Since I had spoken to my OS on a Friday evening, I had to wait until Monday to really explore my options. The first thing I did was call the chiro to see if he was a good fit for me, and to see what his fees are since they do not take insurance. To make it short, sweet and simple, I hated him! He was arrogant, condescending and an all around asshole. There is no way I can work with someone like that.
I also have gone over the MRI report and gone over it again and again. I have discussed things with my husband to no end. He thinks I am being silly and stubborn and need to bite the bullet and agree to an open surgery. I think I am starting to agree, but the thought of it scares the crap out of me. TO scare myself even more, I watched a video of the procedure today....probably a very bad idea.
I emailed my OS because I have a ton of questions and think we need to address a lot of issues, mainly that I am freaking out!!!! Of course he has to be on vacation at the exact time that I am having an emotional breakdown, but I guess it doesn't really qualify as an emergency!
So I will "patiently" wait to hear from him, and go from there!!
Thursday, July 21, 2011
Monday, July 18, 2011
MRI # 7 Report
On the current examination, there is no occult fracture or osteonecrosis. No bulky synovitis is seen. There is however, marked attenuation of the iliofemoral ligament with some progressive hyperintensity in the interval since the prior study in 3/10 but overall residual discontinuity and poor tissue remodeling. There is considerable scarring of the synovium adjacent to the ligamnetum teres and this is progressive in the interval since the prior study. Effects of neck debridement are noted. There is high grade cartilage loss over the posteromedial parafoveal aspect of the femoral head extending focally down to the subchondral bone. Marked hyperintensity and high grade partial loss is seen anteriorly over the dome with progressive hyperintensity and partial wear since the prior study. No defined bone on bone contact is seen. There is intrasubstance degeneration of the superior labrum as well as degeneration of the anterior labral remnant but no defined split.
The hip abductors and short external rotators are notable for mild insertional gluteus minimus tendinosis. Insertional iliopsoas tendinosis is seen with a remodeled insertional partial tear. There is no atrophy of the iliacus muscle in the pelvis. There is no trochanteric or iliopsoas bursitis. No ischial bursitis is seen. Bilteral hamstring tendinosis is seen with a nonacute low grade partial tear affecting the semimembranosous origin on the right.
Subsequent quantitative MR imaging demonstrates prolongation of relaxation times, most strikingly affecting the parafoveal posteromedial aspect of the femoral head, some prolongation anterior medial dome with relative preservation over the superolateral dome.
Impression:
MRI of the right hip demonstrates features of instability with poor remodeling of the iliofemoral ligament and progressive scarring of the synovium, adjacent to the ligament teres in the interval since prior study 03/10. There is also progressive wear of cartilage with corresponding prolongation of relaxation times, as outlined above. Degeneration of the anterior labral remnant is noted without acute split.
The hip abductors and short external rotators are notable for mild insertional gluteus minimus tendinosis. Insertional iliopsoas tendinosis is seen with a remodeled insertional partial tear. There is no atrophy of the iliacus muscle in the pelvis. There is no trochanteric or iliopsoas bursitis. No ischial bursitis is seen. Bilteral hamstring tendinosis is seen with a nonacute low grade partial tear affecting the semimembranosous origin on the right.
Subsequent quantitative MR imaging demonstrates prolongation of relaxation times, most strikingly affecting the parafoveal posteromedial aspect of the femoral head, some prolongation anterior medial dome with relative preservation over the superolateral dome.
Impression:
MRI of the right hip demonstrates features of instability with poor remodeling of the iliofemoral ligament and progressive scarring of the synovium, adjacent to the ligament teres in the interval since prior study 03/10. There is also progressive wear of cartilage with corresponding prolongation of relaxation times, as outlined above. Degeneration of the anterior labral remnant is noted without acute split.
Sunday, July 17, 2011
Psoas Release...something to consider
A few years ago, prior to my first revision surgery, I had an argument with my OS about whether my psoas tendon should be released or not. I, under no circumstance, wanted it released. He insisted that I should let him release it. I ended up not allowing him to, and 4 years later, we have this study. I do not have increased femoral anteversion, but I am having other types of instability and cannot imagine where I would be now if we had to add a lengthened psoas to the mix of issues.
Study Identifies Patients Who Should Not Undergo Surgery for a Snapping Hip Tendon New York—July 10, 2011
Researchers at Hospital for Special Surgery have identified a group of patients who may have increased difficulty for surgical treatment of a snapping psoas, a condition that usually develops because a teenager or young adult has a pelvis that grows faster than their psoas tendon. The study will be presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM), held July 7-11 in San Diego.
“The conclusion from this study is that you should be cautious about releasing the psoas tendon, particularly in cases where there is some structural instability in the hip, specifically increased femoral anteversion, because although the tendon may be causing pain, it is also providing some dynamic support to the hip so it can cause problems if it is released,” said Bryan T. Kelly, M.D., who led the study and is co-director of the Center for Hip Pain and Preservation (www.hss.edu/hippain) at Hospital for Special Surgery (HSS) in New York.
The study received the 2011 Herodicus Award given annually by the Herodicus Society at the AOSSM meeting for the best paper submitted by an orthopedic resident or sports medicine fellow.
The hip is a ball-and-socket joint where the head of the femur (thigh bone) rotates within the cup-shaped socket of the pelvis. The head of the femur is supported by an angled neck which joins to the long thigh bone. At the base of the femoral neck is a boney protrusion. The psoas tendon is one of two hip flexor tendons that attaches to this protrusion. When the pelvis grows faster than the psoas tendon, this tendon becomes tight and snaps over the pelvis during walking or other activity. This condition, which can be painful, is known as a snapping psoas tendon.
“The reason that it snaps usually has to do with the anatomy of the pelvis. We usually see it in adolescent hips where the pelvis is growing at a faster rate than the tendon can accommodate for the growth,” said Dr. Kelly. “Structurally the tendon is not long enough to accommodate the bony anatomy.”
Doctors usually treat a snapping psoas tendon with physical therapy that involves stretching and strengthening, anti-inflammatories and corticosteroids, but if this doesn’t work, doctors resort to surgically lengthening the tendon. Because the tendon does not have the ability to stretch, surgeons cut slits in the tendon in what is called a partial release of the tendon or a fractional lengthening. “You cut it in a way that allows the muscle to elongate,” Dr. Kelly said.
Studies have shown that arthroscopic and open surgery can achieve similar outcomes for this condition. Few studies, however, have studied whether abnormalities in hip structure, specifically femoral anteversion, can impact outcomes. In most people, the center of the femoral neck points toward the center of the hip socket. Femoral anteversion is a condition in which the center of the femoral neck leans toward the front of the socket. This causes the knee and foot on the affected side to rotate internally or twist toward the midline of the body.
In December 2006, HSS researchers started a prospective registry of all hip arthroscopy procedures performed during a three-year period, 2006 to 2009, by a single, high-volume arthroscopic hip surgeon, Dr. Kelly. The study presented at AOSSM included all patients who underwent a psoas tendon lengthening at the time of surgery, a minimum of six months follow-up, and a preoperative high-resolution computed tomography (CT) scan to detect femoral anteversion. Patients were not included in the study if they had previous tendon hip surgery or hip trauma.
Sixty-seven patients underwent arthroscopic lengthening of a symptomatic psoas tendon, either in isolation or in conjunction with treatment for hip impingement. CT scans showed that 19 of 67 patients had high anteversion. The researchers assessed clinical outcomes both before and after surgery with modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS) questionnaires. These are commonly used to evaluate a patient’s ability to carry out specific activities that involve the hip: activities of daily living, such as climbing stairs, and athletic activities, such as running and jumping.
Prior to surgery, patients who had high anteversion scored significantly worse in terms of athletic activities on the HOS, but there was no difference in either questionnaire scores in terms of daily living activities. After surgery, patients who had high anteversion scored significantly worse on the MHHS questionnaire with regard to athletic and daily living activities, but the HOS scores were similar between the two groups. Twice as many patients who had high anteversion had to undergo revision surgery.
The researchers say the psoas tendon may be an important stabilizer in the hips of patients with high anteversion, and the tendon’s release in these patients may result in a delayed return to activities after surgery and inferior outcomes.
“The results of this study indicate that there are certain groups of patients that respond very favorably to surgical treatment of the psoas tendon, but there are other groups of patients that due to mechanical reasons, surgeons should exercise extreme caution in proceeding with any tendon release around the hip,” Dr. Kelly said. He said these patients should be considered for alternative treatment strategies.
Other authors of the study are lead author and orthopedic surgery resident Peter D. Fabricant, M.D., and Katrina Dela Torre, R.N., M.Sc., at HSS, and Asheesh Bedi, M.D., former HSS fellow now at the University of Michigan.
Study Identifies Patients Who Should Not Undergo Surgery for a Snapping Hip Tendon New York—July 10, 2011
Researchers at Hospital for Special Surgery have identified a group of patients who may have increased difficulty for surgical treatment of a snapping psoas, a condition that usually develops because a teenager or young adult has a pelvis that grows faster than their psoas tendon. The study will be presented at the annual meeting of the American Orthopaedic Society for Sports Medicine (AOSSM), held July 7-11 in San Diego.
“The conclusion from this study is that you should be cautious about releasing the psoas tendon, particularly in cases where there is some structural instability in the hip, specifically increased femoral anteversion, because although the tendon may be causing pain, it is also providing some dynamic support to the hip so it can cause problems if it is released,” said Bryan T. Kelly, M.D., who led the study and is co-director of the Center for Hip Pain and Preservation (www.hss.edu/hippain) at Hospital for Special Surgery (HSS) in New York.
The study received the 2011 Herodicus Award given annually by the Herodicus Society at the AOSSM meeting for the best paper submitted by an orthopedic resident or sports medicine fellow.
The hip is a ball-and-socket joint where the head of the femur (thigh bone) rotates within the cup-shaped socket of the pelvis. The head of the femur is supported by an angled neck which joins to the long thigh bone. At the base of the femoral neck is a boney protrusion. The psoas tendon is one of two hip flexor tendons that attaches to this protrusion. When the pelvis grows faster than the psoas tendon, this tendon becomes tight and snaps over the pelvis during walking or other activity. This condition, which can be painful, is known as a snapping psoas tendon.
“The reason that it snaps usually has to do with the anatomy of the pelvis. We usually see it in adolescent hips where the pelvis is growing at a faster rate than the tendon can accommodate for the growth,” said Dr. Kelly. “Structurally the tendon is not long enough to accommodate the bony anatomy.”
Doctors usually treat a snapping psoas tendon with physical therapy that involves stretching and strengthening, anti-inflammatories and corticosteroids, but if this doesn’t work, doctors resort to surgically lengthening the tendon. Because the tendon does not have the ability to stretch, surgeons cut slits in the tendon in what is called a partial release of the tendon or a fractional lengthening. “You cut it in a way that allows the muscle to elongate,” Dr. Kelly said.
Studies have shown that arthroscopic and open surgery can achieve similar outcomes for this condition. Few studies, however, have studied whether abnormalities in hip structure, specifically femoral anteversion, can impact outcomes. In most people, the center of the femoral neck points toward the center of the hip socket. Femoral anteversion is a condition in which the center of the femoral neck leans toward the front of the socket. This causes the knee and foot on the affected side to rotate internally or twist toward the midline of the body.
In December 2006, HSS researchers started a prospective registry of all hip arthroscopy procedures performed during a three-year period, 2006 to 2009, by a single, high-volume arthroscopic hip surgeon, Dr. Kelly. The study presented at AOSSM included all patients who underwent a psoas tendon lengthening at the time of surgery, a minimum of six months follow-up, and a preoperative high-resolution computed tomography (CT) scan to detect femoral anteversion. Patients were not included in the study if they had previous tendon hip surgery or hip trauma.
Sixty-seven patients underwent arthroscopic lengthening of a symptomatic psoas tendon, either in isolation or in conjunction with treatment for hip impingement. CT scans showed that 19 of 67 patients had high anteversion. The researchers assessed clinical outcomes both before and after surgery with modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS) questionnaires. These are commonly used to evaluate a patient’s ability to carry out specific activities that involve the hip: activities of daily living, such as climbing stairs, and athletic activities, such as running and jumping.
Prior to surgery, patients who had high anteversion scored significantly worse in terms of athletic activities on the HOS, but there was no difference in either questionnaire scores in terms of daily living activities. After surgery, patients who had high anteversion scored significantly worse on the MHHS questionnaire with regard to athletic and daily living activities, but the HOS scores were similar between the two groups. Twice as many patients who had high anteversion had to undergo revision surgery.
The researchers say the psoas tendon may be an important stabilizer in the hips of patients with high anteversion, and the tendon’s release in these patients may result in a delayed return to activities after surgery and inferior outcomes.
“The results of this study indicate that there are certain groups of patients that respond very favorably to surgical treatment of the psoas tendon, but there are other groups of patients that due to mechanical reasons, surgeons should exercise extreme caution in proceeding with any tendon release around the hip,” Dr. Kelly said. He said these patients should be considered for alternative treatment strategies.
Other authors of the study are lead author and orthopedic surgery resident Peter D. Fabricant, M.D., and Katrina Dela Torre, R.N., M.Sc., at HSS, and Asheesh Bedi, M.D., former HSS fellow now at the University of Michigan.
MRI Verdict
I spoke with my OS abt the latest MRI. We did a T2 mapping study to visualize the cartilage and get a better picture of the hip. He reviewed my MRI w the radiologist and says that there is no question that I have micro instability bc: 1) the ligamentum teres is torn (not sure if more torn since last surgery bc its the most difficult structure to image) 2) labrum is very small and can no longer provide suction to the joint 3) the anterior capsule is thinned out near the iliofemoral ligament, this is an area that was previously thickened (after the last surgery).
All of this is causing small, excessive motion in the joint. He is not 100% sure what is causing the posterior pain but says it is most likely the ligamentum teres. The cartilage in the back of the joint is a little thinned as well.
He wants me to continue to strengthen the muscles around the hip in order to provide stability to it. The only surgical option is an open surgery- which I told him makes me want to throw up! He knows I feel very very strongly abt not wanting more surgery. We did not get into details abt what he would actually do in said surgery, other than the fact that its a big deal and he has only done 5 of them before.
He is recommending I see a chiro who deals with musculoskeletal issues and treats professional athletes (not sure how he will feel about treating an everyday housewife :-) and does "different" types of therapies. I obviously don't need ART or any release work since I already have instability, and I looked up the chiro and all his techniques are release techniques...but I guess we need to try everything, and I know enough (and have a big enough mouth) to not let him do anything I think will make me worse.
So it's off to the chiro I go!!!!!
All of this is causing small, excessive motion in the joint. He is not 100% sure what is causing the posterior pain but says it is most likely the ligamentum teres. The cartilage in the back of the joint is a little thinned as well.
He wants me to continue to strengthen the muscles around the hip in order to provide stability to it. The only surgical option is an open surgery- which I told him makes me want to throw up! He knows I feel very very strongly abt not wanting more surgery. We did not get into details abt what he would actually do in said surgery, other than the fact that its a big deal and he has only done 5 of them before.
He is recommending I see a chiro who deals with musculoskeletal issues and treats professional athletes (not sure how he will feel about treating an everyday housewife :-) and does "different" types of therapies. I obviously don't need ART or any release work since I already have instability, and I looked up the chiro and all his techniques are release techniques...but I guess we need to try everything, and I know enough (and have a big enough mouth) to not let him do anything I think will make me worse.
So it's off to the chiro I go!!!!!
Thursday, July 7, 2011
Micro Instability???
I'm sorry that I haven't been updating my blog too frequently, it has been tough lately since a) I'm not really sure what is happening in my hip and b)I have very little free time.
I have been in PT for 2 months now and overall have not seen a change in pain level or symptoms. I'm pretty frustrated bc I was really hoping that this would be the solution for me. I saw my OS yesterday to review things again and decide what to do.
PT has been addressing the muscles, and trying to correct a muscle imbalance, I have not made progress :-(
My biggest issue is that I am having all this pain, off and on, yet my MRI shows nothing. To me, this is worse than if it showed a lot of issues, I feel like I am crazy!! My OS assured me that I am not crazy :-) and agrees that we need a better way to image this hip. He is recommending a new MRI with a stronger magnet that can map out the cartilage in the hip. He thinks that I probably have some micro instability due to issues in the capsule and ligamentum teres, and hopes that this new MRI will show something. He also thinks that my labrum is very small, so it is possible that it is no longer providing the suction in the joint that it is supposed to provide.
He explained that he looks at hips in 4 layers- 1) the muscles 2) the 'inert' labrum, ligaments, capsule 3) bony structures 4) nerves. He suspects my problem is with level 2
If you have read previous posts, you will know that me and MRIs do not get along. So I was not thrilled to hear that my first MRI was not of the greatest quality and that I would need another one....So to 'cheer me up' he gave me a rx for Valium for it!
He thinks that if the ligamentum teres is the problem, it will show some changes to the cartilage around the ligament.
If this is the case, then he thinks it would require surgical intervention...then he started talking about the possibility of an open surgery....at that point I freaked out....really really freaked out!!! I told him that I just couldn't discuss it right now, and that I thought the best thing would be to get the MRI first, then discuss it, if needed. He agreed and is happy that we are both on the same page, meaning wanting to avoid surgery at all costs.
I have been in PT for 2 months now and overall have not seen a change in pain level or symptoms. I'm pretty frustrated bc I was really hoping that this would be the solution for me. I saw my OS yesterday to review things again and decide what to do.
PT has been addressing the muscles, and trying to correct a muscle imbalance, I have not made progress :-(
My biggest issue is that I am having all this pain, off and on, yet my MRI shows nothing. To me, this is worse than if it showed a lot of issues, I feel like I am crazy!! My OS assured me that I am not crazy :-) and agrees that we need a better way to image this hip. He is recommending a new MRI with a stronger magnet that can map out the cartilage in the hip. He thinks that I probably have some micro instability due to issues in the capsule and ligamentum teres, and hopes that this new MRI will show something. He also thinks that my labrum is very small, so it is possible that it is no longer providing the suction in the joint that it is supposed to provide.
He explained that he looks at hips in 4 layers- 1) the muscles 2) the 'inert' labrum, ligaments, capsule 3) bony structures 4) nerves. He suspects my problem is with level 2
If you have read previous posts, you will know that me and MRIs do not get along. So I was not thrilled to hear that my first MRI was not of the greatest quality and that I would need another one....So to 'cheer me up' he gave me a rx for Valium for it!
He thinks that if the ligamentum teres is the problem, it will show some changes to the cartilage around the ligament.
If this is the case, then he thinks it would require surgical intervention...then he started talking about the possibility of an open surgery....at that point I freaked out....really really freaked out!!! I told him that I just couldn't discuss it right now, and that I thought the best thing would be to get the MRI first, then discuss it, if needed. He agreed and is happy that we are both on the same page, meaning wanting to avoid surgery at all costs.
Monday, May 30, 2011
Or Is It?????
I am starting to have my doubts again....Over the last week or two, I have been having a gradual increase in pain. Is it because the honeymoon from my vacation is wearing off, or did my cortisone injection actually help more than I thought it did, or am I just plain screwed at this point?????
My new PT continues to address issues in my thoracic spine, ribs, abdominals, which are extremely messed up. I saw her last week, she barely touched my hip and worked a lot on my ribs, which are incredibly messed up, 2 are practically stuck together. She also worked on my thoracic spine and teaching me how to breathe. When I left, my hip was killing me. I thought it was so interesting since she barely worked on it.
What I am experiencing now is an irritation inside the joint when I try to work on hip flexion. I do it in quadruped with gentle rocking, and in standing, by hip hinging. When I try these, I end up with an extremely sore and angry joint.
I am also experimenting and seeing what happens if I only work on the hip or if I only work on the back...what will the hip do. So far both irritate the hip...so I am at a complete loss.
I saw my OS last week, and he agrees with me that I should continue to work with my new PT. He told me that he is finding a different type of problem in women. He called it acetabular-femoral impingement. When someone has regular FAI, in some people, the pelvis will tilt posterior to ease the pain of the impingement, and they end up with issues in the back, like on the hamstring etc. My conclusion is that I have the opposite, I have some sort of problem in the posterior side of the joint so my pelvis is tilting anterior, in turn, all of my anterior hip muscles are "freaking out". One thing my PT is very frustrated at times with is that my pelvis remains more anterior on that side, despite trying to hard to correct it. I am wondering if this is what I am experiencing. Definitely something to discuss this week.
My OS still cannot find anything really wrong with my MRI, which is good and bad! He wants me to come back in 6 weeks, but if things are not better in 3-4 weeks, he wants me to call him. I decided to ask a stupid question, what if PT doesn't help me...then what. He said he would want to scope it, to see what is happening......NO WAY. He promised me that he feels just as strongly as I do about NOT wanting to scope this hip...but it may be the only thing left to do. So....PT needs to start working really well ASAP!
My new PT continues to address issues in my thoracic spine, ribs, abdominals, which are extremely messed up. I saw her last week, she barely touched my hip and worked a lot on my ribs, which are incredibly messed up, 2 are practically stuck together. She also worked on my thoracic spine and teaching me how to breathe. When I left, my hip was killing me. I thought it was so interesting since she barely worked on it.
What I am experiencing now is an irritation inside the joint when I try to work on hip flexion. I do it in quadruped with gentle rocking, and in standing, by hip hinging. When I try these, I end up with an extremely sore and angry joint.
I am also experimenting and seeing what happens if I only work on the hip or if I only work on the back...what will the hip do. So far both irritate the hip...so I am at a complete loss.
I saw my OS last week, and he agrees with me that I should continue to work with my new PT. He told me that he is finding a different type of problem in women. He called it acetabular-femoral impingement. When someone has regular FAI, in some people, the pelvis will tilt posterior to ease the pain of the impingement, and they end up with issues in the back, like on the hamstring etc. My conclusion is that I have the opposite, I have some sort of problem in the posterior side of the joint so my pelvis is tilting anterior, in turn, all of my anterior hip muscles are "freaking out". One thing my PT is very frustrated at times with is that my pelvis remains more anterior on that side, despite trying to hard to correct it. I am wondering if this is what I am experiencing. Definitely something to discuss this week.
My OS still cannot find anything really wrong with my MRI, which is good and bad! He wants me to come back in 6 weeks, but if things are not better in 3-4 weeks, he wants me to call him. I decided to ask a stupid question, what if PT doesn't help me...then what. He said he would want to scope it, to see what is happening......NO WAY. He promised me that he feels just as strongly as I do about NOT wanting to scope this hip...but it may be the only thing left to do. So....PT needs to start working really well ASAP!
