2 Month Post-Op Hip Surgery

I'm now a little over 2 months post-op left hip scope for FAI/labral tear. This last month has gone by quickly. I'm now off all assistive walking devices (since around week 5.5 weeks) and doing most of my "normal" limited activities. I still struggle with squatting/getting down on the floor, walking more than a couple of blocks, standing for long periods, laying on my operative side (though this is slowly improving), and internal/external hip rotation. There are still occasional movements that cause me to gasp in pain, but hopefully with time and therapy these will get better.

Last week I finished an intense week of therapy out of town again. I haven't felt as much improvement as I usually do and I think that is likely due to the fact that I overloaded myself while I was there - seeing two doctors, driving back and forth almost 30 minutes to therapy (which is extremely hard for me) with sometimes multiple therapy sessions in a day - and my therapy was a little more aggressive. Sadly, I continue to have all my pre-op pain in addition to some new pain brought on from the surgery. I am trying to be patient and am praying that with time some of my old pain, especially the sitting pain, will diminish, but it seems like most of the people I have known who have had relief of their pelvic floor pain with hip surgery saw at least some improvement in pain within the first couple of months.

This past month my hip rehab has been much slower. I had a stomach virus which knocked me out for over a week and I continue to struggle to do therapy much outside of the pool without an increase in pain. I continue to have A LOT of muscle dysfunction and pain. My abdomen literally has knots in the muscles and I often feel crampy. I've tried self massage, warm baths, professional massage/manual therapy, moist heat, TENS, and stretches but nothing seems to help much. The more I am upright trying to walk around and do light work around the house and sit for short periods the more my thoracic area and lower lumbar area on the operative side screams at me. It's most likely my psoas and quadratus lumborum that are extremely spasmed from all my glute and hip weakness and sacroiliac joint instability. It literally feels like a stabbing pain around T12 (right about where my ribcage ends). I had these pains pre-op, but they are definitely intensified post-op and it is frustrating because I had them better managed I feel like back before Christmas. The hip PT feels like most of my pain is muscle related and that I have better movement through my hip, but that my muscle tightness and pain are limiting me.

It's discouraging and not what I hoped for, but I'm thankful for what I can do and am continuing to press on by the grace of God.

Praises:

• I no longer have any more tingling in my foot/leg than I did pre-op, though I do continue to deal with symptoms of central nervous system sensitization, a pain syndrome causing hypersensitivity and allodynia (painful responses from non-painful stimuli).

• My knee pain is much more tolerable. I still have a lot of weakness, but my knee is not subluxing or causing me to scream out in pain when I kneel down.

• The areas of numbness on my thigh seem to be getting smaller though I do have some scar tissue around my surgical sites which are creating pain when trying to lay on my left side.

Prayer Requests:

• I have found a local therapist which does myofascial release, a more alternative therapy. Since I have not had any real success with my other local options please pray this therapy might help me work through some of my post-op muscle pain and help me manage my overall pain better/improve my quality of life.

• If it is not God's will for me to get better,  please pray that I would not continue to progressively get worse. Ultimately I want to get stronger, of course, but it would be wonderful to just get to a place where I can function decently (care for my family and attend occasional social functions and church) under my limitations and I am not constantly flaring.

•  Pray that I would be able to get this muscle pain under better control so I can tolerate home therapy better.

• Continue to pray that God would provide for our needs - spiritually, physically, and financially - and that we will trust Him no matter the answer to our prayers.

Thank you for your continued prayers and support.

One Month Post Op Update

Well my weekly post-op updates didn't quite go as planned, sorry about that! Thank you to those who have been praying (prayer requests at the end of this post).

Tomorrow I will be 5 weeks post-op. Recovery is slow as I knew it would be, and there have been lots of ups and downs. I just got back from 4 days (5 sessions) with my wonderful pelvic floor PT and hip PT out of town. I feel so much better when seeing them, but it is very disheartening to return home knowing that I will go another 4 weeks before I get the PT I need. I just feel like if I had access to consistent good therapy that I would be able to manage my pain much better, but apparently that is not God's plan for us right now. 

