More UHC.....

As I have noted in the past, UHC has denied payment for my last surgery. It has been resubmitted numerous times and still denied. After Maria's article was published, I contacted Cheryl Randolph, the PR exec from UHC quoted in the article via email, regarding my claim. I cc'd a few other PR people at UHC as well. I got no response. I sent another email to the same group of people this week, but signed it with my credentials (thanks Maria!). When I got home from work today I had a message from Linda @ UHC regarding my emails.

I called the number and got UHC corporate offices...ooh lala! Linda is a consumer advocate, she told me I would need to appeal the decision. What I explained was that I didn't see the need to do this since the procedure had already been paid for 3 previous times. She was stumped. Regardless, she said to write an appeal and send it to her, and she would expedite it and get it to the right people. And to make sure I stated that it had been previosuly paid for.

I don't know if in the end this will help me or not, but it pays to be the squeaky wheel...someone is going to listen...or get really annoyed!

FML

That pretty much describes the way I am feeling right now. I am having a lot of discomfort in my joint, and have felt my hip "shift" or "sublux" or "de-stabilize" or something multiple times. I am not a happy camper to say the least. I had PT today and my therapist is very concerned about this. He thinks that my femoral head is sitting anterior, which is why I don't have full hip flexion, and why I am so unstable. It is anterior because I have nothing restraining it, I ruptured the ligamentum teres on that 'fateful' June night, and he is pretty sure that my capsular shift was ineffective. He thinks that most likely my capsular tissue was no longer of good quality and just couldn't hold the repair.

That leaves me beyond upset, angry, sad, disappointed.....3 fucking surgeries later and I still have pain. He told me not to give up yet....he is not giving up yet. At this time I am really inflamed so I can't do much of anything. He was also palpating around my ASIS/AIIS and found swelling...he is not sure why but thinks that something there is also very inflamed and irritated. Fabulous.

I am to do one exercise for now. Lying on my back with my knees bent, push my hands into my knees and hold for about 10 seconds. This is to activate my abs...which have most definitely shut down. I iced with the gameready afterwards...it felt great. He wants me to rent one for now but I know I won't use it! It is bags of frozen vegetables for me!!!

He also thinks it may be helpful to get an active fluoroscopy of me bending forward to see exactly what is happening in the joint, and to get an idea of how 'fixable' I am!

Back To Work!

Well, the party had to end at some point I guess, and it was back to work for me yesterday! Work itself went well, it was extremely busy and I had a ton of paperwork, but I managed! Yesterday morning I had what I have come to call one of my "episodes", where I will be doing something and my hip feels like it is subluxing. It usually happens when I am bending down to get something from the floor. It really hurts and is really disconcerting, especially after having surgery to stabilize my hip. I had on and off pain throughout the day, at periods I had no pain at all and others I had excruciating pain. Today was the same, on and off pain throughout the day.I am extremely frustrated with this and was hoping that by 3 months I would be past this. Tomorrow I have PT so hopefully we can work on stabilizing me a little bit and avoid this.

Good News For One Reader

Whenever someone posts a comment on my blog, I get an email about it, even if it is an old post. I was thrilled to get this comment today from Tim on the post about UHC's new FAI ruling:

"I just had my 2nd level appeal hearing with UHC today. Great news! They called back within 15 minutes and have agreed to pay for the surgery I had last September"

Congratulations Tim!!! I hope to get more news like this very soon from many readers!!!

Overcoverage, Undercoverage...Why Can't I Just Get It Right!

I have been totally slacking on the blogging front and once again apologize. I just feel the need to be done with hip shit once and for all.
I am totally done with my original PT and now on to PT #2, who works closely with my OS.

I have been having some feelings of instability, especially when I bend down quickly. Also, I went sledding on Sunday and walking up the hill killed me the next day. I had a lot of groin pain and got really nervous.

I told PT #2 that I really want my full hip flexion, on top of the other things that are going on. He said that one of the issues is that my capsular shift is not doing what its supposed to do, and my hip feels "sloppy", when he externally rotates it there is almost no end feel, it just flops. He also felt that my femoral head was too anterior causing it to jam up into the joint, so he wants to try some things to reposition it. He ended up taping me into a little pelvic anterior rotation to try to get more coverage of the femoral head. After a few hours I had a lot of back pain so had to remove it. We are going to work on some exercises from now on to get that back into place.

He also worked on some muscles trying to get my hip flexion increased. There is a spot on the inside of my leg where the adductor meet the VMO that is incredibly tender, he worked it so hard but it increased my ROM...not without leaving behind some nasty marks though!

I go back to work on Monday...I am nervous about it...I will keep you posted!

Take That UHC

Many many thanks to fellow hipster Maria, who is paving the way for the rest of us to have our claims paid. Below is an article she was interviewed for in the New York Times. As you can see, the article quotes Cheryl Radolph, VP of PR at UHC, who says "the company is now rethinking things once again because of "the changing landscape of medical literature" about the procedure"

Funny, because my surgery was not covered, and the reason UHC gave me is that "This Service Is Unproven And Is Not Covered. Therefore, No Benefits Are Payable For This Expense. In Order For This Service To Be Considered For Coverage, Scientific Evidence Must Be Submitted, That Meets The Standards Described In Your Benefit Plan Language, That Demonstrates The Safety And Effectiveness Of This Service For Your Particular Condition".


Fighting Denied Claims Requires Perseverance

MARIA CARR, a 43-year-old school administrator from Tulare, Calif., could not believe it when her insurer, UnitedHealth, denied coverage for arthroscopic surgery she underwent last year to treat a bone spur on her hip.

Her doctor told Ms. Carr he had successfully performed this procedure for eight other UnitedHealth patients suffering from the same ailment in the same year. To Ms. Carr’s mind, arthroscopy seemed a much less invasive and cheaper way to treat the problem than open hip surgery, the traditional treatment for bone spurs.

“When the denial came I was shocked,” Ms. Carr said, “but I figured I’d just have to find a way to pay.” The total bill for the hospital and surgeon fee was $21,225.

Ms. Carr’s form of shock is all too common. The Department of Labor estimates that each year about 1.4 billion claims are filed with the employer-based health plans the department oversees.

Of those, according to data collected from health insurance industry sources, 100 million are initially denied. In simpler numbers, that is one of every 14 claims.

But Ms. Carr, whose hip pain ceased after the arthroscopic surgery, did not give up on the reimbursement. And neither should you. When Ms. Carr, a special education administrator at a local charter school, read her explanation of benefits statement more carefully, she spotted some instructions on how patients can appeal denied claims.

“I decided I would fight,” she said. “After all, what did I have to lose?”

Ms. Carr researched medical journals and other publications to find proof that her procedure was a bona fide and safe treatment. She then wrote a formal letter to her insurer making her case and including copies of the research she had found. Her doctor backed her up with a thorough letter of his own.

The appeal was initially denied, but Ms. Carr kept fighting. She took her case to her insurer’s external review board, where an impartial medical expert weighed the evidence.

The expert agreed with Ms. Carr, saying UnitedHealth had to pay the claim. “The expert felt UnitedHealth couldn’t call the procedure experimental if it paid for other patients to have it,” Ms. Carr said.

UnitedHealth ended up paying $12,282 for Ms. Carr’s claim — at a rate the insurer negotiated with the doctor and hospital. Ms. Carr’s share was about $500.

“That’s what the appeals process is there for,” said Cheryl Randolph, a spokeswoman for the insurer. “We’re glad it worked for her, and we encourage members to exercise their right to appeal whenever they need to.”

Not that UnitedHealth now happily pays all such claims. Soon after Ms. Carr’s successful appeal, the insurer revised its policy to stipulate that it did not cover that type of hip procedure — although Ms. Randolph says the company is now rethinking things once again because of "the changing landscape of medical literature" about the procedure.

Whatever the treatment or procedure a patient receives or is contemplating, a variety of things can prompt a claims denial. It might be a simple clerical error, like an incorrect address, or a doctor’s use of the wrong diagnostic or treatment code for your treatment.

Then there are the more serious causes — as when a treatment is specifically excluded from your policy, for example, or, as in Ms. Carr’s case, when the insurer deems a procedure experimental and therefore ineligible for reimbursement. Other frequently denied claims involve emergency room visits, especially those at out-of-network hospitals and clinics.

Another big category involves chronically ill patients, who often must try several medicines and treatments to find the one that works best for them. Such patients can become all too familiar with insurance denials, says Jennifer C. Jaff, founder of Advocacy for Patients with Chronic Illness.

But as Ms. Carr discovered, if you are denied coverage you have a right to appeal. And in most cases, experts advise you to do just that. Approximately half of all appeals are successful, according to anecdotal evidence from patient advocacy groups and data from individual states.

“About 53 percent of appeals work in our state,” said the Kansas insurance commissioner, Sandy Praeger. “That demonstrates that the process works.”

Use the following advice to increase your chances of success in appealing a health insurance denial. As you’ll see below, expert help may be available. And if you feel in over your head, and a significant amount of money at stake, it may even be worth hiring a type of specialist known as a billing advocate.

READ YOUR POLICY Always check your policy carefully before you undergo treatment.

Many denials are made because the policy specifically excludes coverage of a certain treatment, procedure or medicine, Ms. Praeger said. When it is spelled out that something specific is not covered, an appeal will not work.

TAKE YOUR TIME When you decide to appeal, do not act in haste, advises Ms. Jaff, of the patient advocacy group.

Most insurers allow a certain amount of time to file for an appeal, usually 60, 90 or 180 days. If you call and say I want to appeal, an insurer may consider that the appeal itself. So you want to take advantage of the time you have (without missing the deadline) to build your case.

Before you file, make sure you have all the information you need from your insurer to start your appeal in earnest. Your explanation of benefits should provide a code for the reason for the denial, and that code should be translated somewhere on the statement. If it is not or if you still have questions, contact your insurer.

Make it clear in your phone call or letter that you are not officially starting the appeal process. You simply have questions. If it is not already clear, you should also ask exactly to whom the appeal should be sent. (You do not want precious time wasted because your appeal was shuffled from desk to desk. )

Whenever you call your insurer, be sure to make a note of the time and date and the person you talked to. If you send a letter, send it registered mail with return receipt, and keep your own copy.

DO RESEARCH Once you learn why your claim was denied, customize your appeal to argue specifically against that reason. A clerical or coding error is fairly straightforward, but just to be sure, enlist the help of your doctor’s or hospital’s billing specialist to back you up with a letter explaining how the mistake was made.

Something more complicated, like an out-of-network emergency claim, will require proof that the situation was indeed a medical emergency and that no in-network provider was available. Obtaining your medical records can help support your argument, so can letters from the doctors who treated you.

Fighting a denial for something your insurer deems experimental can be the trickiest appeal. In addition to support from your doctor, you will need to find articles from established medical journals for evidence that the treatment is not only effective but safe.

You can find abstracts of many articles free on pubmed.gov, the library of the National Institutes of Health. Often the abstracts are enough to make your point. If you need the full article, which can be expensive, ask your doctor’s office for help or check with a local medical school library.

Any proof you can show that other insurers in your area cover the treatments in question can be valuable. Most big insurers list medical policies concerning treatments on their Web sites. Your doctor’s office can probably help with this, too.

You also must prove the medical necessity of a treatment, especially if it is considered experimental.

Ms. Jaff, for instance, learned this when she was denied coverage for a certain drug her doctor prescribed for Crohn’s disease. Her insurer argued that other, more established drugs could treat the problem. True enough, but Ms. Jaff had already tried those drugs without success.

For her appeal, Ms. Jaff collected her medical records that showed when she had tried each drug and how each had failed. The strategy worked, and her claim was ultimately paid.

Be sure to stick to the facts in any argument you make. Emotional or angry arguments, as much as they may feel warranted, will not help your case, said Erin Moaratty, who heads special projects for a group called the Patient Advocate Foundation.

GO THE DISTANCE Even if your well-researched and thorough appeal is denied, do not give up. You still have options, depending on the type of insurance you have.

If you receive coverage directly from an insurance company, say through a private policy or from your small or midsize employer, your insurer is regulated by your state’s insurance department. All but five states, Alabama, Mississippi, Nebraska, South Dakota and Wyoming, allow patients to have their appeals considered by an independent external review board, usually after all internal appeals have been exhausted.

In most cases the board consists of doctors and other professionals with an expertise in your condition. For more information on your state’s rules contact its department of insurance. To find yours, go to the National Insurance Commission’s Web site and click on your state.

Large employers that self-insure — meaning that they pay medical claims themselves, not through an insurance company — are not subject to state insurance laws. But most have provisions for external appeal reviews. Check your plan summary, the large booklet you received when you signed up for health care, for details.

GET HELP Your state insurance department can help answer questions and start an appeal. In addition, groups such as Advocacy for Patients with Chronic Illness and the Patient Advocate Foundation help seriously ill patients file appeals free.

Be sure to check the advocacy organizations for the illness you have. Many offer free advice on dealing with health insurance disputes with specific information related to your condition.

You may also want to seek help from a medical billing advocate (see our earlier column “A Guide through the Medical Wilderness”). Depending on the case, these professionals charge an hourly fee or a percentage of any recovered claim.

My PT Dilema

I told a little white lie today at PT! I told my PT that I went with my friend to her PT and he gave me some exercises to try and some manual techniques to try.

At this point, I am 9 weeks out, the back pain is a lot better just since I have been doing the exercises I got yesterday at "secret PT" and since the "secret PT" worked on my hip.

My complete exercise routine is as follows: Upright Bike, Leg press, single leg press, squats on 2 dynadiscs, sidestepping squats with a theraband, standing hip 4 way with theraband (both legs), squats on a foam roller, seated isometric hip abduction and extension, seated knee flexion with theraband, seated knee extension with 2# weight, seated hip IR with ball and theraband, sidelying hip abduction and end range hip abduction, clam shells, bridges, quadruped hip extension.

My 3 new exercises are: 1)supine, operated leg straight, other leg bent with foot flat, theraband around both knees, operated leg doesn't move, other leg abducts/ER (fall outs) 2) double leg bridge, hold, pick up non-op leg, hold 2-3 seconds, bring it down, raise it again for 2-3 seconds, bring it down, repeat 10 times, then slowly lower bridge maintaining pelvis level. 3) standing on op leg only, bend forward by hinging at hips until torso parallel with ground, keep standing leg straight, arms out to side, slowly bring one arm down to your center and return to start position, repeat 10 times, alternating sides.

My PT is only stretching me and not doing a lot of manual work anymore, there are days when I really need it. the "secret PT" did such a great job on me yesterday, I am considering going back to him. Once I go back to work things will be complicated, but I would rather be complicated for a bit than not well healed. If only P, my original PT were still at my practice I wouldn't have these issues!!!

Secret PT Visit: Part 2

Today was my follow up with my "secret" PT. I most likely will not be seeing him again, but he has been able to give me some great advice. It seems that my back pain is coming from muscle imbalances, mostly my glutes are super weak. He gave me 3 exercises to do for the next 10 days to activate the glutes and hopefully get me stronger and out of pain.

What's great is that immediately when I exercise, my back starts to feel better, so I know that by "waking up" my glutes, I start to move and function better.

In general my back has been better, I have increased my exercises in PT and added a few more challenging ones, and I had my back worked on 3 times last week. I still "spasmy" but definitely getting better.

I have to say that I know I post a lot less than I did for my previous surgeries, but life with 3 kids just wears me out, and by the time they are in bed, I am usually ready for bed too! I am still not back at work yet, but do find myself busy all the time. I plan on returning in 3 weeks. I will be working my regular, part time hours. I agreed to cover someones maternity leave in another office. It would be managing the office and working three 12 hour days....I hope I don't regret it!!

