THR copsham's recovery thread
- Thread starter copsham
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copsham
post-grad
@Legin my thoughts were they are not covering themselves in the event of an enquiry let alone my interest! In both health and social care recording is now seen as important as the direct care. In fact the ward sister was clear to me about her expectations oh well lots to get on with thanks as always for your support x
Legin
big-cheese
Being as I am I see good acurate recording merely reflects the good practice being given to who ever you are working with. I attended a 2 day workshop which looked at cases like baby P. We did an ficticious exercise where different groups became one of the different agencies involved ie school, housing gp hospital police etc. First stage we were given limited info due to poor recording etc it was agreed no worries as per safety. Gradually each agency released more info till in the end full data it was amazing to see the levels of concern rise gradually. Ok will be quiet on topic sorry for going on
Legin THR Sep 14
Legin THR Sep 14
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OP
copsham
post-grad
Don't apologise @Legin another example is that pre hip oP I told a nurse that once every 3-5 years I have weird type of migraine a visual migraine that paralyses my face and effects my speech and my eyesight . This was recorded as "every five years has a migraine!" This did not reflect the information shared and why the exclamation mark? Another example was OS saying he had not taken a Swob when he definatly had and then referring to the notes to prove that he hadn't! Oh well enough of that!
Nana moon 27
alpha
OP
OP
copsham
post-grad
Thank you for asking @Nana moon 27 . Have spent the day with a young friend and her 4 month old baby. This was lovely but exhausting after a sleepless night. Hip seems fine. no more stitches have worked themselves out today but can see one under the skin. Hopefully a better night tonight. Be in touch x
Josephine
NURSE DIRECTOR EMERITA
@Legin I didn't mean this was a case of excessive and egregious malpractice, just that once in a while, in the rush of a clinic, looking at a stitch abscess, which is generally a pretty minor thing, if he took a swab of material he would likely have left it for the nurse to send off. That's what usually happens. And I am in no doubt that that's what the attending nurse would have done. But he himself may have neglected to make a note of it in the notes and he may well have forgotten about it. However, he will be reminded when the lab report comes back! What you have to remember is that these chaps are human and cannot remember absolutely everything they do in the course of a day. Do you remember everything single thing you did a week last Friday?
But I can tell you it was either Vicryl, Dexon, Polysorb or Surgicryl - all of which are made from polyglycolic acid just by different companies. Polyglycolic acid is actually derived from fruit sugars and reckoned to be very compatible with human tissue (and in veterinary surgery for that matter!).
Sutures are graded on a strange system:
2 For repair of tendons or other high tension structures in large orthopedic
1 hip surgery or deep layers in back surgery.
0 For closing of the fascia layer in abdominal surgery, the joint capsule in knee
2/0 repair of bowel in general surgery or general skin closure
4/0, 3-0 skin closure in fine skin and infants
5/0 Used for larger vessel repair such as an Abdominal Aortic Aneurysm
9/0, 8/0, 7/0, 6/0 surgery and for repairing small damaged nerves often due to lacerations in the hand. also used for repairing small vessels and arteries or for delicate facial plastic surgery.
10/0 Typically used in the most delicate surgeries. Common in both Ophthalmic (eye)
Therefore, having seen your photos, I would venture to suggest that the superficial layer beneath the skin, which should have been closed with something like a 3/0 suture, was most likely closed with a much thicker material, say size 0 or 1. Thus resulting in a situation where, being unable to fully digest a foreign body (the suture and most particularly the knot), your body does what it usually does under these circumstances which is to eject it by creating a simple abscess.
Hope this explanation helps.
Well of course it should have been recorded!
But I can tell you it was either Vicryl, Dexon, Polysorb or Surgicryl - all of which are made from polyglycolic acid just by different companies. Polyglycolic acid is actually derived from fruit sugars and reckoned to be very compatible with human tissue (and in veterinary surgery for that matter!).
Sutures are graded on a strange system:
2 For repair of tendons or other high tension structures in large orthopedic
1 hip surgery or deep layers in back surgery.
