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Lisa Mildon Physical Health

Denial Could Have Been the Death of Me

by Lisa Mildon

My life of denial began when I was nearly nine years old. After a routine checkup, the doctor noticed I had high blood pressure. Pretty unusual for an 8-year-old. After further testing, the doctor discovered I had a non-functioning kidney. It had to come out as it was damaging my remaining kidney. So, at the ripe old age of 9, I had my left kidney removed.

My parents were told that I could live a relatively normal life, but no contact sports. I think their fear of losing me made them shelter me like a glass figurine.  Often, I would sneak off outside, climb trees, wrestle with my brother, and other rough and tumble activities. I suppose, even at that age, I was in denial. But heck, at that age, I really didn’t know any better.

My indestructible mentality carried through to my college years. I partied several nights a week, not even thinking twice that I could have any condition that would affect my social life, much less health. Thankfully, I outgrew those wild moments mostly and began taking better care of myself, but my diet was in shambles.

four person standing at top of grassy mountain
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Since puberty, I had always been “fluffy.” I’ve dieted all of my adult life with varying amounts of success. To my recollection, I never had a doctor tell me that my weight was a factor in kidney health. (Denial again, I’m sure.) That was until in 1999, my regular physician sent me to a nephrologist (kidney disease doctor) who said I either lose weight or die young.

This bit of news scared the living sh** out of me. I did a very drastic thing and had gastric bypass surgery. (Basically, a stomach stapling.) It worked. I lost nearly 100 pounds. The downside, I had so many nutritional issues. I could only eat small amounts. Eating protein was painful to digest. Food that swells, like rice, caused me severe pain. I vomited often. My hair started falling out. I was a wreck… but hey, I was thinner.

Despite my surgeon stating that the procedure he did would “never” stretch out, it did. Those painful moments were actually my stomach stretching. Almost 20 years later, I had gained all but 20 pounds back.

Then I found out I had a gluten allergy. Bingo! I changed my diet, eliminated wheat and gluten products. My weight started dropping again. I had lost over 40 pounds and felt terrific. My numbers on my kidney seemed to stabilize. Yet, according to my doctor, not once did she ever mention kidney disease. Just talked about how efficient it worked and the lack of gout.

medical stethoscope with red paper heart on white surface
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I wish she had been more upfront with me about my kidney. Perhaps she thought I had already had a talk with a previous doctor. Unfortunately, he failed to tell me anything other than send me to a nephrologist. She had, at one point, asked me if I wanted to go to a nephrologist. As the only one in the area was the same quack who advised me to get stomach surgery, I politely and firmly said no.

Seeing as she was giving me a choice, I thought this was just a suggestion for future care as I aged and unnecessary for my current situation. So, I blindly followed her advice, much to the detriment of my current health situation.

Then, as luck would have it, I moved out of state and changed careers. While all of this may sound exciting (which it has been.), those changes may have aided in my further health decline. I became a freelance editor and writer, so insurance became my responsibility. I couldn’t afford that insurance for about a year. Once I got insurance established, the pandemic hit hard. 

Trying to play it safe, I waited, thinking that this would be over in a few weeks. Oh, how wrong I was. Out of a considerable dose of precaution, I made an appointment to establish a new physician. My hope was I would find someone who would listen to me and even want my health to improve.

blue and silver stetoscope
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I lucked out big time. My new doctor listened closely to my health history, asked tons of questions, and even offered to get my old records (My old doctor was very unhelpful.). She tested my blood and urine with an expanded set of tests. I thought, “Hey, I might actually get some help with my weight loss.” The weight loss problem was the actual issue I wanted solved.

So, when I received a call to make a nephrologist appointment, it shocked me. Nephrologists are for “those” people who have kidney disease or are in failure, not me. I was in complete denial. I looked at the test results as soon as I hung up the phone. It was pretty grim. It looked like my kidney was on a downward spiral to dialysis.

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“How could it be this bad?” I asked myself. Then thoughts rolled in, images flashed. All those different doctors I had over the years all assumed that someone taught me about kidney care, what things I should eat, what I should avoid, you know, necessary information to extend my life, and the functioning of my remaining kidney.