I'm Relieved To See That These Things Don't Only Happen To Me

I have a friend who is having some hip issues, she also had surgery with BK about 1 1/2 years ago. This is a text I received from her this morning after she went for her PT eval

Toll: $8, Parking: $20, Co-pay: $40, Waking up at 4:45am and being seen by an PT intern: Priceless

The icing on the cake was this afternoon when there was a possibility that the PT that was supervising the intern was actually an OT! In the end, it turned out he was a PT, but what a day it was for her!

The Glamours of NYC

Today was my top secret PT appointment in the city! I will get into it when I have more time, but tonight I may have to kill one of my children! No one is going to bed! Anyway, as I was coming home, minding my own business, a super creepy guy came over to me and said "has anyone ever told you you have sexy legs", to which I clearly had no response, other than my jaw dropping, because really, what does one say to a super creepy guy who thinks yoir gimpy legs are sexy. J got a good laugh out of this!

Health Care Reform

A fellow hipster has brought to my attention an interesting blogger, he used to be a PR exec at one of the big health insurance companies, he is now speaking out against insurance companies. Being that many of us are either in a battle with the insurance companies to cover our past or future surgeries, or know someone who is, she has posted a comment on his blog, we all should do the same.
Here is a link to the post as well as a link to her comment. As promised, here is a link to my comment, look for the comment by Susie L. If this link does not work, please email me, suzq613@aol.com

My Aching Back

Even though I am loaded up on Flexiril and Flector patches, my back is still giving me loads of pain. When I have back pain I have no hip pain, and when I have hip pain I have no back pain. I still would much rather have hip pain! I went into my office yesterday for a co-worker to ART my back. It hurt like a bitch, but I felt a lot better after. Today my PT did some deep tissue work on me. Both said that I am having a ton of tightness all along my spine on the right side, with tons of knots and tender points. I think that my legs are too weak still, and my back is working overtime. Tomorrow I have a "secret appointment" with my OS' PT, I am not telling my other PT, but I need to get to the bottom of this before I go crazy!

In Case You Were On The Fence About Surgery...

These are "the boots"! I was supposed to sleep in them for 2 weeks.....Are you really in that much pain now?????

My New Favorite Drugs

Since my back pain had gone from bad to worse, I got a rx for Flexiril, a muscle relaxant. My PT says I am having back spasms from muscle imbalances, and the strong muscles are pulling too hard and the weak ones can't stabilize. I have been in excruciating pain at times. What's interesting is that I NEVER have back pain at the same time as hip pain, it is always one or the other. I have been applying Flector patches to my back and taking Flexiril PRN, mostly at night because it put me out yesterday afternoon! What a difference these have made. Thurs and Fri nights were the first time I have had a good nights sleep in weeks. I wish I would have gotten the drugs earlier!

I have been paying attention to how I move and have noticed that when I extend my back from a flexed position, or try to stand up from a kneeling or crouched position, I am really straining my back bc my leg muscles are so weak. I plan on hitting PT hard this week and doing exercises at home to help with this. I never thought I would say this but I'd rather have hip pain any day over back pain!

6 (7) Week Appointment

Today was my follow up appointment with Dr. Kelly. I have had some concerns but they didn't seem to concern him. One of my concerns is that I don't have full hip flexion back yet. He said that for 6 (7) weeks, I am in a good place. I am concerned about the excessive ER I have, he just said not to push it. I am also concerned about pain I get in my thigh. He thinks it is muscle weakness, and the pain I get throughout the day is from fatigue and weakness. He did give a prescription for Flector patches for pain/ inflammation. I have been having crazy back pain lately, ever since I started having less hip pain. When I got home I put a patch on my back and it was like a miracle. I was supposed to check with my GI doc first about them but the pain was so excruciating I decided to try it first. I do have an email on to him about it though. I asked him of it was normal that my ankle swells when I am on my feet too much, to which he responded "no its not normal, my ankle doesn't swell", to which I replied "well, it didn't swell before the surgery". He thinks it may be from the traction. He gave me a prescription for Ted stockings for this, lovely.

Something I haven't discussed on my blog yet is the fact that my insurance company denied the surgery as of now, a $30k and $15k charge. He was not too concerned and told me to disregard bills sent from his office! This was a huge weight lifted off of my shoulders. Obviously there is still paperwork to be submitted, appeals, etc, but I feel better about it.

That's about it, anti-climactic, just how I like it. No need for MRIs, CTs, injections...just a follow up in 6 weeks!

Snow Tubing

What A Weekend It Has Been

I feel like this weekend things are finally normalizing. I had a crazy, crazy weekend, which included hosting a friends 30th b-day in my apartment on Saturday night, and then hosting an accessories boutique Sunday night. This involved a lot of cleaning, and picking up, and decorating, serving, cleaning, picking up, and setting up, over and over again. I thought I would be inhaling Vicodin but I am happy to report that I didn't touch it. I did drink quite a bit, so that definitely helped! By tonight at the show, I had to sit down a lot bc my ankle was swelling and my foot felt heavy and uncomfortable. My hip was sore and painful but much better. I also walked 10 blocks to a friends house for lunch yesterday with no more than mild to moderate discomfort.

I wonder if the weather is contributing to this turnaround, it is not as cold as its been here, and feeling a lot more mild. Tomorrow we are going snow tubing, I don't plan on actually participating though. You can find me with Z in the lodge near the hot chocolate!

A Glimpse Into My Day

I was at PT today, working hard on the leg press, set to 75lbs. My PT asked how much weight I was doing, I told her, she responded "good, keep it light and easy"...I responded "this is easy? -I'm busting my ass"! I am pathetic!

What I Struggle With

At 6 weeks post-op, I am doing really well. Looking at me, you would never know that I had a hipscope 6 weeks ago, much less my 4th hipscope. I take the kids to school, to after school classes, run my errands and go to PT. What you can't tell is that when I accidentally drop something on the floor, I pray that someone will be nice enough to pick it up for me. My 4 year old knows not to ask me to carry him, although my baby is growing frustrated with that, and at 30 lbs, it is quite a challenge.

I do what I can, or, as a mother of 3, what I have to. On Friday I decided to go back to some simple cooking. Friday night I was in agony but didn't want to take anything for pain and hoped it would calm down by the morning. Saturday morning, after getting the kids fed and dressed, I turned to my good ol' friend Mr. Vicodin! Sunday afternoon was no better and after lying helplessly on the couch for about an hour and a half, with no relief, I had J bring me another Vicodin. Amazingly, once it kicks in, it kicks in! I was then able to make the kids dinner and got through bed time.

Today was another supermarket day. Again, this proved to be tough for me and painful but I made it through the day with any drugs. I have learn to realize that there will b ups and downs, and I need A LOT more patience if I am going to get through this recovery without the use of heavy duty psych meds!!

You Can't Compare...but

I was just thinking...at this point last time, I was back at work. I had also already ice skated once and climbed a rock wall. I was also off the pill and anticipating getting pregnant.

This time I am not at work and just extended the amount of time I will off, I have pain every morning when I get out of bed, I have trouble sometimes crossing my leg or lifting it up, getting it into the car. Standing for too long is difficult, as is shopping. My limp comes and goes, as does weakness and instability.

But...I am making steady progress and I am pretty sure that my pre-op pain is gone. It is hard to distinguish at this point bc there is so much going on, but the deep, achey groin pain is gone. I could not be happier about that, but wish things could move a little quicker!

Working Girl....Or Not

I have been wrestling with the idea of when I should go back to work, and losing quite a bit of sleep over it. I had told my office that I would be back on 1/25, 7 weeks post op, 2 weeks from Monday. I am still REALLY weak and unstable at times, and I don't feel ready to go back yet. In the past I have gone back around 4 weeks post-op, this time that was sooooo not happening. I have weakness in my ankle that causes me to trip all over the place. I have been working on strengthening it to prevent this, also adding some stabilizing exercises to keep me upright and not falling flat on my face. My PT thinks I should take 3 months off, she doesn't see why I need to rush back to work, I think I am beginning to agree with her. I told my boss that I will be back at the end of Feb. I think this gives me plenty of time to heal and recover.

