Birvidik

04 March 2018 | at last
02 March 2018 | or 'A crisis of conscience'.
09 February 2018
22 December 2017 | or 'Making a Spectacle of Myself'
09 December 2017 | I’m not sure this is a good idea, but what the Hell – I’ll give it a go anyway.
02 November 2017 | or 'The Naked Truth'
21 July 2017 | and if you don't like them...well I have others. - Groucho Marx
31 January 2017 | or Pygmalion revisited
25 January 2017 | (or cries in the wilderness)
31 October 2016 | or 'Foraging & Familiarisation'
23 October 2016 | or 'Technology 4 - Newbury Nil
08 October 2016 | or 'Driven to Distraction'
26 August 2016 | Or 'England Expects'
04 August 2016 | or Take a run at it
26 July 2016 | Or Daniel - Chapter 5, Verse 27
17 April 2016 | or 'Reasons to be Cheerful, Part 3
14 April 2016 | or 'Tales of the Unexpected'
02 December 2015 | you are single minded; he is blinkered
16 October 2015 | or National Stereotypes R us
11 October 2015

The full, gory details

04 March 2018 | at last
So - surgery all done and dusted. It cost five grand altogether, plus flights. Still cheaper than getting it done in Spain.

And what does one get for one's five grand? Well, quite a lot really. In chronological order:

• Consultation with pre-assessment nurse
• Microbiology tests for MRSA amongst other nasties.
• Pre-operative consultation with surgeon.
• Pre-operative blood tests.
• Private room for one day (as long as you're out by 8 p.m.).
• Pre-operative consultation with anaesthetist.
• Disposable theatre gown and fetching anti-embolism socks.
• Use of theatres and services of nursing staff (Reception, theatre proper and recovery).
• Surgery.
• Assorted instruments, drugs and anaesthetics.
• Complementary arm sling in fetching navy blue.
• Post-operative consultation with anaesthetist.
• Post-operative plate of rather nice sandwiches & endless cups of tea.
• Assorted painkillers of varying strengths, including some medium-duty opiates.
• A slack handful of anti-inflammatories.
• Post-operative consultation with surgeon.
• 2 x physiotherapy sessions
• Post-operative INR blood test.
All of this organised and carried out within a two week period. I think they've done this sort of thing before.

Things got off to a bit of a shaky start with the pre-assessment consultation. After the usual questions on medical history and current drug regime, she moved on to lifestyle. "Do you smoke?" she asked.
"Not for 26 years" I replied smugly.
"What about alcohol?"
"Between thirty and thirty five units a week."
This took her aback a tad. I suspect that clinical staff have a very low opinion of patients' veracity when asked questions such as this. I think they have a general modus operandi of taking the proffered answer and at least doubling it. She obviously thought I was in the Oliver Reed/Jeffrey Bernard category or NFJ as it is known.*
She looked at me askance. "What do you mean by a unit?"
"The equivalent of 10 ml of pure ethanol."
This didn't help.
"So what's 30 units in terms of bottles of wine?"
"Depends on the strength of the wine and the size of the bottle." I countered. She didn't seem impressed by this line of analysis. "I'll tell you what" I suggested, "Just put Drinks too much." After that, all went swimmingly.

Apparently, shoulder surgery is a bugger for post-operative pain. For that reason, the anaesthetist used an interscalene nerve block. This completely numbs the arm and has the added advantage of enabling the use of a much lighter general anaesthetic. This is a good thing for decrepit old gits like me as inhalation GAs have a reputation for accelerating the onset of dementia when given to those of us who are already well on the road to ga-ga land. The blocks are also popular with the surgeons as, should the patient start to come round on the table, (s)he still can't feel a thing. I have it on good authority that surgeons find it very difficult to concentrate when there's a load of agonised wailing and thrashing about going on.

The block lasts about 24 hours. This means that when I woke up, my arm didn't. Now this was obviously a good thing given the state it was in. They had ground off a couple of bits of bone and carved away some chunks of capsule. Then for good measure they gave it a good manipulation under anaesthetic. This involves wrenching the arm into all sorts of positions that it really doesn't want to get into, making the MUA a sort of slightly kinder version of the strappado as practiced by the mediaeval inquisition. It still leaves your shoulder feeling like it's just been put through a mangle, but at least it didn't hurt at the time.

