9/29 two days post op

I've been discharged from the hospital and am resting comfortably in my hotel room. I was able to complete the next two physical therapy sessions with no problem -- first one was simply walking part way down the hallway and back, but this morning I was able to go up and down a staircase, walk down the hallway and back on a single crutch. Its exciting to be up on my feet and moving around. There really isn't that much pain as long as you don't twist your leg the wrong way by accident. The basic rules are: "don't cross your legs, don't turn your toe inward, and don't raise your knee past 90 degrees" - got to maintain these rules for 6 weeks.

Sleeping on night #2 was a little more difficult. I think I was less exhausted than the day before after being mostly sedentary all day. I was also less comfortable as the heavy duty pain killers began to wear off. In the end I needed a sedative in order to finally fall asleep around 1am. I was woken up a few times during the night for basic tests of heart rate and temperature, as well as a blood draw for my final lab work. I woke up when breakfast arrived about 8:30am.

I was discharged after successful physical therapy. Dr. Gross' assistant Lee Webb met with me and told me that the surgery had gone "perfectly" and that she was really optimistic for my recovery.

Going forward I will need to take Vicadin and Celebrex (anti-inflamatory) for the next 10 days, as well as administering a shot to myself of Arixta (to prevent blood clotting).

Ready to go!	Hanging out at the hotel	Exercise in the hall	Dad is a lifesaver

9/28 the morning after

I actually slept pretty well last night. Sleeping through most of the night without interruptions. Apparently I was still pretty dopey on the painkillers yesterday because I called a couple of my friends more than once to tell them I was OK. I also don't remember the visit I had from Dr. Gross. He checked on me again in the AM. He said everything went well and that I was his fastest operation of the day because I didn't have much fat on the hip to get past.

Got the catheter and oxygen tubes removed and am feeling pretty good. They still have me on IV and I have a large ice pack on my hip. Hospital breakfast consisted of pancakes, sausage and gritz. Edible, bit not exactly good.

Things got a little dicier when the physical therapist showed up. I was able to all the exercise in bed just fine, but when I stood up to walk, I immediately felt queasy and light-headed. I had to lay down for a few minutes. Its likely that the heavy doses of medication coupled with that sausage for breakfast weren't agreeing with me. After resting I was able to get out of bed and sit in a chair. We're going to try walking again this afternoon.

Recovering in the hospital	The site.	The scar.

9/27 Surgery is complete

I'm in bed now, and feel just fine. I slept through the whole procedure and am feeling remarkably good. This will probably change once the pain killers and morphine wear off.

I arrived at the hospital at 9:30 - they took me to the staging area where I undressed, got in bed and had the usual tests done. The humorous part was when the nurse had me write 'YES' on my left hip with a sharpie. I guess you can't be too cautious.

The less funny part was that the nurse had a hell of a time drawing blood. It took 6 needles in order to get two samples. Not sure if the nurse was having trouble with it that day or perhaps I just have difficult veins to tap. The second draw, of 52cc of blood was taken and prepared with some other stuff to apply to the wound after surgery, apparently this speed recover.

After the procedure, I woke up in a hospital bed. My dad was there to talk to, which was nice. The accommodations are pretty good... actually have a window to look out of. The nurses have been very nice (not naughty!) and so far the recovery has been pretty easy... just sitting and watching TV

Tomorrow I've got physical therapy ... I assume it will be a harder day, I'm intrigued to see if I notice a difference with 2 pounds of steel in my hip.

IV and drugs administered...	Feeling sleepy...	Yes. This is the hip.

9/27 Headed to the hospital

Surgery day is here. I slept normally. Made a point of sleeping on my left side for at least part of the night since I won't have that opportunity again for awhile.

I'm pretty calm at this point. All I can do is trust that things will work out. The leap of faith has already been made. Nice to have my dad here.

I'm thirsty. No liquids after 6pm and my dad's half empty soda cup is looking mighty inviting.

I'll head to the hospital at 9:30. They'll prep me and I go under the knife at 11:30. Apparently the procedure only takes an hour. I'm having a spinal and sedation as opposed to general anesthesia. Having had trouble recovering from general in the past, I'm happy to be trying something different. Apparently I will actually be alert enough to do physical therapy in the afternoon.

