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Friday, June 01, 2007 3:01 PM
Dear family: This is a report to my hippy friends and
relatives, so just quit reading if there is more medical or Gent detail
than you ever wanted to know.
Goodness, I had forgotten how rotten one feels 2 days after
surgery-- sore, exhausted, depressed, weepy, wondering with every
twinge if you have messed up your hip again. Peg and Pat, you bilaterals
have my undying admiration.
This morning dear Marc has straightened my head out by
explaining which muscles atrophied during my year+ of crippledom and
the painful months of therapy that it's going to take to stretch them
out again. Thom, who was watching all this with interest, said later
that he was glad to see that some of those stretches were bound to
improve our sex life. Marc told me to take it very easy today, which was
exactly what I wanted to hear.
Three of us Americans had surgery the same day--Larry from
WI, Sue from CA, and me from GA. I'm progressing faster than the
others in this group and Marc knows that means I have a tendency to
push too hard. But I was determined not to be left behind when the
others left hospital yesterday.
I have never before been in a hospital where there was a
smoking room and you could order beer for lunch. Autres pays, autres
moeurs. The hospital staff are effortlessly efficient. (Although Sue was
very shocked that they hadn't noted her allergy to peanuts on her
chart!) And so young. I felt as if I was being waited on by a bunch
of forest nymphs. Our anesthetist (if that's the word) was a
long-haired blonde 30-something in v. high heels.
Bart says Koen thinks TEDs and heparin injections for
preventing DVT are a waste of time and money. They date from the days when
people spent days in bed after surgery and blood pooling in the
legs was a real problem, BUT they can't give them up because the
Belgian insurance system says they are best practice. I thought the
US was the only country plagued by loony tunes rules imposed by
insurance companies. I should have known better.
Blue Cross is coming to visit the De Smet setup this summer.
I'm pretty sure they have already paid for quite a few patients
to come here. Thom has the guy at the chip shop round the corner
bemused at the news that there's a famous surgeon in his quiet suburban
neighborhood. (I'm not sure how the 2 of them communicate,
but you know how it goes.)
Koen has a 1961 Plymouth Valiant V200 parked at the Villa.
It's the first car he ever owned and he's slowly restoring it.
Decided there was no point in keeping it in the garage at home. Last night
Igor gave Thom a ride to an ATM in it, and left Thom a white and
shaken wreck, as a result of Igor pulling U-turns without warning
when he realized he'd gone the wrong way. ("And you don't have to
retrofit seat belts on a car more than 25 years old.")
It is lovely to be recuperating at the Villa. After hard
beds and much noise in hospital, it was a joy to lie on this comfy
bed last night, electrically propped at a suitable angle, watching
leaves, and birds, blue sky and fluffy clouds through the open window. I
am dying to get downtown, but we all know how easy it is to overdo it
and set yourself back 3 days, so I'm going to follow Marc's advice
pretty religiously, and enjoy lying around playing solitaire in the
meantime.
Love to all, Karen
June 02, 2007 9:52 AM
I think I'm going to be slower than you. But then I'm an
old women--64, which is about the average of everyone here at
the moment. You don't recover as fast as you did at 40. I'm 5 days out
today and don't feel like sightseeing in town yet. I shall try and
crutch down the road to a computer shop. I remembered to pack the
camera, but am in search of the USB cord needed to attach it to the
computer!
Marc keeps saying take it easy and then gives me exercises
that I probably couldn't do when I was 25. He is great at
explaining things. So reassuring that the aches and pains are mainly muscles
that have atrophied and need stretches, etc.
Best, Karen
Art in gent 4 days PO
Saturday, June 02, 2007 3:01 PM
I'm so sorry your broken plates art exhibit is unlikely
to still be around! However, there's a new contemporary art museum that
opened on Saturday that Thom at least will have to explore. He asked
Hugo the difference between this and the modern art museum across the
street and the best Hugo could come up with was 20th century vs.
21st century!
Thom got the tram system pretty well down while I was in
hospital. This morning Bart (nurse) arrived while Marc (PT) was here,
so I'm lying flat on my back struggling with some torture of Marc's
while the men try to make sure Thom understands about tram routes
and how to find the oyster bar in the flower market tomorrow. It
must be about the first time in my life I'm not the tour guide--an
excellent feeling!
