I met with the surgeon...and my head is spinning.

I don't know why I was so nervous to meet with Dr. Guanche this morning, but I was uncharacteristically anxious. I arrived 10 minutes before my scheduled check-in time, and about a half hour later, I was given the necessary paperwork to fill out. Needless to say, the office was incredibly busy this morning. I was finally called back to meet with the doc, and offered whatever combination of MRIs/X-Rays/medical records they wanted. (I've got both the films and the electronic images). The assistant made copies of the reports of the MRI and Arthrogram, and uploaded the images from the discs. Meanwhile, I was given some disposable shorts to change into, and I had a very short wait. I realized that even though I had printed out a long list of questions to ask, I had inadvertently left that at home, so I quickly tried to reconstruct that list. Then doc came in and introduced himself.

To his credit, he asked me to explain the onset of the injury and where the pain is. (Always an annoying question to me, since I feel like an idiot when I say, "I really can't pinpoint the pain. It seems to move around, sometimes in the groin, sometimes in the front, sometimes in my butt, sometimes on the side...I just don't know.") He asked me about popping/clicking, and I said I didn't know if the sensation I experienced counted (I get what feels like when you crack your knuckles, but in my hip -- no associated pain with that though). He seemed to think my description was useful. I tried to recreate it, but of course, that was the one time my hip didn't crack.

I really appreciated that he performed his own full physical evaluation of my hip pain (i.e., range of motion test, etc.) instead of reviewing and relying on the notes from my referring orthopedists. That gave me some confidence. And apparently I'm pretty consistent -- the same positions caused that searing pain with prior exams were the ones that made me cringe this morning.

He showed me some images from my x-rays and MRIs (not sure if it was the regular MRI or the arthrogram), and explained that, not only do I have a labral tear, I also have a combined CAM and Pincer FAI.This was what I feared. It suddenly feels like a much more serious surgery -- removing a bit of my bone!!! I'm not sure why that scares me more than removing some of the cartilage, but it does. It feels so much more structural. And I'm a little concerned that this is the first I've heard of that. Neither my MRI nor Arthrogram Reports indicated the presence of FAI. To the contrary -- my lay man's reading of the reports made me think that there was no indication. (The arthrogram noted "There are no morphologic changes of the acetabulum or proximal femur to suggest primary CAM or pincertype femoroacetabular impingement.") So, I'm scared, I'm confused and I'm concerned. Why the discrepancy? Of course, I didn't remember what was in the report while I was meeting with Dr. Guanche, so I didn't ask him about it. He did show me on the images where he thought the FAI was.  But when I looked online at x-rays of normal hips compared to mine, I just don't know if I see it.

I did my usual skimming of google and came by a website with a roundtable discussion amongst orthopods about FAI and how they're being diagnosed more often, and how 86% of labral tears are associated with combined CAM and Pincer FAI. http://www.orthosupersite.com/view.aspx?rid=40509   That made me feel a little better, that this isn't coming from left field. And that my combination is not particularly rare.

Dr. Guanche took time to answer all of my questions, and I asked him everything I could remember to ask. I did remember to ask him about his feelings about the Game Ready ice machine and CPM machine that I've heard so much about. He said that over the past few months, he's been recommending devices like the Game Ready machine, but that he still has concerns with recommending the CPM machine, because it requires you use if for 8 hours (and most of his patients don't have that ability to do so given the need to return to work, etc.) and that he's concerned that if you slightly adjust your hips, it can actually rotate the hip slightly (and I suppose do more harm than help). The rest of what he told me sounded like what I expected. He told me that he performs approx 250 of these surgeries per year. (I forget when he started, 15 or 17 years ago?) He said that of those 250, annually, there are generally approx 2-3 that need revisions due to complications (scar tissue, etc) and unfortunately there's no way to know whether you're going to be one of the few upfront. I asked a lot about the physical therapy protocol, and I liked the fact that some of my PT would be in the pool. He said within 6 months, I should be able to resume my training, and when I mentioned my love of pilates, was very enthusiastic about my doing it pre-surgery and then (when ready) post-op. He said there were a few positions that would cause me discomfort for now, but most of it should be doable.

He was definitely not Mr. Gloom and Doom with the risks and side effects of surgery. I assume all of that is detailed in the reading materials he gave me, and probably in the pre-op appointment when I'm sure I will have to sign away my life in various legal documents. But truly, I expected a little more of the this-is-a-risky-procedure kind of speech.

After meeting with the doc, I met with the person who schedules surgeries and deals with insurance companies. She told me that most often, insurance companies deny this surgery because they consider it "experimental" or "investigative." They seek pre-authorization, and if it doesn't go through, you can of course appeal it, they will write a letter, but most often, it seems, patients pay out of pocket, and then after the surgery, mail to the insurance company the records from the procedure (showing it was not unnecessary) and sometimes the insurance company will then cover the procedure. But it's not cheap. I got a quote for the facility and doctor, but not the anesthesiologist or any of the physical therapy (which would be 3x/week for 12 weeks, and which I'm certain is not covered substantially by my plan), and I already had sticker shock. It certainly gives me pause. If and when I decide to do the surgery, they would start the process with my insurance company. But I didn't set a date because I am still waiting to get a second (and third) opinion.

I realistically can't do nothing. I'm in way too much discomfort for that. And I'm prevented from doing so much. And for the things that I can do, the pain still gets in the way. It's a constant. But I'm particularly concerned about what happens if this is in fact, CAM and Pincer FAI with the labral tear. I highly suspect I already have a small tear in my other hip, and if it's a bone structure thing -- that makes me think I'll probably end up down this road again at some point trying to fix that hip too.

So, the best I can do is to continue to get more information, continue to try to be healthy and to take each day at a time. I look forward to finding out if the other specialists also think I have FAI.