Let's get practical

I know that at the moment, most of my readers are friends and family, or people who 'know' me off various internet forums (hi everyone! *waves* and apologies to those who are disturbed that I have a real name! lol).

But I started this blog mainly with the intention of it being helpful to people planning to have bunion surgery, because a lot of what I knew in advance about the recovery period was gleaned from blogs.

So this post is probably only really of interest if you are going to have bunion surgery, or a friend or relative is. But of course, everyone is welcome to read!

I found that my surgeon and hospital did not give me any information on how the recovery process would go, or what I might need to make it easier. If you go private, or live in a country where you have to go private, you might get a better level of information, but if you are NHS, you may well find this really useful.

So here are the things I think you need to know, or need to get.


THINGS YOU NEED TO GET

* A beany lap tray (or two). These are so useful, for using a laptop in bed, eating meals in bed, writing things in bed, you get the picture. Or even as a kind of table to have next to you on the bed. You definitely need one. I borrowed two.

* A pouffe or high footstool. For elevating your foot when you're able to get out of bed. Get one as high as you can, or add pillows/folded blankets to make it high enough. Your feet should be higher than your hips ideally. This also has the advantage of marking you out as needing special care, and even small children seem to honour that (well, a bit, anyway).

* A wheelchair. Not absolutely vital, but if you'd like to be able to leave the house before you can walk on crutches, or if you'd like to go further than you can walk on crutches, then a wheelchair means you can be pushed places. I used mine to go to the Little Lady's nativity play, which I would otherwise have had to miss. I got mine from the Red Cross.

* A decent pair of ergonomially designed crutches. Another thing that's not absolutely necessary, but they are much more comfortable than the NHS ones. I imagine you can get them from the Red Cross, although I borrowed mine.

* A toilet frame. Another Red Cross item. I've already said in another post how much I have valued this piece of equipment. It has enabled me to go to the toilet by myself, which is vital for dignity. Without it I would have had to have someone lift me on and off the toilet.

* A large pair of soft socks. For keeping your toes warm when/if you go outside. You can buy fleece things on the LimbO website but they are a tenner (!) and of no use afterwards. You could always make a fleece toe cover, but socks are easier. I bought a supersoft thermal pair in a size larger than my usual one (6-11 when I am a 6).

* Lots of pillows. For elevating your feet and propping yourself up. I use three behind me and about four for my feet, plus a rolled-up duvet tied to keep it rolled. Yes, it is a lot!

* Lactulose. We covered this before but both anaesthetics and codeine cause constipation. Lactulose is a gentle way to resolve it. Nuff said.

* Help at home. There is no way you will manage on your own, even if you have batch-cooked and/or live on ready meals or takeaways. You will get tired easily, you have very limited mobility, it is not going to work. Try and organise someone to be with you 24/7 for at least four weeks (ideally more), or for someone to come in to do mealtimes and cleaning if that isn't possible. If all else fails, employ a cleaner and cook. Seriously. Do not try to do it yourself.

* A TV in your bedroom (if you don't have one already). I hooked up an old computer in our bedroom so I can watch catch-up TV. I haven't used it all that much, but I prefer it to watching TV on the laptop, and it's nice to have it available.

* Waterproof cast covers if you want to be able to shower (or you can strip wash at the sink instead). If you do want to shower, I suggest you might also want a waterproof chair to sit on while you do it. Personally, I haven't bothered with showering but am just washing at the sink. My surgeon recommended LimbO covers, but at £15 each, I decided to live without. YMMV.

* Mobility scooter I think I'm going to hire one of these when the hubby goes back to work. I can walk with crutches a little now but as I have the Little Lady, I'm concerned I won't be able to keep up with her or keep her safe. With a mobility scooter, she can sit on my lap while we ride into town or to preschool. I definitely think it will give me more freedom than I would otherwise have, and would enable me to go shopping.


WHAT YOU NEED TO KNOW

* You will need help washing your hair. If you don't want to be a greaseball for nearly two months, then you will need to get help to wash your hair. The way I have found works best for me is to sit on a chair next to the bath. I sit on the chair sideways with my back facing the bath and then lean back on the edge of the bath, which I pad with a folded-up towel. You will get wet! Get a friend or loved one to wash your hair for you. If you prefer (and I do) they can just wet and rinse it while you do the actual shampooing and conditioning. This does make the back of your neck hurt so sitting up at points throughout is helpful.

* You will have to strip wash. Before I had my casts changed, I sat on a chair at the sink, then washed with a flannel. I am lucky enough to have a tilting wall mirror so I could see my face to wash it, but you could use a standalone mirror, like a shaving mirror. Now I have the smaller casts, I am able to stand at the sink instead of sitting.

* You will have almost no concentration. Before I had the operation I thought I could spend my recovery time knitting, writing and generally catching up on things. But I have found that I can't concentrate on things for too long, so have spent most of my time surfing the net, reading magazines (even books are beyond me!) and doing only things that I can spend small amounts of time on. This is not the time to decide to write that novel, IMO.

There are probably more, and I'll edit and add to this post as they occur to me or as I encounter them. Feel free to add your own in the comments.

Pssst! Want the goss?

I hate to direct you to read the Daily Fail Mail, I really do. But if I'm going to share the gossip, you have to share the pain.

You may have noticed my surgeon is called Ian Nugent.

This is him:

I, erm, borrowed that picture from this website. Credit where credit is (legally) due, and all that.

So, that's Mr Nugent. Now, before I had my surgery, I had a little Google of him. I wanted to find out if anyone had written about having him operate on their bunions, but it seems I'm blazing a trail on that one.

In my searching, though, I found this article.

To save you reading it all (unless you want to) it's about a woman who had her flat feet operated on using a new procedure that took only 15 minutes and involved inserting a "bullet" of silicone into the ankle to prevent the foot rolling over (known as overpronation).

So far so totally not anything to do with bunions.

Underneath, the article has two comments.

The first is this:

Thank you for an excellent article. We love to hear stories like that of Ms. McDonnell and how so many patients like her have eliminated their foot pain with HyProCure. If you are suffering from foot pain, please the HyProCure site to learn more about the underlying causes and solutions. -Fran V, GraMedica

Fran V , Macomb, MI, USA, 26/4/2011 15:43

Which is obviously from the people who make the implant, touting their wares to any unsuspecting readers.

Why unsuspecting?

Because of the story behind the next comment. Which is:

I am a consultant orthopaedic foot and ankle surgeon practicing in the NHS and private practice. I was concerned about this article written by a podiatrist whose views are not supported by the evidence of the medical and surgical profession worldwide. This article infers that this procedure of arthroereisis with the Hyprocure prosthesis is an accepted proven treatment for "flatfoot". The evidence for the results of treatment is lacking and the rationale for the principle of the procedure is flawed. This operation is not recommended as appropriate by NICE for treatment within the NHS and I am concerned that your article infers it is an accepted practice in the orthopaedic foot and ankle world. There is probably an incentive in certain areas of "private practice" for a quick and simple yet unproven procedure to be advertised in the national press, especially as it is considered inappropriate and is unavailable on the NHS.

Ian Nugent , Reading, UK, 26/4/2011 15:03

Ian Nugent? MY Ian Nugent?

Well, yes. If you'll excuse the rather proprietorial tone.

When I had my casts changed, I mentioned this article to Mr Nugent, and that I saw he had commented on it. You probably don't want all the details but it was because I told him I used to be a journalist, and he said there is never 'used to be' when it comes to journalists, ho, ho.

Anyway, then we got to the gossip.

Mr Nugent told me that lady had come to see him prior to having that 'bullet' procedure, I think at his private practice, and that he had told her it wasn't suitable for her. But off she went and had it done anyway

And apparently, three months later, she was back to see Mr Nugent because it had failed!

So there we are. If you fancied it, it may be a good idea to wait until HyProCure have done it on a few more people!

(I was going to say something stronger, but they are American, and Americans tend to be litigious, and I could use the defence of fair comment but I don't want the hassle. I'm sure you can draw your own conclusions.)

Stupidity, thy name is Emma

When I was reading other people's blogs about their recovery from bunion surgery, I scoffed at those that said things like "went to the gym after six weeks and now am in agony".

Ho ho! I laughed. What fools! I won't do anything like that. Oh no! Not me! I will be sensible and look after myself and not do anything that might affect my recovery.

So why, then, did I spend two hours last night sitting at my sewing machine making a Santa sack for the Little Lady?

Considering I know that I cannot sit with my feet on the floor for more than half an hour without them swelling and objecting, what exactly made me think that adding a sewing machine into the equation was going to somehow make it OK?

In my defence, I did think it would only take me an hour, max.

But it was so stupid!

Even before I had finished my feet were swelling, but by then I was committed. I'd decided I wanted to handmake this for my little girl and by golly! I was going to.

Lol.

At the end, I could barely get back upstairs. Despite having spent the last few nights sleeping without my feet elevated, I put them up on a pillow, hoping that my this morning they would be OK.

Nope.

My stupidity has left me in pain today as well. I can feel my swollen feet pushing against the insides of the casts, and my incisions keep throbbing, even through some painkillers.

So if you're reading this in preparation for having the operation, and you're thinking "ha! I will never do anything like that!", believe me, you will, my friend, you will.





But...it was kinda worth it. The bag is fab!

And if you'd like to make one of your own, check out my tutorial on my new craft blog. This link will take you to the tute, but do check out the rest of the blog, especially the post on what's coming soon.

Freedom is a new cast.

Ah! The sweet, sweet joy of being freed! The deep blue of the living room carpet! The brighter daylight through the front room windows! The smooth exapnse of the kitchen floor!

Yes, dear readers. I have been downstairs. T'was a momentous occasion.

Obviously, I had to go down the stairs in order to go to hospital yesterday. I didn't abseil out of the Little Lady's bedroom window.

But when I got home from hospital, I scuttled straight back upstairs again, to my cosy pit nest where I've been very happy hibernating from the cold this last fortnight.

See? It's all set up for me. Who wouldn't want to be there?

But today I had a friend come round for a cuppa and I thought 'why not entertain downstairs?'.

Why not indeed, verily and forsooth? (Sorry, I'm in a funny mood today. Must be all this freedom.)

Employing the 'puppet crab' method, I edged sideways down the stairs, clinging onto the bannister. Classy and graceful, as always.

I ditched the crutches because I have found that I can walk around as long as take weird high steps (because I can't bend my feet). It's a bit like powerwalking only it is very very slow. And hilarious to watch. Kudos to the hubby for not laughing.

My friend and I sat in the living room, my feet perched on a borrowed pouffe (thanks Hannah!) and it was nice to be out of the bedroom.

So nice that I had lunch at the kitchen table. I know! Living dangerously is my second hobby.

But sadly, after a couple of hours my feet were objecting. Despite the surgeon telling me to continue to elevate them, I forgot while I had lunch, and that short period - around half an hour - of them being down was enough for them to swell.

I could feel the casts getting tight, the incisions throbbing.

So I scuttled back upstairs to my lovely pit and took some paracetamol and ibuprofen. I also remembered to do my heparin injection and damn that stuff stings when you're not on codeine!

So freedom is great, for sure, but I think too much of a good thing can be dangerous. Maybe I'll ease myself back into the world slowly.

The big reveal! Sort of. With pictures.

So. You're all here for The Grand Unveiling, yes? The big reveal. The moment of "ta-daa".

Well, I'm sorry to disappoint, but the hospital visit wasn't quite what I expected.

Yes, the casts were removed, and yes, there are pictures of my feet, but they were quickly wrapped up again and put in new casts which I have to keep on for another four weeks. I know! I thought it was a long time too!

So, we get another Big Reveal in a months' time. Or actually, in five weeks' time because for some reason my next appointment is January 22, just the day before my birthday (hint, hint).

But you want to know all about today, no?

My lovely hubby drove me and the Little Lady to the drop-off point, then parked the car while I laboriously crutched my way through the hospital to the reception to meet him, and to catch the 'buggy bus' to the clinic.

It took me ages to get there - it's the longest I've 'walked' since the operation and I was pretty exhausted. I was glad to get on the buggy bus to go to the clinic.

I checked in, and was sent off to be irradiated.

As I went into the X-ray room, the technician, who looked younger than me, said "Oh you've had both done! I didn't think you could have both at the same time."

It turned out that she had had one bunion done in February this year, although not by Mr Nugent, and she needed the other one doing but "can't afford another six weeks off work".

That's one reason I had mine done together - the recovery is slightly more awkward because you don't have even one good foot, but once it's done, it's done.

