7:15pm Stab my girlfriend

Epidural Bruise

Deep vein thrombus. Not just preserve of long haul flights.

It is also a big risk with major surgery, the surgery itself can produce clots and the blood gets sticky. Avoiding blood clots was one of the reasoning behind the epidural, apparently they cause less clots than general anaesthetic. 

 So, it is something that nursing staff drum into you. Drink a lot, keep that blood flowing.  Wear your TEDS, a stocking designed to keep the blood flowing through your lower limbs. My feet and calved have swollen somewhat but not as much as my thigh and bum!  

Getting the TEDS on and off is an entertaining experience as they are quite tight; I discovered each nurse has a technique that works for them.  Mainly this centres around a plastic bag over the foot, the TEDs being folded in half, slid onto the foot and when a half on you unfold it up the calf to below the knee. Then you roll the bottom up the foot a little using the inception hole and pull the plastic bag out.  It is nigh on impossible putting them on yourself. My mother is doing them at the moment as she had experience of them with my Dad after heart surgery and when he does long haul flights (he has had DVT).

The other thing is Dalteparin soduim, a blood thinning medicine. This has proved to be an interesting thing for Mr Gin. As we know, Mr Gin does not like hospitals and a little bit phobic about them. He was not best pleased with sitting with me in the pre-surgery suite, as I rattled away with nervousness and they took blood and stuck me full of needles. I was beyond surprised when Nurse Susan asked who was going to administer the Dalteparin soduim, he offered. Why was I surprised? Dalteparin soduim is a subcutaneous injection. Yep, my partner offered to stab me with a needle on my belly every evening for 30 days!  He is very good at because they do hurt a bit even though they are a thin needle. They go into the belly fat and they hurt, for me, for some time as the liquid spreads through and is absorbed into my belly fat.

The main side effect of this, besides a smug Mr Gin brandishing a needle at my tummy when his phone alarm goes off (labelled stab my girlfriend), is the bruising. I have a tummy with an assortment of small round puncture bruises from the needles. Also the deep bruising of the operation is coming up in a myriad of colours. And any small knock bruises and they are taking forever to heal. 

For now I am doing a lot of feet wiggling when sitting or lying down and not stay in the one position too much but this does mean I want to walk a lot more and that is causing more swelling. It is bloody, swelly tightrope.

South West London Elective Orthopaedic Centre

I’m home and have been so for about 24 hours or so, and I’ve had time to digest my experience at the South West London Elective Orthopaedic Centre (SWLEOC).

They are a Centre of Excellence, within the NHS (National Health Service) and the majority of procedures are knee and hip replacements. There are a number of these centres dotted across the UK and different one specialise in different things.

A number different hospitals feed into the centre, including St Georges and Kings.  It is outside of London but still within the M25. For us it was over two hours on public transport. And almost on the opposite side of London.  The surgeons there are the top of their field and the nursing staff, physiotherapists and other staff are specially trained in the care of joint replacement patients.

The dedication and expertise of all the staff was very apparent, and the regime was intense. The nursing staff worked 13 hour shifts. There was a consultant on duty 24 hours, something that is quite rare. There was physio and radiography seven days a week, on the weekend a smaller staffing of the physio and x-ray.  The ratio is very good and the wards had no more than 3 beds in them, and it appeared that they tried to place people having surgery on similar days together.  The expert nursing staff meant you were in safe hands all the time and they even had prescribing nurses if drugs needed changing or new things needed treating. The goal of coming out independent was very obvious, with all staff being encouraging and gently pushing you to strive but, if you look like a rabbit in headlights they were comforting. The respect and care for the patients was just amazing.

The facilities are world class, five dedicated theatres, a dedicated radiography suite, a day ward and two longer stay wards. It is a separate centre, attached to the Epsom General hospital but very separate. The reason for the separation is to limit patient contact with infection. Infection is the bane of joint replacements. A bad infection can result in a dreaded revision. The SWELEC has some of the lowest infection rates for joint replacements in the word and they do about 5000 procedures a year. Just amazing.

They also will collect you and take you home, hour and half drive home was done by Bill. Which was gratefully received, I could not have done it on public transport.

Even though there was a lot of older patients there were some younger ones and even though it was commented I was young, I could just say I was born with congenital dislocated hips, there were questions of procedures and outcomes that were intelligent and well versed. This led me to believe, I was not that far off the norm. Once the explanation of my age was there, they procedure with me as the same as the oldies.
So, fabulous surgeon world class facility and a top of the line individually selected hip replacement. Pre-planned and measured. Sent home with crutches, exercises and a lot of drugs.  The cost of this procedure?

A large dent in my sick leave.

Nothing, in terms of money. A rough estimate would be about £10,000 maybe more.

I am beyond thankful I was in the UK and the NHS is available to all, including this immigrant. I certainly have not paid £10,000 into the NHS with my contributions.  Thank you for the amazing NHS, a huge organisation that runs 24 hours, seven days week, and I will be campaigning to stop it being privatised because without it, I would have been crippled, in debt or both.  Social healthcare for the win.

Time flies when working hard

So, I am sitting here, planning to be heading home tomorrow. They wanted to discharge me today, but frankly I was still feeling wobbly and I had not attempted stairs and the stairs at home give me the heebies.
Saturday was similar to Friday but a much better night’s sleep but still feeling pain in my knee. Breakfast but the lovely nurse Susan said I was to shower as I had my catheter out the night before. Oh, my lord, it was bliss even though I needed all the help and it was exhausting. I felt knackered but so much cleaner than the day before. I found I have lovely biro (ballpoint pen) marks from the planning on my leg and the bruises are turning the most amazing colours.
Then came physio. I was moved off the zimmer frame of doom and onto crutches. A lot of one foot catching up with the other and trying to adjust my gait to take in the new leg length and general appalling walk from years of favouriting the right hip. There were standing exercises, one that I do beautifully because of all that sock yoga.
The crutches needed practice which I duly did. We did have a bit of excitement with M, one of my ward mates passing out, and causing a great flurry of people coming from all corners of the ward. It was frightening and I was quite concerned that M was going to die, she looked so bad.
Things settled down and I tried to practice my bed exercises and talk to Mr Gin and M did it again, this time I noticed her starting to roll her eyes back in her head and alerted the nurse. Again battle stations were called and she ended up in bed, resting. By the afternoon she was looking much better and brightened when her visitors arrived later in the afternoon.
Mum, Mr Gin and I played dominoes and discussed the revelation I might be discharged tomorrow (Sunday), I expressed my concern with the lack of stair preparation and given the massively steep stairs at home Mr Gin was inclined to agree with me.
He had been a trooper coming out to visit me when his back was sore and enduring the 5 hours of public transport to see me for a few hours. It was lovely to see him, I miss his company terribly and he rocks as a partner!
He helped make sure my bed was flat which was causing the pain in my knee, which meant I was looking forward to a good night’s sleep. Buoyed by being able to get changed myself from day clothes into jammies!
Alas, that was not to happen as the other lady with a hip replacement, E began to throw up and be in enormous amounts of pain. Infection had set in and she was not comfortable. A nurse sat with her most of the night as they juggled drugs, bought the night time consultant to check her, and waited for the antibiotics to kick in. She slept sitting up some of the night and in the morning, this morning looked much better. But neither I nor M got great sleep.
Today was the dreaded stairs day, I really was nervous and not keen. The lovely physio, Karina, was caring and gentle and not that fussed about my tears. We went through steps and then hit the stairs. That was hard work and I really did not feel confident with them. She agreed that I could stay and give them a red hot go tomorrow. We also went through the height of the bed at home and the toilet and practised getting up, down, on and off those heights.
I also had a shower, stood in the shower and managed to give myself and even better wash. AND get my own trousers on, which was great. I still cannot believe I can put my full weight onto my new hip, I can stand unaided but should not do that too often.
I have also started working normally with the crutches, not one foot catching up to the other. Mum came for a visit and we coloured together and chatted as Mr Gin stayed home and rested his back.
As long as nothing happens during the night and stairs go well, I am set for heading home tomorrow. Monday, after a complete hip replacement surgery on Thursday. Amazing.

