Sunday, June 26, 2011

The Black Holes of Healthcare, Lemonade,...And My Plan!

HI Your Fit Day Friends:

I hope you're all enjoying the spring weather. Here in the Bay Area we've had some pretty picture-perfect days. And the days are still getting longer.

Hey! You know what that means, don't you? More daylight hours... for... ex-er-cising! So no excuses; at least for the next 6 months, anyway.

Go enjoy the great outdoors and make fitness fun. Grab your kids-or someone else's-and Go Go Go. Visit your National parks, (hurry, while you still time, since many are set to close in September). Play on the swing-sets. Bike the trails, and run in them thar hills!!

Hey! Speaking of running...that's something I won't be able to do for a while, and I wanted to give you an update on your trainer's life.

My Hippy News

In my Part I of Key to Pain Free I mentioned seeing a second surgeon after I was 'misdiagnosed' by the first. The first surgeon, let's call him Dr. Compassion (not!), advised Motrin daily; told me to come back in six months if I was still in pain; and, without even looking at an X ray or MRI, told me I was too young for any type of surgery and to come back when I was closer to age 60, and sent me packing.

Huh? I see. At my HMO it's obviously all about patient care!

Let me give you a brief synopsis of our email conversations:

Dr. Compassion: (no x-ray to look at, but moves my leg around, taking all of 1 minute) "Yup, just as I thought, you have arthritis."

Debby: "Gee doc, everyone my age and even younger has a little bit of arthritis. I'm in a lot of pain. It came on suddenly. I had a weight training injury in June of 2010, I train a lot. I really think we should think about stress fracture of hip and/or possible labral tear, seeing that I have been quite an avid runner all my life, as well as a myriad of other sports."

Dr. C.: "Nope. Even I have it.(he's sitting back down at his computer now) It's arthritis. Do you get pain in here?" He says, talking to his computer screen and pointing to his lower back. I'm assuming the statement is directed towards me, but with no eye contact it's kind of hard to tell. He keeps scrolling back and forth, up and down looking for something, obviously not my X-ray. I just keep wondering... 'what's so much more important than his live patient in front of him?'

Debby: "Huh? No, I don't. It' in my hip, the top of my butt. I can't squat right", as I get up off the table and hobble two steps over to the door, the only free space in the room.

"Look, watch me squat; look at my right leg, how it doesn't rotate out like the left. It's stuck. This makes it hard to work. And look at my hips. I'm like a tea kettle when poured, off kilter. Something isn't right. I can feel it, look Dr. _...", I'm pleading. He turns his head around for a split second as I'm squatting, then quickly turns back to the computer screen. What on earth is on that screen? What is so much more interesting to evaluate than his live deformed patient, standing sqautting right in front of him?

Dr. C.: "Yah, arthritis, like I said. That happens."


Debby: "Listen, I know my body and something is going on here more than a little arthritis. I need this fixed. I need to be able to do my job, teach my boot camp style class that I just licensed, and build out my new fitness website with my workout videos for online training. I need to be able to move without pain, be know, be in good form for presenting great content to my viewers, who depend on me for their workouts. This is my job."

Dr. C.: "Well, my advice to you is to change your lifestyle. You can stand on the sidelines like the football coaches who yell at the players, and do just like they do. And I'm not going to give you surgery so you can do some You Tube videos and teach a 'boot camp'. My suggestion is to start thinking about your lifestyle and change it. Do yoga, swim, walk. Now, go home, take Motrin. Then, stretch it when you don't feel pain, and keep stretching farther and farther, and maybe some of that flexibility will come back."

Huh? Did he just tell me what I think he did? Stretching is his answer? Stand around and yell? Don't they have a reality show for that?

Debby: "Listen Dr. C. I've been in the fitness industry my entire life. I'm young, strong and extremely athletic. I have many more years. I'm not here to talk about career changes. I'm here to rule out the possibility of a stress fracture or labral tear that could be casuing this malfunctioning hip. [OK?] I need resolution. And even if I were to take Motrin-which I will not-how long am I supposed to take it for? What's your plan? Do you even have a plan?"

Do HMO's have a plan for patients anyway, or is all the bottom line for the HMO? This is NOT a trick question.

