I only asked about the office politics since you mentioned earlier that you do the work at home in order to avoid office politics. Do whatever works best for you.
Funny you ask about the crutches as I have just now tried to get off of them. I'm a therapist in physical medicine and rehab, but I do inpatient so normally don't see this diagnosis. The outpatient physical therapist is rather aggressive, pushing me to get off of the crutches at 2 weeks out whereas the surgeon said to hold off until I was 4 weeks out to let the surgery heal properly. I went with the surgeon, creating a bit of tension between me and the PT.
So, it's been about 2 days without crutches, but the posterior greater trochanter (the same area where gluteus medius inserts) hurts like hell whereas with one crutch it didn't. I'm also showing signs of gluteus medius weakness, which is important since it stabilizes the pelvis. It's funny because I mentioned the increased pain to the technician today, who said "you just had surgery, so of course you're going to be tender". I let it slide for various reasons...too long to mention here. My thought was, "that's interesting, because the MRI showing bursitis, tendinopathy, and generalized edema in the region of the greater trochanter was done before surgery. Maybe she believes in time travel?" Anyway, when I go back in, I'll probably request them to consider giving me something to decrease the inflammation since I can't take non steroidal anti inflammatory medicines like naproxen.
I consider going back to the PT I saw before the surgery (the orthopod wanted me to change PTs to one who really knows the surgery I had) because our personalities fit better and she listens and doesn't just blow off what I say. She handles well having another therapist as patient. I suspect the technicians at the new place are not used to working with someone who is educated. I would be supervising them normally....but here they are telling me what to do, so I guess it's weird to them. I'm a bit bothered that at times I don't have access to the supervising PT for questions because normally he's also seeing someone else. What they are doing isn't illegal, it's just not best practice. The PT I had before was easily available, doesn't use technicians, and I can even email her with any questions/concerns and she'll respond within 24 hours. However, she doesn't know this surgery very well.
So, right now, I am going without crutches to the PT's prodding and also the surgeon says it won't bother his repair at this point. However, it seems the gluteus medius is complaining about having to do work and is wrecking havoc in the posterior greater trochanter area again. I was in rather severe pain 2 hours ago, but now with sitting for 2 hours, it doesn't hardly hurt at all. The PT said he was limited in what he could do due to the labral repair and just said to walk only without crutches, and sit or lay down and rest when it complains....but I wonder why no anti inflammatories. They did give me some piriformis stretches, only I can't get into the position due to other tightness from the surgery of the internal rotators. So, I'm working on stretches every day.
The PT gave me the surgeon's protocol, saying since I'm also a rehab therapist, I would understand most of it and know if I'm on track or not. I might add light weights to the gluteus medius exercise, to help it get stronger in a way that hopefully won't aggravate its tendon. I'm updating what I do at home on my own, then check in with him on it...he's never had a problem with how I update things.
So, that's where the walking without crutches things is....technically, I can, but it hurts like hell (I would call it severe pain) to do so. It's only been 2 days, so perhaps it will improve and hopefully gluteus medius will come around.View Thread
I saw the orthopod yesterday. He said the pain around the ischial tuberosity and posterior hip area could be due to multiple things, which makes it hard to determine the cause. He added that it could be referred pain from the labral tear and repair, so recommended to avoid activity that aggravates the pain, ice it, and then come back in a month to see him so he'll know if it healed itself. He is a conservative orthopod, which I like very much because it's in line with my own views....wait to see if the body will heal itself, and then only intervene if absolutely necessary.
He additionally said that he didn't know why the X-rays showed osteoarthritis because he didn't see any of it when he directly looked at the cartilage with the little camera they put in the joint. All he saw was labral tears. He said that improves my prognosis a lot, and he said the overall prognosis is very good, but I just have to go through the rehab process.
