A Hard Beginning Maketh A Good Ending.

It has been a while since I posted last and I think you are due an update. As there are several months to cover, I’ll provide a little executive summary first.

· My new right hip is doing great and I have almost the same range of motion as before.

· Laura Beth started her medical residency at Brigham and Women’s Hospital in Boston in August 2010 and I spent my third year studying at Harvard Law.

· I graduated from Emory Law in May.

· I finished my final chemo treatment ever in August.

· I took the MA and GA bars at the end of July and find out my results at the end of October and beginning of November.

· I’m now clerking for a bankruptcy judge in Atlanta and flying to Boston about every other weekend. This is my dream job out of law school, albeit in the wrong city.

· My old left hip is starting to collapse as well, and I’m looking at having it replaced this upcoming summer. I’m not on the cane yet and have been getting by on a few ibuprofen a day.

The road to recovery with my new, titanium right hip has been an interesting one. I am incredibly grateful to have done my surgery at Emory, which has a dedicated orthopedic hospital and a staff that deals with joint replacements every single day. When I experienced pain, I trusted the physical therapists and nurses that it was a ‘good’ pain and that I wasn’t stressing my new joint too much. In comparison, I moved to Boston about six weeks after my surgery and continued physical therapy at the Brigham. I consider the hospital one of the best in the country, but it was hard at times to fully trust the physical therapists, knowing that they didn’t see joint replacements day in and day out like the PTs at Emory did.

However, by the time that I moved to Boston, I was well on the way to recovery and most of my physical therapy consisted of walking up and down the two flights of stairs in our house (something LB considered a burden for me, but was key to my recovery) and taking Bailey for walks several times a day. Even though I travelled with my walker, I ended up never using it in Boston, resorting to my cane to get around.

I started at Harvard Law a few weeks later, in early September 2010. It was a fabulous experience. When people ask me to describe what it was like, I explain that the same law was taught, often using the same books. The students were no more intimidating than at Emory, and while I met some incredibly smart people, I also heard some of the dumbest comments ever made in a classroom; essentially, the bell curve of intelligence was shifted slightly up. Academically, I found that I fit in very well, achieving High Passes (Harvard’s version of an A) in several classes. The two biggest differences between Harvard and Emory is the endowment and the opportunities afforded the school. Because HLS is such a large school, north of 1800 students, and because the school has so much money, niche classes, such as “Lawyering for the President,” may be offered. In addition, the Harvard name opens certain doors. During the winter term in the month of January, students have the opportunity to work on Supreme Court cases, spend time in Silicon Valley, or travel to Africa to work on legal projects. Needless to say, I did my best to take advantage of as many opportunities as I could this past year.

In May, I graduated from Emory Law and started preparing for the MA and GA bars. This involved studying primarily Georgia law and trying to learn the few key differences in Massachusetts. I took the GA bar on a Tuesday and Wednesday at the end of July, and then flew to Boston Wednesday night to take the second day of the MA bar Thursday morning (day one of the MA bar being a multi-state test that I took in Georgia that Wednesday). Needless to say, I was pretty exhausted and ready to be done studying. Unfortunately, I wasn’t quite finished yet, having to take a national ethics exam, the MPRE, the next Friday, an exam that most law students take prior to graduation but that I was unable to take due to recurring conflicts with my treatment. I spent the next week taking advanced sailing classes in Boston Harbor during the day, and studying for the MPRE after dinner. Sailing in Boston is fantastic, and part of the tuition for the classes included a month membership to the sailing club, which allowed Laura Beth and I take a 34-foot boat out a few weekends in August and sail around the harbor islands. We’re now planning to charter a sailboat in the Caribbean during her June vacation.

