What I Re-Re-Re Discovered

I have probably said this a hundred times but...when I do nothing I feel better! Since the airport/ Vicodin night, I have done nothing. I have left the house twice, once to go to Starbucks and once to go out to dinner. Zk has been really sick, so I haven't wanted to take him anywhere. He is feeling better, nothing like a round of Amoxicillin with a dose of Prednisone (really bad wheezing and probable ear infection). So for 3 days I have barely moved, and had almost no pain. Its amazing, Zk was finally a little better tonight and I had to try to keep up with him and I could feel soreness returning. Nothing of concern, I mean, I did have surgery 4 weeks ago, but what a difference the activity level makes. This is like after surgery #3, when I couldn't get out of bed for a week because I was so nauseous, my hip felt great!
I have been doing a lot of indoor activities with the other kids too, because I don't want to run around outside just yet. I have sat in indian style more than once, I mean, come on, how can I build a kick ass Thomas track, or a Lego city? I don't do it on purpose, it just happens. It is also hard to sit with Zk on the bed without ER in that hip. I am changing diapers, nebulizing, feeding etc.

I have been sleeping mostly on my non-op side, and I need a pillow in between my knees or else the op side hurts. Also, I am disappointed with the persistent swelling in my thigh all the way to my foot. I need it to go away, it is really uncomfortable.

My Fat Ankle

This morning I had a little incident, nothing really happened, but I will still refer to it as such. I was standing up, doing nothing, and I must have either very slightly turned my leg or turned my body and I felt this very sharp pain deep in the joint. It was a very specific point, and it was a reminder to me that things are still healing and I have a ways to go before things are normal again.

I had PT today and I felt the effects of the incident, I had to lower the weight on the leg press and eccentric SLR were painful and my psoas popped a lot. I stopped doing these.

We are now in Miami, its been a long day, between packing, getting to the airport, the flight... J talked me into taking one crutch since the gates are far, and I am glad bc I ended up using it. Now, I am finally in bed with extremely swollen ankles, heavy legs and a sore hip. Not too mention twice vomited on by an adorable Zk who is sick!

I emailed BK's PT to discuss my concern about the ER. He said obviously don't push it, and he said that I may be one of those people who don't scar down after the surgery...it seems I am always "one of those people"!

Ouch!

Ok, I need to back off a little bit, I can actually feel the inflammation in my hip making a comeback, with more swelling all the way down my leg. So far I've had 2 days off of crutches, and PT yesterday. Again, PT was great, she had me on the leg press at 75 lbs, doing wall squats, hamstring curls with a 2 lbs ankle weight, prone hip extension with my knee bent with a 2 lbs ankle weight, quadruped hip extension, eccentric SLRs, plus a lot of what we have already been doing. Not only was I exhausted last night but I was in pain, so I hit the Vicodin before bed. I am still in bed now and just feeling a lot of heaviness in my leg, soreness in the groin and butt.
We discussed my concerns over the excessive ER. She thinks that it is tight enough now to prevent it from sliding around in the joint now, but that I will have my full range, or close to it, since all the muscles are already stretched out. She is having me strengthen my internal rotators to try to help.

Just as a precaution, I emailed BKs PT about it too, I haven't heard back, but there was a nationwide blackberry outage last night so I hope it went through!

I think I would benefit from a daily anti-inflammatory, but this option is out, I am left with taking Tylenol during the day and if needed, Vicodin at night.

I Think I an Offiially Retire My Crutches

3 weeks to the day of my 4th surgery and I ventured out of the house sans crutches. It was super snowy and icy and I felt that given that I had been walking around the house without them for a while, they may become more of a liability outside. I went to the mall and did way too much walking. On top of that I did a little Target shopping too. Needless to say, I was exhausted by the time I was done. I did have some soreness and discomfort while I was walking, and my gait is definitely off one way or another. I almost feel like I look a little drunk at times, especially if I am really fatigued. I had pain last night but I managed without any meds. Today will be day 2 of no crutches. I have PT later this morning, I will share with my therapist my concerns over the excessive ER and see what she has to say about it. I will report back!

