Second Opinion (Starting Over)

It is has been about 8 1/2 months since I had the surgery to repair my labrum, but that surgery doesn't even seem relevant right now, so I am starting a new timeline.

This morning I did what I should have done 9 months ago, which is get a second opinion.

Honestly, I am really unhappy with what the doctor told me, and feeling extremely depressed right now. But I also know it's the answer I've been looking for, even though I don't like it.

I am also feeling some anger toward my old orthopedist and am certain that regardless of what the future holds, I'm never going back there.

The morning started off very badly when I woke up at 7:17 AM. My appointment was at 7:15 AM, about half an hour away from my house. I set my alarm for 6:15 AM last night but apparently did not actually turn the alarm on. Normally my alarm is on all the time, but since it is spring break for me and the kids, plus we have been out of town, I am apparently not in an effective alarm-setting groove. I tried to call the office to see if they still wanted me to come or if I needed to reschedule or what, but since it was 7:20 AM, the office was not officially open, and no one was answering the phones. So... I decided to just drive out to the office and see what they wanted me to do. I got there just before 8:00. Normally I would hope to be able to sneak in despite being late, since orthopedists are usually running at least 45 minutes late, but unfortunately, knowing that orthopedists are usually running late caused me to take the first appointment of the day, so the orthopedist couldn't possible be running late yet. I apologized profusely, and was extremely grateful that everyone was super nice to me, and that they were willing and able to work me in despite my extreme tardiness.

* * * * *

The first thing I did was have X-rays taken, which was interesting, because my old orthopedist never took X-rays. I had X-rays done before my first MRI; my PA ordered them because it is standard to have X-rays prior to an MRI, but I know that my old orthopedist never looked at them because every doctor I saw in that practice said they were unable to access my X-rays for whatever reason. They didn't seem to think it was a big deal.

However, a while after I had the X-rays, the orthopedist's NP (nurse practitioner) came in to discuss them with me and 'get things started.' She was very pleasant and thorough and explained everything to me very clearly, even sketching things out on a copy of my X-ray for me. She really didn't tell me anything I didn't already know from years of consulting Dr. Google; nevertheless, it was good to hear them coming from a flesh-and-bone healthcare provider. Basically:

• I have very shallow hip sockets.
• This means I have dysplasia. It's pretty bad - 'more than we've seen in a long time,' according to the NP. Both she and the doctor were very interested in my case.
• I also have a 'cam' impingement on the head of my femur (actually both femurs), which essentially means there is a little extra bone, which means that when I move my femur around, there is too much contact between my hip socket and my femur, which causes the grinding feeling and pain.

The upshot is:

• The abnormal anatomy of my hips puts a lot of stress on my labrum. Basically the torn labrum is not really the issue. It is just the result of the dysplasia, which is unfortunately more complex to deal with.
• If I were to just have the labrum repaired again, it would likely just tear again.
• The only way to truly fix my hip problem is to correct the dysplasia. This can only be done by having a surgery called PAO, which stands for periacetabular osteotomy, and sounds horrendous. (You can Google it and find about a kazillion results, and despite the fact that most of the sites you come up with are orthopedic surgeon's sites trying to tell you how much better this surgery will make your life, it sounds like it pretty much sucks. Big time.) This basically involves cutting apart the hip bone and putting it back together with screws in a better configuration. This orthopedist doesn't do this type of surgery, but one of his colleagues does.
• Their recommendation, if I were to continue down the surgical route, is to have the PAO, then a few weeks later go back in to fix the labrum. The recovery time for the PAO is longer than for a labral repair, so basically the labral repair would be wrapped into the PAO recovery, which is 4-6 months, with at least 6-8 weeks on crutches and way more restrictions than with the labral repair.
• Ugh!
• Ugh!!
• Ugh!!!
• I had run across PAO during my numerous consults with Dr. Google, but I have to admit, it wasn't really on my radar as far as possible procedures, just because my orthopedist never seemed very concerned about my dysplasia. In fact, neither he nor his colleague (the guy I saw before him who referred me to him) ever even mentioned the word dysplasia to me before, although he did write about it in the surgery report.

The NP and I discussed a few other things, including alternative treatments to surgery, my DVT, my left hip (and how it's likely that I have the same problems with my left hip), my bursitis (very common as a 'side effect' of greater hip problems, according to the NP), getting another injection (mostly for diagnostic purposes but also for pain relief), getting an MRI of my left hip, and the logistics of everything. She was very friendly and pleasant and did a thorough examination.

