Today was my last PT appointment until after my surgery. I have to be honest, I am PT'd out! I've been going since December and am just having surgery now and I will be in PT for a good number of months afterwards, so it was hard to get motivated to go. Everyone is perfectly lovely and helpful there, but my mental side has had enough. This is not a good state to be in, and I know I have to snap out of it. I guess I have 18 days to do so.
So I went in a bad frame of mind, and with many nervous and stressed out thoughts. I have been reading many different things about the results of the surgery and it has all made me a bit apprehensive. Yes, I know I have to have the surgery, but at the same time my brain is trying to come up with ideas about how to avoid it. My hip did hold up fairly well this week, and I hadn't been limping much until after PT today so does that mean I should skip the surgery? Granted I still can't walk a lot without it acting up and I really would like to be able to exercise properly again and go for nice long hikes so that means I should do the surgery. This is the circle my mind keeps going around and around in and it's driving me completely mad!
I expressed my concerns to my pt's K and S, and S said, "well the surgery is not 100%". That didn't really help to be honest though when I was leaving he said to feel free to ring him before if I had any more questions or concerns. I did make sure my post op PT appointment is scheduled for when they will both be in the office. K kept saying over and over just like a mantra "you will be better". I guess I will have to keep his optimism up somehow and try to stop thinking of what can go wrong. I suppose it's time for faith.
30 August, 2007
27 August, 2007
A bit of relief
After the horrors of last weeks weather, I had practically given up hope of feeling better for the weekend. When the rain starts and stops and the barometric pressure goes up and down, I feel like a ping pong ball being ricocheted around the room!
Although the heat and humidity were pretty brutal on Saturday, I thankfully ended up feeling pretty decent (decent for me that is). I think when you live with pain on a regular basis the "smallish" types of pain just become so constant and regular that you learn to accept them in a strange type of way.
My birthday was Sunday (I turned 30 yet again!) and my friend K's is today, so she kindly arranged for a few of us to go out to dinner on Saturday night. The restaurant was loud and crazy and hotter than Hades, but it was a lot of fun. I wasn't doing too poorly with the hip even when wearing a slight heal - it helps that everyone always insists on finding me a seat! Sad that I need it but lovely that my friends are so helpful :-)
I've been limiting my walking as much as possible (which is really affecting my waistline, or what is left of it) and I believe that is helping to keep it relatively calm-ish. Sunday I vegged out with a friend and in the evening went to my favourite French restaurant in Chelsea. They have the BEST fondant au chocolate known to man, and woman-kind, so I was in utter heaven!
Although the heat and humidity were pretty brutal on Saturday, I thankfully ended up feeling pretty decent (decent for me that is). I think when you live with pain on a regular basis the "smallish" types of pain just become so constant and regular that you learn to accept them in a strange type of way.
My birthday was Sunday (I turned 30 yet again!) and my friend K's is today, so she kindly arranged for a few of us to go out to dinner on Saturday night. The restaurant was loud and crazy and hotter than Hades, but it was a lot of fun. I wasn't doing too poorly with the hip even when wearing a slight heal - it helps that everyone always insists on finding me a seat! Sad that I need it but lovely that my friends are so helpful :-)
I've been limiting my walking as much as possible (which is really affecting my waistline, or what is left of it) and I believe that is helping to keep it relatively calm-ish. Sunday I vegged out with a friend and in the evening went to my favourite French restaurant in Chelsea. They have the BEST fondant au chocolate known to man, and woman-kind, so I was in utter heaven!
If only all things could be fixed with this cake!
A great wine list as well!
The hip was pretty decent for the weekend I must say, but the strangest thing is that it's KILLING me today! I sit most of the day, but do have to run around the office at times but it's not that big of a place so I can't understand what is going on. Nothing about this makes sense to me anymore.
Countdown: 3 weeks till surgery!
The lovely sunflowers my friend C sent for my birthday.
23 August, 2007
Funks gone!
There are very few things that can snap me out of the "funk" I've been in feeling as bad as I do, but my friend K did the trick! We've booked a trip to London (my 2nd favourite city in the world!*) for New Year's and my lovely friend P has opened up his home to us. I have the best friends! So it's a birthday and very early Hanukkah pressie for myself! YAY!!! It's also great motivation to plough through all the PT I will be doing.
*NY is the first - of course!!!
*NY is the first - of course!!!
HENRY!!!
(yes for those of you who are not aware, I have a deep
fascination with Henry VIII - call it a morbid curiosity into his twisted mind.)
(yes for those of you who are not aware, I have a deep
fascination with Henry VIII - call it a morbid curiosity into his twisted mind.)
Various snaps of London
The Tower of London
And its' bridge, not to be confused with London bridge...
M.I.A.
I've been MIA because this weather is killing me. Regardless of the hip, the rest of me feels like it's been run over by a very large 18-wheeler.
So the update is as follows:
I still have not heard back from Dr. Kelly's office about a Dr to see regarding what the PA had been talking about. I've sent multiple messages, and as I'm sure this does not rate high on their list, it's essential to me. So off I've been doing loads of research. My parents Dr recommended a rheumatologist at NYU, and I was going to see him (even though he doesn't take any insurance and it's $550 for the first visit - what cheek!). However, I came across some other names on some hyper-mobility boards I was reading and researched them. The one that seemed to stick out for me was Jessica Davis. She is a genetics specialist and when I rang the office happily found out she takes insurance! I also spoke to her assistant and told her (briefly) my various issues, and she said that is the kind of patient Dr. Davis sees. I try to not get too excited about these little things, but it was a relief to hear that I was barking up the right tree, or at least heading into the right forest. So my appt is for 6th Sept. I cancelled the appt w/ the $$$ rheumatologist for now. I figure that if this Dr says I should see one I can do that, but if there is no need I saved a nice chunk of change, and time too.
Dr. Davis' office asked me to bring any sort of records I could obtain. I believe I had an EKG and chest films a year or so ago so contacted my GP for those and also had to ring the horrid ex-rheumatologist's office to get the last blood test results she did for me. I can't tell you how much I was dreading that she's answer the phone. Thankfully she didn't and she seems to have a new assistant who seemed very nice and hopefully will send over those results quickly. Fingers crossed.
Now it's just for me to get through this horrid weather. When will it stop???
On a happier note, my friend and I are planning to go to London for New Years. I'm not sure how great an idea that is with my hip and what situation I will be in. I figure I deserve a reward for all that I am going through, so bugger it, why not!
So the update is as follows:
I still have not heard back from Dr. Kelly's office about a Dr to see regarding what the PA had been talking about. I've sent multiple messages, and as I'm sure this does not rate high on their list, it's essential to me. So off I've been doing loads of research. My parents Dr recommended a rheumatologist at NYU, and I was going to see him (even though he doesn't take any insurance and it's $550 for the first visit - what cheek!). However, I came across some other names on some hyper-mobility boards I was reading and researched them. The one that seemed to stick out for me was Jessica Davis. She is a genetics specialist and when I rang the office happily found out she takes insurance! I also spoke to her assistant and told her (briefly) my various issues, and she said that is the kind of patient Dr. Davis sees. I try to not get too excited about these little things, but it was a relief to hear that I was barking up the right tree, or at least heading into the right forest. So my appt is for 6th Sept. I cancelled the appt w/ the $$$ rheumatologist for now. I figure that if this Dr says I should see one I can do that, but if there is no need I saved a nice chunk of change, and time too.
Dr. Davis' office asked me to bring any sort of records I could obtain. I believe I had an EKG and chest films a year or so ago so contacted my GP for those and also had to ring the horrid ex-rheumatologist's office to get the last blood test results she did for me. I can't tell you how much I was dreading that she's answer the phone. Thankfully she didn't and she seems to have a new assistant who seemed very nice and hopefully will send over those results quickly. Fingers crossed.
