THR Severe Fall - Four fractures

[spaniel]

I will be getting special orthotics to deal with the continued leg length discrepancy. I will get them tomorrow. It has been about 10 and a half months since the THR. The unoperated left foot parathesias remain and have ascended to calf. Now having back and knee pain . I do believe this is from walking around for 10 months with the discrepancy. Gluteus medius ,trochanter, and IT band issues on operated side persists. I have only been able to speak with doctor’s secretary who indicated that it “takes a year”. Fortunately I have been active singing in many concerts and this is a blast. After holiday season I will seek help outside of local area. I do have a great neuro here and also a terrific DPT

 

[Pumpkin]

Happy you will be getting orthotics to help with you LLD. Hopefully they will help with the challenges you are having on the operated side.

Have fun singing in your upcoming concerts.

 

[spaniel]

I just received my operative notes and anesthesia report etc from one year ago. I see notation by anesthesia saying after first spinal attempt “L paresthesia… redirected” referring to the introducer and obviously enclosed spinal needle. Then it says CSF positive. As I’ve noted before I’ve seen neuro re this and have tried to address with OS. Frankly the paesthesia is the lesser of my ongoing issues (foot and ankle). I have a followup app with neuro tomorrow and I’m thinking of showing him the note. Anyone disagree here-I’m curious? Also I think the custom made bilateral orthotics do help with the now year old LLD. Also I’m heeding @Jamie ’s advice re massage. I can certainly walk but frankly walking is way harder than before the THR a year ago, just at different areas,lateral as opposed to groin. Anyway-I’d appreciate any feedback regarding showing my neuro the anesthesia spinal notes. Thanks. I distinctly remember the spinal pain going into left butt but not to foot.

 

[Jaycey]

Anyway-I’d appreciate any feedback regarding showing my neuro the anesthesia spinal notes.

I think it's a great idea to discuss your notes with your neurologist! Who better to directly address your concerns and perhaps clarify what happened. Please let us know how your appointment goes.

 

[spaniel]

Thank you @ Jaycee. I just got back from this extremely thorough neurologist. I showed him the note and he does think there is a possibility that the multiple attempts made during the spinal may have resulted in the paresthesias. With the note that says “positive CSF”, he said… essentially I had a spinal tap! We both know this happens. But one year out I find out because I ordered my records! OS needed to be forthcoming. Plan of action:MRI of spine even though I will not submit to a surgery unless its life preserving or if dire risk is noted.Neuro respects my take on this at this point. Again I thank you for the response!

 

[Jaycey]

But one year out I find out because I ordered my records! OS needed to be forthcoming.

It's very possible the OS didn't catch this. The anaesthetist should have discussed this with you however. But in any case it sounds like you are in good hands with this neurologist.

MRI of the spine - been there, done that! Take earphones and music and just close your eyes. My experience seemed like it lasted forever. But it was probably only minutes. The length of time depends on what area they want to capture.

Please keep us updated!

 

[spaniel]

Again thanks. Yea I’ve had MRIs and they have not been a big deal for me. The OS was indeed right in the room when I screamed at the third attempt to insert spinal. I had screamed “ this is torture”. I had yelled our “my left butt”twice. I tried to discuss this with my OS on 3/1/2022 and he did say “ I was not pleased”’ But that was it. I had a longer meeting today with pcp discussing the extreme issues with “charting” and referencing matters that I will not put on this site. There were two doc in the room today as I detailed this. As I said, things happen,
,but I absolutely DID bring the specific concerns regarding the traumatic spinal to my OS. But what I was not aware of is that it was in actual WRITING. I recognize that I have an element of PTSD regarding surgical matters at this point . I am planning to actually show the OS the notes tomorrow. Again I am quite versed in hospital matters but I never thought such lack of oversight would occur to me. It will be quite some time before I accept a surgical team without a full debriefing if that’s even possible. Again there is much I’m omitting here . I have a really good friend who has also worked critical care for decades and was charge of his unit. He will not submit to any surgery . Of course this is unwise and somehow those of us who have sustained verified medical trauma need advocates. But I do feel that by opening up, getting hard print records, and sharing them with extremely well respected doctors in a teaching capacity has helped. And certainly the information and camaraderie of this forum has helped me.

 

[spaniel]

May I ask this question of @Jaycey or @Jamie ? I've looked around for local people who do PPT. Now, may I ask if trigger point therapy is synonymous? From what i read, PT's in NY state only got this permission relatively recently, but I may have read wrong. I MAY have been reading about another type of therapy that involves needlessles going way deeper (is that dry needling?). If I'm not mistaken, the dry needling is used with electrical impulses. Please correct me if I'm wrong with all my terminology. I have NO hesitation whatsover with acupuncture as I've done this in the past and the licensed docs around here are well known and have been doing this for decades. Any knowledge if acupuncture is possibily effective for flexor, TFL issues?

 

[Jaycey]

@spaniel Since I am in and UK I can't really comment on what PTs are able to do in the US. @Pumpkin might have some input on this.

