My MRI Report Ordeal

As some of you know, I can be quite obsessive compulsive when it comes to test results. Mri #4 being no different! I was told that it would take 2 business days for the report to be done and delivered to Dr. K. My MRI was Fri at 7am. I called Tuesday, no report. I called again on Tues, no report. I called Wed, no report. So I called the radiology department directly (did I mention I have a touch of OCD), they confirmed that the report was indeed done, and had been sent to my doctor. Hmmmm, sigh! So I called his office yet again (they must love me) and informed them that the report was ready. I was told that they would send someone to go pick it up. I left my fax number and everything. No report. Today I was running out of patience, so I called his office again, no report. I told them it was done, and asked why they didn't have it, they told me that if they didn't have it by mon or tues (today is thurs) that they would send someone to go get it. I got off the phone feeling annoyed and exacerbated, called radiology again and explained my dilema. They offered to fax it to him (they can't fax it to me directly) on the spot, given my annoyance! 30 minutes later I called his office and they had it in the fax machine, now I hold a copy in my hot little hands!!!

Right Hip MRI #4 (edited)
There is mild trochnateric bursal thickening bilaterally. The anterior labrum is somewhat small probably related to debridement. the anterosuperior labrum is deficient, similar to the prior study, with the posterior labrum being intact. There is defect in the anterior capsule superiorly in the region of the surgery extending 2.5cm in transverse dimension.

Cartilage over the femoral head is thinned anterosuperiorly. Focally, there is no full thickness loss. the superior cartilage is high signal. The acetabular cartilage has thinning anterolaterally, slightly more prominent on the prior study as well as anterosuperiorly where there is a focal area of near full thickness loss which has increased from the prior study over 4mm. there is no prominent effusion. No reactive signal in the underlying bone is evident.

The patient has undergone anterior bumpectomy with remodeling of the anterior femoral neck. focal adjacent scar is evident.

There is iliopsoas tendon thickening and high signal representing tendinosis bilaterally.

Prior abdominal surgery has been performed

There is a transitional lumbosacral junction. Disc signal is mildly lost at what appears to be L4-5 where there is a small to moderate central disc protrusion. The sacroiliac joints show mild high signal and osteophytes. Minimal free fluid is the cul de sac. Hamstring origins are intact.
The muscles appear fairly symmetric.

The previously demonstrated left sided edema, presumably from arthroscopy of the left hip has dissipated.
There are 14 degrees of femoral anteversion.

Impression:
Interval bumpectomy since the prior study with postoperative scar and anterosuperior capsular defect.
There is persistently deficient anterosuperior labrum. Since the prior study, there has been a slight increase in the focal acetabular cartilage anterosuperiorly, without advanced arthrosis.

The Week in Review

There is no place like home! We were in Miami for a week and a half, it was great but it is also great to be home!
The trip began with my (not so) quick MRI the night before, getting the results, L's 4th b-day party and a long trip home!
Last we spoke, my knee "issue" was TBD, possible MCL, as seen on MRI, or muscle imbalances, but I am to strengthen and stay off of my spin bike. I still think it is "joint related".

I have been off the bike for 2 weeks, the knee was ok, yesterday I was thinking that staying off of the bike was helping but this morning it was back to normal. So I was feeling unbelievably fat from lack of spinning and lots of eating (Jewish holidays=food) so I rode. I hurt, but I cannot directly attribute it to the bike.
L's party was great, its no wonder my kids love going to my parent's house, check out the BEST 4 year old party ever.







I never had a bounce house or ponies at my b-day parties!!!

While we were away, J had to come home for a day for work. The day before he was to leave, he received an email from the parking company where we leave our car at the airport. It turns out, they needed to move our car to an overflow lot since we were gone for so long, in the process, they left the car illegally parked for "a few moments" and it was ticketed and towed, due to some unpaid tickets (oops).
So, J had to go from the airport to one office in Queens to pay for the tow, tickets, storage fee, marshall fee and judgement fee, then go to Brooklyn to pick up the car! The parking company felt so bad they drove him to all of those places, paid all the fees minus the actual tickets, and gave us free parking for the entire duration of the trip (that is a HUGE savings here). It sucked that it happened but I count my lucky stars that J went to retrieve the car alone than with all of us in tow, especially after yesterdays adventure.

We flew non-stop, through DC (don't ask). We left Miami on time and made it to DC with time to spare to catch the connection. Initially, the flight was delayed an hour. We boarded, pulled away from the gate and were told we would have to sit on the runway bc Laguardia was slowing down traffic. We sat for 2 hours, then they pulled us back to the gate bc there were 6 kids on a 40-50 seater plane...not happy kids. We ended up arriving around 4PM (left Miami at 8AM), then I realized I left L's sweater on the plane. One more hour in the airport, we finally left, without the sweater, and all I could think was :thank goodness the car is here, waiting for us!)

