Bit of background....
He takes warfarin also. Last few ops hes had (knee, hip) have not gone well at all - hes had complications, his last knee one just didn't work. Every time hes ended up with extended stays in hospital.
Now the consultant is saying he can have another knee replacement if he wants. Surely at his age and with his history its very high risk indeed?
Thing is with Dad, as some on this forum will remember, he treats the medical profession badly. He expects to click his fingers and they fix things. Hes also one for making out things are worse than they actually are. Part of me is wondering if this consultant has had enough of his moaning and basically said, "look I can't do any more, have an op or don't".
Dad gets around. He can walk 1/2 a mile or so - yes hes tired afterwards but hes 85. He admitted his other problems (polymyalgia) cause him more pain and his knee isnt that bad.
He doesn't even take all the painkillers the GP gives him. (another story that one)....
I dunno I just think the potential risks are just way too much. He could end up worse off. Months in hospital or worse the op could finish him off.
I know Dad - if he was at the end of his tether with pain he'd let everyone know. For him to say, its not that bad, and still not be taking full dose of painkillers....
(I had back problems and I'd be counting down the minutes to next codeine)
Of course, he wants to chat with me to basically make the decision for him....
Now I don't want to be mean and advise him not to go ahead purely based on my selfish reasons but there is no practical way I could provide the care hes got in mind. As you say, he'd expect miracles from me.
BUT, even without taking into consideration after care it still sounds like a VERY bad idea to me anyway.
He was in hospital a month last time because of complications and he hated it. If he ends up longer there then he would be hell.
I remember back when my Dad was 92, he was having knee pain and his primary doctor sent him to a specialist. Instead of giving Dad ideas on how to work out that pain, the doctor wanted to due surgery, and tried to get Dad to set a surgery date. Thankfully my Dad said "no".
Now a days doctors can help the knee, if it is bone on bone, with a type of gel that be shot into the knee. That maybe something worth looking into. Little down time, and no worry about Dad awaking from surgery with the start of memory issues.... that is always a major worry.
I know its crazy. I can't believe the consultant is pushing it. Last time there were major complications and he spent about a month in hospital.....
BTW - he has cortisone injections at the moment but it doesnt last.
2nd opinion sounds like a good idea but you'd have to pay privately. NHS is free in the UK. No way in a million years would Dad pay.
Problem is past experience shows he wouldnt be happy with that. He moaned last time they were there at 10am for breakfast and wanted me to tell them to turn up at 845am. Never going to happen. Not everyone can have 9am obviously!
All that will happen is he'll have carers for the week then cancel them, then expect me to do it.
Even if he had carers he'd expect a visit pretty much daily. I couldnt even do that.
Thing is with Dad his thinking is (as it always is), I want something or I need something therefore you will do it for me. I've seen it so many times....
It'll be a case of "Well, I need you to help me", "Family will have to manage without you" - it'll be my problem not his to free up the time he wants.
His best is "Make a bigger effort". Drives me up the wall. Number of arguments we've had about that - I tell him hes implying I'm not already doing what I can. His answer as always "Im sure you can find the time".
I used to feel guilty but I'm getting into my head that I really do not.
Just because he has unrealistic expectations is no reason for you to feel guilty.
It sounds as though your son is quite a handful right now. What help are you getting with that?
(CM will know it. Royal Glamorgan in Llantrisant, I live in Newport)
Yes we're getting help with son. Hes on meds, seen by child mental health, school helps. Its been a long old trek though.
We're seeing a family counsellor today who specialises in behaviour of kids with apergers.
p.s. Isnt it 5am in the morning with you?
It will put him in hospital. Then to rehab.
I'm batting my eyelashes at you, Paul. Where does he go from rehab, hmmmm...?
If you want to know what the consultant said to him, you will have to speak to the consultant. Of course the consultant ought not to talk to you. Ring the consultant's secretary and ask her really really nicely to ask the consultant to give you a call back. Of course they shouldn't. They will. Betcha.
"I'm Mr Foel's son, and he asked me to help with deciding on the knee replacement they discussed on Tuesday, so I thought I'd better give Mr Sawbones a quick call..." 99 consultants' secretaries out of 100 will be delighted to help and Mr Sawbones will come back to you by close of play.
You ought to know that a knee replacement costs the NHS £20-30K, and that the budget in Wales is not exactly brimming over, and I don't care how much whining your Dad does he will not have been offered this if he doesn't need it. They don't just say "does your knee hurt much?" They also examine the range of movement and look at the imaging.
Or, it's a gung-ho orthopod who happens to like doing knees. That is also possible.
Anyway. Find out more about it.
