Surgery day (day zero) and post op day 1

May 31st - Surgery day:

This was a long day of waiting considering my surgery was not scheduled to go until 6:30 pm. A little bit of surgery knowledge is, you can technically drink CLEAR liquids up to 6 hours prior to a procedure, but in small quantities (Disclaimer: follow your surgeons orders!) Seeing as I had 18.5 hours of fasting, I did take advantage of drinking some juice and water until about 10 am. Once we got to Detroit and checked everyone into the family housing, I showered (it was extremely hot and sticky!). Then we made our way across the street and checked into admitting. Before I was taken back to the pre-op area, I met Chel, another Z patient, whose daughter had her LPAO first thing that morning. She was doing pretty well, considering. It was wonderful to put a face to the name and be able to meet! She explained that Bailey (who also had her PAO) was either in recovery or up on the Peds floor already with her mom, Jenny, but that the surgery went well.
I was called back pretty shortly and given my pregnancy test and IV. The nurse explained that they would be rush-admitting me because Dr. Z was ahead of schedule by about an hour! I was pleasantly surprised. Z walked in and spoke with me about the procedures and winked when he said he'd be doing the scope "per my request". He did not feel he'd find anything, maybe a little scar tissue. Then the nurses were done with the admission portion and my family was allowed back to see me. Not much time went by when I was bombarded by the surgical team, one after another to go over the procedure and to be told, "not much longer now". The anesthesiologist came in to evaluate me and I asked about a scopolomine patch to battle nausea. He agreed to it as he saw that the team had tried everything else without much success. I was given a patch right away to stick behind my left ear. As quickly as I'd been ushered in, I was told it was time to roll. I think admission took only 20 minutes to half an hour! My family kissed me and wished me luck and off I went on the stretcher. I remember seeing the fracture table for the scope and the traction boots. I also tried looking around for all the tools and instruments but everything was pretty well covered. The room was full of staff and the C-Arm (portable xray machine). I scooted over onto the table, got "comfortable" and had a mask over my face. Last thing I remember seeing was the clock; 5:40 pm.