PT has been going well, today she did some soft tissue work on my gluts/abductors...I definitely saw stars. I am limping on and off, she is not too concerned about it and thinks it will go away with time. Her only concern is the lump under one of my incisions, the fluid from when it opened up, there is still fluid pooled under there and causing me pain.

At 5 1/2 weeks post-op, I am doing the following at PT: Bike, leg press @ 75 lbs (today added ball in between knees), single leg leg press @ 25 lbs, standing hip flexion (knee straight) and abduction, wall squats with ball in between knees, seated resisted knee flexion, ankle 4 way with theraband, quadruped hip extension, prone hip extension with knee bent with 2 lbs weight, sidelying hip abduction, sidelying endrange hip abduction with leg on stool, bridges, prone hip IR/ER with 2lbs weight, clam shells with theraband

I had to cut it short today bc I was sore and anything in rotation bothered me. I am feeling better now, but still pretty fatigued.

How I Long To Be Normal Again

I got back from vacation yesterday and after 10 days of doing pretty much nothing, I was feeling pretty good. I look normal to someone who doesn't know me, my gait looks pretty good and I am not using any type of assistive device. So I got home yesterday (without luggage....long story, but they lost our 3 suitcases) and headed out to the supermarket. I think it was my first solo trip since surgery, but have to re-read my blog just to be sure!

It didn't occur to me that I may have trouble at the supermarket, since I had been doing well on vacation. It only took about 5 steps in the frigid NY air, pushing an empty shopping cart, that I realized maybe I wasn't quite ready. Oh well, too late, we needed milk and vegetables and dinner etc...so I did it. I looked almost tipsy, and in pain, and when you don't have a crutch, no one really cares if you drop things on the floor, no one holds doors for you.....but I survived.

What I Re-Re-Re Discovered

I have probably said this a hundred times but...when I do nothing I feel better! Since the airport/ Vicodin night, I have done nothing. I have left the house twice, once to go to Starbucks and once to go out to dinner. Zk has been really sick, so I haven't wanted to take him anywhere. He is feeling better, nothing like a round of Amoxicillin with a dose of Prednisone (really bad wheezing and probable ear infection). So for 3 days I have barely moved, and had almost no pain. Its amazing, Zk was finally a little better tonight and I had to try to keep up with him and I could feel soreness returning. Nothing of concern, I mean, I did have surgery 4 weeks ago, but what a difference the activity level makes. This is like after surgery #3, when I couldn't get out of bed for a week because I was so nauseous, my hip felt great!
I have been doing a lot of indoor activities with the other kids too, because I don't want to run around outside just yet. I have sat in indian style more than once, I mean, come on, how can I build a kick ass Thomas track, or a Lego city? I don't do it on purpose, it just happens. It is also hard to sit with Zk on the bed without ER in that hip. I am changing diapers, nebulizing, feeding etc.

I have been sleeping mostly on my non-op side, and I need a pillow in between my knees or else the op side hurts. Also, I am disappointed with the persistent swelling in my thigh all the way to my foot. I need it to go away, it is really uncomfortable.

My Fat Ankle

This morning I had a little incident, nothing really happened, but I will still refer to it as such. I was standing up, doing nothing, and I must have either very slightly turned my leg or turned my body and I felt this very sharp pain deep in the joint. It was a very specific point, and it was a reminder to me that things are still healing and I have a ways to go before things are normal again.

I had PT today and I felt the effects of the incident, I had to lower the weight on the leg press and eccentric SLR were painful and my psoas popped a lot. I stopped doing these.

We are now in Miami, its been a long day, between packing, getting to the airport, the flight... J talked me into taking one crutch since the gates are far, and I am glad bc I ended up using it. Now, I am finally in bed with extremely swollen ankles, heavy legs and a sore hip. Not too mention twice vomited on by an adorable Zk who is sick!

I emailed BK's PT to discuss my concern about the ER. He said obviously don't push it, and he said that I may be one of those people who don't scar down after the surgery...it seems I am always "one of those people"!

Ouch!

Ok, I need to back off a little bit, I can actually feel the inflammation in my hip making a comeback, with more swelling all the way down my leg. So far I've had 2 days off of crutches, and PT yesterday. Again, PT was great, she had me on the leg press at 75 lbs, doing wall squats, hamstring curls with a 2 lbs ankle weight, prone hip extension with my knee bent with a 2 lbs ankle weight, quadruped hip extension, eccentric SLRs, plus a lot of what we have already been doing. Not only was I exhausted last night but I was in pain, so I hit the Vicodin before bed. I am still in bed now and just feeling a lot of heaviness in my leg, soreness in the groin and butt.
We discussed my concerns over the excessive ER. She thinks that it is tight enough now to prevent it from sliding around in the joint now, but that I will have my full range, or close to it, since all the muscles are already stretched out. She is having me strengthen my internal rotators to try to help.

Just as a precaution, I emailed BKs PT about it too, I haven't heard back, but there was a nationwide blackberry outage last night so I hope it went through!

I think I would benefit from a daily anti-inflammatory, but this option is out, I am left with taking Tylenol during the day and if needed, Vicodin at night.

I Think I an Offiially Retire My Crutches

3 weeks to the day of my 4th surgery and I ventured out of the house sans crutches. It was super snowy and icy and I felt that given that I had been walking around the house without them for a while, they may become more of a liability outside. I went to the mall and did way too much walking. On top of that I did a little Target shopping too. Needless to say, I was exhausted by the time I was done. I did have some soreness and discomfort while I was walking, and my gait is definitely off one way or another. I almost feel like I look a little drunk at times, especially if I am really fatigued. I had pain last night but I managed without any meds. Today will be day 2 of no crutches. I have PT later this morning, I will share with my therapist my concerns over the excessive ER and see what she has to say about it. I will report back!

Turning The Bend

I just realized I haven't posted in a few days, my sincerest apologies! Things have definitely gotten a lot better since we last spoke! Thursday I had PT again. She had me doing some more standing exercises, including mini wall squats and hip flexion/abduction. The flexion/abduction was fine on the operated leg but the non-op leg was fatiguing quickly. She also added some passive adduction to stretch the ITB. It went well and I felt really good afterwards.

I think I am officially done with painkillers, yay!!! I am also pretty much done with crutches, I have been taking one with me when I am out of the house but think that starting tomorrow I will ditch it. My external rotation is a bit too good right now, which is my only concern. I don't think there is anything that can be done, but there is almost no tension when I accidentally, without thinking, externally rotate. I like to do this thing where I will half indian style sit on one leg when in a chair, I have done this on the op leg and had no pain or restriction. I also wake up with it externally rotated sometimes. I hope this is ok. I don't see BK until 1/20 and don't think this is an issue that I have to call or email about. I will run it by my PT though, just in case.

My thigh pain is getting better, finally! As is the bruise on the side of my hip. An issue that I am not happy with s that my ankle swells, and my hip still feels swollen. I don't remember this much swelling in the past, and although the ankle swelling is minor, only noticeable to me, and probably not seen by anyone since I usually wear boots when I am out, it is still concerning.

I don't plan on leaving the house today since we are basically snowed in. On the bright side, I finally was moved up on the waiting list and got an indoor parking spot (trust me, in NY, this is huge), especially since I have been getting really fed up with my outdoor lot, but have not had any issues with them since the infamous "hell" issue!

In The Blink Of An Eye

The rest of my day didn't go as well as the beginning. I will fast forward to the end of the night which featured me back on 2 crutches, then in bed with Vicodin.

My day did get a bit hectic, Jk had a doctor's appointment which involved me picking him up at school and walking to the appointment, probably a total of 7 blocks. Then giving the kids dinner, which involved a lot of whining, and "I don't want that". We had a leaky diaper incident, some bratty shower moments, and lots more whining.

I was not happy! Luckily J came to the rescue and took over bedtime responsibilities.Hoping for a better day today!

