Caroline RC2K 7/17/06, LC2K 9/2/07 Dr. Frank Smith
2005
At age 42 I have severe osteoarthritis in both hips, with cysts and osteophytes (bone spurs). I've become increasingly disabled, and less flexible with almost zero range of motion, and have had ever-increasing pain since I was 20 years old. Symptoms appeared during my first pregnancy at age 20, although I never thought it was anything to be concerned about and would not find out for another 14 years that the pain and disability were due to severe degenerative changes from osteoarthritis. I just found out now, at my consultation with the surgeon I chose, that my OA was caused by congenital hip dysplasia.
I was told a few years ago (at age 34) that I would need both hips replaced. Luckily, around 2003, my husband brought home an in-hospital newspaper with an article about a relatively new procedure called hip resurfacing, which is much more suitable for younger (eg: under 65), active people. I read everything I could get my hands on and researched both the procedure and the surgeon I eventually chose, for over 2 years.
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Resurfacing is a major surgery, but judging by the wonderful accounts I've heard from other hippies, life on the other side is so much easier, and so much more fun.
That thought is what is keeping me going, knowing that I won't have to live like this anymore and that I will "have a life" again.
And for me, having been like this for so long (23 years by the time I had my first surgery) that I can no longer remember anything else, I think I will be really pleased. I know I should be feeling nervous, but I am trying not to let myself be uneasy. Why be nervous; I have no choice, I *have* to have surgery, if not now, then later (and later may mean a THR, since the degeneration would be so advanced) so it is a necessary evil.
But I tell myself that I was terrified of a root canal I once needed, and it turned out to be nothing...and I have given birth 6 times (twice to HUGE babies lol) so hey, I can do this, right? And it helps to have met (and thoroughly researched) the surgeon; he is extremely well thought of in the southern Ontario medical community and also by his patients, he is very nice and kind and after all my research on him, I feel great confidence in his skills. That all helps, I think.
Early 2006, consultation
I finally had my appointment with Dr. Frank Smith in Hamilton, Ontario, on January 18th, 2006, and I thought I would tell you all how it went, in case anyone else is considering him as one of the Ontario doctors who does resurfacing.
I have to say, first off, that I was really impressed by him. He is very courteous and professional-and very kind; I had three pages of questions and he answered them all, without losing his patience, looking at his watch or blowing me off, bless his heart lol-and judging by the answers he gave me, obviously knows what he is doing.
He is also 110% pro-resurfacing and commmented twice during our visit that so many doctors just dismiss resurfacing right out of hand without knowing anything about it, simply because it is new to them, and how unfortunate that is. He really wishes that more surgeons would get on the resurfacing bandwagon.
As I have said before, my rheumatologist made the referral for me in September 2005, I heard from Dr. Smith's office in October 2005, and had my appointment for January 2006. So the wait time for an appointment is not long at all. When I got there, I only had to wait about 5 minutes before being called in. (Promptness is nice, lol!) Wait time for surgery is, in the doctor's words, about 3-4 months if you don't have alot to do to get ready, and about one year if you need longer to get ready. His nurse phoned me later that evening (day of the consultation) and offered me a surgery date for this Feb. 17th! Unfortunately I could not take it because I have to wait until the end of June when my kids are out of school, so as yet I do not have a date.
I asked which approach he uses and was told it is the lateral approach, although if the patient prefers, he will use posterior. Recovery for both is the same and the dislocation rate is almost non-existent.
The device used is the Corin Cormet cementless, which he feels is superior because it is stronger. Both the device and the surgery are covered by OHIP. Homecare is needed after the surgery and is arranged-if I understood this correctly-by the doctor's office and covered by OHIP. I think, too, but am not positive, that they also make arrangements for all the post-op paraphernalia that is needed, such as reacher, raised toilet seat, and so on. One of the home health care companies brings all the stuff to your home, sets it up, and removes it when you no longer need it.
