medical, personal, ramblings

Ten Things

Having just had my second knee transplant (sorry, total prosthetic knee replacement) I thought that for this month’s Ten Things I should maybe write a few of the important things I’ve learnt about knee replacement operations.
Ten Things I’ve Learnt about Knee Replacement
I’m taking as read all the usual stuff about operations, general anaesthetics, etc. (like anti-DVT stockings, morphine causing constipation). This is knee replacement specific things. First of all it is important to realise that no two knee operations are the same, so what follows is based on my experiences; yours may be different.

  1. There are three key people in a good outcome: a good surgeon, a good physiotherapist and you! Yes, you! A good surgeon and good physio are critical, but it is equally critical that you put in the work at rehab!
  2. If you can find out who your surgeon will be, check him (or her) out. If you have a choice, ensure you get someone who specialises in knee replacements rather than a generalist. What’s their track record? How many have they done? The more experienced they are the better.
  3. Anything you can do before your operation to strengthen your legs muscles, specifically the quads at the front of the thigh, is going to be helpful in rehab.
  4. Before you go into hospital ensure everything is ready at home, especially think about trip hazards: gangways are clear, rugs are stuck down or removed.
  5. Get a urinal (maybe two) with a lid – something to pee into in the middle of the night. (They’re cheap and many come with a “female funnel attachment”.) Even with a light on, you do not want to be staggering to the bathroom, on crutches, maybe in pain, barely half-awake, in the wee small hours and while trying to avoid the lurking cats and dogs.
  6. Unless you have a “slave” (aka. a partner) to fetch and carry for you, get a good bag (shopping bag size) which you can put over your shoulder or round your neck to carry things around when you’re using crutches.


    7. A typical before and after x-ray; note the realignment of the femur and tibia

  7. Post-op your enemy is infection. Ensure no-one (and I mean no-one) touches your operated leg without having visibly washed their hands and are preferably wearing disposable gloves.
  8. Do as much as possible to ensure you get a good physiotherapist. Poor, or no, physio is the fastest way to ensure you don’t recover your mobility. Rehab physio will start in hospital; they’ll likely have you standing with a frame and walking a few gentle paces just 12 or so hours after your operation. You will be given exercises to do. Do them – as much as you can through the pain (but stop when it gets too painful). And keep doing them. Make sure you get as much post-op out-patient physio as you can and that your first session is within 7-10 days of leaving hospital; these sessions will help monitor your progress and adjust the exercises to your needs. The physios are not there to be sadistic (though sometimes it feels like it!) but to get you doing the right exercises, the right way, and at the right time, to ensure the best possible outcome.
  9. Recovery is painful! Think about what has been done – someone has done around 90 minutes serious carpentry to remove the degraded bone and replace it, very accurately, with some highly engineered metalwork; and that’s all on one of the most complex joints in the body. Discuss pain control with your clinicians; they will prescribe the right analgesics. Although the pain will recede over time, do not expect to be pain-free for several weeks. But a good outcome is well worth the pain.
  10. You should be provided with elbow crutches and taught to use them in the day or so after your operation. You will need them for several weeks. Go carefully and don’t get over-confident as this will lead to accidents. On the other hand you should be encouraged to dispense with the crutches as soon as you safely can.

There is a lot more I can say, and I do intend to try to write all this up for the benefit of others. But that will do for now!

books, ramblings, words

Written Rules

If you think that good, clear, written English is irrelevant, pedantic or elitist you really need to think again and read this from the Guardian …

Don’t press send … The new rules for good writing in the 21st century


Regardless of style (which needs to vary with context) good, clear, factually correct writing which is correct in grammar and spelling, helps engage the reader. And after all, that is what you want, isn’t it!?
And yes, NHS and HMRC, I’m looking especially at you!

words

Word: Cunctation

Cunctation
Procrastination; delay; tardy action.


The word is derived from the Latin cunctārī, to delay, and according to the OED was first used in English in 1585.

history, links, science

Your Interesting Links

Here’s this month’s round-up of miscellaneous links to items of interest or amusement from the last few weeks.
Science & Natural World
Is it an asteroid? No. Is it a comet? No. It’s actually something new: a binary comet.


At the other end of the spectrum, fishermen in New England have caught an unusual lobster: not a blue one but an even rarer translucent lobster.
On land, you wouldn’t think a 1kg rat could evade attention for long, would you? But a totally new species of giant, tree-dwelling, coconut-eating rat has been discovered on the Solomon Islands.
Health & Medicine
Just as our grannies always told us: worrying about our health makes us ill.
Most obesity is, in one way or another, caused by over-eating. But why do we over-eat? Until we actually understand that we’re unlikely to be able to crack the obesity problem.
According to the current fashionable theory, biological sex is a spectrum from 100% female to 100% male. Which makes sense when you consider the variety of ways in which genetics can muddy the waters. Scientific American explains.
Sexuality
Does sex (and orgasm) always have to be “red hot”? Many think it does, but reality is that there will be huge variations – and that’s good.
Environment
Concreted over front gardens should be banned. Concrete causes flooding! [Actually in many instances planning permission is already required for concreting over/paving front gardens.]
History, Archaeology & Anthropology
The Romans had a herb which we seem to know almost nothing about, and it was so valuable Julius Caesar kept a cache in the government treasury. [LONG READ]
The Abbots Bromley horn dance is thought to be the oldest folk dance in Britain. It is performed annually on Wakes Monday (the first Monday after 4 September). Some pictures from this year’s celebration.
Sheela-na-Gigs are female genital sculptures often dating from medieval times, or earlier. There’s now a project to catalogue all those in Ireland.
Like black cats, crows and ravens are variously viewed as lucky or malevolent. Either way they have a lot of associated folklore.
London
IanVisits discovers a hidden industrial marvel at Canary Wharf.
And here’s another, more up-to-date technological marvel from IanVisits … 3D-printing is being used to make large pieces of Crossrail stations.
Food & Drink

And finally … We shouldn’t be worrying about Brexit and food shortages, after all there’s always spam and tinned peaches. [LONG READ]

books, sexuality

Book Review: Ethical Porn for Dicks

David J Ley
Ethical Porn for Dicks: A Man’s Guide to Responsible Viewing Pleasure
ThreeL Media, USA; 2016
Do you watch porn? If you’re male there’s a very high chance that you have at sometime in your life, even if you don’t now. If you’re female the chances are still good that you have done.
Do you believe that porn is bad for you? That it incites sexual abuse and violence? That all the performers are doing it because of exploitation, their working practices are unsafe and they have no control?
Do you feel shame because you, or your partner, watch porn?
If the answer to any of these questions is “yes”, then this book is for you. OK it is American and is aimed directly at men, but in my view it is relevant for everyone from mid-teens upwards, and whatever their gender and sexual orientation.
Our media are filled with cautionary, polarizing messages about the dangers of porn, even while sexually explicit images are exploited deliberately and persuasively in adverts and entertainment. This book offers anyone feeling shame and anxiety about their own, or their partner’s, behaviour a non-judgmental way to view and use pornography responsibly, while exploding many of the surrounding myths.
Ley is an expert on issues relating to sexuality, pornography and mental health. As a practising psychologist he is the head of a large behavioural health and substance abuse out-patient programme. Consequently he is able to bring years of first-hand experience, and academic credibility, to understanding what the problems of pornography are, and aren’t.
The book’s style is casual and accessible while remaining evidence-based – it isn’t littered with footnotes, but all the referenced texts are listed in the bibliography. Because it is broken down into about ten chapters, each consisting of several discrete sections, posed as questions, it can either be read cover-to-cover (as I did) or can sensibly be dipped into.
Just two quotes from the book …

Porn, for better or worse, is here to stay. In the US, it is protected under free speech, and it needs to be because if we lose the right of free sexual expression, we lose many other critical protections. Porn, as illustrated by … cave drawings … has been around as long as humanity. Attempts to get rid of porn are just more likely to drive it underground, where it is secret and hidden. And under such secrecy, people are more likely to get hurt or taken advantage of, and lose the ability to freely consent.

