Right hip surgery vs left hip surgery

It sure seems like this surgery/recovery is easier than the first one. I know what to expect, I know what to avoid, and I was in better shape physically prior to surgery. Though similar in many ways, the surgery actually was a different procedure, so that is contributing to differences as well.

What's better:
- Hip labral repair has better outcomes than debridement
- I scheduled my post-op ten days out rather than 6 days out: I think they removed my stitches too early last time and the wounds didn't stay closed.
- No drainage drama this time (last time I dealt with copious drainage for over a week)
- And hence, no antibiotic drama (last time I had a severe reaction to the antibiotic I started to prevent infection when the wound was open).
- The surgery was shorter, so my hip wasn't in traction for as long. That means my whole leg feels better.
- And my hip flexor, especially, feels pretty healthy and strong. It was really weak and irritated for months last time (I couldn't live my leg without using my hands for several weeks post-op).
- Crutch pads...I don't know how I did it without them last time.

What's worse:
- Repairs are more delicate, so I had to use crutches for four weeks. Brutal!
- There is more pain in the joint this time, which is normal since it was stitched.
- Honestly, the timing was terrible with all the stuff I had going on at work plus holiday events, and I was exhausted for most of the first four weeks.
- Post-op anesthesia-related nausea, although better at first, hit me hard the next day and I was miserably ill for the whole weekend.
- Not using a continuous passive motion machine means I have to use the exercise bike every day, and that plus PT plus the incredibly time-consuming act of doing anything means that my days are packed. I actually have to get up earlier now to fit it all in, and walking on crutches to the gym took like 10 minutes from the parking lot!
- My scars are larger this time because a repair necessitates a larger opening than a debridement.

Top: Right hip (for modesty could only show the two large scars; there is a third portal as well).
Bottom: Left hip, so faded that you can only barely see the three scars.

Goodbye brace.

Torture device

No outfit pictures next week because I gave up on the brace. I just couldn't take it anymore, and I took it off four days early. Forgive me!

Part of the reason was plain old intense discomfort (the metal brace is heavy, hot, and presses on your lungs and stomach). The rest of the reason is that I bought a cute new skirt and wanted to wear it. You know, important reasons.
Other than that, I'm weaning off crutches now. I went to one crutch on Thursday, and I've been gradually spending time full-weight bearing. The second day on one crutch, for example, I went too and from the car and up and down stairs without crutches; the third day I also set them aside while cooking. I'll be off them totally by Thursday!

Post-op visit - right hip

I snuck away from work yesterday for my post-op visit, ten days after surgery. It was kind of sad - it was my last time seeing Dr. Van Sice, and that's depressing. He's starting his own practice out of state, which is good for him, but I'll miss him a lot. He's an excellent doctor and a skillful surgeon. And if you are ever in Florida (where he's moving) and need hip surgery, I wholeheartedly recommend him.

We started with x-rays, which showed the difference in bony impingement.
Then Dr. Van Sice showed me the images of the surgery. I wish I'd taken them home like I did last time, because this was pretty interesting: for one thing, you could clearly see the labrum lifted off the bone. You could also see the stitch anchors being inserted in the bone, and the bright blue stitches sewing my tear back up!

This isn't my hip, but it shows the stitch anchors and the sutures! From here. 

We'd already gone over details of the surgery while I was putting my contacts back in right after surgery (I hate talking to people without my contacts: I am afraid I will misunderstand them without visual cues. I'm pretty blind), so I didn't have a lot of questions about the procedure, but Dr. Van Sice laid out the timeline, since a repair heals differently from a debridement.
First two weeks Crutches with touch-down weight bearing only. Expect more pain, since more work was done in the hip than last time (ie, stitch anchors and stitches). Start PT.
Third week: Begin crutch-walking: weight bearing, but with crutches to assist. Allow pain to guide how much work your arms do vs. your legs.
Fourth week: Start using a single crutch on opposite side; wean off crutches.
By 28 days post-op, should be fully weight bearing AND can get rid of the brace.  Last time I was supposed to keep the brace for six weeks, but I gave up around four weeks, anyway...
Range of motion restrictions are mainly lifted at four weeks, though some cautions extend to six weeks.
Pool running can commence immediately following closure of wounds and 48 hours with no drainage. Exercise bike with low/no resistance for up to an hour a day is encouraged. Elliptical can happen around week 8 or 9, pending PT approval.
Running starts week 12, when the labral stitches are all nicely healed!

