About
1. ASL?
I'm a 31 year old girl from Montreal, QC, Canada
2. What was your diagnosis?
In 2014, I was diagnosed with a 3-12 o'clock labral tear in my right hip
3. How bad was your pain? Was it debilitating?
My pain was never debilitating. Daily life was usually with a deep dull pain of approximately 2-3/10. Sport activities would bring that up to 5-6/10. On bad days, it could go up to 8/10.
4. What sports were you into?
At first I was a spinning instructor. But then it became too painful and I had to give it up. I had the opportunity to start training with Jo Hamel, who offered fun, intense circuit training. I'd train with him 4x/week and do boxing 2x/week. I was quite limited in the end...wasn't able to do crunches, deep squats, lunges...even planks were painful. Any internal rotation (right uppercut for example) created a sharp, stabbing pain in the groin.
5. Did you have a cortisone injection?
Yes. One in November 2014 with 100% relief during three weeks. One in June 2015 with 100% relief for one week.
6. Did you try conservative treatment?
Yes. I tried kinesitherapy, osteopathy, chiropractics, acupuncture and physiotherapy. Some would relieve the pain but it would only be temporary.
7. What was your first surgery?
I had hip arthroscopy in Montreal on December 19th 2014. I had labral debridement.
8. Did your symptoms improve?
Unfortunately not. After 6 months, my initial symptoms remained and kept worsening despite intensive physical therapy and modified activity (no return to sport)
9. What did your surgeon say?
Four months after surgery, my surgeon diagnosed me with mild hip dysplasia. He decided revision wasn't an option. His suggestion was to take NSAIDs as well as Tylenol until the day I needed a hip replacement.
I'm a 31 year old girl from Montreal, QC, Canada
2. What was your diagnosis?
In 2014, I was diagnosed with a 3-12 o'clock labral tear in my right hip
3. How bad was your pain? Was it debilitating?
My pain was never debilitating. Daily life was usually with a deep dull pain of approximately 2-3/10. Sport activities would bring that up to 5-6/10. On bad days, it could go up to 8/10.
4. What sports were you into?
At first I was a spinning instructor. But then it became too painful and I had to give it up. I had the opportunity to start training with Jo Hamel, who offered fun, intense circuit training. I'd train with him 4x/week and do boxing 2x/week. I was quite limited in the end...wasn't able to do crunches, deep squats, lunges...even planks were painful. Any internal rotation (right uppercut for example) created a sharp, stabbing pain in the groin.
5. Did you have a cortisone injection?
Yes. One in November 2014 with 100% relief during three weeks. One in June 2015 with 100% relief for one week.
6. Did you try conservative treatment?
Yes. I tried kinesitherapy, osteopathy, chiropractics, acupuncture and physiotherapy. Some would relieve the pain but it would only be temporary.
7. What was your first surgery?
I had hip arthroscopy in Montreal on December 19th 2014. I had labral debridement.
8. Did your symptoms improve?
Unfortunately not. After 6 months, my initial symptoms remained and kept worsening despite intensive physical therapy and modified activity (no return to sport)
9. What did your surgeon say?
Four months after surgery, my surgeon diagnosed me with mild hip dysplasia. He decided revision wasn't an option. His suggestion was to take NSAIDs as well as Tylenol until the day I needed a hip replacement.
Care in Canada
1. Did you try to seek care elsewhere in Canada?
Yes. Since this would be my second surgery, I wanted to have a very experienced surgeon with FAI. I called Dr.Johnston's office in Calgary, AB. Dr.Johnston is - to my knowledge - the only surgeon to perform labral reconstruction in Canada.
2. How long was the wait time with Dr.Johnston?
In the public system, I was told it could be up to two years for the consult.
3. Have you heard of other "good" FAI surgeons in Canada?
I've heard good things of Dr.Beaule, Dr.Ayeni and Dr.Wong but didn't look into any of them
Yes. Since this would be my second surgery, I wanted to have a very experienced surgeon with FAI. I called Dr.Johnston's office in Calgary, AB. Dr.Johnston is - to my knowledge - the only surgeon to perform labral reconstruction in Canada.
