HOSPITAL - WARD 4 - ORTHOPAEDIC
Hospitals are, I sometimes think, a world away from our everyday life, they seem divorced from reality, have strange routines, unfamiliar sounds and inexplicable happenings. It is as though one has passed through a portal into a never-never land. The real world is there, just through those doors, going past that window, I can see it, but am not part of it. Why am I here,? Did the pain or discomfort that I felt warrant this major upset in my life? For I am not like these other folk, they are ill, sick and disabled, whilst I merely have some slight inability to function as before. Perhaps there has been a mistake, maybe I should not be in this ward and yet my name is on the board at the head of the bed so they must know about me. Ah, I have visitors, two doctors both conferring over papers on clipboards, they approach and call me Alex! They roll up my pyjama leg and mark my knee with a black felt pen, an arrow, pointing to my kneecap obviously to make sure that it's a knee that is cut up and not an elbow. A nurse appears, confirms my name and date of birth and fixes a paper bracelet to my wrist with the details, I am now ticketed, docketed and officially a member. Everyone here appears to be conversant with the routine except me, everyone knows the difference between a sister, a nurse, a helper, an auxiliary or a canteen assistant, everyone that is, but me. I feel almost a stranger that I don't belong, an interloper here under false pretences - but my name's on the bedhead.
The first night is the worst, still in the original condition no parts cut or taken away, nothing replaced nothing but temperatures taken, blood pressures, and a peculiar finger stall like a small tea cosy fitted on a finger which by some means can check the oxygen in my blood. So many machines, will there one day be a machine not only to diagnose but to operate, treat and cure us, I think they are half way there already. But that first night's sleep! Not a hope, a strange bed, nurses scurrying ' silently ' up and down the ward, the grunts and snores of the other patients, the whole place takes on a surreal look as the main lights go out and a dim red glow replaces them. However the following day, less than twenty four hours since admission, the ward is familiar, the outside world is receding, becoming somehow insubstantial, a them and us situation, but today, today is ' O ' day..........
The day begins, light breakfast or none at all, depends when you're to go down, that's the term used, "go down", seems apt but sort of sinister, go down, nether regions, almost like "abandon hope" ..... but I digress. You get the pre-med, " just to settle you" but you know very well that it won't work, you know without question that you'll be fully conscious throughout the whole proceedings and furthermore that you will be the only who will know it. Should I draw their attention to the fact? Will someone notice and stop it all? As you are debating what to do you become aware that you are being shaken very gently and a voice is saying " Wake up Alex, wake up" and a face swims through the mist, a familiar face, can't quite put a name to it, "It's all over, Alex" but you know it isn't and you drift off to sleep again. When you awaken again you know only too well that it's over, your leg hurts like h..... and you're the possessor of a bionic knee.
Recuperation..... to recover, to mend, to be fit again these words are for the birds, you're convinced that never again will you walk normally, a life on sticks and crutches is your future, and off you go to sleep again.
The leg improves slowly, gently does it, except that the nurses and the ' physio ' continually harass you to use the tortured limb, straighten it, bend it, flex it...... when all you want to do is to let it lie in peace. Then it's crutches on the second day or was it the third? What day is it anyway, how long have I been in here? How to climb stairs with crutches, " No, no Alex, the other hand, " this familiarity, Christian names, I quite like it actually.
Each day is like a small eternity interspersed by temperatures, blood pressures, physiotherapy and meals which are surprisingly good spoiled only by a lack of appetite. A welcome diversion is Visitors, a breath of fresh air, sanity in this slightly nutty world of hospitals. They are of two kinds, the first timers who enter rather timidly, eyes scanning the beds looking for their fractured relatives or friends, and the regulars who nod cheerily to all the patients as they pass the beds. And attitudes! Why is it that as soon as one becomes a patient everyone assumes that ones mental faculties are somehow lessened, that things must be explained in simple words, slowly, carefully, poor chap, have a grape. Also there appears to be a common misconception that hospital food is not only poor but served in miniscule amounts, for all visitors insist on bringing food be it sweets, fruit, biscuits and bottles of squash. Some patients, poor souls, have a notice over their beds, 'Nil by mouth'. A polite way of saying that they intend to starve you in their own way. A thought occurs to me, would an intravenous drip of vodka be OK?
Modern medical practice dictates that no patient stays in bed a moment longer than can be helped the theory is that it keeps the blood circulating better, but my private opinion is that the staff like to see us suffer, and it makes rather less work for them, no bottles, pans or bed washes! Now bedwashes, that's really something, to experience! A bedwash is one of natures wonders, first the preparation checking that all the equipment is to hand, remembering that flat surfaces are at premium occupied by jugs, jars, bowls, sponges, toothbrushes and towels. All exposed areas are then washed towelled and talcumed, you are then rolled half way over and further parts similarly treated, rolled again and any surface deemed not to have been subjected to the ordeal goes through the mill once again.
Eventually, comes discharge, screens around, outside clothes on, which seem odd after the pyjamas, shorts and bed wear, and suddenly you are not one of the inmates. Bye! you wave, almost embarrassed that you are going and they must remain. Home, for the first few seconds it's as though it's a strange house, but familiarity soon reasserts itself, it's as though you hadn't been away at all.
