My Aching Hip: Deciding to Go Under the Knife

Five years ago, I complained to my primary doctor of a lingering pain in my left hip, causing me to use a cane on our daily walks. After having x-rays taken, he referred me to a surgeon, who told me osteoarthritis had caused cartilage deterioration in my hip. She offered cortisone shots to ease the pain, explaining the shots had to be repeated over time. They were not a permanent fix.

Not fond of needles, I told her I’d prefer surgery. After showing me the x-rays revealed the cartilage had not deteriorated to bone-on-bone contact, she explained Kaiser Permanente’s policy, which was driven by the Affordable Care Act: avoid surgery when other means of pain management are available. She prescribed Ibuprofen, taken daily.

The pain medicine worked well for a while. I told myself, nobody dies of a little pain in the hip. I’d just continue taking those pills. No need to go under the knife for a cure.

Fast forward five years, to when the pills stopped working. The pain and stiffness in my leg had grown to the point where I could no longer put on my socks unassisted. The last time I needed help doing that was from my mother sometime in 1948.

After a visit to my new primary doctor, and more x-rays, I returned to see the same surgeon, who told me the new x-rays qualified me for surgery. She told me someone named Carlos would call me to schedule the operation. She said the current waiting list ran two to three months.

Ever the optimist, I emailed my surgeon a week later to ask when I might expect a call from Carlos. Her nurse wrote back he would call six to eight weeks before the scheduled date. My primary doctor gave me a prescription for Meloxicam, a stronger painkiller. It worked well enough to give me the patience to await Carlos’s call.

To my surprise he called within a week, offering me a November 6 surgery date at Kaiser’s Zion hospital in San Diego, 25 miles from the Chateau. With my pain under control, I told him I would prefer to await an opening at Palomar Medical Center in Escondido, just 11 miles away.  A few years ago, I published a column about the place. I dubbed it, The Palomar Hilton Medical Center, with its rooms with a view and a dream team of nurses. You can read it here: https://www.osidenews.com/2015/07/26/the-palomar-hilton-medical-center/

A week after Carlos’s call I regretted turning down his offer. Awakening that morning, I got out of bed to head for the bathroom. The pain in my hip returned with a vengeance. I managed to make it down the hall only by clutching at the walls and hopping on my right leg. After retreating to bed, and Karen’s insistence, I emailed both my primary doctor and my surgeon, pleading with them to save me from having to spend months flat on my back, awaiting another call from Carlos.

The pain returned to a manageable level after I spent most of the day in bed. Within two days Carlos called again, this time with an offer of surgery at Palomar Medical Center on October 30. I gladly accepted.

Now, as I await my appointment to go under the knife, I’ve had the time to second-guess my decision. What is the operation’s history? How risky is it? Can I trust my surgeon? What will it cost?

What’s the history of hip replacement surgery?

The earliest recorded case of attempts to perform hip replacement procedures dates back to 1891, when Themistocles Gluck tried to use ivory implants to replace the femoral head. In 1940, an American surgeon, Dr. Austin Moore, performed the first metallic hip replacement at Columbia Hospital in South Carolina.

What are the risks?

According to the Mayo Clinic, the two most common risks are blood clots and infection. My surgeon told me the mortality rate for those undergoing the surgery was less than half of 1 percent. The Arthritis Foundation cites a 2011 research report setting it at .029. Looks like my odds of survival are pretty good.

Can I trust my surgeon?

One of my favorite authors, Malcolm Gladwell, wrote a book titled “The Outliers,” in which he explains the 10,000-Hour Rule: the key to success in any field is practicing a specific task for 20 hours a week for 10 years. I, of course, looked up my surgeon’s bio, discovering Amy Steinhoff, MD, has been in practice for more than 12 years, exceeding Gladwell’s standard, and has five-star reviews from her patients.  

How much will it cost?

According to a January 22, 2015 report by California Healthline Daily, the cost of a hip replacement in San Diego County ranged from $24,000 to $47,000. But as a member of Kaiser Permanante Senior Advantage (HMO) we’ll pay nothing for room and board, surgery, anesthesia, x-rays, laboratory, tests and drugs.

Those are the reasons I’m now confident of my decision to undergo surgery at the Palomar Medical Center on Halloween Eve. To see how I’m preparing for that surgery, watch for my next blog entry: My Aching Hip: Preparing to Go Under the Knife, which will appear here:  http://theriehlworld2.blogspot.com/

Robert Frost and Our New Home

In Robert Frost’s The Death of the Hired Man a farmer and his wife are surprised by the arrival of a man who worked for them on their farm many years ago. He’s old and tired now, no longer fit to help with the chores. When his wife suggests, “He has come home to die,” her husband scoffs, “Home is the place where, when you have to go there, they have to take you in.” She replaces his definition with one of her own. “I should have called it something you somehow haven’t to deserve.”

Those lines from Frost’s poem echoed in my mind when Karen and I moved here to the Chateau Lake San Marcos, only five miles from our Carlsbad front door. We loved our LaCosta condo, with its sweeping view of the mountains. For several years we toyed with aging in place. The uncertainties, both financial and emotional, of selling our home of fifteen years and moving to a new place to call home, were daunting. During our 34 years together, we've changed homes six times, across three states. Seven did not sound like a lucky number.  

But a couple of unplanned visits within a year to Palomar Medical Center’s emergency room, together with a dwindling social life in retirement, changed our minds. We had reached the age when good health and good friends can no longer be taken for granted.

We began looking for a new home, where we could find the security we needed to address our chronic health issues, as well as a community of our peers, seeking the same creature comforts. We found all of that here at the Chateau.