Meanwhile, my nurse brought in her trainee, whom I know from Tulane! because she's going out for maternity leave soon. New nurse was supposed to take my stitches out, but the disposable tweezers were hard to work with, and as she kept tugging and probing, the nurse started actually getting grossed out and had to sit down! So I took my own stitches out. Yes, IN the doctor's office. It's akin to self-checkout at Lowes.

Right hip surgery

If you noticed, one of my last post titles referred to labral repair surgery. But last I knew, I didn't have a torn labrum on the right hip - just impingement.
Well, that was wrong. I did have a little tear. My first MRI, the one I actually got for my left hip prior to surgery, seemed to show some infiltrates in the join that indicated a labral tear, although a tear itself wasn't visible. Then we did the MRI for my right hip just a few weeks ago, and it didn't show a tear. However, when my doctor went in for surgery, there was the tear. You can't always see them on the MRI.
Dr. Van Sice repaired it. This is very good news, because of course I prefer a repair to a debridement. But it's also bad news, because that usually means a longer recovery time to protect the stitches!
The run-down of this surgery:
- Small tear in otherwise healthy labrum; required one stitch anchor and was easily repaired. No old, calcified damage that crumbled away this time.
- Cam impingement shaved down; medium impingement
- Pincer impingement trimmed; mild impingement present.
- I had the same anesthesiologist as last time. He remembered me and was kind enough to skip the freaking benzodiazepines prior to surgery (Last time the tiniest dose knocked me out so badly that they had to reverse it before continuing)! That means that this time I was alert and observant until I got into the OR and helped myself to gas (seriously, he was like, "If you grab that mask you can start breathing while I set my tray up.").
- But he got IR (interventional radiology) to come start my IV, because apparently, big veins or no, I was a problem last time. This doctor got one started in my wrist (ew), but it only took her 4 minutes. Rock star.
- I also got the same post-op nurse! I had two nurses, but the second one had me last time and remembered me. She was a sweetheart - really caring and helpful. Just a delight. I am especially impressed because it was getting late, and she never got impatient or frustrated that the incisions were still bleeding.
- I had searing, burning, wracking pain for about an hour after I got home this time. I think they stretched a nerve and it was freaking out. I iced it and took a naproxen and a tylenol and was able to get to sleep; it was better when I awoke.
- I was bleeding a lot after surgery, but it stopped by Monday. I'm hoping for this one to stay closed!
- A few days out, I feel more stiff this time, but no pain once more. And interestingly, my hip flexor feels really good. Perhaps the shorter surgery is the reason, but I don't think it's damaged at all. Last time I couldn't lift my leg unassisted for weeks; now it already feels strong.

And here I am, first day back at work: festive red (even though it's a frumpy old cowl neck) for the holidays, black cords, red and black peep toe flats. This is after I got rained on SIX TIMES yesterday, because of course, it starts storming as soon as I'm on crutches and can't hold an umbrella.

So overall? I think this surgery was a better experience than last time. I'm looking forward to a positive outcome.

Doing too much post-op, and brace style.

Friday - the day after surgery - was a busy day. I did way, way too much: I went to the gym, had lunch at Commander's Palace, took about 9 work calls, and then got a call from a friend from church. He's a professor, and the semester just ended, so he wanted to celebrate. David and I agreed to meet him for happy hour, although we didn't really need a drink at that point!, and he offered to drive.
This led to me hopping into an enormous SUV in my muddy, torn-up, drenched street, in the pouring rain...reversing the process in the parking lot...climbing wet, metal stairs to a wine bar...perching on a dreadfully uncomfortable stylish sofa while my brace compressed my abdominal aorta...hopping back into the SUV, which I swear grew higher and higher every time, to head to dinner...walking blocks in the rain to the restaurant...dropping my crutches loudly at least five times on the restaurant floor...more walking in the rain....back to professor's house....more walking in the rain...card game with him, his wife, David...delirious hands of cards...popcorn....more walking in the rain...leaping from mile-high SUV onto muddy street and puddles and dragging crutches through rain storm to house.
I immediately went to bed, mud and all. My lips were white, my nails were blue, my teeth were chattering uncontrollably, and I was nearly incoherent.
Lesson learned: Do NOT accept a ride right after surgery. You need your own escape vehicle! Not that we didn't have fun, we did; but I'd have preferred not to ride in the Mt. Everest of vehicles, and probably could have ended the evening after the wine bar. Unfairly, I blamed David for not making excuses for us, but since he's a patient darling, he just smoothed my hair and put ice packs on my leg and turned the heater on.
Since then, I have pretty much felt like crap, with waves of nausea and vomiting coming and going. I feel oddly out of it, a little hazy, which is silly. I'm not taking any drugs accept the indomethacin (an NSAID) I am prescribed to prevent bone regrowth, but I still feel loopy and queasy. I tried not to do too much most of the rest of the weekend., though we did walk to church. I'm off today, but Tuesday it's back to work, so I am trying to rest up as much as I can before then.

And in an effort to inspire myself not to dress like a homeless person while doing the crutch/brace thing, here is the first in a series of brace style (a what-I-wore of the post-op ilk):

Swelling looks better, doesn't it?

Jeans, clogs, my NOLA water meter T-shirt, denim shirt. Excuse the ghastly white face and lips.

Day one post-op: Our Christmas tradition!

When I scheduled surgery for the 18th, it was partly because I was already off on the 19th: a day I took off for our Christmas tradition at Commander's Palace: An incredible lunch and some day-drinking with their 25-cent lunch martinis.
Far be it from me to skip our tradition because of a measly surgery!
I managed to find a pair of pants that fit over my swollen leg, and added a silk blouse, pearls, burgundy heels, and a cardigan (I got this leather trimmed sweater off Ebay and I love it).

We sat downstairs at Commander's Palace listening to the carolers, enjoying the holiday bustle, and having delicious food! For not the first time, I chose one of the "Fit NOLA" pre fixe menus. Now, far be it from me to order "healthy" when at a splurge place like Commanders - but these menus always sound delicious, and I wasn't disappointed: my entree was easily the best thing I've ever eaten at Commander's. I started with a roasted tomato soup that you just have to taste to believe: it had this incredible smoky, robust flavor. Even David was wiping my bowl out with french bread, and he dislikes tomatoes!

25-cent martinis and crutches - what could possibly go wrong?

Then my entree - a pickled lobster and avocado salad. It was heavenly - huge claws of lobster meat, diced mango, finely cut and fried plantains, generous avocado. I grudgingly shared a bite with David and I think he almost swooned (he had the sausage-stuffed quail, which I've had in the past - also delicious).
For dessert, I had a cranberry-cointreau sorbet in a spun sugar bowl; David had Commander's' famous bread pudding souffle. I couldn't finish- it was sweet, and I was also tucking away my 25-cent martinis (I had one regular and one Commander's, a bright blue drink that will knock you out).

I was glad we'd found parking close by: it has started to drizzle, and by the time we got home, there was a steady, cold rain, perfect for snuggling by the fire. Haha.

Another year, another successful Christmas tradition, surgery or no!

Post-op hip labral tear: take 2.

I'm home on the sofa, eating Christmas cookies and watching Hercule Poirot, ice packs on my swollen leg.

Ice packs in the winter = very cold

Apparently, the surgery was very successful. And the post-op nausea was not nearly as bad as last time, either. I asked the nurse to skip the promethazine and just used Zofran, and I did better without its drowsiness and dizziness. However, this time I felt pain afterwards, and it took me a long time to be discharged. First, the resident in the OR locked my brace at zero degrees flexion, so I couldn't sit up! To remove it and reset it involved getting up, getting my IV out, getting undressed, etc.

Then, my wound started bleeding. Lots. Tons. Saturating the bandage, sheets, bed - it was bad. I called the nurse, who rolled me on my side and applied pressure. We finally got it under control, but it took a long time, so it was 6pm before we were discharged. I had two nurses during that time, and they were both so sweet and skillful! Definitely getting compliment calls tomorrow. 

At home, I struggled through the muddy construction on our street, trying to remember to use my LEFT foot this time! I was used to using the right! and changed into the only thing that could fit over my very swollen leg (boy shorts and knee socks... hence the limited photos). The swelling is terrible this time! 

What's happening to my knee?!

I also have a bit of pain, bad enough to take a naproxen and an acetaminophen. 

It seems like it's mostly leg pain, maybe some damage from being in traction. 

I plan on icing through the weekend to get the swelling down and hopefully will feel better tomorrow. 

Lessons learned from my left hip

It's been six months since my left hip surgery, a labral debridement with femoral head reshaping. It was an ordeal, but I wanted to share lessons I learned in case others are considering - or just had - this surgery.