After a while, the orthopedist came in and basically repeated everything his NP had told me. I'm not sure if this was normal protocol to see both the NP and orthopedist, or if they were just improvising because they were trying to fit me in. The orthopedist was also friendly and pleasant - not on the same level as my old orthopedist, but I'm starting to realize those qualities are overrated in a surgeon. I apologized for being late and messing up his schedule, and he said it was okay because, 'I'm usually running late, too.' Ha. Maybe punctuality is also an overrated quality, too.

We talked briefly about my old orthopedist and his shortcomings, although I tried not to bad mouth him too much. This doctor said he didn't know my old orthopedist very well, but that 'he seems nice.' I said that he was very nice, which is why I put up with him for way too long, which seemed to amuse him. My old orthopedist had referred to this new guy as a 'friend' and I was sort of relieved that wasn't really the case. I was picturing two guys who drank their way through med school together, but the new guy didn't even know how to pronounce the old guy's name, which in a weird way made me feel better. (Plus, they didn't go to the same college or med school, which I knew in advance from Mr. Google.) The new doctor did say that his colleague, the one who does the PAO surgery, isn't very nice. Okay, so he actually said, 'He isn't very friendly,' but I read between the lines. He definitely implied that he isn't that nice. LOL. However, then he added, 'But he's very good at what he does.' Hmmmm.

The doctor told me that women, firstborns, and babies who were breech were at the highest risk for hip dysplasia, and out of curiosity, asked me if I was a firstborn and/or breech. I said I didn't know, because I was adopted, but that I assumed I was a firstborn (seeing as how my birth mom was a teenager). I must have looked interested in his factoids, though, because he went on to explain further, saying that in first pregnancies, the mother's uterus isn't stretched out yet, making it more cramped for the developing baby. Because of the position the baby develops in, with the legs folded up, being cramped pushes the head of the femur away from the hip socket, which causes the hip socket to develop more shallowly. Interesting.

Anyway, he said that if I wanted to go forward with the surgeries, it would take a lot of coordination between him and his colleague, but that the first step was to set up a consultation with his (not nice) colleague and go from there. And even though I am so not ready for this mother of a surgery and probably never will be, I agreed to a consult, just because. Because I have to do something, that's for sure, and information is never a bad thing.

He said that it wasn't clear to him whether the labrum just never healed or whether it healed and tore again, but that it didn't really matter because either way, he was certain the issue was the dysplasia. Although he could fix the labrum, in his opinion, he did not see any point unless I also had the PAO surgery. He stopped short of saying that he wouldn't do it, but basically neither he nor his NP were at all surprised that the original surgery didn't work. This makes me sort of really mad, to be honest. If I had been told this information from the beginning, I doubt I would have opted for the PAO, but I probably would not have had the labral repair done, either. I don't know if my old orthopedist was negligent or unethical to not have noticed and/or at least mentioned this glaring thing that seemed so obvious to the new guy and his NP, and quite frankly, I'm not sure which one is worse. (It's like the Seinfeld episode where Elaine discovers that all of the preset radio stations in her boyfriend's car are Christian rock. When she expresses concern over how religious he might be, George and Jerry point out that maybe they were like that when he bought the car and he is too dumb and/or lazy to know how to change them. When Elaine gets excited over this possibility, Jerry expresses his dismay over the fact that she prefers dumb and lazy over religious, to which she replies, 'Dumb and lazy, I understand!') But I digress. Either way, the bottom line is that I have basically wasted eight months, plus I have DVT that may never go away and pain in my left hip that wasn't there prior to beginning PT to rehab my right hip. And speaking of my left hip, the doctor did say I have dysplasia in that hip, but it's not nearly as bad as it is in my right hip. So apparently I developed somewhat asymmetrically while in my teenage mother's cramped uterus.

Surgery is optional, of course. The non-surgical option is to continue to manage the pain like I've been doing. And actually, I can't do anything surgically until I'm off the Xarelto, which is a different can of worms. The orthopedist told me that I needed to get a good doctor who can manage the DVT effectively and give me definitive advice as to when, if ever, I will be able to stop taking it safely. He also recommended getting a blood workup done to be sure I don't have a clotting disorder. This might mean seeing a specialist - a hematologist, for example. I'm pretty sure I don't have a clotting disorder, but it's not a huge deal to have a blood workup and it's better safe than sorry. There's no reason to mess around with this potentially life-threatening stuff. The doctor asked who my primary care provider was and I told him I didn't exactly have one. The funny thing is that he was familiar with my PA and was surprised to learn that she had moved, but he had never heard of the doctor she practiced under.

