I’ve recently had a hospital appointment of a pre-op for left knee replacement. Amongst the many issues I have with complying with all the requirements for the best possible outcome, is one of weight. I have put on 6 stone in 6 months (thanks to pred), totally knocked off my feet with a DVT, cellulitis and stress fracture in the right leg, and a very bad arthritic left knee with moderate changes in the metatarsals of the foot causing so much pain that I was advised to rest and get my feet up. I slept a lot but didn’t eat so much or move around, but it just piled on almost without notice if you can believe that. Question.... it was suggested to ask my doc for water tablets to help reduce some of the water retention.? Is this possible, before I go ahead, as I haven’t heard anyone mention it here before?
water tablets: I’ve recently had a hospital... - PMRGCAuk
water tablets
"it was suggested to ask my doc for water tablets" - by whom?
Is it likely to be fluid retention? Some may be but you do need a doctor's opinion - diuretics aren't usually a means for weight loss. You also need to be careful taking diuretics alongside pred since in combination you may end up losing too many electrolytes (sodium, potassium, magnesium etc). They aren't something to play with.
Weight management when on pred does work with cutting carbs drastically - preferably of course from the outset, but weight loss is still possible even when on pred.
The suggestion was made by the nurse practitioner who was taking all of my details. I was quite surprised she made the suggestion which is why I thought I’d question it here.
I find it utterly bizarre - unless there is real evidence you have fluid retention. Do you have pitting oedema in your limbs?
Yes my knees, lower legs,ankles, feet and toes have all been very swollen for quite sometime, with oedema, snake skin etc. Recently my partner purchased a swim spa, which I use nearly every evening when my partner gets home from work. Just being able to walk around in lovely warm water up to my neck is a joy in itself. The water allows me to walk around and do exercises impossible on land without any aids. The change in my legs has been unbelievable, a lot of the swelling has reduced and my skin is looking much better, however I still have oedema but it is a step in the right direction. A recent blood pressure check at my GP’s on my legs was not too bad as my left foot is purple most of the time, however I have now been put on a vascular consultants list, I wasn’t aware of this. My GP instructed me to rest and elevate my legs more but it’s a vicious circle.
PS - we DO recommend cutting processed carbs not only because that cuts simple carbs that hide everywhere in processed food but also cuts salt and too much salt and pred don't mix well, often leading to puffiness, especially around the face. But I really don't think it is going to make 6st weight difference - maybe a few kilos at most if you were lucky.
Who suggested the water tablets? My GP said that it was not a good idea to take them with pred a while back. Is your surgeon happy to do the surgery at your current weight? I assume your surgery is pretty soon if you are having a pre med.
The nurse practitioner who was taking all of my details suggested it. I have never seen it mentioned on the forum so thought I would check. I think my weight will be an issue as I have been on crutches since last August 2022 and need to be back on my feet immediately after the operation to exercise it and get it moving. I have waited 35 years since injuring this knee and finally deciding I have no option but to go ahead as I can no longer weight bear on it but with all my other issues piling up I have to make a move soon.
If you can get around on crutches now you will be able to use them after the op. Also as you will have got rid of the awful pain you should do well getting around. If your surgeon is happy to do the op, I would have thought you will be fine. What date is the op scheduled for?
ASAP, but now I’m being held up because I have an ulcer on my leg too which has been healing since Feb this year. I’m almost there but they say until it’s completely healed the possibility or infection getting into the new replacement is not an option as the replacement would have to be removed to clear up an infection. You name it, I have it.... it all got thrown at me at once unfortunately.
It seems strange they have done a pre med if they did not have a date in mind or they may have to redo the pre med, which is a bit of a waste of time. Or did they find out about the ulcer at the pre med?