- It is a big deal. Don't let "outpatient procedure" fool you. You are under general anesthesia, intubated, and you are having major hip surgery with a long, long recovery.
- It doesn't hurt very much right after. It's arthroscopic, so it's nearly painless. The pain comes later, weeks later, as the bone heals.
- There is very little consistent information available about the procedure or the recovery, so don't let what you read on the internets make you panic. Some doctors have you on crutches for days; other for months. Some give a brace for weeks, others no brace at all. PT recs and return to activity timelines are vastly different. Reports of how you will feel at certain points can be diametrically opposed to how you actually feel. Fret not. Every hip is different!
- You must move the joint. This is so important! While you have to protect your hip flexor to avoid long-term hip flexor tendinitis, you also have to use your joint early and often. As early as the day of surgery, get it moving. You can use a continuous passive motion machine, but if I could do it again (hey, I am doing it again!) I'd hit the exercise bike, too (no resistance). You have to move the joint to promote healing and reduce scar tissue formation.
- You must rest a little, too. I went back to work Monday after a Thursday procedure. Bad idea. It was too soon, and it prolonged healing time. You CAN go back to work after a few days, especially if you have a desk job, but if you have to be active at work, I don't recommend it. I'd say take 5 days minimum.
- Do your PT like it's your job. This is major surgery, and you have a lot of rebuilding to do.
- Let pain guide you at first. While you are still on crutches, you should not do anything that hurts.
- For the 4 - 8 weeks post-op period, you will probably be in pain. You should minimize pain (do not push though pain, and tell your therapist if your exercises cause any pain), but you should not panic if you feel pain later in the day after walking or other normal activities.
- After your labrum is fully healed (8 weeks if debrided; I think 12 weeks at least for repair), you are going to have to push through some pain. The area is probably stiff and full of scar tissue, but you are now at a use-it-or-lose-it point. Your PT should have you doing more stretching and some aggressive strengthening. Listen to him. You've got to do it or you'll lose range of motion and muscle tone.
- Returning to sport is gradual, and should be guided by your pain and tolerance. Don't do anything that hurts WHILE you do it. You might feel soreness and stiffness later. Continue to aggressively stretch and strengthen!
- You will get well. You might not get to 100%, but you'll get better, and it might sneak up on you!
- It is worth it. If you are considering surgery and are on the fence, you've probably read things online like, "Almost everyone has a labral tear in their lifetime" or "It's an artifact and not the true cause of pain" or "Femoral impingement is a myth." Sorry, I don't buy that. I was in so much pain when I tore my labrum that I could not touch my foot down. Five months after surgery I ran a painless sub-20 5k, very close to my original level of fitness. The difference is astonishing. I'm not as good as new, but I'm about 98%, and that's a far better outcome than I expected. You don't want to live your life in chronic pain. Do it!

MRI'm a hypochondriac

I'm sure some of you remember when my doctor told me that I was a hypochondriac. About 9 months after that, I was (finally) having surgery for a torn labrum, and I shook my fist in victory and crowed, "I told you so!"
Except he might be a tiny bit right.
I had my MRI this morning, and I was positive it would show a huge tear of the labrum and severe impingement.
But nope, it didn't at all. It showed a mild blunting of the edge of the labrum, more likely irritation than a tear. And it showed mild mixed femoacetabular impingement:

 - Pincher type, where the socket bone is curving too far over the femur, so there's some bone-on-bone contact when you move, and
- Cam type, where the head of the femur is an abnormal shape, so it doesn't fit right in the socket, and rubs and bumps as you move.
Both are just right outside what is considered the normal joint angle. On my left hip, I had cam-type only, but my pain was mostly from the big labral tear. Now, I really don't have a lot going on with the labrum. It's probably being pinched, but it looks like I caught it before it tore.
That's the good news. If I can keep my labrum intact, that's great! (Although it does mean my "high pain tolerance" card has been revoked. I obviously am super sensitive to any kind of hip pain: I was so sure the labrum would be torn on the MRI.)
Bad news is that I still need surgery on my right hip. My doctor reviewed the conservative measures to try first:
1. Discontinue activity causing pain. This means stop running forever. Not interested! Plus, this is not a permanent solution, as any movement (including walking, which hurts right now) will worsen the joint over time.
2. Physical therapy. The idea is to strengthen muscles around the hip to maintain as little contact between bones of the joint as possible. Dr. Van Sice ruled this out since I just got out of three months of vigorous PT and have been continuing 30 - 40 minutes of hip strengthening and stretching every day since then. He doesn't think I can improve on this area.
3. Steroid for pain control: already tried and failed. Not the best solution, since it doesn't help the bone-on-bone, but it can help the irritated labrum. But it didn't help me.

After discussing the situation, we're going through with surgery. I'm in pain when I walk or run, this is the only real option, and I was happy with my first surgery. I am a fan of catching things early, and I don't want to damage my hip cartilage, so I will be having the femoral head reshaped and the socket trimmed. Perhaps the labrum won't need any work at all (it was clear from the MRI that it is completely attached to the acetabulum, so if anything, it will just need to be trimmed to remove shredded, irritated areas). The surgery will be very similar to the one I had for my left hip, and recovery time and prognosis is also very similar.