Turning The Bend

I just realized I haven't posted in a few days, my sincerest apologies! Things have definitely gotten a lot better since we last spoke! Thursday I had PT again. She had me doing some more standing exercises, including mini wall squats and hip flexion/abduction. The flexion/abduction was fine on the operated leg but the non-op leg was fatiguing quickly. She also added some passive adduction to stretch the ITB. It went well and I felt really good afterwards.

I think I am officially done with painkillers, yay!!! I am also pretty much done with crutches, I have been taking one with me when I am out of the house but think that starting tomorrow I will ditch it. My external rotation is a bit too good right now, which is my only concern. I don't think there is anything that can be done, but there is almost no tension when I accidentally, without thinking, externally rotate. I like to do this thing where I will half indian style sit on one leg when in a chair, I have done this on the op leg and had no pain or restriction. I also wake up with it externally rotated sometimes. I hope this is ok. I don't see BK until 1/20 and don't think this is an issue that I have to call or email about. I will run it by my PT though, just in case.

My thigh pain is getting better, finally! As is the bruise on the side of my hip. An issue that I am not happy with s that my ankle swells, and my hip still feels swollen. I don't remember this much swelling in the past, and although the ankle swelling is minor, only noticeable to me, and probably not seen by anyone since I usually wear boots when I am out, it is still concerning.

I don't plan on leaving the house today since we are basically snowed in. On the bright side, I finally was moved up on the waiting list and got an indoor parking spot (trust me, in NY, this is huge), especially since I have been getting really fed up with my outdoor lot, but have not had any issues with them since the infamous "hell" issue!

In The Blink Of An Eye

The rest of my day didn't go as well as the beginning. I will fast forward to the end of the night which featured me back on 2 crutches, then in bed with Vicodin.

My day did get a bit hectic, Jk had a doctor's appointment which involved me picking him up at school and walking to the appointment, probably a total of 7 blocks. Then giving the kids dinner, which involved a lot of whining, and "I don't want that". We had a leaky diaper incident, some bratty shower moments, and lots more whining.

I was not happy! Luckily J came to the rescue and took over bedtime responsibilities.Hoping for a better day today!

Crutching Away

I have been going back and forth between 1 and 2 crutches these days. I use one in the house for the most part, unless I am in a lot of pain, then I use 2. Or, if the kids are being especially needy, then I use none. Like when I 'lost' zk only to find him splashing around in the toilet. So I had to give him a bath! We have been ok so far, J came home at a decent hour last night to get everyone into bed.

I had PT today, and am progressing slowly but steadily. I am very happy so far with my PT, and especially happy with her conservative manner. I don't feel the need to rush this at all, and everything will come back with time. I was feeling a little discouraged with my flexion ROM, but she measured it today at 113', so I am pretty happy. She did a little bit of passive extension, to 15', and measured my ER at 30', we won't be pushing that anytime soon. I have been concerned about having excessive ER at this point but this made me feel better.

We are going to Miami next week, I hope to be done with crutches by then!!!

Back On Narcs

I can't seem to win. Every time I think I have turned a corner with the pain, I end up doing too much and needing to go back on narcotics. I woke up this morning and I knew there was no way I was managing with one crutch, and no way I was managing without meds. Incidentally, it is a pretty gross day out. I also did a lot of walking in the city last night (ok, not a lot, but a lot for me) and a lot of stairs at a night club where we went to a concert. I did really well last night, just got a little stiff from sitting too long.
This morning I had a lot of quad/ thigh pain. My entire thigh still hurts, all the way to the knee now. It is most likely a side effect of the traction, I just hope it goes away soon. I also had pain deep, deep in the groin, near the adductor insertion, only deeper. I started with an Aleve, hoping to get away with just that. 20 minutes later I couldn't take it any more and ended up with half of a Vicodin. I feel better!

Warning: Graphic, Read At Your Own Risk

No, this is not a sex post!