There are many good things about being surrounded by
professionals during rehab, and one of them is psychological. It was you,
Martha, who first drew my attention to this. As a scientist, the
psychology of hip surgery is not exactly my cup of tea, but you are
entirely right about it. At home, I'd get some stray ache or pain and
be convinced something disastrous had happened. Here, I mention
it to Marc or Emelyne and they explain which muscle needs to be
stretched. This is especially helpful because the pre-op pain was all
in my knee, not my hip, so I have harbored a nagging fear that
fixing the hip wouldn't fix the perfectly normal knee. Confiding that
to Marc has almost got it licked!
Amazing how much progress you make in 24 hours. Yesterday I
didn't dare put full weight on the operated leg. This morning I
walked upstairs one foot in front of the other for the first time
in more than a year. I told Thom I wanted to go on one of his
morning expeditions, and he said "not the newspaper run, you don't.
It's too far." So we set off later to the grocery store (S'match?)
and it was about a million miles (well, more than half a km, anyway).
Since I could hardly lie down in the street and say "I quit," I made
it to the store, where I sat on a heap of boxes while Thom
shopped, and then walked home--tired, but in one piece.
The gift shop here has "Belgian hip pralines." These are
chocolates made in the shape of a BHR. Perhaps these are new? For any
of you who didn't manage to acquire them when you were here, let me
know and I'll bring some home.
Love, Karen
Post-op Day 5
Sunday, June 03, 2007 7:21 PM
Snarly from lack of sleep this morning, but a luscious
breakfast with Josie, a new Dutch arrival who speaks perfect English,
improved the mental state. She was born without an acetabulum so couldn't
walk until surgery in her teens. Which has served her well for 40
years, so she's not grudging Thursday's THR! The Dutch health
system has some of the same vices as the American, such as buyer-beware
training of surgeons, which is why we see so many Dutch here. I also
realized why Louis and his wife don't speak English. He's worked for
53 years and he's 67, which means he went to work in Dad's
factory-cleaning business at the age of 14 and ain't got much eddication.
Happily his children, who I am sure are highly educated, are taking over
the firm now.
System at the Villa, which has 15 or 16 rooms, is that they
assume you will be in for breakfast and lunch, but not for supper.
You can alter this at any time by telling Sandra. Today we're going
out with Sue, so we told her we would be out for lunch and supper.
Avoiding 3 gargantuan meals a day is a perennial battle. It would be a
drag to go home after major surgery and 3 weeks PT to find you'd
gained 5 kilos.
Marc says my leg is swollen, which, when he says it, I can
see is true. Did too much yesterday. 45 minutes with knees above
heart twice a day. Knee still hurts. Otherwise, all progressing fine.
About 11, Thom checks he has Marc's directions and escorts
his 2 cripples to the tram stop, collects change and buys tickets.
Although Sue and I are both draped in fanny packs, shoulder bags,
etc., you are still v. slow when you are on crutches and scared to
death of a fall. (On the way back, Thom ran all the way round to the
front of the tram to wave thanks to the driver who paused for about 5
minutes while we tottered off.) The first McDonalds after the
station is where you get off for the hospital. Then 3 bridges over
canals, Hall of Justice on the right, and Thom hustles his harem off the
tram. Now where?
"Brass band!" says Thom. "This way."
The flower market (7-1 on Sundays) takes place in a smallish
narrow plaza over a car park (with convenient toilet). Brass band
plays moldy oldies in a Victorian metal bandstand with Chinesey
flourishes. The flowers are on tables and on the ground. Bedding plants,
perennials, topiaries, box for hedges, silver willow for
moptops, herbs, veg, hydrangeas, viburnums, all at very reasonable
prices. My goodness it's a good thing I can't take things home.
Orchids, succulents, and cacti for indoors, 50 tulips for 6
euro.....There are a few stalls hoping to entertain kids while parents shop for
the garden, and quite a lot of the young are hanging out,
drinking beer, and flirting. A few people ask us (presumably) what we did
to smash ourselves up, and I confess I haven't come up with a
suitable answer. We are also handed various flyers because there is an
election on Sunday. This is easier, since the handers-out tend to speak
English.
Lunch is from what used to be a newspaper kiosk, styled to
match the bandstand. Thom had taken the precaution of asking Marc the
Flemish for oysters, which sounds exactly the way they pronounce it
in Thunderbolt. He did an impressive job of acquiring a plate
of oysters for himself and toasts with smoked salmon, crab salad, and
prawn paté for Sue and me. And 3 glasses of white wine.
On the way home, I managed to pull a muscle in my left
shoulder. This is highly incapacitating when you are on crutches with an
inadequate right leg, so I guess Marc's edict of more rest will get
enforced with very little effort on his part for the next few day.
Hugs to all, Karen
Resurfacing woes
Saturday, June 09, 2007 12:37 PM
My recovery is progressing slowly in its usual irritating
stop-and- go way. Sue disappeared yesterday. We thought she was having
a day on the town, but turned out it was a 'poor little me' day. You
have a good day and overdo it slightly, followed by a 'poor little
me' day when you have to catch up on sleep, etc.
Thom and I had a disturbing conversation with Koen De Smet.
He spends one or two days a week in town operating, and the rest of
his time all over the world at seminars and conferences, basically
trying to convince people that they need to improve surgeon training
and instrumentation.
He says he is worried about the future of resurfacing. It
has become so fashionable that loads of OSs have leapt on board and the
failure rate is now so high that resurfacing is getting a bad
reputation. The only thing that will help is better instruments and to
insist on higher standards for surgeon training, which is not
happening at the moment in the US or, for that matter, in Holland.
Obviously resurfacing is difficult surgery, but so is THR
and so are lots of other procedures. When you have a difficult
procedure that is widely needed, instrumentation evolves that makes the
surgery easier and more accurate. THR surgery has evolved over 40 years,
with instrumentation, operating tables, etc. evolving constantly,
so it is now fairly easy for a competent surgeon to learn the latest
technique in a weekend refresher course. But resurf is so new that the
instrumentation is still in its infancy. As a result,
success depends heavily on the skill of the surgeon and we all know there
are not many skilled resurf surgeons around, so the failure rate is
high, and that's pretty depressing. It also, as Koen points out, gives
OSs a VERY SOUND reason to say "Go with a THR" if you cannot find
a skilled resurf surgeon covered by insurance without a one-year
waiting list.
Hope all is well with you all, Karen
This and that
Monday, June 11, 2007 9:51 AM
I gave warmest regards from you 3 to Koen. His eyes lit
up and he asked what you were doing. Was especially pleased to hear of
you efforts to educate people to the necessity for excellent and
prolonged surgeon training. I think he remembers most of his
old patients--especially the problem-child bilats, I would
think.
He told Thom that they are gearing up for a flood of resurf
revisions, which is a pretty depressing thought, but it's
obviously going to be necessary, and here's hoping they improve the
techniques there too.
Not much news from here. You know how it goes. We sleep
better and better every night so are more and more likely to be late
for Marc in the morning. Marc wears me out, so I mess around till
lunchtime. Then try and nap after lunch until Evelyn picks up the whip with
4 PM water exercises. Next day Marc says you overdid it with
water exercises, take it easy today. And then there's the
occasional day when I rebel and go into town for a boat ride (Gent is
amazingly GORGEOUS), missing lunch and water therapy, or staying out
late to dinner in the evening and getting locked out by the Villa's
amazing security system. (Luckily we had Thom to send to scale walls
and route out Igor in his pajamas!)
Love, Karen
Sutures
Wednesday, June 13, 2007 10:00 AM
It took 3 strong men to remove the remaining suture from
my butt. Hugo and Ferdi embarked on this herculean task. Ferdi nurse
or nurse in training? He had the courtesy to introduce himself before
he upended me on the examining table. Sterilized his hands,
then he forgot and stuck them in his pockets while Hugo scoured the
premises for a missing suture kit. I'm propped on my elbow with my
butt in the air, admiring the trees in the garden. Koen sticks his head
in to say hi and see that all is going well, Hugo finds the kit and
the deed is eventually done.
Better than Larry's experience, anyway. He went back to
Madison, WI before the suture was ready to come out, so took the suture
kit to the local GP to do the deed. GP failed to read the
instructions and managed to infect the incision.
