So I called Darlene Ramelow, nurse coordinator for Dr Bryan Tompkins, at Shriners'. I told her what Dr Trousdale said we needed to do and she said she would call me right back. Ironically, Braden had an appointment this morning there and Dr Tompkins made sure that Nathan was taken care of immediately! Gotta Love, Love, Love Dr Tompkins and his compassionate heart. For the convenience of mom, Nathan would be doing his pre-op tests and paperwork, while Braden got seen in the clinic. It was such a relief that they were able to work Nathan into the surgery schedule for tomorrow. Accruing more hospital bills from Sacred Heart wasn't what I had in mind when Dr Trousdale called. We need the money for airfare...not co-pays. And before we know if we have to go anywhere, it's vital that those fluids be checked immediately if we have any chance of saving the new artificial joint.
Several of the Mayo doctors that have called have prepared us for what may come. Dr Tompkins hinted last week that this is going to take some radical twists and skills to get the infection out of his hip. The entire new hip will have to come out first, be packed with some kind of cement filler. Then they'll go after the infection intravaneously until they can knock it out. We have no idea how long that could take. But once it's back to healthy tissue, then a new total hip would be put back in and then we start the recovery process all over. Then physical therapy and so on. Months and months of work ahead just to get to a normal baseline. So that's why our hands are tied on making travel arrangements to Minnesota, if necessary, until we know the urgency and extent of the staph infection.
Dr Tompkins is going to be out of town tomorrow, so Dr Glenn Baird will be doing Nathan's operation. He's fabulous and helped in Nate's first surgery at Shriners'. He'll be the 4th surgeon inside Nathan's hip this year! He'll be drawing the fluids out of the joint and then taking a tissue sample from the bone above the ceramic hip. This infection is nothing to mess around with and is causing some drama in four different sets of doctors' offices.
Every time we talk to Dr Tompkins about the first surgery, we get a little more insight into what he saw the first time he opened up Nathan's hip. Today he said that the hip was already basically dead, only held in place by one vein, when he saw Nathan in December 2010. He did the surgery immediately after Christmas because there was no time to lose in trying to buy some time before the next reconstructive surgery was needed. He was entirely optimistic in his language to us at the time, but now hearing his gut opinion of what he saw, tells an entirely different story. Nathan came to him already needing a THR. Dr Tompkins goal was only to buy him some time, mostly because of his age, and the accessibility of having it done locally or not. He was hoping to get him a year or two. (He told us 5-10 years initially--obviously still being highly optimistic, at the time). We got 7-8 months from that surgery, which Dr Tompkins confessed was totally miraculous compared to the original state of his hip. That kind of gives more insight into why he didn't cut Nathan's femoral head off and plate it at the time. Instead, he chose to grind it down and pin it in six places, to make it easier for the next surgeon (Dr Trousdale) to cut the bone right out and put a new hip in. That surgery was 7 1/2 hours. Hardward removal because of impingment, in January 2012, was 4 1/2 hours. Total Hip Replacement in May 2012...less than 1 1/2 hours! If nothing else--Dr Tompkins saved Dr Trousdale a bunch of time, at least!
And, so with that being said, he looked at Braden's x-rays today and told us we have bad luck running in the family. The first set of pictures weren't encouraging, so we were sent back for another set--from different angles. They've determined that the Perthes is done compromising the femoral ball. The body thinks it's been flattened enough, I guess!
Braden now has adequate blood supply to the hip, but he's been having a lot of pain because the flattened head has created an impingement in his hip socket. The cartilage is getting caught between the the hip cup and the femoral ball. A few months ago, he was hoping that the steroid shot would give him a few months of pain relief. It did, for all of two months. But the limp is getting more pronounced as his right side is trying to compensate for the shortened muscle on the left side. Only one option was given--surgical intervention, either to grind the sides of the femoral head down or to cut the head off and reposition it at an angle that relieves the cartilage. Our only choice was when we wanted to do it.
Dr Tompkins ordered an MRI/arthogram be done first, to make sure that the labrum around the head, hasn't been torn. The first availability for that is July 5th. That's going to be a busy day for the big guy. He meets with the audiologists for his second evaluation on his hearing tests and then with the ENT to discuss his hearing aid. We'll just have to cross the street after lunch and go for his MRI. I can already hear what kind of consolation meal will be in order for his cruddy day in small rooms and tight tubes!
The surgery is going to be similar to the one Nathan had in January 2011. Only with Braden, the femoral head will actually get cut off the femur and then repositioned with a plate and pins into a straighter position in the hip. It will automatically lengthen his left leg to match the other side, and should correct his limp and gait. He'll be in the hospital for a week and then two weeks in a wheelchair. By 6 weeks, he should be weight-bearing with crutches. And with physical therapy, he'll hopefully be up and about by 8 weeks. He shouldn't have any pain and should be healed enough that he can ride a bike and even participate in sport-related activities at school. [He'll have to have some of the hardware removed after about a year, but Dr Tompkins seems to think that this procedure should get him into his late 20s before he needs a THR. And with some extreme luck...the kind we haven't had as of yet...his hip may be corrected and healed enough that a THR won't be necessary.]
He'll have the same kind of gruesome scar that Nathan has--even on the same side! 14-16" gashes should make for some interesting small talk later in life. On the upside--he still gets to go to Cub Day Camp, the end of July. The downside...school starts August 14th. Surgery is August 16th. He's going to miss almost the first month of school. Ugg!! At least they can start working with him almost immediately, so that he doesn't fall behind. If he gets the same teacher that Nathan had...she'll know the drill already!
I'm sure that we'll look back in a few years and know why that everything worked out the way it did. We thought 2011 was our worst year on record. But I'm starting to think that 2012 might have it topped--and it's only half over! My only hope is that we don't have a complication with a third surgery before or back to back with Braden's. Crossing our fingers! Who knows...maybe God will be kind with us and either get Nathan back on track before Braden's big day or at least get things squared enough away for awhile so that we're home before the next big event happens. It might just be easier to haul both of their butts to the Mayo so that they can recover together. Wouldn't that be something? [I should have been a nurse...at least I'd be getting paid for all this non-sense!]
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