That is really the only relevant question at this point. After this last flare up in which I was literally bed-ridden for 36hours while my family was visiting I have just flat-out had it with my right hip (and possibly my left if it doesn't start behaving again). I had been doing decently well for close to three weeks and then just as soon as I resumed some PT and strengthening of my pathetic atrophied glute muscles I got slammed with a massive flare-up the started on Wednesday around 4pm and didn't let up until Saturday afternoon. Consequently, I missed my sister's college graduation and dinner and was hopped up on pain killers for most of the time my family was in town. This is the situation that I cannot live with anymore -- not being able to plan even a week in advance because I don't know how my hip will respond and whether it will freak out on me. In two years I've yet to have a visit with my family in which I wasn't gimping around in pain. I'm really not asking for alot here -- just some consistency and the ability to plan a weekend trip or a vacation without worrying about trip insurance and change fees. I had a moment of clarity while I was sobering up from my 48-hrs of Tramadol-induced haze and I decided that I am DONE with this situation - I need a permanent solution and not a temporary patch. This isn't any way to live popping painkillers and anti-inflammatories like candy on a daily basis. Not when there is a solution out there that is much more reliable than my native hip. I don't care if I feel marginally better in 3 months. I don't care if I can ride a bike or snowshoe for an hour or swim. I don't care if I have days that are relatively pain free here and there. And I really don't care if I am in my 30s and setting off metal detectors. I won't ever be able to return to any real level of activity on my current hip not to mention have a child and live a comfortable, engaging life and I see no reason to prolong the inevitable and wait it out until I am older and even less active.
And so I am gearing up for Round Number 3. I've thought seriously about going abroad given the cost and experience of the surgeons. Traveling 12 hours to Belgium or even 24 to Chennai, India to get my life back and be out of pain seems entirely worth it at this point in this saga. April will be the two-year anniversary of this ordeal -- what started out as a sports injury and is now a full-blown disability - and let's hope that April 2010 becomes a new kind of anniversary.
Wednesday, December 23, 2009
Tuesday, December 8, 2009
The Holding of Breaths
After realizing that my sanity (and marriage) depended on it I've been trying the WMD approach to pain management for my hip. It took about 2 weeks for the prescription strength NSAIDs to build up in my system and I've also brought in the reserves in the form of Flexor patches and Tramadol at night. Essentially, I'm trying to get the inflammation in my right hip down enough to be able to move forward with PT and a gradual return to activity. Over the last 12 days I've noticed a very subtle but significant improvement in my pain levels and function. While we were gone in Steamboat over T-day I did two 45 min-1 hr "walks" in the snow and didn't suffer terribly the next day and since then I've stayed moderately active with some biking, elliptical and even a one hour "hike" up Bear Canyon in the snow on Sunday. I haven't woken up in significant pain in over a week and any pain I have been experiencing has been the kind that I classify as moderately annoying versus all-out distracting.
I had my 5-week follow-up phone appointment with Sampson last week and we went over my op report and findings in greater detail since my memory was pretty hazy after surgery. He said he is not worried about my left but that it "remains to be seen" whether my right will heal or will have to eventually come out. I guess I am glad that he was more honest with me than I had anticipated and didn't just tell me that I would absolutely recover - at least this way I know I won't have such an uphill battle if I decide to "quit" and go metal.
I am incredibly thankful that no matter what this whole experience the second time around has been dramatically better in terms of how soon I've recovered from the surgery. I may have still had quite a bit of pain and I'm sure there is quite a bit more in my future but at 6 weeks I'm doing things that I wouldn't even have contemplated at 12 weeks last time around. I've even been cleared to snowshoe and x-country ski in a few weeks. Maybe the winter won't be so bad and by late February or early March I just might get an easy day out in the backcountry. As much as I miss real skiing like a hole in the heart I do have to admit that the pressure to be in 'tele shape' is so overwhelming every winter that I can put my efforts elsewhere.
I had my 5-week follow-up phone appointment with Sampson last week and we went over my op report and findings in greater detail since my memory was pretty hazy after surgery. He said he is not worried about my left but that it "remains to be seen" whether my right will heal or will have to eventually come out. I guess I am glad that he was more honest with me than I had anticipated and didn't just tell me that I would absolutely recover - at least this way I know I won't have such an uphill battle if I decide to "quit" and go metal.
I am incredibly thankful that no matter what this whole experience the second time around has been dramatically better in terms of how soon I've recovered from the surgery. I may have still had quite a bit of pain and I'm sure there is quite a bit more in my future but at 6 weeks I'm doing things that I wouldn't even have contemplated at 12 weeks last time around. I've even been cleared to snowshoe and x-country ski in a few weeks. Maybe the winter won't be so bad and by late February or early March I just might get an easy day out in the backcountry. As much as I miss real skiing like a hole in the heart I do have to admit that the pressure to be in 'tele shape' is so overwhelming every winter that I can put my efforts elsewhere.
Friday, November 20, 2009
Out Damn Hip, Out
That's kind of how I have been feeling lately about my right hip. I'll start on a positive note though and say my left has been doing well -- a few tweaks here and there, some aching and pinching but little inflammation or pain and it has been only 3 weeks since surgery. Left hip seems to have benefitted from the surgery at least as far as I can tell while the repeat offender is just furious with me for subjecting it to another round.
I know I'm supposed to be kind to myself and my body and support and nourish it through this traumatic event. I have been eating well, limiting my alcohol intake (er, this week at least), taking loads of vitamins and supplements and trying to get enough sleep. But frankly, I can't shake the overwhelming feeling that my right hip is just a rotten body part that has ceased to function properly or even at all. It can no longer be counted on to be the largest weight bearing joint in my body and take care of the rest of the muscles, tendons and ligaments around it - not to mention my knee, ankle and back. I've tried to give it every chance it deserved to stay around but I'm pretty certain its given up the fight. I can really say I've tried everything under the sun to keep this hip of mine -- 2 major surgeries, countless hours of PT, thousands of dollars in injections and experimental treatments and close to two years of rest from most impact activities. And I know that because its only 3 weeks from surgery everyone will say I haven't given it enough time but the truth is its the same old pain I've had since the spring of 2008 and its worse rather than better from all the inflammation that comes with surgery (see attached photo of angry hip). Orthopedic miracles do occasionally happen and I would (and did) put my money on Dr. Sampson any day to make one happen if it was going to happen. But my instinct still says my body will ultimately be better served by a shiny new ball and socket compliments of Smith and Nephew. I will dutifully wait it out another four or six months to see if things improve but my gut is telling me to get this rotten joint out of my body and let the rest of it heal from having spent years compensating for and protecting a busted body part.
As one would imagine, it has been tough to go from being moderately active and in a modest amount of pain pre-op to being completely sedentary and in more pain post-op. But this journey has always been about ups and downs and just believing I would have a better result this time doesn't ultimately change the outcome. It just makes it a bit harder to accept when its all said and done and the immediate fog of recovery starts to clear. Alas, one day this will hopefully be a distant memory and I can classify it as "Amy's hip era - circa 2008-2010" and days will go by in which I do not think of said hip.
Saturday, November 7, 2009
Hipscope Redux California-Style
I returned from San Francisco last Friday, October 30th having had a 7 hour (!) bilateral surgery the day before. Its pretty amazing when you think I could even fly the next day -- compression stockings and all. I'm not saying it was a comfortable trip by any means but I sat in the bulkhead absorbed in some good celebrity rags and the 2 hour flight was over before I had a chance to really even complain about much. My biggest problem after surgery was that I could not lift my legs forward for a few days and this made any kind of step very challenging until I figured out a way to walk up the stairs in my house backwards with crutches for support. I was pretty achy and sore getting in and out of bed, car, etc until about Sunday but the progress has been rapid since that time. More on that in a moment.
Sampson: A World-class Surgeon with a Heart, A Brain, and Courage
No ruby slippers but he did wear over-sized rubber galoshes during surgery. I am thoroughly amazed by Dr. Sampson and his wonderfully competent staff. I knew that I would like and trust him which is why I flew all the way to SF when there is, uh, a certain well-known hip surgeon only 2 hours up the hill in Vail. Everything about my surgery experience with Sampson far exceeded my expectations and I can rest assured that no matter what happens with my hips in the future I was literally in the best hands in the world (at a cost of roughly $4500 an hour I would fucking hope so!). And that's just Sampson's personal fee -- does not include the costs of anesthesia (even Cigna considers this to be a medical necessity), the surgeon's assistant, surgery center fees or the compression stockings which I'm fairly certain you could get at Rite-Aid by purchasing ballet tights fit for a 12-yr old.
