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Her pain is terrible and she has to take Codeine and Paracetamol (she's tried other painkillers with bad side effects). She wants to avoid an operation due to having a stroke and age, but she is so sick of taking painkillers all day - they are making her sleepy and feel crazy! Any advice or help would be really appreciated.

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Success with any joint replacement depends on motivation and preparation.
Spinal anesthetic and heavy sedation is the way to go. As someone said you don't want to hear the saws and hammers during the surgery. There can also be considerable discomfort to the shoulder you are forced to lie on for a couple of hours for a hip. Surgery won't be successful if you don't do the rehab. It will be uncomfortable but take your pain meds half an hour before the session and it won't be too bad. Being overweight greatly reduces the chances for a successful joint replacement.
The use of narcotics for pain relief is greatly misunderstood.There is a big difference between addiction and dependence. I use the analogy of the diabetic who is dependent on Insulin. Using narcotics where there is a genuine need for the relief of pain for a short time will not cause addiction. Long term use again with the need for pain relief will cause dependence. Overtime the need to increase dosage or change the narcotic may make it necessary to increase the dosage as the patient becomes tolerant of the medication.It is very important to treat pain before it becomes intolerable as once it gets out of control it is much more difficult to relieve and may require much higher dose of the drug with the danger of side effects. It is very important to remember that any drug combination that contains Acetominophin {Tylenol} does not exceed the recommended daily dose because this may cause serious harm to the kidneys and can lead to death. If pain is out of control it may be necessary to use a more potent narcotic to regain control. Narcotics are not necessarily the first choice for pain relief. heat, ice, muscle relaxants, massage, anti seizure meds and OTCs all have their place to mention a few as with relieving other bodily problems such as infection, constipation and urinary retention. after a joint replacement swelling, stiffness, pain and some loss of blood are all normal but if the area becomes red and hot and the bodily temperature is raised along with increased pain these are all indications of infection and need immediate medical attention.
I have had a hip and knee replacement and can report excellent results. I was active before the surgery but am now active and pain free.
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Get her to talk to some folks who have had it done, like dandibelle. I just had a knee replaced April 19, spent two weeks in rehab (Nursing Home) and feel just great.
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I am a senior. I fought for 2 years against having a replacement hip operation even though the pain was unbearable. I couldn't walk in the end. I decided with great trepidation to go ahead and do it. What a wonderful operation. From when I came round from the anaesthetic I felt so much better. I was out of hospital in 4 days and could walk up and down stairs. 5 months later I had the 2nd one done. My life is is unbelievable from what it was just a blur of pain. I can walk for hours pain free. Go for it. There is no life without the operation.
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yes I think Lidoderm patches are very good to try.
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Pain relief can happen using a number of various alternatives that have far less adverse effects.
Any that decrease inflammation, help both to lower pain levels, and also, help body repair itself.
Hospice practitioners know, that dosing anti-inflammatory agents is FIRST choice, to reduce inflammation, THEN see if further pain meds are needed...that tactic usually allows far less narcotics to be used, which increases quality of life.
Some non-drug anti-inflammatories include:
==TURMERIC. For large problems, one might need to use larger amounts. capsules that equal about 1 tablespoon a few times a day, if pain is real bad, then decrease it to learn what is best for person. Take it with food. It tastes like Curry, because it is part of what curry is made from.
==OMEGA 3 fatty acids: for greater pain, one may need to consume 1000 mg. per day or more, of only the omega 3's. this stuff not only lowers inflammation and pain, but it helps mental processes, helps overall health. It can be got from fish oil, flax seeds, chia seeds.
==MSM: Methylsulfonylmethane. This is fundamental sulfur--NOT sulfa drugs. One cannot be allergic to MSM, or they pretty much cannot be breathing!
Fundamental sulfur is one of the body's main building blocks.
It can help decrease inflammation, decrease pain, and helps rebuild/repair body. I have started with a lower amount, like 1000 mg daily, then built up to several grams daily. Maintenance might be 1000 mg daily, and can be split over the day.

Acupuncture is great stuff, done right.
You could see if an acupuncturist in your area would teach you to do the required points, and/or, show you how to use magnets instead of needles--that way, fewer office visits to pay for.
SOME insurances DO cover acupuncture, particularity for pain control--while Medicare does not, if one is enrolled in a Medicare Advantage Plan, some of those plans DO cover it.
Group Health, in WA does, for instance...if they lack in-house practitioners for it, they will refer a person to an outside practitioner, and cover it as if done in-house.
Kaiser Permanente might do that now, too--years ago, they were just starting to get their feet wet in that art, so didn't really offer it then--they might, now.
Ask around!

