18 weeks - progress and an update

We are so overdue a post, and I have not told you about quite a few appointments, that I almost don't know where to start with this. Which is partly why I've not posted, because I'm one of those people who becomes overcome with procrastination when I am behind with things. Even though that just makes it worse! I know, I'm weird.

Anyway, it's been six weeks since I last updated. Then, I was finding driving challenging, limping on the foot the orthotist had yanked the toe of, getting more mobile, and due to go back to the hospital.

Now, I have been discharged from the hospital, I've been back to the orthotist (who was nice this time!) and had my feet cast for custom orthotics, and had two physio sessions.

At my discharge appointment I was very disappointed that, once again, I did not get to see my surgeon! So I haven't seen Mr Nugent since he changed my casts at 2 weeks, and won't get to see him ever again!

Is it just me, or is that weird? I really wanted to hear how HE felt it had all gone, but that's not going to happen. I did consider phoning his office and arranging to see him, but I never got around to it (see, it's that procrastination again) and now I guess I can't see the point. But it would have been nice.

Going back to the orthotist was interesting. Mainly because I spent hours beforehand trying to buy some shoes that would fit my standard orthotics, only to be told by her that I should wait till I got my custom ones. Just as well I didn't buy anything!

She had a really good look at my feet, and commented that I have good control over my tendency to overpronate (roll my feet in). I do work hard to remember to hold them straight, and it's starting to become a subconscious thing now, so that's good, as I believe that will also help my knee problems a bit.

I'm waiting for my custom orthotics to be made. They cast your feet using oasis - the stuff florists use - in a shoe box. They just just push each foot into it and then make a cast from that, then use that cast to make the orthotics.

It hurt a bit doing the oasis, because she pushed my foot down first and my toes bent up a bit, so on the next foot I asked her to push the toes down at the same time, which was much better.

I go back to get them on April 22 and then I will have to try and find some vaguely attractive shoes that will accommodate them! I've been researching already, and will do another post on that.

As for physio, Ed is very patient with the fact that I don't do my exercises as much or as often as I should! He actually is a really great physio and listens to my silly worries and then works with me to see what we can do about them, which is fantastic.

I really need to video and photograph all of them, but I already told you about the one with the elastic band in this post, and now I also have a resistance band that I have to use to work the muscles that lie along the sole of my foot and around my ankle.

I hook it around a leg of the kitchen table, then put my foot in it with the band around the big toe side, and kind of scoop my foot. The instructions say "as if to look at the sole of your foot". I'm supposed to do this 10-20 times, two times, and twice a day, building up to three to four sets of 20, once a day.

It is extremely hard work. More so than you'd imagine. And so I'm a bit lax about it which is bad, but I do try and keep up with all my exercises as much as possible. There just seem so many now!

I do have a video of me doing it, which I made a few weeks ago, and I'll upload it to YouTube and get it posted soon.

Last time I went to see Ed, we talked about how scary it is for me to do things like sit back on my heels with my toes tucked under. Like this:




So we talked about some things I can do to improve my ability to do that without the frankly frightening levels of pain it currently causes.

He also measured my progress in terms of being able to go on tiptoe. Previously, I was achieving 35 degrees, but now I have improved to 45 degrees. I'm really pleased with that, and hope to improve it further.

Last time I posted about physio, I said that 35 degrees was two third of what Ed can do, which means he can manage about 53 degrees, by my rudimentary maths. So that's something to aim for, and maybe I could even improve on it?! (competitive, me?)

Finally, in this quick round-up of the past six weeks, I'll end with the letter I received from Mr Sikranth Kodali, the doctor I saw at my discharge appointment at the Royal Berks.

He was writing to my GP, and summed up my progress as: "She is having mild discomfort in her big toes otherwise she is doing fine. I can see her excellent range of motion in the first MTP joint and the osteotomy site is solid. All the X-rays done before are satisfactory. She is not 100 per cent happy as the correction of the big toe is not 100 per cent straight. I explained to her that there is always five to seven degrees of distal interphalangeeal joint angle, but otherwise the overall alignment is absolutely fine.