And it is done!

There has been some eventful few days, a little recap of Thursday and Friday.

We were all up at 5:30 am and out of the house at 6:45 am to be lead along a meticulously planned journey by Mr Gin. My mother and I sort of sailed along in his wake and we embarked on the 2 hour public transport trek to Epsom.

We got there in plenty of time and played in the star trek chairs before Mr Gin and I headed up to the Pre surgery unit. There we had to answer all the questions and then meet the anaesthetist, the registrar and finally Mr Jonathan Hutt, the man of the moment.  The anaesthetist, Mr Singh was lovely, very through and then explained that they generally do an epidural instead of a General Anaesthetic.  This was a bit of a new one for me, it is not something I have done before and was feeling a little apprehensive about, I had no experience of them and frankly major surgery is not something I want to listen to. In the end he convinced me and I opted for it with heavy sedation.

There was an x-ray of the CAD program that Mr Hutt had used to plan the drawing. When Jenny the registrar came in to mark my leg, I added the smiley face to add good luck to the surgery.  Mr Hutt explained what he was going to do and that we were looking at two to three hours of surgery and possibly a blood transfusion.  The words complex and difficult were bandied about but Mr Hutt was confident and everyone I spoke to, nurses and other staff said he was very good.  When speaking with medical staff I have learnt they don’t give high praise unless it is deserved, they are more likely to say just good or okay if they are not that impressive.

I was wheeled into surgery after saying good bye to Mr Gin. In the theatre there was an array of cloth covered trolleys and a bed for me. On my side and bent into an uncomfortable position I exposed my spine (and bum) and once in position sedated. And that is it.

I woke in recovery feeling pretty good in the grand scheme of things, not the normal heavy nasty feeling after a general. The leg felt pretty good too. Very numb as they inject the area with local anaesthetic and touching your own leg and not feeling it is very strange. Mr Hutt and Jenny checked in on me. He was pleased with the outcome and there was one minor hiccup . I have a piece of wire around the femur because a crack developed. My femur is not as big as he expected.  He was very pleased with the outcome and felt it should last me 20 years!  That is great news.

The other big surprise was that he did manage to take the screws out in one piece! And I have them, my companions for thirty years and they will continue, I think the form of earrings! (Need to get my ears pierced first.)

Once I had something to eat I was taken down (or up) to the ward. I was still feeling fine, very unusual, legs a bit tingly and the dead wood feel of the local still happening. I had chosen to have a catheter for avoiding the dreaded bed pan. This is also a weird experience and one I am not sure I want to repeat again.
My Mum and Mr Gin met me on the ward, a three bed with two older ladies, E, 80 having a hip done and M, 72 having her knee done. I was given morphine and unsurprisingly that made me a little spaced and chatty. All in all I felt okay, not completely comfortable but not as uncomfortable as I thought. My leg was a remarkable red colour from the disinfectant. The wound site is covered in a water proof bandage and stuck together with glue! The bruises are amazing and continue to be so, high lighting the old scars running through them.

They left and I was exhausted and ready to settle for the night. The lights were bright and I could not get comfortable. My right knee became more and more sore. Once the lights finally did go out I desperately tried to go to sleep but just could not settle.

I rang the bell and the night nurse gave me some morphine which helped a little and I waited an hour and was almost in tears by this stage. She hooked up a paracetamol drip and I finally got some sleep, about 3 hours worth!