The technician had metal screws in her foot, whereas my pins will dissolve, so we had slightly different procedures, but she showed me her foot and how straight her big toe is now, and I started to get a little bit excited about seeing mine.

She did two X-rays of each foot, sent them through to Mr Nugent, and I went back to the clinic where he was waiting to enact the reveal.

First, Mr Nugent cut off the bandages, and then he simply wiggled and slid the casts off my feet. I did brace myself for some pain but it was actually just really tickly! I'm not good with having my feet touched so it was hilarious.

I was pretty amazed by how my feet looked. They are so thin! Now the lump of the bunion has gone my whole foot shape has changed. Yes, I know that's the point but I just could not envisage it until I saw it. It's incredible.

There wasn't much time to take pictures, because as soon as they were uncovered, Mr Nugent was making some toe separators out of quick-hardening putty (which the Little Lady was pleased to note was pink) and then wrapping my feet up again in some fluffy padding, before putting a new cast on.

He then taped bandages over the cast, just like before, and there we were. Done.

"The X-rays look good," he said, almost as an aside. And that was it.

Actually, there was a teensy bit of gossip but I'll share that on another post. This one is all about me!

So here we go with the pictures. The initial rating on the Grimometer is zero.

In this first one, Mr Nugent has removed the cast from my right foot and is making the putty toe separator by moulding it between my toes and letting it harden. You can see that he has cut the bandage on my left foot, and it is hanging loose round my ankle.

In this next one, he has removed the cast from the left foot, and the toe separator on the right is hardening. This gives you a real idea of the new shape of my feet. They are amazeballs!

My left toes look like I'm holding them funny, but that's just how they were. I was too scared to wiggle them! I guess once I'm back in shoes and walking around they'll start to settle down.

So here are both feet with new toe separators. You can see the fading arrows on my feet from the surgery, and the slight tan I appear to have is the yellow antiseptic stuff they paint onto you prior to operating.


If you've been waiting for the grimometer warning, here it is. The next few pictures show my steri-strip stitches. I don't personally think it looks that grim, but I'll give it a 5/10 rating. If you want to avoid them, I suggest scrolling to the very bottom then slowly working back up till you see a picture of my feet wrapped in fluffy stuff. Stop there and read from that point.

Here's a small break so you don't unexpectedly see the pictures of the stitches. Off you go squeamish ones!

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OK, those with strong stomaches still with me? Here we go!

So these are the steri-strip stitches on my right foot. The incision is getting on for three inches long. In this one, the new shape of my foot looks like it might be Roman (see this post) which is interesting. I guess the Greek shape had only appeared because of my bunions making the big toes look shorter, because of the angle they leant at. And it means the Little Lady does have my feet, so I'll have to make sure I look after them.

Another angle of the same foot. That's Mr Nugent lurking in the background.

The left foot's stitches. There's a bit more blood here, which might be why this one has been slightly more painful.


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The next photos are back to zero on the Grimometer scale. Squeamish people can rejoin the post here.

All wrapped up in fluffy padding and waiting for a new cast.

And here they are back at home in the new casts. They don't look much different, but actually the circumference of each cast is just over an inch less than the old ones, which shows how much swelling there was immediately after surgery.

I don't think my feet are swollen at all now. They certainly didn't look it today.

I think they looked amazing, and I am so excited to get them properly unwrapped in five weeks' time!

Are you Roman, Egyptian or Greek?

Very soon I will get to 'meet my feet' as it were, and to see how well Mr Nugent was able to correct the deformity.

So I thought I'd do a quick post on feet and their shapes.

Here are my feet as they were before the surgery:

And for comparison, here are the Little Lady's gorgeous feet. You can probably tell she took the picture herself.

While I was doing research for this blog (yes, I do research! It's not just my thoughts spewed out onto the screen!), I found the following diagram. Apparently everyone has one of these three types of feet.

Mine are Greek, with a longer second toe. (A cruel date once told me I had enough second toe to make two toes with, starting off my negative obsession with my feet.)

My husband's are Egyptian, with toes that slope downwards in decreasing height from a longer big toe.

The little Lady looks like she has Roman feet, where the big toe and second toe (and sometimes the third toe too) are all the same length.

Which is weird, because you'd think she would get her feet from one of us. I wonder if I used to have Roman feet, but the big toe moving over caused my second toe to change length? I have read that that can happen.

Unless I can dig out some old photos of my feet as a small child, I guess I'll never know. If I find any, I'll be sure to post them though.

What shape feet do you have? What's your favourite shape? I think I like Roman feet the best.

Tomorrow I meet my new feet!

Tomorrow afternoon I go back to hospital and will have the plaster casts removed from my feet. For the first time since my operation, I'll get to see my feet, and the incisions and stitching on them, which will give me an idea of what level of scarring I will have once it's all healed.

I'm actually quite nervous.

I've obviously had a lot of time to stare at the tips of eight of my toes peeking out of my casts, and the thing that has struck me is that the big toes don't look as straight as I expected them to.

Now, I can only see the very very tips of them, just the toenail in fact, but when I point my foot up at the ceiling my big toes don't point exactly up, they point just slightly towards the outsides of my feet.

See?

This was worrying me so much that the other day I started Googling images and I did find some pictures of feet have big toes where the end joint is not totally straight even though the rest of the toe is.

I'm really hoping these are the kind of feet that I have.

It seems odd not to know, but when I think back I cannot remember a time when I did not have bunions. When I was younger I didn't know they were called that, and I don't think I realised that my feet were technically deformed, but I honestly can't picture my feet ever having had straight toes.

So tomorrow will be exciting!

In a way, it's like giving birth. Something has been happening without me being able to see it, and tomorrow afternoon I'll finally get to see the result.

I just can't wait to meet my feet!

The view from my bed - picture post

I thought some of you might be wondering what it's like to be bedbound for a couple of weeks.

Being totally honest, I've quite enjoyed it! As a mum of a three-year-old, life tends to be lived at high-octane level, so the chance to kick back, relax, and just be at leisure has been nice.

I've acually done even less than I thought I would while I was in bed. I had planned to do some knitting, maybe some crafts, read loads of books, blog, write, and watch TV.

What I've done is go on the internet, blog, go on the internet, watch TV, go on the internet, read, go on the internet, sleep, go on the internet and, erm, go on the internet.

Maybe if I'd kept off the internet some of the other stuff might have got done!

