Bionic's Bone Blog

[Bionic]

Arrived in S. Carolina last night.  The airport is small but modern and very clean.  It was a $60 cab ride (including tip) to the Residence Inn, which is just across the street from Providence NE hospital, where my surgery will be performed tomorrow.  "Just across" is a bit misdescriptive, since the distance walking from the hotel to the hospital is about 1/4 mile, if my arthritic hip is properly calibrated.

The feeling of driving to the hotel at night was like entering the middle of nowhere.  Just a road with no discernable features and then, without warning, you're there.  It seemed to be the periphery of civilization.  But then Wendy's, Long's Drugs, and Cracker Barrel came into view, and I realized that this was probably more an outpost of civilization.

A vague concern was rising up in me.  Was this for real?  Was this truly where I could find the pinnacle of medical procedure and technology? 

Any emergent fears were quickly quashed when I entered the hotel.  I was greeted by a smiling and good natured young man.  I'll call him "Joe."  I told him I was there for surgery with Dr. Gross and noticed him immediately suppress an even bigger than usual smile.  He said he'd have something special for me, but he was keeping it a secret.  Civilization or not, I had definitely arrived somewhere and was already starting to feel welcome.

Okay, I thought.  This is nice.  Then Joe said the "evening social" was just wrapping up, and we might be able to catch the end if we hurried.  The "social" room was just opposite the front desk, so we stopped there even before dropping off our bags.  They were serving spaghetti and salad.  This was a surprise.  I had thought it was just drinks.  After a long plane ride without dinner, the spaghetti and salad hit the spot and more or less made up dinner.  I knew that the the price at the Residence Inn included breakfast, but I didn't know the social could pass for dinner as well.  Good deal, I thought.  The serving lady kept calling my wife "honey" and "sweetie."

The Residence Inn is very new and clean.  You get two rooms.  The living area has a kitchenette with a fridge, stove, microwave, sink, granite counters, dishwasher, plates, and coffee machine.  The living area isn't huge, but it's easily roomy enough for two.  The sofa has a fold-out bed.  There's a table and two chairs, as well as a coffee table and TV.

The bedroom has a queen-sized bed, dresser, closet, and TV.  The bathroom is off the bedroom.  I asked for a handicapped-accessible room.  You can literally wheel a wheelchair into the bathroom and the shower.  There's no ledge to enter the shower.  You can roll right in.  The shower has a seat and a removable shower head.

We got the munchies last night and went hunting for food.  We found a fridge and freezer next to the front desk, with very reasonably priced food and drinks.  I bought a chicken pot pie and bottle of G2--for less than $5.  My wife asked Joe if they had any vanilla ice cream.  He said no, and there was that suppressed smile again.

Today, we were out and about dealing with doctors and the hospital.  We came back around 3 to find Joe back there again.  He asked us to wait up and then came back with a half gallon of vanilla ice cream for my wife (no charge) and a get well card and balloon for me.  The card had Joe's signature and those of lots of people I hadn't met yet.

So this is Southern Hospitality!  I knew I was missing something.

[Tekka]

Bionic,

Glad to here your accomodation is so good.

Good luck tomorrow and you can look forward to no more pain mate.

All the best.

Terry

[Todd]

Wow!  The food at the hospital must be horrible if they are feeding you so well at the hotel.  Really, that's fantastic.  Wouldn't you be surprised to see Joe looking down on you with his supressed grin in the operating room assisting Dr. Gross?  Maybe he's just moonlighting at the hotel.  Sounds like your adventure has gotten off to a memorable beginning!
todd

[Bionic]

Thanks, Terry and Todd.  This week has been a b*tch, with all the rushing around to get ready for this trip without ibuprofen.

I had my appointment with Dr. Gross today.  First I met with Nancy, who had me complete a pre-op questionaire.  She also described pre-op and post-op procedures and gave me a heads up on what to expect in the hospital.  Then Lee came in.  She fielded my many questions, explained my x-rays to me, and checked my ROM on both legs.  

She observed that the foot of my right (affected) leg turns out, and noted that it would most likely straighten after surgery.  That was nice to hear, as I've always been self-conscious of my duck-walk.  

She said the leg length discrepancy I was experiencing was most likely not a true length difference but rather a result of my foot turning out.  She called it some sort of contracture--I forget exactly what--and was the result of osteophytes and perhaps other deformity in the joint, which the surgery will correct.  She told me to throw away my heel lift--I won't be needing it and will need time to adjust to the new skeletal/muscular configuration.  The heel lift will just interfere.

Lee also confirmed her earlier statement that I was the "ideal" candidate for this surgery, which was a great comfort to hear.  It turns out I am exactly the median age for Dr. Gross's patients--47.

Lee left to get some sample implants and returned for the show and tell.  My first impression of the implants were that they were surprisingly small.  I suppose I could have measured how big 60mm was, but somehow I expected them to be bigger.  This impression made the surgery appear even less invasive than I had previously imagined.

