What I learned about temporary handicap placards in California

I picked up my temporary handicap placard from AAA today (since AAA provides DMV services and in my experience is run much more efficiently).  I learned some interesting things about it that I hadn't known:

• I was given a form that designates who I am, my address, the ID number on my placard and the expiration date.  Apparently, I need to keep that with me (and with the placard).  If I leave the form in my car and take the placard with me in a different car and end up being questioned by the police about it, that will be a problem.  Good to know.
• Apparently, there's a lot of theft of these placards, especially by people in jobs such as valets, car washes, etc. So I was discouraged from keeping the placard in the glove compartment, and instead, to keep it in my purse.
• Cops apparently are not sympathetic if you place the placard on your dashboard instead of hanging from the mirror. The guy at the DMV warned me that they'll fine you $300 (or thereabouts) for the mistaken placement.
• Don't drive with the placard hanging from your mirror. (That one was rather obvious given its size. Hello visibility?!?)
• The placard allows you to park in on-street metered parking at no charge.
• The placard also allows you to park on streets where preferential parking privileges are given to residents and merchants (private off street merchant parking facilities may be restricted to customers and employees however).
• The placard allows you to park next to a green curb for as long as you wish. (Green curbs indicate limited parking times).
• Of course, you can park next to a blue curb authorized for handicap parking, or in parking spaces designated by that blue international symbol of access (i.e., a wheelchair). (That one I knew about also). 
• And, with the exception of gas stations that employ only one person, the placard also requires service stations to refuel at the self-service rates.

There are still the obvious normal restrictions -- no parking next to a fire-hydrant, no parking next to a red curb or where signs say "no parking", no parking next to yellow curbs or white curbs, or spaces that look like handicap spaces but have white crosshatched patterns (those are reserved for wheelchair and wheelchair lift access).

I am able to use the placard in anyone else's vehicle within California, so long as I have both the placard and the form that shows it's registered to me. But I can't lend the placard to anyone else if I'm not in the vehicle. Duh.

I feel uncomfortable having the placard -- like the designation makes my injury more official or something.  And I feel like I look like a pretty normal person, and for the most part, despite the pain, I'm not limping obviously.  I feel like I'll definitely be judged if I park in a handicap spot.  And the stupid competitive aspect of my personality is egging me to test my limits and try not to use it.  But I didn't get the placard for fun or to be lazy. I got it because I'm in pain, and because walking (at least for now) increases that pain.  So I'll suck it up and use it when I need it and I'll try to be a bit more compassionate before judging other people. It's not fun here on the other side.

As for hip news -- I called the office of Dr. Guanche again. Earliest appointment is in August. It's looking unlikely that I'll get to come in for an earlier appointment than the mid-July appointment I've got scheduled. No news from the Steadman Clinic or Dr. Phillipon. That's still expected, but I'd like to hear back as soon as possible of course.

I didn't try out the waterproof iPod Shuffle case and headphones yet because when I woke up this morning, the pain was pretty awful. My knees, especially, for some reason, also hurt today. Hopefully I can try them on a very simple workout tomorrow. I realized that the pool has floatation devices that are designed for your legs so that you can swim with your arms and not use your legs. I'm concerned that by squeezing my legs together that would actually hurt, but maybe not. I can try a lap and see how it goes.

Waiting. Sucks.

I'm not the world's most patient person.  I hate waiting for appointments.  I know that waiting two more weeks to see the surgeon means I have two weeks more till I can schedule a surgery.  Which means that the earliest I can schedule said surgery has also been delayed by two weeks (minimum).  I suppose there are many more problems that are of much greater significance.  But I'm anxious to get on my way to recovery.

I did manage to get the paperwork for the temporary handicap placard.  My general physician was able to sign off on it, having reviewed the extensive amount of documentation I faxed to him.  But of course, DMV services were down this morning when I tried to actually get the placard, so I need to try again tomorrow.

Yesterday, I ordered a waterproof case and headphones for my Ipod Shuffle (2nd gen) to keep me excited about swimming.  Of all of the sports out there, swimming just isn't my calling.  On the other hand, since it's pretty much all I'm able to do at the moment, I am desperate to find a way to make it interesting.  I'm hoping that books on tape or some good music helps.

So far I have been calling Dr. Guanche's office each day and trying to get an earlier appointment.  They keep telling me that I should keep calling back because people cancel all of the time, and, because they don't keep a standby list.  Despite my pleas of desperation yesterday, there were no earlier appointments and I'm getting concerned with how follow-ups might be treated and scheduled post-surgery with Dr. Guanche.

