Hanging in here

I don't have much of an update, but I thought I'd make my site more cheerful looking. I've been feeling pretty good. Earlier this week, I definitely had a set-back and pretty severe pain whenever I'd stand up. It also hurt when I was sitting and moved my legs a certain way.
I'm not sure what set it off. I tried a new exercise during Gyrotonic class on Monday evening that I think I might have overdone. But it could have been my shoes...I was wearing heels (though they're comfy wedge heel boots) on Monday. It might have been the fact that I didn't take enough standing breaks throughout the day. Who knows. Maybe it was an extra pound of Halloween candy.

The pain is all but gone now. My Gyrotonic class this morning was pure bliss. But I'm not going to take any of my pain-free moments for granted.

HUGE decision

I've made a very big decision. I cancelled my appointment with Dr. P. 

Am I insane? Possibly. But I came to a couple of important realizations:

• I'm feeling really good. So good, in fact, that the risks of surgery far outweigh the pain I've got currently and have had for a few months now.
• The diagnostic injection would inform me that I have some muscular imbalances, tears, etc. My amazing chiropractor has been helping target those muscles and I've already been working on the muscular issues I have. That is probably a huge reason why I've been feeling so much better.
• I would like to have children at some point. I realize that pregnancy could exacerbate FAI. But I am losing weight so that hopefully if and when that time comes, my weight won't increase beyond what it was at my heaviest. Also, the surgery, recovery and then strains of pregnancy present several more unknowns and risks and I'd prefer for my hips to shift and do whatever they're going to do before trying to correct the underlying bone structure.
• This is still a relatively uncommon procedure, and they're still learning more about it and getting better at it. Who knows what they'll discover within the next 5, 10 years.
• I am leading an active life right now without running. I miss running, but I'm loving the other activities I've integrated into my routine. I don't feel deprived, nor willing to undergo the risks of surgery for the sake of running, especially given how good I feel. (Of course, I don't plan to run because I don't want to tear the labrum anymore).
• If I'm not going to act on the information I receive, then I'm simply getting info to satisfy my curiosity. That's not worth the high expense of seeing an out-of-state doctor and undergoing expensive tests. At least not now.

I'm well aware that I may be postponing the inevitable. Without fixing the underlying bone structure, I assume that the muscle imbalances, strains, etc., will continue to bother me.  And of course, surgery could go perfectly and I could have a speedy recovery.

But I don't like risks and I would like to try everything I can before going down that route. I still have plenty of non-invasive options if what's working for me now ultimately isn't sufficient. I thought about writing that doing nothing can be harder than acting...but that's not what I feel like I'm doing.  I am doing a lot.  I'm using yoga, pilates, gyrotonic, gyrokinesis and physical therapy exercises from the pool to increase my flexibility, lengthen the muscles and strengthen my body (especially my hips). I'm swimming, ellipticalling, walking and occasionally biking to increase my cardiovascular health. I have deep tissue massage and electro-whatever-it-is that my chiropractor uses to lengthen the muscles and fix the tears. I am avoiding high impact exercises to prevent additional tears. I'm writing to help me emotionally deal with the frustrations of managing an injury. I'm working with a nutritionist to help carefully and healthfully lose weight. I'm actually doing a lot.

And for now, at least, it's enough :-)

Paradigm Shift

Last night I experienced somewhat of a paradigm shift in how I've been looking at my hip issue.

Until now, I've been trying to exhaust my options of things I can do on my own to heal my hips (or at least the parts that I can heal, such as the muscle tightness and the strength imbalances) so that if and when I need to undergo surgery, I'll be in a good place mentally and physically. I know that, if I undergo surgery, I'll have a long recovery process, but I anticipate that (unless something goes wrong) I'll eventually be "healed." This way of thinking has been frustrating me because I am feeling increasingly frustrated with the pain and waiting around for it to go away. After all, I've been doing so much!

So a wise person asked me, what if there is no "end" to the hip pain? What if I think about "managing" the pain rather than erasing it?

My first reaction was to reject this idea completely. Of course. Why else would I even think about surgery unless I believed that I wouldn't be forever doomed to have hip pain.

But, I thought it through a bit more. From what I've read, it seems like even in "successful" surgeries, there can be some residual weakness and pain that will require physical therapy, stretching, or some other way to keep strong and limber. And not all surgical patients end up pain-free. It's my understanding that doctors consider the surgery a success if the pain goes from a 10 to a 3. So if I were that patient, I'd still be in the position of having to manage the pain long-term.

A life filled with yoga, gyrotonic, swimming, biking, stretching...all to stay strong, increase joint mobility and reduce pain. Is that really so bad? Would I really even want to give that all up if I woke up and found myself "fixed"?  (Granted, I'd really love to add the running to that list, and I'm hoping I'll be able to add that back into my routine at some point.)

The best part about thinking about pain management instead of pain elimination is that I instantly stopped waiting for the day when I'm healed, but rather, gained a measure of peace in knowing that I'm making a difference on a daily basis.

I'm definitely not ready to throw in the towel on the possibility that the surgical route could correct the underlying issue that is causing my muscles to be all out of whack. But I'm also not ready to throw in the towel and say I've done everything I can do to manage the pain and I'm ready for someone else to fix me. I am going to focus on whatever pain management I can do now, and cross the surgery bridge if and when I get there. I've realized that the activities I'm doing so that I can manage my existing pain are also going to help me prevent pain from developing in other areas of my body.

Gyrotonic/Gyrokinesis

I'm taking a moment from my lunch break today to exclaim at the top of my lungs (well, from the tips of my fingers) how amazing even my brief introduction to Gyrotonic and Gyrokinesis has been. I started to get sore from sitting at my desk this morning, and so I tried two of the Gryokinesis moves I learned.  Bam -- immediate relief.  I cannot wait until my full session tomorrow.

What's really going on?

I have been asking myself for months now what is really going on in my body? What's really causing all this pain? I visited another doctor and I got another answer. My chiropractor believes that all of the symptoms I've described, including the clicking and stiffness in the hips, could be explained by muscular imbalances and tightness in my hip and rear areas -- particularly the Psoas.

But what about my MRI? It clearly shows a tear and FAI. Well, according to him, that may have been what started all of this, but given the extent of the muscle tightness I've got and the fact that I've lived with this pain for roughly 1.5 years now, he thinks there's a good possibility that if it was a small enough tear it could have healed over or that, even if it didn't, it's not what is causing the pain.

It's not the first time I've been told about this possibility...isn't that the point of Dr. P's interest in trying to isolate the problem by using a shot of Kenalog (sp??). To see if it's the hip or if it's really something else that's causing the pain?  But I don't see him for another few months and in the meantime, I'm not sure what that means for me.

I'm definitely better on days that I do yoga, pool exercises, gyrotonic, or bike. Sitting or standing for long periods of time always triggers the pain. 40% of the time when I stand up, I still get that sharp shooting pain in my inner groin area in both hips. BUT, if I've been sitting for a while and try to stand up, that percentage is more like 95%.

I'm having a hard time mentally dealing with the hip limitations. There's a concert I really wanted to attend this week that I ended up passing on because it's standing-room only and I knew my hip would be screaming within 30 minutes. I haven't gone for a hike or a jog in so long. I miss it so much and I'm itching to give it a try.  But I'm pretty sure I shouldn't yet. This month has been particularly tough. Last year this month, I ran the Nike Women's Half Marathon and, despite fleeting and occasional pain, still felt on top of the world.  I'm having a hard time accepting that I'm not running at all anymore. Since that race, I think I've only logged about 4 miles -- all of which triggered excruciating pain. I was only a "runner" for a fleeting 9 months. How can I miss it so much?

On the other hand, I've come a long way from where I was a few months ago when I started this blog and had difficulty walking through a parking lot. I'm exercising about 5x/week, even if it's not particularly high cardio stuff...though I'm trying to build up my stamina.  I've lost weight and am still losing. I've learned a whole lot about the human body and the many muscles that stabilize our hip and help us move our legs. I've learned quite a bit about nutrition and have discovered some very different but complementary methods of cross-training. I've gotten slightly less neurotically focused on running and have gained a whole lot more respect for the body.

I want to throw my hands in the air and say, fine I surrender universe -- I accept it's not in my control. I'll keep doing what feels good and seems to make me healthier, but I will be grateful for all the blessings in my life and the fact that what I'm going through is hardly a big deal compared to so many people out there who are going through much more serious and upsetting problems. I really want to do that. But I'm having a hard time letting go. The irony though is that I'm not actually holding onto control. I never had any. So what am I holding onto so tightly?

Frozen Yogurt Pet Peeve

I classify this blog post as related to my hip because I'm trying to lose weight.  I went to a frozen yogurt self-serve restaurant last night, one of the thousands that have popped up recently throughout LA. The joy of self-serve is you can make any flavor combination you can think of, put any fruit or candy in your yogurt, any strange mix of sauces and syrups, and you simply pay by the ounce.

The problem is the cup they give you to fill. Did I say cup? I meant bucket. That thing can easily hold 12 ounces of yogurt. There are no smaller cups, or even kids' cups. Nope. Just pull the lever and fill your trough with sugar.

So, mindful that I wanted only a serving of yogurt (4 ounces) and some fresh berries as a topping, I measured out my yogurt before adding the toppings. But 4 little ounces of yogurt looks so pathetic in that huge container. As a visual eater, I would much rather have a small cup and fill it to the top and feel like I'm eating more than to take a huge cup and only fill it a fraction. Booo. How ridiculous is it that eating a serving of fro-yo and berries left me feeling somewhat deprived?

Anyway, I got over it and really enjoyed my serving. I even sprinkled on some coconut shavings for an extra treat.

reflecting on pain

I was thinking a bit today about pain and illness. When the pain really flared up in my hip, I was in the midst of an intense year of marathon training and had convinced myself that I would qualify for Boston sometime before I turned 50. (Given that I was averaging a 12-13 minute mile, and I would have to average something closer to a 7 minute mile to qualify at this point, that was an insane goal, but something I thought would encourage me to keep working at running over many years).  But I wasn't training well -- I was still eating poorly, I wasn't really cross-training, I barely did any strength training or stretching -- all I did was run, walk, and do a little bit of stretching on occasion.  I had symptoms that something wasn't right...the hip pain came on gradually and sporadically, and I simply ignored it and worked through it.  Had the pain not gotten as intense and debilitating as it had, I would have kept on going with such an incomplete system of training.

This injury forced me to stop and change everything about the way I treat my body and train. It forced me to revamp my diet, to strengthen my muscles and to pay attention to the imbalances in my muscle strength. It forced me to cross-train -- to introduce low impact exercise into my routine. It forced me to even consider how I enter and exit vehicles, stand up, walk and even what kind of shoes I wear. It forced me to take the time to stretch my muscles and improve my circulation. And through yoga and Pilates, has also helped force me to pay attention to my breath and how it impacts my body and my mind.

Are we faced with injuries to force us to re-evaluate our lives (physical or emotional)? I think that's a different question than do we deserve the injuries we get, which I heartily believe we do not. I don't think anyone deserves to get sick or face cancer or any serious illness. But I know that such illnesses change us, help us appreciate the support in our lives, the good days, the pain-free and illness-free moments. They help us appreciate the now and the things that work. And, at least in my case, they've forced me to revamp my life.

I don't know that this is a particularly scientific thought-process. Of course, people who live really healthy lives with well-balanced diets, exercise, etc., get horribly ill. I'm not sure what to make of that. On the other hand, being physically balanced does not always mean that we're emotionally balanced and aren't facing tremendous mental challenges. Maybe our physical illnesses, despite good physical health, are a manifestation of our emotional issues.

I don't really have a clue. Regardless of why I ended up with such pain, it has been a frustratingly life-altering mirror reflecting back to me the choices I've made and the goals and values I've had up till now. So although I go through moments of denial and frustration and depression, I'm really trying to embrace the gift of forced self-reflection.

A glimpse of the other side

I tried something new this morning -- Gyrotonics. What is that? According to the Gyrotonic Health Network website, it "is an exercise modality that guides users to simultaneously stretch and strengthen muscles and tendons while also articulating and mobilizing the joints. Corresponding breathing patterns are engaged during the performance of the exercises, thereby increasing coordination, endurance and aerobic activity." (http://www.gyrotonic.com/index.aspx)


It was similar to Pilates in some ways, isolating areas of the body and moving from the core. But it was also very different -- a larger potential plane of motion, stretching in different ways and really opening the joints. I left the studio feeling like I haven't felt in a year. On a scale from 0 to 10, 10 being excruciating blinding pain and 0 being completely pain-free, I was a 0. WOW. Being at a 0 was strange. I've grown so accustomed to a general uncomfortable throbbing in my hip/leg that what I've come to believe is a general 2-3 has gradually become my 0-1. But this feeling was a true 0. I had literally forgotten what being pain-free felt like. And oh my, it was bliss.

I use the past tense intentionally. Leaving bliss behind, putting on heals, sitting at a desk, the general dull throbbing returned within an hour and a half.  The good news is that my dull throbbing isn't as bad as it normally is. So that's improvement, I guess. But I am already looking forward to my next session and curious whether I can re-harness that amazing feeling.

During the week, I attended a new yoga class. It was a combination of gentle yoga (i.e., lots of stretching) and basic yoga (basic postures, but still challenging for a newbie like me). It was a great class for me and I'm getting more comfortable doing my own thing when I need to. I'm listening to my body and respecting it more so when the teacher had us move in a way that I thought would aggravate my hip pain, I either modified or continued doing what was feeling good until the teacher moved on. After class, I asked the instructor for her suggestions on stretches for the IT band and piriformis and she gave me some that I really felt. Glad I stuck around and asked.

I don't know if my eagerness to heal myself without surgery is smart or simply a doomed attempt at self-delusion and denial. Ultimately, I wonder if it matters. Were I to have the surgery, wouldn't I still have all these other muscular imbalances and issues to deal with at that point?

Whatever I can do

I saw Dr. Klapper for a follow-up on Tuesday and the long and short of it is that there is some moderate improvement in the right hip and the left hip is more problematic. I'm going to keep up with the physical therapy and see whether I still have pain in another 6-8 weeks. If I still do, he recommends surgery and if not, then no worries. He said there's a possibility that some tears form something of a callus and so it would be possible to have something of an irregularity without pain. He doesn't think that you need to necessarily operate simply because there's an irregularity on an MRI or X-ray.

I don't know what to make of that.

I described to him the pain I had following Pilates last time, and he explained that it's not the hip that is causing the pain, but the surrounding musculature and weakness. So I asked him if I could do Pilates and/or Yoga, and he gave me the answer that I can do it as long as it doesn't hurt. Okaaaaaaaaaaaay.

So I went back to Mind2Body today and worked with the owner, Lani. She identified a bunch of ways in which I was unintentionally compensating for weak muscles by overworking the stronger ones, and was so good at explaining ways to isolate the ones that I need to strengthen. As a runner (or should I say former runner -- booo), I was particularly fascinated by the weakness in the inner foot and big toe area. I'm so used to putting the pressure on the outside of my feet from the way I pronate, and it's amazing how that has made my inner feet weak. I managed to get through the entire hour without pain, and I am hoping to get through the rest of the day in such a way. But the thing I found most interesting is that I think, despite my best efforts, that I'm compensating improperly in some of my water exercises. It's hard to tell because nobody is there watching me contract each muscle specifically. Some of the Pilates exercises seemed like the pool therapy exercises (but on land, of course). I would love to do both because I think they compliment each other and that by getting better at one, I'll necessarily get stronger and improve my form in the other.

I had a massage last night, which was really helpful to loosen the areas also. My massage therapist suggested that I get regular deep tissue massages (I'd love to if they lowered their prices, lol), and to try rubbing certain essential oils into the hip/thigh area. She also suggested that I try acupuncture. Her other suggestion was to sit on a tennis ball where the butt and leg meet to send blood to the area and to loosen up that area.

In light of all of this, I got very excited and a renewed sense of optimism that I may be able to forego surgery. After all, it seems like even if they fix the joint, I'm still going to have to deal with all this residual weakness and imbalances. But my husband brought me back down to reality with the simple, "it's all necessary, but it may just be postponing the inevitable...you may still ultimately need to have the surgery to correct the joint." Maybe, but either way, I want to do EVERYTHING I can do to strengthen and heal on my own first. No regrets.

I saw one of those inspirational questions the other day that asked if you could change one thing about your life, what would it be. I would normally answer that question "lose weight" but I realized something was different when that no longer felt like the honest answer. I AM losing weight (approx 13 pounds so far). I still have a way to go. But my new answer to that question is "heal my hips." I want this done and far behind me. Is that too much to ask?