I did paint the nails on my left hand today, trying out some paint effects so I can decide what to do on the toes that I can see out of my bandages. I am fed up of looking at bare toenails so was experimenting with two of my top coats - a gold glitter suspension in clear, and an iridescent flake glitter in clear - over bases of white, gold and a pale pinky-white that is used for French manicures.

Here's the result:

Feel free to leave a comment below and tell me which one is your favourite.

So, onto my view. I used the panoramic assist on my camera, but I can't get them to display side by side on the blog, and right now I can't be bothered to stick them in word and then save it as a whole picture, so you'll have to piece it together in your own head.

This one is of my table. It's one of those TV tables, with two legs that curve down and underneath so you can pull it over your lap. We bought it after we had the Little Lady, so I could breastfeed and eat/surf the net at the same time, but it's been pretty handy for this too, as it pulls over the bed like the tables in hospital.



And this next one is my bedside table. It looks cluttered, but that's because I have about three drinks on there - water, tea and a homemade smoothie from my lovely friend Ish. She made it with raspberries, watercress, orange and TOFU! It tasted amazing and was presumably really healthy.



The next one is what I look at most of the time, because it's directly in front of me - the TV! My lovely hubby set up our old computer in our room so I can use the internet to watch TV live, or on catch-up. We don't have televisions in bedrooms in our house, that's a house rule, but we made an exception for my recovery period. Today, the Little Lady and I watched The Little Mermaid together so she got some Mummy Time and it was lovely.

So there you are. I'll tell you what, it's going to be exciting going downstairs after a fortnight of being up here!

Two steps forward, one stumble back - day 13

Sub-titled Progress and A Cautionary Tale

Because I've read in so many other people's blogs that doing too much too soon causes pain and can even affect your overall recovery, I've been really erring on the side of caution, and doing everything I can to maximise my recovery.

So I've been elevating all the time, even overnight, and only walking around to go to the bathroom.

But pride comes before a fall. In my case, literally.

To get around, I'm using the hospital-issue crutches. I do have some lovely ergonomic-handled ones my friend George has lent me, but I'm saving those for downstairs. It's like an incentive to graduate!

Anyway, when I first came hom from hospital I was properly crippled. I could hardly bear to put weight on my feet, and really bore my weight through the crutches. It took me ages to shuffle slowly and painstakingly to the bathroom.

In fact, I borrowed a toilet frame from the Red Cross so that I have help to get onto the toilet by myself. Here it is:

It just sits around the toilet and has handles at just below hip height, which means I can hobble in on crutches, lean the crutches against the wall while leaning my weight on the frame, and then use both frame handles to lower myself. They're also extremely useful to get back up again.

I honestly think that without this frame I'd have needed physical help to sit down on the loo and get back off it again, so it's really saved my dignity (which presumably I've just lost through telling you all this).

I have borrowed a few things from the Red Cross: the toilet frame, a wheelchair for when I go outside further than I can hobble (pretty much everywhere for a while) and I did also borrow a commode chair, as I'd read from another blogger that their pain was so bad they couldn't do anything more than slide from bed to commode.

Thankfully, I haven't needed it so it will be returned unused.

The Red Cross is amazing. They are a charity, so they lend you the equipment for just a small £5 deposit. And then you just pay what you can afford for the hire. Obviously, we will be giving a reasonable donation because we're not poor, but how fabulous for those people who don't have much money, because the hospital won't help at all - they refused to lend me a wheelchair.

I found out about it accidentally while Googling, but if you want to know more then have a look at their website here, and if you are able, please consider giving them a donation in recognition of their incredible work.

Back to my progress report.

So at first I could hardly move, it hurt and was difficult and I really NEEDED those crutches.

About three or four days ago, so on day nine or ten after surgery, I realised that I wasn't leaning on the crutches so much, In fact, I was able to walk a few steps just holding the crutches.

I experimented a bit, and discovered that I could stand without the crutches or any other support, so suddenly I was able to turn the light on for myself, or open my curtains, instead of having to call for help.

And that was my problem. I got a bit cocky on the crutches. And yesterday, I was speeding back to the bedroom when I lost my balance. I stumbled, which is fine if your feet haven't been sliced and diced, but was not great for me.

I banged my left foot on the floor trying to catch my balance. I didn't get shooting agonising pain or anything like that; in fact at first I thought I'd got away with it.

But since then, my left foot has been unhappy with me. It aches and twinges at the place where I knocked it, which just happened to be the exact spot where it's been cut open.

It's obviously not very happy. And I feel so stupid for rushing around and not taking it easy. After all, I'm not in any kind of hurry at the moment.

So this is my cautionary tale. If you're having this surgery, make sure you take all parts of your recovery slowly. Don't rush, don't push yourself too far too fast.

From now on, I'm staying like a little old lady and leaving the speeding to Lewis Hamilton.

Anticoagulants, herbal remedies and being on your guard, part 2

This is the second in a small series of posts about remedies and medicines I have found out interact badly with anticoagulants yet contain no warnings, or hidden warnings, to that effect on their packaging. The first post, about arnica, is here.

This post is about that pregnancy staple, Pregnacare.

To be fair to Pregnacare, this is slightly different, because Pregnacare is OK with aspirin and heparin, but it is not OK with warfarin or other oral (taken by mouth) anticoagulants.

And that information is, bizarrely, not included in the information leaflet that comes in the box, but is instead in small print on the side of the box under the title 'Food Supplement'.

So I contend that almost no-one reads it. I nearly didn't, except the box just haappened to be on my bedside table, and just happened to have that side facing me, and I just happen to be spending a lot of time on my bed right now, so I just happened to read it.

Believe me, I've taken Pregnacare on and off for four YEARS now, and it's the first time I've read it.

Here's a bad picture of the warning:

In case you can't read it (and I don't know why my camera won't allow me to take a better picture than that, I held the box right next to a lamp for goodness' sake) the second paragraph says:

As pregnacare contains vitamin K, if you are taking oral anticoagulants (e.g. warfarin)do not take Pregnacare except on the advice of a doctor. Vitamin K is not known to specifically interact with the action of aspirin or heparin.

And this is in white text on a quite dark green background, in letters that can only be about one millimetre high.

If you're visually impaired, forget it, you won't be able to read that. And the leaflet inside, which is where you usually expect to find contraindications? Nothing but a big fluff for Pregnacare and it's various products.

I find this very concerning.

Thankfully for me, heparin is OK with Pregnacare, but what if you were on warfarin? I have never heard a midwife or chemist's shop assistant or a doctor or anyone mention that Pregnacare isn't totally safe to take.

And most of us are not clued up on vitamin K and its effects on prescription drugs.

We're back to that notion of informed choice. We can only make one if we are informed. And I believe that manufacturers of vitamins, herbal remedies and, ahem, food supplements, have a duty of care to make sure we are properly informed.

Which means putting the information in at least 12 point font, in black text on a white background, in the main leaflet that goes inside the box because that is where we consumers expect that kind of information to go.

Hiding it on the side of a box in teeny tiny writing, in white on green, under the title *Food Supplement*, for crying out loud, is just not good enough.

You hear me, Pregnacare? We expect and deserve better. Hop to it.

Shake me and I'll rattle

In my last post, I mentioned the amount of painkillers I'm on. Some of you might be wondering why I'm on so many different drugs, and why I'm taking them all at once.

The short answer is: the nurses told me to.

But anyone who knows me, knows I don't take anything the medical profession says to me at face value, and I always ask questions.

So yes, I did ask why I was taking three painkillers.

Specifically, I asked why everyone on the ward was being given paracetamol, as in my experience, paracetamol does absolutely nothing to manage pain at all, not even the slightest headache.

I almost think of it as a placebo, so useless have I found it.

But the nurse explained that it works WITH the other tablets, increasing their effectiveness.

I did try to find some kind of study or article explaining this but was defeated by not really knowing the best keywords to Google. I ended up reading a slightly shocking chatroom discussion on how best to get from various legal drugs, and a few illegal ones, which was illuminating in a number of ways but shed no light on the drugs synergy issue.

Anyway.

I already knew that ibuprofen is an anti-inflammatory, and so it helps to prevent and bring down swelling.

And of course, codeine is a strong painkiller. As well as being, for some people, a bit of a high. Sadly, I'm not opne of those people. There's no buzz for me when I take it, more's the pity, although if I were constantly high at the moment my Christmas cards wouldn't be getting written, so I guess I should be grateful.

And on a serious note, codeine is known to be highly addictive, which I'm assuming is because of that high so many people get from it, so I'm glad that I will be spared the possibility of becoming hooked on it, especially as I have 100 - count 'em! - tablets of it in my bedside table drawer right now.

Apart from the painkillers, I'm also taking heparin, which I inject daily, to thin my blood and prevent DVT, which I am more prone to anyway because of my Factor V Leiden, but which anyone who is bedridden and immobile is at risk of.

In hospital, we injected it around 10pm, but at home I've been finding that a really bad time of day for finding the mental strength to stab myself in the tummy and inject a liquid that stings, so on Saturday I skipped my evening pincushion session and instead injected the next morning, about 45 minutes after taking my meds.

That worked much better. I felt mentally more prepared, and I also seemed to feel the pain a bit less because I wasn't tired like I am at the end of the day.

I don't think I put myself at too much risk by postponing the dose 13 hours, but if they had set the injections at a decent time when I was in hospital, by giving it to me in recovery as I expected rather than late at night when I finally demanded I have it, then I wouldn't have had to do it anyway.

In addition, I'm also taking Pregnacare, which is a vitamin supplement designed to get your body ready for, and keep you healthy during, prenancy, as well as supplement your diet during breastfeeding.

I'm taking it because the Hubby and I plan to TTC (Try To Conceive) soon, and it's recommended that you take it for three months before conception. With our history of miscarriages, even though they are caused by the Factor V Leiden, I'm not taking any chances, so I'm popping a Pregnacare pill each evening to ensure my body is as healthy as possible.

The other medicine I'm taking - I think drug is too strong a word - I began taking yesterday, but if you are going to have this or any other surgery that will mean you having a general anaesthetic, and/or you are going to be on codeine for more than a couple of days, it is one you should get ready in your medicine cupboard.

It is Lactulose.

Look away now if you are squeamish or don't have any desire to know about my bowel habits, because here's the thing - Lactulose is great for constipation.

General anaesthetics give you constipation, and so does codeine.

If you're going to have this surgery, or even any surgery requiring painkillers afterwards, you need to know about this stuff. The hospital weren't very bothered about my constipation because it's not like people die of it, but when it's you, it is very uncomfortable and makes you feel yuck, so my recommendation is to get some Lactulose in.

I recommend Lactulose rather than senna, because Lactulose is much more gentle in the way it acts on the body, and yet is very effective. Considering how much medication I'm putting into my system, I want to try and be as gentle as possible.

This link explains what's different about them and how they each work.

I'll be doing a post soon on what I think you need to get ready in advance of having your bunions done, which will include medicines but also will cover lots of other things you might not have thought of and which your hospital is unlikely to tell you about.


*Your Mileage May Vary, or, your experience may be different to mine.

Thoughts on pain (or lack of it). Day 7

I know that many people reading this will be considering having bunion surgery themselves. And I also know that the main thing you hear or read when you start to look into surgical correction of bunions is pain. Lots of it.

Pretty much everything I read before I had my surgery said it would be "the worst pain ever", that I might pass out from it, that it would be so awful I wouldn't want to have to go through it again (see my surgeon's comments from the pre-op appointment).

And yet, as I said the other day, I'm just not experiencing that.

Now, I know I have quite literally a whole army of people praying that I will have an easy, complete and pain-free recovery, and I believe wholeheartedly in the awesome power of prayer, so yeah, it could be that.

But I'm also wondering if, maybe, it actually isn't necessarily all that painful?

I don't want to negate anyone else's experience. If they have been through the surgery, and found it excruiating, then that is their truth, and I'm not trying to call bullshit on them at all. Everyone experiences pain differently, and what's bearable to one person is bring-you-to-your-knees awful for someone else. I get that.

After all, ask any mother her experience of childbirth and you will get a different story each time. Some people need the full panoply of pain relief to get through it and others don't even want a sniff of the gas and air.

I guess what I want to do is talk about how it isn't necessarily really painful to have your bunions done.

I do know that I am on a veritable cocktail of drugs. I take 60mg of codeine, 1,000mg of paracetamol and 400mg of ibuprofen four times a day. That's a lot of medication. And I know that that might well be making a huge difference.