Crutching Away

I have been going back and forth between 1 and 2 crutches these days. I use one in the house for the most part, unless I am in a lot of pain, then I use 2. Or, if the kids are being especially needy, then I use none. Like when I 'lost' zk only to find him splashing around in the toilet. So I had to give him a bath! We have been ok so far, J came home at a decent hour last night to get everyone into bed.

I had PT today, and am progressing slowly but steadily. I am very happy so far with my PT, and especially happy with her conservative manner. I don't feel the need to rush this at all, and everything will come back with time. I was feeling a little discouraged with my flexion ROM, but she measured it today at 113', so I am pretty happy. She did a little bit of passive extension, to 15', and measured my ER at 30', we won't be pushing that anytime soon. I have been concerned about having excessive ER at this point but this made me feel better.

We are going to Miami next week, I hope to be done with crutches by then!!!

Back On Narcs

I can't seem to win. Every time I think I have turned a corner with the pain, I end up doing too much and needing to go back on narcotics. I woke up this morning and I knew there was no way I was managing with one crutch, and no way I was managing without meds. Incidentally, it is a pretty gross day out. I also did a lot of walking in the city last night (ok, not a lot, but a lot for me) and a lot of stairs at a night club where we went to a concert. I did really well last night, just got a little stiff from sitting too long.
This morning I had a lot of quad/ thigh pain. My entire thigh still hurts, all the way to the knee now. It is most likely a side effect of the traction, I just hope it goes away soon. I also had pain deep, deep in the groin, near the adductor insertion, only deeper. I started with an Aleve, hoping to get away with just that. 20 minutes later I couldn't take it any more and ended up with half of a Vicodin. I feel better!

Warning: Graphic, Read At Your Own Risk

No, this is not a sex post!

Now that that is out of the way, I can begin. I have been having a lot of pain on the outside of my hip, it is swollen and ugly and bruised, and tender to the touch. The sutures came out Wed. and have been covered with steri strips, but one of them has felt very hard and had a huge lump around it. I decided that this may be scar tissue so began working on it earlier in the week. It didn't change much. Last night I decided to take off the steri strips (even though I had been told to keep them on for a week) and see what was going on. Indeed, there was a hard lump around one of the incisions. I began once again trying to work on the scar tissue when suddenly, a gush of blood shot out from a small opening at the bottom of the incision. As this happened, I felt a release around the incision. As I squeezed the lump, blood oozed from the tiny opening. It was very dark blood. The lump got smaller and smaller as I squeezed. I suddenly had less pain in the area and the lump was disappearing. Last night I was able to sleep on my operated side for the first time since surgery. It seems I had a pocket of fluid collecting under one of the incisions. I had a similar issue after my c-section with L, a pocket of fluid collected under the incision.

As far as yesterday went, I was really getting depressed. Today wasn't too much better so I put myself on a low dose of Zoloft, leftover from my first 2 postpartum weeks. It did the trick then and should do the trick now!

I have a lot less pain today, I haven't taken any type of pain medication (including OTC) in 24 hours. I can walk in the house almost all the time with one crutch, when I fatigue I need 2, usually I feel it in the IT band first and then I know its time for 2 crutches. I am going to a concert tonight...wish me luck!

My Breaking Point

It seems as if I am hitting a rough patch this morning. I am beginning to feel frustrated and sad at the same time. It just doesn't seem fair. As I sit at my computer, holding back tears, I wonder what I could have done wrong to end up back in this situation, 3 small children to care for on crutches. Up until now, my mom has been here and has been doing pretty much everything. She went home today and I am feeling extremely overwhelmed. I am using 2 crutches for the most part, I am able to get around the house a little bit on one crutch, but the pain in my ITB gets worse when I do this, so I know it is not a good idea. Jk wants me to take him to school, L is concerned about how I am going to dance with her at her school Chanuka party next week, and Zk just wants me to hold him.

I know this is temporary. I have been here before. I am almost positive that I can read back to another post and I will have written the same thing at around this point post-op. It is just so hard to have to rely on others for just about everything.

If I continue to mope, I start to wonder why I was destined to have 4 surgeries, in less than 3 years? I try to be positive, I guess this is not the worst thing to have. It is not life threatening, more of an inconvenience. But as I am living with the reality of it, it is hard to be positive. And just like in the past, I know that this too shall pass.

Fourth Op- Report

Preliminary Diagnosis: right hip labral tear status post instability episode, status post prior hip arthroscopy with re-tear of labrum

Postoperative Diagnosis: right hip labral tear status post instability episode, status post prior hip arthroscopy with re-tear of labrum

Name of Operation: Revision right hip arthroscopy, labral tear debridement, synovectomy, debridement of ligamentum teres, and capsular shift procedure with revision decompression cam and rim side.

Indications: The patient suffered from persistent right hip pain 2 years status post a prior hip arthroscopy after she had been in a forced external position after she had a baby. She had a stretch of the anterior capsule with persistent pain, re-tear of the labrum, and also tearing of the ligamentum teres. She had failed non-operative measures and given the persistent pain and lack of improvement, she was indicated for right hip arthroscopy and associated procedures.

Procedure: After the patient was correctly identified in the holding area, she was brought into the operating room. Spinal epidural anesthesia was administered. She was placed in the supine position on the traction table and approximately 10mm of distraction were achieved across the acetabular joint. The right hip was then prepped and draped in the standard surgical fashion.

A lateral portal was established under fluroscopic guidance using the Seldinger technique. Then a mid anterior and additional anterior lateral accessory portal were both established. Arthroscopic examination demonstrated a labral tear anteriorly with evidence of a defect in the anterior capsule. There was some residual mild bone spurring bone spurring on the acetabular rim as well as mild superior lateral cam impingement lesion. Residual remaining aspects of the decompression were in good condition. There was synovitis adjacent to the capsular rent, and there was synovitis in the fat pad in addition to a partial tear of the ligamentum teres.

At this point the labrum was debrided of non viable tissue. The capsule was elevated off the residual rim impingement and then a rim decompression was performed. The ligamentum teres was then debrided of non viable tissue and a fat pad debridement was performed. The cartilage on the femoral head was in excellent condition as was the remaining aspect of acetabulum.

The scope was then placed in the peripheral compartment where a T capsulotomy was performed for good visualization of the superior lateral aspect of the cam lesion. There was some extension of the cam superior laterally. Cam decompression was completed up in the superior lateral 11 to 1 o'clock position with good visualization and protection of the retinacular vessels during this period of time. There was some irritation and erythema around the labrum in this position consistent with the residual impingement. At the completion of the residual cam decompression, no further impingement was present.

The T capsulotomy was then shifted for solid clossure of the anterior capsule. The medial limb was brought lateral with 5 sutures passed side to side using ideal suture passer and a bird beak penetrator with good secure fixation of the capsular repair. at the completion of the capsular repair, no residual defect was present. the head was well contained with the socket. At this point no further pathology was identified.

The instruments were removed from the hip joint. It was drained of fluid and the arthroscopy portals were closed with 3-0 nylon sutures. A marcaine cocktail was placed in the joint. The wounds were cleaned, dried, sterile dressings were applied, and the patient was awakened from anesthesia and brought to the PACU having tolerated the procedure well.

Sutures...Gone!

I don't know if I have mentioned that sutures really gross me out. Yes, I see them all the time but it just seems so unnatural to have them in your skin, and my PT thought they may be part of the reason I feel so tight and pinchy.

It was no surprise to me that I showed up for my appointment today, which was scheduled the day I scheduled surgery....with a whole discussion on whether it would be ok to have them out 9 days post-op...and I had no appointment. The same thing happened with surgery #1. At least this time I hadn't thrown up in the car on the way down, and was in the correct office. And just like last time, there was no way I was coming back another day!

I think from now on I just won't make appointments because I get seen a lot quicker this way, no waiting in the waiting room, little waiting in the room! J/K

So the incisions look good, except for one which is still good but needs some time with the steri strip. My flexion ROM is good, and I have decent ER, I can stop wearing the @###$$%&$ boots at night! The bruising and swelling is probably bleeding from the capsule. He had to do a capsular shift, so he cut the capsule and instead of just approximating the edges together and suturing, he overlapped the edges and folded over the extra tissue, I now have a tighter capsule with a REALLY strong repair. He showed me the scope pics, the psoas looked great and is "unscathed" (guess he knows who he is dealing with). He was really impressed with the quality of the cartilage, I am thrilled about this.

I am very concerned about the repair and the ER so I spent some time discussing this with his PT. He said stick with gentle ROM for 6 weeks, it will come back. No joint mobs for 6 weeks. He said treat it like a shoulder with a repair, you want the mobility but you also need the stability. I feel better but still nervous about it. I see him again in January, I hope the ROM is good by then.
I have the op report and will post is as a separate post.

Swollen Swollen Swollen

That is the best way to describe my thigh right now. It is so gross! I really feel like it will burst open any minute, I feel like when the sutures come out tomorrow, the leg is going to explode. My bruise is getting more purple each day. I also have a faint black and blue line around my shin, must be from the boots in traction.

I had PT today and was complaining about tightness and tenderness to the ITB. My PT worked on it, and kept asking if I was ok, if it hurt, could I tolerate more etc.....it was basically numb. She could do whatever she wanted and I barely felt it. Its not numb numb bc I feel something, so we will refer to it as parasthesia, or decreased sensation. The front and lateral aspect of my thigh have decreased sensation. Hopefully once the swelling goes down it will get better.

I am afraid to put on anything other than sweatpants, I don't want any material rubbing on my thigh, or anything tight around it. So I am going into week 2 of sweats only!

I have my post-op appointment tomorrow, I plan on asking why I look like I had the crap beaten out of me (i.e. huge purple bruise on the side of my thigh) and if I should possibly go back on an anti-inflammatory for a while to bring down the swelling. I will let you know what he says...

My Frustration

My goal at this point is to be pain free and no longer need to take narcotics. Unfortunately, I have not hit this goal. I would also really like to be able to ambulate in the house with one crutch, this too is not happening. Usually, the reason I can't go down to one crutch is weakness and a horrible limp. I don't think I am that weak this time, I actually have pain if I put too much weight on that leg...except if I take Vicodin. so I land myself in this situation, I can do a lot more with Vicodin on board, but it is just masking the pain. Once it wears off, I have a lot of pain. I don't remember having this much pain any other time. I will have to go back and read my old posts again, but I am pretty sure I didn't.

I am also exhausted beyond belief. I can't sleep at night bc I am limited to which positions I can get into. I can't sleep on the operated side bc it is really painful, still swollen, and still has some bursitis. The bruise on that side continues to get worse, it looks awful.

Anytime I try to do exercises the leg feels so stiff and swollen, almost like it wants to burst at the seams. Occasionally, I will get this funky kind of pain in the front of my thigh and then down in my foot, I assume this is some sort of nerve irritation and hope it resolves quickly. My ITB is still very tight and tender.

Today I have PT again, hopefully I will leave feeling better this time!

I keep forgetting to mention the good news...the left leg is holding up beautifully, no pain or soreness. Occasionally a bit of fatigue but that is it!

I Want My Life Back

I always seem to over do things post-op and always end up regretting it. I have been looking through old posts and seeing what I was doing when. I seem to have a knack of trying things too soon.
So, just an update, I tried to walk with 1 crutch around my bedroom last night, this was after a party where I spent about 30 minutes on my feet, then sat for almost the rest of the time. I was pretty excited because I was able to do it. Unfortunately, I woke up with a lot of pain today. I am trying to avoid pain killers so ice is my best friend. The leg also feels more swollen today and the incision sites are painful.

One thing I have been looking back in my blog for is this business about an invisible bruise. My entire thigh hurts in the front, almost down to the knee. There is nothing there. Just pain, almost an aching. I am also very bruised on my lateral thigh, close to the greater trochnater, I had ugly bruising like this last time. This bruising developed a few days post-op and seems to get a bit worse each day. It is painless, but ugly.

I have very good flexion ROM but IR feels pinchy, I hope and pray that this is temporary. ER is still restricted, and if I accidentally go into it, it HURTS.
I have been doing my exercises and can do a sidelying straight leg raise (abduction). I have been practicing in bed, abduction (gravity eliminated) but get a lot of ITB pain. The ITB may have a touch of tendonitis so I am definitely sticking to 2 crutches and being super careful.

I have my next PT session Tuesday and see BK on Wed., hopefully I will be able to do more next week!

Not a Good Morning

Again, I woke up feeling very un-rested. I "kicked" off the boot sometime in the middle of the night and slept on my left side with pillows in between my knees. L woke me up at some point and wanted me to take her to the bathroom. I was in horrible pain so I took a Vicodin (at least I hope it was a Vicodin, it was pretty dark). This morning the pain was better but I woke feeling slightly dizzy and lightheaded. I don't know if it is from the Vicodin or just a combination of all the drugs I am taking. I had to fill out some paperwork yesterday at PT, and I had to write down the meds I take, it looked like this: Vicodin PRN, Indocin (anti-inflammatory), Prilosec (to prevent "issues" from the Indocin), Zofran PRN (nausea), Pentasa (Crohn's) and Xifaxan (Crohn's). Between that list, and marking the hip on the body chart, you would never guess that I am 29, more like 92!

I will take lightheadedness over nausea any day, but I really hope it goes away soon!

Let The Rehab Begin

Have I ever mentioned how much I hate PT? Ironic, I know, I guess I should clarify and say I hate being the patient in PT. Today was my first PT visit.

The day started off pretty crappy, I woke up nauseous, which made me panic. The first thing I did was run (ok, not run, but limp) to the Zofran. Next I put the Vicodin out of reach. This can not be happening. I also quickly called my OS office to have a new Scopolamine patch called in. I don't really know if it is working or not, but the placebo effect is powerful enough for me! The Zofran helped and my pain wasn't too bad today, so no Vicodin all morning. For whatever reason, the Zofran made me very lightheaded.

My PT appointment was at 2, so my mom and I decided to go out for lunch. I wore my oh so gorgeous brace since I am trying so hard to be compliant with my restrictions. It definitely helps me, but on the flip side, people stare like you are from outer space. It makes me really think twice about wearing it again, except when the possibility of ruining my newly repaired capsule comes to mind. I don't have plans to leave the house again until Saturday night so I will re-evaluate the brace situation then.

PT was simple today. My old PT P has left the practice, I chose C to be my new PT because she has helped me a lot in the weeks leading up to surgery, and she is significantly older than the other therapists I work with, so I figured she has a lot more experience. The rehab for this surgery can be tough, if I feel like it is not going the way I want it to, I will see one of the PTs my OS recommends.

My exercises for now are: heel slides, glut sets, bridges, hip abduction in supine, trying to perform hip abduction in side lying, seated long arc quads, standing hamstring curls. She also did some gentle PROM into flexion, abd and a hamstring stretch. She also had me do ankle exercises to help with the swelling.

I am in a lot of pain now and went back to the Vicodin. I may have overdone it with the abduction because I am having a lot of ITB pain, even when I am in bed. I feel like I have to put even less weight on my foot now and have to be super careful when I move. I may also have a touch of bilateral greater trochanteric bursitis.

Any advice on sleeping? The boots are killing me. This is how bedtime goes for me: J puts me into the boots. 10 minutes later I begin to feel claustrophobic. At 12 minutes my heart begins to race and I begin to be on the verge of a panic attack. At 12 1/2 minutes the left boot is off and I feel better. J then has to move the bolster that goes in between the boots to the outside of the right boot. I will fall asleep on my back for a little while. Then I wake up and NEED the right boot off. The boot comes off and the pillow comes back. I then sleep on my left side for a bit with pillows in between my knees, until the bursitis on the left begins to act up. So as you can see, sleeping is no fun for me!

