Finally Some Relief

I don't know if it was the multiple massages last week or the distraction of my practice, but I am finally feeling better this week.I have also had a ridiculous amount of anxiety, which causes me to feel no pain at all, so I guess I have to pick my poison!!! Its hard for me to really know what is helping as I have always had good days and bad days and for no apparent reason, but I have had a bunch of good days in a row so I am keeping my fingers crossed!

I saw my OS today and since things seem to be better at the moment I didn't really press any of the issues I have been having. He did review my MRI with a hip MRI specialist and she thinks there was a good deal of synovitis in my joint. It could be a reaction to the allograft or part of the normal healing process. She did recommend a new MRI in 6 months just to check on the progress of the healing of the allograft. There is still some fluid in the joint but not too much, the capsule is intact. In my opinion, this is going to require more time to heal. My OS said normal tissue takes 3 months to heal and this is by far normal tissue.

The one thing that doesn't thrill me is the amount of ER I have in the right hip. My OS is not all that concerned but it doesn't feel normal to me. He attributed it today to a differece in version angles between my right and left hip, right is 6 degrees and left is 13 degrees, making it more likely to ER. I don't really buy that answer right now, especially because the left has some acetabular retroversion so the 2 hips should be pretty equal.

One thing I keep telling myself is that this is no longer a normal hip and I can't expect it to do normal things. It has been operated on 4 times, it will never be the same again. I think in another 6 months we should know if the surgery was successful and how much permanent relief I will have.

I am Just Completely Worn Out With This

Interestingly, my husband and I bought our current home in 2006, immediately after, things started to go downhill for me health-wise. That was when I was officially diagnosed with Crohn's and immediately after that, FAI. You know the FAI story......It seems that the previous owners developed a liking for multiple mirrors, and my house is lined with mirrors, in a lot of places, and in a lot of places where you wouldn't ordinarily expect a mirror (bathroom ceiling???). My point is that I can't even walk from my bedroom to the kitchen without having to catch a glimpse of myself, and what I have noticed is as time has gone by, I am just looking completely worn out. I do think I do an excellent job of not letting see what is going on, I don't have a visible limp, I am able to attend PTA events, social outings (usually), my kids' sporting events, but the toll this is asking on me is becoming quite evident to me in the multitude of mirrors.

I sent an email of desperation to my OS last week. We spoke on Fri, I am not sure what he really thinks is going on but he said he wants an MRI of my hip, to see what is going on and why it responded so well to the cortisone, and to get an image of the tissues etc. He also said he wants one of my back. I said look, I don't think there is a problem with my back, I am pretty sure it is all coming from my hip, but if you feel strongly about it then I will get an MRI of my back too. He decided to wait until I see him in 1 1/2 weeks to make the decision about my back. He thinks that at this point my problem has now become even deeper and is a neuromechanical problem. He said he thinks I am having trouble finding a balance in my hip, and that is why I go from hip to back pain over and over again.  This article may provide insight into what that means.

The layer concept: utilization in determining the pain generators, pathology and how structure determines treatment.

Draovitch P, Edelstein J, Kelly BT.

Source

Hospital for Special Surgery, 525 East 71st Street, New York, NY, 10021, USA, draovitchp@hss.edu.

Abstract

The level of understanding of pain in the non-arthritic hip has made significant strides in the last couple of decades beginning with the discoveries of Reinhold Ganz, MD. However, even with the detection of subtle bony abnormalities, including femoroacetabular impingement, a clinician's ability to differentiate pain generators in the hip has been ambiguous. Deciphering the etiology of the pathology versus the pain generator is essential in prescribing the proper treatment. The Layer Concept developed by Dr. Bryan Kelly, is a systematic means of determining which structures about the hip are the source of the pathology, which are the pain generators and how to then best implement treatment. Four layers will be discussed in this article. Layer I, the osseous layer, Layer II, the inert tissue layer, Layer III, the contractile layer and Layer IV, the neuromechanical layer.

PMID:

 

22371303

 

[PubMed - in process]

 Of course this is what they know the least about at this time. He also spoke about finding a PT that I can work with, that will WORK. I said its been 5 months, I'm pretty sick of PT and I really don't want to be in PT for the rest of my life.He agreed with that. I asked if I should go back on Lyrica, he said to try it and see if it helps. I also had an acupuncture treatment 2 nights ago, it definitely helped the spasm in my back and I slept better than I had in weeks. I also had a massage 3 days ago but I might as well have flushed the money down the toilet. What was interesting though was that it actually helped the pain in my back temporarily but made the pain in my hip worse.

What I started doing to help my pain and core is a series of exercises that I have been using on my older patients, those that are either low-functioning, are post-op from spine surgery, have osteoporosis etc. I find that while I am doing them I get pain relief, so I will continue. they are from a book called "Walk Tall" by Sara Meeks. I highly recommend this to anyone who is having back issues that are not responding to any other therapy. These are simple exercises, each one very carefully and specifically explained with pictures, they are easy to do and easy to follow, I keep the book with me when I am treating.

So the current plan is Valium+MRI, see OS to review MRI and possibly obtain back MRI.

Post Injection

It has been a week and a half since my cortisone injection and I am happy to report that the pain in my joint has finally decreased. I actually feel human again and have been functioning normally the last few days. The pain in my back is not gone though, but the referred pain to my lower leg is improving. One of my greatest achievements is finally coming to fruition, I have started my own private practice. This comes just at the perfect time, sometimes life works in mysterious ways! Check me out www.hudsoninhomept.com
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