Tuesday, October 28, 2014

No News is Good News (16 Weeks + 1 Day)

I don't have a lot to say, and that is a GOOD thing. Very good!
  • My hip still feels good! Given that I was feeling good the last time I saw my orthopedist, and that I'm still feeling good, I must be going on almost four weeks of feeling good. I still have low-level pain, and pain when I get up after sitting for a while (déjà vu all over again), but it is so much better than it has been, and even better than it was before surgery (um, finally). It seems sort of ridiculous to be excited over the fact that almost four months after surgery, I feel better than before the surgery, but, hey, whatever. 
  • Of all the things I've tried post-surgery, it seems like the best thing I've done for my hips is to stop physical therapy. (LOL - What's wrong with this picture?)
  • My surgeon's MA called me last week, on Friday. My cell phone told me it was from ABC Orthopedics, which immediately made me nervous. It was my orthopedist's MA, who seems like a super sweet woman. I don't know if it's because she really cares a lot or if it's because it's her job to clean up after unresponsive orthopedists and she's just really good at her job, but either way, she's always super nice and seems extremely competent as well. I was relieved it was her and not my orthopedist (although who are we kidding - why would it be him?). She said she had gotten 'another e-mail' from me and went on to say that she was sorry my doctor hadn't responded to me, that she had given him my results, and said that she would have stayed on him if she knew he hadn't gotten back to me. Eventually I figured out that she was talking about the nastygram I sent on Tuesday, and I told her that my doctor had in fact gotten back to me. She seemed relieved, and when I told her, 'Yes, I finally worked a response out of him,' she laughed somewhat knowingly and said apologetically, 'I'm sorry you feel like we aren't taking care of you.' She actually sounded very sincere and not snarky or anything. Since I was at work and didn't really want to get into it with her (it's not her fault), plus I was shocked by her apology and didn't know how to respond, I just said, 'Oh, well, thank you for that,' and confirmed that I would see them on November 7th. And that was that.
  • In other other news, I've been having some GI issues. I'll spare you the details. LOL. They started about two weeks ago after having sushi, which can always be a cause for concern - though I've never gotten sick from sushi, even sushi that I've eaten in a strip mall in Nevada. (I can't say the same for McDonald's.) However, since no one else in my family got sick, I ruled out the sushi. Of course my next concern was that it is the medication I'm on, as both the Xarelto and the meloxicam are causes for concern. And then there is always the concern that I'm just a hypochondriac, and the anxiety I cause myself by being a hypochondriac either causes or exacerbates symptoms I already have (which may be due to anxiety from hypochondria or 'real' reasons). I do have some experience with GI stuff, and GI stuff is tricky. Eventually I concluded that anxiety and hypochondria alone were unlikely to produce such nasty symptoms for so long. (In my experience, anxiety can produce pain, but not usually bleeding.) So, I stopped taking meloxicam on Friday because of concern over my GI tract, plus the fact that my hip is still feeling pretty good. I figured it would be a good test for my hip, and not taking meloxicam hasn't had any effect on my hip. Granted, it has also not had much of an effect on my GI tract, but I have to figure if it's having zero effect, good or bad, I might as well not take it.
  • I've been feeling sort of crappy overall, so I added Vitamin D back in to my pill-taking regimen. So now instead of taking Xarelto + meloxicam in the morning, I take Xarelto + Vitamin D. So far it doesn't seem to be helping, when I subtract out the possible placebo effect. Which leads me back to my original diagnosis of anxiety and hypochondria. HA!
To summarize: overall, things are looking good. Time is flying; it seems like last week that I saw my orthopedist, but I know it has been almost a month because next week I have book club on Thursday night followed by the orthopedist on Friday, which seems to be fairly standard these days. Also, on the Sunday following my appointment, I will turn 40, which will make my '39 and Hip' moniker seem a bit passé, but hopefully it means I won't have much more to say about my hip, which was certainly my hope when I started writing this. :)

Wednesday, October 22, 2014

And the verdict is... (15 Weeks + 2 Days)

Okay, so 'verdict' is probably too strong of a word, but I did get an 'emergency' second opinion today (via husband via his doctor, who saw me for my DVT after I was treated in the ER). He and my husband actually have a text-each-other-regularly type of relationship. My husband recently had some routine lab work done as part of his annual physical, and he told me Dr. A just texted him the results telling him he was fine. Oh I'm so jealous.

Anyway. Dr. A stuck by his original suggestion, which was to take the Xarelto for six months. He hadn't looked at the report (because I'm not even his patient), but said that he would, but that it basically didn't matter. Six months, and he was going to stick with that. Add into that the fact that the clot isn't even gone - it's just 'better' (supposedly?) And even if it were gone, you continue taking the medication for a period after it's gone to make sure it stays gone.

And then he asked my husband, 'How do you hide a dollar from a surgeon?' (See answer below.)

On a related note, I was talking to a friend today who also has hip pain and has been taking meloxicam as well. I asked her if she was still taking it and she said no, her doctor told her she shouldn't take it for more than a month because it can cause heart problems if you take it for too long. WTF? I've now been taking it for two months. This made me seriously wonder if my orthopedist flunked pharmacology in med school! However, when I got home, I consulted Dr. Google, who didn't say anything about adverse long-term effects. In fact, Dr. Google told me that meloxicam is indicated to treat pain for rheumatoid and osteoarthritis, which makes me think it must be (relatively) safe long-term, given that these are permanent conditions. (???) Maybe this means my doctor isn't the only doctor out there who failed pharmacology in med school. LOL.

