Post Surgery: 5 Weeks / 2 Weeks UIRTW

I wrote this entry yesterday, but I didn't get to finish it or post it because of a rather ironic twist in my situation, which I will write about soon. Since I can't remember what else I was going to write, I'll just post what I have.

I had an appointment with my husband's primary care doc today. I've seen the guy once before and he just didn't work for me. I don't know what my husband sees in him, lol. But at least my husband came with me, so I didn't have to say much. Aaaannnyway, he confirmed a lot of what Dr. Google told me, including the following:

• I will need to be on Xarelto for six months. Six freaking months! After six months, I'll have a follow-up ultrasound to see if the clotting has resolved. If it has not, I am looking at a lifetime of anticoagulants. (My husband better keep his job, because that could be extremely expensive!)
• The doctor did give us some Xarelto samples, though, recognizing that, 'That stuff ain't cheap.'
• In the meantime, I should elevate my leg when I'm sitting, and 'moist heat' is also recommended. (WTF is 'moist' heat? A bath? Or a dog licking you?)
• I should try to walk and get 'light' exercise when I can. 
• However, I need to avoid contact sports and things that might make me bruise and bleed, given that, hello, I am on medication designed to make me a hemophiliac. 
• I wonder if skiing is considered a contact sport considering the risk of hitting a tree or another person.
• Speaking of bleeding, I'm a little nervous about being on an anticoagulant. For one, my blood is already 'thin,' for lack of a better term. Perhaps this is due to my abnormal hemoglobin, which I wrote about yesterday. (The doctor today confirmed that this would make my blood 'thinner.') I feel like, if anything, I'm a 'bleeder' versus a 'clotter.' For example, my whole life, I've been very susceptible to nose bleeds; in fact, once time when I was in first grade I had to have my nose cauterized after a nose bleed that lasted all day long. And one time in high school, I had a massive nose bleed in the middle of a math exam. I remember sniffing, and thinking I had a runny nose, then I put my hand up to my nose and the floodgates just opened up. My math teacher was actually a real jerk, so I was freaked out about what might happen, especially considering we were in the middle of an exam. I put both my hands up to my nose and ran up to the front of the room, and I remember him saying, 'Oh my God, go! Go!' I ran to the bathroom and didn't even bother trying to use paper towels because sooo much blood was coming out. I just stood over the sink and let the blood pour out until the bleeding stopped, which was about the time the bell rang. (I'm not sure what ever happened with the test; I can't actually remember that part.)
• So I have to say I'm pretty nervous about the effect Xarelto is going to have on me. At the same time, it is also somewhat alarming I managed to develop such a massive blood clot despite being a 'bleeder.'
• The doctor did not see the need for me to wear the lovely compression stockings that Dr. Google recommended for the treatment of DVT. Thank God. Because I have a secret: there's no way I would have worn those to teach in unless someone told me there was a 100% chance of me having a PE if I didn't. Sorry, but I have to look cute when I go to class.
• The doctor agreed that it might be a good idea for me to ditch the birth control, and furthermore, that it might be a good idea for us to consider, ahem, more permanent options. So if something good comes of this, perhaps it will be that my husband will finally get that little sniparoo I've been wanting him to get.
• On a funny side note, the doctor is very into martial arts and said that he once did a vasectomy on one of his martial arts buddies, who was a stereotypical big, huge, muscle laden 'tough guy.' As a joke, he laid out a bunch of his rusty tools in the room before the guy came in, ha ha ha.

In other news:

• My hip (oh yeah, this is a blog about my hip) is holding its own, although I have noticed it is a little sore. Then again, at times I have so much pain that I don't even know where it's coming from anymore.
• I am trying to walk as much as I can because I feel like this is good for my DVT, but I am limping a lot. I don't know if this is okay or not. I know my PT thinks limping from hip pain is a sign I need to stop, but does it matter if I am limping because of leg pain?
• According to Dr. Google, there is no agreed upon protocol for DVT with respect to the question of whether or not it is better to rest or to be active. There are no definitive conclusions that I can find. Granted, I have not searched the literature high and low, but still.
• I have an appointment with my orthopedist tomorrow. I am okay with my husband's doctor managing my blood clot long-term, but I do want the orthopedist's input on how I should go about rehabbing my hip given this recent complication. Plus, I think he should be aware of this recent development given that he was certain it was not a blood clot at my two week post-op appointment.
• After my doctor's appointment, I went up to work to meet with the instructor who is taking over my course. Reconnecting with colleagues after almost the entire summer was good. I normally go up to work a lot more during the summer, when I'm not recovering from surgery. 
• I decided that I'm going to go up to work for the next two weeks rather than trying to work from home. It is an atmosphere much more conducive to getting work done.
• However, I realized I will need to rearrange the furniture in my office so that I can sit and work at my computer with my leg elevated. I have to keep reminding myself this is a long-term thing.

