Just Do It: THE PAO

The PAO.  Those letters sound terrifying.  Really.  Who wants their pelvis broken, twisted, then screwed back together.  Nobody in their right mind.  So, perhaps I am crazy, but I am going to call the surgeon's office this week and schedule a left PAO.  Ugh, I can't believe that I just typed that. 

So here are the plans: suck up the next 6-7 months doing medical school rotations and then take all of my vacation at one time (giving me 7 weeks off).  So at 8 weeks post op, I will return back for one month of rotations (likely radiology/pathology...something that is not very intense), and then I'll have a month off after this rotation before I start residency.  It ends up that I will be 15ish weeks when I start up my new job (wherever that may be).  It sounds reasonable to me!

In the mean time I have a lot of 'hanging in there' to do!  It's a daily struggle as I can't stand for more than 2 minutes without needing to sit down. I'm taking Tramadol almost daily.  I am not sleeping well anymore.  I suppose this all comes with the territory of having dysplasia, but doesn't mean I have to like it.  So, that's the scoop.

Now I have several months to mentally prepare myself for this surgery.  And I'm gonna kick the PAO in the butt! The left hip better watch out, cuz he won't know what hit him!

To PAO or Not? That is the question.

I can't believe I am even flippin' considering this as an option.  Really? I mean having somebody breaking my pelvis in three places so as to give me a hip joint...sounds just...barbaric!!

According to my MRA results, the cartilage looks surprisingly good...great rather.  Like what the heck?! I'd rather not have a decision.  But now that I have a decision.  Do I want to look like this:

Or do I want to look like this:

I do not know at the moment.  I have started to get my crap together to send to a world re-known hip surgeon who does the PAO.  And if he agrees with my current surgeon, I am afraid I will have to submit and have it done. Although I would MUCH rather get a replacement for current pain levels, but is this the best thing to do in the future?  I need to be able to walk when I'm 70!  But I also need to function now.  There are no guarantees that the PAO would work either.  I am so incredibly confused.  I wish I had seen a PAO surgeon a LOOOOONG time ago!

The only thing I know now is that I want my life back.

Measurements

Physical Examination:
Left Hip:

• Flexion:  90 degrees
• Internal rotation at 90 deg: 10 degrees
• External rotation at 90 deg: 30 degrees
• Internal rotation prone:  20 degrees
• External rotation prone:  40 degrees

Right Hip:

• Flexion:  120 degrees
• Internal rotation at 90 deg: 30 degrees
• External rotation at 90 deg: 45 degrees
• Internal rotation prone:  40 degrees
• External rotation prone:  60 degrees

Radiographs:

• mild joint space narrowing
• subchondral sclerosis
• Lateral CE Angle:  20 degrees
• Tonnis Angle:  15 degrees
• Posterior wall sign
• Anterior CE angle:  14 degrees

Arthrogram #4 MRI #8

On May 31st I had my fourth arthrogram and my eighth MRI test.  And let me tell you, this was one of the least pleasant experiences I have had (as far as arthrograms go).  I was nervous about this test for a week prior and the day of was no different.  I had to work in the morning so I was at my hospital prior to having to drive across town to another hospital.  Morning rounds were fairly uneventful (although we had a couple of very interesting yet puzzling cases on our list).  We had noon lecture where I couldn't gag any food down my throat because I was so nervous.  The residents let me go after lecture and I headed off to the hospital in which I was to have my test.  I had to arrive 30 minutes early to fill out paper work, get changed, and then sat around for only 10 minutes or so.  Then the real fun started.

After I climbed onto the fluoroscopy table, I found that the PA was the one doing my injection.  I thought it was odd that a PA would do it, but whatevs, it shouldn't be terribly difficult.  I couldn't have been more wrong.  After explaining what she was going to do, she started up the injection very nonchalantly.  Then she started wiggling the needle and making weird faces at the monitor.  I was like, umm, this can't be good. She moved the needle around more and more and, after 15-20 minutes of trying, the radiologist had to come in and he had to put sterile gloves on and try.  He tried for 30 more minutes to get the needle past my hip capsule into the joint space.  He kept saying that it didn't feel right as he was jabbing me, poking me, repoking me, and grinding against bone (which is a horrendous noise).  He explained that my hip capsule is so thick that they couldn't tell if they had any space at all in which to inject the gadolinium.  To make matters even more complicated, my entire hip is scarred down so none of the muscles felt normal as the needle was passed through.  He did finally end up getting a good blush in the joint and then sent me on my merry way to MRI.

In between the MRI I had to walk around to get the joint well lubricated with the gadolinium.  It seems that this wouldn't be such a problem because I was all numbed up, until you think about having extra fluid in an unstable hip.  I could barely walk since my hip felt like it was going to fly out the front of my body (no joke, horrible feeling). After my limping around for several minutes I was called back to the MRI.

In the MRI, I was happy to be vertical for a bit.  I got all strapped in with the intensifier around my left hip, they put on my favourite country music on the head phones, and the banging began.  It wasn't terrible, but very long.  It was most uncomfortable for my back since I've been having a flare up of the back pain lately.  When all the banging stopped, they pulled me out and told me that they were going to MRI my knee.  I was totally caught off guard, but apparently my surgeon is doing a study on knee anatomy and people with hip dysplasia.  So, back into the machine for a couple more rounds of banging.  By this time my ankles were sore from being taped together all afternoon and my back was pounding.  Luckily my hip was well lidocained up and wasn't too painful.

I managed to get a CD of my imaging but it is a shame I don't know how to read it.  I got home and iced up real well and had pizza for supper.  Which was absolutely amazing since I hadn't eaten anything all day.  After supper came the pain.  I took a tramadol thinking it would curb the pain a bit.  Boy was I wrong.  I felt like I was post op, pain extremely bad and radiating all the way down my knee and anterior leg.  It made me cry and had to simply go to bed.  I figured I would be sore given they shoved a needle in and around my hip for 50 minutes, but whoa!  Dude, UNCOOL.

Saturday was a bit better than Friday evening, but I was still having a very difficult time walking.  I hurt when I put weight on my leg and if I move too quickly it catches me and makes me do that grunting sound and takes my breath away.  I'll tell you, it is extremely sexy when trying to walk when you have to stop and grunt.  I can't stand up straight because my hip still feels like it is going to fly out the front of my leg.  It is still a very odd sensation.  Frankly, I am super unimpressed with this entire experience.  I have had arthrograms before and they were 90% easier than this.  It is almost ridiculous how sore I am, I still couldn't get comfortable this evening on the couch with a Tramadol on board.  I am seriously hoping tomorrow is better because, like, whoa, I can't do this much more without stronger pain meds.

I will be getting a phone call from my new surgeon when he reviews the study.  I was supposed to call the office and leave him a message after my studies were done, but since it took 2.5 hours total, the office was closed for the weekend.  I called the answering service but my only option was to have them call the ortho doc on call to see what he could do.  And I know what it is like to be on call and I wouldn't want to have to deal with a patient who just wanted an MRI result.  So I'll call Monday and see if I can leave a message and the surgeon should call my cell to tell me what he finds and what he thinks our next step should be for this hip.  Although I am very certain I want a hip replacement, having this study will give us a better idea of what we are up against and how long I can possibly put surgery off.  I reeeeeeeally hope I can get a THR in March-ish if I can save up all of my vacation time.  Fingers crossed!  I will def post again when I hear back about what the heck is really going on inside my hip.

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.