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Truth about Total Knee Replacements

Joint Replacements | Last Active: Aug 18, 2021 | Replies (50)

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@toughchickie

STRESS TESTS Pre TKR (Scroll to end for long story short.)

I apologize upfront for inserting myself into this conversation because my questions are not directly on the topic of issues emerging from TKR. However, I reckon that this group will at least have had sufficient personal experience to answer questions on prerequisite eligibility for the surgery itself. I'm a prospective patient awaiting a slot for TKR.
[Age 79, recently diagnosed with A-fib, though that discovery was made after my first ER/ambulance visit. I had been dosing myself with ever-increasing NSAIDS (most Aleve and Diclof. Sodium for years); had slight abdominal bleed and resultant anemia and then atrial fibrillation was noted].
I have bone on bone osteoarthritis in both knees since just before Covid (!) lockdowns in 2020. I now walk with a cane, and over a year ago was awarded one of those cardboard "disabled" signs to hang on my rearview mirror to help me avoid having to walk huge distances from my car to my destination. Small compensation for inability to stand upright for long periods.
Finally, in spring 2021, I met with a reputable local orthopedic surgeon and graduated into a queue list for end August 2021 surgery - and felt great relief. I had only to "pass" various tests and get through rehab before I could gradually begin to live again, or so I thought. The "tests" required were lab work, X rays, a Cat Scan, and appts with various new doctors (ENT, Pulmonologist, Cardiologist..). to be sure all was well, and, of course, the pre-op exam with my PCP. But there's the rub. All went well except my pre-op, which was done by an unknown-to-me RN in my PCP's office (My PCP was away on pregnancy leave!! Just my luck!)

I see I 'm getting into the weeds here, sorry. Bottom line, this RN has insisted I get a stress test. Not the stress tests I aced in my middle years by running on a treadmill (when I could still run), but the stress test that is given by injection of a medication that artificially increases your heart rate to simulate running on a treadmill. Scary. Months ago I had spoken with my PCP about this stress test, and she advised I meet with a cardiologist of her choosing to see what he thought of a stress test. I was a little reluctant, but finally agreed just to get the show on the road!

After waiting weeks to secure an appt, I met with the Cardio guy; had an EKG (my third or 4th EKG or ECHO that I've had in the past two years - each doctor seems to demand them, took BP, heart rate and all the usual, which were fine. The doctor actually briefly checked my heart with his stethoscope, said a few words - asked what meds I was taking (only metoprolol and levothyroxine) and proclaimed, in so many words, "You're good to go for surgery." End of story.

But while driving home I suddenly realized that there had been NO mention at all of a stress test! And being a harried and anxious patient, in the best of times, I had forgotten to bring it up. I figured, naively as it turns out, that I'd gotten lucky - until this almost-2-months-later
pre-op meeting. But as it's less than 2 weeks till my scheduled surgery date, I knew there would not be enough time to get another cardiologist appt. So I've been told I will have to postpone surgery. Very risky now, due to Covid surge.

I want to make clear that, of course, I will get the test if the RN continues to insist to my surgeon that I have the stress test after all. I just wish I had been told about this earlier. Most importantly, I want more details about this stress test. I've read that certain medications to increase heart rate have caused patient deaths (!).

Has anyone here had this kind of stress test by IV? (IS it administered by IV?!) How long does it last?
Who administers it? Side effects??

OMG. Help.

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Replies to "STRESS TESTS Pre TKR (Scroll to end for long story short.) I apologize upfront for inserting..."

Hi Toughchickie,
What a long (and unfinished) road to getting your TKR. Having said that, I'm glad your medical team is ensuring your safely. The stress test you are referring to is called a nuclear stress test. Here is more information from Mayo Clinic:
- Nuclear stress test: https://www.mayoclinic.org/tests-procedures/nuclear-stress-test/about/pac-20385231

To learn more about what it is like from other patients who've had it, please see this discussion:
- Nuclear Stress Test: I'm afraid to do it https://connect.mayoclinic.org/discussion/nuclear-medicine-stress-test/

When will you get the test?

If I were you I would call your cardiology doctors office back, ask either for him to call you back or speak with his nurse and explain the situation as you did here. He should be able to talk to the other office if he doesn’t feel the need for it to be done. If he wants it done he should be able to answer all your questions and might get it done for you before surgery date. Best wishes