Sunday, June 30, 2013

4 Weeks Post Op!

“Life takes on meaning when you become motivated, set goals and charge after them in an unstoppable manner.”
~Les Brown

It has been four weeks since the surgery and to be honest, everything is going great (knocking on wood).  I did not see my PT this week as he feels I am progressing well enough with the current workouts I am doing along with the exercises he has provided for me.  I do have to pay better attention to my energy levels as I think I am pushing the workouts more in the beginning of the week and I tire out by the middle of the week.  Some adjustments in my workout schedule should fix that pretty easily, along with reminding myself that rest is just as important as active exercise.  One minor milestone accomplished this week is the ability to cross/rest my right ankle on/over my left quad/knee.  Previously my range of motion did not allow for this and I caught myself constantly trying to do it and then having to stop prior to getting my leg up and over.  Also, I am now able to drive, albeit short distances and lengths of time, but at least I have some freedom and I'm able to get to a full-sized pool.  I had another massage today, and again, it was SO beneficial to workout any muscles that have been used for compensation of the non-weightbearing leg.  There are still days where the road seems so long, but I just keep my mind and focus on the goals I have, and just drive forward.

Tips:

  • Get a massage or two.  Your muscles are compensating for not using the effected leg, and they will need some relief as well.  Plus it is just relaxing!
  • Get your rest!  I know this is repetitive, but I even find myself wearing down by the time Wednesday night or Thursday rolls around.  Try to balance your workout routines so that you have an equal amount of effort being applied everyday...AND TAKE A REST DAY OR TWO.
  • By this point, most people will be driving to some extent and able to do some things by yourself, if you haven't already, get a handicap tag for your car!  Driving will tire you out, and you will have to crutch around wherever you drove to, so no need to crutch any further than needed.
My current weekly workout schedule/routine:

  • Monday/Wednesday: Stationary cycle with low resistance 2x20 minutes, 1200-1600 meters freestyle swimming, leg exercises given to me by PT
  • TuesdayThursday/Saturday: Stationary cycle with low resistance 2x20 minutes, 4 sets of 1:00 planking, 15 push-ups, 40 crunches and 5 pull-ups (maxing out on last set), 10 inverted rows all with NO to MINIMAL rest between exercises or sets, and leg exercises given to me by PT
  • Friday:  See Monday/Wednesday, but may drop the swimming depending on energy levels
  • Sunday -cycle 1x20 minutes and leg exercises given to me by PT




Thursday, June 27, 2013

Breathing Techniques While Running

So I figured it was time to start writing about my passions and offering up tips and advice based on my own experiences and references from experts and well respected sources. The first topic I will touch base on is breathing while running. Now I know I am biased, but I truly believe that running is the best activity for for fitness and weight control...plus it is fun and it is pure. It is the first "sport" that all of us participated in, and most of us did so with a huge grin on our faces. However, for many newbies, or those returning to the original sport, their faces turn into contorted, strained messes when trying to breath. Just when it seems like they are getting going at a comfortable pace, they begin to feel like they are running out of air, they start huffing and puffing, and their legs begin to feel heavy and cramped. After an experience or two like this, it is no wonder that many give up or become frustrated with running, as opposed to embracing it. So, what to do? Just like you would train yourself to run at certain paces and certain distances, you need to train yourself to breathe. This takes practice, and sometimes this is more easily done with a little background knowledge on breathing and respiration and how they are incorporated in exercise.

Breathing is the act of taking in and expelling air. Respiration is the transport of oxygen from the air taken in during breathing to the cells of tissue and on the flip side, the transport of carbon dioxide out of the tissue. Oxygen is key in exercise as it is the key ingredient in converting fuel sources to energy, also known as aerobic metabolism. If you do not take in enough oxygen, or expend energy more quickly than the oxygen-fueled energy you create, you will then venture into the realm of anaerobic metabolism. This results in lactic acid build up, or the burning and heavy sensation you experience while running. So then, the goal is to take in enough oxygen to fuel a sustained effort while running, and learning how to breathe properly will help accomplish this.

There are many different opinions on the best breathing technique for running. Most all have one thing in common, belly breathing. Belly breathing is the result of engaging your diaphragm more fully, which increases the amount of oxygen one is able to take in during each inhalation. The best way to figure out how to be more of a belly breather is to simply place a hand on your abdomen and the other on your chest. Take in deep breaths and note which hand moves more. For most of us, the hand on the chest will move more. Therefore, the next step is to practice using your diaphragm more, or moving your hand you placed on your belly. Once you have managed to become more of a belly breather, the next task will be to determine the best "breathing pattern" to use while running.

