Geoff

Age at interview: 64

Brief Outline: Around 2007 Geoff was diagnosed with arthritis in his left knee and had partial knee replacement surgery. Around 2011, four years after having surgery to his left knee, Geoff was diagnosed with arthritis in his right knee as well. In 2014 he had his right knee replaced.

Background: Geoff is a painter/decorator. He is married and has 4 adult children. Ethnic background / nationality: White British.

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Around 2007 Geoff was diagnosed with arthritis in his left knee and had partial knee replacement surgery. His operation was successful and he could do most activities such as walking, cycling and bending the knee. At that time the Nuffield Orthpaedic Centre, an NHS hospital, invited him to take part in a five year study of people who’d had partial knee replacement surgery. 

Around 2011, four years after having surgery to his left knee, Geoff was diagnosed with arthritis in his right knee as well. His GP said that he would refer Geoff to the hospital but, one year later, Geoff still hadn’t heard anything. He phoned his GP and found out that he had not been referred, as he had been told. His appointment finally came about because, as part of the five year study, Geoff had an appointment to assess the progress of his left knee. After telling doctors about the arthritis in his right knee, Geoff was given an appointment to go back to the hospital five months later. At that appointment, he saw the specialist and partial knee replacement surgery was discussed. Given his experience with his left knee, Geoff was not at all worried about having knee surgery and agreed to have it again. Surgery to his right knee was also successful and Geoff could do most things like walking, going up and down the stairs and climbing a ladder. He has no pain and can bend the knee without problems.

Geoff is very happy with the hospital care and health professionals that have looked after him on both occasions. He feels that doctors have provided enough information and explained things well and in detail. He found the Technology Enhanced Patient Information (TEPI) information videos very informative and watched them several times on his own and with his wife and grown up children. He would have liked the website to have had information on exercises as well.

Geoff feels that there is room for improvement in terms of aftercare and information. He would have liked more information about how to manage his pain medication. When discharged from hospital, he was given painkillers but very little advice on how long to take them for, particularly as they were a high dose. With hindsight, he says that he probably was told by the hospital staff but he couldn’t remember. Geoff also found it difficult to wean himself off the painkillers (tramadol). For a week after stopping them, he had the shakes, felt hot and couldn’t sleep. Geoff was also unsure how long after surgery he was supposed to keep the leg stockings on to prevent deep vein thrombosis.

Geoff would have liked physiotherapy after surgery. He was given a leaflet that showed the exercises he needed to do but feels that feedback from a health professional would have been helpful.

The whole family knew what Geoff’s operation would involve. He watched the videos again after surgery and was reassured to learn his discomfort was normal.

They also had a video that I could watch. So I could… they gave me this and they showed me where you could see the partial knee replacement, the damage it had done, the things that they were going to do to it and the things for recovery, which was good.

Was that the pre-op, the pre-med appointment or with the surgeon?

With, I think it was with the surgeon. I went to see the physio lady and she went through it with me and told me what would happen and get on the site and do this.

So you looked at it while you were there?

Yeah and then I looked at it when I got home. She said… told me which… she wrote down which website it was and I watched it when I got home and showed my wife, showed the kids.

What did they think?

They all thought it was pretty good. It was good information and everybody knew what was going on instead of thinking, 'Well Dad's going in.' I mean my children are old, they're over thirty but, 'My Dad's going in and he's just going to have a knee stuck on and he'll be back home.' But they could actually see what was happening.

So that was good to have that website?

Yeah, yeah

Did you have anything like that for the first knee?

No it was just…this was new, it was good.

And you saw it once with your wife and kids, did you look at it again at all?

Yeah, I looked at it when I'd come back home after I'd had the operation and looked at it a few times.

What kind of things were you thinking about when you think, 'Oh I think I'll have another look?' What sort of information were you trying to get?

Well I was trying to make sure that the exercises and the pain, well not the pain but the discomfort – no pain but discomfort – was normal. So I thought I'd go and have a look and see if it's a normal thing and apparently it was.

Geoff was only given a week’s worth of painkillers. He phoned an emergency number to get a prescription for more but was unsure how long to take them for.

