A running diary of my hip joint replacement surgery and some background to put things into perspective.
"The patient is the one who has to heal," says Dr. Elissa Santoro, a pioneering surgeon and founder of the Breast Care and Treatment Center at Saint Barnabas Medical Center in Livingston. "I tell my patients, 'I will be your mountain guide, but you will climb the mountain.' "
Well, I feel like I've been climbing a mountain for months.
Yes, it's been 5 years since my hip replacements, and all is well. I phoned my surgeon as directed to make an appointment to see him for my 5-year checkup and his office told me that if everything was okay, he didn't need to see me.
So, that's it, very lucky, blessed, to have had the surgeries and have had everything work out well.
I'm not anticipating any (or at least many) new blog posts. The whole story is here.
If I can offer one word of advice to prospective hip replacement candidates it's this: do your post-op exercises and don't stop. I've continued now for 5 years, am as flexible as ever.
If I get two words of advice: My doctor, Dr. Buly, at the Hospital for Special Surgery, and his team and the entire hospital are terrific, outstanding, excellent.
Well, it's now 18 months since my second hip replacement, and I am doing great. My thoughts turn less frequently to how lucky I am to have received those implants and more frequently to those who suffer and are unable to get the surgery I received. I feel for those people.
My daily routine now starts at the JCC gym in Rockland County -- a superb facility with attentive trainers. Once a week I spend 60 minutes with Marilyn who makes sure that my heart gets pumping and I work up a sweat shortly after I start. And once a week I take a boxing lesson with Chris who pushes me through 3-minute speed drills that empty my arms' gas tanks of all energy until I am running on fumes.
I've become pretty good on the speed bag. Try it. It's a lot of fun. With wraps or small gloves I can hit the bag straight on and with the edge of my hand, go hand to hand, and even double up as I switch hands. It's a lot like drumming and because I am a drummer, I think that the speed bag has come relatively easily to me. I've noticed that the boxing lessons have done more to build up my shoulders and arms than anything else I've done in the past year.
The morning ends with a shower and a short stay in the steam room, and I leave clean and refreshed. A great way to start the day.
My hips, of course, are fine. Happily the pain I endured prior to my surgeries is, as promised, a thing of the past.
I think that regular exercise, however, is crucial. And I plan to continue my daily morning gym exercise forever.
Had my one-year check up this week and it went very well -- excellent, in fact.
X-ray images show that both hip replacements have fused well with the bones and that they have not moved even a tiny bit.
Dr. Bully manipulated both hips and determined that all is well.
What a miracle surgery! A year ago I could barely walk and then only with a lot of pain. I have no pain. It's the surgery and follow-up care. I exercise almost daily and that's helping a lot.
Bottom line: it has been a great experience. If you're on the fence about getting hip replacement surgery, all I can say is that you will know when it's time.
Okay, so I am sorry for not posting in quite a long time. Been busy which is good.
I am fine. Really fine. The surgeries and post-surgery physical therapy are nothing short of amazing.
I now walk (without a cane, of course) comfortably and can lace up my own shoes. (That's an improvement because at my worst, I could barely slip on a pair of sneakers with Velcro tab closures.) I'm driving and I can sit comfortably on a hard chair and even climb and descend stairs (though that's still not perfect and I'm working on it).
My second hip surgery was a month ago. I'm now walking (using a cane only occasionally) and, as of yesterday, driving. I feel good and, best of all, there is no hip pain. That's gone!
I have been working out at physical therapy and my legs are strong. The surgical scars are healing nicely and all certainly appears to be moving along in the right direction.
This experience has reinforced the notion for me that we are all very fragile, and that we must be careful in our daily lives not to do anything to increase the possibility of injury. We are not indestructible.
I am still having a little difficulty getting into and out of a car (my left leg needs help elevating -- and sometimes I get by wiggling my left foot and inch-worming my way out the passenger side door). But I'm sure that will improve with time and exercise. And walking steps is still a one-at-a-time deal, although I have tried walking upstairs by alternating both legs, but I'm just not ready for that yet.
Each day I get a bit stronger, a bit more flexible. I've been putting in almost full days at my office which, thankfully, is not a physically taxing environment under normal circumstances.
I am very grateful for the excellent medical and rehabilitative care that I received at Hospital for Special Surgery (New York City), Helen Hayes Hospital (Haverstraw, NY) and Sportcare Institute (West Nyack, NY).
It's been almost two weeks since my second hip replacement (the first was two months ago to the other hip). Some readers of this blog will be persons considering hip replacement surgery for themselves or others. Many of my friends have told me that they have hip pain or know someone who's had replacement surgery. The most common question is "how will I know when I am ready".