4  hours later and going into post op day 1 (June 1st)
I woke in recovery in quite a bit of pain but was pretty calm. I looked around, saw I was the only patient there and asked the nurse what time it was. She told me about 9:50 pm and I had just come out of surgery. I asked if everything went well, she said as far as she knew. I drifted in and out until the time for the transport team came to get me and move me to the Peds floor. Moving hurt and made me very dizzy. We got to my room and as we rolled in, I looked around and was so happy...I had a private room! I asked how I lucked out on that and the answer was vague. My room was the Cinderella room. My parents, T, and mother in law (MIL) came in shortly after that. I was glad to see them, but also fighting waves of pain that were becoming really similar to my SDD experience. My husband could tell I wasn't doing the greatest and went to look at the IV PCA. It was morphine. My heart sunk and he was pretty upset. Morphine was the first drug they used for my SDD and it didn't work, resulting in such severe pain upon waking. I, for some reason, do not respond AT ALL to morphine. It's like giving saline in someone's IV, zero effect. T and MIL called for my nurse right away to try to resolve this conflict while I tried to make jokes and laugh about stupid stuff, because what else could I do? Crying was next, but I didn't want to give into that. My nurse was nice enough but not very pro active. She said she called the resident on call, but that the resident wanted to evaluate me first herself, before switching the morphine to dilaudid. She made it sound like she'd be in within a half hour tops. Well, 3 hours later, she finally came in. Meanwhile I was set up on the CPM and SCD's. This was hell. By 2:15 in the morning, I finally got a bolus dose of dilaudid and the PCA was switched over to dilaudid with a basal rate (continuous infusion) along with me being able to push the button. This was all to help me catch up with the pain which was getting to be ridiculously unbearable. Once I got the bolus dose, I felt immediate relief and when the basal rate was going, I actually felt comfortable enough to sleep a little. My dizziness and lightheadedness were still a problem and anytime I lifted my head, the room spun. By morning things were much better on the pain scale but I was starting to itch a lot! Almost to the point of gouging myself. I had a back scratcher that was so helpful in reaching places I couldn't get to myself. But my new day nurse thought the dilaudid had to go. I thought she was evil. We tried benadryl to combat the itchies but no use. I tried to convince her that itching was preferable to being in pain, as annoying as it was. She wasn't having it. Once Dr. Z came in to make rounds, she had gotten her talons into him and convinced him that "I"didn't want to itch anymore and therefore should be taken off the dilaudid. When he came in to see me, he checked everything over and then dropped the bomb. We would be stopping the dilaudid and putting me on vicodin, today....now. I never disliked a nurse more than right at that moment. I told Z ok, no problem. I asked about the dizziness I was experiencing. He looked at the blood pressures and felt they were ok (90/50's) and said maybe the blood loss during surgery. I lost around 400-500 ml blood this time. My blood work came back stable this morning so no blood transfusion needed. He made sure I didn't need anything else and waved goodbye. So, once he left, my dictator (nurse) came in to take down the dilaudid and give me a vicodin. So I really only had my PCA for maybe 7 hours! I wasn't even going to get IV push for break through pain. I swear she was smirking. Really, she wasn't, she thought she was doing me a favor by stopping the dilaudid so I wouldn't itch, but really, being in no pain was the best present I could get! End of the story today is, the itching slowly abated, but the pain slowly crept back up to unacceptable levels. I was on vicodin 5/500 tabs, one every 3 hours. I guess I started asking for more pain meds sooner than I should have and frustrated my nurse. God forbid. Anyway, she asked what my pain scale rating was and I told her 8/10. I wasn't exactly happy with this. She did call for a stronger form of vicodin without my knowing, bless her, and next time meds were due, I got the 10/500 pill. These helped to get the pain back under control and they brought them to me round the clock every three hours. Finally, I was not itching and my pain was well controlled, worst being 5/10 with activity. Mostly it was 2/10. I was still dizzy and lightheaded but that was the least of my problems for now. Nausea was coming and going in waves but it wasn't too bad yet. I was also taken off the nasal cannula. Today (post op day 1) was spent in bed only, resting, and seeing PT for evaluation and isometric exercises. Amy was wonderful! We chatted, had a good laugh, and she asked me how I was doing. I told her that honestly, if I was still feeling the way I was today by tomorrow, I wouldn't be getting out of bed. She grinned and said, "not an option". I knew that, but thought I'd try anyway. She promised to be back before noon tomorrow. I was actually looking forward to getting out of bed due to the stickiness of everything (the temperature was in the 90's) but was dreading it too. With all the movement Amy had me doing in the bed, I got a little more nauseated and needed zofran. The scopolomine patch was beginning to wear off. I wasn't interested in eating but I was drinking moderately. My foley bag was draining quite nicely. My hemovac drain was also getting pretty full. I munched on ice chips and tried to combat my cotton mouth. This was probably the worst dry mouth I'd ever had. My voice was nearly non existant and scratchy too, but my throat didn't hurt. At least there was that. I was tucked up in bed and trying to watch the hockey Stanley Cup finals for the night, but I kept drifting in and out of sleep. Second night down, nothing interesting happening.

Scope findings:

Apparently Dr. Z was actually surprised at how the inside of my joint looked with the scope. He was disappointed to find my labrum to have degenerated more since the SDD and the cartilage to be spongy and soft. I have chondromalacia anteriorly and superiorly. He was able to palpate the cartilage with an instrument to approximately 12 mm down. Posteriorly the socket looks great. The femoral head is only slightly arthritic and still looks great since the SDD. He also opened the capsule by doing an arthrotomy with the PAO. He stated that while the cartilage did look like it was degrading, I have an 85% chance of going 20 years before I will need a hip replacement due to the positioning of the PAO. He is very happy with the position of the socket and said I have a good, stable hip. I obtained my surgical report and the preoperative diagnosis is:
1) right acetabular labral degeneration
2) right acetabular dysplasia
3) left painful iliac hardware

the postoperative diagnosis:
1) right anterior labral degenerative tear
2) anterior acetabular chondromalacia
3) acetabular dysplasia
4) left painful iliac hardward

operation:
1) right hip arthroscopy with partial labral resection
2) right hip arthroscopy with acetabular chondroplasty
3) right periacetabular osteotomy
4) iliac crest graft
5) arthrogram with radiologic interpretation
6) removal left iliac hardware

Blood loss: 400 ml