Yesterday I had another PT appointment. I was pretty knackered before I even got there. I sit mostly at work but was told to move around every 45 minutes, which I am sure has stretched out to longer. I just don't have the energy as the crutches are wiping me out and killing my hands. When I left for PT, the timing was bad as all the cabs were "off duty". I was ready to cry until finally a nice cabbie that was off duty stopped to ask where I was going and he was kind enough to give me a lift. The walk to PT from my office is about two long blocks and four short blocks, but there is NO WAY I could have made that on crutches. I am so tired from the crutches, I think you really expend a lot more energy with them than just walking normally.
Pain and torture was excruciating yesterday. I did the bike for 15 minutes, and then some internal rotation and kneeling on the table. When K, one of my PT's, came over, I told him that my psoas has been REALLY tight and driving me nuts. His response was that we have to keep it tight per the Dr. I said yes I know that but the Dr also said that he wants it to move smoothly, not just get stuck with extremely limited ROM. I understand it's a fine line, but I can't have this feeling forever because it will drive me nuts, but I also don't want the laxity to get to where it was before the surgery. I'm losing my mind. So K massaged the psoas and then all of the scars, and started stretching me A LOT more than has been done. It was uncomfortable but bearable, until all of a sudden I had a shooting pain down the outside of my hip. I don't know what triggered it but it lasted about 5-10 minutes as was horrible. After that and some manual resistance exercises with K I did the electrical stim for about 10 minutes and then iced. I am spending about 2 hours from start to finish there.
After I finally changed and got all of my things together, I went down to go home. I didn't even entertain the thought of a cab as it was rush hour so was beyond pleasantly surprised when I reached the corner and saw an available one. He was so nice he even got out to open the door for me. It was such a relief to not have to take the bus home. I was a zombie by the time I got back to my flat so ordered some (not very healthy) dinner but I didn't care. I spent the evening on the couch and then decided to take a muscle relaxer for my psoas. I must have been in more pain all over than I thought because that didn't even knock me out. My fibro is flaring up something awful with this crappy weather and my whole body is aching, which is why I didn't sleep. When the alarm went off this morning and could barely move. I can't say "when I woke up" because I had been up for ages. It took me an hour or so to just get up to get to the loo. Thankfully my friend T is staying with me this week and was able to help get me sorted and then we took a cab down to work.
So I am sitting here taking a break and have ice on both my hips, but wish I had more ice packs for my hands and shoulders. I wish I could have just stayed in bed today but will go home straight after to rest and will try my "magic pill" tonight so hopefully some sleep will be in order.
Next week I start PT twice a week, G-d give me strength!
11 October, 2007
09 October, 2007
Snail
Today was my first day back at work. I am not even done with the day but am pretty wiped out. NYC buses really need to get their act together. Why do they all have to hang out for a coffee klatch and then at the same time all arrive? I waited for almost half an hour for the 5th ave bus today. During that time my left hip started to kill and my back hurt from my bag, which has turned into an intense neck pain now. So frustrating. At least it didn't rain on me, though it looks like the heavens are going to open up at any time. But I still feel like a snail going at this pace. I am normally a very quick walker, so it is so frustrating!
My office is being amazingly understanding and letting me come in a little late this week, which helps to take the pressure off. And most of the bus drivers, whilst they can't tell time, are very patient with me boarding the bus. I am hoping each day just get a bit easier.
Pain in the right hip has been tolerable, and I haven't (touch wood) had the need to take a pain pill in a few days. I did take a muscle relaxer last night because my psoas has been so tight for the last few days. I notice it especially when I walk.
As for PT, they couldn't get me a late appointment for this week, so I rang yesterday to see if they could squeeze me in, but no luck. I rang back asking if there was anything all week, and they said possibly on Wednesday but they'd get back to me. I still haven't heard so will ring them shortly. I don't really want to miss PT at the fourth week out. I did have my appointments booked for the next four weeks so at least I don't have to worry about that.
PS - just heard from the PT dude and thankfully they can get me in tomorrow at 4pm, so am relieved about that.
My office is being amazingly understanding and letting me come in a little late this week, which helps to take the pressure off. And most of the bus drivers, whilst they can't tell time, are very patient with me boarding the bus. I am hoping each day just get a bit easier.
