My activity level has increased slighlty over the past few days in the way of walking but decreased in the way of spinning due to some other things going on (I won't get into that yet).
I have had some pain on my right side that bothered me a few days ago, and I wondered if I was going crazy. I had some medial sided pain, but the usual anterior medial, it is purely medial hip pain. It is not bad at all, but being that I am generally not in pain or discomfort, this was slightly disconcerting. It happenned Sunday, and then Sunday night, my leg felt tired, as I lay in bed. It started up again yesterday,and today,I walked about 80 city blocks and experienced it again.
Yes, 80 blocks is excessive, am I asking too much of my hip? I am not sure what is going on other than some crazy hormonal shit at the same time (not getting into it though), I did wear my Danskos all day to prevent knee and hip pain.
Obviously, I know things will never be perfect again, and I am nitpicking here bc things have been so great, I just want NO DISCOMFORT at all.
I do try to not think about the fact that this hip will eventually deteriorate into a nasty case of arthritis, but when I do, I hope and pray that this is not the beginning of it. I know, I need to chill out, but I am very "high maintenance".
Tuesday, May 27, 2008
Thursday, May 22, 2008
I am Defnitely Going To Hell
Today started out like any other Thursday, I was in housewife mode, I went food shopping in the morning, and then decided to meet my sister in the city. I decided to leave my car at home and take public transportation since the car usually becomes more of a burden in the city, plus, with the price of gas and parking, I was trying to be economical and eco-friendly. See, I am also VERY lucky, I have a parking spot. It is not in the indoor, valet garage in my building. That one has a long waitlist. It is about a block away, outdoors, on a poorly paved empty lot, but it is a HUGE luxury in NY. For the 6 months that we did not have a spot, I hated going out early in the day bc I would surely home home during "alternate side" and not be able to find a spot. I also didn't like to go out too late bc then there would be no spots left on the street. Having a spot gives me freedom, plus I sleep a lot better at night knowing my car won't be ticketed (again).
So today I received a call from a woman who works at the office who manages the garage. We are being kicked out of our spot bc someone who lives in the building adjacent to the lot needs a spot. What a load of crap. I have been parking there for 1 1/2 years. Apparently, I was the last one in the lot, so I am the first to get the boot. Well, I was furious, and yelled and screamed, but to no avail. So I had J call, bc I am too emotionally involved.
J didn't know what to do, so here is what happened in the conversation between J and the man at the parking place:
Man: Look, I am really sorry but the owner of the lot also owns apartments in the building and he is renting one out and needs a parking spot for the tennant.
J: But we have been with you for 1 1/2 years, we are good tennants, and we had no idea this was a possibility, we would have had a back-up plan in this case.
Man: I know, I'm sorry, but you are tenants at will, there is no contract, we don't even bill you, you just send us a check each month.
J: Look, I work in the city, I have 2 kids and my wife is disabled
Man: Oh, she's disabled
J: Yes, she just had 3 surgeries.....
Man: Oh, I see, I'm so sorry, let me see if there is someone else we can kick out, I will get back to you
So you see, we have a little white lie going here. Yes, I had 3 surgeries, but I am far from disabled. We are sooooooo going to hell for this. But parking is such a HUGE deal for me....
Can you feel the jewish guilt????????????
So today I received a call from a woman who works at the office who manages the garage. We are being kicked out of our spot bc someone who lives in the building adjacent to the lot needs a spot. What a load of crap. I have been parking there for 1 1/2 years. Apparently, I was the last one in the lot, so I am the first to get the boot. Well, I was furious, and yelled and screamed, but to no avail. So I had J call, bc I am too emotionally involved.
J didn't know what to do, so here is what happened in the conversation between J and the man at the parking place:
Man: Look, I am really sorry but the owner of the lot also owns apartments in the building and he is renting one out and needs a parking spot for the tennant.
J: But we have been with you for 1 1/2 years, we are good tennants, and we had no idea this was a possibility, we would have had a back-up plan in this case.
Man: I know, I'm sorry, but you are tenants at will, there is no contract, we don't even bill you, you just send us a check each month.
J: Look, I work in the city, I have 2 kids and my wife is disabled
Man: Oh, she's disabled
J: Yes, she just had 3 surgeries.....
Man: Oh, I see, I'm so sorry, let me see if there is someone else we can kick out, I will get back to you
So you see, we have a little white lie going here. Yes, I had 3 surgeries, but I am far from disabled. We are sooooooo going to hell for this. But parking is such a HUGE deal for me....
Can you feel the jewish guilt????????????
Monday, May 19, 2008
Revision Hip Arthroscopy/ Failed Hip Arthroscopy
I always wonder how many other people have fallen into this predicament as well. What I have noticed is that these are key words that often bring people to my blog. I have no way to really keep track, but often I will scan my sitemeter which will tell me the search words used by readers. It doesn't always work, for example, "Landsickness" through google brings up my blog, o the top 10 (I checked), but so do other key words, like FAI, hipscope, hip arthroscopy,psoas....and my all time favorite, "Bryan Kelly hipscope", my blog is #1 on google if you put in those words. This is quite embarrassing as well as pretty funny, if you ask me! (If he knew, he probably wouldn't agree!)
So, my point is, I was curious, who has had a failed hip arthroscopy? or failed FAI surgery? or failed surgery for a labral tear? Who has retorn their labrum?And even more importantly....why...what reason were you given??
Now would be a great time for all lurkers to share their story, so we can all learn from each other.
Me? An conservative surgeon who didn't want to take down too much bone if it was unnecessary. We found out the hard way that it indeed was necessary, but a happy ending for all involved parties!!!
So, my point is, I was curious, who has had a failed hip arthroscopy? or failed FAI surgery? or failed surgery for a labral tear? Who has retorn their labrum?And even more importantly....why...what reason were you given??
Now would be a great time for all lurkers to share their story, so we can all learn from each other.
Me? An conservative surgeon who didn't want to take down too much bone if it was unnecessary. We found out the hard way that it indeed was necessary, but a happy ending for all involved parties!!!
Monday, May 12, 2008
6 Month Post-Revision Update
Wow, I can't believe it has been 6 months already. 6 months since I tossed the hip brace, 6 months since I retired my crutches, 6 months since I was praying to a higher power to either make me stop vomiting or take me out back and shoot me, 6 month since I have had an argument with a surgeon :-)
For those of you just joining my blog, here is how it all went down: In March of 2007, I had my right hip scoped for a labral tear and pincer FAI. In July, the left hip was scoped for a labral tear, cam and pincer FAI. At that point, the right hip went bad and I realized I needed surgery again. It took a lot of diagnostic tests, injections, pleading and begging, but finally, my surgeon agreed to do it, but.....there was a catch. He was convinced that my pain was from a tight, impinging psoas, I did not think so. In fact, I was so sure, I made him promise he wouldn't touch my psoas. I wouldn't even sign a consent for for it I was so sure. So, he hesitantly agreed to do the surgery with the psoas promise, and as a compromise, I agreed to let him do a psoas bursectomy, if needed. Lo and behold, I woke up with an intact psoas as well as sans bursectomy since the psoas was not the problem.
3 months of long, intense rehab, with a few blips and bumps and knee injuries along the way, as well as some intermittent PRN PT visits, here I am.
I can't believe that 6 months later, I still walk around and gleefully think to myself "whoohoo, I am no pain", with a little smile. I still feel like I am walking on clouds some days and as if this was a dream, and I will soon wake up with that dreaded groin pain. I still say to myself almost every day. "shit, I am one lucky chick to have a happy ending after so much bullshit", 3 surgeries in 8 months really takes a toll on you, physically and emotionally.
So, what is still going on? My psoas has its moments, and more than once I have had to return for a quickie PT session to have it worked on. It also has caused me to have some back pain in addition to the muscle aches. My adductors are weak and tight, and I swear I think I have had a "snapping adductor". My psoas does snap now, I am not sure if it did, or to what extent it did pre-op. My theory to why I have so much muscle pain now is well described in prior post. I have soooo much more ROM now than I ever did and my muscles are trying to compensate by tightening up. I need to continue to strengthen them, but I prefer Spinning to PT, so who knows how this will end!
All in all, muscle pain and soreness 6 months later is a good deal for me if it means I have no more joint pain! If you need a surgeon, I have only positive things to say about mine! And what can be better than a happy ending!
For those of you just joining my blog, here is how it all went down: In March of 2007, I had my right hip scoped for a labral tear and pincer FAI. In July, the left hip was scoped for a labral tear, cam and pincer FAI. At that point, the right hip went bad and I realized I needed surgery again. It took a lot of diagnostic tests, injections, pleading and begging, but finally, my surgeon agreed to do it, but.....there was a catch. He was convinced that my pain was from a tight, impinging psoas, I did not think so. In fact, I was so sure, I made him promise he wouldn't touch my psoas. I wouldn't even sign a consent for for it I was so sure. So, he hesitantly agreed to do the surgery with the psoas promise, and as a compromise, I agreed to let him do a psoas bursectomy, if needed. Lo and behold, I woke up with an intact psoas as well as sans bursectomy since the psoas was not the problem.
3 months of long, intense rehab, with a few blips and bumps and knee injuries along the way, as well as some intermittent PRN PT visits, here I am.
I can't believe that 6 months later, I still walk around and gleefully think to myself "whoohoo, I am no pain", with a little smile. I still feel like I am walking on clouds some days and as if this was a dream, and I will soon wake up with that dreaded groin pain. I still say to myself almost every day. "shit, I am one lucky chick to have a happy ending after so much bullshit", 3 surgeries in 8 months really takes a toll on you, physically and emotionally.
So, what is still going on? My psoas has its moments, and more than once I have had to return for a quickie PT session to have it worked on. It also has caused me to have some back pain in addition to the muscle aches. My adductors are weak and tight, and I swear I think I have had a "snapping adductor". My psoas does snap now, I am not sure if it did, or to what extent it did pre-op. My theory to why I have so much muscle pain now is well described in prior post. I have soooo much more ROM now than I ever did and my muscles are trying to compensate by tightening up. I need to continue to strengthen them, but I prefer Spinning to PT, so who knows how this will end!
All in all, muscle pain and soreness 6 months later is a good deal for me if it means I have no more joint pain! If you need a surgeon, I have only positive things to say about mine! And what can be better than a happy ending!
Wednesday, May 7, 2008
Woe Is Us Part Deux
My Turn!
If I ever doubted that the entire body is connected and works as one impressive chain, today would have changed my mind.