0 For closing of the fascia layer in abdominal surgery, the joint capsule in knee
2/0 repair of bowel in general surgery or general skin closure
4/0, 3-0 skin closure in fine skin and infants
5/0 Used for larger vessel repair such as an Abdominal Aortic Aneurysm
9/0, 8/0, 7/0, 6/0 surgery and for repairing small damaged nerves often due to lacerations in the hand. also used for repairing small vessels and arteries or for delicate facial plastic surgery.
10/0 Typically used in the most delicate surgeries. Common in both Ophthalmic (eye)
Therefore, having seen your photos, I would venture to suggest that the superficial layer beneath the skin, which should have been closed with something like a 3/0 suture, was most likely closed with a much thicker material, say size 0 or 1. Thus resulting in a situation where, being unable to fully digest a foreign body (the suture and most particularly the knot), your body does what it usually does under these circumstances which is to eject it by creating a simple abscess.
Hope this explanation helps.
Legin
big-cheese
Josephine i think you missed a very important point no I would have difficulty remembering a week ago hence all recording is completed by end of shift. Also recording retrospectively is not chronological recording as there should be. I merely pointed out that if this had happened in any care setting the care comision would land heavily as I know they have done in past.
Legin THR Sep 14
Legin THR Sep 14
OP
OP
copsham
post-grad
Hi Josephine
The situation was that there was no nurse in attendance. The consultant took swobs from 3 areas of the wound and put them in little tubes. When I asked for the results two weeks later he told me he had not taken swobs. I was not asking if he remembered or if he had recorded it. He volunteered that he could not have done swobs as there was no note to that effect and no note from the lab. The swobs were definitely taken and did not come back from the labs so the conclusion I make is that they were not sent off. This has got to be poor practice.
Thank you Josephine for the information about stitches. My wound came up later with like a nettle rash as well as the inflammation, as well as the infection and small holes (cannot remember the official word) hence I was told it was a hypersensitivity reaction. I think it is poor practice to have no record of what was used or my reaction so that I/they can be clear about alternatives in the future if needed.
Advice that I have gleaned:
"Some people ARE intolerant to synthetic absorbable sutures ..... If you have that reaction you should make sure everyone knows about it should you ever have more surgery"
"Braided sutures like Vicryl have that problem sometimes. The monofilaments like Monocryl almost never do"
This is all like a nightmare to me. I keep thinking the wound is nearly better and then within a very short while I am back to stitches coming out. Oh well could be worse.
The situation was that there was no nurse in attendance. The consultant took swobs from 3 areas of the wound and put them in little tubes. When I asked for the results two weeks later he told me he had not taken swobs. I was not asking if he remembered or if he had recorded it. He volunteered that he could not have done swobs as there was no note to that effect and no note from the lab. The swobs were definitely taken and did not come back from the labs so the conclusion I make is that they were not sent off. This has got to be poor practice.
Thank you Josephine for the information about stitches. My wound came up later with like a nettle rash as well as the inflammation, as well as the infection and small holes (cannot remember the official word) hence I was told it was a hypersensitivity reaction. I think it is poor practice to have no record of what was used or my reaction so that I/they can be clear about alternatives in the future if needed.
Advice that I have gleaned:
"Some people ARE intolerant to synthetic absorbable sutures ..... If you have that reaction you should make sure everyone knows about it should you ever have more surgery"
"Braided sutures like Vicryl have that problem sometimes. The monofilaments like Monocryl almost never do"
This is all like a nightmare to me. I keep thinking the wound is nearly better and then within a very short while I am back to stitches coming out. Oh well could be worse.
OP
OP
copsham
post-grad
Hello All,
I am tired of this "hip replacement stuff". I really am going forward and much luckier than some BUT I go 2 steps forward and one step back. I am 10 weeks post op and have diligently followed advice, sought my own, used alternatives, used Bonesmart and I can honestly say I am tired of hips. The trouble is that I can forget my hip for a while and then I am forcefully reminded of it.
At the weekend I went for a country walk in the rain. It felt so special. Spring flowers coming out, smell of the old leaves etc. Following this I did not go into the house but did a couple of hours of gentle gardening. I was happy. I had no reactions the following days. THEN yesterday I cut my toenails just quickly (!) and today I can hardly move.
Back on the roundabout of icing and elevation. i know i am asking too much but sometimes I just want to be normal. I know its only 10 weeks and I need patience ........ Oh well I will get back my equiplibrium soon!!
