Getting Hip

Health Care and the Free Market

2009-08-19T15:39:00.000-07:00

So, lately there's been a lot of discussion about what kind of health care system we should have in this country. Currently we don't have so much of a system as a patchwork quilt (with some holes in it). We've got all different types of public and private insurance, and I'll discuss these types more later. I think most of us are in agreement that health care as it is now is becoming unsustainable--prices are going up exponentially, many people aren't covered by insurance, and even those who are covered sometimes have trouble paying bills or even have to declare bankruptcy. We do have lots of modern technology, but we aren't doing some things as well as we should (our life expectancy is nowhere near the top; we have really high rates of expensive chronic diseases like diabetes and cancer; etc.).

There are several economic reasons that purely market-based health care systems don't work well. One reason--externalities. Externalities happen when consequences of an economic transaction are externalized--experienced by a third party who wasn't involved in the original transaction. These can be positive or negative. An example of a positive externality might be something like this: I don't want to get my kids vaccinated for the swine flu, but since all the other kids in the class are vaccinated, my kids aren't exposed and don't get sick. I don't pay for the vaccine or expose my kids to any risk, but I'm getting rewards because the kids are protected since everyone else is vaccinated. An example of a negative externality is when the uninvolved party has to pay the costs accrued by someone else. For example, I go to the hospital but I can't pay. I declare bankruptcy, but the hospital never receives any money, so they raise their rates. Everyone following me has to pay my costs. This is something that happens a lot (over half of bankruptcies in the US are related to medical concerns--and most of these people are middle class homeowners with jobs and health insurance). In other words, those people who don't want to pay for other peoples' health care already are, in the form of higher bills (from providers like doctors and hospitals, or insurance premiums). Not paying for anyone else's care means that as a society we have to be willing to accept that people will be turned away from emergency care, and that people will die from preventable illnesses. I'm not okay with this because I don't want it to happen to me, or to anyone else I know.

Another set of issues with health care and the free market comes from having imperfect information. In an ideal market system, the consumer can compare the price and quality of the service or good being received. For example, I purchase a share in a CSA (community-supported agriculture), giving my money to some farmers, and in return I get produce. Although it's probably more expensive than the grocery store, I think it's higher quality and I like the fact that I can go and see how my food is being produced. Of course, lots of decisions are made based on price alone (that's the reason so many airlines now have extra fees for baggage etc.--people often choose whichever ticket is the cheapest, even if it's only by $5). With health care, we do not have information on either price or on quality. When we go to the doctor, we generally have no idea how much we are going to pay, or how much the insurance company is going to pay. I pay my deductible and almost always end up getting an additional bill later. When I had to have surgery, I called and tried to find out the price of the surgery if I had to pay it myself, and they wouldn't tell me. That's because there is not one price! The price depends on what is negotiated between the insurance company, the group plan, the doctors, the hospital, etc. Often, people paying out of pocket with no insurance end up paying much more than those with insurance, because they don't have the negotiating power that the large groups do. Also, it's very hard to compare quality of doctors and hospitals. The Agency for Healthcare Research and Quality has some indicators, but I haven't been able to really find specific ratings of hospitals and doctors, and it doesn't seem very accessible to the general public. Besides, many of our most important health care decisions are made based on what is most convenient! If I get in a car wreck, please don't take the time to check the AHRQ website--just take me to the nearest hospital!

So, without being able to compare price and quality, it's hard to say that we have a truly informed "choice" on any health care issues. These kind of market failures are classic examples where society/government/some larger body needs to step in and create some rules. I can't see any way around these issues for health care. I have heard suggestions that Health Savings Accounts (HSAs) would enable more standard pricing of medical care. Under this scheme, people put aside money toward health costs and pay out of this account rather than having insurance, or supplementing insurance. This way, the theory goes, people would be more conscious of their own medical costs because they'd be paying themselves, not relying on insurance companies, and they would become healthier. Although I'm all for encouraging people to be healthier, the fact is that even low deductibles for preventive services like Pap tests and colonoscopies are enough to stop many people from getting those services. This means that later on, those who didn't get preventive services are at higher risk of expensive diseases and likely don't have the money to pay--thus we run head-on into the externalities. Also, if paying for ones' own medical care resulted in better health, you'd think that uninsured people would be the healthiest--and this is not the case at all.

I guess what I'm saying is that we are already paying for each others' health care, in various ways. This is the basic idea of insurance. We pay in each month and pool our money, and spread our risk. Then when one in the pool gets sick, the money from the pool is used to cover the costs. We're also paying for those who aren't in the insurance system--somebody's got to pay for those unpaid bills, after all. If we did it in a planned way, encouraging healthy behaviors and prevention, it's likely we could help people be healthier AND save money. Other countries have figured out how to do this, so I'm sure we can too.

Jumping into the fray

2009-08-16T10:06:00.000-07:00

While I was dealing with the situation with my hips, I also had a rather stressful situation with health insurance and bills. I didn't blog about it too much, for various reasons. But now, with everyone talking about the health care system in this country, I think it's important to let people know what I went through.

At the time I was diagnosed with AVN, I was working on a fellowship at a federal agency. I was not a federal employee, and my fellowship did not come with a health insurance plan. I was able to extend coverage from my previous job through COBRA for a while, I believe it was 18 months. After this expired I purchased my own individual plan, which is the coverage I had when I was diagnosed with avascular necrosis (AVN). After my diagnosis I ended up going to many doctors for various consultations and appointments, and bills started piling up, and the insurance company started paying less and less of them. I also started receiving letters from the insurance company--they wanted me to send them ALL the records from every single doctor I had seen for the past several years. I had already had to go through a similar process when I first purchased insurance from them, but this was way more extensive. It was pretty obvious to me that they were either trying to prove that my AVN was pre-existing, so they wouldn't have to pay for it, or else they were trying to find something that would make me ineligible for coverage altogether. During this time I had one outpatient surgery. I received bills for thousands of dollars. I did not document all of the expenses because with everything else I was dealing with, I just did not have the time or energy, or morale.

Meanwhile, I had been asking around at work and I found a different type of fellowship that came with a group plan for health insurance. I would have to pay my own premium, which would be raised from $167 a month to $333 a month. However, because of the fact that the individual policy was suddenly not covering anything and appeared to be about to take some kind of further action, I felt that the change was well worth it. I switched to the new plan before my hip resurfacing surgery. Although I stayed in the hospital for four days, I only payed $200. Compared to the thousands I had paid for the outpatient surgery, this seemed like a real bargain! A few other bills came up once I got home, for some therapists who had come by the house during my recovery, but overall this extensive surgery ended up being MUCH cheaper than the minor surgery, just because of the insurance plan I was on.