And by the way, the answer to my Dr. A's riddle: You put it in the patient's chart.

A Ship without a Sail (15 Weeks + 1 Day)

This is not my proudest moment. But... sometimes you have to do what you have to do.

I feel like all I've done lately is bitch and bitch and bitch and piss and moan and bitch some more. Since I feel so overly negative, I've been trying to leave out a few details about my orthopedist that have been really frustrating me pissing me off. Honestly, I try pretty hard to give people the benefit of the doubt, especially medical professionals. I can get along with most people, at least on a superficial level. And I've tried reeaaaaally hard to be positive about my orthopedist, who is a super nice guy, and who I really want to like. However, I've had a few concerns about him. Specifically, I don't have any confidence he knows how to handle DVT appropriately. Not that I know how, either, but based on everything that I've read and opinions from other medical professionals, I'm... unsure. And this is sort of a big deal - it's not like getting a bad opinion about a sore wrist; this is acute and extensive DVT, which can be really serious. I know that orthopedists don't really 'do' blood clots, but shouldn't they at least be... I dunno... proficient? Maybe he is and maybe I read too much shit on the Internet, but I do have my doubts.

Also, it's not just my lack of confidence in him, although that is obviously the biggest and most pressing issue. However, I'm also less than thrilled with his lack of responsiveness to the questions I've sent him via the patient portal, which claims that you will receive a response within two working days. Of course, he was extremely responsive to me pre-surgery and his medical assistant was very responsive for the first week post-surgery and then post-blood clot. But lately... no responses. And it's not as if I'm constantly sending him e-mails with huge demands or anything. After my September appointment, when he said that my labrum had not healed yet, I got to wondering if it was okay for me to be, like, doing stuff, if he thought my labrum was still torn. I mean, that's why he said I had to be on crutches for a freaking month - to let the labrum heal. I sent him a quick e-mail asking what type of activity level he would recommend. He never responded. After my last visit, I mentioned that he had only ordered an ultrasound on my calf and the back of my knee (which to be honest didn't give me much confidence that he's even paying any attention to what's going on). I sent him an e-mail making sure the ultrasound would be of my entire leg. (Hello! It is the clot in the femoral vein that has been the most distressing from the start!) I wasn't sure if it was necessary for the order to explicitly state this, especially since I was having the repeat ultrasound at the same location, but I didn't want to take any chances. He never responded. I took care of it myself. After my ultrasound a week ago, the tech told me that my orthopedist would have the report by the end of the day. My orthopedist had told me he would follow up once he had the results of the ultrasound. I had talked briefly to the tech, who knows stuff, but said that a radiologist would read the images and send an official report to my doctor. I gave my orthopedist a few days, then on Friday sent an e-mail asking if he could let me know the official results - i.e., prognosis? recommendations? He didn't respond. Not that I expected a response on Friday, but I gave him two business days before unleashing my fury on him today (Tuesday).

And unleash I did. As I said, I'm not proud of it, but man. Seriously? The title of my message was 'Can you please respond?' LOL. Given that the only time he has ever personally responded to any of my inquiries was pre-surgery (i.e., in the wooing phase), I was doubtful he even gets the e-mails. Or if he does get them, it seems doubtful he actually reads them, given his lack of response. I figured if anything, his MA reads them, and he only responds to the ones his worker bee can't handle. Perhaps when I composed my pissy e-mail I had it in my mind that no one was actually going to read it, given that there is no evidence that anyone does. I mean, I GET that orthopedists are busy. I GET being busy. I, too, am a busy lady. But, if you are that busy, then the patient portal should not be programmed to send an automated response that someone will get back to you within two business days if no one is actually going to (which I wrote in my pissy e-mail). Maybe I am a problem patient, but I really don't feel like I'm being that high maintenance with a few basic questions + one refill request for Xarelto within the past two months ( = four e-mails total - including the refill request and and my repeat request for my ultrasound results). It's not like I'm a Patient Portal Abuser. And the alternative to the patient portal is calling the office, waiting on hold for 10-15 minutes, getting the runaround, then being routed to an MA's voice mail (which I also wrote in my pissy e-mail). Who has time for that?

I know reports and e-mail are a huge time suck for health care providers, and trust me, I understand the time it takes to answer e-mails. I get (and respond to) many, many e-mails a day from students, and I'm aware that writing a report takes a lot of time. E-mail and reports do not seem to be my doctor's strong suit. Not that the latter really matters - after all, the whole idea of the patient having access to her/his reports is something that comes along with the patient portal, which as far as I know is a fairly recent invention. (For routine health care matters, we always seem to go for the solo practitioners, none of whom can afford this.) At any rate, since the patient portal seems to be mandatory for being a patient at this particular practice, it has been interesting for me to read the 'care summaries' the doctors write. Notably, my doctor never writes anything, except All of the patient's questions were answered and they state they understand and agree with the discussed treatment plan. They will follow up as planned, sooner if any problems. This must be some default option in the report-writing software. Interestingly, the only time my doctor has ever written anything other than this was after I had my second cortisone injection. The doctor who gave me the injection asked me what my doctor thought of my ongoing pain and I said I didn't have any idea what he was thinking. I noticed the report after that actually contained information. Word-for-word:

