Month: November 2017

I’m scared of this surgery.  I’ve never had surgery before, I’ve never even been in the hospital.  So it feels like a big deal.  And they’re not just removing a little something, they’re chopping off a hefty chunk of bone and replacing it with artificial pieces.  Makes me a little queasy thinking about it.

I’m mostly scared for two reasons.  First, I had a co-worker many years ago, fit and in her early 40s, who went in for a routine knee surgery to fix her ACL.  Two days later, a blood clot went to her heart and she died almost instantly.  So that freaks me out.  Second, I’m very sensitive to drugs in general and hardly ever take anything.  NyQuil once made me hallucinate.  So I’m scared of the effects of the onslaught of anesthesia, pain killers, antibiotics, blood thinners and whatever else I’m going to get.  I’m afraid I’ll be sick or unhinged for some time after.

And then there’s the joint replacement itself.  Will it take?  Will it work?  How will my body integrate it?  Will everything work right afterwards?  Will I be one of those few whose legs are noticeably different lengths?  At a dinner party, a nurse kindly informed me that sometimes the sciatic nerve gets damaged and you can never flex your foot again.  These things are not pleasant, but my functioning is impaired enough now that ending up slightly wonky doesn’t actually worry me too much.

So I’ve been preparing.  I figure the stronger and healthier I am before this trauma, the better.  So I’m exercising more (luckily I can ride a bike without much pain).  I’m faithfully doing the strengthening and releasing exercises my physical therapist has recommended for all the outraged muscles around both hips.  I’m doing gentle and therapeutic yoga to make sure I don’t freeze up, even though my range of motion is limited now and will be worse for a while.  I’m eating healthy and drinking lots of nourishing and anti-inflammatory teas and things.  Turmeric root and ginger root, for example.  Maybe I can even lose a few pounds.

I’m worried about my horses.  For the first week after surgery, my husband is taking off work and will be around to help me and do horse chores.  After that, it gets sketchier, and I have to do what I hate the most: ask friends and neighbors for help.  I don’t know how long before I should be walking around the muddy paddock carrying feed buckets and climbing through fences, but somehow I think it will take more than a week to get there.

I wish I knew better what to expect in that first week or two.  They tell you generally that you have to walk a lot right away, do your PT exercises, ice your leg.  There will be some pain and swelling.  You’ll have drugs to choose from.  You may need a raised toilet seat, maybe a shower chair.  But what will it actually be like for me and for how long?  I live in the mountains and I don’t know that the walker they recommend will go over bumpy dirt roads, so will I be confined to walking around the house for a while?  All I can do is pile up books to read, collect the equipment they recommend, and stack my Netflix watch list.  And wait to find out.

I had an MRI on my left hip at the suggestion of my physical therapist.  I also made an appointment with an orthopedic surgeon specializing in hips.

I got a written report from the MRI people.  Here’s what it said:

• joint effusion with synovitis
• degenerative osteoarthritis
• joint space narrowing and chondromalacia
• subchondral cystic change
• exuberant osteophytosis

OK, then.  I spent a lot of time with the online dictionary and learned that my joint was inflamed, there were cysts forming in the fluid parts of the joint, I had bone spurs forming, and greatly reduced space in the joint.  All of it was “moderately severe.”  At least my bone spurs were feeling exuberant.

My tendons were all intact, so the pain I’d been having was not an injury there, but some part of the arthritis complex.

I pretty much freaked out.  I was hoping for a nice little tear to the labrum fluid sac that could be fixed with a micro-surgery.  Or maybe just some inflammation that would respond to more PT and dietary changes.  This sounded much worse.

After fretting over the list of ugly words, I finally got in to see the orthopedist.  Of course I’d been on Google, so I had a list of treatment possibilities to ask him about.  PRP injections, where my own plasma would be concentrated and injected into the joint.  Arthroscopic surgery to do tiny touch-ups.  A thing called a partial hip replacement, that simply put a smooth metal helmet over the femur.

I’m sure doctors love patients who have been on Google.  I know I love it when my legal clients come in knowing all about the law applicable to their case.  Luckily, he was very patient, and luckily he showed me the X-rays first.

I don’t spend a lot of time looking at X-rays, but my left hip looked awful.  There was no visible space between the femoral head and the hip socket.  Everything looked jagged and chaotic.  He showed me another angle, where a bone spur the size of my fingertip was sticking out.  My questions about non-invasive measures dried up in my mouth as the doctor said there was nothing to do but replace the whole thing.  I believed him.

I asked him why this was happening.  I’m young for this.  I have not been an intense athlete.  I am a medium-sized person of healthy weight.  He showed me around the X-rays a little more, pointing out that my hip sockets are too shallow, and more vertical than they should be.  Hip dysplasia.  It was inevitable, he said.  It may have come a little faster because you’re an active person and have fallen from rollerblades and snowboards and horses.  But it was unpreventable.