Sampson speaks in a gentle, soothing voice and actually asks you questions about yourself and what you do for a living, tells you where to go for sushi in Japantown, etc. He is kind and genuine and doesn't have even a hint of the arrogance typical of a surgeon and certainly one of his caliber. Brian and I met with him on Wednesday afternoon before our surgery and he spent more than an hour with us going over all of my films and scope pics from last winter. He examined me and told me exactly what he planned to do based on what he thought he would find and what he would do if he found something different. He was pretty certain that the large cartilage blister on my acetabulum was causing all of the trouble and was planning to get it to adhere back to the bone either through microfracture or tacking it back to the labrum if it was not too damaged. He did not think Psoas or It band were issues but said he would make sure that neither of these muscle/tendons were involved. His approach is very different from Dr. P's because he does not treat the hip as just a "labral tear and impingement issue". He has various methods for contouring the FAI CAM impingements and performing acetabular rim trimming but he also thinks that just repairing the labrum and removing the impingement is not capable of a one-size fits all approach.
In my case, he emphasized that I did not even really have a "labral tear problem" but rather a cartilage delamination issue of the labralcartilaginous junction caused by cam impingement wear and tear. Just suturing the labrum back together was not going to solve the problem last January nor now. Essentially, the articular cartilage on my acetabulum was starting to separate from the labrum and tear away leaving a big blister and flap and a whole shitload of pain (er, 18 months worth).
Adventures in Japantown
After our two-hour pre-op appointment on Wednesday afternoon we had plenty of time to enjoy a stroll around Japantown and an early dinner at one of approximately 840 sushi restaurants within a 2-mile radius. I didn't sleep all that much the night before surgery but figured that the 3 hours of sleep I got Tuesday night before we left Denver would tie me over at least until they knocked me unconscious on Thursday morning. (Thanks to Frontier who cancelled our flight at 10:30pm the night before forcing us to purchase tickets on United at twice the cost and take a 6am flight out of Denver lest the 1 inch of snow on the ground cause us further delays). I'm sure lots of soy sauce, raw fish and sake are not on the recommended list for pre-surgery dinners but, really, when has that ever stopped me. We opted to walk to surgery at 6:20 the next morning because it was going to be the last walk we took for a while.
The Private School of Operating Rooms
The whole surgical experience was vastly different at the Post Street Surgery Center than my previous surgeries (2/08 and 1/09) at Boulder Medical Center. Being the only patient having surgery that day probably makes a difference in the level of personal attention one receives I suppose. In any event, everyone was exceedingly kind and reassuring as they helped me dress and prep for the OR except maybe the anesthesiologist who started griping about his divorce lawyer about 2 minutes before he gased me.When I awoke a minute and a half later (well 7 hours to be exact) I was in an obscene amount of pain for about an hour till the morphine drip kicked in and the warming blankets helped with the awful bone-chilling cold from lying stark naked for 7 hours in a 45-degree room . Apparently, they keep the OR cold, cold, cold to keep the level of infection down. I guess I feel worse for the nurses and assistants who are just standing by passing a bunch of metal objects to the surgeon for hours on end in an ice-box. Its hard not to focus on how much pain you're in when you are still mostly paralyzed from the anesthesia. I read a piece recently by a well-known anesthesiologist defending his trade who said that major surgery is like getting hit by a truck except that the wounds are neater. In any event, when the nurse said I had been under 7 hours I immediately had that sinking feeling knowing that there was probably alot more damage than we had expected. And there was.
The Damage
Unfortunately, Right Hip is pretty trashed -- it appears that in the 10 months since my last scope the blister had now become a full-on flap which was partially separated from the bone. Sampson couldn't get it to stick back in its place so he cut it out and microfractured the area and used some tissue from the joint capsule to decrease the surface area between the labrum and cartilage hole (decreasing the total area in which I need to re-grow cartilage). Microfracture involves drilling tiny holes into the bone to promote bleeding which then creates "scartilage" to form over the hole. Not what I was looking to hear of course and I was pretty surprised about it because I had felt so much better in the 2 months prior to surgery. My left hip was about a year behind the right hip so we are now calling it Good Hip. There was cartilage damage in that hip too so its comforting to know that my misfortune was not the result of an NFL-sized tackle by my brother at age 11 or too many powder days in the back bowls of Vail but rather good, old-fashioned genetics and back luck. And, needless to say, The Race of 4/17/08 was not the cause of said misfortune, rather, it was only the straw that broke this camel's back.
Sampson, ever positive and a true believer in Joint Preservation Surgery, hopes that I will grow back the cartilage within 2 years and that I could possibly avoid a hip replacement in the future. I know he truly believes in what he does and that is admirable on many levels. I'm fairly certain based on statistics however that I will be replacing my faulty hip joints with balls of steel at some point. Hopefully this surgery bought me a bit more time than I would have had without it though. And in that regard I have to say that I am extremely pleased with the progress I have made so far due exclusively to Sampson's refined surgical techniques and expertise in minimizing the time the hip is in traction . I am already walking around without crutches, driving, doing light housework and not being forced to spend hours a day in that awful CPM machine. Being weight-bearing immediately is a Sampson trademark and I think it has already made an enormous difference in restoring function and strength to my hips as well boosting my mental state which is undoubtedly shakey. Most surgeons require 6-8 weeks on crutches after microfracture in order to allow the cartilage to regrow but Sampson believes it does not make any difference and the bigger issue is mobilizing the joint early through walking and biking and keeping the muscles from atrophying.
Ad Nauseum
Yes, its absolutely astonishing and maddening and crazy-making that I have been dealing with this for more than a year and a half and there is still no clear way out of pain and back to (most of) the activities I love. I am still trying to wrap my head around the fact that I have suffered such an enormous misfortune as to be looking into hip replacement options in my 30s when my 68-yr old dad is playing tennis 5 times a week. I realize in the scheme of medical misfortunes this is not life-threatening but as I have said it is life-altering and that is worthy enough of some self-indulgent blogging. Did I ever think 2 years ago as I enjoyed 3 days in a row of tele turns at Beaver Creek and Breckenridge over Christmas that I would be ready to sell my quiver back to Neptunes knowing that all of my skis - phat and skinny -- will be outdated by the time I can really ski again? More importantly, did I ever think that I would be paying someone $20 an hour to walk my two dogs on a weekly basis because I can never anticipate when I'll be feeling ok enough to do it myself?
Kind of makes you wonder what the hell life has in store for you, doesn't it.
Tuesday, October 20, 2009
T Minus 9 days
Good grief. How is it that it is already the week before the date of my bilateral surgery? I've been lame again about keeping up with the blog and sadly I have no excuse because I have actually been doing alot better and not suffering in chronic pain nearly as much as I was this summer. I've almost wondered whether I should really go through with this surgery...ALMOST. But every time I think maybe I should just wait it out and give it more time I am reminded that nearly 10 months after surgery I am still sore from doing very basic things and have trouble hiking/walking more than 1 hour at a time.
I'm running short on time at the moment because I need to get some work finished or should I say started before I leave here today...but I am going to do a big update about our trip to Montana, the stem cell experience and some of the things I have been able to do since late August. And then of course beginning around 36 hours after surgery when the anesthesia starts to wear off I will be posting on a regular basis because I will be bored out of my gourd.
I'm running short on time at the moment because I need to get some work finished or should I say started before I leave here today...but I am going to do a big update about our trip to Montana, the stem cell experience and some of the things I have been able to do since late August. And then of course beginning around 36 hours after surgery when the anesthesia starts to wear off I will be posting on a regular basis because I will be bored out of my gourd.
Monday, July 27, 2009
The (same ol') waiting game
I'm close to the three weeks out from my first stem-cell injection but I've yet to notice any measurable improvement or change. This is not to say that I have been doing terribly all this time but rather I just haven't had any marked change in pain levels commensurate with an increased activity level. Things are still day by day, week by week. Last weekend I decided to really 'push it' and see what my hip was capable of in terms of weight-bearing activity and got my answer relatively quickly. On our girls' camping weekend in the Mt Massive/Elbert Peak wilderness we did a big day hike up that climbed into a high glacial cirque with three isolated alpine lakes and loads of wildflowers. The hike was probably around 8 miles and had a good bit of elevation gain (maybe 2000 ft?). My hip/groin really started to ache just before we got to the lake for lunch and I decided it would be a wise decision to turn back considering I still had at least 4 miles of down-hill hiking to go. The way down was pretty rough even with my hiking poles (dork) and by the last two miles my groin was really aching with every step. It bummed me out to feel that nagging pain but I have to qualify that by saying I didn't know I could even hike 8 miles, even painful ones. I was really sore the rest of the evening and the next day but by Monday things were pretty improved which is a good sign. The problem just seems to be - consistently - that there is little to no consistency in terms of what my hip can handle, when it feels like behaving and when it decides to hurt for no apparent reason. Yesterday, I walked approximately a mile from the parking lot in Lyons to the Rockyrgass festival and my groin was really aggravating me. That is the kind of thing that I just feel like has to change at some point, especially if I want to have kids in the next few years.
