Wednesday 27 January 2010

The Gory Details

I'd have loved to have live-blogged it, but I'd never have been allowed and they might have thought I was taking the mick, so I didn't ask.

I'd had all my checks on Wednesday, the only one of which surprised me was the pregnancy test. It's routinely done on women who haven't been through the menopause, but I think I'd have made medical journals, though probably not a record, for lateness of natural conception, not that I've checked. Sad to say, I'm not pregnant.

We arrived at the reception desk and were taken to my room. A few minutes later, a nurse joined us. The Sage looked relieved. "I'd better leave you to it," he said, but I made him stay. She explained what would happen in the next few hours and that I'd be fetched for my operation at about 11.30. After she left, I said goodbye to the Sage and he said he'd phone about 2 o'clock. The surgeon came and he drew a big black arrow on my right thigh, with the letters THR, which was reassuring. The anaesthetist visited and we discussed the operation and agreed that I should only have the spinal, but further sedation could be used if appropriate.

When I was taken downstairs, I had a cannula put in my hand and a small amount of antibiotic put in. As there was no reaction, the rest went in a few minutes later. I sat on my bed with the operating table in front of me and leaned forward. I was warned that the antiseptic spray would be very cold, but I still squeaked. A few moments later I remarked in a conversational way that it continued to feel colder - it had an alcohol base, apparently. I was given another spray which wasn't quite as cold. Then I felt a sharp prickle in my back and I was told that the anaesthetic was being injected, and then I moved on to the operating table - I was able to do it myself with some support because it was awkward - and lay down again (I'm doing my best to remember this exactly, but may not get it 100%) and the anaesthetist pinched me below my waist and asked if I could feel it, I said I could. Then he asked if I could feel his fingers on my thigh. I said I could feel a touch. He told me he'd given quite a sharp pinch. My legs were becoming very heavy. When asked, I said that it felt that I'd cycled too far and fast, and that my muscles were tired and wobbly. They continued to feel heavy. Two nurses came to fit a catheter and I wondered how they were doing it without moving my legs. When they moved aside, I saw that my legs were bent at the knee and apart, but they still felt as if they were in contact with the operating table. It was then 11.45.

The surgeon came and chatted to me, looking very cheerful, and we confirmed what was happening (regarding the spinal, we both knew about the operation) and he asked what music I'd like. It didn't matter what I'd have said, because he liked 80s pop and that was mostly what we got! The theatre staff were all cheerily identifying the music "as you'll be awake, he'll turn the volume down a bit" I was told. "Mr T prefers opera" said someone darkly. I was given an oxygen mask, can't remember what if anything else and I was wheeled in soon after noon. I'd been laid on my side. I was greeted by a cheery operating team. A blue sheet was put up to separate me and the anaesthetist from the others.

We chatted. "You'll hear hammering, and you'll feel it, but it won't hurt." There were quiet voices from the other side of the sheet but I didn't make much out of what was said. Then I heard the buzz of a saw. It was so peculiar to know that my femur was being sawn through, although the thought didn't bother me at all. It was not as loud as I'd expected, nor did it last as long. My blood pressure, heartbeat and breathing were being monitored, of course. I'd watched the machine for a while in the other room and would quite like to have kept an eye on it now, but I couldn't see it. We talked about the operation some more and he said I was doing well. I was calm and relaxed. He said that I might not get it because of the mask, but if I could smell burning, it was because some cauterising was being done to minimise bleeding. "I can smell it now," I said a few moments later. It smelled of bone rather than flesh, I thought.

We started talking about schools. His daughter is taking the entrance exam, or possibly has taken it, for the same Norwich school that Weeza went to.

I felt hammering. It was just like when you hold a fence post and someone bangs it into the ground - hard thumps that go right through you but are not painful at all. More hammering. Then he started reattaching everything, so there were just quiet voices again. The anaesthetist spoke to them every few minutes and relayed any useful information to me, without describing the actual scene. I wished I had the nerve to ask to see what they'd cut off. I wished it had occurred to me to ask to see what they were putting in. But it didn't matter.

"Now you're being closed up. He's using glue, so you won't have to have stitches removed".

I heard someone say that I'd lost 350ml of blood, which they seemed pleased about - that it wasn't more, of course, I mean.