A nice surprise

My car battery died while I was at the office yesterday. That was annoying, but AAA came and jump-started the highly corroded battery. They wanted to sell me a new battery for 3x its value. I declined. They told me to run the car for 10 minutes. I drove home to grab a bite to eat, and left the car running for 15 minutes. But that wasn't enough time, apparently.  When I tried to leave, it was dead again. 

So rather than calling AAA again, I called the dealer around the corner and asked them how much a new battery   and installation would be. Again, too much. So I called my husband who agreed to pick up a new battery on his way home, and I dusted off the ol' bike. I haven't ridden it in several months and the tires both needed air. But I did that, and rode it back to work. 

That horrid pain in my left leg went away! My right hip felt open. What an unexpected surprise! Granted, the ride wasn't too far (1.5 miles). But to put it into perspective, this is only the second bike I've ever owned and it's a basic mountain bike from REI. My first bike was the one I rode as a child, no gears, no hand brakes, etc. So I'm not exactly a proficient biker. Figuring out how to put air in the tires, thus, was something of an accomplishment for me! 

So I drove the bike home and also had no pain. I woke up this morning with some serious soreness where my butt met the seat. I know they make padded shorts for biking, but seriously -- either I'm doing something wrong in how I ride, or true bike-riders must literally have buns of steel. But other than that soreness, I feel great today. 

What a great surprise!

Not again!

I had a wonderful Labor Day weekend with my husband. We went wine tasting and had a great time. But unfortunately, my hip pain returned with a vengeance. And not just in my injured right hip. My left hip (and associated muscles) are tight, spasm-ing, and all together consistently awful. Again, it's nearly all I can think about. I want some relief and I want it soon.

But most of all, I'm just disappointed. I really hoped that my two-month improvement was the start of a trend. That I would be able to avoid surgery altogether. Now, I'm not so sure. And I'm devastated.

I filled out some paperwork about my injury the other day and it made me re-evaluate what I did before I was injured and how my life has changed post-injury. The reminder of just how limited I am (i.e., the activities I don't bother participating in, the way I decide if I do want to do something) really hit me hard.

On the upside, my injury is making me more conscious of all of the people who are out there freaking out about various procedures and health issues.  My dog recently passed his AKC Good Canine Citizen test and I'm looking into various programs at hospitals, etc., to volunteer our time and help use my dog's amazing gifts in a therapeutic way.  The group I'm most impressed with however has their own testing and evaluation process, so it looks like it will take some time for me to get started. But I think it will be worth it.

Experiment - Part 2

So it's been 24 hours since my Pilates experiment. Drumroll please.....the result is that I am not sure if I can do it or not. I know, pretty anticlimactic. Basically, my sciatica (I think that's the muscle in my butt that was spasm-ing but I'm not sure) bothered me off and on for the remainder of the day. I rolled it out with a foam roller in the evening, and that helped somewhat, and I iced it twice, which also may have helped. This morning I woke without that pain (though the other side hurt a bit). So I don't know.

Could it have been triggered by the Pilates? Absolutely. Could it have been something else? Sure. Am I scared and did I go into the typical worry-cycle assuming the worst? Of course. Will I give Pilates another chance? Yes, but I'll ease into it...I'll keep up with my physical therapy and take one day at a time. And I'll wait a week before attempting Pilates again.

I wish this were easier and that there were some guarantees. I guess there are some guarantees, though just not the kind I want. I'm guaranteed that if I go out and run, I'll be in pain. I'm guaranteed that if I don't move, my muscles will weaken. That seems to be the extent of my guarantees at the moment. That, taxes and eventually death. You know what? Maybe I'm not so keep on guarantees after all :-)

Experiment

I decided to try to ease back into Pilates today and see how that works. The jury's still out but it was an interesting experience, so I wanted to share. I returned to my favorite local Pilates studio, Mind 2 Body, for a private lesson with Jamie. I considered resuming my work with a mat class, but ultimately decided that due to my special needs (i.e., avoiding certain positions that will aggravate the hip joint and my labral tear), that I'd benefit from some personalized assistance.

We started with some mat work with some modifications on leg positioning (i.e., not as large of a leg circle, bent legs at 90 degrees instead of straight at 45 degrees) to ease me back into the swing of things. Everything felt good so we went to the Reformer machine, which, if you've never seen one, looks like an ancient torture structure. It's actually a piece of equipment that was designed by Joseph Pilates, however, inspired by the hospital beds he used for rehab. (Most of his designs appear to be based on things patients had in the hospital).  I started with some leg work, modified to avoid the positions I know would hurt the groin/hip area. Everything went really well, until about 10 minutes into it, after we had switched to some arm action, that I felt a sharp knot in my sciatica/rear. I am not an expert in anatomy, so I'm not sure what the actual muscle spasm was, but it was deep inside the middle of my butt cheek.

So I alerted Jamie about the pain, and we stopped, I stretched, and when that didn't really help, we abandoned the reformer temporarily and did some exercises on another piece of equipment -- the Cadillac. A lot of rolling out the spine and stretching the legs. That seemed to help. The pain didn't disappear, but became much less prominent.

We finished up some work on the reformer on the short box (ab work) and ended with some work against the wall where I had to move my arms, but had to keep my back completely glued to the wall. Not easy.

So I'm still waiting on my body's verdict. I didn't experience any of the actual hip joint pain, which is thrilling. We'll see if it shows up later today though. I'm holding my breath a bit. I'm concerned about the butt pain I did experience, and am currently sitting atop of an ice pack to help prevent inflammation. I won't schedule another session until I'm confident that I can do this without aggravating the hip. But I'm hopeful. I think muscle pain is treatable, and maybe I'm just in need of strengthening a new under-utilized area. We shall see!

Tempting Fate?

I have been very concerned with jinxing my progress by explaining how much better I'm doing, but I've decided to tempt fate and share it. 98% of my day I have no hip pain. That is HUGE!!!!! The other 2% of the time is when I stand up from a sitting position. And it doesn't happen all of the time. I'm still trying to figure out how to avoid the pain when I stand, because I assume it has something to do with the angle of my leg, hip, etc. But I feel like a completely different person than I felt when I started keeping this blog a couple of months ago.

Physical therapy is a gift from God. It has to be. I've been able to exercise pain-free, and I'm able to see just how strong I'm becoming. I have been increasing the intensity of the exercises (larger fins for resistance, increased number of squats, faster walking/running). And the water exercises have the added benefit of working my abs and arms also. That sense of accomplishment I got from running -- the pushing beyond my own mental and physical limits -- I'm getting that again, but in the water. And I'm even starting to enjoy the water. It's been hot here -- over 100 degrees each day this week. The water is a wonderful way to workout.

I'm still following Noell's 6-week eating plan (http://pickorstab.blogspot.com/) and I'm not really sure how many inches I've lost or how many pounds, but my clothes are getting very loose. I'm wearing a shirt today that I haven't worn in years (literally). Same with my pants. I even bought a new pencil skirt 3 weeks ago that was quite form-fitting, and I wore it yesterday and it was baggy in places. So, I assume that the reduced weight is helping relieve the pressure I'm putting on my hips also. 

I still haven't really resumed much activity beyond the pool-based, so that's my next challenge. Can I maintain this level of comfort and reincorporate some of the other activities I so dearly want to do -- bike, pilates, walk, yoga? I won't tempt the fates with running. I'm sad about that. There's a Keith Urban song, Till Summer Comes Around, and he's basically frozen in this place where he had a perfect summer love and hopes she'll return each year...she doesn't. He can't leave. I kind of feel like that's me and running. I fell in love, head-over-heals, and (due to my hip), running has said goodbye. I'm still wishing for it turn return to me, to give me the clarity of mind, the release of my over-busy head, the sense of accomplishment, etc. But I think I need to come to terms with the lost love and learn to love again. I'm seeing some shimmer of hope for a long-term relationship with the water.

I still don't know whether or not I'm going to end up requiring surgery. I know that the exercises I'm doing are not actually fixing my labral tear or FAI. They are just allowing me to function with minimal pain. I have a real concern that by not fixing the real underlying cause, I'm just postponing the inevitable, and when I do ultimately get the surgery, I'll have frayed more of my labrum, and caused much more damage to the joint. That is what is driving me to still meet with Dr. P and hopefully gain some more perspective. But at a minimum, I know that losing weight and strengthening my body is the best thing I can do pre-op anyway.

The rest is out of my hands. There isn't anything that this world can throw at me that I can't find a way to endure and of all of the possible things, this truly isn't that bad. Am I tempting fate? Maybe.

