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TKR Kaiser won’t operate If I vape

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jaybird

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Hi all, I’m Jaye. I’ve had psoriatic arthritis since 2005 and it’s finally time to replace my right knee, which has gotten dramatically worse in the past two months. I’ve gone from being a fairly active person to being dependent on a cane and spending a lot of time icing it. OS has been saying it needs to be replaced for more than a year, but I was chicken. I’m not chicken anymore.

So I got a call today from Kaiser to schedule my surgery, and the scheduler asks,”do you use nicotine in any form?”. I smoked from when I was 12 untilI was 50. I tried everything under the sun to quit - patches, gum, hypnosis, acupuncture. Nothing worked until I tried ecigarettes. I haven’t had a “real” cigarette in more than five years now. So I answered yes, and she told me I have to be off nicotine for four weeks and then schedule a nicotine test..

I teach a tax class in the fall (now), and do taxes during tax season. My original plan was to do this next May, but at this point I don’t think I can wait that long. My class ends at the end of November, and tax season really gets going in early February. I figured I’d have just enough time to get this done and still meet with all of my tax clients. If I have to wait four weeks after I receive the non nicotine e-cig juice I ordered as soon as I got off the phone with the scheduling (I had it expressed, so it should be here Monday, latest), to even schedule this, I will be scheduling at least least a week after “sign-ups” open, because they won’t even schedule the surgery until I pass the test. Each month’s schedule opens on the first of the month two months prior for scheduling. If I have to wait into the second week of October just to schedule, I’m afraid I wont get a slot the first week in December like I need. Geting that date is literally the only way I can see this working.

No one at Kaiser had ever mentioned this to me. They told me not to get a steroid shot less than three months prior, but no one ever asked if I “used nicotine” before. They always asked about tobacco or smoking. I don’t do either of those things, so I always answered no. If I’d known ahead, I could have tried to taper down, but now I have to go cold turkey. Even then, I may not be able to get the surgery this year. I am angry and upset. I can’t live like this until May!

I emailed my doctor to see if maybe there’s an exception to be had, but when Kaiser says “that’s the protocol”, I’m not exactly operating from a position of strength. As if this weren’t stressful enough already, now I have to quit nicotine completely for a month.
 

Mojo333

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@Jamie
This is such a controversial topic, wondered if you had any current info on surgical protocols?
 

Jamie

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You know, the "problems" with vaping are just now starting to surface, so there isn't much information out there, much less guidance.

Nicotine restricts blood flow and could slow the healing process. Some early studies have shown that vaping nicotine can adversely impact healing in plastic surgery. There are also some suggestions that the compounds in the vaping liquid may impact lung tissue. But, I'm not sure I agree that these early studies (on animals, not humans) and hypotheses about lung issues should stop a surgical procedure today. However, I suppose a medical or insurance system can impose any rules they want.

You're doing the right thing by enlisting the help of your surgeon to find out if this requirement is a hard and fast rule. You might also recruit your GP to assist as well. You can ask the hospital for a copy of their policy that indicates you cannot proceed with surgery if you use smokeless nicotine products. Every hospital will have a patient advocate, so try contacting that person for assistance too.

This seems like an odd requirement to me so you need to be sure it wasn't just someone's misinterpretation of their policy. I actually had an incident with my February shoulder surgery where the nurse who did my pre-op intake told me in no uncertain terms that I would not be permitted to have Home Health services following my shoulder replacement surgery, even though my arm would be immobilized for 6 weeks and I had a pet to care for and no one to assist me at home with things like dressing or bathing. That was wrong, of course, and they chalked it up to the fact that she was new on the job. So it never hurts to double check the policy.

I hope they can make some allowances for you. Please let us know how things go. Kaiser is such a large company, it will be important for us to know if this is going to be a consistent rule for all their facilities.
 

CricketHip

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Hi @jaybird Gosh, what a pickle!! I agree with you, it should have been brought up way earlier than this.
I can't even imagine your frustration.

I don't have any insight for you other than what Jamie has already suggested.. I hope you can get in contact with your surgeon. Good luck.
 
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jaybird

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Thanks, all. I am hoping that this is overrideable (at least for scheduling purposes). I’m willing to try and quit, but my track record is terrible. I am a sleep deprived :censored: on wheels without nicotine.
 
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Jamie

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From things I have read, I believe nicotine is tremendously addictive - worse than a lot of street drugs. So it would stand to reason that it's difficult to quit it. One of my good friends struggles with it. She uses the nicotine gum constantly instead of cigarettes. So it's sort of better for her. But ingesting all the nicotine is still giving her a lot of health issues. I hope you will find a way to say good-bye to it. There are a lot of programs out there. Keep trying until you find one that works! But, on the other hand, after 3 tries my husband was able to quit after smoking for 40 years.
 

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The CDC report I heard about this morning on the news sounds so ominous I fear you have a real choice to make.
Knee or nicotine. CDC wants vaping to stop with all the recent deaths. It may not be just the nicotine but whatever else unknown is involved.
No one can tell you what to do. I can say that after I had a real odd queasy experience in 2014 with not being able to walk 20 feet without feeling I was hitting a wall and off to the ER.. 95 percent occlusion of the left anterior descending coronary artery.. Its other name is the Widow Maker. I was treated and advised to stop smoking even the 3 cigs a day I was doing.. I protested bargained etc... Of course in hospital I could not smoke.. I was given two choices. Have a massive heart attack ( this one was a warning) or quit.
I threw the pack out on discharge and haven't looked back.. It just took for me a good scare..

The next time may be a success for you and maybe a TKR hoice is what you need.. I wish you the very best and and whatever happens keep us updated.
 
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jaybird

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I’ve gotten my vape juice in the same flavor from the same vendor/manufacturer for several years, so I’m not worried about the recent vaping illness trend. I believe most of the cases have involved cartridges bought from non-legal/licensed vendors. I get mine at a licensed dispensary, so no worries there either.

Interestingly (and quite happily) switching to the non-nicotine juice has been a complete non-event. I guess the concentration I had been using (3%) was low enough that I was basically on a non-addictive dose. There are lower concentrations, which are how I would have stepped down if I’d known about this earlier, but apparently for me they weren’t necessary. I have quit something like twelve times, for as long as six months, and I remember it as being truly awful. So does my husband, who I think doesn’t quite believe I’ve actually quit this time since he’s had zero nastiness from me these past three days.

Now I just need to talk the doctor into either letting me schedule the surgery before I take the nicotine test, or letting me take the test a few days before 4 weeks. That doesn’t seem nearly as daunting. I do feel a little embarrassed at having been such a drama queen over this whole thing.
 
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Jamie

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No need to feel embarrassed. We all get a bit frantic at times with these surgeries. It's stressful and scary and when yo throw in a few challenges to getting the job done, most people have their moments. That's what we're here for is to talk you down from the window sill. :heehee: I'm glad things are looking better for you now.:thumb:
 

Jaycey

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Well done on getting your surgery date! Of course you are scared - we were all in that space pre-op. Keep busy and keep posting here. It does help ease the nerves.
 

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@jaybir
Congrats on surgery date! I had to stop my nicotine gum (5+yrs) in 3 weeks to get my surgery date too. It was rough, SO GLAD I gave my boss a heads up. Now that's over, surgery is over and I am moving along.
Good luck in Dec!
 
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jaybird

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Thanks, all. My lovely husband took me over to the city to go to Room and Board and order a recliner. Then we went to Slanted Door for a long, late, boozy lunch. Ferry home, and now I’m sitting on the deck with my foot up on a chair. It’s weirdly warm here - well north of 80°.

Kaiser’s knee class on Tuesday freaked us both out a little, plus I learned that I have to go off of Inflectra for two months and Soriatane for two weeks. They are the two drugs that have kept my extremely painful palmar plantar pustular psoriasis as well as my arthritis at bay for the past 15 years and I’m terrified. I think I need to get some Ativan or something from my PCP.
 

Jockette

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Check with your surgeon to be sure what his protocol is. My GP told me I would have to stop my ibuprofen 2 weeks before surgery. :yikes:

When I asked at my surgeon’s office they told me my surgeon didn’t believe in that so I had was allowed to take my ibuprofen up until the day before surgery. They only told me not to take it the day of surgery.
 
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jaybird

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I will follow up with him. That’s a good idea. Soriatane is a sort of obscure drug, so I imagine he’s going to defer to my dermatologist on that one, but Inflectra is reasonably common and his opinion may differ from that of my rhuematologist. Thanks for the suggestion.
 
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jaybird

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So I got some Ativan (haven’t actually taken any, just having them does wonders for my anxiety) after jumping through many Kaiser hoops, including an emergency Psych referral because my primary thought I was dangerously depressed based on a questionnaire (I answered honestly about things I can’t do because of my knee). The in person psychiatrist saw that it was purely situational, mostly anxiety related, and totally reasonable. She referred me back, and voila, prescription.

So that’s good.

I’ve found a guy (he’s actually a marine biologist who worked at Steinbart for 20 years, so I’ll no doubt learn a lot from having him come and work on my tank) to come once a week and take care of my fish tank starting 12/2, and convinced my husband that I should hire a cleaning service (who are wonderful). I’ve got an extra (borrowed) ice machine for downstairs, and a former student gave me her walker so that I have up and downstairs ones for that, too.

We have a gazillion people coming for Thanksgiving. It’s always at our house, but this year I’ll do much less than I usually do, just the turkey, a couple of pies, stuffing, gravy. Everything else is potluck (with a few assignments - Thanksgiving without brussel’s sprouts would be sad.).

The winter holidays are my favorite part of the year, but thanksgiving will be pretty much it for this year. I love having a tree, and lights on the house and the boats, but while Art’s willing take on the project, I can’t ask him to do all that on top of taking care of me.

We usually have two trees, upstairs and down, put lights on both of the deck railings (townhouse, 25’ wide) and run lights off of the top of the mast so that the sailboat looks like another Christmas tree. A couple of neighbors have made noises about lighting our boat (they light theirs, and it’s really pretty when they’re all lit up in a row)

The class I’m teaching ends on Friday the 22nd. Then I focus on Thanksgiving and this. For the record, I’m sort of terrified, but also looking forward to being able to hike again eventually. My knee is so bad that just about anything will be an improvement.
 

lovetocookandsew

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I'm thinking that having your usual, and much loved, Christmas decor will be a big mental boost as you go through this recovery. My husband took excellent care of me after my TKR, and still had plenty of downtime where he needed to find things to do to keep himself busy. After my revision, he was so bored, he was out hand watering all our plants-and we have automatic watering systems on every single plant! So, my suggestion is to talk to your husband, let him know how much you'd enjoy your usual Christmas decorations and let him know that, while you don't expect it, if he has time and the desire to do so, you would be very grateful if he could do it this year.

It sounds like you have all your ducks in a row, and are getting ready for your surgery and recovery. It is a scary prospect, but the road you'll travel will be worth it in the end. Just imagine having a functioning knee that allows you to live your life again-that's worth all you have to do to get to that point!
 
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jaybird

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I am trying so hard to think about how this will be better in the long term. And I am basically paid to be a long term thinker. However, I’m having a hard time applying that timeframe to myself. Shoemakers’ children, etc.,...’
 
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jaybird

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The recliner (https://www.roomandboard.com/catalog/living/recliners/arlo-leather-recliners) will arrive next Saturday- yay! I was fully expecting it to be after I have surgery.

Meanwhile, I am tired. The class I teach wrapped up on Friday, so that’s a help. We host Thanksgiving (it is hands down my favorite holiday) for our family, which is usually 10-20 extra people.

I made and toasted the focaccia and cornbread for the dressings today (we have vegans, so there are two versions of almost everything - the focaccia is for the vegans) Tomorrow I’ll do piecrusts. I made and froze turkey and vegetable stock earlier this weekend. I’ve farmed out all the veggies (mostly to the vegans, because fair‘s fair), so day of, I’ll just deal with turkey, stuffing and gravy. Our younger son, who is driving up from LA on Wednesday, is in charge of potatoes. He’s a chef, so we usually have very fancy (and delicious) mashed potatoes.

It sounds like our elder son and his partner are going to come up and do our trees the following weekend. That will be nice if it happens, but I’m OK if it doesn’t. In any case, it’s very sweet of them to offer.
 
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jaybird

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Thanksgiving was fantastic. While eating tons of amazing food, elder son and I agreed that Mr. Jaye and I would acquire and (I’m super-particular about lights, and I like a lot of them) light the tree, and he and his partner would come up on Sunday and hang ornaments while I stage direct. Mr. Jaye and I went over to the tree lot on Bay Farm Island this afternoon, because it’s supposed to pour tomorrow, and got a 6’ noble fir. It smells great, and I’m halfway through stringing the lights. It’s a lot smaller than we usually get, but I have about a million 60’s-70’s Shiny Brite balls, so if I only hang half a a miilion of them, I don’t think anyone will notice.
 
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