Tailwind's Distal Femoral Osteotomy Pre and Post Op Diary

[nikkiluv]

Hi Tailwind,

Glad to hear that you're home and recovering from your surgery! Is it hard to believe that the actual surgery has come and gone already!? I can't believe that you were outpatient, either! I had such a horrible experience with getting my pain under control immediately post-op. Since I was in-patient (as all my doctor's patients are), I went with the epidural over GA because they said it would be better immediately post-op for pain. Well turned out my epidural kinked so when I woke up I literally felt like my femur was broken in two right then and there, and not when I was unconcious. My leg felt like it was literally burning and on fire, I have NEVER and nope to never experience such horrible pain in my life again. So, glad to hear that you are doing much better in the pain department.

I have to say I only had pain in my femur where the DFO was for only about 4, maybe 5 weeks at most. The first few weeks when it was really swollen I could definitely feel the hardware in there, especially down at the knee where it was most swollen. However, after that point and when the swelling went down, I didn't have any pain and have honestly not even thought about my hardware that much because I really don't feel it on a day to day basis. The only time I feel it is when I'm having my IT band massaged at PT, because of course that's where the hardware and screws are, so when they hit a screw it's kinda painful! My doctor doesn't remove the hardware unless his patients have trouble with it, so I'm glad I don't feel it.

The handicap placard comes in SO handy!! My doctor approved mine for 6 months (the longest you can get for a temporary disability placard), and I'm glad he did. Crutching around with such a big and bulky brace definitely gets tiring, and there were also times that when I started to go out I would get so tired from just being out and doing nothing (like just going out to eat), that there's no way I would've wanted to crutch back to the car (although someone would have obviously gone to get it and come to the door if they had to). Also, it's nice that the handicap spots are generally larger, so you can kind of win the doors open far enough to get in and not have to worry about bashing the car next to you. I had to ride across the backseat in the car for the first 6 weeks because of my brace being locked in extension, and there was no way I would've fit anywhere else! (I'm 5' 10", so I always joked that having a brace locked in extension on a really long leg was essentially like walking around with a club that could've taken someone out, haha).

Here's a couple of extra things that definitely help me out a lot. As for the constipation issue, I was on Senna and laxative tablets immediately post-op at the hospital, and probably for a good 2-3 weeks when I was taking the pain meds on a consistent basis. Some other people have tried Miralax and that seems to work too. I was on 8mg dilaudid (hydromorphone) every 4 hours consistently for the first 2, 2 1/2 weels, so without those I would've definitely not been in good shape!

As for the sleeping issue, I'm totally with you. I am a stomach sleeer too, and being ina  Bledsoe brace locked in extension 24/7 as well minus showering and being in the CMP, I thought I was going to die at first. What helped me out was that I bought a bed wedge. It's a foam pillow thing that kind of makes it like you're in a hospital bed. Being p a bit didn't hurt my back so much, and I could add or subtract pillows on top of the wedge to make it more comfortable. It definitely got me through the first 5 weeks at least, until at that point my body had had enough of being sedentary and being on my back like 24/7 from sleeping, the CPM machine, and in a recliner!! The bed wedge also holds another purpose: you can turn it around and put the short end under your thigh and it can elevate your leg for when you're icing and to help with the swelling.

Do you have stitches or staples? My doctor stitched underneath the skin and then used skin glue to seal the incision on the top, so at day 4 (the day after I came home from the hospital), I was able to shower with no restictions and didn't have to worry about covering my incision and keeping it from getting wet.  Hope you have a good day today!

Nicole

[chereb]

Glad to see you back and on the way to recovery. I am 3 weeks away from my surgery date. Keep up on the pain meds and dont get caught short thinking its not too bad. Once you let them wear off it can be quite painful!! I am so shocked you were an OP! Keep updating on the progress. Take care.

[Tailwind]

Chereb

You hang in there. I am thinking good thoughts and you too will soon be on your way.

