Second Opinion

I’ve had pain in my groin and hip for five weeks now. Despite regular trips to the osteopath and consistently doing the range of specified exercises, the problem wasn’t improving very much. Indeed I was getting pain in other places too: I’d developed soreness in my right knee and in my right quadriceps. These limitations meant I’d had to cancel a holiday and a series of other engagements. I was feeling very down. I hated being incapacitated. It brought back so many bad memories of my time in hospital and in recovery from surgery. I decided that I needed another opinion.

I went to see a very good physiotherapist who had treated me before. Kieran is a sports injuries specialist and has an office in Belfast and in Newry. He is from NI, but after qualifying he went to work in England for a professional rugby league club. He returned home and set up business with a colleague who had worked for a premier league football club. Since then he had become the lead physiotherapist for Down GAA and for a series of Game of Thrones actors and stuntmen.

I sent him an email with the history of the problem and Kieran began by asking me questions about it. Then I changed into shorts and he checked me over. He has that ability to find a sore spot you didn’t know you had. He tested my hip by rotating my femur from the knee, there was mild impingement. Then he tested my hip flexors, they were fine. Then he began to test my adductor and found a very sore spot on my inner thigh towards my groin. There was a sprain in the adductor tendon and that was causing my groin pain.

He massaged the tendon quite forcefully. It brought tears to my eyes. I asked him if he had a piece of wood I could bite on whilst he was doing the treatment. He laughed, but carried on for a wee while. He said that the tendon would be quite sore for a couple of days, but then it would settle and improve. Then he turned to my hip and lightly massaged the outside of the greater trochanter. It was sore but not as bad as I expected.

He told me that he agreed with the diagnoses that I had already been given. He thought the reason why my progress had been poor was because I had been doing the remedial exercises too early on. Instead of helping my recovery, the stretching exercises for the outside of the hip had been adding to the inflammation. He gave me just two exercises to do along with regular icing of the groin and hip. I would see him again in a week.

I went home with the hope that this new approach would bring benefits. I’ve had far too much pain and incapacity in recent years. That is why I value my ability to be active so very highly. Any threat to this takes me to a bad place. Fingers crossed that I am now firmly on the journey back.

Rest is as Good as a Change

Perhaps it is an age thing, but T and I are not unhappy that we had to cancel our trip away this week. We were due to go to our favourite hotel on the shore of Clew Bay in Mayo. But I continue to be very sore with my hip injury and T is exhausted from commuting, working and studying. Despite the undoubted delights of being there, we decided that the five hour journey to Mayo was too much for us in our depleted states. We grumbled a little at first, but then relaxed into a week of rest at home. The only member of the family to actually be delighted was Rex who no longer had to go into the kennels.

I’ve been spending plenty of time doing my stretching exercises and icing my hip. But the pain remains very stubborn. Indeed it seems to have spread to my right knee. According to the osteopath, this is not surprising as I am concentrating on stretching the muscles all down my right side. The stored up imbalances are being worked on and they refer pain up and down the leg and into the groin. I’ve begun to take extract of Turmeric, called Curcumin, which is a natural anti-inflammatory. I’m not sure whether it is having a positive effect yet. But I know that I cannot take Diclofenac or any other NSAID because I only have one kidney.

Sitting for any length of time is one of the things that always exacerbates the pain. I’ve taken to using a small padded cushion at home and taking it with me when I go out. We went to the Mourne Seafood Bar in Dundrum for my birthday. The food was excellent as usual, but the plain wooden chairs were very hard on me. I try and go for regular easy walks, accompanying T part-way down the lane. She is now in charge of dog walking.

One of my presents was a Fitbit, a device which records how many steps you take a day. I was surprised how many steps I took just around the house. But the distances that it calculates for you are problematic, as the type of steps you take around the house and when out walking are very different. The Fitbit calculates the distance on a constant stride length. I’ve found that I have to set an average stride length that is significantly below my normal walking stride in order to get anywhere near an  approximate reading of how far I walk in a day (which currently is much less than I would be doing normally).

