Day 6 – homeward bound!

Today is the first day that I actually feel ready to go home. I am less disorientated, and I feel confident that the painkillers (codeine and paracetamol) are on top of my pain. So when the smiley physiotherapists arrive (my ward roommates and I have named them the physio terrorists – a name they are strangely proud of), I am ready to tackle the stairs. This is important because once I can demonstrate I can manage on stairs using crutches, I can go home. Bring it on!

Disappointingly, my enthusiasm does not actually extend to being able to walk to the stairs – a distance of about 20 metres. Dammit, not the most impressive start. However, on being wheeled to the stairs, I find it easier and less daunting than I had imagined. Stairs, it turns out, are easier for me than walking on the flat. Hooray! This means I’ve passed the test! The smiley physio terrorists seem very pleased.

Walking back to my bed, I can’t wait to get back in it. I feel immensely vulnerable, shaky and stumbly. Every little wobble hurts. It’s hard to go in a straight line, it’s hard to go around corners. It’s sore and frankly difficult to move my right foot forward, and well, that’s rather an essential part of walking isn’t it! I am relieved and exhausted once I’m in bed, but resting helps a lot. Learning to walk again is turning out to be quite hard work, but this is normal and it’s early days. I keep being told by doctors that I’m doing very well and to take it easy, and I’m so tired I don’t answer back once! This is rather shocking for Irish, I think he’s not used to a placid wife!

It turns out I get a looong rest after that, because it takes about 6 hours for the pharmacy to put my meds together so that I can be discharged. This was the only part of my hospital stay which was underwhelming. Hospital pharmacists are slow – I’m very glad I was allowed to keep my bed and not sent to sit in the discharge lounge for this time (thank you nurses).

So, at peak rush hour in London, we head away from UCLH on the five hour journey back to Devon. The traffic is kind to us and once we work out how to get my useless legs into the car, it’s relatively comfortable. It feels AMAZING to be home!

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Bonus side effect of major pelvic surgery: beautiful flowers.

Home at last! Here are some good tips for managing the journey home.

1) Bring pillows to add height to your car seat. Once you’re in, push the seat back to give you as much legroom as possible.

2) Audiobooks are great to use in the car when you dont feel like talking and when music feels too grating. You can borrow them from your library for free. I liked the detective story ones. I could follow the plot, but I also found the ‘being read to’ element really soothing and soporific. I snoozed a lot on the way home.

3) Loose, jersey trousers (like yoga pants) in a size too big are the easiest thing to wear.

4) Don’t even think about wearing underwear! Going commando is better than uncomfortable seams stretching across your swollen and over sensitised skin. In fact, I may never wear underwear again!

So there we have it. I’ve had better reasons to be knickerless, but I’ve never been happier to be home.

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Days 3-5: Moving on from the post-PAO blues

Day 3 was the toughest day of my hospital stay. It took me a while to get the fentanyl out of my system, so I still felt pretty dizzy, but I was  more aware of the pain than before. I struggled a bit with the noise and general hustle and bustle on the ward. It felt rather overwhelming and just ‘too much’. I felt a bit weepy, but it didn’t last long. By the end of the day, I felt better.

Once again I was disappointed with my lack of walking ability. I had hoped that today I’d get onto crutches, but all I managed was about seven steps with a walker before collapsing into a chair. I couldn’t lift myself back into bed and by the time I lay down, my ears were ringing, the nausea had returned, and I was sweating like I’d just finished a six mile run!

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Note matching DVT socks and regulation hospital gown – classy!

The good news is that from that night, things began to get a little easier. I started to get some proper sleep. And on day 4, I finally got onto my crutches! I made it to the bathroom where Irish helped me have a sit-down shower and a proper hair wash. Since I wasn’t attached to any drips or pumps any more, I changed into my own nightie. I cannot tell you how good this felt – it felt like a huge step forward in my progress as I’d never have managed all that on day 3!

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A hair wash and my own clothes – that’s better!

The nausea and breathlessness rescinded gradually. I ate more, I slept more. I even read a chapter or two of my novel and began to enjoy my visitors. I still felt very wobbly on my crutches and had one stumble in the bathroom where I had to put my weight through my operated side to avoid falling – ouch, but no real harm done. On day 5, we borrowed a wheelchair and Irish wheeled me around the hospital. It felt so disorientating – amazing how your world shrinks when you can’t move easily. I practiced on my crutches knowing that the smiley physio girls would give me the all clear to go home on day 6 if I could move safely on them.

I began to be aware of things I’d found helpful and things that I didn’t – so here are my list of Do’s and Dont’s for post-op recovery.

DO:
1) Take laxatives from day 2. You will need them. I asked the nurses for some, and I ate a lot of dried apricots.

2) Count up all the tiny wins – the first time you sit in a chair, the first time you brush your own teeth. This helped me realise I was making progress even though it wasn’t always as fast as I liked.

