THR VSlowLife's Pre-op Questions

[GrannyC]

Thank you for the info!

 

[VSlowLife]

I was very impressed with the hip surgeon I saw today. He suggested EOS full body x-rays which he said would be used in an algorithm. The EOS x-rays were easy. Anyone else go through this and how did it work for you?
The EOS x-Ray uses much less radiation than a CT scan.
He recommends the mini-posterior approach with a dual mobility hip and I will not have any 90 degree angle restrictions!
He said my hip was about as bad as it gets.

 

[Elf1]

Never heard of them, just had plain old ordinary x-rays. Nice on the dual mobility, I know you were worried about dislocation due to back issues. Take note, on regular implants if you do dislocate they can usually get you back in place without surgery, usually. With the dual mobility from everything I've read, heard and discussed with my doc that is not an option. Just something to cover with your OS. Seems like they are really interesting and great if you're very active, plus I believe I read they are less likely to dislocate. So, when the date?

 

[VSlowLife]

@Elf1 Thank you! Am I understanding you correctly, that a dual mobility hip is not so easy to insert back in after a dislocation?
I see a second opinion in less than two weeks.

 

[Elf1]

@VSlowLife IF you should dislocate with the dual mobility implant it requires the doc to basically go in to reset it, a new surgery. But they are supposed to be really good at NOT dislocating. Not sure that's a word but you get my drift.

If you have a regular implants, single ball, and you happen to dislocate, they can usually pop it back in, under heavy meds, without opening you back up. Usually.

Sorry that I can't remember where I was reading about that or I would send you a link. I do know that I had asked my OS about the possibility of having one and he said he would have the implant rep have one on site so that if it warranted using one he would have it there. He wasn't super familiar with it so am pretty happy we went with normal implant. I did verify the differences of how the two implants would be fixed in the event of dislocation.

Unfortunately we all have dislocation in our brains so much we're almost afraid to !I've in the beginning. It's really not that bad, just have to be careful. I'm not trying to freak you out of persuade you to go either way, just wanted you to research this for your piece of mind. Let us know how the second opinion goes. But you're pretty much better off leaving the type incision, implant, etc decision to your OS. He/she will use what they are best versed in and what they think is best for you.

 

[VSlowLife]

@Elf1 Thank you so much for explaining it so well. You did do your due diligence in looking into both implant types! I did not ask for the dual mobility (DM) implant, rather the surgeon said that was his suggestion after we chatted. I used the BS guidelines and asked for his opinion, since that is what he would feel most comfortable doing. Although he plans on mini-posterior, he explained there is a risk for femur fracture and that of course would require a longer incision, should it happen. That could happen with any approach.
Since I have a recent history of hyperparathyroidism caused by a tumor, that is a real consideration and I am glad he was honest with me. Since my parathyroid surgery this spring, I having been feeding my “hungry bones” post surgery with plenty of calcium sources. I have osteopenia, and I am not far from osteoporosis, thanks to this hip pain and my parathyroid tumor. The pain in my hip is so bad, I think I will be okay, as long as I know what to do. I have been on crutches before and survived well.
I have seen photos of titanium’s ties around the bone and then there is no weight allowed on that leg until the bone heals, if I am recalling correctly. I was up at 5:30 am to make this trip today. I was icing when I got home.
I do not know much about the DM. I see on BS some folks have psoas rubbing issues, and there can be a concern about more debris wear from the larger head. I am looking into it, now that he mentioned it. They have pretty good statistic in the US for 10-15 years, but no long-term data yet. Europe has better long-term data.
With what looks like one liner ball inside a liner, I can see why it may take a surgical procedure to fix a dislocation. Maybe Josephine knows more about what happens when a dual mobility hip dislocates? I do not think I can contact her directly? Do you know?
I am not sold on it until I learn more. I do know the very high density poly.... with vitamin E does seem to have a very low debris wearing rate compared to other articulating materials. There seem to be a few different types of DM with a variety of materials. This surgeon would be using a Smith and Nephew type.
Gee whiz my x-ray looked bad. All bone on bone. I have several bone cysts now, instead of just one.

