3.5 years post open surgical dislocation

Lately I have been getting a lot of emails from hip patients as well as comments on the blog which makes me wonder if it is coming up higher on search engines than in the past. The multitude of emails has reminded me that it is only fair to continue to update my readers to my progress. Well, here I am, 3.5 years later, and I am RUNNING. Yes. Running. I decided that it was time to once and for all take my life back and get back into shape. A lot of my friends and family members had been talking about a gym/ workout called Orange Theory Fitness. If you don't know what OTF is then I highly recommend you google it. It is a form of high intensity interval training involving a treadmill, rowing machine, weights and straps. About half of the 60 minute class is spent doing cardio and half is spent in the weight room. Throughout the class, your heart rate is monitored and the goal is to spend greater than 12 minutes working at 84% of your maximum heart rate. I started almost 4 months ago. It was a very timid start as I still had trochanteric pain and at times other parts of my hip would flare up. I began with only walking on the treadmill and avoiding high impact activities in the weight room including jumping. After a few weeks, I was feeling good and honestly I wasn't being challenged like I wanted to be. I decided to jog for part of the treadmill time. I jogged when we were to increase the speed and walked when we were to do a slow jog. Well, 3 months later my jog is a run and my walk is a jog. I feel better than I have in years. The trochanteric pain has disappeared almost completely. I can comfortably sleep on my right side, something I haven't been able to do in 3.5 years. In hindsight, my body needed to get strong and I was holding back out of fear. I don't recommend that anyone jump on a high intensity workout when they are still recovering but for me, the time had come. Enough was enough. I am now enjoying OTF 4-5 times per week, my husband comes as well. We are having a blast getting into shape together. When I am having a tough day in the class, I flash back to my post-op X-Ray, and remind myself how far I have come and much I am capable of. 

2 years post open surgical dislocation/ sdd

I guess time really flies. It has been 2 years since I had my open SDD, 2 years since the hellish roller coaster ride of a violent, gruesome surgery. 2 years since my life was turned upside down and permanently changed. But looking back now, 2 years later, I have come a very long way. I now function like a normal person. No one in my new city even has a clue about my past. No one walks up to me and says "wow, you are walking so well" or "wow, you are finally off of crutches". I look just like everyone else does on the outside. Of course no one has X-ray vision and sees my scars, my surgically reconstructed labrum, my cadaver hip, my reattached glute etc. But from what they can see, I look normal. I have come a very long way in 2 years. And yes, most people would have made it to where I am a lot sooner than 2 years, but nonetheless, I am grateful I have come to this point and hope I will continue to make improvements.

14 months post hardware removal

An update....appendectomy was 4 months ago... The most common and simplest surgery! Of course I had a complication. My incision opened up due to the sutures dissolving too early. Fast forward to now ....let's just say my scars will prevent me from ever being a bikini model. But anyway... I had a benign tumor detected and removed from my appendix which had the potential of becoming cancer. I am grateful for that. On all other fronts, my family has relocated from NYC to south Florida. We have always wanted to live in a warm climate, have a house with a backyard and pool for our kids, and we finally did it! I scheduled a cortisone injection into my trochanteric bursa a few weeks before the move because I continued to have pain and discomfort there. I also wasn't able to (still) sleep on my op side and it has been over 1.5 years since my open dislocation. It took 3 weeks but the pain finally diminished and the area doesn't look swollen like it used to. About 5 weeks ago my body was ready to go back to exercising. In my previous life (before hip problems) I was an obsessive Spin class goer. I am happy to say that I am back in the saddle, literally and figuratively. My life is really coming back together and although I know my hip will never be the same, I am finally reaping the benefits of a very very long ordeal. val An update....appendectomy was 4 months ago... The most common and simplest surgery! Of course I had a complication. My incision opened up due to the sutures dissolving too early. Fast forward to now ....let's just say my scars will prevent me from ever being a bikini model. But anyway... I had a benign tumor detected and removed from my appendix which had the potential of becoming cancer. I am grateful for that. On all other fronts, my family has relocated from NYC to south Florida. We have always wanted to live in a warm climate, have a house with a backyard and pool for our kids, and we finally did it! I scheduled a cortisone injection into my trochanteric bursa a few weeks before the move because I continued to have pain and discomfort there. I also wasn't able to (still) sleep on my op side and it has been over 1.5 years since my open dislocation. It took 3 weeks but the pain finally diminished and the area doesn't look swollen like it used to. About 5 weeks ago my body was ready to go back to exercising. In my previous life (before hip problems) I was an obsessive Spin class goer. I am happy to say that I am back in the saddle, literally and figuratively. My life is really coming back together and although I know my hip will never be the same, I am finally reaping the benefits of a very very long ordeal.

Post-appendectomy

It has been 1 week since I had a laparoscopic appendectomy. What a breeze this surgery was. I was in and out of the hospital faster than with any of my hip surgeries (9 hours from check in to discharge) and today, one week later, I went out to work (not to see patients but to meetings). Pain was minimal and manageable. It helps that I already have a list of which meds work and which don't and have no qualms requesting the right meds. I had a long talk with the anesthesiologist before hand and things could not have gone smoother. Of course there is always some issue when it comes to me and surgery. In this case I am having some issues with one of the incisions but its not a big deal and should be fine in a few days. Nothing compared to the nightmare I have been through with my hip!

I was actually hoping that 2014 would finally be the year of no surgeries.

As you probably already know, life throws us a curveball every now and then. The last few weeks I have been trying to run away from my current curveball but have failed. I probably have mentioned that I have Crohn's disease. It is very mild and not a big deal, it just requires some monitoring. A few weeks ago I had a routine colonoscopy which showed swelling of my appendix. I had to have a CT scan to further investigate. It turns out I have a mucocele, which is when the appendix fills with mucous, which is an abnormal finding, and must be removed. I met with a surgeon this week and scheduled surgery for 4/30, less than 3 weeks away. I figure I just want to get this over with and move on, rather than have to think and worry about this. I was happy to actually have a normal appointment with a surgeon. And know that we will not be having a long standing relationship! I figure I saw him for the consult, will see him the day of surgery and maybe once or twice post op and be done. This is how relationships with surgeons should be! I am more than happy not to have his cell phone number and carte blanche to text anytime. We will not be seeing each other extensively for the next 8 years, he will not lose sleep over my case and I won't have nightmares where he appears! This will be routine, normal and quick!

16 Months Post Open Dislocation

Wow, I just realized I haven't blogged since January. Well, what happened was I stopped using crutches and I returned to my life! I am busy running my practice and reaping the benefits of being a hands-on practice owner. I don't have to rely on someone else to do my marketing, do my lectures, go to meetings etc. As I mentioned in my last post, the bitter cold of this winter has been great for me. We are still dealing with cold days and I always feel better on those days. When it warms up I have some pain, but I manage. As we transition into spring, I am a little bit nervous about how the weather will affect me. I will try to post updates more often!

Is this "The Corner"?

Over the past year, and really over the past 8 years, my blog has been full of my downs more than my ups, so today I wanted to write about an "up". Today I finally felt normal! I went through my day like any 30-something, mother of 3, entrepreneur, wife etc would. No crutches, no pain, walked throughout the neighborhood from one activity to another. Basketball game, birthday party, bbq....This is the day I have been waiting for for a very very long time. I will say that it is bitterly cold in NYC and these bitter cold days work miracles on my hip, I can't figure out why but whenever we have had these cold snaps I feel amazing. I hope that this time this feeling is here to stay.

