WHAT IS IT ABOUT HOSPITALS?

 

We leant on the windowsill checking out the silver birches. Yesterday, the one on the left had some bright green leaves in the middle of the tree and the one on the right had no leaves at all. Today the left hand one was a haze of green and the other now also had patches of life. The leaves themselves were crisply defined in the morning sun.

But what was also interesting was the tree felling in the little park opposite. I’m used to seeing window cleaners abseiling down our building with buckets and sponge mops attached to their harnesses, but here the man attached to the tree had a chainsaw hanging from his belt. Gradually, he worked his way down the tree, lopping branches as he went, then sections of the trunk until the tree was a small stump and he was standing as he cut it down to ground level.

‘Well, shall we go for our walk?’ I asked Lyn.

“Yes. Let’s do it.’

We left the room for the first time since arriving, me in my hospital dressing gown and Jan in her own. She was small and the one-size-fits-all was far too long for her. I liked mine. It was a heavy pale blue striped cotton and fitted me well. We were each still in our surgical white stockings, me in my Birkies and Jan in her slippers.

‘Bye!’ we called to nurses behind the desk opposite our door.

So off we headed, exploring the labyrinth of our floor at the Cabrini. It turned out to be a long loop of a corridor with patients on the outside and admin rooms in the core of the building. We chatted away. She was an 82 year old retired nurse and good company. By the time we had solved the administrative and nursing problems of the hospital and done a quick run down of this that and the other, we were back at our room, ready to hop into bed for a little rest before lunch.

We had each had our surgeries done the previous afternoon and during the evening chatted to each other from our opposite beds and brewed up a plan that we were not ready to go home the next morning as expected. I didn’t feel that my pain management was sorted out enough and she didn’t feel ready to go home by herself. Besides, I felt that I wanted a rest. I wanted to be brought my meals, have a bit of a chat with Lyn who I liked, and have a read and just catch up with myself.

So that morning when the surgeon arrived, I explained that although I knew he thought I was ready to go home, I wanted to stay in another day. He was a bit surprised but was ok with that. I had heard Jan having the same conversation with her surgeon who had arrived even earlier than mine. We were set for the day.

I know that people usually like to get out of hospital as soon as they can but I have a strange attachment to them

I had been happy to get dropped off at Entrance B and go through Door H to DOSA  (Day of Surgical Admission) on the First Floor by myself. There was a check in desk right in front of the lift doors. A cheerful young man had all my details ready. I felt the relief you have at the airport when they find your name on their computers and start checking you in. I sat and waited for a few minutes before being taken to a cubicle with a pile of instructions about stripping, dressing gowns, clothes in bag, special underpants and socks, and everything to be put in a locker except for reading classes and to wait, ‘Over there’. OK.

And there I was, waiting with a few others, all stripped bare except for our regulation underpants and bright orange socks, the ubiquitous dressing gown and in my case holding my reading glasses in their turquoise case. I was very pleased with their locker system because sometimes all your stuff is just in a great big paper bag underneath your bed, which doesn’t feel very secure.

From then on, I was swept through the system: my specs put into a bigger clear plastic box that went with me under the bed, into the operating theatre, then recovery, until finally I was wheeled along the corridors to a four bedded room. I discovered later that my belongings had been moved to a locker in this room, waiting for me. I was about to be decanted into a bed back from the window but saw an empty bed next to the window.

‘Is there any chance that I could have that window bed, please? I’d love to be by the window.’

‘Why not,’ they decided and there I was, in a bed by the window, looking at the evening sky and a bare branched silver birch. Eventually some soup and sandwiches came, as did Jan in the place opposite.

I read a bit, listened to the ABC Classics on my phone and felt quite pleased with my room and companion.

What is it about hospitals?

Usually I have a feeling of relief at finally getting there so that my problem can be solved, whether it’s delivering a baby, or perhaps relieving the months of pain and restrictions by getting a new hip joint.

I trust doctors to do the right thing.

I don’t mind some pain as part of the process of getting my body working again.

I like being part of a huge system which is dedicated to me and which ever part of the body needs attention this time. I like the way that everyone works together with one goal in mind. It reminds me of what I liked about working in a school. That we were all there to make each child feel good and learn.

Mum tells me that Dad used to take me on his hospital rounds at the weekend when I was a baby. I could imagine how exciting it would have been for the patients to have a baby carried into the ward. Maybe I just want all that attention again!

Return to Tango – 9 months on.

Well, the time I’ve had my new hip in my body is the time needed to grow and deliver a baby. A strange thought!

