We just got back from the consultation with the surgeon-professor at CU Boulder. I appreciate all of the sweet messages this morning, it means a lot to me!

The CU Sports Medicine team was just amazing. Two providers did all of the intake questions then explained I would have some new X-Rays done. After the X-Rays, the surgeon's PA did an extensive and detailed patient history along with the most comprehensive set of physiological tests I have had done yet. The PA had me walk down the hall so he could study my gait. I super slowly and cautiously made my way down the hall. He asked me, somewhat confused, "Is this how you walk?" And I said, "yes." He was like, "well it kind of looks like you are trying pretty hard not to limp," and I was like, "yes, I sure am." At another point he asked me, "Does your pain wake you up at night?" And I said, "yes." He was like, "awake awake? Like you are sleeping and it wakes you up?" and I was like "yes, it sure does." (And I didn't think much of it, though he made a clear point to explain this to the surgeon later on when he came into the room to do the consultation.) In reflecting I guess these are some examples of things that seem normal to me and yet are concerning to medical providers, even those who exclusively work with a population of patients with rare and complex orthopedic issues. It was also a really lovely example of how kind they were to me. At one point during the exam I apologized for something and the PA said, "okay that's a rule I have, you can't apologize to me." And he also was very empathic during the physical exam, since it can be pretty tricky to completely give your leg over to a stranger to mess around with when you hurt so much!

The surgeon-professor did a lot of extensive testing of my range of motion, my muscular responses to his maneuvers, and finding out exactly what pain is from where and perhaps why. The new X-Rays showed clearly that I have Cam Impingement of the head of the femur, this is the ball of the hip joint. Basically, the head of my femur is more of a oval shape instead of round, which means it doesn't fit nicely into the socket. This is one simple cause of the kind of labral tearing and fraying that I have as the mis-fitting of the joint can shear away the labrum over time which is what inevitably happened. This isn't entirely new information to me but it was explained and shown in a much more clear and detailed way than previously done. They also reviewed with us that even though I also have the acetabular anteversion (the hip socket sits too far to the back) I also have that in a rare combo with overcoverage, which means the acetabulum is deeper than it should be, but due to how it is too far back AND too big, it kind of self-compensates somewhat. 

I hope I haven't lost you yet?

- Lining of socket: torn and frayed

- Ball: oval shaped instead of round which can cause tearing

- Socket: angle sits too far to the back, yet is over covered in size, and so it might be sorta okay

- Femur: bone is twisted in an inward manner

Next, the surgeon-professor explained to us and to the PA (who stayed with us the whole time) that he thinks it is best to start with having the hip surgeon at Steadman Hawkins do the Cam Repair (known as a Femoroplasty) and the Labral Repair first. This means tractioning the hip joint to pull the hip out of the socket, grinding down the ball of the joint into the proper round shape, cleaning out any possible damaged cartilage, the cyst, and etc. and then repairing the fraying torn labrum all in one surgery. Wait a year or two and see how I do, and come back to CU then or sooner if that isn't enough to make the pain and dysfunction manageable. The Cam Impingement alone might be the whole cause of the labral damage and pain, and the surgeon-professor thinks it is safest to address this first and see how it goes. He said he will send his recommendation back to the hip surgeon at Steadman Hawkins, who is the one who worked out the CU referral for me. The Femoral Antetorsion isn't severe enough to risk this operation for me at this age and with my risk factors, and if fixing the Cam Impingement and labral tear can get my symptoms under control, we may be able to avoid the PAO/PFO entirely due to how the overcoverage makes up for the anteversion of the socket. The hip surgeon at Steadman Hawkins was very wise to get a second opinion about me- for me and with me- to have a direction on how to help me. I am hoping to be able to make contact with his office within the week or so to start working on plans to see if he will accept this recommendation from the surgeon-professor. This is a complex case and I feel like it is super wise to try the variable that might offer the greatest possible reward with the lowest possible risk.  My hope now is that the Steadman Hawkins hip surgeon will agree to the plan and that his team can start helping me make some plans for what comes next. This would be a less risky surgery with an easier recovery, hopefully! I am in a bit of shock from how well today went and am also truly grateful for having the opportunity to see some of the best orthopedic surgeons in the country. People fly here from all over the world to see this surgeon and it was an honor to see him at work. I also deeply appreciate that he left his door open to me should I need the more serious surgeries sometime sooner or later.

Something I am still processing is that my Femoral anteversion is actually quite a bit worse on my right side than the left, even though the left is the side that hurts and the right side doesn't. The X-Rays also indicated Cam Impingement on the right side also, even though I don't have pain there. It is my nature to push myself, usually much harder than I should, and I am taking some time to reflect that I will need to continue to need to make some adjustments to my expectations of myself for many years to come. For example, two months ago my new lightweight powered wheelchair arrived. We have been cobbling together a variety of manual wheelchairs and mobility devices over the years via loans from friends, pharmacies, borrowing from a non-profit in Denver, etc. and this has me realizing I really needed this wheelchair a long time ago, and that using it might hopefully help protect the "good" hip I have, which on paper is actually worse than my "bad" hip that I have been seeking help for.

Well, my family and friends, I admit I am mentally and physically exhausted in a way I never have been in my life. I am hoping this news today will help me have a more restful remainder of the day and evening. Eric and the kids have been going above and beyond for months, I hope this news feels like a bit of a weight has lifted for them, too. Thank you all for your love and well wishes, especially as I just celebrated my birthday. I also included a photo of an old drawing my sister drew of me, I love the "spicy" tee shirt she put me in! Sometimes I am really grateful I was born spicy, I feel like I need to be to get through all of this. TTFN.