She's got rheumatoid arthritis...an auto-immune issue. Which might men she is more sensitive to many medications. Talk with the Docs--they know how to arrange these things.
While there is a potential that surgery might stir up/aggravate an auto-immune issue, it is more likely that removing inflammatory issues, by replacing the deteriorated hip, might help calm down the auto-immune issue with the rheumatoid arthritis, simply by decreasing the amounts of chemicals that rattle around in the body flaring things up.

The real key is, your Mom sounds like she is raring to get out and do things--tht means she is still motivated.
Those already impaired too much by illnesses, lose motivation, and stop doing their exercises or complying with protocols that would help them--or else, they are too confused or tired to do it.

OTHER pain meds: non-standard:
While many do not live where it has been allowed for medicinal purposes,
SOME do.
It requires a medical recommendation to get Medical Marijuana.
It can be got as a Creme, which, applied to skin over painful areas, does a remarkable job of killing pain, with few side effects. Those types with higher CBD's are most medicinal and less sleepifying.
Got as a liquid, it can make some folks very sleepy, kills pain, can reduce gut irritations, relieve some asthma, and can decrease some myoclonic seizure activity.
And no, it does not cause "munchies", but, it can allow those who have stopped eating related to nausea from chemo or other ills, to eat.
It is less addictive than harder drugs, and has far fewer adverse effects.
Seriously.
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Sunflower,
Tell your Mom, that these days, hip replacements and repairs are usually done laparoscopically. That means, instead of huge incision, only smaller holes are made to access the works, which means, people are usually able to get up and at it far faster--sometimes same day.
Pain levels for recuperation are much less than dealing with deteriorating joints!
A spinal anesthesia might be accompanies with some general relaxants--one usually does not want to hear the sounds of that operation!
I spoke with a gastroenterologist who had picked just the right anesthesia--it was far easier on me than some others.
TALK with the anesthesiologist, to let them know to use gentler, easier to recover from anesthesia types.
As for a spinal anesthetic:
Rule of thumb I learned in nursing school was, keep that patient FLAT down, for 8 hours post-op, before letting them, or anyone else, lift their head, at all---this prevents post-anesthesia headaches happening.

Knees: If the hips are not working right, knees can suffer.
If knees are not working right, hips can suffer.
Often, the lateral leg muscles that control ability to swing leg away from midline, get weak with age and disuse. When that happens, knees start to bow in--become more knock-kneed, and this can cause increased pain in both hips and knees. Solution to that: exercise those lateral muscles--it helps those and helps the buttock muscles and low-back muscles to support both hips and knees.
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I have my fiances mother who lives with us. she is a cancer survivor, had diabetes, a heart condition, and numerous other medical problems. she fell last year (she is 89) and broke her hip. she had the hip replacement, and is fine. she gets around just like she did before. She did everything the doctors and therapists told her to do.
I know it is hard to get the elderly to realize that they will be better off after the surgery. My own mother had both hips replaced (she is also 89) refused to do the therapy and now can barely walk because she did not do what she was supposed to do. She also can't hear, see, has fluid buildup in her ankles and has a large cyst on top of her head. She refuses to get any of them taken care of. "no more surgery for me" she says.
So there you have it. I have seen it from both sides and I can tell you Ruth (Fiances mom) gets alot more respect from me than my own mother, who just doesn't take care of herself at all.
Your mother should get the surgery and then she will not have to take the medicine anymore. all she has to do is work with the doctors and the therapist and she will be fine. If Ruth can survive this at 88, I am sure your mother can too.
She will be so surprised at how good she will feel and move too.
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That's a hard decision at your mothers age and considering she has had a stroke and has knee pain as well.

Hard to tell whether it will be for the best or not.

My father in law had his knee replaced AFTER having a stroke....he walks EVEN LESS now.

He too was in his mid 80's

For my father in law it didn't help because, he caught an infection in his leg....he told them it hurt, but doctors didn't realize until a year later that he had a bad infection going on inside his knee/leg that had the knee replacement. He then had to have a second replacement.

