Restoring independent mobility is a priority after hip surgery. Hip mobilisation reduces the risk of blood clots or chest infections and our joints and muscles were designed to move. But before you can get up it needs to be safe – the sensation needs to have fully returned to your legs, and you need to be strong enough to stand without the risk of falling. In short, being a Fainting Freda is a barrier to achieving this 🙂
Fainting and sickness
The day I had my knee replacement 3 years ago I was using a walker the same afternoon. I wasn’t sick because I was awake with spinal pain blocker and very light sedation only.
But for my hip replacement 22 years ago, it took 3 days to get me out of bed due to the sickness and fainting I experienced post-general anaesthetic. My friends all know that where alcohol is concerned I’ve always been a total ‘shandy lightweight’. A couple of glasses of wine on a night out and I’d start puking, and my hangovers were fierce. My body just doesn’t tolerate toxins. So anaesthetics are not tolerated well either. All through childhood surgeries, a lot of vomit was an accepted part of the recovery.
So for my hip revision surgery nearly 2 weeks ago, I wasn’t sure what to expect. I wasn’t having a general, instead they used an epidural pain blocker, but unlike me knee replacement, I was fully sedated. What happened post-revision was more like the hip replacement, with the sickness and fainting, but nowhere near as bad on the sickness. For which I’m thankful.
I was sick twice in the early hours of first morning in PACU, but fast acting anti-emetic injections stopped that. The following morning they tried to sit me on the edge of the bed, but with the epidural still attached, and a catheter still in, I was quickly put back into bed for a bed bath. After breakfast at 930 the epidural was removed along with the arterial line, and by 10am I was wheeled down to the ward in my bed. My legs were not fully thawed, my non-operated lower leg taking the longest to return to full feeling. Hip mobilisation was going to take a while.
Meanwhile, I’m watching everyone else get up an about on crutches. My competitive side was not enjoying this! But I know from my first hip replacement I just need to go with it. My body takes longer. And my surgery was more complex and longer than average.
The first tentative steps on Day +1
At 3pm the physios decide it’s time to try and mobilise me. I move to the edge of the bed and then I’m up and walking a few steps on a walking frame. My new hip feels really heavy and stiff, because it’s swollen. But boy does it feel good to move – physically and psychologically. The physio moves me back to sit in a chair, at which point I start to feel dizzy, and I say “I’m going to faint”. The nursing staff were there fast, I was given oxygen, they kept me focused and conscious. They managed to get me to take the few steps back to the bed, where they could tip the bed back to get more blood to my brain. I didn’t actually faint… so this was progress, but my blood pressure had dropped. The 30 degree heatwave outside wasn’t helping, so they brought me a big fan which is now a static feature by my bedside even at home.
Despite all that, the first night on the ward was quite relaxing all things considered. A nice dinner, chatted to the two other ladies in my ward, and we all read our books until lights out.
Out of bed with some anxiety on Day +2
The nurse assistant got me out of bed and into a chair after breakfast, and I didn’t faint which was a good start. Sitting for the first time felt strange and uncomfortable, but then sitting is not that comfy for me generally. My pelvis is very crooked, and so I can never quite sit straight. But I managed to wash with the help of a long handled sponge, and put on my own nightshirt. Another step towards independence. At this stage in recovery, doing one new thing seriously feels being let out for a night out in Vegas. But I also felt vulnerable in the cubicle. What if I faint and break my new hip? What if they can’t get to me?
I waited for the physios whilst watching the 84 year-old who had her surgery last night get up onto crutches, go off and do the necessary hip mobilisation checklist, then she started packing to leave. It was my turn, first up on the walker again, and then onto crutches. Now, with my history, I’m a dab hand on the sticks, even if I do say so myself! All looking very impressive.
Later the physio came back and I was straight up onto crutches. Yay, look at me, so confident. Star pupil. This feels good. And then, yep, you guessed it, I say, “I’m feeling odd, I think I’m going to faint”. We get back to the bed, she takes my blood pressure which has tanked again, and so I was back in bed and on a drip of fluids. Which to me, was a backward step. I shed a few tears as the physio said no more PT today.
