LBHR Rogerson in Madison

[Mi Corazon]

Good people of the hip,

Just a check-in so that others may benefit from information I accumulated from researching, selecting a doc and going through a L-BHR operation on 3-21-2011.  I'm posting here because this site has been the single most valuable resource I relied on in formulating my plan to get beyond a disease that was making my life a mess.

First, all is well.  Day 5 post-op, I'm down to one crutch, and able to hit the square in Madison and walk with fellow citizens who desire for a better vision, process and solution for America's economic short-comings.  Slowly, anyway.

On choosing a doc.  I finally came to my senses 9-21-2010, and realized I needed help in dealing with osteo-arthritis (OA) that had reduced me and my activities to a shell of my former self.  I'm 50, and the OA had been building for + six years into something I couldn't overcome.  I tried osteopathy, Egoscu, yoga, massage, hottubs, hard exercise, NSAIDS, the works.  The limp got worse and the range of motion (ROM) declined, then the activities dropped away.  At first, I could justify it as aging, but by summer 2010, having lost volleyball, gardening and the ability to stand around at parties, I knew I had to do something.

So, I hit the internet.  I'm not a big consumer of health care.  In fact, I'm ignorant of what's available, what it costs, how it works, never even been to a hospital.  It took me 3 months to identify the doctor I wanted:  Dr. John Rogerson of Madison, Wisconsin.  During those three months, I wasted time waiting on appointments at Mayo Clinic in Rochester, and Dr. Palmer in Minnesota.  I wanted to consider both because of reputations, but in the end, after meeting with them, I realized that they were not for me.  Dr. Palmer has a ton of experience, but he is 70 and did not impress on any level.  I also talked to a nurse at the hospital where he does surgeries: lots of swelling and post-operative bleeding, she just shook her head sadly.

Mayo was a joke.  My partner and I met with a retired orthopaedic surgeon as a kind of screener for the surgery teams.  Mayo has six full-time surgery teams out there.  But, they work mostly on older folks, and they have a bias toward Total Hips.  Anyway, this retired doc, Beckley, I told him I wanted to do resurfacing and he got very adamant about how risky it was, and how "we tried that in the '70s", and how, at Mayo, "You will not be able to choose your doctor or your procedure."  Nothing was ever happier in my mind than saying "good-bye" to the white coats in Rochester.

So, on the way home, I called Dr. Rogerson's office and the first surgery date I could get was a full three months out.  Lot's of patients.  Winter vacations.  Doesn't do surgery the week before he heads out -- in case of emergencies.  Etcetera.   Ouch.  That really hurt.  I mean, I was in bad shape, end stage OA.  When you live in a log cabin with just a woodstove and there's a record-setting amount of snow about to fill the woodpile and walkways, it can make for a long winter.  And that's where I've been.

In January, I took a CT scan and sent it to Dr. Rogerson electronically.  From that, he qualified me for a LBHR.  When I met with him in early February, he put that CT scan on his computer screen and showed me an ugly scene:  my left femur had nubbins and spurs and gouges throughout, and the acetabulum did not look much better.  But, the good news, as he was quick to illustrate by way of putting his template forms up against the monitor screen, was that most of that would get shaved off during the prepping of the femur head.  I really want to emphasize this point:  Dr. Rogerson did not just say, "Yeah, I'll do your hip."  He required a CT scan from which he was able to determine conclusively that a BHR cap would just barely still work on my particular femur.  As long as I didn't delay too much.  In 600 resurfacings, he's never had to back out and put in a total hip replacement.  Not once.  That's what I wanted to hear.

After meeting with him, my confidence and general mental vibe about the whole process improved dramatically.  My preparations included a lot of yoga and core body strengthening, with the only leg exercises being a good 30 squats a day, nice and slow.  (Of course, I couldn't really "do" leg exercises this winter anyway....)  Too much leg work and the surgeon may have a tougher time getting "in", and in any case, will still need to disrupt things around the hip capsule.  But, post-surgery, laying in bed, the most important thing is to be able to move yourself slowly, carefully but competently to the edge of the bed, to get yourself sitting up, etc.  Hard to imagine, but that operative leg will be absolutely useless for at least 48 hours and during that time you will still have important needs.  That's where you will feel really grateful about having a strong stomach and upper-body muscles.  I did.

