Tuesday, July 27, 2010
2011?
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
Wednesday, July 21, 2010
Status Update
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
Saturday, July 10, 2010
Bend! (and hip and collarbone...)
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...
Sunday, June 27, 2010
35
I’ve always felt like my “true” age was 35. In part, I guess I always felt a bit older than my years – at 20, I felt like I was 35. I also felt like when I actually turned 35, somehow the stars would align – my “true” age would connect with my actual years on this earth and everything would be good. I guess I had fantasies that at age 35 I’d have everything figured out – I’d be at peace. My struggles with finding a career that I love and figuring out what I want to do with my life, how, where and with whom would be over. Or, if not over, I’d at least have a level of serenity and calm – and harmony I guess. No more struggling.
When I decided to have surgery this last winter – part of my grand plan was that I’d have my hip surgeries behind me by the time June 15 rolled around – my 35th birthday. Obviously that didn’t happen. I had my first hip surgery on April 9, 2010. Now it’s looking like I may need a redux on hip #1, and I’m still waiting for hip #1 to be resolved before starting on hip #2. I also did not ring in my 35th year as I had hoped. My last birthday, I had a few broken ribs, had two fresh plates and 16 screws installed in my collarbone, had just returned to work, and got hit with a doozie of a cold – try coughing with broken ribs. Hell. I recall that I spent that night on my couch, eating take out with a friend, feeling terribly sorry for myself and promising that next year would be my year. I had those plates and screws removed on May 29, 2010, one week shy of the one year anniversary of their installation. Again, I thought for sure that I’d be good to go by my birthday. Have at least my collarbone, if not a full hip, checked off my list in time for 35. As you know, if you’ve been reading my blog, that didn’t exactly go as planned either. I again spent my birthday with a broken collarbone.
It’s now almost July, and I’m well on my way into this 35th year I’d had such high hopes for. I have pretty much accepted that surgery and recovery will be part of my life for the foreseeable future. Plans for Christmas and New Year no longer revolve around cycling for me. I’m no longer plotting my comeback for early 2011. So, I guess this means that 35 isn’t going to be the year I had hoped. Or maybe I just have to look a little deeper.
Undeniably, it’s been a huge loss to be robbed of my athleticism. I never imagined that I would be facing month after month without the ability to push myself athletically – to train, be fit, compete. I’ve lost my biggest outlet at my time of greatest need. It is a true test of spirit – and I’m not sure if I’m winning.
But, I’ve also started down a path towards a career that I love. I’m living with a man that I love, who fascinates me, understands me, and who loves me in spite of my ongoing disabilities and – to put it mildly, my lack of cheer at times. I’m learning exponentially about myself. And I’m being forced to grow and look hard at what I want in life – because I can’t just ignore it and make it good with an awesome bike ride.
So maybe the stars have aligned after all. Here's to 35.
June
This post is going to be quite boring. I want to record what’s happened in terms of progress the past few weeks so hopefully I can look back and it will be helpful later.
Its been about a month since my last post. Just over 4 weeks since I had the plates and screws removed from my collarbone and it re-broke rolling over in bed. I feel like my collarbone is healing. The sharp jabs of pain are less jarring and it takes more to make it happen. I can move my arm around passively without pain, and even do things at my waist without lifting weights - without pain. Yay! There is some concern that the bone won’t heal given the circumstances. Insurance covered an electronic bone growth stimulator which will help it to heal if was not otherwise going to. As my lovely p.t. says - its gravy, and I need gravy right now. Next doctor's appt is July 7, when I have an xray and am hopefully given the green light to take off the sling.
Around the same time I had my collarbone break, I was having a lot of pain in my left glute and down my leg to the calf - like combo piriformis and sciatic pain. It ached and made it hard to sit or to sleep. My hip was also feeling extremely loose. It feels like it dangles in the socket when I am not firmly clenching it in there. And, it felt like my femur was about to poke through my glute muscle if I put too much weight on that leg - like doing a lunge or walking up a hill. The week after the collarbone break Jon and I went for a walk around the neighborhood. I needed air, solitude, the sound of nature. I couldn’t even attempt some of the steeper streets - it just felt too risky on the hip - not to mention the collarbone. About a week later at p.t. they zapped the crap out of my little piriformis/glute area with one of those electrode things - and it was like night and day. I think one of my muscles was spazming/frozen and was irritating my sciatic nerve. The electrodes were just the right thing to get that firing or not firing again - and the pain in my piriformis and down the leg lessened dramatically immediately. That was an awesome success. My femur no longer feels like it will pop through my glute - but the general looseness remains.
Over the last few weeks - since the piriformis pain lessened, I’ve been able to start pushing my glutes, quads, hammies, adductors more. My hope was that in this 8 weeks I’m waiting for my collarbone to heal, I could work my muscles around my hip to see if that would help enough to keep the hip firmly in the socket. All while being very careful not to push it too hard so that whatever healing may need to take place does. I’ve been able to do quite a bit at p.t. and on my own and it does seem to be making a difference. One day last week I actually was feeling almost normal - like my hip wasn’t dropping out of the socket that day. I was very hopefull that day - feeling a ray of light that I may actually be in the clear with my left hip. At this point, the idea of having only one more hip surgery sounds like winning the lottery. But, that was short lived - and it was back to feeling loose the next day. Grrr. Yesterday after pushing it probably a little too hard I had the sensation of it subluxing almost - in the same bent over stretch that did it almost 2 months ago. I do wonder if the subluxing feeling is a tendon popping or sliding over the femur, rather than it coming out of the socket. Who knows. Ugh.
Meanwhile, with my collarbone hurting less, I’m able to do more physically. I’ve had a few good hikes up behind the house on San Bruno mountain.