Then factor in the possibility that if you say "really good idea Dad go ahead" he will of course decide against it.
Wow thats not cheap for a knee replacement. I don't deny that he probably does need it but obviously you've got to think of other things too. I can only imagine Dad sitting there (I've seen him do it) and saying "well what are you going to do about it then". (Hes had ANOTHER big argument with his GP surgery about something similar - the senior partner has phoned to explain that they've told him all the treatment options available, and there is nothing else they can do. He did his usual, phone up to get a home visit because he didnt fancy going down to the surgery).
#1 You have an unarguable reason for delegating all care responsibilities.
#2 You take control of liaison with the hospital and discharge team.
#3 You do not visit.
Once your father is on the operating table you can go round him and don't have to discuss anything with him. You put any undesirable decisions he tries to make down to dodgy pain med side effects or post-anaesthesia. You tell the team that he is very proud, reluctant to accept help, and never admits to discomfort or frailty. Dear old boy, all he needs is the right support. You remind them of the costs of readmission. But above all, you smile at him but you do not include him meaningfully in the care planning.
Your brother would be able to get him out, in theory. But it would involve time, effort and a knowledge of the system. Can't see him being up to that, can you?
Even if he is ultimately discharged home, by then YOU - never mind him - will have been off the treadmill for a while and got used to delegating his care.
I got records from the office before they closed it down, and consulted with new orthopedic doc, just so we have one. The new doc told me in private, that he sees the reason for doing the revision on the right knee. but he would be hesitant to do it. Afraid she would not make it through. He thinks as long as she is not too active, the old replacement might last for the rest of her days. So I will not even consider it, unless she loses her mobility. We were using a transport Wheel Chair before the 2017 surgery, and she hasn't needed it since. I always give her Tylenol Arthritis strength at bedtime (seems to help her sleep better.) She rarely asks for any pain meds any other time. She took Tylenol #3 for brief time after her last surgery, but never finished them.
If she had not done the surgery in December 2017, I don't think I would be able to take care of her in her home like I am. Was a back breaker for awhile. She uses a walker for balance. Can walk down the couple of steps out of the house, and get into car. So she can still go shopping, restaurants, small music venues. Without the surgery, both of our lives would be miserable. We would both have loose screws by this time.
Thing is, as I've said, Dad can walk over 1/2 mile. Not bad for an 85 year old even with bad knees.....
Ask to try those gel injections. The injections, if I remember correctly, are made from a rooster’s red “gobbler” for lack of a better word. I had them and they worked for me so far (1 year out).
Good luck!
What are those gel injections? I'll have to try and find out. Not sure if its available on NHS though.....
Thing is Dad says he isn't in that much pain with his knees. And hes not even taking full dose of painkillers yet....
#1 SURGERY & HOPE
Increased mobility & independance if sucessful.
But rehab is BRUTAL. I mean grown adults crying type BRUTAL. Risk of complications, ext hospital stay, infections. Risk it doesn't go well & then have to move to option 2 anyway...
#2 ACCEPT WHAT IS
Decreased mobility, continuing pain. For some this means eventual wheelchair, loss of independance if cannot self-propel, move to ALF or NH even.
Saw my 82 yr old Aunt choose surgery, big cardiac history & all. Result was very sucessful although she now uses a walker outside (as lost some confidence).
Seen folks determined to do rehab - do very well.
Seen folks do limited rehab - have poor result with stiffness & never get to 90 degree bend.
Heard of one pt who refused any rehab. Went to his Mother's where she waited hand & foot on him. He lay a-bed for 2 weeks. Knee outcome didn't make a difference as he died from a stroke - blood clot in operated limb due to lack of movement. (40 something yr old).
So I would suggest your Dad has a good think about what risk is acceptable to him. And what rehab work he is prepared to put in.
I would certainly check into if it is available and give is a shot😉
Take a look at WebMD for starters.
https://www.webmd.com/osteoarthritis/hyaluronan-injections-knee
They worked for me.
He is still mobile, he still gets out and he says the pain is OK. Like I said he doesnt even take full dose of painkillers...
I dunno maybe I'll be different when I'm older but if it was me I'd say no.
Can guarantee Dad will have forgotten how bad the rehab can be...
By the way, recovery time is longer for an older person.
This is just my 2 cents!
Good luck Paul God knows you do have your hands full!
He also wants me to commit to looking after him if he decides to go ahead....
If you are serious, then fairly obviously you need to be included in discussions with his consultant.
Tell him the only way you think it is a good idea is if they do an attitude transplant while he is in the operating theater. Mary Poppins comes to mind.
If you seem hesitant, your father will be off the list. Keep him on the list. You can always take him off again if you decide later on that you don't fancy the odds.
