Recovery Progress Report

5.5 Weeks since surgery and things are looking up.

The first week after surgery, although most painful, also had the most noticeable day-to-day improvement. After that, there has been steady improvement, but barely discernible from a day-to-day standpoint. Here's what Shira has had me doing:

Week 1: Spinning on bike, no resistance, Lay prone 2 hour/s day, Laying heel pulls, Limit sitting at <=90 degrees leg to body angle, Two crutches, Leg in Constant Passive Motion (CPM) for 6 hours/day

Week 2 Allowed to swim with pull buoy, Iso abs flexes, Glut flexs, Quad flexes

Week 3 Same as 2

Week 4 Allowed to water walk, Down to one crutch, Terminal knee extension, Hip extension - unilateral support, Terminal knee extension (standing), Resisted hip abduction (on stomach), Standing abduction, Bent knee fall-outs, Hip int/ext rotators, can do curls and pull-ups but make sure not to kip.

Week 5 No more crutches, One-leg balance, Side-lying hip abduction, Terminal knee extension (standing), Hip extension - unilateral support, Supine terminal knee extension, Strengthening wall slides, Resisted hip abductor, Bridging, clam shells and reverse clam shells

I made it to the pool the day before my appointment to test out my hip while "lightly kicking" and it didn't feel great. I did one lap kicking and the rest with the pull buoy. I guess we'll work up to regular swimming.

Since I have loose and overly flexible joints, her approach has been to limit stretching exercises and focus on strength.She also wants to postpone any hip flexor work because she feels it will likely result in tendinitis.

Yesterday, however, I visited Dr. Parker. He was unable to see me at my initial post-surgical meeting and after meeting him for the 5-week meeting, I wish he had been there.

We reviewed the scope pics from my surgery and I was able to gain a much better understanding of what the  images actually showed. It turns out, I did not have two labral tears, which is good. There was damage to it due to the pinching between my hip and femur which he fixed. It was also interesting to see the scope pics taken after his work was done. He ground my bones down to the point where you can see marrow. Apparently, it takes about 3 months for the hard exterior of the bone to re-grow and that is the majority of the reason for running restrictions (avoiding a stress fracture). He did some strength and flexibility tests and said that I am ahead of schedule. Dr. Parker said I can resume any activities I want to the extent my hip will allow and probably only need another month or so of PT. Finally, he said I could probably try running again after three months instead of four, so that's great news as well. 

Things are good.

Hip Scope

Had my hip scope on 8/28 at Commonwealth  Medical Center in Herndon. Dr. Parker was in there for 2.5 hours and was able to grind out the bone piece that had lodged itself in my labrum, grind down my femoral neck, grind down my acetabula, and repair two labral tears. Not bad for a day's work.

In the Post-Anesthesia Care Unit (PACU) I remember thinking that I would be able to remember everything and may have for all of two minutes before it faded into obscurity. I was given some Oxycontin prior to the surgery and the staff checked on me repeatedly to ensure they had the right person and correct leg on which to operate.

I got home and slept most of the rest of the day. The day afterward, I actually working for half the day and got to try out my awesome (/sarcasm) Constant Passive Motion machine. I was supposed to spend 6 hours per day in the device that aims to keep my legs moving to inhibit scarring from the surgery. I haven't quite been able to do that.

Day by day, the pain has gone down due, in part, to the local anesthetics that was injected into my leg at the end of the surgery and subsisted there for almost a week after the procedure. Against, Dr.'s orders, I've tried walking without crutches and although there is no pain, it was definitely awkward. The only issue has been one of the suture sites which is pretty sore and has been leaky. During the Post-Op yesterday they looked at it and it is apparently nothing to worry about. I'm only taking anti-infalmmatories now and have stopped the painkillers and never really needed the anti-nausea medication.

Today was my first PT session with Shira Greenburg at Professional Sports and Rehab. She conducted more measurements and gave me my assigned activities for the next week. Butt clinches. Quad flexes. Ab flexes. Laying heal pulls (to work hamstring). Incredibly boring.

Once the sutures healing supports it, I can water walk, swim with a pull buoy, or swim while lightly kicking. At least it's something. I can also do curls and pull-up (no piking) but no push-ups or sit-ups. Still three weeks with crutches and three weeks until I can ride a bike again. I read in the material that it will be 4 months from the surgery before I can run. Suck.

Colorado

Took a brief vacation to Colorado to visit friends Craig and Alison and to watch the USA Pro Cycling Challenge in its second year. Colorado was great!

After leaving the airport Andrea and I met up with them at Pinche Tacos and followed up with a beer at the Vine Street Pub. The next morning we drove out to Aspen, a 4-hour trek through the winding mountain roads. Our arrival time was perfect as we were able to see everything along the race course and visit all the tents prior to a large influx of other spectators. The Women's Crit race was pretty fun but it was great seeing the guys fly down the chute for their Stage 3 finish.

That night, C&A met back up with us for some dinner at Brunelleschi's for some good salad and pizza. Then, we went to Aspen Brewery for some shitty service and limited selection. Thursday morning Craig, Andrea and I (on our nice Giant Avail Carbon frame bikes rented from D&E Ski and Snowboard Shop) got up and started out ride up to Independence Pass from Aspen. The climb was long more than anything, no big climbs to speak of, just constant incline and altitude. I decided I hadn't worked hard enough so I went back down about two miles and did a "charge" back up the mountain. That did it for me and I was coughing and had what felt like a hole in my lungs for a while afterward. The temperature fluctuated wildly depending on the sun/clouds/rain so I bundled up as best I could. We waited and finally the race came through led by the eventual stage winner, Jens Voight of "Shut up, legs!" fame. We hung out in Aspen for the rest of the day and ate at Justice Snow's. Pretty, pretty good. For some brewed digestifs, we ambled in to Zane's Tavern and were greeted with another underwhelming service experience. We did indulge in some hot wings which were quite perfect. Finally, Friday morning we are breakfast at Poppycock's Cafe and ceded our boothed table to none other than Mr. Ken Burns and family.

Then, it was time for some hiking in the mountains. From the outset, we wanted to visit some hot springs and multiple people recommended Conundrum in the Maroon Bells region outside Aspen. We took about 4 hours to hike up and were able to get campsite #10. The highest one in the area but it had a great view and a relatively flat tent area. We dipped into the hot spring for a while and just barely beat a rainstorm we saw come up through the valley. After getting up, enjoying some breakfast and another dip in the hot spring, we headed back down to the car. We cut an hour off the ascent time and started the long drive back. After some deliberation, we decided not to visit fort Collins and instead cleaned up and went to dinner at Cheeky Monk's. Being a Belgian restaurant, naturally, we each had moules and Belgian beer.

The next morning we had coffee and some breakfast at DazBog's in Capital hill neighborhood. Good coffee and a very gay friendly atmosphere but very expensive to buy in bulk (~$!$/lb whole bean) so I declined. We bikeshared to the library downtown and once again checked out the scenery. Shortly before the final stage time trial began, we stopped by the United Healthcare tent and I jumped on the bike and trainer they had set up for, I assume, Training peaks. I blew my load too early and got crushed but then the computer crashed and as we were leaving I told the folks good luck. Apparently, that was the magic word as the guy gave us two tickets to the grandstand. Grandstand access was pretty nice, upgraded bathrooms and a vantage point right on the course 200M from the finish line.

The time trial was actually pretty exciting in that (thankfully) we got a start list and were able to time our breaks and interested depending on who was going out or coming in from the course. Started were staggered by 1:00 and then 2:00. Levi Leipheimer started the stage with a lead but ceded it to Christian Van de Velde and his great time trial.

Overall, great trip. We got to do everything we wanted and I got to be pretty active right before a prolonged period of relative inactivity.

This is either a really bad idea or a slightly dumb idea

In the midst of peer pressure and dozens of DC Tri Clubbers signing up for the inaugural DC Tri full distance triathlon, I have signed up for Lake Placid 2013. Yes, I've been injured all year. Yes, I need hip surgery. Yes, it's a long goddamn event. I know. But maybe it'll force me to recover more quickly because I have to. How's that for some faulty logic?

Aside from that, I finally had my appointment with Dr. Parker. While there, he took another Xray and the 1.6 cm bone piece that was clearly visible on my last Xray was now undetectable. This leaves me to believe that part of my body started healing and basically re-attached itself which doesn't really make me feel good. I also found out that I have not one, but two labral tears in my right hip. Come strong or not at all is what I say.

He also set quite a different expectation of recovery for me. One week using a Constant Passive Motion machine, 4 weeks on crutches and 4-9 months recovery. I asked him about the Ironman possibility and he said it would be tight but we'll give it a go. Date for surgery 8/28/2012. Also, there is a 25% chance I'll need surgery on my right hip as I have FAI there too and "deep sockets" in both hips. Yippee!

Maryland Swim for Life

Since the knee injury, and more recently, the hip injury, I've not really been able to schedule any triathlons not knowing when I'd be able to return to action. Since swimming is significantly less impact, I opted to enroll in the 5-Mile Edition of the Maryland Swim for Life.

The weekend prior I did a 4-mile swim in Wilson Pool and although it was a long time in the pool, it wasn't particularly difficult. The actual swim last Saturday was another beast entirely. The start was delayed by an hour due to storms in the area. This also meant that the 5-Miler would be cancelled and reduced to a 4-mile swim, to my chagrin.

