Damage Over Time

I met with the new surgeon this morning and had myself ready to plead my case for bilateral surgery and a dual recovery. As soon as he stepped into the room he started asking questions about how long the pain has been happening, if there's been a sudden change, if I'm doing anything drastically different in the past few months. After answering several variations of this he had me go through a series of movements testing my strength and flexibility and we settled in to go over all of the imaging.

In theory your socket should cover most of your joint.

                             Mine is short by more than 7 degrees on the outer edge alone. 

He explained that because my sockets don't form completely around the ball joint of my femur that my labrum (the cartilage in the socket) has grown outward to compensate. Also because I'm not formed quite right, the movement has rubbed against that labrum and begun to peel it away from the socket it should be attached to. Normally they would go in, place plastic anchors in the socket, and sew the labrum to them. The problem in my case is that the tear didn't happen all at once or even quickly with a change in activity, it's damage over time (insert joke about tank and healer here) which means that surgery is much less likely to be effective long term. The surgeon could make a perfect repair and the cartilage would continue to deteriorate leaving me with months of recovery for limited relief. At this point the wisest thing to do would be to wait for the pain to catch up to me and have the procedure then so that I get the most out of it.

This is the MRI of my right side. 

The white is the space in the joint showing anterior labrum peeled away. 

In the meantime I've learned that I'm in the beginning of osteoarthritis, which may be the cause of some of my pain. I'm also too far past the point where they can do a repair on the joint itself, so with no chance for an osteotemy we'll be moving straight to a replacement when the time comes.

                                                 The surgeons illustration of my situation.

All of that aside, he said that I should do what I can while I can and that moving is essential to keeping the cartilage healthy. I'm still barred from high impact like running, jumping, or lifting my knees above 90 degrees, but walking, hiking, and pilates are all in. In fact, he said that pilates is one of the best things that I can do given that it strengthens your core and can be modified to accommodate my hip needs. He also said that I should absolutely not miss out on The Camino in April because there will come a time when I can't make those plans anymore, and this trip sounds amazing. He's not wrong.

Training starts Monday.

55:49 Vs. 38:02

When I saw my first surgeon, or and even my primary physician, there were a number of things that I was cautioned against doing. Chief among them was running. Running is considered a high impact activity and is firmly in the "not allowed" category given the circumstances. I was pretty sure that I was fine with this idea, given that running didn't really take off with me. Every mile was a struggle to attain, I had to recover longer after every training run, I never got my lungs to cooperate even if my body felt nearly ready. My relationship with running with contentious at best, but today that was tested.

A friend who is a brewer (find him at #runbrewerrun) signed up for a 5K and a few of us signed up in support and to have a good time. This was pre-surgeon and I thought that I'd be prepping alongside my husband, but obviously that changed in a hurry. We got up before dawn and got ready to go with a chill in the air and the promise of a pint in our a-little-early-for-a-drink future. After a several false starts (how did we all leave our race bibs at home?!) we managed to make it to the start not only on time but in time to get a wristband for the after race drink. With all of us sporting Alta Brewing T-Shirts we all queued up in two different positions with my husband, our brewer friend, and our other friend at the front ready to run. My best friend, her dog Pearl, and I started out at the back with plans to walk as we both have firm directives to keep our place at steady walk for medical reasons.
It was cool, sunny, and there were some great hills to help stretch things out. It was a loop so we got to high five the other half of our party as they passed in the other direction which was great! But something came up: For both my friend and I, this was the first running event that we had both been to without running. We weren't allowed to join everyone else as they ran across the finish line, we couldn't keep up. We briefly discussed running when we got there, but agreed that it sounded painful. I've been replaying something that the hip dysplasia institute published regarding running: a shallow hip socket is like a nut cracker, and every time you run it's another crunch.

Afterward we went to Snooze for brunch and looked up our race times while we waited. I thought that something was wrong with mine because it kept telling me that I was 25, but that wasn't it at all. That was another beer run that I did back in 2013. I had a finished time of 38:02, and I wasn't even in great condition at the time. After more searching I found the right race and it was sitting at 55:49 and I can't deny that it stung a little. That contrast highlights the change between where I was then and where I am now, and I will never be able to go back, but it's going to be ok.

                                          Before (This was the first time I felt like a runner)

                                             After (This was the first time I felt supported)

 In the end it was a good day, we had a good time, Pearl got a medal for finishing, my husband ran his first 5K, and it was beautiful day. It's just some processing that needed to happen. Just because you can't go back doesn't mean that you can't go forward. 

In other news I meet the new surgeon Friday morning, fingers crossed for good answers and surgery in plenty of time for a pilgrimage in April!

First one to cry in the new quiet room!