In fact, it must be, because at night, when I have to go from 10pm till 10am without any drugs, I do feel it. But I only feel it in a five out of ten kind of way. It hurts, for sure, and it is a sharp kind of pain, both right inside the joint and along the incision site, that pulses in an unignore-able (sic) way.

And yet, it's really not that bad.

Bad enough that I'm not prepared to stop taking the meds in day, for sure. I'm pretty certain that that would be utter foolishness. The doctors gave me the drugs and I intend to take them. I've even got another prescription of codeine from my GP of 100 tablets to keep me going for a few more weeks, till I get my dressings changed.

But all the blogs that I read while waiting to have my surgery told tales of agony, of passing out in toilets from the sheer awfulness of having hobbled to have a wee, of not being able to sleep while painful incisions throbbed all night long. And I'm going to take a punt here, that all of those people were also on medication. And yet they found it painful.

Maybe I'm just being a very good patient. Some of those bloggers did talk about "doing lots of housework" or even exercising in these early days after surgery.

I think that's plain insane.

The instructions from the hospital are to elevate your feet about 90 per cent of the time for the first two weeks. To rest your feet and allow them to heal without loads of blood flowing down into them, which can increase swelling and, as a result, pain.

So maybe the lack of intense pain is because I'm resting, I'm elevating and I'm staying in bed.

I'm not the only person to come out this side of bunion surgery with a bewildered 'what happened to the agony?' feeling.

A few people talk about it in the comments of this blog post. WARNING: the post begins with a reaonably graphic picture of a post-op foot, with Frankenstein-style stitching. There's no blood, but if you're squeamish you might want to click and scroll.

And this rather encouraging thread on a foot health forum has a number of posts where people talk about having had less pain than they expected.

In fact, one of them even says exactly the same as me - that obeying doctor's orders really does make a difference in both your pain and your recovery.

So if you're considering bunion surgery, or even on the waiting list to have it done, take heart. It really might not be as bad as you think. It isn't for me.


*Caveat: I gave birth naturally, at home, with gas and air for only the last hour. It is entirely possible that I have a very high pain threshold.

Anticoagulants, herbal remedies and being on your guard, part 1

As I've mentioned, I have a blood clotting disorder called Factor V Leiden, which gives me sticky blood and requires me to inject an anticoagulant (heparin) daily while I'm bedridden to prevent me getting a DVT.

I only recently discovered that I have this condition (see previous post for more details) and as a result I'm not necessarily as fully clued up on it as I might need to be, although I'm trying to educate myself as much as possible.

There's not a lot of information out there about it, and nothing I had read warned me about things you should or shouldn't do while on anticoagulants.

Before my surgery, I had planned to take arnica. This is a natural herbal rememdy that is believed to prevent bruising. I took it before I went into labour and found that I didn't get much bruising while giving birth, so I wanted to take it before this surgery to minimise the bruising to my feet.

Now, its a homeopathic medicine, and I know that homeopathy is controversial, with many people claiming it has no effect at all. But I still thought I'd take it just in case.

I bought mine from Boots, with a bit of help from an assistant, although she didn't seem to know much about it and mostly just showed me where it was on the shelf.

I started taking it a few days before surgery. Then, the night before I went into hospital, I was Googling various things to do with bunion surgery, and taking arnica, and I spotted something that looked interesting. Something about arnica being a natural anticoagulant.

My first thought was "ooh, is it possible to medicate this naturally?"

So I Googled a bit more.

And this was the page of results that I got.

I'm sorry the picture isn't great quality, but if you click on the link above you'll get the same list of results on your own screen. And then, like for me, some words and phrases might jump out.

Phrases like "if you take anticoagulant medicine, use homeopathic arnica with caution".

And "If arnica were taken internally, in addition to serious side effects, it would possibly interact with the anticoagulant".

Woah! Hold up a moment there!

Am I reading this right? I wondered. Are these links saying it's not a good idea to take arnica if you're going to be taking an anticoagulant?

So I Googled some more.

This time, the words arnica and heparin. And got this list of results.

Which yielded some more serious phrases.

Like "It is NOT SAFE to take Arnica if you are on Heparin".

And "arnica may potentiate the effects of anticoagulant drugs such as heparin".

Ooo-kay. So. I've been taking this stuff, and there is nothing and I mean NOTHING on the bottle of arnica tablets to say it might interact with anything. There are literally no contraindications on this at all.

And yet it's a common thing for people to take for bruising. They sell it in every Boots store in the UK. It is not an obscure herbal remedy I'd tracked down in Guatamala and had shipped to me by camel and yak.

I'm pretty shocked. And I plan to write to Boots about it, because this is potentially serious.

I appreciate that not everything you read on the internet is accurate, but there are enough chatroom warnings about taking arnica with an anticoagulant like coumadin or heparin to persuade me that this is true.

This link has some useful info on arnica's side effects and interactions with other drugs, including with anticoagulants.

Quite frankly this is frightening.

It is common for people to take arnica for bruising if they are having surgery.

The very first result from a Google search of arnica and surgery says "It is an excellent idea to use Arnica both before and after surgery".

Now, because I'm a fair kind of person, I had a click on the link in case they then qualified that by saying it's not always safe, etc.

But it goes on to say "Homeopathic remedies are prepared to an extremely dilute potency and there is no risk of an interaction with anaesthesia or other medications".

NO RISK OF AN INTERACTION.

Really?

This is very scary. Doing the wrong search of the wrong keywords will give you false information.

So I'm telling you now, people, DO NOT TAKE ARNICA WITH ANTICOAGULANTS.

And just so I don't look like I'm down on the herbals, I read through the leaflet that came with my heparin.

It has a section called 'Taking other medicines' which mentions ibuprofen (which I've been prescribed along with the heparin), aspirin, clopidogrel, streptokinase, activated protein C, dextrans and vitamin K antagonists such as warfarin, but there is no mention of arnica.

Now, it may be that the risk is small, but I always prefer to make an INFORMED CHOICE on things that involve my body and my health, and the lack of available information is depriving me of that opportunity.

All I can do is use what sources I have at my disposal, namely the internet, and from what I've seen in my searches, it isn't safe to take them both.

Obviously, you will want to do your own research, and if you read this in advance of seeing your consultant, you can ask them yourself about this.

But in the meantime, I hope I've shed some light on this, and prevented other people from potentially putting themselves at risk, like I did, because there were no warnings on items being sold as medicine.