Breathing patterns...this is where you will find many differing opinions, however, the underlying goal is still the same...to take the deepest breath that is comfortably possible. Generally, there are two pattern categories; even-numbered (2-2, 3-3, 4-4) and odd-numbered (2-1, 3-2, 2-3). In both patterns, the first number listed indicates the number of steps taken on the inhale, and the second number represents the number of steps for the exhale. Many experts, legendary coach Jack Daniels included, believe in the even-numbered pattern. In this case, your inspirations and expirations will occur on the same footfalls each time. The odd-numbered pattern has its supporters as well, most notably in Chi Running. In this method, you will inhale and exhale on differing foot strikes, taking in oxygen in an extended pattern while exhaling more forcibly and quickly. An example would be inhaling on left-right-left, and exhaling then on right-left, beginning the next breathing cycle on the right rather than the left foot strike.  Ultimately, you want to take the longest, calmest, inhales and exhales possible, thereby maximizing oxygen intake as well as keeping heart rate down...optimzing your effort.

So which one should you use? Well in my opinion, that depends...on you. Personally, for most of my running career I have employed the even-numbered system of breathing, usually 2-2 and then 3-3 more recently. After learning and researching the odd-numbered system, I practiced the 3-2 pattern for a bit prior to my surgery. It took some adjusting to relearn my breathing technique, and found that I most often fell back into the even-numbered 3-3 pattern. To be honest, I did not feel much of a difference, with the exception of the challenge in learning a new pattern. That is why I believe you ultimately have to decide which works best for you through practicing both techniques.

How to practice:

  • Lay on your back and focusing on using your belly breathing, count out your footfalls in your head.  If a constant inhale/exhale for 2 or 3 foot strikes is difficult, try breaking up each inhale/exhale into shorter bursts for the duration of the foot strikes (in-in, out-out, or in-in-in, out-out-out).
  • Once you feel comfortable with one pattern, repeat this while walking, mirroring the pattern to coincide with your foot strikes.
  • Once you have the walking down, time to progress to jogging and then to running with the pattern you chose.  
Through all of this, do not hesitate or be afraid to tweak the pattern you chose or try other patterns.  Again, I have found that in my experience, so much of what you do and what works for you will be different from others.  The ultimate goal with breathing techniques is to take in as much oxygen as you can and to do so at a slower, controlled rate, thereby supplying your muscles with all the fuel needed to sustain an effective, happy running experience.  Run on!

Helpful links:


Saturday, June 22, 2013

Three Weeks Post-op!

So Thursday was 3 weeks post-op and I had my third PT appointment with Charlie.  He was happy with my progress and threw me onto the bike right away and had me cycling for about 10 minutes, which felt great...no issues getting the pedal around at all.  Charlie definitely increased the ROM on the movements he performed on me and also included some resistance bands this week.  There was some tenderness on the anterior portion of the hip socket at certain positions, but it just felt like a tough stretch on a pulled muscle, nothing more.  He did not add anymore exercises to my daily routines as he knew that I had a follow-up appointment with my doctor's PA, Kyle, on Friday morning.  Other than that, we chatted about the upcoming Hawkeye football season and a possibility of getting a group together to head back to good ol' Iowa to do RAGBRAI some year once I am fully recovered.  Just another thing to add to my "bucket list", although this one is not so intense and therefore pretty likely.

Friday brought my second follow up at the CORE Institute, this time though it was with the PA Kyle.  I would say that he seemed very encouraged by my progress so far.  Below are some points that were addressed:

Good:
  • I can start going up and down the stairs to our third level and thus, finally sleep in my own bed!  He just cautioned on the importance of not putting too much pressure on that leg still.
  • I have not lost any muscle mass/tone in that leg according to what he could tell, and was very happy with that.
  • He agreed with my PT that swimming and stationary cycling with minimal resistance will be my best friend over the next few weeks and had no worries with my level of activity pertaining to those two exercises.
  • He felt I should have no restrictions or concerns for our vacation back to the midwest coming up, and in fact should be fully able to cycle on the roads by that point, thus continuing my recovery full force while "back home".
  • I'm driving again!  Well, for short distances anyways...basically long enough to get me to swim practice at a 25m pool.  Only concern is just being in the exaggerated sitting position for a period of time and the discomfort that would come with that.  But at least I won't have to rely on others to get me and the kids to swim practice now.  Plus, I won't mentally have to deal with the feeling of total confinement, which is a relief!
Not good, but not bad either:
  • We weren't able to lock down a date or even a week for surgery on the other hip...was really hoping to narrow it down so we could start planning around it.
  • Weightbearing has grinded to a screeching halt.  Due to the extensive amount of bone removed and the microfracture procedure performed on both the femur and acetabulum, there apparently is still a fair concern of a fracture...so I am highly limited to the amount of weight I can put on that leg until 6 weeks post-op.  Normally, according to what I have seen, once you begin to put weight on the affected leg, you can increase it by 20% each week, so long as there are no pains, complications, etc.  In my case, however, I have to stay at 15-20%, which is a bit of a bummer, but a fracture would be disastrous...so I will have to just deal with it.  But after 6 weeks it will go to 80% and then 100% by week 8, so things will progress quickly then.
All in all, a good couple of days...I can feel progress being made, which helps with staying focused and determined.

Wednesday, June 19, 2013

Days 18 & 19

I am finding myself to have more energy everyday, and I am sleeping better every night.  It was just me and the kids on Monday and Tuesday as Sara was at work.  They do an awesome job of helping me out and making sure I have what I need where I need it.  We spent a lot of time in the pool and I was able to get a lot of laps in swimming.  I have to be careful of the kicking still as I do feel a little soreness if my kicking motion is too exaggerated.  Luckily, I have never been much of a kicker while swimming freestyle and tend to use my arms mostly so this was not a huge adjustment.  I am looking forward to getting in a full-size pool to swim some true laps, but this will have to do for now.  I also was able to get another core strengthening workout in doing push-ups, planks, crunches and pull-ups.  I am looking forward to using the trainer with my bike to get some cycling in starting Wednesday.  Basically my gameplan is to cycle and swim everyday if possible, and to do my core workout 3-4 times a week.  I feel better after getting workouts in, both physically and mentally.  Plus, I need to make sure I am as strong as possible going into the second surgery.

I was able to get to my kids' cross country practice on Tuesday night, put on by The City of Peoria and coached by my friend Nathan of Tortoise and Hare Sports.  It motivates me to get back to full strength and run with them again and help out at events like this.  I can't believe how driven they are all the while sporting a smile and enjoying the sport.  It reminds me of what running is all about, being a kid again.  Just you and your shoes, out enjoying your surroundings.  I truly believe it is the purest of all sports.

Tips:
  • Slow and easy -I find myself trying to move around more quickly than I probably should on the crutches.  As you begin to feel better and stronger, you have a tendency to try to "keep up" or at least not slow others down, at least I have.  The problem with this is that you sacrifice proper contact and alignment of the crutches.  Over the past few days I have found myself landing off balance or with too much momentum, forcing myself onto the recovering leg and putting way too much pressure, if not 100% weight on it.  NOT GOOD...so keep it slow and easy, it is not worth the risk of hip fracture and totally undoing all the good that has been done so far.
  • Water is your friend -both as keeping you hydrated as well as being in it to work out.  Think about it, no impact, light resistance, and if you lose your balance, no fear of falling and causing other injuries...just fall over and float and regain balance.  You have no idea how grateful I am to have a pool to keep active in.

Day 17 -Happy Father's Day!

Happy Father's Day to any dad's checking in.  I had an awesome day with the kids.  My son got me a new pair of boardshorts as he knows my affinity for the pool and casual summer clothing.  My daughter made sure to keep me styling by getting me not one, but two new pairs of sunglasses, and was proud to point out that one pair were "Hawkeye" sunglasses due to being black and yellow.  My wife treated me to a great cigar which I enjoyed with a Jack and Coke poolside while the kids did some night swimming in the dark.  I was able to enjoy some down time on the couch watching the final round of the U.S. Open...poor Lefty.  All in all it was a good day, but I was exhausted by all the activity by the end of it.  Hope everyone enjoyed their Father's Day as much as I did.

Tuesday, June 18, 2013

Days 15 & 16

I'm not going to lie or try to pretend that there are times already that frustration and impatience creeps in. I am a highly energetic, active and independent person. I am driven to reach goals and having to wait around or rely on others for help with simple tasks is not something I am well-equiped to cope with.  Today was the first day where I had a "moment" with Sara.  I kind of snapped at her regarding some things that needed to be done.  I immediately had to check myself, and realized that my frustration was not with her, but rather with myself and my inability to do them on my own.  Two weeks is not too bad, in my opinion, considering the amount of time we spent with each other during that time.  Luckily, I have an amazing wife, who is more than willing to be there to support me, but also to put me in my place...needless to say, this "moment" was short-lived.