So, here's how the surgery program works with Dr. Rogerson.  You check-in to a kind of rehab facility, downtown Madison, you have surgery and spend two days at the hospital.  You come back to the rehab unit, spend four days doing therapy and generally resting and recovering.  Included is a kind of "magic moment" where you wade into a warm-water pool and spend an hour with your new situation that makes you positively giddy.  The last day, they pull out your staples, put on some steri-strips and you go home.  So, in all, seven days, and as far as I know, no exceptions to that.  And really, why would you want something different?  You get a great start on the new leg.  You have access to Dr. Rogerson and his staff 24/7, in case something doesn't feel right.  You leave ready to begin your new life, with a daily program and good habits already established.  Because we live four hours a way by car, this made sense to us, and well, there are worse places to be stuck in the world than downtown Madison.

I don't know what there surgery/recovery program is like at Mayo, but Dr. Palmer was happy to send me home the second day with a sheet of paper explaining helpful exercises.  My point about Rogerson's program, which he freely admits he modeled after the European programs he studied just prior to the FDA resurfacing approval in 2006:  he has thought through every aspect of the procedure, from beginning to end, and has designed a process that gives patients the maximum possible chance of a successful outcome.

Anyway, I know this is long but just a few more things about the procedure and recovery process.  I can't really compare hospitals, but, everyone who tended me here in Madison seemed friendly and well-versed in their field.  The anesthesia is as advertised.  Boom.  You go down.   You wake up.   Groggy, listless, but at least you are on the other side of surgery.  People are whisking around, noise, lights, sound, but as in a Faulkner novel, no meaning.

The first 24 hours are hell, or, at least they were for me.  People coming, going:  blood pressure, vital signs, inflating leg devices, intravenous this and that, time to pee, time to cough, time to drink.  And the whole time, you lie there absolutely certain your leg has been amputated.  Except it can't be because when it moves, it really hurts.  Only it's really, really hard to move.  And, why won't it move?  Is it paralyzed?  You aren't in any shape to be formulating answers to metaphysical questions.

So, best case at the hospital:  you've got someone there who loves you and that seems really satisfying when you need support, the staff is helpful and friendly, and they have WiFi.  But, be damn sure that the first time you sit up, or stand up, that you have someone ready to catch you because, well, at least for me, I got dizzy, nauseous and felt ready to hurl chunks, then started to sweat.  It's the anesthesia, the blood loss, maybe the pain-killer, but something makes you feel terrible at that point.  Just count on it.  You won't die, but on the other hand, it may be the worst part of the whole experience.

I did self-administer morphine.  Mainly on the advice of nurses.  "Don't get behind on the pain, it's hard to play catch-up."  I think there's wisdom in that, but for me, I either don't mind pain or somehow have had enough of it that I can manage through it.  I took a half dose of the big oral pain killers on day two, and one on day three and then realized that the side-effects were worse than the pain it was attempting to suppress.

Dr. Rogerson is the nicest extremely anal-retentive surgeon I've ever met about possible infections.  He's never had a serious one, the kind you have to go in and deal with at the prosthesis level, and so, on that score, I felt really confident lying in the hospital bed surfing the net. 

Anyway, at first I thought no way would I be ready to leave the hospital on post-surgery day two, but, after a couple of trips to the rehab room on day one, and gaining strength and confidence in my crutch-work, the trip from hospital to rehab seemed totally doable.  Once here, with help from my lovely and capable partner, I knew that the worst had passed.

Not that I was home-free.  I still had to figure out how to sleep at night -- and getting in and out of bed comfortably and safely is one of the most difficult things I do even now -- and then having that first bowel movement.  But, with ingenuity, a strategy and persistence, those things can be surmounted, and every day going forward, they just get easier.  But, I would encourage getting a strategy for each of those, especially the BM, because sitting on that toilet seat is not comfortable or fun with a huge incision on your ass -- neither is having waste pile up in your intestines.

