Latvian Day 3 – Pils

It only seems right that a vacation that felt like a wish granted to me via my fairy godmother would include castles.  Let me tell you, Latvia has castles.  If you happen to watch the TV miniseries of War and Peace from 2016, you might recognize Rundālei Palace that is actually located in Latvia.

We did not visit Rundāle palace while we were in Latvia but the pils we visited were pretty amazing in their own right.

First thing on Friday morning, I picked up the  rental car I reserved months prior to give us the freedom to drive where ever we wanted in the countryside. As it turns out, my forethought to reserve a car was pretty darn smart. Other family members that rented cars that day, out of necessity due to missing the party bus to the wedding location (due to being out with the wedding party till the wee hours the previous night)  paid premium rental prices because of a music festival out in the country side.  Maybe it was the Positivus Festival

Anyway… Our target was was Cēsis, LV. Before heading out to Cēsis castle, we stopped at a hotel in town for a nature break. We had expected that once we got out away from Riga, we’d be more successful communicating in Latvian. Well, once again, tourism won out. English was more easily understood than Latvian.  Either way, we found the toilet and took care of business.  Fortunately, this hotel was just a pit stop, not our destination. A bit farther out is Cēsis Pils.  Before you are able to take in the wonder of the ruins of Cēsis Pils, you need to enjoy the new Cēsis Pils. 

Can I just say now that very few of my pictures do justice to the real beauty of Latvia?

Behind new Cēsis Pils is the old castle ruins.    There are enough walls and bricks remaining to aid your imagination into visualizing how the castle was laid out and what the delightful views one would have from the towers.  There are two other castles in the vicinity of Cēsis Pils.  One of which you can see in the distance of the picture below, however, Cēsis was the only pils we visited that day. One can hardly ignore hungry tummies, especially when the skies continue to darken and threaten rain.

 I’d be remiss not to admit how awed I was of the modern scenic ampitheather that was been created out of the ruins. It must be amazing to watch a performance in that atmosphere. 

A view of inside the castle grounds from the tower

By the time we returned to town for lunch, there was a torrential downpour going on. This made it quite difficult to discern if a cafe had suitable fare for lunch. After running from one cafe to the next, we slumped into the grocery store next to the sports bar that didn’t allow minors in the middle of the day.   Turns out that the grocery store had a cafeteria type restaurant and, honestly, it had some of the best Latvian food we had the whole trip.  We ordered carbonade ( pork chops),  kartupeļi (potatoes), and probably maize (bread, likely rye) or/and sula (juice). Should I mention that we were drenched from the rain, like leaving a trail of puddles through the cafeteria line? 

Once we were done eating and with time to kill, we hit the grocery store to do some shopping.  Afterall, no trip is complete until you pick up a box of Prozit for each person back home. You only need to hope you keep the chocolates in one piece while traveling home so that the liquor inside the chocolates doesn’t escape.  

Castles are not the only thing worth visiting in the Gauja River area.  As is often done in the US, we visited the boyhood home of a man of historical significance.  Well, he was significant to us and many that we know, that’s for sure.  Ivars met us along the roadside and guided us to the boyhood home of Andrejs Kengis, PK’s dad, which is called Sietiņi.  

Childhood home of Andrejs, Ginta (pictured on the right), Aija and Janis


The family still owns land in the area but we are not allowed to go up to the actual house and it’s not visible from the road. Luckily, the barn, built by PK’s grandfather, is still visible from the road. 

The Kengis family doesn’t talk much about the literal story of leaving Latvia.  Essentially, there came a point in the occupation when the Russians began to send farmers off to Siberia (or did other things to them).  The family had been visiting another household when they received word that if they went home they would be killed. So, the Kengis family fled for safety in the middle of the night.  I now realize why Sound of Music has a special place in my mother-in-law’s heart. 

We inquired about where the name Sietiņi comes from. Ivars then guided us to the nearby sandstone cliffs along the Gauja River.  Sietiņi translates to sieve or strainer. 

Ivars recommended that we make a stop at the local cemetery before moving on to the wedding location. I admit, I was reluctant.  What could be so interesting about a cemetery (besides ancestors).  In hindsight, I regret that I did not take more pictures. This cemetery was like a botonical garden on castle grounds.  It was quite amazing. 

Site of Piedkalns: Augusts, Milda and Marija


There was one more castle that we visited that day, but since it was also the location of Matiss’s wedding, I think it’s best to save those impressions for the next chapter, Kāzas (wedding). 

By the way, it rained most of the day.  But, who’s to let a little rain get into the way of fun? 

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Mighty Mighty

I looked in a full length mirror today…

So, here’s today’s workout T-shirt 


I’m in Malvern, PA.  I was walking on the treadmill when a couple of good tunes came across the earbuds. 2.5 miles for the day.  Barefoot no less (literally not possible to be less)  Now, I’m hanging out in my hotel room having a little dance party. 

Soon, I’ll switch over to more mellow music and work on my mobility work.

These hips will be constant work but I am better off than I was.  After all, I drove 3 hours yesterday, left the house at 4:30 am to catch a 7 am flight to Philly. I spent all day sitting on ill fitting chairs in meetings. Considering my past, my inability to get through a day like that without groaning, I am so much better off now.  

Time to sign off for a little Someday I Suppose by The Mighty Mighty Bosstones. You can watch it on YouTube. 

Even though I’m going to dance to it, my oneday needs to be today. 

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Filed under Arthroscopic surgery, Barefoot, exercise, FAI, Femoroacetabular Impingement, Hip Impingement, music

A Sigh of Relief

A man in a small town lays down in his bed at the end of the day and lets out a sigh of relief.  He realizes as he stares at the clumps of dust clinging to the textured swirls in his ceiling that he has been letting out this sigh of relief for so many nights in a row that he can no longer recall how many times he has done it. Or, even why. 

This morning, he woke up, got ready for work, wished his family to have a good day then got into his grey sedan and drove his 30 minute commute to work. There was traffic on the highway but not enough to prevent him from having enough time to collect a medium regular coffee from the drive through just three blocks from his place of employment.

He pulled the grey sedan in the sixth parking space in the lot to the left of the building. Parking in the sixth space, he found, kept him in the good graces of Alice in Accounts Payables who liked the fourth parking space because of the shade provided by a medium sized silver maple, the only tree on the parking lot, on an abundant sunshine day in the dog days of summer. He really wasn’t sure if Alice cared about parking under the medium silver maple on a cold, cloudy March day, but the man was unwilling to test his luck when there were so many important invoices that he would need paid.  

He gingerly carried the regular coffee through a labyrinth of cubicles narrowly missing thevrusj of a human resource admin on her way to a copy machine.  Once in side his own cubicle, he placed the regular coffee next to an endless pile of papers. The pile wasn’t very tall but he never seemed to make enough headway to get rid of it completely.  He spent most of his day responding to emails from customers or working on mundane tasks his boss had assigned.  Often, the man took mini breaks to check his Facebook.

 At 4:30 pm, he climbed into his grey sedan and pulled out of the parking lot to drive the 30 minute commute back home again.  

At home, the kids came and went to practices or study groups or hanging with friends, whatever it was that kids do these days.  The man ate his dinner on the lumpy stained couch next to his wife while watching some reality TV show where the people in the show were required to eat bugs. The man felt lucky that he was eating processed frozen chicken sandwiches instead of beetles. On commercial, the man and his wife exchanged pleasantries about their days but there was no real time for discussion before the show came back back on.  

Laying in his bed, staring now at the spot in the corner where the textured ceiling was pealing away due to a water leak, he realized that his day was neither bad nor good. It was just a regular day of a regular guy with a regular life.  And, while he clearly needed to look into getting the water leak fixed before mold started to grow, he really wasn’t all that anxious about it. So, what, he pondered would make him breath a sigh of relief? 

