Research & Decision Making
1. Do all the reading and research you can, comparing physical conditions that warrant THR (total hip replacement) as opposed to hip resurfacing.
2. Make a “Pros and Cons” chart, listing everything you’ve tried to date and the results. Then list other options (surgical or otherwise) and pros and cons of each. Sometimes seeing it in writing makes you see things you missed before.
3. Research as extensively the physicians you’re considering. There’s no shortage of orthopedic surgeons around. There is a shortage of highly qualified ones who have extensive experience at hip resurfacing. Be sure to ask how many resurfacings they have performed.
4. Contact several resurfacing physicians, sending them your records, etc. I place a LOT of stock in relationships. Your surgery will have a much higher chance of success if you can communicate well with the people treating you. I went with Dr. Gross simply because, medical qualifications being comparable, the office staff in Los Angeles was abrupt at best, more likely rude – and this was in the initial phone contact. Lee Webb in Dr. Gross’s office the polar opposite to this. In addition, I know someone locally who had the procedure done by Dr. Gross two years ago, and highly recommends him.
5. Make sure you know exactly what your insurance will cover, and what it will not. Dr. Gross’s office took care of all that for me. If you have to figure out the insurance yourself, keep in mind that insurance reviewers are trained to deny all claims the first time around. Many have been told to do so for the 2nd or 3rd request. Ask to speak to the medical director immediately, and file your appeals repeatedly. Often they relent. They also respond well to cost comparisons – THR vs. hip resurfacing vs. “conservative therapies” (PT and narcotics, in my experience, which do not help but which DO cost more than one surgery!).
6. Make sure you understand each step of the procedure, and your particular situation in relation to it. For example, I have a spinal stimulator implant, which obviously played a role in my decision. Other factors include age, physical shape, and attitude – the latter being probably the strongest. To me, philosophically, it made more sense to preserve as much of my bone as possible, which was why I opted for the resurfacing – despite 3 trusted local physicians recommending a THR for me. You need to rely on your gut feelings as well as the medical advice you receive. You are the only person who can “know” and feel your body from the inside out!
7. Once you make the decision to go ahead, arrange to have someone who will be there with you through the process, from decision making to home health care. YOU WILL NEED SOMEONE TO GO WITH YOU, WHEREVER YOU HAVE IT DONE, AND SOMEONE TO CARE FOR YOU AT HOME FOR A BARE MINIMUM OF 3-4 DAYS, PREFERABLY A WEEK.
8. I didn’t do much research into the different joints used (Birmingham, Biomet, etc.), the cement, etc. Rather, I chose the physician, and then went with his experience and preferences. This worked with everything except the anesthesia.
9. Research the type of anesthesia that will be used in the surgery. I have had numerous surgeries in my life and, until this one, NEVER had adverse reactions. I did not realize that Dr. Gross prefers to use a local epidural cocktail IV sedation so that you’re unconscious but able to breathe and move (sit up) on your own, although you have no memory of it after the surgery. He has found that this enhances the healing rate of the joint. The drugs stay in your system up to 36 hours, and their effects on me were disastrous.
10. Make contacts on the http://surfacehippy.info/hiptalk/. Three of us who were having the surgery within 2 days of each other got together in Columbia, SC. (through the generous support of Pat Dukes!). Just having that human support is helpful.
11. It is quite easy to become overwhelmed by the plethora of information available. Research enough to make an informed decision, and then go with it. Otherwise you’ll drive yourself nuts.
1. Keep a notebook with all of your questions, and the answers as you receive them. There is no question that is too trivial.
2. If you’re going to Columbia for surgery with Dr. Gross, check on hints from other Dr. Gross patients.
3. You don’t buy every contraption you hear about on the surfacehippy site. Many are helpful, but not necessary. You know yourself, and your house. My biggest obstacle is living in a small town home with 15 narrow stairs separating the kitchen and the bedrooms/shower. Nothing short of a remodel can change that. The physical therapist in the hospital worked with me extensively on how to get by at home.
4. I do recommend:
a. Get at least one raised toilet seat. There are several different kinds. There are just the seats which are raised, and may or may not have arm rests.
First, you will need the armrests after surgery. They will need to be high enough for you to reach back to in order to support your ascent and descent.
Second, If you get one of these wider seats, make sure the seat is split. To put it bluntly, wiping yourself on these special seats is tough when you’re feeling fine. After the surgery, forget it.
For other bathrooms in the house I bought 2 stands that just provide arm support. I even used them daily before I left to make sure I could raise and lower my body without ANY muscles from the waist down. If nothing else, it makes for interesting workout equipment. I ordered them from Skymall.com for about $60 each. (They even come with a magazine rack!)
b. Buy compression stockings before you go. Talk to an orthopedic specialist, podiatrist or your primary care physician as to the strength of the compression you should get. Some physicians use them, some don’t. They’re not cheap – around $40 – however, I really wish I had known about them. They would have prevented an ER trip when I returned home.
c. Many surface hippies have needed some kind of recliner for sleeping, some of whom have spent nearly $200 for the LaFuma. I tried that, and found it to be like cheap patio furniture that sagged. While it’s usually nice to come home to your own bed –a recliner (La-Z-Boy, or even chaise lounge) allows you to sleep with minimal pressure on the incision, and prevents you from turning over, with your operated leg going over and above the other (which is not a pleasant situation, to under-state the case). The advantage to the recliner is that it won’t let you turn over. The disadvantage is that you have to sleep sitting up.
d. An elevated Aerobed has been a godsend for me (better than recliner). It minimizes the pressure on painful parts, and allows my husband a modicum of sleep!
e. A heating pad. With all the ice you’ll have, it allows you to break even body temperature wise!
f. If you’re going to Dr. Gross, take an extra duffel bag to hold all the supplies he gives you.
g. While we are all very different, I’ve heard many say they can’t read much after story. I recommend downloading novels from your local public library onto your MP3. They’re great for when you’re awake, can’t take another minute of TV, have watched all your Netflix, you’re sitting in the airport, etc.
h. If you live in a multi-level home, I suggest getting 2 of the tools that are so helpful – grabber, shoe horn, sock tool, etc. Most medical supply places sell them for about $25, and I’ve found the general rule to be that whatever I need is not on the same floor as I am.
