Beth Said:

Should I have a knee replacement? see details.?

We Answered:

The basis for the decision on knee replacement is on two factors - the anatomy of the knee and the level of existing function.
There are people with a lot of wear and tear on the cartilage who don't have problems with pain or mobility - though the anatomy would say they need surgery, their level of function is good and pain isn't a problem - no surgery necessary.
Get an opinion from an Orthopedic Surgeon, and a second opinion doesn't hurt either.
The important thing is to be an active participant in the rehab they give you after the knee replacement for the best outcome.
The question about the anxiety is a different matter. Lots of people do better with sedatives prior to surgery. But if the panic attacks are showing up in other parts of your life, you need to work with your Psychiatrist on getting it under control.

Larry Said:

What can I do to help ease my mom's surgery fears?

We Answered:

it's not true that they will only give her what she can handle, but in the same respect, if your mom couldn't handle it, either psychologically or medically, they would not do the surgery;; another thing is..she's in so much pain, or so much dysfuntion, that the alternative is surgery, or the pain & dysfunction will only get worse & prvide her with less than a productive life ahead of her;; she's chosing the right way...if she is worried, she or you need to express that to the phys until your mother feels comfortable...
I'm going to be very blunt here...it's surgery;; but the medical staff in every aspect will help her through this;; the first 3 days she will want to remove from memory, they are the worst, therapy will start the next day, up & walking (she MIGHT even be one of those lucky ones to have NO pain after surgery);; the first 3 wks are 'from hell', where she is learning the rights & wrongs of her actions, the good & bad pain;; she will be in the hospital 4-10days, then it will be determined by how much help she has & how she will respond, whether she is referred to a rehab center/nursing home (may stay there 10-14days), or they may just send her home;; doc can help you chose which is the best for your mom after she comes out of surgery...once she is home, the doc will set her up with homecare; pain level generally is about 4-7/10 those first few weeks;; by the 4th wk, she'll pretty much have down what she needs to do with this leg;; by the 5th wk, she's feeling better & like she has an actual life again, can start getting out;; by the 6th wk, she'll be back to 'normal', but the family will still be a little 'protective', & by the 8th wk she should be healed...when she is done with homecare, she most likely will be referred to outpatient PT..
she will be issued a walker in the hospital, she should have a straight cane to manage steps, & will be progressed to using the cane about the 4th wk;; a raised toilet seat makes things more comfortable for her @ home;; they have suction grips (drugstore or hardware shop) for the bathroom shower that are ideal for her managing getting in/out, but if you have a walk-in, even better;; a tub seat helps extensively with her ability to sustain the time for a shower without worry to the leg, & helps her independence;; & a detachable shower head...slip on shoes with soles & a back are the best footwear for her..if she's got tennis shoes, the drugstores sell elastic shoelaces so that she can just slide her foot into it rather than trying to reach the leg that is difficult to bend..all of these, of course, are optional, but help a great deal...what's mandatory for her is a flexible gel cold pack (she doesn't need the 'fancy wrap')..
she won't be able to vaccuum or sweep until it is healed...you also may want to cook extra meals @ your house & freeze them for her for @ least until the 4th wk..she'll need someone to shop, do errands, & get prescriptions, besides her follow up visits with her surgeon & PCP; may have orders to drive about the 6th wk, but dependent on if it's healed...this is general protocol, may have slightly different scenarios based on her actual results from surgery...
she should exercise the leg before the surgery to get the most strength out of it..people do MUCH better when the leg is stronger..& I know that can be difficult for her right now, but ask the doc for a list of them...there are two things she MUST follow through to help her with this..1st..her pain meds need to be efficient for her, they will not get rid of all the pain, but they should help her get to a tolerant level...she should take them AS PRESCRIBED if the pain level is 4/10 or above;;; the second,...she needs to NOT GUARD...try to use the leg like a normal leg & this is where the rehab is difficult;; hard to do when you've been already 'walking funny' because of the pain & instabiity before surgery, & the body has a natural way to protect, or substitute to 'take that pain away'...she CAN'T guard but it's not easy;; the assistive devices & the PT will help her learn this...
I know this is god awful long, but I hope this helps..your mom is gonna be just fine, & don't be nervous or overwhelmed..there is a host of people out here to help you, just ask the doc first...good luck, but your mom is gonna be flying around like a 20 y/o before ya know it..but she needs to be confident with her doc, then she'll be confident with herself;; & DON'T treat her like a baby..she's GOT to get up & move...to prevent blood clots (although the doc will take preventative measures)..& also because the knee LIKES to move...so, contact the doc again with any questions she has...& know there is help out there for both your mom & you!!! keep bending...keep walking!! & good luck, my heart is with ya..but, honestly, if she had a baby or a few, this is cake....& less time 'raising', too...

Charlie Said:

Too young for knee replacement?

