Since 2007 I have been battling with problems associated with my hips and problems caused by the medical profession who seem to be “pattern adopters” rather than “first principles” thinkers.Over the next little while I will be documenting the interesting but somewhat irritating adventures of someone with osteoarthritis and what to look out for when dealing with doctors and so-called specialists.
I grew up on a large dairy farm which ultimately sparked my university career. I thought that life was too short to milk 900 cows twice a day! In hind sight maybe I was wrong!
I went on to complete a degree in agricultural science with first class honours and a PhD in biochemistry. I was blessed with a wonderful brain – still am I hope! After teaching for nearly 7 years at university I decided I would rather “do it than talk about it” – I realized I was a practitioner, not an academic.
And so I decided to get into the business world building on my PhD in biochemistry and I rapidly rose through the ranks to senior management and led the creation of one $400 million annual revenue group and another $220 million annual revenue group, in a different industry.
Then I decided to do it for myself about 8 years ago. Since then I have started several successful companies and floated two on the NZ stock exchange.
Unfortunately things do not always work out the way we want it and for a number of reasons and so I am on “a mission” to get the family’s finances back on track & try and learn from all the past materialistic activities – and focus on real value creation, not just wealth and status.
I hope you enjoy my Blog!
Growing up on a dairy farm was lot of fun and hard work – well maybe more like hard work, but better than being stuck inside.
Sport was on periphery of life during childhood – partly because Dad was never around to take me to footy or whatever – he was busy creating one of NZ’s largest dairy farms the hard way – take 1,040 acres of land, all but 40 acres covered in dense scrub and gorse, and turn it into a high producing farm – no wonder he wasn’t around that much!
When he was, we did the usual childhood things and fishing and water skiing stand out, along with yachting and some occasional drownings (three nearly!).
Mid Life Crisis
Mid thirties I discovered the gym; rowing, weightlifting and general fitness, with a lot of cycling too!
I was, and probably still am, someone who pursues something to the extreme, and fitness was no different.
Personal trainer 3 – 4 days a week, gym 2 – 3 hours a day, 7 days a week!
Not an Uncommon Story
What was uncommon was that I was probably unaware that I had a predisposition to arthritis (probably) and one day while doing some lunges supervised by my personal trainer, I put my hip out – though I didn’t realize what it was at the time. Excruciating pain, I do remember!!!
Being super fit at the time, I just brushed it off and found some other exercises to keep me busy!
Fast forward from 1998 when this happened to 2007.
The Perils of Drinking
One afternoon, glass of red wine in hand, I was walking across the polished limestone tiles at home, when all of a sudden my right foot slipped on a prawn my young son had conveniently spat out sometime earlier!
Being resourceful, and dreading breaking the expensive wine glass in my hand, I managed to stay upright almost!
But I knew immediately I had done something to my back… in a word, bugger…
But I also discovered almost immediately this great sensation like someone had rammed a screwdriver into my right hip joint! Wonderful! @@###!!!
So as you do I carried on and made the best use of the available drinking time…
Golf – a poor excuse for a four-letter word
A week later I went out with some mates to play a round of golf and as I got part way round, it became increasingly difficult to walk and provided me with a perfectly good excuse to justify the poor golfing skills that day!
But by the end of the round (not a quitter) I couldn’t walk much at all – so off to the A&E in great pain, blaming it on the golf so the ACC (government accident insurance) paid the bill – X-ray showed nothing and so a jab of Tilcotil (a Roche non steroidal anti-inflammatory) and I was up and off again, albeit a little slower.
Nothing Lasts Forever
The wonderful NSAID injection wore off far too quickly and as luck would have it I wasn’t allowed another one.
So, off to see my doctor. with my tail of woe, still conveniently blamed on the golf, but somewhat confusing to all.
Hips Sore – Back is too…
Some more x-rays revealed that I had put out 4 – 5 of my lower vertebrae during the infamous “slip on the prawn” event a few weeks earlier; but that did not explain the “screw-driver-in the hip feeling”, but what did I know, I’m not a medical doctor…
So the next step was to be referred to a back specialist, a certain doctor who will remain nameless, and to have my back “put back in”…
Back Treatment – or was that Back-wards Treatment?
Well getting your back treated was quite an experience and I learned a lot too..
When the doctor examined my back and pressed on the vertebrae which where out, they were extremely sore, giving me some confidence we were on to some thing.
At this stage of the proceedings I was hardly able to walk, sit or sleep without uttering many heartfelt curses and observations which were quite acerbic and not particularly forgiving..
