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

Sitting Pretty.

Hello again! Updating on the painful hip issues.

A couple weeks ago I decided to call and make an appointment with Dr. S. to see what's going on with this silly little hip. It hasn't gotten better, and what's more is that it's more painful than it was. I've had a couple pretty concerning episodes with serious pain. One where I actually couldn't even stand up straight or walk at all, I had to have my husband get my crutches so I could get around for a few minutes while my hip worked itself out. The pain eventually went away, but it was scary for a few minutes.
It's doesn't seem like bone pain, though. It seems like it's psoas, or something muscular/tendon deep in there that is pulling. It's a pulling and aching feeling, and it only happens when I use the muscles. It doesn't seem to hurt when the leg is moved without my muscles (like if I move it physically with my hands). Almost every episode has happened after I've been sitting for a while. I am continuing to have a hard time with sitting. Even as I write this, I can feel everything stiffening up. Generally speaking, I can get along just fine with the sitting/stiffness issue. It's only painful to stand up straight, and for a few seconds walking when I get up, but after I move around to get things going again it's not really painful at all. It's just the "start-up" that hurts. I think I need some WD-40.

So, now I just wait until I can see Dr. S. I meet with him in another couple weeks on the 31st of March. It can't come soon enough. I want to chat about my right hip, and I also want to bring up my left hip, which is also stiff and painful when I first get up as well. The left isn't overly worrisome, but I want to bring it to his attention in case he wants to see what's up.

I know it could be any number of things. I could just be that I really need to get back to the gym and work and stretch these bad boys out. It could be that these are the kinds of things I should expect from a PAO-ed hip. It could be that there really is something going on. Who knows, we will hopefully start figuring it out over the next few weeks.

I'll let you know how my appointment with Dr. S. goes.
-D

Growing Pains

This post will be short and sweet. I just wanted to post my latest x-rays to illustrate where my concerns are about excess bone growth. I talked about these in my "Tidbits" post.

Quick reminder of current conditions:
I'm 15 months out of RPAO. I've had RPAO and a right arthroscope to fix torn labrum, to microfracture and to resurface femoral head.

Any thoughts would be much appreciated! I've heard from a few different people and it seems most likely to be something like Heterotopic Ossification (which may, or may not be an issue). Also, regarding the non-union, my surgeon isn't concerned with it at this point. It isn't bothering me on a regular basis. I will be asking him about it again, just to be sure.

I've discussed the bone growth concerns with my surgeon and as a first step he is sending me for an ultrasound to see if there is any cyst formation in the area. I did have cyst growth prior to surgery.

That is all for now, thanks for all emails, comments and well wishes so far. Please feel free to leave your thoughts in the comments below! Any and all input is welcomed.

Thanks guys,
D

Breaking Bad (Habits)

Now that I’m a year on, I find myself really focusing on the little things. I don’t walk with a limp anymore, and I don’t even hesitate to do anything at all with my hip throughout the day. Now, I mostly just focus on all the ridiculous bad habits I didn’t know I had. It’s amazing what the human body will do to “protect” itself over time. I’ve been in pain for so long, that my body developed these coping mechanisms I didn’t even know I had. You change certain things about how you move, and how you position yourself so that you don’t trigger that horrible pain. 

I don’t think I realized how many bad habits I have, until I started trying to break them. For instance, I still have a hard time walking straight upright. I still have somewhat terrible posture. Before PAO, my labral tears were so bad that I couldn’t take a full step across the top of my hip without buckling pain. If I ever even tried it, I would end up bent over cursing at myself. I also couldn’t stand up straight when I walked because the full pressure and stretching on the joint hurt immensely. So, I walked just a little bit hunched over with my shoulders slouched in, and leaning forward to alleviate the stretching in the front of the joint. I took small, half steps on my right side, limping so that I didn’t have to move across the top of the joint. Tom (my PT) used to call this guarding. I was guarding my hip from any motions that would cause pain. 

Another bad habit I learned over the years, to protect myself from my hip pain, was to walk down the stairs facing sideways. So, instead of facing straight down the stairs and putting all of my emphasis on walking down straight onto my hip, or over my hip, at some point I started walking down stairs with my body facing to the side. Usually, I face the left side. Most of the time, now, I catch myself doing this mid-flight of stairs and I think “What the heck am I doing?!” Well…when I really think about it...I was protecting my joint from full pressure and movement. 

