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Month: August 2016

#projectfemur: my hip is now missing a couple of bits… for the better

My hip/femur is now a few grams lighter. There’s less pain and more mobility. #projectfemur – for now – feels quite a bit better.

Sixteen days ago, Dr. Faucett removed some of the hardware from my January 2014 reconstructive surgery. As I wrote about in my previous post, the screws that bound my femoral head to the rod that aligned my broken femur had made their way into my hip capsule, playing bundles of nerves like a guitar pick on a string.

It was painful, to say the least. Standing up, sitting down, lifting my leg, walking, running, skiing – it all hurt. In the weeks leading into this most recent surgery, even riding my bike was painful. The nerves were so aggravated on a ride one week prior to my surgery that my entire right leg went numb, and I had to ride 25 miles back to DC more-or-less on one leg’s worth of power.

No more screws

Look ma: no more screws!

The surgery was a laparoscopic procedure, minimally invasive. One screw came out without a hitch, while the other brought a bit of dead bone with it on the way out so I wasn’t able to keep it. There was a ton of post-operative swelling: laparoscopy requires a lot of fluid to be flushed through the working area to provide a view for the camera, so the incisions drained for the better part of 30 hours. It was painful at first, and awkward.

But the pain soon subsided (I was off of the opioids within a couple of days, save for a few nights’ worth to aid sleep comfort during the heat wave), the swelling went down, and mobility returned to my leg rather quickly. I’m on a prescription NSAID (Celebrex, FWIW) that’s keeping any latent pain in check, but there isn’t a lot of pain to be found. I was cleared to bear full weight on the leg from the get-go, and graduated from two crutches to one within a week.

So things are better, much better.

However, the nerve pain being greatly reduced shows me how much biomechanical compensation I’ve introduced into my walking over the past year. My right hip flexor, gluteus, adductors, and hamstrings are very weak, and my right abductor is smaller than its left counterpart. In fact, my upper leg is one inch smaller in diameter than the left, and both legs are very lean right now. Below the knee, things are just about equal.

Two legs, two sizes

My legs as of August 31, 2016: one is smaller than the other…

So I know what work I need to do in the next two months: get the right leg back into shape and try to get back some of the flexibility it had before necrosis set in. I know not to expect 100 percent pre-injury mobility, and that even 100 percent pre-injury strength is tough given the femur is still eroding. But getting things into shape, and closer to equilibrium, is key, whether I’m heading into a full ski season this winter or a total hip replacement just after Halloween (the timeline depends on how pain levels even out over the next 4-6 weeks, but I’m optimistic).

Dr. Faucett says it’s now entirely my own timeline to write, and I have a prescription for physical therapy to help along the problem areas. The muscles are already saying “thank you” to me in anticipation.

I’ll be researching orthopedists to do my total hip replacement. I have two primary parameters: the orthopedist must be well versed in revisions of previous hip replacements (i.e. compensating for already-compromised and rebuilt joints), and must be good at rebuilding the hips of impact sport athletes. I will leave no stone unturned in finding the right surgeon and the right replacement hardware for my needs.

Until then, I’m back on the bike, starting tonight at the penultimate “Downtown Breakaway” for the year. It’s a ride I organize every year, and I’ve missed the last two weeks due to the surgery. While I won’t be at 100 percent, it’ll be good to be back out there on two wheels with my friends.

Stay tuned…

#projectfemur turns 2.0: osteonecrosis

I know, I know: it’s been a long while since my last update on… well, anything. For this, I apologize.

Heck, two years ago this week, I went on one of my first club bike rides after my surgery.

First club ride after surgery, August 9, 2014.

It was awesome – as was the 2015 riding season!

During the 2015-16 winter season, I had a really successful alpine ski coaching experience, helping my athletes qualify for elite regional championship competitions.

Coach Rudi at Sunday River, March 2016

That rocked!

But there was a specter lurking in the background. It is a single word:

osteonecrosis

Also known as avascular necrosis, it’s a condition where blood supply gets cut off within a bone, causing the bone to die. It is caused by any number of things, and I’m not sure how I happened to develop it, but it’s there, clear as day, in my femoral head.

Avascular necrosis has taken over my femoral head - not good.

Avascular necrosis has taken over my femoral head – not good.

How did my discovery of this come about?

Let’s do a quick recap:

After my one year surgery anniversary, things were good:

My femoral head, one year after its repair.

My femoral head, one year after its repair.

See that nice, round femoral head? See the clean mending of where I was once broken in two? All good!

I skied in 2014-15. I rode my bike a lot once I was free to ride outdoors. I hiked. I ran.

But then things went off the rails.

Back around Thanksgiving of 2015, I started to feel a bit of pain and catching in my right hip. It was here-and-gone stuff, and while my hip had always been a bit stiff in the morning, until then it had been able to get into the swing of things rather quickly on most days.

But by late November, the pain was more intense, sharper, and sustained. Sure, it would go away after a little while, but sometimes it would just stay there all day. Ibuprofen would calm the pain most of the time, but not all of the time. And I’d get a real nerve pinch down my adductor (I believed this to be a lingering side-effect of tearing said adductor a few years before my femur break).

As the ski season commenced, the pain continued to intensify. When I flew out to Utah for a USSA certification clinic, some of the on-snow exercises were tough to pull off. I noticed a decreasing ability to lift my right leg laterally. Every afternoon after the skiing was over, I’d spend time in the hot tub at my hotel, then stretch to try and loosen my hip, often to only semi-successful levels.

During a bike ride over the Christmas holidays in Connecticut, my right adductor would lock up in a painful way, and my hip would mis-track, causing my entire pedal stroke to degrade into spasmodic chaos – no fun. And a ski camp that occurred immediately thereafter was equally pain-laden, though skiing wasn’t too difficult to pull off without pain.

However, as the ski season continued (I was coaching four days per week all season long, sometimes more during intense racing times, from January through mid-March), the pain grew, the pain medications were less effective, and certain activities required in my work (e.g. having to drive long-ish distances to racing venues, skiing with large, heavy bundles of slalom gates, etc.) became downright excruciating. I’d demonstrate skills to my racers, trying to mask the pain in my expression. I even fell on the screws that attached my femoral head during the initial healing time, which was not pleasant at all, smarting for weeks.

Every day was masked in hip pain that would, at times, radiate down my leg. My walking gait became so labored and awkward that everybody could tell something was wrong. At least on a bike, I could be more-or-less normal, my December pain eventually subsiding as I began to ride more in the spring. But my range of motion in my right leg was compromised, catching in painful ways and making me feel like an old, helpless man.

Eventually, I had to clear things up with my orthopedist. X-rays happened, finding that one of the screws in the femoral head had been knocked through the head, the tip impinging my hip socket and possibly dragging over nerve bundles that travel down my leg. My doctor thought this could be part of the cause of the pain, and said that the screws should come out – a simple outpatient procedure.

My femoral head as of June 2016.

My femoral head as of June 2016.

Worrying both my doctor and me, though, was a random bone fragment that showed itself on another X-ray. As X-rays don’t show things in three dimensions, he ordered a CT scan for my right hip. I had it performed at GW Hospital, in their latest CT scanner (a very quiet machine).

When my doctor called me two days later from an out-of-town conference, I knew things were not good.

He kept it simple: I had osteonecrosis, and am facing total hip replacement.

Fuck. Damn. Shit. Why? How? Fuuuuuuuuck!

I received this news a few days before departing for a week long family vacation at Cape Cod, which left me plenty of time to digest this news and start researching my options. There is a lot to learn about hip replacement, that’s for sure!

The long and short: I’ll get back my leg length and range of motion with any hip replacement method, which is a big plus. The minus is that anything other than basic cruising on alpine skis is highly discouraged, as it can displace, dislocate, or fully break the replacement hip. I hope to speak with some elite ski coaches who have had THR to get their perspectives on living with a replacement hip as a high-level skier.

I’ve since seen a second orthopedist to get a second opinion – major medical things like this should get a second opinion – and he confirmed the same diagnosis as my original doctor. He did, however, recommend having the hardware from #projectfemur removed first (the same thing my original orthopedist recommended), allowing the femur to adjust to a non-titanium-enhanced state and to prevent possible infection of the marrow channel if I get a total hip replacement during the same surgery.

And that’s what I’m going to do this coming Monday, August 15th, with my original doctor, Dr. Faucett, doing the honors. It’s a short, outpatient procedure, and recovery should be fairly quick. Hopefully, getting the screws out of my hip socket will alleviate much of the leg pain I have these days – and it is a lot of pain, lemme tell ‘ya!

But I look forward to this next chapter of #projectfemur – and yes, it’ll need a new hashtag. I’ll figure that out sometime soon.

Once the incisions heal and swelling subsides from this upcoming surgery, I’ll assess my pain levels. And I’m going to keep riding my bike – something that’s encouraged by both doctors to maintain strength and cardiovascular health (trust me, I don’t want another pulmonary embolism or similar issue). I’ll be on crutches for a few days, then a cane, then just plain walking again.

And then the bike – definitely the bike.

It’ll be a minimum of two months before I dive into the more major procedure of total hip replacement. Hopefully I’ll get enough pain relief to delay this until spring of 2017 – and thus will be able to ski and perform my coaching duties more-or-less as usual. If not, surgery will likely happen later in the fall, and I’ll be coaching from a lawn chair. I’m up to the challenge, either way.

But right now my focus is on Monday’s surgery. And I apologize in advance to the ski team’s board of directors: I may be a bit groggy during the evening conference call that evening. Heheheheh…

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