Dr. Smith has done between 500-600 of the older (metal and plastic?) procedures, and 120+ resurfacings. So far, none have had to have been revised to THR, no infections, no mortalities, and almost negligible risk of AVN. Average age of patient is in the 40's, although he has done everyone from a 13 year old to a 69 year old. When I asked him what the downside to resurfacing-if any-was, he replied, "None, as long as the bone is good enough". Dr. Smith also commented that he feels that there is no reason why a resurfacing shouldn't last 30-40 years, if not the rest of my life (I'm 42 now) and that in the worst case scenario, a person should be able to get at least 8 years or so out of it which is better than most THR's. I asked what he would do if he got in there and discovered it was much more complicated than he had anticipated and he said that in that case he would give me a large head MoM THR. But he seemed to feel that my situation was not overly complicated. (OA due to congenital hip dysplasia, with osteophytes and cysts).
Choice of anesthetic is up to the patient although most people choose spinal (they don't use epidural due to the increased risk of lumbar clots [?]) and take in a CD player (his suggestion) so they don't have to listen to all the...noise lol. Hospital stay is usually 3-4 days, patient is up the day after surgery with a walker, then on crutches for 3-4 weeks although many are using only a cane after about 2 weeks.
For post-op pain management they use oxycontin, I think he said, and he prefers to avoid opiates as much as possible.
Unfortunately Dr. Smith does not do bilateral surgery; I need both mine done and had hoped to have them done at the same time, but he does them usually about 6 months apart. He told me the reason why he doesn't do bilats and I guess I must not have been paying complete attention, because all I got from it was something about there being about a 20% risk of fracture because of how hard they have to pound something, and that is why they don't do bilats. Sorry if that is as clear as mud lol.
For anyone who is diabetic (as I am), you might be interested in knowing that when I asked whether that would affect the surgery or its outcome, that did not seem to be an issue at all. He certainly did not seem to think that I would not be a candidate for the surgery because of it.
I felt very pleased with him, with all his answers, with his "bedside manner", and most importantly, I felt great confidence in his skill as a surgeon. I had heard from many people (both laymen and those in the medical field) that he was a highly respected, experienced, and skilled surgeon and this visit only confirmed that for me.
Hope this helps,
Caroline
First surgery:
Sun Jul 16, 2006 8:07 pm (PST)
Hi all,
Tomorrow I go in for my surgery with Dr. Frank Smith in Hamilton,
Ontario. I didn't think the day would ever get here but once I got a
date, it just rushed up on me super- fast.
I have found myself increasingly nervous and depressed as the time got
closer. I keep trying to tell myself of all the benefits I will have
from surgery, but it just isn't working lol. The bottom line is, I'm
scared silly! I didn't think I would be, but I am.
Please, everyone, think of me tomorrow if you remember, and for those
of you who are "spiritual", please say a prayer or two...it would mean
so much to me. I wish y'all could come in the OR with me and hold my
hand;-)
Thanks to everyone for being here for me and for all of us. What a
great group of people and wonderful support system for anyone who is
considering resurfacing.
Caroline
On the verge of being hip...LOL
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Sun Jul 23, 2006
Hi all,
Came home today and am happy to be here. Surgery was successful thank God but never in my wildest dreams
did I ever think recovery would be so difficult and painful. What an
ordeal.
Am having serious doubts about whether to get the other one done.
But that is a thought for another day. My bed beckons me now...
Talk more later.
Thanks for being here.
Caroline
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July 30, 2006.
Life is too busy to be sick/injured! I can't STAND sitting here, doing pretty much nothing, looking out my window at my flowerbeds that I spent so much time and effort and money on, getting full of weeds, my lawn needing to be trimmed, the house a mess and the floors in need of a sweep and wash. And so on and so on. Sigh. LOL. Really, it drives me absolutely nuts.I can just *feel* the rotten little weeds as I pull them out of the ground, and I know I can surely feel my weed-whacker going vroom, vroom. Waaah!!! I can't talk about this anymore it's too upsetting. LOL
But I will not complain, at least not in front of my kids, because they are the ones who have been taking care of everything, with the brunt of the work falling on my 18 year old daugher's shoulders. Bless their hearts. It is alot of work for her; as you may or may not remember me saying in the group, I have 6 kids...lots of work, especially if you are not used to it.
The alternative to resurfacing is exceptionally lousy, and it is good to remind myself of that. At 43. I am way too young for THR! It is also good, as one wise hippy once said, to dangle whatever carrot works for us, in front of ourselves. My particular carrot is being able to be a mom to my kids again, and not having to tell them NO everytime they ask if I can take them to the park, or if the youngest can sit on my lap for a story, or do anything else with them. That is so not fair to them to have a mom who can't be a proper mom to them, when I can do something about it.
