On the Other Side of the Mountain

Apologies. I have been very bad and it's been a month since I've posted anything. Albeit, it's been a very crazy month between jumping back into work full time (that is 50 hours a week), some side projects that went on the back burner in May and PT twice a week. I owe you some serious catching up but I'll try to keep things brief.

Walking Status: Yes I'm walking! I would actually like to be running but we will get to that in a moment. On Tuesday, May 27th I saw Dr. Huang again because my leg was not improving at all as far as the discoloration, swelling and coldness were concerned. After some serious jumping through hoops, I saw a vascular surgeon the following day who didn't feel that there was anything critical going on with it. Dr. Huang made the decision to move up the timetable and pulled me out of the brace in case it was constricting blood flow in any way and gave PT the go ahead to start me walking at 50% weight bearing. Thanks to this awesome invention known as an anti-gravity treadmill--a treadmill with a sort of space suit wrapped around 
it that allows you to be partially weight bearing without the crutches--as well as some serious motivation on my part, I went from starting to 50% weight bear to walking independently in only nine days. They expected it to take about three weeks!
Vascular Complication: My leg does still turn purple and can get cool, particularly when I'm sitting down, but the swelling has subsided for the most part. The biggest issue with it is mainly that it will ache and throb when I try to sleep, particularly after I work. I say try, therefore, because sleep doesn't usually end up happening except in 20-30 minute bits and pieces. My family doctor thinks that it's part of whatever collagen disorder I have and that if anything, it indicates I have one with more vascular involvement. Not something I want to hear, but I'm trying to just ignore that until the geneticist weighs in.
Ribs, etc.: My ribs have gotten a lot better now that I'm off the crutches. They still are a little stuck but I've almost gotten used to them and they don't bother me too much. My hope is that as I become more active again they will 'unglue' themselves. My lower back is extremely unstable now that it does not have the brace to support it. I had no idea how weak it had become until I didn't have the brace on and it's not uncommon for my right leg in particular to give out as I step forward getting up first thing in the morning (or evening) because my lumbar back spasms. As I regain my core strength and stability again, it should stabilize. The third issue and my biggest argument for getting back on the ice ASAP is my inability to keep my blood pressure up. I run an extremely low BP and without skating, I start blacking out going from sitting to standing, or even bending over and then standing back upright again. I've had a couple episodes of completely passing out, fortunately all were at home. It's really just very annoying.
PT Status: PT is becoming a full blown workout now. We are focusing on regaining my core strength and stability as well as my proprioception, which is in need of some work. I am now able to do the stationary bike with resistance, am up to 80 lbs on the leg press machine (individual leg presses), and can do lunges with side resistance, planks, clamshells with resistance and squats on the wobble board, to name a few. We have also started doing exercises that will help me return to the ice such as utilizing a slider board, these resistance ankle cuffs that sort of simulate skating on dry land, and bouncing a weighted ball off of a trampoline while balancing on one foot on top of a foam block (and yes it is as complicated as it sounds). My physical therapist is great and puts up with me wanting to run, jump and skate every day I go in.

Yesterday I had a check up with Dr. Huang. I'm currently 8 weeks post op. Although I completely freaked both him and his PA out when I literally jumped up in his office and told him I wanted my skates back--apparently they seemed to think that I was going to destroy the hip they put back together doing one little vertical hop--he was very impressed with my range of motion and the fact that I wasn't having any hip pain. After some intense negotiations, I was able to get him to agree to allow me to start skating again! Of course, this only came with a mile long list of stipulations of things that I am not allowed to do, and he reiterated that my skates were not allowed to leave the ice about a dozen times, but it doesn't matter. Just to be able to step on to the ice will be amazing! As this week is Broadmoor Open, a huge competition at my home rink, my coach is crazy busy so I'll have to wait to let him know I can start skating until after the weekend but I'm so excited. The rules look something like this for now until I see Dr. Huang again in six weeks, when he said he'll start to give me more leeway (hopefully some spins and single jumps!):

• basic stroking and skating skills only, 2-3 times a week, 20-30 minute sessions
• must be working with a coach
• absolutely no leaving the ground
• no spirals, no catch foots, etc.
• no spins, no jumps--see no leaving the ground, etc. 
• no fast cutting or hip twisting action, (i.e. twizzles, rocker chocktaws)
• if anything hurts or pulls, stop
• no overstretching, no using the maxiflex, no laying your hands on the ground in front of you
• focus on core, glute, hamstring and quad strength
• no running until week 10, then 50% up to 80% weight bearing in the anti-gravity treadmill only
• if the running or skating is uncomfortable in any way back off     
• continue to increase weight on leg press, hamstring curls, quad sets, and resistance bike

Honestly if he said to lay on the ice and that's it, I probably would have taken it. Just to get out onto the ice will be amazing! Remember, I haven't skated in 6 months. I see it as an opportunity to start rebuilding my strength and endurance again. Additionally, when it comes to skating skills, I tend to lack in that department, so it's also an opportunity to focus in on something I don't enjoy working on as much and need to work on. It will make me a better skater. So, skates and ice, here I come...hopefully this is the start of the climb down the hill that became a small mountain! 

Overwhelmed

That really doesn't adequately describe how I feel right now. Remember being in middle school and people would try to stick post-it's on each other's backs saying 'kick me'? Right now, I'm the 'kick me' kid. Anyone who knows me will tell you that I'm the person who is always happy. Lets things just roll off her back. Can't be fazed easily. The higher the pressure, the better I handle the situation. I think I'm like that in personality because I had many tough obstacles to overcome as a child. But right now, it feels as though nothing can go right.

Last week I flew home for my father's funeral. This was physically challenging being only 2 weeks out of surgery combined with the vascular complication that I'm dealing with. Emotionally, it was a nightmare for the obvious reasons as well as some lesser known ones. Without delving into some very personal family matters, it will suffice to say that I have not been close with my extended family for many years of my own volition so it was a big family reunion wrapped up around my father's funeral all while in a lot of leg and hip pain. As my biological mother also passed away when I was a child, standing at a grave site where I have now buried both of my parents at the age of 26 is just...well, surreal I guess. I'm still in shock.

