Kitty Osteoblastic Power

Everyone who is recovering from bone surgery needs a little bit of help growing bone. Some surgeons might prescribe vitamin D and calcium to their patients or a bone stimulator. Some even collaborate with Physical Therapists and agree that certain degrees of weight bearing will help bone calcify if in a weight bearing area. Well I have a better, cuter, fuzzier, way sweeter prescription to help grow my bones. Meet Cayman, my 11 year old Manx cat who has been literally glued to my side (and mostly my left like she knows that's where I need her warmth and purring) and has been humorously dubbed "Kitty Osteoblastic Healer".

You gotta get one, ya'll.

Interesting side note; it has been found in some research (although not by me) that the frequency of a cat's purr is supposed to be just as healing as the sound waves of a bone stimulator. So, there you go.

Straightened Out - Post Op Week 2

Two weeks have passed since surgery and I have noticed so much change already in my hip and femur! First off my whole leg is straight. Like, whoa. I mean, I noticed I had bendy bones always, but it never bothered me cosmetically. That's not why I had this surgery. Not even an inkling why. But I will say it is a beautiful thing looking in the mirror and seeing my legs looking like they do, not gonna lie. Vanity be damned, or whatever they say. But the thing I am trying to get at with what I'm really noticing with my hip and femur now, and really since the hospital, is that they do not hurt. At all. It is something so incredibly unfathomable to me that I can't wrap my brain around it. It doesn't seem possible. Now, please be reasonable and understand that I do have normal incisional pain and muscular pain, things of that nature, but even that is so mild I am just in utter shock. I must have been in so much pain before surgery that I did not realize it and this realignment has put my weary body at peace...? And yet I thought the LPAO from 4 years ago had done a pretty darn good job of that too. I just don't know.
But onto the not so good part of the surgery. My tibia is terribly painful and still hurts just as much as the day of surgery, sometimes more. Nothing relieves it except sometimes ice. I'm in the CAM walker boot to protect it, only taking it off to shower and at night while in the CPM. I remain toe touch weight bearing but admittedly I've put down a lot more weight a few times throughout the past few days than I should have. It's hard not to. Bruising and a hard pocket of swelling is starting to surface on the lateral and anterior side of the tibia. Part of me wonders if there is a hematoma. Maybe Dr. Z did break the fibula. I won't know til next Monday at my first follow up. But this pain is surprisingly horrific.
I saw my pain management physician yesterday to follow up after surgery to make sure my CRPS was under control after surgery and to follow up on meds and make med adjustments. He felt my CRPS was very well controlled and is not a concern for my left side, tibia especially, which is a huge relief for me. But we will still watch it and act on it aggressively to keep it at bay, and he did adjust my meds to further help keep me comfortable.
I'm still using my walker. Crutches should be soon. I can already sleep a little on my side for short periods. I can easily do figure 4s with my leg and lift it actively. But I am so easily exhausted and debilitated. The clunking/snapping/popping over the femoral plate is already happening with frightening regularity and it HURTS. But I've reached out to others and it's normal. I just have to get used to it. It will eventually calm down. That or it will stop when the plate is surgically removed. And you can be sure that will be one of the first questions I'll be asking about on Monday.
All in all I just honestly cannot believe how little pain my hip is in at this point! I need to see my xrays...I'm almost skeptical....

Straightened Out - Part 4

Dec 20

Discharge day! My favorite day! The residents, pain service and nurses were encouraging me to stay one or two more days but quite honestly I could not have stayed another minute in that hospital room if I'd been drugged with Vitamin K. And I'm not talking about potassium.

