We Are Not Our Bodies

It's taken me a day and a half to bring myself to write this post. As I sit here, trying to put into words how my life has been completely turned upside down, I can't control the tears that are running down my face. It's impossible to truly describe how I feel right now. I feel so incredibly alone and isolated. I feel trapped in a body that disgusts me. I want to scream and claw my way out of it because it's not me. It's not me. I am a vibrant person. I am the person that makes you wonder how anyone could have the kind of energy I do. I'm vivacious, light hearted, hard working and driven. I want be 70 years old and have every inch of my body aching. I want to say that I truly lived my life to the fullest. But right now it feels as though I've just stopped with the world still spinning around me. I'm just numb.

I went to Vail on Wednesday as scheduled for the battery of pre-op requirements. After a slight scheduling change, I was able to work all night on Tuesday, take a 30 minute nap Wednesday morning, and then get right back on the road. The team at Dr. Philippon's is awesome. Not that I didn't do my fair share of waiting but it doesn't bother you so much when you know you're being treated by the top doctor in the country. After arriving at 10:45, I went through evaluation by the athletic trainers who fitted me for my hip brace and crutches, measured leg circumferences and lengths from various points, and took me through a battery of strength and range of motion assessments. I had a 3D MRI scan and was given a baseline strength and conditioning assessment by physical therapy. I met with Dr. Philippon's two RN's who are also RNFA's (first assist nurses) and his fellow working under his tutelage. The nurses and the fellow initially had me concerned because they said that Dr. Philippon did not normally do hip surgery if a cortisone injection had been placed in the joint in the last 3 months. But when I finally met with Dr. Philippon at 6pm, he assured me that it would be fine. He did an exam and said that in addition to having the large labral tear, I did have the CAM type of femoral acetabular impingement, which is where the head of the femur (the ball part of the ball in socket joint) has excess bone growth and is pinching in the joint. The plan was to shave down a bit of this excess bone and repair the labrum. I discussed with him the fact that the worst of my pain felt like it was coming from the sitz bone and radiating down my hamstring. He pulled up my MRI's and did some measuring before concluding that also had something much rarer called ischiofemoral impingement. In the picture below, you can see ischiofemoral ligament. What happens in this type of impingement is that the distance between the lesser trochanter, a small notch on the inside of the femur bone and the base of the hip bone, also known as the pubis symphisis, is too narrow. This causes pinching of the ligaments, muscles and nerves that run in between.

Dr. Philippon said he would fix this problem by shaving down a bit of the hip bone as well as the lesser trochanter. This would be a more extensive surgery, but it wouldn't impact my recovery time. Grateful that he was able to pinpoint the causality of my hamstring pain and muscle spams, I thanked him and his team, and started on the 3 hour drive back to the Springs. I had a lot to do on Thursday to get ready for the surgery and to go home directly after for the holiday. 

About an hour or so after leaving Vail, my phone rang. It was Penny, one of the nurses from the clinic. She said that while reviewing the cases they had seen that day, the doctors had done some additional measurements on my femur and were concerned about the significant amount of internal rotation it had. The doctors wanted me to return first thing Thursday morning and undergo a 3D CT scan of the femur as MRI scans aren't as accurate as a CT when it comes to measuring bone. The concern was that the lesser trochanter may fracture when they shaved it down, and if it did, it would require a screw or two in order to reattach it. The CT scan would indicate whether or not there was a good chance of it fracturing and if there was, they would postpone the surgery for a couple months in order to let the cortisone wear off, as it would impede my body's ability to fight off an infection in the unlikely event one occurred. 

