Weeks 2 to 5 Post Op

Really week 2 to week 5 were pretty much of a muchness. I find it difficult to think back and separate them. For week 2 and 3 I stayed on 500mg paracetomol and 60mg codeine 4 times a day. The pain was ok, no more than a 3 or 4 out of 10. My back felt great, sitting around for 5 weeks  in the past would surely have sent it into spasm. There was the expected post op surgical pain, but my pain killers kept it pretty well under control. My hand hurt the most, from using the crutches! I ended up a padding them out with soffban dressings and tennis racket grip over the top.

There was a set of rules to follow for weeks 1 - 6:

 

1) Toe Touch Weight Baring only on op leg

2) Hip movements allowed.
Hip flex passively to 70 deg.
Hip abduction to 30 deg
Hip extension to neutral (ie. Lying supine or prone)

3) Hip movements to be avoided
Hip Adduction beyond neutral so no crossing ankles
Any active hip flexion or abduction.
Avoid powering up hip abductors.

My husband did the following passive exercises for me twice day.

1) Passive adduction, not more that 30degrees - 10 times

2) passive flexion, not more that 70 degrss - 10 times

These two exercises are important to maintain motion between the hip capsule and labrum (well, what bit I have left!) and to avoid adhesions forming 

I did the following exercise 3 times a day:

1) static quad sets x 10

2) static glute sets x 10

3) ankle pumps

4) ankle rotations

5) Some Pilates exercises for my other leg, like single leg raise, flexion , adduction

The first 6 weeks after this surgery there are a lot of restrictions. You are not allowed to flex your hip beyond 90degrees at all, so it's important that all chairs you use allow you to stick to this rule. It also means a raised toilet seat is required. I was glad of mine, and I also had a shower stool and perching stool for sitting at the sink. I wasn't able to get in out shower for the first 3 weeks. I just felt unsafe getting in, even with my husband there to help, so I stuck to washing at the sink sitting on my perching stool. Washing my hair wasn't easy and was a right old rigmarole, so I only washed it once a week, leaning back over the sink as far as I could for my husband to wash it for me. I used dry shampoo in between.

Daily life 

I spent the days alternating between sitting in my armchair with either with my feet up on the foot stool or flat on floor, lying on the downstairs bed or sitting at the table doing a jigsaw puzzle. obviously following surgery like this there is a risk of Deep Vein Thrombosis. My surgeons protocol for avoiding this is 150mg aspirin once day, TED stockings and doing the ankle pump exercises regularly. I was glad that the DVT injections I had in my tummy in hospital didn't have to carry on, they were quite sore, like a bee sting.

Getting about at home

It was really a pretty boring 5 weeks, I could do very little for myself. I mean, I could wash and dress myself - with the use of a grabber/helping hand and the a long handled shoe horn with a hook on the end. But beyond that, the fact that I was on two crutches meant I had no free hands  to do anything!(a back pack came in handy for carrying things between rooms, even flasks of tea or noodles/soup for lunch!) Also, with the toe touch weight baring only, getting around was really hard work. My non op hip would burn if I was on it to long, especially standing still making lunch or standing at the sink, I would almost feel like it would give way if I didn't get  to a chair quickly. The stairs were really hard work, going up was the worst and seemed to take for ever going one at a time and taking a break after 2 or 3! to start with I only came down in the morning and up at night, I couldn't have gone up and down more times than that. By week 4 though, I could do a it a couple of extra times during the day but it was still hard work.

Going to bed

Going to bed seemed to take ages, I would generally go and get myself into my PJ's in the downstairs bathroom at 8pm. At 9pm I would collect together my ipad, phone, book, pills etc in my backpack then climb the stairs one by one to bed. Then my husband would do my passive exercises and change my TED stockings. Then I would do my active exercises. whilst Paul came back downstairs and let the dog out, gave her her super, locked the house up and washed my TED stockings by hand ready for the next night (I only had 2 pairs). It doesn't sound like that much, but the same thing night after night seemed like ground hog day and Paul was knackered by the time he got into bed.  

I was  not allowed to actively abduct or lift my leg, so if I needed to move my leg onto the sofa, foot stool or into the car, I had to have someone do it for me or use a dog lead to hook around my foot and lift it.

