I was thoroughly depressed at the thought of a 3rd lot of excruciatingly painful facet joint
injections, which I knew would not work, just as the previous two from the pain clinic hadn't. And they weren't going to happen until November anyway, another 4 months of limbo land. I felt like my life was
just racing away. I was 32 now. The years just kept ticking away and my pain was
getting worse and worse and no one seemed to be able to help me. All these
appointments and tests take months and months to come and go. I could go on
like this forever, not doing the things I love until I am to old to do them anyway. I reluctantly decided that I must go ahead with these facet joint
injections if that was what Mr H needed to do to move me further along his
list. But in the mean time I decided to get a 2nd opinion on my hips
I now had my images so I decided to put this x-ray from 2012 up on the Face Book hip group, expecting people to say my hips looked great, no FAI.
What happened next had me lost for words. A hip surgeon in England who was a member of the group commented
“Big diffuse cam both sides, deep sockets, over covered posterior wall. Barn door”
Ok. Just a few words, but seemed to say more than any other surgeon had about my hips. What followed was brief
exchange about what he meant by “barn door” turns out it is his northern term for
“Blatantly Obvious” I asked him if he thought my situation could be helped by scope
surgery, as suggested by Mr W.
“ The X-rays show deep over
covered sockets with obvious impingement trough at the front of the femoral
neck. I'd struggle to trim the back wall and reattach the labrum
arthroscopically, and if you are the girl with the horse, you seem young enough
to warrant complete correction of the deformities. I would offer open surgery
if a patient of mine had appropriate symptoms and the X-rays shown. This is a
general opinion based on my own experience, and not a recommendation (
disclaimer as I can't be a Facebook clinician!)”
Open surgery?! I didn’t even
know what that involved but I could guess. On research I discovered it meant a
long incision, dissection of the muscles and removal of the head of the greater trochanter
to allow access to the hip joint, dislocation of the hip joint to allow the work
to be done. Then putting me all back together with 3 screws to hold the top of
my greater trochanter back on. It would mean at least 6 weeks non weight baring on
crutches and probably a full year to recover completely. Scared? Yes I was, but
in a good way. I needed to see this man!
So I tried to get a 2nd
opinion appointment via the good all choose and book system, because he was located in Truro. That did not work, some question over funding. Fed up with hitting another brick wall, I made
an appointment to see him privately on the 10th September 2013, 3 days before our long awaited holiday in Cornwall.
I spent the 2 hour trip down to Truro in a fair amount of pain as I wanted Mr F to see me at my worst! I was pretty miserable, and stressed by the time we got to he hospital and I really did not feel I had the mental or physical strength to face yet another recital of my history of back pain. I was worrying about the physical exam too, as the tests that they do for impingement are really painful when you actually do have impingement!! I had been sore for 2 weeks after Mr P did the good old anteroposterior (AP) impingement test,
( you can see what this test is here: http://www.jaaos.org/content/15/9/561/F3.expansionr )
I was pretty much a tight ball of pain and anxiety by the time I went into his room.
Anyway I needn't have worried Mr F was fantastic. I could tell my husband liked him straight away, which is always a help. He spoke in plain English, was upbeat and enthusiastic. During the dreaded physical exam everything hurt, he started to do the AP impingement test on my right leg and it was actually shaking at the thought of the twist and pull he was about to do. And he noticed! "I don't think we need to do that test, it's pretty obvious what your reaction will be" Oh thank god! a surgeon who actually listened to me (and my body)!
I really cannot remember much about the consultation after that. I know he was talking about the fact I had deep sockets with posterior acetabula over coverage, which was what was causing my main impingement pain and that there was also cam impingement. He said both hips looked the similar but the right one had a bigger cam. I know he got my x-rays up on the computer screen and was drawing lots of lines and angles showing us how rubbish my hips actually were. My husband loved that bit. They both spoke the same language, it sounded to me more like they were discussing an engineering project than my bones! He said he would only be able to do the surgery via open dislocation, and that both hips would need doing, probably about a year apart, he would start with the right one . I asked him what would happen if I didn't have the surgery "You will need hip replacement in your mid 40's" . He advised that if I wanted him to do it, I should be able to get my GP to request it through the NHS choose and book system. He then suggested a hip joint injection, if I could hang around a few hours. Not particularly for diagnostic reasons as he could see the impingement from my x-rays, but to try and provide me with some pain relief. How could I say no?!
So I was admitted as a day patient and Mr F performed the joint steroid injection into my right hip. It was VERY PAINFULL, I would say more painful than the MRA dye injections that I had. But the result? No pain in my right groin or lower back.
I was now up to about 11 years of chronic pain, and to be given relief from that honestly felt like one of the most kindest things anyone had ever done for me! I spent the next 3 weeks feeling like a huge weight was lifted from my shoulders. I could bend, twist, walk the dogs, do the hoovering, the laundry, muck out our small pony, ride my horse with pretty much no pain. There was still a niggling pain in my left groin and SI joint but the feeling like my back was constantly on the verge of spasming had gone. A small part of me felt very cross that Mr W had virtually poo-pooed our questioning the benefit of hip injection. But mostly I just enjoyed the feeling of being happy and relieved to be finally getting somewhere!
Here is a copy of the x-ray that Mr F produced, showing how my hip looked then and the lines showing how he could make it look during surgery. Pretty neat!
 |
| Hips September 2012, showing the excess bone causing my impingement |
A bit from the letter following the appointment:
"You have got some long standing low back and sacro iliac pain that has previously been investigated by my colleagues up in Bristol....The x-rays of your hips today are significantly abnormal; with pincer over coverage of both your hip joints with a very large over hanging posterior wall to your hip socket. On the right hip this is accompanied by a fairly significant cam deformity......clinically you have got very obvious signs of cam impingement with pain in what should be the normal arc of movements....I think open surgical hip dislocation and debridement gives you the best chance of having a significant improvement in your symptoms....I am very confident open surgery will give you improvement"
So there it was, in black and white, my second opinion, a bit different from the first!
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