Berkshires, Food & Drug Administration, Hip Replacement, James Howard Kunstler, Johnson, Medicine, pain, Rolfing
My Hip Replacement Operation by James Howard Kunstler.
My Bad Hip – A Melodrama in Three Acts – With Additional Notes
by Jim Kunstler
Act I – Onset of the Condition
When animals feel crippled or wounded they usually crawl off to some quiet corner to await resolution, one way of the other. Since they do not think abstractly, something like depression of the spirit must prompt them to do so, and that preconscious mechanism pretty obviously still exists in humans, too. So when the pain in my bum hip insidiously presented itself, my automatic response was to slide into depression — that is, I wanted to crawl off in a leafy hollow and die.
It became the baseline of my existence,and though I was able to rise above it as occasions presented — dinner parties, public lectures, holidays — I had entered a dark zone of the spirit that would oppress me daily in a thousand small ways until the day of surgery.
My best guess as to how I wrecked my hip is twenty years of jogging on pavements, running the city streets around Saratoga. I loved running. I loved the endorphin buzz, I loved seeing the small sights and dramas of town life as I trotted around, I loved feeling strong and fit, and I loved the rewarding aftermath that always featured a shower and a stiff drink.
But around the fall of 1998, my hips and lower back ached noticeably after every run. I decided that I might have strained some muscle group and ought to lay off for a period of time to see if it might heal. So I did. When I resumed running two months later, the pain returned, so I quit again, this time, it would turn out, for good.
In the period after I quit running, I sustained two injuries. One was in a car crash on the Mass Turnpike. I spun out on black ice in the Berkshires and rammed a guard-rail on the driver’s side, front quarter panel. There was a dent inside the door where my body had slammed into it. At the time, I was much more concerned with the condition of the car — could I make it home? — than with my own body, and had no particular awareness of being injured.
Not long after that, I was tossing a frisbee with a friend on a Caribbean beach when I tripped over an exposed coral head, flew ass-over-head, and landed on another coral head precisely on my left hip — a classic “hip-pointer” as the footballers say. The blow really rang my bell, but I eventually just walked it off and never had it checked out.
A month or so later, I was puttering around the mud room at home when I turned a certain way and a very sharp knife-like pain, of a new and impressive kind, ran through my left hip. It left me breathless for a moment and I remember thinking that I had crossed a definite threshold into the realm of serious injury.
That was about two and a half years ago. Day in and day out after that I was conscious of being injured. I did not go to an orthopedist, though. Instead, I roamed through the margins of medicine (and beyond), seeking relief in every and any “alternative” practice that held out a shred of hope.
I tried a nutritional approach, a year of glucosomine and chondroiten, MSM (methylsulfatemethane) a touted arthritis cure. Neither helped.
I got “Rolfed.” Rolfing, named after it’s originator Ida Rolf, is a kind of extreme deep massage that attempts to separate the muscular fascae. These fascae are a thin film (like you see on large cuts of beef or lamb) which surround individual muscles and allow them to slip and slide over each other as they work in groups. For example, you have the glutei of your ass working in a group that also includes the hamstrings, and abductors and so on, and they need to slide easily over each other to perform the fine modulated tasks of daily life — getting out of a chair, climbing stairs, et cetera. The Rolfers say that that as we age, the fascea loose their slipperiness and movement is therefore impaired. So they go in and pull the muscles apart and attempt to restore slippery movement to these fascea.
Well, I found a gentle soul named Luke, who practiced in our area and he worked on me for ten sessions — muscle group by group — at fifty bucks a session, which seemed fair to me. At the end I perceived that I felt “better” in some vague way, but the core problem remained unresolved, and within a few weeks I was back to feeling crippled, hollowed-out with a strange relentless fatigue, and melancholy in spirits.
I visited at least two chiropractors. The pain in my hip was a fugative kind. It sometimes radiated into my knee also migrated up into my lower back. The chiropractors essayed to loosen up my lower back. I ditched the first guy, Dave,because he didn’t spend enough time with me per session. The second guy, Matt, had a particular kind of table on which you lay face down while he rotated your hips on a sort of gimbaled lift mechanism. It always left me feeling better for perhaps half a day afterward and he charged thirty bucks a session. Matt was a winning, cheerful young guy radient with good health and I always got a buzz from being around him. But alas it was no cure.
