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TKR Meecies musings (questions, comments, maybe some venting here and there too)

Here in the USA at least in California it's commonly either
spinal + propofol
OR
spinal + very short acting benzo (Versed) + very short acting opioid (fentanyl)

None of the above are considered general anesthesia; they are "deep sedation" that one wakes from quickly.
 
mendogal said:
spinal + propofol
Click to expand...
that's what I'd want
I hope it will be an option for me
no versed, it's on my list of things I've had trouble with.


I had an epidural for the C section (back in 1978! LOL) I had to be awake for that which was not fun, but there were no saws involved in that, just a lot of tugging - felt like I was going to be pulled off the operating table, as they had to dislodge my daughter, turn her around and pull her out, and you feel them doing that, No pain but you know what they're doing.
I had gone thru 19 hrs of labor and hadn't slept hardly at all for the 3 days before going into labor but mostly I was just so tired.
 
mendogal said:
Here in the USA at least in California it's commonly either
spinal + propofol
Click to expand...
hi @mendogal

I was just watching a video about the use of spinal and they said you are totally sedated for this

afaik a spinal is quite similar to an epidural, you sit on the edge of the bed and round out your back and the hammer that needle in LOL with something to numb the area first I guess as I didn't feel any pain
but I was fully conscious, there was never any sedation for the c section

I am trying to understand how they can do this if you're sedated- do they just lightly sedate you first so you can respond to commands?
 
@meecies a very cogent question!

In my experience:

If the plan for sedation includes either propofol or Versed (a benzodiazepine sedative-hypnotic), yes they have you sit up with rounded back with an OR nurse supporting you, and the very last thing you will remember is being in that position before the spinal is actually administered, the next thing you know your in Recovery.

If only fentanyl is used, you might remember the spinal being administered, and then wake up in Recovery.
 
ah that makes sense

I didn't know that you can be lightly sedated with propofol. They can't give me versed, had a terrible reaction to it

I'm scared of the idea of fentanyl mostly because it's what is killing so many heroin addicts (including two in my family- a niece and a cousin) but I'm not afraid of the injection into the spine so if I remembered it, that would be fine

I am so glad I joined this forum, I've learned a lot and am starting to calm down a little bit

using a kind of CBT- reminding myself that this is in the future, and getting all worked up over it NOW is pretty silly. it's not happening now, and when it does happen, my PTSD may actually be a benefit to me. When I'm in a vulnerable situation esp when there are men around, I mentally disconnect from the lower half of my body. It's like my feet don't even touch the ground. Odd benefit but in this case it can be quite helpful. It's also why I need to get back to my home asap and why staying with friends would not have worked out.

I will need to re connect with my body to avoid injury from over doing things etc

thank again for all your help @mendogal
 
You're very welcome!

Your fears about fentanyl are understandable.

I want to reassure you that in a health care setting anesthesiologist-controlled IV fentanyl is very safe.
I have had it very low dose for awake relaxation and pain control during minor procedures as well as for deep sedation during knee replacement.
It has the advantage that it clears out of the system extremely quickly, allowing for rapid recovery.
 
oh good to know

I just watched a nurse's "class" about TKR- she's selling it for $49 but gave me access to it for free

did get some good info from it but there's a lot that she never backed up with data, or any kind of science, it was more her preferences it seemed

however she mentioned something I'd never heard of - urinary retention after spinal and was going on and on about how important it is to address it, that you can have permanent damage if you don't!
what?

what is this all about?
 
1) it's a slight risk; this is why you need to drink and pee before being discharged.

2) the extreme risk is NOT from the spinal per se. It's from going home and not paying attention to whether or not you're peeing!

Anyone who for ANY reason can't pee risks infection and bladder and kidney damage.

You should be drinking ample fluids (not exclusively water) and peeing every two to three hours. If you go 6-7 hours without peeing, you will need to notify the surgical office and expect to go to the ER to be examined and catheterized.
 
oh ok
Hell I drink and pee a lot (have been diagnosed with acquired nephrogenic diabetes insipidus (aka water diabetes- not 100% sure that's an accurate diagnosis, not all the the proper testing was done afaik)

I get up every 2 hrs at night to pee, one those rare times I sleep 3 hrs in a row, my bladder is so full I barely make it to the bathroom in time (and sometimes don't)

she never said what happens if you have this condition, only that the damage can be permanent

all I could think was, great one more thing to worry about.
 
well shoot
doing this in the summer was not a great idea, I had a few offers of help with shopping and running errands and those people are going away in August!

I checked with the local grocery store, they do NOT take EBT (food stamps) for their delivery service!

I have one new friend who is a sweetheart and is willing to shop for me BUT she is in a wheelchair and has no wheelchair van, so she can use her wheelchair to get to the store, but would need help to get things from top shelves etc Then she has to lug stuff home on the foot rest of her wheelchair, and there's not a lot of space there, If they put stuff on the back of her chair, she can't get it. She's getting weaker all the time, too, it's incredibly kind of her to offer but I don't think I'd ask her to do this unless I was desperate. I know for sure that the milk, yogurt and bread I buy is up too high for her to get herself, heck I can barely get the milk. I guess soy milk isn't too popular at this store.

she has an old SUV and drives but the thing is, once she's at the store, unless they bring a mart cart out to her (which few stores are willing to do!) she can't get out of the vehicle so I go with her to shop for her, or to get the mart cart in those few places you can get away with it (although officially it's not allowed, Trader Joes will let you do it if you're close enough to the entrance)

I'm helping her with some things she can no longer do, and we're on similar diets so we cook for each other etc

So now I don't know what I am going to do for food!
I have stocked up on canned goods and have frozen some things, but I don't have a freezer big enough to freeze bread and other things I normally buy fresh (almond milk yogurt, soy milk, fresh veggies and fruit)

I was told before I moved in that most of the residents have cars and surely someone would be able to help out, but when I put a notice on the community board requesting to ride along with someone going to the Food pantry, no one offered to take me with them. There are 4 people who go there every week.

that was disappointing.

