How I Spent My Summer Vacation [Spoiler: Not as planned]

I had some plans this summer. Not a ton of plans, and to be fair the school year had ended in a place that was palpably toxic in very surprising ways, which in turn had an impact on other areas of my life that were not what I would call “ideal”. But still, summer was here and summer is for vacation.

The best laid schemes o’ mice an’ men / Gang aft a-gley.

The Prelude:

After my return from Peru in January of this year I was feeling well pleased with myself having completed the classic Inca Trail route: four days of ups and downs at fairly substantial elevation on a path largely made of (somewhat) set stones (no judgment, they’ve been in place for centuries, so it beats most modern infrastructure I’ve encountered.) I carried my own pack, and felt good the whole way through, which was an accomplishment because I had been worried going into the trek as I have remarkable osteoarthritis for someone my age (I’m told). This inconvenience has most dramatically manifested in my knees, one of which has but remnants of cartilage remaining, and the other only slightly ahead of the game. For those of you in the know about these things, you know that there is little to be done for this condition: stay active, maintain a healthy weight, etc., etc. There are some questionable experimental options that some people swear by (emerging stem cell therapy, for which I am hopeful but not sold on at this point, synovial fluid injections…) but there is not a “fix,” as it were, save for replacing one’s knees (which both my paternal grandfather and father had done bilaterally.) As an aside, I was also showing osteoarthritis in my hips as of 2013, which was getting a bit annoying by 2016. My right hip has tended to get pretty aggravated when hiking (more so even than my attitude) for the last couple of years.

About seven years ago, I had my first cortisone injection in my left knee (the good one!) following an acute problem that had occurred. My knee had locked in virasna toward the end of a yoga class and I was unable to re-extend the knee, landing me in the emergency room in an incredibly awkward position (literally) with no discernible cause via x-ray or physical exam, and so “on the count of three we’re going to straighten it!” Three ER attendants braced me and straightened the leg in a swift, excruciating maneuver that left me dazed, mobile, and basically pain-free. Weird. MRI imaging returned no explanations, and so I got a cortisone shot and carried on.

Oh, and the shot was magical.

In 2015, I had my second cortisone injection, in both knees this time, and again was overjoyed at the results including how the shot seemed to alleviate knee and hip pain. I was feeling right as rain.

I had cortisone injections in both knees right before going to Peru as well, and again was amazed at the outcome. I was ready!

IMG_8390

IMG_9282The trip was spectacular and I felt fit, strong, and healthy.

Then I came home.

Back at work in an incredibly challenging environment (more – much more – on this at some point) and in the post-holiday malaise, I turned to my yoga practice as I often do. The first couple of classes I attended were more challenging than they should have been. It had only been a few weeks since I practiced and I had not been sitting around doing nothing – in fact had even done some yoga in Peru in addition to the more obvious exertion. It seemed odd, but I pressed on. At MLK weekend in Tahoe, I attended a yoga class and was even more hampered. By the end of January it became clear something was amiss. Mobility in my right hip had become so limited yoga was becoming nearly impossible even with substantial modifications. (Like, I could not sit in sukhasana, for example, let alone any sort of movement that required hip rotation or extension.)

I went to see the orthopedic guy I had been seeing and we landed on the same conclusion: hip flexor strain. I got some therapeutic suggestions and anti-inflammatories. I also went to see a chiropractor who specializes his work around yoga practitioners. He was attentive, informative, and couldn’t do much to alleviate my situation in the end. By President’s Day weekend I had developed a limp that I could not avoid, and was starting to get pretty depressed. Yoga seemed out of the question, and nothing I was doing was helping. I called my orthopedic people in tears. By the way, if you mention to your medical professionals that you “cannot continue to live like this” they jump to attention.

The next thing I know I am having a MRI of the right hip. The MRI shows significant labral damage and what appeared to be a compound femoral acetabular impingement. Great – this is fixable. I got in for an arthrogram and had a cortisone injection. Again, instant magic, which was a welcome sign as I was off to Hong Kong five days later.

The magic lasted eight days.

