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Thursday, December 28, 2006
Finding Maud
"You should write a blog, Mom."
Our older son, Lars, says it casually, smiling.
His words warm me. I usually feel sidelined and irrelevant to his generation, a
nuisance really.
Four years ago, I consciously began to withdraw from the world, narrowing my
focus to those things I need to do before I die. Now my son is inviting me to
venture into cyberspace.
I begin cautiously at his blog, “Bottles & Bones” at blogspot.com. The title
memorializes items Lars and Kerrie found in the land they bought from her
parents to build their home in the woods.
This semi-scary adventure led them to blog. From their familiar terrain, I find
my way to the button that says: GET YOUR OWN BLOG.
My blog requires a name. I decide to sleep on it.
Lying in bed the next morning, I search my subconscious to see if a name is
emerging. She appears, not merely a name, but a presence: Maud.
Already I have lived almost twice as long as Maud had in 1914, when she died at
31, along with her fourth baby. Two other children survived. The older one, who
was 5, would become my mother.
Lars, an illustrator who specializes in ghouls and monsters, found Maud's large
portrait in its gilt frame too spooky to bear. If he was home alone, he would
turn it to the wall.
He says: "She keeps staring at me!"
A-ha! I laugh. Thank you, Maud.
I relent and put her in the closet. She does not hold it against me. Nor does
she stay there. She knew cyberspace before we did.
Her name calls up in me a sense of ineffable kindness and hope. So we are making
this journey together as Phil takes pictures and helps us reflect on larger
meanings.
We'll be right here if you want to come visit Maud & Me!
Saturday, December 30, 2006
Infectious Diseases
While the FDA dallies, the American medical establishment takes umbrage at the
rapid outsourcing of its market. Doctors here are not happy with me.
“Why not total hip replacement?” they ask. “It’s so reliable here.”
“Too invasive,” I respond, “a waste of good femurs.”
“Do you know how many infectious diseases India has?”
Nothing like the epidemic of guns and hummers here, I think, realizing how
alienated I feel from my own culture with its raw, unregulated greed.
The doctor at the travel clinic knows her stuff. But Maud has issues with her
4-inch stilettos and pointy toes.
What decent doctor would do that to her own body? Maud asks me.
She doesn't like being short, I whisper.
She should worry more about being stupid, Maud huffs. Does she really think
those shoes enhance her stature and authority?
Maybe it's for sex appeal, I suggest. Her generation cut their teeth on MTV.
Doesn't look sexy to me, just stupid, Maud insists.
Shush, I warn. You're not sexy to her either.
Phil, ever the diplomat, says: "You have a wonderful hospital here."
"Yes, if we can keep it," the doctor replies solemnly.
She is being conservative, she says, for our protection and orders up doses of
hepatitis A and B, typhoid, and pneumovax at $743 plus malaria pills and
precautionary drugs for diarrhea at $81. To ward off mosquitoes: $20.
"And the water. Only drink bottled water," she warns, "With the seal intact. The
bubbly kind is best." She really is good.
The medical assistant who administers the shots sniffles with a certifiably
infectious disease. Should be home in bed, but maybe isn't paid enough to
protect her patients.
Maud studies the assistant's long, stylishly unkempt hair and the red plastic
daggers glued to her nails. Don't ask, I warn.
Three black teens in saggy jeans and bandanas pass in the corridor. The
assistant mutters, "Oh my Lord," and slams her door--multiplying the likelihood
of sharing her germs with us.
Racism is an infectious disease, I whisper to Maud. But I am too cowardly to say
it to the assistant with her arsenal of hypodermics.
By evening, Phil is doing fine; I am not. My upper arms ache, stiff with pain--
the AMA’s revenge.
Next morning, Phil helps me put on my socks knowing we have offended a dangerous
lobby. One bad hip has made us a market force.
Top Docs
On Sunday afternoon, March 19, 2000, a new yahoo group appeared with a question
mark: Surface Hippies?
The first posting reads: "Hello out there! My name is David. I am 46 years old,
with a wife and three small children (6, 4, and 9 months). I am three weeks and
two days post-op . . . ."He describes his experiences in recovery from hip
resurfacing and concludes:
"This is not a very large group, so it should be easy to remember names.
Let's hear from everyone.
