Saturday 17th April 2004:
The date for my operation at Derriford hospital, Plymouth (17th May) arrived through the post along with an appointment with my surgeon, and one for pre-operation tests. I was concerned about the timing of my surgery, as my convalescence would increase the workload for my work colleagues, and clash with an important Training Event planned in early June, but I was desperate for this operation, and there never is the 'right' time.

Monday 3rd May:
The day arrived for my pre op tests, the appointment letter said that you should expect to be at the hospital for at least three hours, and suggested that you brought a friend - and something to read! There were lots of questions about my medical history, the medication I was taking, and I was given information booklets to read about the operation and the procedures used. I had checks on my blood pressure, breathing, and an ECG, also blood, urine and MRSA tests were taken. X-rays were taken of my hip from different angles and of my neck. As I was to be admitted to Stannon ward, which is specifically for patients having joint replacement surgery, the tests gave me confidence that my needs would be met, and that I would be well looked after. The surgeon said that he was pleased with the x-ray of my previous hip, but my right hip showed a marked deterioration from the one taken in February. There was no clear bone definition - 'shot to bits' was the term used. He pointed out the risks associated with this surgery, and asked me to sign the consent form. I was actually at the hospital for these tests for nearly four hours, but more than two thirds of that time was spent in the waiting room.

Thursday 13th May:
Today the Orthopaedic Hospital-at-Home Services nurses called at my home for a chat. We were in the middle of moving my home office to my new house, so things were rather chaotic. This scheme allows patients to return home early after surgery, as the nursing team provide care and support for suitable patients. To be considered for the scheme you must:

• Live in the pre-defined catchment area, and be on the telephone
• Have a responsible adult at home with you
• Be medically fit to leave hospital early

The nurses were very friendly and supportive, so I really hope that everything goes smoothly so that I can utilise this service.

Friday 14th May:
The final day for moving my office equipment and I was in a great deal of pain and feeling really tired, only energy for a take-away meal and then into bed. One advantage of the house move has been that there is no time for feeling apprehensive about the impending operation.

Saturday 15th May:
A strange day today, spent unpacking boxes, and packing my case for hospital. I took some time to read the 'Your Guide to a Successful Hip Replacement' and other information booklets provided by the hospital, and the 'Surgery' booklet produced by Arthritis Care.

Sunday 16th May:
Today is my hospital admission day - the letter stated, 'Please telephone the ward on the morning of admission to confirm that a bed is available for you'. I made the phone call to the ward with a little part of me wishing that there was no room for me - but the nurse on the end of the phone said that my test results were okay, and they would be expecting me at 3pm.

The car parks at Derriford were full, it was Sunday afternoon visiting, and it took a while to find a place to park. Fortunately we had taken my wheelchair so my husband pushed me to the ward on level 11. My named nurse introduced herself, and completed yet more paperwork. She put a white name band on my wrist, and a red one as I have an allergy to penicillin. No escape now! I emptied my case and put all the things I thought I would need for my stay in my bedside locker. My husband found out that I was second on the operating list for tomorrow at 10.30am approximately, and was told to phone the ward after 3pm the next day to find out how I was. He left after a while, and I started to chat to my fellow bedmates on the ward. It was a super sunny day (trust me to be in hospital during an unusual heat wave for this time of year) and the view from the window over to Dartmoor helped to pass the time. From my bed I could glimpse the planes approaching Plymouth airport, and the air ambulance landing and taking off again, far too frequently I felt, from the hospital grounds. I cannot remember the delights on the menu for the evening meal, but I was told that the roast beef had been delicious at lunchtime! The night staff put a 'nil by mouth' sign above my bed, and told me, "No eating after midnight, and no fluids after 4am in the morning". I was glad that I had brought a bar of Galaxy chocolate with me, which I had enjoyed earlier with a mug of Horlicks.

