9 Year Old Olivia's Post-Op Diary (double osteotomy)

[cindypruz]

My daughter, Olivia had a femoral derotation osteotomy with a surprise tibial osteotomy on Thursday, 7/31/08. Well, I guess I shouldn't say "surprise" tibial osteotomy . . . we knew there was a possibility for it, but we really didn't plan on it. Dr. Mendelow performed the operation at Providence Hospital in Southfield, MI.  The doctor said he had thought alot about the tibial osteotomy & thought it best to get it done now, in conjunction with the femoral ostotomy.  I took pre-op pictures (thanks for the idea, Lyndsey!) on Thursday morning & was really surprised at how twisted her right leg was.  Then when we met with the doctor pre-op & he discussed the tibial osteotomy, I was even more surprised to see how Olivia has been compensating by turning her foot out.  I knew she was doing this, but I didn't know to what extreme.

Olivia really did great!  The surgery lasted a long 6 1/2 hours, but when she woke up, she didn't shed one tear.  I was so proud of her! 

Day 1: Yesterday was her first post-op day.  It was a little tougher, but with the help of her PT, she got out of bed & sat up in a chair for 45 minutes.  PT plans to get her out of bed today & on crutches for a bit, but she is looking forward to it.  She's tired of laying down.  Basal Morphine drip came off yesterday evening, but she still has the pain pump.  Staff changed her dressing & taped padding on that is supposed to remove "easily."  Hmmm . . .

Day 2 a.m.:  Olivia will be getting rid of her morphine pain pump & stay on valium & lortab (sp?).  The morphine is making her itchy, so she's looking forward to ditching it.  She's not hungry at all & is a little sad today.  She has been getting up pretty easy when it comes to eating, because she's not hungry.  We're just trying to keep her spirits up.  I think the drugs are probably increasing her sad feelings.  Does that sound right?  Anyway, that tape that was supposed to be "easier to remove" isn't so easy.  The NP is pulling at some of the tape to change the dressing & Olivia is just crying in pain.
It's awful.  It certainly isn't coming off easily & it's just awful to watch.  The NP left to get something that will help get the tape off.  Let's hope it works!  I can't stand to see her crying so much.

Sounds like discharge will be Sunday, maybe Monday.  We are hoping for Sunday, just so we can get settled in at home. 

I didn't have my laptop until yesterday evening, so I wasn't really able to send an update until now (too tired last night).  I'll send another update in a day or two.

Thanks!!
Cindy (Olivia's mom)

[Lyndsey]

Hi Cindy!

It sounds like everything went okay with the surgery. Thats great! Morphine makes me itchy and sick. The drugs can do alot to your emotions, so the sad feeling could very easily come from that. I was really out of it for a while because of the drugs. Actually I wasn't back to myself until 10 weeks post op. I forgot things that I know, and counting and following a quick moving conversation was near impossible. It took that long for the anesthesia to wear off.

As far as the tape goes, I don't have any advice for you there. The tape they used on me came off easily, and they didn't have to change my dressing. They just took it off for good at 3 days post op. From there I was left with steri strips.

Are you nervous for her discharge? My mom was with me, but it was okay. I think the drive home scared her the most, but again, it was okay.

Good Luck with everything! You and Olivia are in my prayers!

Lyndsey

[*Tiffany]

Dear Cindy and Olivia,

I posted to you in your previous thread before I found this one. 
Wishing you both the best of luck and hoping the recovery will go well.

I had surgeries as a child too, and my son also.  Makes for such a faster recovery.  I am glad the surgeon did all he could do while he was there, rather than doing the tibial surgery another time. 

Good luck
Tiffany

[cindypruz]

Hi Lyndsey!
Yes, I think everything went pretty well with the surgery.   She's been hanging in there pretty well, but it upsets me so much to see her crying & hurting.  Of course the pain is to be expected, it's just never easy.  

Well, the tape removal is done now & there was screaming & crying, but it's over now & she's resting.  Not looking forward to when PT comes & gets her out of bed. The nurse removed the cathetar, so now she will have to start using a bedpan until she knows how to get up.  I know she's not going to like the bedpan.  

To be honest, I can't wait for her to get discharged.  I just want to get her home & take care of her there.    It would be better if it's tomorrow instead of Monday so my husband can help out.  I think she will feel more comfortable at home.  I know it won't be easy, but there's just no place like home.  I can understand your mom being worried about the drive home.  Did you go back to PA after the surgery?  That would be crazy!  I'm only 20 minutes from this hospital, so I have a lot less of a drive than your mom did!  

Tiffany- thank you so much for your post!  I'm looking forward to seeing how fast Olivia recovers.  I think she will surprise herself & everybody else!  I was glad the dr. did the tibial surgery, too.  It makes for a little tougher time now, but it's one less operation to have to worry about.  Thank you for your kind words & support!!

Cindy

[*Tiffany]

Hey Cindy,

Keep us posted, she will be in our thoughts and prayers.

Most of us have been through the miseries of surgery, and some of use have been through it with kids.  I think it is better at home too.  I am wishing you all the best.  Be in touch if there is any advice or anything we can do to help out. 

Good Luck
Tiffany

[Amanda82032]

Cindy,

That is absolutley crazy that Olivia had to have such extensive bone surgery. Would you mind posting a little about her history and what led her to this surgery? Also, would you mind posting the pics you took pre-op (post-op?)

Hope Olivia is doing well. Best of luck

Amanda

[cindypruz]

Day 2 p.m.:  Olivia had a tough morning, but after her little brother & daddy made it to the hospital, she turned around quite a bit.  Daddy had to have a little talk with her so she could compose herself & not sink too far.  She was just beginning to play the "but it hurts" card & not thinking about the prize at the end.  The good news is after that rough morning, she made a total turn around for the afternoon!  She never used a bedpan for potty breaks.  She got out of bed & used a bedside commode.  Then decided to just hang out sitting at the commode for a while.  THEN she wanted to try her crutches out!  Surprisingly, she crutched about 15 feet to the hospital hallway & back to her bed with the help of me, dad & the PT.  I was so proud of her!!  Now she is taking a well-deserved nap.  All we need to do now is get her to drink more fluids & eat more food.  She's just not hungry.  But, we keep trying!  I feel much better now & appreciate all of your support.

Amanda, I started another thread prior to this one explaining Olivia's history.  Here's the link:
http://www.kneeguru.co.uk/KNEEtalk/index.php?PHPSESSID=175c2d4b2c0574e0f51f8ef5abeca096&topic=43552.msg389997.  Please let me know what you think.  I will definitely post pictures, but will have to do it later.  I'm not equipped to download pics right now while still in the hospital with Olivia. 

Thanks again!
Cindy

[Lyndsey]

Hey Cindy and Olivia,

I am so glad you guys are doing okay. That is great that Olivia is getting up and moving around, even if it is only to use the bathroom. That is GREAT that she got out into the hallway and back. I didn't do that until about 3 days post op! Give her a little more time, she will regain an appetite. The "but it hurts" card is something you will have to face, especially in the future. I have flayed it once or twice, lol. However, I want to be taken seriously, so I try not to cry wolf. My mom and I have a really good relationship, and communication flows well. That is sooo important, especially after a surgery.

How did she do on crutches??? I am pretty good on them, but sometimes I get a little clumsy.

Tell her I said hi, and to keep her head up. This is the worst part. It will get alot better!

Cindy, you hang in there too. This is the worst part. I can't imagine being the mom and watching my child go through all this. I know my mom had a hard time for me. She was my rock, and I really needed that.

Sending lots of prayers and support!
Lyndsey

[kc1124]

Hi Cindy,

I am so sorry your daughter had to go through such a major surgery so young.  I have a 7 year old and 9 year old and my heart just goes out to you and your daughter.  I hope everything went well and she will soon be on her way to recovery.

Just a quick note about the tape - I am allergic to the adhesive on tape and have a terrible time with it.  I developed terrible blisters from the steri-strips they put over my incision from my surgery I had 5 weeks ago.  It was awful.  Any type of tape on me is a disaster.  It just gives me blisters or my skin peels off with it when I try to take it off.  Olivia could be allergic to the adhesive.