Going Out

I didn't go out much in the first 5 weeks, we had borrowed a wheel chair as walking far on 2 crutches was just to painful on my non op hip and shoulders. So my husband wheeled me along the sea wall a couple of times, and down to the farm where we keep our elderly pony. We also went up to see my horse 3 times, taking the chair so I could sit and watch him groom him. Charlie was very good with me in the  wheel chair, he wasn't to keen on my crutches. There was a brief trip out to the GP practice to the see the nurse  at 2 weeks post op and have my dressing removed. The wound looked great, it had been sealed only with glue and looked no more than a nasty cat scratch really.

My Scar 12 days post op (Dressing removal)

 

Sleep

From weeks 1-6 I was only allowed (and able) to sleep on my back and this was one of things I found hardest about recovery. I found it very hard to sleep on my back and often be awake until 3am watching TV or reading. The first 2 nights were  very sore on my lower back and my nurse friend suggested sleeping on the sheepskin rug that we have. It was fantastic. It eased the pressure of my lower back and slept on it every night for 5 weeks. I also had a back rest on its lowest setting angle and my leg on a pillow. And that's how I slept for 5 weeks. 5 very  long weeks! The one thing that made it bearable was my Pie Cat sleeping on my chest/tummy EVERY night without fail. She was good company, and of course, you cant beat the healing power of being sat upon by a cat!

The Healing Power of Being sat upon by the cat!
 

 

Physio

At the start of week 4 I went to see my physiotherapist Donna. She was very excited to so me and it was lovely to see her. 18 moths after hse first suspected FAI we finally at the post op stage! My husband came in and we all had a good chat about things and then showed she him a couple more passive exercise that he could do for and also about massaging around the scar area. The area around the scar was rock solid, it felt like solid tea-plate was under the skin. She said that we needed get this tissue moving to stop adhereing together and forming to much sacr tissue.

So weeks 4-5 we added in the extra passive exercises as well as my static quads & glute sets and also the bio oil massage, along with the continued TED socks changes, this made the task of going to bed even longer. It felt like those weeks were never ending. During week 5 I emailed my surgeon to ak if I  could stop wearing the TED socks and said yes. So that was a bit a relief for me and Paul, one less thing to fight!

 

Week One Post Op

I spent the whole of week one in  hospital. It was supposed to be a 3-4 night stay but unfortunately I had some non-hip related complications.

 

I wont bore you with a day by day account of my stay in hospital suffice to say I stayed  the 4 extra days due to a low haemoglobin count (7) which meant I could not walk very far with out feeling faint. Even going to the toilet on the walking frame meant I had to be followed by the oxygen trolley - just in case - and it exhausted me so much that I was a dithering wreck by the time I got back to bed. It is quiet a shock to go from being able to walk 3 miles  a day one week to being like that. I can remember spending a lot of time sitting on the toilet clinging  to the grab handle on the wall, resting my head on the tissue paper dispenser, my head spinning, whilst the nurse waited outside!!

My catheter was removed on the 2nd morning after surgery (so Wednesday) and the pain buster removed later the same day. It was running up to Christmas, so and I could see the Christmas decorations on the nurses station outside my room, that was nice. And from my window I could watch everyone coming and going from the main entrance and also see the Cornwall Search and Rescue helicopter landing on the helipad for Treliske hospital.

Helicopter from my window!

 

My temperature control was all out of sync I seemed to get very hot all of a sudden, I spent most of the week with the window open and a fan. Crazy in the middle of December.

 

I stayed very itchy all over for about 4 days, That was the worse part really. The pain was managed well with 1000mg paracetomol, 400mg ibuprofen and 60mg codeine  4 times a day, with the occasional oral morphine and also diazepam at night as I was having spasms in my groin. I used the CPM machine a lot, I really liked it. It gave my leg something to do instead of trying to fidget! for the most part, the CPM did not cause pain, but there was a certain point every now and  again, when the flattest moment of the CPM coincided with the air pump cuffs around my legs being deflated, so my leg was at its straightest. That pulled quite a lot on my hip. 

My CPM machine (continuous passive motion) this
prevents the hip joint stiffening up prevents
 the build-up of adhesions

I made slow progress with physio due to my low haemoglobin/fainting tendency. So on the 3rd day post op I had a blood transfusion. This seemed to take for ever to organise and it ended up starting at 11pm and took until 2pm for the 2 units to go in. The two nurses were great  fun though and kept bringing me tea & custard cream biscuits, .

The blood transfusion going in!

 

The next day (day 4 post op) I felt a bit better and was able to progress a bit further with physio, finally mastering the crutches. The day after that I did the stairs and also had a shower which was marvellous. My can of dry shampoo could do no more for my hair after 6 days!

