Re: Attn Dan

[Guest guest]

Message Dan:

Hi Dan:

Thanks for explaining the process and my rights for getting referred reasonably

quickly. I dont know where this 17 weeks comes from but it seems a long time to

wait just to get on the bottom of an already long waiting list.

Appreciate your feedback.

Phil Exeter

Dear Surfacehippies

This may turn out to be a long message/post, so I'll divide it into

various headings. I’ll be posting snapshots as well – check the Photos link

on the left side of the surfacehippy home page.

Facts

I had my left hip resurfaced on Monday, 16th February 2004, at St. Cross

Hospital in Rugby, Warwickshire, United Kingdom. The operation was performed by

Mr. Krikler. The procedure was done on the NHS (National Health

Service), or free of charge.

Chronology

Sunday, 15/02/04 Checked in St. Cross's Cedar Ward; met Harry

who is also a 53-year old with a left hip due for resurfacing by Mr Krikler;

Harry is very fit) I carry some 8 pounds of excess weight round my waist)

Monday, 16/02/04 Agreed with anaesthetist to have spinal

anaesthetic (like epidural for women in birth); Mr Krikler was happy to provide

a " running commentary "

At approx. 12:00 taken to pre-op theatre room where spinal was applied

Apparently was taken to op theatre where Mr Krikler started the incision

and I mentioned that I could feel it - he asked the anaesthetist to apply

general anaesthetic. I do not recall this exchange. I understand that the op

lasted 1 hour and 45 min. Mr Krikler said that the hip was very stiff and that

I had very hard bones. It appears a bit more work than usual. He fitted a

Cormet device with a 48mm cup on femoral head.

At about 16:30 I was awake and back at the Cedar ward.

A couple of hours later Mr Krikler saw Harry and me (Harry was operated

after I was and his op lasted 1.15, I understand). By then the small of my back

was quite uncomfortable and I asked Mr Krikler if it would be OK to turn on my

'good' side (non-operated right). He said that'd be OK (many nurses were later

surprised by this - I guess they are still more familiar with the THR

post-operative procedure which prohibits sleeping on your side, or crossing

legs, for months, I understand)

Spent the night mostly awake; did not use PCA (Patient Controlled

Analgesia) - morphine pump to you and I - as the discomfort was bearable (I have

to stress here that I was not playing macho, but that I have extremely high pain

threshold and went through years of OA with bone-on-bone and a cyst without ever

taking a single pain killer); passed water 4 times (nearly a pint each time?!?)

and sat-up on the bed to wee (I could never do it using the 'goose' bottle lying

down in bed); constant sitting-up and fidgeting led to some leakage and oozing

from the incision which got redressed 3 times that night; all-in-all not too bad

a night.

Tuesday, 17/02/04 Day 1 - is how the hospital staff refer to the

day after the op; given a 'Zimmer walking frame at about 08:00 (after breakfast)

and told to apply full weight bearing on the operated leg/hip

Walked round the Ward and to the main corridor all the way to the lifts

where use of mobile phones is permitted; phoned friends and loved ones to inform

them that all's OK; couldn't find a place to connect my laptop (rather found a

connector but the hospital switchboard could not enable it for external calls to

an ISP - however, this week a new cable system went live there and each bed will

have cable TV, telephony [outgoing only, I understand] and full internet

access); alternated the day between walking, laying in bed reading an obscure

book and talking to Harry and the other 4 patients in our room; had bowel

movement and used toilet.

Wednesday, 18/02/04 Day 2 - had a shower in the bathroom; no problem

washing both legs; could see bits of bruising on my bottom; very little

swelling.

Told that I have a 9-10 " incision/scar (22.5 - 25 cm); not bothered by

that; it is healing beautifully.

Harry and I are given 2 walking sticks/canes each cut to our size; we

start walking with these; usual destination: outside the lifts in the main

corridor; spending a fortune on mobile calls; after an hour I drop one

stick/cane and use one only (I'd like to stress here - mainly for our Yankee

friends - that one is free to walk round and explore as we do not have the

culture of suing the hospital should we stumble, fall and injure ourselves; it

is pretty much left to the patient to be sensible; I always informed the duty

nurse when I went for a walk, especially at night when I couldn't sleep; but I

appreciated the unrestricted, yet caring, environment I was in).

The continuous walking, interspersed with periods of rest/sleep/reading

appear to have speeded-up the healing tremendously - both the bruising and the

swelling are fast disappearing.

Made a mistake of not asking for a sleeping pill and spent most of the

night awake but without any pain.

Thursday, 19/02/04 Day 3 - Physiotherapist gives us (Harry and I)

the steps (up and down) and the platform test (up and down) with one cane/stick

- we pass and are ready to go home.

Blood test shows our INR (International Normalcy Ratio) for blood

coagulation is too low at 1.2 and 1.4 respectively for myself and Harry; the

hospital decides not to release us until we reach the accepted INR window of 1.5

- 2.5 (apparently, if our blood coagulates faster that 1.5 times the blood of a

normal person, i.e. the range between 1.0 and 1.49, we are at risk of DVT of

sorts where a thrombocite can get lodged in our lungs causing sometimes deadly

pulmonary thrombosis; if, however, our blood coagulates slower than 2.5 times

that of a non-operated person who moved round normally, we are at risk of

suffering bleed which could be very difficult to stop and even fatal if internal

and unobserved); at St. Cross's hospital, or maybe even at that Health Trust,

the DVT is dealt with using Warfarin tablets (also known as rat poison as that

what it is commonly used for).

Mr Krikler visits us and I take snapshots - I hope I'll be able to post

these.

Nicola, the occupational therapist, is moving heaven and earth to arrange

all the necessary equipment for me when I'm released - there are peculiar

problems as I am way out of my area (I live in North East London, some 120 miles

south-east of Rugby), and I shall be staying at my sister's place in Essex,

another 50 miles east from my home. Nicola is trying to arrange through the

local social services for raised toilet seat, bed mats, raised chairs, bath

boards (to enter a bath tub safely), grabbers, long shoehorns etc. to be

provided by one Health Trust, via another one where I live in the third one

where I'll be staying - ah the vagaries of bureaucracy.

Friday, 20/02/04 Day 4 - failed the test again; Warfarin

dosage upped to max.

Saturday, 21/02/04 Day 5 - failed again; only managed to get the

ratio to 1.49; Harry is allowed to go home for the night as he lives only 7

miles away.

I continue my 15 min walks round hospital complex/park at least twice

daily without a cane or stick which I carry in my arms but do not use. I regret

not bringing my car to the hospital - I could have driven it already on Day 3 as

it is an automatic and given that in the UK the steering column is on the right

and I had my left hip operated, I could have driven my car without any problems

for, say, 3 hours.

Sunday, 22/02/04 Day 6 - finally passed my INR test (barely,

with 1.51); in the afternoon my daughter and her boyfriend gave me a lift back

to my sister's place.

22/03/04 - 29/02/04 Daily - walks approx. 1 mile without any aides.

Bruising has nearly all disappeared; there's no swelling; once a day,

usually before going to bed, I take 2 Paracetamol tablets and 1 Ibuprofen tablet

- these are meant to be pain killers and anti-inflammatory in their actions; the

latter I welcome, the former I do not need, but I do want to be a 'good patient'

I can do most things without a major inconvenience - dressing and

undressing; using the toilet; walking; using the stairs; putting on/off left

sock & shoe; washing/drying left foot etc.

01/03/04 – 06/03/06 Moved back home; I’m using my bath shower

now; I no longer wear a dressing/plaster over the scar (Mr Krikler used

subcutaneous self-dissolving stitches – the 9-10†incision has fully

healed).

I’ve been driving my car for the last 6 days – no problems in driving

it, getting in/out, etc.

Went to Central London – the usual Friday lunchtime drinks with pals –

I went there unaided (no walking stick/cane) using public transport (bus and

London Underground, or Tube as we call it). Again, no problems using any of

these means of transport.

