Dr. Raphael Klug

Bert Eisenstaedt - BHR December 8, 2006, Dr. Klug

3/13/08
Vicky,

First of all, my apologies for not replying sooner. My story started at the tail end of 2004 with what I thought was a pulled groin muscle from running. I was a runner for 35 years. If my groin bothered me, I would always back off a little from the amount of running I did and it would always get better...except this time it didn’t. I tried to run several times after one particular occurence and one day the pain was so great I could run no more. That started my saga with doctors...first X-Ray showed deteriorating cartilidge and arthritis. But not to worry...I had at least five years left on the remaining cartilidge, but we want to see you every six months for an X-Ray. The first six months passed...first X-Ray showed no more cartilidge left! I was told I needed a new hip...I would get a plastic one, one leg may be longer than the other, etc. I DON’T THINK SO!

By this time, I had met Alan, and he was already educating me about hip resurfacing because he noticed my limp that had started. There was also another member of our club that had both of his hips replaced by Dr. Amstutz in Los Angeles. So that began a long and winding road of research about hip resurfacing and all the physicians involved with it here and abroad. I went down and saw Dr. Amstutz and after X-Rays and a consultation he told me I would be a good candidate for resurfacing. I sent one of my X-Rays to Desmet in Belgium and he, too, said I was a good candidate. I started a lengthy appeals process with Kaiser, submitting my story and a ream of information and data that Dr. Amstutz was kind enough to give to me and submit along with my appeal. I wanted Dr. Amstutz to perform the surgery. But this was May of 2006 and the FDA had just approved the BHR for use in this country. Kaiser, preparing for this, had sent their own doctors abroad to train and learn the procedure and as soon as the FDA approved the device, Kaiser was up and running with Dr. Barber in Oakland and Dr. Klug in Roseville.

I met with Dr. Barber first and actually set a surgery date with him. I wasn’t real comfortable with my decision, so I pressed his nurses and others about more info or recommendations for Barber. Feedback wasn’t good. I ended up meeting with Dr. Klug at the last minute...we talked for about an hour. I was totally impressed with him, and even though he had single digit experience with the prodedure, I felt comfortable with him and subsequent investigation and feedback validated my decision. Although everybody told me that an experienced doctor with many procedures under his belt would be the best, I took a leap of faith with Dr. Klug and have never regretted it. I believe I was his seventh procedure. The fact that I continued to keep myself in good shape was in my favor and by this time the pain was 24/7...I was only sleeping about two hours a night. I was READY, come hell or high water! Plus, Dr. Klug fit me into his schedule...I had to have the surgery in December when my daughter was home from college and I could recuperate during the slow time of my business.

I am a landscape contractor, and the ability to perform at my job was critical in my decision making process for choosing hip resurfacing...I wanted to be able to get back to doing what I did before my hip went bad.

So in December of 2006 I had surgery...facility in Roseville was great! I was on a walker for a week, a cane for a week, and then I was walking on my own and back to the athletic club three weeks after surgery and back to work, albeit in a limited role, one month after surgery.

I strengthened my leg every day...cycling, elliptical machines, weight machines,etc. I am now back to doing everything I used to do...even running. I couldn’t be more grateful and satisfied with the way things turned out and my decision to choose Dr. Klug. I also will be forever indebted to Alan for the invaluable help and advice he gave me. I also believe the better the shape your in before surgery, the faster you will recover after your surgery. I am attaching two pictures, they are both the same one...I don’t know which will be easier for you to adapt if you need to. It is a picture of me up in the Pinecrest, Dodge Ridge area in the summer of 2007. We had hiked several miles up to this point where the picture was taken. Most summers would find me, my daughter and other family and friends camping and hiking. When my hip went bad, I could no longer hike...I was devestated. This picture represents something, that when I was going through all the pain and time period prior to the operation, (two years), I thought I would never be able to do again. Hopefully it is good enough for your purposes...if not, let me know. Thank you for your interest...all is indeed well and I sincerely hope all is well with you. You do a great job getting all this info out to people who need it. If I can be of any further help, let me know.

Bert Eisenstaedt

Bill Frink, 1/16/09, Dr. Klug

I recently viewed the February 2009 interview that Vicky Marlow did with Dr. Klug from the Roseville Kaiser facility and wanted to add some comments about my story and how deeply Dr. Klug cares about his patients. And of course how good of a technician he is. Here is my story.

I knew Dr. Klug was the right doctor for me within five minutes of my first appointment. The video interview is very informative but it does not capture Dr. Klug's warmth, his complete confidence in treating his patents with the absolute best care, and his views on the medical profession. Dr. Klug is young but he is definitely old school. And what I mean by that is that he truly practices medicine to help people. And because he is good at what he does. Something that often lost in this modern world of medicine.

Dr. Klug breathes confidence and compassion when you meet him as a patient. When I asked him why he does hip resurfacing when it costs more than a hip replacement for Kaiser, he said if Kaiser did not let him do what he feels is the best thing for his patients he would not be there. And it would be a huge loss for Kaiser. Dr. Klug hand picks his surgical team which is technically not allowed at Kaiser. His assistant Irene is a jewel and incredibly responsive. And he does 3-4 times more surgeries than required by Kaiser. When I asked him does he make more money for this, he said the pay is the same whether he does 2 surgeries a week or 8. Which of course leads to my next question, why do you do so many surgeries? He said because he likes seeing the results of his work. I hardly need to say more.

Dr. Klug explained to me that my hip was a slow degenerative process versus some patients that go from bad to terrible within 6 months. This would affect my recovery also since not only would I need to heal from my surgery, but I would need to build up strength that was lost over the previous 3 or 4 years. I am 50 years old, 5-11", 170 lbs and very active and physically fit. My hip degeneration kind of snuck up on me, like the frog in the pot on the stove. People would often say that I was limping but I would not even notice I was getting weaker. Dr. Klug guessed that I either had a problem at birth or due to some accident.

I played college tennis, skied all my life, did backcountry running, and had more than my share of mountain bike endo's so an injury could have happened at any time. During the three year period other things happened to wake me up to the extent of the problem aside from the pain. I ripped my Achilles tendon, pulled my hamstring, twisted my ankle, and pulled my quad muscle, all on my right leg. I got an X-ray about two years ago and the local doc said I am a candidate for hip replacement at any time and the final timeline would be completely up to me.

It was at this point that I had a chance encounter with a fireman friend who put me in touch with a fellow hippy, Nancy DeMattei. Nancy put me in touch with Vicky Marlow from surfacehippyinfo.com. I owe a lot to Nancy and Vicky. I was two weeks from a total hip replacement since that is the normal protocol at Kaiser. After speaking to Nancy and Vicky and spending some time at the surfacyhippyinfo site, I was convinced I wanted a resurfacing procedure. At Kaiser, you need to get a referral from your specialist and my doc was against hip resurfacing. He had over 30 years experience and to him the hip resurfacing was not adequately proven. I got the courage to ask him for a referral which he did. Vicky was instrumental in steering me to Dr. Klug due to his experience and past successes

In hindsight I wish I would not have waited so long. For me, the pain was not completely debilitating. I could take some Motrin and keep playing tennis, or bike ride, or climb a mountain, although the doc wondered why I was not in a wheelchair based on my x-rays. When the surgery date approached, Dr. Klug was a little concerned that I would not be a candidate for hip resurfacing. Apparently the ball side of my hip was shaped more like a rectangle, and the sides did not curve back into the neck. According to Dr. Klug this would make it difficult to get the angle right for the prosthesis. Dr. Klug decided to use an anterolateral approach (if you put your hand in your back pocket, the scar is about where your thumb would be) which would give him a better view of the deterioration and to set the angle of the prosthesis better.

One thing I wanted to relate was something Dr. Klug said to me at my 6 week appointment about why he used the anterolateral approach. During the surgery and after he had exposed my hip socket, he was still unsure he could perform the hip resurfacing procedure. As I previously mentioned, the lack of bone definition on the sides of the ball would make it hard to get the angle right. Dr. Klug said he pulled back and viewed the situation while everyone in the operating room waited. I envision he was looking at my hip like a piece of sculpture he was about to create. He drilled the guide post by gut feel and then he used a monitor to make sure it was in at the correct angle. When it was, he knew he could proceed.

I am not an expert, but I think the anterior lateral approach can make for a slower recovery. This approach cuts through your butt muscle and since I am a thin guy, there isn't much muscle back there for me. In other words, my recovery was pretty slow. And I will say, on the painful side. I have a platelet issue so they recommended I go under general anesthesia instead of an epidural to reduce risk of damage to my spine. I guess an epidural keeps things numb for a few days. The next morning after my surgery when they asked me to get up with a walker, I nearly passed out. They quickly checked my blood pressure to see what was wrong but I knew what the problem was. There was some serious pain going on. This happened again on day two. I originally wanted to get off the pain meds as soon as possible since drugs are a bit against my beliefs. But my beliefs quickly went out the window when I would wake up in a pool of sweat from the pain. This lasted at least a week. Week two was a bit better and I was able to get off the morphine sulfate and use Hydrocodone. Although, not being able to sleep on my side must have taken a toll since I threw out my back at week two. This slowed down the process and as I tell people now, being able to sleep on my side was perhaps my biggest source of celebration. I was not able to sleep on my right side until week 4 and on my left side until week 7.