Another downside for my father in law, was that, he is weak on the opposite side of the knee replacement from the stroke...that makes it hard for him to walk, because one side is weak from stroke and the other is from a replacement.

Also, he grew tired and did not want to do that physical therapy.

His other knee hurts him now...he wont have it replaced.

Its so hard when they get to a certain age. Iv read we should have replacement done by our 60's or 70's....or if we are older than that and in very good health....
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Sunflowers45, I just want to say right off that I know nothing about knee/hip surgery, and have heard opinions for and against. I myself have severe chronic pain from various sources (fibromyalgia, arthritis, disk surgery, Degenerative disk disease...) and was places on the Fentanyl Patch, which is pretty much the only game in town for pain, if your Mom doesn't want pills. Not only is this stuff prohibitively expensive without good coverage, it is addicitive. When I say "addicitive," I am really referring to drug dependency, which may not have anything to do with a person's likelihood of abusing drugs. Your body simply makes the decision without input from your brain/heart, and that's pretty much that. Once dependent, a patient may, over time, require higher and higher dosages to get the same relief, but given her age, that's unlikely to be much of a problem. I would say do whatever is necessary to stop her pain. Why on earth should she be in agony all the time? However, given the fact that narcotics can be dangerous when one is extremely old, extremely young, or weakened from other conditions, I would definitely say go to an Orthopedic Surgeon first, as has already been suggested.
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As someone suggested Voltaren gel, just be aware it causes stomach upset, and not just a slight tummy upset. Use cautiously! There is even a small ruler inside the box to dispense a small amount. I used half of what was recommended, and I became extremely nauseated. I stopped and the nausea stopped (this side effect is listed). Have you tried acupuncture for pain? It works great except Medicare doesn't pay for it - yet.
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Your mother has to try Zeal for Life. It is a whole-food nutrition product (not another medication) packed with anti-inflammatories and antioxidants. It is powder you mix with water or juice (not another pill). And it really works! Zeal alleviated the arthritis in my neck that used to cause daily headaches and migraines. My friend Betty says it helped her arthritis better than all the medication she was taking. And the testimonies go on and on. Although I sell it because of what it has done for me and my family, this is NOT a sales pitch. I truly want to help people in need. Check it out online. They even offer a 30-day money back guarantee!
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Thank you very much to everyone for replying to my question! I tried typing this before but not sure it went through.

Mom is 83. She hasn't been able to walk more than a few steps here and there for about 2 years now. She has carers to help her. Despite this terrible pain, she still has an enthusiasm to still get out and about. She accepts the time it would take to get over the recovery and everything that involves. She wants to know people's experiences of recovery after this operation, and how they reacted to the spinal injection (instead of General Anesthetic).

She also has bad rheumatoid arthritis in her knees, and wonders what effects a hip replacement could have on them.

I can't wait to show her your helpful replies! Will be writing again soon.
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My FIL had a partial hip replacement at 94 years of age and did remarkably well.
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If she is over 80, make her comfortable first, the arthritis is probably in more than just her hips. If she had a stroke, would she be able to comprehend all the rehab process and do a lot of hard work? Don't let the MD's push her into surgery if she is opposed to it, respect her wishes.
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Correction ... Above last paragraph shd/say "...increases cortisol, a MEDIATOR of many..."
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Sunflower45...RichardJ is right on. Investigating the expectation if post-surg mobility is important. Before answering, l read ur profile - u dont state mom's age there or in ur post, so some responses r in the dark so 2 speak. U did state that her primary prob is mobility. If thats the fair dinkim, l inferred that she was otherwise in good health. She sounded like my mom, a healthy elder 'cept 4 joint junk.

SuzeQ - sad & hard for u & ur mon that she still has hip pain after her surgery. Degen discs in back could cause "referred pain" to her hip and leg. Ask the doc about this. Combo of Voltaren gel on hip & lidoderm patch on BACK (thanx
LadeeC) might b of help. And ferris1 is a nurse, maybe even a Nurse Practicioner. I dont think anything she wrote was illegal. She is a caretaker too. We are all sharing experiences here to help one another. Some of us have broader experuences than others and sharing those COULD seem like telling someone what to do but l think even if an MD posted here, it would b understood that it would b w/ the proviso that s/he had neither examined the pt nor taken a history, so all said is just information & suggestion w/ the necessity of the pt & his/her caregiver seeing the doctor.