I finally got a call from Dr. P's office to say that they had reviewed my films and that Dr. P "believes I could possibly benefit from a revision arthroscopy". When pressed to give me details his assistant told me that she had none to give and that one of his fellows would likely call within the next few days to explain the basis of his recommendation. Not surprisingly, I've received no call except for a fax with a registration form to sign up for surgery. Not surprisingly, I have no intention of signing up for surgery if I don't have a very good idea of (a) what he intends to fix and how; and (b) what my chances for additional improvement are given the state of my cartilage damage.
So, that leaves me in my current situation which has pretty much been my current situation since March. I will wait it out through September and see how the injections go, get two more opinions from Dr. Rector in Boulder and Dr. DeSmet in Belgium who perform hip resurfacing to see if they believe I am a candidate and whether an additional joint preserving surgery (i.e, hip scope) is unlikely to lead to any real improvement. I figure if I have two opinions from the top hip scope surgeons and two from a local hip resurfacing surgeon and the world's expert that I should be able to make a relatively informed decision about my next course of action. Good grief I don't want to go through another surgery - it really gives me nightmares. But I don't want to be this limited by my hip more than six months after surgery and I don't want to continue living in a way that makes planning more than a week in advance difficult. I realize that there are alot of people who have this limitation with far more serious diseases than a prematurely arthritic hip but this is me and what I am dealing with and I have to do whatever I can to at least try to change the situation for the better.
I'm including this picture of Elliot because it always makes me smile. Every day, without fail, when I pull into the drive-way he comes bounding out of the doggie door and climbs up on the fence to greet me. That's the thing about dogs that everyone who owns one understands -- no matter how shitty your day was you can't turn your back on a wagging labrador retriever who is just as estatic to see you today as he was yesterday and the day before that.
Thursday, July 16, 2009
Stem Cells, Dogs down the River and Wildflowers
As the title suggests alot has been going on lately in our lives. I have had a good three weeks and lest I ever say anything to jinx myself, I'll qualify that with the general trend has been up. We headed to Crested Butte for the 4th of July and were thrilled that my hip cooperated enough to ride 22 miles (!!) on our mountain bikes from the ski area through Gothic and up to Schofield Pass. This was not a technical ride but certainly a huge amount of elevation gain as we topped out around 12,000ft. We rode through amazing high alpine fields of wildflowers - indian paint brush, columbine, larkspur, bluebells and aster. It had stormed hard earlier in the day and we began our ride just as the sun was coming out and the land was dewy and sparkling. I cannot describe the exhiliration I felt as I sweat, grinded up hill and pushed my legs and lungs harder than they had been pushed since last fall. For the first time in months, Brian and I both agreed that we had actually earned our beers and even a double gin and tonic which had me stumbling by the time the fireworks came on. I was expecting to be pretty sore the next day from the big ride but was pleased that I was only slightly sore and was even able to ride another 12 miles up Washington Gulch until we got caught in an early t-storm and had to pack up to return home to Boulder.
This past weekend we had another adventure with our boat. We took our friends Steve and Meredith and both dogs down the 15-mile stretch of the Colorado River between Pumphouse (near Kremmling) and State Bridge. Not a particularly challenging run but I was able to paddle a few Class IIs and Elliot decided that he really likes riding in the raft (Phoebe not so much). He was perched atop the dry-box in his red pfd and had the time of his life watching birds, wagging at Steve in his kayak and barking at dogs in other boats. We camped on an island about half way down the run and had a "family nap" in the tent during a brief evening storm before a tasty dinner of pork fajitas and strawberry daiquiris.
As for the stem cells, I will likely devote a lot more of this blog to a discussion of the stem cell procedure I am under-taking this summer but I'll briefly summarize for now. I've decided to undergo a series of three injections of my own mesenchymal stem cells into my hip joint in attempt to re-grow some of the damaged cartilage that is causing the bulk of the on-going issues with my hip. I am working with a physiatrist based out of Broomfield who is running a regenerative medicine clinic which is one of only a handful in the country. The procedure isn't even FDA approved yet and there is actually alot more controversy about that but I'll save that for another post. In terms of risk, as I see it, I'm risking just as much each time I subject myself to another traumatizing surgery which ends up costing thousands in physical therapy and rehabilitation not to mention the emotional costs of being laid up for so long. The actual risks are small because they are injecting my own stem cells which they cultured for two weeks in a labratory after the initial bone marrow draw in June. I'm one week out from my first injection and can't say I really notice anything yet BUT that would be highly unlikely anyhow and I've also been feeling alot better in general.
Fingers crossed for this weekend as I head out with the ladies for a camping trip in the Mount Massive/Elbert Peak area west of Leadville. I'm going to go for the big hike on Saturday and see whether my hip behaves. If it doesn't, I'll be ok with that because I've been so fortunate to just be able to MOVE so much in the last few weeks. (Last night Brian and I rode our mountain bikes on the Dowdy Draw trails for 2 + hours and I'm not even sore today!). As always, I am trying to be grateful for what I do have and not focus on what I still cannot do .
This past weekend we had another adventure with our boat. We took our friends Steve and Meredith and both dogs down the 15-mile stretch of the Colorado River between Pumphouse (near Kremmling) and State Bridge. Not a particularly challenging run but I was able to paddle a few Class IIs and Elliot decided that he really likes riding in the raft (Phoebe not so much). He was perched atop the dry-box in his red pfd and had the time of his life watching birds, wagging at Steve in his kayak and barking at dogs in other boats. We camped on an island about half way down the run and had a "family nap" in the tent during a brief evening storm before a tasty dinner of pork fajitas and strawberry daiquiris.
As for the stem cells, I will likely devote a lot more of this blog to a discussion of the stem cell procedure I am under-taking this summer but I'll briefly summarize for now. I've decided to undergo a series of three injections of my own mesenchymal stem cells into my hip joint in attempt to re-grow some of the damaged cartilage that is causing the bulk of the on-going issues with my hip. I am working with a physiatrist based out of Broomfield who is running a regenerative medicine clinic which is one of only a handful in the country. The procedure isn't even FDA approved yet and there is actually alot more controversy about that but I'll save that for another post. In terms of risk, as I see it, I'm risking just as much each time I subject myself to another traumatizing surgery which ends up costing thousands in physical therapy and rehabilitation not to mention the emotional costs of being laid up for so long. The actual risks are small because they are injecting my own stem cells which they cultured for two weeks in a labratory after the initial bone marrow draw in June. I'm one week out from my first injection and can't say I really notice anything yet BUT that would be highly unlikely anyhow and I've also been feeling alot better in general.
Fingers crossed for this weekend as I head out with the ladies for a camping trip in the Mount Massive/Elbert Peak area west of Leadville. I'm going to go for the big hike on Saturday and see whether my hip behaves. If it doesn't, I'll be ok with that because I've been so fortunate to just be able to MOVE so much in the last few weeks. (Last night Brian and I rode our mountain bikes on the Dowdy Draw trails for 2 + hours and I'm not even sore today!). As always, I am trying to be grateful for what I do have and not focus on what I still cannot do .
Sunday, June 28, 2009
R is for Regression
And Ridiculous!!! I always seem to speak too soon and then eat my words. I don't know what happened but I have been having intermittent groin pain over the last few weeks and I was trying to use jedi mind tricks to will it to go away to no avail. Hip pain, as much as it is intolerable, is somehow better than groin pain which generally hurts with every step as you move your leg forward. Fun stuff. I was in denial about it for a while and convinced myself it was just a tight psoas reacting to all the new activity but I'm really all too familiar with joint pain at this point to stay in denial for very long. I saw Dr. Seng on Friday and he was pretty certain it was referred pain from the cartilage delamination which leaves me thinking holy shit I'm really going to have to start thinking seriously about hip resurfacing in my 30s. Not at all the direction I was hoping to go but at this point I'm so fed up with my hip I'd glady get a new one if it meant I could be out of pain and get my life back even 80%.
The last week it has been the usual rollercoaster of being able to do a decent 1hr hike in Telluride last weekend at Bluegrass Fest to being reduced to laying low most of this weekend and icing my hip. I swam a few times this week so I am grateful for that but overall it was a pretty marginal showing by my hip. Today and yesterday I felt downright shitty but had some good time with friends and enjoyed the first real weekend of summer around here. At least the dogs are happy as it meant that I took them to the pond to swim no less than 4 times since Friday because I couldn't walk far enough for any meaningful dog exercise. Brian is gone for 4 days on a dude trip on the Gunnison River which means I'm a single dog parent but its always nice to have a little quiet time especially this time of year when its light so late. It is is pretty disheartening thinking about how it was this same weekend last year when Brian was gone on the same dude trip (Rio Grande) and I was hobbling around all weekend on my newly-injured hip. If there is anything positive to see in that sad fact I guess it is that at least I now have a diagnosis. I've said this before but I won't let another year go by without some major improvement. Here's to next June...