These sensory joys, though, had to wait until the block wore off. Until that happened, it was a very weird sensation indeed. The sensory and motor nerves were blocked and so, as expected, I could neither feel it nor move it. This is a strange enough feeling as it stands, but what made it really bizarre was that the proprioceptors were hors de combat as well. These are clever little beasties scattered throughout the body in muscles, tendons and joints. They relay information to the brain that enables it to know where all the different parts of the body are and their positions relative to each other. It is from this that the brain recognizes that different parts of the body exist and that they are part of what the brain recognizes as 'self'.

When the proprioceptors in a part of the body are blocked it ceases to be recognized as part of yourself. The subjective experience is that there is something alien attached to your body; as if some raving psychopath had, just for the Hell of it, removed an arm from a corpse and stitched onto your shoulder to hang there, swinging uselessly. It's a very strange psychological phenomenon. You can look at it and see that it looks exactly like your right arm. You can touch it and see that it's an integral part of your body, but psychologically it's not you. You feel like Boris Karloff in 'Frankenstein'.

This impression is enhanced as the block wears off. Sensation and motor control return erratically and spasmodically. The affected limb behaves itself and follows instructions most of the time but will occasionally and unpredictably suddenly drop or equally unpredictably flick upwards. If you'd put me in a wheelchair I'd have been a dead ringer for Doctor Strangelove.

All this malarkey started about 24 hours post op. After another day or so, things returned to something vaguely approximating to normal. The pain was dramatically less than pre-operatively and the range of movement was much improved although far from what most people would call normal.

Apparently, one of the bugbears of orthopaedic surgeons is that in many cases the degree of success after all their hard work and laboriously acquired skill is, frustratingly, dependent on the pitifully unreliable application and efforts of their pathetically untrustworthy patients. If the patients don't keep up with the physio for months after the procedure then they end up with severely compromised mobility and range of movement. This rather defeats the object of having the procedure done in the first place and plays havoc with the surgeons' stats when the performance data bods come snooping around.

So I'm now looking forward to at least six months of physio and unpleasant stretching exercises. The things I do to massage the fragile egos of the medical profession.

* = Normal For Jersey. Normal For Sark is about three times that.

Whoops! - There go my scruples

02 March 2018 | or 'A crisis of conscience'.
So, having spurned the blandishments of the Spanish ortho I was left with two options – Get it done on the health service in Jersey or go private in Jersey. This, given my working class heritage and left wing Guardianista credentials should have been cut and dried. I had spent my life proclaiming to anyone who’d listen (and many more who wouldn’t) that private medicine was a betrayal of the NHS and a stain on the memories of Nye Bevan and Clem Atlee; a form of class oppression whereby the rich and influential used their power, wealth and influence to jump the queue and ride roughshod over the deserving, powerless, downtrodden poor. For the sake of consistency if nothing else I should have stood shoulder to shoulder with the proletariat and taken my place in the queue.

Well, yeah, but...

It would have been sooo inconvenient and difficult, Dahling. It’s our way of life, you see – it makes things so much more complicated than they are for the common herd. Had we gone through the Jersey Health Service it would have taken an absolute minimum of six months and an endless series of appointments at spectacularly inconvenient intervals. We would have had to write off an entire summer’s cruising while twiddling our thumbs and kicking our heels waiting for the next appointment. Either that or flown back and forth between Jersey and the boat with metronomic and expensive tedium. On top of that, all those flights would have ended up costing us as much, if not more, than one set of flights and getting it done privately.

When principle crashes up against self interest, something has to give.

And in my case it was principle.

I got hold of the contact details of the upper limb and trauma specialist in Jersey and emailed his secretary. Within the space of a few emails we had arranged consultations and a surgery date convenient to all.

I could have made excuses such as that by going private I was helping to ease the financial strain on the overstretched public services, or helping to keep highly skilled and experienced consultants in the underpaid public sector, but that would have been too embarrassingly self-serving and hypocritical even for me.

So I’m just going to put up my hands and ‘fess up. To steal the immortal words of Bill Clinton, I did it because I could. I did it because I happened to be in the rare and fortunate position of being able to lay my hands on five grand without reducing myself to penury and consigning my extended family to a life of Dickensian squalor.

Full, gory details of the procedure have been delayed. To be posted after a suitable period of penance.