However, ferris1, consenting 2 surgery doesn't mean going off all pain meds. Pts can take narcotics up 2 nite b4 surgery so l dont understand ur comment. Pain meds r continued post surgery by injection, bolus/PCA machine or, later, orally. Perhaps u neant a person on NSAIDS, b/c of the blood thinning/bleeding risk, THOSE must be discontinued 10 days or so b4 surgery but are generally replaced w/ a narcotic or Tylenol/narcotic combo to help the pt w/ their pain. Is that what you meant?

And l b'leev too much concern is placed on narcotics and fear of addiction. PAIN can KILL you, drive up ur BP, severly stress ur body which increases cortisol, a neduatir of many dangerously negative effects, etc. Thats why there are Pain Management specialists now. Trouble is, patients shd/b referred 2 them much sooner instead of the PCP dinking around too long trying 2 solve the priblem and prolonging the pts pain, duscomfort and quality if life, IM (never 2 b so) HO.
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LadeeC - yes, lidoderm patch is lidocaine, a numbing anesthetic. There are other pain reducing products or methods, such as prolotherapy injections and voltaren gel that l didnt mention b/c hips are diff. I've had prolo for knee arth & tendonitis in thumb joint. So successful, wanted 2 try on my hips eventho my doc said hips r the hardest. She was right, didnt work and was costly b/c it is not covered by ins. As for Voltaren gel, it is a topical NSAID, very little of which absorbs into bloifstream, so generally ok for ppl who cant take oral NSAIDS. Some success w/ topical & sub-cutaneous pain but not so effective with deeply aching arth such as in hip. Seems 2 b what many report when it comes to using lidoderm for hip arth. B/c if the on & off nature, if relief is obtained, it isnt continual. Some that have reported it useful have said they r using in conjunction e/ other modalities such as cortisone injections & NSAIDS. Chronic use if NSAIDS or Cox-2 inhibitors(Celebrex) is necessary 2 control serious arth pain, however longterm use is not generally a good plan for elders due to the risk of hemmorage, multiplied even more if blood thinners need 2 b used. One never knows in each particular case. The orig post was querying surgery or not. I'm the one who brought up the Duragesic (fentanyl) patch. But lidoderm is an intetesting suggestiin. Maybe the folks could ask the doc if they could give it a try. ANYTHING safe is better than unnecessary surgery.
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With or without surgery, it may be that a lot of her pain is muscular, and might be relieved by massage. Of course it should only be done by someone with proper training to avoid injury. My mother had her hip done and 90% of her pain went away. We visited my cousin and her father, an old boxing trainer and masseur. He worked on her thigh and it was amazing how it relieved the rest of her pain.

