OMG I haven't posted in a long time

Wow, it's been a while! Zach is 7 weeks old today and keeping me busy! Luckily I have great help!
(I have no idea why that is underlined but I can't seem to change it)

I wanted to post last week but never found the time! My brother had his hip arthroscopy last Monday. This has been a problem for him since last April. He had very similar symptoms as me, except that he is extremely athletic and I, well, am a mother of 3 with a job! His surgery went well, and he had a torn labrum, synovitis, cam and pincer FAI. Sound familiar? Weird that we both have (had) cam and pincer.

He stayed with me for 5 days after his surgery and then flew home. My mom was here too. Just so you have an idea of how well he did post-op (or how poorly I did), every time someone called my mom to ask how he was, I always heard her say "He is doing great, so much better than Susie ever did!"





Ok, so I don't do that well immediately post-op, I have a "thing" with drugs, we just don't get along! But long term, I did kick ass, if I do say so myself!!!





So, at 7 weeks post partum with a rather large baby, my hip joint is still great. I did start having some adductor and flexor tendonitis a few weeks ago. I am not sure why. I have in the past developed SI joint issues a few weeks/ months postpartum and I wonder if it is related. The pain is the worst when I "wear" Zach. Yes, I am a "baby wearer", currently in a Storchenwiege wrap.

Yep, Zach is inside the blue fabric, sleeping soundly, at 1 month old, at Disney World!

So all in all, I can say that pregnancy and delivery have not had a negative effect on my hips. I am confident that the tendonitis will resolve (I forgot to mention it is only on the right (revision) side). Exhaustion is kicking now.....

This is Not What I Signed Up For

Firstly, I would like to address an issue that has been brought to my attention. Mainly, it is that I am generally feeling awesome. I don't know how well it is reflected here since I usually only blog about the bad days, If you would prefer, I could post each day and write something to the likes of "Today I had no hip pain". But that would be kind of lame and boring, but it is the case most of the time. And no matter how much I complain, anything I speak of is nothing compared to pre-op and I have never once had second thoughts about surgery (revision too) and continue to be really happy with the results.

That said, I will begin by saying that what is happening now sucks! I think my pelvis/ SI joint is becoming increasingly unstable from the pregnancy hormones, so, like in the past with unstable joints, the muscles are tightening/ spasming in response. This time, it is not my psoas (yay), but my right IT band (revision side). It is so tight it has begun snapping. I never really understood the full implications of a snapping IT band...until now. It is a painless snapping that began a few days ago. My greater trochanter on that side is also tender to the touch. I don't know if maybe this is partly because I sleep on my side now, since stomach sleeping ended a few weeks ago, or bc of the tightness, or both...I don't know what came first. In addition, my left adductors are also tight and tender again. So the right side of both legs hurts, I wonder if the right side of my pelvis is more hypermobile these days, the hip joint definitely is more hyperobile on the right.

To add to all of this, the following happened last night. This is rather graphic, and possibly better suited for the ladies only, preferably the ones who have already had children, so that those of you who have not will not be scared away. So you have been warned. If you don't like graphic, skip the rest of the post.

Way back when, when I only began to realize I had a torn labrum, I also realized that suddenly, my pelvic floor muscles were also very weak. To me, this was really bad since on top of treating orthopaedic patients, I also specialize in treating incontinence and pelvic floor dysfunction. The muscles remained weak after surgery but I never had any "real" leaking. Last night, I was lying in bed and out of nowhere got really nauseous. I realized I needed to throw up, and fast, so made a mad dash for the bathroom. Once I started throwing up, I literally peed all over myself. At the time, it was not funny, now, looking back, I can sort of smile, I know it is not permanent, but standing in the bathroom, not knowing where to go or what to do, I was certainly not laughing. When it all "ended", I sat down to catch my breath, and realized my nose was bleeding as well. Another lovely pregnancy side effect. Did I mention that this is my last pregnancy????

Refocusing

Since this blog was started for the purpose of following my recovery from hip arthroscopy(s), I figured I should take a break from sunbathing and let you know what the story is.

Initially, I was supposed to have a follow-up appointment with Dr.Kelly this week (and Amy too) but being that my current condition does not allow for x-rays, I have cancelled and will reschedule for a later date (i.e after the baby is born). Amy and I will still try to make time for an L/ Jk outing + photo session, the plan is to go to Central Park on Thursday.

