Prepare for India: Surgery April 13, 2006
I got my date with Dr. Bose - April 13, 2006. The Thursday before Easter. I need to get tickets, shots (what kind?), visa (how?), reservations at a resort to recover. Vicky Marlow was great in helping me stay on track: Let Shoba Bhasker help with the resort. And the details in India. I only had to book tickets, get my visa, get some shots.
Tickets. I got round-trip tickets through Orbitz for about $1600US including taxes from Denver to Chennai on British Air. On the way back I only have one stop in London. It'll be a long trip, but worth it.
Visa. Took a little digging, but found out my Indian Consulate is in San Francisco. Web address: http://www.cgisf.org/
I completed this form: http://www.cgisf.org/visa/visaform.pdf , sent it in a certified mail envelope along with a self-addressed stamped express mail envelope (as instructed), included a check for $60 US, and the letter sent by Dr. Bose, and my passport. I had my visa back within a week. Very painless.
Shots. I checked with the CDC. Got a little advice from Vicky and others. I decided to get a Hepatitis A and B, typhoid, flu, and malaria. The Typhoid actually came as a series of 4 pills, malaria I'll get tomorrow from my family doctor. Hep A&B came as one shot, I go also tomorrow to get my 2nd set of shots, one month after my first. (You need to get on the shot program at least a month before you leave!)
Resort to recover: I first booked for Fisherman's Cove, but last week changed to Ideal Beach Resort at the recommendation of Mari Stanley. Her and her husband Mace highly recommended it, and at a price that's 1/2 of what the Fisherman's Cove price, I said yes. And heck, I've never stayed in a 5 star resort in my life, why should I start now? Ideal Resort:
http://www.idealresort.com/ibresort.htm
Decisions: Who, When, What?
What doctor should I choose? When should I get my resurface, this year? What device? To answer these questions, I posted many questions to the newsgroup, surfacehippy. The address is http://health.groups.yahoo.com/group/surfacehippy/
I decided to go with Dr. Bose for several reasons. He has a wonderful reputation, and a minimally invasive approach that should afford me a quick recovery. He has no restrictions on activity after healing. And the price was right - $6500US for all hospital and doctor services. I only had to get over there (to India) and pay for my recovery at a resort after being discharged from the hospital. I am hoping the Birmingham hip is right for me, as the long track record sounds good. But if the ASR affords a better fit, then so be it. I'll let Dr. Bose decide.
As for timing? I have a large commitment in the fall (promoting a large cyclocross race) so it's either now, or after. I chose now. Time to prepare.
What the Experts Said
I sent my x-rays off to the experts (all for free):
Dr. De Smet:
"Looking to your x-rays, age, bone quality, shape of your bones, you are a very good candidate for resurfacing. There is not one reason why I could find a negative reason not to do it."
Dr. Bose:
"I have assessed your x-rays in detail . Your left hip shows advanced arthritis but very good bone stock. i am happy to inform you that you would be an excellent candidate
for hip resurfacing surgery."
Dr. Bala (Dr. Balasubramanian):
Thanks for your mail and the x rays. Your x ray shows adequate good quality bone on the left hip which means you are a perfect candidate for Hip Resurfacing,
Dr. Prakash:
Suitability : The short answer is Yes, you seem to be a good candidate
for hip resurfacing purely based on your x-rays and pending formal
consultation.
Dr. Pispati:
I have seen your x rays...you are very suitable for resurfacing.
Let's See Where We Are
So, now I've learned a lot. I've scoured the Internet for as much info as I could. I saw so much I couldn't remember where I saw it all. But first I had to find out where I was: I needed x-rays. So I started checking around and was ready to just go to any old ortho and instruct them to "just take the x-rays and shut up" but luckily found out about an orthopedic surgeon in the area that was educated on resurfacing, and had done several semi-resurfacings: Dr. Cynthia Kelly. I got an appointment with her and this is what we saw (see x-ray).
"You definitely have arthritis in your left hip. Actually even without your accident, you probably would have been in here eventually. You have a shallow hip socket on your left side. Your right side is perfectly healthy. Even though I can't do it, you are a perfect candidate for hip resurfacing." Ha! My right side is good! But as you can see, my left hip margin is very narrowed at the top (black arrow).
