I returned from San Francisco last Friday, October 30th having had a 7 hour (!) bilateral surgery the day before. Its pretty amazing when you think I could even fly the next day -- compression stockings and all. I'm not saying it was a comfortable trip by any means but I sat in the bulkhead absorbed in some good celebrity rags and the 2 hour flight was over before I had a chance to really even complain about much. My biggest problem after surgery was that I could not lift my legs forward for a few days and this made any kind of step very challenging until I figured out a way to walk up the stairs in my house backwards with crutches for support. I was pretty achy and sore getting in and out of bed, car, etc until about Sunday but the progress has been rapid since that time. More on that in a moment.
Sampson: A World-class Surgeon with a Heart, A Brain, and Courage
No ruby slippers but he did wear over-sized rubber galoshes during surgery. I am thoroughly amazed by Dr. Sampson and his wonderfully competent staff. I knew that I would like and trust him which is why I flew all the way to SF when there is, uh, a certain well-known hip surgeon only 2 hours up the hill in Vail. Everything about my surgery experience with Sampson far exceeded my expectations and I can rest assured that no matter what happens with my hips in the future I was literally in the best hands in the world (at a cost of roughly $4500 an hour I would fucking hope so!). And that's just Sampson's personal fee -- does not include the costs of anesthesia (even Cigna considers this to be a medical necessity), the surgeon's assistant, surgery center fees or the compression stockings which I'm fairly certain you could get at Rite-Aid by purchasing ballet tights fit for a 12-yr old.
Sampson speaks in a gentle, soothing voice and actually asks you questions about yourself and what you do for a living, tells you where to go for sushi in Japantown, etc. He is kind and genuine and doesn't have even a hint of the arrogance typical of a surgeon and certainly one of his caliber. Brian and I met with him on Wednesday afternoon before our surgery and he spent more than an hour with us going over all of my films and scope pics from last winter. He examined me and told me exactly what he planned to do based on what he thought he would find and what he would do if he found something different. He was pretty certain that the large cartilage blister on my acetabulum was causing all of the trouble and was planning to get it to adhere back to the bone either through microfracture or tacking it back to the labrum if it was not too damaged. He did not think Psoas or It band were issues but said he would make sure that neither of these muscle/tendons were involved. His approach is very different from Dr. P's because he does not treat the hip as just a "labral tear and impingement issue". He has various methods for contouring the FAI CAM impingements and performing acetabular rim trimming but he also thinks that just repairing the labrum and removing the impingement is not capable of a one-size fits all approach.
In my case, he emphasized that I did not even really have a "labral tear problem" but rather a cartilage delamination issue of the labralcartilaginous junction caused by cam impingement wear and tear. Just suturing the labrum back together was not going to solve the problem last January nor now. Essentially, the articular cartilage on my acetabulum was starting to separate from the labrum and tear away leaving a big blister and flap and a whole shitload of pain (er, 18 months worth).
Adventures in Japantown
After our two-hour pre-op appointment on Wednesday afternoon we had plenty of time to enjoy a stroll around Japantown and an early dinner at one of approximately 840 sushi restaurants within a 2-mile radius. I didn't sleep all that much the night before surgery but figured that the 3 hours of sleep I got Tuesday night before we left Denver would tie me over at least until they knocked me unconscious on Thursday morning. (Thanks to Frontier who cancelled our flight at 10:30pm the night before forcing us to purchase tickets on United at twice the cost and take a 6am flight out of Denver lest the 1 inch of snow on the ground cause us further delays). I'm sure lots of soy sauce, raw fish and sake are not on the recommended list for pre-surgery dinners but, really, when has that ever stopped me. We opted to walk to surgery at 6:20 the next morning because it was going to be the last walk we took for a while.
The Private School of Operating Rooms
The whole surgical experience was vastly different at the Post Street Surgery Center than my previous surgeries (2/08 and 1/09) at Boulder Medical Center. Being the only patient having surgery that day probably makes a difference in the level of personal attention one receives I suppose. In any event, everyone was exceedingly kind and reassuring as they helped me dress and prep for the OR except maybe the anesthesiologist who started griping about his divorce lawyer about 2 minutes before he gased me.When I awoke a minute and a half later (well 7 hours to be exact) I was in an obscene amount of pain for about an hour till the morphine drip kicked in and the warming blankets helped with the awful bone-chilling cold from lying stark naked for 7 hours in a 45-degree room . Apparently, they keep the OR cold, cold, cold to keep the level of infection down. I guess I feel worse for the nurses and assistants who are just standing by passing a bunch of metal objects to the surgeon for hours on end in an ice-box. Its hard not to focus on how much pain you're in when you are still mostly paralyzed from the anesthesia. I read a piece recently by a well-known anesthesiologist defending his trade who said that major surgery is like getting hit by a truck except that the wounds are neater. In any event, when the nurse said I had been under 7 hours I immediately had that sinking feeling knowing that there was probably alot more damage than we had expected. And there was.
The Damage
Unfortunately, Right Hip is pretty trashed -- it appears that in the 10 months since my last scope the blister had now become a full-on flap which was partially separated from the bone. Sampson couldn't get it to stick back in its place so he cut it out and microfractured the area and used some tissue from the joint capsule to decrease the surface area between the labrum and cartilage hole (decreasing the total area in which I need to re-grow cartilage). Microfracture involves drilling tiny holes into the bone to promote bleeding which then creates "scartilage" to form over the hole. Not what I was looking to hear of course and I was pretty surprised about it because I had felt so much better in the 2 months prior to surgery. My left hip was about a year behind the right hip so we are now calling it Good Hip. There was cartilage damage in that hip too so its comforting to know that my misfortune was not the result of an NFL-sized tackle by my brother at age 11 or too many powder days in the back bowls of Vail but rather good, old-fashioned genetics and back luck. And, needless to say, The Race of 4/17/08 was not the cause of said misfortune, rather, it was only the straw that broke this camel's back.
Sampson, ever positive and a true believer in Joint Preservation Surgery, hopes that I will grow back the cartilage within 2 years and that I could possibly avoid a hip replacement in the future. I know he truly believes in what he does and that is admirable on many levels. I'm fairly certain based on statistics however that I will be replacing my faulty hip joints with balls of steel at some point. Hopefully this surgery bought me a bit more time than I would have had without it though. And in that regard I have to say that I am extremely pleased with the progress I have made so far due exclusively to Sampson's refined surgical techniques and expertise in minimizing the time the hip is in traction . I am already walking around without crutches, driving, doing light housework and not being forced to spend hours a day in that awful CPM machine. Being weight-bearing immediately is a Sampson trademark and I think it has already made an enormous difference in restoring function and strength to my hips as well boosting my mental state which is undoubtedly shakey. Most surgeons require 6-8 weeks on crutches after microfracture in order to allow the cartilage to regrow but Sampson believes it does not make any difference and the bigger issue is mobilizing the joint early through walking and biking and keeping the muscles from atrophying.
Ad Nauseum
Yes, its absolutely astonishing and maddening and crazy-making that I have been dealing with this for more than a year and a half and there is still no clear way out of pain and back to (most of) the activities I love. I am still trying to wrap my head around the fact that I have suffered such an enormous misfortune as to be looking into hip replacement options in my 30s when my 68-yr old dad is playing tennis 5 times a week. I realize in the scheme of medical misfortunes this is not life-threatening but as I have said it is life-altering and that is worthy enough of some self-indulgent blogging. Did I ever think 2 years ago as I enjoyed 3 days in a row of tele turns at Beaver Creek and Breckenridge over Christmas that I would be ready to sell my quiver back to Neptunes knowing that all of my skis - phat and skinny -- will be outdated by the time I can really ski again? More importantly, did I ever think that I would be paying someone $20 an hour to walk my two dogs on a weekly basis because I can never anticipate when I'll be feeling ok enough to do it myself?
Kind of makes you wonder what the hell life has in store for you, doesn't it.
