17 days out: SI Joint of horror

I was feeling really good about my recovery. Every day I was able to do something new. Today is not one of those days.

I went to physical therapy on Monday (2 weeks out) with some nerve pain, probably from swelling inside my hip.  My PT, Brittany, pulled on my leg, and it REALLY helped. I have had no nerve pain on my inner thigh since then.

In an effort to keep things exciting, I tried to exit my shower by myself Tuesday, and I twisted a little bit wrong. Immediately, my lower back/upper butt on my surgery side hurt. a lot. Sitting was just not really an option, and laying down wasn't much better. During the day on Wednesday it wasn't too bad, but by the time I went to physical therapy that night, it was, once again, no fire. Brittany felt my back and immediately diagnosed it as SI joint pain.

In past PT sessions, pre-surgery, she's found my SI joint to be a little out of whack, which throws off my ability to use my glutes for stabilization, leading me to overcompensate in other areas, like my hamstring and hips (hey, FAI). Before surgery, though, I felt no pain along with my SI joint being out of whack. To fix it, she pulled on my leg, hard, and everything flew back into place.

Since I just had surgery, she obviously can't yank on my hip. she pulled on it a little bit, trying to release any tension in the hip joint, and then tried to massage out some of the muscles in my lower back. None of this seemed to relieve much pain. The only good part of PT yesterday is that my personal trainer, Dan, Let me ride the upright bike for ten minutes!  This was the first time I've been able to bike, and I was ecstatic! There was some pinching when my leg was all the way up, but mostly all the pain was centered in my back.

Last night was terrible. I woke up again and again, and today sitting was impossible. I called my doctor's office to see if there is anything else I should/could be doing. First, my PA suggested taking the pain pills I got before to help me sleep. Second, she suggested I come into the office for an xray. She said usually stress fractures present with pain in the front of the leg, but occasionally, they can cause intense pain in the back. I've been so careful. I really hope the x-ray comes out clear. I cant imagine twisting in the shower would break my leg.

Two Weeks Post Op

Two weeks out...things I'm able to do:

• Stand for 3-4 hours. I could probably stand longer, but your strong leg gets pretty tired/stiff. My husband's company was hosting a brunch after the White House Correspondents' Dinner, and I went. Standing the whole time was not really an issue.
• Drive a car! I can finally get in and out of the car on my own, with my crutches and brace. Hooray! Freedom! I probably couldn't sit in the driver's seat, so straight up, for more than 30 minutes, but that's a start!
• Leg lifts! At PT this week, I started to do leg lifts and leg exercises that actually resemble exercises healthy people do at a gym. Hooray!
• Sit on the couch for extended periods of time. Who would have thought being a couch potato would be a measure of success? For the first week and a half, I was having trouble sitting up on the couch for more than 30 minutes. Now, I am able to for a longer period of time. Having my leg propped up allows me to sit even longer.

Two weeks out...things I'm struggling with:

• sleeping is still not going well. I am getting about 3-4 good hours of sleep a night. I don't know if this is because of my body still being confused from the pain pills or if it is from...
• Nerve pain! I've started to have some pain, especially at night, on the inside of my thigh. My doctor warned me that some people experience nerve pain due to swelling inside the joint and around the surgery area. I told my PT about it, and she pulled on my leg to create more room in my joint. This didn't hurt and I was skeptical about the validity of this approach. I'm happy to announce my hesitation was misplaced, and I did not have nerve pain last night.
• Still using my crutches. I know I could walk, PT knows I could walk, and my doctor knows I could walk. Unfortunately, the trained professionals among that grouping agree I should not walk yet. This is crazy frustrating. Crutches are the pits. 

First Doctor's Appointment and Physical Therapy, One Week Out

On Monday, I had my first doctor's appointment with my surgeon.  I got my stitches out, and overall, he was really happy with how I was feeling and how things looked.

He reiterated that even though it may not cause me pain to one crutch, or even walk, it does not mean I should be doing it. He said he's seen stress fractures in people who "feel fine" and begin walking without the crutches after two weeks. Even though I feel fine, my body getting used to a thinner bone will take more time. I was hoping I'd be a miracle case and be allowed to walk again right away. No such luck...

PT was not nearly as scary as I thought it might be. My only suggested exercise, in addition to prone laying (fancy term for laying on your stomach), heel slides, and hamstring stretches, is to add in glute squeezes.  To do this, I lay on my stomach with a foam roller under my feet. Taking the pressure off my feet should allow me to better feel when I am flexing my hamstrings and when I am flexing my glutes. I say should because for some reason, I could not get the hurt leg to fire. muscle memory is a funny thing... The one bad part of PT was that one of my little arthroscopic holes is pretty unhappy about no longer having stitches. I guess if a little cut is the worst facial injury I have from this surgery, it isn't so bad, though.

6 days post op

a week out and I already have less pain than I did pre-surgery.

I am so glad I listened to my body and stopped running before I really ruined my hip. The doctor had to do some bone shaving and took out a lot of angry, inflamed tissue, but I did not have to have my labrum anchored. It was frayed and I just needed it to be cleaned up and trimmed. This is going to make my surgery-recovery a heck of a lot quicker. I could be back to running before I know it!

Today I was able to go to a park and stand about 20 minutes. Getting into and out of cars is still hard, but I have two big pieces of news...


1st) I moved up to 90 degrees on the CPM machine! Last day on it and I hit the ultimate goal!

CPM at 90!!

2nd) I can walk on one crutch for awhile!!!  HOORAY! I'm a one crutch walker! I see my doctor tomorrow, and I will get the official OK from him, but I tried a couple of steps tonight and it went well!!

Four Days Post Op: Things I Can and Can't Do

Although the past four days have been filled with ups and downs, I have to say that thus far, my surgery experience has been mainly a positive one. I can do a lot more than I anticipated and my pain is really under control. I'm going to go through what I can and can't do and a brief timeline of recovery.

Downs:

• I'm immune to the pain-killing effects of hydromorphone. I did not realize this until about 2 a.m. the morning after surgery. After the nerve block and pain killer I'd been given through shots at the hospital wore off about 18 hours after surgery, I was nearing panic. The pain was too intense and unpredictable to sleep and no amount of hydromorphone (Dilaudid) would work. I'd been promised 2 mg would knock me out, but I was taking 8 mg and all it was doing was making me dizzy. My doctor's office didn't open until 8:30 a.m., and when I did call, it took another 4 hours for a doctor to call me back and change the prescription because they were all in surgery. I could not sleep or focus during this time. I didn't sleep for about 36 hours after surgery, until I was prescribed and took extended release OxyContin.
• I'm not off painkillers yet. I have talked about this a lot with my husband, trying to convince him that I should go off of them. He made a good point; right now, every day I am able to do more and more because I am not experiencing background pain. Pain will slow down my recovery, which is progressing really well right now. I don't have an option to go off the painkillers on a trial basis. Because I switched to slow release pills, one pill lasts 12 hours. The last hour before a pill and the hour and a half after taking a new pill are a little rough. I am looking forward to switching out my oxycontin for tylenol, though.
• The pain associated with this surgery is like the injury itself- unpredictable. One of the common complaints about FAI is that the pain changes. First, for me, it was sharp, take-your-breath away pain. Then it turned into an ache that got worse the more I moved. The surgery has different pains associated with it. I've had a lot of burning feeling in my top suture. I felt some pinching using the CPM machine yesterday, that felt like nerve pain. Then there is the muscle pain.

It may not look like it, but this is my most difficult exercise, heel slides. 

• The worst pain is the muscle pain associated with trying to do new activity. My glutes, IT band, and hip flexor are a mess. It feels like someone tied them in a knot. My IT Band and Hip Flexor have surprisingly gotten better quickly, but whenever I add too much weight onto my leg while I am crutching around, my glutes scream at me. and I mean scream. Maybe PT will OK foam rolling? A girl can dream.

Ups:

• I can mainly get around my condo by myself. I can get off and onto the couch and the bed. I was proficient at this about 72 hours after surgery. At first, it is hard to lift your leg and engage those muscles that are so inflamed. I took advice from another FAI blog, Arthroscopic Hip Surgery, and mastered the art of lifting my bad leg with my good leg
• I can go to the bathroom by myself. I was able to do this about 24 hours post op. For me, it was more about learning that I wouldn't hurt myself and how to sit down with a bum leg. My mom and stepdad came in for the surgery, and I think we're all very grateful that they don't need to accompany me on bathroom trips.
• The meds haven't made me sick or totally loopy. I am so so grateful for this; I have read horror stories about how they impact other people's systems. I've been eating mini saltines every time I take pills. I switched painkillers once and need to be on a prescription anti-inflammatory for a month, but thus far I've had very few problems. Like all FAI blogs, I suggest anyone having this surgery eat healthy amounts of fiber each day. 
• the ice machine is great. I got a DonJoy Iceman with a regular/general water pad and it has been great. I iced pretty much constantly when I came home from the surgery, and now I do it a couple of hours a day. I've always been a big fan of icing, and the machine is great. 