Miles and miles away, in another state, a petite brunette sits at a table in the corner of  brightly colored room where the eyes of the subjects in the artwork displayed on the walls watch the radiation from the fireplace dance in the diamond earrings hanging from the petite brunette’s  ears.  The petite brunette sets about her final task of the evening.  She is holding a non-descript doll that she made many months prior.   She gently smooths the hair of the non-descript doll before placing it inside a small box wrapped in plain, brown packaging paper. And, with the doll secure in its plain little box, she places the lid on the box as she lets out a sigh of relief.  

————
Truthfully, this shitty story isn’t even remotely done with the editing but I’m tired of writing it. 

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FAI:The Great In Between

I’ve read so many horror stories on the Facebook FAI pages that I have a hard time believing how my situation is going to turn out.  You could say that I have accepted that I probably won’t be able to do many of the wilder things I’ve been doing in the last few years.  But, that’s not such a bad situation if that means one can do 90% (aka more normal things) of what they used to do. 

However, this past week, someone from a snowy climate posted that they went skiing for the first time since surgery and indicated that their hips might have even been ready at 5/6 months post-op, if there had been snow.  I was so relieved to read that post.  It means I have hope that when this is all said and done, I will do what I want to do.  

Surgery Day- wake up and take last shower for days where I also shaved my legs for the last time until further notice, arrival at outpatient, get into gown with a plunging back so low it looked like a hospital gown, get super warm and cozy blanket from the warmer, have super sexy thigh high Ted stockings put on, make joke with nurse about eating SPAM, kiss the husband good-bye, talk to anesthesiologist about nerve blocks and good knock-em out drugs, talk to Dr. Komanduri and ask him if he’s had his coffee yet, yes, that’s why he was late, go to OR, transfer to weird looking table then have all memories erased, ask husband three times “how long have I been here?”, finally come to – sort-of, attempt to pee in bed pan, continue to lose memories, fall asleep on drive home, too woozy to use crutches so I used a wheel chair, got into bed, ordered 10 piece chicken McNuggets meal, devour meal, sleep, use ice machine for 6 hours straight, watch This Is Us with K-man, say a cheery hello to my friend who made lasagna for us to eat, go to sleep, again. 

Up to 3 weeks post-op

I don’t have the brain capacity to recount the last three weeks post-op chronologically so I’m going with the main points. 

For me, the pain has been minimal. They said the nerve blocker would only last 12-24 hours. I couldn’t tell you when the nerve blocker wore off.  However, I have malfunctioning nerve endings.  Which means that there are plenty of times when I don’t feel pain properly and sometimes when I can’t feel at all.  I’m not pain free, it’s just very minimal pain. I don’t think I’ve ever been above a 3 on the pain scale this whole time. I also used the ice machine for nearly every minute the first several days. 

On the other hand, when I moved, I had someone help me move my leg so that I wouldn’t cause any pain or cause anything to go wrong, like, when I needed to pee, and that need occurred often in the first day or so.  Over the following few days, I could tell my hip was getting stronger so I slowly transitioned away from needing help to moving it on my own. 

When I was up on my crutches, I moved a little more. My doctor put me on 10 days no weight bearing restriction with a brace that only allowed me to bend my hip joint 70 degrees.  I found that when I was on crutches I could swing my leg, just a little, without any pain or other indicators of illadvised movement.  So, every time I peed, I made sure to swing my thigh back and forth and even in small circles. 

I elevated my feet constantly the first 5-7 days. I did not have any swelling. 

