I mean, the surgeon. Ahem. The Royal College of Surgeons leaves out the bit about barbers, but I like to think they might have cut your hair at the same time they chopped up your liver.
Nine months after being originally referred to orthopedic teams, I had my initial consultation with Mr. A, my orthopedic surgeon, on Thursday. He re-took the x-rays that my first shitty GP ordered, this time with the appropriate views. Indeed, this time a cam impingement showed up on the right hip. He also noted that I have several hip issues (the bone islands again, plus short femoral necks that reduce the integrity of the lever-action and thus put more stress on the joint). Upon examination, he noted signs of impingement in my left hip as well. Great. Just great. Until it gives me a problem, however, we're ignoring it. It worries me, however, because four other people have done that same exam over the past 18 months, and never has my left hip hurt till now. I could be back here again next year...
Anyway, given that I'd done my research about FAI, about Mr. A, and about the surgeries, there wasn't much to discuss. He recommended open hip surgery, which I know and he explained has a similar recovery time (overnight in the hospital, go home the next day, 2-3 weeks back to work, 2-3 months PT) and a similar success rate (80%) to arthroscopic surgery, but the surgeon is far more able to see issues during open-hip surgery that didn't show up on the MR-anthrogram. So it's less likely the surgery will have to be repeated. I'm all for that. I don't care about scars.
So I'll go in for the MR-arthrogram when I get back from the States in September, have a pre-op clinic sometime in late October/early November, and surgery as close to the end of Semester 1 in mid-December as we can so that I have time to recover before Semester 2 starts.
Now it's just more waiting, and more meds. I have, however, already ordered my crutches. No way am I dealing with the crappy forearm crutches the NHS issues - after an hour of use, my hands are so bruised I can't bear to touch them.
Sunday 17 July 2011
I couldn't take the punishment, and had to settle down...
Well, the first part is true, anyway. Still haven't settled down. The first time my orthopedic surgeon saw me, my right leg was 30% purple from a shot I'd taken in a soccer game two days previously. Nice.
Anyway...how I got here. I thought about going back through my hip journal and post-dating blog entries till we get to this point. But it's a lot of whining and updates on meds, frankly, so I thought I'd just summarize. Here goes.
My History:
So I did. Of course, I went home and looked up as much as I could about FAI first, finding the papers Ganz et al had published, recommendations, the research that has been done in the decade or so since Ganz brought the issue to light. I read some blogs, discussion forums (horror stories), etc.
So by the time I got to the GP, I definitely knew more about it than he did. He told me to stop my activities till I saw the surgeon, sent me for x-rays, and supposedly referred me to teams.
I went back a few weeks later to get the results of the x-rays (which was nothing because the views were useless). This time, the receptionist actually took note of what I was coming in for, and directed me to a more appropriate GP, who I'll call Dr. N. (I'm not going to use real/full names on this blog - for good or for bad, I think it's beside the point of the blog who is treating me. If you want personal recommendations from me, please contact me privately.) Dr. N. was a much better option as he's a spine & hip specialist, a clinical researcher, and he also has early OA himself - and has thus been treated and operated on by my eventual surgeon, Mr. A (surgeons are called "Mr" or "Ms" here - it goes back to being barbers. Don't ask). He was pissed (American-pissed, not British-pissed) when I told him I'd stopped activity on advice of the GP-who-shall-not-be-named. He also couldn't actually find a referral letter to teams on my file. So he sent another, told me to keep up all normal activity for as long as I could stand it, and he's been the only GP I've seen about my hips ever since.
Dr. N agreed with my PT friend that some sort of impingement was likely. The official PT I saw in December also agreed, and sent another letter pushing me closer to seeing Mr. A. I only had two sessions with the PT, as he gave me some butt-strengthening and stretching exercises and then claimed that there wasn't much he could do for me that I wasn't already doing for myself. Otherwise, other than checking in on meds with Dr. N, I've just been waiting to see the surgeon.
I focused hard on strengthening those muscles, worried about atrophying and having a slow recovery post-whatever treatment I would eventually have. I lost 30 lbs (so far). I maintain a schedule of high-intensity-interval-training 3 times a week, bodyweight strengthening 3-4 times a week (P90X and BodyRock.tv have been really useful), cycling, playing soccer 1-2 times a week, some pilates, and yoga 1-2 times a week. I still ride horses, but generally only when I go home to the States.