I still physically pick up and lift my RPAO-ed leg into the car with my hands after I’ve sat in the seat, and then do the same and lift my leg out when I’m attempting to get out of the car. I don’t have to do this anymore…it’s just a bad habit. This was a habit I learned post PAO. The psoas and rectus muscles were so damaged that I couldn’t even lift my leg up with my own muscles, I had to lift it with my hands and move it into the car. Even today, over a year later, I still have a little bit of trouble doing this on my own…so I still lift my leg with my hands. 

I still sleep on my left side. Every night, always. This one is the worst. I can’t seem to break this habit. The problem is that sleeping on your left side for a million years is not good for any of the other joints…like, let’s say, your shoulder. My poor left shoulder and my left side of my neck are constantly aching because of this. Problem is, I can’t get comfortable any other way! I’ve been trying to fall asleep on my back or right side, it’s been a bit of a battle…but hopefully I’ll get used to it over time. 

These are just the ones I catch myself doing on a regular basis. Now, breaking myself of these things is what I have been focusing all of my “recovery” on. I make myself walk straight up, with good posture. I force myself to go down the stairs correctly. I am trying to remember not to lift my leg into the car, and every night I continue to try and sleep in another position. I’m finding it’s very difficult to change something your body has been doing for years and years. It’ll take some time, but I’ll get there.

Now that I’ve got other hip-y’s thinking about it, I bet you’ll start realizing that you’ve got things you do to “guard” against your pain. Whether it’s before your surgery, if you’re recovering from a PAO or other surgery, or you’re years separated from a recovery…I hope that you and I will both be able to live without guarding for pain.

Hope all are well,

Talk soon,

D xox

365

What an interesting day it was. I felt a strange tugging on my psyche all day. I felt like I was in a strange vortex of time where I was living my current day…but I was constantly thinking about the day in regards to where I was one year ago.  I’d look at the clock: “Oh, it’s 7:45, they were just pumping me with happy juice to head to the OR.”

Or: “12:45? I was about an hour away from being out of surgery.”

Or my favorite:

“2:30? Ugh…I was VILE in recovery at 2:30. Mint green and all sorts of pukey”

And in case you’re wondering, at this time last year (6:40 pm) I was high as a kite on morphine and zonked out of my mind.

Anyway, I wanted to make this a post of reflection. One where I answer the questions I get often from people…and some I know I’d ask someone else if I had the opportunity. So, here goes nothing!

Did you feel like you were fully prepared for surgery and recovery?

Absolutely. We thought we were perfectly prepared…had prepared for weeks.

Were you actually prepared for surgery and recovery?

Absolutely not. But, the thing is, you really can’t be totally prepared. You can’t know how debilitating the surgery is, until you’re debilitated from the surgery. We figured it out as we went…it was a lot of learning on the fly.

What is the last thing you remember before surgery?

The very last thing I remember is looking around the operating room and seeing my surgeon standing around with his surgeon buddies oogling my x-ray.  I remember thinking various thoughts like: “I hope he slept well last night.” “I hope he had a great big cup of Joe.” And “Boy, I hope he’s feeling dapper today!”

What is the first thing you remember after surgery?

Dry heaving! I remember a lot of awful, terrible dry heaving. And I remember my lovely recovery nurse, Sarah, telling me I looked like the ceiling tiles (which were green). I remember she was a rebel and gave me my blood transfusion before she was supposed to…and I remember thanking her profusely because it made me feel so much better. Then I remember drinking a ton of ginger ale (only to later puke it up).

What were the first three weeks after surgery like?

This was the most trying/worrisome/painful/difficult part of surgical recovery. I spent the first 5 days in the hospital. This was both good and bad for a lot of reasons. First of all it was good because I was really nervous about how fragile I was. But…it was bad because you really don’t sleep in the hospital. For a place that wants you to rest, they sure do LOVE to wake you up every chance they get. I also had a little bit of a hard time because I reacted to the transfusion and had a high fever for three days. Once I broke the fever, cleared PT in the hospital, and got my surgeons’ blessing…I went home. I was so thankful to be home with my family…but petrified at the same time because I didn’t have nurses there for my every need. My husband (who became known as Nurse Matt) had to do EVERYTHING for me. We had visiting nurses come to teach us how I could get around in my house. I still to this day tell myself: Good goes to heaven, bad goes to hell. That is what the nurse taught me to remember which leg to use each way when you’re going up or down the stairs with the crutches. Good up, bad down. It was a difficult time. I had to relearn everything, and while it wasn’t particularly painful in the hip joint at this point…it was painful when I had to do my physical therapy.  Overall, it was physically and emotionally taxing the first two weeks at home. I had a hard time realizing and accepting all of the help I needed. I had a lot of moments that felt like a let down. I felt really helpless…and I hate that feeling. It took a few days for me to accept the condition for what it was…and to realize that I needed the help if I was going to get better faster. After those first three weeks, we were in a great rhythm. I was feeling stronger, starting to get my appetite back, and feeling better about myself.

