Monday 28 May 2012

WEEK 3

So looking back through my blog so far I can see how far I have come in the last three weeks!  Reviewing last week, I have been continuing with my exercises doing them three times a day and finding them very easy to do, so adding to the repetitions required.

I would not recommend this to anyone, but with the weather being so hot, up to 26 degrees for a few days last week, I just could not bear the support socks and have stopped wearing them.  I am checking my calves every day and I am taking the anti blood clot medication and prescribed.  I did some internet research and read a paper on research into the benefits of knee high support to THR patients and it seemed to me that it was not conclusive that it prevented a clot forming if it was going to happen.  This is my decision I stress!  I will however wear them during a two hour car journey to Somerset which we will be going on later in the week, as I think this is the time when problems could occur.  We also intend to have a few stops on the way so I can walk around.  My brother stopped wearing his socks 2 weeks ago and I really told him off, and now I am guilty too.

I have enjoyed taking my R and R on my new recliner which is perfect for the job required!  It is years since I have sunbathed and it is a lovely feeling, and I do like my brown legs!  I have a shower late afternoon and although the first shower ever seemed such a traumatic experience with the crutch going into the shower with me and me worrying about slipping etc, it is now so straightforward and obviously refreshing after an afternoon in the garden.

We have been gardening - by which I mean that Nick has wielded the gardening tools and I have pointed at what is a weed and what needs to be moved, and with my grabber been able to pick up the cuttings and tidy them into the wheelie bin, so I have done my bit!  I am not sure how soon I will be able to garden myself, and along with the need to get down on one's knees, there is the issue of getting back up again afterwards, which was pretty difficult before the operation, and now the 90 degree rule must be observed it does require some thinking about.

Along with that thought came the one that I would actually like to lie on my tummy on a rug.  How does that happen?  So, as usual, I googled getting up from lying down after THR and found discussion threads about this which were a bit helpful but not medical in the advice.  It seems that kneeling comes into it, and having a chair handy to assist in getting back up.  I spoke to my brother this morning and he had actually not done this movement, but thought that strong arms and strength in the non operated leg would be needed.  He suggested rolling over while lying on the recliner (which must be done with cushion or pillow between legs).   He has been sleeping on his non-operated side (which I thought was totally banned) by putting a firm pillow between his knees and rolling on to his side.  I was in bed when we were chatting at 7am , so I decided to try this out for myself and continue over to lie on my front - And I Did It!  What a simple movement that was - no 90 degree infringement obviously, and no crossing leg over either! So that is the first part.  It may be good to try and get to standing while on the bed with Nick standing by to catch me, before I do it outside!  (This is all about wanting a tanned back as well as the front - but my previous posts already would have given an indicaton of my vanities, so I make no apologies!)

We had an early Sunday morning visit to our local car boot sale - we planned our breakfast to be sausage and egg baps from the catering van, washed down with a steaming mug of coffee - which all went as planned.  We were there about 8.30 and chatted to a chap who wheels and deals and sells on eBay,who had arrived at 5am!  Obviously if you are a professional that is what you do!  We bought plants and I bought some beautiful antique linen with crochet trim for my chests of drawers.  Amazingly cheap, so I will return for more.  Also will go back another time and stock up the freezer with whole fillet steak (£15) lamb shanks (6 for a fiver) etc, will take cool box and be prepared.  Managed on one crutch and we were there for two hours.

Have also now started this week walking to shop for papers with Nick each morning before breakfast.  This is about a 15 minute round trip, so I take one crutch and then this morning did it with walking stick for first time which was fine.  Have found myself getting a little breathless keeping up with Nick's pace, which is an indication of my lack of any physical activity for a couple of years now.  So I am determined to improve on this so that in a couple of months we can go for some really long walks together again - we might even get another dog!

I can go up and down stairs now without a crutch, normally,bliss!  It's being able to do something like this, such a simple action, but one which I have not been able to do for 2 years that really brings home how gradually restrictive osteo arthritis is, and the benefits of the new hip!!!!

When I write my next blog we will have been away for a long weekend in the country, hopefully been for a few gentle walks, we may go to Lyme Regis (!) that is an on going amusement for us, in which case maybe my brother might be able to meet me from where he lives in Poole.  At  four weeks I am also going to have a little go at driving.  So watch this space!

DAY 15

Two weeks today since my operation!  I really do feel fantastic!  I am comfortable doing everything I need around the house and have my very efficient grabber for picking up anything from the floor.  It can even pick up paperclips and cotton wool buds it's so precise!  Apart from the tender feeling around the bruising, there is no pain in the joint at all - just a slight dull ache if I do too much.

A colleague from work popped in for coffee and brought flowers cards wine and chocs from everyone, so that was brilliant, and especially hearing all the news and gossip!  The weather is hot and sunny and we sat in the garden.  I have decided I need a recliner, so have found a suitable one from Homebase which is padded and multi position and only 19.99 so we will be going to get it later this week.

I have removed my dressing and inspected the incision with a mirror.  It is very tidy, there are a couple of nylon (?) threads sticking out which I have trimmed off, otherwise the stitches have disappeared and there is just the thin line of the incision with still some bruising towards the front.  Underneath you can feel a lot of tissue, almost cupping my hand around it.  I am amazed that such a short cut can allow all that had to happen, to happen!  I am going to massage Bio Oil into it to help with the healing.  My brother is using E45.  I have just remembered the physio mentioned that some people have found arnica very soothing for the bruises.  In fact I remember my mum taking arnica pills before an operation as she believed it helped the body cope with the stress.  Its probably too late to benefit me now, as my bruising is on the way out: down my leg, to my foot and then away for ever!

Spoke to brother who is on Day 29 and has driven today!  Said he felt very naughty doing it, but had sat in the drive and gone through all the motions including emergency stop and felt confident he would be fine.

I think that now there is not so much daily detail to report that I will add to this blog on a weekly basis and update on my mobility and progress that way!

DAY 14

Appointment with physio this afternoon.  She watched me walk with both crutches and then showed me how to use one, she said I was limping and should take both crutches out for any distance but around the house definitely one was fine.

