A Decision About the "Right Time"

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metalheart

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It has been awhile since I posted here, although I have checked in semi-regularlry to browse topics. My last posts were about ambivalence about the "right time" for a TKR for my particular situation and I have post-poned the surgery twice in the past four years. However, I have decided that it is time and I am scheduled for January 5th. My pre-op physcial, cardiology clearance, and x-rays are all done and I only have the dentist and pre-op with the doc to complete. The pre-op physical doc expressed some concern about my cardiac condition, although my cardiologist expressed no concern about the surgery. To satisfy the pre-op physical doc I may have to have an echo-cardiogram.

So here is how I came to this point. I have had significant pain in my right knee since 2010. It has degenerated over time to the bone-bone condition. I am an active 70 year old with 7 hill-side acres of rocks and weeds to maintain. For exercise I cycle about 6,000 miles a year with about 250k feet of climbing. Not as many miles as some my age, but it works for me. Cycling has been in important for my cardiac health: I have had two heart attacks resulting in five stents in two different arteries. I believe cycling has contributed to keeping me alive, so any threat to continuing to cycle raises my anxiety. Although I have continued to cycle these past four years, the number of days when my knees hurts has increased. And, I am compromised in other activities, but I have been willing to accept those compromises if I could continue to cycle.

My ambivalence has focused around the chance that cycling could be seriously compromised post-surgery. Although there are plenty of success stories about TKR and among those are folks -- several here --- who cycle higher mileage, there are also examples of less than successful surgery that inhibit exercise. My past evaluation was that I was willing to live with compromises in other parts of my life if I could continue to cycle.

With the "70" number looming ahead of me and some decrease in my cycling comfort and ability, I decided that now is the time: I am in good overall health, my knee pain and instability is increasing faster than I expected, and I found a surgeon who understands my needs for cycling post-surgery.

I think I am ready, although like most of you who have gone before, anxiety about the surgery itself and the recovery process seems to increase as the surgery date comes near. I have been cycling 2-4 times a week, visiting the gym for leg and upper body strength exercise, and getting the house ready for the post-op recovery.

We all seem to come to a tipping point when life circumstances, health, pain, and other factors indicate that it is time. It took me four years, visiting four different surgeons, and my spouse enduring endless hours of conversations and "ouches" as I ambulated around the house and yard. I think she is as ready as I am, maybe more so
 
It sounds like you are ready---both physically and mentally.
We all seem to come to a tipping point when life circumstance
That is very well stated!
anxiety about the surgery itself and the recovery process seems to increase as the surgery date comes near.
I have to confess that I was pretty much ignorant about the recovery---naive is a better word--but when there was anxiety, it was about the surgery

That being stated, though, I actually found the surgery itself to be very anticlimactic!
 
Hi @metalheart,
The anxiety over contemplating, preparing for, and resigning oneself to surgery expressed itself as a time dilation effect for me. The weeks and days seemed to draw themselves out up to the moment they came in and added something to make me sleepy prior to rolling me away from pre-op. That was really helpful in allowing all my insecurities to build up steam. I was certain that now was the time but little nagging voices questioned the go-ahead decision incessantly.
It is altogether possible that I might have backed down, had it not been for my friends here on bonesmart. When I questioned my resolve, they pulled up key phrases from other posts like 'going up and down the stairs one step at a time for ten years', 'unable to give the boys piggyback rides to bed', and 'waking me up at night', as reminders that my reasons were valid. They also mentioned that no surgeon is going to do this surgery if they don't think it's in your best interest.
So, congratulations on your decision! I hope your results exceed your wildest expectations! I look forward to reading your recovery thread.
Rick
 
Congratulations. I know you didn't come to this decision easily....none of us do really. But it certainly does sound like you are ready for surgery. I think you're going to be pleasantly surprised at what you can do afterwards. For someone who is used to being active, probably the most difficult part will be allowing yourself the time you need to heal. Once you start feeling pretty good, it's easy to overdo things. So keep an eye out for this possibility and plan to take things very slowly once you're in recovery.
 