Now that that is out of the way, I can begin. I have been having a lot of pain on the outside of my hip, it is swollen and ugly and bruised, and tender to the touch. The sutures came out Wed. and have been covered with steri strips, but one of them has felt very hard and had a huge lump around it. I decided that this may be scar tissue so began working on it earlier in the week. It didn't change much. Last night I decided to take off the steri strips (even though I had been told to keep them on for a week) and see what was going on. Indeed, there was a hard lump around one of the incisions. I began once again trying to work on the scar tissue when suddenly, a gush of blood shot out from a small opening at the bottom of the incision. As this happened, I felt a release around the incision. As I squeezed the lump, blood oozed from the tiny opening. It was very dark blood. The lump got smaller and smaller as I squeezed. I suddenly had less pain in the area and the lump was disappearing. Last night I was able to sleep on my operated side for the first time since surgery. It seems I had a pocket of fluid collecting under one of the incisions. I had a similar issue after my c-section with L, a pocket of fluid collected under the incision.

As far as yesterday went, I was really getting depressed. Today wasn't too much better so I put myself on a low dose of Zoloft, leftover from my first 2 postpartum weeks. It did the trick then and should do the trick now!

I have a lot less pain today, I haven't taken any type of pain medication (including OTC) in 24 hours. I can walk in the house almost all the time with one crutch, when I fatigue I need 2, usually I feel it in the IT band first and then I know its time for 2 crutches. I am going to a concert tonight...wish me luck!

My Breaking Point

It seems as if I am hitting a rough patch this morning. I am beginning to feel frustrated and sad at the same time. It just doesn't seem fair. As I sit at my computer, holding back tears, I wonder what I could have done wrong to end up back in this situation, 3 small children to care for on crutches. Up until now, my mom has been here and has been doing pretty much everything. She went home today and I am feeling extremely overwhelmed. I am using 2 crutches for the most part, I am able to get around the house a little bit on one crutch, but the pain in my ITB gets worse when I do this, so I know it is not a good idea. Jk wants me to take him to school, L is concerned about how I am going to dance with her at her school Chanuka party next week, and Zk just wants me to hold him.

I know this is temporary. I have been here before. I am almost positive that I can read back to another post and I will have written the same thing at around this point post-op. It is just so hard to have to rely on others for just about everything.

If I continue to mope, I start to wonder why I was destined to have 4 surgeries, in less than 3 years? I try to be positive, I guess this is not the worst thing to have. It is not life threatening, more of an inconvenience. But as I am living with the reality of it, it is hard to be positive. And just like in the past, I know that this too shall pass.

Fourth Op- Report

Preliminary Diagnosis: right hip labral tear status post instability episode, status post prior hip arthroscopy with re-tear of labrum

Postoperative Diagnosis: right hip labral tear status post instability episode, status post prior hip arthroscopy with re-tear of labrum

Name of Operation: Revision right hip arthroscopy, labral tear debridement, synovectomy, debridement of ligamentum teres, and capsular shift procedure with revision decompression cam and rim side.

Indications: The patient suffered from persistent right hip pain 2 years status post a prior hip arthroscopy after she had been in a forced external position after she had a baby. She had a stretch of the anterior capsule with persistent pain, re-tear of the labrum, and also tearing of the ligamentum teres. She had failed non-operative measures and given the persistent pain and lack of improvement, she was indicated for right hip arthroscopy and associated procedures.

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

A lateral portal was established under fluroscopic guidance using the Seldinger technique. Then a mid anterior and additional anterior lateral accessory portal were both established. Arthroscopic examination demonstrated a labral tear anteriorly with evidence of a defect in the anterior capsule. There was some residual mild bone spurring bone spurring on the acetabular rim as well as mild superior lateral cam impingement lesion. Residual remaining aspects of the decompression were in good condition. There was synovitis adjacent to the capsular rent, and there was synovitis in the fat pad in addition to a partial tear of the ligamentum teres.

At this point the labrum was debrided of non viable tissue. The capsule was elevated off the residual rim impingement and then a rim decompression was performed. The ligamentum teres was then debrided of non viable tissue and a fat pad debridement was performed. The cartilage on the femoral head was in excellent condition as was the remaining aspect of acetabulum.

