Leslie Partridge (Sachs): Dancer with Avascular Necrosis
Your Name: Leslie Partridge (Sachs)
Date of surgery: November 6, 2010
Surgeon: Dr. David J. Mayman, M.D.
Hospital: Hospital For Special Surgery - 523 East 72nd ST NY NY 10023
I had been dancing since I was 7 years old. My training originated with NYCB's SAB, moving on to train with ABT. I attended the HS of Performing Arts, moved on to Bard College where modern/contemporary dance planted it's seeds for my passion through techniques taught by masterful teachers in Cunningham, Limon... My work in dance grew and remained in the contemporary field. I performed the works of many less renown choreographers and developed my own teaching techniques. I was a passionate teacher and my choreography was accepted with much enthusiasm in NYC's downtown scene but my heart and soul rested in my teaching; experimenting with movement and challenges and working to train young professionals.
I was born and raised in Manhattan and though I taught and choreographed in Sweden and Switzerland regularly, NYC was my home. At 35 years of age I felt I was at my strongest and most capable. At 40 I had my first child and continued to teach and choreograph, though my last performance was in Manhattan's "The Kitchen" at 39 yrs old. At 44 I had my second child and my work became difficult to manage with my family. I decided that I would take perhaps a year to focus on my children, particularly the younger one as she was not as willing to join me at the studio. What soon followed was a storm of change in my life. My husband and I bought a house and moved to upstate NY (just an hour form the city) with our children (then 3 and 6). I immediately sought out studio's in the area (none really) but managed to continue with my own training. I then discovered yoga and in one year of training and studied I became certified as a yoga teacher.
During my training for my yoga certification I recognized an ongoing subtle pain in my left groin. Dancers, people in physical expressions and endeavors are notorious for their ability to ignore or forgive such nuisances. I did just this. It took an entire year after 'noticing' the pain, for me to schedule an appointment with a doctor. By that time it had gotten so bad that I was limping regularly, but still practicing yoga and walking my dogs on a daily 5 mile walk. The first medical practitioner I sought was affiliated with a hospital in the Hudson Valley region, as this was most convenient. He diagnosed me with a pulled groin. Though this did not feel like an accurate assessment, I left the office with instructions to stay off my left leg for a week and see how it felt after that time. I did, the pain was still very prominent. I called in for an MRI. I knew something was wrong and I was not going to wait any longer, so I took the bull by the horns, got my prescription for the MRI and had them read by the same physician who told me I had a groin pull. When I entered his office to hear his diagnosis after reading my MRI he unclearly and with such speed told me I had Avascular Necrosis. I could not understand him, I did not know the medical term (why would I) and he proceeded to get up, write a prescription for Fosamax, and leave. He left me behind, with confusion, slight panic and bewilderment.
I went home, figured out what he had diagnosed me with, commonly referred to as AVN. Just after my initial diagnosis of AVN by the Doctor at Hudson Valley Medical Ctr., I returned to an Upper East Side sports medicine practice where I had, three times during the course of my dance career, ambulatory surgeries performed on my right knee, both lateral and medial menisci repairs. My knee surgeon, with whom I was very happy, referred me to his partner in the practice who worked on hips and shoulders. By his recommendation I had a Core Decompression to see if they could revascularize the hip joint as the AVN, according to them, was in stage 1 and early on they had had some positive results with patients through this procedure. It was ambulatory.
In summer of '09 three holes were drilled into my left femur near the head . My pain after this procedure was the same if not worse, another impetus for my seeking out another surgeon who could help me. Apparently, this procedure is not too often successful I later understood. I did a great deal of research and within short time in fall of '09 I sought out a surgeon affiliated with the Hospital for Special Surgery in Manhattan. Doctor Mayman sat with me, showed me my x-rays, both old and the ones he had taken, explained the joint disease and why surgery was my best option. AVN (Avascular Necrosis) is a joint disease whose onset can develop from a number of different possibilities. Alcoholism, age and steroid use are some of the indicators for people who may be prone to the disease. Having been a dancer for my life -- and the stresses that came to my joints, in my case my left hip joint -- left me with a predisposition for such a disease. As an asthmatic and then one who discovered she has a severe allergy to poison ivy (discovered in our first year upstate) I am not unfamiliar with steroids. My use has been minimal for my asthma, however it's possible that the dosage that I took to relieve me of the poison ivy that I suffered from in 2009 - a very massive dose over a 3 week period - could have been enough to generate the disease in my already compromised hip from dance. AVN is a disease where blood flow to the joint ceases and the bone, as a result, degenerates. There is no reversing the degeneration; sometimes there is a halt to the degeneration by taking such medications as Fosamax, as I did. But it is not likely and for me it did not happen. My surgery was scheduled for two weeks from when I first saw Dr. Mayman.
