Howie F-16’s hip resurfacing diary with Dr. Raterman.

11 Nov 2013:  Driving from Panama City, FL to Tampa, FL for evaluation by Dr. Stephen Raterman.  Dr. Raterman is highly experienced with over 1500 HR according to Surface Hippy website.  He is also the closest HR doctor to my home in PC, FL.  After a six hour drive, I arrived at Embassy Suites for one night stay.

12 Nov 2013: I had a 1:00 PM appt with Dr. Raterman.  His office staff is quite friendly.  I was called back rather quickly and worked with the Med Tech to get my history.  We did run into a problem with the X-Ray disc that I brought.  It would not load on their computer, therefore new X-Rays had to be taken in the office.  I was asked if I would like to meet with the NP before or after Dr. Raterman.  I chose before.  I thought it best to go over my three sheets of questions with the NP, so only my most important questions could be answered by the doctor.  Dr. Raterman has two NPs.  I was examined by Kim Myers.  I found her very friendly and knowledgeable of all of the doctor’s procedures and techniques and was well qualified to answer all of my questions.  After reviewing my X-Rays, she performed an exam and discussed my goals for the procedure, timing and rehab.  She also gave me a copy of the Cormet Hip Resurfacing patient’s guide for me to review before I met with the doctor. 

Finally met with Dr. Raterman and we reviewed my X-Rays and he answered all of my most important questions.  I was very concerned, because my X-Rays showed several cysts in the femoral head.  All of the literature, online and in print that I reviewed prior to the trip highlights femoral head cysts as a contraindication for the procedure.  Dr. Raterman explained exactly which cysts were a potential for a problem and exactly how he would handle them.  He also explained that just about all of his HR patients have some cysts in the femoral head.  The doctor also performed an exam of the bad hip and showed that my limitations were actually greater than I thought.  He also explained the different options we had as an out of town patient with regards to follow-up.  I also wanted the doctor to confirm that I can keep on exercising and working out, to my ability, before the surgery. 

At the conclusion of my evaluation with Dr. Raterman, I was escorted to his surgery coordinator Tracy Odum.  Tracy was wonderful at explaining all that I needed to prepare for the surgery, including PCM eval, bloodwork, X-Rays, and EKG.  She made all my appointments for pre-op eval at the Zephyrhills clinic the day before my surgery and for my hospital pre-admittance.  Overall, I found the entire staff extremely professional and friendly.

26 Dec 2013:  Received call today that TRICARE authorization was approved, so I am good to go.

6 Jan 2014:  Drove down today with my wife for pre-op appointments the next day.  We stayed at the Springhill Suites by Marriott for the duration.  It is very convenient to hospital, only a ten minute drive.  The Florida Hospital rate is only $82/night, a very good deal.  It includes a free breakfast buffet, wine and beer social hour in the evening and a suite for a room. 

7 Jan 2014: Pre-Op Doctor visit:  My pre-op appointment was in Zephyrhills at one of the Florida Medical Clinic satellite offices that Dr. Raterman services.  It was a typical appointment.  Brought to the back by a med tech where they took my vital signs.  I then met with Dr. Raterman’s Nurse practitioner, Kimberly Myers.  Kim was helpful in answering any of my questions.  After the release of the Australian Joint Registry information pertaining to the Corin Cormet HR device, I wanted more information as to why Dr. Raterman used that device.  She informed me that Dr. Raterman had switched back to the Birmingham Hip Resurfacing device. 

I next met with Dr. Raterman.  We reviewed the procedure and I also asked him about the Cormet and BHR devices.  He shared with me that he had a couple of BHR acetabulum cups become loose a few years ago and that he switched devices hoping for better results.  Both devices had been designed by Dr. McMinn and the finish on the Cormet cup allowed for better growth, however, it was all a moot point.  The most interesting comment was when he told me that Cormet pulled out of the US market as of 1 Jan 2014, due to lack of sales.  Since his training and equipment was compatible with BHR, he had gone back to installing that device.  All other questions and comments were answered and then I met with the DJO Global sales rep for equipment that I would need post-op.

Here are my recommendations for equipment.  Get yourself a DonJoy Iceman Machine before the surgery.  Retail they are $150, and it is not reimbursed by insurance.  However, you can easily find a used machine on E-Bay for around $40 and a new “in the bag” hip pad will cost an additional $50.  Keep the hip pad in the bag for infection control purposes and let the hospital staff hook it all up for you after the surgery.  Other important items…a walker and 3 in 1 raised toilet seat/bedside commode/shower chair.  Bothe of these devices are usually covered by insurance.  The “3 in 1” is also a must, unless you have access to a raised toilet (handicap level) at your home.  This is important to continue to meet hip restrictions placed on you.  Finally, the 3 in 1 will be suitable for a shower in the early recovery period of the surgery.  Also, for your home, purchase a handheld shower head.  It will help you while taking a shower when you are using the 3 in 1. 

