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TKR at risk now so surgeon says

RICBAK1

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Hi had left knee replaced in 2012. Went to see surgeon today in Park Hill hospital Doncaster he says I am an at risk patient now as I have had heart surgery since last knee op and also have atrial fib and high blood pressure. Now it is up to anesthetist if I am allowed to have the right knee done. He says the operation and the cement for knee puts a lot of strain on heart. So may not get right knee done now just wondering what alternatives might be surgeon would not say.
 

VSlowLife

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I would ask the doctor what factors you might be able to control to make your situation less risky. Could your blood pressure be controlled by weight loss, or is that a moot point because of the A fib? My dad had A fib, but never needed surgery.
 

alexthecat

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We've had a lot of forum members who have A fib. It's not something that I have personal experience with, but I'll tag @Jamie and see if she has any advice for you.
 

Jamie

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I had active a-fib that was somewhat controlled by medication for my first knee replacement and it was no problem for the anesthesiologist. By the time I had my second knee, I had an ablation that took care of the a-fib and it also was not an issue then either.

Of course, it will depend on what yours has to say based on your specific history. But generally, they have a whole toolbox of things to do to stay on top of any heart issues that come up during surgery. Your history will likely mean you are not a good candidate for outpatient surgery, but that's not all bad. It just means you go to a regular hospital instead of an outpatient facility and get a few days in the hospital to make sure everything is stable before you go home. Frankly, I like that idea better that the quick in, quick out that is so popular these days.

What type of heart surgery did you have? There is a big difference between something like stents and a bypass operation or heart transplant. How is your heart doing now?

And is your blood pressure controlled with medication? If not, you will want to work with your GP to either change your lifestyle (diet, weight loss, exercise) or find a medication that lowers your blood pressure. That's something you want to do no matter what for the benefit of your overall health.

Are you on any medication to help with the a-fib? If not, that could be something you might discuss with your cardiologist. It may be a bit more difficult in the UK because many of the drugs used for a-fib are expensive and I've heard that the NHS may not always support their use.

If you are having bouts of a-fib, have you met with an electrophisiologist (a heart specialist, different than a cardiologist, who specializes in heart rhythm issues) to talk about options? I had two ablations and the second one (a cryo ablation) worked wonders. I have NO a-fib events any more and my heart has been just fine for 8 years.

I don't know anything about individual hospitals or surgeons in the UK. So let me tag @Jaycey to come talk with you. It might be that you would need to go to a different hospital where the surgeon is more comfortable dealing with your risk factors. Remember.....a risk is just that...a possibility. It's not a certainty and most of the time it doesn't prevent you from having a needed procedure, providing you find the right surgeon.

Since your surgeon mentioned the potential for problems with the bone cement, I'll say that is a possibility, but it is very, very rare. And the documents I have read indicate it is more of a problem with hip patients than other joints.

People with heart issues get joints replaced in today's medical world. I think you'll be fine if you just talk with some different surgeons and other doctors who can help you get the joint replacement you need.

Please keep us up to date with what's going on. We'll try our best to help you get through this.
 

Jaycey

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@RICBAK1 What heart operation did you have? Were you planning on having your knee op in a private facility?

I think part of your problem is that Park Hill does not have any cardiac care. Typically a surgeon would like cardiology backup if they are operating on someone with a history. You might want to ask your surgeon's office if this is the issue.

If you want to proceed with this surgeon the first thing I would do is either get your GP to approve you proceeding with TKR or ask your GP to refer you to a cardiologist to get their approval. Get it in writing and give a copy to that surgeon and and anaesthetist.

You will need to go through a pre-op assessment anyway. Having prior approval on file will help you get past this roadblock.

The other alternative is to find another surgeon who is more comfortable dealing with your medical history. However this might mean you need to travel. Are you willing to do that?
 
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RICBAK1

RICBAK1

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Hi.
My heart operation was for aortic valve. The surgeon was going to replace it with a mechanical one but when I woke up he said that I had a repair done instead. I asked if while this was going on did they stop my heart and start again to cure my a fib, but I was told no. I take medication to control this.

I did not choose Park Hill. That was where I had my last tkr because a private patient had problems, so they swapped us. This is what he is doing now, sending me to Doncaster DRI next door .
They do this to share the same facilities for NHS. Park Hill has no night cover.

I had my bp taken the same day as seeing my surgeon and first 2 readings were 199/72 . The nurse was ready to admit me, but decided to try me lying in a dark room for 10 mins then took the reading again it was 160/53, so she was happy. This is how mine goes. They are sending me for further cardio checks as I get a lot of dizzy spells and lose all balance for about 2 minutes.

I am on bp tablets, vertigo tablets, and for a fib. I am trying to lose some weight.
At chest clinic last week they were pleased with me I have lost 4 pounds. I also have COPD and pneumoconiosis they say.

I walk, swim 2 miles most weeks, a mile in 40 minutes,and either go out on my bike or use an indoor bike, trying to keep as fit as possible.

So I may have to wait for my next TKR.
got a appointment for a further ECG. I will have to wait and see.
 

VSlowLife

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@RICBAK1 You do have a few things to contend with. I am no medical expert, but I do know what my mom went through with vertigo. For her type of vertigo she was given some exercises and shown how to do them in bed. She did them and managed to move whatever it is in the ear that needed to be moved into a better position, not to experience vertigo.
 
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RICBAK1

RICBAK1

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Hi yes a few things but hey still breathing and playing with grandkids, vertigo may have come from spending to long working underground being a coal miner.No mention of exercise just tablets to try and pump more blood to ears.
 

