September 13, 2008

• Don't Have a Leg To Stand On Department

   

  "A Leg To Stand On"

  A semi regular "column" by Michael F. Nyiri

  It's worse than I thought.

  Friday at 1:30p.m. my appointment with the latest orthopaedic specialist finally arrived. It's been fully two months since the last specialist gave me the news that he couldn't perform a "hip replacement replacement procedure", and I had to get a referral to the new guy, Dr. Longjohn, who works at the USC Medical Facility in East Los Angeles. Usually my doctors are all in Long Beach, where I work. I called to make the appointment back in early July, but I was kept waiting while Blue Cross of California, my HMO, okayed first the consult, and then the X-Rays, since Dr. Longjohn likes all tests to be performed in his office.

  The appointment was finally set for Friday, and I took off work at around 11:30, grabbed a short lunch, and then drove up to East L.A. Since this is a new doctor, I of course had to fill out the raft of paperwork asking me the same questions about illnesses in my family, and I wrote my address for the umpteenth time, and copied all the information from my insurance card onto the forms, even though the receptionist had already made a copy of the card. You can't do anything without paperwork, lots of paperwork, in the medical atmosphere of the HMO. I waited far less to get into the examining room than last time, and of course I had to take X-rays. The radiologist gave me a small piece of paper with the words "X Rays Completed" and sent me to examining room #29. This is where the wait began.

  Since I don't wear a watch, I don't know what time it is unless there's a clock in the room, which there wasn't. Finally, a doctor appeared. They all seem so young these days. This guy, Dr. Alvidar, was an assistant to Longjohn, and looked to be in his 20s. The medical center is part of the USC Medical campus, so perhaps he was a student. At least he was the first to accurately ascertain the damage to my left hip replacement. The last guy three months ago took one look at the X-ray and told me he couldn't do anything for me. Thus this present consult. When I got the original hip replacement back in 1992 (or was it 93?) I went through four separate doctors before I was given the proper prognosis. Real medicine is nothing like on TV, where complicated procedures seem to last only 47 minutes, the length of the episode. Real medicine is a long drawn out process that sometimes takes years. I'm in a lot of pain right now, and it doesn't seem to be going away. Dr. Alvidar explained to me why, in only about 15 minutes, after looking at my X-rays on a handy computer screen in the examining room. I hadn't even seen the "real doctor" yet. My hip replacement not only has a "loose screw", of which I have been joking now since I got the first set of X-rays in June. The rotator cup has been displaced, and my whole upper thigh is in danger of "dislocating". That means the replacement might just pop out of the socket. I have to walk on this leg, so my understanding of the problems I'm going through got real serious real quick. This is no joke.

  After the mini consult with Alvidar, I had to wait another half hour or so until Dr. Longjohn showed up. He looked at the X-rays and pretty much agreed with Alvidar. I would need to have at least the upper part of my hip replacement replaced. I had to smile when Longjohn looked at the X-ray of my 15 year old prosthesis and proclaimed, "That looks like the Zimmerman Z45." (I do think he called the manufacturer Zimmerman, but the model number I'm making up.) It's like when I look into a customer's control panel at work and start identifying components. Hopefully, the bottom part of the prosthesis, which is connected to my thigh bone, will not have to be replaced. I have to go back to my general practitioner and get information regarding the original operation, including X-rays, if they still exist, of the leg and hip before the original operation, and X-rays taken after the operation was performed. I will have to take some blood tests, and get a full CAT scan of my hip region, which will allow the doctor to see a model of the area. He said they might even make a physical 3D model from the computer images. Longjohn doesn't want to go inside my leg more than once, so there will be lots of tests I will have to take. Because of my HMO, everything has to be notated and okayed. I thought I was going to have blood tests yesterday, but even these have to be approved by the HMO.

