realized last night that we do not have a reservation for a handicapped room in Duluth. Yet, I cannot shower standing up. Hmmm, a quandry. So, it seemed like the logical thing to do to call the hotel and change that. However, our new employer made the reservations. So, I had no confirmation number, couldn't tell the lady what our rate was, how many nights we were staying or who the contact person was. After going in circles with her for about ten minutes, she asked to speak to my husband. this was either because the reservation was in his name or because she suspected that I am on drugs. Either is true. I suspect the latter.
She asked him all the same questions, which he was equally unable to answer (to my delight). But for some reason, she actually gave him the information and changed our reservation. Hence, my suspicion that the Vicodin was creating a barrier betwixt her and I.
I am seriously worried about this trip. If I make it through the part where I have to sit on an uncomfortable, tiny airplane seat with a broken pelvis for three hours, I'll let you know. Otherwise, farewell. I have enjoyed writing this blog.

Meet the Piriformis

2009-04-14T10:43:00.000-07:00

Ah, the secondary problems that accompany recovery. Weight gain from sitting on my ass, bed sores from sitting on my ass, piriformis syndrome...from sitting on my ass (and a bike).

Seriously. For those of you unfamiliar with piriformis syndrome, it is lovely. This little, irksome muscle deep in your butt-meat (technical term) spasms and swells and entraps your sciatic nerve. Then you get pain- in your butt-meat and all down your leg. It's caused by sitting, biking, weak muscles, spasmed hip flexors and fat wallets. No, really. George Castanza probably had piriformis syndrome. That's the one risk factor I definitely do not have. I wear my wallet on a cute little string around my neck like an old lady waiting to get mugged in a Mexican airport.

I've been rehabbing on my bike with a bike trainer- a device that allows you to take that bike that you bought to get out into the fresh air and bring it inside so that you can watch reruns while you ride. Birds chirping, be damned!

Well, I've been told to ride an hour a day. And I can't actually reach my foot to stretch first, let alone wrap my leg around me to stretch the piriformis muscle. So I just get on and ride. Then, I sit on the couch or lie in bed for the other 23 hours of the day. Directly on that twitchy little bastard of a muscle. And it has the gall to take exception to this treatment.

I suppose I should be more sympathetic to the a-hole. I'm getting pretty twitchy myself. I just want so badly to MOVE. And be awake- I'm really tired of the fatigue. Oh, and I want to be able to sleep in multiple positions (And no, "propped up" and "slid down" are not two different positions). And if we're making a wish list, I'd like to not have to schedule bathroom trips.

Picky, picky.

POD #23

2009-04-12T17:38:00.000-07:00

I am so very tired. It's mostly because of the half marathon I ran today, but also I just couldn't keep myself from training for my Ironman triathalon next month. Even on a day where I ran a half marathon! I know! I'm just so crazy in love with working out!
Or, in this realitoscape, Jenni came over and taught me how to knit. That's right, I was beaten down by laying on the couch and moving my hands to create 2/3 of what will someday be (in the kindest possible reality) a dishcloth. Jenni promised me that the dishes don't mind the lumps and holes.