I went home on the Sunday. The trip was 2.5 hrs and I loaded myself with relief beforehand, I still wasn’t really in much pain, my lower back felt the best it had for years.  We had to stop at Cullompton service Station but we managed to get the disabled space right outside the door. I felt very unsteady and self conscious on my crutches but made it through the door and saw that the toilets were all the way across the costa coffee shop, it seemed like miles away. But I made it and used the disabled loo ok.

When we got home, I went to bed in the downstairs spare room and slept until dinner time. Are my dinner then went back to sleep. Rock and Roll!

My cat Pie came to see me as soon as I got home

And my other cat Tooie slept on my bed all night!

 

Op Day and Day 1 Post op

1^st  December 2013 We travelled down to Truro the night before and stayed in a B&B. We went out to a local pub and had a lovely steak & chips dinner, which went down OK. I had no idea when I would be eating next and hoped the anaesthetic wouldn’t make me sick, as I really like food! I didn’t sleep very well that night but I guess that was to be expected. It felt like I was the eve of a great leap into to unknown, which I guess I was

2^nd December. Checked in to hospital bedroom at 10:30. The anaesthetist came to tell me I would be having a full anaesthetic which I was glad about, along with spinal pain relief. Mr F came to see me and drew an arrow on my leg. He said he would try  to get away without doing the trochantic osteotomy by going beneath one of the muscles to reach the impingements. That got me a bit worried as I felt like even though no osteotomy would mean less time on crutches, the thought of the full open surgery made me feel like everything would be sorted as he would get full visualization of my joint. I didn't mention that worry to him, as I felt sure he would to the right thing and do the osteotomy if needed.

I got changed into my gown and into bed and got pushed down to the theatre pre-op room at about 12noon. I could see Mr F in the theatre through the round windows in the doors.  I can remember I had to sit on the edge of the trolley with my feet on a stool whilst the anaesthetist  put the cannula in my right hand. There was a younger man standing in front me with both hands holding onto my shoulders. I can remember talking to the Scottish anaesthetist about Gin, Bombay Sapphire on the rocks to be more precise . He said I best have some of his injectable  gin before I had the spinal injection as that would mean I wouldn’t know anything about it. I can remember saying to the young man “Holding” me up that I was glad he was there or else I would fall off the bed. And that was it. Next thing I knew it was 4pm and I was in recovery room and my nose was REALLY itchy!!

The recovery nurse said I had been very naughty trying to remove the oxygen prongs from my nostrils and rubbing my nose. But they were so annoying!!!!. He asked if I was in pain and I said no but my nose is really itchy! And that is about all I can remember really, apart from realising I didn't have that horrid sore throat or lip thing going on that I had with a previous and anaesthetic and  the  feeling of relief to think it was all over. Mr F had finally been in and sorted my hip out. I spent the next half an hour rubbing my nose and trying to pull the oxygen prongs away whilst the nurse kept telling me off for it!

I got back to the room about 5pm I think there was a lot of hustle and bustle whilst they set up blood pressure machine and organised my fluids stand and then the physios came in and put the CPM (continuous passive motion) machine on my leg , which didn’t really bother me, it felt good to get my hip moving as it was stiff.  Then they fetched my husband and we were left in peace. I had a peek under the covers to look at my leg. There was a pain booster tube going in, and  a wound drain tube coming out, with a small bruise around it.  There were 3 big plaster type dressings and my leg was a red colour. The nurse said that was due to the dye in the sterile wash they use.  

After the op
 

after the op, the blue thing is the CPM machine

 

Half an hour later my Mom & Dad arrived. I can't really remember much about that evening. I was really relieved to have a catheter in place, I didn't feel like I could move an inch never mind as far as the loo! I felt quite comfy pain wise, it was just a heavy/stiff feeling in my leg. The thing that really bothered me was how itchy I was all over and the fact I really wanted a cup of tea something to eat. The cup of tea arrived along with a ham & tomato sandwich. It was great! Mr F came to see me, but I cant remember what he said, apart from  the fact he HAD had to do the trochantic osteotomy in the end and "at least you know you are not bonkers now" What a great term! Yes, I now knew non of this was in my head, there was something wrong and that it had been fixed.

Best cup of tea and ham sandwich in the world!