September 5, 2014: still having some sharp pains in her right hip. She has been going to physical therapy. She is still taking her Xarelto for her blood clot a 39-year-old female 2 months status post right hip arthroscopy with labral repair. At this time her hip has flared up and she states she would like to proceed with a intra-articular corticosteroid injection into her hip at this time. She states the Voltaren were not working for thus I will switch her over to meloxicam 15 mg once daily. She'll continue doing the physical therapy to help decrease her pain and improve her function. She'll continue taking her Xarelto also for one more month and we'll check an ultrasound of her right calf at that time I will see her back in 4 weeks' time to see how she is progressing. I do go she is frustrated with her progression but I did reassure I think that she will continue to improve we'll continue doing her physical therapy and try to improve her function and decrease her pain September 10, 2014: Patient here for right hip injection. she underwent a hip arthroscopy by Dr. Z. She says her pain now is worse than before the surgery. She is here for a repeat injection of her right hip joint.

(I'm so glad English composition is a requirement for most med schools!)

Anyway. Apparently my doctor does receive the e-mails through the patient portal, which actually makes it more unforgivable that he hasn't responded in the past. I sent my pissy e-mail close to 6:00 tonight. After putting the kids to bed and taking a shower, I came back downstairs and saw there was a message on our answering machine. The only people who call me after 8:00 PM are my mom, and lately, political campaigns, so I pressed the 'play' button on the answering machine while debating whether or not I had the energy to call my mom back at 8:30 on Tuesday night. I was shocked to discover that the message was from my orthopedist. WTF? I guess my pissy e-mail got through to him. I sort of feel bad about it, but sort of don't. For one, if he had just responded in a timely manner, there wouldn't have been a pissy e-mail in the first place. Also, as someone who works aaaaaalllll hours of the nights answering e-mails and grading, I'm hardly going to cry a river for someone making ten times more than I do who has to work outside the standard 8-5 business day.

(On a side note, I totally freaked a student out one time. I was up late grading assignments, which my students submit online, and I received a 'panicked' e-mail from a student claiming that she had submitted her assignment on time, but for some reason Blackboard was telling her that her assignment was late, and this was obviously a glitch on Blackboard, and she just wanted to make sure she wasn't penalized for this. I immediately shot her an e-mail back - around 1:30 AM - assuring her that I had been on Blackboard ALL NIGHT, for the past six hours, and her assignment was definitely not submitted before the deadline. Just like my orthopedist, the student never responded.)

But back to my original point. My orthopedist seemed super pissy on the phone, and to be honest, I don't blame him. The last thing you want when you finish a long day of work is a pissy e-mail from a patient you're obviously sick of. I know the feeling; I get lots of pissy e-mails from students and respond (semi) pissily. Here is a transcript of his message, plus imagine this in fast-forward mode; he was definitely talking ridiculously fast, as if to make the point that I don't have time for this shit.

Hey Mrs. Moon how're you this is Dr. Z giving you a call sorry to call so late just got done operating. It is... Tuesday night got the results of your ultrasound um they look good so I'll be able to get you off that um blood clot um blood clotting medication um looks good there's still a little... a small clot in there but it looks greatly improved from your last study so we can go ahead and get you off the Xarelto at this time and I think you should be doing just fine any questions feel free to give us a call back at the office tomorrow otherwise I'll talk to you soon thanks bye.

On the one hand, I don't feel like I should complain. This is what I wanted, isn't it? On the other hand, I don't trust this. So I'm supposed to stop taking Xarelto just like that, based on a seven-second message from my orthopedist? As much as I'd love for this to be the case, I can't find any evidence to indicate this is the right thing to do. I get that my doctor is probably super annoyed with me right now and probably just wants me to Go Away Already, but is this grounds for giving bad advice? Is he so pissed he wants me dead? LOL.