The cord coming out above me is the ice machine. Comfy enough to nap!

• And the final, most important up is the support I've gotten has been amazing! From edible arrangements galore to flowers, my friends and family have been an amazing support system. this has made me really upbeat. So much so that yesterday afternoon, I went outside on a short (we're talking less than one block) walk on my crutches! Hooray!

ON THE MOVE!

FAI Surgery Day

On Monday, I got my long-awaited FAI surgery. I'm still on some pain meds, so excuse any rambles within this post.

Sunday night, I had a big macaroni and cheese dinner, prepared by my lovely husband, Chip. If anything can make me feel relaxed and happy, it is pasta and cheese. My mom and stepdad came into town on Sunday, as well. They are staying with us until I am well enough to be on my own during the day while Chip is at work. Although I think it would have been possible for me to be on my own today (Wednesday, two days post op) I would definitely recommend having someone fully available to you for the first 36 hours, since your pain and medication side effects could be unpredictable.

Monday morning I had the first surgery slot at 8:45 AM. I arrived to the surgery center at about 7 to fill out some paperwork and wait around. I was taken back to a prep room and changed into a gown and hairnet. The surgery center I went to was really accommodating; each prep area had a heated blanket so you could be more comfortable while waiting for things to begin. The initial nurse came in and gave me an IV connected to nothing, had me pee in a cup (still not sure why this was needed) and went through the initial questions (did you eat or drink after midnight, how is your hip pain now, do you have metal in your body, etc.). She assured me that putting in the IV would be the most painful part of my day. She lied. More on that later, though.

The anesthesiologist came in next. He explained that I would be going under general anesthesia (totally asleep), which would be administered through my IV and a breathing tube during surgery. He also explained that I had the option to have a nerve black done before the procedure began. If you are given this option, I highly suggest you take the nerve block. This dulls about 90% of the nerves in your thigh for between 12-24 hours. When you come out of FAI surgery, you're still going to have pain, but the nerve block makes it so you ease into the full scope of pain. It also gives you a chance to get ahead of the pain, by taking pain pills before the nerve block wears off.

To administer the nerve block, they'll give you a bit of happy meds in your IV (which hit like champagne. All of a sudden you're lightheaded and giggly), and then they do an ultrasound of your hip so they can watch where the needle goes. He hit a nerve when he was doing it, but the happy meds made me not mind. The nerve block, at least for me, seemed to wear off in stages- my knee area and some of the are around my bandage was still numb last night, 36 hours after surgery. The incision started to hurt at about 2 AM Tuesday, so 18 hours after it was given.

Then, the doctor comes in, goes over his plan, and signs the hip he's operating on. He goes over post op protocol with you and whomever came to surgery with you- in my case, my mom and Chip. It was good they were in there, since my adrenaline was through the roof, and my happy meds were doing their job.

Into surgery I went. I followed the advice of another blogger and did not google what a traction table looked like. I think you only need to see that once, and it is better to see it with your happy meds. The surgery table is really thin. I'm a pretty small person and I definitely spanned one side to the other, width-wise. Then, they put oxygen on you, ask you to breath, and...you're out.

I woke up to a lot of movement. As a note, I am blind as a bat without contacts/glasses and my glasses were with my clothes. I could not see or identify anyone, really. The first thing I remember is being very cold. my teeth were chattering uncontrollably, and the movement was hurting my hip. The PA put some warm blankets on me and then began administering pain meds. My FAI doctor prescribes Dilaudid, which is hydromorphone. Before surgery he'd told me 2 mg should take care of my pain, but I could go up to 8 mg (4 pills). He joked that this was enough to take out a large, pro football player. The PA gave me 2, 4, and 6 mg and it had no effect on my pain or teeth chattering. To try and get the pain under control, she gave me demerol. This worked like a charm. My teeth stopped chattering, and my pain dropped from a 9 to a 2.  That said, it did cause me to immediately break into hives; I told the doctor something along the lines of the hives being worth the decreased pain, but they seemed pretty concerned. At this point, they had let my mom and husband back into the post op room, and they were shut out again as I broke into hives. The PA was trying to help me dress. Everything felt pretty hectic. Before I knew it, though, my hives were under control and I was in the car, on the way to CVS to fill prescriptions of the pain meds, Dilaudid, and an anti-inflammatory/blood thinner mix.

This is important. If you are having surgery in a surgery center without an on-location pharmacy, find out what pain pills you will be prescribed and find a pharmacy that has those pain pills in stock. We went to many pharmacies, trying to find someone that had 60 pills of Dilaudid. Post surgery, my emotions were a disaster so I cried pretty much the whole time we were on this pill hunt.  I was also really thirsty during this time- the thing they put down your throat with the anesthetic makes your throat very dry.