I haven't heard back yet from Dr. Philippon or anyone in his office.  But based on what I was told last week, I shouldn't expect to hear from them until Friday at the earliest, and, given the holiday, probably next Tuesday.

So in the meantime, I'm trying hard to focus on work and on anything other than the pain and the knowledge that I have a labral tear that I'm trying not to make worse. But it's like anything I tell myself not to think about....suddenly it's all I can think about.

Temporarily disabled? Me?

I realized over the weekend that things were getting bad when my husband (Noah) and I went to dinner and couldn't find parking that was close to the restaurant. When I got out of the car and put the weight on my legs, the assault of sharp dagger-like pulses resulted in somewhat of an involuntary but (I thought) quiet string of curses. Noah, who informed me that I wasn't nearly as subtle as I thought, asked me if I wanted him to just drive me to the door and then he'd re-park. Wow, unable to walk through a parking lot?  No, of course not.  I walked it (hobbled, more like) and reached the door, pain aching in my hips and knees. Brilliant. We spotted an empty handicap spot steps from the door, and I realized that post-surgery, I'm going to need to get a handicap placard while I'm injured.  I mentioned this to Noah, who asked the obvious: I'm clearly having trouble walking...why not apply for one in the meantime, especially since I don't know how long I'll be hobbling around before I can even schedule the surgery?

Did it really get that bad? Am I temporarily disabled? It's so strange for me to wrap my head around. I had no idea what California's requirements are for getting a temporary placard. So of course, I googled "how to get a handicap plate" and found a really helpful website:
http://arthritis.about.com/od/driving/a/handicapparking.htm

It provides some general information and then has a state-by-state breakdown of the requirements, forms, etc.  I didn't realize that I truly fall into the category of people eligible for temporary placards in California. I'm not sure what I thought (if I even had considered it at all) the requirements would be. But I thought at least a cast, walker or cane would be necessary to qualify a person as handicap. In the future, I'll definitely think twice before ever again judging anyone in a handicap spot who isn't "obviously" handicap. I'm still amazed at how strong pain can be from such a seemingly-minor injury. Which of course, begs the question, am I just a wuss? Do most "normal" people just suck it up and hurt while they walk through large parking lots with their hip injuries? Is my hip injury worse than I've been assuming?

So, I decided it makes sense to have the placard in case I need it, but of course, I can use it as a backup if I can't otherwise find parking that's close enough. Clearly there are people with greater needs than I have at the moment. So I figure that for the most part, I'll just park in the regular parking. But on a particularly gruesome day or where there's no parking to be found anywhere near my destination, it'll be helpful to have the placard.

But of course, I'm finding that obtaining one is not a simple process -- for me, that is.  The orthopedist who referred me to the surgeon won't sign off on it because he's no longer my "treating" physician.  And of course, the surgeon can't sign off on it until he actually sees me.  I've been calling every day asking whether anyone has cancelled and whether there are any earlier appointments available than my appointment two weeks from now, and so far no luck. So this morning, I swallowed my dignity and begged to at least see the physician's assistant so I don't have to wait two weeks to apply for this placard. They told me they'd see what they could do and would call me back. So far, no call, but I suppose I'll give them at least 24 hours.

My other option is to ask my regular internist to sign off on the paperwork. But I'm sure he won't do that without examining my hip. Afterall, I've been seeing orthopedists and I don't think he's even aware that I have any problem with my hip.

So I'm in a state of limbo. In the meantime, I suppose I don't need to go anywhere with a huge parking lot.

I read that water is supposed to help people with screwed up joints, so I worked out in the pool today, swimming laps, and doing some aqua jogging and walking.  The walking is HARD. Much harder than the jogging, because there's so much more resistance from the legs and arms. The jogging was no impact because I did it in the deep end. Nevertheless, I think I overdid it because although it all felt wonderful in the water, once I got out, it all came crushing down on me again.

And that's something else that I've gotten absolutely no consistent answer on -- how do I stay strong and fit while not messing up my hip with a labral tear? The stationary bike hurt like hell this weekend. So that's out. Yoga and pilates made logical sense but ended up hurting. Swimming may turn out okay, but the way I did it today certainly didn't work. Walking hurts. Heck, sitting hurts. I don't know what to do and it's driving me nuts. I called the surgeon's office and spoke with some assistant who told me to "just do what feels good. If it hurts, stop." Well, that makes sense, but I don't usually know how it really feels until after-the-fact.

How many doctors is too many?

So I looked at my schedule and realized that I had appointments with three local surgeons and one out-of-state surgeon.  That felt a little much, given that the originally recommended surgeon will likely be excellent, and my backup out-of-state surgeon is probably easily sufficient for a second opinion. Do I need a third? Or a fourth?