Pain in the right hip has been tolerable, and I haven't (touch wood) had the need to take a pain pill in a few days. I did take a muscle relaxer last night because my psoas has been so tight for the last few days. I notice it especially when I walk.
As for PT, they couldn't get me a late appointment for this week, so I rang yesterday to see if they could squeeze me in, but no luck. I rang back asking if there was anything all week, and they said possibly on Wednesday but they'd get back to me. I still haven't heard so will ring them shortly. I don't really want to miss PT at the fourth week out. I did have my appointments booked for the next four weeks so at least I don't have to worry about that.
PS - just heard from the PT dude and thankfully they can get me in tomorrow at 4pm, so am relieved about that.
07 October, 2007
The Surgical Record
The HSS Operative Record
Patient Name: Me Date: 17 September 2007
Attending Surgeon: Dr. Kelly
Operating Surgeon: Dr. Kelly
Preliminary Diagnosis: Right hip labral tear with snapping psoas, Synovitis, Combines Cam and Pincer Impingement
Postoperative Diagnosis: Same
Name of Operation: Right hip arthroscopy, Labral tear, debridement, synovectomy, partial psoas and acetabular rim decompression with labral re-fixation and a cam decompression.
Anesthesia: spinal
Estimated blood loss: less than 20cc
Inoperative fluids: one liter of ringer's lactate
Drains: none
Indications: The patient is a 37 year-old female with progressive right hip pain, right worse than left. The patient had combined Cam and Pincer impingement with snapping psoas and inflammation. The patient had persistent symptoms despite non-operative measures and given these persistent symptoms, the patient was indicated for right-hip arthroscopy and associated procedures.
Procedure:
The patient was correctly identified in the Holding Area and the patient was brought to the Operating Room. The spinal anesthesia was administered. The patient was placed in supine position and approximately 10mm of distraction was achieved from the acetabular joint. The right hip was prepped and draped in the standard surgical fashion.
The lateral portal was established under fluoroscopic guidance using the Seldinger technique. A distal lateral accessory portal and a posterior portal were both established under direct visualization. The arthroscopic examination of the central compartment demonstrated a labral tear anteriorly with a significant synovitis with areas of early delamination of the anterior and superior cartilage consistent with Cam impingment and crushing of the synovium and labrum anterior, superiorly consistent with Pincer impingement. There was also extensive tension on the psoas anteriorly consistent with psoas impingement.
The cartilage on the femoral head was otherwise in good condition. The ligamentum teres was in good condition. The patient had a (looks like a word was whited out) injury posteriorly. At this point, a wide synovectomy was performed using the Tac-radio frequency probe starting posteriorly and working our way anteriorly. The labrum in the front where it was torn was debrided gently preserving the majority of the labrum. A capsular cut was then made connecting the anterior and anterolateral portals for elevation of the capsular tissue off the acetabular rim lesion.
The acetabular rim lesion was identified and then a 5.5 mm high speed bur was used to recontour the acetabular rim. The fluroscopy confirmed the appropriate resection. At the completion of the acetabular rim decompression, the psoas was partially released over the front of the joint where it appeared to be compressing the labrum anteriorly. The labrum after it was debrided was stabilized through the transition zone cartilage using the radio frequency probe but no suture anchors were required.
All cartilaginous loose debris was evacuated from the central compartment at the completion of the synovectomy. A partial psoas release, acetabular rim decompression and labral debridement. The scope was placed in the peripheral compartment as the traction was released. The hemi hip joint was placed back in the socket. A Cam lesion was identified and then a Cam decompression was performed using fluoroscopic guidance to confirm the appropriate resection.
The dynamic arthroscopy was performed demonstrating the absence of any residual impingement. At the completion of the Cam decompression, no further pathology was identified. The instruments were removed from the joint and the arthroscopic portals were closed with 3-0 nylon sutures and a marcaine cocktail was placed into the joint. The wounds were cleaned, dried. Sterile dressings were applied. The patient was awakened from anesthesia and brought to the Post Anesthesia Care Unit having tolerated the procedures well.
