Thursday, April 3, 2014

Just a "Pinch" of Pain



Hello again, all!
I had my appointment with Dr. S. on Monday. I wanted to take a few days to digest it all and think about how to write this post before I went about my business, so here goes nothing.
Here’s what we discussed in the appointment:

  1. “Excess” Bone Growth
  2. Psoas pain
  3. Deep groin catching/pulling pain
  4. Non-union
  5. Heterotopic Ossification
  6. Left hip pain

Here’s what Dr. S. said about each of these things:

  1. The bone growth that I can feel on my iliac crest is completely normal and to be expected. Dr. S doesn’t think it has anything to do with my psoas pain or any of my other soreness since the growth is high and above my attachment point. He asked me if the screws that I can feel are uncomfortable and if I want them out, I said no. They are slightly uncomfortable, but I don’t want him anywhere near me with that scalpel anytime soon.
  2. Dr. S. told me that my psoas and some of the surrounding muscles are really tight, but that my hip-flexor and quad strength is actually pretty good. He didn’t seem overly concerned about it, but does want me to try and get those muscles looser and in less pain. We are trying for 6 more weeks of physical therapy (on my own time) to see if that helps the pain I’m having. If it doesn’t, we’ll take it from there
  3. Dr. S. was a little concerned about the deep groin/catching pain I described in my earlier post. He doesn’t like the idea of having pain that won’t allow me to stand up straight or walk (obviously). He’s hoping that it’s a continuation of the psoas tightness and pain and that it will resolve itself with physical therapy as well. If it doesn’t, he’s thinking some deep tissues could be catching on my screw head (see photo below). If PT doesn’t help, we may have to consider taking my screws out. That would not be ideal, since some of my screws are pretty deep. He’d have to re-open my incision and do a lot of moving around to get to the screws. It’s not as cut and dry (tee-hee) of a procedure that I was thinking it might be. He did mention that he’d really like to avoid putting me through that if he doesn’t have to. We will see at the end of the 6 weeks. 
  4.  The non-union is a non-issue. He said that it’s not a weight bearing bone and it’s not going to have any impact on me. He also said that while it appears that it’s not closing, it more than likely is still growing bone and will close on its own eventually. 
  5.  Dr. Schiller did confirm that I do actually have heterotopic ossification (HO) in the areas that I had suspected by looking at the x-rays. He said that's no big deal and it's mostly in the deep muscles tissues and I'll probably never even know I have it.
  6. This is the part where I sigh loudly and with general unrest. As I’ve mentioned in past posts, I’ve been having “start-up” pain in my left hip. This isn’t a new thing, it’s been happening for years. Lately, though, it’s a little more common and a little more startling. I had attributed it to the RPAO and that my left hip has had to work overtime for years. Even before my RPAO, my poor left hip got the brunt of it as I compensated for my right hip pain. So I explained everything to Dr. Schiller. He showed me my x-rays and told me that in terms of coverage, I’ve got pretty good coverage on the left side. He wouldn’t consider LPAO at all. However, he did say that I do have impingement on my left side, and that that is what is more than likely causing all of my left hip pain. He said that if he had to guess, that he’d say my left hip is probably a little degraded due to both the impingement and the overtime work it’s had to put in and that that’s why I’m feeling the pain.
I did a little research on my own so that I could better explain and show you what’s going on (and better understand it for myself). What I’ve got in my left hip is called Femoroacetabular Impingement (FAI). There are a couple different kinds and they are outlined in the website I’ve provided below.

http://orthoinfo.aaos.org/topic.cfm?topic=A00571

I have what’s called Pincer FAI. I’ve attached a couple of my x-rays, one pre-RPAO and one post-RPAO to point out where my FAI is.