But not really, when I think about it. It has actually taken that time for me to feel comfortable, mostly, with this new addition to my body. The hip itself has just sat there, quietly surrounding itself with new bone, but the muscles have grumbled mightily and taken a long time to stretch out, develop and feel easy.

I’ve been sore a lot of the time but, as my physio and pilates teacher said, I am asking for a high degree of rehabilitation by wanting to return to tango with all its physical demands. That’s made me feel better about it all.

And I have been really improving with my dancing. My axis is stronger than it was even when I started learning- I think my hip was starting to weaken back at that point. My legs are also stronger now because of the excellent, very specific and focused pilates classes I do and I have much more strength, control and stability than I did. Now, my body can actually manage to do what I want it to do – most of the time.

I’ve been having some private lessons to help fine tune and consolidate my dancing. This is excellent as I had developed some defensive techniques to wriggle around my weaknesses and it’s terrific to be sharpened up.

Even so, I need to be careful about not doing too much – very frustrating. I do just one class and then only a few dances at the following Practica. A few weekends ago, Sidewalk Tango ran a terrific Vals Workshop which ran for two hours followed by a Practica. I managed the Workshop but was pretty tired. However, I was so pleased to be dancing comfortably that I danced on for far too long at the Practica. Not good. My body was very, very overtired and I was hopeless at class that week and even the next week. Plus, I’ve been a bit sore again and my ankle is now grumbling- on the other leg!!

So! This post has been rather like all the others, a mixed bunch of success and tribulations, but marking a general improvement. It’s not a fast and easy process.

 

Hip Replacement and Tango: 6 months

It’s been interesting the way the targets have sort of spread out and become less noticeable during this 6th month since the operation. The pace, whilst never ‘linear’, has become steadier with fewer clear cut markers or events.

However! The six month visit to the surgeon, Mr Phong Tran, was reassuring in that he is very pleased with both the placement of the new joint and the bone growth around it. I hadn’t been thinking about bone growth so it’s good to have had something happen without me consciously making it happen! I don’t need to see him again. I left with instructions/permission to do as I wish but not to fall over and break my hip.

Pilates continues to be excellent and I love it. Apart from obvious strengthening work there some very enjoyable balance work. I’ve had a couple of massages by the physio to loosen the hip area now that I have some muscles there to loosen. That was good.

My muscles continue to be sore and tight but are improving. Pool walking seems to work very well. This work will go on for about a year at which stage people tell me their bodies suddenly feel normal again. I still get tired but apparently that diminishes too.

Tango is going really well. I’m stronger than I was even when I started a few years ago. I seem to be taller. I can do a whole class now quite easily and have a few dances afterwards at the Practica. It’s terrific!

 

 

Return to Tango after Total Hip Replacement. Weeks 6-10

These last weeks have been all about my KNEE! This was not part of the plan.

During week 6, I developed a bit of pain below the knee on the same side as the hip replacement. Within a few days, it had become so intense that I could put no weight on it and was back on my crutches and scrabbling around for strong pain killers again.

Off to the doctor and off for an Xray and Ultrasound and back on the big pain killers. Results were that I had Bursitis of the Pes Anserine- a bursa just below the knee where 3 large muscles cross. Also some inflammation and degenerative tearing of the Medial Collateral Ligament and inflammation of the meniscus, which I used to know as the cartilage. Well, that explained the pain, at least.

Treatment: 5 day course of cortisone, Targin again and rest and physiotherapy. About a 6 week recovery period.

Apparently, this knee problem after hip surgery is not uncommon and  is related to tightness from the surgery, existing weakness and increasing activity.

What I’ve learnt is that, in this case, ‘rest’ meant sitting or lying with no activity beyond the absolutely essential. That actually made a big difference once I’d brought my version of ‘rest’ down to that.

The physiotherapy is based on releasing the tight muscles around my thigh and strengthening the almost non-existent muscle on the inside of my knee.

This has all been gradually working to relieve the pain but I find it hard to get the balance right between strengthening and straining the muscles. Also, once I started improving, I found it very easy to overdo any walking or exercise and end up sore rather than gratifyingly just tight from execising.

I’ve started going to a remedial masseur also because my body needs loosening up generally, compared to the focussed treatment of the physiotherapist. This has been very helpful in starting to balance up my back, hip and leg muscles from all the compensation during the hip pain before the replacement.

