JENNI MURRAY: As I wasn’t a deep sea diver or an alcoholic, there was only one reason that I needed two new hips
The pain came with a sudden and alarming ferocity. It was New Year’s Day 2008. Friends and family who had stayed the night were sitting around the kitchen table having breakfast. I stood up to make another pot of coffee and cried out.
My left thigh felt as though someone was drawing a serrated bread knife deep inside from knee to groin. I thought I’d pulled or even torn a muscle and abandoned plans for a bracing country walk.
The pain didn’t go away. After an optimistic week or three, I hobbled to the GP.
Amazing recovery: Just 12 weeks after her hip operation, Jenni Murray was walking without support
When you’ve had cancer (mine was breast cancer, diagnosed Christmas 2006 at the age of 56) and then you have pain that refuses to subside, your first thought is secondaries – a spread of the cancer into the bone.
My doctor, who clearly thought the problem was muscular, was sympathetic to my fear and sent me for an X-ray of the femur.
It uncovered nothing untoward. She recommended physiotherapy and for four or five weeks I went along to Ruthie, who massaged and manipulated and was mystified that not only was there no improvement, but the right leg was starting to show symptoms too. Every step was agony.
It was Ruthie who suggested a call to my surgical oncologist, who’d dealt with my breast cancer a year earlier. I described my symptoms to him, explained that I couldn’t walk without crutches and heard, for the first time, the words ‘avascular necrosis’.
He referred me quickly to an orthopaedic surgeon, who scanned my hips and confirmed the diagnosis.
He explained that the corrosive impact on the femoral head, the ball part of the ball and socket joint that makes the hips work, is similar to the effects of severe arthritis, but is caused by a disruption to the blood flow to the end of the bone.
He proffered three possible causes. Maybe I was a diver who’d had the bends. I can’t bear to put my face in the water, so I’ve never even snorkelled. We ruled out diving. Could it be I was an alcoholic? I confessed to liking a glass or two of wine, but not that much. So booze wasn’t the problem. Sometimes it could be a by-product of chemotherapy. Bingo!
The surgeon suggested the least radical treatment that might work if the condition was not too advanced. It would involve drilling a hole into the femur in each leg and might kickstart the blood flow. The torture of walking was so great I would have agreed to anything. We tried it.
I was admitted to hospital and, with what my beloved called ‘the surgeon’s Black and Decker’, a hole was drilled at the side of each thigh into the bone under general anaesthetic.
It made not the slightest difference, but I agreed to wait for six months to see if there was any improvement. They were the worst six months of my life as I struggled to carry on working, travelling weekly from my home in the Peak District to the BBC in London and availing myself of disability assistance at each end of the journey. I felt I’d aged 20 years.
As word got around that I was crippled, I heard from others who’d had the same condition after chemotherapy. One old friend had been treated for throat cancer; another, like me, had the problem in her breast, and a number of Woman’s Hour listeners emailed to describe exactly the same experience. All, in the end, had had their damaged hips replaced.
Now, I can’t say for certain that if the oncologist had warned me of this possible side effect of chemotherapy, I and my GP might have recognised the symptoms sooner and the drilling operation might just have worked. And I can understand why a doctor who is trying to save your life with vicious chemotherapy drugs and who knows how wretched they will make you feel might be reluctant to warn you of potential horrors to come. But I would have preferred to have been prepared.
March to September passed with ponderous slowness. If anything, the degree of my disability increased. I measured out every step from bedroom to bathroom, sitting room to kitchen, back door to car. I refused to abandon the stairs and sleep downstairs, but had to crawl up and down them on hands and knees.
Finally, my orthopaedic surgeon conceded defeat and we set a date for a bilateral hip replacement. Usually a surgeon will do one hip and then the other at a later date because, where the cause is arthritis, one generally gets worse before the other.
In my case, the deterioration was fast, relentless and equally bad on each side. As I was relatively young, strong and otherwise healthy, we agreed to replace both hips on September 11. I couldn’t wait.