The last week it has been the usual rollercoaster of being able to do a decent 1hr hike in Telluride last weekend at Bluegrass Fest to being reduced to laying low most of this weekend and icing my hip. I swam a few times this week so I am grateful for that but overall it was a pretty marginal showing by my hip. Today and yesterday I felt downright shitty but had some good time with friends and enjoyed the first real weekend of summer around here. At least the dogs are happy as it meant that I took them to the pond to swim no less than 4 times since Friday because I couldn't walk far enough for any meaningful dog exercise. Brian is gone for 4 days on a dude trip on the Gunnison River which means I'm a single dog parent but its always nice to have a little quiet time especially this time of year when its light so late. It is is pretty disheartening thinking about how it was this same weekend last year when Brian was gone on the same dude trip (Rio Grande) and I was hobbling around all weekend on my newly-injured hip. If there is anything positive to see in that sad fact I guess it is that at least I now have a diagnosis. I've said this before but I won't let another year go by without some major improvement. Here's to next June...
Friday, June 26, 2009
Nearly 5 months later to the day...
I have intended to re-start this blog for a long time and am finally feeling like I'm in a space to derive some meaning from everything that has happened. Part of why I stopped was because it was so painful to even put down in writing what I have gone through in the last 5 months. To write it all down somehow makes it more real and I've gone through so many emotions that were too powerful to even try to articulate. I resisted blogging about the complications of my hip scope because it hurt too much to even acknowledge it to myself, as if somewhere I was/am accountable and responsible. But this is my life right now and trying to stay in the present is the only real way to perserve. I am going to get through this and come out on the other end a stronger, more resilient person.
This blog really isn't just about my hip. Its about my own unique experience with a serious and debilitating injury that has lasted far, far longer than I could have ever imagined and how I can learn to best cope in the face of such an adversity. I have wondered countless times whether I will ever really be able to walk again without pain and to take part in some of the activities that make me feel whole like hiking, ski touring in the backcountry and possibly even trail running. I've learned to accept, though, that my body will never be the same again.
To summarize as briefly as possible, beginning at around 7 weeks post-op it became very apparent that I was still having even more pain than before surgery. My hip would flare up for no apparent reason and it hurt to walk much of the time. Both of my PTs were concerned and urged me to go see my OS again before my 12 week check-up. After nearly a week of horrid aching pain during which time I mostly lay on the couch, I went to see Dr. S who did a full exam and concluded that the joint was extremely inflamed but that I had not re-torn my labrum or anything that would require additional surgery. He ordered me on a full month of home rest and advised me to do nothing but rest -- no walking, no PT, no stationary bike -- nothing. Just working from home and resting on the couch to try and get some of the inflammation to go down.
March and April of this year were possibly the hardest months of my life. I was in the most excruciating chronic pain that I could not even imagine someone could live this way for very long. I probably sound overly dramatic but I think my family, some close friends and certainly my husband and dogs know the extent of my pain. For those who have been spared the misery of joint pain, it is an awful, seering, deep ache which you cannot get away from and it often follows you through the night. I was on a high dosage of NSAIDs in addition to pain meds and I was still at a Level 7 pain much of the time. I would lie on the crouch in tears trying to concentrate on my work but doing a poor job of much besides feeling sorry for myself and crying to my mom on the phone. The link between chronic pain and depression is well-documented and in every way the two went/go hand in hand for me. The physical pain and feelings of hopelessness lead to depression and on a neuro-muscular level the depression makes the pain worse. The few times I tried to walk the dogs around the neighborhood I would hobble back to the house and spend the rest of the afternoon icing my hip. I was in a pretty bleak state and even dinners with friends, pedicures and saunas didn't do much to brighten my mood. Sometimes I felt like I was being punished -- for what I don't know -- that is a glimpse of the darkness of my state of mind during that time. Thank goodness for my dear accupuncturist who made changes in her schedule to fit me in even on a few sundays because accupuncture was the one single thing that would help with the pain...that and the few dozen bottles of wine I plowed through during that month...but that really isn't so funny.
After living this out for a month as ordered, we went back to Dr. S and all concluded that I needed a follow-up MRI. The MRI showed that the ligamentum teres (the ligament that connects the joint capsule to the femoral head) was completely ruptured. Somehow it was only partially repaired during surgery. Dr. S was not sure this was really the cause of my pain because it is largely believed to be a vestigial ligament we do not need after childhood. He kindly offered to get a 2nd opinion from the world's leading hip surgeon, Dr. Mark Phillipon, at Steadman Hawkins in Vail (and whose review I am still waiting for by the way!). The month of rest had reduced the pain down to a dull roar and I was ready to go back to work and to have the distraction of my job, my commute, my friends at work. We also agreed that I would try a PRP injection into the hip in the hope of stimulating some healing despite that these injections are still largely experimental.
Fast forward to May 15th when Dr. N (a radiologist at BCH specializing in muscular/skeletal imaging) spent over an hour with me looking at my hip via ultrasound and determining where to put the injection. I had already gone to Dr. N earlier in the spring for a PRP injection into my dreadful lateral epicondyle (IT band) which had been bothering me for more than a year due to the altered biomechanics of my hip. This time he injected the rectus femoris tendon (high quad)which is often injured during arthroscopy as well as the labrum itself. PRPs, by the way, are platelet rich plasma -- they take my blood, spin it in a centrifuge to extract the platelets and re-inject them into the injured site to trigger the body's natural inflammatory response to heal the injury. These have been used for years in the OR for abdominal wounds and such but only recently for ligament/tendon/joint injuries. Dr. N asked me whether I was a health care practitioner because I was so full of information and statistics. He also said I had one of the highest pain thresholds he had seen in a long time as he drove the 5-inch needle into my hip. Not so sure I want to be in that club but I appreciate the vote of confidence.
AMAZING stuff these PRPs. Within 10 days I was dramatically better. I could not believe it and I was thrilled to head off on our 5-day river trip down with 16 of good friends in a far better place than I had been in months. I was able to start swimming again which felt great on the joint and I even did a few hikes during the river trip with NO PAIN. Bumping all day through the rapids and getting in and out of the boat lifting heavy stuff - no problem. I laughed really hard and smiled alot on our trip - things I had not done in far too long. I had been nervous about the river trip for months as I pictured myself cramped in a raft in cold water with my hip nagging me all day but I was estatic with how well it all went. When I returned I felt relaxed and happy for the first time in months.
Where I am at today: The PRP has definitely helped tremendously but I'm still very up and down. I had some 'glory days' in which Brian and I were able to ride our bikes for over an hour during the lovely June twilight out and around El Dorado Springs and Sunshine Canyon. I'm still swimming 3-4 times per week and I've been really careful to work very gradually back up to my normal 3000 meter distance so as not to over-do it as is my tendency. I'm back to Dog Walk Wednesdays with my dear pals and our troop of 5 dogs and I have made around the little Shanahan loop at least 5 times. Just being able to be back out in my 'backyard' again as the wildflowers are blooming has done more for my head than any medication ever could. On a lot of days I still have a fair amount of pain -- some days its even hovered around a 5 and I've had to lay low and stay off my hip. But at least I'm active and able to get out of the house and enjoy some of the summer some of the time.
To end this first super-sized blog entry (they won't all be this long I promise) I thought I'd include some humor. Operating under complete and utter delusion after feeling good for about 5 days, I agreed to sign up for Bike to Work day with the crew biking in 35 miles from Boulder to our office. Predictably, my hip told me to fuck off the next day for even thinking such a thing. Yeah, that wasn't going to happen. That would be exactly the kind of pavlovian response that I need to re-condition.
This blog really isn't just about my hip. Its about my own unique experience with a serious and debilitating injury that has lasted far, far longer than I could have ever imagined and how I can learn to best cope in the face of such an adversity. I have wondered countless times whether I will ever really be able to walk again without pain and to take part in some of the activities that make me feel whole like hiking, ski touring in the backcountry and possibly even trail running. I've learned to accept, though, that my body will never be the same again.
To summarize as briefly as possible, beginning at around 7 weeks post-op it became very apparent that I was still having even more pain than before surgery. My hip would flare up for no apparent reason and it hurt to walk much of the time. Both of my PTs were concerned and urged me to go see my OS again before my 12 week check-up. After nearly a week of horrid aching pain during which time I mostly lay on the couch, I went to see Dr. S who did a full exam and concluded that the joint was extremely inflamed but that I had not re-torn my labrum or anything that would require additional surgery. He ordered me on a full month of home rest and advised me to do nothing but rest -- no walking, no PT, no stationary bike -- nothing. Just working from home and resting on the couch to try and get some of the inflammation to go down.
