Birmingham Hip Resurfacing
Patient Journals, Dale Mitchell

Dale Mitchell - 3/20/08 Right Hip BHR

The Hip with "Crushed Sea Shells"

I had a history of ankle and lower left leg problems, but right hip resurfacing was far from my mind. And, unlike many osteoarthritis patients who suffered years and years, postponing THR and/or waiting for BRR to be approved for use in the US, I was fortunate to have the option of hip resurfacing available when physical therapy didn't help and my pain told me it was "time".

In February 2006 I fell on the sidewalk near work. The sidewalk didn't look icy, but was - and I fell hard to the right. Later that night I went to Urgent Care. It felt as if the fall had done something to the right knee, even though MDs told me that x-rays didn't show any damage to the knee. Looking back now, it probably was referred pain from the right hip which had absorbed much of the impact of the fall. Prior to that I had intermittently had a "stuck popsicle stick" feeling in the right hip since another fall in my late teens or 20's.

August 2006 while walking in the bread aisle of the grocery store I had a sudden sensation like a big piece of elastic snapped in my left lower leg just above the ankle. I was put into a walking boot. Later, after MRI, it was determined I had partial tears of both Achilles tendon and the soleus muscle - in the location of a previous ankle break. I wore the walking boot 4 months, coincidentally the entire time our streets and sidewalks were tom up for a major city works project.

During the time I was in the walking boot on my left leg, my gait changed and my right hip periodically became quite painful from the different walking stresses put upon it. I was treated for psoas tightness. While the muscle released fairly easily, the pain inside my right hip near the groin was getting worse. The "stuck popsicle stick" feeling turned into "crushed sea shells" if I walked more than 3 or 4 blocks. I had trouble standing straight up and walking - the right hip joint would hit painfully on something irregular inside the socket. Sometimes leaning over a car trunk or walking down stairs, my hip would "slip" like I was going to fall. At times it flared and was extremely painful.

The physical therapist treating me was suspicious of a neglected labral tear in my right hip. I was frankly shocked when x-rays showed osteoarthritis bone spurs and narrowed joint space - I didn't think of myself as having arthritis. I took fish oil, had worked out regularly since my 20's and my joints weren't swollen or painful. The reduced range of motion in my right hip I attributed to not stretching enough, though I had tried to improve it for about 5 years with no success. I felt like an old Bonsai tree that was frozen into position.

By late 2007 the "crushed sea shells" kicked in after 1 block or less of walking. Going down 3 flights of stairs at work for a fire drill resulted in pain that was excruciating for days after. Errands became difficult. I had not been able to exercise my legs or do elliptical training in over a year, and was very frustrated.

CT scans ordered by Dr. Rogerson's office showed severely degenerated cartilage in my right hip – my “crushed sea shells.”

A Long Long Winter of Discontent

The winter of 2007 to 2008 set records for snowfall. An average season snowfall in Madison, WI is 49.9 inches, according to Channel 3 (CBS news affiliate). The previous snowfall record was about 76 inches. By Good Friday, the day after my surgery, we had over 100 inches of snow. It was a frightening winter for someone recently recovered from left side Achilles and soleus tears who needed a right side hip resurfacing.

I lived life in the months leading up to surgery like a work release prisoner who was allowed to leave home only for work or limited errands. My carpool picked me up for work and brought me home. If the sidewalks weren't too icy and I could safely make it to the gym for an upper body workout right after work, I did. Later the upper body strength proved invaluable. The pain became so bad the last 6 wks before surgery that I used under arm crutches to motor around at work, get to medical appointments or do essential short errands.

"Dr. Rogerson's Patients Do Very Well"

I hope this doesn't embarrass Dr. Rogerson, but when I asked people in the medical field about him - I kept hearing that phrase. From medical providers in organizations with competing resurfacing surgeons, it was conveyed with cautious understatement and professional respect. One medical provider did share that Dr. Rogerson's patients seemed to heal about 2 weeks faster than might otherwise be expected. But everyone who knew Dr. Rogerson, or knew of Dr. Rogerson, had good things to say about his 20+ years of surgical practice in Madison, WI.

My first contact with Dr. Rogerson's clinic was late one afternoon. I had just been told at a nearby orthopedic clinic that I needed resurfacing or hip replacement. Clutching my referral and emotionally still reeling, I showed up as Rebecca was getting ready to close the office. She was warm, encouraging and helpful as she set up an appointment for me with Renee, one of the physician assistants to evaluate me. I had to pinch myself. This is how a patient likes to be treated, but isn't always in the frantic world of managed care.

My appointment with Renee impressed me as well. She assimilated all the medical history and information I gave her very quickly while doing a physical exam, and ordered some more tests. After all the test results were in, I spoke to Dr. Rogerson. Despite some cysts, I was relieved to be a candidate.

3/20/08 Surgery at Meriter Hospital

My husband & I arrived at Meriter Hospital the designated 3 hours before surgery. We checked in at Registration, and were sent to a 4th floor surgical prep area. The nurse there put me into my hospital gown, checked my vitals and shaved the hip just before sending me to surgery. We initialed "JR" prominently on the right hip and put white TEDs stockings on my left leg. They wheeled me off shortly before surgery into an operating room that had a large flat screen with a still picture of flowers. There were about 5 surgical nurses and assistants already in the room. I transferred from the gurney to the table. Within a few minutes I was out.

I barely remember the recovery room, just a hazy presence of a nurse who successfully gave me some medicine. My first solid memory is looking at the wall clock in my 9th floor room and it was about 6 pm.

We had what were called commodes but were in fact adult potty chairs next to the hospital beds and the curtains between us provided some small privacy. After two uncomfortable episodes with the bed pan, I asked to use the adult potty chair. It was quite a production - press the call button, a nurse or nursing assistant appears, unhooks the compression hose, lowers the bed rail, helps the woozy and queasy patient transfer while not violating any post surgical restrictions.

Then transfer back into bed, the operated leg somewhat floppy from the surgery, reconnect the compression hose. I had forgotten how hard it is to pee for the first day after being catheterized. The day after surgery I had some gentle physical therapy, exercises performed lying down. I was coached to go up and down some practice steps, and walked back to my room.

The best part of the day after surgery was being able to finally eat. My last solid food had been about 36 hours before. Oatmeal, yogurt and toast never tasted so good! I woofed down the toast and peanut butter snack before physical therapy, and enjoyed real lunch and dinner meals. Ordering the food was challenging - both my roommate and I found we were foggy headed and had a hard time focusing & deciding what to order (pain meds talking?).

The nursing and nursing assistant staff at Meriter were incredibly upbeat. There was also good coordination of care, and I felt very safe telling my husband to stay home the day after surgery. If you have to be woken up every 1 - 2 hours, the 9T staff were the kind of people you wanted doing it. Some comic relief was provided by a portable intercom system they all wore. A nursing assistant would be helping me and the virtual operator just couldn't seem to understand his or her response, especially proper names. "Did I hear you say__?" and the corresponding answer would be repeated back multiple times while I was being helped with my adult potty chair.

The night before surgery I had a phone consultation with the anesthesiologist to discuss past problems with anesthesia and other medical conditions that she needed to know about (this had been pre-arranged through Dr. Rogerson's office). I was pleasantly startled when the anesthesiologist, Dr. Anglin, visited me the day after the surgery. She, as well as Dr. Rogerson, Joanna and the entire Meriter staff impressed me as being sincerely interested in checking for good outcomes, and fixing any problems that popped up. Joanna and Dr. Rogerson both visited and checked on me during my l-Y2 days post op in the hospital.

There was another physical therapy session the morning I was discharged. My husband picked me up and drove me the short distance to our apartment in HipHab.

My HipHab Experience - 3/22 to 3/26/08

My transition from hospital to HipHab also weaned me off the narcotic pain meds and on to Extra Strength Tylenol. There was no doubt that I had needed pain meds right after surgery, but the soreness (I couldn't really call it pain) was tolerable with regular doses of Tylenol by 2 days after surgery.

There were 3 kinds of soreness that I felt the first week after surgery: sore from being restrained during surgery (pubic area, and rear buttocks), surgical soreness (the hip capsule around the hip joint), and soreness from muscles being used differently. I "grew" one crutch notch from my pre-surgical crutch adjustment to post-surgery at HipHab. After surgery, I could stand tall, but my leg muscles needed physical therapy and some time to adjust.

HipHab is located in a retirement complex. We resurfacing patients are identifiable to the elderly residents - we sport blue crutches, are 20 years or more younger, and typically are accompanied by a coach/caregiver when not escorted by a physical therapist. The residents are acknowledging and say things like "You're with that Doctor, aren't you?". One older gentleman, probably in his 80's, walked by me my first day and told me he had had a hip replacement some 24 years earlier. Being in a retirement complex was actually very freeing - time seemed move at a slower pace and dressing comfortably trumps fashion.

It is absolutely essential to have a coach/caregiver (parent, sibling, spouse, good friend) stay with you. I was fortunate to have my husband with me. You will need help getting dressed or showering, buying food or going out to eat. There will be times (like when you are at physical therapy or taking a nap) that your coach/caregiver can take a walk through downtown Madison or get out for a bit. Madison has a beautiful and interesting downtown - there are historic, shopping, cultural and ethnic dining opportunities within blocks of HipHab.

The HipHab apartment was an attractive remodeled one bedroom specifically tricked out for hip resurfacing patients. By AAA standards, I would've considered it a 3 diamond room - but with the extra amenities at the retirement complex, more like 4 diamond. I enjoyed the cable TV (we don't have it at home) and the highlight of my Hip Hab was watching national Dog Agility Championships. Such energy and enthusiasm!

HipHab is foremost a safe place to start resting while practicing the necessary physical therapy exercises and learning how to use the various gadgets for getting dressed or picking things up without bending. No more interruptions every couple hours! I was able to sleep close to a normal night's sleep, and take naps after physical therapy sessions. There were grab bars in the bathroom, ice packs in the freezer and a small kitchen with appliances. The couch and chair can be adjusted higher with blocks, if needed.

