Stubbornness and Persistence
Qualities to have when managing your own health care

By Craig M. Peters

We have all heard or seen countless stories of a person who contracts a debilitating illness that robs them of any reasonable quality of life. The doctors give the family no hope of improvement even to the point of telling family members to let their loved one go. But due to heroic and unyielding efforts by a family member to uncover all possible treatment options, that patient beats the odds and makes a full recovery. You might say, "This only happens in Hollywood! That stuff never happens to people like me". These are the thoughts that tend to creep into the minds of most people at the worst possible time. These are also the ideas that need to be discarded to give an individual any possibility of hope.

While hopefully most of us will never have a dire medical condition as devastating as the events stated above, each and every day many of us will deal with medical conditions that need careful consideration of all available options. My own personal medical journey, while not life threatening, was threatening my way of life. It meant an extreme, unwelcome, drastic change in how I was going to live the rest of my days. I needed to be my own best friend and do what was right for me in spite of initial medical advice. While I do not consider my actions as heroic, they definitely paid off in the long run. Hopefully, my story will give some individuals the heart to take control of their condition and personally manage their own treatment.

I have always been extremely active in my personal life and I especially loved to participate in sports…especially basketball. At the age of 50, I started to feel something going wrong in my right hip. It started as just a small catching when I would try to stand after sitting for any length of time. It progressed steadily until I was receiving constant, regular signals that my condition was getting much, much worse. I now had an arthritic hip and at the age of 53, the only option orthopedic surgeons were giving me was a total hip replacement. These were not the words I wanted to hear.

Before we delve into my own personal odyssey, let me give a little background information to help paint the whole picture for you. I will leave out most specifics because this story is not meant to be about me. The intention is to give to those individuals who are currently suffering from medical conditions the strength and motivation to take control and become the managers of their own health…. to explore all options for moving towards the best possible conclusion, and properly deal with their own care.

As I previously stated, I have always been active in sports. You might think this is going to be the story about a guy who was so physically gifted that he was always the first one picked when everyone was getting together to play a game. And you would be wrong! There was nothing really special about me. I can never remember myself as being the most physically talented athlete on the field or court. Far from it! My main qualities were that no one ever worked as hard as I did, I played with no regard to ever getting hurt, and I wouldn't listen when others (even coaches) would tell me to give it up. I loved the game of basketball. It was a part of who I was!

I eventually went on to play college basketball and two years of professional ball. I was not a superstar athlete, just an average guy. I am fairly sure most people would not remember much if anything at all about my playing days. My career came to an end because of a fairly nasty knee injury. Once rehabilitated, I had lost a half step which allowed me to still play at a fairly high level, just not quite enough to play in the pros. I never stopped trying to get back what I had lost and continued to play in the highest level leagues I could find. Even up until the age of 48, I was still playing on teams with guys in their 20's and 30's and gave them everything they could handle.

Due to some minor strains and aches, I stopped playing for awhile and took the time to totally remodel my home on nights and weekends. It took me about three years to complete and the physical strain from the moving and pounding and lifting is what I feel caused the ultimate deterioration of my hip. I now had pain when I stood up that was much worse than I had ever experienced in my life. I attempted to treat it on my own using ibuprofen, glucosamine, and every homeopathic remedy I could find. When the problem got so bad that I could no longer deal with it on my own, I decided to seek medical advice.

I went to see a surgeon who had previously done arthroscopic surgery on my knee about 15 years earlier. Dr. G had done a wonderful job on my knee and I had considered him nothing short of a miracle worker. Why wouldn't I want him to help me overcome this hip thing? I told him that I felt that there was floating debris in my hip. My symptoms had increased to every time I sat for more than three minutes, my hip would catch and lock. It would take at least 30 seconds to stand fully straight accompanied by a searing pain. It would also take about another minute or two for me to be able to walk freely with no pain. Once fully upright, I could run. I could walk faster and farther than just about everyone after the pain went away. I was also fairly hesitant to sit down unless it was for more than a few minutes because whenever I tried to stand up, the whole catching and pain scenario happened all over again. This also created problems for me at work. I was a sales and marketing manager for a manufacturer which caused me to go through that ordeal well over 100 times per day.

