The dye is still purply-pink on the front of my right hip as I type this barely half an hour since my second Durolane injection (VGH Ultrasound is basically across the street, so for all the noise of ambulances and helicopters at all hours, living near Vancouver General Hospital does have its benefits.)
I had another first-rate experience this time around, but it wasn’t quite the same as my first injection. The biggest difference is that since I am absolutely sure Durolane worked for me, my expectations going in are sky high. Last time I figured I had nothing to lose and treated the procedure as an experiment and myself as a guinea pig. This time around I want to find out a) if the first injection was a fluke, b) how quickly it works, and with fresh memories of the amount of pain I’ve been in lately without it, c) just how effective Durolane really is. It’s still an experiment and I’m still a guinea pig, but this time I know what to expect.
Another main difference today was that the doctor who performed the procedure was not a marathoner like the previous one and questioned whether running was the wisest choice of recreation for me. After I mentioned I had run the Stormy 50-miler nearly three weeks ago, he warned me, rather bluntly, about the effects running would have on my joints. He hated to break it to me, but he believes that we all have a finite number of steps in us over our lifetimes and that I could either use them all up in my forties running ultras or ease back on the distance and run until I am much older. Either. Or. Cut back the running and pick a low impact activity or prepare for the consequences. End of discussion.
It’s already a little disorienting lying on an x-ray table under little more than a bed sheet so I wasn’t really up for a debate. I thought the whole ‘running is bad for your joints’ myth had long ago been debunked so it was stunning to hear this declaration from a guy with a fistful of medical degrees. But since the guy talking the crazy talk was about to jab several inches of sharpened surgical steel into my hip, I figured the prudent thing to do was hear him out.
I asked if he meant runners like me with osteoarthritis or all runners. He answered that active people, particularly runners, put more stress on their joints so their joints wear out faster than the joints of sedentary people. Essentially he was saying that lazy people have healthier joints since they’ve been hoarding their steps by not getting off the couch. Moreover, since I’ve already got OA, I would have even fewer steps left than typical active people.
I should say at this point that my reservations about his finite steps theory aside, the doctor was completely professional in every way.
The doc also asked me how effective I found the last injection. He seemed impressed that I figured the hip was good for about 7 months after the first injection and then gradually declined to where it has been the last few weeks. He also asked how quickly I felt the effects. I’m pretty sure I felt some relief almost immediately but he said most patients feel the benefits after about 2-3 weeks.
The whole procedure took about twenty minutes as expected. I barely had time to sit down in the waiting area before I was escorted to down the hall to change into my ultra-chic double-gown ensemble — with my Brooks Green Silences on for good luck (a nurse initially instructed me to strip off “everything below the waist,” but then gasped when she saw me barefoot. “I didn’t mean the shoes. This is a hospital after all. You never know what is on these floors!”) Shoes back on, I laid down on the x-ray table, got under some blankets, tucked a lead blanket under my left butt cheek and was good to go. The doctor took measurements of my hip, adjusted the overhead imaging part of the machine and away we went.
I barely felt the anaesthetic as he injected it into several spots on the front of my hip. I did feel the main needle for the fluoroscope and injection briefly going in (I don’t remember feeling it last time). I don’t know anything about needle gauges — other than the lower the number the larger it is — but the doc did tell the nurse he would normally use a 22-gauge for similar procedures, but because Durolane is quite viscous, that he would use an 18 or 20 if it was available. I think he went with the 20-gauge.
The doc took the time to show me on the x-ray that the cartilage in my hip is fairly healthy through most of the joint but thins out toward the top. That was interesting since I get most of my pain toward the front and inner side of the hip. Also notable was a bony bump on the side of the upper part of the joint that he believes is a result of the bones adapting to the changes in my biomechanics as a result of the degeneration of the joint. I’m kicking myself for not taking my camera with me to get a shot of the x-ray — and I seriously considered breaking all the rules by pulling out the world’s crappiest cameraphone — but maybe I’ll draw it from memory and post it here so anyone interested can see what I’m talking about… as soon as I get the splint off my broken middle finger.
I strained my neck to watch the monitor as the doctor guided the needle with the fluoroscopic dye toward the joint. Because fluoroscopy uses x-ray images it was a bit like watching stop-motion animation.
Much like last time, the actual injection of Durolane was anticlimactic and I barely felt a thing.
The doc told me to take it easy today and that I could resume normal activity tomorrow. Anyone for a twenty-miler?
I rode down to the store for the marathon clinic tonight and then served as official timer for the 5k fun run I had the crew do for their first night of speedwork. The injection area on the front of my right hip feels a bit bruised, but — call it my imagination — the joint itself already feels better.