Mrs. Sweeney, ‘Paul’ and Jeannie

A recent visit with my parents reunited me with my lamb’s wool rug.

The rug was given to me by my first nurse, Mrs. Sweeney. She draped it across the foot of my hospital bed to soothe my sore feet after my spondylolisthesis surgery. Mrs. Sweeney’s kind face was there as I emerged from the sleepy web of anesthesia. She offered me minty mouthwash to swish away the cottony-dry after-taste in my mouth, and I will never forget her tender care during those initial, hazy post-op days.

Nursing is like any other occupation. There are those that just put in the hours, and those that go above and beyond the call. Mrs. Sweeney was in the latter category, and so were ‘Paul’ and Jeannie.

After each of my spinal surgeries, Dr. Keim prescribed 24-hour private nursing care. ‘Paul’ was my night nurse during my spondylolisthesis recovery. When we first met, she told me – with her beautiful island accent -- to call her Paul (her husband’s name) because most people could not pronounce her given name. Although I slept through most of Paul’s shift, she was always there when I needed her – encouraging, caring, smiling.

When I graduated to solid food after my scoliosis surgery, Jeannie noticed that I was no fan of hospital cuisine. I don’t like eggs, yet that seemed to be the default breakfast item and it was rare that I would eat more than one or two things from each meal tray.

“So what do you eat for breakfast?” Jeannie asked.

“Toast, with butter and grape jelly.”

“And lunch?”

“Peanut butter and jelly on toast.”

“Toast again…”

Every morning thereafter a plate of buttered toast with grape jelly graced my breakfast tray. And when the lunch menu was not to my liking, Jeannie brought me PB&J on toast. I thought she was requesting these “delicacies” on my behalf from the hospital cafeteria. But I later learned that Jeannie had bought bread, butter, peanut butter and jelly and prepared them for me in the nurses' lounge. And, if that weren’t enough, the night before I was casted, she smuggled two slices of New York pizza in for my dinner.

Mrs. Sweeney, Paul and Jeannie set the nursing bar very high. Now, at night, as my feet snuggle into lamb’s wool, I’m so thankful that they did.

Making the Milwaukee brace

It’s tough being a medical dinosaur.

I will always remember the after-dinner conversation when my brother revealed that scoliosis surgical patients were no longer casted post-op. Less than 10 years had passed since my own surgery in 1978 (I’d worn a body cast for eight months afterward), and I can still recall the feeling of betrayal and envy in response to this news. If only…

Yet, while some things change, others remain remarkably the same.

Recently, I found this video chronicling how the Milwaukee brace is made today. The process bears a striking similarity to how my brace was created more than 35 years ago. One glaring omission “then” was any effort to make the brace visually appealing. Other than that, the process is relatively unchanged.

limping = walking

\ˈlimp\
"to walk lamely; especially : to walk favoring one leg"

During a recent phone conversation with my father-in-law, Bob, he made the brilliant observation that "walk" is an integral part of the definition for "limp."

"So, limping is still walking," he said.

I never thought of it that way! Thanks, Bob!

Hip replacement…can wait

“You walk too fast for a cane.”

That’s what Doug told me during my discharge evaluation following my most recent round of PT sessions.

But he confirmed the cane was set at the appropriate length and showed me, with the aid of a mirror, how walking with it takes the pressure off my right hip.

As he breezed through his discharge checklist, Doug noted that my hip scored three points higher for strength ~ woot! Then he lowered the boom: “Flexibility-wise, you’re in a holding pattern, though. Your arthritis is bone-on-bone, so there’s not much to work with.”

Even though I knew that, hearing it was disheartening.

Every PT session starts with a query to rate my pain level, with “10” being the worst pain imaginable, and “1” being pain-free. I’m consistently at five or six.

Lately, as my curiosity about hip replacement surgery has increased, I’ve been quizzing those “in the know” to learn more.

Doug said I would likely do well recovering from hip replacement because a) I’m young (bless him…then again, the hip replacement patients he treats are in the 70+ club), and b) I already exercise.

“When you’re coming in here with a pain rating of five or six every session, you’ve got to consider your quality of life,” Doug said.

My friend, L, had both hips replaced in the early ‘90s and she’s still doing well – effectively defying the 15- to 20-year rule for prosthesis longevity. We had a good conversation about what to expect and one of the things she said resonated:

“People who hesitate and finally have the surgery often wish they’d done it sooner.”

Hmmmm.

So, after Doug’s encouraging words – and that of L – I was starting to think that the time for my hip replacement surgery – or at least a cortisone shot -- was nigh.

“That would be like jumping from step 1 to step 4,” according to Dr. Kabir, my rheumatologist.

She said that cortisone weakens bones, so it should be used sparingly. In addition, each shot is an opportunity to introduce infection.

Instead, we talked about the in-between steps -- including over-the-counter medication and prescription-strength drugs -- that should be explored before a cortisone shot or two. And then we can get serious about hip replacement.

Currently, I take a couple of ibuprofen “as needed” and find it has a residual effect that can last a few days. So, there’s no reason to rush. In the meantime, I’ll be interviewing some of the hip surgeons Dr. Kabir recommends. Sounds like a plan.

Cane cave

I never thought it would happen, but it did. Today I bought a cane.

More than five years ago, my orthopedist at Barnes-Jewish Hospital in St. Louis mentioned that I would likely need a cane at some point to take pressure off my arthritic right hip.

No way, I thought. Some people might need a cane, but not me. I’ve worked too long and too hard to remain mobile. I will not rely on some stick to get around.

Since then, several doctors have suggested the cane option, and I dismissed each in turn, focusing instead on my daily exercise regimen and the occasional dose of ibuprofen.

This spring, my family visited Washington, DC. As we walked from one site to the next, I tired easily and was always searching for a place to rest. My daughter, J, offered me her arm to lean upon, and I gratefully accepted. But I felt old and – worse -- not able.

When I visited my orthopedist recently, she observed that walking seems to be a “great effort” for me. We talked about a cane and, before I knew it, I was asking her to prescribe one for me.

I have returned to Doug for another round of physical therapy sessions – to treat a muscle spasm in my neck, but also to continue work on my hip and gait.

During my evaluation, Doug noted that I do not bend my right knee when I walk; instead I swing my right leg outward in a half circle – which explains why I keep stubbing my toe and/or cracking my knee on doorways. Now that I’m aware of this, I constantly catch myself and must consciously think to bend that knee as I walk.

Bottom line: I am starting to realize that I’ve been in semi-denial. Exercise is helpful, but it cannot change the fact that there is a hip replacement in my future.

Between now and then, though, there are other options that can bring relief: medication, cortisone and, yes, using a cane.

So, now that fall has arrived, I’m tired of shying away from activities that require a lot of walking. Instead, I will use my new cane as needed to enjoy the State Fair with my family, and accept my friend’s invitation to Raleigh’s downtown ghost walk -- arthritis be damned!

OMG, I'm on 'TV!'

After much ado, my video advocating for exercise and physical therapy to manage joint pain has debuted on WEGOhealth.tv.

Please have a look, "like" it and let me know what you think!

Never say 'never'

If you are a regular Maria Talks Back reader, you know that I prefer exercise over medication to manage my joint pain. But, as Mark recently reminded me, sometimes you just need to take a pill.

I recently returned to Dr. K., my rheumatologist, because -- despite extenstive physical therapy -- the stiffness I experience from inactivity in my right knee was not improving.

"This is a good knee," she told me. I was surprised -- and relieved, since I had convinced myself that I would be needing a knee replacement, as well as a hip replacement, in the not-too-distant future.

So, why is my knee pain so bad?

"It's your hip," she said. Apparently, the muscles extending from the hip, downward, wrap around the knee, bringing the pain along with them.

We talked about meds (again) and (again) I expressed my resistance to prescription-strength NASIDs. Dr. K. offered a compromise: two weeks of ibuprofen, to reduce the inflammation, and another script for physical therapy that will focus on strengthening my quadracep muscles. This will, hopefully, address my knee pain.

I must admit, although I prefer to avoid meds, ibuprofen does wonders for me (God bless, Stewart Adams!). And although I prefer to know how I "really" feel -- without medication -- it's also important to be (and stay) flexible and remain open to other options.