"She can slowly build up her activities over the next six weeks and I am pleased to discharge her."

That last bit was something of a surprise. I didn't remember him saying that to me, and so I'd pretty much gone back to normal, but from the aching and pain that followed it's obvious I should have eased myself back in a bit more. Although how I'd have done that I don't know - after a while people expect you to be back to normal and the help and support dries up, understandably.

Anyway, as of tomorrow I'm past that magical six weeks and so I'm hoping to see improvements in my stamina. Currently, my feet and knees ache almost constantly again, but more of that in my next post, which will be about all the things I am able to do now. It's a long list, hurrah!

A letter from my surgeon

You may remember the rather unsatisfactory dicsussion I had with a doctor the last time I went to hospital, to have my casts removed.

If you don't, then you can read about it here, but basically he told me I could wear any shoes I wanted from that point on, I could drive within a few days, and didn't need to do any exercises or have physiotherapy.

I was deeply unhappy with that advice because I felt that it was, not to put too fine a point on it, wrong.

So I called my surgeon's secretary, who was lovely and agreed to print out an email from me and give it to Mr Nugent.

So I did that on the Wednesday after my Tuesday appointment. On Friday afternoon I realised I'd had a bounceback to my spam folder (doh!) so I resent it. And then I waited.

It took a long time, due mainly I think to the actual time it took for the letter to be posted, but last week I received a letter with some responses to my questions.

I had asked:

Should I be wearing trainers?

Can I walk barefoot in the house? Or should I wear the velcro shoes?

Should I be doing some exercises? The doctor yesterday said no but I have heard of just gently moving the toe up and down, and raising the foot on the toes, to increase the range of motion, and if appropriate I would like to do that - is it OK?

The doctor also said I could drive next week but I don't feel I'll be ready. When is normal to go back to driving?

My middle left toe is very red, swollen and feels bruised, and kept me awake with agonising pain last night despite me taking two codeine tablets. I think the cast has been pressing on it and has bruised it. Is this likely and should I be doing anything?

The doctor told me I could rub Bio Oil on my incisions to help the scars, so I am doing that. Is there anything else I should be doing for scar management?

How much walking should I try to do? I feel very unstable and sore, and not sure how much would be too much?

Also, the skin on my foot where the cast was is very tender, feels gritty and is a speckled red, is that OK? I rubbed all the dead skin off by hand in the bath last night so maybe I was bit enthusiastic?

Can I take the spacers out when I have a bath or do they need to be in 24/7?

My right spacer is very uncomfortable under the adjacent toe when I walk - can I cut it to make it less lumpy or is it possible to get a new one made?

So many questions! But in my opinion they should all have been answered at the appointment, without me having to ask. I'd say they are fairly basic.

Mr Nugent was comprehensive in his reply, which I've photographed removing my identifying information. I hope you can read it. I think that if you click on each picture it will open up an enlarged version for you.

He has said everything I expected to hear, really.

Yes, I need to wear trainers.

Yes, I need physiotherapy.

No, I can't drive immediately.

Yes, I can trim the spacers. Although I didn't expect to be told I could stop wearing them at nine weeks. I'm choosing to continue to wear them.

Yes I need to exercise although walking should be sufficient. I'm choosing to do some specific exercises as detailed in these posts, though, because I think they are useful.

So that's good to know. But I think that such basic information should be in a printed sheet and handed out at follow-up appointments so people don't have to ask, be misinformed, and chase.

Imagine if I'd followed the other doctor's advice? I could easily have ruined my feet. That's not good for anyone; me, or the NHS. I really do think it's time the follow-up care matched the quality of the surgery.

The big reveal part 2. Doctor's verdict.

OK, I teased you a bit in that last post, but what's a little anticipation between friends?

Back at the orthopaedics department, we were called straight in and then waited for quite a while in a side room.

There were big signs everywhere saying "do not take pictures in here" I think mainly to stop you photographing your own X-rays, but laughably claiming it was to "protect your information". Right, not to encourage me to pay a fee to access my own information from you later, then. Of course not. Ahem.

