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CT Scans

On January 5, 2017 I fell. I don’t know what happened, but I obviously wasn’t paying attention and fell backward against the air vent for my heating oil filler. I fell so hard, I moved it:

The scene of the fall

I fell against the heating oil filler air vent and moved it off vertical.

At first I just thought I was having muscle spasms so I took Flexeril and went to bed. Pain didn’t subside and I felt bones moving, so I expected I had broken a rib. I went to the local emergency room three days after the fall and their first question was: “What took you so long to get here?” I had no good answer to that.

Anyway, they did a CT scan and confirmed I had broken three ribs with no displacement. They gave me a Percoset and sent me home, telling me to take it easy. I asked for and got a DVD containing the CT scan data. You can download software to look at a CT scan on your computer, believe it or not, but I could just barely make out the break in one rib.

I sent the DVD to my primary care physician in Boston and she sent it on to the radiology department there for a reading. Here’s their report:

FINDINGS:
Lines/tubes: None.
Lungs and Airways: The central airways are patent. Calcified granuloma seen in
the right upper lobe. Bilateral lower lobe patchy dependent consolidations are
seen. There is mild emphysema.
Pleura: The pleural spaces are clear.
Heart and mediastinum: The visualized thyroid gland appears atrophic. The
ascending aorta is aneurysmal and measures 4.1 cm. There is mild multichamber
cardiomegaly. No pericardial effusion is seen. A small hiatal hernia is seen.
The esophagus is patulous. No mediastinal or hilar lymphadenopathy is seen.
Soft tissues: No enlarged axillary or subpectoral lymphadenopathy.
Abdomen: Lack of intravenous contrast limits evaluation of the intra-abdominal
organs. Cholelithiasis is seen without gallbladder wall thickening or
pericholecystic fluid. A 1.5 cm fat-containing lesion is seen within the
pancreatic body, and likely represents an incidental lipoma. The remaining
visualized upper abdomen is unremarkable. Scattered colonic diverticulosis is
seen without evidence of acute diverticulitis.
Bones: There are degenerative changes. No suspicious lytic or blastic lesions.
There are healed right sided rib fractures.
IMPRESSION:
Patulous esophagus with bilateral lower lobe dependent patchy consolidations
which may represent a combination of atelectasis, aspiration or pneumonia.
Aneurysmal ascending aorta measuring 4.1 cm.
RECOMMENDATION: Follow up chest CT in 6-8 weeks.

They made no mention of my broken ribs on my left side! I called my PCP and said this can’t be me! I don’t have an aneurysm. I don’t have emphysema. I don’t remember breaking any ribs on my right side. And this guy has no broken ribs on his left side!

My PCP was sure it was me and started testing me to confirm the aneurysm and my esophagus and stomach problems. She also asked the radiology department to have another look. They added this addendum to my report:

ADDENDUM:
There are subtle fractures involving left 9, 10 (posterolaterally), and 12th
ribs (posteromedial end) which are non-displaced. There is mildly displaced
fracture involving the posterior aspect of the left 11th rib.
Because findings in this report may be important, an automated tracked email
will be sent to the referring physician upon report finalization by the
attending Radiologist

Anyway, the emphysema and aneurysm will be watched and I will continue my GERD precautions. (That’s another story.)

So the bottom line is if the radiologist is just checking for broken ribs, that is what he/she finds. But if they’re just asked to look at a CT scan, they find all kinds of stuff.

I have also added railings to those steps:

New railings

New railings installed with the help of my grandson, pictured.

An interesting case

I received the following email recently:

Hi Steve
I came across your blogpost about your second hip replacement when trawling the internet and found it both interesting and comprehensive – so I followed up and found the info on your first one as well.

How are you going now, a few years down the track?
(I ask because it’s now 10 years since my last replacement0.

Kind regards,
Nik Macdougall

Here is some more information Nik supplied in a followup email:

Hi Steve
Thanks for the reply – and I’m delighted to hear that your hips are in great shape 🙂

Your site is very informative and should really be promoted as a resource for prospective THR patients. An awful lot of literature out there is highly ‘medicalized’ and, as such, often hard for people to come to grips with. Personal experience – stories – are what make an impact. Well done all round.

I’m 58 and my personal hip history spans 44 years, although only one hip. I’m not sure what sort of thing you might consider putting up on your site, but would be happy to provide any info you feel appropriate.

I hadn’t thought of setting up a website, in fact I initially set out to produce a simple THR self-help booklet. However, since I’m not a medical professional I decided that was probably an unsound choice. So, after much contemplation, I wrote the story up as a memoir. It was a lengthy process – and I had to quell my internal critic from time to time, but I’m glad I did it. I finally self-published on Kindle a little while ago.