Additional concerns:
  • This does not seem consistent with what the ultrasound tech told me. When I expressed my disappointment to the tech, she said it wasn't really realistic for such an extensive clot to resolve that quickly; it often took six months or even a year (and she should know). I realize this is ultrasound tech vs. orthopedic surgeon (via radiologist) but for some reason I'm feeling more confidence in the tech. Considering the whole reason my blood clot was even diagnosed and promptly treated was due to a PT assistant and ultrasound tech, I'm not feeling huge love toward the more highly educated.
  • Following an episode of acute DVT, especially extensive DVT, it seems pretty standard to be on Xarelto for at least three months, more likely six months, and possibly even a year. I mentioned that I saw my husband's PCP the Monday after being treated in the ER, and he said that I would need to be on Xarelto for six months minimum. I realize that family practitioners don't necessarily 'do' blood clots any more than orthopedists, but considering my orthopedist doesn't even realize the clot was in my thigh, I'm... nervous. Fortunately, I asked the imaging place to have the results sent to this family practitioner as well, and I am considering consulting him as a second opinion. 
  • Also, I've been communicating with my former PA for reasons unrelated to my hip. However, my hip did come up, and she said, (S)o sorry you ended up with those complications! DVT's are both scary and annoying. Will it be 3 months on the Xarelto? What did Dr A say? When I replied that Dr. A had said I needed to be on Xarelto for SIX months because the DVT was so extensive, she replied, 6 months sounds right for such a big event. So.... what to think? Again, I'm putting more confidence in my former PA than my surgeon, but... my PA is a really smart woman who knew/knows me so much better than my orthopedist. 
  • So basically I don't know what to do. As much as I'd love to stop taking the Xarelto, I'm REALLY wary of just ditching it willy-nilly, and as far as I can tell, my orthopedist is the only person who is okay with this. And... I don't trust him. At the same time, after my pissy e-mail and his pissy call to me, I don't feel comfortable trying to facilitate any further communication with him.
  • I realize it might be a good thing for me to find a new doctor, especially given that none of this even addresses my ongoing hip issues (remember those?), but a.) I'm starting to think all orthopedists are the same and b.) I'm feeling impatient at this point. Even if there is a better orthopedist out there, it's unlikely s/he could help me in the time period within which I am hoping to be helped ( = ASAP).
I remember an essay I was asked to write at some point in my education about how team captains for sports teams should be selected. I wrote an essay laying out the reasons I didn't believe in team captains, even though it wasn't really true. It just seemed like an easily defensible position, sort of like being pro-life, so I went with it. The response I got was that while my arguments were well laid out, wouldn't a team without a captain be like a ship without a sail? I had to agree.

And now... I feel like a ship without a sail, desperately in need of some guidance. (Any thoughts? Please share... here or on LJ...)

P.S. A few days ago, I wrote that I saw an anti-Xarelto ad on TV. While I was writing this entry, a similar ambulance chaser ad came on for anyone who has Smith & Nephew implants (which I do). So now I have two things working against me. Awesome!

Sunday, October 19, 2014

10 Days and Going Strong (14 Weeks + 6 Days)

Despite the less-than-awesome news on the DVT front, my hip continues to feel really good. Considering I had been feeling good for a few days before my last visit to the orthopedist, I'm estimating that I've been feeling good for about ten days now. (But who's counting?) Today, I had one instance where I could feel the sharp pains trying to return for about five steps while taking my daughter shoe shopping, but... they went away.

I've been trying to think of the reasons I've been feeling so good, not so much because I care WHY I feel good, but because so far, every time I start to feel good it has been short-lived. So just in case the pain returns, here are some possible explanations for why I feel so good right now.
  1. Maybe I'm finally healing. Obviously this would be the best option. :)
  2. I stopped doing PT. I haven't been to PT in almost two weeks. And... I hate to say it, but not doing PT has helped way more than all the things I've tried in PT over the past two months or so, including the beloved massages. Granted, this could just be a coincidence if #1 is the case (fingers crossed), but nonetheless, I'm not missing PT at all. 
  3. I started to take meloxicam in the morning instead of the night. Apparently dizziness is a possible side effect of meloxicam, so I was worried about the side effects it would have on me if I took it in the morning. Once I started taking it at night, I just never got out of that cycle until my orthopedist recommended taking it in the morning. Again, this could just be coincidence if #1 is the case (fingers crossed).
  4. I never sleep on my left side without lying on a pillow. Every since my non-operated side started hurting, sleeping on my side has made it worse. Unfortunately, I often roll onto my side in my sleep and wake up this way. I used an extra pillow on and off since surgery, but lately I've been vigilant about making sure my extra pillow is in place before I fall asleep. This makes my sleeping situation look fairly ridiculous, since I also sleep with my right leg on a huge pillow. (Even if the DVT goes away, I think I'm going to have a hard time sleeping without the pillow.) However, it is good protection against my son, who has been coming into our room in the early morning and crawling in bed with us. It defines my territory. :)
  5. I stopped stressing about the pain.
  6. I've been much happier at work. Combined with #5, my mental state has been much better than it has been in the past.
At night, I continue to ice and stretch both hips religiously, and I'm thrilled this is keeping the pain away. Before, when I did this, I feel like it just got me back to my baseline after my pain increased to unacceptable levels during the day. I hope this means I've busted up this ridiculous pain cycle I seem to have been stuck in for the past two months. 

I know every time I post something like this, I have to post something a few days later retracting it. But since this is the longest stretch of time that I've gone with very little pain, I can only hope it's different this time. Hope is never a bad thing. :)

Tuesday, October 14, 2014

Blood Clots and Fried Green Tomatoes (14 Weeks + 1 Day)

I'm not going to lie, I'm not in the greatest mood right now. Although, I did just eat, so hopefully my mood will improve by the time I'm finished with this. :)

Anyway, I just got back from my 'stat' ultrasound, and as you may have guessed, it's not exactly the news I was hoping for. Apparently it's business blood clots as usual. I mean, I understand this might be something I have to deal with for six months or a year or even a lifetime in a worst case scenario, but I feel so much better than I did before, so I had imagined some major improvement in my situation. The tech did say it looked as if things had cleared up a little, but I can't rule out the possibility she was saying that just to make me feel better and to make herself feel better by not being the bearer of bad news. After all, none of this was an official diagnosis.

