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HerbM Bilateral Total KNEE Replacement surgery Oct 21st, 2014 -- WOW!
Four flights of stairs?? UGH! Double UGH on grocery day~!
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
That is why I have a shopping bag with wheels. And I have to schlep it three times a week.
Lived on the 4th floor (3 flights up) at 18 years old and it was a pain then. Today, I would just order everything by hand delivery and never go out. Smile
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."


Ok, I am at 1 month Post Op the BTKR and 3 months Post-Op the THR.

Tonight, I put both giant puppies on the "2-dog leash" (85lbs x 2 = 170lbs of puppy love) and took them for a short, but actual, walk. We all did pretty good.

My wife received a copy of the final bill from the hospital for the THR (Hip; Aetna Insurance paid it all): $64,660.53.

The surgeon was another $3000 ($2500 + $500 for extras, e.g., computer navigation and assistant surgeon.) FYI: We paid the co-pay on the surgeon for our final co-pay of the year.

We don't have a bill for the rehab services on the Hip, but my guess is $2000 (plus or minus $1000).

Taken all together it is right at $70k all in.

(Twice what Google suggested when I researched it.)


Since we are trying to understand how *I* can have such easy joint replacement surgeries when others do not, the following TED talk is worth viewing as it might contain the KEY reason for my major advantages:

The upside of stress: Kelly McGonigal at TEDGlobal 2013
[url=http://blog.ted.com/2013/06/11/the-upside-of-stress-kelly-mcgonigal-at-tedglobal-2013/

Watch the fairly short (14.5 minutes) video but the key item is summarized here:
Quote:It turns out that thinking that stress is bad for you is … really bad for you. Incredibly, she says, over the eight years of the survey, 182,000 people died prematurely from the belief that stress was bad for them. She extrapolates for us: If that estimate is correct, then believing this is so would have been the 15th largest cause of death in the United States.

Remember that even though the stress people commonly discuss today (and that McGonigal is primarily referencing in this talk) is mental or psychological stress, their is also physical stress from pain or the insult of surgery.

Since I literally treated the entire surgical process (from before surgery day when giving blood or any other pre-surgery activity all the way to the final rehab sesson -- and beyond) as a *FUN* activity, a way to *LEARN*, and as an *INTERESTING* experiment as well as a chance to *SHOW OFF* (e.g., "Hey, watch this folks....") I was able to co-opt the physical (and psychological stresses of the surgery in a similar way.

Thus, while I claim that the key element for success is the skill of the surgeon (Dodge is the best in the world), Dr. Dodgin can honestly claim "It's the attitude of the patient."

There are actually many factors and having the surgery done as perfectly as possible is a big part of a a PERFECT result, but believing the whole process to be FUN and VALUABLE is another.

There is a direct relationship to hypnosis and many hypnotic phenomena, of course. (E.g., 'Placebos are 37%* as effective as Morphine in reducing or eliminating pain.')


* Arbitrary number, i didn't look it up and don't recall the actual figure, but it is something similar to this when controls are used in such studies.

May the Force be with you.
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
Wow! 3000 for the surgeon? You got off cheap. My fee is more around 7k (and before you think, well, he is raking it in, most of that pays for my practice, my assistants, hospital charges, etc, etc, etc - I actually get very little for myself by the end of it) and despite my ranking, I am at the cheaper end, because I am a staff cutter and not an outside consultant.

Well done, Herb - you are right, your attitude makes all the difference.

