As mentioned in a previous post, I had my file reviewed by Dr.Millis a few weeks ago. He came back telling me to cancel surgery until I get a second opinion from a colleague of his in Quebec City.
I was lucky enough to have the Qc City doctor read my file - and this very quickly - which isn't common practice in Canada. Here's what he had to say: - He agrees with Dr.Millis, I have hip dysplasia - No pincer FAI - Since my initial surgeon removed part of my labrum, he wants Dr.Nho to do reconstruction. Since no surgeon in Quebec does this, I'm hoping I'll be able to claim it to the government and get reimbursed - His impression is that arthroscopy will only partially relieve my symptoms as the underlying cause is dysplasia - He was very firm - do not remove any part of the acetabulum since I don't have pincer - He suggests going with surgery and seeing how it goes. If it resolves my symptoms - good. If not, I will probably need periacetabular osteotomy Wow. Not. what. I. was. expecting. I don't really know how to react to this. On one end, I'm happy that someone has finally confirmed it - and that it's backed up with another surgeon. But it's not what I had in mind. What's great is this doctor is willing to take me as his patient, when he usually doesn't since I'm from Montreal. His assistant put me on his waiting list today, so I should be seeing him in about 8 months. Classic Canada. Long wait times. An additional 8 months for surgery if it's needed. I don't know what to do...my plan was to start trying to have a baby once I was rehabbed from arthroscopy. But now I'm not sure anymore :( I don't think it's something I need to think about right now. I have more pressing matters to deal with right now. So I'm going to Chicago anyway since the Qc City surgeon didn't tell me to cancel. I'm going to let Dr.Stover know about all of this and see what he thinks. I really hope he agrees with this...I can't handle another diverging opinion. Sad that it came to this. But happy that I have an action plan in place.
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Well that's it folks, yesterday was my last wedding of 2015. I must admit I'm feeling relieved...working 10-12 hour days on my feet, crouched in crazy positions was getting more and more difficult on my hip, despite taking Celebrex. I had a great season though, with awesome couples and beautiful settings.
In one week, I will be in Chicago for my surgery with Dr.Nho. I'm supposed to get a call from the CPM machine company sometime early this week. I have to start printing out necessary information. Plan what to pack (which I will post in a few days). All on top of working full time at the studio. It's going to be a hectic week. I feel my body is exhausted...I'm going to have to drink tons of fluids and get as much sleep as possible. I don't want to get sick!!!! I'm starting to feel nervous. I had a few nightmares in the past few days. Including one where I was about to go into surgery and decided to get coffee. And then I couldn't find the clinic! And for some weird reason, it was in a mall. And I was panicking "NEAR WHICH STORE IS IT????!!!!" Hahaha. I'm not sure if it's a sign I'm nervous for surgery or if I need to go shopping some more 😁 Wellll...still no development in the file review department.
I called Cynthia from Dr.Millis' office in hopes of getting my hands on the report that explains why he wants me to cancel surgery with Dr.Nho. It's still not typed. Ugh. Dr.Millis is away for the next two weeks...so yeah, I'm not even sure if I'll have access to the report. Also got in touch with Dr.Sink's office, and they didn't receive my file yet. She said to call back on Monday. She reassured me they would have it reviewed before my surgery date. Today I told my PT about the whole "call off surgery" situation and how I'm running like a mad woman to get last minute dysplasia specialist opinions. He brought such a valid point - the more doctors I consult, the more conflicting opinions I will get. Since my case is so borderline, some "safer" doctors will prefer to say to skip revision scope while ballsier doctors will be all "naaaaaaaaah, ya gooooooood" So he told me to stop. That I'm going to drive myself crazy. And he's right. So I'll see if I hear back from Millis, Sink and Belzile next week, but I'll not to freak about it. He also pointed out that these doctors are evaluating my file only. Purely radiographic. That a true evaluation needs to have a physical exam. And the possibility to ask questions directly to the patient. So yeah, felt good to hear that. Dr.Nho's PA emailed me today saying she re-calculated my CE angles, which is 26.7 on the right and 28.2 on the left. Normal values are between 25-40. So I'm within normal limits/low end normal. She also checked with Dr.Nho, who agreed with her. No evidence of dysplasia according to them. I'm slowly gaining back all the confidence to go forward with surgery. Which is a good thing considering it's in 11 days!!!! AHHHH!!! I was a bit stressed out today so decided to go out for some last minute shopping. Hey, I needed a jacket for my trip to Chicago! NEEDED I TELL YOU! Today I called the dysplasia specialist in Quebec City to check if they received my file. I explained I'm flying out to Chicago on the 24th, and asked if it would be reviewed before then. The surgeon's assistant explained he would only see Dr.Belzile next Wednesday, so to give him a call then.
He understands I'm in a tight spot with the fact I'm leaving a few days later and that I'm about to spend thousands of dollars on arthroscopic surgery. I told him that if ever Dr.Belzile strongly disapproves with surgery due to dysplasia, I would definitely consider cancelling. Definitely helps to know I will also hear from Dr.Sink at HSS, and Dr.Stover in Chicago...I'm hoping I'll be able to feel confident with my decision to go forward with Dr.Nho. It's just really stressful that it's all happening two weeks before scheduled surgery. Would of preferred to deal with this with a looser timeframe. I have a feeling I'll be cleared for surgery though...3D CT Scan says no abnormality in the acetabular coverage and the exam was interpreted by a radiologist specialized in the musculoskeletal system and sports medicine imaging. Fingers crossed. Not sure I can deal with other issues than FAI. Especially if I'm indeed dysplastic, I'll only be borderline or mild...which I'm pretty sure has no solution as PAO is probably too invasive for this level of dysplasia. I just can't deal with being told to suck it up until I need a total hip replacement. I think this is the first exam in four years - out of one MRI, three MRAs, several X-Rays, a different CT Scan - that mentions femoroacetabular impingement. I knew labral tears don't happen on their own, but XR after XR...everything came back normal. Shows that FAI is still a relatively new thing, and not all radiologists keep an eye out for it. So there it is, cam FAI. Dr.Nho said I also have pincer impingement, supported by a crossover sign on my AP view XR.
Side note, you need to know the cause of your tear before surgery and make sure that it gets addressed. Remaining cam or pincer is one of the main causes for arthroscopy revisions, from what I've read anyway. I'm hoping the joint space narrowing is simply post-op changes, as Dr.Nho had mentioned in the past. At my first PO MRA, the radiologist confirmed cartilage thinning of less than 50% - which had me worried revision arthroscopy wouldn't help. Dr.Nho reassured me by explaining I did not have any cartilage thinning save for what they usually consider post-surgical changes. The only way to really know is once they'll be in the joint...if they notice any wear and tear, they'll be able to go ahead with microfracture to encourage fibrous bone growth. My surgery is now in two weeks. I'm still hoping to hear back from the dysplasia specialist in Qc City. They received my file today and I'm going to be that annoying patient that calls everyday to see if they have any news. If not, I'll be putting my faith in the hands of Dr.Stover in Chicago. 10 days until my flight to Chicago. 14 days until surgery. Today I'm having my drug provocation test to check if my skin rash is indeed due to Celebrex. I took three capsules so far without knowing if they're placebos or the actual medication. I feel my arm is getting itchy but I think it's just my mind playing games. Guess I'll see how things go, I'm still stuck here for a few hours.