My roommate was A.W.F.U.L. She had a broken tibial plateau fracture (basically the top of the tibia, right under the knee cap/joint space) and had surgery the day after me, so I only had a private room for one night. After that I had to share my room with....her. She complained and swore like a sailor and begged for her pain meds literally every 20 minutes (I timed it out of boredom). She called the doctors and nurses liars when they said they couldn't give her any more meds. She screamed at them for "moving" her leg when all they did was hold it steady while she moved. She stated they hit her and pushed her and mistreated her. Everyday she'd start a phone conversation with her aunt or sister "Well it's just another day of being mistreated and neglected. No one helps me or does anything for me here." She refused to get up, she refused to do therapy, she refused anything but the bedpan, eventually needing the foley catheter put in 3 times. She should have been discharged the day after her surgery but because of her actions, she stayed longer than me. I could not handle it. She stayed up all night with lights on and the TV on and moaning and complaining to whomever would listen to her on her phone. It was high time to get out while the getting was good. Her aunt and sister were super sweet and very apologetic and in secret had apologized to me and my family about her. So we kind of knew we were in for a bit of a rocky stay.

Anyway, on Saturday I had all my ducks in a row. PT and OT had signed off on me the day before and my walker and CPM machine were both delivered and approved by insurance and ready to go. My MIL just needed to fill my prescriptions at the hospital pharmacy and once that was done I was outta there! I had showered and walkered (in 15 minutes, yahoo) so I felt fresh. Dr. Z came by to see me and say good bye and happy holidays. He was a bit concerned with the left leg being so hard to control pain wise so we may be starting PT at 2 weeks rather than 8 weeks. I will find out at my first follow up appt, which will actually be 3 weeks d/t him being out of the office.

The drive home was cake. I stretched out in the back seat after I medicated and got pillows around me and I slept off and on the 3.5 hours home. No problem. Doing the walker into the house was fine too. Going up steps, I was taught you have to go backwards. It was scary in the hospital at first, but at home we only have one step up into the house and that's it. So we were home and I was fine. It was probably the best homecoming out of all my surgeries. Once I was in the house, I was relegated to my recliner and told to stay there and just relax. And that is what I have been doing a whole of since. Merry Christmas!

Straightened Out - Part 3

December 16-20th, 2014

Ok, so let's get to the meat of the story. What we all really want are pictures, right? I've got some. No xrays yet, those will be coming in a couple weeks after my first follow up on 1/5/15. But I did make sure to photo document my leg's before and after journey, and what a journey it has been. 

The left femur and tibia were both derotated more than 25 degrees each. (Side note: Normal femoral version is 14 degrees. Mine was 45-50 degrees internally rotated. Normal tibial torsion is 20 degrees. Mine was 45 degrees externally rotated - all before surgery). At this point in time I don't know if my fibula was also broken but prior to surgery Dr. Z didn't think he'd need to break it. But what a difference, eh? And with the loose body out of my hip, I'm hopeful that having correct alignment and a healthy hip joint will finally be the answer and end  I'm looking for to my left leg's story.

This is just another view of how the rotational difference in my leg looks now. My knee pain and hip catching were all because of my femoral and tibial torsion, which is also known as Miserable Malalignment.

Grumpy cat (gifted to me from my MIL and hubby) joined me after I came out of recovery as I have always enjoyed her...

And now comes with me everywhere I walker. 

My morning view from the 9th floor of Royal Oak Beaumont Hospital over looking the once again beginning to thrive city of Detroit. At night we could see The Joe, Greek Town, The Renaissance Center, among other beautiful things. It was a great view!

Big ol' bandage that was way more dramatic than the incision itself. I expected a huge 12 inch incision like my SDD incision on my right side from 5 years ago, but was pleasantly surprised to find that the incision is only half the length, and no where near as painful. It's hard to see the lower leg, but the tibia has a boot on it (the black material) and that incision is also small. The femoral inc is probably 5 inches and the tibial inc is probably 4-5 inches. I'd have to take a ruler to them to be sure but by my eye that's what I'm guessing. And I'm great at math...

Probably the coolest part of my stay, on Thursday (post op day 2), seeing my friend whom I've gotten to know and become very close with thru the unfortunate situation of hip dysplasia. She is a resident/MD (pain management and rehabilitation) in the Detroit area and has just had her 2nd PAO with Dr. Z recently and amazes me everyday with her strength and ability to forge ahead and persevere through it all. She and I have found so much in common with each other and have had a girls weekend last summer and already plan to make it a yearly thing. We're thinking of getting little tattoos to mark our journey together through all this. So for sure someday that picture will make it in here.

Our girls weekend last July, painting and shopping! Next time the artwork will be tattoos!

Straightened Out - Part 2

December 16-20th, 2014

The 5 days in the hospital were spent as typical days in a hospital would be spent. I laid in bed hooked up to oxygen, IV drips, an epidural drip into my spinal column (which didn't take completely, only numbing my left hip and lady bits), and a foley catheter to drain my urine. Not having had general anesthesia was actually the best thing that I could have had ever. I came out of this surgery smiling, laughing, alert, not miserable, not nauseated, not wanting to die. General anesthesia just has a way of wanting to play terrible mind games with you. I did not feel 100% by any means as I still felt like I had surgery to chop up my entire left side from here to next week but there is something to be said for epidurals and spinal anesthesia. I am a fan. My first night started out pretty well on the ortho floor with a great health care tech and a nurse who would later turn out to be awesome, but that night was not the best. My epidural started to fail early on in the shift and the pain management team had left instructions on how to dose it but she wasn't familiar with it, was getting easily frustrated, and was also getting slammed with tons of admissions throughout the night. My first night was bad. But once the epidural situation was figured out and the medication was maxed, I was more comfortable after that and able to rest better. Physical therapy came to see me the next morning (my dear friend whom I see and trust and love everytime!) and got me up and out of bed at my pace considering I had the epidural in. The feeling leaves you with the sensation of a cement block for a lower body. Or like you are trying to walk through cement that is already setting. It's difficult and very trying. Crutches just weren't going to cut it this time and I earned myself a beautiful new walker ($135 a pop! Thank you insurance). It took 30 minutes to go from my bed to the door that leads to the hallway. And she wanted me to do this 2 to 3 more times today! I am not one to turn down a challenge though and promised her I would. I ended up sitting in the chair next to my bed for a bit until my husband and MIL came over for the day. Then I went back to bed. There was never really a moment where nausea hit, but I was starting to feel "off". The next 2 attempts to try to walk were failures. All I could do was stand up at the side of the bed with the walker to steady me. The last attempt I proceded to dry heave and remain completely immobile for an hour with tears streaming down my face otherwise the nausea was so intense with any movement it was impossible to do anything. It seemed my blood pressure was probably to blame. It was pretty low just laying down, so upon standing, I could feel myself getting really lightheaded and weak, then the intense nausea. Zofran IV and PO did not work, but what did end up working was IV benadryl. It was a nice little treat as it not only knocked out the nausea but also gave me a nice needed sleep. My nurse made sure to just go ahead and give me the IV benadryl around the clock for the next 24 hrs without even asking as I was feeling pretty miserable.

On post op day 2 (Dec 18) the pain team and Dr. Z consulted with me and we decided to take the epidural out that morning to see how I'd do. Once it was out, my foley catheter would be out 4 hours after that to give the bladder time to wake up. I would be switched to oral pain meds with IV push for break thru pain and continue to work on physical therapy. The beauty of all this is it was my decision when the epidural came out. It could have stayed in one more day if I wanted it, but because I was part of the decision process and I was motivated to get out sooner than later, I opted for that day. The switch to oral meds was rough and it took some time to figure things out, especially because I started getting muscle spasms in my surgical leg. My right leg (the one I worried about with CRPS was doing so well and did not bother me at all) but both Dr. Z and I were having some concerns over my left lower leg. The pain response there was out of control and he is not sure what's going on but thinks we'll have to start PT at 2 weeks rather than at 8 weeks as per normal protocol.

Other noteables for this surgery compared to others that I've gone through are that I actually ate meals at the hospital (willingly), I was able to pee on my own after the catheter came out, I didn't have horrible uncontrollable diarrhea. I attribute these things to not having general anesthesia. 

