Post-PAO - 19 months

After I originally posted this, I went back and looked at my previous posts and realized I didn't post ANYTHING after I scheduled my PAO! I was so busy job-hunting and getting ready to move that I forgot about it. After my surgery, I was busy writing other things and then continuing my job hunt. On that note, I have good news - I've been in my new job for a little more than a year and also taking some graduate courses.

So lets see what I've been up to post-PAO (surgery was July 2010). Last fall, I hiked nine miles one Saturday and biked 40 miles a couple of weeks later (with plenty of biking in between). I've been riding horses since just four months after my PAO, so that's not new. I also got back on my snowboard at five months post-surgery (with my surgeon's permission), but this year I stepped up my snowboarding to include jumps and racing. Not bad for a 46-year-old with wonky hips, huh? I also tried some jogging last fall, but with the current trouble I'm now having, that probably wasn't a good idea, and I will probably stick to walking. I'm going to physical therapy for a problem with a ligament, and neither the physical therapist nor my surgeon know why it's bothering me. If it does not clear up with the current round of therapy, I'm planning to try acupuncture. I'll try to remember to post the outcome either way.

Long overdue update

I had the best of intentions about keeping up with this blog, but here is an update...finally. I think I had a mental block about writing more until I had some idea what was going to happen with my hip. Today was almost the first day I had no pain in my right hip for months, but I finally have a plan for this hip.

Last week I went back to the surgeon yet again hoping for some answers. He told me I basically had two choices - live with the pain or to have a periacetabular osteotomy (PAO), which was what he recommended over a year ago. It was only my uneasiness with that procedure that led me to have arthroscopy instead. However, I have yet to be pain-free following that surgery, and it really feels like I have torn the cartilage again. If I had to live with the pain, it's not that bad, usually not much more than 2 on a scale of 1 to 10. But I don't want the joint to wear out prematurely. The surgeon thinks it already has mild arthritis but is confident that I will have a great outcome with the PAO.

So I will lose part of another summer with the hope of enjoying many summer and winter activities without pain in the future.

Update - 3 months and 3 weeks post-op

At my last post, I had just gone back to see my surgeon's nurse practitioner, who diagnosed tendonitis in my hip, and I started a month-long regimen of prescription strength ibuprofen and additional physical therapy. About two and a half weeks into that, I started to see some real improvement, and during this past week, I feel like I'm walking normally for the first time since surgery.

In fact, I'm not back at the point I was right before surgery - occasional pain in my groin and on the side of my hip after exercise. Strangely, I feel a little peace of mind at this after what seems like a whirlwind of recovery, physical therapy, follow-up visits, filling prescriptions, crutching around for the first few weeks, and of course, getting some teaching done! For the first time since summer, I took a walk across the field and up the hill to the pond on the farm and just took some time to sit quietly on the dam. I always feel more like myself when I do things like this. Last weekend I took my canoe to a forest service managed lake and enjoyed the fresh air, the way the light hit the water, and the feel of stretching my arms to paddle the canoe.

If I need to go forward with the surgery that was originally recommended, the lesson I want to take into it is to try to find those moments and those places that make me feel peaceful and relaxed. I want to try to not let my life become just about recovery during that time. This may seem contradictory - after all, shouldn't I focus on the recovery? I think the opposite now - recovery probably comes best when we continue to express ourselves as always and not just become our medical condition. Of course, this applies to any condition, ranging from something correctable like a broken arm to a chronic condition like rheumatoid arthritis.

Update - 6 days after last visit to clinic

At my visit with the nurse practitioner last week, she told me I had tendonitis in the psoas tendon and prescribed ibuprofen for a month along with physical therapy. She recommended not riding horses, but I had already sent in my entry and payment for a schooling dressage show for that Sunday. Being on ibuprofen for a few days before the show really helped, and even though I've ridden my gelding about eight times since the beginning of September, we won one of our classes and took second in the other. It was FAR more than I expected since I was just going to be happy to place and to keep our scores in the 60s (which we did do). It also means that we can't ride in maiden classes anymore at that level, but I'm NOT complaining. For now I'm going to give my hip some time out of the saddle to recover from this tendonitis and do some ground work with my horses (after I get caught up on grading papers). I hope that in three weeks, I can call back to my surgeon's office and tell the nurse practitioner that all is well. I really want to snowboard this winter since I finally got the hang of it last year!

Heading back to the ortho clinic...