You've given it a lot of thought and sound comfortable with your decision. I bet you'll be biking up a storm--once you give the knee a chance to recover.
 
I will give you aTemplate for knee replacements:

New BoneSmart members like you are in various stages of their journey to joint replacement. Making the decision whether or not to have surgery and preparing for surgery can be easier once you have done your research and know what lies ahead. Here are some tools that can help you decide what is best for you.

If you are at the stage where you have joint pain but don't know for sure if you are ready to have surgery, these links may help:

Score Chart: How bad is my arthritic knee?
Choosing a surgeon and a prosthesis
BMI Calculator - What to do if your surgeon says you're too heavy for joint replacement surgery
Longevity of implants and revisions: How long will my new joint last?


If you are at the stage where you are planning to have surgery but are looking for information so you can be better prepared for what is to come, take a look at these links:

Recovery Aids: A comprehensive list for hospital and home
Recliner Chairs: Things you need to know if buying one for your recovery
Pre-Op Interviews: What's involved?


Regardless of where you are in the process, the website and app My Knee Guide can help you stay organized and informed. The free service keeps all the information pertaining to your surgery and recovery in one place on your smartphone. It is intended to be a personal support tool for the entire process.

And if you want to picture what your life might be like with a replaced knee, take a look at the posts and threads from other BoneSmarties provided in this link:

Stories of amazing knee recoveries

************************************************************* few of the library articles we recommend for those who are considering surgery. I am also 70 and love my pain free life.
 
My plan is to progress at a pace dictated by my body and mind..... I have read enough Bonesmart Posts to know the mantras and library suggestions, so I think that in practical terms I am ready. But, can one ever be truly ready for this process .... in reality it is a brutal procedure that I hope is performed by a surgeon who knows what the outcome means for the life that remains. And, I understand that after surgery I bear the responsibility to carry though with the surgery outcome. I plan to do my part and I plan to cycle my butt off in the future!
 
Here's to your healthy new life!!!!:cheers:
 
...the chance that cycling could be seriously compromised post-surgery
- I don't get saddle sores any more because I sit straight on the bike now, where my knees prevented that before
- my knees don't hurt when I ride now, nor compel me to ride super-low (high leg rev) gears as they did.
- I have taken up track cycling since BTKR
- before, my knees used to hurt; now, they don't -- everything else does :)
 
A friend who helped me a great deal arrive at my decision to go ahead with the surgery after a cancellation and two postponements is a 72 year old competitive cyclist ...everyone recovers at a different pace but he was back on his bike two weeks after surgery and playing golf at 6 weeks...he swears his thunder thighs made the big difference...get the EKG for sure and it seems like you are doing all the right things....Best wishes

Vincent
 
A friend who helped me a great deal arrive at my decision to go ahead with the surgery after a cancellation and two postponements is a 72 year old competitive cyclist ...everyone recovers at a different pace but he was back on his bike two weeks after surgery and playing golf at 6 weeks...he swears his thunder thighs made the big difference...get the EKG for sure and it seems like you are doing all the right things....Best wishes

Vincent

Thanks for the encouragement. I know of several folks who have had remarkably quick recoveries and a fast return to intensive cycling. I plan to be patient (my wife would smile at this since I am inpatient in most of life) and cautious, but intent on returning to the bike as soon as recovery allows. I have a Kickr trainer and when the PT says I can use it, then I plan to use that as a first step to get back in cycling shape. I am also one of the "thunder thigh" types. I have always had larger quads and I am doing lots of gym work and as much cycling as weather allows to keep my legs in shape in hopes that helps with recovery.

I am not sure what to think about the echo ekg. My cardiologist did not blink at all about clearing me for surgery, but the physician working with the surgeon seemed more concerned and commented that I was more in the "moderate risk" than "low risk" group for surgery; and, he would feel more comfortable if I had a current echo cardiogram. So, maybe that will be necessary, maybe not.

