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.

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.

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!

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. :)

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!

Out of Words (11 Weeks + 5 Days)

I feel like I am running out of new words to express my frustrations, which is an odd feeling for me. I'm almost never at a loss for words when it comes to writing.

I suppose that I could write nothing at all, but... it is Saturday evening and I am home alone, with only college football on TV to keep me company. Also, as I have progressed through this hopefully soon to end adventure, I've realized how valuable it is for me to have a record of some of my experiences, as I was experiencing them. Of course, my hope is always that what I'm writing won't end up being significant, but so far I'm batting about 500. The leg pain I started to complaining about just a week after surgery turned out to be massive blood clot, which was finally diagnosed a month later. At that point, I stopped taking birth control and started taking Xarelto, which led to massive vaginal bleeding, which I freaked out about. Fortunately, that did turn out to be 'nothing' - if losing enough blood to soak through a super plus tampon and a pad in an hour for 48 hours counts as 'nothing.'

I'm now almost 12 weeks post-surgery, the point at which I was supposed to be all better, 'all better' meaning that I would have no restrictions on my activity, the point at which my surgeon said he had seen NHL hockey players start playing hockey again. Instead? I am feeling horrendous pain, the same, if not worse, than it was before the surgery. I also have a lot of pain in my left hip, which I've mostly been trying to ignore, because honestly, I can't deal with pain in another body part right now. (I warned you early - I have pretty much zero tolerance for stress.) However, I'm starting to get somewhat alarmed by the pain in my left hip, which is relentless and just won't let up.

I know that I supposedly need to be patient, but I am tired of being patient and tired of being a patient. Also, at my last visit with my orthopedist, he assured me it was very likely that I'd be feeling much better in a month. That was almost a month ago, and instead of feeling much better, I feel much worse. And this is after having a second cortisone shot a little over two weeks ago. This does not feel right to me. I realize that recovery from surgery is a process, and everyone is different, and yada yada yada, and just because NHL hockey players are able to play hockey within three months doesn't mean I should expect the same. At the same time, I don't feel like it's normal that I should be feeling worse than I did before surgery at this point. And I'm not asking to play hockey, just to be able to walk without severe pain.

I mentioned a few weeks ago that my therapist had suggested using crutches again, to give my hip a rest. At the time, I saw that as really going backwards, but recently I've become sort of desperate and decided to try this - at least when I'm alone. At this point, it is not muscle weakness or lack of range of motion that is my problem; it is the pain. I can do everything that is asked of me at PT; it just hurts like hell. So maybe a little rest when I can get it isn't a bad idea. With that in mind, I decided to really try to rest this weekend, since my husband took the kids out of town and I was by myself. It has been difficult to really adhere to using crutches to get around, but at the same time, the pain relief that the crutches afford makes it easier.

I was supposed to take an all-day class today that was cancelled. So... I went up to my office at the university and spent the day there. I could have worked from home, but over the past few years I've really tried to make a concerted effort to draw a line between my work life and my home life. I've been so successful that even when I'm all alone, it's hard for me to work from home, with the exception of answering e-mails and grading.

As I said earlier, I am super self-conscious about trudging around on crutches; for some reason this embarrasses me, a lot. However, I figured that I was fairly safe from embarrassment on a Saturday morning at the university, and was fairly determined to give my PT's 'resting when I can' idea a chance. Little did I know that so many of my colleagues work on Saturdays. LOL. Fortunately, everyone knows about my hip saga at this point, so it's not a hugely surprising thing for me to be using crutches to get around. (If I'm not crutching, I'm limping and constantly whining.) The sort of ironic part of this is that yesterday, I had to walk across campus to deliver exams to Disability Services for my students who need a test-taking accommodation. While I was dragging myself past my colleague's office, she asked me where I was headed, as if she knew I was going to Disability Services (work ESP, I guess). When I told her, she came out of her office and asked me if I could take her exams over for her as well. Then she asked me if I needed to borrow her cane. LOL. This woman is actually disabled herself; she was hit by a car while riding her bike to work, and now uses a cane to get from her car to her office. I declined, but apparently she was watching me as I made my precarious descent down the staircase just outside her office. She called after me, 'Seriously! I mean it! You can borrow my cane!' Today when I was sitting in my office, this same colleague passed by my office and commented on my crutches in a tsk tsk sort of way, as if my refusing the use of her cane yesterday caused my need for crutches today. Ha!

