Ten years ago today was the day that I had my first periacetabular osteotomy or as I call it, a “refurbishing” of my hip joints. A periacetabular osteotomy (aka “Ganz Osteotomy”) was invented by Dr. Reinhold Ganz at the University of Bern, Switzerland in 1984. To fix the dysplasia in a PAO, the pelvis is broken at the hip joint. The broken fragment is rotated to the correct angle and then screwed into place. The fragment then fuses back to the rest of the pelvic bone over several weeks. Correcting the dysplasia relieves the unnatural pressure that the joint was experiencing and stops arthritis from forming. Originally surgeons would just perform hip replacement surgery, which is much less invasive and a much faster recovery time. While a PAO is more complicated and months longer to recover from, it very eloquently preserves the hip joint. There is a video of the procedure linked here, which even though I had the open surgery version, the rest of the procedure is the same.
I spent a total of 16 days in the hospital for both surgeries, which was only a small fraction of what I hoped it would be like. I wanted to cry when I woke up in the recovery room after the first operation as I couldn’t feel anything. My mouth was so dry that I couldn’t talk. I couldn’t even focus enough to read the wall clock after the second surgery for almost an hour. Hospital staff were constantly coming in/out of my room, whether or not I was asleep. The IV bag would go empty and start beeping loudly, which the day nurses wouldn’t get around to changing for what seemed like hours. I got lucky with one of my night nurses who could slip in/out of my room without waking me and kept tabs on how much IV fluid I had left so she could change the bag before the alarm went off. She did the same ninja skills when I had blood transfusions at night. Other nurses had no qualms about flipping the lights on and then leaving the door wide open after so the hallway light flooded my room. Dr. Bellino was in my room at about 6 a.m. every morning to see how I was doing. Stanford’s pain management team was excellent in figuring out the correct combination of medication for me so I would be comfortable and coherent. They were also constantly making sure I still had feeling in my legs (as the incision area comes dangerous close to a nerve that if cut will cause leg numbness). I was on a fixed meal time after the first surgery, which typically didn’t line up with when I was actually hungry (or was having x-rays done during dinnertime). Unfortunately that led to my food being whisked away before I even had a chance to eat it. The solution was to have to hide my meal in the room! At least for the second surgery Stanford switched to “on demand” meals so I could call down and order my food when it was convenient for me. I also ordered extra food for my then-boyfriend since he was with me most of the time (and not like I could finish my meal anyway). A few friends and my parents visited me. My Aunt Julia (one of my grandma’s sisters) didn’t recognize me when she visited. I found out the hard way that I’m allergic to morphine. While there was minimal bleeding during the procedures, my red blood cell count dropped for unknown reasons afterwards requiring double unit transfusions. I spent most of the time just watching TV since I couldn’t concentrate enough to read any of the books I brought. Both discharges were postponed as I managed to wake up with a fever on the originally planned discharge date after both surgeries.
Frontal view of my pelvis.
I wish I had written more back when I had my surgeries, but I was constantly tired. Even 2 months after the surgeries I was falling asleep every few hours. Sleeping became uncomfortable since I was confined to sleeping on my back when I prefer sleeping on my stomach. We stacked pillows underneath me to minimize the bedsores. The blood thinner injections left welts all over my lower belly and hurt to the point of crying. I would wake up in the morning and look at the bedside commode wondering how badly did I have to pee. It would take me 15 minutes to get to the commode and I’d be out of breath and sweating by the time I got to it a mere 5 feet away. I’d drink Diet Coke with my first dose of oxycontin and oxycodone in the morning so the carbonation would help break down the pills faster. Tap water tasted like it had bleach in it so I drank bottled or filtered water only. I threw up constantly, frequently with little warning. The pain meds slowed my metabolism to a crawl so typically I was full after only a handful of bites of food. I lost so much weight that you could see the outline of my ribs and pelvic bone when I was lying down. At one point I didn’t even leave the bedroom for 9 days straight. I couldn’t even get onto my couch in the living room. I couldn’t go anywhere by myself as I was in a wheelchair for 3 months after each surgery and needed someone to push the wheelchair, open doors, and drive me everywhere. I couldn’t do some of the simplest things because I couldn’t twist or bend my torso that far. I was miserable.
I’d do it all over again though as it was also one of the best experiences in my life. I learned how valuable mobility is. Physically I’m happier than I have ever been in my life. People usually attribute my fitness level to “youth” whether or not they know that I’m 43 years old. I’ve spent the last 8.5 years working on it. I didn’t appreciate my portability. I’m in better shape now than I was in my 20s because I have a strong focus on my health and fitness now. I decided back then that I never wanted to take my body’s ability to move for granted again and have worked hard on honoring it. It started with swimming at a local gym where I felt great if I could swim 15 minutes. I stopped making excuses for why I couldn’t exercise. I learned to appreciate my body the hard way, but I’m grateful that I have had the opportunity and many more years to use it. My Great Aunt Marge told me once that one’s “golden years” was when you’re younger and could still move on your own and she was right. When I first started swimming again, I had to dig out an old high school team swimsuit and goggles as it had been about 15 years since I’d really swam in a pool. I started swimming 7 days a week. I still struggle with guilty feelings on “rest days” as part of me feels like I’m just being lazy. I never had any formulated fitness plan, I just fell into my current norm. Like a religion, I want to honor my mobility as often as I can.
Side view of my pelvis.