While suffering in Hong Kong – as much a walking city as San Francisco, and perhaps more due to the island where I stay – I decided to see my physio there because since 2008 there has been nothing Leo could not fix for me. Except this. “This is not your normal kind of issue,” he said. “You are going to need to see an orthopedic specialist, this is something new and different for you.”

Fun fact: You never want to be new and different in a medical practitioner’s office. That is akin to being and “interesting case” and as even one season of House will tell you, it’s never lupus and its never good.

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When I got back from Asia in April, I was feeling worse in every possible way: I was no longer able to walk without pain, much less do yoga or any sort of exercise. This was having remarkably obvious impacts on my mental and physical well-being.

Around this time I went to see a body worker who I think is one of the most intuitive and powerful practitioners I have come across, and we talked for a long time about what was going on – all the various aspects of my life that were culminating at this time and place and the ways they were manifesting physically. She was able to alleviate not only my pain, but also my anxiety.

For about 12 hours.

After a tumultuous experience with my primary care doctor, I found myself back in orthopedics talking to a surgeon. Talk about “not ideal. He laid out my three options from most to least conservative:

  1. A new anti-inflammatory and physical therapy, Pilates also recommended.
  2. Hip arthroscopy. This is a procedure where a surgeon – like the one I was speaking to – go in and ‘clean up’ the joint, perform labral repair if possible, shave down bone spurs/impingements. [Although this is considered the mid-range option in terms of aggressiveness, it has a much longer rehab period than the third option…]
  3. Total joint replacement of the hip.

As the surgeon went over my MRI with me, he showed me what we were working with and told me that as a specialist in arthroscopy I was not a great candidate. It would be super temporary because of my arthritis, and also he showed me that I had actually no cartilage left in the joint so my discomfort was being caused by bone on bone contact.

I left with a new prescription and a PT appointment, because who the fuck gets a hip replacement at 47?

When I went to my first PT appointment in the third week of April, the therapist introduced herself, looked at my x-rays and MRIs and said, “Well, we can work on mobility and mitigating pain, but you need a new hip.”

Okay lady, slow your roll.

I started working with a really good rehab Pilates instructor – who is awesome and tolerated my less than enthusiastic attitude towards Pilates by being unbelievably enthusiastic. It was an interesting contrast to my PT who is even more direct than I am, generally speaking. It was a good balance.

Summer is Coming:

By May, I was seeing about zero improvement in my situation. On top of this I was spiraling into familiar body issues that seemed out of my control – my lifestyle had changed so much and so dramatically that my clothes were not fitting. This shame spiral on top of everything else made things seem even worse. I generally felt better when I saw the PT or had a Pilates session, but the relief was short-lived. My PT was consistent in her position that I needed a new hip and I began talking to her about the process in broad generalities in our sessions. How long would the recovery be – like how big of window did I need? (This depends and since every person is different it is really hard to answer.) Was there any other alternative that she saw? (Silence.) What was the actual procedure like? (There are two approaches, anterior and posterior, the anterior is a much quicker initial recovery and the recommended option for anyone who is eligible for it.) Was this really what I needed to do? (Silence.)

I was referred to a surgeon who would be able to see me for a consult in July.

I booked a trip to Southampton for the last week in June since I had scrapped all my other plans by this time – music festivals were not a possibility in my condition, and I was not doing anything else in my spare time at this point so I felt this was well deserved.

How I Actually Spent My Vacation:

In the days that followed the culmination of my absolutely bonkers school year experience, I was suddenly spending a great deal of time searching orthopedic surgeons and forwarding the information to my step-dad for him to forward on to his connections for vetting. We landed on one that we all agreed on after a fairly exhaustive effort and I got the referral (out of area – OMG) to see this doctor.

On July 10.

No.

I began my summer break by getting up every morning to call to see if the doctor had cancellations and after a couple of days I knew all the women who worked in the department. I was told that the doctor was on call for O.R. duties on Fridays but that there were two morning appointments released on Thursdays that I could try to get in for, with the knowledge that I could get cancelled last-minute. I got booked for Friday June 22.

