Tuesday, September 29, 2009

How's The HIP?

Warning 1: this post is long and boring and all about what’s going on with my hip.

Warning 2: I’m beyond frustrated about my hip—the constant pain, the hoops I have to jump through to get this fixed and the time it’s taking. Therefore, my attitude is a bit negative.

So, for anyone that decided to keep reading, let me go back a bit in time...

In college, as a breaststroker (okay that sounds really bad), I had right leg adductor and hip flexor issues. I ignored them like any smart athlete would do... I got as many cortisone shots as they would allow and raced right through my four years of college. Looking back, not the smartest thing I could have done. Hindsight’s 20/20 though, right?

Anyway, after I stopped racing competitively the pain subsided. However, my right hip was always my problem area. I would feel the typical ache and pain after I put in too many running miles or did a long ride. I would typically rest it for a day or so, ice it and pop the advil. If it bothered me for a week or so, I’d go buy new shoes or try arch supports, get a massage, anything to mask the pain. In all honesty, I just kept thinking it’s one of those stupid injuries that I’ll always have to deal with—you know, the bad knees type thing.

The hip survived Ironman training (although it didn’t allow me to run as much as I would have liked) and racing. It was post-Ironman that the real issues began. In April, I started developing intense pain randomly when I ran, then it started occurring on the bike and even walking hurt. It finally got so bad that I knew I needed to see a doctor. It wasn’t just an “issue” it was a problem.

So, x-rays and an MRI later, I was told I had a stress fracture in the neck of my femur. You know the rest of this story…crutches from April to June.
As they were doing x-rays and follow-up tests to see the healing, through an MRI with dye, they discovered the real problem behind all this hip pain. I have a labral tear in my hip and a Femoroacetabular impingement (FAI).

Say what?

FAI is a condition of too much friction in the hip joint. Basically, the ball (femoral head) and socket (acetabulum) rub abnormally creating damage to the hip joint. In my case, damage (what they’re saying is a severe tear) has occurred in the to the labral cartilage (soft tissue bumper of the socket).

Since the final MRI results and x-rays, I’ve seen four hip specialists/surgeons and they’ve all told me surgery is my only option. Without the surgery to fix the FAI and labral tear, it’s very likely that I would have to have a total hip replacement in just a few short years.

So, I’m having surgery to get this fixed. However, given that this type of injury isn’t all that common,it’s taking WAY longer and is WAY more complicated than I ever expected. Here are the options I’ve been given.

Option 1: Get into surgery right away. This would be open hip surgery. The doctor would open up and dislocate my hip (so they can see the bones) and repair the tear and reshapes the hip joint, then puts it back into place. The recovery time for this is LONG. Many more weeks on crutches and it could be more than six months before I’m able to return to a “somewhat” normal level of activity. The reason I can get this right away is there are more doctors available that can do this type of surgery (it used to be the only method).

I’ve decided against option one and going with option two.

Option 2: Arthroscopic surgery using a camera and instruments inserted through small tubes. The surgeon applies traction to pull the joint open so they can work through tiny incisions. Recovery is usually quick – they say patients are back on an exercise bike in 24 hours, just a couple weeks on the crutches and back at it again in a few months. The hard part about this procedure is there are major nerves and vessels adjacent that can get damaged. There is a ball and socket configuration which is inherently round, but they're putting in straight instruments that have to travel deep through the body into that compartment. This is why there are only a handful of surgeons that can do this procedure. In fact, in the US there are about 5. Needless to say, even with not that many individuals needing this somewhat rare surgery, the waiting list for the arthoscopic procedure is LONG.

That said, I found a doctor in LA that is one of that handful. He’s AMAZING and has successfully performed numerous hip arthoscopic procedures. We’re working with the medical board to get me in quickly but as of now, it might be January/February before I can get this done. They were hoping for October/November but I’m not keeping my hopes up too much.

So, yes, I’m frustrated because I’m still unable to run. I can’t bike more than 40 miles without feeling the hip act up, walking is even a chore sometime and I’m still in pain 90% of the time. However, I feel confident about my decision to wait and do the less invasive procedure with a doctor I know has performed this on athletes in the past (his list includes NFL football players). The way I see it, even by waiting I’ll likely recover before I would have in the open hip procedure.

So, there is the hip update. It’s now a waiting game. I’ve learned several lessons in this process. Including the most important one—you’ve only got one body. Treat it right. Take care of it because even in your 20’s you can create damage that if not caught early enough might be irreversible. Pain is a signal that you need to slow down, or yes, even stop. So maybe it took me a long time to learn this…but I’ve learned.