My mother's knee replacement surgery will be on October 21. While her pain is so severe that i wish it could be tomorrow, I know I need the two weeks I have to get everything done and organized.
The Orthopedic Surgeon's Office
Our surgeon's office staff is very well organized. The lady that helped us determined the day for surgery also set up other appointments and gave us a list of what to bring to pre-op. She set up an appointment with the doctor's PA for a last minute physical and to go over mom's medical history. Then she called back, after talking to the hospital ,with our pre-op and surgery times.
When your loved one is facing surgery of any kind, there are some things you'll need to prepare for. I've put together our checklist for this coming week.
Checklist - Surgery Minus Two Weeks
1) Legal Paperwork and a Medical History Every person you deal with, from receptionist at the x-ray clinic to the floor nurse in the hospital, will ask you the same questions. I don't care how many forms you fill out, no one reads them. They just ask you to explain it all again. So now is the time to get all that material together. Look at the side bar for the category "Before Caregiving is Needed." In the two posts, "Before Your Parents Need Help" and "A Personal Medical History," i cover the different legal documents you should have for everyone in the family. When you get to the hospital, they are sure to ask if you have a Living Will (also called a medical surrogate, medical power of attorney, and a directive to physician). If you have one, be sure to have it with you. In our area, some lawyer's offices are now offering free wills in a package including living will and power of attorney. Check around to see if there are any similar offers in your town. The personal medical history, with the example I have in the Pages section of the side bar, will be vitally important as surgery approaches. Now is the time to ask your patient all the pertinent information, such as when they last had a tetanus shot, and what surgeries they have had. The day of the surgery is not the time to ask an anxious elder if they had chicken pox as a child. Most important important for surgery is allergies and medications. My mother is allergic to penicillin and latex. That affects what gloves the nurses and doctors use. And a list of the patient's medication is crucial in anesthesia and recovery. Once you have the history written, you will be able to cut down on the forms you fill out and the multitude of repetitive questions. (It's so much easier just to write "see attached form" rater than fill out long pages. Be sure to take one copy with you when you visit your primary doctor so you can discuss medications (see item 2 below) Then you'll need plenty of copies of the surgery version of the history with you for all your other medical meetings and on the day of surgery. Depending on your patient's condition, you may find that all the questions are directed at you, as their caregiver. And whenever someone gets ready to ask you questions, hand them a copy to find the info themselves while you concentrate on your loved one. 2)
Medical Clearance from Your Primary Doctor
Since this surgery has been a future possibility for a couple months now for us, mom's doctor ordered her chest x-ray over a month ago. At her last visit, 2 weeks ago, he did an EKG and general physical, and ordered lab tests. As her primary doctor, he has to fax the results of the tests to the surgeon along with his clearance that she is physically well enough for the surgery.
If you haven't gotten some of these taken care of ahead, make an appointment immediately. Be sure to tell the scheduling person that you have a date for surgery and you need the patient to be seen as soon as possible, preferably by a specific date. This date will need to be AT LEAST 10 days before surgery to get all the testing done. To save time, have the primary doctor write the orders for the tests with a request that the results be send to him, as the prescribing doctor, AND directly to the surgeon.
At our hospital, the requirement is that blood work must be done within 7 days of surgery, so check with your surgeon on this. Also check to see if your patient must be fasting for the tests. If so, go early in the morning.
Remember, you will need time for the chest x-ray results to be sent back to your doctor. If your doctor doesn't do an EKG in their office, you will have to arrange for this as well. You may have to call around to find a diagnostic center that can do a chest x-ray on short notice. Many won't have an immediate appointment. If you have trouble, ask your doctor or surgeon office staff to help you. Sometimes, a doctor can order the tests to be done at the hospital where the surgery will be done.
Medications--- While you are with your primary care doctor, have your history handy. Go over your medication list. Be sure to include any over the counter medicines, herbals, or supplements you take as well. Discuss what medications, like blood thinners, that must be stopped a week or more in advance of surgery. Other medications, like some oral diabetes medications, might have to be stopped a day or two before the surgery and not resumed until a day or two after. Depending on the time of day of the surgery and how long your patient will be fasting, some medicines should be taken with a sip of water so many hours in advance, like blood pressure medicine.
Have your doctor give you specific directions for each medication and write them down on the medical history so you won't forget them. When you get home, make a duplicate computer file of your patient's medical history. I usually use the same name as the original file with "surgery" and the date at the end so I still have the original for later. Don't delete any medication, just make the notations on each one that your doctor altered in some way, and make multiple copies of the new document. This will tell your surgeon and the hospital staff what you ordinarily take and when you had it last.
(Note: in my information on Personal Medical Histories, I suggest that you do not use personal information, such as SS number and insurance information because you don't want to be carrying that kind of information around with you all the time in these days of identity theft. But this is one time to break that rule. The more information on the history, the less you will be asked. You're the caregiver and your responsibility is your patient, not to answer to the nurse or three doctors what you already answered in admissions, simply because they will not read the hospital file in front of them.)
3) Insurance coverage
As a caregiver, you should already be aware what your patient's insurance covers and what it doesn't. If not, this is the time to check. Depending on the company, some require advance notice on any hospitalization. Others may require a second option. If this is true, you need to know as soon as possible to get an appointment. Your doctor's office can probably help you get a consultation faster than you can call a new doctor cold and get an appointment.
Also find out what you will need for a co-pay if any. Normally, this amount will be collected at your pre-op evaluation so you need to be prepared with either cash, checkbook or credit card.
Mom's surgery will require some time in rehab for physical therapy. She has Medicare and they will pay up to three weeks. Still, I need to call and reconfirm a number of things. What exactly they will pay for and, maybe more important, what will they not cover so I know what to say no to unless I learn the cost to us? What is the number of days of care that are covered? Is there a minimum number of days she must be in the hospital before she can be moved? How do we move her? Will Medicare pay for an ambulance or will I need to transport her myself? What will her secondary insurance pay for and for how long?
4) Rehabilitation facilities
Our surgeon suggested that we get a list of rehab facilities in the area and go check them out. He will release her to which ever one we want. Tomorrow, I will contact the physical therapist I went to after my hand surgery, and get some pointers as to what to look for, what questions to ask, etc. I'll do a post on rehab centers once I learn what to use as criteria for choosing a good one.
Also check with friends, neighbors, co-workers, anyone how has had to be in a rehab center to see if they were happy with their care. Sometimes it is just as important to learn what places to avoid as it is to find the perfect one.
Surgery Minus One Week will cover the final pre-operation appointments: The last meeting with the surgeon, labtests, and the hospital pre-op appointment including a list of what to bring with you.
Until next time, Take Care of Yourself and the Ones You Love.....
Kathy
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