When does a doctor fully realize the nature of a disease?

Sir William Osler, distinguished professor of medicine at McGill, Johns Hopkins and Oxford University, remarked that a doctor only fully understood a disease when he suffered from it himself. Having just recovered from a hip replacement operation, I couldn’t agree more with Osler. So what did I learn and what did I fear?

W. C. Fields, the comedian, when asked what he wanted inscribed on his tombstone, replied, “I’d rather be in Philadelphia.”

I felt the same way as I was wheeled into the operating room. But at least I had the satisfaction of knowing I had first used every medical therapy I knew to prevent this from happening.

Nine months earlier, while on a trip to Israel with other journalists, I fell injuring my knee and hip. I tried to convince myself I was suffering from post-traumatic arthritis and that tincture of time, along with laser therapy and other medication, would cure me.

It didn’t, and pain finally forced me to the operating table.

So, as a surgeon, what worried me about the procedure?

The truth is, not very much. In fact, the easiest aspect of the surgery was the surgery itself.

Since I had a spinal anesthetic and the anesthetist agreed to my request of no sedation, I was awake during the procedure.

What might be upsetting for some patients was the buzzing of the saw that removed the upper part of my femur along with the arthritic ball-shaped acetabulum. This part would be replaced by the hip prosthesis. But I knew that in all probability, nothing would go awry during the removal of this large segment of thigh bone.

My adrenaline went on high alert, however, when I heard the surgeon’s hammer pounding the hip prosthesis into the inner part of the remaining bone. I was aware that, although hammering is needed to drive the hip prosthesis into the femur, too much pressure can fracture the bone, not a good complication. The adrenaline stimulus dropped when the hammering stopped.

So most of my time on the table was spent watching the hands of the operating room clock tick off the minutes.

The operation and post recovery period have confirmed what I’ve always reported about hip replacement.

Years ago as a medical student I witnessed the first hip replacement performed at the Massachusetts General hospital. It was major surgery then and it still is.

Today, due to the thousands done every year in North America, most patients believe that exchanging bone anatomy for a spare part is not a big deal. But don’t rush to the OR. Thank the Almighty that surgery is there when you need it. Just make sure you require it. You never know when you might get more than you bargained for.

For instance, several years ago, Dr. Justin de Beer, an orthopedic surgeon at McMaster University in Hamilton, Ontario, reported disturbing news to the Canadian Orthopedic Association. A worrying number of hip and knee replacement patients suffered heart attacks following the operation.

The majority of these attacks occurred within three to five days of the surgery. Moreover, 29% of patients had no previous history of heart disease. This is not surprising since many patients undergoing hip replacement are not kids, often obese and suffering from diabetes. Besides, it’s impossible to remove a large part of the upper leg bone without subjecting the body to major physiological shock.

Development of surgical wound infection is another major concern today.

Hospitals have become hot beds for antibiotic resistant infections. Every year about 200,000 Canadians develop life-threatening infections in hospital and 12,000 die.

The most vicious infection is Clostridium difficile which can cause up to 40 bowel movements daily.

Luckily, I escaped these potential complications.

But I haven’t yet escaped the tedious daily exercises to strengthen muscles surrounding the hip replacement. It’s a daily reminder that it would have been more fun to be in Philadelphia!

My thanks to the tons of e-mails from readers wishing me well.

Next week – Do you want better sex?

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