THR Questions on THR for elderly parent.

Gooner99

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Hi.

Thanks for letting me join the forum and post.

My 88 year old Mom is booked in for a total hip replacement early next month. There were a few concerns at her pre-op. She had a clot in her leg a few years ago, but has been off blood thinners for four years. She had low sodium levels a couple of times in the last couple of years, but it's now stable. Because it has been put off for so long and the fact that it is bone on bone it means she struggles around the house with a rollator, leaning more and more on it as the weeks go by due to the severe pain. That also came up as a concern in how she would recover afterwards, due to not being able to walk unaided for quite a while. Her other hip is fine. She really wants to keep active and do as much as she can, but it is really restrictive now. All of this has her very nervous (she suffers from anxiety and is on medication) to the point where we are unsure if she will make a decision to have it. We are also very nervous, as on one hand we feel it could give her a new lease of life, but on the other we have the same concerns of recommending something to her that may not go too well. Our hope for her would be that she could live without pain and have at least enough mobility to get around her house with her rollator. The alternative is her going off her feet, ending up in a care home and still be lying in pain.

Has anyone got elderly relatives or friends that have gone through total hip replacement. I would love to hear the experience.

I would also welcome any advice on the op and recovery. Her house is all on the same level, so the plan would be that she would return home two days after surgery and begin physio a couple of weeks later. An alternative is to go to a care home for a week or two. But I think she would prefer to be at home if it was feasible.

Thanks in advance.
 
@Gooner99 Welcome to BoneSmart! What is the date of your Mum's surgery and which hip? We will put the information on your signature for you.
She had a clot in her leg a few years ago, but has been off blood thinners for four years
Most surgeons prescribe blood thinners for several weeks post joint replacement to prevent blood clots. Be sure the surgeon knows your Mum's history.
She had low sodium levels a couple of times in the last couple of years, but it's now stable.
Mum will have pre-op blood tests to look for any problems that might impact her having surgery.

In terms of post op mobility, they will have your Mum up and moving about on her own before she can leave the hospital. All that bone on bone pain will be gone. She will most likely keep using the walker. Not having to deal with the horrid bone on bone pain will help her begin to build strength.

Since her house is all on one level she should have no problem returning home post op. It would be ideal to have someone there with her in the first week or so. Is that possible?

Have a read in our Hip Recovery area. Lots of happy new hippies there in many stages of recovery.
 
Thanks for the warm welcome and reply.

Surgery set for the 4th.

Yeah surgeon is aware of the clot. She will get injections every day for a number of weeks post op. I'd imagine blood thinners too.

She had bloods and heart check at the pre-op. Will also have bloods redone a few days prior to surgery.

It is great to think the terrible pain will be gone. That is the main aim. Increased mobility would be a bonus after that.

We live next door and she will have lots of support from family and friends. We take turns staying with her overnight as it is.

Anxiety and fear are the biggest challenge in the next two weeks. Really hard to decide for her. Really want her to have it done, but would be devastated if things didn't go to plan due to her age.

I must take a look through those posts.
 
She will get injections every day for a number of weeks post op.
Yes, these injections are blood thinners. They do get tiresome but it is a necessary evil. Here's an article from our Library on Blood thinner (enoxaparin, Lovenox, Coumadin) injections. They will show her how to do this in the hospital but I found the extra tips in this article very helpful.

Living next door to your Mum is perfect. She can have her independence yet help is on hand if needed.
Anxiety and fear are the biggest challenge in the next two weeks.
We were all in this space in the run up to surgery. Even those of us who have had multiple surgeries suffered anxiety. But it sounds like your Mum is more than ready to get this done. Just remember, this may be a big deal for you and Mum - but this surgery is a day job for the surgeon and their team. They do this everyday, several times per day. And success rates are excellent. If you and your Mum go into this with a positive attitude, it will really help during recovery.

We will be here for you!
 
Hi and Welcome!

As Jaycey said, living next door to your mum is perfect, she will have her independence, and help when she needs it.

the plan would be that she would return home two days after surgery and begin physio a couple of weeks later.
Just a caution, be careful with the physio, here is part of our Hip Recovery Guidelines:

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

Here’s a look at the rest of the Recovery Guidelines. Each article is short but very informative. Following these guidelines will help you have a less painful recovery.

Just keep in mind all people are different, as are the approaches to this recovery and rehab. The key is, “Find what works for you.“ Your doctors, PTs and BoneSmart are available to help, but you are the final judge as to the recovery approach you choose.

