RTHR set for June 14th and scared!!!

[davidjb]

After a one month delay I have scheduled my Direct Anterior RTHR for June 14th. I've been helping my father recover from prostate cancer and surgery and am now trying to transition back to my hips. I must say I feel like a condemned man. I've not only not been able to lose the 20 lbs my doc wanted me to but have actually gained 10 since my initial visit. If I do some hardcore low carb dieting the next month I might lose 15-20, we'll see. But really, I'm starting to confront those things about the surgery that seem really unsettling.

Just when you think you get a handle on the information you think you need to know, something else comes up. Like, for example, maybe I should try to get a OS that does computer-assisted navigation? Also, the anesthesia, I've heard so many conflicting accounts of the experience I don't know what to expect or what the variables are in order to make an informed decision. I was resigned to not go full general anesthesia and do a spinal or epideral, but one person says, "oh yeah, it was nothing, I just rolled over and thats the last thing i remember". And another person, like a friend of mine who had knee surgery a couple years ago says, "they dug around my back for 20 minutes and the pain was worse than childbirth!, Definitely go general anesthesia!" Are you kidding me? What am I missing here, what accounts for such varying experiences? Also, does someone have to be fully awake and alert while the needle/catheter is inserted or can one somehow be anesthetized or sedated beforehand? Any help on these most troubling concerns would be highly appreciated.

 

[Jamie]

Hi, David....welcome back...it's been a while since you posted. I'm glad you joined us here on the forum. You may noticed that I edited your thread title slightly. We have rules here on BoneSmart and your title violated one of them. I do suggest that you take a look at the Rules of the Forum just to be sure you are up to speed on how BoneSmart operates.

Your questions and fears are normal...something most people experience. You can find many of the answers you seek in our BoneSmart Library (link at the top of the page). Here are a few threads from the library to get you started:

Pain management and the pain chart
How Long Does Healing Take ......
Chart representation of THR recovery
Energy Drain for THRs
Elevating your leg to control swelling and pain
Myth busting: on getting addicted to pain meds
Post op blues is a reality - be prepared for it
Some suggestions for home physio (PT) and activity progress

Please don't worry about your weight. Those few pounds aren't going to make a difference one way or the other. The important thing is to be healthy and well rested going into surgery. Work on that!

As for the anesthetic, you will be partially sedated (or can be if you ask) before getting the spinal. You'll be just fine. For some reason some people just LOVE telling these scare stories. Granted there are some folks who have some problems...but "digging around for 20 minutes?" I think not!!! Most people feel a tiny stick and then wake up in recovery.

Don't worry about the prosthesis or surgical technique. The important thing is that you have selected a surgeon who is very experienced and does at least 250 hip replacements each year.

 

[sharonslp]

David, I predict that when it's all over and you are on the way back to recovery, you will look back at this and laugh at your worries. Not because they aren't worrisome ahead of time...they are. But because reality is rarely anything close to our worst fears.

There is another thread going in this pre-op forum, about which anesthesia to choose. I'm going to try to link to it, but if this doesn't work, it's on page 3.
http://bonesmart.org/public_forum/choosing-anesthesia-type-your-experience-t14505.html

Now...breathe. And know that this surgery works wonders for us.

Sharon

 

[Elizak]

Hi David,
I had the same worrying, obsessing, rethinking every decision, up until the very morning of the surgery when I finally accepted that I was having surgery that day with that surgeon at that hospital, etc.

The day before I was still considering cancelling and going to a different surgeon with a different method in a different hospital in a different city.....or maybe I could suffer for a while longer and not have the hip replacement at all or at least not right now.....

In the end I trusted my intial choice and things have turned out extremely well. As long as your surgeon is very experienced in hip replacements I think that you can leave most of the decisions up to her/him.