The Weightbearing Restrictions Really Do Make Sense Now

I still feel like I am doing really well and the nausea is non-existent. Unfortunately, I remember it once or twice starting day 2 or 3. I spoke with the PA at my OS office yesterday, my biggest concern is the nausea, since I am pretty familiar with how the hip will heal. I left the hospital with a scopolamine patch which is good for 72 hours. I am nervous about what will happen after the 72 hours, even though I don't have even a bit of nausea. He assured me that if I want, he will call another one in for me. Its a good thing I am a junkie on anti-naseau meds and not narcotic painkillers!

Again, I spent a good part of the day in bed with ice packs, I got out to shower (whoops, still early to shower I think), rode the bike 2 or 3 times (vicodin makes me forgetful and dumb) and my friends came by with lunch for me. Sitting is painful sometimes so I avoid it as much as possible. I also had an "outing" today, well, more like an outing out of my apartment! I went down to the lobby twice, once to get L off of the school bus and once to get Jk as he was being dropped off from a playdate.
I am going to blame this one on the Vicodin, being that it is such a good pain killer for me, and that it makes me stupid, when I got out of bed earlier, I accidentally put all of my weight on the operated leg...holy shit...I literally saw stars. And here I was thinking that I don't really need crutches! Now I see that I really do! Since I haven't really ventured into the real world yet, I haven't put on my lovely bledsoe-philippon brace. In the past I have been pretty non-compliant with it, I think this time I will use it to avoid going into ER or extension, since I am supposed to avoid it anyway, and when I forget, the pain quickly reminds me.
Tomorrow is my first day of PT, again, I am breaking the "rules" since I was supposed to go yesterday. I took the liberty of making my own PT schedule this time since the last 3 times I was not at all happy to have to get dressed and out of the house so soon. I am also not looking forward to eventually having to get my ROM back.

I am not having any of the pre-op groin pain. I have butt pain and a lot of surgical pain anteriorly. I am really swollen too, not just my right leg, but all over, my ankles are swollen, my calves...I just look and feel puffy!

Thank you to everyone who has written to me, or posted comments on my blog. Once I can sit at the computer, I will be able to respond to the comments, for now I am blogging with my blackberry from bed!

Day 1...for the 4th time

Post-op day 1 has been pretty uneventful. My pain is pretty mild, I took a Vicodin this morning when I woke up, and one just now (7 hours later) There is absolutely no nausea, the anesthesiologist was great, he said we would give me lots of drugs to help me and I went home with a Scopolamine patch to wear for 3 days. I rode my bike twice already, and am spending the majority of my time in bed with ice packs.

My hip feels incredibly tight, it is hard to move it, but it does flex easily and I can do heel slides. I am also trying to remember to do ankle pumps, just to keep things moving. I am keeping a pillow on the outside of my leg to prevent external rotation.

I showered this morning (shhh...don't tell) with water proof band aids, I just felt really gross and dirty, and "hospital smelly". I have 3 incision sites, I can't tell if they are in the same place as the old ones or not, my thigh is pretty swollen and ugly right now. I am experiencing pain down my thigh and into my ITB, I guess it is to be expected after this surgery. What I don't have this time is the horrible bruising I had last time, which lasted a month. I can't yet tell if I have any numb patches or not, when the swelling goes down I will be able to tell more.
Overall I am pleased with day 1, I have had worse day 1's before!

Hip Arthroscopy #4...over

My heart rate is back to normal, my anxiety has vanished, and to replace it all I now am the proud owner a very tight hip!!

I won't go into details about the day but I will share with you what Dr Kelly has just told me (for the 3rd time today but I did not retain it the first 2 due the drugs!)

My biggest concern has been whether or not I was making the right decision going in for this surgery, he has assured me that yes, by all means, it was 100% the right decision. He primarily found a ruptured ligamentum teres and a deficient anterior capsule. Most likely, the night of the "breastfeeding incident" I ruptured the ligament, the question is why did it rupture? It is most likely due to the capsule issue. He re-stitched the capsule using 5 sutures so it is REALLY tight now. He debrided the torn ligament and said that there was a lot of irritation around it.

He shaved down some bone on the acetabular rim and the femoral neck, just to cover all bases. He now has better tools and can see more arthroscopically, he found some more bone supero-laterally and the labrum was torn there too. He shaved down the bone and debrided the labrum in that area.

The cartilage looks GREAT!!! Hooray!! At least there is a silver lining in all of this!

Because of the capsule repair, I have to avoid positions of extreme external rotation and extension. When I sleep I must wear special boots that prevent the ER....fun fun fun!

All I can say is thank goodness this is over and in the past....once again, thank you everyone for their well wishes, it is truly appreciated!

Thanksgiving

Its 5 am and my heart is racing. I have done all that I can to prepare for surgery, now it is out of my hands. I am just hoping and praying that THIS IS IT. I wanted to thank everyone for their well wishes and words of encouragement. It has truly helped make a difficult situation easier to handle. J is going to try to update my blog today, especially since his posts were such a hit last time!!! I hope to share only good news with you later in the day.

Almost Panicking

As Monday morning quickly approaches, my calm demeanor is going out the window. In the end, I decided to go with an early morning surgery. I got the call on Friday to be at the hospital at 7am for a 9am surgery. This seemed strange to me because my previous surgeries had all been at 8am, but the nurse assured me that I was the first case in that room.

A little while ago I got an email from a friend who works in the hospital, he had tried to help me get my "favorite" anesthesiologist. It turns out she is away next week. He also said that I do have the first case in the room I was assigned, but BK has 2 rooms that day. I don't even want to think about what this really means. But I was assured and reassured that there would be no residents working on me! I will just repeat this request on Monday!

We are still away for Thanksgiving but coming home first thing in the morning. I haven't worked since Tuesday and I have had less pain. The only thing I have started to have is pain with flexion/ER. Weird!

I will try my hardest to stay calm and collected for the next 36 hours...

(I hope this comes out ok, I am blogging on my blackberry)

5 days to go....

I am trying to get things ready for Monday, not there is a whole lot for me to do, just the usual. Had my mani-pedi yesterday, this time, there is a new rule, no colored nail polish.....WTF??? So I had to go with clear. Yes, this should be my biggest "problem"!! Today is waxing day, which I am even more sure I need after seeing Jess's pics! I think psychologically, with surgery, you as the patient have no control over anything, so you begin to try to control the little you can! And if you're like me, and slightly OCD, this is what happens!!!!

I am also a little bit nervous because we are going to Boston today for Thanksgiving and don't plan on being home until Sunday, the day before surgery. This has me feeling slightly anxious, but I guess my mind will be better occupied there and I will have less time to worry, and more time to chase Z up and down the steps!

We are all good with the NSAIDs and I have been "ordered" by my GI to think positive thoughts and hopefully I won't have a flare-up. On the up-side, in the event that I do have a flare up, I will be on Vicodin, so it should minimize the discomfort!

Radiation, NSAIDs and Braces...Oh My!

After my conversation with BK on Sunday, I have been feeling slightly overwhelmed. Yesterday, I received a call from the company that rents out the CPM and Gameready machines. I had told his surgical coordinator not to order them for me because I won't use them. I was going to call them back to cancel the order but started to wonder if maybe the CPM would be a good idea to use this time since I want to prevent the HO.....and of course my mind started racing at 1 million miles per hour. So I sent BK a quick email to make sure it was ok to skip the CPM...its ok!!! Yay!! I hate that thing, plus, the kids think it's a toy!

I also heard back from my GI, and while I am waiting for clarification on something, he did say to go ahead with the NSAID's (Indocin)...I may flare though....given the alternative, I'm willing to risk it. So no radiation near my ovaries!!!

Just When I was Ready To Throw in the Towel....

Tomorrow will be 1 week since I had my CT scan, and I have been waiting to speak to BK about it, since I was rather concerned about the findings. Ironically, my friend B was also waiting to hear from him. B is a "hip friend", but we were friends before the "hip thing", so it is a unique "hip friendship". Tonight J and I invited B and her husband for a late (i.e after the kids were in bed) dinner.