One Month Post Trochanteric Bursa Injection

Things improved with my injection. The swelling in my leg went down miraculously and the bursa started to feel better. I have been able to pretty much get rid of my crutches for the most part. I had a little scare a few weeks ago, my groin pain came back. I had a melt down. Literally. I flipped out. Luckily my OS and PT were very responsive to my drama and I had an MRI and an appointment with him right away. Luckily there is no problem with my new labrum, and even better, it has integrated so well into my hip that the radiologist didn't know it was an allograft. The pain may be from an inflamed suture in my capsule, but things will hopefully settle with some more PT. Pt has been going well, but has been incredibly painful. I have a very very angry hip, and all my muscles are always angry and have developed tendonitis. My OS broke it down nicely, I basically have 4 problems, adductor tendonitis causing medial pain, abductor tendonitis and trochnateric bursitis causing lateral pain, hamstring tendonitis causing posterior pain and the suture issue causing groin pain. All in all one big barrel of fun.... Life has begun to be more normal in some respects. I am able to run short errands with no crutches and attend work meetings as well throughout the city. I get pain with prolonged standing and walking. It has been about a month since my injection and I feel some of the bursitis returning,but hopefully it won't be so bad this time. It has been 13 months since I had the open dislocation and I never, in a million years, expected such a roller coaster of a recovery.

Trochanteric Bursa Injection

I had my bursa injected 2 days ago. It was ultrasound guided and scheduled as a possible aspiration of the swelling in my leg. Fortunately of unfortunately (not sure which) there is no clear defined pocket of fluid but rather it is dispersed interstitially and could not be removed. I am going to speak to my PT about it and maybe start to wear compression shorts to reduce it. I was in a ton of pain yesterday, today was better. I am cautiously optimistic bc my last few cortisone injections have started like this and then been horrible for 2 weeks before subsiding again and kicking in. Unfortunately I am so busy for the next few weeks and can't really take it easy until we go on vacation for the kids holiday break. I will try to write an update soon.

One Year From Open Surgical Dislocation

Today marks one year since my open dislocation surgery. When I think back on the year I am overcome with so many emotions. Anger, sadness, pain, embarrassment, devastation, accomplishment, happiness and so much more. It had been one hell of a ride and as I write this I have tears in my eyes, tears of happiness and tears of sadness. Happiness for all I have overcome and for how far I have made it, sadness for all I endured and had to give up, what my family went through and just plain self pity. When I think of where I was exactly one year ago today, I cry. Fresh 9" incision, newly healing femur fracture, cadaver labrum incorporating once again, IV line, spinal, catheter, and probably the worst pain I have ever been in in my entire life, and a lot more than I probably remember. And now I think of where I am today, and I am crying as well. At one year postop (with a gluteus medius repair 6 months ago) I am making slow progress, but I still need my crutch at some point of every day. I still deal with pretty severe pain in my greater trochanter as glute at times. I still have to ice. I still can't function like most people do. I can't run off to the supermarket if I need a few things, I can't spend the day in the mall, I can't take my kids ice skating, or play soccer with them. I still need daily meds. This surgery was supposed to give me back my life, but it is happening on my body's timeline, which is quite slow. I want my life back, the way it was in October of 2006. That is just before I started my hip journey/ nightmare. My kids don't know what life is like when I don't have hip pain. L was 2 when it started and Jk was one. Z came a long in the middle of it all. He is almost 5 now. L is almost 10 and Jk is 8. I hope and pray that this coming year will bring me back to where I was at that point, no pain and able to be a mother to the fullest degree.

4 months post hardware removal/ glute repair

I have been to PT 3 times and all I can say is that it is has been life changing. I can walk now. Well, I can walk well now. Some things seem like they haven't really changed, but I know they have. I am still on the same routine, crutch when I leave the house, no crutch at home....but I can walk like rock star now with my crutch! Quite honestly, I am pretty fed up with people asking my why I need my crutch since I walk so well, or, my all time least favorite "how much longer do you need that thing?".... To which I'd like to reply "do I look like a fucking fortune teller?" But always smile and say "just a few more weeks". The issue really is that at times, I can walk perfectly, with no crutch. I can stand in my kitchen and prepare meals for over a dozen guests, I can do homework, feed, and put my kids to bed. But usually, at some unpredictable point, my glute will rebel and say enough! Then I am on my own. If I am lucky I have my crutch, other times I have not been so lucky and have gotten myself into a tricky situation where I am half a block from home, no crutch and no functioning glute. I have learned that as much as I want to, I have to take my crutch with me if I am planning on waking more than half a block. My glute now fires but has no endurance and quickly fatigues and shuts down. This is going to be a long an tedious process until I can do everything I want with a fully functioning glute!

3 months post hardware removal

Crazy how time flies!! It's been 3 llloooonnnnggggg months since I had my screws removed and my glute repaired. My medrol mess is pretty much under control. My glute is still painful and swells... A lot.... In an area posterior to my greater trochanter. My OS offered a cortisone injection, I am going to try to put it off for now. I started PT again yesterday. One of the PTs I have seen in the past is now working at a "boutique" private practice and charges an arm and a leg for visits. Since she is the "glute master" I am left with no choice but to pay out of pocket and see her. The plan is to see her every few weeks and be compliant with my exercises at home. She have me a few very very specific and targeted exercises that really work the area I feel won't fire, so hopefully this will be money very well spent. A far as the crutch situation goes, I am not using any indoors for the most part. Occasionally I will have too much pain and swelling and need one. Outdoors I use a crutch. I have tried not to and the results have been poor. I walked my daughter to a play date 1 block away on a day I was feeling good. I decided not to use my crutch. On my way home, I had to stop and rest on a scaffold bc I couldn't continue. 2 days ago I tried avian, 1 block away, but this time I rested once I got to the play date before turning around. Still not great. I guess I am not ready yet. My PT said to expect this I take 6-12 months (from the glute repair) to feel back to normal, or whatever normal will be for me.

Post Medrol Mess

I think I've been off of the steroids for 3 or 4 weeks now. Unfortunately it has left me a mess. I continued to have panic attacks. One was so bad it caused my hands to clench up and paralyze and my feet as well. I thought I was having a stroke and made my husband take me to the ER (that's my second ER visit since the last surgery.... The "easiest one"). They diagnosed it as just another panic attack, which I think was the best thing ever, bc it confirmed than any sensation I have good forward is just a panic attack and not any of the crazy things I had been fearing, like difficulty breathing, difficulty swallowing, tingling in my extremities, tingling on my tongue and lips etc. Since that day, I haven't had a full fledged panic attack, but started taking Ativan when I would feel an attack starting. I hated the Ativan and could feel myself becoming dependent on it. For a good portion of this, I was out of town. I decided I needed to stop the Ativan since it wasn't helping anyway and try to get my hands on my herbal and homeopathic remedies from my acupuncturist. Once I made the switch I felt a lot better. I was finally home yesterday and was able to have an acupuncture session. What a difference, even with 1 treatment. She gave me a regimen of herbs and minerals and other natural remedies to take. As I write I am on a plane heading back out of town, I left my Ativan at home by accident. A week ago, that alone would have caused a panic attack. Today, I am ok without it! As for the hip, still on 1 crutch (I think it's been about 10 weeks) and still with bursitis. I think I may need a cortisone injection to end this but am really scared of steroids. Not sure what to do...

Post- medrol dose pack

I am happy to say the medrol dose pack helped my leg tremendously. The burning I had in my foot is gone and I have graduated to one crutch/ no crutch at times. The medrol was one of the worst meds I have ever taken in my life and will publicly say I will never ever take it again. I started it on a Saturday morning and by afternoon I was feeling amazing, my pain was at least 50% better. By Monday 80% better, one crutch and a friend noted I had a "spring in my step". It was a tapering dose, starting with 6 and one less each day. I realized Tuesday I forgot my last Monday night dose so I took it after breakfast. About 20 minutes later I started having a bad reaction and I honestly though I was going to die. Now I realize I was having a panic attack from the meds but at the time..... I was really scared. My heart would start racing and I would feel like I was going to pass out, and then the feeling would just go away. It finally stopped after a few hours. I called my pharmacist who said take more food with it. When I took it that night I was fine. The next morning it happened again but not quite as badly. That night things got really bad and the panic attack was intense. I still didn't know it was a panic attack. I was shaking on top of everything , I was home alone and freaking out. My husband called my brother in law who happens to be a doctor and lives down the block. He immediately realized it was a panic attack- which is a side effect of the medrol, and had me take Ativan to stop it. For the next 6 days I had to take Ativan to deal with the effects of it. I also skipped the final dose because I was so scared to take more. Luckily I got enough in me to get me over the hump!