 

[Elf1]

@VSlowLife sounds like this surgeon is on top of things. Good that he's the one that wanted to use the dual mobility implant, that means he's quite familiar with it and that's what you want. Did you ask if they had any info on the particular implant he wants to use, like a brochure or something? I'm guessing you could Google the company and see what it says.

Your thyroid treatments definitely threw another monkey wrench in your surgery plan but if the OS feels comfortable and answers all your questions and concerns, and it makes you feel better than I would day it's definitely worth it. I know my hip is so much better than before and I'm only 10 weeks out so still have a way to go.

Like I said, my OS did verify that what I read about the DM needing surgery in the event of a dislocation BUT they are supposed to have much less chance for dislocation, though I would still be very careful the first couple months. And from what you've researched and what I saw these DMs are seeming to be very well suited for folks with spinal fusions. I think you're on the right track but will be curious to see what your second opinion brings.

I'm wishing you the best in your search for a surgeon you're comfortable with, that's one of the most important things, and wishing you the best as you head down the path to surgery. I'm here for any support you may need, just tag me!

 

[VSlowLife]

I just had a list of prepared questions @Elf1 which he read and answered because my pain level goes up and my brain gets less thoughtful. My second goal was to see if they could schedule me in the same day for the EOS x-ray, because it is a very long trip in. I take a special bus with seats that recline. Within 10 minutes after I saw the surgeon, they had me in the EOS machine!

Yes, I can find it online. I found a very nice presentation of 44 pages for the surgeons to read, with many pictures. Someone from his office will call me today and I will ask about the model. I have to say I was very impressed by the staff, how they guide you from one place to the next, and I never needed to wait more than five minutes.

Since I live a distance away he said he would most likely keep me in the hospital a second night.
I walked a total of 8 blocks yesterday and my right knee is on ice today. As the hip has become worse, the knee is corresponding, which I hear is typical. If I am lucky whomever I choose will most likely do the other hip soon, too. And if this knee keeps acting up, who knows? Maybe it will settle down after the hip is corrected.

Even though I write or voice “parathyroid” most people think thyroid. It happens all the time. With the parathyroid it creates increased calcium in your blood and not as much going into the bones. Thirty-two out of 100,000 people get hyperparathyroidism, so most doctors will never see it in their lifetime.

Thank you so much Elf, I really appreciate the support and I am cheering you on, as well a a few others, at this time. It helps me greatly when people tell me about “that pain” being gone, and I can read how much you all are getting out and about.

I do have to go back for allergy testing because I had an allergic reaction to vancomycin, (itchy head and ears 12 years ago) and we have to make sure it was not because it was infused too quickly before that surgery. This surgeon, as well as others like to use vancomycin. I am allergic with red dots all over for a week, to another antibiotic, but it’s not so broad spectrum.

 

[VSlowLife]

@Josephine, @Elf1 brought up a topic you may be more familiar with regarding dual mobility implants, since they have been used in Europe for many decades. If a dual mobility hip dislocates, does it always require surgery to re-insert it? I saw a surgeon yesterday who recommended a mini-posterior approach with a Smith and Nephew dual mobility hip implant. Does it depend on the model?
Thank you!

 

[Elf1]

@VSlowLife I think Josephine is still out having/recovering from a surgery of her own.

Sounds like a great IS office, thinking the second opinion is really going to have to step up! My knee bothered me really bad prior to surgery, I used one of those stretchy type knee braces that you pull up and it helped some. And, knock wood, it hasn't really bothered me since surgery other than when I'm really limping.

 

[Jamie]

This is true if you are ONLY covered by Medicare Part B insurance. It may not be the case for Medicare Advantage plans or if you have secondary insurance. If you are concerned about coverage, you need to call each of your insurance providers and ask specific questions pertaining to your individual coverage.

In the 10+ years I've been here on BoneSmart, I have to say I cannot recall one case where a person's additional consultations with surgeons has been denied by insurance.