3) Tell the nurses if you have pain, nausea, or itching from the medication. They do not want you to suffer.

DON’T
1) Be too ambitious. I felt exhausted for about 3 days after surgery. My body needed rest and didn’t react well to the meds. Don’t punish yourself if you don’t hit your self-imposed goals. Nobody cares about them except you. Let your body recover in its own time.

2) Take too much stuff. I didn’t need half the clothes or books I brought. There is a tv attached to the hospital bed which costs a fortune but which gives you a bundle of about 20 channels plus about 20 movies and Internet / landline calls. It’s worth the money in my opinion.

3) Worry about being self conscious. These nurses have seen EVERYTHING. They have cleaned up, measured, and thrown away every bodily excretion you could think of. There is a time to worry about dignity and this is not it. That said, the staff were great at giving me as much privacy as is safe. Those hospital curtains are not pretty, but they serve a purpose.

Day 1 and 2 post right PAO

The first couple of nights post-op are rather unsettled. I grab a half hour sleep every now and then, but it’s not easy to sleep – very sore, rather than very painful though. I find it hard to sleep through the soreness and with the tubes sticking into my arm and right side. I am quite glad when the ward starts to wake up and bustle again. Days start early in hospital. The meds are brought around at about 6.30am, and the first cup of tea comes at about 7 – and I’m really grateful for it.

Irish is staying with his sister and I’m so glad to see him at about 8am. He tries to persuade me to eat a piece of toast – I manage half a piece but don’t feel hungry. Tea is good though! He sits next to me as I doze on and off. Upping the PCA helps me to nap, but the payoff is more nausea so I get another tablet from the nurse to help with that. It does work – phew.

At about 9am Mr Witt arrives to look at my wound and pronounces everything to have gone very well and tells me the wound is looking great. I am rather transfixed by the incision and rainbow bruising – you can judge for yourself here:

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Looking good? Well I have just been sawn apart , chiselled and screwed back together! Irish’s hand gives you a bit of a guide as to the length of the wound.

I am given a bed bath. The nurses let me do as much as I can by myself, but I can’t sit up without help and I can’t reach my legs easily. They help me so kindly and offer to use my own shower gel etc if I want. It’s lovely to be clean again.

My parents also arrive in the morning and it’s another little slice of normality. Lovely and so welcome…but I’m too tired to do more than hold their hand, smile at them, and accept offers of tea. I try to eat but am not really interested in food.

The physiotherapists also arrive on the morning of day 1. They are lovely, young, smiley women who are so encouraging. ‘Oh, you’re a PAO’, they say. ‘We like PAOs, they are always so keen and competitive’. Maybe that’s because we can’t wait to get back to a life of mobility!

In a keen and competitive manner, I have been trying out the physio exercises given to me pre-op, and they hurt like hell and are so hard to do! I can’t move my leg out to the right at all – ouch. I realise this is because the outside hip muscles were cut through in the surgery, so it’s not surprising and apparently completely normal. I am keen to try to stand up using a walker, but am amazed at how difficult it is. I manage about 20 seconds before collapsing, panting, on the bed, with my ears ringing. The smiley physio girls help me get my legs back on the bed. I am gutted. I wanted to be the one doing stairs on crutches day one after surgery – but clearly that’s not going to happen. ‘Never mind’, say the smiley physio girls. ‘It’s a common reaction to the meds. When you’re taken off the PCA you’ll feel less dizzy.’

They leave the walking frame behind and of course I can’t resist a couple more efforts at standing up with Irish’s help – but am shattered after 20 seconds or so and have to lie down for several minutes afterwards.

On day 2, I feel much the same. Everything is a tiny bit better. I eat a little bit more. I can move my right foot a little bit more (but still -oooww). I feel up to leafing through the magazines my mum brings me. I am told I am not relying on the PCA enough, so I try pressing the button more – this didn’t work for me, I just ended up feeling sick and have to get more meds from the nurse. The anti sickness meds do work though! In the end the nurse injects some into my vein rather than offering me tablets, and the difference is amazing. I feel human.

I begin to be very grateful for the Olympics on TV. I brought a DVD box set with me but don’t feel up to following a plot. But London 2012 is perfect. I can doze off, wake up – and yes, it’s still the Olympics. On day 2 I am moved to another ward where I can see the Olympic park from my bedside. It looks amazing lit up at night.

In the morning, a nurse removes the local anaesthetic tube from my right side. For some reason the thought of this freaks me out, but my mum holds my hand and actually, it was nothing at all. Doesn’t hurt, nothing. I have no idea why I was so nervous and put it down to post-anaesthetic exhaustion. I expect to feel more pain as the local wears off – but I don’t.