Toward the end of the appointment, I was feeling sort of deflated. I think the orthopedist sensed my glumness because he told me, 'But there's good news!' I cautiously asked him what the good news was. He replied, 'Women with this much dysplasia usually develop severe arthritis in their 40s.' I looked at him suspiciously and said, 'That's good news?' He replied, 'No, that's the bad news. The good news is that you have very little arthritis, much less than I would expect from someone with your anatomy.' I did mention the orthopedist I saw in my 20s who had declared with certainty I would need a bilateral hip replacement in my 30s, and he nodded, as if such a declaration was not unreasonable in his mind. So basically I am lucky to still be walking. Geez, isn't that comforting? Good news indeed.

* * * * *

I feel... stuck. Between a rock and hard place. Like... yes, I wanted an explanation for my ongoing pain, and I got it. But it wasn't exactly what I was hoping for. I mean, I don't even know what I was hoping for at this point. I basically had zero expectations for this appointment. On the one hand, I felt relieved that I didn't get more of the same old, same old that my old orthopedist has been feeding me for the past eight months, and I felt validated in pursuing a second opinion. On the other hand, the grim reality that lies ahead, no matter what path I choose, is harrowing. If I choose a conservative option, it is very likely that over the next decade I will develop premature osteoarthritis, which will result in a slow degradation in the quality of my life, eventually leading up to a total hip replacement, probably before I am 50. There is always the remote possibility that I could defy statistical odds, and that this wouldn't happen, but despite how surprisingly good my hip looks now, the reality is that the odds are not in my favor. I already feel like the quality of my life is declining, which is what led me to the first surgery in the first place, and I just wonder how much more I can take, and for how long, knowing that realistically things are only going to get worse. I've mentioned before how much empathy I've developed for people with chronic pain during this ordeal, and I really mean it. Chronic pain sucks. Big time. And I now understand this on a level I've never understood before.

And of course, there is also the realistic possibility that I could choose to have this surgery and still need a hip replacement sometime down the road. There is also the possibility that this orthopedist is a crackpot like my old one, only on the super aggressive versus super conservative side of the crackpot. Unfortunately, what he told me just makes more sense, based on... well, a lot of things. I just didn't believe there wasn't some underlying cause behind my continued hip pain, which my old orthopedist couldn't seem to address, which is why I wanted a second opinion in the first place. I wanted an explanation, and I got one.

I was sort of in a daze during my appointment this morning because of how stressfully the morning unfolded, and plus, it was a lot to think about, all thrown at me in a very short period of time. I talked about so many different things with the NP and the orthopedist, and to be honest, I'm not exactly sure where we left most of them. But... that's okay, because I need some time to think about things. Lots of things. And it's not as if I'm dying to rush into surgery at this point. I think the NP could tell I was overwhelmed at one point, suggesting various options, but telling me that I could think about things and let them know later what I had decided.

From a pure health standpoint, I do believe I need to find a doctor who can competently manage my DVT. This has priority. Not that I'm rushing into surgery, but I basically don't have any surgical options while I'm on Xarelto, and even some non-surgical options are not possible on Xarelto (probably more due to litigation risks than actual risks to life and limb). Beyond that, there are a lot of things to consider. None of this would be as big a deal as it is except for the fact that I'm currently working on a career change, and that career change most definitely involves being able-bodied this summer and for the next year or so. The career change is not set in stone, but at the same time is something that I've been working toward for a long time, and is not trivial by any means.

And so here I am, contemplating. It is a lot to think about.

I can see clearly now... (8 Months + 8 Days)

Maybe the rain isn't gone, but I can see clearly.