I realized that even the quack doctor was trying to tell me I had kidney disease. God, it’s even hard to type it out, much less say, “I have kidney disease.” It scares me to be quite honest. My entire life has been about me having one kidney. Not about my intelligence, not about my sense of humor, just that damned organ in my body.

I had to face the truth. It was time to take action for my health. No more toughing it out with the pain or suffering in silence with an illness. No more sucking it up! It is time I love myself enough to take care of myself.

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I won’t lie. Depression had its clutches on me for a week. All I could think about was how I wouldn’t live to old age. That I would die and leave my loving husband alone, as he has always feared. It was his determination that shook me back to reality. I could still take action.

With his doting care and research, I began tweaking my diet to be more kidney disease friendly. I trimmed back the amount of meat I ate in a day. I increased the amount of water by twenty ounces. Gone are the “woe is me” thoughts only to be replaced with determination.

peaceful lake with residential cottages and lush trees on shore in autumn
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No matter what type of illness or adversity you might face, don’t be like I was and hide from the truth. Dig deep down from within and find that courage and determination. Take action on the care of your body and your mental health. Even from the depths of despair, I chose to live rather than wallow in self-pity.

Look at your situation. You might be surprised by making tiny changes that improvement can be attained. I tweaked my diet by reducing the amount of meat protein I ate a day. I increased my water and even started adding in 10 minutes of cycling on my exercise bike. In two weeks, my kidney numbers improved. I went from stage 4 kidney disease to stage 3. By breaking up this daunting task into small manageable chunks, I took what seemed like an impossible situation and made it something I could handle. 

You can do this too! Believe me, if someone like me who tries to ignore bad news can face adversity head on, so can you. Find your tribe of supporters; they’ll help lift you up when you’re flailing. It’s ok to ask someone for help, even for moral support.

I’m looking at my health with open, honest eyes. No more denial or me shirking away from the truth. It’s time I stop ignoring the obvious and take charge of my life. Because denial was nearly the death of me.

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Guest Contributor Physical Health

Groin and Front Hip Pain in Women

Written by Dr Michael K. Van Antwerp, Edited by Andrea Vasquez

Groin and Front Hip Pain

Groin and front hip pain are common areas we see in women’s health. These can have a host of causes with some more evident than others.

Some of the causes of pain in the groin and front hip can be: hip impingement, labral tear, sports hernia, hip flexor strain, hip adductor strain, inguinal ligament sprain, endometriosis, cam or pincer deformity, hernia, arthritis, osteitis pubis, round ligament pain, stress fractures, nerve entrapments, interstitial cystitis, pelvic floor dysfunction, gynecological or urological pathologies, pelvic or hip surgery complications, SI joint dysfunction, sacral or pelvic plexus injuries.

In the first article of this series, we will look at the musculoskeletal causes.

Functional Hip Impingement

Functional hip impingement is caused by malpositioning of the ball in the hip socket which causes pressure or rubbing to occur in one area. This can be caused by prolonged sitting postures where the hip is flexed with tight hip flexor muscles and tissues. Although it seems simple, it can be debilitating in more severe cases.

Femoroacetabular Impingement (FAI)

In structural hip impingement, bone growth is present at the ball-and-socket joint limiting movement usually with some type of cam or pincer deformity. This structural limited movement and pain is referred to as a femoroacetabular impingement (FAI). It is possible for FAI to lead to osteoarthritis or labral tear. It seems plausible that limited hip movement can also lead to pelvic instability including pubic and sacroiliac joint dysfunction as well as low back pain in addition to the presence of groin/front hip pain.

Labral Tear

The labrum is a gasket-like ring of cartilage that runs around the outside of the hip socket and acts like a suction cup. It can tear due to trauma, structural abnormalities or repetitive motions. An MRI with contrast dye (MRI arthrogram) is the best way to view a labral tear since an MRI without contrast dye can give false negatives. Sometimes labral tears will need surgery; oftentimes, they can be managed with conservative therapy, sports chiropractic and rehab.