Much to my surprise, hip replacement surgery is considered to be "elective" surgery (see "Total Hip Replacement" for a professional discussion by MedicineNet.com). I'm sorry, but in my case there was nothing elective about it. Say, for example, a person puts your hips in a vice and tightens down on the vice causing you constant, relentless, excurtiating pain. Would you consider it elective to extricate yourself from that situation or mandatory?
But, before I get my sheets all twisted up in a knot, thankfully the descriptor "elective" relates to timing, not medical necessity. According to WiseGeek, "elective surgery is non-emergency surgery which is planned, allowing the patient and doctor to determine the best time and place for it. There is a wide range of procedures which could be considered elective, ranging from a hip replacement to a rhinoplasty, and elective surgical procedures are offered at most hospitals. The primary advantage of elective surgery is that it has a much more controllable and predictable outcome, since the variant of chance and emergency circumstances is removed."
So, notwithstanding that my surgery was considered "elective", it was covered. Coverage under my insurance was not an issue.
As to timing, I knew I was ready. My hips went downhill faster than Eddie "The Eagle" Edwards, the first competitor to represent Great Britain in Olympic ski jumping. For a time (more than a year) I was hobbling about, in pain, but managing to some extent on Advil. Things worsened toward Fall of 2009 and by October I was walking in pain but only with a cane.
Once diagnosed with advanced osteoarthritis in both hips I had two choices: (a) live with it and dope myself up to manage the pain; or (b) undergo hip replacement surgery. At that point, I was ready -- so ready that had my surgeon said he could operate the day he saw me, I would have jumped on the operating table immediately. So, that's the answer to the question. You'll know you're ready. There won't be any question.
Retrospectively would I have done anything differently? Sure, I should have been 100or more pounds lighter all my adult life, eaten better, taken better care of my health, etc. But, having found myself in the position I was last October, I would not have changed a thing. I am esctatic that I had the surgeries. My right leg is almost back to normal (operated on Nov. 17, two months ago), and my left leg makes daily positive progress returning to normality (operated on Jan. 7, 12 days ago). Oh, yes, I've lost 75 pounds and continue losing weight through better eating and increasing (albeit currently limited) exercise.
Yesterday I resumed outpatient physical therapy at a local treatment facility (SportsCare Institute, Inc. in West Nyack, New York), 11 days after my second surgery. My progress following the second surgery has been even more rapid than after the first surgery. I attribute that to my having a good opposing leg and hip this time around.
I was also genuinely enthused about being able to do 10 minutes on a stationary cycle without any difficulty, and was even able to move the pedals around their orbit easily and quickly. I was literally speeding! It was a thrill, as if all of a sudden I had two rocket-powered legs. What I had was my two legs being able to use an exercycle without pain. I haven't been able to do that in years. I am feeling terrific about that and look forward to getting back on the cycle tomorrow.
I am also able to get around a bit with a cane (still somewhat unsteady) but still use the walker most of the time.
And, while Vicodin remains part of my daily regimen, I am taking less of it and I can see an end to that in a week or two.
On the topic of costs, I am very lucky. Lucky that I was able covered for much of the expense through insurance, and able to pay for the amounts not covered. Many people are not in that position (most people in the world I would guess). Something's got to be done about that. Being the beneficiary of extraordinary healthcare, I can only wish the same for everyone, and work to seeing that become a reality. So, for those of us who question the current healthcare reform initiative, a choice that involves living with chronic pain is not a choice. Live with chronic pain for a day and you'll see what I mean.
My friends are calling me Lee Majors, the "6 million dollar man". If the cost of my surgeries is a measure, I'd say I'm more like the quarter-of-a-million dollar man.
I'm at home now. At HHH I was assigned to a room that I shared with an elderly man who really should have been assigned to his own single room. I couldn't room with him (noise, toilet issues, cleanliness, etc.). One of us had to go, and I was ready. I stayed from Wednesday until Friday, and got myself discharged.
That was 8 days after surgery. I was a lot further along with my recuperation at that point than I was with the first surgery two months ago. The difference was that this time I have a good and improving hip on the other side, rather than a weak, painful and worsening hip. That is helping a lot.
Transferred to Rehab Cheers rang out through the halls of Hospital for Special Surgery along with choruses of "he's leaving, finally" as I was wheeled out yesterday and into an awaiting ambulette ending a marathon 6 day stay at HSS following successful second hip surgery.
An "ambulette" is basically a van with a raised roof and a tail loader. It can double as a refrigerator delivery vehicle when inter-hospital transfer traffic is slow. The van is equipped with floor-mounted tie-down points to secure wheelchairs for the trip.
Every health insurance claim manager should be required to commute to work one day a month in a wheelchair teathered to the floor of an ambulette.
I say "teathered" because that's the best that my amiable ambulette driver (let's call her "Amy") was able to achieve even after a tighten-down adjustment following the first (of many) hard turn Amy took screaming out of HSS' driveway onto 69th Street. My wheelchair and I didn't take that turn, at least not at the same time that Amy and her ambulette of fun did. We followed like a yoyo follows a string tug. I'd say was pulling about 3 Gs.
