Bizarre and depressing orthopedic consultation

Lilymary

I had my first appointment with the orthopedic consultant today, and I have to say it was a troubling experience. I had always been aware that I am being referred for steroid injection followed by hip replacement, although with no indication of when replacement would be appropriate. So on the plus side, I'm now in the system for the steroid injection "within the next 12 weeks", and for periodic subsequent injections if this manages the pain.

But had not known better I would have thought he was determined to talk me out of a hip replacement, having nothing positive to say about it. This from a man who specialises in hip replacement. Perhaps he's fed up with patients who think they're all going to leap around like Andy Murray after hip surgery (who was frequently mentioned in disparaging terms). I couldn't leap around like that when I was 18, I certainly wouldn't expect it now. I just want to be able to walk properly again.

On the plus side I know a lot more about the inefficacy of flu injections, which he seemed much more interested about, to the point that I wasn't able to get a word in edgeways about how my ruined hip was affecting my life, and what I wanted to achieve out of the treatment. I did manage to quickly mention that I can't do anything at all right now, and I'd like to go fell walking again, but he just said, and I quote, "I can't give you your old life back, I can't do that" and listing the ways hip replacement can fail. I'm not so stupid as to think artificial joints can ever be as good as a real joint in good nick, and I know all doctors have to tell patients what the risks are, but to be honest I've come back from that consultation feeling as depressed as I ever have since diagnosis.

I do know of people who have had complications from hip or knee replacement, but I've heard far more good reports from others, including people of my age or younger, and including family members. He even managed to underestimate my age, knocking 10 years off twice, even after I corrected him. Maybe it was this that made him think I wouldn't be suitable for hip replacement for a long time yet, as I'm aware they can't keep replacing them indefinitely as you wear them out. But I'd like to be able to walk up a hill now, not when I'm 75 by which time it will be the rest of me holding me back, not the sparkly new hip they've finally let me have. I don't know, but I feel like getting under the quilt and not coming out. Sorry for the moan, but rather than feeling full of hope from the glimpse of treatment on the horizon, I'm feeling quite the opposite.

stickywicket

Oh dear! Hang on tight. I don't often do this but it's OK I'm fully sanitised and in full PPE gear. ((( ))).

As my US grandson would say, it sucks. And I don't think I have many words of comfort to offer.

Long before Covid19 we had far too few consultants, theatre staff, theatre availability and far too many patients. My husband was put on the list for a new hip last October and was told it would be before Xmas. In early December he was told it would now be in April at our local hospital but January if he was willing to travel one and a half hours away. He travelled and must have been one of the last people to get one in at the end of January.

The THR is great. He was conscientious about the exercises but he knew that the x-ray showed his other hip to be in àn even worse state. He was offered a choice of which one and based it on pain. Now he's waiting for a first ortho appt for the other one. Neither of us expects it to be soon though presumably the consultant will be willing to operate as he was willing to do that hip last October.

I'm sure you were being put off simply because they can't realistically add any more patients to their lists. That will be of no comfort to you. My guess is that the chat about flu jabs was an effort to be friendly given he could offer no joy on the orthopaedic side. I hope the first steroid jab comes quickly and works well.

frogmorton

Awww Lilymary 😕

I think you dropped a bit unlucky there with that particular orthopod didn't you?

I am so sorry you had such a bad consultation. Did you go alone? If you did my advice is (and has always been) never to see any Dr alone if you can help it. It seems to balance out the power they have over us gives us more confidence etc. Of course you have to chose your person carefully - don't want the neighbourhood gossip for instance!

Now my youngest as you probably know had to have joint surgery not so long ago at 18 (hip) then a new shoulder at 19. She and we knew they would not last forever - she faces a lifetime of revisions ahead but we had no choice at all. The consultant explained that joint replacement will primarily reduce the pain, but all being well allow for better movement too. She is getting on fabulously now and has full range of movement 🙂

Don't be discouraged. Try the injections for now (I hope it's not too long before you get the first) and if they don't help enough you could ask to see a different consultant, but I suspect after a time on the injections he will come round to you having a THR in the future.

Sending you some ((()))

Lilymary

@frogmorton Thank you. I wasn’t allowed to have my husband in with me due to Covid restrictions, and the doc was rattling away like a machine gun so I couldn’t get a word in edgeways (very unusual for me!). It was like he’d seen the X-ray, made his judgement, and asking me how I felt was irrelevant. I’m usually pretty (but politely) assertive with doctors, but this level of medical intervention is a whole new ball game for me, and I was rather knocked off balance by the whole thing,

I ended up sending him a brief and concise email with all the background info I had wanted him to know. I kept it friendly, hopefully it will help for next time I see him, he seemed a nice bloke despite what happened when I saw him.

Airwave!

I have mentioned this a few t8mes, a diagnosis and treatments are not a golden bullet to a better life. Medics are cautious and I bet they pointed out that joint replacements have a limited lifespan for the young and at present there are only so many you can have. Most doctors would dearly love to treat us and give us life changing operations but ‘management’ is the name of the game and appeases their cautions, they are in it for the long run.

We must learn to live within the limits of medicine and deal with our runaway expectations.

Lilymary

Don’t worry, he gave me that speech, and I’m fully aware of the limitations. Fingers crossed the steroid injection will buy me some time.

frogmorton

Of course COVID prevented you having your husband with you! How silly am I?🙄 Hopefully by the time you next go, several successful (I hope🤞) injections down the line, that won't be the case.