I would like to add some additional comments on Dr. Raterman’s staff and how he conducts the office visit.  I especially liked the patient flow that they utilize.  Obviously, every office has the med tech take your vitals.  That is not different.  I really appreciate seeing his Nurse Practitioner before Dr. Raterman.  Kim Myers was extremely helpful in explaining all the answers to my questions before I saw Dr. Raterman.  Let us be honest, the Doctor is extremely busy and I respect his time and value my time with him.  However, I do not want to waste his time with questions that are easily answered by his NP.  After the NP is finished, Dr. Raterman finally comes into the room.  Dr. Raterman is extremely professional and thoroughly answered any questions I still had or wanted his opinion on.  My final comment…I always ask to be the first patient in the morning and although they take the patient’s desires into consideration, the flow is based on technical aspects of each procedure the doctor is performing on any given day.

Pre-Op Hospital Visit:  Dr. Raterman uses Florida Hospital at Wesley Chapel.  This is a BRAND NEW HOSPITAL and is beautiful!  My appointment was for 3:00 PM and I was greeted at the Concierge station in the lobby.  An admit rep then called me into the office for pre-op paperwork…always enjoyable.  Then I was escorted to a small conference room, where I met two other patients of Dr. Raterman and we had a hip surgery education class.  I was the only “surface hippy” and the other two patients, both women, were total hip replacement patients.  The class was a requirement, however I thoroughly read all the material that Dr. Raterman’s office provided and did tons of research on the “surface hippy” website, so I thought the class was not necessary.  I could envision a patient that did not do as much research as I benefitting from this class.

After the education class, we were all paired up with nurses to go over all our pre-admit testing on a one-on-one basis.  In particular, the nurse reviewed all my pre-op labs, X-Rays, and EKG.  We went over additional medical history (mine was lengthy with five previous joint surgery’s).  Also, the nurse swabbed my nostrils to verify if I had MRSA present.  The test came back negative, however if it was positive, more stringent infection control procedures would have had to be utilized.  Finally, I was given a bottle of antiseptic body wash to prepare for the procedure.  I was required to shower the night before, utilizing the body was and once again in the morning.  Given my fear of developing an infection post-op, I utilized the entire bottle and scrubbed endlessly. 

My personal comments on the pre-admit procedure.  I thought it was very efficient, thorough and friendly.  Each patient was given a “book-bag” with our “hip education” information and the antiseptic wash.  I was really impressed with the hospital itself.  It had only been opened since October and was still in pristine condition.  The hospital staff was very friendly and treated each patient very well.  The entire process lasted about two hours.

8 Jan 2014: Surgery day.  My surgery was scheduled for 10:30 AM with a showtime of 9:00 AM.  Once again, I arrived at the hospital with my wife and we checked in at the Concierge desk.  A hospital volunteer escorted us to the waiting area for my inprocessing.  My wife and I waited only five minutes before another volunteer escorted me to the pre-op area.  Also, at this time, my wife was given a “code number” to follow my process on a big screen TV.  It allowed her to keep track of where I was in the “process of becoming a surface hippy.”  I know the family likes that knowledge, however I had to chuckle at the assembly line aspect of monitoring my progress. 

For anyone who has had surgery, pre-op preparation was no different here than most.  I put on the hospital gown, bagged my clothes and had my IV put in.  For the first time, my IV was inserted into my fore-arm and not my hand.  The nurse explained that it would allow me to use both hands on the “triangle” that is setup to enable me to get in and out of the hospital bed.  Once I was prepped, my wife was allowed to join me and the “waiting game” began.  On an interesting note, while I was in pre-op my decision to drive from my hometown of Panama City, FL to Tampa and have Dr. Raterman perform my surgery was constantly reinforced.  All of the volunteers and pre-op nurses talked about how good a hip surgeon Dr. Raterman is and that it was smart to make the drive.  Also, they told me one of his THR patients that day had also driven from out of town for Dr. Raterman to do the surgery.  Finally, it was time to head back to the Operating Room (OR).  In addition to general anesthesia, Dr. Raterman also has a “spinal block” done on his patients.  It helps him when he manipulates the leg, reduces blood loss and is very helpful in pain control after the surgery.  The last thing I remember was having the “spinal block” performed and transferring to the operating table.

I woke up in post-op, with a catheter in place and a bandage on the incision site.  The incision site was more or less on my right buttock and was about six inches long.  After I was stable, I was brought to my hospital room.  The hospital rooms at Florida Hospital Wesley Chapel are beautiful.  Every room is a private room and there is even a small sofa bed in case a family member wants to stay.  That was not a factor for me.  Tampa is a beautiful city, with excellent shopping and I was in no condition to really carry on a lengthy conversation, so after a short visit, my wife enjoyed some time to herself.  Additionally, each room at the hospital is equipped with a TV that allows access to about 100 cable channels and even movies on demand.  What was even more impressive was you were able to access the internet from your bed with a remote keyboard.  Like I said before, Florida Hospital Wesley Chapel is awesome!