Post Surgery: 4 Weeks + 6 Days / 15 Days UIRTW

I am not sure if it is a good thing for me to be consulting Dr. Google about DVT. Dr. Google is starting to scare me a little bit. I finally read through this entire article, which was very informative: http://circ.ahajournals.org/content/93/12/2212.full. However, I am afraid I might be developing an acute case of thromboneurosis, which the article explains in the following way: This clinical syndrome tends to occur in patients who have a morbid fear of the complications of DVT/PE. As another article explains thromboneurosis: [The] heightened awareness [of the potential complications of DVT/PE] has led to what may be called as 'thromboneurosis' - where both the general public and health care professionals are increasingly concerned about the possibility of missing a DVT and its disastrous consequences... Many of the patients who present with such complaints and history of thrombosis tend to exaggerate the nature of their symptoms with the huge concern for long-term disability and even death. So basically it is a mental illness. Great, that's just what I need, ha ha. But in all seriousness, it is pretty hard not to be paranoid when you read the stats on pulmonary embolisms. (Is it even paranoia if there's a very real possibility of something happening?)

On the flip side, the biology nerd in me is very much enjoying reading about how blood clots form and how my medication works. It seems that most of the medications for DVT affect something called Factor X, which is an enzyme involved in coagulation. Factor X is synthesized in the liver and requires vitamin K for synthesis, which brought me back to my conversation with the ER PA - why eating leafy greens might matter when you are being treated for DVT. Coumarins such as warfarin/Coumadin, are vitamin K inhibitors, leading to the production of an inactive Factor X. So eating a bunch of vitamin K could counteract the effects of these drugs, although apparently as long as your vitamin K intake is consistent, the dosage can be adjusted? (I say this with no authority at all.) The injection I received in the ER was a different type of drug, a heparin, which stimulates the activity of antithrombin, which is an inhibitor of Factor X. The oh so expensive tablet I'm taking regularly is known as a direct Xa inhibitor, meaning that it acts directly upon Factor X, although I have yet to find a satisfactory scientific explanation for how exactly it inhibits it. (Is it a competitive inhibitor? A non-competitive inhibitor? Or do they even know? Believe it or not, sometimes the exact mechanism of inhibition isn't even known.) So coumarins and heparins are sort of like when your students complain to the Chair, who then tells you to stop doing something, as opposed to Xa inhibitors, which would be your students telling you face-to-face to stop belittling them and making them feel stupid. LOL. I prefer face-to-face or even in-your-face, as long as it is not in the stomach.

Anyway. I've always had a slight obsession with blood; in fact, blood is one of the things that got me into biology in the first place. As one of my students once said to me, 'When you talk about blood, you are like a kid in a candy store!' Ha. And I don't even like candy; I'd much rather talk about blood. My interest in blood began when I found out, sometime in my 20s, that I have something called hemoglobin E, which is an abnormal form of hemoglobin. (This must have been around the same time that stuff started going down with my hip, too.) At the time, my doctor told me that the most important thing was for my husband to get his blood tested if we were planning on having kids (and I'm not even sure if my husband was my husband at the time or just a significant other), but otherwise gave me very little information about what it meant to have hemoglobin E. Hence, I consulted Dr. Google. Now, I'm a reasonably intelligent person, and even in my pre-biology days I could understand what a torn labrum was, or what it means to have an extra bone in my foot.* However, if you have a limited knowledge of biology, it is more difficult to understand a genetic condition than an orthopedic condition, IMHO. Heterozygous? Homozygous? Homohuh? Plus, I think the quality of information on the Internet was much lower 15+ years ago than it is now. My desire to understand hemoglobin E, combined with my desire for a doctor who would actually EXPLAIN things to me, led me to consider a career in medicine, which did not actually result in a career in medicine, but did get me into biology.

* On an interesting side note, the extra bone in my foot resulted in something called accessory navicular syndrome, which resulted in tendonitis in my posterior tibial tendon, which caused calf pain, which my PCP suspected was a blood clot, for which she ordered an ultrasound.

To sum it up: By the time this ordeal is over, I am probably going to know a lot more about blood than even your average biologist.

In more mundane news, I am not motivated to do much today. My leg pain is manageable, and I haven't had to take a pain pill so far today. I did some yard work earlier in the day, which resulted in me being really tired and feeling nauseous, which launched my thromboneurosis. However, according to Dr. Google, nausea is not a sign of impending pulmonary embolism, nor is it a side effect of any of my medications, so I'll assume it is either unrelated or all in my head.

