Well it's been a very long time since I've updated and with good reason. Well, I had a good reason because bad things were going on. I am definitely a medical conundrum. I will try to do a brief summation to catch up.

4 September 2009 - Started PT at HSS this time. The other place had gone to didn't do much so thought I'd give the big guys a shot. I had a wonderful therapist who was knowledgeable about my multiple problems and willing to work and adjust things depending on how I felt. It makes it so much easier when you have someone like that to work with. I
started going once a week up until my trip to Italy on 2 October.

11 September 2009 – Had cervical epidural no. 3. This time I unfortunately had a spinal fluid leak that gave me one murderous headache. It's incredible how much pain some spinal fluid can give a person! Thankfully it was done on a Friday so I had the weekend to recover. This epidural didn't do much either. I suppose overall I improved maybe 10% if I had to quantify it, but that was after three epidurals three months in a row. Hardly worth going through that again for such minimal pain relief.

2 October 2009 - Off to Italy, a bit weary but being optimistic. Took both my cameras - ended up being too optimistic as carrying one was all I could handle. A bit depressing not getting to use my Hasselblad. From 3-7 October I was in the Cinque Terre. I had planned this trip before my neck had become such a nightmare, and was worried I wouldn't be able to do the hiking around the CT, which was the main reason I wanted to go. I've been wanting to do this for so many years and the way my body is falling apart, I figured the sooner the better. The trails were very steep and narrow and since I'm afraid of heights it was a huge challenge, but I am so happy I did it. For the most part my hips held up and I iced every night to get my neck to stop hurting. I think the movement actually was good for my neck in the long run. I was still in pain - maybe it was just the endorphins from so much activity. 7-13 October I was in Firenze and did a lot of walking around, even climbed the 400+ steps to the top of the Duomo. It was a personal challenge I had set myself and couldn't believe I made it. Won't be doing it again – but was SO worth it! 13-18 was Venice. It started off good, a lot of walking but nice and flat, and then on the evening of the 15th I became violently ill with some sort of tummy bug. I couldn't even keep a sip of water in me for over 24 hours. I spent all day on the 16th in bed/in the loo and could barely sit up or lay down unless I was curled up on my right side. Saturday I was determined to not waste my last day in Italy in bed so made it to a chemists and he gave me immodium, which I promptly took. It's the only thing that got me home in one piece, and I mistook it for getting better. Worse off for me. I was ok on the flight, thankfully, and then went to work on Monday am. I was still running to the loo regularly and by noon was so sick to my stomach everyone made me go home. I woke up on Tuesday, the 20th and there was no way I was going to work. I made an appointment with my dr which unfortunately wasn't until the afternoon. I barely made it there, and spend most of the time waiting for her in the loo. She made me do blood tests and wouldn't let me leave until they came back. She then set up an appointment with a gastro for the next day to have an endoscopy. She also gave me a script for an antibiotic. I left the office, made it downstairs and out the door, then ran back in to use the loo again. Made it to the chemists, and barely had time to get home before I had to go again. I spent the next hour or so running back and forth and then scary time! I saw blood. That freaked me out. I rang my dr, at this point her office was on the service, left a msg and she promptly rang me back and said to get to the hospital. Thankfully a v. good friend came over to take me as the dr felt I probably shouldn't attempt to go by myself, not having eaten or drank anything and being dehydrated and about to pass out.

