Monday, December 31, 2007

Learning As I Go not mix alcohol with antibiotics (or at least Augmentin)
already had 2 incidents of my ever so special 'Susie Puking'
I need to add 'no puking' to my New Year's Resolution
This after less than half a glass of Chardonay...I told you I was a cheap date.

I was just remembering how I spent last New Year's Eve...I did not have a babysitter, I let J go out to our friend's party since I was no fun with undiagnosed hip pain, I was in bed early, and moving my hip in and out of provacative position, just to make sure there was still a problem, and that I wasn' crazy, since I had my first appt with Dr.Kelly on 1/3, and I was not being sent home with a diagnosis of 'nut job', or worse.....more PT!!! Looking back, I was right, there was a 'real' problem, there was no need to torture myself like that!! Again, learning as I go!!!

Why Can't Things Ever Be Perfect???

Yes, I span (spun? spinned?), I am beyond thrilled!!!
Yesterday, things in sinus infection world got bad. My eye got really red and swollen.....this was not good. Luckily, my brother in law is an opthamologist, so he came to my rescue. The redness and swelling were a result of the sinus infection, so he brought over antibiotics and a nasal spray. I have always though nasal sprays were gross, and I have always refused to use one....but I was desperate, and it made a huge difference!!! Since I felt slightly better today, I decided it was time to Spin!!!

The ride was great,I had NO HIP PAIN. It was incredible, I remember pre-op I would get right sided groin pain from riding, especially climbing. I didn't do any heavy climbing today, or any fast sprinting....I am not ready, but everything was painfree and fabulous.

I am still having the thigh tenderness though. It is still a problem if I lean with my thigh into a treatment table at work, or if one of the kids touched my leg. Otherwise, I can handle it. L had a playdate today, and it turns out the boy's father whose house she was at is a general surgeon who specializes in wound healing. I explained my situation to him, and asked his opinion. He said it may be a nicked nerve, and I should call my OS ASAP and get a 5% lidocaine patch for it. I did not call, I am obviously going to 'google' the heck out of 'lidocaine patch'. I have only seen them on patients with severe, uncontrollable pain. Basically, when there is nothing else to do for a patient and they get sent to pain management, they come back with these patches. Great! Just what I need!!
My ride exacerbated my pain/ tenderness...a lot. At first, it was not pain, but 'annoyingness', I can't think of a better word. It was not burning, aching, tingling, numb...possibly close to throbbing, but not really. Towards the end it became painful. Now it is back to annoyingness!!! Ahhhh!! Just when things were really starting to look good!!!!

My New Year's Resolution is to stay out of Dr. Kelly's OR!!!!! Or any OR for that matter!!!
Happy New Years 2008!!!



Sunday, December 30, 2007

The True Test Drive....I give my Hip a B-

I had it this morning. I hate the winter, I hate the cold, I hate ice...I am from Miami....I left for college about 10 years ago and still long for warm weather.
I decided to take the kids out for a walk this morning, a real walk, in the double stroller. I don't think we had done that since my surgery, at least not this distance. I bundled everyone up, stuck them inside the stroller sleeping bags and headed out. The stroller must have weighed 100 lbs. They either got really big in the last 7 weeks or the added weight of winter gear is more than I imagined.

I did have some pain during my walk. Nothing crazy, but pain. Mostly the adductor insertion point, or possibly joint pain, it was hard to tell while I was walking and with all the clothes on. Also, my psoas acted up a bit. but now, 6 hours later, I am fine.

Last night, I had some time on my hands so I went through some old posts, August-November. I am shocked, things got pretty bad. How quickly we forget when things are better. How lucky I feel that I don't have that kind of pain and the emotional issues I went through those months, it absolutely sucked! I know that there are so many more people dealing with similar issues who are not so lucky (or persistent, pains in the ass) to get it taken care of so quickly. And even more people still searching for a diagnosis of their hip pain. It makes me sad. At least I hope that with my blog, more people will learn about their pain and symptoms and seek the appropriate care.

I know everyone is wondering what will become of my PT routine. I am a quitter!! I think I am taking a leave of absence for the time being and seeing how I fare. If I need it, I will be taken back in with open arms!! But the next few weeks will be difficult with the nanny issues, travelling etc, and I feel great! So I am taking the liberty of dropping out. I have not done anything on my own. I should, at the least, be working on my adductors since that is my 'weakest link'. I am not. I still have hopes to return to spinning, just as soon as I am not sick anymore. I can't even make it through the day without a nap at this point. I am calling the doctor tomorrow, regardless of anything!!!