Post Surgery: 4 Weeks + 5 Days / 16 Days UIRTW

A few things:

• I am sort of a mess, both physically and mentally.
• Even if I were able to pull myself together mentally before Wednesday, which in itself is a huge question mark, I really don't know if I can physically be on my feet from 8-5 for five day without seriously jeopardizing my recovery and perhaps even my health. 
• So, I'm not going to find out. I've been in contact with my Chair and explained my situation, and told him that I just don't feel like I can do this, and that whatever I need to do later to make up for it, I will do. Fortunately, I have a good working relationship with the Chair - he is reasonable and knows that I work hard and do my job as well as I can and rarely make excuses or ask for things. He e-mailed back right away and agreed that I should NOT teach the class, and immediately started to work on alternatives. Luckily, he found someone else to teach the class in my place, and the details are being worked out as I write this. It is such a relief for me to have this off my plate, and I am doing everything I can to help the new instructor. I'm basically giving him all of my course material. I just finished a course copy on Blackboard, so he literally has alllll my stuff, which I would normally be pretty possessive about, but... I don't care. Having this off my plate is priceless. My Chair did say that we could always just cancel the class (after all, shit happens, even to instructors) but I would have felt bad about that because canceling a class last minute, especially this one in particular, can really screw students. Getting a replacement is the best option.
• So I now have 16 days until I have to start teaching again, and I feel like the reduced anxiety will be good for my overall recovery.
• That said, I'm actually sort of worried that 16 days won't be enough. But, whatever, it is most certainly better than 4 days. Plus, even in 16 days, I will not have to be on my feet from 8-5; it will be 3.5 hours maximum, which is a very different situation.

Other things:

• I left the ER yesterday with not very much instruction; I need to consult my PCP and orthopedist for specific information about the long-term treatment of my blood clots (AKA acute deep vein thrombosis, or DVT). 
• The PA in the ER told me that sometimes orthopedists 'don't really do blood clots,' and that my orthopedist might refer me to another doctor, perhaps back to my PCP, who might refer me to someone else. Awesome.
• Needless to say, I've been doing a lot of consulting with Dr. Google, and Dr. Google confirms that DVT is odd territory. According to this article: Patients with venous thromboembolic disease (VTE) are seen by a variety of medical specialists, including general physicians, surgeons, obstetricians, hematologists, radiologists, and chest physicians. Because thromboembolic disease forms only a small part of the practice of most of these clinicians, it is difficult for them to keep abreast of advances that are important for optimal patient care. 
• I should add that 'optimal patient care' is very important considering the sort of sobering information the article also gives: DVT and pulmonary embolism (PE) most often complicate the course of sick, hospitalized patients but may also affect ambulatory and otherwise healthy persons. It is estimated that each year 600,000 patients develop PE and that 60,000 die of this complication. This number exceeds the number of American women who die each year from breast cancer. PE is now the most frequent cause of death associated with childbirth. Women are a prime target for PE, being affected more often than men.
• Also: Patients who survive the initial episode of DVT are prone to chronic swelling of the leg and pain because the valves in the veins can be damaged by the thrombotic process, leading to venous hypertension. In some instances skin ulceration and impaired mobility prevent patients from leading normal, active lives. In addition, patients with DVT are prone to recurrent episodes. In those instances in which DVT and PE develop as complications of a surgical or medical illness, in addition to the mortality risk, hospitalization is prolonged and healthcare costs are increased. 
• In other words, this isn't necessarily a 'take these pills and your problem will go away' situation. It is something that will require long-term treatment or at least monitoring. 
• Ugh. Depressing. And sort of scary.
• I mentioned the cost of the medicine in my previous post; that the PA told me it could be $300-$400, even with insurance. What I didn't add is that she actually said $300-$400 a month, which at the time didn't register with me, because I figured you take this for about a month, so $300-$400 a month means $300-$400 total, right? 
• Wrong. Apparently the standard course of treatment is 3-6 months. Like I said, I feel fortunate that I only had a $50 copay for the tablets with my particular insurance plan, because $400 a month for six months might push me to consider stomach injections instead.
• But back to the present moment. 
• Of course, this all came down on a Friday, and I find myself not knowing what to do for the next few days. Am I supposed to be resting or walking? Heat or ice or neither? I assume massage is out, lol, but other than this, I feel like I. know. nothing. And it's not a question of icing your ankle when heat might have been better; what I do could have serious consequences. 
• And apparently a pulmonary embolism as the result of DVT is not actually that uncommon. 
• I have follow-up appointments on Monday and Tuesday, one with a PCP and one with my orthopedist. I don't know which one is better for this, but I'm not taking any chances, so I'm going to see both of them. Considering my orthopedist is the one who missed this two weeks ago because his little test didn't inflict massive pain on me, I'm not exactly feeling strong love toward him right now. Ha.
• On a sort of funny note, I mentioned the blood clot test to the PA in the ER and she knew exactly what test I was talking about. (She told me the name, but I forgot.) Then she added, 'Yeah, that test doesn't work on tough girls.' LOL. (Just an interesting observation: the PA was at least partly Asian, and about my age.)
• I mentioned that my personal PA moved recently - literally, a few days ago (see: http://39andhip.blogspot.com/2014/08/post-surgery-3-weeks-5-days.html). So I actually have no PCP at the moment. However, I do have an appointment with her supervising physician, who is my husband's primary care doctor. And my husband is pretty picky. 
• My husband texted this doctor last night, who suggested elevating my leg to reduce swelling, low heat, and absolutely no massage, so at least that is SOMETHING.
• According to Dr. Google, elevating the leg is a standard suggestion, but so are walking and exercising. Can someone explain how that works?! Ha.
• So basically as far as I can tell I should be elevating my leg when I'm sitting, but I should be walking as much as I can to improve circulation and keep the clot from getting even bigger. 
• The problem is that the swelling is still really bad and causing a lot of pain, which makes walking very difficult. The pain was actually really bad this morning, which is sort of weird. Looking back, I am certain this problem has been developing over the course of the past few weeks, ever since I started to complain about my leg pain about a week after surgery. Yet I can't help but wonder if something set this off so that it became really bad recently, or if it just hurts more now because I know what it is and am freaked out about it. In other words, is it all in my head?
• Regardless of whether it's a psychological phenomenon or not, I could not walk this morning without a crutch, and even that was very painful. At the same time, I was reading all this stuff on the Internet about how sitting still would only make this condition worse. 
• Finally my husband suggested taking pain medication so that I can walk, so that's what I've been doing. The way I see it is that I'd rather be drunk from pain medication than have a pulmonary embolism.
• It's all just a little frustrating, though. 
• Also, when I talked to the pharmacist on Friday when I was having my prescriptions filled, she asked me what specific directions I had gotten for what I was supposed to be doing other than taking the medication, and I said I really didn't get any. She went on and on about how I was soooo young to have a blood clot, and this was serious, and I needed to find out what else I should be doing ASAP. All in all, it was slightly alarming. 

