This page contains advice on how to become more active starting from your time within hospital and to continue at home.

Why is it important to exercise?

Regardless of your age or physical abilities, introducing these exercises into your daily routine will help keep you stay strong and make daily activities easier. Exercise can help you improve:

• Balance.
• Mobility.
• Flexibility.
• Circulation.
• Bone health.
• Skin health.
• Strength.
• Agility.
• Breathing.

Moving more can also improve your mood and sleep. These will help you feel better in hospital and once you are home. 

Things to consider when exercising

Don’t worry if you haven’t exercised in some time. These chair exercises are gentle and easy to understand. If you are unsure of anything, speak to our physiotherapy team.

1. First, find yourself a stable chair to sit on that doesn’t move - avoid any chairs with wheels.
2. Make sure you are in a comfortable position on the chair with feet flat on the floor. Sit upright, away from the back of the chair, and wear comfortable clothes.
3. Have some water nearby.

When to stop exercises 

It’s normal to experience muscle aching after starting new activities. As you do the exercises more often, you may notice the discomfort reduces. If you become suddenly unwell, you should stop exercising and seek medical attention. 

Seated exercises

Here is the exercise programme including warm up exercises. Follow the exercise instructions on the next few pages. Your physiotherapist will tell you which exercises you should do. Your physiotherapist may write down the number of 'reps' and 'sets'  you should do of each exercise. 

• Reps (repetitions) are the number of times you perform a specific exercise.
• Sets are groups of reps with rest time in between.

For example: if your physiotherapist asks you to complete 5 reps, and 3 sets you should:

1. Do the exercise 5 times.
2. Rest.
3. Do the exercise 5 times.
4. Rest.
5. Do the exercise 5 times.

Chest stretch

1. Sit upright in your chair.
2. Extend your arms to the side.
3. Push your chest forwards and hold for 3 seconds.
4. Return to the starting position.

Upper body twist

1. Sit upright in your chair.
2. Cross you arms, reaching for the opposite shoulders.
3. Keep your hips facing forward and turn your upper body slowly to the left and then right.
4. Return to the starting position.

Neck rotations

1. Sit upright in your chair and face forwards.
2. Slowly turn your head to the left and hold for 3 seconds.
3. Slowly return to the centre and turn your head to the right, hold for 3 seconds.

Seated marching

1. Sit upright in your chair and hold the sides of the chair if needed.
2. Start marching your legs: lift 1 leg up with your knee bend and then the other at a controlled pace.
3. Continue this for 30-45 seconds.

Knee extension

1. Sit upright in your chair.
2. Kick your foot out in front and of the floor to straighten your leg. Don’t lock your knee.
3. Slowly control your foot back towards the floor.
4. Repeat with your other leg.

Foot side taps

1. Sit upright and hold onto the sides of the chair.
2. Lift one leg to side, tapping your toe out to the side.
3. Bring it back to the centre then repeat with the other leg.
4. Add a resistance band if advised. 

Ankle flexibility

1. Sit upright and place your feet flat on the floor.
2. Lift your toes off the floor as high as you can whilst keeping your heels down.
3. Lower your toes back to the floor.
4. Keep your toes on the floor, and lift both heels.

Shoulder press

1. Sit upright and start with your hands by your side.
2. Push both arms into the air, straightening your elbows.
3. Lower them to your chest.
4. Add a pillow if advised.

Arm curl

1. Sit upright and keep your elbows at your side.
2. Lift your hand towards your shoulder by bending your elbow.
3. Lower your hand back down.
4. Add a resistance band if advised.

Reaching across

1. Sit upright, hold onto one side of the chair if needed.
2. Reach one arm across your body, try to stretch a few inches further.
3. Then do the same with the other arm. Keep your feet grounded on the floor.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003690

What are aminoglycosides, and what are they used for?

Aminoglycosides are a family of antibiotic medications. They are used either alone, or alongside other antibiotics, to treat serious and life-threatening bacterial infections in many different parts of the body. 

Examples of aminoglycosides used in the UK include:

• Gentamicin (most commonly used). 
• Tobramycin. 
• Amikacin.

The team looking after you have decided to give you an aminoglycoside because it will be the most effective antibiotic for your infection, or because there is a reason you cannot have other antibiotics. 

They are mostly given into a vein as a drip (through a cannula in your vein), or sometimes as an injection. The dose you are given depends on what kind of infection you have, your weight, and how well your kidneys are working.

What to tell us before starting an aminoglycoside?

Before we start you on this medication, it is important that you, or someone who knows you well, tells us about any of the following:

• Any allergies you have and what the symptoms of this are. 
• If you are or could potentially be pregnant. 
• You are breastfeeding. 
• If you have any conditions causing kidney disease or any kidney problems. 
• If you have hearing or balance problems. 
• If you have myasthenia gravis (this is a disease that causes muscle weakness). 
• If you or a relative on your mother’s side have a history of a mitochondrial genetic variant (a genetic condition) or loss of hearing or balance due to antibiotic medicines. 
• This is important for us to know because certain mitochondrial genetic variants may increase your risk of hearing loss with aminoglycosides. 
• If you have ever been told that you cannot have an aminoglycoside antibiotic.

