Tuesday, January 15, 2008

Do you research your injuries/surgeon?

It's funny, for someone who had never heard of a labral tear before, I think I could almost qualify as an expert now. I researched the hell out of it before having my surgery, and had my surgeon vetted like no one has ever done before. After that, I started getting emails from all over, and I mean other countries from people who were scared to death who couldn't be sure of what to do. Having your hip dislocated to do arthroscopy is not something to do on a whim. Trust me on this.

I'm still getting emails from people and most of the time I have no idea how they got my name. A nice guy emailed me this morning from something that I said on Slowtwitch.com. I wish I had been as thorough as he is on this stuff!

Just in case you ever need to have something done, here is what I would call the blueprint of an athletes questionaire before having surgery... If you are going to ask someone a question do it right!

from my email back to Jay...

Hey Jay. I had the same level of frustration as you. In fact, this surgery scared me so much that I went out of network on my insurance to have it done. I’m going to be paying for awhile (4500 out of network max) but I’m really happy that I did what I did. The problem I think is less about the surgery than dislocating your hip and the damage that that does. My doc told me that the dislocation and positioning took 1 hr 45 minutes and the surgery 15 minutes. He specializes in shoulder tears, but has done a bunch of cyclists hips here. (Why cyclists….)

I would tell you that Runnersworld.com has an injury forum. Its very scary. You’ll see Philpons name come up a lot, and maybe its just because he does a bunch of these surgeries, but he seems to have a lot of problems.

My doc was Geoff Higgs at Advanced Ortho in Richmond, VA. I hear great things about Dr Kelly in Boston or NY.

Oh, and if I had my way (and I always do…) it seems to me that removing the tear results in better healing than repairing the tear.

1.) Your age: 42
2.) Was your tear a result of an acute traumatic incident, or did symptoms appear gradually? Appeared gradually and then became acute. I had problems running that happened about age 35 that I thought was an si joint problem or psoas and my hip would rotate. I’m not sure if this led to the tear, or if the tear led to this.
3.) What were your primary symptoms? Weakness in the left leg, leg would go numb while climbing on the bike, and go completely numb running up hill. At the end sitting was so painful that I could only sit 15 min +- before having to get up and stretch.
4.) How severe were your symptoms (1-10, 1 being mild discomfort, 10 being the worst imaginable pain)? I’m a cyclist so that’s not a fair question. Sitting was intolerable, so I’d rate that a 7. The rest I could ignore if I chose to.
5.) How long did you have symptoms before you decided upon surgery? Years, but once it got really bad I needed to get it done quickly.
6.) What made you sure your symptoms were a result of a labral tear and/or FAI?
7.) How long ago was your surgery? April 2007
8.) Why did you decide upon surgery? After my diagnosis I did research and determined that what I had been doing was not working. I’m getting to old to pussy foot around!
9.) What alternatives to surgery did you consider or had you heard about? I did a LOT of Active Isolated Stretching. It would help for a day or two, but I can honestly say that it was not going to be a long term solution. That said, I think all that pre-surgery work that I did payed off big time in how quickly I recovered! AIS is GREAT
10.) What alternatives to surgery did you try, and what were the outcomes? See above
11.) Did you have a cortisone injection into the joint and what was the result? I had lidocane with the MRI which helped for about a week.
12.) Doctor who did the surgery: Geoff Higgs, Advanced Ortho.
13.) What was the success rate your primary doctor indicated to you? He told me that all the surgeries that he had done had been well received by the patient, and he had had no adverse problems to date, but that he knew that many doctors did. (we discussed this in great detail.)
14.) What was the success rate you surgeon indicated to you? No numbers
15.) Did surgery remove or reattach the tear? Remove I insisted
16.) Were you diagnosed with Femoral Acetabular Impingement (FAI)? NO
17.) If so, was it cam- or pincer-impingement? n/a
18.) If so, did you have a procedure to fix the FAI as well?n/a
19.) Any other physical complications involved (FAI, cysts, osteophytes, arthritis, etc)? no
20.) Any complications during the surgery? Yes, I had a spinal as I do not like the affects of general anesthesia. I was unable to feel my crotch for about 2 weeks, had lingering numbness there for two months, and some generalized numbness in my hip and quad (intermittent and more disagreeable than bad) for about 5 months.
21.) Any complications after the surgery? No just the numbness
22.) What was your rehab like? 10 days post surgery I was able to get back on the bike and ride in an easy gear, was up to 7 miles within 4 days and back to riding 30 miles in a month easy. I did go to pt, mostly to get pelvic stability back as I felt that my pelvis would “rock”. Did 4 weeks of pt, 2x a week and had very good results. (mostly on hands and knees and would rock back and forth retraining the pelvis to track properly and some hip flexor strengthening.
23.) How long before any s/b/r? bike in 10 days. Did my first time trial 2 months later. I started running again the end of September as I was cautioned strongly that running was probably not going to be possible. I am running 5 miles easily. (used to be a marathon runner.)
24.) % of normal (pre-injury) you currently are: Probably 80%, and working on the other 20%. This is a long term thing.
25.) % of pre-surgery (with injury) you currently are: light years ahead power wise. I can ride up hill again! Easily a huge improvement
26.) What type of ongoing PT, exercises, management, rehab, etc do you currently do? I really need to do some more AIS to strengthen the area even more and will as soon as I get the bills in order. Other than that I’m just doing normal stretching, and switched my office chair to a balance ball to further strengthen my core muscles.

27.) Are you on pain medication as a result of the injury and/or surgery? No and in fact besides taking 800 mg of motrin, I never took the narcotics that they gave me post surgery. Intense pain is bad, but Id rather have my wits about me.
28.) Would you recommend having surgery to someone in a similar position as you? Yes, with the right surgeon. I think the choice of surgeon is the MOST IMPORTANT THING HERE.
29.) Would you recommend your surgeon? Yes, Geoff Higgs was wonderful and St Francis Hospital was great, clean and well staffed. Went home the same day.
30.) Anything else you want to note about the injury and/or the surgery: I never used my crutches. My doc said to use them as I needed them, but it looked to me that people had problems with adhesion because they did not move their legs enough. So I was walking that day without crutches, went to the US Open bike race the next day and walked 3 blocks. I had the surgery on Friday, and went back to work on Monday. That may have been a bit much, but worked thru lunch and left early the first few days. I also thought the Ice Machine was a waste. They leak. I just had rotating ice packs that I used.
I will tell you that if you run, patience is key. Its not the tear so much it’s the instability in the hip that will get you. I’d really give it 6 mos to get stable before running again. I think that cycling really helped getting everything back in place. Even with that, when I started running again, my forward movement was initially grossly restricted, and I had a “Fred Flintstone” gait. (running in circles w/o forward movement like when they were in the car on the cartoons.) It gets better. I had pelvic pain as well, but I think that was bits of scar tissue breaking up, vs. anything “bone.”

This is scary stuff. But being inactive is NOT an option. Any questions you have just shoot me an email, and I bet Geoff would talk to you. His phone is 804 270 1305.

Best wishes!


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