Drug rounds completed, lights dimmed and we settled down to sleep. It seemed that this was the signal for the patients to activate their buzzers, and the slow march of the walking frames and crutches going too and from the loos had begun! I lay there thinking that I would soon be part of this regime, and pleased at the thought of being rid of this terrible pain in my hip.

Monday 17th May:
I woke surprisingly refreshed and ready for the day ahead. The toast being cooked for breakfast smelt delicious, even the Branflakes being served to my neighbour looked appetising. Fortunately I had to take my steroids, so I was allowed a few sips of water, which refreshed my dry mouth. Soon the surgeon was at my bed looking at my hip, and marking the correct side with a black felt tipped pen. He said to himself, "I must remember to be careful of your knee replacement on that leg". Did he remember or recognise his own handiwork from 1992 I wondered? He left after touching me on the arm, and a quick "I will see you later Janet", which reassured me.

The anaesthetist working with my surgeon was a very calm and confident man, just the sort of person I felt would look after me during the operation. He said, "You must be used to all this now?" "I told him that even if this was my 12th operation, it didn't get any easier!" He told me my operation was planned for around 10.30am, and talked me through the procedure for the anaesthetic and then went off to look at the x-rays of my neck. He was away quite a while, and when he returned he said, "Because of the arthritis damage in my neck, how would I feel about having the operation by a spinal epidural, instead of a full anaesthetic?" "Did this mean that I would be awake throughout the operation, and be able to hear what is happening", I asked. He said that I would be sedated throughout, and he would find me a Walkman and play me some music. From my reading, I knew that the recovery time is so much better using this method, and as I am usually sick after anaesthetic, readily agreed - as long as I could listen to music, and not hear the noises!

As he left, a nurse took me to the bathroom for a bath, my last one for three months! There was hardly time to dry myself before my name was being called to go for an echocardiogram test. So at 9.30am I was being pushed in a wheelchair to the ground floor for this ultrasound test. On my return to the ward, I went to the loo only to hear a nurse calling my name and telling me that they had arrived to take me to theatre. I was quickly given a white theatre gown to put on and I laid on the bed.

My handover to the theatre staff had begun which meant more form filling. My armbands were checked. "Was I the patient"? "What operation was I having?" " Did I have an arrow marking the spot?" "Did I have any jewellery?" I said, "Yes" pointing to my wedding ring, which was then taped up. "Anymore?" the nurse asked. They explained that they needed to be more vigilant nowadays with so much body piercing! "Did I have any false prostheses?" I answered, "six - 2 knees, a left hip, a left elbow, and 2 shoulder replacements". Checks were made on dentures; lose teeth, caps and crowns, hearing and eyesight. I passed the 'test' and my bed was soon being pushed out of the ward, with my fellow bedmates shouting, "Good luck, and see you soon". Our procession moved slowly along corridors and into a lift, my pushers making pleasant conversation to make me feel relaxed. My bed was then parked in an anti room where soft music was being played. A male theatre nurse introduced himself, and made further checks of the paperwork and remarked about my surname, and my disability. I was not in mood for jokes at this time, and settled back to listen to the soothing music. The tannoy sounded to say that they were now ready for me, so they wheeled me to a small room leading into the theatre, a bit like deja vue, I had been in a room similar to this one before!

There was a clock on the wall, and the time was now 10.40am, and the race was on to locate a vein suitable for the procedure. There were three or four attempts to locate veins in my arms, a lot of squeezing and the use of the blood pressure cuff. "I did warn you that my veins are difficult to find," I said pathetically, as they inspected the veins in my ankles. My anaesthetist remained calm and apologetic throughout, but I could sense the frustration of the male theatre nurse (as he sucked hard on the delicious smelling peppermint in his mouth) and the minutes still ticked away. At last I noticed my anaesthetist was not shaking his head this time as he gently said "A sharp scratch again", his patience and perseverance had paid off. The clock pointed to 11.10am we were now ready. As I would have no feeling 'down below' for a few hours following the operation, the nurse inserted a catheter. I was asked to roll onto my right side, and I felt the anaesthetist counting along the bones in my back to insert the epidural needle. It didn't hurt at all, and soon I was feeling happy and drowsy as a relaxant medication was delivered into the vein they had located in my arm. All I can then remember was feeling the sensation of movement as they wheeled me through the double doors into the operating theatre, and me saying, "Don't forget the Walkman, I don't want to hear all those noises!"