On paper, these two plans appeared to cover similar expenses. The differences really only became evident after I had had the two surgeries, and could compare costs. My situation didn't seem that precarious from the outside, because I was employed and had health coverage the whole time. But, because of the high cost of the bills, I would have been in serious financial trouble had it not been for my parents who were fortunately able to help me out. Thanks to my parents, I was able to go ahead and get the hip replacement surgery. If not for them AND my supportive employer, I would have had to either stay in pain and disability, or have accrued medical bills to a degree which could have sent me into bankruptcy.

This scary situation made me realize how easy it can be to get in a really bad situation because of medical bills. This can happen to anyone, but it's especially risky for people who don't have the coverage of big group plans through large companies. The way insurance companies work, the bigger group you're in, the better, because there are more people paying into the plan, so the risk is spread. On an individual plan, there is no group to spread risk around, so if one person starts accumulating lots of medical bills, they look for ways not to pay. Because our health insurance system was set up through employers, people who are self-employed, in transition between jobs, work for small businesses or are entrepreneurs are especially at risk. Any of us could fall into this category (until we're old enough to qualify for Medicare). The current health care proposals out there are not perfect, but they all aim to improve this situation in some way or another.

So here I am, nearly two years after my major hip replacement surgery, and more than a year after the most recent surgery on my shoulders. My hips and shoulders feel great and normal most of the time. Sometimes the metal hip feels weaker than the other, so if I walk lots or dance I'm more aware of the muscles than in the other side. Sometimes the right (non-metal) hip hurts, as well as the shoulders, especially when the weather changes, but overall I'm functioning normally. And, thanks to a lot of help from my parents, I think I've finally paid all of the bills. I just don't think it's right that I should have had to rely on them; I think people should not have to choose between their physical and financial well-being.

All good, for now

2008-06-29T05:21:00.000-07:00

Last week I had a check up with the orthopedic surgeon here in Atlanta (not the one who performed my surgeries). It has been 7 months since the left hip resurfacing and 10 months since the right hip core decompression. The x-rays looked fine! The right hip hurts from time to time. Because the surgery I had was intended to keep it from getting worse, there is still some damage to that hip which will cause pain sometimes. The pain is completely tolerable, but it was disconcerting to worry that the disease process could be worsening meaning I'd need another surgery sometime soon. I'm relieved to find out that this doesn't seem to be the case. My left hip (the metal one) looked good too. The doctor told me, again, all of the reasons why a resurfacing might not work for me, as I was happily standing there in no pain with my x-ray indicating no issues. I've been walking 2 or 3 miles pretty much daily, and my quality of life is extremely improved over what it was last year, so even if the resurfacing were to fail at some point I have gained much joy and use out of it already. The lingering muscle soreness has faded to a point where it's nearly imperceptible, and even my scar doesn't look that bad considering it's less than a year old.

At work the other day someone said "you look like you're walking comfortably." I didn't know what she was talking about--I looked at my shoes to see if they were particularly comfortable. Then I remembered she must be talking about my hip! Actually I've been walking comfortably for a while now but I guess she just noticed. So, it's hardly even on my mind these days.

The doc took shoulder x-rays too, but he's not a shoulder specialist. He didn't see anything to worry about but I'll mail them to Baltimore so they can interpret them. The left shoulder hurts intermittently, but less than before the surgery. So, all's well for now!

Back to Baltimore

2008-05-13T13:40:00.000-07:00

I haven't posted for several months... just to give you all the hip update, my hips are doing well! My left resurfaced hip is good--the muscles are sometimes sore, but it gets better and better. If I sit for a long time and then get up it can be stiff. All in all, I'd say I'm a whole lot better than before surgery and about 90-95% of normal. As for the right hip that had the core decompression, it seems pretty good too. I've been walking a lot lately and it only seems to hurt every once in a while, usually when rain is coming. The core decompression ideally stops the progression of the bone loss but there is still damage to the bone and cartilage, so it's not surprising that it aches a little sometimes.

I found out a couple of months ago that I also have ON of the shoulders. The doctors here in Atlanta didn't really have any suggestions and thought I should do nothing. Replacements and resurfacings for shoulders do not seem to be as common or successful as for hips, and I'm not a fan of the idea of doing nothing while my bone dies. Dr. Mont in Baltimore thinks that we can slow or stop the progression with CD's of both shoulders, so we are leaving tomorrow to go for more surgery. Thank goodness I don't walk on my hands, so the shoulders aren't weigh-bearing! That means the recovery, although it might be painful, shouldn't affect my life as much as with the hips (although I might not be able to drive for a little while).

I'll update and let y'all know about the shoulder surgery.

5 week check-up

2007-12-23T05:36:00.000-08:00

I can't believe how long it's been since I posted... I've been busy! Last week I was back at work full-time and it went pretty well. I need to get up and walk around pretty often, or else my hip gets stiff and sore. Wednesday I had my five-week check-up here in Atlanta with Dr. Steven Smith. The x-ray of the resurfacing looked good and the doctor told me I could transition to walking without a cane. The right hip looks good too, so far. Of course I started immediately walking around the office without a cane to show off--and after I sat down and did some work, then got back up, *ouch* the muscles were sore!

I've still got a bit of a limp, which is worse when I've been sitting and first get up and am stiff and sore. Once I get going I don't think it's very noticeable, although I haven't made another video yet. Yesterday Danielle and I did all kinds of shopping and I was on my feet for hours--way longer than I've spent doing that kind of thing for a while! I was definitely sore but this morning I'm fine. Before the surgery, I couldn't have spent that much time on my feet, and would hardly be able to get up out of bed the next day. The muscles still get quite sore, but I'm looking forward to physical therapy which should help me with that.

4 weeks out!

2007-12-13T16:13:00.001-08:00

I'm four weeks out from my hip resurfacing surgery today. No film today; I don't have Boppa around for the commentary anyway. I'm back at home in my condo (on the third floor, no stairs). Getting up the stairs is okay; I just plan my trips and have help so I'm not constantly running up and down.

I started back to work some this week. I've been going into the office for several hours each day and also doing some work from home. Last night I took of my stockings (the lovely anti-embolism T.E.D.s) and my left (operated) foot was swollen. I've heard of this happening after surgery, but the fact that it hadn't been noticeably swollen up until then (even after surgery) worried me a little. I was pretty active, working and then straightening up at home, so I decided to work from home today and keep my feet up. I think it worked--it doesn't look swollen at all anymore. Of course I'm bored to tears and missing a backyard bonfire as I write, but it's too hot for a bonfire anyway. Right??

Oh--one other hip-related thing happened. As I've said before, I'm not supposed to bend the hip over 90 degrees. In other words, I can sit up straight but can't lean forward. When lying down, I can bend the knee but can't pull the knee forward to my chest. Etc. Anyway, I was sound asleep and my beloved cat Poe was snuggling up to me (something he hasn't done much since I've been back--he's still a little mad at me for leaving him). I awoke to hear, at close range, the gagging sound he makes right before he coughs up a hairball or pukes. This cat weighs 17 pounds and is very stubborn, so pushing doesn't work--you have to pick him up. I sat up and threw him off the bed just in time! As soon as I did so I felt pain in the hip and thought, uh-oh, I forgot to be careful about the 90 degrees... I was still mostly asleep so I'm not sure how much I bent but IF it was more than I was supposed to, it wasn't by much--I don't think I could do much more even if I tried. In any case it feels fine, thank goodness. I was a little worried how I was going to explain to the doctor "um, I dislocated my resurfacing trying to avoid getting puked on by the cat..."

Rae-Rae gets a cane!

2007-12-09T12:09:00.000-08:00

At first my niece Rachel seemed to be afraid of me with crutches or a cane but more recently has taken to holding onto them while I'm walking. Last night she came over and turned over a basket of Christmas cards that also had one of those candy canes filled with Hershey kisses in it. She immediately picked up the cane and started walking with it, just like me with my cane! I wish these pictures had been better but my camera is clearly not made for high-action photos...

The Famous Sock Putter-On-er

2007-12-07T14:48:00.000-08:00

My parents seem to be fascinated with this tool so I wanted to share with you... I can't bend the hip more than 90 degrees so I can't reach over to put on socks (or to shave my legs--so I got 'em waxed today). The hospital sent me home with this nifty tool to help with the socks. I also have a grabber to put the sock and tool over the foot to start out, and to take the sock off, pick things up off the floor, etc.

Thanks to Anne for the photo which is great, other than the funny face I'm making (hey, I'm concentrating!).

To answer yesterday's comment, yes, I'm talking with other people who have had the procedure. I found listservs for people with my condition and also for people who have had this surgery. It's very helpful to be able to communicate with others in the same boat, and I've also learned a lot that way. It's nice to be in touch with people who can relate to my specific experience, but really, I think anyone who's ever had to deal with something sucky in life can relate just fine! Besides, just knowing that so many people are rooting for me makes a big difference in my attitude and morale.

3 week video

2007-12-06T15:20:00.000-08:00

I'm feeling pretty good... still have pain in the hip. From time to time there are sharp, stabbing pains in the skin, muscles and even what feels like deep in the bone. I think these have something to do with the healing process; I just keep imagining that what I'm feeling are nerves and things sort of stitching themselves back together. And, I'm sore at the end of the day, especially if I've walked or been more active than usual. Doing normal stuff like errands seems to tire me out pretty quickly.

I have been discharged by the home health nurse and have "graduated" from physical therapy! The home health nurse says my incision looks great and my scar should be minimal. (To me it looks horrible, but I don't have a lot of experience with surgical scars--thank goodness.) My PT Tom says there is nothing left to teach me, that I just need to keep doing my exercises until the restrictions have been lifted and I can start doing outpatient therapy. Also he okayed me to walk with a cane, check out the video!

Two weeks down!

2007-11-30T08:25:00.001-08:00

Okay really two weeks and one day... I should have posted yesterday. I did film this video of me walking with one crutch yesterday:

I'm amazed at how quickly I seem to be recovering. I'm still sore but getting stronger every day. The nurse came and removed the staples from my incision so I'm now able to take regular showers! Hooray... I've been walking around the neighborhood and increasing the distance by just a little each day.

I've also been enjoying visits from friends. On Wednesday, Danielle came and took me out to Dominick's in downtown Lawrenceville. Other than the unexpected meat sauce on the gnocchi, it was a great first outing! Yesterday Kelley brought this delicious apple pie over, and Cap'n Phil came by to say hi too.

Twelve days out

2007-11-27T08:57:00.000-08:00

I'm still doing fine here, no big news. I'm getting around on two crutches but the physical therapist said I could use one from time to time, so I've been making short one-crutch trips for supplies from the recliner to the kitchen. I'm keeping up with my exercises and improving just a little every day. A few nights ago the muscles got really super-sore but seem to be better now. I'm down to just Tylenol for pain meds. If the weather stays nice, I'll try to walk outside this afternoon--but probably after my physical therapist comes by, in case he has something tough up his sleeve for me. I might also try to venture out to the grocery or drug store, because I'm starting to feel kind of house-bound. Tonight is band practice, but I am still hesitant about going. I'm not sure where I could comfortably sit!

Yesterday was great--my good friend Katie came out during the day while mom and dad went to play bridge, and then some friends of my parents brought yummy thai food over for dinner. I really enjoyed having the company.

Saturday Morning at the Watson Rehab Center

2007-11-24T07:43:00.000-08:00

Breakfast was divine... raspberry cream-cheese filled french toast! I coudn't ask for better care, or better accomodations.

Yesterday the home health nurse came by to check on me. She had to ask me a lot of strange questions (like if I was a coal-miner), and she wanted to see all my medicines along with my explanation of what I was taking them for. She thinks I'm having a reaction to the adhesives--I have a few blisters on my leg and a sore where I had a band-aid on my hand.

Today the physical therapist is coming. I'm looking forward to getting started. I've been doing some exercises on my own, twice a day.

This virtual hip resurfacing is kind of interesting. It shows, in cartoon form, all of the steps that had to be taken in my surgery. Even though it's a cartoon, it's not for the faint-hearted! I'm glad I didn't do it before the surgery. After I did it, I realized why I'm so sore!!

Happy Thanksgiving!

2007-11-22T05:46:00.000-08:00

I'm one week out from my resurfacing surgery, yay! In honor of Thanksgiving here's a list of things I'm thankful for this year:

-I live in Atlanta, where my parents and my sister's family both live. I'm so glad I don't have to travel to see them, and I'm glad I can recuperate with my folks and they can keep doing the things they like to do.

-My parents are retired so they have enough time to take care of me, but still young and healthy and able to take care of me.

-I work with wonderful, supportive people who have really helped me through a difficult year. They have given me tons of advice and support on my health issues, helped me switch to a fellowship with a better health insurance plan, and sent me flowers after both surgeries!

-After a year and a half of worsening pain and more and more limited activity, I'm on the road to getting better.

Here is a picture of my pirate band-aid, next to the longest band-aid I've ever seen. I know it's not the most attractive picture of me--my leg's still swollen, there are some bruises and blisters, and it's still stained with the betadine--but I'm still proud of it.

Below, see video of me walking with commentary by dad. The white socks are NOT a fashion statement--they are the anti-embolism stockings I have to wear to avoid blood clots (for five weeks, ugh).

6 days down

2007-11-20T13:15:00.000-08:00

Six days out. My hip is sore, but it's manageable. It's hard for me to move my left leg, although getting easier and easier. At first I had to have someone lift it and move it to get in and out of bed. Now I can get in bed myself, although I still need a little help getting out of bed (I have a leg-lifter and I'm getting pretty good at using it).

I have some precautions I have to follow for about 6 weeks: my thigh can't be less than a right angle to my torso, my leg can't cross the midline of my body, and I can't twist the hip or leg. Basically this means I have to sit in chairs with arms so I can use them to push up, and I can't cross my legs. I have to sleep with this huge wedge between my legs to make sure I don't cross them or twist in my sleep. It looks rather torturous but I really don't mind it, I'd rather have it than worry about moving the wrong way.

Lillian was commenting about Roald Dahl's hip bone. In my case, my scar is the only souvenir because they didn't take as much bone out as with a total hip replacement. They shaved off the top of the femoral head and capped it with an implant. They also put a metal cup in the acetabulum, or pelvic hip. This resurfacing technique preserves more bone for later in life, in case I need a revision. It also allows for more range of motion and once it's all healed, is less likely to become dislocated than a typical total hip replacement. That means I can do yoga again one day, yay!

To the right is a picture of the kind of implant I have. Click on the picture for more information about resurfacing courtesy of Wright, the company that made my new hip.

Today I walked outside a little bit for practice. Stay tuned tomorrow, I'm planning to post a video of me walking with my flame crutches and shiny new bionic hip!

Home again Home again Jiggity Jog

2007-11-19T16:03:00.000-08:00

Ok so no jiggity jog, but we are home again... at my parents' place, anyway. I'm soooo happy to be here! We had a long day taking the flight from Baltimore to Atlanta today. I wasn't really excited about checking out of the hotel super-early since I didn't fancy hanging out in the airport more than I had to, but it turned out that the hotel was having a FIRE DRILL. At 10 AM. I didn't want to have to go down the stairs, and this was a BIG fire drill, with fire trucks and everything, so we decided it was a good idea to get out of there before 10. But, our flight wasn't until 1:20 pm, so we got there with time to spare.

Getting in and out of the car is still way harder than I had any idea it would be, but I managed to do it and I'm here in my dad's recliner where I hope to stay for a while!

Hannah asked if I were going to have a scar to show off... yes! I'll have a big souvenir! Right now it looks terrible, about 8 inches I guess running down the side of my thigh with staples-looks like train tracks. I'm told that the scar fades a lot. My vain side doesn't want to have any ugly scars, but my story-telling side is kind of excited about fact that I'll have a souvenir to show off and a(nother) story to tell. Not to mention, I'll just be glad to get the dang staples out!

Thanks y'all for keeping up and checking on me.

2 days down

2007-11-17T15:25:00.000-08:00

I think I mentioned how tired I was yesterday... I dozed off and on all day. I could hardly keep my eyes open even when the physical therapists were here talking to me, and needless to say I couldn't read or watch TV (which makes me sleepy anyway).

Today I was much less tired, no naps at all so far and it's 6:30! This morning was really busy with visits from the nurse, a resident who changed my wound dressing (I got to see my incision for the first time which made me cry), Dr. Mont who did the surgery, and the physical therapist. I decided to try my crutches with the physical therapist rather than the walker and I actually felt like I could get around much better with them than with the walker. What a relief! I was too dizzy and light-headed to walk down the hall to the PT area so I got rolled down in a chair, where I practiced going up and down stairs. Because of the dizziness they gave me another IV with fluids which seemed to help right away, and I went walking in the hall later with the nurse. Also my great friend Kirsty came down from New York with her 2-year-old daughter and they were great entertainment! We had lots of fun.

Of course I am still very sore and I keep thinking "is it supposed to hurt this much?" But truthfully it really mostly hurts when I'm up and about, and when I'm sitting and lying down the pain has already subsided a great deal. I'm excited about how much progress I've made today. Tomorrow I'm supposed to be discharged from the hospital and then fly back to Atlanta on Monday! Last night I couldn't have imagined doing this but tonight I feel much more confident about it.

My new bionic hip

2007-11-16T10:24:00.000-08:00

I had surgery yesterday afternoon and came out about 4:30 PM. So far, so good! There was a chance that my bones could be too soft or too degraded for the resurfacing that I wanted, in which case I'd have to have a total hip replacement. But, everything was fine and I got the resurfacing! I'm feeling okay really, of course I'm sore and soooo tired but the pain is manageable. Earlier today the physical therapists came--my task for the morning was getting out of bed and getting in a chair! It was actually harder than I thought, and letting the PT move my leg was a real test of faith.

The staff at the hospital are extremely caring and nice, there's free wireless internet and I'm sitting next a big window where I can see the sky.

Have to make this one short because I'm just so sleepy, but just wanted to let you all know that everything seems to be going fine.

4 AM, Baltimore

2007-11-15T01:12:00.000-08:00

We arrived in Baltimore yesterday for the surgery. The flight was uneventful. I had to go to the hospital for one blood test which was no big deal. I was advised not to eat or drink anything after midnight, and the surgery's not until 1:45 PM, so to "tide myself over" I stuffed my face at dinner last night! Yummy crab cakes and mashed potatoes and bread and pie and wine... needless to say, a full belly, nerves and pain are keeping me from sleeping! I think I'm almost as nervous as not being able to have coffee, water, breakfast or lunch as I am about the actual surgery. I can't stand skipping meals, and as soon as I think about the fact that I'm not supposed to drink water I feel absolutely parched.

We are going to a class at the hospital at 8, where we'll learn more about recovery and rehab. Mom and Dad are going with me. Then I check in for surgery at 10:30.

Although I think the next couple of weeks will be hard, I'm really excited right now about getting my active life back. I'm also very excited that my good friend Kirsty is coming down from New York to see me in Baltimore! I haven't been able to visit her recently because of a generally busy life and then health problems, so I'm really looking forward to it. She'll bring her 2-year-old, and I can't wait to see them both.

My niece Lauren says she's going to help me feel better when I get back home with "a really big Pirate Band-Aid with a little bit of love on it too."

Next update I'll hopefully have my new bionic hip!

Four more days

2007-11-11T14:08:00.000-08:00

My big hip resurfacing surgery is on Thursday! I can't believe it's less than a week now. As it's gotten closer, I've been "faking it" more and more, and trying to enjoy my freedom as much as possible before going under the knife. I haven't been using a crutch or cane all that much since I know I'll have to after the surgery. My leg hurts more, but I guess it's bearable because I know that it's going to be fixed soon. It is pretty painful though, I'm having a little trouble sleeping and it even hurts sometimes in my dreams.

