Tag Archives: PAO

The Good, the Bad and the Ugly

Ever since I got the news that my bones were fully healed, I have been busy living !  And here I am: summer over, tomorrow is October and my mental gears are starting to shift.  This blog title came to me a few weeks ago, but up until tonight, I have been too busy to write.  So here it goes, a summary of the good, the bad and the ugly:

The Good:  

I am healed. I am healthy. I am pain free in my operated hip.  Two weeks ago, I started running again. I can’t think of a better way to enjoy the fall mornings in Colorado. I was going to wait to start running until after my second surgery, but one Monday morning I woke up and thought, “today I am going to try running.”  And guess what? Running feels BETTER than doing the elliptical (which I have decided the elliptical over-strides me and makes me sore).  For the past 2 weeks, I have ran 2-3 times a week for 2 miles. I am slow as molasses, but I really don’t care.  I am running, and it doesn’t hurt.

The Bad:

A second surgery is never fun to look forward to, even if it means eventually being 100% pain free.  Anyone who has had multiple surgeries understands  this.  Sometimes ignorance is bliss.  Now I know the gritty details of reliving five days in the hospital, the nausea coming out of anesthesia, getting out of bed for the first time after having my pelvis sawed apart and screwed back together, the weeks sleeping flat on my back, using a walker for 8 weeks, crutches for 12 weeks, and not driving for at least 2 months (this next surgery is my right side).  And the months of rehab.  Four months to be exact.  But, I am doing it because I can only imagine what it will feel like to have not one, but TWO fixed hips!  Really “the bad” is just having 8.5 weeks before the second surgery. How I am going to fit in everything I have to do with work and my life is beyond me at this point.  I am working 7 days a week for an average of 12 hours a day. I am pushing hard, like I am known to do, but somehow its fine.  Even “the Bad” is fine.

The Ugly:

Healthcare (insurance) in America is ugly.  Nasty ass ugly.  On September 8 or 9, I read on the PAO Facebook support group that Stanford Hospital and Clinics is no longer contracted with Anthem Blue Cross and Blue Shield.  “WHAT?!?!?” I thought. “I have to go through this b.s. again?” (see former post about UCSF and Anthem). Stanford said that they are in negotiations with their contract with Anthem and they are still honoring Anthem members as “in network” while these negotiations are under way.  Stanford even has a dedicated phone line and website focusing on this issue.  Sometimes I hop on the website just to help reassure me that my right PAO and labrum repair will happen on December 16, and that Anthem will pay for it.  The 1st PAO taught me to trust in the process. No matter how ugly healthcare is in America, I have to trust that Stanford and Anthem will have a contract.  Its like the players and the NFL: they need each other.

Relish in the good, tackle the bad and release control over the ugly.  That is my plan.

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HEALED!

I’ve come a long way, baby….

August 19, 2014: I met with Dr. Stoll, the hip specialist who originally diagnosed me with hip dysplasia and recommendation for PAO surgery in March of 2013.  After viewing my x-rays, he had a big grin on his face and he proudly announced, “You are fully healed.  You are cleared for all activities.” What great news at 19 weeks post-op!  We discussed my first love, road biking; it turns out we have the same road bike, so we talked a lot about training, routes, etc.   I was so happy that I can have my active lifestyle back! I wanted to hug and kiss that man.  Instead, I gave him a warm handshake with both hands and simply said, “Thank you. I will see you next year after my second PAO.”

In the meantime, I have been fierce with all activities, though being smart in progressing in distance and intensity: much bike riding, hiking, swimming, lifting weights, plyometrics, pilates reformer, and walking to my heart’s content.  All pain free, though I did have to ice today after my bike ride, my hip flexor tendon (sartorious tendon) was pissed off.  But the good news all is fine this evening.  Icing, I think, should be a regular routine of any athlete.

My friend has a nest of sparrows at his house,  They are metaphorical for me (and cute!) so I took a picture:

 

Baby Swallows
Baby Swallows getting ready to fly for the first time.

I think of my surgery as a sort of rebirth: Like a baby swallow, I had (re-)learn how to walk, move, and “fly”: all with new anatomical alignment that allows me to be pain free.

