The Start of Something Great

Yesterday was my 3 month follow-up with Dr. Kelly. For the first time ever, I left happy, satisfied, elated, thrilled...... We actually didn't discuss another surgery. I have never left his office without having a sinking feeling that this disaster was not ending. I think I had a smile on my face for the rest of the day. I know in the past I have said I was really happy and this is over, but this office visit gave me closure! We barely even discussed my hip, I told him it was great, and I am REALLY happy! Really really really happy!

The visit was even more fun bc I had entertainment! I brought L along, since she is OBSESSED with bones, as well as Amy, who had an earlier appointment and ended up hanging out with us. L really wanted to see x-rays, and she has been talking about seeing them and meeting Dr. Kelly for a while. She is such a funny kid. She even got to leave school early for it. But when the 3 of us got into a room, she became timid, and when he came in the room, she buried her head in my lap and wouldn't look up!

He was excited to show her x-rays, he was even going to get her some MRI's if she wanted to!

He started by showing us my scope pics, especially my "intact" (and absolutely beautiful and perfect) psoas. Lots and lots of shots of my psoas, (for the lawyers, of course, he joked). He told me I was very scary when I "threatened" him during out psoas conversations and the pre-cursor to the psoas conversation. He let L have a sheet of scope pics! She was still buried in my leg but when we got home she was so excited to show J and Jk.

He checked my hips, and found the right to have more ROM (right was scoped 2x), he said it was because he had taken down a lot more bone in the right. I think this explains why I was having a lot of muscular issues there. I now have the ability to move more, but my muscles needed to be retrained in this new range. Kind of like what happened during my continuing ed course.

Of course the conversation turned to football (I will let Amy tell you about that part of the visit as well as the rest of the day, plus the best pic of the day)

But...he kept saying "she was right, she was right", (meaning, there was bony impingement in my hip the whole time) see, I knew I was not making this up August-November. And to think of all the times I nearly lost it during those months!
So things went super, I asked if he wanted to see me again....he laughed! I need an x-ray at 1 year out, I can handle that!!

As I was finishing up with the receptionist, he came back out and told me to come back and bring my chart. He had the Chief Resident there, he took out my scope pics and said "this is why you need to listen to your patients"!!

What My Readers Symptoms of FAI or Labral Tear Were

Ok, so this is not a scholarly peer reviwed journal or anything, but I have found it helpful to know what other people have experienced, and I assume you do too, or you wouldn't be reading this. In the past, I have polled my readers to find out what their symptoms of FAI and or labral tear were, here is what they have shared. Feel free to add your own in the comments section, or email them to me and I can edit this post.
Here were my pre-op symptoms: Groin pain, deep deep groin pain, not always excruciating, but so annoying I felt like cutting off my leg, tight hip flexors, pain with sitting, pain with walking uphill, pain with pushing my stroller. I did not have radiating pain down my legs, all the hip pain was anterior medial.
This is what my readers had to say:
-At original onset of pain, I had acute, sharp pain along with a deeper pain in the anterior (non-PT term - front) hip. Once the acute pain subsided, I was left with a persistent but not 100% constant deep ache (only way I can describe it is comprable to early labor pains, or really bad menstrual cramps, or, in other words, not bad enough to put me in bed, but bad enough to ruin my day - but deep in my hip joint) along with the occasional "catching" of my hip. I would be walking and suddenly it would pinch and hurt too much to walk normally. I would usually stretch or range my hip and that would sometimes work. Otherwise I'd just have to wait it out, and later that day, the ache would be particularly bad. Now (3 + years post op) I'm at the achy stage, with occasional catching and occasional pain that is bad enough to keep me from sleeping, ie: can't find comfortable position, even with pillow between legs, must get up and take 600-800 mg Advil and wait. Those have been my symptoms to date. Hope this helps. I am eager to read about other people's symptoms - knowledge is power. (This reader had a scope a few years ago for a labral tear, her symptoms came back, she ended up being diagnosed with FAI and had an open surgery to address it)

