pre-op: a novella
It only took me a week to write up my pre-op day. This is mostly for my memory and for anyone else who might be facing a PAO. It's probably not fascinating reading, but here we go:
My surgeon is based at Children's Hospital, but I'm five years too old to have surgery there, so it's happening around the corner at Beth Israel Deaconess Medical Center, aka BIDMC, Beth Israel, or BI. The hospitals are two of five total in the Longwood Medical Area, a city within a city connected by pedestrian bridges and employee shuttles and fed by two trolley stops on different subway lines.
Seatmate took the day off to come with me, for which I am seriously grateful.
I met with Beth Israel nursing and anesthesia in the morning and my surgeon's people in the afternoon. Everyone was wonderful to me. They were warm and funny and interested in their work and they made us both feel better about my upcoming broken pelvis adventure.
The woman from nursing ran down the basics about my hospital stay and pre- and post-op requirements. I'll be giving myself shots of a blood thinner every day for a month. A nurse will teach me in the hospital. I'll be wearing compression stockings every day, also for a month. (So stylish.) [Edit: this turned out not to be accurate. I wore them in the hospital but not at home; the daily shots of blood thinner meant I didn't need compression stockings.] She gave me a bottle of antimicrobial soap to use the night before and morning of surgery. I have to turn off the water and scrub my hip for three full minutes. Then, as I mentioned in a previous entry, no skin lotion or moisturizer. Not even on my face.
Also: no jewelry. No purse. No ID. ("No ID?" I asked, surprised. "I promise you, no one's trying to sneak in here for surgery," she said.) No nail polish, even clear, which is not a surprise but a bummer anyway. I keep my nails polished mainly to keep them from breaking. I should probably cut them before I go in.
The woman from anesthesia was very comforting. I told her that I'm worried about post-surgery nausea. She prescribed a scopolamine motion-sickness patch to put behind my ear on the morning of surgery. In addition to the anti-nausea meds she will add to my cocktail, the scopolamine should cut down on post-surgery sickness. She also promised that they will use something to protect my teeth while intubating. My teeth break if you look at them funny.
She checked my airway by having me tilt my head back and stretch my throat. "Oh, you have an amazing airway," she said cheerfully. Behind her, I could hear Seatmate biting his tongue. It's incredible how many unintentionally funny comments I hear from medical people. Maybe I just have a sick sense of humor.
I had to stop taking Advil and anything similar to Advil a week before surgery because they have a side effect of thinning the blood, which increases blood loss. I also had to stop my birth control pills. I woke up two days later with cramps from hell. I thought I couldn't take Advil. Imagine my joy and relief when Seatmate realized I was still outside the one-week rule. I don't take it often but it's a cramp killer.
Once at Children's, I got some last-minute x-rays. Then I met my surgeon's PA (physician's assistant) Erin, who sat down and patiently answered all of my questions and concerns. My surgeon came in halfway through and breezed through them in a minute and a half, dismissing concerns left and right. The PA and I made eye contact and smiled. I'm not worried about his irritating mood. He's a surgeon. He's been very patient with me for a year and a half. And all my questions got answered.
One of my major questions was whether I'll have an epidural, which is a tiny IV that goes into the spine and makes the leg numb from the waist down. Erin assured me that I'll have one, which is a relief. I was afraid about having the epidural put in -- I have to be awake so I can tell them whether it's working -- but other patients have said that it doesn't hurt much and not to worry. The information I've gotten from other patients online has been just invaluable in easing my fears.
The epidural will stay in for three days. After that, I'll switch to pain medication and start getting out of bed. There's a small risk of an epidural headache, which happens when the hole in the spine doesn't close on its own after the epidural catheter is removed. The problem is treatable, but as someone who gets regular migraines, the idea of a hellish headache is really unwelcome. I want the epidural, though, so I'll take the risk.
The surgery will take about six hours. First they have to move muscles and tendons out of the way to reach the hip joint. Then they cut the hip socket off the pelvis, rotate it over the joint, and screw it into place. When the bone is put into the new position, there's a triangular chunk left up at the top. They cut off that piece and wedge it in above the joint. This bone graft heals together with the main piece and adds stability to the new hip socket. It's hard to picture, but it will be visible on my post-op x-rays.
Generally, once the PAO has begun, the surgeons open the hip joint capsule to look inside the joint. They check to make sure that the head of the femur is smooth (no bumps to damage the cartilage) and that the hip labrum isn't torn. But the capsule, of course, is made of connective tissue. The surgeon said he's not going to open the capsule because he doesn't want to weaken it more than it is already. If I have problems once I start healing, he'll go back in and look, but for now, he's being cautious. I like cautious.
The last meeting of the day was with a physical therapist. We talked about the decision to use platform crutches and went over how I should walk. It turned out that zero weight bearing is no longer the plan; I should put my foot down naturally, heel to toe, and bear the weight of my leg and a tiny bit more. The rule used to be zero weight, but their patients kept getting hip flexor tendinitis from holding the leg off the floor. No thanks.
She also gave me various restrictions on movement. No moving my leg out to the side. No extending my leg behind me. No stepping past my right foot with my left foot. A few others. I have to sleep on my back for the first few weeks. That should be fun. Don't worry too much, she told me. Oh, okay.
And then I went home and slept for fourteen hours.
I'm scared, but I'm ready.
"Why worry, there should be laughter after pain
There should be sunshine after rain
These things have always been the same
So why worry now?"
Dire Straits, "Why Worry"
[Edit: If you'd like to follow chronologically, try the "previous" and "next" buttons at the very top of the page to move from entry to entry. Otherwise, try the tags at the bottom, which are unfortunately a bit random.]