What was the best tip or trick you learned to help you recover?

While I was non-weight bearing, the best trick I was taught was to put a plastic garbage bag on the reclining chair before I sat down. This plastic allowed me to slide easily onto and off the chair. It also helped me reduce friction when I was doing my physical therapy. I know that seems ridiculous…but I was so weak I couldn’t even move my leg at all because of the friction between my sweatpants and the reclining chair fabric.

What was the most painful part of the recovery while you were non-weight bearing?

The Rectus muscles. I had a LOT of pain my thigh muscles for a long time. When Dr. S did the surgery, he had to cut these muscles off of at their attachment point to access the hip joint. After he put them back, it took a LONG time for them to recover. I still have weakness in these muscles. The nerve pain was pretty prevalent for the first few weeks as well.

What was the most painful part of the recovery while you were walking?

The psoas. It is STILL the psoas, as we’ve all read in several posts. This has been painful from the very first few steps I took post crutches.

What was the most rewarding moment of your PT? 

The high hurdles! There was an exercise that Tom had me do with these little hurdles that he’d line up on the floor. I’d have to step up and over them and walk over all of them with both legs. The hurdles had a low and high setting. The high setting was only about knee high…but it took me MONTHS of Physical Therapy to be able to lift my RPAO-ed leg high enough to be able to do all the high hurdles without a ton of pain in the psoas. The night I did the all the hurdles on my own, without stopping…I nearly cried. I was so proud of myself.

What was the worst part of recovery?

It is easy to think of a lot of these! Staying at an angle less than 70 degrees! That was AWFUL. Having to sit in the recliner for WEEKS, in the reclining position. Another is that there was a day where my psoas was hurting so bad I had to leave PT early and I limped really badly for the rest of the day. That day, I really thought my psoas would never get better. The first day home from the hospital was really, really hard. Those are the three that stick out in my mind the most.

What is the best moment of your recovery so far?

Walking down the aisle unassisted as a bridesmaid at my brother’s wedding. That was a great feeling of accomplishment for me.

What was the hardest part of recovery?

Everything. But the most difficult part of recovery was constantly finding the patience that was required to get fully “better.” There were times where I just wanted to RUN away from my crutches…or to SCREAM because my stupid psoas was acting up. There were times where I would literally cry because I was so frustrated with how long it was taking. PATIENCE is the most difficult part of the recovery process. They say it takes about a year…because it takes about a year. Recovery is SLOW. Now, repeat that a hundred times when you’re just out of surgery…because you’re going to need to remember that.

What was the most frustrating part of PT?

There were days where I lacked the patience I needed to continue on with PT and recovery. These days I often got frustrated at PT and either pushed myself too hard or didn’t try hard enough because I felt like I was always doing the same thing and it wasn’t making a bit of difference…even though it was. The nagging issues like the psoas, the nerve pain, the pinching in the joint…they were frustrating because they took so long to get better.

Do you wish you changed anything about your PT?

I wouldn’t have changed anything, per se. I think that I may have like to have added massage and hydrotherapy. I hear a lot of people talk about these things and they were not a part of my physical therapy/recovery process. I bet the hydro would have been heavenly for my little hip-y. And who doesn’t love a massage? One of the biggest surprises post surgery has been how screwed up my body has become because of the different (read: correct) hip structure. My back hurts often because my hips are now correctly aligned and it’s not used to that. My sacro-iliac joints on both sides hurt occasionally, my left more so than my right. My core is all messed up because I’ve got a whole different posture. It’s been hard to get everything back where it’s supposed to be. No more slouching over when I walk, no more short steps. Massage through all of this would have been very beneficial, I am sure.

Was it all worth it? 

YES. Yes, yes, yes. It was 100%, no doubt about it, absolutely positively worth it. I am a new woman. I am rejuvenated. I sleep better, I walk better than I ever have in my life. I am living a life doing anything I want without ever worrying about pain. That’s something that I just couldn’t have fathomed before. I feel amazing…like really, amazing.

