Pain in the….

…leg.

Early November my left leg started to hurt somewhat. I could still walk, move around etc. but by the end of each day my leg was in pain, a sharp pain at the hip joint with the entire thigh, buttock and groin aching.

It wasn’t so bad that I thought anything of it. I’d had the odd twinge before and by morning the pain was gone and didn’t really return until later in the day. Working as a waiter you’re on your feet at least 7 hours a day and so sometimes something’s going to ache a bit.

However, after a couple of weeks the pain hadn’t gone away. It had got worse up to a point and then maintained a level that I could live and work with, but it clearly wasn’t getting any better. The general assumption was that I’d twisted myself somehow and had sciatica. However, the simple fact of this constant nagging pain was starting to get to me so I tried to make a doctor’s appointment.

Initially I figured it’s not massively urgent so I called the local health service, but my doctor couldn’t see me for a week so I simply waked in and tried for an emergency appointment. No joy, after sitting around for a while they told me (and a bunch of other people) that all the appointments for the day were taken, the doctor had gone, and best go to the emergency room (in the same building; there are emergency rooms in every local health centre here). The wait there was even worse, so I canned it for the day.

Next morning I trotted off down to the hospital, walked up to the emergency room counter, waved my private medical card at them, and within 2 hours was off home having had an X-ray to check for breaks (none) with a prescription for some anti-inflammatories (enantyum) and a referral to orthopaedics.

The anti-inflammatories helped a bit but I started to get pain in other places; base of the spine, other hip joint, top of hip bone, leg, buttocks; burning sensations, stiffness, stabbing pain, you name it.

A few days later and the orthopaedic doctor listend to my descriptions of what had happened, put me on my back and twisted my leg in various different ways. He said that it wasn’t sciatica, the pain wasn’t consistent with this. Checking my X-ray he said that it was possible I had hip impingement, a relatively recent diagnosis term for a common hip deformity where the bone below the femoral head hits the pelvis during certain motion ranges. This typically leads to a range of secondary problems that in the past were diagnosed and treated as problems in themselves, the root cause being undetermined. He ordered an MRI, and a nerve conduction test to rule out sciatica completely.

At this point I was still feeling that it was something that was probably not too serious and various things were happening at work, so I delayed the tests a few days. By the day of the MRI, still taking the anti-infalmmatories, the secondary pain of my other hip, thighs, back etc. was bad enough that I was functioning far less easily than before.

A week or so later, MRI results in hand, the doctor said that it’s not hip impingement but that the MRI had shown up some abnormalities in my hip suggesting some form of progressive bone problem, possibly as a result of a systemic illnes. He ordered a scintigraphy and referred me to an internal medicine specialist as well as a rheumatologist. This was all just as we were about to start a two-week close-down at the restaurant for our pre-christmas holiday.

The scintigraphy was interesting; basically they take a form of X-ray before and after injecting you with radioactive liquid. It’s only a small amount of liquid but it’s potent enough to go throughout the body and lights up any serious problems through various absorption rates. Inbetween the two, however, you get a 1-2 hour break where you’re told you can do whatever you like, wander round, play in traffic, go for a meal, as long as you drink around 1.5 litres of water. Oh, and only urinate in a specific toilet in the hospital during this period….!

The scintigraphy happened about half way through our two-week break, and given that Christmas was fast approaching the results wouldn’t be ready until after the holidays. So with an appointment for the doctor on the 27th I headed off and didn’t think too much about it.

Returning to normal work at this point was a bit rough. The two weeks off had allowed me to relax, and I’d mixed my days with rest and a bit of physical activity. I’d also stopped taking the anti-inflammatories as I felt at this point they were doing me more harm than good, and sure enough within a day or so pretty much all pain had gone except the original pain in my leg! This pain didn’t really go away, and grew worse as the day wore on.

I worked out that taking 600mg if Ibuprofen before work generally saw me through the night, and I tried very hard to maintain good posture as a lot of the secondary pain was as a result of me subconsciously stooping whilst moving to compensate for the pain in my hip.