Pain Management:
It's important to note the pharmacological zeitgeist in the UK vs the US here. Because of the NHS, big pharma can't speak directly to the consumer - they can't advertise, recommend, market, etc., directly to patients, and generally can't hit up the doctors themselves, either. They sell to the NHS, the NHS makes recs to the doctors. Full stop. So there are some tendencies that are more fair and more thoroughly thought-out, but then there are some that are just plain weird.
For one, they'd way rather have you on opioids than NSAIDs. Argh. I guess they like narcotic addiction more than stomach problems...? I dunno. The first recommended pain med to me was codeine. I shied away from that a bit, went with naprosyn to start. It didn't work, and I couldn't sleep.
So I tried the codeine, coupled with paracetamol (acetaminophen/Tylenol). Didn't work, and completely zonked me. When I was home over the holidays, my mom gave me some Celebrex, so when I came back I asked for it. It works to a low level - for a while it completely wiped out the pain, but now the pain has edged back with a vengeance.
We added tramadol+paracetamol on top of the Celebrex, though I was still using codeine to help me sleep. The tramadol actually works great for the pain, but I do have some side effects that have faded out mostly: dizziness, nausea, blurred vision.
I was worried about getting addicted to the codeine - effectively, not being able to sleep without it. So we're trying amitriptyline, which is an anti-depressant that is now used quite a lot to manage pain as it seems to decrease pain sensitivity. I hate it. It makes me really tired, has no effect on pain, gives me headaches, makes my boobs hurt, and makes me feel as though a dementor is always somewhere nearby. I'm on the lowest dosage, supposed to be ramping up, but I don't think that's going to happen. I'd rather be addicted to codeine.
So the current meds are:
I also find either heat or cold therapy work. Heat is supposed to be better for joint pain, cold for muscle soreness and strain, so I go with whatever is hurting me most.
Anyway...how I got here. I thought about going back through my hip journal and post-dating blog entries till we get to this point. But it's a lot of whining and updates on meds, frankly, so I thought I'd just summarize. Here goes.
My History:
- My mom, maternal grandmother, and one maternal aunt (out of two) all had or were recommended bilateral hip replacements in their 50s, due to early osteoarthritis. My mom put hers off for a while until the technology could advance so she could still ride horses with replacement hips. There's a longer story in there.
- I had hip x-rays taken when I was 18. Other than the weird bone islands that always show up, and that have yet to be explained to me, they didn't see anything. Not that I expected them to - for one, no one was looking for FAI yet.
- I'm a pretty active person. I've played soccer most of my life (and still do), ride horses competitively (3-day eventing, mostly), played rugby, cycle, swim, do yoga and pilates.
- Despite all this, as our story begins, I was about 40-50 lbs overweight. I like to eat. Chocolate.
- I'm American, but I live in the UK, Wales to be specific. So when I talk about doctors, surgery, PT, all that, it will all be through the NHS. Don't come to me for info about insurance companies, because all you'll get is THANK FSM I DON'T HAVE TO DEAL WITH INSURANCE!
- I was 30 when they started. In January of 2010, I suddenly had a stiffness/tightness across my right upper buttock. I thought I'd pulled something in my ilio-sacral joint. I had a bit of treatment from my regular osteopath, and if I took a few weeks off from high impact activities I would get relief, but as soon as I started back to normal activity, the pain and stiffness returned.
- About 7-8 months later, the groin pain started, shooting up into my abdomen, down to my knee. The hip gave out a couple of times, and I fell like the old woman on the panic-button commercials. Fun.
- I have some clicking, but it's not painful, so I generally fail to pay much attention to it.
- Sitting is painful. Standing, movement, all seems okay unless I bring my knee to my chest or try to cross the knee over midline (like you would doing the prone spinal twists in yoga).
- A friend who's a PT does therapeutic massage, and I mentioned this to him sometime in September 2010. He immediately thought FAI (as it would later turn out, one of the ortho surgeons in my area is an FAI specialist, so he makes sure the people he works with are aware of it), and recommended that I see my GP and get referred to ortho teams immediately.
