Two stage surgery

So, here we are again, on the Eve of yet more surgery. I’ve been in the Nuffield Orthopaedic Centre, Oxford for four days now. It feels like a strange place because it’s an NHS (National Health Service) Hospital yet feels more like a private one in many ways. I have to question the common sense and attitude of a couple of people here but generally they are all very nice. Everyone introduces themselves when they meet/work with you for the first time, which is really nice but I have to confess with so many introductions, I have failed miserably at remembered most them.

Because I’m dirty (with infection) I have been placed in a side room as most of the bays are clean (without infection). Although I only see people periodically throughout the day I don’t mind, it’s peaceful and I have plenty of things I can do during the day to keep me occupied and distracted from thinking about the impending surgery.

The surgery has been decided, it’s a two stage procedure that I’m really not looking forward to. Stage one involves the Orthopaedic Team opening up the knee and removing the components of the half replacement already in there. They then do an aggressive washout, shape the bone as needed, place a cement spacer in (that has antibiotics in it) then close up the knee. At this stage I am left with no knee joint (although they are looking to put a slightly flexible spacer in) and only a slight bit of weight-bearing allowed. As you can imagine this throws up the odd problem for an above knee amputee. The Infection Team take over at this point.

Stage two of the procedure can only take place when the Infection Team, to the best of their knowledge, are happy the infection is clear. When they’re happy, which could be anywhere from 6-8 weeks, I’ll be back in theatre with the Orthopaedic Team. They will open the knee back up, remove the spacer and put in a total knee replacement. They think the infection will have eaten the cartilage, and maybe even some bone tissue, so they would not be able to repeat a half replacement. So, let’s go through the people involved in my care and what they have told me.

The Orthopaedic Team
They have only one chance at getting the best possible replacement for me. They’re using a flex spacer so there’s some small movement available to help the soft tissue. If they put in a rigid spacer the joint will become tight, which would make fitting the replacement much more difficult. There’s a chance they may not completely clear the infection in which case they would have to repeat stage one again. They came around this morning for me to sign my consent. He asked me if I was happy to proceeded, I told him that I didn’t really have a choice. He said that was true, because even if they sat me there all day pumping antibiotics into me it would never go away.

The Infection Team
So far they have, from the sample Aspirated from the knee on Friday, managed to grow bacteria. Me, being greedy, can’t just settle for one bug, oh no they have grown three so far. No surprise the E. Coli is still there along with some new relations. What the team are really after is some of the deep tissue removed in Theatre, this will provide the best samples to grow from. Obviously three bugs equals one major head ache for Infection Team. Depending on what they are, what families they belong to and what antibiotics work for the different bacteria, it may mean that we have to go back through stage one a second time.

Yes, they have introduced themselves already, like vultures round a new carcass to play with. I have an exercise to do already, which is to flex the foot as far back as possible to stop the ankle tightening. The only thing I like about the Physio’s is that no matter how bad it is, they will tell it like it is. They don’t try to make it fluffed up and frilly and then when realty hits it’s a total shock to the system. She has told me in no uncertain terms that this is major surgery and that it’s going to be painful. The section where I have the spacer in is going to be particularly unpleasant, I’d already come to that conclusion. Obviously being an amputee is going to cause me slightly more issues than most, but they will still be cracking the whip in any area they can.

Occupational Therapy
The guys in green. Probably the only part of the whole team that’s not going to inflict any pain on me. They have done the usual, asked about the house, adaptions, layout etc. etc. Although most of what can be done has been done, I’m more than happy for a fresh set of eyes over the situation. I have a form to fill in and need to get some measurements of the settee, toilet and bed. They will obviously review me at different stages and will be crucial in what happens to me in the interim 6-8 week period.

That middle part is what bothers me the most, because I won’t be able to bend my leg. I won’t be able to manage at home and it’s not fair to place that much care on my Mum and Dad. There have been a few options bantered about so far. Firstly I could stay here for the whole process. Secondly I could go to a halfway house nearer home or thirdly I go back Hinchingbrooke, great. To be honest anything that doesn’t involve me staying here involves Hinchingbrooke in some way. Apparently when Hinchingbrooke transferred me to Oxford they have to sign paperwork to say they will have me back. Because of budgets, cost and care, everything outside of Oxford has to go through my Doctor. Chances are I’d be transferred back to Hinchingbrooke, then they would find me that halfway house accommodation to be transferred to locally. To be honest I don’t really care what happens but for the sake of my parents visiting I would prefer it to be closer to home.

One of the Nurses came in last night and said that they thought I was the most undemanding patient ever. She said that I never ring the bell, when they come in and ask if I need or want anything I’m fine, she said they wished all patients were like me. I can understand now why the Nurses in Hinchingbrooke like me on the Ward so much. In fact when I’m in Hinchingbrooke and I press the bell it’s normally for someone else, like they can’t reach their button, pulling out a cannula, trying to get out of bed etc. etc. At least here in my own room I don’t have to worry about that, I’m sure I’ll be back in a bay sometime soon, then I’ll have to start using those eyes in the back of my head again.

I’m missing Cody (my Labrador) already, how am I going to manage for another couple of months? I have a couple of little videos of him on my phone I can watch to cheer myself up. So it’s the afternoon, how am I feeling? I can’t explain it that easily this time. I know the amputation was like no other surgery I’d had done and was life changing, but even that didn’t bother me as much as this does. The revision on my stump made me really anxious as it was the last thing that could be done for it, but again, that didn’t bother me as much as this does. I think there are a lot more elements and emotions involved this time and yes I’m scared. I think more importantly I’m just so pissed off with it all. I feel like I can’t take much more of this, the pain, Hospitals, more and more painful surgery, painful recovery, the emotional toll. I ask myself if I really want to go through all this but I have no choice. I still can’t believe I’m even in this position, will it ever stop?
Knee 07-10-13

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