Hip replacement - Pre-Op (long 🤷)

[Jan]

I had my left hip replacement surgery Sept. 21st. I thought I would share some interesting and/or funny parts that might be helpful for someone in the future, knowing what to expect, starting with pre-op stuff. And also to share that I have Generalized Anxiety Disorder and severe white coat syndrome, and I made it through this, so you can too!

Due to increased risk of infection from diabetes, I had to shower with Hibeclens antibacterial soap 5 days prior to and the morning of surgery. Also used mupirocin nasal ointment 2x a day for 5 days prior. Clean sheets and pajamas the night before, and clean clothes the morning of.
The instructions for Lantus were to take 80% of my usual dose the night before.

Check-in time 5:15am (they do diabetics first), shower before leaving house, 1hour drive, so not much sleep. No food after 10:30 pm, only clear liquids until 4:30am, then nothing. At the 4:30am cut-off, I had to drink 20oz water (clear Gatoraid for everyone else). They said it reduces nausea and dehydration after anesthesia. I was worried about having a low, as I had been running low the last couple of weeks, but BG was ~200.

Checked in at pre-op, took three tries to get IV in, my BP was over 200 . The anesthesiologist said if my BP didn’t come down, they’d have to cancel. More anxiety. I knew they wouldn’t wait too long, this orthopedic surgeon does 5 surgeries per day. Finally they gave me something in IV to bring BP down.

My Covid antigen test came back positive ! (More anxiety!) I had Covid end of May, so the pre-anesthesia team told me I wouldn’t even have to be tested! My nurse said I was cancelled, no ifs, ands or buts. I begged and pleaded… I’ve been waiting for 5 months…

The nurse convinced them to do a second test, which they never do. The second antigen test came back negative. I could hear the surgeon and anesthesiologist discussing what to do, and they finally said to go ahead.

The anesthesiologist came in and talked with me, she said I could keep my Dexcom on, and they would use it during surgery. They put a bright pink “limb alert” wrist band on my arm with the Dexcom.

The last thing I remember was sitting on the side of the table, and the anesthesiologist saying, “Just a little poke…” (I had a spinal block.)

Follow up will be “Hip replacement - Post-Op.”

[TomH]

@Jan Thanks for putting this up! While not as extensive as you’re by any stretch, I’m scheduling a hernia operation in the next month and have been reviewing what I need to tell/negotiate with the doc/anesthetist/etc, whether to put a T1 wristband before going, etc. Had a friend recently have her knee done and it’s amazing how quickly they get you up and moving these days! Hope all works out well for you and look forward to your followup!

[Jan]

@TomH

I told everyone I met that I had a Dexcom, and how it worked, etc. I would have told the janitor if I had met them! Just keep pushing!

[Eric]

@jan, that sounds really rough.

I am surprised that they said 80% of your Lantus because that actually sounds…reasonable! You never know what foolish stuff they are gonna come up with - “No insulin for you!”

Glad you were able to get through the surgery. Having to reschedule it would have been lousy.

I will be praying for you for a smooth recovery.

[Jan]

@Eric

Actually the 80% was too much of a reduction. My BG has been high and very resistant ever since the surgery. This may be a result of specifically orthopedic surgeries, since they essentially do carpentry work on your body. I had to call the Diabetes clinic on Friday (2nd day home) because I was in the 300’s and it wouldn’t budge, no matter what I did.

Here was their response: “Be advised that this type of glucose increase is very normal and related to the stress of surgery, post operative pain and decrease in activity levels.”

They told me to increase my Lantus to 10u. I originally was on 7u (5u the night before surgery). I thought 10 was way too much, so I only increased it to 9. Guess what, they were right, I’m still running high, but with corrections I can get it down to the 140-150 range. Tonight we’re doing 10u!

[Jan]

@Eric
And thank you very much for the prayers! I definitely appreciate them. My memory verses have helped me tremendously get through this, both the anxiety waiting for so long, and staying calm during the surgery itself.
Proverbs 3:5-6
Colossians 1:12
1 Peter 5:7
Deuteronomy 31:8
Isaiah 40:31
Isaiah 41:10
Psalm 27:13-14
Isaiah 43:19

[CatLady]

@Eric

know what foolish stuff they are gonna come up with - “No insulin for you!”

I had cataract surgery last Wednesday and the brochure I was given said to “stop diabetes medication and don’t give morning insulin”. I will be offering the practice some thoughts on this, believe you me!

Anyway I told the doctor I use an insulin pump and would do a temporary basal reduction!! I wore my Dexcom, too, having confirmed the reading with a fingerstick, and showed the nursing staff and anesthesiologist. They were totally cool with this!

ETA Gosh, I have learned a lot here!!

[Eric]

@Jan

Actually the 80% was too much of a reduction.

Sure, but the thing is, if your BG dropped to below 70 during the surgery, they would have freaked out and injected you with a bunch of dextrose. So at least 80% was better than some of the recommendations you hear from them.

But after you are done with the surgery, it makes sense that you need MORE insulin because you are stressed and not moving around as much.

As long as you are comfortable with being able to eat carbs if needed, (not sick, not throwing up) and you are conscious and coherent, you can be aggressive with your insulin again.

[TomH]

@Jan It may be “normal” but not desirable if it can be brought down appropriately and safely! I’m with you regarding sounding like a signficant increase in dosing, despite the fact they may have been right in this case; I think it better to go your route and do a partial, see how it works, then add if needed. It’s easier to give more than try to get some of an injection back! Anyway, glad you got under control! On the recovery, hope you get a get a good rehab experience, remember, they aren’t your friend, their job is to ensure a good recovery!! Best wishes…

[Jan]

@Eric @TomH

@Jan

I thought 10 was way too much, so I only increased it to 9. Guess what, they were right, I’m still running high,

Well, I am stubborn! I thought because I had some success with corrections that I was on the road to less insulin resistance. So I only took 9u of Lantus again last night, and here I am above 200 this morning.

Can you take additional basal (Lantus) in the morning? Or do I just have to do major corrections until my next night time dose?

[bkh]

@Jan

Can you take additional basal (Lantus) in the morning?

There’s nothing wrong with taking 9u in the evening and 1u in the morning. Then you could drop back to 8u evening and 1u morning when you become more sensitive to insulin, and then 8u evening and skip the 1u when you no longer need it. Or any other sensible pattern that gradually increases and decreases insulin as your body’s requirement changes.

[CRB]

That’s the way!!
CR

[BillKast]

Thank you for the detailed share! I know this is scary stuff and you did great.