The Tendinitis Trifecta

I  had my 3 month post op appointment with Dr. Ho on Friday morning.  Typically I have been seeing him at his satellite clinic, but due to his schedule, I had to go into the city this time.  This proved to be extraordinarily inconvenient on a number of levels, but I was able to squeeze in some visits with my family.

I grew up in a suburb of Chicago, Naperville, and my parents and sister still live there.  So, I drove up with the kids on Thursday evening and headed into the city by myself Friday morning.  I wasn't sure how bad morning traffic would be, which ended up being fine and I made it to my 10:15 appointment around 9:50.  Dr. Ho is ALWAYS behind schedule at his satellite clinic, so I wasn't sure if it was his MO or just the site. So, when I was called back to the room at 9:53, I was shocked.

After not too long, I filled out my 3 month post op questionnaire that is part of the research study of which I am a participant.  A very confident and comfortable resident came in to complete an assessment and gather some information.  He was a bit pompous, in my opinion, and said a few things that rubbed me the wrong way.  He informed me that I would never fully regain strength and flexibility in my operative leg and it would always be "different" than my other leg.  While he is probably correct, I just didn't like hearing it from him and nobody else has pointed this out.  After hearing of some of my current pain locations--hip, psoas, lower back, and up into the neck area, he confidently stated that no back pain could ever be related to something going on in the hip.  I am no doctor, but I really disagree with him.  It is all connected for pete's sake!

Anyway, I waited a long time to actually see Dr. Ho and started taking some pictures to pass the time.  Excuse my inability to take a selfie.

Here I am annoyed that it is 11:03 and I've been in this little room since 9:53.

Tapping my toes to keep from falling asleep!

In between yoga sets, I tried tree pose along with different warrior variations.

Finally I saw Dr. Ho.  He was pleased with my flexibility, but concerned to hear that I wasn't sleeping well again.  After some manipulation and poking, he determined that I have tendinitis in the iliopsoas, iliotibial band, and the piriformis.  This is not actually uncommon post surgery, but it was something we were hoping to avoid.  I asked him how you are supposed to make progress recovering from the surgery, yet heal the tendinitis and he highlighted that physical therapists should be able to figure that out!  So, hopefully Andy will have the magical formula for a good balance of rest and exercises that will help me.  Dr. Ho mentioned that if I am still having trouble sleeping and if the tendinitis does not seem to heal within the next few months, then I may want to consider an injection.  He extended my physical therapy for at least another 6 weeks and although the script calls for 2-3 sessions per week, I am sure Andy and I will continue the once per week that we have been doing for at least a month now.

I came into the appointment not expecting much because, despite this setback, things are going relatively well.  I was glad that Dr. Ho acknowledged my soreness with a medical term of tendinitis.  I will have a 6 month follow-up in September and hopefully I'll be in less pain.  I will back off on the idea of running any and focus on my cardio from things like the bike and elliptical.

Before leaving the University of Chicago Medical Center, I had to meet with a physical therapist so he could take some strength measurements to use in the research study.  The testing indicated that my right leg is nearly back to the same strength as my left leg.

Getting back out of the city was much more hectic and it took me 2 whole hours to get back to Naperville.  This should have been about an hour long drive, so I will be sure to avoid going back to U of C for future appointments.

Too much traffic---not used to this in Champaign.

11ish Weeks?

Last I had checked in, things were going very well.  I was fairly painfree and pleased with my decision to have the surgery.  I have had a bit of a setback in the last two weeks, though.  This may be as a result of me trying to wear my wedge heels to the promotion ceremony or re-introducing running into my life.  Now, before you go assuming that I did something crazy, the re-entry program is very minimal.

My strength progression and other areas of improvement indicated that I was ready for this.  I do not believe I tried something too early.  Further, in the last two weeks, I "jogged" for a grand total of about 10 minutes on 3 different attempts.  Each time, I walked for about 4 minutes and followed my walking with approximately 1 minute of jogging.  This was not painful.  The day after, and two days after, and three days after, though, have been a different story.

I am no longer sleeping well and have put myself back on a NSAID regimen.  Currently, I'm icing my hip while writing this blog and prepping dinner.

Photo courtesy of my 6 year old daughter, Macy

BBQ Turkey Meatballs

I contacted my therapist last Tuesday, the day after my appointment with him, and informed him of my increasing pain that mimicked pre-surgery stuff.  He encouraged me to rest most of the week, which I did and we resorted to plan B today, which consisted of many manual techniques during my session.  I left feeling beyond relaxed because I basically got a 30 minute massage on my ass.  Now, however, I am in a bit of pain, which I believe is just as a result of poking around and the release techniques they used on me.

