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Saturday, March 17, 2012

Paris Wasn't Built in a Day

I want to preface this by apologizing if this becomes long, I want to make sure that I get everything down.

So, my follow-up appointment in Vail started off to a rocky start. The traveling portion was fine, but the surgeon was going to be in surgery all day and didn't know when he would have time to see me, so I was to call when I got in town and we would go from there. It ended up that they said I could come in to the physiotherapy office, get measurements (ROM and strength) and then have an appointment with the surgeon at 5:00pm.

I went and got my measurements done and everything seemed fine until they tested my flexion and hip flexor strength. The dude said that there was something definitely not normal. Otherwise the strength in both sides is about equal (yay for PT!). But to wait and see what the surgeon said. After this, my Dad and I checked into our hotel, and managed to walk around Vail Village for a little bit. It was a gloriously sunny day, watching the skiers come down the mountain was very satisfying to observe. I could only imagine how nice it would feel to be able to rush down the slopes without a care in the world. I digress...

When we got to the office for my appointment the surgeon's athletic therapist went through my radiographs from my surgery and again did ROM and strength testing. He was quite concerned about the hip flexion as well. After waiting for quite a long time, the athletic therapist came back and said that he had called the OR to see when the surgeon could come back to see me, and he was going to be a couple more hours and that I was to come back first thing in the morning. Ok, no biggie, I know how hectic the OR schedule can get. As I was leaving the hospital my cell phone rang, the office staff said that they had spoke with Dr. P and that he wanted me to get a stat MRI. Instantly, my stomach flipped. "Oh gosh, something is wrong." Although I knew this was likely the case since I have such decreased ROM and am still hurting quite badly, I was now to face what was wrong. After waiting for the orders to go through, I got my MRI. I'm an expert now, having had five of them in the last six years. At 8:30pm we finally left the hospital and arrived back to our hotel where we grabbed something to eat and headed off to bed; we had to be back at the hospital for 8:00am.

In the morning, I had to get several rounds of X-rays to ensure that I did not have HO. Thankfully, I did not have any! Then, I got to go into Dr. P's office where he went through my MRI on a sweet HD computer monitor built into his wall unit. The labrum had healed to the bone and all of the anchors (7 of them) are still firmly attached to the pelvis. I have some edema, but this is to be expected at this point. The only thing is that my hip capsule is extremely thickened, but it shouldn't be causing so much pain. Basically, nothing much to help us figure out what was going on. Then I had to walk up and down the hallway. It is very difficult to walk when somebody is watching you. It really makes you self conscious: am I limping? Do I have Trendelenburg? Are my strides long enough? He kept telling me to 'walk my best'. I was certainly trying, but, alas, still a limp and short stride were present.

While in the exam room with the surgeon, he was incredibly thorough. He spent 45 minutes in there with me trying to think things through. He's only had one other patient, a soccer player, who had similar problems post-op. Lucky me. He ended up narrowing down my problems to either a mechanical block (ie formation of scar tissue) or a neurological disconnect. He said that the scar tissue formation is a possibility since I have a tendency to form it as per my large keloid scaring on the outside of my hip and the large areas of fibrosis found during my surgery this past January (I should note that this is more common in people with EDS/hypermobility). If this is the case, he will have to go back in and clean it up. The other possibility is that since I've had so many surgeries on my hips that the motor pattern between the brain and the hip is completely nonfunctional and my hip is clenched down, so much so, that I can barely move it. In which case, intense and specified exercises are necessary to correct this motor problem. I was given 7 new exercises and have to do them twice daily in hopes of correcting my pain and ROM difficulties.

I was also given new medications to help me get through my days. Medical school clerkship is hard and next to impossible to do whilst being in pain. I can barely stand for more than a couple of minutes before both my hips feel like they are going to implode due to pain. My surgeon kept asking me how the heck I was able to do it. I told him straight up, it sucked and I really don't know how I'm doing it. He listened and gave me two high dose anti-inflammatory meds for which I must take for three months, and he is ordering a special anesthetic cream with lidocaine and verapamil in it to help relax the muscles and stop the cycle of contractions. I was also given two lidocaine/kenalog injections into my hip at two different angles. For two reasons, one, to help him be able to exam my hip and two to help stop the cycle of inflammation. Those injections HUUUUURT! Phew! I have a great poker face though and they were impressed that I wasn't squirming in pain. I am still bruised from them 5 days later.

All in all, I am so extremely happy that I have Dr. P on my side. During my appointment he said that he can't promise that I won't need more surgery, but he promised me that we would get through this together and that we would work to get me my hips functioning again. My heart sank when he said that I may need surgery again, but, he handled it so nicely. He told me that he'd stick with me, that things would be okay and patted me on the back. He is the first doctor in 6 years who has told me that we could get to the bottom of my hip problems and that I would be fixed. I truly wanted to hug him. I have all the confidence in the world that he'll help me, whether surgically or conservatively, we will get my hips fixed and I will get my life back.

As it stands now I have to email weekly updates as to how I am feeling and we will go from there. I am supposed to make an appointment in three months at which time we will see if there has been any improvement. After proposing all options to me, Dr. P said to remember, "Paris wasn't built in a day."

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