Should I or Shouldn't I?

OK, here goes.

The fact that I have to "decide" whether or not to undergo hip replacement surgery has caused me to undertake a great deal of research over the past few days.

A little learning can be a dangerous thing!

Notwithstanding the fact that the nurse practitioner clearly outlined for me precisely where I am "bone-on-bone" in both hip joints, there are many other indications for what could be causing my pain, not the least of which could be weak muscles from years of non-use!

We cannot forget that I am fibromyalgic, a sydrome that in itself imposes far too many limitations on my activity level (but we cannot allow that diagnosis to cloud another, possible different cause for the hip pain).

Add to that the bursitis (that I may or may not have) and the osteoarthritis (that I now seem to definitively have), and we have quite a schmozzle to try to untangle.

I guess the bottom line is, I don't want to have surgery if it is not indicated; but I also don't want to NOT have surgery if it is indicated.

I don't have the earliest reports of the many x-rays, scans and MRIs that have been taken over the years, but I know that as early as 2001 (when my beautiful boy was born), I was already walking with a cane, presumably because the "bursitis" in my right hip demanded that I use something to assist me.

In February of 2002, an X-ray of my lumbar spine reported, "... mild disc space narrowing at L4-L5 with anterior lipping. ... There is arthritic change at the articlar facets at L4-5 and L5-S1."

In March of 2002, a CT scan of my lumbar spine reported:  "At L3-4 ... mild degenerative disc changes ... and mild OA changes of the facet joints; ... At L4-5 ... mild degenerative disc changes with small anterior and right posterolateral osteophytes ...  There is a disc bulge. ... mild OA changes of the facet joints." (Note:  osteophyte = bone spur). "At L5-S1 ... disc bulge with no focal herniation or evidence of spinal stenosis.  ... mild OA changes of the facet joints."

An x-ray of both femurs was taken in January of 2003 and reported "mild degenerative change in both hips with mild narrowing of the joint spaces."

In February 2003, the orthopaedic surgeon who had requested said X-ray commented in her report to my doctor that, "There is definitely some narrowing of the joint space of the hips, but more marked on the left than on the right.  There is no calcification over the greater trochanteric bursitis. ... I am not convinced she actually has a bursitis since her bone scan in 2001 was negative."  (So as early as 2003 it was suggested that we were not dealing with bursitis ... hmmmm.)

As a result of that report, an MRI was done at Kingston General Hospital which reported, "The right hip joint appears unremarkable with no evidence of joint effusion."

Yet, by 2005, I had incorporated numerous pain management techniques, some at considerable cost:

• We renovated our bathroom to install a jet massage bath tub (added in 2003).
• We bought an egg foam mattress insert to provide me with an extra level of comfort when sleeping (eventually, we changed our mattress, at great expense).
• I changed my vehicle to a larger, higher-off-the-ground SUV, because I could no longer get in and out of a car comfortably.
• We installed a stair lift in our home because I could no longer manage the stairs.
• I was by this time going to physiotherapy on a weekly basis and having full-body acupuncture as part of that treatment.
• I started going for bi-weekly massage therapy in 2005.

By February 2006 I was retired, on disability pension, because I could no longer carry out the duties of my job or make the daily commute to Ottawa.  My inability to get restful sleep was taking a serious toll on my state of mind and I was frantically seeking pain relief.

A March, 2007 X-Ray of both knees reported, "no evidence of osteoarthritis." 

In June, 2007, a Bone Mineral Densitometry test was done and found me to be in good health.

Also in June of 2007, an X-Ray of my lumbosacral spine reported , "disc space narrowing demonstrated at the L4-L5 level ... Lumbar spondylosis at L4-L5 level."  (Note:  spondylosis = osteophytes = bone spurs)  So apparently, I have arthritis in my spine too. At L4-L5-S1 -- precisely the points that send referred pain to the hip and down the leg, mimicking hip pain.

In March, 2008, the X-Ray of my pelvis and bilateral hips reported "The hips are bilaterally symmetrical.  There is no significant joint space narrowing or osteoarthritic change in either hip."

In June, 2008, a whole body scan reported, "A mild degree of increased bony uptake in the medial aspect of the left acetabulum as compared to the right side is probably representing mild degenerative bony change."   (Note:  The "acetabulum" is what we lay-people would call our hip socket.)

Also in that report:  "A focal mild increased uptake in the medial aspect of the right shoulder at the humeral head is in favor of mild osteoarthritic change ..."  (Wow, I have arthritis in my shoulder -- who woulda guessed it?)

It was at this time that I started taking Lyrica which helped greatly in the management of the pain of fibromyalgia, but did nothing to relieve the pain in my hips.  I continued to wake every couple of hours because I could not put pressure on either hip joint for any length of time.  Turning over in bed was an impossibility -- I had to actually sit up and reposition myself to switch sides.  The lack of restful sleep was becoming a significant concern.