Hopefully I have more answers after tomorrow. Last week I started to use a crutch again to take some of the pressure off my hip. I was still limping, and that was hurting my other hip (left), my calf muscles, and my back. But it only relieves my right hip temporarily. All I need to do is walk around my classroom a couple of times to aggravate it. Tonight, it hurts all the way down the outside of my thigh, my glutes are sore, and the groin pain has made an appearance.

If I do decide to have a PAO next summer, I hope I won't have to use a crutch until then! More after tomorrow...

First, a little history...

As I post this first entry, I am about two months post-arthroscopic surgery to repair a damaged labrum in my right hip. But before I talk about that, I thought I should go back to the genesis of my hip problems. The first symptoms I remember with my hip occurred when I was about 19 or 20 years old (roughly 1985-1986). I did not have car insurance at the time, so I rode my bike or the bus to my classes or to work. I had been very active in the year or two before this, having moved to Colorado and taken up skiing, but I noticed that my right hip would lock up while riding my bike.

The locking didn't hurt - it was getting it unstuck that was dreadful, but I didn't think anything of it and kept riding. I had also taken up jogging, and about a year later, joined the Marine Corps. The only problem I had while in the Marines was when I got pregnant. Since I ran regularly, I planned to continue as long as possible through my pregnancy. I was going to be one of those women who go on a morning jog and have the baby the next day! Within a few weeks, though, my hips were so loose I could barely walk. I still didn't think anything of it, and after I had the baby, my hips were back to normal, except for occasional locking when I rode my bike.

Fast-forward to the year 2001. For a year or two, my left hip ached terribly in cold weather. My car had vinyl seats, and seating on that cold seat in the winter made my hip cramp up. I replaced my waist-length winter coats with longer coats, which helped a little. I was swimming laps to stay in shape, and during one session, I pushed a little too hard and felt something pop while doing the breast stroke. The next morning - and for the next two or three months - I could barely walk. Swinging my leg slightly forward or backward was excruciating.

I kept swimming without kicking and finally quit ignoring it. I saw an orthopedic doctor who couldn't seem to tell me what was wrong but gave me a cortisone injection. That took the pain away for a few weeks, and after seeing a chiropractor for a few months, I was able to hike again without too much pain. The hip was never the same again, so I started looking for a different doctor on the internet. I came across an article about hip dysplasia, and it seemed that I had the symptoms. I called the office of the doctor who was discussed in the article and made an appointment with one of his associates.

She didn't see anything obvious on the x-rays but recommended an MRI. A couple of weeks later, I discovered I had a torn labrum in my left hip, and the doctor recommended surgery. Now I was to see the doctor from the article about hip dysplasia and to have arthroscopic surgery to trim the torn labrum and to remove inflamed synovial tissue a few months later. The recovery was a little longer than typical, and it took another cortisone injection to get rid of some lingering pain a couple of years later.

In the meantime, my right hip must have been feeling left out of all of this attention and started to bother me. The surgeon had told me not to let it get as bad as the left hip, so back I went to see him. Sure enough, the right hip also had torn cartilage, but the surgeon also explained that this hip was a candidate for a surgery known as a PAO - peri-acetabular osteotomy, which corrects hip dysplasia I didn't know I had. My imaging reports revealed that 1/3 of my right femur head is uncovered, making it less stable than a normal hip.

While still at the surgeon's office, I made the appointment for this procedure and took home a folder to read. I was just short of horrified by the procedure and called his office to ask if he could just do the arthroscopic surgery to fix the labrum. The surgeon explained that fixing the labrum may not work because the rim of the socket will still be getting overloaded, but he agreed to try it.

So here I am about nine weeks later. Instead of trimming the labrum, as he had in the left hip, he put sutures around the frayed edges and two anchors in the bone. Surprisingly, the pain was very manageable, and although a filled a prescription for Vicadon, I still have a completely full bottle. Ibuprofen was enough.

Unfortunately, the progress of my recovery seems to have stalled. I called the surgical coordinator, and RN who explained that it can take four months for the hip to "calm down." During the four weeks since I ditched the crutches, the hip has not changed much. In fact, right now the symptoms are almost exactly the same as before surgery and seem to be getting worse. Today I decided to crutch around to see if that helped, and it seems to have worked. I go back for a follow-up appointment in about a week to see what's going on. I suspect my choice will be to deal with the discomfort or to give in and have the PAO. I've been reading much about the PAO online - the procedure itself as well as the stories of other people who have gone through it - and it seems a little less intimidating.