We will also ask you about your current medications that you are taking, including any that you buy without a prescription (over the counter) or any herbal remedies. Some medications may increase the risk of side effects with aminoglycosides so it is important that you tell us. 

Sometimes, when a patient is extremely unwell due to infection (for example, patients with sepsis), antibiotics should be given within an hour of diagnosis to reduce the risk of serious complications or death. There won’t usually be time to wait until a specific type of infection has been identified, so broad spectrum antibiotics are given first. These are designed to work against a wide range of known infectious bacteria and usually cure most common infections.

If you are extremely unwell, or the above conditions aren’t documented in your medical record, the team looking after you may not be able to consider this before the aminoglycoside is given. The team will always try to confirm details with you or someone who knows you well, but sometimes this will be once your condition has stabilised. The team will then discuss the benefits and risks of continuing the aminoglycoside along with possible alternative treatments.

What side effects can aminoglycosides cause?

Like all medicines, aminoglycosides can have side effects. The following is a summary of the more serious ones. If you would like further information, please speak to the team looking after you.

Ears

Kidneys

Muscles

Allergy

How can the risk of these side effects be reduced?

If you are at increased risk of developing these side effects, we would ideally try to avoid using an aminoglycoside to treat you. However in some serious infections this may not be possible. In this situation your doctor will discuss the risks and benefits of treatment with you.

Aminoglycoside doses are carefully calculated for each individual patient to ensure you get a dose that is right for you.

The amount of aminoglycoside in your blood is measured regularly to check the dose continues to be the right one for you and adjustments made if needed.

The team looking after you will also take regular blood tests to monitor your kidney function. Based on these results the dose of the aminoglycoside, or how often you are given it, could be changed. This will reduce the risk of side effects, and make sure the medication is as effective as possible in treating your infection.

The risk of some side effects increases with longer courses of treatment, therefore the team looking after you will try to keep the course as short as is needed to treat your infection.

To reduce the risk of the aminoglycoside affecting your kidneys, you can make sure you drink plenty of water/fluids whilst you are taking the aminoglycoside.

© North Bristol NHS Trust. This edition published August 2024. Review due August 2027. NBT003703.

Antenatal and Newborn Screening for Sickle and Thalassaemia (SCT)

Background:

Haemoglobinopathies are a group of inherited blood disorders that fall into two main categories: haemoglobin variants such as sickle cell disease (SCD) and thalassaemias. If a patient is a carrier of the sickle cell or thalassaemia gene, it can be passed onto the baby. All pregnant women in England who have accepted screening will have laboratory testing for haemoglobin variants and thalassaemia. If the mother is found to be a carrier, screening may also be offered to the father. 

Haematology Department:

The department of Haematology provides a Sickle Cell and Thalassaemia (SCT) Screening service for antenatal patients in North Bristol and offers a confirmatory service for the newborn screening provided by Clinical Biochemistry. Further information on newborn blood spot testing can be found on the NBT newborn screening page. 

The SCT screening provided by the laboratory follows the government’s published handbook for antenatal laboratories and handbook for newborn laboratories which set out interpretation and reporting guidelines, including which types of carrier states to report.

SCT testing on antenatal patients is undertaken on whole blood samples taken at booking, preferably before 10 weeks gestation. This allows for prenatal diagnosis (PND) to be offered to at risk women and couples by 12 weeks +6 days of pregnancy. Early detection of SCT through screening allows for personal informed choice, timely counselling, clinical monitoring and preparation for those patients identified as having an “at risk” pregnancy.

As well as the general sample labelling requirements, it’s also necessary for the patients’ family origin questionnaire (FOQ) to be completed either on the reverse of the antenatal form or by following prompts when requesting on ICE. Our UKAS accredited laboratory currently screens approximately 7000 pregnant women each year and confirms results for approximately 500 babies for the newborn screening laboratory.

The SCT screening programme is provided in close collaboration with health care professionals throughout the region.

Analysis:

Initial screening is performed on our primary analyser using capillary electrophoresis (CE). 

Abnormal samples are then reanalysed using isoelectric focussing (IEF). IEF separates the proteins into bands allowing our skilled biomedical scientists to identify the types of haemoglobins.    

Quality Assurance:

Turnaround times (TATs), standards and key performance indicators (KPIs)
The laboratory is accredited by UKAS under ISO15189 registration number 8066 and participates in UK NEQAS Quality Assurance Scheme.
Screening laboratories must be able to release > 90% of antenatal results, interim reports and requests for repeat tests in < 3 working days in accordance with SCT screening standards.

Please see below for responses to our most recent user survey:

Developments:

We report our rare, affected babies (those with severe disease) on a named patient basis, and this is to the newborn outcomes solution (which reports to NCARDRS).

SCT Newborns (mdsas.nhs.uk)

More recently, paper copies of the forms have become unavailable: all patient leaflets are held centrally and are available on the government website.

Laboratory Visits:

We offer half-day training sessions to midwives, health visitors, nurses, doctors and other allied healthcare professionals involved in the collection of samples. Please contact us to arrange a visit.

Key Contacts for Haematology Laboratory

Dr Sophie Otton
Clinical Lead for SCT & Consultant Haematologist 
Via Haematology secretaries - Telephone: 0117 414 8401

Reginah Visser
Principal Clinical Scientist 

Grace Van Der Mee
Lead Biomedical Scientist

Jemma Cable
Senior Biomedical Scientist

Helen Izzard
Senior Biomedical Scientist

Pathology Sciences Laboratory
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB
Email: NBTHaemoglobinopathyService@nbt.nhs.uk
Telephone: 0117 414 8356

Opening times: 9am - 5pm Monday - Friday excluding bank holidays.

Clinical advice & interpretation is available during working hours.

Q-Pulse Ref HA/WE/008 V2

What is an MRI prostate scan? 

An MRI (magnetic resonance imaging) scan uses strong magnets and radio waves to create detailed pictures of your prostate. This allows us to detect or rule out potential tumour, or monitor changes in the prostate over time. It is safe and painless, and does not involve any radiation. 

How to prepare for an MRI prostate scan

It is important your bowels and bladder are empty before the scan. 

Please arrive 20 minutes before your MRI scan time. You need to empty your bowl of any stool (poo) and gas. This is important as if there is any gas or stool in your rectum, we may miss a tumour. Even if you feel like you don’t want to empty your bowels, we recommend you sit on the toilet and try. This will move any gas which could blur the images.

To make sure you have the best image quality, avoid sexual activity that leads to ejaculation for 3 days before your MRI scan. This allows the seminal vesicles (glands next to the prostate) to naturally dilate (widen) which allows them to be seen clearly so they can be reviewed for a tumour.

You can eat and drink as usual, but if possible try to avoid things that cause bloating or gas such as fizzy drinks, coffee, strong black tea, beans, onions, or broccoli for 24 hours before your appointment.

Before the scan you will fill out a questionnaire about your health. Because the scan uses strong magnets, we would like to know if you have any metal, implants, jewellery, piercings, dentures, or hearing aids. We will then ask you to change into a hospital gown and put your belongings into a locker.

What will happen during my MRI prostate scan?

The MRI will take about 30 minutes. We will ask you to like as still as possible on a table. The table will move slowly into the scanner which is shaped like a doughnut. Please tell the radiographer if you are claustrophobic so they can help you feel as comfortable as possible.

The machine won’t cause any pain but is noisy and you may feel warm. You will be able to speak to the radiographer through an intercom to let them know if you have any issues during the scan.

Before your scan we may insert a cannula (tiny plastic tube) into a vein in your arm. This allows the radiographer to inject a contrast dye to make the prostate and other organs clearer on the scan. The dye is incredibly safe, but we do want to know if you have any kidney problems, asthma, or allergies. Please tell the radiographer if you have any of these.

Hycosine butylbromide (Buscopan) 

We may give a muscle relaxant called Buscopan before starting the examination. This helps us see the prostate better by reducing bowel movement during the scan. Like all medicines this can cause side effects. Most people have none but if they do they go away quickly. If you have blurred vision, please make sure your vision has returned to normal before driving.

Very rarely Buscopan causes a type of glaucoma called acute angle closure glaucoma. If your eyes get very painful and red within 48 hours of the injection, seek urgent medical advice.

Also very rarely Buscopan can cause urine retention (inability to pass urine/pee). Please seek medical advice if this happens.

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003709. 

This page is for patients who have had surgery to treat a perianal abscess at North Bristol NHS Trust. 

It has advice about what to expect after surgery, and when to seek further advice. 

After the surgery

You will not be able to drive after having a general anaesthetic and will need to have an adult take you home.

Removal of packing/review wound advice

If you have had packing inserted during the operation, this will need to be removed before you are discharged or by your GP Practice Nurse within 24-48 hours. No further packing will be needed after this is removed.

General wound care advice 

The abscess has been left open to allow drainage of infected material. Fluid and blood may leak from the wound, so wearing an absorbent pad may help this. A small amount is normal, if this does not stop, or is a large amount, please seek medical attention. 

Bathing advice 

To allowing healing, the area needs to be cleaned once or twice a day in the shower or bath. Use water to clean the area thoroughly, including inside the wound and avoid using soaps or perfumed products on the area until the wound has healed. 

Please try and insert a finger into the wound to enable full cleaning. Sometimes the skin over the abscess cavity can ‘heal too quickly.’ Finger irrigation can allow the healing to be slower but more effective. 

Pain management advice 

This procedure can be quite painful, but this will improve within a few days. You will be discharged with painkillers. It important to take these regularly if you are experiencing discomfort. Follow the instructions on the prescription. Do not take more than the prescribed dose.

Going to the toilet

You can use the toilet as normal following the procedure. You will be discharged with laxatives to soften your stools (poo). You should wash the area after passing stool (pooing).

When to see GP

Please see your GP Practice Nurse for ongoing management of your wound.

When to go to Accident and Emergency

If following the procedure, you feel unwell, are in severe pain, have high temperatures, or fast heart rate please go to your nearest Accident and Emergency department.

Returning to work and activities

This depends on what work you do and how you feel. 

You should not go swimming until the wound has healed. 

You can drive when you can sit comfortably, handle a vehicle safely, and perform an emergency stop. You should inform your insurance provider before you start driving again.

Accessing follow-up

We will not usually need to see people who undergo incision and drainage of perianal abscess again. However, we may need to see you again if it is causing ongoing issues:

• If your wound is not healing by 8-10 weeks. 
• Associated with another condition (please see below).

If this is the case, then please follow the guidance for getting an appointment with the surgical team:

• Email lowergisecretaries@nbt.nhs.uk
• Phone 0117 414 0835 or 0117 414 0838
• Available Monday to Friday, 09:00 to 16:00 

Potential complications

Most perianal abscesses are caused by a blocked gland in the anus, however in small number of individuals (10-15%), perianal abscesses can also be present with another condition called an anal fistula. This is the formation of a tunnel between the skin and inside the anus/rectum. Fistulas require further investigations and treatment. Symptoms of anal fistula include:

• Skin irritation around the anus/rectum. 
• Pain in the anus/rectum. 
• Anal discharge. 
• Pus or blood in your stool (poo).

If we suspect an anal fistula at the time of surgery, we will explain this and organise follow up for you. If your GP has concerns over an anal fistula, they can refer you to the Colorectal Outpatient Department for assessment. For more information on anal fistulas please see the NHS website Anal fistula - NHS (www.nhs.uk)

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003689.

This booklet has been written by the teams who will look after you during surgery. It aims to help you understand the surgery, guide you through the various phases of your operation, and inform you how you can best prepare and recover afterwards.

You may be given a paper copy of this information which you should bring with you on the day of your surgery. 

This page contains the following information:

• Preparing for your operation
• On the day of your operation
• Going home
• Physiotherapy advice
• Therapy advic

A joint replacement operation is done to improve your quality of life. It will hopefully allow you to do some of the things that have become difficult with your joint arthritis.

From the day you are admitted to hospital, the staff involved in your care will work together to assess your needs in preparation for leaving hospital.

We ask you to provide us with all the necessary information that will help with planning your hospital care and timely discharge, as early as possible.

You will need to make the arrangements for your own transport home prior to your admission. If you or your relatives/carers have any concerns about your hospital discharge or transfer, do not hesitate to ask a member of the team.

Discharge Lounge 

Where possible, discharge arrangements will be made so you are able to vacate your hospital bed. This may include transfer to the Discharge Lounge; we will prepare you and keep you informed.

The Discharge Lounge is a safe area providing nursing care and regular refreshments and meals, including breakfast, where you can wait to be taken home.

Pathway for recovery

Returning home as soon as safely possible, even on the same day as your operation

As a result of expert surgery, anaesthetics, and a highly skilled team of doctors, nurses, and allied health professionals, many patients will not need to stay in hospital overnight and will be ready to go home the same day.

This is the usual pathway in many orthopaedic centres across the country, providing an excellent standard of care with very positive results and patient feedback.

However, some patients may not be ready to return safely home the same day and will need a little longer. If this is the case, we would expect you to be able to go home the day after your surgery, or as soon as all teams treating you are satisfied.

We will only discharge you once you are recovered and able to safely return home.

Managing and understanding the process

It is important for you to have realistic expectations of having joint replacement surgery. You should have a clear understanding of what to expect at each stage. You must prepare appropriately for your surgery and work with the clinical teams you meet during your care.

Preparing for your operation

On the day of your operation

Going home after your operation

Returning home

Everyone reaches their post-operative goals at different times. This determines whether it is safe for us to let you go home on the same day as your operation, or if you need to stay overnight with us at the hospital.

Arrange for someone to collect you

When you have been cleared for discharge, you can contact your family or friends to come and collect you from the hospital.

Arrange for support at home

If you live alone you will need to arrange for a friend or relative to stay with you overnight after discharge and for a few days after returning home. You should arrange this before you come in to have your surgery.

Wound dressing

Your wound is covered by a shower proof dressing so you can shower as soon as you feel able but do not aim water directly at the dressing. You will be seen by a healthcare professional two weeks after your operation to have your wound checked. Please leave any dressings in place and keep as dry as possible until this appointment. Seek advice if the dressing is wet or peeling off the wound.

Keep active after your operation

The sooner you can get up and walk after your operation, the better and faster your recovery will be. You will also have a lower risk of complications after your surgery. Keeping still after your operation tends to result in your leg swelling, which ends up making it even more painful to walk. This can cause more side effects, which requires more pain relief, resulting in a vicious circle.

Pain control

Joint replacement surgery is painful – just like any other surgery. The first few weeks can be a difficult period. However, it is important to stay active and keep up with your movement exercises. We will be giving you strong pain relief medication. However, you should expect there to still be mild to moderate pain when moving. It is not going to be 100% pain free.