I'm a bit frustrated and will interrogate my surgeon on Friday when I see him for my 3 month appointment. Someone recommended that I see if they will prescribe a more serious anti-inflammatory to help.

While I began this post saying I did not believe I tried things too early, I may be willing to admit that maybe it was ambitious.  However, both Dr. Ho and my therapist encouraged this progression and I guess the only way to know if my body was ready for this was to try it out.

To those who are reading--thank you to the two of you and I wish you the best as you continue to recover.  I will keep you posted and will continue actively living my life running around and doing things the best I can, just without a formal running workout:)

Phase 1 for Return to Running

The last week has been a little bit of a downer in that my hip flexor has definitely been noticeable and I've reached a bit of a plateau (in my opinion).  My hip and back were also experiencing additional pain as a result of my monthly visitor.  Due to our traveling for Memorial Day weekend, I was a little more lax with my exercises and I noticed it.  Mentally and emotionally I am tired of the easier workouts (easier to say now when I'm not crazily training).  I voiced this to Andy today at my pt session and, as a result, he not only took it easy on me, but he also gave me his Phase 1 for returning to run program.

Phase 1 is a plyometric sequence to simulate the impact your body takes while running.  If the hip handles the exercises, I'll be ready to move on to Phase 2, which he generously gave me as the carrot to dangle in front of me.  The series has 6 levels to use as a test to see if you are ready.  If I am able to complete each level, which consists of 3-4 sets of different types of hops, then (in theory) I am ready to begin phase 2.

In the meantime, I'll keep with my regular exercises including my side planks, which I am slowly building to not having a leg on the ground.  

2 months Post Op

Today marks my 2 month post op anniversary.  It wasn't until week 7 that I really felt good about my hip.  I've had mostly pain free days the last week and a half and I am elated.  On occasion, if I twist funny, my groin sometimes pops or I get a shooting pain.  I have learned that I notice my hip more on days where the weather is funny and the few days leading up to my period.

Decreasing physical therapy to once a week has probably been just what my body needed to move towards the pain free world.  This allows me to alternate strength and cardio and still do core every day.  I have been trying to hit the gym up bright and early and have stuck to bike or elliptical.  I'm beginning to add weights to my leg exercises and Andy is really excited about me mastering the TGU (turkish get up).  I, on the other hand, could do without it.  I feel silly doing it and when I actually attempted it at the gym on Saturday, I hurt my knee on the non-operative leg.

For the first time in over 2 years, sleeping comfortably is happening regularly.  This is definitely a perk to the surgery and I remind myself that even if I never fully return to my same active lifestyle, this was worth it.  Up until this weekend, the thought of wearing high heels or wedges terrified me, but alas, yesterday I put some wedges on.  The last time I wore them, I reluctantly sacrificed comfort for fashion.  I will put them to the test on May 30th when I wear them for my students' promotion ceremony.

Turkish Get-Up and a Treat

Last week marked the last of my two physical therapy sessions per week.  I have now graduated to 1 per week and Andy took to heart Dr. Ho's recommendation of pushing me.  At the end of last week's session, he told me to come to my next appointment ready to work and that it was going to be so much fun, for him.  I was actually giddy with excitement to hear this, but was working through the logistics in my head of beginning my workday, going to PT at 10am during my plan period on Tuesday, and then continuing my workday.

I've been attempting to return to my early workouts and have made it to the gym a few times by 5:30am and bike for 20-25 minutes before doing my pt exercises.  This is about as much as I've been able to do in addition to the actual PT sessions.  I intend to build in some more cardio starting tomorrow and will continue the strength exercises 3 days a week.

Today Andy introduced me to the Turkish Get-Up.  He asked me if I had ever done it before, which I hadn't, been I was familiar with this:

and laughed at the thought.  Andy emphasized the move and broke it down as simply as possible, but I still need some fine-tuning before I work in weights.

It will be a long while before I even attempt this move at the gym because I look and feel ridiculous.

I have been noticing that I am getting significantly stronger the last two weeks or so.  I don't feel unstable in my hips and all of the lunges and squats are getting easier.  It won't be long before Andy has me doing those weighted as well.  Despite my positive progression, I still get pain in the groin and know that I am far from healed.  My recovery, like I've said before, is not unique to others' that I read about.  This surgery has people progress and then regress, progress, regress, etc.

To celebrate my progress, I treated myself to one of my guilty pleasures, Lululemon.  I had been on a hiatus for awhile since I was predominantly swimming for at least 6 months, but have now fallen off the wagon and anticipate a few more overly priced purchases.  Maybe once I master the Turkish Get-Up, I can treat myself again.

6 week post op appointment and 1st bill

Today I saw Dr. Ho for my 6 week post op appointment.  He seems to be building a reputation of being notoriously behind schedule and I only ever am able to get afternoon appointments, which seems to make it even worse.  Today's 1:15 appointment finished just before 3pm and then a 2+ hour car ride bike home.

