How It All Began

My right hip aka "the asshole." I know this
might be confusing, as hips and assholes
are close together, but in this case I mean the
insulting nickname, not the body part.

The Saga of My Hip
A Novella

I started noticing problems in my early twenties. I’d always known my right leg was pretty crooked, and it’s never been particularly flexible. I discussed the ache with my chiropractor at the time, and he did some adjustments on me periodically that seemed to help.

The pain wasn’t terrible for the first several years. It was a nuisance sometimes, but somehow I blocked it out. I had other things to do - law school, building my law practice. And somehow, I just “got used to it.” It’s almost like it crept up on me. I am also, I confess, deathly afraid of all things medical related. I wasn’t able to get an injection or a blood draw without panicking til I was 25, and anything more than that still causes me to hyperventilate and see spots dancing in front of my eyes. I’ve worked really hard to overcome that, and I’ve made a lot of progress (of which I’m proud - so don’t tell me to toughen up, because I have, even if it doesn’t sound like it) but it’s been a struggle.

So, I’d talk to the occasional doctor about my pain, but the pain wasn’t stronger than my fear until a few years ago.

A few years ago I met with an Orthopaedic surgeon to start figuring out exactly what was going on in there. X rays revealed I had something happening, including an impingement and a tear in the labrum, as well as some arthritis. An MRI further revealed a bone cyst and bursitis. That doctor told me, though, that from what he could see, none of those conditions were severe enough in my case that it could cause the level of pain I was claiming. He wanted more testing. But he also didn’t seem super convinced of my levels of pain, and preceding the last test he wanted before I walked away from him, he said “well I’m 99% sure you don’t have a stress fracture, but I want to do a CT just to be sure.”

This was after 8 months of visits, x rays, and tests, and a cortisone shot that relieved my pain for several months, but which also cost me $1800 out of pocket, even with insurance. I started looking back at all my medical bills - the multiple x Rays, the MRI, the cortisone shot - and just felt like I was paying an awful lot of money for something he was 99% sure wasn’t the case.

I started to feel kind of hopeless at this point. I’m on an HMO. So, the thing you may not know about an HMO is that it can be EXTREMELY limiting on the doctors you can see. Your network can be super tiny. Mine is. If I want coverage, I am stuck with one particular set of doctors in one particular hospital. As a self employed individual, I pay for my health insurance out of my own pocket. Unless I want a premium of over $1000 a month, I am stuck with an HMO. This doctor, and the other doctors in his practice, was my only real option in my network.

So, I did what any self-respecting adult does when confronted with a hopeless situation: I went and cried to my mom.

The thing is, my mom knows a lot of old people, and old people have all kinds of problems - knees, hips, all of it. Two of her friends had recently seen a doctor who had achieved amazing outcomes when it came to their hip conditions. So, we decided to give it a try - yes it’s out of network and yes it’s out of state. But I really wanted to talk to someone who might have answers.

I met with Dr. Yao’s physician assistant a few weeks ago and we got an updated X Ray. Right there in the office, she informed me I had an impingement and a tear in the labrum - information I knew. I relayed to her that my previous doctor had said it wasn’t severe enough to cause the pain I was in. She gave me a look of “um are you serious?” But outwardly said that perhaps his process was different, but they wanted to do an MRI with injected dye contrast. That would reveal a lot more details. She explained that if my cartilage was still in good shape, they might be able to do a repair of the labrum tear and the impingement, and it could give me a lot of relief. But, if the MRI showed more damage to the cartilage, it’d have to be a replacement.

We scheduled the arthrogram + MRI. There was even some suggestion my insurance might apply - ultimately, it didn’t. But we went ahead with it.

The arthrogram is conceptually neat. But, to a needle phobe like me, it was hell. They have a real-time X-ray machine going, where they monitor the process of STICKING A GIANT NEEDLE DIRECTLY INTO YOUR HIP JOINT AND PUMPING IT FULL OF DYE AND SALINE. They numbed me with lidocaine first, but I still felt parts of it. Let me tell you - my body knows when stuff is supposed to be in there, and when stuff isn’t supposed to be in there, and I was actively fighting my brain screaming at me, “INTRUDER ALERT, INTRUDER ALERT” the whole time. It was a five minute procedure. Afterward, I had no blood in my face and my hospital gown was soaked in sweat. That said - I did it. I held myself there, I breathed, and I hummed “The Scotsman” the whole time to distract myself. The people doing the procedure smiled at me and told me my humming was much nicer than the swearing they are used to.

My brain got me to the other side of the injection quickly. After about ten minutes of Sprite and breathing, I felt immensely better and shuffled into a 30 minute MRI. Honestly, that was more painful than the shot. My back and hip were on fire after not moving at all for that long. The MRI technician gave me a 10 out of 10 for my ability to lie completely still. I guess not everyone is as lazy as I am.

This morning, I met with Dr. Yao to interpret the MRI. He came in with two packets of paper. One described the process of impingement repair. The other described hip replacements.

We talked for about fifteen minutes. He asked me about my process with my other doctor, and about my pain, and about my range of motion. As we talked, he gave me an apologetic look and said “I’m sorry, but I have to take this packet away.” He pulled back the packet about impingement repair. He pushed the one about hip replacement in my direction.

He explained that I have areas of bone on bone. In fact, the constant grating has lead to some stress fracturing in some areas. The fact that it’s progressed to this point means I don’t have tons of options.

It would be feasible for me to do a cortisone shot every three months. I responded well to the first one. Some people do that for years. The thing is, imagining going through that every three months for several years... it wouldn’t be reasonable to put me under anesthesia every time. But being awake for it, like I was for the dye injection, is something I just can’t imagine.

So. Hip replacement. The thing is... I’m young. A hip replacement for me is not the same as a hip replacement for someone over 50. I’m going to be more active, just by my very nature. A 35 to 40 year hip replacement for someone 50+ is more like a 25 to 30 year replacement for someone like me.

However... the good news is, new technology has made replacements with some modular components. Whereas someone like me might have had to have multiple full replacements during a lifetime, leading to longer recoveries each time, and more bone being worn away each time, now they have units with components that can simply be swapped out. As Dr. Yao put it, it’d be more like just having to go in for an oil change after 30 years rather than a full engine replacement.

So. In a nutshell. I’m going to have a hip replacement sometime within the next year. I’m not thrilled. It’s scary. I’m frightened. I’m angry. I’m wishing past Stacy had gotten over her fear faster and perhaps tried to get something done before it got to this point - but, ultimately it’s a degenerative condition and I would’ve had this all eventually anyway. But. At least I have my answers. And a direction to go in. Now I just have to keep going, one step at a time.