Planning Orthopedic Surgery: Ask Ahead About Aftercare

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Don’t make the mistake of thinking that orthopedic surgery will miraculously dispense with your bone problems; aftercare is just the beginning of healing. That’s how two women see it. Each woman has had five or more orthopedic surgeries. They report that sometimes they felt abandoned, as if nobody was in charge, and their questions were not answered adequately, or on time. One woman, “Terry,” a wall artist and jeweler, had neck, shoulder, and hand surgeries in the mid-Atlantic; the other, “Gina,” had hip surgery at a few centers in California. Both women said that some of their surgeries went well and aftercare was not a big issue. But for other surgeries, it was hard to figure out who was in charge, and aftercare procedures seemed non-existent. By telling their stories, they hope, for the sake of other patients, orthopedic programs develop more systematic aftercare procedures.

Gina’s hip surgeries at teaching hospitals began when she was a child. She had many satisfactory surgeries, but one left her with intractable pain. “ I never should have been released when I had a pain score of 10 [the highest score]. They never managed my pain. They would just blame me and tell me about how none of the other kids that they treated had pain. I think, especially in pediatrics, they have to trust the patient.” Gina returned to the hospital as an outpatient for six months because of intractable pain. When it came time to have her final surgery after puberty, she refused to go back to that hospital, even though until that time, she and her family had built up a strong, personal relationship with the doctors and the staff. She and her family traveled to a neighboring, but much less convenient city, and they say that they will never go back to the place where her pain was a long-term nightmare.

“Unfortunately,” said Gina, “I think orthopedists think that once the surgery is done, they are all through, but for the patient, the recovery is only the beginning.” Gina also pointed to a lack of clarity about rehabilitation, including physical therapy and occupational therapy. Gina’s mother recently had a knee replacement and she had occupational therapy after surgery, and her recovery has gone extremely well. Even though she was far more comfortable after her last surgery, she said: “I still cannot bend down to tie my shoes. To this day, I wonder whether I should have been referred for PT or should have been told that this is the best that the surgery could do. Was it up to me to ask for physical therapy?”

Terry’s last surgery, to graft two bones together in her thumb, was by far, her worst, in terms of aftercare. Terry considers herself an easygoing person, but she regrets having gone to a big center where nothing gets relayed back to the doctor. I interviewed her when it was close to three months after her last hand surgery, the point at which she was supposed to be healed. “I think I am healing, but truthfully, I am not sure.” That’s because, whenever she had follow-up appointments, she knew that she had to have all her questions organized and not try to get something answered between appointments. “If I forget to ask a question at the appointment, I have to forget it.” After living through telephone menus, getting put on hold, and never knowing where she is being referred to when she calls from home with a simple question, she feels that she often hit a dead end or a dead-letter box.  “Sometimes they can’t find a hand surgeon or nobody wants to comment if that is not their specialty,” she said. Shouldn’t there be some person responsible for handling these things?”

Pain was hard to tolerate in her last surgery. Terry said that getting pain prescription before discharge was impossible. They told me: “We can’t give you anything because you are leaving tomorrow.” That left Terry with having to recruit her husband to go to the drug store to get her pain medication and a hole in time when her pain was not fully covered. During her three-month recovery period, “sometimes, I would call and they wouldn’t get around to ordering the pain pills until the next day.”

Terry does not feel that she has gotten timely feedback on restrictions in this last surgery either. “I have animals: big dogs and horses. It is not practical for me to have months on end where I cannot take care of them. I have tried to ask, is it going to do harm to walk the dog or get on the horse? People never call me back, or if they do, the answers don’t seem very helpful.”

Concerns that she felt were not addressed included getting someone to tell her whether pressure on her hand was as bad as lifting and how to deal with a lot of pain. Often, she found that, if she got someone to talk to her, their responses seemed more focused on their own liability rather than her needs. For example, she said: “When they tell me three months out to try and rest my hand, I want to say to them, how about patients who just don’t have restful lives?”