It’s been strange to remember that I had such a big hip operation so recently with this knee totally up-staging it. ‘What hip?’ I say. I’ve been sorry and frustrated not having been able to just move steadily along with specific hip physio and strengthening and get back to tango and normal walking and activities. However, it’ll sort itself out in time if I’m careful.

Meanwhile, I think I must be going for some sort of record for watching tango lessons from the side. There’ve been no more little walking forays on the floor, just watching. Frustrating but I’d rather be there watching than stay at home while Nick goes to classes. Plus, I’ve had the pleasure of watching him really improve over the last few months and am looking forward to being up and dancing with him again when I’m ready.

The watching has actually been very interesting. I’ve liked listening to the lesson, mentally doing it and just enjoying  and thinking about the many and varied responses of the people in the class. It’s given me time to appreciate even more the patience of the teachers. Best of all, watching and going to Sidewalk Tango through all this has helped keep me engaged and motivated to get back on the dance floor.

 

 

 

 

Return to Tango: Week 5 after Anterior Hip Replacement

The Sidewalk Tango class this week was on Open and Closed Embrace.. I would really have liked to do that class to help me refine what I know already. At least this week, I felt strong enough to stand in the lounge and do some of the steps which don’t involve twisting. 

I enjoyed the regular Wednesday night after-class Practica. My legs and feet felt quite strong and springy as they walked and I relished the changes of pace and direction that Nick led me into. I can now go into the cross and step out backwards and even follow the lead to step over my partner’s leg. This is very encouraging as it’s been a long time since I’ve been able to cross my right leg over towards the left side of my body. I even tried an ocho on my new right hip joint. I did take care to set myself up on my axis and engage every muscle I could think of before moving into the step. It worked and felt alright but at the same time, I was aware that it wouldn’t be a good idea to do many more of them. It was encouraging to be able to complete a whole Tanda.

Background.

Thigh muscles are still tight and complaining but less so.However, I can loosen them more quickly now with stretches.  My upper thigh is still a little bit swollen.

Exercises: I’m increasing the the intensity of these now. It’s odd, but  during the last few weeks most of my energy has been spent managing daily life and I didn’t seem to have the energy for doing a lot of exercises.  Now I have and it’s good to do them and start feeling specifically stronger. My poor old left leg needs as much attention as the right.

Backache: still there and I’m a bit sick of it. But it is ‘just’ muscular for which I am grateful.

Walking: much better around the block now. I can walk quite steadily and at a sensible speed but still find it hard to maintain the enrgy for sustained walking.

Pain relief: down to Targin10 twice a day for a week. Time to step down further.

Return to Tango: 3 weeks after hip replacement

Briefly, for my record as much as anything.

My mobility is much improved. I walk everywhere without crutches. Walking feels smooth and natural  for a few minutes. I find that my right leg (new hip) gets tired on a walk outside after about 5 minutes. Lots of muscles are returning to work. I can balance on that leg for about 10 seconds. 

Physiotherapist has confirmed that there are ‘no restrictions’ and that I can stretch, mobilize the joint gently and continue to work on strengthening. It feels so good to get down on the floor again and start stretching. It’s only in the last day or so that I have felt confident enough about getting up from the floor even if I’d been able to get down there. Now that the incision has closed, I’m allowed to start doing exercises in the pool. 

Pain relief is working. I had a go at dropping it a bit a week ago, but that was not a good idea! Will continue for 2 weeks and then have another go at dropping it.  My GP has been very helpful. The pain is back pain which I’m pretty confident will gradually diminish as I regain fitness and continue with back massage.

The tight swelling around the outer upper thigh is diminishing. I’m massaging and icing it.

Generally, I feel good. It’s been therapeutic to regain independence around the house- today I have returned the hired shower chair. I’m cooking, carrying around cups of coffee and so on. However, I get tired quite quickly and it’s good to go off and rest. I’m still loving sleeping!

Return to Tango: Sidewalk Tango Australia Day BBQ and Milonga.

Nick and I are on the dance floor at Sidewalk Tango. Around us, couples are waiting for the music. We move into the embrace and, on the beat, Nick takes a small step . I step back, feeling the weight on my new hip. It’s alright. I transfer to the other leg and we are dancing. It is very modest. I’m not to straighten my leg on the step back, nor step back very far because of the pressure it puts on my still healing incision. So I’m ‘creeping’ – Don’t look, Di! – but a creep is better than sitting on the side. The embrace feels comfortable and Nick leads me into a little fake. That’s a bit harder but I can do it safely. And so we progress! This is Tiny Steps Tango and I last about half a song. I’m so happy.

Back in December, when this Australia Day BBQ and Milonga was announced after class, yet another one I had watched, I did a quick sum. Thirteen days after my hip replacement. I should be able to get up the stairs and just be there.Yes. I’d aim to do that.

This afternoon, I got out of tracksuit pants and into tango clothes, left one crutch behind and we drove through the quiet, public holiday streets to Swan St , Richmond. The music spilled down the stairs and out of the windows of the Tiki Bar onto the empty footpath. Through the tall wooden doors were the stairs, quite a long straight flight but now, not as insurmountable as I thought they might have been. Up I went, one step at a time with Nick following in case I decided to plunge backwards

No such drama. There I was, up in the Tango world. Couples quietly danced, people chatted, the BBQ on the roof outside the high back windows sent down good smells and our tango friends were there. Food descended from the BBQ, more food appeared from the Tardis like kitchen and we ate and talked and caught up with Christmas and New Year stories. Nick had a few dances with people who could do more than tiny steps and he and I had another short dance.

It was a perfect occasion to emerge from two rather claustrophobic and self absorbed post operative weeks  I spent the entire afternoon with a huge grin on my face.

 

 

 

Return to Tango after a Total Hip Replacement. Day 10

Day 10. My walking has improved a lot, so much so, that I suggested to Nick that we try a few small tango walking steps.

We stood facing each other with my crutches parked against the kitchen bench. We opened our arms to take the embrace. It felt odd and uncomfortable. I think I must have been standing stiffly, Nick’s posture felt nervous and the whole thing was awkward. Nick took a tentative few tiny steps, I tried to follow but my right leg and hip had very little strength. Walking backwards felt unsafe and definitely unpleasurable.

OK. I wasn’t ready for that but decided to practise by myself. I could hold onto the kitchen bench and walk backwards at my own pace. That was better. I continued to walk to the music and when we tried again the next day the ‘experience’ did feel safer and marginally more fluent.

About the next day, about day 12 by now, the muscles in my feet sort of released so that I could walk heel ,sole and toe- not just plonking down a flat foot. That made a big difference to the smoothness of my walking and the practice to the music became very enjoyable. I could do this with just one crutch now.

Return to Tango After a Total Hip Replacement. Day 7.

IMG_20150122_142445 IMG_20150122_142524

My Right Total Hip Replacement-Anterior Muscle Sparing Approach operation was performed a week ago (I’ve only posted this now)

What a triumph of medical technology and surgical skill that has been. This is Mr Phong Tran’s demonstration ceramic and titanium hip joint – the stem and the socket. I like the grooves on the unpolished shaft (see the cutaway image) which encourage the new bone growth to attach to..

It’s a strange thought to think of that new inert shaft being inserted and cemented into my living femur. My femur is now truncated, neatly sawn off, and the slim, shiny titanium stem extends and holds the polished ceramic ball. I meant to ask if it really is pink. I try to imagine how my body’s muscles, blood vessels, tendons and  nerves, adjust to the different proportions, edges and angles.They must have to fold in and around the new structure. I’d like to see a real colour 3D image of that.

I can’t tell by feel. I don’t feel anything in my hip – it’s not numb- but there is no glute pain, no inner ache. Nothing. Is that what normal is like? I’ve forgotten. Of course, I don’t really know what I might be feeling in there because I’m on 12 hourly Targin tablets which I’m presuming are suppressing any pain. Do you have pain if you don’t feel it?

This new hip is working very well. The Anterior approach, a 10 cm incision on the thigh, starting from the crease between the body and the thigh, has eliminated most of the restrictons which follow Lateral or Posterior approaches. The only real restriction is to not lunge or step back too strongly with the new hip. This puts pressure on the incision and the weakened, settling muscles.

This move is actually alarmingly like the lady’s walking step backwards in tango. I’m going to have to be very careful with that for about 6 weeks.

In fact, my new hip is thinking Tango! Today I put some tango music on while I was doing my exercises. I was practising walking tall and evenly with my crutches and found myself walking in tango rhythm. What a happy unanticipated moment it was to feel the spontaneous movement after all the post-op careful, controlled  and on the edge of pain walking up.

Let’s see what happens next!

Right Anterior Hip Replacement, Day 14

It’s been fourteen days since my right anterior total hip replacement operation on Tuesday January 13th, 2015. The operation, performed by Mr Phong Tran, went well. Both hips are level, and here at home I can now walk around without crutches.

