Reflexology

Yes, I bit the bullet and tried something "different" today. On the advice of a patient, I was told it is very relaxing. I have been having a ton of anxiety, like, to the point that I would probably benefit from being medicated at times. It has been so bad that my heart starts racing and my chest feels tight, I guess like a panic attack, only a minor and manageable version.

So I chose a 30 minute session. I have never done this before so I asked the reflexologist if she has a "routine" that she uses or if she kind of feels around for points and works on those. Her answer was basically both. It was very relaxing until she found a huge knot in one spot. She started working on it and said it was the spot that corresponded to the heart, lungs and chest. Weird, but kind of cool given my symptoms. She found one more spot that is the back/ sciatic nerve area....I told her I don't have back pain but do have hip pain, she figured that this point corresponded to the hip. Who knows but I do feel very relaxed and with less anxiety. Now if only I could get a reply concerning my CT I would feel ALOT better!!!

This is Why Doctor's Don't Like to Let You See Results Before Speaking To Them

I had my CT scan yesterday. The report is time stamped 30 minutes after I left the facility, they are fast!!!
I had BKs office fax me the report, and yes, I got it right away! Highlights of the report:
"There is a small ossific density noted in the anterior joint capsule", "small capsular calcification", "femoral version angle +8, anteverted"

So there is bone (?) in the capsule?????? OR calcification? huh? How did this happen? Its possible that it is all from scar tissue, this is probably where he cut into the capsule and the way it scarred down. Or is it nothing. The anteversion seems like nothing too.

I have sent him an email to please look at the scan and let me know what he thinks. I hope to hear back soon!!!

Psoas...once again coming back to haunt me

I have been sort of freaking out these last few days, as I mentioned previously, my pain has gotten way out of control. I assume it is coming from the psoas and today's events confirmed this for me.
My pain is now exacerbated with external rotation and extension. But, I also have pain with active flexion, so I can't cross my leg, lift it up, get in the car, get on the bed etc. I have a new co-worked who incidentally had surgery with BK a little over a year ago. She had a psoas release, so today I picked her brain on what her symptoms were pre-op. She summed it up in one sentence for me- "does your leg feel really heavy?" YES. Ok, so I am convinced that it is the psoas. I have found that if I avoid sitting, it doesn't tighten up quite as much. I also slept on my stomach last night to avoid flexing my hip at all. This helped a little. I also did some stretches into extension today with a rolling stool, all of these things are helping to make a little difference. As I type, I am back in indian style with minimal discomfort.

My co-worker was nice enough to call BKs office during our conversation and have her op report faxed over to us to see. It turns out she had no FAI, just a labral tear and a super tight psoas. I have been asked before how a surgeon can determine if the psoas needs to be released. I will quote parts of her op report:
"arthroscopic examination of the central compartment revealed demonstrated extensive synovitis anteriorly at the level of the psoas with an associated _____labrum anteriorly.
"a synovectomy was performed around the psoas irritation..."
"at the completion of the release, all pressure on the psoas was releived"

These are findings I expect on someone who needs a psoas release.

My symptoms of "psoas pain" just started and seem to be better tonight, it is clearly some compensatory mechanism, maybe for instability???????? Who knows, again, I am still anti a psoas release on me!

Bitching and Moaning

As the 30th slowly approaches, things are quickly deteriorating. For the first time last night, I took a narcotic pain killer (2 actually). I think it is the psoas issue again, and I am looking forward to Tuesday to see my new PT and have her "fix" me again. I think I am having the same dysfunction once again. Last night I decided that a little anterior glide to the femur would help, and it did! Today I was looking in the mirror and noticed that my ASIS on the painful side did not stick out quite as far as the other side, so I tried a trick I have read about and put a rolled up towel under the PSIS on that side for 2 minutes, it is supposed to help glide the inominate anteriorly, it helped a little bit. I need clarification from the PT as to what exactly she thought the dysfunction was, and I will try to pay better attention this time!

I am now limping horribly, I am really nervous about how I am going to work for the next 2 weeks. I do hope that this is just an SI dysfunction that can be taken care of like it was last week and I can go back to simple groin pain!!!

Hip Arthroscopy # 4...Scheduled

Ironically, today is the 2 year anniversary of hip arthroscopy #3, the revision of hip arthroscopy #1, which was a great success. I did really well after it, had a great pregnancy and delivery (hip-wise), and did great for 5 months post-op. After that, well.....

The surgery is scheduled for November 30th, yes, 18 days away. Shit. That is really soon. I also just got my CT scheduled for this coming Monday (I think I called and the receptionist said "shit, I forgot to schedule her CT", because she put me on hold for about 20 minutes and then asked if that day was ok...whatever, it is done and hopefully this is the last procedure they EVER have to schedule for me).

November 30th is the Monday after Thanksgiving. We are going away for the weekend, so I decided that it would be a good idea to have the surgery late in the day. I have always had them done first thing in the morning. This time, I don't really want to wake up at 4:30AM, and I thought maybe I would want to run errands, go to the supermarket, Target....but then I started thinking that I normally don't respond so well to the anesthesia and the drugs...and I don't want to be there all night...or worse, get admitted....so I am thinking of calling back and asking them to schedule me for early afternoon. What do you think? Other than I am obsessing over this too much. But hey, I can obsess over the things that I have slight control over, everything else is up in the air.

On another note, I have been in awful pain lately, much worse than ever. I think my psoas is acting up, but as you know, I REALLY don't want it released (been down this road before). I asked a colleague to work on me today and release it. She started looking and feeling around my hips, and found that they are severely asymmetrical. The right (bad) one is higher and flared out anteriorly. She thinks it is causing the psoas to impinge and cause me pain. She released the psoas, iliacus and some others (I was in a lot of pain and having a really bad day...so I don't remember details), but when she was done, everything was level and the pain was just in the joint, where it usually is. I was also able to flex my hip a little easier. She uses a different technique than P, my old therapist used, but P has left my practice, so I have to move on! She will be the one I use after this surgery. I already booked an appointment with her, but not the day after surgery, it will be Thursday, I don't want to torture myself and have to go out the day after surgery, like I have in the past.

Any suggestions on what to do about the time would be much appreciated!!!

Close Your Eyes and Imagine a High Pitched Scream

That was me you were imagining. See, up until now, my pain has been manageable, and I was sure that once I knew I was having another hip arthroscopy, it would calm down and I would begin to question whether I was making the right decision or not. Luckily, I don't have to struggle with this since over the past 2 days, the pain has intensified to the point where I don't want to walk on my right leg.

I have no idea what is wrong now but I can no longer cross my right leg over my left leg without using my hands to lift it up, and I cannot even get into my "comfort position" of external rotation because that hurts like a bitch. So to put it simply, I don't know what the heck I did to it now...but things are going from bad to worse. (no, I was not breastfeeding)

The Dangers Of Breastfeeding

Disclaimer: Before I get attacked.....I am a big proponent of breastfeeding and would never say or do anything to deter a mother from breastfeeding her child..

As I plan for another hip arthroscopy, I know I am going to be faced with the question "how did you hurt your hip". I have had to explain countless number of times to people that there was actually no injury prior to my other surgeries, which makes me feel like an even bigger ass, at the time, I was 26 and having hip surgery, with no cool and exciting injury. I dreamt of telling people that I had torn my labrum skydiving, or heliskiing, but being that I am a terrible liar, I would have never gotten away with it. Plus, half the time I was explaining that no, I did not have a hip replacement, and no, I am not too young to be having hip surgery, and my all time favorite, no, I could not just live with the pain.

This time, I was thinking of coming up with a cool sounding injury, but again, I don't know how to lie. Plus, all you have to do is look at me, 3 kids, diaper bag, spit up on my shoulder...and you know that my life doesn't get all that exciting. No one would believe me that I had time to actually go skydiving or heliskiing!!! The truth is that I hurt myself while feeding Z, more specifically, breastfeeding Z.

Way back in June, I was sitting on my bed, in Indian style, breastfeeding, as I did hundreds of other times, except this time, When I stood up to put him in his crib, I couldn't put weight on my right leg and my hip HURT. So I have come to the conclusion that I injured myself while breastfeeding!

What sounds better...I didn't really have an injury, or I injured myself while breastfeeding?

The Wait Is Over

Yes, we spoke! We decided that at this point there is really nothing else to do but a scope. Not what I really want (ever again...and no, I will NOT be re-reading old posts to see what I went through then), but given that this has been going on for 5 months, PT, cortisone, PRP, Synvisc and crying did nothing to help my pain, I am left with few options. Living like this is just not an option for me. He did ask me if I wanted to see someone else, I really don't think that I can get different answers anywhere else, nor do I want anyone else doing my surgery.

He wants me to have a CT before the surgery, to make sure that he is not missing anything. I have mixed feelings about a CT given the amount of radiation, and I have already had one on the right, plus an abdominal CT all within the past 2 1/2 years. I had a Crohn's flare back in July and my GI opted not to do a CT because I had had one 2 years prior (I didn't even mention the hip CT to him). But given what I have gone through with this, I want to make sure that ALL bases are covered and ANYTHING that is there will be seen.

As far as timing, he is going to try to fit me into the schedule the first week in December (this is when I can do it, anytime before is too soon to stop working, and too close to Thanksgiving would make it really hard for my mom to get a ticket to come help me). I won't know until about the middle of next week the exact date.

For some strange reason, I feel a little more calm right now than I did 24 hours ago, despite the fact that the S bomb has been dropped, and is now a reality. I am not sure how well I will deal with it from now until then but I will do the best I can...

Sauvignon Blanc

This will not be my choice for tonight's anxiety fest! Just to keep you informed, Tuesday...no call (Cabernet Sauvignon night), Wed morning at 4am, I emailed BK to re-re-re-schedule our call. I got an email back saying it would be Wed in the pm. By 9:30 I could no longer keep my eyes open anymore (Zk has been very confused with the time change and white wine apparently makes me sleepy) so I left J on phone duty (I also gave him one time access to my email, just in case he emailed). J came to bed around 1am (after the World Series was over) and told me that he had emailed. I checked the message...tonight at 6pm.

All I can say is that if this was a "real" date, I would have dumped him a long time ago!!!

On A Positive Note, I am Helping To Keep the Wine Store in Business

No $%&#$%&#@&%$# call. Seriously. WTF???????
For all of you psychology people out there, 2 questions:

1)Can copious amounts of wine act in similar ways to anti-anxiety drugs, or is it just the placebo affect?

2)Is it normal that as my anxiety level has gone up (dramatically) this week, so has my pain level?

I Was Stood Up!

At just around 10pm, I went to pick up my blackberry to email BK and re-schedule our "date", only to find that he had beat me to it. He had just gotten out of the OR (I would hate to be that patient) and will call me tomorrow. But, he thinks we need to talk about looking at the hip arthroscopically since I am not getting better.

I am sooo not good at this waiting thing!!

Just an Update as I Wait....

I emailed BK on Thursday night and said I can no longer wait....this is not working, lets move on (In slightly nicer, toned down words). After some back and forth, we have a set a "phone date" for tonight, where we can discuss this crazy hip business. It is 8:55 and I am beginning to think that I am being stood up!!!!

When Your Insurance Company Won’t Pay: 12 Tips

I was doing some "googling" tonight and came across this article, here is the URL http://thyroid.about.com/cs/newsresearch/a/insurancepay.htm
Since many people are finding my blog by way of search words related to insurance companies and unfair denial of claims, I thought I would post this

By Mary Shomon, with Dr. William Cline
1. Don’t assume that the first “no” you receive is final.About 10 percent of all insurance claims are unjustly denied but less than 1 percent of people making insurance claims even question their insurer when their claim is denied. The majority of policyholders who do contest their cases either win their cases or improve their settlements.

2. Insist on a written explanation. Most state laws require insurance companies to provide written explanations of claim denials. Failure to comply may constitute an illegal practice by the insurer.

3. Read your policy carefully to determine if the claim was legitimately denied. The insurance company may have interpreted a clause in your policy differently from the way you understand it. Respect your sense of fairness and what you expect the policy to cover. If the ruling doesn’t sound fair, there’s a good chance that it isn’t.

4. Do not accept filing errors as ground for refusal. Always follow your insurer’s instruction for filing a claim. But if you fail to fill out a form correctly, or if you miss a deadline for submitting a claim – even if you are months late – an insurance company cannot refuse to pay an otherwise valid claim unless the company can show it has been harmed by your error or prevented from making an adequate investigation due to your delay.

5. Do your own research to support your claim. If your insurance pays less than you expected for care provided, check what other doctors in your area charge for the same care. If other doctors charge more than you received, challenge the payment.

6. Ask your insurance agent or group policy administrator at work for support. The agent from whom you purchased your insurance has a duty to make sure the coverage protects your interests.

7. Contact the insurance company directly. If your insurance agent or claims administrator doesn’t resolve the problem within 30 days, telephone the insurance company yourself. Be polite but persistent, and keep going up the corporate ladder. Be sure to make a record of all phone calls, including the names and positions of everyone with whom you speak. Save your phone bills that list the calls. Follow up each call with a brief letter stating your understanding of the conservations, and requesting a response within 30 days.

8. Complain in writing if your phone calls don’t work. Begin with the person who denied your claim, then write to the person’s supervisor. Include your policy number, copies of all relevant forms, bills, and supporting documents and a clear, concise description of the problem. Request that the insurer responds in writing within three weeks. Keep copies of all correspondence. Send letters by registered mail. Explain what negative effects the denial of your claim is having. Use a courteous, unemotional tone and avoid rude or blaming statements.

9. Write a follow-up letter. If you receive no response, send follow-up letters, with your original letter attached to the insurance company’s consumer complaints or customer service department and to the company president. In most states, failure to respond promptly to letters regarding claims is an unfair insurance practice.

10. Enlist outside help. If necessary, add pressure from:
Your state Department of Insurance – this is free. The amount of these departments can help varies from state to state. But some states with strong departments (California, New York, Illinois) will mediate your dispute.
A professional arbitrator.
A lawyer.

11. Gain doctors’ support. If you can enlist your doctors’ support for your claim, you have a better chance of successfully challenging a claim. 12. Look for violations. If your claim is denied because of a reduction in coverage, determine if you were ever notified about that reduction in coverage. If you were not, then you have a good chance of winning your claim since failure to notify the patient of a reduction in coverage is a violation of the law.

Resources for Additional InformationConsumer Coalition for Quality Health Care1275 K St. NW, Ste. 602Washington, DC 20005Phone: 202-789-3606Web site: http://www.consumers.org
Center for Patient Advocacy1350 Beverly Rd., Ste 108McLean, VA 22101Phone: 800-846-7444 or 703-748-0400Web site: http://www.patientadvocacy.org
Consumers for Quality Care1750 Ocean Park Ave., Ste. 200Santa Monica, CA 90405Phone: 310-392-0522Web site: http://www.consumerwatchdog.org
Excellent Book to ReadFight Back & Win – How to Get Your HMO and Health Insurance to Pay Up, by William M. Shernoff. Amazon.com, Barnes & Noble

Other Trouble With UHC

A few months ago J had an endoscopy done by an in-network provider, at an out of network facility with an out of network anesthesiologist. We got a bill from the anesthesiologist because our deductible was applied to his bill.

Last night I called UHC to complain, we used an in-network doctor, we had no choice regarding the anesthesiologist. Last night I got the run around and was told the only thing to do is file a written appeal (this didn't get me very far when I wanted the CPM covered).

I was advised by a fellow hip friend (thanks Maria) to ask for 'rapid resolution'. So I called again today and explained to the rep that I was unhappy with the outcome of my call yesterday, she voluntarily (without me asking) transferred me to rapid resolution. The rep at rapid resolution (again) explained that because the facility was out of network, they will not pay for the anesthesiologist at the in network rate. I didn't back down when she told me (again) to file a written appeal. Since I again, kindly asked that UHC pay for the anesthesiologist, she decided to look into my plan. She then told me that I have the "fully insured plan" (not sure what that means) and that she can forward this to the appeals department. I should have an answer in 15 days.

What is the point of my story? Had I just accepted what was told to me on the phone yesterday, I would probably be screwed. I still may end getting screwed, but I feel like something was accomplished today because I was persistent with them.

The Way Things Used to Be

Without going on and on, and sounding like a super complainer, I will leave it at this. I am in so much %$&*@%$##$%% pain (use as many descriptive words as you feel is necessary). It has been 1 1/2 weeks since the super fun synvisc injection and no, it is not helping, no, I don't feel even a teensy bit better. In fact, the pain is so horrible that once again I am trying to figure out what the easiest way to cut off my leg would be.

I am sick of people saying "try PT", "try drugs", "get another opinion", "give it more time". I think I have given it plenty of time, for gods sake, this happened at the beginning of June. How much more time do I need before I lose it altogether, as opposed to just a little, like now. Case in point, I almost had a nervous breakdown last night when I asked for cucumbers and tomatoes to be cut into little pieces for salad. I came home, first, to find they were cut in chunks, and the cucumbers were not peeled, just sliced. As I was re-cutting the tomatoes, J kindly pointed out that the so called cucumbers were in fact mini zucchinis. Poor J didn't think I would lose it over zuchinni.....well.....super bitch is back! If you are reading this and have never dealt with pain and the frustration involved, you probably think I am nuts, for those of you who have, I'm sure you can easily relate.

What brought me to write this (and no, it was not just to complain) was that I was walking Jk to school last week and can distinctly remember the day 2 springs ago that I was walking L to school on the same path and finally was able to say to myself, "OMG, nothing hurts". I was thinking about that as I was walking last week, and the left hip still feels perfect, yet the right one feels like ice picks are running through it. I hope that I can have that same feeling once again really soon. What keeps me from the brink of insanity is that I have the left to remind me that things can be good again, and were, for a very long time, and it is possible to fully recover from these issues.

Had I not had such a good outcome on the left, or the 1 1/2 good years on the right, I think I may have given up and resigned myself to live like this, but I know that there is bigger and better out there, so in the meantime, I will keep trying to remember that day in the spring, and try to keep super bitch at bay as much as possible!!

Having a Shitty Day

I am in so much pain today I am contemplating biting off my leg. I don't know how it got this bad, its not like I am out running marathons, or climbing mountains, or anything even remotely physical. The only thing I did yesterday that I haven't done in a while is go to the park with the kids. We had a gorgeous day yesterday, I couldn't let it go to waste. It is about a 10 minute walk, if that, I pushed Z in a single stroller, and I sat for most of the time that we were there. This morning I went to the supermarket. That's it, nothing else. I have been cooking today and have had to take breaks from standing in the kitchen. This has never happened. I am so shocked, and depressed as well, how could things get so bad all of a sudden? If I can't even make dinner, how am I going to work? I guess we'll cross this barrier on Monday, by then things should have calmed down I hope.

Let The Waiting Game Begin

It has been 6 days since the Synvisc injection. I hurt. It has not helped. I am not happy. In fact, the pain has been worse since before the injection. Why do I always get so lucky!

BK wants me to wait it out a little longer....which is fine, given the alternative, but my feeling is is this going to get better? I don't want to waste any more time, this has been going on since June already. It is starting to really drag on and it is really getting to me. I haven't had a good night's sleep in a while, I am up every few hours from anxiety. When I first went into practice, I was surprised at the number of patients who came to see me whose medication list included some sort of anti-depressant or anti-anxiety drug. It all makes sense now.

Yesterday was a beautiful day in NYC. I had a great afternoon with fellow hipster Carrie, who was in town seeing BK following her 3rd surgery (2 scopes and 1 open). She is still having pain and inflammation post-op, and limping quite a bit. We walked around the city a bit at a leisurely pace. Towards the end of the walk, I had to ask her to slow down because I couldn't keep up. Sorry Carrie but that was so pathetic on my part!