That was a sight - my 76 yo mother on the couch, slightly horrified, with 80 yo Uncle Albert grabbing and rubbing her thigh. I'm so grateful he used his expertise to help my proper southern lady mother.
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My mom uses the Lidoderm patches for the pain in her shoulders due to arthritis. Mom says they help relieve the pain and she goes around doing whatever she wants w/no sleepiness. She doesn't drive when she is wearing one of the Lidoderm patches though.
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+I am 79 yrs. old had two knee and one hip replacement two years ago, also have Afib and high blood pressure. Best thing I have ever done health wise. Hip replacement was a snap, no pain and quick to heal. Knees take a little longer with some pain. If you have a good Doctor and good Hospital it can be possible and make you a new person. Make sure they give you Coumadin for several weeks to keep blood clots at bay. Good Luck. Marion Oppenheimer
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It's so hard to decide what is best for our Mother's. The risk that comes with surgery or living with the pain. My 90 yo Mother had hip replacement 2 1/2 yrs ago and is now in a lot of pain because of no motivation. She also has degenerated discs. Everyday she says it's from working on the farm. NOT! Just sits all day and then when she gets up she's in pain and can only walk a little ways. She's been on Tylenol w/codeine and something like Darvocet. They all made her sleepy, cries and depressed. So she just sits all day and takes Tylenol 2x a day and complains. I feel so bad I can't do anything for her.
ferris1: I don't think you should give out medical information, it's illegal.
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Without knowing her age, cognitive status and who has a Medical POA to for her in case she cannot make that decision will determine what advice I give. If she does consent to the surgery, all pain meds will have to be stopped anyway, so better find out now if she can do that. Codeine and I haven't heard of the other, is a narcotic subject to addiction. Has a doctor (orthopedist) recommended her getting this hip surgery or is she thinking by doing so it will eliminate the pain meds? As a nurse, I need more information sunflower45.
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You don't provide enough detail. You need to find out the expectation of her ability to function after surgery. When is the last time she has been active, and how active? Interview the orthopedic surgeon, but also the anesthesiologist. You have to weigh the risks of surgery against the risk of being on pain medications and having limited or no mobility. Make the best informed decision and then hope for the best.
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CaroLynn ... our doctor prescribed "lidoderm" patches to help control the pain of compression fractures in her spine. We've been using them for about a year, with no noticeable side effects, like sleepiness or constipation.
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Your mother is right to be cautious about having surgery. How old is she? According to our primary care doctor, who works a lot with the elderly, "they don't come through the anesthesia very well." We were considering having a repair done to my mother's 18-year-old prosthetic hip so I researched this and found that general anesthesia can have a devastating effect on an older person's mental capabilities. A local surgeon was ready to cut, but we took Mom back to the Mayo Clinic in Jacksonville and saw the surgeon who did the original operation. Dr. O'Connor said there were way too many risk factors and strongly advised against it. We agreed, even with a spinal rather than general anesthesia. And then, amazingly, Mom gradually recovered. Apparently her muscles compensated for the deterioration of the prosthetic device and to see her walk, you wouldn't know anything was wrong. She will be 95 this week. Go Mom!
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Corrections 2 my previous posts above: part 1, the tranquilizer given in conjunction w/ the epidural was Demerol l believe; part 2, MS-CONTIN isn't a "pull form", it is a "pill form". V. sorry, typing from my Android is challenging.
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(cont.) ... HE would not cooperate with any of her needs. I called her ortho doc in frustration and the DEAR man made a "house call" to the nursing home (completely unexpected and irregular), overrode the resident doc, upgraded her pain med 2 MS-Contin (a pull form of morphine) AND ordered that she either be given her pain med EXACTLY 1/2 hour BEFORE PHYS THERAPY and if the nurses were off in their schedule for any reason, that phys therapy verify that they are taking her EXACTLY 1/2 hour after med administration. Mom miraculously began to "cooperate" with her rehab & her recovery started going smooth as glass.

You just have 2 stay on top of everything and everybody to make it work.
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Pain patches - there r only 2 types: a "counter-irritant" type containing camphor, menthol, capsaicin, etc (not generally effective 4 much more than mild pain) and a narcotic called fentanyl (Dura-gesic & generic patches) that comes in several strengths & is effective but has narcotic side effects, the most diff is, IMO, to get enuf to control pain w/o making the elder woozy, which could lead to falls, already a concern with the elderly & bad hips.
So, you didn't mention mom's age?
My mom had her Rt hip done in 1996 at age 78 and her Lt done in 2003 at 85.

To be sure, my mom was in relatively good health other than her need for jount replacement. But what the anesthesia doc decided to do was give her a heavy tranquilizer intravenouslyink) + an epidural, saying that there is a dementia threat to elders with general anesthesia.

Rehab was tougher on the 2nd hip b/c of her age. The medicos seem 2 b in constant fear if addiction 2 pain meds, so tend 2 under-prescribe for pain. Many of them don't seem 2 have the sympathy or empathy 2 appreciate the pain these elders have ALREADY been thru and that they need 2 more responsive 2 the pain adjustment needs of the patient.

In my mom's case, she was in rehab @ a Skilled Nursing Facility & they were giving me notice that she needed 2 b discharged b/c she wasn't "cooperating" w/ her rehab & wasn't "progressing", a medicare requirement to stay in a SNF for rehab. I knew & could see that she "wanted" to cooperate but she was in too much uncontrolled pain when phys therapy came 2 work w/ her. I talked 2 the doc in charge of the patients at the nursing home and HE would not
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As far as the pain goes they have had much success with the patch. If she is tired of taking the pill forms inquire with her Dr. if this is an option for her. They are time released and will keep her comfortable. She would have to have pain meds with either choice so I would look into it for her.
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I agree with Danna24, I also had bilateral hip replacements at an early age, the surgeries gave me back my life. I had pain that awoke me from sleep. Chronic pain is so exhausting. My gait difficulties really increased my fall risk prior to surgery. The pain from surgery was less than what I was having prior to surgery. If she hasn't been evaluated by a board certified orthopedist, do that as soon as possible. Elders can have this surgery safely.
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