I need to write a letter this week to United Airlines. In the world of air travel that has become less and less about the customer and more and more about the bottom line, they went above and beyond to accommodate me on my flights from upgrading me to seats with more leg room to checking my luggage through to my destination without the typical baggage charges and at most stops having a wheelchair waiting for me at the gate. (Although after what I paid for a last minute flight, a little accommodation was in order...) One customer in first class on a flight even asked the flight attendent to find "that tall redhead on crutches". He was offering to trade seats with me so that I would be more comfortable and on a second flight another gentleman did trade seats with me. There really are some kind people out there. Just a heads up, the only carrier that still offers bereavement fares is Delta and it is a meager 10%.

My leg started warming up about 3-4 days after starting on the high dose aspirin. It's definitely still swollen and purple but warmth is a good thing. The blood is flowing! Except that now that the blood is flowing, I have some sensation back which means that it hurts. Understatement. The pain is ridiculous. Just for comparison, by day 4 post op, I was taking 800mg ibuprofen for pain and then 5mg Valium in the evening for muscle tension/spasms. Now at it's worst 10mg Valium, 10mg oxycodone, 800mg ibuprofen and ice packs on my hip and calf aren't making me comfortable. Don't get me wrong, I'm glad the blood is flowing again...a cold leg is not a good thing. But there are definitely times right now that I would rather have my leg ice cold with little sensation than warm and feeling like someone has chopped it up with a chain saw. Of course this is a wonderful predicament to find myself in heading back into 4 day work weeks this weekend. The pain isn't off the charts 24/7. It is constant and it is always much more intense than it ever was after initial surgery. But it varies between 'okay I'm going to suck it up and push through this because I have to' and 'OMG I can't move and I'm trying not to scream right now'. And you just don't know what you'll get when. I've left two separate messages to try to schedule with the vascular surgeon as instructed since I'm back in the Springs this week but they have not returned my calls. Talk about frustrating. And you can't just schedule like a normal patient. All new patients must schedule through the nurse. I'm not sure what I have to do at this point to get the appointment. I don't think they'll really do anything but it would at least be nice to know how long of a ride I'm in for with this pain roller coaster.

I started physical therapy today which was less than pleasant. I had no desire to go since my leg has been hurting so much. After being asked about 10 times by the therapist if I was sure that DVT had been ruled out, I asked a few questions of my own, none of which led to answers I liked:
1) My hip is snapping/crackling/popping around with small movements like it did before the surgery. Is this normal?
The PT didn't like the sound of that and was going to talk to my surgeon about that. Because of my collagen problem we aren't even ready to start moving my hip around in passive range of motion yet.
2) The surgeon say I could lose the brace and crutches at week 4 which is next week. How will we go about that?
My PT spoke extensively with my surgeon about my case today since I'm 'not normal' and said that at the 4 week mark it will take an additional 1-2 weeks to get me off of the crutches. I will need to stay in the hip brace an additional 3-4 weeks from the 4 week mark until we achieve enough stability in the hip joint that the brace isn't needed to help ensure that the joint can keep itself stable.
3) The surgeon said that I would be able to start doing simple stroking and footwork on my skates around the 3 month mark and jumping probably around month 4 with being at the full level of play I was at before surgery around the 6 month mark. So I get to start skating again in early August right?
The PT looked at me like I was nuts and then said it would be September or October before I would be able to even touch a pair of skates for footwork alone.

Needless to say that made for a pretty rough afternoon. Nothing, and I mean nothing, seems to be able to go right with this hip surgery. First the damage being much more extensive than originally thought, then the vascular complication, the insane amounts of pain in my leg from the complication and now you're telling me I not only don't get to toss my crutches and brace next week (which I've only been counting down the days til) but instead of early August it's going to be September or October before I can start skating again?!

Someone please come take my skates so that I don't have to hop past them every time I go in and out of my garage? Wait--first can I be pulled across the ice on my good foot just to feel the cold air in my face and maybe do a few power pulls? That might be reassuring. Then please take them away so I don't have to see them until I can have them back. My heart is in my skates and right now it's in a million pieces for a lot of reasons.

Doctors' Wives, Lawyers' Wives and Nurses

That's who Kristin says post op complications always happen to (or in the modern world of course, the husbands too). But before I go any further with this, Kristin gets a huge, Texas-sized, shout out wrapped up in a thank you because there is no way I would have survived the past week emotionally or physically without her. She has been a friend, a mom, a grizzly bear, a drill sergeant and a sneaker of not-so-secret updates to her husband who is a surgeon making sure things never were too out of control all of for which there are no words to describe how immensely grateful and lucky I am to have had her and to continue to have her nearby.

At my initial post op check up, I asked my surgeon if some mild swelling in my left ankle and foot as well as some slight darkening in color were normal. He said yes but never looked at them. I took him at his word and went home. I continued to feel better as the week progressed and was on track to head back to work on Friday evening, still on crutches and in my lovely brace of course. The pain was continuing to subside and I was only taking ibuprofen for pain control and Valium at night as needed. I was honestly just feeling pretty stir crazy and was looking forward to getting back into my groove. As the week progressed, however, I noticed that my leg started to turn darker in color. It was so gradual, however, that it didn't really strike me until I was getting ready for work on Friday evening that there may be a problem. I was dressing and noticed that the discoloration was from the hip down, and was dusky to ruddy purple from the knee down. There was some marked swelling and it was hard to bend my toes. Additionally, my leg felt cold to the touch. As a nurse, I know what signs and symptoms to look for after surgery in patients as a common complication is a DVT or deep vein thrombosis (a blood clot), however, I was missing several key markers for it. I figured it was just swelling from the hip and went on to work. The next evening, however, it was much worse, and the capillary refill (how fast the blood refills an area of skin when you push down firmly on it making it blanch) was slower than it should be. I took a picture of it and sent it to my mom. She freaked out a little. Kristin had returned from being out of town that evening and as I headed out the door I asked her if she wouldn't mind running it by her husband Brook, who is a surgeon, just to make sure it wasn't a big deal.

Apparently your leg isn't supposed to look like mine did, as he called her as soon as he received the text. After being berated for not calling about it sooner, I very begrudgingly paged the PA the next day who, of course, sent me immediately to the ER to be evaluated for a DVT.