The scope was then placed in the peripheral compartment where a T capsulotomy was performed for good visualization of the superior lateral aspect of the cam lesion. There was some extension of the cam superior laterally. Cam decompression was completed up in the superior lateral 11 to 1 o'clock position with good visualization and protection of the retinacular vessels during this period of time. There was some irritation and erythema around the labrum in this position consistent with the residual impingement. At the completion of the residual cam decompression, no further impingement was present.

The T capsulotomy was then shifted for solid clossure of the anterior capsule. The medial limb was brought lateral with 5 sutures passed side to side using ideal suture passer and a bird beak penetrator with good secure fixation of the capsular repair. at the completion of the capsular repair, no residual defect was present. the head was well contained with the socket. At this point no further pathology was identified.

The instruments were removed from the hip joint. It was 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, dried, sterile dressings were applied, and the patient was awakened from anesthesia and brought to the PACU having tolerated the procedure well.

Sutures...Gone!

I don't know if I have mentioned that sutures really gross me out. Yes, I see them all the time but it just seems so unnatural to have them in your skin, and my PT thought they may be part of the reason I feel so tight and pinchy.

It was no surprise to me that I showed up for my appointment today, which was scheduled the day I scheduled surgery....with a whole discussion on whether it would be ok to have them out 9 days post-op...and I had no appointment. The same thing happened with surgery #1. At least this time I hadn't thrown up in the car on the way down, and was in the correct office. And just like last time, there was no way I was coming back another day!

I think from now on I just won't make appointments because I get seen a lot quicker this way, no waiting in the waiting room, little waiting in the room! J/K

So the incisions look good, except for one which is still good but needs some time with the steri strip. My flexion ROM is good, and I have decent ER, I can stop wearing the @###$$%&$ boots at night! The bruising and swelling is probably bleeding from the capsule. He had to do a capsular shift, so he cut the capsule and instead of just approximating the edges together and suturing, he overlapped the edges and folded over the extra tissue, I now have a tighter capsule with a REALLY strong repair. He showed me the scope pics, the psoas looked great and is "unscathed" (guess he knows who he is dealing with). He was really impressed with the quality of the cartilage, I am thrilled about this.

I am very concerned about the repair and the ER so I spent some time discussing this with his PT. He said stick with gentle ROM for 6 weeks, it will come back. No joint mobs for 6 weeks. He said treat it like a shoulder with a repair, you want the mobility but you also need the stability. I feel better but still nervous about it. I see him again in January, I hope the ROM is good by then.
I have the op report and will post is as a separate post.

Swollen Swollen Swollen

That is the best way to describe my thigh right now. It is so gross! I really feel like it will burst open any minute, I feel like when the sutures come out tomorrow, the leg is going to explode. My bruise is getting more purple each day. I also have a faint black and blue line around my shin, must be from the boots in traction.

I had PT today and was complaining about tightness and tenderness to the ITB. My PT worked on it, and kept asking if I was ok, if it hurt, could I tolerate more etc.....it was basically numb. She could do whatever she wanted and I barely felt it. Its not numb numb bc I feel something, so we will refer to it as parasthesia, or decreased sensation. The front and lateral aspect of my thigh have decreased sensation. Hopefully once the swelling goes down it will get better.

I am afraid to put on anything other than sweatpants, I don't want any material rubbing on my thigh, or anything tight around it. So I am going into week 2 of sweats only!

I have my post-op appointment tomorrow, I plan on asking why I look like I had the crap beaten out of me (i.e. huge purple bruise on the side of my thigh) and if I should possibly go back on an anti-inflammatory for a while to bring down the swelling. I will let you know what he says...

My Frustration

My goal at this point is to be pain free and no longer need to take narcotics. Unfortunately, I have not hit this goal. I would also really like to be able to ambulate in the house with one crutch, this too is not happening. Usually, the reason I can't go down to one crutch is weakness and a horrible limp. I don't think I am that weak this time, I actually have pain if I put too much weight on that leg...except if I take Vicodin. so I land myself in this situation, I can do a lot more with Vicodin on board, but it is just masking the pain. Once it wears off, I have a lot of pain. I don't remember having this much pain any other time. I will have to go back and read my old posts again, but I am pretty sure I didn't.

I am also exhausted beyond belief. I can't sleep at night bc I am limited to which positions I can get into. I can't sleep on the operated side bc it is really painful, still swollen, and still has some bursitis. The bruise on that side continues to get worse, it looks awful.

Anytime I try to do exercises the leg feels so stiff and swollen, almost like it wants to burst at the seams. Occasionally, I will get this funky kind of pain in the front of my thigh and then down in my foot, I assume this is some sort of nerve irritation and hope it resolves quickly. My ITB is still very tight and tender.

Today I have PT again, hopefully I will leave feeling better this time!

I keep forgetting to mention the good news...the left leg is holding up beautifully, no pain or soreness. Occasionally a bit of fatigue but that is it!

I Want My Life Back

I always seem to over do things post-op and always end up regretting it. I have been looking through old posts and seeing what I was doing when. I seem to have a knack of trying things too soon.
So, just an update, I tried to walk with 1 crutch around my bedroom last night, this was after a party where I spent about 30 minutes on my feet, then sat for almost the rest of the time. I was pretty excited because I was able to do it. Unfortunately, I woke up with a lot of pain today. I am trying to avoid pain killers so ice is my best friend. The leg also feels more swollen today and the incision sites are painful.

One thing I have been looking back in my blog for is this business about an invisible bruise. My entire thigh hurts in the front, almost down to the knee. There is nothing there. Just pain, almost an aching. I am also very bruised on my lateral thigh, close to the greater trochnater, I had ugly bruising like this last time. This bruising developed a few days post-op and seems to get a bit worse each day. It is painless, but ugly.

I have very good flexion ROM but IR feels pinchy, I hope and pray that this is temporary. ER is still restricted, and if I accidentally go into it, it HURTS.
I have been doing my exercises and can do a sidelying straight leg raise (abduction). I have been practicing in bed, abduction (gravity eliminated) but get a lot of ITB pain. The ITB may have a touch of tendonitis so I am definitely sticking to 2 crutches and being super careful.

I have my next PT session Tuesday and see BK on Wed., hopefully I will be able to do more next week!

Not a Good Morning

Again, I woke up feeling very un-rested. I "kicked" off the boot sometime in the middle of the night and slept on my left side with pillows in between my knees. L woke me up at some point and wanted me to take her to the bathroom. I was in horrible pain so I took a Vicodin (at least I hope it was a Vicodin, it was pretty dark). This morning the pain was better but I woke feeling slightly dizzy and lightheaded. I don't know if it is from the Vicodin or just a combination of all the drugs I am taking. I had to fill out some paperwork yesterday at PT, and I had to write down the meds I take, it looked like this: Vicodin PRN, Indocin (anti-inflammatory), Prilosec (to prevent "issues" from the Indocin), Zofran PRN (nausea), Pentasa (Crohn's) and Xifaxan (Crohn's). Between that list, and marking the hip on the body chart, you would never guess that I am 29, more like 92!

I will take lightheadedness over nausea any day, but I really hope it goes away soon!

Let The Rehab Begin

Have I ever mentioned how much I hate PT? Ironic, I know, I guess I should clarify and say I hate being the patient in PT. Today was my first PT visit.

The day started off pretty crappy, I woke up nauseous, which made me panic. The first thing I did was run (ok, not run, but limp) to the Zofran. Next I put the Vicodin out of reach. This can not be happening. I also quickly called my OS office to have a new Scopolamine patch called in. I don't really know if it is working or not, but the placebo effect is powerful enough for me! The Zofran helped and my pain wasn't too bad today, so no Vicodin all morning. For whatever reason, the Zofran made me very lightheaded.

My PT appointment was at 2, so my mom and I decided to go out for lunch. I wore my oh so gorgeous brace since I am trying so hard to be compliant with my restrictions. It definitely helps me, but on the flip side, people stare like you are from outer space. It makes me really think twice about wearing it again, except when the possibility of ruining my newly repaired capsule comes to mind. I don't have plans to leave the house again until Saturday night so I will re-evaluate the brace situation then.

PT was simple today. My old PT P has left the practice, I chose C to be my new PT because she has helped me a lot in the weeks leading up to surgery, and she is significantly older than the other therapists I work with, so I figured she has a lot more experience. The rehab for this surgery can be tough, if I feel like it is not going the way I want it to, I will see one of the PTs my OS recommends.

My exercises for now are: heel slides, glut sets, bridges, hip abduction in supine, trying to perform hip abduction in side lying, seated long arc quads, standing hamstring curls. She also did some gentle PROM into flexion, abd and a hamstring stretch. She also had me do ankle exercises to help with the swelling.

I am in a lot of pain now and went back to the Vicodin. I may have overdone it with the abduction because I am having a lot of ITB pain, even when I am in bed. I feel like I have to put even less weight on my foot now and have to be super careful when I move. I may also have a touch of bilateral greater trochanteric bursitis.

Any advice on sleeping? The boots are killing me. This is how bedtime goes for me: J puts me into the boots. 10 minutes later I begin to feel claustrophobic. At 12 minutes my heart begins to race and I begin to be on the verge of a panic attack. At 12 1/2 minutes the left boot is off and I feel better. J then has to move the bolster that goes in between the boots to the outside of the right boot. I will fall asleep on my back for a little while. Then I wake up and NEED the right boot off. The boot comes off and the pillow comes back. I then sleep on my left side for a bit with pillows in between my knees, until the bursitis on the left begins to act up. So as you can see, sleeping is no fun for me!

The Weightbearing Restrictions Really Do Make Sense Now

I still feel like I am doing really well and the nausea is non-existent. Unfortunately, I remember it once or twice starting day 2 or 3. I spoke with the PA at my OS office yesterday, my biggest concern is the nausea, since I am pretty familiar with how the hip will heal. I left the hospital with a scopolamine patch which is good for 72 hours. I am nervous about what will happen after the 72 hours, even though I don't have even a bit of nausea. He assured me that if I want, he will call another one in for me. Its a good thing I am a junkie on anti-naseau meds and not narcotic painkillers!

Again, I spent a good part of the day in bed with ice packs, I got out to shower (whoops, still early to shower I think), rode the bike 2 or 3 times (vicodin makes me forgetful and dumb) and my friends came by with lunch for me. Sitting is painful sometimes so I avoid it as much as possible. I also had an "outing" today, well, more like an outing out of my apartment! I went down to the lobby twice, once to get L off of the school bus and once to get Jk as he was being dropped off from a playdate.
I am going to blame this one on the Vicodin, being that it is such a good pain killer for me, and that it makes me stupid, when I got out of bed earlier, I accidentally put all of my weight on the operated leg...holy shit...I literally saw stars. And here I was thinking that I don't really need crutches! Now I see that I really do! Since I haven't really ventured into the real world yet, I haven't put on my lovely bledsoe-philippon brace. In the past I have been pretty non-compliant with it, I think this time I will use it to avoid going into ER or extension, since I am supposed to avoid it anyway, and when I forget, the pain quickly reminds me.
Tomorrow is my first day of PT, again, I am breaking the "rules" since I was supposed to go yesterday. I took the liberty of making my own PT schedule this time since the last 3 times I was not at all happy to have to get dressed and out of the house so soon. I am also not looking forward to eventually having to get my ROM back.

I am not having any of the pre-op groin pain. I have butt pain and a lot of surgical pain anteriorly. I am really swollen too, not just my right leg, but all over, my ankles are swollen, my calves...I just look and feel puffy!

Thank you to everyone who has written to me, or posted comments on my blog. Once I can sit at the computer, I will be able to respond to the comments, for now I am blogging with my blackberry from bed!

Day 1...for the 4th time

Post-op day 1 has been pretty uneventful. My pain is pretty mild, I took a Vicodin this morning when I woke up, and one just now (7 hours later) There is absolutely no nausea, the anesthesiologist was great, he said we would give me lots of drugs to help me and I went home with a Scopolamine patch to wear for 3 days. I rode my bike twice already, and am spending the majority of my time in bed with ice packs.