I won't have access to the internet for a few days. Hopefully my dad can post here to let folks know everything worked out alright.

My last left-footed kick	My last left-footed leg cross

9/26 The day before surgery

A quiet day before surgery. First order of business is a stop into the hospital at Providence Northeast for blood work. My father arrives tonight and will be with me the rest of the way, but right now the experience is a little lonely. Its hitting me that I'm about to undergo a pretty major ordeal, and even with the support of family and friends, its something you go through alone. The questions come up as expected, "Do I really need this now?", "What if something goes wrong?", "Is the pain really that bad?", "Will I be able to move like I did before?" I try to savor each step, and in quiet moments - in private - I kick and pivot my hip to see if it really still hurts. The verdict? Kind of.

After leaving the hospital, I fill my prescription. Unfortunately I'll need to take an injection for the first 10 days after surgery to make sure that my blood doesn't clot. This is one of many uncomfortable aspects of recovery I'm not looking forward to. My dad can help the first few days but I'll have to give the injection to myself when I get home. Blue Cross initially rejects the prescription as not covered ($400+), but the pharmacist at Long's drugs makes the case for me and they do ultimately grant an exception, cutting the cost down by 2/3. I also have to pick up dressing changes for the wound. I find out later I'll be heading back to the pharmacy for Vicodiin and Celebrex, as well as a raised toilet seat.

At noon I head over to Dr. Gross's office in West Columbia. The receptionist seems a bit harried. There are many patients in the waiting room. I pass the time talking with another patient who is back for his 6 weeks post-op appointment. He tells me that the experience is likely to be really unpleasant for 10-14 days. I can expect to have to get up to go to the bathroom frequently during the night. My leg will swell up like a pumpkin. He says he hopes to be skiing again, but that the target for returning to full activity is 6 months. I'm disappointed because I'd convinced myself it was about half that. He also mentions that there is a clicking noise that he can hear when he moves his joint, but that it doesn't restrict movement.

After about 35 minutes, I'm taken back inside and I have x-rays taken of both hips. I spend about 15 minutes waiting in a room and then am joined by Lee Webb, Dr. Gross' assistant. She's friendly and helps fill out my remaining paperwork. Towards the end of her time with me, she brings in the Biomet device that I'll be getting implanted. It is a combination of cobalt and titanium -- the part spins very smoothly in the socket, but the thing that strikes me is the weight of it... it feels like it may way about 2 pounds. It wonder if this is going to slow me down when I'm recovered. I'm pretty sure that wearing 2 pound ankle weights wouldn't speed me up! I'm glad the metal is solid and not going anywhere, but it makes my heart sink a little to think about the extra weight. She tells me the clicking noise is common and goes away after 3 months or so when the ligaments have strengthened -- apparently its the sound of the parts knocking into each other. Sinovial fluid (body juice!) should fill in the gap to reduce the friction.

After 30 minutes or so (be sure to bring a magazine you like), Dr. Gross joins me in the room. He's taller and has more of a presence than I expected after talking to him on the phone. He has an intense gaze. He seems bright and earnest. Our conversation is pretty brief. He confirms that 6 months is the time required for full recovery. He thinks I'll be able to play soccer and snowboard again after that time, but he mentions that only time will tell whether these activities are a good idea -- the industry's experience with the device isn't extensive enough for any long term data to be available. He doesn't want me riding a bike outside for that time either, which means it looks like I'll be taking Muni to work for a while. In the end I don't really have a lot of questions for him. My perspective, right or wrong, is that he knows what he's doing and there's nothing I'm going to ask him that is likely to change what goes down. I've made my decision and am sticking with it, despite my last minute jitters.

I spend the afternoon driving around Columbia looking for a good restaurant for my 'last meal' without much success... I get a snack at Sonic and a forgettable dinner at Ruby Tuesday. I'm sure there are better options for the informed, but I do find myself missing San Francisco cuisine. I stick pretty closely to the 6pm cutoff - not eating or drinking after that time. I head to the airport at 10pm to pickup my dad.

