Post-operative planning (or ‘Leaving it to the Unfeeling One’)

Why on earth would men want to get a body wax?  I forgot to mention that I had to have an ECG on Monday during the pre-assessment clinic, and the nurse shaved parts of my chest so those little sticky bits would actually adhere to me.  The growth on my chest is rather lush (I use the word in its original sense, ie ‘luxuriant growth’, not the meaning applied by modern ‘youff’ to anything that they regard as cool) and, in addition to razor rash (it was a dry shave), I am itching terribly as it starts to grow back.  My plan to walk around shirtless, to stop the stubble being plucked, was thwarted instantly by the Unfeeling One who reminded me, most cruelly, of my slightly excessive BMI and the fact that the neighbours, and she, might not appreciate the sight.  I noticed that the nurse didn’t feel the need to shave my legs and, instead, pressed the sticky pads on with a very firm pressure. I swear I saw the corners of her mouth curling up at the edges as she ripped away those sticky bits once the ECG was complete.

I left the hospital on Monday clutching a load of paperwork which, if I were to be totally honest, hasn’t been read in much detail. By me.  Not in any detail at all, truth be known.  I suspect that the pamphlet entitled ‘Knee Replacement, a complete guide to your operation and recovery’ is something I really should read but with only one week between pre-assessment and my op, there is only time for a quick scan.  It was suggested that I take it in with me so I’ll read it properly then.  Mind you, the quick scan I have had has uncovered some fairly useless advice.  An example.  ‘Try to maintain a healthy weight for your height. You can ask your General Practitioner or practice nurse for advice’. I am not sure how those of you kind enough to read this blog get on with your local surgery but, within one week, I have a more realistic chance of getting my BMI down to an acceptable level than I have of getting to see my GP or practice nurse. The maximum time between pre-assessment and op is normally 28 days.  If you are like me, but don’t have your own Unfeeling One, I would recommend trying to get more than a week between the two.

Whilst the pamphlet warns patients about the possible side-effects of a general anaesthetic, it doesn’t mention that some patients come round feeling extremely hungry and bad tempered.  After one op I had, I was thrown out of intensive care after an hour (instead of the 24 hours I was supposed to be there) for being a pain.  Should I warn them or will they put in measures to stop me wandering and looking for food and snarling at anyone who gets in my way?  Seriously, though, the advice I had from an (extremely eminent) surgeon not to work for at least 2 weeks is because of the effects of the anaesthetic, not the recovery from the surgery itself.  The older you are, the longer the effects take to wear off.  As you know, I am ‘quite young’ so it should go through my system reasonably quickly (I told them a month at work).

Having got bored with even a cursory skim of the documentation, I have decided that I really don’t need to read it all anyway.  With her in-built need to plan, organise, and manage, the Unfeeling One has read all the paperwork, including the pamphlet, several times and can now repeat great swathes of it verbatim.  As usual, I will be told exactly what to do and when to do it. Every planned activity will be put onto a checklist which, just as happens in up-market public conveniences, will require my initials and accompanying time stamp to prove that the required action has actually been completed.  It won’t be left within easy reach of the bed of sofa either.  I should point out that the necessity for a checklist is because she won’t actually be there to supervise:  she will have been at work and neglecting me (she glossed over the bit of the pamphlet that advises having someone with you at all times for a few days after your discharge).  I may even have to take up the offer from my very elderly and infirm mum to come and look after me (‘Flower Club comes first though, dear’).  I can, however, take it easy, safe in the knowledge that my post-operative recovery will go exactly as the pamphlet says it should because the Unfeeling One is in full control.

We also had a read of njrhippychick’s blog and her experience of pre-assessment, done in an NHS hospital, appears to have been very different.  The NHS appear to get lots of people in together and give out most of the post-operative information during pre-assessment, including advice from physiotherapists et al.  She was also part of a large group who could compare experiences and, as she puts it, ‘have a laugh’ whilst waiting for individual tests to be carried out.  Apart from the pre-assessment nurse, I didn’t get to speak to anyone (if you don’t count the lady in the corridor who I bumped into whilst carrying my over-filled specimen bottle back from the gents to the consulting room), and it was over and done with in slightly over an hour.  Although I had the opportunity to ask questions, it was clear that I was expected to read most of the documentation myself and get myself sorted.  How different that would have been had I been the average age for a knee replacement (69.95 years according to the NJR’s most recent annual report), I don’t know.  I will ask.  What was made clear to me was that I would see the physiotherapist after surgery and that they would give me all the advice and information that I needed before I was discharged.  A different approach and one dicated by resources and finance I suspect:  the NHS may not be resourced to follow up individual patients on the wards after surgery and it is easier to run clinics for groups of patients beforehand.  I will chat with hippychick after her operation and get back to you.

The Unfeeling One also noted that hippychick will have to spend at least 12 weeks sleeping on her back and that she cannot bathe or shower until the wound is completely healed. Having told the Unfeeling One that I did not need to sleep on my back and that, I too, would not be able to shower or bathe for a similar amount of time, she simply remarked that as I already slept on my back, all I was doing was adding unpleasant odours to my vibrant snoring.  I do not snore.  Pain deprives me of sleep, so I cannot snore.  I won’t even attempt to describe the look that I got in response to my suggestion that she might give me bed baths.  The pre-assessment nurse had already scotched that idea (you need to be up and about, not lying in bed) but the Unfeeling One didn’t know that. As there is no chance of her feeling any sympathy for making me roll over in the middle of the night, despite the post-operative pain in my knee, or helping with my daily ablutions, I suspect that the recently cleaned and aired spare room is beckoning.

Well, less than 72 hours to go now, but I will try and fit in another post before I go into hospital on Monday.  The Unfeeling One will not be coming to visit me (we are agreed that looking after Lyle, the dog, is more important at the moment), so please feel free to leave comments.  I won’t have too much else to do except to respond to them.  Kneedyman.

Pre-Assessment – What did they do to me?

When in their training do nurses get taught the same lie?  Considering that the nurse doing my pre-assessment was a Kiwi, it is obviously a lie of international proportions.  I don’t like needles. At all.  However, every nurse who has ever taken blood from me has always said, ‘You’ll feel a slight scratch’. Since when could having a needle jabbed into you ever have been likened to a ‘scratch’.  At this point I am usually staring fixedly at the far junction of two walls and the ceiling, muscles clenched, just waiting for the pain.

I was duly offered the National Joint Registry consent form to complete, and remarked that I ought to sign it as it was me, I continued, modestly, who wrote it.  I don’t want to take the Mystery Shopper thing too far, after all.  I was not, however, given, an NJR Patient Information Leaflet and it was not until I was sitting on the couch waiting to be swabbed that I noticed one on the wall next to me.  It was an old one and very out of date.  Much tutting from me, ignored by the nurse, so I will need to speak to the member of the team responsible for this region and make sure that they have up to date information. Swabbing, however, was not something that I had been warned about and I was a bit concerned when a fresh pair of latex gloves went on and some rather large cotton buds appeared. The gloves were dark blue.  I remember them very clearly. Concern turned to alarm when I was invited to drop my trousers.  Two tips when attending pre-assessment: firstly, ensure that you have blown your nose thoroughly; secondly, ensure that you are well scrubbed ‘down there’ and that the state of repair and/or design of you undergarments are not likely to cause embarrassment when viewed by a stranger. Fortunately, Monday is shower day and I suffered no embarrassments.  Mind you, at the same hospital last year, in front of the Consultant and a nurse, I removed my left shoe to be greeted by the sight of my big toe peeking at me through a large hole in my sock.  I saw a knowing expression pass between the Consultant and the nurse, and I hurried to reassure them that, whilst my salary didn’t provide me with enough money to afford both a mortgage and new socks, I was on the company medical insurance scheme and that they would get paid handsomely for what they were about to do to me.  Inevitably, it involved needles.  Three of them, each getting successively bigger.