March and April of this year were possibly the hardest months of my life. I was in the most excruciating chronic pain that I could not even imagine someone could live this way for very long. I probably sound overly dramatic but I think my family, some close friends and certainly my husband and dogs know the extent of my pain. For those who have been spared the misery of joint pain, it is an awful, seering, deep ache which you cannot get away from and it often follows you through the night. I was on a high dosage of NSAIDs in addition to pain meds and I was still at a Level 7 pain much of the time. I would lie on the crouch in tears trying to concentrate on my work but doing a poor job of much besides feeling sorry for myself and crying to my mom on the phone. The link between chronic pain and depression is well-documented and in every way the two went/go hand in hand for me. The physical pain and feelings of hopelessness lead to depression and on a neuro-muscular level the depression makes the pain worse. The few times I tried to walk the dogs around the neighborhood I would hobble back to the house and spend the rest of the afternoon icing my hip. I was in a pretty bleak state and even dinners with friends, pedicures and saunas didn't do much to brighten my mood. Sometimes I felt like I was being punished -- for what I don't know -- that is a glimpse of the darkness of my state of mind during that time. Thank goodness for my dear accupuncturist who made changes in her schedule to fit me in even on a few sundays because accupuncture was the one single thing that would help with the pain...that and the few dozen bottles of wine I plowed through during that month...but that really isn't so funny.
After living this out for a month as ordered, we went back to Dr. S and all concluded that I needed a follow-up MRI. The MRI showed that the ligamentum teres (the ligament that connects the joint capsule to the femoral head) was completely ruptured. Somehow it was only partially repaired during surgery. Dr. S was not sure this was really the cause of my pain because it is largely believed to be a vestigial ligament we do not need after childhood. He kindly offered to get a 2nd opinion from the world's leading hip surgeon, Dr. Mark Phillipon, at Steadman Hawkins in Vail (and whose review I am still waiting for by the way!). The month of rest had reduced the pain down to a dull roar and I was ready to go back to work and to have the distraction of my job, my commute, my friends at work. We also agreed that I would try a PRP injection into the hip in the hope of stimulating some healing despite that these injections are still largely experimental.
Fast forward to May 15th when Dr. N (a radiologist at BCH specializing in muscular/skeletal imaging) spent over an hour with me looking at my hip via ultrasound and determining where to put the injection. I had already gone to Dr. N earlier in the spring for a PRP injection into my dreadful lateral epicondyle (IT band) which had been bothering me for more than a year due to the altered biomechanics of my hip. This time he injected the rectus femoris tendon (high quad)which is often injured during arthroscopy as well as the labrum itself. PRPs, by the way, are platelet rich plasma -- they take my blood, spin it in a centrifuge to extract the platelets and re-inject them into the injured site to trigger the body's natural inflammatory response to heal the injury. These have been used for years in the OR for abdominal wounds and such but only recently for ligament/tendon/joint injuries. Dr. N asked me whether I was a health care practitioner because I was so full of information and statistics. He also said I had one of the highest pain thresholds he had seen in a long time as he drove the 5-inch needle into my hip. Not so sure I want to be in that club but I appreciate the vote of confidence.
AMAZING stuff these PRPs. Within 10 days I was dramatically better. I could not believe it and I was thrilled to head off on our 5-day river trip down with 16 of good friends in a far better place than I had been in months. I was able to start swimming again which felt great on the joint and I even did a few hikes during the river trip with NO PAIN. Bumping all day through the rapids and getting in and out of the boat lifting heavy stuff - no problem. I laughed really hard and smiled alot on our trip - things I had not done in far too long. I had been nervous about the river trip for months as I pictured myself cramped in a raft in cold water with my hip nagging me all day but I was estatic with how well it all went. When I returned I felt relaxed and happy for the first time in months.
Where I am at today: The PRP has definitely helped tremendously but I'm still very up and down. I had some 'glory days' in which Brian and I were able to ride our bikes for over an hour during the lovely June twilight out and around El Dorado Springs and Sunshine Canyon. I'm still swimming 3-4 times per week and I've been really careful to work very gradually back up to my normal 3000 meter distance so as not to over-do it as is my tendency. I'm back to Dog Walk Wednesdays with my dear pals and our troop of 5 dogs and I have made around the little Shanahan loop at least 5 times. Just being able to be back out in my 'backyard' again as the wildflowers are blooming has done more for my head than any medication ever could. On a lot of days I still have a fair amount of pain -- some days its even hovered around a 5 and I've had to lay low and stay off my hip. But at least I'm active and able to get out of the house and enjoy some of the summer some of the time.
To end this first super-sized blog entry (they won't all be this long I promise) I thought I'd include some humor. Operating under complete and utter delusion after feeling good for about 5 days, I agreed to sign up for Bike to Work day with the crew biking in 35 miles from Boulder to our office. Predictably, my hip told me to fuck off the next day for even thinking such a thing. Yeah, that wasn't going to happen. That would be exactly the kind of pavlovian response that I need to re-condition.
Tuesday, February 24, 2009
Feets on the Ground
I guess I've been pretty lazy about keeping up this blog lately mostly because I was having so many ups and downs that things changed daily, er, hourly and I didn't really feel like charting my emotions lest I reveal the true state of my lunacy in cyberspace. Anyway, I'm almost 5 weeks post-op. Its almost tougher these days than when I was confined to the bed or couch and CPM machine because now I get more of glimpse of what I'm missing outside the asylum. I've had stretches of 3 or 4 days where I barely touched a bag of ice or Flexor patch and consequently felt pretty encouraged. I've also had some down-right rotten days where the pain was overwhelming and worse than before surgery and I had to fight back the tears while sitting cramped on the bus back to Boulder in the evenings. I've been pretty religious with my PT -- I've done 2 "sessions" per day on most days with the occasional slacking on the second session because I was sore or exhausted and felt that sleep was equally as important as hamstring curls and single leg raises.
I weaned myself off the crutches very gradually -- 3 weeks at 2, then 1 week at 1 and another 4 or 5 days with 1 as needed in the evenings. My gait is totally off -- I tend to lean over the "involved" hip to protect it and it feels like I cannot really straighten my back all the way. I look like I'm constipated or someone just took a 2x4 to my spine. I'm hoping this gradually changes in another week or I am going to worry for real. I see Dr. S on Friday and I have a laundry list of questions to bug him about (lateral hip pain and tightness? knee is really pissed off? can I get a platelet injection for my IT band? what can I expect in the way of pain level at 3 mos.?).
I've also been gradually working my way up on the bike and am excited to report that I broke a sweat today -- mind you, I intentionally wore insulated running pants and a long-sleeve shirt to the gym so that I would sweat but it was a sweat all the same and I think I may have even gotten my heart rate elevated for a few minutes. Now I'm a little achy and stingy but who knows if this is the dog walk around Shanahan Ridge that took place after the bike, my glute muscles still sore from this morning's dry needling session with Sue (ouch!) or any other dozen or so things that can set my hip off into a red and angry state.
Sue, the PT who I see for trigger point dry-needling at Boulder Center for Sports Med said I have one of the highest thresholds for pain from the needles that she has ever seen. Could that possibly be that I have been in pain for so freaking long now that its really all very relative?? I swear, those needles hurt like a bitch going into the muscle but it does seem to work and I can definitely tell it gets the glute medius and multifidus (sp?) firing again so my IT band isn't doing all the work. I feel like I've been SPANKED hard for a day or two after the butt needling but the muscles surrounding the joint that have been at Threat Level Orange for the last month are able to get a break for a few days. In case you were wondering, I have no formal scientific training past college biology but this whole injury has made me, necessarily, wholly familiar with anatomy, physiology and a host of other sub-disciplines I never would have any reason to know or care much about in a previous life.
I weaned myself off the crutches very gradually -- 3 weeks at 2, then 1 week at 1 and another 4 or 5 days with 1 as needed in the evenings. My gait is totally off -- I tend to lean over the "involved" hip to protect it and it feels like I cannot really straighten my back all the way. I look like I'm constipated or someone just took a 2x4 to my spine. I'm hoping this gradually changes in another week or I am going to worry for real. I see Dr. S on Friday and I have a laundry list of questions to bug him about (lateral hip pain and tightness? knee is really pissed off? can I get a platelet injection for my IT band? what can I expect in the way of pain level at 3 mos.?).
I've also been gradually working my way up on the bike and am excited to report that I broke a sweat today -- mind you, I intentionally wore insulated running pants and a long-sleeve shirt to the gym so that I would sweat but it was a sweat all the same and I think I may have even gotten my heart rate elevated for a few minutes. Now I'm a little achy and stingy but who knows if this is the dog walk around Shanahan Ridge that took place after the bike, my glute muscles still sore from this morning's dry needling session with Sue (ouch!) or any other dozen or so things that can set my hip off into a red and angry state.
