Going With The Flow

13 miles at 6:02 avg pace... felt relaxed and controlled, except for the massive tear in my external oblique.

Half of that sentence is true :-)

Saw Dr. Brown in California today. I have a pretty significant tear in the aponeurosis of my external oblique (at the pubic bone attachment) and potentially the internal oblique and adductor in that region as well. He will know for sure once he operates tomorrow. He is also concerned that there might be some damage to my iloinguinal nerve, and that might be contributing to the persistent pain. He showed Jake how to palpate the damaged area and there is a "hole" that you easily feel (when you know what you are looking for).

So... Surgery first thing tomorrow morning. It's a quick procedure, shouldn't take more than an hour. I decided to get local anesthesia and hope I don't have panic attack! Needles, blood, and surgery freak me out.

I hope tomorrow is the beginning of a new chapter. I'll update once I'm coherent again :-)

Surgery day.

I was very nervous before surgery this morning.

Everything went about as smooth as it could have, though. They gave me twilight anesthesia and that knocked me out good. I woke up just after the procedure was finished. After it was over I hugged all the nurses and immediately asked for a milkshake - I was so hungry because I had been fasting, something I am not used to!

Then they let Jake come back and see me, and we waited a little bit for Dr. Brown to join us and explain exactly what he found/fixed, and show us the pictures.

Here's the quick rundown:

-external oblique aponeurosis tear, about 2 inches long, was sutured back together.

-internal oblique underneath that spot was damaged and about to tear, thicker portions of the muscle were sutured together across the compromised area. It had also separated from the conjoint tendon, and needed to be sutured back to that.

-2 branches off the iloinguinal nerve were frayed; these were cut off.

-adductor longus was partially torn off the pubic bone and was attached to the adductor brevis in order to relieve some pressure from the pubic bone.

He said it was the WORST injury of this type he has ever seen in a female. He said something along the lines of "i dont know what in the world you did to cause this!" This is a much more common injury for men (although still quite rare)... go figure it would happen to me.

Post-surgery... I can't say it is going great. Apparently you use your abdominal muscles for everything, so any movement at all puts me in A LOT of pain. I'm not feeling too good right now. I owe Jake a lot for being my nurse and dealing with my constant whining. It can only get better from here, right?

I will post some more info about what he did (and pictures of the tear) when I get home on a real computer... Not to mention being able to sit up and move more than an inch. I'm such a baby when it comes to pain.

Thanks everyone for the support and for thinking of me :-)

Post-Surgery Day 1 (day of surgery, yesterday) ended up being pretty rough. I really couldn't move without significant pain. I tried to stand up (with lots of help from Jake) and both times I was on the verge of passing out. Most of the pain was at the site of the incision and my back was also cramping quite a bit. I finally called the doctor at night, and he doubled the dose of pain medication. It took a while to kick in, but I finally felt a little relief.

Post Surgery Day 2 was overall better except for the traveling home. I could stand up for a while and finally loosen up a bit. We went to the park and laid on the grass to soak in some sunshine. I was stupid enough to think I would be fine traveling today. The traveling went okay at first (with a wheelchair of course). By the time we got off the plane, got on the shuttle then to the car, I was not doing well. I started to shake and panic from the pain which only made things worse. It took us two hours from the time we got home to calm the pain and be able to go to sleep. Poor Jake had to deal with me...

This was waiting by the door when we got home :-)

Post Surgery Day 3

Got some sleep (in about 2 hour increments). The incision area(s) are still painful and sore. I am able to move a little better today and my range of motion has improved some as well. But it is still hard to walk and I get shooting pains when I walk. Overall I think I am making progress, although I wish I was improving faster!

Dr. Brown called to check in for the 6th time in the past 48 hours. I am very impressed with him and his concern for me. He told me not to stretch at all for a while, and try to slowly taper off the pain medicine without putting myself in too much pain.

Here are some pictures from the surgery. If you are squeamish, don't scroll down any further...

The injury I had is what is considered a "sports hernia" although it really isn't a "hernia" at all (somehow it got that name a name a long time ago because it occurs in roughly the same area as a regular hernia and happens to athletes). A better term to describe it is Athletic Pubalgia. Diagnosis is very difficult, because it basically occurs through process of elimination of all other groin/hip injuries. It is also rare (very rare in females), and a lot of doctors don't even know about it (for example, I had one surgeon in Utah tell me such an injury didn't even exist!). Matt Poulsen actually suggested this could be the problem all the way back in September, but he also knew it would take some trial and error to accurately reach this conclusion. He was right all along. Typically, people with this injury are encouraged to try several courses of physical therapy (along with ruling out FAI, labral tears, etc). I did all of those things and as you will see by the size of the tear, there was no way this was ever going to heal with PT or conservative treatment alone. The amount of surgeons who work with higher-level athletes and repair this injury can be counted on one hand. Dr. Brown was the closest to SLC and had excellent reviews; I'm very glad I chose him as my surgeon.

This is the location of the injury, for reference:

This first photo is of the primary tear of the external oblique aponeurosis. The tear is 2-3 inches long and separated by a full thumb's width. The arrows show where the tissue should be attached. That entire area between the arrows is torn.

The second photo is another layer down, now looking at the internal oblique. This area wasn't torn, but the area outlined by the yellow box was very thin and barely being held together. It was at risk of tearing at any point. The internal oblique was also torn from the conjoint tendon (but I don't have a photo of that).

The third photo is showing how Dr. Brown is pulling thicker/stronger portions of the internal oblique together over the thin/compromised area.

The fourth photo is Dr. Brown pulling the external oblique together (essentially attaching the ends separated by the yellow arrows in photo #1 back together).

I don't have good photos of the adductor repair or the damaged nerves. Maybe that is a good thing, I don't know if I need to see that as well. This is enough. 

Post surgery Day 4. Moving a little better again today - I can walk 50 ft instead of the 25 ft yesterday :) Incision area is still pretty swollen but less numb. Sitting up and side motions cause pain, lifting right leg is okay now, and the cramping has lessened.

Goal for the first 7 days is merely to recover...go on short walks as tolerable but mainly just rest. Slowly taper off pain medication. Glad the weather is nice to lay out in the sunshine!