Sunday: I expected the usual DVT workup: EKG to rule out pulmonary embolism, ultrasound of the veins in the leg to look for DVT and blood thinners if indeed I did have a DVT. What I didn't expect was that after determining that I did not have a DVT and the PA was ready to discharge me, the ER physician came in, took one look at my leg and combined with the fact that they couldn't find any pulses in the foot or ankle by touch but rather had to use a machine called a Doppler, ordered a test called an ankle brachial index which tests for blockage in your arteries in your arms and legs. (I might mention that the test on my left leg made me nearly lose it the pressure of the BP cuff on my leg was so incredibly excruciating) Mine came back significantly decreased on my left leg. This of course set off a series of tests to then determine what was blocked, all with relatively potentially scary outcomes. First they did a CT scan looking for blockages mainly in the pelvis. When that was negative, they then did an ultrasound of the arteries in my leg looking for an arterial occlusion. Let me clarify for a moment here. DVT's are a fairly common complication after a surgery that keeps a patient bedridden in the sense that some 600,000+ a year are diagnosed. And those are the ones we know of. These are blood clots that form in a vein, which takes blood from an extremity back to the heart and lungs to pick up fresh oxygen. Arteries carry blood that just came from the heart and lungs and is delivering it to the extremity. What makes an arterial occlusion so much scarier than a DVT is that a blocked artery means that wherever the circulation is being cutoff at isn't receiving oxygen. That means that every minute all of the tissue beneath that occlusion goes without oxygen, it slowly dies. Arterial occlusions in the extremities have up to a 25% loss of limb rate. Scary! Very fortunately, that test also came back negative. Finally, they redid the ABI test using a computer that gives a much more accurate reading than the bedside one they did in the ER. It came back slightly lower in both legs than they would have expected but still passable and okay. After 9 hours, they had no answers as to why my leg was swelling, turning dark purple and freezing cold, and loosing pulses. As if that wasn't frustrating enough, at no point did we so much as see a vascular surgeon nor did anyone from my orthopaedic surgeon's large group ever come in. I know the ER did call vascular surgery in on my case because Kristin specifically told them to and she herself called the answering service for my surgeon multiple times and wanted him paged to the ER. I wouldn't have minded if whoever was on call for the ortho practice came in, but to be put through nearly every vascular test in the book and not so much as be seen by neither an orthopaedic surgeon from your surgeon's group nor a vascular surgeon I think is wrong. Clinical observation is an important part of medicine. Otherwise, we could turn medicine entirely over to computers and robots. The way I see it is if we went off tests alone, I wouldn't have had my gallbladder out 4 years ago. I had problems with it for 5 years before they finally took it out, despite the tests being normal. The first words out of my surgeon's mouth were, "I didn't need a pathology report to tell me that should have come out years ago." You have to put the tests together with the hands on assessment.

Monday morning: I had an already scheduled appointment with my ortho surgeon. I'm going to put a disclaimer in here and say that maybe someone made the group decaf coffee or something that morning. It was quite a strange appointment. Kristin had wanted to go with me to ensure that they were on top of things after the previous day's events, however, she had a previous commitment. So I left the house under strict instructions not to leave the doctor's office until they could thoroughly explain what was going on. They had already been copied on the ER visit because the PA took me back and made some offhand comment about me having quite the day yesterday. Another woman came in the room and said she was the NP and that we had met before. I said we hadn't met before but it was nice to meet her. She said she had assisted in my surgery. Okay hello, um I think it's a little obvious then that I wouldn't have met you since I was under general anesthesia at the time...so she looks at my leg and basically ho hums it off that it doesn't look very bad (unfortunately it wasn't looking nearly as bad for whatever reason that morning) and starts talking down to me about how 'we as medical professionals sometimes know too much about things and overly read into things and can panic ourselves'. Okay stop. Last time I checked I wanted to wait until my appointment that morning to have my leg looked at. I was being told by my coworkers, friends and, oh yeah, friend's husband who has been a surgeon for 20 years that it needed to be looked at. And so I called your answering service. Explained what it looked like to your PA. Who then berated me for not getting it looked at sooner and said I should have gone to the ER Friday night. So no I didn't push the panic button. When I start to get a little snippy with her, she finally goes out and gets my doctor. Wait. I just spent 9 hours in the ER last night and I wasn't going to get any face time with my doctor? He comes in, looks at my leg and says that they see this complication in about 2% of cases, what they call 'slowed venous return', explaining that there's swelling in the hip from the surgery putting pressure on the veins so they aren't able to return the blood to the heart as quickly as normal. He said that swelling in the hip peaks at 7-10 days (I was at 11 days post op). He said to wear a compression stocking which should help with the swelling and discoloration. He then said we needed to get physical therapy going ASAP. I had to remind him that he said we weren't starting PT until I was 4 weeks post op. I then also had to ask if he was going to have my stitches removed. He sent in the PA to do that. The PA then tried to schedule me for a 1 month follow up in July. And I had to ask about if PT would contact me in two weeks and if I could literally just start walking in two weeks or if I had to graduate down from the crutches. Truly a bizarre visit.

Wednesday morning: Brook was coming in to town and we were planning on him having a look at my leg as he has had experience in vascular surgery. But he did need to know some basic instructions that, come to think of it, were never issued from the orthopaedic office such as how many hours a day to wear the compression stocking, how long to expect to wear the stocking, at what point would they expect a resolution to the issue, at what point or what symptoms would warrant a call to vascular, etc. You would have thought they would have made those clear. After several phone calls back and forth, they basically said they didn't want to issue any instructions, they wanted vascular to made those determinations. Woah, wait. You never said you wanted me to follow up with vascular. If you wanted that, you should have said that at 8:20am on Monday morning when I was in your office. Now it's Wednesday, I have to get on a flight this weekend and go home for the following week, and there's no way they'll get me in by Friday. Not to mention now I don't really feel comfortable not being seen by vascular for two weeks if you want them to see me. So they then say that since the tests came back fine in the ER and vascular has no appointments this week, I'll be fine until I get back in town. Oh and by the way, you're at an increased risk for DVT's since you're flying. Thank God that girl was on the phone with me when she said that...my leg is turning purple,

I'm a nurse and you're going to tell me I'm at an increased risk for DVT because I'm flying. Guess what? The only reason I'm flying is because it's less of a DVT risk than the eight hour drive.

