Six months and beyond

The six month check-up: De Smet says the x-ray looks perfect

The six month check-up came and went. I sent the above x-ray to De Smet and he wrote back saying: "the x-ray looks perfect". "Perfect" sounds good.

The weather hasn't been very cooperative this spring for weekend climbing, although I've gotten out some. We've climbed in the bosque, Paredes Naranjes and another area on La Barrosa that I established called the Matrix (I hope to write up a report on the Matrix when we climb there again latter in the spring). Highlights include my first redpoints of 5.11 in more than two and a half years (an 11b and an 11c in the bosque) as well as climbing a few interesting new routes I'd never done before.

One of the new routes we tried was a nice crack squeezed between two bolted face climbs at Paredes Naranjas. I wouldn't be surprised if this was the first time the crack had ever been lead. 

The old fat guy placed gear in a crack right next to bolted faces

Here are three shots of Martin flashing the crack, using the gear I placed:

Martín flashes the crack using the gear I placed

No problem here

Go Martín

El Groso, Gaby and Matoco, down from the Himalayas to climb at Paredes Naranjas

Another highlight was Cecilia redpointing the 5.8 crack to face route en el bosque (her first serious redpoint  in Balcarce). This is the same route where I reinitiated my climbing in the fifth blog post.

Ceci redpointing the crack to face route in el bosque

Ceci looking strong before a tricky move on the face

I went bouldering a couple of more times, but I haven't really been able to get into an outdoor bouldering rythmn yet. I hope to put in some nice reports on some of the local bouldering areas once I get my mojo working, Meanwhile, by supplementing my outdoor climbing with sessions in the home gym, I have been able to maintain about three days of climbing per week. I also try to go on hikes at least two of my non climbing days. Typically these hikes range from 4 to 6 miles, but today, for example I hiked around 8 miles. The highlight in this category was hiking the length of the sierra, La Barrosa from end to end on top and then returning along the base. This is a fairly intense three hour hike which I hadn't done for several years. Now I've done it three times since the revision.

Back in Córdoba

Tim climbs Criollitos, an 11a in the Sierras of Córdoba, summer 2009

When I first came to Argentina from Salt Lake City, in September of 1994, I knew there was climbing in Patagonia, but I didn't know much at all about the Province of Córdoba, the place where I was going to live and work. One of my roommates in Utah and my main climbing partner at the time, José Pereyra, had informed me there was established rock climbing in the Sierras of Córdoba and encouraged me to go to Argentina. Jose's encouragement was one of the main reasons I had decided to accept a two year position at the University of Córdoba instead of staying in the US.

My first taste of Argentine climbing came at an indoor wall, situated in a municipal gymnasium in the city of Córdoba and run by Club Andino Córdoba. There I met a young, ambicious 17-year-old climber named Diego Roldan. We hit if off from the start: he didn't speak much English and I didn't speak Spanish, yet somehow we managed to communicate. The following weekend we were on a bus to Los Gigantes, the oldest and most traditional climbing area in the Sierras of Córdoba. The place seemed strange and magical to me and ever since that first trip, Córdoba has become one of my favorite places to climb.

The sierras run north-south down the backbone of the province in two parellel ranges: the Sierras Chicas to east and the higher, more extensive Sierras Grandes about 50 kilometers to the west. In many areas the Sierras Grandes reach well over 7,000 feet in altitude and the high region captures sufficient moisture to form a complex system of streams, canyons and rivers. Rising up to approximately 9,150 feet, Cerro Champaqui, located smack dab in the middle of the Sierras Grandes, is the loftiest point. Sharp, crystal-studded granite abounds throughout the mountain range and climbable rock is pretty much unlimited, although the established climbing is largely concentrated in two main areas: La Ola and Los Gigantes.

Storm clouds brewing over Cerro Champaqui in summer, 2009.

Climber's camp in La Ola, summer 2009

Mariano Maceri climbs Cazen a Willy, an 11a on La Ballena, summer  2009

Cecila climbs 5.8 on La Ola, summer 2009

Climbing possibilities are more limited in the Sierras Chicas. However, in the region surrounding Cerro Uritorco (the tallest of the Sierras Chicas, with an altitude of about 6400 feet), there is a nice collection of climbable rock. This area is locally referred to as Capilla del Monte, for the name of the small town that sits at the base of Uritorco. Although there is some climbing (difficult to access) on the high faces of Cerro Uritorco, the bulk of the climbing at Capilla del Monte is located close to town, along a short canyon carved by the Rio Dolores as it exits below the dam that forms Lago El Cajón. I first climbed here back in 1995, with Diego Roldan, my wife Gaby and other climbers from Córdoba. In fact, Capilla del Monte was the last place I climbed at in Córdoba before I went to Balcarce in August 1996. More recently, an active group of local climbers has blossomed and the quantity of established routes and boulders has exploded. Because of the low altitude and dry, sunny winter climate, Capilla del Monte is without a doubt one of the best winter climbing spots in all of Argentina.

Today is Wednesday and we have been in Rio Cuarto with the inlaws since Saturday night. I've been trying to stay as active as possible, mainly by going on long walks by the river. As far as I can tell there isn't even a small climbing wall to be found in Rio Cuarto but I'd sure like to hear about one if someone knows. Meanwhile I'm doing what I can to keep my arms from going all limp and noodlely (as if they weren't aleady that way) including traversing the brickwall in my inlaw's backyard.

This is the only climbing I could find in Rio Cuarto

Not exactly your destination climbing area

Day after tomorrow, Cecilia and I are on our way to Capilla del Monte to meet with Martín, Analía and Rafi. There should be more posting after the climbing begins.

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