Category Archives: Injury

The Injury. The Answers.

Although I was confused shortly after surgery, over the last few weeks I’ve visited with doctors, physician’s assistants, and physical therapists. We’ve gone over the surgery pictures, examined how my body has responded to surgery, and finally been able to find some answers.

As you can see in my injury history, I had been looking for answers for a long time. We looked into several potential diagnoses, ruling them out one at a time. Since I’ve been blogging along the way, I’ve received numerous suggestions on what it could be, most of which were well informed and definitely possible. It’s amazing that after all this searching, with a help of a few surgical instruments, all my questions over the last 1.5 years were answered.

In the diagnosis phase, there was one thing that kept popping up that was a possibility – a torn labrum. There were plenty of symptoms, the most notable being that my hip would audibly pop. We had four MRIs. Yes, four, and none of them showed a major tear. One of them did show a minor tear, not one that was serious enough to require surgery.

In reading the surgeon’s report, it’s clear that he didn’t know what he would find. He just knew that my condition had deteriorated enough that surgery was the only way to get answers.

He found a torn labrum and a lot of messed up cartilage, and he corrected it. More on that in a moment.

The torn labrum was probably there from the very beginning. The only real question is how it materialized in the first place. Could it have happened on Grandfather Mountain? Could it have been a combination of all of my big riding in 2012? Could it have been there a year earlier and only started bothering me with heavy riding? We’ll never know the answer to that question. All we know is that it was exacerbated as a product of cycling.

He said that the stress fracture and the torn labrum were two different things, but they are clearly related on some level. The labrum protects the bone, and with it torn, it probably made me susceptible to a fracture. I’m lucky I didn’t get another one.

After the stress fracture healed and I was able to train again, I still had the torn labrum, even though I didn’t know it. What he found during surgery was that there was a lot of beat up cartilage. That was probably due to me riding on the tear. The doctor showed me all of the damage on the pictures (which looked like cloudy planets), and it was pretty severe.

What’s interesting is that the torn labrum wasn’t the cause of any the pain. The labrum does not have any sensation. It cannot breath, and that is why it can only be healed with surgery. The pain was all the cartilage damage, and that would reoccur later.

As I continued training and riding harder, the popping would be more frequent. At times it would hurt quite awhile after. At some point in September, anytime I tried to ride, it was pure pain. It felt like I had a pebble in my hip, and the strongest of the strongest could not have ridden through this. Now I know why.

Remember that this is an unscientific description, and I’m translating what the doctor told me that I barely understand. Somehow because of the bad cartilage, the torn labrum and the instability of the bone, things became out of alignment. It caused a pinching every time I moved my hip flexor. That meant with every pedal stroke, it would pinch. The more I pedaled, the more it would hurt.. It came to a point that after every ride, I would have to take a few days off just to let the pain subside. Then I would ride again, hoping it had healed, and repeat the cycle of pain.

The pain became so bad that I had to get off the bike completely and walk with a cane for the majority of the winter. If I walked regularly, I would engage the hip flexor and feel pain. I had two cortisone shot and one iliopsoas shot, neither of which gave me any relief.

When the surgeon found the tear, he had to make a tough decision. Would he debride or repair? He decided to debride, which means he removed the part of the labrum that was torn. I wish I had a say in the matter, because I would have asked him to repair it. He expects me to make a full recovery, but whether I can achieve the same athleticism that I had before and more, is still up in the air. Without a full labrum, I could be susceptible to the same sort of problems (stress fractures) that I had before. Or maybe not. It depends on a lot of things, and that’s a conversation we still need to have. Right now it is about recovery.

I mentioned already that he performed a microfracture on my hip. That means he broke the bones so that my labrum would heal correctly. As he subtly put it, “we poked a few small holes in you.” He also performed what’s called a chondroplasty, which is pretty much like the microfracture, but instead of breaking the bone, he dug in and broke the cartilage.