I've met with Dr. Rogerson here at the place, his PAs visited me twice in the hospital, everything they have said has been accurate and true, from prep to surgery to rehab.  I'm in the upper quartile so far in recovery.  That's what I hoped for, even casually expected.   So tomorrow when I get those staples pulled and he tells me what to do to maximize my continued recovery process going forward, I'm going to follow it. 

Cheers, and best hopes for everyone and their recoveries from what, to me, seems like a miracle surgery.

[halfdone]

Great story MC. Thx for posting.  Congratulations on your new hip and welcome back from the dark side.  :) Best wishes on your continuing recovery and rehab.

[Mi Corazon]

Today is day 11 post-surgery, and things are going well.  The leg is getting stronger and more stable.  I'm using one crutch on walks, but can hobble effectively around the house without a crutch.  The incision wound itself has been kind of a pain in the ass, as far as sitting goes (though absolutely no draining, at all), and the tissue and muscles right in that area are tight and uncomfortable.  But the joint itself feels stable and I can stand without pain or stiffness for the first time in years.

I went out on the trekking poles a couple of days ago and almost got stranded on the road because it just wasn't time yet.  Really the trekking poles are like free-walking, and I just am not at that point on long walks, so I still bring the one crutch.  But, I am able to drive the car to town (automatic transmission) and shop and do things like that.  It just takes a little time to get in and out of the vehicle.

I wake up a couple times a night and hobble to the bathroom to pee, sometimes it's difficult to get back to sleep.  So, I've realized I need afternoon naps to get through the day with a clear head.  First time in years I've needed to do that, but resting feels really good.

Getting in and out of bed and finding comfortable positions is getting easier and easier.  At the beginning, moving in and out of bed felt very risky and uncomfortable.  The foam fit cushion pillows between my legs are absolutely indispensable.

Every once in awhile, I feel kind of claustrophobic, like, I can't just get up and go do things;  it's always hobble, slow, hobble, slow, feel the pain.  I can't wait for the time when it's just pop out of the chair, down the steps and out onto the lawn to play with our dog. 

[halfdone]

Glad things are going well.  :)

[ScubaDuck]

Thanks for the thorough description of the procedure and recovery.  I am planning to have a LBHR this summer at the age of 50 also.  It doesn't sound like I have gotten quite to the point you did.  I think the stengthening, biking, and stretching I have done over the last six years have kept the damage from progressing rapidly.

In any case after a couple of bad days this last week I know it is time.  It is a matter of finding the best time to miss work and when my girlfriend will be available.

Thanks again and speedy recovery.

Dan

[maxi]

very happy to hear you are going well ..    8)

dont rush into anything, let the body heal, i read somewhere that all the exercise in the world wont hasten the healing progress ...

[newdog]

Mi,

Glad you're doing well. You will hobble and wobble for a while, just be careful and don't fall!
Progress will come faster than you think, don't hurry. Good stuff.

Steve

[Mi Corazon]

Day 20 post-op check in.  Almost three weeks since surgery.  Things are going well.  Yesterday was the first day I got up and just did not need the crutch.  I felt more energetic, got out and watered the plants, worked with a rake and pitch-fork on our muddy driveway, took a long walk in the woods, did all my exercises.  So, in all, feeling more life in the body and more capabilities as well. 

I had a guy work on my legs on Thursday, ortho-bionomy, trying to get the muscles to relax and find their place in the new scheme of things.  What ended up happening is the sore muscles and trauma that was in the upper thigh migrated down toward and eventually into the knee.  So, when I walk this morning, I'm feeling muscle stiffness and soreness in and around the knee, which is kind of weird, but I'm sure just the way my body tries to move things out.

The actual operated hip joint feels solid.  I'm careful not to overload it on the downhill but, on the other hand, it is feeling better than it has in years so it's very tempting to do things that I just haven't been able to.  I'm leg over leg on steps, though going up, I like to keep a hand on the rail.  I've been driving since day 8 post-op, though I'm a little slow in and out of the car.   The incision is finally not so tender, which makes sitting on the can or in chairs a lot more comfortable.  I never did bleed or drain fluid at all since day two, so I'm thinking the skin part of this is in good shape. 