This was fine for the first week, but regardless I was basically in continuous pain, 24 hours a day, and had been for a good 6-7 weeks at this point.

A week later, after doing some work at the restaurant in the morning, I headed off to the doctor. The results of the scintigraphy had ruled out transitory osteoporosis (a form of osteoporosis that basically fixes itself after a few months)  but had highlighted the problems in the hip. The problem has been pretty much narrowed down to some other form of osteoporosis, avascular necrosis (also known as osteonecrosis), or a type of arthritis. At this point, the doctor tells me to stop using my leg, put no weight on it at all, relax as much as possible, use crutches to move around.

What? Umm, I run a restaurant and work as a waiter and although I’m in some pain I can still function and you want me to stop working and leave the other waitress on her own during the busiest two weeks of the year? Are you nuts?

This was lunchtime. I walked out of the doctors office somewhat stunned and upset, but on getting home fished out some crutches that were at the back of the garage and started to use them. After various brief and abortive attempts at denial over the next few hours we started looking around for someone to cover for me. Although I went down to the restaurant as normal that night, before 7pm (opening time) I was on my way back home in a taxi.

I knew this was going to be hard for me. I have a really strong work ethic and sense of duty, especially when it comes to the restaurant, and quite suddenly I had been denied the ability to work. If I’d had an accident and broken something and was in hospital I could have lived with this more easily, but I apparently had the choice to walk, should I wish to. There was nothing stopping me walking other than a verbal instruction from a doctor. My desire to work on top of how busy the restaurant was likely to be and the lost opportunity for income made staying at home really hard.

There was no doubt in my mind that I was going to be in a bad way very quickly, at home alone when I should be working. I immediately called my sister who had previously worked in healthcare for many years, and has been going through similar issues with her husband. I think that conversation probably saved my sanity. It’s all well and good being intelligent and self aware, but knowing that you’re reacting in a particular way doesn’t help you get through it. Just simply talking to someone was a help but my sister, from her own training and experiences, also knew exactly how to direct my thoughts and what pitfalls to avoid.

It quickly became clear that I had a lot of questions that needed answering. As she pointed out, some of them there’s no point in asking as there’s no sensible answer. A lot of my questioning was through unwillingness to accept that I couldn’t work. I knew this, but whilst knowing it might stop you ruminating over the problems it doesn’t necessarily make you feel any better!

On the advice of my sister I wrote down all the questions I had, put them to one side for the night, and arranged to talk to the doctor by phone the next day. The conversation with the doctor was brief but helpful; I discovered I could sit in a chair, drink alcohol, drive (though not necessarily at the same time!), no need to take any medication unless I was in pain, at which point take NSAIDS. The other half of the questions I didn’t bother to ask; as my sister pointed out I realised there’s no point asking as there’s no way the doctor could really know until other tests were completed or I was simply pushing for an answer that would allow me to do what I want, i.e. go back to work. Things like what’s the root cause; is that still an issue; how long will I be on crutches; what will happen if I put weight on it; etc.

Now it’s a week later. I have bought some new crutches that are the right height for me and have better hand grips. I’m largely getting about though at the moment though I’m not really able to do anything that requires you to stand for any length of time and use both hands, or move whilst carrying something (drinks and plates of food have to be relayed or carried by someone else – or I just eat/drink in the kitchen!) which cuts out a lot. I’m also not about to do anything that requires me to move long distances on the crutches as my upper body strength isn’t up to it yet!

I’m also relatively pain free. There are some dull aches now and then. I’m most comfortable sitting at my desk. Lying down my hip feels a bit numb but it’s ok. Certain chairs make my hip and then my back hurt. A lot of activity, even though I’m not putting weight on my hip, also makes things hurt more. Driving is ok but not great – short distances are fine. Overall, though, even when it does hurt it’s nowhere near as bad as it was a week ago.

I’ve got an appointment in a week’s time for physiotherapy plus the internal medicine results a day after; a week after that I’m due to see the orthopaedic doctor again, and I’ve also an appointment with a rheumatologist in 2-3 weeks . Until then my ability to balance on one foot is improving rapidly and I’m learning how to do lots of things with one hand…!

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