Sports Hernia

A sports hernia is often defined as any sprain/strain of ligament, muscle or tendon in the lower abdomen or groin area. However, it may be more specific to an injury of the transversalis fascia with pressure on genital branch of the genitofemoral nerve or it might be an injury to the pubic aponeurosis. It is a different injury than a traditional hernia which is why it is sometimes referred to as athletic pubalgia and more recently core muscle injury (CMI). In the past, it was referred to as Gilmore’s groin.  A sports hernia will often have no anterior bulge; whereas, a traditional hernia often has bulge from the internal organs pressing or pushing through tissue. The presence of femoroacetabular impingement and pelvic instability seem to lead to increased risk of sports hernia. A sports hernia can be quite painful with difficulty in sitting up or moving and has even ended sports careers.

Hip Flexor Strain

The psoas and iliacus are front hip muscles that help flex the hip. They can be strained in activities such as running, but oftentimes can start hurting from prolonged sitting. In addition, the upper quadriceps and upper sartorius muscle can be tender and/or strained as well. This can often mimic FAI, athletic pubalgia and labral tears initially.

Hip Adductor Strain

The pectineus, part of adductor magnus, adductor longus, adductor brevis and gracilis all attach at the pubic bone. These muscles pull the thigh inward from the hip joint and control the rate of outward movement of the thigh. These muscles can often be strained in sporting activities.

Inguinal Ligament Sprain

The inguinal ligament runs from the front point of the pelvis to the pubic bone, and one is present on each side of the pelvis. It forms the angled crease we have in our groin area. On occasion it can be sprained. In other cases, it can be quite tender although a definite sprain may not have occurred. The lateral femoral cutaneous nerve, femoral nerve, femoral artery, femoral vein, inguinal lymph nodes and genitofemoral nerve all run across this inguinal area.

Round Ligament Pain

The round ligament is a round band of fibromuscular tissue that connects the upper front part of the uterus to the groin. One is present on both the left and right sides. It is part of the several supportive ligaments of the uterus. Normally the cardinal ligaments support the uterine angle, but during pregnancy the round ligaments help maintain this angle. As the round ligaments stretch, they can cause a sharp pain and/or spasm feeling on one or both sides of the lower belly or groin. Rapid movements such as sneezing, coughing or quick exercise can set off the pain. It is often considered a normal sign in pregnancy and is more common in the second trimester. A technique for helping create space for a baby to turn when in the breeched position called the Webster Technique uses relaxation of the round ligaments along with sacral positioning.

Stress Fractures

Stress fractures can occur from repetitive stress to the bone from impact activities such as running. They can also occur from non-impact activities in individuals with osteopenia or osteoporosis.

Hip Arthritis

Osteoarthritis (osteoarthrosis, wear-and-tear, degenerative joint disease) can affect the hip. The joint space of the ball-and-socket area can thin along with having bone spurs. This can be caused by wear over time. However, a previous injury could also be the cause of hip degeneration over time. In a lot of cases, movement and rehab can help keep the hip moving. In severe cases, a hip replacement can be helpful.

Osteitis Pubis

Osteitis pubis is inflammation of the inner pubic bones at the pubic symphysis (cartilage disc between the two pubic bones) and the surrounding muscle insertions. It can be caused by pelvic surgery, pregnancy, trauma or sports injury. The sports that this occurs more often are ones that involve repetitive quick changes of movement such as soccer, rugby and racewalking.

Sacroiliac Joint Dysfunction

Sacroiliac (SI) joint dysfunction can refer pain to the front of the hip and groin even though the problem is in the back. In the absence of hip ball-and-socket pathology, it makes sense to look at the lumbar and SI joint. It has been found that SI joint dysfunction was more likely to cause groin pain than lumbar disc herniation and lumbar spinal stenosis.

Discussion

An evaluation by a licensed healthcare provider that specializes in the hip and pelvis is a good place to start in figuring out the cause of groin and hip pain. Since we are discussing musculoskeletal causes today, an extremity chiropractor, physical therapist and athletic trainer can be good place to start for this type of evaluation. Imaging with x-ray or MRI may be ordered if needed. A diagnosis is developed along with a treatment plan. An orthopedist or other surgical specialist might be needed depending on the severity of the condition. A physiatrist and pain management specialist might also be needed depending on the condition.

