I see dead people in my future.

I have had a bit of a time with planning my next operation. The timings all centred around Squeaky Cub and him finishing with the Spica. When we knew the Spica journey was coming to an end I contacted Johnathon Hutt at St Georges, only to find out that he was moving to University College of London Hospital to take up a position there.

This put timings out a bit and I had to think if I wanted change hospitals or surgeon.  After thinking I decided to continue with Mr Hutt and we moved hospitals and I saw him three weeks after he started in his new role.

To resolve the pain issues from the implant I am going to have a bone graft to hopefully distribute the pain that flares up and either reduces or removes it.  The pain is okay in the summer but winter it can be terrible. I ended up on my stick a couple days with a cold snap and it certainly was nagging.

This stem pain is a known side of the implant (S-Ron) and the bone graft should resolve it. If it doesn’t then I am going to lump it and chase a toddler, as the other option is a revision and I am too young for that. Neither I not Mr Hutt are keen on that option, because in his words, those replacements are hard to take out.  The graft will be donor bone, so prepare for dead people jokes and a push to donate your bits when you move on. (Tell your family.)

When I saw Mr Hutt, he was not sure what his waiting list was like and I have some plans coming up that we needed to work around. With some phone calls I sorted a date with the lovely scheduler and I have surgery on the 17th of September.  This could very interesting; the recovery shouldn’t be as long as a replacement but could be more painful to begin with. This could be interesting with a toddler!

I have had the pre-operation appointment and considering there has been no communication it is all go. Fingers crossed Squeaky is walking and we have begun planning, the logistics are a little worrisome.

Six Week check - Mr Hutt

So, today was my six week check up.

I trundled my way out to the far reaches of Wimbledon. Went through the now standard excitement of X-Ray (Yay for yoga pants) and then without much waiting it was off to see Mr Hutt.

Mr Hutt 

He was very pleased with the scar, even though I have had an awful outbreak of eczema around the scar. That should be solved with large amount moisturiser.

The implant is a titanium and ceramic S-ROM implant with a Pinnacle cuff. It is attached using ‘Press Fit’, which means they are both uncemented and the bone should grow to attach them firmly.  It has a long stem and the reason for some of the thigh pain I have. Hopefully this will disappear but this could stick around. It also is closer to a normal hip on its angles so I have a different range of movement. Not a huge different but it does explain why my turn in is not as awesome as it used to be. The small fracture I got in surgery was because I have round shaped femur and not elliptical like most people. The stem is shaped for normal people and was a very tight fit.

Mr Hutt was awesome and answered the three pages of questions I had. Very matter of fact. Very little sugar coating. The left hip looks good but not great and I should be aware that it could go but he said that is a while away yet.

He was impressed by the knee bruise, he felt it was referred bleeding from the operation.It was not something he had seen before. He said that knee had been twisted but not to the bruising extent.

He also said that I can ski and ice skate but to be aware that if I do take a tumble and fracture the right femur it is more likely to be a nasty fracture.  So I shall think about those. Cycling and swimming are for the win the win. This bit is for Red, Mr Hutt was slightly horrified at the thought of Skydiving and that the release of the shute could cause some issues. He did not say no but did look little bemused by the suggestion. He did say that marathons were totally off the table.

So, onto slightly more practical matters. I am able to get rid of the second crutch and when the Physios are happy with the walk, getting rid of the second crutch soon. Also, I can gently attempt to go for putting on socks and tying up laces. If my muscles allow it I should also be able to squat and to sit cross legged.  If I manage to sit cross legged, this will be something I have never done! Never!

There is very little I should not be doing. Most of the danger zone for dislocation is over, and I have to be aware of some twisting but generally it all good. I doubt Prima Ballerina is going happen but I think that there will be a new me.

So, this is a large thank you to Mr Jonathan Hutt for undertaking the job.  At six week I am more than happy with the outcome and the care both he and the EOC showed. Mr Hutt said that we really should know in 12 months how well it has gone.  Hopefully the year mark will be a show case for exciting new movement and life.

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.

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.

We have a date.

This came in the mail today. It is not a surprise to me, I had been rung to confirm it but I wanted to have it in writing.

So 2016 is the year of the Hip. The year of the S-RON! 21 of January. A Thursday.

I have a lot of pamphlets to read and a DVD, no operations show.  Boo.

If you can read the procedure line on the letter, there is a word in brackets. (Complex) I think I may have to get that tattooed somewhere.

Slow, slow, lightening fast.

Friday afternoon was a touch stressful, I got a phone call from Central Booking at St Georges, offering me an appointment to see a consultant on Monday morning.

It seems that the email to PALS worked, but I had no idea it would be that short notice.

Sadly it is not with the surgeon I originally asked for but it is with Phillip Mitchell, he has written lots of papers on the 'nitty gritty' aspects of replacements, he also seems to have a reputation for taking on complicated cases and ones that other surgeons won't touch.  I am pleased with this, because although my hip is very odd and looks like it was built by a blind plaster, it is not a complete mess, nor shattered and not a result of other trauma. The other thing is that he does almost double the national average hip replacements. As long as he or Mr Bridle are doing the surgery, I will be happy.  (He is also younger and does a lot revision work and maybe still working when the left finally goes.)

I have a long list of questions, I am EXTREMELY nervous. I am doing this initial consultation solo. I am making sure I wear sensible underwear, because no doubt, sans trousers hobbling and scar looking will be needed.

