Freaking Out a Bit

[mountaingoat]

I am now less than a month out from my scheduled bilateral with Dr. Gross. I'm currently finally making my hotel and plane reservations. I waited until now because I was convinced that I wasn't going to pass my pre-op clearance blood tests because I had been having some issues with anemia and low platelet counts after pregnancy (but all good now). I am procrastinating so much on this because I am terrified and because I am not in any significant pain right now. All the articles in the NY Times, the WSJ, etc are making my anxiety sky rocket.

I spent all of last summer dealing with hip pain and the limitations that go along with it. I was done. I had been dealing with my hip problems for 3 years at that point and I had already tried arthroscopic surgery twice with only short-term results. When I scheduled my surgery with Dr. Gross in September my hips were as bad as they had ever been - I could only walk about a mile before the pain set in and even cycling was giving my groin pain and problems. I was frantic at that point and grabbed the first surgery date availabe in January. My bad hip was deteriorating so quickly at that point that I was worried I would be using a cane or crutches within a few months. And then, miraculously, I got a round of Synvisc injections in both hips on September 29th and the relief has been nothing short of amazing. I truly cannot believe how well I've done with these injections - as I mentioned in previous posts, I am back hiking, cross-country skiing, cycling, etc. My hips aren't perfect by any means but the pain has been tolerable.

But back to the issue at hand - surgery in approximately 25 days. I can't wrap my head around it because when we're not in a lot of pain its hard to sign up for something so significant and debilitating as major surgery. The injections have been a mixed blessing for sure - an amazing stop-gap measure that has allowed me to stay fit and active the last 3.5 months but also sends me into surgery without a lot of pain and wondering whether I should be waiting longer.

I am trying to move forward under the auspice that (1) the injections will run out eventually whether it is in 1, 2 or 4 months and I will be back to hating life; (2) my bone density is borderline osteopenic from all the past injections presumably and I cannot just keep shooting myself up with liquid dope to buy myself more time regardless of my age; and (3) although resurfacing is a risk I' going with one of the best surgeons and if everything goes well I should be back to my life by May hopefully (even given that I will be on crutches for 6 weeks). I could wait another few months, for sure. But what pushes me forward even with all this horrid fear is that I am so done living the hip rollercoaster. I want to go into this summer of 2012 and next ski season 2012-2013 with no doubt in my mind that my hips won't be problematic anymore and resurfacing is the best chance at that.

BUT, that nagging doubt in me lingers and keeps me up at night...I am only 36, I have an 8-month old baby and its going to be a colossal pain in the ass to care for her while I'm recuperating, what if I fracture my femoral neck b/c of my low bone density, what if I get an infection, what if I never wake up (well, no point in worrying about that one ), etc etc. These will be my 4th and 5th orthopedic surgeries so I am no stranger to the surgery process. I just had my shoulder done in October in fact. But I am still absolutely terrified all of a sudden. What if I am that 1%?

You see, if I were hobbling around in disabling pain like I was last summer, I wouldn't even worry about being that 1% because I wouldn't have another option - I'd be practically begging for a THR if that was what it would take to get rid of my hip pain. But I'm not so I just cannot wrap my head around all of this even still.

I'm trying to stay the course but what if all this doubt and fear is a sign from the Universe that I'm suppose to wait on this??

Amy

[Dannywayoflife]

Hay amy,
              I was like you I before my op didn't have a great deal of pain(although I've now realised there was more than I thought). My main symptom was a horrible rom and a feeling of weakness in the joint.
I had my bhr 7 weeks ago today! After a slow start I'm now recovering well!
To behonest I spent the best part of 12 months researching hip resurfacing and I personally wouldn't put any weight to the one sided misinformed articles you've read in the nyt.
The alloy used in the bhr has been used as a mom bearing surface since the 60s! And some of the thr's that predated the bhr lasted over 40 years! So it has a proven track record.
However there have been issues when these devices have been placed incorrectly by the surgeon! You are going to a very experienced surgeon and so I wouldn't worry too much!
Hope this helps! Danny

[OtterDriver]

Hello Amy..."She's Super Freaky!"