Here's a little recap of the last few weeks:

Day 16-21 post op: I experienced a big flare up in my pelvic floor pain/burning. I couldn't even sit for 5 minutes without being on fire! I feel like it was due to being too aggressive with my glute sets and bridges while trying to strengthen my hip. I backed off these exercises for a while and it finally calmed down some thankfully. This is frustrating though because I need to strengthen, but I know I am just going to have to be patient. At three weeks post op I went to see my hip PT out of town. I saw a major improvement in post-op hip related pain thanks to lots of manual therapy. My quad was really angry prior to seeing the PT. She didn't add any new exercises since I was still struggling with an increase in pelvic floor pain, and encouraged me to get in the warm water pool as much as possible.

Week 3-4 post op: I got a massage (right now I am trying to do bi-weekly massages) - this helps with all my overall muscle pain due to the dysfunction and compensation. I also went to the warm water pool 4 times this week without any real flare-up in pain. I tolerated my hip exercises much better in the water than I did on dry land.

Week 4-5 post op: I began to start taking steps around the house without my crutches or with just one crutch. My hip PT didn't really want me to use only one crutch due to fear of worsening my muscle compensation so she suggested I use a cane. I don't feel like the cane really helps that much so unless I am walking outside my house, or unless it is the end of the day, when I often begin to feel like I can't stand up on my own anymore, I've just been walking without an assistive device. I'm glad to be walking some again, but I am experiencing a good bit of muscle pain. A lot the muscles that support my pelvis are so tight they feel like bricks. The muscles that are the worst are my psoas, rectus abdominus, quadratus lumborum, and the erector spinae (which are more superficial - to the surface of the back - than the quadratus lumborum and psoas).

Image source



 

Image Source

I've had problems with these muscles for a long time now, but my psoas and rectus abdominus got so bad this past week that it felt difficult to stand up straight or even eat as my abdomen was so swollen/irritated. I'm not sure what exactly caused this, but I think that maybe I was overly aggressive trying to tighten my transverse abdominus (TA), to support my core, while trying to do my pool exercises.  Since I am very weak, due to years of dysfunction and worsened due to recent surgery, it is easy to recruit other muscles . My pelvic floor PT said that you only need to contract the TA to about 30% of maximum contraction. This is much easier for me to do lying down than standing up in a pool though!

I've also been having some significant knee pain. Getting down on the ground to play with my daughter is still difficult and the knee is also painful when walking. My hip PT gave me a SERF strap to borrow to see if it helps with the knee pain. So far it has I think, but I hope the knee pain will lessen once I build back some quad strength.


Praises:

• My circulation issues seem to be getting better. I still have some tingling in my foot and after standing for a long time occasionally my surgical side foot is more red than the other. I saw the surgeon for my 1  month follow-up and he and the PT are hopeful that with time and full-weightbearing this with go away. Although they have bought mentioned Complex Regional Pain Sydrome as a possibility. Continue to pray that this will resolve at least to my pre-op normal.

• My bandiad rash finally went away!!

• Praise God I have access to a warm water pool (for a price we can afford!) and that it provides reduced pain levels, even if for only a few minutes.

• Praise God I am regaining the ability to walk around the house more. Please pray that this continues and that the knee pain will go away as I gain more strength. 

Prayer Requests:

• That I will be able to get the muscular tightness and pain under control so I can continue to strengthen. The main goal of this surgery was to regain strength, please pray that in time I will be able to do this.

• Pray that God will provide a way for us to get good physical therapy more consistently. The only way we see this happening is if we move. My husband continues to look for jobs in larger cities where I would have access to the specific medical care I need. If it is not God's will for us to move, please pray that He will help me learn how to manage my pain with the resources I have locally.

• I continue to have some numbness on my upper and outer thigh either from surgery or from the nerve blocks I received in recovery. These areas are very sensitive if I rub up against them or try to lay on my left side. Pray this will decrease in time (sooner rather than later!).