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August 14, 2006
was in hospital from Monday July 17th to Saturday July 22, 2006.
The actual surgery took an hour and a half, and went very well. No complications, and the anesthetist was completely agreeable with my desire for no narcotics and no sedative. It was kind of cool to hear them banging and clanging, and I KNEW when I heard a particular metallic clanging sound and felt my body being hammered, that they were hammering in the acetabular cup. <big grin>
I had a spinal for the surgery and epidural for two or three days after that for pain control. When they removed the epidural, IV, and catheter, they used oxycontin every 12 hours and oxycodone every 4 hours if needed for pain control. At first I was taking Tylenol 3 for pain but a clever nurse noticed after one dose that it was not working for me and switched me to oxycodone. Worked quite well, although I did find the second, third and maybe part of the fourth day, somewhat uncomfortable. Much of that discomfort was from the gas pains I had, not the hip. Gas from the anesthetic and painkillers lodged up under my ribs and sneaked around my back and just stayed there. That hurt worse than the hip ever did!
Every day we would have a team of two nurses. One evening I was really getting sore from the gas and from being on my back for so long, and the pain was increasing, so I rang for the nurse. She said there was nothing they could do for me. I rang her again about half an hour later because the discomfort was increasing so much that I was getting to the point where I could not stand it any longer. She had the nerve to answer the call bell with a very snotty, "What do you want? I was just in there." And she still insisted there was nothing they could do for me. Luckily, shortly after that, the other nurse on that day's team came in and by that time I was sobbing in pain. I told her what was wrong and she, bless her heart, went right away and brought me Diovol, a hot blanket to put on my stomach and ribs, and some pain meds. In about half an hour I felt like a new person, about 90% better. I don't understand why the other one refused to help me and kept insisting that nothing could be done. What a witch. How frightening to voice your fears and not be listened to. Talk about being totally helpless and at someone else's mercy!
They got me up walking the second day post op and that was SO not fun. I could not lift my leg so the physiotherapist had to walk behind me and shove my leg forward each time I took a step. So then the physio said she was very worried because I was not doing well and that she thought I would have to stay in a rehab centre for anywhere from a week to a month before I went home! Gack! The next day I was amazingly better;-)
I lost 13 pounds in the five days I was in the hospital, if you can believe it! I have been in three hospitals in my life and they all had fantastic food, lots of salads, fresh fruit, nicely cooked vegetables and lots of variety. This hospital messed up so badly with my diet (I have a zillion allergies and am diabetic) that I had only ice water and apple juice the whole time I was there. They kept sending me stuff like milk (don't drink it) and Jello (don't eat it) Even though I am a diabetic and have multiple allergies, not once did they send a dietician or nutritionist to talk to me like other hospitals always do. They also took it upon themselves to decide that I had celiac disease (gluten intolerance) instead of the allergies to wheat and corn I told them I had. They repeatedly sent me stuff I was allergic to, stuff with sugar in it, sweetened tinned fruit and sweetened fruit juice. Twice only I was sent a hot meal with instant mashed potatoes (straight out of the box for that good, wholesome cardboard taste lol), a tiny amount of mushy, terribly overcooked vegetables, and meat that was some kind of processed, sliced, cardboard, which I didn't eat...Well, having said all that, I guess I will have some good horror stories to tell my grandkids. What an absolute comedy of errors.
I am very happy with the surgeon that I chose. He is not only very skilled, but incredibly kind. No ego on him at all. He walked into the OR with me and I was grimly joking that I had changed my mind and decided not to have surgery after all and he smiled at me, rubbed/patted my back in a sort of fatherly way, and quietly reassured me that while the OR was no one's favourite place to be, I would feel so much better afterwards and be happy I had had the surgery.
Recovery is going well although I am feeling a bit frustrated at my lack of mobility and independence. It does have its funny moments, though. The other night I was in the washroom and my slippery satin pyjama pants fell down around my ankles and I could not pick them up without breaking the 90 degree rule! Talk about feeling helpless. Of course I did not have my reacher with me; I only take it in when I am going to change clothes. Had to call my husband to come and rescue me.