Anyway....I go most of the time without even realizing that my left hip was ever operated on. I feels great, no pain (at least not in the last few weeks/ days that I can recall as I type this). The only catch is that my activity level has seriously plummeted since the pregnancy began. I am constantly battling bone crushing fatigue so I drive everywhere. Last summer, I walked to the pool every day, this sumer we drive. The pool is across the street from the park I walked (crutched) to 6 days after my second surgery, so it is clearly not that far. The nausea still has not subsided but thanks to amazing drugs, I function! (Thank you Zofran)

The right hip is a different story. Yes, it was operated on twice, and yes, the left hip has 4 months on the right hip, but I can't help to wonder at what point my progress will plateau. Don't get me wrong, it feels great, amazing, a million times better than pre-op, but since I have a "perfect" left hip, it makes me sad to have to settle for less than perfect.

I know, my famous line is "once it is scoped it will never be the same again", I know, but one can only dream! Considering the amount of work I had done on it, I should not be complaining, but should be jumping for joy. The actual joint is great, no more FAI, no more pain in there, so yes, mission accomplished! What bothers me is more superficial pain, around the incisions, yes, the nerve pain is still there. Much diminished, but sigh, still there. My (gasp) psoas gets tight still and once again decreases my stride length. If I had the energy, I would stretch more, but every second I have to myself I am usually in bed (like now, the kids are in the living room watching cartoons and I am in bed. J is out of town for the week).

Of course, I am still anxious about the delivery. Plus, my new decision to try to go as natural as possible. I am thinking of hiring a doula, to help me during the birth. In my messed up mind, if I don't have an epidural, I will feel pain in my hip and prevent it from being put in bad positions. I had hired a doula for L's delivery and needed a c-section bc she was breech. For Jk, I couldn't even think that far ahead, all I could think about was not having a repeat c-section, I didn't care how I went about it. Also, for L's birth, I was petrified of having an epidural. I have now survived a c-section, a vaginal birth and 3 hipscopes with some form of spinal or epidural anesthesia, so the fear factor is slightly decreased, but if I can avoid it, I will. J is not in favor of a doula, he thinks it will lessen his role, but frankly, he had no idea what to do last time and I was rather pissed for a while (I think I still am a little), so thinks that I am trying to punish him by getting a doula. Whatever, next time, he can birth a child and do it his way!!!!

The Ups and Downs and Then Some

Since becoming pregnant, I have stopped spinning, not bc I think in any way shape or form that it is harmful to the baby, but I have been to busy puking, lying in bed feeling nauseous, lying in bed feeling sorry for myself that I am so nauseous, or simply lying in bed bc I am too tired to move or do much of anything else. It is also unbelievably hot here, especially over the past few days, my feet have started to swell, which makes me REALLY unhappy.This has never happened to me so early in a pregnancy....but I digress.

My point is that my activity level has gone down...drastically, so my ROM is not as great as it once was and my hips feel tight on and off. This week I was at my breaking point with the tightness and succumbed to asking P for a quick PT session so I could walk like a normal person again. I have had my usual anterior tightness which limits my extension when I walk, so if I have to be anywhere quickly,I have to take smaller steps bc that bungy cord in my hip feeling is back. Not even 5 minutes of some anterior hip mobilizations and quad stretching brought me back to normal! YAY!

I'd like to resume spinning soon but I practically pass out every night once the kids are in bed, especially bc we spend all afternoon outdoors by the pool (I have not gone in for a while bc my bathing suits don't fit anymore...I ordered some this week, I hope they fit!!!)

I remember after one of my surgeries (I'd like to think it was #3, this would support my theory) I told P not to work on my scars, I wanted to see if there would be a difference long term in the appearance and quality of the scar. Given the fact that the revision scars are 4 and 8 months younger than the other scars, they look awful. I really do believe that these were the "experimental scope sites". They were worked on a little bit, P got mad at one point and said I was being ridiculous about it and he was not going to let the scars go to hell. I did let him work on them a little bit, but no where near as much as the other ones. These scars are not red and elevated, and one is pretty painful to the touch. Cosmetically, couldn't care less, trust me, no one ever sees them! And they never get sun, so that is not a problem. I wonder how that plays in with my "nerve pain"/ "invisible bruise" issue. I don't use any creams or scar therapy lotions, I think it is a waste of money, especially given how the other scars look and feel, but it makes me wonder, maybe PT really does work! hahahaha!! Just joking! It was a personal experiment, I always work on my patients scars but there is ever a way to really know of the results would be the same if I didn't, now I know and my work has been validated!!!