Alex Smith
THE HEART MANUAL
On the 21st October last year I battled my way up to the Astley Ainslie Hospital in Edinburgh to take part in a two-day training programme to become a Heart Manual facilitator.
The Heart Manual is a six-week home-based post heart attack rehabilitation programme, designed by a cardiac rehabilitation team and supported by the British Heart foundation and the Scottish office. The programme is currently in use in more than 80 hospitals and contributes to the recovery of more than 6,000 heart attack patients every year.
The patient begins the programme on discharge from hospital following an interview with a Heart Manual facilitator. The facilitator will explain to the patient how to use the manual. Two cassette tapes are also issued which covers common questions and answers and how to relax in times of anxiety. The manual is broken up into six parts, one part for every week of the six week programme. The content of the manual covers facts about heart disease, risk factor modification, nutritional advice, exercise recommendations with progress charts, tips on relaxation, stress, anxiety, medication and surgical procedures. The facilitator may contact the patient through out the 6-week period by either telephone or house calls to check the progress of the programme.
The Heart Manual is suitable as a stand-alone rehabilitation programme or can be integrated with existing hospital or primary care based programmes.
The effectiveness of the Heart Manual was put to the test in 1988-91 when a trial took place. In the trial a number of patients were randomly allocated to a Heart Manual group and a control group. The Heart Manual group received the manual, while the other group received a package of health education literature. Patients were reviewed at six months and one year. There were a number of key findings that support the use of the Heart Manual. Key findings are as follows:
MUSCLES
5. Gluteus maximus
The Gluteus maximus is the largest muscle of the human body and is situated in the buttock area. The muscle plays an important role in human locomotion, if it becomes weak it will affect you from standing from a seated position on a chair and may contribute to a forward leaning posture of the upper body at heel strike when walking.
Where is my Gluteus maximus muscle?
The Gluteus maximus originates from the outer surface of the ilium (upper portion of the pelvis), the posterior (rear) surface of the lower vertebrae. The muscle inserts into the upper part of the thighbone.
What is the action of the Gluteus maximus?
The Gluteus maximus extends and laterally rotates the thigh.
How can I strengthen my Gluteus maximus?
Performing an exercise called a bent leg raise can strengthen the Gluteus maximus.
To effect a bent leg raise, rest your body weight on your forearms and one knee. Keeping the leg bent at 90 degrees, smoothly take the leg both out to the side, and upwards whilst maintaining the same position.
Perform one or two sets of 10 to 15 repetitions.
Exercise precautions:
Avoid excessive twisting from your lower spine throughout the exercise.
Some cardiac medications such as Beta Blockers can cause a delayed response in blood pressure when changing from exercises on the floor to an upright posture. This may result in the feeling of dizziness.
(Please note, before performing any exercise at home it is recommended that you seek the advice of an exercise professional).
GOOD SERVICE?
The British Heart Foundation in association with the British Cardiac Patients Association have published a booklet entitled "Good Service?" concerning the National Service Framework for Coronary Heart Disease (CHD). It is a guide for heart support groups, consumer groups and individuals interested in how services for CHD in England are developed and describes the services and care that can be expected by a CHD sufferer. The booklet explains what the framework is, why we need it and what it could achieve.
The Framework for CHD covers the reduction of heart disease in the population, preventing CHD in high risk patients, heart attacks and unstable angina, stable angina, revascularisation (angioplasty, bypass), heart failure and rehabilitation. There are four leaflets included with the publication which summarise the tests and treatments that a patient should have. The four topics relate to the period in hospital after a heart attack or suspected heart attack, the period when the patient first returns home, heart failure and stable angina.
It is made clear in the publication that it is not a substitute for for the advice that the patient's own doctor or cardiologist can give, based on his or her knowledge of the patient's own condition and points out that in some cases there may be medical reasons for not giving a particular treatment, so not all people may receive the treatments descibed in the National Service Framework for CHD.
Anyone interested in this publication can get a copy from the British Heart Foundation, 14, Fitzhardinge Street, London W1H 6DH Tel: 0207 935 0185
STENTS
Angioplasty is a well proven treatment for opening up narrowed coronary arteries which supply blood to the heart. The technique involves inflating a tiny balloon in the part of the artery which has been narrowed by a build up of deposit on the artery wall. The balloon expands the artery and thus improves the blood flow to the heart. Since it has been discovered that the artery can collapse again after this treatment it is now usual to insert a tiny perforated tube, called a stent, at the blockage site to hold the artery open. In some cases the battle is not over! One of the drawbacks of stenting has been a tendency for tissue to grow around and within the stent, blocking the artery once again. This process is called re-stenosis and in order to prevent this a new stent is now available which is coated with a drug which is released into the area immediately around the artery. This drug works by interfering with the growth of new tissue and as a result there is far less re-stenosis than might otherwise occur. Large-scale clinical trials have yielded impressive results.
You may have noticed, or perhaps not, that your Editor has sported a stent for the last five years. Obviously this is one of the old type but seems to have worked well so far. When it was fitted I asked if there were routine maintenance inspections to monitor its efficiency but told such procedures were not necessary. I am sure that many other THROB members have stents and I would be interested to hear if any of you have experienced this problem of re-stenosis and if so what was done to alleviate it. Any useful advice could then be passed on to other members through the Newsletter.