1 Step Forward, 2 Steps Back

Another year. Another surgery. Another long unexpected hospital stay.

After sitting out last season with my elbow, I had high hopes of racing my first Ironman and qualifying for Kona this year at IMTX.  Training was going really well and I was just starting to get into the longer rides/runs.  In late February, I was on a 16 mile run at Riverbend park and at the 6 mile mark, my left hip tightened up.  I ran about 1/4 mile on it and stopped to stretch it for 10-15 minutes.  I tried to continue on my run and only made it 100 meters before I pulled the plug on the days run.  I probably could have made it another 10 miles but who knows what damage I would have done.  At the time, I thought it was just muscular and didn’t want to risk damaging it more.  Live to fight another day.

The next couple weeks was spent stretching, icing, chiro visits, and more stretching.  I tried running on it a few times but would only make it 10 minutes before I would feel something was still off.  If you’ve ever had a hip issues, you know it is extremely hard to determine where the pain is coming from and difficult to describe (this is one of many reasons why hip injuries are often mis-diagnosed).  Fortunately, I was never in excruciating pain.  I was walking fine (without pain) and was still able to bike.  After a couple weeks of minimal improvement, a friend had recommended I go see Dr. Matthew Harris who is a hip specialist.  I saw him a few days later where he sat down with me for an entire hour!  I scheduled an x-ray and MRI shortly after which confirmed what Harris had already told me: femoral acetabular impingement (FAI… I have a cam on the femur head) and a labral tear.  I was given 3 options:

1. Surgery
2. Doc could get me to race IMTX but would be risking further damage
3. Rest and PT

I opted for option 3.  I did 8 weeks of PT which helped some but I still felt something was off.  I then tried a cortisone injection which alleviated my pain for 2 days.  I ran on the 2nd day and 10 minutes into the run, the pain was back.  At this point, it was late May and I had already started to think about surgery.  Labral tears do not heal…. ever.  FAI (which is essentially a bone spur) does not fix itself without surgery(think bone structure).  Many athletes are able to compete with FAI and labral tears pain free by PT and/or cortisone injections.  In my opinion, it’s only a matter of time before those symptoms come back.  Whether you have a cam or pincer, the acetabular and femur head will continually hit each during hip flexion and coincidentally slice the labrum in between.  I had already thought about what could happen months or maybe years down the road if I was able to get back to training pain free without surgery.  Since my pain wasn’t going away and not wanting to delay it anymore, I opted for surgery.

Surgery was only supposed to take 4 hours but when I woke up in post op, I asked what time it was and was told it was 6:30 PM (surgery started at 7:30 AM).  I was in surgery for 9 hours.  9 freaking hours.

NOTE: The MRI had only revealed 1 tear in my labrum.  Harris had my MRI specifically done on a 3T machine compared to a 1.5T.  Think 720p TV compared to 1080p TV.  Most MRI’s are done on a 1.5T machine but sometimes you need better resolution to see everything going on.  If you ever get an MRI, ask your doctor about 1.5T vs 3T and dye injection.  

Dr. Harris found not 1, not 2, but 3 tears in my labrum and nice big bump on my femur head.  Because of the location of the tears, Harris concluded my tears were actually from blunt force trauma (my bike wreck last year).  I landed pretty hard on my hip during the wreck.  The x-ray from a year ago in the ER revealed nothing wrong and I was only sore for a week or two.

Amazing what they can do with just 3 small incisions

I woke up in post op, I asked why do my feet and right leg hurt?  My feet felt like there was clamp on them.  They were both swollen and I could barely feel anything when the nurses touched them.  My right leg was completely swollen (like 4 to 5 times the normal size).  They had hooked me up to a catheter during surgery and they told me my urine color had turned brown (tea color).  They called in a nephrologist in fear of kidney damage.  He ordered some labs which came back with my ck level in the 30k’s (normal is below 300).  Ck is the muscle enzyme and if your muscles start breaking down too much, it will get in your blood stream and can cause kidney damage/failure.  The nephrologist diagnosed me with rhabdomyolysis.  I was originally supposed to stay 1 night in the hopsital as precaution for my hip on the orthopedic floor.  With rhabdo, I was admitted to the ICU and was told I would be in the hospital for a few days until my ck levels get back to normal.

So you are probably asking how do you get rhabdo from surgery.  Don’t worry, the doctors were asking the same thing for two days.  Fast forward two days to my birthday, I’m still in the ICU, my right leg is still swollen like crazy, I can barely bring my right knee towards my chest while lying in bed, my groin is black and blue, and I haven’t been out of bed for a day and half.  The only good thing was the operative leg felt great.  I needed to get out of bed to get things moving.  Harris had me move around quite a bit after I nicely complained about my aches.  I crutched around the ICU hallways and sat down/up in a chair in an effort to get things woken back up.  Shortly after, the nurses took labs again (they had been taking them roughly every 8 hours).  Labs came back and my ck level had gone up to 41k.  Needless to say, the nephrologist started freaking out.  I was ordered back in bed and not to move.  The nephrologist was really worried about my rhabdo and kidneys but had no idea why my ck levels were so high.  He ordered a heart ultrasound (my hr was in the 150s when I was walking around with my crutches), ekg, ultrasound on both legs to look for any blood clots, and a complete MRI on my lower extremities.  The ultrasounds and ekg all checked out fine.  MRI results come back showing a grade 3 strain in my right adductor muscle.  The muscle was so strained that it started breaking down causing the rhabdo.  During surgery, they took my right leg and moved it out to the side (abduction) and it sat like that for 9 hours on the operating table.

