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Saturday, August 1, 2015

Post-op update: give me back my broken parts

   Well, I had a good 30 year run of no major dental work, no acutely broken bones, no surgeries, and never even taking painkillers for anything.  I guess that's a good enough track record, given that I've spent ~25 years in organized sports of some sort.  Then I turned 30 on 9/29.  On 10/1, dental implant #1 went in; on 10/29, it fell out (1+29=30).  11/30 was my crash.  I was sick on 12/30.  Dental implant #2 went in on 3/30.  5/30 was the last long bike/run I did before the ominous hip pain started.  Then, yesterday, 7/30, I had my hip scoped.  Thankfully, there's only one more 30 in a month before I turn 31 (which gives me a little pause, because Dave is racing Muskoka that day-hopefully he'll turn this stretch around).

  Anyways.  That surgery thing.  As I mentioned in my last post, I'd had all of the hip imaging done, and was waiting on one final step to try to figure out if my pain was intra-articular or extra-articular.  I'll take a step back first, though, and sort of explain how I went from planning a season one second to on the operating table the next (well, trust me, it did not seem NEARLY that fast to me).  As I had previously mentioned, a few days before Keuka, I started feeling some deep, sharp pain in the front of my right hip/groin area after a run.  Had I had this type of pain before?  Well, yes, it mimicked the pain that I'd had with the acetabular fracture early on in this whole game.  The pain kept worsening, though.  It hurt with impact and stair climbing, and it got bad-bad to the point where I couldn't run a step without sharp pains, and bad to the point where I was again laying awake at night, worrying.  X-rays showed nothing.  A follow-up pelvic MRI showed that the fracture line at my ischial tuberosity was still there to some degree, but that didn't explain my newer pain.  Knowing that injury to the hip labrum and other joint structures wouldn't show up on a standard MRI, I wasn't satisfied that this was nothing, so off to the hip orthopedist I went.
Post-Keuka coach/athlete beer hand off.  Had I know what was going on with that hip, I would have finished the darn can instead of the cool down  Photo courtesy of Alex Tong.
  As the doctor had explained it, because my fractures were all on the non-impact side of my pelvis, they were caused by the ball of my hip joint smashing into the socket.  Before bone hit bone, it had to go through cartilage and labrum.  Therefore, a fairly significant chance of damage to those structures existed.  It could seem strange on the surface that the pain had taken so long to set in, but several factors went into that.  Early on, I would have had no way of distinguishing hip joint pain vs. fracture pain, and I'd been so immobile in that time, anyways.  Looking back, when I'd done some cross country skiing over the winter, that had been the main area that had bothered me afterwards, even though that was the first fracture pain to dissipate.  I'd felt pain there in my first few runs, before promptly hurting my foot and being away from running for another couple of weeks.  I then took lots of anti-inflammatories for the foot, which I had stopped taking about a week or two before the hip pain started in earnest.  I had just done my first 100mi ride outdoors in ages, and being down in the bars impinges the hip more.  Most notably, I was finally running somewhat consistently with a reasonable build, and I was getting into better shape and running a bit more quickly as a result.  Unfortunately, it all added up just a bit too well.
The moment in Mexico when I realized that the non-impact side didn't want to accept weight.  Oh, poor clueless Jennie.
  The longest, most torturous step of it all for me was waiting to get the MRI with contrast.  That suggested a labral tear, but things still weren't necessarily a clear-cut joint problem.  So, I went into the doctor's office soon after getting those results (lucked out with a cancellation on that one), and had lidocaine injected into my joint.  From there, I went over to the PT department to perform some "functional tasks"-running a bit, hopping, step downs, etc.  The criteria for surgery was 50% better.  If enough of my pain was relieved by in essence numbing up the joint, that would mean that a significant enough portion of my pain was due to joint damage.  So, functional testing it was.  Some of the tasks were a little hard for me to tell-I don't ever exactly hop around on one foot or do many cutting movements (as demonstrated by my coordination), so I had no basis for comparison.  Running felt ok, though-50% better from how it had felt earlier that day when I'd done a few 100-200m test jogs in the woods with the dogs that morning seemed about right.  Most telling was afterwards, though.  By that point, due to decreased training, my symptoms with walking, stairs, etc had calmed down somewhat, but I was still getting what I referred to as an "ice pick stabbing my groin" whenever I sat for more than a few minutes, especially after heavier activity.  After the injection, though, I went and sat doing work for a little while with absolutely no pain.  I then went home and hopped onto my bike for half an hour, hammering out some intensity in aero, standing, etc, and that was also significantly better.

