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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by Greg on October 17, 2000, at 8:48:05
I'm having knee surgery on Oct 23rd. Pretty basic stuff, torn and frayed cartlidge and loose stuff floating around in the knee joint. Doc says I might even be up walking around the next day. This isn't my first surgery (by a long shot, #15), but I'm getting very apprehensive about it. The thought of surgery doesn't bother me, it's my reaction to the anesthesia. Up until my last few surgeries, I've always been very tolerant of the anesthesia, but the last few have been pretty nasty. I get very sick and feel horrible for days. I'm sure my age has something to do with it. It's also my first one since being diagnosed Bipolar II.
Can anyone suggest something I might do help counteract the negative side-effects either before or after the surgery? I've even give thought to requesting a local, but I'm sure my surgeon would have issues with a patient having a panic attack while lying on his table...
Any advice/input/feedback would be greatly appreciated.
Thanks,
Greg
Posted by Mark H. on October 17, 2000, at 10:12:26
In reply to Upcoming Knee Surgery - A Question, posted by Greg on October 17, 2000, at 8:48:05
Dear Greg,
My wife Sue had arthroscopic knee surgery after a cycling accident about six years ago (so she would have been about 46 or so at the time). Our one big regret was the use of general anesthesia. The woman in the bed next to Sue's, also an older and physically very active woman, had insisted on a local, or a spinal plus a local, and she came out of knee surgery chipper and ready to get on with her healing.
Sue's doc hadn't given her an option. The effects are difficult to describe, but she felt awful for at least a couple of weeks, sleeping half of the day and feeling poisoned. The emotional effects were strange -- she seemed to lose her confidence in her abilities for two or three months. But mostly, she said she felt sapped of energy, and it took her a good six months before her normal stamina returned. (After that, she's been fine.)
Sue had had several prior surgeries when younger, and because of her fitness she "shouldn't" have been set back so much by less than an hour of general anesthesia. But in retrospect, I think she would have endured almost anything to have avoided it.
As it was, she waited until the last minute to discuss the options with her doctor, who easily talked her out of using a block plus local.
Recently, though, we discussed with a surgeon whether Sue should get surgery for her hiatal hernia, which has caused ulcers in her esophagus and other problems. After hearing about Sue's anesthesia experience with a relatively short procedure like knee surgery, the surgeon basically said she should exhaust every other option available to her before even considering a three to four hour operation.
Hopefully, general anesthesia wouldn't affect you as severely as it did Sue, but she and I share your concerns. I just keep thinking of the woman in the next bed who got the same surgery that morning and went on with her life relatively uninterrupted.
I realize it's fruitless to generalize from one experience -- my boss recovered from an emergency appendectomy in a week with no apparent ill effects at all -- but if sharing Sue's experience could help open your options, that would be great. In addition to a spinal block and local, they could hammer you with Valium or Xanax for the anxiety, since you won't be driving yourself home from the hospital or clinic anyway. Just a thought.
Thank you for your kind and conciliatory note this morning. I have a lot to learn, and I will do so by having forgiving and patient friends like you.
Best wishes,
Mark H.
Posted by noa on October 17, 2000, at 12:02:05
In reply to Re: Upcoming Knee Surgery - A Question, posted by Mark H. on October 17, 2000, at 10:12:26
I have bad reactions to general too, but the doc said that my surger would be too long and they would be applying pressure, etc. and he was concerned my not being under would cause me to tighten muscles, etc. that would hinder the process.
Posted by medlib on October 17, 2000, at 13:53:00
In reply to Upcoming Knee Surgery - A Question, posted by Greg on October 17, 2000, at 8:48:05
Greg--
I hope that all 14 previous operations haven't been on your knees! Have any of the earlier surgeries been on this knee? If so, were they arthroscopic or had you a long incision? From your description, this coming surgery sounds like it will be an intracapsular arthroscopic procedure. Is that correct?