I don’t do physical activities unless I enjoy them though. It’s like why I work in a career at a company that I love as it doesn’t feel like work. Swimming in the ocean or any time on my bike doesn’t feel like a workout. Maybe that was the problem when I was struggling at the boring gym. I was just asked a few minutes ago by my friend Simon on how long would a 200k bike ride take me and I said about 10 hours. I don’t think about how many hours it’s going to be before I start. I just think that I’m riding that route with my friend Ken that day. Just one little pedal stroke at a time. It’s nurtured my love of being outside and during the pandemic has been the only time that I feel like I’m really alive and part of this world. I’m grateful that I’ve been able to continue going on my swims, rides, and runs outside while successfully avoiding a highly contagious and deadly virus. COVID-19 has been a reason why I’ve still been getting up early to start my trail runs with a headlamp as I know I will be able to do 2/3 – 3/4 of my trail runs without crossing paths with another person. Similar to when I started swimming again in a pool in 2012, the early start times also means I can get a couple of hours in before starting work for the day.
Now when I travel I want to see as much as I can of the natural world on my own power. When I was in Hong Kong a year ago, I hiked all 4 days that I was there, even though my legs were sore. A childhood friend and co-worker are from Hong Kong and neither knew there was any hiking there. There were some steep hikes (5 miles / 3000′) and not so steep, but I loved every minute of it. I was getting to see a side of Hong Kong that most tourists (and locals) don’t ever experience. I then went cycling and hiking in Singapore and onto swimming and running in Thailand. After 19 days I came home feeling more myself than I had felt before I left on holiday. I will probably never be happy with the holiday that just involves laying on a beach doing nothing all day. Being physically active on holiday isn’t about keeping a fitness level at a certain point, but instead of getting to marry physical activities I love with new environmental stimuli. I’m lucky that for running I can really only run on dirt trails (asphalt hurts my hip joints too much) so I have to get a little creative with where I can run when traveling. By default, that puts me on the paths literally less traveled.
Side view of my pelvis.
I get asked a lot on how my hips don’t bother me with all the long distance / endurance cycling and swimming. Those activities really don’t use my hip joints. I remember after reading my friend Catt Tapoli’s Conscious Fitness: Strength Training For The Evolution Of Body, Mind and Spirit book that I was on a stationary bike trying to focus on my hip joints and thank them for allowing me to be able to ride. I realized that I couldn’t feel them. I could feel my quads, glutes, hamstrings, etc. contracting and relaxing, but not the joints. Cycling doesn’t use the joints as they’re just along for the ride (pun intended) while the muscles are doing all the work. Catt was thrilled at my revelation as I understood her whole point on what conscious fitness really means. Neither cycling nor swimming have impact on my hips which is why I can do both of those activities for hours without any negative affect on them. Again, they don’t feel like exercise when I’m outside on a bike or in open water. I’ve laughed to myself some mornings when I’m over an hour into a bike ride and think about how I’d barely noticed that hour whereas an hour feels like forever in a spinning class or pool.
I don’t want to be defined by my hip dysplasia though. I’m not trying to make a career off of it or expect sympathy from people for it. I’m proud of what I went through and where it got me to today. The experience inspired me to re-evaluate how I wanted to live my life for myself. Many people go through surgeries to physically fix themselves, but I’m not sure if it alters their personal life view. I didn’t expect to come out of my surgeries the way that I did, but I’m happy that it was a life changing experience. I went into a whole new world that I didn’t imagine existed. I used to think that health freaks were the stereotypical gym junkies with all the powders and nonsense. I’ve carved out something that works for me every day and keeps me fulfilled. My life feels very natural and like it was waiting for me all this time.
Recently I had my 10 year check-up with Dr. Bellino. There is no sign of any further development of arthritis in my hips and everything looks perfect in the surgical areas. He’s impressed with how physically active I have been. He asked if I’d talk to some of his other patients who are apprehensive about being able to return to a full active lifestyle after a periacetabular osteotomy, which I happily accepted.
Today in honor of the 10 year anniversary of my first PAO, I ran 10 miles in Wunderlich County Park. I regularly do the route, but today’s was special. I spent a lot of the time reflecting on the last 10 years. I chose to run today since of all the activities I do, the 390 pounds of force that running exerts on my hip joints is the one thing that would have been physically impossible for me to do without the surgeries (along with the dirt cushion). Modern medicine and a very talented surgeon are why I can physically run now.
I believe that everything happens for a reason and am grateful every day that I was born with hip dysplasia as I feel like that gave me a second chance of what to make with my life in terms of physical health. The physical health has tied into my mental and emotional health where I feel better overall when I’ve gotten in one of my various outdoor activities. No two swims, rides, hikes, runs, etc. on the same route are ever truly the same. They’re always different experiences and memories. You don’t get that from a gym or staying at home doing a home workout video for the billionth time. It isn’t about just burning calories so my clothes fit better, the reflection in the mirror is more appealing, collecting endorphins, providing anything to myself or anyone else, or so I can eat cake after dinner (which I rarely eat dessert anyway). It’s simply making good on a decision I made during a time in my life when I’d temporarily lost one of the most basic fundamental skills most of us learn when we’re toddlers. There are days that I don’t want to get on the bike and have to talk myself into it, but I also tell myself that I know I’ll feel really good in a couple of hours. I have yet to be wrong.
Dr. Michael Bellino and me at my 10 year check-up in 2021.
“When everything’s taken away from you, you appreciate those little peddle strokes.”
— Paul Gasagoita, former competitive mountain bike champion and spinal cord injury survivor