About the Synvisc, I spoke with BKs nurse while Carrie was seeing him. She said another one of their patients had relief about 3 or 4 days after having it injected. BK thinks the cortisone can still kick in within the next few days.

Keep your fingers crossed!!!

Who Wants To Bring It To The Media

There was recently a newscast locally which spoke about FAI and labral tears
http://wcbstv.com/health/healthwatch.hio.injuries.2.1182996.html

I have thought about contacting that station to see if they would run a story about UHC calling the surgery experimental, my only issue is that I am not currently being denied anything, rather, it seems, just a trouble maker!!!! Does anybody out there have a pending denial who would like to initiate this, I would do everything I can to help, as I am sure others would too. This would make a great headline!!

I Forgot To Mention About the Synvisc One

I received the statement from the pharmacy that filled the prescription...
Amount Charged: $844.80
Amount Paid by Insurance: $844.80

What more could a girl ask for!!!!!

Synvisc One Injection....Done!

It has been a very long week and I am finally getting tot he computer now! Yes, the injection is done, and I am REALLY sore!

I had it done yesterday around 3pm, same radiologist as always, so I wasn't too nervous bc he is so gentle, although no intra-articular injection is ever going to be 100% pain free, this was no exception.

Apparently, the makers of Synvisc One suggest using a fatter needle to inject the material, fatter needle translates into more pain! Also, the radiologist explained that he couldn't inject Lidocaine into the joint for me, like he normally does, because it will dilute the Synvisc. He did offer to flush the needle at the end with a tiny amount of Lidocaine, hey, a little Lidocaine is better than no Lidocaine, right!! He did numb my skin with Lidocaine first though, that helped a bit.

Unfortunately, I did feel every move of the needle as it pierced muscle and the joint capsule, and came to rest inside my hip joint. He first injected the Synvisc One, followed by Kenalog (like cortisone) and then my vitamin dose of Lidocaine!

I am supposed to be keeping a pain log but have been too busy to even think about it. Last night I was in a lot of pain, and even immediately following the injection I was in a lot of pain. The radiologist explained that the Lidocaine that he normally uses probably masked that pain for me all the other times. I am still not too happy but I guess only time will tell. I am hoping the Cortisone kicks in soon, or maybe it did but I am sore from the fat needle....who knows!!!

I know that I have not written the UHC letter as I promised, or been very proactive with that lately. I have been thinking about making some changes in my life, which I will get into when I can, and have been really busy with that, as well as my vacation last week. I will keep you posted on how the Synvisc One works!

The SynviscOne is Here

Now if only I could inject it myself......

Vacationing

I think the solution to my problem is not Synvisc, or cortisone or exploratory surgery, it is a lifestyle change. I am in Miami now, we have been here for a week, with nothing really to do. I have had a great week! My hip pain has been so manageable here, I think I will start doing nothing all day and solve this issue!

...The hip bone's connected to the...foot???

I guess the pain in my hip is starting to take its toll on the rest of my body. I started to develop pain in my right foot (right hip is the problem) over the past few weeks. It is right around the 2nd metatarsal. I am currently on vacation in Miami where luckily, a friend is a podiatrist, who just happened to be over for dinner Friday night.

I asked him to look at my foot since it was really bothering me. He started feeling around and said that the area I was having the pain in had developed a nasty callous. Since I am favoring my right hip, I must be twisting the foot in some way and putting unnecessary pressure there. He also thinks there must be inflammation inside, in that area. Additionally, I have developed a callous on the outside of the left foot too. So I must be shifting all of my weight to the left, sub consciously, to unload the right side. He recommended I get new orthotics which is probably a good idea anyway since mine are about 7 years old.

He came over tonight and shaved off the callous (I know, eww) and casted me for new orthotics! They should come in about a week and a half!

Articles supporting FAI and Labral Tear Surgery

In my quest to make my voice heard regarding insurance companies (UHC) policy on FAI surgery, I am compiling articles supporting surgery for FAI and labral tears. Please make your voice heard as well, call, write letters, emails etc. I have contacted a patient advocate regarding this matter and she suggested that we contact our members of Congress, letting them know what is going on.

What she did point out regarding the policy is the following:
The thing that nags at me about the new policy is this: "Although arthroscopic hip surgery for FAI is a procedure that is not subject to FDA regulation, devices and instruments used during the surgery require FDA approval. A search of the FDA 510(k) database revealed over 500 arthroscopes approved for marketing (product code HRX); however, the available studies did not provide sufficient information to determine which 510(k) approvals correspond to the instruments used."

So they can't tell which FDA approvals correspond to which device, so therefore they refuse to pay for any device, even if it's FDA approved? This is a major cop-out.

Another thing:
One more thing you might want to know. They cite to a Hayes brief. Hayes is a company that writes this garbage for insurance companies and justifies not paying for things. Any time you see Hayes, you know it's a biased assessment.

Articles

J Bone Joint Surg Br. 2009 Jan;91(1):16-23.
Links
Outcomes following hip arthroscopy for femoroacetabular impingement with associated chondrolabral dysfunction: minimum two-year follow-up.
Philippon MJ, Briggs KK, Yen YM, Kuppersmith DA.
Steadman Hawkins Research Foundation, Vail, Colorado 81657, USA.
Over an eight-month period we prospectively enrolled 122 patients who underwent arthroscopic surgery of the hip for femoroacetabular impingement and met the inclusion criteria for this study. Patients with bilateral hip arthroscopy, avascular necrosis and previous hip surgery were excluded. Ten patients refused to participate leaving 112 in the study. There were 62 women and 50 men. The mean age of the patients was 40.6 yrs (95% confidence interval (CI) 37.7 to 43.5). At arthroscopy, 23 patients underwent osteoplasty only for cam impingement, three underwent rim trimming only for pincer impingement, and 86 underwent both procedures for mixed-type impingement. The mean follow-up was 2.3 years (2.0 to 2.9). The mean modified Harris hip score (HHS) improved from 58 to 84 (mean difference = 24 (95% CI 19 to 28)) and the median patient satisfaction was 9 (1 to 10). Ten patients underwent total hip replacement at a mean of 16 months (8 to 26) after arthroscopy. The predictors of a better outcome were the pre-operative modified HHS (p = 0.018), joint space narrowing >or= 2 mm (p = 0.005), and repair of labral pathology instead of debridement (p = 0.032). Hip arthroscopy for femoroacetabular impingement, accompanied by suitable rehabilitation, gives a good short-term outcome and high patient satisfaction.


J Pediatr Orthop. 2008 Oct-Nov;28(7):705-10.
Links
Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: a preliminary report.
Philippon MJ, Yen YM, Briggs KK, Kuppersmith DA, Maxwell RB.
Steadman Hawkins Research Foundation, Vail, CO 81657, USA.
BACKGROUND: Hip arthroscopy is becoming a more popular method of treatment of pediatric hip disorders. We report on the treatment of femoroacetabular impingement (FAI) in the adolescent population. METHODS: Between March 2005 and May 2006, 16 patients (aged 16 years or younger) underwent hip arthroscopy for FAI. There were 14 female adolescents and 2 male adolescents, with 1 patient undergoing a bilateral procedure. Five patients had isolated pincer impingement, 2 had isolated cam impingement, and 9 had mixed pathology. All patients had labral pathology. Seven patients were treated with suture anchor repair of the labrum and 9 with partial labral debridement. Subjective data were collected from each patient during their initial visit and at follow-up after surgery. Subjective data included the modified Harris hip score (MHHS), patient satisfaction, and hip outcome score (HOS) activities of daily living (ADL), and sports subscales. RESULTS: The mean age at the time of arthroscopy was 15 years old (range, 11-16 years). The mean preoperative MHHS was 55 (range, 33-70), HOS ADL was 58 (range, 38-75), and HOS sport was 33 (range, 0-78). The mean time from injury to surgery was 10.6 months (range, 6 weeks-30 months). The mean time to follow-up was 1.36 years (range, 1-2 years). The mean postoperative MHHS improved 35 points to 90 (range, 70-100; P = 0.005), postoperative HOS ADL improved 36 points to 94 (range, 74-100; P = 0.001), and postoperative HOS sport score improved 56 points to 89 (range, 58-100; P = 0.001). The mean patient satisfaction score was 9 (range, 9-10). CONCLUSIONS: Hip arthroscopy for FAI in the adolescent population produces excellent improvement in function and a high level of patient satisfaction in the short-term.


Knee Surg Sports Traumatol Arthrosc. 2007 Jul;15(7):908-14. Epub 2007 May 4.
Links
Femoroacetabular impingement in 45 professional athletes: associated pathologies and return to sport following arthroscopic decompression.
Philippon M, Schenker M, Briggs K, Kuppersmith D.
Clinical Research, Steadman Hawkins Research Foundation, 181 W Meadow Dr. St. 1000, Vail, CO 81657, USA.
Femoroacetabular impingement (FAI) occurs when an osseous abnormality of the proximal femur (cam) or acetabulum (pincer) triggers damage to the acetabular labrum and articular cartilage in the hip. Although the precise etiology of FAI is not well understood, both types of FAI are common in athletes presenting with hip pain, loss of range-of-motion, and disability in athletics. An open surgical approach to decompressing FAI has shown good clinical outcomes; however, this highly invasive approach inherently may delay or preclude a high level athlete's return to play. The purpose of this study was to define associated pathologies and determine if an arthroscopic approach to treating FAI can allow professional athletes to return to high-level sport. Hip arthroscopy for the treatment of FAI allows professional athletes to return to professional sport. Between October 2000 and September 2005, 45 professional athletes underwent hip arthroscopy for the decompression of FAI. Operative and return-to-play data were obtained from patient records. Average time to follow-up was 1.6 years (range: 6 months to 5.5 years). Forty two (93%) athletes returned to professional competition following arthroscopic decompression of FAI. Three athletes did not return to play; however, all had diffuse osteoarthritis at the time of arthroscopy. Thirty-five athletes (78%) remain active in professional sport at an average follow-up of 1.6 years. Arthroscopic treatment of FAI allows professional athletes to return to professional sport.


J Arthroplasty. 2009 Sep;24(6 Suppl):114-9.
Links
Labral disease associated with femoroacetabular impingement: do we need to correct the structural deformity?
Nepple JJ, Zebala LP, Clohisy JC.
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
In this study, we compared the clinical results of arthroscopic partial labral resection to augmentation of this procedure with limited open osteochondroplasty for the treatment of symptomatic femoroacetabular impingement. Two consecutive cohorts were evaluated: (a) group I, arthroscopic treatment of labrum and articular cartilage, and (b) group II, hip arthroscopy augmented with limited osteochondroplasty of the femoral head-neck junction. Group I (23 hips) and group II (25 hips) patients had no difference in age, labral disease patterns, osteoarthritis grade, or chondromalacia. Mean follow-up was slightly longer in group I. The modified Harris Hip Score showed a trend toward higher values in group II. A 10-point improvement was more common in group II, and fewer group II patients required subsequent surgery. These preliminary data suggest that patients with cam femoroacetabular impingement may have improved clinical outcomes when the impingement deformity is corrected.


J Bone Joint Surg Br. 2008 Dec;90(12):1570-5.
Links
Early outcome of hip arthroscopy for femoroacetabular impingement: the role of femoral osteoplasty in symptomatic improvement.
Bardakos NV, Vasconcelos JC, Villar RN.
The Richard Villar Practice The Wellington Hospital, London, England. nbardakos@yahoo.com
There is a known association between femoroacetabular impingement and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient's symptoms. This study compares the results of hip arthroscopy for cam-type femoracetabular impingement in two groups of patients at one year. The study group comprised 24 patients (24 hips) with cam-type femoroacetabular impingement who underwent arthroscopic debridement with excision of their impingement lesion (osteoplasty). The control group comprised 47 patients (47 hips) who had arthroscopic debridement without excision of the impingement lesion. In both groups, the presence of femoroacetabular impingement was confirmed on pre-operative plain radiographs. The modified Harris hip score was used for evaluation pre-operatively and at one-year. Non-parametric tests were used for statistical analysis. A tendency towards a higher median post-operative modified Harris hip score was observed in the study group compared with the control group (83 vs 77, p = 0.11). There was a significantly higher proportion of patients in the osteoplasty group with excellent/good results compared with the controls (83% vs 60%, p = 0.043). Additional symptomatic improvement may be obtained after hip arthroscopy for femoroacetabular impingement by the inclusion of femoral osteoplasty.


Arthroscopy. 2008 May;24(5):540-6. Epub 2008 Jan 7.
Links
Arthroscopic management of femoroacetabular impingement: early outcomes measures.
Larson CM, Giveans MR.
Minnesota Sports Medicine, Eden Prairie, Minnesota 55344, USA. christopher_larson@med.unc.edu
PURPOSE: The purpose of this study was to evaluate the early outcomes of arthroscopic management of femoroacetabular impingement (FAI). METHODS: Ninety-six consecutive patients (100 hips) with radiographically documented FAI were treated with hip arthroscopy, labral debridement or repair/refixation, proximal femoral osteoplasty, or acetabular rim trimming (or some combination thereof). Outcomes were measured with the impingement test, modified Harris Hip Score, Short Form 12, and pain score on a visual analog scale preoperatively and postoperatively at 6 weeks, 3 months, and 6 months, as well as yearly thereafter. Preoperative and postoperative radiographic alpha angles were measured to evaluate the adequacy of proximal femoral osteoplasty. RESULTS: There were 54 male and 42 female patients with up to 3 years' follow-up (mean, 9.9 months). The mean age was 34.7 years. Isolated cam impingement was identified in 17 hips, pincer impingement was found in 28, and both types were noted in 55. Thirty hips underwent labral repair/refixation. A comparison of preoperative scores with those obtained at most recent follow-up revealed a significant improvement (P < .001) for all outcomes measured: Harris Hip Score (60.8 v 82.7), Short Form 12 (60.2 v 77.7), visual analog score for pain (6.74 v 1.88 cm), and positive impingement test (100% v 14%). The alpha angle was also significantly improved after resection osteoplasty. Complications included heterotopic bone formation (6 hips) and a 24-hour partial sciatic nerve neurapraxia (1 hip). No hip went on to undergo repeat arthroscopy, and three hips have subsequently undergone total hip arthroplasty. CONCLUSIONS: Arthroscopic management of patients with FAI results in significant improvement in outcomes measures, with good to excellent results being observed in 75% of hips at a minimum 1-year follow-up. Alteration in the natural progression to osteoarthritis and sustained pain relief as a result of arthroscopic management of FAI remain to be seen. LEVEL OF EVIDENCE: Level IV, therapeutic case series.


J Bone Joint Surg Am. 2007 Apr;89(4):773-9.
Links
Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement.
Beaulé PE, Le Duff MJ, Zaragoza E.
Division of Orthopaedic Surgery, University of Ottawa, Ottawa Hospital General Campus, 501 Smyth Road, Suite 5004, Ottawa, ON K1H 8L6, Canada.
BACKGROUND: Femoroacetabular impingement has been recently described as a common cause of hip pain and labral tears in young adults. We evaluated the early clinical results and quality of life after osteochondroplasty of the femoral head-neck junction for the treatment of femoroacetabular impingement. METHODS: Thirty-seven hips in thirty-four patients with persistent hip pain and a mean age of 40.5 years underwent surgical dislocation of the hip and osteochondroplasty of the femoral head-neck junction for the treatment of camtype femoroacetabular impingement. All of the patients had had preoperative evidence of pathological changes in the labrum on imaging. The clinical course and the quality of life were assessed postoperatively. RESULTS: The mean score on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) increased from 61.2 points preoperatively to 81.4 points at a mean of 3.1 years postoperatively (p < 0.001), the mean University of California at Los Angeles (UCLA) activity score increased from 4.8 to 7.5 points (p < 0.001), the mean Short Form-12 (SF-12) physical component score increased from 37.3 to 45.6 points (p < 0.001), and the mean SF-12 mental component score increased from 46.4 to 51.2 points (p = 0.031). None of the hips underwent additional reconstructive surgery. There were no cases of osteonecrosis. Nine patients underwent screw removal from the greater trochanter because of persistent bursitis. Six of the thirty-four patients were dissatisfied with the outcome. CONCLUSIONS: Cam-type femoroacetabular impingement is associated with insufficient concavity at the anterolateral head-neck junction and with pathological changes in the labrum. Osteochondroplasty of the femoral head-neck junction following surgical dislocation of the hip joint is safe and effective and can provide a significant improvement in the overall quality of life of most patients. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


I will post these as a start, and keep this as a work in progress. But right now it has been a VERY long day and my bed is calling me, as will my alarm clock in less than 5 hours!

Just When Things Were Getting Ugly.....

If you don't have a lot of time to read this post, I will post the gist of my visit with Dr K yesterday in one line:

"I think I need to go in and look around to see what is going on"

If you have the time, here are the details:

I had the PRP injection into the joint capsule about 3 1/2 weeks ago. It has not helped a bit. I am still having pain with walking, walking uphill etc (same as always)
As is the topic of many posts on my blog as well as responses to comments and personal emails, hip arthoscopy is very specialized and has a steep learning curve. What he is finding is that as his technique has changed slightly, patients are doing a lot better. He is not having any trouble from the "newer" patients, but the "older" patients are having issues. He did say that he knows a lot more now than he did when he did my surgeries (great!) One of the differences now is that he is stitching the capsule closed after he cuts it, instead of just approximating the edges. This was one of the things I learned when I observed him operating on one of my patients last year. I just re-read that post, he had mentioned that it puts less stress on the anterior structures and reduces tendonitis.

He has said from the beginning that he thought it was the capsule, I didn't agree. He thinks so bc I was in external rotation and that puts pressure on the anterior capsule. My MRI shows something wrong with the capsule, so did my ultrasound (during the PRP injection), my clinical signs do not. I have pain with flexion, pain with adduction, pain with internal rotation. No pain with external rotation, very little and seldomly pain in the posterior part of the joint. If I had pain in the posterior part he would think it could be ligamentum teres pain. I explained that I often sit or stand in external rotation, it is the most comfortable. He flipped through the MRI a few times and really didn't see anything of concern. He said he doesn't think it is my psoas, I agreed.
He sat down, sighed and said "so what do you want to do?", so I said "can you just cut it off? I really can't deal with this anymore". He laughed and said "should I amputate above the pelvis? you may look funny like that" so this went on a little.

Then he said it:
"I think I need to go in and have a look"
My heart stopped for a second and I got a little tear eyed I think. I said "You want to do an exploratory scope?" He said he doesn't think we have any other choice/ solution. He thinks that when I got up that day way back in June and had pain, I must have torn through some scar tissue, it then kind of flipped over and got stuck in the joint and now healed down like that.I was quiet for a long time (which is unlike me). I looked REALLY upset, and I think he was nervous that I would break down and lose it, so he said "do you want to try one more injection". Fine, what do I have to lose at this point. So we went over what I had injected in the past and what worked, what didn't. Do I want to inject the psoas? HELL NO, that was the worst one ever! So we agreed that injecting the joint would be a good idea since I had 2 days of relief last time, and since I have a "hole" in the capsule, it will leak out into the psoas anyway, so we are killing 2 birds with one stone. Fine.

So he left the room to dictate his note, I changed and went out to get the Rx from him. I walked around the corner to his receptionist and he followed me a minute later and said that he remembers we had discussed Synvisc a while ago. Anyway, he said at the time get the cortisone first and then we'll see. We ended up with the PRP then. So now he said try the Synvisc, it can be done with the cortisone.

As I drove home through crazy Manhattan, Friday afternoon traffic, I felt defeated. I was really sad, and angry, and anxious and a million other feelings all at once. I hope I can make the right decision on this and return to my prior level of function.