*This is the first of (so far) two posts on medicines/remedies that potentially interact with anticoagulants yet which have little or no warning on their packaging. Next post: Pregnacare

Day 4. Let's talk about pain.

Being at home really makes a huge difference. While I'm missing the others on the ward, as we used to chat and now I'm upstairs on my own most of the time, I did at least get a brilliant night's sleep and that has made me feel so much better.

Today I've noticed that home beds are not as good as hospital ones, because I can;t adjust it so I'm getting a numb bum which is a bit painful.

Talking of pain, I still don't have any, which is weird.

I expected to be in agony. Almost everything I read told me I'd be in so much pain I'd want to cry.

But I'm not. Occasionally I get a painful twinge in my feet where the incisions have been made, usually but not always when I'm trying to hobble to the toilet, but there has been no real pain, which seems really odd.

Admittedly, I'm on painkillers, but only codeine, ibuprofen and paracetamol, so I'd expect to feel something, especially as I only take those every four hours four times a day.

Someone did say to me today that it's possible for the nerves to go into shock, and not feel anything for a few days, and that the pain sometimes then kicks in, so now I'm nervous about that and kind of waiting for it to happen.

It does seem odd that you can be cut open, have bone sawn, broken and pinned, and tendons moved, then be sewn up, and experience no real pain.

Or maybe giving birth at home with only gas and air has made me super-tough?

Tales from hospital part the fourth: day 3. Homebound.

My extra night in hospital was marginally better than the first one. The nurses were quiet but I still found it very hard to sleep. I had even kept myself awake all day after my fainting episode so that I'd be exhausted enough to get off, but there was something about being in hospital that made it impossible.

I forgot to mention I'd had loads of visitors the night before: two colleagues from the Breastfeeding Network popped in around their wards shifts, my mate George and of course Andy, my husband.

We were woken in the morning and the nurse said: "Do you want to have your breakfast sitting in the chair?"

"Do I take it that means you think I ought to?" I asked (Bet those nurses just loved me!)

"Yes," she said, so I agreed I'd eat breakfast sitting in the chair, but first I needed the loo.

I got her to wheel me there,and when I came back my bed had been stripped! Seriously. I know I'd said I'd eat in the chair but I'd been planning to get back into bed for a nap afterwards.

"We need the bed," I was told. "We've got people backing up in recovery. You need to go home."

Charming. Way to go with the bedside manner.

So I had my toast, then sat around waiting to have some X-rays, get my drugs, that kind of thing. I also had a little practice at stairs under the guidance of the physios, and tried out using crutches.

We also got to have a wash! I assume we should have had that opportunity the day before, but it didn't happen, but we were brought cardboard bowls of hot water with disposable cloths, plus a washbag with soap, toothpaste, etc.

So I had a nice strip wash and felt so much better afterwards.

Here's my bowl:

In the end, a nice nurse let me stay on the ward till Andy picked me up at 2pm.

This post is quite dull, really, as all I did then was come home and get myself into bed.

So here are some pictures of my bandages to liven it up:

You can see that the bandages are like cocoons, rounded underneath. This is to stop me from putting any weight on the front part of my foot. I also have to wear some super-sexy velcro shoes whenever I get upright.

Tales from hospital part the third: day 2

So, I knew it was all going too well, despite the utter lack of sleep.

The day after surgery the physio came round to see me. Up to this point I'd been on bed rest, not allowed to get up at all, even to go to the toilet. I'll gloss over the details but suffice to say I'm glad I have good core body and upper arm strength. How elderly people manage to use bedpans without spillage is beyond me.

Anyway, I'd been lying down for hours, my feet raised above my hips, maybe sitting up a bit assisted by the rather whizzy electric bed.

And then the physio gets me up, out and walking around.

Does anyone sense disaster?

Using a walker frame, I edged gingerly and painfully around the corner of my bed, and then thought: "While I'm up, I might as well use the toilet instead of the bedpan."

In a demonstration of complete lack of judgment by both the physio and me (although she's the professional so I'd have thought she might have said no) I got her to wheel me on a chair to the toilet.

And there she left me.

I managed the business part fine. Washed my hands, then realised the world was going a bit grey, my stomach was feeling rather nauseous, my limbs were going heavy...

I pulled the help cord and heard the alarm go off.

After a while (probably not that long but it felt it) I was unable to support myself any more and getting panicky. The nausea was so bad I felt I was going to throw up all over the floor, I couldn't keep my eyes open, my head was swimming, my body was just. so. heavy.

Somehow, I managed to open the tricky bi-fold toilet door a bit.

"Please help me! Someone help me!" I called out. I felt like I was shouting but it might have been just a whisper. I recall the frightened face of a woman lying in bed in my sightline as I began to collapse.

Suddenly a nurse appeared with a wheelchair.

"Get in the chair!" she barked at me.

"I can't," I gasped. "I feel so ill. I need to lie down."

"You can't lie there! Get up! Get in the chair!"

"I can't..."

The next thing I knew I was slumped in a chair next to my bed, with another nurse slapping my face.

"Emma, Emma, focus, open your eyes. We need you to get on the bed."

Like a sullen teen, I replied: "I can't."

"But if you won't, then we will have to get the hoist."

"Get the hoist."

The world went black again.

Slap, slap.

"Emma! We're getting the hoist. Focus! You need oxygen."

An oxygen mask was put on my face, blasting air into my nose and mouth at hurricane speeds, suffocating me.

I pulled it off. "Don't like it!" (there's that sulky teenager again).

They turned it down and put it back then hoisted me onto the bed.

I passed out again.

...

Later, I gradually came round and lay for a while breathing the oxygen before I felt well enough to pull the mask off.

"Welcome back," my fellow patients chorused.

"You were grey! You were the colour of the sheets! We thought you were dying! It was so scary!"

Yeah, me too. In fact, I ended up crying while a lovely nurse gave me a hug.

It wasn't so much the faint; I've been there before. It was the fact that I was left in a toilet, with no-one answering the alarm call, and then being almost shouted at as though I were an inconvenience.

The physio came back later and apologised, which I appreciated. For while I shouldn't have suggested going to the loo, it was up to her to say that it was too much too soon. She's the professional after all.

Later, I indulged my time obsession by asking my neighbour how long I'd been out for. I was expecting her to say about 15 minutes. She looked at the clock, calculating. "Oh, about an hour and a quarter," she said. Crikey. no wonder everyone was so worried.