On a positive note, my left hip is better and better every day, to the point that I don't notice anything wrong with it at all! I'm coming up on the six-month mark, and I really think that's the benchmark - where you are at 6 months tells you a lot about your overall recovery. I feel like my hip is about 95% well: it sometimes clicks and once in a great while I feel a twinge, but generally it feels fantastic. So I am hoping I can say the same thing about my right hip 6 months from now!

What a bad idea.

Being on crutches while my street undergoes FIVE MONTHS of closures, requiring me to park blocks and blocks away, sounds like the worst idea I've ever had.

My house is behind those huge bushes on the left. There's a backhoe in my parking spot :(

Catching a labral tear early and getting it repaired by a surgeon I trust for free after I've met my insurance max, however, sounds like a pretty sound idea.

So, I am scheduled for right hip labral repair December 18th. I have very mixed feelings about this! Part of me is glad to solve the problem, happy about the insurance and cost situation, and relieved that I know there is a fix. The other part of me really doesn't want to undergo the ordeal I just completed with my other hip, and wonders if I'm jumping the gun.

With my left hip, I was in excruciating pain before surgery: at first, I couldn't walk without crutches; even touching my toe to the ground sent pain shooting through my leg. But now? I'm still running. But then, it is better to catch a tear early before it can lead to cartilage damage, so maybe that's a good sign.

When I went to my doctor's appointment to follow up on my (useless) steroid shot, he almost immediately asked about scheduling surgery. That took me aback - I hadn't even had an MRI done! But he told me he'd like to schedule me first, to make sure we got it in on my insurance before January, then do the MRI in the meantime. "You sound pretty confident you know what's going on," he told me, "And actually, I think I already saw a tear in your right hip from your MRI last summer." I'd had my first MRI done at an outside source, and the report listed nothing wrong with my right hip. But Dr. Van Sice pulled up the film, and pointed out a tiny tear on the right. He'd noticed it before, but back then my right hip was asymptomatic, so he didn't bother with it (obviously, you do not treat asymptomatic labral tears). He remembered it after my last visit, though, and when we looked it up, sure enough - a little tear. So we aren't doing unnecessary surgery, but I still feel a little unease thinking about it.

The truth is, recovery from this procedure is miserable! Totally miserable! Crutches at work are hard, wearing a brace for 4 to 6 weeks is hard, pushing through the inevitable pain later in PT is hard. I do NOT want to do it again. But then I compare my weak, wobbly, throbbing right joint to my strong, pain-free left joint and I know it's a smart decision - unless I want to give up running. I don't want to, so I've committed to having surgery done.

Making progress, making choices

The last three weeks have been really encouraging to me. Since being allowed to return to activity, I felt like my hip was stuck in a pattern - wake up stiff, feel ok with movement, but then start aching in the afternoon or evening. I was worried that this was as good as it was going to get, and I actually considered making an appointment with my doctor. I didn't, though, because ....

I started to feel better. I started having days when I almost didn't notice my hip. I had a few runs that felt good - really good. I'm so used to nagging pain and aching that it wasn't until after a run a few Sundays ago (five miles on the soft dirt loop around Audubon Park) that I realized I hadn't felt any pain. I couldn't even remember the last time that happened - I always have some kind of hip, groin, thigh, or osteitis pubis pain. Later in the week, when I kicked a root and hurt my hip (this is still the most painful thing for me - kicking an obstruction or a stair step and knocking my leg back in my socket. Ouch), it definitely hurt. But then it felt better, and quickly. It's starting to feel better all the time, and when it does hurt, I recover quickly.

I think I turned another corner, and I'm really excited about that.

But. It's time to make a tough choice. I've mentioned before that my RIGHT hip has felt mildly off ever since I returned to running. I saw my doctor at the hospital the other day, and he asked if I ever felt that my right hip was symptomatic, since it has the same impingement pattern as the left. Well, I said sort of. And he recommended that I follow up on that NOW, for two important reasons: for one, I've maxed out on my insurance, so everything here on out is free of charge until the end of the year. For another, he's strongly considering entering into his own practice out of state. He wants to make sure he takes care of everyone before he goes.

So I actually made an appointment for this week - after all! One one hand, I know that everything he says makes sense. At least I should get an MRI before my new deductible takes effect! But on the other hand, I JUST went through all this, and it wasn't fun. And I was enjoying running again!

