Hip Arthrogram MRI

This is a shoulder joint. I show it only to demonstrate the
size of the needle, which is comparable to the needle I saw
on my x-ray. I couldn't find a hip image of similar quality.

My first words of advice to anyone who is scheduled for a hip arthrogram MRI are: don't read blog posts about hip arthrogram MRIs. I understand this is a counterproductive thing to write, given the title of this post, but. I had one done today, and I made the mistake of reading online about the procedure yesterday. As a result of my reading, I was somewhat terrified at the apparent prospect of terrible pain, both during and after.

Perhaps I had an exceptional experience, and perhaps an exceptional doctor, but I doubt it. That's not to say that the staff at Humber River Hospital in north Toronto weren't excellent - they were. But I am not certain how one procedure could vary so much from one location to another.

The procedure goes as follows. First your hip is swabbed with iodine and another sterilizing solution. Then, you have an x-ray of your hip done. Then the doctor (in my case, Dr. Anthony Mascia, brisk, efficient and energetic) injects a freezing agent, then the contrast media (guided by the x-ray) - the contrast solution is, as he described it, 99% water and 1% gadolinium. I had a glimpse of the x-ray, and then two reactions - 1. wow, that is a long needle and 2. my hip looks so, well, normal (sigh). It felt like it took all of two minutes, and I really do think that's all the time it took.

Then, I was wheeled off to MRI. Wheeled, not because I couldn't walk, which I could have, I felt numb-ish, but not unstable, but because if I had walked, apparently the contrast media would have leaked out (their words) of the joint and thereby would not have been as contrast-y (my word) for the MRI.

In the MRI room, I laid down on the table, had my feet taped together so my legs wouldn't move out of position, and then the chunka chunka chunka of the MRI began. Which was astoundingly loud, even with earplugs in. The tech, on a speaker directly above my head, would check in occasionally to see how I was faring, and to tell me that the next segment of imaging would be so-and-so minutes, and then I was done. About 15 minutes, I think.

Off the table I went, then got changed, and then out into the world. My partner Stewart was there to drive me home, which was lovely, but I'm quite sure I could have easily driven myself. And now, here I sit, typing this post, with a slight ache in my hip joint, but nothing terrible. I am a bit tired, because I didn't sleep well (anxious) last night, but other than that, quite fine.

Again, perhaps my experience was exceptional. I found an abstract of a report done on reaction to the contrast media, and was granted access to read the first two pages, on page two there is a conclusion: "severe adverse reactions from intravascular administration of iodinated contrast are seen in approximately 0.26 to 3% of cases." It goes on, a bit, and the curious can read it at the URL indicated above.

Next, I wonder what the MRI will show.

MRI Arthrogram. Plus, movement = happiness.

Near Driftwood Cove. Just one of many beautiful stops on the trail.

At last. The longish and winding-ish road of the story of my leg has led to the place I'd wished to be from the start - at an MRI. But, an MRI with a twist!

When I went to the doctor this most recent time (a couple of weeks ago now), he was more puzzled than ever. The numbness and 'humming' in my foot, the full feeling in my calf, the leg/glute pain already described all added up to what seemed to be a confusing problem to him. "The hip is very complicated," said he, "we're learning new things about it all the time." I can only imagine this is true of any part of the human body. Anyway. Since the xray told him nothing, and the ultrasound told him nothing, but I continued to tell him that there is a very real problem with this dumb ole leg of mine, he has now ordered the test mentioned in the title of this post: MRI Arthrogram. Wherein, I learned, a contrast media called gadolinium (which sounds cheerful, somehow) is injected into one's hip, to enhance the visualization of joint structures (phrasing from the rather useful Center for Diagnostic Imaging).

Unfortunately, the test won't be done until December 13. Which feels a bit like forever from now. But then, while this is a vexing problem, this leg thing, it makes sense that there are probably people who have much more dire pains and injuries who should take precedence. Plus, sigh, I've waited this long.

Moving on - literally - a week of exercise at the end of August while on vacation in the Bruce Peninsula proved, once again, that for me, movement is happiness. Even on a 20 kilometre hike on the most rugged of terrain (from Cyprus Lake to Tobermory on the Bruce Trail), and many many hours of awesome mountain bike riding, and some spectacular swimming in the beautiful waters of Georgian Bay, my leg didn't bother me nearly as much as it can after a couple of hours at the desk. Sheesh. Perhaps I should figure out a way to make money hiking.

Chronic pain.

Tara Stiles doing 'pigeon pose'.
Still from her youtube video.