Riding in Amy's ambulette is something like flying in NASA's padded training jet -- the one that simulates weightlessness for astronautsby flying parabolic trajectories, including the nauseau.
My body and wheelchair needed to be wound wrapped like paletized cargo to keep my freshly operated leg from swinging out beyond the "precautionary" limit during lane changes, especially when the van would go one way and my wheelchair the other way.
Enough about the ambulette. HSS was stellar; my docs and staff could not have been more professional, expert and accommodating. And the view east and south along the East River was grand.
The staff at Helen Hayes Hospital (in Haverstraw) greeted me like old friends, "he's back, ugh!"
At HHH I started with a "heart healthy" diet which translates to no taste, fewer calories. At 3:00 a.m. the hungries woke me. I need to make some adjustments.
It's Sunday evening, January 10. Yesterday the Jets beat the Bengals; this afternoon the Pats were embarassed by the Ravens; and I'm watching Green Bay struggle unsucessfully to reprise last week's win over Arizona. You now have a good idea about what I've been able to accomplish this weekend.
My surgery went well Thursday. I am now the happy host of two replacement hip joints. Dr. Buly used size 7 Titanium Stryker pressure-fit stems driven into the centerline of my femors after carefully dislocating them from my hip plates and removing the tops to get access for the spikes.
Atop each spike is the ball portion of the ball joint that is a replacement hip. The balls' contact surfaces are ceramic and the mating cups by Depuy (a Johnson & Johnson company) are fashioned from polyethelene.
My recovery experience from this surgery seems to be a bit less daunting than the first time around. The accomodations and service at the Hospital for Special Surgery are again superb. Pain control continues to be a priority and everyone here appears to have only one priority -- patients' well-being and comfort. HSS has implemented what every service institution should strive to acheive.
I was able to shuffle along the hallway with a walker yesterday and today. I didn't go very far but it was good to get out of bed and move about.
The plan is to discharge me tomorrow morning, hopefully directly to Helen Hayes Hospital in Rockland County where last time I had a week of rehabilitation following my first hip surgery two months ago. That decision is pending approval from my insurer Oxford. I won't know for sure until tomorrow morning.
I'm looking forward to getting this experience behind me, and to walking again and even playing golf, not that I was ever any good at golf but I have worked my handicap down to 20 on my Tiger Woods Electronic Arts iPhone golf simulator and am growing anxious to test my newly honed golf skills on a real course. Any chance my technique will carry over?
I didn't think so.
Post-op exam of my right hip went very well. That surgery is healing well, and I am able to put full weight on that hip joint. Quite remarkable.
I am hopeful that recovery will be more rapid this time, and optimistic because this time I have a good hip joint to assist with mobility.
Thursday's surgery is scheduled for noon.
Kazatski is not in my future but dancing should be.
It's now six weeks since the surgery to replace my right hip and I am finally feeling close to normal. I shook the Vicodin about two weeks ago and went through an uncomfortable week of withdrawal. Then about two days I ago I gave up Tylenol (I had been taking 3g per day). I've had only one 500mg Tylenol in the past 48 hours.
Today is the first day since my surgery that I can say I feel right. I am using a cane to assist the left hip but am quite ambulatory.
Physical therapy is helping quite a bit. Found a great therapist who spends about 15 minutes moving, pressing, etc., after a 45 minute routine of machine and stationary exercises.
So, the good news is I feel good. Looking forward to getting the second hip done and moving on with life.
Last Tuesday night at 3:30 a.m. I took my last Vicodin (5mg Vicodin, 325 mg Tylenol). The last six days I've been feeling pretty poor. When I recognized that I was taking Vicodin to control feelings of malaise, chills, emotional downs -- symptoms of opiate withdrawal -- rather than to control pain, I knew it was time to get off the Vicodin.
Previously I had been trying to wean myself off the drug but successively longer periods of time between doses. But that only caused me to experience the repeated beginnings of withdrawal numerous times without acheiving my goal of Vicodin independence.
So, I stopped taking Vicodin altogether and determined to deal with the withdrawal over a period of days. And it did take several days -- days of feeling pretty crappy, poor temperature control (usually cold), feeling down. But I think I've come through it now, some six days into the process.
I've been dosing with 500mg Tylenol tablets, one every four or so hours. That's 3g per day total, versus a limit of 4g per day of Tylenol.
Okay, so it's 4 weeks (today) since surgery to replace my right hip joint and I am more than pleased with my progress. Sure, it's been a bit difficult here and there, but it's not been painful at all (controlled largely by Vicodin 5mg, 4 times per day; needed mostly to deal with the left hip joint which is scheduled to be replaced in a little more than 3 weeks, on January 7, 2010. The difficulties have been diminishing, consisting mostly of limited mobility which, with exercise and time, have been steadily decreasing. And, I've not been able to drive. Getting in and out of our car on the passenger side is becoming easier each day.
A word on Vicodin. The positive is that it does work for me. I was able to cut down the initial dosage from 8 pills to 4 pills per day, about 6 hours apart. I find that anything less (or a longer time period between pills) rather quickly results in chills, malaise, and increased pains and stiffness in my left hip joint. The negative is that after the second surgery I am sure to experience withdrawal symptoms, probably about 6 to 8 weeks post-surgery when I hope to be coming off the pain medication (late February or early March).
Getting dressed is not a problem except for getting compression stockings on my legs. Renee has been diligent about that task each morning.
The surgical scar is healing nicely. The steri-strip covering the dissolvable stitches is coming off piece by piece. The wound looks good, no oozing, no odor. I have my physical therapist check it each time I see him (2 or 3 times per week). There is a slight red portion which the therapist attributes to a "pinch point" where the movement of my hip results in movement of that portion of the surgical site.
Also, keeping my legs elevated whenever possible has been a challenge. A new lift/recliner chair works well for that, particularly when augmented by a large triangular foam pillow under my legs which helps elevate my calves when the chair is moved to reclining position. Highly recommended.
Physical therapy also works well to combat the edema present in my legs following the surgery. That's my primary focus now -- reducing and eliminating the edema.
As you've read (below), my surgery was scheduled for 1:30 p.m., Tuesday, Nov. 17. I spoke with the surgeon around 11:00 a.m. and he said that he had one to do in a few minutes and that it should take an hour and a half; that I should be good to go around 1:30 p.m.
Evidently there were problems and that surgery lasted longer than expected. At 5:00 p.m. the anesthesiologist came to us to say that he had reviewed my medical information and that it would be medically irresponsible to do both hips during one surgery. Complicating factors include weight, history of atrial fib, elevated creatinine. So, they decided to do only one hip, the worst one.
My surgery was uneventful, took 90 minutes and all went well. I had a nice semi-private room overlooking the East River and Roosevelt Island. Also, plenty of beautiful nurses caring for my every need, waiting on me hand and foot, 24/7 -- just like I'm accustomed to receiving at home.
On Friday, I was transferred to Helen Hayes Hospital, a sub-acute rehabilitation facility in Rockland County -- first class. I spent 8 days there and was discharged last Saturday, a couple of days after Thanksgiving. I am getting around with a walker and sometimes with a cane.
I began physical therapy in Rockland this week. And I'm doing exercises to strengthen my legs. Each day brings some improvement in mobility.
Unfortunately, it is now the un-operated hip that is limiting my movement and causing the most discomfort. I have been able to reduce my reliance on Vicodin from 8 pills per day (5 mg each) to 2 or 3 pills per day.
All in all, I feel better than I did pre-surgery. And by February, I hope to feel great.
I had a special treat this evening. My daughter and granddaughter connected via Skype for a short video phone call. MY $300 HP Netbook worked perfectly. I sang my repertoire of nursery rhymes and was treated to my 20 month-old's punctuation, singing and rocking and rolling as I sang to her. Doesn't get much/any better than that.
And I received another special treat when my other daughter phoned to report my 6 year old grandson's delight at having been visited overnight by the tooth fairy. I understand that the going rate has risen but from what I remember, in my day one could have redeemed an entire mouthfull of baby teeth for today's price of a single tooth.
Doing well in rehab. Arrived late Friday from NYC. Not much going on in the facility over the weekend but I did manage to get in some OT and PT sessions. OT teaches basic skills like dressing, washing, reaching for things, etc. PT involves strength training, positions to avoid while healing, practice walking, stair climbing, rappelling and mountaineering.
Today I received my schedule and I have 5 classes per day.
Pain is basically gone. The right side old pain (groin, quad, glute) is totally absent. Vanished. (Left side glute hurts a bit but possibly because aggravated by sitting too long on a hard wheel-chair cushion).
The surgical site is doing well. I get a low level of post-op pain from there but less than "1" on a 1-10 scale. I've been taking 2 Norcos (5mg Vicodin plus 325mg Tylenol) 4 times per day.
Eating relatively little but getting a bit hungry at 4:00am so I've been saving something from dinner for those times.
Lots of girls here. Average age 82.
Daily blood tests to adjust Coumadin dosage.
Staying at a magnificent facility owned and run by NY State. Terrific view of the Hudson River.
Surgeon used dissolving stitches and a steristrip to cover the 10" incision so I've been able to shower since I arrived at rehab.
I hope to stay as long as possible. This is a terrific facility.
I'm recuperating at Helen Hayes Hospital in the Hudson Valley where visiting hours are 11 to 9. My stay could be 5 to 7 days.
