November 19, 2008

• My Left Hip: A Wayback Post

  The essay below is a Wayback Post from Aug. 8th, 2005. It originally received 26 comments, and was linked from allthingsmike for three years. Since the hip replacement described in this essay recently "broke" and I'm facing another one of these operations, I thought it would be fun to post my observations on the original again. Bear in mind that this essay is three years old. I describe the pain I was still having not knowing that in fact my prosthesis might have had a screw loose back then! MFN/ppf 11/19/18

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  I used to love to dance. My mother taught me how to clog at about six or seven. In elementary school, the PTA held box socials and square dances. There were Friday night ballroom dancing classes and regular dances in junior high. I could jump, twirl, splitz, trot, waltz, and even knew some ballet. At times I could get out on a dance floor and command exclusive attention.

  I have always walked real fast. I like to walk "ahead of the crowd" so developed a strong, quick gait. Even though I am of average height, I have always been able to outpace much taller men. In school I could run pretty fast, and broke a record for the 660 yard dash when a junior in high school.

  I knew that at some time I might develop arthritis, which would have crippled my father, except that he always kept active, making sure he was a few steps ahead of his disease. Throughout my early life, I was always pretty healthy, and because of my parent's ill health, and reliance on doctors, I stayed away from hospitals and clinics for most of my twenties and thirties.
  I still don't know when my left leg started to give out on me. The instance I remember the most was one afternoon while I was in my twenties in the garden department of the retail establishment in which I worked, where I walked really fast into a stack of a couple of pallets, and caught my left foot in between the slats of the top pallet, causing me to trip and fall. My leg hurt terribly after this mishap, and I can clearly remember that I had trouble walking after the incident. Being young, I dismissed the pain, expecting it to pass. Being stubborn, I refused to believe anything could possibly be wrong. Later in the week, I pitched forward when walking from one end of the store to the other. My leg just "gave out" on me. I stepped down on my left leg, it didn't hold my weight, and I found myself sprawled out among the dry goods section. I got back up the best I could, and limped bravely on.

  As the years passed, my limp got to be more pronounced, and I was constantly in pain. Still feeling that doctors could be bypassed, I never went to have the pain in my leg checked. I suffered and adapted. I danced a little less, and walked a little slower.

  Pain was everywhere when I was growing up, and finally my parents' early deaths quickly interrupted the evidence of pain. As my leg continued to hurt, and as I would frequently suffer falls because of the leg, I began to become aquainted with pain myself. I had always said I grew up in "a house of pain" and it seemed I had never really exited that house, even after many years without my parents.

  Suffering and perserverence became my twin mantras. I rarely mentioned my limp, the pain, or the feeling of unbearable fright that someday I might lose all feeling in the leg and be forced to sit in a wheelchair for the rest of my life. I was young, and felt young, even though the pain oozed into my reality with each and every sunrise. There were many pursuits to which I clinged that helped alleviate and quell my ever throbbing pain. I relegated the physical strife to poetic odes to suffering. I would suffer for art, I surmised. Besides, it didn't hurt all the time. Some days were better than others. In time I accepted this quirk of my physical being, same as I accepted my poor eyesight, and crooked teeth. Those conditions were "corrected" however, and on the cusp of turning forty years old, I finally began to think that perhaps I should correct the condition that had caused my leg to hurt so much for over a decade and would sometimes cause me to fall over.

  At the age of forty, I made a pact with then girlfriend Pat to "straighten up" my life. In anticipation of a life in tandem with another person, I had some personal issues to get in order. Probably the most important of these issues was my lack of a driver's license. When my license was revoked because of a drinking problem, I shied away from driving for a bit, but eventually bought a motorcycle and hit the road, sans the little laminated piece of regulation that legally granted me the provision to do so. Feeling somewhat invincible, and without any seeming responsibilities to anyone, I barely needed to be "legal". With Pat's urging, I received the proper documentation, and even paid insurance to legally drive a car in the state. I never paid off my student loan from college, and subsequently my credit history was in deplorable shape. I got in contact with the holder of the loan, and arranged a payment schedule. My third and biggest problem was my leg, and Pat and I had many conversations in which I told her everything would be all right, and I didn't want to start going to doctors.

