The fantastic logic of an Endocrinologist

The last few days I was wondering if I should write more in detail about my visit to the Endocrinologist and now I know. It was too  special  “not” to share.

Read on and you will see why.

 

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My Endocrinologist greeted me and said “so, you are here to get the results of the bone density scan.” So I told him “not really. I know the results already. I am here to find out if there is an underlying issue going on.”

Spends some time looking at the PC and tells me “You had another scan done in 2011. It looks like you had 12% bone density loss since then.” Takes a minute his time and asks “did you ever have another bone density scan done?” “Yes. In 2011.”

 

(This should have given me an idea of how the appointment would go…)

~~~

He asked if I lately had any fractures and there it went. I told him about my complete hip fracture and after determining it is unusal for somebody my age to get this, the investigation got started.

 

 

Doctor: “ What happened?”

Me: “ I had a ski accident. I slipped, both skis were pulled away right under me and I fell very fast and very hard on my right side. Like a log.”

Doctor: “ So you ran against a tree.”

Me: “ No. I had a “slip & fall”.”

Doctor: “ You mentioned a log.”

Me: “ Yes. I fell in a straight line. Like a log.”

~~~

Doctor: “ Did you know right away you broke it?” ( How would I know? It’s not like I do this on a regular basis.)
Me: “ No. I just knew something is majorly wrong. I was in severe pain and could not move.”
Doctor: “So you walked to the  ER  then? (I was just thinking to myself “you are not walking anywhere with a complete hip fracture!”)
Me :” I was picked up by ski patrol and their tabbagon.”
Doctor:” What did you fall on?”
Me :” Snow.”
Doctor:” Snow???” (Do I speak Chinese? 😶)
Me: “ Yes. Hard packed snow.”
~~~
Doctor :” To which  ER  did you go?”
Me:” Snowmass village in Colorado.”
Doctor :” Why there?”
Me:” Because that’s where we were skiing.”
And finally,  T-H-E   conclusion of the day…” so it was a skiing accident?” Aaaaaargh!
~~~
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~~~
And to finish it off, he asked if I was suicidal. Huh???
~~~
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~~~
I sure hope he is smarter, looking at lab results than he is talking to a patient. Geez!
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And yet another interesting week…

Borderline 9 months PO –  R  hip pinning

 

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I tried playing tennis again. My precious 20 minutes on the court, very simplified and very careful.

Short balls? Nope. Wide balls? I am letting go as well. At this stage it’s not about improving my tennis technique or kicking butt, it’s about being out there and making contact with the ball. Back to the basics.

Might not be the best tennis I can play, but hey, beats being on crutches  ANY  day!

 

I still have to work on my  R  side. Especially the rotation part, strength and sprinting. I tried for a few balls to get to it and while my left side felt great, my op side leg felt like I am a marionette. Stiff and wooden.

 

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~~~

We got another bill from insurance, telling us my physical therapy cost of almost $ 3,000 was covered. Yeah.

This rounds the whole ski accident, with surgery, ambulance, hospital stay, meds ect. ect. up to a whooping $ 50,000. What a memorable vacation.

 

The one advice I can give to others who are going through this is, keep every single bill and paper you get. I have a whole folder with bills from the hospital, insurance and PT. They came for months afterwards and if one is not organized, one can lose track easily. I seriously felt like Harry Potter at some point…

 

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~~~

To make my strengthening exercises “fresh”, I got a book – “exercises for glutes and squats” and looked up some videos on youtube, using your own bodyweight. Kinda nice, doing something new after many months, doing the same old exercises.

Some exercises go well and confuse my muscles in a good way, others are barely to not at all happening.

 

“Bulgarian squats” aka one legged squats?

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Work well on my left leg, my right leg with the operated hip – much weaker and the balance is not the best either.

 

Sideplanks. (For the record, I hate “plank – anything”, but I guess they are good for you. So I have a love/ hate relationship with them.)

Ideally, this is what it looks like…

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Mine look like this on my left side. On my right, my hip stays firmly on the ground. It does not feel too well in the op hip and I guess my cores on that side also need more love.

~~~

The other day I saw my regular doctor and of course my latest hip surgery came up. She assumed I had “ORIF” = open reduction and internal fixation. (Basically the surgeon cuts the thigh, goes through muscles and opens up the hip capsule, to realign the bones with orthopedic hardware.) A way more invasive surgery than mine.

My surgery was percutaneous pinning.

Anyways, two different approaches and two different recoveries. When I corrected her and said I did not have  ORIF, her response was “oh…! So you just  had hip pinning done??”

(What the hell?) I have gotten this response several times already and each time from a medically trained person. “Just hip pinning?” Did I miss something? They make it sound like it was nothing. This was one brutal recovery, I am not sure why it is being belittled.

 

She did get a bonus point again when she told me, I am more active after recovering from a complete hip fracture than the average healthy person though.

 

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~~~

I also finally had my appointment with the Endocrinologist, to see if there is another reason why my hip broke. He said having borderline low bone density and  a fractured hip at my age  AND  being pre- menopausal makes it not just very uncommon but tricky. (Welcome to my world.)