Anyway, good luck to all.  I will keep you gals in my prayers.

Kat

[cat]

Hey Cindy,
How are YOU doing? Having surgery yourself is one thing, having your kids go through it is something entirely different. My 12 yr old looks to have the same funky knees her moma has and it freaks me out a bit to think she might need a derotation one day. Sounds like you've got one tough little gal there. To have both osteotomies done at the same time is alot of surgery but I've heard the outcome is often better that way. Best wishes for a speedy recovery and lots of smiles from everyone.
  cat 

PS am looking forward to your pictures.

[katmomx2]

Hello Cindy and Olivia,

I am  happy you came thru your surgery so well, the worse is behind you and each day will get easier. I hope you get to go home today, because you will feel so much better at home with mom and your family. My thoughts and prayers are with you and the family for a speedy recovery.

Hugs Kat in Texas

[cindypruz]

Day 3:  Well, after another long day at the hospital, Olivia was discharged!!  Yay!  We weren't sure it was going to happen because of some icky green gunk found on one of the incision bandages.  But, at about 4:45 p.m. the doctor didn't think the discharge was a big deal & gave us the OK.  Olivia & I are SO happy to be home, but not without some fears & concerns, of course.  Despite another tough morning, Olivia really makes up for it with her evenings.  We made it home safely & she is maneuvering around our house without too many difficulties.  My husband & I are helping as much as we can, from carrying her up the stairs (that would be my husband because she's having a hard time lifting her foot on her own) to helping her foot along when she's crutching from one room to another (that would be me, crawling on the floor lifting her foot with every step she's taking).  OBVIOUSLY, this cannot last forever!  I've told her I can't keep doing that for her & she gets upset & cries, but I think she's getting the point.  So, Olivia & I will be sleeping in my bed & my husband is in hers for the time being, until she's more comfortable. 

I thought I'd give a little more background history on Olivia, since I don't think my previous thread covered it 100%.  Olivia's knee problems started about 1 1/2 years ago when she was in 2nd grade.  She would come home from school & tell me that she fell down, hurt her knee, was crying & went to the office for ice.  I didn't think too much of it, figuring maybe she twisted her ankle a little or lost her balance or something.  After about a half dozen of these little conversations, I started to question what was really going on.  I began to ask her more detailed questions, like "did you fall first, or did something happen to your knee first?"  & "did your knee feel like it moved?", among other questions.  I really should have known better from my own kneecap dislocation experiences . . . she's just so young, I didn't think she would go through such things at such an earlier age!  Well, wasn't I wrong.  I took her to a pediatric orthoped (who was useless, mind you) in April '07, who prescribed a knee brace & sent us on our way.  I got the knee brace & everything was cool for a little while.  We'll just call him Dr. D.  In the first week of school (September '07), Olivia was walking to the drinking fountain & dislocated her knee (WHILE WEARING HER BRACE).  Lovely.  Even better, I was working at the time & the school never called me, despite my including this information on Olivia's health card!  That's another story.  Nevertheless, the school removed her knee brace, iced her knee & sent her back to school.  By the time I got home from work, Olivia couldn't even walk!  I took her back to see Dr. D, who prescribed a DIFFERENT knee brace (which was inadequate, mind you) & a month of therapy, telling me to come back in a month.  Therapy started about 3 weeks later (couldn't get in to the PT center due to lack of availability) in October '07 & I took Olivia back to Dr. D at 4 weeks.  He asked if she was running & jumping like every other kid . . . I laughed & said "of course not, she's still very weak."  He indicated that she should be stronger by now & therapy should only last about a month.  Well, Olivia's sneaky therapists & I decided to just push through some PT scripts to his office every month & he blindly signed them, okaying the therapy for another month.     Of course we knew that a month of therapy wasn't enough.  Her knee wasn't tracking right & her quad was really weak.  During the 6 months of therapy she had, we switched doctors.  In February '08, I started taking O to Dr. Mendelow (an excellent pediatric OS out of Novi, MI), at the suggestion of one of her PT's.  Dr. Mendelow liked how the therapists were working with Olivia & encouraged us to look into USBL orthotics to help Olivia's foot pronation.  Dr. MEndelow basically assesed that there were many little things adding up to cause Olivia's knee problems.  One was her foot pronation, another was her femural & tibial anteversion & lastly her shallow trochelea groove.  He really wanted us to give PT a good chance, in hopes of no further injuries.  3 days after therapy ended in April '08, Olivia was walking with one foot on a slanted curb in a street of my parents subdivision & the other foot on the street pavement & her kneecap dislocated again.  Thank God I was there, because this time it didn't pop back in on it's own.  I was able to put it back in for her.  What an awful day that was.  Dr. Mendelow said the condition would not get better, that it would only get worse from that point & ordered a CT scan.  The CT report indicated a 44 degree anteversion in both of Olivia's femurs & Dr. Mendelow advised that the increased anteversion is a force that adds to/creates the problem with Olivia's kneecap dislocations.  He wanted to do a femural osteotomy because the soft tissue work that has been done in years past is prone to fail.  We of course got several opinions.  Here is what the other doctors said:

[cindypruz]

Dr. Z:  "NO!  Don't do the surgery.  Her kneecaps are straight.  Wait till she's 16 or 17 & do extensive knee repair."  (Sounds like a good plan . . . if she were 14 or 15.  BUT she's only 9.)  "So, she won't be very active.  She'll survive.  A dislocated knee isn't the end of the world."  (I actually really liked this doctor, but his solution just wasn't good enough for me.  I wanted Olivia to be a kid!  Decided to see another doctor).

Dr. J:  "She just needs to do her knee exercises."  To which I replied, "she was in PT for 6 months."  Dr. J said, "6 months!?!  She should have only had PT for 1 day & then done the exercises at home!"  Another useless doctor.

Dr. V:  "Olivia needs the osteotomy surgery.  You're in good hands with Dr. Mendelow.  I just recommend some additional soft tissue work to her knee because there is so much laxity." 

Dr. T:  "No way around surgery for Olivia.  I also would consider soft tissue work to anchor her knee down, due to her laxity.  An osteotomy is the way to go." 

Well, the 2 doctors that agreed were two of the top OS's in the area, working for prestigious medical centers.  I felt I was making the right decision for our daughter & was hoping for the best.  So, finally, the day of surgery arrives & Dr. Mendelow recommends the tibial osteotomy in addition to the femoral derotation.  The reason being that by turning the femur, her whole leg will turn, including her foot.  Olivia compensates her leg twisting by turning her right foot out a bit.  The foot would just turn out more & based on the CT Scan, she had some increased anteversion in her tibia as well.  My husband & I felt Dr. Mendelow had thought it out thoroughly & his explanation made sense to us.  So, here we are 3 days post-op with our little girl having not one but 2 osteotomies.  We're just hoping we did the right thing. 

I am having trouble downloading the pre-op pics of O’s legs into photobucket, but will try again tomorrow.  I’m really tired & need to get to bed!  Thanks for all of your support, advice, prayers & thoughts!

Cindy

[Amanda82032]

Cindy,

So I've finally read about Olivia's pre-op history and wow! Olivia is a strong girl. I'm appauled by the first OS you went to see to ignore such a problem like this. And kudos to you for being such a go-get-em mom. I've talked to young girls whose moms won't do a thing about their knees because they don't believe them or feel they will grow out of it. I'm sure it helps that you're a veteran with the knees

Keep up the good work Olive!! and keep your spirits up Cindy! Good luck and keep us updated!!

Amanda

[FormerlyActive]

Cindy
Thanks for including all the additional information. Its sad but not suprising about those doctors, really their creed is "do no harm" which sometimes translates into wait and see or do nothing, rather than really trying to partner with the patient/caregiver to solve the problem. Your story would make an interesting one for a pediatric-child magazine and maybe help other parents.

Re the tibial osteotomy. It would be interesting to know what degree of rotation there was to the tibia shown in the CT Rotational Study? What I like about what your doctor did was instead of just trying to fix or correct something, he decided to essentially set her up for the future with the best alignment possible. This does seem a very smart decision.

You and your daughter are in many peoples thoughts and prayers. Best wishes.