6+ weeks from hardware removal

As usual, things have been slow, if nothing else. At 6 weeks I was still in crutches without a firing glute and to make matters worse, I had burning in my foot. It started around week 5 and was not getting better. I saw my OS last week who wanted me to start a Medrol dose pack (tapered steroids). I initially said no, and we agreed to increase Lyrica and the compound cream I have. A few days later I was going to rip off my foot....it was time for the steroids. I started them Saturday morning and by lunchtime I felt better. That night I had very little burning in my foot. On Sunday my whole leg felt better and I was using one crutch all day. I feel like superwoman, I even cleaned up the entire kitchen last night, emptied 2 dishwashers, bathed the kids.... I know I know..... Don't overdo it....but I feel like I am free!!!! I have a small worry in the back of my mind.... What will happen in 4 days when I am done....but I am trying not to worry about it and rather enjoy this liberating feeling of finally feeling better! I will report later in the week!

First PT appointment after hardware removal

I've been having a lot of hypersensitivity on my hip lately. It hurts to touch. I've also been unsuccessfully trying to come off of crutches. He said the hypersensitivity is from fluid collection in the tissues, the exercises I am supposed to do will help move it all out. At 5 weeks out from the glute repair he does not think I should be coming off of crutches yet and thinks I need to wait a little longer. My OS had said start weaning off around now but clearly my hip has a mind of its own.

4 weeks since HWR and Glute repair

Well, I can say that this surgery has certainly thrown me for a loop, which I should have expected, but was trying to be hopeful. It has most definitely not been my easiest surgery, as my OS assured me it would be. At 4 weeks I am still on 2 crutches. I tried using 1 yesterday and I can walk well with it but there is significant pain in my glute and I paid the price later in the day. I have had horrible bruising, it is finally going down and fading now. I have my first PT session next week so we will see what my PT wants me to start with. At 4 weeks I don't feel better than preop but I am sure it will come soon. I am still really sore on the greater trochanter and really swollen. Ice is my best friend because I have completely stopped pain meds because I was so sick a few weeks back. I am still occasionally battling dizziness, headaches, nausea etc, but less and less every day.

2.5 weeks post hardware removal

I have a few complaints to make... The first is that my OS said this would be easiest surgery out of the 7..... It has not been. Also, I was expecting a 3" incision. We are at about 9" or 10". As usual, my post op period has not gone as planned. Initially I was in so much pain from swelling. I developed a large bump at the top of my incision. My OS told me it was probably a hematoma and not to worry. My massage therapist showed me how to do lymphedema work on it. The next day it was a lot smaller but my leg looked like it had been through a war. I've never, in my personal and professional life seen bruising like this. It is slowly resolving. About 6 days post op I was sitting at my computer trying to work and I became extremely dizzy. I moved back into bed and basically stayed there for days. I was so sick- weak, dizzy, lightheaded, nauseous, headache etc. I've never felt so sick before. 4 days later I was still sick and could barely pick up my head off of my pillow. I asked my OS what he thought and what could be causing this- he didn't know but suggested I go to urgent care if it got worse. At urgent care I was seen by a nurse practitioner who felt that I had decreased breath sounds and sent me to the ER to rule out a PE (pulmonary embolus). I was really hoping urgent care would give me IV fluids and send me home!! At the ER they did give me IV fluids and some Reglan, ran a million labs and did a CT to check for a PE. Everything came back negative but once I had the IV I felt so much better. I spent the entire week following the ER in bed (again) slowly recovering. I am finally feeling a lot better, which I attribute to my acupuncturist who I saw 2 days ago. The day I saw her I felt worse but I woke up the next day feeling great. I am still on crutches and hope that when I see my OS this week he will let me go down to 1.

Op report #7

Right Hip Open Removal of Hardware, Bursectomy and Gluteus Medius Repair Indications: the patient had a prior surgical dislocation, painful hardware and loose medius and adductor weakness. She had a failed non- operative management and indicated for removal of hardware and Bursectomy and gluteus medius repair. Procedure: The patient was correctly identified in the holding area, she was brought to the operating room. Spinal anesthesia was administered she was placed in the lateral decubitus position and the right leg was prepped and draped in the standard, sterile, fashion. Approximately 4cm incision was made over the previous lateral incision from the Gibson approach and taken down to the level of the iliotibial band. Scar tissue was debrided. The iliotibial band was split using modified anterior Gibson approach in line with the fibers of the gluteus Maximus. There was significant bursal inflammation on the undersurface of the iliotibial band which was excised and resected en mass. Three 2.5 mm screws were identified and extracted. The abductor tendons were intact although there was some attenuation of the posterior superior facet, insertion of the round fibers of the gluteus medius. Using drill tunnels through the posterior, superior facet, modified Mason- Allen sutures using #1 OrthoCord sutures were used to restore tension on the abductor in this region. The PRP was then injected at the site of the abductor repair. The wound was copiously irrigated. A light closure was performed with 0 vicryl for the iliotibial band and 0 vicryl 1 and 2.0 Vicryl for the deep layer and a 3.0 Monocryl sutures with Steri Strips. The wounds were cleaned, dried and sterile dressings were applied.

I am unscrewed!

My unscrewing was 4 days ago. Leading up to the surgery I was pretty calm. My OS and I had discussed things and decided that while taking out the screws he would do whatever he could to help my gluteus medius. This including repairing any and all tears and injecting PRP. It turns out I didn't have a bad tear but I had a stretched out tendon. I am not 100% sure why it was stretched. My OS said it may have healed like that after the open dislocation or, since I hadn't been firing, it looked all loose. I guess it's one of those situations- what came first, the chicken or the egg. Surgery was on Thursday (6/20/12) and I was supposed to come home that day. Since I am usually not the star patient in the PACU, I had a lot of trouble recovering and was in a lot of pain so I ended up staying over. The next day things didn't go too well. I was in a lot of pain and very dizzy. The hospital won't discharge you until you "pass" PT. I was too dizzy for PT so I was stuck another night. Yesterday was almost a repeat of the day before. I failed PT twice bc I was too dizzy and in pain. Plus the PT said I was way too pale and was nervous I would pass out. Everyone gets PT 2x/day so I maxed out my opportunities. I REALLY didn't want to stay another night so I skipped a dosage of pain meds and made sure I drank a ton of juice and ate a little. I asked my nurse to beg the PT to give me one more chance. A really nice PT came back and cleared me to leave! Yippee!! So now I am home, I feel like I did after my open surgery, if I don't move I am fine, if I walk, roll in bed, sit, scoot etc I see stars. My OS took pics with his phone so I a waiting for him to send the to me, he showed me in the PACU but I was a little out of it!

Hardware Removal Pre-op Appointment

I decided to make an appointment with my OS to go over some last minute pre-op concerns. Primarily what the heck is going to happen with my glutes. He will fix whatever needs fixing and suture it back down. He will also put prp in while in the surgery to promote healing. Post op I will be on crutches for 2 weeks minimum and no active abduction for 2 weeks minimum. Since I've been on crutches this whole time I shouldn't expect to miraculously walk!