What Good Aftercare Might Look Like

Both women felt that relatively simple systems could be put into place that would not have left them with a sense of patient abandonment that put them into a funk. Gina suggested that just being able to send an email and know that your doctor was going to get back to you by the end of the day would be a big help. There also has to be a shift in medical training so orthopedists don’t just walk away and abandon patients after surgery.  Both women think that a written description of what to expect after surgery would be a major plus.

I contacted the American Academy of Orthopaedic Surgery  to reach an orthopedist for comment, but at press time, I had not heard back. Since this article was published, I learned that an  orthopedist will be getting back to me. A response will be published in the comments below.

Have you had a hard time recovering from orthopedic surgery? Was it difficult to reach people who could advise you about mobility, activity restrictions, or pain? Or did things go smoothly because you had your surgery at a place that had good aftercare practices in place. Let’s hear from you. Consider leaving a comment here.

 

This entry was posted in Aftercare, Orthopedic surgery, Pain, Physical therapy, Rehabilitation. Bookmark the permalink.

10 Responses to Planning Orthopedic Surgery: Ask Ahead About Aftercare

  1. HARRY BOLLES says:

    In the ’60s I had a full patellectomy. I was told to do leg lifts with a five pound can, or bag of sugar. Strap it on somehow. Noone was going to help me with that and no facilities were available. I did it half-heartedly and irregularly, and have never felt my muscles came back to full strength. I don’t remember troubling myself about the “post.” After surgery — still in my hospital bed — one of the interns came in and had me do some leg lifts. It strained my wound which began to ooze at the stitches. Later, when the surgeon was visiting, the intern suggested I do some leg lifts, but the surgeon said to wait a few days for that. In later years, I found that orthopedists were completely unacquainted with the after-effects of a patellectomy, wondering if I could climb stairs, or walk without pain. In fact I do just fine.

  2. Galina says:

    You are absolutely right. In many cases patients are left to figure out what to do next. Even if after surgery they are able to get help with Physical Therapy they would still need to continue to train their bodies for years to come, if they want to live a full pain free life. I have a solution to the problem- we offer highly individualized wellness solutions that address the issues that are discussed in this article. We work with people to help them to live their lives to the fullest by eliminating aches and pains with corrective fitness, by addressing all systems of the body, and how they interact with each other. Comprehensive structural evaluation allows us to get a perspective on a condition of your body and to create a program that would lead to strengthening it as a whole.
    Add healing yoga and health and fitness life coaching (services we offer) to your corrective fitness sessions and you will see the results in no time.

  3. I went in January 25th, 2011 for a basic hip arthroscopy to fix some acetabular impingement. It was an easy procedure- 3 incisions, 2 hours, 1 long recovery. It went seamlessly and I was home by dinnertime.

    I was told before the surgery that physical therapy would be necessary for rehabilitation. What I was not told is that the waiting list for their personal therapists was approximately 6 months long. The other office they recommended did not have the best waiting time either.

    Luckily the second office’s owner was willing to take time from his lunch to come and work on my hip. I am two weeks away from being done with therapy, and cannot wait.

    I don’t understand why my mother and I were not told to set up appointments prior to the procedure- it would have caused a lesser headache had we been told. I am thankful for the owner who chose to come and give me part of his lunch break. It has gotten me back up on my feet and I am walking well again.

    Patients need to know upfront what all their surgery and recovery will require of them. It is unnecessary to put that extra burden on a post-op patient recovering from any surgery. Tell it to them like it is- dates, times, expectations, medications, additional appointments. All of these things are standard and should be told upfront.

    Michelle

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  5. Tracey G says:

    I agree totally. Last year I had Open Heart surgery to repair a hole in my heart and the roadmap of recovery was very well mapped. What to expect..at week 1 through 12. Later in the year in August I had surgery to remove the broken piece of my heelbone. The surgeon who did the procedure never asked what exercise I was doing before the operation (5 x 4 km walks per week) so at my 6 week checkup he said “Just take it easy” WTF does that mean? After another 6 weeks (now November) he said “If its still stiff in March come and see me”.
    After a couple of weeks of stewing about it I wrote him a letter as he doesn’t do email and asked him to refer me back to my Sports Doctor. Her comment was “How lovely, James has reffered you back to me”.
    The Sports doctor also advised me to take it easy – if you don’t know anything about my life…how can you say that? What’s taking it easy for me might not be the same as the next person.
    In the end I was sent off to a Podiatrist – Fantastic stuff. He said I had pain, stiffness and a limp because, just wait for it, I hadn’t been exercising it!!
    Next time (cross fingers there’s not one) I’ll know what to ask and when to ask it.

