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Hip op hope for cancer patients

An underlying medical complaint, even a rare blood cancer, doesn’t automatically mean you can’t have surgery to replace a painful hip or knee, writes Judy Hobson.

Retired greengrocer Brian Barnard, who lives with his wife Christine in the Yorkshire village of Mapplewell, has myelodysplasia, a blood cancer where his body does not produce sufficient red blood cells. This means that for Brian any kind of operation carries an increased risk.

In July, the 72-year-old took that risk and had his right hip successfully replaced at the Spire Leeds Hospital. Thanks to his operation, Brian can now manage to get some sleep at night and even take his two Labrador dogs on pheasant shoots.

“Before my op,” he says, “lying down made the pain much worse. The only way I could get any sleep was to sit in an armchair. My wife Christine used to dread nighttime and seeing me in such pain.

“Not only has the surgery taken away the agonising pain in my right hip, it has also meant the sciatica in my other leg has disappeared. Having the operation means that now, for however many years I’ve left, I can make the most of them.” Brian’s surgery was able to go ahead because of meticulous forward planning by Mr Anthony McWilliams, consultant orthopaedic surgeon at Spire Leeds Hospital, along with the hospital’s haematologist and anaesthetist. It could also proceed because there was a bed in the hospital’s High Dependency Unit where Brian could receive round-theclock nursing care afterwards.

“My hope is that Mr Barnard’s story will inspire others in severe pain who have other underlying health conditions to consider undergoing joint replacement surgery”

Consultant orthopaedic surgeon Mr Anthony McWilliams

Mr McWilliams says: “It is rare that patients undergoing hip surgery don’t have some form of underlying health problem because osteoarthritis is very common in older people. You find many are being treated for high blood pressure; others have longstanding chest or breathing difficulties; and some have Type 2 diabetes, putting them at increased risk of infection if their blood sugar levels are not kept under control.

“The beauty of this type of surgery is that it is elective and not performed as an emergency. This means you have time to carefully plan and are able to discuss it in depth with those patients who are at increased risk. You can provide them with all the information and then let them go away and think about what is, after all, major surgery. In my experience, very few don’t choose to go ahead.”

He points out: “Even if someone has bone pain from cancer and doesn’t have long to live, it can still be worth them having a hip replacement because it will provide them with a good quality of life for the time they have left.

"Six weeks after the operation, when the intractable pain has gone, you see your patient become a different person. Indeed, seeing the difference it has made to Mr Barnard is very rewarding and is the reason I went into orthopaedics.

“But I can’t pretend I was the only one involved in his operation. You can’t perform surgery in these circumstances without a multi-disciplinary team – the anaesthetist, the haematologist, theatre staff, physiotherapists, nurses, cleaners and caterers. Everyone has their part to play.

“Mr Barnard is the first patient I’ve operated on with this type of blood cancer. His surgery had to be carefully planned out in consultation with the haematologist and we had to ensure a bed was available in the high dependency unit where he could be closely monitored afterwards.

“The day before surgery, Mr Barnard had a blood transfusion to ensure his blood levels were high enough. We also had to ensure there was sufficient blood on standby during the procedure. To help minimise blood loss, we used a drug called Tranexamic acid, and to expedite recovery the operation was done under spinal anaesthetic.”

It took one and a quarter hours, which is normal for such surgery.

Mr McWilliams adds: “My hope is that Mr Barnard’s story will inspire others in severe pain who have other underlying health conditions to consider undergoing joint replacement surgery.

“A lot of people born during the war or just afterwards assume that because of their increased age they should expect to be in some pain, but the truth is they don’t have to be, even if they do have some other complaint.

“It certainly isn’t the case that another health problem automatically rules you out from having a new hip. An orthopaedic surgeon would very rarely tell a patient it would be unsafe to go ahead. If he did so, it would be because he thought the patient was too frail to survive the op or post-op period.”

Brian’s surprise cancer diagnosis

From the age of 15, Brian sold fruit and vegetables on market stalls in Barnsley and Leeds. He also ran a greengrocer’s shop in Wombwell. Working long hours and walking his dogs, he considered himself to be very fit.

In 2014 after suffering from severe abdominal pain, his GP referred him to Barnsley Hospital, where he was put onto intravenous antibiotics and treated for an inflamed bowel. While in hospital, blood tests revealed he was suffering from myelodysplasia, a rare blood cancer. Brian says: “I’d never heard of it and was both stunned and alarmed to hear I had a rare type of cancer that means I don’t make enough red blood cells. As a result every fortnight I have to have a blood transfusion to top them up.”

The early symptoms of myelodysplasia can include fatigue, shortness of breath and frequent infections, but Brian had not noticed any.

“Looking back, though,” he adds, “instead of walking straight up the hills when I was out with my dogs, I was starting to get out of breath, but I’d put that down to age.”

Two years after his cancer diagnosis, Brian began experiencing pain in his right hip.

“It grew worse and worse so I could no longer take my dogs on pheasant shoots. At night I couldn’t get comfortable in bed and had to sleep in a chair.”

At first his GP put it down to muscle pain and referred him for physiotherapy but that didn’t help. He was then sent for an X-ray at Barnsley Hospital, which revealed he had osteoarthritis in his hip. He was prescribed painkillers and before his op was taking Naproxen four times a day.

Eventually he persuaded his GP to refer him to an orthopaedic clinic in Barnsley where he saw Mr McWilliams, who told him he needed a replacement hip but before going ahead he would have to undergo a pre-op assessment.

Brian says: “When I asked how soon I could be assessed, I was told six weeks. I then asked how long before I could have surgery and I was told six months. I was in so much pain I couldn’t face waiting that long so I opted to go privately.

“Both Mr McWilliams and the anaesthetist explained the risks. Even on the day of the op they came into my room to check I still wanted to go ahead. I said, ‘Do you think you can get me through it?’ and they both replied yes, so I said, ‘Let’s get on with it.’

“I was admitted on the Monday and went home on the Saturday morning on two crutches. Within a week I was down to one, and a week later just using a walking stick. My new hip has given me my life back and has been worth every penny of the £12,000 it cost.”

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