Two bronco busters cowboyed my ambulance up the East Side Drive this afternoon, across the GWB and onto the PIP where the road finally smoothed out. Not to be frustrated in his efforts to give me the world's roughest ambulance ride, driver Soto weaved constantly from lane to lane in what seemed like a concerted effort to put the truck into sinuous rhythm and me strapped inside on a hard bench into an asynchronous harmonic as I bounced into the wall with each swerve of the wheel. All this as his colleague Nicki entertained between strains of a heavy beat pouring from the radio sufficient to set all of 180th St. in motion. From time to time we'd roll over the cutouts lining the lane to protect drivers who stray too far from the road with a sudden bright staccato machine gun burst that wakes those dozing drivers so as to prevent an unintended rollover.
The ride was entertaining. Good thing I had taken my pain meds in advance of the trip.
The rest of the day has been uneventful as I get settled in for PT to begin tomorrow.
Surgery went well, about 90 minutes, beginning at 6:00 p.m. Tuesday evening. Pain management is a high priority at HSS and that has been evident all through my experince here.
Unfortunately my anesthesiologist vetoed a bi-lateral about an hour prior to surgery which was a big disappointment. So I am hoping to get the second hip operated on in early January, if possible.
Where I go from here is up to Oxford, my health insurance provider. Best case would be Helen Hayes, an acute care rehab facility in Rockland county. I am hoping that Oxford will approve it.
I am resting comfortably and hope to be discharged Saturday. A big "Thank you" to everyone who wrote, called, expressed interest and concern, or even just thought about me. I am fine and will be as good as new soon.
This is my final entry in this blog. The rest will be merely rest and rehab. So I am signing off. This post is my 30.
Just spoke with Ellis, who is recovering amazingly well after his one hip replacement. He is in great spirits, cracking jokes and feels great. They have already had him walking around and should be admitted into a semi-private room later today.
He made it a point to thank everyone for all the prayers and speedy recovery sentiments. For information as to where to send gifts/flowers, though he says they are unnecessary (the emails and phone calls have really touched him), please contact Edd Schillay at edd@trial.com
I've been told that Ellis went into surgery at 5:00pm and came out three hours later with one of the two hips done. He is doing well and is in the recovery room at the hospital, where he'll stay until some point tomorrow.
The doctors stated that they didn't want to keep him under too long and will have to do the second hip after he recovers from this surgery - most likely two months from now.
Thanks to all for the phone calls and requests to send gifts/flowers. Once Ellis is assigned a room or moves on to a rehabilitation facility, I will be sure to post an update.
Arrived at HSS at 10:00 am and walked in as a matter of principle (as opposed to using a wheel chair). I figure "walk in, walk out". Let's hope so.
Family waiting room very nice with 4-story window onto NY's East River. The gently flowing massive olive green slug of liquid is, I am sure, water. I give it about 4 knots in the southerly direction. A Kings Point Merchant Marine ship just sailed by rapidly.
The sun-filled waiting room is packed with families and patients like me waiting to be called. Breaking the white noise din every so often is the voice of a hospital official politely calling out a surname. Each time that happens I get a jolt. Will that be my name?
Hungry. Haven't eaten since "dinner" (3 ounces of chicken and a baked potato -- no sauce). Yum! A small food service stand is serving breakfast. I'll deal.
A woman announces that visiting time (11:30am) had arrived for patients in the recovery room. She sets forth the rules: 20 minute visits, one patient at a time in the recovery room; extra visitors must queue up. The waiting room empties to about half the number of people earlier.
It's Tuesday, surgery day, and time to throw off the teather and go wireless. This is my first post from my iPhone.
Slept well last night to the credit of some vintage Willie Nelson music that I find very calming and soothing. The Bose noise-cancelling headset was comfortable and delivered a you-are-there sound environment.
Spoke with all my children yesterday. A load of emails, and a bunch of phone calls, from friends.
Well today I received my hospital arrival time (10:30 a.m.) and surgery time (1:30 p.m.). I am very positive about this, very calm, looking forward to getting better.
Today's food intake was limited to non-fiber light eating: corn flakes, skim milk, cottage cheese, turkey and Cling peaches (reminiscent of Edith Bunker anyone?). Tomorrow will be clear liquids only.
I've downloaded "The Essential Willie Nelson" and some Willie Nelson and Johnny Cash podcasts to my iPhone, as well as a few new games, Scrabble (terrific) and iBowling being the best. Both allow interactive play with someone else on the Internet, so I ran a shakedown Scrabble game with my brother Steve. To say that I was thoroughly whooped would be an understatement. Despite a respectable mid-200 score on my part, Steve was bumping up against 400.
When I played the game alone against the iPhone's CPU, I noticed something quite unfair. The CPU has access to and uses every word in the dictionary, including many I never heard of. On the other hand, when I use words that the CPU never heard of, they are rejected. Now I ask you, is that fair? Hmmm.