• Pray that we would rejoice always that I have a living hope and a future in Jesus! This is a daily battle as chronic pain wages heavily on us.

I was reading in a devotional Jesus Calling by Sarah Young that a sweet new friend with chronic pain gave me. (I do not necessarily advocate for reading this devotional as I feel the author's take on "hearing from God" and writing in the first person as Jesus is a bit presumptuous, but as with any devotional book one must take the author's writing as just that - the author's writing. So if you read "Jesus Calling" take Mrs. Young's writings as a grain of salt and be sure the majority of your spiritual food is coming from God's true word - The Bible.) Today's reading was so very appropriate as I am tempted to worry about the future and how I will ever get my crazy tight muscles under control (and especially without good PT!). Here is a portion of today's reading:

I am your Strength and Shield. I plan out each day and have it ready for you, long before you arise from bed. I also provide the strength you need each step of the way. Instead of assessing your energy level and wondering about what's on the road ahead, concentrate on staying in touch with Me.... Refuse to waste energy worrying, and you will have strength to spare. (Psalm 28:7, Matthew 6:34, Psalm 56:3-4) 

2 Week Post Op FAI/Labral Repair Update

I'm finally back after my left hip arthroscopy to correct my femoroacetabular impingement (FAI) and labral tear. (For pictures and a more thorough explanation of labral hip tears/FAI click here)  I have had some bad days, but in some ways I am doing better than I thought I might be at this point.

My surgery was delayed 2 hours and I was the last case of the night at the outpatient surgery center. When I met with my surgeon pre op I was under the impression that I would have the opportunity to pick from a few different several different nerve blocks pre op to help with post surgical pain. But when the anesthesiologist came in to talk to me he said they only do two types of blocks - femoral nerve block and a lateral femoral cutaneous nerve (LFCN) block in recovery if post op pain is uncontrolled. He warned me that these blocks would not help with "bone" pain - pain coming from inside the hip joint only with surrounding soft tissue pain.

My recovery experience was horrible. I don't remember a lot because apparently my pain was uncontrolled and they had to give me a lot of medication. The anesthesiologist also gave me  a femoral and LFCN block, but I remember feeling a lot of pain like I had never felt before and since the block didn't help much other than to numb my leg making walking/moving difficult, i assume my pain was coming from inside the joint. My nurse was not the nicest. I was extremely hoarse from the intubation tube (this took a good week to get better) and she just sat at the end of my bed and said "huh" over and over. They didn't let my husband see me for a long time and I remember at one point waking up and seeing another patient and their spouse looking at me and the man said, "you're in a lot of pain, aren't you?" Yes, I was. When they finally did let my husband back he told the nurse I was in a lot of pain (I guess I told him I was or he saw it in my face - thankfully I don't remember this experience much) and the nurse said, "well I've already given her enough medicine to knock out a cow!" This nurse obviously wanted to get out of there. I don't blame her. It was 9pm on a Friday night. I never had gone to the bathroom post op so she rushed me into the bathroom and gave me about two minutes. When I hadn't gone yet she said, "well if you haven't gone in 6 hours just call your doctor." I told my husband to ask for her name. Needless  to say I have reported my experience. My level of consciousness and pain level was too poor to be discharged. I should have been admitted to the hospital overnight.

Thankfully we only had a 15 minute drive to my grandmother's house. My husband was able to use her wheelchair to get me into the house and I slept on her couch for the next two nights. The first night I had to urinate about every 1-2 hours as I had such bad urinary retention from the anesthesia I guess. I was itching horribly, and  I would shake like crazy every time I had to get up to go to the bedside commode (it's a good thing I was staying at my grandmother's where I had access to these things!). Benedryl and pain meds helped me get through the night. We also rented a ice system machine called a "Game Ready" (more about this later) that cycled on/off every 30 minutes. My poor husband "slept" in the recliner between my bathroom calls and filling up the Game ready.