We decided that the prosthesis would be metal and plastic implant. The metal and plastic implants are the most commonly used hip replacement implants. Both the ball and the socket of the hip joint are replaced with a metal prosthesis, and a plastic spacer is placed in between. The metals used include titanium, stainless steel, and cobalt chrome. The plastic is called polyethylene. The implant is secured to the bone by one of two methods; it is either press-fit or cemented into place. In the press-fit method, the implant is fit snuggly into the bone, and new bone forms around the implant to secure it in position. When an implant is cemented, special bone cement is used to secure the prosthesis in position. The choice for this prosthesis was due to my skeletal frame, which is tall and slight. Any impact from activity could easily be sustained and not threatened by the plastic cup which in turn would give me more fluid rotation.
I went into the hospital on the morning of Saturday November 6th and was released on the morning of Tuesday November 9th. Immediately following the surgery I was assisted and using crutches. I had PT in the hospital twice per day and worked diligently by myself while sitting or supine.
My surgery had gone wonderfully, though this was talk and I had no idea what my body would be able to do. I did not take any of the pain medications that were prescribed to me in the hospital or when I went home. I wanted to experience the feeling of my body as I worked through healing. My pain was gone. I recognized the difference between the pain of a surgery and the debilitating and severe pain that I had endured for over a year. My mind was well aware that from surgery we do heal, and I did.
I had PT in my home 3 times per week and worked daily by myself on exercises. I was rigid with myself to follow all protocol regarding the DON'Ts and DO's after surgery. My left leg still does not cross my midline as I am waiting for my 6th month surgical visit with my doctor. At one point I did email my surgeon to ask a question (after the 3 month mark) regarding my beginning an easy yoga practice. His response was within the hour, and though he indicated that it was OK he explained the possibilities of error and why it was important to wait the 6 months fully and maintain the PT exercises and strength building activities that posed not one bit of threat for dislocation. So I have been waiting. I ride a stationary bike, less often than I should, and do walk 3 miles a day with my dogs.
Immediately after the surgery I was mortified to find that my left gluteus medius and maximus were gone. Atrophy is swift and unforgiving BUT, the muscle returns quickly with exercise. My incision is lateral/posterior and approximately 3 inches long. The scar has healed beautifully.
My 6th month visit with Dr. Mayman is on May 9th - 3 weeks away. I am elated and have my questions ready. How much can I do? My body at 50 years of age now, is still extremely agile and I would like to return fully to yoga and dance. Can I return to full flexion? 170 degrees in extension? Fold my body? Can I internally rotate? The latter is a big question for me. I do know that external rotation is perfectly ok with THR's, but in the surgery they dislocate the femur from the acetabulum (socket) by total internal rotation to pop it out. As a result the tendons and other connective tissues are over stretched and marred. It takes the full 6 months for proper healing particularly of the connective tissues. It is my understanding that not all THR's remove the femur from the hip socket by these means.
I am pain free. The sense that there is something different with my left hip is true. It is not a big issue, not a sensation that I can fully explain. With the knowledge that I have prosthesis and some element of truth that the body recognizes a foreign element within it, I simply have a different sense of my left hip. This is not a bad thing, just different.
I feel very fortunate that I was able, after a $500 co-pay, to have my surgery fully paid for by my insurance. That I chose the Hospital for Special Surgeries had to do with several people who had made the recommendation. The surgeon I stayed with, as I would have spoken with another if he did not feel right, was magnificent. He was an informative, patient and caring physician. He took his time to explain everything before and after the surgery, as did his team. The hospital was the better of what hospitals are in general. The care was an A- . Do have friends/family bring you healthy foods for rebuilding tissue and healing after surgery as the hospital (all of them) is remiss when it comes to nutrition, and nutrition is essential in good healing.
I must admit that I am anxious to learn what my body can do and feel determined to eliminate the idea that it "can't" do any movement in particular. I believe that my return to physicality with caution and care will have me 100% by this summer (2011).
Leslie I Partridge Sachs
Submitted April 20, 2011
I had my 6 month post op visit with my surgeon on May 9th. Up until this date I had been meticulously careful with all range of motion and only worked on strengthening exercises, e.g.: walking, biking, small weights and these activities that had me using only the sagital plane of motion (forward and backward). I also, kept flexion to a minimum to be safe.
My visit was both wonderful and non-eventful. I was given approval to carry on with all activities with a full range of motion BUT with a caution that any deep flexion at my hip along with a spiral or twist toward that hip would always be a possibility for dislocation.
I have since returned to yoga (and I do modify certain movements). I feel strong and getting stronger. I plan to return to movement classes of some kind at some point, right now I am working to rebuild my core strength as that is what seems weakest. I have not one twinge of pain and feel grateful and positive.
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