dunroving

Ah, yes - bingo!! Any tips or advice??? You can PM if you think it's more approriate (I don't mind either way).

rebs

Don't mind sharing - there's nothing really sensitive, my guess is from what you have said in the past about your lifestyle I would imagine you are pretty fit and healthy going into your surgery.

The only generalisation that my sister has shared with me regarding recovery (more from hips than knees I think) is that some men are more motivated to get back to a good level of activity whereas some older women are only bothered about getting mobile enough to get from the front door out to a car...

She has talked about patients being 'non compliant' and not following the guidelines they are given for post op (again, possibly more hips) something about not bending more than 90 degrees - things like putting on socks and stuff.

At this point, I should say that I am not medical at all - and am, in fact quite squeamish about all things medical so am probably not a great source of info!

Good luck with your procedure, I'm sure all will go well

dunroving

Grand, thanks so much for the advice. It's on Nov 15th and things have been so full-on at work this semester that I'm only now trying to get an idea of what to expect. I've rehabbed from 5 (or maybe 6? Can't remember them all!) knee surgeries and know how important it is to stick with the programme, but this is a bit bigger than the usual keyhole surgery so I know it'll be more of a challenge.

I must say it's been very difficult to get information from the NHS (at least, it's difficult to get "face time" with a real person) - the power of the internet is coming in useful as I am now finding some personal experiences online. They range from the downright scary to the successful/positive. Even the latter, though, seem to involve something like 2 months off work (yikes, not sure how I'll cope with that!)

morayeel

I came back to scotland 2 years ago to help my mum recover from a hip replacement. I am not a nurse, but knew I could help with general things, cooking,cleaning etc . She was 74 at the time. The staff at the hospital were very pleasant and she got ambulance transport home. THe doctor came in every day the first week to check on her and the district nurse came in every other day. If I had any concerns I called the district nurse. It was very painful for her the first 4 weeks but she is a trooper and 2 years later I am flying back Nov 6th to help her out as she is getting her rotator cuff done on the 9th November. I read how important it is to do physical therapy after this surgery. I am hoping they give detailed instructions on exactly what to do as far as physical therapy after the surgery..I wish you well

rebs

Expect to see more of you on BE then

My sister just had 12 weeks off work after some pelvic floor repair work, but that wasn't too bad for her as she was able to drive after about a month or so, so could get out and about. I think they gave her extra time off work due to the physical nature of her job.

One thing she did was get organised with online grocery shopping - you maybe do that already, but that was useful for her.

rebs

A tiny bit more info - apparently it's useful to try and strengthen your quad muscles as much as poss ahead of the operation.

After the op concentrate on keeping your leg straight and avoid the temptation to support your knee in a bent position even though that may feel more comfortable.

Take all the painkillers on offer!

She said at her hospital you would have had a pre op class by now which would have included physios giving you info on exercises to do ahead of the operation, so if you are trying to make contact with the hospital, perhaps try to contact the physio team.

Here's a link to the orthopaedic dept at her hospital - I don't suppose there is any info on here that is not on your hospital website, but you never know

http://www.rbch.nhs.uk/our_services/...nformation.php

Which did a report on orthopaedic surgery best practices and her hospital was a 'Which best buy' so I guess they do know a thing or two about it

http://www.which.co.uk/news/2011/11/...ilings-271116/

dunroving

Thanks - I've been doing all the terminal knee extensions and that sort of stuff, to keep my leg strength up.

I'll see if I can find my hospital on the list (or maybe Which is a subscription only site ...?)

Will also use the other link to look at info. There is no pre-op training here but with the right information I can do it myself.

Thanks!

dunroving

OK, live update on "the real NHS". This will probably be a long one, so I'll try to use paragraphs.

I just spent a short stay at the taxpayer's expense in one of Glasgow's hospitals getting an early Christmas present (a new right knee). It was a really interesting and insightful experience. I was there from Thursday until this morning (total of 2 days and 15 hrs between the surgery and being released to come home). My head is pretty fuzzy so hopefully this will make sense. I think my body is putting all its reserves into mending the knee and rerouting energy away from my brain!

First the positives (which far, far outweighed the negatives):

Overall, I thought the experience was excellent, considering this is a "free" (tax-funded) system (or as the Tea Party would call it, "a socialist system, booh!"). Sure the hospital wasn't tarted up like US hospitals, and the office staff looked like real people (slightly scruffy, not especially good looking, rather than immaculately-dressed Barbies). But if that keeps costs down, I’m all for it. I’d rather be in a clean, efficient hospital than a pretty piece of architecture.

Throughout the stay, I could see clearly all of the checks and balances to make sure my treatment was safe. My room (which I had all to myself!) was opposite the nurses' station and all day I could see them stopping at the wash basin to clean their hands - there is a major drive to keep infections off the ward. Any strong medicines (like the opiate painkillers I was on for the first 36 hrs) one nurse would read out my name and serial number and the other would check it against the prescription, They would also wait until they saw me take it.