When I was a toddler, they put inserts in my shoes to correct toeing-in or pigeon toes. When I was 14 or 15, they took x-ray's of my femurs because my knees were still severely turned in. They said that yes, my femurs were rotated inward, but it wasn't a big concern and the surgery to correct it was massive, invasive and had a 25% death on the table rate due to blood clots. So the issue, which I had always assumed was mainly just cosmetic, was never addressed again. Babies are normally born with 30-40 degrees of what is called anteversion, or the turning inward of the femur bone. By the time growth is completed, boys average 8 degrees of anteversion and women 14 degrees. Penny said that depending on which doctor was measuring the MRI's they were getting 32-38 degrees of anteversion. Here's a picture from a textbook describing femoral anteversion. I can do all of these positions very comfortably. In fact, I can get my feet to no more than about 3 inches off the floor doing the position in the lower picture and in the upper left picture with the patient doing what is called W sitting, I can lay my back completely on the ground in that position. Alternatively, I find sitting 'Indian style' very uncomfortable and am always in trouble in any type of ballet or off ice training class for not being able to keep my knees over my toes and for lack of turn out. 

Penny said that they were hoping the CT scan would come back with less femoral anteversion, perhaps around 22 degrees. If that was the case, they would simply proceed with the surgery as planned on Friday. If it came back as 32-38 degrees like the MRI indicated, they would need to evaluate whether or not the lesser  trochanter was going to fracture. If it looked strong in the scan, they would do the surgery on Thursday afternoon just in case it fractured and required screws. If it looked like there was a good chance it would fracture, they would postpone the surgery for a couple months. So I raced home, quickly packed for the next week, loaded Christmas presents into the car, did laundry and tidied the house. I slept for a few hours and went to the rink for the 6:30am session on Thursday morning for what I was assuming would be my last skate for a while. By 7:30 I was in the car heading back up to Vail. They did the CT scan and I waited for the results. Dr. Philippon's fellow came out of surgery to discuss what they read on the CT scan. Us medical people get pretty good at hiding emotions such as sadness or shock from patients. This poor guy, though, who couldn't have been more than 5 or 6 years older than me, couldn't hide his shock or how badly he felt for me as he told me what the measurements came in at. The CT said that my left femur is rotated inward 50 degrees. Here's a picture of a normal femur bone versus an anteverted femur bone, which is what mine is. 

Dr. Philippon did not want to repair my torn labrum because it has such an incredible amount of pressure being put on it due to the torsion of my femur bone. If they repaired it, it would most likely tear again very quickly. The diagnosis only gets worse from here. Femoral anteversion affects both legs except in very rare cases, and I'm certainly not one of those. While they didn't fully catch my entire right femur in the scan, they said it looks about the same as my left. My own research in the last day has indicated that except in extreme cases, both legs are within 8-10 degrees maximum of rotation difference. Therefore, my right leg is somewhere between 40-60 degrees anteverted as well and it's very likely that I actually tore the right labrum last summer when I had about 10 weeks of the same kind of pain before it finally subsided. Penny explained that they would send my scans immediately to a specialist in California to review. The team was 95% sure that this doctor will say that I need a major surgery called a derotational ostotomy, to which, through my tears, I immediately said 'hell no.' This picture sort of illustrates what this surgery would do.

This surgery involves cutting the top of the femur bone, turning it out in the correct rotation, about 14 degrees of internal rotation, and then reattaching it using rods, plates and screws. Since both of my femurs are affected, they mostly likely could not just fix one. They would have to fix both. On top of that, I would still need the labrum and FAI repair.

Obviously this has been shattering news. They say medical personnel always make the worst patients because we know too much. Having this kind of surgery absolutely scares me to death. A million questions are racing through my mind. How will I possibly pay for a trip to California to have this surgery done? I can't be out of work for 6-8 weeks so they would have to fix only one leg at a time...meaning that I would need two trips to California. I definitely can't do this one on my own, but my mom has all of the kids at home to take care of and her own financial responsibilities. And what about needing to still have a third surgery for the labrum and FAI repair? How long will it take for me to be able to walk like a normal person again? Will I be able to skate again? Is this going to take a full year out of my life? What about the fact that I don't want 6 inch scars down my legs with three pounds of metal in my body and a card to present to the TSA when I get on a flight that says 'no I'm not trying to blow up a plane, I was just made in a mold that was broken'?! I'm only 26! I have my entire life in front of me!

