Denied TKR Until I Lose Weight

[LizAnn]

Hi All!

I found this site while I was viewing youtubes on TKR surgeries. What a perfect place this is. I just joined and can see all the support that is given to each other.

I'm 56, 5'7", 253 lbs (yea I know .. yikes), bone on bone in both knees. I've been suffering for almost 5 years now. Two weeks ago I was walking and.. "bam"... sharp severe pain that made walking impossible. A visit to my GP said I sprained a ligament. This seems to happen on a fairly regular basis and walking over the past years is very frightening. I am now on crutches and released from work until the end of next week. I will probably have to quit.

Five years ago my Orthopedist said I was too young and the new knee wouldn't last so he wanted me to wait. Well now it's 5 years later and my knees are horrible. I have put on weight due to inability to have much mobility. I made an appointment to see him last week to discuss my TKR and he denied the appointment, sending me back to my GP. I cried. At my GP appointment he said I HAVE to lose weight. My BMI has to be down to 25-30 (I'm currently at 39). Until then I'm denied. I am in so much pain.

I know I'm overweight but the pain is very intense. I used to be a runner and feel all my running to stay fit has worn down my knees. I went on Optifast 2 years ago at the recommendation of Kaiser and lost 15 lbs. I have kept that off. I am now on Weight Watchers and doing what I can to lose weight but it's coming off so darn slow. I'm sure it's due to my lack of mobility.

I take 2 ea. 325mg of Norco each morning along with Aleve to get me some relief. I repeat that in the afternoon. I basically can not walk. I'm at the point where I will probably be going on to long term disability as working is no longer an option. I can't walk without crutches on a rare occasion I use a cane but that generally isn't enough. I constantly hear popping and grinding in my knees.

I don't know if I have a question but rather just need to vent. I'm not seeing the light at the end of the tunnel right now. I get encouragement by reading all the success stories on here and I thank all of you for that. In the meantime I'll just wait for my turn.

 

[Jozilla]

Welcome! So sorry you are suffering. I don't think your weight should stop you from this surgery. You just need to find an OS who will do the surgery. Have you tried calling other surgeons? Hopefully one of the moderators can help you with that. The surgery will enable you to have a much more active life than you have now! Good luck to you.

 

[Celle]

There are surgeons who will operate on overweight patients.

There's an article in the Library here that you might find encouraging:
https://bonesmart.org/forum/threads...-joint-replacement-surgery.24276/#post-601728

@Josephine and @Jamie may be able to help you find a surgeon who is willing to operate on you.

 

[kneeper]

Yes, you need a surgeon who understands that it's difficult to lose weight when you can't walk very well. I'm having a hard time being active with my knee. I do try to at least do non-weight bearing toning exercises and a little bit of walking but I can only do about 10 minutes before the knee protests.

Good for you for doing weight watchers. Hopefully you will find a surgeon who appreciates that you're trying.

 

[VancouverUSAgal]

I am 7 weeks out from BTKR's and my BMI is probably higher than yours. For 10 years, I was told I was too fat by Kaiser but now I have different insurance. I got on the phone and started calling the offices of OS and asked if they had restrictions and kept calling till I found one at a local sports medicine clinic who didn't have a certain BMI limit. He expressed no concerns about my weight - simply said he might have to make longer incisions because of the size of my legs. It hasn't been a picnic but lots of obese people get this surgery every year so just keep on searching till you find the right surgeon.

 

[midwest girl]

I'm 5'7" and weigh more than you and my surgery is this coming Tuesday. Neither my OS nor my dr who is an internist have never said that I had to lose weight before surgery. Granted that would be ideal, but I think they understand it is extremely difficult to do that when it is so painful to even walk let alone exercise to lose weight. I passed my physical and am good to go for Tuesday. I even asked a friend of mine who is an OR nurse and she said they do replacements on all sizes of patients. I would seek out another surgeon. There are those who will do TKA on overweight people.

 

[Josephine]

Your BMI is under 40. Mine was 42 when I had my first knee done and it's now 47 and my surgeon has me on his awaiting list for the other knee. Don't be discouraged by these ignorant surgeons. They are simply protecting their records of successful outcomes as we all know there is a marginally increased risk of various complications for us big folk! But the risk is ours and shouldn't be dictated by a third party - not ever!

 

[referee54]

Don't be discouraged by these ignorant surgeons.

Exactly!!! There are plenty of excellent surgeons who will work with you and take care of you---and, when you are fully recovered from your TKR, you will have a better ability to lose the weight that you want to lose.

As the others have said, there are many OS's out there who will help you---just keep on looking; you will find the one who is best for you!

 

[LizAnn]

Thanks to all of you for your kind words of encouragement. I have done some research today and found my Dr. online with not so good reviews. Apparently he has sent others away and told them he'd buy them a cane. Others reported him as being "rude and insensitive". I'm glad I found that so now I know to move on to someone else. I am tied to Kaiser so I hope they all don't have the same requirements. I understand it would be ideal for me to be thinner, and I am trying, but I currently have no quality of life. I found some research that indicates people lose weight after surgery because they can move again. I will be searching around this site doing some reading. I'm glad there is a lot of information here already found If anyone happens to know a OS affiliated with Kaiser in Irvine CA, or nearby, I'll go see him/her. Again thanks everyone. I'll keep searching.

