LPAO update

Surgery day: November 30th

Todd and I got up early this morning and got everything ready to drop off at his mom's (the pups, who could tell something was brewing) and all their belongings. I was not feeling nervous, actually slept really well. It's amazing what your own bed and surroundings will do for you. We had a timeline to get to the hospital by 12:30 so we could get Todd, his mom, and my parents settled into their condos before I had to check into surgery at 1:30. We made it to Beaumont hospital at 1:00, so a little behind schedule but still able to get everyone settled into their condo units before heading over to the pre-sugery area. Was in pre-op by 1:30, by myself until the IV was started and the surgical history was taken by my RN. IV was absolutely painless and the nurse got it on one try! I told her I had a pretty bad headache (lack of caffeine and stress) and she got some versed on board for me...already the versed begins! She explained that my surgery was already going to be behind because there was still another surgery ahead of me yet. Thank goodness for versed....My family was allowed in and we all sat around and chatted, while being interrupted by various members of the OR team, the most important being anesthesia. The anesthesiologist did have a note that I was extremely anxious about pain upon waking up from surgery and looked at the prior surgical notes and saw that I was really only given pain meds in the beggining of surgery and not at the end. He assured me that I would be well loaded all throughout surgery and not to worry. He said the only drawback would be that I would take a lot longer to wake up. I was A-OK with that! Then Dr. Z came in. Being the ever humerous man that he is, he placed his hands on my legs and patting the right leg, said "PAO" and then the left leg, "screw removal" with a slight smile and gleam in his eyes. I fired right back at him with a smile, "No!" He laughed and said, "oh, your legs are crossed, I got confused". He did a last minute explanation for me and my family about the surgery, how long it should take and recovery. We were still waiting awhile by the time Z came to see me but he assured me that it wouldn't be long before I was next. My circulating nurse saw me right after and she said it was time to go. Then another dose of versed and I was off to surgery! It was a late surgery, about 5:30 or so before it began and it was supposed to go at 3:30 originally. But, being an OR nurse, I completely understand how those things go. I really don't remember much this time about the transfer to the OR or even getting on the bed. I do remember thinking that the amount of surgical instruments didn't seem all that much! It felt like they put me out before I got on the OR table, but I'm sure that's not true.

Recovery and transfer to my inpatient room:

Waking up in recovery was a much smoother process this time around. I was calm, my hip didn't really hurt per se, but it did feel horribly stiff and like it was full of lead. I don't actually know how long it took me to wake up and come around, but I was able to talk to the recovery nurses this time. I asked what time it was (8:30 pm) and how late they stayed open (11:30 pm). I don't know why I had to know that tid bit but it made me feel better. I did notice however that there was a very irritable man in recovery (my anesthestist who took over my case, I think???) who kept angrily yelling at everyone and also wasn't really very kind to me. Not to get into too many details, but he was pretty belligerent with the staff. It was making me a bit nervous.
I was aware for the most part during my awake time in recovery and remember being transferred from recovery (but not the ride itself) and then remember being placed into my room on the children's floor, The Wizard of Oz room. I did have a roommate, a 12 year old CP patient who had broken her leg that day. My transfer was uneventful and I was settled in nicely. I had a dilaudid PCA set up, but no basal rate this time. I can push the button every 6 minutes for meds. My family came in a little bit after that and I was more awake, able to smile, wave and say how I was doing. It's about 9:30 or so now. The staff are "A+" and I am confident they will do a great job with me. At this time my mom starts to complain of feeling hot and just "not right". Sue, my mother in law, is a nurse also and she noticed my mom fading. She told my dad, "let's get her into a chair" at which time I looked at her and saw she wasn't looking right either. I asked her if she was ok but she didn't answer, just had a blank stare at the ceiling and the proceded to pass out right as my dad and Sue got to her. Dad said she stopped breathing for a minute too. I was flat on my back, panicking, crying and begging Todd to get a nurse to help my mom. 3 nurses came rushing in and helped her, and she finally opened her eyes, wondering why everyone was in her face...!!  She said she was dreaming right before she passed out but didn't know she had passed out. Vitals all checked out ok on her and she refused treatment. Must have been a vagal vasal reaction we're all thinking. My family stays until about 11 pm, when they know I've calmed down from the scare and mom is ok to get moving.
The CPM (continuous passive motion) machine arrives about 2 am along with the SCD's (sequential compression device). It feels good to have them on. Still loving my nurses:)

