Saturday, June 30, 2007

36 Hours To Go

I am unnaturally calm. I think I should rename this post "The Calm Before The Storm". I was really anxious yesterday, I had to tie up all loose ends at work, finish all my paperwork (Fridays I usually leave some paperwork for Monday!!), and make sure my replacement knew all my patients and what I do with them. Maybe now that that is behind me , I am more relaxed!
But who am I kidding, of course I am anxious about this. This time, I don't have the luxury of "ignorance is bliss", Last time, I could simply not fathom that my leg would hurt that much, boy was I wrong. So now I am going into surgery with the knowledge of what is waiting for me on the other end.

I also hate the fact that around 15 strangers will be seeing me completely naked, while I am asleep!! This is why I waxed, mani'd and pedi'd already. I know the morning of surgery I will be up blow drying my hair and applying make-up! Those OR lights can be harsh! I will also be spending the day tomorrow out by the pool, perfecting my tan!

All this takes my mind off of what really worries I making the right decision? I hope I am, I have been doing really well with my first surgery (still not fully recovered from it, or my "twisting episode" on Thursday), will this surgery negatively impact the recovery and prognosis of the first surgery? Will this scope be all I need? Will I need a replacement soon down the road? Will I recover well from the anesthesia? All of this swims through my head, and increases my anxiety level, so I focus on what I can control, like my nail polish color!!

Luckily, I have a great deal of control when it comes to rehab, and I attribute my progress and well being at this point to a wonderful team of PT's who put up with my demands, complaining, worrying, and occasional doubts!
If everything this time goes as well as it has for me so far, I will be grateful, I feel truly blessed!
I hope to post at least once more before the surgery, but I know tomorrow may be hectic, L starts camp on Monday morning!!!!
Wish me luck!!!

Thursday, June 28, 2007

Pre/Post PT measurements

Being that I am rehabing in my own office, I don't always have time for everything I need to be doing. The scenario constantly changes, it can either be that a collegue has an emergency to tend to, so being that I am in the office already, I am the obvious one to cover his or her patients. The more likely scenario is that my schedule becomes booked, then double booked, so I tell patients to come in before my official start time, since I am around anyway. It seems that word has gotten out about my unofficial hours, so now a lot of my patients show up early, thus cutting into my exercise time!!

Yesterday, P, one of my PTs, took measurements for me, we checked strength as well as ROM. My operated leg has bounced back nicely, my strength was up to 4+/5 for the most part (I don't recall specifics) and my ROM was very nice, about 120 degrees of hip flexion, and I believe 38 degress of internal rotation. Those were my biggest concerns in the beginning, external rotation came back right away! What I do have is residual pinching in the joint, groin area, with full flexion (120 degrees for me), and with flexion, adduction and internal rotation. At this point, I don't know if I will ever be pain free in those positions, but really, I only know that they are painful because I am compulsive PT who is constantly checking, they are not functional positions!

My unoperated leg was a different story. The ROM was fine, interestingly (again, I only know this bc I am compulsive), the ROM fluctuates, specifically hip flexion, my guess is it has to do with the amount of swelling in the joint, because on bad days, I have less ROM. The strength on this leg was pathetic!! P gave me a 3+/5, and I think he was being generous and didn't want to make me feel bad!

This morning, I had a near disaster with the operated leg (from here on in, it will be referred to as the right side). I was in the bathroom, getting ready for work, and I twisted/ pivoted on it. It got stuck, my body turned but the leg stayed, then popped/ clunked into place, it really HURT. It scared the crap out of me. It kept hurting me on my drive to work, but later in the day was fine. I am hoping that I broke through some scar tissue, and nothing more. I had a few episodes of breaking scar tissue early on in my recovery. I remember complaining a lot of lacking extension, and it bothered me most when I walked, I felt really tight anteriorly. So I would try to push my leg into extension. Once, at around 3 weeks out, In was watching L in ballet class and thrust my leg back and heard an awful pop, felt pain, but then felt relief. My ROM improved immediately! It happened again at 4 weeks, we were in the airport on our way to Puerto Rico, I turned around and there was a huge pop, even J heard it, I have never seen him so white! But again, pop, pain, relief!! I don't have the same relief this time, so hopefully time will heal! I better heal in the next 3 days though, I am on a tight timeline here!