And finally:

• When I left PT on Thursday afternoon, both the PT assistant and PT asked me to please call them as soon as I had any news and let them know what was up. Even though the PT office is associated with the orthopedic office, which is why my therapist was able to find a PA so quickly to do an exam and write a script for an ultrasound, I'm sure they're probably the last people to get information. Before I left, both the PTA and PT repeatedly requested that I call them directly with any results ASAP.
• So I called the office from the ER on Friday. I figured I was there because of them - and I don't mean that in a bad way - so common courtesy told me that I at least owed them the phone call they had requested. I wasn't quite sure how to leave a message, but fortunately the secretary seemed familiar with my story, so I didn't have to do an assload of explaining. At least, when I told her, Please tell Jay and AJ that they were right, I do have a blood clot, and apparently it's pretty massive. In fact, I'm at the hospital right now getting treated, she seemed to know what I was talking about.
• My therapist actually called me on Friday afternoon. He kept apologizing, saying that he was soooo sorry things turned out this way, and I had to keep telling him that I was thankful that he was on top of things, and that it certainly wasn't his fault. I guess he was sort of freaked out because somehow at the hospital got conveyed to him as in the hospital, which worried him. I assured him that I was fine, and that death wasn't imminent, at least not that I knew of. LOL.
• It was good that he called, because I was actually sort of wondering if this changes PT, and if so, how, and apparently he doesn't have much experience with DVT, either. I mentioned that I was supposed to come in for PT on Monday at 9:15, but he confirmed that we should cancel that appointment until he had had a chance to talk to my orthopedist. He said he had tried to find him today, but that he wasn't in, which I already knew due to my ER ordeal. I asked if I needed to call and cancel the appointment or if he could take care of it. He told me he wasn't actually at work - I just left - but that he would take care of it when he got in on Monday morning. So he called me from his cell phone on the way home... how sweet. And for once I'm not actually being snarky! Seriously, I'm getting a lot of feel good vibes from my PT lately.

As always, despite the fact that it goes against my nature to do so, I'm trying to stay positive and hope for the best.

Deep Vein Thrombosis (4 Weeks + 4 Days / 5 Days UIRTW)

I guess I'm not quite out of material for this blog yet.

