While I was sitting waiting for the first of several people to see me I started to remember more about my first pre-admission day. I had so many questions written down and was anxious to ask them, afraid I would forget some so my boyfriend and I had made a plan. I’d ask the questions and (try to) absorb the information and he’d take notes, cause I knew that there was no way I could properly take the information in and write it down at the same time. Thank goodness we had this plan because I wouldn’t have remembered half the stuff or been able to process the large amount of information.
While meeting with a bunch of disciplines they document a lot of information down in a booklet. At the end of everything they provide you with the booklet in a package so that everything is clearly outlined (as you can see in the picture for this blog). The day before my pre-admission yesterday I looked through my previous package to remind myself of what to expect.
I also used this package to keep any paperwork and prescriptions received from the hospital during and following my time there. It’s a nice central area to keep everything organized.
So last time I had a list of questions and definitely utilized my time with each discipline that came to see me. The people that met with me were: a nurse (RN), a pharmacist, an anesthesiologist, a social worker and a surgical resident (not the actual surgeon). This is your one on one time with someone that knows a whole lot about what you’re going to be going through. While I didn’t have the same massive list of questions based on EVERYTHING yesterday, I did have questions that more specifically related back to my previous experience and how my body reacted and recovered (which I speak about a bit at the bottom of this post).
What Generally Happens on a Pre-Admission Day
Yesterday was short and sweet for me (surprisingly, I didn’t anticipate being back home by 11 am), but this was simply because I had already been through everything about 7 months prior and I did not have to meet with everyone or do the class again.
Usually the day is from 7:45 am (at the hospital, not including the 5:30 am alarm to drive into Toronto) to about 2:00 pm (not including the drive and traffic to get back home). It is a long and draining day. Wear comfortable clothes and shoes, not because you’ll be walking around but because there is a lot of waiting around.
Ultimately, don’t be nervous to ask any questions you have! It’s your body and you have to be comfortable moving forward. There is no stupid question when it comes to surgeries (it’s not an everyday occurrence that anyone can anticipate you already know all about). It will change your life and you should be ready for what’s to come.
The RN
The nurse is the first to meet with you; she co-ordinates everything by the looks of it. She took my blood, some swabs, checked my lungs and heart and took down a lot of general information on my paperwork (confirming what I had previously written down or getting more information). The nurse was also very willing to answer any questions (like my high heart rate, I’ll get to that near the end of this post) and was very supportive and helpful. She pops back into the room from time to time to check in and ensures the day goes smoothly.
The Pharmacist
This is where the bag of drugs comes in (you have to bring any and all medication and vitamins that you take… consistently or inconsistently.) She will tell you when to stop taking particular medications prior to surgery and address any questions about in hospital medications that they may give you after surgery.
Yesterday, I spoke to the Pharmacist about my reaction to the pain medication after the last surgery. How I struggled with taking it because of the severe nausea that I would get (nothing stayed down… nothing). She said that because of how I reacted to the drugs that we would try to focus more on non-narcotic pain medications, such as Tylenols, to help me out.
The Surgical Resident
The Resident goes over the procedure and what the new hip joint will be made out of and work (we had a TON of questions about all this the first time around, we spoke to him for quite a while). They then do a little physical exam by watching me walk, and having me lay down on the exam table and moving my leg around in different directions. Lastly, as they go over the risks and get you to sign consent forms for the surgery to happen.
My resident yesterday started using medical terminology for a few things. For example he called Dysplasia DDH so I looked at him funny and said him “I have what?” I had never heard it called that before. He then started talking in a way that I understood, none medical terminology. Don’t be afraid to tell them you don’t understand something, we don’t all have medical degrees.
Since I previously had a lot of my questions and concerns addressed prior to my first surgery many of my questions were curiosity questions (like the small incision I spoke about below). The resident was very helpful and willing to answer any questions we had. He also told us a few things to tell my surgeon on the day of surgery (type of bone graft, type of stitches and ask if they could get a picture of the chip that’s chilling in my left hip) that we had talked about during our meeting.
The Anesthesiologist
This is your best friend when it comes to surgery. Be nice to them, they make you feel good (aka nothing at all)! I learned so much when we met with him before the first surgery. I hadn’t thought much about how they would put me under, I just knew I wanted the good stuff!
I was completely surprised by the way they tend to deal with hip replacements. There is general anesthesia and then there was also a low back needle (similar to but not the same as an epidural). Learning that this was the recommended means (as it’s a better recovery process) absolutely blew me away! They want to cut me open, saw off the head of my femur, screw on new bone, hammer a stake into my leg and grind a new socket into my pelvis while just putting a needle in my lower back to number my lower body?!?!