So I took off the velcro shoes, and waited on the bed.

This was my view.

You can see how much of the steri strips I let the plaster lady pull off before I wimped out. My skin is still yellow from the stuff they paint on before surgery, and if you look closely you can see how dry and flaky my skin is.

At this point, I thought the worst dryness was on the top of my foot, near my ankle, and on the balls of my feet, where I could see it cracking.

After quite a while waiting a doctor came in to see me, but it wasn't Mr Nugent.

I have to say I wasn't happy about that. I had wanted to see my surgeon, and my dissatisfaction was exacerbated when this doctor - I didn't catch his name - said "Right, we'll get new casts on you then".

What?!

"Er," I said. "I've had them on for seven weeks, I thought they came off today."

"Oh yes," he said. "That's right, I thought you were at two weeks."

Really NOT confidence inspiring!

I was not happy. I asked him my questions about driving, exercises, shoes, and he told me "You can wear any shoes. You can drive on Monday. You don't need to do toe exercises. But don't exercise till you come back at 12 weeks."

Right.

So Mr Nugent told me to bring trainers, which I bought especially with money I don't really have, and now I'm told I can wear anything? And I don't need to do any exercises to improve my range of motion? And I can drive in six days' time?

I call BS on that, frankly.

I was, and am, really unhappy with that appointment. I feel that the doctor was not fully informed and I really wish I could have seen Mr Nugent.

Before I left, he got me to walk a little but I was SO SCARED that I couldn't really do it, and just put my weight on my heels. I was terrified of being in pain.

So I hobbled over to the computer and he showed me my X-rays. To be honest, I wouldn't know how good it was. I could see where the bone had been cut and moved, but without the old ones next to them, it was hard to tell anything really.

I want to know if Mr Nugent is happy with them, as he is my surgeon, but more of that later.

So, unsure about the shoes thing I put the velcro shoes on to go home and once we'd got the Little Lady to bed I ran myself a lovely warm bath so I could start de-flaking my feet.

If you want to see lots of pictures of that (my feet, not me nekkid in the bath) then look out for part 3 which is coming soon.

The big reveal part 1. Plaster room and X-ray.

Sorry everyone. There you are, waiting on tenterhooks to hear about the casts coming off, to see the final result, and I go AWOL.

Apologies.

The excuses are that my appointment on Tuesday was right at the end of the day, and by the time we got home and put the Little Lady to bed and had something to eat it was bedtime. Plus, I haven't worked out how to take good shots in artifical light and the flash on my camera bleaches everything out close-up, so I needed to wait.

And yesterday was my birthday, and I decided that instead of blogging and taking pictures that I would see friends, go out to lunch, and generally have a nice day.

So, sorry, but this is the first chance I've had to write.

Regular readers will know that I had my casts changed after two weeks, then had the new ones on for another five weeks, so a total of seven weeks.

We went to the hospital and this time I had to have the casts removed before having the X-rays.

I was sent to the plaster room (last time my surgeon removed the casts) and they did the same thing - cut the bandages round my ankles and then wiggled the casts off.

The lady did start to pull my steri strips off but it made me so squeamish I almost cried so I begged her to stop and told her I'd soak them off at home.

Another nurse dealing with the lady next to me (no privacy here, this is the NHS) told me she had had one bunion done, and I got the usual "you were brave" comment about having them both done at once.

I have to say, I don't feel brave. I mean, I know the recovery has been more onerous as I've not been able to walk at all, but at least I don't have to go through this again!

After the casts were off I felt very vulnerable, so I put my velcro shoes back on and wow! They wrapped so far round my feet I had to fold one of the flaps under! Amazing just how big those casts were.

See how thin my feet look there!

In X-ray, I had the same girl again who had one of her bunions done. She was impressed with my feet, which was reassuring, and we talked about shoes. She said she rarely wears heels now and makes sure her shoes are soft and supportive. I guess I really am going to have to rethink my shoes for a while!

Once she'd taken two shots of each foot, I went back to wait to be seen by Mr Nugent.

Head on over to part 2 for the next installment.

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.)

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.

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.