Hip dysplasia and pregnancy.

Diagnosed with Hip Dysplasia

        When I was about 10 months old it was discovered that I had hip dysplasia, also referred to as congenital hip dysplasia or developmental dysplasia of the hip (DDH). Although I had all the usual testings at birth and then at 6 months- somehow the difference in my legs was not caught until my aunt noticed that my legs looked uneven.

     My mother took me to the doctors and x-rays showed that my right hip was not in the correct location. Since my dysplasia was not diagnosed right away it is uncertain if it was congenital (meaning from birth) or developmental. To correct the problem, I was fitted for a brace that was to align the hip in the proper position so that it could develop properly. Unfortunately I ended out having problems with the brace and it did not work as it should have. I had check ups and treatments from that point on but my hip bone never developed properly.

Some general information about Hip Dysplasia

     Hip dysplacia is a broad term that can include issued of the location or formation of the hip bone. The severity ranges from slight to extreme. In babies the joint is actually made of cartilage and is malleable so it can sometimes develops incorrectly. Because of that reason proper swaddling is very important. The exact cause of hip dysplasia is unknown but it is widely believed to be developmental. DDH can develope at time of birth, after birth, or in childhood. According to the International Hip Dysplasia Institute, " approximately 1 out of every 20 full term babies has some hip instability and every 2 or 3 out of evey 1,000 infants will require treatment." At the early stages of dysplasia there is no pain so the baby/ child does not cry or complain about pain which is why it is sometimes overlooked right away, such as in my case. Hip dysplasia prevents the hip from functioning properly and can limit mobility. The joint(s) also wears out faster than normal and often leads to early onset arthritis.

     For more information I highly recommend the website for the International Hip Dysplasia Institute. Growing up I found limited information on my condition and many people did not understand what it meant when I told them I had hip dysplasia. The website above is the most comprehensive site that I have come across and it has a lot of information about infant, child, and adult dysplasia including signs and symptoms, plans of treatment, and patient stories. They even posted a video about proper swaddling in their prevention section, which I have attached here:

My childhood with hip dysplacia continued

     I got a little side tracked but I felt it was important to include some general information about hip dysplasia because many people are not familiar with it. I'm going to get back to a bit more about my condition.

      As I mentioned before, I had treatments from when I was diagnosed as a baby and from that point on I would have orthopedic visits at least once a year. Growing up I became very familiar with the numerous doctor and clinic visits, the repeated questions of when it was diagnosed, how it was treated, the various mobility tests to see if I can bend and move both hips and legs properly, and tons of X-rays. As I grew my right hip bone continued to form incorrectly and I developed a discrepancy in my leg lengths. Actually the length of both of my femurs are the same however the misshaped formation of my hip causes my right femur to sit higher up resulting in my right leg being shorter than the left.

         This is an Xray from 2013. You can see the difference in the hip joints & that the femur starts higher up my right hip (left side of the xray)

     During childhood while I was growing it was suggested that I have surgery that would cut into my left knee (my healthy leg) and scrape some of the cartilage as it grew. If all goes well the cut out cartilage in my left leg would help even out the the difference between my leg lengths. After a second opinion from another doctor my family decided against this idea because if it failed I could end out with problems in both legs.
     The difference in my leg lengths was about an inch and a half at the time. I did have a special lift put into my shoe during junior high, however the technology then was not as good as it is now so I was limited on the type of shoes that I could modify, the lifts were heavy, and sometimes seemed to do more harm that good by wearing me out quicker and throwing off my balance even more when I took off my shoes. Besides no kid wants to have one Frankenstein shoe and one normal shoe that draws attention for being weird or different.
   
     Children find reasons to pick on each other over the most minuet things, so having a limp or strange shoes as I did me insecure. I also got tired quicker and the more active I was the more I limped. Balance issues made me clumsy as well.  Looking back my mobility was not limited too much but I did have some extra challenges.

Other complications resulting from my hip dysplasia
   
     My misshaped hip that caused the discrepancy in the length of my legs caused me to have other issues. My balance was and still is constantly off, which has affected my stability. I was always a clumsy child and I fell down the stairs a number of times. One time I broke my collar bone and knocked a rib out of place by falling down the stairs. The leg difference also makes my spine shift out of balance from which I have back pain. I also dislocated my left knee while playing soccer during high school but it popped back in place. It was not discovered that my knee dislocated until years later, when in my 20s I was again playing soccer and I began having knee pain. Nothing showed on the x rays yet again, but when an MRI was done there was a trail were my knee had popped in and out of place more than once. Since my legs are uneven I distribute the weight unevenly and that alignment is not normal. I can tell in my shoes from the way the sole wears down that more weight is put on the outside edges of my feet and not flat and evenly. This shift in alignment can lead to me mis-stacking my joints and cause extra wear.  That also may be why I dislocated my knee.

     The deformed shape of my hip does limit my flexibility and the degree that I can bend my legs. It's interesting because I have more issues with my left leg and the inability to bend or contort it into certain positions. Perhaps it is because that's my longer leg. I do however get more pain in my right hip. The pain is usually stronger if I am more active; do more walking, bend my hip a certain way, or stay too long in the same positions.
   
     As I have gotten older the pain has gotten worse and spread. I also began having signs of arthritis about a year ago so now I have increased pain on wet and cold days.  As you could imagine I've taken painkillers for a large portion of my life and my tolerance to over the counter pills like Tylenol is very high. I was on prescribed pain killers for some time but I can not stay on them for extended amounts of time because I will develop a tolerance to those as well or I'll become addicted to them. So I needed to find other ways to cope with the pain.

Pain Management of my hip dysplasia

     Being able to find ways to deal with the pain that doesn't involve pooping pills was extremely important to me. Over the years I found a number of things that help ease the pain such as laying on a hard flat surface for an hour or two, hot baths, heat compresses, Amol (Polish herbal rub made with alcohol), limited walking, lots of breaks between and during activities, and changing up between long periods of sitting and standing.  I began doing bikram yoga 4 years ago and I found that it helped with my alignment and balance and eased the pain in my back. Bikram yoga is a series of 26 postures that are done in a room that is heated to 105 degrees and with humidity of 40%. The heat helps get a deeper stretch and I like that it is a very slow paced yoga where you get into a posture and maintain it. For me this is important because I need to modify and adjust postures to make sure I am distributing my weight evenly. The practice has helped with my balance and that has helped minimize pain. The last thing that I found helped ease the pain was weight loss. When I lost some weight and there was less pressure on my joints the frequency and severity of my pain also subsided. I do my best to get by use a combination of these methods to deal with the pain. And when all else fails there are various painkillers to help do the job.

Pregnancy with hip dysplasia

     Pregnancy in itself is difficult between the hormones, body changes, morning sickness, and aches and pains. Hip dysplasia can be difficult for all the reasons I mentioned above. When you combine the two it can be downright torturous. When I became pregnant I not only had to deal with all these new pregnancy symptoms but I've lost my ability to deal with my hip dysplasia.

     Nearly all the methods I used to deal with my hip and back pain are no longer an option. Take for example medication. When you become pregnant many medications are unsafe and you become limited in what you can take. For my hip and back pain it means I am limited to Tylenol. Not just that- I'm limited to no more than 2 tablets every 4-5 hours. Preferably no more than one tablet every 5 hours and no more than 8 tablets in a given day. Before I was pregnant when I had pain I used Tylenol, Alieve, Acetaminophen or any other OTC painkiller that I was popping 5 or 6 pills at a time with up to 12 or 15 pills in a day. This was even approved by my orthopedic and family doctor and that did not always alleviate the pain it just decreased it. Some people might consider taking 15 painkillers in one day on a near daily basis crazy but you have to consider that I've been taking painkillers since childhood so that's not as extreme as it seems. Another reason why this was the norm is because my doctors feel it was better this then to have me on daily doses of percocet or vicodin. The issue with these stronger pain killers is that they should not be taken on a constant basis. Yes people are prescribed these meds but usually for an injury or after surgery during recovery. They are not good for someone such as myself, whose condition will never go away but rather it will gradually get worse. So my limitation of 2 tylenol every 4 hours means that I don't get any relief and I might as well not bother because the small dosage does nothing for me.

