Friday, February 19, 2010

Quick Update

1. HIP

My swelling continued to go down, my PT said today. I think it's the new anti-inflam because we're not doing anything else significantly different, or at least anything that would affect my inflammation that quickly.

She also tested my flexibility because I was complaining that my leg felt tight, particularly in the quad. Yeah, well... NOT. I'm still hyperflexible. The pain I'm feeling IS nerve pain. It's sinking in slowly. VERY slowly. Each piece of information sits, absorbs, and is added to a previous piece of information.

It's hardly a wonder I'm not religious - if I need 3 weeks of continuous examples, education, and proof that my pain is not muscle/tightness related, think how much proof you'd have to show me to convince me that God actually exists! (This is not a comment on anyone who IS religious, by the way. It's just the way I am. I don't take things at face value. Sorry!)

Talking of which... my PT is a believer and has taken my studious silence during a recent chat with her intern about where she worships, as agreement with the same. Now my PT includes instruction on how to pray for better health and to put my fate in God's hands.

Sorry folks... I don't see God poking my nerve endings. I'm going to stick with trying to fix this one myself.

And lest you think that I am a horrible heathen (which you may very well do anyway), I am at least not planning on telling her that I am a non-believer. She is a nice person who is just trying to help me and, quite honestly, I don't want to have "that" conversation with her (and she is the type that would have "that" conversation.) I respect her right to worship whomever she wants and neither want to be converted nor engaged in a religious debate. So, I'm staying "mum", as wel say in Blighty.

Last note on this: pain is still pretty constant. Not much change there, although I take my friend, e's point, that my overall trend may be slowly downwards by small degrees; it may take a while to register that there's a difference.


Today 147.8lbs and 36.3% fat. So, my tally is 13.2lbs lost and 2.8lbs to go to my target. 6.3% of my bodyfat still to lose. Blech!

On the plus side, with all this physical therapy focusing on strengthening my trunk, I'm going to end up with six-pack abs!

Wednesday, February 17, 2010

Inch by inch

Today my physical therapist told me that the swelling in my sacrum/low back area, had subsided a tad. It was a small change but the only positive one in the two weeks I've been with her, so we had a mini celebration. (Basically, a quiet and brief "woot")

Who knows what made the difference between Monday and Wednesday? Who knows if it was anything I changed that recently or just accumulative effects of everything I've been doing over the last two weeks.

All I can tell you is what changed:
  • On Monday, at my doctor's appointment, he did some osteopathic manipulation on me, cracking my lumbar and hip areas. Not as much as the previous time and I didn't feel any immediate relief, but who knows?
  • Doc also gave me a different anti-inflammatory. I was taking plain-ole Ibuprofen in prescription strength (600mg) before and I have been taking that, in one dose or another, for many years for headaches, aches, and pains. Instead I'm now taking an NSAID that is typically prescribed for arthritis patients, Meloxicam.
  • I started sitting less at my chair in my office and just less overall. What I discovered was that standing wasn't a whole lot better, either. My back got really tired really fast and I felt as though I was going out of alignment big-time; I would end up standing with all my weight on my good leg and then that hip would start to hurt. Walking around and sitting or laying down periodically seemed to help overall. Basically, not doing anything for too long seems to be the key.
  • I've also been cutting back on caffeine and sugar. I've gone down to only one sugar in my coffee and am trying to only have one cup of coffee in the morning. When I was pregnant I only drank one cup in the morning and, in the first 6-7 months of my pregnancy, my hip symptoms all-but went away. I have no idea if this has anything to do with anything, although I do know that sugar and caffeine can be inflammatory.

Any one of these things could be the difference... or not. It's so hard to tell, especially when I am personally not feeling any improvement from the pain and tightness side. In fact, I would say that, without the ability to stretch things out or get massage, I have felt tighter and more pain overall. Not that my pain is a 7 out of 10 or anything but the things I could previously alleviate with self treatment, I can no longer affect, so they persist.

