Saturday, January 31, 2009

Young mother gets new life following hip surgery

For 26-year-old Melissa Martinez of Buckley, taking walks with her son and making regular trips to the grocery store are considered miracles. That's because Martinez had used a wheelchair and crutches for three years.

Martinez was diagnosed with lupus when she was a teenager, and the prolonged use of prednisone, a steroid medication to treat it, only worsened her condition.

The medicine caused her hip joints to erode, leaving her in constant, excruciating pain and, eventually, reliant on a wheelchair. Having the ability to walk and stand up straight seemed impossible.

But that all changed this summer when she met George Verghese, an orthopedic surgeon in private practice in Kankakee and Joliet, who performed a bilateral hip replacement -- a procedure not typically done on young people.

"I never thought it was going to happen," Martinez said.

An active child

Martinez was an active teen. In high school she was a varsity cheerleader, in sports and involved in many academic clubs.

But during her senior year, after feeling constantly ill and achy, Martinez was diagnosed with lupus, a chronic autoimmune disease that affects the joints and organs. Lupus causes the immune system to make antibodies against itself, causing pain and inflammation. It can also damage organs, as it did with Martinez's kidneys. She also experienced heart problems and seizures. She had to give up extracurricular activities.

Treatment is limited to anti-inflammatories, like prednisone, and immunosuppressive drugs, said Annette Myarick, executive director Philadelphia tri-state chapter of the Lupus Foundation of America. There has not been a new drug approved by the FDA for the disease in 50 years.

An estimated 1.5 to 2 million Americans have some form of lupus, according to the Lupus Foundation of America. There is no proven cause of the disease, but there are some believed underlying factors, including certain antibiotics, infections, genetics and extreme stress. Doctors believe stress was a factor in Martinez's case.

To manage the pain and inflammation lupus caused, doctors put Martinez on the prednisone, and she began feeling back to normal. She even started jogging every morning.

But after a year of feeling healthy, she started noticing pain in her hips that gradually intensified and made it impossible to put pressure on her legs. She was diagnosed with avascular necrosis of the hips, caused by prolonged use of prednisone. Verghese said this is not uncommon; the disease causes bones to die and collapse because of a temporary or permanent loss of blood supply.

While there are no statistics on the number of individuals with lupus who have been diagnosed with avascular necrosis, Myarick said she has known quite a few lupus sufferers who have had joint replacements because of it.

Dealing with the pain

For three years, the sharp, burning pain in Martinez's back and hips prevented her from being able to sit comfortably, stand up in the shower, climb stairs, go out with friends and do everyday activities most people take for granted.

"It was embarrassing to me ... I didn't want people to see me," Martinez said, starting to cry.

Martinez's grandmother, Barbara Denniston, said it was hard to watch her struggle with pain and not able to live a normal life.

"I don't think everybody can do it," said Denniston, with whom Martinez lived during part of her illness. "She's got a lot of willpower and a lot of drive."

But another life-changing event occurred in the fall of 2007 -- she became pregnant. It was a miracle in itself, as doctors had always told her she would not be able to get pregnant because of the strong medications she was on.

Her pregnancy was not easy. Javier Emileo Hurtado was born in March, two months early. Being bent over from the pain in her hips, she was unable to carry him upright, which caused her to go into early labor. The delivery caused her hips to crack even more.

Martinez visited a number of doctors in Chicagoland seeking help. She had a variety of procedures, but they only minimized the pain temporarily.

When she met Verghese, the pain was so debilitating she was curled up in her wheelchair and could not stand straight because her spine had curved over time.

Verghese suggested a hip replacement. Most doctors avoid doing them on young people because the implants have a limited life span, but Verghese said sometimes they are forced to in order to restore some quality of life.

This was the case with Martinez.

"My goal was to have surgery before he started crawling so I could chase him around," she said.

The two surgeries, which she had in June and August, replaced the joints in her hips with plastic artificial implants that Verghese said could last her a lifetime, depending on their wear and tear.

Each surgery required weeks of rehabilitation and physical therapy. She spent a few weeks in a nursing home after the first one, receiving daily physical therapy. By the Fourth of July, she was able to get around with a walker, and eventually graduated to using a cane. Three weeks following the second surgery, she was able to walk again on her own, and her spine had straightened out.

"She is amazingly tough," Verghese said.

Today, Martinez lives with her boyfriend, Javier Duane Hurtado, the baby's father, and is back to living an active, normal life. She looks forward to swimming and taking long walks with her son, now 10 months.

Her lupus is monitored now through regular doctor's appointments and lab tests, and she is treated with a short batch of medications when she has a flare-up. She also regularly takes a blood pressure medication to help her kidneys.

Said Martinez, "I owe everything that has happened to good luck."


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