Finally, though, the the kayaks were launched and the first wave entered the water.

Immediately, it was clear that this would be no stroll. The current was strong and it felt like every time I looked up to sight I was a little off course and barely moving forward. Then, around the first buoy at .5 miles, my feet and calves started cramping up. This only ever happens after more than a couple miles and usually only when I push off the wall after a flip turn in the pool. When my feet were cramping I couldn't use my legs at all and resorted to an upper body stroke. When they weren't cramping, I could only muster a very light kick to try and avoid the cramping. Add to that, for some reason my right hip was hurting whenever I kicked. Big suck-fest.

I continued to pick-off turnaround buoys and was excitedly arriving at my turn-around buoy 2 miles out. I reached it and started heading back to shore. And then, after about 5 minutes it happened. The tide started coming in. That hour delay created a hell of a penalty. Sonufabitch. The tide created a nice chop in the water further arresting progress and meaning I would essentially be swimming upstream both directions. My spirit sank a bit but I was resolute to continue.

I grabbed some water from a kayaker in hopes it would alleviate the cramps. It didn't. But I kept going. Little by little and finally reached shore. Garmin results here. Looking at the map, I didn't stray too far from the line but you can definitely see all my small corrections along the way.

I was also warned ahead of time that most of the people doing this swim were members of Masters and other swim teams and I shouldn't expect to come close to the top. Goddamn right. It was my worst performance ever as it relates to a starting wave of which I've been a member. But fuck it, I'm injured.

After finishing, I was completely gassed. It was like a 2+ hour power workout. The next day, I was sore everywhere. Shoulders, abs, lower back, triceps and my right shoulder joint really hurt. I'm sure everything will get better shortly but I may have to reconsider my swim of the English Channel. I'm signed up for the Nation's Triathlon Aquabike but it remains to be seen whether or not I will participate. Maybe I can get on a relay team instead. Shitty swim finishing pictures (oh, and not running and biking adds 10 pounds):

Bring the Pain

Went to see Shira Greenberg at Professional SportsCare & Rehab to check the box on Physical Therpy. She conducted her assessments and didn't see any weakness (naturally) that she could focus exercise on to alleviate my issues. She could give me stuff to do but ultimately, to get back to doing the things I want to do, I would need surgery. Despite that expected outcome I was anxious to start doing more.

So, I was feeling frisky on and June 16, decided to go for a long ride. Things seemed fine, my hip only announced itself a couple times during the ride and Sunday I was slightly sore. Monday however, I was ready to cut off my leg. I couldn't move it in any direction without excruciating pain. I almost cleared my medicine cabinet of analgesics and none were helping. I called my Doctor's office and was met with the unsympathetic response that the Doctor would get back to me when he could but he was busy all day and the one following so it might be a while. Not satisfied with the response, I continued calling until I got a return phone call. Finally, I was able to get a prescription for Relafin, a 750mg anti-inflammatory I was to take twice per day. Unfortunately, I only got the prescription on Wednesday and it took three days to kick in. Naturally, I pressed the Doctor on an MRI and scheduled another appointment.

Fortunately, I was able to get pre-authorization fro the MRI from United Healthcare. I scheduled an arthrogram as part of an MRI at Progressive Radiology. For those that don't know (or didn't want to click the link, lazy ass) an arthrogram includes the injection of a solution containing rare earth metals directly into the hip joint. They use a local anasthetic but it is still uncomfortable as you can feel the needle hitting the bone in the joint. In any event, I had the series of images taken and took a look and it was pretty clear that there was a tear, something mirrored by pretty much everyone that has made an assessment of it.

Back to Ochiai. He reviewed the MRI and original X-Ray and provided me my options.

1. Do Nothing
2. Physical Therapy
3. Hip Arthroscopy
4. Fix/Secure the bone fragment to my hip via screws

Meaning that my only real option is to get my hip scoped. He suggested removal of the 1.66cm bone chip, re-shaping of the acetabula, and repair of the labral tear resulting in 2.5-4 hours of out-patient surgery. Surprisingly, he said the day after surgery I could spin with no resistance but it would take about 3 months to determine if the surgery was successful. "Success" as determined by a noticeable improvement or the ability to say knowing what I know now, would I do it again? The procedure has a 93% success rate, 5-6 percent of failure is attributed to a 'no' answer to the aforementioned question. 1-2% of failure due to infection or other complications. Naturally, I opted for surgery.

I was ready to schedule the procedure ASAP but Back to the drawing board; Ochiai is out of network for me. I contacted the other hip arthroscopy specialist in the area, Dr. Anthony Parker. Due to the dearth of specialists in this area (geographic and medical) the earliest I could get in with him for a consult is 8/10. The waiting game begins anew. I just want to get this done and get better.