Now it's just for me to get through this horrid weather. When will it stop???
On a happier note, my friend and I are planning to go to London for New Years. I'm not sure how great an idea that is with my hip and what situation I will be in. I figure I deserve a reward for all that I am going through, so bugger it, why not!
20 August, 2007
Gimpy's adventure
This past Saturday I had made plans to go to the football match at the Meadowlands with a friend. Just to clarify, I am talking football, proper football - the type you play with your feet, not American "football". Yes, I could call it soccer since that is what they do in America but regardless of all my friends that pick on me, I will still call it football, because that is what it is. I'm a bit stubborn, but that is the least of my worries.
My friend had an extra ticket for the Red Bulls vs. Galaxy match. I've never been to a live, professional match before so I was excited. All that excitement was tempered with the logistics of getting myself there. Once I got into the match I would be seated, but there was to be a tailgate first - that was a whole new experience for me too. My friend assured me there wouldn't be too much walking, but at the tailgate there is really no place to sit. That concerned me more than anything. 3 hours at least of standing made me start to hurt even before it was Saturday.
Friday after work I stopped off at BB&B to see if they had a cheapish folding chair. They didn't. I did find one by the exit, but it was too heavy to carry, so I was still stressing that night. Thankfully Saturday morning I found a folding chair that came in a bag and it was not very heavy. Sold! I felt much better after getting the chair, knowing I could sit as long as I needed.
I then dropped the chair off at my flat and went to go pick up a sandwich. I live in the city, and went to a place one block away figuring it was close, so I wouldn't be stressing my leg out. Not so much! By the time I arrived at the store I was limping. This did not give me faith for the rest of the day at all. I had already put some lidoderm patches on the hip and then iced it when I returned home. I iced and iced to no avail. I was meeting my friend at the subway station near me. It was extremely nice of her to come up there as she lives further downtown, and that was the way we were heading. I find it very difficult to ask for help and feel overwhelmed when it is given. I must say I am very fortunate with my friends that go out of there way for me.
We met up at the station and then went the bar where they were chartering a couple of buses and headed out to the stadium. I won't even enter into how daft our driver was, other than - how hard is it to locate the Lincoln tunnel? Seriously! Signs are EVERYWHERE!!! But I digress.
I was trying to keep a low profile on the bus regarding the hip but once we got off and I was limping it was hard to keep it a secret. There were very nice people whom I had just met that helped me, my chair and food get to the tailgate, which was thankfully not too far from where the bus parked. (Who knew lot 14 was next to lot 18 at the Meadowlands???)
Invariably when one is sitting and everyone else is standing it becomes awkward. First because you feel like you're not hanging out with everyone - you can't go stick a chair in the middle of a group of standing people, and secondly because it becomes an issue to others why you are sitting. Think of it as "inquisitive minds want to know". No matter how long I try to hold off, it always seems to come out that yes, I've a bad hip, and once that is mentioned, all the other questions seem to appear (did you injure it, no, how did it happen then, what type of surgery, etc). I try to take it in stride as it will only get worse once I've had the surgery and get the crutches and wear the brace on. I've been through this before w/ my hand surgeries. You'd truly be amazed at the idiotic things people say when you have a cast on your arm. I suppose they think they're being clever, but trust me, they're not.
Many of the guys at the tailgate were very sweet and helped me carry my items to the stadium. The stadium workers and their rules were another nightmare. I truly don't know where they come up with some of them but they seem ludicrous. They wouldn't let me carry in my chair, that was folded and in a canvas bag, but they let people bring in large drums and various percussion instruments. They claimed the chair could be used as a weapon - how is that different from the large brass instruments? They wouldn't let you bring in water with a cap on it either. (I took the cap off and put it in my pocket, the guard saw me, but I gave him a look like, go on, just try it - and he let me go. But that was because he and his buddy had given us a hard time with the chair, so I think he realised I was at the end of my tether.) My fabulous friend went all the way over to another gate and checked the chair for me. If we had to leave it out there it wouldn't have been the worst thing, but I greatly appreciate her doing that. Not only did she take the chair, she did not let me go with her. She had one of her friends take me inside, and then after the game she went to pick up the chair, again sans me, and had another friend make sure I made it to the bus. I am usually the super-organised-never-gets-lost girl, but when you feel like crap and are a gimp, it's amazing how much it lowers your self-esteem, confidence and the sort.
In closing I am glad I was able to go to the game, it was a lot of fun, and I hope to go to more when I'm no longer a gimp (hopefully that will not be too far off, please G-d!) But I also want to thank my friend and all of her friends for helping me make it through the day's events. I could not have done it alone.
My friend had an extra ticket for the Red Bulls vs. Galaxy match. I've never been to a live, professional match before so I was excited. All that excitement was tempered with the logistics of getting myself there. Once I got into the match I would be seated, but there was to be a tailgate first - that was a whole new experience for me too. My friend assured me there wouldn't be too much walking, but at the tailgate there is really no place to sit. That concerned me more than anything. 3 hours at least of standing made me start to hurt even before it was Saturday.
Friday after work I stopped off at BB&B to see if they had a cheapish folding chair. They didn't. I did find one by the exit, but it was too heavy to carry, so I was still stressing that night. Thankfully Saturday morning I found a folding chair that came in a bag and it was not very heavy. Sold! I felt much better after getting the chair, knowing I could sit as long as I needed.
I then dropped the chair off at my flat and went to go pick up a sandwich. I live in the city, and went to a place one block away figuring it was close, so I wouldn't be stressing my leg out. Not so much! By the time I arrived at the store I was limping. This did not give me faith for the rest of the day at all. I had already put some lidoderm patches on the hip and then iced it when I returned home. I iced and iced to no avail. I was meeting my friend at the subway station near me. It was extremely nice of her to come up there as she lives further downtown, and that was the way we were heading. I find it very difficult to ask for help and feel overwhelmed when it is given. I must say I am very fortunate with my friends that go out of there way for me.
We met up at the station and then went the bar where they were chartering a couple of buses and headed out to the stadium. I won't even enter into how daft our driver was, other than - how hard is it to locate the Lincoln tunnel? Seriously! Signs are EVERYWHERE!!! But I digress.
I was trying to keep a low profile on the bus regarding the hip but once we got off and I was limping it was hard to keep it a secret. There were very nice people whom I had just met that helped me, my chair and food get to the tailgate, which was thankfully not too far from where the bus parked. (Who knew lot 14 was next to lot 18 at the Meadowlands???)
Invariably when one is sitting and everyone else is standing it becomes awkward. First because you feel like you're not hanging out with everyone - you can't go stick a chair in the middle of a group of standing people, and secondly because it becomes an issue to others why you are sitting. Think of it as "inquisitive minds want to know". No matter how long I try to hold off, it always seems to come out that yes, I've a bad hip, and once that is mentioned, all the other questions seem to appear (did you injure it, no, how did it happen then, what type of surgery, etc). I try to take it in stride as it will only get worse once I've had the surgery and get the crutches and wear the brace on. I've been through this before w/ my hand surgeries. You'd truly be amazed at the idiotic things people say when you have a cast on your arm. I suppose they think they're being clever, but trust me, they're not.
Many of the guys at the tailgate were very sweet and helped me carry my items to the stadium. The stadium workers and their rules were another nightmare. I truly don't know where they come up with some of them but they seem ludicrous. They wouldn't let me carry in my chair, that was folded and in a canvas bag, but they let people bring in large drums and various percussion instruments. They claimed the chair could be used as a weapon - how is that different from the large brass instruments? They wouldn't let you bring in water with a cap on it either. (I took the cap off and put it in my pocket, the guard saw me, but I gave him a look like, go on, just try it - and he let me go. But that was because he and his buddy had given us a hard time with the chair, so I think he realised I was at the end of my tether.) My fabulous friend went all the way over to another gate and checked the chair for me. If we had to leave it out there it wouldn't have been the worst thing, but I greatly appreciate her doing that. Not only did she take the chair, she did not let me go with her. She had one of her friends take me inside, and then after the game she went to pick up the chair, again sans me, and had another friend make sure I made it to the bus. I am usually the super-organised-never-gets-lost girl, but when you feel like crap and are a gimp, it's amazing how much it lowers your self-esteem, confidence and the sort.