Wednesday afternoon: Dr. Brook Redd to the rescue. Seriously. There is nothing like cutting through a mile sized ball of insane medical red tape than using a blowtorch. This is how healthcare in America should be. Parking it on a couch for five minutes, seeing what's what and making some professional judgement calls. And that's all there was to it. The tests were all normal so it was simply a matter of first making sure that clinically the tests weren't missing something based on the way my leg looked, and secondly how to manage it. That's the not so awesome part as it tends to involve a very sexy thigh-high compression sock

pretty much from the minute I hit the floor in the morning, parking myself whenever possible and super elevating it (like that's happening), and mainlining high dose aspirin--no one trip me, the bruises are already starting to pop up. It's going to take a while, 4-6 weeks at least he said. But, trying to stay positive here, after Sunday there are a lot of really bad things it could have been that it's not. And for that I'm very thankful. And I'm just as thankful to be able to know that I'm okay to go home this weekend. And I'm thankful to be able to get around all the...well you fill in the blank...I've been dealing with since Sunday. Super. Hero. Doctor Guy.

Saturday: AGONY. Okay I've pretty much been in agony since about 9:30pm last night. We went to a movie and while Kristin will be the first in line to tell you it's impossible to get me to park it I obviously did sit for the movie. Sitting is not the most comfortable position just yet. I was in a lot of pain by the time they dropped me off at home last night. Somehow, my Valium ended up downstairs instead of up--in case you're contemplating any kind of surgery involving crutches, either buy a ranch or temporarily move into one--and literally by the time I was in bed, settled with an ice pack on my hip and had realized it wasn't on my nightstand, I was in too much pain to move, let alone go all the way back downstairs to try and find it. I had a hair appointment Saturday morning so that I wouldn't have to mess with my hair on Sunday and Monday--I have strong leg muscles but there's no way I'm standing on one leg to straighten my hair for an hour. I suppose at this point it may be necessary in explanation to mention that on Sunday, after we got home from the ER, my mom called me and told me that my father passed away, which is why I am flying home. Obviously, one would not normally undertake that kind of trip two weeks post hip surgery with this complication as well. I took my aspirin and 800 mg ibuprofen (I'll take my chances with gastritis at this point) and headed out. Had the car washed and toughed it out through the hair appointment. I offered to come help Kristin with unpacking boxes as they just moved but thank goodness she didn't need any help because I literally sat in the garage for 10 minutes trying to find the willpower to get myself out of the car. I knew I was in trouble. I somehow managed to get parked on the couch with three pillows each under my leg and foot and ice packs on my hip and calf but they didn't get me far. As I had to work later that evening, Valium was off the table. I finally caved and took some Oxycodone when the spasms started. I tried to nap a little so that I wouldn't be too exhausted for work but the pain was still very significant. In nursing we have patients rate their pain on a 0-10 scale 0 being no pain and 10 being the worst pain of their lives. I was trying to convince myself I was comfortable enough to nap around a 5-6. Needless to say the meds were doing more for my brain trying to tell me I was okay than the actual pain. I'm just hoping the pressurized plane isn't a recipe for misery tomorrow. I vaguely remember texting Kristin asking about it and I think Brook called me. But between trying to not sound like I was crying--when you're hurting that much you're like a leaky faucet--and being a little med goofy it's all kind of fuzzy.

Perhaps it goes without saying that this whole week has quite possibly been the most convoluted week of my life. I don't think Hollywood could even have come up with this one if they tried. The Serenity Prayer may very well become my mantra for the next few days...if nothing else to keep myself from playing a game of real world kitchen style operation on my leg ha ha!

Ice, Ice, Baby

Five days out of surgery and it seems as though it's been five weeks. I'm not sure why I was so incredibly anxious to have my hip repaired because the aftermath is significantly overrated. Take this morning for example: it took two hours for me to shower, start a load of laundry, unload the dishwasher and fix a bowl of cereal. That's insane! The amount of energy it takes to get from point A to point B usually leaves me about ready for a nap by the time I'm finished. I seem to live and die by ice packs so thank goodness for the homemade ones we've made. We found a recipe online, however, it seems to be a bit backwards and the correct ratio seems to be three parts water to one part rubbing alcohol double bagged in ziplock freezer bags.

I had a check up with Dr. Huang yesterday who said everything was looking good. He was greatly surprised that the MRI gave no indication that I had any damage other than a torn labrum. This lead him to believe that he would be performing a simple labrum repair with the slight reshaping of the head of the femur as it was not perfectly round (this is very common in labrum tears). When he was performing the surgery, however, he found that I had extensive cartilage damage and due to that damage, I had also developed a bone spur which he removed. The cartilage damage was why he had to perform the microfracture. He used a newer technique that a well known surgeon in California and he have been using for about eight months and have been seeing excellent results from. I was cleared to head back to work this weekend if I so choose but aside from that I have to pretty much stay parked on the couch for the next three and a half weeks. The brace has to stay on unless I'm laying down, I'm not allowed to sit up or bend past a 90 degree angle and there is absolutely no internal rotation allowed with my leg (which is much easier said than done as zero degrees of rotation is my extreme point of external rotation).

I am proud of the fact that I made it until bedtime last night without any oxycodone (I win our bet Jen) but I still need the Valium for the muscle spasms occasionally. I don't start physcial therapy until week four when I'm allowed to start walking again because of the collagen disorder but a normal patient would have started it immediately, which I would think would be pretty miserable! But then again I also feel like the brace is the only thing that keeps my leg from just flopping around at the hip so maybe normal people don't have that sensation either.

Well it seems to be nap time again so until my next post, feel free to send some energy my way!

Day 1 Post Op

Well it's day one after surgery. There is a lot more pain than I had anticipated but most of it can be attributed to the fact that the damage to my hip was much more severe than anticipated. 

My skating friend Alyssa's mom Kristin took me to the hospital yesterday morning and stayed with me until they kicked her out of the pre op room. I may not have admitted I was a bit nervous going in but I was. The surgical staff were absolutely incredbile. My nurse Jane had to be the best RN in the building. She quickly had me set up in a bed, IV line started, fluids and antibiotics running and oxygen on. I didn't find out until I was in pre op that they would be doing a nerve block in my hip. Dr. Huang, my surgeon came in and chatted with Kristin and I for a bit and answered my questions. Anesthesiology came in shorly after him. They gave me some Versed so that I wouldn't really be awake for the nerve block and the next thing I knew, Jane was telling me I was in post op and it was all over. They did a great job with pain control and just gave IV Torodol and then oxycodone by mouth--the only two drugs I can actually handle. As soon as I said I felt slighly sick to my stomach, they loaded me up with Zofran, Phenergan and a Scopalamine patch. Dr. Huang was very thoughtful and had left orders for every drug they had so there was no waiting around for the nurses to call and get orders from him. 

Dianne and Jerry my 'adopted grandparets' (very good family friends) spoke with Dr. Huang after the surgery and were very impressed with how he took the time to explain everything he did, how I would be feeling and answered all of their questions. They then were able to come back and be with me while Jane gave them my discharge instructions. Without question, this was the easiest surgical experience I've ever had. I had no problems maintaining good oxygenation like I have in the past, never threw up and was so coherent I gave Di and Jerry directions to my house. I even was able to get upstairs to my room easily and they picked up my medications. I'm so grateful they were there for me!

I'm equally thankful for Kristin and Alyssa without whom I would not have made it through the last 24 hours. They've heated up food, brought up drinks, made ice packs and made sure I'm comfortable and drinking plenty of fluids. I've decided that having your gallbladdder or appendix out is MUCH easier than this surgery...just getting up to go to the ladies's room is a 20 minute undertaking!

Dr. Huang had said that there was no indication on the MRI that I would need the more extensive microfracture repair done, so we had planned on the simple labrum reattachmet and shave down of the head of my femur bone since it's not completely round (which is fairly common in labrum tears). Unfortunately, when he started working on my hip, he found the damage to be more severe than the MRI indicated. He did have to do the micofracture as well as remove a bone spur that he found. This means that instead of the 2 weeks on crutches, I'll be on them for 4-6 weeks. It also means that the pain will be more intense than if he had only done the simple reattachment. 

So for now it's lots of pain meds, muscle spasm meds and ice packs. And full week of taking it very, very easy. I have a follow up appointment on Monday and my hope is that I'll be over the worst of it by then. I have a little shower stool and a rolling walker with seat in it so that I can roll around the house and work instead of hopping aroud which should be very helpful. That's about all for now; I'll keep you posted. And for my Kansas friends, I should be coming for a visit in 2-3 weeks. 

Answers...sort of...

It's been a while since I've posted an update. I had every intention of posting after my appointments at the Mayo Clinic and Boston Children's Hospital but unfortunately, I didn't end up walking away with a game plan immediately from the appointments. It took a couple weeks for everything to fall into place but finally, finally, I can say that I am going from point A to point B!

The trip to Mayo Clinic was less than productive. Since it is the Mayo Clinic, I'm sure they see the sickest of the sickest patients all day so to have me trotting in on my own two feet logically prompted the question of, 'and you're here, why?' Not a great question to ask someone who has just spent the majority of the last two days awake and has been waiting three months to be seen by a doctor who knows something more than Google about femoral anteversion. It is best that we simply try to forget that I traveled to Minnesota and we fast forward two days to my trip to Boston.

Dr. Michael Millis and his team at Boston Children's Hospital were wonderful. Over two days I spent probably close to four hours with them. About the only thing I didn't do for them was skate. After all the travelling and walking around airports that week (remember, I had been in Minnesota two days earlier), I was in pretty bad shape as far as hip pain was concerned. I do tend to walk with a slight limp when I get overly tired or sore and have for...well as long as I can remember (it may have been since I ripped that piece of bone off the top of my right femur when I was 12)...and this was definitely no exception. This actually worked out well because they could see me on my absolute worst hip day. They literally started with 'how were you born, when did you walk, etc.' and went from there. My left femur is at 45 degrees of anteversion (internal rotation) and can turn out to zero degrees. My right femur is at 50 degrees of anteversion and stops at 5 degrees anteversion when being turned out. They had me twist and turn in every way imaginable. On the second day, they had the team look at me which included a radiologist, a PA, a fellow, a couple other doctors and physiatrist, a specialized doctor that's a cross between a physical therapist and kinesologist. He was looking for psoas involvement when my hip snaps and pops (there wasn't any) and for SI dysfunction as a part of my low back pain (also checked out normal). They discussed how they were split on what they thought I needed. Dr. Millis was leaning toward trying to repair the labrums and working with a physiatrist first to see what kind of results that achieved while his partner Dr.Kim who does labrum repairs felt that I needed the derotation osteotomy surgeries. They asked for a bit more time to discuss my case as a group and come to a consensus. While this wasn't quite the outcome I expected, this team had quickly earned my respect and I was willing to wait another week or two to make sure that I had the best game plan for me. As Dr. Millis pointed out, some of my problems have been present for many years, so the solution wasn't just going to be found in two seconds.

I spoke with his administrative assistant this past week who was able to forward me the team's reports. They determined that I have a three part problem: first is of course the anteversion and second is the labrum tears. Third is, however, a term that was also quickly tossed out at Mayo Clinic: a collagen disorder/ liagmentously lax. Time out--you just went into medical speak again. Ligamentously lax is just a fancy way of saying that my ligaments aren't tight like they should be.

Ligaments are connective tissue bands that, just as the name suggests, connect your bones together and also help to stabilize your joints. Think of a ligament as a rubber band or ponytail holder. When you have a brand new one, it has good tension. You can stretch it, but it returns to it's normal size and shape easily, has strength, and most importantly, tension. Now think of that same rubber band or ponytail holder, only this time, picture one that is super stretched out. You can still stretch it. In fact, it probably now stretches even farther than it could when it was new. But, it cannot return to the tight, firm, and tense shape that it had when it was new. It will remain lax, floppy and stretched out. Normal, healthy ligaments are like new rubber bands or ponytail holders. They can certainly stretch out, but they have tension and strength. Their job is to be what connects bones to bones and helps to stabilize your joints. In someone who is ligamentously lax, their ligaments are like that overstretched rubber band or ponytail holder. While the ligaments can still stretch out, they can't return to the tight, tense state required to do their job of holding the skeleton together. So what's a body to do? Well, fortunately for us the human body is pretty amazing otherwise we would probably all be dead by now! When the brain realizes that the ligaments aren't doing their job and holding the skeleton together, it tells the muscles to tighten down to hold things in place. The muscles can't do as good of a job as the ligaments because they aren't designed to hold the skeleton together but they can get the job done. Unfortunately, this can cause other problems over time, with some of primary problems being spinal damage and degeneration, tendonitis and osteoarthritis.