He examined me, asked 1000 questions, blood was taken and as a special treat I am supposed to collect my urin for 24 h in this container. No comment.

 

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The results from the lab will be discussed at my next appointment.

 

Already about 10 minutes in my new doctor threw the name of a medication (“Fosamax”) at me and suggested trying it out for five years.

I have made enough research to know, this is not something I want to take. It increases your bone density but also makes it more brittle at the same time and it comes with an increased risk of hip, femur, shoulder and knee fractures. Nope. Definitely  NOT  signing up for this one.

 

Before I left a nurse shoved a little plastic container in my face and looked anxiously at me. I had no idea what she wanted from me and told her so. “Pee in it” was the response. (Talk about clear instructions and making minimalistic conversation with a patient.)

~~~

So, for now – back to the gym, work on my right side and one of those days is dedicated “orange bottle time”… The fun just never stops.

 

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Sports after hip pinning

8 months/ 1 week post operative – R  hip pinning

 

I was thinking for a while about it but didn’t feel quite ready for it – trying out for some tennis. Yesterday I went for it!

 

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It was only some light mini tennis, easy groundstrokes from the baseline and a bucket of balls for serving, all in all roughly 20 minutes and  VERY  simplified but hey, I was out there!

Of course it was no US Open material and nowhere close to where I used to be, ahem… three hip surgeries earlier, but still. One has to start somewhere!

 

I had a lot of fun and it was awesome to be back on the court.

Here is what I (hip wise) noticed:

  • footwork to the left forward works well, footwork (small, light steps) to the right & backwards feels like I move with the agility of an elephant.
  • (backhand) rotation with the hips to the L works well, (forehand) rotation with the hips to the R not great.
  • going for low balls – difficult, going down and coming up
  • overall stiff and tight feeling on my R side, mostly muscular
  • explosive and fast moves – nope.
  • Rotation, deep knee bends, weight transfer on the serve? Not really.
  • sudden change of direction? Not the best idea.
  • fast sprints? No.

 

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Lots of important things missing but I am sure it will get better with time. (Honestly, I thought it’d be worse with a lot of payback.)

It was a good try out and certainly a great way to confuse the muscles. My hip was NOT  hurting afterwards, I was a bit tight and tired but that was it. Considering where I am coming from, I was pretty happy.

 

So back to the usual – my op side needs more love and attention. Have to work on strengthening, building up muscle mass and gaining endurance. No rest for the weary.

 

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8 month PO update

Another 31st of the month and another milestone – 8 months post operative to hip pinning, to the day. (Longest 8 months ever.)

 

Fortunately I have more good to say than bad.

 

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The positive:

  • I can live a normal life again.
  • I am mostly pain free, aching now and then but nothing dramatic.
  • My good hip took quite a beating for many months but has calmed down quite a bit.
  • My workout routine is going well. (Elliptical – 15 minutes/ level 1; treadmill – 20 minutes walking medium pace; stationary bike – 17 minutes/ level 1. Of all of these exercises my op hip probably likes the bike the least.)
  • Good gait
  • I can walk a mile very nicely

 

Best compliment I have gotten recently?  From my husband, who said “if one does not know you had a hip fracture, one would never know it, just by looking at you.”

 

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The negative:

  • Sports are still not happening. Neither is outdoor biking on a real bike.
  • Walking anything over a mile gets tiring very quickly and the more I walk, the slower I get and the more the limp comes back.
  • Muscle atrophy is still a big subject
  • Muscle imbalance

 

Task ahead:

  • Keep doing what I am doing
  • Work on endurance
  • Build up strength
  • Keep  ROM  going
  • REPEAT! 

 

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Plot twist

6 months, 3 weeks PO

 

Since it is  VERY  unusual for somebody in the early 40’s to just “slip & fall” and have a complete hip fracture, it was time to investigate further. A  DEXA  scan was performed to measure my bone density in my spine and left femoral neck (my R, op hip, has too much metal in it. Go figure.).

My spine is great but my hip shows early signs of “Osteopenia”.

 

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Osteopinea is the step “before” osteoporosis. The bone is not quite as dense as a healthy bone but not as bad as one with osteoporosis.

~~~

Last time I had one done was 8 years ago, before my hip saga started five years ago and it came back with very good results, spine and hip.

 

I made research and know now that I got this probably because of being on crutches for so long and being very restricted. (3 hip surgeries/ 4 years = 44 weeks on crutches.)

To maintain good healthy bones you need a good, healthy diet and weight bearing exercises. My diet is indeed very healthy and I am quite active but I have not been able to do “sports” like I used to. I am either in recovery mode or doing physical therapy/ exercises since years.

My first two hip surgeries, combined with two stress fractures in my pelvis, took me three years to recover and now I am in my 3rd recovery and in my 6st month.

 

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In one medical article I read “if one is inactive or bedridden for a long time, it can cause it”. I am sure that’s it. EVERY  other question I answered with no.