While I was laying about the rest of the time, I read up on blogs of others who have been throughout scopes for FAI.  The post-treatment ranges on what patients are allowed to do.  An example is some doctors saying no crutches are necessary to some saying 4 weeks on crutches.  About the time I hit 5 days post-op, I was ready to move.  I woke up in bed with an aching back. I decided that I would do two things. 1 I would do some of the exercises mentioned in blogs where PT started immediately after surgery. 2. I would make broccoli and cheese soup for dinner.  1. The exercises included things like slides, raise up on elbows, cobra, prone glute raises, etc. 2. The soup included so much cheese it might be better called cheese soup with broccoli.  

When I finally got to start PT, I was so anxious, I called ahead of time to make an appointment for the same day as the doctor’s follow up so there would be no further delay in my active recovery.  The follow up appointment was very interesting. The doctor walked in, asked me how I was doing then opened the door and told me to walk down the hallway.  No brace. No crutches. I was not expecting that but I was excited to try it. I was as graceful as a two minute old foal.  Doc gave me directions to use crutches as needed.  I went directly to Walmart and drove the amigo while I shopped.  Who wants to be a foal in China shop? 


I am now one week pre-surgery #2. My right hip is doing great.  I’m walking around home with no crutches. I’m still icing for hours every day to keep all inflamation at a minimum as I push to get stronger. The therapy isn’t what I expected but, today, my PT added some exercises and stretches.  It feels good to graduate to the next level. I even drove to PT today which was 5 minutes away.  

I’m beginning to think about everything I have learned from the first time around.  I worry and fret that #2 is going to crash and burn or I’ll tear up #1 in the process.  I’ve trusted my doctor thus far, I no reason not to now.  I started working with my pull-up bar at home to strengthen my shoulders, arms and hands for a second go on crutches.  I worry but I am ready. 

At home exercises for PT–Flex/point toes, glute sets, hamstring sets, quad sets, squeeze a pillow between knees, pelvis rockers, bridges, seated leg raises, raise up while on stomach, slow buttkicker while in stomach.  

~2 weeks post op. 3 little holes.

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FAI : The Road To Surgery

I want to share my story with others trying to learn about FAI and arthroscopic surgery.  However, I think there will be some advantage to walking through the steps so that I have the same confidence in my decision that I made in September.  

It started in the chiropractors office.  My chiropractor took x-rays of my lower back and hips.  She decided that she didn’t like something in the x-rays so she sent me over to MK Orthopadics to see the hip specialist. It turns out that whatever she thought she saw in the x-rays was nothing at all. But, I’m glad she sent me because Dr. Komamduri replicated my pain without even thinking hard about it.  He showed me the X-rays and explained what FAI is.  What the X-rays couldn’t show is the state of the labrum. We’d have to do an MRI with contrast dye to find out if the labrum was torn. 

Within a couple of days, Dr. Komanduri’s office had me back for an MRI of my hips.   Each hip was done separately.  So it took about 4 hours total.

 Never having this done before I was naive about the process. The contrast dye is injected into the hip. I don’t know why but I thought that would be done through the fatty part of my hip. Instead, they inject the dye, after a numbing agent, through the groin directly into the hip joint. Duh, I know, but I’ve never thought  much about anatomy.  In the process of getting the dye into the hip, the PA hit a nerve that sent a sharp pain down the front of my thigh. It wasn’t so bad on the right hip but she had trouble finding the mark on the left hip, so,  she went across the nerve several times and caused several tears to fall. She had to pull out the needle and try a second time.  She gave me more numbing agent so the second time I ended up not feeling a thing.  In addition to the dye, they shoot saline into the joint to expand it for better MRI views. 

The injections are done in a sterile room.  After removing the needle, she put a band-aid over it and said, “I just put a hole directly in your joint.  Leave this on for 24 hours.” followed by a direct look that warned me not to screw this up.

Walking over to the MRI with my expanded hip was no problem.  Laying on the MRI table for an hour at a time was a big problem for me. FAI patients commonly have SI joint pain (high buttocks /lower back). I was packed into the MRI machine pretty tightly so there wasn’t anyway to get relief until it was all done. 