The bone and the cartilage will normally take 8 weeks to heal. Right now I’m at 6.5 and I’ve made improvements, but the challenge is that it is difficult to not bear weight on a hip. Even when sitting down, I am putting a little bit of weight there. A few weeks ago it seemed I was ahead of schedule. As of now, it feels like I’m behind, so it could be another few weeks on crutches. The great thing is that the doctor thinks my body has healed enough for me to take anti-inflammatory drugs, which make a world of difference.

At this point, recovery is up in the air until the surgery wounds heal. That’ll probably be the subject of another post that will focus more on the physical therapy techniques to rebuild strength and expectations on when I can return to exercise.

I know this all sounds like a downer, and I’ll admit that it has been trying on my patience, but I’ve actually enjoyed my downtime. I have dedicated my time to some other interests, and found that being a couch potato is not all that bad. I just have to keep reminding myself that this is temporary, and that soon enough, maybe sooner than I think, I’ll be back out there.


Successful Hip Arthroscopy

Chilling before surgery.

Chilling before surgery.

Doctor Guy visited me before the operation to chat about how things were going, what to expect, and so forth. He asked how I was doing, and I told him that to my surprise, I had felt a little better these last couple days. I even wondered if maybe rest was helping heal whatever condition I had.

He told me that there was still an option to back out. I could still leave if I wanted. I seriously considered it. I even asked him what he would do in my shoes. He didn’t answer that (and frankly, he couldn’t), but he did get into specifics about possible outcomes. My main concern was that they would find nothing, and I would be spending a lot of money and pain for nothing.

Ultimately I did not take the door. That was the right decision. If I had left, I probably would have started riding again, and the cycle would repeat itself. The solution to this problem was only going to be found in the operating room.

We were pretty convinced that the problem I had was in the hip joint. As he put it, neither of my MRIs were very “exciting,” but they might not always show everything. If they found a tear, they would either repair or debride. Even if they didn’t find anything, they would still do the iliopsoas release where they trim the tendon to relieve me of the clicking and popping. That set my mind at ease. Even if they found nothing, there was going to be a surgical fix.

I gulped and said, “Let’s do it.”

Hours later, there were a lot of people yelling at me to wake up. I was disoriented, temporarily forgetting where I was. As they wheeled me through the hospital, I found myself telling people “good morning” as we passed by.

I would later learn that I had a labral tear and they had fixed it with debridement. Doctor Guy spoke extensively with my wife, even showing her pictures, which she translated for me.

During their first pass through the labrum, they didn’t see anything. As they delved deeper, they finally found the tear. Dr. Guy said that if I were younger, in my 20s, he would have repaired it. Instead, he debrided, removing damaged cartilage. He felt that this was the cause of all of my pain, all of the popping, and this should fix the problem. There was no need to do anything with the iliopsoas.

As I slowly came out of my fog and realized what had happened, I was thrilled. This was the cause of all of these problems over the last 17-months, and they would be no more. In the back of my mind, there was a worry that I would never ride again. That won’t be the case.

This was almost the best possible outcome of surgery. Even though today I’m in a little pain because of the surgery, I can tell that it is different. Even today, it is less painful than the worst days living with the injury. Before I felt like there was always something in there, like a big walnut as my anesthesiologist said, who was also dealing with a torn labrum of his own. That feeling is gone, and I couldn’t be happier.

As I understand it, there are advantages and disadvantages of the debridement. The best part is that this will be the quickest recovery, possibly even 3 weeks. Repair or release would have been at least 4-6 weeks. The downside is that this was not a total fix, and it might limit me my physical capacity. Or it might not. I may come back stronger than ever. The key is that I WILL come back.

This long nightmare is over. I’ve said this many times before, but I cannot thank all of you readers enough. Having so much positive encouragement and prayers through this blog has made this process so much easier. If not for all the great advice I’ve received, I might have given up long ago.

For now, I will rest. Eventually I will climb.

I feel like shouting from the rooftops! YES!!