My surgeon is based at Children's Hospital, but I'm five years too old to have surgery there, so it's happening around the corner at Beth Israel Deaconess Medical Center, aka BIDMC, Beth Israel, or BI. The hospitals are two of five total in the Longwood Medical Area, a city within a city connected by pedestrian bridges and employee shuttles and fed by two trolley stops on different subway lines.
Seatmate took the day off to come with me, for which I am seriously grateful.
I met with Beth Israel nursing and anesthesia in the morning and my surgeon's people in the afternoon. Everyone was wonderful to me. They were warm and funny and interested in their work and they made us both feel better about my upcoming broken pelvis adventure.
The woman from nursing ran down the basics about my hospital stay and pre- and post-op requirements. I'll be giving myself shots of a blood thinner every day for a month. A nurse will teach me in the hospital. I'll be wearing compression stockings every day, also for a month. (So stylish.) [Edit: this turned out not to be accurate. I wore them in the hospital but not at home; the daily shots of blood thinner meant I didn't need compression stockings.] She gave me a bottle of antimicrobial soap to use the night before and morning of surgery. I have to turn off the water and scrub my hip for three full minutes. Then, as I mentioned in a previous entry, no skin lotion or moisturizer. Not even on my face.
Also: no jewelry. No purse. No ID. ("No ID?" I asked, surprised. "I promise you, no one's trying to sneak in here for surgery," she said.) No nail polish, even clear, which is not a surprise but a bummer anyway. I keep my nails polished mainly to keep them from breaking. I should probably cut them before I go in.
The woman from anesthesia was very comforting. I told her that I'm worried about post-surgery nausea. She prescribed a scopolamine motion-sickness patch to put behind my ear on the morning of surgery. In addition to the anti-nausea meds she will add to my cocktail, the scopolamine should cut down on post-surgery sickness. She also promised that they will use something to protect my teeth while intubating. My teeth break if you look at them funny.
She checked my airway by having me tilt my head back and stretch my throat. "Oh, you have an amazing airway," she said cheerfully. Behind her, I could hear Seatmate biting his tongue. It's incredible how many unintentionally funny comments I hear from medical people. Maybe I just have a sick sense of humor.
I had to stop taking Advil and anything similar to Advil a week before surgery because they have a side effect of thinning the blood, which increases blood loss. I also had to stop my birth control pills. I woke up two days later with cramps from hell. I thought I couldn't take Advil. Imagine my joy and relief when Seatmate realized I was still outside the one-week rule. I don't take it often but it's a cramp killer.
Once at Children's, I got some last-minute x-rays. Then I met my surgeon's PA (physician's assistant) Erin, who sat down and patiently answered all of my questions and concerns. My surgeon came in halfway through and breezed through them in a minute and a half, dismissing concerns left and right. The PA and I made eye contact and smiled. I'm not worried about his irritating mood. He's a surgeon. He's been very patient with me for a year and a half. And all my questions got answered.
One of my major questions was whether I'll have an epidural, which is a tiny IV that goes into the spine and makes the leg numb from the waist down. Erin assured me that I'll have one, which is a relief. I was afraid about having the epidural put in -- I have to be awake so I can tell them whether it's working -- but other patients have said that it doesn't hurt much and not to worry. The information I've gotten from other patients online has been just invaluable in easing my fears.
The epidural will stay in for three days. After that, I'll switch to pain medication and start getting out of bed. There's a small risk of an epidural headache, which happens when the hole in the spine doesn't close on its own after the epidural catheter is removed. The problem is treatable, but as someone who gets regular migraines, the idea of a hellish headache is really unwelcome. I want the epidural, though, so I'll take the risk.
The surgery will take about six hours. First they have to move muscles and tendons out of the way to reach the hip joint. Then they cut the hip socket off the pelvis, rotate it over the joint, and screw it into place. When the bone is put into the new position, there's a triangular chunk left up at the top. They cut off that piece and wedge it in above the joint. This bone graft heals together with the main piece and adds stability to the new hip socket. It's hard to picture, but it will be visible on my post-op x-rays.
Generally, once the PAO has begun, the surgeons open the hip joint capsule to look inside the joint. They check to make sure that the head of the femur is smooth (no bumps to damage the cartilage) and that the hip labrum isn't torn. But the capsule, of course, is made of connective tissue. The surgeon said he's not going to open the capsule because he doesn't want to weaken it more than it is already. If I have problems once I start healing, he'll go back in and look, but for now, he's being cautious. I like cautious.
The last meeting of the day was with a physical therapist. We talked about the decision to use platform crutches and went over how I should walk. It turned out that zero weight bearing is no longer the plan; I should put my foot down naturally, heel to toe, and bear the weight of my leg and a tiny bit more. The rule used to be zero weight, but their patients kept getting hip flexor tendinitis from holding the leg off the floor. No thanks.
She also gave me various restrictions on movement. No moving my leg out to the side. No extending my leg behind me. No stepping past my right foot with my left foot. A few others. I have to sleep on my back for the first few weeks. That should be fun. Don't worry too much, she told me. Oh, okay.
And then I went home and slept for fourteen hours.
I'm scared, but I'm ready.
"Why worry, there should be laughter after pain
There should be sunshine after rain
These things have always been the same
So why worry now?"
Dire Straits, "Why Worry"
[Edit: If you'd like to follow chronologically, try the "previous" and "next" buttons at the very top of the page to move from entry to entry. Otherwise, try the tags at the bottom, which are unfortunately a bit random.]