Straightened Out - Part 1

December 16, 2014

I started out the day of surgery expecting to go in pretty late in the day as per usual, as I had a scheduled time of 5:30pm, but the hospital did call me and ask that I get down there ASAP as they had a cancellation and wanted to get me into the OR at 1pm. Unfortunately as far away as we were, it still ended up being about 4pm before I was taken back to surgery. Getting the epidural was a bit of a challenge in itself as well as it seemed there was miscommunication between the pre-anesthesia screening call the day before and when I talked to the CRNA the day of surgery. But once the anesthesiologist and Dr. Z talked things over, they decided that we would go ahead with a spinal and a continuous infusion epidural rather than a general anesthesia. To be honest, that had me a little freaked out and I wasn't really cool with being "awake", but we were already so far behind schedule and it took so much just to get the epidural that I just went with it. I kissed and hugged my husband and MIL and got a good dose of versed before being wheeled into the cold halls of the OR maze. We entered my surgery suite and there was a host of people there with tons of equipment and I saw my surgeon who was waiting for me with a smile in his eyes. I also had two very kind circulating nurses ready to assist me while I was positioned for my epidural and they talked me through it and next thing I know I'm told that I should feel a nice warm and heavy sensation in my legs, which I did. As I was laid back on the OR table, my legs were last felt to be laid straight out in front of me yet when I was watching Dr. Z examine my ROM with his resident he had a pair of legs flinging around in the air doing all sorts of weird movements. Then I realized, they were my legs. Seriously, that is bizarre! A flurry of activity began from then on as my foley catheter was placed and then the sterile drapes were put over me and a clear plastic drape placed above my face. I listened to Dr. Z and the circulator do the "Time Out" where they state the name of the patient, the procedure, the correct side of procedure and antibiotic given, etc. Then it was go time. Suddenly I realized I was staring at Dr. Z through the clear drape and listening to him say "oh we have a loose body, please hand me _____ instrument " and I saw him switching out different scope instruments within my hip joint. Also I recall him having conversations with his staff during the scope. He also spoke to me saying that my hip had a loose body but he got it out and that the hip looked pretty good. Some parts of the femur were "scuffed" but not bad. As I answered him back it dawned on me that I was awake. That's when I looked at the anesthestist and said "I'm not going to be awake for the Osteotomies am I?!" She said no and patted my arm. The scope was over pretty quickly after that and I recall being transferred over to the fracture table and in my drugged up state I grabbed Dr. Zs arm and told him "thank you, you're doing such a good job" (doh!). He just smiled and squeezed my arm back. Then they situated me again with a blue drape over my face and this time it was totally lights out during surgery. All in all it was 3.5 hours of surgery. I was taken back to recovery after Dr. Z woke me up and said everything went really well and I had a beautifully straight leg, and a really healthy looking hip joint. I felt very calm but very shaky. The epidural wasn't set up to the continuous infusion yet so I had quite a lot of burning and searing pain in my thigh where the femoral osteotomy was done and my tibial osteotomy felt like it was that crushing/squeezing pain. It took the recovery nurses almost an hour to figure out how to get the epidural to work before it began to give me relief but they did allow me a PCA while they tried getting the epidural set up. I couldn't stop shaking and my sternum and shoulder blades burned with an icy hot sharpness that no one could figure out either. But my EKG was ok so no one was overly concerned and figured maybe the epidural went a little too high. Once the epidural boluses finally brought relief after two hours in recovery I was moved to my room on the orthopedic floor where I started out with my own room. It was a fairly decent first night except that my left foot just would not respond to any pain meds or interventions that we tried at all. I couldn't feel any pain in my hip or femur though which was great. My main concern was just not having a flare of CRPS in my right foot/ankle and spreading it to my left side and so far we seemed to have avoided that. But as the night progressed, my left foot became more and more worrisome and I was becoming more distraught. My nurse was very distracted and not able to attend to me as much as I needed her too either because the hosiptal had been hit with over 200-300 admissions alone that day/night for the flu and patients were filling every available space the hospital had, including areas of fresh post op spaces. Yep, there were 7 flu patients on my floor just a few doors down from me....but no worries, they were quarantined. So, although my left hip had responded nicely to the epidural, the rest of my lower body pretty much had full feeling. And that was just the beginning to my pain teams adventures.

A Little Before And After

As close as I'm getting to my surgery, I realized I don't really have anything to photodocument the changes of what will take place. The photos within this post display xrays and CT scans of my knees and also my corrected right tibia. Then the leg photos are to show my legs post right tibia derotation/pre left DFO/TO. In some ways parts of me will miss having the wonky legs that can do the circus tricks because of the anteversion. But I will not miss the pain or instability. In years past it was a lot like cracking my knuckles when I cracked my left knee. It didn't hurt, it just felt good. Now it hurts and my knee buckles, and also bruises along the joint line often. Luckily with my hip, it hasn't stuck again since summer but there have been moments of stabbing pains and just those generalized limping marathons.

30 days until I will be straightened out.

Details for December

Things have been set up for December 16th for a left hip scope, a derotational osteotomy at the hip with plate and screws and derotational osteotomy of the tibia and fibula with plate and screws. Each derotation will be a 25 degree correction, the femur external (outward) and the tibia internal (inward). Those a considered pretty significant numbers. My surgeon says it'll be a pretty rough surgery and to plan a minimum of 12 weeks of down time. A double level osteotomy is difficult on pediatric patients at best, so on the adult patient it's even more difficult meaning I may not recover easily or timely. I'm definitely determined to beat those predictions and recover well. 

On the CRPS front I've been switching up my medication regime and I have switched from neurontin to topamax and Nucynta ER. This combo works so much better than what I was doing before, but holy cow, I drink tons of water but don't sweat anymore, I barely pee, get kinda nauseated. And the biggest thing is I haven't had any pop in 6 weeks!! That's huge because Diet Coke has been a staple in my diet all my life. Topamax apparently has this side effect commonly. It's worth it though. 

The biggest hurdle I'm going to face now going into surgery is trying to get a spinal or block of some to protect my right leg from going into a flare during and after surgery.

Preparing For The Left Femoral and Tibial Osteotomies

I'm the girl who usually loves going to Detroit to see her orthopedic surgeon. The guy practically gave me my life back by correcting my hip sockets when he did. But this appointment I just had this past Monday I was less than enthused. I consulted with my OS about my left leg and hip, why it's still hurting and should we really consider doing the femoral and tibial derotational osteotomies. He agreed it's time and also wants to scope my hip since it sounds like there is a labral tear as well. He didn't seem too excited either and I don't know whether to attribute it to disappointment that the PAO wasn't enough or he just had a rough day. His long time assistant, whom I had become friendly with and used often to help me through the maze that is my OS's world, just up and quit a few weeks ago, leaving him in a lurch. He looked tired. I'm bummed because I have to deal with a brand new person who doesn't know me from Adam. Regardless, I'm waiting to hear back from her about a date for surgery, hopefully it's in December to avoid paying a huge deductible in January. Z mentioned a 25 degree internal correction for the tibia and 25 degree external correction for the femur, and 3-4 nights in the hospital. He also thought this would be my roughest surgery yet, even worse than the PAOs. I'm keeping a poitive outlook that it won't be any worse. I have to get some more questions answered from him but he thinks I could just call him a week or two before surgery to have my preop rather than drive down to Detroit to save me a trip. I need to ask him about time non-weightbearing, time off work, where the levels of the osteotomy will be for each part, and if he will consider a spinal or epidural for me since I do have CRPS now. He seemed concerned about whether my right leg was up to supporting my left side. I told him absolutely. What else am I gonna say?  So while I am truly excited that this really should be it for me with corrective surgeries, I'm not happy to have to do it. I just want to be done already. I see hardware removal and a right THR in my future and that should be the extent of what I'll ever need. Anything else would be completely unforeseen. As for my right hip, the joint space is staying stable but the medial and most distal part of my socket is getting more spurs and cysts than the last xray. It's feeling like it too. I'm pretty stiff in the morning and when Z and his PA put my hip through the motions, flexing it hurt enough that I flinched and squeaked in surprise. It's ROM is about the same too, 80 degrees of flexion comfortably, and 90 if pushed. But that hurts. The left is still normal around 110-120 degrees, although flexion and external rotation does hurt now. 

Stuck

Not my most glamorous moment today...I got "stuck" on the toilet, at work. My left hip was stuck in a painful position and it took a few tries to get it unstuck before I could move without crying. I'm sure either the labrum snagged or it was subluxation. What a pain in the butt (or anterior hip)! Now imagine the fun email I got to write to my surgeon's assistant...! I am asking to be able to get a cortisone injection here at home now versus driving 3 hours to Royal Oak for one or waiting until October when I have my follow up with Z. I thought I was going to skate by on this side until this winter since I just passed the 3.5 year post PAO mark. Hmmm... Well played hip, well played.

And since I brought it up (it's my blog) I just celebrated 3 years post RPAO and 3.5 years post LPAO on Saturday the 31st of May. No new or exciting things to publish. I have noticed however that humidity is a natural enemy to my hip joints (and foot/ankle joints) more so than freezing temps, I dare say. I would never admit it to my husband though since I have him convinced that we need to move out of the north and flee south...far south where summers last longer than 2 measly weeks. I'm unpacking my winters clothes as we speak. No, seriously!

I'm also coming up on 1 year post op on my foot and ankle surgery this Saturday, June 7th. I'm making slow, slooooow strides in the right direction. I still depend on meds to control the nerve pain and have discovered a little more that I really can't wack my ankle plate against things, 'cause hey, it really hurts! I'd like the hardware to be removed but if my pain management doctor's face is anything to go by, I'm going to guess that's not the brightest idea. I'm going to try to live with it. It scares me to think I could get back to where I was when my CRPS was out of control so I'll heed his warning and get him to stop making faces at me everytime I bring it up. I'm also scared to sit on the toilet again, but I can't hold it forever...pass the toilet paper, eh?

A year in review

I'm going to try something different to bring everything up to speed without writing a book and just summarize by month.

August 2013: Still struggling with severe pain in foot/ankle. Swelling, burning, stabbing sensations in foot.

September '13: Went to California for a 10 day vacation and used wheelchair for a lot of the trip as still on crutches and boot, unable to successfully bear even 50% weight. Neurontin dose increased, seems to work a little better. Started PT and really difficult but lymphadema therapy is crucial.

October '13: Saw Dr. B and he is concerned about CRPS. Sending me to pain management physician for eval on CRPS and treatment. Saw Dr. G at pain management office, basically meet all criteria for CRPS. He performed a lumbar sympathetic block to see if it helped the ankle and foot and it resulted in a 9 degree increase in temp and a nice warm soothing sensation. CRPS confirmed. Neurontin increased again. Still on crutches and able to start wearing shoes again with the block on board as the swelling in foot decreased enough to allow shoes. Plan is to return for a series of blocks to hopefully stop or dramatically decrease CRPS symptoms.

November '13: Able to wean off crutches totally and continued with more blocks. Still needing to increase neurontin and added a compound cream of ketamine, lidocaine and neurontin for my foot/ankle to help with desenstization. Muscle strength is getting slowly better with PT and benefits of the tibial derotation and ligament reconstruction starting to show as ankle never rolls anymore. Big toe still exquisitly painful, as is the area around the plate and screws. Saw Dr. Z and had yearly follow up for hips, explained tibial surgery and ligament reconstruction, and also that left leg still bothering me. He said he'll be available whenever I am ready to go ahead with left FO/TO but to try to let right leg heal up awhile.

December '13: More lumbar blocks from pain doc and moderate success with these. PT finished up, and PT gave me a lymphadema pump to use on leg at home. I use it for a 1/2 hour at night and really like it. Still wearing TEDs on the right as the edema is still pretty bad, probably only 2+ anymore but still bothersome.

January '14: Right hip really starting to hurt a lot more than usual, which puts a strain on everything else because I walk funny to alleviate that. More blocks done for foot/ankle and baclofen added to meds as I started getting really wicked muscle spasms in the foot and toes. Saw Dr. B again and he set me up for an injection into the ankle and toe joints to see if this helps pain at all as it's still pretty severe. I've tried exercising on the treadclimber and it's too painful. Injections won't happen until March d/t scheduling issues.

February '14: Saw Dr. G at pain clinic for an "emergency" lumbar sympathetic block as I'm going on vacation to Mexico. Block did not help this time. Vacation was good, but I wasn't able to walk very long on the beach. Also because of increasing hip and back pain, script for PT was written. Started at the pain clinic and getting manual therapy on my back which I love. Also got a script for noretriptyline to help compliment neurontin with nerve pain and ordering an EMG to see if there is a specific nerve lesion as this is ongoing and frustration is setting in on my part. Still fiddling with best dose for neurontin, and 2400 mg is where I've settled. Pain is still pretty significant. Muscle is finally starting to come back in calf. Plate and screws hurt to be touched and leave a pins and needles sensation. Lots of popping in right ankle now. I started gentle Yoga at the end of the month. Very challenging for right hip poses but a very satisfying class overall. Cannot do Warrior Poses without pain though.

March '13: Ankle and toe injection this month. Surprisingly worked really well after the last two sympathetic blocks did not work. Toe much better, ankle less stiff. Able to rapidly decrease neurontin dose down to 1200 mg. Plate and screws most bothersome issue. Manual therapy has done wonders for back pain and possibly foot. Back pain was 6/10 and now 1-2/10. Foot has gone from 8/10 to about 4-5/10 (with meds, PT, and injections combined).

April '14: Able to decrease neurontin to 600 mg. Thinking noretriptyline has a lot to do with it along with injections directly into the joints. Saw Dr. B and everything looks good from an orthopedic stand point. He said he will take the hardware out whenever I want and I don't need to follow up with him for another 4 months.

Saw Dr. G at pain clinic the day after and he recommends not taking hardware out as he feels I'm going into remission and we should avoid anything that can aggravate CRPS at this point. He also said out of 12 patients who have hardware and CRPS, only 1 had any beneficial relief and the rest actually got worse. Will give script to decrease neurontin to 300 mg and putting EMG on hold. Don't need to follow up for another 2 months unless I need sooner intervention. I'm pleasantly surprised at how quickly things have gotten better. Yoga finishes this month. No benefits in flexibility but my balance is better. Back pain is still minimal since PT. Right hip is still the only thing that seems to be stubborn. Left knee and occassionally the hip still painful too. Very noticable difference in look of legs; right is straight and left is all twisted. Tried taking on a job in the surgery dept and only lasted a week. There was too much pain in my hips on down. I ended up going back to my quality job. This is frustrating that I can't seem to be able to walk more than 10 minutes or work without pain and limping. The worst offenders right now are my right hip, left knee, right foot.

I still have slight swelling of the ankle, especially around my plate and I notice that I have what I would term as cold sensitivity with the hardware. It feels yucky! 

Next few appts will be over the summer and in the fall. I will see Dr. Z to have a yearly hip follow up and possibly a "pre op" appt in October. I'll likely schedule my left leg FO/TO surgery for late December '14 or late January/February of 2015 depending on insurance.

The pain doc is really hesitant that I do this but also understands my reasons. He will help support me for prevention of CRPS during that time, and especially when it becomes time to have the right hip replaced since it will be on the same side as the foot/ankle with CRPS.

I really hate that my life has become this never ending cycle of doctor appointments, treatments, medications, and surgeries. There's nothing good about it and no one likes being around a walking medical Debbie Downer. Although I suppose I am walking, so that's a good thing!