I barely slept last night: A. because I was stressed and B. because my leg hurt quite a bit. I had a book club meeting, which is really more of a girls' night in with some of my neighborhood friends/fellow moms. We mostly just eat and drink wine, with a little bit of book talk thrown in. My friend, colleague, and neighbor hosted this month's book club. Her house is five blocks away, and I was determined to walk there with one of my other book club buddies, who lives up the street from me. I ALMOST backed out of walking because I wasn't feeling stellar when I got back from PT, but then I decided to suck it up, mostly to give me the option of drinking wine freely :). I brought a crutch with me, but I ended up carrying it the whole way there, and back! That is the good news. The bad news is that my leg hurt quite a bit when I got back, and somehow the pain + the wine + the stress made for a pretty sleepless night.

Needless to say, I was reeeeaaallly tired when I got up this morning and had to drag myself to my 7:45 AM ultrasound appointment. But, I figured that I would just come home afterward and take a nap, seeing as how the rest of my family is still camping. Unfortunately, my morning unraveled in a very different way than I had imagined.

During the ultrasound, I tried to follow what the tech was doing, but like I've mentioned before, I can never make sense of those things. So instead of watching the screen, I watched the tech's face for telltale signs of... something. She seemed a little concerned throughout the ultrasound, although I couldn't tell if it was actual concern or just concentration. It turns out it was the former. When she told me she was done, I asked if she had found anything interesting. Sometimes techs will tell you stuff and sometimes they won't, but I always ask anyway. She looked at me and took a deep breath and replied, 'Yes. I did.' Then she went on to say that she found clotting, and that it was very extensive, going all the way from above my knee down most of my calf, which would explain why my leg hurts and is so swollen. After that she added, 'That's the bad news.' I asked what the good news was, and she said, 'It's a really good thing we caught this.'

She called my doctor, who wasn't in, and after some ado, she sent me to the ER to get treated, along with a diagram of where the clotting was and a CD of the ultrasound. The ER involved quite a bit of waiting, although I've definitely had worse ER waits. Eventually, I saw a PA, then the physician on duty, who was communicating with the physician on call for my surgeon. The PA told me I was going to get a shot of an anticoagulant, Lovenox, in my stomach, and after that I would need to administer the shots to myself twice a day. I would also need to modify my diet substantially (e.g., cut out leafy greens, wtf?) and have my blood drawn for testing every week. I think I sat there staring at her with my mouth open. Because then she added that there was actually an alternative; I could take a tablet twice a day with no changes to my diet and no need to draw blood. So of course, I'm thinking, Are you crazy? Do you even have to ASK which one I'd prefer?! Until she added, 'The only problem with the tablet is that insurance companies don't like to pay for it, and it's very expensive.' She asked what insurance I had, and when I told her, she said they were actually pretty good about paying for the tablet medication, but that it might still be $300-$400. I decided that I didn't care; I would consider it $400 well spent, and the next time I am miserable at work, I will remind myself that I am working so I don't have to inject myself in the f-ing stomach twice a day. OMG.

Eventually I got the shot, and it was super unpleasant, let me tell you. I'm pretty sure that if I hadn't already decided to suck it up and pay whatever it took to avoid the shots, I would have changed my mind after the shot. It wasn't as bad as the cortisone injection, but it pretty much sucked, and I seriously can't imagine inflicting that on myself. Once a week, maybe, but two times a day?! Uh, no thanks. And, the good news is that it turns out I have pretty stellar insurance, and the medication, rivaroxaban/Xarelto, only cost me $50, so it was a good decision.

So, to sum it up.

Bad news: Extensive clotting with the risk of it traveling to my lungs, heart, kidneys, or brain, and killing me. LOL. Lots of swelling and pain. Though apparently not as much pain as this should be causing, which is likely why it took so long to figure out. The PA actually prescribed oxycodone for pain. Seriously, it doesn't hurt that bad, which is apparently why I passed the surgeon's blood clot test with such flying colors, and no one has been worried about this for the past four weeks.

Good news: Lucky to have caught this. Thank God for my observant and competent PT assistant and my PT. And thank God, too, for good insurance. And, I guess, thank God I finally have an explanation for this pain that has been plaguing on and off since 1 Week + 1 Day post-surgery. Apparently it is going to take a long time for the clotting to resolve and for the pain to go away, but at least knowing what it is makes it a little easier to deal with.

Post Surgery: 4 Weeks + 3 Days / 6 Days UIRTW

This damn pain in my right leg. 

A while back, while my husband was working on my calf muscle, he mentioned that my calf muscle was really hot. He acted all freaked out and told me I should call my surgeon. Of course, this is my husband, who freaks out worse than I do over teeny tiny things. I told him I would, but then I didn't, and fortunately my husband has a short memory. I have to admit that my calf did feel warm to the touch, but that didn't seem like something my surgeon needed to know about.