-Clicking, catching (especially when changing direction when walking or getting in and out of car), deep aching. Now post op (scope with labral debridement of fibrillated labral tear) and still have aching (especially with sitting for long periods), nerve pain in thigh and butt, episodes of the hip giving way (though less frequent now). Pain is better with rest and worse with increased activity. Am now six months post op. Wish I had just broke it lol

-My symptoms started with groin pain, which seemed both deep and also superficial, and sometimes radiated up to my lower right pelvic/abdominal area. After awhile, I developed pain over my greater trochanter and in my piriformis muscle. Before my first scope I had SI joint discomfort as well, and also IT band tightness and soreness down my thigh to my knee. At first my pain was intermittent, but over time it became constant; it would get better or worse, but there was always a baseline amount of pain. Driving was horrible. Groin pain was always the worst symptom. Yuck!

My 1 Year Anniversary

Today marks the 1 year anniversary of when my hip saga began. For anyone just beginning their journey, I can assure you that in the hands of the right surgeon, there is a light at the end of the tunnel. I am going to do a flashback to November 28, 2006.

Shit, my hip hurts. It hurts when I drive, and especially when I push the kids in the double stroller. It is a really annoying pain. It feels like something is in my joint. My friend/ PT is coming into work around 3, I will ask her to work on it and hopefully get some relief. She showed up and I told her I was dying of pain, she did a painful release on my iliacus/psoas, I felt better immediately, but in the car on my way home, things got bad again.

I went into work the next day, again, in agony. First I had one therapist stretch my hip flexors and ITB, thinking this may help. Then I had another one check it out. She said there is definitely some kind of impingement. Then I asked P for help. He was really busy so I waited until he was done seeing patients. What makes the day so memorable is that it was Jk's 1st birthday, and I was having a small dinner party, and lacking a few key ingredients. I used P's full schedule to run to the supermarket near my office but didn't find what I was looking for (which I now don't even remember what it was). P did all kinds of releases, ART, mulligan mobs...It felt good...until I was in my car again. Shit. What is this????

I got home, L had ballet and there was no food for my party! I ended up ordering pizza, Jk didn't know the difference! After we had cleaned up and the kids were in bed, I hit the computer. I had a feeling I had a labral tear, and the word impingement reverberated through my head. I think I first looked for a surgeon, before I did anything else, that is me, always thinking ahead! I was trying to remember when I had seen a hipscope, and who did them, and no one was popping into my head. At the time, there was a hipscope patient in my office and she was a wealth of information, but I wasn't willing to see her surgeon (he was in NJ), I knew it had to be someone at HSS. So I looked and searched, and researched labral tears, FAI.....Not just that night, but every night after that for weeks. After a week or 2, I decided this wasn't getting and made an appointment with Dr.Kelly. I was between him and another surgeon. I had emailed a professor of mine about this and he had recommended against the other surgeon for personal reasons. So Dr.Kelly it was. If things didn't go well, then I would pursue other options, it was just a consult, right. Hopefully he would order an MRI and get to the bottom of this. The rest is history....but in a nutshell...

3/5/07 R hip arthroscopy, Pincer impingement, labral tear debridement, synovectomy
7/2/07 L hip arthroscopy, Cam and Pincer impingement, labral tear debridement, synovectomy
11/12/07 R hip revision arthroscopy, Cam impingement, removal of scar tissue, synovectomy, upon examination, found to have beautiful psoas

11/28/07 Riding high on life (bc everything else makes me sick) and enjoying a painfree lifestyle, looking forward to ditching my single crutch very very soon! :-)

Details, Details,Details

I am in bed, took a Percocet about an hour ago. No one else is up in my house yet so there is no point in geting out of bed.
I had to be at HSS at 5:45AM. I had already filled out the majority of the paperwork last week, so I waited. In the meantime, I met the people from the magazine who were doing the photoshoot. They didn't call me in until after 6:30. I had to take a pregnancy test (negative, phew), and put on one of their cool hospital gowns with the heater attachment, and the 'hip scope breakaway' shorts! The camera crew came in to take some pre-op pictures. The PA came to do his mini pre-op physical around 7, 7:15. J was still in the waiting room. I was getting nervous bc in the past, everything has been done by 7, but hey, it wasn't like they were going to start surgery without me, right!
Next came the woman who washes the surgical body part, so she washed my hip. Then J was allowed to come in and we hung out for a bit.

