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. 

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.

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.