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Really not much that you can do at this time until the MRI confirms it. I'm not familiar with the procedure and since I'm a chiro and not an ortho surgeon I couldn't offer you much any ways.
There is a med school at the U of Victoria so you're in an area where there should be some high quality ortho people who would be familiar with the latest procedures.
John H. Post, III, MD
Medical Advisor, TrainingPeaks
Ironman Certified Coach
Contributor, IRONMAN.com, TrainingPeaks.com/blog
Ian D. Toms
Took some time of work to train for triathlons and went along to specialist orthopeadic vet in my spare time to watch. Scrubbed in an assisted him with a hip labral tear surgery and will never forget. He just diagnosed it by x-ray and when he showed me the x-ray I could barely see it.
Holding all the instruments for him to access it through all the muscles I saw the little flap which he removed(then he did some other work on the area affected).
Since I was training for tri's it really made me think; to me it looked like it would be sore most of the time and it would only get worse if not treated.
So I feel for you if you have a labral tear of the hip. Apparently it is also what has put a halt to Emma Snowsill's season.
Am guessing it is harder for human doctors to diagnose as there is even more soft tissue for a basic x-ray to go through making it hard to see.......tricky to diagnose.
all the best.
Full event coverage of triathlon/ironman in photos.
Anyhow, my sports med doc wasn't really familiar with arthroscopy repairs for torn labrums so he referred me to a hip surgeon who didn't even do arthroscopy. I quickly realized that if I wanted things to move forward at a reasonable pace and in the right direction, I would have to do things myself. While I can't post any insight into the surgury experience, orthopod experience, etc., I can post my experience with finding orthopedic surgeons in southern Ontario.
Initially, I had a heck of time figuring out where to start but I think I have made some progress in the past week or so. Essentially, very few orthopedic surgeons in southern Ontario do arthroscopy to repair torn hip labrums. I believe the main reason for this is that the surgery is quite new so the surgeon would have to be trained for this specific procedure in the last maybe 5-8 years, generally less. Dr. Marc J Philippon in Vail Colorado has done the majority of the research with repairing torn hip labrums and he seems to be the foremost expert surgeon in this area. Prior to 2005, it would seem most arthroscopy of the hip didn't repair the torn labrum but just cut off the flap of tissue that was causing the pain, cleaned up the area and that was it. In some cases, that is all the surgeon can do. If the labrum is still in good enough condition than a newer option became available that revolved around repairing the labrum (suturing the labrum back to the acetabulum), not just cutting out the flap (labral tear). I believe early indications suggest that repairing (called a labral refixation) vs. cutting out the labral tear (called a labral resection, debridement) can help prevent early osteoarthritis. There seems to be strong links between a poor functioning labrum and early osteoarthritis, therefore it would stand to reason that there is an advantage to having a labral repair/refixation vs. a labral resection, if the patient's hip is able to be repaired (based on surgeon's opinion). Early results of the refixation surgery suggests that refixations have a better return to performance for athletes and less hip osteoarthritis in the years following surgery. Use Google Scholar to research recent papers online.
Based on the information I have gathered, my thinking is that if I see arthroscopy surgeon that does resections (which has been around for at least a decade) but not repairs/refixations (not many performed before 2005), than there is a 0% chance that my outcome will be a repair, which potentially points me down a path that has a greater incidence of osteoarthritis. If I see a surgeon that is trained with repairs, than, if possible the surgeon will do the extra work and repair my hip versus just resecting it, which lead me to narrowing down surgeons in Southern Ontario that are trained in hip arthroscopy refixations/repairs. There are few. As a patient, you have to figure out who does it, how long their wait times for consults are and how long after will a surgery be scheduled for. As of the spring of 2011, I have heard that 1-2 months is the best consultation time with many appointments being 8-10 months in the future. After that, surgery can be as soon as 1-2 months but other surgeons wait time is an additional 8-10 months. Therefore, some surgeons may be available with 1-2 months for a consult and then 1-2 months for surgery, other surgeons are 9 months for a consult and then another 9 months for surgery. Keep this in mind when getting referred to a surgeon. Do your homework. Call their assistants, talk to them and ask several questions before being referred to just any orthopedic surgeon for your labral tear. Here is my list so far of orthopedic surgeons in southern Ontario that, based on my research, have been trained in hip arthroscopy for labral tears and likely but not guaranteed, are able to do labral repairs, if warranted. Random Order....
Dr. Douglas Naudie, London, Ontario
Dr. Dan Whalen, St. Michaels, Toronto
Dr Gavin Wood, Kingston, ON
Dr. Lucas Murnaghan, Sick Kids/Womans College Hospital
Dr Olufemi Ayeni, McMaster, Hamilton
Dr Rajev Gandhi, Toronto
Dr. Ginty, Oakville
Dr. Veillette or Dr. Ogilvie-Harris, Toronto (same clinic).