I packed a small bag with some baggy p.j.'s, toiletry items, socks, a shirt and a sweatshirt (the latter two being TRIAL.COM logo products, of course). Tomorrow is the big day.
I've been limiting contact with the outside world so as not to catch a cold, or infection or do anthying else that might throw the schedule off. Today, though, my daughter-in-law Dara and my son Jason hosted my soon-to-be 88 year old Dad (who is in town from Boca Raton, Florida), and the rest of the Mirsky family for brunch. Jason used his new smoker to smoke salmon -- absolutely the best smoked salmon I have ever had. It was moist, almost fall-apart soft, and major league delish.
Spent the rest of the day at home nodding off between NFL football plays and switching the channel incessitantly unsuccessfully seeking something decent on TV to watch. I did the same thing yesterday while watching a non-stop succession of college football games. I think the college games were better than the pro games this weekend.
Had a lot of time to ponder just how lucky I am in so many ways. First I have a tremendous support base of really good friends all over the U.S. and Canada from my work with law firms over the past 17 years and The Network of Trial Law Firms that I set up. The messages I have received from scores of those friends are heartfelt and gratifying.
Of course my family and other friends have been in touch with support and encouragement. I am lucky and thankful for that.
But putting this thing into perspective, how lucky am I that within several months of diagnosis, I am to be operated on by one of the leading surgeons in the world at one of the best hospitals in the world, and as a kicker, most of the expense is expected to be covered by my insurance? Considering how many people there are in the world, how many of them must need this kind of surgery, and how many just cannot get it, I am more than lucky. Blessed is a better description. Makes me want to do something to help those less fortunate to get access to this kind of life-altering solution.
When I was an engineering student at City College of New York in the late 1960s we were just scratching the surface of bio-mechanical engineering. The kinematics I studied were based around railroad link drives and internal combustion engines. I'm glad that creative thinkers chose instead to devote their attention to designing mechanical and other medical prosthetics, for soon I will be a beneficiary of that work.
I feel like I am about to enter a 6-story water slide. Confident it will all be fine but a bit apprehensive about taking the plunge. However, almost constant discomfort and pain continually remind me there is no alternative.
A pre-admission case manager phoned with a few questions relating to post-surgery rehabilitation:
1. Does my home have stairs to get in? 2. Does my home have stairs inside? 3. Is anyone at home to help me?
She told me that screening nurses from two of the local rehabilitation centers (Helen Hayes in Rockland County, and Burke in Westchester County) are on-site daily at HSS.
Admission to one of those facilities will depend on approval by my health insurer (Oxford) and availability (room at the inn).
I understand that, from a patient's perspective, rehabbing at one of those facilities is much preferred to rehabbing "at home" or even at a nursing home with rehab capability because of focus, expertise and frequency of rehab exercising.
However, sometimes (?) a health insurer case manager might have a different view as to "medical necessity". In my case, with both hips being replaced, HSS' pre-admission case manager is of the opinion that I should have no trouble getting insurer approval. I'll let you know.
I am told that sometimes advocacy is called for. I'll have to see if anyone I know is skilled at that. ;-)
Completed pre-op screening this week and received clearance for bi-lateral hip replacement surgery this coming Tuesday. I met with an anestheseologist and was examined by a doctor.
HSS also conducted an hour of patient education where we learned about the upcoming surgery and handling post-surgery everyday things like sitting, standing, turning, walking, putting on socks and using a toilet.
Also I stored a pint of blood for possible use during surgery, or donation if not needed.
Many Years in the Making: Now that I have had a chance to think about it, I have been having hip joint symptoms for many years but I never associated the symptoms with the source. My symptoms were groin pain, PITA, and quadricep pain (all both sides). (Most patients think that their hip is in the region of the buttocks and are surprised to learn that true hip pain is most commonly experienced in the groin. Source: The Hip and Knee Institute) The cause apparently was arthritic deterioration of my hip joints. But what was the cause of that? Many theories, but overload, too much weight on those weight-bearing joints appears to be the primary culprit. My weight at least contributed to and possibly accelerated the development of the problem. But there were other causes as well.
Some Congenital Contribution Also: I have been overweight all of my life. That led to a variety of leg and foot problems (principally swelling, insufficient circulation, pain). But, thinking back, about twenty years ago a friend (Bobby Zelin) pointed out that I was walking on the outer edges of my shoes. That was probably a precusor of things to come. And, interestingly, when my surgeon Dr. Buly threw my hip x-ray onto a light board, the second thing he noted was that one of the sides of my femur was convex rather than concave. He said that apparently my femur continued to grow after my young adulthood, when growth should have stopped (eventually leading to impingement with the pelvis). (That was the second thing he said. The first thing he said, when he saw the degree of arthritis that has resulted in bone-on-bone contact in both hip joints, was "oh, you must be in a lot of pain". Thank you. Yes, a great deal of pain and constant.)
