Sunday, May 24, 2009
J's Update
I think a while back I mentioned that J was complaining of hip pain. It has been bothering him again, and pretty bad, so he finally has allowed me to make him an appointment to see Dr. K. I can't help but laugh (really hard), but really, its not so funny! I think he may have bilateral FAI and torn labrums. I hope he can get an appointment soon because I don't know how much more complaining I can take!!!
Monday, May 18, 2009
Another "Jeff" Update
My brother is now about 2 1/2 months post-op. He is running, swimming and playing doubles tennis. This is after hip arthroscopy for cam and pincer FAI and a torn labrum (debridement). To add "insult to injury" (bc hey, I was soooo not even close to being this active at 2 1/2 months out) he went skydiving this past Sunday and had no trouble whatsoever! I think he is in the clear to call his surgery a success!!!
On another positive note, J is now 6 months post-op from his surgery and down 96 lbs!!! Here we are celebrating his 29th b-day! Looks like Z is more interested in the cake than anything else!Monday, May 4, 2009
A Gross and Rainy Day
For those of you who live in the Northeast, I need not tell you about the dreary weather we have been having. It is cold and wet and just gross. Occasionally, when this happens, my hip will flare up. Not so much the actual joint, but minor problems I have had along the road to recovery seem to rear their ugly head on days like this.
The biggest problem is my residual nerve damage. If you remember way way back, after hipscope #3, I had a large patch of numbness on the front of my thigh. This slowly went away but was painful at times. On days like today, I have a lot of pain and soreness along the front of my thigh. It is also tender to the touch. I assume there was some sort of trauma to my lateral femoral cutaneous nerve and it is not fully healed. Will it ever be? Who knows.
I also had a bit of adductor tendonitis today, which I assume is also weather related. So this morning I was not a happy camper in hipville. Things have since calmed down and I am back to status quo, but it makes me wonder if this is something I will have to live with forever.....
The biggest problem is my residual nerve damage. If you remember way way back, after hipscope #3, I had a large patch of numbness on the front of my thigh. This slowly went away but was painful at times. On days like today, I have a lot of pain and soreness along the front of my thigh. It is also tender to the touch. I assume there was some sort of trauma to my lateral femoral cutaneous nerve and it is not fully healed. Will it ever be? Who knows.
I also had a bit of adductor tendonitis today, which I assume is also weather related. So this morning I was not a happy camper in hipville. Things have since calmed down and I am back to status quo, but it makes me wonder if this is something I will have to live with forever.....
Monday, April 20, 2009
Some Pics
I know I have been MIA for a while again, but all things hip continue to be good! I promise an update on my brother this week (ok, I promise to try). Here are just some pics of what has been keeping me busy, plus, I was just away for a week and a half in Miami!
This was actually my carriage as a baby. all 3 kids have used it for the first few months when they sleep in my room!
L at the Clinique counter
Life is Good!!!
Yes, I give my 3 month old cereal to get him to sleep through the night!
This was actually my carriage as a baby. all 3 kids have used it for the first few months when they sleep in my room!
L at the Clinique counter
Life is Good!!!
Yes, I give my 3 month old cereal to get him to sleep through the night!
Sunday, April 5, 2009
ICD-9 and CPT codes used for Hip Arthroscopy
Many people have been asking me what kind of magic I used to get my surgery paid for...well....none really. I think the OS office has a lot of experience dealing with it and billing correctly. My OS was also in network, which took a lot of headache away from this.
Below are the codes used for all 3 surgeries. Maybe one day in the distant future, if I find myself with some time on my hands, I will look up the up and add the name as well. For now, this is the best I can do...
And a link to an older post of what exactly was paid for each surgery
3/5/2007
CPT
29862
27120
29863
ICD9
719.45
738.6
718.85
715.15
7/2/07
CPT
29862
29863
27120
27179
ICD9
719.45
738.6
732.2
11/12/07
CPT
29862
29863
27179
ICD9
719.45
732.2
Below are the codes used for all 3 surgeries. Maybe one day in the distant future, if I find myself with some time on my hands, I will look up the up and add the name as well. For now, this is the best I can do...
And a link to an older post of what exactly was paid for each surgery
3/5/2007
CPT
29862
27120
29863
ICD9
719.45
738.6
718.85
715.15
7/2/07
CPT
29862
29863
27120
27179
ICD9
719.45
738.6
732.2
11/12/07
CPT
29862
29863
27179
ICD9
719.45
732.2
Wednesday, March 4, 2009
Another interesting article
I came across this article this week, and if I remember how, I will add it to my "article" file.
Acetabular Labral Tears
Paul E. Beaulé, Michelle O'Neill and Kawan Rakhra
J Bone Joint Surg Am. 2009;91:701-710. doi:10.2106/JBJS.H.00802
A few key points:
Current Concepts Review
Acetabular Labral Tears
By Paul E. Beaul´e, MD, FRCSC, Michelle O’Neill, MD, FRCSC, and Kawan Rakhra, MD, FRCPC
-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.
"Despite the recent advancements in imaging as well as
operative techniques, patients are often misdiagnosed. In one
report, it was documented that patients visited, on the average,
3.3 health-care providers before being correctly diagnosed with
a labral tear and waited an average of twenty-one months for
the diagnosis18. More importantly, 33% (twenty-two) of sixtysix
patients received an alternate diagnosis prior to being diagnosed
with a labral tear. In addition, the lack of a complete
understanding of the function of the acetabular labrum as well
as its anatomy has made treatment recommendations difficult
to establish"
"Lage et al.7 described four categories of labral tears based
on etiology.
1. Traumatic, based on a clear history of hip injury and
the subsequent onset of symptoms. More recently, a traction
injury of the labrum by the iliopsoas tendon has been reported
in some cases40, with the intra-articular portion of the iliopsoas
tendon noted to be attached to the labrum in those cases.
2. Congenital, based on the presence of acetabular dysplasia,
defined as a center-edge angle of <25>1041-43.
3. Degenerative, based on radiographic evidence of arthritic
changes, such as joint space narrowing or osteophytes,
or the identification of severe chondral damage at the time of
operative intervention.
4. Idiopathic, based on the absence of any other findings."
"However, three recent studies in which the presence of
osseous abnormalities was retrospectively examined in patients
with a labral tear demonstrated that the majority (49% of
seventy-eight, 79% of ninety-nine, and 87% of thirty-one17,44,45)
had an osseous dysmorphism consistent with femoroacetabular
impingement. It would thus be more appropriate to rename
the so-called idiopathic group femoroacetabular impingement.
Ganz et al. described two mechanisms of femoroacetabular impingement
15: pincer type secondary to acetabular overcoverage
and cam type secondary to a lack of femoral head-neck offset
(Fig. 2). In pincer-type impingement, repeated contact between
the femoral neck and the prominent anterior aspect of the acetabular
rim leads to initial damage of the labrum36,46 and often a
contre-coup lesion leading to premature wear of the posterior
articular surface. In cam-type impingement, abnormal jamming
of the head-neck junction causes an outside-in intrasubstance
avulsion of the labrum from the adjoining acetabular cartilage
15,36"
Diagnosis of Labral Tears
Clinical Evaluation
"In the majority of patients, the chief symptom is anterior groin
pain made worse by long periods of standing, sitting, or walking.
The pain can also be referred to the gluteal area or the
trochanteric region. The onset of pain is usually insidious4, with
the patient often unable to recall a specific traumatic event9. In
one study, only 9% (six) of sixty-six patients with a labral tear
had a major traumatic episode as a causative factor18. The pain
is often sharp in nature and aggravated by activity such as
walking and pivoting on the affected side. The presence of
mechanical symptoms such as clicking and catching is highly
variable and not necessarily indicative of intra-articular hip
pathology9."
"On physical examination, the most reliable sign of labral
pathology is pain reproduced with flexion beyond 90 combined
with internal rotation and adduction4. This is referred to as the
impingement sign"
Acetabular Labral Tears
Paul E. Beaulé, Michelle O'Neill and Kawan Rakhra
J Bone Joint Surg Am. 2009;91:701-710. doi:10.2106/JBJS.H.00802
A few key points:
Current Concepts Review
Acetabular Labral Tears
By Paul E. Beaul´e, MD, FRCSC, Michelle O’Neill, MD, FRCSC, and Kawan Rakhra, MD, FRCPC
-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.
"Despite the recent advancements in imaging as well as
operative techniques, patients are often misdiagnosed. In one
report, it was documented that patients visited, on the average,
3.3 health-care providers before being correctly diagnosed with
a labral tear and waited an average of twenty-one months for
the diagnosis18. More importantly, 33% (twenty-two) of sixtysix
patients received an alternate diagnosis prior to being diagnosed
with a labral tear. In addition, the lack of a complete
understanding of the function of the acetabular labrum as well
as its anatomy has made treatment recommendations difficult
to establish"
"Lage et al.7 described four categories of labral tears based
on etiology.
1. Traumatic, based on a clear history of hip injury and
the subsequent onset of symptoms. More recently, a traction
injury of the labrum by the iliopsoas tendon has been reported
in some cases40, with the intra-articular portion of the iliopsoas
tendon noted to be attached to the labrum in those cases.
2. Congenital, based on the presence of acetabular dysplasia,
defined as a center-edge angle of <25>1041-43.
3. Degenerative, based on radiographic evidence of arthritic
changes, such as joint space narrowing or osteophytes,
or the identification of severe chondral damage at the time of
operative intervention.
4. Idiopathic, based on the absence of any other findings."
"However, three recent studies in which the presence of
osseous abnormalities was retrospectively examined in patients
with a labral tear demonstrated that the majority (49% of
seventy-eight, 79% of ninety-nine, and 87% of thirty-one17,44,45)
had an osseous dysmorphism consistent with femoroacetabular
impingement. It would thus be more appropriate to rename
the so-called idiopathic group femoroacetabular impingement.
Ganz et al. described two mechanisms of femoroacetabular impingement
15: pincer type secondary to acetabular overcoverage
and cam type secondary to a lack of femoral head-neck offset
(Fig. 2). In pincer-type impingement, repeated contact between
the femoral neck and the prominent anterior aspect of the acetabular
rim leads to initial damage of the labrum36,46 and often a
contre-coup lesion leading to premature wear of the posterior
articular surface. In cam-type impingement, abnormal jamming
of the head-neck junction causes an outside-in intrasubstance
avulsion of the labrum from the adjoining acetabular cartilage
15,36"
Diagnosis of Labral Tears
Clinical Evaluation
"In the majority of patients, the chief symptom is anterior groin
pain made worse by long periods of standing, sitting, or walking.
The pain can also be referred to the gluteal area or the
trochanteric region. The onset of pain is usually insidious4, with
the patient often unable to recall a specific traumatic event9. In
one study, only 9% (six) of sixty-six patients with a labral tear
had a major traumatic episode as a causative factor18. The pain
is often sharp in nature and aggravated by activity such as
walking and pivoting on the affected side. The presence of
mechanical symptoms such as clicking and catching is highly
variable and not necessarily indicative of intra-articular hip
pathology9."
"On physical examination, the most reliable sign of labral
pathology is pain reproduced with flexion beyond 90 combined
with internal rotation and adduction4. This is referred to as the
impingement sign"
Monday, March 2, 2009
OMG I haven't posted in a long time
Wow, it's been a while! Zach is 7 weeks old today and keeping me busy! Luckily I have great help!
(I have no idea why that is underlined but I can't seem to change it)
He stayed with me for 5 days after his surgery and then flew home. My mom was here too. Just so you have an idea of how well he did post-op (or how poorly I did), every time someone called my mom to ask how he was, I always heard her say "He is doing great, so much better than Susie ever did!"