POD #22- On the receiving end of kindness

2009-04-11T09:19:00.000-07:00

We had a changing of the guard yesterday. My mom left and Eric's mom arrived in town. It's going well, but I realized as I was preparing for Mary that my life has become a veritable cornucopia of minutiae. What I can and can't do, what pills I take, how long I can be up before I get tired- it's all important. Then add Nora's routine on top of that and it is a lot of information. And it has to be overwhelming to someone dropped into the middle of it. For Pete's sake, I'm overwhelmed and my chief occupation is laying around and sleeping.
One thing that has made things tenable is that people have been very generous with us. Our friends and family have brought meals and offered help and support beyond what I ever would have expected.
My friend Rachel presented our situation to the community at her church and they have provided the majority of the meals that we have eaten for the last three weeks. These are busy people that I have, at most, met briefly. And they have made casseroles and shared the vegetables from last summer's garden and baked cookies for us, virtual strangers.
I have never been on the receiving end of such a beautiful gesture. And I have composed a thank you note many times in my head and have been unable to fully express just how much this has meant to us. It's not even the food that even now fills our fridge and freezer as much as the love and well-wishes behind it that has propped me up when I've felt demoralized.
And it's been a wonderful lesson for me as well. Living in the Deep South as long as I did, I've had a lot of frustrating experience with the type of Christian who goes to church on Sunday and thinks that that is enough. I have long held that meeting Rachel and her husband, Peter, was a turning point in my life, because they showed me, through the little daily actions that make up how they live, that there are people out there who believe in living life in a Christian way, seven days a week. It sounds sort of trite to say it, but it was a revelation for me. They are mindful of how the things they do affect their neighbors, locally and globally. And it changes the way they shop, eat, work and raise their children. It's not about proselytizing- it's about living in a way that is loving to others. It's been inspiring me for five years now.
It shouldn't have surprised me that her church responded they way they did. After all, I've been there. They, like Rachel and Peter, are welcoming, caring people (who are Mennonite and thus respond to crises with food). Still, it did surprise me. It saddens me a little to realize that I've become so jaded to the idea of community that such an outpouring comes as a shock. And saying "thank you" falls so flat in the face of that (very pleasant) shock. I am astounded, bowled over and overjoyed. My heart is so full of gratitude I can't imagine being able to express it.
I only hope that I have the opportunity to astound someone like that someday. I know that I will be looking for opportunities, now.

POD #19- Set backs

2009-04-08T17:37:00.000-07:00

I was frustrated today. Yesterday, I biked and swam just like the day before, but it didn't feel the same. Whether it was the cumulative effects of five days of exercise or what, I was exhausted afterward- the kind of tired where you can't move but you also can't actually get to sleep. And I woke up this morning in pain.
I wanted so badly to hop out of bed and get on the bike, get over to the pool early and finish it all so that I could have a full, productive day. I'm not even sure I know how to do that anymore. I couldn't get out of bed to pee before 10:00. It took two rounds of Vicodin (four hours apart), a Celebrex and scrambled eggs to shoehorn me into some clothes. Then, I rode the bike and then, I was unable to convince myself to go to the pool. Or change into real clothes. Or shower.
And I'm still exhausted tonight. I think that's what frustrates me the most. I rested. I relaxed. I sewed my daughter a hat. And I feel like I've been hit by a truck.
I'm supposed to go to Duluth with Eric and Nora in 10 days or so. We are scheduled to have business meetings at Duluth Clinic, meet with our partners, shop for houses and interview daycares. And of course, I can't neglect my therapy. How on earth am I going to manage all that when I have yet to eat all three meals at the table?
As irritating as the weight-bearing restrictions are and as time-consuming as the therapy is, what is really chafing me is the lack of stamina. I'm living this life right now that is so much slower than I'm used to. I thought that would afford me some sense of peace, but it turns out that there is a fine line between peace and stagnation. And the more I try to kick myself back into the stream of things, the farther I sink.

POD #17

2009-04-06T11:44:00.000-07:00

So, I'm no longer the slug I once was. Starting 2 days ago, I've been riding a stationary bike for an hour a day. And today, I added swimming.
I initially intended to swim for about 20 minutes, after having ridden for an hour. But I got to the gym today and the woman at the desk refused to let me in, because I didn't have a written doctor's clearance. I offered to write her one on the spot. She was less than impressed with this suggestion. So I went to the pool and swam for about 30 minutes, walked in the water for 20 minutes and treaded water for ten minutes (thinking that bicycling my legs against no resistance in the pool would be similar to bicycling my legs against no resistance in a gym). I figured that I was going to spend the rest of the day strapped to my CPM machine and sleeping, so I might as well give what I had.
Then, on my way home, Eric called and brought up the possibility of riding the stationary bike another gym near us and just paying the day pass fee. After I got over feeling stupid, I agreed that that sounded like a good idea. So, I'm headed over there now. I'm trying to think of rehab as my job right now. If it takes everything out of me, consumes my whole day and requires me to eat more to support it, so be it. I want to give this surgery as good a chance of succeeding as I can. At least I know that a blood clot is unlikely. And I should sleep well tonight.

POD #14

2009-04-03T17:52:00.000-07:00

Two weeks ago today, I signed a consent form to have someone break my pelvis. Now, I'm living with that. Just a thought.

In other (but related) news, I awoke this morning to Nora giggling. The last two weeks, I have been waking up to the throbbing of my hip as my pain medicine wears off. It was like stepping into sunshine to not wake up to pain. So, obviously, I felt better about weaning off my pain medicines. I decided to play it by ear.