     Bikram yoga, another of my methods for coping with pain, is also not allowed. Although yoga, more specifically prenatal yoga, is not restricted but rather encouraged during pregnancy- hot yoga is not. Some doctors and sources list that even hot paths are advised against while pregnant. Some say the heat may be dangerous to the baby or cause miscarriage. More so the issue is not the heat but rather the high risk of becoming dehydrated, dizzy, or lightheaded which can cause you to faint or pass out. There's debate over this because I have also read accounts of woman that did bikram yoga while pregnant and I even had a pregnant student in my yoga class a few years ago. It's not recommended if you are new to hot yoga, but if you have been practicing for sometime there's some controversy if it's really dangerous or not. From my experience, I have been doing hot yoga for 4 years and at my most active state I did it three times weekly. I'm very familiar with it and hoped to continue during pregnancy. That was until the first class I did while pregnant and I struggled thorough the entire class and felt that I might seriously pass out. It wasn't until after that incident that I even looked up if bikram is ok to do while pregnant and when I spoke to my doctor he advised me to stop until after the baby is born. So that's the second thing of my list.

     I quickly found out that I can't do many of the things I used to when I had hip or back pain. Amol has alcohol, more specifically ethanol, in it so it's not allowed. Hot baths, if very hot, are also discouraged for the same reason my hot yoga class was- there is risk of fainting and in a bath tub that can mean drowning. Ok- so that seems very extreme and no I do not think I will drown in my bath tub but I do feel that running the water a little cooler than I normally would might not be a bad idea for the sake of the baby. Even laying down on a hard surface for an hour or two will no longer be an option because at the third trimester doctors advise against pregnant woman lying on their back. The added weight of the baby and uterus presses on the major vein and can restrict blood flow. That leaves me with the option of a heat compress and rest or to constantly change up between lying down and sitting.

     So at this point I covered how I have limited ways to deal with my existing hip and back pain. What's worse, the pregnancy is going to increase my pain and severity as time goes on. In normal pregnancies woman get back and leg pain from the pressure of the baby on their spine. The added weight throws off their balance and it can make walking or standing up difficult. Plus the growing baby means weight gain. All three of those things will intensify my existing problems. I already have hip and back problems and the added pressure just adds to it. My balance is off normally so the baby will make it even harder and increase my chances of falling over. The biggest issue is the weight gain. The added weight adds more strain and work on the joints. All of these have caused my pain to become worse and there is very little I can do about it until the baby is born.

     At this point I am in my second trimester. I am not even half way through my pregnancy and I have had days of extreme pain. I've also missed at least 6 days of work because when the pain is bad it makes sitting at a desk for 8 hours impossible. I would have missed even more days but this winter was extra brutal so my office was closed for a good 5- 6 days because of the weather. Good thing because the cold and wet made my pain worse and had there been work I would have needed to call out all those days as well. For a while I was worried I would lose my job because of all the days I missed. As you can imagine I've been stressed out and it just adds to the frustration.

     I hoped that my orthopedic would have some helpful tips of what I could do. I saw him a few weeks ago but there is nothing he can do for me while I am pregnant. He said that I'm already doing all that I can and he didn't sugar-coat it when he said it will get worse. He said that as the baby grows the extra weight will make the pain and balance issues worse and in extreme cases it can lead to being bedridden especially at the end of pregnancy. His only positive note was that since my hip dysplasia is at the hip and socket and not much in the pelvis I should be able to have a normal delivery. Woman with hip dysplasia that deformed the shape of the pelvic bone often are limited to Cesarean deliveries. Regarding the pain he offered me a prescription for precocets but he knows I wouldn't take them because of the risks to the baby. His only other suggestion was that if the pain becomes too extreme and I can't work perhaps I can work out a deal with my employer to take my maternity leave before the baby rather than after the delivery. That was what some of his other patients had done. Not a realistic plan if you ask me because I know I'll need the maternity leave after to recuperate and to take care of the baby. At this point I realized that I need to take it day by day and manage the best that I can. I am learning to accept that some things are out of my control so rather than worry about them in advance I need to trust that somehow things will work out.

I'll be sure to add updates of how my hip dysplasia affects the rest of my pregnancy and if it affects the delivery at all.