I expected to be scared. I wasn’t. Perhaps I’ve become blasé about surgery after a mastectomy, breast reconstruction and the earlier drilling attempt. I expected a lot of pain in the immediate post-operative period and I was dreading having to get off my bed and walk, but everyone I’d spoken to who had been through a hip replacement said it gave them back their life.
I gritted my teeth, endured the epidural and slid off happily into fully anaesthetised sleep.
I’d considered staying awake. The novelist Maeve Binchy had told me how she’d had one of her hips replaced with no pain relief except an epidural and what she described as happy pills, and said she’d had a jolly time making the theatre staff laugh. My surgeon wasn’t keen. It would take several hours to complete both sides and I suspect he couldn’t face the prospect of me acting as if I were the host at a gruesome party.
I came round lying on my back with a wedge between my knees and registered the dire warnings that I must on no account attempt to cross my legs – a sure-fire way to dislocate the surgeon’s handiwork. I vaguely recall anxious sons and husband at my bedside and not much more for 24 hours.
And then the shock of two smiling physiotherapists at my bedside with a Zimmer frame and an uncompromising order that I should get up. The mere idea seemed quite ridiculous. I still had legs, but I wasn’t sure they belonged to me. But the physiotherapists insisted and, carefully, I slid sideways across the bed, swung my feet to the floor and stood up. Miraculous and pain free.
One day later I was making tentative steps into the corridor; after three days I was on crutches and attempting the stairs. In less than a week I was saying ‘Goodbye’ to the ward staff, armed with instructions on how to exercise, how not to sit in a low chair for six weeks for fear of dislocation and a clear command not to go back to work for 12 weeks.
It took a while to gain the confidence to abandon crutches and move to a stick, and the 12 weeks were pretty much up when I finally plucked up the courage to walk without any support, but the results of the operation were wonderful. The pain had vanished.
Just one word of warning. After hip replacement, take good care of your back. It was a cold night in January when I was alone in the house and the fire began to falter. A sensible person would have used a small shovel to load on the coal. I picked up the scuttle and felt something go. I’ve had it before. The usual solution is to go to the osteopath who puts one leg across the other, makes a big click and all’s well.
But, on account of the new hips, it was no longer a treatment option. Fear of dislocation again. I had dreadful sciatica, which a series of steroid injections helped but didn’t cure, and I’m now in the hands of a cranial osteopath with magic fingers. There’s no clicking or cracking, but she places her hands under my spine, does gentle manipulation and I feel the strange sensation of fluid moving around. She explained that it works by stimulating the spinal fluids that carry messages from the brain.
I can’t say I understand enough about how the human body functions to comprehend fully what she does, but after each visit I stand a little straighter, bend a little easier and walk a little less like a penguin. I’m active and mobile again and in awe of the wonders of modern science.
Why Jenni’s hip bones began to collapse
Avascular necrosis (AVN) is a disease resulting from the temporary or permanent loss of blood supply to an area of bone. Without blood, the bone tissue and surrounding cartilage dies and the bone collapses.
AVN usually affects the joints at the shoulder, knee and hip. There are around 2,500 cases in the UK a year and risk factors include alcoholism, decompression sickness, sickle cell anaemia, rheumatoid arthritis and lupus.
It can also be brought on by injury, chronic high blood pressure, vasculitis (inflammation of the blood vessels) and as a side effect of various drug treatments.
‘It is extremely uncommon to see AVN as a side effect of chemotherapy, and we would expect it to occur in less than one per cent of patients,’ explains consultant oncologist Dr Peter Harper at the London Oncology Clinic. ‘We are not sure why but for some reason the toxic drugs used to destroy the tumours also, in these instances, destroy the fine blood vessels within the joints. Most GPs would never see a case in their entire career and the symptoms are easily mistaken for other conditions.
‘Those who experience pain in the hip or another joint should speak to their oncologist as there are treatments such as drilling, which can re-establish blood supply, or hip resurfacing, that can be tried before replacement.’