Unofficially: The Hip's Shot

Fortunately or unfortunately, whichever way you want to see it, this left hip will most likely end up to be ceramic or metal within the next year (hopefully March-ish) but we will see how things shake down.

I had my appointment with a new orthopaedic surgeon this past week and after examining me, watching me walk, listening to my history and pain levels the surgeon said that when he sees patients present as I do, that they have always ended up with a THR.  The radiographs have slight joint space narrowing (not significant, nor has it changed since December), so he has ordered an MRI/arthrogram to determine the extent of cartilage damage and to see how long I can delay having to have it done.  We may do an exam under anesthesia as well, if the cartilage looks good, just to ensure that it isn't the muscles that are causing my issues (I am guarding so much due to pain that the full ROM cannot be tested in the office).

My only other option would be a periacetabular osteotomy as I lack any form of anterior hip socket (meaning very severe anterior congenital hip dysplasia).  But my cartilage would have to be good enough for that, and even then it doesn't guarantee a success.  My right side is just as dysplastic as the left, so that hip won't last me either (although it is less symptomatic than my left and I am not sorting out this hip until the left is organized).  After much discussion, we were both disappointed that the dysplasia was not identified as a problem with any of my previous surgeons, as I could have avoided several unnecessary scopes, had a PAO, and possibly avoided or delayed a THR.

I feel almost relieved, because I have made up my mind and will be perusing a THR at the end of medical school.  I have done my fair share of hip preservation and I can't go through such a large surgery like a PAO with even the slightest chance of failure (I already know I have grade II arthritis from previous operative reports).  So, regardless of the MRI/arthrogram results, I will be doing the full replacement, but the results may dictate how long I can put this off.  The surgeon feels that I need to consider taking time off from school, again, to have this fixed because I am, "...so young, not even thirty!" And, "...we are talking about your health here, and we can't mess around with this because you need to be able to live your life."  Both of these statements are absolutely true, but there is no way that I can mentally or physically handle another surgery in the very near future (as the surgeon is eluding to wanting to do).  I need some time to try to recover from my previous surgeries.  I realize I am exhausted from the constant throbbing, but I just don't think that I can do another surgery for a couple more months.  I feel that if I save up my vacation I can use it all at the end and finish school early and have the replacement on the left side.

I thought that he would be pushing for me to do a PAO or something, but he was adamant about the fact that a THR will most likely be my best bet.  And even if the MRI/arthrogram comes back with small amounts of arthritis, he wouldn't blame me one bit for still going through with a THR.  Enough is enough and I need my life back.  Living like this is in no way, shape, or form tolerable or desired.  Life is too short.  I will be willing to curtail my activities in order to allow my replacement to last as long as possible.  I haven't been able to do anything physical for the last 7 years, and to just get the chronic pain relief will be more than welcomed.

So that's the scoop.

MRI/Arthrogram: May 31st, 2013

Brain Storming

So this week is the week that I meet with a new surgeon to determine what my hip's problem is and hopefully to get some pain management solutions.  I am excited, but even more nervous.  I can't stop thinking about what he might say.  What does the fresh set of eyes with no previous surgical experience inside my hips see?  I am curious and scared.  But I'll have to face the fact that something is not right with my hip.  I particularly realized that something is wrong when I was driving to the hospital last week and every bump hurt my hip, THAT was a sign that I am doing the right thing by seeking out another opinion. 



In light of my upcoming appointment I have been thinking of different questions I should ask at my appointment.  If you have any suggestions, feel free to email me or comment!

• Pain meds/NSAIDs for day?
• Pain meds for night?
• Do I need a pain management referral?
• Go through my angles (CE, Sourcil, Alpha)
• THR vs PAO vs SDD?
• Arthrogram still needed if I am not going to do surgery in the near future?
• Scar tissue issue?  Could my bone structure be causing the recurrent scaring? 
• Will I be able to wait another year if I do need surgery?

Between a Rock and a Hard Place

Yes, this is where I am.  I have to say that I am extremely thankful for having completed my surgery rotation, that was the least fun I've had in medical school to date (well, boards are right up there, but you get the idea). I am thankful that I am able to do my medical school, albeit, with physical difficulty, but I am still getting up every morning, driving to the hospital and do what I need done.  Yes I hurt, but I can't let this stop me.  I know it's not normal for somebody less than 30 years of age to be throbbing by noon time, or have hip pain while going over every bump while driving, but there are a lot of things for which I can be thankful.

I have 10 days before my appointment with a new surgeon.  I am basically freaked out...maybe I'll ask for a Xanax the day before from the residents! (hehehe) --I won't actually do this!  I feel like I'm stuck: darned if I do and darned if I don't.  I realize my pain is abnormal, but if I do find out what is wrong, that may mean more surgery.  Surgery that cannot fit into my life right now.  I have hurt this badly in the past and I have tried to get it fixed, and look how wonderful that turned out for me.  It makes me very weary about seeing yet another surgeon.  Every single doctor I have seen for my hips ends up saying that they can't help me.  What makes this one any different?  I shouldn't be so skeptical, but I can't help it.  With so many failures over the last 7 years, how can I trust that things are going to get better?  I have to, or else I will end up going crazy...it's just amazingly difficult.

So next Thursday I will have my appointment with a local surgeon.  I am basically going there for some direction, for some pain relief.  I have ended up with no doctor willing to write me a single script for pain or inflammation.  This is my main reason (in addition to the fact that I'd like to know what is going on with my hip and to get a fresh set of eyes on my case).  In any event, I'm nervous.