Then the surgeon appeared by my side as the screen was taken down, saying it had all gone very well and he'd see me in a few minutes. As I'd been moved from my side to my back, I noticed that the top of my thigh was pale flesh but then it suddenly turned very pink, unnaturally so. Now, I only had a stocking on my unoperated leg and my paper pants were gone. It was a bit late, but I felt self-conscious. I still wore a gown of course and soon had a blanket put over me. I felt that my legs were cold, but I touched them and they were warm.

I was wheeled into the recovery room and noticed it was 1.15. My legs still felt as heavy as ever. I was asked if I could wiggle my toes yet. I tried and couldn't. I tried harder and moved my feet, but the surgeon, who had followed us, pointed out that I was doing it with my whole leg from the waist, not wiggling toes at all.

He left, and so did the anaesthetist, once he was happy I was all right. He told me I was unique to him in not having any sedation for a total hip replacement, but I don't know if he meant that literally - that I was the only patient he'd had in that situation - or colloquially, meaning it was unusual. He said that he could see I was as relaxed as I said I was, from my vital signs.

I was there about an hour and finally could twitch my toes and was taken back to my room. My legs still felt cold and heavy and continued to do so for a long time, although sensation gradually returned. After some time, I was offered the chicken sandwich that had been prepared for me and I ate and enjoyed it, and sipped water. The Sage and I had had a short but cheerful chat on the phone. Later, I was asked if I'd like to try to get up. I was helped to sit and moved to a sitting position on the side of the bed. I admitted that I felt woozy, but said I'd like to stand. I slid my feet down to the floor and put my hands on a frame, that had been adjusted to my height that morning, and stood. As I felt dizzy, it was agreed that I'd better not try walking, but if I wanted to try walking on the spot I could. I did so and it all seemed to work, although it felt odd in a way I can't now remember. I said I'd better get back on the bed before I fainted and I was helped back - a few moments later I asked for a bowl and the sandwich returned, not even slightly digested.

Now at last my feet felt warm and I lay there feeling quite cheerful. I had another injection of paracetamol into the cannula, which I might not have mentioned before. Later, I was given some morphine, but only a little. Actually, I was quite disappointed in the morphine, which I'd been looking forward to. Later again, I rang the bell to say it hadn't done much, so I was given a codeine tablet. I slept, but only for a short while and kept waking up. My hip ached in the way it has been doing so every night for some weeks - different cause but exactly the same pain. The only difference was that I couldn't and mustn't turn over. I didn't want more drugs so toughed it out. It was only a bad ache, not agonising pain.

I lost about another half litre (a pint) of blood and fluid through the drain in my thigh. Once I could walk, which I did the next day, first around the room and into the corridor with a frame and later down the corridor about ten yards to the desk on two sticks, the catheter was removed. I was glad. It had been embarrassing to go along with the physio carrying my bag of pee. On Sunday morning the cannula was removed too and I felt much freer, even though my blood pressure dropped that day and I had to accept that I couldn't go home the next morning, which had been suggested at one point on Saturday. In fact, I woke at 2.30 on Sunday morning feeling loads better and ate a banana - I think the anaesthetic had finally left my body.

In view of this, I'm glad I didn't have a general anaesthetic. It wasn't that I felt particularly ill - I'd brought up my Saturday supper too, undigested some seven hours later, but it was a relief to do so as it was sitting there doing nothing - but that it would have taken me longer to get over and probably made me sicker. As it is, I've been feeling great ever since. Having been busy on Monday, doing a lot more walking, going up and down stairs - which was a lot easier than I expected - sitting in the chair for several hours and having several people visit, I expected to be absolutely whacked on Tuesday. But I feel fine. Oh, and that pinkness on my leg was as unnatural as it looked - it had been painted on. It was referred to as iodine, but it was quite the wrong colour. I think it was some sort of sanitising stuff.

Now, I can walk steadily with two sticks, using an "opposite" gait - that is, left stick and right leg forward, right leg and left stick forward - and get about just as steadily with one stick. I can walk unaided, but with a limp.

I've just remembered what felt so odd when I first stood. For the last year, my right leg has been shorter than my left. Since March, I've worn a heel lift in my shoe to compensate for an effective shortening of between 1 cm and 1/2 inch of my right leg which corrected a limp to start with but not latterly. When I stood with legs of (I think now) equal length, it felt as if my right leg was too long.