*gulp*

Almost complete obliteration

The, the past month, five weeks has been tough.

No movement on a consultant appointment, three weeks off sick, read the x-ray report and played with lots of medication. Time for a catch up!

Things have been going down hill for a while, stress migraines popping up, lots of pain killers, still just paracetamol and ibuprofen and curtailing life in general. Jobs taking longer, rests are longer and I generally have felt pretty low. We had the Victoria tube line interrupted because of engineering work, this meant a longer, more crowded commute and having to use my cane a lot more than I would like. Work knew but really, the understanding of my commute and the knock on effects were not there. This was frustrating. The pain levels increased with the commute and my mood plummeted. Even when the commute went back it, the body didn't bounce back.

Exhausted, in pain and depressed, I took some sick leave, citing hip pain but also out of cope. I figured some better painkillers were needed. A phone call to the doctors to sort that out and in that conversation I was told the xray report. That there is almost complete obliteration of the joint space. Obliteration, not a word you want attached to your body.

That was a gut blow, I cried a lot, I cried at my supportive boyfriend, I cried into my cat's fur as they lay in a cat puddle, twisted together. The brave face cracked. I realised work was a part that had to be taken out of the equation. It was not helping in the physical management and I desperately needed head space.

After a week, I physically saw a doctor and he signed me off work for two weeks. Also told me to up my new medication,naproxen and prescribed tramadol. He also said chase the consultant appointment, because over a month was certainly enough waiting.

I did that, and spoke with two people at St George's who said they would call me back, but didn't, I did give them a week each to do this.

So, the third try it was recommended I contact PALS, which I did.  More on that outcome later.

I returned to work and had a meeting with my line manager and his manager, I explained the drugs and generally that sitting all day and the commute is killing me.  I have said the same thing to Occupational Health and they have backed me up with a report suggesting one day a week working from home.  This would break up the tube travel which I am finding increasingly difficult to deal with, it hurts to sit and stand on the tube and the sheer amount of people is nuts and they knock into you!  I have a meeting next week to see if the team can do that, if they can't I am not sure what to do.

One positive has been a sports massage that seemed to loose a lot of the muscles around the hip and in my back that has reduced my pain, a lot!  Swimming is still helping but currently shopping for slip on shoes! Such an old lady!

It is now down to choice.

I have two names, that I am trying to decide to go with.

I have selected them on their reactions to my email.  the ones, who just sectaries responded to, I have dismissed, ones that seemed this will easy, I have dismissed.

I have not looked at the surgeon statistics as a wise friend pointed out to me that, all of these top surgeons will have higher revision rates as they do lots of no standard replacements.  I have checked out their private practice, publications and general googling for stories, blogs etc.

First is Mr Briggs.

He is located at the Royal National Orthopaedic hospital.  His response indicates he may not have looked at the x-ray but I have emailed for clarification.  The hospital has very strict referral guidelines and I  have had three names, who practice there.  Mr Briggs has said that I can go to RNOH as I am a complex case.
At the moment, even without the slight confusion if I have had a replacement, I am leaning towards RNOH, because there are a lot of talented people there.

Second is Mr Bridle.

His response was the first and swift.  I am a gut person, and my gut liked his response. Measured and careful, without arrogance that comes through some times.  He is also adverse to resurfacing.  St Georges have a very good reputation and both Surgeons I contacted there were happy to see me and come up in top ten surgeon article from a few years back.

Both operate out of hospitals that could be difficult to get to but RNOH have a central London spot too.

So, who will I choose?  I will have to go to my GP at the end of the week armed with a name.  I really don't know.

The Joy of overdoing it.

Today I am at home, not at work.
Why?  Because everything was sore this morning and the thought of public transport filled me with horror.
Overdoing it meant, sitting in training on non office chairs for five hours.  Checking out some art for an hour and half and walking down a hill to the tube.  Frustrating because I could have done that easily 9 months ago.

But it is not all doom and gloom.  On Monday I spoke with a lady a decade older than me who had her hip replaced.  She is very happy with it.  The lead up to the replacement is a bit of a horror story and confirmed to me that starting now is a grand idea. I have been told, 12 month wait is not out of the question.

A member of the WI has also backed up my thoughts on a Stanmore surgeon, so I have contacted him.  Additionally I have two other surgeons contact me.  I am currently reading reviews and as much literature on the surgeons who have agreed to see me.

Then off to a GP, to get the consultation.  It is moving quite quickly!

The first bite

Today has been interesting.  I really did not expect an answer straight away from my email.
I had two this morning, that is 50%.

The first response was from a private clinic, headed by the women who replaced the Queen Mother's hip. Unfortunately, their recommendation was for a fellow at Stanmore, a hospital I would struggle to get an appointment with.  I have contacted them directly, and I will attempt to contact the suggestion just on the off chance.

The most positive response comes from Mr Simon Bridle, listed in the Daily Fails top hip surgeons. He also has a great website and does not advocate resurfacing.

His response is as follows:

I would be very happy to see you

Surgeons have done a good job and both hip joints are in right place, so joint replacement will be relatively straightforward

If you would like appointment I'm sure Diana can arrange it

Simon

I am very, very pleased with this response, it means Mr Dickens did do a good job, just as we thought, it is really nice to discover this.  I am also pleased he did not turn around and say no straight away.
I have a few more leads to chase and then I will be looking at failure rates of each of the surgeons.  Such a boring thing but needful.