How Would a Physician Prepare for Their Own Hip Replacement?
This week, we spoke with PeerWell PreHab user, Dr. Elizabeth Chabner Thompson. Dr. Chabner, MD, MPH is a Radiation Oncologist and successful business-owner who holds several patents for women’s medical products. During our interview, it became abundantly clear that Dr. Chabner wasn’t the average hip replacement candidate. For one, she’s not only a physician, but an entrepreneur, lecturer and researcher. For two, she’s an ultra-marathoner who competed in a cross-country ski race one week before her replacement. For three, she’s juggles all of this with four children. To say that Dr. Chabner is “superwoman” would imply that she has supernatural powers and this wouldn’t give her enough credit. Rather, among many things, Dr. Chabner is exceptionally hard-working, a master scheduler, and consistently dedicates time to self-improvement.
We couldn’t wait to hear her personal journey, as both a doctor and a patient, towards hip replacement surgery. How would someone with an excess of medical knowledge and access to cutting-edge treatments go about their own joint replacement surgery? What “insiders knowledge” would they apply to ensure success?
A major part of these answers can be summed-up in two words: PeerWell PreHab.
Dr. Chabner recounts that she was born with congenital hip dysplasia and was supposed to live out her early childhood in metal braces. However, when she started walking normally at 11 months old, Chabner’s mother asserted she would be fine. And she was. Dr. Chabner, explains, “ I lived normally until I was about 43 or 44 when I started to notice after long runs that my hip was achy.” Having run more than 100 marathons and ultramarathons (yes, there are races more grueling than the standard 26.2 miles), being an active tennis player, golfer, and all-around high-level athlete, Dr. Chabner’s hip was functioning on borrowed time.
Her breaking point was during a “crazy marathon in Utah from Deer Valley to Park City” where after completing the race, she realized, “Wow, I can’t step up anymore... I can’t walk.” This scare drove her to consult with an orthopedist and chiropractor. In March 2016, x-rays revealed that her hip was completely bone-on-bone with no cartilage to spare. From this day forward, she began taking a nonsteroidal and stopped running entirely.
It would be one full calendar year before Dr. Chabner would go in for her total right hip arthroplasty in March 2017. However, as you may have guessed, she wasted none of this lead time in steering her procedure outcome.
Why PreHab Before Joint Replacement Surgery?
With a year to prepare for surgery, Dr. Chabner was determined to stay active active and design the fastest recovery possible. With running no longer an option, she turned to other lower-impact activities like roller skating, swimming, barre classes and abdominal core work. It was important that Dr. Chabner remained active and keep her body strong for the upcoming stress of surgery. She attributes remaining in solid physical shape a key part of her fast recovery.
Spoiler alert: Dr. Chabner is recovering at lightning speed.
Even though keeping busy, eating well, and maintaining fitness remained at the forefront, as her surgery date neared, Dr. Chabner kicked things up a gear and sought out PreHab. She explains, “The best results come from those who are well-prepared and not surprised by things. The more knowledge, the better you’ll do on the other side.” As a physician and business owner that operates under the same premise as PreHab: “the more you know ahead of time, the better you’ll do after”, devoting time to prepare for surgery was second nature. With that, Dr. Chabner sought out a solution that would bundle up all of the information in a way that was “condensed and distilled”.
Dr. Chabner used PeerWell PreHab app for during the final few weeks before her scheduled replacement. She explains, “With prehab, every day you get a series of tasks, like a countdown, and it gets you ready in terms of mindfulness, nutrition, participatory aftercare and exercises. It gets you to think about a lot of things, like a legal will--things come up that may be significant. By taking all of these things together, I was prepared for surgery.”
For a physician who’s well-versed in most of the information covered in the PeerWell PreHab app, a lot of the value for Dr. Chabner came from timing and cadence of the program. By breaking everything down into must-do, must-know tidbits, the most impactful exercises, tips and information are absorbed when they’re most relevant. Dr. Chabner, shares, “Even though I’m a physician, you forget sometimes. The app was helpful”. She continues, “it’s hard to anticipate what you need to know but what helped me was a review of “how to do this” or “where to move your leg when going downstairs. Having this planted in your head helps you be a better patient. These are things that may never cross your mind. You’ve never had the procedure before. It’s not instinctual, people need reinforcement.”
Having this reinforcement broken down into daily bite-sized tasks during the crunch period before surgery allows patients to recall crucial information when it matters most. This gives PreHab participants a head start when hitting the recovery milestones that their surgeon, nurses and physical therapists are looking for in the hospital and beyond. Dr. Chabner illustrates, “the remarkable thing that I appreciate about PreHab is that a lot of the exercises I do now [in recovery] are the ones I saw ahead of time.”
In summing up her PreHab experience, Dr. Chabner added, “This is another one of the great things: it doesn’t take much time out of your day. You can do it in line at the supermarket while waiting for someone or in between meetings, but on the backend, it really helps.”