I have been keeping a pain journal but it has only served to confuse me more about what may be making a difference and what may not because the same thing on two different days can produce different results. Plus, my pain is often diffuse, varies throughout the day, and can present differently - as burning, as tweaking, as stabbing/acute, as sticking/popping/clicking, or as aching - in different areas, at different times. There are some constants, of course, but I can't say I've felt any positive improvements in any of them; as I said, I'm actually feeling a bit worse.

I'll spare you the details but my PT has an educated explanation for everything that is happening to me (including the wild fluctuations in case/effect and pain) and so I still have confidence that I am getting the best possible care. So, the journey continues. I'm doing as I'm told: doing the exercises, doing the icing, doing the resting, doing the journaling, doing the change in body mechanics, doing the NSAIDs... I just have to keep in mind that I'm trying to undo possibly 4.5 years of misdiagnosis, wrong treatments, and bad behaviors.

As I said to a friend recently however, hope without proof or progress is hard. At least this little budge in my inflammation is a positive sign we may be on the right track.

Monday, February 15, 2010

This week's mission: no sitting

I have been keeping a pain journal over the last week or so at the suggestion of my new physical therapist. Our goal, of course, is to try and determine what actions aggravate my pain symptoms.

So far it has not been incredibly helpful. My pain levels have always seemed to spike and subside without any real 'event' to pinpoint. The journal is mostly confirming this, although it is beginning to help us hypothesize some scenarios regarding my level of activity.

In short, I generally report better pain levels on days after being active. That is not to say hiking and running around like I used to (oh that would be wonderful again some day, but clearly not yet) but just days where I'm not sat at my desk for most of the day, the way I am M-F when at work. When I'm really busy, like last week, I can get so engrossed in what I'm doing that I can easily sit down one minute and, four hours later, look up to find I haven't moved, eaten, or drunk anything. When I do go to stand up again, my brain begins to clue-into the pain I have been ignoring, presumably because I'm always in some sort of pain and have become accustomed to putting it to one side most of the time, at least mentally, and when my brain is otherwise engaged. I also feel a slight clunk in my sacrum area (probably actually my S.I. joint, but I'm still learning to pinpoint exactly where that is) as if everything is trying to realign as I stand.

The mornings after these kinds of sitting days, I notice that I have more nerve pain (I have begun to differentiate now between nerve and muscle pain) in odd places, like down my leg into my knee, sometimes in my calf and ankle, up into my groin and psoas and often on the opposite side to my primary injury. It's not pain all at once, everywhere, but it's like someone is randomly poking you with a needle from the inside out, at different spots at different times, whether sitting and resting or standing and moving around.

This is not to say that I am pain free on days when I am active, or the day after. I definitely experience some of that same stabbing pain, only less, and some soreness in my muscles of my leg and lower back - more like a soreness, as I said, though, or a dull-ache - not the stabbing neuromuscular pain of other days.

So, my PT is hypothesizing that my SI joint issue is aggravated by compression and sagnation, meaning that sitting compresses my SI joint, putting pressure on it, and that my inflammation is made worse by periods of inactivity, where fluid has time to settle and build.

This would be good news if this was the case because the alternative would be that my joint is made worse my compression, load-bearing, and motion - meaning, sitting and laying down more would be the prescription. As someone who likes to be active and who, mentally, feels like this kind of prescription is a death sentence (almost literally), I am hoping against all hope that the first one is true.

My PT told me the story of a woman who was told by her surgeon that she needed back surgery but that, after the surgery, she would not be able to sit for some time because she would be pulling ont he muscles he cut through and would be hindering her healing. She was, understandably, pretty freaked out by this because the idea of completely eliminating sitting from her life for a while, was pretty daunting. So, she did something really smart: instead of waiting until after the surgery to figure this out, she decided to practice for a month before the surgery, by only laying, walking or standing for three weeks. You've probably already guessed what happened to her - after 3 weeks, she was cured. She had no back pain whatsoever and didn't need the surgery! Wow!

So, for the next week, my mission is to all-but completely avoid sitting. I'm going to stand at my pub table to work on my computer (as I am now) and if I need to rest I'll lay down or I'll walk around a bit to avoid stiffening up.