The pain relief package you receive has been specially designed to try and control your pain as well as possible. It starts from the day of your surgery and continues after your discharge home. We will give you the same pain relief tablets whether you stay in hospital overnight or return home on the same day as your operation.

The pain relief package requires you to take your medicines at specific times.

Ward staff will inform you of the pain relief that your surgical team have prescribed for you, when leaving hospital. This discussion will also include advice regarding paracetamol, where we advise patients to source their own supplies if they are able to do so, in line with North Bristol NHS Trust Policy.

Additional medications

We will ask you to take additional medications to help minimise side effects, such as nausea or constipation. Other medications will be given to reduce the chance of certain complications, such as blood clots after your operation. You will be given clear information about the medicines you are sent home with, and when to take the doses.

What to expect when you get home:

Swelling: it is common to have some generalised swelling of the leg. Swelling will often get worse if you sit for a long time, so we encourage you to remain gently active. To help reduce lower limb swelling you may need to rest for at least 20 minutes in the morning and/or afternoon on the bed initially. If you have increasing swelling and pain, please seek medical advice.

Constipation is usually due to the pain relief medication you are taking. We will give you some laxative medication as part of the routine pain relief package. However, please make sure you take these as prescribed, along with drinking plenty of water. Keeping mobile will also help reduce symptoms. If you struggle, then please discuss this with your GP.

Pain is the biggest issue. It is something you should expect after your operation, but it is key that you do not stop doing your exercises. In the first couple of weeks it is vital to balance ice treatment with pain management and careful limited physiotherapy. Please make sure that you follow the pain management program you were discharged with to help control your pain.

Ice therapy can be very helpful in reducing swelling and pain after your operation. If you are given an ice band please make sure you take it home with you. If not, you can use a bag of frozen peas or similar at home. An ice band can be applied but if using frozen peas etc, wrap them in a damp tea towel/ pillowcase before applying to your leg.

Ice therapy can be used for up to 20 minutes. You should leave at least one hour after each ice therapy application to give your circulation time to recover. Make sure your wound dressing does not become wet.

If you have any of these conditions you should discuss this with your Physiotherapist before using any ice therapy:

• Problems with your circulation.
• Fragile skin.
• Loss of skin sensation.

Difficulty sleeping: it is common for people to experience some disturbance in their normal sleep pattern in the first few weeks after an operation. Please do not worry as this usually improves with time. You can sleep in any position including lying on either side.

What to look out for

Deep vein thrombosis (or DVT) blood clots in the leg can happen after joint replacement surgery. If your leg becomes hard, swollen, hot, and painful, especially in the calf area then this could be a sign of a blood clot. Please seek medical advice if you get these symptoms.

Infection is very rare. However, if your joint replacement or scar becomes hot, red and/or increasingly swollen, or if you feel unwell, then please seek medical assistance.

Support after discharge

The ward team will let you know what arrangements have been made for your follow-up appointments.

Following your discharge from hospital there is always someone you can contact for advice

If you would like more information before your operation or have any questions after you have been discharged home, or concerns about your wound, contact your Consultant’s Secretary in the first instance unless you have been given an alternative contact such as a Specialist Nurse/Practitioner.

For therapy related queries, please contact Physiotherapy admin 0117 414 4412 or Occupational Therapy admin 0117 414 1272.

Physiotherapy advice

Completing the exercises below will benefit your recovery, improve movement in the knee joint and develop the strength of muscles around it.

These exercises should be completed before and after your surgery. Doing these exercises before your operation will benefit your recovery. We recommend you continue these exercises for a minimum of 6 weeks after surgery. Complete your exercises 3 to 4 times a day, repeating each exercise up to 10 times.

Total knee replacement exercises

Ankle pumps

Lying on your back, quickly point your toes up and down 10 times. 

Repeat every hour you are awake.

This exercise improves the circulation in the lower limbs, helps to prevent the formation of deep vein thrombosis (blood clots), and reduces swelling.

Knee bracing (static quadriceps) exercises

Lying down or slightly reclined with legs straight. Pull your ankle up and push your knee down firmly against the bed. Hold 5 seconds- relax.

Repeat 10 times.

This exercise helps you to regain control of your knee ready for standing and walking. It also helps you to achieve a straight knee.

Knee bending (flexion) on a sliding sheet

Lying down or slightly reclined with a sliding sheet under your heel. Bend and straighten your knee by sliding your foot up and down the sheet.

Repeat 10 times.

This exercise will improve your knee bend which is important for getting into a car and sitting. Your hamstring muscles will become stronger.

Straight leg raising

Lying down or slightly reclined. Lock your knee straight. Lift your whole leg 10cm (4 inches) off the bed. Aim to keep your leg absolutely straight. Hold for 5 seconds. Repeat 10 times.

This exercise challenges your thigh muscles and tests their ability to support you when you are standing.

Knee stretch (posterior capsular) exercise

Lying with leg straight out in front of you, place a folded-up towel underneath your heel. Allow knee to straighten so you feel a stretch behind your knee. Hold for 30 seconds.