Do you know what you need to know?
The pain killers thing as well. GP has prescribed him codeine. He doesn't take the full dose because it clogs up his bowels, GP gave him senna, he won't take that in case it has the opposite effect. Surely you can't even consider the pain to be an issue if you're not going to listen to medical advice and take the meds they prescribe?
I just remember my back (spinal stenosis). When its bad I'm literally clock watching for the next dose. Dad is not like this at all. He even said its "not that painful".
A lot of this is Dads attitude to things. He wants it all 100% his way sorted. It gets him in trouble with the medical profession because he demands they "fix" him....
What's the clinical justification for this proposed second TKR?
Pre-admission - what adjustments to the Warfarin, what are the risks of doing that, who's going to monitor compliance (I wouldn't rely on your father to follow the instructions, would you?)
Surgery - is this going to be under epidural or general? What anaesthesia did he have before? Who's the surgeon? What prosthesis are they using? (you'll want to look it up)
Recovery - how long, and where?
Rehab - do not consent to anything less than residential. No "home from hospital" malarkey. Your father lives alone. He has recently been incontinent (true). Infection control will be a joke. Compliance will be a joke. If they can't find him a rehab place then it's not happening. There are (quick search) 21 suitable nursing homes in the area. But don't approach this subject with any negative expectations: you say "of course he will need residential care throughout his recovery," inviting agreement from the consultant.
Remember that you are talking to an orthopaedic surgeon. Stereotypes come about for a reason. You may have to do most of the actual thinking. Good luck!
I remember last time they admitted him days before to sort the warfarin. He had general.
Last time it was "home from hospital". This is what Dad is thinking now to be honest...He had this conversation with the guy the other day and he asked, Dad said he had two sons who would help (cheers Dad) who lives locally so consultant said thats ok then..... Jeez. (Local is not 30 mins away in my book!)
Sort of fell apart a bit when I said "so when do they need to know then". Avoided that question but turns out - next appt in 6 months! OMG.
And do not rely on anything your father tells you. As daughter said to me yesterday "do not attribute to sinister intention anything that can be explained by incompetence."
It still baffles me that it bothers you so much that he makes up pathetic feeble reasons why you have to visit him. So they're rubbish. So what. You're either going or not going, what's the problem? Have you tried categorising these as "white noise"?
But same for the illness thing. Hes cried wolf so many times to get me there and then I'd turn up and hes right as rain.
Once she went into Independent Living, I did the same thing. She was an hour away. It meant no more extra weekend job. Less time with my kids and with my husband. Once mom moved to a NH 1.5 hours away, I visited every other week but spent more time on the phone with her, with docs with the home. It was exhausting.
But here's the thing; I determined what was important. I think what you find wearing is your dad's demandingness and wheedling, whiney neediness.
Iignore it. Let it be white noise. This, though, is important. It's an opportunity on so many levels.
Go or don't go to discuss, but arrange to talk to the consultant and show up at the next appointment.
If I went one a week, he'd push for twice a week, if I went twice a week he'd push for once a day....
I'm going to see him later. He's already pushing for "if he has the op" and planning for me to visit him in hospital on my way home from work every night. I've told him thats impossible... His answer - tell you're wife she'll have to take a break from work for a few months to have the kids so you can visit me. You'll be pleased to hear I've said NO to that one.
Jeez - I can't even tell my wife hes suggesting that she'll go up the wall!
Waiting for consultant to get back to me but I dont think Dad realises the rehab needed.
As I said, last time he pretty much did not bother himself and moaned that it was "their job to do it right in the first place without all this potch afterwards". Exactly.....
As I've said before, his GP wont come out to his home anymore and neither will ambulance. Number of times hes convinced hes dying....
He seems to have difficulty with getting old in general. Wants everything "fixed". Its hard work.....
Number of times I've heard him tell me he had a really bad chest infection and I get there (I dont rush up there now) to find hes got a slight sniffle....
Or get a new one - unfortunately the analogy rather falls down, there.
Point is: when it comes to your father's health and wellbeing, you need reliable information and you won't get it from him. You KNOW that. So fine-tune your sources and trust your own judgement.
"Are you ready to sign up to that Dad?" YOUR knee, YOUR rehab, YOUR choice.
You know if YOU choose, the outcome/pain will be YOUR fault... (according to him).
My sister blamed me for having to have a OPG Dental Xray (a 5min zero pain xray)! Umm, no, your Dentist requested the xray - I just drove you there. So... I will not be involved in any health decisions for her (unless deemed incompetent).
He'll sit at home, moan the op hasn't worked, and then expect his minions (me) to wait hand and foot on him.