What You Waiting For

It's been a few days, and I feel like the initial shell shock of the hip replacement suggestion has subsided some.  The relief I felt not having to decide about labral repair surgery has been swept away, but only to be replaced with the weight of deciding when I should do the hip replacement.  

 

So I had a little come to Jesus with Lauren, my physical therapist.  I'm proud of myself for only getting a tiny bit teary eyed with her, as opposed to the involuntary flow of tears the orthopedist got to witness.  Lauren's suggestion:

In her opinion, waiting until 55 is ideal. 

It's already been a year of pain, loss of function, and feeling like a watered down version of myself.  10 more years of feeling this way is a hard no for me.  Which is what brought on the teary eyes.  But she explained that kicking the can down the road until you get into your 50s decreases the likelihood of a needing a revision 20-25 years from now.  Advances in the materials used as well as the actual surgical technique are making recovery quicker, the limitations of the replacement fewer, and the lifespan of the replacement longer.  Waiting has its distinct advantages.  But back to one of my biggest concerns with my current diluted lifestyle...

Unless you're Ryan Psimas, maintaining your weight becomes more challenging as you age.  Being limited by pain has compounded this problem for me, and I worry about the negative side effects to my overall health.  My level of fitness has been in a downward spiral over the past year...I'm walking at a snail's pace, and I've lost range of motion, flexibility, balance, and agility.  I hate feeling incapable, and I haven't worked this hard on my fitness my whole life to only be strong and capable until age 45.  

So how would waiting until at least 50 benefit me if I spend another 5 years losing fitness (and probably gaining weight)?  Lauren's suggestion:

PT for a solid year.  Cortisone injections as needed.

Not an answer I particularly liked, but decided to hear Lauren out and listen to her why.  Right now, my activity level is mostly limited by pain.  In the past year, my level of pain was at it's lowest between January and April, after I had a cortisone injection and I was diligently doing my PT homework.  It was because I was feeling better that I slacked on the homework, causing the pain to come back with a vengeance.  If I hit it with the cortisone injections a couple times a year to ease the pain, I can hammer those muscles with PT to build strength.  Since hip replacement is imminent anyway, we're not worried about the cortisone further eating away at the joint cartilage.  And as for the weekly PT visits at an unsustainable $70 a pop, she's confident I can spread those visits out to once a month or less if I'm consistently doing my homework.  If after a year I'm in less pain and have more function, I can try to go another year.  Repeat until I'm in my 50s.  But if I'm still no better than I am now, we revisit the idea of surgery.

While I hate putting off something as life-disrupting as major surgery when it's imminent, I think Lauren's plan is one I can live with, mentally, physically, emotionally, and financially.  Guess I should schedule that cortisone injection. 

In the sha-la-la-la-low

 I have shallow hip sockets.  

That's what the orthopedic surgeon concluded from my x-ray, MRI, and current symptoms.  Shallow hip sockets, AKA hip dysplasia.  Yup, just like the ailment German Shepherds are afflicted with.  Woof.

Here's a helpful visual:

In a "normal" hip, most of the ball (the head of the femur) is within the socket, allowing the bones of the pelvis to bear much of the load.  With a shallow socket, much of the ball is outside of that socket, leaving the head of the femur and the surrounding labrum to bear the load.  Over time, the labrum and the head of the femur start breaking down, leading to tears in the labrum and arthritic changes in the femur.  When you've been active your whole life, those changes can cause problems at a younger age than a more sedentary individual.

And that means surgery to repair the labrum won't do jack squat (ouch, squats) to help me.  Which is good news and bad news.  Good news because the decision to have surgery to repair the labrum seemed impossible (not a great success rate, especially in patients over 40), and now I don't have to make it.  The bad news is that the ultimate solution for this hip of mine is a total hip replacement. 

I'm 45.

While I had an inkling that a hip replacement would be in my future at some point, I was not expecting "some point" to be like, now.  Old people have their joints replaced.  But as the wise Lara Spencer from GMA once said:

The timeline is completely up to me.  I can kick this can down the road by popping countless Advil, more PT (at $70 a visit!), and/or cortisone injections,  but

I have already modified my activity level beyond what I'm willing to continue indefinitely.  I'm unable to do things I love, and there is constantly some level of discomfort.  One of my greatest fears is that the longer I'm stuck living like a bump on a log, the sooner all the health problems that plague my sedentary ancestors will come knocking at my door.  I'm not ok with that when the success rate for hip replacement is so high.  And sure, a hip replacement at age 45 sounds startling, but why NOT use my age to my advantage when it comes to recovery?  And let's face it...there aren't a whole lot of advantages to being a 45 year old woman, am I right?

So nothing is on the books yet, because while giving me a new hip is just another day at the office for the surgeon, it's a complete upheaval of my life that will also prove to be quite the kick in the nuts to my husband and children.  There are still a lot of decisions to be made, like when would be the least inconvenient time to be laid up for several weeks?  Do I sacrifice my summer because I wouldn't miss work and my kids would be around to help me, or do I sacrifice my income and do it in the spring?  And there are ducks to get in a row, like do we change our health insurance plan during open enrollment to get the most bang for our buck?  

Sounds like my shallow hip sockets are going to send me off the deep end.

 

Used to be young

 October 5, 2022.

That was the last day I laced up my sneakers and went for a run.  It was a slow and easy three miles, the kind I'd been enjoying more and more in my early 40s.  No beating myself up over pace or distance, just going out to clear my head and get my blood flowing.  I finished that run, and I haven't been the same since.

My left hip had been whispering to me during some runs prior to that day, but as someone with many miles under her belt - and a bachelor's degree worth of understanding about the musculoskeletal system - I figured I was just overdoing it and needed to take it easy.  But as I finished that easy run on October 5th, literally as I was slowing down in front of my house and stopping my Garmin, my hip screamed at me.  So I tried reasoning with that hip.  I told it I'd take a week off of my already easy runs and spend more time stretching and strengthening and treating it real nice.  One week didn't quite do the trick so I took another week off.  And then another.  My symptoms (groin pain, pain with hip flexion past 90 degrees, clicking and catching with certain motions) were not so subtly hinting that it was a torn labrum, so I scheduled an appointment with my PT.  I started a glute strengthening program to see if that helped at all, and since I had already met my deductible thanks to a very costly yet unrelated issue earlier in the year, I scheduled an MRI for confirmation.  

I normally love being right.  Not this time.  Although to be honest, I did experience a brief twinge of relief...I've known several people who have gone to a doctor for what seemed to be a musculoskeletal issue only to learn they had advanced cancer.  I thanked my lucky stars nothing like that showed up on my scan.  But after the gratitude came the reality check of what the diagnosis of a torn labrum means for me.  First, to catch you up on a little Anatomy 101, your hip joint is a ball and socket joint.  The ball is the very top part of your femur (thigh bone), and the socket is where the femur connects to the pelvis.  The labrum is a ring of cartilage that sits inside the socket, deepening and cushioning the hip joint.  A tear in that cartilage can cause pain, clicking, and catching of the hip joint as the head of the femur moves around in the socket.  Unlike a torn muscle that can heal thanks to the ample blood flow it receives, the labrum has minimal blood supply and will not heal on its own, making your two options surgery to repair it or modifying your activity to manage symptoms.  Insert sad tuba.

The anatomy of the hip socket with the pesky femur moved out of the way.

Even with a deductible that was fully met, I knew better than to go the surgical route right out of the gate.  Success rates for labral repairs aren't stellar, and there's no guarantee I'd be able to run without pain again even after surgery.  I started seeing a magician of a physical therapist, who basically told me the muscle imbalances throughout my body were pronounced, and if we can wake up some muscles here and tell some muscles to shut the fuck up there, I could get some relief.  She was confident that if I diligently did my homework and had some patience (what's that?), I'd be able to run again in some capacity.  The exercises she prescribed, along with dry needling and cupping, provided instant results.  

Super weird exercises, performed several times a day.

Dry needling (not me, duh)...imagine acupuncture, only instead of just lying there with the needles in you, the therapist wiggles the needle around until your muscle jumps over and over again.

Cupping.  It looks gnarly and leaves big purple hickeys on your skin for weeks, but it helps minimize the soreness the dry needling creates.

I'm not kidding.  Magic.  Or maybe black magic since the dry needling makes you feel a bit like a voodoo doll.  I was in less pain and had greater pain-free range of motion.  Like deep squat range of motion.  I even worked my way back into running, one little minute at a time, until I ran a whole mile without taking walk breaks.  I was filled with hope and even cancelled the appointment I made with an orthopedic surgeon.  I had a little setback in April, and with so many other things going on (spring cleaning, spring break travel, and major home improvement projects), instead of working to get my body back on track, I neglected my PT homework for a while.  At the time I was only having symptoms when I tried to run, so I just didn't run.  Problem solved.  Ha ha no.

The pain, clicking, and catching came back with a vengeance, and it was no longer just when I ran (because I wasn't even running anymore).  Walking hurt.  Biking hurt.  Squatting hurt.  Standing hurt.  Sitting hurt.  Getting up from sitting hurt.  The pain was constant, and it ranged from moderate discomfort to nauseating pain.  So back to PT I crawled (crawling hurt too, in case you were wondering).

Six more weeks of PT later, I'm not feeling consistently better.  The needling, cupping, and exercises provide temporary relief, but they don't seem to have lasting effects, and I'm starting to doubt they ever really can if the labrum is still torn.  I'm at a point where I can concede not being able to run miles at a time, but I cannot tolerate this constant discomfort and the significant modification of my lifestyle.  At work, sitting criss cross applesauce with my littlest friends is out of the question, and so is squatting to get down to their level.  If a kid is a flight risk, there's no way I'm catching them, and forget having any fun with them at recess.  I typically come home from work and lie flat on my back for a while before tackling the evening's agenda.  My workouts - which I need to combat the cesspool that is my genetic makeup - are mediocre at best.  Cardio is non-existent, but if I'm having a good day I can sometimes walk, bike, or swim - as long as I know it will no longer be a good day by the time I'm done.  I've put on weight.  My blood pressure is up.  My cholesterol is up.  Yoga - my dear, sweet, magical yoga - causes more pain and sadness than it's worth (oh how I miss child's pose, and happy baby is no longer happy).  

At least I could justify buying some cool new goggles.

Of course I'm thankful this condition is not life threatening and in the grand scheme of things I'm fine, but my quality of life has taken a nose dive this year and I don't feel like myself.  I scheduled an appointment with an orthopedic surgeon for later this month to gather some more information about the best course of action for me (especially since all these visits to PT have made a nice little dent in my deductible).  Stay tuned.