How many of you have had surgery?

[NatCh]

Have you been on the receiving end of the scalpel? I just had my fourth orthopedic surgery yesterday. Not that I’m recommending it, but it can be pretty educational seeing what your patients go through.

Random thoughts as I’m icing at 3am:

• Nausea sucks. It’s worse than pain. Zofran ODT tastes like **** though. Blahhh.
• During anesthesia induction the patient is still lucid long enough to hear the OR staff chatting. Stay positive, professional, and don’t condescend. Your patients can hear you.
• Having to wait for a busy pharmacy to fill your postop prescription(s) one hour before they close when you get home late in the afternoon from your case can cause some anxiety. Being able to pick up meds at least the day before is nice.
• Compassionate nurses are a godsend.
• Ice machines are a godsend.
• Surgery is hella expensive.
• Thank you multimodal anesthesia.

Okay, back to sleep…

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[dtrack22]

Have you been on the receiving end of the scalpel? I just had my fourth orthopedic surgery yesterday. Not that I’m recommending it, but it can be pretty educational seeing what your patients go through.

Random thoughts as I’m icing at 3am:

• Nausea sucks. It’s worse than pain. Zofran ODT tastes like **** though. Blahhh.
• During anesthesia induction the patient is still lucid long enough to hear the OR staff chatting. Stay positive, professional, and don’t condescend. Your patients can hear you.
• Having to wait for a busy pharmacy to fill your postop prescription(s) one hour before they close when you get home late in the afternoon from your case can cause some anxiety. Being able to pick up meds at least the day before is nice.
• Compassionate nurses are a godsend.
• Ice machines are a godsend.
• Surgery is hella expensive.
• Thank you multimodal anesthesia.

Okay, back to sleep…

ACL recon in college. I send post-op pain meds in 2-3 days before surgery. I also tell patients to take a pain pill post-op night 1 even if there is no pain from a block as mine wore off around 1-2am and I thought my knee was going to explode through the skin. Nobody warned me. Hard to catch up with that pain and get back to sleep. They must have given me enough versed before wheeling back that I only remember coming through OR room doors and nothing else after that.

 

[Feli]

Really good thoughts.
Wishing you a speedy recovery.
How the heck do you put bullets in posts???

...I have only had abdominal surgery... reeeally takes your energy away for a week or two. Comedy movies are a very bad idea.

I have always done the Rx and DME logistics at the pre op visit the week or two before surgery date...
-Rx written for analgesic, nsaid, etc
-DME air boot, Rx for walker, etc ... tell them to practice with them
-get ice packs for behind the knee, create clear paths in the home
-temp handicap parking form, tell them to go by MVD
-recommend good grocery shopping, get some movies or books or etc cued up

I think the forward-thinking logistics are really a big help. I still get the occasional pre-op morning where the patient tells me they are going to get the hydrocodone on the way home, but its rare with a good pre op consult. I am not sure how to deal with the patients who think they'll "probably be ok with just tylenol" ...don't really want to argue with them, but 95% are way wrong. I just say, "well, it's bone surgery, and it hurts even if performed very well... we will send it in and I hope you fill it so it is available if you need it."

I do a lot of revision bunions and other stuff now, and I hear commonly pre op how painful the original surgery was (often just Austin or McBride and stuff... sometimes bilateral tho). I think those guys are nuts who make the patients go by pharma on the was home from the surgery or who weightbear right away. I do NWB everything -even soft tissue and lesser toes - for at least 2 weeks (NWB best of pt ability) just from pain/edema/wound healing standpoint.

It's too bad 99% never learn this stuff in school or residency. That's just what works for me.

 

[NatCh]

Years ago I had a patient no-show for her surgery and completely ghost us after picking up her pain meds so after that for awhile I only made the Rx available on the day of the case. I've revised my approach since then, deciding that I was maybe overcompensating for what was likely a one-off event.

I've been sending patients home with DME two weeks before surgery so they can practice living with it beforehand -- especially navigating staircases.