My PT would like for me to get back on NSAIDs as he believes it has an effect on limiting my pain. He feels that without it my hip becomes irritated much faster. So we'll see. I'm supposed to get my 3D CT scan results today. I'm afraid of what it'll say. I'm afraid it'll say everything is normal because the I'm afraid doctors will think my pain is not real. I'm afraid it'll say that I have dysplasia, meaning I may not be able to get surgery. The worst is that no report is ever the same. It's definitely a hard thing to accept, especially when you're the type of person that needs to know everything, all the time. A few months ago, I started seeing a second physiotherapist to give dry needling a try. I had previously done acupuncture with no clear relief (same with osteopathy and chiropractics), but I had heard from several people where dry needling helped them. Luckily enough, the clinic I work at offers physiotherapy and the owner came highly recommended. I like to think that I'm a pretty tough cookie. I've had 5 hour tattoo sessions where I fell asleep on the table. I once broke a rib during a basketball game and kept playing. I barely took any pain medication following my first hip surgery. But dry needling? OMG. OK OK, awesome women who had children with no epidural, I'm not saying this is worse. But wowza. Every single time (which is once a week), I have to bite into my scarf or dig my fingers into the bed to avoid swearing out loud. My PT explained what the process is. In my case, my ongoing injury has caused my surrounding muscles to compensate. He explained that muscles constantly send signals to the spinal cord, and this information relays back at how much natural tension should be kept within the muscle. Over tense muscles - following injury for example - will send wrong signals and the spinal cord's response will be "stay contracted". So the issue isn't simply within the muscle, but is now also neuromuscular. Dry needling acts like a reset button. It'll send a signal to the spinal cord to basically tell it "yo, relax." And wow, does that work. For me anyway. When the session is done, my muscles feel so relaxed/loose that it's almost as if they weren't working. And the best thing is that the following week, they often stay relaxed. Or if I was busy, they're a bit tense but nothing compared like what it could of been before. He usually inserts the needle deep into the muscle, goes in and out, and then removes it. Yesterday he left them in for 15 minutes. He said the first technique is more to jolt the system, and treat more aggressively. The second acts more slowly, and might have a slow releasing effect which hopefully will be useful since I had bad, painful week. I don't say that this is the solution to every problem, but after trying so many things to help relieve my hip pain...I'm happy that this seems to work well. Now I add foam rolling to help maintain what we gain, and he also tapes my IT band which gets pretty tight these days. I'm writing this laying in my bed. I realize that I'm unable to stay comfortably seated in our sofa. Sitting with my legs up on the ottoman, switching to crossed leg sitting, then slouching into the couch...no position is comfortable for more than 5 minutes. And this is pretty annoying. Good news? SURGERY IS IN THREE WEEKS. THREE. TROIS. I cannot believe how fast time seems to be going. In three weeks, I'll be starting a new chapter, and hopefully the last one in this hip saga. In three weeks, I'll be in Chicago, only a few hours post-op in my little apartment room. Seems so unreal. Today Cynthia, Dr.Millis' administrative associate, called me to discuss his findings. For those who don't know, I sent my file to Dr.Millis who's a hip dysplasia specialist.
Rewind. 4 months post-op. I asked my surgeon to look at my X-Rays. He had never looked at my Xrays, nor MRIs pre-op. When he pulled up the films, his resident said "is that a crossover sign? Pincer impingement?" - Yes. Yes there's indeed FAI, but what bothers me most is the dysplasia" That was the first time I heard the word "dysplasia". He said it's very mild. At my 6 months PO visit, my symptoms worsened and I asked about revision surgery. To which he explained he didn't think revision surgery would help because of my dysplasia. That arthroscopy would not address the instability issues created by dysplasia. That his solution was NSAIDs until the day I need a hip replacement, as my dysplasia is too mild for a PAO. Back to my first paragraph. Cynthia said Dr.Millis re-reviewed my file and wants me to call off my surgery with Dr.Nho. She explained that Dr.Millis even consulted with his colleagues to have their opinion about my file. They did not all agree about my films, but she said they agreed that I should call off the surgery. Dr.Millis wants me to consult a hip specialist in Quebec City. I don't understand why they don't want me to go see Dr.Millis directly. Since he and his colleagues did not agree on my diagnosis, I'm guessing he wants me to see another specialist for another opinion. I asked Cynthia why he wants me to call off surgery and she said the report wasn't in the computer yet so I need to call back next week. But my guess is there's more to my hip than just FAI. This hit me like a tons of bricks. Not only was everything planned - flights booked, accommodation booked, surgery booked - but this has been the light at the end of my tunnel. This was the hope I was so desperately holding onto. After almost a year after an unsuccessful