Bills and PT

The bills have started trickling in. So far I have received the following bills:

service, billed to insurance, what I paid
anesthesia, $3,150.00, $427.00
epidural, 2 of 5 days, $540.00, $73.20
x-rays during surgery, $47.50, $4.92
ultrasound of legs (checking for clots), $111.00, $11.68
rental of hospital bed, 30 days, $71.54 , $14.30
rental of CPM machine, 21 days, $495.72, $60.40
hospital charges from surgery day , $169,773.90, *$970.62
total, $174,189.66, $1,562.12

*I have not paid this bill yet. The amount listed on the bill was $1,919.82. My out-of-pocket limit on my insurance is $1,500. When I saw the bill over my limit, I called the insurance company, Group Health. It took a while for her to track down information and figure out what had happened, but after being on hold a few times she figured it out. The hospital sent a bill to GH, GH paid the hospital…then the hospital amended the bill and resent it…then they amended the bill again and resent it. That explains the extra grand in the bill. Once the third bill from the hospital is processed I should owe about $900 to get me to my limit.

I have received the explanation of benefits for the surgery day bill and find some of the specific costs very interesting. These are my favorites:

service,  billed to insurance
surgery, $16,170.00
private room, $14,496.00
implant support (screws), $44,475.00
OR services, $72,314.00
anesthesia services, $7,080.00
recovery room services, $6,744.00

Since my last post I have been walking in my hilly neighborhood. I’m up to about a mile in about 25 minutes. I’ve been riding by bike on the trainer in the basement a bit. It’s sort of like a stationary bike except the position is more aggressive since it’s an actual road bike. The “aggressive” position means I’m bent over at the waist more than a stationary bike. Right now that’s a bit uncomfortable. If I sit up, without hands on the handlebars at all, the hips feel better but the saddle is less comfortable. Can’t win. I’ll deal with the sore rear so I can get the exercise.

Thursday was my first appointment with the same PT, Dan, I saw last year. He had moved to a different clinic farther away but I decided he was worth the drive. Why mess with something that worked so well before? I wondered if Dan would remember me. He did. He said he recognized my name when he saw it on his schedule. He even remembered a few little details about me, like Steve being really into cycling and that I’d had some weird numbness in my hand last year.

The first appointment consisted of a lot of measurements to determine my range of motion. Dan also watched me walk with the cane and without. Right now the official PT orders have some restrictions (no straight leg raises, no abduction) that I think were included as an oversight. Because of that there are a few exercises he doesn’t want me to do until he clarifies the restrictions (not worth him risking malpractice if something bad were to happen). I did go home with instructions for a trunk stabilization exercise (lie on back, knees bent, heels dug into the floor, lift butt 1-2 inches off the floor, hold 10-20 seconds, make it harder by squeezing a pillow between knees). I also have 2 thicknesses of stretchy bands for a seated exercise (close knot in bands in door, sit on chair facing door with band around ankle, pull leg away from door 20-30 times or sit with back toward door and kick leg away from door).

When Dan hears back from Dr. Mayo’s office lifting those restrictions, I’ll have a standing exercise called the 4-way hip. To do this one the band is in the door and you start facing the door and pull the band away from the door, rotate your body 90º and still pull away from the door, then repeat the last 2 directions.
I also went home with 3 sheets of “Dan’s Rule of Four. Return to Activity Guidelines,” one for walking, one for the trainer, one for cycling on the roads. He wants me to do a certain duration 4 times before going farther/longer. So I’m walking a mile now. He wants me to walk a mile 4 times, then walk 1.5-2 miles 4 times, etc. Same for the bike. I’m riding on the trainer 15-30 minutes now. I’ll build up to 30-40 minutes 4 times, then 50-60 minutes 4 times, then I can start riding on roads for 30 minutes.

I’m really pleased to know now what I have to do to get back to road cycling. Also, since Dan knows I’ll do the work on my own and since it’s a much longer drive, he suggested I see him once every week or two. Last year I started with appointments twice a week. He said he was flattered that I followed him but also understood the challenges of his new location given where I live. I’m 100% confident I made the right decision to follow Dan to his new clinic.

I was hoping to have x-rays to post by now, but there have been some problems with the software. First, it does not work on a Mac, so Steve has had to use his PC at work. He has been very busy at work and doesn’t have a lot of extra time available. On two different occasions he has tried to open the desired images the software has quit. Hopefully he’ll be able to get it to work, otherwise I have no way to see my pictures. Might have to ask a favor of the IT guy at work.

LPAO 8-week check up

Last Thursday was my 8-week follow up appointment with Dr. Mayo. Since I haven’t been walking, much less driving our stick shift car, Steve had to take me. It was actually a nice break from work for him. We left the house at about 9:15am and drove down to Tacoma General in about an hour. We had to drive up and down all the levels of the parking garage to find one last handicap spot. In my opinion, they leave too many spots for their valet parking. I rarely find an open spot and usually have to valet the car, which I never prefer.

Anyway, we got into the waiting room right on time and I was quickly taken back for x-rays. They took three, one standing and facing forward, one false profile (standing almost perpendicular to the plate, left hip touching the plate, with right foot angled out), and one lying on the table with feet hips width apart and toes straight up. I barely had time to sit back down in the waiting room before Stevi took me and Steve back into an exam room. (To clarify, Stevi is Dr. Mayo’s PA…Steve is my husband.)