On the other hand, as a very wise nurse friend pointed out to me yesterday, I need to think about what my body is going be like in 20 years. I've had knee tendinitis since I was 15 or so. I've had low back pain since I was 19 and the last three discs in my back are compressed and lacking in disc fluid. My entire back, particularly the lower half, is extremely hypertonic, meaning that the muscles are rock hard and sometimes spasm, to the point that it has caused some muscle induced curvature changes in my spine, not to be confused with scoliosis. The MRI indicated I already have mild arthritis of the pubis symphisis (the lower portion of the hips) on both sides. All of my life I've been told that I have tight hip flexors, tight hamstrings and tight IT bands. After showing Dr. Philippon's team some videos of what I do on the ice, they flat out said that I'm actually very flexible and it's pretty amazing I can do what I do on the ice considering how turned in my femur bones are. It also explains why I can't do spread eagles, Ina Bauers, hair cutter spins and Biellman spins. I've always said I'm 'stuck' and apparently I'm really not exaggerating. In all honesty, it was also pretty unlikely that I've achieved what I have on the ice. Jumping through double Lutz, pulling off intricate footwork and multiple position combination spins probably should not have been possible given how twisted my hips and legs are. I suppose I should be really proud of myself, but right now I just want to scream, 'Get me out of this body!"

I don't know what comes next. Penny said it will take 3-4 weeks to hear from the doctor in California. In the meantime, I could skate if I wanted to but the more I skate, the faster the cortisone wears off. And I'll need to save every dollar I can for what is probably going to be a very expensive next few months. In addition to the expenses of travel, I don't have any PTO benefits with my job, meaning that every shift I would miss at work is missed income. I'll have to pay my insurance deductible twice now. I've hit it this year now with all of the scans etc, and I'll definitely hit it in the new year as well with the impending surgeries. The ice is the one place that I can leave everything else behind for a little while and just focus on what I love to do. Flying across the ice, the cold wind in your face, feeling free. Weightless. Beautiful. But right now, looking across the room at my skating bag is a painful reminder of how messed up my body is and how it won't do what it's supposed to. Then again, just looking at my legs stretched out across the sofa is sharp reminder of the new reality that I can't run away from. Thomas Gray had it right when he said, "Ignorance is bliss." 

Phone Calls, Paperwork and Post-Op Planning

I had spent most of the weekend hoping that the clinic in Vail would call me today. I just wasn't prepared for the mountain of...stuff...that was about to come crashing down on me. The surgical scheduler, Linda, called bright and early. And I mean early as in I didn't get to the rink before she called early. She said that they could either do the surgery tomorrow or Friday. I said either would be fine. Linda said she would talk with Dr. Philippon and see what he preferred to do. The first snag of the day occurred when she said that the doctor requires all of his patients to stay in Vail for a minimum of four days after the surgery so that they can attend physical therapy with his team twice a day. I hadn't counted on this at all. Vail is an expensive town to stay in and the week before Christmas is probably one of the worst times to try and stay in a hotel or condo on a budget. Furthermore, they require that you have a family member or friend with you to assist you as needed. So while I tried to wrap my head around this new development, she sent me a secured email with some paperwork to fill out. Eight pages to be exact, several of which needed to be printed, signed and scanned back into the computer. After completing that, I started looking up various hotels and condominiums in the Vail area. Sticker shock quickly set in as I was seeing $800-1,000 for three nights in a hotel there. Stressed out, I decided I couldn't make any decisions until I knew when the surgery was. I had just settled in for a nap (as I had worked all night) when the phone rang again. This time, it was the billing department notifying me that my insurance had approved my surgery and inquiring as to whether or not I had met my deductible for the year yet. Just to give you an idea of the cost of this little procedure, they require out of network patients to pay $7500-10,000 up front before the surgery and cash paying patients to pay $15,000 up front. And that's just the doctor's fees. That doesn't include the hospital, MRI, physical therapy...but I'll get to that momentarily. After hanging up with them I had to call my insurance to verify that they were going to cover all of the medical equipment that I would need after the surgery such as the ice machine, CPM (continuous passive range of motion machine), SCD's, (those ankle cuffs that inflate and deflate that you see in the hospitals), hip brace, rotational boots and crutches. At this point, concerned I could be in surgery tomorrow, I started doing some laundry and getting some things ready in my house. My head was in a full tailspin waiting to find out what the next day or two would hold for me. Finally, the scheduler called back and said that they would do the surgery Friday. And in case my head wasn't already spinning, she was about to completely knock it off its axis. My schedule for the rest of the week now looks as follows, remembering that I slept for all of an hour Monday and worked all night Monday night:

Tuesday: Appointment with primary care doctor for physical, clearance for surgery and bloodwork. Work all night but leave work at 3 am to be in Vail by 6:30am Wednesday.
Wednesday: Appointments in Vail starting at 6:30am. 3D MRI, evaluation by the head physical therapist, evaluation and strength and conditioning testing with the head athletic trainer, evaluation and meeting with Dr. Philippon's surgical fellow and staff, office appointment and evaluation with Dr. Philippon, surgical scheduling and pre-op prep appointment with Dr. Philippon's nurse and meeting with a pharmacist to discuss post-op medications.
Thursday: One. Last. Skate. :-) Pack up for the trip, tidy the house, and some extra sleep certainly wouldn't hurt.
Friday: Surgery day.

Seriously. Please shoot me. Are you sure that I'm just having a laprascopic hip procedure and not an organ transplant? Buried within all the paperwork that has to be filled out and instructions for verifying your insurance's contract with every party involved from the hospital to the physical therapy office, there are many other things that I'm supposed to do such as arrange PT for when I return home and bring proof of this on Wednesday, begin showering with special antiseptic soap for the next three days, stay away from any anti inflammatories (aka my best friends), arrange lodging for the post-op stay in Vail, arrange for someone to be responsible for my post surgical self upon discharge from the hospital on Saturday, arrange transport to and from therapy twice a day after surgery and shop for/pack up food items that I'll need while I'm staying in Vail as I'm pretty sure I don't see myself jumping in to the car to grab McDonald's for lunch. And it's not nutritionist approved. But I digress...

Luckily, one of my coworkers has an aunt and uncle that have a house in Vail and they have graciously agreed to rent me a sort of mini suite in it for my post-op stay at a very reasonable price. This will also put me within a few minutes of the hospital and also local bus service if I don't feel up to driving myself to PT. This is a huge asset and I'm extremely grateful. Still, however, I can't help but feel extremely overwhelmed tonight by the sheer magnitude of what will transpire over the next few days, slightly anxious about going through this procedure by myself, (hey, who doesn't seriously want their mom when they're sick or hurt, regardless of age?) and well to be perfectly candid, the lack of sleep today is really starting to hit me. Time do some program walk through's to stay awake!

You're In

I am 85% type A personality. All of my other type A 'planners' our there or anyone who knows one will appreciate this: I tend to plan for all contingencies. While adhering to a schedule or plan certainly makes me very happy, accomodating last minute changes or a shake up to the normal routine doesn't bother me in the least. This is the 15% non type A part of me: I'm laid back. But I do like to plan. So needless to say the planner in me combined with the nurse had all of the potential hip diagnoses and the repercussions of each neatly laid out in my mind. You know what they say about plans, however... So after the doctor on Wednesday (December 11) was done trying to see how many times he could re-position the needle in my hip joint without making me cry, I backed him into the corner--okay not literally--and very directly told him i wanted to know what the MR-A results were. He tried to get out of it but eventually relented. Now let me just preface this with the fact that I had previously stated to a few friends that the worst thing that could possibly happen would be that the MR-A was perfectly normal and they therefore had no idea what was causing all of the hip pain and problems. Nothing worse than a non-diagnosis. The radiologist said that while yes there was a tear in my labrum, they were more concerned about my L4-L5 and L5-S1 discs that were picked up on the scan as well because they may be herniated. I now put my entire foot, skate and all, in my mouth.