Pre-RPAO
Post-RPAO


So, what now? Well, Dr. S. said that there are some surgeons who would have fixed it as soon as they saw it, regardless of if it was really bothering me or not. He doesn’t really operate that way (pardon the pun). He would prefer to leave well enough alone until it starts to bother me to a point of needing fixing. Over time, it will probably continue to wear at my labrum and joint space, and eventually I will need to have it addressed. It would more than likely be a scope surgery like what I had last March on my right hip. Probably not a big deal. We’ll have to take a day at a time and see how it goes. For now, he wants me to do what I’m doing on my right side for PT to my left side as well. That way we can see if PT will be help to me for the FAI.
That’s that, in terms of what I spoke about with Dr. S. I will say that I’m disappointed to hear that I’ll more than likely eventually need another surgery on my other side. Going through degrading pain on the other side now is not something that I’m looking forward to, I can tell you that much. I guess that we’ll just have to see what happens. Maybe it WON’T get worse after all. Time will tell.
I have to keep doing the PT on both sides for 6 weeks. At the end of six weeks I have to call Dr. Schiller’s office and let them know how I’m feeling and make an additional appointment if PT doesn’t seem to help either side.
I’ll post later about what I’m doing on both sides (RPAO-ed and left FAI) for physical therapy exercises.
Thanks for listening, and we’ll talk soon,
D

4 comments:

  1. I've been looking for an update from your appointment! :) sounds like it's given you some food for thought. Let's hope the PT works wonders on both hips!! I've been having a bit of an issue over here. Getting really painful flare ups of radiating pain down my PAOd leg...:( can barely walk, and it lasts for a couple days. Just wondering if you've felt anything like this...?? My PT put me on hold today until I see my dr. We shall see!

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    1. Hi Brenda!,
      Well, I did some PT last week and all I can say right now is OUCH! It's definitely working the area, don't know what that pain means yet. We'll have to see if a couple of weeks.
      I did definitely have some episodes of radiating pain, but it didn't last that long at all. It was mostly acute situations where it would happen for a minute or two and then calm down. I think a lot of it had to do with the nerves and how they heal/cope with the surgery. Does your pain seem like burning nerve pain? Or is it like an aching bone pain? I'll be curious to see what your surgeon says.
      When do you see your surgeon about this? I hope it's soon, I'm sure that's troubling!

      Good luck and please let me know how you make out! I would mostly just recommend resting the leg and taking it really easy.

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    2. Hi Danielle!

      So I saw my surgeon on Tuesday. As for my hippy...very hard to describe what exactly is going on. Thankfully he feels everything is structurally ok and the joint looks good. He believes it's all muscular, but also says I'm healing quite slowly :/ Basically he said the muscle tests they did show that my gluteus medius, tensor muscle and a couple other muscles over there are in "shut down" mode... Meaning they aren't firing properly and I guess by continuing to use them in their pathetic condition makes them contract and spasm like crazy. Does that make sense? :/ so, sad face, they want me using one crutch for at least a week to go easy on the muscles, and really lay low and do nothing outside of work etc. No PT for now, just simple strengthening exercises to help the muscles back into "go" mode. I can barely do the simple exercises they gave me! So frustrating...I feel like I'm back to square one. They also put me on a local anti inflammatory patch and I am going to start using a bone stimulator. I wish I knew WHY almost 6 months post op my muscles decided to go on strike! But no one has a good answer for me...

      Hope PT becomes a little less painful for you!
      Will talk soon,
      Brenda

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    3. Oh Brenda,
      You poor thing! Having set-backs is something we are always told to expect, yet, nonetheless, we are always disappointed when they happen. I have to say that I completely understand what you're saying about muscle spams and contracting because the last few days I've had terrible problems with my psoas.
      I know that it's frustrating for you to sort of "regress" back to one crutch, but remember that you definitely don't want to push it make make it worse! The exercises will get easier as you continue to do them over time. I know how frustrated you are, I've been there, too. It seems like this recovery is NEVER-ENDING! I'm interested in the anti-inflammatory patch, do you like using it? My surgeon had to prescribe me Valium for my muscle spasms, and I have to admit it makes me a little loopy. Not a huge fan of it, although it is only my first couple times taking it. It IS helping the spasms, and hopefully will serve as a preventative measure to stop the spasms from happening in the first place now. I didn't have the bone stimulator, but I'm sure it will be easy peasy, and you're probably going to benefit from it a lot. When you went to PT to start, did they use any stim on your muscles? I never had anything like that and am wondering if that might help my issues?
      I can't understand the timing of it either...I'm 18 months out of surgery, was SMOOTH SAILING, and now I've got this debilitating issue. I know it's so disappointing, and it's been making me pretty down the past couple days. Trying to keep my head up and hope for the best!

      I wish you so much luck over these next couple months, I hope that you get over this hurdle easy and quickly!
      Keep in touch, hip-y friend,
      Danielle

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