We went through the exercises I do, which cover all the necessary muscles and she was very happy with how I did them; she added a couple more to try and said increase the repetitions when I felt comfortable.  She said listen to your body as it will tell you when it is ready. She said my consultant does not like squats or exercises done lying face down.  She re-iterated wearing the socks for 6 weeks and sleeping on the back for 6 weeks.  She said all consultants have a different take on the recuperation, and one of them puts no restrictions on his patients at all, where as mine is quite strict.  This explains why when you look at internet chats and sites about THR you see so many different versions of what is allowed.  The things that everyone agrees on however, is the 90 degree rule and the not swivelling on the foot or crossing the legs.  When you consider this there are actually a lot of things you can do without infringing this ruling.

We discussed stairs, which I am finding I can now walk down normally, but walking up normally does not yet feel wholly ok, and I maybe do a couple properly and then revert.  She agreed that that was the best way to do it, every day adding another step or two until I feel comfortable going up and down normally with one crutch.  Then try going down without a crutch, etc.

She did know of a pool where there are physio sessions, but suggested we discuss this after the 6 week check.  She said she saw no benefit to me of seeing her on a weekly basis, as I understood and was obviously doing the exercises necessary, and in my case it was more a question of taking it easy as my personality was obviously one that liked a challenge and could easily overdo it.  Considering I would have been happy to pay for a weekly session I thought that was most impressive.  I asked her if any of the THR patients at the Nuffield needed one to one sessions on a weekly basis and she thought hard and could only think of one lady a while ago who needed a lot of support to get mobile.  So it would seem to me that maybe my brother's physiotherapy is not really needed - he wont agree though! Maybe consultants are friendly with physios and recommend to patients as insurers will pay up and its win win for everyone!

She said there was no reason not to take off my dressing, so I will do that after my shower later.

I lay on her couch to do some of the movements and it was interesting to see how well my new hip behaved and compare that with the limited movement which is now affecting the other hip!  Of course in the usual course of events, if one is not a gym visitor or an exercise class attender, one would not know that the mobility of a joint is affected if all it is asked to do is walk, climb stairs and sit down! So I intend to exercise both sides and hope that when the time comes to have a THR on my left side, the muscles are already as prepared as they can be!  I think this must be a couple of years away though as there is no pain from it yet.

I asked her about driving and she said without  a doubt I would be driving at 6 weeks and that some patients who had recovered quickly, as I was doing, were happily driving after 4 weeks.

Altogether I was very happy with my hour spent with her.  My questions were answered; I felt reassured about my progress; I felt less anxious about exercises.  I will see here again in five weeks time.

DAYS 12 AND 13

This is my second weekend home and quite a contrast to the first!.

My first social outing today with my cousin to a gastro pub, which if I had walked would have been about quarter of an hour, but of course, I didn't, we nipped up in the car!  I was concerned about height of chairs and also the loo side of things, so we arrived early to make sure we secured a table with chairs rather than the sofas with coffee tables or stools, and found the perfect position.  I cannot tell you how lovely it was to be back in the world and away from medical concerns!  I just took one crutch as I am finding that totally comfortable inside and for short distances - I would definitely take both for a walk.

This pub, being newly refurbished, has every disabled person's dream of a loo, with plenty of room, bars to support you, things at the right height, brilliant, so I need not have worried.  I nearly dispatched Nick in advance with a tape measure to check the facilities, I was so concerned.  A normal height loo with no handrails would be totally impossible.  One could get on it but not off it I think!.

After lunch we decided a visit to TKMaxx in search of handbags might be a good idea, and that was a great success, I must have been on my feet for an hour or so in total, with no discomfort at all.

Sunday was a quiet day with a couple of feet up rests - I could tell that I had maybe done a bit too much the day before.

DAY 11

Had a really awful night, got up to the bathroom 3 times, had four sessions of light on and reading (Nick should be really glad I'm in the guest room!) and saw most hours pass on the bedside clock!  Managed to get up and have breakfast at 8, but went back to bed at 10 to catch up on sleep and didnt wake up till 1pm.  I think this is the result of over-exertion - it is my body telling me it is stressed.

Tidied around the kitchen and could 'cruise' around the work tops without a crutch.  Tried a tentative walk across the kitchen space, but I am limping a lot without the one crutch.

DAY 10

We have excitement today! Excursion to Sainsburys!  So I am putting together a list of groceries to last us two weeks, so we dont have to do it again soon!  Also calling into Argos to collect vibrating baby chair for imminent first grandchild, and dropping off tin of biscuits and card to staff on my ward - they were all so brilliant - and I know that people who want to complain are always the noisiest, so it is good to get a 'thank you'! While at hospital, also buying extra long 'grabber' as I think mine is too flimsy and not good for picking up small items from the floor.  I can't believe it is just 7 days since I was in hospital, I would never have believed that I would so quickly be on my feet and doing the usual things.

The shop lasted about an hour and a half and I was glad to get back in the car at the end of it!  I started just pushing the trolley with crutch inside it, and that was perfect until it got too heavy, so then just the one crutch.

Came home and had chat with brother: he reckons he can probably have up to ten sessions of physio paid by his insurer.  He is doing, amongst the other normal exercises, leg squats, and lying on front and curling legs up! - none of which I would even think of doing!  So I am beginning to feel that my little exercise regime is a bit feeble and that my muscles will not be working very hard to support the new joint.  Then that I may be compromising my strength in older age, so I do feel concerned and pleased that I will be seeing the physio after the weekend.  The cost of the initial consultation and 5 subsequent half hour sessions will be in the region of £300 I believe, which I cant really afford, but feel is essential to getting back to work in six weeks time and feeling strong through my hip.

The back of my knee is black and blue with bruising and the whole of my lower leg and round my ankle is bruised and tender, but the swelling is going down now.  Had a lovely shower and feel tempted not to put support socks back on, but I do!

DAY 9

Had an appalling night.  I get this really tense restless sensation of wanting to escape and run off somewhere, it feels impossible just to lie and relax and then sleep, like I need to be somewhere else, not here in the middle of the night, stuck on my back like a beetle, I would do anything to be able to sleep on my side but I am too scared of dislocation now to risk turning.  I keep putting on the light, and reading and piling up the pillows to try for some comfort.  This really is the worst part of the whole thing for me.

Finally morning, and I checked my bag of medecines.  Nothing much left now except senokots, so I will just buy paracetemol and keep taking it as I was told to.  Or not, maybe they assume you know what to do as in (a) keep taking it at regular intervals, or (b) just when you need it.  I don't know, who should I ask.

I suspect this is my body in stress due to over exertion yesterday.  But how would I know.  No-one has told me how much walking I should be doing, how many crutches I should be using.  I like a challenge, I like to know that after a week, this is what you could be doing, 2 weeks, another goal go achieve.  I realise that people of all ages and levels of health will arrive at these stages at different times, but surely some guidelines could be offered!

Bruising is now down on my foot, all around my heel.  The inner thigh bruising is becoming lighter in colour.

Tip - have a notebook and pen in every room, even the bathroom, because thoughts that require action pop up all the time and can easily be lost!

Finally got through to surgery and I can book a telephone conversation with my own nice efficient lady doctor in 2 weeks time, can you believe it, so I said then I would speak to 'anyone' and so some other doctor will call this afternoon at 2.30 and I will ask about physiotherapy.

Well that GP conversation got me precisely nowhere.  I was advised that the hospital had done everything expected of them and that as I had my exercise regime to continue with, all is as expected.  If it was felt I needed any additional physio help, a session could be booked in 6 to 8 weeks, but there was no NHS provision in this area for anything more than what I have had.  I pointed out that I was intending returning to work in 6 weeks and was also aware from my research that there were considerably more elements to the physio side of things than I had been offered.  He was not at all helpful, so then I rang Nuffield Health, which has a private hospital about ten minutes away, and booked to see their senior physio on Monday.

Friday 18 May 2012

DAY 8

Following new regime was up and dressed etc by 8.30 and took pills with breakfast rather than before on empty stomach as I think this was making me nauseous.  I took a couple of paracetamol and 2 naproxen, which are my NSAIDS from before the operation. 

Spent the morning doing light housework and feel better for being up and about.  Had an after lunch feet up session with the frozen pea treatment on the bruised areas - actually  I would need a freezer-full of veg to simultaneously apply it to all of my bruising!

Spent some time on line researching exercises for post hip op patients.  As I was doing the standing up exercises on the landing alongside the banisters realised that if I had both feet on the floor, as you do, I could actually turn it into a bit more of a routine and exercise the above waist bits as well, so I spent some time on the internet to see if there was a dvd aimed at post hip op people. Again found plenty of items from US but nothing quite what I was looking for!  I'll keep looking and do a link if and when I find one.

I did find Arthritis UK though and that was brilliant I think that right at the beginning when I was first informed I had osteoarthritis I had a look around the site.  For me, in my early fifties I just said 'I've got a problem with my hip' I really thought arthritis was for old people and I didn't see myself like that.  Now at 60 it is relevant!  And certainly on this site there is an expectation that physiotherapy will play a large part in the short term (first 6 weeks) and long term recovery.  Hydroptherapy was mentioned as well, so I felt confident that there should be more help available for me and everyone else who has just had this major operation.  So I tried to call the surgery to book a telephone conversation appointment with my doctor but it was always engaged and I gave up for today.

The bruising is spreading down my leg, really painful behind my knee where the top of the sock cuts into the swollen area - sound lovely doesn't it! I measured the knee and the thigh and it is actually only about an inch bigger than the other leg, but it looks huge to me.

Have called OT and arranged to collect a longer length grabber cost £7.00. It seems sturdy and more exact than mine and far less expensive than  anything on Amazon. 

It was a lovely evening so we set off for a short circular walk which ended up taking around 30 minutes, half the time with both crutches and then with just the one and Nick's arm.  It was painfree, really, though there is a stiffness which sometimes feels like pain.  I did feel a little light headed once but it passed.  We had supper then I climbed on to my elevated 3 seater sofa, stretched out and raised my leg on cushions, glass of wine, blissfully comfortable!

Thursday 17 May 2012

DAY 7

Good night's sleep and woke feeling really full of energy!  Had morning tea and did some deep thinking about now my first week of 6 off work is complete and how best to handle the structure of the next 5!

 I decided that I had been too reliant on the pills I came home with - without advice I had taken 2 paracetamol and 2 codeine 4 times a day - I mean without advise on when to take and whether to take both - and found myself feeling sleepy and unmotivated.  At first I put this down to my body adjusting to the trauma of the operation, but once I thought about it, my custom had been to wake up at 6 and immediately take both painkillers,  just as I thought I had been given in hospital.  Then,instead of getting up as planned and getting myself a nicely thought out breakfast, I just fell back to sleep again and dozed till late morning.  The other problem was looking forward to a meal (I do love food!) I would take a timed dose of painkillers and then feel nauseous and not want anything.  This happened particularly before breakfast when I had obviously taken the paracetamol etc on an empty stomach.

It had taken 4 days of being home to work out the above I am afraid!!

So today I took nothing until I had eaten and it worked perfectly.  Also decided just to take what was needed in terms of pain instead of medicating at regular intervals all day as I thought I was supposed to.  I think the nurse who handed over the bag of pills to me assumed I would know to do that - she was wrong.  A printed out do and don't sheet would have been so good to refer to. 

My New Daily Plan also involves getting ready for the day just as if I was going to work, although about an hour later.  So I have to be up washed, dressed, make up on and hair done and be downstairs between 8 and 8.30 for breakfast.  I will report on how this works, but I feel a schedule will be a million times better than just wafting around in PJ bottoms and a T shirt!  Plus, I am leaning heavily on my partner for all the stuff I cant do whilst trying not to nag about housework, so the least I can do is look fragrant at breakfast for him!  Especially as we are not even sleeping together due to bed height issues.  He really does not like doing the feet washing and stocking application activity, bless him!  I read today that sexual intercourse can be resumed after 6 weeks, carefully!  We shall see, although I dont think that is an area I will cover in my blog!

After breakfast I plan some light pottering, I can vacuum with one crutch, I can iron, and I can mop (if someone else sorts out the bucket) and I can dust.  So I will do these things and not just sit about looking at them as I was doing.  We dont have a cleaner as we cant afford one, if we did it would be a godsend as a couple of hours a day would keep everything just perfect.  But on the other hand I would then have Nothing To Do at all, so may be not so good!  This way I can be on my feet, strengthening my muscles and occupying myself and burning calories as well.  Win Win!

I also suspect the beginnings of a pressure sore on the heel of the operated leg and think that is due to slothful lolling around, so the more time spent out of bed the better really

I will have a feet up rest late morning with a skinny latte, but not sleep.  Maybe make calls or lists or read.  Then lunch, then a walk out with both crutches, gradually extending the distance each day. Plan supper, make shopping list and then put feet up and watch Rosemary and Thyme from 4 till 5.  Then go for a walk together, first with two crutches and then with just the LH one and his arm for support.  No pain, not tired, really good.

So all in all a successful day and a positive mindset!  Summary of pill taking: 2 paracetamol with breakfast, 2 codeine at 2pm and 2 paracetamol at bedtime.  Not in any noticeable pain. Took other medication as prescribed for bowels and blood clots.  But I think in view of the reduced codeine intake the senokot pills could probably be dropped unless indications show otherwise! (Nurses are always obsessed with bowel opening I found.)

DAY 6

Woke up a couple of times - now have 8 pillows of varying density to arrange and actually semi propped up suits be best rather than lying down.  I don't think I snore that way either which is a Good Thing, not that anyone would notice as N is in our bedroom!

Am now comfortably pottering with only left arm crutch, and even no crutch at all whilst standing tidying the airing cupboard or doing stuff in the kitchen.  I wouldn't go into space - that is cross the kitchen - without one crutch, but I can happily 'cruise' along the 3 sides of worktop.  I have been planning my shower later - there are a lot of elements to consider.  I decided that as our shower does not have any shelf in it for products, that hair washing was out due to no bending down to pick stuff up.  So I washed my hair in the kitchen, as that is at a good height, and quite manageable along.  Then carefully assembled on the required items and made sure they were all reachable.  You must have a non slip mat or use an old towel to stand on to guard against slippiness.  I even took the crutch in the shower with me, it makes me feel more secure that way - the shower, along with stairs, is the place where people most frequently damage their new hips - so I was ultra careful.

Apart from getting in and out of bed, I am not in any actual pain, and in fact the pain I feel is mainly down to the bruising on my inner thigh and behind my knee.  For this reason, and to make exercising as pleasant as possible, it is a good idea to take the paracetamol, even if I don't think I need it, I think.

Felt actually quite exhausted with the day's activities and took myself early to bed.

DAY 5

This morning feel a lot better than yesterday when I really did feel uncomfortable and depressed,  Still not much appetite, but that is Good Thing!

Spoke to dear brother who had just had really good hydrotherapy session on a one to one basis with his physio.  Similar moves to the out of water ones but with the resistance and support of the warm water more effective.  Decided I must research to see if I can find somewhere locally.  His therapist charges £48 for 30 min session (which he doesn't pay personally as it is covered by his health insurance).  Jealous.  He says that also 4 hip recoverants have got together to share the cost between them, and turn the session into a bit of a social event with lunch afterwards! - that sounds perfect, I will see what I can discover around here.

Had long chat with SWATT lady on phone and asked about sleep positions as I so hate being on my back.  But she said I must stay on my back for 6 weeks because of the danger of displacement.  She said in her experience, if it happens once then it happens again and is only corrected by a revision in the end.  She said after 6 weeks could lie on operated side; she didn't know about lying on the front but couldn't see it would be a problem as long as you didn't twist the hip getting into position.  I just don't want to risk it - I will stay on my back.  Asked about hydrotherapy - she hadn't got a clue about that and said she would ask one of the physios.  They called me back later and said no-one had any information about that at all!  What???

Dear daughter2 came this afternoon with cream tea ingredients and we sunned in the garden for an hour or so.  She has also brought me a long handled brush as my first shower is imminent and I thought I could reach feet with it (as it turned out, it was not long enough, so Nick did an extension and it turned out perfect!) Then the best bit, we adjourned to the boudoir and she re-painted my toes a delicious crushed strawberry! One of the many irritating things about the whole hip problem is that for the last 18 months I have not been able to cut my own toe nails.  It is such a simple thing, and not a job that one can really delegate to the man in one's life without a sense that some of the romance is leaking out of the relationship!  He struggled manfully with them once, but I think we both knew it wasn't working! - so I resigned myself to an all the year round pedicure done professionally, instead of just during the summer months when toes are on show.

It may sound trivial, but when,folding back the toes of the horrid support socks, I see my ten beautifully pinked toenails, I do feel immensely cheered up!  We also took a photo of my tree trunk leg which at some point I will add on here, just so you know what to expect!  The bruising is spreading across my lower back and round the inner thigh and has even appeared around my heel - incredible - what on earth did they do to me while I was unconscious?  Someone suggested there is a lot of tugging and manipulating going on to get it all in place, and may be to get the legs the same length - for which I am eternally grateful.  Limping around with my right leg half an inch shorter than my left was not at all where I wanted to be.  I was looking forwarded to re-creating my elegant languid hip sway of yore!

After she left I had my feet up for a rest, then we had a takeaway at 8 and watched the Bridge at 9 - really struggled to keep eyes open.

Wednesday 16 May 2012

DAY 4 HOME

I woke up feeling really uncomfortable.  The wound itself doesn't really hurt in any significant way, its ok even if with light pressure when sitting.  I think the pain is in the area around the new joint and there is a particular burning sensation which I remember getting with my own old joint which is even more so right now.  I conclude its in the tendons around the joint and it happens most on waking and moving first thing.  Getting out of bed and standing up with the help of the crutches is virtually painless - as long as you discount the process of getting the lying down legs round and on to the floor to stand up in the first place!  Standing up from bed in the morning used to be the most agonizing movement and I would have to count slowly to ten before I could walk - none of that now, once up I'm off painfree!!

