Thursday, September 22, 2011

The Dealer Folds

The ortho and I both looked at the black-and-white picture on the wall.

"So you can see the deterioration here, and here. Both the condyle and the acetabulum are involved. There's just not a lot left to work with."

I could see that. Yes.

Last year I began to notice some difficulty reaching my right foot.

Nothing sudden, or startling. But it got difficult to bend my right leg at the hip, and I found that I had to perform an odd contortion of waist and knee to do simple things like tie laces or trim nails.

Have I mentioned that I have this knee problem? I think so. It's my parent's fault. Really; I have a congenital knee malformation called "patellar subluxation"; my kneecaps look outwards, are turned towards the outside of my legs. This has caused the outside of the kneecap to wear on the outside of the knobby parts of the leg bones (the condyles) and has reduced the bony parts of my knees to a pretty tattered state. I can jog briefly, and walking is usually fine, but running more than a short distance will result in a sleepless night of sore knees and Motrin.

So I thought this might be some sort of complication from the knees. Until this winter, when the stiffness and loss of range of motion began to be accompanied by pain in my right hip.

It started as just a soreness after a hard day at work, or playing soccer with the kiddos. But by May it was a constant soreness than ranged from a barely detectable hum when I sat quietly or walked slowly to a startling sort of wince if I tried to run or kick.

Finally in June I went to see my internist.

Like every American today I can't just "go to the doctor". I knew perfectly well that I had some sort of skeletal problem; likely related to age, hard, use, and deterioration (which didn't stop me from occasionally indulging in lurid nightmares about bone cancer or some other gawdawful fright) but clearly beyond the purview of a general practitioner.

But - also like every American today - my medical life is controlled by a massive bureaucracy. Not a government agency that I could petition for relief, but an insurance company that operates like a Sumerian god; opaque, dictatorial, and random.

So to appease the Gods of Blue Cross off to Dr. Le I went.

I love Le. She's this shrewd, no-nonsense character that talks like a B-girl from a Vietnam movie.

"What you do? Mess this up?" she said, poking me in the hip. I winced.

"Yeah, doc. I think I got a bum part and I need to go to Third Shop for an overhaul. You know a good bone wrench?"

"You go see Doctor Langwire. He hip man, Portland Ortho. He check you out."

Sure enough.

So with my all-important referral slip in hand, I spent a sunny afternoon having my leg manipulated by a physician's assistant and getting an x-ray. Which the doctor and I were both looking at now.

"If you were 75 or 80 there would be no question." the orthopod looked me up and down, "I'd be recommending a new hip. Yours is among the worst I've seen, and that includes men in their nineties."

"But..." I already knew the but, having read the little "Total Hip Replacement" brochure, the one with the little old man on the cover.

"Hmm. Yes. But the level of activity possible with a replacement hip would be very restrictive for an active man in his fifties." The doctor paused and looked at the x-ray again. "And there's the issue of functionality; a replacement today would probably mean another before you were seventy. And second replacements tend to have complications, especially if the person, again, intends to remain active."


Yeah, I'd read that, too. Hip replacements aren't what you tend to think; you don't go skiing the next week. They're really quite fragile, you have to be extremely careful about things like inverting your leg or the thing will dislocate. Dislocations run about 5-6%, and, remember, we're talking mostly about old gaffers in the seventies throwing a hipjoint out shuffling down the grocery aisle to pick up some stool softener.

"Honestly, doc; what would you do."

To give him credit, I think he really thought about it.

"Well, I'd lose some weight". We both looked down at the thickness around my middle. I like to think of myself not so much as...fat...but as "dense". But I'm fat; I've lumbered around 230-240 for the past decade, ever since my knees really packed in.

"And I think I'd exercise to the best degree possible. And I think I'd try and keep my original hip as long as I could. Because when it becomes too much to go on, you're going to lose a great deal of what you can do now, and never recover that. You will be able to walk again without pain, though. Which at that point might be worthwhile."

I thanked the man, and walked out of the big, airy office in the old Pearl District brickstone building, and got in the work truck, and sat behind the wheel for a long, long time.

I don't want to make some sort of big tragedy out of this. I can do most things just fine. I have a terrific job, a wonderful family, I make a good life in a city I love. If you pressed my I'd have to say that the past nine years - my married life with Mojo and our kids - have been the best years of my life.

But my body is starting to fail me, and that's never happened before.

And I will admit; I abused the hell out of it, me, and the U.S. Army.

I threw it around, and piled heavy loads on it and told it to go past the point where it told me it was ready to stop. I made it bend and stretch in ways it didn't like, and hurled it against hard objects until it protested by swelling up and whining creakily. In my twenties, thirties, and forties I walked and ran further and faster than most Americans do in a lifetime; I climbed everything from hills to mountains, lifted and carried, squat, knelt, and sprawled. I played contact sports for my own entertainment that towards the end would see me with ice packs on both knees.