Thanks for asking - well done if you've got to the end because it's a terribly long post, and not very gory or dramatic at all. But I realised as I wrote that I was already starting to lose details, and now I've got them all down so that, if anyone wants to know what it's like, I can tell them. In fact, a friend who is going to have a second hip op in March has already asked about the spinal, as she'd like one because she's asthmatic and the private hospital she's booked in to and where she had the first one done has refused.

Now I'll write a brief and cheery post with pictures of my room, as you've suffered long enough, and then post them together.


Marion said...

Well- I did read it all. You could be an acomplished medical writer. I find it unusual you took such an analytical view and not the emotional one as most do.

Anonymous said...

Wow. That was absolutely fascinating Z. I have wondered, since you first mentioned it, what it would be like having a hip replacement with only a spinal - now I know - albeit second hand :-).

lom said...

I got to the end, I knew someone who's mother had a spinal to have her kneecaps replace. We all had a good laugh when she told us she thought they were repairing the bed when the banging started.

Can they do any op with a spinal, I hate the thought of being knocked out.

Blue Witch said...

I enjoyed that. Thank you.

Z said...

I was trying to remember it all in order - I noticed the unemotional tone but it was just the way it came out.

I don't know, LOM, I wonder if some ops might be a bit much to cope with if they are long or involve the face. I mean, for example, my mother had a stent fitted, which must have gone through her mouth all the way to her bile duct, God knows how. It would be ghastly to be awake through that, even sedated. And not all surgeons care for the idea anyway. I think the thing is to raise the subject early and sound very sensible!

Christopher said...

Thank you, Z. Please detect no callousness in my first reaction, viz. that if ever you need the other hip doing you've only to change right for left in the text and you've got a post ready made. But my second was of feeling very relieved for you.

Anonymous said...

Thank you for that Z, it was really interesting.

Z said...

Matter of fact suits me nicely, Christopher.

Slightly embarrassing to write bits of it, CA, but otherwise I quite enjoyed it.

Pamela Maunsell said...

I had a spinal (11 weeks ago) and that knocked me out even before they topped it up with a light anesthetic. I'd just have soon gone without the (albeit light version of the) anesthetic. I come out anesthesia kicking and screaming just like I think someone has been cutting me up and I've got to defend myself :)
Luckily I'm not aware that I'm doing that and the more tactful staff tell me I was just "a little disorientated" the others tell me the truth (how embarrassing!)

Z said...

He knew I specifically wanted to be awake, so maybe he was cautious with the spinal. I'd wondered if it would make me dopey, but I felt just the same. He made preparations for an epidural, but didn't need it.

To be honest, I was not keen on the prospect of possibly making a fool of myself on coming round (control freak that I am) and that was one reason (not mentioned to the medics) for wishing to remain awake!

Z said...

By the way, Pamela, on your site you ask for feedback but I can't see where to give it - am I being dense?

Anonymous said...

I remember seeing a locally anaesthestiesd hip replacement on 'Your Life In Their Hands'. I turned it over once the chiselling started....

luckyzmom said...

I must be a real baby because I had much more discomfort (screaming pain) than what you described, at the surgerical site just after I woke, even though I had a morphine drip that I controlled with a button. Perhaps that was an added benefit of the spinal. I will definetely ask about being awake next time. Thank you for posting the details.

Z said...

I feel I'd be intruding by watching an operation. I sort of would quite like to see my own, in a way - but if it were to upset me, I couldn't unsee it and it would always be there in my mind, so safer not.

LZM, some people have told me that the pain had completely vanished when they first woke up - though they must have been on medication as it can't be true that there is no post-operative pain. I was talking to a nurse about pain and she said that one person simply can't be compared to another. Each has their own experience and we all have a pain threshold that we can't help either.

Also, those who were most relieved had had great pain from the arthritis over a long period and your acute symptoms came on quite suddenly, I think.

My legs first started hurting eight years ago. I've had a good mental block in place and tend not to acknowledge how much it hurts. If I admit it, I feel it more.

tvpartyjames said...

Excellent description! This makes things so much clearer for those of us who feel they don't get enough information when asking about procedures. (But would mention that a "left, right, left" gait is not opposite, but correct military march!)

Z said...

Hello James - sorry this wasn't published before, it got put in the spam folder, I don't know why.

I see what you mean - the arms and the legs going forward - but the way I was walking didn't look very military and I wouldn't know how else to describe it.