Dr. Millis feels that the damage in my spine--that is the degenerated, compressed discs and spinal stenosis--as well as the knee tendonitis, both problems that have persisted since my late and early teenage years respectively, are a result of my lax ligaments. The problem with the lax ligaments is that it's difficult to determine what they are affecting, what the labrum tears are affecting and what, if anything, the femoral anteversion is affecting. The best way to go about determining what's what is to address the labrum tears and the collagen disorder, which is what is causing the ligament laxity. After that, they will be able to see what, if any, problems are being caused by the femoral anteversion. Dr. Millis, however, felt, that based on my exam and history I actually seem to function pretty well considering how significantly my femurs are turned in and that more than likely I have little problems from them other than some less than idea air positions on my skating jumps and certain spin positions that I flat out can't do. For the record, however, I would like to once and for all state that it is truly a physical impossibility for me to achieve what is considered a standard air position for a figure skating jump. This has been an epic battle from day one for me and my coaches. It's not you, it's me. And it's not my lack of effort, desire or most importantly, willingness to try it and trust myself. It's literally my own anatomy. I can either hit it and fall or do it my way and land. Take your pick. Now that we've clarified this, should I go back to high level skating when it's all said and done, we may have to get a bit creative in utilizing the 'less than classical looking but gets the job done' wrap style of air position.  And now I've digressed and lost everyone who is not in the skating world...sometimes though it just feels so good to be validated!

Tuesday, March 8th I met Dr. Michael Huang right here in Colorado Springs. This is lucky doctor number...who knows I've lost count at this point...who actually gets to fix me! He was awesome. Agreed that I had been really put through a bit of a circus over the last five months and thought as have a few people at this point, that it was a bit ridiculous that the labrum repair surgery wasn't at least attempted in December. He actually trained with Dr. Kim so he is very familiar with Dr. Millis and was already in the loop as they had copied him to their notes on my case. He scheduled me up for the left labrum repair surgery on April 30. After thoroughly impressing him with my ability to twist in strange ways, he assured me that he was going to get me on the road to recovery. These were his thoughts on things overall:

1. Due to the highly suspected collagen disorder, he will go about the surgery a bit differently. A collagen sac that encases the hip that is cut through during the surgery is normally not sutured shut as the body repairs this naturally. He will suture this shut tightly as my body will not heal it on its own.
2. While he normally does not place his patients in any sort of brace after the surgery, he will place me in a hip brace to restrict the amount of movement my hip has. The upside to this is that I won't require any CPM machine because we want to slow down my motion. 
3. The downside to being able to move in strange ways is that unlike most athletes who would proceed directly into physical therapy, I will be restricted to stretching for at least the first six weeks post op with absolutely no internal rotation of the hip allowed. His hope is that these three steps will actually result in a reduction in my amount of internal rotation (no complaints here). 
4. At some point down the rehab line he will evaluate my right hip and determine the course of treatment for it.
5. While a cardiology workup is indicated for patients who are diagnosed with collagen disorders as the collagen deficiency can cause problems with the aorta, he feels there is currently no need for me to see one. A cardiologist would put a collagen disorder patient through a stress test. Since a skating practice is the equivalent of one and I haven't shredded an aorta yet, we can assume that my cardiovascular system is working just fine for now. Which is great! Of course, should anything change, follow up with the primary care doctor, etc.
6. With that being said, it would be an excellent idea to be seen by a geneticist to determine what specific collagen disorder I have to better understand what systems will be affected in the future as each disorder is different, what the likelihood is of passing it on to future children, etc. Some of the better known disorders include Marfan Syndrome and Ehlers-Danlos Syndrome. Since geneticists are so easy to come by (not) I have an appointment with one in Denver that specializes in collagen disorders in August. 
7. I have 2-3 herniated discs in my lumbar spine, however, since I have been dealing with low back pain since I was 19, and have been skating for the last 4 years, it's highly unlikely that these are the culprits. Additionally, although a lot of my hip pain runs down my hamstrings, it was alleviated by the cortisone injection, indicating that it was coming from the labrum. Dr. Huang has seen this many times before and while he says he is unable to explain why some people have pain in the hamstring from the tears, if it resolves with the cortisone injection, it resolves after the repair. 

All in all I am very happy to be finally moving forward and feel that Dr. Huang is a great choice to be fixing my hips. If the repairs are simple I will only be on crutches for two weeks. If they have to do a more extensive type of repair called a microfracture, where they put microscopic fractures into the hip bone in order to help graft the labrum back into place, it's 4-6 weeks on crutches. Unfortunately, they won't know how they will repair things until they actually get in as there is only so much that the MRI will tell them. Fingers crossed that it will be a simple repair, although all things considered, even the microfracture would be a cakewalk compared to the open derotation surgeries. So the game plan now will be to fix the left labrum in 3 weeks, start the rehab on that hip (which will take about 6 months to return me to full competitive skating status), at some point in there evaluate and determine the course of action for the right hip and meet with the geneticist who can hopefully complete the circle with a definitive diagnosis that will provide a long term understanding of not only why my body is the way it is but what I will need to watch for in the future. But regardless of what is determined, it will only be a label. A guidebook of suggestions. I will not let it dictate what I will or will not do with my life. I think at this point it's a little late for that....as it's recently been made fairly clear to me that people with collagen disorders should not engage in high impact sports. Okay. It's also been made recently clear to me that with the twisted femurs I have there's really no logical way I should be able to do half the things I can do on my skates. The only real reason I probably can do them is because I'm 'super stretchy' from the, oh yeah, collagen disorder! So with that being said, bring it on life. I'm ready for you...but first I'd like to get my torn labrums fixed so that ice packs and heating pads aren't my best friends! Let the countdown begin.

Sitting, Waiting, Wishing

It's been about a month since my last post and if it seems like you've been left in the dark, you're not alone. I've spent the past month trying to physically put myself in front of someone who is capable of fixing me. For anyone reading this who is starting this process, you may want to consider investing in a large amount of patience. Like a take a second mortgage out on your house kind of patience. I actually have three different blog posts currently sitting around in the draft stage because of false developments over the last several weeks. So pardon me as I quickly pull up my last post to see where I should begin...