Sorry...I started singing that song when I saw your subject title and it's probably not a pretty thing...my singing that is!

I lasted nineteen years longer than you apparently did before I decided to go ahead with Resurfacing.  Had it done in mid-October.  Similarly, I started second guessing my decision about the procedure...but now about ten weeks into it, I'm very glad I went through with it.  I'm pretty sure most everybody goes through that apprehensive phase!?

Admittedly, I don't have an eight month old little one to contend with and I only had one side worked on.  You'll have your work cut out for you, but presumably family to help you with it all?  You are probably well aware that "time flys" whether you're having fun or not, so before you know it you'll be well on your way to being able to chase after your little one.

In regards to your "sign from the Universe" comment...you've got me singing the "Age of Aquarius" now.  Thanks a lot!

Happy New Year to you!

Bruce

[Jbennett]

I hear you. I'm scheduled with Gross for 3/14. I don't like the news stories either. Even had a very well known Orthopedic guy at our club tell me not to do it. I'm like please shut up dude. You're like 100 and I know you are successful in the politics of the medical world and edit a national journal etc but I don't trust you on this one. (He was the first to diagnose my OA 5 years ago) I feel good about Gross and know I'm not willing to deal with the limitations and discomfort anymore.

[Aerial]

Hello- I just had surgery with Dr. Gross on December 5.  If you look in hip stories, I chronicle my recovery.  Keep in mind I only had one hip done but I was feeling well and walking on my own by three weeks.  The first week will be tough but it gets better quickly.  No sense delaying the inevitable.  I would really think about caring for your child.  The toughest thing is the 90 degree restriction for 6 weeks.  It would be difficult to scoop a child off the floor when under the 90 degree restriction.  Also, do you know if you will be able to do the rapid recovery protocol with your bone density?  I would ask about this because it will impact the length of your recovery depending if you are on the "fast" or "take it a little slower" track.  Others have said it and I will too, I am fully pleased with the results so far after three years of pain that took away many of the activities I enjoyed!  If you can figure out the logistics you will be glad you took the plunge!

[lori.36]

Amy if you are having no pain can you call dr gross and give your surgery date to someOne else?  Maybe trade with someone in Feb?  At your age I would wait, but that is me.  Only you can make this decision.  I think your bab being young is fine. Because you will have help. 
I will be here to support u no matter what!  Is the whole fam going?  If so I used Brno.com to rent a house when I traveled to Boulder.  It worked out great.
Best of luck

[maxx6789]

Amy, I mean no disrespect ... but ... if YOU are unsure, YOU should wait.

Making the decision to have voluntery surgery was far from easy for me (or anyone, I assume) but I decided it was right for ME ... not what my doctor thought, not what my family throught ... but what I thought. Do some people wait "too long"? Probably. Do some people have the operation too soon? Maybe. But ... I believe, you need to be 100% committed to YOUR decision.

Even though I was 100% committed, after going to the "Hip Education" class (I now call it "Hip Scare Tactics"), I re-questioned myself.

I truely, truely, truely wish you all the best with your decision and your hip!!

[mountaingoat]

JBennett - I think you were the one lamenting that you couldn't get a date until March, right? I would soooo switch with you if I could!!  But I can't 'cause my husband is going to be gone the entire month of March rafting the Grand Canyon while I hobble around on crutches and then a cane...nice! (I think our marriage has a better chance of surviving this surgery if he is gone and completely out of cell phone range for most of the recovery ). My Mom will be staying with me to help care for the baby.

I appreciate everyone's concern. I really don't have the option to do it in February or March - mainly because Dr. G is all booked during those months and is already into mid-April I believe. My feeling is that waiting until April means I will be really pushing this into the summer which I don't really want to do. I know that my worse hip definitely needs it done in the next 6 months - there is no question about that but the timing isn't perfect unfortunately as I'd just like to wait a few more months and can't for various logistical reasons.

I guess I will call Dr. G's office and just tell them my issue and see what they think. My family has already planned the entire thing but I know that's not a reason to have surgery.