The day started early as they do with hospitals.  All three of us started the same routine, breakfast, and the bed baths. The amazing red disinfectant was removed and the bandage checked. The sexy TEDS (dark green stockings for stopping my legs swelling and halt blood clots forming) were applied with a bit of wrestling.  Then the physiotherapy team came in and there was in bed exercises and then there was Zimmer frames! Walking! You read that right. Up walking in about 16 hours of surgery. Not that painful as there was still local anaesthetic rattling the joint.  Although very awkward with the catheter.

The oddest bit for me is it felt all cock-eyed when I stood up. Mr Hutt had almost made me completely level. A very surreal and distinctly odd feeling. It has taken my brain a little time to catch up.
There was more physio after lunch, walking with a Zimmer frame and generally a bit of exercising and drinking all water because if you filled it enough you could get it out.

I was taken to x-ray which proved to be a difficult, I felt very much pushed around and put into an EXTREMELY uncomfortable position that upset me a bit. But I did get to see the x-ray and it looks amazing. A nurse came in and told me that Mr Hutt was pleased with the x-ray.

By Friday dinner time I was pretty over the catheter, uncomfortable and annoying and I was drinking heaps and filling it up. The Physio was happy I could walk myself to the toilet. I asked the nurse if I could get it out and she said I had to wait till morning. I was a little disappointed with that and willing to wait morning but it was driving me bonkers. The head nurse then decided to do it then and there because she felt that I would be okay. Not the most comfortable experience but very thankful for the nurse to get it out quickly and understand that I was over it.

My visitors went and I collapsed for the night it had been a long couple of days.

Nervous, nah.

Currently riding the Victoria line tube with two suitcases, my mother and Mr Gin also a percentage of London's tradesmen as they head to work. It is early, there are cheap energy drinks being clutched and gentle body sways of the people with the ability to sleep sitting up.
Today is the day. We are heading to Epsom to check in. Surgery is happening today.
I got asked at work if I was nervous a while back, the answer was no, bloody petrified but not nervous.
I've had enough operations to know what to expect, generally, I'm pretty good with general anaesthetics and I've researched the facility well enough to be comfortable they know what they are doing.
I'm petrified of the other side. The pain factor of having bone removed is unknown, the ability to bounce back is unknown and although I know the percentages of complications, they still scare me, a lot.
The threat of nerve damage and infection are looming shadows. Nerve damage, especially of the sciatic nerve worries me a lot. There is no guarantee of its location and in my case if it is not caught up in scar tissue. It is going to be stretched and nerves really dislike this, really, really. I have a friend who has periodic bouts of sciatica and to have that all the time is something I would struggle with.
Infection causes all sorts of mayhem, it may cause a revision, having to fix or put in another replacement. At my age, 41, I can not afford that. I'm only going to be able to have three possibly four replacements in my life, they last about 15 years and my grandmother lived to 93. As you can see, I really want avoid a revision.  I have had a friend who had revisions done in her 40s and the effect on her mobility is affected to a life changing extent. Again an outcome that I want to avoid at all costs.
So, here I am, an empty tummy and dry hands because no food since midnight and no moisturiser allowed.
At midday my life will change and hopefully Mr Hutt  will make it for the better. I have list of things I want to do when this is over.
So, not nervous but suitably scared of downsides to work bloody hard at avoiding them.

Sock Yoga.

How I put socks on!  Hopefully this will change!

Toes and good to go.