The week after the MPRE was also a pretty big event (which may be the understatement of the year). Within a week, I took two bar exams, the MPRE, and had my last chemo infusion EVER. After almost 3 years and 5 months, innumerable sticks and pokes and prods, and countless pills and infusions, I was finally done with my chemotherapy treatment. When I told people this, the response was often, “really? I thought you finished like two and a half years ago.” Well that was my intensive chemo (read: hair falling out and me puking everywhere). The chemo I just finished was the maintenance chemo that, studies have shown, help keep the cancer at bay by providing a constant minimum ‘pressure’ of chemotherapy for a period of time. But no more. When people asked how we celebrated, I’m afraid my answer is a little lame. I came home and slept and did nothing for a few days. I was just so exhausted from the constant emotional strain of studying and pushing myself to the limits because of the exams, and to have that capped off with a chemo infusion, I was ready to just sit on my ass. I think Laura Beth and I went out for sushi, not to ruminate on all that we had been through the past 3.5 years, and the stress I had put LB through while studying for the bars, but on our future, now that we were finally in the next stages of our lives in so many ways.

During the summer, I also managed to lock down a clerkship with a bankruptcy judge in Atlanta. The clerkship has been an absolutely amazing experience thus far, and I am grateful to be in bankruptcy, a field that I want to specialize in. Flying back and forth to Boston can be wearing at times, but Laura Beth does not have every weekend off, so we make the most of it and get to see each other on average every other weekend.

Finally, my left hip has started to collapse even more, pretty much ensuring that I’ll have to have the left one replaced as well. I am not yet on a cane again, but I am starting to have to take ibuprofen at least once a day and sitting for long periods causes my hip to freeze up and make it painful to walk immediately after I stand up. I’m eyeing having the surgery done next summer, but I’ll have to see with our schedules.

I realize this has been a really choppy and disjointed update, but there has just been so much information to cover that I really can’t cover everything in detail. Hopefully I’ll have a chance to update you further about what has been going on and what is next for us.

First Steps

It's been thirteen days since my surgery and I've made (figurative) leaps and bounds since the surgery. Today I walked nearly a mile and have little to no trouble going up and down stairs, getting in and out of cars, and getting in bed. I am still on a walker for the majority of the time, but am able to use a cane to navigate crowded spaces and narrow passages (it turns out that the doors to 2/3 of the bathrooms I use on a regular basis in my house are not wide enough for a walker to pass through). It would be nice to move to a cane this week, but that won't happen until I can walk with a normal gait with my cane.

Below is a video of my learning to walk again.

If the above video doesn't work, try clicking this link to see a video of me taking my first steps.

I have been to physical therapy twice so far, but have been doing exercises they sent me home from the hospital with twice daily. I was surprised at how little I would have to go to PT but they said how many times you go to PT a week depended on your initial strength and that the daily exercises are where you see most of your progress.

In terms of pain, I have gone from 10 hardcore painkillers a day the first week after surgery to about 1.5 pills split up throughout the day. I hope to soon move to just Alleve as the oxycodone causes pretty serious drowsiness.

The range of motion of my hip is getting better and better. I don't think it'll ever be 100% back to what it was when I had a normal hip, but so far I have not encountered very many situations that I cannot get my hip in and out of.

There are 3 rules that I must follow for 6 weeks to prevent a dislocation or other catastrophic issue with my hip: 1) don't bend hip past 90 degrees, 2) don't cross my legs, and 3) don't turn my right leg inward (don't move my right leg in front of my left, don't rotate my right foot in too far, etc.). It has been easy remembering not to bend over, but remembering which way I can and can't turn my hip and not being allowed to cross my legs is really tough. To help get through the day with these restrictions, they sent me home with several tools. These aren't my exact tools but its the best I could find on the internet. The tool on the far right is this multi-use tool. I use it to put on and take off clothes, hook and pull things around the room, and in a sign of ultimate laziness, use it to reach the fan switch by the wall next to me like some bed-ridden obese person (it usually involves me banging it up and down against the wall until the switch turns). On the bottom is a luffa, which is just fabulous to use. Then above that is a grabber for when I drop things (which happens, A LOT). The thing in the middle is a sock putter on-er. Slide the sock on the right, slip your foot through on the left, pull the webbing and BOOM, your sock is on. It'll blow your mind. Finally, the elastic bands are to replace my tennis shoe laces. Yes, I now have new balance slip on shoes.