Surgery tomorrow is at 11:30am

Capital building in Columbia	Providence Northeast

9/25 Traveling to South Carolina

Today has been one of those travel days that everyone dreads. Arriving at the airport at SFO and confronted with a giant line for check-in and security. After standing in a slow-moving line for 20 minutes I decide to risk it with my roll-on bag, shoulder back and crutches and print out my e-ticket. I’m thankful that they let me carry all three items on because I would have missed my flight to Chicago if I’d waited to check my bag.

At O’Hare I discover that my connecting flight to Columbia has been delayed two hours due to mechanical difficulties. Then it is cancelled. After haggling with a United service rep, my only option appears to be a flight through Dulles and a connection that will get me in at 11:15. So much for a good night’s rest before my pre-op. This story is nothing new for frequent travelers – but I can’t help but think while I’m sitting in the airport how much more convenient it would have been if I could have been operated on in my own area. I trust that going with a surgeon who has done this procedure hundreds of time will be worth it, but I'd be lying if I didn't spend a little time rethinking the decision. At least I didn't have the operation in India as I'd considered!

I also find myself wondering how unpleasant the trip back is bound to be. I notice the steps I’ll have to navigate on crutches on my way back if there is a terminal change required at O’Hare. I think about the long hours sitting in pain. It will not be a fun trip.

I finally reach my hotel at midnight local time, 14 hours after I set off. Hopefully it will go more smoothly on the return.

September 2006: a brief history of my osteo-arthritis

I found out 4 months ago that I have osteo-arthritis in my left hip. As a thirty-seven year old recreational athlete, this came as a big shock. I’d been having hip and groin pain for 4 or 5 months but I had chalked it up to my usual pattern of playing through the pain and rushing back from injuries too soon. Sure, I was on the older side for my peer group – recreational soccer players playing 3-5 times a week – most of whom were in their mid twenties and early thirties – but arthritis was for old people. How could it happen to me? What could I do?

I’m a couple of days from surgery – a newer procedure called hip resurfacing – and I’m both excited and terrified. I thought it might help me to write about my experience before and after the procedure. Perhaps it will be useful to others, either to keep up with my progress or to help them make decisions about their own condition.

First symptoms
I noticed the pain for the first time in February of this year. I was playing in an all-day soccer tournament. We did well enough in our first three games to qualify for the playoffs. This meant a fourth (and possibly a fifth) game of the day. It was midway through the third game when I began to feel a tightness in my thighs, which developed over the course of the game into a pain that made it difficult to lift my legs to run. I finished out the day but assumed I’d finally overdone it, having played a few times earlier in the week and perhaps not hydrating properly for the games. A few days later, I was back on the field and found that the pain had moved up my leg and was causing me discomfort in my groin, particularly on the left side. I decided to take it easy for a few days.

What followed over the next few weeks was a pattern of playing, taking a game off here and there, giving myself 3-4 days to feel better, followed by a return to the field and subsequent return of the pain. Sometimes I could play the game without intense pain, but I found my ability to accelerate was limited. Always, however, the next few days after playing would involve me limping around the office. I would find myself sleeping on my right side to avoid the discomfort that was growing in my left hip. Taking a week off here or there didn’t seem to help either, the pain always returned, so finally I went in to see the doctor.

Early diagnosis and Treatment
My doctor did some flexibility and strength tests and felt it was unlikely I had a fracture… nor did the symptoms suggest a standard groin injury as the pain in the hip and lower back suggested the inflammation stemmed from my hip. The only likely explanation at this point was that I had bursitis, inflammation due to overuse. This seemed plausible. He prescribed me 6 weeks of physical therapy and also suggested an osteopathic surgeon if that didn’t work out.

Long story short, after weeks of physical therapy, it became clear that something still wasn’t right. The therapy seemed to help with flexibility and pain reduction, but after returning to the soccer field, it took about 20 minutes to find myself right back where I was before. I couldn’t sprint. I couldn’t kick. I couldn’t make sharp cuts. I was a shadow of the player I was before. It was frustrating and took the fun out of the game for me. I began to feel old. Yet, I didn’t want to believe it was over. Sports (soccer, basketball, football, snowboarding, tennis…) are such a big part of my life – I cherish the moments of glory, the pressure, the structure of it, the social aspects of being out there working towards a common goal with people I know. The sheer joy of accelerating, flying down a field or having your body do something amazing without your even planning it – these are things I miss.

