I was thinking about the steps along this journey - diagnosing what's wrong, ruling out other possibilities, and determining I'm a candidate for getting a new joint. For a couple of years, my pain and level of function would wax and wane, so it really wasn't a linear process getting here. Over the last six months, the pain has been constant and quite localized, so it eventually became obvious what was wrong. But for the better part of two years, that wasn't the case. And, since I'm relatively "young," the idea of a bad hip wasn't first on my mind nor my doctor's. Your actual mileage may vary, but here's how I got here:1. My primary care doctor initially suspected a pinched nerve in my back. The pain location wasn't just in my left hip, it was also in my left lower back, so this seemed plausible. He started me on prednisone, did some x-rays, and ordered an MRI. My out-of-pocket on the MRI was $500. Ouch.
2. X-rays and MRI were negative - no pinched nerve. The nurse called with the news and said my doctor wanted her to schedule me for physical therapy. Well, I think you really need a diagnosis before you start therapy, so I pushed for a referral to an orthopedic specialist next. You have to advocate for yourself in cases like this - and I'm glad I did.
3. Orthopedic specialist said he agreed with my primary care doctor's wanting to investigate the pinched nerve theory... said it was a "good call," although it turned out to have been wrong. He ordered some more x-rays and then suggested an injection in my lower back to see if the problem was my sacroiliac joint - the long, jagged joint that transfers weight between your spine and your hip. He saw some places on the x-ray to suggest some arthritics in that joint and my hip (first mention of hip!) and asked if I'd had any trauma or family history of arthritis. (I had both - a sister with rheumatoid arthritis and a rear-end collision about ten years ago. I had my left foot on the clutch when I was rear-ended and I remember my back and leg hurting for several days afterward). Before doing the sacroiliac injection, this doctor wanted blood tests to rule out rheumatoid arthritis. He ordered those tests and started me on a common anti-inflammatory drug.
4. The sacroiliac injection is done under fluoroscope - a live x-ray machine - so it had to happen at a hospital. That sucker hurt more than I ever expected. The back pain eased for a day or two, but the hip-area pain never went away. Back to the ortho doc who again looked at my x-rays, this time not focusing on the sacroiliac joint. Just about three inches below that is the hip joint and he looked at is as if it somehow wasn't there the last time he popped the x-ray into the viewer. "Oh, there's your problem," he said without emotion. "You need a new hip." He traced the uneven surface between the ball and the socket. "There's nothing there," he said, pointing to one spot. "And look here - a bone spur. And here... cysts forming in the joint." He snapped off the x-ray light and started writing. "I'll refer you for a new hip - I don't do that surgery," he said. Wow - just that fast. I started asking a few questions but he was already mentally beyond me. By the way, the anti-inflammatory drugs did nothing and the blood tests for rheumatoid arthritis were negative.
5. I saw an orthopedic surgeon who talked about the pros and cons of having a hip replacement. He didn't try to sell me, which I appreciated. I don't think I had a lot of my questions answered during that visit, but I felt as if I'd at least begun a dialogue. This doctor ordered an injection in the hip joint - similar to the back injection - another procedure done in a surgical suite a week or so later. This time I opted for the IV drugs they offered - Versed, specifically - so I don't remember if this procedure hurt. I'm guessing I should have done this with the back injection a month or two earlier.
6. The hip injection left me pain-free for about a day... essentially confirming what the x-rays had indicated: The pain was coming from my hip joint. I coincidentally had an unrelated appointment with my primary care doctor who did a thorough orthopedic exam of my hip, just like the two I'd gotten from both ortho specialists. By this time, it was obvious to me and anyone who twisted my leg that way - the problem was my hip.
7. I started looking around for another surgical opinion. It's not that I didn't have confidence in the first surgeon I'd met, I just didn't feel a real connection - I didn't feel like this was the guy. Plus, honestly, I wasn't really sold on getting the procedure done. I knew I needed it someday, but I was still in a bit of denial. Just a month or two ago I thought I had a pinched nerve that would get better with a round of prednisone. Now I was contemplating a big operation and weeks - maybe months of rebab.
8. About the same time I began, through my research, to realize there are now minimally invasive hip replacement procedures, I heard of Dr. Jeffery Mokris in Charlotte. A friend told me of a coworker who'd gotten a new hip in February and was home the next day, walking without assistance just a week or two later. This was a radical paradigm shift for me. I was really fighting the idea of surgery, despite the pain and limitations, because I just wasn't mentally prepared for five or six days in a hospital bed, weeks of physical therapy, and months of limitation. Who knew things had changed so much in joint replacement surgery?
9. I researched Dr. Mokris and realized I'd stumbled upon a real expert in his field. He does 500 joint replacements a year... publishes, presents, and teaches in the field. By the time I met him a day or two later, I was armed with a list of questions about the various prosthesis, materials, surgical procedures, prognosis, etc. We had a good meeting. I was beginning to get my mind around what needed to happen. What clinched it for me was his promise that I wouldn't undergo full general anesthesia - no breathing tube, no risk of all that mess. I'd have a spinal block and my old friend, Versed. At the end of that meeting, I nodded and said, simply, "OK - let's do this."