20 October 2009 – The joys of the ER begin. Thankfully I didn't have to wait too long in the waiting room with all the icky sick people (yes I know I was one of them but still…) This was a trick though, because once I got into the ER, they kept me there for 24 HOURS as there were no beds available. It seems my dr had thoughtfully called everyone she knew at the hospital and I was now a celebrity of sorts, which is all good when you feel like you're about to die. The worst part of the ER was not having my own loo – since that was where I was spending most of my time. Even the IV fluids were going right through me. My parents came in from the island and waited with me until after I had a CT scan around midnight. This finally revealed that I had one hell of an angry gut. The gastro guy, Dr. Chun (he was quite a laugh) came by and said that I needed to have a colonoscopy but not till Thursday as they wanted to give my body a chance to calm down. The funniest thing he said was that they were going to give me the prep on Wednesday night. I couldn't stop laughing. I said there was no way I was taking anything that was going to make me go to the bathroom more than I was, it wasn't humanly possible to go more than I was. So he made me promise to not eat or drink anything. Like I even wanted to – the nausea was so bad that they kept giving me anti-nausea meds with my IV. After 24 hours, the last few of which I had to listen to one of the most annoying human beings on the planet complain that he didn't want to be in the ER – even though his dr had sent him there directly to have a defribulator put it as quickly as possible – and still he wouldn't leave, only kept threatening to. Now as a side bar do not ever ever ever go to Lenox Hill ER under any circumstance. By the time I was finally moved to a room, they had two beds to where one was meant to be and I was literally blocked in on each side. Every time I had to get up to go to the loo (about every 10 mins) I had to climb to the foot of the bed, with my IV bag, and try to find an empty and relatively clean loo.

So finally around 7pm on Wednesday I am told there is a room for me. YAY! I get wheeled up to some floor, and the room hasn't been cleaned, so they leave me in the hall. Ironically in front of a copy of a Monet painting of VENICE! Seriously, I couldn't make this up! Finally housekeeping comes to clean the room and I have to listen to the woman complain about her job – all the time trying to be patient but REALLY needing the bathroom. Turned out my roommate couldn't get out of bed which was a blessing for me since I couldn't get out of the loo.

Thursday morning I get woken up at the crack of dawn and taken down to have that colonoscopy. I barely recall any of this b/c I was so weak at this point and then with the drugs they gave me I was delusional for the rest of the day. Random doctors kept showing up to see me and I couldn't tell you what they said. In the end it turned out I had a very bad case of colitis. Of course the doctors couldn't decide if this was just from an infection I caught (my vote) or that I now had IBD (inflammatory bowel disease). It is surprising how dr's really want it to be the more serious, long term thing. I kept telling them that I had a perfectly normal colonoscopy over the summer and that I did not randomly develop IBD out of nowhere, but they think they know everything. Which they don't. But they don't like it when you tell them that. Unfortunately for their egos I tell them regularly.

So Thursday night I try to eat a little something, drink some water, take it easy. They are pumping me up on antibiotics and IV fluids and I'm still going to the loo, but maybe only 3x an hour now. Hey it's progress. Thursday pm/Friday am this daft intern comes in to draw blood. I haven't mentioned how much blood they took from me this whole time, as well as they had to keep moving the IV from one vein to another. Human pin cusion at your service. So this intern can't get a vein. He tries a second time. No luck. He has no clue. I tell him he gets one more try and that's it. He thought I was kidding. I said NO, I'm not kidding, I'm not here for you to practice your ineptitude in drawing blood. He didn't get it the third time – no surprise there – and I kicked him out. He sent in his resident a couple of hours later. I told her straight out that if she didn't get it the first time, that was it. The only people that are good at getting my blood are the phlebologists. My veins like to hide and move. I warn everyone that unless they're good, don't bother. But these mini wanna be "dr's" have egos way too big for them, so she tried…and failed. She truly thought I was going to let her try again. If there is one thing I've learned over the years it is this, dr's don't really care about you. They only care about themselves. I no longer have any problem telling ANY dr what they can or can't do – no matter who they are. So she said something about waiting until the phlebologist do the draw in the am. DUH! By Friday I was still icky but I guess blood tests were a bit better - the people who know how to draw the blood took it without a problem – and the dr's are saying that I could probably go home on Saturday. By Friday afternoon I couldn't take it anymore and just wanted to go home so I lied and said I felt a lot better, forced myself to eat a banana – which made my gut swell up to some crazy size that I could barely close my trousers – but it worked. I got home Friday night! My parents stayed with me until Sunday night which was v. helpful as I was still weak and not great.

