San Antonio Express-News (Sunday)
Hip replacement surgery can have unexpected side effect
Q: Four years ago, my wife had hip surgery caused by a fall. About eight months after the surgery, she noticed her left leg was 3 inches shorter that her right one. Her doctor agreed it was shorter and said that does happen frequently. She must use a cane to walk and is now in a lot of pain just walking in a market or around the house. Is it common for this type of disability to be caused by hip surgery? Is there any type of procedure to correct it? What can be done to alleviate the pain and discomfort from this injury?
G.W.
A: Up to a quarter of people will have a change in the length of the leg after hip replacement surgery. I’m not sure that’s what your wife had, but that’s a common surgery after a fall.
A “significant” difference in the length of the two legs is one that causes symptoms; some surgeons use 2 centimeters. Your wife has a difference of almost 9 centimeters. I don’t know whether she had a difference before the fall (some people do and never notice), but if this is new since surgery, treatment is best sooner rather than later.
She should have a careful measurement of the length of the legs. This is harder than it seems, and often a patient’s measurement is inexact. A shoe lift can be made to correct the length discrepancy. Since it has been so long since surgery, many experts do not attempt to correct the entire difference. However, with treatment, she should have better movement and less pain. She should see her orthopedic surgeon.
Q: I am 65 years old and have been on cholesterol medication for about 12 years. My doctor has also indicated that I need to watch my sugar and carbohydrate intake, as I’m just below the diabetes level. I recently read about the possible benefits of taking glucomannan supplements to reduce sugar and cholesterol being absorbed into the
J.S.
A: Glucomannan is a watersoluble fiber from the elephant yam plant. It has been tried as a weight-loss agent. There is mixed evidence but not very strong that it is effective. Although people who lost weight while taking glucomannan did have some improvements in blood sugar and cholesterol levels, this is probably due to metabolic changes from weight loss, not from an effect of the supplement. It certainly does not prevent absorption of sugar or cholesterol.
There is not enough evidence of benefit to recommend this supplement. Because it is a nonabsorbable fiber, very large doses can lead to blockages of the gastrointestinal tract at various locations.
The best treatment remains a healthy, mostly plant-based diet, combined with regular exercise. I recommend fiber come from vegetables and legumes rather than from supplements whenever possible. Fiber supplements are best reserved for people who need them for treatment of diarrhea or constipation. It can help with both those problems. Psyllium is an excellent and safe source of fiber for most people.
Q: I was diagnosed a few years ago with gastroparesis, and I took domperidone for a while. The medicine didn’t change anything, so I discontinued it. I’ve had stomach-emptying tests, colonoscopies and endoscopies looking for answers. I have pain in my upper-right abdomen and also occasionally get a cramp in the muscle in that area at times.
My most recent issues started last year and include never being hungry and feeling no urge to empty my bladder unless I’m going to have a bowel movement — then it’s an urgent feeling to urinate. I recently had a scan of my upper abdomen with no answers. I’ve spoken to a gastroenterologist, primary care and gynecologist, and no one seems to have an answer. I can go all day without eating and never get hungry. I eat because I know I need to, but it’s hard when there is no hunger. My weight has been stable for a few years.
I’m 74 years old, don’t have diabetes and am fairly active with golf and walking on my treadmill. I have looked online and learned that nerves may be involved in not signaling my stomach nor my bladder to empty. Where should I go next?
C.H.
A: “Gastroparesis” comes from the Greek roots meaning “no stomach movement.” Although diabetes is a common cause for this uncommon ailment, most people do not have an identifiable cause of gastroparesis.
Some medications can trigger it, and some cases start shortly after a viral infection. You are correct that in the vast majority of cases, the underlying issue seems to be in the nervous control of stomach and intestinal movement, but what exactly produces this remains unknown. I am not sure whether the source of your gastroparesis is also at the root of your urinary symptoms.
Dietary changes help some people. Fatty foods and food with high fiber content tend to cause worsening of symptoms. Acidic and spicy foods can be irritating for many as well. Excess air (such as seltzer water or other carbonated drinks) should be avoided, and both tobacco and alcohol often worsen symptoms, and should be avoided.
When medication treatment is needed, many experts use metoclopramide. Long-term use of this drug may be complicated by a severe movement disorder called tardive dyskinesia. Domperidone is said to be an excellent treatment for many, but it is not available in the U.S. (you are in Canada), so I have not used it. Unfortunately, it didn’t work for you. I have had very good success in many patients with the antibiotic erythromycin. It’s not that there is any infection involved; rather, one of the side effects is increased stomach motility (many people notice nausea or diarrhea with erythromycin due to this side effect).
One treatment of last resort is called cisapride, but it has a very serious potential side effect of a dangerous heart rhythm. Only experts can prescribe this medication through a limited-access program from the manufacturer.
Finally, the combination of your urinary symptoms and gastroparesis suggests an underlying neurological issue. Multiple sclerosis can cause both the urinary symptoms you have and gastroparesis, although this would be an extremely unusual presentation. A visit to a neurologist might be worthwhile.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.