  6. Rashad says:

    Perfect information, I am browsing back again persistently to look around for upgrades.

  7. Michelle says:

    This is really helpful information. If the doctor you are seeing does not discuss aftercare, that is a clear sign they may not make it a priority. They should be able to tell you ahead of time if you need physical therapy, who to set it up with, and any changes in life style that will be necessary after the surgery. Part of me thinks that part of med school should require the med students to experience some of the difficulties associated with aftercare. For example, they should experience life with a cast on or what is like to have to constantly ask friends or family for assistance with basic tasks.

  8. Eve Harris says:

    Almost 1.5 million Medicare beneficiaries’ can’t lie! Based on the abstract of an observational study published today in JAMA, poor post-op planning is a HUGE problem! While total hip arthroplasty hospital length of stay has decreased, readmission rates have jumped. What’s in between D/C and R/E? Many times it’s lousy aftercare. Sadly, it happened to my father after a revision surgery (which the study found essentially the same as primary). I regret that we were unable to advocate sufficiently for him and he continues to struggle, seven months post-op.

    • Laura Newman says:

      Thanks a lot for your comment. I will take a look at this article in JAMA. Well I still haven’t heard back from the American Academy of Orthopaedic Surgery. Maybe between the JAMA study and this piece, orthopedic surgeons will start to recognize the problem.

  9. Michael Cox says:

    I was referred to an orthopedic Surgeon for total knee replacement. At the initial meeting he was extremely personable, knowledgeable and confident about the procedure. I expressed my biggest concern which was pain management during the 6 week post-op period. He assured me that any pain concerns would be addressed post-op by his experienced staff and not to worry. My wife and I decided to schedule the surgery as soon as he was available as I needed relief for my bone on bone condition. Prior to the surgery date, I went to the Surgeons office for a pre-op examination with one of his P.A.’s, and I reiterated my pain concerns, as i also have pain issues with my orher leg from a previous accident, and was given all of the same reassurances regarding aftercare pain management. I came throught the surgery and was in intense pain but felt like it was managed as well as possible by the hospital staff. The Surgeon visited me each morning, he was very personable and had an excellent bedside manner. i was released from the hospital 3 days later and that is when “all individualized treatment” came to a complete end. I had to call his office each Monday to request a “one week supply” of 40 loratabs, and was told not to call before Friday because they weren’t allowed to give me additional pills. Each week, they reduced the milligram amount of the lots tab. I complained to my home health care providers, nurses and therapists that my pain was higher than I felt it needed to be but they said the surgeons office did not like them to contact them regarding patients pain complaints. Finally, after the fourth week, I confronted one of the surgeons nurses on the telephone and asked her “if you have a patient who is female, 80 years old and weighs 120 pounds…does she get the same pain meds as a male, who is 53 years old and weighs 270 pounds?” And her reply was ” yes, absolutely, the Surgeon has an aftercare protocol and it is the same for every patient”. So much for individualized aftercare!!! My advice is this: Do not count on your orthopedic surgeon or his office to treat your pain differently than any other patient. If you have a high tolerance for pain and do not mind being intensely uncomfortable for 6 to 8 weeks then it might not be a problem for you. But, if you have a low pain threshold and/or other issues that cause you pain, then Do Not Trust your orthopedic surgeon to meet your pain needs! After some research, I have found that almost all of these orthopedic surgeons have “Aftercare Protocals” and their office staff personnel are trained not to deviate from these protocols. My surgeons office personnel actually “guilt” you and make you feel like a drug addict if you question their “one size fits all” pain med protocol! After this experience I will avoid orthopedic surgeons at all costs, and if I ever need another orthopedic procedure, I will “load up” and hoard pain meds prior to the procedure so that I won’t “needlessly suffer” during the recovery process!!!

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