Half Way

I am officially half way through my general surgery rotation, and, as previously mentioned, it is a huge struggle.  The pain is most distracting.  I stand there wishing I could just sit down.  I really do think that something is wrong.  I have been very patient and hoping for some healing and relief with time, but this does not seem to be working.  When I hurt 24/7 and need heating pad and muscle relaxants to sleep really makes me wonder what's up.  Is the dysplasia the culprit? Narrowed  joint space? Would I need more surgery? PAO? THR? What medications should I take? I have so many questions and no answers. 

For obvious reasons, I have made an appointment with a local orthopaedic surgeon who specializes in hip scopes, open hip surgeries, PAOs for some direction and help to figure out what I can do to help me get through life right now.  It is inappropriate to live in so much pain and simply be trying to struggle through life without any plan.  I need a plan of action to help reduce my pain levels so that I am less miserable.  I really believe that a fresh set of eyes on my case will help determine what the next step should be.  I am no looking for surgery at the moment, although realize it may be a possibility in the future.  I am just looking for an understanding of what could be wrong with my hip at this point in time. 

I am currently 10 months post op and have been very patient to see results from the surgery.  Given that I have had four previous hip scopes on this hip, I was told that I should see results from 6-12 months.  I  will give it longer than 12 months before I do anything drastic, but I need something to help me currently.  NSAIDs and ice is just no cutting it currently.  So, May 16th is the day I meet with another surgeon to discuss what's up and what we can do to make me less miserable.

God Bless Those Who Want To Be Surgeons.

...and pray for those who don't.

I have started another rotations at school and have survived a week of pure torture.  This surgery rotation is the worst possible rotation of which I could think.  Not only is is mentally challenging (which I don't really mind at all, I thoroughly enjoy thinking and learning), but physically, I am struggling to say the least.  I have been doing 12-14 hour days on my feet.  Something that is next to impossible with a sore left hip and a sprained right knee.  But I don't have a choice and must keep up.  Yesterday was particularly difficult as the case in which I was scrubbed, turned into a five hour surgery.  Imagine trying to stand for five hours when it normally hurts to stand for 5 minutes.  Needless to say, it was difficult and I really don't know how I did it. I am paying for it now, but this was absolutely expected.  I have no idea how I am going to be able to do three more weeks of this intense work schedule.  It is very tough for me.  I know that this type of work is difficult for everybody, but coming off of so many surgeries and still struggling makes it particularly hard to handle the physical demands of my rotation.  Please pray that I get through these next few weeks--I seriously need some divine intervention.

It would be unfair to try to give an update on the status of the hips as everything just darn hurts.  I really, really hurt and am struggling and don't want this post to turn into a poor-me discussion.  Thus, I won't elaborate.  Suffice it to say--I need some prayers for strength and perseverance.  Thanks!

One Day at a Time

I am trying to remain positive and am currently taking one day at a time.  This is easier at some times than others.  If I am honest, I am extremely happy that I have my right side pain free.  It is a dream and I am extremely thankful for the relief.  This has provided me with one side on which to stand for the majority of my day on my feet.  I try to sit when I can, but this is nearly impossible on the rotation that I am currently completing.  I try to count my blessings, I really do, but sometimes it is very difficult especially when one hip has constant pain and reduced ROM.  It seems that pain and hips decide on what I can and cannot do; which is annoying.  Having said this, I realize that there are many other people who have it a lot worse and I am not as bad as I was before (at least now that I have one decent hip).  God gave me so many blessings in my life and I need to be thankful and acknowledge them more often...especially here on my blog where I tend to vent my frustrations and fears. 

I have learned many things throughout my hip journey.  I have met amazing people and realized who will support me and encourage me through thick and thin.  I am blessed.  Also because of my hips, I have chosen a completely different field of medicine than what I had originally planned before all the surgeries last year.  I think that because of my hips, I will be better in my field and be a better physician.  I understand the chronicity of pain and the social, mental, emotional, and physical tolls it takes on an individual.  Pain is so multifaceted that it is hard to empathize with patients dealing with chronic pain if you haven't experienced it.  I am thankful for the guidance the Lord has given me on choosing my career and will definitely do the best with what I have been given.  Bum hip and all!

Calmed Down A Bit

Yeah, I've calmed down some since writing my last post.  I truly believe that I need to get my act together and become more positive.  Everybody keeps telling me how positive I am during the last phase of my life, though deep down (and apparently on my blog) I am a Debbie Downer.  I need to get my act together and become more positive and focus on the great things in life.  I am truly blessed in life.  I have my health (except for my orthopaedic issues), I have an amazing family, I am doing what I want in life and will have an amazing career of my dreams when I am done with school.  These are things that I must be thankful for and not forget that I have them. It is too easy to focus on the chronic pain, the things I can't do, the things decisions I have to make all because of my hips.  They truly do impact life and make me who I am, but they should not take over and make me miserable.  Although I have to acknowledge that I have this pain and may have to do something about it in the future, I have to realize I have an amazing support system.  All family and virtual friends have been amazing through this journey.  I will most certainly keep the friendships I have made through this journey for the rest of my life.  I am blessed (even blessed with bad hips!).

I am contemplating going to see a pain management doctor or a sports medicine doctor who may be able to prescribe me some medications that would help me get through my day.  I would be grateful for a way to get through my day (or the majority of it) without hurting.  I am usually throbbing my noon whilst on Voltaren.  We will see what I decide.  I am doing a physiatry rotation beginning next week and may ask the doctor for a recommendation for a doctor that may be able to help me.