Saturday, December 29, 2007

A Look Into the Past

My neighbor left me a trashy magazine at my door today. We had been discussing the Brittany Spear's sister pregnancy thing and she mentioned that she had bought OK magazine bc it featured a story on it. I read the story (nothing out of the ordinary for a teenage pregnancy) and then read my 2008 horoscope, honestly, this was my horoscope:
Health: Last year exacerbated health issues for many Cancers, mainly due to stress and demanding work schedules. This year, your health improves, and you should have more of that cherished nesting time. Add variety to your workouts.....

I wish I knew this a year ago and I would have been prepared! 2007 brought more doctor's visits, diagnostic tests, radiation exposure and surgeries than many people experience in a year.

I think I am not going to PT on Monday, and will soon take on the official 'dropout' status.I had better keep my mouth closed though. After my second surgery,P and I had discussed 'dropping out' at 6 weeks since I was doing so well but then I had the joint capsule/ psychotic psoas issue, as well as the whole 'revision BS'.

SHIT! I had though that it was 6 weeks out when that happened, and I was free and clear. Seems like it was closer to the 2 month mark......(color draining from my face) that whole episode and the next few days were awful, especially the next morning. But I will keep a positive attitude and keep plugging along.

On a more negative note, I am still soooo sick. I am definitely going to the doctor on Monday, there is no question that I have a raging sinus infection and NEED antibiotics. It is sad that I have an entire arsenal of narcotics here, I could easily maintain a healthy drug habit with all of my pills, but I lack a simple Z-pack!!!

Thursday, December 27, 2007

Making Good Always

I went ice skating today. I went ice skating in lieu of going to the doctor for my throat/ ear/ sinuses and cough. The premise was that we would call a friend tonight to call in a Rx for me but...he is on vacation. So I am in bed, prior to 9PM, having just taken cough medicine, which totally wipes me out (at least it doesn't make me puke), and freaking out since my nanny is now officially on vacation.

I woke up this morning and became super mom/ housewife, once again. 2 loads of laundry, dishes, cooking and cleaning up. For those of you who know me, I can be a bit of a diva at times, so this no nanny business is freaking me out. To cover my ass(ets), I have one person babysitting only, and one person cleaning only. So tomorrow, I will actually have a 'staff' in my home so I can comfortably go to work and know things will (hopefully) get done and the kids will be ok. But just to make sure, I got the house ready today so that day #1 would not be too overwhelming, hence the laundry and cleaning. J said he has never seen me so domestic!

So after my cleaning streak, we went ice skating. I was pretty scared, I should not be ice skating at 6 weeks...I should probably not be ice skating even at 12 weeks! But I did. If I was my patient, I would absolutely have put a stop to the ice skating. My hip friend Amy is a professional ice skater, and was not allowed back on the ice after a scope for JUST a labral tear for 8 weeks, and she clearly knew how to skate...well! But L really wanted to go, and I really wanted to take her. Luckily, she was not too keen on ice skating, so we only made it one lap, it took about 20 minutes! I should have followed her off the ice and called it a day, but no, I decided to try a few laps. Interestingly, I could only do a single leg skate. My right leg just wouldn't work. I guess it was sending me a message.

When I came off of the ice, my ITB and TFL really hurt. But the joint is good, painfree and intact! We had a great time the rest of the day as my kids always seem to be up for an adventure.

We were at an indoor amusement/ attraction center, and they had some indoor kiddie rides. They were on the wild side, but my kids never say no to adventure. One ride took you straight up and dropped you down little by little in jolts, looked scary as hell. L tried it with a friend, L loved it but the friend freaked out. L wanted to go again, and Jk wanted to join her. Jk is 2....I said absolutely not. But he insisted and threw a tantrum, and the ride operator assured me it was safe for him and would stop it if he freaked I let him go. The kid loved it. I had to turn away and not watch bc he was wiggling around in his seat and had his hands in the air....but he had a great time!
He also rode the kiddie version of 'teacups', each time it turned, he was flung into the side of his cup, he realized that if he didn't hold on to the handlebar, he would be flung harder and faster, so he let go. Again,I almost had a heart attack, but he was having the time of his life.

Now they are both sleeping very soundly, and I am ready to join them, as I figure out how to juggle my schedule tomorrow and see all my patients, see my kids and get to the doctor!!!