Just Wait, It Gets Worse!

Bad news, injured again. It started 5/20 after a short run and a pool workout. During the evening my left hip felt a little out of sorts - like it was misaligned or slightly dislocated. It had been a minor annoyance initially but developed into something that was impacting my ability to sleep at night. The following weekend, I went to Deep Creek Lake and put in some good miles of hills. During that time, there was still some issue but I thought it possible that it was a soft tissue problem that was maybe referring pain to my hip. On 5/31, things seems to have improved a bit and I went for another short run (2-2.25 miles). The following two days were full of immense pain and I considered going to an Urgent Care clinic to have things looked at. I got on the calendar for Dr. Bennett and Dr. Johnson although the earliest they could get me in were 6/12 and 6/22, respectively. During the interim, I loaded up on painkillers and arranged an appointment with Dr. Shrefler at Shrefler Chiropractic on 6/5. For the low, low fee of $198 he performed a 40-minute evaluation of me an determined that there wasn't anything he could do as my pain was not a result of a soft tissue problem. He suspected that I might have a labral tear and would need an MRI and then referred me to a couple hip specialists in the area. I appreciated his admission of an inability to help but things were getting very frustrating.

I was able to get on the schedule for Dr.Ochiai at Nirschl Orthopedic for Monday, 6/11. Then, a weird thing happened. I was out with some friends on Saturday night, 6/9 and got into a cab. Somewhere during the course of the cab ride, my hip pain disappeared. I tested it by running a few times on short bursts and miraculously, no pain. Slept fine and felt 100% through Sunday as well. I still attended my appointment on Monday just to confirm that I could return to training, et. al. After a 1 hour wait, Dr. Ochiai saw me and performed some tests on my flexibility and movement, whether or not I felt pain. nothing showed up. He was about to dismiss me but decided to order an X-Ray just to be sure. I am somewhat suspicious of orders I feel may be necessary but since this issue was so bizarre, I didn't object. I got the film taken and it automatically popped up on the computer screen in the examination room. Naturally, I looked at the issue was immediately clear, there was some irregularity near the ball joint of my left hip. Dr. Ochiai came in and identified the same thing. He wanted a better look focusing on the area in question so I returned to get another X-Ray. Results:

He diagnosed me with femoroacetabular Impingement (FAI) syndrome, with a broken acetabula which has, in all likelihood, torn my labrum. At least I know what it is now.

He suggested an attempt at resolving the issue with physical therapy in an effort to avoid surgery. I agreed to try the PT and after getting a PT script mailed to me, contacted recommended physical therapists via the DC Tri Club. I asked what their experience with FAI is in order to determine the practice I want to go to. The hips was feeling a bit better so on Thursday, I went to Hains Point for some laps with sprints. No harm afterwards so I decided to queue up a long bike ride for Saturday. I went pretty long for my current level of fitness and I barely noticed my hip while on the road. Then, the pain came. Sunday hurt pretty bad, sometimes constantly, other times when moving outside a specific range of motion.

I managed to play through the pain and bought a new city bike after selling my 1960's Sturmey Archer internally geared hub bike. I was vacillating between a Scwhinn off of Amazon, the Fuji Absolute from Big Wheel Bikes or some other option. I was looking for something that was not too expensive due to the possibility that it might be stolen so my original budget was $200-400. Naturally, I settled on a $479 Trek from Revolution Cycles and purchased a $55 set of fenders to go with it. Budget schmudget. I test rode the Fuji Absolute 2.0 at the Big wheel in Georgetown and it felt great. Unfortunately, they did not have a black Absolute 4.0 there but did at their store in Clarendon. Since we were in the area, we stopped in at Revolution in Georgetown and spoke with Santi, who was great. Unfortunately, we had a similar issue there in that the specific bike I wanted was not available in that store. Tried the Absolute 4.0, hated the grip shifters and felt stretched out so went to Revolution and tried the Trek 7.1. The sales guy sucked a bit, immediately trying to upsell me. When I finally pulled the trigger, they refused to provide a free install of my current rack on the brand new bike I just bought. I was almost shocked that they wouldn't comp a $15 service fee after buying a full-price (albeit entry-level) bike and a relatively expensive accessory. Fortunately, another co-worked overruled the decision and they will install the rack when the fenders come in. I love the new bike, unfortunately, I cannot ride it right now. The bike/fender purchase in addition to the new lock, bell and lights made for a rather expensive Sunday.

So, this week I will try a PT session, go see Dr. Johnson on Friday and see what's what. I'm fairly certain, however, that I will need surgery based on the pain I am constantly experiencing. Sucks.