United Healthcare's new FAI Ruling

It has been brought to my attention that UHC has made a ridiculous ruling, basically trying to screw us all out of getting our symptomatic hips fixed and allowing us to return to a normal life. I am currently compiling information to prove that their ruling is wrong, unfair, and based on a small number of articles which state that further research needs to be conducted in FAI. they neglected to include the other articles which show that FAI surgery is successful. Below is their take on the issue. Please feel free to write, call, email etc the people at UHC and voice your opinion. If you would like the names of specific people to email (i.e VP and president of HR, medical director), please email me, or leave your email in the "comments" section of this post.


This information is being distributed to you for personal reference. The information belongs to UnitedHealthcare and unauthorized copying, use and distribution are prohibited. This information is intended to serve only as a general reference resource regarding our Medical Policies and is not intended to address every aspect of a clinical situation. Physicians and patients should not rely on these Medical Policies in making health care decisions. Physicians and patients must exercise their independent clinical discretion and judgment in determining care. The enrollee's specific benefit documents supercede these policies and are used to make coverage determinations. These Medical Policies are believed to be current as of the date noted.
Confidential and Proprietary, © UnitedHealthcare, Inc. 2009
Femoroacetabular Impingement Syndrome
Type
Technology Assessment
Number
2009T0530A

Approved By
Approval Date
Medical Technology Assessment Committee
8/20/2009

Description
After evaluating relevant benefit document language (exclusions or limitations), refer to Coverage sections of this document to determine coverage.
This policy describes surgical treatment for femoroacetabular impingement (FAI).
Coverage
All reviewers must first identify member eligibility, any federal or state regulatory requirements and the plan benefit coverage prior to use of this policy.
Coverage RationaleSurgical treatment, both arthroscopic and open, for femoroacetabular impingement (FAI) syndrome is unproven. This includes the arthroscopic or open procedure itself, removal of any bony and soft tissue pathology including resection of excessive acetabular bone coverage, resection of femoral head-neck junction, labral repair with or without grafting, and debridement or shaving of articular cartilage. At the present time, there is insufficient evidence of long-term efficacy and safety. Long-term, randomized controlled trials are needed to help clinicians better understand the diagnosis and make effective recommendations for treatment.Centers for Medicare and Medicaid Services (CMS): Medicare does not have a national coverage policy for femoroacetabular impingement surgery. Local Coverage Determinations (LCDs) does not exist at this time. Accessed May 11, 2009.
Regulatory Requirements
U.S. Food and Drug Administration (FDA): Although arthroscopic hip surgery for FAI is a procedure that is not subject to FDA regulation, devices and instruments used during the surgery require FDA approval. A search of the FDA 510(k) database revealed over 500 arthroscopes approved for marketing (product code HRX); however, the available studies did not provide sufficient information to determine which 510(k) approvals correspond to the instruments used.Additional information is available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm Accessed August 3, 2009.
Research Evidence
BackgroundFemoroacetabular impingement (FAI), formerly called acetabular rim syndrome or cervicoacatebular impingement, is the main cause of early damage to the acetabular labrum and articular cartilage of the hip, particularly in young, active patients and high-level athletes. In patients with FAI, limitation of both flexion and internal rotation occur at the hip joint as a result of premature pathologic contact between the skeletal prominences of the acetabulum and the femur. FAI generally occurs in one joint; however, in rare cases both hips can be involved. Surgical treatment has been utilized to improve the clearance for motion at the hip joint and lessen the femoral thrust against the acetabular rim. If left untreated, FAI may lead to osteoarthrosis of the hip. (ECRI, 2008)FAI is common in patients presenting with low back pain, cartilage damage, hip pain, loss of range of motion, disability, and sport hernias. Most patients can be diagnosed with a good history, physical examination, plain x-ray, and magnetic resonance imaging. The three types of FAI include the following (ECRI, 2008; NHS 2007): 1) cam impingement due to an aspherical portion of the femoral head-neck junction (i.e., femoral cause) which is most common in young athletes;2) pincer impingement due to focal or wide-ranging excessive coverage of the ball or femoral head (i.e., acetabular cause) which is most common in athletic, middle-aged women; 3) mixed pincer and cam impingement which is the most common type of FAI. Clinical EvidenceA systematic review by Bedi et al. (2008) reviewed 19 articles to determine the quality of the literature assessing outcomes after surgical treatment of labral tears and femoroacetabular impingement (FAI), patient satisfaction after open or arthroscopic intervention, and differences in outcome with open or arthroscopic approaches. The studies reviewed support that 65% to 85% of patients are satisfied with their outcome at a mean of 40 months after surgery. A common finding in all series, however, was an increased incidence of failure among patients with substantial pre-existing osteoarthritis. Arthroscopic treatment of labral tears is also effective, with 67% to 100% of patients being satisfied with their outcomes. The authors concluded that the quality of literature reporting outcomes of surgical intervention for labral tears and FAI is limited. Although open surgical dislocation with osteoplasty is the historical gold standard, the scientific data does not show that open techniques have outcomes superior to arthroscopic techniques.In a prospective observational study, Tanzer and Noiseux (2004) examined the role of FAI in hip disorders. For this study, 38 patients who had labral tears detected during hip arthroscopy and who had radiographic evidence of FAI were followed prospectively after arthroscopic removal of the torn portion of the labrum. Labral tear development was acute as evidenced by a twisting episode or well-defined precipitating event for 19 (50%) patients, insidious or gradual onset of worsening symptoms for 12 (32%), and due to major trauma as evidenced by a violent impact or dislocation for 7 (18%). In 16 (43%) of these patients, arthritic changes were identified on radiographs taken after arthroscopy. Damage associated with acetabular tears included femoral or global arthritic changes in 7 (18%) patients, anterior acetabular arthritic changes in 6 (16%), and femoral chondral lesions in 3 (8%). At 1 year of follow-up of 24 (63%) patients, mechanical symptoms had resolved completely in all patients; however, only 6 (25%) of these patients no longer had pain. The authors concluded that although arthroscopy for hip impingement is promising, future studies are needed to determine if correction of the anterior hip impingement, early in the natural history of the disease, may delay or prevent end-stage arthritis. This study is limited by small sample size with short term follow-up and a non controlled study design.In a prospective study by Peters and Erickson (2006), 30 hips (29 patients) with femoro-acetabular impingement underwent debridement through a greater trochanteric flip osteotomy and anterior dislocation of the femoral head. Cam (femoral based) impingement was noted in 14 hips; pincer (acetabular based) impingement in 1hip; and combined cam and pincer impingement in 15 hips. Mean patient age was 31 years. The mean duration of clinical and radiographic follow-up was 32 months. All patients were followed according to a prospective protocol, with Harris hip scores and plain radiographs obtained preoperatively and at 6 months, 1 year, and annually for a minimum of 2 years. The mean Harris hip score improved from 70 points preoperatively to 87 points at the time of final follow-up. In 18 hips, severe damage of the acetabular articular cartilage that had not been appreciated on preoperative plain radiographs or magnetic resonance arthrography was noted on arthrotomy. Eight of these 18 hips subsequently had radiographic evidence of progression of the osteoarthritis, and 4 of the 8 hips required or were expected to soon require conversion to a total hip arthroplasty to treat progressive pain. The authors concluded that surgical dislocation and debridement of the hip for the treatment of femoro-acetabular impingement in hips without substantial damage to the articular cartilage can reduce pain and improve function. This study is limited by its uncontrolled study design and small sample size.Sampson (2005) conducted a retrospective study of arthroscopic hip surgery for FAI, which reported results for 156 patients, some of whom underwent bilateral arthroscopic surgery. The ages of these patients ranged from 14 to 75 years, and most were between the ages of 20 and 40 years. Symptoms were generally mild and included somewhat reduced range of motion (ROM), poor tolerance of prolonged sitting, and inability to participate in sports. For the majority of patients, pain relief was 50% in 6 to 12 weeks, 75% in 5 months, and 95% in 1 year. Patients no longer needed crutches after 2 to 4 weeks. After follow-up ranging up to 22 months, 3 (2%) patients opted for total joint replacement due to continued pain. The average follow-up period and protocol for follow-up were not reported. This study is limited by its retrospective design, heterogenous patient population which limits the generalization of this data to other populations or who is best suited for the procedure, and lack of defined follow-up period and protocols.An uncontrolled study by Larson and Giveans ( 2008) on 96 patients (100 hips), was conducted to evaluate the early outcomes of arthroscopic management of femoroacetabular impingement (FAI). There were 54 male and 42 female patients with a mean age was 34.7 years. The surgical procedures performed were 26 (26%) proximal femoral osteoplasties, 21 (21%) acetabular rim trimmings, and 53 (53%) combination osteoplasties and trimmings. Patients also underwent labral debridement and repair or refixation as needed. At a mean of 10 months follow-up compared with baseline, mean pain score decreased from 6.7 to 1.9, mean Harris Hip score increased from 61 to 83, and mean SF-12 quality-of-life score increased from 60 to 78. All of these improvements were statistically significant (P<0.001). n="19" name="
References and Resources
ResourcesAmerican College of Rheumatology (ACR) [website]. Recommendations for the Medical Management of Osteoarthritis of the Hip and Knee. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000;43(9):1905-1915. Available at: http://www.rheumatology.org/publications/guidelines/oa-mgmt/oa-mgmt.asp?aud=mem Accessed June 1, 2009.Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy. 2008 Oct;24(10):1135-45.ECRI Institute. Hotline Response. Surgical Treatment of Femoroacetabular Impingement. June 2008.Hayes, Inc. Health Technology Brief. Arthroscopic Hip Surgery for Femoroacetabular Impingement (FAI). Lansdale, PA: Hayes, Inc.; July 18, 2008.Ilizaliturri VM Jr, Orozco-Rodriguez L, Acosta-RodrE, Camacho-Galindo J. Arthroscopic treatment of cam-type femoroacetabular impingement: preliminary report at 2 years minimum follow-up. J Arthroplasty. 2008;23(2):226-234.Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcomes measures. Arthroscopy. 2008;24(5):540-546.National Institute for Health and Clinical Excellence (NICE). Open femoro-acetabular surgery for hip impingement syndrome. Interventional Procedure Guidance 203. London, UK: NICE; January 2007a. Available at: http://www.nice.org.uk/nicemedia/pdf/IPG203guidance.pdf Accessed May 1, 2009.National Institute for Health and Clinical Excellence (NICE). Arthroscopic femoro-acetabular surgery for hip impingement syndrome. Interventional Procedure Guidance 213. London, UK: NICE; March 2007b. Available at: http://www.nice.org.uk/nicemedia/pdf/ip/IPG213Guidance.pdf Accessed May 1, 2009. National Library for Health (NLH). NHS Evidence. Surgery for Femoroacetabular Impingement. 2007. Available at: http://www.library.nhs.uk/trauma_orthopaedics/viewResource.aspx?resID=269337 Accessed June 1, 2009.Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and din young adults. J Bone Joint Surg Am. 2006 Aug;88(8):1735-41. Philippon MJ, Yen YM, Briggs KK, Kuppersmith DA, Maxwell RB. Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic adolescent patient: a preliminary report. J Pediatr Orthop. 2008 Oct-Nov;28(7):705-10.Philippon MJ, Stubbs AJ, Schenker ML, Maxwell RB, et al. Arthroscopic Management of femoroacetabular impingement; Osteoplasty technique and literature review. Am J Sports Med. 2007; 35(9):1571-1580.Sampson TG. Arthroscopic treatment of femoroacetabular impingement. Tech Orthop. 2005;20(1):56-62.Stahelin L, Stahelin T, Jolles BM, Herzog RF. Arthroscopic offset restoration in femoroacetabular cam impingement: accuracy and early clinical outcome. Arthroscopy. 2008;24(1):51-57.Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;(429):170-177.
History/Updates
9/1/2009
New Policy.
Coding

The Current Procedural Terminology (CPT) codes and HCPCS codes listed in this policy are for reference purposes only. Listing of a service code in this policy does not imply that the service described by this code is a covered or non-covered health service. Coverage is determined by the benefit document.CPT Codes:
27299
Unlisted procedure, pelvis or hip joint
29999
Unlisted procedure, arthroscopy

When Will It Ever End

I haven't updated in a while bc things have been status quo since my PRP injection, no better no worse, just plain old shitty. To add insult to injury, I was sitting in my car yesterday with that leg in slight internal rotation. I went to reach into the back seat and the hip went further into internal rotation and I felt an awful ripping/ tearing in my hip. I immediately felt really nauseas too. Now it is super sore and stiff and really painful. My hope is that it was scar tissue tearing (I imagine there is a ton in that hip) but in the past when I have torn through scar tissue my hip felt better.

Today I have been really uncomfortable, I have pain and burning in the groin, sitting in the car was really uncomfortable. Walking is really uncomfortable. I don't know what the hell happened but needless to say I am scared shitless. I see BK next week, if this hasn't gone away by then I will be this much closer to losing it completely.

To all my Jewish readers, happy new year!

PRP Injection...done

After much anticipation, and 3 months after my problem started, I had my PRP injection. But not without snafus!

My appointment was at 11am. at 11:45 the radiologist came out and asked me if I knew if BKs office arranged for the PRP machine (centrifuge) to be brought over. Umm, I would assume so given all the trouble it had been to arrange this. He said he hadn't seen the rep from the company around but knew she was over at HSS, so she was "in the neighborhood".

At around 12:15 the rep arrived with the machine. We began getting the injection underway close to 12:45.

First, the radiologist, using ultrasound, checked out the hip. He could see the debrided labrum and where bone had been shaved, as well as "reduced echo" on the anterior joint capsule. He then took blood from my arm, 10cc. For some reason, this was more uncomfortable than normal. He handed the blood to the rep who spun it down for 5 minutes and then placed 3 cc of plasma into another syringe. The radiologist then injected this into the area around the capsule and the muscles and tendons. He went through the muscles a few times leaving me pretty sore. It has been 11 hours and my thigh really hurts. I just want to climb into bed and sleep for 12 hours!

I really really hope this works!

What I learned from the rep (who was super sweet) is that there are different kinds of PRP, this specific one is called ACP, autologous conditioned plasma.
http://www.orthoillustrated.com/index.cfm?ResDiaRelID=122

I am still not 100% what the differences are but I am working on learning more. The rep is emailing me some info tomorrow!

Putting Out

Yesterday, I was speaking with a patient who recently underwent a total hip replacement after years of groin pain. I have treated her for quite a while so we have become close. She was asking me about my hip, and how I am coping.....She asked if I was depressed. I am not, surprisingly. I think so many people with pain are, and I understand why, but luckily, I am not one of them.

The topic of sex got brought up (remember, besides for orthopaedic issues, I am also a pelvic floor therapist). I told her that sex is one of the hardest things for me, it oftentimes hurts, and when the act itself doesn't hurt, I pay for it the next day.

She thought about it for a second and said to me: "Honey, you better put out for him because you don't want him to get it from somewhere else"

Duly noted!

Desperate Times Call For Desperate Measures....Or At Least I Thought So

I haven't really mentioned it here before but Z has given me a run for my money. As cute and adorable as he is, he is constantly sick and having "issues" that worry me. His latest has been scary sounding wheezing. About 3 months ago, I took him to a pulmonologist, we will call him douche bag. Db basically said that Z was fine and I was an idiot/ crazy mother who thinks that sniffling is wheezing. I checked DB out with some friends and it turns out that he is pretty much the top pediatric pulmonologist around, but there was no way I could ever deal with him. After discussing with my pediatrician, she agreed that he indeed had acted like a db and that I needed a new pulmonologist ASAP since she was convinced Z would need constant care from one.

Fast forward to about 1 month ago, I see the new pulmonologist, NP. He took one listen to Z and confirmed that he has asthma and some other crazy breathing stuff going on that I won't get into. He thinks he may need to do a bonchoscopy..... this does not make me happy. He told me to try some meds first and come back in 2 weeks.

This is where the desperate times/ desperate measures comes into play. I took Z to a chiropractor after being convinced by a co-worker (non-PT) and a family friend.
The chiropractor assures me that he can "fix" Z. Fast forward 2 weeks, Z has been on his meds and seeing the chiro and is doing great.

Today the chiro suggested I should see him too. I laughed. My issues are soooo ridiculous and so complicated, you don't want me, trust me!! So I left and walked back home, during which I was in a ton of pain. I decided that at that moment in time I was willing to try anything....so I called him and he told me to come in.

He started off by taking an x-ray of my lumbar spine/ pelvis. He was shocked at what he saw. My iliac crests were not even, trochanters were not even and my spine curving in some funky way. I am not quite sure what he had expected but he said that he would expect the spine to curve the other way given the leg length discrepencies. He suggested putting a small lift into the shoe on the non painful side. He did some manips and I was in a lot of pain. The rest of the day the groin pain was pretty bad.

So now I can add chiropractic to my list of "what makes my pain worse", which now includes: walking uphill, pushing my stroller, PT, sex, repetitive crouching to the floor (like when cleaning up toys) and other random activities. I am puting all my money on the PRP injecion!!

Injection # 6...Scheduled...Finally

To show that I am not an impatient bitch, here is a timeline of events....


Jun 6- all hell broke loose in my hip
Jun 17- appt with BK
Jun 26- MRI
July 2- spoke to BK re MRI and getting cortisone injection
July 21- Cortisone injection
July 29- spoke to BK re PRP injection
so when would you guess it is scheduled.......

no...keep going........

a little longer........


Sept 2- PRP injection scheduled

so yes, I am slightly annoyed and growing impatient. I haven't posted about the annoyance in getting this one scheduled but the mere act of writing about it annoys me. But here it goes. I spoke to BK on a Wed. He said "let's try to get it done this week", to which I simply replied "ok", I wasn't about to start explaining to him how miserable it is to schedule something with his office (I will save this for my next appointment, which will be Sept 25th). I was also supposed to wait for his office to call me with the appointment time.

6 days later, I, of course, had heard nothing, so I called them. They were trying to figure out which hospital should do the injection (HSS or NYP). I let the rest of the week go by, still nothing. I called them back on Monday (this is now 1 1/2 weeks later)....still trying to schedule (it was decided that yes, it could be at NYP with the good radiologist). Radiologist was not in the office that day so nothing could be done. I finally got a call the next day, could I do the following Monday at 10:30? No. I see patients then. Of course, during the past week and a half, no one bothered to ask me what my availability was, mind you, I am pretty flexible, I only see patients 3 mornings/ week, but this never occurred to anyone.

Fast forward to yesterday, 2 weeks + 1 day since it was decided that I would get the PRP. I called his office to see what the problem was now. To which I got this response: "Oh, didn't X call you?" NO...."Can you do Sept 2 at 10:30?" FINE. Clearly I was not about to start having them find me an earlier time, I will take what I can get with them and just deal with it....complain about it, but just deal with it!!!!