This exercise helps to stretch tight muscles at the back of your leg (hamstrings and calf muscles). If they are significantly preventing your knee from straightening, the Physiotherapist will advise you how often to repeat this exercise.

Exercises in the sitting position

By the second day after your operation, you will begin to notice improvements in your knee bend, muscle power and walking.

The flexibility and bend of your knee is best achieved as soon as possible.

You may have an increase in knee stiffness when you wake up in the morning. This is because your knee is less active at night.

You will need to work hard in the morning to achieve the same range of movements you had the previous evening. Aim to improve range throughout the day.

Your physiotherapist will advise you when to progress to the next set of exercises.

Knee bending (flexion) in sitting

Sit on a chair with your feet on the floor. Bend your knee as much as possible.

Repeat 10 times.

This exercise helps your knee to bend. Your goal is to sit comfortably in a chair with your knee at a right angle as soon as possible. A good bend will be needed in the future for stairs and getting up from a chair.

Self-assisted knee bend exercises

Sitting, cross your legs at the ankles with your good leg on top of the operated leg. Use the good leg to help bend the operated leg backwards.

Repeat 10 times.

Seated lunge exercises

Sitting, bend your operated leg, back as far as you can. Keep your foot flat on the floor and do not allow it to move forwards. Slide your bottom forwards on the chair.

Repeat 10 times.

This will help to bend your knee further.

Knee bends/squats

Standing whilst holding onto a stable surface (as shown in the photo). Slowly bend your knees. Keep your heels on the floor. Slowly return to standing by straightening your knees.

Repeat 10 times.

This exercise encourages the muscles around the knee to work together in a smooth and coordinated fashion. It prepares your knee for getting up and down off low chairs and toilets.

Using a walking frame

For the first day after your operation, you will probably find that you feel more confident using a walking frame especially when walking unsupervised.

Follow this order of movements:

1. Move the frame forward.
2. Take one small step forward with your operated leg.
3. Brace the knee of the operated leg.
4. Step through with your other leg whilst using the frame for support.

Tip: do not walk too close to the front of the walking frame. 

Using sticks or crutches

Once you are confident with the walking frame you will progress to using sticks/crutches (whichever you and your therapist feel is most appropriate).

Advice for walking with sticks/crutches:

1. Move sticks/crutches forward together.
2. Step forward so the operated leg is level with the sticks/crutches.
3. Place weight as necessary, through your arms onto sticks/crutches.
4. Brace the thigh of the operated knee.
5. Step your other leg forwards past your operated leg.
6. When you feel confident enough to use only one stick/crutch, hold it in the opposite hand to your operated leg.

Walking

Following your operation, you will be encouraged to get up and walk. It is important to walk on a regular basis, and to steadily increase the distance as you recover. It is normal to put full weight through your operated leg.

As soon as possible, try and walk placing one foot past the other in a normal walking pattern. You can progress to using one crutch or a stick held on the side opposite to your operated leg as soon as you feel safe and comfortable to do so. If you are uncomfortable or if you limp when walking, continue to use your walking aids.

Stairs

The therapist will practice with you how to safely use the stairs before going home. To go up and down the stairs, use a banister rail if there is one.

Going down, put the crutch/stick on the step below then step down with the operated leg, followed by the unoperated leg.

Go up leading with the unoperated leg first, followed by the operated leg and then the crutch/stick.

 

 

 

Therapy advice

Sleeping

You may sleep in any position including lying on either side. It is essential that you do not sleep with your knee bent over a pillow. 

Getting dressed

We encourage you to get dressed into your own comfortable day clothes as soon as possible after your surgery rather than staying in pyjamas or a hospital gown.

Driving and car travel

You can travel as a passenger in a car immediately following your operation.

• It is best to sit in the front seat, have someone move it well back.
• If possible, get into the car directly from the drive or road rather than the kerb or pavement.
• Use your arms to lower yourself onto the edge of the car seat.
• Slide back into the seat.
• Lift both legs in as your body turns to sit in the seat.

Stop regularly on longer journeys so you can get out of the car to change position and move around.

You should not drive until you are able to perform an emergency stop safely.

We recommend you inform your insurance company before you start driving.

Returning to full activities

At first you will need help with household tasks which involve carrying items or kneeling. Kneeling may be uncomfortable for the first few months. Sometimes the scar remains sensitive and not everyone finds it possible to kneel after a knee replacement.

You should be able to start your normal activities such as gardening or bowling as soon as you no longer need walking aids. This is normally 6 weeks after surgery.

You should not swim before your wound is fully healed.

Discuss your lifestyle and activities with your consultant at your clinic review at 6-12 weeks. They will be happy to advise you on returning to your normal activities.

The time of your return to work will depend on your job. Your consultant will advise you on this.

Equipment

The walking aids and any equipment prescribed to you after your surgery are provided by an equipment company. Please ring the number on the sticker on the equipment, to discuss its return.

© North Bristol NHS Trust. This edition published November 2024. Review due November 2027. NBT003722.