Gone...Just like that

My new found painlessness has disappeared just as quickly as it came. I guess I have a very shortened cortisone life in my hip. I am back to pain and crutches :-( The "good" news is that I scheduled my hardware removal for June 20, hopefully that will put an end to all of this and I can finally move on!

The Light

Fianally- after 6 months of pure hell, I can walk without crutches (well, at home, for short periods of time). Seems like with most other things related to my hip, the cortisone took a long time to kick in but it finally did and I feel like a new person. I can walk again! It's like night and day. This has been a game changer in so many ways but most importantly, I am so so so happy right now. Since injecting near the screws made all the difference, they have to come out. I feel like I am living with a dark cloud hanging over me with this fear that any day the cortisone will wear off and I will be back to where I was before. Right now it looks like I won't be able to coordinate my husband and my Mom's schedule for another 4 weeks but I guess in the grand scheme of things what's another 4 weeks? It's been 6+ years since this started and I can't wait for it to finally be over.

At the 6.5 year mark I may have reached my breaking point

I think I may have just had the worst 24 hours of my hip journey. Given everything I have been through, I think I have done a damn good job of keeping it together, pasting a smile on my face every day, and just continuing to plug away. In the last few days/ weeks, the pain on the side of my leg has gotten so bad I can't take it anymore. I am also developing compensatory tendinitis in every muscle around my hip, contributing to my pain issue. The fact that the injection did nothing for me and the increasing lateral pain has left me in such a poor emotional state that I have had more than one meltdown in the last 24 hours. I don't know what the next step is, I don't know what to do and I don't know how I will manage at this point with pain this severe. I am hoping it is a temporary flare up- maybe from too much walking or activity.

Trochanteric Bursa Injection

I ended up having the injection yesterday. After yet another ridiculous fight with Oxford and Orthonet, I got approval about 1.5 hours before the procedure was scheduled (will post on this soon). I am a little disappointed because the numbing medication (marcaine) did nothing for the pain I have been having which is just posterior to the greater trochanter. While there is pain at the trochanter and screw sites- it is the pain posterior to that that is debilitating. My MRI report shows a glute tear and my scan from September does not. I plan on asking for a re-read on the glutes to know specifically what had changed. I still cannot walk without crutches and have a major trendelnberg if I try to. I still can't believe that I am still dealing with this, having to have scans, injections and anxiety oer my hip. It makes me so mad....

MRI and CT are done!

I was finally able to have my scans last week (report coming in the next day or so). I already spoke to my OS and have his report on it. My osteotomy is pretty much healed which is amazing at 4.5 months. My allograft looks great as do all my muscles. No tears in my glutes and no denervation. My glute med is a little atrophied but that is to be expected. I do have a lot of inflammation and irritation laterally from the screws so they will come out. The question is when. Technically, my osteotomy is healed enough to do it now but that would be incredibly aggressive. I am going to have the bursa injected to give me some more time and the screws can come out in the next 2months or so, giving the osteotomy sufficient time to be healed.

My MRI Drama

Ever since my husband switched jobs about 1 1/2 years ago, our health insurance changed from United healthcare to Oxford. If you recall, I had major issues w UHC back in 2010 when they denied my surgery. After an appeal the denial was overturned but I later had more issues with my out of network benefits. Oxford is owned by UHC but operates under its own rules. One of those rules is that under my particular policy, I require pre-certification for every MRI, CT, surgery, injection and god knows what else. Generally the scans are approved within a day or 2. This time things were not quite as simple. Oxford outsources their radiology pre-certification to a company called Care Core. Care Core is supposed to approve or deny the procedure within 2 days. My CT (which is a less expensive scan) was approved right away. The MRI was not. Care Core needed more info- specifically "was my hip pain treated w 4 weeks of NSAIDs" as it "typically" should. Well, this got me a bit riled up....I mean- how many Naprosyn's does Care Core think will make me walk? And to be honest, I wouldn't call this "typical". So, my doctor's office had to send more info and explain that I had already done more than 4 weeks w an NSAID cream.... And the MRI was denied. So I became a little more agitated....and why didn't they have he same requirement for the CT? I mean- if I have to be on 4 weeks of NSAIDs then lets adhere to the same rules all across the board... Not just for expensive scans. In the end, the MRI was approved, 10 days after the initial request. Once it was approved, a lovely representative from Care Core called me to let me know. (It is important to note that she was lovely bc everyone I spoke to was lovely. It is the game that medical management companies play- its much harder to yell and scream at someone who is sweet as pie) "My MRI is approved to be done at XYZ facility in the Bronx". Huh? The Bronx? Wtf? I calmly explained to her that I will not be having my MRI in the Bronx but at the same hospital where I have had all (I forget the number) previous ones. And why was this particular facility chosen?? "Bc your doctor requested it. And your Ct is approved at that facility as well". Hmmm, my doctor only allows MRIs at 2 facilities and I am pretty sure neither is in the Bronx. And when I received the call about the CT, I was told it had been approved at my regular CT facility. Why was it changed? I did get them to change both scans to the right facility but why the hell is Care Core trying to pull a fast one? What the hell is going in w medical management in this country??? Last time I checked I had a very pricey PPO policy and I am shocked at the lengths an insurance company would go to cut costs

OS#2 not too concerned

If you recall, my "regular" OS who did my 5 (yes, 5) scopes had to brig in another OS to do the osteotomy portion of my surgery. He happens to be a pediatric hip surgeon and the one who I took my son to last summer when he was having hip pain. Yesterday my son happened to have a follow up with him and my crutches were a topic if conversation. His nurse first said that with multiple surgeries it is common for the glute to take a while to wake up. He concurred and he also said that he doesn't cut the glute. So my first question (in my head) was why does my OS think it was cut? They routinely do this surgery together. OS#2 barely batted an eye at the fact that I can't walk. I don't think I told him about the pain but regardless- he was cool with it. I asked his nurse later on if they would order scans at this point (4 months) and she said probably not. At 6 months they would. So I am confused about my OS concern, esp bc he is never concerned about anything it seems. I am still going ahead w the scans- the best case scenario will be glut tendinitis that will resolve w the screw removal.

OS not too happy

I spoke with my OS last night who is no longer ok with me being on crutches. It's not "normal" anymore and he wants to figure out why. He said that I may be having problems from my glute medius tendon which is cut and then repaired at the end of the surgery. It is most likely very irritated from the screws but we have to rule out other problems like denervation or tears. I went to see my PT today but the appointment was hijacked by my OS. He said (again) that my screws must come out ASAP. The soonest it can be done safely is 6 months but I have to have a CT to check the healing of the osteotomy. My PT checked all my muscles and my ROM and everything is great except for my glut. med. All the muscles fire well but the med wont turn on. Which is why I can't walk. I should hopefully have the scans in the next few days as my OS is anxious to see what is going on. I am beyond upset with this and wish my hip would just cooperate, for once.

4 months and still on crutches

That about sums up my feelings right now. I just can't believe that I am still on crutches. I tend to compartmentalize my life by events- and there were abt 6 event post op that I wondered whether I would need crutches at. So far the answer has been yes. To add to the excitement, I have a raging case of trochanteric bursitis so bad there is a huge swollen area halfway between my butt and the outside part of my leg. It is so painful I want to take a knife an saw off that part of my leg. I've been away for abt 1.5 weeks and came home to my housekeeper/ nanny being on vacation. I unpacked from the trip and have been keeping my house clean.... I want to take the knife and cut off the rest of my leg. I have a call with my OS next week and an appt with my back up PT next week as well. I had a massage session today w my Reiki/ Energy/ craniosacral/ healing massage therapist. He wasn't able to go too deep on my op leg bc of all the inflammation. I am ready to take my crutches and....