Dr. Gross soon followed.  We chatted amiably about his implants, the FDA, insurance companies, and, of course, my case.  He was not rushed and answered all my questions patiently.  We had a laugh because I ran out of questions to ask about my hip and moved on to my knee!

He spent a lot of time answering questions about the implants. It turns out their inner surface is not tapered internally but rather cylindrical, and semi-circular at the top.  During surgery the femur is shaped so that it's about 1 or 2 mm larger across than the cylindrical inner diameter of the implant.  This makes for a tight press-fit that has absolutely no tendency to lift off.  It looks like it should work!

I also learned something about how the components mate.  We've heard a lot about "clearance."  I remember one doctor saying the ASR implant had a very low clearance, meaning space between the implants (inner diameter of acetabular component minus outer diameter of femoral component).  I had always thought the ideal "clearance" was 6mm, but that is wrong.

It turns out the clearance is really much smaller, more like 150 microns!  It is just large enough to leave room for lubrication--synovial fluid.  The 6mm number refers to something else--the outer diameter difference of the two implants, I think.  In any case, that number has nothing to do with the bearing surfaces.

Dr. Gross told me that the original BHRs were made with very tight clearance--less than 150 microns.  This caused problems with some patients as the acetabular component sometimes can deform when it's pounded in and develop an equitorial (football-shaped) distortion.  This distortion, if severe, can cause excessive friction between implants, high wear, and high ions.

There appears to be a tradeoff involved.  Tight clearance is generally a good thing, as long as there's some room for lubricant, but too tight can also be a problem since it can lead to accelerated wear.  Dr. Gross believes the clearance of the implants he uses represents a good compromise between the different factors.

Dr. Gross said he has now done about 600 uncemented femurs.  The data still look very good--certainly no worse at this point than cemented femurs, although it's really to early to tell for sure.  The benefit potentially is on the far side, 10 to 20 years from now, when the uncemented implants are likely to still be attached whereas the cemented ones may or may not be.  

Who knows?  It's imponderable.  Dr. Gross inspires a lot of confidence, and that was no small part of my decision to go forward with these implants.  Of course he made no promises.

From the clinic, we went straight to the hospital (a 15 minute, $40 cab ride).  There, I met "Terry" (not her real name, but a real person).  I had spoken to Terry previously on the phone.  She was so nice.  You know you're not in Kansas (Boston) anymore when the lady behind front desk gets up from her seat and personally escorts you around the hospital.  She showed us the dining area, the pre-op area, and the check-in area.  She personally delivered me to the woman in charge of registering me.  There's that southern hospitality again!

I spent a nice, unrushed time registering--and paying.  No escaping that, even in the South!  I signed all my paperwork.  Then, once again, I was personally escorted to the pre-op area, where I had blood drawn for blood typing and possibly some other test.  I got a wristband identifying my blood test number, which I'll wear to the hospital tomorrow.

From here, it's no food or drink after midnight and no over-doing.  I'm due back at the hospital at 8:30 tomorrow morning.

[obxpelican]

One of the highlights of my surgery with Dr. Gross was the way you are treated at every step of the way.  I still think the food sucked though, for hospital food it was ok, I guess.

Good luck tomorrow, I suspect we're going to see a post from you by mid afternoon. 

Now tomorrow you're going to tell them a thousand times which hip they need to operated on.   :D


Chuck

[Bionic]

Right!  I mean, "correct."

[stevel]

Hey Bionic,

Good luck tomorrow.  I had great food after the first day when they weaned me on soft liquids and soup.  I even had a fillet of salmon for dinner.  I was asked many times my DOB and Dr. Su even initialled my left thigh before surgery.  My surgery was scheduled for 1 PM but it was moved up due to a cancellation.  I zonked out from anesthesia at 12:45 PM and woke up in the PACU (post anaesthesia care unit at 3:30 PM).  A technician was taking a supine x-ray of my hip and I confirmed it was a BHR.  I stayed there five hours until the effects of the spinal anaesthesia wore off (numb feet) and I was moved to a semi-private room at 8:30 PM.  Limited visitation by immediate family was allowed during this period (to minimize infection).

[mari]

Thanks for all the details!  I am watching your progress with much interest, since I myself will be there a week from today, going through the same process. 

[Bionic]

Where will you be staying, Mari?

Another thing about the Residence Inn.  They leave you a shopping list pad in the room.  Just write down what you want and leave it at the front desk.  The groceries show up in the afternoon.  You pay for the groceries, but there's no charge for the shopping.

[John C]

Hey Bionic,
Continue to enjoy that great southern hospitality. When my wife and I were there for my surgery, we decided that the whole world should visit that area, just to see how people should really treat each other.
When you wake up from the surgery, you will be delighted at how good you feel. Say hello to Dr Gross and Lee from all of their fans!