Ok, so I don't do that well immediately post-op, I have a "thing" with drugs, we just don't get along! But long term, I did kick ass, if I do say so myself!!!
So, at 7 weeks post partum with a rather large baby, my hip joint is still great. I did start having some adductor and flexor tendonitis a few weeks ago. I am not sure why. I have in the past developed SI joint issues a few weeks/ months postpartum and I wonder if it is related. The pain is the worst when I "wear" Zach. Yes, I am a "baby wearer", currently in a Storchenwiege wrap.
(I have no idea why that is underlined but I can't seem to change it)
I wanted to post last week but never found the time! My brother had his hip arthroscopy last Monday. This has been a problem for him since last April. He had very similar symptoms as me, except that he is extremely athletic and I, well, am a mother of 3 with a job! His surgery went well, and he had a torn labrum, synovitis, cam and pincer FAI. Sound familiar? Weird that we both have (had) cam and pincer.
He stayed with me for 5 days after his surgery and then flew home. My mom was here too. Just so you have an idea of how well he did post-op (or how poorly I did), every time someone called my mom to ask how he was, I always heard her say "He is doing great, so much better than Susie ever did!"
Ok, so I don't do that well immediately post-op, I have a "thing" with drugs, we just don't get along! But long term, I did kick ass, if I do say so myself!!!
So, at 7 weeks post partum with a rather large baby, my hip joint is still great. I did start having some adductor and flexor tendonitis a few weeks ago. I am not sure why. I have in the past developed SI joint issues a few weeks/ months postpartum and I wonder if it is related. The pain is the worst when I "wear" Zach. Yes, I am a "baby wearer", currently in a Storchenwiege wrap.
Yep, Zach is inside the blue fabric, sleeping soundly, at 1 month old, at Disney World!
So all in all, I can say that pregnancy and delivery have not had a negative effect on my hips. I am confident that the tendonitis will resolve (I forgot to mention it is only on the right (revision) side). Exhaustion is kicking now.....
Wednesday, January 21, 2009
Tuesday, January 13, 2009
The Birth Story
With my due date quickly approaching and night after night of false labor (16 hours one night), I was losing my patience. I was uncomfortable, swollen, out of breath and in pain a lot of the time. I took an unofficial poll of my friends on facebook to see how they suggested I get this baby out. Castor oil and sex were the top picks, sex had not worked up until then. So J went out to buy castor oil. I was nervous about taking it, it hadn't worked for some people, others threw up from it, but I needed to do something. I had also asked my doula abt it and she didn't seem to recommend it unless you are facing an induction with pitocin.
So once the kids were in bed, J mixed 4 tbsp of castor oil with a small amount of ice cream. It wasn't as bad as I expected and I would recommend the ice cream method to anyone thinking of trying it. 2 1/2 hours later I threw up. I was disappointed that it hadn't worked and was not willing to try it again. About an hour later I realized that I had not thrown it all up and what was in me began to work. After several trips to the bathroom, it had done its job.
I went to bed around 11. At midnight I was having some contractions but was able to sleep and kept remembering all the false labor I had been having. At 2:30 I got up to go to the bathroom and began having awful back labor with the contractions 4-6 minutes apart and lasting about a minute. This all started very suddenly with J insisting the contractions were very close together. I called my doula who suggested we meet at the hospital rather than at my house. The contractions kept coming, now abt 3-4 minutes apart.
We just grabbed my bag and left, I decided I would be better off on the floor in the back of the car on my hands on knees with my body pillow. As I got into the car my water broke. J raced to the hospital and actually had a cop pull in behind us at the hospital but I guess we were excused! The contractions kept coming quickly.
On the way to labor delivery I had 3 contractions. Once we got into the room, they kept coming. I went into the bathroom to change into a gown when I had another contraction and felt the head coming down. The nurse wanted to check the heart rate but I was in too much pain to lie on my back in the bed. I got onto my hands and knees and she tried to find the heart rate, she said it was too low and I should change positions. Turns out she was picking up my heart rate bc the baby was so far down.
He then decided he was ready to be born and was "caught" by the nurse. My doctor didn't make it in time! It was the best birth I have ever had, which have included a c-section after a failed version, a vbac with epidural and pitocin and some tearing. It has been 30 hrs since he was born, I feel great, am sooooo ready to go home.
The big question that belongs on this blog......how are the hips? Remember, my first ever groin pain came right after my last delivery, with the epidural, feet in stirrups, hips being forcibly flexed. This was so fast there was none of that and I feel absolutely no hip pain today at all.
I will continue to monitor in the coming weeks but I am pretty sure that I was able to have successful hip arthroscopy followed by a pregnancy only 5 months later. So yes, it can be done. On a side note, if you are able to I highly recommend getting a doula for birth, it was such a great experience, even though I only used her for a short amount of time.
So once the kids were in bed, J mixed 4 tbsp of castor oil with a small amount of ice cream. It wasn't as bad as I expected and I would recommend the ice cream method to anyone thinking of trying it. 2 1/2 hours later I threw up. I was disappointed that it hadn't worked and was not willing to try it again. About an hour later I realized that I had not thrown it all up and what was in me began to work. After several trips to the bathroom, it had done its job.
I went to bed around 11. At midnight I was having some contractions but was able to sleep and kept remembering all the false labor I had been having. At 2:30 I got up to go to the bathroom and began having awful back labor with the contractions 4-6 minutes apart and lasting about a minute. This all started very suddenly with J insisting the contractions were very close together. I called my doula who suggested we meet at the hospital rather than at my house. The contractions kept coming, now abt 3-4 minutes apart.
We just grabbed my bag and left, I decided I would be better off on the floor in the back of the car on my hands on knees with my body pillow. As I got into the car my water broke. J raced to the hospital and actually had a cop pull in behind us at the hospital but I guess we were excused! The contractions kept coming quickly.
On the way to labor delivery I had 3 contractions. Once we got into the room, they kept coming. I went into the bathroom to change into a gown when I had another contraction and felt the head coming down. The nurse wanted to check the heart rate but I was in too much pain to lie on my back in the bed. I got onto my hands and knees and she tried to find the heart rate, she said it was too low and I should change positions. Turns out she was picking up my heart rate bc the baby was so far down.
He then decided he was ready to be born and was "caught" by the nurse. My doctor didn't make it in time! It was the best birth I have ever had, which have included a c-section after a failed version, a vbac with epidural and pitocin and some tearing. It has been 30 hrs since he was born, I feel great, am sooooo ready to go home.
The big question that belongs on this blog......how are the hips? Remember, my first ever groin pain came right after my last delivery, with the epidural, feet in stirrups, hips being forcibly flexed. This was so fast there was none of that and I feel absolutely no hip pain today at all.
I will continue to monitor in the coming weeks but I am pretty sure that I was able to have successful hip arthroscopy followed by a pregnancy only 5 months later. So yes, it can be done. On a side note, if you are able to I highly recommend getting a doula for birth, it was such a great experience, even though I only used her for a short amount of time.
Monday, January 12, 2009
Wednesday, December 24, 2008
Weight loss Miracle
I thought I had posted this already but it seems that in the midst of a few winter storms and 2 preschoolers in the house, I actually did not.
J is now 5 1/2 weeks out from lap band surgery. The way lap band works is that for the first year you return to the surgeon monthly for adjustments to your band, to tighten it so that you feel some restriction. J's first scheduled adjustment was this past Fri. When he arrived, he saw the PA who could not believe how much weight he had already lost (just about 50 lbs). She said the average is 2 lbs per week, he is at around 5 lbs per week (since the surgery). She was so impressed that she called in the 2 surgeons who were in the office that day to see him, who were also blown away by his progress. They said they haven't seen this kind of result in a long time, if ever. They want their research team to contact him about it! He is soooo happy, as well as relieved that he avoided an adjustment that day!
He is still complaining of hip pain though. I am not sure if he should continue to wait a bit and lose more weight before addressing it, or get, at the minimum, an x-ray now. Actually, I am not sure how much whining I can take at the moment, so my patience may dictate how long he waits!!!
In the baby world, I have been having mild contractions/ cramping for a day and a half. It is nothing serious, more of an annoyance. I was at my OB yesterday who thinks it may be because the head is super low, but she would ideally not like this baby born for another 2 weeks. My bigger concern is that she is going on vacation on Saturday for a week, so if this baby is coming soon, it needs to come before Sat., or wait another week!!!
J is now 5 1/2 weeks out from lap band surgery. The way lap band works is that for the first year you return to the surgeon monthly for adjustments to your band, to tighten it so that you feel some restriction. J's first scheduled adjustment was this past Fri. When he arrived, he saw the PA who could not believe how much weight he had already lost (just about 50 lbs). She said the average is 2 lbs per week, he is at around 5 lbs per week (since the surgery). She was so impressed that she called in the 2 surgeons who were in the office that day to see him, who were also blown away by his progress. They said they haven't seen this kind of result in a long time, if ever. They want their research team to contact him about it! He is soooo happy, as well as relieved that he avoided an adjustment that day!
He is still complaining of hip pain though. I am not sure if he should continue to wait a bit and lose more weight before addressing it, or get, at the minimum, an x-ray now. Actually, I am not sure how much whining I can take at the moment, so my patience may dictate how long he waits!!!
In the baby world, I have been having mild contractions/ cramping for a day and a half. It is nothing serious, more of an annoyance. I was at my OB yesterday who thinks it may be because the head is super low, but she would ideally not like this baby born for another 2 weeks. My bigger concern is that she is going on vacation on Saturday for a week, so if this baby is coming soon, it needs to come before Sat., or wait another week!!!
Sunday, December 14, 2008
HSS non-hip Visit Follow-Up
This past Thursday I took Jk back to his OS for a follow-up on his elbow. At first, the doctor went over the old x-ray and said he was still not sure what exactly was going on with his elbow but we should go get a second x-ray, if it didn't show bone healing, he would need an MRI. So we went down the hall, got the x-ray and came back. Thank goodness it showed that it was a fracture (as opposed to an infection or (no I am not joking) a tumor) and he is fine. It is healing nicely and the bone is filling in. He can also stop PT now! Hurray! My guilt is slowly starting to lift and I am becoming slightly less neurotic about him getting hurt!
Tuesday, December 9, 2008
What Goes Around Comes Around
You are not going to believe this......J, who is down over 40 lbs was lying on the couch last night and out of the blue says to me "you know, my hip hurts". WHAT.
So, by now, he obviously (one would hope) knows that "hip pain" is groin pain, and not pain on the outside of your hip, butt or thigh. But I reply "Where does it hurt", and he takes his index finger and points to that spot, you know the spot, right in the groin. THE spot. I couldn't help but laugh. Really, it is funny. "And", he added, "It hurt when I was walking to the train and it clicks". More laughter from me.
He was still lying on the couch. I told him to bring his knee up to his chest, I think he saw stars! When I had him turn the knee a little more to his opposite shoulder, he saw even more stars. I can already see where this is going and I am not prepared to handle it right now!!!!
So, by now, he obviously (one would hope) knows that "hip pain" is groin pain, and not pain on the outside of your hip, butt or thigh. But I reply "Where does it hurt", and he takes his index finger and points to that spot, you know the spot, right in the groin. THE spot. I couldn't help but laugh. Really, it is funny. "And", he added, "It hurt when I was walking to the train and it clicks". More laughter from me.
He was still lying on the couch. I told him to bring his knee up to his chest, I think he saw stars! When I had him turn the knee a little more to his opposite shoulder, he saw even more stars. I can already see where this is going and I am not prepared to handle it right now!!!!
Thursday, December 4, 2008
Pain(s) in the A$$
34 weeks of pregnancy seem like an eternity, I am wondering at what point I can safely begin hoping to go into labor. Maybe 2 more weeks? I have an ultrasound scheduled for next week, to confirm that the baby is still in proper position and hopefully get an estimate on size. Maybe if it is really big I can will it out quicker!!!
