Episode 218 | I’m Having Surgery: Pulling Back the Curtain – Part 1

What is up, team? We are having a little bit of a different episode today. This is one that I was debating whether to do, and I was like, let’s do it. A lot of you guys have been following for so long, listening to what’s crazy in all the episodes. I just feel like I need to share this with you guys because it’s something that’s important in my life, and I feel like I talk so much about this ACL rehab process for clinicians, for ACLers, for coaches, for supporting roles. 

I just wanted to pull back the curtain a little bit for these particular episodes because guess what—I’m having surgery. This is something that I’ve been trying to tackle for quite some time now. And to give you guys just a little bit of background, that’s going to be the focus, especially for part one of this episode, is to just share my perspective, just where I’ve been, and just my story. And leading me up to today recording this very specific podcast, which is I’m having surgery tomorrow.

This is something that I just want to give you guys the full transparency of this whole process and give you my journey. You guys are probably wondering what kind of surgery and what’s going on here. Just lean in, hear me out here. I promise you that there is going to be so much value from this. My goal is to just be raw and transparent. 

As we started this off, I just want to share—look, I’ve had a lot of injuries over my years of being alive, for now, 33 years. It’s crazy playing sports, growing up in a small town. I’ve dealt with my fair share of injuries. Bad luck, if you will. But there have been blessings in disguise from all this stuff. I wouldn’t have had this podcast or this company or anything if it weren’t for my ACL injuries. I do not regret any of this stuff. And the thing is that my two biggest injuries over these years have been the ACL injuries. And they were my two only surgeries that I’ve had outside of wisdom teeth. But with that said, my first surgery was in 2008 and my second surgery was in 2013. These two surgeries came at different time points in my life. I was in high school for my first one and I was in my senior year of undergrad in college. It was just a very interesting experience going through these two processes, especially with it being ACL and navigating it myself for the most part, with having immigrant parents and not understanding the healthcare system.

But I mean, let’s be honest, y’all who does understand the healthcare system. But with that said, it makes it even more challenging with parents whose English isn’t their first language. They don’t understand a lot of the healthcare processes. It was just you trust the healthcare providers, or whoever is local to you. We didn’t have Google to necessarily search all the best things or all the ratings at the time, especially in my first surgery. Therefore, you’re relying on hoping you can trust the healthcare providers. 

I’ve had a lot of experience in my life. Sure, I’m only 33 years old, but guys, I’ve dealt with a lot of stuff, and so the thing is that I want to share, essentially, this whole process of what is leading me up to having this surgery, which is different. It’s actually for a different joint, and a lot of you are probably suspecting the knee joint, but it’s my hip joint. It’s my left one to be exact. While both are dealing with issues, my left one has been dealing with issues for quite some time. While this podcast is focused on ACL rehab, I do want to make sure I share this journey up until this point, because I do think this will provide a lot of insight for y’all. I want to be super unfiltered and raw about this and just share everything, and share the timeline, the steps that I took to get here. And honestly, just like wrestling with this for years and years and years. I’m someone who honestly knows better. I do in the healthcare process. I’m very well up-to-date. I understand the system. I understand the human body. It’s kind of crazy, especially being a medical provider and a physical therapist, has honestly made this process all a little bit more challenging for me. It’s been crazy. I know way too much, I see way too much, and I’ve honestly experienced way too much. I’m too cautious sometimes It’s made really hard for me to get to this point, especially being 33 years old. But here we are… 

I’m having surgery on my left hip tomorrow. I put in less than two days, but it’s tomorrow.  I’m having what’s called hip resurfacing. What this is, the doc is going into my left hip, and they’re gonna put a metal cap on my femur and a metal socket in my pelvis. The thing that creates your hip joint, the ball and socket, I’m going to have a metal piece that is the component of that joint coming together. So yeah, the thing that is similar to a hip replacement.  Probably your grandmother or grandfather or very elderly patient, if you will, in their 70s, maybe 60s, maybe 80s, they’re getting done. This is something like that, but I get to keep my femoral neck and my head versus getting that thing completely cut off, which is what commonly happens in a hip replacement. This is just a little different. I’m going to get a metal cap on that thing and then a metal interface for the socket. If you take your fist and you open up your other hand and create like a little bit of a socket, and you put those together, the integration of that is going to be metal. It’s honestly been a lot for me to process. But before I talk about this, I do want to highlight the journey and the background getting here. That’s what a lot of this is going to talk about. 