In hindsight, I think it's a good thing that my orthopedist was so completely useless at my last appointment - first talking to me about the results of my DVT ultrasound from October, instead of the one I had a few weeks ago, then basically telling me that he couldn't/didn't want to do anything about my hip. He tried to blow the 'recurrent tear' off as an 'artifact' of the surgery, and maybe it is, but then why does my hip continue to hurt so much? I understand you can have a torn labrum and live with it - in fact I did, for 15 years - but when objective results show there is a problem and your patient has symptoms that are highly correlated with said problem, shouldn't you, like, not totally blow the patient off? Like... I mentioned that the radiologist who read the MRI also remarked that I have what appears to be a very large uterine fibroid. According to Dr. Google, just like torn labrums, uterine fibroids may or may not be symptomatic. Since I don't have any of the symptoms related to uterine fibroids, I'm not concerned. However, if I had gone in for an MRI for heavy menstrual bleeding and pelvic pain and constipation, and they found that I had a 5 cm uterine fibroid, that would be a significant finding. Hello. I went in to have an arthrogram of my hip because of continuing pain in my hip. According to the radiologist, I have a 'recurrent' labral tear, which given the circumstances, seems relevant. No? And if not, then offer me an alternative explanation for the pain or at least tell me you have no idea what it is.

Geez.

At any rate, it is all good. It is good because at least this last appointment made me realize that I have had. enough. And I am sooooo looking for a new doctor, which I probably should have done a while ago, but didn't for a number of reasons. Among those: a) I hate change, and don't deal well with it at all; b) I hardly ever go to the doctor, and it's a big deal for me to go to a doctor, especially a new one (see 'a'); and c) I like my doctor; he is super nice and personable (and cute, lol), which unfortunately made me put up with his shortcomings as a healthcare provider for way too long. I guess I needed something to finally push me over the edge, and this last appointment definitely did that.

I called another orthopedist on Friday - the one my current orthopedist recommended back in January. I'm not sure how much I trust my orthopedist's judgment, but it's not as if I have an abundance of choices. If I don't get a good feel from the guy, I won't waste any time giving him second and third and fourth and fifth chances, but it's worth at least one chance. I haven't heard back from him yet, which is not a great sign - although I did call late on Friday afternoon, so we shall see.

To add to my list of gripes about my current orthopedist, I mentioned that there has been an ongoing issue with the pain cream he prescribed in January, which I never got and apparently never will get because my insurance won't cover it. Thus, when he prescribed another cream/gel thing for my bursitis on Thursday, I was wary, but he told me that unlike the pain cream, this was something any local pharmacy would be able to provide. I had no problem getting it, and it turns out the gel is Voltaren/diclofenac, which I had previously tried in pill form for my hip pain, but didn't really help and caused a lot of GI distress. (Interestingly, the gel form has helped a lot, and my left hip feels a lot better already.)

Anyway, because his MA had spent so much time on the pain cream, the one that has to be ordered from an out-of-state compounding pharmacy for whatever reason, I sent an e-mail via the patient portal explaining the situation and clearly stating it was all just FYI. (It's now clear to me that only the MAs read the e-mails.) I mentioned that I got a response from a different MA saying that she had talked to the doctor and he could prescribe a pill for me instead, which I thought was weird considering he never mentioned it before. So I e-mailed her back and asked what the pill was.

She replied: 'The pill is called diclofinac [sic] 75 mg.'
I replied: 'I am confused. I do have a diclofenac gel - that was covered by insurance and I was able to get it in town. The cream I was referring to was the one that needs to be ordered from an out-of-state compounding pharmacy.'
She replied: 'Oh I see that Dr [Loser] ordered voltaren gel as a topical, I don't see he ordered a compound medication.'

So the one time I get a prompt response back from a well-meaning MA, she obviously doesn't have a clue, and neither does the doctor. Geez.

In other news, it is beautiful outside today, around 70 degrees. I, of course, used the beautiful weather to get a jump start on yard work. As I was doing yard work, I noticed that my right leg hurt when I went to squat down, much the same way it used to hurt when I had a raging case of undiagnosed DVT. To be honest, I was alarmed when I noticed it, but tried to ignore it. However, mid-afternoon, my mom stopped by and, completely unsolicited, asked, 'Is your blood clot in your right leg?' I said yes, and she replied that my right leg was totally swollen. I looked down, and sure enough, Mom was right. (Of course she was; this is coming from someone who hasn't been to a doctor in a decade, who does not notice things like this unless they're really bad.) Ugh. I mean, I always knew it was a possibility that given the extent of my DVT, it might never go away and might cause permanent damage to my veins and might be something I would have to deal with forever and ever. But I knew this in the same way that I knew that hip surgery might not fix my hip pain and might even make it worse. I knew these were worst case scenarios and assumed they wouldn't apply to me, and that the probability of them NOT applying to me were in my favor. Nonetheless, I have to admit that my leg is very swollen, and hurts. I'm not sure what, if anything, I am going to do about it, but a little voice inside of me is telling me that perhaps I need to find a doctor who knows something about DVT. I don't know.