Meanwhile I'll keep up my walking now the weather is better, as a control, and see how my pain journal looks this time next week.

Of course, if this doesn't work, I'm going to have to try a week of not walking. However, based upon the fact that my symptoms have not got any better on this decreased activity plan that my PT has me on (and, in regards to the nerve pain, sometimes worse!) I'm going to guess (hope?) that it's the sitting thing that is my nemesis.

I'm also going to tape-up my hips while I'm standing and walking, again as my PT suggested. She did this to me last week and I had an instant feeling of relief and decompression in my lower back and sacrum area. (Further proof this is an SI joint issue, she says.)

My inflammation is not down yet but I'm hoping that we can get beyond that this week with this new plan because I've been doing my exercises 2-3 times a day, icing 3 times a day, changing the way I bend down and pick things up, and generally being very cognizant of my back, and yet nothing feels remotely better yet. I need some progress in order to feel like I'm on the right track and even the PT said that I should have started to feel some kind of incremental improvement by now. So, something is still wrong and unaddressed. I hope this is it.

Wish me luck and, if you're on FB and want to send me a nudge every once in a while to be sure I haven't forgotten myself and started sitting down again, go ahead!

On a completely unrelated note....

This weekend I FINALLY met a goal I have had for the last 2 years - I did a one day photography workshop with Penny Silvia, the photographer who has been taking pics of me, Joss, and Daisy since I was pregnant.

Although it was a crash course for amateurs in how to utilize your camera's settings and I definitely cannot claim pro status yet, I already found the information I learned incredibly helpful yesterday when the family went to Tahoe. I think I got some really cute pics of Daisy in the snow, that I am really proud of. Here is one I LOVE here, and you can see more in my photo set on Flickr, if you'd like to provide some feedback! :o)

Daisy Month 10_Tahoe 260

Friday, February 12, 2010

The nature of love

I heard this on NPR this morning. It's one of the many stories that come out of the Story Corps series that touch my heart and leave me sitting in the car long after I should have got out, with a lump in my throat.

I have thought about sharing many of them over the years but this one was too wonderful to pass up. It speaks to me about the nature of love. So pure, so honest, so authentic. It's the stories and moments like this in life that make it worth living... at least for me.

On a completely unrelated note, I wanted to confirm that I have not given up on FRIDAY MOTIVATION posts. However, since I have been more focused on my physical therapy and trying to follow that plan, losing weight/gaining muscle has not been at the top of my list.

But, I have been trying to keep my weight down, by cutting back further on calories, especially given my decreased overall activity on the new therapy plan. (Something which pains me, by the way, my exercise is for my mental as well as physical health and I'm having a really hard time not "going for it" at the gym and not doing any yoga.)

Anyway, just wanted to let you all know that I'm still hovering around 148lbs... if I can at least not put on weight while I'm on this limited activity program, I'm going to consider that a win.

Monday, February 08, 2010

From counter-productive to counter-intuitive

As you know, I have a new physical therapist - Marcia. I've been seeing her for about a week now and it's been a difficult 7 days. Not because of the therapy or the pain (no change there yet) but because of the prescription. Essentially, she is undoing everything I was doing to self-treat for the last 4.5 years; every piece of advice and diagnosis I've received from countless doctors, surgeons, physical therapists, chiropractors, and osteopaths.

It's proving to be not only a physical adjustment but a mental one as well.

In the last few visits, I've had the opportunity to quiz Marcia more about my diagnosis and prescription for recovery; to try and understand it from different angles. I'm not sure I'm 100% in-tune with it yet but, oversimplified, this is what has begun to sink in.

The pain(s) in my hip, buttocks, and leg that everyone has been treating as muscular are, in fact, neuropathy - nerve pain. This is wild to me. Just WILD. Not a single medical practitioner until this point has even mentioned nerve pain. Not one. The continued diagnosis of tight this muscle and irritated that ligament has been such a constant in the last four years that I can't even begin to get my head around the fact that the pain I'm feeling in many instances (obviously not all) is not muscular.