I told Dr. G that I wanted to get back to playing basketball. He said he needed to see what was going on. He sent me over to get X-Rays and after reading them, he told me the bad news. I had what was termed as SEVERE DEGENERATIVE ARTHRITIS of the hip. Next, he said those words that went through me like a knife. "Your basketball playing days are OVER. You need a TOTAL HIP REPLACEMENT". I'm absolutely sure he thought my reaction to his diagnosis was strictly a case of denial. I told him that I did not believe it was as bad as he said it was. How could it be? I could run and walk with the best of them and it was only the two minute span when I got up from a sitting position that I had a problem.

He asked, "What do you want from me"? I told him that I would like him to do an arthroscopic procedure on my hip. He informed me that he did not do that procedure on hips and did not know any surgeons who did. He went on to tell me that I would not be a candidate for that procedure anyway. My reply was that with all due respect, how could he tell me whether or not I was a candidate for that surgery if he did not perform that particular procedure? This didn't seem to sit well with him.

Have you ever run into that attitude that most surgeons can give you when you question their opinion? This was definitely the case here. While I respect the training and experience of EVERY surgeon out there, many of them tend to roll out the GOD COMPLEX when they are being questioned. They seem to forget at that time that it is the patient who has to be assured on what is their shot at the best possible conclusion. We are the ones who are PAYING THE BILL but ultimately (and most importantly), we are the ones who will have to live with the end result of whatever procedure is performed on us! I debated with him for another ten minutes and then asked for a referral to another surgeon who does do that procedure. He said he would do what he could. A week later, I received a form from my medical group approving a referral for a second opinion. I was referred to a Dr. SB.

A few weeks later, I arrived at my appointment with Dr. SB, and was actually seen by another doctor in his practice, Dr. KJ. Dr. KJ went through the usual examination and afterwards said that I might be a candidate for arthroscopy, but that they did not do that procedure on hips in their practice either. The only solution they could offer was a total hip replacement as well. I rejected that opinion for the same reason as before. Dr. KJ told me that she would consult with Dr. SB and see if they could find a surgeon that did hip arthroscopies to send me to. I was called later in the day and told that Dr. SB did not know anyone in Southern California that did hip arthroscopy. She also stated that Dr. SB not only felt that I was not a good candidate for hip arthroscopy, but that he also did not believe in that procedure on hips anyway. Since this was in mid December and our company insurance was being changed to another provider on January 1st, I decided to wait and continue the process with our new insurance.

I saw my new primary care physician in late January and was immediately referred to my third orthopedic surgeon in four months. I saw Dr. PB in mid February. "Saw" was a good word for it because the whole consultation lasted less than seven minutes. It appeared that I scheduled my appointment for the worst possible day because this particular office seemed severely overbooked. I showed up 20 minutes early for my appointment and waited 90 minutes past my scheduled time to even be brought into an examination room. I gave his assistant my X-Rays and she put them on the light box to be ready for the doctor. I wasn't ready for what came next.

Dr. PB walked into the examination room and without even asking my name or addressing me in any way, looked at the X-Rays and said, "It looks like someone here is headed for a hip replacement". I said, "Oh really? Would it interest you to know that the person those X-Rays belong to can run and jump and walk for long periods with no problems?" Dr. PB then said, "Then why are you here?" I told him that my hip catches and it hurts like hell for about two minutes afterwards and that this happens 100 times or more per day due to the requirements of my job. He said, "What do you want me to do?" I told him I wanted to explore the option of hip arthroscopy. He informed me that he doesn't do the procedure, doesn't know if I would receive any benefit from the procedure, but would put it through to the medical group to find someone to refer me to. He never even put me through the usual range of motion examination. He got me out of his office as quickly as he could. I guess he had someone more important to see. I guess I should have seen what was to come next. In retrospect, I wasn't surprised about the outcome.

His report did not make it through the system for approximately six weeks. It was obvious he took less than complete notes because when his report finally surfaced, it basically stated that he had informed me that I needed a total hip replacement and I just didn't want to listen. The findings in that report killed any more progress from the medical group because they now refused to do anything more with me. The choice I was now faced with was to either undergo a total hip replacement or go away and shut up! I spoke with my primary care physician and he said that he would help me fight the medical group. He asked that I write a letter stating the whole process that I had experienced. He wanted me to refute Dr. PB's version of what happened. He said that if I wrote it as if it were coming from his office and then sent it to him to process it, the finished document would be much more complete than what his office staff could produce. I immediately wrote the letter and emailed it to my PCP's office the same day.

After two months and numerous inquiries from my PCP's office with no reply from the medical group, I pushed them for an answer. The answer finally came back that the medical group was washing their hands of this problem and they were now giving it back to the insurance company to do whatever they felt was necessary. They didn't want to do their job and just wanted me to go away. I was now so frustrated with the whole experience, I told my wife that if I go ahead and have the total hip replacement, I would never be able to play ball again. Not only that, but even in my compromised state, my current level of activity would need to be curtailed once the replacement procedure was done. I told her that even with the pain, I might as well go out and play basketball until my hip was totally blown out. She wasn't too happy with that decision, but knew that once my mind was made up on any topic, it was fruitless to try to dissuade me. For the first time in my life, I was getting close to the unthinkable…giving up!

File that idea under the best laid plans. Just like everyone else, I get frustrated too and considered forgetting the whole thing. But reality soon raised its ugly head. Throughout this whole ordeal, my hip was rapidly deteriorating. I was only able to play basketball two times over the next two weeks until I realized because of the pain that something needed to be done. Besides, my effectiveness at playing basketball was at an all time low. I stunk up the place. I spoke with my insurance company. What happened next was an experience I will never forget. The rep from my insurance said that the medical group couldn't do what they did. He said that he wanted me to stay on hold while he spoke directly with the medical group. He came back on the line two times to apologize for how long it was taking and to ask me a couple more questions. He finally came back and said that the people at the medical group were awful to deal with. He asked if I cared if they changed me to a different medical group to get me taken care of. He asked if I could call back later because he needed to get management authorization.

I called back later and was immediately transferred to the manager. It was then that I was informed that I could not change medical groups because I had received a diagnosis and treatment from Dr. PB. I informed them that I did not receive treatment from Dr. PB and I was the one who provided X-Rays that were ordered from another doctor while on another insurance plan. I never received so much as an aspirin from Dr. PB … not even a hello! She went through a list of scenarios and that if I met even one, I was dead in the water. After going through the list, I did not fit into any of the situations listed in their criteria. It was at that point that I was informed that I could change medical groups and was given a list of providers to choose from. Imagine that…an insurance company trying to get me authorized for a procedure when the medical group was trying to prevent it!

I tend to do a great amount of research online and had been searching for well over a year for every available option to a total hip replacement. I still wanted to explore hip arthroscopy and found after calling no less that 350 orthopedic surgeons in Southern California that although they all do arthroscopy on knees, elbows, and shoulders, less than 5 percent of them do hip arthroscopy and only about half of that group accept much in the way of insurance. In going over the list of surgeons provided by my insurance, a very familiar name came up that had surfaced many times while doing my internet search. The name was Dr. Robert Klapper, also known as the "Hip Doctor". Dr. Klapper's specialty is the area of treating conditions of the hip. He is also Chief of Orthopedic Surgery at Cedars Sinai Medical Center in Los Angeles, California.

After going through the usual insurance process of picking a PCP and medical group, I was finally in a position to receive the best possible information. Dr. Klapper performs all available known options to treating my condition, so there was nothing in it to push me towards any certain procedure. I told my wife that if after being examined by Dr. Klapper, and if he still felt that a total hip replacement was the best thing for me, I would take that path. I arrived at my appointment extremely upbeat. Once into the examination room, I gave the nurse my now 1 year old set of X-Rays. She informed me that they would need to take new ones to see where I was at this point in time. Since the X-Rays were actually taken in his office, they were ready to go in ten minutes.

The moment that I had been waiting for over a year was finally here. Dr. Klapper came in and spoke to me for a few minutes. We went over my ordeal in trying to see if hip arthroscopy was an option for me. Dr. Klapper looked at the X-Rays and said, "I'm afraid you're not a candidate for arthroscopy". This was starting to sound like a broken record (translation: CD or DVD if you're younger than 40). I was now thinking that this session was going to go pretty much the way the last three had gone. I soon found out that I was in for a big surprise.

I asked him to please look at my X-Rays from a year ago to see if I would have been a candidate back then. He did as I asked and told me that at the time those X-Rays were taken, I was definitely borderline, but given my health and activity level, he probably would have done the arthroscopy anyway. That comment made me feel even worse because my having to fight the system for over a year cost me the chance to do a much less invasive procedure.

