Knee surgery - special needs for transplant people?

[natnnnat]

Don't know if this is the right place to post this...
My DH is going in for knee surgery next week.  Apparently the cartilage in his knee is "broken", and the lining between the bones (meniscus?) is breaking too.  There is a lot of broken cartilege "floating around" in there which the surgeon is going to clear away, as this might reduce the knee pain he gets.  His knee seizes up, and he is hopeful this procedure will help.   They aren't talking about knee reconstructions as he is apparently too young, or the knee isn't in bad enough nick... though the surgeon described it as "stuffed".

Anyway, given that kidney people have to watch the dye used in angiograms, I was wondering if anyone has had day surgery on their knee, and/or are aware of things we should be concerned about.  He will have general, and is used to that :-) and iis going home later that same day.  I don't actually know much about how the procedure will be undertaken.  Any advice would be gratefully received.

(19 June - edited title fixed spelling error - blush)

[bette1]

 Make sure you knee surgeon knows that you are a transplant patient- they my want to give you antibiotics before the surgery.  Talk to your transplant team too because I am sure that there are extra precautions they will want you to take.   I actually had a knee replacement while I was waiting for the transplant because I was afraid to get one after the transplant.  I had avascular neucrosis of my right knee due to long term steroid use.  If I can help in any way please pm me.  Good luck.

[Chris]

I just had knee surgery of the same type in late April. Told the problems are due to years of diabetes, dialysis, and transplant meds. My knees are degenerating, but to young for  knee replacement, so this surgery was done and will be done 1 or 2 more times on the knee I had surgery on. Myother knee is also degenerating, but at a slower rate and the pain I can deal with on that side.
 
Find out when the surgery is, get clearance from docs, get all necessary test done 30 days before surgery, stop or reduce mg of aspirin if he is on that, but ask your transplant center,and also ask which meds you can skip taking before surgery incase you are scheduled early and told to dry swallow your meds (role tongue and swallow meds). The surgery coordinator maybe able to give advice also on what to ask or give further instructions. A nurse will call also from the surgery center to also give instructions.
 
Also best to bring a printed out list of all meds taken with dosage, times taken, reason (some nurses are real stupid).
 
Almost forgot, but can't think of med that was given post surgery without searching for it, but it was bad to take because it can harm the kidney the transplant center told me. Once prescriptions are given post surgery, call your transplant center. A pain med, an anti viral, and something else was prescribed. The something else I need to dig out since I only took 2 doses before my transplant center said to not take it anymore.
 
After P.T. tomoow I will dig it out and post what that med is.So it will be  late post.
 

[natnnnat]

Thanks for this good advice and the good luck wishes.  He is getting nervous now.  Another question:  how long did it take to recover?
He worries about it at night, at bedtime, that's when he talks about his knee.  He's hassling to go for a walk at present.  Its odd, that walking seems to be good for the knee and sitting around makes it sore.  Anyway, he's champing at the bit.  Better go.

[Chris]

Depends on his definition of recovery. I am still going to therapy and I hurt the knee when landing hard off a curb I did not see, so lots of swelling and pain was caused. I was told recovery will be lower due to having the diabetes and transplant meds, so recovery can take about a 1 1/2. I  get tired after walking a lot and have to rest the knee and ice it. Your suppose to rest the knee throughout the day, but that's not always easy if your busy throughout the day and not home. Depending on how he is with balance, a walker might be better than crutches and then switch to a cane after a few days to help get around.. Canes cane be bought for less than $20 with many colors or patterns to choose from. The walker though is expensive if n insurance covers it and so far they only come in two colors, red and the old clasic standby of aluminum, prices around here start at $80, but with a doctors prescript, insurance may or will cover it which Medicare does if he has that.
 
I still need to dig out that medication I mentioned, long day today with doctor visits and came home and slept. I am told tiredness is part of the recovery process, but I also have other things going on to.
 
Ohhh, if they give him something to drink afterwards, stay away from the cranberry juice, go with Ginger Ale or something easier they may have, he may    after waking up from surgery and drinking cranberry juice, or it could just be me.
 
