Where am I

I managed to slip over on 6-November-2015 and fracture the femoral head of my right hip. This blog is just to keep friends and relatives up-to-date with my recovery. It also will show where the NHS is good and where there is opportunity to improve. If you click the images tab (above) there are a few images of the break before and after the repair.

Update 10-June-2016 - sadly the femoral head has avascular necrosis and a total hip replacement will be carried out on 15-June-2016

I am home in Stoke Bruerne

Wednesday, 29 June 2016

Day 13

I very good session with my physio yesterday (actually she's technically a Musculo-skeletal therapist)  but when it comes to getting me mobile I don't think it matters what they are known as but rather what they do - I have the utmost faith in Liz and that helps but I came away feeling really good.

Today is staples out day - looking forward to that as they do irritate a little and I'll be able to have a shower rather than an up as far as possible and down as far as possible (without forgetting the possible)!

It's going to be a long slow road to recovery but speed is increasing and I feel a change from 1st gear to 2nd gear on the way.

Just back from the doctor (in fact it was Irene the practice nurse) who took all 35 staples out - they were not as I imagined them - tiny little W or M shaped spring steel things which I imagine relied on tension to pull things together - I feel much better without them.  I am further precluded from showering until Saturday in order to stop any infection getting into the little holes created by the staples.  Irene said that all was looking good but to keep an eye on it in case it oozes a bit.

Monday, 27 June 2016

Day 11

Well we are in to 'normal' recovery procedures now so I'll only update this as and when there is anything significant to report.

Recovery continues - managed to get to the museum and back (70m) yesterday with just a walking stick but I did feel slightly vulnerable.  Mobility is not my best subject at the moment.

Wimbledon starts today (weather not looking too promising) so that will entertain me for the coming fortnight and my very good friend Sue is coming to stay for the second week of Wimbledon.

Sunday, 26 June 2016

Day 10

Not a good night last night; not sure quite what happened but I tossed and turned (as best I can!) most of the night.  I must say I am becoming heartily sick of the pontificators talking about Europe. The decision is made and we have to abide by that decision - now what do the prices of houses look like in New Zealand?!

Did go for a little walk yesterday - not far but far enough to make it worthwhile (the Museum) but most of the day spent watching rugby (NZ beating Wales, England beating Australia and South Africa beating Ireland) and bit of Euro 'soccer' stuff but that was just so boring I am afraid.

Hip continues to improve, albeit slowly; but it's probably better slowly and surely than a flash in the pan. 

Saturday, 25 June 2016

The Diagnosis

This is the diagnosis sent to me following my appointment on 10-June.

AVN (Avascular Necrosis) of the right femoral head post DHS (Dynamic Hip Screw) and cannulated screw fixation done November 2105

We reviewed this lady again today in the clinic.  She was seen last time 6 weeks ago but she asked to be seen earlier than the expected appointment.  She complains of worsening right hip pain that shoots down to her knee.  Repeat radiographs today have demonstrated significant collapsing and flattening of the right femoral head with some kind of osteophyte on the lateral boarder of the femoral head and proximal migration of the cannulated screw with evidence of shortening of the femoral neck. Clinically and radiographically it seems that this has started to have some avascular necrosis of the femoral head.

Friday, 24 June 2016

Day 8

I managed to get myself in an odd position in bed sometime during the night and wondered if I'd ever get back to 'normal'. I did, very quickly, but it did concern me for a short time especially as my phone was out of reach.

Momentous events overnight - who knows what leaving Europe will bring - a new Prime Minister for a starter!

Hip doing really well - still 'sore' but I am making good progress with physio and staple removal already booked.

I am just not good at sitting about waiting for things (like hips to heal) to happen.

Thursday, 23 June 2016

Day 7 of recovery

Back to NGH this morning, this time for an eye appointment (previously torn retina). I'll not be able to focus my eyes util about 15:00 today due to the drops they put in.

The hip is becoming more flexible and the stairs less of a psychological challenge.  I find sleeping on my back a bit of a challenge and would rather roll on to my side but I physically cannot do that at the moment.  Am sleeping well (really deep sleep during the day) and just biding my time as my stamina and flexibility return. Deep down I am sorry that the Dynamaic Hip Screw repair failed but, in the modern parlance, we are where we are so I have to make the best of the situation.  I'll have to miss going to the Braunston Historic Narrowboat weekend but there will always be next year but this year is a Grand Union year!

I am reminded of some advice my mother gave me many years ago - you are born with a hand of cards, I cannot change those cards but I can help you play them to your best advantage.  A bit of good old fashioned advice, still as valid today as it was when she mentioned it to me.  Bless her.

Wednesday, 22 June 2016

Day 6 of recovery

Ready to go to physio quite early which meant up, washed and dressed.  My friend from last time in NGH, Brian, came and collected me about 10:00 and off we went to physio.  I apologised to Sue who did so much to help me in November.

