Monthly Archives: November 2016

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

Latvia Day 2 : Dienā, Rīgā

I sat bolt upright in the bed with full daylight streaming into the window.  Panicking, I was sure that we had wasted our one day full day in Rīga by sleeping in! Luckliy, my trusted iPhone assured me it was only 5 am.

Wait! 5 am? How was that lucky?? It’s vacation and I like to sleep! 

Being unprepared for the intensity of the sunlight at such early hours, I had not drawn the heavy curtain across the window.  After a few tugs on the curtain, I climbed back into bed for a little more sleep.  While I may have drifted in and out of sleep for a short time, it was apparent that the excitement of touring Rīga was not going to allow sleeping. 

Our second day in Rīga was all about family, my family, family living in Latvia, family visiting Latvia, family in Latvia for the first time and soon to be family.  But, mostly, our second day was about Vecsriga.  All in all, we squeezed in a pretty significant day. 

Armed with a map, iPhone GPS and detailed notes I had written down in a little book with “Don’t Panic” written in friendly letters in the front, we headed out on our own into Vecrīga.  


There is no doubt that on your first visit to Rīga that everyone will tell you that you must go see Svētā Pētera baznīca (St. Peter’s church) which is the tallest church in Vecrīga providing fabulous views at every angle.  Not to be dismissed is the much smaller Svētā Jāņa baznīca (St. John’s) next door that claims to be the oldest church in Rīga.  However, there was no “established date” posted for me to find out just how old it was. I have since found out that St. John’s began holding Lutheran services in 1213 AD.  I was stunned at the beauty of the ceiling but, then, the mathematician in me loves the geometric patterns. 

The Gothic ceiling of Svētā Jāna baznīca


If you are curious as to what filled our time in between the highlights that I am capturing in the blog, the answer is walking.  Walk, walk, walking.  However, in this particular case, Svētā Pētera baznīca (St. Peter’s) is right across the street from St. John’s.  

Mikel in front of Svētā Pētera baznīca

 

St. Peter’s started showing up in history in 1209 which is, technically, before St. John’s claim as the oldest church.  However, I’m sure each church has their own way to spin the story on being the oldest.  St. Peter’s is much larger and has a long history of periods of construction, lightening fire, World War II fire, steeple collapse, reconstruction  and a total of seven different roosters on top of the steeple.  In more recent times, an elevator was installed so that you can go to the top of the tower, 236 ft., to see what the rooster saw. 

The Rooster’s Eye View: One of the spectacular views from St. Peter’s tower

 

I’ve been on the top many towers from Seattle to Toronto to New York. I’ve been in the top of many duomos in Italy. Let me tell you, Italy is beautiful. I could see why the US general forbade the bombing of Sienna in WWII.  Yet, I think the view of Vecrīga is possibly the most stunning city view I have ever beheld from above.  Modern cities are primarily shades of grey. Vecrīga is the whole rainbow.  In hindsight, I didn’t take enough pictures of Vecrīga’s architecture.  Luckily, there is a page on Facebook called Latvia Art & Architecture that regularly shares spectacular photos of Latvia for me to enjoy and remanisce.  A picture of Riga

After St. Peter’s, we walked over to the  nearby square for a short break on a bench while absorbing the architecture of the House of the Blackheads.  It was reconstructed in the 90’s. A prophecy was once written on the building’s doors: “If I am destined to ruination, I will be rebuilt by you!” 

The single most impactful event of the trip to Latvia was our visit to the Occupation museum.  Unlike the rest of Vecrīga, the building housing the Occupation Museum is far from an architectural delight. Given that the subject of the museum is Occupation of Latvia by the Soviets and Germans, I think the appearance of the building suits the subject. Inside the boys got their first real connection with how their grandparents ended up in the US.  Countrymen being deported to Siberia and living in wooden barracks. Some never to return or be heard from again. Our relatives being lucky enough to receive a warning not to return to the farm on one particular evening as the Soviets descended upon the farmers… The Latvians that remained behind resisted the occupation through a calm and strong ability to hold onto their culture and folk songs. Eventually, their freedom was restored after 51 years of occupation.  

By now, we’d already been to many important sights around Vecrīga and it was not even lunchtime yet. Cousin Rob texted to say that he and the boys would meet us at the Irish Pub.  Perhaps Paddy Whalen’s Pub isn’t what you would expect in Riga but Rob claims it’s as Latvian as you can get since it’s been in business for over 20 years. We had been at the Hard Rock Cafe knock off but we lost interest as soon as we saw that there were only four things on the menu and PK couldn’t really come up with a translation to tell us what they were.  At Paddy Whalen’s, Rob ordered karbonāde (pork chops) without even looking at a menu.  Over beer and apple juice in the courtyard, and while the Irish dancers practiced on the wooden stage, Rob filled us in on his memories as a young man on the town in Riga at Paddy Whalen’s Pub.

By the way, let me recommend the apple juice in Latvia. Besides the apple juice being delicious, juice is one of those American drinks that isn’t served with ice so it is a lot easier to accept that you won’t get ice in your drink in Latvia when you order apple juice.   

