London June-July 2016………not! The Season of ‘The Hip’

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Thursday 2 June was a lovely day, the first nice day for a couple of weeks. I was no longer working and had arranged with Stewart McLean to go for a ride with his Thursday group and the most convenient meeting place for me was Unitec at 9.30 at which point we would decide on the route.

I left home in reasonable time as I didn’t know how long it would take. I was slightly unnerved by weekday traffic but the trip was uneventful with my choosing to cross at the pedestrian crossing at a couple of places rather than going with the traffic. Arrived at 9.10 – note to self ‘don’t need to leave so early next time.’ Stewart, Andrew, John and Stewart’s brother Bruce arrived at 9.35 and we set off deciding to go west.

The Northwestern cycle way is much improved since I first started cycling – wider, underpasses, fewer treacherous places – just a narrow bit where two cyclists would be hard pressed to pass without one getting off.

Reached Henderson and the group decided to extend ride along a path through Central Park, Henderson which we had done ages ago on the tandem at the beginning of my cycling career – up and down twirly whirly path and at one stage I did get off and walk one short bit and Stewart warned me about some tricky parts to come. But going down a slight incline and round a gentle bend, was the offending bridge – slippery metal strips in between slippery wooden strips. Disaster. Bike disappeared from under me and I landed heavily on left hip. No grazes. No bruises. No blood but couldn’t weight bear on my left leg. It was about 10.30 am.

By that time the others had realised I had come off and because I couldn’t walk, carried me using a fireman’s lift from the bridge to a car park not far from the Henderson swimming pool and Pak’n Save. Some debate ensued as to what to do next but it was clear I would have to get X-rays, and an ambulance was summoned arriving about 15 minutes later and the others completed their ride and got themselves home. Stewart offered to go home, pick up his car and transport me, but the ambulance was able to carry me AND Red Rhinoceros.

In the car park while waiting for the ambulance, the boys observed that the wise thing would be to ride mountain bikes on this path during winter. Too late for me!

During the ambulance trip to ED at Auckland City Hospital – the pain on any movement was intense. My bike came in ambulance too (needed for my ride home!!!!) I was given entonox, morphine via IV inserted by student ambulance officer assisted by two others, and we chatted away all the way to ACH. Didn’t tell Greg yet as I felt there was still a chance that the injury was not serious and I would be able to ride home or at least be dropped off, and I didn’t want to worry him.

Arrived at ED – and texted to Juddy as it wasn’t looking good. To phone me when free. The ambulance officers and ED staff gave me funny looks when I said I would need the bike to ride home. X-rays# NOF. Bugger. Trip to UK, Slovenia, Croatia and Italy off. Greg came as soon as he could and his lovely colleagues covered his afternoon appointments. Had a nerve block of the femoral area – ED registrar being taught by experienced anaesthetist. Admitted by very young looking Ortho registrar and seen by orthopaedic consultant Hugh Blakely – I googled him to ensure he was competent enough to carry out MY THJR, the treatment of choice for someone of my advanced 64 11/12 years. Completed consent forms etc, including form for my bone to be returned to me. Surgery could possibly be done today as I was still NBM from 8 am. To be on crutches for 6 weeks and off the bike for 6 months. Double bugger! Texted the mouldy lot and everyone on my phone contact list and received many commiserating texts back. Consternation all round.
Transfer to ward 77 – couldn’t be done today so enjoyed the first food and fluid since 8 am.
Had severe pain on movement. Not surprising because of the displacement of the femoral head. Morphine X 2 during the night – oxymoron! Greg has a list of things to collect from home – I didn’t set out on my ride prepared for a hospital stay! He later wrote a poem on this state of affairs.

Plan B

So suddenly it gets you –
riding the undulations,
winding beside a bushy creek,
grinning at the calm blue sky
on a morning after rain,
better than being at work
you say, this is the life;
thin tyres, wet footbridge,
thud and you’re down, bike and hip.

Things to please bring to the ward –
knickers, ipad and charger,
lip balm, hairbrush and mirror,
Earl Grey tea bags, Listeners,
radio with ear pieces,
toothbrush, toothpaste, deodorant,
dressing gown, headscarf, teeshirt;
and while you’re at it you can
cancel our trip to Europe.

Don’t mothers warn their kids to always have clean underpants on in case of an accident, but cyclists go ‘commando’ with no knickers under their padded shorts and I was no exception as was noted when they took them off intact in ED.

Friday 3 June operation day. First on list. Bedpan for number two the height of embarrassment. Last of own clothes taken off, interview with anaesthetist and then oblivion due to a spinal and a light general ………….until a few hours later when it was all over when I came to in recovery. Operated on by the Orthpaedic Fellow – Daniel Dowen, a member of Hugh Blakely’s team as I found out later when I obtained the operation note. Hugh is a specialist in joint replacement and Daniel, the ‘fellow’ had come from the UK to learn some new techniques.

Moved from Ward 77 to 62 so that the elective surgery ward could look full!

Saturday 4 June first time out of bed day – instructions not to cross legs, not to bend / sit so that the hip angle is less than 90 degrees, not to twist at the hip. Walked with a frame. Shower. Managing hospital/hat hair with trusty bike bandana. Greg had a 1976 40 year reunion at Med School this weekend so he attended several sessions which as it happens has been quite convenient for visiting. It was Queen’s Birthday weekend and we were not up at Sandspit as planned.

Over my stay in hospital I was visited by Mike and Helen Wing (Helen has had two elective hip replacements so knows the ropes), Jan and Stewart McLean with marshmallows and chocolate, Kate Milligan, Kathryn, Simon and his girls, and of course Juddy who was very attentive.

Sunday 5 June first day on crutches and practice on steps, applying GAS and SAG method, a mantra I was to repeat over the next few weeks as I mastered the stairs at home and the Jac House – good affected stick or stick affected good! Shower.

Monday 6 June Queen’s Birthday holiday going home day with assorted ‘rest home’ equipment’ – upright chair, toilet chair, shower chair. Just fitted in to JUDDY’S.

Things used in hospital with no sophistication and state of the art equipment spared:

Pain pump + call bell
Electric leg squeezer to prevent DVT’s
Wound drain with sucky device
Iv antibiotics + 2 other ivs including arterial line
Catheter
TED stockings
Call bell
Electric bed raiser
Machine which takes BP and logs oxygen sats and pulse
Flash non slip red and white sox
Shower chair for use at home
Toilet stool
Armchair for lounge

Tuesday 7 – 9 June mobilising, sleeping, shower sitting on loaned stool. Read account of Teina Pora’s two convictions for rape and murder which he did not commit and the Privy Council’s quashing of these. An astounding account of police incompetence, fraudulent affidavits, police desperation to arrest somebody. Much discussion about the initial pathetic government offer of 2.5 million not inflation adjusted, for his 21 years of imprisonment. Comparison with Arthur Allan Thomas and David Dougherty’s payouts shows this offer is insulting.

Friday 10 June first expedition out day. JUDDY’S is good because of the high seats and Greg created a cushion which helped my getting into the car, bottom first and gingerly leaning back and lifting both legs in together. WINZ interview for National Super and did a recce of Frolic where I expect to be a frequent customer in the next few weeks as part of my ‘rehabilitation’. Attended a Hausmusiknz concert at Rannoch Sir James Wallace’s art gallery / mansion, high chair and all. A miserable night.Lovely.

Weekend Saturday 11 – 12 June new trees planted on the top of One Tree Hill at a dawn ceremony with a substantial crowd. All Blacks beat the Welsh and I watched it sitting on an improvised high sofa – not the most comfortable. Roger and Margie and a bunch of tulips visited.

Monday 13 June Lunch with Helen McKessar at Frolic sitting on their ‘bar stools’. Have to allow more than an hour to have shower, and get dressed. Good to get out and about. Discussed the virtues of not working in a ‘job’. Helen has a couple of adult education jobs, but no longer works in an organisation with its inherent dysfunction, politics, power struggles etc, things people like us have worked in for years. I find I get quite tired after expeditions, hip starts to ache and I am happy to get back to my bed. Commiserating phone call from Tim Akroyd after he received my hospital discharge summary.

Tuesday 14th Appointment at Greenlane Clinical Centre. Because Greg was now back at work I arranged through my ACC case manager Charlotte to be picked up and dropped off by a mobility van as I was still not allowed to sit on a normal seat. The orthopaedic clinic was a wonderful sight to behold – a people watcher’s dream – people arriving on stretchers, on crutches, walkers, with moon boots, soft collars, wheelchairs and being called and disappearing for their orthopaedic reviews. Could have been a religious healing meeting! When it was my turn, the nurse took my dressing off, removed the steristrips and I waited for Hugh Blakely. He emphasised the ‘hip precautions’ and suggested that I wouldn’t have to wait for the expected 6 months before getting back on the bike – after 6 weeks maybe a stationary bike and then on the back of the tandem providing I trust the person on the front (!!!!!) and don’t behave recklessly….and of course not fall off! I planned to make a physio appointment after 6 weeks to advise on a ‘return to cycling’ programme.

Leonie and Robyn and lovely white bunch of flowers visited on their way to the Auckland PHO mid year function. Some PHO gossip!

Wednesday 15 June Coffee at Frolic with Jane Williams who has resigned from her Child Health position at Waitemata PHO and settling in Taupo. Caught up with immunisation gossip – rates have dropped to less than than 94% since I left. Not necessarily cause and effect but one does wonder!!!!!!

Over the rest of the week I had been able to set up Greg’s laptop to watch Happy Valley via TVNZ On Demand ‘and also the latest Fatso offering – The Night Manager. Also enjoyed 4 pictures 1 word and online Scrabble not to mention Listener reading and radio listening. Still quite tired and slept a lot.

Saturday Greg went for a long hilly ride with the boys. Simon and his girls came for dinner and the girls stayed the night while they used our tickets to Indian Ink’s Elephant Thief.

Sunday Greg took the girls on a three hour expedition around Cornwall Park and they were picked up late morning.

Monday Greg worked today as he had been unable to get a locum to cover, so it worked out well although it was a long late lasagne dinner night which I managed to cook, hobbling around the kitchen clutching the bench.

Tuesday After a sleep in, drove to the Jac House. PSYCHL had had a flat battery and it was hoped that the journey would charge it but as we turned into the drive, the car stalled and would not start. Diagnosis the battery was dead, as confirmed by the Warkworth AA man. New battery in situ Greg was now able to unload the car all by himself as I was in his words ‘pretty useless’. Hadn’t been here for 3 1/2 weeks and we were very happy to be here although I was not be able to indulge in my Lego ‘folly’.

We stayed at the Jac House for 2 very quiet weeks of awful weather with wall to wall rain and heavy showers almost every day. Some spectacular days as our time here was coming to an end! Spent the time reading Listeners and books, doing crosswords catching up on DVDs (we really enjoyed the whole series of Michael Palin’s ‘Himalaya’ which Rachel gave us as a birthday present a few years ago but which we had not finished watching) and I was still quite tired from the surgery so slept more than usual. I felt bad for Juddy who has locum cover for 2 1/2 weeks but we did not get to do anything more interesting. He has looked after me superbly and ensures I carry out some chores ‘for my rehabilitation’! We could have done worse than spending time at our favourite Jac House. He was happy to go on lengthy bike rides and runs and rode with the Warkworth Riders. Visited the Parsley Pot with the expected comment about not recognising us out of cycling gear and my injury. When weather allowed I went for hobbles with crutches further each day towards the wharf. I aimed to ‘walk’ as far as the cafe on the wharf before we went home. Had lunch at Morris and James pottery works – the child sized fish and chips was perfect. Bought lovely pot for the Jac House front porch, with birthday money from Wiki. Some Wimbledon on TVNZ Duke channel available on Freeview. Fatso provided some DVDs and have watched some Prime Suspect dated 1991 – good drama but the boofy hair and shoulder pads showed its age and Helen Mirren looked so young.

My mobility improved day by day, managing with no crutches for short distances, one crutch or both, limited only by aching if I did too much. I thought that I am (more) pigeon toed in my left leg! I tried playing with my trains but it was a challenge to get down to floor level while maintaining the 90 degree angle of my left hip, and then getting up again! Could shower perfectly well without my cripple’s stool, but still needed the toilet seat and upright chair provided by the hospital. I was also happy with my long handled pincer device although putting on sox and tights remained a challenge. Took me 20 minutes on one occasion! Baked gingerbread and lemon cake but needed to sit down after a while. No pain as such, just some altered sensation at the wound which has healed beautifully and the occasional jarring type stab in the groin. Still cannot believe what has happened. Met Sandie and Bruce at Matakana as they drove to their Omaha Bach. Bruce was one of the blokes who carried me to where the ambulance picked me up. I did walk to the Wharf cafe, but guess what – it was closed so I hobbled back home having done a bit too much probably. Went out in the car most days to do messages, for a change of scenery. Tried not to muse ” if I hadn’t broken my hip and had to cancel our trip, we would be ……(in London, cycling in Slovenia in 28 degree heat) ” substituting what we would be doing each day….

Ross and Jenny Segedin came for afternoon tea and 3 hours of catching up on the 39 years since our momentous year here – 1977.

While we were here, Britain voted to ‘Brexit’ with potential repercussion being discussed endlessly via all media.

The next hip related activity was expected to be attending my 6 week follow up appointment at Greenlane Clinical Centre.