You must think I’m crazy!!! (my little secret)

No, this isn’t Susie writing today. I’m her 25 yr old brother who had surgery on Feb 23, 2009 to repair a partially torn labrum of the right hip. I do follow this blog, not religiously like some, and yes, on occasion I’ll comment either as myself, or anonymously like my brother in law and write obnoxious comments. ie don’t hesitate to amputate. But I digress, I’d like to let all of you a little secret, and I don’t say this because Susie is a PT but because it’s true. PT with my therapist, Ira saved my life. My life is dominated by sports, ice hockey, tennis, soccer and the most recent to be added to my list is the triathlon. (oh yeah, skydiving too). I get moody and slightly depressed if I’m not active or in this case, hyper-active. (no I don’t have ADD) Immediately after surgery Susie pushed me to my limit, which on days 1-3 post-op was extremely limited, but this little lesson would help me along the way. PT 2x a week, swimming for an hour every day and stretching with thera-bands among other things. I won’t get to technical with my stretches and regimen b/c that’s not my thing. I’m an analyst by trade. But here’s a little timeline…
8 days out one crutch, 15 days no crutches, 3.5 weeks a mile on the treadmill, 6 weeks 15 minutes running on the treadmill, 10 weeks back on the tennis court, 12 weeks 20 miles on the road bike in an hour Now I won’t say I’m 100% because I do feel pain every now and then, but nothing to indicate a tear. Just general tightness which is easily alleviated by a few stretches but 90-95% sounds about right. I’m 5 ½ months out, I’m back on the ice, playing soccer, riding my bike, playing tennis 2-3x a week and just got back from the state tennis tournament. (4 matches in 3 days in 95 degree heat and 90% humidity). A little hip pain won’t stop me! I just try my best to stretch and stay loose everyday. If you think my life sounds hectic and my days are consumed by sports, you’re right. Did I mention I have a girlfriend too? Oh yeah I like to go out drinking when I get home after playing. So figure I get home at 10, shower, go out and wake up at 7:30 everyday and do it all again. What do you think, can you handle it? Oh wait, I forgot to mention, I’m eyeing a triathlon late Sept early October. You must think I’m crazy!!!!!

Still Waiting

It has been 6 days since I spoke with Dr. Kelly regarding the "new plan". I have not been able to schedule the injection yet. I finally got around to calling his office today, there seems to be a conflict regarding the vendor of the machine for the PRP and which hospital uses which (big fat mess). There may be a possibility that the radiologist who has been doing my injections will not be able to do this one because his hospital uses the "other" vendor. As usual, red tape and silly delays.

In the meantime, I am truly miserable. I am in so much pain a lot of the time, and having ass pain again. Feeling like I am back to square one is taking an emotional toll on me and I am just worn out. I don't even know if I agree that my pain is being caused by the joint capsule having a problem. My pain is the same as it was pre-op, I have pain with flexion and internal rotation and I have lost most of my active internal rotation on that side. I am really concerned. I am sure, positive actually, that all of the impingement was removed during my last surgery. I don't think I would have had such a great year and a half, and pregnancy and delivery, but what is going on now? He did mention that it is possible for the bone to grow back, but that just seems insane to me.

And if it did, then what? why would removing it again guarantee me that it wouldn't happen again?? And why does my ass hurt?

The New Plan

I spoke with Dr K earlier tonight regarding my injection and funky reaction. Of course he has never seen this happen before, the only possible thing he can attribute this to is some high signal in the capsule on the MRI. Given no other signs, and given the reaction to the injection, he does not think that Synvisc is the way to go at this time. He would rather I try a Platelet Rich Plasma (PRP) injection into the capsule and then see him 4 weeks later.

I am ok with this. Actually, I am so desperate to be pain free I would have agreed to pretty much anything at this point! Now the question is how long until his office can make this happen!!!

What A Waste

I am back to status quo, meaning, the way things were immediately before the injection. What does this mean?? My awful medial and posterior pain are gone, thank goodness. But the painfree days I had immediately post-injection are gone too, I am back to having old fashioned groin pain :-(

Now I most certainly have no idea what is going on and I am getting pretty upset about it. If I had "tweaked" my hip and caused some localized inflammation, the cortisone would have taken care of it. The fact that I had those 2 perfect days clearly shows that the pain is from the hip joint, but now the question is why??

I have a call in Dr. K, he will hopefully get back to me within a reasonable amount of time, or before I do something drastic, like amputate!!!

Despite Everything, I Still Have Something To Smile About

Not So Much Happiness

In all of my worse case scenarios, this was not even a possibility....Let me begin by saying that my injection was Tuesday, Wed and Thurs were amazing, I felt like I was dancing on clouds with rays of sunshine jutting out and birds chirping in my ear. Then came Friday. I woke up with some pain, as the morning went on, I kept feeling this horrendous pain a little more medially than where I normally do. I got home around 1PM and suddenly I could barely put weight on my leg. Of course I called J in a panic, who asked if I was going to be ok because he had to run into a meeting! That subsided but I have been left with really bad medial hip pain and posterior hip pain. All I can say is WTF??????????? I have no idea what is going on, what could have possibly happened, and why I am in so much pain? And why does my ass hurt all of a sudden?

Cortisone = Happiness

Yes! I am once again in a happy place in hipville!! I feel sooooo much better! I don't want to jinx anything but this seems to have done the trick. My plan is to give BK a call on Monday and let him know I am doing well, and re-visit the issue of more injections. It seems silly bc I feel so good now, but lets be honest here, cortisone is much like a bandaid, who knows what the real deal is here! I am just nervous that the cortisone will wear off and basically leave me f--ked all over again! Who would have ever imagined that things would get so complicated!

Injection # 5...over

A huge sigh of relief! My injection into the joint was about 5 1/2 hours ago. I have to say that the radiologist who does all of my injections is truly first class. He is so gentle and thorough. 2 hours ago I was completely pain free, it was such a wonderful feeling. Now the marcaine is beginning to wear off, I hope I am not in for a hellish night.

The injection went very smoothly. First he moved my hip around into deep flexion, then flexion with IR, then flexion with ER. I had to rate each position using a pain scale. Pre-injection I rated 5, 10 and 0 respectively.

He then marked the areas he did not want to inject and the area he did want to, injected a local to numb the skin, again, so gently. Then the big needle. It wasn't bad at all. Yes, I felt it, but it was a piece of cake. He then injected some contrast material and took an xray to see where the contrast went. It all kind of pooled around the femoral neck. He pulled up my old films and explained that he didn't like what he saw because last time, the contrast material moved more medially and did not pool like that. He decided to reposition the needle. Ugh. But again, it was not bad at all, and this time, the contrast spread as it was supposed to.

He injected everything in, gave it time to settle, and retested my hip ROM. This time, my pain was 0, 0 and 0.

So now what??

Hopefully, the pain will just go away, and never come back, and this was just a blip on the radar of successful hip arthroscopies!!!

Soccer

I have been quietly dealing with this flare up of hip pain but it is getting to the point where I am starting to lose it (again). What I have noticed is that soccer is making me soooo much worse. We are not talking about running through long fields, blocking balls with your head, diving into the ground soccer. What it is is playing with L and Jk, who are 5 and 3 1/2 respectively, just lightly kicking around a ball and stopping it with my foot. That is it. This seemingly innocent game is causing a hellish scene in my joint. By hellish I mean that given the opportunity, I may cut off my leg.

Interestingly, I wouldn't even rate the pain as that intense, it is the quality of pain that is getting to me. It is searing, aching, deep deep in the joint. Sound familiar? A little too close for comfort if you ask me.

Day 8

It is scheduled! Phew! Not until July 21st, but i'll take it, it is not worth the aggravation of having to have them call and see what is available, and call me back, So July 21st it is.

As I was about to write this, I got a call from HSS MRI department, calling me to confirm my MRI this Sunday.....huh? I already had my MRI. They said that someone from Dr. Kelly's office called to make me an appointment for an MRI of my right knee. Huh??? I told her to call Dr. Kelly's office since there seems to be a lot of confusion there. Maybe it was for the Laura they were looking for when they called me. So, Laura, if you read my blog, you have an MRI scheduled this Sunday at 3:30 @ HSS! Good Luck!

Day 7

You guessed it, nothing scheduled yet, not even a call back yesterday from his office. I have never heard of such complete and utter bullshit.

6 Days Later

It has been 6 days since BK and I spoke about getting a cortisone injection. It is not yet scheduled, I know, you are completely blown away. I called his office on Monday to schedule, they did not yet have the prescription, but I was assured that as soon as they had it they would call me! I called again yesterday, they were about to get the prescription and call me back...good thing I didn't wait all day by the phone. Actually, I shouldn't say that, they did call, except not for me. I got a call from his office asking for Laura, so I explained that I was not Laura but was indeed waiting for a call back from them, so again, I was assured that they would call me back "very soon". And here I am, waiting and waiting!!!

At least I am not waiting in a state of panic and anxiety, like I have been in the past, when the injection was the deciding factor between surgery and no surgery. This time, it won't change much other than (hopefully :-) my pain level!

I have added a "Follower" button to my blog, I am not 100% certain what it is, but a fellow hip blogger (Sarah) just sent me a link to hers and I see other blogger friends using it, so I figured it is the "thing" to do!!!

So What To Do Now????

So I spoke with Dr. K tonight regarding the MRI and the results. The good news is that there is no sign of an acute injury (subluxation, etc). There is some fluid in the psoas, and scarring on the capsule, both of which may be causing me trouble. He has never seen someone who presents the way I do (of course not, I am very special, he agreed) So...he thinks I should get an ultrasound guided psoas injection.

My last psoas injection was miserable, it took about 45 minutes, and following it, I lost all active hip flexion for a few days. I don't want to do that. He understands and is ok with that. He thinks I should then go ahead and get the joint injected, since the psoas and capsule will benefit from it as well. I don't know if this seems like a final solution, I just am not sure and I don't know what to do. I asked about getting Synvisc injected into the joint, he said he generally doesn't inject Synvisc into people "like me", meaning with no arthritis. I pointed out the cartilage thinning in the joint, he didn't think it was all that impressive. He said that if I go with Synvisc, they first do a cortisone injection about a week before, then 3-5 Synvisc injections after. Or, I could go with super duper non-FDA approved Synvisc that is given only one time. Or...I could go with a platelet rich plasma injection, of which the results are not yet conclusive.

So...... a lot of options, not a lot of evidence...nothing of great significance (shocker) on the MRI. So, I have decided to go ahead with a cortisone injection into the joint, I can then decide if I want to stop with that or continue on with the synvisc. I hope that this will be the solution for me because I am getting pretty fed up with hip pain!

My MRI Report Ordeal

As some of you know, I can be quite obsessive compulsive when it comes to test results. Mri #4 being no different! I was told that it would take 2 business days for the report to be done and delivered to Dr. K. My MRI was Fri at 7am. I called Tuesday, no report. I called again on Tues, no report. I called Wed, no report. So I called the radiology department directly (did I mention I have a touch of OCD), they confirmed that the report was indeed done, and had been sent to my doctor. Hmmmm, sigh! So I called his office yet again (they must love me) and informed them that the report was ready. I was told that they would send someone to go pick it up. I left my fax number and everything. No report. Today I was running out of patience, so I called his office again, no report. I told them it was done, and asked why they didn't have it, they told me that if they didn't have it by mon or tues (today is thurs) that they would send someone to go get it. I got off the phone feeling annoyed and exacerbated, called radiology again and explained my dilema. They offered to fax it to him (they can't fax it to me directly) on the spot, given my annoyance! 30 minutes later I called his office and they had it in the fax machine, now I hold a copy in my hot little hands!!!

Right Hip MRI #4 (edited)
There is mild trochnateric bursal thickening bilaterally. The anterior labrum is somewhat small probably related to debridement. the anterosuperior labrum is deficient, similar to the prior study, with the posterior labrum being intact. There is defect in the anterior capsule superiorly in the region of the surgery extending 2.5cm in transverse dimension.

Cartilage over the femoral head is thinned anterosuperiorly. Focally, there is no full thickness loss. the superior cartilage is high signal. The acetabular cartilage has thinning anterolaterally, slightly more prominent on the prior study as well as anterosuperiorly where there is a focal area of near full thickness loss which has increased from the prior study over 4mm. there is no prominent effusion. No reactive signal in the underlying bone is evident.

The patient has undergone anterior bumpectomy with remodeling of the anterior femoral neck. focal adjacent scar is evident.

There is iliopsoas tendon thickening and high signal representing tendinosis bilaterally.

Prior abdominal surgery has been performed

There is a transitional lumbosacral junction. Disc signal is mildly lost at what appears to be L4-5 where there is a small to moderate central disc protrusion. The sacroiliac joints show mild high signal and osteophytes. Minimal free fluid is the cul de sac. Hamstring origins are intact.
The muscles appear fairly symmetric.

The previously demonstrated left sided edema, presumably from arthroscopy of the left hip has dissipated.
There are 14 degrees of femoral anteversion.

Impression:
Interval bumpectomy since the prior study with postoperative scar and anterosuperior capsular defect.
There is persistently deficient anterosuperior labrum. Since the prior study, there has been a slight increase in the focal acetabular cartilage anterosuperiorly, without advanced arthrosis.

MRI #4...Over!

All my nervousness and planning was for nothing! I "passed" with flying colors, I don't even think my heart rate went up once during the scan. I followed my own rule about keeping my eyes closed the whole time, let the cool "breeze" from the machine's fan keep me feeling like I was not in an enclosed space, and actually enjoyed the time away from work, kids and my blackberry! I did bring a cd with my own music but it stopped working after the first song, I'm not sure why, the technician wasn't too savvy with the stereo system, but despite this, I was still cool as a cucumber! I did inform her that I was nervous, which at first didn't thrill her. But I explained that it was my 4th scan (5th if you count the knee one last year) and I have always gotten through them. She wanted to know what I did, so I explained that deep breathing helps and that the technician tells me how long each particular series will take. She seemed ok with that and spoke to me in between scans. It even got annoying because I almost fell asleep!!!

Now, the waiting game begins for the results! I will be at a continuing ed course all day Sun, Mon and Tues, so this should keep me occupied! I will post once I know!

Too Cute

and an update....

My pain has not gone away but it is a little better. Saturday I did absolutely nothing...I didn't even leave the house, and I felt fine. Yesterday I did a little more and the pain was there, but it is clearly related my activity level. I played some Hopscotch Twister with L and of course the pain came back. I have managed to change my MRI appointment to this Friday (one week earlier than originally scheduled) so we will see....

And the Good News is.....

Today was my appointment with Dr. Kelly. I had my first ever post-op x-rays done. They showed that my joint space is great on both sides, no arthritis and no narrowing of the joint space! Hurray!!!

One view of the x-ray showed a 'shadow'...he wasn't too clear on what it as, but another view did not have it. Shadow on x-ray=MRI :-(

He thinks there is a possibility that my hip may have subluxed and spontaneously reduced the night when all this started. This may have resulted in a cartilage injury. Possible cartilage injury= MRI :-(

The good news is that he really doesn't think I could have damaged any labral tissue, since it has all been debrided! The good/bad news is that oftentimes the labrum sort of regenerates and you get a nice layer of fibrocartilage there, not quite as good as the articular cartilage labrum, but better than nothing. the bad news is that this may have been injured. Again, possible regenerated labrum injury= MRI :-(

So, as you may have imagined, I have to have an MRI. This will be my 4th, yes, 4th hip MRI in 2 years!

He wanted me to get it tomorrow or the next day, I have soooooo much going on this week between ballet recitals, Pre-K graduations, end of the year parties, parents visiting....this was not a possibility. Luckily (for me), the hospital is booked solid for MRI's for a week and a half, the next available appointment was next Friday @6:00pm. This doesn''t work. Monday and Tuesday I have full day continuing education courses, so Wed, July 1st is the first day I can go. Deep down, I think I am hoping the pain will go away and I can cancel it. I am also looking to score some tranquilizers before I do it LOL!!!! I will have to read back on my surviving MRI tips if I go through with this!

Here is a clip from L's recital. She is the one in pink in the middl.

Making Headway???

This whole thing has me extremely upset and anxious (which is why I can't sleep at 10:30 when normally would be passed out). I "broke down" today and called Dr. Kelly's office. I am just so confused as well about this.

We spoke this evening, I explained what I did (or lack of "did"). He thinks its possible that my hip may have 'slipped', so I should get an x-ray. Its also possible that my extremely tight psoas (yes, it's very tight and snaps) may have been put into a lot of tension when I was sitting indian style and could have irritated the joint. There could be synovitis. Also, by addressing the FAI surgically, the cartilage can soften making it more susceptible to injury.

So the plan is to see him (he was sooo nice and accommodating) and get an x-ray. I am juggling my schedule in my head trying to figure out the best way to do this. Friday is looking good. Hopefully, the x-ray will be ok, and my joint didn't shift or move or slide (not sure what the solution is to that), then an MRI (shoot me). I asked him if he thought an MRI would show anything at this point, he said it would show an acute injury or inflammation or synovitis. Then, maybe an injection. I'm not taking any anti-inflammatories bc of my other issues (Crohn's disease), and haven't taken anything for pain, but was reminded tonight that Tylenol works great for me.

J thinks I am overreacting and had the audacity to tell me I have a low tolerance for pain. Need I remind him I just had a baby without any drugs at all, as well as the lack of drugs I ever took pre-op. Yes, I am freaked out, but after all I went through, I REALLY can't go through it again.

Speaking of J, he is down 100+ lbs

This Really Can't Be Hapenning To Me

I am still in pain. It has been 3 days and no relief. Yes, I am completely freaking out. This is not supposed to happen.I am supposed to live "happily ever after".

I feel a lot of the achiness and soreness in the groin that I have had in the past, but luckily, the sharp (impingement) pain is not there. Synovitis? Psoas tendonitis? labral re-re-tear? I have no idea, but I am scared.

What am I going to do? I'm not sure yet. should I call BK? I am not in the mood to deal with office shit and waiting days (weeks?) for a return phone call. I also will not have an MRI at this point. I think it would show nothing, regardless of whether something is there or not given the vast amount of work I have had done already. Maybe it is early onset arthritis, I should get an x-ray, especially since I have never had one done post-op. what I really, really want is a cortisone injection (not sure into what though) to get the magical pain relief it has provided me in the past!

I will keep you posted!

Anyone have any Ideas????

It has been 1 1/2 years since my last hip scope and as you can see, things have been great! Last night, I was sitting indian style on my bed, feeding Z, I went to get up and had an awful stabbing pain in the right hip (revision side). I ended up going to sleep in the middle of the movie that J and I were watching, not because the pain was unbearable, it is more of an annoyance. It is starting creep up in intensity as I sit and write this, and when I try to cross my legs it hurts. I have no idea what is going on, no energy to really think too much about it, less energy to apply my own professional opinion to it (Z is not sleeping through the night yet, but he is soooo cute, 20 lbs of solid cuteness), but need this to go away. Anyone care to give their opinion?

J's Update

I think a while back I mentioned that J was complaining of hip pain. It has been bothering him again, and pretty bad, so he finally has allowed me to make him an appointment to see Dr. K. I can't help but laugh (really hard), but really, its not so funny! I think he may have bilateral FAI and torn labrums. I hope he can get an appointment soon because I don't know how much more complaining I can take!!!

Another "Jeff" Update

My brother is now about 2 1/2 months post-op. He is running, swimming and playing doubles tennis. This is after hip arthroscopy for cam and pincer FAI and a torn labrum (debridement). To add "insult to injury" (bc hey, I was soooo not even close to being this active at 2 1/2 months out) he went skydiving this past Sunday and had no trouble whatsoever! I think he is in the clear to call his surgery a success!!!

On another positive note, J is now 6 months post-op from his surgery and down 96 lbs!!! Here we are celebrating his 29th b-day! Looks like Z is more interested in the cake than anything else!

A Gross and Rainy Day

For those of you who live in the Northeast, I need not tell you about the dreary weather we have been having. It is cold and wet and just gross. Occasionally, when this happens, my hip will flare up. Not so much the actual joint, but minor problems I have had along the road to recovery seem to rear their ugly head on days like this.

The biggest problem is my residual nerve damage. If you remember way way back, after hipscope #3, I had a large patch of numbness on the front of my thigh. This slowly went away but was painful at times. On days like today, I have a lot of pain and soreness along the front of my thigh. It is also tender to the touch. I assume there was some sort of trauma to my lateral femoral cutaneous nerve and it is not fully healed. Will it ever be? Who knows.

I also had a bit of adductor tendonitis today, which I assume is also weather related. So this morning I was not a happy camper in hipville. Things have since calmed down and I am back to status quo, but it makes me wonder if this is something I will have to live with forever.....