I have been going a little bit crazy lately with this leg of mine. Despite what genuinely seemed like real progress over the winter months and into the early spring, I have lately felt as though there has been a reversal of progress in healing. I can ride my bike. I can go to the gym and work out. But I also have pain in my leg, from hip to foot, regularly and relentlessly. It strikes most fiercely when I spend a long design day at the computer. I get an awful 'full' feeling in my calf (like the skin can't contain the stuff inside), and a binding in my knee, and sometimes, the scariest tingling feeling in my foot. When I lie down at night, I feel a weird hum (best word I can think of to describe) in my right foot, and fierce aching in my whole leg. This all despite best efforts to stretch my legs and hip flexors (yoga's pigeon pose) is superb for this, and (as discussed in previous posts) lots of work in hip/core/glute/quad strengthening/stablizing (deadlifts, squats, split squats and lunges, among others).

And yet, the physical part is only part of the problem.

I have also been hamstrung (useful term, that) in the realm of medicine. I was scheduled, July 27, for a deep tissue ultrasound, as mentioned, and then possibly a cortisone shot, depending on the results of the ultrasound. I was assured by my sports medicine doctor that "[the cortisone shot] would put out the fire" and that I would be thereby relieved of pain. Excited, I was. And yet, when I arrived at Humber River Hospital, on July 27, prepared and energized to find some answers to this ongoing and vexing problem, I found I had been mis-scheduled – nearly blithely trotted into the xray department for a contrast/xray guided cortisone shot (sans ultrasound), when I asked the question, "what about this part on the requisition which reads 'ultrasound assessment, cortisone if necessary' "? This, plainly written, even though by a doctor. The response from the tech, bless her, was chagrin, and a "the charge nurse books these, it does seem wrong, I'll have to check it out"...but still, obvious screw-up. So, I waited, and then had an ultrasound done (but not done by Dr. Mascia, as expected), and no cortisone shot. A week of waiting for results ensued, no word from the sports medicine doctor, and my call last Wednesday (August 8) to their offices yielded a startlingly unsympathetic (I don't even know what to call her) person who, when I asked to speak to the doctor, said, "I'll see if he has time."

Exciting times, today, then - when, to my surprise, a voicemail from their offices today said the doctor doesn't want to speak to me, he wants to see me, on Monday (!) (a somewhat amazing difference, in terms of scheduling, from the 3 months I waited to see him last time). Either the ultrasound has shown something, and there's a course of treatment on the horizon, or, the ultrasound has shown nothing, and the next step is an MRI. One way or the other, I just hope there's some kind of answer pending.

Chronic pain is confounding. In a way, you get so used to it that you sort of dismiss it as a natural state of your life. But it's not a natural state. It really shouldn't be that when you lie down to go to sleep at night that your first thought is either a) "did I take an ibuprofen so I can sleep?" or b) "holy crap, my leg hurts - and what's that weird hum in my foot". The other confounding part of chronic pain is that one does get tired of being a one-note song, always complaining about the same thing. I sometimes feel helpless in the grip of this stupid leg of mine, which feels, often, almost disconnected from me - 'you are not my leg, you vexing thing you' - we are ever at odds, it seems.

This has been a long post. But it's been a while. In my renewed attack on solving the mystery, I have an appointment with my GP on Friday, the sports med guy on Monday (surprise!), and a physiotherapist on Tuesday.  I will have some things to report - even if no thing (per se) in the days to come.

Back to biking: so far, so good.

Mono Cliffs PP - beautiful views, fun trails.

So it's begun. I have been able to ride my bike many times, since my last post, without too much pain. Truth: there are some times when my knee gets a bit sore, and I feel that weird tightening up my leg into my hip, but not so much that I feel the need to stop riding.

What has made the difference this year? Certainly the effort made at strengthening my hip flexors and leg muscles (particularly the good ole glutes). The work done with Steve Neal, I think, was vital - and if it wasn't for the need to purchase a new furnace ($: sigh), I would definitely still be doing (ahem, could afford) those awesomely fun workouts. But, interestingly, it's not as though I've had setbacks since stopping those workouts just about a month ago now. I make sure to not ride too long (so far, not over an hour). I make sure to moderate, if I can, my effort while I'm riding - which can be tough, when having trail fun. And I've been keeping up with weight training twice a week - doing deadlifts and squats and lunges and glute bridges and so on - and thereby staying strong for time spent in the saddle.

In more good news, I've also begun to run again. Short runs (nothing over 5K), and at an easy pace. Sticking to trail helps a lot, and again, not enough credit can be given to the strength work done since February.

Still haven't had the ultrasound/cortisone treatment that was prescribed when I went to Collingwood Sports Medicine - I did follow up with a phone call, thinking I had missed something, but they reiterated that they would call me when the appointment had been set up. Hm.