I'm done with the TEDS socks, the Lovenex injections, and I never really did use the Celebrex or Hydrocodone, so I'm down to a couple of Extra Strength Tylenol, an iron pill and the one Enteric coated aspirin. 

At times there are interesting feeling blood flows moving through the leg, like things starting to open up and come alive again.  All of my PT exercises are showing improvement.  Sleeping is easier and easier, though I still wake up at least once a night to drain the bladder.  The need for an afternoon nap is declining.  The operated hip, at this point, is already in much better shape than pre-surgery -- after just 20 days.  And now the question is:  at what point will the operated hip feel better than the non-operated one?  At that point, it will be very tempting to schedule the next surgery.

Looking forward to getting on the bike this week, and also, into the sauna to really move the damaged tissues out of that operated leg.

Peace out there

[phillwad]

Mi - great notes - thanks.

I go to Madison on a regular basis but I always end up walking around the student union by the lake, not the downtown square - the beer is better at the lake  ;)

I am 4 weeks post op and I talked with my Doctor's PA recently, he asked if my knee was hurting as I had started walking outside, it appears that having the pain travel down to the knee is common.  My doctor wants me to be on crutches for 6 weeks so I think about your walks in the woods and driving with a smile - soon, soon I will be able.  I am off all teh pain meds - just the asprin and a calcium suppliment

I do spend some time on an exercise bike in the basement if the weather is bad and I can not get outside

keep it up and thanks for the posts - Phill

[nekko]

Mi, I like when you say "You get a great start on the new leg."

Thanks for posting and have a prompt recovery

[Mi Corazon]

Day 26 Post-Op, approaching four weeks.  Still feeling positive and getting stronger and stronger.  Been without a cane for over a week and enjoying it.  Went out with the trekking poles on uneven ground today and and it felt great.  Earlier the trekking poles didn't feel as good, but now they are a nice workout, I can fully extend both legs and work at a level that i get some cardio involved.

At this point, the incision is a non-issue, no pain, no sensitivity, nothing really to worry about.  I can sleep on it, and in general, sleeping is more continuous and not as rocky as earlier.  And, in truth, occasional naps and certainly a good night's sleep still feel essential.

Getting in and out of the car is easier and easier.  I can even step in with one leg like most people.  I am leg over leg up and down stairs.  And, last night, I took my first sauna, which really drained a lot of fluid from the leg and allowed for some deep and total relaxation for the first time in many weeks.

On the concern side, I still have some soreness and swelling moving around in the operative leg.  It's fallen down into my knee, and even below the knee.  Kind of weird to have tightness down there, but that's where the tissue disruption has flowed and I just have to deal with it.  At times, I have glimpses of how good this is going to be and my heart soars.

Workouts involve Yoga, squats, marching stretches, backing each leg out, adductor stretches, and now, some biking.  Maybe I'm lucky, but every day I feel like I can do more and more, push further.  By now, I'm way better on my left leg than pre-operative:  I can walk further, freer and with less sensitivity than before.   I believe I am only a matter of weeks before having the operative leg better than the right one.

So in all, I have nothing but positive thoughts about BHR.  Before the operation, I thought that I might feel odd, even alienated, having something foreign in my body, but in truth, I can't "feel" anything foreign in my body, and more and more, what I do feel is better ROM and a stronger, more stable joint.  And that feels great, even natural.

[newdog]

Mi,

Wonderful post! Way to stay active. I can't wait to get on a bicycle again. For now, just walking in long comfortable strides is a joy hard to explain. You're doing good!

Steve

[Mi Corazon]

Regular weekend check-in.  Today is day 34 post-op.  Lots of little improvements, and some big ones, continue to pop up.  It was a big week of rehabbing.  Saunas four nights.  I believe they squeeze any damaged tissue out of the leg and help blood flows, and in any case, generally reduce inflammation, always a good thing.  Hiking consistently without pain or assistance, and able to walk as long as I want.  Also, got the bike out as weather improved, and riding feels wonderful, though the old muscles are not anywhere near what they were.  Yoga also a great part of the program, and I can already see, in certain positions, where the operated leg has better ROM than the right. 

