Too Young

“Hip replacement? You’re too young to have a hip replacement!”

I have heard this over and over in my daily excursions and in the telling of the story over and over again to people who are wondering why I am crutching around with my two kids in tow. I am often amazed at how perfect strangers have absolutely no inhibitions about stopping a person in the grocery checkout line to ask about why one is using crutches.

“Surgery,” I say, as I unload my overfilled cart with one hand and no help.

“What kind of surgery?”

Most of the time I think to myself, “None-of-your-beeswax surgery,” but given that my energy levels have not yet returned, I avoid the urge to fight this battle publicly.

“Hip replacement surgery.”

“BUT YOU’RE TOO YOUNG TO HAVE A HIP REPLACEMENT!”

It’s almost as if you can anticipate the rhythm of the stanza and dance to it.

I’ve tried to come up with clever retorts in the moment, but half the time, my school-age daughters are with me, and unfortunately, none of my brilliant comebacks are rated G.

These conversations are fine when I’m having a great day, but as I recover from hip replacement surgery, there are good days and bad days.

On bad days, I ache or I’m more tired than usual. When I hurt or ache and I am trying to accomplish some simple task like filling my car with gas, or picking up a take-and-bake pizza, almost predictably some large, overweight person with no personal boundaries will start with a line of questioning about why I am on crutches, finish with the “too young to have a hip replacement” thing, and then start in on some family member’s medical menagerie that has no parallel whatsoever to a hip replacement. All the while I am gritting my teeth, just trying to get through the moment and not be terribly rude. I just want this person to please stop talking to me about their horrific healthcare experience. It is at this time, that I must bite my tongue or go to my “happy place” and refrain myself from speaking my mind. After 12 years of emergency room nursing, one tends to be creative. The litany of one-liners that I have collected abounds. It’s really all about choosing one in the moment. Since there are so many possibilities, I am reticent to choose one, and therefore keep my mouth shut….., but a few of them sometimes slip, shrouded in sarcasm.

“I can see that you are taking much better care of your hips by not doing much at all. ”

“Perhaps I wouldn’t be in this mess if I had watched more TV. Clearly, it’s working for you!”

“Really? What exactly is the recommended age for a hip replacement? Do you think I should have waited? Oh Please! Tell me more! Because really, I’ve got nothing better to do with MY day.”

“Because smoking and drinking and having sex with multiple partners would have been a much healthier way to have spent the earlier years of my life…..Ski racing?…..what was I thinking?”

I cannot tell a lie. I have had all of these thoughts at least once and yearned to use them as a response. Sometime, I feel like a circus attraction.

Respectfully, I tell people that I have successfully worn out my hip in half the allotted time, that I have triumphantly used my hip so much that it simply could not keep up, and that modern medicine is now taking a stab at seeing if it can produce a better product for my very demanding physical lifestyle. I, either, lose my audience to complicated mental calculations of why anyone would be proud of this fact, or people just laugh and nod and that’s the end of it.....unless of course they are Raiders fans. Raiders fans get it and usually give me a fistful of solidarity and a hearty “Hoo-rah!”

Most of the people who ask are laypersons who have no prior medical knowledge, nor personal boundaries (or discipline for that matter). Then there are people who look at me with pity and tell me how sorry they are that I had to have surgery. I feel compelled to set them straight about the fact that surgery actually fixed me and once healed, I will have an opportunity to live another 15-20 years without hip pain. Unless of course, I get hit by a bus tomorrow which is an entirely different conversation……

These social interactions that I have been having have stimulated my brain to wonder certain things.

“How young is too young?”

“What is the median age of the hip replacement patient?”

“Is there an increase in incidence of joint replacements and if so, why?”