Dr. Rogerson came to check on me several times during my Hip Hab stay over the Easter weekend. Joanna came early the Wednesday morning of my discharge to take out my staples and answer any last questions. Despite the fact I was "on my own" in an apartment, I felt that Dr. Rogerson, Joanna and the therapy staff at Hip Hab were monitoring me and providing helpful encouragement and suggestions to hasten a good recovery.

NOTE - Meriter Heights changed ownership just after my HipHab stay, and is now known as Capitol Lakes Retirement Center. The restaurants, health & wellness center, physical therapy staff etc basically are the same. Interestingly, the ownership change happened 4/1/08, but they decided not to announce the ownership change until 4/2/08 (so no one would think it was an April Fool's prank).

Physical Therapy - Outpatient & At Home

I went back to the retirement complex for outpatient physical therapy in the two weeks following discharge from HipHab. At home, I continued doing my assigned physical therapy exercises. Walking with one crutch was pretty easy 2 weeks after surgery, and then the physical therapist had me start using the one crutch as a cane. At home, I walked 2000+ steps a day in loops around my upstairs, usually 600 to 800 steps at a time just after physical therapy exercises. The first two weeks after surgery it was easiest not go out of the house much. I was giving myself daily injections of Lovenox and had to wear the TEDs hose. The worst of the post surgical fatigue lifted about 3 weeks after surgery. About 3-1/2 weeks after surgery I was able to drive short distances and started walking 5000+ steps a day. One of my first errands was to buy a pedometer so I didn't have to consciously count all my steps!

Like many resurfacing patients, my posture changed after surgery and physical therapy is key in stretching out and preparing the muscles to work differently. I understand that my daily physical therapy exercises at home must be done for 6 months after surgery. Besides doing the physical therapy exercises, walking is essential to recovery.

3 Months Out - Looking Back

I went back to work half time (desk job) at 5 weeks post surgery and full time the following week. It was still another month until I could bend my operated leg well enough to lace up & tie shoes by myself. During the interim, I used curly laces (available from home health care outlets and similar places) which allowed me to use my grabber and long shoe horn for putting on shoes.

Here are some things I used in my recovery, that mayor may not be useful for others:

1. Acupuncture - to help the healing process & manage other health problems. I wasn't able to start my first treatment until 4 wks after surgery. Besides helping overall & hip healing treatments helped bring my allergic and non-allergic rhinitis back into control (the neti pot and corticosteroid sprays that I missed during hospitalization had set me back). I went once a week for 3 wks, then settled into every other week with my regular acupuncture provider.

2. Massage - I had a massage at the end of each of my first two weeks back to work. The therapist didn't want to do anything "deep" that might interfere with the hip capsule healing, but did do some work that helped my IT band (exterior, along outer thigh toward the knee) and psoas release (front). The gluteal muscles are slower to fire up after surgery and the inner groin muscles were going double duty, and she helped release and relax those muscles.

3. Lavender oil- Vitamin E oil had been recommended to me, but I like the scent of Lavender oil and used it to rub on my incision. I also rubbed or massaged the incision a few times a day, to help loosen it up.

4. Pedometer - When I could drive and leave the house, I bought a pedometer to track my steps in a day. Within a month after surgery, I was walking 5000 steps a day. To avoid overtaxing the muscles, I made a conscious effort to do "spurts" of Y4 mile or so at a time. If the inner groin or psoas muscles got too tense & sore, I would back off the next day. I ''timed'' my efforts to increase activity just before an acupuncture treatment and then give myself a few days at a lower level of activity. At 3 months after surgery, I am averaging between 5000 and 8000 steps a day.

5. Elliptical trainer - I used a machine in the exercise room at work for 5 minute sessions during morning and afternoon breaks for several weeks. When I went back to the gym about 2 months after surgery (upper body workouts only), I was able to increase the number of minutes fairly quickly. At 3 months after surgery, I go 20 to 30 minutes on the elliptical trainer (no hills, slightly increased resistance) about 3X/week.

"Life Changing Surgery"

My allergist used to be a primary care MD. When we discussed my hip resurfacing, he commented that he had observed over the years the two most life altering surgeries were cataract surgery, which restores sight; and joint replacement (more recently, hip resurfacing), which restore function.

After 2 years of declining function, increasing pain and growing frustration, it IS amazing to wake up from surgery and have all that pain gone. It is a joy to be able to walk around the Farmer's Market and to no longer plan the day's activities around the safest and shortest way to get somewhere. It is amazing to feel strength and ability restored so dramatically in middle age.

My husband & I are forever grateful to Dr. Rogerson, Joanna, Renee, and the clinic staff. Dr. Rogerson's surgical skill, meticulous attention to detail and interest in tweaking the whole process are evident. Dr. Rogerson could have been an engineer, a scientist or a professional in any number of technically challenging fields. We are thankful he decided to be a surgeon, and that he set up shop in Madison, Wisconsin.

7/30/2008