"Hello Janet, the operation is over, it has all gone very well". I was lying on my left side, and my anaesthetist was talking to me. My left ear was hurting, I had been lying on the earphone of a Walkman, but I can't remember any music! I was asking lots of questions, and what the time was, my anaesthetist told me it was 1.30pm, and remarked that he was pleased that I was so alert after two hours of surgery. I was still on the operating table, so they turned me over, and lifted me back on my bed. I looked around and I noticed the huge theatre table lights. I had never seen inside the operating theatre before as I have had a general anaesthetic in the past. They wheeled me to the Recovery ward, and I told the male nurse that I remembered the smell of his peppermint sweet before my operation. "I'll get you one", he said and soon he was unwrapping me one from a white paper bag and popping it in my mouth. My, it tasted good. The nurse responsible for me said, "There wasn't a place on her observation sheet to record, 'patient sucking a peppermint'!" She checked my temperature, pulse and blood pressure, and asked about my pain level. I was feeling no real pain, though I had no feeling in my legs, in fact it felt as though my legs were strangely bent up towards my chest, but the nurse reassured me that they were not. She told me that she was also called Janet and her sister-in-law's maiden surname was the same as mine, and she lived in Plymouth. My surgeon walked by and said, "The operation had gone well, with very little blood lost". I thanked him for his skills, and felt relieved that all had gone well again this time. The nurses attached my booties (an A-V Impulse System) which was to be my constant bed companion during the coming week. These open-toed slippers (one edged with red and one with blue) wrap around your feet and assist by helping to push the blood around the body via a foot pump. I was very grateful that this equipment was being provided to prevent deep vein thrombosis, but surprised how many patients refused to wear them as they kept them awake!

It was now 2.10pm and it was time to return to the ward. My named nurse welcomed me back with a smile, as the theatre staff handed me back into their care. I felt comfortable and slept off and on between the periodic observation checks by the nursing staff. At teatime the trolley provided me with an egg mayonnaise sandwich (those who know me will know it is my favourite), and I ate it slowly and enjoyed the taste along with a small cup of tea. In the evening my husband arrived, and was surprised to see me awake and able to have a conversation. He is used to finding me sleepy after surgery, and clutching the sick bowl! I was a little sick after he left (no, it wasn't seeing him, it was probably the morphine!) The feeling was slowly returning to my right leg, but I still couldn't move my left leg however much I willed it to, (the feeling didn't return until the early hours of the morning). I slept well despite the observation checks, and the foot pumps sounding, and pushing the soles of my feet every 10 seconds.

Tuesday 18th May:
My surgeon prefers his patients to spend the first day in bed following surgery, so I was pleased because I still had a catheter attached that I did not have to use a bedpan (one of the worst indignities about being in hospital). My named nurse gave me a bed bath, and other nurses helped to roll me on alternate sides so that they could change my sheets. I remember it being quite painful to move my right leg, and the room was spinning a bit as they rolled me to one side. The nurse checked my wound, and said it all looked good, and there was no oozing. Fortunately I didn't have a drain in this time, as there had been so little blood lost during my surgery. As I was now drinking well, they removed the saline drip from my arm. I found all this activity quite exhausting, so slept until l was woken up by the phlebotomist pushing her trolley next to my bed. "I can see you are going to be difficult she said, which vein is the best?" I straightened out my right arm and pointed to the place where I have my monthly blood tests at my doctor's surgery. After three attempts she had her two phials of blood, and wheeled her trolley over to the next patient.