Anesthesia came next. It was not Dr. Jules, the one I had requested. But I remember Dr. Kelly reminding me that all the anesthesiologists are great, so I was ok.He asked if I had had issues with anesthesia in the past. I explained that when I had a spinal with scope #1, it took me a long time to recover, so scope #2 was done with a combined spinal epidural, much better. So he said he would plan on that.
The nurse was next, almost 7:45, we were running out of time. She had to go over my medical history again, then start the IV. She wanted my to lay down, I assured her I wouldn't pass out, but she insisted.

While she was doing her thing, Dr. Kelly showed up to 'sign' my hip. I asked him to please write 'do not release psoas', in case he forgot! He said he would remember, and wanted to know if I was going to have the psoas police in the OR!! He even showed me the consent form, he said 'look, it is not even on here', so I said 'good, bc I don't consent'. I asked if I am his biggest pain in the ass patient, he said not even close, I just know too much. I didn't have a response bc just at that second, the nurse inserted the IV needle which silenced me! He said he was just going to go in and remove scar tissue, adesions and obviously the cam bump. Ok, fine,I could deal with that.

The OR nurse came next.She looked at my hip brace and asked where the rest of it was? Huh, thats all I have. What about the posts and pillow?Huh?? That's all they gave me. So off she went, super annoyed, to find whatever it was that was missing (I still am not sure). she came back to bring me to the OR, 'we are 5 minutes behind' she said. I left J, and we went to the OR. We passed someone who was looking for whatever it is she was missing.He said 'I told Dr. Kelly', to which she got clearly annoyed and said 'don't tell Dr. Kelly'. I assume they found it bc we proceeded into the OR. The camera crew was in there with someone showing them all the scope tools, I was trying to get a glimpse, but they needed to get the anesthesia going. I was laying on the table and the anesthesiologist gave me something to relax me, and asked if I could sit up,I told him I didn't want to feel the needle go in, he told me he would make my skin numb, and then I was out!
Part 2 to follow after coffee!

Warning....Complaining to Follow

My hip really hurts today. And for the past few days...a lot. I am completely back to pre-op/ pre-injection pain levels, when you feel like you just want to hack off your leg. Granted, I have done a lot of walking the past few days, but just walking, no running, no jumping, no cycling.....just plain old walking.
Just wanted to get that off my chest.

My Schizophrenic Hip, or is it?

I have been laying low over the past few days, and left the posting to Amy (thanks again), and have been doing some self reflection and deep thinking. Ok, as much as I can with 2 rugrats tugging at each ankle, but maybe a little thinking.

See, my hip pain is intermittent, sometimes it can be fine for 2-3 days, sometimes the pain can bring me to tears, which is why I call it schizophrenic. So on the good days, I decided to let it take its course, and not have a revision, if it comes to that, but then on bad days, I want to call Dr. Kelly and beg him to do it that minute. And then one of the kids needs me, and I don't call him!!!
So you can see how this would drive one (more) insane, and then throw in the sexy shoe dilema, and you have a big problem on your hands.

By Sunday, I was not having a revision, regardless of anything. By Sunday afternoon, I had spoken to a woman at the pool who had just been resurfaced 6 weeks previously. She has had bilateral hip pain for over 10 years and has not wanted to deal with it. I spoke to her about my progress and PT, we compared notes (btw- she is soooooo happy with her resurfacing, but she was bone on bone). As we were finishing our conversation, she said if there is one piece of advice I can give you, it would be to take care of anything that needs 'taking care of'' now, rather than later. Your kids are still young, I feel like I missed out on the last 10 years of my kids lives because of this.

She left me with a lot on my mind, and I understand where she is coming from, but on the other hand, I do everything, I push through the pain when I have to, but will I always be able to? I also am not 100% sure of the results on my left side. It is great, don't get me wrong, and better than my right currently, but I need more time to see what my results will ultimately be. (I will give a good detailed update later in the week)

Whenever I start thinking, my mind goes racing at a million miles per hour, and it ended up thinking about microfracture. Would I want that on the right, since there is a focal area of bone on bone? I don't think I can handle the recovery from that, but maybe the long term benefits outweigh the 6 awful weeks? But that is so ahead of where I need to be thinking right now, but I do anyway. I need to focus on the 'now', and the next step is to call Ariana this week. I put it off today since I didn't feel like dealing with it, I will try to deal with it tomorrow!

At this point, I want a gameplan, I don't want to have to follow through with anything yet, but I want a plan, so I can plan my life and know what is in store, I don't want to be living in limbo, the way I feel I am right now.

In an unrelated topic, I am having a ridiculous allergic reaction, I am pretty sure it is not from the injection last week, but I have been so itchy, and full of hives, my skin is so sensitive that if I lightly touch it, I develop a red streak on that area. I am still in the investigation process, has anyone had a reaction like this from an injection? Or anything else?

Thats what friends are for....

As I have previously mentioned, I got together this week with my 'hip friend' Amy, who has had her left hip scoped twice by Dr. Kelly and will be having her IT band released in the next few weeks/ months. I asked her to write a guest blog post.

Susie asked me to write a guest spot for her blog.... Hmmmm.. what to say?!?! I met Susie as a result of posts on the labralicious and FAI listserves. We had been talking as she had decided to see Dr. Kelly and I had experienced surgery with him. We talked quite a bit on-line and by phone. When I flew up to NYC on March 21st, the day before my surgery, we decided to meet. Needless to say, we clicked. My ride home to my friend's apartment in the city fell through because of complications with getting my surgery started, and Susie came to my rescue just two weeks after her own surgery. She drove in to New York Presby to pick me up and take me to my friend's place. Of course, meeting her two adorable kids in the car on the way home from the hospital sealed the deal!! We are forever "joined at the hip!" On my next trip up, we met and went to the Central Park Zoo together. I had a blast with Susie and her kids and it was a welcome afternoon of fun for both of us. Being able to jump in puddles with L and JK was the highlight of my day!! As a result of meeting on the listserves, we have become friends with this horrible hip problem in common. We have been through each other's ups and downs and frustrations. .... and the "emotionally unstable:" e-mail subject line on multiple occasions. It is wonderful to have the support of someone who is going through the same thing... and with the same doctor. It also doesn't hurt that she is a PT either, and I have picked her brain on multiple occasions!!! This last trip up was just as much fun as it was frustrating... I flew in to NYC on Tuesday afternoon and met up with Susie and the kids. We went to the swimming pool and chilled out for a while. I had a blast taking pictures of all of the kids at the pool, and it has cemented my feeling that maybe I should consider getting back into photography for a living... That evening, we went to see Xanadu with my best friend, Marni. The three of us had a blast at the show, but looked like the walking wounded headed away from the theater! But, for that 90 minutes that the show was on (with us seated on the stage), we were feeling no pain! Well, except for when one of the cast members hit me on the head with a rubber mallet! The frustrating part was the visit to Dr. Kelly. I hate waiting in doctor's offices. It seems like you wait for hours and then get to see the doctor for a few minutes. I think that Dr. Kelly really didn't want to deal with me, because Susie's appointment was 20 minutes after mine and he saw her before me!! He agreed that I need to have my IT Band released but that it should be done back home in Pittsburgh by Dr. Gruen as an open surgery because he has never done an IT Band as messed up as mine with a scope. At least he admitted to is limitations. That is a big thing for a surgeon. As you have already read in Susie's blog, he admitted to missing part of her impingement in the original surgery. We are in the same boat there, as he did not address impingement in my first surgery either. It is a very frustrating thing to deal with to say the least. I did have the opportunity to strangle him playfully when he mentioned our last "argument' over the phone and I was telling him that both of my hips hurt now!! So, for all of you who have wanted to strangle your doctor (Kelly or other) I did it for you too!! I had a happy mood swing that afternoon when I took L to Wave Hill for a "supermodel photo shoot." We had so much fun, and L posed beautifully for me. Her Mom never gets pictures like that... always the "cheese" face, never the cute stuff!! It ended too soon as I had to catch a flight home. It truly amazes me how friendships can develop out of adversity. Heck, I even told Susie that if she has to have another surgery and her Mom gets sick of being there I would come up and help her out. (Provided I am on my own two feet at the time.) After all, That's what friends are for!

