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I’m Disabled, Shout It From the Roof Tops

Recently on Facebook an interesting discussion came up on one of the groups I am in.  This is a group for people who have had total hip replacements at a younger age than normal.  Someone posted the following question:

‘If you have a THR (total hip replacement) and are doing great, are you still considered a person with disabilities?’

One of the first responses was, ‘I have NEVER considered myself disabled’ and there were quite a few more like that.  A lot of people being very quick to dismiss ever having been disabled at all made me feel quite sad.  As a society do we see it as so shameful or insulting to be disabled that we deny it and try to hide it?

My first thought was they are fools to deny being disabled as they will have missed out things that could have made their lives a lot easier.  For one thing my disabled parking badge had been extremely useful during my worst periods of pain in my hip, so that I could still go out and enjoy places without having to walk too much.  I could not have even gotten that badge without my GP signing to say I was disabled.  Then there is the financial benefit of officially admitting to being disabled so you can get disability benefit of some kind, which helped me pay for things like taxis to places most people could have walked.  Plus all those discounts they were missing out on at the theatre, leisure centre, theme parks and so on, when either you get a cut price ticket or your career/ friend or in my case my mum could get in for free.

For me I could hardly remember a time when I was not disabled having been diagnosed aged seven with my hip problem.  I soon got used to the idea and it became normal for me to consider myself as disabled.  However if you become disabled later in life due to an accident or illness and did not grow up as disabled I think it must be a lot harder to accept.  It can mean having to adjust your sense of identity  and can bring on a lot of strong, mixed emotions.  Before being disabled you may have had an idea of what you think it is to be disabled, ‘Whatever image you had of disability will be the image you first apply to yourself” (Life on Wheels: For the Active Wheelchair User, by Gary Karp).  You may have seen disabled people as unable to be independent, unable to have families or careers, which may make you feel like you have now lost all that in your life.  This is of course untrue of being disabled, but it can take a while to find that out and in the meantime you may try to deny the disability to yourself and others so you can carry on without the fear of change.

Trying to act normal as if your disability does not exist is often known as passing or passing for normal.  There is nothing wrong with wanting to be as independent as possible and being a part of everyday society, however passing is not about that, but more about the problems denying being disabled can cause.   This person with Fibromyalgia writes a good example of passing,

‘I had cut off anything that required long walking, like trips to the zoo, or going window shopping for the day, etc. etc. Slowly but surely, they had just dropped out of my life. As I could no longer do them “normally” meaning on my own two feet, without paying a price of extreme pain. Not to mention, being miserable the entire time.

I would do things like take a long ride or plane trip and would fall on my face when I tried to walk, after being in a forced legs down position for hours. I did this to myself, repeatedly, rather than let the flight personnel bring a chair up to the plane for me. I avoided travelling on account of it.

I finally said to heck with normal ! Got myself a wheelchair, or had them bring me one and went back out and did things again. I finally had to make a choice of, use the chair, or just let such activities slide out of my life … forever. I chose not to permit that to happen,’ (“Passing for normal” cultural pressure and disability).

I can understand why people try to pass themselves off as not disabled.  Quite often society can make you feel like a victim or as a problem.  It can be hard to convince some people who having a disability does not mean you can’t be independent and that you are not going to be a burden.  As Gary Karp writes ‘the boundary between making the most of your abilities and trying to pass as not disabled is a fine line’. However there often comes a point where either you give up on life and ever doing very much or you give up caring what other people say and think about it and just get on with living your life the best way you can for you.

My favourite response to the discussion on Facebook was ‘If you can hardly walk I think that makes you disabled.  All this brave stuff is great, but sometimes you need help.’

I am not sure of the actual answer to the initial question posted on Facebook.  I feel like I am temporarily not disabled any more as my new hip lets me walk and stand longer and I am not in very bad pain frequently.  However I know false hips tend to last about fifteen to twenty years, then they wear out and start to cause pain again.  Then I may well feel disabled again.

I have more than come to terms with calling myself disabled, in fact I kind of like it now as it means I have something interesting to talk about when I meet new people.  Being disabled has led me to meet some of my closest friends who are also disabled and found we had something that bonded us.  Being disabled is just part of being me and I am not going to deny a part of myself.

 

 

 

 

 

 

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Facts about Perthes Disease

I was diagnosed with Perthes Disease or Legg-Calve-Perthes Disease aged seven and since then it has impacted on almost every aspect of my life.  Not many people know what Perthes Disease is or how it can affect the lives of those who have it, so I have put together a list of basic facts to guide people.