The next guy I saw was a weird fellow with a bizarre practice. He billed himself as a chiropractor / kinesiologist, and I went to see him because he had a reputation among certain of my middle-aged male friends as a sort of healing wizard of the region. My first session with him was a long interview, at the end of which Wayne declared summarily that I was at once to give up eating all wheat and dairy products. Wow. Forever? Yes forever. That was a stunner. So I embarked on a half-year soy-based dietary adventure. Wayne also had a ten-session program in which he strapped you on a big rotating table (it could turn you completely upside-down) and waved little specimens of various substances — copper, barley, tar — while he applied pressure against the muscular resistence in your arms and legs. It is perhaps hard to picture what I am describing. He would have you press your arm against his while he wielded a little glass vial of something-or-other. It was extremely queer. During the performance — and in retrospect it was clearly a shamanistic act — Wayne kept up a rapid patter of information that was both abstruse and excessive so that you couldn’t really take in what he was saying. At the time I had a very vivid sense of being taken for a ride, but trusting soul that I am, I went through the whole ten sessions because I didn’t want to embarrass Wayne with my skepticism. Anyway, part of me was wishing for a miracle, I suppose. Total cost for Wayne’s ten ministrations: five hundred bucks.
I also stayed on Wayne’s extreme no-wheat / no-dairy diet — which perhaps shows how credulous and suggestible I am — but it did not prove beneficial regarding my hip-and-back pain and the associated fatigue and depression.
The next healer I found was a lovely peaceful lady who did both deep massage and cranial-sacral massage.The former was rather like Rolfing. She really dug in and manhandled the muscles. The latter, which I tried only once, was a weird matter of her holding the back of my head in one hand and the top of my ass (the sacrum) in the other, and making minute movements at each end. So far as I understood it — which was not far at all — the idea was to modulate or adjust the flow of some essential life force that ran like an electrical current between these two poles of head and ass. She was lovely and gentle and I always left her chamber in a state of elevated tranquility, but my back and hip pain and its entailments returned remorselessly within hours.
The last “alternative” or “holistic” practice I tried was acupuncture. This was administered by a female MD up in Glens Falls, who had one foot in the world of conventional medicine and one in the spooky realm. I had six sessions with her. She was very good at putting the needles in. I hardly felt a thing. (There is, after all, something off-putting about being used as a pin cushion.) She tried different deployments of the needles in each session, everywhere from my ankles to my ears. At several sessions, she hooked up some of the needles to a little battery pack, which sent an electrical pulse into the muscle. It produced an odd but not-unpleasant tingling sensation. Like all the previous methods, acupuncture left me with a temporary placebo afterglow which soon dissipated. It is a fact that I was on her table stuck full of needles the very hour that the jets slammed into the World Trade Center last fall.
During the year that followed, I gave up on alternative medicine and just plain suffered. We moved into another house across town in October of ’01, which required a lot of manual labor on my part, carpentry in particular. It was very painful to lift things up, carry heavy power tools and lumber up and downstairs, build bookcases, and work on things that required bending. I was also losing the ability to walk more than a few blocks at a time. During the winter I virtually gave up on cross-country skiing, a sport that had been a major winter social activity the past twenty years. My physical world was getting smaller.
During that winter also the picture of my true condition finally resolved. I could no longer evade the conclusion that my hip joint was shot and would probably have to be surgically replaced. The only remaining question: when?
It was a grim winter. No cross-country skiing, no skating, no long walks — all these things I loved so much. I could not drag myself out to the countryside with a French easel to paint — it was too painful to climb into the Carhardt insulated jumpsuit. My world got smaller and smaller, and, believe me, the alternative universe of the Internet was not an adequate replacement for the real world that I was losing.
These circumstances combined to put me in a really morbid frame of mind. The previous year I had nursed my mother through a two-month losing battle against pneumonia and emphysema, and by a weird happenstance my father had expired forty-eight hours before she did, far away in another city. My dog Chloe had died. Mortality was very much on my mind and I felt myself in the grip of that universal undertow that eventually takes us all away to the fathomless eternities. These things are not pleasant to ruminate upon if you are not a quantum physicist.
Finally, in March, 2002,I made the momentous appointment with the orthopedist, Larry Fein. He took a few x-rays and the problem was immediately apparent: osteoarthritis in the joint, cartilage worn away, bone spurs at the margins of the capusle. In short, enough to produce a painful and crippling condition.
Larry agreed that total joint replacement would be appropriate, but he had two reservations, both of them more or less pro forma: 1.) I was relatively young (53 then) for the operation, and 2.) that this procedure, like all major surgeries, carried the risk of death — something could go wrong, you could develop a blood clot, yadda, yadda. I sensed that No. 2 emenated from the physician’s liability insurance concerns.
A couple of weeks later, I went to Albany to get a second opinion from the region’s orthopedic eminentissimo, Dr. Marc Fuchs, who had operated on some of my friends. Fuchs’s opinion was that I was indeed a candidate for full hip replacement and that Larry Fein was “an excellent surgeon.” Thus I decided to go with Larry.
I sent Larry a letter saying that I was aiming at a fall surgery, around Halloween. I was facing a huge load of physical labor over the summer involving planned renovations to our lake house, and I was determined to carry it out on my last legs so to speak.
It almost killed me. Our place on Schroon Lake is accessable by boat only and, as we had over the preceeding three years, everything had to be loaded off our truck, into the boat, off the boat, and carried uphill to the site of our “camp,” as such compounds are called in the local vernacular. I’m talking twelve foot long two-by-twelves. Big lumber and lots of it. Not to mention the difficulty of working on a 45-degree slope. All very very bad for the hips. So, by the end of the summer of toting lumber, I was pretty well done in.
I coasted through the fall, flying around the country giving lectures — sitting on airplanes wasn’t so bad — and I spent a lot of time at the gym and in the pool, doing everything possible to strengthen my leg muscles before surgery. The last ten days, I gave two units of my own blood in anticipation of the gory operation. On November 6, I was ready to be chopped and channelled.
Act II – The Operation Itself and Its Aftermath
It is now four days since I was carved up like a Thanksgiving turkey in Saratoga Hospital and received a full hip replacement. Before the details fade, as grotesque experiences are apt to, I want to record them and with brutal thoroughness. So I will start in the middle of the story — the operation and it’s immediate aftermath — then work backward to the insidious onset of my condition, and finally catch up with the recovery process.
The day of surgery, November 6, I reported, as instructed, to the pre-op department at quarter to six in the morning. Jennifer, my wife, stuck around as long as she was allowed to. But once I entered the system things moved pretty swiftly. A nurse told me without ceremony to change into one of those backless hospital didey gowns. She put my street clothes in a clear plastic sack like a police evidence bag, gave it to Jennifer, and basically dismissed her. I was told to climb on a gurney. IVs were started in the back of both my hands. The anesthesiologist, Dr. Morber, materialized and asked me a few questions — was I allergic to latex, penicillan, etc? the surgeon, Larry Fein, popped by to say hello. It was obvious that he was briskly eager to commence the day’s business. Morber started the IV sedative, a cocktail composed, I think, of demerol, valium, fentanyl, and perhaps versed. The combo is devised to block pain, wipe out all anxiety, and induce amnesia of everything that follows until the operation is over and you revive in the post-op department — which is exactly what happened. I will however side-step a moment to give an extremely simplified account of the procedure based on what I learned after the fact.
A curved incision roughly ten inches was made on the side of left buttock. The muscles below, various glutei, were carefully sectioned and retracted until the head of the femur and the pelvic illium were accessed. The ball of the femur was sawed off, inspected, and disposed of. The pelvic socket, or acetabulum, thus exposed, was reamed and smoothed to receive the all-titanium replacement (no plastic liner, as has commonly been used until very recently). Then, a titanium ball at the end of a nine-inch spike-like post was fitted down into the femur (with the aid of hammers and chisels). The ball was inserted into the socket, the ligament “capsule” was reattached over it, the muscles were stitched back together, and the skin was closed with metal staples. A drain tube was left in the wound site to evacuate blood and lymph. It is a big, gruesome, buckets-o-blood, Grand Guignol type of operation. Anyway, I have absolutely no memory of being there.
So, I woke up in post-op minutes after the conclusion in strangely jolly spirits,with little sense of having been savagely sectioned and sawn. Dr. Morber, the anesthesiologist turned up. I tried desperately to clown around with him, calling him “Moby,” but he wanted none of it. My wife turned up, hung out, left, came back. I was hooked up to a morphine drip with a hand-held button — PCA, patient-controlled analgesic. I had little sense of time passing, but in fact I remained queued up in post-op for seven hours and did not get up to my room until nearly five in the evening. It was hard on Jennifer.
When I finally got up to the room, t he great pee crisis commenced. For some reason, I came out of surgery without being catheterized. I hadn’t had a pee since before six o’clock that morning. The nurse gave me a plastic jug designed for the male organ, but lying there in bed I just could not release the now-prodigous contents of my bladder. I assumed it was my fault, an extreme and unfortunate case of shy bladder syndrome. I did not learn until later that anaesthesia and morphine both tend to disable the urinary valve, and mine was paralyzed. I gamely and fruitlessly kept at it with the plastic jug quite a while longer, but nothing would come out. By 10:30 p.m. I was seriously concerned that I would explode and not only die ignominiously but leave a mess of shredded tissue all over the room when my bladder exploded, so I rang for the nurse and begged to be catheterized.
She quickly gathered up the necessary equipment and set about the procedure expertly. Two female aides watched her perform the procedure, and I was looking down from above. There was a real sense of theater about it. They have to thread the catheter tube through the urethra and then inflate a tiny balloon in your bladder to keep the tube from blowing out. I watched the two aides watching the procedure raptly.
“. . .okay, we’re passing through the prostate now. . . ” the nurse announced.
Strange to relate, it hardly hurt at all, and the successful result of the procedure was a loveliness so far beyond the known boundaries of the word “relief” that I entered a kind of near-mystical rapture. Over the next ten minutes, they collected over 2200 cc’s of pee out of me– more than two quarts — full of wonder themselves that such a thing could be.
You’d think I would have dropped into a narcotic slumber right away, but once the bladder emergency was over, I began to apprehend that I felt like I had a spear wound in my ass. The morphine, for all it’s vaunted pain-blocking power, had some nasty side effects. It dried you out so severely that you felt like your lungs were full of sheetrock debris. It gave you a flaming case of heartburn. And it made your head feel as if you had paint-soaked rags where your frontal lobes used to be. I didn’t like it at all and I didn’t push the PCA button many times that night. Sleep was just out of the question.
Luckily, I had a garrulous roomie, a 71-year-old retired machinist and short-order cook named Billy who’d had his left knee replaced an hour after me by the same surgeon, Larry Fein. He couldnt sleep either, for similar reasons, so we yakked all night about the old days in Saratoga (way before my time) when you could rent a decent apartment for $17 a month, and the mob still ran the posh supper clubs like the Brook and the Piping Rock, and a steak dinner was $1.75, and Billy kept a little12-foot racing sloop out at Saratoga Lake. Nowadays, with his wife dead two years of diabetes, Billy lived to play golf, five days a week in season, and he was looking forward to capital improvements in his ability to walk the links. We got perhaps ten minutes of febrile sleep in that first night, and anyway, the nurses barged in every half hour taking vital signs and so on.
The first full day was very rough. A kindly young male physical therapist turned up to get me on my feet and road test the new joint. After twenty-four hours on my back I was amazed just to be upright within the metal walker frame and then lurching forward. The new joint itself didn’t hurt at all, but the surgical wound sure did. I also got the idea that the surgeon and his crew had hyper-extended virtually every ligament in my left leg while flopping me this way and that way as they chopped and sawed away, meaning that all these muscles were more or less sprained.
The PT guy and I went about fifty feet down the hall and back. I noticed that my left foot no longer splayed out at a 45-degree angle. It now faced forward like a normal foot. Cool. But by the time we got back to the room, I felt cored like an apple, nauseated, light-headed, and I was afflicted with gas pains from not having a bowel movement in two days, so they sent up for an EKG to make sure my heart as okay. It was. Turns out that morphine is also extremely constipating.
The tube they had left inside to drain the surgical wound was removed around noon that first day. The nurse advised me to take a hit or two of morphine on the PCA button beforehand, but it was still like having a sword pulled out of your ass-cheek. Around the same time, they took out the catheter. This led to the big melodrama of the day, to wit, would I be able to pee on my own. The morphine was still making me horribly parched and I was drinking great gouts of ice-water, and as the day advanced toward evening, my bladder filled remorselessly. I dreaded the event.
Around seven that night I was inspired by the memory of a prank we used to play in summer camp forty years ago called “midnight sailing.” It worked like this: first a victim was chosen (the leading loser among the year’s crop of campers). Secret preparations were made (we spirited an enamled steel basin out of the infrimary). Late at night, hours after taps, and after the end of the Red Sox game which we listened to faithfully over the radio in the peenting darkness, we stole out of bed, got the enameled steel basin, filled it with warm water, took it to the victim’s bed, ever so carefully work his hand free of the bedclothes, and slip it into the basin of warm water. Voila: the magical result would be a relaxation of the victim’s bladder. By the time he awoke mysteriously soaked and weeping, we would be back in our beds with sheets stuffed in our mouths to stifle our delirious laughter. Afterward, of course, there would be interrogation by the angry counselor, and often punishments meted out, such as holding rocks out at your sides until a charley-horse bucked through your deltoids, crippling you for days after.
The long and short of all this being that I decided to take myself midnight sailing.
It took twenty minutes just to get myself up onto the walker and into the cramped bathroom with it. The sink was deployed a scant eighteen inches behind the toilet. I threw open the hot tap, filled the basin, and plunged my left hand in. Like magic. a kind of miniature rumble started somewhere behind my prostate gland. Then, like some scene out of a documentary on the heroic irrigation projects of San JoaquinValley, the miniature rumble turned into a gushing torrent as, first, the sluice gates of my mind opened, and then the actual stream poured forth from Jumbo, as my generative member is called. It was a transcendent moment that surely surpassed my first sexual experience.
It was not enough to permit me to sleep through the ridiculous hurley-burley of a night ward, though, so Billy and I yakked and swapped recipes until dawn.