In closing I am glad I was able to go to the game, it was a lot of fun, and I hope to go to more when I'm no longer a gimp (hopefully that will not be too far off, please G-d!) But I also want to thank my friend and all of her friends for helping me make it through the day's events. I could not have done it alone.
16 August, 2007
Answers
The doctors PA rang me and we were on the phone for half an hour! I truly appreciate all of her time and patience on the phone. I did have quite a list and did get some answers. I tried to write down everything but it was hard so here are the q's and what her answers were (I've made them short and to the point though she was quite specific)...
In general she said the surgery should help with the pain, and also asked if I had ever been tested for a collagen disorder (not that I am aware). She is going to check w/ the dr to see if he thought I should and to recommend a rheumatologist that could do the testing. My main issue she said is the laxity I have.
Will these procedures help to “tighten” the tissues and muscles supporting the joint so that it will not be so lax? Will they help my “hyper mobility” in this joint? to an extent it will help but you cannot cure laxity.
What could have caused the labral tear? lax patients are more prone over time to develop tears. she said b/c of my laxity i can move my joints into positions that don't seem over extended for me, but over time it could wear on them.
Is FAI degenerative? yes
Is the underlying femoral neck misshapen and also causing the impingement or a result of the impingement? my FAI is believed to be mild, but I still have impingement. they can shave down the bones if they need to and get rid of any bony abnormality
For the PSOAS release, what is exactly done? Is it the muscle or tendon that is released? Would ART help rather than surgery for it? they release (cut) the tendon portion and only 10% of muscle, the part that is snapping over the acetabulum. Patients tend to do well and not snap after, but b/c of my laxity it is tricky b/c it is a stabilizer for my joint. the dr will decide in surgery, but if it is done i can expect to be weaker than patients that don't have laxity, and they will work on that in rehab. The ART is not recommended for me, again b/c of the laxity, and it would only be a temporary fix, so surgery in my situation is the way to go.
Is my IT band tight? Do you anticipate having to do a release for me? Would you lengthen the tendon or remove a section? my IT band is probably tight if it snaps, which it does. they will check this in surgery as well and if necessary will release it with a knife cut through the IT band, lengthening it.
Re: the trochanteric bursitis debridement, are you definitely removing the bursa or will it depend on what it looks like when you go in? if inflamed they will remove it, and there is a pretty good chance it will be removed. she said i should be ok w/o it because now it is only causing pain from inflammation as it's located between the bone and IT band.
Can you tell if I have any large chondral lesions? they can't really tell this on the MRI so will observe when in there. This is the articular cartilage (the type you have in your knee that is affected when you have chondromalacia), which is different from the labrum which is more like a meniscus cartilage.
Could the PT have made the FAI worse? yes it could hurt the tear, not the FAI, if the pt has been really working you hard and moving leg in extreme positions. i haven't been doing anything extreme so hopefully it didn't make it worse. basically so long as you listen to the pain and not do what causes you pain - though at this point walking and sitting cause pain!
What is the success rate you have had with these procedures? hard to say in a number value, but she feels most people who had a labral tear were glad they had the surgery, but it also depends on what caused the tear. The five categories are laxity, degenerative (arthritis), trauma, psoas and fai. She feels that I am in the laxity category which is one of the worst to be in, and that I will most likely not have 100% improvement, maybe 80%. At this point I'll take the 80! Also, b/c of my situation I really have no choice but to do surgery b/c w/ laxity the options are limited. I am not the best candidate, but at the same time forced into it b/c of the lack of other options. And this surprises me why?
How long for a full recovery, on average? four to six months, but up to 12 months.
After recovery, are there any restrictions? Can I ever ride again? granted the thought of riding at the moment is extremely unappealing, i would eventually like to be able to do this, and happily, she said that they do have patients that have gone back to riding, so after about 4 mos it should be fine. I'll wait longer but glad that i will be allowed to. on the other had, she said riding probably didn't help the situation, and though i haven't done it very much in the last few years, i did it a lot when i was younger, so i could have affected what is happening now.
What are the chances the surgery will need to be repeated? Dr. Kelly does not like to do surgery again, unless, in some cases, it's a revision b/c the tear did not stay repaired after they repaired it, as opposed to debridement it.
Does this surgery increase the chance of needing a hip replacement in the future? there's no data out there b/c this procedure is relatively new. A hip replacement would only help if there was an arthritic condition.
In general she said the surgery should help with the pain, and also asked if I had ever been tested for a collagen disorder (not that I am aware). She is going to check w/ the dr to see if he thought I should and to recommend a rheumatologist that could do the testing. My main issue she said is the laxity I have.
Will these procedures help to “tighten” the tissues and muscles supporting the joint so that it will not be so lax? Will they help my “hyper mobility” in this joint? to an extent it will help but you cannot cure laxity.
What could have caused the labral tear? lax patients are more prone over time to develop tears. she said b/c of my laxity i can move my joints into positions that don't seem over extended for me, but over time it could wear on them.
Is FAI degenerative? yes
Is the underlying femoral neck misshapen and also causing the impingement or a result of the impingement? my FAI is believed to be mild, but I still have impingement. they can shave down the bones if they need to and get rid of any bony abnormality
For the PSOAS release, what is exactly done? Is it the muscle or tendon that is released? Would ART help rather than surgery for it? they release (cut) the tendon portion and only 10% of muscle, the part that is snapping over the acetabulum. Patients tend to do well and not snap after, but b/c of my laxity it is tricky b/c it is a stabilizer for my joint. the dr will decide in surgery, but if it is done i can expect to be weaker than patients that don't have laxity, and they will work on that in rehab. The ART is not recommended for me, again b/c of the laxity, and it would only be a temporary fix, so surgery in my situation is the way to go.
Is my IT band tight? Do you anticipate having to do a release for me? Would you lengthen the tendon or remove a section? my IT band is probably tight if it snaps, which it does. they will check this in surgery as well and if necessary will release it with a knife cut through the IT band, lengthening it.
Re: the trochanteric bursitis debridement, are you definitely removing the bursa or will it depend on what it looks like when you go in? if inflamed they will remove it, and there is a pretty good chance it will be removed. she said i should be ok w/o it because now it is only causing pain from inflammation as it's located between the bone and IT band.
Can you tell if I have any large chondral lesions? they can't really tell this on the MRI so will observe when in there. This is the articular cartilage (the type you have in your knee that is affected when you have chondromalacia), which is different from the labrum which is more like a meniscus cartilage.
Could the PT have made the FAI worse? yes it could hurt the tear, not the FAI, if the pt has been really working you hard and moving leg in extreme positions. i haven't been doing anything extreme so hopefully it didn't make it worse. basically so long as you listen to the pain and not do what causes you pain - though at this point walking and sitting cause pain!
What is the success rate you have had with these procedures? hard to say in a number value, but she feels most people who had a labral tear were glad they had the surgery, but it also depends on what caused the tear. The five categories are laxity, degenerative (arthritis), trauma, psoas and fai. She feels that I am in the laxity category which is one of the worst to be in, and that I will most likely not have 100% improvement, maybe 80%. At this point I'll take the 80! Also, b/c of my situation I really have no choice but to do surgery b/c w/ laxity the options are limited. I am not the best candidate, but at the same time forced into it b/c of the lack of other options. And this surprises me why?