It is now 14 hours later. I have taken no MS Contin and only 3 Vicodin all day. And I'm in no pain. Granted, I'm in my standard 6-hours-of-CPM-threatening-to-give-me-a-pressure-ulcer pose on the couch. But earlier, I went to the pool and bought a membership, then ran errands until 1:00 and went to lunch. (Don't worry- Mom drove.)

So, it's exactly 14 days after surgery and I think I'm turning that corner that the surgeon told me I would turn at 2 weeks. Hunh. Turns out he knows what he's talking about.

Post-op check up (day #13)

2009-04-02T16:51:00.000-07:00

Today, we went to the doctor's office for my post-op visit. There are no stitches or staples to remove, so it was really just a check on the wound and a discussion of what my restrictions are now. It was a case study in the good, the bad and the weird.

First, the good: I only have to do the continuous passive motion machine for another week. And I've been given an out. If I can find a way to start the next stage of rehab early, I can ditch the CPM as soon as I have it arranged. So now I just have to find a stationary bike that I can ride for an hour a day. He also cleared me to swim or walk in a pool. So I'll be getting off the couch momentarily. That's incredibly good, since I was about to chew my leg off like a raccoon in one of those traps with the shiny things and the nails. (Never mind. Just re-read "Where the Red Fern Grows" if you didn't catch that one.)

Now, the bad: They want me to wean off my pain medicine. Which is good- this whole bowel regimen thing stinks. And so does being sleepy so much of the time. And so does the itching. But it's also scary. They are telling me that right about now, I should be turning the corner and my medication needs should be decreasing drastically. Physiologically, that makes sense. This is about the time that the bones will have fused enough to not be moving around against each other causing pain, even if they aren't strong enough to stand on. And I do see that somewhat.

But last night, for the first time since leaving the hospital I was awakened from sleep by gnawing pain and an inability to get comfortable every time my Percocet wore off. And that was on top of the MS Contin. Then, today when I was up and around and going to the grocery store (in a wheelchair) and cooking (on crutches) I was fine and needed no Percocet. Until the MS Contin began to wear off. And now I am back on the couch waiting for it to kick in. So I'm a bit skeptical that I'm ready for this.

But I know from being on the other side of this interaction, what exactly it looks like when a patient is dragging her feet about stopping narcotics. And one of my biggest fears about this surgery was getting hooked on painkillers. What if I trust my gut and decide to keep going on the meds until I feel ready to wean? That sounds great except for the part where I run out of medication and have not yet completed an appropriate taper and have to choose between asking a doctor for more medication that I know he feels is inappropriate or undergoing a severely uncomfortable (but not life-threatening! Hooray!) withdrawal syndrome.

And finally, the weird: Yesterday, I accidentally ripped off about half of the Steri-strips holding my incision together while dropping my pants to pee. When Eric saw the resulting carnage of flopping tape and perfectly healthy skin underlying it, he moved quickly (and without any warning, the bastard) and yanked off the rest of the strips. The surgeon looked at it and agreed that the incision looked great, but was worried about it. Because the wound is a foot long, goes against the skin fold lines and passes through the sweaty fold of the groin (Mmmmm...sweaty fold), he thinks that it is at high risk for re-opening. Unfortunately, my eczema has had things to say about the stress of surgery and the sheer number of exposures to sticky tapes and dressings. There is a lot of irritation where the Steri-strips were. So he decided to forgo putting those back on and has asked me to use an apparently time-honored technique recommended by the plastic surgeons for scar healing- paper tape.

Whaaa?

So I'm supposed to put paper tape on my incision. The stuff that is notorious throughout the medical world for falling off if you sneeze near it is going to hold a 12-inch wound together? Sure, there are sutures under the skin and all. But paper tape? My unofficial poll (n=4 doctors, including me) went something like this...

Me: Have you ever heard of this?
Eric: Sure. The plastic surgeons use it all the time.
Me: Do you use it?
Eric: [insert jargon about Langerhans and partial nephrectomy incisions here to get us to a short answer of] No. But you should.

Me: Have you ever heard of this?
Dan/Denise: No. Sounds like voo-doo to me.
Me: Yeah, that's what I thought, too.
Dan/Denise: You should probably do it anyway.
Me: Oh, I totally will.

So. we're agreed. Paper taping the incision it is. Anyone digs up a reference on this and I'll buy you dinner. Not you, Eric- I buy you dinner every night.

Milestones for today (Post-op day #11)

2009-03-31T16:08:00.000-07:00

1. I ate two of today's meals at the table (instead of in bed).
2. Two of my steristrips fell off.
3. I used my crutches in a store.
4. I made a bag of microwave popcorn- all by myself.

Post-op Day #8

2009-03-28T16:44:00.000-07:00

This is a big day! According to the surgeon, when I get to POD #8, I can shower. Like, for real, running water, hot as I can make it, not worrying about what gets wet shower. And that's what I did.

It. Felt. Awesome.

Eric also decided that today is the day for other big milestones. I have only been outside once in the last 8 days, and that was traveling from the hospital to home. I've become mighty tired of staring at the inside of my house, but have been scared to venture out.

I'll be frank here. Up until last night, I hadn't even gone down the stairs. With the delicate application of a electric cattle prod and the offer of an ice cream sandwich (false and true, for those of you who are counting my blatant lies), I was coerced into a very nice evening watching tv with my husband. I've been a little shaky on my feet and it is extremely reassuring to tackle some of these hurdles while spotted by someone who could easily pick me up off the floor, dust me off and deposit me back in bed if need be.

I was still a bit nervous when Eric laid it on the line. By "it," I mean "his plan to butter me up with a quick wheelchair ride around the yard, followed by hoisting me into a truck for a nice lunch at Neato Burrito." I am happy to report that the burrito was delicious. And also, we have Siberian irises blooming! It turns out that your worldview narrows a bit when you stop interacting with other people or leaving your house.

We ran a couple of errands after lunch and I learned how to navigate the handicapped stall in the bathroom at the grocery store. By the time we got home, my arms had given out and refused to lift me into the truck even one more time. My quads (which were detached during surgery) have made their displeasure known through a coordinated coup, otherwise known as "a really freakin' big charlie horse."

It all represents baby steps, but they're important ones. Eric says that if I don't feel like this a tthe end of the day, I'm probably not pushing myself hard enough. Let's see if he still says that after I punch him in the thigh, recreating the uprising in my left leg.

Mommy snuggles

2009-03-27T08:56:00.000-07:00

Yesterday was pretty rough to begin with. I can't really point to anything in particular that made it worse than any other day, but it was. I was more stiff and sore and bloated and heartburny. It was rainy and gloomy, so at least I didn't feel bad sleeping the day away.
Then, my mom went to pick Nora up from school and took her to the library as a special treat for a kid who has been a total trooper through all of this. She just didn't seem to get into it, so they came home earlier than they had planned to.
Nora just stood by my head on the couch and jabbered about her day. At one point, I asked her if she was hungry for dinner and she got a big smile on her face and said, "Yeah!" Then, she vomited all over both of us.
This put us in a quandry. These days, I do not move quickly when I move at all. Nora has no idea what to do with the puke running down her front. I called for my mom who took Nora into the bathroom, where she continued to ralph. By the time I had gotten myself off the couch and down the hall, she was in pj's and feeling better. I took her into her room and she read a story to me while mom cleaned up the living room.
Sitting in that rocking chair for fifteen minutes sent me whimpering back to the couch and reaching for my pain pills.
In the middle of the night, I awoke to hear Nora crying very quietly. Sometimes, she cries in her sleep, so I listened for a while before poking Eric and making him go check on the kid. She had again, thrown up all over her self, her stuffed animals and her bed. She was sitting in the farthest corner of her bed from the wet spot, trying to take off her shirt. Or so Eric tells me. Despite the fact that she was crying for Mommy, Mommy wasn't there.
He brought her in to me, feverish, naked and glassy-eyed and she cuddled up to my side while the functional adults in the house fixed everything. Then, he gave her Tylenol and tucked her back into bed.
Needless to say, Nora is not at daycare today. It's a burden on my mom to be taking care of both of us, so I'm trying to help. But I'm limited to fairly horizontal activities. Luckily, even when all the other Mom activities are taken away, comforting a sick kid is still an option. My arms work just fine for snuggling.

The Basics

2009-03-24T18:43:00.000-07:00

In the continuing adventure that is surgery and recovery, I will indubitably encounter situations where I ask, "Would anyone want to know that?" and it's inevitable corollary. "Do I really want anyone to know that?" This is particularly true when the surgery and subsequent swelling is close to your vital organs known as your bladder and bowels.
On the one hand, ew. And ugh.
On the other hand, if someone is reading blogs about PAOs trying to decide whether it's right to proceed with having their pelvis broken (which I did a lot of), it seems dishonest to gloss over just how much your body is returned to a more, um, basic level of functioning.
So how about this- it's there. It's an issue. My husband continues to be a rockstar. Or maybe that's a bad analogy here. He definitely isn't contributing to my problems by divorcing me and throwing televisions out the window. He's amazing. Instead, he gets up with me in the middle of the night to help me to the bathroom, wakes up early to give me shots, rearranges his life and generally takes care of me. I love him more than anything and I'm beginning to think that he likes me too.

Post-op day #3, bustin' out

2009-03-23T18:58:00.000-07:00

So I passed PT today and they let me go home. It was an amazing series of "coincidences" orchestrated largely by my husband. I wouldn't have passed yesterday and as I hobble around here tonight, I feel pretty certain that I wouldn't have passed had they checked me much later in the day. Of course, I may just be excessively tired and sore from all the activity related to the trip home, I guess.
They pulled out the epidural this morning, which I was pretty sure was not working anyway. I was rocking the Casbah on just Percocet. But the resident wrote me for MS Contin as well as Percocet. I scoffed at that, thinking that the pain is going to get better every day, right? That lasted until 4:00 this afternoon. I broke down and started the hillbilly heroin (I know, not really, but life is just funnier this way.)
Tonight, I feel rough. But I'm home. In my bed. With my husband and daughter and bathroom and food and no one checking vital signs in the middle of the night or insisting leave the catheter in place.
And it took several acts of Congress to get me here, many of which fall firmly within the category of doctors making the worst patients. For instance, Eric removed my catheter. This was surprisingly not awkward. I guess you just get to that point in your marriage someday. I didn't think it would happen quite so soon...

Post-op day #2

2009-03-22T04:58:00.000-07:00

It's been an interesting couple of days here on the orthopedics floor. I'm currently attached to an epidural, two IVs, a Foley catheter, a drain and a continuous passive motion machine. I'm hoping that they'll let me travel a bit lighter soon.

I'm feeling a little crummy. My Hematocrit dropped to 19 yesterday, making my blood pressure drop and my heart rate to speed up. All I knew was that I felt miserable. They gave me back the 2 units of blood that I banked before surgery and my blood counts still aren't setting world on fire, but my tongue is pink again. It was white yesterday. That was so freaky.

I also had a couple of fevers since surgery. It's nothing anyone is concerned with. They have me on antibiotics anyway and it's not likely a real infection. I can't say that I've ever experienced shaking chills and sweating through the sheets before. I could do without it to be honest.

Eric has continued to be awesome through this. They used a sterile prep goo on me that is supposed to be great for long cases because it doesn't come off. Unfortunately, it doesn't come off. And it itches. And I was prepped from my breasts to the bottom of my foot. Eric found a big bottle of rubbing alcohol and painstakingly removed all the adhesive and prep and miscellaneous crud. Then, he bathed me. That is love (or at least that's what he keeps telling me).

If anyone is interested in coming to visit, I'm up for that now. The narcotics are making me sort of loopy, which I tend to realize when the nurse or physical therapist gives me this long look, indicating that what I just said made little or no sense. Good times! So come on up to room 3245 and laugh at me. I'll laugh right along with you!

It's alive!

2009-03-20T17:03:00.000-07:00

I made it through surgery- 9 and 1/2 hours of it. Eric actually went in for about 2 hours near the end. I never, ever could have done that. Mad props to the boy! Also props for the fact that he has washed my face for me and fluffed my pillows. He's an excellent fluffer.

So, it looks like there was no cartilage tear, but there was lots and lots of impingement from my fat femoral neck, so they shaved that down and did the PAO after that.

So the part that I was mosty scared of is over. Now, all I have to do is get through the recovery.
That's easy, right?

PS- If you're wondering how I'm capable of blogging, the answer is simple.
Epidural.