I'm going to see where this appointment takes me. I've been off running a few days (post-race, plus we were traveling to see friends this weekend), so it's hard to assess how I feel, but a thorough exam and some imaging might guide me. I guess the choice I might have to make is - do I have surgery if my right labrum is torn, even if it is mild or close to asymptomatic? Or do I wait it out until I have severe pain? I'll know more in a few days, so I will keep you posted.

The best hip exercise I've learned

One of the things I am working on in PT is strengthening the hip stabilizers. Mine were weak to begin with, thanks to having a hip injury for so long, and after trauma to the area, they're even worse. Here is one exercise I've been doing that has really helped strengthen my muscles:

1. Start as if you are going to do a clam.
2. Then, lift your feet up at a 45 degree angle off the ground (picture 1).
3. You can do clams like this and it will be a bit more intense than a regular clam (picture 2).
4. Or, for an even better exercise, you can add a leg extension. While the clam is "open", extend your leg by straightening your knee (picture 4).

Top: Clam with legs lifted
Bottom: Clam with legs lifted plus extension

I actually taught this one to my PT! We started adding it in, and I really like that you can feel the burn after a few sets of 20. With regular clams, I never felt like I was doing anything.

My resource for these exercises comes from Princeton Athletic Medicine, and you can read the descriptions here.

PT that hurts

I had to take a two-week break from physical therapy thanks to the disaster that is Tulane PT (I love the PTs, but they schedule into a PAPER DAY PLANNER and when the scheduler went on vacation, nobody could schedule me with my new plan of care. I'm not sure why, since I think the day planner system must be pretty easy to learn).
Upon my return, I asked Christian to focus mostly on stretching, because in my absence I felt like my hip area tightened a lot. We did some good stretches, but I will post those later because I'm buying a strap to assist with stretches and I haven't, you know, won that Ebay auction yet.

But in the meantime, here are three moves I'm doing that surprisingly hurt!

1. Bottom leg lifts. I do this on both sides, and it gives me a good yet painful piriformis stretch on the top leg (here I'm stretching the injured side, which is why the angle is off. I have a lot of range of motion to gain back). 

2. Passive hip flexor stretch with motion in hip capsule. You pull the opposite leg to your chest, which stretches the flexor and causes the femur to readjust inside the socket. It hurts. Also note how tight: my left leg should be on the ground, not four inches in the air!

3. Cat/cow with hip capsule stretch. This part is fine, but at the end of the cat/cow cycle I sit all the way back on my heels, and that still hurts.

4. One-legged bridge. Holding the active hip tight in the socket still hurts. Notice that the lifted leg is at an angle, not straight up: that changes the position of the other hip, and is easier. I never get to do the easy stuff. 

Since these are still painful, they'll be a good barometer of progress as I heal (IF I heal), so I'm keeping them on my PT list. 

Do you do any hip PT/strengthening/stretching daily?

Sports doc follow up

I saw my doctor for what should have been my last post-op visit this week.
I might as well say it up front - things didn't look very good. I mentioned that I've had some pain off and on, but I assumed that was normal. To a certain extent it is, but my pain has been accompanied by clicking and movement of the hip. Dr. Van Sice is concerned that the small strip of labrum I'm left with isn't enough to firmly hold the femur, and I may continue to have pain.
Right now, I feel pain that reminds me of the labral tear pain, only without the pinching quality. Some things I could not do before surgery (go down stairs, pistol squat) I can now do without pain. But there is groin pain all the same, and it's associated with the clicking - so it could very well be pain from the labrum.
So, bad news.
But I'm not losing all heart yet.
I will see Dr. Van Sice in 4 more weeks. In the meantime, my range of motion and strength look good, and I can now add regular biking, and next week I can add resistance on the exercise bike and elliptical. And I'll watch and wait with the hip. The pain could improve: my bones aren't done healing yet, and the labrum might still be raw, plus the hip capsule could be taking extra time to heal, too. I will need to avoid impact to protect the bone and hip capsule, but movement restrictions are totally lifted.

I got this email today. GO AHEAD AND RUB IT IN, SPORTSPHOTO!

Now, way back at week one post-op, Dr. Van Sice told me I could get back to running at week eight. That's this week. At the time, I didn't post the date, because I doubted it would be true! That seemed way too early to me! And sure enough, that is not happening. I am in too much pain! But all the other protocols I looked at had a return to running at 12 weeks at the earliest, so I really didn't expect to be running at 8 weeks. Dr. Van Sice is pushing it back to 12 weeks, and that's only if I get the pain down. Meanwhile, I just need to be aware that pain is a sign to pull back a little. I am supposed to push "to" pain but not "through" pain while I stretch and strengthen.

