Now + Then = Total Hip Replacement

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Total hip replacement…that is a surgical option no 30 something should ever have to hear. Unfortunately for me, I’m not a typical 30 something. After consulting with my pain management doctor, rheumatologist, hip surgeon, and 2nd type of hip surgeon, I will be having my right hip replaced on October 23rd at 11:30am.  I guess I should say thank you hip dysplasia and arthritis at this point, I guess.

For those of you that don’t know, hip dysplasia is “the abnormal formation of the hip joint in which the ball at the top of the thighbone (the femoral head) is not stable within the socket (the acetabulum). The ligaments of the hip joint may also be loose and stretched” (http://www.medterms.com/script/main/art.asp?articlekey=14426, 2014).  In my case, my “abnormal formation” is a large flat spot on the femoral head, which I was born with. This flat spot has lead to the progressive wearing away of the cartridge in the joint, osteoarthritis. To make it simple, it hurts like hell to sit for any extended period of time and exercise causes my right hip to feel like its locked in place for awhile. Not fun.

I was first made aware of my hip condition while sitting in recovery after my neck surgery. Turns out that the pain in my neck was masking the pain in my left hip. My rheumatologist at the time, Dr. Eckland, tried steroid injections which brought me little to no relief. However, he was able to get me into a research study where patients were given synvisc injections (synvisc is traditionally only used in knees). These synvisc injections provided almost 2 years of relief before I needed surgery.

Since I was a young 30 something at this time, my surgeon Dr. Menzner (who will be doing my right hip replacement surgery next month) was not thrilled with the idea of replacing my left hip for obvious reasons, to young! Dr. Menzner referred me to a surgeon in Salt Lake City Utah (Dr. Peters) who had developed a procedure where he dislocates the hip joint in order to gain access to the femoral head in order to basically sand out the flat area and make it round again. If this was not a possibility, Dr. Peters was also the only the surgeon who Dr. Menzner knew of at the time performing hip resurfacing surgery which was considered a safer, and less evasive surgery than total hip replacement for young people like myself.

At this point, I want to admit that I know that I’m incredibly lucky to have access to a supportive family with enough money and resources that made traveling to another state for a relatively “new” surgical procedure a possibility. To many in our country do not have the same access to healthcare as I do for which I’m both grateful and sad. No individual should have to rely on luck in order to receive care or have access to be better quality of life. With that said, if you do have the necessary resources to travel for healthcare access, please do not be afraid to do it. Not having immediate access to your doctor is difficult, but when the surgery is successful the difficulty becomes worth it.

O.K., back to my story. While in Salt Lake City, Dr. Peters alerted me to the fact that my right hip showed the same flat spot as my left hip and offered to perform the same surgery on it. At that time I was experiencing no pain in my right hip so having surgery on it at that point did not seem like a good idea. Just fix the left hip and get me back to Boise was my plan of attack.

While under, Dr. Peters discovered that the arthritis in my left hip was too much and performed the resurfacing surgery. The surgery went great. I had checked in for surgery on a Monday and was released from the University of Utah hospital on a Wednesday. On that Thursday we loaded up my Chevy Blazer and drove back to Boise. I flew down to Salt Lake a couple of more times for a couple of check ups and that was that. It was now time to concentrate on my left knee surgery, then right knee surgery, and then left shoulder surgery.

Fast forward to about 3 years ago. I started to notice more and more pain in my right groan area, which is exactly how my left hip pain started. It would generally last up to a few days then go away for sometimes weeks at a time. Sometimes the pain in my neck or the pain from my headaches would mask it. At this time I was still in physical therapy which provided relief during particularly bad flares. As any chronic pain patient knows, I was coping.

At the beginning of 2014, my pain levels jumped in my right hip. I started to lobby my pain management doctor for synvisc injections since I had such positive results with them versus the steroid injections in my left hip. My pain management doctor didn’t think my insurance would approve synvisc at this time but recommended steroid injections. However, I was having injections and nerve burns in my lower back for a bulging disk/pinched nerves in May and had maxed out on allowable steroid injections for the year. My year clock went back to 0 in September at which point I could try the steroid injections in my right hip.

Although my quality of life was declining in May because of the hip pain, I was still able to manage pretty good with my anti-inflammatory and hydrocodone pills. Towards the end of June I had a visit with my rheumatologist who took some blood in order to keep tabs on my liver. Turns out my liver was quite angry so my rheumatologist wanted me to only use my anti-inflammatory and hydrocodone pills during the worse of the worse of pain flares. This was the first time my liver panels had been this bad which was kind of scary.