I have been having incredible muscle pain over the past few days, it hasn't been this bad in a while. Yesterday and today I have been dealing with the right side (2 scopes), I feel my psoas pulling at my vertebrae again, and then I get awful pain on medial side of my thigh, not quite groin. This is palpable too. I am so stiff and clicky as well.
Yesterday was a sore day. As I was waiting for the elevator to go down and pick L up at school, I started stretching and trying to get my hip to extend, and hopefully stretch, or possibly break up scar tissue. I got it to pop, but then it hurt. It did get better at some point, I don't remember exactly when or what happened. Which leads me to beleive it was scar tissue
Today, that side was a mess again. I felt like my hip was so tight I was losing extension again, like in the early pre-op days. I did the "stool stretch", where I put my knee on a rolling stool and stretch my leg out behind me. It felt good, I got up to walk, and my right knee was a disaster (i.e. the good knee), I was limping for a while. This too, cleared up, but the hip remains tight.
Like the uncompliant,impatient patient that I am, I had a good ride on my spin bike tonight. I know this is not helping the psoas issue since I am sitting, and spinning my legs, fast, in a small arc of motion. The psoas just winds tighter and tighter.
I have been strtetching it, still, and still doing my abductor and adductor exercises, as if this balances out the "don't spin" part.
Time to get on the floor and stretch stretch stretch!!!
If I ever doubted that the entire body is connected and works as one impressive chain, today would have changed my mind.
I have been having incredible muscle pain over the past few days, it hasn't been this bad in a while. Yesterday and today I have been dealing with the right side (2 scopes), I feel my psoas pulling at my vertebrae again, and then I get awful pain on medial side of my thigh, not quite groin. This is palpable too. I am so stiff and clicky as well.
Yesterday was a sore day. As I was waiting for the elevator to go down and pick L up at school, I started stretching and trying to get my hip to extend, and hopefully stretch, or possibly break up scar tissue. I got it to pop, but then it hurt. It did get better at some point, I don't remember exactly when or what happened. Which leads me to beleive it was scar tissue
Today, that side was a mess again. I felt like my hip was so tight I was losing extension again, like in the early pre-op days. I did the "stool stretch", where I put my knee on a rolling stool and stretch my leg out behind me. It felt good, I got up to walk, and my right knee was a disaster (i.e. the good knee), I was limping for a while. This too, cleared up, but the hip remains tight.
Like the uncompliant,impatient patient that I am, I had a good ride on my spin bike tonight. I know this is not helping the psoas issue since I am sitting, and spinning my legs, fast, in a small arc of motion. The psoas just winds tighter and tighter.
I have been strtetching it, still, and still doing my abductor and adductor exercises, as if this balances out the "don't spin" part.
Time to get on the floor and stretch stretch stretch!!!
Tuesday, May 6, 2008
Woe is Us
To even the playing field around here, J has a possible torn meniscus. You would think orthopaedic issues were contagious. He did something yesterday and heard or felt a pop, and today, he has been complaining of clicking and locking and and medial sided pain. He also has pain with palpation to the medial joint line. Tonight, he couldn't put Jk to bed bc "his knee hurt", couldn't change a diaper and had to take the car to go 8 blocks to a friend's house (to watch a basketball game). Just as a reminder (J), I never stopped my "motherly responsibility" during a year of hip shit, 3 surgeries and a crap load of PT. So, either a) suck it up b)make an appointment with an OS to have it checked out, and suck it up or c)keep complaining to me but suck it up anyway. Or maybe I can throw back some of the lines you gave me:
"Why do you have to look for problems?"
"I really think there is something seriosly wrong with you"
"Do you need surgery...AGAIN?"
"It can't be that bad, you don't even limp"
"Can you get off of the computer, stop blogging and stop looking for articles"
"You are crazy" (said in reference to many other things)
I told J to wait a week, if he does not feel better, make an appt with Dr. Kelly. He said he does not want to see Dr. Kelly bc he is afraid that I will have to contradict everything he says, and bc he is afraid he doesn't like me bc I am so opinionated. Haha
"Why do you have to look for problems?"
"I really think there is something seriosly wrong with you"
"Do you need surgery...AGAIN?"
"It can't be that bad, you don't even limp"
"Can you get off of the computer, stop blogging and stop looking for articles"
"You are crazy" (said in reference to many other things)
I told J to wait a week, if he does not feel better, make an appt with Dr. Kelly. He said he does not want to see Dr. Kelly bc he is afraid that I will have to contradict everything he says, and bc he is afraid he doesn't like me bc I am so opinionated. Haha
Sunday, May 4, 2008
You Know its Not Going To Be A Good Day When......
for starters, you wake up with pain on the inside of your ASIS, on the hip that was operated on 10 months ago. When your back feels so stiff it hurts to lean forward. When you have 3 parties within 4 hours...and you are hosting one of them...and the guest list is comprised of twenty five 4 year olds.
My psoas has been giving me issues lately, on both sides, I think. It is hard to remember sometimes, although today we are talking of the left side. Operated only once in July 2007. Last night I began to diligently exercise adductors and abductors on both sides to help my "ailing" knee and "psychotic psoas". I also have been stretching the hip flexors a lot more lately. But this morning, I felt like I made a 9 month backtrack in muscular issues (Joint is still good, you can all breathe a sigh of relief, joint is actually amazing and I am super thrilled, which is why I save my muscular issue complaints for when they are really bad). My iliacus is a mess for some reason. Iliacus is the top portion of the combined muscle called "iliopsoas", iliacus+psoas=iliopsoas. It is found posterior to the ASIS and can be palpated by bringing your fingers just under the ASIS. I have not attempted to manually work on it, but have been stretching it as much as possible (all hip flexors). I stretched before I took L to ballet, after I picked her up from ballet, while she was at a ballet birthday party, and before we left to go to her birthday party! I still have a lot of pain localized to that area. It is an improvement from this morning, I think I could almost feel it pulling on my vertebrae, and that is why my back was bothering me. The stretching seemed to have helped with that a lot.
L's party was at Gymboree and I have never seen so much chaos in my life. The 2 teachers (we had to pay extra and hire a second one bc we had so many kids) were useless. They could not run the party and it ended up being mostly free play. For some reason, walking barefoot on the mats made my bad knee crazy, and then once we got home, it starting having shooting pains.
We just unwrapped all the presents, cleaned the living room and put the kiddies to bed!
I am praying that tomorrow is a better day(probably less fun, but hopefully less pain too!)
My psoas has been giving me issues lately, on both sides, I think. It is hard to remember sometimes, although today we are talking of the left side. Operated only once in July 2007. Last night I began to diligently exercise adductors and abductors on both sides to help my "ailing" knee and "psychotic psoas". I also have been stretching the hip flexors a lot more lately. But this morning, I felt like I made a 9 month backtrack in muscular issues (Joint is still good, you can all breathe a sigh of relief, joint is actually amazing and I am super thrilled, which is why I save my muscular issue complaints for when they are really bad). My iliacus is a mess for some reason. Iliacus is the top portion of the combined muscle called "iliopsoas", iliacus+psoas=iliopsoas. It is found posterior to the ASIS and can be palpated by bringing your fingers just under the ASIS. I have not attempted to manually work on it, but have been stretching it as much as possible (all hip flexors). I stretched before I took L to ballet, after I picked her up from ballet, while she was at a ballet birthday party, and before we left to go to her birthday party! I still have a lot of pain localized to that area. It is an improvement from this morning, I think I could almost feel it pulling on my vertebrae, and that is why my back was bothering me. The stretching seemed to have helped with that a lot.
L's party was at Gymboree and I have never seen so much chaos in my life. The 2 teachers (we had to pay extra and hire a second one bc we had so many kids) were useless. They could not run the party and it ended up being mostly free play. For some reason, walking barefoot on the mats made my bad knee crazy, and then once we got home, it starting having shooting pains.
We just unwrapped all the presents, cleaned the living room and put the kiddies to bed!
I am praying that tomorrow is a better day(probably less fun, but hopefully less pain too!)
Saturday, May 3, 2008
Hmmm.....Can Anyone Else Relate Too??
Doctor Who? Are Patients Making Clinical Decisions?
ScienceDaily (Feb. 12, 2008) — Doctors are adjusting their bedside manner as better informed patients make ever-increasing demands and expect to be listened to, and fully involved, in clinical decisions that directly affect their care. In a study just published in Clinical Orthopaedics and Related Research, Dr. J. Bohannon Mason of the Orthocarolina Hip and Knee Center inCharlotte, NC, USA, looks at the changes in society, the population and technology that are influencing the way patients view their orthopaedic surgeons. As patients gain knowledge, their attitude to medicine changes: They no longer show their doctors absolute and unquestionable respect.
Demographic change, education, affluence, availability of information via the Internet, patient mobility, direct-to-consumer marketing, patient age, patient activity demands, cost pressures and physician accountability are converging to present the practitioner with a patient who is more informed and has higher expectations than any prior generation of patients.
Today's patients do not simply have a medical complaint, they desire a particular operation and sometimes even a particular implant. The doctor is no longer the sole source of medical information. Patients have enough snippets of information to stimulate a dialogue and clearly express their expectations for a particular outcome and technique to achieve that outcome. They are also demanding quicker recovery, return to higher-level sport activity and earlier discharge from the hospital.
"Patients have come to expect miracles in medicine as the norm, yet these miracles are not without inherent risk," cautions Mason.
Providing true patient-centered care relies on doctors' ability to supply patients with accurate, evidence-based information and to improve communication. However, patients are not necessarily motivated by evidence-based medicine. They are often willing to adopt the promises of direct-to- consumer marketing.
In Mason's view, the doctor's responsibility is "to maintain control of validated information sources and of the exchange of information with the patient. [Doctors] need to be interpreters and balancers of scientific information to help guide [their] patients through the maze of medical hyperbole. [They] need to discuss new treatments and technologies openly and honestly."
And crucially, they must also understand that although patients' demands are changing, the surgeon's accountability and responsibility for their patient's safety and care have not.
Journal reference: Mason JB (2008). The new demands by patients in the modern era of total joint arthroplasty. Clin Orthop Relat Res (DOI 10.1007/s11999-007-0009-2)
Adapted from materials provided by Springer.
ScienceDaily (Feb. 12, 2008) — Doctors are adjusting their bedside manner as better informed patients make ever-increasing demands and expect to be listened to, and fully involved, in clinical decisions that directly affect their care. In a study just published in Clinical Orthopaedics and Related Research, Dr. J. Bohannon Mason of the Orthocarolina Hip and Knee Center inCharlotte, NC, USA, looks at the changes in society, the population and technology that are influencing the way patients view their orthopaedic surgeons. As patients gain knowledge, their attitude to medicine changes: They no longer show their doctors absolute and unquestionable respect.