Some of the exercises and activities I engaged in during my life probably contributed as well, including those mandatory standing broad jumps in the 7th grade, jogging when that was the craze during my 40's (I was actually jogging 6 miles), as well as inattention to the condition of my shoes and sneakers which I tended to wear well beyond their useful lives.
Relieving or Living with the Pain:The clues were there for a long time. About a year ago I began noticing groin pain. I mistakenly attributed that to a slip and partial split in the shower. Then my gluteus maximus (buttocks) began aching along with my quadriceps which would become rock solid tight. Walking anywhere became a chore. Walking over uneven surfaces was worse.
I found some comfort with an occasional dose of Advil. Aleve didn't do squat for me. UltramER was prescribed but ineffective at the dosage given. I began to need regular rub-downs with a "Thumper".
Finally, Dr. Brian Israel, D.O., my primary care physician, guitarist and guitar collector, prescribed 5-500 Vicodin-Tylenol and that worked.
Physical Therapy Ineffective: Early on I started treating with a physical therapist. The warm moist heated blankets were soothing, the light back massages too light, the laser heating comforting, but nothing lasted. Eventually I stopped treating because nothing was working to relieve my pain long-term.
Weight Loss with Purpose: At the same time I had re-embarked on an on-again, off-again long-term program of weight loss under the guidance of a nutritionist with Phelps Hospital in Tarrytown, New York. I have tried many different diets, and have been somewhat successful, but my middle initial, "R" doesn't stand for "Richard", it stands for "Recitavist". I was a recitavist dieter. No matter how well I did on a diet program, I always gained back the weight I had lost, and more. I was a Duncan® Champion Yo-Yo dieter. Eventually, I essentially gave up, resigned myself to being big, and kept purchasing ever larger clothes.
There came a time when the only thing I felt good about buying was an extra-long tie. Even my shoes weren't fitting. My feet had swollen as well as my legs.
Recommittment to Weight Loss: So, I started losing weight again, cutting back on portion size, making better food choices. Wight loss, for me at least, is sporadic. I loss weight, then I plateau. I had plateaued at about 50 pounds down from my all-time high. With a renewed the assault, came another 10 pound weight loss. But I got stuck again. And now, with impending hip surgery, I knew the time had come to get down.
I consulted Dr. Louis J. Aronne, a weight expert whom I had consulted many years ago and with whom I dropped 10% of my weight. Down 60 pounds, Dr. Arrone reviewed my blood work and history and prescribed a low dose (500mg) of Metformin, a drug with an off-label use controlling blood sugar and appetite.
Metformin has been good for me so far. I've lost another 10 pounds, bringing my total to 70 pounds lost. When and if I plateau again, we might try Welbutrin, an off-label use for which is weight loss.
Currently I have very little appetite. That's good. It's especially good because the pain-killer I've gotten to, 5-500 Vicodin-Tylenol, has one very nasty side effect -- constipation. Let's leave it at that, except the calcium blocker is also constipating. Needless to say, when one experiences so much difficulty eliminating, one's food choices narrow considerably. Granola, fruit, prunes and other good-for-you stuff are now staples in my diet.
When I go out to eat, I order less and generally eat less than half of what I order. My appetite is greatly reduced, sometimes non-existent.
With my recent weight-loss I went shopping -- in my basement where I had saved two or three wardorbs worth of smaller clothes from earlier times. I am now wearing clothes I haven't fit into for 15 years. And yes, still in style (my style).
Back and Leg Pain: But the pains in my back and legs were not diminishing. I was referred to an anesthiologist, Dr. Vinoo Thomas, who concluded that my pain was emanating from my sacroiliac ("SI") joint. Under minimally invasive fluoroscopy, I underwent two cortisone injections into each SI joint which provided me with some relief -- enough that I was able to trek around Israel this past May with occassional resort to ibuprofen. (If you like the photos of Israel, you might want to see my photos of Africa.)
The pain continued to escalate in scope and intensity. I couldn't sit for long, especially on hard surfaces. I was referred to Spine Options in White Plains, New York where I was seen by Bradley S. Cash, MD, FAAPMR who examined me and set me up with a course of physical therapy in his office. My therapist, Hemalatha Ramraj, PT, MS, was wonderful. But there was little marked improvement in my condition after several months of treatment. Eventually my insurer came to the same conclusion that I did -- the sessions were not working to improve my condition which was, in their words, "chronic" -- PT was not going to improve my condition.
Hema, my physical therapist, suggested that I have my hips x-rayed and her supervisor, Dr. Cash, ordered the x-ray. Bingo! Finally we had gotten to the problem -- advanced osteoarthritis in both hips. An earlier MRI of my lower back revealed disc herniation at L5 and T12 and the easy conclusion would have been that the disc problems were causing my leg pain. Not so. It was the hips.