Post op day 1: December 1st:

Today is a "chill in bed" day per Dr. Z. I'm not going to be doing much of anything except resting. I saw Dr. Z and 2 residents (seperately) and neither of the residents were in on the surgery, so I couldn't ask them anything about how it went. Z says everything went great and I have 3 screws, can't wait to show me the xrays. I forgot to ask him questions though. It's so early in the morning that all I care about is sleeping!
Only on ice chips at this time (not even water) because I am not passing gas. Until I pass gas, I can't have anything else. I'm actually kind of hungry this time around, so I'm working on getting the gas out:)

My family came in about 8 am and settles in for a long day of visiting and watching me sleep. I feel bad that they were "stuck" there, but they did get up and go out to town a few times. I can't thank them enough for just being there.

Amy (PT) does come see me today (she amazingly remembers me from last year!!!) and shows me some isometric exercises I'm going to do while in bed. This means taking me out of the CPM...I am so comfortable though, I don't wanna move!  But Amy is a pro and she removes the CPM and my leg with ease, doesn't even hurt, just a bit of stinging at what I assume to be my incision. I am wrapped in a huge ace bandage compression dressing from stomach all the way down to my left knee. She says this is pretty new and that Z has only just started doing this. She said she would give him a call today to find out his reasons on why he's wrapping his PAO patients now. The isometrics are simple: ankle pumps, butt squeezes and thigh squeezes. I can't get my left thigh to squeeze, but Amy says she can tell it's doing something as she places her hand on my leg. Okay! I notice my whole left leg, from hip to toes, has a weird tingly, pin prick feeling, but not numb. Amy says to mention to Z about that next time I see him. I try to feel for the famous numb patch that all PAOers seem to have, but I don't really feel it, just the tingly feeling. Good sign I hope!
I'm told the goal today is to do the isometric exercises 20 times, twice more today and to be out of the CPM flat on my back 2 more times today. Amy helped get me back in the CPM, reminding me NOT to use my left leg at all. She or someone else would need to lift my leg to guide it where it needed to go while I used my right leg to move my body. It is really hard to not use the leg at all!

My nurses and nurse aides continue to be phenomenal!! I am so pleased with the care. They really know what they are doing. Especially a nurse aide named Michele:) My mom is doing great today by the way.

The second time out of the CPM was not so great. Sue and Michele helped me out of it and I had a breakdown. They didn't do anything wrong but my leg just hurt soooo bad for some reason and I begged Sue "don't drop it, don't drop it!!" I started bawling and hiccuping and it was really awkward b/c everyone was standing around just staring at me, waiting for me to get it together. It really hurt, but was no ones fault. After I calmed down, it was all okay. I laid flat awhile and did my isometrics again. We just have to figure out a good moving pace.
Cierra (Todd's cousin) and her boyfriend stopped by  later that night to see me. It was nice to see them again, although we all agreed we had to stop meeting in the hospital:)
My night staff was equally amazing, can't believe my good fortune in care I'm getting. I'm still only on ice chips as I have not passed any gas....getting really hungry now! My pain is still so minimal on the PCA and I can't even tell my right hip had a screw removal done to it. I remain in the CPM and SCD's for the night and sleep pretty peacefully. I do recall my poor little roomie being a bit hysterical at times too, from when the staff had to move her around as well:(

Post op day 2: December 2nd:

It's early in the morning again when the resident stops in to see me, still can't answer any surgical questions b/c he wasn't in there. He pulled my drain, and it didn't hurt at all. Dr. Z doesn't see me today.
Nursing staff, again, is incredible. They help me with whatever it is I need. Listened to my bowel sounds and although they're there, they're sluggish and I'm still not passing gas. Ugh! Still on ice chips. Still in minimal pain. Rumor is I may advance to a clear liquid diet anyway, so that makes me happy! My family stops in again around 8 or so. My mom and dad will be leaving today, later this afternoon, once they know I am comfortable getting up and walking.
Amy stops in about 10 am and says today is the big day. I'm getting up and walking! Yeah! But I'm kinda nervous too. She helps me get up, but has me move all on my own (provided she's handling my left leg) and although it wasn't as bad as yesterday, I still have a bit of a breakdown and cry. It's such a weird and awful feeling from where the muscles were detached and reattached and all that pulling and stretching on them isn't the best feeling. Amy is patient though and says "Take your time, I'm not going anywhere" She's a tough love PT, but it works. Dad has to leave the room because he can't stand seeing me hurt or crying. Standing up felt weird, I was shakey but not dizzy or light headed. Amy told me how to get the left leg going and even had to nudge it with her toe but once I got moving it felt great. It was awkward and my leg felt heavy. I had a difficult time not putting any weight on the leg and Amy said, think of a graham cracker under your foot, you don't want to crush it. I crutched down the hall and back and then sat in the chair to do the dreaded 500 exercises that Dr Z requires. (knee in and out and knee to chest). She also relays that the ace wrap is for swelling and it's something new he's trying to see if it helps. This is the moment I started to pass gas, whoo hoo! I get a regular diet tray and ate a chicken salad sandwich, pretzels, and an ice cream from ben and jerry's.
Todd and Sue leave to go to Trader Joe's and my parents go out to lunch. My friend Sheena visited me at this time because today is her pre-op for her PAO and she wanted to see how I was doing. It was a nice visit and I hope she came away feeling better about everything.  I still have little pain, even after walking. The PCA has been discontinued and I am switched over to vicodin and my foley is taken out too. Now I have to get up to use the bathroom, boo! My parents left for home at this time and I was sad to see them go but so happy they were there.
About this time, early evening, I started to get really nauseated and feel like I might throw up. I got IV zofran, but it didn't seem to work, so my nurse gave me a Reiki treatment which was amazing!! It turned out I didn't throw up but I had 2 severe bouts of liquid diarrhea. It was awful. I don't eat again, I actually went back to just water and ice chips. I begin to sleep a lot too, to escape the nausea.
My nurses are super impressed with my pain tolerance as I have not been taking much vicodin and my pain, even with getting up and walking, is remaining any where from 1-3/10. I slept from 10 pm to 7 am and it felt great!

Post op day 3: December 3rd:

I saw the resident again, super early, and he says I am doing great overall but I may need to regress to a liquid diet seeing as what happened yesterday. Boo. Then Dr. Z came in and saw me. He says I can eat whatever I can tolerate (since I pooped yesterday) and that due to how my stomach was feeling I will go home tomorrow instead of today but could go home this evening after PT/OT if I feel good enough. He also explained that the whole leg feeling tingly might have been from the drain, since he punctured a big blood vessel when putting it in, but I tell him the feeling is gone now anyway. He gives me the best news that I can shower today after the dressing is removed by the resident, YAY! I asked him if the quad was detached and he told me it was and also reattached and that my coverage looks great, but to wait to see the xrays. He warned I may feel a bit more sore in the next 10 days but then should get better. No weight bearing but when I asked about a wheelchair for Disney World, he said I'd be getting around good by then, but he'll still write a script for one if I remind him at my follow up.
Nurses are awesome yet again:) I have some of the same nurses, which is nice, day after day. They know how to take care of me.
Todd and Sue get in around 8:30. Amy also arrives around this time and has me walk in the halls. It is a HUGE difference today in how I felt getting up. No tears! I am still at a 3/10 at the most for pain on vicodin alone. Still feeling nauseated though. Amy also had me do stairs, and although not bad, it was kind of scary. I felt unstable on them going down. But I passed her standards:) Amy helped me into my chair and then said "No offense, but I hope I never see you here again!" We said goodbye to each other and then OT came in to show me how to dress and use the toilet and take a shower. All a bit slow and awkward, but with time and practice it will get easier. Always, always pick up the bad leg for everything, don't let it move on it's own til Dr. Z gives the ok.
My Aunt Di and Uncle Gil came to visit me today and brought me flowers. It was so sweet to see them. They didn't stay long as they were only passing through the area, but it was lovely none the less.
I am still not eating, only ice chips as I have not passed gas again since my incident yesterday. I got up in the halls a few times and I guess I wasn't spacing out the vicodin very well, so I had to have IV dilaudid to help with breakthrough pain. Todd and Sue go to Trader Joes again and I get a well deserved nap! I am patiently waiting for my dressing to be removed so I can shower.
Resident comes in around 5 to take the dressing off and I can't believe how good everything looks. You can't even tell where Z took the screws out the incision is so small!! I have glue holdng my LPAO scar together and a bruise where the drain was. Shower time!! It was heavenly. I have never felt so nappy before and to be able to shower was the best. Todd had to help me and did great. Once showered I went back to bed with the CPM and started to feel super queasy again. My nurse offered Zofran but it didn' really work again this time. We opted to try another anti nausea med, phenergan. It knocked me out good!!! The nurses also kept me on a "round the clock" pain regimen with my vicodin and it seemed to help a lot.

