Day One

Friday, May 31, 2013
After a decent and uneventful first night, I had an appointment with Dr. Brown bright and early at 8:00AM.  While he had shared information regarding the procedure in a conference with Sara and Jacque, I was anxious to hear the details firsthand.  So, here is the rundown:

• damage was more extensive than first thought and what was visible in MRI, therefore the longer surgery time
• the excess boney structures were "like the hills of Sedona" and he removed a significant amount of bone
• cartilage was missing from the femoral head indicating an existing arthritic condition, microfracture procedure was performed to stimulate cartilage regrowth
• additional cartilage damage was found elsewhere within the joint and and was cleaned up
• my labrum was "chewed up" in his words, he tried repairing part of it, but it would not hold with sutures, so he ended up having to remove some of it, about the size of a dime, and was able to fix/cleanup the rest
• microfracture procedure was also performed on the acetabulum to try to stimulate growth of cartilage there as well

Overall, Dr. Brown was quite surprised that I had been able to accomplish the things I had recently in regards to running and other physical pursuits.  He stated that I was on a fast track for hip replacement, like within 2 years or so, had we not done this surgery when we did.  He mentioned the length of my drive to and from work and the fact that I have an 8 hour a day sit down job as main reasons for the extensive damage, and the running just compounded the pain.  He felt that I will return to running and an active lifestyle, and that it just may take a little longer or extra work to get back to the level I was prior to this.  It is also to be expected that I will be heading towards full blown hip arthritis somewhere down the line, it will just be a matter of how long it takes to get there based on how well I take care of it.  He also advised absolutely no weight bearing on the right leg for 2 weeks, and crutches and no work for at least 6 weeks.  This kinda sucks, a lot, as I am not one to just sit around or be patient and inactive.  He said I could begin swimming in a couple of weeks as part of my rehab and I could do some basic core exercises at home as I felt up to it, such as planks, push ups, crunches and pull ups, etc.  He wanted me to see the Physical Therapist within the next week so that I could begin some passive movement exercises. 

I asked about diet going forward, and any suggestions for supplements, etc.  He stated a diet high in protein: chicken, red meat, protein shakes and so on.  He also gave me a list of supplements that he uses, as he suffers from hip joint pain as well: 

• fish oil
• multi-vitamin (any kind)
• resveratrol
• glucosamine/chondroitin
• creatine
• undenatured type II chicken collagen

Quick note on the last item, the chicken cartilage.  Apparently, when you have damaged cartilage hanging around, your body's immune system treats it as a foreign body and tries to break it down further, potentially causing more damage.  The thought behind taking this supplement is that it will prevent an autoimmune response to your own cartilage.   A study overview can be found here.  Again, as always, I am not a doctor nor a healthcare professional in any sense, so check with your PCP with any questions you have regarding your own health.

Overall the appointment went well and in fact, made me feel validated in the choice I made to have this procedure.  I know have no doubt that the right decision was made.  By doing this, I have given myself a best case scenario of getting back to a competitive level, hoping to reach my goals of qualifiying for Boston and completing a full Ironman.  Worst case scenario will be a reduced activity level, think 5Ks and 10Ks, or maybe pursuing goals in other sports such as swimming, but at least I will be active.  Also, hearing that he too suffers from hip pain lets me know that he knows what I'm going through.  He also is very active and in fact wants to train for a triathlon, so he also understands that athlete mentality.  The final thing he covered was the need to address the left hip, as 73% of people affected will have to have both hips operated on.  Due to the extensive damage in the right, symptomatic, hip, he would like to look into doing the same procedure to the left hip sooner rather than later.  He does want me to be rehabilitated as much as possible, however, so that I can have sufficient weight bearing strength in the right leg for post surgery.  This is something that will be discussed more formally at the next follow up appointment in three weeks.

The rest of the day was spent relaxing and trying to sleep as much as possible.  No pain as far as the hip itself is concerned, but a little from the incisions.  Overall, a good day considering what I had just went through at the end of the prior day, in fact I felt that I was moving around very well.