My surgeon preferred spinal with sedation. I would have preferred to be completely sedated for the entire 6 weeks preop. Spinal with sedation has some real benefits to your recovery. Less blood loss, less chance of being nauseated after surgery, more alert quicker after surgery (I did not like this idea, but postop pain should be well medicated), less chance of complications, able to move around quicker after surgery so body gets back to normal faster, etc.

I remember being asked to sit up in operating room (I assume this was for spinal) and don't remember anything after that until the recovery room. I did not even feel the spinal.

In any case, if you can help it, let the surgeon and hospital staff worry (that is what they are paid for) while you get ready for your recovery.

Best wishes

 

[Elizak]

I have lost 10 lbs since surgery because i am moving around better, so I would not worry about weight at this time.

I was definitely sedated prior to the spinal. I don't remember leaving my preop room to go to operating room and only a flash in a operating room when I was asked to sit up.

Remember, the surgeon and operating staff do not want you to be awake/aware enough to make a fuss and bother them. The opposite, in fact.

 

[Josephine]

Oh they do love to tell those scary tales! Ignore them.

 

[Elizak]

Hi David,
I just wanted to check in. I can understand after your dad's illness that hip replacement is a daunting task. I read that you are having the anterior approach. There are quite a few bone smarties who have had this approach. You may want to read of their experiences.
If you do not feel certain with your surgeon you have plenty of time to consult with other surgeons. This may be a very good thing. Even if you do not change you may feel more at peace with your decision. Regarding computer assisted placement, I know nothing about it. It may make sense in the DAA approach or all approaches. Let us know what you find out. Best wishes.

 

[Oakviewneighbor]

Hi David,
First stop on the weight already. Do not go on some hair brain diet to loose weight now. You need to be preparing yourself for the surgery by eating healthy. There is nothing wrong with treating yourself to a nice steak dinner with a lovely salad. :wink2:

On anesthesia go with what you feel is right for you. General happened to be what was right for myself and the decision was made with the help of my anesthesiologist just minutes before surgery. Your anesthesiologist will guild you to the right choice for you the day of the surgery.

Right now the best thing you can be doing for yourself is preparing your home for an easy recovery. I took my walker on a test run making sure I could get to things easily. It took a few times of moving stuff around to get it right. I rearranged my frig so I could get to stuff I wanted. I purchased a few dollar store baskets and use them in the frig for like items to make it easier for myself. I put another basket on the table with items I needed for cooking and places some pots with lids on the stove that I would be using. I also made sure I could get to my clothes easily so I wouldn't break my precautions. For my rest area I have a tv remote, lap top computer, my phone, pillows to elevate my legs, snacks, puzzle books and meds. I have a nice cozy recliner. If you don't have one - now the time to get one. Set up your bathroom with grab bars, nonslip mat and high toilet seat. Toss the rugs in a closet for now if you have any.

Pat

 

[Oakviewneighbor]

Guild should be guide :oopss:.

 

[titac]

I feel like I have some company. I am scheduled for a LTHR on June 13, 2012. That is one day before you. I am "scxicted" - exicted and scared at the same time. Right now I an just focusing on preparing for the procedure and getting my head all ina positive zone. I wish you all the best going into the procedure.

 

[davidjb]

Hi everyone! Sorry for my earlier title-I got a little carried away. Thank you for all your thoughtful responses. It helps so much. I'm still researching the anesthesia and trying to find out what might be best before rolling into the operating room and having to make that decision under less casual circumstances while the OR clock is ticking. The Surgeon on "Weight of a Nation" on HBO this week said the mortality rate for general anesthesia is 0.3%. 1/300. Though I'm sure these unfortunate patients are those suffering from other complex problems or risk factors, it would be nice to avoid that if I can tolerate the spinal/epedural.