Back to pre-assessment.  We spent rather a lot of time going through the form that I had completed but had failed to post back to them.  They only gave me two weeks. What can a man do in the time?  It took me a long time to fill in or, being strictly truthful, it took me a long time to fill in one box: ‘Your Weight’.  Despite what the Unfeeling One thinks, I am not totally unobservant and I have noticed a few pounds going onto my otherwise svelte frame. It took me ten days to pluck up enough courage to get onto the scales, only to discover that the battery had gone flat in the 6 months since I last climbed on.  Obviously the scales in the hospital reckoned I was heaver than did my own scales (holding my breath and trying to stand on tip toe did not help) and my BMI was duly calculated.  Not as bad as I feared but still enough to contribute to that ever climbing curve, produced by one of my colleagues, that shows the increasing BMI of total knee replacement patients.  I do need to lose weight, if for no other reason than it will give my new knee a better chance.  At least I know where to start.  As I got off the scales at home, the Unfeeling One, who had been watching closely, muttered one word: ‘Beer’.

I also discussed anaesthetics with the nurse and it was a very short discussion:

‘Mr Kneedyman, have you considered what type of anaesthetic you want?’

‘Yes.  The sort where I sleep a lot and have absolutely no idea of what is being done to me’.

Who on earth wants to know what is going on? I don’t want to hear the muttered ‘Ooops’, followed by a lengthy, collective silence.  My mum was awake throughout both her hip replacements but, obviously, the ‘sterner stuff’ gene didn’t get passed on.  I shan’t be having a pre-med either.  I had one many years ago, just prior to the first time my left knee was hacked into. The nurse came in and I lay there, in my happy state, and watched him shave my right leg. Ten minutes later, the surgeon, with entourage, swept in and confidently drew a big black arrow pointing up to my shaven right knee, topping it with an even bolder and more confident ‘L’: ‘Don’t want to chop up the wrong knee, do we Old Boy? Hey? Hah, Hah!’  Fortunately one of the entourage piped up, ‘Colonel. I think that’s the wrong knee’.  I, woozily, had just assumed that as he was the surgeon he knew something I didn’t.  A fresh razor was produced along with another board marker (red this time) and my left knee was duly marked up.  A green marker was used to cross out all the writing on my right knee. The ink was there long after the hair had grown back.  No, no more pre-med for me.

So, in summary,  do make sure that you are offered the NJR Consent Form and Patient Information Leaflet: the Registry can’t do it’s job of improving patient outcomes and patient safety without your details.  Do complete and return the questionnaire before going to your pre-assessment clinic:  it saves busy people some time.  You will have a lot of information thrown at you and it may become overwhelming.  Ask questions and ensure that you are given enough time to consider your choices.

I shall now compare experiences with Hippychick’s blog  and see what differences there are for hip and knee patients after their operation. Will get back to you tomorrow. Kneedyman.

How on earth will they cope without me?

Had my pre-assessment clinic today and it is starting to dawn on me how long I will be out of circulation.  The advice I have been given by another (extremely eminent) surgeon is that I should not look at emails for 2 weeks and not make any decisions for 3 weeks.  How will the team cope without me? ‘Very well’, seems the general response which is a bit of a blow to the ego.  I must confess that I have tried to time the surgery when it will be of least inconvenience to the job and I have realised that no time is a good time. Do it when you have to get it done, not when you think it will be the least bother to anyone else. What I have done, is to keep everyone at work informed and they have been fantastically accommodating. Mind you, I think that my boss, at 6’7″, was probably getting fed up of walking at my speed. Having kept them informed, we have had to time to farm out my work amongst the rest of the team.  I am, however, concerned that they will realise how little I actually do………