Anyway, fast forward to today. My husband and daughter left yesterday to go camping with some friends, and this morning I drove my son up to drop him off at the camp site. (The camp site is right next to the river, and we thought two nights with an almost three year old next to a river would be a bit much, but that one night would be okay.) When I woke up, I noticed that the pain in my leg was probably a little worse than yesterday, but still manageable. I did a lot of walking yesterday, so I was thinking I was just sore. Or whatever.

I got back from dropping my son off this afternoon and realized I needed to eat something before going to PT. I decided to fix myself some potatoes, only I went into the pantry to discover that my husband had taken the whole freaking bag of potatoes with him. Since my stomach was set on potatoes, I decided to dig some out of my garden; after all, the restrictions on my thigh flexion have been lifted, so I can squat now as long as it doesn't hurt. Unfortunately, as I squatted down, I noticed that it did hurt, and quite a bit, but not because of my hip. It hurt when the back of my thigh pushed up against my calf, which I quickly realized was because the back of my leg, and especially the back of my knee, are totally swollen. Nevertheless, I managed to dig the potatoes out and grab a bite to eat before heading off to PT. While I was eating, I iced the back of my knee, because I really wanted to have a great PT session.

My appointment today was with the friendly PT assistant, Jay, whom I just adore. (I'm pretty sure everyone does.) However, I was a little worried because although he is the life of the PT room, I've only worked with him once before, so I wasn't sure how aware he was of my ongoing leg pain, and I felt like it was important for him to at least know. My regular PT knows about this pain and although he has never specifically done anything about it, he is aware of it. So I told Jay about the pain and swelling first thing, and he took a 'let's proceed with caution' attitude, which was fine. I rode the bike and then did some standing up exercises and felt okay. However, while I was doing them, Jay commented, 'Your right ankle is really swollen.' I looked down, and sure enough, it really was. WTF? My ankle doesn't even hurt, yet it was definitely ballooned out to the point that Jay noticed it from across the room.

After that, I went to do some stretching, and there was one particular stretch that was soooo uncomfortable, I actually started crying. I don't know why I started crying; honestly, it didn't hurt that bad. I think it was more just because I am soooo stressed out right about now and also frustrated because I feel like this damn leg pain is the only thing that is really holding me back. And while the pain is not horrendous, it just won't let up no matter what I do, and no one seems to know what it is. Fortunately no one actually saw me crying, but Jay could tell I was in pain and told me to stop. Then he said that he was going to try to do some soft tissue work, AKA massage, on my leg, to see if that would help.

So I rolled over, and he put some massage cream on the back of my knee and on my calf, asked me a few questions about where my pain was, and then said he would be right back. A few minutes later, he returned with AJ, my 'regular' PT. They both stood there for a minute, then AJ asked me to roll over, and poked around a little bit, and asked me a few more questions. Eventually, Jay apologized, and said he would be right back, and he and AJ stepped around the corner. At that point I was thinking, Just give me my damn massage so we can get this show on the road. LOL. When Jay came back, it was him, AJ, and some other guy, who introduced himself as Kevin, a physician assistant. Kevin repeated a lot of what Jay and AJ had done, then spoke briefly with AJ. They asked me to sit up, and then told me that while they did not want alarm me, they all agreed that I needed to go to the hospital and have an ultrasound to rule out the possibility that I had a blood clot. As Kevin explained (which I sort of already knew), there are three huge risk factors for blood clots: smoking, birth control, and surgery. And I had two of the three, plus pain and swelling in the most common area for blood clots. So while they did not really think this is what it was, and were hopeful that the ultrasound would 'just be a waste of my time,' they could not rule it out, and were not okay proceeding with any sort of treatment until this had been ruled out.

I mentioned that I had told my doctor about my pain at my two-week post-op appointment, and he seemed confident it wasn't a blood clot. Although, interestingly enough, the stretching exercise that I was doing with the PTA that brought me to tears was very similar to the 'test' that my surgeon did on me at my post-op appointment. And one of the reasons he definitively concluded that it was not a blood clot was because 'If it were a blood clot, that would have hurt a lot.' (These are times when I worry about a high pain tolerance.) Anyways, both AJ and Kevin said that although my doctor wasn't in this afternoon, they were certain this was what he would have wanted as well. They repeated that they really didn't think it was a blood clot, and that I should not freak out, but that they needed to rule it out for sure. Because if it's not a blood clot, it's just a waste of time (and money, I add), but if it IS a blood clot, it is a potentially life-threatening situation, so it is worth it to know for sure.

Apparently it was too late in the afternoon to schedule an ultrasound, so I am going in tomorrow at 7:45 AM. This was actually good news for me, because I have book club tonight, which I sooo look forward to, and I did not want to miss book club while stuck in the hospital waiting to have some ultrasound for a condition I probably don't have. And with that said, I am off to book club. It is five blocks away, and I am attempting to walk there, so wish me luck.