surgery, I have been counting down the days to the beginning of this new chapter of my life. I had finally found a surgical team that I fully trust, and I couldn't wait to be post-op day 1, day 2, day 3...and back to my active life. But now everything is on hold. I never expected Dr.Millis' office to tell me to cancel surgery. I was SURE they'd say "no dysplasia, all good for surgery" as no one but my surgeon + one radiologist had ever mentioned it. Not one other time in the countless numbers of Xrays, MRIs and MRAs. I called Dr.Millis' recommendation in Quebec City. I had no hope. Seeing a specialist in Canada usually takes one year, even more sometimes. I explained my situation, and was told: "You're from Montreal? We don't take Montreal patients as we're already covering a large territory around Quebec City. We refer Montreal patients to Dr.X" Dr.X is the surgeon that performed my surgery. I was completely discouraged. Dr.X clearly cannot help me further. I begged the Dr's assistant for his help. He made an exception. He told me to send my file. That he'd have it reviewed so that I could get his impression to know if I'm OK to go forward with surgery. And that if he had he need to see me, I could go in for a consult. So there is hope, right? I'm just so worried I won't hear back before I fly to Chicago. I wish I would have a clear idea to where this is going. My friend and PT today told me it's like I'm river rafting. I never know which direction my boat will take me. And that it's never predicable. It's been the story of my life - hip wise anyway. I cried all evening long. I was not expecting this. I didn't want this. And I don't know where this is going. My allergy test tomorrow sounds so irrelevant right now. Everything feels irrelevant right now. I feel like giving up. I know I won't, but right now I want to. What's even more frustrating is I now wonder what my surgeon would have said and most importantly, what he would have done if he had looked at my films before surgery. Maybe I would of never had surgery in the first place. I would not have gone through the past 8 months of pain, worsening symptoms. I'm so completely lost right now. This morning I had my 2nd CT scan done. Yup. 2nd. I had one done a month ago at the Montreal General but when I picked up the CD/report I realized they didn't make it in 3D as asked by Dr.Nho. Since surgery is in three weeks, I had to go to a private radiology clinic if I wanted the test done on time. The exam went well...the technician was really nice! He seemed pretty surprised when I told him I wasn't nervous as I already had one MRI, three contrast MRIs and one CT scan done in the past. The radiologist - Dr.Desmarais - made the 3D conversions in a few minutes and I walked out the doors with a USB key with all my images.
I looked over the images with my PT and we did seem to notice acetabular overcoverage in my right hip. Would correlate well with the crossover sign found on my Xrays. I'm supposed to get the report sometime within the next 24-38 hours...so I'll see what it says. Well I'm off to bed...tomorrow I'm going apple picking with a friend. Semi-day off...yay! Hoping my hip collaborates. Twenty three days. 23 days until revision surgery. I honestly cannot wait to get it done. The last few days were tough. I photographed a rehearsal dinner on Friday, then a wedding on Saturday, then an engagement session yesterday. All the walking, squatting, going up/down stairs/mountains has put a lot of stress on my hip and it's clearly letting me know that its unhappy about it. Since I'm still on hold for any anti-inflammatories (possible allergy to Celebrex), I'm taking Tylenol...which is pretty much as useful as drinking a tall glass of water. This morning I woke up at 5am, in pain, unable to fall back to sleep. I got up and walked around in hopes to feel better, but each step would create a sharp pain in my joint. Dr.Nho said there's possibly a re-tear on my PO MRA and I wouldn't be surprised if that's what's causing the pain and catching. I'm happy to know he'll be able to repair or reconstruct if ever necessary. Couldn't be in better hands. I decided to get up and have breakfast, as pictured. Did you know there's now REESES SPREAD?!? It's basically like putting cake frosting on toast. Not the healthiest option for sure...but once in a while is fine, right? Anyway, this week is pretty busy as tomorrow I'm having my 3D CT scan. I will finally have imaging for version analysis and bony growths - which will both be useful for Dr.Nho in the operating room. I also need to get my pre-op labs done. And I have my drug provocation test on Friday to rule out NSAID allergies. Every day is one step closer to getting back my normal, active life. Happy that I'll be getting surgery during the fall this time around. Last year, having surgery a few days before Christmas was so tough, with family dinners, New Year's parties, crutching through ice & snow. At least now I'll be able to get out of the house without risking my life lol. I love fall. The colours are starting to make their appearance. Love the view from my living room. |
AuthorMy name is Marie-Christine. I'm 34 years old and live in Montreal, QC, Canada. I have had two failed hip scopes on my right hip to do undiagnosed hip dysplasia. My amazing surgeon, who is in Quebec City, performed periacetabular osteotomy in November 2017. He also did one left hip scope (non dysplastic) in February 2017. Archives
May 2018
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