The rest of the day was uneventful. I was supposed to go home but it was decided I had to stay in another night after that episode, and there was much checking of my obs because my blood pressure is naturally low and they were worried.

The only other excitement was learning to inject my heparin that evening. I'm such a wuss I actually cried while Queen of Hunter called over: "I do it every night! It's easy! Just do it! Stop working yourself up!"

And actually she was right. The needle didn't hurt going in at all. The heparin stings afterwards but by then it's all over. I can do this!

Tales from hospital part the second

"What time is it?"

For some reason, that is always the first thing I ask when I come round from surgery. I seem to be obsessed with how long I've been in theatre.

For this surgery, I'd gone in at 1.45pm and woke up at 3.20pm, which was pretty quick as I'd read it was around an hour each foot for bunions. Either Mr Nugent is a genius or a total butcher. I'm hoping it's the former.

Forewarned as they were about my fainting episodes, the staff on Recovery kept me lying down, checked my obs almost obsessively, and only moved me towards being upright very slowly over a long period.

For once, I felt fine. No fainting, no passing out or feeling sick, just chatting away and wondering why the room looked ever so slightly like a morgue.

Just before 5pm, they decided I was fully recovered, and I was wheeled away into Hunter Ward, where I ended up in Bay B, bed 4, next to the cruciate ligament lady and opposite a lovely girl who was in having her second hip replacement despite being under 40.

I dubbed her Queen of Hunter, because she knew all the staff, and how everything worked, and wasn't afraid to ask for what she wanted: "Get me some oral morph please!"

Luckily I was out of theatre and onto the ward in time for tea, so I did get my fishcakes, mash and beans after all. They tasted like school dinners, which I've always liked, and while Michel Roux Junior won't be asking the hospital cooks onto Masterchef anytime it was perfectly OK and I'd even go so far as to say I liked it.

Here it is:

That first evening was uneventful. I got given drugs, injected (quite roughly) with my first dose of heparin and then spent the night wide awake listening to people snoring and the doctors and nurses apparently having a small rave in the corridor. I can't get no sleep..do,do,do,do,da,do,do...

Tales from hospital part the first

So here we are, it is done.

I did mean to blog before I went into hospital, but time ran away with me and I was still packing my hospital bag at bedtime the night before. If I had posted, it would have been full of fear, because all of a sudden I got really scared and nervous about having it done. Even on the morning of the surgery I briefly considered not going through with it, and had to give myself a stern talking-to.

So on Monday morning I was up at Unacceptable O'clock and ready to get in my taxi at 6.30am. It was still pitch dark and felt like the middle of the night. The driver did attempt some conversation but soon gathered from my incoherent grunts that I was attempting to pretend I was still asleep in bed, and that this taxi ride was just a bad dream, so he gave me up as a bad job and instead silently delivered me to the door of the Royal Berkshire Hospital.

I dragged myself through the hospital, pausing briefly to to breathe deeply the tantalising smell off coffee from the AMT kiosk, before hauling myself through the corridors to the far end of the hospital, past the plush bit and into the section that looks like it belongs in Calcutta.

After wandering about wondering exactly how much it would cost to put some signs up so people would actually know where to go, I found the Chesterman Suite, where people go to wait to be cut up.

I had been too keen. Almost no-one else was there, but it did mean I could bag myself a comfy seat on the burnt orange sofa near the television, and opposite the fish tank.

I filled in a form, and a menu for what I'd like to eat on the ward when I came round. I remembered the advice I'd been given by people who have experienced the gastro-offerings of the RBH, and chose the simplest thing on the menu, which turned out to be fishcakes, mash and baked beans, with orange jelly to follow. More of that later.

After a while, the room had filled up and I got chatting to a couple of other ladies. One was having her shoulder replaced, the other surgery on her cruciate ligament in her knee.

Then Mr Nugent started having chats with us. He drew two fetching arrows on my legs - "So I remember to operate on both" - and told me what he'd be doing. I was surprised to hear that I was going to have not metal pins but some made of something dissolvable, so that ultimately I won't have foreign bodies in me, which I hadn't thought much about but still felt pleased on hearing.

After Mr Nugent, a lovely anaesthetist came round. I didn't catch her name, but as Paul the Doctor had advised, I mentioned wanting a Des and Remi, and ankle blocks.

"I always do ankle blocks," she said. "And I can do you a Des, but I'm not sure about the Remi. I always use Des though, the hospital would like me to use something cheaper but I only use something that I'd want used on myself if I were having surgery."

Reassuring! I warmed to her and was glad that if anyone were in charge of me not dying or feeling any pain on the operating table, it was her. She had fab hair too, all pre-Raphaelite.

Then we waited.

The anaesthetist came back after a while, and let me know that she'd worked out her list and I would have surgery probably about 12.45.

"So have a cup of tea now," she said. "You must be gasping. And then only water till 10.45 after which nothing."

A cup of tea! Fantastic.

Sadly, I was too lazy to walk to the cafe and instead went to the League of Friends kiosk nearby which, while friendly and helpful, made possibly the worst cup of tea I've ever had. Still, it was wet.

I did get so bored waiting that in the end I lay down on the sofa and went to sleep. At which point, naturally, they called me in.

I had to walk to the operating theatre, and then the lovely anaesthetist chatted to me while she put me out. Next stop, Recovery.

Another call from the hospital

The other day I got an unexpected call from the hospital.

A young-sounding girl called Cassandra told me it was a courtesy call to make sure I was OK about my forthcoming operation.

Which sounded positive.

Until she started asking me for my name and address, and whether I'd been to a post-op assessment, and when was my operation, and what time, and when was I nil by mouth from.

Don't they already know this stuff? Why phone me up to ask me?

She then asked me if I had any questions. Why yes, I do. I asked about anticoagulants, and where I am on the list, but sadly Cassandra was unable to help me.

"She probably just expected you to ask if you could take your slippers," said my Mum. "And to check you're going to turn up."

Ah, well, if that's the case, why not just ask that? I get that missed appointments cost the NHS hundreds of thousands of pounds each year, but calling me up and asking me basic questions they know the answers to is a waste of everyone's time and an insult.

I'm sorry to sound so down on a system that was once the envy of the world, but I do think the NHS needs to sort out its processes and stop wasting money with this kind of nonsense.

I really do hope they are more efficient at the actual surgery and care end of this!