Physicians POV: What to Do and What to Look Out For
It was interesting to hear Dr. Chabner’s journey to joint replacement as a patient, but we wanted to zero-in on her perspective as a physician. How did she select a surgeon? What does a physician-turned-patient know that the average patient does not? What advice would she give to orthopaedic surgeons performing the procedure in the future? We asked this and more.
Look at the Hospital’s MRSA Rate
We were curious what the process looked like for a physician evaluating another physician. Upon talking to Dr. Chabner, it seemed the vetting process wasn’t a simple “one and done”. Having a double edged sword of “knowing too much”, Dr. Chabner knew the red flags to look out for, and worked on a process of elimination when selecting her orthopaedic surgeon. She explains, “I consulted with several orthopedists. I took everyone’s recommendations and looked at who had the lowest complication rates and best recovery times.”
Interestingly, a lot of the factored weight when selecting the best orthopedist for the job was looking at the hospital. Dr. Chabner elaborates, “A lot of hospitals have flashy names and well-known physicians but also have a lot of MRSA. The rate of MRSA at a hospital is important to know---this knocked out hospitals and physician groups I would have otherwise considered.”
MRSA (Methicillin-resistant Staphylococcus aureus) is a bacterium that causes infections in different parts of the body. The rate of MRSA for a hospital is often publicized and should be taken into account. Higher rates mean higher rates of patient inflection and surgery complications.
Arm Yourself with a Surgeon’s Stats
Dr. Chabner suggested that anyone facing a hip or knee replacement and researching surgeons should visit the ProPublica website. The ProPublica database has Medicare and Medicaid reported data on a surgeon’s complication rate and how many times they’ve performed hip and/or knee replacement surgery. “The numbers don’t lie”, Chabner shared. Armed with hospital MRSA rates and surgeon statistics, Dr. Chabner met with those who passed her initial screening. When meeting with a potential surgeon, she looked for things like: the nursing care set-up, the hardware of the facility, and a strong pre-op and post-op routines.
Being very pragmatic, Dr. Chabner, said that “everyone is going to have a bad story from every surgeon” and that bedside manner shouldn’t weigh heavily in the selection process. She explained, “This [hip replacement surgery] is a very technical procedure, so I needed someone with skill-set. I wasn’t worried about that [the doctor-patient relationship]”
Bonus Tip for Patients: Be The First Patient of the Day. Dr. Chabner shared that it’s fairly significant to have surgery early in the day: “I asked for the first case in the morning. It’s really important to be as early as you can. This is a secret among doctors.”
The reason? Dr. Chabner explained that if you’re the first appointment of the day there will be fewer delays, the room will be cleaner, the surgeon is less tired, and you have more time to recover. Patients, put this one in your back pocket!
A Doctor’s Advice to Fellow Physicians
Dr. Chabner describes her experience being the patient “incredibly humbling”. For Chabner, it underscored how important it is to “be confident in who’s taking care of you”. Along the same vein, Dr. Chabner’s advice for doctors serving joint replacement patients is this: “You need to instill confidence in your patients. Not brazen confidence, but confidence about what you’re doing and that you’ll learn as much as possible about what a particular patient needs in order to deliver the best outcome.”
Touching on the importance of Prehab, Dr. Chabner, recommends that physicians “give patients what they need to grow and learn ahead of time. There are going to be things you can’t control and that’s what patients are most concerned about.
Dr. Chabner further explains why Prehab is effective by saying, “Give patients things they can control. This way, they’ll feel like they have some ability to affect their own outcome by their own preparation. By doing this, you’re giving them 90% of the workload and you can really enhance patient confidence. Don’t send them away with less information, send them away with as much as you can. They won’t be in the dark, they’ll be empowered.”
As for why orthopedic surgeons and care teams should use PeerWell, Dr. Chabner, had this to say: “Figuring out how to empower patients with knowledge by creating preparatory guides, manuals, and videos, takes a long time. If someone else has put this together and it applies to your patients, why wouldn’t you give it to them? People are inherently curious, so give them as much as they can do ahead of time.”
In this section, we ask respondents to answer “rapid fire” style with the first word or sentence that comes to mind. Here’s what Dr. Chabner had to say.
What advice do you give people preparing for a replacement?
DR: Be proactive, not reactive.
How exactly did PreHab help you in your recovery?
DR: It gave me a familiarity with exercises and nutritional aspects that I might have forgotten about or not known how to do.
What is one thing that surprised you about a replacement?
DR: The sensation of having something foreign in your body. Very strange sensation.
Describe your replacement in one word.
Rate your entire joint replacement experience on a scale from 1-10 (1 being the worst thing ever and 10 being the best thing ever).
DR: Health-wise? It would it a 9.
As of this writing, Dr. Chabner is two weeks into her recovery and is already walking one mile unassisted, is back to exercising, and continuing to run her business. A professional and personal inspiration to many, her role as “patient” has been just as impressive.
Visit Dr. Chabner’s website, BFFL Co., to learn more about her and to see her line of recovery and treatment products, such as bras designed for surgery.