David"
Today 5,547 members post well over 2,000 messages each month at
http://health.groups.yahoo.com/group/surfacehippy/
One of those members, Vicky, instantly takes me under her wing. She has returned
from India enthusiastic about Dr. Vijay Bose and offers her research to other
prospective surface hippies. She responds to my email in less than an hour and
sends spread sheets comparing eight doctors: their prices, the number of
procedures each had completed, the length of their incisions, and their rate of
"revisions"--operations needing correction. Vicky offers to share this with
other prospective surface hippies at
vickymm@comcast.net
Following Vicky's advice, Phil puts x-rays of my hips and knees on a glass table
with a fluorescent light beneath. He stands on a ladder and shoots digital
photos. (You could also photograph x-rays against a computer monitor. Some
radiologists will save you the trouble and deliver your x-rays on CD.)
I email these to four doctors using the addresses Vicky provides. Within an hour
my first response comes from Dr. Koen De Smet in Belgium. Credited with 2,107
resurfacings, including Lisa's, he is author of the informative report on the
metal-on-metal Birmingham hip resurfacing prosthesis (BHR) that is now
state-of-the-art in Europe and Asia:
http://www.hip-clinic.com/assets/downloads/BHRlagomaggiore.pdf
Dr. De Smet writes:
Dear Anne,
Looking at your x-rays you certainly are still a candidate for resurfacing!!!
You have osteoarthritis of both hips.
Right one is bone to bone, left still is not so quite bad yet.
Your right knee has also started arthritis, but mainly at the patellofemoral
side (after kneecap)
I think that mainly the knee problem will be from the right hip!
Good bone quality, so best thing to do is resurfacing!!
If you require any further information?, just ask,
Greetz
KOEN
With the intimacy of the internet, we are already on a first name basis. I
welcome his lack of pomposity. But his price, while far less than in the U.S.,
is still twice that in India.
Besides, Phil and I have been to Europe already, but never Asia.
Every few hours I check my email to see if Dr. Bose has responded. I hear from
two American doctors, agreeing that I may be a little old for the process, but
both consider me a likely candidate.
Where, oh where, is India?
Vicky sends off an email on my behalf to the Apollo Hospital in Chennai,
guessing that Dr. Bose is off teaching other docs the procedure. Finally he
writes back:
Dear Ms. Grant,
Thanks very much for your mails with the x-rays of your hips and knees.
Apologies for the late reply. I was out of chennai to do some surgeries in
another city.
As you are only 60 yrs of age, hip resurfacing would be a much better option
than conventional hip replacement. Hip resurfacing would enable you to be very
active after the surgery.
I have assessed your x-rays in detail. Your right hip shows bone on bone
arthritis but excellent bone stock . I am happy to report that you would be an
excellent candidate for hip resurfacing surgery.
Your left hip shows the changes but to much lesser extent.
Regarding your knee, both of them show degenerative changes but nowhere near
needing major intervention like a knee replacment. The best option for the knees
to have a conservative knee rehab programme concentrating on the patello femoral
joint. The patella (knee cap) shows the max. changes especially the right side.
The physio combined with a course of visco-supplementation injection would be my
suggestion for your knees. Further once the hip surgery has been done, then
there is a good chance that your knee may feel better as referred pain in the
knee from hip arthritis is very common.
I will also need details of your medical history and the extent of severity of
your hip problem. Please give information regarding the following: co-existing
illness like diabetes etc/ previous surgeries/allergies/ current medications/
previous hospitalisation details (if any). Kindly add a description of your hip
symptoms and how it affects you.
I have attached some information on hip resurfacing.
Currently, I do hip resurfacing for about 15 Americans / Canadians every month.
Hip resurfacing is a technique invented specifically for younger patients with
hip problems. Conventional Total hip replacement, while being a good option for
an elderly person (above 70 yrs) is a poor choice for young patients as it will
fail rapidly. The hip resurfacing operation is an alternative to hip replacement
and has 3 crucial advantages.The first is that no plastic (polyethylene) is used
like in conventional hip replacement. Since an anatomical sized 'metal on metal'
bearing is used it lasts for a very long time, manifold that of conventional hip
replacement and is extremely popular in Europe, Australia and some parts of
Asia. The anatomy and bio-mechanics after resurfacing mimic a normal hip very
closely.
The second advantage is post operatively: patients are encouraged to be very
active and must play some sport, do swimming etc. No activity is restricted
including sitting on the floor, crossing legs etc. In short, it behaves like a
normal hip enabling patients to return to their normal lifestyle. In contrast
after a hip replacement one has to behave like an elderly person (for whom this
has been designed) to be safe from dislocation and to prolong the life of a
prosthesis. There are also other advantages in Resurfacing like preservation of
bone stock (as no bone is removed in this operation unlike hip replacement where
the head and neck of the thigh bone is completely removed.) Further it has been
proven that bone stock actually increases after hip resurfacing due to the
restoration of normal biomechanics in the hip and proximal femur.