Demographic change, education, affluence, availability of information via the Internet, patient mobility, direct-to-consumer marketing, patient age, patient activity demands, cost pressures and physician accountability are converging to present the practitioner with a patient who is more informed and has higher expectations than any prior generation of patients.
Today's patients do not simply have a medical complaint, they desire a particular operation and sometimes even a particular implant. The doctor is no longer the sole source of medical information. Patients have enough snippets of information to stimulate a dialogue and clearly express their expectations for a particular outcome and technique to achieve that outcome. They are also demanding quicker recovery, return to higher-level sport activity and earlier discharge from the hospital.
"Patients have come to expect miracles in medicine as the norm, yet these miracles are not without inherent risk," cautions Mason.
Providing true patient-centered care relies on doctors' ability to supply patients with accurate, evidence-based information and to improve communication. However, patients are not necessarily motivated by evidence-based medicine. They are often willing to adopt the promises of direct-to- consumer marketing.
In Mason's view, the doctor's responsibility is "to maintain control of validated information sources and of the exchange of information with the patient. [Doctors] need to be interpreters and balancers of scientific information to help guide [their] patients through the maze of medical hyperbole. [They] need to discuss new treatments and technologies openly and honestly."
And crucially, they must also understand that although patients' demands are changing, the surgeon's accountability and responsibility for their patient's safety and care have not.
Journal reference: Mason JB (2008). The new demands by patients in the modern era of total joint arthroplasty. Clin Orthop Relat Res (DOI 10.1007/s11999-007-0009-2)
Adapted from materials provided by Springer.
Thursday, May 1, 2008
A Work In Progress
The previous 2 posts will be added to and updated as I have time and will be able to be accessed from a link on the right side of the page. I hope everyone finds this useful and helpful.
I have also added a few additional links along the right side of the page, which also gets updated periodically!
I have also added a few additional links along the right side of the page, which also gets updated periodically!
Failed Hip Arthroscopy and Revision Hip Arthroscopy Articles
Radiologic and Intraoperative Findings in Revision Hip Arthroscopy
Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.
Benton E. Heyworth, M.D., Michael K. Shindle, M.D., James E. Voos, M.D., Jonas R. Rudzki, M.D., Bryan T. Kelly, M.D.
Arthroscopy. 2007 Dec;23(12):1295-302.
Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.
Revision Hip ArthroscopyMarc J. Philippon, MD*, Mara L. Schenker, Karen K. Briggs, MPH, MBA, David A. Kuppersmith, R. Brian Maxwell and Allston J. Stubbs, MD
Am J Sports Med. 2007 Nov;35(11):1918-21. Epub 2007 Aug 16
Background: Hip arthroscopy has become increasingly popular; however, little is known about revision hip arthroscopy.
Hypothesis: Revision hip arthroscopy is associated with unaddressed femoroacetabular impingement. The purpose of this study was to describe reasons for revision hip arthroscopy.
Study Design: Case series; Level of evidence, 4.
Methods: Between March 2005 and March 2006, 37 revision hip arthroscopies were performed by the senior author. Data were collected through retrospective review of clinical and operative notes.
Results: All patients required revision surgery because of persistent hip pain. There were 25 women and 12 men with an average age of 33 years (range, 16–53 years). The average time from prior surgery to revision was 20.5 months (range, 2.9–84 months). Common findings among patients needing revision were hip pain, decreased range of motion, and functional disability. The average modified Harris Hip Score was 53 (range, 22–99). Thirty-six patients had radiographic evidence of femoroacetabular impingement at the time of revision. Revision procedures included 34 (95%) for femoroacetabular impingement, 32 (87%) for labral lesions, 26 (70%) for a chondral defect, 23 (62%) for lysis of adhesions, and 13 (35%) for previously unaddressed instability. Two patients had total hip arthroplasty after revision, and 3 patients required further revision. Of the remaining 32 patients, early follow-up was obtained on 27 (84%) at an average of 12.7 months postoperatively (range, 6–19 months). Outcomes showed patients regained some of their lost function within the first year.
Conclusion: Patients commonly required revision hip arthroscopy because of persistent impingement.
Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, San Diego, California, February 2007.
Benton E. Heyworth, M.D., Michael K. Shindle, M.D., James E. Voos, M.D., Jonas R. Rudzki, M.D., Bryan T. Kelly, M.D.
Arthroscopy. 2007 Dec;23(12):1295-302.
Purpose: The purpose of this study was to identify possible causes of failure of hip arthroscopy by reviewing the intraoperative and radiologic findings in a series of patients requiring revision hip arthroscopy. Methods: We retrospectively reviewed 24 revision hip arthroscopy cases performed in 23 patients (14 female and 9 male; mean age, 33.6 years; 1 bilateral). The review included indications for surgery, intraoperative findings, and arthroscopic interventions for both the primary and revision surgeries. Imaging studies, including radiography, magnetic resonance imaging, and 3-dimensionally reconstructed computed tomography scans, were analyzed for the presence of preoperative bony impingement lesions (e.g., femoral head-neck junction “cam” lesions or anterosuperior acetabular “pincer” lesions). Results: The mean interval between previous hip arthroscopy and recurrence of symptoms was 6.1 months. In 13 of 24 cases (54%), patients had no significant improvement at any point after the primary hip arthroscopy. The mean interval between the previous hip arthroscopy and revision surgery was 25.6 months. Unaddressed or undertreated bony impingement lesions were found in 19 of 24 cases (79%) and were identified on imaging studies before revision hip arthroscopy. A tight psoas tendon and corresponding labral impingement lesion were identified by arthroscopic visualization in 7 of 24 cases, for which partial psoas tendon release was performed. Eight cases of failed labral repair were addressed with labral debridement and removal of suture material. Of these 8 cases, 6 also had bony impingement, which was also addressed at the time of the revision surgery. Conclusions: Failure to address bony impingement lesions of the hip and a tight psoas tendon are key factors in unsuccessful hip arthroscopy and may require revision surgery. Furthermore, failure of labral repairs may be the result of unrecognized bony impingement at the time of initial surgery. Level of Evidence: Level IV, prognostic case series.
Revision Hip ArthroscopyMarc J. Philippon, MD*, Mara L. Schenker, Karen K. Briggs, MPH, MBA, David A. Kuppersmith, R. Brian Maxwell and Allston J. Stubbs, MD
Am J Sports Med. 2007 Nov;35(11):1918-21. Epub 2007 Aug 16
Background: Hip arthroscopy has become increasingly popular; however, little is known about revision hip arthroscopy.
Hypothesis: Revision hip arthroscopy is associated with unaddressed femoroacetabular impingement. The purpose of this study was to describe reasons for revision hip arthroscopy.
Study Design: Case series; Level of evidence, 4.
Methods: Between March 2005 and March 2006, 37 revision hip arthroscopies were performed by the senior author. Data were collected through retrospective review of clinical and operative notes.
Results: All patients required revision surgery because of persistent hip pain. There were 25 women and 12 men with an average age of 33 years (range, 16–53 years). The average time from prior surgery to revision was 20.5 months (range, 2.9–84 months). Common findings among patients needing revision were hip pain, decreased range of motion, and functional disability. The average modified Harris Hip Score was 53 (range, 22–99). Thirty-six patients had radiographic evidence of femoroacetabular impingement at the time of revision. Revision procedures included 34 (95%) for femoroacetabular impingement, 32 (87%) for labral lesions, 26 (70%) for a chondral defect, 23 (62%) for lysis of adhesions, and 13 (35%) for previously unaddressed instability. Two patients had total hip arthroplasty after revision, and 3 patients required further revision. Of the remaining 32 patients, early follow-up was obtained on 27 (84%) at an average of 12.7 months postoperatively (range, 6–19 months). Outcomes showed patients regained some of their lost function within the first year.
Conclusion: Patients commonly required revision hip arthroscopy because of persistent impingement.
Hip Labral Tear and FAI Articles
Acetabular Labral Tears
by Cara L Lewis and Shirley A Sahrmann
PHYS THERVol. 86, No. 1, January 2006, pp. 110-121
Anterior hip or groin pain is a common complaint for which people are referred for physical therapy, with the hip region being involved in approximately 5% to 9% of injuries in high school athletes.1 Although anterior hip pain is known to result from a number of musculoskeletal and systemic pathologies, a tear of the acetabular labrum is a recent addition to the list that is of particular interest to physical therapists. This mechanically induced pathology is thought to result from excessive forces at the hip joint2,3 and has been proposed as part of a continuum of hip joint disease that may result in articular cartilage degeneration.2 Although the number of recent articles in the orthopedic literature identifying acetabular labral tears as a source of hip pain is increasing, labral tears often evade detection, resulting in a long duration of symptoms, greater than 2 years on average, before diagnosis.4–8 Studies have shown that 22% of athletes with groin pain9 and 55% of patients with mechanical hip pain of unknown etiology2 were found to have a labral tear upon further evaluation. In order to provide the most appropriate intervention for patients with anterior hip or groin pain, physical therapists should be knowledgeable about all of the possible sources and causes of this pain, including a tear of the acetabular labrum and the possible factors contributing to these tears. Therefore, the purpose of this article is to review the anatomy and function of the acetabular labrum and present current concepts on the etiology, clinical characteristics, diagnosis, and treatment of labral tears.
Acetabular Labral Tears of the Hip: Examination and Diagnostic Challenges
RobRoy L. Martin, Keelan R. Enseki, Peter Draovitch, Talia Trapuzzano, Marc J. Philippon
J Orthop Sports Phys Ther. 2006:36(7):503-515. doi:10.2519/jospt.2006.2135
The purpose of this clinical commentary is to provide an evidence-based review of the examination process and diagnostic challenges associated with acetabular labral tears of the hip. Once considered an uncommon entity, labral tears have recently received wider recognition as a source of symptoms and functional limitation. Information regarding acetabular labral tears and their association to capsular laxity, femoral acetabular impingement (FAI), dysplasia of the acetabulum, and chondral lesions is emerging.
Physical therapists should understand the anatomical structures of the hip and recognize how the clinical presentation of labral tears is difficult to view isolated from other hip articular pathologies. Clinical examination should consider lumbopelvic and extra-articular pathologies in addition to intra-articular pathologies when assessing for the source of symptoms and functional limitation. If a labral tear is suspected, further diagnostic testing may be indicated. Although up-and-coming evidence suggests that information obtained from patient history and clinical examination can be useful, continued research is warranted to determine the diagnostic accuracy of our examination techniques.
Video of Hip Exam from this Article
The Hip Joint: Arthroscopic Procedures and Postoperative Rehabilitation
Keelan R. Enseki, Peter Draovitch, Bryan T. Kelly, RobRoy L. Martin, Marc J. Philippon, Mara L. Schenker
J Orthop Sports Phys Ther. 2006;36(7):516-525. doi:10.2519/jospt.2006.2138
Recent technological improvements have resulted in a greater number of surgical options available for individuals with hip joint pathology. These options are particularly pertinent to the relatively younger and more active population.
The diagnosis and treatment of acetabular labral tears have become topics of particular interest. Improvements in diagnostic capability and surgical technology have resulted in an increased number of arthroscopic procedures being performed to address acetabular labral tears and associated pathology. Associated conditions include capsular laxity, femoral-acetabular impingement, and chondral lesions. Arthroscopic techniques include labral tear resection, labral repair, capsular modification, osteoplasty, and microfracture procedures.
Postoperative rehabilitation following arthroscopic procedures of the hip joint carries particular concerns regarding range of motion, weight-bearing precautions, and initiation of strength activities. Postoperative rehabilitation protocols that have been typically used for surgeries such as total hip arthroplasty are often not sufficient for the population of patients undergoing arthroscopic procedures of the hip joint. Postoperative rehabilitation should be based upon the principles of tissue healing as well as individual patient characteristics. As arthroscopic procedures to address acetabular labral tears and associated pathology evolve, physical therapists have the opportunity to play a significant role through the development of corresponding rehabilitation protocols.
Video of Hip Arthorscopy from this article
Acetabular Labral Tears
J Bone Joint Surg Am. 2009;91:701-710. doi:10.2106/JBJS.H.00802
Paul E. Beaulé, Michelle O'Neill and Kawan Rakhra
Acetabular labral tears rarely occur in the absence of a structural osseous abnormality.
Labral tears are frequently associated with lesions of acetabular cartilage such as delamination.
Hip arthroscopy is the preferred operative approach in the treatment of labral injuries in the absence of substantial structural osseous abnormalities.
see a later posting for more on this article
by Cara L Lewis and Shirley A Sahrmann
PHYS THERVol. 86, No. 1, January 2006, pp. 110-121
Anterior hip or groin pain is a common complaint for which people are referred for physical therapy, with the hip region being involved in approximately 5% to 9% of injuries in high school athletes.1 Although anterior hip pain is known to result from a number of musculoskeletal and systemic pathologies, a tear of the acetabular labrum is a recent addition to the list that is of particular interest to physical therapists. This mechanically induced pathology is thought to result from excessive forces at the hip joint2,3 and has been proposed as part of a continuum of hip joint disease that may result in articular cartilage degeneration.2 Although the number of recent articles in the orthopedic literature identifying acetabular labral tears as a source of hip pain is increasing, labral tears often evade detection, resulting in a long duration of symptoms, greater than 2 years on average, before diagnosis.4–8 Studies have shown that 22% of athletes with groin pain9 and 55% of patients with mechanical hip pain of unknown etiology2 were found to have a labral tear upon further evaluation. In order to provide the most appropriate intervention for patients with anterior hip or groin pain, physical therapists should be knowledgeable about all of the possible sources and causes of this pain, including a tear of the acetabular labrum and the possible factors contributing to these tears. Therefore, the purpose of this article is to review the anatomy and function of the acetabular labrum and present current concepts on the etiology, clinical characteristics, diagnosis, and treatment of labral tears.
Acetabular Labral Tears of the Hip: Examination and Diagnostic Challenges
RobRoy L. Martin, Keelan R. Enseki, Peter Draovitch, Talia Trapuzzano, Marc J. Philippon
J Orthop Sports Phys Ther. 2006:36(7):503-515. doi:10.2519/jospt.2006.2135
The purpose of this clinical commentary is to provide an evidence-based review of the examination process and diagnostic challenges associated with acetabular labral tears of the hip. Once considered an uncommon entity, labral tears have recently received wider recognition as a source of symptoms and functional limitation. Information regarding acetabular labral tears and their association to capsular laxity, femoral acetabular impingement (FAI), dysplasia of the acetabulum, and chondral lesions is emerging.
Physical therapists should understand the anatomical structures of the hip and recognize how the clinical presentation of labral tears is difficult to view isolated from other hip articular pathologies. Clinical examination should consider lumbopelvic and extra-articular pathologies in addition to intra-articular pathologies when assessing for the source of symptoms and functional limitation. If a labral tear is suspected, further diagnostic testing may be indicated. Although up-and-coming evidence suggests that information obtained from patient history and clinical examination can be useful, continued research is warranted to determine the diagnostic accuracy of our examination techniques.
Video of Hip Exam from this Article
The Hip Joint: Arthroscopic Procedures and Postoperative Rehabilitation
Keelan R. Enseki, Peter Draovitch, Bryan T. Kelly, RobRoy L. Martin, Marc J. Philippon, Mara L. Schenker
J Orthop Sports Phys Ther. 2006;36(7):516-525. doi:10.2519/jospt.2006.2138
Recent technological improvements have resulted in a greater number of surgical options available for individuals with hip joint pathology. These options are particularly pertinent to the relatively younger and more active population.
The diagnosis and treatment of acetabular labral tears have become topics of particular interest. Improvements in diagnostic capability and surgical technology have resulted in an increased number of arthroscopic procedures being performed to address acetabular labral tears and associated pathology. Associated conditions include capsular laxity, femoral-acetabular impingement, and chondral lesions. Arthroscopic techniques include labral tear resection, labral repair, capsular modification, osteoplasty, and microfracture procedures.
Postoperative rehabilitation following arthroscopic procedures of the hip joint carries particular concerns regarding range of motion, weight-bearing precautions, and initiation of strength activities. Postoperative rehabilitation protocols that have been typically used for surgeries such as total hip arthroplasty are often not sufficient for the population of patients undergoing arthroscopic procedures of the hip joint. Postoperative rehabilitation should be based upon the principles of tissue healing as well as individual patient characteristics. As arthroscopic procedures to address acetabular labral tears and associated pathology evolve, physical therapists have the opportunity to play a significant role through the development of corresponding rehabilitation protocols.
Video of Hip Arthorscopy from this article
Acetabular Labral Tears
J Bone Joint Surg Am. 2009;91:701-710. doi:10.2106/JBJS.H.00802
Paul E. Beaulé, Michelle O'Neill and Kawan Rakhra
Acetabular labral tears rarely occur in the absence of a structural osseous abnormality.
Labral tears are frequently associated with lesions of acetabular cartilage such as delamination.
Hip arthroscopy is the preferred operative approach in the treatment of labral injuries in the absence of substantial structural osseous abnormalities.
see a later posting for more on this article
Another Anatomy Lesson
L with her latest b-day gift, "Bryan the skeleton". Many thanks to Amy for finding this toddler size one! Click here to have L teach you many bones and muscles!!! Here she is pointing out the radius.Tuesday, April 29, 2008
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!)
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!)
Tuesday, April 22, 2008
Even I Didn't Think I Would Hear Back So Soon
Before 3PM, my phone rang...guess who it was...you got it! J and I were in the supermarket at the time, with both kids, and both were being extremely wild (the 2 kids, not J and the kids) . It was hard to have a conversation and make sure no one got hurt/killed at the same time.
Since I had already read the MRI report report, we got right down to business! What the heck is going on? He said that there was increased signal on my MCL, so he wants me to go into a brace. To which I obviously had a reply of "hell no". See, I know I have MCL problems, which is what I majorly damaged in December. This is a different feel, I explained, it feels "like joint". He thinks there is probably a muscle imbalance, residual effects of the hip arthroscopy (I knew it would come back to haunt me) and wants me to continue strengthening it and stop spinning. (we'll get back to that soon). I am of the opinion that the MCL is not involved in my complaints, yes, it hurts at times, but there is another pain as well, it almost feels like the same pain I had in my hip, but in my knee.
So.....strengthen, avoid aggravating activities like stairs and spinning and call him in 2 months if it still bothers me and we can do an injection then. I knew he would be stingy with the cortisone! If this persists, I don't think I will last 2 months and will probably call sooner, but hopefully it will go away on its own. I will be more diligent about specific strengthening, not just spinning and pilates, and if necessary, tape my knee like P has done in the past.
So the no spinning thing.....I don't know if I can do that. I tried it for 5 days a while back but went back since it didn't seem to make a difference. I didn't spin once last week because I was super busy at work and then with my appointments, packing and travelling. This week, I had grand plans to return to the gym I used to spin at when I lived at home, but just to "test the waters", I will hold back and stay off of a bike for this week as well. I return to NY on Monday, and if my symptoms have not changed, I will return to spinning. If they have gotten better, I will probably return as well, might as well if there is no pain. So in a nutshell, I cannot give in to no spinning and I don't like bracing knees, especially in a situation like this when it will only weaken all the other structures around it.
I don't feel like I am being given the runaround, I am in no hurry to do anything drastic here, and like I think I have mentioned before, the knee is not surgical, and even if it were surgical, ITS NOT SURGICAL!
Since I had already read the MRI report report, we got right down to business! What the heck is going on? He said that there was increased signal on my MCL, so he wants me to go into a brace. To which I obviously had a reply of "hell no". See, I know I have MCL problems, which is what I majorly damaged in December. This is a different feel, I explained, it feels "like joint". He thinks there is probably a muscle imbalance, residual effects of the hip arthroscopy (I knew it would come back to haunt me) and wants me to continue strengthening it and stop spinning. (we'll get back to that soon). I am of the opinion that the MCL is not involved in my complaints, yes, it hurts at times, but there is another pain as well, it almost feels like the same pain I had in my hip, but in my knee.
So.....strengthen, avoid aggravating activities like stairs and spinning and call him in 2 months if it still bothers me and we can do an injection then. I knew he would be stingy with the cortisone! If this persists, I don't think I will last 2 months and will probably call sooner, but hopefully it will go away on its own. I will be more diligent about specific strengthening, not just spinning and pilates, and if necessary, tape my knee like P has done in the past.
So the no spinning thing.....I don't know if I can do that. I tried it for 5 days a while back but went back since it didn't seem to make a difference. I didn't spin once last week because I was super busy at work and then with my appointments, packing and travelling. This week, I had grand plans to return to the gym I used to spin at when I lived at home, but just to "test the waters", I will hold back and stay off of a bike for this week as well. I return to NY on Monday, and if my symptoms have not changed, I will return to spinning. If they have gotten better, I will probably return as well, might as well if there is no pain. So in a nutshell, I cannot give in to no spinning and I don't like bracing knees, especially in a situation like this when it will only weaken all the other structures around it.