Some Pics

I know I have been MIA for a while again, but all things hip continue to be good! I promise an update on my brother this week (ok, I promise to try). Here are just some pics of what has been keeping me busy, plus, I was just away for a week and a half in Miami!

This was actually my carriage as a baby. all 3 kids have used it for the first few months when they sleep in my room!

L at the Clinique counter

Life is Good!!!

Yes, I give my 3 month old cereal to get him to sleep through the night!

ICD-9 and CPT codes used for Hip Arthroscopy

Many people have been asking me what kind of magic I used to get my surgery paid for...well....none really. I think the OS office has a lot of experience dealing with it and billing correctly. My OS was also in network, which took a lot of headache away from this.
Below are the codes used for all 3 surgeries. Maybe one day in the distant future, if I find myself with some time on my hands, I will look up the up and add the name as well. For now, this is the best I can do...
And a link to an older post of what exactly was paid for each surgery

3/5/2007
CPT
29862
27120
29863

ICD9
719.45
738.6
718.85
715.15


7/2/07
CPT
29862
29863
27120
27179

ICD9
719.45
738.6
732.2

11/12/07
CPT
29862
29863
27179

ICD9
719.45
732.2

Another interesting article

I came across this article this week, and if I remember how, I will add it to my "article" file.

Acetabular Labral Tears

Paul E. Beaulé, Michelle O'Neill and Kawan Rakhra

J Bone Joint Surg Am. 2009;91:701-710. doi:10.2106/JBJS.H.00802

A few key points:


Current Concepts Review
Acetabular Labral Tears
By Paul E. Beaul´e, MD, FRCSC, Michelle O’Neill, MD, FRCSC, and Kawan Rakhra, MD, FRCPC
-Acetabular labral tears rarely occur in the absence of a structural osseous abnormality.
-Labral tears are frequently associated with lesions of acetabular cartilage such as delamination.
-Hip arthroscopy is the preferred operative approach in the treatment of labral injuries in the absence of substantial structural osseous abnormalities.

"Despite the recent advancements in imaging as well as
operative techniques, patients are often misdiagnosed. In one
report, it was documented that patients visited, on the average,
3.3 health-care providers before being correctly diagnosed with
a labral tear and waited an average of twenty-one months for
the diagnosis18. More importantly, 33% (twenty-two) of sixtysix
patients received an alternate diagnosis prior to being diagnosed
with a labral tear. In addition, the lack of a complete
understanding of the function of the acetabular labrum as well
as its anatomy has made treatment recommendations difficult
to establish"

"Lage et al.7 described four categories of labral tears based
on etiology.
1. Traumatic, based on a clear history of hip injury and
the subsequent onset of symptoms. More recently, a traction
injury of the labrum by the iliopsoas tendon has been reported
in some cases40, with the intra-articular portion of the iliopsoas
tendon noted to be attached to the labrum in those cases.
2. Congenital, based on the presence of acetabular dysplasia,
defined as a center-edge angle of <25>1041-43.
3. Degenerative, based on radiographic evidence of arthritic
changes, such as joint space narrowing or osteophytes,
or the identification of severe chondral damage at the time of
operative intervention.
4. Idiopathic, based on the absence of any other findings."


"However, three recent studies in which the presence of
osseous abnormalities was retrospectively examined in patients
with a labral tear demonstrated that the majority (49% of
seventy-eight, 79% of ninety-nine, and 87% of thirty-one17,44,45)
had an osseous dysmorphism consistent with femoroacetabular
impingement. It would thus be more appropriate to rename
the so-called idiopathic group femoroacetabular impingement.
Ganz et al. described two mechanisms of femoroacetabular impingement
15: pincer type secondary to acetabular overcoverage
and cam type secondary to a lack of femoral head-neck offset
(Fig. 2). In pincer-type impingement, repeated contact between
the femoral neck and the prominent anterior aspect of the acetabular
rim leads to initial damage of the labrum36,46 and often a
contre-coup lesion leading to premature wear of the posterior
articular surface. In cam-type impingement, abnormal jamming
of the head-neck junction causes an outside-in intrasubstance
avulsion of the labrum from the adjoining acetabular cartilage
15,36"


Diagnosis of Labral Tears
Clinical Evaluation

"In the majority of patients, the chief symptom is anterior groin
pain made worse by long periods of standing, sitting, or walking.
The pain can also be referred to the gluteal area or the
trochanteric region. The onset of pain is usually insidious4, with
the patient often unable to recall a specific traumatic event9. In
one study, only 9% (six) of sixty-six patients with a labral tear
had a major traumatic episode as a causative factor18. The pain
is often sharp in nature and aggravated by activity such as
walking and pivoting on the affected side. The presence of
mechanical symptoms such as clicking and catching is highly
variable and not necessarily indicative of intra-articular hip
pathology9."


"On physical examination, the most reliable sign of labral
pathology is pain reproduced with flexion beyond 90 combined
with internal rotation and adduction4. This is referred to as the
impingement sign"

OMG I haven't posted in a long time

Wow, it's been a while! Zach is 7 weeks old today and keeping me busy! Luckily I have great help!
(I have no idea why that is underlined but I can't seem to change it)

I wanted to post last week but never found the time! My brother had his hip arthroscopy last Monday. This has been a problem for him since last April. He had very similar symptoms as me, except that he is extremely athletic and I, well, am a mother of 3 with a job! His surgery went well, and he had a torn labrum, synovitis, cam and pincer FAI. Sound familiar? Weird that we both have (had) cam and pincer.

He stayed with me for 5 days after his surgery and then flew home. My mom was here too. Just so you have an idea of how well he did post-op (or how poorly I did), every time someone called my mom to ask how he was, I always heard her say "He is doing great, so much better than Susie ever did!"





Ok, so I don't do that well immediately post-op, I have a "thing" with drugs, we just don't get along! But long term, I did kick ass, if I do say so myself!!!





So, at 7 weeks post partum with a rather large baby, my hip joint is still great. I did start having some adductor and flexor tendonitis a few weeks ago. I am not sure why. I have in the past developed SI joint issues a few weeks/ months postpartum and I wonder if it is related. The pain is the worst when I "wear" Zach. Yes, I am a "baby wearer", currently in a Storchenwiege wrap.

Yep, Zach is inside the blue fabric, sleeping soundly, at 1 month old, at Disney World!

So all in all, I can say that pregnancy and delivery have not had a negative effect on my hips. I am confident that the tendonitis will resolve (I forgot to mention it is only on the right (revision) side). Exhaustion is kicking now.....

Welcome to the World Baby Zach

The Birth Story

With my due date quickly approaching and night after night of false labor (16 hours one night), I was losing my patience. I was uncomfortable, swollen, out of breath and in pain a lot of the time. I took an unofficial poll of my friends on facebook to see how they suggested I get this baby out. Castor oil and sex were the top picks, sex had not worked up until then. So J went out to buy castor oil. I was nervous about taking it, it hadn't worked for some people, others threw up from it, but I needed to do something. I had also asked my doula abt it and she didn't seem to recommend it unless you are facing an induction with pitocin.

So once the kids were in bed, J mixed 4 tbsp of castor oil with a small amount of ice cream. It wasn't as bad as I expected and I would recommend the ice cream method to anyone thinking of trying it. 2 1/2 hours later I threw up. I was disappointed that it hadn't worked and was not willing to try it again. About an hour later I realized that I had not thrown it all up and what was in me began to work. After several trips to the bathroom, it had done its job.

I went to bed around 11. At midnight I was having some contractions but was able to sleep and kept remembering all the false labor I had been having. At 2:30 I got up to go to the bathroom and began having awful back labor with the contractions 4-6 minutes apart and lasting about a minute. This all started very suddenly with J insisting the contractions were very close together. I called my doula who suggested we meet at the hospital rather than at my house. The contractions kept coming, now abt 3-4 minutes apart.
We just grabbed my bag and left, I decided I would be better off on the floor in the back of the car on my hands on knees with my body pillow. As I got into the car my water broke. J raced to the hospital and actually had a cop pull in behind us at the hospital but I guess we were excused! The contractions kept coming quickly.

On the way to labor delivery I had 3 contractions. Once we got into the room, they kept coming. I went into the bathroom to change into a gown when I had another contraction and felt the head coming down. The nurse wanted to check the heart rate but I was in too much pain to lie on my back in the bed. I got onto my hands and knees and she tried to find the heart rate, she said it was too low and I should change positions. Turns out she was picking up my heart rate bc the baby was so far down.
He then decided he was ready to be born and was "caught" by the nurse. My doctor didn't make it in time! It was the best birth I have ever had, which have included a c-section after a failed version, a vbac with epidural and pitocin and some tearing. It has been 30 hrs since he was born, I feel great, am sooooo ready to go home.

The big question that belongs on this blog......how are the hips? Remember, my first ever groin pain came right after my last delivery, with the epidural, feet in stirrups, hips being forcibly flexed. This was so fast there was none of that and I feel absolutely no hip pain today at all.

I will continue to monitor in the coming weeks but I am pretty sure that I was able to have successful hip arthroscopy followed by a pregnancy only 5 months later. So yes, it can be done. On a side note, if you are able to I highly recommend getting a doula for birth, it was such a great experience, even though I only used her for a short amount of time.

Its a Boy

Born Jan 12 at 4:30am, 8lbs 7oz.
Name and birth story to follow.

Weight loss Miracle

I thought I had posted this already but it seems that in the midst of a few winter storms and 2 preschoolers in the house, I actually did not.
J is now 5 1/2 weeks out from lap band surgery. The way lap band works is that for the first year you return to the surgeon monthly for adjustments to your band, to tighten it so that you feel some restriction. J's first scheduled adjustment was this past Fri. When he arrived, he saw the PA who could not believe how much weight he had already lost (just about 50 lbs). She said the average is 2 lbs per week, he is at around 5 lbs per week (since the surgery). She was so impressed that she called in the 2 surgeons who were in the office that day to see him, who were also blown away by his progress. They said they haven't seen this kind of result in a long time, if ever. They want their research team to contact him about it! He is soooo happy, as well as relieved that he avoided an adjustment that day!

He is still complaining of hip pain though. I am not sure if he should continue to wait a bit and lose more weight before addressing it, or get, at the minimum, an x-ray now. Actually, I am not sure how much whining I can take at the moment, so my patience may dictate how long he waits!!!

In the baby world, I have been having mild contractions/ cramping for a day and a half. It is nothing serious, more of an annoyance. I was at my OB yesterday who thinks it may be because the head is super low, but she would ideally not like this baby born for another 2 weeks. My bigger concern is that she is going on vacation on Saturday for a week, so if this baby is coming soon, it needs to come before Sat., or wait another week!!!

HSS non-hip Visit Follow-Up

This past Thursday I took Jk back to his OS for a follow-up on his elbow. At first, the doctor went over the old x-ray and said he was still not sure what exactly was going on with his elbow but we should go get a second x-ray, if it didn't show bone healing, he would need an MRI. So we went down the hall, got the x-ray and came back. Thank goodness it showed that it was a fracture (as opposed to an infection or (no I am not joking) a tumor) and he is fine. It is healing nicely and the bone is filling in. He can also stop PT now! Hurray! My guilt is slowly starting to lift and I am becoming slightly less neurotic about him getting hurt!

What Goes Around Comes Around

You are not going to believe this......J, who is down over 40 lbs was lying on the couch last night and out of the blue says to me "you know, my hip hurts". WHAT.
So, by now, he obviously (one would hope) knows that "hip pain" is groin pain, and not pain on the outside of your hip, butt or thigh. But I reply "Where does it hurt", and he takes his index finger and points to that spot, you know the spot, right in the groin. THE spot. I couldn't help but laugh. Really, it is funny. "And", he added, "It hurt when I was walking to the train and it clicks". More laughter from me.

He was still lying on the couch. I told him to bring his knee up to his chest, I think he saw stars! When I had him turn the knee a little more to his opposite shoulder, he saw even more stars. I can already see where this is going and I am not prepared to handle it right now!!!!

Pain(s) in the A$$

34 weeks of pregnancy seem like an eternity, I am wondering at what point I can safely begin hoping to go into labor. Maybe 2 more weeks? I have an ultrasound scheduled for next week, to confirm that the baby is still in proper position and hopefully get an estimate on size. Maybe if it is really big I can will it out quicker!!!

I have been having a ton of ITB pain every night. It begins high, and will start with piriformis pain/spasm and travel down to my TFL and down the entire length of my ITB. It is horrific. It happens every night now when I "slow down". Walking helps the most but, hey, I need to sit down at some point. Interestingly, it is only on the right side (revision side). I also have been experiencing bolts of nerve pain at times, mostly on the right, that occur sometimes when the baby moves. This is why I have decided that it is a big baby! My first was 7 lbs, second was 8lbs 4 oz. If this one is going to also be a whole pound and 4 ounces bigger, we are looking at a 9 lbs 8 oz baby. I hope the trend does not follow!

What I am sort of hoping for is that my pelvis is beginning to separate and the muscles that attatch to it are trying to stabilize it, thereby going into spasm and causing me excruciating pain! I also have bouts of adductor pain but not as often.

J, who is down 42 lbs since surgery, has become an expert at ITB massage (it took him a while to figure out who to go with the fibers as opposed to across the fibers), but sadly, it does not help that much.

Jk has been in PT 2x/week for 2 weeks for his little elbow! He loves going and his ROM has improved. We are concerned about some possible swelling and bruising as well as lack of supination. He will be back at the doctor in a week so maybe they will take a repeat x-ray.

My brother has failed in PT! He still has pain and decided he needs surgery. He finally scheduled it this week and was given a surgery date of Feb 23rd. I know, 2 1/2 months away, crazy. But he is fine with it and doesn't wish to push for something sooner, so I won't either!

Another day spent at HSS...but not for me!

Being the mother of 2 sort of crazy kids, I count my blessings that we have never had a serious injury or required stitches, though we have been close on more than one occasion. About a month ago, my nanny mentioned that she thought Jk hurt his arm in the tub. When I asked him, he said he had a booboo but L had done it. He seemed to be alright, playing, climbing, jumping, throwing himself off of the couch etc. IT really only seemed to bother him if you touched his elbow and if you got him dressed too quickly. So I have been careful getting him dressed and sort of been keeping an eye on it.

Last week my nanny got mad at me and said the arm is not better and I have to take him to the doctor. So I did. First, I made an appointment with someone who I thought was a great pediatric OS and have even had friends use, but he did not take our insurance. I made the appointment anyway (the consultation fee was $350) but J freaked out and demanded I find someone in network. His rational was that we don't even know if anything is wrong, figure it out first and if there is really a problem, we can explore other doctors. Fine. So I found someone.

We went on Thursday. He found that Jk couldn't really extend his elbow all the way and said it was either fractured or he had a subluxed radius (nursemaids elbow). So off to x-ray we went. What was nice was that it was a whole pediatric floor, so the x-ray tech dealt only with kids, the nurses dealt only with kids, and there was even a nice lady handing out snacks for all the kids. It made me feel better about having switched to this OS.

Jk was so good during the xrays, he sat nicely and put his hand where it needed to go, and he was rewarded with tons of stickers! He couldn't have been happier. As soon as we got back to the doctor's office (right down the hall) he came in to look at the x-rays, and lo and behold, a fracture.

Shit. What kind of mother am I, my kid has a broken arm and I had no idea. He said it was too late to cast it, but he is pretty sure the olecranon (proximal end of the ulna) is fractured, as is evidenced by new bone growing and some soft tissue swelling, and Jk needs PT. The mechanism of injury must have been him landing on or hitting his elbow on something. Obviously this is most likely. If he is not better in a few weeks he will need an MRI, which becomes a huge ordeal because he needs to be put to sleep.

I wasn't quite sure what to do about the PT thing. He needs the kind of PT I do, and that we do in my office (orthopaedic) but we don't generally treat kids that little. I have a lot of friends who are pediatric PTs but they treat mostly developmental delays and torticollis, and they don't take private cases. We have one pediatric PT in my office but I was not even sure what she treated. So I frantically called her and she assured me that she would love to treat Jk and she has done this a lot, and that it is a very common injury.

So he has his first PT session on Tuesday. I also have an OB appointment that day, and he has a special enrichment program at school for Thanksgiving. I see the next few weeks looking something like that, running around from PT appointments, to OB appointments, to swim lessons, to OS appointments!

Never a dull moment here!

1 Year Revision Anniversary

It has now been one year since my last (and final) surgery. How the time has flown. What a great feeling it is to know that my surgeries have been successful and I have no limitations from them in my life.

The joint feels perfect! I will have a post-op x-ray at some point after the baby is born to check for signs of arthritis or anything else, but I suspect nothing will turn up. I do occasionally battle some muscular issues, which I mention on this blog when they come about. Like currently, my ITB is not too happy, but again, who knows how much of it has to do with my actual hip joint and how much has to do with being 7 months pregnant. Since I got pregnant so soon after surgery, many of these questions will remain unanswered. The only question I can answer is that 3 hipscopes have not really affected this pregnancy. I do have significantly more swelling in my feet than I have had in my previous 2 pregnancies, but a) it is unclear whether it is directly related to the hipscopes and b) in the grand scheme of things, it is merely an inconvenience.

In other parts of my life, J's surgery went extremely well last Monday. He is already down 32 lbs since beginning the 2 week pre-op diet, and having been "banded" for 6 days. My brother has been in PT for about 5 weeks with no change in his pain level. He does report feeling stronger though. He has decided that he probably wants surgery. My only request to him was that he PLEASE call Dr. Kelly and discuss this ASAP because I would really appreciate it if he had the surgery before the baby is born. He has yet to call.

Jk will turn 3 this month, marking the 2 year anniversary of when my hips "fell apart", a lot has happened in 2 years!

Many of you have been sending me questions by posting them on older posts. I will usually read your questions and then forget to write back! If you would like a response, your best bet is to email me directly suzq613@aol.com

J's Surgery

A few weeks ago I tried to start a second blog about J's upcoming lapband surgery but realized that I barely have time to maintain this blog and answer all of your posts and questions, so nixed the idea. But things have been kind of stressful and crazy around here in anticipation.

See, in order to have lapband surgery, there are many hoops to jump through (much more than I could have ever imagined, and so many more than for a hipscope!) He finally attended a seminar given by the surgeon, obtained 6 months of medically supervised weight loss, saw a psychologist, saw a nutritionist, had a physical, saw the NP at the surgeons office and finally met with the surgeon. This over a course of 17 months. (I remember going to the seminar with him on crutches).

Part of the drama has been dealing with a semi-incompetent surgical coordinator at the surgeons office (who definitely hates me). At the time that we scheduled the surgery, she thought we would have a problem since J's 6 months of documented weight loss did not have an entry for the month of March, rather one at the end of Feb ad one at the beginning of April. Imagine waiting that long, and going through all of that to be told that this tiny little glitch would bring this entire, delicate house of cards crashing to the ground.

Being that I have assumed the role of "project manager" with his surgery, I quickly (and quite hysterically) called the insurance company to straighten it out. I was told that this indeed may pose a problem, but they would do their best to get this approved. The next day I received a phone call telling me that the surgery would be approved! YAY!!

When we left the surgeons office, we were given a packet with instructions (that the coordinator hastily went over with us) but were rather unclear and quite confusing. J had to have his medical doctor fill out some paperwork approving him for surgery which he was to take to the pre-admission testing. Pre-admission testing would fax it to his medical doctor who should fax it to the surgeons office. Retarded? I think so!

This past Tuesday I received a call from the woman in charge of collecting the aforementioned paperwork, looking for approval from J's medical doctor for the surgery. I informed her that it was on page 22 of the fax that had been sent to them (I am not kidding about being "project manager"). Everything seemed like it was all set to go.