Hip Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
elevate
ice
take your pain meds by prescription schedule (not when pain starts!)

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.

4. PT or exercise can be useful BUT take note of these
BoneSmart philosophy for sensible post op therapy

5. Here is a week-by-week guide
Activity progression for THRs

6. Access to these pages on the website
Oral And Intravenous Pain Medications
Wound Closure

Pain management and the pain chart
Healing: how long does it take?
Chart representation of THR recovery

Dislocation risk and 90 degree rule
Energy drain for THRs
Pain and swelling control: elevation is the key
Post op blues is a reality - be prepared for it
Myth busting: on getting addicted to pain meds
Sleep deprivation is pretty much inevitable - but what causes it?

BIG TIP: Hips actually don't need any exercise to get better. They do a pretty good job of it all on their own if given half a chance. Trouble is, people don't give them a chance and end up with all sorts of aches and pains and sore spots. All they need is the best therapy which is walking and even then not to excess.

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask the at each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 
My mother had her hip replacement surgery at age 87. Her doctor basically ordered it because he was afraid she would fall. So there wasn't a lot of agony involved among my siblings and myself.

She had a difficult initial recovery but that was because she had a heart problem that made it hard for her to breathe. Once the heart problem was treated, she had a great recovery.

On anxiety, the truth is in their late 80s, most of us are vulnerable. We're vulnerable if we do nothing and we're vulnerable if we go for a treatment.

So I'll just say the option of canceling the surgery is also a risk. Pain can cause all kinds of psychological and emotional problems and depression and those problems (really our emotional life is ultimately "physical") affect the rest of the body. Eating, motivation, morale, all of those are affected by pain. And untreated pain in one area makes us really overwhelmed by new pain in a different area. Our older ailing parents have to use willpower to ignore lots of pains and aches or not pay too much attention to them. The pain can tip them into a point where they basically give up hope.

Untreated pain is a risk. I guess that's what I'm saying.

In your position, I'd vote for the surgery. But I'm infected by hindsight. My mother's surgery got her three really good years afterwards. She wasn't hindered by her hip and her fear ... Ultimately heart problems and cancer lead to her death.

So you can cut yourself a break. Your mother is vulnerable right now with all her ailments (I hope that isn't callous for me to say--I don't mean it that way). Choosing the surgery can be a loving act of hope and kindness. I'm not telling you what to do but I'm saying that we don't have control here. There are no pure and easy options. So give yourself some compassion, see if you can face that she is vulnerable and make the best choice you can. That's all you can do. Choose a surgeon you trust and have them explain how they will handle her current ailments, and do your best.

But just be aware that not doing anything is also a risk.
 
@Gooner99 my Aunt had a hip replacement a couple of months ago. She is 92. She has recovered incredibly, walking around her kitchen just days after surgery. She called me after one of my cousins told her I needed one & was putting it off. She was an inspiration to say the least. She's getting around now like she's had that hip all along. Best of luck to your Mom. Sounds like she's got a great support network.
 
My 97 year old aunt broke her hip from a fall and had surgery about a year ago. Her biggest issue was the general anesthesia affecting her premorbid major hiatal hernia with effect on the gastric system. Unfortunately they were not able to do spinal anesthsia which might have been so much better. Again, hers was an emergency surgery so there may not have been backup anesthesia folks for the spinal. She does have a leg length discrepancy, but again this is from a fracture, not a hip replacement. She wears a lift and still goes out almost daily with "the girls" from her independent living center. My cousin adamantly demands that she use her little walker when outside, and that's understandable. But she is a happy lady and doing well .
 
Hi. I hope you are all keeping well.

Thanks all for the replies so far. They are very inspiring and helpful.

I have read little bits from here to my mum. She is always saying everyone that I say had a hip replacement is younger. But I can now relay stories of people her age or older having it done. It all reassures.

As of now my mum looks like she will still go for the op. We haven't had any calls from the hospital, so that means there wasn't anything that came from the pre-op that concerned them enough to cancel.

Her house is fairly well set up. As she was restricted for the last couple of years she has a solid chair, raised toilet seat, aid for getting in and out of bed. So she really doesn't take risks other than bending with her good hip to pick things from the floor, like the dog bowl.

She really likes to be up and about every morning, getting dressed herself, making her breakfast, etc. She doesn't like lying in bed even though she is very tired due to lack of proper sleep at night. So I don't think we will have too much trouble post op getting her up and going.

