Changing meds

[CookieinAL]

Having to spend 3 days in hospital to restart sotalol. EP says upcoming knee replacement will cause major stress and fatigue, which are my biggest triggers for AFib. Had ablation in June, and have had a couple of episodes, all during times of stress and/or fatigue, Not a happy camper over this.

[Hidden]

G'day,

My AF is well controlled through diet/lifestyle and meds and stress was not a trigger for me. Food was/is ! However, I have had a knee replacement (whilst on Warfarin and a shedload of other meds) with a highly successful outcome but I feel whilst you should not ignore your EP, its time for one of two things to start happening ..... your EP should start talking about you and your AF and its triggers to your Orthopaedic surgeon .... or failing that you need (and forgive me if I'm teaching you to suck eggs or telling you something you have already done) to do it.

These Ortho guys and gals are pretty cute but you need to open up to them and as far as you can tell them exactly what is happening with your AF.

When r u due to go under the knife ?

I'm off to work on the buses shortly. I'll write more tonight and try and help you.

John

[rosyG in reply to Hidden]

Any advice on knee replacements with af would be most welcome John. I have one on the horizon !

[Hidden in reply to rosyG]

Hiya Rosy,

Sorry to learn you are hobbling your way to the AF/KR club.

I have had the good fortune to have had two brilliant health care professionals in my life, my GP in Dorking, Surrey who was the mover and shaker in getting my AF identified so quickly at East Surrey Hospital in Reigate and my Orthopaedic Consultant who did my partial knee replacement in Cornwall.

I had a partial done on my right knee, medial compartment. The need for this surgery arose 15 years earlier when my right knee cartilage had been removed at which time the surgeon then identified the onset of OA, back in the day in 2000. My partial occurred on 6 Nov 2015. I was done as an NHS patient in a private hospital in Truro.

My anticoagulation is well controlled by Warfarin. I had already told the Orthopaedic guy of my AF history and he wasn't at all phased by it. Just told me to come off Warfarin 6 days before surgery (if you are interested I have a table that shows how my INR readings behaved before and after knee surgery).

I went in the morning of 6 Nov and was discharged on 9 Nov. I think from memory surgery was around 3 to 4 hours and as soon I was awake and back in my room I was given a double dose of a bridging anticoagulant, Fragmin - around 3 pm ish I think. In the evening at my usual evening medication time I returned to my normal prescribed doses of Warfarin .... and all my other medication. No sweat, no problems whatsoever. However, as you might have gathered from some of my past posts Warfarin has never ever been a problem for me.

Exercising and stretching started straight away, gently at first but increasing the frequency. I was given a little NHS booklet describing all my exercise that I had to do and pretty pictures too. However, it wasn't enough for me and I went onto YouTube and typed in the search box words to the effect "exercises and stretches after knee replacement surgery. That was a brilliant move and answered so many questions I had and enabled me to come to grips with my recovery so well.

Over the 15 years since my cartilage had been removed my leg geometry all got out of alignment and the spin off from that was my right side Sacrilliac joint (Si) was causing more problems ( not forgetting the pain) as the years rolled on. So, while my knee was being done the surgeon also had to restore my leg geometry to something like giving me a normal gait/walk. In effect as part of my recovery I had to learn to walk again. In an exagerrated way its .... heel of foot, ball of foot and toe; heel, ball toe and you have to feel each as you walk. You feel it work on the leg.

The thing is although you've had the knee done you have to have a total leg mindset for the recovery process.

From memory I had my dressings removed on 21 November by Nursing staff at my GP's surgery who remarked on how well I'd healed. Now here is the rub, its all about scar tissue, and in my view so important I am surprised the NHS don't talk about it more ..... but they don't ........ because of my Si joint problems over the years I had been consulting privately a sports injury massage therapist and she offered to work on me after my knee op. she was brilliant .... she understood what the knee had been through and about ligments, muscles, soft tissue and bone.

As soon I had the dressing removed and was declared clear of any infection I went and started massage therapy, on a weekly basis. The therapist massaged the incision line and the surrounding area. The purpose was to stimulate all the soft tissue etc with the aim of preventing scar tissue forming - the reason is if scar tissue gets set in the wound your chances of doing the exercises and even walking properly again become a bit remote. She smeared the operated area with Aloe Vera Gel and worked through that.

Now, in terms of doing exercises and stretches at home make sure you keep up the pain relief all the time. Because of Warfarin I was restricted to CoCodomol 30/500 ( prescription grade). If you don't keep up the pain relief your chances of successfully doing the exercises and stretches are remote, particularly in the first few weeks. I was like a zombie, blown outta my mind but ... hell ... who cares I wasn't going on prime time TV Strictly come Dancing or Dancing on Ice now was I !

In terms of the recovery time. Its like this - the surgeon has done his bit now its your turn - you just gotta do the exercises ( and in my view the massage therapy). Once your dressings are off just apply yourself ....don't have too high a level of expectations, if you do your exercises etc and look after yourself your body will understand and cooperate. It will heal at its own rate .... we all respond differently ... listen to your body.

However, as a timeline guide I was driving my car at 8 weeks and back at work driving my bus ( both manual transmission, not that it matters as I had my right leg done but, you have to be able to do an emergency brake stop) at 11 weeks. As the months roll on post op, you'll most likely experience different sensations in the operated knee, don't worry its normal. I think I could have done all these things about 2 weeks earlier but Christmas 2015 intervened and my surgeon went away on holiday. I did telephone my car insurers both before and after surgery. 8 weeks is the minimum time before you can legally drive again - remember you have to demonstrate that you can drive safely, which includes an emergency stop.