Friday was massage day, and boy was I looking forward to it!  It was only my second one ever but figured it would be beneficial to my recovery.  I utilize my favorite local running store, Tortoise and Hare Sports.  On Fridays, they have a free yoga session at 8:00AM and then the instructor, Lisa, who is also a massage therapist, is available to work out all those sore muscles.  It really is a sweet deal, $39 for an hour, $29 if you have bought shoes from the store.  Anyways, I was anxious and enjoyed every minute of it.  If you have not ever gotten one before or used it as a training tool, you need to strongly consider it.  If nothing else, it is an hour of relaxation and peace.  We also went to get a scale, so I spent some time trying to get to know what 20% felt like...whatever, I'll wing it.

Saturday we ventured out and ran some errands that were desperately needed to be completed.  It felt great to get out, but it is still a challenge crutching yourself around.  We decided to challenge me by taking the Jeep...getting in and out of that thing was...interesting.  Once I figured it out it wasn't too bad.  While it tired me out, I wouldn't trade it for anything, as mentally it was nice to get a break from the confines of the house.  Pool time in the afternoon with a little nap definitely was a worthy reward.
  • Positive mindset -by this point you are feeling pretty good physically (hopefully).  My incisions were pretty much fully healed and the only soreness was muscle soreness from exercises.  But mentally, you may be realizing how long the road ahead is...just keep focusing on small victories along the way...putting weight on your leg, going out to run errands, etc.  Also, keep in mind why you did this in the first place...to improve your quality of life.  Revisit these goals often, as it will help you get through the long, slow days.

Days 13 & 14

Well, Sara was back off to work.  Which means I am left to my own devices.  Wednesday I basically turned into a vegetable.  I think I put so much effort into hanging out with the kids that I was worn out.  I basically sat on the couch and zoned out all day.  There was an NCIS marathon on I think, as I went in and out of sleep most of the day, with the exception of doing my exercises.  Overall, noneventful. 

Thursday, two weeks post op and finally able to put some weight on my leg.  Standard is 20% of your weight, but I began to think, and what is 20%?  I mean, I've spent my entire life walking around with 100% of my weight on my legs, so how do I figure out what 20% is?  And yes, the obvious answer is a scale, but we don't own one, yet, so I was winging it.  I'm not sure if anyone had the same experience as me, but it certainly was an unusual feeling placing my foot down and rolling through a gait cycle, even though it only had been 2 weeks since I used it.  I was apprenshive and also wobbly even with the little weight I was putting on it, but hey, it was a milestone reached and I was happy to see progress.

I had my secont PT appointment with Charlie.  He said my range of motion had improved since my first appointment, so I guess I am heading in the right direction.  The goal is to be at 100% range of motion by week 4.  Me being the typical competitive athlete asked how I was doing compared to others who had gone through this surgery and compared to protocol and he told me I was doing well.  I was able to get on the recumbent bike and do some light pedaling for 10 minutes.  Let me tell you, it felt AWESOME to be doing something other than passive movement exercises.  He added two more exercises to my three times a day routine and told me I could start cycling at home on a trainer with no resistance.  Let me tell you, the feeling of "moving forward" in recovery does wonders for your psyche.

Once the help, Sara, and the kids were gone, the days grew long.  Definitely time to find something to occupy my time!
  • Prepare for alone time -not only do you need to find things to keep you occupied, but you have to think ahead and consider what you will need to have access to throughout the day.  Have TV trays set up in the area of where you plan to spend your time so that you can have a place to put things.  Consider having lunches already made or plan on making simple lunches like PB&Js.  Have magazines, books, movies, etc. set up and readily available to pass the time.
  • Exercise -I know I'm beating a dead horse here, and it may seem obvious, but it is key to recovery.  Do your exercises and you will be less likely to be down as long.  However, do not overdo it...do what has been prescribed for  you and stick to it, nothing more, nothing less.

Monday, June 17, 2013

Days 11 & 12

Monday and Tuesday, my days for having the kids, Sara's last two days working from home.  I was feeling amazingly better.  My stomach woes were gone and I was sleeping soundly through the nights.  We wanted to try and determine what all would need to be done, set up, whatever, before she left for work each day so that we would be prepared for that and I wouldn't be left to struggle.  We just kind of brainstormed things I'd need easy access to while she is gone for an entire day; water bottle with a loop so I can carry it while crutching, easily prepared snacks/lunches, laptop/charger in area where I would be spending my time.

As for activities these two days, they were basically the same as the previous three, just trying to do as much as I could with the kids and enjoy time with them.  Sara and I took them to swim practice on Monday, which was awesome to watch them practice, but also fueled my desire to get in and start additional rehab and training that way.  I am beginning to chomp at the bit to get going again. 