Oh and yes, sitting does bother my knee then and now, but not as much now. Being up helped and helps now to a certain extent till I need a rest, which Ijust sit and have my eg at an angle instead of bent. That will get better over time I am told, but hopefully before I need another surgery on the same knee.
 
Well that's it for now that I can think of, I need to go back to sleep.

[cariad]

My husband had meniscus surgery about 4-5 years ago. He is not on transplant drugs, obviously, but was in severe pain before his procedure. The bits of meniscus that had broken off and were free-floating were behind the bulk of the pain. He needed to rest for the first day, but was walking by the second. (He had to walk a little bit on the first day as our bedroom is on the first floor.) I would say he was in awful pain for the first 48 hours, and it took a few weeks for the pain to subside almost entirely. Does Gregory have a knee brace at the ready, ideally one that can be frozen and heated (or two, one for each temperature)? Gwyn relied on those for a long time. I would say that he had twinges of pain for years after, but just like any surgery, it was just fleeting pain now and again. Every once in a great while, he would start limping again, but that would just last a few hours at worst. Is Gregory on prednisone? As horrifying as that drug can be, it is actually an excellent pain killer in these circumstances and will probably serve him well that first week or so.

Gwyn has zero regrets about the surgery, even though the pain was intense for a while. The knee pain he was experiencing on a daily basis pre-surgery was strictly limiting his activities, and he is doing well today. I would strongly suggest Gregory ask his transplant centre if he can take Glucosamine Chondroitin (a supplement.) The orthopedic surgeon who worked on Gwyn highly recommended it, and it is supposed to be excellent for the joints. Gwyn is a disaster when it comes to remembering meds, so he did not follow this advice even after I bought him the supplement, but now that you've reminded me, I may just get on him about this. One concern we have: people with torn miniscuses are literally everywhere. About half the people we know have this problem. Some opt not to get surgical correction because it is supposed to cause arthritis problems in later life. I don't think Gwyn was made aware of this before the procedure, and I doubt it would have changed his mind (better to improve quality of life now than worry about what might happen) but it is a worry.

Good luck and fast healing to Gregory!

[Chris]

The medication my transplant center told me to stop taking ASAP was Cataflam (Brand Name) / Diclofenac Potassium ( Generic ) due to what it can do to the kidney. It was prescribed by the surgeon, so double check with your clinic on what meds are prescribed post surgery. You may have to call the surgeons office to get a new prescription that is safer for the transplant.

[natnnnat]

Hey!!! Thanks for that Chris, we'll keep an eye out for that one, and in fact whatever they do give us, we'll double check as per your advice and Bette's.  I'm grateful of your experience so generously shared.    Gregory is a puker, that's a fact, they give maxalon to keep it at bay.  But I heard of a lady recently who had so much maxalon {sp} that she got lockjaw and her body froze up a bit too,body lock,  it took an hour to come good.  Gregory doesn't seem to worry things as much as I do, instead he is sitting over there giggling and muttering, "body lock!  body lock! Hee hee hee"   He's a silly man, thank goodness.  Yet he is also not good today, he's worried and it's hard to watch them worry.  His mother was just diagnosed with cancer, and he has this operation on the same day as she gets her test results.  She has to have radiation.  Its no wonder he's low.  He wont see her for a while till he can get back out of the house, and he also worries that he's goiing to get fat by missing his daily walk.  And of course we are both stuffing our heads with lamingtons (an australian cakey snack)(comfort eating).

Chris and Cariad:  I sent the link to this thread to him so he could read about your recovery adventure stories, I think he is less anxious about that now, or at any rate more informed.  I hope so.  We have no knee brace, but will keep an eye out for same.  He isn't on prednisone, today I learn that prednisone and prednisalone are different.  [you truly need a medical degree to work all this out].

Re Glucosamine.  Yes well.  I am from an old established hippy type family, and we are always on at Gregory to drink less diet coke and more tea, (he calls it "the tea propaganda machine") and to take things like Glucosamine.  He resists.  But I got his permission to try it after this surgery.  I actually might try the liquid variety which I have heard is very good.  But I will take it to DH's renal doctor first for the okay, good call.   I bet you anything you like that after the dust has settled, it covers the once opened container of glucosamine. 

Importantly, gregory's surgeon knows he is a kidney transplant recipient, and I also got gregory to double check with the nurses when they rang to book the time, to make sure that they had to look at the page and register it in their brains.  Of course it will be a different shift etc etc.  I will print out the list as you suggest and present that to the people on the day.   Gregory said, stop fussing.  He has faith in surgeons which doesn't come native to me. 

[Chris]

My surgeon knew I was a kidney and pancreas transplant, but still got prescribed medication that could harm the kidney, which why it is advised to check with your transplant clinic.
 
I was given a patch pre surgery for nausea and then a medication thru the IV that I can't think of to to reduce the chance of vomitting. Of course that didn't help.
 
As far as not getting around, they want you up and moving around ASAP. They told me after 2 days post surgery, no walker or crutches, but as much as I tried, I still needed the walker for a couple more days. Then I use a cane to help because the doctor wants you, well me to start putting pressure on the knee so it does not seize up. But since I have had this problem for a long time, my rehab is going longer because I have to relearn how to walk correctly, plus I had a slight setback.
 
The worst part post surgery is not being able to take a shower post surgery till the bandage is taken off and the incisions looked at. I only had 2 small incision areas with one stitch in each of them.
 
He will be able to get up and move around, but maybe sore and tired for a few days, but should be able to get out of the house. I was out driving in 3 days, which was painful and hard to do till you find a good way to get in and out of a vehicle. Unfortunately I have a truck that is higher off the ground, but lucky enough to have electric seats to move the seats back for easier entry and exit.

[cariad]

Chris and Cariad:  I sent the link to this thread to him so he could read about your recovery adventure stories, I think he is less anxious about that now, or at any rate more informed.  I hope so.  We have no knee brace, but will keep an eye out for same.  He isn't on prednisone, today I learn that prednisone and prednisalone are different.  [you truly need a medical degree to work all this out].

Re Glucosamine.  Yes well.  I am from an old established hippy type family, and we are always on at Gregory to drink less diet coke and more tea, (he calls it "the tea propaganda machine") and to take things like Glucosamine.  He resists.  But I got his permission to try it after this surgery.  I actually might try the liquid variety which I have heard is very good.  But I will take it to DH's renal doctor first for the okay, good call.   I bet you anything you like that after the dust has settled, it covers the once opened container of glucosamine. 

Hey, Nat,

Far as I know, prednisone and prednisolone are just variations on the same theme - synthetic cortisol. There are others as well - deltasone springs to mind, but I think they all help a lot with arthritic pain by bringing down inflammation. He hopefully will have an easier time of recovery by taking it.

Hippie family? How cool! Good luck with the glucosamine. He really should take it, I have heard so many testimonials. Less diet Coke is a superb suggestion. I used to drink a load of sweetened iced tea, but then decided I did not want to have all of that sugar. Today I could not imagine sweetening my tea. I drink it hot and cold straight, and I cannot get enough of it. It may have taken some getting used to, but I am so glad I put the effort in to become a tea convert. Cheaper than those bloody diet Cokes, too. (Can I have a job with the tea propaganda machine now?)

PS - Do you ice tea in Australia? I once ordered an iced tea at a Starbucks in London. I thought it was safe, since Brits claim/whinge that London has more Americans than Brits. The barista asked me if I wanted milk in my iced tea, and I knew that instant that they just did not get it.

[natnnnat]

So we went into hospital on Monday armed with a list of Gregory’s medications, which was received admiringly by ... the man… who did paperwork ... and wore nursing gear… maybe he was a theatre nurse?  He was really nice, we liked him at once.  He was from Gregory’s old hospital, knew all about renal patients, knew all Gregory’s old renal surgeons and generally helped to make Gregory feel much less nervous.  I know one thing about Gregory, he’s been all his life till now at one big hospital, and he trusts it with his life (literally).  He says, Westmead is my home away from home, I wouldn’t go anywhere else, but he had to this time and meeting this man who knew so much of Westmead made him feel better I think.

