emancipated patients: bone-0n-bone

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bone-on-bone

By Patrick Neustatter, MD

Although it was only 5.30 in the morning, as I lay in the bright lights of Mary Washington Day Surgery Center, on a gurney, feeling vulnerable in what seemed like a tissue paper gown, there were already a mass of staff bustling every which way, checking my pulse oximeter, blood pressure, I.V., ID bracelet, name and date of birth a million times.

Despite the inclement hour, they couldn't have been nicer. They were prepping me for Dr. Brian McDermott to change out my old hip for new.

The Upright Primate and The Search I am one of those primates who, some time back, adopted an upright posture, putting undue burden on the joints of my appendicular skeleton - hips in particular. "When are we going to start?" I ask innocently as I came too from the Propofol - when of course it's all over.

My X-rays showed degenerative joint disease - or "bone-on-bone". Confronted with this issue in the past, orthopedic surgeons, in their macho way, reasoned, "if the joints worn out put in a new one. "

What to make it of has been the problem. What will be friction free, not wear out, disintegrate, or induce an immune reaction?

The very first attempts was with ivory - which amazingly was quite successful. Then a steel shaft with a glass but the glass shattered.

Then metal and a variety of plastics, or metal on metal, but there was a tendency for both to disintegrate and shed toxic particles into the body. The latest - touted to last 20 years - is metal and ceramic.

Much of the development of hip replacement is attributed to Sir John Charnley - a native son of Bury in Lancashire, England. Interestingly a bit of a duffer in high school, but like others who just need to find their niche, a star when it came to inventing orthopedic devices - which he would manufacture himself on the lathe of his home workshop.

He was on staff at my old almamater, Guy's Hospital in London for a while. And many years later, when I was a junior hospital doctor there myself, I would assist with the vigorous pulling, and twisting, required to do a Charnley Total Hip Replacement. A Taste of my Own Medicine Now I was the patient. It was me getting manipulated. Having that disconcerting experience so many friends getting a colonoscopy joke about.

Also confused why someone else's legs are in the bed with me. Then gradually realizing they were mine numbed and paralyzed by the spinal anesthetic.

Home that same day by 2 pm such are the advances in THR - and passed on to Home and Heart Health, Inc, to provide hardly needed nursing care, but, the unavoidable tortuous rehab of physical therapy.

Here I digress to make an editorial point. A point about how medical practice has gone mad with busy-work, documentation and consents. All of my colleagues in practice complain about this, how documentation and forms are depriving them of time with their patients.

I don't mean to single out this agency as aberrant, but it's an example that they are obliged to provide me information on advance beneficiary non coverage, Medicare non-coverage, photo consent, admission agreement, two different lists of the agencies Policies and Procedures, criteria for referral and transfer, privacy practices, patient's rights, advanced directives, fee schedule, homebound handout, cover your cough guide, communicating your healthcare choices, hand washing, home safety, and flu and pneumonia vaccine information.

A little OTT. Maybe fussing about this is one of the peculiar symptoms of healing I have experienced - a lot of energy needed for recovery, leaving me lethargic. But also a wee bit irritable.

Otherwise, as the pain subsides and the mobility improves, I am beginning to be happy to join so many of my ageing buddies and the ranks of "Bionic Man."

Patrick Neustatter, MD is the Medical Director of the Moss Free Clinic