Week three pretty much consisted of using a walker and trying to do simple physical therapy. But if I pushed the PT, there was a loud wake up call in the evening telling me to back off. At 10 days I had my staples removed and then started swimming and walking in a pool. This was great therapy. I also found that I could walk on a treadmill using the rails for 10 minutes at a time. I bought a cane at week 3 and I really started pushing the PT by week 4. I had my first appointment with the Kaiser physical therapist at week 3 and then again at week 5 and week 7. I started walking without a cane at week 5 but my PT said even at my week 7 visit, that I should still be using a cane based on the way I was limping. His concern was that I could tweak something else in my body.

Now it is the end of week 8 and I did my first long walk without a cane. I have been riding a bike for a few weeks now. My hip flexor is still tight and my butt is weak but I feel that the worst is behind me (no pun intended). I even went out and hit some tennis balls today

And I am incredibly thankful to Nancy, Vicky, and of course to Dr. Klug and his great staff.

Darrah Yates RBHR 12/10/09 Dr. Klug

I am 55, female, single, live in Denver CO, healthy, and have Kaiser insurance. Two winters ago, 2007, I slipped on the ice in front of my home and landed on my right side. No big deal at the time as I got up and continued on my way. But over time I started having trouble with that right hip. And by trouble I mean it started to ache and the range of motion started to reduce.

I lived with this inconvenience for several months before I started seeking help.
Over the next 2 years I saw 11 different health professionals: (in no particular order):

• 1 family practitioner who could do nothing but refer me to specialists;
  
  
• 1 chiropractor, one who wanted me to come in 3 times a week for 8 weeks, and was sure it was my lower back causing me grief. (I knew better.)
  
  
• 1 chiropractor that worked on me for 10 minutes each time and did not have my confidence,
  
  
• 1 who worked on me for 1.5 hours each visit who did relieve the nerve sensation that was going down my leg;
  
  
• 2 personal trainers each of whom set up exercise programs for me that I followed to the letter; helpful but there was no improvement in my hip
  
  
• 1 physical therapist whom I had no confidence in whatsoever,
  
  
• 1 homeopath that gave me 3 little seeds to put under my tongue and charged me $500,
  
  
• 1 neurosurgeon who gave me a battery of tests to determine that my problem was not neurological (good info),
  
  
• 2 orthopedic surgeons who said to live with it and come back in 5 years when I am screaming in agony (x-rays showed bone on bone) and they would give me a THR. (Are you kidding me??? I am miserable now!!!)

The diagnosis was the same from all of them, arthritis. Well, ok, but I have arthritis on the left side also and it has the same amount of mileage on it as the right side. What is different about the right side from the left? And more importantly, what can be done to help me?

So, after asking so many different health professionals to fix my hip, nothing was helping. In fact it was getting worse. By 2009 I was unable to put my socks and shoes on, was starting to limp more, couldn’t walk any significant distance without it bothering me, and basically my quality of life was significantly diminished. All this time I was not in great pain. In fact I never even took a Tylenol to reduce pain. I called it an ache, which I lived with.

I started to come to the realization that my hip was not going to get any better no matter what I tried. It was about that time that I started doing some research on my own on the web thinking that there has to be someone out there that can make my hip move correctly. That is when I discovered Vicky’s website and learned about hip resurfacing. I also learned from Vicky’s website that surgeon selection was critical. That eliminated the two Ortho’s that I had previously seen in Denver. They never even mentioned resurfacing. So I started seriously looking into the differences between THR and HR.

But how to choose one procedure over the other? Vicky offered to email my x-rays to Dr. Bose in India and to Dr. Klug with Kaiser in Northern California. He was the only doctor within the Kaiser system that had completed a significant number of HR (200+ at the time) all with excellent results. Both doctors reviewed my x-rays and said that I was a good candidate for HR. So my choices were: to go to India for 11 days alone and pay the fees out of pocket which I was willing to do, or go to Sacramento CA for 5 days with my son and have Kaiser cover the fees.

