Scantlings

I thought I would start a new thread on this.

Ish wrote:

LarryHoward wrote:I found mid December the best time for a knee replacement. A 'scope just needs a 2 week break from long walks and stairs and another 2 weeks of being careful. If your situation warrants, look into a partial replacement. Outpatient procedure. A couple of weeks of rougher rehab and another 6-8 weeks of increasing mobility. Do it mid December. Be back to work for year end stuff and 100% by launch date.

Ish. I know there is a lot of good in NHC but can't get my thoughts around a significant waiting list for covered surgery. My partial replacement was 2 weeks from when we decided it was time and a week of that was getting a cardio work up and surgical clearance since it had been too long since I had had my heart checked (determined to be hard and cold but pumping fine).

It's one of the things that I'm willing to put up with, communist canuck that I am. If it's the same for everyone, based on need, then there's a level table. I'm going to respect Rob's request to not get involved in political discussion.

I just got scheduled for July 6th for a total knee replacement. This past winter my knee declined to the point where walking and getting out of bed have been painful. I had to wait about 2 1/2 months for an appointment with the surgeon I want. I saw him last week and was favorably impressed. I'm starting a series of hyaluronic acid injections which may provide some pain relief. It's a viscous substance that acts as a lubricant; it won't grow new cartilage.

I've got some worries about it, but I really need to get it done. Winter would have been a good time to have it done, but summer is OK too.

I'd be interested to hear more from folks who have had or are contemplating this.

Always bear in mind that the only time surgery is minor or routine is when it's done to someone else.

Rob McAlpine wrote:Always bear in mind that the only time surgery is minor or routine is when it's done to someone else.

Well said, but general anesthesia scares me more.

After a "classic boot-top compound tib/fib fracture" while night skiing, I had several surgeries, including a bone graft, to get that leg functional again. 30 years later, it's catching up with me. Last year it wasn't so bad, but this year it's bone-on-bone grinding and my knee hurts like hell. My surgeon prescribed a knee brace to get me through until surgery, which could be anything from 2-8 months from now. The brace works but it's a pain in the ass. Surgery really doesn't bother me that much, and I have a high pain threshold so I don't need a lot of painkillers after the fact.
I'm looking forward to being pain-free when this is over, but I'm not looking forward to the recovery process. All for the good, I guess.
Bull, just tell me the pleasant parts, OK?

Gentlemen: I have three pieces of recovery advice for you knee replacement patients:

Do the PT

Do the PT

Do the PT

Your welcome.

kimbottles wrote:Gentlemen: I have three pieces of recovery advice for you knee replacement patients:

Do the PT

Do the PT

Do the PT

Your welcome.

Easy for a cyclist to say. How many have you replaced? Hopefully less than three.

OK. Three "scopes" of my right knee for various running/sailing related insults and wear and tear. Blown up like a basketball 3-4 times from various things someone my age shouldn't have been doing but gave Lynne moments of great mirth watching me go down. No healthy cartilage remaining so 1.5 years ago evaluated for replacement and decided a "partial" was a good approach as my surgeon wants to hold off until I'm 65 for a full replacement if possible.

As Kim says, PT, PT and then more PT. Yeah, it will hurt a bit to push anyway. Take a pill 20 minutes before if you need it. My cutter had the gas passer put in a significant nerve block for the leg as well as the spinal so I was walking with a brace and a walker in the recovery room/ward. I went to work the next day (Lynne was not amused when she found out). Worst pain was 2 days after surgery when the block wore off and the heavy PT and going immediately back to work got back at me and I saw a significant but temporary reduction in range of motion due to swelling.

Find a PT you like and do the work. It will pay off. Only surprise was a loss of feeling in the skin around the knee. Doc said it's pretty common as nerves to the skin get severed during surgery. Eventually it came back. Only lasting effect from the partial replacement was that it still hurts to kneel on a hard surface.

One sister and my mom had full replacements of both knees in the same session. As I recall, recovery from that was a bitch but both would do it again. My mom was a pain wimp and told me that she should have had her knees done years earlier. Common statement from all I know who had full replacements.