After the physio session I had an Occuptional Therapy session which involved making a cup,of coffee and a cup,of tea.  I was then signed of as fir to come home subject to medical approval! Medical approval came about 13:00 so I packed up and was wheeled from down to the discharge suite. I sat there until 18:00 when I asked why I was still there and everyone else was going home.  It turned out I had been dropped off the  transport list!  Not impressed.

Anyway home in a wheelchair taxi accompanied by Nurse Aid Claire who was delightful.  Claire took my suit case upstairs for me (that's sometime I just can't do at the moment) and then I walked (shuffled) up to the Museum Green for a BBQ and a performance by the Mikron Threatre.

On the whole a good day but a bit of a restless night - I thought I'd sleep much better.

Tuesday, 21 June 2016

Day 5 of recovery

A day of steady progress yesterday. I had a visit from Occupational Therapy (OT) and physio. Luckily all the remedial work I did in the house is standing me in good stead and, at the moment, it looks as if I may get home on Thursday this week, if not sooner.  OT need to be 'happy' that I can look after myself - no more talk of carers so I left that topic out of the discussions.

One of the issues I am going to have to face is that the muscles that were messed about with and cut to facilitate the dynamic hip screw repair in November did not recover fully (and in fact started to go 'backwards') before being cut again in a slightly different place to facilitate the total hip replacement. I think that means a lot of hard graft for me.

Lots of advice from friends and family who have had a new hip to follow the physio's instructions to the letter.  I think probably the most important thing is to take life quietly (what me?) and exercise plenty.

Monday, 20 June 2016

Day 4 of recovery

A day of highs and, sadly, an extreme low.

Night of 18-June I really didn't feel like eating so didn't bother, I had been feeling a bit odd and dizzy but thought I was over that.  Yesterday morning (Day 4) I felt quite awful, cold and clammy and sweaty.  The staff in the ward were wonderful and called the on duty doctor who took me away for a series of blood tests and ECGs - my heart was running at anything between 88 beats per minute and 140 which he was unhappy with.  He told me I must eat more and he would pop back and see me as he thought I may have a blood infection.  He did pop back at about 20:00 and said he thought it was an adverse reaction to one of the drugs I have been given; he would return about midnight to carry out some final tests - really excellent customer service I thought. I have had two more blood tests through the night with the last at 04:45!

I have a managed to go to the loo on my crutches and take my full weight on my new hip - great.

The extreme low concerns my very long standing friend Trevor Skoyles (lock keeper at Hanham on the K&A).  Trevor wanted to be my Next of Kin for the new hip and he was duly entered in all the hospital papwerwork.  I now have to remove him as NOK as Trevor, very sadly, committed suicide on Saturday evening.  I have spoken to Trevor's mother but there is little I can do from my hospital bed with her in Westbury - it is an unmitigated tragedy - Trevor came and stayed a fortnight ago.  I am lost for words.

Lovely vists from Helen Westlake and Trevor Morley this afternoon - it's amazing what a tonic such vists are. 

Sunday, 19 June 2016

Day 3 of recovery

As the days go by things get better and better.  I don't particularly care having to be reliant on others I am afraid but I am getting better at accepting that I have to be, especially in the earlier stages of recovery.

The big thing today was not losing blood pressure when I stood up, caused I am told, by too many opiate substances being in my body; not surprising after the 'free' access to Morphine!

The nurses got me up at about 14:00 and I spent the next three hours sitting alongside my bed watching the world go by.  I have a catheter which at night is connected to a large bag but during the day is connected to a smaller bag attached to my leg.  I can watch it imperceptibly rise during the day. I imagine proper 'No2' will recommence shortly - it is really quite amazing that the body knows to temporarily shut that function down.

We had a lady admitted today who had sustained some cruciate ligament damage - I have never heard such a fuss (I assume it is painful) but the demands made on the nursing staff and the phone calls that went on into the wee small hours were a bit too much in my opinion.  At one stage we had an Indian family with their mother on my right scoffing Kentucky Fried Chicken and drinking large bottles of coke and I think someone spilt some 'poo' on the floor - really quite entertaining. One of the nurses came along and remonstrated which resolved the situation.

It's always quiet on the long term front at weekends but I am sure that after a quiet Sunday things will start to move on Monday - I think I am going to have to accept that I need a carer (for as short a time as possible).  I have an appointment with the Eye Department in NGH on Thursday (following my torn retina) so I'll see if it is possible to stay here until then to remove the need for someone to bring me in to NGH (and return again).

I decided not to apply for a postal vote for the Europe Referendum so I'll either not vote or need someone to take me up to the village hall on Thursday.