Patient Name: Me Date: 17 September 2007
Attending Surgeon: Dr. Kelly
Operating Surgeon: Dr. Kelly
Preliminary Diagnosis: Right hip labral tear with snapping psoas, Synovitis, Combines Cam and Pincer Impingement
Postoperative Diagnosis: Same
Name of Operation: Right hip arthroscopy, Labral tear, debridement, synovectomy, partial psoas and acetabular rim decompression with labral re-fixation and a cam decompression.
Anesthesia: spinal
Estimated blood loss: less than 20cc
Inoperative fluids: one liter of ringer's lactate
Drains: none
Indications: The patient is a 37 year-old female with progressive right hip pain, right worse than left. The patient had combined Cam and Pincer impingement with snapping psoas and inflammation. The patient had persistent symptoms despite non-operative measures and given these persistent symptoms, the patient was indicated for right-hip arthroscopy and associated procedures.
Procedure:
The patient was correctly identified in the Holding Area and the patient was brought to the Operating Room. The spinal anesthesia was administered. The patient was placed in supine position and approximately 10mm of distraction was achieved from the acetabular joint. The right hip was prepped and draped in the standard surgical fashion.
The lateral portal was established under fluoroscopic guidance using the Seldinger technique. A distal lateral accessory portal and a posterior portal were both established under direct visualization. The arthroscopic examination of the central compartment demonstrated a labral tear anteriorly with a significant synovitis with areas of early delamination of the anterior and superior cartilage consistent with Cam impingment and crushing of the synovium and labrum anterior, superiorly consistent with Pincer impingement. There was also extensive tension on the psoas anteriorly consistent with psoas impingement.
The cartilage on the femoral head was otherwise in good condition. The ligamentum teres was in good condition. The patient had a (looks like a word was whited out) injury posteriorly. At this point, a wide synovectomy was performed using the Tac-radio frequency probe starting posteriorly and working our way anteriorly. The labrum in the front where it was torn was debrided gently preserving the majority of the labrum. A capsular cut was then made connecting the anterior and anterolateral portals for elevation of the capsular tissue off the acetabular rim lesion.
The acetabular rim lesion was identified and then a 5.5 mm high speed bur was used to recontour the acetabular rim. The fluroscopy confirmed the appropriate resection. At the completion of the acetabular rim decompression, the psoas was partially released over the front of the joint where it appeared to be compressing the labrum anteriorly. The labrum after it was debrided was stabilized through the transition zone cartilage using the radio frequency probe but no suture anchors were required.
All cartilaginous loose debris was evacuated from the central compartment at the completion of the synovectomy. A partial psoas release, acetabular rim decompression and labral debridement. The scope was placed in the peripheral compartment as the traction was released. The hemi hip joint was placed back in the socket. A Cam lesion was identified and then a Cam decompression was performed using fluoroscopic guidance to confirm the appropriate resection.
The dynamic arthroscopy was performed demonstrating the absence of any residual impingement. At the completion of the Cam decompression, no further pathology was identified. The instruments were removed from the joint and the arthroscopic portals were closed with 3-0 nylon sutures and a marcaine cocktail was placed into the joint. The wounds were cleaned, dried. Sterile dressings were applied. The patient was awakened from anesthesia and brought to the Post Anesthesia Care Unit having tolerated the procedures well.
One step forward, two steps back
At least that is what it feels like at times. I have slept the last two nights but only because I've taken my "magic" pills. I am trying to get as much sleep as possible to get ready for next week.
My mother and I did a 'test run' to the office on Friday. I was originally going to do it during rush hour, but since I hadn't slept that night and was so sick from the pain killers, it was delayed for a few hours. We ended up leaving about 12.10 pm from the flat. I had to walk one block to the crosstown bus, take that to 6 long blocks to the Park, and then switch to a downtown bus. There was a lot of traffic from road works. We finally reached my stop, got off and walked a block and a half to the office. The whole trip took over an hour. I was pretty wiped out when we got to the office, but at least I made it. I waited there for a bit to see one of my coworkers who was out to lunch, and also thought to ring Dr. Kelly's office to see if they had the surgical report yet. After a couple of calls they finally faxed it to me. I will see if I can post it as the PDF or will have to retype it all. I was also extremely relieved to find out that my bosses will be out on Monday and that M arranged for me to work from home. It felt like a stay of execution - not that work is horrid, just getting there at present is quite a workout.