Oh dear. It seems as thought I do have some explaining to do. I'll start with a quick recap of how things became stuck in limbo. There are four orthopaedic surgeons in the country who are considered the best doctors for treating femoral anteversion. After Dr. Philippon sent my scans to Dr. Santore in San Diego, I found out that Dr. Santore is a cash only provider. Since I obviously make a very comfortable, mid-range six figure income as a pediatric nurse, this was of no consequence whatsoever. Ha. Right. That was a non starter considering each surgery with him would likely be upwards of $15K in surgeon's fees. So, I had my scans sent to two other doctors who are qualified to perform derotational osteotomies: Dr. Joel Matta in Santa Monica and Dr. Michael Millis at Boston Children's Hospital. I also called the Mayo Clinic in Rochester, Minnesota to request an appointment with Dr. Robert Trousdale. The Mayo Clinic agreed to take me as a patient but only schedules their doctors 3 months out. So, I was placed on a waiting list with them. With several phone calls over the course of three weeks, I was able to get an appointment in mid March thanks to a cancellation. However, this is for a consultation only and Dr. Trousdale is currently scheduling about 8-10 weeks out for surgery. Dr. Matta reviewed my case and spoke with Dr. Philippon last week. He recommended that Dr. Philippon proceed with the labrum repair and felt that I did not need the derotational osteotomies. You can imagine my joy at finding this out! When I called Dr. Philippon's office to inquire about proceeding ahead with the labrum repair, I was told that somehow the nurse wasn't notified that their original consult, Dr. Santore, had evaluated my case and stated that I absolutely needed the derotational osteotomies and that was the opinion they were sticking with. Feeling cut out of the equation a little bit yet? It gets better. Then there is Boston. Dr. Michael Millis heads the Adolescent and Young Adult Hip Clinic at the Boston Children's Hospital. A tenured Harvard medical school professor, he established the clinic to meet what he felt was a growing need for a clinic that specialized in treating serious hip conditions often not discovered until adolescence or young adulthood. After sending off my scans, I was told that Dr. Millis would accept me as a patient and they simply needed to work out the scheduling. He could do the evaluation and surgery all in one visit. Fast forward three weeks later of me calling every other day before I finally was given a date. Apparently there was some miscommunication and Dr. Millis feels that my case is rare enough it warrants a consultation with a multidisciplinary team. This would include Dr. Millis, a second surgeon who would do the labrum repair (as Dr. Millis would only do the derotational osteotomies), radiologist, physical therapist, and I'm sure some other medical professionals. I have requested that a doctor in the sports medicine department who specializes in treating figure skaters be brought into the group at least for consultation as she can better speak to what I will need to physically be able to skate afterwards. She will also 'speak skater' and will understand that not being able to jump again is non negotiable. (It may be worth noting that in my limited understanding of orthopaedics as a nurse, fracture sites are actually stronger than the rest of the bone once they have healed. Therefore, I can't imagine them saying I wouldn't be able to jump again once everything has healed.) Although it has been quite the headache getting scheduled for this consultation in Boston and I should probably send Dr. Millis's assistant some cookies as an apology for my constant badgering, I do like the idea of sitting down with a multidisciplinary team who can work out a comprehensive plan of action. Additionally, Dr. Millis's assistant has said that they can most likely schedule the first surgery within a week or two of the consultation, should of course, that work with my mom's and my schedules.

So I now have both consultations scheduled, and ironically, they're in the same week. I'll spend March 16-17 in Minnesota, return home for a day (literally) to work a shift and a half, and then jet off to Boston March 19-20. At this point, the Mayo Clinic does not anticipate needing any further testing or imaging and has me scheduled for my consultation with Dr. Trousdale first thing in the morning. I have scheduled my return flight for the evening so that they have the rest of the day to work with just in case. Dr. Millis at BCH will see me on Wednesday March 19 in his office before being evaluated by the multidisciplinary team that he has put together for me on March 20. It'll be a bit of a crazy week and while I initially thought that I wouldn't go to both consultations, I've decided that I want the opinions of the two remaining top four doctors in the country who treat femoral anteversion. Since one of these two will get selected to perform the surgeries, I want to hear what both of them have to say, what their game plan would be, etc. I'll feel better going into this whole ordeal knowing that I have had multiple opinions given on the matter and a full understanding of what I'm signing up for. In a month, I should have a lot more answers, information, and probably most importantly, a surgery date. My left hip is pretty unhappy at this point and I'm very close to going into my kitchen with a knife, nail drill, tweezers and a suture kit and fixing the torn labrum myself. Kidding...sort of.

I need to give a few thank you shout outs before I sign off. First of all, to my Mom who has dealt with me crying on the phone once a week for the last few weeks: thank you for being there and for promising that you'll be with me for the first surgery. I know I'm asking a lot for you to come with me between your work and the kids and having that assurance has been the singe most reassuring and calming thing in the last month for me. Secondly, to my skating pal and her mom who have been staying with me while they shop for a Colorado house: you have been so kind and supportive, particularly on the days where I've been ready to scream at the doctors' offices. Finally, to my coworkers who are working extra or strange hours to cover the shifts I'll miss while traveling to the consultations: I really appreciate it and I appreciate your assurances that you'll rearrange your schedules for the weeks that I'll miss during the first surgery so that the patients are all cared for!

And now all I can do is sit back and wait...updates from Minnesota and Boston as soon I have them!

Finding the Reason, Motivation and Joy

It's been two weeks now since I received the devastating news about my hips and legs. It's crept into every aspect of my life. I can't go a single day without a million questions running through my head. "Is this really happening to me? Will I ever be normal again? What is my life going to look like 3, 6, 9 months from now? Is my insurance premium and deductible going to skyrocket next year after all of the surgeries?" Stupid, everyday things that I take for granted suddenly have new meaning now. "Am I going to be able to get up and down the stairs of my house by myself? Doing laundry may be interesting for a while. I had better stop being clumsy and dropping things on the floor. Will I be able to adapt well enough at work to meet expectations?" I start criticizing myself if I'm not filling every second of every day with activity. "You shouldn't be laying on the couch resting for an hour, that's all you'll be doing soon enough. You should have worked harder at the rink. It's 40 degrees today, you should be going for a run. You should be deep cleaning the house, tackling small projects you've been putting off, running errands you won't be able to do." And yet as hard as it is to admit, I find myself very unmotivated to do even the things I love. Skating is emotionally painful and mentally frustrating. "You need to be able to do jump A or spin B well before the surgeries so that you'll have an easier time coming back. You didn't work hard enough at the rink today. You should have tried harder to get that extra bit of rotation you don't trust yourself to do. Who cares if you fall and it hurts? You're a chicken. You suck. You're never going to accomplish your goals. You'll never really be able to come back from these surgeries. You just weren't cut out for this. You don't want it enough." And let's not even talk about the path my dietitian had me on. One day I'll barely eat anything at all and the next day I could eat a whole pizza followed by a entire carton of chocolate ice cream and wash it down with two bottles of Cabernet. If I thought I didn't sleep well before it's nothing compared to now. After working all night Saturday, I slept from 7am Sunday morning until 11. That's about par for the course.