Weirdly enough, if I had a choice between dealing with hip pain for the rest of my life and dealing with DVT for the rest of my life, I'd choose hip pain. I just hope it isn't both.

Cry Cry Cry (8 Months + 5 Days)

I was listening to Johnny Cash's song Cry Cry Cry on the way to my appointment with my orthopedist, and that's exactly what I wanted to do. I don't think it was necessarily even about my hips, but more general stress about a lot of different stuff. My hips certainly aren't helping, but I can't blame everything on them, either. My kids have the flu, and in addition to the usual challenges that having sick kids and a job poses, my husband and I are both running on about four hours of sleep. So, the fact that I wanted to burst into tears even before my appointment might be more of an indication of my general state of mind than anything else.

I'm not sure if I am just so tired I couldn't fully function during the appointment, or if I'm just out of words. I felt like I just sat there the whole time and stared off into space and nodded my head. Obviously I have a lot going on in my mind at any given time, and some of it is stuff I would hope to be able to discuss with my orthopedist. Yet, I said virtually nothing, probably because I was too tired and knew it wouldn't make a difference. Sweet surrender.

So apparently there is still a tear in my labrum. I am unsure whether it is a new tear or part of the old tear or what. My orthopedist only seemed to care about the fact that the area where he had repaired the labrum was intact and the anchor was still in the bone. At the last appointment, he seemed most worried about the possibility that the anchor had come out, which in a weird sort of way might have been the best thing. Based on what Dr. Google told me, surgery to remove a loose anchor wouldn't be a huge deal and could offer significant pain relief. But that's not what it is, so it doesn't matter.

Since I didn't feel like my orthopedist was offering me any useful information, and mostly seemed intent on convincing me that it wasn't his fault that my hip still hurts (not that I'm even blaming him), I asked his MA for a copy of the report so I could read it myself. It says:

(T)here appears to be a recurrent tear of the anterosuperior labrum, across the labral base. (...) The tear is positioned just posterior to the acetabular anchor, involving the anterior aspect of the superior labrum and the superior aspect of the anterior labrum. (...) The superior labrum is relatively large, potentially hypertrophied due to the relatively poor coverage of the superior femoral head by the relatively small acetabulum. (...)

IMPRESSION: Recurrent right acetabular labral tear at the junction between anterior and superior labrum. The tear passes beneath labral base, just posterior to the labral anchor.

Honestly, I don't know what I think about any of this. I don't have any energy to even think about what I think about it. I'm so tired of thinking about it.

In other news:

• The report also states: 'A large-field-of-view coronal sequence shows a large myometrial mass that measures approximately 5 cm in diameter, is very similar to the prior study, and is likely to represent a uterine fibroid.' Good to know. LOL. Honestly, when I started to read the report and it was talking about uterine fibroids, I thought I had the wrong report. I would hope that if this were a significant finding, someone would have mentioned it to me by now; nonetheless, I consulted Dr. Google about uterine fibroids, just to make sure. Apparently they are 'normal' and don't usually cause any symptoms, and I don't have any of the possible symptoms listed, so it's just one of those things.
• Ever since my arthrogram, my left hip has been hurting a lot. I know that it is 'just' trochanteric bursitis, and that it comes and goes, and is probably related to how my right hip is feeling and how much I am limping. I'm not usually too concerned about it because I have my right hip to worry about and I can't worry about two hips at once. (Remember, I have a ridiculously low stress threshold.) However, it has been very painful for about a week, to the extent that I have been icing it many times a day to try to manage the pain. And, it actually hurts worse than my other hip at this point, which has not been the case in a long time. Dr. Google told me the best treatment for severe bursitis was a cortisone injection, and my orthopedist agreed. He said that unlike the cortisone injection into the joint, it was no big deal to inject the bursa, and there were usually very good results. I said I didn't feel like an injection was necessary just yet but would consider it if this episode didn't resolve itself like the other ones have. At any rate, he told me that pain in my bursa was 'a much better problem' than pain in my hip joint; he had definite solutions for bursitis (and I totally believe him, because every time he has told me everything is going to be awesome, he has been right </sarcasm>). He prescribed a cream (another one!) for it, one that I could pick up at a local pharmacy, and said that if it wasn't better in six weeks I should come back and have a cortisone injection.
• I also have a touch of bursitis on my right side, although it's not nearly as bad as on my left side. The doctor did say that if I had the right side injected as well, he would recommend doing one side at a time. So apparently it's not a completely painless procedure.
• Whatever. I have no plans for injections anywhere in my near future. (I'll wait until I'm in complete agony. LOL.)
• The doctor also mentioned that he thought physical therapy could help the bursitis, 'if you're up for it.' I said I felt like PT is what started the bursitis in the first place, to which he replied, 'Okay, never mind.' I said that in the past, these 'flares' usually calmed down on their own, though I was starting to worry that the current one was my left hip starting to go downhill. His reply: 'No, that's not allowed.' If only it were that easy.
• Speaking of PT, on the way out I popped in to say hello to my physical therapist. We had a cordial conversation and he said he was sorry he didn't have any ideas to help me. Then he mentioned that there were huge changes in the future, as their practice was 'partnering' with (i.e., getting bought by) a major healthcare system. Interesting. And sad. I mentioned in a previous post that I've always been drawn to small practices, and oftentimes, solo practitioners. It is sort of depressing to me that even this major orthopedic group is being bought out, as the group in its current state is already really big and impersonal.
• Also sort of on the subject of PT, last night in my EMT class, we practiced applying traction splints for broken femurs (which is something we will be tested on but never use in real life, according to our instructors). However, when it was my turn to be the fake patient and have the traction splint applied to me, it felt so good I actually volunteered to be the fake patient a second time. I've had my leg pulled on a few times before in PT, so maybe there is something to it.
• I mentioned that I still hadn't received the pain cream we had talked about. The MA gave me a number to call, and I actually did. Apparently my insurance doesn't cover snake oil produced at sketchy compounding pharmacies in Southern Mississippi, so they never sent it. (You'd think they could have just told me that a month ago.) I'm not opposed to paying for things out of pocket, depending on how much I think they will help and how expensive they are, but based on my experiences with this pharmacy thus far, there is no way I am going to give money to this place and just trust that they are going to send the cream to me. Plus, $1 per gram is pretty expensive for something I have my doubts about. So, whatever.
• As a courtesy, I sent an e-mail via the patient portal with a snake oil update, and briefly described my negative experience with this pharmacy. Both the doctor and the MA told me they had actually switched pharmacies because the previous pharmacy was so sketchy and they had soooo many problems, so I thought they should know this one sucks, too. To my surprise, I got a response within a hour from a different MA than the usual one, who said that she spoke to my doctor, who said he could prescribe the same medication in pill form if I wanted. I'm still sort of contemplating this. What type of medication are we talking about here?
• Even though my PCP is now taking care of my DVT (supposedly), I still had the ultrasound results sent to my orthopedist, since he was the one who set off this whole thing to begin with. When he first came into the room, he started talking to me about my DVT, and how it might be a lifelong condition, etc., etc. He was saying all of this as he was reading the report from my ultrasound, which he then then left for me. It was only after the appointment was over when I read the report myself that I realized that he was looking at the report from October. Needless to say, this didn't exactly inspire confidence.

It's ironic that after overthinking all of this for way too long, I truly don't want to think about any of this right now. After laying out all my plans for X, Y, and Z scenarios, now... I'm not sure what I think. I need to sit on everything for a few days. And get some sleep.

Three (8 Months + 3 Days)

Three.

That's how many new doctors I need.

I need:

1. an orthopedist
2. a primary care provider, and
3. an OB/GYN

I guess ideally #2 and #3 could be one person all wrapped up in one, like my old PA was. It's not as if I'm usually that needy. I typically only need antibiotics once or twice a year, plus I go in for my annual well-woman check up, mostly so I can get a prescription for birth control. I haven't gone in this year because I don't have a provider I would let touch me down yonder, and I'm not currently taking birth control due to my DVT.

Unfortunately, I'm needier now than I've ever been in my adult life, and I feel like I need a 'go to' person. I really, really miss my PA. I had a third ultrasound for my DVT over a week and a half ago, and I've been not-so-patiently waiting for my current doctor to get back to me with the official results. I haven't been taking Xarelto for the past few weeks because I was instructed to stop taking it five days before my arthrogram, which meant I was supposed to stop taking it on Thursday, 2/26.* Conveniently, I was also running out of pills around the same time, and I didn't renew the prescription because I was having an ultrasound on 2/27, and I hoped it would be good news, and that it would be a good time to ditch the Xarelto altogether.