Quick Jeff update: He saw OS #2 who confirmed the labral tear diagnosis, despite the fact that he felt the quality of the MRI was pretty poor, and who added "we always order these with contrast". He did not see any FAI. I am concerned about this. Given my extensive personal research and "networking", I cannot think of a single person who has had surgery for JUST a labral tear who is doing exceptionally well. I wold like further investigation into the "no FAI" thing with possible a CT-scan, although my CT-scan missed my FAI.....but better to be safe than sorry.I still strongly believe he needs to make a trip to NY to have this checked out and addressed!

The Pregnancy Scoop

I definitely feel as if I have slightly abandoned you over the last 3 months, but if you will let me explain myself. To put it simply, I don't do pregnancy gracefully. If you will recall my post-op issues after hip arthroscopy #3, you will get a better sense of what I have been going through (I tried to add a link to one of those posts but it seems that they are either too graphic or don't capture the full picture adequately, if you so desire, read up on posts from Nov 13-21 2007). Basically, I have been REALLY nauseous. It started around 6 weeks of pregnancy, way before I was sharing the news. J went away for the weekend with L, and Jk and I stayed home. I luckily had a few Zofran (my super duper anti-nausea meds I convinced Dr Kelly to prescribe for surgery #2 and 3 after a bad experience with #1), but like the "junkie" that I am, I was nervous they would not last the whole weekend and I would be screwed. Plus, I didn't really want to bother my OB-gyn over the weekend. Luckily, I have a friend who just the week before mentioned she had Zofran left from her last pregnancy, with refills! She happened to be at the park that day and I casually pulled her aside and explained my"situation". She was wonderful, dropped off the "goods" that night plus refilled it for me. I was feeling a lot more confident about venturing out of the house and not causing a really embarrassing scene for myself.





Tuesday morning I put in a call to my doc for more drugs, plus, I was having awful acid issues in my stomach, so I needed something for that as well.Acid+nausea=terrible feeling, wishing you might die, reconsidering the whole pregnancy thing (although it was a little too late). So, a few calls to my insurance company (by me and the docs office), I was able to take 4 Zofran a day plus 2 Prevacid. It made my life manageable but by no means enjoyably or pleasant. I kept saying that this was definitely the worst pregnancy yet.





Then, by the middle of week 11, I made it until 3PM on one Zofran, this was record breaking for me. And since then, I have been down to 2 Zofran/day, still with 1-2 Prevacid/day, and feeling much more human,most of the time.





The real question is how have the hips been? Given that pregnancy is a time of hormonal fluctuation, one of which is the hormone Relaxin (I can go on and on about this as I wrote my thesis on orthopaedic issues and pregnancy)....My SI joint has been a little cranky.

A. ilium
B. sacrum
C. acetabulum
D. pubis
E. pubic symphysis
F. ischium

What has been happenning is that my ilium (A) will rotate ever so slightly due to ligamentous laxity.As you can see, the acetabulum is at the bottom (C), so when the ilium shifts, so does the acetabulum, making me one very unhappy camper. In the past, the SI issues used to only cause unilateral back pain. On really bad days, it also causes hip pain.

Another issue I have been having is that the right hip has been feeling extremely tight. I am not sure if it is because I have dropped my activity level drastically (see above), or I am having a build up of scar tissue. Whatever the reason, I need to do something about it, but am usually too tired at the end of the day for any self assessment, and much less stretching or the like.

Another issue that the pregnancy seems to be exacerbating is the nerve pain I have had all along, remember the invisible bruise on the front of my leg. At times it becomes pretty painful, and even more tender to the touch, and then a little while later, it will be all gone. Strange.

Other than that, the hips have fared pretty well so far. My biggest concern (which I will probably mention a million times from now until I actually give birth) is the actual delivery. Epidural+weird hip positions= me really nervous. I don't want to opt for a c-section bc of this, bc, to be quite frank, if I had a choice,I would much rather have a hip scope than a c-section (meaning, if the delivery somehow screwed up my hip), not that it would, but I REALLY don't want a c-section, been there, done that. You will get so sick of hearing about this but it is what plays on my mind all the time!