Post Surgery: 4 Weeks + 2 Days / One Week UIRTW

On Monday, I had a glass of wine with a dear family friend, who used to have a high-up position in administration at my school but is now retired. We talked about life stuff and job stuff and other stuff, but mostly job stuff. She gave me some good perspective on some job concerns I have, but never mind that; that is material for my other blog. The point is perspective. At several points in my life, I've had heart-to-hearts with Wise People, who have told me to take a step back and look at the big picture. So with that said, in the Big Picture of my hip, things really are going great. Nagging pain in my left hip and ridiculous consistent pain down the back of my right leg aside, I feel pretty good. Almost all of my anxiety is centered around having to start teaching in a week, which even in the absence of hip surgery would be causing me anxiety. And of course my overall mood affects my ability to deal with pain and the anxiety that comes with that pain and so on and so forth.

But to put things in perspective, I have really come a long way in the past month. In reading old entries, I was mostly focused on little things, simply because I didn't have to be thinking about big things, like my job. Now I have to be thinking about those things. I'm concerned with things such as how will my hip hold up when I have to teach from 8-5 for five days? What will my pain be like? What will it be like if I have to teach on crutches? And if it comes down to that, will I actually suck up my pride and do it or will I be stupid and push through the pain and jeopardize my whole recovery just because crutches don't jive with my teaching persona? These are the things that keep me awake at night.

In the interest of big picture perspective and positivity, I wanted to reflect on a few things that gave me a lot of trouble post-surgery but are now no longer a problem, or at least getting better.

• It took me a while to settle into physical therapy and feel good about it. But I'm now in a good place as far as PT goes. I feel like PT is playing a very positive role in my recovery, which is what I had hoped for.
• Post-surgery, I had a lot of pain in my right knee when I sat. That pain is gone now. I do still stretch my quads out as my PT showed me how to do, and maybe that is what made the pain go away, or maybe it really was just one of those post-surgery freak-outs your body has that resolves with time. I think I've just read too many horror stories on the Internet about how people have been promised their pain will go away eventually, then it never does, which just drives home the point that you must proceed with caution on the Internet. Not that there is anything wrong with reading things on the Internet, I just think Internet blogs are inherently biased toward people who have negative versus positive experiences. Positive experiences, by nature, provide less material to blog about.
• The pain in my right leg, although persistent and annoying, is nothing like it was at its worst a few weeks ago. I still feel this low-level squeezing pain in my hamstrings and especially my calf muscles, but it is nothing like the all-out muscle spasms I used to have. Also, I have not taken a pain pill in few days. I am ditching the pain pills.
• The fact that my knee pain went away with time gives me hope that my leg pain will also go away, given a little more time. My left hip is a different story, but I can't think about that right now.
• Right after surgery, I had a lot trouble sleeping and getting into regular sleep pattern. That's over now. My sleep problems are now no worse than they were pre-surgery.
• A few weeks ago, it seems as if I was tired all the time. I now feel like my energy levels are pretty normal. And I am doing a lot more than I was before. I'm pretty much in a normal routine now.

In more specific news, today was a good day. Around the house, I would say that I was able to get around free of any walking aids for 70% of the time. Of note:

• I rarely use two crutches anymore, except on stairs. (Damn those stairs.)
• When I wake up and am groggy, it takes me a while to 'find my legs.' No way I can jump out of bed and walk crutch-free. I need a crutch first thing in the morning.
• I need a crutch to go long distances ('long' being more than 10 feet, lol). Now, this is apparently sort of weird territory, and fortunately there are many blogs out there to make me realize I'm not a freak. The thing is that I can actually walk pretty well now, for a while. The problem is that I don't know what 'a while' is, as there are many factors that go into this, including but not limited to: Is the distance flat or hilly? Are stairs involved? Are children involved? Is carrying things involved? What time of day is it - i.e., what was my energy level to begin with? And so on. And I don't want to start off thinking, wow, I feel great, and then get stuck realizing, whoa, I really pushed it too hard, now I'm stuck three blocks from where I need to be and I can't walk without passing out. So my crutch comes with me for security if I have to go more than, like, 30 feet. And I use it, even if I don't really need it, because apparently if you don't use it, people will think you are faking it. Admittedly, it does look sort of weird if you are just walking along carrying a crutch.
• On this topic, I read a post by That Crazy Crippled Chick that was extremely interesting. Now, I am not in any way trying to compare myself to Crazy Crippled Chick; we have completely different circumstances. But the take home message is applicable many situations, and that is that it is that things are often more complicated than they appear. Also, in reading blogs by people who have had hip surgery, it can be difficult because sometimes you need crutches and sometimes you don't and people just can't deal with this back-and-forth. In their minds, you either need crutches or you don't. So if you are using a crutch, you should appear to be in extreme pain or leaning heavily on your crutch, or both.
• It is Wednesday today, so I went to the farmers market. This was the first time since my surgery that I just walked (with one crutch) from where my dad parked to the market, and then back again. Again, I wasn't SURE I needed the crutch, but better safe than sorry.
• I feel like I am improving logarithmically. I feel 10x better today than yesterday and hope that I feel 10x better tomorrow. I was initially a little discouraged by how totally weird it was to try to walk on Monday, especially since I had already prepared myself for the fact that it was going to weird. For it to be weird on top of the weirdness I had already prepared for was sort of a bummer.
• However, now that I am past that weirdness, I feel... good. The only thing really holding me back right now is my left hip pain and my right leg pain. Fortunately, those pain levels are manageable, and I am holding on to the thought that just like my knee pain, those, too, will resolve. 
• Sooner would be better than later. 