I feel tearful today, and small things are making me feel down.  It feels like depression - maybe there's a post operative depression thing which happens Day 4?  I feel its medical in its origin rather than emotional as I'm not a depressed type of personality.  I think its all the stuff like having to ask for help, being irritated that my home is not being kept as clean and tidy as I would like and I just have to put up with it; everything always not being where I need it.  I strongly recomment duplicating on frequently needed items, or at least organising a soft cross body bag in which to collect and transport items as you move around.  Have discovered that I can put phone in bra so that I dont keep leaving it in the wrong place and then rushing - on crutches not good - to get to it, as that was causing me problems; my clothes dont have pockets and I knew if I dropped it: 1.  I couldn't pick it up and 2. I could damage it!

I feel unsupported.  There are numbers I can call, but I have looked on line and there seems in other parts of the UK with more support certainly in terms of physio and OT (Occupational Therapy) than I have received.  My initial information pack told me an OT person would come to the house to help me with adjusting to my new hip and advising on the basic movements and what to do and not do.  I think that they have actually economised by 1.  Covering this information on that Pre Op day 2 months ago, and (2) by sending an OT person to the bedside as I hazily remember someone appearing waving a packet of compression stockings and a grabber to see if I wanted to buy either of them.  And I had only one session with the physio and as I did stairs on Day 2 they said that's fine you can go home as far as we're concerned!  So what that means in our area is that once you are home you are left to sort it all out for yourself.  If I did not have access to the internet and had not watched various YouTube vids - mostly american in origin - then I would not have even a fraction of the information I have.  I really did not get what they meant about 90 degrees until I watched a YouTube film with a chap on a chair demonstrating when a position was risky.

My brother (several days ahead of me with his op in Dorset) says he is advised to rest with legs elevated twice a day, but level at night with pillow between calves.  Luckily SWATT nurse arrived at 11am, she took blood pressure and temperature, both ok.  Went through my four lying down exercises and showed me some standing up ones holding on the the banisters.  She took off the dressing, which turns out to be a thick and rubbery version of a giant elastoplast, which sticks to the skin with a very heavy duty gel type adhesive - and its apparently waterproof!! - which means that .... I can take have a shower!!  Hurrah!!  Hospital did not give me any guidance on that at all and I supposed I had to wait till it comes off which is Day16.  She also said my scar was shorter than normal and as it has stitches not staples they will dissolve by themselves.  My brother sent me a photo of his scar which looked scarily huge and I counted over 30 staples in it!  She said that as I am doing so well she wont need to visit again and will just call me tomorrow and then if all is fine, sign me off to the care of my GP.  Another economy.  I know it sounds awful, but I almost wish I was in worse shape so that I didn't just get signed off all the time and then left to myself!

DAY 3 HOSPITAL AND HOME

Woke around 6 and got myself up to visit bathroom.  Drugs came round and observations done, all ok.  Breakfast arrived: cereal, croissant, juice and tea.

Teams of physios arrived and got everyone up .  The two older ladies seemed to be in a lot of pain and struggling with their frames - no hope at all of progressing on to crutches.  Another lady has had her knee done and is now managing on crutches with a lot of groaning.  Sue opposite has had the same hip as me and today has got onto crutches, but not stairs.  She is feeling a lot better - and says seeing me flying around on the crutches yesterday really motivated her to get on too!  Apparently my achievement with up and down stairs yesterday meant they could sign me off and I could go home today if all else was fine, so no one came to talk to me from the physio dept.  I wanted more attention!

A doctor arrived and said I was definitely going home today and could I confirm that I would be collected asap.  They wanted to put me in a chair while I waited as there was a new lady already there and waiting for my bed!!  Apparently if I had not been ok to leave, she would have been sent home.  I would totally have hated that if it had happened to me - you get yourself all mentally geared up for it and then just to be told to go home would be awful.

I got myself dressed easily by dropping my elastic waisted skirt over my head and not bothering about knickers, and pulled on a long sleeved top, wrapped my scarf around me and there I was in the wheel chair waiting for N to arrive! All packed up!  I was brought a bag from the pharmacy containing:

Paracetamol (2 x 4 times a day)
Codeine (as above)
Senokot (2 at night)
Lactulose - bowel softener (15ml x 2 a day)
Dabigatran - anti blood clot (2 x 110mg at 6pm)

Also  a doctors note for 6 weeks.

I was surprised that there was nothing stronger in the bag, after all we take paracetamol for a headache and I have just had major surgery so I thought I should have had some morphine!  I will ask my brother what he is taking (the result of that is he has got Tramadol which is an opiate based painkiller, but he was prescribed this to help with bad pain before his op so it is ok for him to carry on with that, but not for me to start with it unless my pain becomes really bad. He is also taking his Dicloflenac as before.)

Nick arrived and wheeled me to the car.  I had left my cushion in a slippy Gap bag on the passenger seat and got in bum first and swung in my legs and felt fine.  We used my Focus as the seat seems higher and easier for me to access than his car.  I have had to get into a car this way for about 3 years now so I am used to this action.  Its also a very ladylike way of getting in and out of cars, particularly when wearing no knickers (!) as the knees can stay together.  Stopped at Waitrose, I waited in car, and bought sandwiches for lunch and few bits for later.

Once home, carefully made my way upstairs - so glad I had the rail fitted as there is no way I could have done it without.  Remember good to heaven (meaning lead with non operated leg) then follow onto same step with operated leg and crutch.  Going down: bad to hell (lead with operated leg and follow with good leg. Into bed and served a very delicious sandwich and fruit lunch!
I had prepared a few basic meals for the freezer, bolognese sauce, ratatouille, fish pie, beef in red wine, and plenty of assorted frozen veg, so that Nick could sort out meals for us easily for the first few days, and this has worked well.

Nick has done battle with two raised loo seats and one stool - all wrapped up in tubes and tape and then needing height adjustments - I read that Occupational Therapists came to your home and sorted all this out for you whilst helping you with chairs and getting in and out of bed but they just delivered the stuff and left.  More NHS economising.  The loo seats also have arms and make a huge difference, you could not possibly cope with a normal height loo.  I am wondering if disabled loos in restaurants will be this high.  If not you couldn't risk it because you would dislocate the hip in struggling to stand up from a below 18 in height - if indeed you could stand up at all.  Do not go anywhere without a tall loo. You could inadvertently sit down before realising you could not get up again.  How dreadful!   This could be limiting - I will have to give this some more consideration.

I have been doing my 5 lying down exercises:

 Clench buttocks, hold for 5.  10 repeats
 Bath towel rolled up placed under knee.  Lift leg hold for 5.  10 repeats
 Pull foot up towards ceiling, press down with knee.  Hold for 5.  10 repeats
 Plastic bag under foot slide up to bend knee.  Hold and repeat as above
 Plastic bag under foot and slide outwards.  Hold and repeat as above.  This is the most painful of all!

On Day 2 I could barely move my foot at all for the last exercise, but it gets easier each time you do it, as you'd expect!  I just breathe deeply through the pain and make it work!

It's been lovely getting lots of cards, texts and messages from friends and family, so I am occupied replying or telephone everyone!  I am however finding it hugely problematic getting around with the crutches as I dont have a free hand to carry anything with.  I keep leaving some essential item in the wrong place and feel like crying with frustration when I have manoeuvred myself onto the loo, only to find my trousers have fallen on the floor, and the grabber I need to pull them up is in another room!  If the crutch falls on the floor, and they do have a life of their own when not on your arm, then you cant pick that up either! In feel very dependent and its not a good feeling.  I am taking the pills to the hospital routine and feel quite sleepy, so I will sleep!

DAY 2 HOSPITAL

Had no sleep at all really, too much groaning by others (TIP take eyeshades and earplugs )!  Really wanted to visit the loo but still had catheter and drip so bed bound.  6am nurse came and took catheter away, hurrah I thought, bathroom here I come, but no, I was not to get out of bed until physio arrived to tell me how to do so, but I could have a bed pan.  Great.  Curtains drawn, bed pan arrived, but so did a new lady to occupy the bed across from me with a very vocal and attentive husband.  No bed pan action under those circumstances so I resigned myself to wait for physio and just lie there, waiting, in discomfort!

Physios arrived with frames and crutches and everyone was shown how to get out of bed and transport themselves a short distance from their bed.  I transported myself straight to the bathroom with enormous relief! They decided that as I was a 5* pupil on the frame, I could go to the top of the class and have the crutches, which were much better.  Wasn't aware of any major pain that prevented me from doing what they asked.  The staff explained that it is important to take the pain relief regularly to keep pain at bay all the time rather than just take it when the pain appears as then it is not as quickly effective, and prevents you from doing the strengthening exercises.

It was bliss being able to stand up and move off with none of the awful pain from before! The physios went through the four or five bed exercises they wanted us to do three times a day.  The abductor where you attempt to swing the operated leg out to the side was a killer, I could hardly move it an inch.  It was suggested I put a slippy carrier bag under the foot at home and that would make it easier in the beginning.  It became evident that none of the other ladies could get anywhere near me in terms of hot crutch action!  I was the star of the ward, and revelled in my fame as word spread along corridors!  Well, not quite, but I was keen, and took off a couple of times myself, just as a change from bed, and to get away from the inane conversations going on around me.  When in bed I took to putting the tv on radio 4 and putting on the headphones and pretending I couldn't hear anyone speaking to me!   I didn't mind chatting to the lady next door to me, but had no intention of broadcasting conversations across the entire ward, as were the others!

Lunch and supper were both hot and delicious and plenty of cups of tea, really whenever you wanted one.

I was advised by a friend to take in a bag of Tesco fruit and nut mix, as a healthy, easy to store snack for hungry moments, but I never felt like I needed them.  I thought the water might be awful and took in large bottle of Evian, but the water jug and glass were changed and filled frequently (TIP drink as much water as you can as it keeps your temperature down and helps with blood pressure apparently and thus aided a swift exit home).  The new incumbent in the bed opposite appeared to have come stocked up with rations to withstand a siege.  Packets of jaffa cakes and biscuits, huge amounts of fruit and god knows what.  Not needed at all I would say.  Apart from the fact that your appetite goes down anyway, you really dont want to be lying around eating unhealthy snacks all day.  Probably a couple of bananas and some washed grapes in a tupperware box is all that's needed.  Some fruit cordial to help with the water if you dont like the taste could be nice. 

Physio returned after lunch and wheelchaired me to a staircase with my crutches.  I went up twice and down twice - that was it she said - well done Jill, that's all we ask you to do here!!

I will make a few points here on how the smart hip replacement patient might be kitted out for frame/crutch activies:  I thought a lot about what to take in with me, in the end, too much, but I do like a choice!  If there are any men reading this, I do apologise, but I can only put the female angle!

What would have been ideal would have been something along the lines of the M&S striped nightshirt. This is pastel in colour, so blends nicely with all the blue and white around you; its a decent length, it looks smart when you are sitting up in bed and you can receive visitors without worrying about them seeing bits of you, that you normally keep covered up, in my case armpits and upper arms as I hate them.   When you get out of bed it's knee length so quite decent.  So why didn't I buy it?  Hmmm, because I am 5'8" it is shorter on me than I would like, I thought the long sleeves might be too hot and would have liked a short sleeved version. Also I  thought I might find something better, but having scoured all obvious sources of nightwear: Debenhams, House of Fraser, John Lewis, The White House on line, I found nothing suitable at all. Left it too late and in the end just took a light weight silky cobalt blue dressing gown, some pj bottoms and vest tops with coordinating cardies to act as a bedjacket type garment.

 Because while you are in hospital they want to come and look at the dressing of your wound several times a day, a nightshirt can be easily pulled up to reveal.  So can a nightie, but trust me, those in nighties looked so awful hunched over their frames shambling around in furry slippers that I was just so relieved I had given it some thought.