The first thing Stevi said to me was something about me looked different. She looked at me for a few seconds and asked if I usually wore glasses. Very observant…yes I usually wear glasses but I’d put in my contacts that day. I was surprised she picked up on that. She sees tons of patients every week. Next, she took vitals and asked about refills for prescriptions. Um…never had any prescriptions to begin with. When I mentioned that she remembered the huge hassle pre-op with getting approval for IV Tylenol because I didn’t want to take oral narcotics. Apparently there’s still a battle going on in the hospital over it. Stevi said the problem was that the IV Tylenol is much more expensive than oral. They already have it, same exact medicine, for pediatric patients but are hesitant to make it available for all adults. Apparently I stirred up a little controversy. All I know is it worked well for me and I’m glad Dr. Mayo was able to get me 24 hours worth of doses.

Kenda came in next and had me hop up onto the exam table to check out my range of motion. Lying on my back, she moved my leg, bent, toward my chest. I started to get resistance and a little pain well past 90º, so she seemed pleased with that. When my leg reached the stopping point, she rotated my lower leg toward the inside of my body and asked if that made it better. It did. Then she rotated my lower leg toward the outside and asked if that made it worse. It did. She seemed to expect both my answers of yes. Interesting. She also looked at the scar and seemed pleased with how it was healing.

Next she pulled up the new x-rays on screen…the film x-rays hadn’t finished printing yet. This was my first look inside #2. I have 7 screws this time. The false profile x-ray is a bit ridiculous…13 screws on top of each other because of the angle. She looked around in the files for photos taken during surgery. I’d seen one photo from surgery #1. She didn’t find any photos but there was a video that she played for me and Steve. It showed my femoral head and labrum through the big incision. Dr. Mayo was probing behind the labrum with an instrument to see how well the labrum was attached to the bone. If the instrument can get fully behind the labrum, then it needs to be reattached with surface anchors. It reminded me a little of when the dentist pokes around between your teeth and gums. You don’t want too much space there either. Thankfully, my labrum was fine.

Kenda told me everything was looking good and went off to print PT orders. She asked if I wanted a prescription for pain meds to use when I start PT. I declined, but she said it was okay to take Ibuprofen or NSAIDs again, so I’ll probably do that before therapy. Shortly after that Dr. Mayo came in along with another man he introduced as a doctor from Germany. I assume this other doctor, I don’t remember his name, was there learning from Dr. Mayo. He asked if he could show the other doctor my 2 scars and then did a quick check of my range of motion. We talked briefly about the continuing stiffness on the other side and agreed to deal with that after I rehab my left. I’ll also talk to my PT about the stiffness in my right hip when I’m there for my left hip. I bet he’ll have some exercises for me to try.

After finishing up with my appointment, Steve and I went to visit my friend Sasha, who had her PAO the previous day. She had a rough first night with low blood pressure and an epidural that wasn’t working but she was more comfortable by the time we were there. I do not miss the days of hospital gowns and catheters. It was a good reminder of how far I’ve come in 2 months. We chatted with Sasha for a little while and then left so she could rest. She looked really tired. After that we ate lunch in the cafeteria and got a CD of all my x-rays from the records department. (I should have x-rays to post next time. The software provided on the CD to view the images doesn’t work on my Mac and Steve hasn’t had time to make me screen grabs on his PC at work…too busy architecting lately.) Then we headed home.

Since then I have scheduled my first appointment with my PT, Dan, at his new clinic. I have to wait almost 2 weeks to get in, but I think he’s worth it. I have removed the toilet seat raiser from the bathroom, which is nice since our bathroom isn’t very big. I have started walking around my hilly block using 2 crutches for stability. Inside the house I’m using one crutch to get from room to room and I’m walking unaided if I just need to go a few steps. I have a significant limp. In order to walk on my left leg, I have to shift my weight evenly over the top of my leg. Even dropping down to one crutch is such an improvement to everyday life because I can walk and carry something, a plate of food or a drink, at the same time.

Over all, I’m walking better than I expected…better than I was at this point last surgery. Maybe my weight bearing cheats the last 2 weeks have contributed to that. Since my leg has been feeling stronger than I expected, I decided to try out the stick shift car. At first I only backed up about a car length and then pulled it back in. That went fine, so over the weekend Steve and I ran an errand a few miles away from our house and I drove. I figured if I was having problems I could pull over and have him take the wheel. Again, that went fine, so I’m thinking I won’t need to borrow my friend’s car after all.

I’ve had a few other firsts since my appointment. I went down the steps to my lower level, holding one crutch and using the handrail for support. I can also shower standing up. I still have to sit down to shave my legs, but it’s a big improvement over sitting the whole time. I am a very happy girl!

One thing I’ve realized after talking to more and more women having PAOs is that things never go perfectly. Everyone has their “thing” they have to deal with or overcome. My “thing” was the dizziness and long hospital stay. For other women I know, it’s been low blood pressure, or poor pain management, or continuing pain after surgery, or torn labrums, or HOs (heterotopic ossification…bone that grown where it’s not supposed to grow). One friend, Tessa, had her HO removed and it came back. How rude! Everyone deals with something. My “thing” was very frustrating while I was in the midst of it, but everything has gone so well for me since then. I really can’t complain.