Dr. Paul Beaule, Ottawa,
Do your own research, call the surgeons assistant first, talk to your family doctor as you will certainly need a referral, look them up online, look up ratemd type of websites, etc. My research is pointing me towards Dr. Lucas Murnaghan based on a variety of factors (recently trained, able to do repairs, wait times, etc.). I have yet to meet him, I have not had surgery (and may not need it?), and I have not talked to anyone that has.
Check out http://www.orthoillustrated.com/ and look up the hip section. Good video that shows hip labral repair. There is also a good paper by Robert Fry, M.D., and Benjamin Domb, M.D. titled Labral Base Refixation in the Hip: Rationale and Technique for an Anatomic Approach to Labral Repair.
My high level KOS son has seen him for follow up of an osteochondritis dissecans of his knee. He is a nice guy and has done triathlons himself. Good luck!
edited to add link
I just have to ask with all the talk about health care. Are you happy with taking 2 years of various visits and half a year to get an MRI? My knee blowout from day 1 to post op and done with rehab was faster than your MRI wait time. If you had a total knee blowout would they have put you up to the front of the line? Just want to hear the details from someone actually in the system. Even my non emergent shoulder was a 48 hour deal from doc visit to MRI and into rehab.
With that said I hope you get it all squared away and back on the road asap! Rehab stinks, but it works.
I just found this thread while researching surgeons who do hip arthroscopy in British Columbia. I've had ongoing hip pain for 6 years and have been getting the runaround all that time. Some days I think I must be going crazy and that it's all in my head. I haven't ridden in nearly 3 years because of the pain, running is bearable most times as long as I keep it to a short, slow shuffle. But the pain is variable, comes and goes, some days it's very bad and some days my hip is relatively good. Sometimes it keeps me awake at night, or hurts so much that I can't sit at my desk, while other times it gives me relatively little trouble even when I've been fairly active.
GP says I'm getting older and should just get used to slowing down. I'm 47 fer cryin' out loud! Sports doc found tendinosis and refuses to look further even though I repeatedly explained that I have other pain that's nowhere near the vicinity of the tendon and is of an entirely different character.
Finally had the good fortune to have my last appt on a PMS day - I suppose the tears helped my cause - and GP finally referred me to an orthopedic surgeon and for a contrast MRI. Both appts are 7 months away, and now I understand that after seeing the local orthopedic surgeon I will likely be referred on to another surgeon who does hip arthroscopy, as it's fairly new and not many docs do it. The one that I know of, Mike Gilbart in Vancouver, has a wait list of 3 years just for a consult, unless I pay privately, then it's only 2 weeks.
If any fellow British Columbians have any insight/advice/suggestions for how to move things along I'd sure appreciate hearing from you!
I'm not saying our health care system is perfect, but I'm not saying it's horrible...for *me* at least. I love my health care and don't want anything changed about it whatsoever. Never had a single complaint with my delivery system.
I feel for you and have a business acquaintance from Montreal who came to the states to have his knee done in Greenville, SC done about 2 years ago. He had been kicked around the Canadian system for a couple of years w/o having had any success in getting the knee done. Come to find out he had 2 bucket handle tears in his medial meniscus. He paid cash out of pocket and is as good as new.
By the way that is EPIC. 3 years for a consult and 7 months for a contrast MRI? That is the most EFFED up delivery system, hopefully I won't ever have to endure it.
There are definitely pros and cons to both the Canadian and American health care systems. Unfortunately, speed of treatment is not one of our advantages it seems. Perhaps it's true that you get what you pay for.
I'm going to see this Dr. Gilbart privately for a consultation to see if he thinks he can do anything for me. Cost is $500 for half an hour, review of my images, and one follow up. Private contrast MRI is another $1,200 if he thinks it's necessary for a diagnosis. If surgery is needed it will be $10,000 - $12,000. Maybe I'd be better off to take a holiday stateside...sounds like it could be the cheaper option, even with travel and a couple night's stay?
I am athletic playing competitive hockey and soccer, and now men's league hockey only. I used to do the traditional "bodybuilding" style workouts and managed to get to a bodyweight of 225 lbs, with a 34 inch waist at 5'10. All that to say, that those workouts made me worse, and I eventually stopped alltogether at 27 yrs. I have since managed to keep my pain progession to a slow crawl, but it still progressed. One good thing that came out of this process is my determination to find smarter ways to workout. I haven't searched much of this sight, but it appears to be a running based site. I prefer weights, but have moved into cardio circuits with weights. I have found kettlebells, and have been using them for over 8 yrs. now. I have also found that training movements instead of muscles, has changed my outlook on training, making it more effective and efficient. Some great resources to help you help yourself during your search for a proper diagnosis to your pain are as follows:
-Functional Movement Screen(FMS)-developped by physiotherapist Gray Cook-geared towards a systematic approach for assessing faulty movement patterns in a person, and correcting them through exercise-there are certifications with many practitioners Canada
-Magnificient Mobility DVD-Eric Cressey-shows you how to warm-up properly and why stretching before an athletic activity is counter productive
-Core Performance Essentials-this has been a big part of my workout for the past 3 yrs.-it's main goal is to get your body to work properly-this would be even more effective if you had the FMS first, but it's best features are smart exercises with planned progression-ie. if I asked you in 4 months how your workout was coming you would actually be able to tell me how much you improved
-Pain Free by Peter Egosuce-this book didn't fix me but it changed my view on how I could achieve a permanent solution to my pain, and gave me greater insight into how the body works-there's a website also
-read any articles from Mike Boyle, Eric Cressey, Mike Robertson, Gray Cook and Brett Jones-Jones and Cook collaborated on a project using kettlebells and Indian club swinging to restore proper function to your body
Sorry for the long reply, but I wanted to share my experience with pain, and how I increased my knowledge in terms of exercising intelligently to find a lasting cure to my pain. Wtih that being said, my pain still progressed until I was properly diagnosed inn April 2009.