Friday morning (the final business day before his Monday morning surgery), the surgical coordinator called me and told me she was missing the medical clearance form fro J's medical doctor. Shit. I told her to look for that page 22 letter again. She informed me that this was not good because it was dated prior to the pre-op testing.

I hit panic mode, and yelling mode. How the fuck did they not realize until THE DAY BEFORE THE SURGERY that they were missing this quite important piece of information. J was having trouble getting through to the doctors office, I was yelling at the surgical coordinator in between patients. It was quite a sight. She needed the paper by 3PM. At 2:25 she did not have it, J was frantically leaving messages. At 2:28 the surgical coordinator called me and said that they would just go with the original letter they had. At 2:33 the fax went through.

So now we are 19 hours away from surgery. Unlike me, J is not frantically cleaning closets or getting a mani-pedi! I will keep you updated!

This is HOT!!!

Clearly what you have in mind is NOT what is on my mind right now! If you could see the box that these stockings came out of, you would see that it reads: "Recommended for: tired and aching legs, swollen and minor fatigue, minor heaviness".

I was at wits end today, my ankles no longer exist. They have been replaced by what used to be "cankles" but today became fat feet oozing out of shoes, to put it gently. I was no longer able to stand on my feet, much less walk and function, so I broke down. I had a quick break at work and literally raced to the nearest surgical supply store in search of these. Sexy, right! Mine are black!

I found the store, ready to buy my super cool, black lacy stockings (with moderate compression), and imagine my surprise to find that it is "manned" by 3 old men. Imagine walking in Victoria's Secret to find THE outfit, and have men helping you.

Well, maybe that is an exaggeration, but eww. Plus, there was no one else in the store, so all 3 were "helping" me.

Once we all determined what I needed, I happily left with my new piece of wardrobe, ready to attack all orthopaedic ailments that would walk through the front door of my office. I grabbed the bag, ran tot he bathroom to put them on, and to my horror, there was a brown pair in the bag. Shit.

So another 2 hours of tortuous leg pain got me through the rest of the day so I could make another run for the store. This time, there was only one old man working there, who politely informed me that they were "final sale, and no returns". As usual, the patheticness of my situation made him feel sorry for me and he quietly swiped the brown pair for a black pair. I also ended up purchasing a knee high pair to wear at home, when no one is looking!

I am not sure why I am having this much swelling, but it is pretty bad. (Bad enough for me to buy compression stockings!). I have an OB appointment tomorrow, I am hoping that this is a problem limited to my feet and legs, and will resolve in the near future. There is always the little voice in my head asking if there is a lymph issue from my surgeries, but since it was not a problem when I was not pregnant, I am confident that it will clear up after this pregnancy!

2 Days Later

As promised, here is an update on my "situation".
I did wake up pain free on Monday morning, as expected. Later in the day, I stupidly performed the same maneuver that had started this mess. I was kneeling down on one knee, with the other foot flat in front of me (right foot). When I went to get up, I practically had no strength in that leg again and began to have pain, all over again.

So clearly there is a major strength deficit in my right hip extensors with an imbalance that can explain why this is happening. Sadly, I will not even attempt to address this now as I am too overwhelmed with everything else going on. Hopefully it will resolve after the birth, or at least I can address it then in a calm fashion. The good news is the joint is still good!!!

28 Weeks Pregnant

Just this morning I was thinking that I haven't blogged in a while, and how thrilled I have been with my hips throughout my pregnancy. Until today, the only time I have experienced hip pain was in conjunction with my SI joint issues, which do occasionally happen, and are common in pregnancy. The only other time I felt anything in my hips was after a 3 hour car ride. That's it, I really can't complain.

Then my luck changed! I don't know exactly what happened, or what is happening. I was sitting on the floor, building a kick-ass train track for Jk today. When I went to get up, I kneeled on my left knee and used my right foot to push up and something felt weird. From that point on, I began having right hip pain, all over again. It is not exactly groin pain, it is more of adductor/psoas/ joint capsule crap. The one thing that does reassure me though is that when I did my mini "hip test" if flexion and flexion/ adduction, it did not make the pain worse. So a huge sigh of relief. Most likely just some muscular things going on, due to the prganancy and hormones and change in weight and forces and all that fun stuff that comes with being months pregnant.

I will hopefully wake up in no pain tomorrow morning but will keep you updated on this sudden turn of events!

My Other Blog

Life in the hip world is unusually calm these days, life in my house is not!!! Although I can't imagine that anyone with 2 1/2 kids, a job, a husband and a type A-ish personality ever has relative calm in their life! Today I started a second blog to document J's upcoming surgery (not hip) and my role in it (basically, do everything necessary up to the day of surgery since men can oftentimes be rather incompetent). It is a work in progress but I have a lot to say (shocker, I know) and will probably have many posts there in the coming days!http://myhusbandslapband.blogspot.com/

Repair Vs Debridement

I just came across this website today
http://www.orthosupersite.com/view.asp?rid=32004
Differences seen between repair vs. labral debridement for hip impingement at 1 year
Researchers saw a significant increase in radiographic degenerative changes in the debridement group.
By Gina Brockenbrough1st on the web (October 13, 2008)
October 2008
WASHINGTON — Research indicates that although there is no significant difference in the early clinical outcomes between arthroscopic labral debridement and labral repair for the treatment of femoroacetabular impingement, significant changes were seen between two treatment groups at 1-year-plus follow-up.
In a consecutive series of patients who underwent arthroscopic management for femoroacetabular impingement (FAI), Christopher M. Larson, MD, and colleagues compared the results of those who underwent labral refixation to those who underwent a labral debridement prior to performing any repairs.
The investigators discovered no significant differences between the groups regarding Harris Hip Scores, Visual Analog Scale (VAS) scores for pain, SF-12 scores and alpha angles on both anterior-posterior and lateral views with a minimum follow-up of 1 year. The analysis also revealed no significant differences in these outcomes among patients who had debridement, excisions with rim trimming or repair at that time.
Degenerative changes
However, “With further follow-up at 1 year and [beyond], there is a statistically significant increase in radiographic degenerative changes in the debridement group and statistically improved Harris Hip scoring in the labral group,” Larson recently told Orthopedics Today.
However, he noted that 5- to 10-year follow-up is needed to fully compare the outcomes and said that follow-up radiographs may detect changes earlier than clinical scores.
“It is a consecutive series, and management with this technique is evolving,” Larson said. “And if a difference does show up with time, the question will remain whether this relates to labral preservation or improved technique in managing impingement.”
Larson presented the study during the 27th Annual Meeting of the Arthroscopy Association of North America.
The investigators studied 80 hips; the labral debridement group included 37 consecutive hips that the researchers studied before performing repairs.
“All of these cases were reviewed and were felt to be repairable by current techniques,” Larson said. Patients in this group had a mean age of 31 years and a mean follow-up of 14 months.
The labral refixation group had a mean age of 27 years and a mean follow-up of 8 months. In both groups, most patients had minimal or no degenerative changes.
Procedures
Patients with pincer impingement underwent a labral debridement, rim trimming and labral refixation with two to six suture anchors. Those with cam impingement had a capsulotomy and a proximal femoral osteochondroplasty.
Surgeons performed 29 femoral osteochondroplasties in the debridement group. Eighteen patients in the group underwent labral debridement without rim trimming and 19 had rim trimming with labral excision. In the refixation group, 36 patients also had a femoral osteochondroplasty and 40 patients underwent rim trimming.
Larson noted that the groups showed good and excellent results postoperatively and that the study investigated labral tears without significant degenerative changes.
“There are finite element models that have suggested that the labrum has a ceiling function,” he said. “In the absence of this sealing, strains within the cartilage matrix increase, which may increase those degenerative changes over time.”
For more information:
Christopher M. Larson, MD, can be reached at Minnesota Sports Medicine, 775 Prairie Center Drive, Suite 250, Eden Prairie, MN 55344; 952-944-2519; e-mail: Christopher_larson@med.unc.edu. He receives research or institutional support from Biomet, Omeros Corp., Arthrex Inc. and Zimmer and miscellaneous funding from Smith & Nephew.
Reference:
Larson CM, Giveans M. Arthroscopic treatment of femoroacetabular impingement: Early outcomes evaluation of labral refixation/repair vs. debridement. Paper #SS-04. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.


This got me thinking about a few things. My first thought was "hmmm, I wonder what my hips look like now, radiographically, at almost 16 months and 12 months postop"? Being that I had to postpone my postop x-rays due to my current "situation", I will not know for some time.

It also got me thinking about how accurate the study could be. I don't know any type of detail, I only have read what I posted here, so I may be totally off base, but here it goes:
In the debridement group, the labrum was probably more damaged than in the repair group, meaning that they had either been dealing with the FAI and labral tear for a longer period of time, or had a more severe injury. The repair group had to have a labrum that was in essence "repairable", i.e. not as "far gone" as the debridement group. It would make sense that the group that had more damage would show more degeneration in a shorter amount of time.
Does this make sense?
Wouldn't the surgeons try to repair as many labrums as possible if they could, and not debride the "repairable" ones?
Just a thought......

Was I a Psychotic, Crazy Bitch for a Year?

Why am I posing this question now? (J, this is purely rhetorical, do not feel compelled to answer). While we were in Miami last week, my SI joint went out of whack for about a day and a half. It was most likely a posteriorly rotated inominate on the right, but I honestly don't remember anymore. When this happened, I had immediate right sided PSIS pain and right sided groin pain.

When the groin pain started, I immediately reverted into a bad mood, very irritable, and just downright annoyed. See, after 2 hipscopes, I don't care what the reason, there should be NO GROIN PAIN. Yes, I knew it had nothing to do with the labrum or FAI but it was the same pain all over again, and I was not a happy camper.

Being that this is my 3rd pregnancy, I have had plenty of experience with SI pain in the past, and it has never led to groin pain before, so in a way, yes, it is related to the labrum and FAI. IMHO, there is probably still healing going on, and the temporary change in geometry put pressure on areas that are not supposed to handle pressure, and instantly gave me pain and put me in a REALLY bad mood.

The good news is that it resolved quite easily and quickly. Once I had a moment, I used a self muscle energy technique to re-adjust the pelvic bones and voila, everything was back to status quo and I was once again happy!

This leads to my to digress for one quick moment. Many pregnant women suffer with SI pain for months and do not seek treatment. Sometimes the OB says it just "normal", sometimes they don't know something can be done. back pain in pregnancy is one of the least tapped resources in physical therapy, and one of the easiest and quickest things to fix in most cases.

A comment was posted this week on an old post asking if anyone has had a successful scope, being that most people don't read the old posts, I will say yes, I have had 2!!! If anyone would like to share a success story, please do so!

Packing Painfree

We are on our way out the door, for a trip to Miami for the Jewish new year. Packing was a pleasure this year. When my hip problems were running rampant, packing used to be a nightmare, the squatting and lifting and carrying etc. The only issue this year seems to be that kids are so excited to go they have been up since 6:45, asking when we can go to the airport!

The only issue I continue to occasionally experience is nerve pain on my anterior thigh. It has been 10 1/2 months since my revision, I don't think it will ever fully go away. And its not like I constantly deal with it, only some days, it seems to come and go. A small price to pay in my opinion.

While I was bragging about Jk last week, I forgot to mention L's astute comment about the baby! Have I mentioned that the baby has been named "ice cream"? So one day, L says to me "Mommy, is ice cream in your blood"? Hmmm, how do I explain this one, its not quite as simple as "the femoral head sits in the acetabulum". "No, L, ice cream lives in a pouch in my tummy". She started cracking up like it was the funniest thing she had ever heard. "Mommy, you're not a kangaroo", she said. To which I started cracking up. We ended the discussion with me pulling up a schematic on the computer of a pregnant woman's uterus, with the baby inside, "pouch" and all! Now she gets it!

An update on my brother: He has to go to PT first, I don't know if he has actually started but definitely has a bad attitude since PT did not work for me pre-op, and for many others.

An update on my patient: I am still a huge wuss!! She is off of crutches, went to Costco and Target in one day this week. She is painfree- she used to have debilitating back pain as well, she no longer does. I am so amazed. Pre-op, for many years, she walked with a cane, she no longer does. And she did not have cortisone injected into the joint during surgery (I witnessed it with my own eyes!)

My Kids Are So cute

A lot of my "bragging" has been about L, my 4 year old princess/anatomy lover!! Although this is in no way hip related, it was too cute to keep to myself.Jk is 2 1/2 (almost 3 actually) and sometimes I am not so sure if he understands the whole new baby concept. Boy did he prove me wrong on Sunday.

We were out for lunch and at the table behind us there was a little boy about Jk's age, and a baby in a carseat. The little brat, I mean boy, started teasing Jk and saying "hahaha, you don't have a baby, hahaha" (Imagine that being said by a 2 or 3 year old in a sing song voice). To which Jk turned around and (like a small genius) said "I do have a baby, its in my mommy's tummy"

How Cute!!!!

Thinking of How Things Were 1 Year Ago

Today we went apple picking. It was our second time, the first was about a year ago. That put me about 1 month pre-revision. Apple fields around here tend to be rocky and hilly, with uneven terrain, and spread over many many acres. Last year I had a really tough time "navigating" the apple orchards. I was in a lot of pain, for some reason, I have very vivid images of the groin pain I felt that day. I don't generally remember the pain all that well (thank goodness for small favors) but for some reason, apple picking brought back memories!

I am happy to report that this year, there was no groin pain. There were other issues, which I will get into momentarily, but that achey, deep hip pain was no longer there! Yay!

I have been having a lot of swelling in my legs lately, and a feeling of heaviness. I haven't really had it with other pregnancies so I will assume it is related to having 3 hip surgeries. There are days I wake up and I cannot imagine how I will go to work and stand because I am having so much aching up and down both legs. I don't even remember if I blogged about my DVT scare a few weeks back (I will have to look back and check), but my legs have been sore and swollen, even on days I am not on them that much.

It is possible that there was some damage done to the lymphatic system, and now that it is being stressed things are "backing up". It was not an issue before I got pregnant.

There are also days that my "invisible bruise" pain comes back, these are the days I know I should have stayed in bed!!! I usually notice on my way to the car. My ankles feel fat, my thighs feel heavy, and I have pain over a large area on the front of my thigh. And that is only 7:30AM!
I still haven't seen a single patient!

Despite this, I am back to cooking! Over the course of the summer, I had resorted t serving the kids mac n cheese and hot dogs quite often because we were spending every afternoon at the pool, and these dinners were quick, easy and portable. Now I have no excuse. It is back to the kitchen for me!

I am actually having a mild obsession with Panko breadcrumbs. I have a friend who manufactures the brand I use and I jokingly offered to be her "recipe blogger"....she is now expecting recipes! I will share with her as well as you...coming this week, Teriyaki Panko Oven Baked Onion Rings.

My other obsession these days is childbirth. Mostly, that I CANNOT have a c-section. This baby seems to enjoy being breech, but I WILL NOT have a 4th surgery right now (hear that kid). I have been doing breech turning exercises (anything that involved having your hips higher than your chest) which does work, but gives me a massive headache! I have an ultrasound on Thursday, and based on the position, I will decide if I will start the Webster technique for turning a breech.

Don't worry, once the baby is in in proper positing, I will be obsessing about how to deliver it without messing up my hips!!!

PS- I have about 15 lbs of apples in my kitchen...anyone have good (and easy) recipes???

Things Can Never Be Simple, Can They?

I am now 22 weeks pregnant. The hips seem to be holding up just fine, yay!
I had a scheduled OB appointment 2 weeks ago, but it was cancelled at that last minute bc of some scheduling issues. There was no other time for me to come in until 2 weeks later, but I was concerned about the 20 week ultrasound. This is how the conversation with the receptionist went:
R: Sorry, we have to cancel your appointment, can you reschedule for...
S: No, I can't make it, but what should I do about the 20 week ultrasound, I am 20 weeks now
R: What 20 week ultrasound?
S:Umm, THE 20 week ultrasound!?!?
R: Oh, you mean, like, to find out the sex of the baby?
S: Umm, no, like, an anatomical scan at 20 weeks
R: Well, do you want to find out the sex?
S: No
R: Well then why do you need the ultrasound?
S: Um, to make sure my baby doesn't have 2 heads (ok, I wasn't that snotty, but come on, everyone knows about THE 20 week ultrasound. And this is a receptionist at an OB office)
S: Can you please put someone else on the phone

This person assured me I was not crazy and that there is indeed a 20 week ultrasound that EVERYONE gets.

So yesterday I had the 20 (22) week ultrasound. The baby (who has been named ice cream by L) apparently does not have 2 heads and looks good (I asked if the hips are checked during the ultrasound...I have become slightly paranoid about genetics and hips lately...I was told no, but they will check for dysplasia after birth). But the baby is breach. OMG. L was breech and it was a disaster that ended in a c-section. I do not want to re-visit the world of c-sections (or any other surgery for that matter). I was reassured that it is too early to worry, but I reminded my doctor that L was breech at 26 weeks and never flipped. I am on the verge of a breakdown. I have already begun breech turning exercises, contacted a chiropractor who does a technique to turn breech babies and am awaiting a co-worker to return from vacation to give me the name of an acupuncturist who specializes in this too. And you thought I was only anal and crazy about hips!!

Holy $hit, I Am A Really Big Wimp

A few things I wanted to share with you but have been falling asleep each night before I get a chance to blog.

The first is that my patient, the one who had surgery last week, the one I observed, is doing awesome. I asked her for permission to write about her. She is 40, with many many medical issues, including chronic back pain, foot and ankle problems, fibromyalgia. Dr K wasn't even totally convinced she would do great with the surgery. I was really nervous for her as well, it is a tough recovery, plus, she had some minor dysplasia so everything was up in the air. She also takes narcotics on a regular basis for her back, so the pain relief made me nervous. She ended up being home 2 1/2 hours post-op, in her bed, on the cpm, resting comfortably. I told her to call me in the AM if she didn't feel up to coming to PT that day or if she had any issues/ problems. When I arrived at the office, she had already called. "Shit, she must be having a lot of pain" I figured. I called her back. She was feeling great, just couldn't remember how to go down steps with crutches!

She arrived in my office looking amazing, only 15 hours post-op, in NO PAIN. I figured the marcaine hadn't worn off yet. She kept saying that her back no longer hurt and she had no internal hip pain. Her biggest complaint was that the incisions hurt and the spinal bock site hurt. I kept waiting for the drugs to wear off, but kept my fingers crossed as I held my breath over the next few days.

I called her Friday, honestly expecting her to tell me that she was in a lot of pain...Nope. No pain. She was completely off of all narcotics (Including pre-op ones), still with no back pain either. I think she was also shocked that the back pain went away, this was totally unexpected, but a nice added bonus.

I saw her in the office yesterday again.She was feeling amazing, so happy that the pain was gone, and thrilled that it was such an "easy" fix! She wants to do PT 3x/week instead of one lose the CPM and resume life! I am so thrilled for her.

Looking back, I was (am) a 26 year old healthy, with no other issues, simple hip patient who ended up with so much post-op shit. It just goes to show you how we are all so different.

Another thing....Jeff, my brother, was here this weekend and had his appointment on Fri with Dr K. Yes, he has FAI, seen on x-ray.And the OS in Miami swore up and down to me that there was none. He went for a CT scan Fri as well, to make sure there is no more FAI than what was seen on x-ray, as well as an intra-articular injection. Weirdly enough, since his hip problem started, his foot has been bothering him,once he had the injection, the foot pain went away. He is not too clear on whether the injection helped or not, but once the CT results are in, decisions can be made!!

Hip Arthroscopy is SOOO Much Cooler When You Are Not The Patient!