Meanwhile, there's other issues with insurances...sure most folks can relate....so I may miss some PT appointments, but I'm working on it and me and PT will do the best we can given the situation.View Thread
The orthopods here are very busy as it's an underserved area, and therefore patient education is not optimal. From what I can gather, the prognosis of the surgery is uncertain, especially since I have evidence of other problems, ie osteoarthritis. I'm now 2 weeks out. After the initial angriness over being partly dislocated, which only lasted a few days, the hip had no appreciable pain other than in certain positions a sharp stabbing pain in the groin, so I avoid those positions. So, I walked a lot with the crutches as well as doing the PT exercises at home, then the deep gluteal pain around the ischial tuberosity and buttocks started up again and is limiting how much I can walk. I am not able to complete all the repetitions that PT wrote for without the buttock pain and tenderness starting up, even though they are not demanding exercises. I see the orthopod in 2 days to follow up, and we'll see what he says.
I don't know if I need another PCP. It's very hard to tell as her house was on fire on that particular day. Still, I wasn't impressed. At the same time, I don't feel like going through the change since I've had so many other changes in my life to contend with right now. I may change later, after the hip issues get resolved...however long that may be.
I'm surprised you are having a regular job since you said the company politics get to you at times. How did all this come about?
Around here, it's fire season, so my asthma is still high yellow, still taking a whole lot of inhaled corticosteroids. I'm doing what I can to not take prednisone since I want things with the hip to heal well. We have fires and smoke from fires, so I'm wearing a mask to filter out particulate matter when I'm out of my friend's house. I anticipate spending the next few weeks moving over to her and her husband's house after getting the orthopod's and PT's thoughts on if the hip can tolerate stairs with a modified approach and if it can tolerate driving. I'm really at a loss to know what to do with employment, and no one seems to know what will happen with the hip.View Thread
I'm a few days after surgery. They said the orthopods were correct and in fact the labrum was torn. He printed out some pictures of various tears with the camera on one side and an instrument on the other to make it more visible. He also sewed it back up and printed out some of those pictures. It appears there was more than one tear, but I might be misunderstanding things. My mind is still in a fog due to the anesthesia and now the pain medicines. It's the first day I've been able mentally to sit up and concentrate even on minor things.
The left hip is very unhappy, having had a camera stuck into its joint and being partly dislocated, but hopefully the sewing the orthopod did will mean that PT will actually have an effect now. I go in tomorrow for the first post surgical PT appointment.
I'm in a high yellow zone asthma wise, which surprised me how much they were concerned with that as it happens all the time with me. So, for whatever reason, they said they would stick a tube down my throat during the procedure, which I okayed. Not sure why they did it, maybe they put me on a ventilator or something....I don't know. I've had surgery before and did fine without a tube down my throat....but I wanted them to feel comfortable with the whole thing. To me, the asthma attacks have been pretty mild and just part of life.
It will take time to see if the surgery helped or not....I hope it will result in functional gains.View Thread
I don't think the PCP was correct either...if she doesn't know the answer and knows the orthopod doesn't know, then she needs to refer to someone. She didn't...just said it was the orthopod's responsibility and if he didn't know, then I was just out of luck, basically. I was probably probably not being technically correct when I mentioned a medicine that guards against GI bleeds, actually the proton pump inhibitors protect the stomach from ulcers which can then bleed. She was yelling at me that it was definite that I had to take them, yet when they did endoscopy in the hosptial everything they looked at had no ulcers....although they didn't look at everything, just the most common areas for problems to occur. Overall, the tests didn't have bad results....either a very stable slow bleed which would probably heal on its own as long as I don't take NSAIDs or a recent bleed that already healed....depending on how you interpret the results. However, when I tried to correct her misperception of the events....that it wasn't a massive bleed, she wasn't listening. I don'tknow why the shot only lasted 3 or 4 hours, only that they were trying to verify the pain was coming from within the joint capsule since the MRI images were not optimal. The arthroscopy is later today, May 12. The cartilage involved is the labrum, and since the blood supply isn't good to the area, it will never heal on it's own. The sewing it back into place is the healing. The sutures will hold it, I believe...then again, don't know much....so I could be wrong. As far as I know, the best way to slow the progression of osteoarthritis in a weight bearing joint is to lose weight in my case and take NSAIDS. I can't do NSAIDs due to risk of GI bleed, and the weight is a challenge due to asthma meds, but I'll do the best I can with it. I have muscle imbalances, wear orthotic devices, etc which also should help. They can't surgically correct osteoarthritis, but they can do a surgical repair of a torn labrum. It's hard to describe the difference in words...you'd have to see a picture.