The email was a good idea I hope he understands your situation better now.

Do let us know how things go

JoeB

When I joined this forum some time ago I ventured something of my professional background via my first post on the 'Say Hello' thread. That post was removed as it apparently broke the rules.

Hence I am going to venture rather carefully here but hope I can covey effectively what I would like to say without falling foul of the rules.

Here goes ..

I know a few people in the medical profession.

A fair number of those are surgeons - including orthopaedic.

I have worked closely, sometimes very closely, with the above.

Once upon a time a very experienced (40+ years) surgeon told me :-

"when I was a student (late 1920s) surgeons very rarely operated. They explored every other option first. Today (mid 1980s) far too many surgeons rush in and see how much they can do. I prefer to see how little I can get away with".

Food for thought as my headmaster would have said.

A surgeon who tells the patient all the reasons to avoid surgery and the limitations of success is my type of surgeon.

Even with the greatest surgical skill, team and aftercare possible, complications from otherwise routine orthopaedic surgery can and do occur and can often be very difficult to remedy.

However I was not present at your consultation and it may well be that he conveyed his thoughts and reservations about your particular situation in a rather poor manner. Surgeons are not always noted for their diplomacy and social skills.

Nevertheless - if it were me I would ponder what he said with an open mind.

I hope this is of some interest (and does not fall foul of the forum rules).

Arthur

Lilymary

@ArthurCJ , thank you so much for your comments. They very much reflect what my surgeon was saying, he just went a little overboard on the negative aspects for me, and it rather knocked me sideways. But then I'm very new to this type of surgery, I have been much blessed with a body that has mainly been in full working order up to now (if not exactly world class at anything), other than tonsilectomy when I was 6. My sister took the fall for all of us, and has major surgery for one thing or another most years, poor lamb. They're doing something scary to her spine tomorrow 😥, We can only hope it relieves her awful pain.

I think part of my problem was that I didn't have a chance to discuss what I expected from the surgery, he went straight into his delivery of the complications with none of the benefits, and I was left feeling there was no hope for me. So I emailed him, just a short, polite and cheerful missive, briefly outlining what this particular patient is about, so that he could make his comments in context (yes, I can do "brief"!). He sent a very kind and helpful reply, reiterating that the aim of all treatments to an ailing joint is pain management, not a completely refurbished fully functioning joint (my words, not his). It has started with oral analgesia, next steroid injections, and when all that fails, then surgery. I knew a new hip is never as good as a fully functioning "normal" one, but I hadn't realised what we have to go through to get to that point. He was very scathing of Andy Murray, and I think he felt aggrieved that his surgeons had done all that work to his hip only to watch him ruin it on the courts.

I think I hadn't fully absorbed this in his consulting room, ie the whole pain management thing, rather than the shiny new back-to-normal joint scenario, so his reply and your comments have helped me to understand this better. Thanks again for taking the time to comment and explain this. It has really helped.

JoeB

I'm pleased that my perspective may have assisted and that you have now received some answers from your surgeon via e-mail.

Arthur

Mike1

Ten years or so ago a Neurosurgeon turned me down for surgery on my neck on the basis that, in his opinion, there was too great a risk of paralysis. Remembering the pain I was in at the time, which was not a patch on what I have suffered since, I would personally have taken the risk. Around about the same time a famous top flight soccer player had the same operation, privately obviously with the best possible aftercare, and he was back playing soccer 6 weeks later!

Lilymary

An update, the steroid injection 6 weeks ago had zero effect, so attended for a review yesterday and saw a different doctor. What a breath of fresh air he was! He finally took a case history, discussed my options, talked me through the X-rays etc.

He spoke very highly of the surgeon I've been allocated to, but ultimately we decided I need to switch to a different surgeon, as this one only does one type of THR procedure, which while it has less risks and usually good outcomes, would put me on crutches for 12 weeks rather than 6. As I live in a house that has a steep path and steps in both gardens and no downstairs loo, plus I’m self employed and won’t be able to work at all during this period, and as there is no over-riding clinical reason for me to have this particular procedure, we’re switching me to a surgeon who does standard posterior THR. A friend has had this surgeon for THR and was very happy with him.

I’m slightly annoyed that if I’d known this 8 weeks ago when I first saw this surgeon I could have switched then, but I’m so relieved to feel I’m being treated as more than the face belonging to an X-ray, I’ll just have to live with that.

The bad news is that the waiting list is around 8 months after my first consultation with the new surgeon, and who knows when that will be? I offered to go on the cancellation list, but it sounds like everyone else is already on it too. Looks like me and my stick and the cocodamol are going to be hanging out together for a lot longer 😢 but this is what happens when your hip gives out at the start of a pandemic.

frogmorton

Oh @Lilymary

Ignoring the wait time to see the new consultant and the wait time thereafter for the operation I am THRILLED for you.

Without needing to make a fuss at all you have managed to do two things:

a) change from the specialist that you really didn't feel at all comfortable with and

b) get a more suitable procedure anyway.

Overall a good consultation I hope you are feeling a good bit better about the future now?

Lilymary

Thanks @frogmorton , I do feel much better. The length of the wait is depressing, but as you say, that aside, I feel things are on a much better track now and it’s like a weight has been lifted off my shoulders. Just got to keep hobbling along meanwhile and managing the chaos it wreaks on my life,

frogmorton

Exactly Lilymary you've come this far and can keep going now that their really feels like light at the end of a very long tunnel. I am so pleased for you 🙂