Expecting the Unexpected

It's Friday night.  Surgery is Monday afternoon.  The phone rings at 8 pm.  Be at the hospital Monday morning at 7 a.m.  The doctor has moved your surgery up to #2 in the queue.

Rats!

TKR minus 4

Yesterday afternoon, Bill and I went to my final pre-op appointment with the surgeon.  After waiting the obligatory hour, we visited with Dr. Kerina.  He went over all the things that can go wrong, including, but not limited to, death. Most of the other possible, but not likely, outcomes were not so dire.  Not being a pessimist, however, I'm expecting it to go fine, while still expecting the unexpected.  He said the surgery itself (his part) should be 35 minutes or so, but 1 1/2 or 1 3/4 hours all-told.

We are to be at the hospital at 11 a.m.  Surgery is to be at 1 p.m.

Joint Registries

I found the below information posted on a bulletin board.  I learned in the seminars I went to that Sweden and Australia require a registry of every knee operation done by every doctor including the brand and type of device that was implanted and the results, including revisions.  This post includes the links to the two registries.  While I have looked through these, this is the kind of research that takes a lot of time, and since I have already chosen my doctor, and by virtue of that choice, his preferences, or contractual agreements or whatever arrangement exists between physician and implant manufacturer, my new knee is already determined.  So, I have not sorted through this.  But, I am a firm believer that this country should have a registry as well.  What better way to track the success or lack thereof, of these various devices and implants, not to mention the ability of the physicians?

This is a quote:


"I posted this on the total knee board, but as the registries also include unicompartmental results, I thought I would duplicate it in here. Some of the prosthesis in these countries are not sold here, and vice versa.
Following a previous post, a number of people have asked me to post the links to the Swedish and Australian Joint Registries. Hopefully the mods will make this a sticky. 
In Sweden and Australia, it is a legal requirement that every operation and knee is recorded. The UK also has a registry, but suppying information is voluntary (20% of cases go unreported, you can make your own mind up why some might not be reported)

Every company likes to tout figures on their success, normally studies by surgeons who are friendly to them, however, the registries include every single surgeon using the device, good, bad, or indifferent. They include tens of thousands of operations so will help nullify unusual events.
Its incredible to see that some knees that are commonly used in the UK have more than double the failure rate of others, must cost thousands in recovery costs.
Anyway the reports are below, 

The Swedish Joint Registry 
  http://www.knee.nko.se/english/online/uploadedFiles/113_SVK2009ENGL1.0.pdf
Gives results to 10 years, total knees are page 30-33 (or 34- 37 in acrobat). There are also some easy to understand graphs
Uni knees are page 34 (38 in acrobat)

Australian Joint registry
http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2009.pdf
Total Knee results to 8 years are on page 145 (161 in acrobat)
They have a list of knees to avoid on page151 (167)
Uni Knees are on page 123 (139 in acrobat)"


Australian Orthopedic Registry

The Swedish Knee Arthroplasty Register

Pain is Your Body Telling you Not To Do Something

This is a saying I have always sort of believed in.   I considered twinges of pain, or more severe pain, as a sign to stop doing what I was doing.  It would seem that philosophy is being summarily thrown out the window.

Nurse Cindy said yesterday that the good news is that this pain is "operational" pain as opposed to arthritic pain, difference being that arthritic pain is continuous, while operative pain gets better every day, so you have that daily improvement to look forward too......except for the occasional step backward.

I hate the exceptions.

