The week that was

Well it's good to be back home and online after my resurfacing surgery. What a week eh? I actually can't believe I was discharged in time for the weekend. If you asked me on wednesday if I would be, my answer would have been a definite NO!

Sunday 7th March:
A little late getting to the ROHB due to roadworks, but after calling them to let them know they were only concerned about whether I was having a safe journey to the hospital rather than being late for my 'check-in'. They are so nice there. Once there I was placed on Ward 3, the hip and knee ward, and subjected to a ton of paperwork. I had to have blood taken too - cue the on-call weekend lacky, er junior doctor! I hate the doctors taking blood and no-one had informed this 'trainee orthopaedic oncologist' that taking blood with a regular 20ml syringe and needle had been banned a while back (they use those vacuum syringes now). Couple the giant syringe with the fact he didn't release the tourniquet to draw blood and it wasn't the best experience. Don't worry, I told him so in no uncertain terms! Anyways, apart from that and a giant arrow drawn onto my leg, sunday was relatively unremarkable.

Monday 8th March - the day of surgery:
7am: Woken up and sent for a shower.
7.30am: Visit from the anaesthetist - we briefly discuss anaesthesia and what I'd like. I ask for a general anaesthesia with a single spinal shot (lasts 7-8hrs as opposed to the 24-48hrs of an epidural).
8.30am: Taken down to pre-op theatre, shoogled onto the operating table, stuck with a cannula in my hand, hooked up to monitors and plastered in electrodes!
8.58am: I was given 5 bottles of wine, sorry, the anaesthesia.....then.......
10.30am: Awoke in recovery seeing the clock on the wall, oxygen mask on my face, IV fluids into another cannula in my wrist and the noise of the hot air filling the heated blanket over me. I ask if the surgery was successful, the resurfacing, yes it was. Relief. Then I feel the ache. Morphine given. Ache still there half and hour later - more morphine. Better :o)
12 noon: Was about to be moved to the ward but started to feel sick due to the morphine. Blood pressure also low so they kept me in recovery.
1.15pm: Back on ward 3 fairly awake and very comfortable. Parents came in to visit me not long after that.

Spent most of the day napping and feeling sick due to the morphine. Was sick a few times and decided that I wouldn't take morphine that night, just the NSAIDS and paracetamol. I was not allowed out of bed either - like I could, my leg felt welded to the bed!!

Tuesday 9th March - day 2 post surgery:
Mmmm.....perhaps not taking the morphine wasn't such a good idea! It was at this point that I remembered all the times that I'd forgotten to take the diclofenac and how crap it was to play catch up with the pain. So most of day 2 was spent wrestling with the breakthrough pain and the sickness of the remnants of the morphine, joy! During this time the super-smiley physiotherapists turned up to get me out of bed!!

This was the moment I was dreading and it was just as joyous as the last surgery. Well, as the spinal had worn off it didn't feel as traumatising turning straight-legged using the monkey bar to get your legs over the side of the bed. Bending the legs at the knees over the bed however felt so tight and heavy I thought my feet would never get to the floor. The incision site felt like it was going to burst - they assured me the staples would hold, don't panic (they did!). So, feet finally on the floor, a zimmer frame gets plonked in front of me. Now, as a 31 yr old spring chicken one might think that the site of such a contraption would just induce a depression, but honestly it was a god send - when your leg feels welded to the floor and someone is asking you to do something impossible like 'walk' you take anything you can hang on to with welcoming arms. This is always the point where you think "what the f*** have I just done to myself! I can't walk, I can't remember what it's like to walk, will I walk again?". The latter question was a good one as I did manage to move the leg forward, although there was little control over it and I could hear myself shouting in my head at my leg "MOVE damn it, MOVE!"....it's like the first scene in Kill Bill when she wills her big toe to move after waking up from a long coma - yes, its THAT hard to do! However, 3 steps on and I'm hit with a massive wave of nausea and several bright white spots cloud my vision. Couldn't open eyes due to feeling blinded by said bright spots and the physio's manhandled me back into bed asap. My blood pressure had plummeted to 93/51. No more getting out of bed for me til the next day. As I was still in pain, the nurses decided that sickness wasn't a good enough reason not to take the morphine, I gave in. The rest of the day was spent vomit-worthy but pain free. I was also getting told off by my parents for being too hard on myself as I just wanted to get up and walk - I'm thinking the morphine and anaesthesia affected me in more ways than one mentally.

Wednesday 10th March - day 3 post surgery:
Woke up still vomit-worthy so the on-call doctor gave me IV anti-sickness drugs which actually worked! Hurrah! By this point the diclofenac with paracetamol was working so no more morphine. I still couldn't stomach much food though which was making me feel crappy as I had no energy. I could barely stay awake on day 3 due to this. The porter kept coming to take me to x-ray but the Sister kept shooing him away as I couldn't be mobilised until the physio's came back again, and until I stopped throwing up! Apparently Mr. O was desperate to see his handy-work!

