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Wednesday, May 28, 2014

Surgery on schedule

Where we last left off, my spinal MRI came back normal and healthy, meaning that a compressed disk or other spinal source wasn't causing my pain. It was a rule-out before scheduling surgery. Once my doctor got those results, he called me to recommend surgery to repair my torn hip labrum.

In the days between getting my MRI results and my doctor's phone call, I'd done some research. I know the surgery is elective, and I've read or heard about plenty of runners who pass on the surgery and manage the pain by activity modification, physical therapy, and medication or steroid injections. And I guess if only running was at stake, I could consider that. But I feel this tear during activities of daily living, and I just can't imagine being in pain for the rest of my life. Plus, the reasonable level of pain I'm feeling right now (able to work, walk, even run short distances) is while taking gabapentin, and I'm not comfortable with taking medication every day for something like this.
I did some literature searches on PubMed, and could not find any conclusive data about degeneration of the hip following a torn labrum. But I'm still concerned that the tear is the first step in cartilage breakdown, and puts me at risk for (at a minimum) arthritis and (worst-case scenario) total hip. My doctor doesn't agree with this view, and it's true that there isn't substantial data to prove my argument, but sometimes the meta-analysis hasn't been done or the studies just aren't there. Sometimes you have to base your conclusions off of your prior knowledge. I know the function of the hip labrum, so I am concerned that leaving it alone will lead to more damage.*
I agreed to the surgery.

Right now, I have very little info on the whole process. I'm not meeting my doctor for a pre-op visit until the day before surgery (I know, great planning) right before I see anesthesiology. I have a date scheduled - June 12th - and I got coverage for work, which is the most important thing. I'm trying to go back to work pretty early, but a lot is still up in the air. Once work settles down (handling a big corporate project right now, without ANY extra hours or support) I can, you know, handle my own health. But at least I have a plan!

*There is actually reason to believe that labral surgery can lead to hip degeneration, especially if the torn part of the labrum is removed, rather than repaired. Lots of conflicting info on this topic.

Monday, May 26, 2014

Happy Memorial Day!

Bayou St. John
Thank you to those who serve or served our country.

Saturday, May 24, 2014

I survived Greek Fest 5k

They're called endorphins, and they mask pain! 
Sorry, just had a revelation about that. I managed to get through the Greek Fest 5k slowly but not too painfully! Really, the pain was almost unnoticeable during the race. I was too busy trying to catch my breath and marveling at how quickly one loses running fitness...

This year was actually one of the best as far as I remember Greek Fest. It was not horribly hot, and although it was humid, the weather has definitely been much worse in past years. David and I met in the parking lot after work, and had plenty of time to run to the port-a-potties, socialize, and get in a warm-up. I get off work at 6 and still had to change clothes, drive to the race, and park for a race that starts at 7pm, but since there is a one-mile race before the 5k, there wasn't a time crunch.
So much sun in my eyes.

I was nervous about warming up first, since I didn't want to do any extra damage to my hip, but I knew I'd be sorry if I didn't, so I jogged about a mile (with some breaks to stop and talk to friends). Right before the start, I saw Andy from our running group. He's always in the "next-fastest" group at the track, but recently has been picking his speed up. He told me his goal was under 21 minutes, and I told him I'd try to keep up!

New Orleans Track Club has chip timed gun timed races, so I tried to get sort of near the front, but it was tough with the crowd. This is a popular 5k. But being pushed back helped me stay at a reasonable pace when the gun went off. The first mile was all passing people who slowed down - many people! I wasn't able to settle in without weaving until after the turn around (it's an out-and -back). Right about then, I caught up to Andy. He looked strong and smooth, so I stuck with him. We both hit rough patches in the last mile - Andy running out of steam, me suddenly feeling a loud hip click and mildly panicking - but were able to kind of help each other through. I was really impressed with Andy's race - I lost him at the finish, but it was a big PR for him and he hung tough at the finish.

We had been a good eight or ten yards behind a lady for most of the last mile, and at the 3 mile mark, I decided to try to outkick her. I really hadn't drained my tank, and shockingly, I easily passed her at the finish. I have the worst kick in the world, so that surprised me. I ran a 20:54, didn't feel terrible, and today my hip didn't make me want to die. And, as one of the top 100 finishers, I got a blue wineglass at the finish, which an NOTC staffer filled with wine for me (I have some great runner friends!).

So I'm calling that race a success. I can't be begging for PRs anymore - those days are done. I'm happy with running a 5k under 21 minutes off of nothing but muscle memory! Isn't the body kind of amazing?

Friday, May 23, 2014

One Last Race before surgery

I'm doing something pretty silly today.
My hip labrum is torn.
My surgery is scheduled.
I'm running a 5k tonight!

With doc's permission, of course. We'll just find out how much pain I can handle I guess!
The Greek Fest 5k is a miserably hot Friday night 5k...that gets you free entry and free beer at the Greek Fest. I love the tradition of sitting on Bayou St. John post-race, drinking an Abita and eating lamb sausage and fries with feta.
So, we signed up for this race, and I'll just jog it. It will be fun anyway, and my first race in a long time in which I'm just running (not racing, not training run, not pacing, not trying to PR). I guess it's time to see what that feels like!
This year the race handed out socks instead of T-shirts. I love getting something besides a T-shirt at a race. They're good quality Sock Guy socks, too.

By the way, as for the "doctor's permission" part, he has insisted that it's fine to run if you can tolerate the pain. He actually has several runners with labral tears under his care who opted out of surgery and just manage the pain. However, I just can't handle this much pain every day (not just when running!), and I don't want to end up arthritic or needing a total hip. While I like that Dr. Van Sice considers surgery a last resort, I can't wrap my head around leaving this painful injury alone. So surgery it is, and in the meantime, I run lightly while I still can, limiting my miles, speed, and frequency. I'd rather not make this tear worse, and I can't take the pain for very long.

I think I should install a "pain scale" widget on this blog until I'm better. Ha!

Wednesday, May 21, 2014

Spine MRI

It's fine. I have mild scoliosis (knew that) and mild arthritis (in the area of scoliosis, of course). Everything else looks fine.
Now? I just need to talk to my doctor about surgery for the torn hip labrum. I'm scheduled to go in today.

Monday, May 19, 2014

Other things I'm doing

Besides limping, I've been:
1. Finishing up the semester of tutoring. I tutor reading for a local non-profit, STAIR (Start the Adventure in Reading), and on the very last day this little guy took the test to pass his second STAIR level. He started out the year pretty far behind, so to go up two levels took him close to grade level! Our coordinator sent out cards with snapshots of us teaching, but - I didn't think it was right to post his face so I cut it off  :)
Here is my student's arm.

2. Taking scary car pictures. Kidding. This is meant to show you that I found BOTH my missing name tags in separate places on the same day. In files. One was labeled, "Tags". The other? "Name tags". My husband's obsession with GTD is annoying!

3. Shopping. Yellow jeans for summer. It is summer soon, right? Because it was in the 50's earlier this week. That has to be a record.

And I love these shoes. I totally wore them to work with a black top and pants cropped with a tiny cuff. I was fine for 9 hours of standing and walking!

4. Going to a running form clinic. I guess I'll just store those lessons for later!

5. Having a date night at Domenica, followed by War Horse at the Saenger theater.
Clam pizza and roasted pork with salsa verde 

I walked over to the restaurant after work, and David dropped me back off at my car when the play was over. This was on the sidewalk outside my parking garage. Yeah, Tulane Medical Center is in a gross part of town.
I texted this to David while I was driving home and he answered, "Put your clothes back on, girl!"

Saturday, May 10, 2014

One last MRI

After popping gabapentin for a few weeks (not really, it is just 300mg daily), I'm feeling medium-okay. It doesn't hurt to walk most of the time, and running is tolerable if I go short and slow.
How I found this out:
1. I intended to run 5 miles, but thanks to street flooding (last night we had very heavy rain and flooding; our drains got overwhelmed and things are still wet today) I looped around to make an approximate eight. At mile seven, the pain got pretty bad.
2. I tested my limits by running with a faster group for Varsity Sports' Thursday night social run, with disastrous results. No. Not happening. Jogging is it for me until I figure things out.