"Here is the name of a surgeon that has dedicated his career to hip resurfacing. His name is Dr. Amstutz. Talk with him if you need it soon."
OK, so now I have my x-rays, I can start getting some opinions. I knew I could send my x-rays to Dr. Bose and Dr. De Smet and get free evaluations. And there were all the US doctors, but also the insurance problems to deal with...
"I recommend starting your investigation by joining the Yahoo Surface Hippy chat room"
That was the first sentence in the email from Louis Welt. I received this email January 13, 2006. It was a Friday afternoon (Friday the 13th, the luckiest day of my life!).
He proceeded to tell me about the two best docs in the world, Dr. De Smet and Dr. Bose. "Read the newsgroup and in a week you will be an expert. And don't let anyone talk you into a total hip replacement!"
And in one week I was indeed an expert. There were certainly folks that new more, but I was an expert compared to the Drs. Doom-and-Gloom I'd met! What a bunch of idiots!
But mostly I had hope. I could look forward to the possibility of an active life in the future. I still had a lot to learn, but I saw pictures of people that were skiing after hip resurfacing. I saw pictures of people that were doing ironman-length triathlons after resurfacing. I saw hope!
2001-2005: Knowing, and living a restricted life
So I have arthritis. So do a lot of other people. I won a national championship on the mountain bike, so that part of my life is complete. I can still ride, so that is OK. Doesn't hurt much anyway. In 2001 I am part of a 4-man 35+ team, we earn another national title. Cool. Then my son, Brady, comes of age on the bike (he's 14 now). We do Ride-The-Rockies together, have a blast (2002). In 2003 he's asked to join a new developmental team started by Tour deFrance rider Jonathan Vaughters. Brady's excited, and so am I. I decide to race in 2003 with him, because by now we're pretty well matched. We race on the road together, trading beating each other and wins in the local cat 3 races, and on the mtb. I race the national championships at Durango and win my 3rd national championships. All is well. We start the 2004 season together but I break my collarbone in a crit on Memorial Day weekend. The season is pretty much over for me, but that's OK.
My hip becomes more-and-more problematic, but glucosamine and condroitin help a lot. And I'm doing less. But now I'm having pain in the other leg, compensating I guess...
January 3, 2006. After 2 days of painful skiing, I can barely hobble around the office. An officemate says, "You should talk to my friend Lou, he just went to Belgium for something with his hip. Not sure if it's the same, but you should talk with him."
Do I owe that friend (my officemate, Dave) A LOT...
Dr. Doom-and-gloom #3
OK, on the recommendation of a different friend, I see a different orthopedic surgeon. Pretty much the same story, but with a slightly more upbeat twist: "I don't have a problem with you riding your bike, but you should avoid running."
I can deal with that. No running - not a problem. I like it but can live with out it. No skiing bumps. Well, maybe I can every once and a while...
No riding my bike. Unacceptable. But this guy says it's OK, so I can live my life. OK, let's get on with it.
January 2001: Dr. Doom-and-gloom #2
So, after listening to Dr. Upbeat (not) #1, I take the advice of a research Dr. friend of mine and visit another ortho. He's older, and low-and-behold, his prognosis is even worse.
"You have arthritis. The best thing you could do for the rest of your life is sleep." (HE ACTUALLY SAID THAT!!!) "There is no new technology in hip replacement, we are doing the same thing we did in the '60s, and that won't change in our lifetimes. And by the way, I don't like what I see in your x-rays. I'm ordering a MRI as I think you might have avascular necrosis. If so, we'll need to do a hip replacement right away." HOLY CRAP!
So I get the MRI, and the diagnosis is not AVN, whew! But he continues "you should not ride your bike. You should not run. Anything you do will wear out your hip. Think of it as having 100 pennies in a jar - use them wisely as they will run out. Then you will need a new hip."
OK - same old story, let's try one more ortho...