Now that I have started the process of coming off crutches, I feel like I'm no longer counting the days post-surgery, but rather, I'm in a countdown until I have to start teaching. I've decided to name this countdown UIRTW ( = Until I Return To Work). This is one week UIRTW. Yikes!! I repeat, YIKES!

Post Surgery: 4 Weeks + 1 Day

The highlights of today:

• I took my daughter to get a back-to-school hair cut, and I also got a hair cut. For the first time in a long time, I got bangs cut. I haven't had bangs in a long time, but I decided I needed a change. Here is why: the reason I haven't had bangs in long time is because I've always felt that bangs make me look a lot younger. Apparently I already look young for my age, and back in my bang days, I was actually asked for ID to buy a can of spray paint when I was in my 30s. (In California, you have to be 18 to buy spray paint, as I learned.) I know I must officially be old now, because I actually feel a compelling need to look and feel younger. Since I started my current job, I've acquired a massive amount of gray hair (which my old hairdresser affectionately referred to as 'hair bling'). Somehow all this gray hair plus having hip surgery before my 40th birthday has made me feel a little uneasy. I'm not ready to be a gray-haired old lady with a limp. 
• So yesterday, while I was picking up a refill for my pain medication, I bought some hair dye as well. I mean, what the heck? I have never dyed my hair before, aside from one brief dabble with henna when I was in college, which did nothing because, hello, my hair is black as black can be. But my current mental state is telling me that the gray hair has to go. Like I said before, I'm not ready to be a gray-haired old lady with a limp. And since it is a real possibility that I will be a lady with a limp or a crutch (or both) once school starts, I should at least have a cute hair cut and no gray hair? I don't know. Whatever.
• I made up my mind a while ago that I needed a hair cut, and had imagined this as my getting off crutches reward. But, it couldn't wait. While I am 'allowed' to walk as much as I can, retraining my body to walk again is going to take longer than I had hoped, no matter how well my physical therapist tells me I'm doing. I get my hair cut at the mall, which is somewhat of a trek (at least, more than 3-4 feet, lol), so I used a crutch. Just one, though. Progress!
• I bought a cane. I can't believe I'm even admitting to this; canes definitely fit into the same category as raised toilet seats in my mind. And because my daughter was with me, I bought a ridiculous zebra cover for it, because having a cane when you look like you are 20-something isn't attention-grabbing enough. LOL. However, the cane is really to use around the house. The thing is that I'm finding that there is a big difference between walking with even one crutch and walking totally crutch free. I feel like I need something in between. When I was at PT, I had to do all my walking in front of a mirror to make sure I had good posture and wasn't limping, but it's harder to do that when you're trying to navigate through a house. Without a crutch, it's really hard for me to have good posture and not limp. Not because of pain, but because of muscle weakness, and because either the surgery or being on crutches so long has really thrown off my sense of balance. And since limping is something that I'm not allowed to do, I feel like I need some sort of aid to help me not limp that is not a major as a crutch. So there you go.
• This does sort of bring me to another worry. You always hear people say, 'Well so and so is totally using this as a crutch.' I feel sort of alarmed right about now that I'm not having a little easier time walking, and I'm worried I'm using my crutch (literally) as a... crutch (figuratively). I know I am only one day past my official 100% weight bearing date, but I am feeling anxious about how tentative I feel on two legs with no support. I feel like if I just suck it up and force myself to walk around with no walking aids, my body will remember how to walk, yet at the same time, I don't want to overdo it. As my PT said, the one thing I really don't want is any pain. It is just hard to find that balance between pushing yourself enough and pushing yourself too hard.
• I'm sure I'll figure it out, though, one way or another. :)