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Between surgeries: Waiting for relief, receiving support from other hippies...
I had my right hip done July 17th and am on the waiting list for my left hip to be done. I really don't want to have another major surgery but know it is the only way I will get better. I have no choice; I can't go on like this.
I am bone on bone and haven't felt the great relief that so many others have. At times I almost wonder if I ever will feel as great as everyone says I will. I can *SO* relate to another hippy's statement that while she'd had one hip done and the arthritis pain was gone, she still had a sense something was not quite right. I do not as yet "have my life back" and my left hip has gotten so much worse since I had the right one done. My surgeon told me while we were walking into the OR that I was "going to feel so much better" but it hasn't happened yet.I do believe him, and do believe I will feel better eventually, but sometimes it is easy to feel moments of fleeting doubt when even the simplest everyday activities are so very difficult and painful. Gives new meaning to the term "daily grind"<smile>
Other hippies stories give me hope that maybe there is a chance for me, too, to feel better, to get the relief that so many others have found, and to have a normal life. I keep hoping that after my next surgery I will have the same great experience that so many have had-a sort of "Eureka!!!" moment, lol, where everything falls into place and I realize that it really was worth it after all.
Emotionally, it is not easy being in the position of being dependent on others for even the simplest of thing. I am a very independent person, hate to ask anybody for anything, and hate to be cooped up indoors, so found being so darn helpless and dependent on everyone else really galling. I was so frustrated: not being able to do even the simplest little everyday things we take for granted really got to me. At times I thought I was going to go INSANE. I really felt like the top of my head was going to pop off;-) And that is really saying alot, since
I'm normally the most laid-back, easy-going, good-natured and cheerfully optimistic person around, but at times, I found myself close to tears, almost yelling at people including my poor innocent kids who had done absolutely nothing wrong whatsoever, just feeling like a raging tempest on the inside.
I felt such frustration and a feeling of helplessness, and wondered if things would ever get better or if they were going to stay like this forever.
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Still waiting for the 2nd surgery...
Oct. 13, 2006
For those of you who have gone through end-stage OA, please tell me how you got through it. My left hip is bone on bone and is getting worse literally by the day. Without a word of exaggeration I feel like a 110 year old woman.
I *think* my operated hip is pretty good although for the most part I can't tell because it is so eclipsed by my other, bad hip. The operated hip does still have some pain in the saro-iliac joint. I know that I do have arthritis in it...
My family doctor gives me a lecture each and every time I go to ask her for more Oxycodone; last time she gave me only 60, telling me that that was enough for one month, at 2 per day. Well, that is just not enough, and because I sometimes need more that 2/day, I either stop doing anything and just lie on the couch, moving as little as possible so I don't cause even more pain, or I ration my pills until I just can't stand it anymore and absolutely HAVE to take a couple, which means that I spend most of the time in pain. I know she believes she is trying to protect me from addiction, but...
How does anyone in this position continue, and function? Is there some other pain medicine I could ask for that actually works? My bad leg is getting harder to use, too; now I have to go up the stairs sideways-when I CAN go up the stairs at all. Walking is harder all the time, even getting onto and off of the raised toilet seat is now difficult.
I'm not looking for pity, I just want some helpful suggestions and advice as to how to hang in there until my next surgery. I have a large, very busy family and it is essential that I at least be able to be partially functional <grin> most of the time.
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Finally, the second surgery:
I got home from the hospital last night about 8pm. I'm now officially a bilat hippy, and boy oh boy am I glad it's all over! I hope to God I NEVER have to go through another hip surgery again in my life.
I had my surgery Friday morning at 8 AM. I tried to get the same anesthetist but had no luck there. I explained to the one I got how what I used last time (spinal-only for surgery, local-anesthetic-only with no narcotics for pain control post op) worked really well for me, and she listened and smiled and agreed. Or so I thought. The spinal did not "take" very well-actually, it took fairly well on the other, non-op side and while it did not hurt (until they got to the staples), I felt EVERYTHING they did; all the drilling, all the movements, tugging, pulling, and so on. She turned the "juice" up once or twice when I told her I could feel it but since she kept telling me it was "normal to feel something during surgery as long as it was not painful", I just gave up trying to explain that I had not felt ANYTHING last time. I said some prayers and...then it was over. Actually, I felt calm, it didn't scare me or anything, but I
would have preferred to not have felt anything physically and to be as numb as I was the first time. Oh well...
