Asked to have a psych evaluation?

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wednesday210

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So I'm a a little unsure if I'm just being overly sensitive or what I thought the best people to ask was you.

I had a successful LTKR four years ago at age 45 due to severe arthritic degeneration and of course our familiar friend pain. It wasn't easy by any stretch of the imagination but by 12 months out I was very happy to have done it.

To appease my surgeon and for my own desire to be healthy, I had a gastric bypass in order to take pressure off the other craptastic knee.

I lost 70lbs and while I'm still no supermodel, I've felt great for the last couple of years.

Four weeks ago, I was injured while doing some full contact gardening and tore my MCL & posterior horn meniscus. It hurts very much.

The new surgeon (do none of these guys have a shred of kindness???) immediately again says I'm still too fat, Thanks Doc, and that there is nothing to do but replace the joint. But...
Here is where it starts to get crazy.

He then proceeds to say he doesn't want to do surgery even while admitting it's the only fix. He wants me to diet and exercise, take anti inflammatories and purchase an $800 brace that my insurance won't cover then reassess in two months.

What? Insert quizzical puppy look here.

I tried my best to explain that 1- with the bypass and a history of ulcers there is NO anti inflammatory that I can take and that 2- I already am on an 1000 calorie a day meal plan for life so I'm like, yeah, no.
And 3- I can't flipping walk my dog much less run on the treadmill.

He then says he can tell I'm upset, says he will send his PA in and leaves.

The PA comes in offers a steroid injection as an alternative and I leave since I had explained on the 40 page medical history that of the ten or more injections I've had, the last three did jackdiddly except cause more pain.

A couple of days later I get a survey "how was your experience " call. So I told them. Yesterday I get another call asking me to come back in to discuss scheduling surgery.

So I go for my 3:30 appointment and sit in the waiting room until 4:10, then the exam room until 4:25. He then comes in apologizes for our "miscommunication" last time.
But then proceeds to tell me that he wants me to have a psych evaluation from a psychologist in his group to make sure I'll be a successful candidate for surgery before moving forward with scheduling.
I asked what made him concerned that I wouldn't be. He said I seemed to have a lot going on. What???
I did list an antidepressant on my medications because I thought being honest was you know, important. I also explained that my sister died last year after an extended illness. It was very hard for me. But am I like two steps from the psych ward? Not until now!

But I try to be mature and ask, if I consent to this evaluation how long would it take me to get the knee fixed and he replies 4-6 weeks.
I walk to the check out desk, they schedule me me for my psych evaluation and say his FIRST AVAILABLE is the end of January.
No flipping way.
Nope.
Nein
Nyet
Not gonna happen.
9-10 weeks then another six for his surgical schedule???
I don't like feeling all paranoid but I swear my spider-sense are tingling.

I cannot be the only person on antidepressants needing surgery in this country. In fact, for my last surgery my primary care doctor suggested them because she said the help your pain receptors or some such.

Have any of you ever had this type of experience?

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@wednesday210 I am so sorry to read about your horrid experience! Having gastric bypass is hard enough - that's one major op!

If it were me I would find another surgeon with a bit more bedside manner. It sounds like this guy is making all the excuses and you don't need that. Can you get a second opinion?

All you want is a chance to get on with life. Start talking about quality of life issues. No wonder you are on antidepressants!
 
Look for another surgeon pronto! I am overweight and my weight was never mentioned when scheduling my upcoming BTKR.
The psych evaluation is bizarre to me. If you had a very difficult time with you first tkr ........perhaps......otherwise I cannot hazard a guess.
 
I agree, too. This guy is not the right surgeon for you.
 
The right surgeon is vital and this guy isn't it. Take a look the Find a Clinic tab at the top and make some calls. If this is how he treats you I'd be left wondering how he'll handle pain management or any other issue that may arise. Run (or walk quickly) away from this one. :running:
 
the most important aspect in having a TKR is the trust that a patient has in the surgeon---selecting the absolute right surgeon is paramount.