My wife suffered from hip pain, had a labral tear repaired by the famous(now retired) Dr. Fowler in London Ont. The surgery did not fix her pain, and subsequent visits to other "experts" provided nothing. They said good luck with physiotherapy. Finally after another trip to a different doctor, he recommended her to see Dr. Paul Beaule here in Ottawa. He found her problem in 3 minutes, using an x-ray only, on her first appointment. He performed a proceedure called a Bernese Periacetabular Osteotomy(probably spelled wrong), where he cut her pelvis into three peices, adjusted it to fit properly, and screwed it back together. She was back riding a Harley less than 6 months later. She was a national team rower(now a mother of two), and still in great shape. The surgery was a complete success!
I then booked my appointment with Dr. Beaule and was seen April 1/09. It took him less than a minute to find my problem. Femoral Acetabular Impingement-FAI. Music to my ears-my pain wasn't in my head. From all the research that I had noted above, I figured that my hips may be the source of my pain, and now it was confirmed. Beaule stated that improper hip function, will cause back pain. If you read Cook's and Mike Bolye's "joint by Joint" approach to training, they say the same thing.
I got the call for a surgery date 2 weeks ago, and am going in for a bilateral hip arthroscopy on July 21/11-almost 2 yrs. and 4 months later! The wait has sucked big time, and my pain came to a head in late March when I severely pinched my sciatic nerve working out no less. I have been on light duties at work ever since-surgery can't come soon enough!
Things are progressing quickly in the area of hip surgery, especially FAI, and my doctor, who originally told me he could only operate on one hip at at time(I have FAI on both hips), will now be operating on both at once. I am nervous and the reason for my search was an attempt to find anyone else who had both hips operated on at once-I have had negative results so far.
My research has shown that I am very lucky to have Dr. Paul Beaule here in Ottawa, that his last job before coming here was in UCLA, and that he is a leading researcher in the area of hip athroscopy. He chairs many educational seminars(for other hips surgeons), with one coming up in New York this month. From my understanding he specialized in the Arthroscopic proceedure while studying pro athletes with hip pain. Traditional "open" surgeries were to invaisive and the rehab so hard that many pro athletes solved their pain problems, but never returned to play pro. His advancements in the arthroscopic proceedure has brought this number up significantly.
This is a long reply, just venting about my experience, sorry. I would call his office in Ottawa, and ask for a recommended doctor in your area. I would also look at some of the information I provided above to help you along while waiting for your appointments-be proactive. Lots of information about how to train your body to function properly is out there, as well as improved methods to recover after surgery. For any hockey fans out there, Ray Emery(goalie for the Anaheim Ducks) had the same hip disease as Bo Jackson did. He got surgery-I don't know what kind-and rehabed his hip in Toronto with a private trainer named Matt Nicol. I contacted him telling him about my FAI, and he stated that he could help me prepare my body for surgery, and help rehab me afterwards. He also recommended a local trainer-Lorne Goldenberg strength coach for the Montreal Canadians-here in Ottawa. I contacted him and he also offered to help. I never went because I felt that it would be to expensive, but wonder if it would benefit me.
I'll end it here, search lots, stay diligent, keep your spirits up, and keep moving.
Have you had your follow up with Dr. Gilbart yet, or just seen the results of the MRI? I had my follow up appt a couple of weeks ago and am booked for surgery on August 16th. There didn't seem to be a problem with wait times when I was in...maybe he's taking a holiday or something? The nerve LOL!
Dr. Gilbart came highly recommended to me and I was lucky to get moving through the process relatively quickly, though I went the private route too. It's just not worth waiting any longer after 6 years. I understand his public clinic has a 3 year wait list just to get in for an initial consultation! I was told the wait for surgery through the public system (having already seen him privately and received a diagnosis) is 6-9 months, but only 2-4 weeks privately.
I wish I could help with recommending another surgeon, but hopefully things will be moving again soon at the private clinic. Let us know how it turns out for you!