I believe and understand what Marcia is saying intellectually but there is still some part of me that won't grasp it, refuses to grasp it. It's like saying that the last four years, or at the very least the most recent two (since my surgery) have been a lie, a mistake, a serial misdiagnosis. I want to believe and trust that she is right - because she sure sounds like she knows what she's talking about - but to do that I have to have faith in the fact that she, this one person, has looked at the same person, the same symptoms, and come up with a completely different diagnosis. That's hard to grasp.

Of course, once you accept that your problem is not muscular but neurological, then you have to accept that the solution, your treatment strategy, and everything you've been doing up until this point, has been 100% wrong. And, in some cases, even counter-productive. Again, this is tough to accept; it's a big paradigm shift.

The nerve pain is not only made worse by excessive stretching (my previous self-treatment MO) but, my increased or hyper flexibility from the stretching, is preventing my muscles from protecting the irritated nerves and, therefore, continued stretching only serves to make the muscles spasm more, in order to try and protect the nerves. Basically, everything is freaking out, one thing trying to protect the other and actually making things worse. My pattern of stretching, doing yoga, and massaging only served to make my joint more unstable (hello pops and clicks) and my muscles more freaked out (hello IT band syndrome, psoas pain.)

So, yoga, at least for now, is out. (There's another big adjustment.) Anything that involves twisting or stretching my lower back or side-bending, is bad. No touching the toes, no picking things up below waist-height without bending my knees, no sitting straight up out of bed, no turning around in my car seat to grab Daisy's binky. In fact, Marcia taped my back after today's appointment, to help me understand all of the movements I make in a day that can potentially inflame my back. I have 3 layers of thick tape - one vertically to prevent forward flexion, one diagonally, to prevent twisting, and one horizontally to prevent side flexion - and feel as though I have a mini corset on.

For a good hour, the lack of mobility made me feel like I was a zombie. I got used to it as the day progressed, however, and have identified my sitting on the floor, legs crossed, as being the primary culprit, pulling and tugging on the tape. Otherwise, I have found that I do a pretty good job of avoiding any of the offending movements, probably because I have subconsciously been modifying my movements for some time and, also, I admit, because I knew the tape was there. Of course, when you have an active ten month old, avoiding sitting on the floor isn't always the easiest goal to meet.

In addition to the taping, Marcia has got me doing some core strengthening exercises and icing at least three times a day. In fact, I think that ice and rest is going to be a frequent prescription for my aches and pains in the long term. Learning what makes my symptoms flare up and avoiding that whenever possible is the primary objective - but that's in a perfect world; for the real world, RICE is going to be my new best friend.

As I said at the beginning of this post, I have not felt a significant difference in pain or discomfort yet. My pain and irritation usually fluctuates (sometimes wildly) from day-to-day, week-to-week, and so it's hard to determine what, if any benefits, I am getting from the new course of treatment. One thing I am very cognizant of, however, is that my previous pattern has been in place for four years and so it's going to take more than a week to undo the habits and damage done.

Right now I just have to have a bit of blind faith that Marcia is significantly smarter than about 10 other people who were equally, if not more, medically qualified on paper. So far, I have to say that it's hard to stay the course and not jump back into old habits, especially when any benefits from the new plan will be small, incremental, and long term. There is nothing to tell me I'm on the right track yet and for this impatient, results-oriented A-type personality, that's the toughest adjustment of all.

Wednesday, February 03, 2010

Going backwards

... to go forwards.

That's the highly abbreviated version of the plan my new physical therapist prescribed for me today.

I'll start with the fact that I cried.

Yes. Me. Tears. WTH?

From the moment that Marcia, my new PT, started talking, I began to get a lump in my throat. I think that it was a combination of stored-up anticipation and last-ditch hope being released, as I began to realize that this chick was no ordinary PT. My new doc was right - she is the bombdiggedybomb of physical therapists and, given that she will be PT #5 for my hip, I should know the difference.

Then, when I started to talk (and she actually listened!), to explain my five years of pain and failed treatments, the way my life has been impacted both physically and emotionally, the sense of hopelessness that I will ever find relief, and the simple things that I wanted to achieve by being there, the tears began to flow.

