The world is not only getting warmer, it’s getting older, too; the planet, plus the thin, scattered organic layer of humans upon it. For the first time in history, more people are over age 65 than under 5.
Don’t blame me. I’m only 58. But I see what’s inching closer to me — or rather, I’m plodding closer to it, rolling as I go from osteoarthritis in my right hip. I learned about it five years ago when I banged up my knee skiing in Colorado — a good, youthful ailment! — and the doctor looked at the hip as well.
“Bone-on-bone osteoarthritis” he pronounced or, in English: the goo that once lubricated the hip socket has vanished to that place where youthful dreams go.
The prime-of-life approach to medical care is something goes wrong, you fix it. But old person medicine isn’t that straightforward. Conditions are chronic and tricky. There are reasons to postpone hip replacement. The surgery, like all surgery, can kill you, whether by botched anesthesia, or blood clots, or infection. And infection is a permanent problem — a mechanical hip can get infected by having your teeth cleaned.
Artificial joints also break or wear out. If you can push the replacement to 70 or later, the thinking is, maybe you’ll get lucky and die before you need another one.
I had gathered all this folk wisdom before consulting a surgeon last October, the head of orthopedics at … let’s draw the veil … a prominent Chicago hospital. He showed up with his intern, or valet, or somebody. I made the mistake of betraying knowledge sniffed out on my own, and this seemed to offend him. He shot me that “Who’s the doctor here?” look and soon I was back on the street, thinking, “I should talk to a doctor about this.”
Next stop, my own general practitioner. He listened to my symptoms and replied, “Don’t wait. Just do it” — easy to say when it’s not your hip — and gave me the name of someone at the Illinois Bone and Joint Institute, a massive facility that seemed like it was processing all 340,000 hip replacements done in the United States annually on the day I visited. The surgeon breezed in, looked at my X-rays, said, “You are a perfect candidate for this,” and handed me his card. Call and we’ll schedule the surgery.
“I’m worried about the psychological stress of scheduling the surgery,” I replied. He paused, as if pondering whether something so ridiculous need be addressed, decided it didn’t, and slipped away.
I stuck the card on my bulletin board.
A publicist pitched Dr. Derek H. Ochiai, of Arlington, Virginia. “May we call you to schedule a call with Dr. Ochiai?
God yes! I replied, and soon he was on the phone.
“Wait as long as humanly possible, right?” I asked.
“I don’t think ‘as long as humanly possible’,” Ochiai said. “It’s all a matter of one perspective. How much it bothers you, are you noticeably limping? A patient who can hardly straighten out his leg, that type of person gets a hip replacement, they feel amazing. ‘Gosh this is great, wonderful, I can walk.’ They’re very, very happy.”
I felt a “but” coming.
“If your symptoms are relatively minor and intermittent, good days and bad days, and you’re still able to hike in Chile for two weeks, you may not be as happy with your hip replacement. Not because didn’t have an excellent job with surgery. If symptoms were relatively minor, you may notice differences in how your hip feels more than people who were miserable.”
Differences such as?
“Leg-length discrepancy. If the hip is really bad, you won’t care. But if it’s not that bad, you sort of notice differences, that your leg used to turn out and now it turns in. Or you feel a clicking. You hear a noise in your hip. Those kind of things.”
I told him I was treating the hip with dieting and swimming laps four times a week, which really seem to help.
“Keeping your weight down is number one,” he said. “Any amount of weight loss helps. Physical therapy for mild hip arthritis is shown to be very beneficial. It has a cumulative effect: your hip feels better, you are more active, lose more weight. It cycles up, positively.”
Cycling up positively sounds like a plan, and we old people, we like to plan.