Wednesday, December 26, 2007

I Think I Am Going to Become a PT Dropout

I have had it, for real this time. It has been 9 months, like a PT pregnancy, nausea and vomiting included, as well as back pain, skin marks and plenty of discomfort. I think I am doing amazingly well for 6 weeks, I am even considering going ice skating tomorrow. My only persistent issue is the 'invisible scar' pain. P worked on it today, without any progress. It is just a sore area, just anterior to the greater trochanter, across and diagonal, covering a good chunk of thigh. P did some ART there, thinking it was my sartorius, but this did not help either, other than to cause a lot of pain.

I am bored beyond belief with the exercises, my strength rocks, other than adductors, which measured today at 4-/5 on the right and 3+/5 on the left. I can technically work on this at home.

I am sooooo ready to go spinning but am still really sick. I may actually have to go to the doctor tomorrow, which poses a slight problem since I made a promise to myself when I had my sutures removed after scope #2 . (see that post if you really care :-)

So, if anyone has a solution for my invisible bruise, I would love an answer since it is extremely irritating and painful.

Tuesday, December 25, 2007

Pictures From The Train Show

We had a lot of fun but the kids have become impossible to photograph, they are so wiggly!!!!!!!!!!!!

The cutest tushies!

Monday, December 24, 2007

6 Week Update

I can't believe it has been 6 weeks since my revision surgery. I see that there are a lot of new readers, so welcome, I hope you are enjoying this pathetic rendition of what my life has become!!! J/K!! I am actually really happy!

Just to recap- I had a revision hip arthroscopy on November 12, 2007 after my original scope on 3/5/07 failed secondary to residual FAI (femoroacetabular impingement). I originally had a labral tear and cam and pincer FAI, the initial surgery did not address the cam FAI (long story). In the long run, I am very happy my surgeon was not overly aggressive because you can always go back in and take down more bone, but you can never put it back!

So, 3 hip arthroscopies later, I can say that it was all worth it because I am in a much better place.

Just yesterday, we went to the NY Botanical Gardens holiday train show, it was our 3rd year going, I guess it is a tradition now! I have vivid memories of going last year. My hip hurt so much, and this was before I had been 'officially' diagnosed. I was so anxious at the time, as well as frustrated that the simple task of pushing my stroller hurt. Yesterday was a pleasure, for my hip anyway. We waited in line for over 40 minutes just to get in, and then the entire show was done in 'line form'. The kids loved it, and we had a blast. I never once thought about my hip!

I cannot remember if I have joint pain. Clearly, it is not an issue. What is still an issue is the 'invisible bruise' on my thigh.It still bothers me at work, when leaning with that leg against a treatment table. I have learned to fold a towel in between me and the table to help add more cushioning and protection there. The scope sites have been neglected this time so are tender to the touch, they are in the vicinity of the 'invisible bruise', so the entire area is tender to the touch, still.

My numbness is still there, and most recently has began to burn. It is not constant, and has only happened a few times, but is quite irritating. The alternative would be to try a heavy duty med called Lyrica, but the side effects are pretty intense, so I can only imagine what that would do to me, so no thank you! Hopefully it will not get worse than this.

My pain in the ass is better, but my piriformis is still in spasm, not as bad as last week though, phew. I had PT today and had P work on the scars and 'invisible bruise' and stretch my psoas, which is tight (but not so tight it needs to be released!!!)

I am supposed to go back to Spinnning today/ this week as per my own goal but I have a pretty bad sinus headache/ infection so it will have to wait a few days until it clears! Tomorrow is a new day though!!!!!

My left side is almost 6 months out, doing great, with just some pretty noisy popping/ snapping. The noisiness is painfree so I am not in the least bit concerned.

Saturday, December 22, 2007

On a Nerdiness Scale of 1-10, I have reached an 11

Today, as both kids napped, I picked up a PT journal (this is not where the nerdiness ended). I began reading an article:
"Manual Therapy Intervention for a Patient With a Total Hip Arthroplasty Revision "
J Orthop Sports Phys Ther 2007;37(12):763-768.

It was about rehabbing a patient with a revision total hip replacement. As I reached the end, the authors quoted another article:
Marc J. Philippon, Mara L. Schenker, Karen K. Briggs, David A. Kuppersmith, R. Brian Maxwell, and Allston J. StubbsRevision Hip ArthroscopyAm. J. Sports Med., Nov 2007; 35: 1918 - 1921

The first article quoted the second article saying that the authors found that the primary reason for revision hip ARTHROPLASTY (i.e total hip replacement) is impingement. As I was reading, I said, out loud, WTF??? That is not what that article says, I know that article like the back of my hand and they don't speak anywhere about arthroplasty, only arthroscopy. Yes, we all know that the primary reason for a revision ARTHROSCOPY is impingement. The authors misquoted Philippon et. al. My husband thinks i have gone off the deep end...again, he can't believe I caught that, and that I plan on emailing the authors regarding their mistake!