I would request a meeting with the anesthesiologist ASAP--at least a week before surgery, even postposing the operation to do so, if necessary. You'll need to take in a list of ALL drugs and amt.s you take regularly, RXs, OTCs, and PRNs, also any supplements.
Tell him/her about your recent gen. anes. experiences and ask in detail about alternatives. Possibilities might include a spinal + local bloc, local or systemic skeletal muscle relaxants, and/or "twilight sleep" IV to manage anxiety reactions. Find out which daily meds you should take when before surgery and how soon they can be restarted after.
Surgeons often want to operate under general anes. because it's easier for them; the body part can be manipulated however necessary and muscles are relaxed. Ask your anesthesiologist to consult with your surgeon to come up with an appropriate non-general alternative. MarkH is right; your mental and physical health after surgery are at least as important as (and, IMO, *more* important than) the surgeon's operating preferences. There are plenty of orthopods, particularly sports knee specialists, who wouldn't dream of using a general for scoping a knee, even a complicated scope. Whether arthroscopic or not, there are alternatives to general anesthesia for most operations, when necessary--and, to me, this sounds like a clearcult case of "necessary."
Good luck! Keep us posted, please.
Well wishes--medlib
I'm having knee surgery on Oct 23rd. Pretty basic stuff, torn and frayed cartlidge and loose stuff floating around in the knee joint. Doc says I might even be up walking around the next day. This isn't my first surgery (by a long shot, #15), but I'm getting very apprehensive about it. The thought of surgery doesn't bother me, it's my reaction to the anesthesia. Up until my last few surgeries, I've always been very tolerant of the anesthesia, but the last few have been pretty nasty. I get very sick and feel horrible for days. I'm sure my age has something to do with it. It's also my first one since being diagnosed Bipolar II.
>
> Can anyone suggest something I might do help counteract the negative side-effects either before or after the surgery? I've even give thought to requesting a local, but I'm sure my surgeon would have issues with a patient having a panic attack while lying on his table...
>
> Any advice/input/feedback would be greatly appreciated.
>
> Thanks,
> Greg
Posted by Greg on October 17, 2000, at 15:33:07
In reply to Re: Upcoming Knee Surgery - A Suggestion » Greg, posted by medlib on October 17, 2000, at 13:53:00
Wow! I'm really glad I asked this question. There were a lot of things I didn't even stop to consider about this. I'm printing out all the responses for my pre-op today. I think if I had to opt for something right now it would be the local. I'm am very concerned about potential interaction between my meds and the anesthesia drugs.
All the previous surgeries were on different parts of the body, eyes, feet, shoulder, back and stomach. Sounding a little like the six million dollar man? It is the intracapsular arthroscopic surgery and he says I might possibly be up and walking the day following the procedure, I hope so.
I will make sure I do what's best for me and not let the doctor influence my decision based on what's easiest for him. Thanks again to all for the input and I'll keep you informed on what I decide to do.
Greg
Posted by Snowie on October 17, 2000, at 18:14:57
In reply to Upcoming Knee Surgery - A Question, posted by Greg on October 17, 2000, at 8:48:05
Greg,
I'm with Medlib. Definitely discuss "twilight" anesthesia (commonly referred to as a "Big Mac" according to my anesthesiologist brother, but I don't remember why). I was put into a twilight sleep when I had foot surgery in 1996. The anesthesiologist basically puts you to sleep for a few minutes (possibly with a strong benzo, but long enough for the doctor to deaden the affected area and to make the initial incision), and then the anesthesia is withdrawn. Usually there is a drape over your face, and you sleep through the surgery and wake up when it is over with no side effects. My podiatrist told me that I talked some during the surgery, but I have no memory of it whatsoever.
Good luck!
Snowie
> I'm having knee surgery on Oct 23rd. Pretty basic stuff, torn and frayed cartlidge and loose stuff floating around in the knee joint. Doc says I might even be up walking around the next day. This isn't my first surgery (by a long shot, #15), but I'm getting very apprehensive about it. The thought of surgery doesn't bother me, it's my reaction to the anesthesia. Up until my last few surgeries, I've always been very tolerant of the anesthesia, but the last few have been pretty nasty. I get very sick and feel horrible for days. I'm sure my age has something to do with it. It's also my first one since being diagnosed Bipolar II.
>
> Can anyone suggest something I might do help counteract the negative side-effects either before or after the surgery? I've even give thought to requesting a local, but I'm sure my surgeon would have issues with a patient having a panic attack while lying on his table...
>
> Any advice/input/feedback would be greatly appreciated.
>
> Thanks,
> Greg
Posted by Rzip on October 17, 2000, at 19:21:36
In reply to Upcoming Knee Surgery - A Question, posted by Greg on October 17, 2000, at 8:48:05
>Hi Greg,
I do not have much in terms of medical info. to offer. But, I do wish you the best. I hope the surgery will be a breeze and you will be up and about the next day.
I might sound too optimistic, but I hope the thought will count.
Sincerely,
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX I'm having knee surgery on Oct 23rd. Pretty basic stuff, torn and frayed cartlidge and loose stuff floating around in the knee joint. Doc says I might even be up walking around the next day. This isn't my first surgery (by a long shot, #15), but I'm getting very apprehensive about it. The thought of surgery doesn't bother me, it's my reaction to the anesthesia. Up until my last few surgeries, I've always been very tolerant of the anesthesia, but the last few have been pretty nasty. I get very sick and feel horrible for days. I'm sure my age has something to do with it. It's also my first one since being diagnosed Bipolar II.
>
> Can anyone suggest something I might do help counteract the negative side-effects either before or after the surgery? I've even give thought to requesting a local, but I'm sure my surgeon would have issues with a patient having a panic attack while lying on his table...
>
> Any advice/input/feedback would be greatly appreciated.
>
> Thanks,
> Greg
Posted by Greg on October 17, 2000, at 19:29:25
In reply to Re: Upcoming Knee Surgery - A Question » Greg, posted by Snowie on October 17, 2000, at 18:14:57
All,
We decided to go with a spinal block to deaden me from the waist down (although I know people who would prefer me that way from the waist up...). They'll give me Valium or something along that line to keep me calm. We did discuss the Twilight Surgery but apparently they don't do that procedure at this particular hospital. He said a local wouldn't be an option as it is critical to keep my legs from moving. He says 3 to 5 days on crutches with a little therapy done on my own starting the day after the op. Physical Therapy will depend on how I feel after the first week. We'll discuss my meds when I pre-register, I'll be talking to the anesthesiologist (sp?) then.
I'm really grateful to everyone who replied. There were a lot of things I hadn't and would not have thought to ask about. Despite the number of surgeries I've had they don't get any easier. This is the first I've had since being dianosed BP II. Kinda scary...
You guys are great!
Peace and Love,
Greg
Posted by shar on October 17, 2000, at 20:44:16
In reply to Re: A spinal it is....., posted by Greg on October 17, 2000, at 19:29:25
Greg,
I had general once and puked my guts out (almost literally) for about 24 hours. Dr. (who was in a different town from where I lived) made me spend the night at his house. That is my main bad reaction to anesth. Also to codeine.This is gross so either skip the post or read the last paragraph: when I was pregnant I vomited constantly for the whole 9 months; about every 3 hours, and at least once at night (wake up and puke). I mean anything I ate came back, if I didn't eat, if I took something to settle my stomach, sometimes even drinking water would cause it, etc. I was actually very ill (and dr. didn't realize it until I passed out on the exam table at about 8 months) and it's sort of a miracle (and being 18 probably) that baby and I did so well. Point being that I seem to now have a very sensitive vomit button, so once I start it can be very, very hard to "break the cycle" and it can go on for days. From the flu, something I ate, etc.
I know now that they can add anti-nausea drugs to the anesth. so you don't have to puke forever. If I were ever faced with the option again, I would definitely add the anti-nausea.
However, when I had a breast biopsy not long ago, they used "IV sedation" (which I guess could be a benzo) and a local. I don't remember anything about the surgery except toward the end and I sort of woke up and they were talking about going dancing and closing the place down, and I said the last place I closed down was a department store, with my sister--but it was Xmas and they stayed open til 11:00. Then sort of went back to my dreamworld. No nausea resulted from that surgery. It was outpatient.
At any rate, if you have nausea or vomiting as a reaction, I would be on the safe side and either ask for anti-nausea stuff with the drugs, or get a script for Phenergan suppositories, 25 mg. (don't mess with the 12 mg) (and, yes, I know everyone hates suppositories, well, maybe not everyone) because if you can't keep anything down, anti-emetic oral meds often do not stay in your gut long enough to work. I insist on it if I'm nauseous from sickness or anything, or I will be off on another puke fest. It's very effective to go to the dr's office in the midst of a puke fest, because you will get your Phenergan for sure.
Good luck with your surgery! I will be thinking good thoughts for your quick recovery.
Shar
Posted by medlib on October 18, 2000, at 0:12:00
In reply to Re: A spinal it is....., posted by Greg on October 17, 2000, at 19:29:25
Greg--
Very good news--spinal bloc is a big improvement over a general! Bad news--you likely will have a *major* headache afterwards; good news--whatever you take for knee pain should help with the headache.
Can you stand another suggestion? Before the procedure, talk with whoever writes rxs for post-surgical pain to make sure that what is ordered is compatible with your psych meds and doesn't cause nausea (as codeine and related derivatives do to many). Neither you nor they are likely to want you to move too much right at first. As a surgical veteran, you probably have a good idea of what works for you.
Hope everything goes great.--medlib
Posted by medlib on October 18, 2000, at 1:09:13
In reply to Do you have nausea, etc. Gross post. » Greg, posted by shar on October 17, 2000, at 20:44:16
Shar--
Read your post above with interest and empathy. I keep Phenergan suppositories in the fridge at all times--unfortunately they don't travel well, when I'm likely to need them most.
By any chance, were you ever treated for Helicobacter pylori (the stomach bacteria responsible for most ulcers)? I ask because fairly recent studies have revealed that protracted "morning sickness" is very often associated with h. pylori, and antibiotics usually cure both. I just wondered if your hyperactive emesis "button" might be connected with an otherwise asymptomatic "pylori presence." (It can live in the stomach undisturbed and undisturbing for years.) I believe (or think I remember) that its presence often can be detected by a special breath test--if true, a grand step forward from an upper GI, a truly nauseating procedure even to contemplate.
If this subject interests you at all, I can find some Medline citations. Just a shot in the dark--or, more likely, the musings of one desperate to avoid more productive endeavors.
Well wishes---medlib
Posted by shar on October 18, 2000, at 10:20:49
In reply to Re: Morning sickness ad infinitum? » shar, posted by medlib on October 18, 2000, at 1:09:13
Med,
Yes, anyone who opens the "butter place" in my refrigerator ain't finding no butter there!
Thanks for the info. I have never been tested for that, but I have been on courses of antibiotics since the 30 years ago when my son was born. Do you think h. pylori can reoccur and need more treatment. Or would getting rid of the bacteria once take care of it?
Thank you!
Shar
Posted by stjames on October 18, 2000, at 16:48:53
In reply to Upcoming Knee Surgery - A Question, posted by Greg on October 17, 2000, at 8:48:05
it's my reaction to the anesthesia. Up until my last few surgeries, I've always been very tolerant of the anesthesia, but the last few have been pretty nasty. I get very sick and feel horrible for days.
James here....
I am a classical singer most of us fear major surgery, with it's nasty intubation process that
can wreck your voice. If it were me and the surgery was not major (like culling into gut)
were I would have to totally out I would ask about
a spinal and local anesthesia, ie numbing. IV sedation to induce sleep or near sleep. Last time I had oral surgery they used IV sodium pentathal.