I do have a blog, but the topics are more broad ranging than my hip story. However, if you’re at all interested, the book’s called Girdle of Bones.

All the best,
Nik.

http://nikmacd.com/teacup/mission-accomplished/

From her blog:

Hi , I’m Nik Macdougall.

I fell off a 100 foot cliff and had 9 hip replacements over 35 years. AMA

Pretty interesting, huh? I haven’t read her book, Girdle of Bones, so can’t recommend it directly.

It’s been a long time; Is everything okay?

It has been more than two years since I posted last. Someone emailed me to see if everything was okay, so I’ll answer the question. The hips and legs and knees are just fine. Right now I finished mowing the lawn. It takes about 4 hours walking behind my self-propelled mower. The legs and buttocks tell me I’ve done more walking than they would like, but that’s just fatigue, not hip replacement problems.

I have a FitBit and an iPhone both measuring my steps. On an active week I average around 8000 steps. On a less active week I average around 5000. I’d like to always do 10,000 steps but that only happens occasionally.

More Physical Therapy

The outside of my right thigh just never got better. I was worried that my IT band had been damaged. So I went to Berkshire Physical Therapy in Lee for more physical therapy. Rachael listened to my story and watched me walk. Her diagnosis was that my gluteus medius and lateral quad were weak. They couldn’t support my weight when, during walking, all my weight was transferred to my right leg. So the IT band had to take over and it was stressed.

So the good news is that my IT band is fine but overworked. The gluteus medius is split during posterior hip replacement and sewn back together. The lateral quad was probably stretched too far when they were manipulating my leg during the surgery.

Rachael gave me a series of exercises that strengthened those muscles and, after a few months everything is much better. Still not perfect. If I stand on my right leg for an extended time or stand on it and bend over, for instance while trying to put my left leg into my pants while standing, it cramps up.

I do what I can to force the right quads to work hard. For instance, while walking up stairs, my body tends to push off with my left leg to spare my right quads. I work hard to overcome that tendency.

Hard to tell how much of this problem is because of the THR and how much is caused by my abusing my body by sitting in front of my computer for hours on end.

Knee

Three days ago I went to see Dr. Tomford about my knee. He looked at the x-rays and said my knee looked great. It must just be a problem of the knee adjusting to the new mobility of the hip.

20130529 knee.0002

20130529 knee.000320130529 knee.0001

I was using the cane in my left hand and it seemed to relieve the pain in the knee when walking. He said I should be using the cane in the right hand for a problem with the right knee. Using the cane in the right hand was less comfortable, but I did it anyway.

Now I don’t need the cane any more. Was it just a few hours using the cane in my right hand that did the trick? Was it all in my head and all I needed was to be told by Dr. Tomford that my knee was fine? I don’t know.

The knee is still weak. I can’t balance on my right leg. There is pain along the outside of the thigh. I think that is the iliotibial (IT) band. Dr. Tomford says it is split during the hip replacement then sewn back together. IT band syndrome is a pain like I’m experiencing that is caused (among other things) by a sudden increase in activity. Well, that certainly fits.

That part of my thigh has always hurt since the surgery. If I lay on my left side and raise my right leg, it hurts. When I switched the cane to my right hand, that is the part of my leg that hurt. I am icing it now and icing my knee.

Interestingly, I had (and still have to a lesser degree) a similar problem associated with my left hip replacement in 2004. I wound up with “snapping hip” which is a juddering caused by inflammation where the IT band slips over at the top of my femur. So my IT bands are a problem.

I have ordered copies of the x-rays taken and will post them when I get them.

Now it’s the knee

About 10 days ago my knee started acting up. A sharp pain low and inside on my right knee, which is the side of my new hip. So I’m back on the cane after a a week or so free of any encumbrances. Using the cane seems to help avoid the load on the knee that it doesn’t like. But it is not getting any better; in fact, seems to be getting worse.

It is at its worst after being inactive for awhile, like in the morning or after sitting at my computer. I suppose I should stay off it, but it’s hard to do all my exercises and get in my 10 minutes of walking every day if I can’t use my knee.

I’ve made an appointment with Dr. Tomford for next week. Maybe it will be all better by then.

From Two Crutches to One

I can now officially walk with just one crutch or a cane. It has been one month since my operation. Don’t tell Dr. Tomford, but I have been walking with one crutch occasionally when I needed to carry something. I’m down to two Tylenol Extra Strength per day. My recovery is going very well.