Sunday, October 7, 2012

Hip Labral Tear Repair Impingment FAI Arthroscopic Surgery Hip Dysplasia

There is tons of negative stuff out there about the complex rare world of hip labral tears, impingement  FAI and Dysplasia. So much that I almost did not go through with the surgery.  I hope this helps you process your issues and you are able to make a decision with predictive success. -- Micah





Diagnosis: Labral Tear Right Hip, Bone Spurs, Cysts, 50% Arthritic (Worn Cartilage) and Hip Dysplasia 18% and FAI. 
Age: 38
Weight: 190 lbs
Height: 5' 11 3/4"
Activities: Former Div 1 Decathlete/Pole Vaulter and active Basketball/Surf/Wakeboarder/Half Marathoner, Countless hours of baskeball. 
Options: Total Hip Replacement, Wait and See, Arthroplasty or Arthroscopic Surgery
Procedure: 3.5 Hours, Repair of Labral Tear (With Stitches Not Debridement) shaving of bone spurs
Surgeon: Dr. William Jiranek, VCU Richmond VA
Risks: Hip Dysplasia will cause another tear making the arthroscopy a waste and increase the need for early Total Hip Replacement
Symptoms: In-Frequent Pain Sitting, Driving, Trouble Sleeping, dull aches, sharp pains, tight hip flexors, 


Pre-Surgery
This page lays out the facts better than anything I could find on the internet: http://www.bryankellymd.com/hip_arthroscopy.html

I firmly believe labral tear was triggered my college freshmen year training as a track & field athlete at Liberty University. Although congenital hip dysplasia is my overall issue the over activity of training 6 to 8 hours a day increased the degeneration. I had the popping hip treated with inserts, ultrasound, injections and rigorous stretching. I finally gave up and learned to just deal with the pain. Unfortunately, at longer distances I always seem to give out faster than others regardless of training, endurance or heart. A 17ft pole vault in the video below and a 7,400 decathlon score is still very respectable and most years earns D1 All-America.  

I've had off and on pain through my 20's but honestly I was not that active while trying to climb the corporate ladder in Tampa. Heavy wakeboarding ages 28-35 daily might have contributed but I feel my last three years chalking up over 1,129 miles on Nike+ was where I did most of my cartilage destruction.
http://nikeplus.nike.com/plus/running/home/MicahGaudio



Day 1 - Surgery Disorganized Confusion

I was really losing confidence in my choice with Juranek. It was only 3 weeks since I first met him on 9/6 and was diagnosed. It all seemed to be happening too fast and the more I read on the internet the more I wanted to just wait. His office called twice; the first time they said they were performing Arthroplasty instead of Athroscopy.  He called and asked me about our conversation which I didn't remember - but I think I would remembered a conversation about hip cracking and resetting my hips with a year recovery. He agreed to do the arthroscope first. He also said he does about 50 Athroplasty's & Arthroscopes a year which is pretty diverse given he is ranked as a top 10 Hip Replacement Doc in the country. I received another call the Friday before telling me my surgery was at 12:00 then another call stating the surgery was at 7:30 am. I was beginning to believe there was two Micah Gaudio's in the country have hip surgery the same day.  

We arrived at VCU Medical Center 5:30 am left around 6:00 pm. There is no Valet before 6:00 am. Confusion in the pre-opt room, they were about to do a spinal epidural until Juranek stopped them and said he wanted to be as least invasive as possible. I asked him if he was going to debreede the tear or stitch repair or would he make the call once inside based on damage. He said he had already made the call to repair and save as much tissue as possible and it should only take an hour and a half. That put me at ease. 



Three and a half hours later they said I woke very nauseated - I don't remember. My left "Good" leg was wrapped in ACE bandage totally numb from the knee down. A (not so smart) nurse said they bone grafted my leg which sent me into a anxiety attack. It was great having nurse after nurse stand over me why I tried to urinate - maybe like four hours. Hand in hot water, a warm wash clothe, more fluids - the pain to go was so intense.  One nurse trying to revive feeling by massaging my feet grabbed and popped my broke toe. Ouch! At nurse change around 4 or 5 a new (more common sense) nurse came in removed the ACE bandage, tired of waiting for Juranek to come back from another surgery. His name was Tony - he was great, he even went down to the drug store on his own dime and got me the blood thinners that the VCU mobile prescription nurse couldn't fill - only God knows why - its just aspirin people. He even helped me to my feet - I couldn't walk because my good leg was completely numb and walk to the restroom where I urinated for a straight 15 minutes. Juranek came back after the ordeal and explained because of the longer surgery the left leg circulation should come back the next day.