15 weeks postop

Time is slowly going by, almost as slow as my walking speed. I never dreamed that at 15 weeks I would still be on crutches, but here we are, slowly moving forward. I am down to 1 crutch most of the time in the house. At times I get too tired for one and the pain doesn't allow me to be on just one. But, sometimes I lose one crutch! I have Millennials and they are side specific, so they are not interchangeable. And since my right hip is the involved one, I need the left crutch. Sometimes I have to make a choice, do I walk to the kitchen with one crutch, even though my leg really can't handle it, or do I go and look for the lost right crutch? It takes longer to find the lost crutch most of the time so I go with choice A!! Groin pain continues to improve. Lateral pain is there and is exacerbated with a lot of walking and activity. I still can't fully lie on that side. My new cream def helps when I remember to apply it. My PT situation has changed and I am without a PT right now. I have an appointment w a massage therapist this week and hopefully it will be a weekly thing if I like him. I hope I can be disciplined enough to do the exercises on my own. I had been really good about doing abs every day but have been slacking lately. Work is busy and so is life!! My recovery has been anything but linear, and probably best describes as a staircase!

13 weeks

I saw my OS last week and he seemed fine with my (lack of) progress. He said he'd much rather I take things slow given my colorful history with my hip. At this point I have more trochanter pain than groin pain for the most part. He said that as my muscles get stronger, the forces on the joint will decrease and the groin pain will stop. He has said that before and I never quite understood until now. Right now my abductors and external rotators are very weak so my hip is always wanting to adduct and internally rotate, putting excessive strain in the joint and causing groin pain. The more I walk the more groin pain I have. Same for the trochanter pain, the more I walk the more it hurts. For the trochanter pain, he prescribed a topical cream that has an anti inflammatory, muscle relaxant, anesthetic, gabapentin and some other stuff. He thinks it will help with the trochanter pain. He also casually mentioned that some people need the screws out to get rid of the trochanter pain. Topical cream sounds like a much better solution!

11.5 weeks post op

I have spent the last 2 weeks on "vacation" and then recovering from vacation! I went w my family to Disney World, mostly because my kids really wanted to go, and L had told me over winter vacation, when we didn't go anywhere, that "it was the worst vacation ever". Sorry kid, I was 3 weeks postop and could barely get out of bed!

I rented a scooter and the trip went fine! Now that I am home I am playing catch up with work and life. 

I am still on 2 crutches but can do some walking in the house with 1. I still am very limited with walking with 1 and am feeling discouraged because the progress is super slow. I am also making a few more "public appearances" and am really sick of people saying "oh, you are still on crutches? How much longer do you have to use them?" I wish it was that simple and I could say "I have to use them until Monday and then I will be perfect". I wish I knew how much longer I would need them! I wish I didn't need them anymore!

There is no magic number of weeks on crutches, weeks of not driving, weeks of not working etc. Unless you have had this procedure (or any procedure) you won't get it. If you are an outsider looking in, don't ask "how much longer until...." We don't know. If we knew, we would tell you!

I have started driving more and spent quite a while in the car yesterday. I also ran my first errand. I went to one store and bought one thing. I have to start somewhere!

9 weeks post-op

I can't believe it has been 9 weeks since my surgery. Some days I am shocked at the lack of progress, others I can't believe how far I have come. At 9 weeks I occasionally go a day or 2 without narcotics, other days I need 1 or 2 Dilaudids to get me through the day. I am still in 2 crutches 95% of the time. Occasionally I can walk to the bathroom from my bed with one crutch. Some days even to and from the kitchen. Unfortunately I end up with a lot of groin pain when I do too much single crutch walking. 

My pain these days is mostly groin. Or at least it starts there. If it progresses the greater trochanter starts to hurt, then the entire incision, I have a "hole" from my last surgery at a scope site- that starts to get tender followed by all the muscles surrounding it. If things get really bad the nerve pain comes back. 

I play games and end up losing to pain- I wait and see if I "really" need narcotics and usually I do, and it gets to be too late to actually effectively control it with meds so I end up nauseous and in tears. There is no way a scope was anywhere near this tough bc there is no way I would have agreed to a second....or fourth. 

As far as functioning- I am still mostly home. I drive only if I absolutely have to, and only very, very short distances I have driven a total of 4 times since my surgery. Ice is my best friend, still. 

So, in summary, at 9 weeks post op, life is pretty crappy. I am going away this week to part of out trip will be Disney. Should be interesting. My kids and husband think it will be so fabulous since I will need a wheelchair so they will be able to skip lines. I'd rather stay home!

7 1/2 weeks post op

I saw my OS last week and he is very happy w my bone healing. He wants me to slowly wean off of crutches but not before 4 weeks. I have been having a tough time but the last few days seem to finally show me there is hope! I have actually gotten dressed (skirt and tights!) 2 days in a row for a few hours. The pain is less as well. I keep thinking of what a fellow hip friend told me- recovery is not linear! I keep reminding myself of that. 

My PT keeps telling me how strong I am and how mobile I am. Yes, I can get on and off the bed, on and off the floor, all around the kitchen. I guess you can say I am seasoned!!

I am so happy that things are turning around. I am going to drive tmrw morning. I've driven a teeny bit but it is painful. I have the added problem now that there is a bus strike in nyc so I am relying on friends to transport my kids. Z walks to school and my neighbor has been taking him but we are in the middle of a deep freeze and walking to school is just not an option. I will drive him the 2 blocks tmrw and hopefully the pain won't be too bad. It has been 7+ weeks and not driving is becoming a burden. 

6 week X-ray

It's been 6 weeks

I have been thinking about the past 6 weeks and boy have they been hard. I recently found these pics and was thinking that I haven't smiled like that since!

 

and a before and after shot of my feet!

5 1/2 weeks post op

Sigh! It's been 5 1/2 weeks, you would think that by now I could manage my pain effectively and cope with this situation. I really dislike having to take pain meds so I wind up in a mess of a situation some days. I try to avoid narcotics so I'll start to have pain, I'll try taking 3 extra strength Tylenols, sometimes it helps, sometimes it doesn't. What happens next is the pain will get worse and I'll start asking myself if I really need pain meds..... This will continue until I realize that I can barely walk and I have tears in my eyes from pain....and then I realize that I am being ridiculous about the meds. But because I let the pain get so out of control its hard to get it back under control. At 5 1/2 weeks postop I can say that now I have left the house 3 more times- once for Z's birthday party, once for a manicure and once for a quick lunch with a friend. Each outing is exhausting both physically and mentally. Additionally, the motivation to go out is not there. I look so worn out, I have no energy or desire to stand in the bathroom and put on makeup or do my hair. I haven't attempted to put on anything other than sweatpants or yoga pants for fear of anything touching my greater trochanter. If I am lying close to the edge of my bed and my kids sit next to me, it hurts if they touch my leg there. Needless to say I am still not driving. I keep saying "maybe next week". So at 51/2 weeks I don't spend the day in bed but I am home. I work from home which is a godsend. If I get busy and sit too long I get pretty bad pain. I try to rest ad ice during the day but it doesn't always happen. I am trying to be patient....

Op report #6 (open surgical dislocation)

The patient suffered from persistent right hip pain, sense of instability. She failed non-operative measures and had clinical, radiographic and diagnostic studies consistent w given pathology. Given the persistent pain, she was indicated for a revision allograft labral reconstruction, capsular repair and revision arthroplasty. Spinal epidural anesthesia was administered. She was placed in the lateral decubitus position. Right leg was prepped and draped in standard surgical fashion. A lateral portal was made down to the iliotibial band. A modified Gibson approach was performed and the gluteus Maximus was retracted posteriorly. The trochanteric flip osteotomy was then performed with a 15mm trochanteric wedge. The minimums was dissected off the anterior capsule and dissected anteriorly. A T- capaulotomy was then performed allowing for good visualization of the labrum. Hip was dislocated after ligamentum teres was cut. Labral reconstruction from prior semitendinosis allograft appeared to be well incorporated but was not providing a suction seal, probably due to the thin tissue quality. As a result, augmentation of the labral allograft reconstruction was performed. The edge of the acetabular rim was prepared and a total of six 1.4 mm anchors were placed and labral allograft reconstruction was performed with good anatomic restoration of the labrum. Dynamic arthroscopy was performed and demonstrated no evidence of any impingement in any direction at all. There was no subluxation of the joint. The iliopsoas was very tight so some additional bony decompression was performed with a psoas across the front of the femoral head to minimize any underlying pain that may have been related to the iliopsoas. Subsequent to this, the capsule was repaired anatomically and tightened to improve capsular stability as well. Trochanteric osteotomy was then prepared with three 3.5mm screws and the wound was copiously irrigated. Then the wound was closed in layered with 0 vicryl to close the fascia, 2-0 vicryl followed by running monocotyledons suture and steri strips. No drain was necessary as there was no bleeding. 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 without complications.

Muscles? What muscles?

I was getting dressed yesterday morning and was beyond shocked at what has become of my leg. Since children I have given up on the gym but I have always been muscular. I think atrophy would be too "light" of a word to use. My muscles have disappeared and been replaced with fat..... Or maybe jello. It's only been 3 weeks but my legs are un-identifiable to me. Will they ever return????

Post-op Appt

Post Op Appointment I went in to my first post op appt with one goal in mind- to discuss pain control. This week has been pretty bad and the Norco I have been taking just wasn't cutting it anymore. I had to go back and add in Percocet and I was taking a lot of pills. My OS was very pleased w my progress but not happy with my pain levels. He offered me Dilaudid which I felt was way to strong for me. He told me to try it since some people respond differently to different drugs. So I reluctantly accepted the prescription and had it filled immediately. I have to say it is my new wonder drug. As I write this it is 430pm, I took one pill at 7am followed by 2 Tyelnols at 11 and am having the best day I've had all week. I'm also taking Lyrica 3x/day and icing as needed. I definitely have some side effects from it, in the morning I felt a little woozy but nothing like the way I feel on Percocet. Functionally, nothing has changed. I still basically lay around all day. I can't drive and sitting is uncomfortable. I know that this is the norm but its a tough pill to swallow for me. My kids are off from school next week which will make for a very interesting week.

2 weeks Out From Open Surgical Dislocation

The last 2 weeks have been pretty rough and I'm not sure how prepared I was for this. I knew this surgery would be like no other but I must say the recovery has taken me by surprise. The pain is not horrific but I most certainly need my pain meds. The pain is mostly lateral, in the place where I imagine my leg was sawed and screwed back together! I have started to be able to sleep on my non-op side w pillows between my legs but the angle has to be "just right" or I start to feel a lot of pulling laterally. I spend the majority of my day in bed still. Over the last few days I have been able to tolerate sitting at the table for dinner. Everything is exhausting. I left the house for the first time on Friday for an acupuncture appointment. It is about a 2 min drive but I was worn out and paid for it the next day with increased pain and swelling. I have been using my CPM a few hours/day. I don't find it as helpful as I did after my last scope but I am using it. I am completely unable to care for my kids, luckily my mom is still here running he show. I have a toilet seat riser and a shower bench that are a must after this surgery. My incision has to stay dry until I see my OS so I cover it with tegaderm when I shower. I know my blog used to be a lot more detailed and I never held back info, I will try to provide all the info I wanted pre-op. You can always email me for more Info. One of the things that stressed me out pre-op was what to pack for the hospital. I'll give you a list of what I decided to pack and then I'll tell you what I used! Of course I was concerned about post-op underwear. I'm sure there are many people who found this blog post just by googling those words! I had 2 hip friends recommend 2 different things, one recommended men's boxers and one recommended Victoria's Secret string bikini as the band wouldn't touch the incision. I went w the string bikini and have been very happy w that choice. So I packed a few pairs of underwear and few pajama sets (pants and shirts), a robe, a sweatshirt, socks, bras, toothbrush, toothpaste, mouthwash, deodorant, dry shampoo, lip balm and hand cream. Additionally, a friend gave me a pre- surgery care package with sucking candies, a silk, flax seed filled eye pillow/ mask, and a few other toiletries. I also packed a loose pair of sweatpants to come home. I had no dressing on the incision by the time I came home but there was significant swelling. I wore nothing but a hospital gown the entire 4 days. Surgery was Monday, the catheter came out Wednesday. At that point I had no energy, or a care in the world. I started using a bedside commode that day and couldn't even imagine having to remove clothing. The first time I tried on my new underwear was when I got dressed to go home! I used my toothbrush and toothpaste (the hospital provided but I prefer my own), deodorant, lip balm(all day), hand lotion and sucking candies. I didn't touch the dry shampoo- the morning of my surgery I washed my hair twice and blowdried and flat ironed it hoping to get a long run out of it. It worked. I also recommend to anyone going into the hospital to get an eye mask. It made a huge difference. All the clothes I packed remained un-touched. I laugh now at how stressful the "packing situation" was when in the end all I needed were some comfy hospital gowns! I keep wondering when my leg will stop feeling "broken". Hopefully soon and hopefully I will be cleared for increased weight bearing soon!

Open Surgical Dislocation....Over

I had my open surgery 5 days ago. For the entire week prior to the surgery, I was a mess. I was constantly on the verge of a panic attack. The only reason I was able to finally calm down was because of my acupuncturist who is the most amazing woman I have ever met. If you live in the NYC/lower Westchester area I highly recommend you see her for just about any ailment. http://www.acupunctureforlifeny.com/ I see her for anxiety, which is directly related to this surgery. The Monday before my surgery I was feeling panicky so I stopped by her office so that she could put in tiny needles in my ear at points that help me control my anxiety. I felt so much better the next day. Maybe it is just a placebo affect but when I went for pre-op testing in Wed, I was expecting my blood pressure to be through the roof and it was normal. I couldn't believe it. I saw her for a full treatment Thursday and on Monday, the day of my surgery, it was still normal. My pre-op blood pressure is usually really really high! I was on the same floor that I have been for my previous 5 hip surgeries and my shoulder surgery. I was surprised they didn't have a sign that said "welcome back Susie"! I got my favorite nurse who in the past has been a goddess getting my IV started. Unfortunately this time my veins weren't cooperating and it took 3 times to start my IV. The other difference was that I had to put on TED stockings prior to the surgery to help w my circulation. The surgery was done using a spinal epidural and sedation with the anesthesiologist maintaining low blood pressure to prevent too much blood loss. I was brought to the OR around 430 or 5. The next thing I remember was waking up in horrific pain, probably the worst pain I have ever experienced in my life. I was so nervous about this happening and I had a long discussion abt it w the anesthesiologist and with my surgeon's PA. The floor I had surgery on is where mostly the arthroscopic surgeries happen. The bigger surgeries happen on another floor. I was afraid the PACU wouldn't be able to handle me! It took 2 hours and whole lot of dilaudid to get me comfortable. Once I could think I realized that the epidural had worn off on the right (op side) and not the left. Not good! I had a pain pump w Dilaudid in it so they kept telling me to press the button on it. I don't think it helped too much though. At around midnight they moved me to the PACU on the floor where they do the "real" surgeries and I spent most of the night there. The nurses was great and let J stay with me since there was only one other patient in there. I began to feel very itchy from the meds so she gave me some Benadryl in my IV. I had a strange reaction and began to cough. We didnt think much of it and it worked so quickly I just fell asleep. By around 5am I could move my legs an acceptable amount and was transferred to a room. I was comfortable and in no pain as long as I didn't move. I had a urinary catheter and an epidural still in place. The pain pump went right to the epidural and the catheter was a blessing in disguise because there was no way in hell I was getting out of bed to use the bathroom. I was getting meds round the clock, I don't know why I was getting some of them but I was too out of it to question or argue. I was getting iron, a multi vitamin, aspirin, Percocet, toradol in my IV, Zofran in my IV and Nubain in my IV for itching since I had a weird reaction a second time to the IV Benadryl. As far as the surgery went, I have spoken w my OS a few times but need to get the op report to know exactly what he did. From what I understand, the old allograft had actually incorporated nicely but wasn't functioning at all. It was pretty easy to dislocate my hip. Once he put in the new one it created a good seal that could be seen since it was an open surgery. I think he also said he shaved down bone under my psoas but I will have to confirm this when I am less drugged. The epidural and catheter came out on the 3rd day and I began using a bedside commode since I wasn't doing great in PT. I think I got as far as sitting at the edge of the bed and standing on the second day. The 3rd day I took a few steps and made it from one side of he bed to he other. By day 4 I was feeling a lot better and really wanted to go home. I pushed myself in PT and walked far enough to make them happy and did a few steps. The best part of coming home was taking a shower. I got to use my fancy shower bench and I have to keep the incision dry until my OS can check it, but it was a real shower! My incision is closed with dissolvable sutures and steri strips. Since I've been home I have spent most of the time in bed with my CPM. I have to take aspirin and wear TED stockings to prevent blood clots.