Seems that the offending vertebrae would go back in but they loved to pop out again – so a new form of medical torture was devised… put the vertebrae back into position and then inject something called sclerozin (or some such name) into the back, supposedly to cause scar tissue to form and hold the vertebrae in place…
Well, maybe it did, maybe it didn’t, but it sure hurt like hell – like injecting liquid fire into your back – many expletives were uttered there and hobbling from the doctor’s offices – the cure seemed worse than the problem… But the new pain sure kept my mind off the old pain, except the screw driver was still in hip joint… but this was explained away by … referred pain… or something like that. AND by now the pain was spreading down my leg my femur and knee hurt like hell too!
So the cycle developed – hurt like hell for a few days… feel good for a few days … then off to get more injection torture… and on, and on, and on.
Enough of the Back Treatment!
After about 3 months of taking my mind of my other pain by paying the doctor to give me more pain treating my back I got tired of the cycle and hobbling around like an old man at the ripe old age of 50 !
One memorable day I was walking across Melbourne airport and I thought, “God I’m not going to be able to do this, I’m going to have to get a wheel chair”. But pride and a very stubborn streak didn’t allow that and so I finally made it – a two minute walk became 15 minutes of agony…
So I rang my back specialist from the airline lounge and relayed my problems and was told that I probably had a “myalgia”
Myalgia means “muscle pain” and is a symptom of many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group … see here
So I went back to my general practitioner and explained my growing tale of woe – and my increasing inability to walk without major difficulty.
And – I got a referral to a “rheumatologist” because maybe the pain in my right hip and leg wasn’t all that related to my back?
Maybe I had some form of arthritis?
Medical Poisoning – Salazopyrin
Well, I welcomed a fresh approach to my steadily declining mobility…
So the Rheumatologist was a great guy – took some blood tests and told me that I didn’t have anything in my blood tests which indicated arthritis and he was at a loss to explain my pain and loss of mobility – read “hardly able to walk”..
BUT as I later learned Osteoarthritis seldom shows up in blood tests – whereas Rheumatoid arthritis does!!!
He prescribed a drug called Salazapyrin – used in a number of different disease conditions. And in fairness I did have really painful joints too…
Salazopyrin belongs to a group of medicines called anti-inflammatory medicines and is used to treat and manage Ulcerative Colitis and Crohn’s disease which are diseases of the bowel. Salazopyrin EN tablets are also used to treat rheumatoid arthritis, which is a painful joint disease (see here).
He mentioned that this drug was a derivative of aspirin and in rare cases some people had a reaction to the drug.
So like a good little medical problem/victim I went off and got the drug from the pharmacy and started taking it as directed.
About three weeks later I caught the flu – or so I thought – I took to bed with a 40 C fever and lay there for about a week before my wife finally convinced me to go to the A&E – maybe it wasn’t the flu or if it was I needed some medical treatment.
I got my sorry ass to the A&E and finally battled through the room of sports injuries, coughs and colds and screaming babies to finally see the doctor. He agreed – all was not right and so some urgent blood tests were ordered and I was sent home to rest…
Three hours later the A&E rang me at home and said I needed to get to hospital immediately – my blood tests were off the “Richter scale”, so to speak, and I needed to get there – pronto!
So in I went and lots of tests later they decided that I had “chemical hepatitis”. I had had a massive reaction to the Salazapyrin and it had nearly killed me!
Symptoms of an allergic reaction to Salazopyrin may include skin rash and itching, breathlessness and anaphylactic reactions (major allergic reactions (see here)).
• nausea and vomiting
• loss of appetite
• raised temperature
• redness and itchiness of the skin
• stomach pains
• swelling of the liver
• change in sense of smell or taste
• ringing in the ears
• yellow skin
• allergic reactions
• swelling of the face
• skin rash
• loss of hair
• increased sensitivity to light
After about a week in hospital I was released, some 7 kg lighter! So good does come out of bad.
BUT the worst was yet to come – because my liver was so knocked about I wasn’t allowed to have anything alcoholic… bugger … and I still had the hip pain …
BUT – given I was so sick I did not want to eat and so I lost 20 kg in total – WOW – I had people queuing to buy those pills – weight loss wonder – but somewhat fatal potentially!
Hips R Us
On of the good things the Rheumatologist had done was to refer me to an orthopedic surgeon to see if there was actually something wrong with my hip.
