Category Archives: Hospitals

Ginastica Italian style.

    First off, latest news. I got a new piece of information yesterday. It’s always something it seems. So I was counting on being moved from here to Prosperious for the rehab, as you know. I had a gaggle of people in the room to include the “big” doctor. I guess he’s the head guy – il capo. He has everybody’s charts and makes decision about care. I asked when I’d be moved to Prosperious and he explained that the hospital I am in is a rehabilitation hospital and they don’t send people other places. So if I want to go somewhere else it’s on me to figure it out. Again, blindsided by the System. Luther had asked the nurse on Friday and she had confirmed I could go there but nope. But misunderstanding again. He asked can she go to Prosperious after she’s finished here? Well yes, of course I could do more after. But after means after two weeks of rehab HERE. There has been much gnashing of teeth. Should we pursue the change to Prosperious, considering we didn’t know exactly how? Or should I just tough it out here. I knew my doctor was here and that’s a consideration. But Prosperious is one of the best in the country. We slept on it.

    Any orthopedic docs in the house? This was interesting to me. A list of my new parts that they gave me.

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    Another scrumptious lunch. 😏 I could eat the pasta, but not the secondi. It was unknown fish and crustaceans and extremely fishy tasting. Not to my liking.

    Physical therapy Italian style
    So, today was my first ginastica, or Physical Therapy session. I’m finding it hard to slow down to the pace they want here. I started walking with a walker yesterday. And he told me to slow down. I naturally move fast. Italians naturally move slow. And he caught me carrying the walker once and I was reprimanded. I was not to ever walk without using it. In trouble again 🙄. This morning a gaggle of us headed upstairs to the top floor (which is orange) for a session. 5 women and one man. We laid on beds and Rikki and Francestino told us what to do. I did a total of four exercises. Blink. I think the session lasted maybe 30 minutes. The man to my left fell asleep. The lady at the far end was snoring. So what’s this going to help? Of course it didn’t hurt to do some exercises. I’m sure it did some good. If/when I transfer to Prosperious we will see what difference there is. One thing is all the ladies are in their 70s or 80s, one looked to be in her 90s, so how can they stress them too much. And the man? He did as little as possible.

    Afternoon we were all herded up to the top floor again. They let me use my crutches. This session they placed two electrodes on my injured leg and for an hour I sat bored to tears listening to the other 4 Italian women talk. These ones aren’t very old. Some could be early 50s. I need to look up the procedure to see what it does.
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    Final news flash
    Il Capo of the hospital came to our room on his rounds and in our conversation he mentioned that my surgeon had initiated a transfer to Umbertide to Prosperious! So the decision was made for us and I’m sure it’s the right one. That my doctor did this means he is fine with me going there. And this hospital is fine with me going there since it is convenient for family and friends to visit. Totally different viewpoint. Since it’s National Health, it’s not for profit so they are fine with me going elsewhere. Interesting.

Hospital impressions

Now for my hospital impressions.

Two hospitals: Silvestrini (S) and Casa di Cura Liotti (CCL). I had my first operation in January 2018 in Silvistrini. It is a huge University Medical center. Casa di Cura is a small, partly private hospital in downtown Perugia where I am now, September 2019. Here are my impressions of the two plus some other things I found interesting. Some are a bit mundane but it’s what I noticed!

(CCL) Is rather dark and dreary due to the lurid paint they use here. And they don’t like putting the lights on in the halls. (S) Was more the norm that you’d see in the US with light walls and neutral colors.

The colors they choose differ with each floor. What were they thinking? 🤭

(CCL) The beds are electric and I can up and down as I wish. You don’t know how empowering that is! (S) had cranks, and I was stuck in bed and couldn’t get to it.

(CCL) There are two beds. No curtain between them. Cozy. A bit hard to get used to but it is what it is. (S) DID have curtains in it’s shared rooms.

(CCL) Each room has a private bath to share by its two residents. (S) there was one very odd bathroom which was shared between two rooms by four patients.

(CCL) The food is not so bad. Palatable I’d call it. And with my little pack of additions it’s almost good. I don’t have a lot of appetite but my blood is low so I’m eating. (S) practically inedible.

A little different from my normal food pictures ha ha. I ate the pasta which was pretty good. Not the mystery meat or eggplant. I normally like eggplant but not this.

(CCL) All the staff are young and nice. They go about their work cheerfully to a person. Not one has been mean or short with me. I don’t have a nurse Rachett or a Senore huff n puff like last time. Way better here than (S).