TW

[lostandhopeles]

Out patient, WOW. I had a lot of trouble with the meds in the hospital and was put on tramadol when sent home. They worked pretty good, not much pain. I was given a script for 150 pills 2 every 6 hrs as needed. I had the same symptoms you have. My problems worsend when I quit taking the pain meds. The best thing is to discontinue use as soon as pain is tollerable. The side effects last as long after as the time you take the pills. The DMV will be a fun trip. You will get to go to the front of the line thou. You will still be abused by the people we are paying there. Anyway enjoy all you can and keep in mind you are now on the way to getting better. Todd

[sarbah77]

One of my friends, who is admin staff at a hospital "somewhere" in California says most (leg) osteotomies are done on an outpatient basis.  You can understand my EXTREME disappointment when I was told I'd be spending the night!!

Tailwind, by the time I have my HTO, you'll be almost 2 months post-op! Wow!!

[nikkiluv]

Really Sarbah?! My doctor fights for overnights for people whose insurance companies want to make it an outpatient surgery. I also had an ACI with my surgery but I had a 3 day hospital stay and I'm glad I did. It got me through the first few worst days post-op, and I know when I went home I was in better shape than I would've been in had I gone home the same day. I would've never thought to have gone home the same day after having such a major surgery. Granted I wasn't thrilled at having to stay in the hospital, but it was best for me and I definitely realized that. One night isn't that bad at all, they try to kick you out as soon as possible anyways, haha.

[sarbah77]

Well, keep in mind you also had an ACI, Nikki, which i think makes a HUGE difference.  I never read anything that indicated THAT was outpatient. 

(My original doctor had suggested that I look in to it (or the allograft) and then went and talked to my OS for me, so I'd spent quite a bit of time looking it up)

And personally, on THIS side of surgery, I'd rather be home!!!

[jumpi5d]

Wow! Major props to you on the outpatient thing. I was in the hospital for 4 days and had an epidural for over 24 hours!!! Can't imagine doing it out patient.  I'm glad to hear that everything is going good for you.

[nikkiluv]

Sarbah,

I do know several people that I have had ACI and been sent home same day, and also had osteotomies and ACIs and sent home the same day. If you read the Carticel website yes, they say that it's an overnight procedure. But, as we all know insurance companies seem to have complete control over everything, regardless of what other information tells them would be best for the patient.

Also, I never had any pain/soreness at my ACI site until I started weightbearing, which was at 6 weeks post-op with 1/3 weightbearing. I'm sure it also helps that my doctor doesn't use periosteum from the tibia for the cartilage patch covering. Instead, he uses a Bio Guide membrane which decreases the chance for graft overgrowth, leaves me with only one incision instead of two, and keeps me from having shin pain which a lot of people have following ACI. For the first 4 weeks all the pain was in my femur at the osteotomy site. I know that I could've gone home same day if I just had ACI, but with my osteotomy there's no way I would've been able to or would have wanted to. My insurance approved the 3 day stay and out of a $54,000 bill I only owe $100 (my copay for a hospital overnight), so I'm glad I was there will the really great drugs and help the first 3 days (because with all the help and assistance my family gave me and I needed I'm glad they had the 3 days extra they didn't have to help me at home)!

Good luck, and I know it's impossible but try not to make yourself too worried about things. Preparing yourself as much as possible with things you'll need, books, DVDs, cleaning, meals, beads , etc. will hopefully take away some of the worry and make you feel more in control of things.

Nicole

[Tailwind]

One surgical nugget I forgot to share is that rather than taking out a bone chip from my hip to insert into the opening wedge of the osteotomy, my surgeon used donor tissue. This was a pleasant surpise as I had been told that the hip wound was painful and would further complicate post-surgical sleep. Last night sleep was significantly better. I have much less passive pain and pain associated with changing positions. I  am going to start weaning off the pain meds. And this should also help with the constipation.

My short 30-45 minute errand trip in the car yesterday with my wife was good. A nice change of scenery. When I returned home I was tired and took a nap.

[Tailwind]

Post Op Day 5

I am writing this the morning of post op day 5. My subject leg is in the continuous passive motion machine (CPM) and I’ve settled in for the morning.

Immediately post op, my pain level was high (6-9) and I was taking the pain meds to get through the day and to sleep. As this pain decreased, I wanted to decrease them. I took my last oxycontin the night of day 3 and last night, day 4, I slept pretty well without any medication.

As I mentioned before, I was constipated after surgery. On day 2, I started to become concerned and a bit more proactive. I started taking a mild stool softener. This had no effect and on day 3 I took a little stronger laxative. Again, no success. I started to get preoccupied with this for a couple of reasons. First, I had no appetite. I needed to eat both for healing and nutrition purposes but also because I needed to have some food to take the pain meds. I was eating just a little bit – enough to take the pills. Next I decided to get a little more active and started crutching around a bit. I thought the combination of getting the blood going and being upright and letting gravity take over would help. Again, nothing.