“Blackbird singing in the dead of night
Take these broken wings and learn to fly
All your life
You were only waiting for this moment to arise”

-The Beatles, “Blackbird”

11-weeks Post Op

I have had several blogs brewing in my head for a week or so, and it may just come out into one post.  I thought about naming it “parallels” or “life begins at 40” – but settled for the time marker title. Weeks 1-9 post-op I was sailing strong and steady with my recovery, with little complications.  Last week, week 10, I hit a wall emotionally and physically.  I am still walking with 1 crutch.  I was cleared to go weight bearing at week 8 (my surgeon is very conservative to ensure full healing of the fractures) and I thought by 2 weeks of weight bearing I would be walking perfectly unassisted.  I have always placed high expectations on myself, and PAO surgery recovery is no exception.  I crumbled when my physical therapist told me, “not yet…you are not strong enough to walk unassisted.  Keep the 1 crutch…its just a strength issue from being non-weight bearing…it takes time…”  those words put me into a tailspin of sadness and defeat.  I was not meeting my self-imposed, unrealistic, expectations.  I was pissed at the world, looking at Facebook feeds of everyone’s summer adventures, while I was still mostly at home, alone, gimping around.  The meal train ended week 9 and so have the emails and phone calls of asking how I was doing.  Feeling alone, defeated, and depressed, I decided to try to go back to metalsmithing, which is not ideal being on 1 crutch.  I had to do SOMETHING!!!  It was not easy, but I learned something:

Metal-smithing and surgery recovery has its parallels. For both, each step must be fully completed successfully before proceeding to the next step.  In metal-smithing, if a piece of metal does not solder properly together, I would have to go back and reset everything and try again.  In PAO surgery recovery, if I take a step without the crutch and feel my hip fall to the side due to lack of hip stabilizer strength, I have to go back to the 1 crutch for awhile and then try again.  I cannot solder metal together without placing paste flux on the metal, nor can I walk properly without doing my strength exercises.  This analogy between my work and my recovery helped my get my head around the fact that it may be awhile before I start walking unassisted again.  Patience, steps, being deliberate, deep breathing when things go wrong…those are all components of successful metal-smithing and successful surgery recovery.

Prong pendant metalsmithing
Prong pendant about to be re-soldered.

As for the “life begins at 40” title, I turned 40 last December. I knew 2014 would be an epic year for me of deep proportions.  I knew I would have not one, but TWO major surgeries (PAO on both left and right hip) and everything that comes along with living the PAO life, and in the end: reinvention. I have had a lot of down-time with my surgery recovery.  Hours of laying in bed has forced me to think a lot about my life and where I want to go once I can get my life back.  One major decision I made, and it was not made lightly, was to officially retire from Personal Training.  I have been a Personal Trainer, running coach, and triathlon coach for 18 years. I have made lifelong friends and helped dozens of people.  It has shaped who I am and my values on health.  In recent years I discovered bringing my inner artist to the outer world, and have been working hard to build my reputation and livlihood as a jewelry artist.  It was time for me to move forward and put 100% of my energy into my jewelry business to ensure its success.  My last client has been training with another trainer in Boulder since my PAO surgery.  It has been going well, which made the transition that much easier.  I wanted to make sure she was in good hands! We met last night over margaritas, empanadas and chips and guacamole as I told her my plans.  She knew already: she is a very busy person and I do not request her time unless there is good reason.  She joked that I was firing her, and I said, “No, I am breaking up with you.”  While I was sad and it was not easy for me to do, retiring last night felt freeing.  After an intense, short thunderstorm, the air was cool and crisp.  Going 50 miles an hour, I rolled down the windows, popped the sunroof, blasted music, and I felt alive.  I almost forgot what it felt like: to feel really alive in the present moment.  For those minutes, I totally forgot about my PAO and hip saga. And it felt damn good.

4-Weeks Post Op

Last Thursday, 6:30 a.m.: I woke up stiff and sore from sleeping on my back, completely immobilized by 5 pillows.  I sleep with my legs up on an elevated leg pillow with 2 additional pillows and my head and upper back propped up on 2 more pillows, which helps to press my spine into the bed.  With my “good leg”, I kicked out the 3 pillows supporting my legs so that I can move. With the urgency to pee, I scooted myself to the edge of the bed, my shoulders cracking and creaking from bearing my body weight. I then aided my “dead” leg off to the edge of the bed. There I sat, staring at my walker.  For the first time since my surgery, I looked at my walker with hate and dread. “4.5 more weeks more of this shit?” I thought bitterly. I knew my mood wouldn’t last forever, but spending an average of 20 hours a day in bed without the freedom to move as I please is wearing on me.

Today, 6:30 a.m.: I woke up stiff and sore. I kicked the 3 leg pillows out from under me so I can move. I scoot myself to the edge of the bed, my shoulders creaking and cracking from bearing my body weight. I aided my “dead” leg off to the edge of the bed. I sat in front of my walker. Without a second thought, I stand and make it to the bathroom to pee.

Today is different.  Today is my 4-week post op anniversary.  I am at the half-way mark of moving with restrictions (only toe touch aka 30 lb. weight bearing, no active hip flexion). Each day I get stronger: I can sit a little longer, move a little more. My shoulders still creak and crack and my wrist and elbow are sore, but I ignore it. I already know this surgery was worth it because the crippling pain that I had before PAO surgery is gone.  And, I have learned a few things along the way:

  • Daily naps help pass the time and aid in healing.
  • Stairs aren’t as bad as you think. Practice pre-op paid off and always have a spotter the first few times going up and down the stairs. (Last night I made it down my 38 stairs for a Cinco de Mayo party.  Going up took a little longer…thanks to the two margaritas!)
  • A daily routine is critical; I just wrote mine out a few days ago. Even though its mostly comprised of activities of daily living, structure helps.
  • Balance Facebook and email time with reading books or writing.
  • Try to schedule a friend visit at least every other day. Human interaction is key to fighting depression. Isolation is the enemy, especially when one is house-bound.
  • Have a project.  My projects are blogging and my online gemology class.  I highly recommend an online course in a topic that is of interest, or a craft.
  • While I have a gazillion things to do with work, I realize my job for the initial 8-12 weeks following PAO surgery is to heal.  Work has to take the back burner temporarily.
  • Get out in the sun. I read that Vitamin D aids in fracture healing. I calculated my sun exposure time and I need and average of 6-10 minutes of sun a day to get my daily dose of vitamin D. In the late afternoon, I walker out to my west-facing deck. I sit quietly with no distractions.  I imagine the sun rays absorbing into my skin, processing the Vitamin D and going straight to my pelvis. I can notice a difference already in my mood and energy level.
  • Meal Train or similar websites are a God-send.  And so are the people that are willing to sign up and provide a meal.
  • Be polite to your caretakers.  And be specific with what you need help with and what you can do on your own (this may change daily).

So while my shoulders creak and crack, my leg continues to feel “dead”,  and I sleep immobilized with 5 pillows, I am excited to count down the days to where I can walk again unassisted, sleep on my side, and drive my car to wherever I please.  The countdown begins!

Recovery Phase II: Chez Sudre

The one piece of advice that I have for other hippies facing PAO surgery is that it is critical to have a  good caretaker and support team, at least for the first two weeks following surgery.  I feel very fortunate that I am able to recover at my sister’s house in the Bay Area for several weeks before I fly home to Colorado.  She was able to arrange to work from home, which turned out to be necessary given that I needed assistance initially with not only getting in and out of bed, but also being able to safely sit on the raised toilet seat, shower, and provide meals. ( I still need help showering and with meals, but at least I can get in and out of bed and go to the bathroom by myself).  A lot of demands are placed on the caretaker, so to help ease the stress, even when I just feel like crying, I try to put on my brave face, be cheerful and polite, and always grateful.

I have to admit, I am spoiled here. You couldn’t ask for a better climate to recover: every day its been sunny and at least in the high 60’s or low 70’s.  I love the fresh air with a slight breeze gently flowing into my room. She has a ranch style home so its very easy to walker around. She has a beautiful back yard with a deck, pool and flower garden that I can enjoy on the days I feel energetic enough to go outside. My niece and nephew are adorable, so its nice to be able to see them every day. My brother in law is understanding and provides additional help when necessary. My sister is an incredible, strong soul who never complains about helping me.  My family has certainly raised the standard on care-taking and I am the lucky recipient. And I am forever grateful.

The other bonus about being in CA to recover these initial weeks is I get to see my other California “team members” who provide comic relief and moral support.  A special thank you must go out to my friend and PAO-buddy, Jessica, who visited me pretty much every day in the hospital and cooked dinner my family and me last week.  It is so nice to be able to talk (and vent) to another hippie because she understands PAO life from personal experience.

Tuesday I will be 2 weeks post-op.  I will be flying home 18 days post-op.  My goal for this week is to get my stamina and energy back so that I can make the 2.5 hour flight home with ease and make it up my 39 stairs by crutch walking!

 

Luxury Stay at Stanford

I was fortunate enough to have my own private hospital room. My view from the window was a beautiful flower garden.  Days 1 and 2 were pretty smooth sailing in terms of pain management. I had my epidural in for those 2 days and my pain level never got above a level 3 (on a scale of 1 to 10).  Even being hooked up to 2 wound drains, IV, foley catheter and epidural, I managed to take 3 steps with the walker the day after surgery. Loved ones came and went, gifting me with flowers, candy and stuffed animals.  My appetite came back quickly and I was able to select from a room service menu that looked like a menu from a regular restaurant.  Turkey and gravy with cornbread dressing or basil Thai noodles and a side of baby back ribs?  Oh…decisions!

On day 3, the epidural came out and they began me on oral pain meds: oxycontin, oxycodone, prescription strength acetametaphin, gabapentin (nerve pain), DOK (stool softener), and zofran (anti-nausea).  While my pain level never went above a 3, my overall well-being started to decline. The nursing staff was still not pleased with my low blood pressure (it was an average of 80/48) and I was told I had a low red blood cell count, but not low enough to receive a blood transfusion. (I lost about 800ml blood during surgery). Dazed and confused, my nausea came back times 10. I couldn’t sit up, I could barely eat. They skipped PT and OT on day 3 because of the low blood pressure and my nausea. The nursing staff, all who were very caring and sensitive to my needs, gave me additional anti-nausea medicine, but it didn’t seem to work. I just tried to sleep as much as possible as that was the only way I felt o.k.

Day 4 the foley catheter came out and now I had to pee using the bedside commode. Did I mention how happy I was to have a private room? I was fortunate to be able to urinate easily and without pain, though I almost passed out every time I got up to pee. By the end of the day, I realized I had had enough with the nausea.  There had to be something they could do for me. I asked nurse Irene, an older RN who was no nonsense though it was apparent her patients’ comfort was her top priority. I talked to her about how I was feeling and she said I was maxed out on all the current anti-nausea meds (zofran and other IV bolus’). She agreed to call the Resident on call to see what can be done. I explained to Irene I had phenegran in the recovery room and it was effective.

Irene came back and said that at first the Resident said, “well, she will just have to get used to the nausea.” Not easily intimidated, Irene proposed my suggestion of oral phenegran, and finally the resident conceded.  I started to feel better, but was still not 100%. The thought of getting in a car for 30 minutes to my sister’s house seemed impossible. They let me stay another day.

Day 5: On the mend from the extreme nausea, I felt my appetite return and I was determined to regain some of my strength. The nurse told me my systolic blood pressure (the “top” number) had to get  above 90 in order for me to get discharged. I decided to distract myself by making my stuffed animal cat dance to Journey songs on the Mp3 player and it made me laugh.  That odd trick worked with raising my blood pressure. Perhaps laughter is the best medicine.  Once PT cleared me, my discharge was in process. When it was 4:00, I was feeling ready to move on to the next phase of my recovery, at Chez Sudre (my sister’s house).  It was time.

Overall, my hospital stay was quiet and comfortable. The Stanford nursing staff is second-to none. Dr. Bellino visited me every day except for once. My room was awesome with that garden view, and the food was actually not half-bad. In a way, I was sad to leave but I had to continue on the road to recovery.

The Big Day

April 8, 2014, 7:00 a.m.  With sponge side foaming from an orange liquid, I began my microbial scrub in the shower. Each little area over my entire body, I began self talk: “This is it. You got this. You will heal quickly.”  At this point, everything seemed so real, and unreal.  I was in a state of unusual calm and petrifying terror of being cut open and having my pelvis sawed into pieces. I was caught in a state of opposing forces that cannot easily be explained. And somehow, I was suspended in neutral.

I got to the hospital on time and quickly checked in with my pre-op nurse, Judy. An older woman with an easy nature, she helped put me at ease with her down-to-earth personality and answering all my last minute questions. She reassured me that Dr. Bellino is “one of the best” and she has never seen him frazzled.  The head resident drew her initials on my hip to which it was to be operated.  I think the pre-op the staff asked me about 100x “What is your full name, date of birth and the procedure you are having today?” No room for error.