I don't feel like I am being given the runaround, I am in no hurry to do anything drastic here, and like I think I have mentioned before, the knee is not surgical, and even if it were surgical, ITS NOT SURGICAL!
I Have The Results
I guess this is why most docs don't like faxing patients the results of exams prior to speaking with them!!!!
No meniscal tears, no ligament tears, no joint effusion, no joint space narrowing!
WHOOPEEE!!!!!!
But...why does it hurt like a bitch?????????
No meniscal tears, no ligament tears, no joint effusion, no joint space narrowing!
WHOOPEEE!!!!!!
But...why does it hurt like a bitch?????????
I'm Taking Bets
My MRI report is in, and has just been placed on Dr Kelly's desk. It was not faxed to my office by the Imaging office but I did request that his office send me a copy.
When do you think I will a) hear back from him b)have a copy of the report in my hands
To even the playing field, the receptionist I spoke with is the more efficient one who usually gets things done for me when I need, and has always been very helpful in the past. I also asked her to put a "big, big" not on his desk to call me with the results!!
When do you think I will a) hear back from him b)have a copy of the report in my hands
To even the playing field, the receptionist I spoke with is the more efficient one who usually gets things done for me when I need, and has always been very helpful in the past. I also asked her to put a "big, big" not on his desk to call me with the results!!
Thursday, April 17, 2008
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!!!
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!!!
Wednesday, April 16, 2008
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!!!!
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!!!!
Monday, April 14, 2008
I Told You She Is A Genius
As I have mentioned before, L knows many of her bones and muscles. Here she is doing a beautiful job...until the end when she has trouble with her name! But we love her and think she is the smartest preschooler in the world!
Now if only her parents could figure out how to use proper lighting for filming....
Thursday, April 10, 2008
Why I Still Don't Think My Psoas Needs to Be Released
I have been experiencing pain in my psoas with some snapping, and no, it is (still) not pride that keeps me from running back to my OS to have it released. My feelings still hold true in my case, and in many cases regarding releasing tendons.
Many of you have asked me why I was so adamant about not having my psoas released. No, I am not a psychotic bitch who wanted to make my OS absolutely crazy, or an arrogant PT who thinks she knows everything. Firstly, I knew with all my heart that it was not the root of my problem, so releasing it would not have abolished my pain, and I was 100% correct in that, as was found on arthroscopic examination. Another point, for me, is that I have a hypermobile SI joint, which periodically gives me problems. All of my surrounding muscles are extremely tight, hamstrings, TFL, ITB, Piriformis....My feelings are that my muscles tighten to protect my SI and maintain in correct alignment.
My right hip is the one giving me the psoas issues.This is the "revision hip". This hip now has a tremendous amount of ROM, compared to pre-op, and compared to the contralateral side, since a lot of bone was taken down. Don't misunderstand, I love the way it feels now, but, my body has never functioned in this range before, it "thinks" that I now have an unstable hip, which in comparison to pre-op, I do. My ROM values are normal and not indicative of a hypermobile hip, yet I do not have the neuromuscular control yet to feel stable there. Initially, my adductors were tightening and going into spasm to stabilize. Once I strengthened them well (with a few knee blips along the way), they fared quite well.
Then my ITB went haywire, and still does occasionally, but I had been doing a lot of abductor strengthening as well. Psoas is now playing into this and making sure to get its share of the limelight. I am hoping that my new found love of Pilates will help with the neuromuscular control I need in the right hip, to help the entire joint stabilize and function well.
Lets just say, I did not have this realization, and decided that now would be a good time to have my psoas released, since it is acting up, I would most likely end up even more unstable hip and would probably begin to have problems with my ITB or maybe the adductors again. This would lead me down a vicious path of multiple releases. Even if the releases are not surgical, but rather manual (PT type) releases, things don't always work out so well, as I experienced at another course I took. It is imperative to retrain the muscles properly to avoid this and to re-educate the joint. Neuromuscular re-education needs to be a huge part of rehab, not just bridges, straight leg raises and clam shells.
I know I am having issues because I have not been the most compliant patient with my PT, especially after the MCL incident in December. But, I am pretty fed up with hip issues, so maybe I need to stop writing and get my butt into Pilates gear!!!
Disclaimer: This is in no way meant to be printed and brought to your OS to negotiate a tendon release (tenotomy), every case is different and every body is different. This post (and the entire blog) represent only my opinions, are not medically or scientifically backed, but rather, me venting and sharing personal ideas and experiences.
I will get off of my soap box now.
Many of you have asked me why I was so adamant about not having my psoas released. No, I am not a psychotic bitch who wanted to make my OS absolutely crazy, or an arrogant PT who thinks she knows everything. Firstly, I knew with all my heart that it was not the root of my problem, so releasing it would not have abolished my pain, and I was 100% correct in that, as was found on arthroscopic examination. Another point, for me, is that I have a hypermobile SI joint, which periodically gives me problems. All of my surrounding muscles are extremely tight, hamstrings, TFL, ITB, Piriformis....My feelings are that my muscles tighten to protect my SI and maintain in correct alignment.
My right hip is the one giving me the psoas issues.This is the "revision hip". This hip now has a tremendous amount of ROM, compared to pre-op, and compared to the contralateral side, since a lot of bone was taken down. Don't misunderstand, I love the way it feels now, but, my body has never functioned in this range before, it "thinks" that I now have an unstable hip, which in comparison to pre-op, I do. My ROM values are normal and not indicative of a hypermobile hip, yet I do not have the neuromuscular control yet to feel stable there. Initially, my adductors were tightening and going into spasm to stabilize. Once I strengthened them well (with a few knee blips along the way), they fared quite well.
Then my ITB went haywire, and still does occasionally, but I had been doing a lot of abductor strengthening as well. Psoas is now playing into this and making sure to get its share of the limelight. I am hoping that my new found love of Pilates will help with the neuromuscular control I need in the right hip, to help the entire joint stabilize and function well.
Lets just say, I did not have this realization, and decided that now would be a good time to have my psoas released, since it is acting up, I would most likely end up even more unstable hip and would probably begin to have problems with my ITB or maybe the adductors again. This would lead me down a vicious path of multiple releases. Even if the releases are not surgical, but rather manual (PT type) releases, things don't always work out so well, as I experienced at another course I took. It is imperative to retrain the muscles properly to avoid this and to re-educate the joint. Neuromuscular re-education needs to be a huge part of rehab, not just bridges, straight leg raises and clam shells.
I know I am having issues because I have not been the most compliant patient with my PT, especially after the MCL incident in December. But, I am pretty fed up with hip issues, so maybe I need to stop writing and get my butt into Pilates gear!!!
Disclaimer: This is in no way meant to be printed and brought to your OS to negotiate a tendon release (tenotomy), every case is different and every body is different. This post (and the entire blog) represent only my opinions, are not medically or scientifically backed, but rather, me venting and sharing personal ideas and experiences.
I will get off of my soap box now.
Update on CPM and Gameready Crap
I spoke to a lovely woman at the company who didn't seem to see a problem with paying $100/month until the balance is paid off. Now, J wants to have his HR department look into it and possibly reimburse us, since our health insurance is through his job. Again, I will keep you posted!
Gameready and CPM Crap Still Happening
As I mentioned previously, my insurance company denied payment for my CPM and Gameready. I have been in contact with the company that rented them to me through the process, so obviously I was quite shocked to find out that they put me into collections.
I called this morning and was informed that I was not really put into collections, but it was more of a scare tactic (my words, not theirs), to get me to pay. My balance is $515, that is the rental of 2 CPMs and 1 Gameready (I paid out of pocket for the Gameready for surgery #2 and did not get either machine for surgery #3).
I called and tried bargaining it down, they took off $45, I tried playing the "professional courtesy" card, they didn't buy it. Then I tried getting them to break up the payments for me, so I am waiting for a call back. I don't know what will happen.....wish me luck!!!
I called this morning and was informed that I was not really put into collections, but it was more of a scare tactic (my words, not theirs), to get me to pay. My balance is $515, that is the rental of 2 CPMs and 1 Gameready (I paid out of pocket for the Gameready for surgery #2 and did not get either machine for surgery #3).
I called and tried bargaining it down, they took off $45, I tried playing the "professional courtesy" card, they didn't buy it. Then I tried getting them to break up the payments for me, so I am waiting for a call back. I don't know what will happen.....wish me luck!!!
Tuesday, April 8, 2008
Never Stop Learning
If I ever feel that I have no more to learn, I will have to change professions. I learn something new almost every day, just by treating, being in my clinic and with my patients. I just returned from another continuing education course. It was not my favorite course, but it should prove to be very helpful in my treatments. In PT school, and in PT courses, there are no models. We do everything on each other.Luckily, this was a "tame" course which did not require the removal of clothing like some do!!
As usual, I am very "dysfunctional" when it comes to muscular and alignment issues. I am tight in all the wrong places, weak in all the other places, an overall mess. I started off the weekend with pretty bad back pain, my psoas had kicked i again and was unbelievably tight, pulling on my lumbar spine, topped with being in a different car than my own with poor back support (or poor ability of the driver, i.e. me, to figure out how to properly adjust the seat!!) My psoas got so bad that it became tender to the touch and full of trigger points. This usually pulls me into poor spinal alignment, making everything else go to hell.
So.......it turns out that my "partner"at the course used to work with P, she actually taught P how to release a psoas, irony of ironies. Today, she tried a release on me like no other. At the psoas insertion on the lesser trochanter. WHOA! Pain, but I sucked it up and let her do it, and then, less tender, and less clicking. I think this will be the only time I will have this done as it required her to put her hands in places I would rather not have P at!!! But just another trick to add to my "bag of tricks".
I am still on the fence with my knee. I am having less pain, and is always delayed onset pain. It still feels tight often, and the joint surface feels "weird", still "squishy" and "not right". One week to go before the appointment, still time to change my mind!!!!
As usual, I am very "dysfunctional" when it comes to muscular and alignment issues. I am tight in all the wrong places, weak in all the other places, an overall mess. I started off the weekend with pretty bad back pain, my psoas had kicked i again and was unbelievably tight, pulling on my lumbar spine, topped with being in a different car than my own with poor back support (or poor ability of the driver, i.e. me, to figure out how to properly adjust the seat!!) My psoas got so bad that it became tender to the touch and full of trigger points. This usually pulls me into poor spinal alignment, making everything else go to hell.
So.......it turns out that my "partner"at the course used to work with P, she actually taught P how to release a psoas, irony of ironies. Today, she tried a release on me like no other. At the psoas insertion on the lesser trochanter. WHOA! Pain, but I sucked it up and let her do it, and then, less tender, and less clicking. I think this will be the only time I will have this done as it required her to put her hands in places I would rather not have P at!!! But just another trick to add to my "bag of tricks".
I am still on the fence with my knee. I am having less pain, and is always delayed onset pain. It still feels tight often, and the joint surface feels "weird", still "squishy" and "not right". One week to go before the appointment, still time to change my mind!!!!
Saturday, April 5, 2008
Click Clack Moo
That is the title of one of my favorite children's books in our "collection". It is about cows with a typewriter who demand electric blankets. Each time I read it I get a smile on my face. I highly recommend it for those of you with kids (I read it to Jk, he is 2).
Lately, when I read this book, it reminds me of my right hip. See, I have started getting into Pilates. I actually really like it alot. The only issue is that some of the moves, especially with my legs straight when I am on my back, cause my right hip to click. It is my psoas. Hahaha!! I know what you are thinking. Don't worry, it is painless clicking, but I do actually feel the psoas snapping over "stuff". No, I am not getting it released. I think that even if it was a "problem" and became painful, pride would prevent me from EVER getting it released (newer readers check out posts from October and November of 2007 to get my feelings on releasing psoas).
I have had it click every now and then. The left one clicks when I sit on a low stool or chair, or the toilet sometimes. I was doing a move on Wednesday night, you lie on your back, legs straight and up in the air, separate the legs a little, circle them around, then bring them low and together, and finish with them bent at your chest. Every time I circle them, the psoas clicks. It is more annoying than anything. Maybe something I will just have to get used to.
In the end, the cows give up their typewriters in exchange for electric blankets, the duck acts as the neutral party, exchanging notes between the farmer and the cow. The last page of the book is a picture of the ducks in their pond, the page reads "Click Clack Quack".
Lately, when I read this book, it reminds me of my right hip. See, I have started getting into Pilates. I actually really like it alot. The only issue is that some of the moves, especially with my legs straight when I am on my back, cause my right hip to click. It is my psoas. Hahaha!! I know what you are thinking. Don't worry, it is painless clicking, but I do actually feel the psoas snapping over "stuff". No, I am not getting it released. I think that even if it was a "problem" and became painful, pride would prevent me from EVER getting it released (newer readers check out posts from October and November of 2007 to get my feelings on releasing psoas).
I have had it click every now and then. The left one clicks when I sit on a low stool or chair, or the toilet sometimes. I was doing a move on Wednesday night, you lie on your back, legs straight and up in the air, separate the legs a little, circle them around, then bring them low and together, and finish with them bent at your chest. Every time I circle them, the psoas clicks. It is more annoying than anything. Maybe something I will just have to get used to.
In the end, the cows give up their typewriters in exchange for electric blankets, the duck acts as the neutral party, exchanging notes between the farmer and the cow. The last page of the book is a picture of the ducks in their pond, the page reads "Click Clack Quack".
Wednesday, April 2, 2008
Is it Real or Am I Crazy??
Again with the fucking intermittent pain. This time, I can go a day and half with not even a twinge of pain in my knee, making me "this close" to cancelling my OS appointment in 2 weeks, and then one tiny misstep or walk down a step the wrong way, and bam, pain, and the ever pleasant "squooshiness" in my knee. I know there is a ton of psychology playing here, mainly the fact that I am praying for this to disappear, and I really really want to cancel my appointment, not lose a whole afternoon/ evening in a waiting room, pay a fortune for parking and then get stuck in rush hour traffic, all for nothing. I know, ridiculous. You are probably thinking "susie, just go for the appointment, what is your problem?" well, a lot. First, I think I have a fear of being told nothing is wronfg if I do in fact think there is something wrong, and I wouldn't be going to the appointment if I didn't think something was wrong. So, if I cancel it, it is because I no longer think anything is wrong and then I will be happy once again, and have "great joints". It stinks to think you know a lot but really, not know anything, and on top of it, have schizophrenic joints. Knee, please stop hurting and making my readers think I am a nut job. Please take the cues from my hips and behave yourself.
Saturday, March 29, 2008
5 Month and 9 Month Hip Updates
I haven't mentioned my hips in a while as other things have taken precedence lately. But here we go:
I am back to normal, or as normal as I will get with scoped hips. I will not use the treadmill, I think it is too hard on them and I really want to keep "these" hips for as long as possible.
I am getting more aches and pains now than I did before the knee thing (BTKT) began, so I totally attribute it to compensation. Previously, I had almost no achiness. Now I occasionally get achiness, right more than left (right was scoped twice), my adductors still get spasmy occasionally, more now than BTKT. I also now have a alot of clunking and clicking in both, I think left more than right. It is painless but loud. I have gotten into he habit of "cracking" my back, so I use various techniques, adopted from what I would use in the clinic. I always say that whatever needs to crack will crack with a manipulation, so at time, I will be focusing on my low back/ SI joint and will get a nice crack in a hip. I still hold onto the theory that it is scar tissue, and I don't worry one drop about it because it is painless, there is no FAI in either hip anymore so I won't tear my labrum again, plus, a good chunk of labrum was debrided so even less likely to tear (bc it is gone), and it is important to stay positive.
My IT bands get tight and tender sometimes, but I think they always were, even before the hip shit started. My "invisible bruise" on the right is still there, believe it or not. It does not interfere with my life anymore and the box of lidocaine patches sits on my desk, untouched. The area does consistently get smaller but the pain level is about the same, just in a smaller area.
I can push my stroller with no hip pain, I spin with no hip pain, I work with no hip pain, what more can I ask for :-)
A big part of healing, and healing well, is staying positive, focusing your energies and returning to life and moving past this messy chapter, and always remembering, things could always be worse!
I am back to normal, or as normal as I will get with scoped hips. I will not use the treadmill, I think it is too hard on them and I really want to keep "these" hips for as long as possible.
I am getting more aches and pains now than I did before the knee thing (BTKT) began, so I totally attribute it to compensation. Previously, I had almost no achiness. Now I occasionally get achiness, right more than left (right was scoped twice), my adductors still get spasmy occasionally, more now than BTKT. I also now have a alot of clunking and clicking in both, I think left more than right. It is painless but loud. I have gotten into he habit of "cracking" my back, so I use various techniques, adopted from what I would use in the clinic. I always say that whatever needs to crack will crack with a manipulation, so at time, I will be focusing on my low back/ SI joint and will get a nice crack in a hip. I still hold onto the theory that it is scar tissue, and I don't worry one drop about it because it is painless, there is no FAI in either hip anymore so I won't tear my labrum again, plus, a good chunk of labrum was debrided so even less likely to tear (bc it is gone), and it is important to stay positive.
My IT bands get tight and tender sometimes, but I think they always were, even before the hip shit started. My "invisible bruise" on the right is still there, believe it or not. It does not interfere with my life anymore and the box of lidocaine patches sits on my desk, untouched. The area does consistently get smaller but the pain level is about the same, just in a smaller area.
I can push my stroller with no hip pain, I spin with no hip pain, I work with no hip pain, what more can I ask for :-)
A big part of healing, and healing well, is staying positive, focusing your energies and returning to life and moving past this messy chapter, and always remembering, things could always be worse!
Tuesday, March 25, 2008
I Got Denied
By my insurance company on my second level appeal for the CPM and Gameready :-(
The billing people in my office had told me that if it got denied I could attempt a grievance appeal or something like that.
I thought is was a great letter. I will include it below since I have been asked for copies if it by readers.
To Whom It May Concern:
Please be advised that I have received a bill for a Game Ready TM Vasopneumatic Compression and Cold Therapy device, as well a Continuous Passive Motion Machine (CPM). These 2 pieces of equipment were prescribed to me by Dr. Bryan Kelly, the bill is from Biodynamic Technologies.
I went to see Dr. Kelly for disabling hip pain secondary to a torn labrum, which Dr. Kelly was able to repair via arthroscopy. Dr. Kelly prescribed the equipment mentioned above to maintain and increase range of motion (ROM) as well as to decrease inflammation and decrease pain, and prevent the build-up of scar tissue. At this point in time, there does not exist a CPM primarily for hips, therefore, a knee CPM must be used for all hip surgery. I would imagine that you do not deny charges for CPMs for patients that are status post knee surgery.
The Game Ready is unique because it supplies a combination of continuous cold therapy and intermittent pneumatic compression. RICE (Rest, Ice, Compression, and Elevation) is the universally accepted method of treating acute musculoskeletal injury and post-surgical trauma. The Game Ready device combines the two most difficult to manage aspects of the RICE regimen (ice and compression) in one easy to use system.
I am shocked to know that if an in-network physician prescribes a product to a patient, which in turn will help relieve their pain and reduce the possibility of further injury that you, a credible insurance company, would not pay for that product. I was under the impression that anything prescribed by my doctor would be covered. I believe that this decision was made unfairly, and would hope that you will rectify this matter immediately.
I have included a copy of bills from Biodynamic, Information on the Game Ready and a select list of clinical studies on cold and compression.
Respectfully,
Susie
I thought it was a great letter!!! I don't have the "select list of clinical studies" since I forgot to make a copy before mailing the letter. I obtained it by calling Gameready directly and explaining the situation to them. I will keep you posted on the progress!
The billing people in my office had told me that if it got denied I could attempt a grievance appeal or something like that.
I thought is was a great letter. I will include it below since I have been asked for copies if it by readers.
To Whom It May Concern:
Please be advised that I have received a bill for a Game Ready TM Vasopneumatic Compression and Cold Therapy device, as well a Continuous Passive Motion Machine (CPM). These 2 pieces of equipment were prescribed to me by Dr. Bryan Kelly, the bill is from Biodynamic Technologies.
I went to see Dr. Kelly for disabling hip pain secondary to a torn labrum, which Dr. Kelly was able to repair via arthroscopy. Dr. Kelly prescribed the equipment mentioned above to maintain and increase range of motion (ROM) as well as to decrease inflammation and decrease pain, and prevent the build-up of scar tissue. At this point in time, there does not exist a CPM primarily for hips, therefore, a knee CPM must be used for all hip surgery. I would imagine that you do not deny charges for CPMs for patients that are status post knee surgery.
The Game Ready is unique because it supplies a combination of continuous cold therapy and intermittent pneumatic compression. RICE (Rest, Ice, Compression, and Elevation) is the universally accepted method of treating acute musculoskeletal injury and post-surgical trauma. The Game Ready device combines the two most difficult to manage aspects of the RICE regimen (ice and compression) in one easy to use system.