The 3rd advantage is that the polyethylene 'wear particles' does not damage the
surrounding bone like in conventional hip replacement and the quality of bone
actually improves with time after hip resurfacing. This makes a revision
solution (if at all needed) very straight forward surgery, unlike the very
complicated revision scenario in a conventional THR.
The patient is usually made to walk full weight bearing the day after the
operation and is usually discharged from the hospital at about 5- 6 days from
the operation. They can resume any work at 3 weeks from operation and sport is
started 6 weeks from operation.
I have also attached some details of our centre in Chennai, India. The hospital
where I work is known as Apollo speciality hospital in Chennai, India, and this
hospital is as good as any other facility one sees in Europe or North America.
The hospital has an excellent international patients division which would help
you with your requirements. Complimentary pick-up at the Chennai airport is
always arranged by the hospital for all International patients.
www.hipresurfacingindia.com
www.apollohospitals.com
I have now done more than 700 hip resurfacings and have the largest series of
hip resurfacings for AVN & for fused hip resurfacings in the world. There have
been many overseas patients including some from Canada, USA and the U.K.
The cost of the Hip Resurfacing surgery package in Chennai, India, at Apollo
hospital would be a 'package rate' of U.S $ 7,000 for one side. This is an all
inclusive rate and includes the following:
Pre-op consult with surgeon
Pre-op consult with aneasthetist
Hip resurfacing implant. (The BHR manufactured by smith & nephew and the ASR
manufactured by Depuy are the ones used.)
Single private suite with toilet, TV, Internet connection etc. This has an
attendant's couch as well.
Professional fees for surgeon, assistant & anaesthetist ,
All pre-op investigations (Surgipak) which includes ECG, Echocardiogram,
Liver, Renal & Clotting profiles.
Consult with cardiologist (if required.)
Diet
Pre & Post op Radiology
Nursing
All medicines
Operation Theatre charges
Private nurse for the first two post-op days. (This is very useful for patients
travelling alone.)
There are no additional costs for routine hospital stay apart from personal
usages like telephone, laundry etc.
Payment can be made at admission by banker's cheque, traveller's cheque or by
credit card. Personal cheques are not accepted. U.S dollars or Euros are the
accepted currencies.
The hospital arranges for the patient to stay in a seaside resort close to
chennai by the name of Fishermans' Cove before flying back. The cost for this
would be extra. The resort has facilities for Ayurveda--traditional Indian
therapies which are known to rejuvenate the mind and body.
A total of 11 full days gap (Hospital+Resort) from surgery is advised
(mandatory) before taking a long-haul international flight.
The person to contact regarding travel arrangements like airport pickup and
resort bookings is Mrs Shoba Bhasker at shoba_bhasker@yahoo.co.in She is the
International patient co-ordinator. Kindly post a copy of any e-mail to me so
that I keep a track of things as well. Kindly take note that a tourist visa is
mandatory to travel to India. Please do apply for a tourist visa and not a
medical visa as other formalities are involved in a medical visa. A tourist visa
can easily be obtained from any Indian consulate.
List of Indian embassies world wide where one can apply for a visa to travel
to India can be found in the following link
www.india-visa.com
This is the link for the U.S embassy
http://www.indianembassy.org/consular/visa_guide.htm
If you need any further clarifications please let me know.
I have attached the link to a recent article that appeared in the News &
Observer published in Raleigh, U.S.A and a link to the CBS 60 mts programme
which featured our facility and my patients
http://www.newsobserver.com/672/story/427249.html
http://www.cbsnews.com/stories/2005/04/21/60minutes/main689998_page4.shtml
with best regards
Dr. Vijay C. Bose
MS ( Orth); DNB ( Orth); M.Med .Sci ( Trauma) Birmingham; MCh ( Orth )
Liverpool; FRCS(Orth) U.K
Consultant orthopaedic surgeon.
Department of hip surgery
Apollo speciality Hospital
320, Mount road
Chennai-600 035
India
mobile: +91-98400-32251
www.hipresurfacingindia.com
His email relieves Phil's anxiety.
Nine days after I had emailed my x-rays, Dr. Bose puts me on his surgical
calendar for January 19th, 2007. I am in!
See Anne's complete
blog with LOTS of PHOTOS from India including the APOLLO HOSPITAL at
http://maudandme.blogspot.com
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