Dr. C.: "I would say come back in six months. And if it's still the same or worse then we can do an MRI, maybe. But I want to see the X-ray first. And if it's arthritis, like I'm sure it is, then we wouldn't fix a labral tear anyway."

Debby: "Well, I don't want to take Motrin indefinitely if you have no game plan, and you won't give me an MRI. That's ridiculous. I need to know NOW what this is. And if the X-ray doesn't show a stress fracture then I want an MRI; I am entitled to one."

Dr. C.: "Get the X-ray. I'm sure I am right. Oh, and don't bother making another appointment. You can just email me and we can discuss your options online. Save your co-pay . Now, I have to get going I'm late."

And he slid out the door trying to make a getaway.

Late? I waited for over an hour, he spends 15 minutes with me, max, and he's late? This is my hip.This is my life. 'I'm in pain here Doc', I was screaming inside.(I had just started with M.A.T. again)

I shoved all my stuff into my backpack, slung it over my shoulder, half open, and I rushed after him down the hall.

Debby: "Wait, what do you mean I can just email you? What about patient/doctor relationships? Why are you so concerned with my co-pay?" And he was through.

In the big picture, when you want a resolution, that co-pay is insignificant. And emailing your provider at my HMO only allows 1000 characters per email. Now, assuming you've been reading my blogs that's hardly a conversation for this blogger.

I want one-to-one interaction; I'm entitled to one-to-one interaction with my provider; And, hey! I pay my HMO membership!

Well, I didn't wait for him to email me, nor did I set up that one to one with him. I high tailed it online to my former shoulder surgeon, and in under 1000 characters she was able to find me a wonderful, compassionate, caring female orthopedic surgeon who happened to be a competitive runner, skier, swimmer herself, and was privy to my pleas for help. Let's call her Dr. Yours Truly Compassionate.

But I wasn't going to see Dr. Yours Truly until I made sure I had my MRI. And getting that was like finding water on Mars.

The Expansion Of Black Holes

Sometimes, trying to get through the HMO system is like falling into a black hole. And once you get stuck in their vortex you have to be pretty strong to pull yourself out to get something done, and in a timely manner.

Well, since I was stuck in the HMO vortex, for now, I had to resort to their emailing system. And since I could only write 1000 characters at a time, I was usually cut off mid sentence, even half word. So it took me quite a few emails to finally get through to that first doc and get my MRI.

Here's how that conversation went:

Debby: "O.K. Dr.C., so you say I have moderate arthritis. But I am entitled to an MRI, and I'm entitled to a second opinion. And I'd like to have the MRI first. I need to see exactly what is going on inside my body so I can move forward, make a plan, and visualize the healing and get on with the process."

Doc: "Like I said, take the Motrin and if that doesn't work then we can go in a different direction. There is nothing you can do about the arthritis. Change your lifestyle. You may have to give up some things"

Debby: " I'm telling you, something is wrong with the structure of my body. I can tell. And I can't move forward if I don't know what's wrong. I can't start my group exercise camps. At least if I have an MRI we can rule out what it's not. I use my body to make my income. People are depending on me to provide workouts on my website. I depend on my body like you do on your hands for surgery. Please, I want my MRI."

Am I actually begging my HMO?!

Doc: " I am 100% sure that it is only arthritis as we see it in the X-ray. And it's moderate arthritis at that. You are not a candidate for surgery with moderate arthritis. There is no reason for an MRI. "

Debby: "Listen, nobody is 100% sure unless they are God!. Just please order the MRI. Look at it this way, if there is nothing in the MRI then you can pat yourself on the back, and you were right. But if something else shows up then we will all be happy, and we can move forward and fix the problem. But I can't wait 6 months to find out. And you should not make me wait six months. Well, if you don't order the MRI now, then I might have to hold my HMO accountable for anything that happens to my body from the day that I saw you."

You've Got Mail

Man getting mail
Almost as slow as Snail Mail

Well, the next day I had, in my HMO Patient Inbox, a referral to the NMRI department. (The N stands for Nuclear, by the way). I finally got my MRI. Then I had a second opinion from the compassionate female orthopedist. Just for the record I'll rate her a 10 on the scale of 1-5!. Well, that was the visit where the Dr. yours Truly read the MRI.

