Dr. Michelangelo and My Five Hips

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Michelangelo was an Italian sculptor, painter, architect and poet of the High Renaissance. My wife, Mary Michael, and I have been to Florence and Rome and relished many of his breathtaking paintings and exquisite sculptures.

The works of Michelangelo have brought joy and pleasure to millions of people throughout the world since the 1500s. He is considered by some to be the greatest artist of all time.

It is with great delight that I compare the work of Robert W. Piston, M.D., board certified orthopedic surgeon, to that of Michelangelo. Dr. Piston’s superb surgical skills honed through extensive medical training followed by three decades of surgical practice bring joy and pleasure to me and thousands of others.

I have had three successful, major total joint procedures from Dr. Piston: he replaced my left hip in 2001; replaced my right hip in 2002; and revision joint replacement to my left hip replacement last October when two of the three the original components deteriorated, as expected.

He also performed an effective outpatient surgical procedure on my left hand in 1992, his first year of surgical practice.

Dr. Piston, of Hermitage, PA, earned his medical degree from Temple University School of Medicine, Philadelphia, completed several internships and residencies, then completed two fellowships. His first fellowship was in total hip and knee replacement surgery at the prestigious Anderson Orthopaedic Research Institute, Alexandria, VA, under Dr. Charles Engh, an internationally known orthopedic surgeon.

The Anderson Institute is a world leader in medical research and product development relating to joint replacements. Dr. Piston’s second fellowship was in hand/upper extremity and microsurgery at Thomas Jefferson University Hospital, Hand Rehabilitation Center, Philadelphia.

Until 1999, I was perfectly happy with my two original hips. For 48 years my left hip, my right hip and I went everywhere together: running, jumping, sitting, standing, sleeping, eating, drinking, and over the hills and through the woods to grandma’s house for the holidays.

You might say we were joined at the hips.

Then pain arrived in my life. My lower back, groin and buttocks screamed at me on a regular basis. My active lifestyle stalled.

I was diagnosed with moderate-severe osteoarthritis of both hips. My family doctor, William Herbert, D.O., and a rheumatologist, Magdy Iskander, M.D., agreed: I needed surgeries to replace both hips.

Then came months of denial. I hobbled around best I could while consuming Tylenol, glucosamine, and chondroitin. They brought very little relief.

Always my best friend and confidante, Mary was even more supportive—she saw the pain on my face. Mary helped me with basic, everyday chores such as dealing with socks and shoes and getting in and out of our vehicles. Some days it seemed my feet were living in a different zip code.

I talked with friends and coworkers while researching hip replacement surgical options and read as much as possible from medical journals and trusted medical-related websites. I assumed a major medical center would be my best option, even though I was employed at Sharon Regional Health System, Sharon, PA.

I was wrong.

Enter Dr. Piston and three others who aided me.

I was acquainted with Dr. Piston only a little from the hand surgery eight years prior. I had no idea of his expertise with total hip replacements. Then I heard many success stories from Dr. Piston’s patients, friends of his patients and hospital staff. He had replaced hundred of hips, including some revision joint procedures on patients who had their original surgery at such (supposedly) renowned hospitals as Cleveland Clinic and Johns Hopkins.

Enter Terry Gibson.

Terry convinced me to talk with Dr. Piston. I think Terry made my first appointment. I knew him a little from our West Middlesex days; Terry went to school and played basketball with my older brother, Bob.

But I trusted Terry, especially when learning of his return to nationally-ranked tennis on the senior level following a 1993 total hip replacement surgery from Dr. Piston at Sharon Regional. That was very encouraging.

The early spring 2000 appointment with Dr. Piston changed my life. Dr. Piston patiently explained x-rays in detail, assessed my limited range of motion, examined me as I stood up, and watched me walk in the hallway.

“Walk” is only a term. I was “walking” like Cro-Magnon man.

My expected 15-minute session grew to more than an hour. Dr. Piston wasn’t only professional and thorough he was friendly and compassionate. When he affirmed my need for two surgeries, I trusted him totally. Terry was correct: Dr. Piston is an honorable, decent, caring man aside from his numerous successful joint replacement procedures.

Surgery would be only a last resort, Dr. Piston stressed. The timing of surgeries would be my choice. For pain relief he prescribed Vioxx, a non-steroidal anti-inflammatory drug (NSAID) new on the market, and scheduled an intra-articular steroid injection into my left hip with an interventional radiologist. Dr. Piston also urged me to stay as active as possible.

My immediate concern: Mary and I had a Penn State Alumni Association long-planned and paid-for trip to Sorrento, Italy coming in May. Dr. Piston urged me to keep our plans, take the Vioxx, but be careful with the wine. He alleviated most of my concerns about traveling the long distance.

We made the Sorrento journey. I took Vioxx as prescribed, had only a few sips of wine, and luxuriated in warm water bathtub soaks. Mary and I enjoyed our fellow Penn State travelers, wondrous cuisine, and historic sites as much as possible.

The Vioxx, occasional injections, and some exercising allowed me to get through the summer. I scheduled my left-hip surgery for January 2001 when best for work schedules for Mary and me. We were ready.