The most interesting reading that the Fitbit takes is its recording of your sleep patterns. Each morning it tells you how much time you spent awake, in light sleep, in REM (dreaming) sleep and in deep sleep. I believe it calculates the stages of sleep from pulse readings and the episodes of wakening from the motion sensor. So if you are awake and unmoving it will record that as light sleep. Each morning I look forward to seeing its calculation of the types of sleep I had. And its calculations of how little or much REM and deep sleep I had seems to correlate well with how tired I feel on waking. 

Over the week we have both been catching up on our sleep. T has been sleeping in and reading in bed till noon. Although I would tend to get up rather than lie in, I’ve taken to having afternoon naps again. There is an old saying which goes something like, when you begin to rest you find out just how tired you actually are. This week we’ve both discovered that we have been pretty run down.  We could both probably do with another week of good rest.

Greater Trochanteric Pain Syndrome and Frozen Peas

I have the results of my MRI scan. The source of the excruciating pain I’m getting in my right side is inflammation in the muscles, tendons and bursae on the outside of my hip. I’m delighted to find that my hip joints are normal. Also my lumbar spine is worn but not too much. I’m very glad about this, as over twenty years ago I was told to give up running because of a chronic back condition. Since then I’ve been very careful to do stretching exercises for my back every morning and to focus on cycling and low level hillwalking. And my back feels better now than it was decades ago. I’m shocked to learn that soft tissues can cause such terrible pain around my hip. But having an accurate diagnosis, which rules out other complications, is a good starting point.

The inflammation is in the complex of soft-tissues that surround the greater trochanter, the bony protuberance you can feel at your side. This is the knobbly top of your femur, where the leg bone turns towards your groin to form the ball of your hip-joint. And this is where the muscles from your leg, buttock, side and abdomen all converge. It also gives an insight into how my problem probably came about. Around two months ago Rex ran full pelt into my right leg, just as I was stepping forward. He caught me under the knee and forced my leg back, so much so that I toppled forward like a sprinter lunging for the line. My side has not felt right since then. I imagine that this accident pushed some of these tissues out of alignment and the inflammation has been building up.

The treatment for greater trochanteric pain syndrome is icing, stretching and gentle exercise. The osteopath tells me that he hopes I will get better in four to six weeks. He’s given me a long list of exercises to do to stretch the soft tissues around my hip. So now my morning exercise routine takes around twenty minutes to do, instead of the normal five. And he suggests that I do these all again later in the day. He also advises that I do a selected few of these before bed. I’m pretty stiff because I’ve not really stretched very much since my surgery four and a half months ago. But I am getting better at the exercises and they are helping to reduce the pain somewhat, although it is slow progress and I can see it will be some time to get everything back into healthy alignment.

Icing is to help reduce the inflammation. I can’t take anti-inflammatory medication (NSAID) as it is very hard on your kidneys; I only have one which I must look after. Instead I bought three bags of Tesco frozen peas. You don’t need fancy gel packs, the frozen peas are the very best for the job. They mould easily to your body and work quickly. You need three bags to be able to rotate them in the freezer. The recommended way is to put the peas on for ten to fifteen minutes, then let your body warm up to normal temperature for an hour or so before repeating the treatment. Just remember not to make them for tea.

Gentle exercise is to help disperse the inflammation. I’ve found that sedentary activities: sitting for over an hour, driving in the car to Belfast and sleeping all increase the pain as the inflammation builds up. I go for short walks down the lane with our mad dog and try not to sit for too long. Sleeping is at best a problem because it's hard to find a position that is comfortable. I'm afraid it has become normal for me to wake in the small hours in pain. However, I’ve taught myself not to reach for the morphine, but instead to get up, stretch and rummage in the freezer for a trusty bag of peas.