Doing well (for now)

I haven't updated my blog recently because I'm not sure what to say except that, for the most part, I've been feeling pretty good. I am definitely getting stronger, and have been increasing the resistance of my ankle fins during the pool PT sessions. When I do the exercises on my own, because I don't have the fins, I've increased the number of reps I do. I have added in-water squats to the mix and some stepping exercises also. I've been having a really hard time with the straight-legged walking motion in that my legs kind of wiggle through the water. Jenn (my physical therapist) says that it's because I have extremely weak gluteus medius muscles. That is the butt muscle on the side, so it makes a whole lot of sense that its weakness has been making me compensate with other muscles, etc., and that's why my IT band is so darn tight.

I've been doing my pool PT 3x/week, and my land-based PT exercises the other 4 days. Additionally, I've thrown in some swimming and some walking, both of which are mostly comfortable. Last night, for the first time in over a month, I tried my easy 20 minutes Pilates mat video. I definitely am tighter in my legs than I used to be, but with some modifications (bending my legs slightly), I was able to get through the DVD without any pain. No pain a few hours later, but I did stiffen. This morning, I had no pain, but was tight. So, next time, I'll make sure to stretch but....yay!!!!

I admit though that I'm still concerned. My hip is constantly clicking, and I still get the occasional blinding pain when I stand up. I'm getting a little more careful in how I stand, so that I evenly distribute the weight, and I'm wearing better shoes, etc., so that pain seems to be less frequent. But it's frustrating to know that any step could be the one that hurts.

I don't know if the reduced pain is the result of my PT or my weight loss, or both. I haven't lost a ton of weight, but I definitely have lost some and my clothes are getting much looser! I have a strong but highly unrealistic dream of losing all of this excess weight and finding that my hip stops clicking and I can run without a problem. It's silly, I know. It's not like the bone will reshape itself.

I'm feeling a weird mental challenge at the moment. The stronger I get, the more excited I feel and the more I want to try doing the things I was doing before I was injured. Of course, I know I can't, and that makes me very sad. And I'll have random moments throughout the week where, for no apparent reason, I just burst into tears at the utter uncertainty and the pain and the frustration, the why me's, etc. The waterworks don't last for long, and they sometimes are empathetic tears when I read someone else's blog posting. But one surprising thing has helped me over the past few days --  I discovered the story of Job this week. That story definitely struck a chord with me...I'm clearly not the only person who has ever wondered why rotten things happen to good people.  And it helped me come to terms with the fact that I don't understand why or how I ended up with a mis-shaped hip, and that I don't know what will happen (in terms of whether I'll need surgery or whether I can postpone it indefinitely with the pool PT).

But I'm seriously lucky. Things could be so much worse than they are, and I have so many good things going on in my life right now. In a few weeks, I'll be celebrating my five-year anniversary with my husband. I've got some of the greatest friends in the world. I enjoy the work that I do, and especially the cases where we get to help employees who have been victims of harassment, discrimination and/or retaliation. I may not be saving the world, but I'm trying hard to make it a little more decent of a place to live in.

Payoff

I'm still impressed with myself for returning to the pool to complete my PT on my own yesterday, and finally, I feel like maybe it's working. I woke up this morning feeling stronger, more stable, and sans pain! Don't know how long it will last (or if I'm jinxing myself by writing this), but I'm pretty excited.

But alas, this morning did not go exactly as I had planned because I awoke to an unfortunate surprise that one of my dogs left for me in the kitchen (ewwwwwwwww). BUT, since I'm in the mood to see the silver lining, in order to clean it, I had to do a lot of bending and scrubbing, and that did not seem to aggravate the hip!

Commitment

I realized today just how strong my commitment is to trying to heal my hip (or rather, strengthen the area and hopefully avoid surgery) by the pool physical therapy program. I got a late start on the morning and can't even put into words how much I didn't feel like going to the pool. I wanted another 10 minutes of sleep. A large coffee. Anything but having to actually go through the exercises... much as I love being able to do some exercise, I still don't particularly enjoy pools because the process to exercise at our public pool takes forever.

But I did it anyway. I went to the pool, later than I had planned, but I got there and started my routine. I was doing pretty well 17 minutes into the exercises when a lifeguard came over to me and said that the pool was closed. Closed? Yes, I know I was running a bit late, but it's 9am on a summer day. "When do you reopen?" I asked. He said at 11. So I had to stop my exercises and leave.

I decided that I really needed to finish my exercises, so I went back to the pool during my lunch hour. It was swamped with children of all sizes. It never ceased to amaze me how people so little can make such enormous waves, kick the water so hard, and displace so much water. But I found a "safe" little corner in the deep end and finished my entire set of exercises. I didn't start over from the beginning because I didn't want to overwork the muscles, but I did my first set again to warm up my body. I think that was a good idea. I started to have some pain while I did the exercises, so I backed off of the intensity and I focused hard on my form and squeezing the correct muscles.

I got a lot of curious stares but nobody pestered me. Of course, people don't tend to approach people who are wearing headphones. The music in the water is a good thing and a bad thing. I have a tendency to want to push harder when certain power songs come on. I have to fight that urge. BUT, it keeps the pool exercises a little more enjoyable, and that helps me actually get going. Yay for fun!

I'm proud of my commitment. At the end of all of this, if I ultimately have to undergo surgery, I want to look back at my effort and know that I did everything I could do to the best of my ability to help get better. Beyond that, it's out of my hands.

I tore my labrum AND my jeans

Before you start with the fat jokes, please realize that my jeans were actually quite baggy. But sadly, the universe decided that I dress too sloppily and ripped my jeans. The damage is irreversible :(  Why do I think it's a message from the universe? Well, I don't really. BUT, I had been shopping most of the day to replace my horribly tattered and size-inappropriate (for once, too baggy) wardrobe.  I found some very sharp ensembles and felt quite sophisticated when trying on what became my new purchases. But the contrast of what I purchased with the way I was dressed was actually somewhat funny (and sad). So, I just happen to have an unwearable pair of jeans and a whole shopping bag of fashion. I guess I'll just have to wear the classy looking stuff! :-)

I had a great weekend and somewhat of a semi-local, semi-vacation. I did my pool PT exercises on my own at the pool at the hotel in which my hubby and I were staying. I had purchased my very own floatation belt for the occasion (and future ones) so that I could do my exercises without having to sacrifice form while trying to stay afloat. It mostly worked. The deepest portion of the pool was only 5 feet. I'm approx 5'3" so I did scrape the bottom once or twice. But I got through all of the exercises. And if I thought I got stares during my electric cart ride through the airport a few weeks ago, ha! Everyone stared at me with looks that said, "hmmm....should I keep my kid away from this nutcase or not?" Whatever. I had fun and felt pretty good.  I had some pain later in the day when I was sitting in my car for a while, but the pain was primarily in my left hip. Weird.

I had PT again this morning. This was the first time that I've done the exercises in the pool that I've felt real pain when I did them. But the pain was a little unusual for me. It felt like it was in my right groin and front of the leg, but it also felt like it traveled down toward the knee. It wasn't the sharp awful pain I'm used to, but rather, was like that horrible feeling you get just before you get an horrid muscle cramp. Pervasive and all I could think about. We stopped the exercises and Jenn helped me stretch my quads and that helped the pain dissipate, though not dissapear completely. She also spent some time on my extremely tight IT band. Thankfully. The pressure on it hurt so badly but in that good sort of way that tells me it's effective. And I reduced the intensity of all of the exercises I did. But then I really felt like I wasn't doing a whole lot of anything. She assured me that I am, but I shouldn't feel any pain from these exercises.

I did get a couple more exercises to add to my list, including a quad stretch, and the best glutes exercise. For that one, you grab the wall and extend your body, front down so you're floating on the water. Then you do a sissors motion with your legs, straight, moving slowly and strongly and squeezing your butt. The legs press down through the water, so you work through all of that resistance. We do a bunch of sissor motions -- but this one is the only one I've done face down rather than "standing" and I think it's much harder to do. But that's probably because I have not developed these muscles as well as others. That's the coolest thing about doing exercises in the water. It really shows you where you're weak. It's obvious because you'll literally spin toward the side that is stronger. It feels like I'm canoeing with one paddle sometimes. And when I'm trying to move my leg straight and forward, sometimes I'll bend, or swing it outside of the frame of the body before I can get it realigned. It's weird because I do that when I walk also, but because the motion is so much faster out of the water, it's hard for me to really notice it or correct it. I wish I had learned these water-based exercises before I had even started to learn how to run. I would have been so much stronger. It's the best cross-training I've found yet.

I heard back from Vail.  Dr. P wants to meet with me and have me do another MRI before he decides whether or not to operate. I suspect that he'll also do that injection thing to isolate the problem and see whether it's just the hip or if the back side pain is coming from something else altogether. But he can't get me in before December. AND, that's only tentative until October when they finalize his December calendar. So my date might get moved (so no purchasing airplane tix quite yet). BUT, I have 14 pages of forms to fill out and return in the meantime, and I will definitely have an opportunity by then to see what kind of progress I can make with the pool PT.  Fingers crossed!!!!

Feels like someting else

Well, I'm experiencing firsthand proof that the "recovery" process (if that's what you can call what I'm doing....it's more like "precovery") is a lot of stepping forward and moving backwards.  I went to stand up after sitting for a few hours, and that blinding pain from the groin to the side of the hip prevented me from completing the motion. Worse even, the pain was in both hips and was most severe in my "good" hip. It is coming on in the same way as might right hip pain did. I assume that if, ultimately, the water PT helps the right hip, it will also help with the left hip pain. But if not, I'm not looking forward to the prospect of going through this whole cruddy process for two surgeries. 

Sigh. I guess one step (literally) at a time. Maybe this pain is reasonable to expect after the horribly sedentary month that preceeded it. I'll see how I feel tomorrow. Looking forward to "swimming" with the pull buoy and giving the hips a rest since I know they worked really hard this morning.

Feels like dessert

Physical Therapy this morning was mostly familiar this morning, with a few key distinctions. 1) I got to work out in the middle of the deep end, tethered to the wall so I wouldn't float all over the pool, 2) I got to work with ankle fins for additional resistence, and 3) I got to experience dessert! No, they didn't feed me. No, I didn't burn enough calories to actually justify dessert. BUT, when I was finished with all of the PT exercises, Jenn strapped some weights around my ankles, gave me additional floatation devices, and send me to relax in the deep end. She said I had earned some dessert. Now, back in the day when I actually used ankle weights for working out, probably the last word I'd use to describe them was dessert. BUT, in the water where my top half is kept afloat and my bottom half is pulling down, it gave me the most marvelous stretch and opened the hip joints. I got to hang out like that for 10 minutes! Initially my muscles in my butt and thigh were trying to hold on tight and were tense figuring out what was going on. But I finally relaxed into the stretch and it felt soooo good. I just wanted to stay like that all day. Sadly, I couldn't. The transition to gravity was dramatic, just like it was on Wednesday, but a little less jarring because I was expecting it. Since PT, my hip has been a little twingy, but no severe pain. Fingers crossed!

Not the end of the world

I won't lie...the blinding pain I had last night scared me and sent me through the whole spiralling thought-process about the futility of PT and the ultimate result of surgery, and concern that I haven't heard back from Vail, etc. etc. So I was really scared to wake up this morning and see what sort of pain awaited me. I felt a little twinge when I rolled over in bed, which I promptly ignored and snoozed through. But eventually I couldn't put it off any longer and I scooted myself to the edge of the bed and stood up. A quick systems check, and voila, no hip pain. (A little muscle tightness though, and I think my IT band is still pulling on my right knee). But I took a large sigh of relief, and went through my morning routine. Fingers crossed that I get through the entire day pain-free!

And a set-back

My enthusiasm may have been a bit too early....

This evening, I bent over to get something out of a bag that was on the floor, and when I went to stand upright again, I got the sudden sharp, excruciating pain in my hips. It was actually much worse in my "good" hip (the left one), but it was definitely present in both and I had to hold onto a chair for support. It went away within a few seconds.

This is the first of that degree of pain I've had now in about a week and a half. I'm so disappointed. But it may have been the angle that I was using, or maybe it was the fact that I stiffened when I was sitting for a while before that. Maybe it was the angle I was sitting on the couch. Maybe it was the fact that I worked out harder than I have in a few months. Maybe it's the fact that I have a torn labrum and FAI.

It's now been 2 weeks and I still haven't heard from the scheduler at Dr. Philippon's office. I fear that although the PT may help, I'll ultimately need the surgery and I certainly want to move ahead so I'm able to pursue that option. I guess I'll call the office tomorrow if I don't hear from them by mid-day.

Why can't things be easy and straight forward?

Pool Therapy First Session

Today I experienced my very first pool physical therapy session. Let me preface this post with the fact that 1) I've never seen, let alone been in, a therapy pool before, and 2) I had previously looked at some exercises in a book for water workouts and after completing these exercises, ended up in quite a lot of pain for the following week.

I had to shower before getting into the pool, which I think is pretty typical, except that I was early, so once I was wet and freezing, I had to go sit in the waiting area by the side of the pool for 5 minutes. Next time I'll try to time it better. But then I was invited into the water to do a quick warmup. There was a waterproof wheelchair that I didn't need to use, but that I was impressed was even made, and a ramp with a handlebar that gradually let you enter the pool. I used the ramp and was very pleased to find 92 degree water. Fabulous.

Along the perimeter of the pool were two handlebars which reminded me of the bar on the wall of a ballet studio. My physical therapist, Jenn, had me "warm-up" by walking forward, backward, and side-to-side across (and back) the shallow end of the pool. Then, she secured a floatation belt around me, and taught me a whole bunch of exercises to be done at the side of the pool in the deep end. I started out with a "deep run" for 2 minutes, followed by a "power walk" for 2 minutes, followed by "flies" (hello adductors and abductors!) for another 2 minutes. I did three rounds of these exercises, followed by a minute each of "quick scissors," "abdominals" (i.e., keeping my body steady with the bar and bringing my knees into my chest), "bicycle" "straight-leg deep" (i.e., similar to the challenging exercise I've been doing on land), and "scissors" which is like "flies" but I'm at a 90 degree angle and can't let my butt fly away from the side of the pool. Then I do some stretching, (hamstring and thighs). Then I moved into the shallow end to do some leg raises (lateral), leg swings (forward), leg circles (lateral), knee swivels, quad extensions and hamstring curls. That was a lot to remember, so I got a laminated card (so it can get wet and I can bring it with me to the pool) with pictures of the exercises and instructions on how many of each to do.

Basically, it took me 45 minutes, but without the instruction in the future, I think it's about 30 minutes of actual work. There were a few exercises that I felt immediately, and a few more that were somewhat challenging, but I asked Jenn a few times if I was doing something wrong because I didn't really feel it. She checked my form, chuckled and said I am doing it right. She told me that we'll eventually add resistance, but she wanted to make sure I learned the exercise and had the right form during this session, and see how I do.  But I didn't fully comprehend her chuckle until I got out of the pool.

YOWSERS!!! Gravity hit me and I felt like I had just finished boot camp. I got a phenomenal workout. And apparently, when I had previously tried to do exercises on my own, I did them completely wrong. And, given that I have difficulty gauging my effort level in the pool, I had completely overdone it too. So working with Jenn was VERY helpful and in order for me to not do anything stupid on my own, I made sure to check and double check what I'm "allowed" to do on my own, and how often. Here's what I get:

• I can swim!!! (No breast stroke, that'll hurt my hip). BUT, I don't HAVE to use the pull buoy as long as I don't have any pain (though I can use it if I want). No pushing off of the side of the pool though. No swimming on days that I do my pool PT exercises. 
• I should try the pool PT program on my own 1x this week. (That'll be Sunday or Saturday probably). I shouldn't do it every day, and since I've got PT again on Friday, that means tomorrow is a swim day or rest.

So, I'm pretty excited. She told me to take it easy on the duration, but pay attention to how I feel. I think that given how hard I worked my legs today (and my abs, wow), I will probably go ahead and focus on my upper body tomorrow and use the pull buoy tomorrow so I can be at top form for PT on Friday. 

YAY!

Prescription PT

I decided to try Dr. Klapper's suggestion and do a water-based physical therapy program. I met with the physical therapist last week for the initial evaluation where she put my legs through a variety of strength and range of motion tests. Not quite surprising was the fact that my right leg was weaker and had less range than my left in nearly every aspect. I was given 5 land-based stretch/strength exercises to do on a daily basis. I am finding that, if I do the exercises correctly, they're challenging. If I cheat and use other muscles than the intended ones to accomplish the result, they become very easy. That tells me that I've really been compensating for some muscle deficiencies (but they're still there).

I've been watching what I've been eating with particular care this past week. I had been seeing a nutritionist who gave me guidelines to a healthy diet (which I had been getting increasingly less careful following), until last week, where I coupled my nutritionist's advice with a 6-week challenge, courtesy of Noell (http://pickorstab.blogspot.com/), whose challenge essentially mirrors the advice I've been given from my nutritionist! With the combined burst of motivation from the challenge, and some helpful accountability from my nutritionist, my sister and my hubby, I lost 4 pounds last week! And (maybe coincidentally), I haven't had much true hip pain this week. Only a few twinges. The discomfort I have felt this week has been entirely muscular -- things are so tight, especially my IT band.  But the muscle pain is actually much preferable to the joint pain because that means there is something I can do to make it better! I believe that PT will help me strengthen and lengthen the muscles around my hip (and hopefully all over). 

I'm so ready to start my pool-based therapy, but my first in-pool session isn't until Wednesday. Grr. But, in the meantime, in addition to my land-based exercises, I went swimming on Saturday for 20 minutes. The public pool was packed for a swim meet, so I ended up driving to the gym and using the pool there. But that pool didn't have any pull buoys, so I had to constantly remind myself to take it easy with the excessive kicking. But I didn't remember not to squat and kick off of the sides of the pool, so about 18 minutes in, I realized that I probably did more damage from that repetitive motion than I did from any kicking of water. Darn. But I got an incredible massage that evening to help loosen the muscles in my butt and hip and outer thigh and I think it helped a lot.

I feel really good today. Not just because my hip is not hurting (though it doesn't feel quite normal), but I have a lot of energy and I'm just excited. I don't know why I'm excited, but I think it's the first time in a while I truly feel hope. I also feel fear of feeling hope, but that's not really productive, now, is it!?!

I think that my biggest challenge this month will be sticking to what I'm instructed to do, and not overdoing it and pushing it. I walked my dogs yesterday, and it was a relatively short walk (though the first I've done in a while). I felt good and I wanted to keep going and thankfully, Noah reminded me that I should stop when I feel good, not when my hip is throbbing. So I did. And today, I feel like I can do it again. Maybe I'll add on another minute or two. But I don't seem to be good at self-moderation. Hence, my injury in the first place.

But I have a new healthy admiration of the human body. And I want to treat it with the respect it deserves and not treat it like a trash can I can throw whatever junk I want into and expect it to run properly. I have this amazing vessel I've been given in which I can explore and experience this life. And, in a weird way, I'm grateful for the hip injury. It is the only thing in my life that has really given me pause to truly think about the body I've been given, not as simply a superficial how-do-I-look kind of thing, but as a gift. Had I not injured my hip, I may still be running right now. But I'd otherwise be continuing down the same unhealthy lifestyle. I have a feeling that, for the long run, my hip pain may have been the wake-up call that saved my life.

Too Good To Be True?

Ok, this is going to be a long post. This morning I met with another local orthopedic surgeon, Dr. Klapper, who is the Director of the Joint Replacement Division at Cedars-Sinai here in Los Angeles. I had an idea of what to expect from him because I read the book that he wrote entitled Heal Your Hips, in which he advocates non-surgical approaches to hip recovery and hip well-being. He only advocates surgery when the conservative approach fails. But what I like is that his conservative approach seems to be a joint pool and land therapy program. In his book, he discusses the downward cycle of hip pain, how it causes people to move less, and that lack of using the hip joint (and replacing the fluids in the hip) actually causes the hip to stiffen and results in more pain, when thus, makes you even less active, etc.

He looked at my films and the MRI and arthrogram reports, performed a physical examination of both of my hips to see at what point in the range of motion I have pain, and then he showed me on my x-ray where the extra bone portion is located and explained to me how that is bumping into the labrum. He said that it is FAI. BUT, unlike the other surgeons who have looked at my films, Dr. Klapper did not believe that I have mixed-FAI. He saw the evidence of it only on the ball, not the socket. If he's correct, and the portion of the socket were shaved down, there's no question it would make my hip unstable. So who is correct? YIKES! And ultimately, I'm not sure anyone can be 100% sure what's going on simply by looking at these films. I assume once I'm cut open, it's a whole other world and they'll actually see what is what.

But Dr. Klapper said words that I didn't dare to hope to hear:  "I don't advocate surgery for you, and definitely not yet."  Given the fact that this past week I've been nearly pain free and given that I have almost full range of motion, he suggested that I learn the pool therapy exercises and see if we can keep the pain from returning while slowly reintegrating activity into my life. He said that my labral tear was small and that although some surgeons will scare the crap out of me, tell me they need to cut sooner than later or I'll end up with early on-set of arthritis, they simply don't have the conclusive studies on that. Will I get arthritis? Maybe. But can I make some modifications to my lifestyle now to postpone it for many years? Possibly.

But Dr. Klapper said the words I dreaded -- that running is the best activity for mood, stress regulation and weight loss, etc., but the absolutely worst activity for your joints. He wants me to give it up completely. No running ever, unless I'm being chased.

At first, I immediately rejected that suggestion. And then I really thought about it. I'm not a professional athlete. Until last year, I wouldn't have even called myself an amateur athlete. A little over a year ago, I'd have never even considered running to be enjoyable. Now I adore it. Maybe I could feel that way about a different sport that is less taxing on my joints. I love to exercise outside. Okay. But I can swim, walk, and bike outside.  (Once I'm feeling better). I absolutely LOVE pilates. The mat work, at least, is not high impact. (Actually, I don't think it's impact at all, it's just the bending motion that was irritating my hip). If I want to do marathons or half-marathons, many of them allow you to walk. And I know first-hand, walking 26.2 miles or 13.1 miles is no easy task. What is it that I want long term? To be a fast runner? To complete Boston? Or to have a lifetime of mobility, activity and good health?

I keep hearing horror stories of complications from surgery. If you dislocate a joint, it's my understanding that that joint will always be a little less stable than it was before the dislocation. But that's what they'd do (to some extent) to get into the labrum to repair it. There are simply no guarantees with surgery, no matter who is doing the cutting.

Is it realistic for me truly to live a life with FAI and a small labral tear with minimal pain and moderate activity? Who knows. It certainly seems like I've got nothing to lose by trying. The pool therapy sounds like a really good idea to try because it's non-impact and I'll have someone trained to explain the exercises and watch me to make sure I've got the right form.

He wants to see if I've got any improvement in the next 6 weeks. Either way, I wasn't planning on having surgery then, so I don't see why I shouldn't give it a try. And if I ultimately need surgery, I'm still waiting around for a call from Vail to set a surgery date. And if I don't end up needing it, I don't end up needing it. Still, I don't want to get my hopes up. But if I could have a week like this week every week for the rest of my life (and I mean that level of comfort while doing activity, not while sitting around), I would definitely forego surgery.

But two conflicting ideas are swimming through my head, both trying to answer the question of why was this week so much better than the last bunch? 1) I did very little activity of any sort this week. That makes me concerned that once I kick up the activity level, I'll go right back to the pain. 2) I ate better this week than I have in months. No added sugar, no alcohol, no processed foods, regular healthy snacks and small healthy meals. Lots of water. I'm sure I've lost a few pounds. Maybe my excess weight is really a huge factor that the surgeons are awkward about calling my attention to. I know that FAI and the labral tear won't go away. BUT, maybe without the extra body weight, the pain would go away. There's only one way to know for sure, and it's about time I shed this fat!

My First Hip Surgery-Related Nightmare

I tend to have nightmares when I get stressed about things. So I'm not at all surprised that I had a nightmare about hip surgery last night. But upon a bit of reflection this morning, I found it sort of funny.

Basically, I went to the hospital to have the surgery, having never met the surgeon. They prepped me and suddenly I panicked. I wasn't sure, if I didn't speak with the surgeon, if he'd know which hip he was supposed to operate on. I was told not to worry about it...to just draw a smily face on my right hip, and they'd know what to do. So I responded, "but shouldn't I at least meet the surgeon before you guys put me under?" I was told that this was purely routine and if there were a problem, I'd be introduced. But then I had to wait, wearing a thin blue surgical gown that did not keep me warm at all, and they told me that the surgeon was running behind schedule, and that I should just spend the night at the hospital, and they'll get around to performing the surgery at some point during the night or early morning. So, I held my husband's hand and I fell asleep.

And then I woke in a cold sweat, freaking out and wondering why I would let my dream-self progress so far into the surgical process without having met the surgeon.

Some News!

Ever have a problem that you can't wrap your head around, and that no matter how hard you think about it, you can't make any progress? You know that irony when you finally stop thinking about it, and suddenly the answer comes to you? That's pretty much how things seem to be working for me on this hip thing.  I finally accepted that I can't do anything to rush the process and I will just make the best of the time I've got during this waiting process, and I got a call from Dr. Philippon's office yesterday!