Monday, May 16, 2011
Wow, PT is working!
I have been to my new PT twice so far, but I am definitely more compliant with my exercises than I have ever been in my life. We (she) have discovered that my glutes have completely stopped working, my hip slides anteriorly, my ribs/ thoracic spine are really tight, all of my "large" hip muscles are working overtime and my smaller, stabilizing hip muscles are not working at all. Even if my ligamentum teres is torn, she thinks that by strengthening the proper muscles and getting the "wron" ones to shut off, I will regain my ROM and restore my pain free status.
One of he things I have been doing alot of is rolling on a tennis ball to release trigger points in my muscles. I am amazed at how tight and painful my quad is. It is by far the most painful muscle to roll out.
I still have pain with sitting but it is nowhere as bad as it used to be. I am definitely seeing a light at the end of the tunnel and am keeping my fingers crossed that this is what I have needed the whole time!
One of he things I have been doing alot of is rolling on a tennis ball to release trigger points in my muscles. I am amazed at how tight and painful my quad is. It is by far the most painful muscle to roll out.
I still have pain with sitting but it is nowhere as bad as it used to be. I am definitely seeing a light at the end of the tunnel and am keeping my fingers crossed that this is what I have needed the whole time!
Tuesday, May 3, 2011
Taking a Different Approach
Sorry if I left you hanging! I was on vacation for 10 days and as usual, incredibly busy with life at home. The good news is that while I was on vacation, I felt great, after a few days in sunny Florida where I did absolutely nothing, my pain started to disappear. Once I got home, it slowly started to come back, which leads me to the conclusion that I should retire now!
It is not as bad as it was before I left and I can tolerate sitting which is a huge plus. But I have decided that I need to do something, and everything that I have been doing is not working, and no one that I have worked with knows how to help me, and my brain has shut off regarding this. So I found myself a new PT. I definitely feel that I am cheating on my old PT, but since I wasn't getting better, I needed to move on.
I saw my new PT yesterday. It is a totally different experience than my old PT, who ran his office similarly to the way my office runs. Chaos, patients everywhere, running around from one patient to another. My new PT only sees one patient at a time, the office reminds me of a spa, I walked in to absolute silence. A completely different experience than I have ever seen at a PT clinic. I gave her my ridiculously long hip history, which took up most of the session!!! She found a lot of dysfunction in my back, it is stiff and I don't move well. Also instability and weakness in my hips. Surprising to me, she found a lot of tightens in my upper back and she thinks that those restrictions are what is causing my hip and SHOULDER problem. I am definitely getting a bang for my buck!!! As she started releasing restrictions in my upper back, I don't think I have ever experienced such pain before. But then she re-checked my hip flexion and I had gained ROM. She then checked my abdominals and found a lot of restriction in my external obliques. She also said my rib cage was tight. So she worked on releasing restrictions there, ouch. Ounce again, my hip flexion ROM increased. It was pretty incredible, something I had never thought of.
I am going to try to see her 1x/week, I have appointments set up for the next 6 weeks. It is pretty far away and she doesn't take insurance, but I think that if she can help me, it will be priceless.
My homework is the continue to work on releasing restrictions in my abdominals, and try to expand my ribcage. Also quadruped rocking to maintain my hip flexion, and learning to breathe properly with diaphragmatic breathing.
Keep your fingers crossed that this is the solution!!!
It is not as bad as it was before I left and I can tolerate sitting which is a huge plus. But I have decided that I need to do something, and everything that I have been doing is not working, and no one that I have worked with knows how to help me, and my brain has shut off regarding this. So I found myself a new PT. I definitely feel that I am cheating on my old PT, but since I wasn't getting better, I needed to move on.
I saw my new PT yesterday. It is a totally different experience than my old PT, who ran his office similarly to the way my office runs. Chaos, patients everywhere, running around from one patient to another. My new PT only sees one patient at a time, the office reminds me of a spa, I walked in to absolute silence. A completely different experience than I have ever seen at a PT clinic. I gave her my ridiculously long hip history, which took up most of the session!!! She found a lot of dysfunction in my back, it is stiff and I don't move well. Also instability and weakness in my hips. Surprising to me, she found a lot of tightens in my upper back and she thinks that those restrictions are what is causing my hip and SHOULDER problem. I am definitely getting a bang for my buck!!! As she started releasing restrictions in my upper back, I don't think I have ever experienced such pain before. But then she re-checked my hip flexion and I had gained ROM. She then checked my abdominals and found a lot of restriction in my external obliques. She also said my rib cage was tight. So she worked on releasing restrictions there, ouch. Ounce again, my hip flexion ROM increased. It was pretty incredible, something I had never thought of.
I am going to try to see her 1x/week, I have appointments set up for the next 6 weeks. It is pretty far away and she doesn't take insurance, but I think that if she can help me, it will be priceless.
My homework is the continue to work on releasing restrictions in my abdominals, and try to expand my ribcage. Also quadruped rocking to maintain my hip flexion, and learning to breathe properly with diaphragmatic breathing.
Keep your fingers crossed that this is the solution!!!
Sunday, April 17, 2011
Video Presentation on the Ligamentum Teres
During my "research" today, I came across this: More than 120 physicians from around the world gathered in Vail, Colorado on March 17–19 for Smith & Nephew’s 5th annual Vail Hip Arthroscopy Symposium. The three-day educational event was led by Marc J. Philippon, MD, managing partner of the Steadman Philippon Research Institute. Link to Symposium info The focus of the symposium shifted to “New Procedure and Unique Cases” on Day Two. Richard Villar, FRCS, Spire Cambridge Lea Hospital, UK, opened the session with a presentation called “Ligamentum Teres: The Forgotten Ligament.” Mr. Villar described the three classifications of ligamentum teres injuries; Type 1 (complete tear), Type II (partial tear) and Degenerative (not torn but not functioning). Treatment options include removal (with RF or shaver) or reconstruction. Mr. Villar reached the following conclusions: The ligamentum teres is likely to have a function; do not ignore it Arthroscopic surgery (of whichever sort) appears to work The ligamentum teres may have healing potential Video
PT...Again
I had my latest PT appointment on Thursday, it was incredibly disappointing. I guess I am looking for a miracle and there really isn't a miracle out there at the moment. I said to my PT "so, he didn't know what to do with me so he dumped me on you", he agreed!!! He is at a loss, pretty much, and with his expertise, if he is at a loss, I am screwed!! He said he wants to treat it like an ACL/PCL injury in the knee, where all the stabilizing structures are gone. So we started with some gentle isometrics and proprioception exercises. I am going on vacation tomorrow so will continue to do them while I am away and see him when I get back. In the meantime, I deiced to explore some other options and contacted another PT who may have a different kind of approach. I am going to see her at some point as well when I get back from vacation. I hope she is more optimistic and can help me, bc I don't know how much more pain I can take at this point.
Wednesday, April 13, 2011
The Latest Appointment, Still No Answers
I saw my OS yesterday...he still doesn't really know what's going on. His best guess is that ligamentum teres is torn, which is why I am having so much posterior pain and so much trouble sitting, and that the capsule got stretched out, which is why I am having muscle spasms, to try to stabilize the hip. I have a lot of clicking going on, he initially said its prob psoas but then he actually heard it and said it is not psoas, sounds like intra articular clicking, maybe ligamentum teres...bottom line is he said avoid doing it! He also said that he was actually really upset that I had relief from the cortisone injection since it does mean that the problem is coming from the joint, he was hoping that it wouldn't help at all and we could address things outside of the joint. We discussed the drugs I have tried so far, Celebrex made my Crohn's disease flare up, and Ultram made me dizzy and crazy. "Lucky" for me, I brought J along with me for "support", my OS wanted to know how Ultram made me crazy, "basically, it turned me into a psychobitch", to which J added "well, it was hard to tell the difference from how she normally is". Thanks J, really appreciate the support :-) I made him compare my 2 MRIs side by side, to actually see if there was a change in the capsule, they both looked pretty good (one from this month and one from last year), so he doesn't think the capsule is actually torn. He wants me to go back to PT, gave me Baclofen for the muscle spasms, and see what's happening in a few weeks. He also wanted to give me a medrol dose pack for the pain but we ended up agreeing that it wasn't what I wanted bc of the very remote possibility that it can cause AVN. He wants me to be patient and try to work through it w PT and see what happens! When I came out of the room his PA was there, so I said to him "he basically has no idea what is going on", and he told me that my OS studied my mri so hard, trying to see a problem. "I guess I have really photogenic hips" I said So that's the story!
Sunday, April 10, 2011
Turning Point
Last Friday was definitely "rock bottom" for my latest hip saga. Things began turning around this past week, I think I was wrong about the cortisone and it is finally kicking in, it took its sweet time but yes, I began feeling its effects mid week. Most importantly, sitting is not excruciating anymore. The best days were Wed and Thurs I think, I had absolutely no posterior hip pain at all, I had some groin pain those days, but I did well physically and emotionally. Friday was not as good as Thursday and Saturday was not as good as Friday, but I hope to continue to get some help from this latest injection. Yesterday I had an event to go to and I had to wear heels. I had no pain while wearing them, but I just did not feel good about it. My hip could not handle the heels and the joint just felt "slidey", like it could not control my leg in the shoes. Ironically,I came home and put on sneakers and had a ton of pain, go figure!!! As I sit here writing this, It is getting a little difficult to sit. My husband keeps telling me to "stop thinking about it", but how can I not, I am still nervous, and I am still in pain. I see my OS on Tuesday, stay tuned for an update Tuesday night!!!
Sunday, April 3, 2011
And The Saga Continues
Monday was my cortisone injection, Tues-Thurs were a little bit better. I went for a session of reflexology on Thursday afternoon, since it usually helps relax me, and my nerves have been shot lately, Ive never had so much anxiety in my life. I was speaking to the massage therapist about my "issues", and he thought I should get a massage. My muscles are in horrible spasm, I kind of wanted a massage but was scared of getting one because in my mind, the muscles are in spasm for a reason. I texted my PT, he said to ice and tape my hip. I really cant tape it on my own, and I cant stay in bed all day with ice. I texted him again on Friday morning and asked if I should just get a massage to ease up the spasm. He called me back and said that a deep tissue massage would be a bad idea, but a lighter massage may help. I told him that if one more person at work asked me if I was ok, if I should be working, if I should be doing this, I was going to scream. He gave me permission to punch the next person in the face :-) He also, again, said I need pain meds! So he called my OS office and I got Ultram. I took one Ultram late Friday afternoon, it helped with the pain but not fully. so I decided to take another. Bad idea. I could barely get off the couch, I was so dizzy and lightheaded for the rest of the night, and I didn't sleep well. Saturday I took 1/2 of a pill and was less dizzy, but dizzy nonetheless. The good thing is that for me, a little goes a long way and it has really helped my pain. I don't want to take one today because it is L's b-day party in the afternoon and we have a lot to do, and I don't want to feel like crap. Icing also goes a long way for me, unfortunately its hard for me to find time to do it. The second I lie down with ice my kids either need my ice, need me to get up and do something, or decide to jump on my leg.