B has had one hip scoped by BK and was waiting to discuss her latest injection on the non-operated side with him. At 9:45, her phone rang....you guessed it......it was him!!! B, being the good friend/ hip friend that she is, prefaced her conversation by saying "you know, its funny that you're calling now because I am actually sitting in Susie's living room and I'm sure she would love to speak to you too!" So, 20 minutes later, when B was done, she passed the phone on to me! Who would have thought the waiting game would have ended like this!!!

So....it looks like there may be some overcoverage on the acetabular rim....FML. I asked if he thought it was new bone growth or old...he wasn't sure. Apparently, he is (has been) concerned about ossification at the site of the labral debridement, plus that tiny ossification in the joint capsule.......all of this points to the possibility of heteroropic ossification (HO). It is treated with NSAIDs once it is removed to prevent it from coming back. I have never taken NSAIDs post-op bc I also have been "blessed" with Crohn's disease. If I cannot take the NSAIDs post-op, the alternative is a single dose of radiation... so I am stuck between a rock and a hard place. I put an email in to my GI to see what his thoughts are on my lovely predicament. I am leaning towards the NSAIDs and dealing with the GI issues as they come. Radiation in that area (close to the ovary) does not thrill me.....Any thoughts??

Reflexology

Yes, I bit the bullet and tried something "different" today. On the advice of a patient, I was told it is very relaxing. I have been having a ton of anxiety, like, to the point that I would probably benefit from being medicated at times. It has been so bad that my heart starts racing and my chest feels tight, I guess like a panic attack, only a minor and manageable version.

So I chose a 30 minute session. I have never done this before so I asked the reflexologist if she has a "routine" that she uses or if she kind of feels around for points and works on those. Her answer was basically both. It was very relaxing until she found a huge knot in one spot. She started working on it and said it was the spot that corresponded to the heart, lungs and chest. Weird, but kind of cool given my symptoms. She found one more spot that is the back/ sciatic nerve area....I told her I don't have back pain but do have hip pain, she figured that this point corresponded to the hip. Who knows but I do feel very relaxed and with less anxiety. Now if only I could get a reply concerning my CT I would feel ALOT better!!!

This is Why Doctor's Don't Like to Let You See Results Before Speaking To Them

I had my CT scan yesterday. The report is time stamped 30 minutes after I left the facility, they are fast!!!
I had BKs office fax me the report, and yes, I got it right away! Highlights of the report:
"There is a small ossific density noted in the anterior joint capsule", "small capsular calcification", "femoral version angle +8, anteverted"

So there is bone (?) in the capsule?????? OR calcification? huh? How did this happen? Its possible that it is all from scar tissue, this is probably where he cut into the capsule and the way it scarred down. Or is it nothing. The anteversion seems like nothing too.

I have sent him an email to please look at the scan and let me know what he thinks. I hope to hear back soon!!!

Psoas...once again coming back to haunt me

I have been sort of freaking out these last few days, as I mentioned previously, my pain has gotten way out of control. I assume it is coming from the psoas and today's events confirmed this for me.
My pain is now exacerbated with external rotation and extension. But, I also have pain with active flexion, so I can't cross my leg, lift it up, get in the car, get on the bed etc. I have a new co-worked who incidentally had surgery with BK a little over a year ago. She had a psoas release, so today I picked her brain on what her symptoms were pre-op. She summed it up in one sentence for me- "does your leg feel really heavy?" YES. Ok, so I am convinced that it is the psoas. I have found that if I avoid sitting, it doesn't tighten up quite as much. I also slept on my stomach last night to avoid flexing my hip at all. This helped a little. I also did some stretches into extension today with a rolling stool, all of these things are helping to make a little difference. As I type, I am back in indian style with minimal discomfort.

My co-worker was nice enough to call BKs office during our conversation and have her op report faxed over to us to see. It turns out she had no FAI, just a labral tear and a super tight psoas. I have been asked before how a surgeon can determine if the psoas needs to be released. I will quote parts of her op report:
"arthroscopic examination of the central compartment revealed demonstrated extensive synovitis anteriorly at the level of the psoas with an associated _____labrum anteriorly.
"a synovectomy was performed around the psoas irritation..."
"at the completion of the release, all pressure on the psoas was releived"

These are findings I expect on someone who needs a psoas release.

My symptoms of "psoas pain" just started and seem to be better tonight, it is clearly some compensatory mechanism, maybe for instability???????? Who knows, again, I am still anti a psoas release on me!

Bitching and Moaning

As the 30th slowly approaches, things are quickly deteriorating. For the first time last night, I took a narcotic pain killer (2 actually). I think it is the psoas issue again, and I am looking forward to Tuesday to see my new PT and have her "fix" me again. I think I am having the same dysfunction once again. Last night I decided that a little anterior glide to the femur would help, and it did! Today I was looking in the mirror and noticed that my ASIS on the painful side did not stick out quite as far as the other side, so I tried a trick I have read about and put a rolled up towel under the PSIS on that side for 2 minutes, it is supposed to help glide the inominate anteriorly, it helped a little bit. I need clarification from the PT as to what exactly she thought the dysfunction was, and I will try to pay better attention this time!

I am now limping horribly, I am really nervous about how I am going to work for the next 2 weeks. I do hope that this is just an SI dysfunction that can be taken care of like it was last week and I can go back to simple groin pain!!!

Hip Arthroscopy # 4...Scheduled

Ironically, today is the 2 year anniversary of hip arthroscopy #3, the revision of hip arthroscopy #1, which was a great success. I did really well after it, had a great pregnancy and delivery (hip-wise), and did great for 5 months post-op. After that, well.....

The surgery is scheduled for November 30th, yes, 18 days away. Shit. That is really soon. I also just got my CT scheduled for this coming Monday (I think I called and the receptionist said "shit, I forgot to schedule her CT", because she put me on hold for about 20 minutes and then asked if that day was ok...whatever, it is done and hopefully this is the last procedure they EVER have to schedule for me).

November 30th is the Monday after Thanksgiving. We are going away for the weekend, so I decided that it would be a good idea to have the surgery late in the day. I have always had them done first thing in the morning. This time, I don't really want to wake up at 4:30AM, and I thought maybe I would want to run errands, go to the supermarket, Target....but then I started thinking that I normally don't respond so well to the anesthesia and the drugs...and I don't want to be there all night...or worse, get admitted....so I am thinking of calling back and asking them to schedule me for early afternoon. What do you think? Other than I am obsessing over this too much. But hey, I can obsess over the things that I have slight control over, everything else is up in the air.

On another note, I have been in awful pain lately, much worse than ever. I think my psoas is acting up, but as you know, I REALLY don't want it released (been down this road before). I asked a colleague to work on me today and release it. She started looking and feeling around my hips, and found that they are severely asymmetrical. The right (bad) one is higher and flared out anteriorly. She thinks it is causing the psoas to impinge and cause me pain. She released the psoas, iliacus and some others (I was in a lot of pain and having a really bad day...so I don't remember details), but when she was done, everything was level and the pain was just in the joint, where it usually is. I was also able to flex my hip a little easier. She uses a different technique than P, my old therapist used, but P has left my practice, so I have to move on! She will be the one I use after this surgery. I already booked an appointment with her, but not the day after surgery, it will be Thursday, I don't want to torture myself and have to go out the day after surgery, like I have in the past.

Any suggestions on what to do about the time would be much appreciated!!!

Close Your Eyes and Imagine a High Pitched Scream

That was me you were imagining. See, up until now, my pain has been manageable, and I was sure that once I knew I was having another hip arthroscopy, it would calm down and I would begin to question whether I was making the right decision or not. Luckily, I don't have to struggle with this since over the past 2 days, the pain has intensified to the point where I don't want to walk on my right leg.

I have no idea what is wrong now but I can no longer cross my right leg over my left leg without using my hands to lift it up, and I cannot even get into my "comfort position" of external rotation because that hurts like a bitch. So to put it simply, I don't know what the heck I did to it now...but things are going from bad to worse. (no, I was not breastfeeding)