You Would Think That By The 4th Time I Would Be Used To It

An MRI that is. Yes, today was my knee MRI, I work quickly. After a 1 1/2 hour wait (no exaggeration), they took me. At which point I was pissed off bc at my designated appointment time, they told the "appointment coordinator" was on the phone for me, she apologized profusely but said there was a "complication" with the patient in the MRI machine before me and there would be a 1 hour delay. So I patiently waited, 1 hour became 1 1/2. When I realized that the person in the MRI machine before me had walked into the facility after I had, after my "consolation" phone call", I realized I had been lied to and got pissed!

I didn't say anything to the technician since I didn't want to piss off the person who would be controlling the "torture tube". I figured I would be ok this time, even though MRI 2 and 3 were by no means a picnic. Mainly a bad cold during MRI #2 left me feeling like I couldn't breathe and leaving my "this close" to a panic attack.

I made sure my head would be out of the tube, which he said it would be, but not exactly. There is the tube but on the outside of the tube is a larger opening which to me is still a tube. So I get my headphones on with my own music, I close my eyes, and my heart begins to race. Oh no, I am actually going into a panic attack. Slow deep breaths....I end up calming myself down and continue with my breathing. Luckily, a knee MRI is only about 20 minutes and I survived! Then off to pay my exorbitant parking bill!!!!

I am packing, we are going to Miami tomorrow for a week and a half!!!

A Sigh of Relief

I kept my appointment, thank you for all of your encouragement! Dr. Kelly was pleased to hear that my hips great. He does NOT think I tore my meniscus bc I have tenderness at the joint line in conjunction with pain above and below the joint line. He thinks that a meniscus tear would present with pain at the joint line only. Also bc of the way my knees are angled, and the fact that it started with an MCL sprain (while rehabbing after my 3rd hip arthroscopy...of course I had to throw that one in)!

He said I can get an MRI and we can proceed from there. I asked what he did think it was, he said possible pes anserine issues or a capsular tear "which he can repair with a few sutures" to which I said HELL NO. I got up and joked that now I was going to be messed up for the rest of the day, but I was serious bc after the exam I was in serious pain...so he then insisted on the MRI. So off I go tomorrow, for the MRI, in the city again.

On a side note, many thanks to J for saving us the parking expense! Thanks to our teamwork, I arrived in the city, put the car at a 1 hour meter with a couple of quarters, and then J picked up the car and took it home. I managed to get home with hipster Amy (who also had an appt today, so we double teamed again) on public trasnportation!

I also wanted to mention a HUGE thank you to J, who has just replaced my missing engagement ring, it has been missing since August, when L took it. It is beautiful.

Now if I could only find time for a manicure!!!!

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! :-)

Objectives Vs. Subjectives

I can't believe no one 'de-lurked'. I am very disappointed. I was going to go on a blogging strike until you did, but this is killing me.
I am going out of my mind. I have been having so many doubts about whether I am making the right decision or not with revision surgery. I think L sees that I am losing it. I went out tonight, to Target (needed milk, light bulbs and undershirts), as I was leaving, she said to me: "Mommy, be careful, don't step into cars, wait for the walking man and if a car comes, stop." How adorable is that, L is only 3!

So here is my dilemma. I went through this with my first surgery as well. I always have good days and bad days. On the good days, I wonder if I am going crazy. What would calm my fears was that I had an MRI which showed pathology, it disproved my theory that I was crazy (at least in this sense) . This time, I have inconclusive scans. But, there is the cam impingement. Do you see where I am going with this? Yes, straight into the psych ward!!!

My intra-articular injection got rid of all of my pain, the psoas injection helped with some of the pain but the joint injection was a million times better. I really don't want my psoas released, and Dr. Kelly knows that (maybe bc I repeated it like a million times!). But what if I am wrong? What if he is right? But none of my imaging revealed a problem with the psoas, but then again, it didn't reveal a problem with much of anything. But he has never touched, stretched or looked at my psoas, much of our discussions have been over the phone. So really he is going on all of my subjective complaints. It is scary. So that is why I have been freaking out.

On a different note, I ordered a spinning bike. I am so excited, it should arrive tomorrow. I used to be a maniac spinner, nothing in the world gives me the same high as spinning. I don't see any reason why I can't go back to spinning, I desperately need to exercise and this is perfect for me and my lifestyle since I don't have time to go to the gym! Hopefully by tomorrow night I will be able to go for my first ride!!

Highlights From My MRI

I am missing the last page of the MRI report (sound familiar), hopefully tomorrow I will be able to get it (sigh), nothing can be simple, ever!!!

To illustrate the absurdity of my life at times, the chinese delivery person no longer rings my doorbell or knocks on my door, rather, just pushes it open and announces her arrival. I guess she feels that being 'invited' over 3 times per week (at a minimum) has made her a part of our family, and she can simply come and go as she pleases! The doorman no longer calls up when she arives, not that we would turn away food, regardless of whether we had ordered it or not!!!