The other concern is who will look after my Border Collie, Lyle, during the day when I am in hospital.  We lost his brother, Tate, totally unexpectedly in May this year and, at the beginning of September, we discovered that Lyle has an inoperable tumour on his spleen. They gave him 3 weeks and he is still going 10 weeks later: no-one has told him that he is unwell. If the stress of a dodgy knee and a knee replacement isn’t bad enough, it is nothing compared to waiting for the moment your dog keels over. Clearly, he can’t go into kennels. I had considered asking Little Sister to look after him as, having a 14 week old baby and being on maternity leave, she has nothing to occupy her time.  However, the Unfeeling One’s compulsive organising and planning behaviour has kicked in big time and she has already organised a dog sitter: Mother of Unfeeling One.  Before assuming her duties, we will need to ensure that Mother of Unfeeling One is taught how to play Frisbee tennis and how to kick a ball.

I told a whopper of a lie to the lovely pre-assessment nurse today (she also referred to me as being ‘quite young’):  I told her that someone would be at home to look after me when I was discharged.  I didn’t let on that, having picked me up in the morning and brought me home, the Unfeeling One is going straight back to work.  I had assumed that Number One (and the only one) Child might take an interest and be persuaded to look after his not-so-elderly father but the Unfeeling One reminded me that he had actually finished school and had gone to University in September.  I didn’t see much of him when he was here, but there were certain clues that should have made me realise that he had gone:  my bank account empties more quickly each month; I only have my dirty dishes to fight through to get to the sink; my ability to pair socks on laundry day has increased exponentially.  I do,vaguely, remember a conversation in August when he told me that he was off to to study Theoretical Physics (‘It’s numbers an’ stuff, Dad ,don’t worry about it’).  The reason that it sticks in my mind is that he was expecting me to buy him beer tokens for four years instead of the usual three.

It is a problem. I will be by myself during the day immediately after discharge and am not sure what to do if something happens. I have a number of options:

• Give the Unfeeling One a pager so that she can react instantly to my every urgent need.
• Offer to pay for a rail ticket and an additional weekly beer allowance for Number One Child to come and look after me.
• Not steal my Mum’s sticks so that she can come and administer to me. I am obviously more important than the Flower Club.  Mind you, having nursed my father through a couple of knee replacements after getting both her hips done, I suspect that she will be slightly less than enthusiastic.

Asking Little Sister and teething baby is not an option.  Apart from the noise, Little Sister’s attention will not be focused entirely on me.  I am sure that the Unfeeling One will sort something out for me.  She usually does.  It is a lot to think about.

Interesting time was had at pre-assessment today, especially the MRSA test swab. More to follow. Kneedyman.

‘You cannot be serious…….!’

The more senior of you, and I number myself amongst you, will remember John McEnroe’s (pre Federer, Nadal, Murray, Djokovic etc) disagreement with the referee on the centre court at Wimbledon.  My expostulation on second contact with my medical insurers was pretty much the same except I didn’t have a tennis racquet to threaten them with.  Not that they would have seen it.  I promised you a blog about the pitfalls of medical insurance and I apologise for the slight delay.  I have been fighting, with partial success, the onset of a serious bout of man-flu.

I am a member of my company’s medical insurance scheme which is a premium policy and allows for pre-existing medical conditions. Last year, I had a load of yucky looking fluid drained from my knee, followed by x-rays, an MRI scan, and an arthroscopy.  As explained in an earlier post, this was an attempt to delay the inevitable.  The insurers were terrific and very helpful.  However, a few months later I received a letter from the medical insurers stating that they would no longer support ongoing treatment of my knee which was deemed to be a chronic condition.  They would, however, consider further, appropriate surgery.  Five months later when my knee took a serious turn for the worse, I contacted the insurers and they authorised an appointment with my Consultant.  The day after the appointment I rang them and informed them that I needed a total knee replacement and that the surgeon required x-rays and an MRI scan.  After a pause in which I was passed off to someone slightly more senior, I was told that the appointment with the Consultant should  never have been authorised and that they would not pay for any x-rays or MRI.  Rolling this back, it would mean that I would have to persuade my surgeon, without any appointment, that a self-diagnosis of the requirement for a knee replacement was sound, book my own operating theatre, invite the surgeon and his team to turn up on the given day, and, just to make it really challenging, not give them any idea of what they were dealing with until my leg was opened up.  This, clearly, would lead to a great outcome. The confirmation of my supposition led to my John McEnroe moment.  I argued with them. A lot. It caused me a great deal of stress at a time when I was in a great deal of pain and just wanted my knee sorted.