LPAO weeks 7-8…routine

Two weeks have passed since I posted. Not too much has been happening. The life of recovery has become routine. I guess there’s nothing wrong with that. As of yesterday, I am 8 weeks post-op and feeling good. I have been cheating a bit with the crutches even more and “cruising” along counters…even managing to make it across my galley kitchen by taking one step on my good leg. I’ve definitely put more than 45 lbs. on the op leg but haven’t felt any pain. I’m anxiously awaiting my 8-week check up in 2 days. I should have at least a final x-ray to post then if not some of the x-rays taken during the procedure. I’m curious to know how many screws I have this time. I have 6 in my right hip.

Knowing that I’ll likely leave my appointment with PT orders, I decided to check in with my PT from last year, Dan. I got on the website for the clinic and couldn’t find his name listed among the therapists. They had some photos of the location I went to (they have 5-6) and I saw Dan in the background of one of the pictures, but I couldn’t find his name anywhere. I sent off an email to the generic account for that office and then started internet stalking. A quick Google search of his name showed that he seemed to be working at a different clinic much farther away. The first clinic emailed back confirming he had moved on and gave me his phone number. They also stated any of their current therapists would be happy to see me.

What to do? The original clinic is a 10 minute drive, the new clinic is probably 30 minutes away and the commute involves driving on the highway. I’m not too excited about driving on the highway initially. I haven’t driven since before surgery. Our car is a stick, so with this surgery on my left hip, I won’t be able to drive our car for a little while. Thankfully, a very good friend is going to swap our stick for her automatic. If it wasn’t for her, I would only have 1 option, the original clinic. I can take a bus there with minimal walking. The bus trip to the new location downtown would involve walking several blocks up a steep hill. It’s just not feasible on crutches. Thankfully I will be able to drive to my first few weeks of PT appointments in my friend’s automatic. I’m pretty sure I’m going to stick with Dan, even if I have to drive 3 times as far.

One highlight of the last 2 weeks was having a face-to-face meeting with a new hip friend, Sasha. She’s having a PAO with Dr. Mayo tomorrow and wanted to ask me some questions. There’s not too much about going through surgery that’s overly positive, but being able to answer questions and share my experiences and put someone’s mind at ease even a little bit is very rewarding. About a month before my first surgery last year, I met with Cindy, who was 3 weeks post-op from her PAO. I remember thinking she was doing so much better than I imagined someone would just 3 weeks after surgery. It was a huge encouragement to me. I hope I was able to pass along that encouragement to Sasha. So, many prayers go out to her tomorrow.

I have had a few adventures over the last 2 weeks. Last weekend Steve’s computer needed to be seen by an Apple Genius. We decided to make a day out of it. First we went to breakfast at one of our favorite local restaurants, Alexa. It involved parking on the street (no handicap options available), a short wait for a table (luckily there were benches outside), and navigating the full floor of tables to get to the bathroom. All went well. We used up a Groupon and had a great breakfast. Next we drove to an outdoor mall with an Apple store. We had to wait about 90 minutes for an appointment and occupied our time looking around in a few stores. Shopping also went well. I was pretty tired toward the end though. It was more walking than I was used to.

Last weekend Steve did a bike race in a nearby suburb. It was a criterium (short course, lots of laps, spectator-friendly since the pack comes around about every minute). I managed to navigate the crowds with a folding camp chair over my shoulder and settled into a good spot just before the finish line. Rain threatened a couple times but I only got a few sprinkles that were mostly blocked by the tree next to where I was sitting. After Steve’s race was over, a bunch of teammates ventured over to the beer garden to toast to a good race. I managed to squeeze myself and my crutches all the way to the front corner. We sat and ate peanuts for a while as bike talk ensued. There was some amount of hip talk too, as the guys were interested in how I was doing. Many of the guys were aware that Steve’s wife had surgery but didn’t know too many details.

After a while most of the group made our way down the street to a burrito restaurant. All around the 4 corners of the race, temporary free-standing metal barriers had been set up to keep cars off the course, the kind that hook to each other to form a fence. We were walking down the sidewalk right along the race course with the barriers separating the racers from us. The women happened to be racing. After we got about 10 paces past the corner, I heard the unmistakable sound of bikes and people hitting the deck. I had been looking at the sidewalk, making sure I wasn’t going to trip with my crutches so I did not see the wreck happen. Quite a few women went down and in the course of the chain reaction, a few of them crashed into the metal barrier with enough force that the entire length of barriers went crashing down onto the sidewalk. Luckily I had been walking on the outside of the sidewalk, otherwise the barrier could have landed on my legs. That could have been bad.

Most of the women who went down were okay and ended up getting back into the race. There were a couple more serious injuries. I think one woman who used to race on Steve’s team broke her collar bone, a very common injury among bike racers. After that unfortunate excitement passed, we sat calmly eating burritos and watching the action out the windows. By the end of the evening I was tired from more walking than I was used to. I look forward to being able to build up some stamina again.

I also look forward to my appointment on Thursday with Dr. Mayo. I should be allowed full weight bearing as tolerated at that point. Once I can weight-bear, I’ll probably move the toilet seat raiser out of the bathroom. I haven’t needed the extra height to the seat, but I’ve continued using it because of the handles on the sides. It’s easier to get myself to the toilet using those. It will be nice to know that I no longer need some of the aids I’ve relied upon for the past 2 months.

LPAO week 6…grateful

Warning: scar photos at the bottom of this post.

Why am I feeling grateful? Because this week I was reminded how fantastic my friends are. On Sunday a group of ladies came over with brunch. We sat around the dining room table and ate and talked. Steve joined the festivities. One thing that’s tough about being confined to my own property is that I realize I’m not quite normal when I can’t go anywhere by myself. The farthest I can go is out on the deck to sit and read a chair…and there haven’t been too many days I’d want to sit outside so far this summer. So, when some friends offered to come up with brunch I was really excited.