Saturday, June 23, 2007

You Never Appreciate Something Until it is Gone

Today it really hit me...I love cortisone! I know it is really bad for your joints, but it has afforded me so much relief, none of which I really appreciated until now.

I don't mean to complain, well, maybe just a little, especially because I tried complaining to my husband, J, and he answered me "which side hurts?..oh, the un-operated, who cares, is going to be fixed next week".

This is not a good answer to me, especially since I have been a lot better since my injection. I had the injection on May 1, I had one great week, basically pain free. After one week, I decided the injection wore off, but really, it didn't. I was no longer pain free, but nowhere near as bad as I was pre-injection (I guess a painscale would help here).

I had a slow increase in pain after the injection, but one day, I do remember thinking it was less pain than pre-injection. So I decided it did work.
I also began thinking about my first injection, and I had 2 good weeks, almost no pain, but then some pain, looking back, the pain never reached the pre-injection level again (surgery was about 1 month later).
So now, 8 days before my surgery, I long for another injection. I know, getting one now would be just plain stupid, but the pain is aggravating the hell out of me.

I understand now why I get patients with chronic pain, also on anti-depressants. No, I did not reach this level in a few days with pain, but I can see that I could reach this level quite easily if this was a long term thing.
I am also glad that I listened to myself, and pushed for an MRI and injection when this began, and that I continued to listen to myself and scheduled surgery.
I admit, there were days when I felt so good, I contemplated cancelling the surgery (don't tell J), but now I see that it was the cortisone talking!!!

Wednesday, June 20, 2007

The Countdown Begins

Today was my official "pre-op/ post-op" appointment, after this they will all be post-op/ post-op.

My non-operated hip has been pretty bad since a little incident on Monday requiring me to sprint after jk to prevent him from scaling a fence close to a river! It was a close call, interestingly, I had zero pain during the actual run, but I limped home afterwards!

I only waited about an hour this time, not too bad! I happen to really like my surgeon, he is an excellent surgeon with great bedside manner, something you don't always find. The first thing he said was "sorry for the wait". I know he must say it a lot, but it is nice to hear!

Really, this could have been done for the most part over the phone...he moved my hip around, checked my range of motion, and that was pretty much it! He then proceeded to check the non-operated hip, which he had already done at my last visit. That visit consisted of me telling him the other side was torn and him telling me it was just "muscular". I have already had an MRI on it, there was no need to move it and check it, but he it really hurts, and for no good reason!
I asked him if he needed an x-ray of the hip before the surgery, he was surprised that there won't one done last time. I, again, reminded him that last time he doubted that there was a real issue but I insisted on getting an injection, so he requested an MRI then.

I also asked him if I can have the same anesthesiologist this time, I loved mine last time. I am petrified of spinals (I had a spinal with sedation). He said we can try, but honestly, they are all great! And the ones that are not great don't last!

I also discussed my pain med issue, I do not want a repeat of day 3 from last time. To prevent this, we are going to try darvocet for pain, and zofran for nausea! Zofran is my favorite drug in the world, I discovered it during my first pregnancy, 8 weeks into it, I threw up 5 times before lunch! Zofran changed my life, and allowed me to think about getting pregnant a second time without fear of uncontrollable nausea and vomiting!!

When the tear was discovered in my other hip, I spoke to my surgeon and he said he does second sides 8-12 weeks out. I decided to wait longer, I was not ready then! Today, he agreed with me that it was smart to wait until now to do it!
After he examined me, he said "ok, I think we should proceed with the surgery, if you feel comfortable", "I alredy scheduled it for a week from Monday!!" I told him!
As much as I am dreading starting from scratch, I am looking forward to regaining the use of both legs and getting out of this pain once and for all!!!

Sunday, June 17, 2007

Is this Real or am I dreaming????