I had to go see the gastro dr on the 28th and even though I had had a bad reaction a million years ago to flagyl he felt that was the best medicine for this so he put me on it 4x a day. It had some of the worst side affects – metallic taste in mouth was one of them, headaches, oh and you can't drink any alcohol at all. Not that I was even contemplating that, but supposedly if you do you can get violently ill from the combination. Beware. After being on the meds for week I was told to stop them. Unfortunately whatever was making my gut angry was still around and within three days I was violently ill again – running to the loo, couldn't keep water in me even. Had to ring the gastro over the weekend as I even developed a fever. He put me on the meds again. During the time from the hospital to now I had been doing stool samples and blood tests constantly. It was getting boring already. Oh and more colonoscopies. Fun Fun Fun! The gastro couldn't decide for sure if I had IBD (even though I swore I didn't he just wouldn't take my word for it) or an infection, but since I was responding to the flagyl he decided to try something new and I had to wean myself off of it for two weeks. We started 4x a day for 5 days, then 3x a day for 3 days, then 2x a day for 3 days and then 1x a day for 4 days. Thankfully when I stopped I didn't get crazy sick again, but I have to say my gut, 3 months later, still isn't what it was. But at least it isn't like it was in October!

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.

almost 48 hours after...

This has been quite an "adventure". I will be as detailed as I can for now as I've just popped another pain pill before I start to hurt like hell again. Last night was rough.

In chronological order:

I set my alarm for 4.30 am on Monday as I was told to report to the hospital at 5.45 am. This turned out to be completely needless as I went to sleep around 8 pm on Sunday, woke up about 12.30 am and could not for the life of me get back to sleep. I've never been a good sleeper in the best scenario, so this was really no surprise to me. The worst part of no sleep was the fact it was making my fibromyalgia flare-up worse. Lack of sleep and stress are two of my three big triggers.

After I took a shower and put my pj's on (yes I wore pj's) we took a taxi to HSS around 5.15 am and were the first people to arrive in the ambulatory surgical waiting area. I filled out some forms and then waited for a nurse to call me to the back area. It was freezing cold in the waiting area so I couldn't sit still. Around 6.15 am I still hadn't been called so I went to the bathroom. Of course that was when the nurse came out to get me. I happen to be someone who wakes up every night to go to the loo. It doesn't seem to matter how much I drink or what I drink, but I invariably wake up around 4 am every night. This was no different that night other than I was awake already, so when I went to the bathroom I really didn't have much left over if you know what I mean. My mother came to get me and I went to follow the nurses to the back area. It was cold in there too, though not as bad. The rule is that they need you to pee to take a pregnancy test. I know there was no way I was unless it was immaculate conception, but the nurse insisted. I explained to her the situation and said that she would hook my IV up early as that would help.

Then the nurse asked me tons of questions, all of which I had already filled out on various forms. Redundancy was the word of the day it seems as this went on with every new person I met. My nurse was very nice but I think my small veins intimidated her. After her having one go on my right hand for the IV, she decided to get the "pro" in. Personally I think she should have done this at the beginning because she kept looking at my hand and saying how small the vein was and seemed pretty nervous about it. At least she only had one go though. I've had people try over and over when it was obvious they didn't have what I call "the touch". My nurse sent in the "pro" who definitely knew what she was doing, you could tell when she looked at my veins in my hand that this was going to be easy for he, which was a huge relief to me. She got it in one go, though I did think my arm was going to fall off because of how tight she put the tourniquet on. They put the drip on high so I would be able to go to the loo quickly, and that worked as I was able to give them a small sample, which thankfully was enough.

I had requested a specific woman anesthesiologist which was ok'd by her office and Dr. Kelly's office, but it seemed that she was busy elsewhere. I was a bit worried because the last anesthesiologist I had was a man who completely butchered me. Dr. Kelly came in to sign my leg and we went over a few things, and he reassured me that all the anesthesiologists were great at HSS. I was still weary but then a very handsome one walked in with a great sense of humour, so surprisingly that made everything alright! Funny that :-)


The OR nurse had come in to go over everything paper wise one last time. He was nice but I could barely understand a word he said, I don't know if it was because I was exhausted or he had a very thick accent. Either way we managed to get everything sorted and then we walked down to the OR. The OR was freezing as well, and the last thing I remember was the cute anesthesiologist telling me he was putting sedation in my IV and the nurse putting a nice toasty blanket on me.