After they left, another friend stopped by in the middle of a bike ride to rest and visit. A little while after she left a neighbor knocked on the door with a Get Well mylar balloon and a nice bottle of red wine. Wine helps with bone healing, right? The next day, other neighbors stopped by with a home-made apple and cranberry galette.

apple cranberry galette from the neighbors

For the past several weeks, my friend Cara who had the baby right before my first surgery last year has been visiting once a week. The last 2 weeks we’ve gone out…lunch one week with another friend and lunch plus a splash park (it was one of the rare warm, sunny days) the next week. There’s nothing bad about sitting in a camp chair in the sun watching cute kids running around having fun in the water. It helps me to feel more normal when I can do “normal” things.

On Friday, I was able to get a ride to a professional group I am a part of. We’re all women business owners and are either graphic designers (like me) or something related to the field (illustrators, photographers, calligraphers, letterpress shop owners, print brokers). There are also a lot of friendships among the members, so our meetings are part social and part business.

Other than being somewhat confined to my house, I’m doing well and feeling well. The CPM and hospital bed have both been sent back. The only device I’m regularly using is my crutches. I’m able to do more and more things around the house, which is helpful to Steve. Starting later this week, I’ll have to start cooking dinners. I pulled the last dinner out of the freezer for tonight. The challenge now is to find dinners that are easy to prepare on crutches. I’ll probably pull out all my favorite crock pot recipes.

hospital bed and CPM machine

On Saturday, I managed to change the sheets, slowly, on our king-sized bed. I’m able to “cruise” around furniture, like a toddler learning to walk. (At least I’ve progressed past my infant stage with “tummy time” when I was supposed to lie on my stomach for 30 minutes a day.) As long as I can take some of the weight on my arms on a counter or another piece of furniture, I can get around much quicker than grabbing the crutches every time. That’s how I get around in our small bathroom and somewhat in the kitchen.

Honestly, I think I could easily take a few steps now. Some doctors allow you to progress to full weight bearing at 6 weeks. Dr. Mayo has his patients wait until 8 weeks. Even though I’d like to try to walk now, I’d be so angry with myself if I screwed anything up so I will wait until my 8-week check up. It could be worse though. Some doctors want their patients toe-touch weight bearing for the first 6 weeks. That means a max of about 5 lbs. on your leg, so little weight that you wouldn’t break an egg if it was under your foot. Progressing from 5 lbs. to full weight bearing takes about 6 weeks. I’ve been allowed 45 lbs. from the beginning and if I progress like I did last year, I could be off crutches completely and on just a cane in 4-5 weeks. Bring on the 8-week check up!

It’s been a while since I’ve posted a scar photo, since week 2 I think. I’ve been trying to take a new photo every week because it’s changing noticeably at this point. Here’s a photo of week 4 on the left and week 5 on the right. Between the two photos, all of the dermabond has peeled off and the purple marker is gone. Not looking too bad…for a really big scar.

scar at 4 (left) and 5 (right) weeks

LPAO week 5…shots

When I left the hospital I went home with blood thinner injections to help prevent blood clots in my legs. I had started them the day my epidural was removed and needed to give myself a shot at home every night for 3 weeks. Last time I was given pre-filled syringes of Fragmin. I had to inject the needle and push the plunger but it had a spring to extract the needle and pull it inside the plastic of the housing so it was safe to throw in the trash. The hospital was out of the pre-filled syringes so I went home with vials of Lovenox, empty syringes and a quick lesson from the nurse about in how to draw a shot.

Here’s how it works:

Step 1 — draw air into the syringe in the same amount as the dosage of medicine you need to inject. I need .4 ml of Lovenox, so I start by drawing .4 ml of air into the syringe.

giving yourself a shot, step 1

Step 2 — clean off the top of the medicine bottle with an alcohol wipe. Insert the needle into the bottle. Push the plunger so the air goes into the bottle. This is done so that you don’t create a vacuum inside the bottle by just drawing out liquid.

giving yourself a shot, step 2

Step 3 — pull the plunger out drawing in the medicine. If there are air bubbles, push the air back into the vial and draw back liquid. It won’t hurt you to inject air, but it means you’re not getting the correct amount of medicine.

giving yourself a shot, step 3

Step 4 — choose an area on your stomach in a different spot than the injection site from the day before. It hurts less if you inject into fat instead of  muscle. Once you’ve selected a spot, clean the area with an alcohol wipe.

giving yourself a shot, step 4

Step 5 — insert the needle at an angle, slowly push the plunger, and remove the needle.

giving yourself a shot, step 5

Step 6 — store the used syringe in a sharps container. The nurse suggested a Gatorade bottle because there was one sitting on my tray while she was giving me the tutorial. Once I’ve done my last shot I can put the lid on the bottle and throw the bottle in the trash.

giving yourself a shot, step 6

It’s not horrible to give yourself a shot, but it’s a little unpleasant. Sometimes it hurts to insert the needle. The medicine usually burns starting a few minutes after it’s been injected. Sometimes I’m left with a little round bruise around the injection site. This week I completed my 3 weeks of shots. Now I’ll switch to an aspirin a day for 6 weeks.