This all started about 2013. As you guys can tell, this is probably hard for me to talk about because it’s all being real and it’s happening. I’m trying to process a lot of this, and I have…but telling you guys about it has honestly like struck up some emotion about it. But I’m going to do it. This all started in 2013, 2014, so it’s been a while, 11, 12 years ago. I tore my ACL in November of 2013, which was quite interesting about this whole process starting. I was graduating from undergrad in May of 2014. I wanted to delay going to PT school immediately after, and decided to focus on my ACL rehab and doing my internship with UGA Strength & Conditioning along with lots of other jobs. It was a very busy year, focusing on those things. I cared a ton about performance and lifting and just geeked out super hard. I just went all in on this stuff, super focused, especially with my internship with UGA Strength & Conditioning. It was super intensive and so I was curious about the human body. I already had been, but especially with my injuries, I was just like, why me? I love performance, I love lifting and guiding people. It was just cool to be in this world. 

I always questioned one of the things about myself. Before I was like, oh, squatting was bad for your knees. I think it was more of my cop-out because I just couldn’t squat to full depth. It’s just something I’d always had trouble with, but never really pain or issues with it. People just have limited squad depth. I didn’t start digging into this until a little bit later. Once I got to this phase of life, and being like, okay, well, is it just range of motion in my hips? Is it just a mobility thing? But I always just felt limited. 

I stumbled upon a PT named Kelly Starrett, who some of you may know. But he was really big on YouTube at the time. He honestly was a big encouragement for me getting into PT because it wasn’t just this like cookie-cutter, lay on a table, do these few exercises—it was performance-based. It was self-care and taking care of your body. And while not everything he preached was in the book or evidence-based, he still was a front-runner of someone leading the field and changing the game. It was something that one of the things that at that time he was big into band mobilizations and trying to open up more range of motion, especially with CrossFit coming onto the scene and people just wanting to take care of their bodies more. Health was starting to become a little bit more of the forefront of old school stuff versus new school stuff, especially in 2010 and beyond. Especially with social media, people were able to reach things a little bit more and easier, see other people’s philosophies.

I started getting into these band hip mobilizations, just seeing like, all right, cool, can I free up some room in my hip and get some better range of motion in my squats? I thought my hip limitations and squat depth was a mobility thing. I just felt like I didn’t have good mobility. Sometimes people feel stiff or, don’t feel like they can get all the way with their arm overhead or get into that squat depth. There are differences in people’s actual range of motion and their anatomy. Anatomy will dictate your function. Some people are built with deeper hip sockets or more bone, and some people are built with less. Then they have a lot more range of motion and more mobility. And then muscles create tension, and so do ligaments and tendons and all those things. Everyone’s range of motion is different to some degree.

Now, we have normative data of like, all right, this is normal ranges for most people. Just like most people have hyperextension in their knee or their flexion might be around 140 to 150 degrees, depending on their muscle mass. These are things we know are normal, but at the same time, people have minus 20 degrees hyperextension because some people have different anatomy or different, genetics, or different hormones in play. For me, I thought it was a mobility thing. I thought I had the range of motion, but I thought I just needed to work on it. I worked on it so freaking much. All kinds of other drills too. It’d improved a little bit, like I’d feel it a little bit better. But then it would regress. I just wanted like really good squat depth. I wanted to be able to sit all the way down into a squat. I always wondered why I couldn’t, and it is something that I always wrestled with. I just didn’t have enough knowledge at the time to dive deeper into it. What I would do is I would work on these things. I’d force myself into positions, and over time just with lifting and working on it and playing sports. I would flare the hip on and off, all the time, especially on the left side. In the front, I would get these sharp, weird pains, these pulls, and it would flare up. I would work around it, think nothing of it. I’m like, ah, like I’m getting this thing used to these positions. Again, not understanding, a deeper understanding of the hip, I just kept working on mobility drills, thinking it was still a problem. And then I got into PT school, and I finally set up a physical therapy evaluation with a local PT. 