While an incompetent surgeon can really bugger things up, and on occasion so can a good one (it happens - we're human. Sometimes) the real point of failure or success is the patient - naturally, their anatomy and individual problems but also their attitude and determination to heal and make lifestyle changes - the actual surgery isn't guesswork any more - it is very precise and controlled, prosthetics are of an incredibly high grade of material, custom fitted with tried and tested techniques and cements, the drilling is partly computer controlled against x-ray images for precision, and the greatest point of failure on the part of the surgeon is accidentally cutting nerves or damaging the area under treatment or in closing the wound. While it does happen, it is pretty rare these days - we no longer go in with a hammer and chisel to do this sort of thing, so the sort of failure you get from using brute strength is now pretty much eliminated. We're even starting to experiment with robotising the whole thing for even greater precision and less trauma to the patient (and when they make robotic hands and wrists that are smaller than mine, and as flexible and fine, I will be very happy to support it). That means the variables more often lie with the patient than the surgeon now. I have replaced a joint on an 80 year old woman and she was pretty much hopping about within a week and was 20 years younger within a few weeks, being so free of pain. Did the same joint type on a 50 year old man who did not exercise afterwards, took the physio half-heartedly, made no lifestyle changes and smoked, and within a year he was back on the table for a clean up operation and considerable pain management. The patient is the key to the success of failure of these ops these days. That is why I instruct my charges to assess the attitude of the patient going in and make it an important factor in their history and how they treat the patient. We have been even considering, under the insurance companies' prompting, restricting such ops to motivated patients as the failure rate with unmotivated patients is quite high, all things considered. Heart ops, especially. There is already a premium charge added to smokers who don't quite on many treatments now, as smoking and surgical intervention don't mix well. I have no idea what happens to the money from the charge, but my feeling is that, because the patient is informed of this, it is meant to motivate them to quite smoking. No idea if it works. I haven't cut up anyone since the surcharge was introduced, only supervised others in the procedures, so I actually never met the patients involved.
And this is part of 'my' problems... the 'fun' and 'adventure' of joint repair/replacement is past for me.
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."


Doc Wills, I believe $7000 would be entirely reasonable (remember the hospital is billing $64k).

My Doc was only billing $2500 (the $500 was for extras which I happily agreed to pay if the insurance did not -- Aetna however paid it without a whimper of protest.)

Remember too, that I spent not a single night in the hospital for my hip replacement. I walked out same day using a single cane.

With the knees, I was (unfortunately and unhelpfully) kept over for two days (and decided to stay a third) so that I spent 3 nights in the hospital.

When we see the bill for the knees this will be an additional cost over the hip.

I still need to talk to the hospital's Risk Review Board about their screw ups to ensure that they consider these issues and avoid visiting such problems on other patients.

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
Herb,

Our hospital bills considerably less that 64k unless you are a "private" patient (we have three tiers of health insurance - allgemein, which is obligatory for everyone to purchase and covers all the basic medical related stuff, including GP and pharmacy, then semi-private and private, mostly related only to hospital treatments levels (which surgeons or doctors you get, size of room, number of people in room, menu, etc). But the cost of the joints and milling them is hugely expensive, I can tell you, as is the basic surgical costs. So it probably balances out. Not so sure I would have released you on the same day for hip job, but then I don't know if you would have had the same type of procedure here - each country has their regulations concerning procedures used, and concerning minimum safe stay for monitoring. And yes, good idea to talk to the risk review board - I wish more patients would. Good on ya.
Part of the attractiveness (initially) of my surgeon was the fact that he has been doing "outpatient hips" on a regular basis -- using the "anterior approach" of course.

When he agreed to "let me go as soon as I could go" for the BTKR, he likely had NO IDEA that I would just get up and be ready to leave immediately -- I think that even knowing me (and his own skill) he still didn't BELIEVE.

Also, my wife cried to him afraid she wouldn't be able to care for me (and that would NOT have been necessary since the deal was that I could care for myself.) She was so upset he changed his mind on letting me go.

This was unfortunate and my only complaint with him.

The hospital then screwed my electrolytes, diuretics, and fluid balance in ways I would easily have corrected myself. (I was trained, prepared, and taking the necessary measurements to do so -- and eventually did this myself once released.)

Pain was NEVER a significant issue -- I took myself off the pain meds less than two hours after waking from the surgery due to a touch of nausea -- it was simply easier to skip the meds than have even a small chance of further nausea.

(Then was prompted due to my vomiting once right after they combined my PCA with an IV dilaudid injection and with the after effects of the surgical anesthetics -- it wasn't even a big deal, being over in 30 seconds with no residual effects.)

I simple stopped pressing the PCA button and told them to hold any further IV pain medicine for the night.

The next day, I did switch to oral Oxy (Percoset) at 10 to 20mg to "stay ahead of the pain" and discomfort but there is no doubt that I *COULD* have skipped all further pain meds and had a reasonable recovery. (It was easier with the oxy but that it wasn't a necessity is entirely certain.)

Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."


Sounds like you had an ideal situation, Herb. Most people aren't that lucky, especially with the post op pain.


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