Knocked me out.james
Posted by Rzip on October 22, 2000, at 0:26:10
In reply to Upcoming Knee Surgery - A Question, posted by Greg on October 17, 2000, at 8:48:05
>Greg,
I know that you are going to have knee surgery on Monday. How are you feeling about it (the spinal anesthesia)? I am just wondering if you have any last moment anxieties as the day/time approaches.
I hope the anesthesia effect will not be too lasting. You will be in my thoughts on Monday.
-Rzip
Posted by Greg on October 22, 2000, at 11:07:48
In reply to Re: Upcoming Knee Surgery - A Question » Greg, posted by Rzip on October 22, 2000, at 0:26:10
Our Zip, (get it? Rzip/Our Zip, cute huh?)
Thanks for the thoughts. I am trying to keep my mind off of it but the thoughts are getting thru. I'm not nearly as bad as recent times, but I'm always worst the morning of. I feel good about my decision to go with the Spinal, I think it's going to be much easier to stave off the after effects of Valium or whatever they decide to use than a full-blown anesthesia like Sodium Pentathol. I've always been put off by the theory that being put under is the closest you can get to death without dying.
I will feel better knowing that my friends are thinking about me.
Peace,
Greg> >Greg,
>
> I know that you are going to have knee surgery on Monday. How are you feeling about it (the spinal anesthesia)? I am just wondering if you have any last moment anxieties as the day/time approaches.
>
> I hope the anesthesia effect will not be too lasting. You will be in my thoughts on Monday.
>
> -Rzip
Posted by tina on October 22, 2000, at 12:45:26
In reply to Re: Upcoming Knee Surgery » Rzip, posted by Greg on October 22, 2000, at 11:07:48
Greg:
My absolute best of all wishes to you for an easy surgery and a zippy recovery. I'll be thinking of you.
Love ya
Tina> Our Zip, (get it? Rzip/Our Zip, cute huh?)
>
> Thanks for the thoughts. I am trying to keep my mind off of it but the thoughts are getting thru. I'm not nearly as bad as recent times, but I'm always worst the morning of. I feel good about my decision to go with the Spinal, I think it's going to be much easier to stave off the after effects of Valium or whatever they decide to use than a full-blown anesthesia like Sodium Pentathol. I've always been put off by the theory that being put under is the closest you can get to death without dying.
>
> I will feel better knowing that my friends are thinking about me.
>
> Peace,
> Greg
>
> > >Greg,
> >
> > I know that you are going to have knee surgery on Monday. How are you feeling about it (the spinal anesthesia)? I am just wondering if you have any last moment anxieties as the day/time approaches.
> >
> > I hope the anesthesia effect will not be too lasting. You will be in my thoughts on Monday.
> >
> > -Rzip
Posted by Cindy W on October 22, 2000, at 21:28:29
In reply to I'll Be thinking of you too!, posted by tina on October 22, 2000, at 12:45:26
> Greg:
> My absolute best of all wishes to you for an easy surgery and a zippy recovery. I'll be thinking of you.
> Love ya
> Tina
>
> > Our Zip, (get it? Rzip/Our Zip, cute huh?)
> >
> > Thanks for the thoughts. I am trying to keep my mind off of it but the thoughts are getting thru. I'm not nearly as bad as recent times, but I'm always worst the morning of. I feel good about my decision to go with the Spinal, I think it's going to be much easier to stave off the after effects of Valium or whatever they decide to use than a full-blown anesthesia like Sodium Pentathol. I've always been put off by the theory that being put under is the closest you can get to death without dying.
> >
> > I will feel better knowing that my friends are thinking about me.
> >
> > Peace,
> > Greg
> >
> > > >Greg,
> > >
> > > I know that you are going to have knee surgery on Monday. How are you feeling about it (the spinal anesthesia)? I am just wondering if you have any last moment anxieties as the day/time approaches.
> > >
> > > I hope the anesthesia effect will not be too lasting. You will be in my thoughts on Monday.