Thursday, December 20, 2007

Distracting Pain

I think I had some ass spasms today, as well as invisible bruise pain...but I am not too sure. My knees hurt so much that everything else pales in comparison.

I woke up and they still hurt,I think the left is worse than the right, but it changes. I went to acupuncture today, and it was actually pretty cool. I asked him to be careful when putting the needles in my leg bc of the MCL sprains. He asked if I wanted him to treat that too, so I said ok. He palpated around me knees and felt where it hurt, then he put some needles into my elbows and felt my knees again... most of the pain was gone. There was still an area that was painful, so he adjusted one of the elbow needles and it got better. All I can say is FREAKY. Unfortunately it did not have long lasting effects, they still hurt. I iced a little tonight but lost my icepack to an eager 3 year old.

Why is it that I, the PT, actually injured myself during PT.
This is a lesson to all of us....Listen to yourself. I told P I didn't think I could do that exercise...but I tried it anyway......STUPID!!!!!!!!!!!!

Wednesday, December 19, 2007

The Fun Continues

Things have been 'wonderful'. Not only was my ass spasming, my thigh hurting, my adductors weak and spazzy (is that a word?), now I have blilateral MCL sprains (in my knee), whoohoo, it is a never ending party around here.

I have to admit, the MCL pain is worse than a lot of the hip related stuff, pre and post op. I have a stingy feeling on the medial side of both knees, feels like the ligament is ripping if I do certain things, but haven't been able to pinpoint what.For example, I am in bed with my laptop and they hurt. P tried taping one but it didn't really help. I should ice, it would really help snice the MCL is more superficial than say, my labrum, but I hate ice. Once again, I am hoping that I will wake up tomorrow and I will be better.

So what provoked this? Remember on Monday I tried the Fitter for my adductors. Apparently, I was sooooo not ready. It seems my knees went into too much valgus as I attempted to pull the fitter across into adduction and stressed the MCL. Ouch.

An update on my ass: It is piriformis.Much to my dismay, P did some ART on it and as painful as it was, it really did help. It hurt too. Today was rough! I am ready to pass out and have knee relief ASAP!!!!!!!!!!

I was just much more pathetic can this get, I injured myself while rehabbing!!!

Tuesday, December 18, 2007

Pain in The A$$

Before you freak out...yes, my surgery was still definitely successful. I am now dealing with the aftermath of the trauma, traction and crutches.

The first few weeks were great, I did very little, spent the first week in bed, and really was good at taking it easy. I am so done taking it easy, so now I am paying for it. It is difficult for me, I will give you an inside look at my day.

6:30 Am my phone rings, I don't pick up but let it go to voicemail. My nanny is not coming in, her back hurts and she is at the ER. I had to cancel acupuncture. I also am not sure when she is coming in. So I have to clean up the apartment. I change L's sheets, straighten up the living room, get the kids dressed (I just throw my coat on over my pajamas!) and walk L to school.

I figure since I am home, I will clean out L's room. Pre-op, all the bending and standing would have killed me, I am ok! I also made a 'fancy' lunch for Jk and I, walked to CVS and did 2 loads of laundry. Then the fun began.

I have been having serious butt pain. I can barely sit on my right cheek, I think it is piriformis but the bone hurts. I will have to see how P can figure this out as I am not letting him touch my butt! My adductors have still been acting up as well. Jk and I went to pick up L at school. He loves her friends, I think he has a crush on one of them! So they were all running around and they usually run out the door and down the block and wait at the corner. I didn't realize but Jk was with them. I saw him running towards the street and made a mad dash to get him. I still can't really run, and whatever it is I did, HURT. I got him, and was so angry afterwards as I limped to the car. I felt like my adductors were on fire. Same with my piriformis.

After school we decided to go to an indoor playground with balls and slides... Note to self: 5 weeks post-op is not enough time to be climbing rope walls and jumping in ball pits.

Needless to say, I am wiped out and in pain. I am craving anti-inflammatories! If history does repeat itself, I will be complaining for about another 4 weeks! I will not take it easy, slow down, or do less. I just can't.

I just have to remember that this is all surgical. One eventually has to resume life and cannot expect to be painfree. There is a fine line between causing damage and living life, I think I am living life, the hip will survive, if only with some complaining!!!

Hopefully I will have a good explanation to the butt pain tomorrow!!

Monday, December 17, 2007

I Still Never Learn

I spent some time tonight reading posts from August, which would put me at a similar point in recovery after my second scope. I should have just copied some of the posts and pasted them here instead of rewriting!!

It seems that my activity level is putting a damper on my pain level. I was pretty sore today, and being at work never helps this. I started to worry but see that the same thing happened in August. I guess what they is true, history does repeat itself!

My day started with pain, I hate waking up in pain, luckily I can't remember the last time this happened. Clearly yesterday's stupidity was not resolved with a good night's rest! I briefly spoke to P about the adductor and thigh pain. We agreed that nothing could be done about the thigh pain (more on it momentarily), but he agreed that the adductors needed strengthening. He decided I should do the Fitter into adduction. I didn't think I could do it, even with low resistance. He said I could and even demonstrated it to me. Ok, didn't look too bad, so I went to try it. First with the left leg. I could barely move the platform across. 'Oh', said P, 'you really are weak'. It was also really painful since all the wrong muscle tried to compensate, I felt like my patella was going to dislocate medially. Not good. So I tried a few on the right. Surprisingly, it was a little better, but still really difficult and hard on the patella. I need a few more weeks and will return to this!

We settled on standing hip adduction with a theraband and sidelying hip adduction with no weights. I was sore the rest of the day.

I was also super drained today, not sure if the pain got to me or what, but I fell asleep at 7:00 and took an amazing power nap while L slept next to me in my bed!

If history repeats itself, the next few weeks will be tough, as I return to life as it was pre-surgery with a newly shaped hip. My muscles will be sore and tight and the joint irritated and painful with my activity. But 5 1/2 months after the second scope, I am doing great and my only complaint is spasmy adductors. I can take some muscle soreness and aching joint!

Back to the pain on my thigh, which has beautifully worked itself onto the bony portion of my butt! Yep, so now it hurts to lie on my back too! Interestingly, the invisible bruise got worse when everything else hurt more, and as I gently leaned on a table or wall, it screamed out to remind me it was there. I will also have to further investigate the pain in the butt and get back to you. I will be going for acupuncture session #3 tomorrow, maybe being relaxed will help the muscles too!!!

Sunday, December 16, 2007

(Trying to) Set Limits

I just got home from a wedding, I had to wear my sexy shoes of course. This is after I attended L's ballet recital this morning. When we got there, she was being shy and didn't want to practice her solo, which consisted of her following these commands from her teacher: 'Jump out, Jump in, Jump out, Jump in, Jump out, Jump in, Boogy Woogy Woogy'. She decided that she wanted mommy to do it with her. Ok, I though, how bad can 6 little jumps be? BAD. I am such an idiot. It seems I had forgotten that less than 5 weeks ago I had a chunk of femur shaved off, so even though it has been feeling great, jumping on it wouldn't be the smartest of things to do. I am probably at risk still for a femoral neck fracture. Stupid. Anyway, I did the jumping, in fleece lined Crocs. Normally, when I do stupid things (wow, I do stupid things often enough that I can say 'normally' when referring to them), I feel the effects later, either later in the day, that evening or in the morning. Not this time. I did my jumps, took a step and was hit with 'Stupid! Why did you do that?' Even J saw me from far away and asked what I was thinking. Sometimes, a mother has to do what a mother has to do. Did I do great damage? No. Probably just some irritation on my recently shaved bone, some inflammation, no big deal. I am guessing it will feel great in the AM (I am really really hoping this)!

We then went to a wedding tonight. I did not even attempt to dance (see, I don't always do stupid things). I sat a lot, and we even went home early since my babysitter called and said the kids weren't behaving!
I am sore now, in the groin (gasp....but I am ok), it is soreness, not pain, I will live!!! I will check back in in the AM with an update!

Saturday, December 15, 2007

Pain in Weird Places

For those of you who know me well, you must be starting to realize that it is either all or nothing with me. What do I mean? I am either out, in heels, doing crazy things, or in bed, puking my guts out, and not moving. Some things never change. I am almost 5 weeks out, from a surgery I was initially told would take 3-4 months to heal from, and then 4 months later was told by my OS that he is finding patients doing still making progress at 12 months. So to put things into perspective, I am pretty far from the 12 month mark. Today I found myself out, pushing Jk in his stroller, on ice, in high heeled boots. Stupid? Absolutely. Especially when yesterday, I was leaving my building and the doorman gently reminded me that my parking lot was extremely icy and the last thing I needed was to fall! Thanks!

So after one day of gingerly walking through snowbanks and icy streets (wearing rubber, flat boots) and one day of walking in high heeled boots, I found myself with a teensy tiny limp (gasp). I don't do limps. Especially when I am so crazy and anal about gait, and how I hold on to my single crutch until every bit of evidence of a recent hip surgery and resulting Trendelenberg is gone, I found myself limping in my boots. It didn't help that I had to carry Jk and all of his 28 lbs plus a few toy trains.

I am not even sure where I hurt, it was too much to take in. It did resolve on its own when I got home and took off the boots, and put Jk down. J pushed the stroller home so that helped too.

I have been having pain in my adductors, on both sides, and they go into spasm sometimes. I think I have mentioned before, this is not something I mention to P or let him work on since it is right where my adductors insert into my pelvis. Too close for comfort, especially when we will be working together 15 minutes later. Yesterday, during my ice walk, the left side was in horrible spasm (left, yes 5 1/2 moth old surgery), and there was nothing I could do but keep 'walking' to my car. I am guessing that my adductors are really weak, resulting in this 'fun' spasm. Time to hit the gym and attack those muscles, I guess. I have been a lot more laid back about PT this time, I guess after 9 months, it sort of gets old, boring and lame (Don't tell anyone I said that).

My insurance, for some reason, is still paying for PT. I have had probably close to 90 sessions by now, my insurance covers 30 visits/ year. The people in the billing department know how to 'work the system' apparently! I am supposed to be doing 2x/week at this pint, I did one last week, and have 2 scheduled for this week. I know that after my first and second scopes, I was already doing 3x/week. I am too burnt out though!

My other weird pain is a bruiselike pain across the front of my thigh, starting medial/anterior to the greater trochanter, moving across the front of my thigh, about 1/3 of the way down. It does not hurt with activity, only to touch. It has not gotten better or worse since surgery.I am stumped. The only thing that may be related is that I had awful bruising for the first 3-4 weeks, plus all the bleeding early on.

Otherwise, things are great in post-op land!!!!

Thursday, December 13, 2007

Another Interesting Article

Radiologic and Intraoperative Findings in Revision Hip Arthroscopy

Original Article
Radiologic and Intraoperative Findings in Revision Hip Arthroscopy

Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.

Benton E. Heyworth M.D., a, , Michael K. Shindle M.D.a, James E. Voos M.D.a, Jonas R. Rudzki M.D.a and Bryan T. Kelly M.D.a
aHospital for Special Surgery, New York, New York, U.S.A.

Available online 5 December 2007.

Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.

Wednesday, December 12, 2007

1 Month PT Measurements

Hip Flexion: R=4/5 L=5/5
Hip Abd: R=4-/5 L=4/5
Hip ER: R=4/5 L=4+/5
Hip IR: R=4/5 L=4+/5
Hip Ext: R=4/5 L=4/5

Not too shabby!!!! I think this is my all time best ever, even pre-op!! Yay, no impingement, no inhibition, nothing but strength!

Work today was better than Monday, no pain until the end of my day, and even then, it was slight. I think this is a huge improvement! If it wasn't so cold, I would be testing out my limits with the double stroller!
Manually, P worked on extension mobs since I am still pretty tight anteriorly, but it is getting better. Today, me exercises consisted of single leg walking on the treadmill, I stand on the left leg on the side of the treadmill and let the right leg move backwards on the belt to the endrange of my extension. I did walking squats with a red band, isometric hip abduction, Hip IR with a blue band, hip abduction with a blue band, isometric adduction with a small ball, bridges and modified single leg bridges, sidelying abduction with added hamstring curl and IR/ER rotation, clam shells and...........

Holy shit!!!!!!!!! At 7 weeks out last time I couldn't do more than 1 1/2 SLR! This is amazing! I think Dr. Kelly added some special magic steroid so that he would never have to hear from me again!!!!! Who cares, this way we will both be happy!

THIRD TIME'S A CHARM!!!!!!!!!!!!!!!!!!!!!!!

Tuesday, December 11, 2007

South Beach Diet

Ok, I am going back on! I fell off the bandwagon after my first scope but now I need to go back on. If anyone want to be my SoBe buddy, let me know, it is always easier with a friend!!!!
I will keep you posted~

Monday, December 10, 2007

First Day Back

I WENT TO WORK TODAY!!!!!!!!!!!!!!!! want to know how it went? I actually had pain. Surprise? Not really, my job is pretty physical and was a killer pre-op. At first I was nervous bc I thought I had joint pain but it turned out to be adductor pain, which is, well, a pain, but manageable!
I was planning on taking Naprosyn when I got home (I know, big Crohn's no no) but ended up not needing it. So once again, I am flying high on life (yes, nothing else).
I skipped PT today since there was no way I was going to survive a day at work after therapy, so I will be going Wednesday only this week! We need to work on my abductor strength. I was demonstrating a step up/ down for a patient and noticed that my leg totally collapsed inward during the step down. I need to do that to head off the knee pain that will surely follow if not taken care of!

I will have P strength test me Wed. and give an update.

For those of you still having trouble, I do not mean to rub it in your faces. I have been there and want you to know that there is a light at the end of the tunnel! And when you get there, I will be there, cheering you on!

Sunday, December 9, 2007

Toys Toys Everywhere

Prior to my last surgery, this would have meant me picking up all the toys with multiple trips between the kids' bedrooms and the living room trying to sort everything out, followed by severe pain in my hip from the repeated bending and standing. Yesterday proved to be slightly different. We had our company for lunch, which totalled 5 kids under 4. After 6 hours in my house, it appeared that a hurricane had hit. Once the guests left, I was left to rearrange the entire toy collection on my own. I was nervous knowing what this had been like in the past, but couldn't bear to see my living room look like Toys R Us had thrown up in it. So after 1 1/2 hours, the toys were picked up and I could once again see the floor. But...I began having soreness in my hip. It was definitely abusive on my poor hip, who less than 4 weeks ago had a large hunk of bone shaved off, but my sanity called for a clean house. I had soreness for a few hours the rest of the night but I am happy to report that I woke up today with no problems. Whoohooo!! This really really worked, how amazing!!! I am fixed! I go back to work tomorrow!!!

Friday, December 7, 2007

Today's Accomplishments

I am having company so I finally went back to cooking, real food!!!

The menu includes soup (not shown), fish, chicken, meat and potato stew, strawberry apple souffle, popcorn cauliflower, apple pie, crunchy cookie brownies.

Wen I cook, I really cook! I have been in the kitchen all day. My leg doesn't hurt but it is very fatigued. I guess Monday will feel the same when I come home from work. I can handle this, it sure is better than it was pre-op!!!

Thursday, December 6, 2007

The Little Things In Life That Come Back To Haunt You

I was reminiscing tonight about the events of the past few months, and how lucky I feel to have a happy ending, and my thoughts turned to my career and then school. During my first year of PT school, we had gross anatomy. On the second exam, I scored a 98%, I missed one question, believe it or not, it was psoas. The muscle was tagged in a funny way and I couldn't identify it. If only I could retake that exam now....

Wednesday, December 5, 2007

If My Leg is Mine, Why Won't It Listen To Me

As Monday draws closer, and I plan on returning to work, bits of anxiety seem to be rising to the surface. I have not had any anxiety since I woke up from surgery. Now I am getting nervous. I am mentally very ready to return to work, but physically, I am not sure. My leg isn't doing what my brain commands.

Yesterday, I was walking to my car and an old lady was walking directly towards me, since I no longer use my crutch, people assume that I am 'normal' and can easily dodge these obstacles. My brain told my leg to quickly move to the right but my leg didn't quite get the message and I almost ended up colliding with the lady, I missed her by a hair.

Also, sometimes the phone will ring and I will be with the kids in one of their bedrooms, the phone will be in my bedroom, so I try to quickly get up and tell my leg to walk fast to grab the phone before voicemail picks up, but it just won't go.

There is still a little more weakness than makes me happy, but I have to keep reminding myself the extent of the work that was done plus the week I spent in bed wasting away! I am also not doing as much as I can for myself, I can do so many of my exercises at home but choose not to. I guess by the time I have time, it is really late and I would rather crash.

I am disappointed that only Jess responded to my previous post.

Tuesday, December 4, 2007

Let's Try This Again

Quick Update: I woke up today and had a serious debate with myself about taking one crutch with me to walk L to school, I hurt from the last 2 days of crutchless walking. I ended up leaving it at home and did great. As I walked, the muscles warmed up and became less achey.
On a side note- my butt hurts, like if I sit only on my right butt cheek (not that I do this often, but think of sitting/ lying in bed), also my greater trochanter is still painfu, so I am still betting on the trochanteric brsitis.

I had to go to CVS today. The pharmacy called yesterday to inform me that my Percocet which was picked up on 11/13 was never paid for (the copay). Seriously? Its been 3 weeks and you just noticed? And how the heck did you allow a controlled substance to leave without being paid for? Anyway...they had pink canes!! Had I known last week, I would have splurged on one!!

Ok, what are we trying again. I am calling on all of my readers to please post in the comments section what your symptoms of FAI/labral tear are/were. If you are a frequent poster, infrequent poster, lurker or first time reader, please comment. I want to create a list to help other people, as I was never able to come across a 'good' list. I tried this once before and it didn't really work out, let's make it work this time.