In September 2008, my doctor had me try Ralivia for added pain relief.  It didn't work for me so we went back to Codeine. 

In 2009 we replaced the mattress we had bought in 2005, hoping it would lead to a better night's sleep.  Within a few months, I added a piece of egg foam to my side of the bed because I needed yet more cushioning under my hips.  In spite of these changes, I continued to wake every couple of hours to switch sleeping sides -- a physical effort that was becoming increasingly difficult for me.

In March, 2009, an X-ray of my pelvis and both hips reported, "Both hip joints appear normal.  No evidence for osteoarthritis."  (What, it went away?  All by itself?)

In March 2009, steroid injections in each bursa failed to give me any relief.

By April 2009 I was using Oxycodone for pain relief, except it wasn't working overnight.  I still woke every few hours to switch sides, so now I was doped all day long because I couldn't get a good night's sleep and I was taking a powerful narcotic.  It didn't take long though for my body to decide that it wanted more of that "good stuff" way too often (physical dependence) so I pulled the plug and took myself off it, cold turkey.  Since I was effectively in "withdrawal" every six hours while I was taking it, I opted to go through the misery and force my body to do without and just "get over it."  It wasn't pretty, but thankfully I hadn't been on it long enough to make it too difficult a process.

In June 2009, on the advice of the rheumatologist who had tried the steroid injections in my bursa, my doctor prescribed Cesamet (synthetic marijuana) for pain relief.  I used it successfully for eight months until it became obvious that it was causing an eating disorder (I had lost 20 pounds without explanation and I was experiencing severe discomfort on food intake).  Discontinuance of the drug plunged me into withdrawal symptoms such that I probably should have been hospitalized (nobody should be made to witness their loved ones going through that).  Another 20 pounds was lost through that episode.

Having now tried opioids unsuccessfully, I stopped using anything for added pain relief, choosing to take Codeine on an "as needed" basis only.

In January 2010, my cervical spine was X-rayed: "Marked disc space narrowing is seen at C-5-6 and C-6-7 with some moderate narrowing at C-4-5, in keeping with degenerative disc disease." 

In February 2010, an MRI reported, "There is increased joint effusion on the left in comparison to the right.  There is associated alterations signal articular cartilage weightbearing surface of the acetabular roof. ... There is also slight effusion along the trochanteric bursa. ... On the right ... No significant trochanteric bursal effusion."  (So, the degeneration is worse in the left than the right, and there is evidence of bursitis on the left but not on the right.) 

That same MRI reports, "Hamstring tendonosis at the tuberosity insertion right and left.  No significant attenuation."

The conclusions of that MRI report are: "1. Effusion of the left hip more so than the right. ... The changes at the degeneration are fairly symmetrical to the contralateral side.  2.  Minimal bursal effusion. 3.  Tendonosis hamstring insertion."

In June 2010, a steroid injection in my left hip joint gave me 12 weeks of heaven. I was able to walk like a normal person for the first time in many years.

In August 2010, a steroid injection in my right hip joint only gave me eight weeks of relief (but by then, my left hip was too painful for me to truly enjoy the lack of pain in my right hip).

In October 2010, another X-ray of my pelvis and hips reports, "There is mild sclerotic change and irregularity of the acetabular margins of both hips, suggestive of mild degenerative change."

As of this date, I am not using any drug for added pain relief.  I have become so used to the ever-present throb that I barely notice it now -- until I make a move that causes a tearing pain through my groin.

I go to physiotherapy every Tuesday, and as long as I don't overdo my physical activity, I can hold the benefit of the treatment for about 48 hours.

I have massage therapy every Thursday.  While previously I had been using massage therapy on a bi-weekly basis, it is only since last October that I have been going every week.  It took until January of this year for me to reap the benefits of those weekly sessions.  I now recognize the need for me to continue using massage as one of my pain management tools. The massage benefit holds for about 48 hours too, but again, I can't overdo my physical activity if I want to truly enjoy those benefits.

Since I need to "hold the benefit of treatment," I cannot plan social engagements on the days following those therapy sessions.  That shortens our social week considerably.

Taken all together, my inability to sleep through the night would appear to be my "priority" complaint since it is the lack of restful sleep that is impacting so seriously on my emotional well-being.

And that inability to sleep through the night would appear to be the result of pain in my hips (and legs).

The pain in my hips would appear to be the result of osteoarthritis.

But, osteoarthritis of what?

The hip joint itself, where there is "mild" degeneration?

Or L4-L5-S1 and facet joints, where there is also "mild" degeneration but which would also cause referred hip and leg pain?

Or is the pain in my hips that is so badly disturbing my sleep a result of bursitis?

Or is it just another manifestation of fibromyalgia?

I'm thinking that only the surgeon can render his opinion now, and I will have to rely on that.  I will take this summary to him and let him wade through my history.  If he recommends surgery, so be it.