Tick...tick...tick

2009-03-19T05:32:00.001-07:00

There is a building here in Hershey that never fails to tickle my gallows humor funnybone. It was a standard gift shop or something until about 2 years ago. Then, it was converted into a after hours urgent care clinic called "Good Nights" or something like that. They painted it dark blue and put up a neon sign of a new moon and stars with a clock in the middle. It threw me off for months until I figured out that it's not actually a functional clock.

Then, after less than a year, the clinic went out of business and the building sat empty until just recently. It was nice to see that Gift of Life was establishing an office in the area, but I wish they would have redecorated. I suspect that they don't have either the funds or wherewithal to remove that clock.

The message it sends to me is, "Now is the twilight of your life. And time is ticking." So very, very wrong.

So when I started thinking about the countdown to my surgery, I automatically thought of the non-functional, highly politically incorrect organ donation clock. We're at less than 24 hours now on a working clock.

Travelogue

2009-01-19T17:11:00.000-08:00

I understand that when a young adult plans a trip to Europe, everyone tells them to keep a journal. The advice to write it all down is bordering on cliche. The thought, I guess is that you will change so much and have such a fantastic time that you will never want to forget it. So I understand. I've never been to Europe.

I keep wondering why I even bother committing all of this to metaphorical paper. I feel like I'm doing a lot of whining and really, do I even want to remember this time of my life? I tend to write to process and I always had trouble writing about those experiences that were fun, but not terribly thought-provoking. And I always had too many fun things to do on vacations to write a lot. Then, today it hit me. This trip has more life-changing potential than visiting another country, even if you backpack.

Theoretically, I could learn a lot from this experience and become a better doctor. Or I could completely fall apart physically and emotionally and never doctor again. Either way, should be an interesting story to tell. And god knows, I've got enough processing to do.

Wanton Self-pity

2009-01-18T16:40:00.000-08:00

I'm feeling bad for feelng sorry for myself.

The socially-conscious part of me keeps saying, "You know, this is an opportunity that people living in poverty all over the world do not have. this surgery isn't even available to everyone in our country, let alone developing countries. Grow up, pull up your big girl pants and answer the fucking door when opportunity knocks."

Then, the spoiled brat hiding not-so-deep within stomps out, slaps that hippy-dippy flake, storms back into her room and resumes crying. She feels like she should get a chance to mourn for the life that she went over $200, 000 into debt to acheive.

I'm sticking with the brat on this one.

Expectations, Readjusted

2009-01-16T05:51:00.001-08:00

I'm becoming someone else. It sounds dramatic, but I can't think of another way to say it any better. Let me explain.

I was told as a teenager that my hips wouldn't make it past about 50 years old. When you're young and active, that's easy to dismiss as something that happens when you're old. Now, I'm not so young and activity hurts. So I lose weight, thinking that being heavy is causing the pain. The pain gets worse. So I go to the doctor. And they tell me that X-rays and MRIs look good. Sure, I have hip dysplasia and some femoral deformity, but nothing that looks like it needs to be fixed. Again, it is easy to dismiss the threat of early arthritis.

Then, the surgeon pages me to tell me he thinks that he can fix the pain and delay the hip replacement. But he reiterates that even with this surgery that he is recommending, my left hip particularly won't be my natural, God-given joint by my fiftieth birthday.

I have managed, over the last fifteen or so years to ignore the hip replacement in my future. I have cycled and skiied and hiked and swam. I have never had any plans of stopping these things. I always saw myself growing old as the lady who everyone in the neighborhood shakes their head at affectionately, because she's still riding her bicycle to the grocery store at age 80. Probably wearing a funny hat.

Now, in my post-phone-call-with-the-orthopedist world, I'm not going to be that little old lady. After a hip replacement, there will be no skiing or skating for fear of falling and dislocating the hip. There will no hiking, since that will wear out the joint too fast. I can ride my bike to the store, as long as the road there is completely flat and I don't buy anything when I get there. I will be able to swim, so now I see myself as the little old lady who everyone shakes their head at because she still wears a bathing suit.

The crux of the issue for me is that I have to change what I'm expecting out of life. The whole rest of my life. I chose a career that demands that I stand, walk and run when necessary. After a hip replacement in a young person, failure of that joint is anticipated, since the joint doesn't have as long of a lifespan as the patient. In that case, it may get to the point that I can't perform my job adequately. Does anyone expect themselves to be the person who has to stop working and go on disability? Of course not. I want to retire, because I had a fulfilling career and it is time to focus on other things. I want it to be my choice. It very well may not be.

