THR Wide Awake - Mailman Chases Dogs Away

[Eman85]

I am sharing my experience in the hope it may help those with a concern about the very real possibility for cognitive decline from anesthesia, especially for those over 60 or 70 who have already experienced some memory loss and ability to think as quickly and clearly as they once were. It's an accepted fact that by using drugs that only affect a local area instead of the entire nervous system, including the brain, this concern is eliminated

I did plenty of damage on my own years ago, wasn't concerned that anything they used would do any more. I had no urge to have the full experience you did. I guess it's good somebody did and can tell us about it.
I was awake when they were placing me and strapping me down for my 2nd THR. I questioned some of what they were doing. I'm sure they were happy to put me to sleep.
The whole deal about dislocation is the direction they rotate your femur to work on it. In our normal everyday movements we tend to rotate less in the direction used for anterior and with less force. The rotating during surgery weakens the muscles that hold the hip in place.

 

[Mailman]

@dnordo220 Did you have posterior? Anterior is supposedly less prone to dislocation but of course everyone is different beyond the type of THR they have.
Still I'm curious.
And I'll be sure to not overdo. That's in line with my discharge instructions... No PT

@Going4fun Yes, yes and yes.
Being a little scared but also excited seems to to be totally appropriate and I also believe that attitude is going to have very much to do with eventual outcome. Your brothers story is an excellent example.
It would have been very different for me if I didn't connect with both my surgeon and anesthesiologist and by extension I suppose the entire team. Especially the anesthesiologist. I spent most of the time under the fabric near her head to head. At times it was a bit like we were kids playing under a tent we made out of sheets and furniture in our parents living room.

For instance, the surgeon popped over to our side to announce the hard part was complete, the new joint was in place, and added that I had very hard and solid bones (good thing!). Five minutes later I asked how the stitching was going and she poped her head up over the screen and asked " 3 or 4 layers" and then explained there were going to be 4 layers, something about anatomy and they were still just on the first. Every time I closed my eyes I saw the same animated red motif and we talked about that and and all about her job and aspects of anesthesia and anything else that I wanted to talk about.
As you may imagine them time went by quickly.

 

[Hotchocolate]

This was better than any scary Halloween story could have been, thank you

Glad it wasn't a bad experience for you tho!

 

[Mailman]

Me too!!

 

[Ruth123]

My husband had his THR with no meds, just the spinal block. At the time he was just a few months into congestive heart failure with a very very low LVEF (heart pumping rate). After consulting with his surgeon, his cardiologist and the anesthesiologist, he opted for nothing as the safest course.

His view was blocked but he said it sounded like a car repair shop with all the clanging, banging and power tools!

A friend of ours who had his THR about 20 years ago in Vallarta was awake and able to watch the surgery in the reflection of a surgical lamp.

I OTOH opted for general. How big a wuss am I?? I get twilight sleep at the DDS for a cleaning.

 

[Hippielife]

The whole experience by Mailman is what I call becoming your own self advocate. Study up on procedures snd once understanding is completed , accepted and watching the process on video even knowing about anesthesia and components is important. Then the whole process becomes so much easier to comprehend before surgery and during rehab. Takes away a lot of unnecessary anxiety.

Excellent job Mailman…this is what I have been preaching relentlessly for a long time. Your a great example … of how to take THR surgery to a place of understanding, education and awareness thru the many factors we can become better at coping and accepting responsibility for Ourselves. Congratulations on becoming your own self advocate by understanding and taking the responsibility to learn what you can about THR surgery and sharing your experiences. Super Kudos to Mailman.

 

[Goma]

Your experience is fascinating and clearly your decisions regarding the procedure is the right approach for you.

The body goes through major trauma and I personally don't like to think on it too much. I haven't even looked at my x-rays yet.

I've noticed that my eyesight has deteriorated after this surgery. I don't know if it's the meds or a consequence of the procedure and I had a spinal block with sedation.
I'm hoping it gets better.

Thanks for the detailed explanation, if I hadn't read of your experience I doubt that I would have heard of it elsewhere.

 

[myglasshalffull]

I read all your posts with great interest and found them very informative.
I can see you really did your homework. Unfortunately my surgery was not planned, fell on ice and fractured my hip so no time to educate myself.
There's a wealth of information in your posts and thanks for sharing and keep us posted on your recovery.
I wish you the best.

 

[Mailman]

@Goma
Glad you found my experience of some value.
I gather you already had a THR on one side after which your eyesight has deteriorated. I'm very sorry to hear that. I don't know that propofol or whatever drug used with your spinal block has the potential to do more than shut your eyes and eliminate memory of your experience while under it's influence. I don't know whether it has the ability to reduce the ability to remember other memories as well and not a clue how it works.
To me if I had the slightest belief I could lose my eyesight from any medicine I would never chance it, yet everyday we are pushed to accept and even desire products that have proven to be harmful. Just minimize them and call those proven potential harms 'side effects'.
I too didn't want to deal with a bad hip when it first started to give but instead of not looking at the X-rays I did look at them and then just ignored them for 5 years, until I could barely hobble around with a cane, and still I didn't want take the chance of trading mobility for cognitive. So you might imagine how happy I was when I found a way to not have to do that.
During the surgery I had the benefit of talking with the anesthesiologist who managed my care but had little do except stand by insofar as the spinal block wss created by an injection she had already made 15 minutes before I was wheeled in to surgery.. So for over a hour we had a chance to talk, during which she confirmed the fact that there is a real potential for POCD (post operative cognitive decline) when sedatives and anti-anxiety medications are added during the procedure, especially as people age and especially those that already have some degree of cognitive decline.

