Early Preparation for Surgery

Transcription

1 Early Preparation for Surgery

2 Outline Joint Replacement Surgery Pain Management Physical Activity Home Safety Nutrition & Weight Management Setting Goals

3 People who are prepared for surgery have Better hospital experiences Fewer complications Smoother, faster recovery

4 Things are changing New standard of care: shorter hospital stay WHY? 8 hours 2 days Reduces risk of infection Improved activity and sleep at home Better use of resources You will be sent home when you meet discharge criteria

5 What is Osteoarthritis? Breakdown of cartilage May cause joint pain, stiffness & swelling Typically affects weight bearing joints

6 Anatomy 101 Hip X-Rays NORMAL Pfizer 2004 The Arthritis Society OSTEOARTHRITIS

7 Hip Precautions; For 6 weeks - 3 months post-op No bending past 90º L -shape No crossing the legs No twisting See p.10 Before, During and After

8 Hip Replacement Milestones 0-3 WEEKS: walk with walking aid, use stairs 3-6 WEEKS: walk several blocks with a cane, ride a stationary bike 6-9 WEEKS: walk further, better balance

9 Anatomy 101 Knee X-Rays NORMAL OSTEOARTHRITIS Pfizer 2004 The Arthritis Society

10 No pillow under knee No squatting, kneeling or twisting Knee Precautions; For 3 months post-op See p.18 Before, During and After

11 Knee Replacement Milestones 0-3 WEEKS: increased knee motion, walk with a walking aid, use stairs 3-6 WEEKS: sit on regular chair, ride a stationary bike 6-12 WEEKS: walk longer without limp, fully bend/ straighten knee

12 Helpful Surgical Resource Ortho Connect - Canadian Orthopedic Foundation Speak to someone who has had a joint replacement GIVE BACK! Be a volunteer after your joint replacement.

13 Pain Management

14 What is Chronic Pain? Pain lasting > 3 months the result of an over stimulated nervous system The nervous system gets better at what it practices.

15 Calming strategies dial down the nervous system Meditation, breathing exercises, calming imagery, positive affirmations Helps pre-surgical anxiety Distraction: music, exercise, socialization, hobbies Good sleep hygiene Cognitive therapy

16 Multi-Modal Analgesia approach Pain diary Triggers, pain levels & what works Modify activity accordingly Use all the tools in your tool box: Calming strategies Exercise Medication Activity pacing and mobility aids Complementary therapies

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18 What medication is right for me? Talk to your Doctor or Pharmacist about: Pain level Risks, side effects Drug interactions Medication timing

19 Where to start when managing arthritis pain Acetaminophen (Tylenol Arthritis Formula) Lowest risk caution with liver disease Lasts 8 hours Maximum dose 4000mg per 24 hour period Creams and gels Persistent and consistent application Site specific (not as helpful for hip) Wash your hands

20 Medications to use with Tylenol Non-Steroidal Anti-inflammatory (NSAID) Advil, Motrin (Ibuprofen), Aleve (Naprosyn) Beware of side effects Do not take with other NSAIDS like ASA Arthotec, Celebrex NSAID by prescription Take NSAIDs once in awhile for inflammation or if maximum dose of Tylenol does not work, particularly at bedtime Tylenol and NSAIDS can be taken together

21 Medical Cannabis Can be used in conjunction with all other medication Non narcotic, non toxic, non pharmaceutical Legal access through Health Canada CBD helps with pain; THC makes you feel high. Use: High CBD and low THC Ointment, suave or oil applied to affected area Tinctures, oil or flower taken orally or by vaporizer Do not smoke

22 Narcotics for severe pain Only use when all other methods, used correctly, fail Tylenol #3 - not helpful for OA pain Tramadol - effective for some people; others have extreme nausea and sleepiness Hydromorphone and Oxycodone though highly effective, also highly addictive Common side effects: drowsiness, constipation, nausea and itchiness After surgery, your GP should help you ween from narcotics as soon as possible

23 When should I take medication? Pre-medicate 1 hour before known triggers Take Tylenol regularly for long term and keep track of 24 hour doses NSAIDs for breakthrough. Try topical before oral NSAIDs. Ice for inflammation, heat for stiffness No driving when using narcotics

24 Additional Reading (and a break!) Heal Your Knees: How to Prevent Knee Surgery and What to Do If You Need It Klapper & Huey Heal Your Hips: How to Prevent Hip Surgery and What to Do If You Need It Klapper & Huey Total Knee Replacement & Rehabilitation; The Knee Owner s Manual Brugioni & Falkel

25 Physical Activity

26 Benefits Strong muscles less joint stress Joint mobility Endurance Weight control

27 But it hurts! Start small, increase gradually Break up the activity (2, 3, or 4x/day) Minimize joint stress Water Exercise bike Walking aids Respect your limitations

28 Avoid over-doing it 2-hour pain rule Extra joint pain for more than 2 hours after the exercise - you probably did too much, too fast! Slow down and do less next time Apply ice or heat to relieve symptoms

29 Move It! Gentle movement, 5 to 10 repetitions Heel slides in bed Knee bending/straightening Pain-free, as often as possible Stretch leg muscles, 20 30s hold Watch Prehab Education Exercise Videos

30 Strength Arm and core muscles Helps with transfers, daily activities Chair push-up, tightening tummy muscles 8 to 15 repetitions, work to fatigue Leg exercises gluts, quadriceps Watch: Prehab Education Exercise Videos

31 Balance

32 Fitness Options Community Centers / Pools Watermania Richmond Physiotherapy clinics Knee/Hip Replacement Exercise Guide GLA:D Canada - HealthLink BC Physical activity information and counselling

33 Home Safety Be prepared

34 Home Set-up Install stair railings, grab bars Remove clutter, tripping hazards Seats 2 above knee Foam cushion, bed blocks, raised toilet seat, bath seat Move frequently used items to waist-height

35 Other Equipment Crutches Walker Long-handled reacher Long-handled shoe horn Elastic shoe laces Sock aid

36 Where can I get equipment? Medical supply stores - Rent or purchase - Check for coverage through extended health plan Local Red Cross locations: - Equipment on loan for up to 3 months - Need a signed equipment form

37 A healthy body supports healing A healthy immune system fights infection Nutrition If underweight, get a referral to a Registered Dietitian for assessment

38 Weight Management Each extra pound = 4-6lbs of stress on joints Set a goal: Do not lose more than 3lbs/wk Limit calories from fluids Look at what causes you to eat Use a divided plate

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40 Healthy Eating Eat more vegetables (7-10 servings/day) and less grain products Consider portion size Choose(more often): dark green, orange and red vegetables; orange and red fruit whole grains, high fibre, low sugar

41 Milk Products, Calcium and Vitamin D Promotes bone healing Vitamin D - decreases risk of falls, hip fractures, cancer Aim for: 1200 mg mg calcium for bone repair IU vitamin D

42 Meat and Alternates Sources: Fish, eggs, meat, poultry, tofu, peas, beans, lentils, nuts and nut butters Supports muscle building, healing While healing, increase recommended daily protein and diary by 20-50%

43 Iron and Surgery Low hemoglobin = anemia Fatigue, light-headed, weak Low iron stores may delay replacement of blood loss Choose iron-rich foods Discuss iron supplements with your doctor

44 Constipation Prevention is key Fiber: grams/day from non-animal foods Fluids: 8 cups (2L)/day Exercise Take extra precautions before/after surgery

45 Resources Health Link BC or dial OASIS Nutrition and Supplements / Mindful Eating classes

46 Short & Long Term Specific Action-based Realistic Setting Goals What will help you get ready for surgery?

47 Goal Setting I am going to eat healthy VS. I am going to eat 7 servings of vegetables, 3 times this week I am going to walk around the park for 10 minutes, 3 times a week

48 Tips to succeed Write your goals down Post them where you see them Share your goals with friends and family Have a back up-plan

49 Other considerations before Surgery Smoking Higher risk of complications Hospital no-smoking policy Alcohol use Moderate alcohol consumption for men is 10 drinks/week and 6/week for women Please be honest with hospital staff about greater than moderate drinking for a faster, safer recovery.

50 Other Considerations Low income - register for Fair Pharmacare at least 6 weeks before surgery Vitamins and supplements stop one week before surgery Prescription blood thinners talk to the doctor who prescribed them

51 What s next? Pre-op Education 1 3 weeks before surgery Pre-admission Clinic up to 2 weeks before surgery

52 Resources OASIS website OASIS Primary Education The Arthritis Society Arthritis Info Line: OrthoConnect

53 Summary People who are prepared for surgery are more likely to have a positive experience Set some goals: Exercise Home safety, equipment Nutrition Weight management Pain control

54 Questions?