Threw Away
Hip Brace

Letting Go...of My Crutches

I went all day yesterday without crutches. It was the first time I began having any pain. Mostly, my psoas, glut med, TFL and adductors. They got really sore, I guess since I was finally using them. I tried to sit as much as possible, and kept PT light. P really worked my incisions yesterday and they REALLY hurt, as did the entire area around them.

Since I was finally 'free', I decided to run some errands at the mall that I had been putting off. Walking was difficult since I took the long way around (not on purpose) but as I 'warmed up' the muscles relaxed a little. I did develop a limp last night, since it was the end of the day and I was exhausted. But overall, the day went well.

As I sit in bed with my laptop, I feel the effects of yesterday's adventure. I will try to keep my activity light today,I need the muscles to feel better and my gait to be perfect since I am going back to work next Monday.

Sunday, December 2, 2007

Our First Snow Day

I decided I was less likely to kill myself when I went out this morning if I left my crutch at home. It went well, I had Jk's stroller to use as a 'walker', but overall I did well, I am just exhausted from it. At least I am not missing anything by being home since the weather is so awful!

Saturday, December 1, 2007

Third Op-Report

Indications: The patient is a 27 year old female with a prior hip arthroscopy with persistent pain, secondary to capsular adhesions, scar tissue and residual cam impingement.

Given her persistent symptoms and lack of improvement with nonoperative measures, she is indicated for a right hip arthroscopy and associated procedures.

After the patient was correctly identified in the holding area, she was brought to the operating room. Spinal anesthesia was then administered and she was placed in a supine position on the traction table and approximately 10 mm of distraction was achieved across the femeroacetabular joint. The right hip was then prepped and draped in a standard, surgical fashion.

A lateral portal was established under fluroscopic guidance and a distal accessory anterolateral portal was established. Arthroscopic examination demonstrated some scar tissue anterior superiorly with areas of softening and mild delamination of the anterior superior rim. There was also some synovitis throughout anteriorly superiorly and posterior superiorly. The cartilage in the femoral head was also in good condition. The acetabular cartilage was also in good condition, with the exception of the softening anterior superiorly. The labrum over the posas was in good condition.

At this point, a wide synovectomy was performed using the Tac-S radiofrequency probe and then the adhesions of the capsule, adjacent to the prior debrided labrum were removed using a beaver blade. the labral capsular junction was then debrided to remove any adhesions and scar tissue of the capsule adjacent to the labrum.

The labral tissue was freed up anterior-superiorly, anterior inferiorly and posterior superiorly, extending posterior -inferiorly. The labral tissue was in excellent condition. There was no evidence of any adhesions of the psoas tendon against the anterior inferior labrum. So no additional surgery was necessary around the psoas tendon.

All the area of the residual inflammation and irritation was anterior-superior, where the scar tissue was most prominent.

After the labral debridement, capsular scar excision and synovectomy in the central compartment, no further pathology was identified there. The traction was released and the hip was brought back into the socket for evaluation of the peripheral compartment.

A T-capsulotomy was made for better visualization at the site of presumed impingement and there was a small cam impingement lesion there that was present with evidence, also of a pincer trough.

At this point, using fluoroscopic guidance and a portal lateral to best evaluate the anterolateral neck, cam decompression was performed using the 5.5 mm high speed bur. this was contoured to the normal concavity of the inferior neck with reestablishment of normal offset.

The decompression of the cam side was extended from approximately seven o'clock anterior inferiorly, up toward the twelve o'clock position. both the lateral retinacular vessels as well as the medial synovial fold and medial___ were clearly identified and preserved throughout the procedure.

At the completion of the cam decompression, all bony debris was evacuated from the joint. Fluoroscopic guidance confirmed good reestablishment of the contour anterolaterally. The hip was dynamically moved to approximately 100 degrees and then internally rotated and no residual bony impingement was present. There was good clearance within the acetabulum, with full flexion and internal rotation.

At the completion of the cam decompression and removal of bony debris, the instruments were removed from the hip joint. The arthroscopy portals were drained of fluid and the arthroscopy portals were closed with 3-0 nylon sutures. A Marcaine cocktail was placed in the joint. The wounds were cleaned and dried. Sterile dressings were applied. The patient was awakened from anesthesia and was brought to the Post Anesthesia Care Unit having tolerated the procedure well.

What We Have Been Up To The Last 3 Weeks

Jk, in the car, on the way to Play House Disney Live

Me and Jk at the show

My awesome train set construction

Jk and L being monkeys

Jk eating my Millennial Crutches