They say that whenever something happens that has a significant impact on your life you go through the five stages of grief. Denial/Isolation, anger, bargaining, depression and acceptance, not necessarily in that particular order. I definitely spent the first week in the denial/isolation stage. I had no desire to see anyone for the first few days and the only thing that made me leave my house, or for that matter my couch, was that I had to work. I now think I'm bouncing between depression and bargaining. At times that I feel more positive and upbeat I tend to think of a 'perfect' scenario where they may do the major surgeries but at a later time, allowing me to continue competing and have the smaller labrum repair surgery. But most of the time I definitely am ambivalent towards things at best, functioning on 'auto pilot'. I know it's a process and most of the time it's an internal fight between how I think I should be feeling and behaving and how I actually feel and want to behave. With another week or two to go before expecting to hear anything from the specialist in California, it feels like time is both crawling and flying at the same time.

While I found happiness and motivation for a few days in putting together an artistic program for an audition that my head coach is conducting at the end of the month, it quickly faded this week. This past week was, well, just downright tough. I think I walked around with a sign saying "Kick Me" on my back. By Friday morning, I probably should have just been put in isolation. I was unquestionably Eddie's grouchiest lesson of the day (poor guy I owe him an apology Monday morning). I had no desire to be on the ice in a jumps lesson at 7:30am on my only full day off of work (I worked a split work week last week), was mad that all of my lessons for the week had been rescheduled due to an out of town skater, costing me sleep and extra ice sessions, and was quite frankly at rock bottom when it came to my own self confidence in my jumps and lack of recent progression (see destructive self talk above). After spending 2.5 hours straight on the ice (due to the rescheduling issue) I went home and was really ready to throw my skates through a window. As fate, Karma or whatever else you want to call it would have it, I was supposed to go up to Woodland Park--a small mountain town about 30 minutes outside of the Springs--and give a coworker and her kids some skating lessons that afternoon. Feeling defeated and drained, I headed up into the mountains. I spent the next two hours on a full sized outdoor ice rink. It was two hours I wished I had taken for myself a week ago. I haven't coached skating since moving to the Springs. Spending an hour teaching the basics of skating reminded me of how rewarding it is to teach someone and watch them master a skill for the very first time. The look on a young child's face the first time they do a basic 2 foot spin or a toddler doing their very first bunny hop and realizing they didn't crash or an adult learning how to feel in control of themselves in a practically friction-less environment is every bit as rewarding as achieving a new jump or spin yourself. That simple hour of coaching brought back the joy of skating to me that I had lost in the last few weeks.

When I was in high school, we would go and visit my mom's family in Denver on school holidays. I always looked forward to going to the outdoor ice rink at my grandmother's country club in the winter and skating. I would stay out there until everyone else was begging me to get off the ice so we could go home. I remember my grandmother saying how I naturally took to the ice and looked graceful skating out there. She would tell me about her sister skating on the Central Park ice rink in New York when they were growing up and spinning beautifully in the middle of the ice. I taught myself how to spin on two feet after hearing that story. A few years later when she was dying from cancer and we were caring for her, I would go up to a small outdoor rink at a nearby mall in the early afternoons before the schools let out. I would often have the ice rink to myself. I'd turn on my iPod, put in my earbuds and loose myself in the cold wind blowing in my face and the smooth feel of the ice beneath my feet. After my grandmother died and I moved back to Oklahoma, I tried many times to get in touch with the local ice rink and arrange lessons for myself, but no one ever called me back. It would be over two years before I took to the ice again.

As I spent that second hour in Woodland Park simply skating for myself, I was overcome by how different it felt. The cold wind, the trees, the occasional pine needle on the ice catching under my blade...no coaches yelling across the ice. No fighting 17 other skaters to set up a jump or spin. No having to constantly watch over your shoulder for a skater running their program. No annoying tween music playing off of some 14 year old's iPod who doesn't know how to compile a decent playlist for a practice session. It was just me, the wind and the ice. I couldn't tell you the last time I worked so hard on the ice. I must have reeled off 75 jumping passes easily. Throwing combination after combination because I didn't have to worry about another skater 3 feet away from me. Jumping every time I went around because there was no one to cut off my setup. Being bold and unafraid to try different adjustments to jumps that are not consistent for me because no one was there to tell me not to. Doing things in my own time because I wasn't constrained by a 45 minute session with 25 other people on the ice and having to 'be ready' for a lesson to start at a scheduled time. It was fun. I was flying. I was free. It's been over 5 years since I've been on an outdoor rink, let alone one so quiet and surrounded by huge mountains and beautiful trees. For the past two days, I haven't been able to get that rink out of my mind. I found the reason why I fell in love with skating and why for me, it's worth the long overnight shifts at work, living very conservatively so that I can put every extra dollar I have into my training, carefully monitoring what I eat, feeling very sleep deprived, having permanently ice cold toes, and pushing my body beyond its limits. When I'm on the ice, I'm free. It's how I express myself. It's where I've known both triumph and defeat. Success and failure. It's where I discovered myself and where I can find myself when I'm lost. It's a part of me.

Skater says that once you start skating, it's 'in your blood' and I think there is a lot of truth to that. Do I still feel like I'm essentially 'skating toward an end'? Absolutely. Are there still a million unanswered questions racing through my mind? Probably two million. Have I miraculously been pulled out of my funk? Yeah right. But what I can tell you is I'm excited to get to the rink tomorrow. And probably do a ton of butt bouncing. But I'm also really excited to get back to Woodland Park this Friday and just skate for myself. And I'll tackle the issues, the questions and the grief process in two weeks when a game plan is formulated. In the meantime, perhaps I should just walk around wearing a shirt that says, "I need understanding and kindness right now". And maybe that's an okay thing to humbly ask for.

Here is a link to an informal resume of the orthopaedist I'm being referred to in San Diego. http://www.omgsd.com/pages/dr_santore.htm