How long for a full recovery, on average? four to six months, but up to 12 months.
After recovery, are there any restrictions? Can I ever ride again? granted the thought of riding at the moment is extremely unappealing, i would eventually like to be able to do this, and happily, she said that they do have patients that have gone back to riding, so after about 4 mos it should be fine. I'll wait longer but glad that i will be allowed to. on the other had, she said riding probably didn't help the situation, and though i haven't done it very much in the last few years, i did it a lot when i was younger, so i could have affected what is happening now.
What are the chances the surgery will need to be repeated? Dr. Kelly does not like to do surgery again, unless, in some cases, it's a revision b/c the tear did not stay repaired after they repaired it, as opposed to debridement it.
Does this surgery increase the chance of needing a hip replacement in the future? there's no data out there b/c this procedure is relatively new. A hip replacement would only help if there was an arthritic condition.
Pain pain go away, don't come again - EVER!
I'm in a slightly whinging, aching, miserable mood, mostly due to the weather acting up my fibro and also the fact that my left hip has been starting to hurt more and more. I think this is b/c the right one is bad so I've been limping more, but I still don't like it! I apologise in advance for a negative update, but I've got to vent for a bit. This week has been one annoying thing after another.
On Monday I had a doctor's appointment for a check-up. To begin with I feel like a beached whale! I've never been so overweight in my life, and it's driving me batty that I can't do any cardio. My doctor kept asking me how long it will be till I can exercise. Not very subtle, but it touched a very sensitive nerve. I never thought I'd miss exercise so much in my life!
Speaking of...I had PT yesterday. I haven't gone for two weeks because of insurance reasons. I have been doing my PT at home in the meantime and trying to do some exercises in the pool as much as I can tolerate. The last few days I've been in a lot of pain so my PT wanted to do some stim with a weight. Fine, not a problem, except...his trainee came over and set it up and then put a 5 pound weight on my ankle, unbeknownst to me. The most weight I've done on my ankles has been 3lbs and though that does not sound like a lot to most people, for me it has been a huge achievement. I tried to move my leg up and it was not moving. I asked her how much she put on and she said 5!!! I'd be quite happy if I could do 5 lbs but I am the one that suffers after and I don't mean just being "sore" from muscles. I mean, can't move the leg or put pressure on it and feel like some one's stabbing a knife in me - type of pain. Anyway she kept saying oh sure you can do it, like that was somehow going to miraculously make my leg strong enough. If sheer will power could get me better I'd be there already. The point of this rant is she just made me feel how slow it's all been for me and I've not even had surgery yet, and with all the concerns and fear and worries in my head, I was about to cry from this.
To add insult to injury, last night I came home to a message from the Dr's PA. She said that she thought ringing would be better b/c she's never seen so many questions before. I'm quite happy to speak to her directly, but it seemed as it was a bit of a jab. Seriously, this is my body, I have a right to know what they're going to do! I know people who are not very proactive and just go along without asking questions, so perhaps the dr's are used to that. Anyway, it was too late to ring back so I left a message for her this morning and hopefully will hear back from her today.
Ok, glad I got that all off my chest.
On Monday I had a doctor's appointment for a check-up. To begin with I feel like a beached whale! I've never been so overweight in my life, and it's driving me batty that I can't do any cardio. My doctor kept asking me how long it will be till I can exercise. Not very subtle, but it touched a very sensitive nerve. I never thought I'd miss exercise so much in my life!
Speaking of...I had PT yesterday. I haven't gone for two weeks because of insurance reasons. I have been doing my PT at home in the meantime and trying to do some exercises in the pool as much as I can tolerate. The last few days I've been in a lot of pain so my PT wanted to do some stim with a weight. Fine, not a problem, except...his trainee came over and set it up and then put a 5 pound weight on my ankle, unbeknownst to me. The most weight I've done on my ankles has been 3lbs and though that does not sound like a lot to most people, for me it has been a huge achievement. I tried to move my leg up and it was not moving. I asked her how much she put on and she said 5!!! I'd be quite happy if I could do 5 lbs but I am the one that suffers after and I don't mean just being "sore" from muscles. I mean, can't move the leg or put pressure on it and feel like some one's stabbing a knife in me - type of pain. Anyway she kept saying oh sure you can do it, like that was somehow going to miraculously make my leg strong enough. If sheer will power could get me better I'd be there already. The point of this rant is she just made me feel how slow it's all been for me and I've not even had surgery yet, and with all the concerns and fear and worries in my head, I was about to cry from this.
To add insult to injury, last night I came home to a message from the Dr's PA. She said that she thought ringing would be better b/c she's never seen so many questions before. I'm quite happy to speak to her directly, but it seemed as it was a bit of a jab. Seriously, this is my body, I have a right to know what they're going to do! I know people who are not very proactive and just go along without asking questions, so perhaps the dr's are used to that. Anyway, it was too late to ring back so I left a message for her this morning and hopefully will hear back from her today.
Ok, glad I got that all off my chest.
14 August, 2007
driving myself crazy
I have been going back and forth trying to decide about asking the dr all the new questions I have come up with in the last couple of days. A friend said that I have every right, and they are valid questions. I agreed and figured it would put my mind to rest to hear back, so I emailed the dr's administrator this afternoon and she said she would get the questions to the PA. Hopefully I will hear back in the next few days!
13 August, 2007
Descriptions of (possible) procedures
I've gone and done a ton of research about the "possible" things the dr may do to my hip. I appreciate that they have to request all the possibilities for approval from the insurance company, but hey, inquiring minds want to know what could happen in there!
Here is what I came up with. If anyone has better descriptions then what I found on the web, please let me know.
Vastus-Psoas release for acetabular exposure in revision hip surgery.A technique is presented for wide exposure of the acetabulum for revision total hip arthroplasty surgery in the presence of a solidly fixed, modular, or monoblock femoral component without the need for trochanteric osteotomy. The technique involves release of the proximal portion of the vastus lateralis, vastus intermedius, and vastus medialis muscles and the iliopsoas tendon form the femur and placement of the femoral head/neck posterior to the acetabulum. The exposure afforded by this release usually precludes the need for trochanteric osteotomy and/or removal of a well-fixed femoral component in revision surgery that is being done for isolated loosening of acetabular components, thereby decreasing operative time, morbidity, and the risks of complication of trochanteric osteotomy.
Arthroscopic psoas tenotomy. Wettstein M, Jung J, Dienst M
Department of Orthopaedic Surgery, University Hospital, Homburg/Saar, Germany.
Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months. Published 14 August 2006 in Arthroscopy, 22(8): 907.e1-4.
ITB release (Iliotibial Band Release Surgery)
What is iliotibial band syndrome? Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle--the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result. ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. Cause: ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury.
Title: Endoscopic iliotibial band release for external snapping hip syndrome.
Author(s) Ilizaliturri VM, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J
Institution Department of Adult Joint Reconstruction at the National Rehabilitation Institute of Mexico Orthopaedics Institute, Mexico City, Mexico. vichip2002@yahoo.com.mx
Source Arthroscopy 2006 May; 22(5) :505-10.
Abstract PURPOSE: The external snapping hip syndrome is caused by slippage of the iliotibial band over the greater trochanter. Most cases are treated conservatively but if this fails, open surgical treatment is commonly performed by Z-plasty or by creating a defect on the iliotibial band. We present a series of 11 hips that were surgically treated by an endoscopic technique. TYPE OF STUDY: Prospective consecutive series of patients.