 

That night was one of the longest nights of my life. I was right out side the nurses station so it was quite busy. I could not sleep I was so itchy!! I just wanted to scratch everywhere all the same time and I couldn’t. They said it was to do with the anaesthetic meds. I had piriton and some oral morphine in the hopes I would settle and go to sleep but it didn’t work. I just lay there, trying to fidget and scratching my arms and legs mostly!  About 2am I had fidgeted so much that I manage to undo a connection on my catheter and so now I had a bed full of wee. Great.  The nurse came and reconnected it then set about changing my bed sheets. I had thought this would involve me having to get out of bed, not something that filled me the sense of fun, but honestly its like magic how they can change a bottom sheet of the bed with someone still in it!! She had to take my CPM machine off to do this and didn't put in back on.

I didn’t sleep at all that night. Paul came about 8:30am and was a bit cross that my CPM machine had been taken off. The physio came at 9am and put it back on, and when she doing that,  I realised just how much my hip had stiffened up and it quite painful. I had to have some more morphine to take the edge off. I didn't do much that day. Just stayed in bed, watched TV and tried to dose, unsuccessfully. Usually just as I dosed off, a nurse would come crashing in to do my observations. I made it my challenge to eat all food and drink all tea put in front of me. The food was really nice. I was still quite miserable with the itchiness, which was still persisting. I really needed one of the back scratcher things with a hand on!

Mr F came and told me a bit more about what he had done. He said he had addressed the cam and pincer impingement and that my labrum was calcified, which was why he had ended up doing the osteotomy, so that he could remove the calcified labrum. He said I should do just fine without a labrum, better to have non than the calcified one that was damaging the head of my femur. He showed me two pictures that he had taken during the op. He had them on his iPhone! The brief glimpse of the inside of my hip was a bit shocking and made my head spin! He said the physios would get me up on walking frame the next day, and to make sure I kept up with the pain relief, that there are no medals for trying to be a hero coping with pain. He said the morphine is very good at taking the edge off but only lasts an hour so, so to try and keep on top of the pain by asking for it before I felt I needed it. Throughout that day I also taking paracetomol 1000mg and codeine 60mg, four times. In terms of pain, it was mainly just a very sharp, achy feeling in my groin.

That 2nd night was the next worst of my life. I cant really remember much of it as I was completely whacked out. The night nurse decided I should try some of my amitryptaline that I had bought with me as a repeat GP prescription. She thought it would help me sleep. I had it at the same time as some oral morphine. Big mistake. I was convinced I was freezing cold. I was dithering so the nurse bought an electric heater in and a duvet and left me to it, closing my door behind her. I think I probably spent 4 hours with a sky high temperature, which fuelled my amitryptaline and morphine induced  nightmares, as well as still being VERY itchy. I really wanted my husband - or my Mom. I know was talking to myself and I can remember thinking there was a man standing by the door. I woke at some point pouring with sweat and pressed the nurse buzzer. She came and turned the heater off and removed the duvet and left the door open. I spent the rest of the night drifting in out and of bizarre sleep & nightmares, I thought daylight was never going to come! But it did.

Further Information on FAI and Open Hip Debdridement Surgery

I wanted to include a few bits of information before finally getting into my op story:

 

In case you haven't read my earlier posts or need a refresher, this is a really good information document on FAI ( but you really must replace the grey head models with younger, more active types!

http://www.eorthopod.com/Booklet?ClinicID=6138752e01d21f68baaa5b7b82751802&TopicID=0a0773151e66b80b97aa3f0f9ca765a9

This is a really helpful document produced by the Cornwall Hip Foundation team which outlines pretty much everything to with Open Surgical Dislocation and Debridement for FAI:

http://cornwallhipclinic.com/resources/Documents/Open-FAI-info-sheet-11Jan2009---MRN.pdf

The Cornwall Hip Clinic Website:

http://cornwallhipclinic.com/index.html

There are  couple of You Tube videos showing the open dislocation/debridement surgery.... I wont post them here as they are rather graphic, I will leave you to search You Tube for "Open hip debridement surgery" if you wish!

 

 

2013

2013 was not unlucky for us, though it was probably one of the most stressful years of my life. As well as battling with my continued chronic back and hip pain, we also moved house. We exchanged contracts on the 31^st May 2013 and so began the mammoth task of moving out of our rented house and into our new home by the end of June. They say moving house is on life's most stressful activities. When you also have 3 cats, a dog, chickens, rabbits and small pony to move, whilst doing it all through the fog of chronic pain, the stress if magnified. I think the only thing that got us through it was the fact we were moving to pretty much our dream home , right on the beach front. It is our forever home.