They don't have soy milk or almond milk yogurt at the food pantry and all of the bread is white bread, which I don't eat.

oh well. darn

I can't afford the only option where they do take EBT and deliver, Whole Foods. Their prices are absurdly high and it's mostly high end floofy stuff I don't eat.

in other news I am no longer nervous about the surgery. can't wait to get to the other side, so I can get back to my life and my hobbies!

and hopefully this time next year, I will be doing my friend's shopping for her and walking to my community garden 2 miles away and getting to all the other places I cant' walk to now.

it'll be good

eventually!!
 
My only thought is to ask the apartment building manager if they can suggest residents you might not have met yet who have vehicles and reasonable fitness and sociability.
 
mendogal said:
My only thought is to ask the apartment building manager if they can suggest residents you might not have met yet who have vehicles and reasonable fitness and sociability.
Click to expand...

it was the apt caretaker who told me that there were ppl who would likely offer me rides or be willing to take me with them when they went shopping, etc

That was when I was deciding whether to move to this place.

Weeks after I'd moved in, she told me that when her car was in for repairs and she had nothing to drive for a few weeks, no one would give her a ride, either, not even to the places that they were going to anyway like the Food Pantry

so um, yeh, that was a bit of a shock.

The people who said Just call me, I can help you out! with shopping etc, knew my surgery date but must have forgotten they planned to be away in August

I'll figure something out but it can't be a total stranger, I am going to have to trust this person enough to give them my EBT card and password.

The people I know the best and can trust all live too far away

I just pray that I'll be able to get out to the store by myself before I run out of food.
 
ok so I am back in limbo

thinking that going forward at this time with so many un answered questions, plus the remarkable results of just 2 PT visits, and the lack of help and resources- would just be foolish

still looking for good info on my particular valgus deformity with a longer, not a shorter, leg and did find a few things out-
complications with a valgus knee include

Tibiofemoral instability of up to 70 %
Tibiofemoral instability usually requires revision surgery

and that's just one of the many common complications of a valgus TKR

another one:
  • Recurrent valgus deformity (4–38 %)
Also read some studies where even a 5 mm leg length discrepancy led to problems. I've got way more than that NOW, so adding 5mm (which the dr said was "insignificant" ) seems like a stupid thing to do-
I may be in the best shape possible NOW without the surgery and surgery could leave me worse off. Not being much improved would be hard enough to live with but being worse- no no no


It would be bad enough to lose a year of my life to pain and constant struggle with this thing but to have to face more than one surgery- hell no

for those of you with plain ol simple OA of the knees, I can surely understand why you are happy you had it done

but this is too darn scary for me at this time in my life
I'm only 68
 
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I will do some research later, but yes I agree you should consider giving PT a chance in terms of overall quality of life.
 
 
www.ncbi.nlm.nih.gov

Total knee arthroplasty in valgus knee deformity: is it still a challenge in 2021?

Total knee arthroplasty in valgus knee deformities continues to be a challenge for a surgeon. Approximately 10% of patients who undergo total knee arthroplasty have a valgus deformity. While performing total knee arthroplasty in a severe valgus knee, ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
You are right that surgery in the valgus knee is more of a challenge.
This is the best paper I found on this issue. Is this one you have already seen?
 
EalingGran said:
You are right that surgery in the valgus knee is more of a challenge.
This is the best paper I found on this issue. Is this one you have already seen?
Click to expand...
yes there are others are on PubMed- you need to search leg length difference

I am digging up the web address for the other site that will show FULL studies, not just the summary or extracts... I had it bookmarked but must have it misfiled, lol
 
mendogal said:
I'm curious where you found a citation that anything involving knee replacement has a 70% chance of instability? Can you share a link?
Click to expand...
I'll dig it up later

but this alone would give any reasonable person pause (from one of the links you shared)
  • common cause of early failure following total knee arthroplasty


~~~~~~~~~~
now here is where I have an issue with every OS that I have seen, they have totally dismissed this as a concern or insisted it made no difference


Would that inspire confidence in your doctor if you were told this? when you know darn well that it IS a concern?
Since most of my questions are surrounding this issue and how it would be addressed (as well as wanting to know their experience and failure rate with this type of surgery) that totally stops the conversation. For them it may be a non issue but it is definitely an issue for me. Medicine is first and foremost a business now. Would you buy a car or a house or a boat when someone refuses to divulge information that you need to make a decision? We are hiring them, they are working for US. In no other business arrangement or purchase do we give away as much power as we do when dealing with the medical system and we seem to have accepted that there is nothing we can do about this.

So they just basically gave me the "don't you worry your pretty little head about you line" and refused to answer-
that does not fly with me and I can give you a LONG LONG list of reasons and past experiences where I was told the same, just trust the dr to make all the decisions

THEY do not live with the consequences- I have had to live with them

THEY took risks with my life and my health that I NEVER would have taken if I had known what the true risks were
and this has cost me more than you can imagine.

if 20% failure rate or revision rate doesn't worry you, good for you.
that's far too high for my comfort
esp considering that I am a low priority patient

No one is looking out for me except for ME

medicine is more like car shopping or any other type of big investment, except that it's not just money on the line when it comes to medical care, it's your health and your life that is on the line


I don't expect that I would lose my life, but my health and my quality of life is the only thing of value I have and it's precious to me




If they can't be bothered to answer my questions...............!!!

they can find themselves some other guinea pig
 
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We're here for you with or without the surgery and hoping the PT makes a really big difference!!!
 
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