After researching Dr. Klug and looking honestly at my own life style (I am not a major athlete but do work out regularly) I decided that HR with Dr. Klug in CA was the way I wanted to go.

I then started to get the ball rolling to get this over with…. waiting just didn’t seem to serve any purpose. I contacted Dr. Klug’s office to determine what I needed to do on my end to make this happen and what their schedule was. Irina, Klug’s assistant, worked closely with me making sure all the ducks were in order between Kaiser Colorado and Kaiser Northern California. She told me on Thursday, Dec 3 that there was an opening that just came up in the operating room schedule on Thursday Dec 10th and can I get there by then? What a whirlwind the next few days were trying to get approvals, referrals, and clearance for surgery etc. I made the mistake of asking one of the Ortho doctors for the referral rather than my primary care doctor. His response was that he did not think I was a candidate for resurfacing due to my age and gender but that if I still wanted one he would do it. That again reinforced my decision to go see Dr. Klug. I was not about to have a doctor operate on me who: 1) does not believe I am a candidate for a particular procedure, 2) has not done many of them, and 3) that never even mentioned this option to me. Also, Vicky had mentioned that she had heard of patients who go in expecting a resurfacing and come out with a total hip. The doctor makes a medical judgment call during the operation and performs the surgery that he wants to. I wanted a doctor that believes in resurfacing and who believes that I am a good candidate for one.

But on Monday Dec 7 at 5:30 I got my last approval. So I went home, bought 2 airline tickets for Tuesday night, hotel reservations for my son, and a rental car. We arrived in Roseville Tues night and I went to my appointment with Dr. Klug on Wed morning (Dec 9). He spent well over one hour explaining to me: 1) what was wrong with my hip (osteoarthritis), 2) why I was having trouble (bone on bone causes increased bone density in that area which can also cause the growth of bone spurs, which lead to limited range of motion. My bone spurs were about the size of a pea), 3) the various options that I had (resurfacing or total hip), and 4) answered all my questions (recovery expectations, etc.). He showed me the BHR device that he will use and compared it to the THR device. Both were there in his office for me to see and examine. He stated that he prefers the direct anterior approach and since I had no druthers regarding that issue I had no concerns. He also made me understand that he was planning on giving me a HR since that is what I wanted, but that when he was able to actually see my bone and determined whether or not it was viable for a HR, the possibility of a THR needed to be an option for him. I agreed. I felt very comfortable with Dr. Klug and came away with the feeling that he is doing what he was born to do. He genuinely cares about his patients and wants to see everyone in good health. His office walls are plastered with thank you notes and pictures of many of the people that he has repaired. Seeing the hand written notes and the photos of previous patients was very reassuring. So, Thurs Dec 10 at 4:30 I went under the knife and came out 1 hour and 15 minutes later with a resurfaced hip.

Fri Dec 11 they tried to get me out of bed but I had major low blood pressure issues. Just raising the head of the bed caused me to get dizzy and standing up caused black-outs. So we took it slowly and when I walked for the first time I only went about 6 feet from the bed and back. I was hoping to start doing laps around the hospital floor but that was not to be. I also had leg compressors on my calves to improves blood circulation since I have a history of blood clots. Sat Dec 12 showed a small improvement but not enough for me to feel comfortable getting on a plane the next day and flying back home to Colorado. So Dr. Klug ordered 2 units of blood to be given to me Sat evening and Sun morning when I woke up I felt like a new woman. I was strong enough to leave the hospital, go to the airport and fly home to Denver!!!

The next few days were slow and lazy but gradually I grew stronger and started moving around with a walker. I much prefer walkers to crutches…. 4 points of stability rather than two, and you can release them anytime to use your hands. I used the walked for 2.5 weeks at which time I felt comfortable progressing to a cane. Today I am exactly 3 weeks post-op and do not use anything to walk with. I do still have a swagger when I walk, and I am slower that normal. I started driving yesterday.

My care at Roseville Medical Center was excellent. Everyone involved with my case seems to always know what anyone else had to say or what I needed next. There was never a lack of communication between nurses, PT’s, PA’s or doctors.

I return to work one week from today, which will be 4 weeks post-op. I am a high school science teacher so am on my feet all day setting up labs and lecturing. I will try my best to take sit-down breaks and to limit my steps. I think I will be fine.

I am looking forward to moving more freely and with greater strength. Dancing, working out, walking and even putting my shoes and socks on wont be such a challenge soon. And since it has been two years since I was up in the mountains skiing, maybe I will be back on the slopes before the ski season is over..... you never know!!!