The great thing about living in the 21st century is that we have a lot of medical technology that simply wasn't around 20-30 years ago. Herniated spinal discs are no longer a crippling death sentence in a literal sense. However, for a competitive figure skater, they absolutely are. Conservative treatments often fail, disc removal and spinal fusion are not a option for a skater (or for that matter, anyone who has an athletic lifestyle) and the requirements a skater places on the spine as far as shock absorption, torque, strength, stability and flexibility are incredible. The radiologist said that they would need to do a lumbar MRI to fully see the discs and that if they were what was causing the problem, the cortisone and lidocaine injection into my hip joint wouldn't help with the pain and stiffness.

I went back to the dressing room to fumble back into my pants--in case I had thought putting pants on was challenging before getting joint injections, the injections made it ten times more difficult since the joint was full of fluid--while trying to process this information. As I reached down to attempt to wiggle into my tennis shoes, I noticed that I wasn't being restricted nearly as much by the shooting pain throughout my hip and hamstring that I was so accustomed to. I halfheartedly tried to do a straight legged toe touch. Since July, I couldn't get more than halfway down without my left knee buckling and rotating inward. I was touching the tops of my shoes before I realized what was going on. My knees were unbent, my legs straight. I was still hurting and very stiff but I was actually touching my shoes. Still, it was impossible to not be absolutely scared to death that my life as I knew it was over. Skating, running, heck for that matter going from sitting to standing without feeling like my hamstring was being ripped out by muscle spasms...what was my life going to look like if I had herniated discs?

Four hours later, however, the tears of fear had practically turned into tears of joy. I had laced up my skates and was tearing up the ice like my life depended on it. I could jump without sharp pain every time I took off. I was doing split jumps for the first time in months. It didn't hurt to go into a layback. And best of all, I even was able to throw a couple death drops! Okay they were absolutely awful ones, but it was a starting point. After I went home I sat on the floor at a 90 degree angle, legs straight out in front of me and was able to stretch out and grab my feet. I had my left leg propped up on a counter top and was laying on top of it. (Both very standard hamstring stretches) I was so excited I was sending selfies of my stretches to my mom with a big smile on my face. Never would I ever have thought even 24 hours before that I would be happy  to have a labrum tear.

By Thursday morning, I would rate the pain at about 75-80% less of what it had been before the injection. Eddie, my head coach, put a call in to The Steadman Clinic, in Vail, Colorado (about 3 hours away from the Springs). Dr. Marc Philippon is a world renown surgeon who has not only piloted new arthroscopic techniques for repairing hip labrum tears, but is considered one of the foremost doctors in the world when it comes to repairing these injuries in elite athletes AND returning them to their previous level of athletic performance. His resume boasts NFL, Team USA and even Olympic athletes, including the top male pairs skater in the US. For the average person, getting an appointment with him can take months. Training at a Team USA designated Olympic training facility with some of the top coaches in the world does have benefits...less than four hours after Eddie's call, a scheduler had contacted me, emailed me online paperwork to fill out, and requested that I send a copy of my MR-A scans via Fed-Ex overnight so that the doctor could look at them on Friday. They arrived Friday morning around eleven. While the scheduler had said she would call me back on Friday, I didn't receive a call. I wasn't incredibly surprised, though, as working in the medical field I know that Fridays tend to be a very light day for most doctors in private practice. So all weekend, I've tried to prepare for what will most likely be imminent hip surgery. Purchasing and wrapping the last of my Christmas gifts, making an extra large grocery store run, doing some holiday baking for gifts and cleaning the house. All while enjoying being able to move freely and with very little pain! The way I'm choosing to look at it is that the sooner my hip is repaired, the sooner I can begin to 'prepare to come back' as Eddie calls it. And if anyone can get me back on the ice chasing my dreams, apparently it's Dr. Philippon. He has the reputation of being someone who doesn't like to do a lot of waiting around. That is, once he requests a patient's records, he is known for studying the case, evaluating the patient and performing surgery all within a few days. My hope, therefore, is that I can be up in Vail by mid-week getting put back together so that I can spend the holidays with my family and have a solid 10 days before I will have to go back to work, albeit with some modifications. Fingers crossed because type A girl is not good at dealing with uncertainty!

