Posted , 7 users are following.
You guys are so smart - thank you! Have put off hip replacement years, but was planning for it next summer. Obviously PMR and steroids are a complication. Any advice is welcome. Again thanks!
0 likes, 14 replies
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BettyE valdez
Posted
I put off hip replacement until it hurt so much I had to do something. If my other one gives trouble I'll be asking for a referral next day.
I was in the middle of a second round of PMR at the same time and by the time I plucked up courage to go for the first X-ray I was taking 5mgs of Pred. and had higher BP than was ideal ( 160/95 ). but anaesthetist said " that's not too bad; you'll be all right". I was having an epidural and light sedative not a GA.
Hospital pharmacist said must not reduce Pred any further ( by this time I was down to 1mg. ) until after the six week follow up check.
All was absolutely fine and I'm pain free and on no medication three years later.
The hospital I went to ( NHS ) initiated the Enhance Recovery Schedule for hip and knee replacements. Worth a Google as it might point you in the best direction for any worries you may have. I was home in less than 72 hours.
Good luck.
EileenH valdez
Posted
Discuss it with your surgeon - some like you to be at a lower dose of pred, others don't bother about it. So if one says no at the dose you are at - try another one. You do need to have the PMR well managed for the rehab post-op.
Betty is one of two ladies I know who had hip replacements while on pred with no trouble at all. I think the other was at 10mg at the time, and was able to reduce to zero post-op - it was as if the hip pain had fed the PMR.
susan29426 EileenH
Posted
I believe that not attending to my hip in a timely manner may have actually caused my pmr. Can't say for sure, but in my case, I stubbornly avoided the hip surgery until I could barely walk. When they went in, the surgeon said it was the "angriest" joint he had ever seen. He also said that this extreme inflammation had no connection to the pmr symptoms that appeared about 6 weeks before the surgery. My situation is different from Valdez', since I was not yet on prednisone, but I think it would be advisable to get the hip surgery at the earliest safe opportunity.
EileenH susan29426
Posted
I think that is very common - and many people say post-op they were scared and now they wish they had gone far sooner.
The localised inflammation may not have caused the PMR - but I bet it didn't help your immune sytem being stressed with inflammation and pain together.
jeanne333 valdez
Posted
As the saying goes .. Don't put off till tomorrow what you can do today .. my motto is "getter done today" .. I would have had the hip replaced when it started bothering me ... I can't answer your questions. . but I'm sure there are others that can .. good luck to you ..
Anhaga valdez
Posted
Sounds like you have a choice. Here if your hip starts to bother you the chances of a replacement within two years are dismal. Likely to be much longer if you can still hobble around and are not yet in a wheelchair. One woman I know was actually happy when she fell and broke her hip because she suddenly was at the top of the list for replacement, which was successful She must have had a "lucky" break!
valdez Anhaga
Posted
That's SO pathetic! I can relate to this - they consider it "elective" surgery. Anyone with a bad hip knows it's not elective.
Just returned from Rheumatologist, who affirmed my diagnosis, 1st made 9 years ago. I'd forgotten how long it was. But my symptoms have some differences, and she's doing tests to make sure it's not something more serious. thank you! I never knew this group existed.So helpful. She put me on 15 mg/day, and like you advised to not raise it. Thanks again!
EileenH valdez
Posted
Elective just means it is planned in advance - as opposed to emergency surgery where you are taken to theatre without time for certain checks which reduce the risk of the surgery. It doesn't mean it needn't be done quickly - it just means they have far more information about the patient and they are probably in a better condition and stable going into theatre.
Even in the cash-strapped NHS, if a hip has deteriorated to the stage it needs to be replaced they do it asap - because the patient is fitter and better able to do the rehab. But there is a queue in all non-private systems and the worst come first - which is only right and proper. OTOH, everyone does have the option of going privately and then there is no queue.
Anhaga EileenH
Posted
In Canada people are very worried that the very argument you can go private and avoid the queue will be used to allow private clinics. There's a cse underway in BC at this very moment where a doctor wants to set up and American style private clinic, thus opening the door for the same all across the country. At this time you can't go private for things like this unless you leave the country. What we fear is a two-tiered system where only the rich will get the best care, and our medical personnel will be siphoned off into the private system. The answer really is to make sure we have enough of the right kinds of doctors available. I know of two young orthopaedic specialists who left Nova Scotia within the past couple of years because the powers that be said there were no openings for them.
They've both gone to other provinces. Setting up a private clinic to hire such people would be one "solution" but most people would not be able to afford it.
EileenH Anhaga
Posted
You just have to be sure they are separate if it bothers them that much - as is the case in the UK. You get no subsidy from the NHS if you choose to go privately. Don't look at the USA as an example.
However, having private options does actually have positives - those who can afford to go private do so and remove themselves from the state waiting list, thus shortening it for the others. In Germany the system is mixed - and hospitals have both systems running in parallel. Equipment is purchased for the private side - and is used for the general patients when free, which may be at strange hours but at least it is there. This has double advantages in that not only does it increase the capacity but also makes more expensive procedures available, piggy-backing on the private side.
It's up to the government and how they regulate it - but at present as far as I see, you have the worst of both worlds in Canada with a shortage of medical care and no option even if you DO want to go privately.
There are no openings because, like virtually every nation, the state funded healthcare is cash-strapped. In that Canada is not alone. Those orthopods will be unlikely to move back - so NS has probably lost them simply because they do not have a broader system. The big city probably called - and eventually so will abroad. That's what happens here - and there is an added complication in that everyone in the healthcare service is meant to be bilingual. Only locals will fulfil that and there aren't enough of them.
No - private is not all bad.
Anhaga EileenH
Posted
No these two individuals, one of whom I know personally, the other was in the news, both wanted to stay in NS. There is something weird about our system, in that the authorities say this is how many people we can have in a given specialty, and that's all we're going to have, even when there are young local doctors who want to stay, whose families are here and for whom there is no shortage of work. The issue with private care is that because we are next to the US it will be inevitable that big US health care providers will move in and it will be game over for our public health system. One of the big problems with health care in Canada is that it is controlled by the provinces but largely funded by the federal gov, which has came up with a bright new formula that actually penalizes provinces like mine with a higher than average number of seniors and gives relatively more money to those with younger populations. Another huge problem, which could be dealt with if we had a proper national scheme, is the skyrocketing price of drugs. We are the only country, I think, with public medicare which does not also have public pharmacare (there is a limited and expensive plan for seniors in my province which we opted out of, having other coverage). Other problems, I'll spare you, but did want to emphasize that because of the US influence, and the terms of a free trade agreement we have with the US (NAFTA), it's imperative we remain public only.
BettyE valdez
Posted
Is your GP willing to refer you? I believe the target of a maximum of four months waiting is still in place at least in theory. I didn't have to wait long for the first appointment with X-ray but then chose not to have the op until Spring.
I have a friend whose GP insisted he was " too young" so he paid for a first consultation as the pain stopped him working ( He is a builder ) and was then referred back to NHS hospital who agreed to do both; second three months after first, depending on recovery. All went well and, because he was willing to accept last minute call if there were any cancellations he didn't have to wait long at all.
But, of course, the first move has to be yours.
valdez
Posted
Hello, I'm in the USA, and don't understand the other health care systems that you are referring to. Sounds like Canada, right?
Anyhow, It must be brutal to wait for authorization for surgery. I postponed mine by choice that I'm unable to take 6 weeks off while working.
Anyhow, thank you all for your wisdom and advice. I'm enjoying reading your entries.
EileenH valdez
Posted
The USA healthcare system is unique! Whether that is good or bad I'm not qualified to comment.
However, patient.info is based in the UK and the majority of us are in Europe - all of which have state-funded healthcare systems and where you join a queue according to need rather than the amount of money you have, no-one is excluded from healthcare cover on any grounds.