This guy is 180* the wrong way. You need to find one who will accept you for who you along with your medical history---and will work for you to get you the TKR that you truly need.

It is time to continue the hunt for the surgeon who is the right fit for you.
 
Just keeping it unanimous, me; go and find another surgeon.

Oh and make sure he has no connection to the one you're using now
 
There are other OS. Find one of them. My mom died in February, I had gastric bypass in 2014 on my own to try to buy some time for my knees. I lost 112 lbs and bought myself 2 years. I am under a lot of stress due to the estate situation but not a problem. Keep looking.


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So just as a matter of interest, what is your BMI? Or if you don't know it, would you tell me your weight and height so I can work it out for you.

Assuming your BMI isn't in the 50s or more, I also think that it's outrageous for him to require you to have bariatric surgery before he will operate. I had a BMI of 43 (254lbs) when I had both my knees done (5 years apart) and I also nursed a lady who had her knee done and had a BMI of 63 (400lbs) and she did terribly well. We both used the same surgeon!
 
I agree with everyone else. Find a new OS. When I first went for my bad knees the first OS said he wouldn't even treat me (I was asking for cortisone or Synvisc shots) until I had a BMI<30. (My BMI at the time was 50).

I found a new OS who scheduled the Synvisc injections right away.i bought myself almost 10 years with the injections. When I went for my last set of injections in Jan 2016, my OS told me I seriously needed to consider BTKR surgery when the injections wore off. He also said that losing weight would make recovery easier for me and recommended that I lose weight (BMI=40) but he did not require it.

By the time I had my surgery, my BMI was down to 33, which I'm sure did make some things easier, but I can't even imagine the stress if that weight loss (or more) was required before he would consider operating.

Get a new surgeon.
 
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What??? You need to run (well, at least limp as fast as you can!) to another surgeon! I can't believe the insensitivity of this guy! You've had a rough year and seem to be coping quite well. Please say there is another surgeon in your area that you can make an appointment with. Let us know.....
 
Hello- I'm new to this forum and may not know all the protocols- first time posting. Had a right total knee replacement 8 days ago.

Most insurance companies require a psych evaluation before any weight-loss surgery. Is it possible that you may have already had an evaluation before your bypass surgery? If so, maybe you could return to that psychologist on an expedited basis --maybe get in to see that person quickly and have an update completed very easily? It wouldn't hurt to ask.

Good luck, Wednesday210, and I hope you find a way to get your medical needs taken care of without too much more delay.


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Welcome to the forum, @SJCL. So glad you joined us. I suggest you start a recovery thread of your own and tell us a bit more about yourself and your recovery so far. This new thread will be the place where you'll post updates and ask any questions you may have.
 
Yes. Years and years ago I was trying to get some help with my knees and the OS gave me the same line. What I didn't know then, but I do know now, is that he did not and would not want to do my surgery. And I believe this is true with your OS also. It's important that you recognize that you don't want him to do your surgery either. Please find yourself another OS that you trust. Hang in there to find just The right surgeon. It will be better in the long run for both you and your OS to be playing on the same team!


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@wednesday210

Ugghhh. My spidey-sense would be going off gangbusters too! I wouldn't want this guy to touch me! I am on anti-anxiety meds, not benzos, and a psych eval was never even suggested. It's bizarre that you were mentally healthy enough to go through a gastric bypass but not a TKR? Don't they do a LOT of vetting for the bypass?

I would bet that I am way more obese than anyone on this board, and only 39, yet my OS didn't hesitate at all because of these reasons. I'm having my second knee done on 11/28! I hope you find someone who can treat you for the pain you have and help you get to the point where you can move around and be active. I know I have had a hard time even walking, much less exercising to lose weight! Catch-22...

Good luck!
(I thought I was the only one that used the word craptastic!)

Jen
 
I would bet that I am way more obese than anyone on this board
Wanna bet?
I had a BMI of 43 (254lbs) when I had both my knees done (5 years apart)
I also nursed a lady who had her knee done and had a BMI of 63 (400lbs) and she did terribly well.
We both used the same surgeon!
 
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