Only You

I've always had an uncanny ability to have the unusual happen to me. Call it a curse, call it a blessing, call it downright weird. If it's strange or unheard of, chances are I can make it happen. Case in point: at the young age of 12 I managed to acquire an avulsion of my right lesser trochanter. In English, you say? My muscles, which were stronger than my bones, managed to actually rip off a small bony prominence on the inner thigh bone that connects the muscles and tendons that run down the inner thigh. The doctors at the ER all looked at the x-rays, looked at me and scratched their heads. "We've only seen this in textbooks," they said. "We've never even heard of this happening to a girl. It typically happens to 18-22 year old football players. What did you say you were doing again?" High jumping for my middle school track team.

I also seem to have a somewhat high threshold for pain. Or maybe it's just that I love skating so much I can flip a switch in my brain and ignore it. Either way, even though the nurse in me knows better, I really think that any injury can be trained through on the ice with Advil. Case number 2: My right foot started hurting in December 2011. After about three weeks, I was pretty sure that I had a stress fracture. Having had three of them in my ankles caused by skating boots that were too stiff, you learn to recognize the very distinct, sharp pain they cause. Agreeing with my suspicions given my history (and the inability to see stress fractures on x-rays), my family doctor put me in a walking boot for three weeks and kicked me off the ice. Day one back on my skates, my foot was worse in five minutes than it had been before the CAM walker. I then saw the orthopedic surgeon who had previously diagnosed my ankle stress fractures. His response after not seeing anything on the x-rays was, "You'd see stress fracture changes in an x-ray by now. There's nothing wrong with your foot. Quit being a wuss." This is the same doctor who was shocked to hear that I was still skating after he found stress fractures in my ankle the year before. So, I simply continued to train. For the next 8 months. Finally, I saw a doctor in Colorado Springs in August 2012 who, also saying there was no way I would be able to skate with a stress fracture in my foot, ordered a MRI to look for soft tissue damage. He personally called me two days later, his voice full of surprise, telling me I had not one, but two stress fractures in my foot that he was diagnosing as non-unions (fractures that have not healed after 6 months). A month or two using a bone stimulator produced great results.

I've been very lucky since moving to Colorado Springs in July 2012 and have stayed injury free. Any skater will tell you they are nearly always battling some form of acute or chronic injury. It's in the nature of what we do. No matter how beautiful, graceful or powerful skaters look, the bottom line is that the human body was NOT made to hurtle itself through the air, rotate multiple times in less than two seconds, and land on 1/8th of an inch of steel on an ice cube. Skaters land double and triple jumps with the force of up to eight times their body weight. That puts a 120 pound skater at 1,000 pounds of pressure when landing a jump.On one foot. It's even higher for quad jumps. And that's just the jumps. If you think that twisting your body into a pretzel while spinning is easy, or kicking over through the air and landing in a spin is a piece of cake, it's not. With the new IJS judging system, skaters can't just be great jumpers, they have to have the full package: jumps, spins, variation, artistry, speed and power. And we have to make it all look like Joe Somebody could strap on a pair of rental skates and do what we do.

