The simplest way is to call his secretary with your authorisation code (if insured) and she will be able to book you an appointment at one of the locations he consults at. If you have a preference for one location, then you can either let her know that, or arrange an appointment with the hospital directly.
It is preferable although not essential to bring a copy of any referral letter with you. It also helps (if applicable) if you can bring with you any previous correspondence about the same condition, or other conditions, and a list of your current medications. If you have any scans on discs or reports, please do bring those along as well.
Insured patients should bring with them their policy number and authorisation code.
If you need any tests such as x-ray, CT scan, MRI scan, blood tests etc, these will be booked on the day. Insured patients should confirm with their insurance company if they are insured for tests and scans. The hospital will confirm the cost in advance of any test for self-paying patients. If there is availability in the hospital these tests/scans may occur on the same day however when this is not possible patients will need to return for the tests/scan. These can be booked yourself with the relevant department, or call Mr Welck’s secretary and she will book it for you. You will then be brought back at your earliest convenience to discuss the results and to come up with a treatment plan.
Every operation is different and therefore will involve different length of stays in hospital and different arrangements after the operation. Mr Welck will explain the details of the proposed surgery, and the relevant aftercare. He will also go through some of the relevant risks. He will give you a form to read with some of the other, less common risks, that you should read at your leisure, and bring with you on the day of surgery to discuss and sign. It is important to find out how long you might be off work (if applicable) so this can be discussed with your employer.
You may then be contacted by the hospital for tests to make sure you are safe to have an anaesthetic. You will be provided with reporting instructions, and for patients undergoing general or regional anaesthesia, advice on when you can eat and drink. If you have any questions at all please contact Mr Welck’s secretary on 0207 042 1869.
If you have any questions after your consultation please contact Mr Welck’s secretary and she will help you, or ask Mr Welck for you.
After your surgery, Mr Welck will see you to ensure that you are well and provide details of the operation / answer any questions you may have.
If you have concern after surgery, again you can contact Mr Welck’s secretary on 0207 042. If it is out of hours you can contact the ward from which you were discharged from. They will be able to contact Mr Welck in an emergency.
Smoking cigarettes has been shown to significantly increase your risk of wound healing problems, bone healing problems and is also associated with increased pain after surgery.
Studies have shown that stopping smoking 4 weeks before and 4 weeks after reduces complications by 20%. Each additional week stopped also reduces complications by 19%. E-cigarettes may cause a lower rate of cancer and heart disease however its effect on wound healing and bone healing is uncertain and may be little different to cigarettes.
Some operations are done asleep (under general anaesthetic) and others are done awake (under local anaesthetic or nerve ‘block’). Mr Welck works with anaesthetists who specialise in nerve blocks, which help provide immediate postoperative pain relief, but also to allow awake surgery where appropriate. He will come up with a plan for you based on your preference and the procedure you are having.
Any operation that may be painful afterwards is usually given a nerve block in the operating theatre. This means you wake up with the foot/ankle numb. That lasts 24-48 hours. It means the foot or ankle will not be painful during that time. When the block wears off, the acute pain has subsided, and you will be given pain killers to go home with. The bandages or plaster cast also keep the area well-padded and wrapped to prevent pain.
Each operation has its own protocol these can be found here (link to rehab guidelines). They will be clearly discussed with you before the surgery.
Some patients will just have a sticky plaster, others a flat Velcro shoe, others a shoe where you walk on the heel.
If you are given a plaster, it will initially be soft on one side to allow for any swelling.
Also, the amount you can walk on it very much depends on the procedure. Some are allowed to walk normally after, others are advised to put some weight on with the help of crutches, and other to put no weight on it. The physiotherapists on the ward liaise with Mr Welck and will teach you the correct way. There are commercially available aids suitable for some patients who are advised not to put weight on the operated leg.
Some cases are ‘day cases’ which means you come in and go home on the same day. You will be told how long you are expected to stay in for long before your surgery to allow you to make suitable plans.
When you are discharged from hospital you will be given your medication, any instructions and an appointment (usually in 2 weeks) to come back and have the wound checked. It is vital to listen to the advice you were given on elevation and keeping the dressings clean and dry.
Mr Welck usually uses fully dissolvable stitches, avoiding the need to have anything taken out. Occasionally a special type of stitch is used to hold the toe and that is easily removed at 4 weeks. The wires (if used, come out at 4 weeks). By that point they are loosened and are not painful at all to remove. The wounds are usually left undisturbed for 2 weeks as the dressings were applied in a sterile environment. Seek advice if the pain increases, if you develop a temperature or if the dressings become wet or foul smelling.
This very much depends on the type of surgery and the recovery. In general, patients that drive automatic cars can drive earlier if the surgery is on their left foot. You should inform your insurance company if Mr Welck is happy for you to drive, so that your insurance is not invalidated. Once all dressings are off, the most important thing is that you can safely perform an emergency stop if required. This decision will be personal and made with the physiotherapists. The ultimate responsibility for your safety to drive a car is yours.
The main issue with flying after surgery is the increased risk of blood clots. Mr Welck will assess your personal risk of having a blood clot based on your own risks (including any history of previous clots, history of clots in the family, any clotting diseases etc) and the risks from the procedure. In general, more minor operations such as bunions, it is advised not to fly long haul for 4 weeks, and for 3 months after more major surgery (such as ankle fusion). Useful information on flying after surgery can be found at https://cks.nice.org.uk/dvt-prevention-for-travellers#!scenario
Mr Welck will inform you when it is safe to shower or bath the wound. It is not advisable to rub creams on the wounds too early due to the risk of introducing infection. It is essential that any dressings are kept clean and dry. There are several products available to keep dressings/casts dry (e.g https://limboproducts.co.uk).
You will likely be asked for keep the leg elevated after surgery. This can be done with pillows. It also helps to put something under the mattress to elevate the mattress. There are commercially available leg elevators that may also help.