  Longjohn asked me how active I was. I told him I'm pretty active. Heck, last week I was standing on a ladder placing shelf paper in my kitchen cabinets. A few weeks ago I was lugging heavy pieces of furniture out to my garage. I did stop my daily power walks after the last doctor told me this was a bad idea, but I admit to having hiked into the Hollywood hills at least once after seeing the last doctor. Since I'm still pretty active, the doctor said he feels I should have as much replaced as possible, so that I'll be good as new when the healing is finished.

  "I should probably be using my cane more often", I remarked.

  "You should be on crutches", Dr. Longjohn said matter of factly.

  This is when I knew that my condition is a mite more serious than even I had imagined. I've been using the cane as much as possible, but not around the house, and I sometimes forget to use it when my hip doesn't hurt so much. If it weren't for my HMO, I would have been given the crutches right there at the medical center. However, I have to have them issued by my regular doctor at Harriman Jones. Since it's the weekend, I won't be going back there, in Long Beach, where I work, till Monday. I'm lucky that after returning home and telling my roommate about all this, he told me he had a friend whose sister had used crutches recently after a fall, and she is now completely cured, so Mike gave me the gal's crutches to use in the interim. They seem to fit pretty good, although I will be going in to my doctor on Monday anyway, and I'm not going to go out to the L.A..County Fair this weekend as I'd planned.

  I was running out of pain pills, so the doctor jotted a prescription for some more Tylenol Codeine with three refills. Prescription medicine in the HMO age always fascinates me. My prescription copayment is $10.00. Last time, my regular doctor gave me a scrip for 45 pills with two refills. Dr. Longjohn gave me a scrip for 60 pills with three refills. So I'm getting 15 more pills for my ten bucks!

  I finally got out of the doctor's office at 4:00p.m. I'd been there for 2-1/2 hours. I wanted to go into Santa Monica to see a movie that night but after driving home from East L.A. along with all the other commuters on Friday evening, I didn't feel like driving again at all.

  I opted to stay home this weekend.I've got crutches and a cane now, strategically placed around my house. I now have to wait for Blue Cross to approve the tests, and of course this could take some time. Also, Dr. Longjohn recently acquired a bunch of patients from a fellow doctor, so he's a bit overloaded. I was lucky to be able to see him in September. The next appointment available was in late October.

  So for a while, I'll be sort of immobile, which is quite different for me. I do have my twin Lazyboy recliners, one in each room in which I hang out. I'll try to stay comfortable, and be more careful, and not pop my leg out of it's socket. The deterioration could have been caused by simple aging of the prosthesis, or perhaps infection and inflammation has begun to wear away the plastic parts of the prosthesis. We don't know yet, and will have to wait for the tests.

  The bottom line is that I will definitely have to go in for at least one surgery, possibly two. I'm not looking forward to this at all, and even though I'm always grousing about money, when my health is involved, I will do what I have to do to make myself right, no matter what the cost. (Which hopefully will be only my $1500.00 deductable from my HMO. The procedure in 1992 cost me only $500.00, which I considered a bargain back then.) This could last into next year, but I'm not worrying too much. As I've often written here in this blog, it's always the little things that seem to upset me, and I've got a short fuse, but major problems just seem to wash off my nerve damaged back. I've lived with pain all my life, so I'm used to it. My stride may be hampered by a pair of crutches, but believe me, within a few days I'm sure I'll be moving along with at least the same or similar velocity as usual.

  I'll just have to take this "in stride". I'll be writing updates as they happen.

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  This is one of an ongoing series of entries dealing with my hip replacement replacement operation. For a look at the history of "My Left Hip", including the story of the first operation and other entries in the series, all have been tagged with the word "HIP" and can be accessed by that page.  In the X-ray photo detailed above, the solid red area is the rotator cup, which is part of the prosthesis. The red line to the left is where it should line up. I didn't notice this when the first orthopaedic surgeon looked at the earlier X-rays. My thigh is attached to the hip with three screws, and one is completely loose, meaning that the other two screws are now overloaded.

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