And the pain was escalating. On a 10 scale, it had gone from a "3", controllable by Advil, to a regular "6-8", sometimes a "10" (when my hip would essentially hang up on a spur when I would sit a low couch in my TV room. That caused my hip joint to get stuck out of position, putting me in "catch-your-breath" agony). The only relief for me when that would happen was to wiggle to the floor and thrash about until my stuck hip joint fell back into place. I don't sit on that couch anymore and hope someday to see it at the curb awaiting my town's next bulk refuse pickup.
Confirming Diagnosis: I consulted with a friend of mine (Dr. Adam Levine, Associate Professor of Anesthesiology at Mt. Sinai) who recommended that I see Dr. Harry Spiera, a terrific diagnostician and rheumatologist. Dr. Spiera confirmed the diagnosis of advanced osteoarthritis. He said that surgery was definitely in my future.
At that point Anne Grundstein, my sister-in-law, an occupational therapist, arranged for a heavy duty cane to be delivered for my use. I have been using it daily since I received it.
My condition has continued to deteriorate markedly, and especially within the last 2 months. A couple of months ago I was able to hobble through airports in Newark and Atlanta for a dinner meeting with attorneys celebrating the 10th anniversary of their firm's founding. Last week I needed a wheelchair in Newark and Orange County airports to get to Laguna Beach, California for a CLE program that my Network produced. And while at the hotel I used an electric powered three-wheeled Lynx-3 (which I found a bit too short in length for my 5'-11" frame for me to be comfortable -- my feet hung off the front of the vehicle, but it beat trying to walk around the hotel). The decline in my hip condition has been rapid and irreversible, but for the upcoming hip joint replacement surgery.
Humor Even Under These Conditions: It took 6 weeks just to get an appointment with Dr. Buly. A number of other fine doctors were recommended to me, but Dr. Buly had operated on my neighbor who had a particularly challenging problem -- she needed to replace a hip prosthesis that was installed many years ago. She was referred from one doctor to another, each declining to operate, until she got to Dr. Buly. Her surgery was successful.
The moment Dr. Buly punched my x-rays up on the light board, he remarked, "you must in a lot of pain". Yes, I certainly was.
"Dr. Robert Buly is one of New York magazine's "Best Doctors in New York" (2002-2009) and one of Castle-Connolly's "America's Top Doctors" (2003-2008). He specializes in joint-preserving surgeries for both hip and knee - including arthroscopies and osteotomies to correct anatomical problems like dysplasia and impingement that impair movement, cause pain and ultimately lead to arthritis. Dr. Buly has pioneered novel techniques to treat hip impingement arthroscopically, rather than through conventional open procedures. In complex cases, Dr. Buly works in concert with bio-engineers to design custom implants that solve unique problems. Dr. Buly is invited to lecture around the world to teach other surgeons about his techniques.
"Dr. Buly is on both the Surgical Arthritis Service at HSS as well as the Orthopaedic Trauma Service in combination with New York Hospital."
My surgery will take place Tuesday, November 17, 2009 at the Hospital for Special Surgery ("HSS") in New York City.
HSS has an interesting history having been founded during the American Civil War in 1863 as the Hospital for the Ruptured and Crippled (R&C). It was the first and only orthopaedic hospital of its kind in the U.S.
INTRODUCTION: I thought it would be good to make a diary of my experience having my hip joints replaced. A friend of mine, Steve Meyers, kept notes during the process of his hip joint replacement process and I found those notes to be immensely helpful.
I thought that this blog might be of some help and comfort to others who will experience hip joint problems.
Also, so many of my friends have asked me to keep them posted on my progress that the prospect of periodically writing dozens of emails became daunting. A blog seemed the perfect solution.
So, here it is, to be updated from time to time as I have the opportunity.
[I found this note to my primary doctor and thought it would make for good reading as to my condition months prior to surgery.]
"I stopped treating at Sleepy Hollow Physical Therapy as I did not see any improvement in my hips/back/gluteus area. A friend recommended Spine Options (Dr. Cash) at 244 Westchester Avenue in White Plains. After a short physical examination, I began a series of physical therapy treatments that included deep tissue massage of the gluteus muscles (both sides) which brought some relief but temporary; and electrical stimulation of the lower back and gluteus area while covered by a warm wet blanket.
"After about 4 weeks of treatment, Oxford determined to stop covering those treatments on the ground that my condition is not improving and is considered chronic. Nice after 20 or so years of paying premiums. I’m working on getting that decision reversed.
"Dr. Cash prescribed a hip x-ray (2 views) which was performed at Phelps last Friday. The radiologist’s report: bilateral (both hips) advanced osteoarthritis at the hips. Mild lateral sublaxation of chronic nature at the right hip."
