Showing posts with label torn labrum. Show all posts
Showing posts with label torn labrum. Show all posts
Tuesday, January 10, 2012
new beginnings...new blog
I have three current blogs. That's a bit too much to update on a regular basis, so given that I don't have much to say about my labrum that I haven't already said...if you're curious what I'm up to these days, feel free to check out my training blog (http://trainforamarathon.blogspot.com/) and my weight-loss blog (http://my75in365.wordpress.com/).
Monday, July 12, 2010
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.
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.
Tuesday, June 29, 2010
Waiting. Sucks.
I'm not the world's most patient person. I hate waiting for appointments. I know that waiting two more weeks to see the surgeon means I have two weeks more till I can schedule a surgery. Which means that the earliest I can schedule said surgery has also been delayed by two weeks (minimum). I suppose there are many more problems that are of much greater significance. But I'm anxious to get on my way to recovery.
I did manage to get the paperwork for the temporary handicap placard. My general physician was able to sign off on it, having reviewed the extensive amount of documentation I faxed to him. But of course, DMV services were down this morning when I tried to actually get the placard, so I need to try again tomorrow.
Yesterday, I ordered a waterproof case and headphones for my Ipod Shuffle (2nd gen) to keep me excited about swimming. Of all of the sports out there, swimming just isn't my calling. On the other hand, since it's pretty much all I'm able to do at the moment, I am desperate to find a way to make it interesting. I'm hoping that books on tape or some good music helps.
So far I have been calling Dr. Guanche's office each day and trying to get an earlier appointment. They keep telling me that I should keep calling back because people cancel all of the time, and, because they don't keep a standby list. Despite my pleas of desperation yesterday, there were no earlier appointments and I'm getting concerned with how follow-ups might be treated and scheduled post-surgery with Dr. Guanche.
I haven't heard back yet from Dr. Philippon or anyone in his office. But based on what I was told last week, I shouldn't expect to hear from them until Friday at the earliest, and, given the holiday, probably next Tuesday.
So in the meantime, I'm trying hard to focus on work and on anything other than the pain and the knowledge that I have a labral tear that I'm trying not to make worse. But it's like anything I tell myself not to think about....suddenly it's all I can think about.
I did manage to get the paperwork for the temporary handicap placard. My general physician was able to sign off on it, having reviewed the extensive amount of documentation I faxed to him. But of course, DMV services were down this morning when I tried to actually get the placard, so I need to try again tomorrow.
Yesterday, I ordered a waterproof case and headphones for my Ipod Shuffle (2nd gen) to keep me excited about swimming. Of all of the sports out there, swimming just isn't my calling. On the other hand, since it's pretty much all I'm able to do at the moment, I am desperate to find a way to make it interesting. I'm hoping that books on tape or some good music helps.
So far I have been calling Dr. Guanche's office each day and trying to get an earlier appointment. They keep telling me that I should keep calling back because people cancel all of the time, and, because they don't keep a standby list. Despite my pleas of desperation yesterday, there were no earlier appointments and I'm getting concerned with how follow-ups might be treated and scheduled post-surgery with Dr. Guanche.
I haven't heard back yet from Dr. Philippon or anyone in his office. But based on what I was told last week, I shouldn't expect to hear from them until Friday at the earliest, and, given the holiday, probably next Tuesday.
So in the meantime, I'm trying hard to focus on work and on anything other than the pain and the knowledge that I have a labral tear that I'm trying not to make worse. But it's like anything I tell myself not to think about....suddenly it's all I can think about.
Thursday, June 24, 2010
How many doctors is too many?
So I looked at my schedule and realized that I had appointments with three local surgeons and one out-of-state surgeon. That felt a little much, given that the originally recommended surgeon will likely be excellent, and my backup out-of-state surgeon is probably easily sufficient for a second opinion. Do I need a third? Or a fourth?
Ultimately, I may. But given that I haven't even gotten a single opinion yet, I decided that I should cancel the first appointment. Nothing against Dr. Snibbe. His credentials looked amazing, and he appears to have performed this surgery ample times. He appears to be board-certified, which sounds impressive, though I'm not actually certain what that title specifically entails. But given the great things I've heard about Dr. Guanche, the surgeon to whom I was specifically referred, I decided that I'd wait until I see him before going for a second opinion.
So I'm currently scheduled to see Dr. Guanche in the middle of July. I keep calling the office to see if they've had any cancellations, but the best I've been able to do is to move my appointment ahead by one day.
In the meantime, my pain has gotten worse and I'm miserable. I seriously am running out of patience and I just want to get my full range of motion back. Dr. Klapper, another surgeon with whom I've scheduled an appointment (at the end of July) co-wrote an excellent book I've been reading on hip care (called Heal Your Hips). In it, he and Linda Huey provide a set of exercises to perform in water as well as on land. I'm looking forward to trying them out (though I need to copy and laminate the page or I'll ruin the book at the pool).
But I am concerned that maybe I should have kept my appointment with Dr. Snibbe. Seriously, how does a person choose a surgeon? Is it overkill to seek a second opinion? a third? a fourth? It seems indulgent to do so, but on the other hand, it's my hip. And I'm young. I want to maximize my chances of having the best possible outcome.
It's pretty scary.
Ultimately, I may. But given that I haven't even gotten a single opinion yet, I decided that I should cancel the first appointment. Nothing against Dr. Snibbe. His credentials looked amazing, and he appears to have performed this surgery ample times. He appears to be board-certified, which sounds impressive, though I'm not actually certain what that title specifically entails. But given the great things I've heard about Dr. Guanche, the surgeon to whom I was specifically referred, I decided that I'd wait until I see him before going for a second opinion.
So I'm currently scheduled to see Dr. Guanche in the middle of July. I keep calling the office to see if they've had any cancellations, but the best I've been able to do is to move my appointment ahead by one day.
In the meantime, my pain has gotten worse and I'm miserable. I seriously am running out of patience and I just want to get my full range of motion back. Dr. Klapper, another surgeon with whom I've scheduled an appointment (at the end of July) co-wrote an excellent book I've been reading on hip care (called Heal Your Hips). In it, he and Linda Huey provide a set of exercises to perform in water as well as on land. I'm looking forward to trying them out (though I need to copy and laminate the page or I'll ruin the book at the pool).
But I am concerned that maybe I should have kept my appointment with Dr. Snibbe. Seriously, how does a person choose a surgeon? Is it overkill to seek a second opinion? a third? a fourth? It seems indulgent to do so, but on the other hand, it's my hip. And I'm young. I want to maximize my chances of having the best possible outcome.
It's pretty scary.
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