My hip feels incredibly tight, it is hard to move it, but it does flex easily and I can do heel slides. I am also trying to remember to do ankle pumps, just to keep things moving. I am keeping a pillow on the outside of my leg to prevent external rotation.

I showered this morning (shhh...don't tell) with water proof band aids, I just felt really gross and dirty, and "hospital smelly". I have 3 incision sites, I can't tell if they are in the same place as the old ones or not, my thigh is pretty swollen and ugly right now. I am experiencing pain down my thigh and into my ITB, I guess it is to be expected after this surgery. What I don't have this time is the horrible bruising I had last time, which lasted a month. I can't yet tell if I have any numb patches or not, when the swelling goes down I will be able to tell more.
Overall I am pleased with day 1, I have had worse day 1's before!

Hip Arthroscopy #4...over

My heart rate is back to normal, my anxiety has vanished, and to replace it all I now am the proud owner a very tight hip!!

I won't go into details about the day but I will share with you what Dr Kelly has just told me (for the 3rd time today but I did not retain it the first 2 due the drugs!)

My biggest concern has been whether or not I was making the right decision going in for this surgery, he has assured me that yes, by all means, it was 100% the right decision. He primarily found a ruptured ligamentum teres and a deficient anterior capsule. Most likely, the night of the "breastfeeding incident" I ruptured the ligament, the question is why did it rupture? It is most likely due to the capsule issue. He re-stitched the capsule using 5 sutures so it is REALLY tight now. He debrided the torn ligament and said that there was a lot of irritation around it.

He shaved down some bone on the acetabular rim and the femoral neck, just to cover all bases. He now has better tools and can see more arthroscopically, he found some more bone supero-laterally and the labrum was torn there too. He shaved down the bone and debrided the labrum in that area.

The cartilage looks GREAT!!! Hooray!! At least there is a silver lining in all of this!

Because of the capsule repair, I have to avoid positions of extreme external rotation and extension. When I sleep I must wear special boots that prevent the ER....fun fun fun!

All I can say is thank goodness this is over and in the past....once again, thank you everyone for their well wishes, it is truly appreciated!

Thanksgiving

Its 5 am and my heart is racing. I have done all that I can to prepare for surgery, now it is out of my hands. I am just hoping and praying that THIS IS IT. I wanted to thank everyone for their well wishes and words of encouragement. It has truly helped make a difficult situation easier to handle. J is going to try to update my blog today, especially since his posts were such a hit last time!!! I hope to share only good news with you later in the day.

Almost Panicking

As Monday morning quickly approaches, my calm demeanor is going out the window. In the end, I decided to go with an early morning surgery. I got the call on Friday to be at the hospital at 7am for a 9am surgery. This seemed strange to me because my previous surgeries had all been at 8am, but the nurse assured me that I was the first case in that room.

A little while ago I got an email from a friend who works in the hospital, he had tried to help me get my "favorite" anesthesiologist. It turns out she is away next week. He also said that I do have the first case in the room I was assigned, but BK has 2 rooms that day. I don't even want to think about what this really means. But I was assured and reassured that there would be no residents working on me! I will just repeat this request on Monday!

We are still away for Thanksgiving but coming home first thing in the morning. I haven't worked since Tuesday and I have had less pain. The only thing I have started to have is pain with flexion/ER. Weird!

I will try my hardest to stay calm and collected for the next 36 hours...

(I hope this comes out ok, I am blogging on my blackberry)

5 days to go....

I am trying to get things ready for Monday, not there is a whole lot for me to do, just the usual. Had my mani-pedi yesterday, this time, there is a new rule, no colored nail polish.....WTF??? So I had to go with clear. Yes, this should be my biggest "problem"!! Today is waxing day, which I am even more sure I need after seeing Jess's pics! I think psychologically, with surgery, you as the patient have no control over anything, so you begin to try to control the little you can! And if you're like me, and slightly OCD, this is what happens!!!!