Functional hip impingement, hip flexor strain, hip adductor strain, inguinal ligament sprain, round ligament pain and SI joint dysfunction can all be managed with conservative care if they do not have any higher-grade tissue ruptures. They do will with rest, manual therapy, extremity chiropractic, physical therapy and eventual progression of rehab exercises. There are maneuvers that really open up movement of the hip joint as well as maneuvers to help the muscle and other soft tissue. For example, I use the wishbone maneuver by Whyte-Ferguson to aid in mobility of the hip joint and reduce anterior pressure. Mobility exercises progressed to stability and strength can be quite helpful. Eventual progression to full daily and sports activity is usually the goal.

Osteitis pubis often needs rest and removal of activities that irritate it with eventual progression to a rehab program.

FAI can often be managed conservatively, but sometimes needs surgery if the cam or pincer is too progressed and is limiting any recovery.

Suspected stress fractures need rest from impact activity, but often need imaging to confirm their diagnosis; if they are confirmed, they need to be seen by an orthopedist.

Labral tears can be managed conservatively, but need MRI arthrogram to properly visualize them with an orthopedic surgeon consult if found to be present.

Hip arthritis develops over time as is expected with wear-and-tear. Maintaining movement through a mobility and strength program along with some therapy can be helpful. It is possible that a severely arthritic hip might need a hip replacement.

Round ligament pain during pregnancy can be conservatively managed by healthcare providers experienced in therapy with a pregnant patient. There are techniques in prenatal chiropractic such as Webster Technique that can help. Therapy techniques with a physical therapist experienced in pelvic floor and prenatal can be helpful. There are specialties in athletic training and yoga for pregnancy that can be quite useful.

I am always fascinated how front hip pain can occur. It can be simple but difficult to figure out. For example, I have treated intense front hip pain from a patient that hooked one foot behind the leg of their office chair. After several weeks we finally figured out that this position tractioned the front hip at an odd angle which caused the front hip pain. I had a friend that swore they needed hip replacement because their hip was hurting so badly, but it turned out after asking questions that they were sleeping with one hip in frog-legged position. This was the cause of their intense front hip pain. A skateboarder friend who had multiple falls common to the sport turned out to nut just have impact injury and old hematomas but revealed a cam deformity that was the cause of their pain. We were able to manage it conservatively. Earlier on in practice, I was working with a racewalker that was having pubic area pain; I discussed this with a colleague who had worked as an US Olympic Team chiropractor and he gave a suggestion to check for osteitis pubis; I went back and checked, and it was; I have found this with several racewalkers since. Even though athletic pubalgia is more common in males than females, I have seen several cases in gymnasts, soccer players and dancers.

Thank you for your time. We will explore nerve impingements and organic causes of groin and hip pain in future articles.

Dr. Michael K. Van Antwerp

Dr. Michael Van Antwerp is a specialty chiropractor called a Certified Sports Chiropractic Physician (CCSP). There are only ten CCSPs in Oklahoma, and he is the first one in Tulsa. He has trained with the top extremity chiropractic practitioners in the United States and has developed his own specific hip and shoulder treatment protocols. About half of his practice involves working with extremity issues. Besides athletes, he has a full practice treating a wide variety of patients from infants to seniors. He sees patients during pregnancy and treats a variety of pelvis and hip issues.

In addition to his chiropractic degree, he has the additional professions of Certified Strength and Conditioning Specialist (CSCS), Certified Pedorthist (CPed), and Fellow of the American Society of Acupuncture (FASA). He also has a host of certifications including Chiropractic BioPhysics (CBP), Kinesio Tape (CKTP), CrossFit Movement and Mobility, MovNat and Neurokinetic Therapy (NKT).

Dr. Mike became interested in chiropractic through injuries in martial arts. He later transitioned to marathon running and cycling. He is active in yoga and climbing. He works with a variety of coaches and trainers in town.