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.