Apparently the back of my knee is still very clotted, which I hate to say I sort of knew, on some level. When my orthopedist did his blood clot test, which we know he sucks at and does not work on me, I didn't even try to exaggerate because I knew I was getting an ultrasound, which would tell the objective truth. (Plus, it really didn't hurt much at all.) However, then I reminded him that my blood clot went all the way up my thigh, too. So then he pushed on the back of my knee and asked if that hurt and I reflexively responded, 'OUCH! That does hurt!' He seemed somewhat taken aback, because I never scream like that. I was actually somewhat surprised myself by how much it hurt, but I guess my hope was that the pain was just from residual swelling. Ahhhh, denial.

In other news:
  • My husband made crepes for breakfast this morning, and they were awful, or at least mine was. This is weird because he's quite a proficient (and pretty awesome) crepe-maker normally. The kids didn't complain, although they are not discriminating. Perhaps I just got the part of the batter that was not mixed well. At any rate, I could NOT eat my crepe and had to throw it away after my husband left to take my daughter to school.
  • By around 10:45, I was starving, especially as my colleagues started warming up their lunches in the microwave, and all the yummy smells of frozen TV dinners wafted into my office. LOL.
  • I left around 11:15 for my 11:45 check-in and 12:00 appointment, which was stupid. I'm so used to going to PT and to my orthopedist, which really is a good 30-40 minutes away, office to office. However, I quickly realized that the imaging place was actually only about five minutes from the university. Oops.
  • I ran a quick errand and still arrived somewhat early. I got checked in immediately and then sat... and sat... and sat some more. I knew I was early, but eventually I checked the time and it was 12:23. 
  • Eventually, I went in for the ultrasound and immediately saw the reason for the delay: it was a new tech. I was a little bummed out by this because the tech who did my last ultrasound was fabulous - very competent and readily shared information with me. Plus, you figure it's never a bad thing for a repeat ultrasound to be done by the same person. Fortunately, the new tech was being trained by the tech who did my original ultrasound, who remembered me from the last time. And since she was talking the new tech through the whole procedure, I sort of figured out what they were doing. (FYI: If they stop and take a picture and use their little tool to draw a line across a black circle, it's a blood clot. I know you were dying to know that, ha ha.)
  • At any rate, the new tech was (understandably) sloooooooow, and the ultrasound took foreeeeeever, and I didn't get home until after 1:00, at which point I was very hungry and very grouchy.
  • When I got home, I made fried green tomatoes, which I don't even really know to make. My husband erroneously told me it was going to freeze last night, so I went out and picked a bunch of tomatoes. It did not freeze, and now I have a bunch of green tomatoes in my kitchen. And since I've rarely met a fried food I couldn't eat, I figured what the heck. They weren't bad considering my total lack of direction.
And now... I am still somewhat grouchy, but at least not hungry anymore. :)

Monday, October 13, 2014

14 Weeks and Feeling Hopeful

It is hard to believe that I am 14 weeks post-surgery, but yet, here we are.

I am feeling really good right now. I don't even want to write this, because the last time I wrote that I was feeling great and speculated that I had finally turned the corner, my pain returned with a vengeance. However, I'm not actually that superstitious, so I'll just say it: I'm feeling really good right now! And even if my pain returns an hour after I write this, I'm still feeling good right now!

I mentioned that when I met with my orthopedist on Friday, he wrote orders for me to have a follow-up ultrasound for my DVT. I called right away to schedule it, because I am anxious about this, and I knew it might take a while to get an appointment given my fairly tight schedule. The imaging place had not received my orders yet, but since I had a copy of the orders, I was able to schedule an appointment anyway. I noticed as I was reading the orders that they just called for imaging of my calf and 'popliteal' (back of the knee), even though my original blood clot was also in my thigh. I immediately shot off an e-mail to my surgeon to make sure I could also get an ultrasound of my femoral vein and to make sure he had changed the orders (if necessary) before Friday.

Today, when I got out of class, I had a message on my cell phone (plus two messages on my home answering machine, which I discovered when I got home - WTF?). It was the imaging place, telling me to call them back immediately. Of course when I did, they asked how they could help me, and I was like... I don't know, YOU called ME. LOL. It turns out the orders were 'stat,' which apparently means my doctor wants the ultrasound ASAP. Honestly, I was fine doing it on Friday, which I tried to tell the woman on the phone, but apparently she was afraid I would die before Friday and they would get sued, so I agreed to go in tomorrow. Ha. I had to actually tell her that no, I could NOT go in today, and I was certain I'd be fine for a few more days. This is in stark contrast to when I called on Friday and basically had to fight to get an appointment for the following Friday. But really... what is a few more days in the large scheme of things? I mean, I'm sort of anxious about this, but it's not as I'm dyyyyyyiiiiiiiing.

At any rate, I am feeling hopeful. Although I know I still have swelling in my leg, it feels so much better than it did at the beginning of this ordeal. And unlike my hip pain, which comes and goes, my leg pain is consistently non-existent, except for when I squat down. I would love to be able to put this hiccup behind me. I realize that a clear ultrasound doesn't guarantee anything, but at the same time, it is a baby step, which seems to be what I'm resigned to these days. :)

It doesn't help that I was watching TV last night and an ad came on from one of those ambulance-chasing personal injury law firms. It started off: 'HAVE YOU OR A LOVED ONE TAKEN THE DRUG XARELTO AND SUFFERED FROM ANY OF THE FOLLOWING?' It then went on to explain all the horrible things that had happened to people taking Xarelto and urged us to contact them if we were interested in receiving compensation for our suffering. Needless to say, that didn't exactly inspire confidence, especially knowing that Xarelto is a relatively new drug and there aren't many (any?) data on its long-term safety.