LPAO week 4…feeling better

Sometime at the beginning of the week I noticed a few welcome changes. My pain had been relatively minimal from the beginning but it was always worse when I was moving or bearing weight. I’m allowed to put 45 lbs. of weight on my leg, but wouldn’t come close to that because it increased the pain. Starting earlier this week, the pain when bearing weight seemed to be extremely lessened.

As the pain got better I also experimented with cutting back on my Tylenol. I started out with 1000 mg 4 times a day and every couple of days I’d drop one 500 mg pill. I’m currently down to 2 pills a day. Maybe I’ll drop them completely within a week or so.

One more exciting change at the beginning of the week was that I no longer had to wear the TEDs. They’re unpleasant for a few reasons. First, they’re unattractive. Second, since the bottoms are a bit slippery and I have wood floors I had to wear the equally unattractive safety socks with grippers on them…just like baby socks.

very attractive TEDs

The socks are also difficult to get on because they’re long and tight. I could manage to get the socks on my good leg, but until the last few days, I couldn’t bend my op leg enough to maneuver the sock onto my toes. Steve had to put my socks on for me. I finally figured it out the last 2 days I had to wear them. The final reason I didn’t like the socks was that they left weird smiley face marks on the backs of my calves. I didn’t notice they were there until I was home from the hospital and had my socks off for my allowed one hour a day after my shower. I’m guessing the socks were pinching my skin a little too much, causing the marks.

weird marks left by TEDs

By later in the week, I was so tired of sleeping in the living room. As the angle of the CPM machine increased (I was supposed to work up to 90º) it started to shutter and jerk when it was lowering. I tried to shift the weight of my leg around to get it to stop, but nothing would help consistently. That made it more difficult to sleep while using the CPM.

I started tapering down the time I was spending in the machine overnight to transition off of it. Since returning home, I’d been waking up at least once overnight. I started turning off the CPM when I woke up. On Friday night I decided it was time to sleep in my own bed…first time in almost a month. I woke up a few times in the early morning, but it felt great to be back in my bed.

Saturday morning I got up, slowly, making sure I sat on the side of the bed for a while. Feeling okay, I crutched to the bathroom. Steve followed me. Last time it was after the first night sleeping in the bedroom when I fainted. After getting up from the toilet I felt a familiar early precursor to my couple of fainting episodes, a muffled ringing sound in my ears, so I sat down and put my head between my knees, or as close as I could get to my knees. That helped some but I still felt a little off. Steve gave me a ride to the hospital bed on my office chair and I rested for a while. Within about 90 minutes I was feeling better. As the day progressed, I was back to normal.

Changing topics, I have received support in many ways from many different friends and family. On Monday, our wonderful neighbors across the street brought over dinner. Yummy! Salmon and roasted veggies. He had surgery on his shoulder about 3 weeks before me and he’s still off work…and maybe a little bored. Luckily he likes to cook and is very good at it.

dinner made by our neighbors

On Tuesday afternoon I had a visit from my good friend Cara and her toddler Greyson. He was born 2 days before my first surgery last year. I’ll always remember his birthday. It was great to catch up with her and watch him motoring around my house. Who knew a bucket of kindling by the fireplace could be so entertaining?

On Saturday evening, our good friends, the Harringtons, brought over pizza and salad for dinner from one of our collective favorite places. We sat around in the dining room catching up and noshing. I had my first half glass of wine since surgery. After dinner we made a trip to Dairy Queen for ice cream. Everyone got to reap the benefits of my handicap parking pass.

LPAO week 3…on my own

Since I once again have “icky” looking things on my body, here’s a warning about a scar photo at the bottom of this post.

Starting the morning of day 15, I was on my own during the day. Steve was able to go into work a little late to make sure I was okay the first day, but as the week went on he had morning meetings, so I was on my own by about 8am. I managed to prepare, transport, eat, and clean up from breakfast and lunch. I was getting to the bathroom and back fine too, but the added activity left me more tired. Sad that making a meal was tiring. Each afternoon I’d lie down with an ice pack on my hip and my leg slowly moving in the CPM.

On most Tuesdays, Steve rides hills with some teammates and other cycling friends after work. The ride originates a few blocks from our house at a park, so he usually comes home after and eats dinner at home with me. The rest of the group usually goes out to eat somewhere after. This particular Tuesday they were going to a new local brew pub. Steve thought it would be a good opportunity for me to get out of the house and see some friends, so we decided to join. A few days before, I had ridden in the car when we took my mom to the airport, but I hadn’t actually gone anywhere yet.

My first outing went well. The restaurant had a parking lot with handicap spots close to the door. It was the first time we used the handicap parking pass with many more to come. I was grateful there were no steps to get into the restaurant, although I could have managed them if necessary. The walk to the table seemed very long, but I was rewarded with a chair at the end of the table and group of people happy to see me out of the house.

We chatted with the group and enjoyed the food for a couple hours. Even though it was a brew pub and they had a nice, big beer list (and a few ciders on tap too…I don’t like beer) I didn’t think alcohol was a good idea yet. I was still feeling tired and a little weak. I was joined in my water drinking by one woman at the table who was pregnant. It was a great first outing but I came home and fell asleep earlier than normal due to all the extra activity of the day.