Any nurse worth her salt will tell you that obesity is the root of all evil. While I make bad jokes and terrible, stereotypical suppositions about people who carry extra weight, the fact is that the American diet is really to blame. Combined with a sedentary lifestyle that includes a desk job and a television, the American diet contributes to the top five killers of humans today. Obesity is a major risk factor associated with Heart Disease, Stroke, Some Cancers, Diabetes, High Blood Pressure, Osteoarthritis and Disability. The American diet is a total travesty. Even if you have money to burn and hire a chef or nutritionist, the fact is, our food supply is tainted with hormones and bacteria, lacks the nutrients we need, and is full of stuff that we don’t need at all. Our bodies are rebelling the American diet via the inflammatory response, which eventually manifests as joint pain and other incurable disorders.

We humans are also living a lot longer than we used to and doing more activities. According to the CDC, in 1900, the life expectancy for males and females respectively in the United States was only 46.3 and 48.3 years. If that were the case today, I’d be retired and living large at 40! In 2006, it was 75.1 for males and 80.2 for females. In 106 years, our life expectancy almost doubled. In 2007, life expectancy reached an all-time high of 77.9 years (total population). Our structural makeup, however, hasn’t changed too much. Technology has provided us running shoes, bicycles, skis, skateboards, scooters, skates, (and helmets!) and other mechanisms we use to hurl ourselves across the planet, self-propelled. Given the higher speeds, the increased impacts, and the ability to do more over a longer period of time, it is no wonder that we are wearing out our parts.

The most common reason for joint replacement is pain and decreased quality of life from osteoarthritis. With an aging population and one-third of Americans obese, prevalence of osteoarthritis is expected to increase (CDC 2009 Health Summary**). Demand for joint replacements will grow an estimated 175 percent for total hip replacements and six-fold for total knee replacements by 2030. While most joint replacement patients are older, longer-lasting joints make the procedures a viable option for younger and more active patients. (“Ten Statistics & Facts about growth in Joint Replacement”, Becker’s Orthopedic & Spine Review).

Sooooo essentially, I’m a trendsetter. Technically, I am not too young for a hip replacement. Rather, medical technology has finally caught up with the needs of my cohort who have spent most of their lives hurling themselves down mountains and across vast expanses of turf and asphalt. Humans are not the only ones with increased life expectancies. New body parts are lasting longer and longer, and surgery is becoming more tolerable with faster recovery rates. So now, a trip to the joint doc is like a trip to jiffy lube or In-and-Out burger. This means that the prior median age of 65 for hip replacement surgery is dropping…..fast. Young, active people are getting wind of this and when they realize that they can get 10-20 more good years out of their young limbs, they are going for it. According to Wikipedia, 97% of patients who have their hip replaced, report improved outcomes, and spend a large portion of their latter life asking the question, “why didn’t I do this sooner?”

If you had a 97% chance of improving your life, would you do it? Surgery is still risky business. But there comes a time when one weighs the status quo against the risks. Living in a constant state of pain and inflammation compromises a healthy immune system among other drawbacks, so it’s not necessarily “risk-free”. Basically, you are throwing the dice in consideration of either direction.

Being on this side of the recovery room, I have decided that I am definitely NOT too young to have a hip replacement. However, I AM too young to be sidelined by hip pain. I am way too young to be morbidly obese because an arthritic hip keeps me from healthy exercise. I am too young to suffer from an inflammatory disease or a cancer that is caused by the stress of joint pain and I am far too young to be on disability because I can no longer work as an RN. I AM too young to watch my life swirl the drain prematurely, especially if a smart, smooth-talking and fabulously persuasive Doctor in LA says he can fix me and has the resume to prove it. With a life expectancy of 80.2 years, I am only halfway done with my life, and the best is yet to come.

…Unless, of course, I get hit by a bus tomorrow. However, if I DO get hit by a bus tomorrow, I sure hope today was not wasted sitting around, complaining of hip pain.

**Health 2009 CDC (http://www.cdc.gov/nchs/data/hus/hus09.pdf#executivesummary)

Health, United States, 2009 is the 33rd report on the health status of the Nation and is submitted by the Secretary of the Department of Health and Human Services to the President and the Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was compiled by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). The National Committee on Vital and Health Statistics served in a review capacity.

The Health, United States series presents national trends in health statistics. Each report includes an executive summary, highlights, a chartbook, trend tables, extensive appendixes, and an index.