All went well. Surgery, five-day hospital stay, six weeks confined to home with hospital bed, home health nurse twice a week, surgical compression stockings, daily anti-coagulant, and a weekly blood draw was the program.

My recovery restrictions during the six weeks at home included only toe touch on my left foot—basically no weight on the left leg. It was healing time for the implant and muscles cut along my left hip for a six-inch incision and closed with 60 staples.

When in bed, I could sleep only on my back with a large foam wedge between my legs to keep them from crossing. When out of bed, I was either in a wheelchair set at 70 degrees or “walking” around the house on a walker or two crutches.

Next was extensive rehab and back to work part-time with one crutch for stability. I progressed to a cane after three more weeks. Walking on my own came at about 11 weeks post-op.

One hip replaced, one to go.

The 2002 right hip surgery was on my 51st birthday, March 5. It was my best birthday present ever—nothing else is a close second.

It was déjà vu all over again. After a second extended recovery of hospital, home, multiple restrictions, and physical therapy, I was pain free for the first time in three years. Dr. Piston not only replaced my hips, he corrected leg-length differences and delicately repaired my sciatic nerve.

Not every orthopedic surgeon can perform those last two issues. But Dr. Piston can, due to his training and expertise in microsurgery.

What a thrill to be able to live pain-free with legs the same length. Ah, the joy of being able to dress myself. My feet and I were back on a first name basis.

Mary was just as happy as me; the pain was erased from my face as well.

I gleefully returned to all pre-pain activities except running—no need to pound my new hips. Some total hip recipients run. I chose not to risk anything.

The gradual deterioration of my first hip replacement, the left hip, was no surprise. Implant materials available in 2001 had a lifespan of 10-15 years. Dr. Piston made me aware of this in 2000. Regular x-rays over the years showed a progression of microscopic disintegration.

The October revision replaced the original ball and cup; fortunately the third component, the stem in my femur, was fine. Due to extensive bone loss from the original, Dr. Piston used human cadaver bone from two donors to rebuild my pelvis then placed five screws to secure the cup.

Check the x-ray on the right and note Dr. Michelangelo’s skills. The artificial hips are three-part left and right implants of cup, ball, and stem and are brighter shades. Four of five screws are visible.

Dr. Michelangelo indeed.

Hopefully this third time is a charm. I am pain-free, again, and possibly done with hip surgeries. The right hip replacement of 2002 is of more durable material; x-rays show it in almost exactly the same position and condition 17 years later.

I will do my best to protect my two works of art, courtesy of Dr. Michelangelo, I mean Dr. Piston.

Heartfelt thanks go to the doctor and his surgical assistant, Ciera Vandervort, PA-C; registered nurses Dolly L. and Cathy B.; LeRoy Clark, PT, CSCS, director of the doctor’s Rehabilitation Center and director of Physical Therapy; Michelle L., physical therapist; and Center therapy assistants Mike S., Chris C., Lee B., Rachael L.

Dolly, Cathy, and LeRoy were professional, prompt, and caring to frequent questions and concerns I had post-op. I was a frequent flyer at the rehab center: Forty rehab visits over four months with instructions and oversight from LeRoy and therapy staff were needed to regain my strength and balance.

They say everything in life happens for a reason. Supposedly the people we encounter are part of a larger plan.

Enter Jon Kolb, MS, physical therapy/exercise expert.

Jon and I were with Sharon Regional in 2000. He was director of Fitness, Wellness and Sports Conditioning and designed a personal exercise and fitness program designed to keep me at least a little active prior to surgeries.

His life after four Super Bowls with the Pittsburgh Steelers focused on continuing his education, teaching, coaching, and helping others. Jon helped me tremendously.

Jon is the antithesis of today’s professional athlete; he is humble, educated, and articulate. Jon and sons Caleb and Eric operate the non-profit Adventures in Training with a Purpose (ATP) that has several locations in western PA.

Enter Alexander Kalenak, M.D., orthopedic surgeon.

Dr. Kalenac and his wife were among the Penn State crew of 45 on our Sorrento trip. Among other things, the 1957 Penn State graduate had a distinguished medical career at the university where he taught, established a sports medicine program and was the orthopedic surgeon for athletics.

Dr. Kalenac retired in 1995 but kept current on developments in orthopedic surgery. During several discussions, he affirmed everything Dr. Piston told me a few months earlier. Everything.

Should an emergency arise, Dr. Kalenac supposedly “agreed” to do a hip surgery for me in Italy. At least that was Mary’s understanding. Gregarious, persuasive and loving Mary always looks out for me.

It is questionable if Dr. Kalenac actually “agreed.” But it became a moot point. My hips and I made it safely back to the U.S.

Thank you Dr. Kalenac, Terry, and Jon. Dr. Kalenac passed away in 2008. Mary and I were fortunate to share his presence for a few days.

Mary and I will soon return to Italy thanks to the talents of Dr. Michelangelo, the wonders of modern medicine, and Mary’s unwavering support. She and I will walk pain free and enjoy the works of the original Michelangelo.

We are blessed.