And the countdown begins…

My opinion of orthopedic surgeons is a matter of record. In a word: arrogant.

So it is with no small measure of surprise that I tell you how unconceited were the three orthopedists I have recently met in my quest towards hip replacement surgery.

In my last post, the first surgeon (Dr. David) admitted that he had no experience doing hip replacement in a “patient like me,” and he referred me to Dr. Bolognesi at Duke.

As often happens when I’m nervous, my anxiety had shifted into overdrive and, by the time I was in the exam room, I worried whether Dr. Bolognesi would recommend revision surgery before a hip replacement could be done. As usual, my anxiety was for naught.

Dr. B. immediately put me at ease.

“Hi, I’m Mike.” [he had me at “Hi”]

Both he and his resident (who had talked to and examined me before Dr. B. arrived) had obviously reviewed my X-rays, MRI and doctor’s notes before entering the exam room. Due to the forward tilt of my pelvis, Dr. B. said I would likely benefit from a new technology to help ensure the new hip joint was placed at the correct angle. He told me about his colleague, Dr. Wellman (great name for a doctor, don’t you think?), who was trained in Boston where the technology originated, and recommended that I confer with him.

Coincidentally, Dr. Wellman had had a cancellation and I was able to get an appointment for the next day [my friend Michele said that’s a sign from the universe, telling me it’s time to finally have this surgery].

Dr. W. proved to be as informed and thorough as Dr. B. Because he practices at Duke, Dr. W. treats some of the most complicated joint replacement cases -- often requiring reconstruction -- but in my case, the challenge is determining the correct angle. Therefore, my hip replacement surgery will require “more planning” than usual, specifically a CT scan beforehand. The results of that test -- entered into a software program – will give Dr. W. the guidance he needs to correctly place my new hip joint.

My parents and I consulted with three different orthopedic surgeons before agreeing to let the third – Dr. Hugo Keim – perform my spondylolisthesis fusion in September 1975. Although high-risk, that surgery was a resounding success.

Thirty-seven years later, I’m hopeful the third surgeon will again be “the charm” in September.

The downside of ‘unique’

Being unique is usually a good thing. Except when an experienced orthopedic surgeon examines your X-ray and admits he’s “never seen that before.”

But that wasn’t the worst news I received during my recent consultation with Dr. David Fajgenbaum.

After examining me and observing my gait he said that, because I have waited so long, the muscles in my hip joint are likely to be so atrophied that I may never walk without a limp – even after extensive physical therapy.

“If it’s as bad as you say, why am I not in more pain?”

“I don’t know.”

Then he recommended I get a bone density test because my bones appeared “thin” in the X-rays. [The results from my bone density test were normal, so maybe he’s wrong about my recovery too!]

Getting back to my X-rays, Dr. David pointed out the two views of my right hip: one of extreme arthritis and the other of a hip out of its socket. And for that reason he did something he does not routinely do – he ordered an MRI.

Although his candor surprised me (and sometimes reduced me to tears), I was ready to let Dr. David perform my hip replacement. I have met my share of arrogant orthopedic surgeons, and he is not among them. Throughout our meeting, he stressed that the decision to have the surgery – and when – is mine. “We treat patients, not X-rays,” he said. “We’ll do the surgery when you say you’re ready.”

The MRI confirmed “markedly advanced degenerative joint disease evident at the right hip with severe joint space narrowing…” among other ominous medical jargon. From the report Dr. David concluded that the discrepancy on my X-rays is likely due to my spinal fusions, which are causing my pelvis to tilt forward. As a result, I could be at a slightly higher risk of dislocation following hip replacement.

“Have you ever done a hip replacement on a scoliosis patient like me?"

“No. So I think you should get a second opinion.”

He recommended Dr. Michael Bolognesi at Duke Medical Center. Based on the volume of spinal surgery at Duke, Dr. David thinks Dr. Bolognesi is “more likely” to have encountered a patient like me. Here’s hoping.

Facing the inevitable

Lately, I feel like my arthritic hip is getting worse, despite my continued commitment to exercise. I am relying more on ibuprofen to take the edge off, and its effectiveness seems to be waning. But it wasn’t until I caught myself envying my mother’s flexibility -- as she stretched her muscles after a morning walk -- that I realized just how far the mighty have fallen.

I long to appear “normal” – a status I am able to achieve as long as I remain stationary. But as soon as I mobilize, my secret is revealed. And I honestly believe it may have cost me a job.

Earlier this year, I was approached by one of my freelance clients to apply for a part-time copywriting job. The hiring manager, Jim, was new to the company, but when my contact there had recommended me and shared samples of my work, he liked what he saw and asked me to come in for an interview. The meeting went well. I was clearly qualified for the position and I thought we struck up a good rapport. He offered to walk me to the door afterwards and, since I am most stiff after being seated for awhile, there was no hiding my limp. In the end, although Jim approached me for the job (after his co-worker recommended me), he hired someone else. Am I being paranoid?

And then there is the kind concern from folks like “Bill” at Home Depot. As Mark and I waited for Bill’s co-worker to track down the deck paint we specified, he considered me with a thoughtful smile.

“Hips, back or knees?”

“Uh, hips and back. I need a new right hip.”

He nodded with understanding. Turns out he had a degenerated disc repaired recently. In addition, his former girlfriend “walked just like" me before her knee replacement. We discussed surgeons and how much better I will feel after I have my hip replaced.

At this point, it is difficult to imagine having two relatively pain-free, strong, flexible hips. And how lovely it will be to actually see the other side of my right calf, the better to shave it!

Although I have recently posted about postponing my hip replacement until other, less invasive options have been exhausted, I’m psyching myself up to face the inevitable. So, in this season of politics, you may call me a flip-flopper. I’m meeting with a hip replacement surgeon next month and will keep you posted.

Once a parent…

We never know the love of a parent till we become parents ourselves.
~ Henry Ward Beecher

Yesterday was my 50th birthday and, as much as I dreaded reaching this milestone, it’s not so bad. In fact, I feel like I’ve crossed over to a whole new perspective: “I’m in my 50s, so I don’t give a damn!”

In the months leading up to the big 5-0, I caught myself thinking about my parents – particularly my mother – and how old she was when I experienced major life events. She was 25 when I was born, 43 when I graduated from high school and 47 when I got married. And she was 38 and 42, respectively, when I underwent spondylolisthesis and scoliosis surgery.

As a parent, I now understand the depth of love and helplessness my parents felt as they watched me live through two surgeries, and several years in body casts and back braces. I remember Mom telling me, “If I could do it for you, I would.” The truth and significance of that declaration were lost on teenage-me, but now that I’m a parent, I get it.

When my son, R (age 10), was crying and refusing to drink the God-awful bowel-cleansing concoction he needed to have before his colonoscopy last summer, I said those very words to him ~ and with every fiber of my being, I meant them.

R was diagnosed with inflammatory bowel disease (officially “indeterminate colitis”), which translates into either Crohn’s disease or ulcerative colitis. At this point, it’s just semantics; treatment is the same for both conditions.

The good news is he was diagnosed early.

The not-so-good news: after less than one year on the least-invasive medication, he is once again symptomatic. I want to make it all go away for him, but I can’t. Just like my parents couldn’t make my spinal issues disappear.

We’re awaiting blood test results and researching other treatment options, including dietary changes and integrative medicine. In the meantime, I would ask for your prayers of healing – for R and all those who suffer from this chronic disease.

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!