She will have two additional challenges. The first is that she is very intolerant to medication and can't take pain meds other than paracetamol tablets (currently of 8 x 500mg per day). They only take the edge off. Do you think she will be ok with just paracetamol when she returns home post op?

Her other challenge which you guys have mentioned is mental health. She had a traumatic time while in hospital last winter. She was quite a long time in A&E and she wasn't allowed any visitors during her stay. She is quite a nervous and anxious person at the best of times, but this really brought it to a head. She is currently on Mirtazapine (for depression/low mood) and Ativan (for anxiety) which do help, but she still feels down quite a lot. Hopefully she can cope. It's quite hard reassuring an elderly person as it is understandable to feel like this when you are getting older and have health issues. I guess it's not so easy to help them through this. All we can do is reassure as best we can. The pre-op doctor said that I should say to the nurses on admission that it would be helpful to them if I could spend a little time with her while they begin the journey to the operation. She will be admitted just a few hours prior to surgery.

She was told she didn't have to stop any meds prior to the op. They did ask her to consider stopping or reducing her smoking. She smokes quite a bit (10-20) a day. She used to smoke less, but I can fully understand why she smokes more this last while. It's both a pass time and something to help calm her nerves. The only good thing on that front is that she never smokes in her living room and it gets her up to walk to her kitchen, even though she's in terrible pain. So I'm not sure if I should be trying to get her to reduce or stop at this stage?

I value all the advice and support you guys are offering.
 
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@Gooner99 my mom had a partial HR at 91, with dementia, on hospice (except for the 6 nights in the hospital), living in memory care. Her hip sheared (osteoporosis!!!) as she turned back to pick up her glasses, and she fell to the floor inside her walker.

It was a very hard call. They couldn't pin as the fracture had shifted the bone parts, and doing nothing would leave her bedbound and in pain for the rest of her life. We were fully prepared for the GA to do her in-- she was already very frail--, but she sailed through a successful surgery! She was given rudimentary PT a few times in hospital. We'd found a "mobile self-pay geriatric orthopedic" physical therapist who was happy to work with her, stipulating that he'd wait until a week after she returned to her facility. His goal for her was to walk on her walker to the dining room and back with a short rest. She loved the attention and walked well for several months, until her already advanced dementia pushed her downslope again. She did have narcotics while in the hospital, but only tylenol (paracetamol) on her return "home", and didn't seem to need more.

There is a thing called "hospital delirium" to which apparently anyone over 65 is prone, no matter the state of their mind/brain. Mom had already exhibited it once a couple of years prior, and did it again after the hip. It helps tremendously to have someone trusted in the room with the person as much as possible. Mom's incident was in 2019, so things were normal. If family members are not allowed to visit your mum due to precautions, perhaps you can hire a caregiver who's been prescribed as a medical necessity, and introduce them now to mum, so they can get to know each other.
 
Your mom sounds motivated and reasonably independent. I’m a big believer in care at home provided there is someone there .Nothing worse than being alone in rehab or hospital unless it absolutely can’t be helped.
 
Thanks again for the replies.

A bit of any update. I spoke with the physio in the local rehab/nursing home and they said it could well be a good option to go in there for some respite care if she felt she wanted to, as they would see her daily (weekly if at home). So it's good that it's an option if she felt she doesn't want to return home straight away. I also spoke with the local nurse and she will call in with her Today for a chat.

But as of now I'm not sure what will happen. While she is enthusiastic about getting up and going every day, she is not enthusiastic at all about the surgery now and mainly focuses on the negatives. Her anxiety levels are getting more and more with every passing day and her mood is low and she feels down. Again this is an ongoing battle for her for the past year. She is on meds for this, but I guess there is only so much they will help with. Her head is sore/fuzzy/dizzy and she is looking for a medical reason. Her doc says it's flashing, another that gave her an injection said it was neuropathy. From being with her day in day out I believe a lot of it it's stress/anxiety and meds.

It's a difficult situation for us all now. It's a kind of damned if you do damned if you don't. Not having the surgery won't have a good long term outcome for her either. But maybe that's how things are meant to pan out.

It will be a long two weeks if we decide to press on. And I'm not sure canceling will be the best thing either.
 
And I'm not sure canceling will be the best thing either.
I agree @Gooner99 ! If you wait longer I am afraid your mum will get more and more frustrated with the decreasing mobility and the increasing pain. Surely that would added to her already anxious state.

What are the negatives she is focusing on. Perhaps we can help you with how to address these negatives.
 
Thanks for your support Jaycey.

A little update. The local nurse visited my mum Yesterday which helped to reassure her a bit. She told her she looked great for her age and had good health otherwise. she was lucky to be getting her op done in a hospital with a great reputation and they wouldn't do the op unless they felt confident. hip surgery was one of the most common and successful surgeries. having a spinal reduced the risks. she was lucky to have so many around to help her post op. that the terrible pain would be gone and that she would be up and mobile again, able to go out and about, etc.

My brother also went through a successful surgery Yesterday, which I think also helped. I think we need to keep her mind off the surgery as much as we can. Two weeks is a long time when your in the house and have lots of time to think during the day when there is no one about. Broken sleep at night I'm sure also sends the mind into a loop of thinking and over thinking. We plan to get her out to the hairdresser this weekend and she will catch up with a couple of ladies her own age there. Try and keep her busy, distracted and as positive/neutral as possible.

It's hard to pin down her negative thinking. At times when she was low after her hospital stay I would ask and she couldn't even tell me why she was anxious and feeling down. So she has a general anxiety issue and a bit of depression. My guess it's fear of the unknown, fear of surgery, and a fear of the worst possible outcome. As I say I have inherited that trait myself and yes sometimes you just don't logically know what your stressing about, but it's hard to break the cycle even though you know there is no real need to stress in many situations. I guess I'm nearly as apprehensive as she is about it, lol.

I welcome any tips and tricks you guys think might work for the next two weeks to make the buildup as stress free as possible and deal with negative thoughts when they arise.

Thanks again.
 
@Gooner99 Depression and anxiety before and after surgery is quite common. Before - pain, apprehension about having surgery, worry about what the "after" will be like, sleep disturbances, and worry about "being a bother to family and friends" are a big part. After - side effects of anesthesia and pain medication, worry about "not getting better fast enough", sleep disturbances, worry about being unsteady on one's feet, worry about things going wrong - all those may play a part.

With elderly patients they can have brains that are more fragile and susceptible to medication side effects than younger patients. So have your Mom's pharmacist or surgeon go over ALL medications and look for possible adverse interactions and side effects that could cause her problems.

Keeping her busy and engaged before the surgery will help a lot. After wards she will need more sedentary activities for a while as she will need to elevate her leg and apply ice packs for periods during the day - plus she will probably be napping more that is usual for her at least for the first few weeks.

Keep reassuring her that everyone involved with her care before, during, and after the surgery is a professional who has her best interests as their primary goal. You know your Mom better than most anyone else - does she do better with more information about up coming stressful situations or does more information just make things worse? Does she want to know what actually happens during the surgery or would that frighten her more?
 
Thanks for the reply. I think she does best when she only gets the information she really needs to hear.
 
My guess it's fear of the unknown, fear of surgery, and a fear of the worst possible outcome.
All very normal concerns for anyone waiting for surgery. If she does not want any details about the surgery you might just want to stress the huge success rates of this procedure.
I guess I'm nearly as apprehensive as she is about it, lol.
I'm sure you are anxious as well. I found researching the heck out of the whole process helped. By the time I was in the hospital waiting to go to theatre for my LTHR I knew exactly what would be done. I actually felt very calm. A good start is this page of general information articles. Then the recovery articles Jockette left for you in post 5 of this thread. If you are very familiar with the process you can inform her as needed and reassure her as well.
 
Good Morning :wave:
All the best to you today! May your surgery be uneventful and recovery easy.
Please join us on the healing side once you're resting comfortably at home.
We'll be watching for you. :)
@Gooner99
 
Good Evening.

Hope I find you all as well as possible.

Sorry I didn't post back here. Long story, but my mum's surgery was canceled last minute (I'll go into it at a later date) and it left us all a bit up in the air.

She was relieved at the time, but in the end it left her more anxious and reluctant to go again. Anyway due to very severe pain she has Yesterday decided to go again with the 2nd of February the new date, all going to plan. I have a couple of questions if you don't mind.

Since the last time she has gone onto Fentanyl patches, 12,25 and now 50. Anyone know if they need to be ceased before surgery. I will ask the hospital, but just checking if anyone has experience?

My mum's had a couple of UTIs in the last couple of months. If she were to have one close to the surgery would taking antibiotics too close scupper the surgery?

Thanks again for your help and advice.
 

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