I go through periods with no pain...ok, I had a steroid injection in my hip, but this the magic answer??? I think about this sometimes, especially when having a few good days, and then bam, out of nowhere, pain.

This morning, Jk woke up at 6:15, yes, on a Sunday. After unsuccessfully trying to lull him back to sleep, we decided to take a walk, we walked for about 45 minutes, with a single stroller (as opposed to my double, which weighs 35lbs on its own, empty). I also walked yesterday for about 45 minutes with Jk, and then 45 minutes with my daughter, L. No pain in my unoperated hip!

A little later in the morning, I had to walk L (daughter, 3 yrs old) to ballet, not even half a block into the trip, I had pain, it was so random....why then and not earlier???? Why not during my numerous long walks earlier? The only difference I can possibly attribute it to is that I did have the double stroller, but even so, am I crazy???

I also noticed that I am compensating with my foot, I don't like to put the medial side of my foot down when I walk.....crazy!
So surgery is in 2 weeks, I feel weird going through with this when I have painfree days....but I should watch what I say, because I know that right after that comes out of my mouth....I will have pain!
btw- I don't use nor do I believe in painscales, so I will never refer to my pain being a "3", or whatever!!! Also, I really like orange strollers!!!!

Thursday, June 14, 2007


I know that my blog, up until now, has been out of order and maybe confusing at times, so I would like to make a timeline of events to make it clear what led up to 3 surgeries.
November 2005- Jk was born (2nd child, boy) via VBAC, I felt hip pain, but what didn't hurt! Pain went away on its own.
November 2006- Hip pain came back, ignored it for 2 weeks, on Jk's birthday (how ironic) pain was AWFUL, had 3 different PT's work on it, PT only made it worse
Dec 2006- Exercise makes my hip hurt more, manual therapy makes my hip hurt more, time to look into seeing a hip specialist
Dec 2006- Don't get to bed until after midnight, for weeks as I am doing tons of hip research and investigating specialists, come across 2 articles in JOSPT that are encouraging. Found hip labral tear and FAI web forums, learn a ton from other people's experiences
Dec 2006- Choose hip doc, get an appt one month later (see earlier post)
Jan 2007- See hip doc, agrees with self diagnosis, order's MRI (no injection, he believes his MRI machine is good enough to pick up a labral tear without contrast)
Jan 2007- Receive call form hip doc's PA, MRI showed tear and FAI, go get diagnostic injection and make an appt to see hip doc 2 weeks after
Jan 2007- Have injection (see earlier post), injection provides immediate relief
Jan 2007- Go to Disney World!!!!
Feb 2007- See hip doc again, he is pleased that I got relief with injection, lets hold off on surgery, maybe the injection was enough. I don't agree, I want to get this over and done with, as long as he feels comfortable operating. He says "oh, I feel comfortable, I just didn't know if you did!!"
Feb 2007- Schedule first hip scope for March 5
March 2007- First post-op visit, 1 1/2 weeks later, things seem to be going well, I mention that my other hip hurts, he says its compensation, we leave it at that, he wants to see me in 6 weeks
April 2007- 2nd post-op visit, at this point, the other hip is becoming a major issue, I make it very very clear to him, most importantly, it is affecting my rehab on the operated hip, so I want it injected, just for pain relief, he agrees and wants an MRI too
May 2007- 7am MRI followed by 12pm injection, relief with second injection
May 2007- doc calls, MRI positive, looks identical to MRI on other hip. He generally will operate a second time 8-12 weeks out from the first
May 2007- after 3 sleepless nights, I schedule the second surgery, they will be 17 weeks apart
June 28 2007- Twisting motion while applying make-up causes loud, painful pop in right hip
July 2 2007- Left hip arthroscopy, findings: torn labrum, cam and pincer impingement,loose bodies
July 18 2007- 1st post-op appointment, right hip pain is compenastion, left is doing fine
July 26 2007- Right hip is unbearable, call doc, decide to schedule MRI
July 31 2007- Right hip MRI- shows farying of labrum anteriorly and Cam impingement, doc says it is nothing to worry about, do I want injection? I will think about it
August 28 2007- Finally have arthrogram (intra-articualr injection), got 3 painfree hours
August 29 2007- See doc, discuss cam impingement in right hip, he tells me that sometimes he needs to do revision surgeries in cases like this
September 2007- Discuss situation with doc, he believes it may be my psoas as well, schedule CT scan, scan inconclusive
October 2007- Doc strongly suspects psoas involvement, I still disagree, we agree to try a psoas injection, bad reaction, mild pain relief
October 2007- See doc post-psoas injection, beg him to put me out of my misery, we agree to set a tentative date for surgery and wait 1 week to see how I fare with injection
October 2007- Injection did not help, Nov 12 2007 date set for Right hip revision arthroscopy
November 12 2007-Right Revision Hip Arthroscopy, cam impingement, scar tissue, synovectomy
April 2008- Get pregnant with Zk
January 2009- Zk is born, once again via VBAC (drugless too)
June 2009- After sitting in Indian Style for 30 minutes, I procees to stand up and hip is too painful to stand on
June 2009- MRI of R hip shows increased signal in capsule
July 2009- Intra-articular injection of right hip gives approximately 2 days of relief
September 2009- PRP injection of the joint capsule gives no relief
September 2009- BK tells me he thinks I need exploratory surgery (this will be surgery #4)
September 2009- I freak out, BK agrees to try one more injection
October 2009- Synvisc + Cortisone injection scheduled for right hip