Koen De Smet, our surgeon is quite the character. All you
gather from a photo is that he is 40ish and small--maybe 5'3" and 120
lb, glasses, casually dressed with hair that looks as if he runs
his hands through it every 5 minutes (although Thom warns that
this may in fact be the latest $300 Euro jetset hairdo.) Impish grin,
nice sense of humor, and inquisitive nose. Gorgeous Italian wife
and 2 charming 10ish children. He operates and consults here one
or 2 days a week and spends the rest of the time on the road,
teaching, conferences, developing new instrumentation, etc. all for
hip surgery. He's been to LA twice since we've been here, and
Rome at least once.
Gotta go; torturer Marc is here and we've got a date
downtown. I'm feeling much better in the sense of having more energy, so
we're doing more sightseeing--if the guys haven't removed all my
strength with that suture.
Love, Karen
Sunday, June 17, 2007 12:52 PM
We are spending a week in Antwerp, then another in
Amsterdam before going home. Left Gent on Friday. It's nice
to be away from home during this recuperation period because
I have a million problem children awaiting my attention at
home, which would be driving me mad, and this way they can't
get at me.
I am nearly to 3 weeks post-op and very much in the same
state I was 3 weeks post-op the THR. i.e. the leg is healing
nicely, but healing is using staggering amounts of energy
and calories, so I am pretty exhausted most of the time. I
have enough energy to do exercises and an hour or so's walk
a day. The rest of the time I just want to sleep, and
usually can't. It's a drag and only time will cure it. But
the osteoarthritis pain is completely gone, of course, which
is a joy.
What fun to meet Peggy Gabriel! I do agree with her that at
your age you should go for a resurf if you can possibly
swing it. Blue Cross is sending a site inspection team to
Gent to look at the De Smet setup this summer, which must
mean that at least some branches of BCBS are planning to
authorize De Smet resurfs on a regular basis. BCBS has
already paid for some De Smet resurfs. I don't remember the
details. It's all on the surfacehippy web site somewhere.
I have a Stryker small ball COC in my left hip. Before I
left Ghent, I asked De Smet what I could do to make it last
as long as possible and he said, "Sit in your chair. Don't
move!" Ha, ha! Seriously, though, he said get the x-ray
reviewed by someone who knows what they're going every 2
years. Apparently problems often show up in x-rays before
you feel any pain from them and they are easier to repair at
that stage. My THR shows no problems at this point (3
years), but it's probably only a matter of time. De Smet
very kindly promised to review my THR x-rays over the years,
so I shall have the comfort of knowing he's keeping an eye
on that, anyway.
If you do go for a THR, remember that the surgery is not as
difficult as resurf, but it is still not easy. Make sure you
get a surgeon who has done lots of them and has a low
failure rate. Also, DO NOT be seduced by anyone who says
they will do it though a small incision (for rapid healing,
beautiful bums, etc.). The incision for a THR should be at
least 4.5 inches. Mine's more like 7. Reason is, the surgeon
cannot see what he is doing through a small incision. De
Smet says that essentially ALL the revisions he has done in
the last year are of resurfs and THRs through small
incisions where the prosthesis was not properly positioned.
A large scar is good! My resurf scar is more than 12" around
the side of my butt. It is now completely healed and looks
as if it will be invisible in about a year.
There is a Dr. Koech working with, and trained by, de Smet.
He's done hundreds of hips and his price is less than De
Smet's. I was offered a discount if he did my resurf. If I
was in your position, I would investigate him. Ask what his
revision rate is. I bet it is as low as De Smet's.
"Attendant" means husband or friend who goes with you. They
are very useful to have, of course. But on the other hand,
there are always stray husbands and friends around who are
happy to do shopping for anyone. Plenty of people go by
themselves. We befriended a delightful Californian who was
on her own and had resurf the same day as I did. Thom did
some shopping and errand-running for her, and when we were
up and about, we all went on trips out to dinner and into
Gent together. The staff at the Villa are as helpful as can
be. You only have to ask and someone will come up with a
solution to your problem.
Very very best of luck to you as you try to figure this one
out,
Affectionately, Karen
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