With that, I just started; she was someone that I respected at the time. What she did was she blamed it on some muscles and gave me some drills to do. In hindsight, looking back when I look at what I know now, and looking at that evaluation, she didn’t assess what needed to be assessed. She didn’t assess my hip range of motion well. She didn’t listen as much to some of the issues I was dealing with, and she was someone, honestly, who could have caught this problem for me early enough and guided me. But she didn’t, and she just wanted to honestly stick needles in my TFL and some muscles around there and just give me some exercises. Of course, this is not her fault, but at the same time, I talk a lot about like working with someone who knows their stuff. At the time, it was flashy exercises and needles and stuff like that, and inundated with it that I just leaned into that without vetting it.

And then in hindsight I was like, man, that she didn’t know what she was talking about. If someone was truly listening to my story and someone who was truly doing a full evaluation and looking at things, they would’ve caught that this hip was having issues that needed further insight on it, or at least said, “Hey, like, let’s work on this versus and if not, we’ll refer you somewhere to get some more imaging and get this stuff further assessed.” But no, it was, let’s just stick needles in it. Let’s do some exercises and cross our fingers that it gets better. It’s just interesting because I started learning more and more in PT school and asking questions. I started to connect some more dots. I was like, oh, this is how the hip joint works. This is the anatomy of it, this is the normal range of motion, this is its function. These are the muscles that attach to it. This is how they’re all supposed to integrate together. I was starting to put things together and understand the deeper levels of this process. Then I started to connect that, man, this seems something structural. It’s not adding up.

I set up an appointment with a local hip surgeon here in Atlanta. I got X-rays on both my hips, and I got an MRA on my left hip. MRA is an arthrogram. It’s basically like an MRI but a little different. The difference is that they inject contrast dye into the hip joint or the specific joint if it’s somewhere else. They’ll do this for the shoulder too. But this is guided by X-ray. They’ll do the injection into the hip capsular, into the joint, and that contrast dye is going to help to point out certain tissues and highlight them underneath an MRI, essentially. It shows if something’s going to be torn or not, because sometimes it’s difficult with just smaller tissues and the signal of it to see it on MRI. So that’s why an MRA is done to be able to get a little bit more insight into what is truly causing these issues. The labrum specifically is the thing that they’re trying to look at, especially for the hip joint, to see the labrum, which is, think about a gasket around your hip joint, and sometimes that could be torn. If that’s torn, it could provoke some issues, and it could also just not have as much of strong seal on the hip. It’s still locked in there, but it could just be a trigger for the pain and issues people deal with. It turns out that what I had it was called FAI (femoral acetabular impingement).

This is where people have bony growth around their femur and the acetabulum. So that’s where that ball and socket come together, the ball-and-socket joint. I had a torn labrum along with some other tissue that was a little bit inflamed. I met with the surgeon and honestly, he sucked. He was not a great surgeon. I didn’t even really get to explain my concerns or anything. He just walked in. He put up the X-rays on the little light-up thing. He’s like, yeah, you got some bony growth here. He’s like, you’ve got a torn labrum, said surgery must be done for both hips, first hip, let’s do that, ASAP. And then six weeks later, the other one’s going to get done. It didn’t stop to answer any questions. He pretended he was you… Do you have any questions? It’s one of those things where it’s like five minutes. This guy is about to do surgery on my hip, and I’m about to trust him with this surgery. They have to pull your hip out and be able to reshape some of the bony pieces and fix the labrum. I’m about to trust this guy that I’ve talked to for five minutes, who didn’t answer any of my questions, to do this surgery as a PT school student. I was roughly 24 at the time, so I’m not an idiot. I’m still an idiot, but not as much of an idiot as I was whenever I was younger. I understand this stuff a little bit. The procedure itself, to give you guys that idea is that they’re going to go in and they’re going to reshape that stuff and they’re going to repair that labrum, as I had mentioned.