I decided against the surgeon who was the family friend who had just replaced two hips on one poor guy – the first one had been the wrong one and so the surgeon had to do the correct one for free!
The surgeon I went to see was recommended by any older friend of mine – said he had done a great job and as he was a mad-keen golfer, always out playing, I thought it was a fair recommendation!
The surgeon examined me and confirmed what I had long suspected, that my right hip was severely “dodgy” and most likely needed to be replaced!
An MRI confirmed that both hips had arthritis but the right hip was by far the worst – it had a 2.5 cm cyst in the hip joint – bone-on-bone and that explained why it made that “dry paper crackling noise” when I walked (with some difficulty, I might add).
From there one more test was done to make sure it really was the hip, there was one final interesting procedure required – an x-ray guided injection of steroid and local anesthetic into the right hip joint to see if the pain was knocked out – if it was, then this proved the hip was the source of the pain…
Interesting procedure and not very modest at that! Complicated by a very pretty doctor and nurse…
So that was it – the hip was the problem…
So after 13 months of hell I was scheduled for a total hip replacement – I could hardly wait ….
14 August 2008
The day of the hip replacement finally arrived.
The operation took place at a nice reputable private hospital which was well-equipped and routinely used for orthopedic operations by the private specialists.
My wonderful health insurance paid for the operation – about $28,000 in the end.
The lead up to the operation was pleasant and I got to meet the staff and anesthetist on the way into the operating theatre.
The total hip replacement took about 3 – 4 hours and I recall waking up in the post-operative area and speaking with the surgeon – all had gone well.
I recall being told the hip was a real mess and while I had signed up pre-operation to have it donated to the “bone-bank”, I was told it was too damaged and it was being sent to histology to make sure there were no other issues. I asked to see the hip and I must admit that it was quite a mess, even to my befuddled brain.
NAME: Earl Stevens – dob: [removed]
DATE & HOSPITAL: 14 August 2008 [removed] Hospital
OPERATION: Birmingham/Spectron total hip joint replacement – right
A 50 year old man with inflammatory arthropathy of unknown aetiology with a slightly dysplastic right hip and severe pain. There was a formal synovium lying over the acetabulum particularly in its inferior aspect and there was marked thickening of the capsule both anteriorly and posteriorly. Osteophytes at the acetabular rim anteriorly and at anterior aspect of femoral neck.
Spinal plus general plus urinary catheter. A standard posterior approach was made with release of the insertion of the deep part of gluteus maximus, identifying the sciatic nerve. The short external rotators plus quadratus femoris were taken down and the capsule of the hip joint excised as completely as possible from the posterior approach. The hip was then dislocated. The femoral neck was sectioned using a saw. The acetabulum was reamed down to cortical bone and 3 or 4 cement holes were inserted. The cup was cemented in satisfactory position. The femoral shaft was prepared and the appropriate femoral component was cemented in satisfactory position.
Reduction was achieved and was stable once the osteophytes mentioned above were removed and the thick anterior capsule excised.
A Stryker was inserted and deep tissues closed with heavy Dexon with nylon to skin. Tulle gras, gauze, Gamgee, elastoplast dressing.
POST OPERATIVE INSTRUCTIONS:
IV fluid, analgesia, anti-emetic, antibiotics as charted.
Remove Stryker on instruction.
Mobilise on Stryker removal.
Discharge 7 – 10 days with removal of sutures as appropriate.
See rooms at 6 weeks.
Warfarin to commence on evening of surgery and ultrasound done day prior to discharge.
Femoral: No. 2 femoral, distal centraliser, +4 52mm Birmingham head.
Acetabular: 58mm Birmingham.
Cement plug: Nil.
Copious specimens were sent for histology.
I was taken back to the hospital room and I was remarkably pain-free – thanks to the spinal infusion of morphine!
There was a drain from the site of the operation and the blood was recycled back into me (as I recall) and there was no need for a transfusion.
I had no feeling from the hips on down and slowly over the next day or so I got my feeling back.
Even though the replacement hip hurt like hell I have to say the feeling was a whole lot less painful than it was before the operation!
On the first night, several nurses had to move me around as I wasn’t capable of moving. I recall being unhappy when they rolled me onto my right side – but I didn’t feel anything – just couldn’t understand why they would do it?
I had a urinary catheter in and so there was no need to move! I do recall a very disconcerting feeling when the feeling returned I realized I was passing urine! Thankfully I remembered the catheter!
