Bringing You Up to Date

Many Years in the Making: Now that I have had a chance to think about it, I have been having hip joint symptoms for many years but I never associated the symptoms with the source. My symptoms were groin pain, PITA, and quadricep pain (all both sides). (Most patients think that their hip is in the region of the buttocks and are surprised to learn that true hip pain is most commonly experienced in the groin. Source: The Hip and Knee Institute) The cause apparently was arthritic deterioration of my hip joints. But what was the cause of that? Many theories, but overload, too much weight on those weight-bearing joints appears to be the primary culprit. My weight at least contributed to and possibly accelerated the development of the problem. But there were other causes as well.

Some Congenital Contribution Also: I have been overweight all of my life. That led to a variety of leg and foot problems (principally swelling, insufficient circulation, pain). But, thinking back, about twenty years ago a friend (Bobby Zelin) pointed out that I was walking on the outer edges of my shoes. That was probably a precusor of things to come. And, interestingly, when my surgeon Dr. Buly threw my hip x-ray onto a light board, the second thing he noted was that one of the sides of my femur was convex rather than concave. He said that apparently my femur continued to grow after my young adulthood, when growth should have stopped (eventually leading to impingement with the pelvis). (That was the second thing he said. The first thing he said, when he saw the degree of arthritis that has resulted in bone-on-bone contact in both hip joints, was "oh, you must be in a lot of pain". Thank you. Yes, a great deal of pain and constant.)

Some of the exercises and activities I engaged in during my life probably contributed as well, including those mandatory standing broad jumps in the 7th grade, jogging when that was the craze during my 40's (I was actually jogging 6 miles), as well as inattention to the condition of my shoes and sneakers which I tended to wear well beyond their useful lives.

Relieving or Living with the Pain:The clues were there for a long time. About a year ago I began noticing groin pain. I mistakenly attributed that to a slip and partial split in the shower. Then my gluteus maximus (buttocks) began aching along with my quadriceps which would become rock solid tight. Walking anywhere became a chore. Walking over uneven surfaces was worse.

I found some comfort with an occasional dose of Advil. Aleve didn't do squat for me. UltramER was prescribed but ineffective at the dosage given. I began to need regular rub-downs with a "Thumper".

Finally, Dr. Brian Israel, D.O., my primary care physician, guitarist and guitar collector, prescribed 5-500 Vicodin-Tylenol and that worked.

Physical Therapy Ineffective: Early on I started treating with a physical therapist. The warm moist heated blankets were soothing, the light back massages too light, the laser heating comforting, but nothing lasted. Eventually I stopped treating because nothing was working to relieve my pain long-term.

Weight Loss with Purpose: At the same time I had re-embarked on an on-again, off-again long-term program of weight loss under the guidance of a nutritionist with Phelps Hospital in Tarrytown, New York. I have tried many different diets, and have been somewhat successful, but my middle initial, "R" doesn't stand for "Richard", it stands for "Recitavist". I was a recitavist dieter. No matter how well I did on a diet program, I always gained back the weight I had lost, and more. I was a Duncan® Champion Yo-Yo dieter. Eventually, I essentially gave up, resigned myself to being big, and kept purchasing ever larger clothes.

There came a time when the only thing I felt good about buying was an extra-long tie. Even my shoes weren't fitting. My feet had swollen as well as my legs.

Recommittment to Weight Loss: So, I started losing weight again, cutting back on portion size, making better food choices. Wight loss, for me at least, is sporadic. I loss weight, then I plateau. I had plateaued at about 50 pounds down from my all-time high. With a renewed the assault, came another 10 pound weight loss. But I got stuck again. And now, with impending hip surgery, I knew the time had come to get down.

I consulted Dr. Louis J. Aronne, a weight expert whom I had consulted many years ago and with whom I dropped 10% of my weight. Down 60 pounds, Dr. Arrone reviewed my blood work and history and prescribed a low dose (500mg) of Metformin, a drug with an off-label use controlling blood sugar and appetite.

Metformin has been good for me so far. I've lost another 10 pounds, bringing my total to 70 pounds lost. When and if I plateau again, we might try Welbutrin, an off-label use for which is weight loss.



Currently I have very little appetite. That's good. It's especially good because the pain-killer I've gotten to, 5-500 Vicodin-Tylenol, has one very nasty side effect -- constipation. Let's leave it at that, except the calcium blocker is also constipating. Needless to say, when one experiences so much difficulty eliminating, one's food choices narrow considerably. Granola, fruit, prunes and other good-for-you stuff are now staples in my diet.

When I go out to eat, I order less and generally eat less than half of what I order. My appetite is greatly reduced, sometimes non-existent.

With my recent weight-loss I went shopping -- in my basement where I had saved two or three wardorbs worth of smaller clothes from earlier times. I am now wearing clothes I haven't fit into for 15 years. And yes, still in style (my style).

Back and Leg Pain: But the pains in my back and legs were not diminishing. I was referred to an anesthiologist, Dr. Vinoo Thomas, who concluded that my pain was emanating from my sacroiliac ("SI") joint. Under minimally invasive fluoroscopy, I underwent two cortisone injections into each SI joint which provided me with some relief -- enough that I was able to trek around Israel this past May with occassional resort to ibuprofen. (If you like the photos of Israel, you might want to see my photos of Africa.)

The pain continued to escalate in scope and intensity. I couldn't sit for long, especially on hard surfaces. I was referred to Spine Options in White Plains, New York where I was seen by Bradley S. Cash, MD, FAAPMR who examined me and set me up with a course of physical therapy in his office. My therapist, Hemalatha Ramraj, PT, MS, was wonderful. But there was little marked improvement in my condition after several months of treatment. Eventually my insurer came to the same conclusion that I did -- the sessions were not working to improve my condition which was, in their words, "chronic" -- PT was not going to improve my condition.

Hema, my physical therapist, suggested that I have my hips x-rayed and her supervisor, Dr. Cash, ordered the x-ray. Bingo! Finally we had gotten to the problem -- advanced osteoarthritis in both hips. An earlier MRI of my lower back revealed disc herniation at L5 and T12 and the easy conclusion would have been that the disc problems were causing my leg pain. Not so. It was the hips.

And the pain was escalating. On a 10 scale, it had gone from a "3", controllable by Advil, to a regular "6-8", sometimes a "10" (when my hip would essentially hang up on a spur when I would sit a low couch in my TV room. That caused my hip joint to get stuck out of position, putting me in "catch-your-breath" agony). The only relief for me when that would happen was to wiggle to the floor and thrash about until my stuck hip joint fell back into place. I don't sit on that couch anymore and hope someday to see it at the curb awaiting my town's next bulk refuse pickup.

Confirming Diagnosis: I consulted with a friend of mine (Dr. Adam Levine, Associate Professor of Anesthesiology at Mt. Sinai) who recommended that I see Dr. Harry Spiera, a terrific diagnostician and rheumatologist. Dr. Spiera confirmed the diagnosis of advanced osteoarthritis. He said that surgery was definitely in my future.

At that point Anne Grundstein, my sister-in-law, an occupational therapist, arranged for a heavy duty cane to be delivered for my use. I have been using it daily since I received it.


My condition has continued to deteriorate markedly, and especially within the last 2 months. A couple of months ago I was able to hobble through airports in Newark and Atlanta for a dinner meeting with attorneys celebrating the 10th anniversary of their firm's founding. Last week I needed a wheelchair in Newark and Orange County airports to get to Laguna Beach, California for a CLE program that my Network produced. And while at the hotel I used an electric powered three-wheeled Lynx-3 (which I found a bit too short in length for my 5'-11" frame for me to be comfortable -- my feet hung off the front of the vehicle, but it beat trying to walk around the hotel). The decline in my hip condition has been rapid and irreversible, but for the upcoming hip joint replacement surgery.

Humor Even Under These Conditions: It took 6 weeks just to get an appointment with Dr. Buly. A number of other fine doctors were recommended to me, but Dr. Buly had operated on my neighbor who had a particularly challenging problem -- she needed to replace a hip prosthesis that was installed many years ago. She was referred from one doctor to another, each declining to operate, until she got to Dr. Buly. Her surgery was successful.

The moment Dr. Buly punched my x-rays up on the light board, he remarked, "you must in a lot of pain". Yes, I certainly was.