I have been having a ton of ITB pain every night. It begins high, and will start with piriformis pain/spasm and travel down to my TFL and down the entire length of my ITB. It is horrific. It happens every night now when I "slow down". Walking helps the most but, hey, I need to sit down at some point. Interestingly, it is only on the right side (revision side). I also have been experiencing bolts of nerve pain at times, mostly on the right, that occur sometimes when the baby moves. This is why I have decided that it is a big baby! My first was 7 lbs, second was 8lbs 4 oz. If this one is going to also be a whole pound and 4 ounces bigger, we are looking at a 9 lbs 8 oz baby. I hope the trend does not follow!
What I am sort of hoping for is that my pelvis is beginning to separate and the muscles that attatch to it are trying to stabilize it, thereby going into spasm and causing me excruciating pain! I also have bouts of adductor pain but not as often.
J, who is down 42 lbs since surgery, has become an expert at ITB massage (it took him a while to figure out who to go with the fibers as opposed to across the fibers), but sadly, it does not help that much.
Jk has been in PT 2x/week for 2 weeks for his little elbow! He loves going and his ROM has improved. We are concerned about some possible swelling and bruising as well as lack of supination. He will be back at the doctor in a week so maybe they will take a repeat x-ray.
My brother has failed in PT! He still has pain and decided he needs surgery. He finally scheduled it this week and was given a surgery date of Feb 23rd. I know, 2 1/2 months away, crazy. But he is fine with it and doesn't wish to push for something sooner, so I won't either!
I have been having a ton of ITB pain every night. It begins high, and will start with piriformis pain/spasm and travel down to my TFL and down the entire length of my ITB. It is horrific. It happens every night now when I "slow down". Walking helps the most but, hey, I need to sit down at some point. Interestingly, it is only on the right side (revision side). I also have been experiencing bolts of nerve pain at times, mostly on the right, that occur sometimes when the baby moves. This is why I have decided that it is a big baby! My first was 7 lbs, second was 8lbs 4 oz. If this one is going to also be a whole pound and 4 ounces bigger, we are looking at a 9 lbs 8 oz baby. I hope the trend does not follow!
What I am sort of hoping for is that my pelvis is beginning to separate and the muscles that attatch to it are trying to stabilize it, thereby going into spasm and causing me excruciating pain! I also have bouts of adductor pain but not as often.
J, who is down 42 lbs since surgery, has become an expert at ITB massage (it took him a while to figure out who to go with the fibers as opposed to across the fibers), but sadly, it does not help that much.
Jk has been in PT 2x/week for 2 weeks for his little elbow! He loves going and his ROM has improved. We are concerned about some possible swelling and bruising as well as lack of supination. He will be back at the doctor in a week so maybe they will take a repeat x-ray.
My brother has failed in PT! He still has pain and decided he needs surgery. He finally scheduled it this week and was given a surgery date of Feb 23rd. I know, 2 1/2 months away, crazy. But he is fine with it and doesn't wish to push for something sooner, so I won't either!
Sunday, November 23, 2008
Another day spent at HSS...but not for me!
Being the mother of 2 sort of crazy kids, I count my blessings that we have never had a serious injury or required stitches, though we have been close on more than one occasion. About a month ago, my nanny mentioned that she thought Jk hurt his arm in the tub. When I asked him, he said he had a booboo but L had done it. He seemed to be alright, playing, climbing, jumping, throwing himself off of the couch etc. IT really only seemed to bother him if you touched his elbow and if you got him dressed too quickly. So I have been careful getting him dressed and sort of been keeping an eye on it.
Last week my nanny got mad at me and said the arm is not better and I have to take him to the doctor. So I did. First, I made an appointment with someone who I thought was a great pediatric OS and have even had friends use, but he did not take our insurance. I made the appointment anyway (the consultation fee was $350) but J freaked out and demanded I find someone in network. His rational was that we don't even know if anything is wrong, figure it out first and if there is really a problem, we can explore other doctors. Fine. So I found someone.
We went on Thursday. He found that Jk couldn't really extend his elbow all the way and said it was either fractured or he had a subluxed radius (nursemaids elbow). So off to x-ray we went. What was nice was that it was a whole pediatric floor, so the x-ray tech dealt only with kids, the nurses dealt only with kids, and there was even a nice lady handing out snacks for all the kids. It made me feel better about having switched to this OS.
Jk was so good during the xrays, he sat nicely and put his hand where it needed to go, and he was rewarded with tons of stickers! He couldn't have been happier. As soon as we got back to the doctor's office (right down the hall) he came in to look at the x-rays, and lo and behold, a fracture.
Shit. What kind of mother am I, my kid has a broken arm and I had no idea. He said it was too late to cast it, but he is pretty sure the olecranon (proximal end of the ulna) is fractured, as is evidenced by new bone growing and some soft tissue swelling, and Jk needs PT. The mechanism of injury must have been him landing on or hitting his elbow on something. Obviously this is most likely. If he is not better in a few weeks he will need an MRI, which becomes a huge ordeal because he needs to be put to sleep.
I wasn't quite sure what to do about the PT thing. He needs the kind of PT I do, and that we do in my office (orthopaedic) but we don't generally treat kids that little. I have a lot of friends who are pediatric PTs but they treat mostly developmental delays and torticollis, and they don't take private cases. We have one pediatric PT in my office but I was not even sure what she treated. So I frantically called her and she assured me that she would love to treat Jk and she has done this a lot, and that it is a very common injury.
So he has his first PT session on Tuesday. I also have an OB appointment that day, and he has a special enrichment program at school for Thanksgiving. I see the next few weeks looking something like that, running around from PT appointments, to OB appointments, to swim lessons, to OS appointments!
Never a dull moment here!
Last week my nanny got mad at me and said the arm is not better and I have to take him to the doctor. So I did. First, I made an appointment with someone who I thought was a great pediatric OS and have even had friends use, but he did not take our insurance. I made the appointment anyway (the consultation fee was $350) but J freaked out and demanded I find someone in network. His rational was that we don't even know if anything is wrong, figure it out first and if there is really a problem, we can explore other doctors. Fine. So I found someone.
We went on Thursday. He found that Jk couldn't really extend his elbow all the way and said it was either fractured or he had a subluxed radius (nursemaids elbow). So off to x-ray we went. What was nice was that it was a whole pediatric floor, so the x-ray tech dealt only with kids, the nurses dealt only with kids, and there was even a nice lady handing out snacks for all the kids. It made me feel better about having switched to this OS.
Jk was so good during the xrays, he sat nicely and put his hand where it needed to go, and he was rewarded with tons of stickers! He couldn't have been happier. As soon as we got back to the doctor's office (right down the hall) he came in to look at the x-rays, and lo and behold, a fracture.
Shit. What kind of mother am I, my kid has a broken arm and I had no idea. He said it was too late to cast it, but he is pretty sure the olecranon (proximal end of the ulna) is fractured, as is evidenced by new bone growing and some soft tissue swelling, and Jk needs PT. The mechanism of injury must have been him landing on or hitting his elbow on something. Obviously this is most likely. If he is not better in a few weeks he will need an MRI, which becomes a huge ordeal because he needs to be put to sleep.
I wasn't quite sure what to do about the PT thing. He needs the kind of PT I do, and that we do in my office (orthopaedic) but we don't generally treat kids that little. I have a lot of friends who are pediatric PTs but they treat mostly developmental delays and torticollis, and they don't take private cases. We have one pediatric PT in my office but I was not even sure what she treated. So I frantically called her and she assured me that she would love to treat Jk and she has done this a lot, and that it is a very common injury.
So he has his first PT session on Tuesday. I also have an OB appointment that day, and he has a special enrichment program at school for Thanksgiving. I see the next few weeks looking something like that, running around from PT appointments, to OB appointments, to swim lessons, to OS appointments!
Never a dull moment here!
Sunday, November 16, 2008
1 Year Revision Anniversary
It has now been one year since my last (and final) surgery. How the time has flown. What a great feeling it is to know that my surgeries have been successful and I have no limitations from them in my life.
The joint feels perfect! I will have a post-op x-ray at some point after the baby is born to check for signs of arthritis or anything else, but I suspect nothing will turn up. I do occasionally battle some muscular issues, which I mention on this blog when they come about. Like currently, my ITB is not too happy, but again, who knows how much of it has to do with my actual hip joint and how much has to do with being 7 months pregnant. Since I got pregnant so soon after surgery, many of these questions will remain unanswered. The only question I can answer is that 3 hipscopes have not really affected this pregnancy. I do have significantly more swelling in my feet than I have had in my previous 2 pregnancies, but a) it is unclear whether it is directly related to the hipscopes and b) in the grand scheme of things, it is merely an inconvenience.
In other parts of my life, J's surgery went extremely well last Monday. He is already down 32 lbs since beginning the 2 week pre-op diet, and having been "banded" for 6 days. My brother has been in PT for about 5 weeks with no change in his pain level. He does report feeling stronger though. He has decided that he probably wants surgery. My only request to him was that he PLEASE call Dr. Kelly and discuss this ASAP because I would really appreciate it if he had the surgery before the baby is born. He has yet to call.
Jk will turn 3 this month, marking the 2 year anniversary of when my hips "fell apart", a lot has happened in 2 years!
Many of you have been sending me questions by posting them on older posts. I will usually read your questions and then forget to write back! If you would like a response, your best bet is to email me directly suzq613@aol.com
The joint feels perfect! I will have a post-op x-ray at some point after the baby is born to check for signs of arthritis or anything else, but I suspect nothing will turn up. I do occasionally battle some muscular issues, which I mention on this blog when they come about. Like currently, my ITB is not too happy, but again, who knows how much of it has to do with my actual hip joint and how much has to do with being 7 months pregnant. Since I got pregnant so soon after surgery, many of these questions will remain unanswered. The only question I can answer is that 3 hipscopes have not really affected this pregnancy. I do have significantly more swelling in my feet than I have had in my previous 2 pregnancies, but a) it is unclear whether it is directly related to the hipscopes and b) in the grand scheme of things, it is merely an inconvenience.
In other parts of my life, J's surgery went extremely well last Monday. He is already down 32 lbs since beginning the 2 week pre-op diet, and having been "banded" for 6 days. My brother has been in PT for about 5 weeks with no change in his pain level. He does report feeling stronger though. He has decided that he probably wants surgery. My only request to him was that he PLEASE call Dr. Kelly and discuss this ASAP because I would really appreciate it if he had the surgery before the baby is born. He has yet to call.
Jk will turn 3 this month, marking the 2 year anniversary of when my hips "fell apart", a lot has happened in 2 years!
Many of you have been sending me questions by posting them on older posts. I will usually read your questions and then forget to write back! If you would like a response, your best bet is to email me directly suzq613@aol.com
Sunday, November 9, 2008
J's Surgery
A few weeks ago I tried to start a second blog about J's upcoming lapband surgery but realized that I barely have time to maintain this blog and answer all of your posts and questions, so nixed the idea. But things have been kind of stressful and crazy around here in anticipation.
See, in order to have lapband surgery, there are many hoops to jump through (much more than I could have ever imagined, and so many more than for a hipscope!) He finally attended a seminar given by the surgeon, obtained 6 months of medically supervised weight loss, saw a psychologist, saw a nutritionist, had a physical, saw the NP at the surgeons office and finally met with the surgeon. This over a course of 17 months. (I remember going to the seminar with him on crutches).
Part of the drama has been dealing with a semi-incompetent surgical coordinator at the surgeons office (who definitely hates me). At the time that we scheduled the surgery, she thought we would have a problem since J's 6 months of documented weight loss did not have an entry for the month of March, rather one at the end of Feb ad one at the beginning of April. Imagine waiting that long, and going through all of that to be told that this tiny little glitch would bring this entire, delicate house of cards crashing to the ground.
Being that I have assumed the role of "project manager" with his surgery, I quickly (and quite hysterically) called the insurance company to straighten it out. I was told that this indeed may pose a problem, but they would do their best to get this approved. The next day I received a phone call telling me that the surgery would be approved! YAY!!
When we left the surgeons office, we were given a packet with instructions (that the coordinator hastily went over with us) but were rather unclear and quite confusing. J had to have his medical doctor fill out some paperwork approving him for surgery which he was to take to the pre-admission testing. Pre-admission testing would fax it to his medical doctor who should fax it to the surgeons office. Retarded? I think so!
This past Tuesday I received a call from the woman in charge of collecting the aforementioned paperwork, looking for approval from J's medical doctor for the surgery. I informed her that it was on page 22 of the fax that had been sent to them (I am not kidding about being "project manager"). Everything seemed like it was all set to go.
Friday morning (the final business day before his Monday morning surgery), the surgical coordinator called me and told me she was missing the medical clearance form fro J's medical doctor. Shit. I told her to look for that page 22 letter again. She informed me that this was not good because it was dated prior to the pre-op testing.
I hit panic mode, and yelling mode. How the fuck did they not realize until THE DAY BEFORE THE SURGERY that they were missing this quite important piece of information. J was having trouble getting through to the doctors office, I was yelling at the surgical coordinator in between patients. It was quite a sight. She needed the paper by 3PM. At 2:25 she did not have it, J was frantically leaving messages. At 2:28 the surgical coordinator called me and said that they would just go with the original letter they had. At 2:33 the fax went through.
So now we are 19 hours away from surgery. Unlike me, J is not frantically cleaning closets or getting a mani-pedi! I will keep you updated!
See, in order to have lapband surgery, there are many hoops to jump through (much more than I could have ever imagined, and so many more than for a hipscope!) He finally attended a seminar given by the surgeon, obtained 6 months of medically supervised weight loss, saw a psychologist, saw a nutritionist, had a physical, saw the NP at the surgeons office and finally met with the surgeon. This over a course of 17 months. (I remember going to the seminar with him on crutches).
Part of the drama has been dealing with a semi-incompetent surgical coordinator at the surgeons office (who definitely hates me). At the time that we scheduled the surgery, she thought we would have a problem since J's 6 months of documented weight loss did not have an entry for the month of March, rather one at the end of Feb ad one at the beginning of April. Imagine waiting that long, and going through all of that to be told that this tiny little glitch would bring this entire, delicate house of cards crashing to the ground.
Being that I have assumed the role of "project manager" with his surgery, I quickly (and quite hysterically) called the insurance company to straighten it out. I was told that this indeed may pose a problem, but they would do their best to get this approved. The next day I received a phone call telling me that the surgery would be approved! YAY!!
When we left the surgeons office, we were given a packet with instructions (that the coordinator hastily went over with us) but were rather unclear and quite confusing. J had to have his medical doctor fill out some paperwork approving him for surgery which he was to take to the pre-admission testing. Pre-admission testing would fax it to his medical doctor who should fax it to the surgeons office. Retarded? I think so!
This past Tuesday I received a call from the woman in charge of collecting the aforementioned paperwork, looking for approval from J's medical doctor for the surgery. I informed her that it was on page 22 of the fax that had been sent to them (I am not kidding about being "project manager"). Everything seemed like it was all set to go.
Friday morning (the final business day before his Monday morning surgery), the surgical coordinator called me and told me she was missing the medical clearance form fro J's medical doctor. Shit. I told her to look for that page 22 letter again. She informed me that this was not good because it was dated prior to the pre-op testing.
I hit panic mode, and yelling mode. How the fuck did they not realize until THE DAY BEFORE THE SURGERY that they were missing this quite important piece of information. J was having trouble getting through to the doctors office, I was yelling at the surgical coordinator in between patients. It was quite a sight. She needed the paper by 3PM. At 2:25 she did not have it, J was frantically leaving messages. At 2:28 the surgical coordinator called me and said that they would just go with the original letter they had. At 2:33 the fax went through.
So now we are 19 hours away from surgery. Unlike me, J is not frantically cleaning closets or getting a mani-pedi! I will keep you updated!
Wednesday, November 5, 2008
This is HOT!!!
Clearly what you have in mind is NOT what is on my mind right now! If you could see the box that these stockings came out of, you would see that it reads: "Recommended for: tired and aching legs, swollen and minor fatigue, minor heaviness".I was at wits end today, my ankles no longer exist. They have been replaced by what used to be "cankles" but today became fat feet oozing out of shoes, to put it gently. I was no longer able to stand on my feet, much less walk and function, so I broke down. I had a quick break at work and literally raced to the nearest surgical supply store in search of these. Sexy, right! Mine are black!
I found the store, ready to buy my super cool, black lacy stockings (with moderate compression), and imagine my surprise to find that it is "manned" by 3 old men. Imagine walking in Victoria's Secret to find THE outfit, and have men helping you.
Well, maybe that is an exaggeration, but eww. Plus, there was no one else in the store, so all 3 were "helping" me.
Once we all determined what I needed, I happily left with my new piece of wardrobe, ready to attack all orthopaedic ailments that would walk through the front door of my office. I grabbed the bag, ran tot he bathroom to put them on, and to my horror, there was a brown pair in the bag. Shit.
So another 2 hours of tortuous leg pain got me through the rest of the day so I could make another run for the store. This time, there was only one old man working there, who politely informed me that they were "final sale, and no returns". As usual, the patheticness of my situation made him feel sorry for me and he quietly swiped the brown pair for a black pair. I also ended up purchasing a knee high pair to wear at home, when no one is looking!
I am not sure why I am having this much swelling, but it is pretty bad. (Bad enough for me to buy compression stockings!). I have an OB appointment tomorrow, I am hoping that this is a problem limited to my feet and legs, and will resolve in the near future. There is always the little voice in my head asking if there is a lymph issue from my surgeries, but since it was not a problem when I was not pregnant, I am confident that it will clear up after this pregnancy!
Tuesday, October 28, 2008
2 Days Later
As promised, here is an update on my "situation".
I did wake up pain free on Monday morning, as expected. Later in the day, I stupidly performed the same maneuver that had started this mess. I was kneeling down on one knee, with the other foot flat in front of me (right foot). When I went to get up, I practically had no strength in that leg again and began to have pain, all over again.
So clearly there is a major strength deficit in my right hip extensors with an imbalance that can explain why this is happening. Sadly, I will not even attempt to address this now as I am too overwhelmed with everything else going on. Hopefully it will resolve after the birth, or at least I can address it then in a calm fashion. The good news is the joint is still good!!!
I did wake up pain free on Monday morning, as expected. Later in the day, I stupidly performed the same maneuver that had started this mess. I was kneeling down on one knee, with the other foot flat in front of me (right foot). When I went to get up, I practically had no strength in that leg again and began to have pain, all over again.
So clearly there is a major strength deficit in my right hip extensors with an imbalance that can explain why this is happening. Sadly, I will not even attempt to address this now as I am too overwhelmed with everything else going on. Hopefully it will resolve after the birth, or at least I can address it then in a calm fashion. The good news is the joint is still good!!!
Sunday, October 26, 2008
28 Weeks Pregnant
Just this morning I was thinking that I haven't blogged in a while, and how thrilled I have been with my hips throughout my pregnancy. Until today, the only time I have experienced hip pain was in conjunction with my SI joint issues, which do occasionally happen, and are common in pregnancy. The only other time I felt anything in my hips was after a 3 hour car ride. That's it, I really can't complain.
Then my luck changed! I don't know exactly what happened, or what is happening. I was sitting on the floor, building a kick-ass train track for Jk today. When I went to get up, I kneeled on my left knee and used my right foot to push up and something felt weird. From that point on, I began having right hip pain, all over again. It is not exactly groin pain, it is more of adductor/psoas/ joint capsule crap. The one thing that does reassure me though is that when I did my mini "hip test" if flexion and flexion/ adduction, it did not make the pain worse. So a huge sigh of relief. Most likely just some muscular things going on, due to the prganancy and hormones and change in weight and forces and all that fun stuff that comes with being months pregnant.
I will hopefully wake up in no pain tomorrow morning but will keep you updated on this sudden turn of events!
Then my luck changed! I don't know exactly what happened, or what is happening. I was sitting on the floor, building a kick-ass train track for Jk today. When I went to get up, I kneeled on my left knee and used my right foot to push up and something felt weird. From that point on, I began having right hip pain, all over again. It is not exactly groin pain, it is more of adductor/psoas/ joint capsule crap. The one thing that does reassure me though is that when I did my mini "hip test" if flexion and flexion/ adduction, it did not make the pain worse. So a huge sigh of relief. Most likely just some muscular things going on, due to the prganancy and hormones and change in weight and forces and all that fun stuff that comes with being months pregnant.
I will hopefully wake up in no pain tomorrow morning but will keep you updated on this sudden turn of events!
Thursday, October 16, 2008
My Other Blog
Life in the hip world is unusually calm these days, life in my house is not!!! Although I can't imagine that anyone with 2 1/2 kids, a job, a husband and a type A-ish personality ever has relative calm in their life! Today I started a second blog to document J's upcoming surgery (not hip) and my role in it (basically, do everything necessary up to the day of surgery since men can oftentimes be rather incompetent). It is a work in progress but I have a lot to say (shocker, I know) and will probably have many posts there in the coming days!http://myhusbandslapband.blogspot.com/
Repair Vs Debridement
I just came across this website today
http://www.orthosupersite.com/view.asp?rid=32004
Differences seen between repair vs. labral debridement for hip impingement at 1 year
Researchers saw a significant increase in radiographic degenerative changes in the debridement group.
By Gina Brockenbrough1st on the web (October 13, 2008)
October 2008
WASHINGTON — Research indicates that although there is no significant difference in the early clinical outcomes between arthroscopic labral debridement and labral repair for the treatment of femoroacetabular impingement, significant changes were seen between two treatment groups at 1-year-plus follow-up.
In a consecutive series of patients who underwent arthroscopic management for femoroacetabular impingement (FAI), Christopher M. Larson, MD, and colleagues compared the results of those who underwent labral refixation to those who underwent a labral debridement prior to performing any repairs.
The investigators discovered no significant differences between the groups regarding Harris Hip Scores, Visual Analog Scale (VAS) scores for pain, SF-12 scores and alpha angles on both anterior-posterior and lateral views with a minimum follow-up of 1 year. The analysis also revealed no significant differences in these outcomes among patients who had debridement, excisions with rim trimming or repair at that time.
Degenerative changes
However, “With further follow-up at 1 year and [beyond], there is a statistically significant increase in radiographic degenerative changes in the debridement group and statistically improved Harris Hip scoring in the labral group,” Larson recently told Orthopedics Today.
However, he noted that 5- to 10-year follow-up is needed to fully compare the outcomes and said that follow-up radiographs may detect changes earlier than clinical scores.
“It is a consecutive series, and management with this technique is evolving,” Larson said. “And if a difference does show up with time, the question will remain whether this relates to labral preservation or improved technique in managing impingement.”
Larson presented the study during the 27th Annual Meeting of the Arthroscopy Association of North America.
The investigators studied 80 hips; the labral debridement group included 37 consecutive hips that the researchers studied before performing repairs.
“All of these cases were reviewed and were felt to be repairable by current techniques,” Larson said. Patients in this group had a mean age of 31 years and a mean follow-up of 14 months.
The labral refixation group had a mean age of 27 years and a mean follow-up of 8 months. In both groups, most patients had minimal or no degenerative changes.