Because this hospital we went to Monday was close to the centre of Sydney, where parking is a nightmare and traffic is hell, going in by car would have been horrible and getting out of there at rush hour would have been worse. I rang the hospital and checked how mobile they expected him to be, they said he’d easily be able to walk (slowly) and get onto trains.  And he was able to walk about at a very gentle pace, so we took a taxi to the station and caught a train home, using the lift to get to the platform. The plan was to get a taxi from Revesby station, but mr stubborn-head got himself off at Padstow and wobbled his way home with me growling and snapping at his heels the whole way. When you are fit its about a 2 minute walk.  He got home alright, but last night he twisted it getting in to bed, and that hurt a lot by the sounds. I woke before 6 to find that he was still muttering and wincing, he said, "ive had a bad night..." I showed my inexperience in these things by getting very upset, silently pondering the situation in the dark and thinking along the following lines: "they" give him no pain killers, "they" send him home while he is still groggy from the anaesthetic, "they" talk him through the discharge instructions while he is half zonked, while I am sitting in the foyer downstairs. Why tell him, why not tell me? I'm alert and I've been there all day. Result: I don't know what he should and shouldn’t be doing. Anyway. That said, "they" were all very nice helpful friendly and attentive people, knowledgeable about renal medications and the ins and outs of renal patients and transplant patients. And the hospital foyer was a reasonable place to hang around for a day.  I knitted.

When collecting him in the afternoon, and I discovered at the lifts that he had no pain killers I went back to get them, but they said, he won’t need them.  Obviously he was being stoic, as usual, and since he’s a hard-ass dialysis patient (ex), nothing is “painful” to him anymore.  So they didn’t give him any painkillers!! And wouldn't give any to me no matter how I worded it.  Must have been my drug-addict good looks put them off.  Nor did they give him any other medications.  So there is nothing to double check with his renal doctor…   He was groggy but happy after the operation and he insisted that panadol is enough, and he did seem happy with life.

He got a medical certificate which gives him till August, yes August, to rest at home. Nice one.  I think that's because I said to the man who did the paperwork:  he needs a certificate that is longer rather than shorter, as his job involves bending and standing and squatting and moving all day on his feet (he's a library technician)... so he wrote down, "job involves bending, squatting and crawling".  I think crawling did the trick.  It does involve crawling too, but not that kind.
 

[natnnnat]

A long post already but I’ll push on.  I was thinking this afternoon about a paper I read a long time ago, in which heart patients sometimes feel that they should
not seek too far for information about their condition: they sometimes feel that "the expert should act as the mediator of suitable and appropriate medical
facts for the patients. Thus, lay patients [feel that they] should be more like receivers than active sense-makers and seekers of medical information."
(Tuominen 2004)

It might be the kind of person that I am, and my background with parents who questioned diagnoses and took a proactive approach to their health. Now as a
carer i am trying to make sense, not just to be given information but to work out what it means. So if someone writes on Gregory's paperwork, "weight bear as
tolerated", what does that mean? Does that mean walking, standing, sitting... how soon... (does that mean, waddle home from the station because you're still
on anaesthetics???) and other things besides, like how did the operation go, were they satisfied with the outcome, were there any surprises... but I find
that sometimes I feel like I have to elbow my way into the conversation. When he goes to "normal" appointments, like with his renal doctor or a GP, that's
between him and them, if I'm there at all, I sit quiet and just listen and think and take notes, maybe at the end I'll ask questions that I've jotted down. But
at hospital, that's different, Gregory is woozy and I need to know how to proceed with the next few days or week. Yet at the hospital, I still seemed to
have the role of chauffeur more than partner in care. When I was summoned, it was to take Gregory home, all the debriefing had been done and he was still
sitting there woozily trying to put his socks on :-) Not an angry rant, this, so much as a reflective piece of pondering.

n

and because phd students have to put their sources, its

Tuominen, K. 2004, ''Whoever increases his knowledge merely increases his heartache.' - Moral tensions in heart surgery patients' and their spouses' talk
about information seeking', Information Research, vol. 10, no. 1. http://informationr.net/ir/10-1/paper202.html

[natnnnat]

Still sitting here in the middle of the night, talking to myself. 

I mentioned that he insisted on walking from the station to home didn't I. Well the anaesthetic wore off today, and he said it "stings a bit now", and "I can feel the holes in me knee". He didn't say anything else but I noticed that he goes and lays down a lot, and was making lots of hissing noises. So I went on a mercy dash to get panadeine forte from his mum, who has moved past panadeine forte so had some left over. He said to me, "you told me not to walk home". I said, "stupid man, serves you right". I even found when I got home with the pain killers that he had gone and got the washing out of the machine and hung it up in the living room. For god's sake! The perfect excuse to sit on his chair and for once I want him to do just that!!! Leave the washing alone!!!

His mum has radiation therapy ahead of her but she has some serious pain killers now which have actually put some of the spring back in her step. Its amazing what pain, or the lack of pain, the difference that makes in how you feel at a day to day level. 

[Chris]

I got through one post and part of the 2nd one before I needed a break from reading (Focusing takes a toll on one eye).
 
The bear weight as tolerated mainly deals with anything that puts weight on that knee, from standing, walking, holding  weight. I consider sitting because I could not tolerate sitting in one position, nor could bend knee for long. To me it is bear pain as tolerated.
 
I was given antibiotics post surgery which maybe a precautionary measure and the pain killers I did ask for, but the other med given that I was told was bad for me by the transplant linic I do not remember what that was for. I was told when I was groggy, but I no longer remember what it was for.
 
I read that he got a certificate to be off work till August, hopefully they are going to do rehab on his knee to get full motion back and at that point they can determin if he needs more time.
 
I'll read the rest of the 2nd post and 3rd post later after a break.

[natnnnat]

I probably could have made those posts shorter.  Now I've given you a headache, that's a pretty clear call for less words.
I'm just so impressed that you drive a truck Chris.  Would that be a pickup, or what kind of truck?

[Chris]

Ok, I missed one thing you mentioned.
When I was discharged, most of the information was given to my friend who was taking me home, well we were staying in the city at a nearby hotel since I didn't know how I was going to feel. So your situation is odd to me where they didn't go over anything with a spouse. I realize things are different around the world, but this is still odd to me when it comes to important information to share post surgery.If you have a PDR, check to see if that pain med is ok to take with his other meds, but best to ask a doctor although in this situation it would be a no no because they did not prescribe it or any of his docs.
 
As for my vehicle, it's a pickup

[natnnnat]

Quick update:  the man is taking life quietly, we've gone for a few car trips but getting him in and out of the car is the problem, his legs are way too long.  But it clears his head to look out the window.  Here's a picture of him observing the opera house and bridge :-)

One worry: when I redid his bandage last night I noticed his ankle was swollen.  Only on that leg, the other leg is alright.  This happen to you Chris?  This isn't ... you know... kidneys, is it?  Surely this is something to do with inactivity in that leg.

The photos are: 
gregory contemplating the view
the view:  the opera house and the coat hanger
the local swimming pool, emptied for winter.

[paris]

I can't comment on any of the knee stuff, but I do have to say that this is a brilliant conversation and will be so helpful to others in the future.  Isn't it great to have this place to come to in the middle of the night and let all your thoughts out and put on "paper"?  Natnnnat - love your detailed posts.  Everyone deserves a caregiver like you.  Tell Gregory that we all hope he starts getting around soon (but not until after August!)     

[Chris]

I did not have the swelling, but I was told it could happen due to my gait pattern (how one walks) being affected (body's center of balance, torq, alignment). Since I had this going on since 2008, my knee and gait pattern became more efected over time and have been in physical therapy since 2009 due to the toll it was taking on my back.
 
Gregory's situation is probably diferent and I'm not sure if he is having physical therapy for the knee, but I would bring it up with the therapist and the doctor. I only had the bandage on for a week and that's when they took the stitches out also.. I like hearing how things are one differently over the world.
 
Does he move the seat all the way back for easier entry and exit from the vehicle? That has helped me.