Knee Replacements and Mental Status Changes
To the family of the father 2 weeks after knee replacement with mental status changes.
This is of real concern at times. Sometimes it is also a common (note I did not say "normal") response to major surgery in the elderly. Of the serious things that can happen- your father could have had a small stroke, a brief time of oxygen loss in the operating room, or may have a self-limited chemical imbalance- sodium levels, potassium levels, for example. The medical doctor should check out all of these "organic" causes of a mental status change.
In general the term "allergic to Morphine" is one I don't care for. Morphine is a kickass pain medicine with powerful side effects of nausea, dizziness, and changes in mental status. The street form of Morphine is heroin. The addicts don't take it to get them in touch with reality - but rather to remove themselves. In the same way, a common response to morphine, especially in the elderly, is confusion and mental status changes. Reversal of the morphine with a drug called naloxone would make the diagnosis immediately. If will also give your father a return of the pain, immediately. A small short-term price to pay to make an important diagnosis.
Assuming no organic cause, these mental status changes whether from the morphine or what is often called "sundowning" (the unexplained weird behavior of the elderly at night), will drift away.
Dr. K.
Related Topics: Newly Diagnosed with Osteoarthritis, How Osteoarthritis Affects Your Knee
Technorati Tags: kneereplacement, elderly, confusion, medicationreaction
This is of real concern at times. Sometimes it is also a common (note I did not say "normal") response to major surgery in the elderly. Of the serious things that can happen- your father could have had a small stroke, a brief time of oxygen loss in the operating room, or may have a self-limited chemical imbalance- sodium levels, potassium levels, for example. The medical doctor should check out all of these "organic" causes of a mental status change.
In general the term "allergic to Morphine" is one I don't care for. Morphine is a kickass pain medicine with powerful side effects of nausea, dizziness, and changes in mental status. The street form of Morphine is heroin. The addicts don't take it to get them in touch with reality - but rather to remove themselves. In the same way, a common response to morphine, especially in the elderly, is confusion and mental status changes. Reversal of the morphine with a drug called naloxone would make the diagnosis immediately. If will also give your father a return of the pain, immediately. A small short-term price to pay to make an important diagnosis.
Assuming no organic cause, these mental status changes whether from the morphine or what is often called "sundowning" (the unexplained weird behavior of the elderly at night), will drift away.
Dr. K.
Related Topics: Newly Diagnosed with Osteoarthritis, How Osteoarthritis Affects Your Knee
Technorati Tags: kneereplacement, elderly, confusion, medicationreaction
11 Comments:
Dr. K., Does this also apply to depression? I'm 54 and had TKR 4.5 months ago..Immediately I became very depressed, which was a big surprise to me. I have had a couple of nasty surgeries and never experienced anything like this. I had wondered about the morphine from the start. I woke up from that surgery feeling like a different person..Argumentative and very emotional. I could not even respond to PT. I had no patience for it and really didn't care about it. I finally saw my PCP and he said I had situational depression caused by the surgery. I had never heard of such a thing happening. He put me on 10mg daily of lexapro and I quickly started feeling like myself again. I was able to get back into therapy and accomplish all my goals. Now, we are going to start taking me off the lexapro and see how that goes.This was the first time in my life to ever need an anti-depressant. I will have a second knee replacement soon. Is it likely this will repeat itself? Should I talk to my Doc. about continuing with the lexapro or maybe go back on it right before the next surgery?
Laurie
Excuse Me Doc!? You don't like the term Allergic to Morphiene? I happen to be allergic to Morphiene. I itch like a crazy person when I take Morphiene and Penicillin. I'm told that is a true sign of an allergy. The itching starts in my face, then goes all over my body until I just can't stand it anymore and I start scratching so much that I make marks in my skin. It is not a nice feeling. I always thought I had an allergy to codiene, also but what I actually have is a reaction. I throw up and get real sick with that. But they still won't give it to me. So, while you don't like the term allergy to Morphiene, it does apply to some of us. We don't like it, either.
My husband is facing shoulder replacement surgery. I am scared to death he will never be ok again!
How has medicine made this surgery
better over the years? What will his down time be?
Thanks
Tresa
Hello Dr. K,
My mother had knee replacement surgery on 8/8 and today it is 9/1. Her knee is functioning great. Her mind is still off (mental changes)and she still shows signs of not getting back to her old self. She is very anxious and cannot concentrate on anything. She was a driving, independent, church-goer, non insulin diabetic, 74 yr old. Will it take more than a month for her mind to get back to normal? How long should I wait until looking into her condition further?
Thanks,
Daughter in distress
My mother has been showing little signs of possible dementia/memory loss for a year and ahlf.(approx) She had TKR in June. Had intensely frightening sundowning, halllucinations, and extreme dementia in the hospital, and for 5 days after surgery. It is now 9/8 and her sundowning/dementia/ forgetfulness/hallucinations are still with her. All are considered a little less intense than when in the hosp, but easily twice as bad as before surgery. She's seen a neurologist who did a CT, and scheduled the next appt for 6 mos away. We are very unhappy with the lack of info on this trend, and the extreme lack of info from her drs on it. the hospital staff acted as if this were an everyday occuranc--if so, why did nobody prepare us for this/ We were terrified & nearly histerical! I've found info online that states up to 40% of elderly people showing moderate signs of dementia will get worse following tramatic surgery. Why wee we not given any information on this prior to her surgery? It would've been a huge factor in her decision on whether to go through the surgery. She had no pre-op pain and was having the procedure because her dr insisted she should (due to the bone on bone status of her knee). she was getting around just fine! Now they want to do the other knee!?!?! Not it it'll cause this extent of mental deteriation again! We're scared--HELP!