2. How long was the wait time with Dr.Johnston?
In the public system, I was told it could be up to two years for the consult.
3. Have you heard of other "good" FAI surgeons in Canada?
I've heard good things of Dr.Beaule, Dr.Ayeni and Dr.Wong but didn't look into any of them
Care in the US
1. Why did you want to seek care in the US?
Because I could not/did not want to wait over a year to see a new surgeon. Being inactive was making me miserable, working was becoming more and more painful and I want to eventually start a family (and have my hip issues resolved). I also knew surgeons in the US are much more specialized in hip arthroscopy than in Canada.
2. What do you mean, more specialized?
Labral reconstruction, for instance. Also, capsule work. My post-op MRA showed abnormalities in the capsule and when I asked my surgeon about it, he said there was nothing to do. In the US, several surgeons practice capsule plication - where they close the hole or reconstruct from graft if needed.
3. Is it covered by the government?
It can be. Protocol varies from province to province. In general, you need to have an orthopedic surgeon who practices arthroscopy write a letter saying you cannot get the care needed in Canada. Either the technique needed isn't offered here or the wait time is too long it will cause irreversible damage to the joint.
4. Where to start?
Several surgeons in the US offer free file reviews. This will allow you to get an opinion on your radiographic exams and see if surgery is a good option. For FAI there's Dr.Philippon in Vail, CO and Dr.Shane Nho in Chicago, IL. For dysplasia, there's Dr.Millis in Boston, MA...but I recently heard there's now a fee with him.
5. If government funding is denied, how much should one expect to pay for hip arthroscopy?
It varies widely from surgeon to surgeon. From what I've shopped around, surgery (facilities + anesthesia + surgeon fee) can go between $15000 to $70000USD.
Because I could not/did not want to wait over a year to see a new surgeon. Being inactive was making me miserable, working was becoming more and more painful and I want to eventually start a family (and have my hip issues resolved). I also knew surgeons in the US are much more specialized in hip arthroscopy than in Canada.
2. What do you mean, more specialized?
Labral reconstruction, for instance. Also, capsule work. My post-op MRA showed abnormalities in the capsule and when I asked my surgeon about it, he said there was nothing to do. In the US, several surgeons practice capsule plication - where they close the hole or reconstruct from graft if needed.
3. Is it covered by the government?
It can be. Protocol varies from province to province. In general, you need to have an orthopedic surgeon who practices arthroscopy write a letter saying you cannot get the care needed in Canada. Either the technique needed isn't offered here or the wait time is too long it will cause irreversible damage to the joint.
4. Where to start?
Several surgeons in the US offer free file reviews. This will allow you to get an opinion on your radiographic exams and see if surgery is a good option. For FAI there's Dr.Philippon in Vail, CO and Dr.Shane Nho in Chicago, IL. For dysplasia, there's Dr.Millis in Boston, MA...but I recently heard there's now a fee with him.
5. If government funding is denied, how much should one expect to pay for hip arthroscopy?
It varies widely from surgeon to surgeon. From what I've shopped around, surgery (facilities + anesthesia + surgeon fee) can go between $15000 to $70000USD.
Dr.Nho - Midwest Orthopaedics at Rush
1. How did you find out about Dr.Nho?
Through the Hip Impingement Support North America group on Facebook. A fellow Canadian informed me of her process - from getting poor treatment in Ontario to surgery with Dr.Nho. She gave me so much information - useful information - that brought me to where I am today. This is why I created this blog - hopefully I can help someone the same way she helped me.
2. What was the initial process?
I sent my file (XRs/MRAs) by mail. Two-three weeks later, I received a call from Sara - one of Dr.Nho's PAs (physician assistant) with Dr.Nho's impressions. I then emailed Jeannie - their administrative assistant - to get a quote for his services. Once I decided to move forward with surgery, everything was quick and easy. I booked the initial consult and surgery date.