Once home after practice, I did manage to get in the pool at home and swim some easy "pull only" laps.  I also went through my first true workout since the surgery, in addition to my daily PT exercises.  I kept it simple and just went through 3 sets of planks, push ups, crunches and pull ups.  It felt AWESOME to work the body a bit!  But it was also taxing on my energy, and I was pretty wiped out the rest of the night and into the next day.  I did manage to get into the home pool again the next day to do some more laps and was feeling well enough to go to the kids' cross country practice that night.  I love watching them run...nothing but smiles everytime they pass by.

Again, here are some of my tips/thoughts, etc during this timeframe:
  • Exercise -IF you are feeling up to it, and IF you get clearance from your doctor/physical therapist, this is probably a good time to start doing things you can do without risk of injury.  I cannot tell you how amazing it felt to be able to get a workout it, not just physically, but mentally and emotionally...it is so rejuvenating.
  • Focus -once I got past the physical ailments I was experiencing and was no longer feeling pain at the incision sites, it is then that I realized that this was going to be all mental...I had kind of known this going in, but once the initial pain/soreness goes away it hits you...stay focused with your eye on the prize.  Find small, gradual goals you can accomplish so you can stay motivated and focused.

Days 8, 9, & 10

The kids returned for my weekend with them and I began to feel a little bit better.  The toughest thing is not being able to be as active with them as I usually am.  Plus, they have some lofty goals in regards to their triathlons this summer, specifically being Ironkids National Champions.  With me being down and out, we are having to alter how I help them train.  They currently go to swim practice once a week with me and I try to get them to run at least twice a week.  They go to cross country training on Tuesdays so that helps.  It sucks not being able to be out there with them, talking them through it and giving them immediate feedback.  Luckily we have a neighborhood with a loop that is about 1/3 of a mile long, so I will have them doing repeats as I sit in a chair sipping my sweet tea! 

It is a bit of a challenge keeping them occupied, so I encouraged them to play board games and such, as they can play those right next to me as I lay on my backside and occasionally can play with them.  We also ventured out on Saturday to get them some arts & crafts stuff to do so that they can stay busy and inside once they are tired of the pool.  All in all it was a good weekend with my family and my hip seemed to do pretty well.  I was able to get on top of the stomach issues with the help of some OTC meds and also staying on top of my meals.

BONUS!!  Bandages came off on Day 10 (Sunday).  It felt good to get them off and let them breath.  They had basically used disolvable internal sutures and then just steri-strips externally, so that I wouldn't need to worry about getting traditional, external sutures wet or having to go in to have them removed.  I had VERY minimal brusing around the incision sites and was amazed at how small they are, literally the width of a pen or pencil.  Seeing that just blows my mind because they had to remove bone that had been shaved away through instruments that fit into those incisions...GO SCIENCE!!!

As for any tips for this time period, I would just say take it easy, get naps as you can and continue on with the things that have worked for you up to this point.  You will still notice that you get worn out and need to rest, and that is OK.  I have read where others were on their butts sleeping for pretty much the entire first two weeks.

Days 6 & 7

These were the worst two days since the surgery, by far.  I had some major stomach issues and was not in a good mood.  I was not doing a good job of staying on top of eating/fueling, which I think made it worse.  You know how when you are a little nauseous or your stomach is upset and how you decide to not eat because that is the last thing you feel like doing?  And then it only gets worse cause now you are nauseous AND you are lacking proper fuel for your body to heal and you get even more nauseous since there is no food in you?  Well, that was the cycle I found myself in...and it sucked.  The hip, in all honesty, was feeling great considering what was done to it.  In fact, I was commenting on how if it weren't for my stomach, this would be a breeze...that the surgery and recovery to this point was way less than anything I had expected.  I was getting around fairly well when I was rested.

I did have my first appointment with my physical therapist on the 7th day.  I took particular care in choosing a PT as I wanted to make sure, that like my doctor, they understood the type of person/athlete I am, as well as the goals I had.  The CORE Institute had their own physical therapy on sight, but I made my decision to go with someone outside of their group.  My son had been diagnosed with Sever's Disease earlier in the year and had gone Charlie Boeyink, PT, MPT, OCS for his treatment.  Feel free to read about him here and his additional work specifically with endurance athletes here and here.  I think you can see why I chose to go with him, plus, if you paid attention, he is a Hawkeye...so it was obviously meant to be.

The appointment went very well I felt.  He thought that I had very good range of motion for it being only one week since surgery.  He gave me some passive movement exercised to do at home and with Sara's help and felt I only needed to come once a week since there is not much else I could do at this point being that I was still on a no weight-bearing routine.  Once I am able to put weight on it we will increase the frequency of my visits so that I can begin rebuilding my strength.  Overall it felt great to get out and also to get some extra exercises to stay active and assist in my recovery.

