Ramblings, musings and generally boring stuff. Mostly about bikes...

Sunday, January 29, 2017

Diminishing returns

I've contemplated starting this back up for some time but wasn't sure if it was worth it. I've been reading a lot of blogs about other people's experiences, thoughts, recommendations and journeys but unsure if lending my voice would lend anything meaningful.
I think I'll take a stab at this blogging thing again, more for my own processing and archiving than anything else.

I used to be a cyclist. I've been clinging to my identity as an amateur athlete for the last year, but I am watching it slowly slide away from my reach each day. My experiences to this point have been a little surreal. It started with some pain in my hip a couple of years ago. Despite it, I was able to ride, train and race, but the injury was nagging and would often worsen in the winter months when strength training and trainer time increased. I was able to do most things I wanted to do but I noticed fatigue, lack of ability to recover as quickly, muscle aches... You know, the stuff most people deal with as they age.

At first, I tried rest, ice, arnica/biofreeze. Massage, chiropractic appointments, a round of PT came next. Despite these interventions, I wasn't feeling better, but still riding. There were good days, and not so good days. I tried to keep up with running as cross training and watched my speed decline as the pain grew.

In February 2016,  I finally saw my PCP and he referred me to a Sports Orthopedic MD. Dr. Nawas took xrays and ordered an MRA with contrast. On my 41st Birthday, I received a diagnosis:  Hip Dysplasia, a small labral tear, impingement, cam lesion. For some reason, the Hip Dysplasia was not what I focused on in that appointment. I'd never heard of that in humans before and didn't think it was that big of a deal. I was concerned about the impingement, labral tear and cam lesion.  That appointment was kind of a blur. Dr. Nawas told me he could not treat me. He said there was a doctor in St Louis who specialized in a procedure that may be able to treat this.

I moved forward with doctor appointments and went to see Dr. Clohisy at Barnes about 6 weeks later. He confirmed the Hip Dysplasia and threw out some other terms I didn't fully understand. He assured me we didn't need to even think about surgery at this point and wrote scripts for anti inflammatory and a cortisone injection. Relieved, I left his office with the injection appointment and started Meloxicam.

I started the Meloxicam right away and didn't think I noticed a difference, until I had to stop taking it the week prior to the cortisone injection. I was very anxious about the cortisone injection, after the MRA essentially left me unable to lift my leg to walk for several hours and caused increased pain in my hip (I think from having my toes taped together in the MRI machine for 45 minutes). The injection went quickly, without incident. I was hopeful it would be amazing and wonderful, but I am not sure it made much difference. I was still having pain in my thigh and above my knee when riding hills, in wind or pushing hard.

Still, I continued to ride and race as much as possible. I managed to keep up with the Wednesday Night Time Trials, with times that were not that far off from the last 2 years. I experimented with kinesio tape on my thigh and knee, with position on the bars, saddle, maintaining a flat back and opening my pelvis. As the season ended, I watched my training volume and intensity decrease gradually but steadily.

August brought my follow up with Dr. Clohisy. The cortisone was not the magic shot I had hoped for, but I went into my appointment hopeful that there were other, non-surgical, options yet to be explored. I was completely taken by surprise when the resident started to explain the surgical procedure, "Dr Clohisy will cut your pelvis in three places....." Woah! Wait a minute.....

I managed to convince myself and Dr. Clohisy that another round of physical therapy was really what I was missing. We agreed to put off a surgery decision until I had gone through a few more months of PT. I set up an appointment at Washington University for late August. In the meantime, I started investigating some personal training options, to compliment the PT work.

My PT assessment gave me some insight into what was happening, but also lead to more pain, frustrations and questions. I've learned my glutes were not firing and I have significant muscle imbalances, particularly on the right side. My quads and psoas are overactive, trying to do all of the work. I also learned that some curvature of my spine is further complicating and adding to the imbalances and challenges.
I left PT with exercises and hope. Despite making improvements over the next several months, I felt like I was going backwards on the bike: Struggling to ride, still having pain and moving slower than I have in years. In November, the PT said I was successful by her goals but those just weren't in line with mine. Her response was to give me a list of things to stop doing, which pretty much consisted of everything I was interested in doing. I cut out most of my strength training, all running, did very gentle modified yoga, limited riding and trainer workouts. Yet the pain would still come.

It's tough though. So many people around me are in PAIN. Like make you want to toss your cookies and see stars. I don't have that kind of pain. Rarely, if ever, do things hurt more than a 5 (sometimes, if I've "pulled" something, it momentarily goes higher but I can avoid those movements until things improve).

Sometimes I get defiant and I try to do things I know bring me pain. I tried to run a 5K in October and could barely walk at the finish. Sometimes my joint just "isn't right". It just doesn't move correctly. I struggle to take stairs the normal way, foot over foot. But I can live like this, right?

After looking at how much I've modified my life, I decided to go back to Dr. Clohisy with the consideration of surgery. Phil accompanied me, and we ran through my long list of questions with the resident and Dr. Clohisy. The outcome was a surgery date: July 17, 2017. Periacetabular Osteotomy.
Dr. Clohisy will break my pelvis in three places to provide better coverage of my hip socket over my femoral head, shave some off the cam lesion off the neck of my femur, if necessary and I'm not entirely sure what else. I'll be gifted with several screws holding my pelvis together while the bones heal. I will be on crutches for 6-8 weeks of non-weight bearing and then moving off crutches over several more weeks. All in, it's about a year to fully recovery, but the success rates are pretty good. I figured I could schedule surgery and still "see how things go" over the next few months. Really, no matter how I look at it, I'm screwed.

My head's a mess from all of this. I'm barely on my bike at all any more. I've ridden outside less than 6 times since November. My trainer time reduces each week. I'm isolating more and more, although there's not been much opportunity to be social. I don't seem to even get invited to ride with the usual friends any more, but I understand I'm more of a burden to include now. I feel like I've fallen out of favor. I'm still here. I'm just a different version of myself.

I don't even feel like they really understand what's going on with me. Wow, that sounds whiny. And I don't really understand what's going on with me.
Maybe I'll just sit with that for a minute.

No comments: