Cannot have a TKR unless I get my BMI down to 30

[yesyvonne]

For anyone who is serious about losing weight, I strongly encourage you to check out Bright Line Eating. There is a book by that title, written by a neuroscientist who has studied food, nutrition, and brain function around eating. She was once obese herself, is now slim and trim, and still follows the plan. Please do consider it, @Westie13, as you sound quite desperate. There are astonishing success stories with before and after pics at the website. I have been on it since last October and have lost 40 pounds so far. It's all about what you eat (real food, fresh food), how much, and when. Also there's a community of strong support, which is essential.

I think whether or not you find a surgeon to do your knees, you will be happier if you take at least some of that weight off and regain some degree of increased mobility.

Now I don't really know how the bariatric band would impact Bright Line Eating, but there are ways to be in touch with Bright Line support and you can ask about that.

My heart goes out to you. I hope this is helpful for you.

 

[lovetocookandsew]

@Westie13 While I don't know specifically about your life and situation, I do know that I have gained around 40 pounds since my original TKR due to an inability to move around enough. My eating habits have not changed since I was lighter, I still hover on or under 1400 calories per day, watch closely my carb and fat intake to balance eating enough of them, but not too much; I eat tons of fresh vegetables (we have a huge garden and I take advantage of that year round), I cook nearly 100% from scratch using very little pre-made food in the preparation, make my own 100% freshly ground white whole wheat bread, (although occasionally I do use a blend of wheat and white for certain types of breads, but then only eat one piece), etc. I tried to drop down to 1200 calories, but I was just too hungry at that level. At my height and bone structure, 1200 calories is just not enough, so I stay at 1400, which is still low but easily doable for me. Being active, riding my bike, swimming and the like doesn't burn a ton of calories, but it speeds your metabolism for a while after, plus those calories do add up big time over a long period of time.

I would encourage you to keep searching for a surgeon who looks at your knees as a big issue with getting to and maintaining a healthy weight, rather than looking at your weight as a barrier to getting strong new knees. We cannot move around enough if our knees hurt like , so we need them to function as well as possible. Then, if you are able to find a surgeon and get them fixed, I encourage you to make it a top priority in your life to move around as much as possible when recovered. At first it may be only a little walk to your garden (or similar) but as time goes on and you are faithful to moving around, it'll become easier and you'll find yourself taking long walks, maybe doing some swimming or similar activities that suit your life and likes. Good luck to you and keep us posted!

 

[Westie13]

Why on earth would anyone go through having a gastric band fitted to lose weight and then make smoothies etc and suck chocolate as you suggest Josephine, it makes no sense at all. Why bother having the surgery if you are not going to work with it?

I get why people don't believe that I must cheat or I would have lost weight and that is their choice to think this but I know what I eat and so does my Husband. Why would I want to live in so much pain through choice if I could get rid of the pain by eating less. I am stuck in the home as in too much pain to try and get in the car as cannot bend my leg far enough to sit down. I do not choose to be stuck at home as my life is passing me by.

But anyway this is not why I sought out this website. All I wanted to know was if anyone else was able to get surgery done when overweight.

As for winning the lottery being no help, I disagree as if you are paying for your own surgery then you have the choice to go anywhere to have it done be it in the UK or abroad. Look how many have said they have had it done with a higher BMI. You even said yourself you had your own done. So I would go to one of these hospitals if money was no object.

The address I sent my email to I found online when searching for City Hospital website. It is NEOS Nottingham Elective Orthopaedic Service and the contact email it gives is [email protected] I understand they must be extremely busy and cannot drop everything to answer an email as they probably get a lot of mail to answer.

