My hip and the NHS

A collection of climate stories mostly

Image courtesy of Chester Medical School

Almost complete joint space loss within the right hip joint, which also demonstrates joint/femoral head remodelling. Subchondral sclerosis and subchondral cyst formation noted.

I can’t remember when someone first commented on my limp. It used to happen after Sunday football, now, when I’m walking down the 17th fairway at Ealing, earlier if the course is hilly.

My reaction is the same. I wake-up, consciously focus on my walk, improve my posture by standing tall and try to take even steps. In other words, I stop walking like an old man who looks like he’d be more comfortable being pushed around in a wheelchair. It usually works, until the next time.

I must have had arthritis in my hip for years. Golf might have nudged it along, but now, sitting on the edge of my boot in the car park, my right leg is stiff and aches as I haul up my ankle to rest on my left knee, an engrained move with years of practice for shoe removal.

I’m not special. I expect half the car park feel exactly the same after 18-holes.

In my case, the GP referral led to the radiologist report. On the follow-up, my doctor said an appointment with orthopaedics would take a few weeks. That got complicated by Christmas and then the GP practice closed. You’ll find that story here.

The new surgery bandies the word triage around a lot and employs medics as well as doctors? I haven’t met anyone, but they gave me a phone number for orthopaedics at the local hospital. So far I’ve listened to a recorded message - expect a long wait. I hung up.

I’m not expecting to burden the NHS with my irregular hip joint any further. Prior to the x-ray, I’d been visiting a chiropractor to help with my movement and hopefully a more syrupy golf swing. He spotted the lack of rotation and prescribed some stretches which I half-heartedly followed like most old men, brought up on warm-ups being a quick jog. Warm-downs and stretch programmes didn’t exist.

When the pain increased, he recommended two orthopaedic surgeons and I decided to visit one whose web site I liked. He put himself in front of the camera to explain typical conditions and likely outcomes. He also offered an anterior hip replacement, which means no cut glute (bum) muscles, less pain and quicker recovery.

Cromwell Hospital sign on registration

To meet him I had to go to the Cromwell Hospital. First impressions were I’d entered an expensive hotel reception. The staff were attentive, it was only the occasional person in green fatigues, walking purposefully across the foyer, which gave the game away. It might be a hospital, but it didn’t smell like one and everyone was smiling.

Before seeing my 5 start rated consultant professor, I needed to register. The sign reaffirmed what I already suspected, but I was still shocked to read the words, sponsoring embassy.

This was a BUPA cash machine, performing routine treatments, by NHS trained doctors and nurses.

I looked them up. The Cromwell is a BUPA private hospital but is also an internationally recognised centre for complex liver and renal conditions. If you’re really ill, you might be seen here on the NHS.

My surgeon was bang on time. 20 minutes later and £300 lighter, I’d established that a new hip was no more than about 6 weeks away. The conundrum is replacements only last about 20 years. There’s a good chance, I hope, that I might still be around in my early eighties, which means another one.

I told him to be patient and that the earliest I’d be back was in a year or two.

He seemed to think that it might be a painful wait and prescribed me some OxyNorm. I’m yet to succumb, more because I’m scared stiff that I might develop a habit and the pain is still intermittent.

I like YouTube, it was how I found my current golf coach. It was also how I found a pair of US physios who have designed and sell a hip stretching and strengthening programme. I’m referring to all the muscles which are associated with a hip, there is no magic bone pill beyond Glucosamine and Chondroitin, which everyone of a certain age has probably heard of.

I now understand that one of the reasons why I have a problem is because of how my muscles function or more accurately malfunction. My glutes aren’t firing correctly, the quads lend a hand, which puts strain on the hip joint, and after years of abuse, it complains.

So why is the answer always hip replacement as thousands of people undertake every year?

At my gym the physiotherapy team questioned whether my hip replacement recovery wouldn’t be better served at their other facility where there are no steps to climb. The surgeon said recovery is a minimum of 3 months, but more likely 6 months, maybe longer.

The description of bone on bone sounds awful, with little to no cartilage left to prevent grating and grinding. Am I about to collapse on the floor because my hip has turned to dust? It crosses my mind, otherwise why are so many routine operations carried out?

One of the US videos encouraged me to rub my knuckles together, do it as hard as I could. How did it feel? I wasn’t in agony, in fact there’s no pain at all, just a bit of warm friction. They’re making a point.

Most of the pain around the hip joint is as likely to be coming from the muscles that support our hips and not any bone on bone crush.

No one has said there’s a quick fix for my hip either. The physios whose programme I now religiously follow and who have both suffered from hip issues took about two years to regain full mobility with no recurring pain.

The good news is everything I do now to increase flexibility and strength will aid recovery, if I do get a replacement.

A final thought.

I’d pay the junior doctors every penny of what they’ve lost in real terms since 2008. (I’d do the same for teachers and anyone else working in further education).

In return, I’d want any junior doctors who become consultants to spend more time working for the NHS during their careers.

My operation includes the surgeons fee of £3500, an anaesthetist, £1,000 and £11,360 for the hospital estimated stay of 3 nights.

I’m sure this deal is also offered to all of those embassy staff who are looking for world class treatment, while they’re working in London. I think it’s important that the NHS gets a bit more pie, given its commitment to provide healthcare for everyone based on their needs rather than their ability to pay. They deserve it don’t they?