The thing is that the outcomes at that time had some variability. It was being done at such an increased rate. If people had hip issues, surgeons would see this problem and they’d go in and then they would have surgery. The thing is that they weren’t referring people to physical therapy at the time. They were just jumping to surgery. And sometimes people’s outcomes would not differ because they didn’t necessarily tackle the problem. Because people have problems that show up on imaging. The thing is that, are they symptomatically related to the imaging and the clinical testing? And that’s the thing that’s super important here. Especially in the time of 2015, around this time, 2015, 2016, it was growing and spiking in popularity of the surgery. But then the outcomes were still fine, but we didn’t know the long-term outcome. Between him not being awesome, he sucked me being in PT school. Early on, I was so deep in wanting to learn and be involved in that, and I cared so much about like studying and getting good at this craft. I was like, between that, I didn’t have a lot of help or resources. I had awful insurance. Reminding you guys that if you haven’t learned about my previous story, I had to pay 10K out-of-pocket max, $10,000 for my ACL surgery in 2013. The thing is, I was still paying on that. I barely made a dent in that. I was still paying the minimum $25 monthly in PT school from my second ACL surgery, so it wouldn’t go over to collections. I was still paying on that. I had to debate this. And guess what? My insurance and PT school, $10,000 out-of-pocket maximum, man, good old US healthcare system really serving us well.

I was like, I don’t want to keep going into debt. Oh, I had undergrad debt. I also had a PT school debt that was accumulating, which I knew was not going to be cheap. This kind of stuff, you think about it. And then the last factor in this decision was, I started consulting other PTs in the field and different surgeons as well. This was something that I was just like, do I want to do this? At the time, as I had mentioned, the surgery was blowing up, and it was happening to people with no symptoms. I was just like, you know what, my symptoms aren’t that bad. I’m not that limited. I could still play sports and do things. I was like, all these things combined, I decided to wait. Especially because my pain, as I had mentioned, wasn’t awful and my biggest issues were just getting into deep positions of hip flexion and squatting. If I forced myself into those positions, I would flare the hip up. But if I avoided them, I was fine. 

Now, fast forward to the past two to three years, I’ve noticed that my hip mobility and pain started to get worse. My hip mobility and range of motion just continue to get less and less. I just feel super limited, and to give you guys a good idea of an example of things that I’m struggling with. I can no longer tie my shoes on my left side. I have to wear shoes that I can just slip into. Or if I need to tie my shoes, I’ll pull my left shoe off, bring it up to me, and tie my shoe. Sitting in a chair, like the chair I’m sitting in right now, makes my hips ache, especially my left hip. I can’t sleep on my left side. I can’t sit on the ground comfortably with my 1-year-old. And that’s probably been the biggest thing that has like really sat with me, is that I have a 1-year-old. I’m able to do most things with him, but I can’t crouch down on the ground with him necessarily comfortably. I have to kneel as if I’m kneeling. It’s just awkward, but it’s fine. But he’s going to get older and he’s going to want to move and he’s already moving all over the place like a little gremlin, and we want to have future kids too. It is just something that factors into this, but I can’t sit on the ground comfortably. I’m not going to say this like appropriate, but I’m Indian so I want to be able to sit on the ground, Indian style, crisscross applesauce, whatever they say. And the thing is, I can’t, and it’s crazy. This is my heritage. I should be able to do this. We sit on the ground, we use the toilet with a hole in the ground. And I’m like, how is this possible? And I can’t do any of those things. I can’t even sit on a normal toilet comfortably. It is crazy. I can’t pick up something off the ground with two legs. I have to do a single-leg RDL on my right side because it’s a little bit better to pick it up. From a pencil, heavy dumbbells, kettlebells, barbells, plates, whatever it is, I have to do a single-leg RDL to get myself down there to angle it to pick it up.

My hip is always in discomfort. It just depends on how much I’ve tried to push it. If I do push it, I do pay for it. Therefore, it impacts movement and activity for me, because it’s this cycle where I might hold off a little bit. After all, I don’t want to flare it up. The lifting activity, in general, has been pretty limited for me, even more than it was before. When I truly think about how much this hip limits my abilities, I’d say it’s about 80%. I’m operating at a 20 percent-ish capacity, and that’s how it’s honestly felt since I’ve noticed this issue in school to some degree, especially with lifting and being able to work my legs. A little better then, but now it’s not great. When I go to lift in the gym I am reduced to a lot of machines. And y’all trust me, I know how to work around exercising, I know how to regress and progress things, I know how to modify things, I know how to do all this stuff with lifting. And the thing is that it’s just so challenging because there’s not many positions that I feel like I can utilize my legs well. I’m going to get off of this pity party here. Just wanted to expose you guys to the limitations of this. And I think the main thing for this is, I’m not sharing this to get you guys to feel sorry for me. I’m getting this to share this is real life sh*t we deal with. It happens to all ACLers, it happens to people who are dealing with physical limitations. There’s also a mental side to it. But the thing is that it’s real. I think you guys like going through this ACL rehab process knowing what you’re dealing with is real, the limitations are real, the life changes are real, the things you can’t do are real. I want you guys to know that and I feel that, and I felt that with the ACL stuff, I feel that so much with this hip stuff.

And the thing that sucks the most, I will say is that my biggest hesitation over the years, more than anything, has been insurance and healthcare. I don’t trust it. And especially as a small business owner, my insurance has been awful. It’s terrible. My wife works for a small nonprofit, and they don’t have great insurance either. There are some years where I’ve opted to get on it, and luckily I’m on it this year. But it’s still awful, y’all, it’s terrible. We pay so much money for insurance. That is awful. And what I’m going to share with you guys in part two is the actual numbers and the breakdown of this stuff. You guys can have transparency of someone in my position going through this process and the steps I am taking. I’m giving y’all all the numbers. I’m giving you the raw information on what we’re spending, our deductibles, like how much this is going to cost me this year, just so you have full transparency of someone who knows this stuff, who goes through it, and who is paying for it. And to be able to live their life. I want y’all to know about this stuff. My biggest hesitation has been insurance. 

Last summer, to walk you guys through how I got to this point today, is that last summer I decided to finally find a doc here in Atlanta I trusted, especially now that I’ve been more connected with surgeons and just the community here. I can find people, I can vet them a little bit better. I understand talking to them. I’m not intimidated anymore talking to these surgeons. I’ve found a really solid one by just reaching out to my network. I was like, it’s time, I have a kid who’s three months old at the time, which was last summer. I need to be able to move more. I was hoping to get the procedure that I was going to get done in 2015, 2016 done now. I had X-rays done again last year. I had MRIs done to both hips, on the left hip and the right hip, to see what was going on. It turns out it’s now progressed from what it was to osteoarthritis. My left hip was not great, it’s not in great condition. It is moderate level osteoarthritis, and my right hip is a little bit better; it’s mild osteoarthritis along with all the things. It’s got osteophytes in there. It’s got a torn labrum. It’s got a cyst on there. Of course, lot of arthritis, plus there’s a lot of bone that was there before, but even more now. If I’m honest, when I found out about this, my heart sank. Because the surgeon this time was like, the previous procedure you could get, the hip arthroscopy procedure, where they could go in and they could shave the bone down and repair your labrum isn’t an option anymore. He was like maybe on the right side, but the left side definitely not. He was like, I don’t know any surgeon that would touch this with a hip arthroscopy.