As I settle into this new future that I should have been (but wasn't) expecting, I find that I can see myself finding peace with it. It's different than what I thought my life would be, but I can start to see how this life might be okay, too.

That being said, I want to ride my bike a few years longer.

Does this thing open in the back or front?

2009-01-14T15:50:00.000-08:00

How do you stop being a doctor? When it's time to walk into a medical office by the front door and ask someone else's opinion on a problem with your physical engine, how do you lay aside the whole language and culture to step into the shoes of the guy who sits in the chair that doesn't spin?

I'm currently staring down the barrel of major surgery. An orthopedist, whom I trust, thinks I may need my pelvis broken and realigned to delay hip replacement. But he is trying to be neutral and leave it up to me. He gave me the information (He referred to it as "realigning my expectations.") and asked me to do some research. Another physician, a friend, whom I also trust, in Sports Medicine, thinks that I should get a second opinion.

In fact, every physician I have talked to about this has a opinion. And they aren't shy about sharing them, even with limited information. This is not a common surgery or even a common problem, so it's not like everyone I mention it to understands the intricacies of hip dysplasia in the adult and corrective surgery for it. I guess it's a product of how the medical system has raised us into big, grown-up doctors. We're too used to sharing our opinion, informed or not. And we assume that the person in front of us is interested in what we think.

Add to that the fact that even a family doctor, like me, who avoids to operating room as if it were covered in capsacin can imagine all too well what it might mean to have your pelvis cut apart to the point that the hip socket is free-floating and then may be screwed back into place. We can picture the incision, the osteotomes, the blood loss, the ICU stay, the clot risk, the weight bearing restrictions. And most doctors want to ask about those things. And discuss them, in gross and fine detail. They ask intellectual questions about the interestingly rare problem and procedure in order to learn more. They don't think about the immediacy of the issue for me, the interesting patient.

So who do you talk to? Laypeople often don't understand the magnitude of what I'm talking about. I've gotten a lot of "Yeah, my grandmother had a hip replacement." But it's not a hip replacement. And I'm betting your grandmother wasn't 31. Which is a large part of the problem. It's not that simple.

Part of me- greater than 50%- wishes that for this, I could just return to laymanship. I want to not be able to imagine what is going on after the anesthesia kicks in. I want to not know what questions to ask, so that I can't get the utterly terrifying answers. I want someone to just say to me, "I have the expertise in this area, so let me make the decision." Because as it turns out, I don't have expertise in this area. And I don't know that I can make a decision. I certainly can't make an objective decision. And I feel like every new opinion makes me doubt my previous resolve.

I don't know how to lay aside a lifestyle that encompasses my work, home and social lives. I don't even know if laying it aside is the right thing to do. I just know that sitting on the exam table, when you're used to the rolling stool, is pretty uncomfortable.

Paranoia

2008-08-31T17:40:00.000-07:00

I used to spend a good portion of well child checks inwardly rolling my eyes at the parents. I love kids. I think that well child visits are a great way to get the families in to the office to talk about prevention and screen for serious stuff that goes on behind closed doors.

What always killed me was the questions. Mom will have heard from her sister/mother/neighbor/appallingly inaccurate Internet source of an outbreak of listeriosis/autism/influenza/bubonic plague and they are now convinced that little Jimmy (OK, these days it's more likely to be little Jayvon) has contracted said disease. It doesn't matter that Jayvon has never been ill a day in his life/missed a developmental milestone/sneezed twice in a row/been a serf in medieval England. Nothing I can say at this point can trump Aunt Tilly/Mom/Ms. Jones/www.wrongdiagnosis.com (Sweet Jesus, save me from wrongdiagnosis.com!). Which brings up the intriguing, but ultimately irrelevant question of, "If I can't convince you otherwise, why are we even having this conversation?"

Then, the inevitable happened. I popped out one of my own. At various points in the past two years, I have been convinced that my child had measles, pyloric stenosis, Kawasaki disease, and a tail. Granted, that last one was before she was born.

None of this can beat the things that my husband, also a physician, can come up with when pressed. The same man who has repeatedly talked me out of emergent trips to the hospital readily acknowledges that he performs an extensive abdominal exam on our daughter every time he bathes her, just to make sure that no tumors have snuck in under the radar overnight.

When I was twenty weeks pregnant, we both managed to get out of work at the same time for our prenatal ultrasound- a feat that has yet to be repeated. Seriously, I delivered the baby on a weekend that he just happened to not be on call.

We debated beforehand whether or not to tell the technician that we were medical personnel. There are a number of studies that show that if you get treated as a VIP, you are more likely to received sub-standard care in the name of respecting your privacy or honoring your wishes. Our cover was probably already blown by the scrubs covered in mystery fluid that the father of my fetus was wearing. Any residual doubt was eliminated by his first words upon seeing his first-born:

"Oh, good. It has a brain."

Maybe my imagination is sub-standard, but nature has certainly invented fates that are infinitely more terrifying than anything I could have come up with on my own. Having studied embryology, pathophysiology and pediatrics gives those fears the power of realism and crystal clarity. What I underestimated was the extent to which I would worry about this soft, breakable creature with half of my genes.

So, part of me understands why parents are scouring the neighborhood, the Web and my office looking for The Answer, that horrible answer that makes all their kids' symptoms fit into the puzzle and delivers the crushing blow that they really are losing their soft, breakable little creature after all.

And part of me wants to shake those parents. I want to say, "Look. I'm stuck with this knowledge. My kid gets poked and prodded far more than necessary because of this knowledge. Relax. Let me worry for you. That's why I'm here." When I think that way, I start planning my charge on Congress to form a moratorium against all information on the Internet and a gag order for Aunt Tilly.

Here's the thing:

2008-08-29T12:50:00.001-07:00

I've never been a feminine woman.I cringe when I think about the extent that I went to in college to fit in with the Southern girls. I spent money on clothes. I lost weight in entirely unsafe ways. I flirted and primped and practiced my walk. I, oh God, joined a sorority. Granted, it was the agriculture sorority and not exactly filled with fashion plates, but still. I wonder now what people must have thought of me. I figure that it was somewhere along the lines of, "Who is that drag queen and where did she buy that awful lipstick?"
And after all that, it didn't stick. As soon as I got into medical school, I got bsy and the backslide began until I find myself here. All I have to show for those years is a cringe-inducing set of memories and a tendency to avoid Wranglers.
In the course of a day, I frequently get mistaken for a nurse, social worker or the girl who brings lunch. Seriously? I'm wearing a white coat, stethoscope and patently not carrying a tray of food. I just asked you intimate details about your bowel movements- which, by the by, you answered. Somehow, these social cues escape most people's attention.
Interestingly, it's usually the women, and not necessarily older women, who assume that I cannot possibly have made it through the requisite schooling to be their physician. The breasts, you know- they prevent your arms from moving far enough toward midline to dissect things or read books.
Not that I disagree. I frequently wonder how I ended up with other people's life or death decisions on my hands. I have trouble getting dressed and making to my car without a near-fatal accident. I almost brained myself on the coffee table this morning because I tripped over the hem of the pants that I just bought on sale and swore that I would shorten before wearing them to work.
It's a never-ending gauntlet to be a woman doctor. Especially one who's hair resolutely refuses to go grey. Not that I want to get old, but it would be nice not to have the following conversation four times a day:
Me: Good morning! I'm Dr. Smith.
Patient: Hi. When did you say the doctor was coming in?
Me: I am your doctor. Dr. Smith. It's on my badge and everything.
Patient: Oh! Sorry. You just look so young. How old are you?
Me: Older than I look.
Patient: They just keep getting younger, don't they Bob?
Bob: Yup. They just keep getting younger. How old did you say you are, sweetheart?
Me: Old enough to be your doctor. How about that rectal bleeding you've been having? That topic sounds significantly less uncomfortable than this conversation.
If there's one thing that I hate more than the joke about asking their grandson to prom, it's being called sweetheart. I don't look like a sweetheart. I don't act like a sweetheart. Calling me sweetheart is only acceptable when used ironically. Unfortunately, in this area of the country, there is apparently a rash of incurable ironopenia.
The truth of the matter is that people don't want to admit that they are sexist and assume without thinking that doctors are big, manly men and nurses are women. I thought, going into this whole thing, that my inability to dress myself and total lack of makeup or hairspray would cancel out that big, fat assumption.
I am proven wrong every day.