Procedures
Patients with pincer impingement underwent a labral debridement, rim trimming and labral refixation with two to six suture anchors. Those with cam impingement had a capsulotomy and a proximal femoral osteochondroplasty.
Surgeons performed 29 femoral osteochondroplasties in the debridement group. Eighteen patients in the group underwent labral debridement without rim trimming and 19 had rim trimming with labral excision. In the refixation group, 36 patients also had a femoral osteochondroplasty and 40 patients underwent rim trimming.
Larson noted that the groups showed good and excellent results postoperatively and that the study investigated labral tears without significant degenerative changes.
“There are finite element models that have suggested that the labrum has a ceiling function,” he said. “In the absence of this sealing, strains within the cartilage matrix increase, which may increase those degenerative changes over time.”
For more information:
Christopher M. Larson, MD, can be reached at Minnesota Sports Medicine, 775 Prairie Center Drive, Suite 250, Eden Prairie, MN 55344; 952-944-2519; e-mail: Christopher_larson@med.unc.edu. He receives research or institutional support from Biomet, Omeros Corp., Arthrex Inc. and Zimmer and miscellaneous funding from Smith & Nephew.
Reference:
Larson CM, Giveans M. Arthroscopic treatment of femoroacetabular impingement: Early outcomes evaluation of labral refixation/repair vs. debridement. Paper #SS-04. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.
This got me thinking about a few things. My first thought was "hmmm, I wonder what my hips look like now, radiographically, at almost 16 months and 12 months postop"? Being that I had to postpone my postop x-rays due to my current "situation", I will not know for some time.
It also got me thinking about how accurate the study could be. I don't know any type of detail, I only have read what I posted here, so I may be totally off base, but here it goes:
In the debridement group, the labrum was probably more damaged than in the repair group, meaning that they had either been dealing with the FAI and labral tear for a longer period of time, or had a more severe injury. The repair group had to have a labrum that was in essence "repairable", i.e. not as "far gone" as the debridement group. It would make sense that the group that had more damage would show more degeneration in a shorter amount of time.
Does this make sense?
Wouldn't the surgeons try to repair as many labrums as possible if they could, and not debride the "repairable" ones?
Just a thought......
http://www.orthosupersite.com/view.asp?rid=32004
Differences seen between repair vs. labral debridement for hip impingement at 1 year
Researchers saw a significant increase in radiographic degenerative changes in the debridement group.
By Gina Brockenbrough1st on the web (October 13, 2008)
October 2008
WASHINGTON — Research indicates that although there is no significant difference in the early clinical outcomes between arthroscopic labral debridement and labral repair for the treatment of femoroacetabular impingement, significant changes were seen between two treatment groups at 1-year-plus follow-up.
In a consecutive series of patients who underwent arthroscopic management for femoroacetabular impingement (FAI), Christopher M. Larson, MD, and colleagues compared the results of those who underwent labral refixation to those who underwent a labral debridement prior to performing any repairs.
The investigators discovered no significant differences between the groups regarding Harris Hip Scores, Visual Analog Scale (VAS) scores for pain, SF-12 scores and alpha angles on both anterior-posterior and lateral views with a minimum follow-up of 1 year. The analysis also revealed no significant differences in these outcomes among patients who had debridement, excisions with rim trimming or repair at that time.
Degenerative changes
However, “With further follow-up at 1 year and [beyond], there is a statistically significant increase in radiographic degenerative changes in the debridement group and statistically improved Harris Hip scoring in the labral group,” Larson recently told Orthopedics Today.
However, he noted that 5- to 10-year follow-up is needed to fully compare the outcomes and said that follow-up radiographs may detect changes earlier than clinical scores.
“It is a consecutive series, and management with this technique is evolving,” Larson said. “And if a difference does show up with time, the question will remain whether this relates to labral preservation or improved technique in managing impingement.”
Larson presented the study during the 27th Annual Meeting of the Arthroscopy Association of North America.
The investigators studied 80 hips; the labral debridement group included 37 consecutive hips that the researchers studied before performing repairs.
“All of these cases were reviewed and were felt to be repairable by current techniques,” Larson said. Patients in this group had a mean age of 31 years and a mean follow-up of 14 months.
The labral refixation group had a mean age of 27 years and a mean follow-up of 8 months. In both groups, most patients had minimal or no degenerative changes.
Procedures
Patients with pincer impingement underwent a labral debridement, rim trimming and labral refixation with two to six suture anchors. Those with cam impingement had a capsulotomy and a proximal femoral osteochondroplasty.
Surgeons performed 29 femoral osteochondroplasties in the debridement group. Eighteen patients in the group underwent labral debridement without rim trimming and 19 had rim trimming with labral excision. In the refixation group, 36 patients also had a femoral osteochondroplasty and 40 patients underwent rim trimming.
Larson noted that the groups showed good and excellent results postoperatively and that the study investigated labral tears without significant degenerative changes.
“There are finite element models that have suggested that the labrum has a ceiling function,” he said. “In the absence of this sealing, strains within the cartilage matrix increase, which may increase those degenerative changes over time.”
For more information:
Christopher M. Larson, MD, can be reached at Minnesota Sports Medicine, 775 Prairie Center Drive, Suite 250, Eden Prairie, MN 55344; 952-944-2519; e-mail: Christopher_larson@med.unc.edu. He receives research or institutional support from Biomet, Omeros Corp., Arthrex Inc. and Zimmer and miscellaneous funding from Smith & Nephew.
Reference:
Larson CM, Giveans M. Arthroscopic treatment of femoroacetabular impingement: Early outcomes evaluation of labral refixation/repair vs. debridement. Paper #SS-04. Presented at the 27th Annual Meeting of the Arthroscopy Association of North America. April 24-27, 2008. Washington.
This got me thinking about a few things. My first thought was "hmmm, I wonder what my hips look like now, radiographically, at almost 16 months and 12 months postop"? Being that I had to postpone my postop x-rays due to my current "situation", I will not know for some time.
It also got me thinking about how accurate the study could be. I don't know any type of detail, I only have read what I posted here, so I may be totally off base, but here it goes:
In the debridement group, the labrum was probably more damaged than in the repair group, meaning that they had either been dealing with the FAI and labral tear for a longer period of time, or had a more severe injury. The repair group had to have a labrum that was in essence "repairable", i.e. not as "far gone" as the debridement group. It would make sense that the group that had more damage would show more degeneration in a shorter amount of time.
Does this make sense?
Wouldn't the surgeons try to repair as many labrums as possible if they could, and not debride the "repairable" ones?
Just a thought......
Wednesday, October 8, 2008
Was I a Psychotic, Crazy Bitch for a Year?
Why am I posing this question now? (J, this is purely rhetorical, do not feel compelled to answer). While we were in Miami last week, my SI joint went out of whack for about a day and a half. It was most likely a posteriorly rotated inominate on the right, but I honestly don't remember anymore. When this happened, I had immediate right sided PSIS pain and right sided groin pain.
When the groin pain started, I immediately reverted into a bad mood, very irritable, and just downright annoyed. See, after 2 hipscopes, I don't care what the reason, there should be NO GROIN PAIN. Yes, I knew it had nothing to do with the labrum or FAI but it was the same pain all over again, and I was not a happy camper.
Being that this is my 3rd pregnancy, I have had plenty of experience with SI pain in the past, and it has never led to groin pain before, so in a way, yes, it is related to the labrum and FAI. IMHO, there is probably still healing going on, and the temporary change in geometry put pressure on areas that are not supposed to handle pressure, and instantly gave me pain and put me in a REALLY bad mood.
The good news is that it resolved quite easily and quickly. Once I had a moment, I used a self muscle energy technique to re-adjust the pelvic bones and voila, everything was back to status quo and I was once again happy!
This leads to my to digress for one quick moment. Many pregnant women suffer with SI pain for months and do not seek treatment. Sometimes the OB says it just "normal", sometimes they don't know something can be done. back pain in pregnancy is one of the least tapped resources in physical therapy, and one of the easiest and quickest things to fix in most cases.
A comment was posted this week on an old post asking if anyone has had a successful scope, being that most people don't read the old posts, I will say yes, I have had 2!!! If anyone would like to share a success story, please do so!
When the groin pain started, I immediately reverted into a bad mood, very irritable, and just downright annoyed. See, after 2 hipscopes, I don't care what the reason, there should be NO GROIN PAIN. Yes, I knew it had nothing to do with the labrum or FAI but it was the same pain all over again, and I was not a happy camper.
Being that this is my 3rd pregnancy, I have had plenty of experience with SI pain in the past, and it has never led to groin pain before, so in a way, yes, it is related to the labrum and FAI. IMHO, there is probably still healing going on, and the temporary change in geometry put pressure on areas that are not supposed to handle pressure, and instantly gave me pain and put me in a REALLY bad mood.
The good news is that it resolved quite easily and quickly. Once I had a moment, I used a self muscle energy technique to re-adjust the pelvic bones and voila, everything was back to status quo and I was once again happy!
This leads to my to digress for one quick moment. Many pregnant women suffer with SI pain for months and do not seek treatment. Sometimes the OB says it just "normal", sometimes they don't know something can be done. back pain in pregnancy is one of the least tapped resources in physical therapy, and one of the easiest and quickest things to fix in most cases.
A comment was posted this week on an old post asking if anyone has had a successful scope, being that most people don't read the old posts, I will say yes, I have had 2!!! If anyone would like to share a success story, please do so!
Sunday, September 28, 2008
Packing Painfree
We are on our way out the door, for a trip to Miami for the Jewish new year. Packing was a pleasure this year. When my hip problems were running rampant, packing used to be a nightmare, the squatting and lifting and carrying etc. The only issue this year seems to be that kids are so excited to go they have been up since 6:45, asking when we can go to the airport!
The only issue I continue to occasionally experience is nerve pain on my anterior thigh. It has been 10 1/2 months since my revision, I don't think it will ever fully go away. And its not like I constantly deal with it, only some days, it seems to come and go. A small price to pay in my opinion.
While I was bragging about Jk last week, I forgot to mention L's astute comment about the baby! Have I mentioned that the baby has been named "ice cream"? So one day, L says to me "Mommy, is ice cream in your blood"? Hmmm, how do I explain this one, its not quite as simple as "the femoral head sits in the acetabulum". "No, L, ice cream lives in a pouch in my tummy". She started cracking up like it was the funniest thing she had ever heard. "Mommy, you're not a kangaroo", she said. To which I started cracking up. We ended the discussion with me pulling up a schematic on the computer of a pregnant woman's uterus, with the baby inside, "pouch" and all! Now she gets it!
An update on my brother: He has to go to PT first, I don't know if he has actually started but definitely has a bad attitude since PT did not work for me pre-op, and for many others.
An update on my patient: I am still a huge wuss!! She is off of crutches, went to Costco and Target in one day this week. She is painfree- she used to have debilitating back pain as well, she no longer does. I am so amazed. Pre-op, for many years, she walked with a cane, she no longer does. And she did not have cortisone injected into the joint during surgery (I witnessed it with my own eyes!)
The only issue I continue to occasionally experience is nerve pain on my anterior thigh. It has been 10 1/2 months since my revision, I don't think it will ever fully go away. And its not like I constantly deal with it, only some days, it seems to come and go. A small price to pay in my opinion.
While I was bragging about Jk last week, I forgot to mention L's astute comment about the baby! Have I mentioned that the baby has been named "ice cream"? So one day, L says to me "Mommy, is ice cream in your blood"? Hmmm, how do I explain this one, its not quite as simple as "the femoral head sits in the acetabulum". "No, L, ice cream lives in a pouch in my tummy". She started cracking up like it was the funniest thing she had ever heard. "Mommy, you're not a kangaroo", she said. To which I started cracking up. We ended the discussion with me pulling up a schematic on the computer of a pregnant woman's uterus, with the baby inside, "pouch" and all! Now she gets it!