I am also a little bit nervous because we are going to Boston today for Thanksgiving and don't plan on being home until Sunday, the day before surgery. This has me feeling slightly anxious, but I guess my mind will be better occupied there and I will have less time to worry, and more time to chase Z up and down the steps!

We are all good with the NSAIDs and I have been "ordered" by my GI to think positive thoughts and hopefully I won't have a flare-up. On the up-side, in the event that I do have a flare up, I will be on Vicodin, so it should minimize the discomfort!

Radiation, NSAIDs and Braces...Oh My!

After my conversation with BK on Sunday, I have been feeling slightly overwhelmed. Yesterday, I received a call from the company that rents out the CPM and Gameready machines. I had told his surgical coordinator not to order them for me because I won't use them. I was going to call them back to cancel the order but started to wonder if maybe the CPM would be a good idea to use this time since I want to prevent the HO.....and of course my mind started racing at 1 million miles per hour. So I sent BK a quick email to make sure it was ok to skip the CPM...its ok!!! Yay!! I hate that thing, plus, the kids think it's a toy!

I also heard back from my GI, and while I am waiting for clarification on something, he did say to go ahead with the NSAID's (Indocin)...I may flare though....given the alternative, I'm willing to risk it. So no radiation near my ovaries!!!

Just When I was Ready To Throw in the Towel....

Tomorrow will be 1 week since I had my CT scan, and I have been waiting to speak to BK about it, since I was rather concerned about the findings. Ironically, my friend B was also waiting to hear from him. B is a "hip friend", but we were friends before the "hip thing", so it is a unique "hip friendship". Tonight J and I invited B and her husband for a late (i.e after the kids were in bed) dinner.

B has had one hip scoped by BK and was waiting to discuss her latest injection on the non-operated side with him. At 9:45, her phone rang....you guessed it......it was him!!! B, being the good friend/ hip friend that she is, prefaced her conversation by saying "you know, its funny that you're calling now because I am actually sitting in Susie's living room and I'm sure she would love to speak to you too!" So, 20 minutes later, when B was done, she passed the phone on to me! Who would have thought the waiting game would have ended like this!!!

So....it looks like there may be some overcoverage on the acetabular rim....FML. I asked if he thought it was new bone growth or old...he wasn't sure. Apparently, he is (has been) concerned about ossification at the site of the labral debridement, plus that tiny ossification in the joint capsule.......all of this points to the possibility of heteroropic ossification (HO). It is treated with NSAIDs once it is removed to prevent it from coming back. I have never taken NSAIDs post-op bc I also have been "blessed" with Crohn's disease. If I cannot take the NSAIDs post-op, the alternative is a single dose of radiation... so I am stuck between a rock and a hard place. I put an email in to my GI to see what his thoughts are on my lovely predicament. I am leaning towards the NSAIDs and dealing with the GI issues as they come. Radiation in that area (close to the ovary) does not thrill me.....Any thoughts??

Reflexology

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

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

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

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

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

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

Psoas...once again coming back to haunt me

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

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

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

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

Bitching and Moaning

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

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

Hip Arthroscopy # 4...Scheduled

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

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

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

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

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

Close Your Eyes and Imagine a High Pitched Scream

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

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

The Dangers Of Breastfeeding

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

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

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

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

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

The Wait Is Over

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

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

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

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

Sauvignon Blanc

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

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

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

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

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

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

I Was Stood Up!

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

I am sooo not good at this waiting thing!!

Just an Update as I Wait....

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

When Your Insurance Company Won’t Pay: 12 Tips

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

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

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

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

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

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

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

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

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

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

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

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

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

Other Trouble With UHC

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

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

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

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

The Way Things Used to Be

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

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

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

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

Having a Shitty Day

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

Let The Waiting Game Begin

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

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

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

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

Keep your fingers crossed!!!

Who Wants To Bring It To The Media

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

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

I Forgot To Mention About the Synvisc One

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

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

Synvisc One Injection....Done!

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

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

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

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

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

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

The SynviscOne is Here

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

Vacationing

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

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

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

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

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

Articles supporting FAI and Labral Tear Surgery

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

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

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

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

Articles

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


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


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


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


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


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


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


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