> > >
> > > -RzipGreg, I'll be thinking of you too! Hope things go well and you're healed soon.--Hugs...Cindy W
Posted by stjames on October 22, 2000, at 22:38:48
In reply to Re: Upcoming Knee Surgery » Rzip, posted by Greg on October 22, 2000, at 11:07:48
easier to stave off the after effects of Valium or whatever they decide to use than a full-blown anesthesia like Sodium Pentathol.
I've always been put off by the theory that being put under is the closest you can get to death without dying.James here.....
full-blown anesthesia is not Sodium Pentathol. Pentathol, or others, are used for
sedation so you are not aware of the procedure. Full-blown anesthesia
envolves many drugs but the primary ones are the inhalation anesthetics.
This requires mechanical ventalation to breath for you.james
Posted by Cam W. on October 23, 2000, at 6:45:15
In reply to Upcoming Knee Surgery - A Question, posted by Greg on October 17, 2000, at 8:48:05
Greg - Good luck, dude. Enjoy the down time. I'll be thinking of you today. Take it easy on the nurses (Just bash the docs, but wait until after the surgery). - Cam
Posted by Greg on October 23, 2000, at 10:32:41
In reply to Re: Upcoming Knee Surgery , posted by stjames on October 22, 2000, at 22:38:48
James,
I of course realize that you are right. Just to me, anything that puts me under is full-blown. Either way, I'm awake for this one, I hope to get the monitor in view, I'd like to see what the inside of the knee joint looks like. I know, pretty sick huh? Update to follow....
Greg
> easier to stave off the after effects of Valium or whatever they decide to use than a full-blown anesthesia like Sodium Pentathol.
> I've always been put off by the theory that being put under is the closest you can get to death without dying.
>
> James here.....
>
> full-blown anesthesia is not Sodium Pentathol. Pentathol, or others, are used for
> sedation so you are not aware of the procedure. Full-blown anesthesia
> envolves many drugs but the primary ones are the inhalation anesthetics.
> This requires mechanical ventalation to breath for you.
>
> james
Posted by Mark H. on October 23, 2000, at 13:38:44
In reply to Re: Upcoming Knee Surgery , posted by Greg on October 23, 2000, at 10:32:41
Dear Greg,
Just want you to know I'm thinking of you and doing extra practice and mantras today, asking for your rapid recovery from knee surgery and the anesthetics.
In peace and appreciation for all that you are,
Mark H.
Posted by Greg on October 25, 2000, at 11:48:33
In reply to Re: Happy Healthy Thoughts for You Today, Greg, posted by Mark H. on October 23, 2000, at 13:38:44
Maybe the SB just hadn't worn off yet, But the last 24 hours I've felt like someone hit me in the knee with a sledge hammer. But I was kind of expecting that. It'll pass though. The walker and crutches are coming in very handy. But I might just have to take the entire week off from work and you don't know how much that breaks my heart....
Ahhh... the sacrifices we make in the name of science. The upside of this is that all my new meds are still working and keeping everything under control and for that I am grateful.
Peace to all,
Greg> Dear Greg,
>
> Just want you to know I'm thinking of you and doing extra practice and mantras today, asking for your rapid recovery from knee surgery and the anesthetics.
>
> In peace and appreciation for all that you are,
>
> Mark H.
Posted by Noa on October 25, 2000, at 14:07:45
In reply to Re: The day after, posted by Greg on October 25, 2000, at 11:48:33
OUCH!
But you sound upbeat, despite the pain. Hang in there. Take the time you need.
Posted by Cindy W on October 25, 2000, at 21:36:17
In reply to Re: The day after, posted by Noa on October 25, 2000, at 14:07:45
> OUCH!
>
> But you sound upbeat, despite the pain. Hang in there. Take the time you need.Greg, glad to hear you made it through your knee surgery! Hope you recover quickly so you enjoy your forced "vacation"!--Cindy W
Posted by Cam W. on October 25, 2000, at 21:51:25
In reply to Re: The day after, posted by Greg on October 25, 2000, at 11:48:33
Greg - You're alive, but not kickin' - Cam
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