METHODS: Diagnosis of external snapping hip syndrome was clinical in all cases and anteroposterior pelvis radiographs were taken to evaluate the hip joint. Endoscopic release was performed with the patient in the lateral decubitus position without traction using 2 portals, the superior trochanteric and inferior trochanteric. A standard 4-mm, 30 degrees arthroscope was introduced at the inferior trochanteric portal over the iliotibial band. A needle was placed at the proximal trochanteric portal and visualized endoscopically. The portal was then established and subcutaneous tissue resection was performed with radiofrequency (RF) probes and a shaver until the iliotibial band was identifiable and released with a vertical cut made using an RF hook probe. The arthroscope was introduced into the space created under the iliotibial band and a transverse cut at the middle of the vertical release was then made, creating a cross-shape. Next the 4 resulting flaps were resected to make a diamond-shaped defect.
RESULTS: Between September 2001 and December 2003, we treated 11 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years, for external snapping hip syndrome using an endoscopic technique. At an average 2-year follow-up, we had 1 patient with nonpainful snapping. The rest of the patients in the series had no complaints and returned to their previous level of activity.
CONCLUSIONS: We present a reproducible endoscopic technique for the treatment of external snapping hip syndrome. Our results are comparable to those reported for open procedures.
Excision of heterotopic ossification
Heterotopic ossification (HO) is the abnormal formation of true bone within extraskeletal soft tissues.
Debridement trochanteric bursitis
definition: SURGICAL DEBRIDEMENT - The surgical removal of dead tissue, debris, and contaminants from a wound.
What is hip bursitis? Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful. In those few cases where surgery is needed, this can be done through a small incision, or sometimes it can be performed arthroscopically. Either way, the bursa is simply removed (called a bursectomy), and the patient can resume their activities. The surgery is done as an outpatient, and most often crutches are only used for a few days. Patient's do not need a bursa, and therefore there are few complications from this type of surgery. The most common complications are anesthetic-related complications, and infection.
Acetabuloplasty
ac·e·tab·u·lo·plas·ty (s-tby-l-plst) n. Surgical repair of the acetabulum; plastic surgery on the acetabulum intended to restore its normal state (as by repairing or enlarging its cavity)
Osteochondroplasty
Osteochondroplasty is an arthroscopic removal of excess bony osteophyte that affects the geometry of the hip. Treatment for FAI.
Labral Debridement
remove a tear in the hip cartilage
Labral Repair
repair a tear in the hip cartilage
Here is what I came up with. If anyone has better descriptions then what I found on the web, please let me know.
*************
Psoas releaseVastus-Psoas release for acetabular exposure in revision hip surgery.A technique is presented for wide exposure of the acetabulum for revision total hip arthroplasty surgery in the presence of a solidly fixed, modular, or monoblock femoral component without the need for trochanteric osteotomy. The technique involves release of the proximal portion of the vastus lateralis, vastus intermedius, and vastus medialis muscles and the iliopsoas tendon form the femur and placement of the femoral head/neck posterior to the acetabulum. The exposure afforded by this release usually precludes the need for trochanteric osteotomy and/or removal of a well-fixed femoral component in revision surgery that is being done for isolated loosening of acetabular components, thereby decreasing operative time, morbidity, and the risks of complication of trochanteric osteotomy.
Arthroscopic psoas tenotomy. Wettstein M, Jung J, Dienst M
Department of Orthopaedic Surgery, University Hospital, Homburg/Saar, Germany.
Tenotomy may be indicated for psoas tendinitis or painful snapping if conservative treatment remains unsuccessful. Because of significant complications with open techniques, endoscopic operations have been developed. We present a new arthroscopic technique to access and release the psoas tendon from the hip joint. This procedure can be performed in addition to other arthroscopic procedures of the hip joint or alone. To exclude additional hip disease, a diagnostic round of the joint should be completed. After hip arthroscopy of the central compartment has been performed, traction is released and the 30 degrees arthroscope is placed via the proximal anterolateral portal lying on the anterior femoral neck. The medial synovial fold can be identified. This fold lies slightly medially underneath the anteromedial capsule at the level of the psoas tendon. The arthroscope is turned toward the anterior capsule. Sometimes, the tendon shines through a thin articular capsule, or it may even be accessed directly via a hole connecting the hip joint and the iliopectineal bursa at the level of the anterior head-neck junction. If this cannot be done, an electrothermic probe is introduced via the anterior portal to make a 2-cm transverse capsular incision. The tendon is released with the back side of the electrothermic device turned to the iliacus muscle that lies anterior to the psoas tendon. A complete release is achieved when the tendon stumps can be seen gapping at a distance and the fibers of the iliacus muscle are visible. The first 9 patients who underwent surgery performed according to this technique developed no complications, and their hip flexion strength was restored to normal within 3 months. Published 14 August 2006 in Arthroscopy, 22(8): 907.e1-4.
ITB release (Iliotibial Band Release Surgery)
What is iliotibial band syndrome? Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle--the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result. ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury. Cause: ITBS can also occur where the IT band connects to the hip, though this is less likely as a sports injury.
Title: Endoscopic iliotibial band release for external snapping hip syndrome.
Author(s) Ilizaliturri VM, Martinez-Escalante FA, Chaidez PA, Camacho-Galindo J
Institution Department of Adult Joint Reconstruction at the National Rehabilitation Institute of Mexico Orthopaedics Institute, Mexico City, Mexico. vichip2002@yahoo.com.mx
Source Arthroscopy 2006 May; 22(5) :505-10.
Abstract PURPOSE: The external snapping hip syndrome is caused by slippage of the iliotibial band over the greater trochanter. Most cases are treated conservatively but if this fails, open surgical treatment is commonly performed by Z-plasty or by creating a defect on the iliotibial band. We present a series of 11 hips that were surgically treated by an endoscopic technique. TYPE OF STUDY: Prospective consecutive series of patients.
METHODS: Diagnosis of external snapping hip syndrome was clinical in all cases and anteroposterior pelvis radiographs were taken to evaluate the hip joint. Endoscopic release was performed with the patient in the lateral decubitus position without traction using 2 portals, the superior trochanteric and inferior trochanteric. A standard 4-mm, 30 degrees arthroscope was introduced at the inferior trochanteric portal over the iliotibial band. A needle was placed at the proximal trochanteric portal and visualized endoscopically. The portal was then established and subcutaneous tissue resection was performed with radiofrequency (RF) probes and a shaver until the iliotibial band was identifiable and released with a vertical cut made using an RF hook probe. The arthroscope was introduced into the space created under the iliotibial band and a transverse cut at the middle of the vertical release was then made, creating a cross-shape. Next the 4 resulting flaps were resected to make a diamond-shaped defect.
RESULTS: Between September 2001 and December 2003, we treated 11 patients, 9 female (1 bilateral) and 1 male with an average age of 26 years, for external snapping hip syndrome using an endoscopic technique. At an average 2-year follow-up, we had 1 patient with nonpainful snapping. The rest of the patients in the series had no complaints and returned to their previous level of activity.
CONCLUSIONS: We present a reproducible endoscopic technique for the treatment of external snapping hip syndrome. Our results are comparable to those reported for open procedures.
Excision of heterotopic ossification
Heterotopic ossification (HO) is the abnormal formation of true bone within extraskeletal soft tissues.
Debridement trochanteric bursitis
definition: SURGICAL DEBRIDEMENT - The surgical removal of dead tissue, debris, and contaminants from a wound.
What is hip bursitis? Hip bursitis is a common problem that causes pain over the outside of the upper thigh. A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursal sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful. In those few cases where surgery is needed, this can be done through a small incision, or sometimes it can be performed arthroscopically. Either way, the bursa is simply removed (called a bursectomy), and the patient can resume their activities. The surgery is done as an outpatient, and most often crutches are only used for a few days. Patient's do not need a bursa, and therefore there are few complications from this type of surgery. The most common complications are anesthetic-related complications, and infection.
Acetabuloplasty
ac·e·tab·u·lo·plas·ty (s-tby-l-plst) n. Surgical repair of the acetabulum; plastic surgery on the acetabulum intended to restore its normal state (as by repairing or enlarging its cavity)
Osteochondroplasty
Osteochondroplasty is an arthroscopic removal of excess bony osteophyte that affects the geometry of the hip. Treatment for FAI.