At the end of day 3, I emailed my surgeon’s assistant to give her a general update and also ask about this problem. She said I was on the right track and to let time work it out. She also reminded me to drink a lot of water. Then a light bulb went off in my head. Drink! I hadn’t drunk much since the night before the night before surgery. I was certain everything in my system was sitting there like concrete preventing all the laxatives from finishing the job. I drank 3 bottles of water in 90 minutes. Almost immediately I could feel things start to work. About 10 hours later, in the early morning of day 4, I had some relief. Phew! I was really happy. I had of course been imagining all of the horrible possibilities if I didn’t solve this problem – all made possible by googling “post surgical constipation” and reading about these patients who had to have their intestines resected after not going for two weeks…… Now I was free to eat (I was suddenly very hungry) and concentrate on my leg.  Lesson: DRINK AFTER SURGERY.

I had a pretty mellow day 3. In the morning I did about 2 hours in the CPM and did a few sets of straight leg raises. I was able to get my leg to 60 degrees of flexion in the CPM. I usually start at 40-45 degrees and then build 5 degrees at a time after I get warmed up. There has been little pain with this and my leg just tightens up at the top, letting me know I’m at the limit. My goal is to be at 90 degrees by day 10 when I go to my first post op visit to the OS.  I got picked up by a friend who took me to the post-cycling coffee get-together my athlete friends do after the long Saturday ride. They have renamed this “Caffeine with Gimpy.” It was good to get out in the fresh air. I had no trouble crutching the 100-150 feet from the parking spot to the café. I think my friends were surprised I was moving around so well and looked pretty good. These guys looked about to cry when I described the operation. This DFO is cementing my reputation as a serious MOFO among people who deal with pain and injuries and consider themselves tough guys. I don’t, really. Later that day it was a nap followed by another hour in the CPM.

I slept well last night and found a position where I could sleep on my stomach with the subject leg in the brace sort of splayed out, resting on the inner part of my thigh, I spent a good part of the night like this but I did have some pain this morning when I woke. I attribute this to the jostling of getting into the stomach position and back on my back a couple of times during the night. I was also stiffer starting this current CPM session with a bit more pain at the top of flexion.

Before I started typing I looked back at Aturpin’s diary to check my progress against hers. At this point, she had been doing a bit more of the PT exercises. I think that the constipation issue had me off track a bit and I am resolved to do more non-CPM exercises today.

I have showered twice since surgery and changed the surgical dressing twice. The first dressing had a bit of blood and ooze, but not horrible. The incision is about 6 inches long from about 1 inch from my lateral joint line up the lateral thigh. I don’t see any stitches but I can see the glue stuff under the steri-strips. I think the scar will be relatively non-scary. My thigh doesn’t resemble a thigh. It looks like a raw roast beef. White and pasty with no muscle definition. I have the muscle tone of mashed potatoes.

All in all, i feel like on on the right track. Getting lots of help and support from family anfd friends. I must remember to thank them a lot and pay this back and forward.

p.s. It turns out that pain I felt on the CPM was my incision opening a bit. I had a few drops of blood. The pain felt like a rip or icepick digging in about an inch from the end of my incision near the knee. Doc's PA says this is normal, change the dressing and dial back the ROM on the CPM for a while. Anyone had this?

[lostandhopeles]

  Great to hear your doing well. I was surprised to see you had a 45 min outing the other day. That coulden't have been to the S.O.S. office they never move that quick. Its great that you have been able to get  off the pain meds. Do they have you on any antibiotic ? Just curiious, i would think that with drainage at the incision may be a good idea. The best thing you said was that will make the differance is getting out. That was the worst problem I had. I wish I had the ability to do that after my surgery.  keep in mind that healing takes time.  try not to over do it. Todd

[Tailwind]

Post Op day 6.