Dr. Van Sice is leaning toward spinal involvement, but the tear is there on the MRI. If there were impingement, I'd definitely have to stay off it to prevent further tearing and damage. Since there isn't, and the tear runs right along the rim, he prefers some movement. There is anecdotal evidence that there could be limited healing with movement to stimulate the very limited blood flow. And I've healed a little on my own, based on symptomatic improvement (from absolutely no weight bearing possible to walking normally even before any treatments were started). So I am okay with running within the limits of pain, just to keep active.
Then again, I don't always trust sports medicine doctors when they say that it's ok to run within pain limits. I think all sports docs tell you to keep doing X that caused your injury to begin with, just to keep you happy. I've almost never heard, "Stay off that! Stop running!"

Metairie Imaging, where I got my last MRI, called to set up my spinal MRI, which was finally approved. I really like Metairie Imaging, if you are in the area and looking for an affordable MRI. They were a good $100 less than the next cheapest place, and they got me in and out from start to finish in under 50 minutes last time!
Unfortunately I didn't get to call them back, but I should be able to squeeze an appointment in next week. One last MRI before maybe schedule surgery!

Saturday, May 3, 2014

Oh, the irony.

I got my age group award plaque from Rock 'n Roll in the mail today. I went ahead and propped it up by the crutch I relied on for the past month.

So, how've you guys been? Missing my miserable injury, reinjury, and new injury recaps? Of course you have been. I got hurt again and took a break until I had a sort-of diagnosis.

Briefly, I was having a STELLAR week of training - killed my track workout, knocked out a perfect progression long run, had a lovely yoga stretch day that made me feel 10 years younger - when I got hurt. The week ended in Atlanta, visiting friends, and I jumped in a 5k kind of last minute. I wanted to test my fitness, and this race had a gift card for overall winners and a history of slow winners :)
Looking back, I can identify weird hip and groin pain during the race warmup, but I didn't pay attention then. Mile two of the race I suddenly stumbled in excruciating groin pain! But I was winning the women's race, so I plugged/limped on to a pathetic 20:xx win. I wanted that gift card! And I paid for it by being totally incapable of walking by the end of the day. In fact, as soon as I got home from my trip, I borrowed crutches and called my doctor. He told me stay off it, it was almost certainly a pelvic or femoral neck stress fracture and pretty serious.
Smiling right after the race, before my hip completely called it quits 
Well, it took so long to try to get an appointment with my regular sports doctor, that I ended up seeing a different doctor: Wade Van Sice, a hip specialist. He's great! And I'm glad I went. He suggested a hip labral tear and did a steroid injection, plus MRI.
I do indeed have a hip labral tear on my MRI, but Dr. Van Sice is not sure that's the cause of my pain. The steroid did not help the pain, and some people run on labral tears with no problem. He put me on a trial of gabapentin (an anti-seizure medication generally used for neuropathic pain) to see if perhaps there was nerve / spine involvement.
A week into my course of gabapentin, and I'm 50% better. He's probably right! His interpretation of the situation is that I may have had this torn labrum for a very long time (it may have caused last year's lingering thigh pain, and is almost certainly my REAL diagnosis for groin pain, not osteitis pubis!). The tear on the MRI may be an artifact - old, not a source of new pain at all. Or it could be worsened, and I could have two sources of pain right now: nerve, and labrum.

So where am I now?
- Have to schedule MRI of spine to look for pinched nerve or compression
- If negative, will discuss surgery to repair labral tear. It's basically the only treatment, but Dr. Van Sice isn't positive I'll do well with surgery based on position and condition of labrum.
- My activity is limited by pain: ie, do whatever you can and still tolerate pain. Now that I'm on gabapentin, I've actually felt much better, so much so that I've gone on a few runs. I do still feel the area (I definitely do!) but it's not very bad and it isn't causing a limp.
- "Competitive running" is over and done for me. I mean speedwork, long runs, races - that's history. I'm ok with that. I was getting slower and slower anyway. Now I just want to be able to tool around the park for some fresh air.
- I miss everyone. All the running bloggers. All my real life running friends. My running group. It's time to get back, even if I'm just hanging out and not running.

So that's my story. I'll keep you updated. Have a beautiful weekend!