pre-surgery testing

[lala_land]

Hi all-
my mother (66yo) decided early January to have TKR. The first thing she started was to get the requested clearance from her cardiologist. He made her do stress tests, wear a monitor for 30 days, and all kinds of stuff. Ultimately she is doing great (probably should come off some of her meds, but we'll talk about that at her next appt) and after 6 weeks or so got the all clear. Next she set up an appt with the ortho to go ahead and get the ball rolling. First she did the required bloodwork, so that when she had the appt the results were all in. Her hemo level was 11.5, which they (ortho) considered very low. They said she would have to take 3 weeks shots of Procrit before they would do the surgery. We are still waiting on the OK from her insurance to pay for the Procrit. I have spoken to co-workers who have dealings with Procrit and say thy are willing to bet her insurance will NOT cover it for a level of 11.5. So we are waiting for the final word on that.

I've done some searches here and can't really find anything regarding testing like this with anyone else here. Is her Dr the only one that seems to have this rule about the hemo levels, or was everyone pushed on this issue? I am very curious....
Thanks...

 

[Jamie]

Lala....Josephine (our resident nurse on the forum) can probably do a much better job explaining the reasons why this is an issue for surgery. But I do know that I had to have the same tests prior to my knee replacement - cardio, EKG, blood work, chest xray. In addition, the surgeon offered the opportunity for me to give my blood prior to surgery in case I needed a transfusion. Evidently it is possible to have some blood loss during knee replacement surgery and some people prefer to use their own blood instead of getting it from the community blood bank. While I was in the hospital after surgery for three days, they continually monitored my hemoglobin level and, had it dropped, I would have had to have the blood. I was fortunate that it stayed in the normal range. So I'm guessing that the surgeon does not want to start with a level like your Mom's and run a risk of it getting too low. I don't know what the normal range is for hemoglobin, but I'm betting that her level is probably below what is considered normal. I would say that's a great surgeon you have who is looking out for all those things for your mother! At 66, is she on Medicare? If so, you could ask your pharmacy if Procrit is covered under the Medicare program. Otherwise, you can call her insurance company directly and ask them. Sometimes things that are not automatically covered can be supported if the doctor writes a letter to the insurance company explaining why the name brand drug (expensive versus generics) is required. If all else fails, try that and dispute their non coverage for this specific situation. Good luck!!! Keep checking back and Josephine will provide additional information I'm sure. She checks the posts daily but is in Great Britain, so there is a time difference from all of us in the USA.

 

[Nursepair]

Welcome Lala. Pre testing is usual, I am 53, and had all the abobe but the stress test done. My heamoglobin was also low but I was just started on iron pills. This was only done a week before surgery as my dates were moved forward a week. I was just fine and continued the iron until I ran out a few weeks after surgery.

I'm sure Josephine will be along later to advise you...Sue

When is she having the surgery. Will she be able to post after? If not make sure you do for her.

 

[JenniferG]

Hi and welcome. Lots of info and support here. All that testing sounds normal to me. I know they watch the blood levels after as well. You loose some blood during surgery and healing takes a lot of energy, so i suppose they want it all to be optimum to start. i had a couple tests that i hated but looked at it this way, if I wanted the surgery, I had to get these things signed off on, so i played ball. Best to your mom and bless you for looking out for her. Keep us posted.

 

[lala_land]

When is she having the surgery.

No idea, since they will not schedule it until they have an end date for her 3 weeks of Procrit!

 

[Josephine]

Hello, lala! Welcome to the forum.

I can tell you that no anaesthetist would touch a patient with a low haemaglobin as it is crucial for the patient's general health and well being. It affects all sorts of things like the blood gases and the patient's ability to respirate well and get oxygen and nutrients to parts of their body that need it. It also affects their ability to shake off an anaesthetic, whether general or regional. I have often known operations, even emergency ones, be cancelled because of a low haemoglobin.

Nevertheless, I would have thought that, given there is no urgency here, a course of iron tablets would have served as well rather than injections - unless there is some medical reason why an oral treatment was contraindicated.