Saturday, July 12, 2008

Decisions, Decisions

I hate making decisions. I am probably the most indecisive person you will ever meet. Any decision, whether big or small causes me great anxiety. Back and forth I go from one choice to another weighing my options and getting nowhere fast. It even took me a while to decide whether I should write a journal about this subject or not. Argh!

I have a really big decision to make right now. As some of you already know, I have bi-lateral avascular osteonecrosis. I had my right hip replaced five years ago. Right now I am at a point where I need to think about getting my left hip replaced. The pain is unbearable at times and is severely impeding my quality of life. For most people, this would be a no brain-er. Go get it done, right? Well, it's not that simple.

There have been some advances in techniques since 2003 when I had my right hip replaced. One of my options is to have a total hip replacement with an anterior approach incision. This means they go in through the groin, not the side of the hip. This eliminates cutting into all the muscle that is located on there hip area. One of the main reasons for the long recovery in traditional hip replacement is that once those hip muscles are cut it takes about three months for them to knit back together. This leaves the new hip vulnerable to dislocation and other complications if you bend and move around too much. So, with the anterior approach, this is not an issue. The surgery is the same as far as composition of the new joint and what the surgeon does once he gets inside. It is still a full hip replacement.

The second option is a bone sparing hip resurfacing procedure. It is similar to capping a tooth in that they shave off a portion of the ball joint and cap it with a titanium hood (along with plastic that mimics cartilage) and secure it with a small pin. This makes it easier when revision surgeries are inevitably necessary, since the joints only last 10-20 years. At my relatively young age (38 when I had the first surgery, 43 at present). I will most assuredly have at least one, if not two or more revisions in my lifetime. Sparing some of the natural bone will be very beneficial. The drawback to this surgery is that he uses a traditional incision on the outside of the hip, making recovery a longer process.

So, my choices are short recovery and totally hip replacement that may cause complications later on or longer recovery now, but a chance to save some of my natural bone, making it easier on me when I am older and have to have more surgeries.

To further complicate matters, If I go with the anterior approach, I will have to change doctors (Dr. Emerson). If I decide on the hip resurfacing, I can stay with the doctor (Rathjen) who did my right hip replacement. I really like him and have a good relationship with him and am happy with the result of my first surgery.

I have made appointments with both doctors. Since it has been a while since I saw Dr Rathjen, I have to go in to be evaluated by his assistant before I can even make an appointment to see the doctor himself. I will be going in on July 24th. The earliest appointment I could get with Dr. Emerson is September 3rd. So, for all intents and purposes, I couldn't make a decision now if I wanted to. This is a little frustrating to me.

Right now I am on heavy pain killers, something I really didn't want to do. I was on them for about nine months prior to my first surgery and getting off of them is a formidable process that I did not wish to repeat. My procrastination and difficulty with decision making have gotten me to this point, so I can only blame myself, but it doesn't make the pill any easier to swallow (no pun intended).

I am feeling very frustrated and cranky these days. Chronic pain makes a person snappish and touchy. Pain medication does not help with mood swings and irritability. Knowing that is my own fault that I waited this long makes me even more cantankerous.

Oh, well...I press on.