Anatomy of denial

joint |joint|

noun

1. a structure in the human or animal body at which two parts of the skeleton are fitted together.• each of the distinct sections of a body or limb between the places at which they are connected : the top two joints of his index finger.

The hip is a ball and socket joint. The significance of this, and what separates it from a hinge joint like the knee is that not only can it flex and extend, but it can also abduct, adduct, internally and externally rotate. Given the flexibility of its host, it's a remarkable joint with endless possibilities. Wikipedia has a fantastic explanation on the structure and movement of this joint and all the factors that contribute to its success, or in my case, failure.

In 2005, I started having pain, but it was odd. It was only when I was slightly flexed at my trunk and internally rotated. I would have this sudden sharp pain and unable to support my weight at the same time. I thought it peculiar. However, I was just on the backside of two pregnancies and deliveries. I had experienced similar pain during pregnancy but pregnancy for me was one giant pain and I dismissed all of it as a result of raging hormones and a really bad attitude. Mother nature is very cruel in this arena. To gear you up for the most important, most significant and quite possibly most difficult job you will ever do, she turns you into an oversized troll, makes you crazy with hormones and creates pain in places you never knew existed in your body. I am still trying to figure out the primal significance of this. If you weren't a damaged diva before, you certainly are after pregnancy.

When my pregnancies were over, and after the year long celebrations of this through breastfeeding and changing diapers, I noticed the pain was not going away. hmmmmph. Vaguely remembering that I previously hurled myself into a pole at roughly 60 miles per hour some years back, I had an inkling that maybe pregnancy might have knocked something loose. So I went to the doctor. The doctor took pictures commonly known as X-rays and the interpretation was comforting: "a normal healthy hip". Yay! Off I went, pretending that the pain was simply a fabrication in my mind that would eventually go away on its own. This never works with my car by the way. Usually, when I selectively ignore a sound or rattle, it turns out to be at least worth $1000, and that little voice deep down said.....this is not over.

In the spring of 2010, five years and multiple trips to the MD later, I finally accepted that the pain in my hip was not only "not" going away, but getting worse. Frustrated, I went to my primary care physician, who was thinking initially that this was either Sartorius or Iliopsoas tendonitis related to my lifestyle of overuse via triathlons, marathons and death rides. He already had the anti-inflammatory script written.

Dr. L: "Where is the pain....'exactly'?"

Me: (Pointing to my groin) "Here."

Dr. L: "That's not your hip that is your groin."

Me: "Yeah, medially located to my hip joint."

Dr. L: "You said you had 'hip pain'."

Me: "Yeah, right here on the inside of my hip."

Dr. L: "This is an entirely different thing."

Me: "Oh."

My doctor is an excellent physician. He is well-informed, skeptical of western medical practices, patient, kind, and well.....busy. Suddenly, my hip pain was not actually hip pain, but groin pain which can be a whole host of serious problems. I don't think he was anticipating a lengthy exam but he did a thorough assessment and sent me to an Orthopedist.

Dr. L1: "I'm sending you to Dr. L2. He is an Orthopedic surgeon who now does holistic care. He's seen plenty of OR's and can tell you which direction you should start. I'm not going to order a $2000 MRI until he takes a look at you."

So it was off to Dr. L2. Our kids go to school together and I work with his wife, so this was not a stretch of faith for me. Dr. L2 is a fantastically patient person, peaceful, kind and no longer pro-surgery, he seeks to heal patients through alternative means. Being a very skilled surgeon in his own right, he also knows a bad hip when he sees one.

Dr. L2: "You need an MRI."

Me: "Yep."

The MRI told a soft tissue tale of woe. Torn labrum (cartilage in the socket), spurring around portions of the pelvis and lots of fluid and inflammation. He also saw arthritic cysts beginning to form just behind the socket portion on the X-Ray, which for all intents and purposes is the kiss of death for a hip joint. The look on Dr. L2's face was grave.

Dr. L2: "I'm sending you to Dr. K in San Jose."

Me: "Why?"

Dr. L2: "He does hip arthroscopy and sometimes if we can clean out the joint, we can reduce the rate of degeneration of the arthritis."

Me: "I'm gonna need a new hip someday arent' I?"

Dr. L2: (pause) "Someday."

And thus began the string of visits to doctors who told me the bad news over and over. Dr. K thought he might be able to fix the soft tissue damage via hip arthroscopy which is less invasive than replacing the hip but only buys so much time and is still, well, hip surgery.

I wanted a second opinion and a chance to confirm my denial, so I put it out to all of my homies in the skiing world. Hey Homies: who knows a good hip guy on the West Coast that does this hip arthroscopy thing?

Dr. S has done thousand of hip arthroscopies. He works at the Stanford Medicine Clinics so I figured if he needed backup, he knows and has access to plenty of REALLY smart people. Plus, he came highly recommended from the doctor of the husband of my bestest ski friend in all of the world.

Dr. S.: "You have an arthritic hip."

Me: "Yeah, can you fix it?"

Dr. S: "Possibly, temporarily, but the odds aren't good."

Me: "What kind of odds?"

Dr. S: "Well, there's a 1 in 5 chance I can make it better. There's a 2 in 5 chance it won't change and there's a 2 in 5 chance it will be worse."

Me: "Those aren't very good odds."

Dr. S: "Have you tried steroid injection?"

The news was starting to sink in. As a nurse, and not just a dumb jock and mother of two, I could see the writing on the wall. I had a diagnosis. Hip Arthritis. Hip arthritis does not carry a very strong prognosis. In fact, hip arthritis is a death sentence for a hip. There is no cure for Osteoarthritis of the hip and it slowly degenerates into a situation of pain and suffering. But denial can be a strong force in a person's life and mine was no exception.

"No Dr. S., I haven't. Could you set me up with one?"

(to be continued.....)