The physio's came back again with military precision to get me out of bed for round 2! Urgh. This time I made it across the room to the bathroom - HUGE achievement this, a glimmer of independence was emerging with the sight of the bathroom door. Washing in bed is bloody impossible and horrid I can tell you. The physio's also told me that there would be no restrictions on my movements either during recovery. This is the big difference between resurfacing and replacement - there's a list of restrictions with replacement so you don't dislocate the joint in the early stages of recovery when the muscles are at their weakest. I don't have to worry, just to use common sense. Obviously I cannot touch my toes just yet because my muscles just won't let me, far too tight! But they will stretch out soon.

Thursday 11th March - day 4 post surgery:
Today was a good day! Despite having had zero sleep (despite my fabulous foresight to bring an eyemask and ear plugs - trust me, worth it when in a ward bay of 4 people!) I was so alert thursday. I got a shower!! Oh I cannot express how fabulous it was to sit under the hot water and wash away that hospital smell....bliss *sigh*. The X-ray dude then carted me off which cheered me up no end as it was my first trip out of the ward bay in 4 days! Then when I got back to the ward the physio's turned up again with 2 shiny new crutches for me. We did the full length of the corridor and then the stairs. With that it meant the physio's signed me off for discharge! HIP HIP HOORAY! Just need to get the occupational therapist and ward Sister to sign me off for discharge and FREEDOM! The OT had to witness me getting in and out of bed safely and unaided - check. They also made me show them that I could sit on a toilet safely without the use of a raised toilet seat and hold rails - just using my crutches and reaching out for guidance. That's easier said than done and not something I could have done post-PAO. But 2 tries and the OT was happy to sign me off for discharge too! The ward Sister was happy with my progress and was happy to discharge me with one exception - I was not allowed to travel back to Scotland in the car! The ROHB do not like their hip patients to travel in cars. So an ambulance was booked, but it meant getting away thursday was impossible - 8am friday morning and I would be free!

Friday 12th March - day 5 post surgery:
6.30am: Woken up to get ready to leave. Wound checked - holy crap, 30-35 staples! Given painkillers to take home and a supply of clexane injections for 1 month (to prevent DVT's, rather than the sexy TED stockings!).
8am: No ambulance yet.
8.30am: Done 4 laps of the corridor and collared Mr. O's registrar to show me my x-rays (wow!). Still no ambulance.
9am: Ambulance!!! Hurrah! Bundled onto the stretcher into the ambulance, en route to Scotland.
3.20pm: Home sweet home baby yey! Very stiff as we only stopped once. Walked about the house lots to relieve it.
11pm: Asleep in my own bed!

Penultimate Day

So we'll be heading off to the hopital soon for me to 'check-in' and be subjected to more pre-op paperwork, tests and of course, the drawing of arrows on my leg! I'm not that nervous right now...I was more so on friday as I was saying goodbye to my friends (as I won't see them for a few weeks as I'll be in Scotland). It's been such a crazy week that I haven't really had much time to dwell on it. Once I get to the hospital it will kick in. Time seems to slow down in hospital and once you've got your wristband on you are at the mercy of the institutions routine. Hopefully this time next week I'll be back in the comfort of the family recuperating......watching 'feel good' sunday night tv with the family!

Here's signing off for now and see everyone on the other side! x

One week to go

Okay, now that I've ascertained that the actual date of my surgery is in one week (and I'll be checking up on that!), how am I feeling?

Overwhelmed. And not due to the surgery! I have so many things to be wrapping up by the end of this working week, throw in a job interview and a ball for good measure, and I'm trying to work out when I can do silly little things like laundry prior to going down to Birmingham next sunday. I'll be begging for that anaesthetic just to shut my brain up!

My priority is this job interview. Given that academic job interviews are tantamount to exams, I'm stressed with all the studying whilst trying to ease my right hip off inbetween. I did take saturday off from work to go to the Thackray Medical Museum (Leeds) with a couple of friends. As I might be leaving Leeds in the coming months I thought I'd take a gander up the road for a visit - that and they currently have an exhibit on 'old for new', being bionic (being a cyborg!! sounds like something that escaped from Dr.Who than your average grandmother!). We spent nearly 3.5hrs going round the museum! Even though I've been using my crutch daily for about 2 weeks now, I was completely wiped out despite having 5 minute sit-downs every half hour. I was hoping to come home and study a bit more, but I had to take a bath to help my poor muscles, and after that I was too tired - watched a movie and had an early night. Gosh, I'm such party animal for a 31 year old!

Because I got most things ready for hospital for last monday, I don't really have much organising in that department, just laundry. I think after the disappointment of the surgery date being put back it has made me realise that even if I get nervous I'm still going ahead with it, so why worry too much. No doubt I'll be more nervous next weekend and on the day, I can't imagine anyone not having those nerves on the day! But for now, I'm focussing on wednesday's job interview, the masquerade ball on thursday night and a friends leaving do on friday night!

My brain's fried, I need sleep..... zzzzzzzzzzzzzzz

Another Amendment!