  • Are you over 50? No.
  • Are you done with PMS? No.
  • Do you drink alcohol? No.
  • Do you drink soda? No.
  • Do you consume a lot of coffein? No.
  • Are you petit? No.
  • Are you small boned? No.
  • Do you drink a lot of coffee? No.
  • Does it run in your family? No.

 

Some other risks include being white and female. Guilty.

I have to make more research because the  LAST  thing I need are brittle bones. With Osteopinea also the risk for hip fractures increases. No kidding!!!

 

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My doctor prescibed me a diet, rich in calcium, take vitamin D 3 pills and exercise “more” which is a bit easier said than done because all of this aside, I am still recovering from a hip fracture and need to be sensible about it.

~~~

Looking back to December 31. 2017, my accident on the slopes – it really was the perfect storm and the last missing piece of the puzzle was just found.

 

Time to rethink and face another challenge. At least I know now.

 

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Things are going according to plan

6.5 months PO

 

I am doing good. My hips like my new PT/ workout routine much better than physical therapy which turned into bootcamp in the end.

 

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I still get achey with my op hip, on “very special” days it’s both hips, but in general they are much calmer. Compared to two months ago I feel much stronger too. Of course that will be put to the test at some point and I probably still can’t keep up with others over longer distances but I am getting there.

For example, I can walk a bit more than a mile now and I even can pass people, so I am officially not the slowest one in the park anymore. Ha!

~~~

  • My Elliptical is up to 11 minutes on level 1,
  • the stationary bike I can do 16 minutes on level 1 and
  • walking on the treadmill is also okay for 16 minutes, medium fast walking speed. I guess adding a minute every two weeks is safe. Of course it’d be nice to go for more but what’s the result? Two pissed off hips.

 

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At my 6 month follow up with my orthopedic surgeon X-rays were taken and everything is healing nicely. There is continued bone healing and bone remodeling taking place and no complications.

 

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He reminded me again, that this is a recovery that can take up to a year. I believe it but I do feel like I have, for the most part, my life back already.

I can take care of my family again, run the household & errands and except for doing sports, I am the same as before I so geniusly kissed the snow. Now it’s all about fine tuning.

~~~

He examined my hip and it is gliding smoothly and its mechanics work well. It is not completely anatomic anymore since the fracture was impacted and I might have aches here and there from now on, but when do I not? I expect things to get even better with time and I am already very happy with the healing process.

 

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I should “keep doing what I am doing” with my exercises and should be able to go skiing again early next year. Music to my ears!

~~~

My daily steps are also improving. I am now doing 10,000 steps several times a week but I also learnt two lessons the hard way last week.

a) I went too fast on my stationary bike and was limping and hurting the whole next day.

b) I have to watch my walking speed and gait. For one of my walks I walked too fast and my stride was too long, was hurting the whole night. So back to walking a bit slower again and making smaller steps.

 

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Big milestone!!

 

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Today I am 6 months post operative and hopefully things continue to go well for me.

The past half year was very tough, physically and mentally.  First the ski accident and surgery that came out of nowhere, trying to accept the situation and the fact that I had to start from scratch yet once again; deal with brutal pain the first few weeks, to doing my 20 weeks on crutches – learning how to walk again, do stairs and just little things.

Especially “the little things in life” everybody takes for granted are not so little, if you can’t do them on your own or not for a long time.

~~~

I seriously could not have done it without the endless support and care of my husband. He was and is there for me when nobody else was/ is. ❤

 

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This was my third and by far, the most difficult hip surgery recovery and what you learn very quickly is, who is a real friend and who truly cares. Let’s just say the list of people who stood by my side was very, very short. Teaches you a lot about people…

~~~

I started physical theraphy at 6 weeks PO with my PT and did home exercises on a daily basis at home ever since. I am still not done with it but the roughest part is over.

Now it’s all about endurance, strengthening, giving it time and waiting for things to fall into place.

 

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My range of motion is good in my op hip, the pain level is okay on most days but I still get achey quite a bit. On a good day I am on a 1-2/10 pain level, on bad days it can go up to 5/10.

My gait looks good but the more tired I get, the more I will start limping. Also, still lots of compensation going on which my good hip is not too fond of and gets upset too. (Good times when both hips are cranky…)

~~~

Stairs are working fine, if they are reasonable and my op hip is in a good mood. The more tired or achey it is, the slower the stairs will be.

Driving my car is no problem anymore and sitting in general is fine.

I am still putting a huge effort into my recovery and do my exercises. As I know from my previous hip surgeries – “happy hips are a lifetime commitment”.

 

Atrophy (as well as scar tissue & adhesions) is also still a problem I am working on.

At this point I can walk 1 mile/ 1.6 km nicely. Not as fast as other people, but not slow either. I also can do about 8,000 steps/ day and feel fine. A bit more is doable but I will get achey. 8,000 steps is a good day.

This was last weeks summary, according to my Fitbit.

 

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In general I feel good and I am happy again but I know there is still lots of work ahead.

Pretty much the only thing that is totally not happening right now is sports, anything beyond PT exercises. Hopefully this will come with time.

Till then, chin up and keep going.

 

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