Now about my AF, prior to surgery my previous AF event was April 2015. The next AF event was sleeping on my left side in February 2018. I had nothing in between - particularly during and after surgery. I might add now I have had nothing since Feb 2018. Surgeon remarked after surgery that my heart at no time misbehaved.

I might add, my sister had a full knee replacement well after me in Royal Surrey at Guildford and she had a spinal anesthetic ( I had a general). Whether this is surgeons choice or patients choice or dependant on how the surgeon feels about operating on a patient with AF I don't know. My sister said that while she was out of it she was aware of voices talking, drilling and hammering going. She thought they had the builders in the theatre.

Rosy, I think I've covered everything for you, but, I might have missed something in which case I'll add a PS post later. Please feel free though to ask me any questions that come to mind, either on here or PM me.

By the way, when I was on crutches I never did perfect the art of bangin' around the kitchen taking the top off a beer bottle or the Gin bottle. and still hangin' onto my crutches. Lol!

May the force be with you.

John

[Desanthony in reply to rosyG]

I had a knee replacement back at the end of August. It really is the most painful thing I have ever had! Most of my friends who have also had knee replacements agree with this so I was pretty much prepared for this. The Ortho surgeon thinks I probably had more bruising, swelling and bleeding because of the apixaban and therefore recovery did take longer than usual with his patients - though everyone is different. I had a successful CV (my second) in the July before the op but went back into AFib in the October. Can't really say that this was because of the knee replacement, pain and physio as there is no way you can know that. I have since had another CV which has been successful and am waiting for an ablation. My knee replacement is really good and I am doing well. I paid for my knee replacement as didn't get my usual routine 6 monthly check with ortho at my local hospital - infact had not seen anyone for over a year despite calling to find out when my appointment would be. I had physio twice a week for nearly 5 months at no extra cost as physio said until he was happy with me he would keep giving me physio. All in all not a bad experience. So long as all the medical professionals you come into contact with know about your AF you should be OK. The thing is to do the exercises they give you religiously and maybe to start exercising before hand. You may be able to get more advice from the Knee pain group on here. You can google pre knee replacement exercises and just do gentle exercises.

[CookieinAL in reply to Hidden]

Thanks, John. Good to know you have had successful knee surgery while taking these meds. I am having my surgery on 30 March.

I was not really considering not going in the hospital to start sotalol, just venting some frustration with the process. It's one thing to be in the hospital when ill, and quite another to be confined when you feel well!

Have a good one - Kathy

[Hidden in reply to CookieinAL]

Hi Kathy,

The thing to remember is that this is pretty major surgery, more so with the knee than with the hip and at some point in your recovery you'll need to learn how to walk again, which your body ( damaged knee) will have forgotten about due to pain ( I assume your knee job is as a result of osteoarthritis). In an exagerrated way ............ its ........... heel down, ball of foot then toe ....... so its heel, ball, toe, heel, ball, toe.

If you do it now, pre op, you may find it/feel it working on your lower leg.

Post op, don't skimp on your pain relief, once the pain takes over you'll find it very hard to successfully manage your exercises and stretches.

What sort of anesthetic are you having ? I ask this question because there are two ways of doing the business - epidural ( there may be a posh name involved which I don't know) in which case you'll be unconsciously aware of what going on. or a full blown general anesthetic. I had the latter, now what I can't recall is whether this was my choice or the surgeons choice based on the fact that I had AF. A year or so later my sister had a knee replacement and she had epidural - but she doesn't have AF. In my case my previous AF event ( nothing too dramatic) was in April 2015 and my knee job was in November 2015.

My surgery was around 3 and half to 4 hours plenty of time for the heart to get up to its old tricks but I had no issues and the surgeon was delighted with the way my heart performed.

Anyway good luck on the day, you'll be fine. And good luck with your recovery too.

John

[Desanthony in reply to Hidden]

Absolutely take your pain medication on time all the time. You will need them. Also get a new prescription filled before you finish what you are given to come home from hospital as you will need it - be surprised if you don't.

[rosyG in reply to Hidden]

Thank you very much indeed. It’s so helpful to hear your experience. I’m already doing exercises and had wondered about pain relief while being on Apixaban and will ask my go for codeine. I will message you post op with questions Thankyou .

[Hidden in reply to rosyG]

No worries Rosy, anytime.

[CookieinAL in reply to rosyG]

Rosy, when is your surgery? I am doing PT, too. Hoping for the best outcome, but a little worried about pain and meds while taking eliquis and all the other heart meds. Good luck to you.

[Desanthony in reply to CookieinAL]

I was on eliquis too. I stopped taking it 48 hours prior to the operation and then continued to take it 12 hours post the operation but a lower dose for 2 weeks - this was the arrangement my ortho and cardio came to. I took paracetamol tablets and codeine tablets and oral morphine. Before doing anything which may cause more pain (like getting in or out of the car or physio) I took the morphine. Both were to be taken every 4 hours so I spaced them so that I was taking some every 2 hours for example morphine taken at 8am and then paracetamol and codeine taken at 10 and so on. It worked for me (most of the time).

[MarkS]

I take it you're in the US. In the UK you don't go into hospital to start sotalol, even if you're a private patient. You might need to consider why you're being made to go to hospital for no good reason. As you're restarting and presumably you didn't have problems with irregular rhythms before, there's even less need for you to go.

[CookieinAL in reply to MarkS]

Had an ablation in June. Still having some occasional irregular beats and a couple full episodes of AFib. In the US, the protocol is to start sotalol while in the hospital, with 24 hour monitoring and blood tests.

So, it is what it is. - 3 nights in the hospital.