After my first go on the crutches I went off to the bathroom with my own nightwear and washing items.  I was glad of my dressing gown to cover up my back view as the hospital gown does not do up!  It felt fantastic to be clean and fresh and in my own clothes.  I thought I looked very together in my planned bedwear.  Some people might think 'what on earth is she on about' here, but I put a lot of thought into what I wear every day anyway, so it is second nature for me to plan ahead not to look an eyesore. At some point in this blog I will go through my own personal grooming preparation for the hospital stay, that would also see me through the first weeks convalescing at home.

By the end of this day, they had told me that if all my observations were ok the following day, then I could go home!  Eldest daughter came to visit which was lovely.  Cleaning was going on while she was there - I was surprised to have the same cloth smeared around the frame of the bed as they used on the floor and the table I eat from!  I wonder who I should tell about that?  Given that they are all wearing latex gloves, and when not, using the gel at the end of the bed, why then use one cloth for all these areas???

DAY 1 HOSPITAL NIL BY MOUTH

I was asked to arrive at the ward at 7am and advised 'no solids for 6 hours before op and no drinks 2 hours before op'.  We unpacked my stuff and we decided that N should leave, as I was quite happy to chat to the lady opposite and really was not feeling at all nervous or in need of support!  On the table was a hospital tie-at-the-back gown and a black wedge which I knew would be placed between my calves after the operation to keep my legs in the right position.  The lady across the way had had two knees done, and was waiting the all clear to go home.  She offered me her TV payment card which still had a day's viewing left on it.  I then thought that I should have bought my debit card with me for purchases that might occur of that sort.  Various hospital staff began to arrive to deal with me:

The first was a student nurse checking through paperwork, and asking health history questions.  During that time my surgeon arrived, had a brief chat about what was happening and drew a large black arrow on my right thigh 'to avoid any confusion'!! The nurse then noticed my nails, and as the surgeon was leaving she asked him if they were ok (they were pale and pearly deliberately in the hope I could keep them!) and he said 'yes'!  (At least 3 other staff commented on them and suggested they should be removed between that time and the operation, so in retrospect, I think it is probably better to not have them.) 

Then a nurse and a student nurse arrived and asked me to put on the hospital gown.  I got on the bed and they painted me with iodine from waist to ankle and wrapped me up in green paper and tape and then in blankets.  They then noticed the toenails and got a bottle of acetone to take that off.  I asked if they could just take off the left foot and leave the right as the left I can reach and re-do, but they said 'no', so that was that!  They opened a packet of support knee highs (white with little flaps that can let your toes come out to breathe; my brother in his hospital in Dorset had olive green, so maybe men get darker colours!) and put one on the non surgery leg and tied the other on the end of my bed for later.

At 9.30 the anaesthetic doctor arrived and discussed the two options with me:

General Anaesthetic where you are totally unconscious the whole time.  Downside you take longer to return to feeling ok, can feel nauseous etc.

Spinal block which is injection into your spinal column and anaesthetises the sciatic nerve and numbs everything from the waist down.  From the waist up you then have a choice whether you want to feel happy and away with the fairies but conscious and chilled, or knocked out.  A catheter is put in with this option so that there are no peeing issues.  I asked her which she would choose and she said the spinal.

So I decided that the second option sounded more interesting and because 30 years ago I had a bad response to GA I felt it was the right choice for me.

At 10.30 a very jolly girl arrived who turned out to be the bed pusher and she wheeled the whole thing with me lying in it out of the ward, into the lift and up to the theatre.  There in the anaesthetic room I had a connection for the drip put in the back of my hand.  This is also used to give you anything else you need during the next 24 hours or even longer if necessary.  The anaesthetist administered the spinal block and put in the catheter and then I was turned on my side and blue paper was taped all over me and created a screen from shoulder downwards.  I asked when I was going to feel happy and chilled out ............... and the next thing I woke up, saw the clock and it was at 12.30 and it had all been done!  I never had a chance to ask why I was completely knocked out, maybe to stop me talking all the way through the op! 

My anaesthetist brought me my hip to look at, or rather the ball at the top and the 2 or 3 inches of femur (?) they had cut off.  It looked just like the leg bit in a leg of lamb, obviously bloody, but you could see all the wear on the ball, I asked if I could have it; in my woozey state I thought vaguely I could preserve it somehow, freeze? No. Boil up and then dry and keep? - this sounds gruesome, but it was rather strange seeing something from inside one's own body and as it was mine I rather wanted to have it.  Anyway, she said 'No'!

I was wheeled into a recovery room where my blood pressure and temperature were constantly checked, and the dressing to make sure there was no bleeding, and eventually I was wheeled back to the ward. I was attached to a drip which was hydrating me and putting back electrolytes to replace those lost.  Anti biotics were also delivered this way.

My waist down was totally numb I could not move a toe, but my waist up felt fantastic, I was so cosy and comfortable and pain free and hungry!  So they bought a lunch pack of sandwiches, Kitkat, banana and orange juice and I had all of it!  I do not think I would have felt so perky had I had the GA.  I heard other patients discussing their anaesthetic and they all had a GA because they seemed to think they would hear sawing and grinding and feel tugging, I was the only one who had opted for the spinal block.

I sat up and gradually noticed a slight clamping on my legs - this was compression pads which were filling up to press my calves automatically and help prevent the forming of blood clots - this also meant the medication was starting to wear off and a began to get a little movement in my toes.  I called all those who I thought might want to hear from me and two of my daughters arrived late afternoon bearing gifts of wine, chocolate, grapes and flowers!  Only the grapes got to stay as flowers not allowed on wards anymore and I couldnt face the wine or the chocolate, uncharacteristically!

Nurses were doing the observations (blood pressure and temperature) very regularly, and plenty of cups of tea were provided.  My ward, which was ladies only, contained 6 beds, all either hip or knee/knees.  The knee people seemed to have more pain than the hip people.  There was plenty of staff and a lot of different coloured tunics - there was a bedside book to interpret who was wearing what, but I lost track after the fourth option - there must have been about ten of them.  Anyway every single person I met was kind, cheerful, patient, professional, brilliant.  There were two elderly ladies in my ward, one of 80 who had had the same (RH) hip as me, and one 90 who had had her knees done, and they both did a lot of groaning and found it very difficult to get going out of bed at all, but the staff were so patient and caring and thoughtful and and respectful.  Nothing like the horror stories one has recently come across in the press.