So today I had my day in the OR. Of course things did not go as planned. On Friday, I was supposed to hear from the surgical coordinator regarding where to go, who to meet etc. He never got back to me. Luckily, I knew the patient and she let me know what time the surgery was at. I sent another email this morning to the coordinator.The surgery was scheduled for 2pm. He sent me an email at 2:38 letting me know it was at 2. Gee, thanks!

Basically all day I was a nervous wreck since I hadn't heard from him, and texted Amy all morning about it, but decided to just show up and figure it out when I got there. The paperwork was done anyway. I was also waiting for the PA to email this AM about the time, but she didn't either (added to my anxiety) but it turns out there were major scheduling snafus.

I made it to the surgery reception area where without much question, they took me back to get scrubs, in the meantime, the PA emailed me to let me know they were about 2 hours behind on scheduling (thank goodness for blackberry). So I got changed and hung out with my patient for a while.

At4:00 we were in the OR. I have to say I have observed 2 other surgeries and been a patient in 4 (3 hipscopes and 1 c-section), this was the first time that no one has yelled "Don't touch anything". I guess I looked more authoritative this time!!!

She had a spinal block with some sedation and we were ready to roll. I did have to step out of the OR at times bc they use fluroscopy and I didn't want to take a chance with the radiation and the baby (pregnancy + x-ray does not mix well). So I watched the portal placement through a window, as well as the tractioning, which I would have loved to watch (Hopefully this patient will do well, but she will probably need the other side done so it should be after I have the baby and I can come back.) When I came back in, he showed me the large labral tear, looked like it was from a cam lesion. there was also a bunch of synovitis.He did a synovectomy and then debrided the tear. There was no evidence of a pincer lesion there as well as on x-ray, MRI and CT. THE PSOAS WAS LEFT INTACT!!!! Whohoo!!! They then released the traction to look for the cam lesion. Again, I stepped out for some x-rays, they had to cut into the capsule to access the bump. He performed a cam decompression and then approximated the edges of the cut capsule and put in some sutures. This is a newer procedure (I don't think I had it done) but apparently it decreases the stress on the anterior structures and decreases tendonitis during recovery and rehab. I will let you know how she does.

I stood right behind Dr.Kelly the whole time and got to see the screen as he did. He explained what he was doing, showed me the anatomy and the damage, and the pre an post x-rays.

That was it. It was 2 hours from the time we entered the OR until she was resting comfortably in the PACU. It was incredibly awesome for me to watch, I feel like I learned a lot and have now been on all sides of this! She looked great in recovery, much better than I ever did. I think they used less sedation on her. She was already beginning to wiggle her toes before I left, she was on the CPM too. She received PT prior to the surgery because of the long wait time, which was nice, they fitted her with the brace and taught her to use the crutches before she was all drugged up!

I am just about in seventh heaven! I need a life!!!!

Hipscope #4

I will be in Dr.Kelly's OR this Tuesday for the 4th time.....
but for the first time, I will not be on the table!!

One of my patients is having her hip scoped and I will be there to watch! You can only imagine how excited I am, and how much I will enjoy this! After all I have been through, I am so excited to see what happened after I drifted off into lala land!!

She has a labral tear, FAI and he is (gasp) releasing her psoas, but my mouth is shut. I can only be a pain in the ass when it involves my own hips and I am so grateful to be allowed in the OR!

Who's 'da Man

After a rough start to my day, I finished the morning with my ego quite inflated. Let me explain.

I am currently treating a 30 year old woman with hip pain. Plain MRI showed no pathology, I do not have the x-ray reports. Her chief complaint initially was clicking in the hip and pain and tenderness. She was diagnosed with hip flexor tendonitis. A load of crap, said I, humbly!

She did have extremely tight and painful hip flexors but she also presented with a positive impingement sign, and her pain is relieved with traction and any type of distraction I do on her hip. Her hip flexors have started to feel better from the extensive amount of manual work I have been doing but she still coplains of joint instability, clicking, and just a "funny feeling". So I have been telling her from the very beginning that I suspect there may be something wrong with the joint, despite what the MRI said. I think she started believing me and decided to go back to the doctor after we spoke on friday morning.

When I arrived in the office this morning, there was a handwritten note in my box that said to call that OS office ASAP. In my office, we NEVER use handwritten notes, every message is sent via intra-office email, and then the recipient knows who it was from in case they have questions. This had no name in it, no signature, nothing. Just to call regrding this patient, and ASAP. I thought "oh shit", I pissed him off with my brazen hip views and opinions. At that point, all I could do was suck it up and call, take him yelling at me, and move on. Ironically, the patient was in the OS office at the time I called. I also was not sure who from the OS office had called, bc the note said that his office had called, not him personally.

So I finally got through (after about 3 or 4 busy signals), and the receptionist had no idea who had called me. I went on to further explain that the patient was currently in their office and the message was regarding her. "Oh", the receptionist said, and the next thing I knew, the OS picked up the phone. "Fuck", I thought I had gotten off easy this time!

He said he had been talking to the patient regarding the clicking, and I was "right on" thinking it may be a labral tear, and he was going to order an MR arthrogram. "I think that is a good idea", I said. But I didn't stop there. I asked "did her x-rays show any sign of impingement or dysplasia?" "No, nothing exciting there" he replied,"but you are on the right track".

Ok, I obvioulsy didn't mention my own personal "battles", and how I probably know a little bit more about hip issues than the average PT, but what started out as a morning of me pracically peeing in my pants (for different reasons this time) ended up with me gloating and high fiving everyone around me!!!

As the Snapping Continues, I Think Happy (and cute) Thoughts

We had a great time at Victorian Gardens in Central Park with hipster Amy last week!

This is Not What I Signed Up For

Firstly, I would like to address an issue that has been brought to my attention. Mainly, it is that I am generally feeling awesome. I don't know how well it is reflected here since I usually only blog about the bad days, If you would prefer, I could post each day and write something to the likes of "Today I had no hip pain". But that would be kind of lame and boring, but it is the case most of the time. And no matter how much I complain, anything I speak of is nothing compared to pre-op and I have never once had second thoughts about surgery (revision too) and continue to be really happy with the results.

That said, I will begin by saying that what is happening now sucks! I think my pelvis/ SI joint is becoming increasingly unstable from the pregnancy hormones, so, like in the past with unstable joints, the muscles are tightening/ spasming in response. This time, it is not my psoas (yay), but my right IT band (revision side). It is so tight it has begun snapping. I never really understood the full implications of a snapping IT band...until now. It is a painless snapping that began a few days ago. My greater trochanter on that side is also tender to the touch. I don't know if maybe this is partly because I sleep on my side now, since stomach sleeping ended a few weeks ago, or bc of the tightness, or both...I don't know what came first. In addition, my left adductors are also tight and tender again. So the right side of both legs hurts, I wonder if the right side of my pelvis is more hypermobile these days, the hip joint definitely is more hyperobile on the right.

To add to all of this, the following happened last night. This is rather graphic, and possibly better suited for the ladies only, preferably the ones who have already had children, so that those of you who have not will not be scared away. So you have been warned. If you don't like graphic, skip the rest of the post.

Way back when, when I only began to realize I had a torn labrum, I also realized that suddenly, my pelvic floor muscles were also very weak. To me, this was really bad since on top of treating orthopaedic patients, I also specialize in treating incontinence and pelvic floor dysfunction. The muscles remained weak after surgery but I never had any "real" leaking. Last night, I was lying in bed and out of nowhere got really nauseous. I realized I needed to throw up, and fast, so made a mad dash for the bathroom. Once I started throwing up, I literally peed all over myself. At the time, it was not funny, now, looking back, I can sort of smile, I know it is not permanent, but standing in the bathroom, not knowing where to go or what to do, I was certainly not laughing. When it all "ended", I sat down to catch my breath, and realized my nose was bleeding as well. Another lovely pregnancy side effect. Did I mention that this is my last pregnancy????

More Summer Fun

I finally figured out how to get the blackberry pictures to show in full size, so I went ahead and changed the last pic I uploaded as well from the pool!

Refocusing

Since this blog was started for the purpose of following my recovery from hip arthroscopy(s), I figured I should take a break from sunbathing and let you know what the story is.

Initially, I was supposed to have a follow-up appointment with Dr.Kelly this week (and Amy too) but being that my current condition does not allow for x-rays, I have cancelled and will reschedule for a later date (i.e after the baby is born). Amy and I will still try to make time for an L/ Jk outing + photo session, the plan is to go to Central Park on Thursday.

Anyway....I go most of the time without even realizing that my left hip was ever operated on. I feels great, no pain (at least not in the last few weeks/ days that I can recall as I type this). The only catch is that my activity level has seriously plummeted since the pregnancy began. I am constantly battling bone crushing fatigue so I drive everywhere. Last summer, I walked to the pool every day, this sumer we drive. The pool is across the street from the park I walked (crutched) to 6 days after my second surgery, so it is clearly not that far. The nausea still has not subsided but thanks to amazing drugs, I function! (Thank you Zofran)

The right hip is a different story. Yes, it was operated on twice, and yes, the left hip has 4 months on the right hip, but I can't help to wonder at what point my progress will plateau. Don't get me wrong, it feels great, amazing, a million times better than pre-op, but since I have a "perfect" left hip, it makes me sad to have to settle for less than perfect.

I know, my famous line is "once it is scoped it will never be the same again", I know, but one can only dream! Considering the amount of work I had done on it, I should not be complaining, but should be jumping for joy. The actual joint is great, no more FAI, no more pain in there, so yes, mission accomplished! What bothers me is more superficial pain, around the incisions, yes, the nerve pain is still there. Much diminished, but sigh, still there. My (gasp) psoas gets tight still and once again decreases my stride length. If I had the energy, I would stretch more, but every second I have to myself I am usually in bed (like now, the kids are in the living room watching cartoons and I am in bed. J is out of town for the week).

Of course, I am still anxious about the delivery. Plus, my new decision to try to go as natural as possible. I am thinking of hiring a doula, to help me during the birth. In my messed up mind, if I don't have an epidural, I will feel pain in my hip and prevent it from being put in bad positions. I had hired a doula for L's delivery and needed a c-section bc she was breech. For Jk, I couldn't even think that far ahead, all I could think about was not having a repeat c-section, I didn't care how I went about it. Also, for L's birth, I was petrified of having an epidural. I have now survived a c-section, a vaginal birth and 3 hipscopes with some form of spinal or epidural anesthesia, so the fear factor is slightly decreased, but if I can avoid it, I will. J is not in favor of a doula, he thinks it will lessen his role, but frankly, he had no idea what to do last time and I was rather pissed for a while (I think I still am a little), so thinks that I am trying to punish him by getting a doula. Whatever, next time, he can birth a child and do it his way!!!!

Peace, Serenity

I thought this would give you a good idea of how I have been spending my days and why things in hipville are so calm! L and Jk are "sunbathing" as I carelessly sip an iced tea 20 feet away in the sun!!!

Sometimes I Really Wonder....

There are days I am so spacey, it is a wonder how I got myself out of bed, dressed and to work, and managed to leave L and Jk safely at home, out of harms way. To make matters worse, my legs now hurt just to stand on them. Yes, I am developing cankles (let me know if that needs further explaining). I have had bouts with cankles during previous pregnancies but never this early (15+ weeks). It is so bad that it hurts to stand, which can pose a slight problem at work as I stand most of the time. My Danskos help a lot, but not enough. And I wonder if I am uncomfortable enough to go out and get (gasp) support hose, but I wake up each day and hope and pray that it will be a better day in cankle world.

On top of ankle and foot pain, yesterday, towards the end of the day, my right (revision) thigh started to hurt, in the usual sore areas. But it was a different kind of pain, it was the same throbbing I get in my feet, only it travelled to the op-site. Weird. So now, instead of just sore ankles and feet, I have a sore thigh, I wonder how it all ties together, any ideas? Anyone experience this ever?

While I am on the "sometimes I really wonder" issue, I want to add that I have a few letters after my name that I picked up from an Ivy league institute, no, I am not bragging, but I want you to understand the full implications of the stupidity that at times follows me throughout the day, and makes me (and J) wonder, really wonder what I am thinking.

My latest moment of sheer stupidity came last night, after months and months of talking, I finally decided on which type of window shades I wanted in our bedroom. So I have been price shopping around, and found them really cheap (or so I thought) on a website. I called the customer service number to place my order and the price was 3 times what I had seen online. I was shocked. It wasn't until the sales rep asked if I had actually put in my window measurements on the website that I realized that the price is based on the size of the blind (duh) and they were not as cheap as I thought.

This morning at the supermarket, the expiration date of the milk was on the back side of the bottle, so I tilted it towards me and it looked like it said 08/01, just 2 more days. And every bottle seemed to say 08/01. Until I looked at every bottle and finally actually took one out did I realize I was reading upside down and it actually said 08/10.

Have I mentioned I need a vacation!

Since I Can't Drink, I'll Vent

I need a drink. Really, I am not an alcoholic, but after this week, I either need a very long vacation from treating patients, or a drink. Since neither is feasible, you get to hear about my frustrations.

Most of you have read my blog previously and know my "story", and can probably tell that a)I go after what I want/need until I am satisfied with the results (in this case painfree hips) b)I can be a bit snotty about who I choose as a healthcare provider c)I feel very strongly that that this is the way to get things done quickly and well.

As you can imagine, passive people make me nuts. I am going to use some examples from my week. I know I have to keep reminding myself that not everyone is as aggressive as I am, but when it comes to your health and well being, maybe you should be.

I have a patient who clearly had a botched back surgery. From the first day I saw him, I said he needed a second opinion. I personally gave him the name of 2 VERY local surgeons to go see. Took him a week and a half to make the appt, and was told there was nothing this surgeon could do. What would I do? Start looking into third and fourth opinions, bc living in constant pain, bent over, unable to walk without the use of a cane is not acceptable, and being worse off than before the surgery is definitely not acceptable.

Another patient with arthritic knees, who I told to stop power walking on concrete for a week to see if she would feel better simply cannot stop bc she walks for her mental well being. Well, then she will have a great mental well being but a shitty physical one.

My patients are afraid to ask for x-rays or MRI's when they are clearly needed, half the time I ahve to request them on their behalf, it absolutely akes me nuts.

Patient with a probable labral tear, too passive to even think about getting an MRI, I volunteer to help find an OS who takes her (really crappy) insurance, declines the help and will think about it. Ok, so live with groin pain, I think this is something I know a little bit about and can help you figure it all out, but go ahead and be passive and let pain dictate your life.

Ok, I feel a little better. I could write a book ont his stuff.

Before I forget, there is the lady who called yesterday, she claims she is a former patient, and needs a hip replacement but is too scared to get one (I won't even go there), and she has been sitting in a chair bc she is an artist, and has put pillows under her. When she looks down at her legs, her quadriceps look rounded (WTF). So I (annoyed) say "what exactly is your question", and she continues to ramble about the chair and the pillows and how once she was in a different chair and she turned in it and her groin hurt her, again, I ask "What is your question for me", so she wants to know if I think she should use the pillows on her chair or not. Seriously? How the heck do I know? So I told her to try to take them out, and see if her pain goes away, and if it does, then she should not use the pillows. I swear, she thought I was genius!

The Ups and Downs and Then Some

Since becoming pregnant, I have stopped spinning, not bc I think in any way shape or form that it is harmful to the baby, but I have been to busy puking, lying in bed feeling nauseous, lying in bed feeling sorry for myself that I am so nauseous, or simply lying in bed bc I am too tired to move or do much of anything else. It is also unbelievably hot here, especially over the past few days, my feet have started to swell, which makes me REALLY unhappy.This has never happened to me so early in a pregnancy....but I digress.

My point is that my activity level has gone down...drastically, so my ROM is not as great as it once was and my hips feel tight on and off. This week I was at my breaking point with the tightness and succumbed to asking P for a quick PT session so I could walk like a normal person again. I have had my usual anterior tightness which limits my extension when I walk, so if I have to be anywhere quickly,I have to take smaller steps bc that bungy cord in my hip feeling is back. Not even 5 minutes of some anterior hip mobilizations and quad stretching brought me back to normal! YAY!

I'd like to resume spinning soon but I practically pass out every night once the kids are in bed, especially bc we spend all afternoon outdoors by the pool (I have not gone in for a while bc my bathing suits don't fit anymore...I ordered some this week, I hope they fit!!!)

I remember after one of my surgeries (I'd like to think it was #3, this would support my theory) I told P not to work on my scars, I wanted to see if there would be a difference long term in the appearance and quality of the scar. Given the fact that the revision scars are 4 and 8 months younger than the other scars, they look awful. I really do believe that these were the "experimental scope sites". They were worked on a little bit, P got mad at one point and said I was being ridiculous about it and he was not going to let the scars go to hell. I did let him work on them a little bit, but no where near as much as the other ones. These scars are not red and elevated, and one is pretty painful to the touch. Cosmetically, couldn't care less, trust me, no one ever sees them! And they never get sun, so that is not a problem. I wonder how that plays in with my "nerve pain"/ "invisible bruise" issue. I don't use any creams or scar therapy lotions, I think it is a waste of money, especially given how the other scars look and feel, but it makes me wonder, maybe PT really does work! hahahaha!! Just joking! It was a personal experiment, I always work on my patients scars but there is ever a way to really know of the results would be the same if I didn't, now I know and my work has been validated!!!

Quick Jeff update: He saw OS #2 who confirmed the labral tear diagnosis, despite the fact that he felt the quality of the MRI was pretty poor, and who added "we always order these with contrast". He did not see any FAI. I am concerned about this. Given my extensive personal research and "networking", I cannot think of a single person who has had surgery for JUST a labral tear who is doing exceptionally well. I wold like further investigation into the "no FAI" thing with possible a CT-scan, although my CT-scan missed my FAI.....but better to be safe than sorry.I still strongly believe he needs to make a trip to NY to have this checked out and addressed!

Dear Jeff Part II

To avoid any last minute, in the waiting room, phone calls, I am creating a list for Jeff (or anyone) who is going for a second opinion tomorrow for his labral tear.

To recap: Jeff, my younger brother, has been dealing with hip pain since April. He recently saw an OS who ordered an MRI which revealed a labral tear. The OS was clearly clueless about hips, so I found another OS locally for Jeff to bring his films to and get more answers.

1)What caused my labral tear?
2)Do I have FAI
3)What type of FAI, cam, pincer or both?
4)Do I have any cartilage damage?
5)Do I need surgery?
6)Can it be done arthroscopically? Can all the FAI be addressed arthroscopically?
7)If I put off having surgery, will this get worse?
8)When can I return to sports?
9)What about a cortisone injection?

I think that about covers it! Did I miss anything?
I am not including questions about the surgeon's experience and post-op protocols etc since you all know how I feel about "other"OS's and know that if he needs surgery, he won't be having it in Miami.
Let me know what you think!

The Pregnancy Scoop

I definitely feel as if I have slightly abandoned you over the last 3 months, but if you will let me explain myself. To put it simply, I don't do pregnancy gracefully. If you will recall my post-op issues after hip arthroscopy #3, you will get a better sense of what I have been going through (I tried to add a link to one of those posts but it seems that they are either too graphic or don't capture the full picture adequately, if you so desire, read up on posts from Nov 13-21 2007). Basically, I have been REALLY nauseous. It started around 6 weeks of pregnancy, way before I was sharing the news. J went away for the weekend with L, and Jk and I stayed home. I luckily had a few Zofran (my super duper anti-nausea meds I convinced Dr Kelly to prescribe for surgery #2 and 3 after a bad experience with #1), but like the "junkie" that I am, I was nervous they would not last the whole weekend and I would be screwed. Plus, I didn't really want to bother my OB-gyn over the weekend. Luckily, I have a friend who just the week before mentioned she had Zofran left from her last pregnancy, with refills! She happened to be at the park that day and I casually pulled her aside and explained my"situation". She was wonderful, dropped off the "goods" that night plus refilled it for me. I was feeling a lot more confident about venturing out of the house and not causing a really embarrassing scene for myself.