Tuesday, March 29, 2011
Hip Injection #8...done
I was able to get in for an injection yesterday afternoon purely by the grace of G-d...and maybe a little begging on my part to "please take me out of my misery"!! Driving down I could barely sit, the posterior joint pain and lateral posterior pain (what I believe to be ischiofemoral impingement (IF) was really awful. Before I had left my house, I tried some pain provocation tests so that I could have a baseline and a before and after. I did a lunge with the left leg in front and on a stool, some impingement tests and some other movements of the leg. The injection was more painful than I remember it ever being, probably because I have scar tissue built up in there. Before the injection the radiologist tried to provoke pain, he did some FAI tests and they hurt in the groin, he could not reproduce the posterior pain but I explained that I had been able to earlier. He told me to check those maneuvers out again later. I said if I could drive home without pain I would be thrilled!! After the injection most of the tests he did provoked no pain anymore. I limped back to my car, sat down and panicked...the back of my hip still hurt. After a minute, I guess the drugs made their way back there and posterior pain was GONE! I drove home comfortably and happy. The IF pain was still there but without the posterior joint pain it seemed a lot more manageable. After 3 hours my "honeymoon" was over and the pain hit hard. When the kids were finally in bed I was able to ice for about an hour. I then decided to go to sleep but the pain was there so I went back for the ice and ended up falling asleep with it on until I woke up 3 hours later! This morning I think the posterior pain is better, the true test will be when I get into the car in an hour! Keeping my fingers crossed
Friday, March 25, 2011
Why Why Why
Thurs morning after PT I was in the car and using the "water bottle trick", after about 2 minutes I began having anterior hip pain. When I got out of the car my psoas/ iliacus were in spasm. That's when I began to freak ot. I texted my PT with a desperate message. He called me back, said to stop doing that bc it was causing my femur to be pushed anteriorly and making the psoas try to stabilize it. He also said I needed to get my pain under control ASAP, I coldn't sit down. So I tried to get in touch with the OS office.....
Yesterday I iced, took Vicodin, Motrin....Was in a lot of pain. I was up in the middle of the night icing and medicating...its been rough.
I finally spoke to the PA today, he called in Celebrex for me and I am going to try to get a cortisone injection next week into the joint to calm things down. He said the psoas is going into spasm to stabilize. I don't like this one bit.
Yesterday I iced, took Vicodin, Motrin....Was in a lot of pain. I was up in the middle of the night icing and medicating...its been rough.
I finally spoke to the PA today, he called in Celebrex for me and I am going to try to get a cortisone injection next week into the joint to calm things down. He said the psoas is going into spasm to stabilize. I don't like this one bit.
Wednesday, March 23, 2011
Still No Answers
I got home from PT last night with more questions than answers. My PT thinks the hip is loose and and lax,this is about all I got. I am also really weak in the glutes, he is not sure if it is a straight out weakness or if they re inhibited by pain. The rest kind of went in one ear and out the other. I am so overwhelmed with all of this that I cant even process anymore. He thinks there may be a coverage issue somewhere (don't ask me where) but I could be getting pinching from some sort of impingement posteriorly. Honestly, this is all too much for me to handle. I was doing a lunge yesterday (just to demonstrate for a patient) with the good leg, the bad leg was behind me, in extension. This set off so much pain I think I saw stars and almost passed out in the middle of my office. My PT wanted me to try that with a posterior pelvic tilt and an anterior pelvic tilt to see if one was better, I was too scared to reproduce that pain again that I couldn't do it. He thinks I may need a stress test to check for laxity in the hip, I'm not sure what this would accomplish, or what it entails, I was too scared to ask.
In the meantime he gave me one exercise to do at home, a standing hip abduction with my hip in IR. He also told me to put a small water bottle under my thigh near my butt when sitting to make sitting less painful, it takes the pressure off of the ischial tuberosity.
And so the roller coaster ride begins, and the psychosis, paranoia etc. Because there will be days when I have no pain at all, and days that are excruciating, and it will drive me up a wall!!
In the meantime he gave me one exercise to do at home, a standing hip abduction with my hip in IR. He also told me to put a small water bottle under my thigh near my butt when sitting to make sitting less painful, it takes the pressure off of the ischial tuberosity.
And so the roller coaster ride begins, and the psychosis, paranoia etc. Because there will be days when I have no pain at all, and days that are excruciating, and it will drive me up a wall!!
Monday, March 21, 2011
It's Official, My Shoulder Officially Sucks
Tomorrow will be 2 weeks since I had my AC joint injected and my pain is back full force. I guess I was dreaming when I had hoped to get 6 months out of this latest injection. I don't know what to do now, But working is killing me. I had someone in my office work on it today, I got a whole 90 seconds of relief...so not worth it!!!
Wednesday, March 16, 2011
Hip MRI #6...done
Yes, I had yet another MRI on my hip. Last week my x-ray was fine, over the weekend I was able to ice and rest and was feeling better. Monday the pain was back with a vengeance. I freaked out and emailed the PA from my OS office. He said to have an MRI and come in today.
Since this latest "episode" of hip pain started, I have been having a ton of anxiety and been having trouble eating bc I am so scared. I took (my first ever) Xanax on Monday night. this morning I woke up at 3:30 with my heart racing and my stomach in knots. By 5:30 I decided to eat something since my stomach probably hurt from lack of eating. By 6:30 my heart was still racing and I felt like I was going to throw up. Xanax #2 was a god send. It totally calmed me down and took the edge off. The MRI was almost relaxing!! It was the first time I was able to rest with no kids calling me, no blackberry, no work!!
Right after the MRI I went to see my OS. I explained what happened, and that I was having posterior joint pain. He looked at the MRI, the labrum and capsule were fine, thank goodness. There seems to be a little abnormality at the ligamentum teres, which could cause posterior joint pain. there is also irregularity at the quadratus femoris, which is what can get impinged with ischiofemoral impingement. I have not done all that much research on ischiofemoral impingement but I guess that will be on my to do list. It is an extra-articular impingement, he thinks its possible that bc I have some more motion now that that is getting pinched. But, I have pain in the joint with internal and external rotation, which leads him to believe it is being caused by the ligamentum teres.
The plan is to keep trying to ice and rest, go back to PT, in 2 weeks if its not better then we can discuss an injection. Where? I'm not really sure, but I'm hoping that PT can help decipher where the pain is coming from, and better yet, eliminate it to avoid an injection.
When I left his office, I was feeling better, less anxiety, but later in the day the pain got bad again and all of my anxiety came back....I don't know where I am going to find the strength to deal with this...again
Since this latest "episode" of hip pain started, I have been having a ton of anxiety and been having trouble eating bc I am so scared. I took (my first ever) Xanax on Monday night. this morning I woke up at 3:30 with my heart racing and my stomach in knots. By 5:30 I decided to eat something since my stomach probably hurt from lack of eating. By 6:30 my heart was still racing and I felt like I was going to throw up. Xanax #2 was a god send. It totally calmed me down and took the edge off. The MRI was almost relaxing!! It was the first time I was able to rest with no kids calling me, no blackberry, no work!!
Right after the MRI I went to see my OS. I explained what happened, and that I was having posterior joint pain. He looked at the MRI, the labrum and capsule were fine, thank goodness. There seems to be a little abnormality at the ligamentum teres, which could cause posterior joint pain. there is also irregularity at the quadratus femoris, which is what can get impinged with ischiofemoral impingement. I have not done all that much research on ischiofemoral impingement but I guess that will be on my to do list. It is an extra-articular impingement, he thinks its possible that bc I have some more motion now that that is getting pinched. But, I have pain in the joint with internal and external rotation, which leads him to believe it is being caused by the ligamentum teres.
The plan is to keep trying to ice and rest, go back to PT, in 2 weeks if its not better then we can discuss an injection. Where? I'm not really sure, but I'm hoping that PT can help decipher where the pain is coming from, and better yet, eliminate it to avoid an injection.
When I left his office, I was feeling better, less anxiety, but later in the day the pain got bad again and all of my anxiety came back....I don't know where I am going to find the strength to deal with this...again
Thursday, March 10, 2011
##$%#&* Right Hip
Ok, so if you read the yahoo group postings yes, I am having hip issues again. At first I was having throbbing in my hip at night mostly. The pain started getting worse, it was radiating to the side of my hip, the back of my hip and down my thigh. It was for the most part groin pain though. I was trying to stretch it and stretch it since it is tight in the front still, and at times it bothers me that it is so tight. Yesterday, i was stretching it and got a good pop, which is not abnormal for me, when I had it in external rotation. Since then, I have a lot more range into ER, but when it gets to endrange, I have pinching in the back of the joint and behind the greater trochanter. I also have a ton of posterior hip pain, all the time, it hurts to sit down which is really hard for me.
I had an xray today, and of course I had no idea what happened to me (it wasn't until later that I was able to clear my mind and and remember these events, and even now, I'm not 100% sure if this is the issue). Thank goodness the xray was fine, no fracture or infection, which was a big concern of mine. As of now, my butt really really hurts, and ER, which used to be my position of comfort, is not uncomfortable. I am limping at times....this stinks.
Hopefully hopefully hopefully, it was popping of scar tissue, and now there is localized inflammation and it will pass in a few days. I will keep you posted!!!
I had an xray today, and of course I had no idea what happened to me (it wasn't until later that I was able to clear my mind and and remember these events, and even now, I'm not 100% sure if this is the issue). Thank goodness the xray was fine, no fracture or infection, which was a big concern of mine. As of now, my butt really really hurts, and ER, which used to be my position of comfort, is not uncomfortable. I am limping at times....this stinks.
Hopefully hopefully hopefully, it was popping of scar tissue, and now there is localized inflammation and it will pass in a few days. I will keep you posted!!!
Tuesday, March 8, 2011
The Good and Bad News
I had been putting off going back to my shoulder doctor for fear that he would want to order an MRI. The good news is that things looked bad enough on x-ray so an MRI is not needed. The bad news is that I am practically bone on bone in my AC joint and he is recommending a distal clavicle resection. It does not need to be done now, he did give me another cortisone injection, but warned me that I cannot keep having them, and I will have to have it 'fixed' sooner rather than later. I am hopefully going to get a long stretch of relief from this injection and not have to think about this for a while.
Saturday, March 5, 2011
Popping In To Say Hi
I haven't bothered anyone with my woes lately, life has been busy, the kids are 6,5 and 2, and getting big! My left hip as always, is perfect. My right has been once again giving me some trouble, I'm not sure exactly what is going on, I see my OS next month, so we will find out then. My shoulder is a mess, I see the shoulder OS on Tuesday, hopefully for another lovely dose of cortisone!!! I just wanted to add a few cute pics of the kiddies and day hello!
Saturday, January 22, 2011
New 2011 CPT Codes for Hip Arthroscopy
◦29914 – Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
◦29915 – Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
◦29916 – Arthroscopy, hip, surgical; with labral repair
◦29915 – Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
◦29916 – Arthroscopy, hip, surgical; with labral repair
Friday, November 19, 2010
Aetna and FAI 2
A few months ago a fellow hipster sent me a post and asked me to publish it on my blog. It was about Aetna and their refusal to cover FAI surgery. That post generated many replies, including the one below.
This is a response from Aetna:
The date on our website is not the date that the update will be published, but the date that it will be discussed by our Clinical Policy Council. All updates have to go through a subsequent review, approval and implementation process. We expect the update to be published by the end of the year.