As far as my OS, I am happy with him. He is the chief trauma surgeon at UCLA and though his numbers are probably more in the 200/ year or slightly less from what I can gather, he's done this approach for 5-6 years and appears very competent. My decision was based on my interest in getting a Direct Anterior Approach, UCLA itself, and a bonesmart user here with a good outcome with him. Moreover, the only other two OSs in the southern California area that I have found with notably higher numbers for the DAA don't accept insurance. (humming God Bless America;)

I just don't know what to expect I guess, its all foreign. And then there's that folley catheter. Omg. What year is this? Can I get some light sedation for that? Geeez! Its looking more like the Spanish Inquisition. I really love your story Elizak. Thats what I'm hoping for, something like that-don't even remember the spinal. And maybe as Sharon said, I will be laughing at all this when its over I hope. The two things I am trying to repeat over and over again in my mind are:

1. This is one of the most routine and successful operations in modern surgery.
AND
2. As my dad often says, "Its the OS and surgical team that has to do all the hard work, all you have to do is show up!"

So I'm trying to keep my outlook up and not fear the unknown. A special word out to titac. Yes we have a lot in common and I am thinking of you and wishing you the very best as well.

 

[Poppet]

Hi David, and welcome to BoneSmart.

Your Dad is so right, it is all about the surgeon and his team. I too did heaps of research for nearly eighteen months and in the end I had to change surgeons and just go with my faith in him.

Sure I had a few unrelated surgery complications, but at six months, I am seeing improvement each and every day.

If I could give one piece of advice is to have a very realistic timeframe regarding recovery. No two THR recoveries are the same, as no doubt you will read.

I didn't have PT, it is not common here in OZ and right from the start I read and followed Jo's advice... Hips have a way of working out and the best exercise is walking. When you think about it that is what we mainly do... Walk... So I took it slow and steady.... I wish you all the best

 

[rider1960]

Hi, and welcome to the forum!

You will meet with either your anesthesiologist the day of surgery, or with some one from the anesthesiology department when you do your pre-op testing or even before that if you request a meeting, depending on the hospital's procedures and policies. They are your best resource for this info and recommendations.

All I can tell you is my own experiences. I had general for a hysterectomy in January of 2010. I woke up suddenly, and kind of "not all there" and feeling quite a bit of pain. I had hoarseness from an endotracheal tube for about a week afterwards. I could still talk OK, but my voice "wore out" quickly. I'm a "talker" kind of person, so that bothered me a lot.

I had a spinal block with some nice IV sedation (don't remember a thing) for my hip replacement January of 2011 and it was great. The only thing I remember from the spinal was being told to sit on the side of the table, leaning over a pillow being steadied by a nurse, and the next thing I remember was calmly waking up in the recovery room feeling no pain. It took probably a couple of hours for the leg to get feeling back (which was fine with me!). I had a chance to get some pain meds on board as the numbness was wearing off.

Everyone is different, but for me the spinal was my favorite by far, and I plan to have it done again for my next hip in June.

Throughout this whole hip replacement process, you may hear horror stories ... or the other way around--stories about people who could or know of someone who could move mountains and lift cars two days after surgery. Take both extremes with a grain of salt. What you will actually experience is more likely to be in the middle area which is fine--that's how my experience was--pretty much middle of the road the whole way through. Nothing bad, but nothing super wonderful either. Just a nice, uncomplicated surgery and recovery ... except for the post op fatigue I had which wouldn't have been such a big deal if I had slowed down when my body was telling me to do so. It's important to listen to your body and do what it is telling you it needs. Everyone and every surgery/recovery is an individual and needs to be treated that way.

About the dieting/weight loss--don't get too carried away. You don't want to do anything to compromise your nutritional status the last month especially. I've read in more than one place--"do not diet during the month before surgery"--for that reason. Of course, they don't mean to eat recklessly, but they do want your nutritional status to be really good going into surgery. I think you will find that you will lose 10-20 pounds in the first couple of months after surgery between just being able to be more mobile again and the boost in your metabolism while healing. My appetite was fine, but I lost 15 pounds during that time just because of the metabolism factor. It's more effort to simply walk around and do your normal activities of daily living in the immediate post op period. All that uses more energy. I think you will be pleasantly surprised about this.