 

[lovetocookandsew]

Hi. I had my surgery at Kaiser just over 3 weeks ago. I am also not a skinny one-and my Dr. never mentioned my weight, not even once. I have Kaiser in Northern Calif...maybe you got a lemon for a doc down there and need to check out other Kaiser facilities. Sometimes it's the individual doctor, sometimes it's the chief of the dept. I'd encourage you to see a couple of other OSs at the same facility, then if you have the same prob. try a diff. Kaiser facility.

 

[LizAnn]

Hi Love ..
Thanks for your comments. I'm in So. Calif and will search out another Dr, at the same facility, for a second consult. It will be interesting to see what they have to say.

It's nice to hear you are three weeks in. How are you doing? Also, can I ask what your BMI is?

Thanks!

 

[lovetocookandsew]

I'm actually doing okay, had a few setbacks due to the flu, but otherwise I'm recovering nicely. I'm icing and elevating for the majority of the day, and my PT is quite happy with my flex and extension. I do PT when she's here, very easy and gentle PT, then do some on my own other days. I'm careful not to overdo and my swelling has gone down a ton. She is thrilled with that too-she says the leg color is great, my scar is doing well, and she's amazed at how little swelling I have. It's all due to the Bonesmart mantra and following their ideas for recovery and PT,and letting my knee be in charge. Let us know how it goes, and if you need anything, I have had Kaiser for 36 years, through choice, as I love it, and I've had it both in Northern and Southern Calif. I've never had any real probs with it as I pick the best of the best for care, and know how to call for assistance if needed. Kaiser picks the cream of the crop of doctors, and I have always been happy with them. Once or twice I've found one with an attitude and just switched as it's easy to do. Keep us updated.

 

[scaredinCA]

I"m in the San Fernando Valley in CA and I'm with Kaiser and have a very good knee doc. If you are close by, then I can give you his name/details. He never mentioned one word about my weight (which is up there).

 

[Jozilla]

I would bet that most of us have high BMI's due to lack of exercising. The good news for me was I lost 20 lbs after surgery. It just took a long time for my appetite to return to normal. That OS should not even be a doctor with that attitude. Let us know how you make out!

 

[LauraLeigh]

LizAnn, I'm 17 days away from my BTKR - woohoo! I'm also 5'7" and 317 lbs. last time I checked. My doctor had no qualms about my weight. He said in January when I scheduled my surgery that it would be helpful if I could lose some before my surgery, which I have - I've lost about 10 lbs. since then. As you know, it's very hard to lose when you can't do much in the way of exercising! But my health is good, other than my knees: normal blood pressure, good cholesterol levels, etc.

I'm just trying to follow the tenets of mindful eating: choose healthy foods, watch my portion sizes and be mindful of my body's signals to know when I'm full. As for exercise, I do strength training (upper body), chair aerobics, chair yoga, and I take a deep water aerobics class once a week. In 2009 when my knees weren't as bad I was doing a boot camp workout 5 days a week and on a 1200-calorie a day diet. I got down to 257 lbs. which may still be fat but I was quite fit. Keep in mind that BMI is not a measure of health: Dwayne "The Rock" Johnson is considered morbidly obese by that reckoning and we all can see how fit he is!

Best of luck in finding a new and better doctor who will do your surgery!

 

[msmechanic58]

I did lose the weight. 70 pounds! Did nothing to help my knees. The concern is for every pound of weight it is four pounds of pressure on your knee. When you step it is 8 pounds of pressure on the weight bearing knee. He wants the best possible scenario for healing. However, I would suggest a second opinion. I'm at 30-35% BMI and having bilateral tkr in 9 days.


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[VancouverUSAgal]

I was turned down for years by Kaiser in the Portland, Oregon area. I tried several different OS and they all said it was their policy not to do knee replacements over a certain BMI. They suggested I have gastric bypass which I didn't want to do. After I left the Kaiser system, I was still turned down by several surgeons before I found the one who did mine. He's not very personable but that's not the important thing when you desperately need your knees fixed. I didn't need a friend - just a surgeon willing to operate on me. I wish you luck in finding one.

 

[LizAnn]

ScaredInCa it's nice to see another Kaiser patient in here. San Fernando Valley is about an hour away. Monday I'm going to try to set up an appt with another knee Dr. out of the Irvine location (that's my area). If I don't have luck I'll ask for your Dr in a PM.

Laura I'm so excited for you! It's very nice to follow everyone along here in their journey. I am focused on my weight, as you are. I've been doing so well on my diet these past two weeks with weight watchers. I think I'm so desperate to lose weight now I'm afraid to cheat. I see my primary next week so that he can extend my medical leave. I'll weigh in again and I hope to see a few more lbs gone.

msmechanic.... wow 70 lbs! That's fantastic! I know my Dr ultimately wants the best for me regarding my weight. It's just that I now can not walk at all. But I'm focused to lose.

Thanks for this site and for all of you.

 

[msmechanic58]

I understand completely! I hope you have more luck with the new dr Monday.


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[Jamie]

Hi and welcome to the forum! These guys are all correct. You must keep looking for a doctor who looks at this surgery more compassionately. Who in the world could exercise with bad knees??? Doctors are out there. You ought to be able to get a list of surgeons from your insurance company (maybe on the website). Or you can use the BoneSmart Find A Clinic locator (tab at the top of the page). It may be that you will need to drive a bit to get to the right doctor, but it will be worth it! And by the way, I have had 2 knee replacements with a BMI just about what yours is. No problems at all!