(CCL) Provides water for patients and delivers it, and other help you need if you ask for it. (S) Did NOT provide any water and would not bring any. Nor could you drop something on the floor and ask someone to help you get it back or ask your bed get cranked up or down. They expected the family of the patients to do that. Two very different places.

My medicines caused a stir. I always wondered why they have their pills in little blister packs. Lots and lots of waste. I prefer the easy bottles we have in the US. Well, today I think I figured it out. I had brought my own blood pressure medicines which I had removed from the blister packs and placed in small jars. No, no, no they aren’t good if not fresh. An aha moment.

They have a passaggita in the hospital. Just like in a village! All the crutches and walkers come out and it seems like all able patients walk up and down the hall.

I have a room mate. She’s a small rotund Italian woman who had a fall which got her here. I’m guessing she’s 80. Her name is Francesca. She’s sweet and we’ve become friends. She’s been here over two weeks and I just heard she leaves Thursday. Happy for her. And, get this, she came with at least three family members from Puglia! 550km away. Her doctor said she wouldn’t get the good care she could get here. So I guess he got her set up here. I had heard the health care is much worse in the south, a definite consideration if a person is planning to move here. Just goes to show the huge difference people talk about may be true.
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More tomorrow.

Ginocchio intervento 2 – knee operation 2

This will be a brief post just to update on how I’m doing.
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So the day arrived to check into the hospital. We arrived at 4pm as instructed. The orthopedic floor was full so I was put on the floor above. I had a nice quiet room to myself. I had broth for dinner.

Next morning I woke early and waited and waited for the surgery. Finally got wheeled off about 10:30am. First big surprise was they did the anesthesia differently. I had known I would get an epidural which numbs you from the waist down. The last operation they used mega tranqs to make me sleep and did the spinal in my sleep. This time it was done while I sat on a table! It was scary more than painful but it did hurt. And when they wanted to use gas to make me sleepy I said “I don’t want to hear, see, or feel what is going on!” Make me sleep. They did.

I woke on the way to my room. I guess I got there around three. The doctor came and explained the entire old prosthesis had to be replaced. The other one was defective. This was interesting news. They did give me morphine for the night. And another pain killer the next day that was different but strong. I’m afraid I was woozy and I don’t remember it well.

The next day the doctor visited and lifted my leg and bent it slowly. I was actually amazed at how far he could bend it with no pain. They put me on the bend machine which repeatedly bends the knee to a percentage of flex for an hour. Twice a day. And the flex increases daily. But I’m up to 70% with no pain. I am so happily surprised that this is so totally different from my last experience.

Next post I will give my impressions of the hospital experience and compare with the last one. It’s pretty entertaining.

Packing…

When a person goes to the hospital in Italy they must bring everything they think they will need…and then some! In some areas of the country this even includes bringing your own toilet paper. On my last hospital stay I didn’t need to bring that, but I did need to bring my own coffee cup if I expected to have coffee in the morning, and my own cutlery. I also had to provide my own water.

Since my trip this time will be over three weeks long (!) I need to bring a lot of things. I have a little bag which I filled with things to improve the horrible food. Like olive oil, vinegar, salt and pepper, and hot sauce. Maybe this will help. We’ll see. I also have soap and a wash cloth and towel. And a bowl to use as a basin. I am bringing the noise canceling headphones we have. I had some last time and they were invaluable since my roommate had the TV on from 7am to midnight, tuned to bad Italian TV of course. I’m also bringing my own pillow. Better than the hard-as-rocks hospital pillows.

For the rehab I need clothes I can wear to work out. I got some capri length pants with wide legs so my knee will be easily accessible. I need to bring gym shoes and tee shirts too. Of course, I can get Luther to bring anything I find I need in the meantime.

Here is the array of things I’m bringing.

Note the cup, spoon and cutlery!

These are the things I’m bringing to fight the horrible, bland hospital food. Olive oil, hot sauce, balsamic vinegar and salt and pepper. I should be all set I hope.
So today is the day I check into the hospital at 4PM. The surgery is tomorrow morning. I’ll try to post later on the rest of the story!

Now for something less cheerful


As some of you know, my initial operation in January 2018 to replace my knee was less than successful. In April of this year I consulted with a new doctor, Dottore del Citerna. I had met him twice previously in consults about both my knee and hip. If I had understood the system better he would have been my initial doctor. But I did not understand. I had thought I must go to an in-system doctor. So I chose Dottore Trinchese. He practices at Silvestrini hospital, the big university medical center in Perugia. It is where my first surgery was done. When I chose him I did take time to get recommendations and looked up his reviews.