The doctor who had been in the OR for the first part of the operation with Dr. Smith told me later that I had had (at least) three large cysts and that Dr. Smith had done a bone graft. He implied that if I had not had such an experienced doctor I probably would have ended up with a THR. At least, that is how it sounded to me.
Because of the bone graft, I am on touch-weight bearing for 8 weeks (maybe longer? Not too sure on that, have to ask) on crutches.Ugh. I feel as if I could just start in doing all kinds of normal activities, but that's not to be!
The pain this time was much worse, at least for the first 2 days or so and my leg is HUGE; very, very swollen. I did the toes-above-the-nose thing this morning and it helped so will use it again. The afternoon of the op, for some reason, the pain got really bad, and went up to about a 9 on a scale of 0-10. Finally they got it under control, but I have no idea why it was allowed to get so out of control in the first place.
I have no idea how many staples I have (later note: 23 staples for this hip, 18 for the first one) nor how long my incision is (7 inches this one, 4 inches the first one), but will ask when I get them out. On about the 2nd day post-op I developed a pressure sore, which hurt more than the incision or hip. It still hurts, but is getting better slowly (Sept. 08, no longer hurts but there is still a lump there). They had to bring in a special mattress for me because of it. I also began to get pressure sores on my elbows and last night woke up feeling like my big toe on the operated foot was rubbed raw with sandpaper. I also had 2 blood transfusions (2 units, transfused one unit at a time) and was given several units of potassium by IV.On a happier note, I feel that this recovery is going much faster than the first, and I don't have all the fatigue and stuff that I did the first time.
Will write more later...
Caroline
RC2K 17/07/06
LC2K 09/02/07
Dr. Frank Smith
Hamilton, Ontario, Canada
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Wed Mar 28, 2007 7:52 pm (PST)
Hi all,
I had my 6 week checkup with Dr. Smith on Monday and thought I'd let you all know how it went. I was given permission to start putting 25-30% weight on that leg (I had been on touch-weight- bearing only), which means I can now manage the crutches and go up and down stairs-I can have a SHOWER now, finally!!!!! !!! Yee haw!!!!! lol And even better than the shower is that I can go outside. I LOVE LOVE LOVE being outside, I am not an indoor-type of person, and now it is spring and my bulbs are all coming up...beautiful. So now I can get out on the porch and have my morning coffee and plan my flowerbeds and stuff. <<Bliss!>> I have to continue wearing the TEDS for another month or so (ended up being much longer-until I was completely off all weight-bearing restrictions), and have to observe the 90 degree rule until my next checkup (he is being so conservative this time around because of my multiple cysts and the bone graft he had to do).
I saw my Xrays and this hip is really weird looking, much more vertical than horizontal, with a visibly shallow acetabulum, and he had to put the implant in on somewhat of an unusual angle (looks like a crooked dreidle lol) but he assured me that it was fine. I really believe that if I had had a less-skilled doctor, I would have had a THR on that side. I also asked him about my foot, which is at times varying-and alarming-shades of purplish-red and a bit swollen. One walk-in clinic doctor diagnosed me as having "very bad circulation" and said that "it's not critical YET but you need more tests" and so on and so forth. Quite alarming news for a diabetic to be told, but thankfully Dr. Smith said he believes it is just something to do with a nerve or nerves, is related to the surgery, and should clear up over the next 2-3 months. He also said that I have "a pounding pulse" in that foot (meaning there is nothing wrong with it, it's good and strong) and that I had gotten "quite a misdiagnosis" from the clinic doc. Thank God!
I keep feeling like saying, life doesn't get any better than this, but I guess it will, won't it? lol. I'm doing well, and feel great.
Caroline
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Wed May 2, 2007
I had another check-up with my surgeon today. I didn't get the exact results I was hoping for, but didn't get bad news either, so I guess that's good, right? lol He told me I could go to 50-75% weight-bearing from the 25-30% I am on now, for the next 8 weeks, then perhaps-hopefully- at that point
we would be able to go to full weight-bearing. He referred me for warm water pool therapy, too,which should really help in getting back my range of motion etc.