My leg recovery was fine I didn’t have too much trouble. The only thing I had trouble with was controlling my pain relief because he said you have to control your own pain relief. They only give me a week's worth of tablets and I thought, 'Well is that supposed to be enough?' 

And I had to phone the emergency number in [hospital name] to get some more which meant I had to go into Sainsbury's on the Sunday to get some. And I didn’t know what to do really; I didn’t know whether to keep taking two every two hours or to gradually cut them down.

So some information on that would have been helpful?

Yeah, yeah. I wasn’t sure how long I needed to take two every four hours for.

You were given a week's supply of taking two every?

Yeah, I think it was about eighty three/eight four I think they gave me which was two; I was sixteen a day for, or eight - two, four, six, eight a day, eight a day.

So you were originally taking eight a day for the first week?

Yeah

And then you weren't sure what…

No, I didn’t know what to do after that. They said control your own pain relief. The first week I was taking two of those and two paracetamols every day.

So when they say control your own relief they hadn’t really given you much more information other than that?

No, no

What would have been helpful to… for them to say to you?

I don’t know really because everybody's pain threshold's different so I would imagine that would be quite a difficult thing to plan for someone. But I don’t know if he said, "If you get any problems visit your GP," well he probably did actually. But when you're in a hurry to get out the hospital you don’t really listen to everything. But I did eventually go to the doctor and he said, you know, "Just try and wean yourself off them if you can."

Geoff was unsure how long to take tramadol. When he was weaning himself off, he felt hot, shaky and couldn’t sleep. It took 1½ weeks.

How did you find it weaning yourself off, was that OK?

Quite difficult, yeah it was difficult. 

Can you tell me about that because what was difficult?

Well I'd just get so hot and shaky. I'd just shake like anything when I started only taking one, I was sort of shaking like I had like, not DTs or whatever you know.

Because you'd been taking them for a while?

Yeah, yeah. I was shaky and all terrible things. Really hot, couldn’t sleep, could sleep for nearly a week, just cat-napped.

So which tablets…which tablets were these now?

Tramadol. 

Right. Did you have any idea this could happen?

No.

Nobody mentioned anything?

Hadn't a clue. I slept in the other room. Well I didn’t sleep, I laid in the other room because I just kept my wife awake all night and luckily we've got a spare room so I just laid in there listening to my music and cat-napped in the day time.

What would have made this situation easier?

I don’t know.

Any information, would information have helped or?

I don’t know any, but I suppose if they told you how to wean yourself off a little bit better maybe or have some sort of timescale, say please don’t take these tablets after four weeks or, after four weeks if you're still on the maximum dose try and wean yourself down to one an hour.

Would it have been helpful to know what could happen while you're trying to wean yourself off, so you know if you were being shaky but you knew that this might happen.

Yeah, if you read the leaflet on tramadol you could have anything up to two hundred symptoms I would think. There's so many – I read the leaflet and oh I got that, you know.

Did you phone the GP at all or you carried on?

I just sort of carried on. I thought, 'I've got to get off them.'

And how long did it take to wean yourself off?

A week and a half. Had a week with no sleep and then gradually got better. 

Geoff would have liked to know more about looking after the wound, preventing infections and how long to wear the stockings.

The other thing she (physio) said, "Don’t get any infections” when I left hospital. How can you not get infections if you fall over and cut your leg, how can you not get them? So I didn’t know whether to keep a bandage on it, an elastic bandage sort of thing or not, that was one of the other things. And they give you these types – you know the leg stocking things for deep vein thrombosis sort of thing. And they don’t tell you how long to keep wearing them for.

So more information about how long to wear that; how to look after the wound and, you know, make sure that you can prevent infections.

Yeah, yeah. Because if you’ve got hairy legs, those stockings drive you mad. So the first thing you want to do is pull them off. You know if they say, "Well you should wear them full-time for a week," then you'll have some information, somewhere to go instead of just putting them on when you need to or when you think you need to.

Walking down 13 steps at home was daunting and Geoff sometimes wondered if he’d damaged his knee.

Was there a video showing the exercises as well or?

No, I don’t think so no, no. Had a booklet mm.

And did you use that booklet at all or because you knew from the first time?