 

[Pumpkin]

@spaniel
I assume PPT means pressure point therapy, most PT's are exposed to some sort of PPT, trigger points etc in school. Recommend you ask about additional training if this is what you are seeking.
Dry Needling requires additional training the PT should be certified from one of the approved continuing education providers. Most state will require certification before allowing a PT practice of dry needling. Again ask were the PT was certified to perform dry needling before allowing dry needling.

Acupuncture helps some and not others, if you had a good response previously, most likely you will benefit from acupuncture. Since you are familiar with providers in you area suggest you ask them if they can help your TFL and flexor issues.

 

[spaniel]

Thank you @Jaycey and @Pumpkin . Thanks for trying to clarify the terminology a bit more. Yes from what I am gathering PTs cannot do dry needling in NY. However I found acupuncturists right around the corner who do this. One of the guys has twenty years experience. My former acupuncturist has about twenty five- but I have yet to call her to see if she does dry needling. I trust her immensely. I might try pressure point first. But I’m still thinking about all this! Again I appreciate your time!

 

[Jamie]

Glad you got the responses about pressure point therapy and trigger point therapy being the same thing. When I had mine, my therapist indicated they did receive an abbreviated course on it in school, but I don't feel that's good enough. A person either needs additional training or a fair amount of experience to be good at it. So don't hesitate to ask about their training/experience if you give someone a try. It's a specialty and not all therapists have the expertise.

 

[spaniel]

Thanks @Jamie . Yea I personally don’t want anyone putting even the filiform needles in me without major training. There are a bunch of PTs around here who do the massage pressure point (also known as trigger point massage). The part that had me confused is some sites using the term pressure point therapy via the use of needling. (Again in NY only licensed acupuncturists are legally able to do this at this time if I have read it right,and these were recent statements.) I also should do more icing…but upstate NY is cold as it is! Again, thanks for your time!

 

[Merrimay]

@spaniel, at my PT place, the ones doing pressure point and dry needling all had certification in those therapies on top of their Masters or PhD in PT. Hope you find real relief from these modalities. I sure did.

 

[spaniel]

Goodness yes… I have a great deal of trust in PTs.Here most PT have their doctorate. It is true that NY state does not permit PTs to do dry needling so I guess I would suspect that those trained here would not have much experience if/when the scope of practice is changed. So I think that I’d have to go the accupuncture route (with acupuncturist who is experienced in this.) With that said I’ve read debates amongst acupuncturists who indicate that in effect,they are already dry needling. But I cant say I’ve dug deep into this at all. I guess I could easily hop over the border to Vermont or Massachusetts… but I’d have to check out credential link there! Thanks @Merrimay

 

[spaniel]

I probably should change my heading, but I’ll keep it for me as this persists. It has been well over a year since my RTHR. I am gradually improving in terms of IT band stuff,trochanteric stuff, glute stuff. It has been one seriously long haul. The LLD persists and even though it is only a bit more than half an inch it still wreaks havoc with the rest of my body (Especially right side of back and left knee.) I must say the orthotics that were carefully designed for me by a great pedorthist help. But I am told that the main way to correct this now would be to have other hip done. Two X-rays by two independent radiologists show only mild to mild/mod OA on the unoperated hip (L hip). I think this is odd advice given that I have no issues with my left unop hip.Does anyone else think it is odd advice? Why operate on a reasonably well hip to “hopefully” get both hips more even?Again I am not in massive distress but the stress on the other parts (back,left knee)… is worrisome and back is hurting more. I personally feel that operating on a well leg is weird. Anyone?

 

[djklaugh]

@spaniel I don't know who told you to have other hip done. And yes it does sound a bit weird though I suspect that would be the way to fix the LLD problem. However, given what the x-rays show, I doubt you will be able to find a surgeon willing to do that surgery at this point in time. If the orthotics are working for you stick with them now. IF your other hip starts to cause problems and pain at some time in the future, then get it reassessed.

 

[spaniel]

Thanks.It was the suggestion of an advanced ortho practitioner. The orthotics do help but only to an extent. Without them(I.e.getting out of bed to go to bathroom or kitchen) is a real strain. It’s been over a year. It is still a strain walking with the orthotics if I walk on let’s say hard floors such as the big box stores.

 

[spaniel]

It’s been awhile since my 2022 THA. It seems as the LLD, though not dreadfully severe, may have taken its toll. The actual hip surgical area seems ok. But alas the foot and ankle of that side totally gave out. I am recovering from a broken fibula having land on almost all body part including my head! (This was on carpet). After about two months with a mildly displaced fracture, I have lost stamina and I walk with a pretty significant limp.Now I’m getting groin pain in the unoperated hip site. I was walking with an air cast. I am hoping against hope that the unoperated hip is “just” bursitis or “tendinitis”. I am astounded by the degree of limping! Am I expecting too much?

 

[myglasshalffull]

Oh no, so sorry to hear about your fall.
I remember us "recovering" together.
I don't know why you have groin pain on opposite side but I'd call OS & get in for X-rays & possible MRI to see what's going on.
Keep us posted.