The Hard Stuff and Winter Pressures

I’m back on the morphine again. This is not because I’ve become an addict and can’t resist it; indeed, only a few weeks ago I went through the cold turkey of withdrawal. Nor is it because I have done something bad to my hernia repair, but because I’ve got a hip injury that has been excruciating, particularly at night. I tried all the normal painkillers but they just didn’t work, so I reached for the bottle that had been on the bedside table since I came home from hospital and took my first 3mg dose. After a further pain-filled and sleepless hour or so, I took another dose and then another, until I began to feel the pain receding a little and I sank into sleep for a while.

The pain in my hip had come on steadily. At first I felt an ache when lifting my right leg in and out of my trousers. Then the pain became more widespread across my hip and buttock, which felt swollen and very sensitive to touch. I went to see an osteopath who manipulated me and gave me some exercises to do at home. I followed them carefully and iced the hip, but the pain didn’t reduce. It was always worse at night. Then I woke with a severe stabbing pain in my right hip. I leapt out of bed and began to rub my side, I could hardly walk. It was a spasm; my hip was throbbing as if it had terrible toothache. I took plenty of morphine, but I was in agony for the rest of the night.

T was away, so I had to drive myself to A& E. It was Sunday. The waiting room was full already. It steadily overflowed with new patients as few were called to be seen. Eventually I was called into the clinic. There were only a couple of doctors on duty. One examined me briefly. He told me that my injury wasn’t serious enough to be treated today. He gave me a short course of anti-inflammatory tablets and sent me home to see my GP. I asked what was causing the pain? He said that to him it wasn’t that important. He was only concerned if the problem was sciatic or it stopped me peeing. What about an X-ray, I said? He said I needed a MRI to determine the source of the pain, but I probably wouldn’t get that on the NHS.

I had waited for four and a half hours in Craigavon and was seen by the doctor for less than five minutes. I drove home thinking that all the reports which said that the NHS was stretched to breaking point in A & E were indeed true. The problem was exacerbated by people misusing A & E with trivial complaints, so that doctors had to sort the long queue of patients into those that needed emergency treatment today and those that could be returned to the GP. Considering the level of pain I was in, I was very disappointed to have been put in the latter category.

I spent another painful and sleepless night. If I took enough, the morphine would knock me out for an hour. But I would always wake up in agony. I went to see the osteopath again. He said that the pain in my hip could be coming from my lower back, my sacro-iliac joint or my hip. He said he would refer me for a MRI privately at a clinic in Hillsborough. It would cost £500 but would probably be done by the end of the week. I didn’t think twice, I had to find out where the pain was coming from and what could be done about it.

After several pain-filled and sleepless nights I got in to see the GP. He reiterated the osteopath’s view on the source of the pain. But importantly he restocked me with morphine. I was now taking around 30mg a day, mostly at night. This was almost two thirds of the dose I was on in hospital. The morphine combined with severe lack of sleep left me burnt out and in a very dopey state during the day.

I got a call from the clinic and went in for my MRI. It was brand new and had been opened by Rory Best. After paying up and answering the long list of questions about metal in my body I was put inside the machine. An MRI scanner is rather narrow and noisy. They put headphones on me. Throughout the forty minutes of the scan I was assailed by the gushy and rather puerile warbling of an unrecognisable boy-band. I wasn’t able to take the headphones off as my arms were strapped down by my side. When I was released I asked if they had chosen the music especially, no they said, it was the only CD they had. I drove home with a DVD of my scan. I didn’t think I would be playing it at home this evening. But I would get the radiologist’s report the next day. The luxury of private medicine.

It was disturbing to see, at first-hand, how the underfunded NHS only really works for acute problems and how the private sector has been encouraged to expand and take up the demand that is not able to be treated. I am very lucky that I can afford to pay for a MRI privately to help diagnose my injury. Otherwise I would be in extreme pain with no prospect of finding a diagnosis or appropriate treatment anytime soon.