Below are some more tips/thoughts at this point:
  • No wasted motion -what I mean by this is plan your movements around your house or out and about, if you are out at all.  Consider this:  your body expending a fair amount of energy to repair and recover, you are moving around in a manner that is not normal for you and requires more energy to do so...you will get tired much, MUCH faster than normal, so plan ahead and try to not have any wasted movements.
  • A bed! -Night 6 was the first night I ventured to a bed for a night's sleep.  I was not as concerned at this point about rolling over onto the surgical side so I went for it.  I was feeling so miserable due to my stomach that I felt a more comfortable setting may help.  It didn't stop the stomach problems but boy did it feel great!  Next time I will probably only crash on the couch for the first 3 nights.
  • Get you PT on sooner rather than later -if your doctor approves it, go to PT within a week of surgery.  They will give you exercises/motions to do at home that will help increase your range of motion and prevent the build up of scar tissue.  This will be key, I think, to my recovery to the level I want to get back to.

Saturday, June 15, 2013

Days 4 & 5

So Monday and Tuesday brought the return of my kids and their first time seeing me since the surgery.  They were hesitant at first, as we expected they would.  I explained what all the doctor did and showed them the X-rays and photos.  My 10 year old son wasn't too interested, but my 7 year old daughter was very interested, we think she will be a doctor or nurse.  I tried to be as active as possible as I wanted to do things with them, but I was limited to what I could do and was tired.  We got them to swim practice on Monday and to cross country practice on Tuesday.  They swam a couple of times as I napped and Sara worked.  We played lots of board and card games and watched TV.  Other than that, pretty uneventful.

Still no real pain as I was continuing to take the pain meds.  Again, appetite was difficult to gauge so many meals were last minute runs to Subway or just a PB&J.  Water and sweet tea continued to be my favorite drink.  Below are some more tips on things I felt helped me out:

  • Naps -they are your best friend.  You will get tired, and are probably more in need of one than you think.  I tried to take two a day, but I pushed it some days like I knew I would.
  • Showers -getting a fresh shower each day, even though you aren't doing anything, does wonders for you.  It is well worth the energy expended to take one for the feeling you have after.
  • Breakfast -eat it, right away when you wake up.  The anesthesia and pain meds they administered during surgey are completely out of your system by the third day, so your body may feel a little off and getting food in right away helped me.
  • Pain meds and bathroom routine -they say the pain meds can clog you up, and to be prepared to take a laxative...a good friend of ours who is a nurse suggested trying Senna...nonprescription laxative...worked great!
  • Exercise -I know, I know, I know...I'm supposed to be resting as much as possible, but what I mean by this is passive motion.  I made sure that I as I was lying down on the couch, I was very cautiously and easily bringing my knee up causing hip flexion, but not beyond a right angle, I was also gently rotating, or abducting, my leg outward as I was lying on my back with my feet flat and knees bent.  All of this was done VERY softly and carefully, just to keep motion going and blood flowing.

Friday, June 14, 2013

Days 2 & 3

So the Saturday and Sunday after the surgery were pretty uneventful.  I tried to sleep as well as I could for being on the couch.  Getting up and to the bathroom proved to be fairly easy and I was generally moving around pretty well.  Showers were interesting as I had to "hop" in and balance on my good leg and try to wash my body, needless to say this wore me out quite a bit more than I expected and usually included a period of rest after completed.  I wasn't experiencing any pain with the exception of the tenderness at the incision sites.  Eating was kind of tough...I didn't have much of an appetite and when I finally got hungry I didn't really know what I wanted.  So there was a lot of last minute decisions to run to local spots to pick up food.  I did make it out for a couple of trips to the store to get necessities as we figured out what I needed to make myself more comfortable.  I appreciated having friends stop by and hang out to keep me company, even though the meds kept me pretty lethargic.  I also was able to make it out to the pool with the help of Sara and Sarah.  We got a pretty sweet set up by placing one of our patio chairs on the second step of the pool as it is fairly deep and wide, and allowed me to keep the surgigal site just above the level of the water.  My bandages were covered with a Tegaderm-type bandage so I wasn't too worried about getting them wet.  They then moved the umbrella and stand over so that it covered the general area where I would be sitting.  I gently lowered myself in and was able to sit and enjoy the pool for a bit.  Hindsight being 20/20, I probably pushed myself a bit much that first weekend, but I felt so good and I knew I'd be confined for awhile so I wanted to get out as I could.  Below are some tips and things to consider, based on my first weekend.

  • I know this goes without saying, but STAY ON TOP OF THE PAIN WITH YOUR MEDS-     I can admit I am guilty of not wanting to take any meds, I'm terrible at taking Tylenol or ibuprofen, but this is so very important to prevent discomfort and unnecessary pain.
  • Try to keep eating meals and snacks at regular times - helps with the pain meds and obviously you need fuel
  • Stay hydrated - I felt that my mouth was always dry and just wanted water and sweet tea
  • Get a raised toilet seat - depending on your strength, balance, etc., you can probably get away with just the raised seat, but you may opt for the one with extra handles/bars on the sides for support in lowering and raising yourself down on it.  I was OK just using the seat without the bars.
  • Shower seat - I personally did not get one or use one.  Again, this may be dependent on your strength, balance, etc.  I did not get one because I was going to be using a smaller stand alone shower, and also considered the need to then lower and raise myself while wet in a confined area...I liked my chances going it alone with a spotter, Sara.
  • Comfy clothes - this probably also should go without saying, but it should be noted.  I prefered technical athletic material, basically anything I already had in my running dresser.  The exception to this was the shorts, I prefer shorts made of that athletic material, but longer like basketball shorts and with pockets.  Do not underestimate the need for pockets!  How else will you carry things while on crutches? (UnderArmour makes an awesome pair called HeatGear Performance Loose that I have 3 pairs of)
  • Crutch pads - buy the extra padding for the crutches, you're going to be on them for awhile.  I picked up a pack at Walgreen's that included pads for the handles as well.  You may also want to consider cycling or weight-lifting gloves to protect your hands from blisters from the friction...but then again, I probably got mine due to being overactive those first few days.
  • Pillows - not just for your head, but between your legs.  You will be way more comfortable if you can keep your hips/legs aligned at about hip-width.  I slept and lounged with one between my legs, even while lying on my back.
  • Couch - it is my opinion that a comfy couch is the best place to be the first few days.  Centrally located, near a TV, and, if positioned correctly on it while sleeping, you will deter yourself from rolling onto the incision side.

Tuesday, June 11, 2013

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.






May 30, 2013 - Surgery Day

Not going to lie, I was nervous as hell...you start to second guess your decisions.  Surgery is not typically Option #1 when trying to treat any physical ailment.  What if the surgery causes more issues than it solves?  What if there are complications?  So many unknowns and such a long road back...and no guarantees.

I had stayed up until midnight so that I could fill my belly as I could not have any food or drink, not even water, after that time.  This is no easy task for anyone, and is especially difficult for me as I have a very high metabolism.  My plan was to lay low as much as possible that morning so as to not waste any energy.  Surgery was scheduled for 1:30PM and I did not have to be at the hospital until 11:30AM.  Sara for the most part steered clear of me most of the morning, as she is a smart one and knows I get cranky without my food or coffee.  Her and her mom, Jacque, would be taking me to the hospital. 

We arrived at Del Webb Hospital and were quickly escorted back to the prep area.  On the way back, the volunteer gave Sara a quick rundown on a video display that would update her on my progress via an assigned number and color-coded statuses.  Pretty cool stuff. 

Everybody I encountered were so very helpful, attentive and knowledgeable.  I am so grateful to the people below for all the information and reassurance they provided:

Prep RN: Linda -about as mom-like as you can get without having your own mother there
CT: Pat -efficient in getting me all hooked up...no nonsense and funny
Surgical RN: Chris/Kris -direct and cool confidence
Anesthesiologist: Mike -hilarious Aussie and fellow runner...started talking about cocktails and happy drinks...yes, please!
Recovery nurse: Julie -caring and yet strong enough to counter my stubborness in wanting to get up and get out of there!

**Cool side note (well, at least to me)  they had what basically amounted to a personal cooling and heating system for the gowns!  As uncomfortable as it already is being in a hospital, then to throw in the gowns and the blankets and the general temperature...it i s difficult to find a happy medium.  But they just hooked up this hose to my gown and I was able to adjust the dial cooler or warmer.

As usual there is a whole lot of hurry up and wait (hello Army days!), but after they get you all hooked up they invited Sara and Jacque back to sit with me until the surgery.  Dr. Brown came in to see if I had any questions or concerns, to which I replied "This is on the right hip, right?" and he just laughed and initialed that hip.  The procedure was scheduled to take 1.5 to 2 hours and with about 1.5 to 2 hours in recovery, I'd be home in time for a Jack and Coke and a steak, or at least that was my dream.  Dr. Brown headed to the OR and Mike came back in and popped some Versed in the IV and away we went.