We Answered:

That's a rough problem to have. I'm 24 wih knee problems. I'm not sure how young is too young, but the choices seem pretty clear to you. Pain or surgery with rehab and pain. You just have to decide if the knee replacement is worth it to you. Think long term.

Francis Said:

knee replacement surgery...bad recovery?

We Answered:

Here is a typical protocal for post-op TKR:
Surgery day: after recovery room-patient is sent to hospital room with a CPM machine on the leg.. Each day they try and increase ROM in knee via CPM.
Day 2: PT attempts to get patient out of bed and possibly walking a few steps with a walker. PT (Physical Therapy)also assists the patient and teaches patient how to get out of bed and ambulate safely.
Day 3: When the patient is able to get out of bed and ambulate to the toilet and back to bed indepentantly, and if there is someone at home to assist in home care, the patient is sent home with a walker. This is all assuming there is no complications.
Day 3/4- Once home from the hospital a CPM machine should be at the home and set-up and a tech from the company or hospital should be there to give instructions on its use and the degrees of ROM and time durations in the machine. This needs to be placed on the patient ASAP,(within a few hours of being at home) because this is a critical time where stiffness can occur quickly. Pretty much the first few days is out of bed for bathroom, otherwise in the machine. Compression stockings should be worn for the first few weeks and some kind of blood thinner protocal should have been already in place.This varies greatly from MD to MD, but usually home PT should be in place at least 3-5 days a week. Critical!
The deal is, most patients are not motivated for any kind of movement due to the pain, recovering from general anesthesia, and generally feeling fatigue from all the surgery and everything it involves. Given that, it is very important to have PT there not only for the Range of motion, but for motivation as well. After a few weeks, when the patient is able to get outside and into a car, Physical Therapy is usually done outside the home at at the PT office. This should be done at least 3 times a week. The goal of PT is to get Range of Motion(ROM) in the knee, teaching ADL'S (activities of daily living), motivation, and lastley,
gradually showing you how to become indepentant and able to do home exercises, thus weaning off outside PT.
And, to finally answer your question, the only way I know to regain ROM and regain her life back is more physical therapy. Plain and simple. If you don't like your therapist or feel like it is not helping, then get a different therapist. She will get her life back, she is only 54, which is fairly young for a total knee, but hard work is ahead for her.
I am sorry your Mom didn't get the therapy she needed sooner. I would be pissed at your Doctor, because ultimatly, he is responsible for laying in place the tools to make your recovery sucessfull. Things will work out, just hard work, more therapy, motivation, etc. Good luck with the recovery!
MY DISCLAIMER: I am not a doctor, and as such, you need to check this all out with your MD, and I only explained a typical recovery from a TKR assuming no complications. The post surgery protocal can also vary greatly from physican to physican.

Geraldine Said:

questions after knee replacement surgery:?

We Answered:

You should use your walker or crutches as instructed. If you had a cemented procedure, you'll advance the weight you place through your sore leg as much as you feel comfortable. If yours was a noncemented procedure, place only the toes down until you've had a follow-up X-ray and your surgeon or therapist directs you to put more weight through your leg (usually by the fifth or sixth week postoperatively).

Beth Said:

is there anything u can do to slow down aortic valve sten from progressing? it is currently at severe level?

We Answered:

jessiejasper - I'm sorry to hear that your mother is doing so poorly. The good news is that people can actually survive with aortic stenosis for a fairly long time without developing symptoms. Unfortunately, once symptoms do appear (chest pain, heart failure, or fainting) people tend to become very sick very quickly and are at high risk of dying within years. Right now, we have no medicines that are known to slow the progression of aortic stenosis. It was thought that the cholesterol medicines called "statins" could potentially help, but this has not been borne out in more recent studies.

As you are aware, a 30% risk of death is very high. Therefore, you really need to weigh that risk against the benefits. Assuming the surgery is successful, will your mother feel better as a result of it? If she is not having any symptoms from the valve, to put her through surgery would be to put her at a high risk of dying for no good reason. On the other hand, if she can't even walk across a room without gasping for air because of the valve, she may have more to gain. Honestly, it sounds like she is so limited by her other health problems at the moment that there is not much benefit to be had by fixing her valve.

One thing to consider... if the doctor feels that your mother is truly having symptoms as a result of her tight valve, one alternative to surgery is balloon valvuloplasty wherein a balloon-tipped catheter is passed through the tight valve and expanded so as to crack the valve open. While the long-term results are poor, some newer research suggests that radiation therapy following the procedure can improve long-term results. (See the RADAR pilot trial in Catheter Cardiovasc Interv. 2006 Aug;68(2):183-92.)

The purpose of this would be to temporarily improve symptoms and therefore quality of life. It is a lower risk procedure compared with surgery but, like all procedures, still carries the potential for problems such as stroke and death.

I would suggest that you discuss these issues with the doctor who knows your mother best. He will be able to tell you if the valve is affecting her life at all and whether she would be a candidate for the balloon valvuloplasty procedure.