It's a tough asthma season around here as well, but mostly due to wind and particulate matter in the air....I could barely see the mountain today. I don't know, but it looks like the fires have already started. Smoke from fires do a number on my asthma.View Thread
You asked about the Tramadol. Yes, it helps, but it's also addicitive, so I just use Tylenol if possible. I don't know why I said, "degenerative osteoarthritis" since all osteoarthritis is degenerative. They first did an injection into the gluteus medius/bursa area on the side of the hip. The pain in that area went down about 80%, but the pain in the groin and the pain in the back of the hip remained. They did an injection into the hip joint itself, within the joint capsule, where there are no muscles or tendon or bursa, mostly just cartilage. With that, the rest of the pain went away very dramatically. However, it only lasted for 3 or 4 hours. What this means is that a lot of the pain was coming from within the joint capsule where there are no tendons or muscles or bursa and it wouldn't responded to rest and ice. So, they have to do an arthroscopic surgery, stick a little camera in there, and see the condition of all the tissue to know what to do next. The tissue within the joint capsule usually does not heal on its own with rest, which would explain why it's been 4 months and not improving. They'll have to see if they can sew it up and repair it arthroscopically.
The reason the swimming is causing pain is because it forces hip extension, which is putting pressure on some damaged tissue inside the joint capsule. Until they sew it back together, that will be the situation.
The shot had both corticosteroids and analgesic medicine in it. Analgesics for pain relief, corticosteroids to decrease inflammation. They have the same risk of prednisone for tendon damage, but what can you do? I can't walk well and need help right now.
Yes, everyone is in agreement on the surgery. However, I am having to deal with the whole GI bleed thing again. The orthopod normally does aspirin to prevent blood clots, but the hospital GI doctor said I couldn't take it because of GI bleed risk. The orthopod recommended consulting the PCP, who should have an overall view of things and could make a determination of risk and benefit. The PCP yelled at me about it, saying it was the surgeon's job. I've worked in healthcare for 14 years, and she's wrong. Normally, such a decision requiring an overview of the person's health to determine overall risk and benefit in complicated cases is in fact the job of the PCP. I asked what she would do in my position, and she told me it was up to me to decide what to do with my own medicines because she doesn't know and doesn't do surgery. She was angry and talking about how the surgeon needs to do his own job and how it was his office's fault for not telling me what to do and that it was within the scope of practice for an orthopod to decide the risk of blood clots versus the risk for internal bleeding in the GI track. From my experience, she is absolutely wrong....orthopods don't know that kind of thing, they only know the typical way to medicate to prevent blood clots in uncomplicated cases and they usually will refer out and consult with a generalist in complicated cases to determine overall risk and benefit and to clear for surgery. She then asked why I wasn't on medicine to protect against GI bleeds, I told her she said last time she got an email from the GI doctor with recommendations and that she decided not to follow it. She denied this, and I told her I didn't know if she got the email or not, only that it is what she directly told me last time I saw her. She asked again why I wasn't on medicine to protect my stomach, and I said, "I don't know, ask yourself....you decided against it last time."
I get tired of dealing with doctors yelling at me for their own ignorance and mistakes.....but the majority are good and nice and trying to help. Welcome to an underserved area of healthcare.View Thread
Don't worry about being out the loop; I just saw this and so I am also out of the loop. I had to cut expenses and disconnected my personal internet. Using a career service is a good idea, but this has been a financial hardship for me, so I may not be able to afford it. I spoke with a social worker and know the contacts in my state for vocational rehab. The challenge will be to find something that can use someone who can't walk so well and also sometimes can breath and sometimes can't. It may involve applying to social security disability, but I need to learn all of that. I'm also learning how to apply for various welfare type benefits. A friend of mine said she and her husband could have me live with them since I can't do my normal job physically, and since we are in an underserved area, it takes a long time to get into anyone. For example, the guy in the area that would be the best for what they think is happening schedules 3 months out....you have to wait 3 months just for the initial visit.
I honestly don't know what happened to the hip. The PT doesn't either, because it's just funky looking. It doesn't present like your normal degenerative osteoarthritis with a labral tear according to her, but the orthopods right now are continuing to look at it. They think it's bursitis with gluteus medius tendinopathy combined with labral tear and osteoarthritis....but the presentation isn't normal for that....they are thinking that based on MRI, but the MRI was hard to read in places. I changed orthopod practices and the new practice wants to inject the joint itself to see if that helps to verify it actually is a tear in the labrum since the MRI wasn't definitive, but only said, "suggestive of horizontal labrum tear". I rest it, then try to reintroduce activity like you should, only it flares back up. I'm damned if I do and damned if I don't. By rest, I mean literally laying all day and all night in bed or on the couch, expect for absolute necessities. I did this for 5 weeks, the pain went down, but never completely went away. Then, with the least bit of increasing activity very conservatively, it flares again. So, yes, you are right, it takes a long time to heal....but the PT said it was very odd because normally even a damaged hip would not flare back up with the stuff she was adding (ie, lay on the left side and lift the right leg without weights so the gluteus medius has to stabilize the pelvis a bit). This is hardly any exercise at all. She does not believe it will get better with PT alone, and from my own experience working in inpatient setting (each setting sees different diagnosis, which is why I thought it worth consulting an outpatient PT) I don't think so either. Right now, I'm swimming with a pull buoy as long as the hip doesn't scream at me and doing gentle exercise in the pool or laying down gravity eliminated again as long as it doesn't scream at me. I've been resting it to some degree (meaning doing less than my regular activity and listening to pain and altering activity) for 4 months now. I laid down on the couch basically continuously for 5 weeks. Overall, it's not getting better.
They put a shot into the bursa a week ago, so 80% of that pain went away. Later this week, another shot into the joint itself, see if it helps, then talk to a guy who does hip arthroscopic repair next week. PT says it will require more than PT and probably some type of orthopedic surgery. The orthopods are considering doing an arthroscopic repair of a probable labral tear because that doesn't heal on it's own. They said that it's cartilage, and does not respond to rest and ice like muscle and tendon do. The PTs I know concurred, saying the only way for the labrum to heal is for someone to go in and sew it back into place.View Thread
What you described I've run across in another form. Don't have a good answer, except to mention the ADA and reasonable accommodations, but that can also be hard. Is SCVRD South Carolina Vocational Rehabilitation Department? Just wondering...my state has a vocational rehab department and they are the main ones you go to to find about the ADA, so that would really ironic.View Thread
I assume you are talking about eczema or atopic dermatitis. I looked it up on youtube awhile back because the itching was driving me crazy. I found that using a humidifier (one that has controls to lessen the amount of mold that grows inside) and using Cetaphil cream after I bathe every day as well as triamcinolone acetonide (a topical corticosteroid) for break through sores really helps. I use antihistamine as needed to decrease itching. That's what worked for me, don't know if it will for you.
I don't know, though, you're talking about allergies on your face...if you haven't already, you might want to be sure it's atopic dermatitis...not to scare you but other diseases, like lupus, present as a rash on the face.View Thread
Sorry about the pain. It makes sense she would give you some pain meds. It seemed from reading your comment that she didn't know what was causing it and so was giving you something for pain as opposed to determining the cause. The only other thing I can think of to suggest is to get a second opinion either from another internal medicine doctor or a family practice person. A lot of things other than asthma can look like asthma. I'm not knowledgeable enough to know exactly what else it could be...cardiac or pleurisy as you say, or whatever. It doesn't sound like your present doctor knows what it is...no one doctor can know everything. I would get a second opinion.View Thread