“Hypocrisy is the homage vice pays to virtue.”
Francois de La Rochefoucauld (1613 – 1680)

The best laid plans....

09 February 2018
Sorry for the delay. I did get the op done in the end, but not as I originally (and naïvely) anticipated. The procedure, once it was eventually done, was an unqualified success, but it left my right arm hors de combat for a while. Attempting to operate a computer with just the left arm is tedious and time-consuming in the extreme, hence the delay in updating this blog.

Anyway, so much for forethought and planning. My confident prediction that I would end up getting the operation done cheaply and quickly in Spain (See 'Health & Efficiency') proved unfounded. My suspicions were aroused during the consultation with the orthopaedic surgeon. I appreciate that orthos are a special case in that whereas most surgeons think they're God, orthos know that they're God. Given this little professional foible, I'm willing to accept a degree of airy, facile condescension in my encounters with them*.

This guy, though, took the biscuit. Any question or concern that I raised elicited a standard response of a dismissive wave of the hand, a long-suffering sigh and a barely concealed snort. The implication was that such weighty matters were beyond the ken of mere mortals such as patients and should be left to proper clever people, such as him. I suspect that the concept of informed consent had passed him by.

I also suspected that his attitude was partially a result of a somewhat fragile ego. This was reinforced by his bristling reaction to my asking how many of these procedures he had done, given that his website indicated that his specialism was spinal surgery rather than upper limb and shoulder. Queries such as this were obviously considered particularly glaring examples of lèse-majesté, as were questions on the staffing ratios and standard of care of the private hospital in which the op was to be performed; matters that had prompted several comments in reviews, as had suspicions of bumping up the price with unnecessary tests.

What really put the tin hat on it, though, was his response to my questions on the anaesthetics to be used and possible complications and side effects. Now, I appreciate that he's not an anaesthetist and I wouldn't have expected a surgeon to be au fait with the finer details of poisoning the patient to within an inch of his life (preferably without finishing him off completely). I would, however, expect him to have a rough idea of the usual anaesthetic procedure; you know, something along the lines of whether there would be a spinal block or which anaesthetic was normally employed.

Instead, he blustered, distracted and prevaricated. In the end, he suggested halothane, chloroform or ether as possibilities. Halothane has been under a cloud since the 1980s, mainly due to concerns about liver damage and sometimes fatal cardiac arrhythmias. It looks positively benign though in comparison to the other two. Chloroform is nastily toxic, especially to the heart, and frequently causes fatal fibrillation. It hasn't been used as an anaesthetic since the 1930s. Ether, although slightly less toxic than chloroform poses a serious risk of fire and explosion, especially when it is mixed with oxygen; which is almost always in the case of anaesthesia. It went out of use in the developed world shortly after chloroform. Either the surgeon was covering up for his ignorance or he'd accidentally fallen into a wormhole and been transported here from the late 1800s. Thank Christ he wasn't in charge of the clap clinic. If he were he'd probably have been prescribing tincture of mercury and arsenic enhanced by blowing tobacco smoke up the patient's arse.

My enthusiasm for getting this op done in Spain was waning rapidly. It wasn't helped by the discovery that the incidence of patients waking up on the table was even higher in Spain than it was in China, which was one of the most notoriously iffy countries in that department.

My mind was pretty well made up at this stage but he had yet to play his trump card. I asked how much the procedure would cost in all. "Between 6000 and 12000 euros", he replied. That was enough for me. If laughing-boy here said 6 - 12K you can bet the graduate debt of an entire medical faculty that it'd be as near to 12K as makes no difference. Previous investigations had indicated that having it done in Jersey would have cost around five to six thousand quid, including flights. I impersonated a News of the World reporter and made my excuses and left.

Jersey it was then.

In the interests of not overtaxing the already somewhat limited attention spans of our readers, the full, gory description of developments in Jersey will be recounted in the next, unedifying, entry.

* There are, of course, the odd exceptions to this rule and one or two orthos do bear a passing and superficial similarity to normal human beings. You know who you are JP. You may affect an air of normality but I'm on to you.
Vessel Name: Birvidik
Vessel Make/Model: Victory 40
Hailing Port: Jersey C.I.
Crew: Bob Newbury
About: Liz Newbury
Extra: 11 years into a 10 year plan, but we get there in the end.
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