Personally, aside from my initial bleeding, which could have happened on any anti-coagulant, I seem to have tolerated Xarelto fairly well. Nonetheless, I am anxious to be off of it, or to at least know I won't have to be a life-long taker of anticoagulants. Of course, almost every source I've read suggests being on an anticoagulant for a minimum of three months, and probably closer to six months considering the extent of my DVT. Regardless, having a clear ultrasound, or at least one showing improvement, would still give me a tremendous peace of mind.

Here's to hoping!

Friday, October 10, 2014

Let it Go (13 Weeks + 4 Days)

For no particular reason, I'm having a good day. In fact, I saw my orthopedist this morning, and basically he was not helpful at all, yet I'm feeling a lot happier than I have in a while. Maybe it is the residual effects of book club, which seems to buoy my mood. Or maybe my orthopedist was more helpful than I give him credit for.

For one, he seemed much less rushed than usual, and took the time to really talk. So while I did tell him I had been feeling better over the past few days, I mentioned that I had clusters of good days and bad days, just like I did before the surgery. He seemed cautiously optimistic about the good days and did not dismiss the bad days. We then talked about various things.
  • I explained the motions that really hurt - the combination of flexing my thigh and then putting weight down on it, which occurs when I walk and especially up and even down stairs. He asked if I could ride a bike and I said riding a bike was fine; it definitely seems to be weight-bearing that hurts. He said it was a good sign that riding a bike was okay, but quickly added, 'But I understand that walking is pretty important.' LOL. 
  • I mentioned that the pain usually got progressively worse and was always the worst at the end of the day, especially the days when I teach. I finish my last class at 1:30, then mostly sit in my office for the rest of the afternoon. It's when I get up to go home that the pain is the worst - walking down endless flights of stairs to go to my car. He asked, 'What about when you get home?' I told him that when I get home, I lie on the couch and cover myself with ice and drink beer, which isn't exactly true, but he thought that was pretty funny. Ahhhh, yes, self-medication!
  • Since he seemed to be in listening mode, I also told him that I had gone hiking a few weeks ago and had felt great and really thought I was getting better. Unfortunately, the pain returned after the weekend and after a day of work, and I told him AJ's theory of work being the problem. He did note that it was interesting that the pain came back so long after the actual hiking.
  • He did a few tests and said that my strength was good and that I seemed to have full strength in my hip, so he didn't feel that it was a question of needing to strengthen anything. He also said that my range of motion without pain was much better than the last time, and that it did not appear that I had re-torn my labrum. I supposedly passed the labral impingement test, but we know how that goes.
  • Speaking of which... he also repeated his blood clot test on me (Homan's test) although I don't trust him at all on that one! Fortunately, he ordered a repeat ultrasound so we can see where we stand with my DVT without having to rely on his examination skills (or lack thereof). I did tell him that while my leg was definitely better, I still had some pain when I tried to squat down. I told him I realized this when I tried to put air in my tires the other day, and I ended up crawling around on my hands and knees in front of the gas station.
Other interesting tidbits:
  • While he was examining me, he asked how classes were going. (I'm always amazed he remembers that I teach.) I told him they were going well. He asked if it was midterm time yet, which is interesting, because I feel like a lot of people have asked me that recently, and I don't know anyone in my department who gives 'midterms' - a pretty standard biology course is three or four exams and a final. I told him I don't really give a 'midterm,' but the class had just had their first exam. He asked how they did and I said they did pretty well, that the average was around a 70%. His jaw dropped. Then he asked if I scaled that up at all. I said no, 70% was actually a pretty good average for the first test. He just stared at me with his mouth open, so I added that a lot of people score in the 30s and 40s, which has to mean they aren't even trying, so I never scale up based on the average. I added that I do bump up grades on occasion if I don't have enough As; I like to have at least 10% of the class have an A. He kept staring at me and said, '10%?!' Then he declared, 'I'm glad I didn't have you for biology - I might not be a doctor now!' HA HA! (Have I mentioned that I really value sense of humor?)
  • Before I saw the doctor, I asked the medical assistant if I could get a copy of the surgery report. I added that I knew it was sort of awkward, but I felt like I might have to see a different doctor at some point and would like to have the report. She was understanding. She said she would print it off for me, but then she never came back. After I saw the doctor, I thought she might come back in with the orders for the ultrasound, and hoped I could ask her then, but unfortunately the doctor came back in himself with the orders, which meant that I had to ask him for the surgery report. I could have just ditched the idea at that point, especially since I felt like the visit went well, but. But. But. I asked him for the report and it ended up being fine, but... eh. On an amusing side note, I had to laugh at the very first sentence, This is a very pleasant 39-year-old female... Me? Pleasant? Even very pleasant? Did he just add that in there before giving me a copy? I didn't know they put notes about your personality in surgery reports. Besides, aren't most people pleasant when they are anesthetized? LOL.
So after all this... my doctor seemed a little stumped, just like I am. As he said, physical therapy doesn't seem to be helping and the cortisone injection didn't help, either. He contemplated the situation for a good while and then said, 'I'm thinking we should just... maybe... give it a rest.' I immediately understood, and agreed. Let it go. While this isn't exactly helpful, it sort of is. I was thinking about this before my appointment: What exactly is it that I want my doctor to say or do that would satisfy me? Yes, I suppose he could order more X-rays or another MRI, but I'm not sure that's really what I want right now. I sort of just want a break. I think this is what I was getting at about a week ago, when I wrote about just trying to accept my pain for what it is, and stop stressing about it so much. That actually helped me a little. And hearing this from my doctor validates it a little more.