Here's where I could really use an awesome doctor or physical therapist. I feel like I'm stuck in this weird territory between needing to strengthen my hip and return to normal, and needing to rest my hip to not cause more pain and inflammation. Since I don't seem to be getting much guidance, I've been consulting Dr. Google again. After much consultation with Dr. Google,  I've come up with the following possible explanations for my continuing pain:

1. It is just typical post-surgery pain, and I need to give it more time. This would be the best explanation, though I find it hard to believe that all of this pain is just normal pain. During my last visit with the orthopedist, he commented that my labrum had obviously not healed yet, and that I needed to give it more time. Later I got to wondering about what traipsing around on a still-torn labrum was doing, considering the reason he told me I needed to be on crutches for an f-ing month was to let the labrum heal properly. I sent him an e-mail but never heard back from him.
2. I somehow tore the labrum again. Aside from falling the afternoon after surgery, I don't see when this could have happened. For once, I've been an extremely compliant patient throughout all of this.
3. I have tendonitis in my hip flexors and a lot of scar tissue that is causing the pain. This is what the therapist I've been working with has suggested. At my last appointment, she used the 'spatula' on me and commented on how much scar tissue I seemed to have. However, she did not think this would necessarily be causing the continued 'grinding' sensation I have in my hip joint. Nonetheless, I Googled treatment for hip flexor tendonitis, and non-surgical options include... rest... and ice. Check.
4. I have avascular necrosis (AVN), which is basically when the blood supply to the bone is interrupted, and the bone begins to die. Not to be a hypochondriac, but I'm sort of alarmed at how much of what I'm feeling seems to match up with the symptoms for this. Also, this condition is often associated with clotting that cuts off the blood supply to the bone. While I know enough about anatomy to understand that clots in veins are different from clots in arteries, I can't help but wonder if there could be some connection between DVT and AVN. All my literature searches on AVN tell me that most cases of AVN are idiopathic ( = no known cause), but it still makes me think... hmmmmm... Of course, I Googled treatment for AVN, and non-surgical options include... rest... and electrical stimulation. Check.

So... I have a plan of sorts. My next appointment with my orthopedist is on Friday, October 10th. If I'm not feeling much better by then, and if he tells me once again to be patient and wait it out, I'm going to get a second opinion. I'm also going to try to find a new physical therapist and perhaps see a pain doctor that my PA recommended to me initially. This is sort of tricky, and involves some level of confrontation that is difficult for me, but might be necessary, IMO. I've tried so hard to be positive about all of this, and I really like my surgeon, and don't want to be angry with him, but at the same time, I don't feel like he is helping me right now. And I really need help!

I think the other part of this that I'm struggling with right now is whether or not it was a good decision to have this surgery in the first place, considering that I'm now feeling worse than I was before the surgery, plus have been dealing with a potentially life-threatening blood clot. It doesn't help that I have my mom constantly reminding me that you should never see a doctor unless you will otherwise die (which is the attitude with which I was reared). However, I have to say that I'm not yet at a point of pure bitterness. I still don't regret my decision. While I'm disappointed in the outcome of the surgery, and how my surgeon has dealt with it, I still know that I had to give this surgery a chance. If I weren't here whining about how much my hip hurt post-surgery, I'd be here whining about how much my hip hurt because of a torn labrum and loose cartilage floating around in the joint, and you'd all be thinking that I should just have the surgery so I would shut up already.

And... to conclude, I'd like to say that I am still thankful every day that this is the biggest problem I have in my life right now. I realize it could be so much worse, and I am extremely grateful that it isn't.

Post Surgery: 5 Weeks + 3 Days / 11 Days UIRTW

Yup, I'm still alive. I'm still wrong, and still happy about. I'm still bleeding, but the good news is that if I am bleeding to death, it is very slowly. :)

And I have some sort of good news. It is mostly good news, I just have some mixed feelings about it. I've decided to drop to 1/2 time this semester. I e-mailed my Chair two nights ago in the midst of my hysteria, which was not the best idea, but I re-read the e-mail later and it wasn't too embarrassingly hysterical (although he did reply that we would deal with a certain issue in the future, but For now we need to manage your stress).

I've written more about this over here: http://dontcallmeprofessor.blogspot.com/2014/08/im-not-dead-yet.html.