So, one of the biggest issues I've had is my feet in general. Putting on shoes and socks has increasingly become more difficult.
I have a yoga routine to get my socks on and have worn the same pair of slip on sneakers for the past four months. Everywhere and with all outfits.
The other issue has been looking after my feet in general. Cutting my toe nails has always been odd. I tuck my foot under the opposite leg and cut them backwards, sole up first. Very odd position but worked for me. I no longer can do that for one leg.
Mr Gin did it a few times but that freaked both of us out.
Some work colleagues suggested I get a pedicure, what a brilliant idea. But that would be a complete stranger playing with my feet was going to take some effort. I'm a bit funny about people touching my feet.
So, a couple of weeks ago I headed to a local nail bar and soaked my feet, had the nails trimmed and cleaned, all rough bits removed and finally a deep red polish applied. It was odd and lovely. My feet looked amazing.
Yesterday I did it again, mainly to have the nail polish removed.
This because the surgery team need to look at my nail beds to check my circulation.
I have my instructions for my surgery day, only two days away now. 9 am role call and like gremlins no food after midnight!
It is getting real now.

Good bye old friend

Scars, I have a lot of them. I have little nicks on my hands, chicken pox on my fore head and belly and of course the one on my jaw from childhood bath fall accident. Most people have them, scars are a sign of life will lives, they are stories of carelessness or bravery or so small you can not remember where they came from.
My body shows the story of my hips in stark relief. I have a 2 cm thin white line on my right wrist. It is a reminder of what happens when a two year old rips out an IV line.  I have another on my knee from an ulcer that developed because nothing is going to stop a six year old running around, not even a half body cast. (Although my mother did keep me from getting it too wet, like similar aged boy we saw one day, his cast was brown and smelled!)

The big guys are hidden, I have a lovely curvy one on my left hip and a whole world of train train tracks and fun on the right.  I used to I use to fairly self consciousness of the scars, growing up in Australia and being a swimmer they were on display a lot and you picked up the furtive stares. As I have got older it is less of an issue. I worry about my belly more than my old friends.  Along with my limp they just tell a story, not all that interesting but on that has been intervening in my life. Effecting decisions and general  life.
I have hidden them, hated them and slowly grown to love them,   I have photographed them and am comfortable showing them off.




But on Thursday I am going to lose one. The long straight one down my right thigh. The one someone once though was cotton hanging from short shorts.



It will be cut out and a new scar will be in its place.  This feels a little odd. It is the last one that was opened, I can remember the stitches coming out.

The new one will be longer and will trace around onto my butt.  Something to photograph?  Yep.

Heading out and staying healthy

Well, it is 7 days to go, this time next week it should be all over besides the fat lady groaning.

It was drummed into me when I at the health check, if I had a cold the operation would be off!

So I have spent the last few weeks looking like a Casualty extra who has wandered off set or I 'm auditioning for a star wars role wearing my face mask on the tube and generally out in London.

Also I'm obsessive with hand wash, and anti-bacterial things, this is not really me, at all. I am in the what does not kill you will just make you stronger camp.

I am also avoiding parties and gigs, which is depressing and wearing the mask at the cinema. Very sexy! Pictured above is my going out kit. Drugs and anti-bacterial stuff abounds.

So far so good, no sniffles or cuts or scratches. Fingers crossed for the next week.

Two weeks to go and I can not wait.

So, it is two weeks today till surgery and I can not wait. I am over the pain and in the grand scheme of things I have little to belly ache about it.
I am in the privileged position that my pain should disappear within month of the operation.  It may hurt from time to time but it has always been manageable. I was born broken and although my mother did the best she could in a small country town, I was not fixed. In the end a very good surgeon did the best he could with a bad situation. We knew that it was all going to pear shaped at some point and it was just a matter of time. Having always being broken, I don't really know different and it is just a way of life, frustrating at times and down right depressing at others but on the whole fairly happy and my normal.
Recently, someone on the Internet suggested I had more right to complain about pain and illness than others, because they felt I had an identifiable issue. ie mashed up hip. And I was 'allowed' to whinge. This rankles quite a lot.  Not only because that sort of statement is pretty ridiculous but also because it touched on something that I have been thinking about for a long time. The privilege of pain and that I am in the white straight man zone.
First, I just want to talk a little about pain. Up until recently I have had bouts of being pain free, if I sat for a while or was in bed it was pretty good. I know can feel the joint in bed and some day there is little I  can do to ignore it and have taken all the pain killers. I hobble about and swear a lot and rest a lot but I can get stuff done. Not as much as I would like but I am pretty good at working out what I can get done on a given day. But I have had to adjust everything in my life. I am not out as much, when I am out, I am packing heavy pain killers so I can walk, socialise or generally try and live life, within a hip that is rubbing bone on bone allows.
It is isolating because being at home is the best, less distance to walk, no pesky public transport and comfy couch and amazing bed. Our couch also allows me to lie down and there is a big arse telly with Netflix and a the Skybox. So, home is safe and cosy but we do live a fair way away from most of our social life when you are on a cane and restricted with distance.
That isolation plays havoc with your mental health, social media shows people out and about doing things, some that you have had to turn down. As time wears on getting people to come to you and getting to things becomes harder and it is easier to curl up at home. At home I have one person to complain to. Mr Gin is lovely but he does not need to hear that, me being in pain is tough for him too. He is doing more around the house and in general being the rock for my crazy. And crazy is the operative word. I have a couple outlets, social media, taking photos and sewing. Sewing is becoming difficult as the standing and the physical action of using the sewing machine foot is getting harder. So, the outlets are becoming smaller and social media is the best place to feel less like you are alone, driving the love of your life nuts. Facebook is a pub and twitter a huge nightclub.  Inevitably you end up being that person who has a one update. Or a couple, that revolve around how shitty you feel and you are cancelling again. But it is an outlet and an important one.
But I am very privileged. I have a light at the end of my tunnel, I have juggled and am on a road that should lead to new and possibly a better normal. As long as it does not go wrong relatively pain free, able to dance all night and then walk home. Why is this privilege? Because there is an end.
I have a number of friends with chronic conditions there is no end, there are less pain options but you have to give up something in some cases or there is simply nothing that can be done but managing life and expectations. And that isolation I have only had to deal with a short period is their life. And justifiably they have to have outlets because life is bed of roses and roses have big bloody thorns.  One friend, who has Ehlers-Danlos, a rare joint disorder was on the receiving end of some nasty stuff because she vented on Facebook. I was once briefly was misdiagnosed with Ehlers-Danlos, I am just overly bendy, nothing that causes the issues she has. And has no way to get away from them. Personally, I would be complaining a lot more than she does. And hell, more than most friends with issues.
Mainly because I have walked in their shoes for a mile and I don't like it, not one freaking bit. I am prevailed and acknowledge it. Next time you see that whiney sick mate complaining on Facebook, don't tell them to pull their socks up. Offer to take the party to them or just listen. And don't be a dick.
Bring on Thursday two weeks away.

Health check!

So, finally, I got my health check. One of the most intensive health assessments I have ever done.

There was five hours of public transport travel, four different questionnaires, three vials of blood, two different nurses and one X-ray and pee sample.  And that was just the highlights.

Mr Gin and I travelled across London to the Epsom General Hospital and the Elective orthopaedic Centre.  We were there for two hours but there really was not much waiting around. The waiting room was filled with older people but the nursing staff seemed used to younger patients. (I know I am 41 but in this procedure I am quite young)
There was a quick height and weight check along with a charming stick up the nose moment.
Then a different nurse took some of the most comprehensive health questions I have ever had. We worked out that I have had 15 General anaesthetics, a fairly high amount. It was nice to meet a medical practitioner that knew the proper names for the procedures I have done!

Also there was a "Wow!" when the x-ray below was produced! Apparently I do good work.  For comparison I have included the x-ray from nine years ago. Sorry for the poor quality.

2009

2015

At the end of the health exam, with all the bells and whistles including checking that all my blood goes to all the right places, she answered a number of concerns as we had.  It was drummed into me not to be sick and I am taking lots precautions to avoid colds, scratches and anything that could halt the procedure.

Then there was blood given and x-ray taken. Then we headed home.

All together painless and now the serious count down begins.