Packing list for Hospital.

This is not really about what is happening to me now but more advice on what to take to hospital. Of course, your mileage may vary, the EOC does things differently to other hospitals and I am bit younger than most hip replacement patients.

When I was packing for the hospital, the EOC had provided a pretty good list I have added some bits to the list with additional notes:

• Walking Aids (Be prepared not to be using your old one when you leave.)
• Slippers and/or trainers. Nothing open backed BUT slip on with a good grip on slippy floors is the best. I had a pair of slippers and pair of sketchers that are slip on, Additionally your feet are likely to swell the size of small melons, so have some shoes are a little too big or stretchy unless you want leave in socks! 
• Nightwear – loose is good but also if you intend to wear a night gown, long enough to go over your knees when sitting. I am not the most modest woman but frankly flashing the people opposite you is a little carefree.  If you are going to get a catheter, consider a nightshirt of very loose, short pyjama bottoms. Also, I took a light dressing gown, it was handy at various points.
• Loose day clothing – stuff that will stretch over your swollen leg, I swear by yoga pants, minimal waistband and enough stretch to accommodate a leg at least twice is normal size and looking like it belongs to elephant. Also the high waist of yoga pants are a little easy to deal with when having to deal with limited mobility. 
• Big knickers! Not grandma knickers but something without tight elastic around the leg and with a reasonable amount of fabric across your butt and not to narrow at the side. I wore girl boxers, that have no elastic in the leg and covered most of the incision site, this minimised the amount of rubbing and were easy to get on!
•  I took enough clothes for five days and that was a little much but better than having to ask Mr Gin find a black t-shirt in a drawer of black t-shirts.
• Personal Towels (not white) – I could have got away with not taking a towel but for me it was nice to have one of my own. Also if you like big fluffy towels, this is something hospitals don’t have! Also take a flannel, scrubber or such like. Orthopaedic surgeons love a permeant maker and mine liked a bit of ball point pen. When you finally get to have shower you are going to want scrub that graffiti off.
• Toiletries – If you don’t normally use soap, you will need a bit because of the graffiti loving surgeon. (I don’t use much soap due to it making me itch if I use too much and didn't pack it.) If you are female and have not been through the menopause route be aware that major surgery upsets lots of things and my hormone cycle was upset. I was caught unprepared and I cursed my body at that point.
• Helping Hand, long arm grabber, reacher. I did not have one of these. Get one before you go in if you don’t have one and if you want to be able to put on your own underwear you are going to need this. Amazon provided mine. (Some councils and hospitals will also provide them.)
• ALL YOUR DRUGS! In their boxes! No doesette boxes. Also any other aides – splints, braces!
• Glasses, hearing aids, contact lens and dentures. I wouldn't bother with contact lens, mainly as putting them in when taking opiates is bloody difficult.
• Fruit juice, ready to eat prunes, apricots. Now I did not really understand this but opiates are evil for giving you the worst constipation. If you have some food you know helps get things moving take it with you. I also got bored of drinking all the water, and had Mr Gin bring in some diet lemonade for me. If you thingy about your tea and coffee, I suggest you take in a small supply too. E, 80 hip lady had a china mug and her own tea and that made her very happy.
• Coat and keys for the house. Self explanatory, especially if the hospital take you home.
• A  Cushion. I have carried around a chair pad a fair bit because being a little higher is easier and if you have to get in a car being high is a blessing!
• No valuables including jewellery. Don’t wear anything into theatre but if you, like me feel naked without your rings take some non-important ones with you.

Added to the list by me!

• Something to do with visitors – if you are having visitors, a game, we had dominoes is something that is helpful so you are not discussing bodily fluids all the time.
• Sleep mask and ear plugs – sharing a ward with strangers is entertaining up until they snore like the stream train from Whitby to Pickering without the wonderful views. Additionally hospitals are not the quiet places and sometimes getting the lights turned off is not a battle you want to take on.
• Something to do. I took a book, as did the other ladies on the ward but we all struggled to concentrate. So, I spent a lot of time on my phone, I got extra data because I knew that Wi-Fi in the hospital was pricey. I also had a small deck of cards and I played Patience because that is all I could concentrate on. I also had my laptop and played games (Minecraft of course). If you have a tablet that would be a good thing, but of course keep an eye on the expensive technology. I also had pencils and a colouring book.