Ok, back to the MRI, once I have the full report, I will type it up and add it, in the meantime I will just point out the parts I found interesting. Both hips are observed on the scan.
Left hip (most recently operated on, not reason for MRI)- incidental note is made of a moderate amount of fluid in the left hip joint, not present on prior study on 1/07. In addition, mild high signal is demonstrated in the anterior margin of the proximal left gluteus medius and minimus muscle, without established muscular atrophy.
Right hip- mild bony offset at head-neck junction of the proximal right femur that may contribute to a cam-type femoroacetabular impingement. There is an attenuated and frayed anterior labrum, as well as a deficient anterosuperior labrum, without a displaced tear.
Progressive Chondral loss is seen in the interval since the prior study of 1/07 with focal small full thickness defect over the superomedial margin of the acetabular dome, adjacent to anterosuperior labral detachment. (Rest of cartilage looks good, no synovitis, muscles and tendons look good, nothing going on in the pelvis)

He Called...finally

So after 2 messages an email, and a conversation with his PA (unrelated to this issue) he called me!!
Here's the deal....the MRI report shows a fraying of the labrum, when comparing the MRI images to the scope pics, he says it is normal, and in the area of the debridement. There is no large flap or loose body in the joint. There is no sign of synovitis, but it is usually not reported, and there is some fluid around the psoas. There is also some loss of cartilage in the area of the original tear, which apparently we knew about after the surgery (I don't recall this though).

I can get the psoas injected if I so desire, at the time of our conversation, I was in no pain, now of course I am!! I told him I would prefer to have the joint injected, since I think that is where my pain is, and that I will call him when I go back to work since that is what has been causing me the most pain. I will decide then.
As for now, I am unsure what this all means. Obviously, a frank, obvious retear would be devastating, but I am pretty sure it is not my psoas.
I have PT tomorrow morning, I will have P really check everything out and we can come to a decision (hopefully together!!) about what to do next!

MRI #3...over

I am going to start this post like yesterday's...I DID IT!! ITS OVER!! IT SUCKED but its OVER!!! I feel accomplished!
I had a lot of apprehension leading up to this MRI, and I am not a nervous person, but since my last MRI sucked so much, I was pretty anxious about having to do it again. I was anxious all day, I could barely eat at lunch, and it was just an MRI. I am less apprehensive about huge needles going into my hip and even surgery, I don't get it!
I decided to bring my own music this time, at my first MRI, I was given an array of choices, classical, rock, pop, country... I chose pop and ended up enduring 45 minutes of rap music. At my second MRI, I explained to the technician what had happened with my music choice, so he put in a Billy Joel CD for me, it was better than the rap!! But everything else went wrong with that MRI (see earlier post).

So needless to say, I was scared of having another bad experience, I would not say I am claustrophobic, I hate labels, but confined spaces don't thrill me. I was mostly afraid of swallowing, and having the swallowed contents get stuck in my throat and block my airway, as in MRI #2. So I have been practicing in my bed every night, swallowing while lying down, while taking slow deep breaths. I discovered that if I tilt my head back a little, it is easier.

As I was waiting for the technician to come for me, he brought back a lady who had just had her MRI, she said he was wonderful, but I didn't think it mattered how wonderful he was, unless he was having the exam instead of me! But boy was I wrong. I told him upfront that I was scared, and explained what had happened last time. He joked around with me and just made me feel at ease. He joked a lot, it took a few minutes to set me up, with the pads in the right spot, the coil on my hip, my legs taped together...Just as I lay down, my heart started racing, shit, I couldn't swallow, so I sat up and asked him for some water, and apologetically explained that I am not normally such a pain in the ass! He was fine with my request and jokingly asked if I wanted scotch instead..YES!!!

I finally settled in, he gave me cool glasses with a mirror so I could see behind me, and see him in the little room behind the glass. I really liked him, he promised to keep talking to me and letting me know what he was doing. He showed me how to adjust the glasses, and asked if I could see the man in the room, he said "in 15 minutes I am leaving and he's taking over", "Yeah right!!", "No, I'm serious, my shift is over and I go home, you'll be fine, I'll tell him you're scared and he will continue to walk you through". OK, I can handle this, I made it this far already!!

So we began! 3 seconds in, I started to have a panicky feeling, shit, I am going to have to stop this, and reschedule with Valium. No, I am here, lets do this. So some deep breathing, happy thoughts and Green Day playing in the background got me through the worst!

He kept me informed of how long each scan would be, finally, he said, "OK, last one, 4 minutes", phew! I am doing great, only 4 more minutes, I can do this! It ended, and I am getting really hot, and the panickiness is returning, I need to get out, I know the end is near. He announces "I am just checking the pictures", in my head, I was saying, they better be perfect because that will be as good as they get! They were, and he came to take me out!!