Dr. Raterman makes his patients get out of bed on the same day as the surgery, so once I was “awake enough” the nurse helped me move to the chair.  I was allowed a liquid diet, based on the anesthesia and that is a good thing.  Apparently, the anesthesia didn’t agree with me, because I ended up vomiting my liquid dinner back up about 15 minutes after eating.  I also found out that I was not the only person with this problem that day.  The nurses were surprised, because that was not normal and they all thought there was a different anesthetist than usual on the job.  My wife was kind enough to bring me some chicken soup from Panera a couple of hours later, but I still couldn’t keep it down. 

9 Jan 2014:  The first day after my surgery, I was finally able to eat some crackers, drink some ginger ale and was able to eat a full dinner that night without any nausea problems.  The physical therapy staff arrived early that day for me to learn how to use my walker and get out of bed.  I am a very goal oriented person and the typical mind over matter part takes over when I am faced with these situations.  I was told that as soon as I could walk 250 feet with the walker, I could be discharged.  I knocked out over 100 feet that morning and felt confident that I would meet the requirement the next day.  I spent a lot of time in the chair in my room this day, rather than the bed.  Other than PT, not much else was unusual that day.  A couple of complements for the hospital staff; they were terrific.  Every time I “beeped” for assistance they responded extremely quickly.  The nurses and tech’s were friendly, helpful and they never made me feel like I was imposing on them whenever I needed assistance.  The food service staff was also great.  After each meal, they would go over the menu for the next meal, one-on-one with me and help me decide what I wanted to eat.  Finally, the catheter came out that night! 

10 Jan 2014: I was feeling great and got out of bed, washed up myself in the bathroom and even shaved.  I have learned over the years that personal hygiene is one of the best determinants of how you feel.  If you get out of bed, wash up, shave and stay clean, then you just naturally feel better.  It always works for me, so I recommend it to others.  Now that I was feeling better, I was eager to meet with Physical Therapy and walk my 250 feet and get out of the hospital and go home.  PT arrived around 8:30 and we walked to their training room.  I was instructed how to negotiate stairs, practiced it a few time and then walked back to my room…well in excess of 250 feet…I sensed liberation was right around the corner.  Finally, at 10:30 I was discharged, approximately 48 hours after arriving at the hospital.  My wife picked me in my pickup truck and we began the drive home.

Many of the surface hippies comment about using the large garbage bags to help get into and out of the car.  I was not faced with that problem.  I have leather seats in my pickup and combined with my nylon basketball shorts (recommended by surface hippy’s everywhere) it was quite easy to get in and out of my truck.  I also liked sitting up in my truck.  There is much more room than our mini-van in the passenger seat.  Pain control on the drive home was aided by a couple of Percocet’s and two stops to get out and move around a little.  It took about six hours to get home, but I was surprised how comfortable I actually was for the trip.

11 Jan 2014.  Home health and home PT visited today to check the incision site and get me started with my recovery.  The incision site was in good shape.  I had been “glued back together” so the incision site was covered with steri-strips and a dressing.  Home health cleaned the site and reapplied a clean dressing.  Home PT arrived a little later and reviewed all my exercises with me and gave me some new ones.  In the end, Home Health nurse visited on Tuesday and Friday for two weeks.  Home PT visited three times a week.

Overall home recovery:  My home recover has gone very quickly.  I was off the pain meds by the third day and controlled any pain with non-narcotic pain meds and icing.  PT has gone great.  My instructions from Dr. Raterman were “weight bearing as tolerated.”  I was done with the walker about a week after surgery and have been on a cane every since.  Even now, two weeks after surgery, the cane is really just for balance and not even used to bear any weight. 

21 Jan 2014.  Two week follow-up with Dr. Raterman.  I had my two week follow-up with Dr. Raterman at his Zephyrhills clinic.  We drove down the night before and stayed once again in the Springhill Suites once again.  My appointment was at 1:30 in the afternoon.  This time, the med tech brought me in and I just met with Dr. Raterman.  I demonstrated my walking and he was happy with the recovery.  We reviewed the X-Rays and he inspected the incision site.  I had a lot of questions and he answered all of them.  Because I was an out of town patient, I received copies of all his home health and PT protocols to ensure I was on the right track for recovery.  It was important to get the PT protocols, because I am the first surface hippy in our town and the local PT community is not up to speed on the differences versus a THR.  My next follow-up is at the two month point.  Dr. Raterman offered to do it telephonically if I send him my X-rays to prevent the long trip.  I will consider and decide at a later date. 

In closing, I am very happy with my decision to become a surface hippy, instead of a THR recipient.  My recovery seems to be progressing faster than any THR patient I know.  My decision to go to Dr. Raterman in Tampa was a good one.  He is a highly experienced hip resurfacing doctor and has performed over 1800 to date.  I was concerned that the cysts that had developed in my femoral head would prevent this surgery, however Dr. Raterman’s experience easily solved this problem and in the end they weren’t as bad as we thought and were “milled” right out during the reshaping for my cap.  Dr. Raterman’s staff is top notch and the hospital he uses is AWESOME!  I highly recommend Dr. Raterman as a hip resurfacing surgeon, even if you have to travel from out of town.