Eventually, we got home. I live up three flights of stairs, and there is significant sidewalk to walk into the building. Walking into the building, which is downhill, was terrible. After FAI, your muscles are a mess from being in traction- this hurts more than the pain of the surgery really does- you'll still be under the effects of anesthetic, too. I exhaled when taking a step with my bad leg, which helped, but this still ended up being pretty teary. Stairs weren't nearly as bad as walking, which surprised me. Just using the railing really helped.

My doctor sent me home with pictures of the surgery from within the arthroscope. My labral tears turned out to not be as bad as he had anticipated, and he said there was no trouble rounding out the top of my femur. What was surprising was the large amount of irritated tissue in the joint. He removed all of this. This was what was causing my pain. I've attached some pictures below, but I'm not sure what exactly they mean besides red tissue being the inflamed tissue.

Inflammation in the Joint

I think this is the labrum. sorry for the terrible picture quality.

Once home, I got comfy on the couch and just hung out. I was actually feeling pretty good. Every time I had to go to the bathroom, I was reminded how knotted my muscles were, but besides that, I was doing OK.  Being an athlete, I was familiar with muscle pain and felt more comfortable wit this sort of pain. My next post will be on pain management, and my experience with it after this surgery. I had some problems with the pain killers that lead to unnecessary pain and sleeplessness.

FAI: lead up to the surgery

I haven't posted in a long time. I'll write another post catching everyone up, but the long and the short of it is that I tried to run a marathon, but after my final long run, I started experiencing sharp, somewhat random pain in my hip. the pain started about 4 days after the run, and got worse quickly.

I went to a doctor, and he did x-rays, which showed that I did not have a stress fracture. He suggested I have an MRI with contrast. This is when they give you a shot of light sedation, and then stick a large needle into your hip joint to insert the contrast. this feels very strange. They give you the shot with a live x-ray, so you can watch it go into your joint. I am pretty squeamish, but I thought this was awesome. The rest of the day it feels like you have liquid in your hip- it's like there is extra pressure in there. It doesn't hurt, it just feels uncomfortable.

The first doctor I went to was a shoulder doctor. He and I knew he wouldn't be the final doctor I'd see, but hips and shoulders are pretty similar in the ways things go wrong. He said the MRI showed some fraying of the labrum, but noting too serious. He tentatively diagnosed me with femoral acetabular impingement (FAI), but didn't seem concerned since he saw so little fraying. This was disappointing, since it left me wondering if the sharp pain that was keeping me from running was coming from something else. He prescribed me physical therapy, and I began going twice a week. My PT at the time was very into muscle release through massage, or, as I liked to call it, she pressed into me really hard wherever it hurt. This PT was pretty non-aggressive in her exercises, though. For instance, I never did anything more strenuous than leg raises on a stability ball. This got annoying quickly, especially since I was going from such an active lifestyle to one that was pretty still. I've since changed PTs to Jackson Clinics, which I have really enjoyed. Half of each session is spent with my PT, while the other half is spent with a personal trainer, working on specific exercises.

My first doctor said that if it still hurt in December, to make an  appointment with Dr. Andrew Parker of OrthoVirginia. I had the surgery today and am in pain, and even under these conditions, I would definitely recommend him. The one downside was that it took a really long time, like 2 months, to get an appointment with him. He is the doctor for the Redskins so he's a little busy. He is calm, patient, and knows FAI backwards and forwards. He's done FAI surgery thousands of times so he's seen it all.

He reread my MRI and showed me where my bone was shaped unevenly, which was causing the labral tears were. He said he understood why it was causing pain and that he was confident he could fix it through arthroscopic hip surgery. This diagnosis felt so freeing, since I finally understood where my pain was coming from. He spent a long time with me going over how FAI occurs, how I irritated it, and how he could fix it. If PT doesn't work to "fix" FAI (reduce the symptoms, since you cannot actual fix the impingement), arthroscopic hip surgery is the next option.

I told Dr. Parker I really wanted to ski in Vail with my in-laws the first week of April. He was really supportive of this- he said I wouldn't be able to do any damage that he couldn't fix up in surgery. His understanding of my need to continue to be active, even though it hurt, was something I really appreciated. I scheduled surgery for April 13, and went about life until then.

Before the surgery, I focused on strengthening my core and glutes, hammering out planks, leg raises with resistance, and squats as much as I could. In the end, I think this really helped, since after surgery, you can't use many of your muscles at all.

Next post: Surgery Day