Ultimately, I may. But given that I haven't even gotten a single opinion yet, I decided that I should cancel the first appointment. Nothing against Dr. Snibbe. His credentials looked amazing, and he appears to have performed this surgery ample times. He appears to be board-certified, which sounds impressive, though I'm not actually certain what that title specifically entails. But given the great things I've heard about Dr. Guanche, the surgeon to whom I was specifically referred, I decided that I'd wait until I see him before going for a second opinion.

So I'm currently scheduled to see Dr. Guanche in the middle of July. I keep calling the office to see if they've had any cancellations, but the best I've been able to do is to move my appointment ahead by one day.

In the meantime, my pain has gotten worse and I'm miserable. I seriously am running out of patience and I just want to get my full range of motion back.  Dr. Klapper, another surgeon with whom I've scheduled an appointment (at the end of July) co-wrote an excellent book I've been reading on hip care (called Heal Your Hips). In it, he and Linda Huey provide a set of exercises to perform in water as well as on land. I'm looking forward to trying them out (though I need to copy and laminate the page or I'll ruin the book at the pool).

But I am concerned that maybe I should have kept my appointment with Dr. Snibbe. Seriously, how does a person choose a surgeon? Is it overkill to seek a second opinion? a third? a fourth? It seems indulgent to do so, but on the other hand, it's my hip. And I'm young. I want to maximize my chances of having the best possible outcome.

It's pretty scary.

Hassles of Gathering Medical Records

I'm currently in the process of obtaining copies of all of my medical records from the various doctors and physical therapist I've seen about my hip. So far, I've got most of the documents and all of my images (conveniently on disk).  But I wish I had simply asked for copies each time I visited each doctor. Then I wouldn't be running around the city, picking up documents, and returning for the ones they inadvertently forgot to include. One of the reasons I'm attempting to collect these materials is because I need to copy them and send them to Dr. Philippon in CO, but the main reason I figured I should have copies is that this is my hip. Years from now, who knows what further issues I'll have in either hip. But I can count on myself to keep all of my documentation for comparison purposes and general history.  I don't know how easy these materials will be to get 10, 15 years down the road.

Yesterday was brutal. The pain was so severe I could barely concentrate on anything else. Today, thankfully, it seems much more manageable. Each time I stand, it hurts, and I've noticed I'm limping slightly. I spoke with my mother-in-law, who recommended that I don't put off treatment because even though I might not realize it, I'm probably making adjustments in response to the hip.  Those adjustments might wear away or result in injuries to other body parts, such as my knees. That's a scary thought. But it makes a whole lot of sense.

I'm picking up a book at the library today on water therapy and pool exercises that should be hip friendly. I'm not a huge fan of swimming (I find it somewhat boring), but given the importance of staying strong and healthy, I'm willing to give it a shot. Particularly if it can help this awful pain dissipate.

I don't know how people live with chronic pain. And so many people do. How do they function? How can they put up with it? I don't know if I'm especially wussy, or if other people are exceptionally strong. I must have broken down into tears three separate times yesterday. And I truly believe my tear is a minor one. I don't know how I'm going to deal with this pain for the immediate future, much less however long it takes me to get the surgery and recover. But I suppose I can only take one day at a time.

I tore my what? How? So what now?

I've decided to start this blog (rather than simply adding injury-related posts to my marathon training blog) because it looks like I'm in for a lengthy, physically and emotionally exhaustive process. But as I've been struggling for answers online, I realized how helpful I found other individuals' blogs and message board posts, and my hope is that the information I share will provide someone else out there with a bit of solace and information.

Here's the abbreviated version: I injured my right hip at some point during my training for a marathon. I went from a pretty unactive 27 yr old to a marathoner in 4 months, overdid my training, didn't properly focus on stretching or cross-training or strength training, and ended up with excruciating hip pain. The orthopedist I saw ruled out a stress fracture, and the MRI suggested a possible labral tear but given how my symptoms were presenting at that point, tendonitis seemed the more likely cause of the pain. The MRI also revealed a huge cyst in my right ovary that might have also been possibly causing referred pain in my hip. I went through physical therapy, which helped a great deal, and I got the cyst removed. Ultimately, the pain persisted though it became very erratic and not always in the same exact location. It is severe sometimes when I get out of a car and put my weight on it, or when I go from sitting for a while and stand up. I had resumed running, and though it didn't hurt while I ran, it hurt more a few hours later. So I went in for an MRI-Arthrogram which revealed the labral tear. I don't have a medical degree and I haven't studied any science since high school, but from my discussions with my doctors and from google, as I understand it, the labrum is the protective cartilege in the hip socket. The tear doesn't repair itself and the pain comes from the piece of cartilage sticking out that's rubbing against the other side in an uneven way, wearing down other areas of protective cartilage. My tear appears pretty small and because my orthopedist doesn't specialize in the surgery, he referred me to a local surgeon who does -- Dr. Carlos Guanche. I haven't met with him (couldn't get an appointment until the middle of next month), but given that this is my only right hip, I decided it would be a good idea to do some research and find someone to give me a second opinion. That's where I'm at currently. I haven't met with any surgeons yet, but I'm in the process of figuring out who will be the surgeon I want to operate on my hip and arthroscopically repair or remove the torn labrum.