I have come to really like Dr. Ho and firmly support his approach.  Since he did a psoas release on me, it made me a candidate for one of his research studies.  He is examining the recovery period necessary to regain strength after the illiopsoas lengthening.  A physical therapist assessed my strength in a few positions and used some fancy dancy tool in order to acquire numbers for the study.  The therapist was very friendly and he reaffirmed my positive opinion of Dr. Ho.  He mentioned that I am lucky to have had a surgeon with so much scope experience because his recoveries tend to go quicker.  The therapist mentioned that he had other patients who had seen other doctors and the recovery was not good because their scopes "weren't as clean as Dr. Ho's."  That was great to hear.

I didn't really have much to ask Dr. Ho and didn't really expect much out of the appointment.  After refreshing his memory on the specifics of my surgery, he seemed surprised that I had returned to work after 3 weeks.  This was odd to me considering he was the one who encouraged this just 3 weeks earlier!  He mentioned that "with a person like me" he is okay pushing things a little more aggressively and gave me the go ahead to try a yoga class and hinted that I may be able to run before the 12 week mark.  Despite this, he was surprised at what seemed to be my lack of flexibility.  He said he would have expected more flexibility from "someone like me."--that must have been the phrase of the visit.  I have to somewhat disagree with him and contribute this to his (and his fellow's) haphazard quick movement and assessment of my leg.  Coming into the surgery, my flexibility was never a problem and compared to other group fitness junkies, I believe I am fairly flexible.  Now, obviously, post surgery, my movement on the operative side is more limited than in the past, but it seems to be coming along.  I will consult Andy, my therapist, but will add in some yoga and stretching to see what I can do.

I've read a significant amount about hip arthroscopy and recovery and would say that my experience is not unique.  Dr. Ho and I discussed the fine line between working hard to progress and doing too much.  It would be convenient if there was some magical tool that helped patients know when to stop and what worked best, but unfortunately, it is just trial and error.  I'll see him again in another 6 weeks on June 13th and, in the meantime, I intend to straddle the line between too much and not enough.

I also received my first bill related to my treatment from Dr. Ho which charged me the amount of the fluoroscopy from surgery day that my insurance will not cover.  I intend to keep a close eye on this and am willing to share what the total ends up costing me.  To date, with Dr. Ho, I've had 3 appointments with a $50 copay for each visit and now $249.73 for me to pay of the $1,921 billed to insurance.  Without looking back at my records, prior to surgery, I spent around $500 out of pocket on physical therapy and close to that (if not more)for my Xrays, MRI, and MRA.  I am not quite sure how my insurance measures up, but I am just thankful to have it and that I am satisfied with seeing Dr. Ho as my in-network provider.

One Month Post Op

One month ago today, I embarked on a new journey into the hipster world.  I think things are moving in the right direction and I am making considerable progress with my rehabilitation.  Co-workers continue to encourage me, well, most of them (the ones who don't call me gimpy), when they see me crutchless and walking pretty normally.  What they don't see, however, is that I still have significant healing to do.  I have been struggling with hip problems for well over two years, so I've gotten skilled at hiding my pain and just trekking on.  I've had to.  Nobody wants to hear about my hip day in and day out, especially my husband.  Quite frankly, neither do I.

Remaining optimistic and hopeful for my active future has helped me to not dwell on the little aches and nagging sensations that are still present (at times) in the hip/groin area.  My physical therapist reminded me this week that medical professionals recommend giving the bone 12 weeks to properly heal.  So, in the next two months, the priority is on my healing and getting stronger and not worrying about the what-ifs.  Admittedly, it is kind of refreshing to not be on a training schedule and having to plan my weekends around when I'm getting my long run in!

Look at me, squatting down, pain free!

Each day my exercises get a little bit easier, even though my therapist continues to build on my routine.  Currently, I am using a lighter resistance band on my leg lifts in each direction, one of the weight machines for my squats, and the stability ball to practice seated leg raises while focusing on my core.  I am up to biking 20 minutes continuously with some resistance and for the purpose of getting a cardiovascular workout.

My workday usually starts painfree, but by lunch time, I notice some aches and try to sit down more.  I am still limiting my walking throughout the day, but have begun to  monitor the hallway with less fear of jostling the hip.  I really haven't iced much in the last week and have even caught myself joining in on some of the dance parties that periodically occur with my own children.

I think back to the first few days and even week or two after surgery and remember how I couldn't comprehend healing enough to be functional for work.  I'm happy to say that I'm on the road back to my normal self.  Slow and steady has often been my motto in races, so I'll use that to get me through the next few months.