 

[Mollymax]

Westie13 I know how hard it is to lose weight and even more so if you can't exercise. It is a hard thing to do because weight goes on so much quicker than it comes off. It's a very long term plan to lose several stones in weight. Although I joined slimming world it was more for the advice and help they could give me. I had been on every diet known to man and I thought nothing worked. In fact it was my mind that didn't work. I needed to get my head round it. To me SW was a way of life. Healthy eating. Everything made from scratch. Plenty fruit and veg. Nothing was banned. I just had to count things like biscuits, chocolate and stick within the syns. Bit by bit the pounds started to come off but I had to stick with it. At times it was hard but so worth it when I went to class to be weighed and had a good loss.
You will manage it. Even before this operation I was feeling the benefit of losing 6st. I was so much healthier and fitter.
Now I need to be careful because for the last 2 weeks I have been eating what I wanted and old habits are easy to slip back into. I need to get back to my healthy eating. I know I am only 2 weeks post op but I dare not slip back.

I really hope you manage to get your BMI down a bit and find a surgeon happy to do the operation.

 

[Josephine]

Why on earth would anyone go through having a gastric band fitted to lose weight and then make smoothies etc and suck chocolate as you suggest Josephine, it makes no sense at all. Why bother having the surgery if you are not going to work with it.

Oh Westie, I wasn't accusing you of cheating! All I was saying is that there is no point in having this surgery because it IS possible to cheat. Very easy in fact. Common sense tells you that. It tells ME that, anyway! And further more, I have no intention of ever even considering hyperbaric surgery. Good for people for whom it works but I know far too many it hasn't worked for!

It is NEOS Nottingham Elective Orthopaedic Service and the contact email

This unit is not going to answer your question. It says in the sub-text

The service provided at the NCSEM-EM is appropriate for patients over the age of 18 years who suffer from musculoskeletal pain, including meniscal tears, chronic knee instability or ligamentous injury, mechanical hip, knee or shoulder pain, osteoarthritis, shoulder impingement, capsulitis, rotator cuff tear, and shoulder subluxation or instability. All appointments are made through referral from your GP. You should initially make an appointment with your GP to discuss your problem after which your doctor may refer you to our department. GPs can then make an appointment through choose and book.

In other words, it's an MSK unit - a doorway to the hospital whose sole objective is to steer people away from surgery and save the health authority money!

My only advice to you is to look out a number of surgeons and ring their NHS secretaries and ask them if he ever operates on people with a high BMI.

I know for certain that my surgeon will do them as he once operated on a lady with a BMI of 63 (400lbs) and she did terribly well. I understand she wasn't the only 'biggie' of that size he's ever done! And if you wish to undertake a journey up to Sunderland, Tyne & Wear, I'll be more than happy to put you in touch with him!

 

[SusieShoes]

I totally understand your weight loss dilemma, @Westie13. My sister and I are both heavy and have been for years. We've both had TKRs, too. Both knees in the both of us. She had the hyperbaric surgery so she could have her TKRs, and she lost a lot of weight before the operation. I didn't have hyperbaric surgery but had TKR anyway. I was never as heavy as she was and I've lost weight since my surgery through lots of walking. She's since gained her weight back and she really doesn't eat much. I don't eat much either. I swear I can survive for a week on a can of tuna. I'm the person everyone should want to have with them on a desert island. While we work toward survival the other guy or gal can have all the food.

Just do the best you can and keep trying to find a surgeon. Josephine's surgeon sounds like a good one to start with! It's worth the trouble and even expense to travel if you can get a surgery that will change your life. Both my sister and I would not trade in our new knees for anything.

 

[Josephine]

I don't eat much either. I swear I can survive for a week on a can of tuna.

Susie, that's an interesting point as I don't eat much either. I'm always being told off by my sister (also T2D) and my diabetes nurse (done food diaries for her several times) that I don't eat enough or regularly enough. Have a breakfast of sorts, infrequently a lunch and rarely an evening meal of an substance. I could go into more detail regarding my GI tract and other things but you don't want to hear that. It all complicates things. I might add that I keep regular stocks of Immodium on hand. Information sufficient!

 

[Westie13]

Josephine, do you know if your surgeon works from any other hospitals or is it just Sunderland. Because of my knee and other health problems, I am not a good traveler any more as cannot sit for long before I get to stiff to move. I have just googled it and it is 142 miles and 2 hours and 30 minutes away. My usual limit when I could actually get in the car was around 50 miles before I got set.