An orthopaedic consultant visits every morning and tells me I’m doing really well and that I’m on track to go home soon. I find out there are 3 screws in my hip. I am visited again by smiley physio girls, who get me to stand up a little longer. They tell me I can put 30kg of weight through my operated leg and ask me to stand with my right foot on a scale so that I can feel what that’s like. I can’t even press hard enough on the scale to get up to 30kg! I find this quite reassuring. However, efforts to walk using the walking frame are less fruitful. The nausea comes back and I feel so faint. I try not to get downhearted.

That afternoon, the PCA is taken down and I start using codeine and paracetamol for pain relief. I still feel very sore so am nervous about how I will cope – but I do cope. In fact it’s great to be free of all the tubes! Just the cannula in my hand now, nothing else. I ask for something stronger pain relief-wise at night, and am given oral morphine. It gives me judders all night so I decide to stick with codeine and paracetamol in future.

So the summary of day 1 and 2 post-op is:
1) I was pretty out of it.
2) the meds affected my ability to progress with physio.
3) I was pretty sore, but not unbearably so.
4) The nursing and medical care was faultless.
5) It felt great to have my family around me.
6) It wasn’t pleasant – but it wasn’t as bad as I’d imagined.

It’s PAO-time!

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Ahhh, morphine!

So, as you can see from the picture, I was PAO’d (right hip socket) by Mr Johan Witt on 31st July at 9am. We arrived early at about 6.30 and I was the first into theatre. I can honestly say that the last hour or so before surgery was far worse than the ones that came after! I was so frightened. But all the doctors and nurses I met were so reassuring, I felt in very good hands.

When it came to the surgery, I was brought, shaking, into a kind of surgical ante-room, where they checked my details, and put a cannula in my hand. A very nice anaesthetist said ‘this might make you feel a bit woozy’, as he injected something into it.

‘I don’t feel woozy’, I said. ‘Oh well’ says lovely anaesthetist, reassuringly, ‘breathe into this mask’. He places a mask over my mouth, and that’s the last thing I remember.

The next thing I remember is a nurse calling my name to wake me up, and telling me the surgery was over and I was in recovery. She pointed out that I had a tube delivering local anaesthetic to the site of the surgery, and a pump that I could control which delivered Fentanyl (like morphine) when I pressed a button (this is called a PCA – patient controlled anaesthesia). She also told me that I’d had a spinal epidural which would wear off over the next few hours. She told me not to pull the oxygen tube out of my nose. The lovely nurse gave me some water and asked if I felt nauseous or in pain. I didn’t. I felt happy and relieved it was over. I dozed.

Then Mr Witt came and told me the PAO had gone really well, and checked the wound, which already looked so small and neat – a thin line of about 4 inches in length, along my bikini tan line. I was very excited by this. I felt quite high. He went over the various drugs and told me that my urinary catheter would be removed soon. I was happy about this – before surgery thoughts of the catheter had made me feel quite squeamish. I went back to sleep, with a smile on my face.

Then Irish arrived, having some how managed to bribe / kidnap the recovery staff into letting him in – this is not really allowed. I was so excited to see him and apparently revealed my entire naked lower half to the whole room in an effort to show him my incision.

I ended up having to wait several hours in recovery because there were no beds available on the relevant ward. This wasn’t a hardship, I was very drowsy and lovely nurse sat by my side all the time, giving me sips of water. She took my catheter out at some point – she asked me to cough as she removed the tube and it was out in less than a second. This was a huge relief, I had been inordinately worried about the catheter and was happy to use a bedpan instead. Once I put dignity to one side, the bedpan wasn’t an issue. I used my good leg to lift myself off the bed in a kind of yoga shoulder bridge (not unlike my blog photo!), and slid the bedpan under me. This hurt – but I topped up with morphine before and after and just got on with it. The nursing staff were great at giving me as much privacy as was safe. A girl’s gotta do what a girl’s gotta do.

When I did move to the ward, it was lovely to see Irish and my parents waiting for me. I couldn’t stop smiling. I was unspeakably glad it was over. It was painful, but not unbearable. I was very conscious not to let people jerk my bed or approach me from my right side, because it hurt to press on my foot or move my leg. But I could wiggle my toes without much pain. I tried out the physio exercises I’d been given for post-surgery. They hurt, but it was rewarding to know I could start this straight after surgery. I started to feel a bit nauseous from using the PCA and yet another lovely nurse gave me a tablet which helped. The epidural wore off, but I had absolutely no increase in pain as a result.

I spent the evening dozing, watching a bit of TV, holding my mum’s hand and having a first cup of tea (heaven). My family left about 8pm and I dozed on and off through the night. I didn’t sleep much because I was woken regularly to have my blood pressure / oxygen / temperature checked (all fine), and because I needed to use the bedpan a lot because of the fluids going into my arm. I guess a catheter would have avoided that, but I didn’t really care.

Looking back, my memories of this day are quite sketchy, but more than anything else I had the sense that the wait was over, and that I was in the best place. My advice for the day of surgery for any PAO-ee is to just go with it, put your trust in the experts, and know that in a very few days you’ll be seeing improvements every day…

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