Well no, I did use the booklet. It may change, things might be different but I did use the booklet and I read it quite a few times because I thought I was doing some things wrong which seems that I weren't. It all seems quite good now.

So did you find the booklet helpful?

Yeah, yeah. I found the website more helpful to be honest with you. If they'd have put those exercises on the website then I would, I think, looked at it more often.

So you would have liked to have the option to look at the exercises as well on video?

Yeah, it would be good to watch someone doing them as well, not just sort of, this is what you do, bend your legs and…yeah it would be good to have a video to watch.

So were there times when you were wondering, 'Am I doing this right?'

Only coming downstairs, I had a problem coming down the stairs. I could go up but I couldn’t come down, not properly and that…I was getting a bit worried about that. I was thinking, 'Well is it because it's not glued in?' I mean it's a stupid thing to think but if it's not glued in, is it bouncing up and down; it seemed strange, it was a strange feeling.

So a bit of information even in the booklet about going up and down the stairs at home would be helpful?

Yeah, yeah. Yeah I could stand on the bottom step and do that but coming back down thirteen stairs was a bit more daunting.

Geoff would have liked physio before going back to work. He would have been happy to have it locally and pay a small fee towards the costs.

You came home, you did your exercises?

Yeah.

Did you feel you were doing them OK or how ...

Yeah, yeah.

But it would have been nice to…

To have some feedback really, to have someone else to tell you that you're doing OK. You know you think you're doing good, you can get around but you don’t know what anybody else has experienced so, with no feedback, you don’t know if you're doing good or you just sort of messed it up really until you go to a physio and they say, "Well your leg's doing well," and they bend it right over.

What would have been the ideal situation in that time, so if, you know, if the hospital or the GP or the physios could, you know, provide a service and they were listening to your feedback, what would you suggest?

It would be good after, let's say for… the first eight weeks really you can just do the standing on the stairs and whatever you do and the exercises they gave you. But after that and you're going back to work, I think it would be good to have half a day physio just doing knee bends or building your muscles up.

Half a day physio?

Well a couple of hours, not a whole half day, but yeah.

Just once or?

Just once a month maybe so once you get the idea of what you need to do you can carry on that for yourself, which isn’t so bad. But you're frightened to do anything for yourself because you know what damage you're going to do.

And there was no one available to give feedback. Did you ever feel like going to the GP or you felt…?

No, I was fine. I was happy to have no pain and go back to work.

But there was no physio at all?

No, no.

The physio is my sort of main…well not complaint really, it's just a theory from my point of view. You know, I think that it would have benefitted me just all the way through from the first time I met the physio guy to going back to work.

Even if that’s just someone here local rather than having to go back…?

Yeah, most surgeries or cottage hospitals have a physio department and you only need to spend an hour. I mean if you have to contribute towards that it wouldn’t be the worst thing in the world would it? You know, if you say you're going to see a physio it's ten pounds a session, I don’t think many people would complain about paying that for every week or every fortnight. And I think to make that decision on your own is, you don’t know if you're doing the right thing so that would be my only thing – physio all the time. And the physios I've had at the hospital and everywhere else have been really good; can't sort of complain about it, it's just not got the time to do it with everyone.

You need to increase the exercises gradually. Geoff recommends setting small goals and building up to doing more. He felt much better within ten weeks.

I would think don’t really rush it the first six weeks, take your time. Don’t try and walk up the stairs three times a day if you don’t need to, once is enough. If you’ve got a downstairs toilet, use it; don’t just go upstairs because you think it's going to make you better. It really does need to build up but I think personally, you know, I think you need to do the exercises; you need to build it and then gradually do all these things but not all in one week.

But do you think people will have a tendency to want to do everything as quickly as possible?

Mm most people I know would say, "Well I'm going to do that today." Set little goals and think, 'Well I've done it today, I'll do twice as much tomorrow.' And then when you sit in the chair and you think, 'Oh that hurts a bit,' you know and you cause yourself a lot of pain I think.

And if someone was told they had arthritis and they were suitable for the half knee replacement, and they're thinking about having it, what would you say to them?

I'd say have it every time. Yeah, I've got a friend now who's got the same problem that I've got and he said he's going to have to have it done – so go and have it done. Within ten weeks you're going to be fine.