Aerial - I unfortunately will have to be on the slow recovery protocol. My bone density score was literally at Dr. G's cut-off for the fast recovery so I have to be on crutches for 6 weeks. I will also have the 90 degree rule which stinks but if I'm on crutches I won't be able to carry my baby anyway.  When I asked around, Dr. Su's office told me they wouldn't want me carrying her for at least 3-4 weeks either so there isn't all that much difference. She is a chubby 20lb 8-month old too so not exactly a dainty little thing. 

I agree that one really needs to enter into this surgery very sure of what they are doing as there is no going back. I was at that place 3 months ago hands-down but now I am having the inevitable doubt. But I don't think you can really be 100% about something - we always have some doubts/fears/anxieties that creep in and color our decision-making.

[Luanna]

Hi Amy,
I can completely understand your freaking out. If you are not currently in pain it makes it hard to disrupt your life for major surgery.

Here's the deal I worked out with my surgeon - when the time was right and I couldn't take it anymore we'd work together to decide  if it was indeed the right time for surgery or time for a different intervention. We did that and after 3 years of periodic check ins and buying time with PT and injections the time came and he had me in surgery within 3 weeks.

If you want to try and buy more time perhaps you could work out something like that with Dr. Gross? Just an idea.

Luanna

[mountaingoat]

And Lori - thanks for your response. I didn't rent a house actually. It was a really tough call but my husband and baby are not going to stay for my surgery - my Mom and Dad will each come for a few days and stay with me. My husband and baby are going to fly out with me for the long weekend before the surgery but then they are going back. I am sad about it for sure but he has no more time off of work and we thought keeping her in a hotel room all week would be a major disruption and she'd be better off at home with her familiar surroundings, the dogs, the nanny, etc. Its going to be WAAAAY worse on me than on her is for certain!

I will look forward to the time when I am home recovering and I can just relax and snuggle with her and play with her on the bed...I think a baby might be easier than a toddler but I'm not sure about that one yet!

[Tin Soldier]

Don't listen to the NYT journalist.  He's not very well informed (that's putting it nicely).  He based all of his articles on the ASR which had a 20% failure rate, or something like that.  You are going with one of the best surgeon's in the world with a very good record.  I assume Gross is in the 1% failure rate like McMinn and others, but maybe less than 1%, plus he's got with one of the biggest datasets.   Also, you have to realize that Gross probably gets this same question/concern from half his patients, "when is right, should I wait?...".  Talk to him about it.  Maybe you should putt it off til the fall.  What's the rush, other than getting back to a really active lifestyle.  That's all great, but for piece of mind and confidence, you might want to wait.  It's ok to slow down a little. 

I'm only 42 and I was super active and couldn't even imagine getting a new hip, or having OA.  I dealt with it for a few years and pretty well beat myself up and then finally had to do something about it.  If you're not in excessive pain or you can live with the poor ROM, maybe wait.  Maybe you should leave the kid with the grandparents and float the Colorado with the husband?  How's that for a big change of plans? 

[ScubaDuck]

I agree with Tin except for the fact that your bone density is borderline.  What does Dr. Gross say about it deteriorating further?  That seems like the real question here.  Are you willing to wait and possibly having a THR (and the restrictions that come with that) instead of HR now?

No easy answers unfortunately.

Best wishes.
Dan

[Dan L]

By all means you should be comfortable before you take this on.  I had some panic about 1 month before the surgery (when I got the last injection, while in the operating room for that procedure), so I know what you mean about freaking.  This is no small undertaking by any means and anxiety is completely understandable, and 2 at once is twice the fun.

I am in same boat for the 2nd bhr with less symptoms due to injection, but now 4 months out from last intrarticular injection in that hip, and as occurred 4 months from the first one in spring 2011, all the symptoms are starting to come back.  Bone on bone while walking, sleep disruptions, etc.  The OA is not going to improve, so for me I went ahead and scheduled the other one, definitely with some nagging doubts like yours when I scheduled it because I had few bad symptoms at that time in that hip, and I wanted to get to the end point of all the restrictions as soon as possible (12 months after last surgery).  The injections just buy time and temporary relief.

