Thursday, 28 November 2013

Well, 'tis done!

When the surgeon had mentioned back in July that I might be home within a day, I really didn't believe him. On Monday morning at 1130 Cath dropped me off at Airedale Hospital and I walked in ready for my hip replacement operation. At 1800 on Tuesday evening I was back home, done and dusted!

On admittance I got asked lots of questions, most made sense though the question about when I'd had my last period was a bit strange - apparently one bloke had replied "not since my hysterectomy!" I suppose they have to cover all the bases. A blood sample then it's a visit from the anaesthetist who persuades me to have a spinal rather than a general anaesthetic though I request that I be sedated as well, I'm not too keen on the idea of listening to an operation going on when I'm the subject!

At about 1300 the surgeon comes to see me, marks up my leg just to make sure that we get the right one then half an hour later I'm following the nurse to theatre and pre-op. I really wasn't looking forward to this part, the anaesthetist couldn't work out my logic in being afraid of a needle but not the surgery. Then it was through the doors in to theatre.

I can't remember a time in my adult life when I have been as frightened. I've soloed alpine routes and hard rock climbs but have always been able to rationalise my emotions, but now I just couldn't do it and was shaking uncontrollably. Well my top half was, my legs had gone to sleep and we're just lying there. A squeeze of the plunger and the sedative took effect.

I came to about an hour later with the operation still ongoing. On the other side of the curtain it sounded like the seven dwarves were at work hammering away at the insert. It was utterly bizarre to be lying there talking to the anaesthetist and his assistant whilst just a metre or so away the surgery was still under way. Another twenty minutes and they were done and I was wheeled in to the recovery room.

After half an hour here I was deemed safe to return to the ward which was only a few metres away. It was still only 4pm. By the time Cath came to see me in the evening the anaesthetic was just beginning to wear off and I could start to wiggle my toes. Half hourly blood pressure, pulse and temperature checks meant that I didn't get to sleep until around 2am so by morning I was pretty tired.

After breakfast the Physio arrived with a Zimmer frame. One trip around the room on that and it was straight on to crutches and up and down the ward corridor. "Just keep at it and we'll be back this afternoon to sort you out on stairs". The rest of the morning was spent doing increasingly long walks in and around the ward.

By afternoon I'd had another visit from the surgeon and the Physio had got me walking up and down stairs so once my latest blood test had come back I was free to go. One last thing was being shown how to self inject the anti-coagulant drugs then it was just wait for Cath to take me home.

Initially getting in and out of bed was painful but as the swelling/bruising has gone down then this has got easier. Having to sleep on my back is awkward as I'm not used to it so I'm getting fitful sleep at the moment meaning that I need naps through the day.

The impingement pain in my hip has gone, not just reduced, gone. There's still the pain from the op itself but that's easing all the time. Due to being restricted in the movements I can do for the first three months I don't know how the rest of the hip is shaping up, I'll have to be careful as otherwise it could dislocate.

I'm in awe of just how quick and efficient the whole day was, twenty years ago hip replacement patients spent two weeks in hospital now it's just one to three days.

The surgeon has done his bit, the rest is up to me.

Thursday, 21 November 2013

Autumnal changes

Autumn finally appears to have arrived, that mixture of crystal clear and dull dank days where you are never quite sure what the morning will bring. November has never been my favourite month, memories of snagging cold wet turnips on the farm and increasingly short daylight, it always feels like it's a stop gap between the good weather of summer and the hope of winter.

As a consequence I've always used November as a recovery month, just let the body catch up, whether that's letting my fingers rest when climbing or my legs when running or cycling, it's just time to chill before the next ramp of effort. With my operation now very close, it's also quite important not to push things and potentially have an accident. Open wounds or scars aren't particularly welcome in the operating theatre.

A couple of Sundays ago I decided to skip the A group ride and go for a spin up Wharfedale to Kettlewell. My main rule was to stick in the small ring all day - the day was a clear one and pretty cold so pushing the speed would only produce extra windchill. Having set out late enough for the frost to have thawed away there weren't many of the local riders out and I only saw a handful all the way up the Dale.

At Kettlewell I had a choice - either head in to the cafe straight away or head up Park Rash. Of the five roads out of the head of Wharfedale, Park Rash is the hardest though not the longest - that's the southern part of Fleet Moss; next year's Tour de France will head over Kidstones which is the easiest; the other two head up Arncliffe Cote and out of Halton Gill. Now I'd only ever ridden down Park Rash and according to the 100 Climbs book it is meant to be equivalent to Fleet Moss from the north. Time to find out!

The first climb out of the village was covered in leaves and a few skids ensued. There then follows a section along the valley floor before the main event: around 200 metres of 20-25% followed by a long section of 18% before an easing and the final 20% to the summit. In to next to bottom gear (always gives me that psychological boost knowing there's another gear left) and hit the slopes. The steep section isn't actually too bad and since there's no traffic I can take it wide on the hairpins. It's the 18% that I find the killer as there's no respite from the effort below and I hit bottom gear. Then it's the easing and soon the final rise is done and the summit reached.

Four cyclists at the top ask if the descent is icy and there's a large icy pool on the road where I turn round - they'd all hit the deck several times coming up Coverdale and were a little worried. So it's a blast down to the village and the cafe. The ride back down the Dale was pleasant in the afternoon sun with just the climb up Park Lane to get home. There was hail still on the ground and it felt as hard as the climb at the other end of the ride.

