Thursday 20 September 2018

Dear Dr Nina: Does mum need rehab after hip replacement

Photo posed
Photo posed

Nina Byrnes

My 74-year-old mother is going into hospital next month to have a hip replacement operation. Unfortunately I'll have to be overseas for work for a month at around the same time, so I won't be able to help out. Her GP wants her to go into a rehab home for a spell after the operation, as he says she won't be able to manage on her own. But my mother is stubborn and is digging her heels in, saying she'll cope with the help of her neighbours. How can I make her see sense? What can she expect in the aftermath of the hip operation? She's in excellent health otherwise.

Dr Nina replies: The majority of cases of arthritis occur in people over the age of 55. The most common form of arthritis in this age group is osteoarthritis. This is most common in the hips, knees, and spine although it can occur in other joints such as the shoulders. Those affected commonly complain of pain and stiffness that gets worse with exercise or use of the joint and there is often a sense of clicking or grinding. Movement can become quite limited.

There is no cure for osteoarthritis, so the goals of treatment are to reduce pain, improve mobility and muscle strength. For some people, the joint damage and pain becomes so severe that a surgical joint replacement is necessary. This can be a very daunting operation, but the improvement in quality of life is often dramatic. Joints replaced today can be expected to last up to 20 years.

Your mum probably has friends who have undergone this surgery and they have had a dramatic improvement in quality of life afterwards and it sounds like she is anticipating a similar outcome. She may be looking forward to life after surgery, but be quite wary of the process itself. The thought of surgery and a hospital stay is daunting, especially to older patients, who are often fearful they may never get home. Those of your mother's generation often consider admission to a nursing home a terminal event.

I agree that some time for inpatient rehabilitation is a good idea. Hip replacement, although fairly routine, is major surgery and recovery takes time. Inpatient hospital stays are shorter, but a few weeks of rehab can be really helpful. Your mum will need to be careful for the first few weeks. Trips, falls and slips can be extremely dangerous post operatively. She will be on painkillers immediately after her surgery. Her recovery physiotherapy will begin within a few days of the operation, but movement will only increase gradually. Eating well and getting quality rest is also important when recovering from surgery and this should be stressed. Your mum will also need help bathing, dressing and mobilising in the initial days and weeks. She will likely be tired and it wouldn't be ideal for her to have to cook and clean for herself. If she has stairs at home this would add another layer of difficulty. Her wound will be healing and someone will need to keep an eye on this and help with dressing changes.

Recovery from an uncomplicated hip operation takes from three to six weeks. In my experience those who transfer to rehab care find this really helpful and their recovery is swift. I would advise visiting your mum's GP with her. Allow her to express her concerns and wishes as regards her post-operative care.

It may also be a good idea to visit the rehab facility that has been recommended. If your mum gets to see it and perhaps meet some other people who are recovering from a similar operation, she may get a better insight into the benefit of staying after the operation.

Lastly I think it is really important to reassure her that this is only going to be for a rehab period. You need to allay any concerns she may have that this would be a more permanent stay.

 

Q: My two-year-old has always drooled a lot, but lately it’s worse than ever. I think he is still getting teeth — so could this be what is causing the drooling, or could something else be wrong?

Dr Nina replies: Drooling is very common in children, especially those under the age of two. Saliva is produced to irrigate the mouth, moisten food and protect the structures of the mouth and throat.

We all produce litres of saliva daily, most of which we swallow. Infants and babies tend to drool largely due to inefficient or infrequent swallowing. Babies don’t tend to keep their mouths closed in the resting position. This is learned as the muscles of the face and mouth strengthen and develop.

Drooling is more common when teething and this may indeed be the cause of the recent increase you noticed. Other causes to consider could be very large adenoids or tonsils or nasal congestion leading to excessive mouth breathing.

If your child is developing normally in every other way I would not be concerned, unless the drooling progresses into the third or fourth year.

Drooling itself is not dangerous, but it may lead to dermatitis of the face and mouth. Angular stomatitis can cause uncomfortable cracking, redness, scaling, bleeding and ulceration of the corners of the mouth. This may affect one or both sides of the mouth. Angular cheilitis may be caused by bacteria, candida infection, drooling or altered anatomy of the angles of the mouth. Dermatitis, secondary to drooling may ultimately become infected.

One of the more common causes is infection with staphylococcus. This is a bacterium that normally lives on the skin. When skin becomes red or inflamed and breaks down, this bacteria may increase leading to further inflammation and infection. Candida is another common cause and if antibacterial didn’t work an anti fungal cream may also help. A cream with hydrocortisone is often more effective to help reduce inflammation.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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