The rest of the week was less active. I watched a lot of mindless TV (and started blogging) and rested. Luckily I felt good the whole time. Each night when Steve was home from work I would take a shower. Seeing my legs reminded me of something I’d decided after my first surgery. When it comes to muscles, the phrase “use it or lose it” is so true. After just over 2 weeks, there was an obvious difference between the sizes of my thighs. I’ll once again have a lot of work to do to build back my left leg. One day my nurse told me about a study she’d read. Young, healthy participants were told to stay in bed for 2 weeks. They could do anything but get out of bed. After the 2 weeks were over, even though they had not had surgery or any other procedure, they all needed help to get up and walk. Very interesting.

atrophy at 2-3 weeks post-op

I had gotten into a tolerable, but not very enjoyable evening routine. At 10pm every night I have to give myself a shot in my stomach of a blood thinner. More details on that in a future post, but I will say now it’s not fun but it’s not as bad as I would have imagined.

At about 11pm I get ready for bed. I’ve been taking the easy route with clothing and dressing in yoga pants or sweats…anything with an elastic waist. I’ve been sleeping in whatever I wore that day. Why bother changing from sweats into pajamas? I’ve been sleeping in the living room on my rented hospital bed because I’m supposed to use the CPM for 8 hours overnight. I doubt Steve would be able to sleep with the noise of the CPM and the sheets moving around all night. I don’t mind the CPM, although it makes some squeaking noises sometimes. My problem with the sleeping arrangement is that I have to sleep on my back (I’m usually a side sleeper) and I can’t roll over. I still usually wake up once overnight and I think it’s because I am stuck in one position.

A little over 2 weeks after surgery I took the first photo of my scar. The purple color is where I was marked before surgery for the location of the incision. You can see 4 short lines perpendicular to the incision. I’m not sure what those were for. Covering the entire length of the incision is dermabond, a type of skin glue used to close the incision. I have internal stitches that will dissolve, but on the outside I have just the dermabond. I think it results in a much cleaner and less-noticeable scar. With stitches or staples, you have the incision and also little dots along the edges of the incision where the stitch or staple went into the skin. Less-noticeable is a relative term though…I still have now 2 8-9 inch long scars from my groin to the outside of my hip bone. Kinda hard not to notice those.

The photo also shows some marks on the outside of my thigh. The 2 dots on the left are from the 2 small tubes attached to the hemovac. For the first 4 days, it removed blood and fluid from the surgery site. This helped to keep the swelling and bruising to almost none. You can see a small ring around the top whole…minor bruising. The larger reddish spot to the right is also a bruise. Both small bruises started out a little larger and darker, but considering all that was done to me I think that’s pretty good.

scar, day 15 post-op

LPAO week 2…home

Steve, mom and I arrived home mid-afternoon on Tuesday of week 2. I was slow to get out of the car, having to maneuver my leg with my hands, and then slow to ascent 3 steps to the front porch. The reward was being inside my own home again and seeing my cats. I settled into my living room bed as they scurried around unpacking and settling themselves back at home.

I made it into the tub

Steve went for a much-deserved bike ride as mom helped me get myself into the tub on the shower seat. It was way more challenging than being wheeled into a shower room at the hospital, but I managed to get in, clean myself, get out, and get dressed. Mom doctored up a frozen cheese pizza with some toppings and made a nice salad for dinner. That night was my first of many sleeping on the hospital bed in the living room using the rented knee CPM. I woke up once on my own but quickly went back to sleep. It was the first night I wasn’t woken up for blood draws or vitals or meds.

Wednesday I woke up feeling pretty good. I quickly realized the walk to the bathroom is much longer than the 5 steps in the hospital. I made it to the bathroom fine but when I stood up to leave, I felt a little dizzy. I called Steve to spot me as I walked back to bed and made it there fine. Later after a little food and some Gatorade I needed another bathroom trip. Steve had gone to work, so mom followed me. Again I made it there fine and felt a little sketchy trying to get back to bed. I didn’t want to take any risks, especially since Steve wasn’t there, so mom rolled my office chair next to the bathroom and pushed me back to bed. Shortly after that I napped for about an hour, something I don’t normally do. I felt better and was able to walk without dizziness later in the day (and haven’t felt dizzy since).

I gained more strength over the next couple days and was slowly able to eat more food, which I’m sure helped. On Friday, 3 days after being home and eating more, so likely gaining back some of the weight I’d lost in the hopsital, I stepped onto a scale. Since a day or 2 before surgery, I’d lost 10 lbs. So I guess surgery and a long hospital stay would qualify as an effective (but very unpleasant) way to lose weight. I’m sure some of it will come back as soon as my appetite returns fully, but I was trying to lose a few before surgery, so hopefully I’ll end up where I wanted to be.

By the end of week 2, I’d received several gifts in the mail. A college friend, Adam, sent a huge tin of cookies (with magic healing powers, according to him).

cookies from Adam

My old boss in Ohio, Stuart, sent some beautiful tulips. Well, I’m sure his wife, Julie, was the source.

tulips from Stuart

My brother, Michael, and sister-in-law, Deb, sent a lovely flower arrangement. I especially loved the poppies.

flowers from Michael and Deb

My mom was so fantastic throughout the entire 2 weeks of her stay. Aside from staying with me in the hospital the whole 9 days so Steve could go to work, she cooked dinner each night, leaving leftovers for us to eat the next week, she cleaned, she did laundry, she brought me anything I needed. On Sunday morning she flew to meet my dad for a week of vacation. Taking her to the airport was my first trip outside the house since coming home from the hospital. I had mixed feelings about her leaving. Not only did we really appreciate all the ways she helped, I enjoy being around my mom. But, her leaving marked a big step for me. Dr. Mayo requires his patients to have someone with them 24/7 for the first 2 weeks after surgery. I was once again allowed to be alone.

me and mom

LPAO hospital stay, part 5

Day 7 — On Monday I woke up hopeful that the blood transfusion the night before had pushed me over the edge. My first trip to the bathroom went fine, no dizziness, but when I got up the second time it was a repeat of the past several days. I knew immediately that meant I would not be going home that day. Do I sound like a broken record yet? It sure felt like I was stuck going round and round, trying desperately to escape on a tangent.