John

[DirkV]

Best wishes for a successful surgery and good recovery.
I'm nearly a year post surgery, and am still amazed at the reverse-aging phenomenon - as time goes on, I feel better and better. I hope you get significant parts of your life back!
Keep lookin up,
-Dirk

[Bionic]

John C, Stevel, and DirkV,

Thanks for all the good wishes!  I'm heading off for the hospital shortly.  I'll ask my wife to bring my computer along later.  Maybe I'll post if I'm up to it, but, after only 3 hours of sleep last night, I wouldn't hold my breath!

Off I go ...

[Bionic]

It's done.  Got a little sleepy in pre-op. I remember being moved to the OR table, noting that it was firm and comfortable, and feeling that the temperature was cold.

Next thing I remember I was lying in a different bed and asking when the surgery was going to be, only to find out it was done.  Damn, I missed the whole thing! 

I am perfectly comfortable and pain free.  The surgery's been done for hours.  I just slept a long time afterward.

I feel slightly medicated, but not bad or groggy.  I feel like myself, except that a few hours are missing.

Apparently, part (or all) of my surgery was filmed.  Maybe you'll get to see my bones on line!

Dr. Gross also told me he had already fimed a complete uncemented procedure, to be posted soon.

I have no nausea.  I just ate dinner and I was fine.   The food was not bad--pot roast, carrots, and mashed potatos, served with a small Shasta Twist.


The feeling is now starting to return to my feet.  Maybe I'll get some pain soon, for for now it's good to go!

(can't type well--my finger is connected to a heartrate monitor)

[mari]

we will be staying at the Courtyard right next to the hospital.  My husband decided he wanted to be close enough to walk over, and I wasn't sure how close the Residence Inn actually was.   

Good luck on your recovery!

[Bionic]

Still can't type right.

I continue to be pain free (did they really do this operation?).  Fell asleep last night around 11 and woke up at 2:15.  Aside from a little dozing, that was it for sleep.

Feeling a little woozy.  This morning I got my catheter removed.  Then PT came in.  The therapist taught me some exercises and gave me lots of cautions, like the 90-deg rule.

I managed to get out of bed and stand up, but I still couldn't walk--I was simply too dizzy from the medication.  My blood pressure is really low--90/38.

The PT told me that my worst days would be tomorrow and Saturday, as far as pain is concern, but currently there is no pain at all.  Let's hope I get walking today.

[Todd]

Congratulations Bionic!  You are with the living again.

The dizziness will subside and blood pressure will come back in time.  Mine was pretty low too after surgery.  I recall being upright standing for about 5-10 minutes before I needed to lay down and rest.  Enjoy the experience.  No pain is a great way to wake up, and you'll be dancing a jig in a matter of weeks. I have a feeling you'll get a nap or two in during the day, and sleep will come easier tonight.  Keep getting better and let us know of those little milestones as they happen.  Celebrate!
todd

[obxpelican]

From what Bionic said the positives about the Courtyard is that it's close and I think it's a bit cheaper.  Looking back it would have been nicer for my family had we stayed at the Residence with that extra room though.... the Courtyard is nice though.

At least you guys won't have to deal with the heat like we did in August, it was 109 the day of my operation.  We swam in an outdoor pool that was 92 degrees the night before my surgery, it was like a bath tub.... too warm for me though. 


Chuck

we will be staying at the Courtyard right next to the hospital.  My husband decided he wanted to be close enough to walk over, and I wasn't sure how close the Residence Inn actually was.   

Good luck on your recovery!

[Tekka]

Hey Bionic,

CONGRATULATIONS...mate, everything you say reminds me like it was yesterday.

Like Todd says, each little improvement is milestone.

I still can't believe I am pain free, and you to will be amazed as well, I'm sure.

Keep us posted.

Regards

Terry

[stevel]

Hi Bionic,

Congratulations!  The arthritic pain is gone.  Your road to recovery will be in positive progressive increments.  This is exciting.  I was inspired to do the PT to get better.

[Bionic]

I just managed to walk up and down the hallway.  :D  Certainly I was a little stiff.  There were also a couple of very quiet clunks coming from the joint.  I was surprised to have done as well as I did.

Unfortunately, the good times rolled straight on past me, as my BP once again crashed.  I went gray and felt like I was at risk of falling down.  The therapist brought me back to my room.

I was supposed to have climbed stairs today, but given my BP problems, that won't be happening until tomorrow, at the earliest.

At least I'm sitting up and feeling okay.  Pain has moved from a zero to about a one or two.  I think maybe the walking had something to do with it.  It's also been awhile since my last pain pill.

I saw Lee Webb, the nurse practitioner who assisted Dr. Gross in my surgery.  She reiterated that everything had gone extremely well.  My bone was very hard, and they were able to get excellent component placement.  I should have my post-op x-rays soon, so I'll be able to confirm placement myself.

She also said that I was completely bone-on-bone and that it was a good thing I didn't wait any longer.  Life with my old hip was not going to get any better.

I had one small cyst, which they grafted.  Otherwise, the femur was clean.  Needless to say, I am hoping for the best!

Thanks for all the good wishes!  It is upward and onward from here!