3. How soon could you have surgery?
I could of had surgery 3 weeks later (I booked a few months later so I could get all my work done)
4. Did you have to fly to Chicago for the initial consult?
I flew in a few days before surgery and had my consult the day before.
Through the Hip Impingement Support North America group on Facebook. A fellow Canadian informed me of her process - from getting poor treatment in Ontario to surgery with Dr.Nho. She gave me so much information - useful information - that brought me to where I am today. This is why I created this blog - hopefully I can help someone the same way she helped me.
2. What was the initial process?
I sent my file (XRs/MRAs) by mail. Two-three weeks later, I received a call from Sara - one of Dr.Nho's PAs (physician assistant) with Dr.Nho's impressions. I then emailed Jeannie - their administrative assistant - to get a quote for his services. Once I decided to move forward with surgery, everything was quick and easy. I booked the initial consult and surgery date.
3. How soon could you have surgery?
I could of had surgery 3 weeks later (I booked a few months later so I could get all my work done)
4. Did you have to fly to Chicago for the initial consult?
I flew in a few days before surgery and had my consult the day before.
My revision surgery
1. Did your government pay for the surgery?
Unfortunately not. My first surgeon said arthroscopy would be useless because I have dysplasia. He also did not believe me when I said I had cam impingement. This is based on my first MRA report that said I have an alpha angle of 48 degrees (my alpha angle was actually 63 degrees, confirming cam impingement) So I could not get a letter from him. I tried going to the first orthopedic surgeon I saw, but he refused to write a letter since he does not practice arthroscopy. I've been on a waiting list to see another OS in Quebec that does hip scopes...still no news (and no guarantee she would write one). That's why I decided to take matters - i.e the cost - into my own hands.
2. How did you find the funds?
Luckily, I had saved up the money for a future downpayment on a house. Hip > House
3. How about your hip dysplasia? Isn't hip arthroscopy contraindicated in that case?
Luckily, Dr.Nho wasn't concerned by hip dysplasia. They encouraged me to seek advice from dysplasia specialists so that I could be confident with my choice of moving forward with a hip scope. I had my file reviewed by Dr.Millis as well as a dysplasia specialist in Quebec City. Both confirmed mild dysplasia. I also took an appointment with Dr.Stover, a hip dysplasia specialist in Chicago.
4. How did it go?
Dr.Stover is simply amazing. I had a consult with him two days before surgery for a second opinion. I've seen a LOT of doctors in the past four years and Dr.Stover did the most thorough physical exam. He checked for hypermobility, evaluated my gait/ROM and went over my XRs/MRIs. He spent so much time explaining his findings and made sure we clearly understood everything. He confirmed hip dysplasia but that it's very mild. His opinion is that my symptoms point more towards FAI and that he believes I would benefit from arthroscopy with Dr.Nho. If ever there's a recurrence of symptoms or a re-tear, then we can consider instability as the cause and treat accordingly (periacetabular osteotomy). I highly recommend Dr.Stover to anyone dealing with or suspecting dysplasia. He and his PA were great.
5. How about Dr.Nho?
My consult with Dr.Nho was one day before the scheduled surgery. I started by seeing the fellow working with him, and then Dr.Nho came in. He was really thorough, going over my exams and showing me on screen where the cam impingement was, and where there seemed to be a tear. He answered all my questions, including the chances of returning to impact sports - which he feels very confident is possible. He even gladly looked at my left hip MRA and unfortunately showed that there's also a small tear on that side. I never felt rushed and he really gave me his undivided attention. He was so calm and attentive. He made sure we went through everything, which we really did and I knew I made the right decision to have surgery with him. Then Leah and Sara - both of his PAs - came in and quadruple checked for remaining questions, and I was set! Talk about being in great hands!