Hip replacement surgery with a competent surgeon at a good hospital usually goes very smoothly, especially with your being young and probably not having any other health problems that could get in the way. I bet you will bounce back pretty quickly.

Dorothy

 

[Elizak]

Hi David,

I may not remember anything but apparently I was talking the entire time ! My surgeon gave me a funny look afterward and asked which neighborhood I lived in and then told me I was talking and talking about another neighborhood. The staff is the recovery room told me that as I was being brought in from the operating room I was loudly thanking everyone for fixing my hip !!! If you have any secrets, guard them well ;-)

 

[davidjb]

Thank you everyone for your thoughtful responses. I've been able to slightly reduce my daily vodka-tonic regimen accordingly as a result.:cocktail_martini: Smja, we overdo the whole PT thing here in the states I think. Not to denigrate them, my cousin is a PT and they do valuable work. But I think its a symptom of our defective fee-for-service system here. There's a lot of money to be made at rehab centers, that is, I think, above and beyond the call of duty. When I was first diagnosed with AVN, the hot-shot OS in my area affiliated with our big medical center immediately ordered me on indefinite PT up to and until my "core decompression", and then of course afterwords. Needless to say, I didn't stick with him or opt for the CD. Even subsequent OSs I saw kind of laughed and said you don't need PT, you need a hip replacement. Of course it can be very helpful after a surgery but its over done here, so don't feel like you are missing out on anything. I think its kind of a racket here, if you ask me. Walking seems like the most natural therapy. That stuff with the big rubber band and pulling your leg up on your side you can do at home anyway.

Dorothy, thank you so much. It was really nice to read you experience, impressions and support.:ThankYou: And all the best for your next one in June.I hope its as smooth as you described the first. My RTHR is in June and not sure how long I can hold out on the left. As far as anesthesia, though I'm not exactly the wake up and eat nails for breakfast kind of guy, I can certainly handle a little prick in the back. But when i hear these human pin cushion stories, jabbing around someone's back fruitlessly with a big spinal needle, i sometimes think I should opt for the gas. When I pressed my friend again on her experience she said "it seemed like 20 minutes", and she believes that they did the spinal before giving her any IV sedation for some reason. Who really knows? But yes, these maybe are extreme stories.(I hope:prayer1 All the more reason why I want to know "almost" everything before i go in

Thanks Pat and Dorothy on the weight advise. It does make me feel a little better. I'm not exactly huge (yet) but I did recently creep into obese territory and have put on almost 50 pounds since my diagnosis. My exercise plummeted to zero but my appetite did not. And these OSs are so emphatic about a healthy weight. One spooked me out a lot I guess when he said being overweight was the biggest component to complications both during the surgery and during recovery. But, as we all know, its really hard to exercise when you can barely walk. Moreover, I know I've done more than a little emotional eating at times too.:choc: I just have these terrible fears that the OS doing a DAA, hard enough to position everything right to start with, is going to have more of me to get through to do the job right. So I'm thinking to postpone my surgery by 1-2 weeks. Give myself a full month to diet. One OS said low carb high protein is the best if you cant exercise. Its a bummer, (say goodbye to the mohitos) but I've had some success in the past with it and think i can pull it off for a month.
Funny story Elizak. My father just had a robotic prostateectomy. He was the opposite of me. Very calm and enjoying meeting and chatting with the nurse, Anesthesiologist, and surgeon. The last thing he said he remembered was being wheeled into the OR and asking what the robot's name is? I guess that's when they said enough with this guy!:hysterical:

David
Bilateral AVN of the Hips at 38
FICAT II and IV

 

[enoughpain]

Hi David:

Have not yet had my THR, so can't speak about the experience, but have had three epidurals for other surgeries to date, with no sedation beforehand. It is a very common anesthesia for childbirth and they don't give any sedation, as it could reach the baby. I felt the sting of the initial numbing shot (like novocaine at the dentist, only I think it's less painful in the back than in the gums), and then did not feel the spinal needle at all. There was a slight feeling of pressure in my spine and I immediately started to go numb. I have only had general anesthesia once and would always choose spinal/epidural over that if I could.