And in a little over a month, I go back to discuss options. Will I need some anti-inflammatories? More PT? A joint injection? We'll have to have those conversations later. For now I'm still hoping for a miraculous improvement!

Ups and Downs

Now past week six post-op, I can agree with my doctor that hip surgery recovery will be up and down.
On Wednesday I felt great.
On Thursday my hip ached.
On Friday the pain was almost constant, just aching and throbbing a little.
On Saturday the pain vanished, and I felt not a twinge the whole day.
On Sunday I felt mostly wonderful, but some aggravation after a long walk.
On Monday I was in pain.
Ugh!

I'm plugging away at PT, and can now do:
- Bridges
- Squats (not all the way down)

Leg lifts

- Lunges (!!!) - believe it or not, they do not aggravate the hip, and are a great mild stretch to the hip flexor, as long as you keep the back leg totally straight and directly below the hip.
- Balance moves on half-bosu (or at home, a stack of pillows)
- Side leg lifts
- Wall sits

The better I am about PT, the better I feel, so I have been trying to get it in twice a day, although I occasionally slack off.

Last week I got a chance to talk to another runner who was having the same surgery. She had it this Friday; I spoke to her Wednesday (I just met her, but I know her boyfriend well). She had a lot of questions prior to the surgery, but I felt like I had NO helpful info for her - there is just so little consistent information out there about hip labral tear surgery! She is seeing the other hip specialist in town, Dr. Suri, and his post-op instructions differ hugely from those of my doctor (like, wearing a brace for only 10 days versus 6 weeks from my doc!).

I'm being patient with the ups and downs, because I was told to expect that. I'm just hoping that in time (but not too much time!) the ups overtake and leave behind the downs.

I feel like a million bucks

So I'm backing off everything.
One of the discharge instructions I read from a prominent physician who performs hip labral tear repair mentioned that patients will often feel very good around 4 or 5 weeks post-op, and then they overdo it.  I don't want to be one of those patients! The last thing I want is a set-back of any kind. So when I woke up feeling like surgery was a thing of the distant past, I slowed down instead of speeding up.

- I was given a whole list of new PT I can do now that it's been over 4 weeks, but instead of introducing it all all at once, I just added one new activity a day.
- I completely skipped a walk in the park, knowing I might have to park far away for a birthday party/Bastille day celebration later in the day.
- I actually reduced the number of reps in PT
- I wore heels to a dinner party but made sure I either stood correctly (with weight evenly distributed to both legs) or sat.

At the city's Bastille Day celebration on the River

I was glad I made those choices, because I accidentally hurt my hip yesterday! Don't laugh, but I was cleaning the bathroom and was trying to put a new mophead on the mop. As I fiddled with the screws, I sat down on the toilet seat while I was working on it...except I forgot I had just cleaned the toilet bowl, and the lid and seat were up. I expected the seat to be higher than it was, so I CRASHED down that extra two inches, catching myself squarely on the injured hip. It did NOT feel good! Luckily, the pain was short-lived, and I was fine after about five minutes, but I would have been frustrated if I wasn't. If I had done too much, and it hurt all day, I'd keep wondering if I hurt it accidentally or by overdoing it.

I didn't just feel good physically yesterday. I felt good mentally and emotionally, too, because I got some quality time with good running friends! My running group, Varsity Sports, has more or less kept tabs on me via Facebook, but a couple in the group, Jon and Janell, invited us to dinner this weekend. We joined them at their lovely home, along with several other group members, and it really was wonderful to see everyone again. Jorge was there - he and I were probably the closest in speed on speedwork Mondays, so he's sort of a training partner; also several of the members who've been with the group for years, and Andy, who I ran with for the Greek Fest 5k. It was so nice to see everyone, especially Jon and Janell, whom I really look up to. Jon is a cancer survivor and I would like to tell his story here once I get his permission.

It did suck a little to hear everyone's racing and running stories, but that mild pain was worth the pleasure of good company, good food, and good wine.

Thank you for your patience

Last day, if all goes well. 

I'm so ready to move on!

I wish I could say that this recovery continued as smoothly as it began, but the last week has been borderline awful. I'm so ready to move on from this phase of recovery!

It kind of went like this:
Draining wound => Fever, chills, short illness => Bactrim DS prescription => Terrible oral ulcers, mostly under the tongue, a Bactrim side effect => Guyon's Canal Syndrome

Guyon's Canal Syndrome is basically a pinched ulnar nerve, thanks to pressure on the palms while on crutches. It's not the end of the world, but my pinky fingers are numb and my palms ache. It makes using crutches tough. Now I'm working with crutches I can't use, and I can barely speak thanks to mouth sores. Not exactly a picnic.

