The day started off quite nicely; the volunteer who had given me a hand and arm massage the other day popped by again to see me and to tell me that some advice I’d given her had worked. She was was so happy and it felt good to think I’d helped her, when she had cheered me up so much. She stayed to give me another hand and arm massage and we were happily chatting away, when my Consultant’s Registrar appeared at my door. My stomach lurched and the whole relaxation process went out of the window. Afi finished up, wished me luck and left me with the team of doctors that were to carry out the Hip Procedure. At least I hadn’t had chance to get too nervous.
The procedure itself was to take place in my hospital room and the ultrasound equipment etc was wheeled through and set up next to my bed; this consisted mainly of a laptop attached to an ultrasound device and a probe. I had to lie as close to the edge of the bed as possible, at a slight tilt to make the hip capsule more accessible; I had nothing on from the waist down, but thankfully was covered with sterile sheeting that just left a square of skin visible for them to scan/inject. As well as the Registrar, who would be carrying out the procedure, there were several other people in the room to observe and take notes: a second medical registrar to assist, a nurse (who held my hand), two student nurses, two student doctors, two auxillaries (who were just curious I think!) and other nurses from my ward that kept popping in and out! In fact, it felt like the whole place had come for a good ol’ nosey!
I was nervous but, as I have said before, tried to overcome this by making myself relax and breathe so as not to get too worked up or anxious, which I know never helps in these situations. The fact that the nurse was holding on to my hand so tightly didn’t really help and I also realised I’d developed a habit of digging my thumb nails into my palm when expecting pain. The students asked a few questions before the Registrar started and his responses didn’t do very much to ease my concerns either. I have said previously that this doctor didn’t fill me with confidence… I should explain that this is due to his manner rather than doubting his competence; he has very little ‘tact’ and I wonder if this is lost in translation. Example:
Nurse: Is it possible to catch the bone with the needle on approaching the joint capsule, despite the ultrasound guidance?
Registrar: Oh yes it is definitely possible; because the needle is so fine, it just about shows up on the screen to guide me… and trust me, if I do touch the bone, Laura will feel it.
Not exactly reassuring doc.
But anyway, back to the procedure. Once I was lying comfortably and the Registrar had set up his equipment, the first step was to scan the hip joint with the ultrasound. This was the same technique they used last week; the probe was covered in a sterile glove (to prevent infection, since the skin would be broken) and then covered in a layer of jelly. It was then moved quite firmly across the surface of the skin, over the hip joint, to get the information that he needed to guide the aspiration needle into the joint capsule. From what I could tell by listening/watching, this meant positioning the hip bones and planning a route to access the joint capsule itself, as well as taking measurements to make sure that the right lengths of needles were used.
Once the all important preparation was out of the way, it was time to start the procedure itself. I couldn’t see a lot of what was happening in the hip area and that was probably for the best, but I’ll try and describe things from my point of view as accurately as I can. Firstly, the local anaesthetic was administered into the hip through a fine needle; this was done gradually and with ultrasound guidance, to make sure that it was going into the right place and without hitting any blood vessels and so forth. After we’d given this a few minutes to take effect; a larger, hollow ‘shunt’ needle was then guided into the joint capsule via ultrasound too. Once this was in place, the Registrar would be free to guide different needles through to achieve what he needed to do. This was quite a time-consuming part of the procedure but it was also relatively painless and I gradually found myself able to relax.
Until the laptop went off.
He’d only forgotten to plug it in and so the battery had ran out – it could only happen to me I swear! There was a bit of a panic while they hurried to plug it in and reboot the system, as I lay there with the metal shunt in my hip. “Don’t move, you’ve got a great big needle sticking out of your hip” the doctor said, while I assured him I was quite aware of that and wasn’t thinking of going anywhere. I even tried to make a joke out of it, despite feeling a little bit concerned about how much time all this was adding to things. I just wanted it over and done with. Once everything was up and running again, he had to re-feed the first size needle through the shunt again, which turned out to be just a teeny bit too short. So then we had to start over again with a longer but finer needle, which would be more difficult to position. It was really starting to test my relaxation techniques.
It took a long time before the Registrar was happy that the needle was in the right position within the capsule of the hip joint; I’d say perhaps twenty minutes to half an hour. It was slightly uncomfortable but nothing compared to the pain I had been experiencing with the hip itself. He was kind enough to explain what he was doing as he went along and pointed things out to me on the laptop screen, which took my mind off things a bit. There was a dark area, where synovial fluid had accumulated within the joint again and he removed this via aspiration; I’d say this is the most painful part of the procedure, as you can feel the suction change the pressure within the joint, but again it was more of a dull discomfort than pain.
Next it was time to inject the cortisone into the joint capsule. The above steps were repeated, a little bit quicker this time, and it took only a minute or two for the injection to be administered gradually, then it was all finished for that side. A small dressing was placed over the area but there wasn’t much bleeding. He told me that the cortisone they inject into hips is a crystalised form, meaning that it takes longer to be absorbed but stays within the joint capsule itself rather than spreading to other tissue, where its effects would be wasted. The hips were likely to feel slightly more uncomfortable at first because of the increased pressure within them but, once the cortisone was absorbed and the inflammation subsided, I would really feel the benefit.
I was told to stay in bed for the remainder of the day to give the hips time to settle, but was allowed to walk to the bathroom using the zimmer at least. I didn’t need much persuading to rest, as by the time the whole thing was over I was absolutely exhausted and just wanted to sleep. I had a dull, throbbing ache in my hips, back and groin, plus it was more painful to bear weight through them when walking, but still nothing like before and taking the Oramorph hourly took the edge off. Because a lot of the ward staff had observed the procedure, they took extra good care of me that day, or at least that’s how it felt. I slept through lunch and a couple of hours after it, but they saved me something to eat later on. The rest of the day passed in a bit of a blur: sleeping, listening to my audiobooks and watching TV. My boyfriend came to visit around tea time and stayed to get me ready for bed because I was struggling more, as they had said I might. I think I fell asleep as soon as my head touched the pillow.
I’ve posted an image at the top of this post that you might not be able to make out very well. It’s actually of the small incisions left from the procedure, taken when I removed the dressing a few days later; as you can see, there is barely anything at all and it all healed up pretty fast.
So that rounds off my post about the hip procedure. It was mildly uncomfortable but nothing compared to the pain that the inflammation and fluid had been causing; so if it can prevent that from happening again it was totally worth it and I’d have no qualms about having it done again. Now all that’s left to find out is how long it lasts. Fingers crossed it will be a one off and won’t need repeating.