Just from looking at the diagram of my body on the intake form, where I'd scratched angry Zs and diagonal lines to show pain, ache, and burning in various places, she was able to hypothesize 90% of what I was going through and why, before I'd even given her the verbal ins-an-and outs. I knew this because, in a stroke of luck, she was training an intern from Sac State that day and, through her explaining her thought process and strategy for quizzing me, I was able to learn not only what she knew, but also what that knowledge was telling her. Her experience was skipping her ahead, joining the dots almost quicker than I could place them.

She would be examining me and asking me questions and saying things to the intern like, "Typically in patients experiencing xyz, the abc nerve is also inflamed and patients will also describe discomfort doing 123 or 456,"meanwhile I would be nodding profusely, as she named seemingly disconnected symptoms that I hadn't yet described.

Then, she grabbed a life-size skeleton of the pelvis and lower back and began to explain to me, not in lamens terms, but in real medical language that assumed I was an intelligent and engaaged adult, how my SI (sacro-illiac) joint, pelvis, pubic bone, and lumbar spine worked together, where the nerves came in and out, what differnt kinds of nerves produced different kinds of pain and why, how they played off one another, how inflammation played a role and how my surgery had resulted in some problems and my pregnancy in others. It was a comprehensive explanation that I will spare you the specifics of because, although I got the general gist of it, I couldn't even begin to remember 90% of the terminology. However, the fact that it all made sense to her, that everything came together in an explainable story, made me want to jump up and kiss her. I was close, let me tell you.

I also liked the fact that she stopped me a couple of times as I went to bend down and pick something up, or get on the treatment table in a certain way, or try to turn over from front to back. She stopped me and showed me how my movements could be affecting my pain and inflammation right now.

The end-result of all of this is the following:

  1. Nerves around my hip, specifically in my SI joint, were/are inflamed after my surgery and never really got the opportunity to calm-down. They're now causing irritation and inflammation in other nerves - in other words, the inflammation has been spreading. This is the cause of a lot of my referred pain and muscle pulls. So, strategy #1 is immediate and short-term: to reduce the inflammation through ice, anti-inflammatories and avoiding activities that irritate those nerves. This includes repetitive motion of my hip particularly with impact (walking), anything that involves bearing weight on that leg singularly (yoga, lunges), and stretching my leg across the plane of motion that replicates the pain (yoga and many of the stretches that previous PTs gave me). I am now icing my lower back three times a day with ice directly on the skin which, she believes, provides a deeper kind of numbing and cooling for those deep nerves that are pissed off in my lower back and hip.
  2. My hip and groin on the right side is hyper flexible in one specific plane of motion and impinged in the opposing plane of motion. The hyper flexation is causing instability in the joint overall (popping and snapping and clunking). So, strategy #2 in the short term is to stabilize the muscles all around that joint properly, ensuring a more natural range-of-motion and pattern of movement that will, in turn, begin to alleviate some of the core nerve irritation/inflammation and prevent further injury. I already have some exercises to start me on that journey.
  3. Long term, her goal for me after the short-term goals are achieved, is to get me to a place where my physical check-book is balanced. She explained to me that it wasn't that I would never be able to do many of the activities I did before I was injured and that now irritate the injury, but that I would just need to balance those negative activities with the positive ones. So, maybe I can ski again one day but maybe I can only ski one day at a time vs. two in a row and instead, on the second day, have a day of rest and self-treatment. I liked the way she explained this. It made sense to me. Just don't go into the "physical red". I can do that.

So, I'm off on the new plan... stepping back on some of my regular physical activities for a while with the goal of forging forward with renewed knowledge and awareness of my body and what makes it tick (or, specifically for me, click). I already did the icing at lunch time and about to do it again after I publish this post.

Wish me luck...

Tuesday, February 02, 2010

A sad story about Richard Gereis

There are moments in life that crystalize for you that you are no longer as young as you used to be; that you're no longer the hip, young generation. In fact, you're one of those respectable folks that teenagers would think are grown-up or even, God forbid, old.

Usually these moments are brought on by things like an aching back after a night dancing like a fool at a club too young for you, listening to the DJ and not knowing who the hell recorded half of the song sor why on earth they became so popular, and then the hangover that never now seems to last for the entire week afterwards.

Today, however, Hubby and I had one of those moments in the most bizzaro way. We were at a Starbucks and it involved Richard Gere.

Well, let me explain. Richard Gere wasn't actually there. (Shame, I know.)

We were at a Starbucks in a Target to be exact. We were there doing very adult things like purchasing formula and yet another Congratulations card for a friend who just had a baby. Truth be told we go out after work with Daisy just to get out of the house. We both have about a ninety minute time-limit on how much time we can spend watching her walk in circles around the living room, picking up and walking with the same toys. We're impatient and we hate to do housework on work nights, so we go out somewhere, anywhere, just to avoid all those mundane, responsibility-type things. (Yes, this is why my house does not look like a model home. I'm over it.)

But I digress...

So, we're ordering our mochas and lattes, when the pimply-faced boy at the cash register stopped and asks us if we know who "Richard Gereis" is. He said it exactly like that: Gere-is.

"Do you know who Richard Gereis is?"

It stopped Hubby and I in our tracks, not sure how to respond. Was this some kind of competition, I wondered, where, if we could get the right answer, we got a free latte? You know, sometimes they have those "Question of the Day" chalk boards with a different piece of a trivia for customers to guess? I actually looked for the chalk board but couldn't find one.

"Gereis?" Hubby repeated, being sure to get this "is" part in, for clarification. Of course, we had immediately jumped to he of Pretty Woman fame but, at the same time, were both wondering together, yet without collaboration, if there was some new alternative rock-band or extreme snowboarder who had come onto the scene under our radar and didn't want to appear "out of touch" by admitting our ignorance. So, we hedged our bets. Well, Hubby did, I stayed silent for the same reasons he sought clarification: I didn't want to look stupid.

"Yeah, you know, he's an actor. What movies has he been in?" the Pimplehead asked us. Again, we both looked at one another a bit puzzled.

"Do you mean Richard Gere?" Hubby said now, more confident in putting himself on that limb because the guy had at least verified that the mysterious Mr. Gereis was a movie actor.

"Um, yeah, I guess. Do you know of any movies he's been in?"

I still thought that this was some kind of quiz for a free latte, so I dove in with gusto. "An Officer and a Gentleman!" I almost yelled, determined to save my $3.50. Pimplehead looked at us with a blank expression. I realized with growing horror that he had no idea what I was talking about. "Pretty Woman??" we both offered-up, less enthusiastically.

It took him a moment but he finally seemed to have a flash of recognition. "Oh yeah, I think I remember the guy in that," he said.

You think you remember "the guy"??? Seriously? I was so stunned that it took a while for my old, slow brain to realize that, not only did this kid not know who Richard Gere/Gereis is but that iconic movies that were indelibly inked into my teenage psyche, didn't even exist for him. It was almost as though he was inquiring about some long-gone movie star from the silent era and, worse still, he thought that Hubby and I looked suitably old enough to know who the ancient Mr. Gereis is (or, presumably from pimplehead's perspective, potentially even "was!")

So, there it was. No free latte prize. In fact, the reward for our knowledge was somewhat unwelcome: a sinking feeling that we were old, unhip, and outdated; the realization that someone we considered to be "contemporary" is actually now so virtually irrelevant in popular culture that the "younger generation" (gulp) have no idea who he is.

If you're wondering why he was asking, by the way, it was because a customer before us (presumably someone of a similar age) told the female barista that she had eyes like Richard Gere (which she didn't.)

And why "Gereis"? The only conclusion I can reach is that the customer in question asked the girl if she knew who "Richard Gere is" and she, in all her youthful ignorance, had heard "Richard Gereis".

Sigh... Wasn't Pretty Woman like, just a couple of years ago or something?

