PAO pre-op

MRI-arthrogram #5 did not go so well today. It was pretty painful/uncomfortable compared to the others. And the video goggles were no longer available when I went into the MRI machine. I do think that I can safely say that I will not have to endure another one of those again though!

My pre-op, however, went well. Dr. Z was absolutely wonderful, per his usual self! He met my mother in law (who will be with my hubby and me at the hospital for surgery) and chatted a few moments with her about me and nothing in particular:)  He then noticed the t-shirt I was wearing and inquired about it. My t-shirt is the one that was made during my Hippy Union in Chicago and it says "screw-it". It's a Nike shirt and instead of "just do it" we came up with "screw-it"...he got the inside meaning right away and thought it was really great that a bunch of us got together from around the country.

He checked my range of motion in both hips and then felt for the screws on the right hip again and yup, they still hurt! A lot. They are scheduled to come out after the PAO is done. He also explained everything that would happen during the surgery and what to expect afterward.
He and I had a bit of a pow wow regarding pain management since he explained that he doesn't do epidurals for his PAO's anymore. I am really nervous about not having proper pain management after I wake up and I told him this. He said he wants me to be happy, so he will discuss this with anesthesia and see what we can come up with while trying to avoid an epidural altogether. He suggested a caudal block, so I will still have the area numbed, just shorter term and without as much risk as a spinal poses. The reasons he has against epidurals is this: causes prolonged hospital stay, may cause increased bleeding which increases the chance of needing a blood transfusion, they don't always numb everything all the way or the right area, and a patient is unable to start therapy as soon as without an epidural. I am willing to forego the epidural as long as we can come up with a pain block that won't delay recovery. I really need to pray about this since he wants me to strongly consider a general only but will not force me into only a general.

Details of the surgery and hospital stay/recovery:
surgery takes about 2-2.5 hours
I do not need a scope
I do need a femoral osteochondroplasty (reshaping the femoral head and head/neck junction)
I will have 3-4 screws
he may not need to detach the quad muscle, he'll know more when he gets in there. (not sure what      determines this....)
MUCH more invasive surgery than SDD
1st day post op I'll just chill in bed, maybe learn some isometric exercises, use CPM
2nd day post op PT will get me out of bed, teach me to use the crutches. This is the day I will wean off of the PCA and start using oral pain meds.
3rd day post op I will continue crutch walking and try stairs. This is the day all drains (hemovac, foley, IV) are removed if they haven't already been on day 2. There is a small chance I could go home this day.
4th day post op I continue with therapy, crutch walking, stairs, etc. Probably go home this day.
5th day post op is possible if pain or bowels are an issue.
I have an ob-gyn yearly physical in early January (have to be in stirrups...) and he feels this should not be an issue.
recommends AT LEAST 3 months off work, possibly 4 for my line of work (nurse).
total recovery time is 6 months to one year.
He explained that he is the only one who does any of the work during surgery and that he talks to the residents to explain the procedure and why he does things the way he does them during the procedure. I really like this about Dr. Z. He said that his PAO pt's tend to recover quicker and are discharged quicker than those of his colleagues (epidurals have a big part in this) and his incision is typically different than most other PAO surgeons. He also discussed the femoral cutaneous nerve being affected during surgery which almost always causes a numb spot on the front of the thigh but eventually may go away over time or it'll be something that will not be so noticable anymore after a few months since most of his patients have told him they don't tend to notice it after a while.

My mother in law asked Z about pregnancy after the PAO and how it would affect the hips, whether it was wise to wait a certain amount of time before getting pregnant (6 months for those who are curious) and he answered that it would depend on how the right hip reacts as he is concerned about the fact that it is still shallow and may need a PAO as well. I am a little surprised to hear this since he had not really mentioned this before, however I do recall the surgeon that did my hip scope saying that the right hip may still need a PAO. I am a bit disappointed by this. I thought that I would be out of the woods once the LPAO was done. I still plan to try for a family once the left hip is healed and see where the road takes us from there. Maybe in a few years the right will have to be done but I don't want to wait any longer than necessary for my family to begin.

Towards the end of the appt my surgery time was brought up and I learned that I am the last surgery of the day....which is good and bad. Good because I don't have to be in Detroit until 2 pm so no hotel stay which saves us money and I can sleep in my own bed and environment but bad because that's a long day of waiting, nerves, and no drinking or eating. I am the oldest patient having surgery that day as they go by chronological order of age. As it was so nicely put, I said "I must be the 'old fart'" and to which Z replied, "you are that day!".