I have some objective understanding that anxiety is a natural part of this process: anxiety about the surgery itself, possible complications, a less than desired outcome, and the need for longer than desired recovery. My response to the objective anxiety is to physically prepare and to think positively about the outcome and the future. But, my blood pressure goes crazy with each pre-event doctor visit and that shows my unconscious concern.

All of you who have been through this probably recognize this type of concern and reading your posts over the past couple of years has helped me better prepare and have the state of mind to deal with the unconscious concerns. Thanks for sharing your experiences here.
 
My thighs have always been rather large---to the point of having to buy pants with a larger waist size and having them taken in. My umpiring plate plants always have had massive amounts of tailoring to get them to fit the way they should.

I was very active and fit right up until my BTKR---but the strength in my thighs and legs did not help speed up my recovery any---five months to lose a slight little limp, and six months before I was at 80%-85%; eight months before I was at 90%-95%.

I am hoping that you have a quick and easy recovery, but patience is a tremendous thing to have just in case...
 
My blood pressure was a bit of concern, and it was high pre-op. It's better now.

Anxiety over the surgery is real, and I contemplated postponing. As a younger guy, the doubt was always there in my mind. Now two days in, I'm glad I did it. Its such a routine thing these days and the knowledge of that, plus my new friends at bonesmart helped tremendously. Bottom line, if yourknees are adversely affecting your quality of life, it's time, my friend. Good luck to you.
 
@metalheart The echo can't hurt. It is not an invasive procedure as far as I know.

A question to ask yourself is: even if your recovery is longer than you would like (though sounds like small chance of that) would you regret having the surgery? It sounds like you have bothersome pain and from what others say, it won't resolve on its own. Do you have a history of other knee procedures?
 
Echo is painless and is prudent for major surgery particularly if you have any cardiac risk...Echo is also a way for physicians to cover themselves in the unlikely event something is wrong......I have hypertension that is controlled with medication to 130/75 and at the PRE OP exam I was 180/100 the old white coat factor and once they give you the happy juice it drops.... As far as preparation everything will help you in your recovery as you do need stronger legs and arms to get around......I am 5 weeks and 1 day post op and played my 5 th round of golf this week today and I do attribute some of that to my condition with most going to my OS...I am totally pain and discomfort free and have taken no pain meds since leaving the hospital ...it is very much out of the norm apparently but I am obsessive and very goal oriented and that has to help and I always go by Yoda. "Do or do not there is no try".. You will do great .

Vincent
 
I have hoped that strong leg muscles going into surgery would help with recovery, but then large quads may just mean more muscle to cut.......

Blood pressure: mine has always been an issue and it is a family thing with my parents and siblings all having higher than normal blood pressure. Mine is controlled with meds to about 130/70, but it will spike with each doctor visit. How much it spikes is usually an indication of my conscious or not anxiety and the spikes the past couple of years have always been highest at my visits to the ortho doc.

I see my cardiologist every 6 months and a prerequisite for surgery was a visit to him for "cardiac clearance." We talked about the surgery, he listened to my heart, did an EKG, and then we talked a lot about cycling since he also cycles. He seemed to have no concerns about clearing me for surgery. However, the desire for the echo cardiogram (my last one was in February of this year) was from the physician who does the medical clearance for the surgeon. I guess he has the last word on go or not for surgery, so I will probably know early this coming week if he wishes one and then it is just getting it scheduled before my 12/30 preop appointment with the surgeon.

I am physically and mentally prepared for the surgery, but I am still anxious, but not to the point of desiring to cancel or postpone it. I expect there will be a good outcome, my recovery will be normal, and that I can return to exercise and a relatively normal daily life post surgery. If something goes awry, well, I'll deal with that when it happens, but it seems that for now keeping a positive attitude and feeling prepared is what works for me!

Thanks again for the comments and sharing your experiences.
 
You would not be normal without some anxiety...my OS said it was clean in part because I had so little fat to deal with...although I must admit I am in the holiday mood and pounding the cookies big time..you have done your homework and preparation and will sail through....

Vincent
 
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