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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....

I'd love to show your Dad the local othopedic residential rehab unit with people on crutches doing it tough, along the corridoors, going up & down stairs etc.

"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).
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paulfoel123 Jun 24, 2019
No chance in a million years - he just wont bother with the rehab. I know this from last time....

He'll sit at home, moan the op hasn't worked, and then expect his minions (me) to wait hand and foot on him.
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My father's knee was quite bad and he wanted a knee replacement done at 88. Sure enough the doctor okay'd it. I was extremely concerned because of his age. At the time Dad was mentally fit and I felt it was his decision - although I didn't hesitate to give my opinion against it. Turned out he couldn't have the surgery due to a blood cancer showing up on his pre-op blood work. Forward two years and my father was unable to walk because of that knee. I'm convinced that his inability to get around hastened his dementia as he was always a very independent, do for others type of person. So there are pro's and con's. The surgery is a big risk, but as in my father's case not having use of his knee was ultimately his downfall as it affected his quality of life. I would definitely recommend a second opinion from a doctor who isn't potentially wanting to just quiet him down.
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paulfoel123 Jun 24, 2019
Thanks amilie - yes I am hoping he'll go for a 2nd opinion.
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Would you expect your telly to tell you why it wasn't getting a signal? Your car to say "excuse me, would you mind having a look at the drive belt please?" No. They just make odd noises. You still look after them and give them routine maintenance and all is well, and if something unusual is *really* wrong then you notice and you call for help.

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.
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If he can walk a 1/2 mile, it must not be that bad. I come from a family of male "whiners" it is in their genes. He is probably driving the doctor nuts about this, so the option was offered. I would say no.
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paulfoel123 Jun 21, 2019
Yes hes the worlds worst honestly.... As I said in this thread he can be really unreasonable with doctors etc so I do wonder.
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....
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I’ve had my knee replaced . It’s painful ( ortho told me it’s the most painful replacement ) and takes a lot of rehab, the exercises are not “ uncomfortable “, the early ones are excruciating. I have other health issues so decided I wasn’t doing the other one unless I can’t walk to the bathroom due to too much pain... and I’m not 85. Any doctor will treat you if you ask and there is a problem but you need to decide if the aftermath is worth it. Imo , no way
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paulfoel123 Jun 21, 2019
Well thats just it. He can walk around the house easily.....
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.....
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Paul, from the time my mom was 87 or so, I visited her once a week, to set up her meds, take her shopping. We scheduled doc appointments at my conveince.

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.
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paulfoel123 Jun 21, 2019
Yeh know what you mean.... Im getting there.

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!
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Paul if you want to you can get that next appointment brought forward by going with him.

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"?
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paulfoel123 Jun 21, 2019
Know what you mean CM but I think "hang on when you really do need to see me for something then I'm not going to believe you"...

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.
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Managed to turn this around into yet another reason why I've got to visit him this weekend. Apparently, he needs to see me to discuss how hes going to proceed with this..... Jeez he has no limits.

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.
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In my experience with warfarin and surgery, they will want him off it for 3 to 5 days prior, replaced by self-administered Lovonox injections. I would not think that your dad can follow this regimen on his own.
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paulfoel123 Jun 20, 2019
Nah no way would he do injections. Last time he went into hospital in advance....
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Suggestion is you ask for a complete care path plan. Pre-admission, surgery, recovery, rehab.

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!
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paulfoel123 Jun 20, 2019
thanks CM. A lot here....

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!)
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No. And not ONLY because of the blood thinners and the potential for a bleed, or even a stroke without them. You mention he can walk 1/2 mile. That seals it for me. If he is getting around AT ALL at this age I would vote not. I am a retired RN. I understand that I saw those where it didn't go well, but as age became more a factor it often didn't go well, and there is more to be afraid of than you can even know. The fact is that I saw great mental deterioration happen rapidly with the administration of anesthesia. My answer would be "Thanks. But no thanks." Only my two cents worth, you understand.
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paulfoel123 Jun 20, 2019
Yes I don't understand. Hes 85. He can walk and get out. Why on earth risk it? I wasn't even aware of the mental deterioration risks until I googled it today to be honest.

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....
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When you speak to the consultant do not voice any reservations even if you have some.

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?
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paulfoel123 Jun 20, 2019
yes. I think so. but open to suggestions...
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Can't you just hear it now? You need to come stay with me, right now! I can't even get around and this is all your fault because it was your idea to have my knee replaced!!!"

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.
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Countrymouse Jun 20, 2019
There is an ulterior agenda, though. If Paul plays this right, it could be an orderly route to residential care which would be - oh...! - such a good outcome.
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Paul, are you serious when you say that your father wants you to make this decision for him, or are you just being gloomy?

If you are serious, then fairly obviously you need to be included in discussions with his consultant.
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paulfoel123 Jun 20, 2019
Yes he pretty much wants me to decide for him. Id rather not. I've left message for consultant to call me.
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I would advise to someone of that age to not have surgery. The older we get the higher risk for surgical complications, and the anesthesia takes longer to get out of ones system. And again higher risk for temporary and permanent complications with anesthesia. But your dad sounds like he will do what he wants when he wants.

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!
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paulfoel123 Jun 20, 2019
Yeh. Part of the problem is Dad wants me to make the decision for him.

