MIL and knee replacement fixation. Any advice?
MIL has stage 4 kidney failure and takes a long list of medications. She insists that she needs a knee replacement. She had one knee replacement several years ago and it was a disaster from beginning to end. She was on pain medication for months. Her risks for infection and other issues are higher with her failing kidneys.
She rants about how awful last surgery was, but trying to reason her is hopeless. The ortho barely cleared her for surgery, he is all about how great he is at is craft, not so much her and risks (I know, but this is the impression I am seeing in this particular practice). When asked if she is willing to take these risks, she said . "Oh yes". She said she cant go up steps. She lives in a single story home with no steps. She is not climbing stairs on a daily basis.
I suggested that she truly think this through and ask her the hard questions. I asked if she had decided on a "full time caregiver" should something happen? She said, "No." She was told that due to her poor health she would not be giving "normally prescribed" doses of pain medication. I asked if she could handle that. She said, "Yes." Thennnnn...she falls back into how much pain she was in with last knee replacement! I feel like I am going nuts. She has a history of making impulsive decisions and being rebellious. Her healthcare history involves refusing to take medications correctly, refusing to change medications that are less toxic to kidneys, stating that "doctors never her told her...xyz." She only hears and believes what she wants to hear and believe. Also, I think some people enjoy having surgery for some delusional reason. I have been going to her medical appointments to be a second set of eyes and ears..she refuses to wear hearing devices. All of this is taking a toll on me. I want to have a positive relationship with her and to assist my husband (he helped me with my parents), but I think I just need to step back. Any thoughts are appreciated.
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Yes, sometimes it's because they are looking forward to getting the pain meds.
But, in your MIL's case, it may just be due to her loss of reason, logic, memory and empathy from cognitiive impairment. If I were in your shoes, this would be a hard no. Don't enable the conversations about it. Divert and redirect the conversations. Don't give her any ammo to focus on or this topic or you will just continually go in circles with her.
If she has a MPoA, this person can tell her a "therapeutic fib" that her doctor has not cleared her for the surgery - "It's too dangerous.". This takes the onus off of your husband about not having the surgery and hopefully closes the door on this discussion.
Step back. Let hubby interact with her on all this. Just have to tell him, I'm OUT when it comes to this knee replacement convo. If you want her to have it, you deal with it.
Do you think this knee actually needs replacing? When you mention ortho barely clearing her for surgery, is that for the knee already done or for the 2nd one that she wants/doesn't want?
At best I would do nothing to support this plan. If hubby wants to allow it, then it's got to be up to him to deal with. And she will have to go to rehab after.
If she didn't do well with PT last time, it will be even worse this time.
injection…..
Fil had two strokes. He has postural hypotension when getting up. He won’t drive again. He’s only safe with a walker now. Especially now that he’s had a third of his intestine removed, he will always need Depends.
Given that the knee op is not immediately life extending, they’ve chosen to defer. They know the next general anesthesia could send him into hospital delirium that could turn into dementia.
And just because your husband helped you with your parents doesn't mean that you have to continue to endure his mother, who sounds like a diva. She won't wear hearing aids? She refuses to take meds correctly?
You know deep down that if she has this surgery that she will not do much to aid in her own recovery and probably expect you to help her. If things go wrong, she may end up being unable to continue living in her home. Then what?
She had one knee done, that really needed to be replaced, bone on bone. She did not rehab well at all, and when she decided to have the 2nd knee done 'in case it got bad' her ortho doc not only refused her, but 'fired her' and said he could not, in good conscience, do a 2nd knee replacement, she would wind up in a wheelchair (which is honestly what she wanted and liked)--Also the anesthesiologist did not clear her for surgery, so that was a big factor.
So no surgery and some months of pouting about it.
She didn't try very hard to get that 2nd knee done. We knew it was 'old' but it was by no means in need of replacing.
We all just listened to her complaints and moans about aches and pains and reminded her sometimes, that her CHILDREN were in their late 60's and 70's. We're not perky, super healthy 20 yo's.
She was not compliant with any PT after the in home PT stopped, so that was indeed a big factor. No surgery except for the knee replacement really 'helped' her.
She really LOVED a good surgery!
If the Ortho would would her PCP and other doctors she sees?
I would bet that one of them would not approve the surgery.
Tell her that ALL her doctors have to approve her for surgery.
I would also encourage her to go through some PT and OT BEFORE the surgery to increase strength, mobility, and current range of motion.
If all her doctors approve I would think a few sessions of PT might change her mind.
Then the caregiver HAS to be lined up before the surgery.
the other think you might want to do is step back, let your husband step up and care for his mom for a bit. He may see things the way you see them if he is a bit more involved. He might have more sway with her convincing her that surgery is not in her best interest.
I think the only thing in your power is to hold firm on insisting she goes to rehab after surgery.