Pan into Fire

Physically, I felt better today than I have in three weeks.

That's strange, since today's news ain't good.

Yesterday, trying to take advantage of the hemoglobin reprieve from Wednesday's transfusion, I managed two half-hour walks. Then I spent 10 minutes on a recumbent bike — nowhere near as tiring as the last time I tried that a few days ago — and did a few relaxation asanas. Had a slight fever off and on all day from the transfusion.

That morning I'd read up on avascular necrosis of the femoral head and neck. My CT scan showed trouble there, suggested followup X-rays and MRI. Dr. B had sent me for X-rays, but I was so focused on the leukemia that I just didn't think about it much. I realized I'd better face the music.

That might have been a mistake. By bedtime I started having the (to me) telltale signs of an impending muscle spasm. (Psychosomatic?) By 3 AM my right hip was on fire. I had to haul out the Vicodin.

Bone's alive. Avascular necrosis means that part of a bone loses its blood supply and begins to die. It can recover, and in fact bits of bone are always dying and being replaced by new, living tissue, but in necrosis the dying outpaces repair and eventually becomes permanent. The blood supply can be cut off temporarily or permanently, by trauma, arterial blockage (caused mainly by alcoholism), steroid use, half a dozen other things. Or it can be "idiopathic," meaning we have no idea why this happened to you. In my case, aikido, hyperextension of the hip joint in yoga, maybe the 4 cortisone injections I had in the 1990s, might be causes. If I have this. It's not uncommon: 10-20,000 cases a year.

One day in the winter of 2001, Gabrielle and I went cross-country skiing for a couple of hours in 15° weather. When we finished, we jumped immediately into the car, drove somewhere, spent perhaps an hour sitting in a very cold car. It had been a huge workout — and if you ski you know that the back of the hip does most of the work — but I'd never stretched. When I got out of the car I could tell something was wrong. By the end of that day my right hip ached fiercely. This continued for several days while I essentially ignored it and tried to power through my usual regimen of cycling, stretching, yoga. By Day 4 it hurt so much I couldn't walk. Standing in one place hurt even more than walking; the tiny postural movements your hips make to keep you balanced burned like fire. By then, with one muscle after another trying to take over the load from the other, exhausted ones, the spasm had spread to the entire pelvic girdle. The following morning no position at all — not even lying down — was pain-free. I remember I was supposed to deliver a presentation with Tim Killeen — now director of NCAR — at 8:30 AM, but I literally could not stand up. I had to call and cancel 30 minutes before the presentation. Tim could not have been happy about that.

I finally went to see my doctor. He laughed when I told him about it. You kicked your own butt! He prescribed Vicodin, muscle relaxants, and bed rest.

It worked. I had to stay flat on my back in bed for 3 days, loaded on Vicodin, but after that the spasm subsided and I gradually returned to normal over the space of a few weeks. Even 3 months later, though, the muscles in that hip remained stiff.

Since then this same hip spasm syndrome has recurred, four more times. The etiology was always the same: major exertion with failure to stretch afterward, either preceded or followed by prolonged sitting or lying down. Once after a night on an old, rock-hard futon; another time during a marathon drive from South Africa to Namibia. Right now, a mild workout following a week or so of lying down most of the time. I learned to handle it: eat ibuprofen like candy, ice the hip like crazy for a few days, stretch slooooowly and gently, massage.

Anyway, I always thought of this as your basic sports injury, probably a torn piriformis. Now it seems like it could be a symptom of whatever's going on in my femur. Maybe the skiing produced the original trauma; maybe not. Maybe avascular necrosis isn't it. But Nurse M, who saw the recent X-ray results, told me today that they've asked for further evaluation.

That means an MRI. And from what I've read, they only do an MRI if they think you might have this. It's pretty bad news. Avascular necrosis never goes away on its own. It can take a few years to progress, but it virtually always ends in total degeneration of the hip joint. By the time you get symptoms like mine, the treatments are basically all surgical. Core decompression (carving out the core of the bone in hopes that it will revascularize and repair); this doesn't work very well (15-20% success). Metal-on-metal joint socket repair. Total hip replacement: those artificial joints only last 10-15 years.

Nurse M requisitioned the MRI on an urgent basis. I'm trying, trying to hope that this'll turn out to be something less serious. Meanwhile I'm doing what's worked before to make the spasm subside. But once again I feel like I've entered a dark tunnel. Nothing to do but grope on through and hang on.