Here's some background for those unfamiliar with my story:
About 16 months ago (at age 27), I began training for my first-ever marathon. Prior to this, I was an occasional exerciser and certainly not a particularly athletic or fit person.  But I love challenges and I was doing this marathon to raise money for blood cancer research so I was highly motivated on both fronts.  Training went pretty well and I found I was most comfortable with short intervals of three minutes running, one minute walking.  I never had any hip pain while I ran.  But I did notice something unusual for me.  After sitting for prolonged periods of time, occasionally when I would try to stand up, or when I'd shift my weight to get out of a car, as soon as I put weight on my right hip, I felt an excruciating jolt of pain that would last for a few seconds and would dissipate as soon as I caught my breath and started moving.  Because the pain never occurred when I was running, I simply didn't associate the two events and because the pain went away so quickly, I just ignored it.

By the time we got into the really high mileage, I had missed one of our long runs due to the flu and when I tried to keep up with the training schedule, I decided that I could push the mileage higher than recommended, so long as I walked. So I did that. My hips hurt when I walked, but not the same kind of pain. Just the pain of having walked for 4 hours straight on sometimes hard and uneven surfaces.  By the time the marathon day arrived (after 4 months of training), I felt strong and I chose to walk the entire thing with friends. It was such an amazing feeling to cross that finish line that I was hooked and signed up for a half marathon in the fall that I aimed to run.

So two months post-marathon (I tried to take it easy but may have taken it a bit too easy), I started to amp up my practices and added strength training and cross-training (which, of course, I should have been doing during my initial marathon training). I was determined to run/walk the half marathon and beat the time from my previous half marathon that I did during my initial marathon training.

Two weeks before the half marathon, I made some pretty bad choices with my training.  I did a nice 9-miler on some big hills at Griffith Park and really felt the impact going downhill but ran through it anyway.  A day or so later, during my strength training, by the end of my circuit workout I had completed approximately 200 squats and 200 lunges.  The following morning, I did a vigorous 5-mile hike with walkers who were much faster than I was and I tried hard to keep up.  Knowing I had 13.1 miles to do about 10 days later, I figured I would just rest my legs and do nothing until race day. Brilliant plan. So that's what I did.

Of course, race-day didn't go as planned either, and I ended up in the wrong pace to start and basically sprinted the first half mile. I ultimately beat my time by 45 minutes (yay) but then I did something even more brilliant.  I sat in a car for 6-7 hours. Needless to say, I could barely move when I got out of the car. 

This was October 18, 2009.  I had signed up for another half marathon in early November, but due to the fact that I was in so much pain, I opted to cheer instead of run.  My first actual good decision!!! But I had also signed up for a half marathon at the end of January, so I wanted to get back into training.  I tried. And I was in such excruciating pain, I literally couldn't do it. The pain woke me up. It hurt when I sat, when I stood, when I moved and when I rested. Painkillers weren't strong enough. I was miserable. Not to mention, grumpy because I couldn't do my favorite stress-relieving exercise.

So I saw an orthopedist in November.  He ruled out a stress fracture with x-rays and he sent me for my very first MRI ever. I assume that normally an MRI isn't a painful experience but given that they had to tape my toes together to keep my hips in alignment (and given that everything hurt my hips at that point), it wasn't my favorite experience. But it didn't seem as though the MRI showed a whole lot. There was inconclusive evidence indicating a possible labral tear, but the MRI did conclusively show a cyst in my right ovary that was 5.2 cm big. YIKES!  So my orthopedist thought that given the way my symptoms presented (and the fact that I didn't have any popping, clicking or catching of the hip), the labral tear wasn't the likely culprit and that I probably had tendinitis and should work with a physical therapist. He also recommended I follow up with my OB/GYN on the cyst.

I worked with the physical therapist regularly through the end of February, and I felt a lot better. I still had pain in certain positions, and still had those unpredictable moments of sharp agony when I stood up or got out of a car. But I could bike, use an elliptical, and even started running again (with longer walk intervals and shorter run intervals). Meanwhile, I worked with the OB/GYN to remove the cyst non-surgically, but I ended up having the cyst removed arthroscopically at the end of March. That put a damper on my physical therapy progress, but I eventually resumed it and started running again. 