I left in a bit of a daze.  I had still been hoping for some minor procedure.  I made an appointment for a second opinion.  Doctor two said the same things and reached the same conclusion.  I had few options but the total hip replacement.

The modern technology on this is called the anterior approach.  The incision is made in the front of your hip and your muscles are just pushed aside, rather than being cut.  This makes healing much faster and less painful.  He showed me the prosthesis — a very neat contraption with a titanium stem that gets inserted into the center of the femur and a ceramic ball on top that sits into a nice smooth cup made of plastic and metal.  They are expected to last upwards of 30 years, although there are some failures sooner than that.  If I’m lucky I’ll get into my 80s doing OK and then deal with what comes next in a new era of medical technology.

I didn’t wait very long before scheduling the surgery.  I couldn’t accept the grave limitations on my life.  And if I did it before the end of the year, it would cost me very little as I’d met my deductible and almost my out-of-pocket maximum.  Once I had absorbed the reality on those X-rays, why wait?

 

About two months ago, I learned that I need a total replacement of my left hip joint.  About one month ago, I scheduled the surgery.  In about one more month, it will happen.

I want to blog about it because I was totally confounded by my symptoms for a very long time and could not find any helpful information.  I also found very little specific information on what to expect with the surgery and the rehabilitation.  If these posts can help anyone else going through this procedure, I’ll be happy.

So how did I know my joint was failing?  I didn’t.  For a few years (a bunch of years if you go back to the very first unidentified twinges), I’ve had mysterious, shifting pain in both my legs and hips.  First on the right, then the left, then both sides, then the left again.  At first it was just now and then, until it slowly (over three years or so) became almost constant.  Sometimes my IT band was cramping, then it was my hip flexor, then an adductor, then the glutes.  I mostly noticed it on occasion when walking and, slowly, it got to be reliable on any walk over 30 minutes or so.

At the same time all this was going on, I noticed strange things happening with my left leg.  I did yoga regularly, and all of a sudden, I couldn’t do certain poses on the left side.  Anything that brought my left knee toward my chest or armpit, or anything that twisted my left knee toward my right hip or shoulder, was suddenly impossible.  And it hurt.  Instead of the expected muscles hurting — those on the outside of my left leg and hip that were being stretched — it was my left adductor on the inner thigh and groin that cried out when I tried to twist in its direction.  The adductor is supposed to relax when the leg moves toward the midline, but mine was screaming.

I also felt awkward and clumsy.  My left leg felt strangely weak and unreliable.  Sometimes it would suddenly give and shoot me a twinge of pain.  Standing up and making my way through a crowded restaurant or down the row in a theater was an ordeal — I didn’t trust myself not to fall into people.

This was all very strange.  I never felt anything resembling a swollen or stiff joint, only very angry, sharply complaining muscles.  So I got massage and acupuncture.  I had private yoga lessons.  I saw a Rolfer and checked with my chiropractor.  No one could explain my bizarre symptoms or why stretching and massaging weren’t helping.

It got bad.  I could no longer walk more than 20 minutes without a lot of pain.  I had pain after yoga class, pain after sweeping the floor.  I still thought I had strangely tight muscles for some unknown reason, but it was impairing my life too much.  And besides, I was healthy and in my early 50s, how could it be anything else?  Finally, a physical therapist I’d consulted said it reminded her of a labrum tear.  The labrum is the fluid cushion in the hip joint, like the meniscus in the knee and the bursa in the shoulder.  She suggested an MRI.

I’ll get into the details in another post, but suffice it to say by the time I had the MRI and took it to an orthopedist, he said I did have a labrum tear but that was the least of my problems.  Many of those confusing symptoms were part of the quickening failure of my joint.

I Googled my symptoms several times and never got anywhere.  If you know to look up hip arthritis you might find something, but if you have no idea what’s going on with you and you just put in hip flexor pain, you’ll get a mess back.  So here is my personal, unscientific list of symptoms that I think signaled the demise of my hip, in the hopes someone could find them and be helped.

• loss of range of motion — your knee will not fold upward or cross-wise like it used to
• instability — you feel wobbly standing on one leg or taking a step on one leg after first standing up
• weakness — one leg is a lot weaker than the other; very obvious when climbing stairs
• pain — unexplained pain and throbbing in any of the muscle areas surrounding the hip joint, like the hip flexors, glutes, piriformis, IT band and quads
• groin pain — sharp or throbbing pain in the inner thigh or adductor muscle, especially up near the groin

Now that I know what’s going on inside, a lot of this makes sense, but it has been both confusing and discouraging for a very long time.