  • Perthes Disease affects the head of the femur (highest part of the thigh bone), which is the ball of the  hip.  Blood supply to the growth plate of the bone becomes limited.  Growth plates are the areas of developing tissues at the end of long bones in children and adolescents.  The growth plate regulates and helps determine the length and shape of the mature bone.  Due to lack of blood the bone at the ball of the hip softens and breaks down.
  • Regrowth of the blood vessels will occur over several months, and the blood supply will return to the hip bone.  New bone is laid down and the femoral head regrows.  It can take several years to regrow.  During regrowth the femoral head may be weakened to the point where it collapses leading to a deformed joint surface or even a complete flattening of the head which can lead to a permanent change in the shape of the hip.  In my case this led to a less than spherical shape inside a spherical socket.
Stages of flattening of the femoral head

Stages of flattening of the femoral head

  •   In the UK about one in every one thousand children get Perthes Disease.  It is most commonly seen between the ages of four and eight  years of age.  About four boys for every one girl are affected.  Roughly twelve percent of cases are bilateral, in both hips.  The younger the child when diagnosed the better the chances of a full recovery, especially under the age of five.
  • For younger children non-surgical treatment is often the preferred option.  Many children are put on crutches to become non or only semi weight baring to help with the pain.  Some are given wheelchairs to use for longer distances, but generally crutches are preferred as it keeps the other the muscles in the other leg strong.  In most cases the advice is to avoid heavy impact on the hip such as running or jumping.  Physical therapy is often used to help maintain a good range of motion within the hip.  The exercises tend to focus on hip abduction and rotation.  Hydrotherapy and swimming is highly recommended as non weight baring exercise that causes the hip less pain.  Traction is sometimes used when lack of motion in the hip has become more of a problem, although this is become a less common treatment.  A brace may be used in the most sever cases, with the brace keeping the leg slightly abducted, to keep the femoral head positioned well in the socket.  Anti-inflammatory medication such as ibuprofen are used to help regulate the pain in older children.
Scottish Rite Orthosis brace  The brace allows the child to walk and play while it holds the hip joint in the best position for containment.

Scottish Rite Orthosis brace
The brace allows the child to walk and play while it holds the hip joint in the best position for containment.

  • Surgical treatment is sometimes used on older children, generally preferred when over the age of six.  A tenotomy surgery or tendon release is used to release an atrophied muscle (a decreased muscle) that has shortened due to limping.  Once released a cast is applied to allow the muscle to regrow to a more natural length.  The cast is usually left on for six to eight weeks.  An osteotomy (cutting of the bone) surgery may be done to help realign the femoral head in a more protected position within the hip-joint socket.  Occasionally the osteotomy may be done above the hip socket so the hip socket can be repositioned to help the formal head have less chance of becoming deformed.
Varus femoral osteotomy uses a plate and screws to hold the hi in the correct position.  A wedge of bone is added to the acetabulum to restore hip stability.

Varus femoral osteotomy uses a plate and screws to hold the hip in the correct position. A wedge of bone is added to the acetabulum to restore hip stability.

 

  • A lot of Perthes patients end up with leg-length discrepancy, when one leg is longer than the other.  This can be caused due to the effected limb growing slower than the other leg and failing to catch up.  By the time I finished growing I had a one and half centimetre discrepancy.  This can cause a more server limp and a gait abnormality, changing the way someone walks.  This can cause posture issues including lower back pain.  Leg-length discrepancy can effect balance, for example I found it very hard to balance on a bike without stabilizers.
  • Perthes affects children during growth, once fully grown it is no longer Perthes, but it may  have left the hip damaged.  Perthes patients are at a higher than average risk of developing osteoarthritis in the hip, often at an earlier age than normal.  The more abnormal shape the hip grows back into the more at risk of osteoarthritis the patient is.  Older children who get Perthes are also more at risk.  Osteoarthritis can be extremely painful, making it painful  to bend over or even to walk.  If it gets very bad it can hurt almost all of the time including when at rest.  In the worst cases this can lead to the need for a total hip replacement, which I had aged twenty-five, being told I had degenerative early onset osteoarthritis.
  • Children who have Perthes at a younger age, usually under the age of six are often less at risk of developing problems with the hip in early adulthood, with the hip likely to grow back more rounded and correctly in the socket.
  • There is no clear reason why some children get Perthes Disease.  It is not due to an injury or blood vessel issue.  In some cases it does seem that Perthes runs in families, but there is no clear reason as to why.  However it often appears very randomly with no family history at all.
  • Legg-Calve-Perthes is named after three physicians who independently described the condition in 1910. There were American Arthur Legg, French man Jacques Calve and German Georg Perthes.
  •  Dogs also seem to get Perthes Disease, mostly seen in miniature, toy and terrier dogs.  They are usually about five to eight months in age when effected.  It effects the dogs hind legs.
  • In the UK The Perthes Association charity was set up in 1976.  It aims to aid research to find a treatment for Perthes Disease and hopefully a cure.  They help families with information and advice on the disease.  They can also loan equipment such as buggies and hand propelled trikes. http://www.perthes.org.uk/what-do-we-do/  In the USA Perthes Kids Foundation was started in 2007.  Its main aim is to raise global awareness of Perthes  Disease, further research into it to help find a cure and to help connect and support families effected by it.  Link to their Facebook page

There are other various treatments and issues regarding Perthes Disease that I have not covered, so if you are worried about your child and any hip issues they may have, please see your doctor.