There was no need to go to the bathroom to pass a motion as the morphine and codeine conspired to make me severely constipated. In fact, despite huge quantities of laxative it was about 5 days before I finally managed to get unblocked. This has to rank as one of the most painful and humiliating experiences of my life – I was placed on the toilet and given a glove and had to manually remove the compacted faeces. I thought I was going to die, it was so painful.
Memo to self: – next time, make sure they give you laxatives from day one!!!
Within a day or two I was up with assistance and encouraged to take the apparatus and me for a walk, albeit slowly, up and down the hall way…
Learning to walk with the new hip was good fun but tiring and then the practice of going up and down stairs on crutches was quite a feat too – I still remember the little ditty – the good goes up to heaven and the bad goes down to hell…
After about a week or so the stitches were removed; all seemed well.
A few days later I was taken down for an ultrasound and they discovered I had a large clot in the femoral vein. Great, now what? Onto larger doses of Warfarin to thin the blood and ensure the clot didn’t dislodge and cause a pulmonary embolism (from memory – need to check this), or worse.
Finally I was released from hospital, all schooled up on what I had to do and how to monitor the Warfarin dose.
For the first week or so at home, having ventured up the stairs to the bedroom, I stayed put and my darling wife looked after me for meals; the district nurse came every few days to look after the dressing until it was removed altogether. The diagnostic laboratory sent their mobile blood collection guy around and took blood tests principally to see what the Warfarin was doing and to adjust the dosage.
The surgeon had schooled me up on the dangers of doing more than you should which could lead to a dislocation – so the crutches were a necessary evil for the first 6 weeks or so. I had learned in hospital how to get on and off the bed without putting the hip out and the physiotherapist had given me a range of exercises to improve strength and mobility in the right hip/leg.
After about 2 weeks I just needed to get a blood test weekly to check the Warfarin dose and fortunately the diagnostic lab collection point was not too far away and it was great to get out of the house.
At 6 weeks I went to see the surgeon. Just before seeing him I had fresh x-rays and overall he was happy with the progress. He was a little less happy that I had turned up without my crutches and so I didn’t see the need to ruin his day totally and tell him that I had driven to the appointment.
About mid-October I was back at work a little each day despite the fact that the hip was still healing and it required quite a lot of care going up and down the stairs at work.
I went to work one morning and was just settling into work when I thought the lights were flashing, certainly my computer screen seemed to be. Then I noticed jagged saw-tooth like flashes of white light on the peripheral and lower quadrant of my left eye, then it started in my right eye. And then I lost peripheral vision and vision in about the left 1/3rd of my left eye. My speech became slurred and I could hardly think.
My office bookkeeper kindly drove me to the local A&E where the doctor examined me and thought it was quite likely a massive migraine (never had one before in my life) but because I was on a fairly heavy dose of Warfarin, they could not rule out the possibility of a temporary ischemic attack (TIA) or a brain bleed which can happen when on Warfarin (commonly used as rat poison). So I was taken by ambulance to the local Hospital’s Emergency Department and admitted. After spending nearly 18 hours in a hospital bed parked in the corridor of the Emergency Department (chronic overcrowding and not enough beds is a real problem in NZ) I had a CAT scan and was put into a temporary ward. Next day the doctors in the hospital put it down to a migraine and I was discharged.
At about 3 months I was given the all-clear on the blood clot, after a couple of medical opinions! I was pleased to get off the Warfarin.
However, at this stage I still required pain killers (Panadol) as the hip was still quite sore still.
But I was mobile! And the pain was so much less than before; so I was very happy.
Balance of 2008
Overall I was a lot more mobile than I had been before the hip operation.
However, the right hip replacement continued to be sore – strangely I still seemed to be aware of hip pain which was clearly ridiculous as I did have a hip – just a lump of stainless steel (or that is what thought because that is what my surgeon had told me).
I tried a few games of golf but quite quickly decided that a golf cart was a necessary evil, even though and older friend of mine, who had had a hip replacement by the same surgeon seemed to manage to walk around the course OK.
As the surgeon had mentioned it would take up to 18 months to get the full benefit of the operation, I just put it down to the fact that the hip was still healing and I was still getting used to it.
I continued to take Panadol regularly and some Voltaren which seemed to help.
An Eventful 2009 – 2010
During 2008 the Global Financial Crisis (GFC) was hitting NZ and 30-plus finance companies went into receivership and liquidation.