5. I highly recommend taking care of a will and a durable medical power of attorney before you leave, and bringing several copies with you. Your surgeon, the pre-op people at the hospital and the nursing staff will need copies of this. I’d bring more just in case.
6. If at all possible, particularly for the return trip, upgrade your airline seats to first class. The leg room is worth it. As an aside, confirm orally & GET AL L E-MAIL CONFIRMATIONS that you are on first class. The United Airlines call centers in Mumbai, or wherever, do not have a vested interest in getting it right for you.
7. Before leaving home for your surgery, arrange in both your kitchen and bathroom the things you are most likely to need/use when you return. It is best to have them at waist level or above. The “grabber” won’t lift jars, etc. If you’re a neat freak, put them in plastic storage drawers. For a while, it takes a LOT of energy to do the most basic things.
8. If you take several medications or have specific allergies, prepare a list of these and bring 10 copies with you. Include the brand name, the generic name, the dosage, the prescribing physician, and how often you take it. Provide the doctor’s office, the hospital, the nursing station, etc., with copies. Get the doctor to write on the orders that you’ll take your own meds. It will save you money and aggravation. As long as the doctor has the list, knows what you’re taking, there’s no reason you shouldn’t be able to take your own medications.
9. Remember the usual stuff, like holding mail, canceling papers, etc.
Make a checklist of everything you take with you. Keep one copy in your luggage, and one with the papers you’ll be carrying with you. This comes in handy because you move from hotel to hospital to hotel, and because airlines don’t often get everything to where it’s supposed to be.
The Big Event
1. Rent a car you’ll be comfortable driving in. We flew into Charlotte, SC, and Columbia is about 90 minutes away. I had a hard time getting up into the seats of SUVs. All that was left was a Mercury Marquis – which looked like a throwback to the 70’s – but wow, was it comfortable!
2. Stay at a Residence Inn if you can. They’re reasonably priced, and have full kitchens. It is very nice to have everything you need at your fingertips. You’re not going to feel like a night on the town after your surgery. Having access to food you like to eat is very important (especially if you’ve traveled to a region with food quite different from what you’re used to). Some say to request a handicap room. I found that to be difficult, because everything was lowered, which is exactly what I DIDN’T need.
3. You’re going to be in no shape to deal with difficult situations, including the possibility of a minimally competent nursing staff, for the first 2 days after your surgery. You will need an advocate for you at the hospital, who will either stay with you, or will be very close by and be available 24/7.
4. FYI, if in the hospital you are receiving substandard nursing care, call “0” and ask for the nursing supervisor. I didn’t even know for 2 days that I had a telephone in the room, because of the layout, let alone that there’s someone whose job it is to listen to patients and meet our needs.
5. Some people have found it easier to sleep in the recliner in the room because you can get up and down on your own – you don’t have to ring for the nurse every time you have to go to the bathroom.
6. Keep a running list of the questions you want to ask the doctor when he comes to see you next.
Coming Home and surviving at Home
1. Do this yourself before you leave or, ideally, a friend can do it when you’re gone: stock the fridge with the basics for 2-3 days: milk, juice, eggs, bread, etc. It really helps!
2. When they tell you to use crutches for 10 days, then switch to the cane – listen to them. I learned the hard way.
3. Walking with one crutch isn’t much different than walking with a cane. When you need the crutches, walk with both of them. If you can’t manage with crutches get a walker.
4. You may feel like you can run a marathon a day or two after surgery, but count on crashing soon. Your body needs the time to heal – let it.
5. I read recommendations on the surface hippy lists that skirts sans underwear worked best for women flying home. That wasn’t the case for me. I kept tripping over the skirt if stairs were involved . I had very little pain from the incision, so loose sweats did the trick.
6. Airport security on return trip told me I had to walk through without my crutches. Right. Do not let anyone tell you that you have to walk through without your crutches, period. Go for the alternative, a body search.
7. Use a wheelchair in the airport or hitch a ride on an electric cart as much as possible. It minimizes the swelling (the flight will provide enough of that!).
8. Once at home (as well as in the hotel, post surgery), when things start to hurt – WALK. This is at least as helpful as some of the pain meds.
9. Once home, take it easy at first with the walking. A hotel hallway just isn’t the same as a city block!
10. Some swelling is natural in your hip, leg, foot and ankle. After an ER visit that verified there was no blood clot or stress fracture, I was told to expect this kind of swelling up until 6 weeks after surgery!
11. Set up a place where you can spend a good portion of the day, taking great pains to clear the area of as many wires and cords as possible. Put your crutches somewhere where:
a. you can reach them to help you get up
b. you don’t have to violate the 90 ° rule to pick them up
c. you won’t trip over them when (not if) they fall over. I tripped & fell 12 days after surgery over the crutch. There is no description for that kind of anger and fear!
12. Don’t wait until your pain is unbearable. It is easier to control pain than to wait until the situation becomes acute.
13. If you bring a computer with you, don’t work with it sitting on your operated leg.