My long-term game plan is to fly back to Boston on July 30 with my friend Adam who will help me corral Bailey into a crate and wheel both Bailey and I through the airport to our flight. He'll stay for the weekend and then head back to Atlanta. And for me, I will continue PT in Boston. By that point, I should not really be using the cane anymore and should likely be going more much longer distances on the bike.

Oh, and one last note: one of my requests of the doctor came true. I asked the doctor to make me taller and it turns out that I'm about 1/4 to 1/2 inch taller on my right leg. They warned me this would be a potential side effect as placing the hip is more of an art than a science and is only an issue if I have my feet right next to each other (causing me to bend my right knee).

Quick Post-Op Update

I apologize beforehand for any ramblings, misspellings, etc, as I am still on some good painkillers that make me a little loopy.

My total-hip replacement surgery on Wednesday went extremely well. I had some nerves leading up to the procedure-the surgery, in the end, is elective and there was still a tiny nagging feeling questioning whether what I was doing was the right thing.

I made several requests of the doctor, all of which were immediately rejected.

1) I wanted to keep the femoral head to turn into a cane/keep in a jar/etc. No luck.

2) I wanted Dr. Roberson to make me a few inches taller, but with the left leg remaining the same length this would pose problematic.

3) I wanted photos of the procedure. But still, no.

All of that aside, my physical therapy has progressed nicely. The afternoon of my surgery (yesterday), I stood up and walked a few steps forwards, back, and side to side. Today, I walked down the hallway and up and down two flights of stairs. I also learned how to use the sock-putter-onner and the grabber, among other interesting 'life assistance devices.'

It looks like I'll be able to go home sometime tomorrow. There are several criteria that I must meet before being discharged (go up and down stairs, get in and out of bed, etc.) but I have a low grade fever (which is apparently very, very common post-surgery that they want to keep an eye on.

I'll try and update more soon.

Brief Update

I realize that it has been over 3 months since my last post and a lot has occured since then. I'll have to resort to bullet points to quickly cover everything and prevent this post from turning into a manifesto.

• My right hip. After meeting with five different orthopedic surgeons in Atlanta, I chose Dr. Roberson to perform the total hip replacement on my right hip. He is the chair of the orthopedics department at Emory and comes highly recommended. I scheduled the surgery for July 7 (unwittingly, on my brothers' birthday), and will spend one or two nights in the hospital before returning to my mom's house to recover for a few weeks.
• My left hip. Since finding out I had avascular necrosis in my right hip and that the head had collapsed, leading to the need for hip replacement surgery, I have learned that my left hip is also affected. After the first diagnosis on my right hip I had them perform a CT scan on my left to check for similar signs of degradation. The scan revealed that most of the left head is affected and, unfortunately, is currently in the process of collapsing, which is a quite a painful affair. Based on the rate of deterioration and pain level, I will likely try and schedule my left hip to be replaced during Christmas break, and hopefully LB will be able to get time off during the recovery period.
• LB's graduation and medical residency. I have to brag on my wife (and I am sure that I will pay dearly for this later). LB graduated summa cum laude from Emory Medical School this past Monday. I, and the rest of our families, are incredibly proud of her! Match Day occurred on March 18 and LB matched at Brigham and Women's Hospital in Boston, MA in the internal medicine-primary care program. BWH is a Harvard-affiliated hospital and LB's program has a strong focus on developing the future curriculum for residency programs and medical schools and is big on having its former residents 'spread the gospel' to other hospitals.
• My third year of law school. As we are moving to Boston, I will be spending my third year of law school at Harvard Law School as a visiting student (akin to studying abroad). My degree will still come from Emory Law, but I am thrilled to be gaining 1/3 of my legal education from Harvard Law. Classes do not start until the beginning of September, which will give me about 2 months to recover after my hip surgery before attending classes.
• Our place in Boston. LB spent her spring break in Boston with my mom, scouring the local real estate high and low. On the last day, they finally found a suitable apartment that allowed dogs (a HUGE hanging point at most apartments). It is a 2 bedroom unit up a two-story walkup (which will be a challenge immediately before and after my surgery). We are actually living in Brookline, which is a little suburb of Boston. LB's commute is about 15-20 minutes by train and is walking distance in the event of a blizzard, flood, etc. shutting down public transit. Harvard Law is about 40 minutes to Cambridge by bus or train, which is a longer commute than I would have liked, but I think I am making up for literally living across the street from the law school this past year. Our place is in a 3 unit brownstone building in a really neat part of town. There are great restaurants walking distance, as well as a Trader Joes and it has a little dog park across the street for Bailey. Link to map. One of the most exciting features is that it is a straight shot down to Fenway Park; keep that in mind as we will always be open to visitors (seriously)!
• Moving. LB and I are leaving for Boston June 6th and plan on being there when the movers arrive June 8th. Her residency starts June 15. I, unfortunately, must come back to Atlanta as I have a summer internship in the legal department at Piedmont Hospital reviewing and drafting contracts and research agreements. It is a really interesting job and provides transactional experience, which is what I am interested in doing in the long run. After my surgery at the beginning of July, I will spend a few weeks recovering at my mom's house and hopefully be in Boston by the end of July.

