2011?

Talking to various doctors, scheduling appointments, etc. seems to be a verrrry slow process. After several weeks, I finally spoke to the surgery scheduler for Dr. Philippon. I tentatively scheduled surgery to reconstruct my left hip/labrum for the end of January 2011. Also tentatively scheduled surgery to fix my right hip for March 2011. Yipes that is far away!

I haven't even spoken to Dr. Safran yet to get his opinion on the idea of reconstruction of my labrum or to hear the results of the mri i had almost 2 weeks ago (frustrating!). I'm also still waiting to go talk to Dr. Sampson about what he'd do. I'm hoping waitlists will work in my favor here...

The reading I've been doing suggests that having your labrum removed (rathe than repaired/reattached) leads to generally less successful results and apparently causes micro-instability and more rapid wear and degeration of the hip cartilidge. I think its unavoidable in some cases (mine apparently), and only a few surgeons will actually do a reconstruction of the labrum from other sources (if they cannot repair it using the tissue that is there). There is no way for me to know if my looseness and instability is a result of a loose joint capsule alone or if its the result of having 1/3 of my labrum missing - other than to pick one surgery and go with it. If I'm going to have another surgery on that hip anyways, it seems like a good idea to have it be the most thorough as possible? On the other hand, its tempting to just tighten the joint capsule and see if that is enough... since i could have that surgery asap and the recovery would likely be less. I guess there is no way to know what the result will be with either surgery. I just have to take my chances. Not so into that. Either way, a successful result is not guaranteed, and a perfect result is apparently unlikely. I am not seeing very awesome odds with the studies I'm reading. Basically, its considered a success if the patient is better than before the surgery... the dream of having pain free hips may be just that - a dream.

After getting the 2011 appointments set up, I started to reorganize my next several months in my head ... Wonder if I could get back to riding my bike, once my collarbone is sturdy enough (I am seeing progress finally!!!! and am out of the sling most of the day as of this weekend), and just ride and swim as pain allows for the next several months. I miss riding in the sun, coming home exhausted, being fit. Can I get back to enough of that over the next few months to make the wait bearable? I guess I just have to try and see. My collarbone is still not crutch-worthy yet, so I have some time to make these decisions.

I do still have pain in my left hip and in my right. As of today I have pain the the front of my left hip again - similar to what I had before the surgery. The pain levels alternate and migrate back and forth between hips. Burning, sharp pains, popping, aches, stiffness - seems to be in both hips. sometimes i struggle to get up from a sitting position. At the same time, I know I am doing a lot compared to some convalesing hip patients (much less than others!). I do go on hikes and walks. Sometimes I walk through the pains and stiffness, and sometimes I suffer the consequences. I went for a hike this weekend with a friend who does not generally hike (cyclist) and who is 8 months pregnant. I felt about about as i have for the past month or so, and I could barely keep up. So, I don't think my expectations are too high. But, maybe they are. Its been interesting not being able to ride my bike - since i can't compare the pain level in my left hip pre-and post-surgery. I was able to ride pretty hard and pretty far before surgery - but I had achiness, burning, stiffness, sometimes badly, sometimes not so badly. I don't know if I'm better off now or worse. I think its differnet, but its not good. I am almost 4 months out. How long should I expect to wait to get back to living my life normally?

In the meantime, my primary doc is checking to see if I have some underlying issue thats making my joints loose and making my collarbone take forevs to heal. I am guessing they are just two totally separate events, and that the loose hip is simply due to a surgical issue, but I think its better to turn over that stone - for peace of mind.

Not the most thrilling post, but there you have it :)
ciao,
v

Status Update

While I'm waiting for my collarbone to heal (please please please please heal), I'm taking the opportunity to get second opinions on what is wrong with my left hip - why is it loose? how can it be fixed? I am currently scheduled for a revision surgery with my original OS on August 6, but that will be pushed back regardless. My collarbone is still flexing - and there is no way I could use crutches at this point.

So... after sending off films and operation reports to the Vail doc (Dr. Philippon) several weeks ago, I finally had the chance to talk to his fellow yesterday. They had sent me a short letter saying i was a candidate for surgery, but hadn't described what they would do. Yesterday I learned the specifics of what they would do to fix the looseness in my left hip. In my original surgery Dr. Safran debrided/removed a significant amount of my labrum (the cartilidge band around the hip socket - that helps with stability and suction) - from 11:00 to 3:00. He also didn't close up the joint capsule on his way out of the hip. Dr. P thinks that both of these things are contributing to the instability and looseness in my hip and that only closing the joint capsule (which is what Dr. S is proposing) won't lead to a result that I'm happy with.

Dr. P. proposes to go back in to the hip and repair the labrum where it is missing. If there is insufficient labrum left (which I think is the case) they will take a piece from my IT band to create a fake labrum, and reattach that with sutures to the rim of my hip socket. That will apparently function as a new labrum. I was told that in studies they have found that the new labrum will actually re-grow/re-attach permanently to the hip socket. Success with this procedure is 85% according to a 2-year study Dr. P recently did.

This approach makes sense to me. But, I want to talk to Dr. S. about it and see what he thinks. I also have an appt. with Dr. Sampson in a few weeks (hopefully sooner if there are cancellations) and will ask his views as well. It is a bummer that there is no consistent agreed-upon approach to these surgeries. I wish there were longer-term studies about what works and what doesn't. I'm sure in 5 years they will know so much more. Its frustrating to say the least.

In the meantime, please send healing vibes my way for the collarbone.
Thanks!
Virginia

Bend! (and hip and collarbone...)

