Ready and Willing

I had been thinking over the last month or so of beginning a blog so that I could document my trials and tribulations with this relentless hip injury in the hopes that someone else could learn from my experience and not spend as much time as I did just trying to figure out what went wrong. I also figured blogging into cyberspace might be a more productive option then spending as much time as I had been over the last 8 months thinking/worrying/getting depressed and angry about what happened to my formerly very athletic self. And then....

On December 23, 2008 I drove to East Denver to the old Lowry airforce base for a high resolution MRI after the initial MRI-arthogram from last August was negative for a labral tear. Fed up with the littany of wrong diagnoses and failed attempts at healing through conservative treatment, I pushed an MD to order an additional MRI. And within less than 24 hours I finally had my answer -- the one I've always known but couldn't get anyone else to agree with and accept. My MRI came back positive for a tear of the acetabular labrum of my right hip along with some other unfortunate things including "early osteoarthritis" and mild degenerative fraying of the articular surface of the joint. Not wasting any time I scheduled an appointment with one of the highly-regarded hip scope surgeons in town, Dr. K.S., and the very next day I spent one and half hours in his office going over the MRI, taking additional x-rays of my hip and talking about my surgery options. Dr. S confirmed mild femoralacetebular impingement in both hips but obviously prophylactic surgery on the left isn't an option at the moment...let's just take care of one thing at a time. FAI is a congenital abnormality of the hip in which the femur "impinges" on the labrum and can cause it to tear. Most of the time when people have labral tears it is because they also have underlying FAI or they are very unlucky and were involved in an accident or some kind of twisting injury such as might happen in soccer, ballet, golf, tennis, etc. Runners and cyclists also get labral tears from general wear and tear on the hip joint but it is much more likely to happen if you also have FAI.

Dr. S assured me that given my age, my good health and fitness and the fact that my impingement wasn't especially bad, arthroscopy was an excellent option and I would likely recover fully though it would be a rough road, which I knew.

Hip Arthroscopy has been around since the mid 70s but it really hasn't gained much ground in the US until the last 15 years or so. Because the hip joint is so deep (compared with other joints in the knee and shoulder), it has taken a much longer time to develop minimally-invasive scope procedures that allow the doctor to access and repair the joint without doing too much damage on their way in and out. This is a much less common surgery than ACL repair or rotator cuff surgery so consequently there are fewer orthopedic surgeons trained in the technique. Thankfully, one of the pioneers of the hip scope, Dr. Mark Phillipon, is based at the Steadman Hawkins clinic in Vail and many of the surgeons who perform the scopes in this state have either trained under him or are at least up to speed on the latest developments. I'd hate to be living in, say, Anchorage, Alaska, if I needed a hip scope.

In any event, it isn't an easy recovery and virtually everyone has been honest about that much. The "success rate" is 75-80% which is acceptable but I certainly wish it were a little closer to the 85-90% range. Not that I have another option though -- that is precisely the issue. Labral tears will not repair themselves because the hip joint is avascular so unless you are one of those very fortunate people who have managed to treat the tear conservatively until it eventually becomes less symptomatic, you are looking at surgery as the only option. Not doing the scope also requires a lifestyle change that I wasn't willing to make -- we're not talking a Boulder lifestyle change of going from ultramarathons to triathlons but a genuine lifestyle change such that I wouldn't really be able to be active much at all. I actually could accept at this point not running again -- I know it will be a long time before I can do that again. But I won't accept -- nor should I have to ---not being able to hike in the hills behind my house with my dogs, ski in the backcountry, ride up Flagstaff on a warm fall day with the Aspens glowing in the sunlight or ripping up a powder day at Beaver Creek on my telemark skis. So, yeah, surgery. No big question mark there.

It wasn't a very hard decision anyhow because I've been in so much pain over the last month since the second cortisone shot wore off (much like the pain I was in all summer long before the first cortisone shot) that my daily life is impacted and it has become a drain on me and my dear husband in more ways than one can imagine. As anyone who has suffered from it knows, chronic pain makes you crazy, depressed, pissed off, irritable, alienated and distracted, amongst other things. Not being able to vacuum the house or take out the recycling or clean out the garage without causing my hip to flare up from the bending and lifting isn't very conducive to an equal division of labor in the household. Sitting at a desk all day is my job and when it hurts to do that I can't really tell them I'm taking a sick day. Sometimes lately it even hurts to drive or be in the car for a long time.

Given all this, I'm ready and willing to be a Big Girl and let them fill me with lots of scary drugs, stick my leg in a medieval traction device and weigh down my feet with a 40lb block so they can pry open the joint, get their cameras and tools in, fix the place up and get out so I can be home in time for cocktail hour. I'm sure I've left out essential details like what exactly they will be doing to repair the labrum and get rid of the impingement but there will be plenty of time for details when I'm home doped up on Vicodin and watching House re-runs in a passive motion machine for four (eight) hours a day.