Tuesday, July 29, 2008

Sometimes I Really Wonder....

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

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

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

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

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

Have I mentioned I need a vacation!

Friday, July 25, 2008

Since I Can't Drink, I'll Vent

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

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

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

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

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

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

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

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

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

Saturday, July 19, 2008

The Ups and Downs and Then Some

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

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

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

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

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

Thursday, July 17, 2008

Dear Jeff Part II

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

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

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

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

Sunday, July 13, 2008

The Pregnancy Scoop

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





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





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





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


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

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

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

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

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

Wednesday, July 9, 2008

I Was Right

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

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

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

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

Friday, July 4, 2008

Wednesday, July 2, 2008

Today is My 1 Year Anniversary

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

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

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

Tuesday, July 1, 2008

And The Verdict Is....

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

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