 

[Mailman]

@Goma
Sorry. I pressed post before I had a chance to finalize editing on the above. I meant to explain at the top that before my procedure I didn't know for sure whether sedatives and anti-anxiety medications were problematic but then at the bottom would talk about how that was confirmed during the surgery.
My anesthesiologist by the way is an MD with a PhD and is the supervisor of her department. She told me they do tens of thousands of cases each year, for all kinds of surgeries, using all kinds of methods and drug formulations. Clearly someone you can trust.
She differentiated between general and regional anesthesia, in my case being spinal (regional), by saying, and I remember this word for word since it was only 2 days ago, "spinal only affects part of the nervous system while general affects the entire nervous system" to which I added, "which includes the brain, right?", to which she replied matter of factly, "yes, which includes the brain".
So why did the first surgeon I consulted 'prefer' general over a more limited acting spinal block? Without adding on a sedative like propofol or anti-anxiety drug like valium or other benzodiazapine, all of which have the potential for POCD, the spinal block employs only one well known drug such as lidocaine or in my case bupivacaine due it's appropriate length of duration at full potency for the expected length of my procedure.
When I asked the first surgeon I consulted why he preferred general I couldn't get a straight answer. Fortunately I eventually found someone else who aligned with my priority, which was preserving at age 74, what cognitive function I still have left.

 

[Goma]

Until I'm recovered I won't know if the eyesight will improve but when I had my knee replacement I also had worsening eyesight.
I was on alot more medication for a longer period then as the recovery was much more difficult than the hip.

My eyesight did improve after the drugs were eliminated from my system, I'm hoping for the same outcome this time.

Regarding taking drugs....in this case risking COPD. I personally did take that chance because I wanted to alleviate anxiety and used the sedative to knock me out. The anaesthetic gave me low blood pressure and I wasn't discharged until it got to 103/75 thereabouts. Had to stay over 100. It took 3 days.

All drugs have side effects and there isn't a doctor on the planet that will tell you any drug or procedure is 100% guaranteed without risk to cover their own backs. Just depends on how much risk you want to take. The scariest part of surgery for me is the anaesthetic but unless it's life threatening I'll go under. I'm not mentally strong enough to stay awake...fear and all that ...

We all make choices for our bodies hopefully armed with the facts..good and bad.

Same as you, delayed the surgery but inevitably went ahead hoping to live pain free. What a blessing.

 

[Mailman]

@Goma
All drugs have side effects that's true and that's why I forego their benefits. The benefits never seem to be enough or to ignore the potential for harm. "Above all else, do no harm" and all that applies to. A drug that ignores potential for POCD is not worth spending time researching any further. But that is my fear. Each to their own.
I hear that during surgery it's both scary to be awake and also scary to not be awake and lose control. Lose lose. So this is a huge issue since anesthesia is involved in more and more surgeries even to the point of avoiding not only pain but even discomfort.
Fear of physical pain relates to the death of the body but mental distress applies to even more, the death of the self. I approached my surgery thinking briefly I might die and in fact they warn you if that before you get in the table. So we compensate rather than face what is a simple fact. I not only watched the live procedure over and over until I desensitized myself. As a fringe benefit I gained knowledge, which is power, power that can be modified, amplified, reused, given away or even monetized if that floats your boat.
After watching those videos I also took to revisit the Ken Kesy's 'Sometimes a Great Notion' in which a logger in the woods in Oregon has to cut his brothers trapped leg off with a chainsaw and carry him home to same him from drowning, or a generic civil war scene in which a medic must amputate in the field try to save a soldiers life.
So then compare the two. A joint replacement becomes a walk in the park.. not quite so scary at all.
It may still not be believable to some but once i got my mind right I actually enjoyed my surgery. I got high. And I actually questioned whether there was something inherent in the spinal injection to cause that. But a much more plausible explanation is that something is me.

 

[Goma]

Yes you're correct it is each to their own.
Fortunately people can make decisions regarding their health and the potential of medicines and procedures to improve their lives as we have done. Decades ago we would've all limped around and most likely ended up in wheelchairs.

You've had the forethought to prepare yourself for your surgery and I went in with blind faith.

Regarding the benefits of medicine....l took narcotics for weeks for pain relief eventhough I knew they were addictive and put me in a brain fade but I couldn't do it otherwise. As a female I'm on HRT , my debilitating symptoms are better , my life is better and I use it eventhough I have a higher risk of breast cancer. I'm aware.

Luckily we have choices that we can tailor to our physical and mental health.