Next up was Dr. Schaffer, the anesthesiologist. Since most of my fears related to being “put under” (I have never had surgery before) I was happy to meet the man who was going to be responsible for suspending me in a state of unconscious limbo.  I immediately got a good vibe from him, he was very nice and easy to talk to.  He answered about 100 questions of mine and again assured me “Dr. Bellino is one of the best.” He was happy to read my healing statements as I was going under and coming out of anesthesia.  In fact, as he scanned the piece of paper with the healing statements, he said, “Funny, this is what I usually tell my patients.”

Before I knew it, he gave me a bit of “happy juice” in my I.v. and I was rolled into the O.R.  I remember sitting up and leaning over as the epidural went in.  All of a sudden, I was moaning and groaning that I was going to pass out. Apparently I had a vagal response and my heart rate went just below 30. They quickly remedied the situation and I was feeling myself guided flat on my back, each arm being stretched out to my side and strapped down, as if it was some sort of crucifixion. Then…nothing.

It didn’t seem but 5 minutes later (actually, the operation took 4.5 hours) that Dr. Schaffer was in my face reassuring me gently, “Your operation went well. You will feel comfortable.”

I was in recovery. My blood pressure was low, which is normal – especially with an epidural. I remember suddenly having extreme nausea and moaning and groaning and dropping the f- word “Please make it f—ing STOP!” as the world spun around me. It was like having the stomach flu and you are at the point where you just want to die.  I heard a lot of hustle and bustle and they placed a patch with medicine behind my ear and gave me some anti-nausea drugs through my i.v. Once that subsided, I asked if I will have a private room (haha!). (note: At Stanford hospital, you can ask for a private room at pre-op as it costs the same as a shared room.  Its not a guarantee, but worth asking). At least I have my priorities straight.

Before I was released to my room, Dr. Bellino visited me and told me the operation went “very well” and that I was “rock solid.” He looked tired but kept his direct and professional manner with an underlying energy of sincerity and compassion. My surgeon succeeded in the left periacetabular osteotomy, and giving me my life back.

Our Precious Gift

When I first met her, I was struck by her beauty; I could tell she was of Native American descent, her clear beautiful blue eyes were captivating. She had a certain intensity about her like most artists do, she was the owner of a local art gallery focusing on art from New Mexico and Native Americans.  Immediately I admired her for living her dream of owning a gallery at such a young age. It has been a dream of mine to own a gallery to showcase my jewelry and crystal and mineral collection – a dream that has had to be postponed due to my upcoming PAO surgeries.

Fast forward 6 months, which was Sunday morning, I got an email from a mutual friend of ours, stating that Brianna passed away suddenly Friday morning at the young age of 29. Shock and sadness filled me.  No cause of death was mentioned, and I racked my brain as to the cause. She was healthy, so vivacious!   I had only met Brianna a handful of times, she touched my life: she showed me that is is possible to live my truth and follow my dreams.

Last night was the Celebration of Life at a local restaurant; I learned that her passing was due to heart failure, caused by pulmonary hypertension that was only diagnosed 2 weeks prior to her death. They had a table filled with photos, her artwork, her favorite costumes, copies of her poems for people to have.  I didn’t cry until I got into my car. It hit me like a thunderbolt: life is too precious to be wasting my time on worrying about my health and financial problems. I need to release and trust all will work out. I need to replace that time worrying with enjoying the little things that life has to offer.

We are all fighting our own battles with hip dysplasia or any other chronic disease.  We are warriors of the sort. Despite our battles, our precious gift is life, and it cannot be wasted on worry or regret, nor should this gift be taken for granted. I think I am going to start a gratitude journal to give thanks to what my precious gift has to offer me.

Below is a poem that Brianna wrote, the words resonate deeply:

“Purple runners creep into my heart,
slowly surrounding me
in a protective power as
roses burst into life around my soul,
keeping harm at bay.
Their pulsing life energy
flows through me
washing/cleansing away negativity,
doubt, anger, fear.
Within their encircling arms
is eternal spring & everflowing rejuvenation.
I can feel the Universe
through their roots,
linking to all that is or was or will be.
And I know that the purple light & sacred rose
will shield me always in their warm embrace.”
-Brianna Murtha, 1/12/85 – 2/21/14. RIP

Flip Side

Its been about two weeks since I got the news of the postponement of my surgery, and not only a postponement, but with another surgeon and at another hospital. Dr. Bellino at Stanford is also one of the best in the field, and if you read my former post, I had a helluva time deciding between Dr. Diab at UCSF and Dr. Bellino as Stanford. In the end, it seems that the Universe decided for me.  Divine timing trumps everything else.