When I scheduled the MRI, I asked if I would be able to drive myself home. The boys had a bunch of after school activities, so,  I didn’t have my husband come with me. Yes, technically, I was not drugged. Between the pain of the saline and contrast dye and the stiffness from laying on the table for several hours, I would have preferred to have been able to sit in the car with having to worry about driving. As it was, I stood outside my car for several minutes on the brink of breaking down from the thought of getting into a car. Quite fortunately, my pain receded quickly.  Still in pain, I was able to drive home. Within 2 hours, things felt normal for me again.  

A few days later, Dr. Komanduri reviewed the MRI pictures showing a labrum tear on both sides. We discussed that surgery would be necessary to shave off the extra bone causing the impingement then he would reattach the labrum.  Since I hadn’t attempted any treatment specifically for my groin pain, we decided that I should try physical therapy as conservative treatment to see if it alleviated the pain and for insurance sake.  

I’m a believer and practioner of functional fitness. I have followed programs that incorpate similar activities to physical therapy. At my first appointment, my therapist said I was fairly strong in the hips during my initial evaluation.  I figured that was both good news (the programs that I follow work) and bad news (confirming pain wasn’t caused by poor muscle performance).  We worked for 4 weeks starting at a higher level since I was demonstrating good strength already.  However, the key pain areas never went away. 

I met with Dr. Komanduri again and agreed to the surgery.  I tried to fight it but my husband pointed out that I was unable to drive to visit family just 2.5 hours away without having to stop due to intense pain.  Now, it was just a matter of getting insurance approval. Hip arthroscopy is an out patient surgery. My insurance doesn’t require pre-certification. In these cases, because it is an expensive surgery, the office requires pre-determination from the insurance company. It is essentially the same process as a pre-cert but since it is optional, the insurance company takes 30 days to give an answer.  Just enough time to doubt, double doubt and scare myself senseless about what I was about to do. 

A few days before the surgery, I had my surgical clearance physical then was outfitted for the hardware.  The brace wraps around your waist, hinges at the hip and is set at 70 degrees to protect the hip joint.  The brace is also strapped around my thigh.  They put the brace on you when the surgery is done so that it is under all your clothes. I also purchased an ice machine through the doctor’s office. It is not covered under insurance so it cost me $265.  I easily justified the expense since I have two surgeries to deal with and they promised faster healing.  At this point, I was all about securing the fastest track to normality, whatever that is.  

The hospital called the day before the surgery to confirm a 5:30 arrival time. 

Heavy with doubt and worry, I dressed in my comfy-s and headed to the hospital. 

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FAI: I didn’t know

“I didn’t know you were in pain.”

 I did not know either. 

I know that seems like an improbable statement but it’s true. 

First of all, I’ve been this way for so long that I didn’t know that it wasn’t normal.  I have it in my head that because my FAI is in both hips that there must be a genetic influence. It’s not like one day I went skiing and blew out my hip as I failed to performed a radical trick. I cannot pinpoint a day zero as to when the pain started.  So, either I grew up this way or the condition came on so gradual that the change from day to day was undetectable.  As you might recall from my last post, my original treatment goal had been to recover from chronic achillies tendonitis not to find out why I don’t like to sit down. 

Second, I would describe most of my pain as more like an ache than a pain. I rarely take anything for pain management. I’m almost always just uncomfortable.  I assume it’s similar to how most people feel  feel after a very long car trip, only I feel that way immediately when I sit down. 

I feel pretty lucky.  Many of the FAI blogs and members of FAI groups are in terrible pain and need prescriptions to alleviate their pain.  Because I’m not in that state, there are many days when I question if I really need this surgery. I am often told, however, that the labrum cannot repair itself. If I don’t have it fixed now, I’ll have full hip joint replacement down the road when I can’t take any more pain. That doesn’t sound like a very good option to me.  

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Filed under Arthroscopic surgery, FAI, Femoroacetabular Impingement, Hip Impingement, injury, Uncategorized

Femoroacetabular Impingement 

…or FAI for short.