As far as the weight, my OS tells me that the DAA is better for overweight patients for two reasons:

1. you are on your back, so there is no maneuvering the patient before or during surgery.
2. we tend to gain less weight in the front of the thigh than in the back so there are is better access.

Everyone here will support you in your choice. Don't read horror stories elsewhere.

 

[davidjb]

Thanks Enoughpain. That should be my motto. So they numbed the site first with novocaine before the spinal needle. Interesting, and reassuring. That sounds like the way to go, and with a little sedation too, even better. Still I wonder how some of these unfortunate patients are having unpleasant experiences if it is so streamlined. Also, I understand spinal and epidural are not the same? Epidural, I believe, allows for the implanting of a catheter that can be left in place indefinitely and topped off with more anesthetic as needed? Whereas a spinal is more of a one-shot? I wonder how that works with hip replacements. How does one lie on their back with an open catheter in it? Maybe it is not generally necessary since the hip only needs to be numbed for a few hours?

I'm happy to have the option of the DAA. I searched long and hard and at considerable expense to find someone who I felt was competent to do it at a highly regarded medical center and still within my insurance coverage. I have high hopes for what ever benefits it may have. In the end, its still a THR and I know I'll have many months of recovery.

Earlier, I mentioned computer assisted navigation in THRs. That is one approach in addition to the DAA that ideally i would have liked to have had as an option. We all want the greatest longevity of this stuff as possible, especially those of us who are on the younger side, who may unrealisticly hope that we will not need another revision. The computer navigation has been used more widely with knee replacements and is now making its way very slowly to hips. There seem to be very few OSs at this point doing it though there are studies out of the UK and Canada I believe that indicate it allows for less blood loss, more accurate leg length and placement of the components, allowing for potentially longer life and lower ware characteristics where less than a mm sometimes matters. Markers are placed on the thigh bone and on the pelvic bones before incisions are made to measure distances and angles in a GPS fashion with the use of computer software. Bert Thomas at UCLA uses it with the DAA but he is out of my network. Lawrence Dorr in Los Angeles also uses it with an MIS posterior-lateral approach. It seems like this may be a kind of wave of the future in hips, but of course requires more expensive equipment, training and some have argued it adds a few precious minutes to the surgery. Hard to tell what the long-term benefits are at this point since there are obviously no long-term results yet with this technique. So I'm hoping that the UCLA OS I have lined up using the good old "eyeball" method works well enough. Nevertheless, if anyone should have access to a skilled surgeon with good numbers that uses a computer navigation assisted DAA, that might be someone to really consider.

 

[Jamie]

David.....please don't try to delay your surgery in an effort to lose weight. Even if you lost an extra 10 or 20 pounds in that extra week or two, it won't make a bit of difference in your surgery. Honest!! The best course of action is just to get on with it so that you're recovered enough to begin exercising as soon as possible.

Don't worry about the catheter.....if used, it will be placed once you are asleep. As far as the spinal goes, I cannot speak for those "others" you've talked to or read about, but I CAN talk about YOU! You will be just fine if you tell everyone you see once you get to the hospital that you are a little anxious and would like some "happy juice" before you get to the surgery area. The nurses will be thrilled to accommodate you because a happy you makes their job easier as well. You won't be out, you just won't give a dang about what is going on. I would be really surprised if you feel anything more than a small stick.....next stop - recovery room!!!

 

[davidjb]

Thank you very much Jamie.:ThankYou: I'm giving your advice careful consideration. I wanted to weigh in sooner but my dad and I and his girlfriend were in an auto accident Tuesday. We are okay, we were rear-ended on the Pasadena freeway. Nothing serious, but we all have some whiplash. Though I have a history of them since I was a child, the incident triggered a severe migraine which necessitated me going to the emergency room in the wee hours of last night after violent vomiting and some real agony. The incident has left me with some questions relevant to my upcoming hip surgery.