And folks, it doesn't look good. I'd include the actual MRI but it's a bit too graphic for this G-rated blog. But here's what the X-ray looked like:

DebbyK hip arthrogram
What do YOU see?

Cool, Huh?

Now, if you're like me you have no idea what you're looking at.

What's not so cool is that I don't have many options, and not a lot of time to decide, given my age and progression of the osteoarthritis. and the pain and lack freedom it causes me.


  1. Do nothing and become a cripple
  2. Learn how to hop on one leg. Great for training but not very convenient in the real world day to day existence.
  3. Get the top of my femur chopped off and replaced with ceramic total hip replacement, THR, which is great for the avid golfer but not the active multi sport fitness gu-ress and trainer like moi.
  4. Go with the new innovative technology of hip resurfacing,HR, which saves most of your bone, the head of your femur and allows for full activities after a year of rehab (Weight training, running, skiing, martial arts, surfing, splits, and all other sports).I can basically do everything except skydiving. Note to self: Set up sky dive session before surgery.

What would you do? This is NOT another trick question.:)

It's kind of a no brainer, wouldn't ya think?

Although the HR is a more complicated, it saves most of the bone so there is more to work with in case of a revision down the road (ie. chop off the head of my femur, lots of thigh bone, and replace it with total hip). However, if the HR is done with precision, and by the right surgeon, who has logged 1000's of procedures, and uses the correct prosthesis best suited for women, especially on small framed women such as your princess of fitness here, the chance for the best possible outcome is optimal.

Just My Luck

Well, not only did my HMO 'mis diagnose' me as having just some arthritis, they didn't even notice in the MRI that I had congenital hip displasia-or they forgot to tell me-which of course changes the playing field when considering what device to place in my hip, not to mention the experience of the surgeon placing it.

So before even consulting with a possible surgeon-who is NO. 3 below-I logged about 60 hours online researching procedures, prostheses, and the top surgeons around the world who had performed thousands of hip resurfacing, with a high percentage of them on female patients like me.

And when I finally talked to Surgeon No. 3 , I came prepared with a file busting at the seems with documentation on the pros and cons of the two most commonly used devices: the BHR and the Conserve Plus. The research for the Conserve Plus shows that it is better suited for small women with hip displasia cases; it comes in many size increments; and there is less potential for rubbing and leaking ions.

The research shows that the BHR is suited for larger men; or women who are 5ft 8 inches and heavy boned. I am 5ft, 6 inches, if that.

And I am small boned. The BHR is large and bulky and does not have as many of the smaller sized options suited for women my size.

There is also documentation showing a higher number of cases of ions being created when the particular metals that are used in the manufacturing of the BHR ball and socket are rubbed together. These ions would leak into my bloodstream. They can never be cleared.

My life's work is about keeping the body toxin free and creating a life free of disease for others as well as myself; not creating a potential breeding ground for cancer, or...whatever else.

Compared to the Conserve Plus device, the BHR has also been documented to show more groin pain after full recovery from surgery, limiting activities. The point of the hip resurfacing is to restore my lifestyle back to a fully active one... pain free!.

These potential problems, as well as ions streaming through my body, is not my idea of fixing the problem.

And based on a report written by Dr. Koen De Smet, who is one of the top-five leading hip resurfacing surgeons in the world, (and speaking with him through extensive emails, where, by the way, I was allowed as many characters as I could possibly write), I am NOT a candidate for the BHR.

Guess what folks?

My HMO only uses the BHR.


I saw three doctors. The first told me to go home. The second told me I had to have surgery, but did not perform that particular type. The third looked at my X ray, told me I hip resurfacing was difficult on women, that he had not done manywomen out of his 300 surgeries, and after looking at my MRI forgot to mention I had a congenital hip displasia. On top of that, even though I had shown him the report comparing the two devices and the how the Conserve Plus had a better track record for women he could only use the BHR.

It's quite obvious that it's not in the best interest of my only right hip, and my future as a fitness professional, to use my HMO's one option, or even their surgeons.

What would you do?