In 2006 I had floated a biotechnology company on the NZX. Mid 2007 I had resigned from the business due to a hostile takeover and in May 2008, just after I had come out of hospital after poisoning due to the Salazapyrin, I was rung up by one of the company’s financiers and was told that the company was about to go into administration or receivership because they had lost confidence in the board and management. This was news to me as all the press releases from the company had been positive. It transpired that the board had not released my personal guarantees as provided for in a deed of separation in 2007. The net result was that I was financially ruined.
So in February 2009 I went to Australia to look for work. I stayed with some very good friends for several months and my wife’s relatives while I found a job – finally in May 2009.
During my time in Sydney, I had no car and so walking and buses was the name of the game. My hip continued to trouble me and it was a major battle to walk the 1 km to the shops and even a greater battle to walk home up a steep hill to where I was living. The hip was painful and as I very little money I could not afford much in the way of painkillers – and I had not been there long enough to get Medicare.
I just put the hip pain down to the “hip settling in” and kept going. I had little choice to be frank.
Once I got a job I was able to afford to go to the local doctors on the Gold Coast, just south of Brisbane.
The hip seemed to be niggling along and so I just kept it under control with Panadol as required. However, with my job there was increasing amounts of driving and flying and the hip started to play up again. Voltaren seemed to be even better and I bought it across the counter and took 50 mg twice a day – much less than I had been taking prior to the hip replacement – mind you, that had put me in hospital twice with bleeding!
About August 2009 I was helping out in the warehouse as we attempted to get all the orders out for a record month of sales and while moving a relatively light pallet of pet accessories around to the wrapping machine, I somehow twisted the right hip and it felt like the actual femoral stem of the prosthesis had moved.
Knowing what I know now, I think it probably had!
I carried on after 30 minutes, as most blokes do and all seemed fine, albeit a little painful – so down with some Panadol.
However, when I got home that night I was in absolute agony and so I had to go to the Gold Coast Hospital A&E. Once I go there after about 2 hours they gave me some strong pain killers while I waited. By about midnight I finally got seen and after some X-rays they concluded that the hip looked fine and sent me home with a prescription for some more pain killers.
Over the next few months the pain killers seemed to be less and less effective and so I went back to taking Voltaren 50 mg twice a day. I bought packs of 25 mg over the counter and took two in the morning and two at night and this seemed to help. However, by this stage I was out with the sales team 3 weeks out of 4 and driving and flying and walking became increasingly painful. Several more trips to the hospital A&E ensued and same result – hip looks OK.
May 2010 I finally had enough spare cash to take out Medibank Private cover – but there was a 12 month stand down period for pre-existing conditions. So I got a referral to the Gold Coast Hospital to be seen by an orthopedic surgeon. Little did I realize then, that it would take another 12 months to secure an appointment at the Gold Coast Hospital Outpatients clinic!
About this time I started having an irregular heart beat which my local doctor seemed to thing was stress related and prescribed a drug called Kalma, but this made no difference at all. The irregular heart beat has continued and I have put it down to a premature ventricular contraction (PVC) but now I am wondering for reasons which will become obvious.
I tried playing golf and going to the driving range during 2010 but always it aggravated my hip and by now the left hip was starting to make its osteoarthritis felt, not to mention bad “tennis elbow” after one round of golf.
I sold my golf clubs in absolute disgust and decided to find other less stressful and punishing pastimes.
By early 2011 I was increasingly concerned at the loss of mobility and the ongoing pain and sensitivity in the hip, the outside of hip, the groin and at time in the pelvic bone area. And by now the left hip was hurting in the groin, down the leg and to the knee.
So my local doctor prescribed Naproxen 1000 mg daily in place of the Voltaren. This seemed to provide some relief for both hips but I also needed a stronger form of Panadol, Panadol Osteo, 2 -3 times a day.
I had a new lease of life and bought some cheap golf clubs and hit the golf driving range, dragging young son (6) and daughter (8) along – the loved it and so did I but after a few days the pain came back with a vengence and so since April I haven’t played golf again.
In fact I have had a number of days where all I have wanted to do is just rest. Fortunately I am not traveling too much at present, apart from driving from the Gold Coast to Brisbane and back each day.
As my Medibank Private finally passed the 12 months in May I saw my doctor and got a referral to a private orthopedic surgeon – and just as I made the booking the appointment for the Gold Coast Hospital came up – so as it is associated with Griffith University and is a teaching & research hospital I decided to cancel the private specialist and go to the Outpatient’s Clinic on the 8th June 2011.
Read on – Current Issues with my hips