Tuesday morning I put in a call to my doc for more drugs, plus, I was having awful acid issues in my stomach, so I needed something for that as well.Acid+nausea=terrible feeling, wishing you might die, reconsidering the whole pregnancy thing (although it was a little too late). So, a few calls to my insurance company (by me and the docs office), I was able to take 4 Zofran a day plus 2 Prevacid. It made my life manageable but by no means enjoyably or pleasant. I kept saying that this was definitely the worst pregnancy yet.





Then, by the middle of week 11, I made it until 3PM on one Zofran, this was record breaking for me. And since then, I have been down to 2 Zofran/day, still with 1-2 Prevacid/day, and feeling much more human,most of the time.





The real question is how have the hips been? Given that pregnancy is a time of hormonal fluctuation, one of which is the hormone Relaxin (I can go on and on about this as I wrote my thesis on orthopaedic issues and pregnancy)....My SI joint has been a little cranky.

A. ilium
B. sacrum
C. acetabulum
D. pubis
E. pubic symphysis
F. ischium

What has been happenning is that my ilium (A) will rotate ever so slightly due to ligamentous laxity.As you can see, the acetabulum is at the bottom (C), so when the ilium shifts, so does the acetabulum, making me one very unhappy camper. In the past, the SI issues used to only cause unilateral back pain. On really bad days, it also causes hip pain.

Another issue I have been having is that the right hip has been feeling extremely tight. I am not sure if it is because I have dropped my activity level drastically (see above), or I am having a build up of scar tissue. Whatever the reason, I need to do something about it, but am usually too tired at the end of the day for any self assessment, and much less stretching or the like.

Another issue that the pregnancy seems to be exacerbating is the nerve pain I have had all along, remember the invisible bruise on the front of my leg. At times it becomes pretty painful, and even more tender to the touch, and then a little while later, it will be all gone. Strange.

Other than that, the hips have fared pretty well so far. My biggest concern (which I will probably mention a million times from now until I actually give birth) is the actual delivery. Epidural+weird hip positions= me really nervous. I don't want to opt for a c-section bc of this, bc, to be quite frank, if I had a choice,I would much rather have a hip scope than a c-section (meaning, if the delivery somehow screwed up my hip), not that it would, but I REALLY don't want a c-section, been there, done that. You will get so sick of hearing about this but it is what plays on my mind all the time!

I Was Right

I love hearing those words, even though the other times I have heard them, it was not relating to great things (i.e hip scopes), but nevertheless, there is something "ego building" about it. The other times were here and here, relating to my non-psoas release days.

So....an update on Jeff: He has a labral tear. I have the MRI report and will share some key lines, but it has no mention of FAI. I am going to have him call and get the radiology report on the x-rays too. The OS told him to take 6 weeks and do nothing. If he still has pain, he can come back and get a cortisone injection, and maybe get the area "resurfaced" (I think he meant scoped to clean up the tear). Obviously, without a cause for the tear, he would not let him "resurface" it, and even more obviously, I would not let him have surgery with that guy.

"Evaluation of the unilateral images and the bi-lateral coronal T1- weighted sequence does demonstrate a region of irregularity and signal change within the superior acetabular labrum centrally extending anteriorly. This finding is suggestive of fibrillation and likely a focal area of tearing in this location."

Wow, I am so good I can diagnose over the phone (that must be the ego talking :-)

Update

I.

Am.

Pregnant.

Today is My 1 Year Anniversary

And I am running late for work! So I will not have time to post a true update, but promise one by the end of the weekend with all the exciting things happening in my life :-)

An update on Jeff (I can't believe we are related): He had his MRI yesterday, it was only about 20 minutes (mine were all closer to 45 minutes), he did say they put a coil on his hip and taped his feet into IR. Here is the "I can't believe we are related part". The doc told him to make an appt for after the MRI to come in and discuss the results (why he can't call is beyond me). What would I have done? Once I got off the phone with MRI place, the next call would have been the docs office for an appt a few days later. Jeff's plan is to call today for an appt. I am going to try (in my sneaky way) to get the report from the imaging center this week, we'll see! Some are good about it, some are not and have rules and protocols!

Once again, thank you to J's HR dept and United healthcare for the wonderful insurance they provide us, Jeff's MRI co-pay was $400, no that is not an extra zero!!!!!

And The Verdict Is....

Hips passed the Boston trip!!!!! Yay!

There was absolutely no pain at any time on the stairs...in the hips. My knee problem took a hit this weekend but things are beginning to calm down again. I am not interested in dealing with it...again! The pain had gotten a lot better with strengthening and is manageable at this time, so as long as it stays there, I won't bother with a cortisone injection. But the offer is still on the table (I hope) should I so desire one!

Testing the Waters

We are off to Boston tomorrow to the in-laws. It is actually J's 10 year high school reunion. In the past, I have not done so well there with the flights of stairs and the kids all over the place. In fact, I think the July 07 trip to Boston was what sealed the deal for me in knowing I needed a revision on the right. I was about 3 or 4 weeks post-op on the left and the stairs were making the right (which was 4 months out) hurt soooooo much more, I knew something was wrong. I was also back in Boston a few weeks after the revision and seem to remember having a hard time with the stairs then to.

So, I will report back when I know. I have been having a hip-issue free period of time, with minor blips here and there, but have been taking it easy. Lets keep our fingers crossed.

The Difference Between Men and Women

Today was Jeff's appointment with the local OS. Like many of you (most likely women), I had done a ton of research prior to my initial OS appointment, including journal articles, textbooks, google searches and speaking to other people in my situation. I had already self diagnosed (correctly I might add) and had a list of questions in my head. I had a plan and was not leaving the office without a script for an MRI. I was ready!

Jeff called me from the waiting room at the doctor's office and said "what should I ask him". exasperated, I asked if he had read my blog yet, he said yes, meaning the "Dear Jeff" post. So, I had to give him the 60 second labral tear/FAI lesson. It went something like this: Make sure they take an x-ray, ask him if he sees impingement. Ask him if he thinks it is a labral tear, make sure he figures out why you have a tear (I can't stress this enough) and get an MRI. Tell him exercise and PT has made you worse. Tell him you started with groin pain and now it is more diffuse throughout your leg and has radiated to your knee. Find out what he thinks is the problem.

So.....Jeff has to get an MRI, the doc has no idea what is wrong, he does not know if it is a labral tear, he said maybe a stress fracture or some inflammation and have him NSAID's to take for now. And he left in more pain than he went in with :-)

Dear Jeff.....

Being that my life can't get any more pathetic these days, now it seems that my problems are contagious. My younger brother, Jeff, has a possible torn labrum. He called me one day in April to tell me his hip had begun bothering him during ice hockey, and he had a triathlon a few days later and didn't know what to do. Although I don't remember the mechanism of injury, it sounded like a possible acute hip flexor strain so I instructed him in a hip flexor stretch (the Susie favorite in half kneeling). He said it really helped and did it the entire week prior to the race. He did his Triathlon and I don't really remember hearing much else about the hip.

My parents are in NY visiting for a few days and mentioned that Jeff had to stop playing tennis and training for his next triathlon bc his hip has been bothering him, and he has an appointment with an OS in Miami. Obviously, an OS in Miami does not meet my "hip OS standards". Jeff things I am snobby and that this guy "does NFL and MLB players", and must be good. So, I thought maybe some of my readers could share some insight with my dear little brother and maybe share their experiences with "great OS's". I told him to make sure he a) gets an MRI (and to find out if they have the "special" MRI's that can detect tears without contrast, and if not, suck it up and have it with contrast) b) get a copy of ALL films to send off for a second opinion c)If he does indeed have a labral tear, does he have FAI d) DO NOT HAVE SURGERY IN MIAMI

He said he is going to see if the doctor can make the diagnosis without him saying anything, and if he does not mention the labrum, he will bring it up. I think this is not so easy when you are in the thick of it with a busy OS, especially if they are arrogant and busy, not that this one is, but, just in case. Do not wait to try PT then get the MRI, push for it now.

So, I admit I can be a bit snobby about hips and hip surgeons, but I think I have the experience and have heard from enough people to know at least a little bit about what I am talking about.

So please, comment, I will forward all responses to him, so he does not have to go through what so many of you have had to.

Close Call

Being that I am "so over" the hip hype, I occasionally wear shoes that are not befitting someone who has had 3 hip surgeries and a bad knee. Occasionally, fashion comes first. Yesterday was one of these days, the fashion required 4" heels. I have to say I did really well until the last 15 minutes of heel time.

I was crossing the street with J, when all of a sudden, I heard/ felt one of my infamous hip cracks, but I was standing on the leg, not sitting down or moving it. It was during the stance phase of gait, and then, for a quick second, my leg almost gave out on me. It happened so quickly I don't think J noticed, but for that moment, horrible thoughts went through my mind, including, but not limited to a fracture. And then, just as quickly as it happened, it was over, I made it to the sidewalk with no further incident.

Scar tissue? Psoas? Who knows. I am fine, my hips are fine, if just a bit rattled!

Funky Popping Going On

Every now and then, I will go sit on a low chair and POP, something (psoas?) will pop/ snap in one of my hips. It doesn't hurt but is rather loud.

Yesterday took the cake! Try to picture this. I was lying in bed, on my right side, very close to the edge of the right side of the bed. I let my right leg slowly hang of the bed (don't know what I was doing) and pop, pop. 2 pops in the hip (psoas). So I tried to re-evaluate what had happened, and came to he conclusion that I had internally rotated the right leg and then it popped. Which led me to wonder if it really was the psoas, or rather some old scar tissue.

I know, I have way too much on my hands!

Why Didn't This Ever Occur To Me?

For those of you that can remember, before all the excitement of all of these surgeries, there were MRI's and CT scans and anxious days waiting for phone calls with the results. Many anxious days, filled with frustration and annoyance, knowing my results were sitting on my OS desk and me not knowing. So I patiently sat by the phone for days at a time, a slave to it, to ensure I didn't miss a call.

I had an appointment today at my ob-gyn's office. I was sitting in the waiting room and a woman walked in and walked to the reception desk. She announced her name and said she as there because she had already called twice and no one had called her back yet. She needed to schedule surgery. Clearly she was very anxious about it. The receptionist told her she that the reason she hadn't been called back was bc the surgery had to be scheduled with the hospital. She wanted to know when they would do it, they told her today or tomorrow. She was not happy with that, to which I can relate, but probably would not have actually come down to the office for this! They told her they would call her when they knew when, to which she replied that she needed options for dates in case she wasn't going to be around.

I know many of us have felt like this woman before but would we ever do that? Was she gutsy or a pain in the ass?? I know I have felt like doing that before, I have also felt like breaking into my OS office and stealing my films, until I got smart and just had the receptionist fax me the results before speaking to him. That was the most ingenious thing ever, less waiting, less anxiousness and me being the control freak I am!

11 Month Update

I am now 11 months post hip arthroscopy #2, the first and only surgery on the left hip. On most days, I would never think I had surgery on that leg. What effects me the most these days is that it is pool season and I am not thrilled with the vampire bite scars on my leg. I know last week there was the slight medial issue, I have not had it since, and I can say I am thrilled thrilled thrilled with it. I have no idea what the ROM is, or what the strength is, functionally, it is amazing and that is all that matters.I don't care if I am lacking some IR, or some flexion, there is nothing in life I currently cannot do bc of this hip.

I would love to x-ray my hips, and see what they look like now, see if arthritis is beginning to set in, what the shape is like....I have not had post-op x-rays, the closest I have come is an OR x-ray on the right side to show the "funky cam impingement" before and after! X-rays will have to wait!
All I can say is thank you Dr. Kelly!!!!

Am I Being Ridiculous? Neurotic? Or Just Plain Naive?

My activity level has increased slighlty over the past few days in the way of walking but decreased in the way of spinning due to some other things going on (I won't get into that yet).

I have had some pain on my right side that bothered me a few days ago, and I wondered if I was going crazy. I had some medial sided pain, but the usual anterior medial, it is purely medial hip pain. It is not bad at all, but being that I am generally not in pain or discomfort, this was slightly disconcerting. It happenned Sunday, and then Sunday night, my leg felt tired, as I lay in bed. It started up again yesterday,and today,I walked about 80 city blocks and experienced it again.

Yes, 80 blocks is excessive, am I asking too much of my hip? I am not sure what is going on other than some crazy hormonal shit at the same time (not getting into it though), I did wear my Danskos all day to prevent knee and hip pain.

Obviously, I know things will never be perfect again, and I am nitpicking here bc things have been so great, I just want NO DISCOMFORT at all.

I do try to not think about the fact that this hip will eventually deteriorate into a nasty case of arthritis, but when I do, I hope and pray that this is not the beginning of it. I know, I need to chill out, but I am very "high maintenance".

I am Defnitely Going To Hell

Today started out like any other Thursday, I was in housewife mode, I went food shopping in the morning, and then decided to meet my sister in the city. I decided to leave my car at home and take public transportation since the car usually becomes more of a burden in the city, plus, with the price of gas and parking, I was trying to be economical and eco-friendly. See, I am also VERY lucky, I have a parking spot. It is not in the indoor, valet garage in my building. That one has a long waitlist. It is about a block away, outdoors, on a poorly paved empty lot, but it is a HUGE luxury in NY. For the 6 months that we did not have a spot, I hated going out early in the day bc I would surely home home during "alternate side" and not be able to find a spot. I also didn't like to go out too late bc then there would be no spots left on the street. Having a spot gives me freedom, plus I sleep a lot better at night knowing my car won't be ticketed (again).

So today I received a call from a woman who works at the office who manages the garage. We are being kicked out of our spot bc someone who lives in the building adjacent to the lot needs a spot. What a load of crap. I have been parking there for 1 1/2 years. Apparently, I was the last one in the lot, so I am the first to get the boot. Well, I was furious, and yelled and screamed, but to no avail. So I had J call, bc I am too emotionally involved.

J didn't know what to do, so here is what happened in the conversation between J and the man at the parking place:
Man: Look, I am really sorry but the owner of the lot also owns apartments in the building and he is renting one out and needs a parking spot for the tennant.
J: But we have been with you for 1 1/2 years, we are good tennants, and we had no idea this was a possibility, we would have had a back-up plan in this case.
Man: I know, I'm sorry, but you are tenants at will, there is no contract, we don't even bill you, you just send us a check each month.
J: Look, I work in the city, I have 2 kids and my wife is disabled
Man: Oh, she's disabled
J: Yes, she just had 3 surgeries.....
Man: Oh, I see, I'm so sorry, let me see if there is someone else we can kick out, I will get back to you

So you see, we have a little white lie going here. Yes, I had 3 surgeries, but I am far from disabled. We are sooooooo going to hell for this. But parking is such a HUGE deal for me....
Can you feel the jewish guilt????????????

Revision Hip Arthroscopy/ Failed Hip Arthroscopy

I always wonder how many other people have fallen into this predicament as well. What I have noticed is that these are key words that often bring people to my blog. I have no way to really keep track, but often I will scan my sitemeter which will tell me the search words used by readers. It doesn't always work, for example, "Landsickness" through google brings up my blog, o the top 10 (I checked), but so do other key words, like FAI, hipscope, hip arthroscopy,psoas....and my all time favorite, "Bryan Kelly hipscope", my blog is #1 on google if you put in those words. This is quite embarrassing as well as pretty funny, if you ask me! (If he knew, he probably wouldn't agree!)

So, my point is, I was curious, who has had a failed hip arthroscopy? or failed FAI surgery? or failed surgery for a labral tear? Who has retorn their labrum?And even more importantly....why...what reason were you given??
Now would be a great time for all lurkers to share their story, so we can all learn from each other.
Me? An conservative surgeon who didn't want to take down too much bone if it was unnecessary. We found out the hard way that it indeed was necessary, but a happy ending for all involved parties!!!

6 Month Post-Revision Update

Wow, I can't believe it has been 6 months already. 6 months since I tossed the hip brace, 6 months since I retired my crutches, 6 months since I was praying to a higher power to either make me stop vomiting or take me out back and shoot me, 6 month since I have had an argument with a surgeon :-)

For those of you just joining my blog, here is how it all went down: In March of 2007, I had my right hip scoped for a labral tear and pincer FAI. In July, the left hip was scoped for a labral tear, cam and pincer FAI. At that point, the right hip went bad and I realized I needed surgery again. It took a lot of diagnostic tests, injections, pleading and begging, but finally, my surgeon agreed to do it, but.....there was a catch. He was convinced that my pain was from a tight, impinging psoas, I did not think so. In fact, I was so sure, I made him promise he wouldn't touch my psoas. I wouldn't even sign a consent for for it I was so sure. So, he hesitantly agreed to do the surgery with the psoas promise, and as a compromise, I agreed to let him do a psoas bursectomy, if needed. Lo and behold, I woke up with an intact psoas as well as sans bursectomy since the psoas was not the problem.

3 months of long, intense rehab, with a few blips and bumps and knee injuries along the way, as well as some intermittent PRN PT visits, here I am.

I can't believe that 6 months later, I still walk around and gleefully think to myself "whoohoo, I am no pain", with a little smile. I still feel like I am walking on clouds some days and as if this was a dream, and I will soon wake up with that dreaded groin pain. I still say to myself almost every day. "shit, I am one lucky chick to have a happy ending after so much bullshit", 3 surgeries in 8 months really takes a toll on you, physically and emotionally.

So, what is still going on? My psoas has its moments, and more than once I have had to return for a quickie PT session to have it worked on. It also has caused me to have some back pain in addition to the muscle aches. My adductors are weak and tight, and I swear I think I have had a "snapping adductor". My psoas does snap now, I am not sure if it did, or to what extent it did pre-op. My theory to why I have so much muscle pain now is well described in prior post. I have soooo much more ROM now than I ever did and my muscles are trying to compensate by tightening up. I need to continue to strengthen them, but I prefer Spinning to PT, so who knows how this will end!

All in all, muscle pain and soreness 6 months later is a good deal for me if it means I have no more joint pain! If you need a surgeon, I have only positive things to say about mine! And what can be better than a happy ending!

Woe Is Us Part Deux

My Turn!
If I ever doubted that the entire body is connected and works as one impressive chain, today would have changed my mind.
I have been having incredible muscle pain over the past few days, it hasn't been this bad in a while. Yesterday and today I have been dealing with the right side (2 scopes), I feel my psoas pulling at my vertebrae again, and then I get awful pain on medial side of my thigh, not quite groin. This is palpable too. I am so stiff and clicky as well.
Yesterday was a sore day. As I was waiting for the elevator to go down and pick L up at school, I started stretching and trying to get my hip to extend, and hopefully stretch, or possibly break up scar tissue. I got it to pop, but then it hurt. It did get better at some point, I don't remember exactly when or what happened. Which leads me to beleive it was scar tissue
Today, that side was a mess again. I felt like my hip was so tight I was losing extension again, like in the early pre-op days. I did the "stool stretch", where I put my knee on a rolling stool and stretch my leg out behind me. It felt good, I got up to walk, and my right knee was a disaster (i.e. the good knee), I was limping for a while. This too, cleared up, but the hip remains tight.

Like the uncompliant,impatient patient that I am, I had a good ride on my spin bike tonight. I know this is not helping the psoas issue since I am sitting, and spinning my legs, fast, in a small arc of motion. The psoas just winds tighter and tighter.
I have been strtetching it, still, and still doing my abductor and adductor exercises, as if this balances out the "don't spin" part.
Time to get on the floor and stretch stretch stretch!!!