This last Sunday was the Cumbrian Cracker Sportive: Grasmere; over Red Bank and down to Coniston then along the east side of the lake and down to Cartmel. Then it's back via Bigland, Grizedale, Hawkshead and Ambleside. There were thirteen of us but after Red Bank we split in to two groups, slow and quick. The quick group then split again as we went down the east side of Coniston Water. The problem was that there were now only four of us (Andy, Rick his brother, the Herb and me) and we could do with more bodies to share the work especially along the speedy section of Holker Mosses.

There was a group of three riding in and around us and by the time we got to the start of the Mosses we were riding together. It turned out that we did the majority of the work anyway with just one of the others taking a turn on the front. There was also another rider just wheelsucking - definitely poor form. A few bumpy bits and we arrived at the food stop in Cartmel.

We'd just sat down when a voice spoke up: "Bob!" It was Nick Wharton who turned out to be one of the group of three that we'd teamed up with. I'd climbed with him in the 1980s and Andy went to school with him. Really quite a bizarre meeting. His mates hadn't helped with the pacing as they were struggling to keep up!

Food eaten we headed on our way. The problem was - it was one of the dull dank autumn days and the drizzle was getting heavier, not only that, I'd forgotten my waterproof and only had a gilet for protection. Time to crack on.

The return journey was quite eventful. First a rider fell off trying to avoid a car that simply stopped in front of him (he wasn't too hurt and kept up with us for most of the way home). Then Andy had a couple of punctures so a bit of easing up rather than hang around and cool down. One steep descent to Hawkshead was taken with care then push on to the finish. As we approached Rydal there were blue flashing lights ahead - a rider had collided with a car and was out on the ground being attended to. It turned out he hadn't broken anything. Just the main road back to Grasmere and the wheelsucker was back - but a bit of determined pacing soon dropped him. We rolled in to the finish in just over 3hrs30 which is my best time for this route so quite pleased.

After food it was time to get changed before the damp got through and chilled me. By the time I got back Cath had finished, also in a good time. Then it was time for the pub - my last alcohol before next week.

Monday, 18 November 2013

More Pre-op sessions

The next stage of pre-operation preparation has been undertaken: the Joint Replacement Education Group. A large part of modern surgery is self help and active recover and this meeting was all about that.

Not too long ago the mantra for recovery from surgery or injury was "rest". When I was run over some twenty years ago and gained a broken leg for my troubles this was the case. As it happened it was a good summer (apart from the broken leg) and after the initial ten days to a fortnight when my body really didn't want to know about doing anything I'd be out as much as possible, some days walking four miles to meet Cath for lunch then back again. I don't think the hospital was too pleased when I returned their fancy articulated cast in an unrepairable state!

Back to the present day and my ignoring of medical advice is now the norm: active rest and recovery has been shown to improve the post-operative outcome. After all it doesn't look good on the hospital and surgeon's stats if you have to come back for a refit. I was the youngest attending the group, by far! One or two of the others were coming in for their second hip replacement, obviously keen for punishment :-)

The first part of the session was going through the pre-op and post-op procedures. The ward sister also passed round an example of the implant we were going to get -  the tang and neck are titanium, the ball is ceramic and the socket is plastic. A bit of Googling reveals that the average femoral head (the ball) is 40-50mm or just a little bigger than a golf ball whereas the ball we looked at was 22mm or so in size. This gives a good basis for the restrictions placed on hip movement in the first three months post-op as there'll be much higher stresses on the smaller joint surface so displacement would be more likely. Some newer replacements are starting to use larger balls to reduce this risk, I'm not sure what I'll be getting.

As part of the active recovery, the ward staff will be looking to have me walking as soon as I get back from the operating theatre and potentially through the night as well. Once I'm able to perform basic
tasks like dressing myself; going to the loo; getting up and down stairs then providing there are no medical complications I'll be discharged. This is usually two to three days after the operation but could be as little as one.

The rest of the session was taken up by physio and occupational therapy and finally the handing out of the various tools we need so that we don't have to bend down - the hip-body angle mustn't go past 90deg, again this is to prevent displacement occurring.

I also had a visit from the occupational therapist to ensure that the house is suitable for me to be discharged to. Again it was making sure that the chairs, toilet etc aren't too low to avoid over-flexing the hip.

Just a week to go now.

Monday, 11 November 2013

Pre-op assessment

I had my pre-op assessment this afternoon. Which was interesting.

Firstly I've shrunk! I always reckoned I was 6ft tall but I'm a bit shorter. It's an age thing apparently. Fortunately my weight didn't go up compared to our bathroom scales so they are reasonably accurate (a Kilogramme or so difference which can be accounted for by clothing).

Then it was on to the ECG, I've never had one of these before and the nurse tried to avoid putting the sticky contacts on too much body hair (:-)) She must have succeeded as they didn't hurt when she removed them. Once all the leads were attached and some advice "Just relax and breathe steadily", she set it going and it promptly had a fit going "wee-wah! wee-wah!" in high pitched electronic fashion. A few more button presses: "Your heart rate is too low - it thinks you've died!" "OK, relax again" Relax?! It thinks I'm dead! This time all went well - presumably the excitement had pushed my heart rate up enough for the machine to recognise I wasn't a corpse.

Then it was a long question and answer session about lifestyle, previous medical history of both myself and of close family. Twenty sheets of questions.

Finally it ended with that awkward question in the other direction: "Do you have any questions?". Well yes, it's just that having been bombarded with information, plied with pamphlets, info sheets, more questionnaires I don't know where to start. So some heavy reading material for this evening before tomorrow's Joint Replacement Education Group.

In two weeks' time it will be done. The countdown begins.