08:00 and a trip to the loo fully weight bearing (but very tiring) and 20 mins to produce almost nothing.  But it is something and we are making 'movement' as it were! I do however feel like a washed out, very used dirty dishrag!

Saturday, 18 June 2016

Day 2 of recovery

A lovely, but brief, visit from Lynda and Sam at lunchtime. Sam, very sadly, had a stroke back in February and was at NGH for a follow up appointment.  In the evening my friend Helen broke off from preparations for Stoke Bruerne Family Festival to see me.

A fairly quiet and uneventful day except for the ongoing issues of the complete lack of blood pressure when standing.  This is very odd for me as I have always been prone to high blood pressure and that's a family history issue.  I understand the low blood pressure is as a result of the loss of quite a bit of blood during the hip replacement but not enough to require a transfusion and the use of morphine through the self-administered process available to me. The blood should have replenished itself by now and the morphine was switched off about 10:00 yesterday so I am hopeful that when we try again later this morning I should be OK.

I had a lovely visit mid-afternoon, from a doctor (Matt) to discuss my ongoing care.  He's very keen on a carer for a few weeks (months) but I find that, whilst a sensible approach, to be the first chink in my armour against getting older.  I suspect he is right and that I will need some help in the immediate future. Likewise he thinks an 'emergency' button around my neck/wrist would not be foolish - another 'capitulation' to getting older but the facts are quite clear:
  • In the immediate future not quite so mobile
  • A house that's not predisposed to infirmity 
  • The potential to do a lot of damage to myself should I slip and fall on the stairs
  • Peace of mind for friends/family
  • I live by myself
So here's to a standing test that doesn't leave me woozy and feeling sick and an acceptance that I may need to compromise on the levels of assistance I need going forward.

Update @14:15 - The good news is that I have just got up and stood on my two feet and sat down on my chair and have no signs of nausea or dizziness; well that is good news, another step forward on what is turning into a very long (226 days today) road to recovery.

Friday, 17 June 2016

Day 1 of recovery

A very quiet day here. I did get up at 10:30 but again felt very weak, sick and 'woosy' so it was back to bed within a few minutes. I don't think I have taken to this second operation at all well and perhaps that's because I have been going 'downhill' for a couple of months.  The operated leg really is amazingly sore.

I did manage to get some voluntary work done for Canal & River Trust - I know it is important work and it does keep me going a little.

In the late evening Binu (who seems to take care of me when she is on shift) found someone to authorise some more 'potent' painkillers and that worked very well in that within half an hour I felt much less pain and gave me the ability to 'exercise' the repaired leg.  I am also back on the self-administered morphine. I do wonder why I am experiencing all this 'pain' and can only put it down to the muscles being damaged in some way during the run up to the THR (Total Hip Replacement).

I'll just take each day as it comes and try and move forward as and when I can.

The Morphine was removed at 10:00 - huge amounts of paperwork to ensure the Morphine is accounted for.

Having trouble with my blood pressure - 115/86 when lying in my bed gut 86/50 when standing - we'll have to work out what to do - my BP has always erred on the high side so this is new ground for me.

Thursday, 16 June 2016

New Hip Done

Here we go again. Things were a bit chaotic yesterday. In here for 07:30 (thank you Helen) and then after registration and being moved on to my Ward (Cedar) I was sat down when the porters came at 15:15. The reason it was so late in the day was because Mr Maundy wished to do my operation personally.

It took two hours to complete but I now have a brand new hip joint and the responsibility for recovery now passes from the NHS to me.

The first thing was a sandwich and a cup of tea and then settling into ward life. No food or drink since the previous day.

Lovely, quite lovely, staff here. Lisa, who was looking after us overnight is a very special lady. About 02:00 I thought I needed a wee but could not produce anything. This went on until about 06:00 when a decision was to insert a catheter - I have produced a litre of wee in 30 mins.

I have been out of bed and borne weight on the new hip but I must admit to feeling a bit sick and dizzy.

I'll do my best to keep the blog up-to-date on a daily basis for a while.

Just had a visit from the Consultant - he thinks I'll be home in five days!

A one stage this morning:
  • My oxygen supply fell on the floor
  • The breakfast trolley missed me out (one sandwich since 20:00 on Tuesday)
  • My catheter fell out
  • My drip ran out
  • The consultant arrived
  • My (robe) had its supplies run through the arm holes so I couldn't take it off
  • I ended up sitting on my bed with nothing on

Not the most auspicious start to the day!

I had a lovely visit later today from the physio. They got me out of bed but I found I felt very 'woosy' and sick (probably too much morphine which is freely available to me) so it was back to bed. 

Also an equally lovely visit from Occupational Therapy to check what would happen when I am discharged. It seems, on the face of it, as if my discharge from here will not be until I am fully able to care for myself and that might be with a carer for some time. How things have changed from last time. 

