Low Risk & Hip Repl. Surgery

[Malissa Kirszenbaum]

My husband will be 66 next month and was diagnosed with a low risk MDS. He has been on watch and wait with no treatment but for CBCs every two months and an annual BMB. We have had some occasional issues with skin infections when his ANC has gone below one, but he seems to reset. His hemoglobin is typically in the upper 10 range to mid 11 range and his ANC .8 – 1.9. So far his platelets have been unaffected. Just like so many of you here his baseline challenges are fatigue and breath. There was no putting off a hip replacement surgery as quality of life for movement just became too painful. When he went in to HOPKINS for the surgery on July 1 his hemoglobin was at 10.75. 24 hours after the surgery his hemoglobin dropped to 6.5. We knew that there would be a loss of blood but did not expect it to drop so drastically. They went ahead and ordered a transfusion on day three which took him up to 7.4. 24 hours later another CBC showed that he actually went up to 8.2. They wanted to stop his IV for most of the day and then do another CBC the following morning to get a more accurate reading of the hemoglobin as the IV fluids can sometimes give a false reading of what the CBC is. After doing that draw, his CBC showed his hemoglobin dropped back down to 6.2. They ordered another transfusion which eventually by day seven took him to 7.4. 7.4 was high enough to discharge him without a third transfusion but he certainly did not feel like he had enough energy to even contemplate recovery from the hip surgery. Here is my question, can a surgical procedure event cause a disruption in what was otherwise a stable existence with this low risk MDS? We were seen today by the oncologist who will be taking another round of blood next week and did start a conversation about procrit and or the possibility of another transfusion. I asked him the same question whether or not the surgery could have stirred something up and now with my husband be battling blood transfusions for these Procrit injections. He tabled the discussion pending the next to CBC‘s over the next two weeks. I was just wondering whether or not anyone else here may have had a similar experience. Thank you so much.

[Michael]

Malissa~

I hope your husband is doing well. I don’t have an answer to your question but have a question for you.

How did the doctor and surgery center or hospital safeguard against infection during the hip replacement? I am 70 yrs old and have been on watch and wait for six years. My platelets are normal, my hemoglobin is 11.5 to 12.5, but my ANC is typically .4 to .9 at monthly blood draws.

My orthopedist wants to replace both knees but I’ve been reluctant based on my severe neutropenia. I have received two injections of Gel One in each knee, which has allowed me to have better quality of life including walking 18 holes of golf 3x per week. As long as those knee injections provide the relief I’m getting Ill put off replacement.

Thank you.

• This reply was modified 1 year, 9 months ago by Michael.

[Malissa Kirszenbaum]

Hi Michael. I’m so happy that you are able to enjoy a sport you clearly love. Good for you. Your question is a good one and one that we had to ask LEON’s oncologist. His oncologist said that surgery with MDS patients should always be the last resort because of the vulnerability of infections and such. Leon’s was definitely a quality of life issue; his hip was so bad that it was impacting all things. His hip surgeon consulted with his oncologist and they discussed what vulnerabilities LEON would have going in. Thankfully his ANC has been at 1.9. We were told that without an ANC of 1.0 it would be difficult to get surgical clearance. His surgeon knew that his hemoglobin was low going in and most assuredly his oncologist knew that LEON would have to probably be transfused. First time since his diagnosis. On the morning of surgery they went ahead and started the blood typing so that after surgery they would be in a position to transfuse him. Because his ANC was 1.9 going in, she felt OK that the risk for infection was not the greater concern. So to answer your question, the surgeon and your oncologist/hematologist would probably discuss the best approach if you were to have knee surgery. They may think that treating you prophylactically going in would be a safe route to take. LEON was originally scheduled for his surgery the Friday before Mother’s Day. He caught a 10 day virus, not Covid, and the surgeon decided that he was going to postpone the surgery for an additional two months just to make sure that LEON fully healed as infection after hip surgery or in your case knee surgery, could become a very serious problem. My husband was a pharmacist but had to retire in 2020 due to health challenges and his MDS. He stood for 38 years on his feet for 12 and 14 hour a day shifts and his right knee is pretty much not good. He does the gel and it is very helpful. I’m glad it is working for you too. Based on the experience that we just had, nowadays a hip replacement surgery scheduled in the morning allows you to be discharged same day. We wound up in HOPKINS for seven days not because complications of the hip replacement but the surgery itself. Leon tossed and turned “should I or should I not do this surgery” almost 6 months. He knew he really had no choice if he wanted to have some quality of life. I hope this helps some but I think you should really have a serious discussion with both a surgeon and your oncologist and it may be that they can put measures in place that will give you the best protection. I hope the Gel continues to give you the relief you need to keep on living life. My prayer is that the surgery has not stirred something up and that his bone marrow takes over and helps replace his RBC volume. We will know probably over the next two weeks as this last transfusion will have fizzled out. If his CBC indicates otherwise they are going to do a bone marrow biopsy to see what progression,if any, is occurring.

This really has been the first major challenge since his diagnosis. We have been relatively blessed when looking at the big picture. We approach each day with a positive attitude and hopeful spirit. It sounds like you do the same. That is a good thing. I hope this helps a little.

Best,
Malissa

[Michael]

Malissa~

Thanks much for sharing in your kind and thoughtful response. It reassures me in my decision process.

Best wishes to you and Leon.

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