Oh, and finally my hip started complaining a little. I'm probably putting a little pressure on it because I'm struggling with the crutches, and it aches and pinches. I was worried that I'm feeling a pinch right where I felt pain before the surgery, but I think that's normal - after all, that's where the work was done! A really nice member of Varsity Sports, my running group, emailed me about her surgery last year. I've never met her before (we're a large group and I only run with them for Monday track) but she saw my post to the group about surgery and reached out to me. I asked her about the pain and she said she felt the same thing, and it takes a long time to return to normal. She's 9 months out and still in PT, although she's finally back to running, so that is a sobering lesson to me to not expect too much, too soon.

This weekend I had to go to a nephew's birthday party at that hell-hole, Chuck E Cheese's, and the theme was Transformers. I impressed by being the only grown up in a Transformer costume:

I transform into a wheelchair, I suppose.

Speaking of costumes, dressing with the brace has been a bit of a challenge. One look I like is a tight undershirt or camisole that stays put under the brace, then a boxy crop top over it. It sort of minimizes the brace. You can't really tell in this picture...which is the point. I just look a little lumpy.

Those are wedges, but yes, I have definitely worn heels while on crutches! 

I still feel like a blob in an awkward brace, but at least I'm a coordinated slob in a trendy crop top.

Everything was going fine until it wasn't

Man, I was KILLING this surgery thing! Back to work after the weekend, continuing with my busy social life, creating delicious meals (green onion sausage and mushroom ragu over polenta with fresh rosemary and creme fraiche), diligently completing PT, feeling not an ounce of pain. Just tired when I got home from work, that's all.

This is a picture of me diligently completing PT. 

Everything was fine!
Then the wound started to drain. And drain and drain and drain and drain. It was annoying and gross. But it wasn't infected, so I just skipped the antibiotic my doctor prescribed (DO NOT TRY THIS AT HOME). I thought the wound had finally closed up, but at PT last Tuesday, it opened up again and the draining started all over again. I was at work later that day when my doctor totally busted me. I was hopping on one leg to help a customer with a bulky bag - I needed both hands, so I put my crutches down - and in walked my doc. The look on his face was terrifying.
He just stared me down for a few minutes, while I sheepishly made up excuses about why I was hoppin gon one leg and why my crutches were 7 feet away, then he asked about the drainage. "But you're taking your Bactrim, right?" he asked. I had to admit that no, I wasn't, as it was clear discharge, no puss. "That's smart," he snapped. "You have an open channel communicating with your joint. How does osteomyelitis sound?"

I was rather filled with shame. I mean, I'm a pharmacist! I filled the prescription. And then I got sick. I swear, the minute my doctor left I realized I was flushed and warm - embarrassed by my doctor? Or...fever?

When I realized I had a slight fever, I rushed to check the wound. Luckily, they still look clean and there is no infection of the site. But my throat ached. The light hurt my eyes. I felt sore all over.

And now I feel like crap. I'm fighting some kind of infection (it feels like a mild late flu), trying not to topple over with exhaustion at work, and on top of it all one of my techs resigned. And it's poured rain every single evening for a week, and I can't exactly manage and umbrella and crutches. It's not fun anymore! I'm ready for the crutch and brace phase to be over!

The torture device I sleep in

At night, I lock myself into a CPM, or continuous passive motion machine, and set the timer for 4 hours. I plop an ice pack on my hip, and go to sleep.

The CPM makes a whirring sound as it cranks my leg from 0 to x degrees - "x" started at 45 degrees, and my doctor has me going up by 5 degrees a night until I'm at 90. I do not recommend enjoying the plush comfort of the CPM machine in the summer, as its fake fur lining reaches about 180 degrees F by midnight. Luckily, my body temperature stays pretty average, as my groin is being concurrently frozen off by the direct application of ice.

When the machine turns off, I wake up. Then I start the long, complicated process of extricating my leg, finding my crutches in the dark, crawling/falling over my husband or my CPM machine (depending on which side of the bed I choose to get out of), and crashing into the bathroom to throw my melted icepack into the sink.

When I get back in bed, having completely ruined my husband's night, I roll onto my stomach for the 2 to 3 hours of recommended tummy time. I'm supposed to lie on my stomach to gently stretch the hip flexors.

It's so fun. You wouldn't believe the wonders my sleeping habits are doing for our marriage.