I can't remember the name of the guy I spoke to, mainly because I was so excited to hear from them at all that I don't think my brain was working at it's normal capacity. But he was nice, patient and explained a lot. He confirmed that my MRIs showed both a labral tear and mixed-FAI. 

But best of all, he asked me all sorts of really good questions that showed that he (or someone there) had read my incredibly long narrative of all of the information I thought that they should know about my medical health in general and the discovery and development of the hip pain. They asked me questions that showed that they were not just looking to jump in and fix the hip, but wanted to ensure that nothing else could be causing the pain, or that my other medications and/or complications from PCOS could be contributing factors. It showed me that they're looking at the body more as a system, than as a butcher might. It gave me some confidence.  It also gave me a little more confidence in my local surgeon's diagnosis.

 As I expected, however, it looks like the process is a slow one. And there are still no guarantees they'll ultimately operate on me. They asked me if I had gotten any injections (to isolate whether the pain is actually in the hip or if it's pain in the lower back that I feel in the butt, etc.). I haven't. I don't know if they'll want me to do that. They also indicated that, since they're backed up scheduling wise and are already into 2011, I'll need to have another MRI closer to the date of the appointment (whenever that'll be). That actually makes me feel better -- I don't want them to be surprised if they cut me open. 

But 2011 -- that's not particularly quick. And I won't even speak with the scheduling person to book a surgery date until approx 2 weeks from now (which I am just going to assume will be closer to a month). So I am guessing that realistically, they wouldn't be able to do the surgery before Feb/March next year.  The guy I spoke with explained that they're very busy -- they get 150 requests per month from people like me, asking for a review of films, etc., and Dr. Philippon does approx 40 of these surgeries per month. Seriously, I don't know how those numbers add up. Does the man sleep? Are there enough hours in a day? And I thought I had a busy schedule!

They're going to look into whether there's any local surgeons that they feel comfortable recommending to me in case things get worse quickly and I don't want to wait. And I still have an appointment with another local surgeon I found on my own. 

But in the meantime, I feel pretty good. Not much has changed between Monday and today, and, in some ways, my life has gained a new level of uncertainty. But I feel good. I don't know why. Peaceful. Like I've gained some acceptance finally. I trust that I'll take the time I need to take to make the right decision for me. And the result is beyond my control and even beyond the complete control of a surgeon. But if I give myself a half a year before surgery, I have the gift of time, which may ultimately be a blessing in disguise.

I'll have time to really research everything and be as knowledgeable as I can. That should help me go into surgery with confidence, which necessarily will help me recover. I'll have 6 months to lose weight. For sure that will help me recover faster. Think of all of that extra weight that I won't have to feel pounding down on my hip joint. I'll have 6 months to save money -- which it seems I'll need a lot of if insurance becomes problematic. I'll get to plan ahead work-wise, and not spring a long recovery on my bosses. And I get to be as mobile and healthy as I can be. 

Yes, I'm still in pain. A lot of it.  But I'm finding ways to live with the pain. No -- I really don't want to live like this permanently. I really want the surgery. But I think I can manage for 6 or so months. I went swimming today during lunch. It was only 20 minutes and I used a pull buoy so I didn't kick with my legs. But I really felt great and it's the first real cardio I've done in a while that I haven't finished in more pain than I started with.  Though my arms may be yelling at me tomorrow! I had purchased a waterproof ipod shuffle case/headphones from H2O Audio, and it worked like a charm. That made swimming laps a lot more fun for me. (I don't know why, but I just don't find swimming particularly fun). But it's exercise, and I'll take it! 

And who knows -- after swimming for 6 months, and biking during recovery and ultimately running again, maybe in a few years I'll end up doing something I thought I'd never be able to do -- a triathlon!

 I believe that we humans are given such amazing gifts, including the ability to choose how we perceive the world around us. We can choose to view a challenge as a roadblock or an opportunity. We have each other for compassion and support. We can focus on what we wish were different, or make the most of what we've got. 

So maybe the only real thing that changed in the past 72 hours is the way I've begun to view the situation. I truly don't have any more answers. But I have a measure of peace. 

Outside My Window

My office is located right next to a park and the view from my window includes a grassy area where people take their dogs, two little league baseball diamonds, and a portion of a dirt track that circles the park. I've got two trees that hummingbirds enjoy visiting, and a small window sill where small finches come to leave dropping and peck my window. And in moments like this one -- where I turn my head and see a Yellow Jacket trying to come through -- I'm actually relieved that the window does not open.

The window (and its associated view) is what I love most about my office, and also, what frustrates me about it.  I love seeing so many active people on the track. In the morning, I see small groups of people performing "boot camp" workouts. As a dog person, I enjoy seeing the variety of excited furry four-legged visitors. My view of the baseball diamonds isn't good enough for me to truly enjoy watching any games, but I feel like there's a world of constant motion outside of my window, and that always makes me smile. I love the colors (primarily browns and greens), but I also love the way the sun's angle subtly changes those colors. And I love watching people run -- noticing the variants in form, expression, speed, companionship, etc.

But it's also easy for me to now see the track as a reminder of what I'm no longer able to do...and of what I wish I had done more...did I hurt my hip because I ran on asphalt and concrete most of the time? If only I had trained here on this softer ground, would I still be running this evening? It's so easy to second guess and let myself feel sorry for myself. But it's sort of silly and self-centered of me. I'm so blessed. Today, I saw two hummingbirds hovering only a few feet away from me. I'm looking at a beautiful blue sky and branches blowing softly in the wind. I live an easy drive from some of the most beautiful places I've ever seen. And I WILL get back out there and enjoy it all. If I can't run, I'll walk. If I can't walk, I'll learn to ride.

And I'll use that track as my symbol of where I've been and of what I aspire to do.

A view through my window

Uncertainty...almost as bad as the pain

The worst part about waiting to hear from other doctors so far is that I feel like my hip is getting worse each week.  It's no longer even just my right hip. My left hip has been popping, and hurts sometimes when I stand up. I wonder if I should start the ball rolling on that hip also, since, I assume, it's probably the same thing as what's wrong with the right hip. My unscientific theory for linking the two hips is that the pain in the left started at the same time as my right hip pain (though much easier to ignore because the pain wasn't as severe) and because it's also getting worse in the same way and the pain moves around in the same way. Or I can try to fix the right hip, and possibly live with the issues in my left. It really doesn't bother me nearly as much as the right. On the other hand, if it's a labral tear, I'm sure it will start bothering me more once I regain my activity. So maybe it's not worth waiting. Who knows. I suppose I should ask the surgeons about it.

But almost as bad as the increasing physical pain is the complete and utter lack of certainty about who, what, where, when and why.  Who will be doing the surgery? What surgery (FAI, labral repair, labral debridement)? Where (in-state, out-of-state), When (next month, the fall, the winter, 2011)? Why? Well, I know why I need surgery, but I link the "why" question with the "what" question. The answer to "what" or "which" surgery I need will necessarily depend upon "why" I need any particular procedure.

I called Vail for an update on Wednesday and spoke with Madeline, who as usual was incredibly kind, but let me know that I probably wouldn't hear anything until next week.  So naturally I'm bummed.  At this point, I'd just like to know if I'm looking at a 2011 surgery or something within the next month or so. I am going to have to take off of work for the surgery and some of the rehab period, and I'm sure I'll need to adjust my schedule somewhat as I return to work (with various PT appointments, follow-up visits, etc). How am I to plan around two completely distinct possible scenarios? And more than actual preparation, I simply have this nonstop nagging in my head about the five W's. It's like a broken record that I can't stop from repeating constantly.  And completely aside from the numerous questions about the surgery, I have as many about post-surgery. Mainly, how will my body heal?

I know I love to be in control and this feels a bit like a sick joke that the universe is playing on me.  But truly, how else can a person learn to surrender control and certainty than to be in a situation where she has neither?

Traveling Tales -- Swallowing My Pride

This weekend, I flew across the country.  I knew I had a layover at the Charlotte airport, which, most inconveniently, seems to spread its concourses as far apart as it possible.  Having literally run through the airport in previous trips (nevertheless missing a flight), I knew the airport would present extra difficulties for me these days, now that walking hurts.  Upon the excellent advice of my father-in-law, I spoke to the gate attendant at my gate in LAX, and let them know that I will need assistance at my connecting airport, and asked them to call ahead to have an electric cart waiting.  They gave me a form to fill out (with three carbon copies), and told me to give the top copy to a flight attendant when I board the plane.  I did.  However, the flight attendant, using somewhat of a rude voice, asked me, "What am I supposed to do with THIS?" Lovely.

So I didn't have high hopes when I deplaned in Charlotte, but to my surprise, the flight attendant had passed on the paperwork to a gate attendant, who had called for an electric cart.  I shared the cart with a guy who wore a huge leg cast and was walking with crutches.  I felt so self conscious, as if everyone who saw me on the cart was wondering why this lazy young lady was taking advantage of the electric cart system.  I had to go from the very end of terminal C to the very end of terminal E.  My embarrassment ended abruptly during the ride when I recalled exactly how large each concourse was. WOW.  I'd have been yelping in pain for the entire trip if I hadn't swallowed my pride and asked for assistance.  

The drivers of the carts (that's intentionally plural -- I needed two different carts because terminal E requires an elevator/stairs/escalator trip) couldn't have been nicer. I was expecting them to take one look at me, give me an angry look and demand to know my justification for the cart.  They're probably not allowed to do that.  But still, it was nice to get the help I needed without any big production.  I was in a bit of pain for sitting on the airplane for a while, but I was able to do enough walking (between my gate and the bathroom) to loosen up, but not so much that I overdid it. 

For future travel, I don't think it's necessary to arrange for transport up front, but it sure was helpful and did save me a lot of time and aggravation. I'm sure that each airport has its own way of doing things, but I feel a little less intimidated by the process. And as with the handicap parking spaces, it's good to remember that people need assistance for all kinds of reasons, and pain is definitely not always visible to others. 

Deciphering x-ray images

Picture time! Here are my x-ray images from the end of last year (from which I've cropped out the text). I think I understand a little better what might be the extra bony part on the CAM and Pincer, though I'm still far from sure. I've been trying to compare my pics with others online and I suppose that given my complete lack of medical training, I may simply be wasting my time. But I think it helps me to wrap my head around my hip issues when I can visualize the problem. This one is me with my right leg in a bent position:

And below is my right hip in a neutral position:

I'm not sure what to make out of any of this. I think I looked pretty much the same in the subsequent x-rays that were taken more recently. Here's the one with my right leg bent:

And here's one of my right hip in a neutral position:

So I'm not sure what to make of any of this. I looked at the x-ray of both hips, and decided that, in my lay opinion, the left hip looks as bad as the right one. That is, if I'm looking at the correct portion of the hip socket -- which I very well may not be. This is the left hip in a neutral position:

So, other than the fact that now my blog has pictures, I don't know what value any of this really adds. I'm not comfortable posting my MRI pics because I REALLY don't understand what I'm looking at, and for some reason, it seems a little too personal to share on the Internet. (But it's truly amazing and somewhat mindblowing just how much of our insides can be revealed through an MRI). 

Anyway, enjoy the pretty pics!

I met with the surgeon...and my head is spinning.

I don't know why I was so nervous to meet with Dr. Guanche this morning, but I was uncharacteristically anxious. I arrived 10 minutes before my scheduled check-in time, and about a half hour later, I was given the necessary paperwork to fill out. Needless to say, the office was incredibly busy this morning. I was finally called back to meet with the doc, and offered whatever combination of MRIs/X-Rays/medical records they wanted. (I've got both the films and the electronic images). The assistant made copies of the reports of the MRI and Arthrogram, and uploaded the images from the discs. Meanwhile, I was given some disposable shorts to change into, and I had a very short wait. I realized that even though I had printed out a long list of questions to ask, I had inadvertently left that at home, so I quickly tried to reconstruct that list. Then doc came in and introduced himself.

To his credit, he asked me to explain the onset of the injury and where the pain is. (Always an annoying question to me, since I feel like an idiot when I say, "I really can't pinpoint the pain. It seems to move around, sometimes in the groin, sometimes in the front, sometimes in my butt, sometimes on the side...I just don't know.") He asked me about popping/clicking, and I said I didn't know if the sensation I experienced counted (I get what feels like when you crack your knuckles, but in my hip -- no associated pain with that though). He seemed to think my description was useful. I tried to recreate it, but of course, that was the one time my hip didn't crack.

I really appreciated that he performed his own full physical evaluation of my hip pain (i.e., range of motion test, etc.) instead of reviewing and relying on the notes from my referring orthopedists. That gave me some confidence. And apparently I'm pretty consistent -- the same positions caused that searing pain with prior exams were the ones that made me cringe this morning.

He showed me some images from my x-rays and MRIs (not sure if it was the regular MRI or the arthrogram), and explained that, not only do I have a labral tear, I also have a combined CAM and Pincer FAI.This was what I feared. It suddenly feels like a much more serious surgery -- removing a bit of my bone!!! I'm not sure why that scares me more than removing some of the cartilage, but it does. It feels so much more structural. And I'm a little concerned that this is the first I've heard of that. Neither my MRI nor Arthrogram Reports indicated the presence of FAI. To the contrary -- my lay man's reading of the reports made me think that there was no indication. (The arthrogram noted "There are no morphologic changes of the acetabulum or proximal femur to suggest primary CAM or pincertype femoroacetabular impingement.") So, I'm scared, I'm confused and I'm concerned. Why the discrepancy? Of course, I didn't remember what was in the report while I was meeting with Dr. Guanche, so I didn't ask him about it. He did show me on the images where he thought the FAI was.  But when I looked online at x-rays of normal hips compared to mine, I just don't know if I see it.

I did my usual skimming of google and came by a website with a roundtable discussion amongst orthopods about FAI and how they're being diagnosed more often, and how 86% of labral tears are associated with combined CAM and Pincer FAI. http://www.orthosupersite.com/view.aspx?rid=40509   That made me feel a little better, that this isn't coming from left field. And that my combination is not particularly rare.

Dr. Guanche took time to answer all of my questions, and I asked him everything I could remember to ask. I did remember to ask him about his feelings about the Game Ready ice machine and CPM machine that I've heard so much about. He said that over the past few months, he's been recommending devices like the Game Ready machine, but that he still has concerns with recommending the CPM machine, because it requires you use if for 8 hours (and most of his patients don't have that ability to do so given the need to return to work, etc.) and that he's concerned that if you slightly adjust your hips, it can actually rotate the hip slightly (and I suppose do more harm than help). The rest of what he told me sounded like what I expected. He told me that he performs approx 250 of these surgeries per year. (I forget when he started, 15 or 17 years ago?) He said that of those 250, annually, there are generally approx 2-3 that need revisions due to complications (scar tissue, etc) and unfortunately there's no way to know whether you're going to be one of the few upfront. I asked a lot about the physical therapy protocol, and I liked the fact that some of my PT would be in the pool. He said within 6 months, I should be able to resume my training, and when I mentioned my love of pilates, was very enthusiastic about my doing it pre-surgery and then (when ready) post-op. He said there were a few positions that would cause me discomfort for now, but most of it should be doable.

He was definitely not Mr. Gloom and Doom with the risks and side effects of surgery. I assume all of that is detailed in the reading materials he gave me, and probably in the pre-op appointment when I'm sure I will have to sign away my life in various legal documents. But truly, I expected a little more of the this-is-a-risky-procedure kind of speech.

After meeting with the doc, I met with the person who schedules surgeries and deals with insurance companies. She told me that most often, insurance companies deny this surgery because they consider it "experimental" or "investigative." They seek pre-authorization, and if it doesn't go through, you can of course appeal it, they will write a letter, but most often, it seems, patients pay out of pocket, and then after the surgery, mail to the insurance company the records from the procedure (showing it was not unnecessary) and sometimes the insurance company will then cover the procedure. But it's not cheap. I got a quote for the facility and doctor, but not the anesthesiologist or any of the physical therapy (which would be 3x/week for 12 weeks, and which I'm certain is not covered substantially by my plan), and I already had sticker shock. It certainly gives me pause. If and when I decide to do the surgery, they would start the process with my insurance company. But I didn't set a date because I am still waiting to get a second (and third) opinion.

I realistically can't do nothing. I'm in way too much discomfort for that. And I'm prevented from doing so much. And for the things that I can do, the pain still gets in the way. It's a constant. But I'm particularly concerned about what happens if this is in fact, CAM and Pincer FAI with the labral tear. I highly suspect I already have a small tear in my other hip, and if it's a bone structure thing -- that makes me think I'll probably end up down this road again at some point trying to fix that hip too.

So, the best I can do is to continue to get more information, continue to try to be healthy and to take each day at a time. I look forward to finding out if the other specialists also think I have FAI.