My dad took me to the ER and accompanied me at all stages. At one point after the Doctor saw me I was placed in a room and a nurse came in to give me an IV. Lets just say she was curt, if not brutish and even snappy with my dad once who gets along with just about anyone. Moreover, she insisted on giving me the IV in my forearm at the elbow, despite having just noted what every other person working with my veins has ever told me, that I have large, great veins especially on my hands. I actually feared her at times and my dad echoed the sentiment after we left. I didn't put up much resistance as I was in real distress, but that IV hurt like crazy despite the narcotics flowing through it and my arm is bruised and black and blue today. Though no IV is exactly painless, every other time I've had one, (two out-patient sinus surgeries and thrice before at the ER, they've placed it in one of the large veins in my hands and it was quite tolerable. Can any one tell me why this happened? Absent some good reason (small veins) can I request, or even insist that the IV be placed in my hand rather than forearm? I can't imagine sleeping with that in my arm.

In addition, I know that in every walk of life, you occasionally cross paths with someone that is a little rude or crude, even a little scary. Last night was one such night for me, though everyone else at the hospital was wonderful. Does anyone know if there is any kind of protocol for requesting a different nurse or technician in a situation like this without creating a rucas or putting oneself in an even more perilous situation?

Last, I have a severe allergy to Ceforoxime, a second generation cephelosporin. Five minutes after taking one Ceftin pill ten years ago for a sinus infection I developed anaphelaxis and required four hours at the ER to stabilize me. Recently, during one of my nightly pre- vodka-tonic research efforts on google, I came across a description of the IV antibiotics commonly used during hip replacement surgery. The three listed were, 1. Ceforoxime, 2.a first generation cepholosporin,and 3. a penicillan . Though Ive taken penacillan products several times without incident, I started to worry that I may be allergic to the first gen. cepholosporin, something I may need in the event of an infection. this prompted me to consider getting tested for atibiotic allergies, a procedure often lasting the better part of a day, with often questionable results, and usually only done at large research hospitals/medical centers. Does anyone have any experience with this? My doctor's office says it cant hurt, and I don't think they would discourage this. But am I going into over-kill on this, or missing something? Could it be sufficient to just inform everyone every step of the way of my known allergy and let them take it from there? :feedback:

David
Bilateral AVN of the Hips
FICAT II, IV

 

[Jamie]

David, I feel like you are worrying needlessly. Anxiety can bring up all sorts of "monsters of the brain" to terrorize you before surgery.

I think you just need to let all of your medical team know of any problems you have had in the past. They are professionals and deal with these types of problems every day. They know what to do.

As you so wisely note, even if you had a positive from an allergy test, those results are sometimes not an accurate assessment of allergies you might have.

I can see why you are anxious. Having a car accident and migraine headaches are enough to get to a person. Add in a tactless nurse and.....that can take things over the top.

Try and stay calm and focused. You have done your homework and have an excellent surgeon. You are in good hands. And, as for the choices you have with your nurses....YOU have the right to ask for your IV to be placed where you want it unless there is a medical reason for it to be otherwise. You also have the right to request that you not been seen by a particular nurse. It's okay to be assertive.....you are the customer here!

I have problems with IVs as well. My veins are very small and tend to roll. Nurses can almost never find one in my arm and so I ususally have my IVs in my hand or at the side of my wrist. That requires a smaller needle than they sometimes use. When I get to the hospital I tell EVERYONE that I'm a "tough stick" ....looking them in the eye when I say it firmly. That usually is enought to get the "A Team" out to do the IV. I tell them it's okay to try where they want to, but only once .... I don't want someone digging around to find the vein. Hospitals have staff who are better than others at this process. You just need to be sure they give you their best!