An update on my brother: He has to go to PT first, I don't know if he has actually started but definitely has a bad attitude since PT did not work for me pre-op, and for many others.
An update on my patient: I am still a huge wuss!! She is off of crutches, went to Costco and Target in one day this week. She is painfree- she used to have debilitating back pain as well, she no longer does. I am so amazed. Pre-op, for many years, she walked with a cane, she no longer does. And she did not have cortisone injected into the joint during surgery (I witnessed it with my own eyes!)
Tuesday, September 23, 2008
My Kids Are So cute
A lot of my "bragging" has been about L, my 4 year old princess/anatomy lover!! Although this is in no way hip related, it was too cute to keep to myself.
Jk is 2 1/2 (almost 3 actually) and sometimes I am not so sure if he understands the whole new baby concept. Boy did he prove me wrong on Sunday.
We were out for lunch and at the table behind us there was a little boy about Jk's age, and a baby in a carseat. The little brat, I mean boy, started teasing Jk and saying "hahaha, you don't have a baby, hahaha" (Imagine that being said by a 2 or 3 year old in a sing song voice). To which Jk turned around and (like a small genius) said "I do have a baby, its in my mommy's tummy"
How Cute!!!!
Jk is 2 1/2 (almost 3 actually) and sometimes I am not so sure if he understands the whole new baby concept. Boy did he prove me wrong on Sunday.We were out for lunch and at the table behind us there was a little boy about Jk's age, and a baby in a carseat. The little brat, I mean boy, started teasing Jk and saying "hahaha, you don't have a baby, hahaha" (Imagine that being said by a 2 or 3 year old in a sing song voice). To which Jk turned around and (like a small genius) said "I do have a baby, its in my mommy's tummy"
How Cute!!!!
Sunday, September 21, 2008
Thinking of How Things Were 1 Year Ago
Today we went apple picking. It was our second time, the first was about a year ago. That put me about 1 month pre-revision. Apple fields around here tend to be rocky and hilly, with uneven terrain, and spread over many many acres. Last year I had a really tough time "navigating" the apple orchards. I was in a lot of pain, for some reason, I have very vivid images of the groin pain I felt that day. I don't generally remember the pain all that well (thank goodness for small favors) but for some reason, apple picking brought back memories!
I am happy to report that this year, there was no groin pain. There were other issues, which I will get into momentarily, but that achey, deep hip pain was no longer there! Yay!
I have been having a lot of swelling in my legs lately, and a feeling of heaviness. I haven't really had it with other pregnancies so I will assume it is related to having 3 hip surgeries. There are days I wake up and I cannot imagine how I will go to work and stand because I am having so much aching up and down both legs. I don't even remember if I blogged about my DVT scare a few weeks back (I will have to look back and check), but my legs have been sore and swollen, even on days I am not on them that much.
It is possible that there was some damage done to the lymphatic system, and now that it is being stressed things are "backing up". It was not an issue before I got pregnant.
There are also days that my "invisible bruise" pain comes back, these are the days I know I should have stayed in bed!!! I usually notice on my way to the car. My ankles feel fat, my thighs feel heavy, and I have pain over a large area on the front of my thigh. And that is only 7:30AM!
I still haven't seen a single patient!
Despite this, I am back to cooking! Over the course of the summer, I had resorted t serving the kids mac n cheese and hot dogs quite often because we were spending every afternoon at the pool, and these dinners were quick, easy and portable. Now I have no excuse. It is back to the kitchen for me!
I am actually having a mild obsession with Panko breadcrumbs. I have a friend who manufactures the brand I use and I jokingly offered to be her "recipe blogger"....she is now expecting recipes! I will share with her as well as you...coming this week, Teriyaki Panko Oven Baked Onion Rings.
My other obsession these days is childbirth. Mostly, that I CANNOT have a c-section. This baby seems to enjoy being breech, but I WILL NOT have a 4th surgery right now (hear that kid). I have been doing breech turning exercises (anything that involved having your hips higher than your chest) which does work, but gives me a massive headache! I have an ultrasound on Thursday, and based on the position, I will decide if I will start the Webster technique for turning a breech.
Don't worry, once the baby is in in proper positing, I will be obsessing about how to deliver it without messing up my hips!!!
PS- I have about 15 lbs of apples in my kitchen...anyone have good (and easy) recipes???
I am happy to report that this year, there was no groin pain. There were other issues, which I will get into momentarily, but that achey, deep hip pain was no longer there! Yay!
I have been having a lot of swelling in my legs lately, and a feeling of heaviness. I haven't really had it with other pregnancies so I will assume it is related to having 3 hip surgeries. There are days I wake up and I cannot imagine how I will go to work and stand because I am having so much aching up and down both legs. I don't even remember if I blogged about my DVT scare a few weeks back (I will have to look back and check), but my legs have been sore and swollen, even on days I am not on them that much.
It is possible that there was some damage done to the lymphatic system, and now that it is being stressed things are "backing up". It was not an issue before I got pregnant.
There are also days that my "invisible bruise" pain comes back, these are the days I know I should have stayed in bed!!! I usually notice on my way to the car. My ankles feel fat, my thighs feel heavy, and I have pain over a large area on the front of my thigh. And that is only 7:30AM!
I still haven't seen a single patient!
Despite this, I am back to cooking! Over the course of the summer, I had resorted t serving the kids mac n cheese and hot dogs quite often because we were spending every afternoon at the pool, and these dinners were quick, easy and portable. Now I have no excuse. It is back to the kitchen for me!
I am actually having a mild obsession with Panko breadcrumbs. I have a friend who manufactures the brand I use and I jokingly offered to be her "recipe blogger"....she is now expecting recipes! I will share with her as well as you...coming this week, Teriyaki Panko Oven Baked Onion Rings.
My other obsession these days is childbirth. Mostly, that I CANNOT have a c-section. This baby seems to enjoy being breech, but I WILL NOT have a 4th surgery right now (hear that kid). I have been doing breech turning exercises (anything that involved having your hips higher than your chest) which does work, but gives me a massive headache! I have an ultrasound on Thursday, and based on the position, I will decide if I will start the Webster technique for turning a breech.
Don't worry, once the baby is in in proper positing, I will be obsessing about how to deliver it without messing up my hips!!!
PS- I have about 15 lbs of apples in my kitchen...anyone have good (and easy) recipes???
Friday, September 12, 2008
Things Can Never Be Simple, Can They?
I am now 22 weeks pregnant. The hips seem to be holding up just fine, yay!
I had a scheduled OB appointment 2 weeks ago, but it was cancelled at that last minute bc of some scheduling issues. There was no other time for me to come in until 2 weeks later, but I was concerned about the 20 week ultrasound. This is how the conversation with the receptionist went:
R: Sorry, we have to cancel your appointment, can you reschedule for...
S: No, I can't make it, but what should I do about the 20 week ultrasound, I am 20 weeks now
R: What 20 week ultrasound?
S:Umm, THE 20 week ultrasound!?!?
R: Oh, you mean, like, to find out the sex of the baby?
S: Umm, no, like, an anatomical scan at 20 weeks
R: Well, do you want to find out the sex?
S: No
R: Well then why do you need the ultrasound?
S: Um, to make sure my baby doesn't have 2 heads (ok, I wasn't that snotty, but come on, everyone knows about THE 20 week ultrasound. And this is a receptionist at an OB office)
S: Can you please put someone else on the phone
This person assured me I was not crazy and that there is indeed a 20 week ultrasound that EVERYONE gets.
So yesterday I had the 20 (22) week ultrasound. The baby (who has been named ice cream by L) apparently does not have 2 heads and looks good (I asked if the hips are checked during the ultrasound...I have become slightly paranoid about genetics and hips lately...I was told no, but they will check for dysplasia after birth). But the baby is breach. OMG. L was breech and it was a disaster that ended in a c-section. I do not want to re-visit the world of c-sections (or any other surgery for that matter). I was reassured that it is too early to worry, but I reminded my doctor that L was breech at 26 weeks and never flipped. I am on the verge of a breakdown. I have already begun breech turning exercises, contacted a chiropractor who does a technique to turn breech babies and am awaiting a co-worker to return from vacation to give me the name of an acupuncturist who specializes in this too. And you thought I was only anal and crazy about hips!!
I had a scheduled OB appointment 2 weeks ago, but it was cancelled at that last minute bc of some scheduling issues. There was no other time for me to come in until 2 weeks later, but I was concerned about the 20 week ultrasound. This is how the conversation with the receptionist went:
R: Sorry, we have to cancel your appointment, can you reschedule for...
S: No, I can't make it, but what should I do about the 20 week ultrasound, I am 20 weeks now
R: What 20 week ultrasound?
S:Umm, THE 20 week ultrasound!?!?
R: Oh, you mean, like, to find out the sex of the baby?
S: Umm, no, like, an anatomical scan at 20 weeks
R: Well, do you want to find out the sex?
S: No
R: Well then why do you need the ultrasound?
S: Um, to make sure my baby doesn't have 2 heads (ok, I wasn't that snotty, but come on, everyone knows about THE 20 week ultrasound. And this is a receptionist at an OB office)
S: Can you please put someone else on the phone
This person assured me I was not crazy and that there is indeed a 20 week ultrasound that EVERYONE gets.
So yesterday I had the 20 (22) week ultrasound. The baby (who has been named ice cream by L) apparently does not have 2 heads and looks good (I asked if the hips are checked during the ultrasound...I have become slightly paranoid about genetics and hips lately...I was told no, but they will check for dysplasia after birth). But the baby is breach. OMG. L was breech and it was a disaster that ended in a c-section. I do not want to re-visit the world of c-sections (or any other surgery for that matter). I was reassured that it is too early to worry, but I reminded my doctor that L was breech at 26 weeks and never flipped. I am on the verge of a breakdown. I have already begun breech turning exercises, contacted a chiropractor who does a technique to turn breech babies and am awaiting a co-worker to return from vacation to give me the name of an acupuncturist who specializes in this too. And you thought I was only anal and crazy about hips!!
Tuesday, September 9, 2008
Holy $hit, I Am A Really Big Wimp
A few things I wanted to share with you but have been falling asleep each night before I get a chance to blog.
The first is that my patient, the one who had surgery last week, the one I observed, is doing awesome. I asked her for permission to write about her. She is 40, with many many medical issues, including chronic back pain, foot and ankle problems, fibromyalgia. Dr K wasn't even totally convinced she would do great with the surgery. I was really nervous for her as well, it is a tough recovery, plus, she had some minor dysplasia so everything was up in the air. She also takes narcotics on a regular basis for her back, so the pain relief made me nervous. She ended up being home 2 1/2 hours post-op, in her bed, on the cpm, resting comfortably. I told her to call me in the AM if she didn't feel up to coming to PT that day or if she had any issues/ problems. When I arrived at the office, she had already called. "Shit, she must be having a lot of pain" I figured. I called her back. She was feeling great, just couldn't remember how to go down steps with crutches!
She arrived in my office looking amazing, only 15 hours post-op, in NO PAIN. I figured the marcaine hadn't worn off yet. She kept saying that her back no longer hurt and she had no internal hip pain. Her biggest complaint was that the incisions hurt and the spinal bock site hurt. I kept waiting for the drugs to wear off, but kept my fingers crossed as I held my breath over the next few days.
I called her Friday, honestly expecting her to tell me that she was in a lot of pain...Nope. No pain. She was completely off of all narcotics (Including pre-op ones), still with no back pain either. I think she was also shocked that the back pain went away, this was totally unexpected, but a nice added bonus.