Oh yeah...

Click the drop down menu and select "unordered list" for bullets

 

[DYK343]

I hope you have a speedy recovery Natch

• I always give medications the visit prior to surgery.
• I call them around 5pm the day before to answer any questions they have and if they havent got their meds I recommend they get them that night.
• I usually supplement the first week with Ibuprofen/Naproxen as it helps signficantly and I havent seen any higher chance of non union from it (I do tell them to stop after the first week).

So far I havent had anyone take the meds and bail but im sure it will happen.

 

[PlainsPod]

I had a tibial sesamoid that looked like a bomb went off in it from repeated stress fractures. It was miserable. I had it removed 13 years ago by a foot and ankle ortho (j/k it was one of my partners) , and haven’t had a day of pain since….no iatrogenic HAV either

 

[Feli]

I had a tibial sesamoid that looked like a bomb went off in it from repeated stress fractures. It was miserable. I had it removed 13 years ago by a foot and ankle ortho (j/k it was one of my partners) , and haven’t had a day of pain since….no iatrogenic HAV either

I had this also... never surgery for it, but it was a nightmare to walk for many months, esp sand beaches in Miami during pod school with max dorsiflex. I was able to just offload and protected WB, but it took a long time.

It's amazing how much even 'minor' stuff can hurt with all of the terminal nerve endings in the toes and fingers.

 

[ExperiencedDPM]

Yep, I’ve had my share of surgery. Contact sports will often result in surgery.

I am not a believer in prescribing narcotics pre-op, but that’s a personal decision.

I spend time in the office prior to surgery to reassure the patient and discuss concerns and the post op course. I also hand out a 4 page folder that has “all” the answers.

I always speak with the patient and family if possible in the pre op area and always speak with the patient and family post op. Always.

And I call my patients in the evening to confirm I’m there for them and to answer questions. They may have been drowsy post op and I want them to know how important it is to follow my written instructions.

I treat my surgical patients like gold. My most recent surgery was a knee scope and I never saw him once post op. In the ASC I didn’t see him and I saw his PA post op.

Not the way I run my practice. I want my patients to know that I appreciate the confidence they put in me and I want to make sure I honor that commitment.

 

[ExperiencedDPM]

And rumor has it that the reason for NatCh’s surgery was because of the stress to his musculoskeletal system carrying all his money to the bank.

 

[NatCh]

And rumor has it that the reason for NatCh’s surgery was because of the stress to his musculoskeletal system carrying all his money to the bank.

I wish!!!

 

[dtrack22]

And rumor has it that the reason for NatCh’s surgery was because of the stress to his musculoskeletal system carrying all his money to the bank.

It’s just carpal tunnel from flipping through and counting all of the $100 bills

 

[ExperiencedDPM]

It’s just carpal tunnel from flipping through and counting all of the $100 bills

Yep, that BIOFREEZE really brings in the bucks.

 

[NatCh]

Nahhh, I'm just a poordiatrist.

 

[NatCh]

It’s just carpal tunnel from flipping through and counting all of the $100 bills

$1 bills weigh just as much!

 

[heybrother]

$1 bills weigh just as much!

Me: Anything else I can do for you
Patient: I'd take 10 lbs of $10 bills
Me: My nurse is always asking me for a million bucks. I think she'd be pretty pissed if I gave it to you instead.
Patient: 10 lbs of $10 bills is not a million dollars.

Turns out he's right.

 

[dtrack22]

Turns out he's right.

Well…how much is 10 lbs of $10 bills?

 

[NatCh]

Well…how much is 10 lbs of $10 bills?

$454!

 

[ExperiencedDPM]

Apparently NatCh is used to all those paper bills from his time on the exotic male dancer circuit. Rumor has it that he was let go because they found out he was a podiatry student and part of his exotic outfit included a stethoscope.

 

[heybrother]

Well…how much is 10 lbs of $10 bills?

Internet seems to believe a million dollars in $100s weighs 22 lbs. A bill weighing about a gram.