  One Christmas season while visiting in Florida with Pat's father, walking around Busch Gardens, as I visibly couldn't get more than a couple of steps without grimacing,  I was asked bluntly by her old man, who was paralyzed and rode in a wheelchair, why I didn't at least find out what was the matter with my leg. This old man hadn't been able to walk for over 30 years, and his look of stymied incomprehension that I didn't see a doctor concerning this is probably the single most jarring instance that got me contemplating asking my doctor about the pain in my left leg.

  I worked for a small electrical parts distributorship, with only very few employees, but we had the Blue Cross health plan, and I had begun taking physicals at the age of 40, partially inspired by my relationship with Pat. My dad had heart problems, and high blood pressure, along with his arthritis. It made sense that since I was straightening myself up legally and financially, that I would look after my health in the bargain. I finally decided to ask my doctor to check out my leg when my fingers started to hurt sporadically. I figured I had developed arthritis, my father's demon being visited upon the son, and if I needed to live with a medicine cabinet full of pills, I might as well start and get it over with.

  While sitting in the waiting room on the third floor of the clinic for my appointment with my doctor, I contemplated the many waiting rooms I'd occupied when a child as my parents visited their many physicians. My doctor was Dr. Mackenzie, a short bald energetic guy who probably only "knew" me from my chart, but always feigned recognition when I saw him anyway, and I've always felt he at least is "my doctor" even though the clinic is part of my HMO. "What brings you to see me today, Mr. Nyiri." "Doc, it's the pain in my leg." Almost seems like a line in a vaudeville joke. I didn't know then that uttering this simple phrase would be the cause of having to see two more specialists, take MRIs and X-rays, and still not know what was causing the pain in my left leg. "What seems to be the matter?" "Well, my upper left leg hurts all the time, I limp terribly, and sometimes I tend to fall over when the leg gives out completely. Sometimes it hurts so bad I can't walk." The doctor asked more innocuous questions. "Have you ever been in an automobile accident or fallen out of a plane?" "Did you have trauma on the leg during birth?" Questions I could easily answer. Yes, no, and no, not that I could remember. My birth was a while ago. As is usual with situations which really need to involve some as yet unknown specialist, my doctor was of no help. I left the appointment in as much pain as when I came in. I did have a prescription for pain pills. Doctors know how to write scrips for pain pills in their sleep.

  I figured I had arthritis. I was sent to a rheumatoligist, who specializes in crippling diseases. After a series of tests, and two more months of doctor visits, it was determined that I did not in fact have arthritis. I received the news via one of those impersonal telephone messages: "Beep. This is the automated attendant for Dr. Bentbone's office. Beep. The results of your "arthritis" tests have come back negative." That's nice. Of course I still  had the pain in my leg, and by now I was getting a bit irked that nobody could tell me why it was there.

  I spent half a year finding out nothing more than I knew the six months previous to that. My pain was seeming to increase the more doctors I would see. I was set up to receive an MRI treatment, which reminded me of something out of Star Trek. Back with Dr. Mackenzie, we conversed about the many ways my leg could have been "mutated" and this was the first time I had heard what exactly was wrong. The X-Rays showed that my left hip "ball" was not in it's "socket" at all. It had separated some long time ago, at the time of some unknown "trauma", like falling out of a plane. Around the ball, calcium deposits had formed. At times, the blood flow to my left leg was impeded, and this caused me to fall over. The pain was caused by the rubbing of the calcium encrusted ball against but not totally inside the socket. No wonder I limped. From the pictures, I'm surprised I could walk.

  I had been in several automobile accidents, but had walked away from them all, and without a limp. The first time I remember pain was at work, and I think it just aggravated itself until it got completely unbearable. The final specialist I had to see was an orthopedic surgeon. When the hip cannot be cured, it has to be replaced. Nobody could tell how my leg and hip had gotten so bad, but everyone was agreed that it was pretty bad. There is no way to treat the damage, so the surgeon was to ascertain whether or not I could benefit from a total hip replacement. A bionic leg, in other words, constructed of shiny titanium, and bolted to another piece of metal attached to what remained of my hip after the doctors had cut away all the calcium.

  This bit of news served to excite and repel me equally. I certainly wanted the pain to go away, but had never had major surgery up till then, unless I counted my many oral surgeries following my auto wreck at 14 (where I broke my jaw, and not my leg.) The prospect of experiencing major surgery was weighed heavily with the kind of operation they were going to perform. My orthopedic surgeon was an Asian woman who had suffered from polio as a child, and walked with the aid of crutches. This seemed rather serendipitous somehow. She was supposed to be one of the top 20 or so orthopedic surgeons in the country. She "told it like it is" and said that because of the advanced rate of mutation of my hip, the only way they could cure my pain was to replace the hip. I was shown bright over detailed doctor's office charts showing the "proceedure" which lasted only a couple of hours while they sawed my bones and screwed in the "appliance". The main concerns with the operation were not with the operation itself, which was "cut and dried', so to speak, but the recovery and physical rehabilitation program, which differed with each patient. I made the decision quickly. I'd spent much too much time in doctor's offices throughout my life, and this seemed to be the "answer" to the question of what to do about my left leg. The operation was scheduled for a couple of months away. I had to make sure employment compensation was initiated for the two or three months post surgery when I would be in physical therapy and unable to go to work. I'm glad I lived with Pat at the time, because I would be physically unable to walk by myself for a few weeks following the operation, without a "walker" and maybe some additional help.

  The picture painted for me was that in three to five months after the operation, my leg would be "good as new" and actually better, and shinier. I was to be one of the youngest people to receive this surgery, usually performed on septugenarians and octagenarians. My doctor openly mused about how long a life the prosthesis had in the body since most of the recipients had died within ten or so years from their operation. This bit of news excited and scared me too. Was I just another guinea pig for science. I considered that doctors misdiagnosed my mother, who knew something was terribly wrong the day before she had her stroke. I didn't trust doctors after that especially, and now I would put my life and left limb into their white gloved and seemingly capable hands, after going through three of them before coming up with a solution as to how to deal with my pain. (If thy left leg offend thee, cut it off.)

  A Friday in September was marked on my calendar, and I prepared my panel builders and lead man at work for a month or two without my immediate direction. Pat grew visibly more agitated as the date neared. She had made me get rid of my motorcycle because her brother had died on one, and now I was going in for surgery related to being able to walk, and her father was a partially paralyzed cripple. She was in fear of seeing me "incapacitated" and needy. I felt her fear.

  At 5am on the morning of the scheduled surgery, I was lying on my back on one of those ubiquitous hospital gurneys in a hall full of dozens of pre-op patients waiting in the queue on their backs for a doctor. I said my "goodbyes" to Pat and they wheeled me in to the pre-op waiting area from the hall. Orderlies were scuttling gurneys everywhere. Each "window" could only be open so long for some types of surgery, and although I'm sure the powers running the hospital knew exactly what they were doing, the scene was chaotic at best, and was not the kind of scene I wanted to have on my mind as I passed out from whatever drug the anesthesiast supplied. My total view was of the ceiling, a certain deja vu concerning my earlier auto wreck and the subsequent wait in hospital hallways flat on my back came back from memory as I watched the ceiling tiles pass overhead. Flourescent tubes became the arrowheads for admission into the actual operating room, which I never saw. In the pre-op room I visited with my general physician, Dr. Mackenzie, who of course wasn't performing the surgery but was there for moral support, and then got knocked out with joy juice. My next memory was the intense pain in my leg following the surgery.

  Modern medicine supplies the patient in pain with a morphine delivery system designed to dispense just the right amount of the hallucinogenic drug before cutting off, and there is a timer, so the patient, who is 'self dosing' himself, doesn't overdose in the pursuit of eradicating his pain. I can tell you unequivocably, when one has his hip replaced it hurts really really bad when you first wake up. The attending nurse explained the machine which dispensed the momentary painkilling drug of choice. I didn't really have time to ascertain the benefits of the inducing high caused by the morphine, because I would wake, push the delivery button a few times, and then fall back asleep. Each time I would awake, through what was most of the day, and into the next night and morning, there would be a different nurse on duty, and I would be in a different room, each with it's ubiquitous morphine dispensing machine, which became like an old friend.

  About the fourth or fifth time I woke from my drug induced slumber, I was able to get my bearings somewhat. I had been flat on my back for about two complete days, and there was a catheter stuck way up inside me through the little hole in the tip of my penis. This obliterated the need to know when you had to piss, and was real annoying. My left leg was enclosed in some sinister looking apparatus which kept it from moving. There were tubes stuck in my leg and in my arm. I was either exceedingly comfortably numb, or reeling from some throbbing pain from where the nearly three inch screws were sticking into my hip bone. What was left of it anyway. Sometimes I would awake, and Pat would be sitting in the visitors chair, then I would close my eyes, open them and she would be gone. New nurses came and went.

