Home sweet home

Looking at the Sierras of Balcarce from my kitchen window

La Barrosa, which has some fantastic bouldering, as seen from my backyard

Two weeks and two days after surgery, I got back home to Balcarce, Argentina. The following Monday, two weeks and six days after surgery, I drove the 130 mile round trip to the national university (UNICEN) where I work as a math professor. I had no real problems working the clutch with my recently operated left leg. So there's one problem with having Koen De Smet as your hip surgeon: no excuse for staying home from work. However, up to this point I've only been doing the trip to the university three days a week. Fortunately I have some freedom to keep up with my nonclassroom work at home.

For rehabilitation and exercise, I've mostly just been walking, using a pair of trekking poles. I also did some leg exercises, light stretching and stationary bike. By the fourth week I was hiking three to four miles a pop (with the trekking poles) and occasionally doing half an hour on the stationary bike. I tried to do some pull ups and light weights to condition my arms for climbing, but I got bored with that and quickly lost interest.

Last Saturday (a week ago today), exactly five weeks and four days after my revision surgery, I started training in my home bouldering gym. Here's what that looks like from the outside:

My daughter Cecilia in front of my climbing gym. The bouldering wall is visible inside 

Even though I have crash pads two layers deep on the floor below my wall, I'm still nervous about causing any impact on my newly repaired hip. The first day on the wall, I just planned on doing a few traverses, but after warming up I felt confident enough to do a couple of moderate boulders that climb to the top of the wall. I felt I wasn't risking a fall, and I carefully downclimbed to get back to ground level. I even put an extra crash pad (three layers deep!) underneath the downclimb zone.

Traversing the wall

Feeling confident on a big move near the top

Heading up the wall. The red pad is an extra, third layer  to avoid impact on the dismount

I tired out pretty fast during these first sessions. Besides being out of shape from the catastrophe of my first  hip surgery, I'm also about fifteen pounds over my peak climbing weight. However, with all the walking I've been doing recently, I've managed to come down about six pounds since my revision surgery. Hopefully this trend continues.

During the first bouldering session, last Saturday, I only managed to complete three moderate traversing boulders and a couple of going up boulders. For the second session, on Monday, I added a couple of slightly harder going up problems to the repertoire. In the third session, on Wednesday I began to loose my fear of "falling" (more like stepping down) on attempted harder moves near the ground, and continued to add a little more climbing to the pre-existing routine. Yesterday (Friday) I went on my longest hike to date (about five miles, with the trekking poles). This hike will be the subject of tomorrow's post. Right now I'm set to start my fourth bouldering session in the gym, as soon as I finish cleaning up the kitchen. Hopefully, in about two more weeks I will begin to climb outside, for real. Wish me luck!

Medical tourism in Gent, Belgium

Gent, Belgium: like Disneyland but for real

My revision surgery with Dr. Koen De Smet took place on Feburary 14th, 2012 in the Jan Palfijn Hospital. That day he did (I believe) six sugeries. People in the hospital told me he likes to save the most difficult surgeries for last. Mine was last. From what I understand, his hip resurfacings were completed in about 45 minutes. My surgery took 90 minutes, so I guess it was a bit more complicated. The next day De Smet did six more surgeries. Holy hip surgery, Batman. After follow-up visits with the patients, he disappeared for a week long vacation.

Seven of us patients were medical tourists who stayed for a rehabilitation period at the Holiday Inn Express. We got along just fine together, seeing each other improve and going out on the town. Our early progress went like this: the day after surgery, in the hospital, we got out of bed, hobbled around on two crutches and sat in a chair. On day two we left the hospital and rode in a taxi-van to the Holiday Inn Express. Our wounds were dressed with waterproof bandages, so I was able to shower in the hotel the second day after surgery. Except for daily visits by a physical therapist and a nurse, we were pretty much free to pass the tiime as we wanted to. By the third day I was walking with one crutch and began gradually increasing the distance quota. We went out on the town, ate in restaurants and drank beer. I stayed in the hotel for 10 days (the other patients left a few days earlier), rehabilitating for the 15 hour flight back to Buenos Aires

My wife Gabriela (Gaby) and I were surprised how much fun this rehabilitation period was. Here are some photos.

Some of De Smet's patients and their spouses out on the town five days after surgery

Gent is pretty at night

My sister and my wife are ready to storm the castle.

A breather in front of the Belgium flag

Downtown Gent

After hundreds of stairs, a view looking down

Tim and the swedes (with their newly resurfaced hips) looking to chow some grub

Some German friends came to visit

Statue points to England in downtown Gent

In Belgium they worship beer

As far as pain went, for about two or three hours after surgery I hurt pretty bad and kept myself busy pumping the morphine button. Later that night I pushed the button a couple more times. After that, I only used pain medication on two seperate occasions, when I didn't even really need it.  