It felt different than the other times when he just told me I needed more time. He didn't say that I was going to be fine, he just suggested trying to take it easy for a month, and after a month we would see where we were and re-evaluate. It is sort of ironic that not hearing him tell me that I was going to be fine made me feel better. I guess that made me feel like he was listening more carefully than before. He did say his usual hope was to have people back to normal after three months but that, of course, everyone is different.

So the plan is:
  • Stop PT. Overall, it's just not helping and seems to be making everyone frustrated. (I stopped by the PT room after my appointment and both AJ and Beth agreed this might be a good thing.)
  • Continue non-weight bearing or minimally weight-bearing activities that do not hurt, such as a stationary bike or elliptical. I'll have to work on this one - perhaps carve out some time to go to the Y.
  • Continue taking meloxicam. It is probably helping a little bit, even if I don't notice any obvious benefits. He also suggested taking it in the morning, which I haven't been doing because I'm afraid of the side effects making me goofy. However, I've been taking it long enough now that I'm pretty sure it doesn't make me goofy.
  • Get an ultrasound on my leg (which I scheduled for next Friday) and try to get off Xarelto sometime in the near future if the blood clot has resolved (fingers crossed).
  • Avoid activities that cause pain. This is hard when walking is one of those things, but fortunately he did not mention the 'c' word. He did recommend perhaps not hiking for a while though. Ha. I need to try getting rest when I can to give my hip a chance to calm down. It's not as if I need bed rest or to go back to crutches, but... I just generally need to try to take it easy.
I'm surprisingly okay with this plan. I also feel as if somehow, in all of this, I was able to let go of some of my anger. I've been feeling a lot of frustration toward my orthopedist over the past few months, and I don't like feeling that way. I felt like he redeemed himself today, and I'm happy to be able to let go of my anger towards him. He truly is a super nice guy, and I do believe that he's trying to help me in the best way he knows how. He seemed concerned today, and ironically, that has renewed my faith in him.

So... onward.

Thursday, October 9, 2014

Book Club Redux (13 Weeks + 3 Days)

I've mentioned that I'm in a book club, and I really look forward to my monthly book club meetings with fellow working moms, who also look forward to this one night a month where putting the kids to bed becomes the sole responsibility of the dad. As someone tonight said, 'It's really more like a drinking club with a book problem.' LOL.

Somehow book club seems to have fallen into the same schedule as my visits with the orthopedist: book club on Thursday night, orthopedist on Friday. At the last book club, I was also anticipating a meeting with my orthopedist the following day. Looking back, I think I've improved somewhat since the last book club. In fact, I'm having a fairly good hip week, and I'm sort of torn as to how to go about with my appointment tomorrow. On the one hand, I'm happy that I've been feeling better for the past few days. On the other hand, the few minutes that I get with my orthopedist every now and then are few and far between, and I feel like he should know about the horrendous pain I've been having for the past three weeks. I realize that perhaps I could actually be getting better (which would be awesome), but... what if I'm not? What if I'm just having a good few days, the same way I was having a good day when I saw him two weeks post surgery and he failed to diagnose my blood clot because I was having a good day?

I feel as if I tell my orthopedist that I've been feeling better, that is all he will hear. He will just take that as a sign that I'm getting better, and that will be the end of it. And while I HOPE that's the case, I don't want to waste my precious minutes (especially at approximately $80/minute) on him telling me that everything is going to be just fine.

Ah, dilemmas.

Friday, October 3, 2014

Baby Steps (12 Weeks + 4 Days)

So back to more practical matters.

Ever since the semester started, I've only been able to make it to PT once a week, even though my orthopedist was still recommending twice a week at my last visit. Honestly, I could make twice a week work, but with my old PT, AJ, it wasn't worth it. It wasn't worth the time or the money. Also, back in August, I mentioned to AJ that I would be cutting back to once a week once the semester started and he thought that was fine. At the time, he said I was doing great, and he actually thought that pretty soon I wouldn't need to come in at all.

Ha.

Several weeks ago, I wrote about how AJ broke up with me. For the past few weeks, I have been seeing Beth, who, despite being 'just' a PTA, is, like, 100x better than AJ. Okay so maybe not 100x, but at least 2 or 3 and maybe even 10. She's just a lot more hands on than AJ, which has actually been pretty helpful. At least, I leave PT with a sense of accomplishment rather than a feeling of extreme depression. I left PT yesterday feeling positive enough about PT that I actually made two appointments for next week.