Its been really cool to explore the trails up there. They are STEEP! They are also pretty much empty, except for me and the hundreds of little white tailed bunny rabbits, birds, bees and the lone snake I saw yesterday creeping slowy across the trail in front of me. San Bruno divides Brisbane from the coast, and the fog comes roaring over the ridge like a wave - the other day it looked like the black smoke from Lost - but white. Crazy.

Today I took it easy and spun on the trainer for an hour. My hip felt fine. Then I went down to the pool. The Brisbane pool is awesome. Definately on the list of the top ten things about Brisbane - its big, clean, outdoors, tucked under some trees, and usually pretty mellow. It was my first time there since the subluxing incident about 10 days out from surgery. I’ve been scared, and I’ve had hip flexor pain so I didn’t think kicking would feel good. Of course, for the past month, I’ve been one-armed, so not much to do in the pool. But, today I went down and did some kicking - holding onto the wall, and then some one-armed with the paddle board - and some pool running - just to test it out and see how it feels. The kicking felt REALLY good. Sometimes I feel like my left hip still hurts like it did pre-surgery - the groin pain, and the deep glute pain still plague me. But in the pool the contrast between my hips was clear. My right hip (the hip still waiting for surgery) hurt to kick - the groin just had a sharp pain from the first kick. The left felt good and strong - though after a while my hip flexor started to hurt a little so i stopped. It felt pretty good to ‘run’ in the water too - just a little pain in the glute and hip flexor- which I seem to get a lot. Sometimes I wonder if I have a torn glute or something. The little sharp pain is in such a specific spot.

Anyway, it was nice to be in the pool and the sun. It was also nice to bond with the other gimps in the pool. One woman in my lane had back surgery recently and was just getting back to exercise. she was stoked. there were two other men - one in his 80s and his son who was attempting to avoid surgery. both were out getting exercise, moving the body around, and soaking in the sun. It was awesome. As I left, there was a line out the door of families with little kids - open swim was starting and its a beautiful day. I want to do that more often. Of course, it helped that it was like 75 degrees and sunny - yay!
I could get all deep and introspective here - this month has brought about a lot of thinking, and not all of it good, but I’ll save that for another day.
I do feel like my collarbone is healing - and I’m looking forward to being able to swim, do some upper body work, some more core, and even ride my bike (YAY!!!) while I figure out what to do next with the hips. Once that happens I’ll at least have moved one step closer to the end of this.
Tuesday, June 1, 2010
update
one other positive thing - when i am finally able to hike, to bike, to run, swim, ski, jump, dance, fall, somersault, and do my heavy squats and deadlifts, i am going to cherish every moment. I'm going to savor the wind in my face, the strength of my body. I will appreciate every second. I think I did before, but it will be multiplied by 1000 when all of this is behind me.
Calamity Jane
So, on Friday I had surgery to remove 2 plates and 16 screws from my clavicle - they had been there for a year, since a crash last May. They bothered me - bra straps hurt, carrying a purse hurt, backpacking was out the the question. I probably could have dealt wtih the first two, but I love backpacking and am not ready to give it up. Anyway, i was told this surgery was a "nothing" and it seemed to be true when i woke up on Friday from anesthesia. I was out the door, not nauseaus, not horribly in pain, and feeling decent 20 minutes after waking. I dozed off the drowsyness all afternoon friday and saturday woke up feeling pretty good. We went to the farmers market, to REI, and had a mellow evening. i was very excited at how minor the surgery seemed and so happy to have it behing me. fast forward to 4 am sunday.
I woke up at about 4am with major pain in my clavicle. walking to the bathroom and back was horrible. very reminicent of the initial break. jon went and got me some vicodin and i made it through the night. that morning the pain continued. i couldn't lift my arm, was having sharp jabbing pains in my clavicle, and had to wear a sling to keep the pain in check.
I called my surgeon's on call service and ended up talking to the fellow, who is sooo nice. he offered to meet me, on a sunday of memorial day (very appreciated) at the surgical center. He said he couldn't get an xray, but at least he would be able to take a look and see if there was anything obvious.
We met, he took off the dressing, and his conclusion was that nothing was broken, that i had a hematoma over the area that was really hurting, and maybe it was that the numbing medication wore off during the night.
So, off i went home, feeling kind of silly. Unfortunately, I still feel like its broken. i can't understand how it would go from feeling so good to feeling so bad in an instant. i can barely sleep, walking hurts, it hurts to get up and down off the couch, typing this is pretty painful.
anyway, i have my first official post op appt in a couple of hours and i am hoping they will take some xrays to confirm one way or the other. I am expecting the worse, but hoping that i'm wrong.
I'll post an update later.