In addition, he said the acetabular cup is incorporating well into the parent bone. I was hoping to be able to go to full weight-bearing and get to work on getting completely better, so I could get out into my flowerbeds, but...it's all good. What is a few months out of my life after 23 years of being disabled? In the end it will all be worth it, I'm sure. It's already good in that I no longer have that awful arthritis pain.
Life is good <big smile>
Take care all,
Caroline
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June 25, 2007, after returning from the surgeon's office...
I have some really fantastic news to share with you all. I'm so excited; today I went to Dr. Smith and after 6 weeks touch-weight-bearing, 6 weeks 25-30% weight-bearing and the past 8 weeks on 50-75% weight-bearing, he finally gave me the green light to go to full weight-bearing! If I could have danced, I would have danced right out of there! I am SO happy:-)
Now I can start working on getting my life back. I told my husband in the car on the way home, I feel as if someone just said to me, "This is the first day of the rest of your life". And the very best thing of all is that I have NO PAIN. For the first time in 23 years, I do not hurt. What an absolute miracle. I never believed that would be possible.
The other day my husband and I went out and weeded my flowerbeds (I got down on the ground on my knees by using a step-stool). My brain kept telling me that it hurt or was going to hurt, and out of habit I kept trying to avoid certain movements because they used to always cause me so much pain, and all the while it was in the back of my mind that afterwards I was going to be so sore, and would have to stagger inside, gulp some narcotics,lay down, then drag myself upstairs to soak in hot water once the drugs kicked in enough to be able to crawl upstairs, and then I would still suffer for at least a
week after.
But then I realized, my brain says it hurts, but my body says it doesn't! I'd been like that for so long that my brain just automatically tries to put my body into "safety" mode. How wonderful not to be like that anymore, although I can see it is going to take a while to undo 23 years of conditioning myself to avoid anything that caused or might cause pain.
I don't know whether to laugh, cry, or do both. I'm SO HAPPY.
Life is beautiful:-)
DECEMBER 2009
I continued using one crutch up until June 2008, and made a decision to return to the physiotherapist I had been seeing before my surgeries, since the effects of being disabled for so very long were really affecting my recovery. She helped me learn how to walk using the correct muscles (which took MONTHS for my body to get the hang of!) since my body had been using another method to walk for years as compensation for not being able to do it properly.
In addition, the PT stretches me while I am lying on my back, with one leg flat. I could not lie with one leg flat and the other bent up for about a year-18 months post-op, and up until very recently (about 3+ years post-op), any gains I made in stretching my leg up would be lost from one visit to the next. I would just stiffen up. So as the visit, I might get up to, say, 95 degrees, then at the next visit, I would be back to 90 or less.
Only in the past 2 or 3 months has my body been able to retain whatever gains it has made, and keep them from one visit to the next. So, my physiotherapist quickly began to space my visits further apart and it appears that I will soon no longer need PT.
I no longer have the horrible, excruciating arthritis pain that I used to have, although I do have the occasional mild twinge, and some muscle weakness at times, which isn't surprising since those particular muscles are new to their job.
At this point in time (Dec. 2009) I can get my right leg to between 90-95 degrees with my other leg flat, and my left leg to between 95-100+, which I know is not perfect, but for me, considering how little flexibility and ROM I had before surgery, is pretty good. I know I will never have completely normal hip function, but my surgeon told me that I will continue to see improvements for up to 5 years post-op.
However you look at it, even if I may have less flexibility than many other people do post-op, for me, it's good, and I'm happy. I'm not in pain and it is not so difficult to do everything as it used to be.
Making the decision to have surgery and going through with it was not easy, but I don't regret it now, and urge anyone else who has bad hips and is a candidate for resurfacing, to go for it! Don't hesitate, just do it. Why waste life in pain and disability if you can do something about it?Life is meant to be lived, fully and happily and, if possible, pain-free. As my rheumatologist once told me, "It's not going to get any better, it's only going to get worse".
Just do it!
Caroline
RC2K 17/07/06
LC2K 09/02/07
Cementless
Dr. Frank Smith
Hamilton, Ontario, Canada