I am tired of this "hip replacement stuff". I really am going forward and much luckier than some BUT I go 2 steps forward and one step back. I am 10 weeks post op and have diligently followed advice, sought my own, used alternatives, used Bonesmart and I can honestly say I am tired of hips. The trouble is that I can forget my hip for a while and then I am forcefully reminded of it.
At the weekend I went for a country walk in the rain. It felt so special. Spring flowers coming out, smell of the old leaves etc. Following this I did not go into the house but did a couple of hours of gentle gardening. I was happy. I had no reactions the following days. THEN yesterday I cut my toenails just quickly (!) and today I can hardly move.
Back on the roundabout of icing and elevation. i know i am asking too much but sometimes I just want to be normal. I know its only 10 weeks and I need patience ........ Oh well I will get back my equiplibrium soon!!
Nana moon 27
alpha
Hi @copsham
I wonder if it was the angle of your hip to knee when you leant forward to cut them. Whereas when you're standing in the garden your angles would be different. I may be wrong. Unless the toenail cutting was the final straw for your hip.
As regards the one step forward, two back that happens so much in recoveries, whether it is hips or knees. It is frustrating, annoying but honestly a bit of rest and the old Mantra, you will be back to feeling better in a short time.
Hope all improves soon
Love Nana moon 27 x
I wonder if it was the angle of your hip to knee when you leant forward to cut them. Whereas when you're standing in the garden your angles would be different. I may be wrong. Unless the toenail cutting was the final straw for your hip.
As regards the one step forward, two back that happens so much in recoveries, whether it is hips or knees. It is frustrating, annoying but honestly a bit of rest and the old Mantra, you will be back to feeling better in a short time.
Hope all improves soon
Love Nana moon 27 x
Constanze
graduate
Hi @copsham, I agree with you, and feel the same. Even though you may think: Now she's a fine one to speak, she hasn't even had the operation", and if you do - you're right
. I haven't even had an operation, and in spite of it, it's been the main subject discussed between me and my husband and daughters for months and my husband, too, would like to talk about something different by now. Luckily in less than one month (the 20th), the waiting will be over. I'm also tired of "justifying" my limp and am becoming self-conscious about it at work. The delay in surgery, well that was partly my fault, but partly not. How it happened is explained in my first pre-op thread.Anyway, you're right when you think there is more to life than hips. I like gardening, too. Actually dug up two tree-stumps and planted a new laburnum in my garden despite my aching leg, and I felt no pain afterwards. The landscape must be beautiful in England now with the daffodils blossoming. My husband has a sister in London, one brother in Welwyn Garden City, Hertfordshire and one brother in the Shetlands.
I hope your self-dissolving stitches will stop being a problem for you, soon. Hugs - Constanze
So sorry you are hurting after the toenail cutting. NanaMoon and Legin are right, though. That movement no doubt caused you to use muscles in a way that you have not for some time and that will make them angry for a few days. I'm assuming you didn't have pain as you were cutting your nails, right? Just afterwards. That would be normal. It's just going to take some time to be able to do all these normal things again. Soft tissues must be stretched and strengthened over time.
At 10 weeks, you're at a time when most people just want to get on with it. It will come. In a few more months you will see genuine progress.
At 10 weeks, you're at a time when most people just want to get on with it. It will come. In a few more months you will see genuine progress.
southernlass
junior member
@copsham, thanks for sharing your frustration and pain. I am 2 and a half weeks Post-Op and am already feeling much the same way as you do. Your post is a good reminder that recovery is a marathon, not a sprint! Regarding the toe nail cutting... How about having a pedicure? Even a lot of men in the U.S. are doing it and those who don't, don't know what they're missing! I started a Mani-pedi monthly routine about a year ago because of Pre-op pain and would seriously consider cutting the grocery budget if I had to in order to keep doing it forever. And, you currently have the perfect excuse for a little pampering. Both my husband and son-in-law have had Pedicures and an older male coworker now gets them once/month as a regular routine after his wife convinced him to do it the first time. I consider it necessary stress therapy. Sending you positive thoughts. Hang in there!
LTHR 3/16/2015
LTHR 3/16/2015
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OP
OP
copsham
post-grad
Thank you all,
I appreciate your support!
@Nana moon 27 you are probably right - after the gardening perhaps the straw that broke the camels back so to speak.
@Legin I finally learnt some physiology. I have been reading posts about glutes for weeks and finally looked it up. What you say is logical (even though you will not believe it) and most likely correct!
@Constanze - its terrible - for weeks before the op I talked about hips, hips and more hips. Then the 7 days before I clammed up taking an "I'm fine" approach. Since January op have been full on talking about it .. poor hubby. You mentioned your limp at work. I found the most amazing thing was to be walking straight again, felt as if I had grown 6 inches! You mentioned Shetlands - my favourite place to holiday! I had to have my hip done so that I could get back to the cliffs to see hundreds of puffins nesting - a highlight to me.
Today my hip has improved just hobbling for a few steps when I get up from sitting.
X
I appreciate your support!
@Nana moon 27 you are probably right - after the gardening perhaps the straw that broke the camels back so to speak.
@Legin I finally learnt some physiology. I have been reading posts about glutes for weeks and finally looked it up. What you say is logical (even though you will not believe it) and most likely correct!
@Constanze - its terrible - for weeks before the op I talked about hips, hips and more hips. Then the 7 days before I clammed up taking an "I'm fine" approach. Since January op have been full on talking about it .. poor hubby. You mentioned your limp at work. I found the most amazing thing was to be walking straight again, felt as if I had grown 6 inches! You mentioned Shetlands - my favourite place to holiday! I had to have my hip done so that I could get back to the cliffs to see hundreds of puffins nesting - a highlight to me.
Today my hip has improved just hobbling for a few steps when I get up from sitting.
X
OP
OP
copsham
post-grad
hi @Jamie
Thanks for reply. What I find difficult is when I do something wrong I cannot feel it at the time only afterwards. It is amazing the difference time makes to the whole process isn't it.
@southernlass thanks for post. It certainly is a weird and wonderful process. You brain is more with it than mine was at 2.5 weeks post op! Its true about pedicure. I planned to go but i never got round to it which is crazy and should be a less. Your scar at 10 days looks like my at 10 weeks, because I had wound infection it took a lot longer. Look forward to hearing more of your recovery.
X
Thanks for reply. What I find difficult is when I do something wrong I cannot feel it at the time only afterwards. It is amazing the difference time makes to the whole process isn't it.
@southernlass thanks for post. It certainly is a weird and wonderful process. You brain is more with it than mine was at 2.5 weeks post op! Its true about pedicure. I planned to go but i never got round to it which is crazy and should be a less. Your scar at 10 days looks like my at 10 weeks, because I had wound infection it took a lot longer. Look forward to hearing more of your recovery.
X
Sadly that's the way it is with recovery. Actually, that happens with a lot of overuse injuries. You don't feel it right away, but .... ohhhhh.... the next day! It's a really fine balance between pushing the activity just a bit so you get back to normal, but not enough so that you overdo it. And....the formula is different for everyone!
But, by thinking about what your body tells you, you're doing just the right thing. You'll have good days and not-so-good days. But the good days should start to happen more often as you go along. You'll get there!!!
But, by thinking about what your body tells you, you're doing just the right thing. You'll have good days and not-so-good days. But the good days should start to happen more often as you go along. You'll get there!!!
Legin
big-cheese
See I do learn apparently. After almost mosta year recovery from ruptured achillies I still remember the day after my first return to squash, OH YES so similar idea see simple does it
Legin THR Sep 14
Legin THR Sep 14
OP
OP
copsham
post-grad
Hi @Legin
I bet squash seems a long time ago. i am planning to get back swimming this weekend. i had been thinking of doing just 2-3 lengths now i am getting cautious and thinking just one or two or maybe one or .... ? I had been going swimming right up to the day before my op so its 10 weeks since I went, definitely need to build those muscles up again. Hope you have an okay day
Kx
I bet squash seems a long time ago. i am planning to get back swimming this weekend. i had been thinking of doing just 2-3 lengths now i am getting cautious and thinking just one or two or maybe one or .... ? I had been going swimming right up to the day before my op so its 10 weeks since I went, definitely need to build those muscles up again. Hope you have an okay day
Kx
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