Cannot stand this anymore

[JerryM]

I am at the end of my rope. I am going to be 53 in July, 2007 and both my knees are bad with arthritis. Both have received Cortisone injections in Oct of 2006. My left knee has been doing well ever since. But my right knee is not. That injection only lasted for about 2 weeks before the pain came back. I have had the synvisc injection in the right knee and it didnt do much good. On Jan 3rd, of this year I could no longer do my job and had to go on disability. My surgeon refused to fill out the forms, saying I was not totally disabled because I could still sit and fold or shuffle papers for the company I work for. Unfortunetly since my knee problem has no direct connection to my job, my employer only wants me to do the job for which they hired me. So in other words, no folding papers. I either do my job or I will be fired. My doctor didn't understand this, so I had to find a doctor that would. The doctor who didn't want to fill out disability forms also said that he will not do any surgery on me because I am too overweight. I weighed at that time 345 lbs. He did not say what weight I would have to be before he would do any surgery. Right now, even though I cannot excersize or even stand on this knee for more than an hour, I have managed to get down to 308 as of this morning. I am still dieting and trying to get some excersize, even though the pain is killing me. I am on pain killers that help but when my knees is throbbing, they dont even do the job.
I have since asked 2 more surgeons if they could do a knee replacement. Only to find them also saying no.. that I am too big. Can someone please tell me what the ideal weight is before they will do a knee replacement. No one wants to tell me.

 

[SWBrainard]

Jerry, I work with Orthopaedic surgeons on a daily basis. Please let me know where you are located and I might be able to direct you to a surgeon. I have several that as you mention, will not do surgery on large patients until they loose weight. I also have some that will. Thanks, SWB - Atlanta.

 

[dids]

That's good you can help her, SWB. The surgeons I worked with here in the UK had no reservations about doing TKRs on big people. Just before I retired we had a lady who weighed 450lbs! (28stone) and she did wonderfully well, too! Such a lovely lady!

Little wonder this is the surgeon who is going to do my knee! (I currently weigh 242lbs!!)

 

[Joanie]

I too was told that I could not get surgery, not so much because of my weight but because of my age-I am 46 and was told that I was too young although my knees looked as though they belonged to someone of 80 or 90. I was reluctant to accept this as I believed that it should be quality of life that mattered rather than age. after seeing my GP, I was refereed for a second opinion and this surgeon has agreed to do both knees. I too have end stage osteoarthritis in both knees, can only stand for 5-15 minutes and can only walk relatively short distances. I too am overweight-have lost 49 pounds in last six months but still weigh 244 pounds. The surgeon has asked me to lose another 14 pounds in three months and he will then put me in for a knee repalcement in January approximately (in this time I will have to continue on a downward trend with my weight). Life is definetely a bit easier since losing some weight as my body is more flexible but I still have much the same pain when I'm standing or walking or sleeping-something that I have come to live with (with the help of anti-inflammatories and painkillers) which is why I can't stand for long or walk very far. I have lost weight by following a healthy eating plan and swimming 3 times per week-even that's limited as I can't move my legs well and both legs have contractures(something that I am tring to fix). It's imperative as far as I'm concerned to keep the muscle strength in my legs up as this will help the healing process. Also too much weight is contadictory to safety during surgery and the healing process itself. So my contribution to reducing my risks is to lose weight; for the purpose of reducing the risks to my health during surgery but also so that post surgery my new knees will last more years- I don't know if you're aware that approximately 3 times your weight is put through your knee joiunt every step you take. I know, if anybody knows just how difficult it is to lose weight when you're so immobile but it can be done-honestly. P.S. I am registered disabled but I still work full time, using my brain and upper body. I know I'm so lucky that I am in a job that I can do this as there's nothing worse than feeling you've been flung on the scrap heap due to 'stupid legs'. Ask your GP, orthopod or local gym to work put what a healthy BMI would be for your height, see if you feel this is achieveable and then ask the surgeon at what weight he'd be willing to do something to help. I got arthroscopes into both knees last year-they used spinal anasthesia rather than a general because my weight made the procedure too risky. This can be done for the knee replacements as well and I might well opt for that anyway even if my weight is within perfect ranges as the after effects are not so unpleasant. I really know whay you mean-I have been suicidal with pain and wanted the lower half of my legs cut off at times but honestly weight loss does help in many ways. If I can help you in any way further-please get in touch.