Labral Debridement
remove a tear in the hip cartilage
Labral Repair
repair a tear in the hip cartilage
10 August, 2007
you learn something new everyday
I came home one night this week to find a letter from my insurance company. I knew the surgery was approved, so I wasn't too concerned. The letter listed the Requested Services Summary and various service codes and descriptions of said service codes. One of the descriptions concerned me as I had not discussed it at all with the doctor. As I am prone to jumping to conclusions at the moment, I flipped out a bit. Thankfully my mum put up with my waking her and ranting on for an hour on the phone. (I owe her a couple of hours of sleep now :-) )
I emailed the dr's office the next day and thankfully they got back to me within a few hours, which is good for them. They asked for the codes and then sent me back a list of code descriptions that the dr uses. It seems the insurance co uses different descriptions, probably to intentionally torment you!
The email from the dr's office basically said (I'm paraphrasing)
"XXXXX is a very tricky insurance company. We have to get authorization for all of the possible codes he might do. If I know the CPT Code (service code) I can tell you what our description is. Each insurance company has their own descriptions and can confuse patients!"
This list helped a lot as it clarified what I was concerned about, but I will still discuss with him before surgery. I am going to bring a list to review before, I'm sure he'll love that!
So learn from my hysteria and talk to the dr before trusting what the insurance company says.
I've also now have a list of the technical medical terms and have done more searches on the web and printed out articles to read. Maybe not a good thing, but I am curious about the details of what will be done to me!
I emailed the dr's office the next day and thankfully they got back to me within a few hours, which is good for them. They asked for the codes and then sent me back a list of code descriptions that the dr uses. It seems the insurance co uses different descriptions, probably to intentionally torment you!
The email from the dr's office basically said (I'm paraphrasing)
"XXXXX is a very tricky insurance company. We have to get authorization for all of the possible codes he might do. If I know the CPT Code (service code) I can tell you what our description is. Each insurance company has their own descriptions and can confuse patients!"
This list helped a lot as it clarified what I was concerned about, but I will still discuss with him before surgery. I am going to bring a list to review before, I'm sure he'll love that!
So learn from my hysteria and talk to the dr before trusting what the insurance company says.
I've also now have a list of the technical medical terms and have done more searches on the web and printed out articles to read. Maybe not a good thing, but I am curious about the details of what will be done to me!
07 August, 2007
Bloody Hell!
Well it seems no matter how you try you just can't win!
I received a call back from Dr. Kelly's office quite quickly after my email. This it seems was not a good sign. I was told that even though my insurance said I have a DME benefit, that once they received the information the claims would still be denied, because you don't need a CPM for hip surgery and you can use ice instead of the game ready. Basically they go for the cheapest way out to not pay. Bugger! Plus, something I do not recall being mentioned earlier, I was told that HSS has a "very strict policy about DME's and where they are supplied from". Kickbacks anyone? Either way, I'm completely buggered and will have to pay out of pocket for both. ARGH!
On a different note, I am searching for a certain type of crutches that seem to be the best for me with my crap hands and shoulders. They are called Platform crutches, similar to forearm but not quite the same. Of course they're expensive and hopefully I will be able to get a hold of these if the PT approves. My main concern is not to destroy my hands whilst trying to save my hip.
Ain't life grand?
Well, the good news is that the surgery was approved, so I guess that is one less fight for me!
I received a call back from Dr. Kelly's office quite quickly after my email. This it seems was not a good sign. I was told that even though my insurance said I have a DME benefit, that once they received the information the claims would still be denied, because you don't need a CPM for hip surgery and you can use ice instead of the game ready. Basically they go for the cheapest way out to not pay. Bugger! Plus, something I do not recall being mentioned earlier, I was told that HSS has a "very strict policy about DME's and where they are supplied from". Kickbacks anyone? Either way, I'm completely buggered and will have to pay out of pocket for both. ARGH!
On a different note, I am searching for a certain type of crutches that seem to be the best for me with my crap hands and shoulders. They are called Platform crutches, similar to forearm but not quite the same. Of course they're expensive and hopefully I will be able to get a hold of these if the PT approves. My main concern is not to destroy my hands whilst trying to save my hip.
Ain't life grand?
Well, the good news is that the surgery was approved, so I guess that is one less fight for me!
insurance insanity
I received the various papers from Dr. Kelly's office this weekend and did not really feel like dealing with them until today.
I guess if you can't plan a holiday, then planning surgery is an option!
I rang up the anesthesiologists office first to see if they are covered. They do not participate in any plans. Ok, fine, the dr's office warned me. However the woman I spoke to in their billing department was very helpful. She said to ring up Oxford and tell them that the Dr and the hospital both participate in the plan, and ask to what extent the anesthesiologist would be covered. Yippee! Ms. Crystal said that since both are covered then the anesthesiologist would be covered as "in network" status. That was definitely one thing off my shoulders.
The onto what is know as "Durable Equipment". I never heard this term before, but it seems the machines the dr wants you to use after surgery fall under this title. The dr's office did tell me that even though the insurance will say that they cover the CPM, when they see the diagnosis for hip they will not, as the machine was made for knee issues. A bit daft if you ask me b/c there is no CPM specifically for hips, but that's insurance co's for you! But it can't hurt to try to get some coverage! I asked Ms. Crystal at Oxford about this and she gave me a list of the nearest Ortho places that they work with for DE's. I rang up one and they referred me to their LI office, saying that all equipment can be sent into the city. They seemed most helpful when I rang, took down all of my information, and asked that the dr's office fax over a prescription for what I need. I've just sent an email to the dr's office requesting that prescription be faxed over (lets see how long this takes). If there is any way I can get some of this covered I'm sure as heck going to try! I have a feeling all of the incidentals are going to add up!
I guess if you can't plan a holiday, then planning surgery is an option!
I rang up the anesthesiologists office first to see if they are covered. They do not participate in any plans. Ok, fine, the dr's office warned me. However the woman I spoke to in their billing department was very helpful. She said to ring up Oxford and tell them that the Dr and the hospital both participate in the plan, and ask to what extent the anesthesiologist would be covered. Yippee! Ms. Crystal said that since both are covered then the anesthesiologist would be covered as "in network" status. That was definitely one thing off my shoulders.
The onto what is know as "Durable Equipment". I never heard this term before, but it seems the machines the dr wants you to use after surgery fall under this title. The dr's office did tell me that even though the insurance will say that they cover the CPM, when they see the diagnosis for hip they will not, as the machine was made for knee issues. A bit daft if you ask me b/c there is no CPM specifically for hips, but that's insurance co's for you! But it can't hurt to try to get some coverage! I asked Ms. Crystal at Oxford about this and she gave me a list of the nearest Ortho places that they work with for DE's. I rang up one and they referred me to their LI office, saying that all equipment can be sent into the city. They seemed most helpful when I rang, took down all of my information, and asked that the dr's office fax over a prescription for what I need. I've just sent an email to the dr's office requesting that prescription be faxed over (lets see how long this takes). If there is any way I can get some of this covered I'm sure as heck going to try! I have a feeling all of the incidentals are going to add up!
06 August, 2007
Expecto Patronum
"The Patronus Charm conjures an incarnation of the caster's innermost positive feelings, such as joy, hope, or the desire to survive, known as a Patronus. A Patronus can be viewed as the exact opposite of a Dementor. Even though it embodies all the positive emotions that a Dementor feeds on, a Patronus is conjured as a protector, and is a weapon rather than a predator of souls: Patronuses shield their conjurors from Dementors, and even drive them away. A Patronus "cannot feel despair, as real humans can, so Dementors can't hurt it." The conjured Patronus protects the witch or wizard that summoned it, obeys his or her commands, and fades away shortly after it is no longer required."