For me, the keys to a successful MRI were: A good, encouraging technician, my own music, and keeping my eyes closed the entire time. I have added this to Learn From My Experience/ Mistakes. I hope I never have to go through this again!!! Now the waiting game begins for the results!!!

Ignorance is Bliss...or is it???

Let me start by saying that I scheduled my MRI, but like everythig else in my life these days, it could have gone smoother.

I called Dr. Kelly's office this morning to have them set it up, which is already annoying, I could just as easily called myslef! So the receptionist asks me when is good, I said Mon. afternoon, or Tues. or thurs. all day, but the sooner the better. She leaves me on hold for about 5 minutes, comes back and says they are not answering. I remind her I need it at HSS, whoops, she is trying to schedule me somewhere else. I need HSS bc they have my prior scans to compare. Oh. So she calls HSS. How is Thursday, after 2? Fine I say, she says ok, so I said what time exactly, bc after 2 is not very specific, so she puts me on hold again, 1:00. Fine, sigh, nothing earlier in the week? No. Fine, I take it.

Later in the day, I am not pleased with a Thurs. appointment. This means I won't have results until the following week, the suspense is killing me! So I decide to take matters into my own hands and I call HSS myself, they can do Mon. at 4:30 (too late in the day for me) or Tues at 2:30. Perfect! Sometimes you just have to speak up and do things yourself!

I have been trying to imagine that all of this is synovitis, or the psoas. I go into my old MRI reports, to see what they had shown. Did I have synovitis the first time? No, both reports specifically say no synovitis. I know this doesn't mean much, since he did find it with the scope, but I want to make sure all grounds are covered, and there are no unexpected surprises. My husband would say stop being neurotic, you know too much, but I think this helps keep me more sane than not!

Uncertainty

I have had a day of indecisiveness!! If I had had time, I would have posted my question to all of you and maybe had some help, but I ended up coming to my own decision. So...what the heck am I talking about???
As you know, my right hip has been pretty bad, it is at the point I was before surgery, sex hurts too, so when I am ready to actually go to sleep at night, I am in so much pain, it is hard for me to fall asleep. I really don't know what to do, I was afraid that if I called Dr. Kelly, he would blow me off, tell me it is compensation, and leave me even more annoyed and frustrated, which I cannot handle now. But I was getting so frustrated with the pain as well...I didn't know what to do. My friend Amy, who has been through a lot of hip shit told me to call him, she didn't understand why I wouldn't, P, my PT said not to bc he knew I would be pissed. So after much deliberation....I called!

My message went like this: Please tell Dr. Kelly that I am having a lot of issues with my right hip, and it is not from compensation!

He called me about 4 hours later, in the past, I have waited 4 days for a call back! I am highly impressed!
I explained that I am having a ton of pain in the right, very much like I had pre-op, pain in the joint, non-palpable. He said it could be the muscles acting up, maybe we should inject the psoas...I repeated that the muscles are fine, my PT worked on them ART'd them...they are not the issue. He said it could be synovitis, the joint is inflammed from the added stress. I reminded him of the twisting episode, and how I am not sure what to think of it, especially since I went on crutches 3 days later, and I really don't know what to do, thats why I called! He said I could get the joint injected if I wanted to. Again, I don't know what I want! So he read the chart over for a few minutes, he said he is confident that I did not re-tear the labrum, this is why he likes to debride, bc there is nothing left to tear. Sometimes, the mechanics of the joint change, causing the muscles to act up. I could get an MRI if I want, but sometimes it is hard to read in the area of the old tear, so it may show nothing. Ok, I really didn't know what to do. He said continue working on it in PT, have somene work on it, modalities of my choice.... still looking through my chart...ok, get an MRI, then we can decide on the injection!!

So, now I am glad I called, at least it is all out in the open, not just on my blog! So, he thinks it is synovitis, I think his first thought is the psoas, possible tendonitis, but the joint hurt first, the psoas does occassionally flare, but it is in response to the joint flaring. So now I am nervous. First of all, my last MRI was awful, I almost panicked. I had a really bad cold and was really congested, also had a cough. Midway through, I needed to cough, alot, but I was afraid to move. But I really had to, I pressed my button, I informed the technician of my needs, he said I could under so circumstances get up bc the machine takes a picture of the hip angles in the beginning and uses them to compare all the images. So I stayed there, and began having a coughing fit, then all this gunk got stuck in my throat and I felt like I couldn't breathe, it was such an awful feeling. I have had awful flashbacks of it, and have been petrified to have to ever have another MRI, I never thought I would! Then comes the issue, what if he finds something bad? I don't want more surgery? Or, what if he finds nothing? Where does that leave me? Crazy????