My mother has bee showing little signs of possible dementia/memory loss for a year and ahlf.(approx) She had TKR in June. Had intensely frightening sundowning, halllucinations, and extreme dementia in the hospital, and for 5 days after surgery. It is now 9/8 and her sundowning/dementia/ forgetfulness/hallucinations are still with her. All are considered a little less intense than when in the hosp, but easily twice as bad as before surgery. She's seen a neurologist who did a CT, and scheduled the next appt for 6 mos away. We are very unhappy with the lack of info on this trend, and the extreme lack of info from her drs on it. the hospital staff acted as if this were an everyday occuranc--if so, why did nobody prepare us for this/ We were terrified & nearly histerical! I've found info online that states up to 40% of elderly people showing moderate signs of dementia will get worse following tramatic surgery. Why wee we not given any information on this prior to her surgery? It would've been a huge factor in her decision on whether to go through the surgery. She had no pre-op pain and was having the procedure because her dr insisted she should (due to the bone on bone status of her knee). she was getting around just fine! Now they want to do the other knee!?!?! Not it it'll cause this extent of mental deteriation again! We're scared--HELP!
My mother has been showing little signs of possible dementia/memory loss for a year and ahlf.(approx) She had TKR in June. Had intensely frightening sundowning, halllucinations, and extreme dementia in the hospital, and for 5 days after surgery. It is now 9/8 and her sundowning/dementia/ forgetfulness/hallucinations are still with her. All are considered a little less intense than when in the hosp, but easily twice as bad as before surgery. She's seen a neurologist who did a CT, and scheduled the next appt for 6 mos away. We are very unhappy with the lack of info on this trend, and the extreme lack of info from her drs on it. the hospital staff acted as if this were an everyday occuranc--if so, why did nobody prepare us for this/ We were terrified & nearly histerical! I've found info online that states up to 40% of elderly people showing moderate signs of dementia will get worse following tramatic surgery. Why wee we not given any information on this prior to her surgery? It would've been a huge factor in her decision on whether to go through the surgery. She had no pre-op pain and was having the procedure because her dr insisted she should (due to the bone on bone status of her knee). she was getting around just fine! Now they want to do the other knee!?!?! Not it it'll cause this extent of mental deteriation again! We're scared--HELP!
my father is 84 years old, he was having pain in his hip and went to the hospital for xrays...he was told nothing was broken and given a shot of morphine, a vial of lortabs and sent home. this was on a sunday, on tuesday he was taken back to the hospital and had to undergo emergency surgery for replacement of the ball in his hip. he had not fallen...
this happened around august 6th, he was living at home at the time and experiencing a little dementia.
it is october 10, he is now in a nursing home and his mental faculties have gone from bad to worse. he does not know any of his family, cannot walk more than a few feet without feeling exhausted.
a mri said no stroke and we had hoped he would "snap" out of it and be able to go home. This is not happening.
could this be a result of the morphine and the surgery? does dementia drop that quickly after surgery? health care providers have said all along he would plateau but we are only experiencing a steady decline.
any advice or words of wisdom?
I am greatly concerned about a dear friend who just (3days ago) underwent double knee replacement surgery. When he was in recovery for over 3 1/2 hrs, he had trouble waking. His eyes and mouth were extremely swollen. When he finally was awake, he told the staff that he was in extreme pain and felt like he was dying. He informed them that the pain was not in his knees, but in his chest and arms. They said he was having an allergic reaction to the morphine and switched him to percassette(sp?) The swelling of eyes and mouth disappeared. Later that evening he suffers a heart attack, Now in intensive care. Do you think the morphine could have triggered this?
I don't see dates on any of these messages, so I'll included it here: 5-24-08.
12 days ago, my 92-year-old father went in for a knee replacement. Prior to the operation, he was fully functional. He drove everywhere, cooked meals for himself and my mother, did light woodworking in the basement, and could discuss most current events at an intelligent level.
On the day following the operation, he was understandably dopey, but ok. That evening, the hospital called to tell us that he was delusional, violent and hallucinating. We spent much of the evening with him an he did calm down.
Over the course of the next week, his condition degraded. He didn't recognize anyone, he didn't know where he was, his hallucinations became extreme and he was paranoid. His speech was barely more than mumbled babbling. It was heartbreaking to watch.
I read on another forum that a patient with a similar reaction responded positively to being hydrated. I convinced the hospital staff to keep an IV in him and we started to see some improvement.
Over the past three days, the improvement has been dramatic. Today, he still has a few hazy moments and has a hard time bringing the occasional word to mind, but he is nearly back to his old self.
Had TKR 12/07 and while in hospital was told I was nasty to RNs when askd to get out of bed for linen changing. Could not eat, had fast beating heart but was told everything was ok. Was told I opened my mail but cannot remember this, cannot being nasty to RNs. Was in hospital for 4 days and then to Rehab. where I felt very depresed, paranoid (seeing evil), strawberry tongue which was bleeding, and did not eat for several days. Then I started to eat and feel better. But not remembering those things I did in hospital bothers me terribly. I have to have another TKR very soon and am petrified regarding the anesthesia or morphine or oxicodine, whatever it was that made me feel crazy. What do I do? I am 75 years old and in pretty good health otherwise.
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