  • Dilaudid every three hours - set the alarm on my phone for accuracy
  • 1 blood thinner 325mg Aspirin 
  • Seemed like I was getting up every two hours to go to the restroom anyway
  • Thank you Shannon for taking care of me
  • Taking stool softener as much as possible even an ex lax to avoid constipation


Day 2 - Coming Home

So far a success! The relief feels as if a thorn has been removed, the joint is fluid and smooth. I was actually able to full weight bear today. Of course, I am taking it easy and have a long road ahead. The most pain has been from the complications of surgery which have forced me to focus on every thing else but my hip.
  • OMG I about died this morning trying to swallow a glucosamine pill - it was literally stuck in my lower throat - my wife was in the hotel lobby getting coffee at Starbucks, 30 to 60 seconds not breathing, choking, holy crap I've never been so scared in my life.
  • 3 hr. trip home back in the car
  • Oozing from front staples minimal
  • 1 blood thinner 325mg Aspirin 
  • No Oozing from back stictches
  • Dilaudid every three hours - set the alarm on my phone for accuracy
  • Mostly stayed in bed and watch a movie with the kids but noticed my hip was suprisingly very flexible and did not hurt at all
  • Left good leg feeling cam back about 95% but still feels a little numb or frostbitten which makes walking with crutches easier
  • I take two anatabloc every night mostly for sleep but it is a miracle anti-inflammatory nuetracetical! Not sure why it knocks me out better than anything else.


Day 3 - Constipation - Really???

  • Removed dressing applied waterproof band aids and took firs shower - Ahh!
  • Make sure you remove all adhesive with acohol or it will cause a rash
  • Still slight oozing from front incisions 
  • noon the constipation set in - I did not win my battle until 11:30pm on the floor with a Fleet Enema - the most pain I have been is so far
  • amazingly the hip tolerated me even full on walking without crutches in moments of constipation pain and extreme jarring on the porcelynn goddess
Day 4 - Back To Work


  • Off pain killers but I still feel dizzy and tire very easy
  • Took several naps, was able to sleep on side and stomache
  • Started using topical treatments for rash of the bandages

Day 5 - Friday

Had a great nights sleep maybe woke twice slept on side for half of the night - got up around 10 tried working but had go back to sleep after Shannon took me to lunch - I was exhausted.


Day 6 - Gameday
Went to homecoming walked about a mile - sore and dead tired.

Day 7 - Church
Had another great night's sleep, walked about a mile around church - I'm pretty confident walking around with out crutches trying to transition to a cane.

Day 8 - Monday
Ouch what the heck - I'm sore and feel like I'm going backwards.

Day 9 - Follow-Up
Nurse removed staples replaced with sticky tape. Said take it easy you will not be recovered until 4 to 6 months? Doctor follow up on Nov 7th. Keep taking blood thinner once a day.




Trying to negotiate 2 substantial corp. business deals at the same time adding to stress levels
Facebook featured my work on the home page of Facebook.com/marketing


Day 10 - Wednesday
Absolutely horrible day! Started trying to walk more with the cane. My hip screams at me STOP! Tired exhausted feel like my energy is half what it used to be. Irritable.

Day 11 - Driving
No problem driving use my right foot to break sometimes and hold leg with my right hand occasionally. Another bad day I feel like me hip is not getting better but staying stable or constant. Using crutches. Falling behind miserably at work - clients are taking notice and are really insensitive, not understanding, flat out demanding. I'm trying avoidance because honestly some of them I would like to fire right now. I'm gaining weight 5 to 10 pounds which could be adding to the sluggish feeling. I only crave bad food. My usual trips to the grocery store to buy and cook fresh are hampered by the hassle of walking with crutches.

Day 12 - Friday - Spoke at a Mocial Seminar
Wow I had to ask someone to carry my bag. There were a few moments of brightness though I feel sluggish. One time I just started walking away from a urinal without my crutches without any pain and felt normal. I was able to lift my leg up to my bed and get into a car with out using the help of my arm. 

Not feeling like the 14 day milestone will be anything great. In fact, I'm wondering if this was worth it - trying to remember how bad my hip was. No doubt - I've hit some kind of wall right now. The fact that it might be spring before I do anything again like jump or run. The fact that I have probably turn my last flip on a wakeboard or possible won't snowboard again, having only to run short distances, not play ball with my son or even really be able to help coach pole vaulters and throwers this winter is setting in. No more breakdancing heck I'm not even sure I'll be able to dance in general. I feel severely handicapped and its really starting to mess with my mind. I've never not been active for more than 60 days in my entire life and that only happened twice. I'm going on 75 days of no activity - feeling like I'm 65 and I'm ready to throw in the towel and start playing video games.


Day 13 - Saturday - A New Man
Woke up Saturday a whole new person and mentally back up! I found it easier to walk with the cane in my left hand it hurts my hip to walk with it in my right. I don't like walking with the cane. Crutches allow my hip to swing freely I can put as much weight as I need or want to. My wife is sick so I championed the hoover round today in the grocery store.





Two Weeks After Surgery Days 14 - 20 Big Improvements
I can walk short distances like going to the bathroom or back and forth from the kitchen. When I push too far its like running up a hill the hip just fatigues like a burn out push up or arm curl and I know I'm done. I rode a bike (Really Stupid) it was great going downhill but could not pedal uphill with out the dull "you are pushing me to hard" feeling.

  • Back in forth between crutches and the cane depending on length of time 
  • Driving well 
  • Sleeping on all four sides 
  • Able to put on socks
  • Fully weight bare on surgery hip and slide on a pair of pants
  • Walking up and down stairs with a handrail
  • Able to resume sexual activity
  • Carrying light objects
  • Lots of itching inside, probably the internal stitches healing and dissolving


(With Cane) Went to my first track practice mid-week and helped coach the pole vaulters - very good for my mental attitude. Playing some Call Of Duty MW3 like a total of 4 hours which is probably a record for me. I work all day sitting and usually go to bed at midnight and wake up at 6am. Don't need three power naps a day now.

(With Cane) Went to HS homecoming game and watched my daughter cheer walked up to the private box.

Stood in line for 2 hours with my crutches, with my 7 year-old and 10 year-old at a popular haunted house then another hour walking through the houses and trails. This type activity challenge was good. I certainly over did it but it empowered me. I took 2 nepraxins immediately when we got home. This is first of any drug I have taken in a week. I stopped the aspirin on day 14. I feel like my body naturally heals better without masking pain or anything else. I need to feel pain, know when I'm pushing to far. I take two anatabloc every night mostly for sleep but it is a miracle anti-inflammatory nuetracetical! Not sure why it knocks me out better than anything else.

Overall: I'm feeling better about having the surgery but I really want to know how far and how quickly will I be able to go? I'm not some elite athlete anymore, who cares, why I am seriously considering not snowboarding or running ever again? I don't like the way people in public want to help me out more than usual or stare at me. Really what keeps me up at night is should I snow ski or snowboard, which will be easier on my hip? Running doesn't sound like fun if I'm going to be handicapped at 50. I did have delusions of competing in the Masters decathlon or even completing an iron man when I'm older - that will never happen. Golf, hunting and fishing are starting to look appealing.

I'm still not right - let's not get ahead of ourselves.


Three Weeks After Surgery Days 21 - 28
OK three weeks after surgery and some slow progression. Stretching really seemed to aggravate my hip more than over use or heavy walking. Overall from the start of the week to the end this is the fastest recovery week. I even was able to stand and dance with my cane at a party on the last day. This is a very slow recovery its like three steps forward two back then four more steps forward the three back if that make sense. The limp is going away but I have to concentrate hard to walk normal its almost like I'm in a habit of limping and its all mental. A worker asked me today if he could help me in the shoe section of Dick's. I said "No, I'm just looking and dreaming about possibly running again before I die!" Even I choked myself up a little bit. At BestBuy, I was starring at a Nike GPS watch I swore I would buy myself if it came in white. And there it was then it hit me that would be a total waste of money.


Four Weeks After Surgery Days 28 - 35
OK so its Monday exactly four weeks after surgery. I now freely walk around house without a cane but if I'm going somewhere I always walk with the cane. Life is starting to resume as normal except for the weight I have gained really depresses me. Going back to a strict South Beach diet. Will keep you posted!