The hip pain worsened, and at some point, physical therapy didn't seem to be improving it, so my physical therapist referred me back to the orthopedist for a follow-up. He suspected a labral tear but referred me to a different orthopedist, so that orthopedist ordered both x-rays and then an MRI-Arthrogram of the hip.

The arthrogram was pretty scary to me. I'm particularly uncomfortable with needles and the idea of injecting some sort of dye into my hip socket grossed me out and intimidated me. But given that I really can't stand the hip pain and how it's limiting my activities, I bit the bullet and got the arthrogram.  It confirmed that I had a labral tear. It wasn't obvious and I believe that the fact that I had an incredible radiologist (Dr. Resnick in San Diego) really helped with the detection.

That's great, but what's a labral tear?

I don't really know. I haven't studied science since high school. I've never studied anatomy. I hated biology. But from what the doctors have explained and from what I have been able to find via google, my understanding of it is this: Inside of the hip socket, lining the meeting place of the ball and the socket, is really slippery protective cartilage. That's the labrum. When that stuff rubs away, you get bone on bone action, which is arthritis (again, I think, but I don't know). But when that cartilage gets a tear, it's known as a labral tear. There's a more specific name depending on where exactly the tear is, but that's beyond my simple google knowledge. From what I can tell, the cartilage doesn't naturally regenerate the way muscle does. I think it's because blood doesn't flow into it. The tears don't always cause pain. Apparently, I'm an exception (though it seems not nearly the only one). It appears the only way to fix it (if physical therapy to sufficiently strengthen the area and stabilize the hip doesn't eliminate the pain) is to have someone surgically remove the portion that's torn and sticking out, or repair it. From what I've been finding on message boards and through google, it seems as though the surgery is done arthroscopically and relatively few surgeons regularly perform this surgery.

So what now?

I'm trying to get as much info as I can about the tear, about the surgery and what reasonable expectations I should have for the entire recovery process, about various surgeons, etc. My orthopedist referred me to a local surgeon (Dr. Guanche) who apparently performs this surgery regularly (and according to an article I found online did a similar surgery on Barry Manilow), but he doesn't have any availability to see me until mid-July. I found two other surgeons in Los Angeles via lots of googling that look promising...Dr. Snibbe and Dr. Klapper.

In my online research (which I should clarify only generally consists of googling terms like "labral tear hip" and "team orthopedist MLBPhilippon, a surgeon in Vail, CO, who apparently performs these surgeries on a regular basis and who performs surgery on high profile athletes. For instance, apparently, A-Rod had his torn labrum repaired by Dr. Philippon, and Dr. Philippon's profile mentions that he's performed surgery (doesn't specify exactly what surgery) on other notable athletes such as Greg Norman, Peter Jacobsen, Mario Lemieux, Priest Holmes, and Louis Castillo. I'll admit, I'm a bit impressed :-)

Actually, one of the most interesting things I found during my internet research was a blog by a woman who traveled from Indiana to Colorado just to have this surgery with Dr. Philippon: http://aprilcz.blogspot.com/2009/03/march-26-4-weeks-pre-surgery.html

So I spoke with his office and he is willing to take a look at my films and radiologist reports and let me know what he thinks. I hadn't seriously considered the possibility of being able to actually have him perform the surgery, but it turns out that he is covered under my insurance plan (supposedly). So I'm now waiting on meeting with local surgeons and I will be sending him my images. I think there are definite drawbacks to having the surgery in another state from where I live (including the fact that I wouldn't be able to stay in CO for more than 2 weeks probably so I'd have to do the bulk of physical therapy and rehab in a different state from the doctor).  That scares me. But on the other hand, this is my only right hip. I'd travel to the moon if it meant I could look forward to enjoying good painless mobility for my next hopefully many years.

One thing I'm certain about. This is going to be a lengthy process. But instead of focusing on that, I'm trying to take advantage of this time to make myself as healthy as possible so I can go into surgery with the best odds of a smooth recovery. I'm working with a nutritionist to help me lose weight in a healthy informed way, and I'm doing some gentle yoga to help stretch the area and keep it from stiffening up. I've been doing pilates (which I'm still not sure if it's good or bad for the hip, but I'm trying to avoid positions that I know will aggravate it). And I'm trying to do low/no impact cardio (swimming, biking) to strengthen my heart and keep me in shape.

This week the pain has been pretty bad and pretty constant, so I'm just trying to take one day at a time.