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Discussion in 'Knee Replacement Pre-Op Area' started by Zommom, Nov 26, 2018.
Also I would like to change my thread title to New Year New Knee
I've changed your thread title for you.
I had an appt with my OS yesterday morning and last night I slept well (if you call 5 hours uninterrupted) sleeping well. He addressed my questions and fears with of course the caveat "there could be complications" etc. I was practically begging for a date earlier than Jan 29 but after hearing what needs to happen before surgery I understood. Preparations include - an MRI of which those are sent to Brussels's for a patient specific Jig. The class where I need to bring my coach (spouse), the pre op exam and then the withdrawal of warfarin 7 days prior. We also discussed my right knee will get done 4 months later! He told me that barring any objections of the anesthesiologist It will be done as an outpatient (same day) surgery (under 65 years of age and no health issues) No PT until 2 weeks later! He wants that knee to heal. Pain management is also a priority with him. After reviewing the latest Xrays it will definitely be a full knee replacement
Here we go!
Here's some insight into blood thinners and TKR.
I'm currently on Eliquis to prevent blood clots caused by AFib. A couple of months ago, my wife and I went to visit my surgeon to tell him we wanted to start the ball rolling to see if I could get permission to have a TKR. He told me their practice does TKRs on people with AFib all the time.
He told us they would have to get "Cardiac clearance with instructions" which they have. The instructions tell the Surgeon 3 things:
How long before surgery to stop the blood thinner.
How long after surgery to restart the blood thinner.
Whether or not you require "bridging with lovenox injections" during that period.
In my case the instructions are to stop Eliquis 48 hours prior to surgery and restart 12 hours after and no lovenox bridging. But the instructions for Coumadin and Warfarin are different and they do require lovenox bridging. When I called in to get my instructions the day I got clearance, first she gave me the Coumadin instructions and then corrected herself when she realized I was on Eliquis.
Now, it should be obvious to everyone that I'm not intending to tell you to do anything other than sharing my experience. Talk to your doctor about lovenox bridging and see if you can have a TKR if your knee is so bad that waiting is unbearable.
My surgeon's exact words were, "we do this all the time." But this is not to say they won't want you to wait anyway. It's quite possible they know all this but still want you to wait. That would be a different story altogether.
@Smokey253 I see you have it all squared away now. That's great. Good luck.
Or as Roseanne Rosanna Danna used to say...nevermind!
(In the future, I'm going to have to take my own advice and read the whole thread before commenting! )
No problem - I was kinda all over the place with different items in this thread. It was reviewing comments on this Forum that I learned that this could even be done! I was told in the hospital after my stroke that I could not have TKR surgery until I was off the blood thinners. I asked how long i would need to be on Warfarin and they said at a minimum of 6 months to forever! My knees decided not to wait and we went to moderate pain to OMG my life went to heck quick > that is when I jumped on to Bonesmart. I went directly to my anti coagulation team and 7 days prior we start the Lovenox shots. Everyone is now onboard OS, MD, Neurologist, and anti coagulation!
That's great! Sounds like all systems are GO!
I have been given another life line in the pain management area preop as well as post op. It is the Iovera treatment plan which freezes the nerves that are transmitting the pain. It is done 3 weeks prior to surgery and should last 90-150 days. It cuts down on the need for opioids after surgery and helps you prepare those important muscles Quads etc. that is so painful to do before surgery. Need to be off blood thinners 3 days prior to the treatment. I am waiting for the go ahead from the anti coagulation team for this. This treatment does not cure the underlying problem but gives you that extra help in the pain management dept. Pray that they approve me for this....
Just got the word on the Iovera treatment. Because I am on Warfarin the 3 days off will not be sufficient. It would be more like 7 days to bring my levels down to normal. Also this will cause bruising and my OS wants a clear palate to do his artistry! I am bummed, angry and scared yet glad I checked this option out!
Question, I know that icing is key to keep the swelling down and for pain management which I do often but my knee gets so stiff after this - I pulled out my heating pad with massager and utilized this a couple of times which feels really good and the knee is more flexible? I haven’t come across any posts talking about this as a presurgery pain management option? Any thoughts?