Sue, the PT who I see for trigger point dry-needling at Boulder Center for Sports Med said I have one of the highest thresholds for pain from the needles that she has ever seen. Could that possibly be that I have been in pain for so freaking long now that its really all very relative?? I swear, those needles hurt like a bitch going into the muscle but it does seem to work and I can definitely tell it gets the glute medius and multifidus (sp?) firing again so my IT band isn't doing all the work. I feel like I've been SPANKED hard for a day or two after the butt needling but the muscles surrounding the joint that have been at Threat Level Orange for the last month are able to get a break for a few days. In case you were wondering, I have no formal scientific training past college biology but this whole injury has made me, necessarily, wholly familiar with anatomy, physiology and a host of other sub-disciplines I never would have any reason to know or care much about in a previous life.
Friday, February 6, 2009
A Little More Myself
I hit my two week mark yesterday and am looking forward to all of the exciting new exercises I will get in the coming weeks. At the moment I am doing isometric, closed-chain glute and quad tightening, some ankle stuff and a little bit of hamstring work. I asked my PT what I have to look forward to and he said I will be able to *gradually* add some resistance back to the bike starting in another week...woo-hoo. According to our modified version of the Phillipon (Vail hip doc) protocol, I'll be cycling and swimming by week 10...but who's counting, not me of course.
The pain level has been manageable lately although I'm still pretty beat by the end of the day. The gimp sticks are getting really old and I find myself cheating around the house when I walk to the kitchen or bathroom or whatever. Not being able to bend over and lift things is proving immensely challenging when you're trying to care for three (3) dogs and your husband left you to go skiing in Utah for the weekend. I don't know where I'd be without so many helpful friends and neighbors. I constantly worry that I've re-torn my labrum and the other day I heard an awful "clunk" much like the clunking I've heard when I lift my knee up to my chest since about August. I've been told its pretty hard to re-tear the labrum now that the bony impingement on my femur is gone but its always essential to have something to obsess over when you're living in my head.
I've been back at work this week for part time. The first day was pretty rough as I realized the distance to crutch to the bathroom, water cooler, kitchen etc. was like crutching across the dog park but I'm doing a little better now on Day 3. Everyone who asks me about what I had done generally has the same story to tell about their grandmother, uncle, etc. who had a hip replacement...did I mention that that gets old too? Ah, well, I can't blame peoples' lack of knowledge about sports injuries seeing as it took me eight effing months to diagnose this one.
Thank goodness for red wine, vodka tonics and Entourage. I'm generally never too incapacitated to enjoy a pre-dinner cocktail or wash down some IB-profun with a few glasses of Shiraz. If that changes, there is definite cause for concern.
The pain level has been manageable lately although I'm still pretty beat by the end of the day. The gimp sticks are getting really old and I find myself cheating around the house when I walk to the kitchen or bathroom or whatever. Not being able to bend over and lift things is proving immensely challenging when you're trying to care for three (3) dogs and your husband left you to go skiing in Utah for the weekend. I don't know where I'd be without so many helpful friends and neighbors. I constantly worry that I've re-torn my labrum and the other day I heard an awful "clunk" much like the clunking I've heard when I lift my knee up to my chest since about August. I've been told its pretty hard to re-tear the labrum now that the bony impingement on my femur is gone but its always essential to have something to obsess over when you're living in my head.
I've been back at work this week for part time. The first day was pretty rough as I realized the distance to crutch to the bathroom, water cooler, kitchen etc. was like crutching across the dog park but I'm doing a little better now on Day 3. Everyone who asks me about what I had done generally has the same story to tell about their grandmother, uncle, etc. who had a hip replacement...did I mention that that gets old too? Ah, well, I can't blame peoples' lack of knowledge about sports injuries seeing as it took me eight effing months to diagnose this one.
Thank goodness for red wine, vodka tonics and Entourage. I'm generally never too incapacitated to enjoy a pre-dinner cocktail or wash down some IB-profun with a few glasses of Shiraz. If that changes, there is definite cause for concern.
Tuesday, January 27, 2009
Spinning Post-op
A quick update. I rode the bike for about 8 minutes last night and another 15 tonite. Getting on the bike proved to be much harder than actually riding it. I had to sort of mount it from behind so as not to put any weight on my right foot and I couldn't lift my leg too high or I would get that horrid stabbing groin pain compliments of the labrum in its newly anchored state. Because I've never had any kind of orthopedic surgery before I wouldn't know this but I can't believe how weak I felt afterwards and how hard it is just to pedal on no resistance for 15 minutes. I mean I know they tell you your muscles are going to be weak but I just couldn't really conceive how weak. I practically had to fall back on the couch with my ice pack afterwards. Its particularly strange when I look at the two tiny incision sites where they stuck the probes and camera in and I can't believe how sore I am. I know "gimp" isn't the most politically correct term but laying in a a machine for 6 hours a day and showering on one leg kind of diminishes my aspirations for political correctness.
In related news, I have been to PT two days in a row and Bob was very pleased with my ROM (range of motion) and told me I was much better off than others a week out of surgery. I can already tell this journey is going to be about finding small victories in every day experiences. Since I won't actually be able to exercise for fitness (as opposed to rehab) for probably close to another month, and even then its going to be very limited, being diligent about The Protocol will be the best possible means for preserving some semblance of sanity.
In related news, I have been to PT two days in a row and Bob was very pleased with my ROM (range of motion) and told me I was much better off than others a week out of surgery. I can already tell this journey is going to be about finding small victories in every day experiences. Since I won't actually be able to exercise for fitness (as opposed to rehab) for probably close to another month, and even then its going to be very limited, being diligent about The Protocol will be the best possible means for preserving some semblance of sanity.
Monday, January 26, 2009
Post -Op Day 4
Surgery was on Thursday, January 22, 2009. I have been too hopped up on painkillers and too sleepy to make a very worthy blog entry since arriving home from the hospital on Thursday evening. Now that I'm slowly kicking the painkillers, I noticed that I have some time to kill to put it mildly.
The days leading up to surgery were stressful and way busier than I had hoped but I really don't know who I was kidding thinking otherwise. We had a house to re-arrange, groceries to buy, clothes to wash, cars to clean, etc. on top of trying to get ready to be out of the office for 3 weeks. It reminded me of the days before the bar exam in 2003 -- I had hoped to be all zen and calm and relaxed but instead I was up till the wee hours the night before getting things ready and racing around the house making my hip sore (I got 2 hours of sleep the night before the CO bar exam and still passed...I got a little more than that for this surgery but I'm not sure it made much of a difference in terms of results). The morning of surgery the girl from the ortho equipment company came to show me how to use the ice and CPM machines...the dogs were barking and chasing eachother around the house, Brian was upstairs vaccuming and I was still dripping from the shower...it was the usual pandemonium. Not suprisingly, I didn't really remember what I was supposed to do with the machines when I got home 12 hours later in a narcotic haze.
Surgery was scheduled for 12pm but they were running behind so it was really a little before 1 when they finally wheeled me into the OR. Brian was a trooper and hung out with me in the pre- surgery room for more than two hours. Surgery prep involved all the usual things -- blood pressure, lots of questions about what allergies and medications, an IV, etc. and then they also rinsed my hip with iodine and stuffed me into some compression stockings to help prevent blod clots. I felt like some kind of creepy hospital clown with white thigh-high leggings, a faux-bronzed ass and a blue shower cap on my head. Dr. Seng came in twice and chatted with us and went over the procedure again. He told us the labral repair and osteoplasty were the easy parts -- it was making a determination about the cartilage damage that would be tougher. If it was "all cobblestone-y" he would probably have to debride some of it because it wouldn't be worth salvaging. Unfortunately, as we found out later, there was some of that cobblestone shit in there. I told him I was lucky to have gotten out once last week on tele skis and he said not to worry it probably wouldn't be that great of a season anyhow. Right.
The anesthesiologist came in about 10 minutes before surgery and explained that I had two options -- a spinal or general. Given the length of the procedure and the fact that a spinal can be a longer recovery in terms of getting cleared to leave the hospital, I opted of course for general. I peppered him with my nerdy questions about whether he uses a brain monitor to make sure his patients don't wake up and he shut me up with a lot of smart statistics about how the brain monitors aren't very reliable anyhow. He said he had never had a patient wake up in 15 years. That sounded like a pretty reliable statistic to me. I listened to my meditation CD as they rolled me into the OR and even though the anesthesiologist said I wouldn't remember the time in the OR beforehand I actually remember virtually all of it. It was freezing and really loud in there -- they were playing some really bad music like Dave Matthews or something and they moved me on a couple of different beds while they got the machines started. Dr. Seng was there wearing his surgical cap and gumb boots on his feet of all things. A nurse said she was just giving me some oxygen when she dangled the gas in front of my face but I had heard that line before....and the next thing I knew I was waking up in the recovery room nearly 3 hours later. I was in recovery for a good hour or so before they wheeled me out to Brian and my Dad and Sam. I was pretty out of it but I knew when Brian didn't immediatley say anything that they must have found some pretty bad damage in the joint. He said the surgery had gone well but that Seng had confirmed that there was a fair amount of damage. I felt pretty bummed about that and couldn't think of much else for the rest of the day but I knew going into it that there was a pretty strong chance of that happenning. I never got a chance to talk to Dr. Seng because he left for the weekend while I was still out of it so I will have to wait until this week to hear the rest of the war story. Maybe in some ways that's good because I'm fairly sure that these painkillers are making me emotional too and I don't know how much more mediocre news I can take at the moment.
