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Ptarmigan Takes Flight

Discussion in 'Hip Replacement Pre-Op Area' started by Ptarmigan, May 10, 2019.

  1. Ptarmigan

    Ptarmigan senior
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    It’s the “spinning part” that has my husband frowning ! He’s decided he wants to get new feet - the adjustable base sits on 8-10” high feet and he thinks that’s the best bet. I was hoping to avoid this...because vanity, I guess...but it’s inexpensive and easy and oh well...If I could safely back onto the step, it would be ok. I just don’t know if new hippies can execute that move.
     
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    Last edited: Jul 12, 2019
  2. Mojo333

    Mojo333 FORUM ADVISOR Forum Advisor

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    Sure they can...carefully:ok:
     
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  3. Elf1

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    @Ptarmigan hep, carefully as Mojo says. Glad you got good news from the Doc and are feeling better about your surgery. Can tell you with the way I feel right now, minus the stay at the looney bin, I am happy I had the surgery done! And please, everyone, DO NOT let my experience with my hospital experience discourage any of you from having surgery. Mine experience is an issue that is isolated to this particular area
    :wave:
     
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  4. Ptarmigan

    Ptarmigan senior
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    @Elf1 You know exactly the most encouraging thing to say! Thank you! If a brand new hippie like you feels positive about the operation from the very start, that makes me believe I will, too.

    I know what happened at your hospital won’t happen at mine, but I did sense an attitude at the pre-op orientation that concerned me. There were several comments that implied hips were much less serious than knees: hips don’t receive opiates unless the pre-op meds “aren’t effective” (Tylenol, Celebrex and Gabapentin), “occasionally” receive ice, etc. Knees get long-acting nerve blocks that go home in fanny packs, routine ice, etc. Of course, I am going to talk to my OS about the meds. And I have confidence that he will tailor his orders to me, rather than run me through the mill - I doubt he’s even aware of the bias, because the HMO contracts with the facility. Still, no one wants to be viewed as a patient with relatively insignificant pain, and that was my clear impression. The good news: all rooms are private with visitor daybeds, so DH/DD will be with me the whole time.
     
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  5. Layla

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    Hi Ptarmigan,
    Overall, I believe healing from a THR is supposedly easier than a TKR recovery. It's been verified many times by those who've experienced both.

    I've never heard that Opiates are only prescribed for patients who didn't find relief pre-op through the meds you mentioned (Tylenol, Celebrex, Gabapentin) I don't recall ever being questioned on what I was taking pre-op, nor was I prescribed anything pre-op. While I did deal with pain, I took an Aleve, or two, approximately 2-3 times per month only because I don't like taking any type of medication if I can't get by without. Personal choice.

    I received an injection of Exparel into my surgical incision just before the end of my THR procedure. It's a local analgesic which provides pain relief by numbing the tissue and offers time release pain control for up to 72 hours.

    In addition, I was sent I home with an Opiate prescription and also a written script for 50 more tabs because we were running into an extended weekend, Fourth of July. I never finished the first prescription, so needless to say never had the second filled. So while some seem to experience difficulty with prescription refills....there's also often the flip side.

    All rooms were private at the surgery center I went through also, with recliners and a double size Murphy bed which hubs slept on through my insistence, mainly because I was comfy in the recliner and didn't want to attempt the bed. It was comforting to know he was there in case of an emergency and to advocate for me, if necessary. They actually encourage someone stay with you overnight which made everything feel less stressful from the beginning. I believe you'll take great comfort in your peeps being close by. No overnight interruptions either. A nurse checked in at midnight for the last time and said "See you in the morning, unless you need us."
    A positive experience overall. I couldn't have asked for a better one. I'm truly thankful. Now my only fear is
    that if /when I need my other hip done....I can never match my first go round. Try not to fear, It can be all good!
    @Ptarmigan
     
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    Last edited: Jul 13, 2019
  6. Layla

    Layla FORUM ADVISOR Forum Advisor

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  7. Ptarmigan

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    Thanks for the article, Layla. It sheds a lot of light on why the presenter had the perspective she did. It would have been more beneficial for me, I guess, if she had not gone quite so far minimizing THR’s by comparison. Water under the bridge now...As someone else said, I am just glad she won’t be the one taking care of me.

    I think my post was unclear in another way. The medication I described is given immediately prior to surgery to all patients (I am not taking them now). The presenter expressed the expectation that some/many hip patients would not receive opiates/opioids after surgery, which came as a surprise to me. That said, I am very intrigued about your injection, and hopeful. Thank you so much for that information. I will be asking better questions!

    One OS I consulted told me he would manage my pain for two weeks after surgery. That sounded arbitrary. So, I investigated, and found out my state has recent law (2018) that defines two weeks as the therapeutic timeframe for opiate/opioid use after this surgery. The guidelines are designed to ensure patients have no leftover opiates/opioids at home after treatment. Every prescription is tracked by state authorities, and exceptions to guidelines must be medically justified and require office appointments. Doctors with higher than normal rates of exceptions are subject to investigation and disciplinary action, including loss of their license.

    With so much pressure coming from regulation, I understand why patients are being given other types of drugs to treat pain. And my primary care doctor has also encouraged me to experiment with other approaches to pain relief: massage, mindfulness, hypnosis, talk therapy. And I know the BoneSmart approach (ice, rest, elevation) is proven and works reliably. I am so grateful I found this resource in plenty of time to prepare!
     
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  8. Layla

    Layla FORUM ADVISOR Forum Advisor

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    Ha! Had to edit my post this morning. To be clear, THR's are known to be easier recoveries than Total Knee Replacements. I know full well, so why the typo? :shrug: I won't be posting after midnight anymore, but instead sleeping as I normally am at that time :yawn: :sleep:
    @Ptarmigan
     
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  9. Barbaraj

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    Well, @Ptarmigan, not sure what hospital you're going to, but I know that mine (NW Hospital) did give me opiates when I was released, both oxy and Tramadol. Sure, I didn't get very much but I didn't need much. I think within a couple days I easily transitioned off the oxy, and within a week and a half I was off the Tramadol as well, (I'd been taking it at night only). I didn't use them all up, and may not bother to pick up these prescriptions for round 2. I can't believe that they'd not give you a limited amount of some stronger drugs! That just sounds ridiculous, and cruel.
     
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  10. Ptarmigan

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    I agree, @Barbaraj - it was very unsettling to me. After the presentation, when I followed up privately to clarify, the presenter did tell me that oxycodone, hydrocodone, and Dilaudid were available if ordered by my doctor, but their “multi-modal pain management” protocol was sufficient for many hip patients while they are in the hospital without the need for opiates. It’s hard to tell if her answer was simply meant to set a patient expectation that opiate use is not routine, or indicative of an anti-opiate institutional bias that is so strong, it may be an uphill battle to get pain managed as an inpatient. My doctor is Kaiser, but the facility is run by Swedish. I’m glad about this, as I believe he will be less subject to institutional bias, and he is the one writing orders for me. I have my surgery clearance appointment with my primary on 7/17, and my pre-op appointment with my OS on 7/31, and I will be discussing medication at length with them both. I have great confidence in them, so I know all will be well once I am completely in their care.
     
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    Last edited: Jul 13, 2019
  11. Elf1

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    @Ptarmigan just continue to discuss your feelings, fears and expectations w with your surgeon and the anesthesiologist when you talk to them so you have a good idea of what you will be receiving and can question anything that doesn't seem right.

    They were giving me Oxy at really weird time frames and dilaudid with an anti nausea med periodically and some liquid Tylenol that was equal to 1000mg. Kept asking why they were giving me Oxy as I had previously discussed this with my Doc previously and had decided on hydrocodone. Brought it to his attention when I saw him morning after surgery and he changed it immediately and I started feeling the difference pretty quickly. That is what he sent me home with, script says enough for 5days. I believe the reason he didn't send me with anything else is he is aware that I have tramadol for something else. He factored that into the equation.

    I can't take oral NSAIDs due to kidney issues, had to fight that with them all the way out the door. You just have to be your own advocate. Again, I just had to go to a Looney bin so I could keep you all entertained with stories!
    :rotfl:
     
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  12. Barbaraj

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    That's interesting, @Ptarmigan. I had a friend who had a hip replacement through Swedish (which is supposed to have an excellent reputation for this type of surgery) and I KNOW she was given strong pain medication, there wasn't any kind of question about that. I know that, like me, she was off the oxy within a few days, dropping down to Tramadol after that for another week or so, and then off everything but Tylenol within 2 - 3 weeks. Glad to hear you'll be talking to your OS and PCP about this. I'm all for being cautious about opioid prescriptions but handled responsibly and carefully, they absolutely make sense to me for effective and short term pain relief. Sure, with the opioid crisis taking up so much focus these days I can see why the medical profession is cautious. But NO strong pain medication still seems crazy to me--and what the heck is "multi-modal pain management"? Sounds like a lofty aspirational goal but in reality does this actually WORK for all patients??! Good luck, and I'm betting your OS will be able to reassure you that medications will be made available to you as needed.
     
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    Last edited: Jul 15, 2019
  13. Layla

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    @Barbaraj My understanding of a multi modal pain approach is using more than one medications to manage the post op pain, rather than opiates alone. Patients receiving more than two methods in addition to Opioids are less likely to need additional opiate prescriptions.

    In my case I received an injection (Exparel) into my surgical incision at the end of the procedure numbing the tissue around the surgical site. This injection released pain medication over time and could control pain up to 72 hrs. I also took Toradol for one week post op which helped to decrease swelling and pain. I feel it was this approach, in addition to icing almost non-stop, that allowed me to only ever need 4 Oxy total over the first three days. I also know I have a high pain threshold which obviously helped. It sounds as though you were doing the same with Tramadol. Not sure if that was you, or your friend, but hopefully this gives you a better understanding of multi modal pain management.

    I guess I'm confused by @Ptarmigan mentioning options excluding opiates immediately post op. I can't say I'm familiar with that approach. Possibly someone will comment if they went that route...
     
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  14. Ptarmigan

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    I really appreciate getting the details about the types of drugs and the length of time you used them, @Elf1 and @Barbaraj . It’s concrete information like this that will help me organize my conversations with both doctors much more productively. @Layla received an analgesic injection, too, and that sounds very promising, so I am feeling really good about my list of questions. You peeps know I like being prepared :) I agree - I have every confidence my doctor(s) will reassure me when I finally get to have those conversation(s).

    I had the same reaction you did, by the way, to hearing the term “multimodal pain management.” I have seen the pendulum swing on the subject of pain a few times over the decades, from “rub some dirt on it” to “treat pain assertively or it will inhibit healing” to truly terrible experiences when my husband was referred to specialist pain management treatment for chronic pain, as mandated by a change in state law. I couldn’t agree more about “lofty aspirational goals that in reality [don’t] actually WORK for all patients.” Fortunately, everyone here at BoneSmart has given me the reassurance that I will very probably fall within the state guidelines for acute pain, and I trust my doctors.
     
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  15. Layla

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    Obviously its wise to be prepared, but you may also find recovery is not as debilitating as you're imagining. Pre-op I kept hearing day three and four we're supposed to be more intense. Well, :bored: it didn't happen.
    I would describe my pain at its worst as strong discomfort. It's easy to obsess and worry about pain, naturally we all do, but hopefully yours is managed well and rather unremarkable.
    I bet you'll do fine. Think positive, lol. Easy to say, hard to do...
    @Ptarmigan
     
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  16. Ptarmigan

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    When I asked for clarification, the presenting nurse said pretty much what you just said, @Layla , about the definition of multimodal, and she went on to say that the medication they administer just before surgery (Celebrex, Gabapentin, and Tylenol) are medications that treat pain through different mechanisms, so that they work synergistically. She didn’t say opiates weren’t available, only that opiates weren’t needed by all hip patients.

    Thank you, by the way, for the information about Toradol. When my husband received Toradol after open heart surgery, it had a dramatic positive effect on his pain.
     
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  17. Fiona444

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    This is an interesting discussion re medications. I think over here in the uk they give the mildest opiate available (codeine) as they did in my case and if that isn’t helpful then use additional non opiate meds such as the nefopam that they gave me. When i have my next op i will be much better informed and will be able to advocate for myself pre surgery. My initial experience was awful and knowing what i have learned here, it doesn’t have to be that way.

    @Ptarmigan you are going into this so well prepared i think you will have a great experience!
     
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  18. Fiona444

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    I am so sorry you had to go through the worry of the lump on your elbow! Very scary! What a relif to know all is ok. These difficulties always seem to come together dont they? I managed to put a hole in my cornea just over a week before my op and i suddenly realised i was more scared of not having the op than having it too. Perspectives indeed!
     
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  19. Barbaraj

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    Okay, I now understand that multi-modal just means giving other drugs a try along with opiates! I guess that is what I got, as they sent me home with opiates but also with extra strength Tylenol which is what I used during the daytime from the beginning. I am sure at the hospital I was pumped full of a cocktail of drugs, not sure what. I know I apparently didn't have a great reaction to one of 'em as they "flushed" my system at some point, or so I was told, but not sure if that was a pain relief drug or not. At any rate, I also think you might surprise yourself, @Ptarmigan, and find that you will only need strong medication for a day or two or not at all and maybe only, like me, at night. Like @Layla, I, too, never recall being in extreme pain following surgery. Sure, I had swelling and I was sore and achy, and often exhausted, but I took hardly any oxy, switching quickly to Tramadol and then just at night, and off that within a few days after that. Everybody is different, and it just seems that, assuming they trust the patient, they should provide access to the strong stuff at home so that if serious pain occurs the patient can get relief. They are so intent in shipping you home the day after surgery, they need to make sure that the patient has options/choices to insure they are comfortable and coping well. I suspect your OS will agree.
     
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    Last edited: Jul 15, 2019
  20. Layla

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    I believe mindset plays a big part in all of this also. Try to think positive when you're feeling anxious. When I was informed I'd be sent home within 24 hrs I was terrified. During a phone conversation with a nurse, who I would again meet in person at a one-on-one appt a week before my surgery, I was informed that I would be discharged the morning after surgery, barring any complications. I was shocked.

    Aside from my parents who each had both hips replaced and spent two nights in the hospital, I had no other recovery to base my assumptions on. The thought of being released to my husband, who's not a medical professional, then informed there would be no visiting nurse, or in home PT, had me in a panic. Not even kidding. I got of the phone with the nurse and immediately called my husband. I believe his reaction was that of surprise which didn't help matters, lol.

    I quickly decided I had to change my outlook to save my sanity. I began by telling myself that if being discharged in 24 hrs without any visiting nurse was allowed, it must be because it's working for the majority, right? And it can be done which I find reassuring, minimizing fear. Even if it's not your surgeon's practice, it's still allowed because it can work.
    The one-on-one with the nurse also reinforced "I can do this" :yes!: I'm truly thankful for her as she was lighthearted, laughed easily and made everything sound easy peasy, NO.BIG.DEAL. I left that meeting feeling confident. Did I still fight some anxiety, yes. Did it ramp up as my date got closer, yes. I did a lot of praying and self talk which is my go to. I avoided posts or threads that would ramp up my anxiety and focused on the positive uplifting threads / posts that had me amazed at how quickly you progress through the recovery process. During my time here, I've read of some being discharged the day of surgery. Drive thru THR! Truly amazing.

    I would imagine for those experiencing a second THR that it's less anxiety producing since you've "been there done that". You have answers to the questions we ruminate over in the silent darkness of the night the first time around. All I can say to those on board for their first surgery is, afterward you'll join in on the refrain "If I only knew it wasn't as big of a deal as I made it out to be." It will soon be just a blip on the screen.
     
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