I'm really looking forward to getting better--but really scared about the surgery and recovery. I'm just planning on giving myself the rest of the calendar year to lay low and get better. I'll work as much as I am able and have a couple of holiday parties already planned, but I'm otherwise planning to just focus on getting well.

I'm planning to stay with my parents for a while. I'll have to see how it goes but I'm expecting this recovery to be much harder than the last one.

It really makes a big difference to know that all of you are thinking of me. Sometimes I feel really tired, discouraged or I hurt and then I remember how many people are rooting for me, each in his or her own way, and I feel better and stronger. So--Thank you!

Getting Closer

2007-10-21T15:47:00.000-07:00

I'm still on for the resurfacing in Baltimore on November 15. Everything seems to be falling into place: I've got the plane tickets and the hotel, the insurance has been approved, lined up a house sitter, and I'm getting things wrapped up at work. I'm really ready--lately I've been missing out on a lot of fun things because I just didn't feel like getting out. So, I'm looking forward to just being able to do what I want to do and not worry about how much standing or walking there will be, etc.

This surgery will be harder than the last one--I'll have several weeks of in-home rehab. they have to take the hip apart and put it back together, so I'll have to relearn to use the muscles and everything. And, there is a risk of complications during or after the surgery. One of the more common complications is that the femur neck can break. If it happens during the surgery while they are hammering on the metal cap that goes over the femur head, they just convert to a total hip replacement. But if it happens after the surgery, they have to go back in and convert it after the fact which doesn't sound fun at all. I think I'll be extra-conservative after the surgery for a few weeks to try and avoid this!

Au revoir Monaco

2007-10-10T01:46:00.000-07:00

Monday I got back from my trip to Paris and Monaco. I'm still jet-lagged; it's 4:50 AM and I can't sleep!

I was really nervous about getting around over there. One of my favorite things about Paris (and other places that were built before cars were invented) is that it's made for walking. This time, though, that seemed a little intimidating. I wasn't sure how I was going to get around. When I got to Paris, my apartment wasn't ready so I had to go entertain myself for a few hours. I had a good time walking around and took a lot of pictures, but I was tired from the plane ride and my hip was pretty painful. I tried to figure out the Velib, free or low-cost bikes that are everywhere in Paris, but it turns out that you need to have a credit card with a "puce", or chip, on it. American cards don't have this. Besides, although there are Velib stations every 300 meters in Paris, the closest station to my apartment was still a few blocks that I didn't necessarily want to have to walk every time I wanted a bike. I found a place that rented bikes for longer-term, and got one for 4 days @ 25 euros.

Riding was so much fun! The mayor of Paris is very supportive of cycling and alternate forms of transportation, and in addition to starting Velib he has added many bike lanes. Smaller streets were great for riding on as-is, medium-sized streets generally had small bike lanes to the side, and large boulevards had a lane dedicated to bikes, buses and taxis. I thought it worked great! I didn't quite get the hang of turning left from a bike lane that's on the right side of the street, and lots of the routes I typically walk were hard to replicate on a bike because of one-way streets, but the fun of riding around more than made up for those minor drawbacks. Plus, riding bikes doesn't put weight on my hip joint, so it just doesn't hurt like walking does.

I took the train to Monaco for a work conference, the real purpose of my trip. I booked the closest hotel to the conference center to try and minimize my walking. This also happened to be one of the most expensive hotels, so I shared a room with my boss. I thought about renting a bike but it was quite expensive, and the conference center was only about a 5 minute walk. Besides, although the ride to the conference center was along the beach and very flat, a ride to anywhere else would have been hard--there are so many hills! I did take the bus some but I also just walked a lot, and it hurt.

The conference was a lot of fun, and my presentation went well. Monaco is beautiful but very expensive, and very touristy (rich tourists). I'm glad to be home!

Resurfacing surgery for the left hip is still on for November 15. I got the plane tickets yesterday.

Crutches are hard

2007-09-23T07:34:00.000-07:00

I found this nice picture Lila took of me when I first got back to my place after the surgery.

The Crutchless Wonder

2007-09-21T18:50:00.000-07:00

On Wednesday I saw a new doctor here in Atlanta, Stephen Smith. I took him the x-rays that I had from the previous week. He didn't say a whole lot about my situation, probably because I told him I had already had the core decompression on the right hip and had scheduled the resurfacing on the left hip with Dr. Mont. He seemed to think that my choices were good ones and he said he could be my local orthopedist, which was a relief. I needed one here but the ones I had already met didn't seem to be on the same page with me. He seemed like he would have been reluctant to perform the resurfacing himself, which kind of just reassured me about my choice to go up to see Dr. Mont in Baltimore. Dr. Smith has only done around 40, and Dr. Mont has done over 1,200 I believe. I'd happily go to Dr. Smith if I decided to just get a replacement though.

As soon as the appointment was over I Fedexed the x-rays up to Dr. Mont. Jill, his physician's assistant, called me Thursday afternoon--it must have been right after they received them. She gave me the okay to walk crutch-free! She said it would help with the pain to use assistive devices (crutch or cane) when possible, but that I had no more restrictions on weight-bearing. Well, she did say not to do heavy loading on that joint for a year, but with the combination of the ON and the future surgery on the left hip that shouldn't be a problem!! I'll be perfectly happy to stay far away from heavy lifting, marathon running, and downhill skiing, thank you very much. Jill also said she thought my left hip looked good for the resurfacing in November, although she was going to check with Dr. Mont and call me back next week. And, she said he had some number of grams of wine that were okay to drink! I was kind of excited about someone telling me an amount to drink that was considered safe, if this is true. I'll check back when I talk to them next week. I'm not always good at estimating what is a reasonable amount of yummy wine to drink or food to eat! I am, on the other hand, VERY good at justifying "just a little bit more won't hurt!"

It's very exciting to be able to use my arms for things other than getting around. Still, it's a little disappointing to recover from surgery and still be in pain and not be functioning normally. As much as I try to fake it, I'm just not very good at walking these days. A girl in the locker room asked about my limp today. I didn't mind answering her questions and I'd much rather someone just be upfront and ask if they are curious, but I guess I thought maybe if I didn't have my crutches that people wouldn't know anything was wrong with me. On the other hand I realized I've grown sort of attached to my crutches: I didn't have my card to get into the gym, and the receptionist wanted to see it. I said "don't you recognize me? I'm the one with the flame crutches!" even though I didn't have them with me. It still didn't work, she didn't recognize me but I stood there and dug through my purse until she got sick of me and just told me to go.

A week from tomorrow I'm leaving for Paris and Monaco! Between now and then I have two major tasks: complete two papers at work and figure out how I'm going to get around over there...