Being disappointed the first time around they shifted my surgery date, then getting a letter stating it was 2 days later than what she told me on the phone, I decide this morning that with 2 weeks to go I'd call the hospital to confirm my date (again!). This time she said "oh that's odd you're the monday list not wednesday! I will call Mr. Orthopod's secretary right away to confirm".

Oh yes, the surgery date they told me on the phone orginially was correct and the letter was wrong! Which baffles me because you have to phone to confirm your bed, which I did and no one at that point told me that either the day or date was incorrect. I never had anything like this last time, I could have missed my surgery!

It will be on MONDAY 8th MARCH. I said "you'll forgive me if I call back next week to check!". Oh I will.....probably more than once....

The Waiting Game

~2 weeks to go (again!)

I'm getting fed up now. I should have had my shiny new hip today, but I'm hanging-on in here for another 2 weeks for Mr. Orthopod! Woke up this morning, fine and dandy, and as I was putting on my boots for work - my hip got stuck!! Like stuck. It sorta clicked as I was leaning over to hook my boot onto my foot. When I tried to straighten up, I couldn't....cue the panic!! It probably only lasted 2 seconds, but it felt like 2 mins before there was the most horrific grating sound and a pop which released my joint back. I'm still cringing thinking on it. Let's just say, it 'stings' a little.....like it stings when you drop a bookshelf on your foot! It gave me such a fright too, brought tears to my eyes.

Once I calmed down and the sharp pain had subsided I discovered that full weight on that leg wasn't happening today. I'm sort of sat on the sofa with my right leg extended out in a strange manner, fearing to bend it now.....it is not comfortable, and there are aches where I had none before. I'm trying to get work done at home, but I'm having to shift a lot due to these strange aches, so its not efficient (not that it would have been efficient in the office either).

Pesky orthopod's diary! Pesky boots once again!! Boooo......

My Biggest Fear

My biggest fear is having a hip replacement. More specifically my biggest fear is going in for hip resurfacing and waking up with a hip replacement. Waking up from surgery and being told that it didn’t all go to plan.

I don’t actually have a problem with having a THR itself, although given the choice between keeping my femoral head or not, I go with keeping it! I think most would. But I know I cannot live with the arthritic pain as it is now and sometimes I think I would happily agree to some sheep’s cartilage or a leg transplant!

I didn’t realise until last week how much this had been sub-consciously playing on my mind. I had been ‘rummaging’ through the older archives on the surfacehippy group messages and had been reading a lot about revisions of BHR to THR, failures, dislocations, going in for BHR and waking up with a THR. Quite frankly I was voluntarily working myself up into a tizzy about it all when the realisation hit me – I am terrified of going in for one surgery and coming out with another. As soon as I had that eureka moment I was able to address it, and let the fear go. This is not without the help of some friends, but at this moment in time my anxiety has been significantly reduced. I’ve been sleeping soundly too.

I will go into my BHR surgery with an open mind. I really want a BHR, but if I do wake up and find that I am the proud new owner of a shiny THR, I will be temporarily disappointed but I’ll let go of it quicker. At the end of the day, it will serve its purpose. Many young people are very happy with their THR’s, I will not consider myself some sort of failure to be joining them if it enables me to get on with my life. There has been too much THR-bashing going on and I’m not surprised so many of us awaiting hip surgery are horribly anxious pre-op. I have a preference (BHR), others have theirs.

BHR versus THR

I decided I should highlight the differences between hip resurfacing (BHR) and total hip replacement (THR). Many people have asked me what BHR is and what are the differences to THR. This will also be a prelude to the next blog post.

Hip resurfacing is NOT where the orthopod goes into your hip and smoothes everything out, as the name might suggest. BHR is actually a metal-on-metal (MOM) hip prosthesis. It comprises a metal acetabular cup and a metal femoral head cap. The metal used is chromium cobolt nickel. THR's to date can be composed of metal and plastic, ceramic and ceramic, and the newer ones are large-head MOM. The biggest difference between a BHR and THR is in the femoral component of the prosthesis. In a THR, the head of the femur is amputated and a metal rod/spike is inserted into the femur which has a ball on the end acting as your new femoral head. In BHR, the femoral head is maintained, it is only reamed down ready for a metal cap to be firmly inserted over the top of the head.

Just for comparison here's a great image from the Mayo Clinic (http://www.mayoclinic.com/health/medical/IM03868):

BHR is therefore more bone conserving and is proving more beneficial to younger people with hip disease as it has allowed many to go back to more higher impact sports and activities compared to a traditional THR. However, it should be noted that the newer MOM THR's are allowing all ages to do exactly the same. The survival rates of BHR prosthesis have shown to be significantly higher than traditional THR at 10 years. But THR surgery has been around a lot longer than BHR (~15 yrs for BHR in UK; only since 2006 in the US), plus there is a skew in the age groups recieving either. So far the data falls in favour with BHR for younger people, but only time will tell.

I don't want to get bogged down with the pro's and con's here, I merely wanted to describe the main anatomical differences between BHR and THR.