6. How about surgery day?
I was scheduled for 11am and had to arrive at 9:30am. We took the pink train and the bus to the Water Towers (Gold Coast Surgicenter - right on Michigan Ave). I changed into a gown, warm socks and the sexy bonnet. The nurses were super nice. It was so nice to have Dr.Nho and Sara come see me before surgery, making sure I didn't have any last minute questions. I was then wheeled into the surgery room where I was quickly put to sleep!
7. What was done and how long did it last?
Surgery lasted about 2 hours. Dr.Nho came to see me after surgery to go over what was done. I was mega high on meds so I don't remember much, but he showed me photos. It was as expected, had cam removed and a large labral tear repaired. Luckily the tissue was in good enough condition I didn't need reconstruction. Then had capsular plication.
8. What was your PO protocol?
I started physical therapy at Rush Orthopaedics the following day...two times a week for the first three months. CPM machine 4 hours a day. Tummy time. Dr.Nho puts enormous emphasis on PT and has a very strict protocol, which I LOVE. What I do NOT love are the booties I must sleep in for one month PO to avoid external rotation. ARG!
9. How was the pain after? What can one expect?
Pain is obviously subjective. But I didn't find the first few days so bad because of all the pain meds. Getting in/out of bed was the hardest...but besides that it was endurable. I'd switch it up between laying down on my back, stomach, sitting in the lazy boy, getting up and walking around the apartment. Moving around helped avoid stiffness. I went out for the first time 10 days PO...walked 10 minutes on crutches and sat at a fast food restaurant. I was exhausted! Clearly I couldn't be TOO active. Happy I have 3 weeks off work.
Unfortunately not. My first surgeon said arthroscopy would be useless because I have dysplasia. He also did not believe me when I said I had cam impingement. This is based on my first MRA report that said I have an alpha angle of 48 degrees (my alpha angle was actually 63 degrees, confirming cam impingement) So I could not get a letter from him. I tried going to the first orthopedic surgeon I saw, but he refused to write a letter since he does not practice arthroscopy. I've been on a waiting list to see another OS in Quebec that does hip scopes...still no news (and no guarantee she would write one). That's why I decided to take matters - i.e the cost - into my own hands.
2. How did you find the funds?
Luckily, I had saved up the money for a future downpayment on a house. Hip > House
3. How about your hip dysplasia? Isn't hip arthroscopy contraindicated in that case?
Luckily, Dr.Nho wasn't concerned by hip dysplasia. They encouraged me to seek advice from dysplasia specialists so that I could be confident with my choice of moving forward with a hip scope. I had my file reviewed by Dr.Millis as well as a dysplasia specialist in Quebec City. Both confirmed mild dysplasia. I also took an appointment with Dr.Stover, a hip dysplasia specialist in Chicago.
4. How did it go?
Dr.Stover is simply amazing. I had a consult with him two days before surgery for a second opinion. I've seen a LOT of doctors in the past four years and Dr.Stover did the most thorough physical exam. He checked for hypermobility, evaluated my gait/ROM and went over my XRs/MRIs. He spent so much time explaining his findings and made sure we clearly understood everything. He confirmed hip dysplasia but that it's very mild. His opinion is that my symptoms point more towards FAI and that he believes I would benefit from arthroscopy with Dr.Nho. If ever there's a recurrence of symptoms or a re-tear, then we can consider instability as the cause and treat accordingly (periacetabular osteotomy). I highly recommend Dr.Stover to anyone dealing with or suspecting dysplasia. He and his PA were great.
5. How about Dr.Nho?
My consult with Dr.Nho was one day before the scheduled surgery. I started by seeing the fellow working with him, and then Dr.Nho came in. He was really thorough, going over my exams and showing me on screen where the cam impingement was, and where there seemed to be a tear. He answered all my questions, including the chances of returning to impact sports - which he feels very confident is possible. He even gladly looked at my left hip MRA and unfortunately showed that there's also a small tear on that side. I never felt rushed and he really gave me his undivided attention. He was so calm and attentive. He made sure we went through everything, which we really did and I knew I made the right decision to have surgery with him. Then Leah and Sara - both of his PAs - came in and quadruple checked for remaining questions, and I was set! Talk about being in great hands!
