A few weeks ago I had gotten the news that the hip pain I have been experiencing for years is actually due to quite terrible conditions and require a total hip replacement despite my younger age. I had tried to get my PCP to help me a few years ago but she told me it was probably Arthritis, which everyone gets with aging, and she could send me to Physical Therapy.

I am quite against Physical Therapy as a first line of defense of you don’t have an MRI to provide a full diagnosis. I have heard lots of stories, my father’s included, where people were sent for years of PT with the problem only getting worse. Only after years of no progress could they get an MRI and then would find out they have a surgical condition which cannot be helped by PT. Unfortunately, all that time inbetween was wasted while their conditions worsened and became emergencies which may have been avoidable.

I decided to get a new doctor this year to re- address the issue. When I first went in, she took and XRay, said she didn’t really see much and diagnosed it as bursitis. She gave me a cortisone shot and scheduled a follow up appointment 6 weeks out. She felt pretty confident the cortisone shot would work but she at least was open to the possibility it might not.

No surprise. It didn’t work at all. She then recommended PT. I put my foot down and said I wasn’t comfortable doing that unless I had a definitive diagnosis indicating PT was the correct course of action. She listened to me and ordered an MRI. I was prepared to be wrong. I was prepared to have something which might require minor surgery. What came back was shocking. Not only was I right, I needed a total hip replacement. I have FAI which is a congenital bone disease making hips grow wrong which eventually wears away at cartilage. It had also digressed to the point of causing a labral tear and some cysts.

If you discover a labral tear alone and early enough, at a young enough age, there is a surgery which can be done to repair the tear which will slow down cartilage erosion. Unfortunately, I am well beyond the point of preventative surgeries, because my original doctor wasn’t listening and likely caving in to insurance company demands without even trying to challenge it.

I was devastated. My new doctor told me that it’s 100% certain I need a total hip replacement which is the only way to remove the damaged cartilage, the labral tear and cysts. She said we could work on pain management for the next 10 to 20 years, anticipating how insurance would never approve surgery if I didn’t waste an appropriate amount of time on PT and more invasive cortisone injections requiring trips to the radiology department of the hospital.

I immediately started to cry. I explained to her that I am a fighter who discovers a problem and then solves that problem so I can move on. I, also an avid traveler whose trips have been sidelined by the pandemic so I was actually hoping I’d get whatever surgeries done now, recovery over the winter and be on an African Safari by next summer. I am not someone who “manages pain” and adapts to life as an invalid, especially during the best years of my life when I have both the time and money to do all my bucket list trips. I made it clear this was not an acceptable plan.

I asked her. If it is certain I need a hip replacement, why would we wait until I’m totally immobilized, having year over year downgrade of my quality of life. It’s about the insurance company, even though any reasonable surgeon would choose to operate right now. I asked her what I needed to do to work within the system. She scheduled me for a very invasive cortisone shot and PT. I wasn’t quite sure the point of PT where I don’t have a fixable issue but she explained I basically have to do it to prove it doesn’t work first. At least with the cortisone shot, there is a possibility I could get some pain relief but I am sure I can make a case for why I don’t want to depend on routine cortisone shots over a course of years. First and foremost most, they I,pact the immune system which I already have problems with. My fight to get a rheumatologist has also been going on, parallel to this one, for years.

Tonight was my first PT appointment. The first thing she said was to politely, but somewhat skeptically ask why I was there and what I thought I could get out of PT. Ahhhhh, I see she had looked at the results and also was unsure the point of PT. I could tell I got one who speaks my language. I was honest with her and said that, if I’m reading between the lines correctly, I don’t think PT can help this problem. In fact, I’m worried it might make the labral tear worse. I told her my only really hope and strategy would be to use PT to gain strength in preparing potential surgery and rehab. She asked when my surgery is scheduled.

I explained I haven’t seen a specialist yet as I wanted to show that I was doing PT, but that I planned to hook up with one from New England Baptist soon. When I told her 10-20 years had been suggested, her eyes went really wide and she stated very clearly that sounded insane – get the surgery as soon as you can.

She did a bunch of tests for my range and gait to see how bad my mobility is in order to assign the right strength building exercises. Then she asked if I felt I would even need to come back, was I good with doing the exercises at home? Meaning, “there really is nothing we can do here.” I told her I would like to come in once a week for the next 4 weeks both for accountability on my part bit to also demonstrate to the HMO “man” I was playing along. She agreed and told me she’d then make a new assessment after that 4 weeks.

I then ended the appointment by asking her if I’m reading this correctly. Am I understanding that you think PT can’t do anything and that surgery is inevitable? I then clarified that I didn’t mean to question her abilities or lack trust – that I totally trust her, just wanted to be clear I wasn’t misreading signals. She confirmed I understood everything correctly and her goal is to prepare me for surgery, that that’s all which can be done.

While this may all sound rather dire, no one really wants to have surgery, myself included, it’s the first day of hope I have experienced since getting my results. This is all stuff I can work with. These are problem solving techniques with actual steps to follow in order to obtain the correct outcome in less than a year, not 20. My inner warrior is back. My optimism is back. The fighter knows she can fix this and get back her life while it still matters. This is a situation my brain understand and can process. I’m actually excited to make an appointment with a surgeon. I’m aiming for my dad’s last surgeon who is the best in the country. He got half his medical training as a medic in Afghanistan rebuilding joints blown apartment by bombs. He will recognize the war inside my hip. He was literally the only surgeon in this country capable of fixing my father’s. I’m excited to match my warrior with his warrior. I think we probably also speak the same language.

I’m back. “It’s Brittany, Bitch!”