I was given any number of reasons why they would not pay for the surgical pre-planning and, on one occasion, was actually told to get the x-rays and MRI done on the NHS!  This approach to the care pathway is novel in the extreme.  As it was a company scheme, I was supported by my HR team and they found themselves caught between an intransigent healthcare insurer and a grumpy, intransigent employee.  It was all to no avail, and I have ended up paying for all my surgical pre-planning.  Why, when I could have got this for nothing on the NHS, did I eventually cough up?  Basically, I wanted to get rid of the pain as soon as possible and I could afford to do so.  My surgeon had also recommended the use of patient specific instruments for the operation which is why the MRI was required. Essentially, engineers produce cutting blocks from the MRI scan which removes some of the need for surgeon judgement whrn cutting the bone.  Whilst the long term outcomes for this approach are unproven (they can’t be any worse, after all), the use of such blocks is less invasive and post-operative recovery much quicker, often resulting in a shorter stay in hospital.  What really annoys me is that, by paying for the MRI, I have saved the insurers at least 3 days of in-patient fees.

Check exactly what you are covered for before you get any treatment or start paying any medical insurance premiums.  I have heard, although I can’t confirm it, that one company will not cover treatment for osteoarthritis.  Last year osteoarthritis was an indication for over 90% of all hip replacement procedures. Bit of a blow when you have been paying medical insurance premiums for years.  Check the policy!

On Friday, I received a call from a lovely lady reminding me that I was due in for my pre-assessment on Monday.  I regard her as ‘lovely’ because she remarked that I was ‘quite young’.  No-one has said that to me for years so I was quite prepared to skip over the fact that she meant that I was young compared to the normal clientele in pre-assessment.  Whilst confirming my appointment, I asked whether I would need sticks or crutches after my operation and was told that the physiotherapist would determine that before I was discharged.  Whatever was needed would be made available to me. At an additional cost.  I have reverted to Plan B which is a raid on my parents’ under stairs cupboard.  They have had 2 osteotomies, 3 hip replacements, and 2 knee replacements between them (one is still angling for a shoulder replacement) so there should be plenty of aids to choose from.  It may hinder attendance at the flower club but, after all, my need is greater because I am still ‘quite young’.

Even if you have medical insurance, check to see what is covered in order to avoid any unpleasant surprises.

With only a week to go before my op, it would appear that I have been unkind to the Unfeeling One.  I have discovered that she is going into work early and halving her lunch break so that she has enough hours to come and pick me up when I am discharged. Maybe she is not so unfeeling as I thought………  Kneedyman

Welcome to a blog in ‘kneed’ of reading…

Welcome to my ‘Kneedyman’ blog – I’ve been encouraged, or rather, press-ganged, by friends, colleagues, and family to write about my experiences either side of a total knee replacement I am shortly to undergo.  This comes after many years of trouble and pain and I have forgotten how many times and how many different surgeons have been in to repair the damage. There is now nothing left to repair so the serious toolkit and replacement parts are needed.  Through my everyday job,  I have become aware of this ‘blogsphere’ and it may be that my ramblings might just be of use to anyone who is facing the same thing. A fellow blogger is www.njrhippychickblog.wordpress.com and I recommend a visit. Our experiences are slightly different, apart from the obvious fact that she is getting her hip replaced, so Hippychick may be able to provide other views. However, I am getting my knee done before Hippychick gets her hip done and that is because, being a man, I am obviously in more pain and, therefore, my need ( I promise to stop it) for surgery is more urgent…… Having set the scene for, and indeed the tone of, my blog, more will follow shortly.  Kneedyman