 

[Annemarie]

Hello Jerry M. There is no real ideal weight, just an average weight. Doctors are frequently reluctant to operate on anyone who's weight is above average because of possible risk factors resulting from the extra weight, factors which can delay or even prevent healing. I remember my surgeon urging me to keep my weight at present level, simply because, and that is according to him, every 10 pound of extra weight is putting 30 pound of extra pressure on the body. So if you are 100 pound overweight the added pressure to your body would be 300 extra pounds, impacting not only the heart, but spine, hips, knees, feet etc. Keep up with your diet and you too could soon join all those who have benefitted from knee surgery. Better still, your knee pain may simply vanish on it's own once the total pressure on the joints have decreased. Good luck.

 

[dids]

You can work out your own BMI with this chart
https://www.caloriecounting.co.uk/resources/charts/bmi.htm

 

[JerryM]

UPdate.........
I have lost some confidence in the Medical field.. But also found a doctor that does not have his own agenda and listens. I decided that while I am losing weight.. (lost 50lbs since the beginning of the year), I would try and get a 4th opinion.
And thank God I did. This was the first doctor to sit and listen first. After we talked and I told him my symptoms.. and what was done, he did his exam and said there may be more wrong with your knee then arthritis. So he did an MRI.. and wow, discovered torn miniscus on both sides of the right knee. Also, some minor ligament tears, and cartilage really damaged. He recommended trying scoping to remove the torn miniscus and repair the ligament damage and scrape the cartilage to promote it to heal itself. I said go for it and I am 7 weeks post op. This past Friday, he gave me a cortisone shot in the right knee. He said that now the arthritis should be my only concern as to my pain. Right now my knee has never felt so good. It has been more then a year since I have been able to go up and down steps without pain. It is like I got a whole new life again. Driving more then 15 miles without pain in my knee is now possible.
All because a doctor decided to do a little more investigating and not have a preconcieved notion as to what is wrong with me based solely on an x-ray.

The bottom line is.. find someone that will take the time to make his own diagnosis, and not follow the crowd. So far it has saved me my knee.

 

[Josephine]

That's so fantastic, Jerry! I like to hear stories like that where someone has actually acted like a carer instead of a prima donna surgeon!! There are far too many of those around.

I am absolutely delighted that he did the obvious and tidied up and washed out your knee to give you some more time instead of just leaving you in your previous misery. I know how much the arthroscopy improved my knee and whilst the other (knee) surgeons I worked with were scoffing and saying they never did diagnostic scopes but just got on with the TKR, I am eternally grateful to my surgeon that he stuck to his tried and tested "old" way. See, he's a good few years older that the other two although they are the accredited knee guys in our area and brilliant, but see, that doesn't always mean it's right for a particular individual! I wouldn't have lost out on this past year for anything and who knows, I may even have another year to go the way things feel today!!

Keep us posted on your progress.

 

[JerryM]

Hi Josephine,
Actually this surgeon was younger then the rest. The others, it seems, had patients that were mainly senior citizens. And I think that mindset of, "they are old so therefore their knees are shot" is stuck in their minds or all diagnosis. The Surgeon I saw at the end was at a independent Orthopedic and Sport Institute doctor. I know something was different when I walked into the place, because there were many young people in there. Although there were seniors, I saw children and people of all ages being treated.. Having a wide variety of patients, I believe keeps their diagnosis window wide open.

 

[Josephine]

Dead right there, Jerry! And many of the current knee specialists - as opposed to the guys who had an interest in it but did other stuff as well - are doing nothing but knees and have a much more proactive approach to things than the previous generation did. Although knee replacements have been around since 1964 (when the surgeon who carried out the first ever one made that incredible breakthrough! - I know, I was there!) it still seems to be, as you say, an attitude of "Well, you're old, what do you expect!" - my sister actually had that said to her when her knee trouble first surfaced and only the week before she was acting as a brickie's mate for her son and standing on a table holding a mounting rose on the ceiling for him to fix!! She was 68 at the time but 68 is different for different people. I am 65 going on 66 but I only finished work last September and I still do a lot of stuff that many can't. In fact I just bought myself a Wii games console which is great for exercising!!