The Appointment

Ahhh, the dreaded/ anticipated appointment. I went with my friend Amy, also a two timing hipster, so I had someone to hang out with in the waiting room. I met a blog reader (Lakewood) who said "Susie, as in Susie711?" It was nice to see there are actually real people who are reading this that I can meet!! I didn't catch your name though, but I hope your appt went well, if you have any more questions feel free to email me suzq613 @ aol . com (take out spaces).
So, I waited about an hour. Dr. Kelly came in with Arianna, we discussed the injection, and what happened with the right hip and what is going on with it now. He quickly checked my ROM, nothing else really, and said he is not really sure of what is going on. I mentioned that I had gone over the radiology reports and noticed that there is cam impingement in that hip (thanks Rachel), he sighed and said "I know" in a concerned tone. Then he sat down. Let's see what happens with the injection, if it is an inflammatory reaction, then the cortisone from yesterday should take care of it, call us in 2 weeks and we can talk about it. He also said that when he was in the joint with the scope, he didn't think the labrum had torn from the cam, since the lesion didn't look 'peeled back', it looked to be consistent with the pincer impingement, that's why he left it. Then he looked at me and said "you don't look too convinced", I said no, I'm not, I have always had residual pinching, even from the very beginning, with the second surgery, I had great ROM from the very beginning, so looking back, something has been not right with the right. I have pain with flexion, IR and adduction, so no, I am not convinced that this is inflammatory. So he said, sometimes, he does need to go back in a second time to correct more impingement, this did not make me at all happy. Then he said, you know what, call early next week instead of in 2 weeks so we can figure this out and figure out what the next step is. So this is where I stand, no concrete answers yet, but the possibility of a third surgery looms.

All in a Day's work

I made it. I am exhausted. But I did it!! Yay!!! I feel so accomplished. Did it hurt? Yes, but it was sooooo worth it!! I am back to work! Luckily, I had a light schedule today. There were a few "issues" involving my work performance, that I had not anticipated. First, I was working with a lady who preferred to be on a low table, so in order to stretch her, I was kneeling, sitting back on my heels, I suddenly developed that deep, gnawing groin pain, and had to find another position to work in. The other issue came from left field. I work in an outpatient orthopaedics facility, with mostly surgical and orthopaedic conditions. We also have a pool. I had a new patient, wheelchair bound, who wanted to use the pool, and needed to be transferred from her wheelchair to the table. This almost never happens, my patients are usually higher level functioning. There was no way in hell I could pull this off, probably even on a good day!!! After some discussion and shuffling, I got the situation under control!!!

Besides for that, everything was going pretty well, until my SI joint decided to give me trouble. Yes, again, when it rains it pours. Interestingly, my dysfunction was a posterior inominate on the right, normally, I get an anterior inominate, I assume it is from the hip flexors tightening up and pulling it forwards. Today it was posterior. P hypothesized that maybe it went that way bc the hip flexors are weak? I muscle tested a 4,4+/5 on that side.....so who knows. He corrected it with a MET, he said I was "stuck" on that side. He also released (sigh, again) my iliacus and psoas, which REALLY hurt. I stood up and felt great, walked to my computer, sat down, and had groin pain (sigh). I am beyond frustarted at this point, I don't even know what to think anymore.

The rest of the day was uneventful,, the kiddies slept late, until almost 5:00, so we did not do anything this afternoon, other than a short trip around the block, L on her bike and Jk in the stroller. What a sight it was, since L is not great at riding, me pulling her with one hand and pushing Jk with the other! As I sit here and blog, my hip pain is back with a veangence, and just in time for my Target excursion!!

If you have gotten this far in my post, I want to try something. One of the hardest things I found when my hip journey began was finding a list of symptoms correlated to a labral tear and FAI. If you would like to help, I want to compile a list of people's sympotms in the "comments" of this post, and in a week or so, publish it as a posting, so others have a place to compare notes.

Here were my pre-op symptoms: Groin pain, deep deep groin pain, not always excruciating, but so annoying I felt like cutting off my leg, tight hip flexors, pain with sitting, pain with walking uphill, pain with pushing my stroller. I did not have radiating pain down my legs, all the hip pain was anterior medial.

Its always because of the kids

Once you have kids, you always have someone to place the blame on, like when I accidentally hit the yellow pole in our garage, my husband asked me how the yellow paint got on our black car....well, the kids were yelling and I was distracted and as I was reaching back to give them crackers, bam, I hit it!!!!So, how did I injure my hip? Unfortunately for me, I don't have an exciting story, I wasn't skydiving, or skiing or even playing sports. The one thing I am sure of is that prior to this episode, I never had hip problems. I am a PT, in PT school, there are no models, anything you learn, you learn on each other, and then practice again and again on each other. So I know in PT school my hips were perfect.
My son was born in Nov 2005, he was a VBAC, immediately following his birth, I remember having hip pain, but lets be honest, after having a baby, everything else hurts too, so some hip pain was not too alarming at the time. And it disappeared, so I forgot about it.
Fast forward exactly one year later, hip pain. Weird, hip pain, in my groin, I cannot touch it, it is deep and achy, it hurts to drive, it hurts to walk, but my muscles and tendons don't hurt...hmmmm, what is going on.
A few days later, it is still there, I tell a colleague, she works on me, it felt great! She released my iliacus muscle (which killed) and did some traction on my leg, I felt great! I practically skipped to my car, I was cured....Until later that night, I felt worse.
What could be happening??? I decided to try some hip tests on myself, which is awkward, but I was not ready to admit to anyone else I was having a problem, and being the control freak that I am, I did not want any surprises and was not going to let someone else diagnose me before I had already decided what was wrong.
Hmmmm...positive, positive, positive. Now what?
The next day I was worse, so I had 2 other collegues work on me, again, I felt better immediately after, but worse later on.
I needed a better game plan, so I decided to try strengthening as well. Bad idea! Exercise was making me worse as well.
Where would I turn now? As a PT, I was not ready to throw in the towel, but there was honestly nothing I could do to help myself, it was time to find a surgeon who could help me.

In the beginning.....

As a service to myself, as well as to fellow hip pain sufferers (OK, mostly to myself, as my husband is absolutely sick of hearing about my hip), I have decided to start this blog about my journey through arthroscopic hip surgery.
My journey began in Nov 2006 and began with hip pain. I will later give details of the first few months and what led up to my first surgery, too bad I hadn't thought about blogging then!!
I have since had a hip scope on March 5 2007 and am scheduled for a second one for the other side July 2 2007.
There is so little info out there on hip scopes and the recovery/ rehab, so I thought I would share my experience for all those interested.
Just a warning....I talk a lot, so be prepared for some long posts. But I hope I can help other's preparing for this, thinking about this, or going through this as well.