Hip Replacement/Low Hemoglobin

[Whittlesey]

Hi Everyone, hope all are somewhat well. Had the left hip replaced. After 7 days, pain is horrific. Motion is intentionally limited to keep the implant from "popping out". Am in a rehab now for two weeks. In ICU, after waking up from the operation --- saw " double". -- scared. In that groggy state -- had to explain to interns about GCA and blindness. My surgeon "got it" and ordered 30 mg of medrol. In a few hours my vision was better. Was moved to a more sophisticated ICU. Vision OK. None of this "walking next day". Started rehab, walking 5th day. Tremendous dizziness. Hospital good. Surgeon said my hemoglobin low. He considered a transfusion but decided against it. Here, I am exhausted. Am on a maintenance dose of 6 MG's of pred. This rehab Dr just said my hemoglobin is low. Felt feverish last 3 days -- temp 99.5. --- for the surgery they gave me a dose of 100 MG's hydrocortizobe - for one day. After surgery couldn't t get my blood pressure up past 70 for 4 days. Still tremendous hip pain. Want to get through this. Not feeling well, weak, very, very worried. Any thoughts, advice, similar experiences, suggestions, greatly appreciated. Thanks. Worried, Whittlesey

[Annodomini]

Are you having no treatment for the low haemoglobin? After my hip replacement 10 years ago, they gave me two units of blood. No question of general anaesthesia but had spinal instead. You seem to have drawn a very short straw and I hope the pain in your new hip will soon subside and you will be on your feet again. Good luck.

[Whittlesey in reply to Annodomini]

Thanks Annodomini. Yesterday they started giving me iron pills. On the blood transfusions -- I had not given autologous blood and have the rare RH Negative blood type. Dr. said I had lost a pint, but he thought my own body would replace it. We have had problems in the U.S. with drug addicts giving blood for money . Addicts with AIDs and hepatitis, etc. Some scandals exposed on this. When he was considering giving me a pint, this was running my mind. He then said, "I think we can wait and you'll replace it.". With all this in mind and the rare RHNegative, I didn't t push him. Apparently, however, the loss of a pint makes a difference. Thanks for your experience, information and concern. All my best,

[polkadotcom in reply to Whittlesey]

You are having a rough deal, Whittlesey. Had my left hip replaced in February of this year and haven't had any real problems. It feels as if it belongs to me already.

I did have an epidural, so perhaps that makes a difference.

[Whittlesey in reply to polkadotcom]

Thanks Polka dot. I also had an epidural with "light" anaesthesia ( which put me out).

Very glad you have had no real problems. Understand about the leg feeling like it "belongs" to you, now. A couple of times in therapy, it felt like it "wasn't my leg". Glad it went well.

[polkadotcom in reply to Whittlesey]

It's the next one which is worrying me..........will be having a partial knee replacement next, although the surgeon has said that it may change to a full replacement once they've had a look!

I just feel that as this one has gone all according to plan the next one won't, will be glad when it's over and done with (probably after Christmas).

Odd, those epidurals. I was aware enough to know something was going on, but it wasn't anything to do with me. I was just hovering there taking it easy. I hope it does that to me again.

[Whittlesey in reply to polkadotcom]

UndSeemed like, to them, it was simpleThem saying , don t worry, we can handle it all. hetood Polka dot. Glad the first one was ok. Hopefully second one two.

I had the epidural which numbed me from waist down. Then the "light anaesthetic" putme out.

What most worried me from beginning to end was that the doctors weren t fully understanding GCA, which can present major problems in any situation like this.

Seemed like the doctors weren t "seei g" it and treating it like ny telling them "oh, my aunt s garden isn t getting enough water and that will prevent/present serious problems for her. "

Them assuring me they could handle any problem.

Well I awoke w double vision.

Not a full understanding of GCA. !!!

[Whittlesey in reply to Whittlesey]

Sorry Polka xot. I have an android and its.gets jumbled. Pls skip the first pp.

[PMRpro Ambassador in reply to Whittlesey]

A pint is about a good tenth of the total so it is a considerable amount if you were already anaemic! I'm surprised they aren't giving you EPO too - being as you aren't a competitive athlete.

And why did they only give the hydrocortisone for 1 day - if they couldn't get your BP up it was probably a sign you needed it for a few days more (or a bit more pred).

As polkadotcom says - epidurals DO make a massive difference to post-op recovery. Was that not an option - just wondering, not criticising.

[Whittlesey in reply to PMRpro]

Agree PRMPro, should have been continuing hydrocortisone, which I thought was the original plan. Though I explained many times about the GCA, there seemed to be no real interest. They would say, Don t worry, we all give you a shot of hydrocortisone before surgery -- Don t worry.

I knew it was more complicated than that -- but could not really belabor the point.

I did have an epidural.

Also had anaesthia, when I woke up - the interns came to see me - and said several things to me - I realized - I was seeing them in double.

I said look "I m seeing you both in double". They seemed to think that was somewhat cute - told me I was coming out of heavy medication, surgery. I told them I had GCA, temporal arteritis -- and seeing double was an early sign of vision loss. That caught their attention. In my groggy state I had to explain what GCA was. After a few " are you sure you lose your vision?".

"Yes " I said. Please call my rheumatologist or your rheumatologisr-- now. "I may need a 20or 30 mg dose of methylprednisobe", eight now. This illness works quickly and sight can be gone fast".

They called the surgeon, who came. I went through this again with him. He said he would the rheumatologists. Within about 30 mins, they gave me a shot of methylprednisone. I fell asleep. When I woke up, I didn't t have double vision.

They then moved me to a more sophisticated ICU, where their rheumatologist saw me every day.

What is EPO?

Thanks PRMPro.

[PMRpro Ambassador in reply to Whittlesey]

It's a hormone that promotes red blood cell production, erythropoietin, EPO for short, and it is very abused by competitive sportspeople as it can improve performance. But it is used medically too - though only for VERY low haemoglobin levels so maybe you are above there (about 12g/dl is the cut-off) and they aren't that worried.

I though the main idea of using an epidural is to avoid using a GA - some hospitals give you a tranquilliser so you doze through the surgery but wake up fast with no "hangover". I did - sitting up and eating dinner pretty much immediately. That wasn't a hip replacement though. The first time I had an epidural for orthopaedic surgery I was awake the entire time chatting to the anaesthetists. The surgeon was too busy to practise his English...

[Whittlesey in reply to PMRpro]

Thanks pmrpro. Not seeing that Dr anymore. He should have ordered a prednisone taper after the high dosage. I believe that was why my bp was so low.

Due to a period following, low bp, I developedblood clots in my lungs.

Ortho said they didn't develop due to my hip replacement.

Well, they did. Every Dr I have spoken to since, says that is the reason.

Not seeing him anymore.

smh

[Whittlesey]

hanks PMRPro. I do have some anemia. A pint is a lot. I will see if my surgeon will EPO. It does sound appropriate, especially with the situation of lowered adrenal function.

Would like to include this.

They have made no more mention of the transfusionn--- quality of the blood worries me, maybe them, too.

Had the epidural, but withe anasthesia, went other .long operation, they cut into the bone.

That part was alright -- the part that was the high stressor -- beibg semi sedated - so relieved, it was finally done and over and then the double vision, which I know is a very bad sign of GCA.

Trying to explain to these surgeon interns what this dangerous vascular disease is. My surgeon "gotit" consulted w vascular and I got the pred.

They probably as you said should have continued the cortisone, because if that doesn't happen then there can be a steep drop in the cortisol blood levels, which I have experienced before.

So what they thought was a help--- the manner of usage may have precipitated the dangerous double blindness.

Thank you PRMPro, will talk to surgeon. Best, Whittlesey

[Whittlesey in reply to Whittlesey]

Hi Pgenotologispoke w surgeon's Physician's Assistant. I brought up through EPO.

"Oh yes" she said. "That would be great".

However my insurance won t cover it unless I have continuing anemia . GCA might qualify for that criteria however, a hemotologist has to prescribe it. Don t have one. -----

Lits of water and iron pills which I am taking. We'll see.

Thanks. Not even close -- to " easy as it looks" --------

[Whittlesey in reply to Whittlesey]

Again, sorry - Android rearranging phrases. Forget the first sentence.

[Hidden]

You are having a tough time of it,hoping you start to feel better soon.

Sending lots of gentle hugs to you.

[Whittlesey]

Thanks Scotch Lassie. Much appreciated reciprocated. Towards better health!