Eric. 6 generals and one spinal since 2003. 4 for knees and 3 for other things. I seem to tolerate it well.

LarryHoward wrote:
Eric. 6 generals and one spinal since 2003. 4 for knees and 3 for other things. I seem to tolerate it well.

...and may you continue to! The risk is a little like that of commercial air travel: Kind of all or nothing-ish.

Ish wrote:

kimbottles wrote:Gentlemen: I have three pieces of recovery advice for you knee replacement patients:

Do the PT

Do the PT

Do the PT

Your welcome.

Easy for a cyclist to say. How many have you replaced? Hopefully less than three.

I base my advice on my son's and my business partner's experience with knee work.

As a cyclist I did not pound my knees too much so hopefully I will not have to follow my own advice. However rehab of a knee uses lots of cycling, so I might be able to stand it OK. I already have lots of bicycles including several of the stationary variety.

Orestes Munn wrote:

LarryHoward wrote:
Eric. 6 generals and one spinal since 2003. 4 for knees and 3 for other things. I seem to tolerate it well.

...and may you continue to! The risk is a little like that of commercial air travel: Kind of all or nothing-ish.

Thanks. I'll try to put that out of my mind the next time the pretty nurse says "now relax and breathe deeply."

LarryHoward wrote:

Orestes Munn wrote:

LarryHoward wrote:
Eric. 6 generals and one spinal since 2003. 4 for knees and 3 for other things. I seem to tolerate it well.

...and may you continue to! The risk is a little like that of commercial air travel: Kind of all or nothing-ish.

Thanks. I'll try to put that out of my mind the next time the pretty nurse says "now relax and breathe deeply."

Just before they put me under to do my neck at the old Walter Reed, the neuroanesthesiologist--evidently a blue suiter--said, "we're going to give you an Air Force experience." I never did figure out WTF he meant, but I did wake up moving everything. You never know what you're going to get at a MTF.

My knee problem started in 1988. I was playing soccer in local league, and tore my ACL. I had a reconstruction, did the PT like a mad-man, and was playing again in 6 months. I'have been continued to play, but had to stop in March, because of what Ish so well described, "bone-on-bone grinding and my knee hurts like hell." I'm hoping this series of hyaluronic acid injection helps. Although the lady who gave me the first one said that I won't really notice anything until several days after the third one, my feels marginally better.

The two weeks following the ACL reconstruction were a nightmare. They used a general anesthesia at that time, lots of it, and I was hung-over for days. The pain management was morphine-based. I was never so fucked up in my life. I understand that they now use a spinal block for the surgery, which should help, and portable femoral nerve blocks afterwards.

Besides the pain and anesthesia, I worry about infection. I have heard a few horror stories first hand.

The surgeon I picked is with Duke University. He has a great reputation. I have corresponded with one of his recent patients. I'll do the PT at Duke. Kim is right about the PT. If you don't do it, you are wasting the surgery.

One of my exercise activities is rowing, and it doesn't bother my knee at all. In fact, it feels better afterwards.

The real bummer is that I will probably only have the new H-Boat in the water for a month or so before the surgery. Phooey.

A friend of mine was an All-American lineman at Oklahoma, he starred on the 1971 team that still holds a lot of rushing records, then played 9 years in the NFL. Very smart guy, he owns an oil company here now.

He's had both knees and both hips replaced. He does at least an hour on an exercise bike at the YMCA every evening. He says he has no choice if he wants to keep the ability to walk.

yy

Bull City wrote:My knee problem started in 1988. I was playing soccer in local league, and tore my ACL. I had a reconstruction, did the PT like a mad-man, and was playing again in 6 months. I'have been continued to play, but had to stop in March, because of what Ish so well described, "bone-on-bone grinding and my knee hurts like hell." I'm hoping this series of hyaluronic acid injection helps. Although the lady who gave me the first one said that I won't really notice anything until several days after the third one, my feels marginally better.

