Referral

Mansy thanks for your feedback.  I will take a look at the various options on social services.  

Although I am agred 74, I do not consider myself, by any means "elderly/" I don't "do, old!"  That may work against me in some respects, Until the arthritis kicked in more severely, I was still running about 3 miles, playing golf and tennis, etc.  

On one occasion, I contacted  an agency concerned with assisting the older members of the community.  I needed a lift to Waitrose, and a couple appeared at my front door.  They were very rude to me, and contacted the agency and stated that I was not 71, and appeared to be around 50 years, and therefore, a fraud!  They refused to assist me. Leaving me feeling very upset, and without any food in the house, as it had been snowing,and had iced over during the night.  I could not get my Alfa Romeo over the bridge across the canal.  They had a four wheel drive, which is what was required. 

Your daughter could stay for a week with you - which would be good for you.

Or you could go to a rehab home.

There is time to save for this endeavour, and personally once you are home and healing, you will not care one jot about many things. Having showers, eating and having a clean environment will mean more to you than anything else.

After two weeks I think you could manage perfectly on your own. First week or two needs thought and planning. My physio said very few people in the UK are left alone after such a big operation.

I am sure you can google local companies close to you. Good luck .

While your waiting for the op if your pain is not bring managed appropriately by your GP your local hospital should have a pain team that you can be referred to. There might be a waiting list though and hopefully you will have your surgery soon.

Your obviously quite fit and this will help your recovery, most females (of any age) don't have very good upper body strength. Good luck.

That's OK.  The UK is becoming as age sensitive as America, unfortunately.  It's a double sided coin, as we are expected to work until we are 65 and then in a few years, 70!  However, we are still referred to geriatrics, and I am far from that!  It is also a quesion of mental attitude. I try not to mention age, unless it is asolutely necessary, and when I do the level or condescension and patronisation is dumbfounding.   I find myself being spoken to as though I had an IQ of -75, information is repeated at least four times, and I have even been told that I "sound sprightly....!"

I try to keep in as good shape as my current condition will permit, but the hip problem is a major inhibitor of any sort of cardio vascular workouts.  I am doing the exercises the physo gave me, and have added in a few such as push ups, as I am aware that the operated leg may be something of a dead weight for a while.

The pain is becoming increasingly problematical.  I attempted the vacuuming today, and although I was able to get around my flat, It caused increased pain.  Unfortunately, I have a Maine Coon cat who is out much of the time, but is still shedding fur and growing her winter coat.  When she comes in, she brings in half the hedge and garden with her, and very often jumps straight on my bed, wet through!  This may be hunting season!

So far, I am popping cocadomol for pain relief.  I do not have unmanageable pain yet, but every so often, I will get sciatic pain, or pain in the gron, that catches me sharply, and often the hip or leg, will give way under me.  Walking any distance at all is almost impossible.  I attempted t supermarket shop yesterday, and had to com home and rest in bed for a few hours after as the pain was so intense, it wore me out.  So, that is pretty much the current status.

I have noticed, when I go into a sports shop that the stock for women is negligible.  I used to run seven miles from my home to the foot of the Golden Gate bridge, when living in San Franisco, and was constantly going through sneakers, etc.  There were par courses (statios where you an stop and work different parts of the body, whilst runing) all along the Marina Green looking out toward the GG bridge and SF Bay.  A completely different lifestyle and attitude toward women's fitness. When I first came back to the UK, I was jeered at, when I was out running - by both men and women!  Fortunately, things have moved along a bit since then, and attitudes toward women's fitness have changed.

I think that the above, is one of the reasons that a lot of women have such difficulty recovering from the op, and they really do need to keep up with the physio exercises they were given pre op, particularly the stretches as that, I hope, will help the muscles stretch out and normalise after the operation.  I know that all of my leg and posterior muscles need a lot more effort than I am currently putting into them, and of course, the butt muscles are compromised, during surgery, so they will need a lot of care and attention.

I do wish that the NHS would work on getting women of all ages to take care of their physical health.  It needs a big push on the part of the medical profession.  There are already Leisure Centers, but they seem to be used, mostly by much younger women, around my area.

I could go on, but that's enough, I think....

Do have a lovely Christmas and a happy New Year

I am now well and truly alarmed, as my understanding has been that we are not released until we are able to perform certain tasks, such as climbing stairs and walking with at least a crutch or a stick.  I live in a gound floor flat, so stairs are not part of the equasion.

There is no way that my daughter can be of any assistance,much less take time away from work.  She does not drive, and would need to be able to drive my car to get over the canal.

I am wondering what sort of assistance you needed in those 5 - 7 days, post release?  There is no way that I would consider going into rehab.  My daughter's father went into rehab, and died there a month ago.  

I had spoken with my GP about post op assistance, and she stated that Social Services would assess my needs and provide any assistance. It sounds as though this is not the case.  Private nursing is out of the question.

I will go back to my GP and ask her given that she has stated that I am "healthy" what level of assistance I will need during those 5 - 7 days.  My undertanding is that we are released after three days, not five!

Did you mantain you physio exercises and build upper body strength before your surgery?  I am going to drop at least 10 lbs to bring my weight down, as I have not been able to do the level of exercise I was doing before the arthritis kicked in.  And, no cardio vascular, either.  Fitness levels before surgery are important, pre op, I have been told.

This is rather worrying, as I have the feeling that I have been rather mislead into what to expect when I am released home!

Keep up the good work, you sound fab and so lucky to have lived in San Francisco!

Very many thanks for your reassuring message.  I have made several posts since receiving Rose's message, which I did find rather worrying.  She states that she is 20 years younger and needed additional care at home.

Your first Para. is what I had always understood to be the case, pre release.  I cannot imagine that the NHS would release a patient back into the "wild", until they were sure that they were able to do the basics.  The law suits and negative publicity resulting from negligence on that level would be of enormous proportions if patients took falls, or whatever, and were unable to call for help..  .  

The problem, having read a lot of the posts on the site, is that we are not able to see the person who is posting, and gauge their level of fitness.  The other issue is that there are indications that many patients have no idea of their anatomy and how the surgery is performed and what was involved around the site of the wound itself.  So that when the body starts to repair and muscles, nerve endings, etc., start to readjust, they have little information and cannot interpret the messages that their body is sending to them.

I have three cordless phones that I keep fully charged around my flat, and one is always with me in my bedroom.  

I will send you a private message, probably tomorrow, as I am feeling somewhat disturbed and anxious right now.

My referral date has been set for January 13, 2016, at a private clinic, which I understand, is where the op will take place under the NHS .  I know the locationn quite well.  It is up in the hills around Bath, and there is a rather nice hotel with a gym and small golf course attached to it.  I started golf lessons up there with a friend of mine some years ago, and then we would nip up to the hotel for lunch on the patio overlooking Bath.  Haven't been able to do anything with the golf for some time, since the hip started to make itself known.  It's a pity, because I did have an aptitude for it, but maybe, by next Summer, I can get up there and at least get onto the putting green.  The swing may be a while off, though, but we shall see what the surgeon says about that!

All the best,

Susie

I have to be honest with you Susie before your operation, that the first few days are tricky and you would be advised to have as much help as possible. No need to feel anxious but simply something that needs arranging before hand one way or another.

I am 40 years old and very healthy and love sports so not really frail by any means.

I think you would feel reassured if you had some support in whatever form. I needed help to the loo initially, someone to make meals, help me in and out of bed etc. You quickly progress to bring able to do it all easily, but it is tricky at the beginning. I am sure lots of people can help with advice and tips on here closer to the time. Maybe you could stay in hospital until you can make meals etc on your own. You do have to do the stairs and chair etc before leaving but somehow it becomes a reality when you get home. It is great you live on

the ground floor, my kitchen is miles away and down a big staircase . This will be a godsend. Don't worry you really will be fine, with a little help it will be much easier for you was my point.

I have just read this post.  You did not mention that you had hypotension, and that there were complications with your surgery:  i.e. that you had lost considerable blood.  The hypoetnsion can lead to syncope (fainting) and the blood loss will leave you weak.  That would explain why you needed additional assistance after you had been discharged.

I have always been completely self sufficient, but become concerend when I read posts that are not in sync with what my GP has told me, what I have researched myself on the various medical sites, and information that has been posted, leaving out vital information.

I do not have to do stairs, because I have none.  However, if required, I would prior to release.  

If you are able to get out of bed unaided, get to the WC unaided, sit in a chair unaided, and walk with whatever is the recommended means of support, surely you are able to make the short walk that I would, to the kitchen to put on the kettle and/or pop a ready meal into a microwave, or in my case, probaby assemble a salad!

My surgery will probably not take place until May or thereabouts, so the weather will have improved, and in terms of dressing, I would be able to throw on a light garment or two, unaided, and sit in the garden for as long as is practicable.

Being always self sufficient with a long career behind me, I do not rely on others, that easily, although should the need arise my GP will have the necessary contacts in place, or so she says.

I am not sure what your pint was, as you had unexpected complications, which hopefully, I shall not.

I am interested in your mention that you will attend a clinic near Bath.

The reason being that because I was refused my choice of hospital/surgeon I started to research options for myself.

One of the best in terms of both surgeon and hospital is the Circle Bath Hospital.

Is this by any chance where you will have your THR?

I understand that Circle Hospitals are private but used by the NHS.

Since being refused my choice I have found out a great deal,it has been a very steep learning curve for me.Until I developed OA it never occured to me that I would be less than fit and active.

At 79 years young I love travel,swim a great deal, used to take long walks on the Dunstable Downs and am dismayed to find that walking is painful and awkward.

Consequently I am determined to find out all I can and find the best Hospital/Surgeon available.

I wish you the very best experience for your needs.I believe that having always been active yourself is the best preparation for the surgery you need.

I would be glad if you could let me know whether Bath Circle where you will go.

Meantime have a great Christmas and enjoy it knowing you are on the way to a result!

Very best wishes

Joy ( also known as Gloria)

Many thanks for your message.

The clinic that I am attending is Bath Clinic at Claverton Down in Bath.  It is on the same road as the University and opposite a hotel, called Combe Grove.  I started golf lessons there with a friend of mine, who was crack golfer.  We used to walk over to the hotel for lunch on their terrace.  I had an aptitued for golf, but of course, the OA put a stop to that.  Hopefully, I can resume after surgery, but not until I have the OK, as the swing may cause dislocation.

Getting back to your question, Circle Bath did come into the picture, but rather fell by the wayside as the clinic, mentioned above was offered.  It is a private clinic, and tkes NHS patients.  The Consultant that I shall be seeing, operates at Circle Bath and RUH Bath.  This seems to be the case throughout.  I am seeing Matthew Burwell, mid January.  Another surgeon, whose name was given to me, is Michel or Michael Bishay.  He also operates at Circle and RUH.  Not sure if he operates at Bath Clniic. I was able to secure an earlier appointment with Mr. Burwell, so that wa the way I decided to go.   Mr. Burwell has done many of these operations, as has Mr. Bishay.  You can research the surgeons, eother by giong onto the hospital or clinic's website or if you have a name, just enter it into Google, using the full name and what they do. 

I have spken to Mr. Burwell's secretary, and she has been more than helpful as has the referral "hub" in Devizes.

I am only at the referral stage, and two years ago the xrays showed moderate to severe arthritis.  I was sent to a physio and given a set of exercises.  They don't do much for me now, but they do include some streteches, that I believe are important to keep up as they should help with recovery after surgery.  I am only too aware that my leg muscles in the bad hip side have atrophied.  

I managed to do a supermarket shop this morning, but returned home in chronic pain, and  almost gave up halfway through the shopping because of the distances tht I needed to cover to pick up what I needed - they do that on purpose, and call it "marketing!"

I hope this helps, but let me know if you need any further information.  The location of Bath Clinic is lovely.  Right on top of a hill, and should have lovely views, although I doubt that \i shall be in a fit tate to fully appreicate them.

Do have a lovely Christmas,

Susie

The bath clinic is somewhere I have been going to for years - the staff are so kind and accommodating - very clean and professional. It is an excellent choice. Best of luck and happy Christmas!

You are quite right if you are in a good position to do so, research your consultant carefully on line and in person.

Thank you so much for the info.

The reason I was interested in Circle Bath is that in my research via the NJR Mr.Burwell came second in my short list of best hip surgeons.

I was not aware of the Bath Clinic,it sounds lovely and I am sure you will have a good experience there and with one of the best surgeons in the country.I am so pleased for you and will be following your progress with interest.

As for me I am not even sure if I will be allowed to be referred to Circle Bath. It's just that my local referral system has the Circle logo at the top of the page.When my first choice was refused and I was unwilling to be shunted into my local hospital I set out to research the possibilities for myself.

It is becoming clear that there are wide discrepancies in quality of care across the country. Having one of the best surgeons and also a hospital which carries out many orthopaedic surgeries in the district where one happens to live is a matter of luck.

Bedfordshire where I live seems to use a different system to everywhere else. GPs are not involved in referral,that is passed to the Circle referral system and I found myself answering a phone call from  a young woman whose main concern was to make me an appointment asap in order to satisfy their time constraints,in other words boxes needed to be ticked.She said that an early appt. was available at my local hospital.I declined to accept and decided to make enquiries for myself.I preferred to wait for my choice of orthopaedic specialist even if that did not fit their league tables.

Suddenly two days ago I received a letter from Circle MSK (Muscoskeletal) Centre offering me a choice of clinics. It seems that here in Bedfordshire a number of clinics have recently been set up.It is explained that each clinic consists of a team of physios,GPs with special interest,hospital consultants,chronic pain specialist nurses,occupational threapists and hand therapists.This service it states is for the people of Bedfordshire and I am invited to choose a clinic and make an appointment within 2 weeks for an initial assessment.

Of course I will attend,but I have the feeling that this is another system for deferring the option of an appointment with the consultant of choice.

Clearly hip operations are far more common than I would ever have imagined,and the best surgeons are in greatest demand.Also nhs trusts are strapped for cash and not keen to send patients for THR if not pressed to do so.

It may be that I may have to go private in the end to have one of the best surgeons.

Meantime I will see what Circle MSK tell me. Compared with what I have read on this forum,my condition is still more bearable than for many others. I am not in pain sitting or in bed.Only when walking and unable to walk long distances as before. Swimming which I love is painless too.

I am interested in the Bath Clinic now you have mentioned it to me I will look it up on google.

I am so pleased for you that after such a long delay you now have your date to go ahead. Now you can relax and enjoy the Christmas break.

Wishing you a wonderful Christmas and all the best for your surgery in 2016.

Regards Joy  

I have heard of THR patients having to travel 300 miles for a THR.  So, I wonder why your county is offering such limited options.  I have only recently heard of the Circle hospitals/clinics, and I thought that they were all private, but do take NHS overflow.  You have mentioned "consultant" would this be "consultant surgeon, I wonder.  If that is the case, then the CS would have pretty high credentials.

I have a referral only.  It is still down to Matthew Burwell to make a decision regarding surgery.  I do know that surgery cannot be delayed much longer, as I cannot rely on my hip and knee to support me, ass I sometimes experience chronic groin pay, and then my hip and knee collapse under me.

I shall know more after January 13.

There is also Circle Bath, and Mr Burwell operates from there, as does another excellent sucgeon, I am told, Michael Bishay.  I ran into one of Mr. Bishay's patients in a supermarket.  She has multiple problems and gave Mr. Bishay a very high recommendation  I believe both surgeons also operate at RUH Bath.

I would make a few more enquiries, and see what is what, because from what I have heard, patients are travelling to their surgeon of choice.  Bedfordshire seems a little out of line with other parts of the country.

Have a lovely Christmas, and keep us posted.

Thanks for that,I will definately try to make sure I am offered a choice I am happy with.

I am sure that now you have your referral to an excellent surgeon such as Mr.Burwell you have started the ball rolling and the outcome will be the best.

The problem for many of us is getting that first referral with the surgeon of choice.

I meant to ask what is RUH? 

Of course by "consultant"I did mean consultant surgeon.

I will be following your posts with interest to see how you get on.

Best wishes

Joy 

My history with the referral went like this:

First xray about 3 - 4 years ago and OA was found ín right hip.  Although I already was aware of OA in both hands in 1987.  Nothing done, other than the GP, at that time recommended against  surgery because he said that I would get MRSA, scaring the life out of me. Instead, he suggested that I take glucosamine sulphate.  I started a course of it, and did not find it helpful.

When my regular GP returned, I advised her of what had occurred. GP advised that this would have been said.  However, we continued down the same path; i.e. nothing done.  I was symptomatic, obviously, but at the time of xray 1 not in dire pain. 

Xray 2 in 2013, revealed moderate to severe OA,a nd I was referred to physio and given exercises, and acupuncture for pain relief was suggested.  Saw physio, just twice, and that was that.  Was also prescribed cocadomol.  Did not pursue the acupuncture route.

Xrays 3, in November this year, which were more thorough, showed that the OA had progressed to further narrowing, and I was experiencing great discomfort and pain.  Also hip and knee would collapse from under me.  Mild arthritis in left hip and right knee.  At this point we moved onto referral and an ECG was done, along with blood.

I received a letter from Devizes, which is our central hub with a reference number and a password.  I called them and stated that I wished to consult surgeon 1.  His appointment times were early morning and quite a distance to drive in the rush hour.  He was a highly recommended surgeon.  Surgeon 2's name came up, also at Bath, and I cancelled the apopintment with Surgeon 1, as I could have an appointment with Surgeon 2 in the early afternoon at the same location, and earlier in the month, which was better timing for me.

I called the referral hub today and asked if I could also have a consultation with Surgeon 1, and was told, in no uncertain terms that it was one surgeon for one referral.  So, if I did not "relate" to Surgeon 2, and he to me, we are both out of luck!

RUH = Royal United Hospital.

I was surprised to learn that I was unable to consult with only the one surgeon as freedom of choice in terms of being able to "interview" more than one surgeon, does not appear to be on the NHS agenda.  I am assuming that this is legal.

In general, when looking for a GP, my understanding is that there is choice.  I am used to the American system, which is totally different, as there is no such thing as the NHS, you need to be covered by an employer's medical insurance.  If you are an independent contractor you have to pay for your own insurance, at a price.  If you do not have medical coverage you are termed "medically indigent!"  

Will keep posting as issues arise.

All the best,

Susie

Thank you so much for taking the trouble to outline your experience.

It is shocking that so many hip patients are given the runaround.It is not even more economic to delay or deny treatment,leaving the condition to worsen.

I do appreciate that THR is a very serious operation,a decision not to be taken lightly.Even so the need to be made aware truthfully of all options available should be the right of every patient. There is so much variation in options offered from one part of the country to another.

Several patients report consulting more than one surgeon,in fact it is recommended to do so, before deciding to go ahead.

As regards patient choice,it is clearly stated as available on an nhs website.  In practice however not so easy to obtain.

In my case I was in denial to begin with,only urged to seek medical advice by friends and relatives.

Went to my GP,was sent for an Xray in June 2013 and OA was diagnosed. However my GP told me the condition is not life threatening and no need to do anything unless in severe pain.

In truth I was relieved and did nothing until the condition became more severe.

Urged to deal with it by family and friends as my limping became more obvious and as a result of advice of a neighbour who has had 1st THR and is awaiting another, I went to a different GP at my practice.I had received a letter naming a new young doctor as my named GP.Apparently a named GP is required for patients aged over 75 by government directive.

Anyway I went to my new named GP and requested a referral to the hospital my neighbour had attended and had recommended.She supplied me with chapter and verse of the whole process,she had her THR at Stanmore Orthopaedic Hospital carried out by the senior consultant.

My request was denied however,and it turns out that the neighbour was known to the consultant as she had worked for ten years for his family.

Not before (in her own words) being messed about by our local hospital for 3 years however.

He the consultant arranged for her case to be transfered to Stanmore and once under his wing she received every assistance, including transport,after care,a stay in a rehab facility,occ. therapy and provision of all home equipment,all courtesy of the NHS.

It seems that for some getting an appropriate referral is an uphill task,while others receive the best care in a private hospital with a top surgeon and the NHS picks up the bill.

The phrase (messed about) I have heard from others too.It seems to get what we need requires determination and persistance.

The first step is getting in front of the right consultant surgeon,easier said than done!

Having been a lifelong believer in our NHS I am so disappointed. I had no idea I would need to learn so much about the realities.

I applaud you for being so ready to share your experiences. It seems that we patients on this forum obtain the most support from each other.

I only wish more members were willing to name their hospital and surgeon.

For me that is the most useful information I could get.

Wishing you the best outcome,at least your surgeon has the highest credentials on the NJR.

I will be rooting for you and following your progress.

Best regards

Joy

At least it does no harm.