On Wednesday, my PT asked me about the class I was teaching. I was surprised he remembered. When I told him I had to get someone else to teach it, he nodded knowingly, as if he had seen it coming. Then he asked about the rest of my classes, and he asked in such a way that suggested he didn't think it was the greatest idea for me to be teaching at all (granted, that was the day that I looked reeeeaaallly terrible). I said that I was trying to get a reduced teaching load and he said that was definitely a good idea. So, I have an endorsement from one medical professional.

I guess my biggest concern right now is over the possible long-term effects of this if I don't take care of it properly. For one, there is a realistic possibility the clot won't actually resolve, even with the medication. There's also a chance of it getting bigger, and if it spreads up to the iliac vein, it's really dangerous, even with the medication. It can also damage the veins, leading to recurrent episodes of DVT. I really don't want to have to take anticoagulants for my entire life. And besides, what if we ever need to change insurance? $400/month for life is way too much; my kids will never go to college. The saddest part of all this is that I had this hip surgery because I felt like 39 was too young to be having such terrible hip pain, yet now there is a possibility of me dealing with DVT for the rest of my life, and I feel like I'm definitely waaaaay too young for that. I feel like every time I talk to people about being on an anticoagulant, they are like, 'Yeah, my grandma has to take Coumadin and it sucks,' or, some of my colleagues who are, like, 60, tell me, 'Yeah, my dad has had to take blood thinners ever since he had his stroke; what a pain.' Seriously, this is medication that only grandparents and the parents of people who are my parents' age take!

Meanwhile, my hip is killing me. 

Ahhhhh, I'm totally dying my hair tomorrow. I need a morale boost.

I AM okay! (5 Weeks + 2 Days / 12 Days UIRTW)

I've never been so happy to be wrong before. So I live to tell about another day. :)

I'm still bleeding, but not alarmingly so. However, I lost so much blood over the past 24 hours I looked like a Geisha girl this morning. Three different people told me before 10 AM that they would pray for me. Seriously, did I look that bad?!

I went to PT this morning, and it felt good to try to get back into the swing of things. Unfortunately, my hip (oh yeah, remember my hip?) is not stellar. It's not terrible, either, but it is actually noticeably sore. Maybe it is just because the pain in my leg is actually improving so now I notice my hip pain more. At any rate, my therapist suggested taking it easy and not pushing things too hard. I was able to do a reasonable amount of exercises; the only thing I can absolutely not do right now is go up on my toes. That causes excruciating pain in my calf. 

My day-to-day plan is to just go about my daily routine, but not do anything crazy. I should try to be active, but not hard core. My PT also advised against long shopping trips to the mall. Fortunately, I don't really like shopping and I definitely don't like the mall. Ha. It's logical to think that rigorous activity might make a blood clot break loose, although there are no data that I can find about this one way or another. But better safe than sorry. Not that I have anything hard core planned considering my hip still limits me significantly (oh yeah, remember my hip?). Apparently the idea of bed rest versus ambulation is unresolved in the management of DVT, but there is little evidence to suggest that just walking around increases the chances of pulmonary embolism. And bed rest may actually make the clot grow. So... moderation seems to be the best plan.

Also, my additional consultation with Dr. Google made me realize that the ultrasound tech was right when she said it was a good thing we caught this. I mean, duh, of course it is, but when she said it, she really meant it. Given where the blood clot begins, in the proximal femoral vein, I had a huge risk of pulmonary embolism. According to this article: It has been suggested that about one half of patients with an untreated proximal DVT will develop a pulmonary embolism (PE) within 3 months. Yikes. I've been trying to find literature on the risk of PE while on an anticoagulant, and while it's obviously much improved over a 50% chance of PE, some of the articles aren't that encouraging about the long-term prognosis. It's not like once you're on medication you're totally fine. But for now I'm just trying to stay in the present, and praying all the prayers will send some healing powers my way. :)

Post Surgery: 4 Weeks + 5 Days / 16 Days UIRTW

A few things:

• I am sort of a mess, both physically and mentally.
• Even if I were able to pull myself together mentally before Wednesday, which in itself is a huge question mark, I really don't know if I can physically be on my feet from 8-5 for five day without seriously jeopardizing my recovery and perhaps even my health. 
• So, I'm not going to find out. I've been in contact with my Chair and explained my situation, and told him that I just don't feel like I can do this, and that whatever I need to do later to make up for it, I will do. Fortunately, I have a good working relationship with the Chair - he is reasonable and knows that I work hard and do my job as well as I can and rarely make excuses or ask for things. He e-mailed back right away and agreed that I should NOT teach the class, and immediately started to work on alternatives. Luckily, he found someone else to teach the class in my place, and the details are being worked out as I write this. It is such a relief for me to have this off my plate, and I am doing everything I can to help the new instructor. I'm basically giving him all of my course material. I just finished a course copy on Blackboard, so he literally has alllll my stuff, which I would normally be pretty possessive about, but... I don't care. Having this off my plate is priceless. My Chair did say that we could always just cancel the class (after all, shit happens, even to instructors) but I would have felt bad about that because canceling a class last minute, especially this one in particular, can really screw students. Getting a replacement is the best option.
• So I now have 16 days until I have to start teaching again, and I feel like the reduced anxiety will be good for my overall recovery.
• That said, I'm actually sort of worried that 16 days won't be enough. But, whatever, it is most certainly better than 4 days. Plus, even in 16 days, I will not have to be on my feet from 8-5; it will be 3.5 hours maximum, which is a very different situation.

Other things:

• I left the ER yesterday with not very much instruction; I need to consult my PCP and orthopedist for specific information about the long-term treatment of my blood clots (AKA acute deep vein thrombosis, or DVT). 
• The PA in the ER told me that sometimes orthopedists 'don't really do blood clots,' and that my orthopedist might refer me to another doctor, perhaps back to my PCP, who might refer me to someone else. Awesome.
• Needless to say, I've been doing a lot of consulting with Dr. Google, and Dr. Google confirms that DVT is odd territory. According to this article: Patients with venous thromboembolic disease (VTE) are seen by a variety of medical specialists, including general physicians, surgeons, obstetricians, hematologists, radiologists, and chest physicians. Because thromboembolic disease forms only a small part of the practice of most of these clinicians, it is difficult for them to keep abreast of advances that are important for optimal patient care. 
• I should add that 'optimal patient care' is very important considering the sort of sobering information the article also gives: DVT and pulmonary embolism (PE) most often complicate the course of sick, hospitalized patients but may also affect ambulatory and otherwise healthy persons. It is estimated that each year 600,000 patients develop PE and that 60,000 die of this complication. This number exceeds the number of American women who die each year from breast cancer. PE is now the most frequent cause of death associated with childbirth. Women are a prime target for PE, being affected more often than men.
• Also: Patients who survive the initial episode of DVT are prone to chronic swelling of the leg and pain because the valves in the veins can be damaged by the thrombotic process, leading to venous hypertension. In some instances skin ulceration and impaired mobility prevent patients from leading normal, active lives. In addition, patients with DVT are prone to recurrent episodes. In those instances in which DVT and PE develop as complications of a surgical or medical illness, in addition to the mortality risk, hospitalization is prolonged and healthcare costs are increased. 
• In other words, this isn't necessarily a 'take these pills and your problem will go away' situation. It is something that will require long-term treatment or at least monitoring. 
• Ugh. Depressing. And sort of scary.
• I mentioned the cost of the medicine in my previous post; that the PA told me it could be $300-$400, even with insurance. What I didn't add is that she actually said $300-$400 a month, which at the time didn't register with me, because I figured you take this for about a month, so $300-$400 a month means $300-$400 total, right? 
• Wrong. Apparently the standard course of treatment is 3-6 months. Like I said, I feel fortunate that I only had a $50 copay for the tablets with my particular insurance plan, because $400 a month for six months might push me to consider stomach injections instead.
• But back to the present moment. 
• Of course, this all came down on a Friday, and I find myself not knowing what to do for the next few days. Am I supposed to be resting or walking? Heat or ice or neither? I assume massage is out, lol, but other than this, I feel like I. know. nothing. And it's not a question of icing your ankle when heat might have been better; what I do could have serious consequences. 
• And apparently a pulmonary embolism as the result of DVT is not actually that uncommon. 
• I have follow-up appointments on Monday and Tuesday, one with a PCP and one with my orthopedist. I don't know which one is better for this, but I'm not taking any chances, so I'm going to see both of them. Considering my orthopedist is the one who missed this two weeks ago because his little test didn't inflict massive pain on me, I'm not exactly feeling strong love toward him right now. Ha.
• On a sort of funny note, I mentioned the blood clot test to the PA in the ER and she knew exactly what test I was talking about. (She told me the name, but I forgot.) Then she added, 'Yeah, that test doesn't work on tough girls.' LOL. (Just an interesting observation: the PA was at least partly Asian, and about my age.)
• I mentioned that my personal PA moved recently - literally, a few days ago (see: http://39andhip.blogspot.com/2014/08/post-surgery-3-weeks-5-days.html). So I actually have no PCP at the moment. However, I do have an appointment with her supervising physician, who is my husband's primary care doctor. And my husband is pretty picky. 
• My husband texted this doctor last night, who suggested elevating my leg to reduce swelling, low heat, and absolutely no massage, so at least that is SOMETHING.
• According to Dr. Google, elevating the leg is a standard suggestion, but so are walking and exercising. Can someone explain how that works?! Ha.
• So basically as far as I can tell I should be elevating my leg when I'm sitting, but I should be walking as much as I can to improve circulation and keep the clot from getting even bigger. 
• The problem is that the swelling is still really bad and causing a lot of pain, which makes walking very difficult. The pain was actually really bad this morning, which is sort of weird. Looking back, I am certain this problem has been developing over the course of the past few weeks, ever since I started to complain about my leg pain about a week after surgery. Yet I can't help but wonder if something set this off so that it became really bad recently, or if it just hurts more now because I know what it is and am freaked out about it. In other words, is it all in my head?
• Regardless of whether it's a psychological phenomenon or not, I could not walk this morning without a crutch, and even that was very painful. At the same time, I was reading all this stuff on the Internet about how sitting still would only make this condition worse. 
• Finally my husband suggested taking pain medication so that I can walk, so that's what I've been doing. The way I see it is that I'd rather be drunk from pain medication than have a pulmonary embolism.
• It's all just a little frustrating, though. 
• Also, when I talked to the pharmacist on Friday when I was having my prescriptions filled, she asked me what specific directions I had gotten for what I was supposed to be doing other than taking the medication, and I said I really didn't get any. She went on and on about how I was soooo young to have a blood clot, and this was serious, and I needed to find out what else I should be doing ASAP. All in all, it was slightly alarming. 