I really do not recall much about post-op initially other than pain. Lots and lots of pain. I do remember telling anyone who would listen that I really, truly love demerol and they should please keep giving me some. Anyone who knows me is aware of my dislike for pills, and pain pill are usually something I stay away from as they make me loopy and I hate loopy, but it's amazing the transformation into addict I become after surgery. At some point I maxed out on the demerol so the nurse had to send a message to the handsome anesthesiologist to ask him if I could have a pain pill, which thankfully he said yes. I believe it was around this time that a very nice "helper" came over to try to convince me to eat something. I'm not much of an eater to begin with, and hospital food really doesn't make me want to eat more, so we finally agreed on some sort of roll with butter, and orange juice. This didn't seem to be a plan my stomach agreed to as after I had one bite I was nauseous. Thankfully that passed or I passed out, who can remember. At some point they put me in the CPM for an hour. I remember crying in agony at first. My mother was there, but then they told her she could leave for a while because I'd be on that for an hour. I was not happy about that, so kept bugging the nurses. After the CPM my mother was not back yet and I had to pee desperately, so the nurse said that I should get in a wheel chair to go to the loo. Earlier I had used a bedpan and that was bloody difficult just to move my hip a bit, so I was not too keen on her idea of actually moving my whole body. She insisted though and I suffered immensely. I'm sure she was doing her job but I doubt she was ready for the level of my agony and my incredibly talented way of letting everyone in the universe know of it. The only thing I can remember from getting me to the chair from the bed was me crying so hard I could not see a thing. The nurse did bring me a whole box of tissues though because of my crying. I couldn't stop. I've been through many surgeries and even my four wisdom teeth being removed, and anyone who has TMJ and has had to do that knows how painful that is. This pain though surpassed all others combined. I still don't know how I made it through. The nurse and the pt took me into the loo and helped me the whole time, but I'm sure the people out in the waiting room were able to hear me screaming in pain. When we opened the door to go back to the hall my mother was standing there and what a look on her face! She looked in as much pain as I was feeling. After this charming trip, they moved me into "phase 2".

In phase 2 they want you to sit in a chair instead of lying in a bed. The PT and nurse both agreed that it was best to leave me in the wheelchair and not even attempt to move me into the chair. This was a great idea because I had no strength to move as well as a huge amount of fear in doing so. I sat there for a while, still I had no concept of time, and then the PT decided it was time to get me walking on crutches. Somehow I managed to walk down one side of the room, and actually climb up their little practice stairs but it's all a blur to me. The pain had taken over my whole body so my brain had all but turned off completely. I said to the PT that a hip replacement would have been easier and she said "oh absolutely".

Finally I was approved to go home, it now being about 4 pm or so. We waiting downstairs with all my new toys for a cab. After we finally got one I thought going in the front would be easier. I don't know if this was a good idea or not, but I just wanted to get home so I could take another pain pill. The cab ride was horrid, every bump made me want to scream. Getting out and into my building is a fuzz to me as well.

I do realise that I've been whinging a bit about the pain this whole write up today, but i have to say that this is the worst most painful thing I have ever gone through. My poor mother is wiped out already. I asked her how she was going to make it three weeks with me if she couldn't handle a day and a half. Hopefully I will improve a bit each day so will not be as reliant on her. I did try to go to the loo last night myself when she was sleeping. I actually did really well, until I tried to get back into bed. I really hurt myself doing that and was a wreck, my dad actually heard me crying and woke up my mother. She was so tired she was in a very deep sleep. The whole point was to try to not wake her, but man was she mad at me for trying to do it myself.

Today I get to take a shower! I don't know how I'm going to get into my shower as it's not the easiest one, but I am determined. And this afternoon I have PT. I am not looking forward to trying to get into a cab again that is for sure.

I will write about what was actually done later as I am exhausted now from all of this typing.