So I did. Of course, I went home and looked up as much as I could about FAI first, finding the papers Ganz et al had published, recommendations, the research that has been done in the decade or so since Ganz brought the issue to light. I read some blogs, discussion forums (horror stories), etc.
So by the time I got to the GP, I definitely knew more about it than he did. He told me to stop my activities till I saw the surgeon, sent me for x-rays, and supposedly referred me to teams.
I went back a few weeks later to get the results of the x-rays (which was nothing because the views were useless). This time, the receptionist actually took note of what I was coming in for, and directed me to a more appropriate GP, who I'll call Dr. N. (I'm not going to use real/full names on this blog - for good or for bad, I think it's beside the point of the blog who is treating me. If you want personal recommendations from me, please contact me privately.) Dr. N. was a much better option as he's a spine & hip specialist, a clinical researcher, and he also has early OA himself - and has thus been treated and operated on by my eventual surgeon, Mr. A (surgeons are called "Mr" or "Ms" here - it goes back to being barbers. Don't ask). He was pissed (American-pissed, not British-pissed) when I told him I'd stopped activity on advice of the GP-who-shall-not-be-named. He also couldn't actually find a referral letter to teams on my file. So he sent another, told me to keep up all normal activity for as long as I could stand it, and he's been the only GP I've seen about my hips ever since.
Dr. N agreed with my PT friend that some sort of impingement was likely. The official PT I saw in December also agreed, and sent another letter pushing me closer to seeing Mr. A. I only had two sessions with the PT, as he gave me some butt-strengthening and stretching exercises and then claimed that there wasn't much he could do for me that I wasn't already doing for myself. Otherwise, other than checking in on meds with Dr. N, I've just been waiting to see the surgeon.
I focused hard on strengthening those muscles, worried about atrophying and having a slow recovery post-whatever treatment I would eventually have. I lost 30 lbs (so far). I maintain a schedule of high-intensity-interval-training 3 times a week, bodyweight strengthening 3-4 times a week (P90X and BodyRock.tv have been really useful), cycling, playing soccer 1-2 times a week, some pilates, and yoga 1-2 times a week. I still ride horses, but generally only when I go home to the States.
Pain Management:
It's important to note the pharmacological zeitgeist in the UK vs the US here. Because of the NHS, big pharma can't speak directly to the consumer - they can't advertise, recommend, market, etc., directly to patients, and generally can't hit up the doctors themselves, either. They sell to the NHS, the NHS makes recs to the doctors. Full stop. So there are some tendencies that are more fair and more thoroughly thought-out, but then there are some that are just plain weird.
For one, they'd way rather have you on opioids than NSAIDs. Argh. I guess they like narcotic addiction more than stomach problems...? I dunno. The first recommended pain med to me was codeine. I shied away from that a bit, went with naprosyn to start. It didn't work, and I couldn't sleep.
So I tried the codeine, coupled with paracetamol (acetaminophen/Tylenol). Didn't work, and completely zonked me. When I was home over the holidays, my mom gave me some Celebrex, so when I came back I asked for it. It works to a low level - for a while it completely wiped out the pain, but now the pain has edged back with a vengeance.
We added tramadol+paracetamol on top of the Celebrex, though I was still using codeine to help me sleep. The tramadol actually works great for the pain, but I do have some side effects that have faded out mostly: dizziness, nausea, blurred vision.
I was worried about getting addicted to the codeine - effectively, not being able to sleep without it. So we're trying amitriptyline, which is an anti-depressant that is now used quite a lot to manage pain as it seems to decrease pain sensitivity. I hate it. It makes me really tired, has no effect on pain, gives me headaches, makes my boobs hurt, and makes me feel as though a dementor is always somewhere nearby. I'm on the lowest dosage, supposed to be ramping up, but I don't think that's going to happen. I'd rather be addicted to codeine.
So the current meds are:
- Celebrex
- Tramadol
- Paracetamol (acetaminophen)
- Amitriptyline
- Codeine when needed
- and it maxes me out on what I can take for pain. Joy.
I also find either heat or cold therapy work. Heat is supposed to be better for joint pain, cold for muscle soreness and strain, so I go with whatever is hurting me most.
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