Urrg! My frustration level is increasing daily - started Monday, Jan 7 my 3 hour knee replacement class first my coach (hubby) decided he couldn't find the place and became frustrated as I tried to give him directions. I went in and checked in and was asked where my coach was - I indicated he was parking and the receptionist stated we will wait for him to check in When he finally arrived the line to the reception area was 5 deep! I finally hobbled up (I am now using a cane full time) and was informed I needed an Xray! and they were to do it right away That was uncomfortable and my left leg is now screaming and my right is singing loudly! I then hobble out to the reception area and was told that they have taken the last group up to class and since I am running behind to go to the class using the directions given. OK so we take the elevator up to the 3rd floor from there we were to follow the cat walk (over the street) into the hospital and the class would be on the 2nd left hall. My husband and I walked and walked and basically ended up in a hospital ward. Of course no one seems to be around. Hubby poked his head into an office and a sweet lady came out and said I will take you as it is very difficult to find On the way (back towards where we came from mind you)...I am limping and tears are starting to flow. A couple of doctors passed us and one said "hey can we get you a wheel chair". I said no thank you as it would take forever to find one and of course my darn fool pride forbid me to use a wheel chair! Ok so we find this small hidden class room full of orthopedic devices and about 40 my fellow knee victims and their coaches, only a few chairs were available which we had to practically crawl over everyone to get to. Finally get settled in and the instructor promptly stated to me to turn off my phone (which I didn't even have with me and wanted to see my medication list which I had all prepared. While I was going over this with her my hubby announces he didn't eat lunch and how long is this going to last. Mind you I did tell him it was a 3 hour class and to eat something before you come. The class was ok learned somethings and the rest was orthopedic equipment for purchase at the local rehabilitation store.
Tuesday I parked in my work parking lot got out and promptly slid on my bum! I scrambled up - brushed myself off put on a smile and limped in to work with both knees absolutely screaming and now my hips are mad. Went home early that day.
Wednesday I noticed I have a stye in my left eye forming and both eyes are red "Infection" the surgery stopper for sure. I quickly made an eye appt. Went home early - hips knees and lower back hurting - knees actually buckled on me.
Today I came to the realization that i needed to use my walker. I swallowed hard and loaded it up and went to work. I wish i would have done this earlier but again my brain doesn't always fire on all cylinders. I along with a lot of my fellow bonesmart friends seem to feel the same about coming to terms with the fact we have these issues! I have always bounced back with anything I have had and confused and frustrated that this is getting progressively worse! I am so tired of the pain Went to my optometrist and she confirmed that it appears to be a staph infection wonderful news - antibiotics for 10 days. I then decided to call the number given at the class for any questions - I inquired about how to get a temp. handicap placard! Why do you need one was the response I got! Because I can't really walk for long distances I said as both my knees are arthritic bone on bone and it's icy and snowy and i have to work and I've already fallen. His response -" well the doctor will determine if you need one at your post operative appointment, but more than likely they will not grant one as they want you to walk ! I get that but sweet .............%&!@ I need it now!
OK I'm done. Sorry it was a long vent. January 29th cannot come soon enough! As my normally patient self is eroding to this impatient and easily annoyed monster!
I’m so sorry things have been so tough. Before surgery I asked my surgeon’s office about handicap parking during recovery and was told I couldn’t have it. It turned out that I managed ok without it. The biggest help it would have been would be that there was more room to open the car door in those spaces, not so much the shorter walking distance.
I hope the next weeks go smoothly for you.
Thanks Jockette! I guess I just have had it with some attitudes! I am very independent and hate to ask for anything and I did understand the wanting to have you walk after surgery I just need a temp to get me through until surgery: snow and ice are making it even more difficult! But worse of all was the indifference on the need! I called my md and sent the form to them 3 months is was a temp handicap placard is ,! Not a lifetime. Ok I’m done
I’m so sorry for the frustrating day!
For what it’s worth, I got a temporary 6-month handicap placard for each of my three joint replacements. The placard hung off my rear view mirror.
I didn’t always use them, but they were invaluable at times - we have a lot of snow, ice, and wind.
I got each of mine using a form given to me and signed by my primary care physician at my pre-op checkup. I never said a word to my OS or his team.
So it might be worth talking to your PCP?
It was an inappropriate time for them to mention the walking and had nothing to do with the therapeutic walking after surgery. Most likely the person who said it has no real clue what needing a knee replacement is like.
Vent here all you want, we all understand!
Thank you all! Once I settled down I did contact my primary care physician and mailed her the form: she will have it ready for me on my pre op appt! No problem I also started my antibiotics so everything evil that is lurking in my body along with the eye style will hopefully be eradicated! As far as the individual who I spoke with his job is coordinating the class that’s the number we are supposed to call! Psst- I kinda wished him just 1 day of knee pain!
Well he could have said it nicer. I was nicely told I couldn’t have it.
Yay!! You have successfully subverted the forces of rudeness and meanness!
Seriously - so glad you’re getting one.
Today was my pre op exam and everything looked good my AIC was a little elevated but in the range to go ahead. When I voiced my concern my md stated that by holding off surgery it would only worsen due to limited mobility. I am cleared to go ! I’m happy and scared at the same time
You have a great attitude and will ace this! The handicap placard will come in handy. Like Jockette said, you'll appreciate having more room for opening the door. Getting closer parking spots can also be a blessing at times. You won't need it for long.
Your medical team will monitor your A1C post-op to make sure it stays in a good range. Once you're home you should manage with no problem. Mine actually went down since surgery. Your doctor is right about the effects of more exercise!