I saw her in the office yesterday again.She was feeling amazing, so happy that the pain was gone, and thrilled that it was such an "easy" fix! She wants to do PT 3x/week instead of one lose the CPM and resume life! I am so thrilled for her.
Looking back, I was (am) a 26 year old healthy, with no other issues, simple hip patient who ended up with so much post-op shit. It just goes to show you how we are all so different.
Another thing....Jeff, my brother, was here this weekend and had his appointment on Fri with Dr K. Yes, he has FAI, seen on x-ray.And the OS in Miami swore up and down to me that there was none. He went for a CT scan Fri as well, to make sure there is no more FAI than what was seen on x-ray, as well as an intra-articular injection. Weirdly enough, since his hip problem started, his foot has been bothering him,once he had the injection, the foot pain went away. He is not too clear on whether the injection helped or not, but once the CT results are in, decisions can be made!!
The first is that my patient, the one who had surgery last week, the one I observed, is doing awesome. I asked her for permission to write about her. She is 40, with many many medical issues, including chronic back pain, foot and ankle problems, fibromyalgia. Dr K wasn't even totally convinced she would do great with the surgery. I was really nervous for her as well, it is a tough recovery, plus, she had some minor dysplasia so everything was up in the air. She also takes narcotics on a regular basis for her back, so the pain relief made me nervous. She ended up being home 2 1/2 hours post-op, in her bed, on the cpm, resting comfortably. I told her to call me in the AM if she didn't feel up to coming to PT that day or if she had any issues/ problems. When I arrived at the office, she had already called. "Shit, she must be having a lot of pain" I figured. I called her back. She was feeling great, just couldn't remember how to go down steps with crutches!
She arrived in my office looking amazing, only 15 hours post-op, in NO PAIN. I figured the marcaine hadn't worn off yet. She kept saying that her back no longer hurt and she had no internal hip pain. Her biggest complaint was that the incisions hurt and the spinal bock site hurt. I kept waiting for the drugs to wear off, but kept my fingers crossed as I held my breath over the next few days.
I called her Friday, honestly expecting her to tell me that she was in a lot of pain...Nope. No pain. She was completely off of all narcotics (Including pre-op ones), still with no back pain either. I think she was also shocked that the back pain went away, this was totally unexpected, but a nice added bonus.
I saw her in the office yesterday again.She was feeling amazing, so happy that the pain was gone, and thrilled that it was such an "easy" fix! She wants to do PT 3x/week instead of one lose the CPM and resume life! I am so thrilled for her.
Looking back, I was (am) a 26 year old healthy, with no other issues, simple hip patient who ended up with so much post-op shit. It just goes to show you how we are all so different.
Another thing....Jeff, my brother, was here this weekend and had his appointment on Fri with Dr K. Yes, he has FAI, seen on x-ray.And the OS in Miami swore up and down to me that there was none. He went for a CT scan Fri as well, to make sure there is no more FAI than what was seen on x-ray, as well as an intra-articular injection. Weirdly enough, since his hip problem started, his foot has been bothering him,once he had the injection, the foot pain went away. He is not too clear on whether the injection helped or not, but once the CT results are in, decisions can be made!!
Tuesday, September 2, 2008
Hip Arthroscopy is SOOO Much Cooler When You Are Not The Patient!
So today I had my day in the OR. Of course things did not go as planned. On Friday, I was supposed to hear from the surgical coordinator regarding where to go, who to meet etc. He never got back to me. Luckily, I knew the patient and she let me know what time the surgery was at. I sent another email this morning to the coordinator.The surgery was scheduled for 2pm. He sent me an email at 2:38 letting me know it was at 2. Gee, thanks!
Basically all day I was a nervous wreck since I hadn't heard from him, and texted Amy all morning about it, but decided to just show up and figure it out when I got there. The paperwork was done anyway. I was also waiting for the PA to email this AM about the time, but she didn't either (added to my anxiety) but it turns out there were major scheduling snafus.
I made it to the surgery reception area where without much question, they took me back to get scrubs, in the meantime, the PA emailed me to let me know they were about 2 hours behind on scheduling (thank goodness for blackberry). So I got changed and hung out with my patient for a while.
At4:00 we were in the OR. I have to say I have observed 2 other surgeries and been a patient in 4 (3 hipscopes and 1 c-section), this was the first time that no one has yelled "Don't touch anything". I guess I looked more authoritative this time!!!
She had a spinal block with some sedation and we were ready to roll. I did have to step out of the OR at times bc they use fluroscopy and I didn't want to take a chance with the radiation and the baby (pregnancy + x-ray does not mix well). So I watched the portal placement through a window, as well as the tractioning, which I would have loved to watch (Hopefully this patient will do well, but she will probably need the other side done so it should be after I have the baby and I can come back.) When I came back in, he showed me the large labral tear, looked like it was from a cam lesion. there was also a bunch of synovitis.He did a synovectomy and then debrided the tear. There was no evidence of a pincer lesion there as well as on x-ray, MRI and CT. THE PSOAS WAS LEFT INTACT!!!! Whohoo!!! They then released the traction to look for the cam lesion. Again, I stepped out for some x-rays, they had to cut into the capsule to access the bump. He performed a cam decompression and then approximated the edges of the cut capsule and put in some sutures. This is a newer procedure (I don't think I had it done) but apparently it decreases the stress on the anterior structures and decreases tendonitis during recovery and rehab. I will let you know how she does.
I stood right behind Dr.Kelly the whole time and got to see the screen as he did. He explained what he was doing, showed me the anatomy and the damage, and the pre an post x-rays.
That was it. It was 2 hours from the time we entered the OR until she was resting comfortably in the PACU. It was incredibly awesome for me to watch, I feel like I learned a lot and have now been on all sides of this! She looked great in recovery, much better than I ever did. I think they used less sedation on her. She was already beginning to wiggle her toes before I left, she was on the CPM too. She received PT prior to the surgery because of the long wait time, which was nice, they fitted her with the brace and taught her to use the crutches before she was all drugged up!
I am just about in seventh heaven! I need a life!!!!
Basically all day I was a nervous wreck since I hadn't heard from him, and texted Amy all morning about it, but decided to just show up and figure it out when I got there. The paperwork was done anyway. I was also waiting for the PA to email this AM about the time, but she didn't either (added to my anxiety) but it turns out there were major scheduling snafus.
I made it to the surgery reception area where without much question, they took me back to get scrubs, in the meantime, the PA emailed me to let me know they were about 2 hours behind on scheduling (thank goodness for blackberry). So I got changed and hung out with my patient for a while.
At4:00 we were in the OR. I have to say I have observed 2 other surgeries and been a patient in 4 (3 hipscopes and 1 c-section), this was the first time that no one has yelled "Don't touch anything". I guess I looked more authoritative this time!!!
She had a spinal block with some sedation and we were ready to roll. I did have to step out of the OR at times bc they use fluroscopy and I didn't want to take a chance with the radiation and the baby (pregnancy + x-ray does not mix well). So I watched the portal placement through a window, as well as the tractioning, which I would have loved to watch (Hopefully this patient will do well, but she will probably need the other side done so it should be after I have the baby and I can come back.) When I came back in, he showed me the large labral tear, looked like it was from a cam lesion. there was also a bunch of synovitis.He did a synovectomy and then debrided the tear. There was no evidence of a pincer lesion there as well as on x-ray, MRI and CT. THE PSOAS WAS LEFT INTACT!!!! Whohoo!!! They then released the traction to look for the cam lesion. Again, I stepped out for some x-rays, they had to cut into the capsule to access the bump. He performed a cam decompression and then approximated the edges of the cut capsule and put in some sutures. This is a newer procedure (I don't think I had it done) but apparently it decreases the stress on the anterior structures and decreases tendonitis during recovery and rehab. I will let you know how she does.
I stood right behind Dr.Kelly the whole time and got to see the screen as he did. He explained what he was doing, showed me the anatomy and the damage, and the pre an post x-rays.
That was it. It was 2 hours from the time we entered the OR until she was resting comfortably in the PACU. It was incredibly awesome for me to watch, I feel like I learned a lot and have now been on all sides of this! She looked great in recovery, much better than I ever did. I think they used less sedation on her. She was already beginning to wiggle her toes before I left, she was on the CPM too. She received PT prior to the surgery because of the long wait time, which was nice, they fitted her with the brace and taught her to use the crutches before she was all drugged up!
I am just about in seventh heaven! I need a life!!!!
Thursday, August 28, 2008
Hipscope #4
I will be in Dr.Kelly's OR this Tuesday for the 4th time.....
but for the first time, I will not be on the table!!
One of my patients is having her hip scoped and I will be there to watch! You can only imagine how excited I am, and how much I will enjoy this! After all I have been through, I am so excited to see what happened after I drifted off into lala land!!
She has a labral tear, FAI and he is (gasp) releasing her psoas, but my mouth is shut. I can only be a pain in the ass when it involves my own hips and I am so grateful to be allowed in the OR!
but for the first time, I will not be on the table!!
One of my patients is having her hip scoped and I will be there to watch! You can only imagine how excited I am, and how much I will enjoy this! After all I have been through, I am so excited to see what happened after I drifted off into lala land!!
She has a labral tear, FAI and he is (gasp) releasing her psoas, but my mouth is shut. I can only be a pain in the ass when it involves my own hips and I am so grateful to be allowed in the OR!
Monday, August 25, 2008
Who's 'da Man
After a rough start to my day, I finished the morning with my ego quite inflated. Let me explain.
I am currently treating a 30 year old woman with hip pain. Plain MRI showed no pathology, I do not have the x-ray reports. Her chief complaint initially was clicking in the hip and pain and tenderness. She was diagnosed with hip flexor tendonitis. A load of crap, said I, humbly!
She did have extremely tight and painful hip flexors but she also presented with a positive impingement sign, and her pain is relieved with traction and any type of distraction I do on her hip. Her hip flexors have started to feel better from the extensive amount of manual work I have been doing but she still coplains of joint instability, clicking, and just a "funny feeling". So I have been telling her from the very beginning that I suspect there may be something wrong with the joint, despite what the MRI said. I think she started believing me and decided to go back to the doctor after we spoke on friday morning.
When I arrived in the office this morning, there was a handwritten note in my box that said to call that OS office ASAP. In my office, we NEVER use handwritten notes, every message is sent via intra-office email, and then the recipient knows who it was from in case they have questions. This had no name in it, no signature, nothing. Just to call regrding this patient, and ASAP. I thought "oh shit", I pissed him off with my brazen hip views and opinions. At that point, all I could do was suck it up and call, take him yelling at me, and move on. Ironically, the patient was in the OS office at the time I called. I also was not sure who from the OS office had called, bc the note said that his office had called, not him personally.
So I finally got through (after about 3 or 4 busy signals), and the receptionist had no idea who had called me. I went on to further explain that the patient was currently in their office and the message was regarding her. "Oh", the receptionist said, and the next thing I knew, the OS picked up the phone. "Fuck", I thought I had gotten off easy this time!
He said he had been talking to the patient regarding the clicking, and I was "right on" thinking it may be a labral tear, and he was going to order an MR arthrogram. "I think that is a good idea", I said. But I didn't stop there. I asked "did her x-rays show any sign of impingement or dysplasia?" "No, nothing exciting there" he replied,"but you are on the right track".
Ok, I obvioulsy didn't mention my own personal "battles", and how I probably know a little bit more about hip issues than the average PT, but what started out as a morning of me pracically peeing in my pants (for different reasons this time) ended up with me gloating and high fiving everyone around me!!!
I am currently treating a 30 year old woman with hip pain. Plain MRI showed no pathology, I do not have the x-ray reports. Her chief complaint initially was clicking in the hip and pain and tenderness. She was diagnosed with hip flexor tendonitis. A load of crap, said I, humbly!
