J: Hip op canx. But we have a plan!

We went in to hospital today and as expected the operation is not going ahead. Actually I was a bit relieved because I am not sure I am quite well enough. We are looking at trying again in two weeks.

My son took me in to RUH Bath for 7:30 this morning. A friend who had had a hip replacement in Swindon recently had found that after reception no companions were allowed. Bath operates a little differently. For most operations you go to what I call the Marshalling Yard where anaesthetists and surgeons surround a central ‘cattle pen’ and call in their suspects for pre-op chats.

Here we were taken straight to my bed in the High Dependency Unit. This is a mixed ward for orthopaedic patients who need extra attention post-op. There is a nurse’s desk in the ward set so that they can survey all eight or so beds.

I explained that I needed bloods done asap so that Mr. Michael Bishay, the surgeon, could decide whether I was fit for the knife and they had that done by 8am. It takes a couple of hours to get the results. The plan had been for our son to go straight after dropping me off, but as he was allowed to stay in the ward, and we thought it more likely than not that the op would be cancelled, he kindly decided to stay.

Mr. Bishay came a little later and we discussed the situation. I explained that I felt pretty well and was still on antibiotics but I still had a catchy cough though my sore throat had gone. He said that was not a problem as long as it was not on my chest – which it isn’t. But the issue was my bloods, where the CRP count had actually risen to 128 on Monday’s sample. Also my haemoglobin is way out; that is apparently manageable as long as they know and a transfusion will help (still waiting for the date for the one booked last week).

I explained to Mr. Bishay that Dr. Beresford (onco) had said that my CRP levels had been consistently high, so did this not mean I’d never be able to have the op? “No.” he said. “It depends on the reason. Normally it suggests an infection. But if we think it is only because your body is fighting the cancer then we could set it aside. ” “What about the blood cultures to tell you what kind of bacteria I have, are they back yet?” “I don’t know but actually they are now outdated as you have been taking the antibiotics.” “Does it matter that the antibiotics are giving me diahorrea?” “Not as such but it indicates your bacterial balance is all wrong – I don’t like antibiotics though of course they have their place.”

Mr. Bishay went off to consult with Dr. Beresford and returned a little later. “We have decided on two options. It is up to you which to take. The first option is to operate today and hope you do not get an infection in the hip. If you do get an infection it will be very painful, you will require 6 weeks of high dose antibiotics into the artery which can be delivered weekly by a nurse at home, and you will need another operation where I will have to open up the wound and clean it all up. We will both be fed up with seeing each other in the next six months.” Sounds great eh? “Your second option is for Dr. Beresford to get you back on the Sutent immediately to fight the cancer, complete a four week course and then we will hope you will be fit enough to operate in about six weeks.”

“Is there not a Plan C?” I asked. “That I don’t take the Sutent now, complete my course of antibiotics in the next few days, operate a high level of infection control at home, allow my gut bacteria to return to normal, get rid of the cough and just get a bit fitter? The risk of course is that the cancer has more time off Sutent to start partying again, but it would get me mobile again earlier and may be a risk worth taking. Also I had no infections all year until starting the Sutent which lowers immunity. And the last one came even after I had finished the course.”

“Hmm.” He replied. “We did not discuss that but yes, I or Harvey Sandhu who you saw before, could operate in two weeks and that looks like a good option. If that is what you would like, then I am happy with that.”

So that’s what we have agreed, and we left shortly afterwards to be back home by 11:30.

This also gives me time to have the blood transfusion which Dr. Beresford requested last week. A nurse came to say that if I did not get it within a few days of the next op to let them know and I would come in the day before and they would do it in the ward. “How about me having two?” I asked. “Won’t that be better?” “No.” she said. “It could send things the other way.” “But at least you could then look at my bloods a little before the op and if necessary I could have a second transfusion?”. “Yes, that is a possibility.”

Like all these things there is no perfect decision because we don’t know the variables. We don’t know whether I will get any fitter in the next two weeks. We don’t know whether I’ll get another infection. We don’t know whether the tumours (existing or new) will kick off. Whether some other old bone will get bashed. We don’t know if the affected femur will break. We don’t know whether I’ll get another pleural effusion (the lung drain is yielding teaspoons). But I feel this gives me the best chance and am committed to the op in 2 weeks unless things change and they advise against it.

Infection control

We are going to take the following steps to reduce the risk of me picking up a bug:

  1. Ask all visitors and indeed residents to wash their hands with antibacterial gel on entering the house. I will use it myself too.
  2. Ask all visitors not to visit if they have or have just had an infection.
  3. Not visit crowded public places. (Like hospitals?). I asked a doctor if wearing a face mask would help and she said not really, only in places like cinemas where you are with the same people for a while – just shopping etc. is fine.
  4. The toughest one of all. No hugging and kissing any women! Grandchildren barred (ours are young and of the age where they are almost always a-bugged).

So fingers crossed that Plan C is a goodie!

And now for something completely off piste
The law of unintended consequences means that the country’s small airfields are now automatically designated as brownfield sites and thus priority for building. Bonkers. As the restorer of one of the last Hurricanes wrote:

KEEP AIRFIELDS GREENFIELDS. Review Airfield Classification as Brownfield Sites.

In 2003 an ‘administrative oversight’ led to the deletion of a footnote in PPG3, noting that airfields and hospital grounds should not be considered as appropriate brownfield sites. Current definitions of previously developed land make no reference to airfields or flying sites. As a result, developers and local planning authorities are increasingly and inappropriately treating airfields as brownfield sites for land redevelopment, leading both to the loss of an important part of national transport infrastructure and the destruction of significant areas of natural habitat within airfield boundaries.

The network of aerodromes around the UK has been recognised by DfT as providing vital amenities for sport flying, connectivity for business travellers and acting as an important part of the national transport infrastructure; providing economic benefits and ‘point to point’ access. This allows passengers and cargoes to be delivered closer to their ultimate destination, reducing time, cost, fuel use and emissions.

They also provide important infrastructure and support for activities such as police and pollution patrols, medical flights, aerial surveys, and search and rescue operations. In recent years however a significant number of airfields have closed and others have been threatened as a result of owners seeking to release the value of their land and local planning authorities prioritising housing and other development on the land they occupy.

It is noteworthy that the curtilage of many airfields is now being recognised as an important ‘open green space’ by many Local Planning Authorities and there is increasing evidence from local nature and environmental surveys that airfields are increasingly important as a low-insecticide, low-herbicide, sanctuary for plants, insects and associated wildlife.

In July 2015, organisations involved in every spectrum of aviation were shocked by the proposal in the Chancellor’s summer budget statement to allow automatic planning permission to be granted for housing developments on designated brownfield sites. This unintended consequence of wider policy on the development of redundant industrial sites was described by ‘Pilot’ magazine as “the darkest news to face General Aviation for some time”.

We demand a review of the brownfield designation of airfields in recognition of the role that they play both as an important part of our national transport infrastructure and as an important yet often overlooked environmental “green space”.

If you support the protection of airfields from the developers, please sign the petition and get others in our home to sign too.