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.
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