 

[Hippie Chick]

I told my OS I did not want to know what was happening. When I read your title I was nervous it had not been planned so very relieved to hear it was. Glad you did well!

 

[Jaycey]

@Mailman Just checking to see how you are doing in your recovery. Is your pain management working? Are you icing and elevating? Hope all is going well!

 

[Mailman]

@Jaycey
Been elevating but stopped icing. Only minor bruising which has stopped spreading now and no noticeable swelling.

Days 1 and 2 were surreal in that I had no pain at all and was only taking 1000mg 3x per day since the 1 oxycodone in the recovery room. I only had the spinal block, so I was fully awake already when the surgery ended around 5 pm (Wednesday). I just sat there in bed enjoying my applesauce and cheese and crackers while the numbness dissipated from my lower body. I was just plain happy and looking forward to seeing my wife in the hospital room so I could tell her all about the procedure. About 10 pm I got out of bed for the first time and with the assistance of the nurse did about a 10 min walk around the hospital, climbed the two steps up and down in the hall no problem and was discharged next morning (Thursday) still completely pain-free. Then we headed home 2 hours, stopping every 45 minutes to get out and walk with a cane and also holding onto her to make sure that I didn't fall. Still no pain but I didn't want to overdo it so we only took a short walk each time. Like I said, the first 24 hours was surreal. Before the THR I could hardly get around the house, certainly without using a cane, and there I was, already able to walk normally unassisted, though of course I didn't take but a few cautious steps to prove that I really could: I might be crazy to do the surgery wide awake but I'm not an idiot.
Thursday night I still had no pain, but also no sleep at all. I was wired.
Friday morning was when you recommended that I don't stop taking the Tylenol, that I might hit the wall on day three which certainly turned out to be true.
By late afternoon I started getting anxious and irritated and had a little bit of discomfort in my hip but the real problem was my mental state. I was very agitated and uncharacteristically angry. I couldn't hold on to my thoughts. Cognitive decline was what I had been trying to avoid and now I had it, and on top of that I noticed that I was hallucinating.
I tried to reach my surgeons office but everyone had already left for the weekend. I was on my own until Monday.
You told me about the anesthesia cocktail that is inserted into the wound that can last up to 72 hours. So I was realized I was still drugged but they were beginning to wear off and I was reacting to that. I also remembered that I had been given about a dozen pills immediately before they injected the spinal block. I had felt so good because of all the drugs but now the price was to be paid.
When I realized all this was about the pills, I felt a little better and set about trying to identify what drugs might have been included in that cocktail by way of their symptoms. By using chatGPT I figured that it was probably an opioid, perhaps Demerol, and that when it started breaking down my kidneys weren't processing it effectively, probably because I hadn't been drinking enough water to the point of perhaps being dehydrated. So I started drinking bunches of water to flush whatever it was out of my system.
Last night I was finally able to sleep and woke up this morning (Saturday) feeling a whole lot better. We went out for breakfast and then did some errands. The pain is tolerable with 1000mg Tylenol 3x day. When I first rise from sitting the wound is burning, and tearing as if the bandage is slowly being pulled off or the sutures are being stretched, but that feeling dissipates slowly once I get moving. If I'm completely at rest then still no pain but if I move the leg in certain ways I have the same burning sensation. The joint itself seems to be rock solid and unaffected.
I'm glad that I took your advice and didn't stop the Tylenol completely just because I was feeling so good (and so drugged) at the time.
What really saved me though was what you told me about the cocktail.
I feel very fortunate to have your help!

 

[Jaycey]

We went out for breakfast and then did some errands.

Easy does it @Mailman . Sounds like a lot of activity for someone just out of major surgery. Read this article again Activity progression for THRs.

 

[Mailman]

@Jaycey
Now I'm into day 4.

What would be the warning signs that I'm doing too much? I don't have worsening bruising and I have little or no swelling. Pain at rest is non-existent and in motion is acceptable with Tylenol1000mg 3x daily. If I took less Tylenol I might be more inclined to be less active but why not do as much as I am able without ill effect?

 

[Jaycey]

Well, if you are not seeing increase in pain or fatigue - go for it. Just listen to that hip. Most people at this stage have no energy to do much of anything. Your recovery is quite remarkable!

 

[Mailman]

I have thought a great deal about pain over the last almost 5 years since my hip first started to give out. Was it the musculature or the joint? Or both? I decided or more likely just hoped it was the musculature and set to work on that. Posture, gait, waking up muscles that were asleep and not pulling their weight, not functioning efficiently with the others. I got rid of the type of pain that would keep me up at night. I figured that might have nothing to do with the joint since there was no pressure on it when I was asleep. The pain that was left was only the sharp pain that came when walking and it soon got worse when nothing else was compensating for the joint, when everything was no longer all wonky. The joint was now all alone center stage. Then as of now after the surgery I don't have any of that muscle pain. All I have is the pain from the wound and maybe some from the bone that has been traumatized but no longer pressure on the joint from no cartilige. The surgeon said that in my case the arthritis was extremely severe even though I was still able to use it until about 2 months ago. I think maybe that is why I am making a quick recovery. I already dealt with a large part of the problem before THR.