November 2000: You have arthritis
Fast Forward 5 years later. While I knew I could develop arthritis, I certainly didn't spend much time thinking about it. I started trail running in earnest in 1997 and would frequently do 50 miles of running in a week along with 200 miles of riding. Lots of fun. Went skiing this weekend, man am I stiff on Monday. Getting up from the computer meant some slow steps down the hall.
I decide to go to my family doctor and get a check up, and mention the symptoms. Knowing my history, he recommends x-rays and a visit with a orthopedic surgeon. So I do the x-rays and meet with Dr. Doom-and-gloom #1.
"You have arthritis in your left hip. You will need a total hip replacement at some point, but you should put every effort into putting this off as long as possible. At the activity level of a 65 year old it may last 15 years. The second will only last half that. The third half of the second." Hmmm, well, I'm pretty good at math: 40 (yrs now) + 15 + 7.5 + 3.75 = 66.25. CRAP! That means I won't be able to walk when I retire! So he continues "Get a cane. Stop running, unless of course you're about to be hit by a bus. Don't ski, but if you do don't ski bumps. Don't gain weight."
Thank you sir may I have another. Another opinion, that is, off to see Dr. Doom-and-gloom #2...
July 23, 1995: The Wreck
Mountain bike racing has more-or-less consumed all my spare time for about 6 years now. I just (One month ago) won my first national series race (Norba national CC 35+ at Vail, CO). I'm leading the Colorado Off-Road Points Series (CORPS), 35+. Today is Sunday. Today's race is the long leg of a 2-day weekend, I won the dirt crit. yesterday in a sprint. The start is fast, maybe a bit too fast. We climb for about 1 minute before a 20-30 minute downhill into our first of two big loops. I get the hole shot over the top and put on the gas. We negotiate a few sliding hairpins and then head into a semi-steep straight-away with some large rollers. Hit the first roller at high speed and when I'm in the air, my pedal unclips. Stupid *@$#@ pedals, too much mud early in the season wore them down. Land it OK, but then hit another. This time I'm going faster, and leave the ground with only one foot on the pedals, seated on the saddle... I start a slow airborne flip, land on my upper-back at speed and start rolling.
I come to a stop in a seated position. Check for feeling in the legs. Check. Look for road rash. Yea, some but not too much. Damn my hip hurts, as does my back. I stand up. Everything OK. But not good enough to continue. I straddle the bike and limp back to first aid. They patch me up and we pack up for home. We have a 4 hour drive ahead of us.
I just couldn't get comfortable the entire trip home. We go to the ER at a walk-in clinic at home and get the word "I don't know much about hips, but I do know they're supposed to be in one piece. We're calling an ambulance to take you to the hospital." Of course I respond, "Oh no you're not, we just drove 4 hrs, we can drive ourselves to the hospital." I broke out in tears for a minute or so because the qualification race for the World Championships was only 2 weeks away. I wouldn't make it.
We were met at the Hospital by a wheelchair and I was admitted overnight. While my hip wasn't bad enough to require surgery, I was told I'd be on crutches for 6 weeks, from there we'd see how it went. "You may develop arthritis in the hip, time will tell." Well, this is how it went: I accidentally put full weight on my leg about a week later and it didn't hurt.
I was back racing in 3 weeks. Just missed winning the CO title by 1 spot, but did win the last big race of the year.
A Little History
Let me start with a little history to give context to my story. I am a Colorado native, born in Denver in March of 1960. I began racing bicycles (road at the time) in high school at the age of 17. I left college for a year and a half to race and then returned to college at the Colorado School of Mines and graduated with a BS degree in Geophysical Engineering in 1985. In 1984 I married my lovely wife Karen and we have two wonderful children, Brady, a national level cyclist and CSM freshman, and Katy, a wonderfully strong girl and pretty darn good tennis player following in her mom's footsteps.
I began racing mountain bikes (cross-country) in 1989 after my son got out of diapers. I did very well, and have been a national cross-country champion in 2000, 2001, and 2003 for my age group. I also was the CO state champion I think 7 times during the last 15 years. It was the pursuit of these titles that led to an unfortunate incident in 1995...
My Journey through Hip Resurfacing
I am sharing my journey through reconstructive hip surgery so others who follow know what it involves. Please follow me if you're interested...