One More Bump in the Road

There's a rug in our bedroom that Bailey always slips on and Laura Beth and I always laugh at the fact that no matter how many times Bailey slips and falls he has yet to learn that if he runs through the bedroom he will fall on the rug. You would think that in my constant mockery of Bailey and his inability to learn, I, myself, would learn this lesson as well. You would be wrong. About four months ago, I was playing with Bailey when I ran away from him and into the bedroom where I slipped and fell directly on my right hip, leading to a nasty bruise and a serious limp.

With all of the drugs that I am taking for the maintenance part of my treatment (5 drugs and between 7 and 21 pills a day), it is inevitable that I will experience some side effects.

I've seen mood swings, had aches and pains and been inexplicably exhausted, but everything has been manageable. Unfortunately, I have become familiar with one particularly nasty side effect from taking steroids: avascular necrosis, which is a disease resulting from the temporary or permanent loss of the blood supply to bone. Without the continued blood supply, the bone tissue dies and the bone collapses.

From what we can piece together, my fall in October acted as a catalyst for avascular necrosis (AVN) to set in on my right hip, made became susceptible to AVN through my steroid use. (click for a gross image of a hip joint from wikipedia.) Here's how AVN works: Picture a smooth ping pong ball.

That is your hip. Now take your thumb and make a dent in the ball. That is my hip with AVN. While a normal ball would move smoothly around the hip joint as you walk and move about, my dented ball catches and pops. In addition, as I continue to walk on it, more and more of the joint continues to die, as if you continued pushing on the edge of the dent in the ping pong ball, causing the dent to expand resulting in more of the ball collapsing on itself. Now, a protip is that a dented ping pong ball can be placed in boiling water for a minute or so and the internal pressure of the ball will pop the dent out. Unfortunately, there is nothing as reliable a solution for my hip. The orthopedist listed several treatment options: drill holes, drill holes and insert dead donor bone, drill holes and insert live bone from elsewhere in my body. All of these have the goal of encouraging bone growth so as to reinforce the joint. Unfortunately, when there are so many treatment options it often means that none of them are very good and they are all designed to delay the inevitable: a total hip replacement.

At some point in the future I will have to undergo a total hip replacement. The orthopedist said that based on my MRI 30-40% of the ball is affected. What that means isn't very clear. Will I be able to make it six months? A year? Two years? It all comes down to the point where the pain is severe enough that the pain meds (and accompanying side effects) are more of a burden than undergoing surgery.

Right now I walk with a fairly noticeable limp that becomes more apparent when I walk up inclines. I can get around fairly well (a recent trip to NYC was a little daunting, but mangeable), but the doctor wants me to take pressure off of the hip to preserve it for as long as possible. So right now I'm in the process of finding a cane that I like. I don't want to use one of those adjustable height canes from CVS; I want something with personality. Whether it has a hidden flask or a sword I have yet to decide.

This is a frustrating experience for several reasons. First, I felt like I already had my "life's not fair" moment. I guess the truth in that statement is that life truly is not fair all the time and is susceptible to multiple "life's not fair" moments.