 MRI showing my adductor strain

A day later and after a lot of pleading with the doctors, I got transferred to the orthopedic floor.  It’s like a 5 star hotel there which was a much needed upgraded from the ICU.  My ck levels had started to go down again but not high enough to get me discharged.  (I also should mention that I barely slept in the hospital…. I probably averaged 2-3 hours of sleep a night).  The next day, Sunday, my ck levels were down to 17k.  At this point we understood why I had rhabdo and my levels were on the decline (they were in the 20k’s the day before).  So after some discussion with the doctors, they agreed to discharge me from the hospital but I had to come back the next few days for outpatient labs.  I was also ordered to stay hydrated (drink 150 ml/hr) and take it easy.  If it wasn’t for Dr Harris, I would have been in the hopsital for another week.  He realized how miserable I was and wanted to get me home ASAP but the nephrologists were very conservative and didn’t want to risk anything.  They wanted me bed rested to keep the rhabdo down while Dr Harris wanted me to move around some to keep my hip/muscles moving.  Talk about a catch 22.  Fortunately Dr. Harris made an agreement with the other doctors that he would keep tabs on me and make sure I was following their strict instructions.  So five days later after surgery, I was discharged from the hospital.

Here’s how the next few weeks went post discharge:

Week 1

– Hydrate
– Cpm machine for 6 hours a day
– Hip flexion restricted to 40%. No external/internal rotation
– Ck levels down to 13k and then 7k
– Right leg still swollen but slowly going down
– Left hip feels good
– Left foot is still numb
– Right foot numbness is getting better
– Crutches suck and sleep is minimal
– I can’t get comfortable in any position (lying down, sitting down, standing)

Week 2

– Hydrate
– Cpm machine for 6 hours a day
– Ck levels down to 878
– Right leg still swollen but getting better
– start PT
– Tried biking on a stationary bike but my adductor hated that.
– Right foot almost back to normal
– Left foot is still numb
– Minimal sleep
– Still completely uncomfortable in any position

Week 3

– Hip flexion restricted to 50%.  No external/internal rotation
– Ck levels finally back to normal at 178.  No more labs needed
– Start 50% weight bearing on left leg after week 2
– Pool work (mainly sculling back and forth)
– Right foot is back to normal
– Right leg swelling is almost gone but the adductor muscle is hard as a rock.  PT did some very light stretching on it.
– Left foot is best its been but its still numb at the top of the foot
– Stationary bike is now tolerable.
– Starting to sleep a little better.  Found a way to sleep on my side and stomach as I can’t sleep on my back
– Still uncomfortable but putting weight on the left leg is helping.

Week 4

– Hip flexion restricted to 60%. No external/internal rotation
– Started swimming but no flip turns (3 sessions of 1.5-2k yards)
– Right leg swelling is gone.  Adductor muscle still hates me
– Left foot numbness continues
– Up to 15 minutes on a stationary bike (no resistance)
– Figured out a way to put on my own socks.  I still can’t tie my own shoes.
– I drove for the first time (getting in and out of the car is a pain the first few weeks)

Week 5

– I can walk! (weight bearing as tolerated but have not needed them).  I walk with a limp but I have no pain walking.  My feet start hurting if I walk too much…. good thing its not my hip.
– Hip flexion restricted to 70%.  No external/internal rotation
– Did some more swimming.  Open turns suck.
– Left foot numbness continues but its the best its been.  Progress is slow.
– Right leg flexibility has gotten a lot better
– PT is getting easy.  I want to start doing more but that idea was quickly rejected.
– Went to watch loggerhead tri which was extremely hard to watch considering I won it two years ago. Next year, next year…

Week 6 (this week)

– Hip flexion restricted to 80%.  No external/internal rotation
– Got a massage on my right leg.  Flexibility continues to improve.  Almost back to normal.

So that just about sums up the past 5 weeks of my life.  It’s a long road back but I’ve never been more motivated and I will come back stronger than ever…

**Special thanks to Dr. Harris, my caring girlfriend, my wonderful mother, and my dog Bear.  Dr. Harris, you went above and beyond what is expected of ANY doctor.  I am truly grateful for all the time and energy you put into my care.  I owe you a beer…. or maybe an entire keg.  Thanks Mom and Mandy for caring for me and being my support team at home.  I love you both!  And, of course, thank you Bear for never leaving my side.**

Back to “training”

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