Brain Tumour Support Worker

The Brain Tumour Support Worker is part of the Skull Base Team and works alongside the registered practitioners to improve care and help patients to self- manage their recovery and return to leading a healthy life. The Brain Tumour Support Worker is not a qualified clinician but is trained and experienced in supporting people with a brain tumour diagnosis.

What they do

• Support people so they can access the appropriate information.
• Direct or refer to a range of services and charities.
• Help patients and carers understand signs, symptoms, or situations to be aware of that would indicate concern.
• Offer Personalised Care and Support Planning (PCSP). This involves a conversation in which you can discuss your health and well-being in relation to your brain tumour diagnosis.
• Create a personalised care and support plan together with you, to support your concerns, priorities, and what matters to you.

Your support worker is happy to discuss any concerns that you might have so please let them know. Here are some examples of the concerns that your support worker can discuss with you:

• Physical concerns such as: wound care, fatigue, pain or discomfort, sleep problems, appetite, sight or hearing.
• Emotional concerns such as: worry or anxiety, thinking about the future, loneliness, isolation or uncertainty.
• Practical concerns such as: money or finance, travelling, pets, smoking cessation, working.
• Other information and support such as: exercise, diet and nutrition, support groups, complementary therapies.

NGS Macmillan Wellbeing Centre 

We offer help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop-ins’ for coffee and a chat or appointments for specific needs.

Opening times: Monday to Friday, 8:30 - 16:15

Phone: 0117 414 7051 

Brain tumour support feedback

How to contact us

© North Bristol NHS Trust. This edition published September 2024. Review due September 2027. NBT003687

Neuro-Oncology Clinical Nurse Specialist Team

The Neuro-Oncology Clinical Nurse Specialists are experts in cancer care; we work as part of the Cancer Support Team. We can answer your questions and give you information about your diagnosis, treatment, and the support available during and after your care.

Cancer Support Worker (CSW) 

The Cancer Support Team also has Support Workers. They are trained to provide support and provide information about physical, emotional, and practical concerns to help you self-manage your recovery and return to a healthy a lifestyle as soon as possible.

Personalised Care and Support Planning (PCSP)

Personalised Care and Support Planning is a conversation and assessment offered with your Clinical Nurse Specialist and/or Cancer Support Worker to help discuss your health and wellbeing in relation to your cancer. It will assess your individual needs and concerns, to understand what matters to you.

Personalised Care and Support Planning includes sharing information with you about diet, physical activity, fatigue, and other practical information relevant to you. This could include anything from emotional support to directing you to local support services, such as benefits advice.

Making decisions about your healthcare

At NBT we encourage you to be a partner in your healthcare. When patients work with healthcare professionals to make decisions about their healthcare plan and treatment, this is called shared decision making. Shared decision making makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments based on medical evidence, as well as your individual   preferences beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments.

Some questions that might be helpful to ask:

• What are my options?
• What are the possible benefits and risks of those options?
• What support and information is available to help me make my decision?

Shared decision making matters to us. Tell us what matters to you. 

NGS Macmillan Wellbeing Centre 

We give help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have any concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop ins’ for coffee and a chat, or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15

Phone number: 0117 414 7051

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at or soon after the time of a cancer diagnosis.

The session provides:

• Information about cancer and related topics that help you participate in your care and recovery.
• The opportunity to meet other people with similar experiences.
• Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

Useful contact information

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003712

Who are we? 

The Sarcoma Clinical Nurse Specialist (CNS) is a registered nurse with specialist education and experience in sarcoma. We are your key worker, which means we are your main point of contact. We can answer questions, provide support during and after your care, and act as a patient representative in the sarcoma multi-disciplinary team (MDT) meetings.

What support and information will be offered? 

• Support during your investigations and at diagnosis.
• Verbal and written information on diagnosis and treatment options.
• Answers to any questions about diagnosis, treatment, and end of treatment plan.
• Directing you to other support such as a physiotherapist, dietician, finance and welfare services, and cancer information and support services.

Cancer Support Worker (CSW) 

The Cancer Support Worker is a non-clinical member of the sarcoma support team. They have received training to provide support and information about physical, emotional, and practical concerns to help you self-manage your recovery and return to as healthy a lifestyle as possible. 

Personalised Care and Support Planning (PCSP) 

Being diagnosed with sarcoma can be a frightening and unsettling time. It can affect many areas of your life.

The sarcoma service offers each patient a PCSP at diagnosis and after finishing treatment. This involves completing a simple questionnaire that allows you to highlight your concerns and to prioritise what matters most to you.

We offer you this assessment to ensure that wherever possible, your concerns and needs are being addressed. We can discuss additional support to help you manage your diagnosis, treatment, and beyond.

Our Sarcoma Cancer Support Worker, Hannah, will contact you two weeks after your diagnosis.

Areas covered by the PCSP may include:

• Physical concerns: tiredness or fatigue, weight change, sleep, appetite.
• Practical concerns: finances, transport or parking, housing.
• Emotional concerns: uncertainty, sadness or depression, worries about the future, feeling a lack of control.
• Family or relationship concerns: partner, children, person you care for.
• Spiritual concerns: faith and spirituality.
• General information and support: exercise and activity, diet and nutrition, health and welling.