The drug trolley came round every four hours and as the anaesthetic wore off we had paracetamol and codeine, and a couple of senokots to help with constipation caused by codeine, and an anti blood clot medication taken in the evening.  I didn't sleep at all the first night and wished I had bought my blindfold with me and probably ear plugs so I would hear the groans of others!  Surprisingly given that we were all sleeping on our backs, there was no snoring!!

Pre Operative Meeting and Considerations

There were about 30 of us in the group and it was a power point presentation.  It was hosted by the physiotherapists who are part of SWATT or South Warwickshire Accelerated Transfer Team.  If you did not attend this meeting you would not be given a date for your operation.  There are a lot of dos and donts which the hospital can then confirm you have been told about should anything go amiss.

During the meeting we were shown muscle strengthening exercises which we were told to start straight away as they would aid speedier recovery.  We were shown a two piece ceramic joint which we would be having fitted to replace our own damaged parts. And we were taken through the procedures and advised what we needed to consider before and after surgery. 

Beds and Chairs:  need to be a minimum of 18" from the floor, and the Occupational Therapists ask you to fill in the necessary forms giving the furniture heights.  They then send special blocks which raise the bed or sofa/chair to the right height.  They also provide loo seats on extendable legs which sit over your own wc pan and provide a really comfortable height position.  I also got something like a bar stool to use in the kitchen as a perch when prepping or cooking meals.  All these were essential.  Post op I made the mistake of going into the garden and sitting down with a cushion on one of our bench chairs and then realised it was not going to be at all easy to get up again.  I had to use my arms to propel myself up rather than put the strain on the new joint.  We measured later and the bench was 14" so it really is essential to consider these heights.

They couldn't raise our kingsize bed for some reason, so I occupy the divan in the guest room!  They did manage to raise the 3 seater sofa after a bit of negotiation.  This is also my 'day bed' so it is a good downstairs alternative when I need a rest.

To summarise:

If Day 1 is the day of your operation, expect to be ready to go home on Day 3 or 4.  So two or three nights seems to be the norm if there are no complicating factors.
 Dont expect to drive until after your 6 week check up.  I believe you are supposed to advise your insurers of your procedure.
You will be supplied with one pair of support knee high stockings and can buy an additional pair for about £5. And you have to wear them 24/7 until the 6 week check.  They are to prevent blood clots and you are also reminded to flex your ankles and go round in circles with each foot while lying in bed to keep your blood circulating well
As you must never allow the joint to go over 90 degrees you need a grabber to pick stuff off the floor and help you dress.  This item was on offer for about £5/6 from the hospital.  If you haven't already got one this is an essential bit of kit.  I already had a rather cheap flimsy one from Amazon, but the NHS one is a much sturdier job and  you really need it to get your pants etc on and rescue all the stuff that falls on the floor.  I almost would recommend one upstairs and one downstairs because you need it so often.
If you havent already got one, add a handrail to one wall of the staircase, so that you can get up and down stairs safely.  Mine was fitted just the day before the op and it made so much difference to climbing the stairs that I wished it had been done months ago.

HISTORY


The first time I felt pain in my right hip was December 2005.  My doctor sent me for an Xray and the result was osteoarthritis in both hips but more advanced on the right hand one.  I was prescribed NSAID Diclofenac to take with food in the morning and/or evening, and given a repeat prescription and a revision appointment every 6 months.  At first the medication did not have much effect and in hindsight I dont know why I wasn't advised at that point to take paracetamol as a pain killer, as this would really have helped me.  Eventually, however, the pain diminished a bit and I was able to carry on as before.  Certain movements were either just uncomfortable or totally impossible, so I had to avoid climbing over any obstacle (such as a style or fence when walking the dog) and getting into the car had to be done by entering bottom first and swinging my legs round, but generally I was ok.  My job means I spend most of the day at my desk on my computer, so there was nothing in the condition that prevented that.  Lying in bed, perfectly still, and still being in pain was very depressing. The pain was not just the hip joint but all down my leg to my ankle.  In my brother's case and that of two of the ladies on my ward, they also had horribly painful groin stabbing sensations, so I am most relieved I didn't have that.  It does seem that everyone can have a different pain experience.

Going upstairs became one step at a time, painfully.

Walking our dog was my general way of getting exercise, and swimming would have been good but the breast stroke kick was not an action my hip joint was going to permit, so as I only enjoy short bursts of front or back crawl, swimming could no longer be in my remit.  Walking any distance became a problem in 2009, and in spring 2010 a visit to my daughter was limited by my slow pace and need for pauses, although we managed a fair bit of Kew Gardens, so it wasn't too bad!

Starting in 2010 getting up from a chair to walk was agonizing, as was getting in or out of the car although I never had any pain or problem whilst actually driving.  At some point my NSAID was changed to Naproxen and I took it twice a day and also had Solpadeine for the pain - which made me feel drowsy so I interspersed with paracetamol fully aware of not exceeding recommended daily amounts.  I started to feel that my 6 monthly reviews were not resulting in any change in how my condition was dealt with and on the advice of a neighbour changed to another GP within the practice.

She immediately sent me for a second Xray in September 2010, (the other doctor had not suggested anything but the original 2005 Xray) arranged physiotherapy and gave me a detailed questionnaire on the pain levels and how my life was affected.  The result of this was my case was put in front of the GP panel and is was agreed I should be referred for surgical assessment.

My appointment in November confirmed that my only choice - unless I wanted to live with it! was surgery - I was so relieved as I really thought they would decide my case wasn't sufficiently urgent.  People I had met said they only operated once you were crawling around in pain these days!  Due to work commitments I entered my 18 week pathway mid January, and was delighted to learn by telephone mid April that I was offered the date of 8 May.  My hospital held a Pre-Operative day for hip replacement patients back in March, which we both attended and came away rather pale and shaken.  I dont think either of us had seen beyond having the operation itself and not considered all the other issues that go on around it.