   So, as instructed, I contacted Dr. Giordano afterwards, and we agreed that it sounded like I was, in fact, a surgical candidate.  I should add that I have been very fortunate in getting in with the right doctor and medical team right off the bat here-Dr. Giordano is the go-to doctor around here for athletic hip injuries (working with several of the area local pro sports teams as well), and I have been impressed with not just his knowledge of the kind of injuries I had, but also his immediate understanding of the type of functional level I'm going for here.  He was to the point, and he gave me a pretty clear picture of what could be going on, and what recovery would entail, which was refreshing after all of the uncertainty of everything up to that point.  Given the overall timeline of my recovery last winter (three weeks away from everything, four or five weeks until I started easy recumbent biking, eight weeks until I got on a "real" bike, four months off of running, and strengthening/rehabbing the hip the entire time), I'd basically already done everything that could be done conservatively for a joint/labral injury.  If it was hurting to the point where I couldn't run after working up to 25mi/week and actually biking in aero here and there (something I couldn't do all winter due to sacral pain), full IM training without getting things fixed in there likely wasn't happening.  After all of this time, too, I was ok with that-I can concede this year, but I didn't want to risk bleeding this too far into next year.

  So, before I knew it, I was scheduling surgery.  Again, after eight months of being injured and in some degree of pain daily, I really just wanted to get it over with and get on the road to full recovery.  I told the receptionist that I wanted first available, and stood there and braced myself on the other end of the line, fully expecting to hear a date that would seem WAY too far in the future (I was thinking MAYBE late August), so when she said 7/30 (1.5 weeks from when I was called), I thanked my lucky stars and jumped on it, even though it meant that Dave and I had to rearrange some plans.  But, priority #1 was just getting the damn thing fixed as soon as I could.  Quite honestly, I was very much over everything.  I'd continued to swim and bike throughout the entire time of diagnosis and planning, but my efforts had been less than inspired, with more than just a little bit of going through the motions going on.  In a display of the effects of stress on the immune system, I'd picked up a couple of little infections along the way, and had really just lacked any sort of major mental fortitude to push through things like I normally would.  Still, I'd had a few days that suggested that there was some fitness left in my, so I felt ok enough going into surgery not really in great shape, but not totally out of shape, either.
I have to fill out this little health questionnaire every time I go in, and this question always makes me laugh a little bit.  According to my bank account after eight months of medical testing and no racing....hmm.

Sh!t got real.  I think the pre-op appointment people expected me to be a little more upset that I couldn't shower for a few days post-op.  Luckily, this is standard weekend fare for me.
  And, oh yeah, Dave had a little race in there-Ironman Lake Placid.  To be up in the place of some of my highest athletic highs at a fairly low pre-op point...well, I can't say that it was easy.  I had more than one emotional breakdown.  Thankfully, I had a crew up there, with Alexa in particular taking the award for the sarcastic friend that kept me laughing and distracted all weekend.  We even took a few hours on Saturday afternoon to decompress and hike up a mountain, which was a really fun way to enjoy the ability to be active for a few more days.  As for Dave?  Well, he swam reasonably (not as well as he wanted, but within a couple of minutes of that), performed his normal crushing of the bike course, and then, well, Dave hadn't been running much due to various foot/shin/hip/crash (we're awesome) injuries, so his run wasn't exactly pretty (GI issues included, as well).  He did give us a moment of excitement coming off of the bike in second overall and maintaining top 10-ish through halfway.  The good news there is that he's recovering well, should be able to get in some run training now, and has another shot at Muskoka in not much time, a course that plays nicely into his strengths as a strong cyclist who does better in normally cooler conditions.  Anyways.
Given I'm relying on him to carry absolutely everything for me right now, maybe I should have made an effort to actually push his bike to transition.  Nah.

Alexa and I at the top of Cascade!  

And a different view.  For the record, I found websites saying that experienced hikers should make it up in 1.5-2hrs.  We made it in 1:13, with my busted hip and both of our low grade infections to boot.

Rolling swim start!  First time I've actually gotten to watch one, pretty interesting stuff.