I don’t really fault Dottore Trinchese with anything. The knee was problematic before the surgery. I DO fault him with not admitting there was something wrong when I went for a checkup six months after the surgery. I knew there was something wrong! He said not. So I kept on. Eventually it got worse, not better. So that’s when I turned once again to Dottore del Citerna. He examined me and he thinks it is the ligaments and muscles which are not holding the kneecap securely. But he won’t know for sure until he does the surgery.

So that’s the back story. My surgery is scheduled for September 27. I am now lasered in on it. All this spring and summer I’ve concentrated on the 3 major trips I had planned. I had put the surgery off until after them. Now, nothing stands between me and it. 😳 There are some differences this time. First, my doctor is private. Second, the hospital is different. It is smaller and part of it is private. I am still on the Italian Health care system so it will cost nothing. I hope this means the hospital experience will be better than the big, busy University hospital. I guess we will see.

Last week I went in for my pre-op tests. It took six hours! Everyone was very nice but there were interminable waits between each procedure. The hospital is called Casa di Cura Liotti. It is rather dreary and right in the busy middle of Perugia.

I was waiting in one of the waiting areas and saw my doctor arrive. He came back through again on his phone. The next time he came over to me and asked me if I was pronta? Or are you ready? I said no, not really. But I was impressed that he recognized me after seven months and spoke to me. I don’t think that would have happened in the US.

Now I have to pack for my ordeal. Next post about what I’m taking 🙂.

Not good news

If you follow my blog you’ll know that I had knee replacement surgery here in Italy in January 2018. I learned a lot about the Italian system before and after the procedure. I learned all about what to expect when you go to the hospital. And what to bring with you, which is very different here.

2018 Knee replacement part 1
2018 Knee replacement Part II
2018 Knee replacement Part III

I learned that the nurses don’t help with many basic things like bringing water. Or ice. They do blood pressure, medications, take blood for tests, basic bed making and body wash. But for your personal self, it’s on you to have a wash cloth, water, soap, a basin and toothbrush, toothpaste etc. for personal clean up. For anything like this you would need a helper. A family member or friend. Odd but true. Different hospitals have different rules. And, of course, very few people speak English. It makes for a lonely time without being able to speak to anyone.

OK so, my operation last year was fine, the PT in hospital was good, if painful. No opiates or pain killers in Italy. I was released but didn’t really understand I was supposed to go into in-patient rehab for 3 weeks. When I found out, this floored me. I couldn’t face it. After being in the hospital for a week I wanted only to be home. So I didn’t go. We arranged a nurse to help with re-dressing the incision. And hired a private therapist for PT in house. And all went ok.

I was told it would take 6 months to a year to recover. So I waited. And did my exercises… and I was in pain. Especially going up and down our 56 stairs. I returned to the doctor 6 months after the operation with concerns about how my knee “looked”. There was a malformation in my opinion. But the Dottore said all was well. Tutti va bene. So. I waited.

Now, more than a year later I am still in pain. Rising from a sitting position and doing stairs are quite painful. And getting more so. I decided to consult another doctor. I knew him from previous consults. I like and trust him. He sent me for X-rays of specific sorts. I returned and he said I need another operation. There are three issues. First the kneecap is skewed to the side because the ligaments and muscles are not holding it in place correctly. Second the top part of the prosthesis is too large for me. Last the bottom part of the prosthesis is slightly twisted off center. He said I could get lucky and they would only have to repair, realign the ligaments and muscles over the kneecap. But if the other two things seem to be an issue I’ll need an entire new implant. He will only decide once he can see it. Sigh. I have to lay this at the feet of the other surgeon. 😡 Not what I wanted to hear but I expected it, I guess.

My doctor asked me when I wanted surgery. I was taken aback. Last year I had no choice. The doctor put me in the queue. It took about 7 months and I had no real choice for the date. This doctor seems to have his schedule in a book he keeps and is able to pick dates. I will never understand this crazy health system here. Since I have multiple trips planned this year. And I don’t want to cancel them. First a week trip to Sicily in April. Then a 10 day trip to the US for my nieces wedding in May. Finally a special anniversary cruise in the Greek islands in July. I decided to choose end of September, after my friend Eunice goes home from a visit.