The appointment did not get cancelled, but all my hope for any alternative to a total joint replacement did. When the doctor looked at my x-rays from 2016 and that morning, and heard my whole story (which I have neglected to mention I was not able to tell without embarrassing sobs for months at this point) it was clear to him that I needed a new hip. I asked if there were any alternatives, it seemed like there should be because I am only 47. (I avoided going full Nancy Kerrigan, but I did want to know why this was the only alternative.)  It turns out, like so many other questions about the specifics of recovery duration and such, there is no definitive answer, although it seems very likely that more than a decade of competitive track and field along with basketball were not necessarily as good for me as we once thought. He asked me what I knew about the procedure. (More than I wanted to.) Then he brought in the “hip” for me to look at. (Heavy fucking metal.)

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Oh, and this surgeon, the one we all liked and had moved mountains to see? He did not do the anterior approach. He recommended the surgeon I had originally been slated to see on July 13. It took absolutely no calculating to realize that the timing and necessary recovery for this was looking like I was going to have to wait a year.

No no no no.

He said he would make some calls.

We left. I was in a mood that I am quite sure no one wanted to be around, so we went out to lunch. I like the way my parents think.

By about 3:00pm I was getting ready to start thinking about heading back to SF, and my phone rang. It was the surgeon. In the time since we had left he had figured out a way to use his surgery time to partner with a doctor he very much approved of to do the replacement.

On July 3.

I sat there and realized that I was going to have a major surgery in 11 days. In hindsight, I think for someone like me having absolutely no time to think things like this through is probably a good thing, and trust me, there was going to be no time. Within an hour I had been scheduled for four days worth of pre-op adventures.

By the end of June I had cancelled my vacation, seen more medical professionals than I had in decades, and was preparing for my ‘hip-cation’ in the North Bay. It was really happening.

In at 5:45am on July 3, the surgery prep began. I certainly can’t say I remember much about it except that my body issues were not imaginary because I had gained 15 pounds since January (!!!) and the O.R. nurses were great, the anesthesiologist was funny (I had a spinal not a general – although again, I was elsewhere), and the surgeon came in to tell me how the “universe just really came together to make this whole thing happen.” I guess, but it certainly seemed like he had a pretty big hand in things.

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I was home by 3:30pm that day. With a walker, an elevated toilet seat and enough pain medication to quell a herd of elephants.

It was weird. It felt weird, even though I couldn’t really feel anything save for the sensation that someone may have taken a baseball bat to the exterior of my thigh. But it was done, I was basically mobile, and that was that.

Because I was at home in Petaluma with my parents (and yes of course I brought the cats with me) I was able to do absolutely nothing but recover. Like really, nothing. I guess it was a vacation of sorts. And because I have health insurance (unlike the 30 million and growing number of people under 65 without coverage) this scenario turned into a money-saving bonanza for me (Ms. I Got No Plans For The Foreseeable). That was pretty relaxing too.

I came home, cane, cats and all, to San Francisco on the 24th of July, three weeks to the day from my surgery. It was – is – good to be back. I am moving slower than I would like, and I get tired much quicker than I would like – and don’t even talk to me about the Frankenstein situation that has emerged on the front of my upper leg (a six-inch incision and 22 staples leave a mark), but I am here, not needing pain medicine beyond Tylenol and having no pain in the hip, well, because I no longer actually have a hip that can feel pain.

I had a chance to visit with two of my favorite people from Hong Kong about a week or so ago, former village neighbors, they now live in the UK and have been touring the US for several weeks, and I was telling Vicky about my summer. As I told her the story and I realized everything is going as it should – actually much better even than anyone anticipated, but I still didn’t feel, I don’t know, grounded or settled or something. I said I felt a little guilty for not being beside myself with joy that I have this new hip and consequently have solved my problem, as everyone seems to think I should. She told me not to underestimate the significance of what I had done, and that I was not just having to physically integrate this huge new thing in my body, but I was also going to have to mentally integrate it as well and that our mind-body connections are so strong that our brains do funny things when parts are removed or added… This made the most sense to me of anything I had heard post-operatively. I still think back to her words when I feel apprehensive about all that has gone on.

All of my ‘precautions’ lift, coincidentally – or not – on the first day that I report to a new job. I like this symmetry and I feel really good about starting fresh with work after the very challenging experience that last year ended up being. And in my vanity, the one thing I said I could not do was start a new job with a cane seems like it is going to be an actuality.

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