I want to get back to where I started.

The hip pain got worse by the day, one year ago. I firth thought that the hernia repair from te prior year was failing, but the surgeon in Colorado said ‘no. My Dutch husiarts ordered an ultrasound and x-ray, result shown right. At the top of the hip, where the thigh bone meets the hip bone, there is a nice gap on the left hip (right side of the photo), with white cartilage in place. The right hip (left side of the photo), however, has collapsed into a luminescent fuzz. A trip to the Dutch orthopedic surgeon for my birthday confirmed that I was going to be gifted a new hip.

A hip implant is generally a low risk procedure, one day hospitalisation and eight weeks recovery. Because I live 40 steps up to the second floor at Kesselskade, we arranged for a two week physiotherapy / rehabilitation at Plataan, a recovery centre in Heerlen. Surgery was scheduled for the end of July in Maastricht, discharge to the apartment in mid-August. Everything went well; I was one of the last cases of the day, but made a quick recovery with good support all around.

I’d been apprehensive about the surgery though, ‘not my usual anticipation of potentially difficult events. I think there may have been some warning echoes from the future. My hip grew increasingly sore, and at late September’s check, the surgeon said he’d like to run some additional tests. The inflammation markers were over 600 (usually under 10): the radiologist took one look and called the surgeon. He told me to collect some clothes and go to the University Hospital (MUMC) in Maastricht for immediate surgery.

A prosthetic joint infection (PJI) is a rare (1%) complication of hip implants, and I was one of the lucky few. The intervention cleaned out the surgical site and replaced the ceramic parts, usually successful unless there is a biofilm on the metal parts of the implant. In my case, the inflammation markers and cultures stayed high, requiring a second try to salvage the implant in mid-October. In most cases, and especially at a regional centre, this is successful. In my case, (now 1 in 500), it was not. The implant needed to come out.

The 2-stage revision procedure involves taking out the implant and putting in a temporary, antibiotic replacement for 8 weeks. That is then removed, and a fresh permanent implant is installed. People usually struggle to accommodate the temporary, it makes clicking noises and you can’t put weight on it, then recovery can be prolonged. There wasn’t really any choice, though, and the first stage procedure was performed in early November. The holidays delayed the second stage procedure until early January, then followed by several weeks of intensive physiotherapy / rehabilitation at Vitala+.

I finally discharged with normal cultures, lab values, and good mobility on January 25, after four months hospitalisation. Infections are tricky things, there is a ‘try and try again’ iterative aspect to treatment, and I can’t fault the care that I received at MUMC and Vitala+. Still, from when this all began in July, it was a long interruption to my normal activities, teaching, and community.

Honestly, I just want to feel like myself again, and to have my old life back…

I’m never too certain of dentists outside the United States, so always save my dental checkups for visits back across the pond.  It leaves me with longer between appointments than I would like, and no backups if there is a tooth emergency, but my comforts is much higher.

This visit, the hygienist started with a blood pressure check.  She used an Omron wrist monitor, an inexpensive unit that we had evaluated and discarded as insufficiently reliable for clinical use back when I was a research director for Physio-Control.  True to expectation, the monitor gave me a 145/110 reading.

The hygienist looked concerned and repeated the measure; I was underwhelmed.  ‘Its something to get checked,’ she insisted.  I explained why I discounted the result, why I disliked the Omron, and that my blood pressure was normally a healthy 110/70.

Nonetheless, it nagged.

So, I went to the Safeway and checked against the cuff testing station at the pharmacy.  140/105.  Twice.

Damn

I am not a particularly high-risk candidate for hypertension: I don’t use salt, watch my weight, exercise, no smoking, lots of vegetables.  The only risk factors are really age, stress, coffee, and alcohol.  It was hard to imagine that my stress level had gone up by that amount in a year, but the data was, unfortunately, consistent.

Nonetheless, I made the appointment at Virginia Mason and then got a bit melancholy about the indignities of expat entrepreneurship.

The doctor listened to my story, then ran a right and left arm clinical measurement with a cuff and stethoscope.  She listened to my heart and my carotids. She thumped my chest a couple of times.  Then, sShe made notes and smiled: ‘You’re healthier than I am, honestly.’

Blood pressure was around 110/70, each arm (the lower number is the important one, and should be less than 100 mm Hg, always).  No murmurs in the heart, no sounds in the carotids.  No cause for concern, keep doing what you are doing, and try to cut down on stress.

I wrote a note to the dentist, saying that he might consider taking the wrist monitor out of service.  Its not a training issue, it’s a device issue.  A nice note returned, saying that he was withdrawing it anyway for the same concerns.

‘just the diversion I needed a few days before Christmas.

It was just one of those stupid things, dragging too many suitcases and bags across the courtyard at Wolfson College after too many miles of driving.   I stubbed a toe on a flagstone and went flat, possessions scattered, elbow skinned.  I picked up, dusted off, forgot about it, went on with business and life.

I think I must have hit a rock, though: a part of the elbow had a deeper puncture.   It healed, but yesterday suddenly puffed up like a plum and started to discolour.  My primary care physician is attached to my Dutch health insurance, and the surgery in Cambridge wasn’t taking walk-ins.  With a pitch in Leeds at 9 the next morning, the A&E was the only remaining option.

The Emergency Department is the Accident and Emergency (A&E) Department in the UK (spoedeisende hulp in Dutch).  Its not too different from the US version: a triage nurse, then a receptionist to check you in, then wait in a colored section based on the level of my emergency.  It’s a bit like jury duty: no phones or wifi, don’t make noise or wander off.  And the wait, about three hours, wasn’t much different than if I walked into a US hospital with a similar problem.

The NHS has been held up as a generally bad idea by both sides of US political opinion, example of everything from out-of-control costs to endless queues to delayed and limited access to care.  But my reality was much more benign.  The staff was nice, checked on me regularly, and progressed me through a reasonable sequence of assessments and procedures.  It was nothing like the rhetoric, echoing my experiences in the Netherlands and Switzerland as well, all at much less cost).

I had a superficial infection that needed some deeper cleaning and antibiotics: the therapy was less aggressive than might have been done in the US.  There were two follow-up appointments to arrange and I was on my way, even before my eReader battery ran down.