Post op day 4: December 4th:

Today is discharge day! I got a new roommate late last night and she was my age and had her 2nd PAO done. We chatted a while and then I saw the resident and Dr. Z. Z says my numb spot should go away quickl because it is not really numb, which is awesome! Todd and Sue came in, and started to pack my things. The nurses came in to get me ready to go as well. I was feeling pretty miserable from nausea and exhaustion and just ready to go! We left around 11 am and getting into the jeep wasn't too bad. Sue had brought 2 king size pillows for me to use. 1 to sit on and 1 to wedge my leg so it wouldn't shake around with the bumpy roads. This seemed to work like a charm. The seat belt didn't even bother me as it didn't lay across the scar.
I will say that going commando with sweats is pretty comfortable, but the sweats should be pretty loose. At least a size larger than what you normally are.
We got to Grand Rapids to drop off Sue and pick up my prescriptions (which took FOREVER) so I napped for the  2 hours it took to fill the scripts. Todd also called the CPM company to deliver the CPM to Sue's house so they wouldn't have to make the trip up north. Once we had everything in order there, we took off for home. Pain is still tolerable but I just feel crappy. We got home about 5 pm and I was settled into the recliner. I slept awhile. But to be honest, I don't really remember the next few days because I would sleep to escape the nausea ALL the time. I think I was literally awake only 3 hours out of a 24 hour period. I couldn't eat and even drinking became a problem. From Saturday til Monday I became weaker and weaker, not passing hardly any gas and sleeping. I could hardly get up by myself. My  hubby and family were becoming pretty concerned. Monday night, Sue brought Toby (my Boston terrier) up for my parents to take home with them and when my parents came over they brought with them a script of zofran from my sister in law. I took a dose, not really believing it would work but miraculously, it did. Within a few hours I was perking up and drinking! By Tuesday morning (Dec 7th) I had done a 180 and felt great! I drank several glasses of water and even had a baked potato for dinner, my first solid food since last week.
Now I feel much stronger and better and pain is still about a 3, sometimes 5/10. I remember that Z said the next 10 days could be worse in terms of pain, so I'm not too worried. I am passing gas more regularly now as I have gotten mirilax and colace on board and am moving more. I am staying awake most of the day now, with short cat naps only. The CPM is our only problem now. It's been replaced once already (quitting on me during the night) and now the replacement may need to be replaced because it clunks on extension and flexion and it just hurts my leg for some reason.

All in all, things now couldn't be going better! I still have a hard time believing I had a PAO for the little amount of pain I'm in. Yes, it hurts, but not to what I thought it would. I am most frustrated with not being able to use my leg at all. I am much more needy with this recovery than I was for my SDD. Todd is an angel though!!! I will have to give it a few more days to compare to how I feel with the PAO vs the SDD, although I can already say this is harder. I don't think I will be doing this for the right hip if it's needed...that's what I feel right now.