  I didn't eat at first, which as as weird as not pissing. The physical act of ingesting, digesting, and defecating are instinctual acts which tell of our animal status, and without them, I did feel exceedingly needy. I didn't know what was going on with my own body, and this was epiphanical. I asked one of the millions of nurses who appeared at my bedside when I could go to the bathroom  and  eat again. When I was well enough to use the walker. I stared in disbelief and awe as the nurse pulled the catheter for what seemed like forever from me. I made an immediate attempt to use a walker and get to the restroom, and the trip across five feet of hospital linoleum was a resounding success. I could piss again. For a moment, I was on top of the world. And then I had to go back to my hospital bed.

  I only stayed in the hospital for four days. I walked earlier than most patients with the same surgery (possibly because I was about 20 years younger) , and made more trips down the hall with the walker, elated to be ambulating again. The pain subsided a bit. I was given dozens of instructions what to do and more importantly what not to do. I couldn't cross my legs, or else the prosthesis could pop out of the socket. I couldn't put undue stress on the leg yet. It needed physical therapy to help builld up the muscles, which had been sheared clean when the doctor needed to get to the area surrounding the old thighbone and the new shinier one. With the muscle buildup, my leg would eventually get strionger. I didn't have any glue cementing my prosthesis to my bone either. Since I was young, the doctor decided to let the bone heal itself around the metal replacement. This would mean I had to be extra careful in the first month or so that I didn't cause any harm to the joints.

  I almost had to be "loaded" into the back seat of Pat's car to get home. I spent the next three months holed up mainly on the couch in the living room, with my walker by my side, and my remote controls laid out neatly on the coffee table in front of me. Getting to the kitchen or going to the bathroom is a considerable chore when one of the limbs one uses to get around is "healing" and isn't strong enough to support one's weight. When I was able, I even drove to work and spent some time in front of my computer. I couldn't build any panels but I could do clerical and design work. Besides, after a few weeks doing nothing except reading and watching television, I was itching for a change of scenery. My physical therapy was finished quicker than most in this situation and I surprised my doctor in the check ups following the operation with the healing process of my leg. In a few short months, I didn't limp again, and felt none of the pain with which I had associated with my leg for many years. Because I had such a highly developed limp, I actually had to learn to walk all over again, with help from the physical therapist the HMO sent to my house in the few weeks after the operation.

  While I was recuperating, Pat goaded me to get one of those handicapped license plates, so we could park up front when we went to the horse track on our regular Friday and Saturday night "dates". By the time the plates had expired, so had my dependence on the walker, and we eventually used it as a "planter" holding one of Pat's hanging plants. In time, I found that I could predict the weather with my leg, which still throbs when hot turns to cold in the air or vice versa. I'm really good at knowing when it's going to rain. My relationship with Pat ended about a year after the operation, and she never did get over the fact that I was "incapacitated" for a while. I am glad I had her support and help during the difficult time after the operation.

  It's now ten years later, and my hip still seems to be in good condition. I go in from time to time and visit with the orthopedic surgeon who performed the operation to make sure that the "screws are still tight." During the recovery process I remember her chief concern was that both my legs were the same length. Due to concern about my cholesterol levels, I began to exercise regularly about two years ago. Each morning, I "take my walk" around our business park at work. I circle the park three complete times at a somewhat rapid clip.

  This exercising has helped to stop subsequent pain which sometimes occurs even with the hip replacement. Sometimes before I started my walks, I could feel familiar leg and hip pain increasing, but with regular exercise, the pain is much less. If I sit down in one place for an extended period of time or walk around all day, then I am apt to hurt when I start walking. I keep a cane in the car in case pain returns prohibiting me from being able to support myself. My doctors tell me this is normal and not to worry. I will never be completely free from pain.

  But most of the time the pain disappears completely, and I feel no different from someone who has a real hip. Sometimes the pain can come and go repeatedly. When it's gone, I can dance again. And it always feels good to dance.

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  The images of the hip replacement used in this article were taken from the web after performing an image search for "hip replacement". The "doctor's chart" was modified to remove the "sample" watermarks since it was a poster for sale on the internet. All the images can be clicked to bring up the full size. 
   

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