All Systems Go

After a slight scare with the weather, my surgery appointment has been confirmed. In fact, it was moved up an hour, which is alright by me. In just a few hours, I’ll head to the hospital and get myself ready.

As I’ve mentioned recently, the rest has done me a little better. Over the last few days I worried that I was healing and this surgery was going to be unnecessary. Yesterday I felt so much better that I hardly even noticed the hip. Just to make sure, I busted out the mountain bike and took it out for a spin.

Despite the sub-40 degree temperature, it felt great riding around the melting snow. If I was going to ride a mile, this was the day to do it.

The hip did not bother me whatsoever on the ride. It actually felt pretty good. My heart, on the other hand, was going bonkers. I really have lost a ton of fitness. I arrived back home feeling alright, but winded.

As I cooled down, the hip started to get tight again. A slight burning soreness developed, just like what I’ve been dealing with for these many months. If I had kept riding a few more miles, I would have been right back where I was a few months ago — sitting on the couch on a lot of pain.

Something is still amiss down there, and I’m glad that I had the chance to re-confirm the need for surgery.

Rather than indulge in the steak dinner I’d been hoping for, we instead chose a plentiful but digestible meal of Mediterranean fare last night. A plateload of hummus, tabouli, feta and falafel filled me up for the evening, and will hopefully keep the nausea at bay later today. I also had a Clif bar just before bed.

The hope was that I would sleep in, and wake up just before surgery. Sleep happened without issue, thankfully, but sleeping in was not to be. I woke up the same time I normally do for work, which is early, well before the crack of dawn. I had a black cup of coffee, and that’ll be it until I leave the hospital.

I expected to be nervous, and maybe I will be as I get closer to the appointment, but this morning I’m pretty chill. I’m going to watch an old, quiet movie to pass some time, and then get going.

Here goes nothing.


Snowpocalypse, 2014

photo-7

Forgive me, but I need to start this post out with a rant.

I went to High School in Atlanta and still have many friends and family who live there. Yesterday they received somewhere around 1-2 inches of snow and ice. Even though there was a forecast for snow, they had not taken precautions. When the snow came, it hit harder and earlier than expected. Thousands of people tried to commute home, only to face endless gridlock traffic. There are hundreds of horror stories, many of which can be found at this Facebook page.

This is ridiculous and unforgiveable. A lot of people make fun of the southeast for closing schools and government buildings when there is merely the threat of snow. This is why. Southeastern cities are simply unprepared for such conditions. The city of Atlanta should be ashamed for how it has handled this crisis.

My Mother was at a luncheon in Atlanta. She left in the midst of the storm at around 12:30pm, about the same time that this above photo was taken (credit James Tobias).

We had texted back and forth. She was telling me how bad it was. Knowing that the system was headed eastward, she warned me to stay off the roads. Even though the forecast showed the snow wouldn’t get to Columbia for an hour or two, I decided not to take chances and went home. I watched the radar as it moved along, and was surprised to see that it split up as it reached the midlands. We had a few instances of sleet in the afternoon, but the big snow would come much later.

1609641_10203189439280889_1033027473_n

My mother got stuck in the Atlanta traffic for hours and hours. We spoke in the evening, and she had only traveled a few hundred feet in an hour. At 10pm, she was about 3-4 miles away from home. I fell asleep, only to wake up a few hours later to see her text at 2am. She made it to a BP station about a mile from her house, which was as far as she could go. She spent the night there, got about an hour or two of sleep before trying again. She made it to a Starbucks that was literally up the hill from her road, but again, that was as far as she could get. As I’m writing, that’s where she still is, stuck in her car in 14 degree temperatures.

As difficult as it was for my mother, it was far worse for others. Some are still stuck in their cars without food or bathroom facilities. I’m not sure how to put this delicately, but, people have been creative on how to handle their … digestive system.