My partner came to visit and brought some lovely messages from colleagues and friends who he’d updated (thank you, they were well timed folks!).
After he left, I lay down and figured out the pay as you go TV. I needed a distraction. Then the nurse came with my blood thinner injection (which is the least painful needle ever really) and I got really anxious. All I could think was – oh no, the cannula made me faint. I got quite upset. He was very patient, let me have my mini-meltdown, then gave me the jab. I settled back to watch Speed (Keanu always helps right?!) whilst taking on the fluids and the breeze of the fan. Watching a movie felt normal and it was the distraction I needed.
This was the longest night. I didn’t sleep at all, the next patient to arrive in the bed opposite was struggling with pain and very vocal, and I almost fainted again when trying to use the loo. So back on the drip, the fan. Was I ever going to get home?
Day 3 – the checklist to get home
It was Friday and I wanted to get home for the weekend. I felt like crap but recognised I needed a plan, and I needed to feel in control. So I started asking the day staff – what do I need to do to get home now?
There were four things:
- Not faint/nearly faint
- Bowel movement and pee without the catheter
- Have an Xray
- Fully mobilised on crutches – on the flat, up a single step, and up and down a flight of stairs
So I had a goal and a plan. I’m good with that, and the fact I asked in itself showed I was ready. I focused on each with determination.
After washing myself in a chair the catheter came out, which made it easier to get up and mobile (dragging a catheter bag around on crutches adds something extra to think about)
The physio got me up and I walked down the corridor on crutches and up and down a single step. I found this easy – up: good leg, crutches, operated leg. Down crutches, operated leg, good leg. When we got back to the bed the physio asked if it was my goal to get home today? You bet it is!! The ward staff said OK, if I could toilet independently.
Shortly after I went to Xray in a wheelchair. I haven’t yet seen the image of my new hip joint, and I’m very curious to see it. I will have to wait until I see my consultant orthopaedic surgeon in 6 weeks.
After lunch, with a bit of extra medicinal help and focus, my bowels finally opened. Poo for victory!
Then the physio took me up and down a flight of stairs, which I already knew how to do. We did my standing, sitting and laying mobilisation exercises so I was clear on them. And proved I could get on and off a raised toilet seat on my own.
We don’t have a walk-in shower at home, so have to strip wash only for 6 weeks (the risk of bending or rotating the hip too far is to big). So I had a sneaky shower in their wet room. Such bliss. Clean hair, the feel of water on my skin. Post-surgery these little moments are so precious. I felt human again.
I then waited for the discharge papers, the sick note, the meds – with the hospital transport already waiting to take me home (we have a mini which won’t easily meet the precaution height of 18.5 ins). Then I was cleared to go. Yippee!!
I was soon cleared to leave, considered fully mobilised. We had to faff a bit with the wheelchair to get me downstairs as it didn’t meet the precaution height. Lots of pillows. It was hard to get into the ambulance, but we managed. It was a 40 min journey, which I shared with a lady who had just had her knee wound staples removed (ouch, remember that one). The ambulance had limited suspension to we felt every speed bump, and the air con couldn’t keep up with the heatwave. But at 5pm, I pulled up at home.
Thankful for home
My partner was there to meet me and with the help of the ambulance driver we got up the two steps. My partner set up a bed for me downstairs, so I have everything I need on one level and don’t need to climb the steep Victorian stairs. Dudley the cat was a bit unsure for a while, but soon came for a cuddle. Another very happy moment.
We ate dinner. We watched an episode of something on the TV (I could sit in a chair for about 30 mins before needing to move). Then got ready for bed. I have never been so thankful for home.
The NHS staff at SWLEOC are incredible. I will also always be thankful for them too.
We’re all differently-abled
As I reflect on this post-surgery mobilisation, I’m conscious that we are all diff-abled. No two people will mobilise the same post-surgery. Some of us just take a bit longer. But we get there.
Until next time, thanks for all the love and support folks xx
Jill Pringle is 54 and was born with bilateral hip dysplasia. You can read more about her experiences of living with this condition, and her various orthopaedic surgeries on this blog, or by following @WalkingJill on Facebook.
