Saturday, August 25, 2007

The Backstory

Let's set the stage for this hip story. This will be a longish post, intended to let you compare yourself to my case to see if anything jives. If you're more interested in the surgery and the aftermath, you might want to skip this too-much-information report!

I'm a 51, male, and a college professor. To counteract the sedentary lifestyle, I try to road bike 4000 miles a year, which between travel and meetings, and the darker winter months here in eastern Pennsylvania, is about all I can manage if I include trainer mileage and can throw in some longer summer rides. I love cycling, and given the state of my knees (and hips), it's the perfect exercise. I've never raced, but I try to average 15 to 17 mph on the hilly rides around here, which I'm proud of even if it's a snail's pace for really good riders. All the riding allows for robust eating and the chance to work out the tensions that accumulate at work (even professors bear their crosses...). I'm 5'10", and seasonally fluctuate in weight between about 202 and 212 pounds with a fat content of about 25% (at least according to a Tanita scale in standard mode). (I told you this post would be boring!). The other reason I try to keep active is that for quite some time now my research has involved field work in the Himalaya and Tibet (see www.ees.lehigh.edu/groups/corners), and even in teaching we lead field trips, so being fit is important professionally as well as personally.

As I recently learned, I have mild dysplasia in both hips and considerable osteoarthritis, partly as a result of the dysplasia. The angle of my femoral neck is also quite shallow. Before my hips became the main focus of my joint discomfort, I was more worried about my gimpy knees, which are missing some ligaments due to untreated ultimate-frisbee accidents in grad school and in retrospect, too much jogging and running (leaping down trails in the Presidential range; humping out heavy packs of rock samples, all the dumb things we do when young...). Interestingly, I've been told by my doctor that the state of your knees is pretty much your fault, but for the state of your hips you can blame Fate.



It's hard to know when the hip pain began. Probably about 7 to 8 years ago I started noticing stiffness in my groin and my thigh after a hard day trekking. Also, standing or shuffling about, like at art museums or during poster sessions at professional meetings, really started to hurt to the point where I was starting to avoid such events. But biking did not cause pain, leading to awkward explanations about why I could happily ride 50 tough miles, but would start whimpering if threatened with a visit to MOMA.

About three years ago, a sampling trek in Tibet went wrong: we thought a route might gradually head up a glacial valley, but instead went straight up a vegetated cliff. It was a desperate few hours, requiring big lunging steps and unforgiving foot placement, and by the time we got up and then back down, I literally could not walk due to the sharp hip pain. When I returned to the US I saw my GP, and she diagnosed osteoarthritis. She put me on two forms of Diclofenac (Voltaran and Cataflam). It was a miracle: little pain, much improved range of motion, and I could ride my bike or play 18 holes of golf walking and carrying my clubs.

Time passed, and gradually the NSAIDs weren't working as well. Walking a round of golf was a crap shoot in terms of pain, I was avoiding museum-type standing, and meanwhile I was wondering about the long-term wisdom of eating the Diclofenac twice a day. In late 2006, at the end of the bike season I noticed that at the end of longer rides I was feeling very sore, and I was backing off agressive attacks on rises and hills. When the 2007 season started, the soreness was still there, but worse.

Then in May 2007 I went to a conference in Hong Kong, and it was nearly a disaster. Getting off the long flight, I could hardly get through immigration, and the daily walk to the conference and the standing around were just crushingly painful. When I arrived back at O'Hare, I honestly thought I would have to declare a medical incident and ask for a wheelchair to get to passport control. In the weeks that followed I could only walk with a painful and obvious limp. When I tried to ride, anything more than 10 miles left me very sore, and I couldn't push any power through my left side. The pathetic finale on June 18th was an attempted 15-mile ride where I got caught in a thunderstorm just as my hip gave out: I bailed, and crept home in a downpour, trying to spin granny gear long enough to get home.

I revisited my GP, who had me go for X-rays, and after seeing them, said she was sorry, but really the only thing to do was to see an orthopedic surgeon.

No comments: