Well, mom is in Week Three of rehab and I'm learning all kinds of things that I wish I had known near the beginning of this saga.
Questions to ask your doctor before surgery........
1) Would exercising before surgery help or harm the patient?
in January, a neighbor of ours, Kay, is going to have both knees replaced...at the same time. Her doctor is having her do exercises now (mid-November) to strengthen the muscles around the knees and help her recover more easily.
This wouldn't have helped my mom but it will be something for me to remember when it comes time to have my knee done in the spring.
2) Diet before and after surgery.
Kay's doctor also said for her to eat well, lots of carbs, before the surgery. She might gain a few pounds but she will most likely be losing weight right after the surgery because most people don't want to eat much for the first week or so.
For us, mom has lost 6 lbs in 3 weeks, but the doctor is keeping track and in case she loses too much or too fast and he has to intervene. He told me today that the state law (Florida) is so strict that if the nurses notice a dramatic weight loss, they will "...pick at me until I do something about it." LOL
3) Diet and Blood Thinner
Many doctors start patients on blood thinners, like coumadin (warfarin), at the time of the surgery to help prevent clots. The prescription may last into rehab or after the patient returns home. You need to be aware of this medication, whether the patient comes home or is in rehab and you are bringing in food from outside. According to an article from the Mayo Clinic, (http://www.mayoclinic.com/health/warfarin/AN00455) new research says you do not have to avoid all foods with Vitamin K, but you should not go over the recommended dosage (120 mcg per day for adult me, 90 mcg for women), The best choice is to stay consistent with what you ate before taking the drug. Vitamin K foods include soybean and canola oils, spinach or broccoli, garlic and licorice.
Beverages on the other hand seem to contain more vitamin K so you should avoid taking Coumadin with cranberry juice, alcohol, or other drinks high in vitamin K, like green tea. Ask the doctor is your patient is taking a blood thinner, how long they will need it, and if there are any dietary restrictions. My "second hand knowledge" is that it is dangerous, even possibly fatal, to mix Vitamin K and certain drugs, so be sure you know what your loved one is taking.
Drug interactions and symptoms to watch for are in another Mayo clinic article. Warfarin Side Effects. http://www.mayoclinic.com/health/warfarin-side-effects/HB00101
4) Blood Loss and Iron Supplements
Many patients are told to start iron tablets before surgery to help build up their blood because this particular surgery is noted for the loss of more blood than some other surgeries. My mother is small (101 lbs) and frail. Instead of just iron pills for the first two weeks, she had to have a transfusion on day 3 after surgery.
In the hospital, the doctors often prescribe medications that you don't notice, so before you go home with the patient, be sure you ask specific questions on ALL the medication they need in addition to what they normally take, like the iron pills, because you may not get a prescription for an iron supplement and it might not get mentioned in your short visits with the doctors...or in our case, I wasn't there and mom's hard of hearing and missed what the doctor told her.
And know if anything is being substituted for a regular medication. You will want to know what the new one is, what it is replacing, and when you switch back to the old one.
Conclusion -
It all comes down to being a well informed patient or caregiver. And be sure to adjust your patient's Personal Medical History (see sidebar) so you will have everything about any new or temporary medications and details of the surgery for future appointments or complications. Be sure to include the doctor and their contact information, the date and place of surgery, etc.
A note about older patients with knee replacement surgery....
Don't let your patient compare their progress with that of other patients. As we know, all surgeries are different. Whether it is the age or the patient, their physical condition before the surgery, or just differences in endurance and pain level, everyone recovers at a different rate. I was catching my mother fussing that this other woman doing so much better than she was. The therapist finally explained to me that the woman mom was comparing herself to was only 61, 25 years younger than mom's 86. Of course she was recovering more quickly. Be sure your patient celebrated each of their personal milestones and not be concerned with what others can or cannot do.
Take care of your patient and yourself....
Kathy
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