I received two transfusions (of my own blood, stored in advance) over the next twenty-four hours, because the operation had been a real Vincent Price extravaganza of flowing gore. I was also shipped down to the vascular imaging lab to get checked for blood clots in the lower leg.
When the next morning’s blood work came back, the rounds doctor pronounced me fit for discharge. They took out the annoying plastic IV valves on my hands, and I was sent home in the custody of my wife.
That was two days ago. I am stationed in a bed set up in the first floor library, off the kitchen. The first day I pottered around in an aluminum walker, but I have chucked that for a cane. The surgical site is still very swollen. They cut through a mighty wad of muscle and it will be ten days before the surgical staples come out. I am still amazingly weak. An hour upright in an easy chair leaves me panting.
I have to inject myself every morning for the next twenty days with a blood thinner. You give yourself the hypodermic in the adipose pinch some ten centimeters to either side of the bellybutton. It’s not so bad as it sounds. After the initial prick, the needle goes in as if you were injecting a chunk of styrofoam. I guess there aren’t many nerves down there.
I commenced today the exercise routine of about 12 various lifts, presses, and extenstions. It hurts, but I expect swift progress. I’m still amazingly weak and have to go lie down about every other hour. I lie there imagining that I am a nineteenth century African explorer — a Sir Richard Burton type — on a mat in a mud hut with a spear wound, trying to keep the blowflies off as I dream of green England and stately women in bustles moving about a lawn. Sleep, at last.
Act III – The Miraculous Resurrection.
Here I am now, three weeks and four days after surgery. December 2.
I am doing pretty well, they say, but the recovery isn’t fast enough for me. I’m tired of being a fucking cripple.
Things really started looking up after the surgical staples were removed, which was ten days after discharge from the hospital. (The removal procedure didn’t hurt a bit.) It was a lot easier to sit at my desk with those annoying things gone.
I’m still walking with a cane. Through the whole recovery period I’ve had sense that my left leg was now a little bit longer than my right leg. I’m told that this is a fugitive sensation that eventually goes away. I won’t know for a while.
I have a lot of discomfort at night and consequently much trouble sleeping. All those hyper-extensions of my leg muscles that happened during surgery left the connective tissues pretty traumatized. My leg muscles were always very tight, even before surgery, but now I have pains from my toes to my knees to my quads and hamstrings. I suppose I may have to get used to doing a stretching routine before bed, but at 10:00 p.m. when I normally retire, I have a hard time making myself do anything.
Many nights, though, I’ll fall asleep briefly, say from 10:20 to 12:30, and the rest of the night I am tossing around or staring at the ceiling, or reading. I keep forgetting to ask the doctor for an Ambien prescription. That shit is fine! (But I don’t want to become dependent on it.)
The good news is that I am back in the pool and the gym. Two days after the staples came out of my ass, I had permission to get back into the YMCA pool. I do a daily routine now, early every morning, that includes forty minutes of aqua-jogging and twenty minutes of regular lap swimming. The aqua-jogging is supposedly a capital method for rebuilding leg strength and range-of-movement because you are suspended in the water, with no weight-bearing or balance issues involved. You just work against the resistence of the water.
This morning (week three + four days), I got on a stationary bike for the first time and was happy to discover that I could do the movement with complete comfort and full range of motion. What’s more, my left knee no longer shoots out to the side on each pedal stroke the way it used to before surgery. Now my left leg rotates very cleanly up and down like a Johnson rod on a choochoo train wheel. Cool.
There are two things that are still kind of hard. One is just standing up for any length of time. I tend to stand now with most of my weight on my right leg, and I have developed a permanent cramp in the plantar ligament of my right foot. And I still can’t walk more than a quarter mile on dry land without experiening a lot of muscle fatigue. I’m still pretty out-of-balance. Something else that happens in surgery, I’m told, is that the iliopsoas muscle running from your pelvis to your thigh gets traumatized and for many weeks after you experince what is called pelvic tilt as the iliopsoas remains in a state of contraction, throwing your gait off. This may be another thing that contributes to the sensation of one leg being longer than the other.
More good news is that I have resumed most normal lifeways. I can climb stairs easily and have gone back to my regular place in the bedroom. I can climb in and out of a bathtub with no problem. I can drive my standard shift pickup truck, no problem.
I can’t play tennis yet.
Early January 2003
I made steady progress through December and had a lovely Christmas. Each day I sense some improvement. I am walking much more fluidly. A persistent stiffness behind my left knee is slowly going away. (I assume that some ligament there was hyper-extended during surgery.) I was feeling a lot of pain in the tendons that wrap around the bottom of my right foot (the plantar region), especially when standing in one place, and that, too, is subsiding as I become accustomed to distributing my weight on both legs again.