Just suppose it was possible that he could do the surgery, what sort of condition are you in for traveling home. Would it be a problem trying to get in the car like it is now given that it will be right after surgery. I have no idea what you can and cannot do right after surgery as I never read any further when I was told I could not have it done.

In your opinion would it be ok to travel 140 plus miles home and still be able to get out the other end and walk into the house. You have had the surgery done and know what it feels like afterwards for putting your weight on the knee and for bending it to get in and out of a car. Normally I drive but I have been unable to drive for the last 2 years as it is my right knee that is done for and I cannot lift the foot for the pedals. It is not responsive enough to risk driving so Hubby has had to do all the driving.

Therefore I have to get in the passenger side and it is my bad leg that has to go in first and take the weight while I get the other leg in. This is where I have the problem as my knee will not take the pressure put on it to get the rest of me inside the car. Do you think it could be possible if the surgeon agreed to do it.

Going back to food intake, I think the way I eat does not help. I have spent my entire adult life not eating breakfast. Simply because I could not stomach food first thing in the morning when I had to rush off to work. I never eat lunch either and my only meal is around 5-6pm. Hubby is the same so this is the only meal we eat. We do not have a large meal, not to the size of some people's meals I have seen piled on their plates. I swear my Son and Grandchildren eat 3 times what we eat but they are active and don't put the weight on.

Apart from this meal we will sometimes have a biscuit or a bit of cereal later in the evening if we did not eat much for supper. I am terrible with fluids too. I have been nagged all my life that I do not drink enough. Hubby gets through umpteen pots of tea a day, where as I will have a mug of coffee first thing and then maybe another one in the evening.

In between this I have a 500ml bottle of flavoured still water, sugar free which will still have some left at the end of the day. I know it is not enough but I really struggle to force fluid down as it makes me gag to try and drink more than the smallest sip at a time and I just don't think to drink. I know it sounds silly but it does not feel like it is needed even though I know it is. So all of this is probably not helping with the weight.

But I really would appreciate if you could put me in touch with your surgeon.

 

[lovetocookandsew]

@Westie13 I understand the no breakfast thing. The last thing I want to do in the morning is eat but I will have a cup of tea, or a sugar free mocha as a treat, in the morning. I generally eat lunch around 11 am and then we have dinner in the evening. After a surgery, I force myself to have a little something in the morning as I know my body needs it as a part of the healing process. But I will say, I do drink plenty every day. I don't like plain water, so I mostly drink either iced white tea that is flavored with peach and other organic fruits or iced tea made from good black tea leaves.


(I abhor those cheap tea bags made from tea dust..lol) The peach ones I buy above are in nice individual silky bags but are made from tea-not tea dust, and it's really delicious. In the winter I drink mostly hot tea and iced tea.

Personally, I can't stand commercially available flavored waters, but will make my own from fruits we grow in our garden. The other day I made a pitcher of it with peaches and raspberries from our garden-it was delicious! I believe that if we don't drink enough (without going overboard to too much) it's not good for our bodies, and also not good for our weight.

I don't know about eating after the gastric surgery, but I have learned for myself that if I forget to eat all day until dinnertime, I'm sluggish and cranky even if I don't feel hungry, plus my weight will actually go up doing that. It seems to me that regular meals during the day keep my metabolism up and I feel better. I used to be so busy all the time that I would forget to eat all day; now I make it a habit and priority to eat regularly.

I know how difficult it is to maintain our weight, especially as we get older, and how easy it is to put it on. But my theory is we do our best to maintain a healthy lifestyle, including eating healthily most of the time, move around as we are able, and love ourselves for who we are, and not for our body weight. Good luck to you in your quest!

 

[Josephine]

Josephine, do you know if your surgeon works from any other hospitals or is it just Sunderland.

No he doesn't, I'm afraid. Only the private clinic on the outskirts of Sunderland at Washington.

As for leaving hospital and going home, my last experience with his surgery was that it was all over in a few days and I drove at about 2 or 3 weeks, if memory serves me correctly. I recommend you read my recovery thread to see how it was for me! Knee recoveries UK style Parts I & II (Josephine)

We now have two hotels Travel Inn and Post House in Sunderland but they don't have any arrangement with the hospital. There is also a private nursing home in Gateshead with post-op facilities but it's a bit expensive although you wouldn't need to stay more than a day or two. Shaun also discharges his patients the day after surgery though for some (like me who lives alone) they were kept in an extra day or two as needs dictated. I'm sure I could help out a bit but I suffer from an extreme fatigue syndrome so am not to be relied upon though I'd gladly accompany you to the clinic if you wanted me to.

I'll have to research more on this.

 

[Josephine]

Just remembered the Gateshead unit. You could contact them and find out what the fees are
https://www.carehome.co.uk/carehome.cfm/searchazref/81719

 

[Sooty51]

First OMG @Josephine I’ve actually managed to get on here and post. Been trying for a couple of days!

I have also had bariatric surgery, cannot eat a full meal yet cannot lose weight. So @Westie13 you have my full sympathy.

I saw a surgeon at Bournemouth General a few weeks ago and was refused surgery on my knee as my BMI was 45.5 and was told it’s not hospital policy to operate with that high BMI. Surgeon suggested I have a gastric band even though I already have had stomach stapling.

I am in so much pain I agreed but I now have lose weight with Livewell Dorset before I can have the gastric band! First criteria is I must join Slimming World or Weight Watchers. Well I already go to Slimming World so they are now going to phone me next week to organise an exercise plan. Not sure what this will entail as I now can barely walk due to pain. I am not saying no to anything as I need this op to get out of the pain. It just seems ridiculous that the NHS will pay for me to have a gastric band so I can get a knee replacement when most studies are now showing that the knee replacement can be just as successful with a high BMI. First excuse I got from the doctor was that it’s because of the anaesthetic. Well I’d have to have an anaesthetic if I have the band and on Monday I’m having a gynae op under general anaesthetic but my BMI doesn’t count those ops!

Does anyone know of a surgeon, preferably in the south of England who will operate with a high BMI?

 

[Josephine]

Welcome to BoneSmart, Sooty!

I didn't know it was possible to have a second bariatric surgery! But the thing is that the theatres and staff are all specially equipped and trained in dealing with obese patients. That's the difference.

The other point is that the BMI barrier is merely to cut down on the number of hip and knee replacements that are being done, purely as a cost cutting exercise. That was made clear about 4 years ago when the new 'management' was installed. They quickly noticed that joint replacements where by far the biggest cost in hospitals and set about deciding to do something about it! How stupid! So they will pay for baritatric surgery, endless physio and medications not to mention sick pay for those in work and loss of revenue to the government when one or two replacements will get people off drugs and back to work! Total idiocy!

 

[lovetocookandsew]

@Josephine Sounds like "Penny wise, pound foolish".

 

[Sooty51]

I did explain to the surgeon that I had already had stomach stapling but that didn’t seem to matter. I just can’t understand how an exercise and diet regime, doing another bariatric op and then if it’s successful doing the knee op can be cost effective. Surely it’s cheaper to just do the knee immediately.

Every Dr/consultant has said to me how low my metabolic rate is and that my weight was not caused by over eating. I actually wish it was because then I could simply diet and be slim. Having said that Slimming World is helping and I have managed to get my BMI from 45.5 down to 44. Small decrease but at least it’s in the right direction. (What I wouldn’t do for a bar of dairy milk though.)

I am having a gynae operation on Monday with full anaesthetic and no mention has been made about my weight for this op. Tends to prove the theory that BMI is simply to keep you off the list for knees and hips.

I have written to several clinics aboard and have 3 willing to operate on my knees, most worrying part is the getting home as I will not be allowed to fly so we have to drive. All these I have to pay for of course although one feels sure she can claim money back from the NHS.

Would still prefer to have my op in Britain rather than traveling abroad but at the end of the day I need the op doing and if I can get it done in Britain where is the best place to go? Where can I get a list of surgeons that can do a good job of knee replacement and are not bothered about the size of the BMI.

Does anyone know if there is a list anywhere of surgeons and their success rate? Also a list of hospitals or surgeons that doesn’t mind a high BMI.

I feel really sorry that the NHS now deals in reactive medicine rather than the pro-active and preventative medicine that our European neighbours are practicing.

 

[babette12]

Oh so much misinformation coming from all corners! If I could I'd buy a copy of this book for every woman I know, including everyone at bonesmart! And a copy for the OP's ignorant surgeon. This explains everything. Hint: it's NOT your fault:

 

[Eeek]

Health at every Size is awesome. It talks about finding ways to adopt healthy habits regardless of weight. There are also Facebook groups for HAES (Health at every size).

But, they are rebranding bariatric surgery to metabolic surgery because it’s supposed to change your metabolism and that has a better image than simply cutting off body parts so you eat less.

I’ve weighed about the same for more than 20 years, and my BMI is around 40 (though it’s been 39 for the past year) big deal, right? Luckily in Switzerland, no BMI restrictions ....yet.

Anyway last year I had a bone density measure - I had breast cancer in 2010, and since 2011, I take arimidex which stops the production of estrogen. I also had treatments of something (zometa) to strengthen my bones - bone density is important since I‘m also post menopausal. So anyway, my bone density is excellent (like a premenopausal woman) And the rheumatologist was giving me the hard sell on bariatric surgery - I thanked him and left. He should have been more impressed with bone density.

But my other docs (gp, gyn, oncologist) disagree - and we are all hoping better knees will let me walk more and sit less. Focus on healthy behaviors rather than weight.

Also, research does suggest that bariatric surgery has the best outcomes in younger patients. If you‘re going to do it........

But it makes me very angry when people are made to suffer these horrible procedures when perhaps a joint replacement would be a far more useful procedure.

Bean counters. Must be better ways to save money.

(Sorry for the rant)

 

[Izabel]

I had breast cancer in 2010, and since 2011, I take arimidex which stops the production of estrogen. I also had treatments of something (zometa) to strengthen my bones - bone density is important since I‘m also post menopausal.

@Eeek I too had breast cancer in 2013 and for four years thereafter was on Anastrozol which caused.contributed to my Osteoporosis. I am now on Alendronica Acid (same as Zometa) to strengthen my bones before my Surgeon will do my Hip Revision. Nasty business all of this.

 

[Westie13]

The surgeon that I saw also told me to go back to Derby Hospital and ask for more bariatric surgery to lose the weight. I was told by Derby Hospital that you get no second chance at surgery once you had already had it done once. The way they see it is that if it did not work the first time then it is your own fault. The only way you can get it done further is to pay private to have it done as they said it was never done on the NHS anywhere in the country.

So I am amazed that they are considering doing it for you. I am pleased that they are for your sake Sooty51 but am most surprised that they are going to do it. I was point blank refused.

My only hope of getting knee surgery is to find a hospital further afield that is prepared to operate on higher BMI. I am so desperate to get my knee done that I will do what ever it takes. I need to get my life back as the way it is now, I do not have one. I am a recluse due to the pain of even trying to go out anywhere and had just about given up until I came across this website. I am so thankful to the people who responded to my initial post and feel so much more positive that there may be light for me at the end of the tunnel after all.

 

[Eeek]

@Westie13 I hope you find someone. It‘s appalling you have to suffer. And the whole blame game thing....oh, it makes me so angry!

@Izabel - hope you‘re doing ok with the cancer stuff. I really lucked out....my bone density was normal when I started arimidex and my oncologist gave me zometa as a prophylaxis. In this case, my weight may have strengthened my bones a bit.