…or Hip Impingement, if you prefer.

…0r, it hurts to sit, to be accurate.

I was finally diagnosed in August with FAI.   Lateral impingement, both sides, pincer type and labrum tear in both.  Arthroscopic surgery is the only option after spending 4 weeks in PT just to make sure. 

Why does it hurt to sit? 

Simply put, the bone over growth in my hip socket pinches the labrum (cartilage) when I move my leg in certain ways like bending at the hips when you sit.  Over time, the labrum has become torn.  So, now, I deal with muscle compensation due to a loss of range of motion, tightness, torn cartilage and inflammation then you add pressure from sitting.  

As time has progressed, it has started to hurt when standing and laying down. The hips are getting weaker. 

How long have you had this? What caused it? Was it running? 

As far as I have read, there is no real answer as to what caused my FAI. It is a mechanical deformity. At this time, most people diagnosed are athletes. But, that could be because athletes move more and use a bigger range of motion regularly.  It’s also a fairly “new” condition so lots of people who had a hip replacement could have been FAI and just didn’t know it. 

I don’t know for sure how long I’ve had a hip impingemt or a torn labrum. If I reach back into my bank of old softball memories, I recall being 18 years old and asking one of my sister’s friends from our recreational softball team for a good stretch for the hip flexor because I had pulled it when running to third base. I have no proof, but I don’t think it was a coincendence.  

The next incidence was in the mid-2000’s when I started having tendonitis symptoms in my hip flexors. I sought treatment. I did not get a diagnosis, explanation, or relief. Treatment included orthopedic doctor and chiropractor.  Eventually, I modified my behavior and learned to deal with tightness in my hips. And, I quit wearing a belt. (The belt was not a cause of the problem but did press on inflamed soft tissue causing pain) 

More recently, a few Christmases ago, I had several days where, I thought, after eating too many Christmas cookies, I had gained so much weight that my pants were too tight thus by the end of the day it just hurt too much to sit another minute. 

Many nights I have gotten back up after going to bed to stretch out my leg muscles because the tension in my quads was just too much to let me fall asleep.

I can’t tell you how many times people  have offered me a seat only to be confused when I refused to sit down. Telling them I prefer to stand did not make sense to anyone.  It still doesn’t. 

Most recently, I was going through treatment for chronic achillies tendinitis.  I decided that all things are connected so I should be dillegent about resolving the tightness in my hips to make sure it did not alter my stride and aggravate  my achillies.   Eventually, this train of thought lead me to Dr. Komamduri.  

My first appointment with the hip specialist at MK Orthopaedics, Dr. Komanduri, was impressive. Before I was even seen by the PA or the doctor, they took five x-rays of each hip. 5! Then the PA came in to see me but could not identify the cause of my pain. She performed numerous tests but found no indication of the cause.

“It’s your back… no, it’s your hips… hmmm, it’s neither.”

She left the room and left me to contemplate yet another dead end and no explanation.

But then I heard a voice in the hall,

“She has pain in the groin and pain when she sits?”

Dr. Komanduri entered the patient room, requested I get on the exam table and immediately proceeded to place my leg at angle that nearly made me jump off the table in pain. 

“It’s a lateral impingement,” he said to the PA, ” only 10% of cases are lateral”

Color me impressed. Dr. Komanduri never asked me a question. He looked at my X-ray, read my chart and immediately replicated the pain that no other single person has been able to do.   

FAI.  Lateral impingemt both sides. Dr. Komanduri told me to go home and read up on it.  But, he was certain that I would agree that surgery would be the answer. 

He was right, I did.  I am now 7 days from having my first arthroscopic hip surgery. 

It’s been a long road.  Insurance is a pain and you learn that sometimes you have to be a pain also.  At this point, I can’t quite believe it’s happening. 

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Filed under Arthroscopic surgery, FAI, Femoroacetabular Impingement, Hip Impingement