I still feel as if my left leg (the one with the new hip) is a little longer than the right, and I honestly don’t know whether it is longer now, or if the pelvic tilt thing is still happening. I slip a heel pad into my shoes (when I remember to do it) but I can’t say with any certainty that I feel a big difference. Perhaps down the road I will need some real orthotics. But I intend to wait and see over the next six months. The sensation of one leg being longer than the other is lessening in my awareness, but that may just be my body adjusting to a new physical fact.
I’ve been going to the gym religiously over the past month. The program: 10 minutes on the eliptical x-country machine; ten minutes on the treadmill walking at about 3mph; twelve minutes on the stationary bike; 15-minute mat series of abdominals and stretches; 20 minutes aqua-jogging in the pool; 20 minutes regular laps, mostly freestyle with backstroke cool-down. I think this program has accelerated my recovery.
We had two whopper snowstorms the past several weeks and I was apprehensive about going out to shovel. But I discovered happily that I was able to do this with no pain whatsoever, and each time I worked for over an hour very pleasantly.
My major complaint at this point is the discomfort and pain that I usually feel when getting up out of a chair. It can sometimes take me half a minute to straighten up completely and begin walkiing. Alas, my occupation keeps me in a chair for long periods of time. My lower back becomes pretty severely cramped and stiff. There may still be some issues between my surgically traumatized hip-and-leg muscles and their connections to the muscles of my lower back. (The pain is definitely on the surgery side.) I like to think that it will resolve in time. I do stretch, but I could probably benefit from doing more or different stretches. I have an another check-in appointment with the orthopedist, Larry Fein, next week, and I will drop in to see the physical therapist to see what he recommends.
On the whole, though, I am very pleased with the outcome so far, and deliriously happy to be free of the grinding joint pain that drove me to surgery.
More to come in another month or so. . . .
As spring approached, I was growing impatient with the slowing progress of my recovery, in particular the extreme stiffness of my gait and a lot of persistent lower back pain and stiffness that seemed obviously connected to a complex range of muscles in my abdomen, hips, groin, and legs. My orthopedist sent me to see a physical therapist he works with as a consultant to the Olympic speedskating team.
Maureen Cormier was a dark-eyed humorous young lady who sized me up as though she was aiming to tune a large musical instrument made of meat. Her studio was a room about thirty by thirty with a lot of semi-medieval-looking equipment deployed around it. She measured the length of my legs, and the maximum angle I was able to flex both legs in various directions, and the relative strength of half a dozen isolated muscles in each side, and she eventually pronounced that she thought she could do something with me. My left leg, she said was marginally a little longer than my right one now, but that wasn’t really the problem.
She proceeded to lead me through a series of about six exercises. Two of them were to be done in the yoga “bridge” position — alternately lifting each leg, as though “marching” in the bridge position. This was rather difficult for me. It became readily clear that my left side was much weaker than the right, in particular the gluteus muscles which make up the meaty part of your ass. The other exercise was squeezing the knees together. I was also taught to do the “pelvic clock” exercise against a wall; a strange motion of rotating around and doing a pelvic thrust at four cardinal points and the diagonal ones in beween. I was surprised to discover how poorly I was able to thrust out on the left side. Finally there was a forward lunge move somewhat like the yoga “warrior” pose, intended to stretch out my iliopsoas (eel-e-o-so-az) muscle.
My problem, Maureen would explain in the eight weekly sessions that followed, was that my muscles were still compensating for the pain in my hip, despite the fact that the operation had removed the source of the pain. The muscles were conditioned to misbehave and many of them had actually atrophied and weakend in the process. Some, like my iliopsoas were permanently clenched, which was a large part of the reason I was having trouble standing up after sitting for long periods, and was also responsible for some of my lower back pain. My glutes were markedly weakened, my sartorius, hip adductors and abductors needed work, and my quads and hamstrings had to be stretched and strengthened.
Around the same time I started working with Maureen, I went to see a massage therapist that a doctor friend had recommended to me. Steve Wemple was a tall bicyclist with enormous hands and arms who was skilled in accupressure and trigger-point work (Maureen had said, “you can’t find trigger points on any kind of x-ray or image, but we know they’re there!”) Steve worked me over, pressing down on several incredible “Jesus” spots along the crest of my pelvis and for a full day after I left his studio, I felt twenty years younger.
Over the following six weeks, Maureen added about eight more moves to my exercise list. Many of them were exercises done with one of those big inflatable Pilates balls: hamstring curls, pelvic raises, and the bridge with alternating leg extensions. She showed me how to do squats keeping the ball behind my back against a wall. I was to alternate legs and it was amazing to discover how weak and unbalanced I was doing squats on my left leg — with the prospect, however, of bringing those muscles back up to strength. She also gave me one of those large rubber bands, with which I was to do resistance movements. Finally she gave me a psoas stretch that I could do lying on my back on a weight bench.
I’ve been doing these exercises — about 12 of them in all — for a month and a half now, religiously in an hour-long session early each morning at the YMCA gym, and I must say I’m beginning to see impressive results. For one thing, the pelvic tilt that was exaggerating the minor length discrepency in my legs has resolved considerably. I am walking without a hitch or a limp now. My hip-and-abdominal strength is equalizing on both sides, my lower back pain is markedly reduced, and I am now actually able to bend at the waist and pick things up off the ground for the first time in two years.
Both Maureen and the orthopedist, Larry Fein, have made it clear that it takes a good year to fully resolve the hip replacement operation. but now midway through the seventh month, my progress has accelerated significantly. Meanwhile, the weather here in the northeast has turned beautiful. I am off on my bicycle several times a week doing an 8-mile-loop out past the rural edge of town and back in again. We’ve opened up our Adirondack lake house — with all the shlepping that entails (like putting in the steel dock), and I am feeling strong and much more flexible than I have for a long time.
About a week ago, on a bright Sunday evening, I took myself to my favorite old trout stream six miles west of town to see how I would make out clammoring over the slippery freestone bottom with a flyrod, an activity that takes quite a bit of balance and exactly the kind of core strength that had been compromised in me for so long. I did very well and I was grateful to be able to get back to this activity I loved so much.
I may even buy a tennis racket this month.
I went to England for two weeks and spent a healthy chunk of it riding a rent-a-bike around Cambridge while my wife went to a professional conference. The terrain was flat and I had a grand time winging around this small city and its outskirts. Then we went to London for three days. Perhaps I was over-tired from biking so much in Cambridge, or perhaps I was suffering the cumulative effects of poor sleep, but I had a hard time marching around London Town on foot. My “fixed” leg still lags behind a little. It’s a fraction of a second late in responding to the command to step forward. I don’t know whether this is because the muscles are still not completely healed (or never will be), or whether a minor nerve or two might have been severed during my operation, which was now almost ten months ago. The net result is quite a bit of pain and fatigue after several hours of strolling. I felt old. Well, I am old (55 next month), or at least not young. Also, my “other” leg — the one that still has the natural hip joint — occasionally aches in the way that the other one did a couple of years before it really got bad. Uh-oh.
I still suffer a little from having my “fixed” leg 3/8th of an inch longer than the other, and the heel shim that I now wear in my shoes does not really seem to help that much. The principle muscles in my repaired leg, the hamstrings, quads, illiotibial band, etc, remain much tighter than the ones in my right leg. I’m going to have to work deliberately this fall and winter on stretching them.
Altogether, though, I am, functioning normally and doing just about everything I want to do. I am not in anything like the kind of pain that drove me to the orthopedic ward last year. Often times nowadays, I even forgot that I even had the operation. Ten months is still a little early to say its all over. There is room for more resolution of this operation.
Long about November, I got motivated to see the orthotics doc. Orthotics are shoe inserts specially fabricated to a mold of your foot and designed to correct a specific problem — e.g. flat feet, pronating (striking the side of the heel instead of the center), and in my case a difference in the length of my legs.
The defining moment came one morning in the YMCA locker room when I was chatting with a gastrointestinal doctor, Arthur O., and idly musing about getting orthotics. Arthur leaned over and pulled two inserts out of his sneakers. “These babies saved my life,” he said. Arthur had severely flat feet and had suffered terrible backaches. He’d gotten the orthotics seven years ago and they completely solved the problem, he said.
Now you can see various people for orthotics. Some people just set up in the orthotics business, period. Then there are podiatrists, who are not doctors in the formal sense but rather technicians who do for feet what optometrists do for eyes. And then you can go to an orthorpedic surgeon who specializes in the foot. Which is what Rich Jones is. Rich had operated on my right foot the year before Larry Fein replaced the hip in my left leg. I’d had an annoying injury called a “Morton’s neuroma,” which is an inflamed nerve bundle between your metatarsals. It feels like someone stuck a soldering iron in the middle of your foot. It is a common injury suffered by runners (and by women who wear tight high heeled shoes) and it is very very annoying. It actually required a trip to the OR and cost me about three grand (my insurance deductible — rats!). They go in through the top of your foot, retract the bones and tendons, and nip out the inflamed nerve. I was awake, though very stoned on Fentenyl, Versed, and other drugs, with a local anaesthetic to the leg, and Rich presented the offending nerve to me like a cherrystone clam. “I can see why this has been bothering you,” he said. Interestingly to relate, you retain about 97 percent of sensation in your toes after the operation, despite the loss of nerve tissue.
Okay, anyway, I went to see Rich Jones a year after my hip surgery to talk orthotics. He appraised the situation quickly. I was indeed off balance. He told me to come in a few days later with a new pair of shoes. So I returned shortly with a new pairt of Nike walkers and he built a temporary orthotic right there in the office. My right foot was also slightly flat, so part of the strategy was to gain some height by boosting the arch, and get the rest of the 3/8th inch in the heel and ball. Actually, I came in three more times and each time he added a little more height to the temporary insert. He wanted to bring me up gradually, he said. I felt immediate relief from the general sense of being off balance. I was able to walk much more easily with a normal gait for the first time, really, in a year.
I must say, though, I was disappointed that my hip surgeon, Larry Fein, had not sent me to Rich Jones much earlier in the process, say a few months after the operation when it was clear that I had a significant difference in leg lengths. I attribute that to fear of liability for not having a perfect outcome. I’d never even considered suing the guy. But one can see here how our fucked up medical establishment creates additional and unnecessary problems, and how you have to be your own medical manager in any of these matters.
The last time I saw Rich, he made a plaster mold of my foot and was sending it off to the folks who actually fabricate a durable shoe insert that should last five years or more. I’ll report on that after I’ve used it for a while.
Another note of interest, though: last week I resumed cross-country skiing after a three year layoff — with a new pair of skiis, wonderfully improved over the old models for truning and stopping and control in general (and the package only cost two hundred bucks). Anyway, My hips and legs felt better after a two hour ski than they have in years. And the ilio-sacral pain I had been experiencing was (temporarily vanquished). My theory: the motion of corss-country skiing for two hours did more to break the surgical adhesions in my left leg, and stretch the over-torsioned muscles, than any of the other exercises Ihave done for fourteen months. I went out again on Monday afternoon, again with salutary results. I feel as though I have come much closer to resolution of my hip problem now. It has been a long and rocky road. Stand by for further reports.
Rich Jones presented me with a permanent orthotic shoe insert in February and I wore it for about eight weeks before concluding that it was not comfortable. Also, it was so big and bulky that it really only fit into one pair of shoes, my New Balance walkers (really just sneakers) and it bothered me that I couldn’t easily swap it around my other shoes.
Meanwhile, off at a lecture gig at the University of Michigan in March, I got together with my old buddy Doug Kelbaugh, the dean of the architecture school. I was complaining about the post-op complications of my hip replacement and how my leg came out 3/8 of an inch longer, and Doug stopped me to say that as a result of a bike crash ten years earlier one of his legs was now 3/4 of an inch longer. He showed me how he had the heel and sole of his left shoe built up by a cobbler and said it worked fine. Hmmmm.
So I ruminated about this and a few weeks later I visited the town cobbler, Nick Sabino, over on Beekman Street in Saratoga. Nick’s shop is in the old Italian ghetto where the old people still grow grapes in their backyards. His street is really coming back, though, with three major commercial buildings renovated over the past year.
Nick is the only shoe repair guy in town and everybody goes to him. He has an air of mystery and secret knowledge about him, and he chain smokes. I explained my situation, my hip operation, blah blah, one leg longer than the other, how my new orthotic was not really comfortable, and told him about my friend Doug had one shoe built up — but Nick stopped me. He said I didn’t want to wear a built-up shoe. He asked to see my orthotic insert. When I took the big clunky thing out of my sneaker, he kind of laughingly sneered at it. He said he could make me something much more comfortable. Then he had me stand in front of him and he checked the level of my hips and shoulders and turned me this way and that way. He said my leg difference was more likely 1/2 inch, not 3/8ths. Without measuring, just looking. Hmmmm. He told me to bring in one dress shoe and one sneaker and he’d make an insert for both types that I could easily swap around different shoes of each type.
Three days later, they were ready. Each one was just a little leather wedge. I told Nick that the surgeon had given me felt heel pads a year ago and they made my achilles tendon ache. He sneered at the mention of the word felt and said these would be better. He said it would take about three days to break in the insert so that it molded to my heel. He charged me $35 for each one, which was a bargain compared to the medical orthotic.
So I have been wearing Nick’s insert for the past week and I must say it is quite an improvement. I feel even more leveled up and my arch doesn’t ache anymore. I am also feeling less pain in the various muscles of my other leg, and the persistant ilio-sacral discomfort I’ve felt for months is noticably reduced.
Am I surprised that a cobbler should be able to solve this problem better than an orthopedic surgeon who specializes in disorders of the foot? Well, a little. But this is still a world of sublime mystery. I will let you know how this is working further down the road.
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