Overall, the rehabilitation when smoothly and I got better every day, with one small glitch. Nine days after the surgery, a small hematoma appeared at the base of my surgical scar. This gave the nurse quite a scare. On day eight I had been very active, walking and so on, but I personally feel the real cause of the problem came from overdoing it with the physical therapist. On day eight we had been working on stepping forward and sideways on the operated leg and then shifting over to balance my full weight on the leg. This felt very hard to me, but I also enjoyed the challenge of getting pushed by the therapist and pushing right back. The next day I felt too weak to repeat the exercise and that afternoon the nurse found the hematoma. When De Smet diagnosed the problem after returning from vacation on Sunday he admonished me for doing too much. I didn't tell him about my antics with th physical therapist. I guess the old "don't squeal" mentality, learned in grade school, runs fairly deep in my psyche. So here's an important safety tip: if you're just nine days after revision surgery don't go balancing full weight on your recently operated leg, even if the physical therapist recommends it. At any rate, since then I haven't had any more set backs and in a few days the hematoma disappeared. Dr. De Smet told me that the usual treatment involves taking antibiotics to avoid infection but since I was already taking a massive dosis for the bone infection, there was nothing else to do. I continued with the walking, although for a few days I eased  back a bit. . 

How I wound up in this mess

If this blog endures, I'm hoping it will be more about climbing and less about hip surgery. At this point I'm thinking it could be of interest to someone who climbs and is facing the prospect of hip surgey. Or anyone  who might be curious about the outcome of my attermpt to mix revision surgery with rock climbing. Perhaps there could be something to gain from learning about my failures and successes. Who knows, maybe I can come back strong enough to make this blog of interest to anyone who climbs, or at least enjoyable to someone who wants to read a travelogue of climbing in Argentina. However, this story starts with a pair of hip surgeries.

My problem was osteoarthritis. It was pretty much symmetric in both hips. I'd known about it for years but it wasn't exactly killing me. I mainly experienced it as a leaden discomfort, decreased flexibility, and occasional low level pain after intense activity days. But it just kept getting worse and there's no going back. I had a tendency to favor my left leg when climbing because it was more flexible. Could this be what caused it to degenerate faster? At one point, after a compressed high-step move finishing a boulder problem, I was left doubled over in extreme pain for more than a week. I needed do something about this.

One year and nine months ago I had my left hip resurfaced by a local doctor. A guy named Sixto Vilicich. I didn't know it at the time but he was a rank amateur. There's no way he should have been doing my hip surgery, yet somehow his convincing sales pitch, together with a strange set of surrounding circumstances, led me to believe he was a good choice. One of my prejudices, one that ended up costing me, was the misconception that it was somehow important to have the surgery done near home. Traveling, I thought, would be too difficult and complicated. Boy was I wrong.

Vilicich plodded through my surgery for almost four hours. An experienced surgeon can do the job in less than one. I didn't know it at the time but he had bungled the results in classic amateur style. The real calamity was that he didn't even seem to know what he'd done wrong. Ten months later I would discover on my own that the acetabular component had been put in way too steep. This problem caused the femoral component to lever against my hip bone when I walked. Maybe that was the reason I had reoccurring pain. Or maybe the pain was caused by the way the misplaced cup stuck out on the back side and grinded against tendons and muscles. Or perhaps it was a result of one of the other problems I would learn about later on. Most likely the cause was a combination of all that. Like an orchestra of complications, the consequences of my hip surgery played against any chance of recovery. Each time I thought I was improving, it was like I would get hit by a freight train.

In the end I decided to have revision surgery with Dr. Koen De Smet, in Gent, Belgium. He is without a doubt one of the world's most experienced hip resurfacing surgeons and also a specialist in revisions. This meant traveling. Since my health insurance does not cover procedures done outside of Argentina, I had to pay from my own pocket. This doesn't change my opinion that choosing De Smet was one of the best choices I made in this whole mess. I'd hoped he might be able to replace the acetabular component, leaving the femoral part intact. "Cup revision", they say. However, I agreed the final decision should be De Smet's call, based on what he found, after he'd opened me up. The day after surgery, he told me what he'd found. He seemed impressed by the amount of what he called "debris" inside my hip. I imagine it's not easy to impress someone who's done more than 6,000 hip surgeries (including several hundred revisions). The acetabular component was so loose it had come out with a tap. The bone above the cup had been poorly and unevenly worked. The placement of the femoral component had been "less than optimal". The kicker was the previous surgery had left me with a staph infection in the bones, further weakening the whole structure. I would need to submit to a massive, two month long treatment of antibiotics. Because of these complications, De Smet decided for a complete revision, utilizing a ceramic on ceramic THR. He placed a screw to fasten the new cup. This entailed the use of a smaller head size, but he said the 40 mm diameter ball should do the job. In the next post I will write  more about medical tourism in Gent and my immediate recovery, but let me just say now: had I gone to De Smet for resurfacing in the first place, I would have saved myself 6,000 euros and a second operation. So you might call this a cautionary tale.

But actually, the fact I'm even writing this blog is an expression of my optimism that I can, as the title says, "get back to it". A declaration of my belief that Koen De Smet is one of the world's best surgeons and an expression of my hope he's fixed my hip in a way that will work for me. We'll see how that goes.

The botched resurfacing

The revision surgery. Koen de Smet says it looks good