Should you have any questions or concerns, regarding these policies contact provider of services dedicated lines; Indemnity and PPO- based benefits plans 1-888-MD Aetna (632-3862) for HMO benefits plans – 1800-624-0756. Our Provider Service Representatives are trained to specifically handle any concerns you may have.
Also, for your convenience any future concerns or questions regarding our policies can also be faxed to us at 859-425-3379.
November 18, 2010 11:56 PM
Below is the original post:
Sent to me by a fellow hip friend:
Aetna’s assessment of FAI is archaic and asinine!
As you all are aware, our cause for UHC’s coverage of FAI was very successful including a NY Times article and many reversed appeals in favor of the patient. UHC along with other major insurers (BCBS, Cigna, Kaiser) now covers the arthroscopic treatment of Femoroacetabular Impingement.
Unfortunately, Aetna still has not caught up with the times. Many of our fellow patients have been successfully treated with hip arthroscopy and have been able to move on to enjoy active lives. People that are insured with Aetna are being discriminated against IF they also have a diagnosis of FAI. Aetna has taken the position that the use of the hip scope is unproven and/or experimental. This is absolutely ridiculous. It is very obvious that the bottom line is that it IS a covered procedure by the other insurers so how is Aetna’s non-coverage of this procedure accurate?
Aetna would rather have a young active patient become so disabled that their medical situation deteriorates to the point of needing a total hip replacement with all the associated medical risks and financial costs. Take the example of your typical patient. Young, active 30 year old Aetna consumer who is denied access to treatment for FAI. Based on Aetna’s opinion, the patient will go untreated for years UNTIL the patient requires a total hip replacement. Of course, doctors won’t typically do a THR on someone under 60 so this patient has to wait 30 years for treatment because of Aetna’s inaccurate and woefully pathetic position on FAI treatment.
Mr. Ron Williams (CEO of Aetna) when is Aetna going to catch up with the peer reviewed literature and your peers? When is Aetna going to reverse the policy so that your clients that need this surgery will have the same rights as patients that have UHC, Cigna, BCBS and Kaiser? When will Aetna decide that they would like the “A” in Aetna to equate to “Amazing” instead of “Awful’?posted by Susie at 7:47 PM on Sep 28, 2010
This is a response from Aetna:
The date on our website is not the date that the update will be published, but the date that it will be discussed by our Clinical Policy Council. All updates have to go through a subsequent review, approval and implementation process. We expect the update to be published by the end of the year.
Should you have any questions or concerns, regarding these policies contact provider of services dedicated lines; Indemnity and PPO- based benefits plans 1-888-MD Aetna (632-3862) for HMO benefits plans – 1800-624-0756. Our Provider Service Representatives are trained to specifically handle any concerns you may have.
Also, for your convenience any future concerns or questions regarding our policies can also be faxed to us at 859-425-3379.
November 18, 2010 11:56 PM
Below is the original post:
Sent to me by a fellow hip friend:
Aetna’s assessment of FAI is archaic and asinine!
As you all are aware, our cause for UHC’s coverage of FAI was very successful including a NY Times article and many reversed appeals in favor of the patient. UHC along with other major insurers (BCBS, Cigna, Kaiser) now covers the arthroscopic treatment of Femoroacetabular Impingement.
Unfortunately, Aetna still has not caught up with the times. Many of our fellow patients have been successfully treated with hip arthroscopy and have been able to move on to enjoy active lives. People that are insured with Aetna are being discriminated against IF they also have a diagnosis of FAI. Aetna has taken the position that the use of the hip scope is unproven and/or experimental. This is absolutely ridiculous. It is very obvious that the bottom line is that it IS a covered procedure by the other insurers so how is Aetna’s non-coverage of this procedure accurate?
Aetna would rather have a young active patient become so disabled that their medical situation deteriorates to the point of needing a total hip replacement with all the associated medical risks and financial costs. Take the example of your typical patient. Young, active 30 year old Aetna consumer who is denied access to treatment for FAI. Based on Aetna’s opinion, the patient will go untreated for years UNTIL the patient requires a total hip replacement. Of course, doctors won’t typically do a THR on someone under 60 so this patient has to wait 30 years for treatment because of Aetna’s inaccurate and woefully pathetic position on FAI treatment.
Mr. Ron Williams (CEO of Aetna) when is Aetna going to catch up with the peer reviewed literature and your peers? When is Aetna going to reverse the policy so that your clients that need this surgery will have the same rights as patients that have UHC, Cigna, BCBS and Kaiser? When will Aetna decide that they would like the “A” in Aetna to equate to “Amazing” instead of “Awful’?posted by Susie at 7:47 PM on Sep 28, 2010
Tuesday, November 9, 2010
Double Update
Hip: I had an appt with my hip OS a few weeks ago but haven't had a chance to post yet. I am almost 1 year out from my last (4th) hip scope and very pleased with the results. I have no pain at all in my hip. the only residual effect from that surgery is that my hip is really tight and still catches and pops quite often. I don't care though, I will take that over groin pain any day. My OS explained that during the capsule tightening procedures, sometimes they make it a little too tight, he recommended more PT to keep it loose, since that is what I do when it gets bad, but he would like me to take a more preventative approach with PT and go before it gets bad. In theory, that is a wonderful idea, in reality, who has time for more PT!!! He also offered me a cortisone injection into the capsule, which I politely declined as well...no more hip injections for me! I will deal with this!
Shoulder: It has been 2 weeks since I had the AC joint injected and I am thrilled with the results. The joint does not hurt at all anymore. Although I still get some pain around the area sometimes, It is tolerable. In a very "susie-like" fashion, I requested the OS office note and the radiology report on my x-ray...OS suspects AC joint arthritis, if the injection doesn't help he will order an MRI to rule out osteolysis, which is not a common problem in 30 year old housewives!!!! (ok, I work too, but still...), it is more of a weight lifter issue, and the only weights I lift are 40 lbs toddlers and pots and pans!!!!
Shoulder: It has been 2 weeks since I had the AC joint injected and I am thrilled with the results. The joint does not hurt at all anymore. Although I still get some pain around the area sometimes, It is tolerable. In a very "susie-like" fashion, I requested the OS office note and the radiology report on my x-ray...OS suspects AC joint arthritis, if the injection doesn't help he will order an MRI to rule out osteolysis, which is not a common problem in 30 year old housewives!!!! (ok, I work too, but still...), it is more of a weight lifter issue, and the only weights I lift are 40 lbs toddlers and pots and pans!!!!
Monday, November 1, 2010
Cost of Hip Arthroscopy has been updated
http://susie711.blogspot.com/2008/01/cost-of-hip-arthroscopy-and-its.html
Surgery # 4 numbers have been added...1 year later!! Life has been pretty busy!
Surgery # 4 numbers have been added...1 year later!! Life has been pretty busy!
Tuesday, October 26, 2010
Cortisone Injection # ?????
As I had hoped, my "new" OS gave me a cortisone injection. He agreed that whatever my issue is, it is coming from my AC joint. He is not sure what or how I injured it since there was no trauma, but he thinks that given my line of work, it is not too shocking. My x-rays were good, no arthritis or separation, he thinks that it is just a local inflammation and hopefully the cortisone will knock it out.
Most of his pain provoking tests referred pain to the front of my shoulder, at the AC joint, and there is tightness with horizontal adduction. I am pretty sure the cortisone in working, I felt no pain right after which is good since he used some local anesthetic with the steroid when he injected.
I hope to continue to report improvement with the shoulder!
Most of his pain provoking tests referred pain to the front of my shoulder, at the AC joint, and there is tightness with horizontal adduction. I am pretty sure the cortisone in working, I felt no pain right after which is good since he used some local anesthetic with the steroid when he injected.
I hope to continue to report improvement with the shoulder!
Monday, October 25, 2010
Shoulder...
As my shoulder issue continues to be an issue, I am happy to report that I finally took the time to listen to what my body was telling me and self diagnose!!! I do not have a labral injury or a rotator cuff injury, rather, an acromioclavicular (AC) injury, or, a separated shoulder. Whats funny is that this is usually caused by trauma or a direct fall onto the shoulder....but not me, I just 'develop' these issues! Since it does not seem to be getting better, and I am having trouble sleeping at night and difficulty working, I made an appointment with a shoulder specialist. What a breath of fresh it air to deal with his office...I called Thursday and was given an appointment for Tues...5 days later....I think I waited for my first hip appointment 4 weeks and currently people are waiting 6 weeks or longer to see my OS. So I will hopefully see him tomorrow, hopefully he will give me a cortisone injection and I will be on my way!!!
Sunday, October 17, 2010
Massage...Ahhh!!
I went for a 1 hour massage on Tuesday in hopes of leaving a little more relaxed and in less pain. The massage therapist asked if I had any "problem areas", so I told her my right shoulder had been bothering me. She said she would focus a little more on it while she worked.
So the massage began and she began working on my scapula and upper trap, "wow", she said, " this is really bad". She continued for another few minutes, and then said "I think I can spend the entire hour on this shoulder, if you want, or I can leave it if this is too painful for you and do the rest of your body". I told her to just do the shoulder. It was excruciating, every spot on the entire upper right quarter of my body was so painful. There were knots everywhere, she used her elbow, she was dripping sweat halfway into the massage. After the hour was up, she said that it looked better, definitely lower and softer, but she could spend another 2 hours on it if she had the time.
The rest of the day and into the next day were really painful. It hurt to touch the area. By Thursday night it was beginning to feel better. I have had a lot less pain in it and am able to use it more than I was. I am hoping that it was a big muscular issue and I won't be dealing with it anymore. I will keep you updated since I still continue to have pain at night and some of the surrounding muscles still hurt.
So the massage began and she began working on my scapula and upper trap, "wow", she said, " this is really bad". She continued for another few minutes, and then said "I think I can spend the entire hour on this shoulder, if you want, or I can leave it if this is too painful for you and do the rest of your body". I told her to just do the shoulder. It was excruciating, every spot on the entire upper right quarter of my body was so painful. There were knots everywhere, she used her elbow, she was dripping sweat halfway into the massage. After the hour was up, she said that it looked better, definitely lower and softer, but she could spend another 2 hours on it if she had the time.
The rest of the day and into the next day were really painful. It hurt to touch the area. By Thursday night it was beginning to feel better. I have had a lot less pain in it and am able to use it more than I was. I am hoping that it was a big muscular issue and I won't be dealing with it anymore. I will keep you updated since I still continue to have pain at night and some of the surrounding muscles still hurt.
Thursday, October 14, 2010
Running...Again
I decided to give running one more chance, how bad can it be, I already had 4 hip surgeries, hurt my ankle, peed all over myself and hurt my shoulder...does lightning really strike twice????
So....most importantly, the pelvic floor exercises really worked, no more incontinence on the treadmill!!! This was the main reason I hadn't gone back to running. It was a huge concern of mine and luckily I was able to take care of it. The hips and ankles did great as well. Unfortunately, running bothered my shoulder.....strange as it sounds. At about 22 minutes I gave up completely on running and stuck to walking, I guess the pounding and vibrations seem to upset it too much.
So....most importantly, the pelvic floor exercises really worked, no more incontinence on the treadmill!!! This was the main reason I hadn't gone back to running. It was a huge concern of mine and luckily I was able to take care of it. The hips and ankles did great as well. Unfortunately, running bothered my shoulder.....strange as it sounds. At about 22 minutes I gave up completely on running and stuck to walking, I guess the pounding and vibrations seem to upset it too much.