Although we did use a removals company for the house contents, we move all our outside things ourselves. That included the contents  of my husbands workshop, a wooden double stable, 2 sheds, a green house and their contents. It was exhausting. I was unable to help my husband with any heavy lifting and so he was more exhausted than I was. My back held out until mid June. I was redecorating our bedroom and  had managed OK with the help from my friend. Then, when I was sat in an awkward position on the floor painting the skirting board, it went into a major spasm. I managed to get down stairs into the garden where Paul was working before it locked up completely. I  took some codeine & diazepam  and lay there on my front in the garden for about an hour, until my back relaxed a bit and I could stand up. That  put an end to any painting or decorating and after a few days “rest” – which also meant cancelling my dog walk jobs, I was relegated to cups of tea making only. It was completely and utterly depressing. This  was before I had been to see Mr F to get my proper diagnosis and if nothing else, it cemented my decision that I couldn't go on with life like that and had to go and see him at the end of the summer, when we would actually have time and mental capacity to tackle it.

After I had been to Mr W in February and he had told me stop horse riding, I decided that I would do quite the opposite. I felt like My life was ticking away not doing the things I loved. I had put a pause on horse riding because Paul was worried that if I did have labral tear in my hip, I could be making it worse. We had placed my horse into full livery in January because we knew I could no longer care for him. It was either that or sell him. And selling  my Charlie Brown was not something that would make me happy. After Mr W dismissed my hip symptoms as bieng related to my back, I decided to ignore his advice and get back to riding my horse whether it hurt on not.  Through 2013, depending on my pain levels,  I alternated between ground  work with Charlie, going for a walk with him like a dog on the end of a lead rope and gentle riding, walk and trot only. This proved beneficial to both of us and we actually developed a better bond, We began to understand each other better because we were doing things slower I believe he knew I was in pain and looked after me. We went out on a few rides on our local bridle paths (once we had conquered crossing the very high bridge over the M5 motorwar!) . It was fabulous to get out into what felt like the middle of nowhere on our own and forget about all the stress of work, trying to get a diagnosis and house moving. I would be in a fair amount of pain when we got back to the stables, but I really didn’t care. My horse and I were having fun at last and it a great anti depressant for me.  

View from a top my horse at the top of a nearby hill.

 

My last ride on him was 4 days before surgery and I felt both really pleased with how far we had come that year, and sad because I didn't know when I would be able to ride again. A part of me was scared that  I would never be able to ride again. The yard owner was all set to ride Charlie for me for the next 3 months or so. So I said good bye to him the day before my surgery not knowing when I see him again.

My physio would have liked me to have undergone an extensive “pre hab” regime prior to surgery to get my leg muscles and core as strong as possible to help with post op rehab. But it was never going to happen. My back and hip were intolerant to any repetitive exercise other than a handful of gentle Pilate's exercises or walking. I had a few regular dog walks at work. I walked a poodle 5 days a week for half an hour, a labradoodle 3 days a week for an hour, a Golden Retriever twice a week for 45 minutes and  a German shepherd cross once a week for 45 minutes. These dog walks became my exercise and were the thing that kept me going through 2013. There were many times when I struggled on these walks, I was careful to choose only flat walking locations, and new all the benches on the routes. Some days I would walk really slow. The poodle in particular was very knowing. He was a big powerful dog but I could see him modifying his pace to walk at my slow speed. Four weeks before surgery I started to use a walking pole, It really helped and I wished I had started using it earlier.  I had managed to organise a someome to take my dog walks on for me whilst I was on crutches, and hoped I would be able to start back walking them in March. I spent a lot of time with all 4 of the dogs, walking miles with them. Sitting on bench's with them whilst I rested. They were a very good alternative to any other pre- hab I could have done.

 

Here some picture of the 3 dogs I spent a lot time with walking in 2013, on thour last walks before my op

 

At the start of November I made a giant to do list in preparation for life after surgery, so much needed organising. There were 3 titles: Home, work, Animals. If it wasn’t on the list, it didn’t get done. Everything was on there, from stocking up on animal feed to arranging the mobility equipment I would need after surgery. It was quite a relief to finally tick the last item off the day before surgery: “Pack bag for hospital”

Yes You Have a Diagnosis, but No You Cant Have it Fixed - October 2013

My GP made a request for my open hip surgery  through the NHS choose and book system (C&B) and it was rejected. I don’t know why. The NHS state the following about Choose & Book:

•  “You can choose any hospital in England funded by the NHS (this includes NHS hospitals and some independent hospitals). 

