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.