November 2009-Schedule Hip Arthroscopy #4 (#3 for right side)
November 2009- Hip Arthroscopy #4 for possible HO, labral tear and capsular shift
February 2010 Hip begins to feel unstable, joint pain becomes awful at times
February 2010 I begin to become concerned that I have a TON of hip ER, despite capsular shift
March 2010 MRI to see what the issue is (this time...sigh)
March 2010 BK thinks it may be my psoas or capsule or scar tissue
March 2010 Discuss possibility of dynamic ultrasound and/or dynamic CT scan

Tuesday, June 12, 2007

Life After the Dreaded Injection

My surgeon follows a specific protocol. Hip pain -> MRI -> trial of PT -> diagnostic injection -> surgery. The injection can be a scary sounding thing. They inject a numbing agent (marcaine) into the joint, followed by some steroids (kenalog and cortisone), if you get relief, your pain is indeed coming from the labral tear in your hip. My doctor tried to reassure me by saying he sends all his patients to one particular radiologist, he is "the best", he has heard horror stories of other radiologists, but never from a patient using this guy.
So I sucked it up and went to have it done. The radiology tech was excellent, he was very reassuring and helped calm me down. After I had changed, he took me to the room where the injection would be done, "Dr. X will be in soon"....wait a second, that's not who I was supposed to have....ok, stay calm, he must be just as good, right??? Turns out he was a fellow...oh no, how many of these could he have done?
He was AMAZING!!! Ok, yes, he did stick a gigantic needle into my hip, but I barely felt it, and he spoke to me the whole time, kept me calm, and best of worked!!
I did put a lot of pressure on him! I said I have to be in good shape for next week, I am taking my kids to Disney World! He finished injecting everything, I stood up, and I had no pain, zero!!!! Wow!! I practically skipped home! I was so happy to finally not have pain!
About 3 or 4 hours later, the numbing agent wore off, pain again, but it did not return to the baseline level of pain I was having pre-injection, it kept going up and up... This was not good! That night, I experienced pain like I never had before, Now I was getting scared, how would I manage in Disney like this?
Luckily, the next morning, the pain had gone away and I was back to being painfree!!
The injection worked so well in fact, that my my plan for avoiding surgery on the second side was to just have it constantly injected! My surgeon was not in favor :-(
He said the steroids would cause too much damage over time!!! So I write this 3 weeks before my second surgery is scheduled!
Disney World was great! I walked non-stop for 3 days!!