I am shocked to know that if an in-network physician prescribes a product to a patient, which in turn will help relieve their pain and reduce the possibility of further injury that you, a credible insurance company, would not pay for that product. I was under the impression that anything prescribed by my doctor would be covered. I believe that this decision was made unfairly, and would hope that you will rectify this matter immediately.
I have included a copy of bills from Biodynamic, Information on the Game Ready and a select list of clinical studies on cold and compression.
Respectfully,
Susie
I thought it was a great letter!!! I don't have the "select list of clinical studies" since I forgot to make a copy before mailing the letter. I obtained it by calling Gameready directly and explaining the situation to them. I will keep you posted on the progress!
Dejavu AGAIN
I feel like someone has put me in a time machine, taken me back to 15 months ago, and moved my hips about 18 inches down. All of my "am I crazy" thoughts have returned, along with INTERMITTENT PAIN.
Ok, so really, I should be happy that my knee doesn't hurt all the time, but what happens is I get excited, like the problem has gone away. But then, without warning, it comes back. It is not even activiy dependent anymore, sometimes certain things will bother me, and then the next day I do the same exact activity and I am fine. Go figure! Then, my other knee will get cranky, further pushing me into a state of psychosis!
OMG, I think I may have plagiarized that entire posting....from my hips!!!!!
Ok, so really, I should be happy that my knee doesn't hurt all the time, but what happens is I get excited, like the problem has gone away. But then, without warning, it comes back. It is not even activiy dependent anymore, sometimes certain things will bother me, and then the next day I do the same exact activity and I am fine. Go figure! Then, my other knee will get cranky, further pushing me into a state of psychosis!
OMG, I think I may have plagiarized that entire posting....from my hips!!!!!
Sunday, March 23, 2008
Someone is Watching Over Me...Why Did I Blow It???
As I was ordered, I have stayed away from my spinning bike, I remained compliant for a total of 5 days, but today, the urge was too intense to resist so I rushed through the kid's bedtime, jumped into my workout gear and mounted my bike. I clipped in and attempted a pedal stroke and heard a loud crash/clunk/metal grindy noise that scared the crap out of me. I then lost all resistance on the pedals, and further freaked out as I thought the pedal had fallen off (mind you this whole scenario lasted about half a second). I looked down and saw a piece of the chain hanging down.
Hmmm, maybe this is a sign that I shouldn't be spinning right now, "baloney" I said to myself (actually, it was more like "WTF, I need to ride"), so I emailed the company I had bought it from and the owner got back to me within the hour (on Sunday, on Easter). Obviously, I had to put J on the phone since I had no idea what he was talking about. But between J and our friend and neighbor Dave, the bike was fixed and I got my 'fix'!
I never learn! Need I say more!
Hmmm, maybe this is a sign that I shouldn't be spinning right now, "baloney" I said to myself (actually, it was more like "WTF, I need to ride"), so I emailed the company I had bought it from and the owner got back to me within the hour (on Sunday, on Easter). Obviously, I had to put J on the phone since I had no idea what he was talking about. But between J and our friend and neighbor Dave, the bike was fixed and I got my 'fix'!
I never learn! Need I say more!
Good People Really do Exist in This World
Warning- not orthopedically related but I really had to share
On Wednesday morning, I put my ipod and phone in my coat pocket and proceeded out the door to my car. We live in NY, so my parking lot is about a block away, a HUGE luxury (seriously). I started the car, stuck my hand in my pocket, and there was no ipod. Shit. Where is it. I assumed I had just thought that I had out it in my pocket but really left it in the kitchen since I have been borderline crazy this week again. When I got to work, I called J and asked him to check the kitchen for me. He forgot, but I assumed all was well. I got home and there was no ipod. My nanny hadn't seen it and L and Jk swore they hadn't touched it. To add insult to injury, my first ipod had been stolen about 1 year ago when I found a super parking spot in front of my building and chose not to park in the lot. Stupidly, I left the ipod in plain site, someone smashed my window and snatched the ipod and the thingy to listen to it through the radio. Buying ipods cannot become a yearly event.
By Friday I had decided it was gone, J was being nice and had loaned me his ipod, probably for fear that I would just go out and buy myself a new one without first truly searching every inch of the apartment. Last night, J went out and called me from the car. 'There is a note on the car " he said, "Did you lose something pink? Call me". Holy shit, it was my parking neighbor. "What did you lose that is pink?" J asked "MY IPOD". Hurray! I am totally shocked. How nice are my parking neighbors?I don't even know them, if I have seen them 1x it is a lot. They live across the street so I will go retrieve it today.
Just in time for me to resume Spinning, as I was 'ordered' to "modify my activities and NOT spin". It is not working bc I am stil in a motherload of pain, so why not do what makes me happy, it is not making a difference!!!
On Wednesday morning, I put my ipod and phone in my coat pocket and proceeded out the door to my car. We live in NY, so my parking lot is about a block away, a HUGE luxury (seriously). I started the car, stuck my hand in my pocket, and there was no ipod. Shit. Where is it. I assumed I had just thought that I had out it in my pocket but really left it in the kitchen since I have been borderline crazy this week again. When I got to work, I called J and asked him to check the kitchen for me. He forgot, but I assumed all was well. I got home and there was no ipod. My nanny hadn't seen it and L and Jk swore they hadn't touched it. To add insult to injury, my first ipod had been stolen about 1 year ago when I found a super parking spot in front of my building and chose not to park in the lot. Stupidly, I left the ipod in plain site, someone smashed my window and snatched the ipod and the thingy to listen to it through the radio. Buying ipods cannot become a yearly event.
By Friday I had decided it was gone, J was being nice and had loaned me his ipod, probably for fear that I would just go out and buy myself a new one without first truly searching every inch of the apartment. Last night, J went out and called me from the car. 'There is a note on the car " he said, "Did you lose something pink? Call me". Holy shit, it was my parking neighbor. "What did you lose that is pink?" J asked "MY IPOD". Hurray! I am totally shocked. How nice are my parking neighbors?I don't even know them, if I have seen them 1x it is a lot. They live across the street so I will go retrieve it today.
Just in time for me to resume Spinning, as I was 'ordered' to "modify my activities and NOT spin". It is not working bc I am stil in a motherload of pain, so why not do what makes me happy, it is not making a difference!!!
Friday, March 21, 2008
Purim 2008
Today we are celebrating the Jewish holiday of Purim. All the children dress up and have a blast. Can you guess what L dressed up as? Jk was a dog but refused to wear his ears!
L and Jk making Purim art projects
L and Jk making Purim art projects
Wednesday, March 19, 2008
And Reality Begins to Set In
This is not going away. I am slowly starting to get over my denial! I made an appointment with Dr.Kelly today, then I emailed his PA. She said to do 8 weeks of PT and then see where I am.
Have I mentioned that I HATE PT. Not PT's, but PT. I have had it. To make matters worse, I began strengthening my quad tonight with some simple, old lady style quad sets, AND THEY HURT. I didn't spin bc I worked an 11 hour day and basically passed out when I got home. It is probably a good thing since it totally killed me last night. I was compliant and iced for a long time tonight. For some reason, I am more inclined to ice my knee than I ever was my hip. Maybe it is due to the superficiality of the knee structures, I can palpate tender spots on it, I never was bale to touch anything on the hip.
Have I mentioned that I HATE PT. Not PT's, but PT. I have had it. To make matters worse, I began strengthening my quad tonight with some simple, old lady style quad sets, AND THEY HURT. I didn't spin bc I worked an 11 hour day and basically passed out when I got home. It is probably a good thing since it totally killed me last night. I was compliant and iced for a long time tonight. For some reason, I am more inclined to ice my knee than I ever was my hip. Maybe it is due to the superficiality of the knee structures, I can palpate tender spots on it, I never was bale to touch anything on the hip.
Tuesday, March 18, 2008
My So Called Life (Part 2)
Left knee has been bad, right hip is yelling at me to fix left knee so it can go back to optimal function. J is being a complete ass about the whole thing, as if I wished this upon myself. I wish men in general were more understanding about the way women work, think and act. He asked me what body part will be next, since it seems like a pattern going on, this time a zig-zag, since we went right hip,left hip, right hip and now left knee.Maybe next will be right ankle? J, I hope you never have to experience any ortho issues bc heaven knows I won't be as supportive as I could be, or should be. As the husband of a PT, you could receive optimal treatment from diagnosis to recovery, but you will be on your own.
Ok, I am (sort of) done venting. Am I the only one with a partner who is totally clueless?
I had pain for the first 20 minutes of my spin tonight, then 10 minutes of "OK" then I had to stop. I iced and now I feel swollen and tight (there is no obvious visible swelling). I am tempted to make an appt with Dr Kelly to figure this out, but am mentally exhausted from all of this. I know, I should, but it is a lot to process right now. There is a lot going on in my life these days. Maybe he can offer a quick fix, like cortisone, I love cortisone!!!! I am in no way shape or form accepting surgery as an option right now, which is why I sort of feel a visit with him is a waste, ah, the beauty of having to make simple decisions. And, nothing says I can't cancel the appointment once it is made. But once I make an appointment, it makes this more real, or in J's eyes, makes me more crazy and neurotic, and needy too. J, maybe you should post a comment in your defense, if you have one. If not, stay tuned to more husband bashing to come in the future.
Ok, I am (sort of) done venting. Am I the only one with a partner who is totally clueless?
I had pain for the first 20 minutes of my spin tonight, then 10 minutes of "OK" then I had to stop. I iced and now I feel swollen and tight (there is no obvious visible swelling). I am tempted to make an appt with Dr Kelly to figure this out, but am mentally exhausted from all of this. I know, I should, but it is a lot to process right now. There is a lot going on in my life these days. Maybe he can offer a quick fix, like cortisone, I love cortisone!!!! I am in no way shape or form accepting surgery as an option right now, which is why I sort of feel a visit with him is a waste, ah, the beauty of having to make simple decisions. And, nothing says I can't cancel the appointment once it is made. But once I make an appointment, it makes this more real, or in J's eyes, makes me more crazy and neurotic, and needy too. J, maybe you should post a comment in your defense, if you have one. If not, stay tuned to more husband bashing to come in the future.
Monday, March 17, 2008
Still Dealing With Crap From Hip Arthroscopy numer's 1 and 2
My wonderful (not being sarcastic) insurance company covered all cost of surgery, hospitalization, anesthesia, rehab (sort of), basically everything associated with the surgery, except the Gameready and CPM, which I was later told by someone in my OS office that these are "luxury items", and "I told you they may not be covered".