Two big things happened yesterday: Our corporate office moved with work, and the surgeon called halfway through the day.
The new office is in a building that they bought and renovated to fit the company, it has an elevator, a coffee maker that's smarter than I am, and a quiet room. It's mostly complete, with a few rooms missing finishing components, but everyone is glad to be in one place and enjoying the great new space.
As we were getting boxes unpacked and answering emails as we could on the fly, my phone rang and the surgeon asked if I had a minute to talk about my MRI results. I wandered off to the still doorless quiet room and settled in to hear about the physical therapy plan. Instead I heard about the labral tears. The tears that were supposed to be minor are not. My right side has an anterior tear and my left a superior tear, and they're severe enough that I'm being referred to an arthroscopic surgeon who is more comfortable taking this on as the original surgeon feels it's beyond his original plan and scope of surgical care.
That's...not what I was prepared for. Instead I got some quiet crying in a comfortable room as some bewildered coworkers walked by, and some more waiting for the next phase.
Nothing to do but move onward.

Did I shave my legs for this?

I expected MRI #2 to go much like MRI #1 but life is full of surprises.
I got up early, hopped in the shower, and thinking of the assistant who would likely not care I shaved my legs for the first time in a while.
When my appointment came around I headed in to the hospital and when I was called out of the first waiting room I got changed into the flattering gown to get ready for the stabby part of this afternoons entertainment. When I laid down on the x-ray table I noticed a stark difference. There were no fake trees to distract you from the needles, and the sleek flat-screen was nowhere to be seen. Instead there was a large CRT monitor suspended above me, and the live view was replaced by the cycle of move the needle, take an x-ray, move the needle, take an x-ray. Somewhere between move the needle and take an x-ray something went a little awry. I suddenly felt wrong, saw stars, and the doctor assured me that I would be receiving more numbing while asking the tech for lidocaine. I looked up and to my right at the monitor to see that the needle was bent, it had caught on the bone as they couldn't see while they were guiding it in. By the time they got the fluids in and I was done they decided that I wasn't fit to hobble to the MRI machine alone and I had to get wheeled down to the basement still clad in Kaisers finest daywear. When they left me in the waiting room I realized that I was the only one dressed for the occasion except for a man just returning from his test. "Nice dress!" I blurted from my chair, "Thanks, I've got the legs for it." he returned. By the time I was done with the MRI and slowly made my way back outside thoughts of a consolation drink were replaced by fond feelings for the couch. At least this part is over and we can get onto the next steps and back to regularly scheduled life.

Needles and Pins

"I'm not going to lie to you, this is going to hurt."
That's not what you want to hear from a medical professional. It hurts bad enough when they tell you it isn't going to hurt, or when they pretend that it's only going to feel like a pinch.
I went for the first arthrogram last Thursday, and it was not my favorite experience. I say first because you can only do one side at a time, apparently the pain from one side being done compromises the other side.
I laid on the x-ray table and stared at the ceiling of fake trees lit from behind as the doctor found and marked out my femoral artery, then used the live feed from the x-ray to guide the smaller needle from the lidocaine, before the larger needle for the lidocaine went deeper into the joint. I lay there staring at the artificial foliage printed on the lighting wondering things like "How hard is driving to work going to be after this?" and "Should I have shaved my legs?" I didn't move as they removed that needle and inserted the giant needle that forced the contrast into the joint, filling it until there was enough separation between my acetabulum and femoral head for them to see the tissues more clearly. I know that it was a giant needle because as it was removed the doctor enthusiastically waved all 5" it in front of me and said "I'm not worried about you passing out because you're already laying down, look how big this is and you didn't even feel it!" He was right. I didn't pass out.
The thing about this is that the doctors congratulate themselves for you being numb while they're in the room, but then they leave and you go across the hall and into the room where the MRI machine is and you have more than an hour in there to let the numbing agent wear off.
There was some concern about my tattoos having been done in Thailand, but I was given an emergency switch in case anything went wrong before being slid all the way into the machine where I stayed while the vault-like door was closed. It was nice to have the thought that my tattoos were possibly prison-quality and could suddenly heat up and try to escape my skin to take my mind off of the idea that I was in a tube slightly larger than my body that blared sounds so loud that the cheap earplugs may as well have been cotton balls. Nothing ever happened, so I supposed they're ok. On the other hand was feeling it by the time I had to get out and stand up. I wasn't a fan of the suggestion of a cane, but by the time I had to be to work I was ready to give in.
I was pretty angry about how long it took me to get up the stairs to our second floor office and I didn't get any faster by the end of the day. I see now why so many elderly people are grumpy, it shouldn't take so long to get around.
It's Monday now and I'm mostly recovered, but there's an odd tip to my walk and I'm still feeling it, not being able to get comfortable when I sleep. My next MRI is this Friday and if I'm lucky I'll be back to good on the this side before I go in.
I can't wait to be done with the anxiety that comes with knowing that pain is coming. I'm not even concerned about the diagnosis because the surgeon seemed to think that these tears are minor, I just want to be finished with the pain and recovery from this so that it can be time for Fall, enjoying San Diegos still summer, and the good feeling that came with moving on from all of the what-ifs.