Monday, October 11, 2010
Shoulder Update
For those of you with shoulder issues, please chime in and tell me if any of
this is familiar. I have pain on and off, sometimes I am 100% pain free, other
times I am in agony. I can do anything with it, but will immediately know if I
shouldn't have bc it will hurt. Nights are the worst, sometimes I can't sleep it
is so bad. The pain is usually right at the top/front of the shoulder but will
radiate to the back of my scapula, down my biceps or triceps and into my upper
trap. I guess it depends what I do and how I compensate. I ice, I heat, I
Flector, they help but the pain come back. I am trying to strengthen my rotator
cuff but it is painful and I usually have more pain later in the day when I do.
My ROM is starting to feel limited at endrange, so I am stretching it daily.
So...those are my symptoms. I have also done acupuncture and moxa, acupuncture
didn't help, moxa may have, I just did it last night so the jury is still out. I
just want a quick fix and for the pain to go away!
this is familiar. I have pain on and off, sometimes I am 100% pain free, other
times I am in agony. I can do anything with it, but will immediately know if I
shouldn't have bc it will hurt. Nights are the worst, sometimes I can't sleep it
is so bad. The pain is usually right at the top/front of the shoulder but will
radiate to the back of my scapula, down my biceps or triceps and into my upper
trap. I guess it depends what I do and how I compensate. I ice, I heat, I
Flector, they help but the pain come back. I am trying to strengthen my rotator
cuff but it is painful and I usually have more pain later in the day when I do.
My ROM is starting to feel limited at endrange, so I am stretching it daily.
So...those are my symptoms. I have also done acupuncture and moxa, acupuncture
didn't help, moxa may have, I just did it last night so the jury is still out. I
just want a quick fix and for the pain to go away!
Wednesday, October 6, 2010
Shoulder Now.....Please Make It Stop
Very interestingly, a few weeks ago, it was brought up on the FAI yahoo group that many people on the list who have had an acetabular labral injury have also had a glenoid (shoulder) labral injury. While the anatomy of the 2 is very different, the hip is an inherently stable joint and the shoulder is an inherently unstable joint, I found it odd that so many people had both issues. I don't think there is a relationship and I doubt that so many people have any underlying soft tissue pathology, but who knows. Honestly, I think that it has to do with the fact that these types of injuries occur in young and active populations. I didn't think much of it until about 3 weeks ago when my shoulder began hurting...alot.
For the past several months, I have had pain at the top of my shoulder and my upper trap, I attributed it to stress and promised myself that I would schedule a massage. Of course I never found time for a massage so continued to suffer. It was especially bad at night, so I attributed it to my pillow and switched to another one. That didn't help. The pain then travelled into my shoulder joint, into my biceps and posterior scapular muscles. It hurt at rest, more at night, felt weak, at times it is difficult to hold a glass of water or coffee cup. I can do everything with it, and it usually doesn't hurt while I am doing it, but will hurt right after. It feels weak but I cannot pinpoint one spot where the pain is, it is an entire area. The last 2 nights I have slept with a Flector patch on it and it seems to be helping.
Just as the hip issues were beginning to clear up, this happens. I am at a loss with this and don't know what to do.....
For the past several months, I have had pain at the top of my shoulder and my upper trap, I attributed it to stress and promised myself that I would schedule a massage. Of course I never found time for a massage so continued to suffer. It was especially bad at night, so I attributed it to my pillow and switched to another one. That didn't help. The pain then travelled into my shoulder joint, into my biceps and posterior scapular muscles. It hurt at rest, more at night, felt weak, at times it is difficult to hold a glass of water or coffee cup. I can do everything with it, and it usually doesn't hurt while I am doing it, but will hurt right after. It feels weak but I cannot pinpoint one spot where the pain is, it is an entire area. The last 2 nights I have slept with a Flector patch on it and it seems to be helping.
Just as the hip issues were beginning to clear up, this happens. I am at a loss with this and don't know what to do.....
Tuesday, September 28, 2010
Aetna and FAI
Sent to me by a fellow hip friend:
Aetna’s assessment of FAI is archaic and asinine!
As you all are aware, our cause for UHC’s coverage of FAI was very successful including a NY Times article and many reversed appeals in favor of the patient. UHC along with other major insurers (BCBS, Cigna, Kaiser) now covers the arthroscopic treatment of Femoroacetabular Impingement.
Unfortunately, Aetna still has not caught up with the times. Many of our fellow patients have been successfully treated with hip arthroscopy and have been able to move on to enjoy active lives. People that are insured with Aetna are being discriminated against IF they also have a diagnosis of FAI. Aetna has taken the position that the use of the hip scope is unproven and/or experimental. This is absolutely ridiculous. It is very obvious that the bottom line is that it IS a covered procedure by the other insurers so how is Aetna’s non-coverage of this procedure accurate?
Aetna would rather have a young active patient become so disabled that their medical situation deteriorates to the point of needing a total hip replacement with all the associated medical risks and financial costs. Take the example of your typical patient. Young, active 30 year old Aetna consumer who is denied access to treatment for FAI. Based on Aetna’s opinion, the patient will go untreated for years UNTIL the patient requires a total hip replacement. Of course, doctors won’t typically do a THR on someone under 60 so this patient has to wait 30 years for treatment because of Aetna’s inaccurate and woefully pathetic position on FAI treatment.
Mr. Ron Williams (CEO of Aetna) when is Aetna going to catch up with the peer reviewed literature and your peers? When is Aetna going to reverse the policy so that your clients that need this surgery will have the same rights as patients that have UHC, Cigna, BCBS and Kaiser? When will Aetna decide that they would like the “A” in Aetna to equate to “Amazing” instead of “Awful’?
Aetna’s assessment of FAI is archaic and asinine!
As you all are aware, our cause for UHC’s coverage of FAI was very successful including a NY Times article and many reversed appeals in favor of the patient. UHC along with other major insurers (BCBS, Cigna, Kaiser) now covers the arthroscopic treatment of Femoroacetabular Impingement.
Unfortunately, Aetna still has not caught up with the times. Many of our fellow patients have been successfully treated with hip arthroscopy and have been able to move on to enjoy active lives. People that are insured with Aetna are being discriminated against IF they also have a diagnosis of FAI. Aetna has taken the position that the use of the hip scope is unproven and/or experimental. This is absolutely ridiculous. It is very obvious that the bottom line is that it IS a covered procedure by the other insurers so how is Aetna’s non-coverage of this procedure accurate?
Aetna would rather have a young active patient become so disabled that their medical situation deteriorates to the point of needing a total hip replacement with all the associated medical risks and financial costs. Take the example of your typical patient. Young, active 30 year old Aetna consumer who is denied access to treatment for FAI. Based on Aetna’s opinion, the patient will go untreated for years UNTIL the patient requires a total hip replacement. Of course, doctors won’t typically do a THR on someone under 60 so this patient has to wait 30 years for treatment because of Aetna’s inaccurate and woefully pathetic position on FAI treatment.
Mr. Ron Williams (CEO of Aetna) when is Aetna going to catch up with the peer reviewed literature and your peers? When is Aetna going to reverse the policy so that your clients that need this surgery will have the same rights as patients that have UHC, Cigna, BCBS and Kaiser? When will Aetna decide that they would like the “A” in Aetna to equate to “Amazing” instead of “Awful’?
Friday, September 3, 2010
Hip Issues and Incontinence
If you are thinking this is TMI, then I suggest you stop reading. As usual, I have no problem discussing the things that no one else wants to.
When I initially had hip pain, over 3 years ago, one thing In noticed was that I had to do a pelvic floor muscle (PFM) contraction, or kegel, when I would cough or sneeze. I never actually leaked urine but felt that I was going to. With regular PT, this got better and I forgot about it. Last week I was doing jumping jacks with L when I suddenly leaked so much urine that it was running down my legs. I was shocked. I not only had never actually leaked urine, but this was a huge amount, and completely out of the blue. I have been having a lot of tightness in my hip, and even had to go back to PT yesterday for a "tune up", but I see no other reason for this.
At PT, my PT loosened up the anterior capsule for me and sent me on my way, encouraging me to go back to running to keep the hip stretched. I did, last night I got right back on the treadmill and began running. I started feeling leakage again and couldn't believe it, I was leaking urine again. Now, jumping jacks I don't do on a regular basis, but running...I never ever had a problem with running. I am totally freaked out by this. My only saving grace is that I was home both times. Yes, I ahve had 3 babies, 4 hip surgeries, but urinary incontinence is NEVER normal.
So, what am I doing about it? PFM exercises, and more PFM exercises. Kegels when I remember, plus hip adduction (squeezing a ball in between my knees) and hip ER/abd with a theraband around my knees. I am going to do them aggressively, I won't be running for a while because I will be travelling a lot in the next week and a half, but hopefully when I get back things will be strong again and I wont have this problem anymore.
When I initially had hip pain, over 3 years ago, one thing In noticed was that I had to do a pelvic floor muscle (PFM) contraction, or kegel, when I would cough or sneeze. I never actually leaked urine but felt that I was going to. With regular PT, this got better and I forgot about it. Last week I was doing jumping jacks with L when I suddenly leaked so much urine that it was running down my legs. I was shocked. I not only had never actually leaked urine, but this was a huge amount, and completely out of the blue. I have been having a lot of tightness in my hip, and even had to go back to PT yesterday for a "tune up", but I see no other reason for this.
At PT, my PT loosened up the anterior capsule for me and sent me on my way, encouraging me to go back to running to keep the hip stretched. I did, last night I got right back on the treadmill and began running. I started feeling leakage again and couldn't believe it, I was leaking urine again. Now, jumping jacks I don't do on a regular basis, but running...I never ever had a problem with running. I am totally freaked out by this. My only saving grace is that I was home both times. Yes, I ahve had 3 babies, 4 hip surgeries, but urinary incontinence is NEVER normal.
So, what am I doing about it? PFM exercises, and more PFM exercises. Kegels when I remember, plus hip adduction (squeezing a ball in between my knees) and hip ER/abd with a theraband around my knees. I am going to do them aggressively, I won't be running for a while because I will be travelling a lot in the next week and a half, but hopefully when I get back things will be strong again and I wont have this problem anymore.
Wednesday, August 18, 2010
Checking In
Wow, what a slacker I have been! The truth is that I turn to my blog when things are not going well, and well, for the most part they have! I am not running at the moment bc it was bothering my hip, but between you and me, running is probably stupid and I shouldn't be doing it. I also just left my job of 5 years, but decided I wanted to try my new job before quitting, so for a period of time I was at 2 jobs. I am now back down to one job and feeling a lot more calm. As far as my hip goes, it has been tightening up, and the capsule gets caught on something and I experience a lot of clicking. It also gets stuck sometimes and will pop loudly when it finally gets unstuck. I should go back to PT for a "tune up" but haven't had time! I will see how things go, and now that I have more time I will go back to running again, and see how I feel!
Wednesday, July 7, 2010
5K Training...taking a break :-(
My 5K training has been going especially well, I a quite impressed with myself since I have never been a runner before but mentally really needed something to get me out of the "hip slump".
Last week I ordered a pair of Fit Flops thinking they would be great to help tone up my legs. Well....they were anything but great. I developed horrendous ankle pain, right worse than left. My right ankle is so swollen and painful that there are parts of the day that I think I have a stress fracture. I was wearing socks at Pilates yesterday and the swelling began hanging over the sock...gross!! When I first wake up it feels ok but as I start walking on it I feel it begin to swell and the pain comes back with a vengeance. It obviously doesn't help that I am on my feet the entire time that I am at work. I am hoping that this will go away on its own...not in the mood for doctors and x-rays :-(
Last week I ordered a pair of Fit Flops thinking they would be great to help tone up my legs. Well....they were anything but great. I developed horrendous ankle pain, right worse than left. My right ankle is so swollen and painful that there are parts of the day that I think I have a stress fracture. I was wearing socks at Pilates yesterday and the swelling began hanging over the sock...gross!! When I first wake up it feels ok but as I start walking on it I feel it begin to swell and the pain comes back with a vengeance. It obviously doesn't help that I am on my feet the entire time that I am at work. I am hoping that this will go away on its own...not in the mood for doctors and x-rays :-(
Sunday, June 27, 2010
When in Doubt, Find An Experienced Surgeon
When I had my appointment with BK, we did some talking about why my surgeries failed and what he has learned, and why his surgeries no longer fail. Unfortunately for me, I got injured 3 years too early. Lucky for everyone else, he too has (and the other "big names") changed his technique. For starters, I could have avoided revision surgery #1 bc now he ALWAYS takes down cam impingement in women. He has found that addressing just a pincer is a big mistake bc women for the most part have larger femoral heads, by doing a rim decompression the problem is just exacerbated. I could have avoided revision #2 bc he now ALWAYS closes the capsule at the end of the surgery, way back when, it was left open. Some lucky few of us subluxed our hips and required the capsule to be tightened (hence the capsular shift I most recently underwent).
What I thought was so interesting was that he was able to just look at my plain x-rays and see that my left was done with the old techniques, and the right with new techniques. He has taken some bone down in each surgery and the final result is a "perfectly shaped" hip on the right! The left looks good, but not quite as "beautiful" as the right, despite the fact that the left NEVER gives me trouble.
What I thought was so interesting was that he was able to just look at my plain x-rays and see that my left was done with the old techniques, and the right with new techniques. He has taken some bone down in each surgery and the final result is a "perfectly shaped" hip on the right! The left looks good, but not quite as "beautiful" as the right, despite the fact that the left NEVER gives me trouble.
Monday, June 21, 2010
"The Recommendation...And What I Am Doing About It
I have been having episodes of groin pain and tightness, definitely better than
a few months ago, but still making me crazy anyway. I just don't want to deal
with it anymore. I saw BK last week, my x-rays look great. Actually, my multiple
scoped hip looks fantastic angle-wise, my single scoped hip doesn't look 'as
perfect' to him, but it is perfect to me! He thinks I should go back to PT to
address my lingering tightness and pain. I agree, but.... I really don't want to
go back to PT! I love my PT but at almost 8 months out, I don't want to continue
or go back. I have decided to work on it on my own and in my craziness I am
starting a 'couch to 5k' program tomorrow. I desperately want to get into an
exercise routine, and have a goal, and be excited to do it. I think this is a
good way. I really hope this won't make my pain worse or my capsule tighter. My
plan is to start tomorrow, if all goes well this week then I will splurge on a
good pair of running shoes next weekend. J is training with me and I think I
convinced my parents too!
Hopefully this can get my past the latest bump in the hip journey!
a few months ago, but still making me crazy anyway. I just don't want to deal
with it anymore. I saw BK last week, my x-rays look great. Actually, my multiple
scoped hip looks fantastic angle-wise, my single scoped hip doesn't look 'as
perfect' to him, but it is perfect to me! He thinks I should go back to PT to
address my lingering tightness and pain. I agree, but.... I really don't want to
go back to PT! I love my PT but at almost 8 months out, I don't want to continue
or go back. I have decided to work on it on my own and in my craziness I am
starting a 'couch to 5k' program tomorrow. I desperately want to get into an
exercise routine, and have a goal, and be excited to do it. I think this is a
good way. I really hope this won't make my pain worse or my capsule tighter. My
plan is to start tomorrow, if all goes well this week then I will splurge on a
good pair of running shoes next weekend. J is training with me and I think I
convinced my parents too!
Hopefully this can get my past the latest bump in the hip journey!
Friday, June 4, 2010
Am I Micro Managing?
Am I being crazy and unrealistic? Wed I knew I was in for trouble, since I had to go do a presentation at L's school. her school is built on the side of a hill ( a very steep hill). Getting there was no problem, since her classroom is close to the bottom. Coming back up was quite an adventure. I still have a lot of trouble walking uphill. That night I had a ton of pain which I wasn't expecting, and made me quite mad!! I really don't think I should be dealing with pain like this at this point, and quite frankly I need this hip to start behaving!
Sunday, May 30, 2010
Time Flies When You're Having Fun...
...Or not!! So once again, it has been a roller coaster of issues with my hip. It is a lot better than before I began this round of PT, the capsule is a lot "looser" and is not getting stuck as often. It does often click or pop. A lot of time I will be trying to shave my legs and the leg just wont externally rotate, it then pops, and is then able to rotate. Weird. What bothers me is that I still get pain in the joint and I don't know why. It is not excruciating, I don't take anything for it, I don't even use the Flector patches on it anymore, I have just gotten used to it I guess. I am at the point where I just give up, at lest for now. I don't think there is anything else to be done at this point, and many people need up to a year to feel better, so maybe I need to have a little bit of patience and wait. This is easier said than done, bc at 29, I don't want to have pain when doing simple activities, like cleaning out my closet, taking the kids for a walk (yes, these are all activities that cause me pain), but I have resolved to "chill out" and give it some time.
My crazy work schedule is coming to an end in 2 weeks, thank goodness, so we will see what happens. I had PT this week, and he managed to really loosen up my hip, and get me to have normal stride length. This lasted a total of 4 minutes. Once I was back outside, walking the streets of NYC, I had pain, which was incredibly frustrating. I have an appointment with BK in a few weeks, mostly to get an x-ray and make sure the bone is where it needs to be. I called about 2 weeks ago (middle of May) to make an appointment, the receptionist asked if I was in pain, I said yes. She told me she would try to "squeeze me in", "how's June 22nd". Seriously!! The truth is that it doesn't even matter bc there is nothing to be done, or at least that I am open to doing (injections, drugs...), but she managed to give me June 15th! I will try to be better about updating my blog, but work is sucking the life out of me!
My crazy work schedule is coming to an end in 2 weeks, thank goodness, so we will see what happens. I had PT this week, and he managed to really loosen up my hip, and get me to have normal stride length. This lasted a total of 4 minutes. Once I was back outside, walking the streets of NYC, I had pain, which was incredibly frustrating. I have an appointment with BK in a few weeks, mostly to get an x-ray and make sure the bone is where it needs to be. I called about 2 weeks ago (middle of May) to make an appointment, the receptionist asked if I was in pain, I said yes. She told me she would try to "squeeze me in", "how's June 22nd". Seriously!! The truth is that it doesn't even matter bc there is nothing to be done, or at least that I am open to doing (injections, drugs...), but she managed to give me June 15th! I will try to be better about updating my blog, but work is sucking the life out of me!
Wednesday, May 12, 2010
Yes, I Won My Appeal
Lately I have been receiving comments on older posts asking if I won my appeal. Yes, I did, my surgery was completely covered :-) Thanks to all who have helped me with the appeal as well as paved the way for me and others to have our surgery covered (especially MC)!
A few weeks ago, I had a 20 minute "hole" in my day and was actually able to leave my office for the first time in the middle of the day since I began my new hours. As I was walking out, I realized I had a voicemail from BKs billing office. I called them back to see what they wanted. His biller called to thank me for appealing my claim, she had received the letter a few weeks ago but had only been able to tell BK about it that day. He was very happy told her to call me to ask for a copy of the appeal I used so that it could be used for other patients with the same issue. I hope that it does and everyone who needs the surgery will be able to have it and move on with their life (some of us a little slower than others!!!)
A few weeks ago, I had a 20 minute "hole" in my day and was actually able to leave my office for the first time in the middle of the day since I began my new hours. As I was walking out, I realized I had a voicemail from BKs billing office. I called them back to see what they wanted. His biller called to thank me for appealing my claim, she had received the letter a few weeks ago but had only been able to tell BK about it that day. He was very happy told her to call me to ask for a copy of the appeal I used so that it could be used for other patients with the same issue. I hope that it does and everyone who needs the surgery will be able to have it and move on with their life (some of us a little slower than others!!!)
Sunday, May 9, 2010
The Exercises
Once again I apologize for taking so long to post, my work schedule is horrendous, and I even had to go in on my day off this week, with the baby no less! I am tired, cranky and counting the days until this is over (Jun 14).
The exercises my PT gave me are not strengthening exercises, in fact, they are just stretching/ mobilizing exercises, and I am supposed to go back to him to get strengthening exercises. (My appointment is 3 weeks from now).
The exercises are meant to keep the anterior capsule stretched out and loose, I don't recommend you do them since most people don't have this problem of soft tissue impingement. The most simple one I do is sit in Indian style (yes, this is how I got into this mess to begin with!!) and put my hands behind me and hold the stretch (I try to hold for 60-90 seconds), if I don't feel enough of a stretch I do a posterior pelvic tilt.
I also do a mobilization with a mob belt, this requires another person. We wrap the belt around my thigh while they sit on a stool and the belt goes around them. Their job is merely to stabilize and provide a tiny bit of a lateral force. I keep my right (bad) leg behind me and stand in a position as if I was going to lunge. I put my arms out in front and rotate my body to the left, so my right leg is getting and external rotation force. This is a very specific an targeted mobilization for the anterior capsule. I am to do this 2x/week.
I can also do a half kneeling stretch but I have chosen not to, since I am getting great results for these 2.
My hip flexion has been as good as 115' degrees, pain free, it does tighten up if I slack off. I felt so great this week I did my first Pilates reformer class and (shhhhh) went Spinning on Fri. I have since tightened up a bit but I really needed that, I think I need to return to exercising as part of this final step in rehab/recovery. I have 2 more Pilates sessions planned for this week and really hope I can spin at least 3x/week for now.
I promise to keep you updated...but please be patient...I have never been so busy and overwhelmed in my life!
The exercises my PT gave me are not strengthening exercises, in fact, they are just stretching/ mobilizing exercises, and I am supposed to go back to him to get strengthening exercises. (My appointment is 3 weeks from now).
The exercises are meant to keep the anterior capsule stretched out and loose, I don't recommend you do them since most people don't have this problem of soft tissue impingement. The most simple one I do is sit in Indian style (yes, this is how I got into this mess to begin with!!) and put my hands behind me and hold the stretch (I try to hold for 60-90 seconds), if I don't feel enough of a stretch I do a posterior pelvic tilt.
I also do a mobilization with a mob belt, this requires another person. We wrap the belt around my thigh while they sit on a stool and the belt goes around them. Their job is merely to stabilize and provide a tiny bit of a lateral force. I keep my right (bad) leg behind me and stand in a position as if I was going to lunge. I put my arms out in front and rotate my body to the left, so my right leg is getting and external rotation force. This is a very specific an targeted mobilization for the anterior capsule. I am to do this 2x/week.
I can also do a half kneeling stretch but I have chosen not to, since I am getting great results for these 2.