I spent alot of time those last few weeks before the surgery being very busy and finding things to keep my focus off the surgery, and sort of ignoring it.

I also came to the realization, that the day before surgery was the last day that I was continue to get worse, and starting the day of surgery, it was going to start to get better.  That really helped with the anxiety.  That has proven to be very true now 12 weeks later.

So many people here have shared similar positive experiences, and those helped greatly through this process.  My wife has spoken to hundreds of BHR patients after discharge and the feedback is almost universally "I should have done this sooner". 

Everyone is diferent and have many things to consider and be comfortable about before you go through all of this in your life, and the risks are a reality, so you really have to be sure you're truly OK before proceeding.   An experienced surgeon like yours with many successful procedures is the best way to mitigate risk as much as possible.

Best regards as you work through this.  It really does get better for the vast majority of people

[mountaingoat]

Thanks everyone! This is the best forum - really. So many thoughtful, supportive folks.

TinSoldier - funny what you said about leaving the kid with grandparents and floating the Grand with my husband...thought about it for sure...rafting has been one of the most consistent activities that I was able to do even when my hip was at its worst following arthroscopic surgery...if all else fails, sitting in a boat in the sunshine drinking beer isn't so bad

DGossack - your response about the bone density is one of the primary issues for me. If I didn't have borderline osteopenia I probably would be holding off on the second hip for another year or so. I really, really don't want to lose the window for surfacing if my bone continues to worsen and clearly I cannot keep getting injections to buy more time b/c I suspect the cortisone is the problem.  I am way, way too young for a THR so the bone density question is certainly relevant.

DanL - I agree with all you have said and I like your perspective on how its only going to get worse from here on out....regardless of whether its in 6 weeks or 6 months. If I hadn't already been through nearly 4 years of ups and downs, 2 arthroscopic surgeries which involved extremely painful recoveries and countless canceled vacations and trips b/c of my hip, I'd be more apt to hold off a little longer...but when I think what I have given up in the last 4 years because of my hip, it seems to make sense to move forward. There was a time when my hip was so bad that I said to myself "Even if I only get 5 years out of my resurfaced hip that is better than the life I am living now".

[Aerial]

And Lori - thanks for your response. I didn't rent a house actually. It was a really tough call but my husband and baby are not going to stay for my surgery - my Mom and Dad will each come for a few days and stay with me. My husband and baby are going to fly out with me for the long weekend before the surgery but then they are going back. I am sad about it for sure but he has no more time off of work and we thought keeping her in a hotel room all week would be a major disruption and she'd be better off at home with her familiar surroundings, the dogs, the nanny, etc. Its going to be WAAAAY worse on me than on her is for certain!

I will look forward to the time when I am home recovering and I can just relax and snuggle with her and play with her on the bed...I think a baby might be easier than a toddler but I'm not sure about that one yet!

My husband and I have a nice house 4.5 miles from the hospital in SC (no kids, quiet neighborhood with a lovely wooded view). I was joking with him that we could "rent" out part of the house as a nice post-surgery suite for out of state patients of Dr. Gross!  Best of luck to you mountain goat!  Let us know what you decide.  I know the presurgery anxiety is tough. 

[einreb]

I think the past experience of pain, surgeries and the borderline bone density are serious reasons to consider that its about time.  You have to make that call though.

FYI, when I went into my first 'group' rehab after my surgery with Dr Gross there were 3 bilats... they were all pretty darn happy to be there.  I think there is a huge weight lifted as the process now will all be about improvement rather than decline.  While the process wasn't easy, I look back very fondly of the entire experience and 10 months out I'm feeling so good both mentally and physically.

Nothing is 100% certain, but the latest data from Dr Gross looks so very solid and you are getting the benefit of his improvements from those small failures.  As of August 2011 in his first 1000 uncemented resurfacings there is a 1.5% failure rate.

