Wednesday, December 24, 2008
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!!!
Sunday, December 14, 2008
Tuesday, December 9, 2008
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!!!!
Thursday, December 4, 2008
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!
Sunday, November 23, 2008
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!
Sunday, November 16, 2008
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 email@example.com
Sunday, November 9, 2008
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!
Wednesday, November 5, 2008
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!
Tuesday, October 28, 2008
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!!!
Sunday, October 26, 2008
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!
Thursday, October 16, 2008
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)
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.
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.
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.
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......
Wednesday, October 8, 2008
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!
Sunday, September 28, 2008
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!)
Tuesday, September 23, 2008
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"
Sunday, September 21, 2008
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???
Friday, September 12, 2008
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?
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!!
Tuesday, September 9, 2008
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!!
Tuesday, September 2, 2008
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!!!!
Thursday, August 28, 2008
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!
Monday, August 25, 2008
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!!!
Wednesday, August 20, 2008
Monday, August 18, 2008
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????
Wednesday, August 13, 2008
Sunday, August 10, 2008
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!!!!
Tuesday, August 5, 2008
Tuesday, July 29, 2008
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!
Friday, July 25, 2008
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!
Saturday, July 19, 2008
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!
Thursday, July 17, 2008
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!
Sunday, July 13, 2008
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.
E. pubic symphysis
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!
Wednesday, July 9, 2008
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 :-)
Wednesday, July 2, 2008
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!!!!!