Spoke to Sandy Alexander at Laura Fergusson with whom I intended to make an appointment after my 6 week check. She advised me to continue the ‘hip precautions’, increase my walking, not to be too quick to leap on the fixed bike and she would provide me with a suitable programme. She has had two hip replacements so she was a good person to advise me.

I received a letter from Frances at LabPlus about my request for my bone(s) to be retained and returned to me suggesting I make an appointment with her to pick it up and so we did on 6 July, parking in a disabled spot outside as I have now received my disability pass for the car valid until September. We returned the equipment borrowed from the hospital as ACC have now provided with the toilet seat and armchair as I have dispensed with the shower chair being quite stable on my pins. Also picked up my AT Gold Hop card, and I’m not even 65 yet.

Looked at a total hip replacement video on YouTube. Gross and hard to reconcile my neat scar with what happened to me while under general anaesthetic – smoke from cauterising blood vessels, digging into the joint, electric carpentry tools, blood, muscles being separated as well as my hip being rotated to assist with implanting the correct size prosthesis – there had been a few ‘diagrams’ on my limb which no doubt helped with the sizing and placing process although I thought I was slightly more pigeon toed than I was before!

At the 6 week mark I had not received an appointment from the hospital so I phoned and they informed me the appointment was scheduled for 9 August which is a bit of a bummer as I had set some store on getting some advice about further rehab. So I extended my activities as the discomfort in my hip allows. This included walking up stairs the proper way and not one step at a time. The left leg was quite weak so strengthening that would be a work in progress for some time I think. Leg lifts from the bed helped. Couldn’t walk or hobble fast enough to get puffed, so there will be plenty of work to do when I can walk decent distances at a decent speed. Was still using crutches for longer walks but trying to use them only as necessary and not for every step. Took the plunge and drove JUDDY’S for the first time to a farewell afternoon tea at Tamaki Campus – no real problem so that was a significant milestone. Had an appointment with Sandy at Laura Ferguson the following week. Greg set up the wind trainer in the lounge but getting on and off was a bit tricky – needed to place a stool from which to launch myself on to the bike and needed to practise this to be safe.

While walking as far as Greenwoods Corner one morning I met Robert practice manager at Hillside Medical Centre who had asked me to do a locum for them when we came back from our trip to England, which I had declined because I don’t know ‘My Practice’ PMS, but I told him the sad story of my hip and said that if they were desperate I would be free to do some locum days for them as “I would probably be better than nobody.” A phone call request to do next Friday was accepted, following later in the day a request to do Tuesday and then Wednesday next week. So I am no longer idle and I will see if this something I would like to do regularly. Did a My Practice tutorial in preparation.

16 July is the day I couldn’t put off any longer to take a more thorough look at my bone. In double plastic bags was an assortment of gross looking stuff – not exactly sure what we were looking at – slivers of bone which looked like little worms from the drilling and amongst other unidentifiable material 2 large pieces of bone, one the ball with the jagged edge of the fracture and part of the other part of the femur also showing the break point and where the socket was sawn off to allow the insertion of the prosthesis. The ball was essentially white and smooth on one side but the broken side looked and felt gross – softish red porous matter probably bone marrow and blood vessels and jagged bone cortex. The material in the rest of the piece of femur above where the surgeon sawed it off was similar and Greg examined it stating he had not done anything like this since medical school on a cadaver!!!! There was no smell and we used gloves as the material had been preserved in formalin. We decided that keeping any of it for show and tell would be gross, so we ceremoniously buried it in the Jac House garden under the lemon tree, still in its double plastic bags in case I change my mind and want to exhume it! Held a little ceremony – “It will not grow old like the other one grows old. Age will not weary it nor the years condemn. At going to bed tonight and having breakfast in bed in the morning, we will remember my ball”

Walked to Greenwoods Corner and around the block via Royal Oak Turama and back home without crutches and back at work doing two days’ locum at Hillside Medical Centre chez Helen Jenkins and Yeen Chan.

Happy Birthday to us! Saw Sandy at Laura Ferguson – I forgot my 1 o’clock appointment and grovelled so she saw me a bit after 3. Went over my permitted activities and she gave me some exercises. She is not happy for me to go on the stationary bike but I suggested that the surgeon had said it was ok after 6 weeks. So am now doing half an hour a day while watching Le Tour de France. She suggested my pigeon toed gait may be due to muscle inactivity and advised me to concentrate on the angle of my foot when walking. Was still using but probably not really needing toilet seat and high chair although they are comfortable.

In the meantime I was extending my walks trying to walk every day weather permitting and now not using crutches. An exception was attending the Travel Conference and needing to walk some distance from the bus stop to the Heritage Hotel conference venue I used a crutch in case my leg gave out and also to protect me from the hoards who according to Sandy, take no notice of people on crutches and knock them over. The RNZCGP conference was on this weekend as well as an ATC play.

At 9 weeks because it seemed that riding a bike is now possible cf the stationary bike, we decided this weekend when we were at Sandspit to try out the tandem again. Initially I was terrified about letting Greg manage all the bike variables but particularly the angle the bike appeared to be as we set off. After a few starts and stops, I finally felt able to relinquish control of the bike to the captain and we pedalled without further hiccups to Kaipara Flats and back to the car – 20 km.

9 August walked and bussed to my appointment at Greenlane Clinical Centre including X-rays and saw Andre Keenan the new orthopaedic fellow from the UK. My surgeon Daniel Dowen has gone back to the Uk. My three questions were answered:
What am I not allowed to do? Do I need a Bone Density scan? How long will the hip prosthesis last? Answers respectively – no simultaneous bending and twisting, no I don’t really need a bone scan, 15-20 years, no limitation about what I do re walking, but need to lie the bike down a little when getting on. Seeing the postoperative X-ray was exciting – the prosthesis with the odd screw there in all its glory and bits of my own hip missing! Requested the before and after pictures which duly arrived on a CD.

The Olympic Games had just begun and I watched them on Sky sitting on my special chair, for hours were to occupy me successfully as I get fitter and stronger. We won 18 medals – including 4 golds – best NZ effort ever!

Saw Tim Akroyd who made a referral for a bone density scan and burned off several of my moles/warts.

Having been encouraged by surviving the first foray on the back of the tandem, I rode Black Sambo around my 21km circuit…..slowly and somewhat gingerly, but managed that too without any adverse effects….so I felt now I have embraced the tiger I really now only needed to get fitter and stronger and while trying to continue my 2 day a week fasting regime, and weather permitting am doing the 20 km circuit around the park. In between rides, am doing some walking and half an hour on the stationary bike. Black Sambo is good because it has the straight handlebars, the non clip in pedals and thicker tyres which make me feel more safe.

After Greg and I did the usual Saturday ride on the tandem at 10 weeks post op I managed to ride 100 km over the week and at week 11 did the Saturday ride on my hybrid bike. OK on the flat but was seriously left behind on the hills but Stewart and Robyn were very patient.  And coffee at Teed St – a situation I never imagined would happen again….at least not so soon. While I’m jobless having finished my locum at HMC fasting permitting I am trying to do a walk or ride each day.

Once my locum at Hillside Medical Centre and I didn’t get a two day a week job with Kai Andreas, it became clear to me that my getting a job and then having to negotiate time off when Greg managed to get a locum was not really going to be possible, I decided that instead I would ‘retire’ from nursing and pursue other options to meaningfully fill in my time considering study to be an editor and proofreader or Travel Medicine. The ED registrar had put on my ACC form under occupation ‘Retired Nurse’ which was  as it turned out remarkably  prescient.

Decided at 12 weeks that it was time to dispense with the baubles of decrepitude and to get the chair and the toilet stool taken away…another milestone. Also that it was time to get back into BUZZIB and let Greg have JUDDY’S back.

Saturday 27th saw me again back with the usual group for the close to 50 km city circuit.  I felt I was getting perceptibly fitter but drafting behind the others on the waterfront helped somewhat and I can almost keep up on the flat. I had a fright at the Mt Eden Road, Balmoral Road intersection where I was cruising ahead of the others down through the lights on a green and a speeding ambulance lights flashing came screaming up to the intersection. I didn’t hear it and when I saw it I jammed on my very effective disc brakes on and skidded. Felt tearful and shaky and realised  I am still a little apprehensive and sensitised to skids!

Stewart has been very solicitous all the way along –  keeping me in the loop about where the group was stopping for coffee and checking out with me that these last two rides have been OK for me, checking on my state of well being on the rides and being encouraging, all of which have been much appreciated.  I did meet the others for coffee a couple of Saturdays  before I got back on he bike and it was good to keep in touch and to inspire me to get back to normal. Greg did the TEAR fund Cycle for Life out Clevedon way today.  I have done it the last two years – it includes 2 rides up the notorious Twilight Road – but conditions weren’t that good this year with horrible winds so I probably didn’t miss much.

This really brings to an end my account of ‘The Hip’ as all I have to do now is to get fitter and stronger. There may be an epilogue to confirm that I was able to achieve my threegoals: To ride with the Sunday boys on the back of the tandem when they get back from France, to get back on Red Rhinoceros with clip in pedals on a Saturday ride and to be as fit as I was before the hip by the beginning of December = 6 months.