Wednesday, May 1, 2019

Forget being hip; you can't even count on a pair that work

     The world is not only getting warmer, it's getting older, too; the planet, plus the thin, scattered organic layer of humans upon it. For the first time in history, more people are over age 65 than under 5.
     Don't blame me. I'm only 58. But I see what's inching closer to me — or rather, I'm plodding closer to it, rolling as I go from osteoarthritis in my right hip. I learned about it five years ago when I banged up my knee skiing in Colorado — a good, youthful ailment! — and the doctor looked at the hip as well.
     "Bone-on-bone osteoarthritis" he pronounced or, in English: the goo that once lubricated the hip socket has vanished to that place where youthful dreams go.
     The prime-of-life approach to medical care is something goes wrong, you fix it. But old person medicine isn't that straightforward. Conditions are chronic and tricky. There are reasons to postpone hip replacement. The surgery, like all surgery, can kill you, whether by botched anesthesia, or blood clots, or infection. And infection is a permanent problem — a mechanical hip can get infected by having your teeth cleaned.
     Artificial joints also break or wear out. If you can push the replacement to 70 or later, the thinking is, maybe you'll get lucky and die before you need another one.
     I had gathered all this folk wisdom before consulting a surgeon last October, the head of orthopedics at ... let's draw the veil ... a prominent Chicago hospital. He showed up with his intern, or valet, or somebody. I made the mistake of betraying knowledge sniffed out on my own, and this seemed to offend him. He shot me that "Who's the doctor here?" look and soon I was back on the street, thinking, "I should talk to a doctor about this."
     Next stop, my own general practitioner. He listened to my symptoms and replied, "Don't wait. Just do it" — easy to say when it's not your hip — and gave me the name of someone at the Illinois Bone and Joint Institute, a massive facility that seemed like it was processing all 340,000 hip replacements done in the United States annually on the day I visited. The surgeon breezed in, looked at my X-rays, said, "You are a perfect candidate for this," and handed me his card. Call and we'll schedule the surgery.

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  1. Try the steroid shots into the hip. Takes maybe 15 minutes & you get them every three months.

  2. I wish I had read this advice a couple of years ago. I had a right hip replacement 14 mos ago (at a prominent Chicago hospital) due to osteoarthritis, and I've had nothing but pain & problems ever since. Chronic pain, worse than before. NOW I'm seeing a different surgeon who specializes in revisions- he may need to fix the 'mistake'. Less prominent hospital, but much better doctor. Moral of my story: never pick a doctor based on reputation, even if s/he is recommended by your PCP. I really wish I'd waited longer.

  3. Thanks for this informative report. A common argument used against a Canadian-style national health care system is the reported long waits for such surgeries. One explanation I've heard for this purported problem is that in Canada they put you through physical therapy *before* any such surgery. If the physical therapy doesn’t fix the problem, surgeries are scheduled just timely as in the US. So, what is perceived as a delay due to the rationing of care is really just a regimen for trying a low-risk, low-cost approach rather than going straight to surgery. Which sounds like what Dr. Ochiai advises. I hope it works for you.

  4. I walk for exercise, a lot. I started having pain in one knee. The doctors said arthritis, the orthos would give me cortisone but seemed eager to operate if I desired. No profit motive, this is the VA, he even admitted he just liked to cut. I tried another option first. I shortened my hikes, slowed my speed and curtailed my intake. Voila, one year later, fifty pounds lighter, the pain is gone and I'm walking more often and more miles. Chapter Two, constant and increasing shoulder pain without an injurious event. MRI says partially torn supra spinatus muscle, one of four making the rotator cuff. Therapy? Nice try but useless. Cortisone shot, like magic, but six months on and the pain is creeping back. The doctors and the internet don't agree on any therapy. No exercise regimen to heal the tear. They don't agree on which of the several surgical techniques for my problem. Since recovery from surgery is annoying at best I will opt for shots and patience until pain makes me desperate. Try the cortisone shots Neil, keep the surgical option in your back pocket, with a buttoned flap.

  5. Almost forgot, Neil. I decided to delay shots for my knee, imagining a long probing painful needle sticking several times. Maybe that is true for knees and hips but for my shoulder the needle was almost comically small and didn't hurt at all.

  6. Cortisone shots are pretty painless now. My husband screwed up his whole left leg after slipping on some black ice a few feet from the entrance to our front door in December. Torn ligaments and tendons, severely twisted ankle, and broken fibula. Awful pain in knee, ankle and hip. Did not opt for surgery; wore the foot/ankle boot for eight weeks, now doing better with physical therapy, exercises and an occasional cortisone shot. Is still in the process of learning to walk properly again. He’s still in some pain, but hanging in there.

  7. A number of relatives have had hip and/or knee replacements. The consensus seems to be that hips are easier. None opted for surgery until the pain became debilitating. A major cause is evolutionary. We were never intended to come down out of the trees and walk on two legs. Or live so long.


  8. I put off back surgery for about four years, trying physical therapy, exercises, and epidural steroids. I could cut the lawn for thirty minutes at a time and then had to lie down and do some stretches. When I told the surgeon how many injections I'd had, his jaw dropped. More than 20. They fixed me up in outpatient at Northwestern and I have to say the neurosurgeon is a wonderful man. Been good for five years. I should have done the surgery about three years earlier.


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