The two weeks following the ACL reconstruction were a nightmare. They used a general anesthesia at that time, lots of it, and I was hung-over for days. The pain management was morphine-based. I was never so fucked up in my life. I understand that they now use a spinal block for the surgery, which should help, and portable femoral nerve blocks afterwards.

Besides the pain and anesthesia, I worry about infection. I have heard a few horror stories first hand.

The surgeon I picked is with Duke University. He has a great reputation. I have corresponded with one of his recent patients. I'll do the PT at Duke. Kim is right about the PT. If you don't do it, you are wasting the surgery.

One of my exercise activities is rowing, and it doesn't bother my knee at all. In fact, it feels better afterwards.

The real bummer is that I will probably only have the new H-Boat in the water for a month or so before the surgery. Phooey.

That is a bummer. It's why I picked December.

As to the infection possibilities, it's a worry but I'd bet Duke has better stats than most hospitals. I know my Doc put me on prophylactic antibiotics a few days before surgery as a precaution.

Summer here is usually beastly: too hot and humid to do anything except swim slowly. Even the surf is usually flat. I hope I'll be up and around enough to sail in 4 to 6 weeks. That's the plan.

The surgeon said that if the magic injections are really effective, I can postpone.

Post op infection stats are important in themselves and a general index of how well a surgeon and a clinic do their thing. Some surprisingly prestigious places don't do so well on measures like that.

Orestes Munn wrote:Post op infection stats are important in themselves and a general index of how well a surgeon and a clinic do their thing. Some surprisingly prestigious places don't do so well on measures like that.

How does a "normal" person get access to those stats? My brother-in-law had some real problems with infections following surgery at Stanford, my normal go-to-place, so I'm pondering how to measure equality in a field I know very little about.

BeauV wrote:

Orestes Munn wrote:Post op infection stats are important in themselves and a general index of how well a surgeon and a clinic do their thing. Some surprisingly prestigious places don't do so well on measures like that.

How does a "normal" person get access to those stats? My brother-in-law had some real problems with infections following surgery at Stanford, my normal go-to-place, so I'm pondering how to measure equality in a field I know very little about.

I don't even know how an abnormal person gets those data, but he first place I would check is CMS.gov because they collect the info and I suspect it's a matter of public record for any institution accepting federal funds. I have a crazy week coming up, but I will look at some point.

Thanks, OM. I'll go start hunting there.

Here's what you're looking for:

http://www.medicare.gov/hospitalcompare/search.html?AspxAutoDetectCookieSupport=1

Orestes Munn wrote:

LarryHoward wrote:

Orestes Munn wrote:

LarryHoward wrote:
Eric. 6 generals and one spinal since 2003. 4 for knees and 3 for other things. I seem to tolerate it well.

...and may you continue to! The risk is a little like that of commercial air travel: Kind of all or nothing-ish.

Thanks. I'll try to put that out of my mind the next time the pretty nurse says "now relax and breathe deeply."

Just before they put me under to do my neck at the old Walter Reed, the neuroanesthesiologist--evidently a blue suiter--said, "we're going to give you an Air Force experience." I never did figure out WTF he meant, but I did wake up moving everything. You never know what you're going to get at a MTF.

Maybe he meant "Off we go, into the wild blue yonder, climbing high, into the sun..."

Bull City wrote:

Orestes Munn wrote:

LarryHoward wrote:

Orestes Munn wrote:

LarryHoward wrote:
Eric. 6 generals and one spinal since 2003. 4 for knees and 3 for other things. I seem to tolerate it well.

...and may you continue to! The risk is a little like that of commercial air travel: Kind of all or nothing-ish.

Thanks. I'll try to put that out of my mind the next time the pretty nurse says "now relax and breathe deeply."

Just before they put me under to do my neck at the old Walter Reed, the neuroanesthesiologist--evidently a blue suiter--said, "we're going to give you an Air Force experience." I never did figure out WTF he meant, but I did wake up moving everything. You never know what you're going to get at a MTF.

Maybe he meant "Off we go, into the wild blue yonder, climbing high, into the sun..."