But every time I asked it to work or play for me, my body always responded. Not always gracefully - in fact, I'm to grace what Republicans are to compassion, an utter stranger - but always.

And now it's starting to just quit.

The doc was right. I'm not ready to become an old man, shuffling along at a slow walk for exercise, worrying constantly about making a sudden turn or sharp movement that will produce the instant screaming agony of a dislocated hip.

But the options are not good.

There's something called a "hip resurfacing" that offers a better joint architecture and a lowered chance of dislocation, and I need to look into it. And I'm not bragging myself when I say I have a pretty high threshold of pain, and I think I can go a fair bit before it becomes too bad for me to take.

Oh. And the last time I weighted myself I was down to 217.

So that's something.

But the damn plain fact is that I've been dealt a pretty shitty hand. I'm a 53-year-old man with the right hip of a sickly seventy-year-old. There's nothing I can do about it, and I can't even really whine about it, since it gave me a better run than most Americans before abuse and my fat ass packed it in.

It's the hand I have, and I just have to play it out.

But I don't have to like it.

And I don't.


Lisa said...

Thank you for the update, Chief, but sorry to hear the news. Perhaps resurfacing can correct some of the joint "fit" problems. (Congratulations on your weight loss, too.)

It is most healthy to express your frustration and feelings of betrayal. I sympathize entirely (really, I do.) I think we are both of the same mind: Make the most of the hand you're dealt.

When faced with betrayal (bodily or otherwise), the only solution is to improve what you've got, which would be you.

Or as Cervantes said, paciencia y barajar".

Pluto said...

I've started this response three times now. Your story has awakened memories of far too many visits to the ortho docs and physical therapists over the last 30+ years.

While I understand your feelings of betrayal after an active life, I never had that chance. I've had to nurse my knees (and hips and wrists) for the last 30 years, finding new ways to do the same old things that involve less stress (or different stress) for joints that were never properly formed or were improperly connected before birth.

I had to give up on going to Philmont Scout Reservation (look up the place on Google, it's amazing) because my left knee gave out two days before I was scheduled to leave. But it could have been worse, the knee could have broken down 1/2 way through and I would have been carried out on a mule.

I'd had some thoughts of joining the service (I was born at Fort Ord) but had to put those aside for obvious reasons.

But things haven't turned out too badly. Thanks to lots of PT and good docs I'm in better physical condition than I was when I was 18 and am in a lot less pain.

My kids were born with more normal joints and the schools have better training on how to keep the kids active while avoiding injury.

So I guess the message here is that I've walked at least a 100 miles in your shoes and the road ahead has its bad points but you take the best you can and life can still be pretty sweet.

FDChief said...

Lisa: The resurfacing has many of the same drawbacks as the replacement, but some advantages.

The advantages are mainly the smaller rate of dislocation - it would allow me to remain more active. The downside is that it has had past problems with the metal-on-metal replacements. Patients have shown pretty serious post-resurfacing issues with metal fragments in their blood and tissues.

The downsides are all the same, mostly fragility and longevity.

And if there is one thing I have learned after more than half a century on this mudball, it is that there is no misery in the world improved by whining and complaining about it. The Japanese have a good saying; death is lighter than a feather, duty, heavier than a mountain.

Any fool can whine and snivel. Or die. Many do; it's easy, and easy is a common affection for us monkeys.

But my feeling is and has always been that much as I may resent the hand I've been dealt, the honorable man's part is to play it out to the last card.

I would like to know when I go down to my long sleep that I fought like hell eve holding a pair of deuces.

FDChief said...

Pluto; I appreciate the wisdom. Part of this is just my irascible unwillingness to bow my head to the collar. As I said, I've never had a time in my life when my body didn't do what I asked it to. Feeling my limits is testing my sosiego.

But you have found that there is hope for the future, and so I must hope and, as I said to Lisa, do the best I can with what I have...

Lisa said...

Whining or complaining has never been your lot, I think. You simply express honestly, which is highly therapeutic. (I can't bear snivelers.) Yes -- we must play it out to the last card :)

I like the Japanese saying. Throwing in one's hand does not seem a noble option.

Barry said...

I've had what I think you're calling the resurfacing (partial hip replacement, where they cap the femur, and put in the regular socket in the pelvis). I highly recommend it. You'll be out of commission for a month, hobbling around for a second month, and then ramping back up at a high rate in month three.

I had mine in early August, and by November I was walking a mile into downtown and back again; dancing by January, and then elliptical trainer work.