This has been quite the week! There has been unexpected great news and wins, surprise lows, a trip to the Emergency Room.....and more. 

TLDR: I'm one week postop, kept previous mobility, developed a painful but superficial blood clot, was discharged and then had to go to the ER to have wound vac removed, waiting for cultures and to see if surgery's goal was successful. 

I had surgery on Monday, April 22nd with the goal of opening the incision, "washing/debriding" all of the tissues and seeing whether or not the sinus tracts went to the joint. The surgery itself went well - it was only about two hours, which is a fraction of the time that the last one was, which means less anesthesia and hangover. They found two sinus tracts that did go to the joint - not good news. They did not take out all of the hardware, but they did replace the head of the hardware which is something that they could do without chiseling everything out. 

Here is the concern - if the infection (yeast) is deep within the joint, no amount of antibiotics alone can get in there and kill it off. The only way to kill an infection deep in the joint is to completely remove all of the hardware. If the infection is not deep into the joint, this surgery has a *chance* of being enough to be able to kill the infection, in combination with continued long-term antibiotics. I wanted to at least try this option first, even though my surgeon did not have the highest confidence that it will work. 

If this does not work, then the next step is for them to go in and completely take out the hardware again, and they essentially cap off your femur and create what is called a "girdlestone." You basically don't have a hip, and limited to no weightbearing. I had this for about a week when I had my original hip replacement saga, and you more or less just have a floppy leg. But this time, they would take out the hardware and it would be MANY months, up to a YEAR in this state. I would be on intense antibiotics to kill the yeast, and the hardware would only be able to be replaced when/if the infection was cleared. Until then, I would have no hip, be unable to bear weight, I'm not sure that I would even be able to live in my home. The cascade of things that comes with this is beyond terrifying and why I insisted that we at least *try* the surgery I just had instead of going straight to this option. 

My surgeon told me that I should expect the healing from this surgery to be very similar to the last, ie very helpless for the first 2-3 weeks and then significantly more quickly after that. This is where I had a HUGE and POSITIVE surprise - I didn't lose ANY of the mobility that I had gained back after my last surgery! I had been mentally and physically dreading having to start from scratch with all of the hard earned mobility that I gained over the last 7 weeks. It has been so mentally relieving to be able to walk (okay, kind of toddle, but still!) without the walker and not be totally helpless stuck in bed. 

I also learned that this time they would not make me wait for almost a week in the hospital for cultures to grow, which was really nice. As of now, no bacterial cultures have grown, which is great news again. The candida (yeast) of course was still there. But, they were able to get a lot more material this time so they can do specific sensitivity testing to see if they can get even more targeted with the medications that I am taking. 

Then, some bad news......a couple of days after surgery, I realized in the middle of the night that the feeling of being bruised on my inner thigh was also a symptom of a blood clot. This lead to a middle of the night trip to ultrasound, who confirmed - yes, a blood clot. Again. Actually, in the very same place that I had one in 2019. Thankfully, it is a superficial clot and not a DVT, so the treatment is just staying on anti-coagulants (which I am on for life anyway). It is VERY painful though, which has been challenging. It will take months for it to slowly dissolve. 

I was still able to be discharged on Thursday. I was sent home with a wound vac to help the incision stay extra sealed. It basically looks like a giant sticker that goes over the incision and then wildly sticky "industrial strength saran wrap" that goes over that to seal it completely. There is a tube that comes out of it, and it is connected to a box that keeps continuous suction going at all times. here's a link if you want to see it - 3m Prevena I had one of these in the fall of my first hip replacement saga as well. I never had any discharge from it for the weeks that it was on then, and I did not have any this time either. It was supposed to be on for two weeks after surgery. 

On Thursday afternoon I was discharged. Cat brought me home, everything went pretty easily, actually. I was SO tired since the hospital is the least restful place imaginable, so I decided I'd take a nap. I got into bed totally normally, took a very amazing nap for just over an hour. When I woke up, the ENTIRE canister was filled with output from my incision - this is a lot, really a LOT. I called the nurse line and of course they said I had to go into the ER. Thankfully, Sara and George came right over and we spent the next six hours hanging out at the Regions ER. Also thankfully, my very favorite ortho resident, Kelly, was on call and made a VERY painful and frustrating situation the leas awful it could possibly be. 

I thought for sure they weren't going to let me go back home, but I got lucky. The hypothesis is that the increased movement of the day jarred something and then the suction from the wound vac just kept it going, so they ended up removing the wound vac (which was EXTRAORDINARILY PAINFUL.......my skin is SO DONE!!!!) and then doing old fashioned pressure bandage along the incision that now has to be changed once a day and requires help. My incision is close to 24 inches long, and you need two solid hands to really get the pressure bandages tight. After Kelly got it all done, I was able to go home and I deeply appreciated being able to sleep again! 

I have been extraordinarily fatigued and sore. I am sleeping a LOT, which feels good. It does actually feel restorative. The skin in the area of my incision just basically feels like I have an extreme burn over the whole thing, my poor sensitive skin that is allergic to adhesives is just constantly having adhesives being taken on and off. And then the blood clot on the inside of my thigh feels like the worst, most tender bruise you could ever imagine.

Now it is basically a waiting game to see how this incision heals and how my labs look to see if this surgery will have been enough, or if I will be heading back to the OR for the extreme surgery in a few weeks.  

I am so grateful to be home with my cats, to be able to sleep uninterrupted for as long as I am able, to have delicious food that Cat cooks each week, to have chosen family/friends coming over to take care of me/my house/my yard/my cats, and just keeping my life going. The new Gofundme has gotten some traction and I have some breathing room for the next couple of months, which is HUGE! THANK YOU to all of you who have shared and donated, it is making a real difference!

https://www.gofundme.com/f/help-angela-through-surgeries-cancer-and-full-recovery

Venmo: @angelacallais

Paypal: angela.callais@gmail.com