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I have so many things to ask/comment on. One being that I actually called a "caregiver" hotline last week and just sobbed. Kind lady was helpful, but it's all the same stuff.


Anyway, today's big question I hope you dears can help with is that my Mom has decided she wants a knee replacement. She had one years ago, and the doctor said she'd need another eventually. I acknowledge it must be painful.


However, she refuses to exercise. She goes from her bed to recliner to toilet (when she doesn't sneak a diaper....because then she doesn't have to get up). She has opportunities to walk daily, whether inside or out. I'm not expecting her to do laps. Just to be active.


Before, she didn't do her PT after the knee replacement. I see the same thing in store. Her doctor again said he'd refer her to the ortho we saw before, who said to delay it. And he warned her lots of PT would be involved. She told her doctor she needs it urgently to walk. I spoke to him and he said she shouldn't be in pain when walking. He thinks the ortho should make the call.


Thing is, she's not walking. She might feel better if she got around the house. I could buy into the surgery if she upped her exercise now, in advance, maybe lost a little weight. I'd be totally supportive. But I can't be right now. Not when she will not get up for anything. In fact, the recliner is almost a bed, she lays it far back.


So of course her knee hurts when she walks on it, because it's not used to being used. I can beg her to walk with me, even just down the hallway and back at home. I took her to get her hair done and she fell in the parking lot. She said it was because of her knee. That wasn't it, she was fiddling around with her cane and her bags (she wouldn't let me carry) and she was rushing around. She's fine after that. To her, it reinforces the need for surgery.


I suggested PT first (as did the ortho). Nope, surgery. She's 86, and there's Covid to think about. They'd likely want to do skilled nursing facility a day or two after (like before). So....seems a bad idea to me.


I don't want to sound awful but I don't want to deal with the recuperation process if she won't try. I had a heart attack two years ago, and the next day I was cooking for her and sweeping. So yeah, I don't want anything else on my plate.


Any suggestions?

caroli1

Ok. Thank you.
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Reply to haileybug
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Imho, is your mother a candidate for corticosteroid injections? That is always less invasive, of course and pardon me if it sounds wrong. Just an option - or not? Prayers sent.
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Reply to Llamalover47
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My suggestion is to prepare a memo to Ortho doctor, giving your reason for letter and all you stated on this forum and any other info and your thoughts on NO replacement. After that when you think ortho doc saw your comments, make appt and let him say "no" surgery. Get him to prescribe PT but no surgery if you think that would satisfy her. OR, let him say he won't do surgery unless she starts walking every day AND agree to PT. Better him say than you. I'm 81 and have two knees replaced one at 68 and other at 75, not a walk in the park but I have no pain because I walk on treadmill several times a week at 3.0 mph. Walking is not painful but I am fall risk and must look down for gravel or something in my path. I choose to be safe on treadmill at speed I can control. Recently had shoulder replacement surgery and wish I didn't, at my age. BUT I do my exercise 4 x a day so I can get out of pain and recuperation and on with my life, little that is left, Is there someone who can walk with Mom? That might help.
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Reply to JoAnne80
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My neighbor is in a wheel chair because her knees hurt too bad for her to walk.

The doctor said she is not a candidate for knee surgery because she can not be put to sleep.

They are actually getting ready to do a procedure where that give her a shot in her knees to numb the pain. The doctor says she will then be able to walk again.

Maybe, this is something you can look into for you mother.
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caroli1 Oct 8, 2020
It's not necessary to have a general anesthetic to have a knee replaced. I din't want one, and my orthopedic surgeon, who had done other surgerieson me, agreed it wasn't necessary. I had a regional anesthetic with no sedative (also my preference), and all went well. I was 61 at the time. Your neighbor might ask a different orthopedist about this possibility. The knee injections--usually cortisone or Synvisc--are only a temporary solution, giving up to 6 months of relative freedom from pain. They can be repeated, but each time they normally help a little less. Eventually knee replacement will be needed if she's still young enough and in decent shape to have it done. I guess if your life expectancy isn't more than a couple of years, you could just have injections. Otherwise, by postponing knede replacement, you might get into situation where it was no longer medically feasible.
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It is hard to ask someone to exercise when they hurt and it hurts when they don't exercise. I would suggest she start doing some water aerobics - nothing formal - just walking back and forth in the pool to start. That may help strengthen her muscles while taking some pressure off of her knee. Does she take any medication for her knee? Aleve and Voltaren gel are my "go to" medications for my arthritis.

I would also recommend talking/seeing her otho doctor. He/she can evaluate the joint and prescribe physical therapy, medications... Of course, doing her physical therapy exercises is the best way to strengthen the muscles that protect the joint. I would let the ortho doctor be the one to make the decision on when mom needs a new knee.
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Reply to Taarna
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My mother has a very bad knee that Ortho recommended replacing. Mom refuses to be active and barely moves at all. She refuses surgery which is good because she would never do the rehab anyway. We keep telling her if she doesn't walk one day she will be unable to. She complains everyday but of course it is painful and stiff due to inactivity.
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Reply to InFamilyService
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How do your H and son feel about putting your mother's life above your own?
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Reply to CTTN55
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Can you convince the Ortho to "prescribe 6 weeks of what I might call "pre surgery rehab" so that she can get her strength up and be in better shape before the surgery. If for no other reason that to strengthen her other leg, upper body and balance improvement. Once she has 6 weeks, ok maybe 4 weeks of activity she would heal faster and be stronger for both the surgery and the rehab. And the Rehab after she would HAVE to follow through.
Funny thing about the Skilled Nursing Facility or Rehab facility. I was talking to my Ortho about knee replacement and he said that he will NOT do a surgery on someone that WANTS to go to rehab facility he said the risk of infection is higher and he thinks the Rehab sites are better and more thorough in post surgery rehabilitation.
As far as COVID the Surgical Sites where most of the joint replacements are being done are awesome. I just had hand surgery and I had to get COVID tested 3 days prior, I was dropped off, only I could enter the facility my temp was checked, I was given another mask, I was the only one in the waiting room. When I was brought back for prep any other patient that was there was in a curtained off room so there was no contact with anyone other than staff. I was very comfortable. So I do not think contracting COVID at the surgical location would be a concern it would be in a rehab facility so that would be a hard no for me. It would be going to a rehab site where the number of people are controlled and contained with proper scheduling. And she would have to follow though at home with the exercises that are given to her. And you would have to be a big part in that in "forcing" her to do the exercises.
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Reply to Grandma1954
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When my dad had a knee replacement we were told the only reason it was successful was his cooperation with the therapy afterwards. And the therapy was a lot for him, but he did it. Obviously your mother has a sound mind and can make her decisions in this. But you can and need to also make your own decisions also. Expect her to come to a table for meals, go to the bathroom, do some light household chores. She’s proven she can walk so no catering to her being a blob in a chair. No doubt she has pain, arthritis is a constant source, but also most helped by movement. Her life needs to become less comfortable in your home. Maybe time to toss that recliner? Above all, guard your own health, I wish you well
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Reply to Daughterof1930
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Only she knows how she feels. My friends who have needed knee surgery were in excruciating pain. Your mom may be also. She may not be able to walk around like you expect she should.

If she is of sound mind, let her choose. Many of her age would be considered ineligible for such surgery. If she is able to have it, the doctor recommends it (even if not quite now) and she wants it, why would you stand in the way?

If you are worried about Covid, ask whether rehab can be done at home or in the safest possible facility.

If you are worried about whether you are physically capable of caretaking, find another available family member/friend or hire a nurse to take your place.
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Reply to ACaringDaughter
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Guys, sorry. My username is confusing. I'm Barb, a lady (ha), and owner of Robert's Nursery. And she already lives with me....
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Reply to robertsnursery
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I noticed you didn't get a lot of replys to your March post telling us Mom just got out of rehab and gave You a list of demands. That post must have gotten lost in the mix.

I hope you didn't cowtow to her. Wanting her food brought to her. You changing things to suit her. Little Ms Queen huh.😊Made me smile. Worst thing you could have done if you did. Love the scooter. The more she does for herself the better.

I think in ur first post, you mention numerous falls and a walker. In this post u mention a cane. A cane does not help unless u need support with one leg. A walker should be used when falling is a constant. The Rollators are great. Easy to manuver. They have seats with storage places. Bags can be hung from the handles. A little expensive but maybe worth it. Not sure if Medicare would cover the cost or even partially. At one time they didn't not sure about now.
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robertsnursery Oct 4, 2020
Oh yeah, I cowtowed, LOL. So many things to juggle, I had to pick my battles better.

You're right on the cane, in fact, I think it makes things more dangerous. But she insists it helps her. (Battles!). She has a walker she got in the nursing facility but won't use it. Why? Because ONE person said 'you're doing so good you won't need it' and she took that as gospel.

It sits right outside her bedroom door.
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With my grandmother, she never would do much walking. She sat most all day in a chair. It wasn't that she was lazy or that she didn't want to, she just couldn't.

My grandmother had bad arthiritis in both knees so badly, it was too painful for her to walk. She had to have two knee replacements.

We just can't force someone to do something they are not able to do. just saying
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Reply to haileybug
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His profile says she lives with him and as such, he will be putting up with her 24/7.

What I would do is make a list of what she didn't do the last time and she doesn't do and won't do now. I would give this list to the receptionist at the Ortho's office and ask that he read it before his exam. This way he can give Mom all the pros and cons of the surgery and emphasize that she needs to be willing to go for therapy in a rehab facility. I have read on this forum that it seems family members so better having rehab in a facility than at home. More inclined to work with a therapist than family. That way you are sure she is getting the therapy and you get a little vacation and maybe she will lose some weight.

You cannot make someone do what they don't want to. Just need to learn what battles to fight. I am not beyond a little threat "Mom if you get this surgery and don't do what you need to and that leads to me doing more for you, you will then need to go to an AL or LTC. Because physically, I can do no more than I am doing right now or I'll die. Then where will u be."
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Reply to JoAnn29
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Don't get involved.

Mother's orthopod needs to *prescribe* a course of pre-op PT, which must be completed before the surgery can go ahead. X sessions, all checked off by the friendly PT him or herself, well done mother.

But don't you nag her about it.
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robertsnursery Oct 4, 2020
aren't you smart? I like this idea. I can play along, and surely someone will shut down the idea. I can't imagine they'd even want to pay for it given her history.
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So, a couple of thoughts. My aunt in her 90s had her second knee operation. She was not very active but probably more so than your mom sounds until you get to the part about shopping, moving too fast, carrying shopping bags, fiddling with a cane. That sounds pretty active.
Anyway my aunt had very little therapy which surprised me in that she did fine with her surgery and then had a full recovery. You are so right that therapy before and after surgery will help her recover. But a painful knee will Tend to keep you grounded. My aunts ‘blew out’ as she put it. She had to have the surgery or accept the wheel chair. She opted for surgery.

However you are missing the larger picture. What about you? I am concerned for you.
You are so stressed with caring for your mom.. You have had a heart attack and you are emotionally distraught. Who wouldn’t be!

Whether she has the surgery now or not isn’t really the issue.

The issue is how will you manage your or her care if you are in the hospital or worse? And I wonder how worried you are about the Covid for yourself. You have every right to be.
But really what are you doing to take care of you?

If mom has money for hairdressers and shopping, maybe she has money for caregivers. If she doesn’t perhaps it’s time for community Medicaid for her. Check with your local area agency on aging.

Meanwhile, Back off. She’s not incompetent. She’s making her own health care decisions. She’s probably not wrong to have the inevitable surgery sooner rather than later. and there are exercises that don’t involve walking on the knee but rather building the muscles in the leg to help support the knee. those really work.

I was in the hospital twice in June in a hot zone. I was amazed how quiet and peaceful it was. How much excellent care I received. To be perfectly honest with you, I would be more concerned about the therapist coming into my home than mom going into the hospital.

You could use the break of her being out a few days. When she comes home, have the aide lined up. Make it clear that the aide is there to stay at least until she is self sufficient. Maybe longer. I see on your bio that your mom lives with you In your home. It might be time to find her a place of her own where she can be free to spend her days as she sees fit and it isn’t so stressful for you to watch. Right now as you describe it, Even with her pain, she sounds a bit better off than you.

Let us know what she decides and how you intend to put Robert back on the agenda. You matter too and we care.
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robertsnursery Oct 4, 2020
First off, it's Barb. Robert's Nursery is for plants, LOL...I'm a lady! Ha.

You are right, I'm having a rough time now. So much going on, normal stuff, but add Covid, a teenager, and some extended family PLUS my mom has made things rough. The activity I mentioned was her going to the hairdresser, she was delighted to get out, and it'd been the first time out of the house in a month. Normally, it's the chair.

We're being careful with Covid and have had good luck so far, just pretty much extreme isolating which is exhausting. How can you be tired when you did nothing? Alas, this is my life.

I appreciate your kind words and ideas.
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There must be a reason she refuses to walk and uses a cane when she does?

Perhaps pain. Maybe arthritis. Your mom may do better after knee replacement.
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JoAnn29 Oct 4, 2020
Maybe laziness. Had a Aunt like this.
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Robert, not everything can be fixed.
Whether or not it is time for the knee replacement to be repeated is up to your Mom's Doctor. Whether or not she wishes to have the surgery is up to your Mom. Whether or not she will cooperate with therapy is also up to your Mom. Her own decisions will have their own consequences.
Meanwhile you should be getting on with your own life. It is my fervent hope that you have not moved in with your Mom, nor moved her in with you. Be certain not to do that, be supportive of her choices. If she ends in a wheelchair then she will be in care needed according to what her assets will allow, or on medicaid, and you can visit her.
Wishing you good luck.
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Reply to AlvaDeer
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Robert, if your mother is mentally competent, she can decide to have any surgery her docs approve her for.

That does NOT mean that you have to move in with her.

Let her go to rehab. Let her hire in-home caregivers.

Why arent YOU getting on with YOUR life?
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