Turns out, not so much. Pretty Woman was released a wopping 20 years ago, which explains why pimplehead missed it - he was probably just getting out of diapers. In fact, if I am off on his age by a few years, it's possible that he hadn't even yet been conceived. Worse still, An Officer and a Gentleman, is now celebrating the (gulp) 28th year of it's release.

Hubby and I are somewhat shell-shocked, although we did joke on the way home that it was probably just as well we didn't ask the kid if he'd ever heard the story about the gerbil...

2/3/10 - edited to add

Hubby bought a burger at Carl’s Jr today and the chick working the register commented that his picture on his debit card didn’t look like him. He said “I know, I’m getting old”, and she laughed. Then he said “a young kid asked me who Richard Gere was yesterday”, and she said “who’s Richard Gere?”.

Back on the hip wagon

It's been a while since I posted anything about my hip. Hopefully a long enough hiatus to ensure that you're not all groaning in misery at the mere mention of it - but then, maybe not! ;o)

Anyway, if you've been following my titbits on Facebook, you'll know that I finally decided to make a doctor/PCP and medical group switch, and today was my first appointment with my new PCP.

Since my insurance is an HMO, my medical group is a big deal, in fact more of a big deal than my PCP, ultimately, becuase it dictates which specialists I can see. Long story short, I was originally with Hill Physicians when I first moved up to the Sacramento area several years ago and was very satisfied with all the referrals I received BUT hated my backwater doctor at the time. I switched to a younger doctor, with computer medical records (woot), who I loved (love) but she was a part of Mercy Medical Group - sort of like a mini Kaiser around here. Unfortunately, the "mini" meant mini service and mini options but with all of the same restrictions as KP. I had to fight to get my hip surgery done arthroscopically because Mercy didn't have a surgeon who had done it before (finally having to get a surgeon affiliated with Hill to scrub-in, so I wouldn't have to have open surgery). I then had to go out-of-network and out-of-pocket for physical therapy after my surgery because the Mercy therapists kicked me out the minute I was walking. Finally, to get the Osteopathic Manipulation my doc felt I needed to progress, I had to drive 45-60 minutes each way, to a town called Lincoln, on a 2-lane highway.

Although I loved my doc and honestly believe it is unlikely that I will ever find someone with a bedside manner that so completely suits me, the reality is that, aside from all but the basic cold, flu type illnesses (which I rarely have), she refers me out and so I spent more time with disparate "specialists" than I did with her. And, as I said, the specialists in Mercy are not all that special, in my humble (yet increasingly experienced) opinion.

It pains me to have to start this whole process again for the third time but I've plateaud with my hip in a place that is not acceptable for me at this time in my life. I honestly don't know if moving around like this is the solution but what I do know is that I've got to keep trying. I won't rest until I turn over every rock, trying to find the magical combination of treatment and care that will help me get to a better place.

Unfortunately, I've eliminated "recovery" or "pain free" from my vocabulary these days, as I'm not sure these are reasonable goals. Honestly, I'd just like to be able to get in and out of my car without worrying about twisting or turning the wrong way, pulling something, or clicking or popping something. Not to have to think about every little movement and make adjustments all the time would be victory for me. I want to be able to chase Daisy around the garden and perhaps even ski down a bunny hill with her for the first time - no black diamonds or anything, just a gentle little slope and some amateurish ploughing. Beyond that, I don't know what I'm going to achieve but I know I'm going to work hard to make it the best result I possibly can.

With all this in mind, I went to my doctor's appointment this morning.

The new guy is literally a quarter of a mile up the street. I practically passed his surgery every day without even paying it a second notice! I found him through my health insurance's online doctor site, by looking for another D.O. (Doctor of Osteopathy.) I have a lot of respect for doctors who do the extra time (2-6 years more than a regular doctor) and become a D.O. and, so far, I like their approach to treatment, so it was important to me not to lose that, if possible, in the switch.