I've been recovering ok over the last four days and am trying to spend the recommended 4-6 hours per day in this passive motion machine (CPM) as directed. I was so sleepy the first few days that Brian would just stick me in it and I'd pass out with my leg slowly raising and lowering 5 times per minute. Sitting on the toilet turned out to be the worst of all the basic tasks that I had to try and accomplish in my gimp state. Needless to say, I think Brian and I crossed some relationship boundaries much earlier than we had anticipated...maybe as much as 30 years early! My Dad has been super helpful - taking our dogs for walks, running errands and cleaning the house so that Brian can spend the day at work and not worrying about me fumbling around the house on crutches. Our friends have been great and have brought us food so that we don't have to spend alot of time digging around for dinner, though I have to say I haven't had much of an appetite especially considering that my stomach has felt like cement since I got home from the hospital. Nothing like being sent home with a bottle of stool softeners to make you look forward to the pile of pills you'll be ingesting over the course of the week.
The hip is still pretty painful -- if I twist the wrong way or lean down too far I feel that familiar stab of pain in my groin or buttocks. When I finally took off the bandage today I was shocked by how small the incision sites actually were considering how many tools they crammed in there during the 3 hour surgery. Oh, and the 4 pages of pictures (arthro-porn) that he sent me home with are pretty unbelievable too. This is coming from someone who can barely thread a needle so the idea that someone else was able to stitch up a piece of flapping cartilage in the deepest joint in the body using a hole smaller than my pinky nail sort of blows you away.
Tonite, I'm supposed to get on the bike and start pedaling with no resistance just to work on ROM and keep the scar tissue from building up. Crutches to a stationary bike is sort of a funny prospect but we'll see how it goes.
The days leading up to surgery were stressful and way busier than I had hoped but I really don't know who I was kidding thinking otherwise. We had a house to re-arrange, groceries to buy, clothes to wash, cars to clean, etc. on top of trying to get ready to be out of the office for 3 weeks. It reminded me of the days before the bar exam in 2003 -- I had hoped to be all zen and calm and relaxed but instead I was up till the wee hours the night before getting things ready and racing around the house making my hip sore (I got 2 hours of sleep the night before the CO bar exam and still passed...I got a little more than that for this surgery but I'm not sure it made much of a difference in terms of results). The morning of surgery the girl from the ortho equipment company came to show me how to use the ice and CPM machines...the dogs were barking and chasing eachother around the house, Brian was upstairs vaccuming and I was still dripping from the shower...it was the usual pandemonium. Not suprisingly, I didn't really remember what I was supposed to do with the machines when I got home 12 hours later in a narcotic haze.
Surgery was scheduled for 12pm but they were running behind so it was really a little before 1 when they finally wheeled me into the OR. Brian was a trooper and hung out with me in the pre- surgery room for more than two hours. Surgery prep involved all the usual things -- blood pressure, lots of questions about what allergies and medications, an IV, etc. and then they also rinsed my hip with iodine and stuffed me into some compression stockings to help prevent blod clots. I felt like some kind of creepy hospital clown with white thigh-high leggings, a faux-bronzed ass and a blue shower cap on my head. Dr. Seng came in twice and chatted with us and went over the procedure again. He told us the labral repair and osteoplasty were the easy parts -- it was making a determination about the cartilage damage that would be tougher. If it was "all cobblestone-y" he would probably have to debride some of it because it wouldn't be worth salvaging. Unfortunately, as we found out later, there was some of that cobblestone shit in there. I told him I was lucky to have gotten out once last week on tele skis and he said not to worry it probably wouldn't be that great of a season anyhow. Right.
The anesthesiologist came in about 10 minutes before surgery and explained that I had two options -- a spinal or general. Given the length of the procedure and the fact that a spinal can be a longer recovery in terms of getting cleared to leave the hospital, I opted of course for general. I peppered him with my nerdy questions about whether he uses a brain monitor to make sure his patients don't wake up and he shut me up with a lot of smart statistics about how the brain monitors aren't very reliable anyhow. He said he had never had a patient wake up in 15 years. That sounded like a pretty reliable statistic to me. I listened to my meditation CD as they rolled me into the OR and even though the anesthesiologist said I wouldn't remember the time in the OR beforehand I actually remember virtually all of it. It was freezing and really loud in there -- they were playing some really bad music like Dave Matthews or something and they moved me on a couple of different beds while they got the machines started. Dr. Seng was there wearing his surgical cap and gumb boots on his feet of all things. A nurse said she was just giving me some oxygen when she dangled the gas in front of my face but I had heard that line before....and the next thing I knew I was waking up in the recovery room nearly 3 hours later. I was in recovery for a good hour or so before they wheeled me out to Brian and my Dad and Sam. I was pretty out of it but I knew when Brian didn't immediatley say anything that they must have found some pretty bad damage in the joint. He said the surgery had gone well but that Seng had confirmed that there was a fair amount of damage. I felt pretty bummed about that and couldn't think of much else for the rest of the day but I knew going into it that there was a pretty strong chance of that happenning. I never got a chance to talk to Dr. Seng because he left for the weekend while I was still out of it so I will have to wait until this week to hear the rest of the war story. Maybe in some ways that's good because I'm fairly sure that these painkillers are making me emotional too and I don't know how much more mediocre news I can take at the moment.
I've been recovering ok over the last four days and am trying to spend the recommended 4-6 hours per day in this passive motion machine (CPM) as directed. I was so sleepy the first few days that Brian would just stick me in it and I'd pass out with my leg slowly raising and lowering 5 times per minute. Sitting on the toilet turned out to be the worst of all the basic tasks that I had to try and accomplish in my gimp state. Needless to say, I think Brian and I crossed some relationship boundaries much earlier than we had anticipated...maybe as much as 30 years early! My Dad has been super helpful - taking our dogs for walks, running errands and cleaning the house so that Brian can spend the day at work and not worrying about me fumbling around the house on crutches. Our friends have been great and have brought us food so that we don't have to spend alot of time digging around for dinner, though I have to say I haven't had much of an appetite especially considering that my stomach has felt like cement since I got home from the hospital. Nothing like being sent home with a bottle of stool softeners to make you look forward to the pile of pills you'll be ingesting over the course of the week.
The hip is still pretty painful -- if I twist the wrong way or lean down too far I feel that familiar stab of pain in my groin or buttocks. When I finally took off the bandage today I was shocked by how small the incision sites actually were considering how many tools they crammed in there during the 3 hour surgery. Oh, and the 4 pages of pictures (arthro-porn) that he sent me home with are pretty unbelievable too. This is coming from someone who can barely thread a needle so the idea that someone else was able to stitch up a piece of flapping cartilage in the deepest joint in the body using a hole smaller than my pinky nail sort of blows you away.
Tonite, I'm supposed to get on the bike and start pedaling with no resistance just to work on ROM and keep the scar tissue from building up. Crutches to a stationary bike is sort of a funny prospect but we'll see how it goes.
Sunday, January 4, 2009
The Countdown
Now that my surgery date is less than three weeks away, I've realized that I actually feel good about my hip for the first time in about eight months. Not that it doesn't hurt every day, not that I don't think about it hurting every day but knowing that I'm moving forward instead of stuck in this awful purgatory of not having a diagnosis has meant the proverbial cloud has lifted for a while. I've got a plan of action and although it doesn't mean there won't be problems down the road, at least there is a plan. I don't have to feel desperate searching for yet another opinion from a skeptical orthopedic surgeon or an over-confident chiropractor. Its going to get alot worse before it gets even remotely better but at least I know I'm on the right track. Six months, or eight months, or even a year isn't all that much time in the grand scheme of things when you have a path forward. When you don't, its interminable.
Oddly enough, I've found that I can skate ski and nordic ski without too much pain. I was actually able to go for close to two hours today at Eldora skating up and down little hills on my rented skinny skis. It doesn't make alot of sense unless you have some understanding of how a labral tear manifests itself. Since it isn't a pulled muscle or ligament sprain, its mostly about finding those activities which don't produce that catching pain of the labrum flapping over the bump on the femur (unpleasant thought, I know). Kicking my leg forward on an uphill slope with a heavy ski boot and tele ski attached is pretty brutal but kicking and gliding in a skate motion somehow stays in the right plane of movement. Just getting to be outside in the sunshine under a bluebird sky was so refreshing after the tedium of the last eight months droning back and forth in the pool or on the trainer bike. If I'm a little sore tomorrow - or even alot -- it was worth it as I actually felt good out there this afternoon.