It was roughly 36 hours after reducing my anti-inflammatory intake to when I called Dr. Menzner for an appointment regarding my right hip pain. Although the pills were damaging my liver they were masking the hip pain quite nicely. Based just on my right hip x-ray results, Dr. Menzner ordered an MRI under contrast. If he was going to replace my right hip he wanted to make sure there was enough damage to justify such a radical surgery because of my age. I was still to young, in his mind, to immediately jump to the operating room he thought.

Dr. Menzner works at a clinic called St. Luke’s Boise Orthopedic Clinic (BOC). BOC has just hired a new surgeon (Dr. Johnson) who performs the same sanding operation that had I been sent to Dr. Peters in Salt Lake City for almost 10 years earlier. The logic was I should explore any and all other options before jumping into replacement surgery. I wasn’t happy with this because I was tired of consolations, I wanted something done now for the pain but I do appreciate Dr. Menzner’s desire to expose me to other options.

Dr. Johnson was extremely nice, friendly, and I would say incredibly patient centered. He listened to me without interrupting, asked about my quality of life and future goals, and then frankly told me that he thought his procedure would not help with my pain issues because of the severity of the arthritis in my hip. His procedure would help with the hip dysplasia, just not with the arthritis issues. I was very appreciative of his honesty because that made the hip replacement surgery decision that much easier.

Now that my hip surgery is a go and has been scheduled I’ve been asked multiple times if I’m scared. I can honestly say that I’m not. In fact, I’m looking forward to this surgery.  I’m much to young to have to come home after an 8-hour workday and crash on my couch with my Direct TV because the pain has completely stolen all my energy. I’m much to young to have coworkers that are 20 plus years older than me asked if I need a cane because I’m limping so much. I’m much to young to have the pain steal my desire to ski, workout, socialize, or generally still be a big kid.

As a quote “epatient” my hope by telling my story is that someone else going through a similar situation can gain some confidence and education from my experiences while they go through their own medical journey. Part of being an epatient is making myself publically vulnerable to others so they can know that they are not alone and can ask for support if need. With that said, I will need help and support as I go through with this operation.

My ultimate goal is to be back on my skis by January. I don’t care if its just skiing on an intermediate groomed run instead of some ski instructor approved off trail powder shot, I just want to be skiing by then. I’m looking forward to physical therapy because that will be the determining factor in which run I ski on in January. From experience I do know that any surgery is tiring and very draining which means I’m going to need emotional support. This is just apart of surgery and healing process that does not get talked about enough. Surgery is very much a team effort, not individual.

Finally, I would like to leave all patients with 2 pieces of advice that have helped me. First, as my first physical therapist after my rock-climbing fall told me, “I’m lots of hurt which means I’ve earned the right to have bad days.” A total hip replacement is a serious surgery which will require a tremendous amount of work to recover from. I’m going to have bad days during my recovery, but I’ve earned the right to have them. This does not mean that the surgery wasn’t a success or that I should not have had it. It simply means it’s just a bad day for which I’ve earned the right to have.

My second piece of advice comes from Julie at www.itsjustabadday.com. Needing a procedure like a total hip replacement does not mean I have a bad life, it’s just a bad day. Despite my multiple arthritis issues and surgeries, I’ve earned a second degree in Accounting, earned the title of Stanford University E-Patient Scholar TWICE now, bought a house, still ski, still road bike on occasions, traveled, work full-time, have ate at one of the country’s best steak houses per Anthony Bourdain, and continue to meet incredible people like Julie, Britt, or Little Wurmie (also known as Joanne). Make no mistake, I’m not done exploring life either. I’ve had my fair share of bad days, but it hasn’t been a bad life!

 

Me Skiing

 

P.S. On second thought, skiing on Christmas sounds better 🙂


Comments

Ski By January Despite Hip Replacement…Christmas Sounds Better! — 4 Comments

  1. Hey Alan
    I’m glad you’ve got your surgery date. I wish you nothing but luck.

    I’m interested in your liver issues. I,too, have issues with my liver. My liver test are always high and I’ve had 6 liver biopsies. I can thank inflammation for the problems. Do you know how your liver problems started? Have your liver problems affected your life? I no longer drink alcohol because of the inflammation and taking MTX with Humira.

    Take care and I enjoyed reading a little about you. Would like to talk to you more about MedX.

    Joe

  2. So much of your post resonated with me. People say we’re much to young to have replacements, but we’re much too young to be living 80 year old lives! I know your surgery will be a success because you won’t accept anything less!!!

  3. This is my first experience with bad liver tests. As of right now I’m being told its fatty liver disease, non alcoholic related.

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