SURGERY!

“Wev’e been here five and half hours. And we are still waiting for Dr. Meyers to come back to the room again”. This complaint was being lodged with the receptionist at the Vincera Institute. I smiled inwardly. I remembered that first appointment. Indeed, between the two MRIs performed and the three doctors I met with it was a 5 hour visit. . . and you know what? I left with answers from a caring team of medical professionals. I guess patients have gotten used to the quick usual answer of “rest and take this medication and all will be well”.

But that isn’t what brings one to visit Vincera Institute. It is certainly not what brought me here. What brought me was a lot of unanswered question after countless X-Rays, an MRI, and an ultrasound along with several different doctors. I thought about this as I contemplated my choices while I waited in the lobby to see Dr. Meyers and his esteemed colleague Dr. Coleman.

After all the testing and my prior visit with Vincera, I knew what the issues were and why I had constant, pulling discomfort in the groin and hip area. Contrary to the first MRI where it did seem as though I was going to give birth to

ET, the staff at Vincera had discovered a Core Muscle Injury (formerly known by me as athletic pubalgia, formerly known by all as the dreaded but poorly-named sports hernia.) Additionally, and perhaps causally, they found a fairly significant hip labrum tear in my left hip. Problem identified. Let’s fix it. I won’t re-bore you with the tale of insurance woes. Basically, I’m paying out of pocket to fix this.

So . . That brings me to Monday, October 16th and an afternoon pre-op appointment with both Dr. Meyers and Dr. Coleman. I’d been waffling constantly about whether to do both the hip and the pelvic floor repair (the repair of the core muscle injury). It really came down to money. If it were unlimited I’d have already had both repairs done. But I hadn’t actually met with Dr. Coleman yet and figured I was far enough in I may as well talk to him and get his opinion.

The office was running a bit behind. This was apparent by the complaint of the gentleman when I first arrived. Honestly, I was okay with this. I know why they are behind. Dr. Meyers and his staff take the time for thorough examinations, thorough interviews, and they take their time examining MRI and other test results. They want you to have an answer and your set of choices when you leave the office.

Today was no different but eventually we were taken back to an exam room where I would first meet with Dr. Coleman. Dr. Struan Coleman is my age almost to the month. His birthday is one month before mine. It’s as though we are brothers, except he is a rich, good looking doctor and I am . .  Well I’m not.

After an examination, Dr. Coleman produced a little 3D model of the hip. It turns out I was predisposed from adolescence to some form of hip/groin injury. My hip ball was a bit misshapen causing a hitch which stresses the labrum. This hitch puts undue strain on the adductor which begin to pull off the pubic bone at their attachment point. I believe the only time I was ever aware of any sort of hitch in my hip was at the 2016 Boston marathon when my left hip began locking up inexplicably.  Dr. Coleman believed that the hip caused the CMI and worried if we didn’t do both that I would continue to struggle. I could also have other problems related to the hip as I grow older including more severe arthritis, and early need for hip replacement. He wasn’t trying to scare me or force a choice and suggested I could try the CMI first and see if that was good enough, but a second surgery would ultimately mean another round of anesthesia which is always the biggest risk in surgery. Dr. Coleman left the room having provided all the information he could for me to make an educated decision.

Dr. Meyers came in next. It had been more than two months since he saw me and I didn’t expect him to remember me. He sees a lot of patients. But he did remember. I’m sure he reviewed my chart but he remembered details that wouldn’t be in my chart. This was also the first he had met Janice and he took the time to introduce himself to her and explain his background.

We then got on with examination similar to that done last time including observing me while I removed my jeans. To be able to do this I had to lean against something when I lift my left leg as trying to balance hurt and was impossible. Janice knew he was observing what I had to do to get undressed.

After the examination, and a consultation with Dr. Coleman, and reviewing my MRIs, Dr. Meyers pointed out the decisions for what to do were all mine. “There isn’t any pressure here but I’m worried if we don’t fix both problems that the solution won’t work for you. However, I’ll do whatever you decide. And it could work out just fine”.

I had already decided I was doing the pelvic floor repair but I was back on the fence about the hip. I thought fixing both was the appropriate thing to do, Janice thought so, and so did Dr. Meyers and Dr. Coleman. I went to see Marcia to finish up some pre-op paperwork including paying for Dr. Meyers. (Ouch.) She then referred me to Alberto who was Dr. Coleman’s assistant to learn about Dr. Coleman’s fee.  (Double ouch . . So far this was pretty painful surgery and a knife hadn’t touch my skin yet).

We were working under the assumption until I said otherwise that we would do both fixes in surgery the next morning. I went upstairs to get fitted for crutches, and a hip brace “just in case I’m doing the hip”. I also met  Sarah, a physical therapist,  who did some preoperative training. She showed me how to get on and off the table or bed, and how to walk on crutches. Again, these would all become necessary if I got both the hip and pelvic floor repairs.

After seeing Sarah, I tracked down Dr. Meyers and asked him one more time. “If I want to get back where I was prior to this injury, able to run fast and far, drive and sit without discomfort, operate in everyday life without discomfort you think my best chance for success is to do both repairs. Correct?” Dr. Meyers without hesitation said “YES”. Okay . . It’s only money. Let’s do it. It seemed silly to do anything less.