This is personal to you, it might be that now is not the right time. The option to create a care and support plan is available to you at any stage of your diagnosis and treatment pathway. We encourage you to ask for one at any time you feel you need one. 

The Sarcoma Multi-Disciplinary Team 

The MDT is a team of specialists with experience in the diagnosis and management of sarcoma. The MDT is made up of: 

• Clinical Nurse Specialists (CNS).
• Plastic surgeons.
• Oncologists.
• Radiologists.
• Histopathologists.
• Thoracic surgeons.
• Retroperitoneal surgeons.
• The MDT coordinator.
• Patient Pathway Coordinators.
• Sarcoma Cancer Support Worker (CSW).

Making decisions about your healthcare

At NBT we encourage shared decision making. This is when patients work with healthcare professionals to make decisions about their healthcare plan and treatment. This makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments base on medical evidence, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments. You are always welcome to bring someone with you such as a family member or friend to your appointments.

Some questions that might be helpful to ask:

• What are my options?
• What are the possible benefits and risks of those options?
• What support and information is available to help me make my decisions?

Shared decision-making matters to us. Tell us what matters you you. 

If you would like a PCSP or a supportive conversation sooner, please contact Hannah on 0117 414 7417.

The Sarcoma Clinical Nurse Specialist can be contacted on 0117 414 7453.

NGS Macmillan Wellbeing Centre 

We offer help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop-ins’ for coffee and a chat or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15
Phone: 0117 414 7051 

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at, or soon after the time of a cancer diagnosis.

The session provides:

• Information about cancer and related topics that help you participate in your care and recovery.
• The opportunity to meet other people with similar experiences.
• Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

Further useful information

© North Bristol NHS Trust. This edition published October 2024. Review due October 2027. NBT003719

The Gynaecological Cancer Nurses

We are Clinical Nurse Specialists experienced in the care of individuals who are undergoing investigations for suspected gynaecological cancers or those who have been diagnosed.

We understand that waiting for test results and appointments can be a worrying time and we are available to help support you from the moment of referral, until you are either discharged from our service or your care has been taken over by the Gynaecological Cancer Team at St Michael’s Hospital, UHBW.

We are here to answer queries or concerns, and provide support and information to you, your family, and carers. We are part of a multidisciplinary team and there will be several different people involved in your care. We act as a ‘link’ to improve communication between them, you, and the wider cancer team.

We aim to: 

• Meet you and your family during hospital appointments when possible, and provide advice and support.
• Visit you on the ward if you are an inpatient.
• Answer any questions you have about your illness, the tests you may need, and discuss treatment plans for you.
• Provide phone, email, and face-to-face support.
• Refer you to other services for support.
• Liaise with community healthcare teams away from the hospital, such as district nurses, GPs, etc.
• Make sure you understand what is happening at each stage of the investigation and/or treatment pathway.
• Support you with concerns about cancer and treatment, symptoms and side effects.

Service availability

Out of hours

Personalised Care and Support Planning (PCSP)

This helps people living with cancer to have a say in how their care is planned and given. This means making sure the care matches what’s important to them.

This includes:

• Having conversations to identify your concerns.
• Developing a Personalised Care and Support Plan.
• Sharing information about diet, physical activity, fatigue, practical information, emotional support, etc.
• Directing you to local support services such as benefits.

Making decisions about your healthcare

At NBT we encourage you to be a partner in your healthcare.

When patients work with healthcare professionals to make decisions about their healthcare plan and treatment, this is called shared decision making. Shared decision making makes sure you are supported to make decisions that are right for you. This means supporting you to choose tests and treatments based on medical evidence, as well as your individual preferences, beliefs, and values.

It can be helpful to write down questions you have for your healthcare team. You should bring these, and a pen and paper to make any notes when you have appointments.

Some questions that may be helpful to ask:

• What are my options?
• What are the possible benefits and risks of those options?
• What support and information is available to help me make my decisions?

Shared decisions making matters to us. Tell us what matters to you. 

NGS Macmillan Wellbeing Centre 

We give help and information about different kinds of cancers and treatments. We also talk about money, benefits you might get, what to eat, and exercises to do. If you have any concerns or just want to talk with one of the team, we have time to listen and help you.

The centre offers ‘drop ins’ for coffee and a chat, or appointments for specific needs.

Opening times: Monday to Friday, 08:30 - 16:15

Phone number: 0117 414 7051

Cancer Information Session

As part of your routine care you may be invited to a group education and support session at or soon after the time of a cancer diagnosis.

The session provides:

• Information about cancer and related topics that help you participate in your care and recovery.
• The opportunity to meet other people with similar experiences.
• Help to enable you to make choices best suited to you.

Venue: NGS Macmillan Wellbeing Centre, Southmead Hospital.

Days and times: Mondays 13:30 - 14:30, Thursdays 10:00 - 11:00

© North Bristol NHS Trust. This edition published September 2024. Review due September 2027. NBT003677