Being cautious.

Today was a bit of a bust.

As I mentioned yesterday I slipped a bit heading into my WI meeting, and as the crutch went in a direction that I didn't I tried putting the foot of my operated leg through a flag stone. Twice.
It was pretty sore by the time I got home and yesterday the bone felt tender. A very different pain to anything that I have had besides when the joint was sore, pre-op style. Morphine help sleeping but last night it was very ouchy.

This morning I called the OEC and they felt that it should be looked at and there was a suggestion to head to St Georges A&E department but to be honest the cab fare would have been very expensive and tube would have been difficult. I figured if I went to my local hospital, Whipps Cross, if it looked bad I could go to St Georges.

Off to X-ray

So, off I went. I bought a sandwich and drink with me, knowing it was going to be a long wait.
All in all it was not too bad. The A&E is tucked away but it is a new building and the staff on point.
A number of x-rays were ordered (and everyone being surprised with my wonderful yoga pants with no metal bits) and then the nurse practitioner and the consultant had a look at the films. They felt there was no evidence of movement of the implant and there was no evidence of breakage or cracking of the bone. They have sent the images to St Georges to have a look at on Monday, just in case. The consultant was good, and said that he understood why I was being so cautious, so that is good.

So about four to five hours in A&E and me being very cautious, it seems it is okay and the pain is just from jarring the bugger.

Tonight I am going to romantic movie with Mr Gin. Deadpool.

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.

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.

An entertaining nights viewing, possibly.

As part of my pack of information I received a DVD of patient information.
This is produced by the Elective Orthopaedic Centre (OCE) out in the wilds of Epsom. It is a practical video, moving through all the stages of the hospital stay and beyond.

There were lots of talking heads, generally the head of the division that they represented. They do 5000 procedures a year. And are world leaders. The wards look clean and modern and they have some strict suggestions for pre-operation, including a visit to the dentist and a flu jab. Both of these I'm going to try to chase down. They have low rates of infections for good reasons. They also want people to cut back on the booze, this could be harder than finding a NHS dentist appointment in December!

There were no real surprises, I have read all the pamphlets they sent. I suspect we are going to need a sexy toilet seat for the first little while and carry a firm cushion for the tube and other sitting experiences. I am currently looking at options to decorate the compression stockings.
It was validating to see my stick my leg out behind me yoga pose for picking up items is a "hip safe" effort. I would like to see what they make of my broken crane yoga wobbling pose I use for putting on my socks.

The patients show were generally old except for the young man in suit trousers and shirt, I think they found him by advertising for a job and filmed the interview. Mind the surgeon speaking to him was in his scrubs and frankly had such an odd head covering we thought he may have been a Dr Who extra.
I learnt there was a colour code with the nursing staff but sadly it was not traffic light colours.

They educated about correct use of crutches and canes, no martial arts involved with that, frankly, again disappointed. I am seriously thinking about inventing a walking stick martial art. They showed a walking frame too, ye olde zimmer frame, still not as cool as the walking frame I had when I was six. It I have to use one of those in the real world I will be adding flames and go faster stripes.

There was a brief moment I thought they we going to talk about post op sex, something I interested in and I am lead to believe is Mr Gin. But no, I have to ask for a separate pamphlet for that excitement. To quote a friend it is like, "GO and read the erotic fiction in the tie in book" That's so lame! When I get the pamphlet I will share it with you, I expect it to be very clinical and unimaginative.

There was no operations show, there was even a trigger notice on the cover saying this. I was disappointed, now considering if they ask to film the op, to ask for a copy. A bit gross and morbid but play to your strengths.

So, in short the DVD was entertaining but lacked any gore or adults scenes.