"Etymology: The Latin word patronus means "father" or (in archaic Latin)"guardian" (see patronus)"protector" . The plural of patronus is patroni, but the plural of the term as coined in the books is Patronuses. The incantation for the charm is Expecto Patronum. The Latin word expecto, means "I await." A rough translation of the incantation is thus "I await (my) guardian/father."
In the French version of the book, the spell is "Spero Patronum". Spero means "I hope" or "I expect," much as ex(s)pecto means "I expect, I await." This could mean that the spell is based on hope and faith."
Well, this brief history of the Patronum spell is to help me to remember what to do when I feel as I have the last few days - utterly depressed. I am not keen on whinging and would rather lock myself up alone than go on and on about all that is wrong.
So, lying in bed tonight, when I should have been asleep (crikey even those pills aren't working now!) I came to an enlightening thought. Of course this could be because I've recently finished the last HP book and only yesterday saw Order of the Phoenix. But never mind that. The thought that stuck with me is this, well, it's what Harry says - think of the happiest memory you can to create your Patronum.
Since nothing else has been able to get me out of this funk lately, I tried to do just that. And it was pretty simple. The memory I came up with was of the hugs I get from my nephews. So from now I on when I am feeling like crap, and I don't just mean physically, b/c that's 24/7, I will think of my two favourite people and the wonderful hugs they give me. And hopefully that will be able to keep those Dementors away!
"Etymology: The Latin word patronus means "father" or (in archaic Latin)"guardian" (see patronus)"protector" . The plural of patronus is patroni, but the plural of the term as coined in the books is Patronuses. The incantation for the charm is Expecto Patronum. The Latin word expecto, means "I await." A rough translation of the incantation is thus "I await (my) guardian/father."
In the French version of the book, the spell is "Spero Patronum". Spero means "I hope" or "I expect," much as ex(s)pecto means "I expect, I await." This could mean that the spell is based on hope and faith."
Well, this brief history of the Patronum spell is to help me to remember what to do when I feel as I have the last few days - utterly depressed. I am not keen on whinging and would rather lock myself up alone than go on and on about all that is wrong.
So, lying in bed tonight, when I should have been asleep (crikey even those pills aren't working now!) I came to an enlightening thought. Of course this could be because I've recently finished the last HP book and only yesterday saw Order of the Phoenix. But never mind that. The thought that stuck with me is this, well, it's what Harry says - think of the happiest memory you can to create your Patronum.
Since nothing else has been able to get me out of this funk lately, I tried to do just that. And it was pretty simple. The memory I came up with was of the hugs I get from my nephews. So from now I on when I am feeling like crap, and I don't just mean physically, b/c that's 24/7, I will think of my two favourite people and the wonderful hugs they give me. And hopefully that will be able to keep those Dementors away!
02 August, 2007
two steps forward, one step back
Dr. Kelly and the pt's said I must keep my strength up, it's v. important before surgery, especially since I was so weak when I first started back in December. So after PT yesterday, I was feeling ok. Went back to work, a touch sore, but was determined to go to the pool. It's been raining a lot lately after work so haven't been able to recently. I have a whole routine I do in the pool to strengthen my legs. Nothing too intense mind you, but enough to make me feel like I am doing some strengthening. I guess it was too much though.
I woke this am and was fine, at first. But within a few minutes my hip started to hurt like hell. And I hadn't even left the flat yet! So I am a limpy person again today. Hopefully it will start to feel better soon, otherwise I may just have to resort to a lovely lidoderm patch and see if that works!
Nothing like being caught in a catch 22!
I woke this am and was fine, at first. But within a few minutes my hip started to hurt like hell. And I hadn't even left the flat yet! So I am a limpy person again today. Hopefully it will start to feel better soon, otherwise I may just have to resort to a lovely lidoderm patch and see if that works!
Nothing like being caught in a catch 22!
01 August, 2007
PT appt
Just to update as of today -
I had a PT appt. My insurance is only approving two more appts at the moment, so we've split them up as Dr. Kelly wants me to be evaluated closer to surgery. Now it's up to me to do more "homework" as I call it. I have been doing some excercises in the pool and will keep that up as much as possible. Also, my PT gave me more shoulder excercise to do so I can strengthen it up for the crutches. He is recommending some type of "elbow crutch" but I will have to do some research. The key is to keep as much pressure off of my hands and shoulders as possible, since I'm such a complete wreck!
He explained more about the psoas muscle release and said it should be fine, but with all that Dr. Kelly will be doing on my hip, I will probably be on crutches 4-5 wks. G-d give me strength, that is going to be rough!
So, onwards and upwards as they keep telling me. I have much to accomplish before I even have the surgery, but I'm hoping all this work will pay off with a (touch wood) quicker recovery!
I had a PT appt. My insurance is only approving two more appts at the moment, so we've split them up as Dr. Kelly wants me to be evaluated closer to surgery. Now it's up to me to do more "homework" as I call it. I have been doing some excercises in the pool and will keep that up as much as possible. Also, my PT gave me more shoulder excercise to do so I can strengthen it up for the crutches. He is recommending some type of "elbow crutch" but I will have to do some research. The key is to keep as much pressure off of my hands and shoulders as possible, since I'm such a complete wreck!
He explained more about the psoas muscle release and said it should be fine, but with all that Dr. Kelly will be doing on my hip, I will probably be on crutches 4-5 wks. G-d give me strength, that is going to be rough!
So, onwards and upwards as they keep telling me. I have much to accomplish before I even have the surgery, but I'm hoping all this work will pay off with a (touch wood) quicker recovery!
Questions to ask regarding surgery
Surgery Questions
*Is there an advantage to doing this procedure/surgery sooner vs. later or not at all?
*Arthroscopic surgery? Outpatient?
*How long does the surgery take?
*What specifically will you do in surgery (what is/are the specific procedure(s) you’ll be doing on me)?
*How would the labral tear be fixed?
*If there is arthritis and cartilage damage - is there anything you can do? If there is more damage than the labral tear, will you fix everything then?
*Success rate - What percentage of patients improve following the procedure? After full recovery - what are the restrictions?
*Will you be the one doing the surgery?
*Will students/residents be assisting in my surgery? -Is there a way for me to request or be assured that only you will do the surgery (no students)?
*What are the benefits of the procedure in terms of pain relief, functioning/mobility? How long will the benefits last?
*What are the risks involved with this surgery? Complications specific to me?
*What if I have had bad experiences in the past with general anesthesia, what other options do I have? What anesthetic will be used? What are the risks? Do I have a choice about the type of anesthesia that will be used on me? What are the pros and cons of my choices? I react v. badly to general and would prefer to not have this. Will I meet with the anesthesiologist in advance? Will he or she know my needs/allergies? (Allergic to: Sulfa, Indocin, ) Can I request Dr. Jules? What is “combines spinal epidural w/ sedation?)?
*What amount of pain relief can I expect from the surgery?
*Will I need any tests or medical evaluations prior to the surgery?
*Will the surgery need to be repeated after a certain amount of time? Increase chance of needing hip replacement in future?
*What type of complications have you experienced with other patients? Both in surgery and after? What are the risks of this surgery, both short and long term? (i.e. - Blood clot, infection, failure to heal, vascular necrosis, nerve palsy, damage to the femoral neck, etc.) And what can we do to reduce these risks?
*Are all various dr’s and hospital services covered by Oxford? If not, what would cost be out of pocket?
*Need pre-approval, who takes care of this?
*Do I need to stop any medications before surgery? How long prior to / after?
Post Op Questions
*What equipment will I need during recovery? (Crutches (how long) ((Millennial Crutches))? Brace? Wheelchair? Walker? CPM machine? Toilet seat riser? Shower bench/transfer? Etc.)