After popping the incision a little bit yesterday I took it easy the rest of the day. No afternoon or evening CPM or exercise sessions. We did go to a movie last night. I sat in the seats reserved for the disabled. They are close to the front, on the main aisle. They have a little love seat thing, so I swung the braced leg onto the bench, which put me turned slightly left. So I had to turn my head right and keep it tilted up to see the very close screen. This got to be very uncomfortable over 2+ hours. In hindsight, I should have just decided to crutch up the stairs and take up two regular seats. I may hold off on the next movie until I trim down the size of the brace (expected sometime after my first post op visit later this week.) Movie review: Inglorious Basterds, 3 ½ stars.

Another highlight of yesterday is I was inadvertently left alone at lunchtime and had to make my own lunch. I crutched my wheely table over to the fridge, put all the food on it, pushed it with my torso over to get utensils and again over to the table. Voila! I was a little proud of myself.

Today I felt much better. I was very stiff at first in the CPM, so I dialed it back a bit on the angle and had a good session. I also did 4-5 sets of straight leg raises and quad sets. I feel a bit stronger on the leg raises. The quad sets really hurt if I try to flex as hard as I would my healthy leg. I’m not sure if the pain I feel there is my cut muscles, the cut bone or the plate and screws. Most “knee geeks” I know try to and can (and are obsessed by) distinguish where the pain is in their knee. Is that my lateral femoral condyle or my shredded meniscus?

I also tried some heel slides and I was disappointed how little I could move my leg on its own.  I will work on this some more tomorrow.

I did a similar CPM exercise session in the afternoon. The incision seems to be back intact with just a spot of blood on the dressing I changed after the morning session.

I have a goal to get out of the house once a day while the weather is nice. My wife drove me to the post office to pick up my business mail (two large sacks worth) and for a quick bite. After eating, we decided to go the drugstore about 300 yards from the café to pick up a few toiletries. I made it there crutching non-stop, but returning (slightly uphill) I had to rest for a minute 2-3 times. It felt good to sweat! This appears to be the current limit of my crutching distance. Also, people look at you when you are crutching around. I’m sure they are thinking, why is that fool crutching? Get a chair. Why doesn’t his wife just drive him to the store? There are plenty of disabled parking spots in front….

As for the disabled placard, we have been careful to use the disabled spots only when a near equally close spot is unavailable. The other factor in choosing a spot is safety. Even though I can crutch 600 yards, picking your way through a closely packed-parking lot on crutches is not always the safest option.

Pain levels are about the same. I’m at about a 2-4 when I wake up. I attribute this to being braced all night and jostling around shifting positions when I sleep. The pain subsides with movement and activity. I am taking ibuprofen a couple of times a day, mainly to help with the swelling, which is slowly dissipating after lots of progress in the first 2-3 days post op.

My biggest challenges are mental. I am ready to start healing and want it to happen faster. And I want my normal life back.

[lostandhopeles]

Getting out once a day is a GREAT idea. I have a problem being see with the walker. I am also afraid that I may slip and fall putting me back to step one.
I understand the feeling you get from other people while crutching. I started using crutches yesterday at therpy. therapist told me to use them at home for a while before going  out so I dont try to speed up to guickley.

 I am going to make dinner tonight for the first time since surgery. I cant belive it has been over 14 weeks. My wife and son have been great thru this time.
 
 Glad to see your off perscription pain meds. You may find the mental aspects improve without the pills. A lot of the pain meds affect mental stability after you stop them. kind of like a withdrawl even from short time use.

 After my surgery I could not do a leg lift for over 2 weeks. heel slides were not a problem. I was alsoat 70 degree on the CPM. I was instructed to do CPM 4 hours on 4 off.

 There is an old saying I use. The hurieder I go the behinder i get. As WE try to make ourselfs heal faster so we can do more things sooner we may be hurting ourselfs more in the long run. Take time to heal. TODD

[Tailwind]

Post-op Day 7

Glad to have the 1 week milestone behind me. Not much new to report. I feel like I am at a plateau on my ROM. Managed to get to 65 degrees, and the thought of 66 seemed beyond my pain threshold.

Other than that, I got a solid 3.5 hrs in the CPM and 2 decent sessions of leg raises, heel slides, etc. Oh, and my appetite has returned, or should I say my sweet tooth, as I devoured a half pint of Ben & Jerry's after dinner. I have actually been eating very healthy and I suspect I have lost a few pounds. Probably not the right pounds, though.

Todd - Thanks for your thoughts. I appreciate all of you who follow this diary. Wishing you all the best.