She did have extremely tight and painful hip flexors but she also presented with a positive impingement sign, and her pain is relieved with traction and any type of distraction I do on her hip. Her hip flexors have started to feel better from the extensive amount of manual work I have been doing but she still coplains of joint instability, clicking, and just a "funny feeling". So I have been telling her from the very beginning that I suspect there may be something wrong with the joint, despite what the MRI said. I think she started believing me and decided to go back to the doctor after we spoke on friday morning.
When I arrived in the office this morning, there was a handwritten note in my box that said to call that OS office ASAP. In my office, we NEVER use handwritten notes, every message is sent via intra-office email, and then the recipient knows who it was from in case they have questions. This had no name in it, no signature, nothing. Just to call regrding this patient, and ASAP. I thought "oh shit", I pissed him off with my brazen hip views and opinions. At that point, all I could do was suck it up and call, take him yelling at me, and move on. Ironically, the patient was in the OS office at the time I called. I also was not sure who from the OS office had called, bc the note said that his office had called, not him personally.
So I finally got through (after about 3 or 4 busy signals), and the receptionist had no idea who had called me. I went on to further explain that the patient was currently in their office and the message was regarding her. "Oh", the receptionist said, and the next thing I knew, the OS picked up the phone. "Fuck", I thought I had gotten off easy this time!
He said he had been talking to the patient regarding the clicking, and I was "right on" thinking it may be a labral tear, and he was going to order an MR arthrogram. "I think that is a good idea", I said. But I didn't stop there. I asked "did her x-rays show any sign of impingement or dysplasia?" "No, nothing exciting there" he replied,"but you are on the right track".
Ok, I obvioulsy didn't mention my own personal "battles", and how I probably know a little bit more about hip issues than the average PT, but what started out as a morning of me pracically peeing in my pants (for different reasons this time) ended up with me gloating and high fiving everyone around me!!!
Wednesday, August 20, 2008
As the Snapping Continues, I Think Happy (and cute) Thoughts
We had a great time at Victorian Gardens in Central Park with hipster Amy last week!
Monday, August 18, 2008
This is Not What I Signed Up For
Firstly, I would like to address an issue that has been brought to my attention. Mainly, it is that I am generally feeling awesome. I don't know how well it is reflected here since I usually only blog about the bad days, If you would prefer, I could post each day and write something to the likes of "Today I had no hip pain". But that would be kind of lame and boring, but it is the case most of the time. And no matter how much I complain, anything I speak of is nothing compared to pre-op and I have never once had second thoughts about surgery (revision too) and continue to be really happy with the results.
That said, I will begin by saying that what is happening now sucks! I think my pelvis/ SI joint is becoming increasingly unstable from the pregnancy hormones, so, like in the past with unstable joints, the muscles are tightening/ spasming in response. This time, it is not my psoas (yay), but my right IT band (revision side). It is so tight it has begun snapping. I never really understood the full implications of a snapping IT band...until now. It is a painless snapping that began a few days ago. My greater trochanter on that side is also tender to the touch. I don't know if maybe this is partly because I sleep on my side now, since stomach sleeping ended a few weeks ago, or bc of the tightness, or both...I don't know what came first. In addition, my left adductors are also tight and tender again. So the right side of both legs hurts, I wonder if the right side of my pelvis is more hypermobile these days, the hip joint definitely is more hyperobile on the right.
To add to all of this, the following happened last night. This is rather graphic, and possibly better suited for the ladies only, preferably the ones who have already had children, so that those of you who have not will not be scared away. So you have been warned. If you don't like graphic, skip the rest of the post.
Way back when, when I only began to realize I had a torn labrum, I also realized that suddenly, my pelvic floor muscles were also very weak. To me, this was really bad since on top of treating orthopaedic patients, I also specialize in treating incontinence and pelvic floor dysfunction. The muscles remained weak after surgery but I never had any "real" leaking. Last night, I was lying in bed and out of nowhere got really nauseous. I realized I needed to throw up, and fast, so made a mad dash for the bathroom. Once I started throwing up, I literally peed all over myself. At the time, it was not funny, now, looking back, I can sort of smile, I know it is not permanent, but standing in the bathroom, not knowing where to go or what to do, I was certainly not laughing. When it all "ended", I sat down to catch my breath, and realized my nose was bleeding as well. Another lovely pregnancy side effect. Did I mention that this is my last pregnancy????
That said, I will begin by saying that what is happening now sucks! I think my pelvis/ SI joint is becoming increasingly unstable from the pregnancy hormones, so, like in the past with unstable joints, the muscles are tightening/ spasming in response. This time, it is not my psoas (yay), but my right IT band (revision side). It is so tight it has begun snapping. I never really understood the full implications of a snapping IT band...until now. It is a painless snapping that began a few days ago. My greater trochanter on that side is also tender to the touch. I don't know if maybe this is partly because I sleep on my side now, since stomach sleeping ended a few weeks ago, or bc of the tightness, or both...I don't know what came first. In addition, my left adductors are also tight and tender again. So the right side of both legs hurts, I wonder if the right side of my pelvis is more hypermobile these days, the hip joint definitely is more hyperobile on the right.
To add to all of this, the following happened last night. This is rather graphic, and possibly better suited for the ladies only, preferably the ones who have already had children, so that those of you who have not will not be scared away. So you have been warned. If you don't like graphic, skip the rest of the post.
Way back when, when I only began to realize I had a torn labrum, I also realized that suddenly, my pelvic floor muscles were also very weak. To me, this was really bad since on top of treating orthopaedic patients, I also specialize in treating incontinence and pelvic floor dysfunction. The muscles remained weak after surgery but I never had any "real" leaking. Last night, I was lying in bed and out of nowhere got really nauseous. I realized I needed to throw up, and fast, so made a mad dash for the bathroom. Once I started throwing up, I literally peed all over myself. At the time, it was not funny, now, looking back, I can sort of smile, I know it is not permanent, but standing in the bathroom, not knowing where to go or what to do, I was certainly not laughing. When it all "ended", I sat down to catch my breath, and realized my nose was bleeding as well. Another lovely pregnancy side effect. Did I mention that this is my last pregnancy????
Wednesday, August 13, 2008
More Summer Fun
I finally figured out how to get the blackberry pictures to show in full size, so I went ahead and changed the last pic I uploaded as well from the pool!
Sunday, August 10, 2008
Refocusing
Since this blog was started for the purpose of following my recovery from hip arthroscopy(s), I figured I should take a break from sunbathing and let you know what the story is.
Initially, I was supposed to have a follow-up appointment with Dr.Kelly this week (and Amy too) but being that my current condition does not allow for x-rays, I have cancelled and will reschedule for a later date (i.e after the baby is born). Amy and I will still try to make time for an L/ Jk outing + photo session, the plan is to go to Central Park on Thursday.
Anyway....I go most of the time without even realizing that my left hip was ever operated on. I feels great, no pain (at least not in the last few weeks/ days that I can recall as I type this). The only catch is that my activity level has seriously plummeted since the pregnancy began. I am constantly battling bone crushing fatigue so I drive everywhere. Last summer, I walked to the pool every day, this sumer we drive. The pool is across the street from the park I walked (crutched) to 6 days after my second surgery, so it is clearly not that far. The nausea still has not subsided but thanks to amazing drugs, I function! (Thank you Zofran)
The right hip is a different story. Yes, it was operated on twice, and yes, the left hip has 4 months on the right hip, but I can't help to wonder at what point my progress will plateau. Don't get me wrong, it feels great, amazing, a million times better than pre-op, but since I have a "perfect" left hip, it makes me sad to have to settle for less than perfect.
I know, my famous line is "once it is scoped it will never be the same again", I know, but one can only dream! Considering the amount of work I had done on it, I should not be complaining, but should be jumping for joy. The actual joint is great, no more FAI, no more pain in there, so yes, mission accomplished! What bothers me is more superficial pain, around the incisions, yes, the nerve pain is still there. Much diminished, but sigh, still there. My (gasp) psoas gets tight still and once again decreases my stride length. If I had the energy, I would stretch more, but every second I have to myself I am usually in bed (like now, the kids are in the living room watching cartoons and I am in bed. J is out of town for the week).
Of course, I am still anxious about the delivery. Plus, my new decision to try to go as natural as possible. I am thinking of hiring a doula, to help me during the birth. In my messed up mind, if I don't have an epidural, I will feel pain in my hip and prevent it from being put in bad positions. I had hired a doula for L's delivery and needed a c-section bc she was breech. For Jk, I couldn't even think that far ahead, all I could think about was not having a repeat c-section, I didn't care how I went about it. Also, for L's birth, I was petrified of having an epidural. I have now survived a c-section, a vaginal birth and 3 hipscopes with some form of spinal or epidural anesthesia, so the fear factor is slightly decreased, but if I can avoid it, I will. J is not in favor of a doula, he thinks it will lessen his role, but frankly, he had no idea what to do last time and I was rather pissed for a while (I think I still am a little), so thinks that I am trying to punish him by getting a doula. Whatever, next time, he can birth a child and do it his way!!!!
Initially, I was supposed to have a follow-up appointment with Dr.Kelly this week (and Amy too) but being that my current condition does not allow for x-rays, I have cancelled and will reschedule for a later date (i.e after the baby is born). Amy and I will still try to make time for an L/ Jk outing + photo session, the plan is to go to Central Park on Thursday.
Anyway....I go most of the time without even realizing that my left hip was ever operated on. I feels great, no pain (at least not in the last few weeks/ days that I can recall as I type this). The only catch is that my activity level has seriously plummeted since the pregnancy began. I am constantly battling bone crushing fatigue so I drive everywhere. Last summer, I walked to the pool every day, this sumer we drive. The pool is across the street from the park I walked (crutched) to 6 days after my second surgery, so it is clearly not that far. The nausea still has not subsided but thanks to amazing drugs, I function! (Thank you Zofran)
The right hip is a different story. Yes, it was operated on twice, and yes, the left hip has 4 months on the right hip, but I can't help to wonder at what point my progress will plateau. Don't get me wrong, it feels great, amazing, a million times better than pre-op, but since I have a "perfect" left hip, it makes me sad to have to settle for less than perfect.
I know, my famous line is "once it is scoped it will never be the same again", I know, but one can only dream! Considering the amount of work I had done on it, I should not be complaining, but should be jumping for joy. The actual joint is great, no more FAI, no more pain in there, so yes, mission accomplished! What bothers me is more superficial pain, around the incisions, yes, the nerve pain is still there. Much diminished, but sigh, still there. My (gasp) psoas gets tight still and once again decreases my stride length. If I had the energy, I would stretch more, but every second I have to myself I am usually in bed (like now, the kids are in the living room watching cartoons and I am in bed. J is out of town for the week).
Of course, I am still anxious about the delivery. Plus, my new decision to try to go as natural as possible. I am thinking of hiring a doula, to help me during the birth. In my messed up mind, if I don't have an epidural, I will feel pain in my hip and prevent it from being put in bad positions. I had hired a doula for L's delivery and needed a c-section bc she was breech. For Jk, I couldn't even think that far ahead, all I could think about was not having a repeat c-section, I didn't care how I went about it. Also, for L's birth, I was petrified of having an epidural. I have now survived a c-section, a vaginal birth and 3 hipscopes with some form of spinal or epidural anesthesia, so the fear factor is slightly decreased, but if I can avoid it, I will. J is not in favor of a doula, he thinks it will lessen his role, but frankly, he had no idea what to do last time and I was rather pissed for a while (I think I still am a little), so thinks that I am trying to punish him by getting a doula. Whatever, next time, he can birth a child and do it his way!!!!
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