 

[Layla]

Hi @VSlowLife
Popping over here from a post of yours I read on Onestepatatime's thread.
You mentioned giving up coffee and missing it. I've never tried this substitute, myself, but have read of a product many times called Cafix. Is a natural coffee substitute made from caffeine free ingredients including barley and chicory, touting a rich full flavor as in regular coffee. You can purchase it from Amazon as well as other places I'm sure. Amazon has quite a few reviews online. May be worth checking out...depending upon how much you're missing coffee. Just thought I'd share. I hope you're having a good week.
Enjoy the afternoon and evening!

 

[VSlowLife]

@Layla Thank you for that suggestion! I will try it. I chose my surgeon today, but NYC is crazy today with UN traffic and I will be lucky to get home by 7 . The office wants me to call after I am home. I have my surgical package. May have to wait until December or January.

 

[Layla]

Hi @VSlowLife
You're welcome. Congrats on choosing a surgeon, you can now check off one more step in the process.
Hopefully you won't have to wait as long as December or January for surgery, fingers crossed.
I wish you comfort in the interim.
Safe travels home in the traffic!

 

[VSlowLife]

@Layla I will have have to wait until December or January. I asked for the soonest date. I was hoping for late fall early winter. I did not want to miss summer. My community has a senior bus when I can’t drive with a lift if I need it. And the local grocery store has a delivery service. Found out my left hip is not quite ready. I have a level, black top driveway which melts ice quickly or light snow. Last winter I did not need my driveway plowed.

 

[Layla]

All good things, sounds like you'll be covered in a lot of ways.
Sure makes it easier realizing how you'll navigate recovery.

 

[CricketHip]

Glad you decided on your surgeon! That is a big step. Traffic was bad today in my area, too. but what you are describing sounds pretty intense. Hopefully you are home and relaxing now.

 

[leejaa]

Congratulations on finding a surgeon you like and trust. This is such an important step. My surgeon and the hospital he operates out of is 1.5hrs away but so worth it. I trust him and like him and his office is very organized and responsive which for me is also vital. I hope you get the soonest date that you desire.

 

[VSlowLife]

@Layla Thanks to the help from the forum advisors and others who post, who have been generous enough to share, I think I will have most things worked out. I bought a used Breg continuous cooler machine with the extended hip pad, from e-bay and it arrived today. I will sanitize it today and test it out.

@CricketHip Thank you. I feel a bit more settled. It was the worst traffic I have ever experienced in NYC. Coming out of the Midtown tunnel was such a wait, that the bus let us off in the street as we approached the sidewalk, instead of going up to 3rd Avenue, which made less steps for me since I needed to go to First Avenue. Police were everywhere. It was a very bad day to need an ambulance in NYC. The ride home took forever. I was home by 7:15 and in bed by 7:30. I had been up since 4 am due to hip pain. The bus had reclining seats and a foot stand so that helped my hips.

@leejaa Thank you for your support. Yes, I had noticed his office was very responsive, too, which I liked. They may keep me another night because I have a long trip home. This doctor gave me quite the exam, was super focused, and spoke to me about both hips. He explained I am at risk due to multiple allergies, some being antibiotics. So I will need to get patch tested for vancomycin for sure. The last time I was infused with it, my head and ears became itchy and the nurse told me that was an allergic reaction, and stopped the infusion. But, if they infused me quickly, it may not be a true allergy, I have come to learn. The surgeons in this hospital like to close the surgical site with vancomycin. Their protocol is to always use antibiotics for dental work because they feel bacteria has an affinity for metals.

@Layla , @CricketHip, @leejaa The office called me today and can’t schedule me until the doctor comes back from a conference. He will be away next week, so no surgery date just yet.
I was given a large packet to read to prepare me for what is to follow, and how my home care will be coordinated with a visiting nurse, occupational therapy and physical therapy.

 

[CricketHip]

Oh shoot!! Thats disappointing,, but I guess nobody else is getting scheduled, either.
The one thing we are all learning with our joints is patience.
Im so glad you’ve found your surgeon, though.. that is a big step.
Enjoy your weekend.