Rates of sexual offending go down as people in a society have more access to pornography. This is research that has been replicated in the United States and around the world. People don’t talk about this because they don’t want to acknowledge what it means. Porn is good for society. A society with more access to porn is a sexually safer society. Access to pornography may decrease rates of juvenile sex offending even more. If pornography were a moral-altering thing, turning weak-minded people into rapists and paedophiles, it would have a greater negative effect on teen boys. And it doesn’t. Just the opposite. Gay men watch more porn than straight men. But rates of rape and sexual violence in gay men are lower than in heterosexuals.

These are two of the key messages from the book. But there are two more which struck me:
First … We need to keep firmly in mind that porn is fantasy, in just the same way that Terry Pratchett and Disney are fantasy. It isn’t real life and we shouldn’t treat it as such. Just as real life isn’t filled with giants, battles and fairy princesses the way fantasy novels/films are, so real life sex isn’t (certainly shouldn’t be) violent, abusive and non-consensual. Porn may portray these traits as part of their fantasy fiction (and indeed many have them as mental fantasies) but neither is real life, properly adjusted, sex. We need to help people, especially the younger generations, understand this.
Secondly … If you worry about the exploitation aspects of porn then there are many producers who create ethical porn – the performers are well paid, their health is looked after, their working practices are safe and they have control over what is, and is not, permissible – then this book references several of these together with a long list of resources at the end.
Having said all that I did find the book rather too easy-reading; I wanted some more meat – but that’s me with my scientific background. Overall, if porn is a subject which interests you, or on which you feel you need more knowledge to help inform your children, then you could do much worse than read this book.
Overall Rating: ★★★★☆

medical, personal

Knees Up Again

1 Comment

[If you don’t like things medical, skip this.]
So it’s now a week and the day since I was let out of hospital after a complete left knee replacement to match the right one that was done at the beginning of the year. On the left, here’s the knee before (notice the impressively neat scar on my right knee that was prepared earlier) and on the right dressed post-op:


I suppose the knee is getting better although it doesn’t feel like that much of the time. Initially when I was in hospital it was a lot less painful than the right one had been but since I’ve been home the pain has been more like the same and at times obviously quite bad – which is very frustrating, depressing and demoralizing; but I guess that all part of healing process.
Admittedly all this is being done privately – we’re very lucky in that we can afford medical insurance – and generally I cannot fault hospital. [For anyone contemplating having knee surgery privately, don’t expect any change out of £15,000 per knee.] I had the same surgeon, the same anaesthetist, most (if not all) the same theatre team, and even the same physio on the ward – and I’m even booked in with the same guy as before for outpatient physio – that’s just one of the benefits of going private!
I had a spinal anaesthetic (so I was conscious; recovery is much nicer than a general anaesthetic) and was in theatre on the Wednesday afternoon (13 September) for about two hours. This was followed by an hour in recovery and overnight in the HDU because of my sleep apnoea. Then back in my room for lunch on Thursday.
I still don’t understand how the medics do this! They can rip you open; do 90 minutes serious carpentry; glue you back together; and have you on your feet 12 hours later. In fact the physio had me out of bed and walking few steps with a frame at 10 o’clock the following morning. Rinse and repeat twice a day. On the Friday morning the physio took the Zimmer frame away and left me with crutches; they also made me do a very small, test, staircase in their gym – this was fine although I had struggled with it back in December.
On Saturday morning my surgeon ran in about 8:20, wearing jeans and a rugby shirt, had a quick look, said yes OK you can go home, I’m now off to Portugal for a week (playing golf, needless to say!). Later that morning a physio arrived and took me to do a complete flight of stairs (down and up) and walk a corridor, which was all OK. All the boxes ticked I was allowed my freedom at lunchtime.
What annoyed me was that everyone arranged follow-up appointments according to some notional idea of what they should be and not what the surgeon had told me to do, and as I had requested. They then left me to chase around on the Monday to rearrange everything. That I was not impressed with.
By the time left hospital I had about 80° of flex on the knee; I probably now have about 90° – which is more quite a few people manage after a year; so I guess I should not be too downhearted.
However since I’ve been home everything seems to have been more painful. My GP had a quick look at the knee on Thursday as she was slightly concerned I might have wound infection. However the nurses at hospital changed the dressing on Friday and were very happy everything was OK and no infection. In fact the wound was actually very good and healing well as you can see from the photograph below.

Yesterday, Saturday, I was worried because I seemed to be able to do nothing except sleep all day; totally unable to stay awake. I just could not get the knee comfortable: sitting at my desk was unbearable, lying down slightly better. It’s still not great, but a bit better today.
What more is there to say? Obviously I’m still on crutches and painkillers and will be for a while – although my surgeon says to get rid of the crutches as soon as possible. Obviously I’m also having to do exercises and I know once I see the physio in out-patients in a couple of days time they will get more and harder.
Noreen is being heroic in putting up with me – anxiety, misery, depression and all – and everyone has been sending me good wishes (thank you, one and all!). To top it all, to cheer me up, my lovely friend Katy has sent me a tasting box of various gins (below) which I shall enjoy exploring once I’m no longer on wall-to-wall codeine.

quotes

Monthly Quotes

So here’s this month’s selection of interesting, amusing or thought-provoking quotes.

Theory is when you know everything but nothing works.
Practice is when everything works but no-one knows why.
In our lab, theory and practice are combined: nothing works and no-one knows why.
[unknown]

The execution of Brexit has been [the government’s] real undoing, for the simple reason that nobody with the competence to do it has any enthusiasm for it, and nobody with the enthusiasm has any competence. It’s not a bad working definition of the worst idea ever, but that’s democracy. It is fitting that the party that put it on the menu should have to cook it.
Theresa May’s early flirtation with a Kim Jong-un Brexit (we do it my way, and nobody needs to know what that way is because I am glorious) has left her rather weakened, but even that isn’t the problem. Her job now is to manage down expectations, and maturely present a series of choices which are hard because they are all suboptimal.
[Zoe Williams, Guardian]

“Having sex for money is bad because it is counterfeiting feelings” wow dude, I have bad news about every other customer service job ever.
[someone unknown on Twitter]

The academies send more people out into the world with their heads full of inanities than any other public institution.
[Kant to his pupils]

Love is not about sex, going on fancy dates, or showing off. It’s about being with a person who makes you happy in a way nobody else can.
[unknown]

The Bill weaves a tapestry of delegated powers that are breathtaking in terms of both their scope and potency …
It is a source of considerable regret that the Bill is drafted in a way that renders scrutiny very difficult, and that multiple and fundamental constitutional questions are left unanswered.
[House of Lords Select Committee on the Constitution, Interim Report on the European Union (Withdrawal) Bill, September 2017]

I am not a liberal snowflake. My feelings aren’t fragile, my heart isn’t bleeding. I am a badass believer in human rights. My toughness is in tenderness. My strength is in the service of others. There is nothing more fierce than formidable, unconditional love. There is not a thing more courageous than compassion. But if my belief in equity, empathy, goodness, and love indeed makes me or people like me snowflakes, then you should know – winter is coming.
[unknown]

He [George Rapp] believed that a prolonged practice of celibacy would restore man’s ability to multiply himself alone, according to God’s original plan for Adam.
[William E Wilson; The Angel and the Serpent: The Story of New Harmony]
Adjectives in English absolutely have to be in this order: opinion-size-age-shape-colour-origin-material-purpose Noun. So you can have a lovely little old rectangular green French silver whittling knife. But if you mess with that word order in the slightest you’ll sound like a maniac. It’s an odd thing that every English speaker uses that list, but almost none of us could write it out. And as size comes before colour, green great dragons can’t exist.
[Mark Forsyth, The Elements of Eloquence]

They were not life forms. They were … non-life forms. They were the observers of the operation of the universe, its clerks, its auditors. They saw to it that things spun and rocks fell. And they believed that for a thing to exist it had to have a position in time and space. Humanity had arrived as a nasty shock. Humanity practically was things that didn’t have a position in time and space, such as imagination, pity, hope, history and belief. Take those away and all you had was an ape that fell out of trees a lot.
[Terry Pratchett, Thief of Time]

Woke to hear Aunt Leonie this morning talking in a low voice as she’s got something floating loose in her head & does not want to disturb it.
[Marcel Proust]