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Haslam's view: Dogged by post-op care instructions

I don't know whether he was just a Friday night job on the canine production line, but my dear Labrador could certainly do with a recall for a body replacement. When he was just a few months old, one of his cruciate ligaments disintegrated, leaving him with a pronounced limp that could only be treated by major surgery.

A few months ago, at the still youthful age of just six years, he pranged his other knee leaping for a tennis ball. Catching tennis balls is an activity genetically programmed into Labradors. It is their raison d'être, their source of the greatest joy and fulfilment. And so telling him to quieten down for the rest of his life was not an option. It was time to visit the vet again.

I've spent many an hour sitting in veterinary waiting rooms. The similarity with general practice is remarkable, from posters advising about immunisation to overheard conversations about extraordinary symptoms. The chief differences probably relate to distemper and euthanasia, neither of which is currently available on the NHS. All the while, my dog sat anxiously by my side, clearly sensing this wasn't a place where he wanted to spend too long. Whether he could smell the anxiety of the other animals, or just had the sense to know that being in a place where nurses brandish needles is never a good sign of anything, I don't know.

The vet, as ever, was superbly helpful, and – unencumbered by the need to score QOF points – moved rapidly to the point of the consultation. An X-ray was needed, Dyson (yes, that's his name) would have to be admitted for a general anaesthetic as conscious dogs tend to wriggle too much on the X-ray machine, and we signed yet another form for our insurance company.

A couple of weeks later, investigations were complete – no need for 18-week targets when cash is involved – and it was clear he needed a second titanium knee replacement.

And so the operation was done, and he was discharged with strict instructions to keep him rested for a fortnight, with minimal exercise for six weeks. Bed rest for a Labrador for a fortnight? Quite ridiculous. But we had our instructions.

And the first day home he wanted to go running in the garden to chase tennis balls. He didn't limp. He didn't need physio. His shaved coat irritated him, but that was about it. We followed our orders and kept him shut in one small room, and tolerated the crying that resulted.

Where do all these post-op instructions come from? As GPs we are often asked by our patients about when they can start doing this, that or the other activity. As far as I can see, most of them are simply matters of tradition. No driving for six weeks after a hernia repair seems to owe more to myth and legend than it does to evidence-based medicine. The ban on vacuuming after a hysterectomy seems equally bizarre. Maybe there are some genuine facts that The Practitioner could one day publish as guidance for all of us facing the ‘when can I start...?' questions, but I would be surprised if the research has been done. It would be far too useful.

But I do remember fondly the advice given by a consultant back when I was an obstetric SHO. He stood in the maternity ward and asked a proud, young and very new mother if she had any questions.

‘Yes,' she said. ‘When can my husband and I resume lovemaking?"

His reply was instantaneous. ‘I would prefer it if you would wait till you get home,' he said, and moved on. Now that's what I call advice.

Author

Professor David Haslam CBE
FRCGP
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser to the Healthcare Commission; and visiting professor at de Montfort University, Leicester

Maybe there are some facts on 'when can I start...?' - but no, that would be too useful.

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