The pharmacists came to check my medication, and the OT's, who I know very well, arrived to check my set up at home (height of loo, bed, chair etc.), and to give me a replacement grab stick. In the afternoon the physiotherapist introduced herself, she wanted to check that I had been doing the exercises from the booklet every hour, which are:

• BREATHING - Take three deep breathes to keep your lungs clear
• BUTTOCKS - Squeeze together
• ANKLES - Pump both feet up and down to keep the circulation flowing
• LEGS - Press the backs of knees down into the bed by tightening your thigh muscles

I was really pleased that the excruciating pain I had been experiencing before my operation had disappeared, the pain from the surgery was different. I still needed to have the liquid morphine periodically to control the pain, but this made me very sleepy and nauseous at times.

Wednesday 19th May:
Today the physiotherapist got me out of bed and walking using a gutter frame with wheels. It felt good to be walking again. I was then able to sit out for my lunch, which was a step further in my recovery. Then it was back on the bed for a rest. Fortunately the visiting times on this ward are 2pm until 8pm, I feel that this is quite long enough when patients have had surgery.

Oh dear, a doctor is approaching with a tray containing items for taking blood, it seems that yesterday's samples clotted. The doctor tied a rubber glove tightly around my upper arm; tapped around a bit, and hey presto hit the jackpot!

Two patients had knee replacement operations today, so there was a change around of beds and belongings to accommodate them in this six-bed ward. They forgot to remove my catheter today, so hurrah no bedpans. I slept well, but it was very hot and humid.

Thursday 20th May:
What progress, I was able to sit out for my wash today. It does seem odd using a washing up bowl perched on an over-bed table, and with help from the nurse to reach the parts I cannot reach. I reminded them about removing my catheter. I can assure you that it doesn't hurt, it's the thought of it that makes your eyes water!

I was taken down the gym today by the physio for my exercises holding on to the bar (no- not a boozy one). Ten of each of these exercises need to be done each hour:

• Lift your operated leg out to the side
• Lift your operated leg up in front of you - NOT beyond 90 degrees
• Lift your operated leg out behind you

I had severe indigestion after lunch, not sure if I should blame the new medication or the hospital food. I pressed my buzzer and asked the nurse if they could give me something to help. Another nurse approached and said that she had checked my drug chart, and unfortunately she couldn't give me any medication as I wasn't written up for anything, but she could give me some milk - yuck. I asked again at dinnertime, and again at bedtime, but still they couldn't give me anything. Thank goodness I had an indigestion tablet in my purse.

I had lots of visitors today, which was good, and bags of cherries from my brother, which are my favourite fruit. One nurse said, "They must have cost a lot!" I said that he had just sold a house near London!

I am now taking only my usual painkillers and anti-inflammatory tablets, as the pain is now manageable. I have my nightly injection into my tummy (to help prevent blood clots, and given via a very fine needle), and settled down to sleep. At 11.45pm we were awoken by the fire alarm going off, and very soon firemen were at the entrance to the ward. Voices were saying that a smell of burning plastic was coming from our ward kitchen. Quickly the windows were closed, and anxious staff voices were rehearsing the evacuation process. I remember lying there wondering how far I could get using my walking frame, especially as we were on the 11th floor! The fireman said that he was going to check the roof as the smell was coming through the vents. It was scary stuff, especially as it brought back strong memories of my friend's house fire 34 years ago which led to me jumping out of a bedroom window to escape, and was probably the catalyst for the start of my RA. Fortunately within about 15 minutes the alarm was switched off, and I tried to get back to sleep assuming that all was okay, it would have been sensible for the staff just to have come around the ward and told us though. Next day we were told that a flex left over a cooker ring had burned through in an upstairs ward kitchen.

Friday 21st May:
The nurse told me that I should be home by Monday, but I told her that I wanted to go home tomorrow, as I was part of the Hospital-at-Home Service. I talked to my friend the OT, and she agreed that being at home would be better for me. There was a query about a missing blood test result, which could hinder my departure. Later that day the (Spanish?) doctor arrived who had taken the blood sample from me before. I told him that he had been successful in the past, and he said, "He was a clever dick". Unfortunately his rubber glove trick, lots of tapping and four attempts later he conceded that he was not a 'clever dick' this time! He said he would give up as it was not important, as my previous blood test was fine.

My surgeon came by and asked how I was getting on, and was the pain better than before the operation? I said that I felt great and the pain was negligible now, and I was planning on going home tomorrow. He said, "Great idea and good luck, and he would see me at the post op clinic" which provided me with my passport to escape.

The physio was pleased to see how well I was walking using my gutter crutches, and my range of movement during my exercises was good. Her superior said I had to try to walk up and down the stairs before I left hospital, despite having no steps, a ground floor bedroom, and a stair lift at home! So they wheeled me along to the stairs, which just happened to be the 14 concrete step fire escape staircase! I tried to pull myself up the first step using this thick banister rail, but had little grip and was unable to achieve it - those of you who know me know that I am unable to use a stair handrail normally because of the limited grip I have in my hands. I freaked out; I was worried that until I passed this 'test' I would have to stay in hospital! The physiotherapists calmed me down, and said it didn't matter. This was really the low part of my hospital stay. Luckily when I returned to my bed, my brother was there and helped me forget this unfortunate episode that pushed me to confront the frustrations of my condition.

Saturday 22nd May:
Luckily my temperature, pulse and blood pressure checks were okay today so my plans for going home were on schedule. It was strange getting dressed, my clothes felt restricting after the freedom of nightwear for a week. The Hospital-at-Home nurses changed the dressing on my wound, and checked all my notes. They advised me to rest on the bed, as I would find the journey home tiring. My medication had been organised and my suitcase packed. Many of the staff were surprised, but delighted that I was going home so soon. They all said how well I had coped, and how self-motivated I was - it is all thanks to practising the self-management techniques that we teach on our Arthritis Care courses. Soon I was thanking the staff and wishing my bedmates good luck as my husband pushed me in my wheelchair outside the hospital, and into the warm sunlight. I had to take care getting into the car in case I dislocated my hip. As we pulled into the drive the Hospital-at-Home nurses arrived and made sure that I was okay.

I felt exhausted as I lay on my bed, but it was a great to be home again. The two cats were pleased to see me, and curled up on the bed beside me. A spell in hospital helps you to appreciate your surroundings, especially peace and quiet, and your own loo!

The Hospital-at-Home nursing team called every day for the next six days. I feel very fortunate that I was able to be part of this scheme. It was comforting to have their daily support, and know that they were carrying out the same checks as would have been provided had I stayed in hospital. I have had to have a variety of dressings on my elbows as I have developed painful pressure sores from pushing myself out of chairs, moving up the bed and using my crutches to get around the house.

Hip, hip, hurrah, fourteen days have now passed since my operation, and I have now had my 28 clips removed. I breathed a sigh of relief as I felt the pull of what I thought was the last staple at the top of my scar. Unfortunately then the district nurse said, "Well Janet that's each alternate one removed, if you are okay, I will start at the bottom of the scar again!

My brain is active (some would say this is unusual!) but I do get tired easily and I am getting bored with TV and videos. Hopefully I will be able to return to work after 6 weeks, but below is just a reminder of the precautions I need to be mindful of during the next three months.

• DO NOT bend my operated leg towards my chest more than 90 degrees
• DO NOT sit on a low chair i.e. my hip must not be lower than my knee
• DO NOT bend over to touch my toes, use gadgets (I wish I could!)
• DO NOT cross my operated leg across the midline of my body
• DO NOT turn the knee on my operated leg inwards

I am sure that if you are reading this diary and have already been through a similar experience that it raised a knowledgeable smile. I hope that if you are perhaps waiting for a hip replacement operation that this account will prepare you, and allay your fears. If you are reading this diary and know that you will not need a similar operation, then I hope that you have found it interesting.

Janet