Nearly six weeks have passed since I gave a thumbs-up to surgery - and I'm now five days from the operation. I've had blood tests, chest x-ray, EKG, a complete physical exam, and a meeting with the anesthesia staff. In addition to various co-pays for the tests, exams, etc., I've also paid another $500 (estimated my out-of-pocket expense) to the surgeon's office. Any surgery is a big deal - and the decision to proceed with what is technically an elective procedure shouldn't be undertaken lightly. I think I've thought this through thoroughly, done what I've needed to do to get to this point. Each of the tests, office visits, and procedures seemed like a hassle at the time, but as surgery day nears, I'm really glad I can say we've done all this stuff.
2. X-rays and MRI were negative - no pinched nerve. The nurse called with the news and said my doctor wanted her to schedule me for physical therapy. Well, I think you really need a diagnosis before you start therapy, so I pushed for a referral to an orthopedic specialist next. You have to advocate for yourself in cases like this - and I'm glad I did.
3. Orthopedic specialist said he agreed with my primary care doctor's wanting to investigate the pinched nerve theory... said it was a "good call," although it turned out to have been wrong. He ordered some more x-rays and then suggested an injection in my lower back to see if the problem was my sacroiliac joint - the long, jagged joint that transfers weight between your spine and your hip. He saw some places on the x-ray to suggest some arthritics in that joint and my hip (first mention of hip!) and asked if I'd had any trauma or family history of arthritis. (I had both - a sister with rheumatoid arthritis and a rear-end collision about ten years ago. I had my left foot on the clutch when I was rear-ended and I remember my back and leg hurting for several days afterward). Before doing the sacroiliac injection, this doctor wanted blood tests to rule out rheumatoid arthritis. He ordered those tests and started me on a common anti-inflammatory drug.
4. The sacroiliac injection is done under fluoroscope - a live x-ray machine - so it had to happen at a hospital. That sucker hurt more than I ever expected. The back pain eased for a day or two, but the hip-area pain never went away. Back to the ortho doc who again looked at my x-rays, this time not focusing on the sacroiliac joint. Just about three inches below that is the hip joint and he looked at is as if it somehow wasn't there the last time he popped the x-ray into the viewer. "Oh, there's your problem," he said without emotion. "You need a new hip." He traced the uneven surface between the ball and the socket. "There's nothing there," he said, pointing to one spot. "And look here - a bone spur. And here... cysts forming in the joint." He snapped off the x-ray light and started writing. "I'll refer you for a new hip - I don't do that surgery," he said. Wow - just that fast. I started asking a few questions but he was already mentally beyond me. By the way, the anti-inflammatory drugs did nothing and the blood tests for rheumatoid arthritis were negative.
5. I saw an orthopedic surgeon who talked about the pros and cons of having a hip replacement. He didn't try to sell me, which I appreciated. I don't think I had a lot of my questions answered during that visit, but I felt as if I'd at least begun a dialogue. This doctor ordered an injection in the hip joint - similar to the back injection - another procedure done in a surgical suite a week or so later. This time I opted for the IV drugs they offered - Versed, specifically - so I don't remember if this procedure hurt. I'm guessing I should have done this with the back injection a month or two earlier.6. The hip injection left me pain-free for about a day... essentially confirming what the x-rays had indicated: The pain was coming from my hip joint. I coincidentally had an unrelated appointment with my primary care doctor who did a thorough orthopedic exam of my hip, just like the two I'd gotten from both ortho specialists. By this time, it was obvious to me and anyone who twisted my leg that way - the problem was my hip.
7. I started looking around for another surgical opinion. It's not that I didn't have confidence in the first surgeon I'd met, I just didn't feel a real connection - I didn't feel like this was the guy. Plus, honestly, I wasn't really sold on getting the procedure done. I knew I needed it someday, but I was still in a bit of denial. Just a month or two ago I thought I had a pinched nerve that would get better with a round of prednisone. Now I was contemplating a big operation and weeks - maybe months of rebab.
8. About the same time I began, through my research, to realize there are now minimally invasive hip replacement procedures, I heard of Dr. Jeffery Mokris in Charlotte. A friend told me of a coworker who'd gotten a new hip in February and was home the next day, walking without assistance just a week or two later. This was a radical paradigm shift for me. I was really fighting the idea of surgery, despite the pain and limitations, because I just wasn't mentally prepared for five or six days in a hospital bed, weeks of physical therapy, and months of limitation. Who knew things had changed so much in joint replacement surgery?
9. I researched Dr. Mokris and realized I'd stumbled upon a real expert in his field. He does 500 joint replacements a year... publishes, presents, and teaches in the field. By the time I met him a day or two later, I was armed with a list of questions about the various prosthesis, materials, surgical procedures, prognosis, etc. We had a good meeting. I was beginning to get my mind around what needed to happen. What clinched it for me was his promise that I wouldn't undergo full general anesthesia - no breathing tube, no risk of all that mess. I'd have a spinal block and my old friend, Versed. At the end of that meeting, I nodded and said, simply, "OK - let's do this."
Nearly six weeks have passed since I gave a thumbs-up to surgery - and I'm now five days from the operation. I've had blood tests, chest x-ray, EKG, a complete physical exam, and a meeting with the anesthesia staff. In addition to various co-pays for the tests, exams, etc., I've also paid another $500 (estimated my out-of-pocket expense) to the surgeon's office. Any surgery is a big deal - and the decision to proceed with what is technically an elective procedure shouldn't be undertaken lightly. I think I've thought this through thoroughly, done what I've needed to do to get to this point. Each of the tests, office visits, and procedures seemed like a hassle at the time, but as surgery day nears, I'm really glad I can say we've done all this stuff.