I do remember a bright light...

Orestes Munn wrote:

Bull City wrote:

Orestes Munn wrote:

LarryHoward wrote:

Orestes Munn wrote:

LarryHoward wrote:
Eric. 6 generals and one spinal since 2003. 4 for knees and 3 for other things. I seem to tolerate it well.

...and may you continue to! The risk is a little like that of commercial air travel: Kind of all or nothing-ish.

Thanks. I'll try to put that out of my mind the next time the pretty nurse says "now relax and breathe deeply."

Just before they put me under to do my neck at the old Walter Reed, the neuroanesthesiologist--evidently a blue suiter--said, "we're going to give you an Air Force experience." I never did figure out WTF he meant, but I did wake up moving everything. You never know what you're going to get at a MTF.

Maybe he meant "Off we go, into the wild blue yonder, climbing high, into the sun..."

I do remember a bright light...

There you go.

Orestes Munn wrote:Post op infection stats are important in themselves and a general index of how well a surgeon and a clinic do their thing. Some surprisingly prestigious places don't do so well on measures like that.

Yale-New Haven is probably the most prestigious hospital in Connecticut. I have no experience of it personally, but we've heard reports that it's not a restful place to be, especially with an "interesting" condition, because you get visited by a parade of visiting specialists, residents, medical students, all there to put you under their microscope (i.e. not to treat you). Infection control requires each and every one of them to obey the appropriate protocols.

OTOH, in small community hospital somewhere, you might have 1/3 of the number of people as potential infection vectors.

So you're saying that hospital patients have better survival outcomes than lab rats?

As I told my patients, it's not good to be in a teaching hospital with an interesting condition, but you should really worry if they ask you back for the exams.

Olaf Hart wrote:As I told my patients, it's not good to be in a teaching hospital with an interesting condition, but you should really worry if they ask you back for the exams.

True. We still had live patients for the neurology boards.

The "suffering index can be very high at big academic centers. The place where my parents got care was a disorganized, noisy, Hell.

Duke is a teaching hospital, but knee replacements are not interesting, so there shouldn't be many tourists. From experience, I can say that Duke has top-notch electronic medical record systems, and a very caring staff, from physicians to orderlies. AND... my niece and god-child is going to begin her nursing career there this summer.

My wife delivered our twins via a planned cesarean. She did ask the doctor about giving birth the usual way. His response was something along the lines of "Baby #1 is blocking the exit. You can go through 24+hours of labour and get nowhere ... or you can have a good sleep, and I can have a good sleep AND my morning coffee in a relaxed way, and then you'll have your babies ..."

Cecil B DeMille would have felt right at home. It was a cast of thousands in the delivery room. Twin births, while not particularly unusual ... 1 in 70 ish--NO, NOT THAT 'ISH'--JUST 'ish' ... (and I realize that the stats vary with mom's age) are still rare enough to attract interest from those early in their medical careers.

Oh, and once you have had twins--your chance of having them again? Something less than 1 in 12. I heard 1 in 4 at one point. Aaaaaaaack!

Tigger wrote:My wife delivered our twins via a planned cesarean. She did ask the doctor about giving birth the usual way. His response was something along the lines of "Baby #1 is blocking the exit. You can go through 24+hours of labour and get nowhere ... or you can have a good sleep, and I can have a good sleep AND my morning coffee in a relaxed way, and then you'll have your babies ..."

Cecil B DeMille would have felt right at home. It was a cast of thousands in the delivery room. Twin births, while not particularly unusual ... 1 in 70 ish--NO, NOT THAT 'ISH'--JUST 'ish' ... (and I realize that the stats vary with mom's age) are still rare enough to attract interest from those early in their medical careers.

Oh, and once you have had twins--your chance of having them again? Something less than 1 in 12. I heard 1 in 4 at one point. Aaaaaaaack!

Junior medical trainees, the good ones at least, are a bit like young dogs in the indiscriminateness and avidity of their curiosity and their total lack of squeamishness.