Something I haven't discussed a lot recently is the pain in my left hip (the non-operated side). This is mostly because I sort of totally can't deal with this right now, so I've tried to block it out. Unfortunately, the pain has recently become un-ignorable because it is preventing me from comfortably sleeping on my left side, and since I can't sleep on my right side, either, this has led to a lot of sleepless nights, which reeeeaaaalllly gets to me. I can't stand not getting enough sleep - although it happens frequently, which probably goes a long way toward explaining my bad personality, lol. 

After a consultation with Dr. Google, I diagnosed myself with bursitis. (This doesn't take a rocket scientist.) And honestly, it doesn't seem to matter what any of any of this is, as non-surgical options for most conditions are the same: rest and ice. (And trust me, I'm 110% anti-surgery at this point.) Unfortunately, 'rest' in a lot of cases means crutches, just like AJ suggested, but let's not go there right now. However, one recommendation for bursitis is a cortisone injection into the bursa - LOL, sound familiar? The up side to this is that it is both diagnostic and therapeutic, just like a cortisone injection into the hip. If it takes away the pain, you know what you're dealing with; if it doesn't help, you can eliminate bursitis as a cause of pain. The down side is, of course, that as I've learned from experience, cortisone injections hurt like fucking hell and are also pretty pricey. Plus, the more I read about cortisone, the more I'm convinced that it's got to be really bad for you or at least not good for you, especially if you use it a lot; after all, it's a steroid. So I wasn't exactly jazzed about a cortisone injection; nonetheless, my left hip has become quite painful and I realize I will have to deal with it at some point.

Yesterday I mentioned to Beth that my left hip hurt quite a bit. She massaged it for a while and suggested that we try a cortisone patch, which basically delivers cortisone to a site without the need for an injection. Instead, the cortisone is delivered via iontophoresis, which is driven by a small battery in the patch. (I looked all of this up after the fact.) Although I've used patches for back pain before (which I'm pretty sure were just numbing/painkilling medications), the idea of the cortisone patch was new to me, and sort of exciting. A cortisone shot without the shot!

And... I have to say... two thumbs up for the cortisone patch. My left hip feels so much better today, I can't even tell you. The sort of funny thing is that I woke up and was like OMG my hip feels amazing! only to realize that my groin area was killing me. It was as if the pain just moved from my bursa into my groin. LOL. However, after a day full of activity, I'm pretty sure the current pain is actually just soreness from all the stuff I did in PT yesterday.

Beth also suggested trying a patch on my right side, and I figured why not. After all, what is one more dose of steroids in the large scheme of things? And as long as it doesn't involve a needle, it seems relatively free of risk. Basically the patch didn't do anything for my right side, but that is at least good information. So it's likely not bursitis on my right side. And actually, at my last appointment with my orthopedist, he did 'check' for bursitis, and he concluded that bursitis was not the problem. I say 'check' in quotes, because I have little faith in his physical examination skills, but I at least agree with him now. :) Unfortunately, when it comes to my right side, crossing bursitis off the list leaves me with much less palatable possibilities, which, in accordance with my last post, I am not going to worry about for the time being. I'm just happy to have some relief in my left hip.

Baby steps, baby steps. :)

Thursday, October 2, 2014

Embrace your Pain (12 Weeks + 3 Days)

J'embrasse mon rival mais c'est pour l'étouffer.

(I embrace my rival, but it is to strangle him.)

Jean Racine (1639-1699)

* * * * *

One time in college, I set out to make an inspirational poster for one of my teammates. This was pre-Internet era, so inspirational quotes were not a Google stop away. I had two books of quotes, one of which was full of quotations from only French authors. Flipping through the book, I found the quote above. It didn't quite work for inspiring better diving, so after a lot of 'fiddling,' I finally came up with: Embrace your fears, and you will strangle them.

It is like our diving coach used to tell us: It is okay to have butterflies, you just have to make them fly in formation. 

I was once an accomplished athlete. My main sports were gymnastics, and later diving, both of which involve a significant amount of fear. I could have been so much better than I was, but unfortunately, fear always got the best of me. My physical abilities were always ten steps ahead of my mental abilities. The thing is that fear and anxiety are a cycle, just like pain is a cycle. Looking back, I think that I sometimes feared the horrible feeling of fear itself rather than the actual dive. I detested that feeling of shaking legs and standing on the end of the diving board full of self doubts, wondering if I actually had it in me to throw myself off the board, do two and a half flips, and override all human instinct and land on my head. When I managed to put these thoughts out of my head, the dive itself wasn't ever difficult for me.

With my current hip ordeal, I've been told I need to break the pain cycle, and I've tried so many things to do this. So far, these things haven't worked. Now I think I need to break the cycle of fear and anxiety and stress. I realized recently that my stress about my pain is worse than the pain itself, just as my fear of doing a back 2 1/2 in diving was worse than the worst thing that ever happened to me from actually doing it. I need a break from the stress. I need a break from worrying about the pain and a break from my constant appointments with Dr. Google and a break from wondering what is wrong with me and why I'm not better and why surgery didn't work and... and... and...

I have an appointment with my orthopedist next Friday, a week from tomorrow. Until then, I'm just going to accept the pain for what it is and do the best that I can with it. Because at this point, it is the stress about my pain that is killing me, not the pain itself. I am tough. I can deal with physical pain. It's the mental stuff that has always gotten the best of me. So I need to tend to the mental part of this.

Embrace your pain and you will strangle it.