We met with the doctor and his nurse the next morning (he came in on Saturday to see his out of town patients). I told them about my experience and that my pain still was not controlled well. They gave me a few new prescriptions, took off my bandage and the surgeon explained what went on during the surgery.

I had an anterior superior labral tear which was repaired with two anchors as well as some posterior labral fraying that was smoothed down.

left anterior labral tear

 

labral tear repaired

The most common cause of a labral tear is femoroacetabular impingement. I had a small CAM deformity on at the head/neck junction of the femur which was shaved down. One of my biggest pre-op concerns was finding out why I had a labral tear since groin/hip pain was only one of my many symptoms. When I asked the surgeon this pre-op he felt like it was likely due to the "way my hips are made" (i.e. FAI). I was concerned, however, after reading this article that the cause might be ligament laxity (since some PTs have felt I have some widespread joint laxity) or due to biomechanical issues and muscle imbalances including lower crossed syndrome (which I have). Lower crossed syndrome often can cause an anterior tilt of the pelvis (which I have) causing increased weight bearing on the anterior labrum and subsequent tearing. When I saw the surgeon the day after my surgery I asked him if he thought my CAM was enough to have caused my labral tears and he said, "no". I want to talk to him more about this at my one month follow up because I am concerned that if the cause of the labral tear is not fixed then there is a greater likelihood of re-tearing. I sure hope this surgery wasn't a waste. Due to my sacroiliac joint dysfunction and pelvic floor pain correcting the lower crossed syndrome has become almost impossible, though my goal with this surgery was to hopefully be able to regain muscle strength in my left glute and leg. Only time will tell if this is possible and if the surgery was beneficial.

 left CAM deformity

CAM deformity shaved

In addition to the labral repair and CAM shaving the surgeon also found that my ligament terres was enlarged. He was able to decompress this with heat and there was also a good bit of inflammation in the pulvinar tissue which lines the acetabulum. The fact that my ligament was so irritated and enlarged concerns me again that the cause of my labral tear might be more biomechanical or that I could have an underlying connective tissue disorder, which is something I have thought for some time now and may be something I investigate further in the future. In order to perform the surgery the joint capsule has to be opened up. Sometimes they leave the capsule "open" after arthroscopic surgery, but thankfully my surgeon closed the joint capsule since I have some ligament laxity .

Enlarged ligament terres

Inflammation of pulvinar tissue of the acetabulum

 The first three or four days of my recovery were pretty rough. We unfortunately chose to travel home on post-op day 2 and my anesthesia was wearing off so the 2.5 hour trip home was difficult. The high doses of narcotics made me extremely emotional/panicky/depressed and they didn't help the pain that much. Ironically once I stopped taking the narcotics and stopped icing I actually felt better. Most people really like the Game Ready icing system, but for me the ice seemed to make my circulation and pain worse (more on this below). A low dose muscle relaxant at night has actually been more beneficial for me and I am taking higher dose anti-inflammatories as prescribed for the first 3 weeks post op. I will be on crutches with 50% weight bearing for at least the first 4 weeks and I cannot flex my leg past 90 degrees or externally rotate my leg at the hip.

At 2 weeks the surgical pain is tolerable unless I am up too long or doing PT exercises.  I drove today for the first time and am able to care for my daughter for very short periods of time. The biggest struggle is that I cannot carry anything with my crutches, bend down, or even reheat food for myself. I had 5 small incisions and got my stitches out on day 10.  Everything seems to be healing nicely except I did develop an allergic reaction it seems to the band aids I was using as I have sensitive skin. I am hoping this goes away soon and then I look forward to hopefully getting in the warm water pool to do some therapy exercises. This is one place where I usually experience less pain. I got a massage on day 10 and tolerated it well, though my therapist was more gentle than normal and stayed away from my left hip. The nerve blocks I had post op took about 7-10 days to resolve. I still have a little big of abnormal sensation on my upper thigh, but nothing I couldn't live with if it doesn't fully resolve. The first three days post op I couldn't move my leg and I felt like I would never walk again, but thankfully my range of motion is improving daily.

My hip at 2 weeks post op with band aid rash

Unfortunately my chronic pelvic, sacral, low back, pain and leg burning has remained the same. I am very thankful I am not any worse though. My biggest concern is that my operative leg has appeared darker in color at times than my right leg. My feet have burned ever since June 2010, but I have noticed that they are more flared up and my left foot sometimes feels like it is asleep/tingling. The doctor's nurse said this could be due to the fact that I am not bearing enough weight or it could be complex regional pain syndrome. Due to my previous "diagnosis" of central sensitization I have been concerned about CRPS for some time. But my pain in my operative leg is not grossly abnormal so I am praying that with time and therapy my leg/feet circulation and burning will get better.

It takes professional athletes 4-6 months to recovery from this surgery and return to their pre-surgery athletic level, so due to my complex and chronic pain I know to expect that long and up to a year (according to my surgeon) to see full healing. Already after only laying around for 2 weeks I notice more muscle atrophy so it is going to take a lot of work to rebuild my strength. Patience is key, as I knew it would be, and I am still very early in my recovery.

Praises:

• I am able to use normal crutches without too much difficulty or increase in any previous chest/underarm pain that I've had in the past!
• My pudendal neuralgia/sacral pain doesn't seem to have been worsened because of the surgery (i.e. I can still sit about the same amount of time).
• My mother did well with her surgery and seems to be healing nicely. Our extended family and church has been a great support to us.
• My GI issues have been much more tolerable! Please pray this continues.

Prayer Requests:

• That my circulation will return to my normal pre-surgery level soon and that the burning in my feet and legs will lessen.
• Pray that my rash goes away soon so I will be able to do aquatherapy
• Patience and peace - that I will trust God is in control and have joy in Him even when the days are difficult
• That I will regain the ability to walk and stand without difficulty (this is especially important since I am unable to sit for long periods of time).
• That some of my chronic pain might eventually resolve with the appropriate therapy and pray that I will be able to get good quality PT as often as possible (I have to travel for this which is difficult for our whole family).
• Continue to pray that God would one day allow my husband to get a job in a bigger city where I could have better access to pain management and therapy treatments.
• Continue to pray for strength for my husband as he cares for us and keeps the home running. He is such a gift from God!

Whew! Sorry for the overdue update. Hope to get back to more regular blogging in the days to come. Thanks for praying and caring.

An Overdo Update: Upcoming Hip Surgery!

I realize I've been a little quiet the last few weeks, but most of my better days have been spent preparing for Christmas, enjoying time with my family, and preparing for upcoming hip surgery. After a lot of thought, research, and prayer my husband and I feel it is wisest to pursue arthroscopic hip surgery to correct a left labral hip tear and femoroacetabular impingement. (I have bilateral hip pathology, but both of my PTs, massage therapist, and I agree it is wiser to do my left side first as I have the most dysfunction/atrophy on that side).

It almost seems surreal that in 2 days I will start the long recovery process (up to one year total time). I think anytime one undergoes elective surgery there are always doubts about whether it is the right decision, but especially when you have tried multiple treatments (and failed) and when you have a very complex case like I have. Sure, I can't do what a normal 30 year old can do by any means, but I am able to do some  things, so do I want to risk getting worse? Maybe this is just God's will for me and I need to accept my disabilities and try to manage the pain as best I can? What if my hips aren't really causing as much of my pain as I think/hope? And the list goes on and on.

I have always been an indecisive person, but at the same time growing up I was always a risk taker (until I had what felt like a near death experience white water rafting the Nile River!). The truth is I don't know what the outcome of surgery will be - no one ever does. But we have prayed for God to give us wisdom and at this time we feel this surgery is a risk worth taking. Even if I do not have any pain relief overall, if I am able to preserve my hips and prevent the need for a total hip replacement in the future (arthritis is often the end result for people with my condition, especially at such a young age, and it is hereditary as my father has this same condition - though he did not have it corrected and is currently biding his time before a replacement will be necessary ) then it would be worth it.