Again, I was disappointed to have to update Steve. I know it doesn’t compare to what I was going through, but having your wife in the hospital for more than a week is no picnic. Every morning he would drive to work and pay $11 to park (he usually takes the bus and uses a bus pass provided by his employer), after work…drive 45 minutes to the hospital to visit me, at 10pm…drive an hour home, feed attention-starved cats, collapse in bed, repeat the next day.

From way too much experience, I knew I wouldn’t be able to pass my PT tests for discharge so when my favorite PT Pam (she is so positive and encouraging) came later that morning, I didn’t even try. She had been there last year and remembered how my situation had completely changed overnight. She also knew once I got past the dizziness, I had all the other skills I needed (walking with crutches safely., etc.).

By the afternoon I was feeling really good. I had been sitting upright as much as I could and drinking a lot of Gatorade at Dr. Mayo’s suggestion. I had my blood tested that morning and the results came back with a hematocrit of 34…almost back to the normal level of 38-46. Since Dr. Mayo didn’t check me before the transfusion, I don’t know what I started with, but it was probably in the upper 20s. 34 was a good improvement.

That evening I was a little hesitant to hope for release the next day. I’d spent many evening in a row hoping I’d go home the next day and been disappointed. For some reason, my mom was very confident the next day would be the day. Steve came for a visit and day 7 came to an end.

Day 8 — Tuesday started out good. I got to the bathroom and back to bed feeling fine. After breakfast, my second bathroom trip also went fine…first time in days I hadn’t felt bad after getting up the second time. This was such a good sign! My mom was encouraged. I was so happy I had to text Steve and share the good news.

Later that morning I faced the real test when the PT (not Pam) made her rounds. I was given the option of using the walker or my crutches. I knew I’d need to do 2 things for the PT, walk a bit in the hall and go up and down a few steps. It would be a lot easier to do the steps with crutches (I’m sure there is a way to do it with a walker). For the first time, I stood up with my crutches and walked out into the hall. I was very aware of how I was feeling. I knew the signs to watch for. I didn’t want to end up passed out on the floor again. After a couple doors, I was still feeling good. I walked a couple more doors then turned around and walked back. No dizziness! Hallelujah. At this point I knew I’d be discharged that day.

standing with crutches

Only one test remained. I stood in the doorway of the therapy room as not-Pam (I don’t remember her name) reminded me how to go up and down steps safely. “Up with the good, down with the bad” is the mantra, meaning when you go up stairs your good leg goes up first then with your weight on your good leg you lift your bad leg and crutches up. When you go down steps the order is crutches, bad leg, then good leg. I had no problem performing the task and still felt no dizziness.

Pam happened to be sitting at the nurse’s station right next to the therapy room when I was with the other PT. As soon as I made it back to my room she popped her head into my room. She feigned being offended that I hadn’t been able to walk and do steps with her…but with this other PT, no problem. The whole time she had the biggest smile on her face. I assured her it was nothing personal. She was clearly very happy for me.

Feeling very confident I’d be discharged, I decided to get dressed in my own clothes…first time since the pre-op room. I also went to the bathroom (without a spotter) on crutches. Later that morning Dr. Mayo came in with a smile on his face. He asked if I was ready to go home. Yes, please! I got a handshake and he gave a release order to the nurse. Later, the nurse aid removed my IV. Finally I was tube free.

After lunch the nurse brought my blood thinner shots from the pharmacy and a script for an anti-nausea medicine. Last year I had gone home with pre-filled shots of Fragmin, but the hospital pharmacy was out of them. They had called my regular pharmacy…they didn’t carry Fragmin, not an uncommon problem. They gave me 2 options…call around to other pharmacies to find one that had Fragmin, or go home with empty shots and vials of Lovenox (a different blood thinner that does the same thing as Fragmin). I decided to go the sure route and take the shots and vials. The nurse gave me a quick lesson on drawing the shots. I already knew how to give myself a shot. She even sent me home with a huge stack of alcohol wipes. More on the shots in another post.

Shortly after that, my discharge orders were ready and I was free to go. Steve left work and headed down to rescue us. Mom packed up all our stuff. I’d been there so long that the flowers I’d received earlier in my stay had all faded. She dumped the flowers and left the vase. Once Steve got there the nurse called for someone to transport me to the hospital entrance in a wheelchair. On the way out I passed a few of the various staff (nurses, nurse aids, PTs and OTs, even the nice man who had cleaned my room a few times) who had cared for me in one way or another. Everyone was so happy I was finally going home.

leaving the hospital

It was so nice to be outside. It was a bright and sunny day. Everything looked extra lush and green and lots of rhododendrons were in bloom. Getting into the car was a little challenging. I think it’s harder to put the bad leg into the car first. I managed though. An hour later, we arrived home. The rental hospital bed and CPM machine were already set up and I quickly settled into my new temporary bed. I was so glad to be home!