Next steps (pardon the pun): picking a goal for late summer, both for riding and for running. And maybe, the Stomp the Quarry run (I think the 5K) on July 28 as an interim effort. We'll see!

Patience.

I was an impromptu fitness model once.
This is my leg before it started misbehaving.

It's tough to be patient. Even when it's been  proven that impatience is detrimental to healing, and, in truth, detrimental to just about anything in life, it's still not an easily natural human trait to be genuinely patient. 

Certainly I learned the hardest of ways that I had to be patient, with this stupid leg problem of mine, what with all the times I would get it so far toward better, and then screw up all that progress by doing something boneheaded like a long trail ride with competitive friends. It is a bit ridiculous, despite all that, that even now, while I know slow and careful is the best way to go toward healing, I still get astonishingly jealous of someone who says 'I was out for 3 hours yesterday on trail with my buddy so-and-so'. You know, considering that a long trail ride would just set me RIGHT BACK where I was before I started all this good healing work?

On the healing note - my leg continues to respond positively to strength training. I have yet to hear when the ultrasound with Dr. Mascia will occur. This is on the list of things to do. Along with (ha) being patient. A funny thing to put on a list of 'to-dos'.

Iliopsoas bursitis. Or, the thing that happens to my leg.

Image is from hipflexor.org, which also contains lots of useful information
  about hip stretches, strengthening and prevention of hip flexor injuries.

After another visit to Collingwood Sports Medicine, I finally have a more certain diagnosis of what the heck is going on with my leg: iliopsoas bursitis. This was well explained by Dr. John Bowman - essentially, the iliopsoas muscle group is the strongest of the hip flexors, it's vital for standing, sitting, walking, running, and in my case, pretty darned important for cycling, too - particularly in mountain biking where there is a lot of standing in the pedals and maneuvering around the saddle. Generally, iliopsoas injuries are caused by overuse/overtraining - which would be accurate for me, as, when this injury occurred, I was trail running, mountain biking, weight training and doing a lot of plyometrics - some weeks adding up to nine workouts/week. 

So what happens, as a rule, with me, is that I'll do one of the sports I love, sometimes have pain in the hip during, and then often or always in my hip, glute, outer quads, knee, and sometimes all the way down to my ankle the next day. So, I'll take that day off, see if I'm pain-free the next day, if I am, go for a ride/run/workout/whatever, and then repeat the cycle. The pain part of the whole deal is the result of the bursa becoming aggravated and inflamed and then sending its consequences down my leg. 

Since I've started my new workout regime, which, as mentioned, involves much in the way of hip strength/stabilization exercises - and stretching - the time from aggravation (pain onset) to resolution (pain mostly to completely gone) has shortened considerably. Where before it could take a few days for my leg to stop hurting, now it's usually on the order of 24 hours. This, obviously, is progress. 

Next steps for my hip? Well, first an ultrasound, to have a look at the bursa. I await an appointment at the Humber River Hospital, with Dr. Anthony Mascia - here is an interesting article about him and the treatment of a patient's chronic pain. Next, possibly a cortisone shot, depending on the extent of inflammation. And following that, I am told, disciplined adherence to exercises to keep my hips and core strong and resilient. 

It is pretty amazing, to have a name to put to this remarkably annoying chronic pain of mine. Also, nice to have an enemy to put forces decisively against. Rawr.

First ride of the year. Also, first ride in 3 years without pain.

On Sunday, I went for a bike ride. And it was awesome. It was very short - perhaps 30 minutes. It was mostly gravel trail, with a bit of single-track and some nice rooty climbing, so it was super easy. But it was perfect. Perfect because my leg didn't hurt within five minutes (which is its usual habit) and even perfect-er because it didn't hurt after 30 minutes, or the next day either.  It truly was the first ride I have had in three years that didn't hurt in any way. Which, on Sunday, was nearly tear-inducing - but ended up being beer-inducing, which is to say, I celebrated  in the sunshine with a cold bottle of, well, beer. 

And, even better, on Monday morning, I had a great workout, which involved split squats and glute bridges and hamstring curls and other exercises which would have ordinarily caused serious leg complaints following a ride (or run) - but didn't - which was cause for more celebration. This time without beer (workday, after all).

I am hopeful. 

I am, actually, more than hopeful. I am energized. I am totally thrilled to have found a way back into biking - which I really must credit to the workouts designed by Steve Neal. His insistence on perfect form and on developing genuine core and hip stability seem to have made all the difference. 

And so today I am going for (oh me oh my) another bike ride. Similar to Sunday's ride (in fact, probably identical). My toes are crossed that it will be another pain-free ride.