1st Follow-Up With Jiranek November 7th - GLUCOSAMINE??? REALLY???
Short and sweet great bedside manner. My choice is simple start running again and I'll get a hip replacement in 5-10 years if I take it easy maybe 20 years. My wife told me to just get better and do whatever I want because by that time hip replacements should be even better given technology. Then the shocker. I swore to the doctors assistant that Glucosmine was the only thing that helped my pre-surgery pain. His exact words were "Good For You" as if to say "keep taking your sugar pills". Then Dr. Jiranek told me the body stops making glucosamine naturally at around 40. Since I'm 38 and the way he scraped the bone this could be a time to rebuild some cartilage. Since I almost died of choking the first day after surgery I thought it was a sign from God to stop. Since I've been taking various mixes of 1500 milagrams a day. I swear to you it works like Alieve for me. I'm taking nothing else and notice if I miss a day.

I've been so busy walking around acting normal and with Thanksgiving totally forgot to blog - sorry. I've done some light biking, swimming and a lot of stretching. My dentist told me a story of a 90 year-old man who constantly beats him and races and he said the key to longevity is rest. Making sure your body heals properly before pushing it too far. So I've been taking that advice. Though I could probably run, jump or even board I'm not until I'm totally sure I'm ready.

Attended the Clemson USC football game tailgated and walked around for about 8 hrs. No Pain the next day. Also rode bikes a few times with my son and blew leaves around the entire yard.

Also been coaching pole vault and track at the local High School. Giving kids spots is probably not the smartest thing but its OK. Rough housing with my kids is something they missed. Picked my six-year-old up and carried him up the step.

SUMMARY - You could say I resumed normal life around 6 to 7 weeks. 



3 Months - December 2012 - Glucosamine is where it is at!
Ok so its December. I played kinnect Star Wars for a good hour Fiday, the most I've sweated in months, jumping, kicking trying to defeat count Dooku. My arm is the only thing that hurts from swinging a light saber. Starting squats, push ups, weights, biking, swimming etc.

Promise I'll start pushing myself in Dec. 

OK nothing happened in December except 10 pounds and a 2 week vacation in FL sorry I'm just enjoying being pain FREE and don't want to push myself.

4 Months - January 2013 - Finally a return to physical activity after 6 months
Got back around the 8th and bought XBox 360 Nike+ Connect Training. Love it keeps me active in all the right places and lost 10 pounds on the South Beach diet. Today is January 31st and I just skied heavily for 3 hours the ski patrol actually came up to me and asked me to slow down "Really" that's funny. I also pole vaulted 12ft with a straight pole at practice this past week - that hurt in a healthy way. I'm kidding about being hurt in this break dancing video. 




Snowboarding is definitely OUT :( it moves my hip in all the wrong places. So is distance running like anything over a light mile. Sprinting, Biking & Swimming is good. Not taking anything - no glucosamine, nothing, not even a anti-inflammatory or vitamins. Very health diet lean meats and fish and vegetables no carbs and sugars - white bread is the devil.     




Overall when I feel pain in the arthro hip its more like re-injuring a bad sprain or a deep stretch. Which I feel is good and part of the rehab process - the pain goes away quickly sometimes I feel good that night. Unlike my other hip where the pain lingers for days.

5 Months - February 2013
February was a really good month. Skiing roughly 3x a week with my son. Scared to get back on a snowboard. I actually feel like I might be better on skis???
Xbox 360 Nike Connect training is awesome and works my hips in all the right places.
Experimenting with different kinds of Glucosamine with mixed results. Trying to ween myself off of it slowly - I use it like naproxen - I'm expecting flare ups but haven't really experienced it severely yet.

This video shows that I'm not exactly leisurely skiing around. Again I had no PT just rest but I did push myself too hard too quickly to walk again.



6 Months - March 2013
Have a trip planned to ski Jackson Hole. We will see...

We got 2ft of powder here at home in VA so I got some great training for Jackson. Everything went well skiing 3x a week but I tried to snowboard for an hour once and paid dearly. Lots of pain just felt like I was grinding my hip down - hurt for a few days then fine.

