12 June 2009

Impatient Information - What the Nurse Said

This is the basics of what I was told about THR at the 2 hour Patient Information Session on Joint Replacement (Hips and Knees) last week. There is a ton of info, so I'll break this into several posts. Keep in mind that this is what is done at Canberra Hospital (see the piccie? That's where I'll be!). This may give you some idea of what to expect for your THR, if you're in the same boat as me, but obviously each country, hospital and surgeon has their own way of doing things.

Hubby came along with me. As expected, I was one of the youngest at the info session - 3rd youngest out of about 20 patients. There was a young girl who looked like she might have rheumatoid arthritis, poor thing, and a man in his 30s with a degenerative joint disease. Everyone else was roughly aged 65-85, at a guess. No-one else had CDH, no surprises there!

The Nurse - Hanna

Some days before surgery there will be a Pre-Admission Clinic, where I'll meet with the nurses, anaesthetist and surgical registrar etc. Blood tests, urine tests, ECG, yet more hip x-rays, and other baseline observations will be made. This is my chance to tell them I have PTSD associated with my childhood surgeries, and that I'll need some help when coming in for surgery (knock me out, please!). More on PTSD later (another post).

The general plan is to come in to hospital on the morning of surgery (not the night before, which is what I've always experienced before). Nil by mouth from midnight, of course. Go to Admission, then into the glamorous "Theatre Gear", and into a Holding Bay until it's my turn off the rank.

I'm actually feeling very anxious about this, it is triggering a lot of my PTSD stuff. I will be sobbing with fear the whole time ... it upsets me even just thinking about it. I really wanted to be sedated in my room beforehand, and oblivious when leaving for the operating theatre. I may be able to change this, I'll discuss it at the pre-admission clinic.

After the operation, it's off to the Recovery Unit, and then Ward 11B, which is for joint replacements only, so all the nurses are very experienced. I'll have a urinary catheter in (put in during surgery), a drain in the wound, and a Charnley Pillow between my legs.

I'll have PCA (Patient Controlled Analgesia) with delicious morphine or fentanyl. You press the button, and you get the nice happy drugs! It's not possible to overdose, as it can only deliver one dose in 5 minutes, no matter how feverishly one presses the button!

There will be either a femoral nerve block in, or an epidural. I really would prefer the femoral nerve block, don't want people mucking around with my spine! Still, don't suppose I'll have much, if any, say. Either of these would be in for about 48 hours, and will numb my leg/s, but I'll still be able to move them.

I'll also be attached to an Alaris pump (IV) and have a canula in my arm, to give fluids and prophylactic antibiotics. This, the catheter, and the wound drain will probably be in for about 48 hours.

On return to the ward, the nurses will check my dressing, make sure I can move my toes, and take my "vitals" (blood pressure, pulse, temp etc) every 30 minutes for the first 2 hours, then hourly for a while, then every 4 hours, tapering down over the days. They'll also give me a bed bath to try to help remove some of the almost indelible bright pink antiseptic paint Canberra orthopedic surgeons favour of late!

Hanna advised wearing nighties (for the women!) for the first few days - it's not really possible to wear PJ pants or undies, with all the tubes and stuff. Dignity goes out the window with this sort of surgery, that much is a given!

There will be 'pressure area care', where I get rolled around in the bed (wheeeee!) to avoid pressure sores. Carefully and slowly, one hopes!

Once the pain machines are taken away from me (why?! WHY?!), the Acute Pain Team (great name, hey?) will come around to see me. They make the decisions about pain control, check me daily, and can prescribe whatever I need. One thing Hanna stressed was to KEEP ON TOP OF YOUR PAIN MEDS. Don't let them wear off before asking for more. This ensures you'll be covered when your physio sessions happen (which are on short notice), as well as helping recovery in general.

Some of the oral pain meds on offer are :
  • Endone (narcotic)
  • MS Contin
  • Good old Panadol - which can enhance the effects of narcotics, and is very effective for bone pain
  • Meds for nausea, if needed
Another tip about pain relief is that the nurses will give regular meds, but if they're not cutting it, and you're still in pain, you need to ask for the strong stuff. Hanna really emphasised how important it is to let them know.

There is a high risk of Deep Vein Thrombosis (DVT) after joint replacement surgery, so there are several things that will happen :
  1. Early mobilisation - ankle & foot exercises right away, and up and walking, even just a little, by the day after surgery
  2. Clexane injections (anticoagulant)
  3. TED stockings (possibly)
I will be on Clexane for a month after surgery. It's an anticoagulant medicine, which helps avoid DVT, as mentioned. It's given by injection, and we have to learn to inject ourselves at home. We were given a CD with a video on how to do this, plus we'll be shown in the ward. Oh joy.

Here's your Petal piccie. She's reading a card sent to her by a friend in the States. One clever puppy, no?