Yup!
Mind you, he then went on to explain how he would also put me to sleep but that I could be woken up with a nudge if needed…
I told him that there was absolute no way that I wanted to see, smell or hear anything that was happening! I was very surprised about this entire process. He laughed at me a little and told me that he can ensure that I won’t. And that this means of sedation is beneficial because the recovery is much easier and less morphine is needed follow surgery.
Note: They did an amazing job when I had surgery, super friendly, and a few jokes about my rugby drinking while prepping me. He feed me some glasses of wine through my intravenous. And I didn’t wake up during and when I woke up afterwards I was fully alert and felt great (sorry no loopy post surgery video to post later).
Today, I didn’t meet with the Anesthesiologist as things went very well last time (as outlined in my note) and I did not want to change anything.
The Social Worker
This is who helps with any post-surgery stuff, including your discharge plan. They provide the information for the rehab clinics in your area, when to call to arrange the appointments, accommodations for family while you’re in the hospital and lots more. They are the resource for you to get answers, even if they aren’t the person with the answer, they will tell you who to ask.
Michelle is super sweet and the same Social Worker I meet with at the last pre-admission. She provided me with her phone number so I could call with any questions prior to my hospital stay.
Pre-Surgery Hip (and Knee) Class
After spending hours in one small room you get to move to another room with everyone that was there that day for orthopedic pre-admission. A physiotherapist and occupational therapist teach this class. They go through all the assistant devices and tools that you will use in hospital and later at home. They show you how to get in and out of bed, a chair, the toilet, etc. They also show you all the hospital physiotherapy exercises that you have to do and what you will need to be able to do before leaving the hospital (go to the bathroom without assistance, meaning a person, and go up and down 3 steps without assistance). It is all outlined in the booklet in the package you received earlier in the day but being able to see it actually happen and the tools is very useful. I felt much better after this class before my first surgery.
When I attended the class before the first surgery (which I didn’t have to yesterday because it happened so recently) I was the youngest by 30+ years. The group is made up of hip and knee replacements and everyone has someone with them (again, it’s a long day, company is appreciated). Seeing how the therapist actually did the movements and used the tools helped me understand better how limited I would be for a while.
A Few Things I Learned Yesterday
The last time I was in the hospital following surgery they almost kept me an additional day because my heart rate was consistently high and I couldn’t seem to lower it (it also continued to be high at home for a few weeks as well). The RN told me that it could be due to 3 things:
- De-hydration (I was drinking water like a fish in hospital to try to help lower my heart rate and there were not changes);
- Anxiety (this would make sense, one ward mate was definitely causing me anxiety and I just wanted to go home, but I tried meditating and breathing exercises to calm myself down. My heart rate was still high when I was at home and in a relaxed state); or
- Poor pain management
Ah ha!!
I suddenly understood. I never knew the pain management aspect. While my body may not mentally allow myself to externally react or feel the pain like other people, my body will still react internally, aka increase my heart rate. Just because I think I can handle the pain and I don’t like taking medication (but I’m also not crazy! I did use the morphine in hospital) doesn’t mean that my body doesn’t need it. Normally you would know to take the drugs since your body is sending pain signals to the brain but I need to pay closer attention to the smaller warning signs, such as my heart rate, as I do not register pain in my hips/legs the same way.
Another thing I learned yesterday had to do with a separate small incision that I had near the top of my hip bone, for which I never understood its purpose. I didn’t see it in hospital (as it was covered up) and never remembered to ask during any of my follow ups, so I asked the surgical resident when we meet. I was thinking maybe a scope? (You know based on my medical knowledge learned through television) Apparently, the incision is where they inserted a rod (or something, I can’t remember exactly what) that’s used to make measurements for the leg/hip length. They use that point to ensure the leg lengths are as close as possible. There are other ways of doing this but that is how my surgeon does it at Mount Sinai. Suddenly the small incision made a lot of sense. I knew that they had to deal with the length of the legs but had never found out how they did it as it just wasn’t a concern of mine.
Overall
So here are the important parts:
- Ask any and all questions that you have, this day is for you so utilize it!
- Ask any and all questions that you have… there are no stupid questions (I can’t stress how important this is, talk their ear off, that is what the day is for)
Since attending the pre-admission yesterday morning I am feeling calmer and less overwhelmed. While I am remembering parts of my hospital stay that I didn’t enjoy (like my loud and stressful ward mate) I am also remembering how excited I was to be on the road to recovery. Once surgery is over it’s only going to get better! And I’m starting to feel that excitement again. I am so close to never having arthritic hips again in my hip!! Who wouldn’t be exited?