I also worry about the long term care of an artificial hip. Also, artificial hips right now last 10-20 years. That means that by the time I (hopefully) reach my 80s, I will have to undergo 3-5 procedures to replace worn parts. I realize that a) these 'upgrade' procedures may not be as intensive as the initial procedure and b) they are constantly making improvements to hip replacement hardware to the point that they may develop a method that lasts 30 to 40 years, eliminating any future upkeep. And I've heard plenty of anecdotal evidence of people who were walking the next day (albeit w/ a walker) and better than ever a month after surgery. But there is a strong likelihood that at some point they will have to take out all of the hip hardware and replace it, and the recovery from such a procedure is much more difficult and a much rarer procedure (i.e. doctors have not performed many of these procedures because only now are patients outliving their hardware).

My lifestyle has also been significantly impacted. I have to limit any impact activities now to limit further deterioration of my hip, and post-hip replacement I will have to continue to limit such activities to prevent premature wear and tear upon my hardware. This means no more running or any activities that involve running, such as tennis or simply running around the yard with Bailey. I also have to avoid sports that could lead to banging my hip around, such as skiing (both snow and water). As you can see, this leads to quite a sedentary lifestyle outside of walking and using an elliptical. I also won't ever be able to achieve my goal of joining the NFL. Alas.

To top it all off, it is not as if the AVN resulted solely from an injury and is limited to my right hip. There is a slight chance that I may have AVN in my left hip as well that has not materialized yet - a ticking time bomb, if you will. I have an MRI coming up of my left hip to determine whether or not it is affected as well.

I've scheduled several second opinions to see what options they recommend, but from what I have heard and read already, their advice is not going to differ drastically from what the orthopedist at Emory has laid out.

I'll keep y'all updated.

No News is Good News, Right?

It has been 150 days since my last update but things have been going really well since. I have continued on my maintenance chemo which consists of two pills a day, 14 pills every Wednesday, one infusion through an arm stick a month, and five days of steroids each month. This lasts for two years (so ~1.5 years left). It sounds like a lot, but compared to the number of drugs I was on this time last year, it is something that I am definitely willing to deal with. There have been very few side effects, which has been a relief.

I finished up school about a month ago and received my grades this week. I was worried that after essentially taking a year off from law school and being loaded down with some pretty intense drugs that my grades this semester would suffer. Fortunately, that was not the case as I did extremely well; better than my first semester, in fact. I put a lot of the credit on both my 2L friends who provided me with a lot of resources from last year and my 1L friends in my study groups who kept us chugging along.

As many of you know, my nuptials to Laura Beth are two weeks away! We are extremely excited, though very busy trying to polish out the last few details. The last 5% of the wedding planning is the hardest part, I would have to say, as it is so detailed oriented. We are getting married at Lake Toxaway, NC on June 20th and then heading to a tiny island off the coast of Belize. When I tell people that you stay in little cabanas open to the sea breezes, they either recoil in horror at the thought of only staying cool via fans, or their eyes glow imagining the tropical nature of the island. LB and I think about the latter. (and after sending almost an entire year trying to stay as sterile as possible while my counts were low, it will be nice to get a little muddy on vacation.)

In terms of what I am doing this summer, unfortunately, two opportunities fell through at the last minute, which has left me recently without a summer job. This is where I put in my plug (it is my blog, anyways): if you know of any full or part-time job opportunities that have a legal slant, would you please let me know? Right now, getting some good work experience is much more important to me than getting a pay check, so I would be willing to work for free.

I will post again in about 3 weeks after the wedding and honeymoon and put some photos up as well!
Take care!

PET scan results

Today the nurse emailed me the results from my PET scan yesterday. She said that the scan was really good and that there was "no evidence of disease" in the scan, which is amazing.

I still have to go through the maintenance chemotherapy, which includes 1 infusion / month, 1 spinal tap / 3 months, 5 steroid pills / month,and 1 chemo pill / day. I started the maintenance yesterday with a spinal tap and infusion which went pretty well but still kept me out of school today.

That leads me to my other point of this post: that I started school on Tuesday. I have four classes a day which is a pretty intense schedule, but only have class tuesday, thursday and friday. It felt amazing to be back in school, even if I had technically already heard all the lectures already.