I like to visit the pre-op side to give encouragement to those who are preparing for their own TKR. One of the threads on that side was about the pre-op approval process, many being "scared" that something may be found that is either "serious" or something that would rule out a TKR because of all of the various tests that are given. I had never told the complete story of my pre-op approval process from hell but laid it out in that thread to hopefully show that even if additional tests are required the likelihood of something serious being discovered or something found that would rule out a TKR is probably pretty low. I ought to know! Here is what I posted:
Chances are that even if additional tests are needed they will find nothing, a false positive, something minor easily addressed or if it is something major then as Josephine has said, better to catch it early. Take it from someone who knows. I have not related the complete story of my pre-op approval but so many of you are concerned about pre-op approval testing that perhaps my story will calm your nerves a little bit, hopefully!
For me, it started with the required approval from my PCP that included a bit of a physical exam, an EKG in his office, blood drawn for a CBC, urine provided and being sent for chest x-rays, blood pressure checked - all the usual. Prior to getting approval I then had the following additional tests:
- a 2nd chest x-ray
- a skull x-ray
- a 2nd EKG
- an echo cardiogram
- 2 CT scans
- 1 PET scan
- a bone marrow aspiration
- an ultrasound
- God only knows how much blood was drawn
- in addition to the normal CBC there was enzyme and genetic marker testing on the blood and marrow
Before it was all over I saw my PCP, my cardiologist, a hematologist/oncologist, an ENT. As a follow up I later saw a pulmonologist.
One would think with all of these tests I was knocking on death's door and I would never be approved for a TKR! However......
the first chest x-ray showed a shadow. The 2nd was to determine if it was what is referred to as "nipple shadow". It was not. The first CT scan confirmed that there was a "pleural based density" on my right lung. When the PET scan was taken 16 days later it had not changed and, in fact, was less pronounced. Ruled as probably scar tissue or some mild form of infection. Follow up dictated is a CAT scan every three months for two years. The first follow up CT scan again showed no change and I was sent to a pulmonologist (lung specialist) who also indicated it is barely a shadow, not really dense, and also said it could be scar tissue and definitely ruled out cancer, nothing to be concerned about. One scare resolved.
The skull x-ray was for a lump at the front of my skull just above the hairline. It had been pointed out to me by the shampoo girl where I get my hair cut. I had never noticed it before. Turned out to be a fatty lesion (lipoma). Nothing to be concerned about - no treatment or procedure required. Scare resolved.
The first EKG in the PCP's office showed an elevated heart rate. Thus being sent to my cardiologist who did another EKG. The rate was elevated but the rhythms had not changed from my previous EKG at his office 18 months prior. He showed no concern whatsoever. An echo cardiogram was given "just in case" and it came back "normal". Another scare resolved.
The ultrasound was for a "growth" that showed up on my right kidney in the 2nd CT scan. Also turned out to be a angimylolipoma - a benign cyst. No treatment or procedure required. Scare resolved.
The PET scan also showed parotid inflammation, an infection of the salivary glands. I was sent to an ENT who used a laryngoscope and he ruled out any infection. He said he can't totally trust PET scans as a lot of things "light up" and turn out to be false positives. Another thing that could potentially interfere with my TKR resolved.
That brings me to the bone marrow aspiration, all the blood that was drawn and the tests that were performed as well as some of the additional things that the CT and PET scans were used to look for. The initial CBC done by my PCP showed an elevated white blood count and other results indicated a preliminary diagnosis of Chronic Lymphocytic Leukemia (CLL). Thus I was referred to a hematologist/oncologist at a local cancer center. After all of the additional tests were done the CLL diagnosis was confirmed. Pretty scary right? Except that the scans show no involvement of any lymph nodes, the spleen nor liver. Basically I am asymptomatic and would be classified as stage "0" or "watch and wait". The enzyme and genetic marker testing indicates that it should be many years before I would ever need treatment, IF EVER. Again, as scary as the use of the word "cancer" may be I was told this is the one to have. Being a white male over the age of 60 makes one more susceptible to CLL and it often goes undiagnosed and is more common than one might think because it will typically only show up when a complete blood test is run for some other purpose, as with me for the TKR approval. Going forward, having CLL means I have a compromised immune system and may be more susceptible to infections. When this was discussed with my OS, since they already take elaborate precautions to prevent infection both pre and post operatively, the only thing done differently for me was to use cement that is laced with antibiotic (ALC). In some countries using ALC for primary TKRs is common. It also means there is no debate for me in regard to taking antibiotics before dental procedures or other invasive procedures like colonoscopies. Scary? Very much at first but not so much anymore.
The point of all of this, again, being that even if additional tests are required because "something" showed up it doesn't mean that whatever "something" is will necessarily be serious. It may delay the timing of your TKR as I saw my PCP on 1/29 and didn't get final approval until 3/6. I then could have scheduled my TKR for as soon as 3/10 but I had not stopped all of the drugs they want you off a week to 10 days prior so I scheduled it for 3/17. I have had a good recovery. I was back to playing golf a little over 9 weeks and have basically resumed all of my normal activities with little thought and little discomfort in the knee.
Canada
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