That’s it! If there’s anything else you’d like to know…or want to add, please feel free! Having input from readers has been so great. I hope that I can continue to be helpful for all of you hip-y’s out there. I’ve had a lot of fun with this, and I hope to keep it going!

So…in closing, let me just say “Cheers!” Cheers to a year that was filled with pain and healing, with hard work and dedication, with small bouts of depression…and big moments of accomplishment, with exhaustion and with rejuvenation.  There was some sadness…followed by elated joy. A year filled with highs and lows, a year of reaching goals only to set more, seemingly unattainable ones. It was the hardest thing I’ve ever had to work through, and now that I’m out the other side…I just cannot believe how lucky I feel. I feel lucky to have had fantastic friends and loving family to support me every step of the way. Lucky to have had a relatively easy, breezy recovery. Lucky to have found a surgeon who cares about me, and what I’ve been through and am still going through. A surgeon who’s skilled at what he does, and provided me the opportunity at a new take on life. One without daily pain and aggravation, a life without constant decision making based on levels of pain and fatigue.  A life where I can get up in the morning and just do whatever I want. I never have to worry about how many pain relievers to take before my day starts. I never have to worry about whether I can run all the errands at the end of the workday, or if I’ll have to save some for the next day when I’m not in so much pain. One where I don’t have to ice or heat my hip to try and alleviate the debilitating pain. I never realized how bad it was, until it was so, so good.

Lastly, I am thankful. I am thankful that I had the opportunity to have the surgery, thankful that I have had such a great recovery, and thankful (every second of every day) that I have had an extremely successful PAO experience.

But mostly, I am thankful for every one of you: all the people in my life who have supported me (silently or loudly). I am thankful, and grateful, and forever honored to have had such amazing people by my side throughout all of this. It’s amazing, what good help will do for a recovery. Most of all I can do today is owed to all of you out there who have been with me this whole journey.  I really couldn’t have done it without you. So, thank you. <3

Deja Vu

Happy 11 months to my PAO-ed Hip!

Yesterday was actually the day, but I just didn’t have a second to myself so I didn’t get to blog. I was out in the field doing wetlands work. I was on my feet in those awful steel-toed boots for 11 hours. I was exhausted, and stiff, and very sore by the time I got in the car to drive home. I was so stiff all night that I had a hard time moving around. The stiffness was everywhere, not just the hip joint. I felt OLD. Really old.

I was absolutely bushed last night so we went to bed a little earlier than usual. I don’t think I moved a muscle all night because I woke up in the same position I fell asleep in. As soon as I woke up, I felt some pain in my hip. I got out of bed and limped for the first time in months. I was really sad. It was an extremely discouraging moment. I got ready and it felt okay. However, after sitting in the car for a bit during my morning commute it was really sore. I had to limp into work from the parking lot. Going down stairs is the toughest. I know “sore” isn’t the best way to describe it…but I’m not sure how else to. It feels very similar to the labrum pain. It’s sore deep inside the joint, not in the groin. It’s like a creaking pain, almost. I don’t know. See what I mean? It’s hard to explain. 

Part of me is hoping it’s because it’s a gloomy, damp day here in RI. The joint is a little bit arthritic and I've had so much "stuff" done to it that I don't blame it for being sore on crappy days. I haven’t felt this much pain in the hip in a long time, though. It feels a bit like the labrum pain, but again, it could easily be a function of being overworked from yesterday and the dampness today. 

I hate to be selfish about it because I know so many of my hip ladies are having loads of trouble with their recoveries. I don’t mean to sound dramatic over a little bit of pain. The main reason for my worries, and for my posting, is that I’m hoping I didn’t do anything to it yesterday while roaming through the woods. It was a tough day in the field. We did a lot of climbing and crouching. I had to lift my leg to climb over waist-high trees more than I care to admit. And it wasn’t rare for me to have to kick down shrubs and saplings. There was even a point where I have to get on the ground and climb under a giant fallen tree. Like I said…it was a tough day. Probably one of the hardest days I’ve had since I’ve been back in the field. 

I don’t know…I could very well be overreacting. I could wake up tomorrow and not have any problems at all. We’ll have to see how it plays out.

Anywho, I go see Dr. S on the 31^st and I just can’t wait to tell him ALL about my successes. I’m so excited to go over everything with him.

I’m sure I’ll post before that appointment, so we’ll chat then.

Thanks for reading,

D