In fact, I'm going to go ahead and say it:  my left leg is now my good leg and the right is holding me back.  That's tough, since for so many years it was the reverse.  But, there just is not the pain, the stiffness, the lack of ROM in the left, and it's feeling ready to continue improving.  The right still gets "stuck" at a certain point and definitely gets OA inflammation.  All this means what seemed inevitable before my LBHR anyway, that the right will need to be scheduled for BHR, and relatively soon.  I don't do that lightly:  the whole surgery and recovery is a rough ordeal, and really takes it out of you.  But, given the result and the increased activity level, the lack of physical exhaustion in normal everyday tasks, it is just a no-brainer.

The damaged tissue, the muscle damage that had slid down into my knee over the last 10 days, has greatly improved.  I don't feel much in terms of anything being swollen or pulled or sore on the left side, except the generic morning slow to loosen up type feel that is probably unavoidable after age 50.  Every once in awhile, I feel a tingly type surge of blood flow up near the skin of my left leg, like someone just turned on a circulating pump and a new area of the leg has opened and is coming back online.

Anyway, I'm back out there gardening.  Moving wheelbarrows of manure and compost, throwing wood around, dealing with water, feed and chickens.  And it feels great, really great.  I can barely remember the level of dysfunction pre-op, but, when I do, I understand that it was extremely severe and that I was end-stage OA, with the next step a wheelchair.  So, even when I'm stiff in the morning, and I certainly can be if I've worked out hard the day before, I know for sure that I am light-years ahead of where I was.

It's a new leg, a new reality.  It's not the old one, and I think that's the way to consider it.  I've got something I've never had before, and I need to understand it's particular qualities:  what it likes, what it doesn't, what it can and cannot do.  And, that journey of discovery continues everyday.  It's still hard to get up from my knees without using my arms to pull me up.  I still have to step onto a bike by laying it on the ground.  It's still turn and fold into the front seat of the car, but, one of these days, with the right stretching and PT, I believe all these things will be possible.

[newdog]

Mi,
I hope everyone here is reading your post(s). They are very informative and inspiring. Post surgery recovery is no fun for the first week or weeks or so. It's not horrible, but it's not something I would want to do again. I think the reason I don't explain in more detail my experiences with the "bad Stuff" is because I don't want to scare the pre-op people. I think most of us want to present a positive light on what it is like, because it isn't anything near as  bad compared to the pain and misery of our hips before they were fixed. Your posts are really well written, I wish I could write as well as you and I look forward to reading them. I hope I'm not rambling too much here. You attitude is great, that's why you're doing so well.

Steve

[Mi Corazon]

Day 40 post-op.  Jesus had 40 days in the desert, this has been a trial certainly, but considerably less demanding than that.  Still feeling good, every day able to do a little bit more, notice some new aspect of improvement.   I had read this type of comment many times on this site, how every day you add a little bit to the recovery process.  But, to live through it is, well, not exhilirating because it is so gradual, but continuously hopeful and satisfying.

Didn't have as much time this week to work out.  Still, got out on the mountain bike several days, did a fair amount of walking, hit the yoga mat twice, and continued to do my standing exercises.  On the standing exercises, here's what I do:  I march in place hanging onto the frame of a skylight (the skylight is open so I can hold the wood portion of the lower sash/frame, which is about shoulder height and feels like a perfect grab point for me).  I lift each leg, one at a time, straight up as high as I can and just march, under control.  I do that for 40 counts.  Then I go out to the side with each leg, lifting as high as I can and holding.  I do that for 30 counts.  Then back to marching for 30 counts.  Then, I throw my legs out backward as far as I can, under control.  I do that for 30 counts.  Then back to marching in place for 30.  Then I do 20 or 25 squats, using the skylight frame and my arms to assist.  I try to keep everything coming from my core, so back straight, head over the hips and level.  Under control, emphasizing reps and muscle ROM.

In yoga, I do a routine, mainly Iyengar stuff, but one which feels so great is the headstand.  At first, I was reluctant to get up into the headstand, or especially to release the legs out to the side while on my head.  But now, it feels so great.  The flexibility that is coming to my left leg and side is truly miraculous.  Every day it is clear that my left leg (operative leg) continues to perform better than my right.  My really constant question now is:  how good is it going to get?  How much flexibility?  How much agility?  How much strength?