So I’m scheduled for surgery on 27 September, in Perugia in a small clinic/hospital and I will be in a total of 18 days. To include rehab. This time I will stay in for the entire rehab. It will be easier if hard to be in the hospital that long. I’m sure not looking forward to it! But it is what it is. On the bright side, I’ll lose weight! Food is awful in hospital.

The news for my blogsters is that I will share another exciting hospital stay experience with you. This time to include all that in-patient rehab! 😳 and Hey! I will learn more Italian.

Meanwhile I’ll enjoy spring in Umbria. And hopefully I can enjoy my upcoming trips. Fino a dopo i miei amici!

Knee replacement Italia – Part 3

I was told at the hospital upon release that I was set up at Prosperius, the therapy center in Umbertide and to go there the next day. The nurse at the hospital seemed puzzled I wanted to go home right away like I wanted to spend another night with them! So uncomfortable there. Anyway we got checked out and it turns out they had ordered an ambulance for me. They were not pleased when we said we didn’t need it. Luther drove us home in the glorious outside. Lovely fresh air. I managed to get up our 53 steps on my hand crutches. And basked in being Home and again with my cats. Home and cats have healing power beyond all else.

I had a welcome home glass of wine and Luther cooked our dinner with a bit of coaching. It was a lovely evening with English language TV for a change. Home!
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Well we found out you don’t know what you don’t know! We went to the local therapy center where I was told to go. And they told me they wanted to keep me for 2 weeks inpatient therapy(!) we had no idea. Gobsmacked. And this, after we SPECIFICALLY asked our GP and she assured us I would not be an in-patient candidate. We know the name of a therapist that a friend recommended who will come to me and we pay him privately. We asked if we could do that. They were fine with it. So we sent a text to him. Meanwhile I will continue to do the exercises I learned in the hospital four times a day. They are extremely painful to do so I have to force myself and remind myself it is important to work through them.
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The stairs are very difficult so I’m adamant I’m staying up here from now on. My doctor is supposed to arrange dressing changes and stitches removal but we are trying to do much of it up here in the house. So, through a friend, I’ve found the nicest nurse who comes here to change my dressing every 2 days. Distressing that she will take no compensation. She is an angel. So one less reason to go down stairs.
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I have also, through a friend, gotten someone to come and give me physical therapy. He is very nice but his job means he hurts me. I don’t think I’d like to do that for a living. But I’m very happy to have him. And he’s told me it’s crucial to do the exercises myself many times a day. I have been dealing with sciatica pain and I asked him about it. He said it’s a side effect of the epidural sometimes. He gave me a good massage which helped some. At least I know why. I want full function so I am going to do these exercises! I know it’s not forever.
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Maybe I was a bit foolish to not just check myself into Prosperius when I got out of the hospital. But at the time I couldn’t face being in another hospital for 2 weeks. So far we are managing here.
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I think my saga is done now except for the hard work of rehab. If there is anything new to add I will write about it as it occurs.

Knee replacement in Italia – Part 2

Musings
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Normal day.
5:45 am. Time for taking blood. 6:00 am blood pressure and temperature. 7:00 nurse arrives and scans your bracelet. Gets your medicines. Administers. 7:30 breakfast lady brings coffee and dry toast, like melba, with jam. Activity levels in halls ratchet up. 8:00 they come remake or change your bed and wash you some. Around 8:30 a gaggle of medical students comes and hears about the cases. PT person comes around this time too. Lunch arrives around 12 – 12:30. Afternoon is more random. More bracelet scans and meds. Coffee break in late afternoon. Dinner comes around 7pm. After dinner more scans and night meds. Ta da. Day is done.
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I contemplated the Italian word for pain, dolore. Or painful, dolorosso. I looked up an ache. Dolore. Hmmm. Seems like they should have that distinction. Fa male means it hurts. Male is the word for bad. Pronounced mah-lay.
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Some people who stood out. Dr. Pain, the first physical therapist. Nurse Ratchet, evil morning nurse who does meds. Sr. Huffinpuff – he does stuff like move beds, bring dinner, move trash bins out, stuff like that. He constantly sighs and pants while doing his work. One blond nurse who was kind and gave me a sleeping pill one night. The nurse who complained I peed too much. Dr. Trinchese, my surgeon. I call him the stealth surgeon. I saw him in the OR and then he did a drive by visit that lasted at most 15 seconds. “Come stai. Bend your leg. Lift your leg. Belissimo” and gone.
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Random thoughts and observations
Full time monks inhabit the hospital, gliding down the hallways.
Bringing your own coffee cup is key.
Bring cutlery.
Some hospitals do not provide toilet paper. I was told I was in a posh hospital because it did provide it.
They move you around in your bed for procedures.
Some nurses are tolerant of my bad Italian, many are not.
In my opinion the food is pretty bad. They try. You get three courses. Not sure if that’s a plus or minus. Bring salt, pepper, olive oil, lemon juice, Tabasco, anything to spice it up. Next time (hopefully a long time off!!) I would not order all the courses each meal. Breakfast is a cup of your favorite drink (not wine) and a packet of dry toast (like Melba) with a container of jam.
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Stay tuned for Part 3.