Injuries are nothing new to us. It's just a part of our way of life. So in late July 2013 when I got up one morning and felt like I had a high hamstring pull in my left leg, I didn't think twice about it. I stretched out extra well in between sessions, and by the afternoon it wasn't impeding me in any way. I had started landing double loops and double flips in recent weeks and my double lutz was just on the brink of cooperating as well. Friday morning, however, was a completely different story. I could barely put my shoes on and had to do quite the acrobatic routine to get my skating pants on. I went to the rink and was barely able to even manage crossovers. I tried to just push through it and thanks to some good ART therapy over the next week I got some mobility back. I had a competition coming up in less than four weeks so I simply skated through the pain and stiffness. In fact, I actually felt the best after getting off the ice. I had a lot more range of motion in my hip when it was warmed up from skating. But as soon as I cooled down, it would immediately lock up again. Over the next four months, I tried to deal with some very debilitating symptoms including hamstring and piriformis spasms especially when going from sitting to standing, sharp shooting pain in my butt and hamstring, dull pain in my outer hip, a clicking sensation over the groin area when extending my foot forward or raising it up, and a louder but more diffuse snapping over the outer portion of the hip when rotating my leg outward. I couldn't do a straight legged toe touch. My leg would automatically bend and twist inward. I couldn't sit at a 90 degree angle on the floor without excruciating pain and my leg would lifelessly flop into extreme external rotation. Since July I have winced every time I dressed, held my breath while putting on shoes, and tried not to sound like a wounded dog every time I would get into or out of the car. Some mornings it was all I could do to put my skates on at the rink. I avoided anything that required forward leg extension and had trouble holding myself on top of my left hip when doing footwork. I swear I developed a severe case of butterfinger-itis since picking things up from the floor is painful and challenging! There were days I would wonder if I would ever be able to throw a death drop again or do my awesome fan kick with my left leg and as time went on those thoughts turned to wondering if I would ever be able to remember what it was like to not have constant pain in my hip and leg.

The week before Thanksgiving my hip had gotten to the point that I couldn't skate at all. I scheduled an appointment with an orthopedic doctor to have it evaluated. At this point, my ART practitioner had been telling me for two months that I needed to get a MRI but being a nurse and a skater makes for a dangerous self-diagnosing problem. Skaters, along with hockey players and football players in particular, do a LOT of what is called axial loading. This is a force that is applied to the body along an axis. In football, players have to do a lot of pivoting and cutting. In hockey, the players are constantly checking each other against the boards and change direction very quickly. And in figure skating, well obviously we have huge amounts of rotational force in our jumps and spins. Because of this axial loading, football players, hockey players and yes, figure skaters, are very prone to an injury called a labral tear and sometimes complicated by femoral acetabular impingement.