My hip flexion has been as good as 115' degrees, pain free, it does tighten up if I slack off. I felt so great this week I did my first Pilates reformer class and (shhhhh) went Spinning on Fri. I have since tightened up a bit but I really needed that, I think I need to return to exercising as part of this final step in rehab/recovery. I have 2 more Pilates sessions planned for this week and really hope I can spin at least 3x/week for now.
I promise to keep you updated...but please be patient...I have never been so busy and overwhelmed in my life!
Sunday, May 2, 2010
Problem Solved....Or So I Hope
I know I am probably jumping the gun, but I definitely feel better mentally about what has been going on. I think I finally have an understanding of what the problem has been, and why I have been having so many issues and problems, and now the final fix will lie with me.
All along, it seems that my capsule has been too tight (since the last surgery), so, as it was explained to me for the millionth time (but this time I 'get it'), imagine that the capsule is like saran wrap, tightly covering the whole hip joint. If it fits well, it will keep the joint in place and allows it to move well through its range of motion. In very rare, super special cases, like mine, it gets too tight, so when I tried to flex my hip, there was no give in the "saran wrap" and it was getting bunched up in the front of the joint. That's why my flexion was so limited, and when I was having the "episodes" and all the clunking, it was the capsule snapping, or getting "unstuck".
The solution was to do some very specific mobilization, we had to tweak them on Friday, but I left PT on Fri so happy! I have had almost no catching/ clunking/ feeling of subluxation since then. I still have pain, but I have increased hip flexion too, so I am happy, and I think I need to be in a good place mentally at this point bc I have been close to losing it more than once.
I have specific stretches to do, to keep the capsule stretched, and twice per week I am supposed to have someone help we with a mobilization using a mob belt. It is an ER mob while my hip is stabilized in extension, it is amazing and works wonders.
I am supposed to begin strengthening in 2 weeks, I can't get back to PT for 4, so I may have to begin on my own. When I overdo the stretching, I can't walk well, and actually have a trendelenberg, bc my hip is not used to functioning in the new range.
I hope things go uphill from here, this is getting very very old!!
I apologize for not being on top of blogging, I am not really on top of anything lately, I have been working crazy hours and most things have fallen to the wayside...my MIL was here for the weekend and re-organized my closets bc they have gotten so messy!!!!
All along, it seems that my capsule has been too tight (since the last surgery), so, as it was explained to me for the millionth time (but this time I 'get it'), imagine that the capsule is like saran wrap, tightly covering the whole hip joint. If it fits well, it will keep the joint in place and allows it to move well through its range of motion. In very rare, super special cases, like mine, it gets too tight, so when I tried to flex my hip, there was no give in the "saran wrap" and it was getting bunched up in the front of the joint. That's why my flexion was so limited, and when I was having the "episodes" and all the clunking, it was the capsule snapping, or getting "unstuck".
The solution was to do some very specific mobilization, we had to tweak them on Friday, but I left PT on Fri so happy! I have had almost no catching/ clunking/ feeling of subluxation since then. I still have pain, but I have increased hip flexion too, so I am happy, and I think I need to be in a good place mentally at this point bc I have been close to losing it more than once.
I have specific stretches to do, to keep the capsule stretched, and twice per week I am supposed to have someone help we with a mobilization using a mob belt. It is an ER mob while my hip is stabilized in extension, it is amazing and works wonders.
I am supposed to begin strengthening in 2 weeks, I can't get back to PT for 4, so I may have to begin on my own. When I overdo the stretching, I can't walk well, and actually have a trendelenberg, bc my hip is not used to functioning in the new range.
I hope things go uphill from here, this is getting very very old!!
I apologize for not being on top of blogging, I am not really on top of anything lately, I have been working crazy hours and most things have fallen to the wayside...my MIL was here for the weekend and re-organized my closets bc they have gotten so messy!!!!
Thursday, April 29, 2010
I Have Reached A New Low In Life
Wednesday was my PT session, as I had discussed with BK and my PT at the conference we were at on Friday. The conference lasted 2 days but I was only able to attend the first one. When I arrived to PT on Wed, I told my PT that my friend who had attended both days loved his presentation on the second day. He asked if she had heard the part about the difficult case he has now, who has tightness anteriorly due to a tightened capsule, but laxity posteriorly due to a torn ligamentum teres....hmm, "is that me?" I asked....Yep!! So my all time low is that I am the "difficult" and "challenging" case that is spoken about at conferences.
So PT was good, he thinks that if he mobilizes me anteriorly, it will give me more space and less pinching. I pinch in the front at 90 degrees of flexion, which is very upsetting to me, I would like to have at least 120 degrees of painfree flexion.
He did his thing and I got about 100-110 degrees of painfree flexion. But I was a bit unstable because I was working in a new range that I was not used to. He did a few adjustments, I was sore but felt like we had made progress.
Once I got home I was having tremendous posterior pain, which made absolutely no sense at all. I guess this whole thing makes absolutely no sense at all...so I emailed my PT, who said to hold off on all stretches for now. I see him tomorrow for some more mobs. We spoke this morning again and I apologized for being so high maintenance!! He was going to speak to BK today and try to figure this whole thing out...again!
So PT was good, he thinks that if he mobilizes me anteriorly, it will give me more space and less pinching. I pinch in the front at 90 degrees of flexion, which is very upsetting to me, I would like to have at least 120 degrees of painfree flexion.
He did his thing and I got about 100-110 degrees of painfree flexion. But I was a bit unstable because I was working in a new range that I was not used to. He did a few adjustments, I was sore but felt like we had made progress.
Once I got home I was having tremendous posterior pain, which made absolutely no sense at all. I guess this whole thing makes absolutely no sense at all...so I emailed my PT, who said to hold off on all stretches for now. I see him tomorrow for some more mobs. We spoke this morning again and I apologized for being so high maintenance!! He was going to speak to BK today and try to figure this whole thing out...again!
Sunday, April 25, 2010
The Pow Wow
Friday was the ortho conference given by HSS, the keynote speaker was Dr Byrd, which was very cool. Other speakers included BK and my PT. After the hip topic was over, Everyone swarmed over to BK, it was hysterical, he was so popular. He made his way through the crowd over to me, and we had a quick meeting! I said I just want us all to be on the same page about what is going on. So we agreed to try one thing in PT, he promised that if I wasn't getting good results he wouldn't make me do it for a long time, and that if when I am at PT this week, if things don't go well, he will come right over and see what is going on.
So, hopefully PT will be on Wed, and Wed night I will have great things to report!
So, hopefully PT will be on Wed, and Wed night I will have great things to report!
Wednesday, April 21, 2010
And the Saga Continues...
Have you ever felt like you needed a time-out from life? I think that is exactly what I need right now. I spoke with BK last night about my ultrasound, he said that, "just as he thought", the problem is that the capsule is thickened and impinging in the joint. He thinks that for now, the solution is anterior hip mobs to stretch it out a little bit and give it more space. This is rather conflicting since prior to the MRI and Ultrasound, my PT wanted to avoid anterior mobs since he felt the joint was a little bit unstable. Now the thought is that it is too tight. See why I need a time-out.
I was emailing back and forth with a fellow hip friend last night, and one of the things she asked is what do I think is going on? Honestly, I have no idea whatsoever, I usually have at least an idea, a thought, something... I am just plain confused now.
The plan is for BK to speak with my PT today and see if he agrees that this 'plan' is a good idea. We are all going to be at an ortho conference on Fri, so the plan is to have a quick little meeting there and discuss this all together.
At this point I don't know how much more of this I can take. I had a mini breakdown last night, because after 4 surgeries, 8 injections, months and months of PT....I am done...I don't want my hip to run my life anymore.
I was emailing back and forth with a fellow hip friend last night, and one of the things she asked is what do I think is going on? Honestly, I have no idea whatsoever, I usually have at least an idea, a thought, something... I am just plain confused now.
The plan is for BK to speak with my PT today and see if he agrees that this 'plan' is a good idea. We are all going to be at an ortho conference on Fri, so the plan is to have a quick little meeting there and discuss this all together.
At this point I don't know how much more of this I can take. I had a mini breakdown last night, because after 4 surgeries, 8 injections, months and months of PT....I am done...I don't want my hip to run my life anymore.
Friday, April 16, 2010
Ultrasound Report
There is mild deep surface fraying of the iliopsoas tendon which is otherwise preserved. No associated iliopsoas bursa is evident. Of note, there is a focal capsular thickening corresponding to abnormality noted on MRI. Area of focal capsular thickening appears to immediately overlie the anterosuperior labrum resulting in mild mass impression on the labrum. No discrete snapping or pain could be elicited with provacative maneuvers.
Impression:
Mild ilipsoas tendinosis with deep sided fraying, right hip.
Focal lateral capsular thickening which appears to impinge along the anterosuperior labrum.
It was elected not to proceed with the ultrasound guided injection today pending discussion with referring clinician.
Impression:
Mild ilipsoas tendinosis with deep sided fraying, right hip.
Focal lateral capsular thickening which appears to impinge along the anterosuperior labrum.
It was elected not to proceed with the ultrasound guided injection today pending discussion with referring clinician.
Wednesday, April 14, 2010
Sometimes Even I Can't Believe that These Things Happen To Me
Today was supposed to be my ultrasound with 'possible' injection, based on what the radiologist and BK saw on the ultrasound. All was going well, I arrived to the hospital on time, they actually did have the appointment scheduled (which I am always a little shocked at!). Then things started going downhill, and all I can say is that I was fucking pissed.
The radiologist came in and looked at the prescription and chuckled a little, "possible injection?" he asked, so I explained that BK was supposed to be there too, so his assistant called BKs office, who, let me sidetrack for a moment, knew that this was supposed to be scheduled so that he could come, as well as my PT, since I had first told the scheduler and then he did as well. Well, you can imagine my shock when the radiologists assistant reported back to us that BK was on vacation. NFW. Why the hell was this scheduled for today then???? So, as you can see, this is why I am not just pissed, I am fucking pissed.
So the radiologist did the ultrasound, wasn't too interested in hearing what I had to say, or have me explain what exactly happens, and that I can't reproduce it at will. He did say that my psoas is somewhat irregular and the capsule is very thick. I asked if it was thick bc of the capsular shift, he said it was even too thick for that. He said he could inject either the psoas or the capsule or both, but really needed to know what BK wanted. So no injection today.
I left rather pissed off, but treated myself to some retail therapy!
The radiologist came in and looked at the prescription and chuckled a little, "possible injection?" he asked, so I explained that BK was supposed to be there too, so his assistant called BKs office, who, let me sidetrack for a moment, knew that this was supposed to be scheduled so that he could come, as well as my PT, since I had first told the scheduler and then he did as well. Well, you can imagine my shock when the radiologists assistant reported back to us that BK was on vacation. NFW. Why the hell was this scheduled for today then???? So, as you can see, this is why I am not just pissed, I am fucking pissed.
So the radiologist did the ultrasound, wasn't too interested in hearing what I had to say, or have me explain what exactly happens, and that I can't reproduce it at will. He did say that my psoas is somewhat irregular and the capsule is very thick. I asked if it was thick bc of the capsular shift, he said it was even too thick for that. He said he could inject either the psoas or the capsule or both, but really needed to know what BK wanted. So no injection today.
I left rather pissed off, but treated myself to some retail therapy!
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