What I am saying to all who are reading, be choosy about the surgeon even in the UK where we don't usually expect to get a choice. Our doctors usually decide who to send us to. But you can still tell them who you want to see. I know surgeons (all over the country) I would have serious reservations about letting them operating on my nearest and dearest. You can find out, ring the hospital and ask to speak to the orthopaedic secretary, check up in the internet - many hospitals have a website nowadays and list the surgeons and what their interests and specialities are. You can even Google the surgeon and find some info on him.

Don't take anything for granted. Sir Lancelot Spratt died a long, long time ago, thank the Lord!!

 

[rattus]

Hi Jerry,
I read your post and was moved by it. I am a big guy too 197 lbs and 6'2". At 61 years old, I have been suffering with bad knees for almost 5 years. They have been gradually getting worse. Taking 1500 mg naproxen and Vicodin for the pain in my knees and my back. (spinal stenosis and a slipped disc (both lumbar) The pain mgmt. doc is a great guy and puts me to sleep for the spinal injections and that terrible terrrible pain has lessened a lot. The vicodin helps with the knee pain in that it makes it bearable. Last fall, I had the 5 Hyalgan shots in each knee. That stuff was great. The Synvisc I had the year before did not help much at all. I don't know why the Synvisc did not help and the Hyalgan did as the Synvisc has a higher specific gravity.

I don't have a lot of pain at night. The Vicodin makes it possible for me to take walks and go to work. I have two more years to work and one year of sick leave saved that I was planning to add to my retirement.

Wintertime goes real well because it is cold and there is not much in the way of physical excericse during the short days. During the winter I take between 1 to 1.5 pain pills.

However, spring and summer, with all of the yard work and home repair is a KILLER on me. I also have govt. travel during that time ---and on a BAD day I will take as many as 4 pain pills, and am still prone to be MISERABLE.

This spring and summer has been the worse one yet---and I am supposing based upon past data that it would be logical to expect that next summer would be worse.

I slipped and fell down yesterday as there is a little bit of unsableness in the joints.

Therefore, I am thinking of putting my affairs in order and having TKRs this fall. I could move up to oxycodone but the pain meds can make me a wretch a little if I take more than a certain amount and the pain wears me out. The doc. says the descision is mine.

The fall and winter would be the best time for me to have them done.

Does anyone have some good ideas as to how long one is laid up after a knee replacement - presuming that they would do the other one a week or two later. I know that my medical insurance pays for medical care when I am abroad, but I don't know whether or not they will go for elective surgery abroad and I have seen a couple of people who have gone to India (one for hip resurfacing and one foe both knees) It was the same doc for both people and the work he did was FANTASTIC. The bib reason I would go there would be that the after care in India was so good. It was also like a vacation for them.

Could some people who have had it done share their experiences and impart advice to me.

V/r,
Rattus

 

[Josephine]

Granted I'm in the UK so protocols might be a bit different, but in my experience, a second knee is not normally done less than 12 weeks after the first. This is primarily because the post op embolism is at high risk for a period after and no anesthetist or surgeon worthy of his calling would want to operate on a patient in their high risk period.

BTW have you thought of trying a TENS machine? I use one on my knee from time to time and even went to work with it on at times! (I'm retired now). Just say if you want me to explain that!

As for the post-op recovery, for a conventional op, the general rates are about 10 days in hospital, 6-10 weeks on one or two crutches, and then about a 2-3 months on a walking stick. Of course, progress is very variable according to the patient's general health, strength and determination. In other words, it's pretty much different for everyone. I know a rule of thumb is that it can be about 8-10 months at least before you're back as "normal" as you can be.

I suggest you read around the other threads in here and you'll see about as diverse a record of experience as you could wish!