1. Femoral neck fracture: 6
2. Early femoral collapse (avascular necrosis): 2
3. Failure of acetabular ingrowth: 5
4. Adverse wear failure: 2

However, items 1,3 and 4 have all but been eliminated with proper post op protocol, tri-cup spike acetabular cup where appropriate and inter-operative x-ray for cup placement.  Again, nothing is certain, but that's some solid results.

-Bernie

[hernanu]

Hey Amy, in a way it was easier for me in that there was no question about what I needed to do. I had one hip dislocating when I played soccer, even when I walked, the other hurting like a ba@##%rd when I went up stairs. It felt like it was only a question of time for when I would be on crutches permanently.

The only question left to me was THR (which several surgeons agitated for) or HR. I chose HR, even with the issues, which the THR surgeons were glad to bring up to me. I checked the sites, saw that my chances were still very high for success and went with an experienced surgeon (not as experienced as Dr. Gross).

My circumstances were much different, I'm a divorced dad of mostly grown daughters, so no nuggets to chase after, but each of us has their own challenges, and it seems like you've gathered your helpers around you. I'm a bi-hippy, but not at the same time, so I can relate somewhat; your path will be more challenging at first, but once done, you won't have to go through it again.

I can tell you that I feel 1000 times better. There is no replacement for the complete absence of OA pain. No feeling of limitations as you walk, run (I'm starting to) and do everything else.

Having said that - it's down to you as others have said. You are the sole judge of what and when it's right. You do have to consider the bone condition and its consequences, but we'll support whatever you decide and so should all the folks around you.

[Tim Bratten]

Hi Amy
I guess all I can say is that Dr. Gross has done much to evolve hip resurfacing and the guy is having phenomenal success. Any interesting decision involves risks. All we can do is weigh the odds as best we can and make the best bet possible. Then we make a leap. If you are sure your hip needs to be done in the near future, resurfacing with Dr. Gross seems to me a good choice. I say this in spite of the fact my first hip resurfacing turned out bad: this was 100% due to surgeon error, followed up the surgeon's incompetence to recognize the consequences of his own error. My only question is why do you want to do bilateral? From my experience with rehabilitation, this will be challenging, to say the least.
Here's my difficult choice: I am still convinced that resurfacing is the best option for me, and at some point I will need to do my other hip. So do I trust a very reputable surgeon in Buenos Aires (who is not specialized in resurfacing) where my surgery will be paid for by medical insurance, or do I pay out of my pocket to go to someone like Dr. Gross (he charges about $25,000 -which is cheap for the US, but you have to include airfare, etc.)?? 

[mslendzion]

Hi Amy
I guess all I can say is that Dr. Gross has done much to evolve hip resurfacing and the guy is having phenomenal success. Any interesting decision involves risks. All we can do is weigh the odds as best we can and make the best bet possible. Then we make a leap. If you are sure your hip needs to be done in the near future, resurfacing with Dr. Gross seems to me a good choice. I say this in spite of the fact my first hip resurfacing turned out bad: this was 100% due to surgeon error, followed up the surgeon's incompetence to recognize the consequences of his own error. My only question is why do you want to do bilateral? From my experience with rehabilitation, this will be challenging, to say the least.
Here's my difficult choice: I am still convinced that resurfacing is the best option for me, and at some point I will need to do my other hip. So do I trust a very reputable surgeon in Buenos Aires (who is not specialized in resurfacing) where my surgery will be paid for by medical insurance, or do I pay out of my pocket to go to someone like Dr. Gross (he charges about $25,000 -which is cheap for the US, but you have to include airfare, etc.)??

Tim,
Thanks for your story.  Do you mind sharing your story about you experience and what corrective actions were implemented?  I hope you are doing well now.

[Tim Bratten]

Tim,
Thanks for your story.  Do you mind sharing your story about you experience and what corrective actions were implemented?  I hope you are doing well now.

Hi mslendzion
I wrote down the details in the "Hip Resurfacing Serious Problems" board (my first post). It's actually kind of interesting, because I haven't seen anyone around here who has had quite the same problem and it was a bit of a puzzle.