The soreness, swelling and discomfort that was in the left leg, and which had migrated into the knee, even below the knee, is completely gone.  I think all the saunas really helped.   I am taking 2 extra strength Tylenol in the morning along with some Vitamin C, the Enteric coated aspirin, and some fish oil.  That's it.  Some days I feel generic soreness in both legs, a little in the back sometimes, but after I get warmed up or do some exercise, it pretty much goes away.  At my age (fifty), you have to expect some discomfort from a bag of bones.

Last night I kicked my shoes off in the cool, soft grass and did some light jogging.  Couldn't go very fast yet:  the bi-lateral muscle coordination is something I am having to relearn.  But, I am very hopeful that, over time, I will be able to run again, and run at a decent speed.  It's one thing that I have dreamt about repeatedly over the years:  being able to run and have that experience of freedom and power, like when I was a young man.  I wake up marveling about what that will feel like and I am hopeful. 

[Lopsided]

Jesus had 40 days in the desert

Really?

[Mi Corazon]

Seven weeks post-op.  Left leg continues to gain in strength/flexibility, whereas the right leg (unoperated)  continues to feel like it is in decline, though really, it probably is just treading water.  Still, psychologically, it is so much more uplifting to see progress and have hope for further improvement than it is to wonder, doubt and worry about how long, what will happen, how bad is it going to get, with the right leg.

Went to Madison and talked to Dr. Rogerson last week.  The X-rays indicate proper placement of the device, so from a technical standpoint, all is well.  Interesting nugget and a hopeful one from Arizona, where the BHR people held a conference:  the longitudinal study by Dr. McMinn is now approaching 14 years, with 98% no revision.  The line has flattened and Dr. Rogerson says if you avoid the femoral head fracture (first six months), and the dead bone under the cup from lack of blood flow (18 months), that the device, God willing, will last a long time.  Maybe a lifetime.

Dr. Rogerson okayed a higher level of activity, though I don't think it includes the mountain biking I'm doing (gently and safely on reasonable trails), nor the light jogging, nor the headstands, nor the farm work.  But, aside from general muscle soreness after a long day, I'm not feeling anything but good about doing these things and how they are helping.  I am staying with the program; when I'm busy, I skip days like any busy adult, and it doesn't seem to hold me back.

Dr. Rogerson said I can expect continued improvement through about 9 months, after which I should be about as good as I am going to get.  Not yet two months into this, my question is:  How good is it going to get?  I can tell from Yoga positions that flexibility is better, strength is better, agility is better.  The incision looks and feels great.   Bing, bing, bing, down the line, all marks are showing improvement.

And so, I am extremely thankful.  I think the surgeon was excellent and the staff. I did a lot of things to prepare appropriately, working on core muscle strength, etcetera.   But, in a lot of ways, you can't say for sure how your leg muscles, the bilateral collaboration, the abs, the glutes -- just a very complex system down there -- you can't say for sure how it is going to turn out, and especially, how functional that system will eventually be.  That's the drama -- and my attitude is to take it like a journey.  Not a return to where I have been, but a trip to some place new.

But, every once in awhile I stop and remember where I was at last winter:  literally unable to walk without exhaustion, pain, total lack of motion.  That's gone.  Don't even think about it.  Where did it go? 

That's the miraculous part.  It's just gone.  And so, when I feel limitations, arthritis, soreness in my right hip, I am starting to visualize what that will be like when it too is no longer there.  Far from feeling like an impossible undertaking, I imagine that it is doable, and that it will lead to higher functioning, less pain and more energy.  That's what will allow me to press ahead, because, in reality, no one should take this surgery lightly, or as just another procedure.  It's serious business, and there are no guarantees.  But, with the right team, conditioning and good fortune, it can, in fact, turn out miraculously well.  And, it sure feels that way this morning.

[halfdone]

MC, I really enjoyed your post - good vibes.  Best HD

[ScubaDuck]

Outstanding!!!  I can only hope for a similar outcome. 

Dan

[phillwad]

Mi - Great news and thanks - I hope to get on my bike for the first time this weekend and just take a gentle ride - taking it easy to start this next stage of the recovery. - Phill