Although my surgeon of choice was located at a private hospital, he has done hundreds of similar surgeries through the C&B system on patients coming to him from as far a field as Scotland.

I will not go into the very dull details of how stressful the next few weeks were as I tried to get the bottom of this, suffice to say the C&B system obviously has some very complicated internal rules and pathways that means it does not work as straightforwardly as they like to make us the patient think.

The final outcome was that my request had been forwarded to “funding panel”  of my local  Care Commissioning Group (Formally know as Primary Care Trust) - This panel did not meet until just before Christmas ( it was now late September). They would review my case and decide whether or not to release funding for me to have the surgery in Truro. I would not get an answer until after Christmas, and the answer might still be no. In which case I would have to make an appeal, filling lengthy forms and about why I felt I needed the surgery etc.

It was pretty much like having the wind knocked straight out of you. I will admit to putting the phone down and crying - a lot. All these years trying to find out was wrong and how it could be fixed, and now we knew,  they didn’t want to fix me. I was gutted to say the least.

I spent until mid October trying find out more out about how the C&B system worked, trying to see if this was just some sort of computer error but I got nowhere. I could not face the thought of struggling in pain through the coming winter. I was getting worse. I was beginning to feel like if I did not get fixed soon, I would either have to modify my work severely – this would mean dropping some long standing clients (I am a self employed pet carer) or even give up work completely. They were both very real yet concerning options. The winter would be the best time for me to get this surgery as it is my quietest time of year. If I could spend December, January & February rehabbing, I would be all set for the rest of the year work wise. If I were to go through the funding panel malarkey, it could be at least 6 months until I get surgery - and that was if they said yes. If they said no, it could easily drag out to another year with an appeal. To have surgery in the spring would cause huge damage to my business, which I spent years building up.

After a lot of discussion, tears and general stress over the situation, we decided to self fund this surgery. I booked the surgery with Mr F for December 2nd 2013.

I did feel like I was letting the NHS get away with not helping me. Perhaps the most annoying thing about it all, is that by having hip preservation surgery now, it  means I should avoid needing a Total Hip Replacement in the future, so I am saving the NHS money again there

Now I don’t want to sound ungrateful for the NHS. The staff on the coal face of it are amazing people, and heaven only knows how much my friends & family have benefited greatly from their care over the years, and will continue to do so. We really are very fortunate to have “Free” health care here in UK. But when a family like us think of the £1000’s of pounds of taxes we have contributed to the NHS over the years, and also to think of some of the things they do  pay for, it really hurts that they are unwilling to help me

If you would like to know about a bit more about the government Quango that is the NHS and its beloved Choose and Book system, click here:

http://www.chooseandbook.nhs.uk/

If would like to read the very dull, but nonetheless informative polices on hip impingement surgery that the NHS and NICE (National Institute for Clinical Excellence)  use to base their decisions for funding upon, then, have a look here:

Open Surgical Debridement:
http://www.nice.org.uk/nicemedia/live/11181/55772/55772.pdf

Arthroscopic Surgery
http://www.nice.org.uk/nicemedia/live/11328/56417/56417.pdf


This is a table showing the surgeries and treatments that are not normally funded by my CCG. (Hip impingement is on page 5):

http://www.bristolccg.nhs.uk/media/14014/new%20branding%20-%20updated%20INNF%20LIST%20For%20Referrers.pdf

There was a policy relating to the above regarding the criteria that needed to be met for the surgery to be funded. The policy does not seem to be available at the moment

Other dull yet helpful pages:

A report of funding requests and results 2012/2013:

http://www.bristolccg.nhs.uk/media/18253/17%20-%2012-13%20Individual%20Funding%20Request%20Report%20240413%20-%20for%20information.pdf


Choose and Book Care Path Ways: http://www.chooseandbook.nhs.uk/staff/communications/fact/carepathways.pdf

Article discussing on restriction on certain treatments offered by CCG's. Hip impingement is listed as being one most serious treatments (i.e for one that causes serious pain) to be restricted by 18 CCG's :

http://www.sochealth.co.uk/2013/03/13/revealed-full-extent-of-camerons-health-lottery/

http://www.sochealth.co.uk/2013/03/13/revealed-full-extent-of-camerons-health-lottery/

No doubt I shall have more to report on this delightful subject as I will have apply for funding for other hip to be done in the future!

Second Opinion On Hips - September 2013

 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 2^nd 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 2^nd 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 10^th 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!