That's another thing about having a plan. I'm not so worried when my hip is stiff and achy the next day because I know I'm not really making anything worse as far as the tear goes -- its just a question of my own pain tolerance and what I can put up with for three more weeks. Its not going to get better on its own so I don't have to feel guilty and depressed every time I wake up with a crappy hip after doing too much the day before. Three more weeks. I can handle three more weeks. That means only about 15,000 more yards in the pool and maybe another 4 or 5 hours on the bike. My PT is adamant that I continue to exercise my hip and stay in shape both mentally and physically as it will make my recovery go that much smoother and faster. My health insurance finally gave in and coughed up the dough for the $400 per box of super-potent anti-inflammatory patches I paste onto my groin every 12 hours (they're super sexy too). And thankfully, I've got four more weekend days in which to get outside and take in the beauty of winter in Colorado before its four walls, my laptop and a bunch of painkillers for the rest of ski season.
Oddly enough, I've found that I can skate ski and nordic ski without too much pain. I was actually able to go for close to two hours today at Eldora skating up and down little hills on my rented skinny skis. It doesn't make alot of sense unless you have some understanding of how a labral tear manifests itself. Since it isn't a pulled muscle or ligament sprain, its mostly about finding those activities which don't produce that catching pain of the labrum flapping over the bump on the femur (unpleasant thought, I know). Kicking my leg forward on an uphill slope with a heavy ski boot and tele ski attached is pretty brutal but kicking and gliding in a skate motion somehow stays in the right plane of movement. Just getting to be outside in the sunshine under a bluebird sky was so refreshing after the tedium of the last eight months droning back and forth in the pool or on the trainer bike. If I'm a little sore tomorrow - or even alot -- it was worth it as I actually felt good out there this afternoon.
That's another thing about having a plan. I'm not so worried when my hip is stiff and achy the next day because I know I'm not really making anything worse as far as the tear goes -- its just a question of my own pain tolerance and what I can put up with for three more weeks. Its not going to get better on its own so I don't have to feel guilty and depressed every time I wake up with a crappy hip after doing too much the day before. Three more weeks. I can handle three more weeks. That means only about 15,000 more yards in the pool and maybe another 4 or 5 hours on the bike. My PT is adamant that I continue to exercise my hip and stay in shape both mentally and physically as it will make my recovery go that much smoother and faster. My health insurance finally gave in and coughed up the dough for the $400 per box of super-potent anti-inflammatory patches I paste onto my groin every 12 hours (they're super sexy too). And thankfully, I've got four more weekend days in which to get outside and take in the beauty of winter in Colorado before its four walls, my laptop and a bunch of painkillers for the rest of ski season.
Thursday, January 1, 2009
On Running
I've been a fairly dedicated runner since I was about 18. I got hooked back in 1995 when I was living in Boulder for the summer after my sophmore year in college. Thousands of miles and a few hunder pairs of ninety-dollar running shoes later, I still love my hour-long jaunts through the trails behind my house and, like many, I've come to depend on running for mental clarity, stress relief, mood regulation and a little bit of self-inflicted solitude. Perhaps most importantly, trail running has also provided me with that ever-essential connection to the natural world which is so lacking in most of our daily lives of endless email, 8 hour-a-day desk jobs, cell phones and all the other things that inhibit meaningful communication with other humans and our environment. I've never really cared about distance or times or mileage or any other means of measuring myself against others. I just like getting outside, seeing different places and watching the seasons change around my favorite loops through aspen meadows in the Colorado high country and the pinon and juniper forests nearer to my home.
I've run in some pretty wild places -- switchbacking up steep passes above treeline in the San Juans during the summer solstice, sub-zero mornings along the dirt roads of rural Vermont biting back tears and frozen fingers from the cold, the foggy beaches of central Chile, the coastal trail in Anchorage on a sunny summer evening with the alder trees sparkling against the bay, the Atacama desert with the snow-capped Andes at the horizon, hazy afternoons aside the Mississippi River in New Orleans dodging skinny stray dogs and broken glass, perfectly quiet mornings after a new snow along the Mesa Trail in Boulder. I've run in probably 20 other countries -- many where people just looked at me like they couldn't figure out what I was running from. I've run in Central Park, in the French Quarter, downtown Auckland and through the dense pine forest parks of Portland, Oregon. I've seen little moments of life in other places and right around the corner that I might never have experienced - the families of quiltros, or stray dogs, roaming the pre-dawn streets of Valparaiso, Chile looking for scraps in abandoned alleys, the smell of fresh bread rising in ovens along the cobblestone streets of Sienna, Italy, a small black bear startled by our approach one June morning a few years ago, the mist rising off Avalanche Creek near Carbondale in early fall, a family of foxes looking at me with wide eyes as they step gingerly across the street and hurry off to the safety of the tall grasses in the fields near our home. I've run with my headlamp the whole hour before the sun appears to the east and in the dim twilight of a summer evening. I've run with numerous friends, ex boyfriends, co-workers, my dog Phoebe and lots of other dogs and much of the time just by myself. I've run on most Christmases and Thanksgivings and almost always on my birthday on July 3rd. I've run through 2 years of college finals, 3 years of law school, 2 bar exams (one failed) and seven years of ups and mostly downs as an attorney. I've run through four break-ups (gladly at this point) and alot of New Orleans-style hangovers. I've had two bouts with a bad left IT band at the knee, some achy shins, a crick in my shoulder and an awful case of plantar fasciitis in my right foot that hurt so bad I felt sick to my stomach in the mornings from the pain getting out of bed.
Now I've got a much more serious injury and its going to be a long, long time before I run again. I didn't get to run on the morning of my wedding and it just about killed me. I had always pictured myself stepping out on my wedding day for a early-morning jog through wildflower meadows in whatever mountaintop setting we would ultimately choose for the exchange of our vows, clearing my head and wondering in amazement how I ever got there. But, as it has been said, life is what happens when you're busy making other plans. And so I'll have to be content with my memories for a while and try to conjure up images of myself jogging for one-minute intervals along the South Shanahan Trail this July. Its going to be a long road back.
I've run in some pretty wild places -- switchbacking up steep passes above treeline in the San Juans during the summer solstice, sub-zero mornings along the dirt roads of rural Vermont biting back tears and frozen fingers from the cold, the foggy beaches of central Chile, the coastal trail in Anchorage on a sunny summer evening with the alder trees sparkling against the bay, the Atacama desert with the snow-capped Andes at the horizon, hazy afternoons aside the Mississippi River in New Orleans dodging skinny stray dogs and broken glass, perfectly quiet mornings after a new snow along the Mesa Trail in Boulder. I've run in probably 20 other countries -- many where people just looked at me like they couldn't figure out what I was running from. I've run in Central Park, in the French Quarter, downtown Auckland and through the dense pine forest parks of Portland, Oregon. I've seen little moments of life in other places and right around the corner that I might never have experienced - the families of quiltros, or stray dogs, roaming the pre-dawn streets of Valparaiso, Chile looking for scraps in abandoned alleys, the smell of fresh bread rising in ovens along the cobblestone streets of Sienna, Italy, a small black bear startled by our approach one June morning a few years ago, the mist rising off Avalanche Creek near Carbondale in early fall, a family of foxes looking at me with wide eyes as they step gingerly across the street and hurry off to the safety of the tall grasses in the fields near our home. I've run with my headlamp the whole hour before the sun appears to the east and in the dim twilight of a summer evening. I've run with numerous friends, ex boyfriends, co-workers, my dog Phoebe and lots of other dogs and much of the time just by myself. I've run on most Christmases and Thanksgivings and almost always on my birthday on July 3rd. I've run through 2 years of college finals, 3 years of law school, 2 bar exams (one failed) and seven years of ups and mostly downs as an attorney. I've run through four break-ups (gladly at this point) and alot of New Orleans-style hangovers. I've had two bouts with a bad left IT band at the knee, some achy shins, a crick in my shoulder and an awful case of plantar fasciitis in my right foot that hurt so bad I felt sick to my stomach in the mornings from the pain getting out of bed.
Now I've got a much more serious injury and its going to be a long, long time before I run again. I didn't get to run on the morning of my wedding and it just about killed me. I had always pictured myself stepping out on my wedding day for a early-morning jog through wildflower meadows in whatever mountaintop setting we would ultimately choose for the exchange of our vows, clearing my head and wondering in amazement how I ever got there. But, as it has been said, life is what happens when you're busy making other plans. And so I'll have to be content with my memories for a while and try to conjure up images of myself jogging for one-minute intervals along the South Shanahan Trail this July. Its going to be a long road back.
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