Ok so the trip to Jackson was epic, about 60 inches of powder fell while I was there. My weight was around 192 and I was in great hiking and skiing shape. My friend noticed on some gopro footage that I was favoring my good leg, very discouraging and it caused some horrific falls - video to come. So the last day I tried skiing just on my bad leg to over compensate. I don't think this was caused because I couldn't apply pressure or that it was weaker in any way. I just think my mind is taking over in situations and guarding my bad hip. Also I could have started skiing in January on one leg and retrained myself a bad habit that will be hard to break. You can see in the video above how my right leg wobbles and there is not equal pressure on the edge of the ski like my left leg. There is even a few times where there is no pressure on the right leg almost resulting in a fall.
Overall hip is good - can you imagine how great I would feel if I wasn't stressing it at all? Not really - I find when I do nothing my hip does sometimes just gets agitated as opposed to doing nothing. Drive our SUV where there is no place to rest my knee agitates my hip as opposed to my car where I can rest it against the console. Since I've been back I've noticed the back of my right knee stiffens up bad when I sit without moving it. Worse now knowing the pain of a tear - I'm 100% convinced I have a tear in my right shoulder. The pain is not to the point where I would put my family or myself through a surgery but it is in my future for sure.

Another thought: that doctor in Colorado and Kelly are the best 2 docs in the business - so if you really want success you should seek these two out they fixed A-Rod and Lady Gaga:

http://msn.foxsports.com/mlb/story/new-york-yankees-alex-rodriguez-calls-return-from-hip-surgery-a-great-challenge-040113

http://www.dailymail.co.uk/tvshowbiz/article-2303457/Lady-Gaga-walks-Singer-struts-yoga-class-high-heels--leaves-wheelchair.html?ito=feeds-newsxml

http://www.nypost.com/p/pagesix/rod_gaga_joined_at_hips_goVHSvozbwTfT4okYgJxVP
  


7 Months - April 2013
Will keep you posted... struggling with weight and binge drinking? Why? Also went wakeboarding and wakesurfing for the first time on 4/11. Noticed the weight favoring on my left leg wakeboarding caused a really bad fall and some whiplash. Neck and abs are killing me but hip is fine. Wakesurfing was great felt like I could go forever but I didn't crouch down really low which is what killed me before - will try next time and report...

8 Months - May 2013
Ok so I'm doing very well numbness in my right knee after sitting or driving for more than 15 minutes. Infrequent could be something else.

9 Months - June 2013
We moved in to a new house. We had three movers but I couldn't resist - only normal soreness. So I bought a lawn mower for the first time 15 years. I love the exercise, mid sized yard lots of hills. NO PAIN. NO SORENESS.

10 Months - August 2013 - Annual Follow Up
So now I know why my hip feels fine but above it is sore. Its called a Heterotopic Bone. See the floating bone above my hip that has grown?  Not sure what to do - will wait until it bothers me then will seek to have it removed. Juranik said it was due to the stem cells of the surgery. 




12 Months - October 2013 - I DROPPED 20 POUNDS!
Now I am exactly the weight before surgery - actually a little better at 184 lbs. I feel great and am not limited in anyway. Just don't think I will run over 3 miles ever again - too much grinding. The South Beach diet takes all the credit for the weight loss. About 100 push ups and 1,000 sit ups on most nights. Wakesurfing is no problem no pain no soreness after which is the big deterrent for me participating in sports but I'm almost 40 - it should take longer to recover.




+18 Months - So feeling pretty good I decided to start running and snowboarding again. Big mistake. Biking and skiing seemed to have no effect even played some hoops with no pain. But the dull pain is pack. I simply forgot how unbearable the pain was. Depending on you injury you have to remember this is for life so why mess it more by being overactive. You can still be active without hurting yourself - find it.

Here's my plan I'll keep you posted.


  • My weight was 184 through the period I was feeling best. Yeah I'm 195 now but 10 lbs could be a big deal.
  • Avoid certain sexual positions - Enough said
  • When I was feeling the best - I was doing about 1,000 crunches a night and using a ball - will post some of the exercises.
  • Crunch Naproxen when you have a flare up - usually a couple right before bed allows the swelling to go down so you can heal.
  • Going to start the glucosamine again tomorrow.
  • Driving long periods in the wrong car - use cruise as much as possible.

SUMMARY
It's all good. Keep in mind most of the things you read are negative because the people that are doing great don't have time to complain about it. And for good reason. I found when I'm doing well its hard to sit down and write about it but if I'm having problems with my hip I'm all over this post sharing. So keep that in mind and best of luck - hope this blog didn't bore you to death. :)