* According to my doctor, I didn't actually need to stop taking Xarelto for five days prior to the arthrogram; this was more for other anticoagulants such as Coumadin. He was supposed to look this up and get back to me, but of course he never did.

I waited impatiently for almost a week before trying to follow up with my doctor about the ultrasound results. Based on what the tech had told me, I felt pretty good, and I really try to give people time and not hold everyone to my personal standard of timeliness, which is apparently abnormal. But eventually I called the office on Thursday of last week. It had been almost a week and I mean, geez, I just don't feel like a two-minute phone call with the results of an ultrasound is asking that much (but apparently it is, because it was a big deal for my orthopedist as well). I left a message with the front desk, but no one got back to me, so after giving them the weekend, I called again yesterday morning, which was a Monday. I didn't get a response all day, nor one today (Tuesday), so I enlisted my husband, who has a texting relationship with this doctor. FINALLY, the guy got back to me, about an hour ago. And...

... apparently the clot is still not f-ing gone, and he is recommending another three f-ing months of Xarelto, and another ultrasound in three f-ing months. Sorry, that is a lot of f-ings in one sentence but I'm feeling just a little ticked off right now. I'm feeling irritated over the f-ing doctor, over the f-ing blood clot, and over the fact that my f-ing hips are still f-ing killing me.

And speaking of my hips, this week is passing soooooo slowly I can't stand it. I have consulted Dr. Google numerous times this week about various scenarios, and each time I have had to cut myself off and remind myself that I had the f-ing arthrogram done so that I could put all of this guess work to a rest. I just hope that when I go in for my appointment on Thursday my doctor has read the results of the f-ing arthrogram.

And while I am pissing and moaning about doctors, let me just be a pathetic whiner for a little bit longer. Before the arthrogram, the imaging place wanted a report from my first MRI, as well as the surgery report, which they said would help the radiologist interpret the results (which yeah, makes sense). They thought they could get the results of my first MRI (which they did), but that I should provide the surgery report. So, I sent an e-mail via the patient portal requesting the report, and never heard back. Of course. A few days later, I called and left a message requesting that the report be sent, and I filled out some paperwork requesting the release of the report, but apparently it never got sent, because when I went to check in for the arthrogram, they didn't have it. I gave them my copy of the report, which I had requested way back when, when I first started having my doubts about my orthopedist. However, this was just a printed version and it cut off about 1" on the right margin, so 3-4 words of every line are missing and you have to sort of fill in the blanks. But, it was better than nothing. Even /I/ got gist of the report, missing words and all. BUT STILL, is it asking too much to send an f-ing report to an f-ing radiologist? I mean, isn't the whole idea of the 'information age' that stuff like this is not a big deal?! I live in a reasonably sized town with a metropolitan area of over 500,000 people, and my orthopedist is part of a reputable orthopedic group with a ton of resources for patient portals, support staff, and all the bells and whistles of modern medicine. (I have more sympathy for my PCP, who is a struggling solo practitioner whose PA just left him.)

And... remember that snake oil/pain cream I discussed with my orthopedist over two months ago? Still nothing. After my last visit with my orthopedist in February, his MA made a big deal about me not getting the cream and told me to hound them until I did. I didn't. Because: a) I just wasn't sure it would help and didn't care that much; and b) Why should I have to hound someone to get something they told me they would take care of? Like... I tell my students to let me know if they have a problem or don't understand something, but I don't say, 'Hound me until you learn something.' WTF?

Okay.

I need to quit. This is unproductive bitching, and I'm guessing that after my 'F/U' I'm going to have a lot more to bitch about. Just a hunch.

MR Arthrogram (Almost 8 Months)

Well, that was unpleasant. I knew it would be, and was prepared for it, but it was still unpleasant. I guess I was hoping it would be better than I was expecting. It wasn't. But, it wasn't worse than I thought it would be, either. It was pretty much what I had prepared for.

It didn't help that I stayed up way too late last night and didn't get to sleep until around 2 AM. I am taking a night class that goes from 6-10 PM, and after psyching up to stay awake through four hours of lecture, I have a hard time winding down. So, I was reeaaallly tired this morning. I practically sleep-talked my way through my morning class, and took off immediately afterward to get to my 11:15 appointment.

Before the MRI, I went in to get the contrast dye (gadolinium) injected. Getting the dye injected was about like getting a cortisone injection. I would say it was somewhere in between the first cortisone injection I had, which was horrid, and the second one, which wasn't nearly as bad. The injection was done by a radiologist, with the help of a tech. Before injecting the dye, the doctor injected an anesthetic, which was actually the most painful part, but apparently makes the injection of the actual dye hurt less. Both the tech and the doctor told me the dye would make my hip feel 'full' because they were adding between 10 and 15 CCs. (Ultimately I think they added 11.) 'Full' is a good way of describing it. It didn't exactly hurt, but it was extremely uncomfortable - sort of how your arm is uncomfortable when you're having your blood pressure taken, only the feeling lasted for over an hour.

After the injection, the radiologist took a few X-rays to make sure the dye was in the joint. For one of the X-rays, I had to do 'frog legs' and that... hurt. Like a mother. First off, my leg felt so weird I didn't feel like I could move it. When I finally did, rotating it outward caused a massive amount of pain. I must have made a face because the doctor asked if my hip always hurt when I rotated it like that, and I said that was pretty much the case. It reminded me of the time I had to get X-rays of my elbow because it was totally swollen and I couldn't straighten my arm. The X-ray tech told me I had to straighten my arm to so she could get a good picture but it was like, 'Helloooo, that's why I am here - because I can't straighten my arm!'

On a funny side note, when I was going over the information with the tech before the injection, I noticed they had listed my birthday as being in 1940. LOL. I told her I was definitely not THAT old. I crossed it off and changed it to 1974. She said they must have been looking at my age when they wrote that. Then the doctor came in and looked at the paper and said, 'Is that right? Were you really born in 1974?!' I said yes. Then he asked, 'So that makes you how old?!' I replied that I was 40. Then he said, 'That's what I thought, but before I saw this I thought you were, like, 18.' I told him that apparently 40 is so old I'm not even offended when people say things like that. Ha.

I must have really been limping when we went downstairs for the MRI because the tech asked me if I needed a wheelchair. LOL. I had a short wait in the waiting room with a woman who was drinking barium and apparently having a very hard time with it. She asked me if I had ever had to drink barium before. Yup, been there, done that, in high school. I'm not sure which is worse, having dye injected or having to drink barium. Barium is seriously so gross it makes you want to throw up, and a lot of times the reason you're drinking it in the first place is because you've been throwing up constantly. I told her I had had to drink barium before and agreed it was awful. I decided maybe having the contrast medium injected wasn't as bad as having to drink it. Plus, when the barium passes through you, it's not pleasant. I'll leave it at that. 

Eventually I went in for the MRI, and aside from being very painful, it was pretty uneventful. My hip was pretty much throbbing at that point, and lying down on my back is very painful. At first I was in such an uncomfortable position I had no idea how I was going to make it through 45 minutes, but then the techs at least put a pillow under my legs so my hips were not hyperextended (which really hurts me). Then they taped my feet together so it would be easier for me to hold still. And in I went. It was louder than I remember. And longer. The last time I had an MRI, I remember telling them to play classic rock, and I had to listen to '80s music the whole time. This time I also requested classic rock, and it seemed like true classic rock, although I could honestly not really hear much at all. I also remember last time thinking the time passed pretty quickly, but maybe that's because I fell asleep. This time I felt like the MRI would never end, but maybe that's because I was so uncomfortable (which is probably why I couldn't fall asleep). In the end, the tech told me I had done a great job holding still, and that they were able to get some great pictures. She said it so many times it made me wonder what most people do during the MRI. It's not as if you really have the choice to wiggle around. Since she kept going on and on about all the great pictures they had gotten, I asked her if she saw anything interesting. She promptly replied, 'Unfortunately, even if I did, I'm not allowed to say anything.' Darn. A by-the-books tech.

When I left, I was in an extreme amount of pain, but the pain wore off after about an hour. I feel pretty good now, although I am supposed to 'limit my activity' for the next 24 hours, whatever that means. Anyway, the arthrogram is done, and I'm glad I had it done because no matter what, it will help me make some decisions as I try to get through this mess. I have an F/U with my orthopedist next week, and until then, I'm just not going to think about it.