Jon and I decided to get away for the 4th of July and make a road trip up to Bend, Oregon. I've been wanting to go for a long time, and had it in my head as a place I'd maybe like to live. I fully expected it not to meet my expectations (sort of like 10 years ago I dreamed of living in Boulder and then I went there and it was less than I imagined). I was so wrong! Bend was all that I had thought. Beautiful and amazing scenery. From town you can see the snow covered peaks of the cascades in the distance, all of the surrounding area is covered by huge pine trees, and the deschutes river runs right through town. In town the river is peaceful and manicured, but just out of town it becomes wild again - roaring between huge walls and over big boulders. The path leading around the river is also manicured around town but it continues with a small dirt train winding over wooden foot bridges and around the river's edge for miles and miles out of town. If I could run, this would be the spot for me. Houses in town are my favorite kind - old 1920's bungalows, with some done up modern, with metal roofs and solar heating, and cool landscaping. The people were friendly, the pace slower, the weather perfect (except for the 9 months out of the year where it is cold and snowy! but even then apparently it is sunny 300 days of the year). Even the town has enough going on that we were more than entertained in the evenings - good food, good wine, a "first friday" with shops and galleries opening their doors and people milling about, and even a small 'critical mass' with a few cruiser bikes running through town. We loved it. Now I just need to get a bunch of friends and my family to move up there... and find a source of income up there... must begin plotting that move...

I know there has been a lot of backlash up there against the growth they've seen in the last 10-15 years, and all of the monied californians cashing out of the bay area and moving up there - inflating the price of homes and the cost of living. so, further investigation is definitately needed. Maybe another trip! :)

In other news, this past Thursday was my follow up appointment with my surgeon - 3 months post-op on left hip, and 6 weeks post-op plate removal and clavicle break. First the clavicle. He took an xray and said the break showed no bone growth. He also said that is normal (?) for collarbones, and bones may not begin to grow in until week 6. that said, he was surprised I couldn't shake his hand - or at least that is how I read his reaction. He didn't say anything about more surgery to install a new plate, and in general, I got the sense he wanted to wait and see it heal on its own. He also said it would take 6 months to fully heal, and for the swiss cheese holes to fully fill in. Strange how this all seemed so minor before I had the surgery. I am actually starting to get mad about this.

My own research on the internet suggests that it can take a long time for breaks to heal without fixation. It could be another month or two before the clavicle feels good. For now, I can move my arm all over the place passively - no problem. I take it out of the sling quite a bit to let it move and not be stiff. carrying anything of weight in that hand puts a strain on the clavicle that I can feel - and it doesn't feel good. The same is true of reaching my arm up in the air unassisted - can't do it without pain in the spot where its broken. Mostly I am still sleeping only on my back, in the sling. so OVER that. I can turn now on my left side - but sometimes it feels like even that pressure pulls on the collarbone and it puts bad pressure on the spot with the break. I have been using a bone growth stimulator for the last 3 weeks. Its basically a large blackberry looking thing, connected to 2 electrodes that I have taped on either side of my collarbone - one on my neck and one on my breast plate. 24 hours a day, seven days a week. I get a lot of funny looks and it is a huge pain in the ass - but if it helps it is worth it.

As for the hip... he was not happy that I'm still having looseness in the joint and said that he recommended we go ahead with surgery to go in and tighten the joint capsule. He said the sugery would be arthroscopic, and I'd be in a hip brace for 2-3 weeks and on crutches for 2-3 weeks. He would either sew up the capsule if it simply hasn't healed, or if it has healed, he would create another hole and sew it up tighter (by overlapping it). He would also clean up any scar tissue or other damage.

Of course, we can't do any hip surgery until I am able to put my full weight on crutches with my right arm - which I definitely cannot do right now. AARRRGH. So frustrating. We picked a date to go ahead with that surgery - one month from now - August 6. He said if the collarbone is still not strong by then we can push the date back. He also moved the leg around to test range of motion and says that I'm tighter than I should be - so I'm loose and tight at the same time. I'm also still having pain - sharp and achy. He said by 3 months he'd expect me to be 60% of normal and he doesn't think I am there. So, even apart from the looseness, this is not going as well as normal. Funny, in every other recovery in life I've felt like i was ahead of the curve, and now i'm behind it. Sucks for sure.

I want the surgery that is going to FIX me ASAP. However, another surgery that is just going to butcher me some more is totally unwelcome. So, in the meantime, I'm trying to get a second opinion on the hip issue. I have pretty much accepted that a second surgery on my left hip is going to happen, but I want to make sure that this surgery actually works. If my joint capsule needs to be sewed up or tightened, fine. But if the real problem is that my labrum is no longer good enough to seal the hip, then I want to address that. I have sent my films to another doc(in Vail) who sees lots of FAI patients. Hoping to hear next week. I am also considering going back to the doc in SF who will do two hips at a time - but is not covered by insurance. I am so done with all of this and it may just be worth the $20,000 out of pocket to have them done together. Only thing is, I'm sure I won't be happy having that $20k bill hanging over my head for the next few years. Of course, the longer this gets dragged out, i'm into 2011, and another out of pocket maximum to meet on my insurance. Plus all the time off of work, various contraptions that I have to pay for out of pocket, etc. Realistically, its not a choice between $20,000 or free. Its probably more like a choice bewteen another $5000 or $20,000. Something to consider for sure.
I am also getting a second opinion on the clavicle. I do not want surgery to replate it, but I also do not want to be waiting in vain if that is inevitable.

Who has time for work and life when you have all of these doctor's appointments and p.t. appointments? its insane. Luckily I was working a flexible schedule to ride my bike - now I just use that time for doctor stuff. Don't be jealous!

Today we are seriously considering a kitty. I'm sort of scared! but i know i'd love to have a kitty running around...