Wednesday, May 23, 2012

Everyone needs a crutch.

Everyone needs a crutch…quite literally in my case.

This past weekend was my first weekend “on crutches.” At my appointment with Dr. Kim on May 4th, he suggested that I start using crutches when I do any significant amount of walking. When he first said this to me…I was taken aback and actually pretty upset. He says that using the crutches, or a cane for short distances, will help me get used to using them for when I need them all the time after the surgery (post-surgery I will be non-weight bearing for 3-6 months). Dr. K also said using these will help me to reduce fatigue in the joint and allow the inflammation in my labrum to subside. Dr. K said he wants me to be completely pain free going into the surgery in the fall.
Listen, I get it…a lot of people have serious injuries that are a lot worse than mine…life-changing injuries/deformities that don’t allow them to ever walk the same, or ever walk again, period. So, please don’t take this the wrong way. I’m not saying this is HORRIBLE or the worst thing that could ever happen. But it IS happening…and it IS a prohibitive deformity. 

Here’s the thing…I am the definition of a DO-ER. I can’t sit still for five minutes. I work 40+ hours a week, I play volleyball at least once, sometimes twice a week, I Co-Chair the local Relay For Life and on Sunday’s I volunteer at the local zoo. My husband and I are lucky if we get to spend one night a week together. But that’s how I am…I thrive on being busy. I’m also proud and very stubborn.
This is now the first time where I really HAVE to slow down because of my hip. It’s my first real speed bump. Playing less volleyball was bothersome, but I can deal with it because I still can play sometimes. Not wearing high heels anymore doesn’t really bother me because I didn’t like them in the first place. And I’ve been walking with a limp for so long that I don’t even realize I do it anymore. But walking with crutches is a bit (here’s that word again) discouraging. It’s cumbersome, and awkward. People stare at you, they pity you, and worse, they go out of their way to help you. It’s a bit of a blow to the ego and the pride. It’s embarrassing. I know people are just being nice, (and honestly, thank GOD they hold the door for me because I really don’t know how I’d get it if they didn’t) but it’s discouraging to know that the person holding the door, or letting me cut them in line, is doing it because they feel bad for me. 
And when I use the cane it’s even WORSE. Kids stop dead in their tracks and stare at me. They ask their parents “How come she has that?” and “What’s wrong with her?” Awesome. I know they don’t know any better, I’m not upset with the kids…it’s just that this whole thing is going to be a serious adjustment. And it’s only just beginning.
With all of that being said…and I hate to admit this…the freaking things help me so much. My hip felt glorious after the whole day of being on the crutches. At the end of the day on Saturday, my husband gave me the “I told you so” look, which is my least favorite look in the whole wide world, especially from him. Saturday morning, just thinking of everything we needed to do made my hip hurt. Our schedule on Saturday consisted of the following: Out for breakfast, Anne and Hope, a Target trip, Harbor Freight Tools, Christmas Tree Shop, and Lowes. The amount of walking we did at Anne and Hope, on a normal day, would have benched me for the rest of the day, walking wise. However, I did ALL of that…and then I went home and planted 14 flower pots and 4 window boxes! I felt GREAT. And just for comparison: I worked at the zoo the next day and an hour into my shift I was limping and having a hard time.

I think my biggest mental roadblock, when it comes to the crutches, is that I've spent so much of my life telling myself that nothing's wrong and that I can just continue to go about my business like there's no issue. Just something I can continue on with, and it's no big deal. Even with the pain, I was okay with that because I didn't have to admit that I have any kind of disability, or problem. This is really the first time that I feel like what I have going on really IS a big deal. It's hard to come to terms with something like this when you've spent so much of your time trying to tell yourself it's nothing. I hate complaining about something as silly as using crutches, but deep down it’s NOT the crutches I’m upset about, it’s the fact that this really is happening…and that I really do need to face this issue. It’s the “What’s wrong?” questions, the “Why are you using a cane?” questions that bother me…because then I dive into the whole ordeal instead of just ignoring it.

So, I’m starting to come to terms with everything, and in the grand scheme of things I know that I am lucky that this is all that I have. I could have serious, life-threatening issues. I’m lucky to be happy and healthy with a good family who loves me. However, after this weekend, it’s becoming more and more clear to me that this is whole journey is going to be more complicated than I thought…emotionally and physically.

Saturday, May 5, 2012

Whad'dya need ta know about PAO?

Hello, again!,
I went to Massachusetts General Hospital yesterday and met with Dr. Kim for a second opinion on my DDH. In short…he told me that Dr. Schiller’s recommendations were correct. That I absolutely do need PAO, and the sooner I get it, the better.
Dr. K gave me some great information. He explained to me that PAO is one of the rare circumstances that they suggest you go through with the surgery BEFORE you are experiencing any hip pain at all (currently, all of the pain I feel is from the tears in my hip labrum), that is because the philosophy with this type of deformity is that you “go into surgery without pain, come out without pain.” Essentially, if you’re already having joint pain before you have anything done, chances are you’re going to come out of the surgery with pain, the damage has already been done.
I came out of there feeling like this is definitely something that I do HAVE to have done, and that it is the right incision…I mean decision (see what I did there? Gotta keep the mood light).

I thought that this would be a good time to show you exactly what is wrong with my hip, and how they are going to fix it. I’m going to attach my actual medical imaging, and try and compare it to my normal hip so you can see what is going on. I’ll then explain to you, in as much detail as I have, what Dr. S will be doing to fix my hip deformity. 

So, first off, here is a series of imaging of my hip. I’ll try to explain what they are as I show them.

 This is an x-ray of both hips. It shows a mostly normal left hip, and my sad right hip. 

To the left is an image in a 3D CT Scan of my right hip. This view is posterior, or from the back. Here you can see what is the proper coverage of the femoral head.

Now, this is the front of my hip socket. You can see how much coverage I'm lacking on both the top of the femoral head and also in front. I have less than 45-50% coverage.

 This one is just an extra view from the 3D CT Scan, which blew my mind. This is looking from INSIDE my pelvis, out towards the joint. See how I've got pretty good coverage in the back part of the joint, but the front part of the joint is really crappy looking.

The opposite angle from above. Mostly I posted these because I think they are crazy. The imaging that they can do today boggles my mind!
Additionally, I have labral tears in my joint. This is really common in DDH patients. But the MRI is awesome, so I thought I'd post it. This picture is if you're looking from the top looking down, into the hip joint. The circle in the middle is my femoral head.

 How do you fix this? Well, obviously PAO. So, I've inserted some information from a really great website who describes in regular people language...instead of doctor-speak.

 "This surgery involves cutting the pelvis around the hip joint and shifting it into a better position to support the stresses of walking (OR volleyball...okay the website didn't say this...but I did!). After the hip is re-positioned, it is held in place with screws until the bone heals. After the bone heals, the screws can be removed, but this is not usually necessary."
-Hip Preservation Surgery for Adult Hip Dysplasia

That makes it sound sooooo easy, doesn't it? They also had these neat looking little diagrams:

So, that is that! It's looking like I will be having the surgery sometime this fall. Probably October/November. In the meantime, Dr. Kim suggested yesterday that I start using crutches when I can to try and get my pain under control. The idea is to reduce usage which will reduce inflammation in my labrum, therefore reducing my pain. He said the best condition to be in when going into the surgery is to go in without any pain. While I'm under for the PAO, they will also be attempting to fix the labral tears. It will depend on what they find when they get in there. 

From here, I'll post as I learn new things and go through the process of getting ready for surgery. 

Thanks for reading! Please feel free to post any questions you have and I'll try to answer them as best that I can. 

 Your gimpy friend,