"You have arthritis"
The surgeon I saw was puzzled by my symptoms – thinking that there might be a fracture of some sort, she had my hip x-rayed. The results came back and were definitive. “Well, we don’t usually see this in someone your age. You have arthritis.” The cartiledge was wearing out on my right hip, but was mostly gone on the left hip. A small cyst had developed on the head of my left femur. “Basically,” she said, “you will need to get a hip replacement. My advice to you is to make this hip last as long as you can because at your age you’ll likely need to have the replacement replaced and that can be more tricky. You can continue to exercise if you want to, but the pain will become prohibitive over time. So you should start thinking about changing your lifestyle – things like swimming and bicycling are better options for you.”

I was devastated. For some, this may have seemed like sensible advice given the circumstances, but these activities seemed like small solace to me, someone who is passionate about the sports I’ve spent my life playing. These other activities are solitary and seem to me very monotonous when compared with the challenges of team sports. Some of my favorite things to do were being taken away from me. More than that, though, was the prospect for a lifetime of pain. It appeared that I would have to hold off on surgery as long as I could, until the pain was crippling and impacting my everyday activities such as walking, standing or sitting. Dosing on Ibuprofen and Glucosomine, trying to stave off the inevitable deterioration.

How could it happen?
The question had to be asked. How could I have arthritis at 37? Heredity was the most likely culprit, but my family has no history of arthritis. Subsequent tests showed no signs of it in my other joints. It appeared to isolated to my hip. Searching the internet, the only explanation I could find was overuse. Something in the way my system is structured has led to the wearing away of the cartilege. Its likely I’ve done more running that any of my recent relatives, so perhaps if they had been as active, this might have happened to them as well. I discovered an article online that described a 10X higher likelihood of arthritis in the hips in professional soccer players – with many of these players requiring hip replacements in their late 30’s and 40’s. While my level of use was certainly not as high as a professional athlete, it suggested that this particular activity might be a big contributing factor. This was different than what affected Floyd Landis or Bo Jackson.

What to do about it
Fortunately for me, I stumbled upon a newer procedure called hip resurfacing. I discovered it while researching treatment options for my condition. One of the first sources I found was a site called 'surface hippy', which was a terrific resource for understanding this procedure. The difference between this procedure and a traditional hip replacement is that it preserves most of the femur and the femur head. The benefits of this appear to be significant. First, by preserving the femur bone the total hip replacement remains an option for later. Secondly, the procedure has much lower rates of dislocation than a replacement which means it is possible to participate in more high impact sports. This procedure is not recommended for people who are older, less active or have significant deterioration to the femoral head. Watching this video of Dr. Mont, gave me hope again (after skipping past the long intro).

Research & Picking a Surgeon
I spend a fair of time reading articles and testimonials from people who had had the procedure done. The surface hippy group on yahoo groups was especially valuable for getting my questions answered. Some people there are really generous about answering questions, in particular I appreciated the help I got from Vicky Marlow. I had a chance to meet her and another 'hippy' for lunch and discuss their experiences. They were very encouraging, having had great success with getting the surgery done in India. After getting excited about the procedure, my biggest worry was whether my femoral head would be in good enough shape to do it. Vicky encouraged me to send my x-rays to Dr. Bose (India) or Dr. DeSmet (Belgium) -- both surgeons were very gracious to review these over email and get back to me... the news was good. I was an ideal candidate.

My plan was to see if my insurance would cover the procedure here in the states, and if not, to go overseas. Unfortunately, this procedure is so new, there were no surgeons in the bay area who had much experience doing it. I wanted to get it done by someone who really knew what they were doing. Vicky had prepared an invaluable review of the differences between the surgeons who had done this operation the most. I ended up selecting Dr. Gross in South Carolina. His office handles the insurance paperwork. His incision length is one of the shortest available, meaning a speedier recovery time. All of the patient testimonials I read were positive for Dr. Gross as well. Once the insurance approval came through, I'd found my surgeon.