I really have accepted the fact that I will most likely have chronic pain, but I am still praying that God would give me a better quality of life/management of my pain. Even for my pain levels to stabilize would be wonderful because I seem to continue to get more debilitated year by year as I lose more muscle and my pain becomes more widespread.

We definitely need your prayers as we begin this new journey. Please pray:

• For post-op pain control. This is my number one concern as I'm not sure how much of my pain is coming from the central nervous system sensitization that I have spoken of before. Unfortunately the infusions I had in November did not provide any relief and only increased my pain. I have considered traveling to see a doctor who specializes in this type of infusion, but from my research it doesn't seem like these drugs help people such as myself with biomechanical causes of pain that have not first been corrected (and I really believe my pelvic pain ultimately stemmed from a biomechanical cause - most likely bad hips or sacroiliac joint dysfunction or both). I am very concerned about the inability to get up and move around much at first as lying in bed often seems to increase my pain and I cannot lie comfortably on my back - this means that for several weeks the only position to rest may be on my right side. Pray that the anesthesiologist & surgeon will have wisdom to know how to best control my pain during and after surgery.

• That I will be able to get the PT post-op that I need. My experienced PTs are 2.5 hrs away and I will only be able to see them occasionally. Pray that my local PT will be able to help me and that in combination with warm water therapy/massage/home exercises will suffice and help me get to a better quality of life.

• My mom has to have an unexpected surgery one week after my surgery. She will have restrictions for several weeks so caring for my 3 year old daughter will be a little tricky as I will be on crutches for 2 months or so and it will be probably a good 4-6 months before I start to feel some relief. We have a lot of extended family help and church support, but pray for my daughter (and husband/father) during the first couple of months as life will be pretty tough for us all. Pray for my mother's surgery and recovery as well.

• Pray that I will not get worse from this surgery and that there will be no complications. Pray that I will be patient as this recovery takes a long time (especially for someone with very complex chronic pain like myself) and that I will fight against my ever-present temptation to be negative.

• Continue to pray for my GI issues. I had an upper endoscopy 3 weeks ago that was normal (showing mild/moderate gastritis). I've continued medication to help with reflux and have been trying to modify my diet some. My symptoms are a little better than they were 2 months ago, but I am still struggling with burping, especially with drinking. My GI doctor thinks this may be more of a neuromuscular esophageal spasm, but unfortunately there are not many treatment options for that. I do wonder if it is just another part of the central sensitization, but I pray it is not. Please pray that I will be able to drink enough post-op to help with healing and that my GI issues might go away on their own as quickly as they came.

• Pray that God will keep me healthy going into the surgery as I am pretty tired from trying to prepare for and celebrate Christmas and get things ready around my home for surgery. Pray that God will calm my fears as well.

• Pray for peace and that no matter the what happens we will continue to trust in God - not for what He can do for us, but in who He is! Pray we would seek Him even more in the coming days and weeks.

I will try to update weekly if I can for at least the first couple of months post-op. Please let me know how I can be praying for you. I will have lots of time on my hands while recovering and the more I can take my thoughts and prayers off myself the better! Feel free to email me your requests at purposeofpain (at) gmail (dot) com.

Thank you for faithfully reading my blog and for praying. May we take hope in our Savior who was born on Christmas Day knowing that He holds our future!

New Cause of Pain after 4 Years: My Hips?

Sorry I've been a little more quiet lately. This past week I've been struggling with a stomach virus that's been lingering leaving nausea and stomach cramping as my companion. Actually, I'm not sure if it is related to the virus, or the fact that I've had to increase some medication due to burning in my legs which is relatively new. I've been struggling to use the computer for long periods to type because I have to lie down and I cannot stand the laptop on my legs. Lying down is the only way I usually get any relief of my pelvic pain, but now even that has become painful as it hurts when my legs touch each other while lying on my side and I cannot lie on my back (due to my sacral pain). It's been a discouraging week to say the least.