Me, being me, initially ignored the bills, which totaled around $700 but were knocked down to $500 for me. After a while, I decided I should stop ignoring them and do something. Again, me being me, I had no idea what to do.Luckily, one of the people in the billing department of my office used to work for one of the companies that rent these same machines, and get this, her job was taking care of denials. So she gave me a huge stack of appeal letters to pick and choose from. I also called Gameready and they sent me literature and journal articles supporting their products. So I wrote a great letter and sent it in, in January.
I then forgot about the letter, until another bill arrived. So I called my insurance and they agreed to "expedite" the claim. Today, I received a letter from them. Excitedly, expecting a check, I opened the letter, which was informing me that they received my letter and will let me know of their decision within 30 days. I can't imagine having to have gone through this for the surgery itself. sigh!
Me, being me, initially ignored the bills, which totaled around $700 but were knocked down to $500 for me. After a while, I decided I should stop ignoring them and do something. Again, me being me, I had no idea what to do.Luckily, one of the people in the billing department of my office used to work for one of the companies that rent these same machines, and get this, her job was taking care of denials. So she gave me a huge stack of appeal letters to pick and choose from. I also called Gameready and they sent me literature and journal articles supporting their products. So I wrote a great letter and sent it in, in January.
I then forgot about the letter, until another bill arrived. So I called my insurance and they agreed to "expedite" the claim. Today, I received a letter from them. Excitedly, expecting a check, I opened the letter, which was informing me that they received my letter and will let me know of their decision within 30 days. I can't imagine having to have gone through this for the surgery itself. sigh!
Sunday, March 16, 2008
Weekend Update
I think I must make a vow to myself that this will not in any way shape or form become a 'knee blog'. No sir. This is going to have to go away. I do not want to deal with this. But yet I find myslef in a deja vu of how my hip issues started. I go through the day saying "I can ignore this, this is not a big deal, oh, now there is no pain, oh shit, now it is back, what am I going to do". Literally, this is what happens. But I really want this to go away.
An update to the taping: Shortly after I blogged, the joint pain came back, the pes and MCL pain stayed away. The tape began to irritate my thigh (I had recently seen a terrible skin reaction on one of my patients from the tape so I got nervous) so off it came. My MCL and pes anserine are ok, but the joint pain comes and goes. Yesterday, I was in a lot of pain again. Today, I did less and felt better. I am not quite sure what to do at this point.
I feel like I am "one of those people", there is always something wrong.I just want to feel normal again, no aches, no pains, no numbness and tingling. Believe it or not, until 15 months ago, I was normal!
An update to the taping: Shortly after I blogged, the joint pain came back, the pes and MCL pain stayed away. The tape began to irritate my thigh (I had recently seen a terrible skin reaction on one of my patients from the tape so I got nervous) so off it came. My MCL and pes anserine are ok, but the joint pain comes and goes. Yesterday, I was in a lot of pain again. Today, I did less and felt better. I am not quite sure what to do at this point.
I feel like I am "one of those people", there is always something wrong.I just want to feel normal again, no aches, no pains, no numbness and tingling. Believe it or not, until 15 months ago, I was normal!
Friday, March 14, 2008
I Am Not Dead
So I am still in pain!! Actually, now, I may headed into a state of unconsciousness thanks to P's grand ideas! My knee was hell today and yesterday. Today, I was limping, I could not jump down from treatment tables onto it, I could not squat. I was wearing my good shoes with orthotics. I was not a happy camper.
I have tenderness right at the medial joint line, on the meniscus, as well as the MCL and pes anserine. P taped my tibia into internal rotation to better align my knee and de-stress the pes and MCL, and miraculously, the joint pain went away too. Now, the key will be how to maintain this, I can't be taped forever, it is pretty ugly!
I have tenderness right at the medial joint line, on the meniscus, as well as the MCL and pes anserine. P taped my tibia into internal rotation to better align my knee and de-stress the pes and MCL, and miraculously, the joint pain went away too. Now, the key will be how to maintain this, I can't be taped forever, it is pretty ugly!
Wednesday, March 12, 2008
Back to PT, Back to Working Out
I saw P today since my hip has been tight and my knee is a mess. I am pretty convinced the 2 are related, when the knee pain got bad, the hip started acting up. He did a great job on my hip, working the iliacus/psoas area (painful but it has been much worse), doing some anterior hip mobs and stretching my psoas. Then on to the knee. The meniscus is tender, but so is my MCL and my pes anserine. So...for now, I have been ordered to wear more supportive shoes and if necessary tape my foot before I exercise. I pronate...a lot, and this seems to add to my problems. I had a negative Mcmurray's test, a positive Apley's Compression and a positive "knee scour", the evidence shows that these tests are not all that great though.
I skipped all lower extremity work on the bosu today and focused on my abs. I will know in the morning if it was a good workout if I wake up sore.
I plan on wearing good shoes tomorrow to see if that helps! AHHHHHHHH!!!
I skipped all lower extremity work on the bosu today and focused on my abs. I will know in the morning if it was a good workout if I wake up sore.
I plan on wearing good shoes tomorrow to see if that helps! AHHHHHHHH!!!
Tuesday, March 11, 2008
Fun and Games on the Bosu Ball
Whoa, where is your mind wandering off to? J is out of town anyway!
I bought a Bosu ball a long time ago, the kids loved coming to my office and jumping on the mini trampoline but I didn't think it was safe to have in the house since the springs made me nervous. So I took them back to my office to try the Bosu and they loved it, they call it the "jumping toy". It has been in my living room forever and I just decided to try the video it came with.
First off, my abs are shot. Beyond shot, they are just about non-existent. I had to modify some of the exercises ALOT bc of my weakness. There was also one exercise where you lie sideways across the bosu and hold your legs up off of the floor, my adductors were too weak to keep the bottom leg off of the floor.
All I can say is thank goodness I was in the privacy of my living room and not at the gym, I would have been mortified!
I did squats, lunges, balancing....the hips did pretty well, the right one did give some indication that the bouncing was not a good idea by throwing in some occasional groin pain. The knee was not happy at all with the squats and step ups, and I didn't even attempt any of the twisting exercises.
It was a short, condensed video but I am going to look into finding some more, with mainly ab work.
I can't believe my abs have come to this, I knew they were weaker but this is bad. Time to kick up the workouts a notch!
I bought a Bosu ball a long time ago, the kids loved coming to my office and jumping on the mini trampoline but I didn't think it was safe to have in the house since the springs made me nervous. So I took them back to my office to try the Bosu and they loved it, they call it the "jumping toy". It has been in my living room forever and I just decided to try the video it came with.
First off, my abs are shot. Beyond shot, they are just about non-existent. I had to modify some of the exercises ALOT bc of my weakness. There was also one exercise where you lie sideways across the bosu and hold your legs up off of the floor, my adductors were too weak to keep the bottom leg off of the floor.
All I can say is thank goodness I was in the privacy of my living room and not at the gym, I would have been mortified!
I did squats, lunges, balancing....the hips did pretty well, the right one did give some indication that the bouncing was not a good idea by throwing in some occasional groin pain. The knee was not happy at all with the squats and step ups, and I didn't even attempt any of the twisting exercises.
It was a short, condensed video but I am going to look into finding some more, with mainly ab work.
I can't believe my abs have come to this, I knew they were weaker but this is bad. Time to kick up the workouts a notch!
Monday, March 10, 2008
I Think That If I Ever Wake Up Painfree I May Actually be Dead
So where do I begin the tale of this beautifully hideous Monday. Maybe with the continued knee pain, or with the fact that I am no longer a PT drop out. Yes, you heard correctly. P will have the pleasure of seeing me again (as a patient) on Wed.
Why? Why is this happening? Should I look at this logically, scientifically? Or more in the "why do bad things happen to good people" way? So....the knee pain is there, it is not constant but it can get pretty bad at times. Luckily, it goes just as quickly as it came. But....I must be somehow compensating (ahhhhh....I hate that word) since my right hip (left knee is troublesome) started acting up yesterday. I have been stretching and FABERing and doing all sorts of fun things but I think it is out of my hands now and needs some 'more' professional help. Hence my crawling back to P to work on it and also have a quick look at my knee since I think this is all due to that adductor exercise way back when.
I am pretty sure the hip thing is the adductor insertion point onto the pubis becoming tight and painful, I am also having trouble getting into a full FABER position. Honestly though, I am not very good about stretching on my own and Spinning is all I do for exercise with a (really) quick stretch at the end. Maybe I need to practice what I preach a little bit more.
I will see what P has to say but the thought of even an MRI at this point makes me want to live in pain for the rest of my life. Also, I don't know how much I want to know what is going on in this knee, in grad school I had it x-rayed for similar issues and it showed decreased joint space and an MRI showed a joint effusion. I never followed up bc I had custom orthotics made which helped 99.9% and then I got pregnant with L, finished school, got pregnant with Jk, had 3 hip arthroscopies...so I have been sort of busy. I am seriously hoping that if I am diligent about wearing my orthotics (cut back on the cute Tory Burch's) and start strengthening and stretching the right muscles, things will get better!
Why? Why is this happening? Should I look at this logically, scientifically? Or more in the "why do bad things happen to good people" way? So....the knee pain is there, it is not constant but it can get pretty bad at times. Luckily, it goes just as quickly as it came. But....I must be somehow compensating (ahhhhh....I hate that word) since my right hip (left knee is troublesome) started acting up yesterday. I have been stretching and FABERing and doing all sorts of fun things but I think it is out of my hands now and needs some 'more' professional help. Hence my crawling back to P to work on it and also have a quick look at my knee since I think this is all due to that adductor exercise way back when.
I am pretty sure the hip thing is the adductor insertion point onto the pubis becoming tight and painful, I am also having trouble getting into a full FABER position. Honestly though, I am not very good about stretching on my own and Spinning is all I do for exercise with a (really) quick stretch at the end. Maybe I need to practice what I preach a little bit more.
I will see what P has to say but the thought of even an MRI at this point makes me want to live in pain for the rest of my life. Also, I don't know how much I want to know what is going on in this knee, in grad school I had it x-rayed for similar issues and it showed decreased joint space and an MRI showed a joint effusion. I never followed up bc I had custom orthotics made which helped 99.9% and then I got pregnant with L, finished school, got pregnant with Jk, had 3 hip arthroscopies...so I have been sort of busy. I am seriously hoping that if I am diligent about wearing my orthotics (cut back on the cute Tory Burch's) and start strengthening and stretching the right muscles, things will get better!
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