Now, the biggest improvement for me is that at night I am sleeping again. I had about nine months before the operation of tossing and turning and never being comfortable in bed. I would have to get up in the night and walk around, do my stretching exercises, refill the hot water bottle, have a cup of tea, anything to distract me from the nagging and niggling ache. I would lie on a tennis ball, judiciously placed under my hip’s right buttock to relieve the inner pain.

The four nights in hospital weren’t good even though I had a spacious private room. A hospital is often noisy at night, and in this orthopaedic ward where there is a constant need for ice to relieve sore joints, the corridors sometimes rang with the sound of ice crushing. I was always waiting  for the pain relief, sometimes up to three hours when the pain had reached the 8/10 mark. The hospital system understandably allows no flexibility in the prescribed timing or dosage of analgesic drugs. The 24 hour time lag in adjustments was difficult. However, the visiting peri-operative physician improved the pain relief regime each day  until it was nearly right by the time I got home.

I went straight home from the hospital, and as soon as I was at home I sat down and looked at what drugs I was able to take and adjusted the timing so that there were no distinct peaks and troughs in pain relief delivery. Being at home meant that I had discretion of up to two hours with the panadeine I took, and that made a big difference.

My first night at home was magnificent. I slept. I did have to get up with a rather restless bladder (I’m drinking a lot of water) but went to sleep again immediately. I’m surprised I’m not bothered by having to sleep on my back. I have now had seven nights of sleep and feel there is quite a bit of pleasant catching up to do.

The pain issue has been interesting and quite difficult for me to work out. During the operation, a tube was inserted  into the joint for 48 hours of constant delivery of local anaesthetic from a little pouch which lay next to my thigh. I felt no pain at all from the joint. But there was a lot of generalised pain around my back, abdomen and thigh muscles. I hadn’t expected this and it was quite difficult to manage. I’ve learned that the back pain is related to the rather vigorous manipulation during the operation in which the hip had to be dislocated, and also to imbalance from the preceding months of limping. My thigh muscles are sometimes excruciatingly painful – not surprising considering that , although they weren’t cut during the operation, they were pulled aside and held there while work on the bone and prosthesis took place. The poor things are still grumbling, as are the tendons, one of which had to be cut and repaired. They like ice packs. My back likes a hot water bottle.

It took a bit of time and a visit to my local GP who helped further with the pain relief management to sort out this rather confusing melange of sensations ranging from quite mild to wincingly strong. But knowing what is going on in my post-op body is good and all this will improve with exercise and physiotherapy,

One of the things I was hoping to be an outcome of the surgery was not having to take pills any more. Usually I take nothing, touch wood, and I was fed up with having to rely on pills and vigilant timing to be able to function at all. Strangely enough, now I am taking many more but I’m not bothered. I think it’s because I know that the prime cause of the pain has been removed and that the need for pills will diminish as I become stronger and my body heals. I’m a bit fuzzy in the head at times but don’t mind. I just have a rest and feel relieved that it’s all over.

I am astonished at how well I’m getting about. As I said, I can walk around home from about 12 days after the operation without crutches, if I’m not tired. It was bliss the morning after the operation when the physio helped me move my leg and lightly bend the right knee which with my leg had been safely immobilised overnight. The leg was really aching by that time. It hurt to move but the movement was better than the ache. I swung around to sit on the side of the bed and lowered it to the floor. It was painful but OK. Then he helped me up into a standing walking frame and there I was, standing on two legs 16 hours after the operation. I walked a bit around the room and from then on walked everywhere. That afternoon he brought my crutches and I walked out to the corridor to do my first set of standing exercises. I’d been doing the bed ones since regaining feeling in my legs and feet.

From then it became easier. Exercises 3 times a day, walks in the coirridor, learning how to go up and down steps. I concentrated on walking tall and as evenly as I could without limping or swaying from side to side. By now I was very appreciative of the pilates and physiotherapy I had been doing in preparation for the surgery.

I managed getting into and out of the car perfectly well, and it wasn’t much different from my efforts before the operation. Home was comfortable and manageable. I had hired a shower seat which feels safe and luxurious. I’m increasing my walks outside on the one crutch now and feel well on the way!

This afternoon I’m celebrating a recovery goal. Nick and I are going to Sidewalk Tango’s Australia Day barbecue and milonga. I will climb the concrete stairs to my tango world. I will see my tango friends again, hear the tango music, enjoy the familiar Tiki Bar, and I will definitely at least stand on the dance floor in the tango embrace of dear Nick who has been looking after me so well.