After we left the office we stopped to get something to eat, I had just a little as I was still queasy from the pain meds, and then we took the bus up Madison. It was not even rush hour but the bus, when it finally did show up, was absolutely packed. No matter when I take this bus line it seems to always be delayed and always be packed like a sardine can. I had to ask a not very happy looking girl to get up so I could sit down. Unfortunately my mother had to stand and I felt so bad, she was getting jostled all about. Some woman decided to step on my right foot with all of her weight for a minute or so, she seriously wouldn't move, put all of her weight on it, till I finally let out with an expletive! My toe throbbed for over an hour. It's like constantly getting beat up, no matter how hard you try.
Yesterday was a bit of a late start, but we didn't have any place to go so it was ok. I had some pictures from my Gran's flat that we needed to hang so we did that. A friend was meant to come by but never heard from her so we went across the street to Starbucks and sat outside for a couple of hours, then I tried to walk around a little bit. I am still wearing my brace as I feel much more secure with it and the doctor told me that I should wear it as long as I feel so. We ended up going to a German restaurant near me, and even though it was early the place was very crowded as it is Oktoberfest. It was pretty good but very expensive. And it also delayed my return to my flat. I normally love my flat but am so tired of it.
Think I will go eat some breaky and do my PT. I have to go shopping later to get lunch supplies for the week also. My mother is going home today and I am stressed about that. She has been a life saver these last few weeks. I wish I had some dosh so I could send her on a well deserved and earned holiday, this year has been rough for her, not even including my surgery. I should start playing the lottery! My friend T is meant to stay with me tonight and for at least part of the week, so I won't be completely alone which is good. I am getting around better in the house but I still feel better if someone is around for the time being. It's all so stressful.
On one other note, this has been a very difficult recovery, not just the hip itself, but all of my other body issues (hands, shoulders, etc). I would like to thank those people who spent time with me. Even a brief visit was such a welcome break from the monotony of this slow recovery - so just wanted to say thank you.
My mother and I did a 'test run' to the office on Friday. I was originally going to do it during rush hour, but since I hadn't slept that night and was so sick from the pain killers, it was delayed for a few hours. We ended up leaving about 12.10 pm from the flat. I had to walk one block to the crosstown bus, take that to 6 long blocks to the Park, and then switch to a downtown bus. There was a lot of traffic from road works. We finally reached my stop, got off and walked a block and a half to the office. The whole trip took over an hour. I was pretty wiped out when we got to the office, but at least I made it. I waited there for a bit to see one of my coworkers who was out to lunch, and also thought to ring Dr. Kelly's office to see if they had the surgical report yet. After a couple of calls they finally faxed it to me. I will see if I can post it as the PDF or will have to retype it all. I was also extremely relieved to find out that my bosses will be out on Monday and that M arranged for me to work from home. It felt like a stay of execution - not that work is horrid, just getting there at present is quite a workout.
After we left the office we stopped to get something to eat, I had just a little as I was still queasy from the pain meds, and then we took the bus up Madison. It was not even rush hour but the bus, when it finally did show up, was absolutely packed. No matter when I take this bus line it seems to always be delayed and always be packed like a sardine can. I had to ask a not very happy looking girl to get up so I could sit down. Unfortunately my mother had to stand and I felt so bad, she was getting jostled all about. Some woman decided to step on my right foot with all of her weight for a minute or so, she seriously wouldn't move, put all of her weight on it, till I finally let out with an expletive! My toe throbbed for over an hour. It's like constantly getting beat up, no matter how hard you try.
Yesterday was a bit of a late start, but we didn't have any place to go so it was ok. I had some pictures from my Gran's flat that we needed to hang so we did that. A friend was meant to come by but never heard from her so we went across the street to Starbucks and sat outside for a couple of hours, then I tried to walk around a little bit. I am still wearing my brace as I feel much more secure with it and the doctor told me that I should wear it as long as I feel so. We ended up going to a German restaurant near me, and even though it was early the place was very crowded as it is Oktoberfest. It was pretty good but very expensive. And it also delayed my return to my flat. I normally love my flat but am so tired of it.
Think I will go eat some breaky and do my PT. I have to go shopping later to get lunch supplies for the week also. My mother is going home today and I am stressed about that. She has been a life saver these last few weeks. I wish I had some dosh so I could send her on a well deserved and earned holiday, this year has been rough for her, not even including my surgery. I should start playing the lottery! My friend T is meant to stay with me tonight and for at least part of the week, so I won't be completely alone which is good. I am getting around better in the house but I still feel better if someone is around for the time being. It's all so stressful.
On one other note, this has been a very difficult recovery, not just the hip itself, but all of my other body issues (hands, shoulders, etc). I would like to thank those people who spent time with me. Even a brief visit was such a welcome break from the monotony of this slow recovery - so just wanted to say thank you.
05 October, 2007
Learning the limits
Yesterday was my third PT appointment. We didn't seem to do as much as the last two, which was okay with me since various parts of my body, sans the right hip, were killing me. One of the PT guys showed me how to wrap my wrists for extra support because my hands are killing me with the crutches. I know it seems all I do is whinge, but this process is getting the better of me. Dr. Kelly was meant to talk to the PT guys about how he wants me to proceed, but it seemed no one had spoken to him so I had to ask them to contact him so we're all on the same page. One of the PT guys did not seem to think it was such a good idea to return to work on Monday, but I really don't have a choice. Mostly I am going mad just sitting here. He is afraid I will do too much and flare up with the various multitudes of bodily issues I have. I guess we'll have to just see how it goes and I will just have to do what I can.
I had it in my head since earlier this week that after PT I would take my mother out for a well deserved lunch at a favourite little bistro that was not too far from the PT office. Unfortunately once I get something into my head that's it. And that was where it all went wrong.
After PT we went to my bank on the corner and then walked a few blocks to the restaurant. Looking back we really should have taken a taxi, but I am so frustrated from not going anywhere that I decided I was going to do it all by myself. I admit it, I am an idiot.
Thankfully there was a table free when we got there, and we had a lovely lunch with a little wine. My right hip started hurting then. After lunch we were going to try to take the bus back but I was too tired and we were very lucky that a cab was free, as most were off duty at that time.
I was so knackered from this trip that I ended up passing out for a while when we got home. I did the Game Ready for my right hip and that helped for a little bit but my psoas was really hurting as well as my right knee and left hip. This kept me up for a while and I ended up taking a pain killer so I could hopefully get some sleep. I eventually did fall asleep for a little bit, but have now been up since around 5 am. I took another pain killer around 6 am and am very loopy and queasy from it. I haven't been this out of it from them for a while, I guess I had started to get used to them but now that I've been not taking them regularly I am more affected.
I was hoping to do a test run to the office during rush hour this morning with my mother, but I am definitely not up for it now. Hopefully later on we will be able to do it.
I had it in my head since earlier this week that after PT I would take my mother out for a well deserved lunch at a favourite little bistro that was not too far from the PT office. Unfortunately once I get something into my head that's it. And that was where it all went wrong.
After PT we went to my bank on the corner and then walked a few blocks to the restaurant. Looking back we really should have taken a taxi, but I am so frustrated from not going anywhere that I decided I was going to do it all by myself. I admit it, I am an idiot.
Thankfully there was a table free when we got there, and we had a lovely lunch with a little wine. My right hip started hurting then. After lunch we were going to try to take the bus back but I was too tired and we were very lucky that a cab was free, as most were off duty at that time.
I was so knackered from this trip that I ended up passing out for a while when we got home. I did the Game Ready for my right hip and that helped for a little bit but my psoas was really hurting as well as my right knee and left hip. This kept me up for a while and I ended up taking a pain killer so I could hopefully get some sleep. I eventually did fall asleep for a little bit, but have now been up since around 5 am. I took another pain killer around 6 am and am very loopy and queasy from it. I haven't been this out of it from them for a while, I guess I had started to get used to them but now that I've been not taking them regularly I am more affected.
I was hoping to do a test run to the office during rush hour this morning with my mother, but I am definitely not up for it now. Hopefully later on we will be able to do it.
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