* Will it be provided by the hospital/surgery center? If not, where do you suggest I get the items?
*Will you prescribe crutches for me ahead of time – what type considering my shoulder and hand issues?
*What are my limitations during recovery?
*How long till I can shower?
*How long until return to FULL activity in sports? (Gym? Swimming? Walking distances? Stairs? Sitting for length of time, ie theatre, work, etc.)
*How long will the recovery take?
*Will I need assistance at home afterwards? For how long? /Will I need 24-hour help? For how long?
*What will discharge instructions be?
*When can I realistically return to work?
*Will I have any disability following surgery?
*Will I have pain following the procedure? What pain relief or pain control measures will I be given? (I have bad reactions to vicadin and that sort. Have used Ultram and Ultracet with some success. V. sensitive to medications.)
*Any other medications you prescribe post surgery? Anything for nausea or a laxative b/c of the pain killers?
*How many post-op visits required?
*How long do stitches/staples stay in? Which do you use?
*How long will I be in PT for?
Discovery Questions
*Do I have arthritis or no arthritis? If so, how much?
*Is the underlying femoral neck misshapen and also causing the impingement or a result of the impingement? if so would that be reshaped as well? how about the socket?
*Do I have FAI (femeroacetabular impingement)? (Untreated FAI can lead to repeat labral tears.)
*How was the bursa?
*Any signs of: Hip dysplasia? Hip instability? Degenerative disease in joint? Osteoarthritis? If so, how severe?
*Are ligaments and tendons intact and supporting the joint?
*Any sign of ligamentum teres syndrome (what does thickening of it mean/imply)?
*Any chondral damages?
*Any implications of bone marrow swelling (edema)?
*Is there an advantage to doing this procedure/surgery sooner vs. later or not at all?
*Arthroscopic surgery? Outpatient?
*How long does the surgery take?
*What specifically will you do in surgery (what is/are the specific procedure(s) you’ll be doing on me)?
*How would the labral tear be fixed?
*If there is arthritis and cartilage damage - is there anything you can do? If there is more damage than the labral tear, will you fix everything then?
*Success rate - What percentage of patients improve following the procedure? After full recovery - what are the restrictions?
*Will you be the one doing the surgery?
*Will students/residents be assisting in my surgery? -Is there a way for me to request or be assured that only you will do the surgery (no students)?
*What are the benefits of the procedure in terms of pain relief, functioning/mobility? How long will the benefits last?
*What are the risks involved with this surgery? Complications specific to me?
*What if I have had bad experiences in the past with general anesthesia, what other options do I have? What anesthetic will be used? What are the risks? Do I have a choice about the type of anesthesia that will be used on me? What are the pros and cons of my choices? I react v. badly to general and would prefer to not have this. Will I meet with the anesthesiologist in advance? Will he or she know my needs/allergies? (Allergic to: Sulfa, Indocin, ) Can I request Dr. Jules? What is “combines spinal epidural w/ sedation?)?
*What amount of pain relief can I expect from the surgery?
*Will I need any tests or medical evaluations prior to the surgery?
*Will the surgery need to be repeated after a certain amount of time? Increase chance of needing hip replacement in future?
*What type of complications have you experienced with other patients? Both in surgery and after? What are the risks of this surgery, both short and long term? (i.e. - Blood clot, infection, failure to heal, vascular necrosis, nerve palsy, damage to the femoral neck, etc.) And what can we do to reduce these risks?
*Are all various dr’s and hospital services covered by Oxford? If not, what would cost be out of pocket?
*Need pre-approval, who takes care of this?
*Do I need to stop any medications before surgery? How long prior to / after?
Post Op Questions
*What equipment will I need during recovery? (Crutches (how long) ((Millennial Crutches))? Brace? Wheelchair? Walker? CPM machine? Toilet seat riser? Shower bench/transfer? Etc.)
* Will it be provided by the hospital/surgery center? If not, where do you suggest I get the items?
*Will you prescribe crutches for me ahead of time – what type considering my shoulder and hand issues?
*What are my limitations during recovery?
*How long till I can shower?
*How long until return to FULL activity in sports? (Gym? Swimming? Walking distances? Stairs? Sitting for length of time, ie theatre, work, etc.)
*How long will the recovery take?
*Will I need assistance at home afterwards? For how long? /Will I need 24-hour help? For how long?
*What will discharge instructions be?
*When can I realistically return to work?
*Will I have any disability following surgery?
*Will I have pain following the procedure? What pain relief or pain control measures will I be given? (I have bad reactions to vicadin and that sort. Have used Ultram and Ultracet with some success. V. sensitive to medications.)
*Any other medications you prescribe post surgery? Anything for nausea or a laxative b/c of the pain killers?
*How many post-op visits required?
*How long do stitches/staples stay in? Which do you use?
*How long will I be in PT for?
Discovery Questions
*Do I have arthritis or no arthritis? If so, how much?
*Is the underlying femoral neck misshapen and also causing the impingement or a result of the impingement? if so would that be reshaped as well? how about the socket?
*Do I have FAI (femeroacetabular impingement)? (Untreated FAI can lead to repeat labral tears.)
*How was the bursa?
*Any signs of: Hip dysplasia? Hip instability? Degenerative disease in joint? Osteoarthritis? If so, how severe?
*Are ligaments and tendons intact and supporting the joint?
*Any sign of ligamentum teres syndrome (what does thickening of it mean/imply)?
*Any chondral damages?
*Any implications of bone marrow swelling (edema)?
learning to not plan
Being a Virgo I live for planning. Only problem is, how can you "plan" what is going to occur when you have surgery. Planning is like a panacea to me, it keeps me calm, makes me feel I have some control over things. But realistically, you cannot have control over some things in life, and this is where my anxiety begins.
After speaking to Dr. Kelly's PA and getting all of the information I need I thought I would feel a bit better. I'd be able to start making those lists, ordering what I need, planning where and when I would stay post op, sort out work, all that fun stuff. It seems I was wrong. I can sort out some of the things, but the truth is, I don't know how I will feel after, I don't know if I'll be up for a car ride to the island a couple days after or not, so I am having to let that all go. Which is very difficult for me. I kept my poor mum on the phone last night going on and on about everything that I can't control. Bless her for her patience, I hope she can keep it as I can only imagine I'm going to get worse in the weeks ahead. Perhaps I should buy pressies for everyone that will have to deal with me to butter them up! :-)
I guess I will try to sort out what I can and just try to let the rest happen as it will. But I will admit this, I'm scared. After having 4 hand surgeries, I know what pain is, and I'm thinking it may be worse to know what I'm getting into. Then again, I really have no choice, so must make the best of it.
Sorry it to ramble it just seems to help to get it written down as I think about it all. I just have to remember - one step at a time.
After speaking to Dr. Kelly's PA and getting all of the information I need I thought I would feel a bit better. I'd be able to start making those lists, ordering what I need, planning where and when I would stay post op, sort out work, all that fun stuff. It seems I was wrong. I can sort out some of the things, but the truth is, I don't know how I will feel after, I don't know if I'll be up for a car ride to the island a couple days after or not, so I am having to let that all go. Which is very difficult for me. I kept my poor mum on the phone last night going on and on about everything that I can't control. Bless her for her patience, I hope she can keep it as I can only imagine I'm going to get worse in the weeks ahead. Perhaps I should buy pressies for everyone that will have to deal with me to butter them up! :-)
I guess I will try to sort out what I can and just try to let the rest happen as it will. But I will admit this, I'm scared. After having 4 hand surgeries, I know what pain is, and I'm thinking it may be worse to know what I'm getting into. Then again, I really have no choice, so must make the best of it.
Sorry it to ramble it just seems to help to get it written down as I think about it all. I just have to remember - one step at a time.
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