Post-op

Cleared For Surgery

I am officially cleared for my open surgical dislocation on Monday  I saw my OS yesterday, had pre-admission testing and medical clearance. I am good to go.

I was already pretty familiar with the procedure thanks to 6 years of dealing with my hip and google :-). A few things I had questions about he clarified though. The old allograft will come out completely with all the anchors and a new one will replace it. The old one is a semitendinosous tendon, the new one will probably be a post. tib tendon, they tend to fray less. The restrictions will be no active abduction or passive adduction. The flexion restriction will be determined in the OR based on when the labrum engages. Additionally, the capsule will hopefully be able to be reconstructed with my own tissue. The advantage of the open procedure is that the surgeon can actually feel the tissue rather than just see it with the scope. If it is of adequate quality it will be used to do a good, open reconstruction. If necessary, there will be a synthetic material on hand to support it.
I will have 6 weeks of protective weight bearing and no driving for about that long as well. 2-3 nights in the hospital, CPM, no brace.

I think that covers everything! Wish me luck.

Open Surgery Scheduled

December 3rd.....details to follow

MRI #10

History: right hip pain. Clinical concern for instability. Status post multiple arthroscopic procedures including labral repair and debridements of the ligamentum teres.

Findings:
Comparison is made to MRI of the right hip dated 5/8/12
MRI of the right hip was performed utilizing large field of view coronal fast inversion recovery and axial fast spin echo, as well as surface coil coronal, sagittal, and oblique axial fast spin echo techniques.
There is no acute fracture or osteonecrosis.
Surface coil images of the right hip demonstrates Osseous debridement of the anterior femoral neck junction, unchanged when compared to last MRI. There has been rim debridement of the labrum with superimposed labra repair. The labral remnant is blunted and degenerated. There is erosion around a fixation device located in the anterior superior acetabulum, which demonstrates slightly more prominent bony erosion when compared to the prior exam. The iliofemoral ligament is hyper intense and deficient, particularly at the anterior margin of the joint. The ligamentum teres is markedly attenuated. This constellation of findings is consistent with features of micro instability of the hip.

There is borderline coxa valga. There is moderate wear of cartilage over the subfoveal anterior margin of the head and anterior wall, unchanged since 5/8. There is also high signal within the cartilage overlying the posteromedial femoral head, with partial thickness chondral loss, and additional cartilage loss laterally in the area of debrident. There is no extensive bone on bone contact or bulky synovitis.

The short external rotators are preserved, as is the posterior footprint of the gluteus medius. There is degeneration of the anterolateral footprint of the gluteus minimums insertion, without tear. There is mild insertional tendinosis of the iliopsoas without tear. There is no iliopsoas or ischial bursitis. The previously noted fluid within the greater trochanteric bursa has resolved.

The hamstring origins are symmetric. The pubic symphysis is preserved a are the abductor origins. Fat planes surrounding the sciatic nerves are preserved. The femoral neuro vascular bundles are maintained.

Impression:
MRI of the right hip status post Ossetia debridement of the anterior femoral head neck junction and labral repair demonstrates findings compatible with micro instability of the hip deficiency of both the anterior margin of the iliofemoral ligament as well as the ligamentum teres.
Ossetia resorption surrounding a fixation device in the anterior superior acetabulum has progressed since the prior exam.
There is moderate cartilage wear, preferentially affecting the femoral head.

MRI results and discussion with my OS

I got my MRI results on Thursday and was not too happy. (I will post the report later). In short, my labrum is degenerated, one of the anchors holding it in is not really holding, I have evidence of micro instability and have cartilage damage that has progressed since my MRI in may. I was freaking out all day Thursday, I couldn't believe the changes in the MRI in just 4 months and that I was unstable again. I sent my OS an urgent email that I NEEDED to speak with him. I knew he was going to the hip meeting the next day but I was so freaked out I didn't know what to do. 

He called me the next night and went over the MRI with me. The labral allograft clearly wasn't working and my ligamentum teres was once again all stretched out. He had discussed my MRI with second opinion OS but wasn't actually able to look at it with him bc of computer issues. He would do that the next day and go over it with other colleagues he trusts. 

He feels terrible and says I am the victim of a learning process that has gone on in the field of hip arthroscopy, he said had I come to him just a few months later I would probably not have gone through all of this. His reasoning for the last scope failing was that possibly the fluid medium during the scope affected the allograft, scopes are done with fluid in the joint to help with visualization. 

What we both agree on is that I will not have another scope to fix this. The only way to do it now is with an open surgical dislocation so he can have full access to the joint, full view, do a very very thorough assessment, a high quality labral reconstruction and a full capsule repair. 

I have been thinking about open surgery for the last few weeks so I was well prepared for this conversation, held it together and was in complete agreement. 

My OS is supposed to call me back after reviewing the new MRI at the conference and I guess we need to discuss details and timing etc. 

As far as timing goes- it couldn't be worse, I just started my own practice and don't know exactly how I will take so much time off. I guess things have always worked out in the past so they should work out this time too. I just want to close this chapter in my life and move on. 

And the Saga Continues.....

As "luck" would have it, my last injection was of no help to me and things seem to have taken a turn for the worse. Standing is painful which is not good given what I do for a living. The pain has just gotten to a point some days that it is now unbearable. I sent my OS an email to let him know and hoping he would let me know he had spoken to the second opinion OS. He responded that he had been emailing back and forth but hadn't yet spoken to him but will soon and will let me know. A few days later he must have changed his mind because he decided that since my pain had gotten so bad after the last injection, we should move up my next MRI to now, and to do it before the IHSA conference this week where all the top hip scope surgeons will be, so that he could review the scan with colleagues as well as second opinion OS.

So today is MRI #10......my valium is packed and I'm ready to go. I don't know what the best and worse case scenarios are for this but I guess all I want are answers. I asked him what specifically he is looking for, he said "integration of the labral allograft"...not sure what he plans on doing if it isn't "integrated"....