6. How about surgery day?
I was scheduled for 11am and had to arrive at 9:30am. We took the pink train and the bus to the Water Towers (Gold Coast Surgicenter - right on Michigan Ave). I changed into a gown, warm socks and the sexy bonnet. The nurses were super nice. It was so nice to have Dr.Nho and Sara come see me before surgery, making sure I didn't have any last minute questions. I was then wheeled into the surgery room where I was quickly put to sleep!
7. What was done and how long did it last?
Surgery lasted about 2 hours. Dr.Nho came to see me after surgery to go over what was done. I was mega high on meds so I don't remember much, but he showed me photos. It was as expected, had cam removed and a large labral tear repaired. Luckily the tissue was in good enough condition I didn't need reconstruction. Then had capsular plication.
8. What was your PO protocol?
I started physical therapy at Rush Orthopaedics the following day...two times a week for the first three months. CPM machine 4 hours a day. Tummy time. Dr.Nho puts enormous emphasis on PT and has a very strict protocol, which I LOVE. What I do NOT love are the booties I must sleep in for one month PO to avoid external rotation. ARG!
9. How was the pain after? What can one expect?
Pain is obviously subjective. But I didn't find the first few days so bad because of all the pain meds. Getting in/out of bed was the hardest...but besides that it was endurable. I'd switch it up between laying down on my back, stomach, sitting in the lazy boy, getting up and walking around the apartment. Moving around helped avoid stiffness. I went out for the first time 10 days PO...walked 10 minutes on crutches and sat at a fast food restaurant. I was exhausted! Clearly I couldn't be TOO active. Happy I have 3 weeks off work.
Etc
1. Where did you stay in Chicago?
An amazing place called the IMG Guesthouse (http://www.imdguesthouse.org/) It's a non-profit organization, collaborating with hospital centres such as Rush University Medical Center. Cost per night is WAY below what you will find in hotels or AirBnB. We had a one bedroom apartment with kitchen. We were given a wheelchair accessible room, meaning there was plenty of room to roam around on crutches. The coolest feature was the bathroom: walk-in shower, railings and high toilet. All very practical things when having a freshly operated hip. They even have weekly free activities in the communal room.
2. How did you pass time?
The following: the internet, this blog, books (currently reading Amy Poehler's Yes Please), adult colouring book, TV (mainly trash such as "Botched"). Add in CPM machine, PT exercises...days go by fairly fast. But I'm a super active person...so it did get tough by times.
3. How did you get around?
Before surgery, we got around using the train and busses. The Pink Line is a 10 minute walk from the Guesthouse. After surgery, we took a taxi back (approx 10-15$USD). Physical therapy is at Midwest Orthopaedics at Rush...and the best thing is there's a free Shuttle service! The best.
An amazing place called the IMG Guesthouse (http://www.imdguesthouse.org/) It's a non-profit organization, collaborating with hospital centres such as Rush University Medical Center. Cost per night is WAY below what you will find in hotels or AirBnB. We had a one bedroom apartment with kitchen. We were given a wheelchair accessible room, meaning there was plenty of room to roam around on crutches. The coolest feature was the bathroom: walk-in shower, railings and high toilet. All very practical things when having a freshly operated hip. They even have weekly free activities in the communal room.
2. How did you pass time?
The following: the internet, this blog, books (currently reading Amy Poehler's Yes Please), adult colouring book, TV (mainly trash such as "Botched"). Add in CPM machine, PT exercises...days go by fairly fast. But I'm a super active person...so it did get tough by times.
3. How did you get around?
Before surgery, we got around using the train and busses. The Pink Line is a 10 minute walk from the Guesthouse. After surgery, we took a taxi back (approx 10-15$USD). Physical therapy is at Midwest Orthopaedics at Rush...and the best thing is there's a free Shuttle service! The best.