Knee replacement in Italia – Part 1

Much of the following posts about my hospital stay are musings of the experience as well as my documentation of what occurred. Most, I wrote while in the hospital.
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The surgery went well. The hospital is pretty modern. Not a young building but up to date. It is also enormous. A University Hospital. I saw very little of my surgeon. He showed up for the operation. Before surgery they take all your clothes and give you a completely transparent gown! I pulled my blanket up for the ride to the OR. As soon as I arrived they cut it off. What was the point?

Returned to my room. During the operation I had only an epidural. Could not move my legs when the tranqs ran out. The surgeon prescribed a bag of morphine for the first night. Since that there were no opiates to be seen. So my intell was correct. What they gave me was ok but my pain when I tried to exercise was through the roof. I was discussing this with one or Luther’s cousins who is a pharmacist. Opiates are properly used for recovery from surgery and for a short time afterward. As she said, “the pain actually increases the fight/flight hormones and delays healing. Also makes physical therapy a lot harder. I think they were giving prescriptions for too many pills at once and not scrutinizing refills [in the US]….” European mainland countries in general do not give pain meds. They do in the UK.

My PT started the day after surgery. It involved a machine that bent your knee over and over to the most painful angle you could stand. Then leg lifts, toe thrusts, tensing the muscles on the back of your thigh and more flexing. I kinda sat on the side of the bed and stood at a walker for a second. Unfortunately the next day was Sunday and then Monday a holiday so things slowed down. I was unable to lift my leg. It was like the signal wasn’t getting there but with a little help to start I could lift it with much pain. I think this is when some codeine would come in handy 😕 the leg was extremely swollen and I was convinced that had to be a part of the problem. I wanted to learn how to use the crutches. It would give me some freedom in the hospital. That was one of the hardest things, being unable to help myself with anything. I took great pains to keep things from falling on the floor. If they did, they were lost to me. The nursing staff are not there to help you. Sure, they would bring me a bedpan if I asked but one night, I had been instructed to drink water after a shot so I had to pee, three times in around a two hour span. She let me know she didn’t appreciate it and said it was not “normale”. I told her I had had 2 bottles of water. I was no longer trying to be nice.

The other thing was the total lack of privacy. I shared my room with another woman knee replacement patient…and her husband. He literally lived in the hospital with her. He brought a small chaise longue. With blankets and pillows and slept next to her. He was a nice man who occasionally helped me with an ice refill or cranked my bed up or down (no electric bed there!). I noticed other people walking up and down the hall with these beds. They expect family members to come care for the patients. I lived with just visits from Luther but they were invaluable.

I was not ready for the loneliness of not being able to speak to anyone, even to casually chat with the nurse or aide. I discouraged visitors so maybe I must take some blame for the loneliness. Luther visited every day and I know even HE was bored. And he hadn’t been there for 5 days
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Stay tuned for Part 2.

Hospital arrival and first day

I was told to arrive at noon today. Which I did. But last time here I neglected to take a picture of this directional board with all its colors. There are building depictions on the sides and on the floors everywhere are colored arrrows to help you find your way.
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They checked me in with much paperwork. Then I arrived in my room. It is a semi-private room and has a curtain on one side only and is very much like a US hospital. I guess it depends on the hospital. This one has nearly everything. There is toilet paper. At lunch there was plastic cutlery. There is a small shared TV. But tonight for dinner I did not have a spoon for the broth I was allowed. So I used the one I brought. They don’t provide water.

My roommate was in bad pain and I spent the afternoon listening to her cry and her husband calling for nurses. They tried a few different things none of which worked. Finally she got morphine. She’s eating and blabbing on the phone tonight. I hope they manage my pain OK. Now her husband has gotten his lawn chair and cushions and a blanket to spend the night. I had hoped it would not be necessary for me. Crossing my fingers. Poor Luther has no lawn chair.