My GP sent an expedite letter to my consultant at my request as I have been off my feet, unable to drive or work and housebound for over a year and cannot claim a bean, so am keen to get back on my feet and back to work. A phone call to the people that look after the lists found I was on the ‘routine’ list, I was aghast. They moved me onto the urgent list and booked my pre-op appointment there and then, I was very impressed. However, as such a lot has gone on since I last seen my consultant these issues were only brought to light at the appointment. Hence, they would not have been aware of the ulcer and other issues. I have been advised my appointment details will be valid for one year. I have to notify the list people when the ulcer is confirmed completely healed (not far away) then hopefully the rest will follow. The nurse also told me that my actual pre-med tests will be taken nearer op. They only took bloods, ECG, blood pressure etc. She appeared concerned regarding all of my meds and risks associated, as am I, but what can be done? Putting me on the ‘routine’ list didn’t make any sense as I have been bone on bone for several years and really struggled to stay on my feet, however I wasn’t overweight at that point. Since seeing him I’ve had the DVT, cellulitis & stress fracture in my better leg (all at once) I think putting more pressure on my bad leg made things far worse and caused the foot/ankle problem. Plus PMR has been thrown into the mix.
So they will have a full pre med when they have a date for you??
Yes that is what the nurse told me, along with a consultant and anaesthetist chat.
Have you met the consultant? Do you know who he is?
Yes, nice chap, Mr John Lloyd at The Royal Gwent Hospital. When I had my MRI scans done on both knees, he sat me down in front of big computer monitors and went through the images explaining everything, it was quite refreshing and interesting, as I have always wanted to know the details of an op.
There is a superb video on Youtube showing the entire procedure ...
Oh good I will check that out, thank you.
No - mine was a recommendation for a UK TV programme, not one of the YouTube ones.
I saw a knee replacement programme on TV, I believe channel 5. It was so impressive. I wanted to see my hip being done live, but the anaesthetist said technology did not allow that yet!
Over the years I have had a lot of arthroscopic (keyhole) procedures on both my knees for wash outs and tidy ups to keep me going. On one occasion I asked my long standing consultant if he would do the two at the same time as I was so accustomed to the operation and using crutches afterwards. He wasn’t too happy but agreed, I also asked if I could watch as I was very interested in what was actually happening in my knees after many years, and also tape it (on old VHS cassette... yes going back a way) Anaesthetic was spinal, a small piece of material blocked my vision of the operation area and there was a nice size monitor that the surgeon used to see what he’s was doing, and so could I, with relaxing music in the background. He explained everything as he went along and it was brilliant. 8 years ago I had a left hip replacement but could not watch that as I didn’t fancy all the sawing and hammering. Now I await the dreaded replacement left knee and have been told that I will be kept awake for that as the spinal is safer due to my conditions. Glad to have it finally done but hope the music in the headphones damps out any noise.
Watch out for the hospital sneaks! I was fully awake for the insertion of a load of metalwork for a bad break - letting the anaesthetists (all 4 of them) practise their English. So I assumed I'd have the same procedure in the UK to have it removed. But no - I had to ASK for a spinal anaesthetic and the sneaky lot gave me a couple of temazepam so I slept through. Really rather t'd off ...
There was no video for my hip, I was awake all the time though as I did not trust them enough to be sedated. They were very keen to sedate me. I wanted to know what was going on. If you have a spinal and get sedated I understand that you can be sedated enough to effectively be totally unaware of what is going on, so you should be fine.
Well I will ask the questions at the next pre-op and hopefully get honest answers. Regarding my initial enquiry about water tablets, I also wanted to ask about my prednisolone. I am currently on a very slow reduction of half a mg from 15mg down to 10mg, every 6 - 8 weeks depending how I feel. I have obviously made them aware that I am on steroids, but what will be the best thing to do when the operation date arrives? They have already sent me their plan regarding my blood thinners (Apixaban) and I have read a few disconcerting stories on this forum about steroids😳 and what doctors may or may not know, do sick day rules apply or is another strategy required?
August 2021 not 2022
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