Doing a little research on him, I was intrigued. In these days of computerized medical records, where doctors half-listen to you while they busy themselves with typing on a keyboard or fighting with an "F" button of some sort, he is an old-fashioned type doctor with an old-fashioned family practice. He "specializes" in total health care, from infancy and childhood, through adulthood, everything from pediatric to women's health, dermatology, nutrition, chiropracty, osteopathic manipulation, in-office minor surgical procedures and physical therapy - all in his surgery. (I KNOW!) I met with him briefly before I made the switch and he bristled at the very mention of referrals. "We like to take care of as much as we can here," he said. "For us, it's about continuity of care." Although I know this could either be a blessing or a curse, it was different enough to make me curious. The PCP >>> referral route hasn't served me too well as yet, so a truely different approach is probably my best chance yet at a different result.

Not that old-fashioned equals "old" or out of date, at least where it matters. No, he doesn't have computerized medical records and has had his local practice for 20 years but he's a fit, energetic, attractive, 50-ish man, the chief physician for the local Hill Physicians region and is involved in academic testing on the California Osteopathic State Board. These things tell me that he stays up-to-date yet is experienced enough to know what's what, especially within his own medical group - and knowing how to negotiate the system is an under-valued quality in a doctor, I am finding.

In person he turns out to be the typical "A-type" personality. A short, brusque, multi-tasker, who knows what he's doing and likes to get to the point. He is constantly on the move with purposeful energy, walking around his surgery simultaneously signing-off on charts, texting on his mobile phone, making and answering calls between patients, and conversing in harried-tones to his staff. He takes notes by verbally recording his voice on his smart phone, presumably because he doesn't want to take the time between patients to sit down and write (or type) something. He moves from one task to the next fluidly and his staff orbit around him in the kind of practiced way that makes you realize that he demands a lot of them but is admired by them; they've also obviously been with him as a team for some time.

His bedside manner isn't touchy-feely and sitting in front of him to explain the reason for your visit is an exercise in summation and verbal bullet-pointing - state your needs up front and remove the unecessary words; get to the point! He's a jolt to the system if you've been used to someone chatty and sympathetic, as I have. And if you're looking for someone to talk about how you're "feeling" non-medically... this guy is not for you.

But, I think I'm going to like him. He's definitely an adjustment for me but one I can easily make with my "get on with it" personality. Although I like to think of myself as a fairly friendly individual, I have come to value expertise and capability over friendliness. I've had friendly and look where it's got me. I go to the doctor to get "fixed" not to socialize, so I can look past this if I get results.

Within five minutes, we'd moved beyond my long-winded hip history (which he rushed me through) and determined that there wasn't much point in looking at what had already been done: Surgery - check; Orthopedists - check; Physical Therapists - check; Osteopathic Manipulation - check; Results - notsomuch. What did I expect to gain from seeing him? he asked me. I couldn't provide a concrete answer because I don't know what it's realistc to expect. It's an open-ended objective, really. We settled on someone different doing something different for, hopefully, a different result.

He immediately whisked me away to his manipulation treatment room where he cracked (and I mean popopopopopopop) my back, my ribs, my hips and pelvis in 3 swift and yet painless movements that took less than 30 seconds to perform. He then told me that I hadn't had really good physical therapy until I had been to a local lady, just half a mile away. He said she was the (and I quote) "best in the west" and if something was "fixable" to any extent possible, she would be the one to fix it. He told me she wasn't within my medical network but that he knew her well enough over the years that he his patients had a special cash rate with her of just $45 per visit (only $20 more that I would have to pay with insurance anyway.) He scribbled illegibly on a pad to refer me to her as we walked out and back to the front desk, mentioned a follow-up appointment in two weeks and said goodbye as his receptionist took his cue and had three appointment times/dates ready for me to pick from.

Not ten minutes after I had first shook his hand, I walked out of there, having been assessed and dismissed in short order. It was like being at the Dennys of doctors: good, solid food you can rely on, dished-out quickly by a busy and well-practiced kitchen. (I like Dennys, by the way. If you don't have a favorable opinion of Dennys, just replace with your favorite fast-and-yummy diner-food joint.)

Of course, as we say in the UK, the proof is in the pudding. Meaning, the results will speak for themeselves. But right now, I'm just happy to be on a different course.

I called the Physical Therapist, by the way, and have an appointment for 8:15am tomorrow morning. So, more after that...
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