Tykey

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Your best chance is to approach a hospital with cardiac and ICU facilities.
I know Barlborough, who have neither are very cautious. I had a mild heart attack, and if it had been within 3 years they wouldn't accept me.
Northern General in Sheffield is the top cardiac care hospital, ie the centre of excellence, so they may be your best chance.
Good luck
 
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RICBAK1

RICBAK1

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Had heart op at Northern had first knee at Park Hill this time I think I will be having it done at Doncaster Royal Infirmary .According to surgeon things have changed since last TKR now the anethatist has final word if he says okay surgeon will do operation so now waiting for appointment with him.
 

Billhart46

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The OHS should have absolutely no reason to cancel surgery as long as it has healed.

I can see that there are some questions about the COPD, vertigo, and high BP.

I have had 2 OHS, bypass and a replacement mitral valve. The surgeon just lwants a note from the cardiologist and the cardiologist is writing one with seeing me for 5 months.
 
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RICBAK1

RICBAK1

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I have been to my surgeon again I am still an at risk now I have to lose 6lbs,as well as seeing my doctor about a recurrent facial abscess I have.I have just been on a 3 week cause of antibiotics but not cured so need to try different before TKR. Told me he would pump more antibiotics in knee if they cant cure abscess but not very happy and still not happy about my atrial fibrillation even though medicated. Looks like waiting a bit longer was told though only option is a TKR because total bone on bone so surgeon will do op as soon as I get things under control.
 

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@RICBAK1 So sorry you are facing yet another delay! It is so difficult to lose weight when you can hardly move. I hope one of our members comes along to suggest something that worked for them. Hope things turn around for you soon! Please keep us updated.
 

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Hope your abcess clears up soon.
 
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RICBAK1

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Thanks been to dentist today sent by doctor to try and clear abscess had x rays then told might be root canal filling needed which could be cause of this.Then Dentist said he cannot do this because might be possibility of infection going to my aortic valve after surgery I had on this before,refering me to hospital dentist and need another echo cardiogram.Feel like not bothering with next tkr just keep limping along then doctors might not find anything else,fed up going to hospital so far 5 hospitals visited,feel a bit sorry for NHS.
 
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RICBAK1

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Back again still no knee op my surgeon has advised me not to have operation till my cyst has stopped leaking.Dentist thinks it may be due to a dead tooth now but this holds a bridge plate,so having this taken out but will not go any further till seen cardiologist.I have had monitor on and my heart is too fast in af predominately with a pause now and again .So waiting to see what else is falling apart on me I think tkr will have to wait or miss all togeather now,but hey summer on way I hope even if we might be in lockdown soon,i am at 3 hospitals this month will soon know doctors by first name.
 
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RICBAK1

RICBAK1

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HI been to my dentist this week had bridge work sectioned ready for surgery at hospital by dentist but now that cancelled due to corona so left with bad knee due to surgery cancelled teeth very sore and rough and to top it all face swelled up due to cyst swelling up but hey we have toilet rolls if you live in England you will know what I mean our supermarket has more empty shelves than full and this is only start.
 

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Sorry your bridge work surgery has been cancelled, but it's probably a wise decision.

We're all in this together. Things will get worse and then they'll get better. My shoulder replacement has been put on hold as well.

However, we'll all support each other through this.
 
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RICBAK1

RICBAK1

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Yes best to be safe my knee surgeon will not touch my knee till I get this cyst sorted.
 
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Jamie

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@RICBAK1 ... I'm so sorry to read that you're needing all these things done and you're now caught up in the coronavirus elective surgery cancellations. I don't know about the UK, but here in the US, dental emergencies are still being done. An infected or abscessed tooth is considered an emergency here and could be taken care of, since it is an outpatient procedure - not even surgery. Here it's done in an endodontist's office. Do you have endodontists in the UK? Much like revision specialists for knees, they are dental specialists who deal primarily with root canals and severe problems with teeth. Perhaps if you're not seeing an endodontist and can find one, you might be able to at least get this taken care of.

A good endodontist should be able to take care of that one tooth. I cannot imagine that you would need healthy teeth pulled, so please get additional opinions if someone is telling you that. Your teeth are important and pulling them all should be your last option. There are also dental implants you can get to replace lost teeth. They function really well - just like regular teeth and help your mouth retain it's bone integrity.

I also noted that you have heart issues including A-fib. I know a lot about a-fib as I used to have it myself. It can be cured or at least improved by a procedure called ablation. There are special heart doctors who do this type of procedure - not just a regular cardiologist. I have searched for another member in the UK and know there are specialists like this at some hospitals....definitely not all of them. The type of doctor you're looking for is an electrophysiologist. Please search out someone like this to work with.

I had two ablations about 5 years apart. The first was a radio frequency ablation that uses heat to burn the problem nerves in your heart that are causing the problem. It is an older procedure that helped for a while, but they built new pathways. In the next 5 years, a different procedure called cryoablation was developed that freezes larger areas in specific areas of the heart to totally destroy the bad nerves. One you have it done, you still need to be on some type of blood thinning medicine (I'm on a drug called Eliquis) to help guard against stroke. But it's been 8 years and I have had no A-fib and no stroke. This is a great procedure. It may be difficult to find doctors in your healthcare system who are willing to consider this treatment, but don't give up!!

Let me know if you have difficulty finding these medical specialists. Either Jaycey or I will try to help you. Do try to get something done with that tooth. It is not good for your general health to allow an infection to continue in your body.
 

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