  1. Heya lovely lady.
    Well, it's only for the tough hey?!
    How soon is all of this?
    Shall write on Rav.
    Big hugs. Yay for hips ; )

  2. you are sounding very brave.
    sobbing is definitely allowed.
    also, yay for puppies.

  3. Will Petal be able to come to hospital to see you?
    : )))

    Lots of pain meds - they're going to help a lot.

    Yes, sobbing is allowed and you do sound very brave.

    I am sure your blogging info will be invaluable to those who are going through same thing as you.

  4. You might want to print all this information off in large type and color-code with highlighters so when you are doped to the eybrows and trying to remember how long you have to have those tubes, you can look it up for yourself.

    If you explain that you will be shrieking hysterically and trying to get out of bed and leave, I think they will be happy to sedate you unconscious. They may even be willing to give you medication for the week before as well. My doc gave me tranquilizers for the night before my hysterectomy so I wouldn't stay awake fretting.

  5. I'm finding all this very interesting, thanks for posting it. It sounds like your team is very experienced and compassionate, which is about the best combination you can ever have, which I hope is comforting you.

    If I may make a suggestion or two...

    -Explain to them about your anxiety, past experiences, and PTSD. Ask for medication for it. Once it's over, you can go back to the stiff upper lip, but during major surgery, you're proving you're tough just by doing it, so ask.

    -That said, try different meds. After ten years of chronic pain myself, I am boggling over finally finding a medication that doesn't make me sick. They really are variants, and they really do have different effects. If one isn't working much, try another. Even if it's the same strength, it may have a slightly different effect and work better.

    -Otherwise, well, take lots of knitting. But you knew that. :)

  6. Hi,
    I'm from Hip Women (luluhalls) and I also have a blog like yours that went into detail my THR that I had last week. It was pertrifying the weeks before...but once I got to the hospital, I felt a sense of peace and acceptance that this was going to happen. You will be given a "cocktail" to help ease you anxiety. I chose regional anesthesia....so I was awake, but now really aware. It's the best way to go...take my advice! Just be prepared to have numb legs for 3-4 hours afterwards. If you don't know this in advance, that is scary! When is your THR? Don't be scared....it's really not as bad as you think once it's over! It's all the fear before that is the worst.

  7. We are very big on pain management here at the present time. It's a huge hospital initiative. The idea is to build a wall of medicine around the pain. Don't be brave. Ask for the good stuff!

  8. Petal is obviously advanced and so intelligent!! She's really reading!!
    Last year I told the doctors I was petrified of my operation and they put me too sleep as soon as I was in the pre surgery room. How lovely. I agree about the pain medication: lots of it and often!! Sounds like they have an excellent programme running: you'll be in good hands!!

  9. Nisi, I can't help but think you're psyching yourself up to a state of stress before the surgery.

    You're older and able to voice your complaints now, something you couldn't have done as a child. You know what is going to happen, and you can ask for drugs this time and you're not ignorant. The power and knowledge are on your side. Things have come a long way since your last stint in a theatre, and I'm sure your nurse and anesthetist will make you life very comfortable for you.

    I'm sending lots of hugs, good vibes and positive thoughts your way.

    It's all going to be A-OK, and you may even be able to face down some of those nasty PSTD demons. Just don't dwell too much on it. The more optimistic your mood, the quicker you'll recover.

    And then there's your adorable Petal to come home to. And there's a happy thought.

    Lots and lots of hugs.

  10. I HIGHLY recommend finding a hypnosis CD or tape to help you deal with the PTSD and relaxation. If you can't, I will record you one. I have lots of hypnosis scripts to help with relaxation. You'll just have to listen to my American speaking voice. See if anywhere they do EMDR for trauma. That will also help. Consult your local therapist. :D

    Honestly, I too have some PTSD stuff from surgery, BUT, I've had some surgeries since and they have not been as scary. AND the anesthesiologist gave me some SWEET drugs before the surgery started. My nerves and BP dropped immediately. Damn I felt good.

  11. Well, you are a writer after all so who would not expect a clear and concise description of what you will be going through. You have held together very well for 40years and not being like the older folks you saw your age will sure help you heal.
    We are here in spirit since many are so far away.
    Petal is such a doll and will be great comfort for you when you come home from the hospital.

  12. I am wishing you a much better surgical experience than you had as a child! Good luck!

  13. Having recently had urgent surgery at the THC I can vouch for the quality of their surgical care. The anesthesiologist and surgical team were ABSOLUTELY fantastic. I was awake for the whole thing and they were very very careful, caring and kind.

  14. Having said that - the food was bloody awful! Make sure you have people lined up to deliver care packages, and take a stash of snacks!!!

  15. It sounds like a horror story but then I can only think thank goodness for modern medicine, and for living in Australia, and for our Medicare system, flawed though it is. Still wishing you the very very best. Loani


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