When I came to I was obviously disoriented and inquisitive as to how things went and where Sara and Jacque were.  I slightly recall joking with Julie, my recovery nurse about bailing out fast as I hate waiting around in hospitals.  She reassured me she would help me escape as soon as I could.  She also informed me that the surgery took longer than expected, as I was in the OR for 3 hours.  We did fight about my desire for some water...I told her I was thirsty and could handle it, she said I would just send it right back up if I had some...she finally relented and gave me some ice chips, which I devoured.  By the way, she was right, as just as Sara came back to help get me ready to leave I got super nauseous and they had to give me some ice cold towels and some organic smelly stuff under my nose.  Julie kinda laughed, I think, and told me she told me so...but things are a bit hazy regarding my recovery and leaving the hospital.  I asked Sara for my hat and sunglasses, she asked why, and I said to keep the sun out of my eyes.  The girls laughed at me and said the sun was gone and it was 8:00 at night.

I was actually surprised at my ability to manuever myself to get into and out of the car and to crutch myself into the house that night, considering how drugged up I was.  Thankfully our good friend Steven was there to help out, just in case.  I got positioned on the couch and to be honest, don't remember much of the rest of the night.  At that point, I would call Surgery Day a success.

Thursday, June 6, 2013

Who Am I?

I'm Jeff, and this blog is about my recovery from FAI/Hip Impingement surgery and my journey back to achieving some lofty goals.  I live in Phoenix, AZ with my ridiculously supportive wife, Sara, and my two amazing kids, Connor and Cambell.

I grew up in Dubuque, IA, and began following my father's footsteps in running at a young age.  I think I was your typical kid, I loved doing the events, and wanted to be like dad, but didn't necessarily want to put in the time to prepare for them.  So I ran the local 1 mile fun runs and 5K's that my dad would sign me up for while he would run his longer distance races.  I dabbled in Cross Country in high school, but never took it seriously and continued to train for road races.

I gained an early appreciation for the Boston Marathon, as I watched my dad train for and successfully qualify for 4 of them, including the 100th anniversary.  The passion he had for that one particular race has stayed with me and is now one of my goals on my bucket list.

I have lived in the Phoenix area for almost 14 years now, and I have continued to meander in and out of running during that time.  There was a period of time in 2004/2005 where I trained for my first half-marathon and full-marathon.  While I had very successful debuts in both distances, life happens, and I made some poor lifestyle choices afterwards, and I fell out of the running community.

In July of 2012 I decided it was time to make a change.  My kids are avid triathletes and I would try to share my knowledge and experience with them, but as I would try to coach them, I couldn't help but think that they had to look at me as though there was no way I could know what I was talking about.  I hadn't been working out, I had been smoking, and so how could anything I told them about training and healthy lifestyle choices hold any validity?  So I woke up one morning, looked at my wife and asked "What are we doing?".  So we quit smoking and I set out on a path to begin completing items on my bucket list.  I set some short term goals, sprint triathlons, with the end goal being the P.F. Chang's Rock N Roll Marathon Arizona.  

My long term goals are to:
  • Qualify for Boston
  • Run a sub-3:00 marathon
  • Run an ultra
  • Complete a full Ironman
  • Complete a variety of marathons with personal significance to me


With the inspiration of my kids love for triathlons, and my wife's support, I was able to focus on training and as a family, we enjoyed doing healthy activities together.  I had some age group successes in the sprint triathlons and at "prep" races for the marathon.  I completed the race in 3:38, which was not quite what I was hoping for, but it had been almost 8 years since my last marathon, and I had been battling patellar tendonitis through the final weeks of training and during the race it completely "blew up" at mile 13/14.  But still, this was a success, not six months earlier, I was smoking a pack of cigarettes a day...now I was not only finishing a marathon, but finishing it well, and was able to feel that I was able to practice what I had been preaching to my kids.  Even Sara became a runner, finding a pure love for the sport, for just getting out there and putting one foot in front of the other with no pressure to compete.

After recovering from the marathon/injury, I set out to improve on my results and start checking off goals on the bucket list.  I signed up for the San Diego Rock N Roll Marathon, with the goal of going "sub-3:00" and in the process qualifying for Boston.  While qualifying for Boston is quite an accomplishment in the running community, the qualifying times are on a sliding scale corresponding to your age.  Doing a sub-3:00 marathon is a set in stone time, a time barrier that other runners look at and go "Whoa!"  Go big or go home right?

Training was going great, and the new and additional training routines and techniques I employed were propelling me towards my goals.  In early April, however, after a hard tempo run, I began to experience severe pain in my right quad, and that is when my journey began with FAI, and my journey "Back to the Roads".