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....
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.
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.
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.
#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
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.
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.
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!)