Sunday, June 10, 2007

Pain Med Saga

My blog is intended to a) let me express myself b) have a place to vent that is NOT my husband c) help people seeking information related to a hip arthroscopy or something similar
So, since I am not holding back, and I am in a writing mood, I will share my experience from post-op days 1-4 x 1.
My surgery was Monday morning. Tuesday morning (yes, the next day), I had my first PT session. When I woke up that morning, I took 2 vicodins since I had slept through the night with no meds. After PT, I decided it would be a good idea to go out to lunch. After lunch, as I approached my house, I began to feel really nauseous, so I had my mom drop me off in front and "ran" upstairs and threw up.
I figured it was my bodies way of telling me I was doing too much too soon.
The next day, I went to the supermarket in the morning and came home, nauseous again. I then threw up, but the feeling of nausea did not go away. I then threw up 3 more times. Hmm, this is not good, I am going to beat my pregnancy record of 5x in one day!!
I called my surgeon's office and explained to his receptionist what was happening, she promised to give the PA my message. Then I threw up! twice! After an hour and a half I had not heard from the PA, and was still sick, I knew I needed anti nausea meds, as well as new pain meds. I called the office again, this time not as nice as I had been the first time. I was told by the receptionist that she had put my message on the PA's desk but she was busy seeing patients. I (not so) calmly told her that I needed anti-nausea meds NOW. She put me on hold for about 10 minutes, came back and told me she would call in Compazine.
It worked ok, I stopped throwing up but was in a lot of pain. The PA called me that night and told me that most people by day 3 need only Naprosyn (anti-inflammatories) and Tylenol. I reminded her that I don't take Naprosyn (see earlier post), so she said to ice a lot and take Tylenol, and if I still needed pain meds, she would call in Ultram for me.
Tylenol was NOT enough the next day. I went to PT on Tylenol only, not fun!!! I called the surgeon's office around 12, at 5pm the receptionist called me to let me know she was going to call in the Ultram. I went the whole day without pain meds.
The Ultram was slightly better in that I could keep it down, but I did still feel nauseous, I only threw up once more throughout my recovery, in the car, on the way to my first post-op appointment!!!!
Note to self: Ask for anti-nausea meds before going home from the hospital

Post-op x 1

I remember waking up in the OR, at which point I think my surgery was over, but I don't really know for sure. Don't freak out, I didn't feel surgery was performed under spinal anesthesia with sedation (maybe not enough!!)
Actually, I wanted to watch the surgery,and my surgeon Ok'd it, but the anesthesiologist nixed the idea!! I'm happy now I didn't, it went quicker this way!
I woke up again in recovery, still pretty groggy, while a PT was putting my leg into a CPM machine. I fell back asleep! Then a nurse asked me if I was in pain, I said my incision hurt a little, I guess she interpreted that as yes, so she gave me morphine. This happened 2 more times, until I maxed out the morphine. This whole time I was supposed to be able to regain feeling and function in my legs but it wasn't happening. I was told that for an 8AM surgery, you should be able to go home by 12 or 1, I remember seeing all the other people who had gone into surgery around the same time as me go home, while I was still trying to wiggle my toes.
My surgeon had come over to me once immediately after he was done to tell me what he had found, a really large labral tear and bone spur on the acetabulum that caused the tear. He also told me that unfortunately, he had not been able to repair the tear, it was too "mangled" and had to be debrided.
Then I went back to sleep!!!! It took me a very long time to come out of the spinal anesthesia, I think the nurses were concerned because my surgeon came back to check on me a second time after he finished his next surgery, I still wasn't moving my legs too much. I did eventually regain control of my legs, at which point I had to eat something..note to self: bring a snack next time!!!
I went home around 5pm, after a nurse shift change so me not eating anything was overlooked and I was given vicodin!! I live 20 minutes from the hospital, and yelled at my husband the whole way home every time he hit a bump or pothole on the street!
Another lesson learned: I will set my alarm the first night and take pain meds every hour. I will never forget the amount of pain I was in the next morning, with 8 hours of no pain meds, I lunged for the bottle of vicodin!!!

When it rains, it pours

At this point, there is a torrential downpour in my life. Let me start off on a positive note, my hip is doing great. I have made some more progress and now have very very little pain, hurray!!!
Monday morning, I was working with a patient, she made a funny comment and I started laughing. As I laughed, I got a sharp pain in my stomach. Later that night, it happened again, I told my husband under no circumstances can he make me laugh, which made it impossible for both of us not to!!! Over the next 2 days, I continued to have pain in my stomach. By Wed., I sent an email to my doctor. Besides for being a 26 year old with hip problems, I also have stomach issues, namely Crohn's disease. It usually doesn't affect me, other than after my hipscope, I couldn't take the anti-inflammatories my doctor prescribed (more on that to follow).
After seeing my doctor, and having a CT scan, it was determined that I was indeed having a Crohn's flare up, as well as a gallstone. This seemed to come out of nowhere for me, and I just started to laugh. It is definitely not funny, but how much more can go wrong in a short amount of time. My doctor said the only thing to do for the gallstone is surgery, which made me laugh again, because I cannot even begin to think about having a third surgery anytime soon. So I am leaving it as is for the time being, or until I am so miserable that I crawl back to the doctor and beg for surgery.
So what caused my Crohn's flare up? Well, after a hipscope, my surgeon prescribes pain killers and anti-inflammatories, but I was only on the painkillers. After 2 1/2 months, I thought I should have less hip pain post-op, so I sought out a second opinion on the anti-inflammatories and was told they were ok, as long as I did not abuse them. So I began taking Aleve, one a day, for about a week. A week later, a flare up. My doctor can't and won't confirm if it was a direct link to the meds, but it was my first flare up in 9 months, so it really makes me think!!!

Tuesday, June 5, 2007

Prehab, day 1

Yesterday started out like every other Mon, Wed, Fri! Drag myself out of bed because I know my PT is waiting for me, I don't want to be late because I will put him behind schedule for the rest of the day.....But then I remembered something, I don't have an appointment, yippee!!!! I am done with PT!

Ok, not really, my official prescription says I am done, but my brain tells me it would be silly not to continue for one more month, to keep the operated leg strong and able to support me on crutches, and hey, I work in the PT office, no one minds me taking up the space (at least they don't tell me they do!). So its one more month of squats on the bosu ball, walking side squats and single leg balancing on a variety of objects! It is going to be difficult returning to PT the day after surgery (yes, the day after, my surgeon is crazy!!!!) and not being able to do more than maybe squeeze my butt muscles!! At least this time I know what I will be capable of doing a few weeks/ months down the line.

I have begun subconsciously preparing for surgery, I am nesting, similar to what pregnant women do as their due date approaches. I organized my closet 2 nights ago, and attacked my daughter's room today. The day before my last surgery, I had 2 closets redone, everything was taken out, new shelves were put in, and I was left with the task of reorganizing both closets that day. There was no way I could go into surgery with a clear head with a messy closet, and who knew when I would be able to put them back together!

Sunday, June 3, 2007

3 month update

So my blog is not exactly in chronological order, since I am trying to write about past events, but think it is important to write about current events while they are fresh in my mind.
I am now 3 months out from my first scope. I really do feel good! The picture above is my daughter on a trip to the zoo we took this past Friday. It has definitely been a roller coaster ride in terms of pain and rehab, but I am confident that the way I am feeling is a good thing. I still have occasional pain in my right (operated) hip, but it is usually with activity only, as opposed to the unoperated hip which can flare up after activity as well. My pain is in a pretty specific place, inside the joint, I am pretty sure this is where the bone spur was. I am not sure the pain will ever fully go away, I will update as time goes on. I have pinching pain with extreme hip flexion, as well as internal rotation.
Shoe choice plays as important role in my pain level, too high, not enough support, too low....all can cause a flare up. I do best in my Dansko's, Crocs, and Juicy flip flops. I wear ballet flats to work on occasion, but I cannot do extensive walking in them.
Tomorrow will be my first day of "prehab". My official "rehab" phase is now over and I will continue on with my exercises to keep my right hip strong for the next phase of crutches.