My mother is going to be okay, even if not entirely comfortable. She’ll probably get a lift home from an all-terrain vehicle at some point. Worst case is that she has to wait a few hours for the sun to come out and melt the ice and snow. She has been able to eat and drink.

Edit: she finally found a Good Samaritan to give her a ride home around 9am. Phew!

Back to me. Remember that I have surgery scheduled for Friday? My concern is that the appointment could be in jeopardy.

We got about three inches here overnight, with a base layer of ice, maybe a quarter of an inch or so. I can tell by looking outside that there will be no driving to work or anywhere else. Temperatures will barely exceed freezing today, so that ice is most likely not going to melt much, if at all. Tomorrow promises to be a little warmer, not much. Some news anchors have speculated that the snow will not be melted completely until Friday afternoon.

That’s my worry. If road conditions have not improved in the next 24 hours, my surgery could be canceled or at least postponed. I’m crossing my fingers. If it is postponed, then it’ll have to wait at least a few weeks. We have some plans in mid-February that we cannot get out of. It would have been a struggle in my 3rd week of recovery, but manageable. It would be impossible in my 2nd week of recovery. The worst case scenario is that my surgery takes place in late February.

So for now, I’m just going to enjoy the day, maybe two, and hope for the best.

For all my friends and readers in the southeast, I implore you to stay indoors, be careful and not take any chances. There may not be a lot of snow on the ground, but from what I can tell, driving is dangerous.


5 Days Out: The Pre-Op Phase

It’s hard to believe that I’m a mere 5-days away from going under the knife. As I mentioned in my last post, I am still apprehensive and nervous, yet also eagerly awaiting it. This has been a 17-month mystery that should finally get solved next week.

As anyone who has been through surgery knows, it takes a lot of preparation. I’ve talked with a number of nurses and physician’s assistants, received detailed instructions, filled out some forms, and asked a lot of questions. Most of the details have been mundane, like where to park and enter the hospital. Others have been more interesting, like trying to figure out what pants to wear to surgery, since they will have to be big enough to accommodate wound dressing on the way out. We’ve settled on loosely fitting sweat shorts.

I’ve received a lot of invaluable advice from friends. The best has come from a co-worker, Beth, who also happens to be a cancer survivor. She’s navigated the medical system more than anyone I know, and has been forthcoming with her advice. My condition pales in comparison to what she’s been through, but the advice has helped immensely. In our medical system, the type of care you get depends on how prepared you are as a patient. She has helped me ask the right questions, and to get mentally prepared for what’s to come.

Oddly enough, over the last week, the hip has felt better than it has in months. It still cracks and pops on rare occasion, but the constant burning has not been there. It has calmed down enough to make me question surgery. Then, when I think about what would happen if I tried riding, running or even walking extensively, I would be back to square one, back to the painful immobility that has plagued me these last 5-months.

During the last five days, I have to stop taking my anti-inflammatory medicine. That begins today and I can already tell that the injury is still there, and it might become more painful in the upcoming days leading up to surgery. Medicine can mask a lot of things.

In my last post, I said I was going to have a steak dinner the evening before surgery. Many people, including the nurses, warned me to change plans. Instead I am going on a healthy diet with lots of fruits and vegetables. Apparently this will help my body with recovery. I can eat a little more the night before since there will be a 12-hour period with no eating whatsoever, but it has to be healthy and digestible. We’ve settled on one of our favorite local Mediterranean spots.

Recovery is a mystery because it depends on what they repair. We know there will be a long period of no weight bearing, possibly around six weeks, hopefully not longer. There should be a good bit of physical therapy, but that has yet to be scheduled. I’ll be traveling to Los Angeles the third week of recovery, which will be an ordeal, but it’s for something I cannot miss. Too bad I cannot bring my bike.

This will probably be my last post on this side of surgery. When I come out of surgery, I’ll be in a lot of pain and heavily medicated, plus I may not know anything until the follow-up appointment.

Thanks for all the encouraging and supportive comments and emails. They have meant a lot.