So…discharged on day 8 with surgery day referred to by the hospital as day 0 means once again I was in the hospital for 9 days. Ugh. I though I had solved the problems of the first hospital stay by avoiding the oral naracotids. So why did I still suffer? Nobody can say for sure. Dr. Mayo’s theory, which makes sense to me, is that I’m just overly sensitive to many aspects of recovery…medicines, blood loss, and just the trauma of major surgery. Maybe my body just needs time to recover. Hopefully I’ll never have to test that theory with a future surgery.

LPAO hospital stay, part 4

Day 5 — Saturday began with some drama. Since the epidural came out the day before I had been getting IV Tylenol and IV Toradol for pain every 6 hours. I was given one dose at about 6am and quickly went back to sleep. When my mom woke up at 7:30am, she noticed the Tylenol bottle was not empty. We called the nurse (different nurse than the one who had administered the 6am meds) who decided the rate of the IV had been set wrong and I’d only gotten half of the Tylenol. She gave me the rest of the dose and apologized profusely. I never saw the nurse who screwed up the dose again. Good thing, because I’d certainly lost confidence in her.

Getting up to go to the bathroom the first time that morning went fine, but after breakfast and another bathroom trip I was feeling dizzy when standing again. I had the nurse spot me as I shuffled the 5 steps back to bed.

Later that morning an OT came to visit. She wanted to go over how to get into the tub/shower on a shower seat. Luckily the therapy room was across the hall. We decided to try walking with a wheelchair following me incase I needed to sit down. The OT stuck close to me, commenting about how well I was moving, while my mom followed with the wheelchair. I made it across the hall to the doorway of the therapy room without a problem but got tired, so I sat down. When I got up again to try moving toward the tub, I got dizzy. We decided to abort and I was wheeled back to my bed. I’m pretty sure I knew better how to get myself into my tub than the OT anyway. She couldn’t imagine a way to get in safely with just the seat I had and not the transfer bench she had which extends outside the edge of the tub.

The botched 6am dose of IV Tylenol was my last. As a new medicine in the hospital, Dr. Mayo was only able to get approval for 4 doses. He’s hoping to have it added as a regularly available medicine. That’s my contribution to Tacoma General…you’re welcome. After getting cut off from the IV Tylenol, I was switched to regular oral Tylenol, 650mg every 4 hours. It worked almost as well as the IV version. I could tell when it was wearing off. Getting meds every 4 hours with the timing I was on meant 2 overnight wake-ups…2am and 6am.

The rest of the day went better. I rested, ate, and got up feeling fine. I was hopeful I’d be fine the next day. Steve came for a visit and the day ended.

Day 6 — Sunday started like Saturday. I got up the first time and felt fine…got up the second time and felt dizzy. When the PT came, I knew it wasn’t going to go well, so I declined. Gradually, as the day went on I felt better. When it was time for meds I talked to my nurse about anything that could be contributing to my dizziness. We decided to stop the Toradol, so once again by day 6, I was taking only oral Tylenol for pain…7 days after having an 8-9 inch incision, 1 muscle detached, 3 bone breaks, and a bunch (I haven’t seen x-rays yet, so I don’t know how many) of screws in my hip.

Later in the afternoon Dr. Mayo came by for rounds. He’d been out of town the previous 2 days. We discussed possible contributors to the dizziness. Earlier, I’d asked a nurse about whether a blood transfusion would help and was told no because my blood numbers were okay. I think I’d asked Kenda the day before too and was told no. Dr. Mayo suggested switching from drinking water to Gatorade. When I asked him about getting blood he explained why the nurse and Kenda had said no.

A patient has to qualify for a transfusion by having a low enough hematocrit, or percentage of the blood that has oxygen-carrying red blood cells. A normal level for adult women is 38-46%. A level of 20-22% indicates the need for blood in the typical patient. Dr. Mayo has come to agree that I am not the typical patient. On day 2 my hematocrit was 25%, so it was surely higher 4 days later. He knew if he checked my levels before ordering the transfusion, he’d get push back for giving blood to a patient with a hematocrit in the high 20s…so he didn’t check it and ordered the blood anyway. Who wouldn’t love a doctor willing to bend rules for the sake of his patients?

Dr. Mayo also suggested I be allowed to take a shower, something I’d been asking for since all the tubes came out on Friday evening. He thought a little mental lift would help me out physically. Understandably, the nurses were hesitant to allow it given my dizziness. They didn’t want me to faint in the teeny-tiny shower in my room. The magic lifting device (see last post) doesn’t reach that far. Nobody mentioned previously that there is a large shower room around the corner. I would have pushed harder for a shower earlier if I had known about the shower room. A couple hours later the nurse aid wheeled me to the shower room and my mom helped me clean up mostly by handing me things…shower head, soapy washcloth. She had to wash below my knees and my back. All modesty was gone at this point. I got a clean gown and my gray non-slip socks were traded for “fall-risk” yellow.

getting transported back to my room after a shower

After returning from the shower, my unit of blood arrived. It was hooked up to my IV and slowly infused over the next couple hours. After the blood bag was emptied, I was given some IV fluids to flush all the remaining blood in the tube into my arm. They didn’t want to waste any of it. It was a little odd to think that someone else’s blood was flowing into my veins, but it didn’t really bother me too much. It makes me very thankful for the people to donate blood. I might look into donating a unit in the fall to replace the one I used. Toward the end of the transfusion, I started feeling a little warm. The day ended with a visit from Steve.

blood transfusion