External Fixator: IN - Internal Fixating Plate: OUT

Well, it's in/on, whichever way you want to look at it:

Last week I travelled to St Thomas' Hospital in London to have my infected non-union treated and operated on first thing on Tuesday morning. As my previous post detailed, this was meant to be a pretty hefty bit of surgery, removing my plate, debridement of the fracture site (which I learnt meant trimming the bone down on each side and re-setting it, which would result in a shorter arm!) and application of an external fixator as modelled above by yours truly.

The good news I was given on the Wednesday morning during my surgeon's rounds was that the situation inside my arm was not as bad as originally anticipated. Usually, according to him, you see tracks of infection leading into the bone where the infection has taken hold... which weren't present. The bone that had started to grow to try and unite the fracture was actually in very good condition and looked healthy. For these reasons, they removed some bad scar tissue and infected tissue, took out my plate and screws and stitched me back up... no debridement! No short t-rex arm! They then made the four incisions for my four lovely pins and bolted my arm together to stabilise the fracture... job done.

I was discharged later that afternoon (not every 36 hours after the surgery started!) with a plethora of anti-inflammatories, painkillers and antibiotics... which, following the swabs which were taken on Monday, are the wrong type for the small infection I do have in the tissue of my arm (the bacteria is resistant to co-amoxiclav, apparently) so they just moved me onto Ciprofloxacin (try saying that five times quickly whilst pissed, I dare you!) to clear that up.

All in all, I'm hoping this is the final straight home!

Infected Non Union of my Broken Humerus

It has certainly been a funny few weeks. We started off with a scheduled appointment with a doctor at the Nuffield Orthopaedic Centre, then it was switched to Stanmore, which was a mistake, and was meant to be UCLH. So imagine my surprise last week when I got a second letter from a hospital in the UK confirming an appointment date in very short notice!

UCLH had confirmed that I had an appointment for the 24th of November to see a specialist there in writing, which I had received on Monday. Thinking that was quite a wait until I saw a doctor again, given the fact that my scar from surgery was still weeping, I arranged an appointment with Mr Surgeon Man's replacement for the Wednesday to get things checked over. However, on Tuesday evening I received another letter, this time confirming a consultation with yet another surgical specialist, at Guy's and St Thomas' Hospital in London for Thursday the 20th of October... the very next day. 

Armed (no pun intended) with this new information, and with the prospect of possibly getting the mess that is my arm seen to sooner rather than later, I saw Mr Replacement Surgeon Man and asked his opinion. He was horrified having seen my arm for the first time and agreed that seeing a specialist as soon as possible was probably the best idea, as in his opinion, I had what looked to be an infected non-union. This was coupled with the fact that my latest set of bloods and swabs had shown signs of infection also. A quick discussion with the surgical team secretary and with the sponsored patient people and I was booked on a flight, along with my old man for support/company, that evening, to attend Guy's the next day.

After being seen by an assistant to the chief upper arm consultant and sent for some xrays, Chief Upper Arm Consultant Man gave me the news:

1. I have, without much doubt, an infected nonunion of my humerus fracture
2. All the metalwork I currently have inside me needs to come out
3. The whole area needs "debridement" with samples sent to test what bacteria is causing the infection
4. I will be placed in an external fixator which will hold things in place until they finally heal
5. This is going to take at least 6 months

So I'm back to St Thomas' two weeks today for an operation on the 8th to have all the above done... but, in a weird way, Mr Replacement Surgeon Man's tact and manner have already calmed me down. He was apologetic for the way things have gone up to now, when he has only just seen me. He was reassuring yet honest, by giving examples and success rates they've had with this technique in the past. 

So, back to square one, as predicted when I first started the blog exactly 2 months ago... I've still not done the back dating of surgery number 2 and the huge pus-filled cyst, but I will get round to it, I'm sure!

Surgical Wound Weeping

Having found out that I was not to be seen by another doctor until the 24th of sodding November, I took it upon myself to have my non-united humeral fracture and its still leaking, weeping wound seen to.

My scar never fully healed over from the original humerus surgery and as such, continues to leak/weep on a daily basis. Due to this, the chances of infection are quite high, so I need to be very careful to keep it clean, etc. This means I have not been able to swim all summer, I've not been able to go to the beach without having it carefully covered. Nor have I been able to do any exercise as sweat running down and into an open wound is never a good idea... hence my expanding waistline!

I saw Mr Surgeon Man's assistant as the new surgical consult/locum wasn't available to see me, and yet again, expressed my concerns about my arm, the weeping, etc. Whilst he went off to get a testing kit, to check for infection, I took the following photo...

Yeah, nice work! :(

Finally have my date for surgical consultancy at UCLH

24th of November... Words cannot describe how that short phrase made me feel. Sick to the stomach that I would have to put up with the constant pain, aching, discomfort and restriction until at least that day before I'm seen by my new consultant at UCLH. Alas, that was the date that was confirmed, and I now have to wait until the Orthopaedic clinic at UCLH sends over more paperwork so I can begin to get my flights and accommodation booked with the Sponsored Patients department at the GHA.

This, coupled with the news I recently had that Mr Surgeon Man is to leave the hospital, has really brought everything to a head... Pissed off :(

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.