Sunday, May 30, 2010

Deciding to get surgery

Deciding to get surgery was a tough decision for me. FAI impingement and labral tears are not exact sciences in the way that an ACL tear in the knee or a rotator cuff tear in the shoulder are. The latter two are no brainers and there are several doctors in Austin I would go see for those procedures without hesitation. But with FAI impingement the more I researched the surgery, the more I became wary.

Quickly I decided that I would have to travel as few surgeons in Texas specialized in hip arthroscopy. If you needed a new hip altogether, there were plenty of Dr's to choose from. But if you needed bone spurs shaved down and labrums repaired arthroscopically, there were just very few qualified to do it.

I also debated for many months whether I even needed the surgery at all. I read many horror stories on the internet of people whose surgery went wrong and now they were worse than before. But I realized that people whose surgery went well probably were out there living their life rather than writing on internet chat rooms.

And when I started looking at the long term research, FAI impingement was fairly common amongst young athletic men. As long as it was detected early and operated on properly, many of them went back to their sports and most studies showed an 85% success rate after 10 years. For surgery, those are pretty good odds.

Still I wasn't convinced so I cut back on all my activities, got PRP injections (Platelet Rich Plasma, it's supposed to stimulate cartilage growth) into the hip and waited. As long as I did very little, my hip hurt very little. So after a few months the choice became clear: continue to baby the hip and be pain free, or get the surgery and get back to an active life. I decided that even though calling myself "young" or "athletic" may have been a bit of a stretch, I didn't feel so old or unathletic as wanting to have to worry about the consequences of going for a run or a hike when I felt like it.

I did tons of research of which Doctor to go to. In a way it was a great limitation to have no real local option. It meant anywhere in the US was fair game. Many of the top ones were used to out of state patients so getting the surgery and leaving a few days later would not be a big deal.

Now along the way of realizing I had a bad hip, I thought I had injured the groin muscle of my other hip. But when I talked to several Dr's who looked at x-rays of both my hips, they told me there was a high likelihood that I had impingement in both hips and would probably get labral tears on both sides as a result. Again I had a dilemma as the idea of flying somewhere once to get surgery didn't seem too bad. But to go out there once, get the surgery, be on crutches for 6 weeks, finally recover only to go do it for the other hip basically meant being out of action for 6 months. But I figured 6 months over a life time isn't that long a time period, so mentally it was what I was ready to do.

But as luck would have it, one of the Dr's in LA that I contacted said his company couldn't help anyone out of network, but he recommended I contact Dr Thomas Sampson out of San Francisco. Dr Sampson ended up emailing me before I contacted him and offered any help he could. This was when I was still trying PRP and other things so we played telephone tag but I never actually spoke to him.

Finally after spending five months looking for other answers, I had decided to get the surgery and was actually pretty set on going with another Dr when I decided that I should at least talk to Dr Sampson. I mainly wanted to be reassured that I was doing the right thing and since he had been the most accessible of any of the surgeons I wanted to go with, I also wanted to hear from an expert in the field as to what I should expect. I'd mainly been talking to people who knew a little about the condition, but Dr Sampson has been doing hip surgery for 25 years and has been a leading innovator in hip arthroscopy for at least 10 years.

I called his office and they scheduled a time for him to call me the next day. The other Dr's office actually called me about 20 minutes before he was supposed to call me and I didn't answer their call. I just wanted some reassurance, someone who knew the subject matter better than anyone to tell me it would be okay. I got a lot more than that.

I was able to talk to one of the top surgeons in the world for over half an hour with no assumption of any financial gain. I got to talk to a man who was experienced but still highly passionate and constantly searching for new ways to do what he does even better. Dr Sampson explained in great detail how his technique varied in almost every aspect, from where he started the surgery, to the amount of time the hip is in traction, to his philosophy on whether crutches were needed post operatively.

He also said that it was likely I had labral tears and impingement in both hips and that he had done the operation on both hips together many times. He recommended it so that the body did not compensate for the "good" hip quickly turning it into the "worse" hip. He also said that many of the studies he had personally done over the years showed that there was no difference in terms of recovery rate, cartilage reformation and pain levels of people who were on crutches for 6 weeks after surgery vs those who were on them only a few days after surgery. He told me exactly what he thought was happening in my condition in terms of the labrum and the cartilage and that he was very certain he could fix my condition.

By the end of the conversation I realized there was no one else on the planet that I could go to. I told him I'd be seeing him soon and a little over a month later, I was in his office meeting him for the first time.

Tuesday, March 30, 2010

Patience for patients

Well I just got my second PRP injection yesterday. Painful as it was before but this time I was ready for it mentally so it's not so bad. I had been training jiu jitsu and swimming the two weeks before that and while towards the end, there was some hip pain, the sharp stabbing pain has not returned. So I'd have to say that's some progress. I already have my third PRP scheduled for early June and even if I'm feeling really good then, I'll still go ahead and get it, just to be sure.

Now I haven't been pushing myself like I did before although I've rethought quite a bit about my reasons behind some of the weight training etc I was doing and I'm comfortable with cutting most of that out of my life permanently.

I may still need the surgery and will get it scheduled with Dr Byrd's office in July, but PRP has helped. I'm amazed at how few people know about it, especially in the FAI world but if I get a better measure of success I will do whatever I can to change that.

Thursday, March 11, 2010

Reality sets in

It's been over 8 weeks since my PRP injection. And if I was the type of guy who enjoyed a leisurely walk as his primary physical activity, I would call everything a success. But since my hobbies tend to be a little more physical I had to start testing things out a little more seriously.

Yesterday was simply working technique on the mat. I really have done almost nothing physical since mid December. The result today is a marked increase in hip pain.

It's time to stop beating around the bush. I am scheduling arthroscopic hip surgery with Dr Byrd in Nashville, TN as soon as I can get it. Life is short and I want the physical aspect of mine back as soon as possible.

Monday, January 18, 2010

PRP for hip labral tears

My plan to heal my labral tear involves several strategies working together.

The main idea is to stimulate my body to heal itself. I recently had a Platelet Rich Plasma (PRP) injection into the site of my labral tear. The basic idea behind this type of prolotherapy is to cause a type of inflammation and there increase blood flow to the labrum, a place that normally doesn't have much blood flow to it at all. What makes PRP different than regular prolotherapy is the platelets are growth factors so there is the double whammy of increasing blood flow and having growth factors available to stimulate new growth and tissue repair.

Now I will say this is all controversial and PRP ain't cheap. But as I wrote in my last post, so is the surgery and going back from that is impossible.

I had my first injection on Tuesday Jan 12th. They warned me that it would be very painful an hour after the injection and offered to write me a pain pill prescription. I laughed it off with a macho guffaw. I was wrong. It really really hurt. But with enough stubbornness, 4 extra strength Tylenol and a mid day powernap, I was able to make it through without the humiliation of having to call the Dr's office back and beg for mercy.

Over the next few days the pain was manageable but I was walking with a noticeable limp. They had warned me this would happen for up to a week.

Today is Monday so it's been six days and I still have some pain in the area.

From here it's a waiting game. Typically you'll know in 6 weeks whether the treatment is helping or not. I have an appointment 8 weeks out from my injection.

What I"m trying to be smart about is limiting my activities that could prevent healing. I spent a lot of money and a good chunk of pain on this, so I want to give it a real chance to work.

Even if it does work (or really if it doesn't too) I"m going to get a second shot in mid March.

My thought is best case scenario I'll have enough labral repair to be relatively pain free by mid spring and may need to get a maintenance PRP injection every year or so.

I'm going to keep track of my progress, along with my increase in posture exercises and see how all of this works.

If it doesn't, then I guess I'll start a blog on how the surgery goes ;)

The hip labral tear conundrum

The hip labral tear and treatment seem to be shrouded in secrecy and myth. Knee and shoulder injuries and the surgeries to repair them seem pretty straight forward. There's a well established track record of options and a ton of good success stories.

But hip labral tears seem different. Many times this injury is accompanied with a bone spur which is thought to be the reason there's a tear to begin with. So the basic idea with the surgery is to shave down the bone and repair the labrum.

It sounds basic enough but the problem with the hip is the socket is pretty hard to get to. It's surrounded by nerves, muscles and needs to be dislocated or put in traction just to get to the torn area. There are two main surgical options: open surgery and arthroscopic.

There are several frustrating things about this surgery.

First off, while the arthroscopic one seems to be desirable in terms of shorter recovery time and being less invasive, it's considered experimental and therefore not covered on most insurance plans.

Secondly this surgery is relatively new and thus there are few surgeons out there who have mastered the technique. I live in Austin, TX and would need to travel to Nashville, Vail or San Francisco to get this procedure done.

Neither one of those problems is a deal breaker but what really concerns me is the fact that I'm reading stories from many people who have gotten this surgery and wished they hadn't. There are stories after stories of people saying that they're still limping six months later. Some talk about needing a second or even third surgery. And others need surgery on the other hip after they get the first one "fixed".

I realize that going on the internet for information about anything might not be the smartest of ideas, but there are whole discussion forums on this very surgery and the prognosis doesn't look good to me

So surgery is certainly not the first choice. And at the moment my symptoms are intermittent enough that I don't have an immediate need to get anything done.

But the other thought is what if I wait? There are even more stories of wearing cartilage down leads to arthritis leads to total hip replacement. While it might be a type of honor to have something in common with Bo Jackson, I'd prefer not to have that.

And while I know that my years of jiu jitsu and working out have put a strain on my body, it seems strange to think that bone spur which has most likely been there the whole time, is now suddenly a problem.

I'm not satisfied with the answers out there, so I started this blog to find better solutions and to keep track of my progress on other types of treatments.