I let Marcia know my final decision and wrote Alberto a check to cover Dr. Coleman’s portion of the surgery, then took my fancy new hip brace and Janice and I left for Rite Aid. I had been given a prescription for Percocet that they recommended filling beforehand. That was an interesting prescription fill. There is much more information required for an opiate-based pain killer these days than a few years ago. My hope was not to have to use too much of them. On a funny side note, the prescription was for 50 pills. My cracker jack insurance would only pay for 48. Go figure.

Once we had the script, we returned to the grounds of the old Philadelphia Navy Yard where Vincera is located, and checked in to the Marriott which is just a couple blocks away. We kept things simple and had dinner in the hotel and turned in. I was to arrive at the surgery center at 5:30.

I must say that everything about  Vincera Institute is clean, and state-of-the-art. The staff are super friendly and patient. The surgery center experience was no different. After I was checked in, I was taken to the prep area by a nurse named Alex who got all my vitals, put in the IV and made sure I was warm before retrieving Janice to sit with me until surgery started. During this time, Drs. Meyers and Coleman came in and took sharpie to my body to mark the appropriate places to cut or not cut. I also met Matt the anesthetist, and the nurse anesthetist Kristin.

Eventually I was wheeled into the OR. The last time I was in an OR was some 40 years ago. The new ones look a lot nicer. That last time I was having some sinus surgery done since nobody could figure out why I was always having respiratory issues and my sinuses had developed some scar tissue. All these years later, I learned I’m very allergic to cat dander. Since I nearly always had a cat that may have explained those childhood issues. Wait . . Where’d the story go? Oh, right. Operating Room. First, one more tale from that early operation. I remember them sticking the pads to my chest and turning the machine on and it flat-lined. The last thing I saw before going under was someone whack the machine with their hand and it started reading properly. I remembered hoping that if it flat-lined again someone would remember to give it another whack.

But back to present day. The new OR looked like a room on the International Space Station. There were people buzzing about. An oxygen mask was placed over my face. Matt or Kristin were there and said something about medicine.

“Hi there. It’s all over.”  Said a very caring voice as my eyes opened. My throat was a little dry and my lower abdomen hurt more and more as I came to. Tanisha, my recovery nurse, acted quickly administering a shot of Fentanyl. I see why it is a popular street drug. Almost instantly the pain was gone. Tanisha assured me it doesn’t last long and I should eat something so she could give me Percocet. She brought some apple juice and some chocolate chip cookies. My mouth was so dry I had to take little bits of cookie and moisten my mouth with apple juice to swallow. But I did get down 3 cookies, enough to have a dose of Percocet as the Fentanyl wore off.

Tanisha went and retrieved Janice. Dr. Meyers had completed his part of the surgery first and had called on her phone to provide an update. His portion had gone well and he explained that I had a major tear on the left side. This isn’t a surprise to me. I’ll confirm with the doctor later but I don’t believe there is any therapy or alternative treatment that could be used to solve this aside from the surgery. Shame on you American healthcare system. Shame on you indeed.

Once I was awake and had a snack and the Percocet I was ready to get dressed and head upstairs to see Sarah. Getting dressed didn’t sound like much fun. But Tanisha and another recovery nurse dove in helping me get on compression shorts (recommended for swelling) warm-up pants, socks, shoes, and shirt. Then it was time to sit up and navigate into a wheel chair. This was not the most fun thing but we got it done. Then it was up the elevator and into rehab where Sarah applied a Game Ready device that massaged the affected areas with cold for twenty minutes.

It was sometime around 3:00 when the Vincera folks helped me into the car and Janice drove us off in search of something to eat. Fortunately, I had no nausea from the general anesthesia which I guess is fairly common. I didn’t know it yet but the only side effect I would really suffer from was an inability to urinate. Apparently, they may ask you to try to do this in recovery but I hadn’t had to because they had a catheter in for surgery so I was pretty empty. It would be hours before I’d feel the need to pee.

In the meantime, my appetite was good. We grabbed a couple sandwiches from a nearby South Philly steak shop and I found a Termini Brothers bakery location not far away where we grabbed a little treat. Then back to the hotel where I ate with a dry mouth. The sandwich was good but required a lot of water to be able to swallow it. I spent most of the rest of the afternoon in and out of naps. Between lingering anesthesia, and the Percocet, I was wiped out.

About 6:00pm I decided I had to pee. At risk of TMI . . Despite my best efforts not much happened. Uh oh. I tried again every so often with minimal effect. I texted Dr. Meyers (he gives you his cell number). We agreed that if things came to a complete stop I’d head to the ER. Fortunately, throughout the night I was able to go enough to not have a lot of pressure or discomfort. Just a little bit at a time. In between I’d fall into a Percocet induced sleep. Every 30 minutes or so I’d get up to go as best as I could and decided if things didn’t get better by morning I’d text Dr. Meyers again.

But they did! I’ve said it before. Never take the little things like peeing for granted. Now if only Sarah and I had reviewed how to be able to sit on a toilet. But that’s definitely TMI.

Today I go back to see Sarah for the initial PT visit which I’ll continue with my go-to PT, Vanessa Bowers starting next week. I’ll also have follow up with Dr. Meyers today and then we’ll head for home.

So the summary is, things seem to have gone well. I’m a bit sore but, oddly, even at it’s worst yesterday the pain was not as bad as what I had at the end of the Boston Marathon this year after running 26.2 miles with this injury.  Now I have two and half months of rehab mostly for the hip. At the end of which I should be as good or better than before. I just hope I can hold on to my swim, bike, run mojo at that point. You can also bet there will be a lot more core work to keep things healthy and strong too.