“When I think of Dr. Bellino, I remember his blue eyes. Clear and calm. Like Buddha,” my PAO buddy, Jessica writes me (she consulted with him in October 2012 and will again in March; as she is in the same boat as me regarding the insurance debacle with UCSF).  Hence, we quickly coined the nickname “Buddha blue eyes” for Bellino. This term helps calm my nerves and helps me to re-frame my mental state about waiting another 5 weeks for my LPAO.  As I remember correctly, he did have a very calming energy about him.

As I write this, I think that if nothing got rescheduled, I would be leaving next Thursday (!) for CA.  I have so much to do with work and getting everything in order that I am now relieved to have the extra month. So, while it was a pain in my culo to reschedule everything, to still have pain for another 5 weeks, I am looking at the flip side of things on the benefits of the delayed surgery:

  • More time to finish work projects: Fitwise Training: Spring youth soccer promotion and next steps on the patent. Anosia: metalsmithing and building my inventory for summer art shows and my website.
  • More time to increase income, which is critical since I am self-employed. I added two local art shows and another month of personal training.
  • More time to increase my fitness and lose a little more weight by surgery.
  • More time to see the friends that I haven’t yet been able to visit.
  • I still have 2 more passes on my ski pass at Eldora, I need to use them! (note: blue runs only, pain will dictate when my day is over).
  • I will have more time to play before surgery this go-around as I am flying out earlier and will have TWO weekends pre-op in CA.
  • When I return from CA, it will be warmer in CO and will be easier to get around on crutches (less chance for ice/snow and falling)

As you can tell, my past two posts were quite dark but I have emerged and am on the upswing.  ONWARD!

Frown Face

Recently a friend of mine asked me:  “What’s wrong with you? You always have frown face.”  My highly sensitive side felt a stab of a knife in my gut.  Pushing back my tears, I replied  weakly, “I just am not feeling well.” Outward, I shut down all emotions. Inside, I am tearing myself apart.

What I really wanted to do was throw a temper tantrum like a 5-year old, jumping up and down, waving my arms screaming,  “WHAT? DO YOU HAVE ANY IDEA? OF COURSE YOU DON’T! YOU HAVE NORMAL HIPS! ITS THE M^%^$^F%$%#%$# PIECE OF SH** HIP DYPLASIA THAT MAKES ME FEEL LIKE SOMEONE REPEATEDLY HITS ME WITH A BASEBALL BAT TO MY HIPS! I CAN’T SLEEP, I CAN’T WALK, I CAN’T SIT, NO MATTER WHAT I DO I HURT! AND NOW MY PIECE OF SH** HEALTH INSURANCE IS MAKING ME SUFFER ANOTHER 5 WEEKS BECAUSE OF THEIR POLITICS THAT I HAVE TO CANCEL MY SURGERY FOR MARCH 6 FROM UCSF AND RESCHEDULE IT TO APRIL 8 AT STANFORD! THAT IS WHY I HAVE FROWN FACE!!!!!!!”

As you can tell, I am worn out. I try to be positive, I try to be strong, but I just can’t do it anymore. I am the PAO warrior who has taken a serious blow. I never had chronic pain until this past year, and I have a whole new understanding of how draining it is on one’s energy and the ability to relate to other people. I am at fault for expecting anyone to try to understand what I am going through. Its an emotional roller coaster of its steepest highs and its lowest lows.  I want to get off this ride. I want my old self back. I always considered myself to have a sunny disposition, but lately storm clouds of thoughts of my pelvis sawed apart, my blood dripping in a bucket, me being dependent on anyone brave enough to see me in such a state is getting me down.  I always defined myself by my career interests or as an athlete, now I am defined by hip dysplasia. And I hate it.

I have to laugh as I write this because when I started this blog I wanted to get my PAO surgeries done so I can be active again. Now I want my PAO surgeries so I can get my smile back.