Comments

Leg length

Mr Krikler explained the mechanics of the procedure in detail; my leg was

1.5 cm shorter; once the bio-physics of the pelvis-to-foot is clear and the

resurfacing procedure is factored in, it is clear to me why the resurfacing

procedure can do very little regarding leg length (mine looks OK now, but I'll

have to wait until my gait and posture are corrected and straight before I can

establish if there'll be a discrepancy) while THR can be much more effective in

mitigating leg length. That's about the only advantage that I could see that

THR may have over resurfacing.

Mobility

Extremely high extremely early - I'm absolutely impressed.

Recovery / rehabilitation

Unbelievably fast and painless (for me at least). However, I realise now

that the operation is less than 50% of the solution - the larger part is

recovery/rehabilitation.

ROM

Could not have imagined that the range of movement would be restored to

such a high level so quickly. I said, probably too optimistically, to Mr

Krikler that I plan to come for a 6-week check-up on my Honda Hornet to Rugby

(ha thought I was mad and he is a biker too).

My final challenge – to tie the shoelace on my left foot/shoe. I hope

I’ll be able to do that in a few weeks time. Standing on my operated leg,

with my good leg in the air (crane-like position), I not a problem but I lack

the balance I have when I stand on my ‘good’ leg.

Blood coagulation risks & management

Probably the least impressive of the otherwise superb NHS (or, at least

that particular Health Trust). Two of us were kept in valuable beds for 3 days

- the only thing that happened throughout these 3 days was the dispensing of the

correct dosage of Warfarin in the evening and a subsequent INR test in the

morning. I'm certain that could have been done in the local surgery / health

centre where the patient is based.

Thanks & appreciation

Where do I start? Mr Krikler for his wonderful manner and style with

patients. He answered every question without ambiguity, without use of a

patronising tone, with the patience that professionals have to have when they're

dealing with a layman. The fact that he was nearly invisible and that he made

himself appear accidental in this process, helped reassure me, and I suppose

other patients of his, that this is a routine op. By the way, Mr Krikler has

performed 330+ resurfacings using Cormet in the last 8+ years. If you ask him,

he'll tell you openly about the 3-4 cases that needed revisions and why. He

does also perform this procedure privately - I understand that the package costs

£9,000.00 (US$16,200.00 at 1.8 exchange rate) all inclusive (of course, there's

the added travel costs for our USA friends). Considering that the Cormet device

costs some £2,000.00, I believe this is very good value for money. Admittedly,

it is slightly more expensive than DeSmet in Ghent, Belgium, but we might be

splitting hairs here.

I must mention Safi, a Ward Nurse who appears to be quietly running the

show. She is a perfect example of a person who gains respect through her

actions and deeds. Her dedication, application, thoroughness, devotion and

professionalism were a sight to watch. Luckily, she was given a student nurse

to teach as well - the student was in perfect hands and would learn the

profession well by being tutored by Safi.

Nicola, who joined this site and offered to help with advice, is one of

these people for whom no problem is unsolvable. One felt safe if she said she

would look into something. I can't thank her enough.

There were numerous staff that were ever so eager to help - I'll mention

Ivan (from Zimbabwe, if I remember correctly) and Riki (from Zambia, I believe).

These guys were there throughout the long night shift and would respond

immediately if you pressed the buzzer - you could have tea at any time of day or

night. Whatever you needed, they provided it.

Lastly, it would be unfair if I did not mention and thank all the other

staff at St Cross hospital. This is a nice hospital with diligent and

conscientious staff that look well after their patients. Even the food was

nice.

I must finish by mentioning the NHS - this is for the Brits - and stress

that anybody who wants to abolish it or plans to privatise it is either insane

or deliberately criminal. We have institutions for both types. And for the

unfortunate Yanks who have to fork out personal cash for the op - consider

strongly Mr Krikler and St Cross in Rugby (although Mr Krikler may suggest

another hospital where he operates also).

I'll shut up now. I hope to have more good news in 4 weeks time when I'm

due to see Mr Krikler for a check-up.

3 +44 (0)7974 981-407

* +44 (0)20 8501-2573

@ dan.milosevic@...

* 1A Cypress Grove

Hainault

ILFORD

Essex

IG6 3AT

United Kingdom