X-rays

2007-09-15T02:47:00.001-07:00

Yesterday I went to the doctor and got x-rays to follow up after the core decompression on the right hip. I also made sure they got my left hip too, so that Dr. Mont can check and see if I'm still a good candidate for resurfacing in November. I just went to my regular doctor, so we don't really know what the official interpretation is yet. Last Monday it had been four weeks after the surgery, but I couldn't get an appointment until Friday. And, I have an appointment with an orthopedist here next week. My doctor's office doesn't have the setup to make copies of x-rays, so I'll have to wait until after next week's appointment with the new orthopedist here to send the x-rays to Dr. Mont in Baltimore. Ugh! I'm ready to get rid of these crutches, at least some of the time. I'm in pretty bad pain so I'll probably keep them around, but it'll be nice to not have to use them.

Of course I snuck a peek at the x-rays. The left hip (the original bad one) looks terrible! I'm no doctor, but it's clear on the film that the top of the bone is misshapen and even the area above it looks messed up. I guess it's the cartilage, and I'm sure there's edema (swelling) too. No wonder the dang thing hurts!! The right hip, where I had the surgery, looks pretty much okay to me. I can't see the holes where they drilled, just one little flat area. I'm sure the orthopedist will be able to tell me all about it next week.

And in case you're wondering about my pain, yes it still hurts. The left hip, as I said, is just really painful, and often wince-inducing when I put weight on it or move it much. I kind of wish I had gone ahead and done the resurfacing on the left when I had the CD on the right. The right hip hurts some too, I guess about the same as before the surgery. I hope it worked.

I've got a date!

2007-09-09T04:23:00.000-07:00

No, not that kind, although my flame crutches are quite popular... I made a date for a hip resurfacing surgery with Dr. Mont in Baltimore for November 15. I posted about resurfacing here, and the Surface Hippy website has a lot more information, if you're interested. Basically they remove the diseased part of the top of the femur bone and cap it off with metal, and insert a metal cup into the socket where the cartilage was. It accomplishes the same thing as a THR but leaves more bone. The surgery is more difficult than a THR, which is why I decided to go to Dr. Mont, who has plenty of experience with resurfacing, and with osteonecrosis patients. The date is not set in stone; Dr. Mont has to review my x-rays and make sure I can wait that long. Oscar at work says you shouldn't be a "beta tester", and I agree. But resurfacing has been FDA approved in the US for eight years and has been common practice in Europe for longer, and Dr. Mont has done over a thousand of them.

After my surgery I decided to become a teetotaller for a while. I've been pretty good about it until last night. Yesterday was my birthday and some friends had a little get-together for me. I decided that just one night couldn't hurt too much--as one witty guest said, "that hip ain't gettin' any less necrotic"!! It was fun to have a margarita and some rose, my favorite summer wine. And, the red Power Ranger showed up to wish me a happy birthday!! For a split second I thought he was Strong Bad, but no such luck...

Girls' Weekend and Flame Crutches

2007-09-03T09:37:00.000-07:00

I finished the rest of last week at work, and ended up being pretty productive. This past weekend I switched places with my brother-in-law--he stayed intown in my condo, and I stayed with my sister and nieces in the suburbs. We had a nice, relaxing weekend and it was fun to have so much time with the girls. On the flip side, I had just spent some time with my parents recovering from the surgery so I felt a little homesick for the city-I would have liked to have gone to the Decatur Book Festival, for instance.

I'm doing alright with recovery, except for the crutches--I'm so tired of them. Yesterday at work somebody told me that I had the hand grips too low and that I needed to move them up a notch. I did that and could hardly control myself, I felt like I was wobbling all over the place and bobbing up and down! Then, last night at band practice, Joe (probably realizing how sick I was of them) tricked out my crutches for me. He painted them flame-style, blue at the tips with a little white-hot turning to yellow, orange, red and then black at the top with a few orange sparks. Today I put the hand grips back where I like them and got to show off my new flaming crutches to everyone at work! They made everybody smile, and then Young 'n Cute at the gym walked out with me and chatted me up on the way out... ;-) Thanks Joe! Still hate the crutches, but maybe I hate them just a tiny bit less. And, instead of people wondering about what's wrong with me since I don't have a cast or anything (heavens! it might be a disability!! don't look...), they're just checking out my awesome paint job. My camera battery is out of juice but I'll post a picture soon.

My right hip has been hurting some, which is kind of worrisome. I keep telling myself that it's normal from the surgery, but it seems like it might be getting worse. I have an appointment next week for an x-ray, and I'll be interested to see what's going on in there. So please, keep those prayers, meditations, incantations and good vibes coming my way!

Cabin Fever

2007-08-27T15:45:00.000-07:00

I was hoping to get back to the office today after one week off and one week of working from home, but this weekend I came down with the dreaded Summer Cold. I thought it was allergies until the moment when I was at Whole Foods with Trusty Sidekick Danielle and felt like I'd been hit over the head with a sledgehammer. Although I do complain about working in a cube, I terribly miss my friends at work and the general routine. Also, I can't wait to get back to the gym... I'm waiting for my wound to heal up before getting in the pool which is frustrating too, since swimming would make me feel better.

The good news is I finally got around to working on some tables today that I had been trying to get to for a while, so I did accomplish something!

The Long Set of Stairs Home

2007-08-24T13:26:00.000-07:00

So I'm almost home, have been staying with a friend for a few days and am glad to be back intown closer to friends (although I miss my family, especially those nieces). Tomorrow I'll be heading home. I'm excited about being there but I'm nervous about the climb up the stairs to the third floor. Thank goodness there are landings halfway up. I'm also a little worried that everyone will think I'm fine now that I'm home again, and I'll be stuck with a lot of smelly garbage to take out!! Carrying stuff with crutches is way harder than it should be.

The good news is my arms are getting pretty buff from using the crutches all the time. I've been showing off my guns to everybody that I've seen...

The Other Hip

2007-08-21T10:36:00.000-07:00

So now I just have to wait and hope that the CD worked for the right hip. That means I have time to start thinking about the left hip. I've seen a few doctors so far about this hip, and they all say that it's too far gone for anything but a total hip replacement (THR). There is a new surgery that has only been approved by the FDA for about eight years, but that's been around for longer in Europe, called hip resurfacing. Resurfacing essentially accomplishes the same task as replacement--putting in fake parts to replace the original worn-out ones-but it leaves more of the original parts in. Basically they just take the worn-out top of the bone off and put a metal cap on it, and then put in a metal piece on the other side too. There's a general rule that people can have two THR's in a lifetime, but a resurfacing still leaves enough bone for two THRs. In other words--if I get a THR now and it wears out in 20 years, I'll have my second (probably last) hip replacement at about age 57. If I get the resurfacing now and it wears out in 20 years, I'll still have two THRs left at the same age--making it more likely that I'll be able to remain active into old age.