And finally:

• When I left PT on Thursday afternoon, both the PT assistant and PT asked me to please call them as soon as I had any news and let them know what was up. Even though the PT office is associated with the orthopedic office, which is why my therapist was able to find a PA so quickly to do an exam and write a script for an ultrasound, I'm sure they're probably the last people to get information. Before I left, both the PTA and PT repeatedly requested that I call them directly with any results ASAP.
• So I called the office from the ER on Friday. I figured I was there because of them - and I don't mean that in a bad way - so common courtesy told me that I at least owed them the phone call they had requested. I wasn't quite sure how to leave a message, but fortunately the secretary seemed familiar with my story, so I didn't have to do an assload of explaining. At least, when I told her, Please tell Jay and AJ that they were right, I do have a blood clot, and apparently it's pretty massive. In fact, I'm at the hospital right now getting treated, she seemed to know what I was talking about.
• My therapist actually called me on Friday afternoon. He kept apologizing, saying that he was soooo sorry things turned out this way, and I had to keep telling him that I was thankful that he was on top of things, and that it certainly wasn't his fault. I guess he was sort of freaked out because somehow at the hospital got conveyed to him as in the hospital, which worried him. I assured him that I was fine, and that death wasn't imminent, at least not that I knew of. LOL.
• It was good that he called, because I was actually sort of wondering if this changes PT, and if so, how, and apparently he doesn't have much experience with DVT, either. I mentioned that I was supposed to come in for PT on Monday at 9:15, but he confirmed that we should cancel that appointment until he had had a chance to talk to my orthopedist. He said he had tried to find him today, but that he wasn't in, which I already knew due to my ER ordeal. I asked if I needed to call and cancel the appointment or if he could take care of it. He told me he wasn't actually at work - I just left - but that he would take care of it when he got in on Monday morning. So he called me from his cell phone on the way home... how sweet. And for once I'm not actually being snarky! Seriously, I'm getting a lot of feel good vibes from my PT lately.

As always, despite the fact that it goes against my nature to do so, I'm trying to stay positive and hope for the best.