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!
Showing posts with label marathon. Show all posts
Showing posts with label marathon. Show all posts
Thursday, July 29, 2010
Tuesday, June 22, 2010
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.
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.
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