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.

That which is left unspoken: infantile scoliosis on the rise

Once upon a time (Winter 2005), I researched the rising number of infantile scoliosis (IS) cases, and whether there was a link between this and “Back to Sleep,” the campaign initiated in the early 1990s to prevent Sudden Infant Death Syndrome (SIDS).

Joe O’Brien, executive director of the National Scoliosis Foundation, had given me anecdotal evidence -- from parents’ inquiries to the NSF -- that the incidence of IS was increasing. A recent email inquiry to him confirmed that is still the case.

Now, as you might imagine, this is an emotionally-charged issue – and rightly so. As a parent, if I had to choose between preventing my baby’s death and sparing her from developing IS, uh, I choose the former and “Back to Sleep” she would go.

And, indeed, my notes indicate I was unable to find a medical authority willing to go on record to confirm a connection between “Back to Sleep” and the incidence of IS. However, (thanks to Joe) I did find Martha Hawes.

A scoliosis patient herself, Hawes wrote a book in 2003: Scoliosis and the Human Spine: A critical review of clinical approaches to the treatment of spinal deformity in the United States, and a proposal for change.

In an excerpt from her book, Hawes notes that research has found a link between plagiocephaly, IS and “Back to Sleep.” She also shows that, before “Back to Sleep,” the U.S.’s infantile scoliosis rate was practically nonexistent, unlike in Europe:

“The same asymmetric forces that cause the postural molding of the head also cause a similar molding of the child's immature plastic torso, resulting in scoliosis. In the past, babies in England traditionally were placed on their backs ('supine position') to sleep, whereas in the U.S. babies are placed face down ('prone'). In his 1985 review McMaster states that ‘in the last decade, there has been an increasing tendency toward the prone position and because of more frequent central heating the infants are less restricted by blankets. Could this account for the decreased incidence of the condition seen in Edinburgh?’ A similar decrease in infantile scoliosis in association with adoption of the prone sleeping position for babies has been reported to occur in Germany (Mau 1981). Thus, Mau (1981) stated that, 'Following the widespread introduction of the prone-lying position for babies in Germany some ten years ago infantile scoliosis has now become a rare entity, so that further studies have been restricted.' McMaster (1985) recommends that in cases of resolving curves, the babies should be 'laid prone when in their cots, and this may encourage a more speedy resolution.'"

Hawes explains that, as Europe’s rate of IS declined, the U.S.’s rate increased following the advent of “Back to Sleep:”

“…In recent years, in correlation with increased awareness of the dangers of the prone sleeping position and increasing compliance with the supine position there has been a reported decrease in SIDS from 153 deaths per 100,000 live births in 1980 to 64 per 100,000 live births in 1998 (Hauck et al. 2002). No one could argue with such positive results. However, if McMaster and Wynne-Davis are right in their speculation about the relationship between the supine position and infantile scoliosis, this new policy can be predicted to reverse the U.S. : European ratio of infantile scoliosis…”

Although some cases of IS resolve without treatment, others have been documented to progress to severe curves of 70+ degrees. Such extreme curves can twist the rib cage and stress internal organs, and this is when scoliosis can become life-threatening.

Hawes concludes:

“The possibility that an epidemic of a lethal childhood disorder is in progress in our country should be explored by all possible methods. If such research reveals that infantile scoliosis incidence has increased since the 'back to sleep' campaign began in the early 1990s, then education and practical strategies to protect babies from SIDS and infantile scoliosis need to be provided to parents immediately.”

A postscript about treatment
Regardless of age of onset, early detection is key to effective scoliosis treatment. And, since fused vertebrae generally stop growing, it is imperative that nonsurgical treatments for IS be explored. Dr. Min Mehta pioneered the use of plaster casting to treat IS, a method that is still being used to great success.

Good news for scoliosis fusion patients

Good news from a recent study of scoliosis spinal fusion patients!

According to this new release from the Hospital for Special Surgery in New York City, a small study of 20 scoliosis fusion patients indicates little to no degeneration 10 years post-op.

New instrumentation is credited with allowing "...the spine to be corrected in a much more natural, physiologic way..." This is one of just a few studies that have examined how scoliosis patients fare years after surgery.

While this report is encouraging, 10 years is not long enough to accurately predict what may happen in the long-term, IMHO. Ten years after my scoliosis surgery (with the now-antiquated Harrington rod), I was doing great, too. It has only been within the past few years (almost 30 years post-op) that I have felt the accumulative affects of degeneration and flatback syndrome. But, hopefully, this is the beginning of a trend to track scoliosis fusion patients as they age.

Search: "Milwaukee Brace"

Although Maria Talks Back is more than two years old, I only recently discovered the “Stats” tab in Blogger that tells me, among other things, what keyword searches lead people to this site.

Interestingly, the keyword phrase most likely to land folks here is “Milwaukee brace.” Similarly, my one and only post on this topic (written on March 17, 2009) has received more than quadruple the page views of any other post!

Clearly, I need to share more about my two and one-half years in the Milwaukee brace. But, in the meantime, perhaps you’ll find pictures of me in the Milwaukee brace of interest (“Milwaukee brace pictures” is the third highest keyword search that directs folks to Maria Talks Back).

You can view these pictures on Maria Talks Back’s Facebook page. And while you’re there, please consider “liking” the fan page. It’s the best way to get notification when a new post goes up. Thanks!