  

Unlike Frost’s farmer’s definition, even though we felt we had to move somewhere, we didn’t move to this place because we had to, nor did this place have to take us in. But it has become for us an unexpected gift, in Frost’s wife’s words, we “somehow hadn’t to deserve.”

It’s become our new home.

Not too late to learn

Shortly after my 70th birthday, I began my quest to conquer calculus. I justified my interest in higher-level math by recalling what I missed in skipping fifth grade. I was able to keep up in all other subjects, but I never made the transition from whole numbers to fractions. Throughout the remainder of my schooling, I decided I was just not good in math, crossing off all careers that required training in it.

I became, instead, a teacher of high school English. After five years of that, having no interest in school administration or counseling, I accepted a position as an admissions officer at a local university. Thirty years later I retired, still lacking fifth grade arithmetic skills.

Unwilling to return to the classroom, I enrolled in the online Khan Academy, which enrolls about 10 million students worldwide, most of whom are decades younger than I. Currently, I’m struggling to graph quadratic equations, enjoying the freedom to learn at my own pace, without a teacher prodding me along. I also like Khan’s requirement for mastery of a concept before being permitted to move on to the next. That’s a far cry from the days I earned a grade of “C” in Algebra I and be happily passed on to earn another “C” in Algebra II, without mastering either level.

A few months after I began my math quest, my wife and I signed up for our first adult education class through California State University San Marcos. It was titled Unbridled Obsessions: The Uncommon Interests and Bizarre Tastes of the Victorian Age, a fascinating class conducted by a fascinating lecturer. It was offered by the University’s Osher Institute, a program designed for students 50 years of age or older. The 30 of us attentive senior students were enraptured by Dr. Jack Williams’ rendition of a quirky time in history with remarkable connections to our own.

We liked the class so much we enrolled in another Osher class last month, titled, Oil, Politics, and the Mideast, taught by an Iraqi-born American, Farouk Al-Nasser, formerly the Executive Director of Iraqi Operations for a San Diego Fortune 500 company. The title caught our interest, not only because of the current world turmoil, but because our son is currently an aid worker stationed in Beirut. Dr. Al Nasser’s presentation has been far more insightful than anything we’ve seen on TV.

Cal State San Marcos is one of 122 colleges and universities from Maine to Hawaii offering Osher Lifelong Learning Institutes designed for students age 50 and older. The founder, Bernard Osher, well known as “the quiet philanthropist,” created the Bernard Osher Foundation in 1977, seeking to improve quality of life through support for higher education and the arts. In 2008 the Foundation provided CSUSM with a $1 million endowment for its program, which now enrolls more than 500 students each year in 13 locations throughout North County.

I’m not sure why going back to school has become so important to me. Maybe it has something to do with my 93-year-old mother, who had to quit high school to help out on the family farm and is struggling today with dementia. It might also be the absence of assignments and grades. This time I go to class only to learn, not to be judged.

Contact me at richard_riehl@yahoo.com

HIDDEN: Diary of a Bad Girl

Today’s rant is a shameless plug for my wife’s new book, HIDDEN: Diary of a Bad Girl. It’s her 15^th on Amazon, since her first, Love and Madness: My Private Years with George C. Scott, was published in 2003.

This short one’s a me-too memoir in diary form. It transports readers back to the days when women were to be seen and not heard. Those who lived through the 1950's will remember the judgmental paternalism of the time. Younger readers will be grateful they don't. Here’s what one reviewer says about Karen’s book.

"Hidden: Diary of a Bad Girl is a nonfiction memoir written by Karen Truesdell Riehl. Riehl was one of the six young women currently in residence at the Florence Crittenton Home for Unwed Mothers when she was twenty-one years old. Whenever they would go out as a group for their somewhat clumsy-looking strolls into town, some of the less charitable townspeople would look down their noses at them and even spout hateful jibes. They were considered bad girls; girls who had shamed their families by getting pregnant out-of-wedlock.

Karen was an aspiring actress who had graduated from Stephens College where she had met and befriended fellow aspirant, Tammy Grimes, and fallen in love with a staff actor named George C. Scott. After graduation, she performed in Summer Stock in Toledo, where Riehl was offered the lead for the theatre’s winter season. Her heart and mind, however, were set on going off to New York City with George. Then she got pregnant, and life became incredibly complicated. Tammy’s mom took her in and helped her obtain a place at the Home. Riehl had been terrified walking up to the rather austere looking building on that first day, but it soon became home for her, and those five other young “bad girls” became family she would never ever forget.

Karen Truesdell Riehl’s nonfiction memoir, Hidden: Diary of a Bad Girl, had me fulminating at the unfairness of societal attitudes toward sex, permissiveness and the genders. While attitudes and opportunities have changed dramatically since the author’s time at Florence Crittenton, there are still some primitive and chauvinistic elements of society who seem to harshly judge young women for behavior that’s perfectly acceptable and encouraged in their male peers. Riehl had my attention transfixed by her story. I loved seeing those other young women through her empathetic lens, and could feel the mingled jubilation and loss they all felt as each of them came to term and were forever lost to their other friends. The author’s story highlights the cultural changes that began during the sixties and seventies and continue to this day. Riehl is a gifted and fluent writer, one who intuitively knows how to tell a story. Those books of hers that I’ve had the opportunity to read have been marvelous. Her memoir is no exception. Hidden: Diary of a Bad Girl is most highly recommended."

Jack Magnus for Readers Favorite

It took a lot of courage for Karen to write this book. I couldn’t be prouder of her.