He also wants me to commit to looking after him if he decides to go ahead....
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I would not do it if he is still mobile and not in a lot of pain esp since he has had complications in the past. my dad fell and broke his hip and had it surgically repaired and then fought hard in rehab for 6 weeks of therapy but got an infection and passed away after 2 brutal weeks in hospital....he was 89.
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paulfoel123 Jun 20, 2019
Yes thats a huge risk isnt it?

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...
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I think this is a second TKR, isn't it? On the same knee?
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paulfoel123 Jun 20, 2019
Yes hes already had both knees done in the past. First one went "OK", 2nd one ended up pretty much same as before.
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The rooster cartilage injectable is named Synvisc -One in the US of A, lol.
They worked for me.
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Is the rooster caw injection available there. It is regenerative. I have known one person that had this done to try to avoid a knee replacement. It worked great for him! I was quite surprised!😲🐓🐓🐓 So was he. Sadly, he passed a couple years later from pancreatic cancer.

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
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So many pros & cons to weigh up;

#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.
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paulfoel123 Jun 20, 2019
Beatty - based on last time it'll be no rehab for him to be honest. He just did not bother. Expected to come out from the op and be walking, then just moaned that it was uncomfortable doing the exercises so didn't bother.
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Where I come from surgeons will not do surgery until three months after the last cortisone injection. And 3 injections max. That may help your decision. I myself recommend no surgery but if the guy is in pain all the time what can you do?

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!
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paulfoel123 Jun 20, 2019
Yes he had cortisone this week. This is the NHS - no chance of surgery for months yet!

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....
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In 2017 the orthopedic surgeon was consulted about doing a revision on Ma's right knee, which had been done in 2002. She's got a screw loose- screw migration. By that time the left knee was bone on bone. Would lock up on her and mobility was greatly impaired. (She was 2 months shy of 88 yo.) It was our choice which knee to do first- I would have hard time caring for her with locked up leg, so we did the one that had never been replaced. She has heart issues, and her cardiologist wanted to be at hospital when the knee surgery was done. Had to hold blood thinner for several days before surgery. Everything went smoothly, and she was happy with the outcome. But she was hesitant to re-do the right knee. We would just go about every 3 months for follow up, and a shoulder issue. We waited too long, as the surgeon died unexpectedly. 
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.
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paulfoel123 Jun 20, 2019
Thanks Sandy....

Thing is, as I've said, Dad can walk over 1/2 mile. Not bad for an 85 year old even with bad knees.....
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No, it's exactly the right time for the fight.

#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.
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paulfoel123 Jun 20, 2019
Ha ha I need to employ you CM as my consultant!
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Grab it with both hands.

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.
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paulfoel123 Jun 20, 2019
Yes good idea I may try and speak to the consultant.

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).
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Paul, of course you can't visit him daily. Nor should you be expected to.

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?
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paulfoel123 Jun 20, 2019
Ha ha he will expect it lol. And the hospital is a good 45 mins drive from home....

(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?
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Paul, you’re damned if you do and damned if you don’t. From the sound of it, Dad doesn’t really need the knee surgery, he just thinks that everyone will be running round making a fuss of him if it happens. If you advise against it, you don’t care enough. If you suggest he goes for it, you then won’t do enough for him afterwards.
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paulfoel123 Jun 20, 2019
Exactly. I can't win....

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.
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The answer to "you'll be able to help me" is "No, Dad, I have to work and care for my wife and kids. You'll need to go to rehab or pay for someone to come in".
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paulfoel123 Jun 20, 2019
Well he would get rehab and/or carers for free. NHS in the UK. May well be a bit ropey but its free. Not a chance in hell dad would pay a penny though.

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.
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I think your concerns about the surgery risks are quite valid. I would want to know what the doctor thinks the surgery could achieve for your dad. What would be the specific expected benefits of the surgery, and how likely are they to occur. Also, I'd want a clear picture of what recovery would look like and how long it can be expected to take. And I would ask the doctor if there are any particular/additional complications to worry about given your dad's other health conditions. I suggest getting an independent second opinion, too, to make sure you are receiving consistent information. It also wouldn't hurt if your dad has a primary care physician who could weigh in. The idea is to get someone who is more objective (surgeons tend to want to do surgery) and who hopefully has an overall, integrative view of your dad's health. Geriatricians can be hard to find, but if you could consult with one that would probably be helpful.
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paulfoel123 Jun 20, 2019
Im in the UK so at the mercies of the NHS here. I get the impression that the consultant hasnt considered aftercare - like you said.

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.
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Paul, I agree with you, the potential risks are just too high for your Dad at his age. And since he's been down that road before on his other knee and had complications, why on earth would he want to go through all of that again?

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.
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paulfoel123 Jun 19, 2019
Freq - Yes I've been reading that older people can have memory issues caused be general anaethetic. Worrying that.

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.
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Paul unless you plan to be the onsite caregiver my opinion is no. He will expect you or Your Wife the Nurse there for free care. Just say no you think it would be a waste of his money since he’ll need round the clock PAID FROM HIS BANK ACCOUNT caregivers. If you encourage it, I’d pack your bag to stay with him cause that’s what he will hound you to do.
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paulfoel123 Jun 19, 2019
Yes that's another thing. Hes already said "but you'll be able to help me won't you?"

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.
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