Orientation

Today I had an appointment at the hospital for an orientation.  As it happens, I was the only person present for the seminar, which was given by Cindy, an RN.  She originally had 3 patients scheduled, but two had their surgeries cancelled/rescheduled.  There was also a PT student observing.  We met in a classroom, and she went through the entire hospital stay from the time you walk into the door to the time you go home.  I was able to ask questions as we went along, and the experience was very enlightening.   For instance:

A femoral drip is an option.  It is a one-time injection that lasts from 24 - 48 hours and numbs the operated leg, which sounds pretty good to me.  The alternative to the Femoral is not to have it.  It works in conjunction the the PCA (patient controlled analgesic), which is a narcotic.  With the femoral, they have found that patients require less of the PCA pain reliever than would a patient who chose not to have the femoral.  The only down side is that it may make the muscle lazy so that it will not hold you up when you stand or walk.  The PT tests for this, and provides a supportive brace if it is necessary.  This is something I will consider and will discuss with the surgeon on Thursday.

General anesthesia or nerve block?  I always thought I would prefer not being put to sleep with a tube down my throat, that a nerve block and medication to put me in la la land would be adequate.  But, when I asked why one vs. the other, she said the operation is loud (read:  electric saws and drills!) and some patients would prefer not to hear those noises.   I'll have to give this some more thought.

Foley catheter:  apparently this is normally done, but this is a subject I will discuss with the surgeon during Thursday's appointment.  It is inserted into the bladder once you are under the anesthesia, and remains in place until the 2nd day after surgery.

The surgery is 1 1/2 to 2 hours, longer than I thought.

I was provided with "THE BOOK" during my first appointment, and I have found it very helpful.  I have been doing the pre-op exercises, and the book offers other useful information to help in the planning process.

Then, a Physical Therapist came in and filled me in on exactly what to expect from the PTs after surgery.  I'm not sure they will be my favorite people; they are very demanding, but it's the PT that will make or break this surgery, so bring it on!

Being a visual person, I asked Cindy if I could see the Ortho Ward, so we took a field trip through the hospital, where I saw the intake area, waiting room, and then up to the ortho floor.   There are some private rooms available (one of which I have requested), and I walked through one.  They have converted semi-private to private, so they are fairly good size.

As for the walker, cane, etc., these items are ordered before you leave the hospital, along with the in-home PT and nurse.  The doctor recommends a provider for these services, but you don't necessarily have to use the one he recommends.  I am on Medicare and have a United Healthcare supplement.  It is my understanding that all of these services are covered, but the hospital has an account/insurance person available if I have any questions.  I will be assigned a Case Manager on intake, and that person will follow my progress.

I had decided early on that I wanted the surgery early in the week.  I would prefer not to be in the hospital (any hospital) on a weekend when 1) my doctor may not be there; and 2) when the hospital my be shorter staffed than during a weekday; hence operation Monday, go home Thursday.....if all goes according to plan.

Preparations (1)

I was told that the hospital experience includes providing you with the necessary "implements" to make it through the recovery period.  However, who pays for that goes through my mind, so I paid a visit to the local charity resale store and picked up a walker for $2.  I was looking for a toilet seat "booster" or whatever you want to call it, but didn't find one of them.  Now, if I could just find a reacher......

"When it Comes to Severe Pain, Doctors Still Have Much to Learn."

Jane Brody, who writes for the New York Times, has a column that runs on Tuesdays in the Science Times section. In 2005, at 63 years of age, she had both her knees replaced, and subsequently wrote about her experiences dealing with the pain, and the lack of pain medication provided by her doctors. I remember reading these articles at the time, and wondering how anyone as well-prepared, knowledgeable, and well connected as she must be within both the medical field and the newspaper/publishing industry, could have had the experience she did. How could she NOT have been able to find the relief she needed, and if someone in her position can't do it, how can any old (or young) ordinary person? Of course, that was 2005, and the entire process has come a long way since then, including pain relief.....I hope. All conversations and indications I have from the various doctors/seminars I have attended have indicated that the medical field now understands that the only way for a patient to be able to get the best outcome, is to be able to tolerate the pain during rehab, and the only way for that to happen is with the proper medications. At least, I hope this is the case. Here are the articles; they are worth reading.

A New Set of Knees Comes at a Price

When it Comes to Severe Pain, Doctors Still Have Much to Learn

Three Years Later: Knees Made for Dancing