The surgery was fascinating. I went into the hospital at 7 a.m. and didn't go into surgery until late afternoon, came out about 6 p.m. I was given a spinal block rather than general anaesthetic, which meant I was awake during much of the operation, having a conversation with the anaesthetist while I could feel them hammering the orthoses into the bone. Fortunately I was asleep while they were sawing off the last 6 inches of my tibia and femur! It was a bit concerning that by 11 p.m., I had feeling back in both legs but not in my, ahem, “Massif Central” ... but eventually all feeling returned (phew!). The following day, the physio printed off the surgeon’s post-op report, documenting EVERYTHING, including a full report of the existing damage (confirming for me that I got this procedure done at exactly the right time), what procedures were conducted, what materials were used, etc.
Because my surgery was late in the day, they didn't get me back on my feet until the next morning (early surgeries they get on their feet same day). I was using a walking frame ("Zimmer frame") initially and was very quickly switched to sticks. The next day I was shown how to walk up and down stairs. Because there was just one exercise I couldn't do during the physio’s assessment (straight leg raise) they were concerned about my leg strength and kept me in one more night so I could be reassessed by the "physioterrorists" this morning (Sunday). I worked bloody hard for several hours and in fact was doing everything by 4 p.m. Saturday so when Sunday came, I was sitting all ready and waiting and was first to be assessed and signed off to leave.

It seemed that EVERYTHING was recorded, making for excellent knowledge and communication between the staff (so for example the physio knew if I had asked for extra painkillers or had managed without painkillers, which I did all day Saturday). It seemed that every nurse was intimately knowledgeable about my bowel movements (painkillers can make you constipated), which was reassuring if also a bit weird. If there’s anywhere in the public sector where “documentation obsession” is needed, it’s a hospital and they got it nailed.

Unbelievably, the food was not too shabby at all, including several choices at every meal time.

The negatives are all pretty minor, but these are things that could so easily be fixed it seems daft not to mention them. If there's anyone on BE who works in a hospital, please take note and pass on:

The lack of communication of information to the patient. I think this is a weakness of the medical profession in general, so not just an NHS thing. So many examples, but a few are:
(a) Why didn’t they tell me at 7 a.m. that my surgery was scheduled for late afternoon? I sat nervously like an arse for almost 3 hours on the edge of the bed before I asked and was told I was at the end of the queue. I then put on my theatre gown and those pretty Calvin Klein paper underpants and made myself comfortable (and mentally adjusted my anxiety meter for a later surgery).
(b) Why aren’t patients told what medicine they are being given and why? This would be an additional safety measure against medication errors (I do research in medicines management and dosage calculation errors and know the importance of this). When I eventually asked some questions, I realised I could have extra painkillers if needed (I did need them, on Day 1, but didn’t realise I could ask). I also started asking on Day 2 to NOT receive painkillers because the pain wasn’t bad and I didn’t want to damage myself overdoing the rehab exercise in a morphine-induced absence of pain.
(c) Hospitals are noisy, bright places. Please suggest inpatients bring earplugs and eyeshades so they can sleep at night. My room, being next to the filing cabinets, the nurse station, and the radio (blaring pop music even during the night) was like Grand Central Station. Consequently, the night after my surgery, I got only 2 hours of sleep (12-2), which also contributed to my lack of progress the following day (I felt like absolute sh*t). It wasn’t helped by a nurse coming in and taking my blood pressure at 2:30 a.m (I think she forgot to do it last thing at night – but again, at least record-keeping drew attention to the omission). I know I could have got out a day earlier if I’d worked on my exercises on the first day in the same way as I did on the second day, but I was so shattered from lack of sleep that I couldn’t do much at all. I’m sure this is also the reason why, on my first attempt at standing, my blood pressure plummeted to 92/50 and I almost passed out (thanks, physios for catching me before my head hit the concrete). I don’t enjoy being the centre of attention at the best of times, but especially not when it feels like I’m in a circus act.
(d) It seems that so many of these simple but important things could have been communicated in an information sheet given to patients when they first arrive.

Lastly, not really an NHS thing, more of a societal thing, I was dismayed at the lack of ownership most of the patients took for their rehabilitation. I was working constantly at my exercise and “walking around the block” regularly, and most people seemed to just lie around or sit around all day, in between the physio visits. Maybe if they had to pay for every day they spent in hospital, they’d be more motivated to work on their own rehab, but I was floored at the extent to which people did nothing to help themselves progress. I can’t believe it’s not even 72 hours after I had a complete knee replacement and I can walk without sticks (I don’t, because I’m not that stupid), I have a knee range of motion of 0 degrees to about 100 degrees (in the surgeon’s notes, he did passive ROM immediately after the prosthesis was installed and before swelling occurred and it was 0 to 125, so I’m already close to that). I also haven’t taken a painkiller since 7 a.m. (it’s now 4:15). I’m pretty sure much of this is due to working hard on my rehab. I know some people getting this surgery are older and were worse before surgery than I was, but the almost completely passive attitude to health care (and subsequent increased costs) is one reason the NHS has a financial sh*tstorm on the horizon.

The NHS is often described as being “cherished”, and I can see why. It could so easily be made a lot better from the patient experience perspective. But I couldn’t fault any of the surgery theatre staff, ward nurses, student nurse trainees, porters, and so far the outcome of a procedure that I can now admit to being very worried about has been outstanding. Well done the NHS!

feelbritish

Dunroving, what a good synopsis of your experience with NHS. Makes you really appreciate what you get in UK. Your post is so good I think you should post a letter to the hospital (most people like to be appreciated) so that they can maybe take on board what the small negatives are. Also perhaps an anonymous letter to the newspaper would be good as well, just edited a bit? People always focus on the negative of the NHS and I believe that the positives should also be given.

Fish n Chips 56

A Brilliant post Dunroving, I'm glad your experience was a good one...

I understand your complaints/faults with the NHS and agree they could be sorted quite easily...

I think Brit's dont own their recovery as they are scared and somewhat used to being carried around, that is not a put down, I think they are told to take it easy for the first few days, still I think your proactive approach is great, it all depends what surgery has been performed.

Not informing patients of surgery time and medication is so typical, Its been like that for as long as I can remember, I think patients would not be on edge so much if they were kept informed of expected surgery times and yes medications need to be discussed for the reasons you spoke of.

Nurses Station Noise, I think that is true here too to minus the radio blasting out, the ear plugs are a great suggestion...

My sister in law just went thru Prolapse surgery in the UK, a 4-5 day stay, she also had the spinal block and General as she has a curved spine, her comments to us were basically word for word what you said, about the strange lack of feeling for her bottom half...

She was totally satisfied with her NHS treatment which says alot as she is usually hard to please, she said the staff could not have been nicer/better, in recent years she had private insurance and care, she actually said she her NHS experience was better than her private ones...

She was sat there all day not knowing what time her surgery would be and that was her only real gripe, so that is exactly the same as you mentioned, she was later told two emergencies put her further behind than they had expected, still it would be nice if you could get an approximate time at the start of the day...

I have to praise the NHS staff as people in any business are what makes all the difference, the caring for others is a gift and some do it extremely well...

Maybe you could write to the NHS with your suggestions, I know change isnt easy for them, but the little details do matter, your suggestions may be helpful to them too.

rebs

Thanks for the update Dunroving, great to hear all went well

Interesting reading your comments on the communication aspects - I sometimes think that the NHS plays to lowest common denominator in terms of communications. You are an intelligent, well informed, articulate person, but I guess not everyone that comes through their doors is the same.

ETA - I just showed your comments to my sister (she's a nurse in an orthopaedic ward). She was very interested in your comments and agreed with them. Said she might show them to her colleagues.

She was particularly interested in what you said about being given your post op details.

Her ward have tried to address noise/light at night and issue patients with eye masks and ear plugs.

Apparently, nearly all patients experience a drop in blood pressure and some do faint! She felt you had done really well though as knee replacements are the most painful!

Bevm

Great report, Dunrovin. Glad it went well.

Are you able to get around the house okay already?

Bev

mikelincs

There was an item on TV recently about doing hip and knee replacements using only a spinal block, the results seem impressive with patients up and about just a few hours after the surgery, those interviewed all thought it a very positive experience.

dunroving

Just a quick update. Yes, I am managing to carry my cuppa from the kitchen to the living room without any spillage, so I think that covers the minimum UK criterion for "getting about"!

I'm working hard at the rehab, not a lot of fun but it speeds up the recovery considerably, so is well worth the effort. I am supposed to use two sticks for 6 weeks but that makes it hard to carry anything so in the house I am using one stick and holding onto things if needed. No point in taking any unnecessary risks. I have some friends living close by who I can call at any time so I can continue to be my usual stubborn self but know that help is there if needed. A pal brought some necessary supplies earlier (chocolate Swiss roll) and we had a cuppa and a chat.

I'm off most of the pain meds too, as I don't like taking them unless I really need to. Pain is there for a reason (to stop you damaging yourself). I must say though that other than a lot of bruising and soreness, I really don't consider that I am in pain (except when I'm doing the exercises!), which is quite amazing considering all the sawing and hammering going on less than 4 days ago.

It feels very odd not going to work - I have taken almost no sick time since I first started working as a paper boy about 40 years ago. Daytime telly is getting very boring already so I'll have to think of something to do.

Last night I watched recordings of a comedy show called "Getting On", set in the NHS, starring Jo Brand. It is hilarious and it was funny to see they use geniune NHS fixtures and fittings (though I did note one character lifting a bin lid to throw rubbish in - that would never happen in the NHS; all pedal bins to avoid spreading germs).

Picture attached for those who fancy a peek - it's not gory. Gotta love those fetching white DVT stockings.

lf1

Dunroving,

Hope you have a speedy recovery and that you will be on the WHW this year. Hopefully you can find something of interest on "catch up TV" to keep you occupied or just get caught up on reading all the books that you haven't got around to yet. Will you be off work for long?