Make Lemons out of Lemonade

Well, that's what Dr. Koen De Smet, the surgeon who wrote the comparison report, and the doctor who I have picked to do my surgery, can apparently do. Make the lemons whole again. Kind of like putting Humpty back together again!

Who doesn't like Lemonade?!

As for me, I'll stick to making lemonade out of lemons and take this as an opportunity to find a silver lining.

I have spent thirty plus years of honing my body and mind and, well... I was born with my spirit! So now, I must take on another great challenge in this life of mine. (If you know me personally you know the others).

But I think of it like this: I will take it on like any other challenging leg day sat the gym; attack it with a plan and put in max effort.

And while I am still fairly mobile and can control the pain I'll prepare for the battle and have the best positive experience that I can doing it.

Yup! You heard me right. Stay positive. Look towards the future. Make lemonade. And here's how...

The Plan

Anyone going into battle has to have a plan. And this woman warrior is no different. So from May until September's surgery I will work on getting into the best PREHAB shape of my life, given the limitations with my hip and the pain, of course.

Since I'm a girl who likes to lift heavy objects with my legs, and since that is no longer an option I am learning new methods of training for my lower body.

(And NOTE to all the ladies out there: lifting weights does help keep body fat off your body).

I am also finding alternatives to running too. Plus, this will be a good time to explore other new ways to keep my body and mind strong and centered.

Eating healthy whole foods and maintaining my 23 years of an unprocessed and sugar free diet to fuel my body is a no brainer!

The Team

Back to the lemonade!

I decided to compile a team of experts who could help me get into the best shape of my life pre surgery, as well as post rehab conditioning.

And here's where the new experiences come into play!

It's obvious that I am limited in my mobility now, and I will not be able to go to the gym right after surgery. But it's paramount that I be able to stay in shape and do progressive athletic prehab and rehab. So setting up a system that I can use at home, or even in my backyard, or anywhere for that matter, is really important.

So to date, with the help from sponsorships by TRX,

TRX Suspension Training Pro Pack
TRX Suspension Training Pro Pack

Kangoo Jumps
Kangoo Jumps

and Kangoojumps, as well as pre and post rehab conditioning programs from Josh Henkin of Ultimate Sandbag Systems, and Ed Le Cara of Sports Plus, I'll be ready for battle.

What You Get!

Remember, this is a team effort and you are part of it. If I don't win, you don't win. So, I will be chronicling my experience through this blog and You Tube channel Your Fit Day , pre and post surgery. All of the workouts I do with the Ninja equipment will be workouts that YOU, too, can do. Right now. At home. Anywhere. No excuses!!

So I want all of you to workout along with me. I plan to incorporate all of the prehab and post rehab exercises into exciting kick-butt workouts, show you knew techniques, and post periodic updates and videos...all to help you get in and stay in the best shape of your life.

And as I bring you along on my journey I hope to be an inspiration to all of you out there who may have limiting beliefs around getting into the best shape of your life. You can do it. Trust me. But you may have to dig down a little deeper this time.

Remember, I'll be working out as hard as I can to stay in shape. I'm not going to let hip surgery steer me off course. Not for a minute. I'll just be working smart, and around the pain of my hip.

But I will never give up what I have achieved and I don't want you to give up on reaching your fitness goals either. We can do this together.

What It's All About

Although I'm a super fit chick, remember this: I still have to work hard at it every day. It doesn't come easy. I live and breathe health and fitness every day. Every minute!

But know this too: being in the best shape of my life every day will make it easier both physically and mentally to get through this challenge and bounce back.

And that is why it is so important for you to get in and stay in the best shape of your life, every day. Nobody has a crystal ball, and you don't know what curve balls life will bring.

Be prepared. Be Strong. Both physically and mentally. Be ready to play ball.

And that is what this blog is all about: To inspire YOU to stay on a path that will lead you to a lifestyle of health and fitness where you will never give up on yourself in becoming the best YOU.

You Give Me Inspiration

And while I'm rehabbing, I want you to inspire me.

Tell me about your workouts and your accomplishments and how YOU feel. I'll be here to cheer you on in your quest for your bad ass bod.

Tell me, what is your greatest challenge right now?

Leave a comment below.