Dave in his element

Dave no longer in his element...but hey, at least one Hansen had a lead cyclist for a bit!
   So, back to Rochester and onto surgery week it was.  Maybe I use up all my nerves when it comes to racing, maybe I was just too numb to care anymore, maybe it was the memory of how much everything had hurt after Coz, maybe anger was taking over, or maybe it was just the level of comfort I had finally having some sort of more concrete timeline to recovery after months in limbo, but I stayed pretty calm heading in.  The whole surgery experience itself was fine.  The nurses were very nice (and skilled at IV placement), Dave hung out with me beforehand, the doctor came in and signed my leg, and (which is still bizarre to me) in what seemed like the next instant, I was waking up and people were telling me that I was done.  If I said anything embarrassing while being put under (which was a concern of mine), well, I don't know about it anyways.  Dr. Giordano popped in and told me that he had done a  labral repair (according to Dave, he said there was more than one tear), cleaned out some scar tissue and adhesions that had built up in my cartilage and joint capsule, and shaved down some impinging bone.  Being me, I'd had concerns going into surgery that absolutely nothing was wrong with my joint and that I was just insane because after almost two months off of running, it didn't hurt as badly anymore, so I was weirdly relieved to hear that I actually had been fixed up.  I'll find out a little more about what exactly went on in a little over a week when I go in for my post-op visit (including possible pictures and video, which excites me a little too much).
Hansen interactions remained entirely normal right up until the time of surgery
Drugged up thumbs-up for Dave, American edition.  Smile looks more defeated by this point.

Not quite as drugged up thumbs-up for Dave, throwback Mexican edition.  Smile was more optimistic here.  Again, poor clueless Jennie.

  For now, I'm a couple weeks on crutches with toe-down weight bearing, and I'm being a good PT patient, sticking to my post-op exercises, sleeping in some awful brace thing (it's mostly the sleeping on the back part, which I hate), and getting in my "tummy time" (as we called it at work, which normally results in napping).  If nothing else, I'm discovering that no, these exercises actually aren't too easy post-op-it's certainly a really interesting shift in perspective for me.  I was allowed onto the bike with minimal resistance just to move the leg around a bit today, which was nice.  I'm not supposed to bend my hip to more than 90 degrees, which makes moving around, dressing, etc interesting, if a bit frustrating at times, but luckily this is only a week-long restriction.  Dave is, of course, enjoying having to carry everything for me :).  Pain-wise, the first few hours post-op were a little rough, but since then I've been well-controlled (and off meds for almost a day now), which encourages me in terms of surgical success.  The swelling is currently putting any sort of post-IM fluid retention to shame (I'm up ~12lbs with a fantastically large thigh), but it's been just over two days, so I wouldn't expect anything different.  I've also been varying degrees of groggy/drowsy/uncharacteristically appetite-less, but again, two days isn't a whole lot of time to reset any of that, either.
This was before the swelling even peaked.  Attractive.

This has to be the least comfortable thing in the history of the universe to sleep in, especially because I DESPISE sleeping on my back.  Not to mention, I can't really get into or out of it independently with the hip ROM restrictions.  I made it until 5am this morning before busting out of it Forrest Gump style, coming downstairs, and promptly falling asleep on my stomach.   Whatever.  Tummy time.

~20W bike ride!
  In terms of "real" training-I'll have to let the incisions heal for a couple of weeks before I can get back into the pool (which is sort of ok with me, all of the swimming with no racing was starting to burn me out a bit), and I'll see with biking.  I'll start on the underwater treadmill in rehab after a couple of weeks.  Again, the timeline to return is actually shorter than what I dealt with this winter (I mean, I at least sat on my bike today!!), and although I never really got a chance to show it before being taken out again, I know that I was able to regain my fitness after that, so I'm trying to keep some semblance of optimism (although some may beg to differ with that statement...).  Is part of me pretty damn scared that I'm in essence about to go an entire year without running?   Do I worry what having zero run base to rely on at this point is going to do to me?  Well, of course I do.  But, I can't control that right now.  One step at a time.  Again, thanks to everyone who has sent me messages, likes, tweets, comments, emails, etc of support when going through this!!  I've read them all, even if I haven't been cognizant enough to respond to everything yet :).  It's been a longer road than I ever could have anticipated when I was in a Mexican hospital, still beating myself up over a DNF, and although I've had plenty of moments of doubting my ability to ever compete at a high level again, my desire to do so hasn't changed a bit, and I fully intend to do everything in my power to get back there.  At this point, I'll take things as they come, but at least I feel like I'm actually in the final step of this particular mess!  It's not all bad, at least I'm getting a chance to, well, fully relax, and Dave and I are spending more time together (for better or worse :) ) than we've gotten to in ages.  I understand that I need to resist my normal urge to work through pain, but I'm not going to baby myself over it all either.  Thanks for all of the continued support and belief from my family, friends, coach, teammates, "fans", etc-nothing is better than knowing that others aren't going to give up on me and kick me to the curb quite yet :)
We actually used to crochet a bunch on the xc/track bus in college (because we were awesome), so I figured I'd pick it back up in this time.  I made a penguin so far.   Highly skilled, and obviously very practical.

Obligatory dog conclusion picture.  The Moose looks cute when she begs.

The Bailey looks lazy when she begs, although it could be argued that she's 100% my current spirit animal in this picture

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