We all left Paddy Whalen’s together to wander around Vecrīga.  Just as we rounded the next corner, we bumped into Matiss, the groom, accompanied by a Kukainis cousin, coming out of a cafe.  These gentlemen were headed over to Petergailis, which is a cafe in the shadows of St. Peter’s church, to meet up with family friends.  They insisted that we should come along with them.  The boys, both Kengis and Kukainis, were not in the mood for more sitting at a cafe even if it was a gorgeous and sunny ~70 degree day.  But, one of the amazing things about Vecsriga is that without cars driving around, it is fairly quiet.  So, the two older Kengis boys took the younger Kukainis boys out to walk around St. Peter’s and play on a wooden horse statue nearby while the adults visited with family and friends.  I’m sure that a normal visit to Latvia would not result in running into family and friends on every corner or at every cafe. But, since a large number of visits to Latvia are the result of attending a wedding, it’s not unusual either.  

Our next adventure was the heavily recommended canal boat tour. It starts on Pilsētas Kanals near Bastion Hill and encircles Rīga on Daugava River.   We selected one of the small, shallow wooden boats piloted by a Russian.  One has to be careful to distribute the weight of the adults carefully to maintain the balance of the boat!  Let’s just say, we had a close call.  

Dzelzceļa Tilts on Daugava

A well balance boat floats true.


Ivars, another Kengis cousin who lives in Latvia, was in Riga for the afternoon while his mother, Ginta, attended the bridal shower.  Ginta lives in Kalamazoo but had been visiting Ivars for the summer.  So, Ivars wanted to meet up while he was waiting for his mom.  It was also a chance for us to unload the lawnmower blades! Finally!  

Ivars presented the boys with souvenir mugs with their names engraved in them. Rīga, the only place in the world that has my kids names on the souvenirs.  Then we ducked into McDonald’s.  Not to worry!  The only reason we stopped into McDonald’s was to avoid a short rain storm. It was our only visit to McDonald’s on that trip and we never went past the vestibule. 

Ivars was looking for a late lunch so we ended up back at Petergailis for the 3rd time that day.  It was actually a lucky break for Mikel because he had noticed the Rīga Cinema Museum (Rīga Kino Muzejs) on the map during our rest in front of The House of Blackheads and had put that at the top of the activities he wanted to do. PK, happy to get caught up with Ivars , stayed at Petergailis while Mikel, Karlis and I wandered through the cobblestone streets on our own to find Kino Muzejs.  

We had been warned on more than one occasion that it was easy to get turned around in the cobblestone streets of Riga.  However, I’m good with maps, Karlis remembers things, and Mikel had a drive to see the film and theater museum. Although, when we arrived at the building I was sure was the museum, it didn’t look like an entrance.  We turned corners and looked up and down streets, always ending up in the same place. Finally, we got the nerve to go up to the door only to realize we had been correct the very first time.  I guess sometimes you need to trust your gut.

Picture taken from the Wikipedia page.


The museum was small but still interesting. It covered films, actors and directors. Most everything had a strong Soviet influence as a result of the occupation. I think it will be very interesting to visit this museum again in the future to see what changes take place now that Riga is becoming a well known European cultural center. 

We parted ways with Ivars and his lawnmower blades. Now, it was time to meet up with yet another Kengis cousin, also first time visitors to Latvia, Andrea and her husband, Tony.  Per Ivars suggestion we went to Rozengrals, a midieval themed restaurant located in the old wine vault of the City of Riga Council of 1293.  This was definitely going to be an adventure, but, before I go any further, just remove any visuals you have of Midieval Times.  It’s not that kind of restaurant.  Although, we knew what we were ordering, courtesy of English language menus, we were not quite prepared for the delights that came to our table. 

Karlis and the pork shank, Mikel too.


Karlis ordered the pork shank. It looked like a huge turkey leg and easily could have fed two grown men. I understand it was delicious.   I’m not sure why I didn’t get to try it for myself.  

I suppose it is a bit much to expect a midieval restaurant to serve ice in the drinks? 

Mikel had the fish that was presented in a way that looked like it was still able to swim right off his plate.  

Photo courtesy of Rozengals webpage

Mikel was a little perplexed in how to attack a fish presented in such manner but once PK helped him lay it open and take out the bones, Mikel didn’t hesitate to devour the flaky fish. I give big props to my kids for going to a forgeign country and eating whatever was given to them. 

The best part of this meal was the dessert.  The boys ordered pistachio ice cream on ice.  So, the waitress brought them two scoops of ice cream sitting upon a block of ice almost as big as a cinder block. 


It was torture.  I mean, just look at Tony’s distress in the background of the picture.  The whole time we had been in Riga, we were searching for ice, ordering ice then asking for more ice.  Then comes dessert served on a large, useless, wasted chunk of ice.  If I could have wrapped it up in a napkin and taken it home with me, I would have. 

After a quick tour of  Andrea and Tony’s 5 star hotel room, Andrea and Tony headed over to a bar just a block from our apartment. PK opted to go back to the apartment with the boys while I went out for just “one drink” with Andrea, Tony, the groom,the bridal party and a significant collection of other friends and relatives.  Walking down the street to the restaurant, the area seemed a little sketchy but once we were inside the courtyard area it was chic and modern. The topic of conversations that I was engaged in tended to center around what we had done or seen in our 1.5 days Rīga. It was always achknowledged that we had completed the top “must see” places of Riga.  Some that I conversed with were surprised to learn about the Kinomuzejs.   Nice job, Mikel. 

I snuck out of the party just as it was getting too dark to walk alone or possibly as another round of tequila was being poured.  I left the rest behind for what I understand was a very, very late night.

I may have missed out on an all night in Riga, but I have no regrets as my Friday was packed full of plans with places to go in Latvia and old castles to see.  

So, tune in next time as my family and I drive off into the Latvian countryside…

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Filed under family, Latvia, Lessons learned, PseudoLatvianism, travel