Another second opinion

I had a phone consult last night with another OS. He is "sure" that I have a delamination defect of the cartilage of the acetabulum. (I will put in an article abt it). He sounded pretty certain abt it, he said he sees it a lot in ppl with continued pain after hip scopes. I asked him why my current OS wouldn't see this, he said "you have to know to look for it". He also thinks my new labrum is not functioning and not providing a suction seal. He would like to go in and repair the delamination defect by microfracturing under it and anchoring it down and removing the new labrum and re-creating it again (I think). I clearly am not to happy with this, a 5th surgery? Seriously? I asked him if he thought this could wait, he said if I was within a comfortable pain zone yes but if I was in a lot of pain no bc it meant I was doing more damage. Well, let me tell you something, I don't reach out across the country for second opinions if I am not in a lot of pain.
He also suggested I not have surgery with the same OS again, or, if I chose to, to make sure that he spoke with him. I didn't like that surgery was the only option, I don't think he did either, he kept saying how bad he felt for me. To be honest, I don't need anyone to feel bad for me, I always say there are no "feelings" in orthopedics, just go in and fix it!!
I was clearly not about to hop on a plane and let him operate on me based on a phone conversation, and a diagnosis that he can't prove or see but feels strongly about. So I asked him if he'd be willing to speak to my OS and discuss this with him, bc really, no one knows what the inside of my hip looks like other than him, he's seen it 4 times. He said he'd be happy to so hopefully they will speak in the next few weeks. I did warn my OS to expect a phone call from him, and he said he'd lookout for it and let me know once they spoke. So once I know what is going I will report back!

http://hiparthroscopy.net/pdf/publications_lectures/Arthroscopic_Treatment_for_Chondral_Lesions_of_the_Hip_T_G_Sampson.pdf

Family Update

Its been a while since I posted pics here and we recently had a really fun photo shoot in the park! When I started my blog, L was 2, Jk was 1 and Zk wasn't around yet! Now L is 8, Jk is 6 and Zk is 3. And I am no longer 26!!!

8.5 month follow up visit with OS

I saw my OS yesterday for a follow up visit and to discuss"what next????" He showed me my CT scan as he  ran it through his surgical planing software and showed me that no where is there any angle that is not normal, all the coverage angles, center edge angle, version etc is all within normal limits. The left, which is still pain free after 5+ years does not look as perfect, he actually said that if my left were bothering me he would be able to find places to take down bone...no thank you! The only possibility that he sort of brushed over is that my new offset on the right may be too much FOR ME, but obviously you can't put bone back and there is now way to know for sure.
I asked him to check my capsule again on the last MRI- he thought it looked ok, but its hard to really see if it actually stretched out or not but it is not torn. He would like to wait 3 more months and possibly get an MRA since injecting gadolinium will stretch the capsule and then he would be able to really get a god look at it, he also wanted to re-image the graft at that point since it was still immature at the last scan. He also wants an MRI of my left just to compare. He is hesitant to go with the MRA because he is pretty certain it will be very painful for me since I have a lot of irritation in the joint and the gadolinium is acidic, I said I'd rather just do it, than have a regular MRI and then find out we need another one. I guess I have a higher pain tolerance than a claustrophobia tolerance.
We spoke about the 'what ifs' and later on the 'whys'. If the capsule is indeed very stretched out...again, he would want to do an open procedure to support it with a mesh scaffold. The why is not known- possibly a collagen issue that is aggravated by the surgeries...the only way to know is to go see a geneticist who specializes in these things. I think its pointless since it won't change the course of treatment or outcome.
I told him I need a quick fix now- I have so much pain some days it makes life very very hard, and I can say that in the last few weeks there have been more than several times that I felt like I was going to lose it, including in his office yesterday. I asked if he'd let me get another cortisone injection. He agreed but said to add Orthovisc to the mix to lubricate the joint. Fine. I was able to have it done yesterday, this time it was ultrasound guided- all my other ones have been fluro guided. I have to say this was soooo much better, I was in and out in 15 minutes.
After the injection I had the "full" feeling in the joint and nerve pain down my leg, I was reminded by a fellow hip friend that the same thing happened last time and she referred me back to my blog for verification!!! I am hoping I get some long term relief from this. We think the issue is that the capsule is too loose and the joint is unstable and sliding around, causing inflammation and pain, so an injection is obviously a bandaid since it will take care of the inflammation and pain but not the capsule.
We discussed the possibility of another PRP injection, this time to the capsule, we ended up agreeing that it wasn't worth it at this time.
On the issue of my son, his bone scan was normal. If he continues to complain we will get an ultrasound to look for inflammation!

8 months post op

I once again apologize for neglecting my readers for so long. My practice is taking up a lot of my time but in a good way. I am incredibly busy, working hard and seeing a lot of patients. 
On he hip  side of things, my cortisone injection has worn off completely and I am back in a lot of pain. Mostly posterior joint pain. I have looked into several things as well as other opinions. One person posted on my blog abt a year ago regarding the possibility of bone growth in the back of the joint. I have been bugging my OS abt that. I have also sent my scans out for a second opinion, hopefully I will hear something by the end of the week. I also see my OS in 1 1/2 weeks. 
In other things hip related, my 6 year old started complaining of hip pain about a month ago. He was limping and complaining of groin pain. I obviously freaked out and wasted no time getting him an appt with a pediatric hip specialist. Initially he diagnosed him with toxic synovitis, which is when a virus settles into the hip joint and causes inflammation. 3 weeks later the pain was still there and now a line showed on his X-ray, right on the femur. The OS wants him to have a bone scan to see what is going on and then will decide if he needs an MRI. Never a dull moment in my home!

Acupuncture for Hip Pain

Since I was having such great success in acupuncture for anxiety, I decided to give it a shot for hip pain. My acupuncturist was willing to try it and I have such great faith and trust in her I went along with it. I don't know if I have expressed this on my blog but at this point I don't let ANYONE touch my hip, manipulate my hip, massage my hip, stretch my hip...you get the picture. I think I have been through 7 PTs to date and I clearly have trust issues at this point.
My acupuncturist started by feeling all the muscles surrounding my hip joint, noting that every single one was tight, tender and full of trigger points.The worst offender was my QL, which has been worked on by many PTs before only to lead to more problems. I knew this, but still, I let her try to treat me, I figured this was a different type of treatment.
At the first session, she needled all the tight and tender muscles in my hip and back. It completely de-stablized my hip and made my pain worse for days. My muscles are tight for a reason, and working on them is not helpful to my hip joint as they need to stabilize an underlying unstable joint.
The next time I told her what happened so she stayed away from the majority of the hip muscles but worked on the QL. When she removed the needles she said the area was very red meaning it had increased blood flow, or something like that :-) So she put in more needles (the kind that stay in all week) into the QL to maintain the bloodflow. Again, this completely destabilized me this time causing thoracic pain too.
So what is the solution? I have no idea. I just sent my OS an email asking him to re-review my CT scan and x-rays and figure out what the problem is!!!!

6+ Months Post-OP

Wow, I have really neglected my readers so I sincerely apologize. Luckily, I have been extremely busy with my new practice and some days barely have time to breathe. As I previously wrote, I was having a period of intense anxiety with real, physical manifestations including heart palpitations and occasional high blood pressure. I have been able to almost completely control this with acupuncture treatments. It is such a wonderful feeling to feel like I am back in control of my own body. The first time I went, I was lying on the table and could feel my body relaxing, as I completely relaxed, pain crept back into my hip. As the anxiety has gotten under control, and as I have increased the number of hours I work, the pain in my hip has returned. If I had to choose anxiety or hip pain, I would choose hip pain any day.

I actually spoke with my OS last night and the only way I could explain it to him is that "my hip doesn't fit me right, it is still feeling too 'loose' ". He is at a complete loss and his only suggestion is to try PRP or prolotherapy into the capsule and hope it scars down. I am not doing anything at the moment, I have way too much going on with work, I am extremely overwhelmed with the responsibility and time it takes to make a new  practice successful...but I am loving it!! The PRP in my hamstring was a smashing success but I had 2 weeks of really bad pain, I really can't afford the downtime right now. I am scheduled to see him in 2 months, at that point I will re-evaluate the situation and if I am still in pain, possibly consider the injection. The cortisone was great while it lasted but I can't get another one yet, and its probably not a great idea if I want to preserve my hip in any way shape or form.

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.