I've been struggling with burning in my groin and upper quadriceps off and on ever since I tried the intense alternative treatment back in May, but this burning throughout my legs and pain when lying down is pretty debilitating. It could be due to muscle tightness caused by compensation from all my pelvic dysfunction, but I feel like it's probably due to central sensitization (this is a link to a short video clip explaining what happens in central sensitization) unfortunately as pain medication doesn't even touch the pain. Next month I am going to try some drug infusions to hopefully help calm down my central nervous system and get the pain under better control.

Please pray that my insurance company will pay for these infusions. My doctor has submitted a letter of medical necessity and I am waiting to hear back from them. Please pray that the infusions will work to help manage my pain better and the side effects will be tolerable. If it does help, this is something I can do on a regular basis to manage my pain. Praise God I found a local pain doctor willing to try this!

Thankfully my doctor is willing to give us a "deal" (though still not cheap) so we feel like we need to go ahead and try the infusions as my pain is just becoming worse and worse. We will battle the insurance company after the infusions if we have to. I am concerned because the dosage this doctor is planning to give me is small and the infusions will only be for 3 days (2 hours each day) so this may not be enough to tell if the medications will help me. But it is the best option I have at this point without traveling across the country to a specialist who deals specifically with this type of pain syndrome.

Three weeks ago we visited a hip specialist and I had an MRI of my left hip (where most of my pelvic floor/sacral pain is). Interestingly they found some damage to my hip - a labral tear and ischiofemoral impingement. I was surprised to say the least, after 4 years of going to doctors and never finding anything concrete on scans. What does this mean? Was this the actual cause of my pain to begin with? I don't know, but it's possible. There is a study (read abstract on page 29 of 32) being done out of New York that suggests a correlation between labral hip tears and pelvic floor pain. However, my case is complicated due to the central sensitization and while arthroscopic surgery can be done to correct the labral tear it is possible that even with surgery my pain could become worse if my central nervous system is driving the pain. It's also important to know the cause of the labral tear, which mine seems to be congenital according to the specialist, but I also have a degree of hypermobility in my joints and this could also lead to a poor surgical outcome. I plan to look into this more in the coming months as well.

I did have a hip injection that relieved my hip pain (which is minimal honestly compared to everything else) for several hours. (I have wondered a little if the hip injection is what set off the burning in my legs, but the injection was only in one hip and my pain is bilateral and the burning didn't start until about 3 days after the injection - but then again anything is possible with central sensitization it seems!) I feel like it is possible that the hip damage has caused all the muscle dysfunction and nerve irritation/pudendal neuralgia in my pelvis and that if the hip was repaired and I had consistent good physical therapy (which is a problem where I live) then over time some of the other pelvic pain might resolve. Of course until I get some of the burning in my legs calmed down I do not know if I feel comfortable pursuing a surgery.

We are traveling this week to see the hip specialist again and I will be getting an MRI of my right hip (I actually have more true hip pain in my right hip) as the specialist thinks I have a labral tear in my right hip as well. I have a lot of questions to ask her and will see their PT as well as my pelvic floor PT. Pray that God will give us wisdom as we seek answers to these questions.

We continue to need prayer that our hope would be in God, especially  for me in these hard days, and that I would call out to Him for grace to sustain me in my physical weakness. And most importantly that we would truly trust Him.

And of course we covet your prayers for healing and if not healing then better days and a better understanding of what is causing my pain and the ability to get treatment to help me.

Recently a Facebook "fan" recommended a sermon to me by Pastor Timothy Keller entitled "Questions of Suffering" that is very convicting. He talks about the "Why?" question of suffering saying that we must:

• Avoid the pat answers of "why do we suffer"
• Embrace living without an answer to "why am I suffering"
• Anticipate the final answer

Listen to it here and be encouraged!