Hold that thought

The day after our planning session I woke up early, walked out to the living room alone, and started going through emails. I had sent a message to my doctor asking for an X-Ray to check in on things before going half way around the world to walk a couple hundred miles, and he had responded. It wasn't what I was hoping to hear.
The condition that I have leads to the loss of cartilage and osteoarthritis. While I thought that I was setting myself up for better adventures, I was actually rushing myself toward the inevitable surgical intervention that comes with all of this. My medical file listed me as leading a sedentary lifestyle, and given that I was diagnosed at birth it was assumed that I knew how to manage this condition. Meanwhile I thought that I had a handle on things because the problem was more or less solved at age 1.
So I set up an appointment, and started reading everything that the International Hip Dysplasia had to offer. It wasn't encouraging, but it was certainly educational. I had been doing things backward, and I was trying to outrun something while actually heading straight for it.
The appointment came and my primary physician asked me some questions, rotated both legs, accidentally dislocated my right hip, then quickly referred me to a specialist and sent me off for X-Rays. I got to see the images and to me they didn't look as bad the deformed and worn out joints that I had seen online. Meanwhile my Dad was here visiting from out of state, we had a lot to talk about with this, and he had some insight to offer with how it went when I was little. He knew the name of my specialist back then, even though 30 years have gone by and he's very likely retired.

 A week went by and I saw the specialist who pulled them up and agreed that things weren't as dire as they seemed at first discussion. I still have cartilage left, and I'm not a candidate for repair or replacement at this time. There is a bone spur on each side, and both sockets are too shallow to fully encase the ball of the joint, but it's not so bad that I'm bone on bone. However it appears that there's a labral tear on both sides. My right side is definitely in worse shape than my left, which isn't a surprise as it's quicker to go out, harder to get back in, and experiences more low-level pain when I've done nothing to agitate it. We're aiming for physical therapy first and surgical intervention as a last resort. The surgery would be minimally invasive and outpatient which is a big improvement over a hip replacement.
I was sent off with orders to get an arthrogram MRI for both hips and told I would hear back after results came in.
Maybe in defiance of all of this, I went immediately after this appointment to pick up my Jeep, the vehicle meant to take me out to more places, more adventure.

The takeaway was this: No running, no impact exercise, no backpacking with heavy loads. If it makes things hurt I need to back off. I can go back to walking, hiking, stretching, yoga, and pilates. But the biggest thing was being cleared for the Camino in April!

Things are ok, and pending results of an MRI with contrast I'm good to go with little or no change to the life I've worked for. Maybe not being sedentary and taking things slow will speed up the inevitable, but I'm making a conscious decision to do what feels right with the time I have before then.

https://hipdysplasia.org/adult-hip-dysplasia/

It’s a Beautiful Day

Last Saturday was Camino planning day number one, the first of what we expected would be many. It started with Carrie and I making the drive from San Diego to Dana Point to meet up with her sister, Jo’l. We presented her with her puffy jacket (we found matching packable ones last weekend) and overheated a little trying them on in the Southern California heat. The next stop was a great Columbian restaurant for lunch and the first bit of planning. Mimosas and Cafe con Leches in hand we discovered that the first few days are going to be the longest, clocking in at 20+ miles each. Jo’l is very fit and ready to go for this. Carrie is in good shape and won’t need to do a lot to get ready. I came up with a training plan for myself that I hoped would keep us on schedule on the Camino; 3 nights a week of 6 miles per night with one weekend a month doing 15-18 mile days back to back to make sure my hips can handle the stress of long distance days. I’ve been doing a lot more regular activity over the past few years, but this needed to be more targeted. 

From La Columbiana we headed off for a long walk in San Clemente starting bizarrely in an outlet mall parking lot before heading to sea summit trails, through the surf and sand below the pier, and back to the car. 

We weren’t done dreaming and scheming so we got iced tea at a corner coffee house that claims to be the best and talked about the cities we would explore in our time before and after the Camino. Lisbon, Porto, Finisterre... 

The whole day was this, when we get there, when we’re walking, while we get ready, because we’re going. We can practically feel the excitement of a new place. 

When we got done in Dana Point and headed back down to San Diego, Carrie and I talked with our husbands who had been planning on their own for the shorter trip after ours when we’ll all meet up to go somewhere relaxing. Tropical plans and dreams of hammocks and beachside drinks were added to the aspirations for long days and sore muscles. The night ended with thoughts of passport stamps and albergues.