I told Dr. Klapper as facetiously as possible that this was just what I wanted to hear. He said, "Don't worry! We have options". I told him I was listening. He said, "We could do a total hip replacement". I said, "I didn't want to hear that one" (even more sarcastically than before). Dr. Klapper obviously understood my frustration and calmly replied, "I told you we have options. Have you heard of hip resurfacing"? I had gone through all the available treatment options during my many hours of online research and had heard of this procedure, but had not found anyone local to me who performed it. I asked him to tell me about the particular hip resurfacing procedure that he performs. He informed me that it was the Birmingham Hip Resurfacing System by Smith and Nephew. He went through the procedure, what to expect, and the risks involved.

I was now starting to see some light at the end of the tunnel. What came next was what I especially wanted to hear. He said, "Once you have healed from the surgery, there will be no restrictions on you. You can do martial arts, mountain climbing, whatever. Just send me a picture of you playing basketball when it is all done!" I had finally received an acceptable option that would work for me! Dr. Klapper asked if I wanted some time to think about it. Since I had well over a year to think about it, I said, "Sign me up"! He informed me that on the day of surgery, he will be the one doing the procedure. No stand-ins. No substitutes! We scheduled a date for the surgery immediately.

I couldn't wait for the day of surgery to arrive. I was almost like a kid waiting for Christmas morning to get there so he could open his gifts. In pre-op, Dr Klapper came in to go over what was to happen and to mark the hip he was going to operate on. He didn't want any questions once in the operating room and wanted to check one more time that it was my right hip we were supposed to do the procedure on. I told him that I had already marked the other hip with a big "NO". We had a good laugh about that one. He left me with the words, "See you in recovery".

When I awoke, I was feeling a little fuzzy and although I felt some pressure in my right hip area, there was definitely no pain. Without going into the whole hospital stay (which was great) and the hospital food (which wasn't so great), I spent three days in the hospital with nurses coming in every two hours asking me, "Are you SURE you don't need any pain medication?" Up to this point, everything had gone better than I could have ever hoped for.

Just before being discharged, I was given specific orders on what I was allowed to do for the following six weeks. I may be an isolated case, but the whole experience has gone much better than anyone could have ever imagined. Three days on two crutches. Three days on one crutch. One week using a cane. Imagine, just two weeks after surgery and I am now walking with no aid and without much of a limp. Four weeks after surgery and I am now walking with no real perceptible limp and the best thing is… no pain when I get up from a seated position.

At six weeks, I had my final followup appointment with Dr. Klapper. Before even looking at my chart, he walked in, shook my hand, and told me to come out into the hall so he could see my gait. He was so ecstatic on what he saw that he called practically his whole office staff over to watch me walk. I now know what a runway model must feel like. At this point, Dr. Klapper also released me to begin basketball related workouts (for building my strength and flexibility) with the plan to attempt to play ball in a month. He left me with the order to listen to my hip because it will tell me specifically when I am trying to do too much. Going into the final stretch, all signs gave the appearance that victory was finally within reach.

I am now totally pain free. I am back to playing basketball. I look forward to each new day rather than waking up each morning dreading the pain that had become a daily part of my life. I am back to living an unencumbered life and doing things that I truly love. My wife tells me I am a much easier person to be around. My energy and zest for life has returned. And all is well with my world. I could have listened to what the very first surgeon said and had that total hip replacement, but life as I knew it would have been forever changed in a negative way. That is why I feel that my stubbornness and my persistence were huge qualities I needed to possess to achieve the most successful conclusion to my health issue.

A widely held belief is that part of the Hippocratic Oath that physicians take says, "First, do no harm". This belief is incorrect because it has never been part of the oath. It is; however, a precept that is one of the main themes taught in most medical schools. By offering me an option which would have negatively affected my life from that point on, three orthopedic surgeons I had seen prior to Dr. Klapper were practicing in direct conflict with that theme. Dr. Klapper demonstrated a care and regard for not only the medical aspect of me as a patient, but my future quality of life as well. That is what separates him from those doctors who have forgotten that they are treating a person and only want to go about the business of medicine. Dr Klapper has given my life back to me. I could never thank Dr. Robert Klapper and his staff enough for what they have done for me.

In closing, Dr. Klapper finally has his trophy from my ordeal … a picture of me playing basketball! I will now forever proudly admit to being very stubborn and extremely persistent! Those "qualities" and Dr. Klapper saved my life! Thank you Dr. Klapper for being there!

Dr. Klapper can be reached online at www.drklapper.com and he can be reached by email at rklappermd@aol.com. His office is in West Los Angeles at 8737 Beverly Boulevard, Suite 303, Los Angeles, California, 90048. His office telephone number is 310-659-6889 and fax number is 310-657-3841.