And so, yeah, I had to sit with this. And so he said, your options are, you could either one: manage it conservatively and just go get shots periodically, every six months or so, to see if that’ll help. He’s like, option two: get a hip replacement. Option three: get a hip resurfacing. And he recommended the hip resurfacing. I honestly did not know anything about hip resurfacing. This procedure, because it’s not super common like a hip replacement, where surgeons within a 15 to 30 mile radius of pretty much any city do them. Everyone knows what a hip replacement is. Everyone knows what a knee replacement is. The thing is, hip resurfacing is a whole lot less common. This is something that some surgeons in big cities do, but there are only, I would say, three to five in the US who are that is their thing; the thing that they do. There are people all over the world. There’s a guy in Belgium, there’s a few in Australia. There are different places for sure, but you’re talking about world renowned surgeons, like who do this thing? There’s far and few between. The thing is that most surgeons get trained in hip replacement because it’s the most common thing. Hip resurfacing is a more intensive from surgical procedure, it’s a lot more work. It’s just something that is not often done. And in PT school, we didn’t even learn about this, to be honest. This was all new stuff to me. I started researching. I was like, oh, this is a thing. I talked to some friends, and most of them have never heard of hip resurfacing. I started talking to people who may be working within these communities of hip and specializing in them, and like, oh yeah, this is a thing. I was like, wow, finding out a lot about this process. 

Andy Murray is a good example. He had a documentary, he had a bunch of hip issues. He underwent and got hip resurfacing after having multiple hip arthroscopies that failed. He ended up having a hip resurfacing done and returned to playing pro tennis again. There are other professional athletes, especially in the NHL who have this done. Dr. Su out from New York. He is a big-time hip resurfacing surgeon. He’s not the one I’m picking, but he’s one of those who has done some of this work. It’s something that does exist and people have good results from it, depending on how their body responds to it and the rehab and all those things. To circle back around after this session, whenever the doc had presented the options to me, I ended up getting injections in both of my hips. Because I felt like I needed to do something, and I was hoping for some reason it would magically help me feel better and reveal a door that can help me manage it. I was just hoping, fingers crossed. Somehow, it freed up my hip. It made my hip feel better. Nothing improved, maybe like 1%. It wasn’t very much, though. I just sat with this for a minute, to be honest. For a while, I was in denial. I felt regret for not getting the surgery back in 2015, 2016, which could have maybe avoided me being here. I’d be lying if I said that still doesn’t cross my mind now. But the biggest thing y’all, is that I don’t want to dwell too much on that, and I’m not that kind of person. I don’t dwell in the past too much. I am very focused on the controllables; complaining about it doesn’t fix anything. I’ve learned that the hard way in the past. It’s just something like, why sit there and complain about it? Here we are doing the thing. 

There’s going to be a part two, diving into the actual, getting to this process and talking through it in terms of my step-by-step of being able to go through the surgeons, the researching, all the things. Because this is something that I know a lot of you guys deal with and you’re going to have to deal with. Hopefully, not to the degree that I do and you get on it. Because if I’m being honest, I wish I were having another ACL surgery, but at the same time, I don’t. It is just something that I think it just feels very personal because it’s my hip, it’s close to my body. It is just something that I’m like, they’re going to pull that thing out and I’m getting metal in my body. It’s a lot of different factors that play into it. 

My goal for you guys is to share this as much as I can. Hopefully, this hits home for some of you, even if it’s just a random story you’re listening to about my life, but I just felt like I owed it to y’all and to be able to share this. And I’m excited, honestly, to share part two about this, which is going through the details of insurance, going through the surgical consultation process, so you guys can see what I went about doing it to know, like okay, this is what he would do in a situation like this. In a world that, honestly, especially with rehab and with the surgical process, I’m familiar with it. But this world, specifically, hip resurfacing is new to me. I’m not in the know of all this stuff. I had to learn a lot of it and understand it. I’m just going to share a lot of this stuff in the following episode to come.

I’m going to go have surgery and just want to say, I’ll see you guys on the other side. Let’s do the thing. Until next time, team, this is your host, Ravi Patel, signing off.