UCLH, Not Stanmore - Getting wound up now!

The words "brewery", "up", "in", "a" and "piss" came to mind yesterday morning. It had been far to early a start what with having to be in the office for 4am for what was eventually a waste of time, so I was already proceeding at quite a pace from "grumpy" to "peeved" and eventually on to "pissed off". The 9:20am appointment with Mr Surgeon Man resulted in a number of admissions, namely:

1. I am no longer seeing Mr Specialist Man at the Royal Orthopaedic Hospital, Stanmore - that was a mistake, he is actually at University College London Hospitals centre in Euston (funnily, even closer to where I used to live in London - a mere 3.6 miles!)
2. Mr Surgeon Man is leaving the hospital as is to be replaced with a doctor with a pretty horrific reputation as he is returning to work in Gibraltar

Now, I can forgive the mixup with the hospital in the UK, it happens... but point two above needs clarification. This is not just some idle slander, this is documented and well known within the local community. There is a great case study here where a patient originally treated by this surgeon went through hell for a broken femur and was eventually fixed properly at a specialist centre in the UK. Which one? Nuffield Orthopaedic Centre in Oxford.

Needless to say, I will be declining treatment by said doctor and have already begun arrangements to continue seeing Mr Surgeon Man privately upon completion of my consultation (and, if required, surgery) at UCLH.

Change of plan, off to the Royal Orthopaedic Hospital, Stanmore

Contrary to last week's post where I was planning to visit the Nuffield Orthopaedic Centre in Oxford, a little bit of internal hospital politics has gotten in the way at the GHA and I'm now going to the Royal National Orthopaedic Hospital (RNOH) in Stanmore, Middlesex... only 10 miles north from where I used to live in London - familiar-ish surroundings at least.

As for the shitty politics, to save going round in circles, the issue can be summarised as follows:

• Mr Surgeon Man knows Mr Specialist Man in Oxford and has referred patients there in the past
• Mr Specialist Man looked at my xrays and case file and decided he needed to see me before making a decision on best course of action
• Mr Specialist Man arranged for an appointment for me at his clinic at the end of October
• Mr Surgeon Man gave this info to the "Sponsored Patients" Department in Gibraltar
• "Sponsored Patients" declined to send me to Oxford... reasons for which are unclear, but I have deduced thus far that it's something to do with cost and/or the fact that they don't have SLAs in place with this centre
• Mr Surgeon Man fought my case with Mr Director of the Hospital Man who refused and told Sponsored Patients to find an alternative
• RNOH is said alternative

I have yet another appointment with Mr Surgeon Man tomorrow where I'll hopefully find out when I'm going to London.

The saga continues...

Off to see a specialist at the Nuffield Orthopaedic Centre

Yesterday I received a call to let me know that I would be going to the Nuffield Orthopaedic Centre in Oxford to see a specialist in non-union of fractures (hereby referred to as Mr Specialist Man). My appointment is scheduled for the 28th of October and I need to go and see the sponsored patients department at hospital to sort out my travel arrangements, etc.

As the Gibraltar General Hospital is just that, a general hospital, anyone requiring specialist care gets referred to a specialist centre such as the NOC in Oxford when their care requires it. As we have a general medical scheme here which means we get medical treatment covered by taxes and social insurance, etc, the Gibraltar Health Authority pays all expenses associated with travelling to see your referred specialist... kind of like going privately, at no expense to yourself.

For now, I only have a consultation to attend in Oxford as Mr Specialist Man wants to see me personally before he decides on a course of treatment... that will be a full 7 months since I originally broke my humerus.

Non-union of my fractured humerus

To be approaching the end of the fifth month after having broken your humerus (following two operations that required general anaesthetic and overnight stays, some day surgery to remove some internal stitches - agonisingly painful without any anaesthetic at all, various trips to physiotherapists and occupational therapists, plastic braces, 6 screws, a titanium plate and more painkillers and medication than you can shake a stick at) and be informed that you have a non-union of your humerus fracture and the metal might need to come out, is pretty soul destroying... Today has been a shit day, summarised below:

Non Union of a Humerus Fracture

When the first words out of your surgeon's mouth after seeing your latest xray are, and I quote: "ohh, shit", you know it's going to be a pretty bad day, especially considering I was only meant to be having the last of my stitches out today. If we take the xrays I had taken on the 27th of July:

with today's:

we can see what the surgeon referred to as non-union and collapse of the fracture site. He quickly gets another surgeon and colleague of his in to take a look and the general consensus reviewing all xrays is that I either have an infection in the bone or my body is rejecting the screws/plate... either way, not good and in all likelyhood the metal is going to have to be removed in a third surgery and I'm going to be back to square one.

For now, I am back in a humerus brace to stabilise the fracture whilst my notes and xrays are sent to a specialist in non-union of fractures in the UK for him to review... great.

Humerus Fracture Operation - Getting My Plate

There are two main forms of reconstructive surgery for a broken humerus that I had explained to me, a humerus rod and a humerus plate. The general gist of each operation goes as follows:

Humeral Rod

This procedure involves drilling through the upper arm and clavical to open up a gap so the rod can be slid down the inside of the humerus. Holes are then drilled through the humerus so screws can be affixed to the rod, securing the break

There is a great photo of the resulting effect on this press release, however, this involves further trauma in order to open up the bone to insert the device.

Humeral Plate

A humeral plate is simply inserted into the arm having made an incision between the bicep and tricep, avoiding the radial nerve and screwed in place to stabilise the break... as model by yours truly below:

Needless to say, the incision to insert a humeral  plate is pretty funky:

As the pictures show, my surgeon decided that not submitting my arm to the further trauma of a humeral rod was for the best and instead opted for a humeral plate. The resulting surgery took in the region of 2 hours and was considerably uncomfortable at first... no surprise there. The most uncomfortable sensation however, was nothing to do with my arm, but hip. You see, they decided that a bone graft was required to stimulate recover within the gap between the bones, and took a piece of bone from my hip, known as an iliac crest harvest. The resulting scar (don't click if you're squeamish) and the sore leg that came with it, were pretty horrific.

Plenty of morphine, tramadol, diclofenac, paracetamol and 3 nights in a private room (beats sharing with "the poor old dear who had obviously left her marbles somewhere back in 1973 who refuses to sleep" again!) and I was released with an appointment to see yet another professional who we will dub: Little Miss Physiotherapy.

Broken Humerus - Time For Surgery

It's hard to believe, approaching the day of my operation, that it has already been over two months since I initially broke my arm with little to no signs of real healing or union as the doctors like to call it. It's Sunday evening, I've been called in to St Bernard's Hospital (yes, the view is actually that nice, from some rooms!) a day early, as the Dudley Toomey Ward already has a bed for me (in a private room no less) and they don't want to lose it (to someone who requires overnight treatment comes in through A&E for example).

I'm issued with theatre stockings (help stop deep vain thrombosis (DVT) setting in) and a gown, offered a bite to eat and reminded that as of midnight there is to be no consumption of solids, and no fluid as of 7am... the fasting starts, the time for surgery is upon me!

7 weeks in a humerus fracture brace - Surgery time!

A couple of nights after the brace was put on and the nice night's sleep with Mr Surgeon Man's prescription for diazepam I was out of hospital, and the next 7 weeks basically followed a pretty structured pattern:

1. Go see Little Miss Radiology or one of her associates on a Wednesday
2. Go see Mr Surgeon Man at the fracture clinic to analyse Little Miss Radiology's pictures
3. Renew my co-codamol and tramadol prescriptions
4. Carry on my day and return the following Wednesday

However, by week 7, with no signs of unison were visible in the fracture area, I guess fixing a broken humerus is harder than originally anticipated... surgery is scheduled for June 6th (a full 9 and a half weeks after the initial break) to insert a titanium plate into my arm. The parts are ordered, I have some pre-surgery tests for infections, that sort of thing and sent on my way, to return first thing on the Monday morning to finally get this sorted!

Hurrah!

Post-script edit:
My broken humerus was sure causing some funky bruising in my lower arm during those 6 weeks: