Teds/blood thinners/alcohol

[nickji]

Nick here again - if I'm posting too much please let me know.

I've just been reading posts about Ted hose, blood thinners and alcohol - first I've heard of any of this in connection with THR. This is one of the disadvantages of having the procedure in India. Two weeks post op. I've had no meds for blood, only advice on DVT is to do foot rotations/extensions 100 x 3 daily, both legs. I'll be flying India - Europe five weeks post op, direct 11 hour flight. Should I definitely get Teds for the flight (or now), or not bother?

Also no advice was given re alcohol, and I'm back to my usual one or two glasses a day. If anyone has advice on these issues, I'd be - as always - most grateful.

Many thanks,
Nick

 

[Josephine]

Re: Teds/blood thinners/alchohol

Yep - that's the kind of thing I worry about on behalf of people who travell afar.

You should get compression stockings for the flight to avoid the settling of blood and restrained blood which could set up the makings of problems for the op. Make sure you get some kind of exercise in the plane even if only walking up and down the aisle every hour or so. Foot work sounds right on. You shouldn't need anti-thrombotic medication before hand but definitely after.

What are your arrangements for return? Like when? Because all of this will be even more important after than before.

Oh yes - and knock off the alcohol and smoking (if you do, that is!) It doesn't make good company with anaesthetics.

 

[nickji]

Re: Teds/blood thinners/alchohol

Hi Josephine,
Afraid my post wasn't clear enough. I have already had a RTHR two weeks ago today, so my question on these three points applies to my situation after the operation. I'll be flying to Europe three weeks from today, five after the op. If I do need blood thinners, do you have any recommendation as to which is best?
Thanks
Nick

 

[nickji]

Re: Teds/blood thinners/alchohol

Hi Josephine,

Sorry to ask for more of your time, but I have a further progression on my concerns over DVT and PE. I emailed my surgeon to ask if I should be taking heparin or whatever and here is his reply:

Hey, all this are concern for bed ridden pt!
Once u walk actively , participate in ur daily routines , this all DVT
remains in books only. Just the foot ankle exercises, lot of walking,
should solve ur problem ! Pressure stockinettes are available , TEDs
at clamps sports shop. U can use a large size thigh length . But
frankly speaking, just walk as much as u can, n watch james bond the
rest of the time.

As a layman, I do agree with him in that I feel that my mind is playing it's 'fear games' with me, as minds like to do..... He's regarded as a high flyer here - 34 year old, top of the tree, plenty of experience, and attends a lot of overseas conferences and treats patients from all over the world. So, I do feel a lot of confidence in him. (the James Bond reference is an in-joke between him and me). However I'd really appreciate your view on what my best course is, especially as I have a long flight in three weeks. Incidentally, I live in India, as an expat for over 20 years, so am not a 'medical tourist'. I'll be doing my tourist thing when I visit Europe in April.

I sent a private message on another subject, through the 'contact us' link, which I hope you received. Thanks again for this wonderful site.

Best Regards,

Nick

 

[UTdave]

Re: Teds/blood thinners/alchohol

Take a few aspirin if it will make you feel better. One full size every 8 hrs for a few days should help. Ted hose are great, but certainly not a cure-all. Your surgeon is right, there is low risk for ambulatory patients, but that certainly does not mean no risk. I diagnosed an active, fit neurologist with a DVT a few months ago whose only risk factor was a car journey of a few hundred miles. Stuff happens.

As for alcohol. It interacts with other meds, the main concern being pain killers and coumadin (warfarin). Alcohol and narcotic pain killers = bad almost all of the time. Alcohol and coumadin = bad if there is significant fluctuation in level of consumption. In other words, if you drink two glasses of wine a day, continue. But don't go to a party and have five glasses or you can effect the drug's ability to thin the blood. Likewise if you get too tipsy and take a spill, crack your head, bleed into the brain. . . you get the point.

 

[nickji]

Re: Teds/blood thinners/alchohol

Thanks Dave, great reply. Made me smile, banished the mind games...
Nick

 

[Jamie]

Just one question, Nick....do you think you're pushing it by planning a big tourist trip only 5 weeks out from this major surgery? I'm thinking you may find such a trip VERY exhausting and it could cause your knee some pain. I'm on Jo's side to wear the TED hose on the plane. Eleven hours is a tremendous amount of time to be basically immobile. I would err on the side of caution....no fear, just caution.

 

[JudyS]

Nick

I like Dave's line "stuff does happen" were I in your situation, I would wear the awful hose on the plane.
As far as blood thinners, I can tell you my experience after hip replacement. I had 10 days of lovenox injections after surgery, that was it.

Good Luck and by the way you are not posting too much.
Judy

 

[Josephine]

Maybe not your actual TEDs, just regular compression hose.

Actually, I don't agree with him. There is more than enough empirical data to support the need for proactive anti-thrombotic treatment post-operatively with six weeks appearing to be the usual period for this. I'm not sure I would have your confidence in someone who would go against such a body of evidence in that laissez-faire attitude. Were it me, I would much sooner be safe than sorry, specially when undertaking such a lengthy journey which has known issues regarding DVT/PE in people not at risk in the first place.

 

[creblue]

Will i have to take coumadin oe other blood thinners?--for how long? will I be off most pain meds -how long post op?

 

[Josephine]

Will i have to take coumadin oe other blood thinners?--for how long?

The usual is 6 weeks post op

will I be off most pain meds -how long post op?

Not quite sure what you mean by this? It reads oddly. Are you expecting to be denied pain meds post op? If so, that's not the way. You need pain meds from the start and how long you take them for is dependant upon how well you do. Some people only need them for about 2-3 weeks, others up to 3 months. Just depends.

 

[nickji]

Hi Josephine,

Thanks again for your advice re. anti DVT measures. The disadvantages of surgery in India are becoming clearer by the day! It's my home, so no real option, but others should be informed.

Anyway, I'm here now, and since my surgeon has dismissed the idea of a problem with DVT, and there is no doctor where I live, I'm thrown back on my own resources - one of which is, of course, this site...

Can you advise me if there is a tablet form of prophylaxis for DVT - other than aspirin - which I can take, and if so, can you let me know the generic name, as brand names here are almost always different, though most drugs are freely available over the counter. I'd like to take something well before I fly, as that seems the highest risk - and I do love this life!!!

Thanks a lot
Nick

 

[nickji]

Hi Jamie,
thanks for the advice. Agreed, 5 weeks (it'll be almost 6 actually) is way to early. But, alas, my 5 year visa ends then, and can't be renewed here, so travel I must. So, any and all advice on how to make a long plane trip safer and more comfortable will be much appreciated - I think I'll start another thread on that, others must have had to do similar trips.
Best
Nick

 

[UTdave]

Here are some reading materials if anyone is interested.

1. The first is from e-medicine and is a very large review of all DVT prophylaxis, so I cut and paste the short section on hips/knees.:

https://emedicine.medscape.com/article/284371-overview

Elective hip/knee replacement surgery

LMWH started 12 hours before or 12-24 hours after the procedure; or start with a half dose 4-6 hours after surgery, with a full dose the next day; OR
Fondaparinux 2.5 mg SC started 6-24 hours after surgery; OR
Adjusted dose vitamin K antagonist, starting 1 day before the surgery with a target INR of 2-3.0 (grade 1A).
Pharmacologic therapy continued for a minimum of 10 days (up to 35 days) after surgery
High risk bleeding: Optimal use of VFP or IPC (grade 1A).

BTW- Vit K antagonist is coumadin (warfarin)

2. The second is from a sponsored website (stryker) and is one guy's opinion, though an informed opinion, arguing for aspirin alone:

broken link removed: https://www.orthosupersite.com/view.asp?rID=24609

3. The third is from American Academy of Orthopedic Surgery and deals with preventing PE only - not DVT. The reasoning for this is that PE (pulmonary embolus = clot in your lungs) is the potentially fatal complication of a DVT (deep vein thrombus = clot in the leg). A DVT is like having a hand grenade in your living room - not a great thing, but not necessarily fatal. A PE is like someone pulling the pin on the same grenade - depending on how things go, there may be a funeral and your living room will likely need a remodel. So they focus more on the PE.

broken link removed: https://www.aaos.org/research/guidelines/PE_summary.pdf

You'll note level and grade of evidence. This is becoming common for medical establishments to use as prior guidelines tended to be based on "expert opinion" which was later found to be off the mark. Higher grading means more research of higher quality. In addition, this site can be searched regarding evidence for various treatments for DVT/PE after surgery.

In summary, there are a lot of positions out there for use of different drugs for different lengths of time. The common theme is that people ought to take something for some period of time.

Clear as mud, eh? ;-)

 

[Jamie]

Hi Jamie,
thanks for the advice. Agreed, 5 weeks (it'll be almost 6 actually) is way to early. But, alas, my 5 year visa ends then, and can't be renewed here, so travel I must. So, any and all advice on how to make a long plane trip safer and more comfortable will be much appreciated - I think I'll start another thread on that, others must have had to do similar trips.
Best
Nick

Ahhhhhh.....NOW I understand! Hope the trip goes okay for you! It will be a challenge, I'm sure!

 

[Josephine]

Thanks Dave - saved me a job!

 

[nickji]

Hi Dave,
Many thanks. Given the fact that I have had no prophylactic meds for DVT or its complications and am now 2 weeks after my op., it seems that aspirin is my best bet - I assume that even at this late date it's worth taking - is that correct? I'll re-check your recommended dose in an earlier post and start tomorrow. Don't feel unduly concerned, since PE does seem quite rare, but still . . . .
Thanks again
Best
Nick

 

[nickji]

Hi Dave,
Another question. You said:

One full size every 8 hrs for a few days should help.

what mg is a full size aspirin? The Stryker sponsored site was very convincing, and anyway, I don't have much choice - can't self-med on warfarin or LW??. too risky. that site recommends 325 mg twice a day. Do you agree?
thanks indeed,
Nick

 

[Josephine]

Aspirin would be your best bet. 75mgm per day would be sufficient. The most crucial 'at risk' period is the first 6-8 weeks so my suggestion is that you take them for 12 weeks.

 

[UTdave]

Nick,

325mg is a good dose, but I'll freely admit I have no idea on the frequency. Aspirin is an irreversible inhibitor of platelets. Platelets are "dumb" and cannot produce new proteins like other cells in the body. So once the aspirin hits, they're affected for life. Your body produces new ones each day, however, so that's why you have to redose. Most patients I see are on it for heart conditions and they only need 81mg a day. I would want to take more if I were in your situation. . . how much? I don't know. Sorry. You may surf the AAOS site I mentioned as it has several papers and presentations on the topic.

I don't suppose your doctor that you paid for the surgery would answer this for you? ;-)