Monday, 13 June 2016

In this world

My parents (I think it was my father) taught me a rhyme many many years ago:

In this world of froth and bubble
Two things stand like stone
Kindness in another's trouble
Courage in your own

Line three stands out for me at the moment because everyone who has heard of the challenges of my next few days has been unfailingly kind.  Likewise I hope I have shown courage in what lies ahead.

11:00 - Just back from the Doctor where I had to 'endure' yet another blood pressure check - it's was a bit high, inevitably and perhaps involuntarily, on Friday.  The doctor put me on tablets and this morning it is down to 150/90 which I think will help a lot to see that Wednesday goes ahead.

For some 'scary' images of femoral head necrosis click here

Friday, 10 June 2016

Oh Dear

A femoral head with AVN
Perhaps I could have been a little more forthright!  I attended Northampton General Hospital (NGH) after requesting an appointment.  The X-Rays, which were quite invasive, showed a badly degenerated right hip (well the ball part) which is crumbling like chalk - it is known as Avascular  Necrosis (AVN) and was one of the risks (1:10 chance) explained to me.

Sadly the femoral head has died but to give NGH their due they said it might, and they have me booked in for Wednesday 15-June as a trauma patient rather than an elective surgery patient.  Then another week or so in hospital and another six weeks of taking life easily - I think I'll just write 2016 off!

The document from which the above image came is here and is really worth reading - there's a number of causes of AVN - mine is due to trauma only!

Why do I have this problem?

There are many causes of AVN. Anything that damages the blood supply to the hip can cause AVN. Injury to the hip itself can damage the blood vessels. Fractures of the femoral neck (the area connecting the ball of the hip joint) can damage the blood vessels. A dislocation of the hip out of the socket can tear the blood vessels. It usually takes several months for AVN to show up, and it can even become a problem up to two years following this type of injury.

Some medications are known to cause AVN. C Corticosteroids (cortisone) such as prednisone or methylprednisolone are the most common drug known to lead to AVN. This is usually only a problem in patients who must take cortisone every day due to other diseases, such as advanced arthritis, or to prevent rejection of an organ transplant.

Sometimes there is no choice, and cortisone has to be prescribed to treat a condition, knowing full well that AVN could occur. AVN has not been proven to be caused by local injection with cortisone, such as one or two injections into joints to treat arthritis or bursitis. But some patients have developed AVN within the first month of taking these drugs orally (pills by mouth). Patients taking both corticosteroids and statin drugs (cholesterol-lowering medications) seem to have the greatest risk for developing femoral head osteonecrosis.

A clear link exists between AVN and lifestyle choices such as smoking and alcohol abuse . Smoking causes blood vessels to constrict or narrow thereby limiting the amount of blood flow to an area such as the hip with its already limited backup supply. Excessive alcohol intake somehow damages the blood vessels and leads to AVN. Deep sea divers and miners who work under great atmospheric pressures also are at risk for damage to the blood vessels. The pressure causes tiny bubbles to form in the blood stream which can block the blood vessels to the hip, damaging the blood supply.

Then there is a long list of other diseases and conditions that are associated with increased incidence of femoral head osteonecrosis. These are referred to as nontraumatic causes. For example, there is a link between osteonecrosis and more commonly known problems like leukemia, sickle cell diseases, and HIV infection and less well-known diseases such as Gaucher disease, hyperuricemia (a condi- tion commonly called “gout”), and Caisson's disease.

What does AVN feel like?

The first symptom of AVN is pain when weight is placed on the hip. The pain can be felt in the groin area, the buttock area, and down the front of the thigh. As the problem progresses, the symptoms include development of a limp when walking and stiffness in the hip joint. Eventually, the pain will also be present at rest and may even interfere with sleep. (I certainly am disturbed by the pain at night and when resting.)

Thursday, 2 June 2016

Is it reasonable?

Last Thursday (that's a week ago) I saw my GP about the lack of progress I consider I am making now; she agreed that I should be making quicker progress and further agreed to refer me back to my consultant urgently as, quite understandably, what's going on with my hip is outwith the range of issues a GP could reasonably be expected to deal with and she was concerned about my walking. So, in those circumstances, is it reasonable to expect that a week later a letter of referral would have been sent - well they do fax them? I already have a consultant so it isn't as if she has to find one for me. If I make my own private (at cost to me) appointment to see the same consultant the process is that I have to produce a letter of referral so the GP is the critical path.

The simple situation is that a week later, despite pressure from me earlier in the week, nothing has happened and the letter of referral has not been written and therefore not sent to the appropriate department within Northampton General Hospital (NGH). I really did think she was doing good things for me but I must say I am extremely disappointed given nothing has been done yet.  Is that a reasonable view to take I wonder?