I think if I decide to choose the resurfacing, I'll go back to Dr. Mont in Baltimore, as he has plenty of experience with these. The doctor here said a few negative things about resurfacing--that it's riskier, that the operation and recovery are longer and harder, etc. According to Dr. Mont, the risk of complications is small, and if they have a problem they can easily convert it to a THR, and the recovery is the same. Patients generally have a better range of motion and less limp with resurfacing than with a THR.

Negatives are that we'd have to go up to Baltimore again, and there are increased metal ions in the blood. This may have negative outcomes for future childbirth-only a few babies have been born to women with resurfaced hips so evidence is lacking. None of the babies born so far have had problems, although I think there have only been nine or so.

Let me know if you have any opinions-I like to think about all sides of a decision before I make up my mind.

Transportation alternatives

2007-08-19T15:19:00.000-07:00

Fortunately my hip pain has decreased so much since Monday, I feel like I'm pretty much back to where I was before I had the surgery. I'm sure that using the crutches and keeping the weight off helps. I have to use the crutches for at least 3 more weeks, and after that can go off them only with the doctor's approval. I had been using one anyway from time to time to help with the pain. However, using two crutches is difficult--since I'm using my hands to get around, I can't carry anything. It's also tiring.

Since my surgery I've been using wheelchairs to get around inside stores when they have them available, so I can use my hands to carry stuff and so I don't get too worn out. I also love to do things that normally require a lot of walking, like going to art festivals, museums, on walks etc. Mom and I decided that a wheelchair might come in handy for me for things like this, that I haven't been able to do otherwise and especially can't do right now (not to mention after I have the eventual hip replacement surgery).

We ordered one on the internet and it should be here Tuesday. I'm excited about it because I think I'll be able to have the freedom to do some things pain-free that I haven't done in a while. On the other hand, I don't want to become dependent on it and get weak leg muscles, so I'm planning on only using it for outings that require a lot of walking--which I would otherwise avoid. Also, I don't like running into people that don't know about my situation when I'm in one. Crutches make people think "temporary injury", while a wheelchair says "permanent disability". Even though that isn't the case for me, it makes people sad to see me in one and I don't want to make people sad!! So please--if you see me in a wheelchair-- I'm not worse, just giving myself the freedom to do something I would have probably otherwise have avoided (or at least would have otherwise been in a fair amount of pain while doing it).

Recovery blues

2007-08-16T07:57:00.000-07:00

I feel like I shouldn't complain because I'm doing so well with the surgery. I'm not really in a lot of pain or anything. I'm not even sure I have stitches--the surgical area is very small.

But--I have to be on crutches for at least four weeks, and that means putting most of the weight on the bad left hip. And, that means at least four weeks of having to use my arms and hands to help me get around, instead of to carry things. I'm sure I'll figure out solutions but in the meantime, carrying a glass of water, cup of coffee, or book from one room to another seems like a major ordeal.

And, I have to wear these white knee-high anti-embolism socks to prevent blood clots--for two weeks--in 100+ degree weather. I'm trying to figure out how to make them fashionable, but since my current wardrobe is basically limited to elastic-waistband pants, I'm not having much luck yet. They are also tight and uncomfortable to sleep in.

Anyway, thanks for listening to me gripe. Everything is really fine, just slightly annoying.

Foamhenge

2007-08-14T17:33:00.000-07:00

We left pretty early in the morning and headed for home. I had to get out every hour in order to stretch my legs a little. Besides the rest stops, another point of interest along the way was Foamhenge, a life-size styrofoam replica of Stonehenge. It was up a hill and not very accessible on crutches, so thank goodness for this virtual tour. Foamhenge is in Natural Bridge, Virginia, named after the Natural Bridge. We stopped at this tourist attraction and although we didn't get to see the actual Natural Bridge, we did see a statue out front of a cowboy riding a dinosaur.

We were planning on going all the way home but by evening I was really exhausted. We stopped and spent the night in Gaffney, SC, home of The Peachoid. Today we made it the rest of the way to my parents' house. So far everything is okay; I'm still tired but I made it to the drugstore and the grocery store. I used the store wheelchairs which gave me a chance to get off of both hips. Besides, with crutches in both hands, I can't pick anything up--but with the chair I was able to help out.

Oh, I forgot to mention one minor mishap that happened along the way. I dropped my cell phone in a glass of water and now it's not working. If you call my regular number, the message will give you my parents' number...

So Far, So Good

2007-08-13T12:55:00.000-07:00

We got to the hospital at eight this morning, did paperwork and waited. They started prepping me for surgery around 10 or so. Dr. Mont came by and visited with me. He seemed busy but he made time to sit and chat with me and answer some questions I had. The nurses, anesthesiologists, and everyone else I came in contact with were very nice. Dr. Mont said the actual drilling portion of the surgery only took a few minutes. We won't know for sure if the surgery is a success for 10 months to a year. Chances are good that if I don't have pain in a year, that hip won't give me any more trouble.

We got back to the hotel this afternoon and have just been relaxing. I feel okay but just sore and stiff. The hotel had a wheelchair for us to borrow, so we went on a short tour of some shops next door. I even felt well enough to go to dinner on crutches, but I was ready to leave by the time the check came! I can definitely tell when the drugs are wearing off, ouch. I'm a little nervous about going around on crutches using the left leg (the original bad side) while I let the right side heel.

Tomorrow AM we are heading south. I'm supposed to get up and move around every hour, so we'll have to make a lot of stops. I guess by the time we get back I'll be a rest-stop connoisseur.

We are here

2007-08-13T02:17:00.001-07:00

We finally arrived in Baltimore just before 10 PM. Got to the hotel and went straight to bed! I was more excited than nervous until I just woke up at 4:20.

No real news yet but I do want to just say that my family, friends and co-workers have been amazing sources of comfort and support to me. Your kind words and deeds have helped me more than you know. Thank you.

The most expensive CD I'll ever buy...

2007-08-09T14:46:00.000-07:00

I'm talking about my upcoming surgery, called a core decompression. Early stages of osteonecrosis (ON) are often treated with core decompression (CD) to try and stop progression of the disease. CD is an outpatient procedure in which holes are drilled into the femoral head. This relieves some pressure and improves the blood supply to the bone. Reported success rates vary from 50%-80%; Dr. Mont, who is doing mine, says he has an 80% success rate. Once the degenerative process has begun, the sooner CD is performed the better the chances are of saving the hip. This is why Dr. Mont was so insistent that I have a CD as soon as possible. Younger and healthier patients also have better success rates.

I've heard varying reports on the recovery process from a CD. I just keep thinking--even if it's an outpatient procedure, they're drilling holes in my bone!! Dr. Mont says it's no big deal, 4-6 weeks of limited weight bearing (crutches and then later, a cane). The papers he sent me don't give a lot of specific information, so I think recovery varies from person to person depending on the healing process. They do say I won't be able to drive for 2-5 weeks. Also, I live on the third floor and there's no elevator, so I'll have to make it up and down the stairs on my crutches.

I'm lucky to have a fairly large support network so even if I'm essentially housebound I should have visitors to help me out with the essentials. I can stay with family and friends, but everyone I can stay with is either allergic to cats or has dogs, so I can't bring my kitties. I can have people check on them but they are so social I don't want to leave them at home alone for too long. Besides, don't you just want to be at home sometimes?

So what's your problem anyway?

2007-08-08T21:18:00.000-07:00

Good question. As I said in The Back Story, I have Avascular Necrosis (AVN), otherwise known as Osteonecrosis (ON). I think ON is the more modern term, although you hear AVN a lot too. Avascular=without blood, necrosis=death. So, in other words, the bone is dying because it's not getting enough blood. Osteo=bone, so osteonecrosis means bone death. Two names, one disease.

There are lots of risk factors for ON. An injury can interfere with the blood supply to a bone, which can develop into ON. Sickle cell disease and other blood coagulation disorders can make it hard for the blood adequately supply the bone. Many times ON patients have other serious problems like cancer, HIV, or lupus and the ON may be due to steriods, radiation or other treatments. In my case, I'm not sure why I have it. I took some steroids for allergies, but not the massive doses that most ON patients take. Heavy alcohol use can also cause ON, but I am (or was) a social drinker and not an abuser. Scuba diving is also related to ON. In my case, based on the timing, I think it was primarily the steroids and perhaps some sort of predisposition to it for some reason.

ON is most common in the hips. Most people who have it get it in both hips, unless it was due to an injury. The femoral head--the top of the femur bone in the leg which sits inside the hip-- doesn't have a great blood supply on a good day, so it's at particular risk. So if you hear me complaining "my hip hurts" and then "my leg hurts", it's not something new, it's the same thing. Sometimes the pain radiates down to just above my knee.

Speaking of pain--it sucks. I have heard that ON pain is as bad as bone cancer pain. Thankfully I haven't had bone cancer, so I wouldn't know. However, I have had a kidney stone, and the kidney stone was worse. Having said that, ON is no... well I want to say it's no walk in the park, but that's just sad because I really can't go for a walk in the park! I guess the best way to explain the pain is a general dull ache that makes it uncomfortable to sit, lie down, or exist in any position, which is made worse by standing up or walking. Oh yes--and then there are the occasional sharp, shooting pains when I almost trip over the cat or turn the wrong way. Before I knew what was wrong I was walking a lot more and some days could hardly get out of bed. I think the pain is still just as bad, but I'm walking less and taking pain meds, so there is probably less inflammation, and I don't feel as stiff as back when I was walking lots.

Chapter 1-The Back Story

2007-08-06T15:34:00.000-07:00

So here is the story.

About a year and a half ago, around April 2006, I started feeling some aches in my left hip. I was pretty healthy and was relatively active; I'd take the stairs instead of the elevator and walk rather than drive, if it wasn't too far or too hot. I thought the hip pain was probably related to some minor back problems, and that things were just out of balance. When the aches continued, I went to see my chiropractor who took x-rays and thought I had bursitis.

I finished my thesis in August and started an exciting new fellowship at CDC in September. I had wanted to work at CDC for a while, and these days the best way to get in is through a fellowship. For these reasons I decided to take the job, even though it meant a pay cut from my previous career as a flight attendant and purchasing individual health insurance. Fellows working at CDC, the nation's public health agency, have to purchase their own health insurance, and they don't have access to the federal plans.

Back in September when I started working, my hip felt okay. My friend Oscar (not his real name) at work says he noticed I had an "antalgic gait", but other people just asked why I was limping.

My hip pain seemed to be getting worse. I was tired of people asking about my limp, and a new chiropractor and acupuncture weren't helping. Finally I went to see an orthopedist who took an x-ray. He took one look at it and said "You have avascular necrosis" (also called osteonecrosis). He explained that the blood flow to the top of the femur bone (the femoral head) had been compromised, and that the part of the bone inside the hip was dying, and that there was no cure for this condition except a total hip replacement. He also told me about two other surgeries, a core decompression and a bone graft. Core decompression consists of drilling holes into the joint, increasing the blood flow. Bone grafts involve taking a piece of vascularized bone from the lower leg and inserting it into the hip joint. The doctor recommended I get a second opinion.

At this point I was totally opposed to the idea of surgery, because a bit of pain and a limp just didn't seem like enough to replace the whole entire hip. I started asking around for referrals and several people recommended the same person, Dr. Roberson. Dr. Roberson told me about hip replacements, and told me there wasn't much else that could be done for the left hip. He told me, as the first doctor had, that he thought I probably had avascular necrosis in the right hip too, but that it just wasn't showing up yet on the x-ray. My right hip had started hurting, but I was hoping it was due to favoring it while trying to stay off of the left one. Dr. Roberson did say there was a technique that could potentially save the right hip, but that if it was already hurting it was probably too late. He also recommended not doing anything for the left hip until it got so bad that I wasn't able to sleep, although he said he'd replace it now because my quality of life was already suffering.

I got an MRI and sent my x-rays and the MRI DVD to Dr. Mont, in Baltimore, who is an expert in osteonecrosis (hereforth referred to as ON). Dr. Mont will provide phone consultations to ON patients, since many physicians don't have a lot of experience with this disease. He called last Sunday--from home--and told me that the left hip would have to be replaced, but that the right hip could potentially be saved with a core decompression (CD). However, there is already a fair amount of damage and he felt that this surgery should be performed as soon as possible--as in, within a week! I had already scheduled an appointment with another surgeon to discuss the right hip but I couldn't even see him until mid-September, so I was sort of panicky about how to get this done quickly. I told this to Dr. Mont and he said "well, I'll do it", but that just seemed overwhelming--how to get the insurance approvals, how to get to Baltimore, does he really have room in his schedule, etc...

First thing Monday morning, as soon as I got to work, my phone rang. It was Dr. Mont's secretary telling me that I had an appointment for a CD on August 13, in one week! So I'm busy getting ready, trying to think of things that need to be done. Mom and Dad and I are driving up Sunday as soon as I wake up, and starting to head back Tuesday assuming I feel well enough. Wish me luck!