The top of the femur (thigh bone) is a ball shaped joint which allows for 360 degrees of motion. Separating this joint from the hip socket is a piece of cartilage called the labrum. This cartilage is present in both the hip and the shoulder. In the hip, this cartilage can become torn by either repetitive motions or direct impact injury. For a skater, a labrum injury could occur from years of jumping, falling, spinning, and pushing the hip's flexibility to the maximum or it could come from a single fall on a jump. While a tear in a small piece of cartilage may not sound like a big deal--after all your ears are almost entirely made of cartilage and you can throw a dozen piercings in them--this particular piece of cartilage is extremely important. It is the only buffer between the femur bone and the pelvis that keeps them from rubbing up against each other. And to complicate things, a torn labrum is often seen as a career ending injury for athletes. The pain is often excruciating, surgical repair complicated, and rehabilitation extensive. In the skating world, two recent examples are Olympic medalist Evan Lysacek and Alissa Czisny. Both have withdrawn from the US Championships in January (which will determine our Team USA skaters for the 2014 Winter Olympics) due to Evan's labral tear that has been unresponsive to conservative treatment and Alissa's unsuccessful comeback from surgical repair of hers nearly two years ago. Being a nurse, it began to become more and more clear to me this fall as my hip slowly worsened that it was most likely a labrum tear. But since this is such a scary thing for a skater, I figured I would just ignore it. Like I said previously, my motto is 'Advil can fix anything'. Obviously this wasn't the best choice as it took getting to the point that I wanted to practically scream getting out of my bed in the morning from the sharp pinching sensation was so severe in the back of my hip before I thought that it might be a good idea to get it checked out. So the day before Thanksgiving I saw an orthopedic surgeon before driving home for the holiday. He quickly agreed with my hypothesis that it was very likely a labrum tear and ordered a MR-A. This is a MRI where they inject a dye into the actual hip joint before they do the MRI which allows them to visualize the hip joint in greater detail and identify any tears in the labrum cartilage. This sounds a lot worse than it actually is. They are kind enough to numb your leg all the way down to the bone, so I only experienced a slight pinch when the doctor inserted the needle into the hip capsule, which he did under live time x-ray guidance called fluoroscopy. The worse part about the whole thing was having my legs taped together in internal rotation for the 45 minute MRI. Internal rotation has not been my friend recently. Now the doctor I saw initially had said that they would also put a cortisone injection into the joint at the same time because it is also diagnostic for a labrum tear. The MR-A has about a 91% accuracy but injecting cortisone confirms that the problem is within the joint if the cortisone significantly helps the pain. Of course, since they're injecting the dye so close to the femoral artery, I couldn't take any of my favorite miracle drug, Advil, from Thursday on. I got through it by telling myself the cortisone would take away most of the pain. Eye on the prize. Of course, it never is that simple. They told me as they were doing the dye injection that they couldn't do the cortisone at the same time because it would be fluid overload for the joint and the dye would wash out the cortisone faster. So, I would have to come back on Wednesday. And I couldn't take any more Advil until they had done the cortisone injection. UGH! But there was one very significant upside. On Wednesday, while trying to suck up the fact that the doctor doing the injection this time was not nearly as good as the previous one on Monday and had not done nearly as good of a job numbing my hip and therefore was causing me quite a bit of sharp pain, I managed to coerce him into telling me what the MR-A said. Aside from being someone who does not like to be kept waiting (my follow up appointment isn't until this coming Monday), there is virtually no point in me going to this follow up appointment. There are only about half a dozen surgeons in the world that have a strong resume of repairing labral tears in elite athletes and returning them to their level of play prior to the injry. As it so happens, one of them, if not the most qualified one, is in Vail. When I told my head coach Eddie what was going on he first exercised some restraint in not strangling me as his daughter had torn her labrum as a competitive skater and secondly immediately said that he was sending me to Dr. Philippon. In addition to having returned a few dozen professional athletes to their respective field of play, he also fixed the top US male pairs skater's labrum about 18 months ago. Thank God for Eddie because any ordinary person calling Dr. Philippon would get stuck on a 3+ month waiting list to see him. Because I train at the World Arena and with some of the top coaches in the world, their one call to Dr. Philippon is the equivalent of a first class ticket on a plane. So, Eddie thoroughly instructed me that I was to 1) not touch the ice until we had a diagnosis 2) never train on that kind of hip pain for 4+ months again without saying how bad it really was and 3) call him as soon as I had the MRI results. So, paying a $40 copay to visit with this doctor in the Springs for 5 minutes to find out the results of the MRI was virtually pointless because he wouldn't be allowed to touch my hip if it was torn. I'm sure he is a great doctor and surgeon but if you could have a doctor that does 20 of these a year or a doctor that does 1-2 a day which would you choose? So, I had to coerce the answers out of the radiologist. And while I was thinking that the worst case scenario would have been the MR-A reading everything as normal, I was gravely unprepared for what this radiologist was about to tell me.