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obese patient without much hope

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sherrymorss60

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I am a 63 year old female in need of a right hip replacement. My pain level has increased dramatically in the past couple of months. I am scheduled to retire in 6 months and was hoping to be able to put the surgery off until then. I was hoping to be able to lose some weight in that 6 months period, and have lost 17 pounds so far.

My problems are these:
1. right now I weigh 373 pounds and am scared to death a surgeon won't operate on me.
2. If the surgeon would operate on me I so afraid of complications and the recovery period.

3. The next major problem I have is no insurance. I have no medical insurance and can't afford to get any at my weight. The company my employer goes through wants over a thousand dollars a month to cover me. That would be my cost. Then this is a pre-existing condition and either wouldn't be covered or would have restrictions for payment anyway.

I will be 65 and eligible for medicare in 18 months and was hoping that I could possibly wait until then if I restrict my movements once I retire. As much pain as I am in now, I'm thinking that is a pipe dream. Right now my doctor has me on two diclofenac tablets and two tramadol tablets a day. The medication helps some, but when it wears off the pain is horrific. I am so scared and so worried I can't even sleep at night. I don't know what I expect anyone to advise me to do. I guess I just needed to express myself. Sorry this post is so long.
 

Josephine

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Oh my dear Sherry. First, welcome to BoneSmart! I can feel your anxiety and stress. This period is horrible, trying to do battle with all the ifs, ands and buts! and in no way is your post long! We don't mind long posts anyway!

So let me address some of your concerns.
1. You've told me your weight but not your height. In order to say how much of a problem your weight would be I need to work out your BMI (body mass index)

2. There are in theory more complications but they are mostly theory. So please don't worry about that. I've been in this business all my life and have seen any number of big people have hip replacements and they've all done splendidly well. And I do mean all! Our biggest problems have been moving the unconscious patient from bed to the operating table and back but that's not a problem you need to worry about as you'll be asleep!
You may find reassurance from this article Operation information: how do I know I will be safe during the operation? and from the knowledge that things like infection and clots are such a tiny amount increased from 'normal' weight people, it's not really a big deal.

The recovery is no worse for a big person than it is for a 'normal' person. You'll do fine. Especially since when you wake up you will be totally FREE of all the pain you have now! Truly. Sure you'll have some aching and soreness from the surgery but that can be well managed with pain meds and ice.

But as for the insurance, I'm afraid I'm from the UK (NHS!) and will have to leave that to others. I'll tag a couple to see if they have any advice to offer. @Jamie @Knitter4444

I will be 65 and eligible for medicare in 18 months and was hoping that I could possibly wait until then if I restrict my movements once I retire. As much pain as I am in now, I'm thinking that is a pipe dream.
You'd be right about that. I've known people think like that and within 6 months they were confined to a wheelchair! Also diclofenac and Tylenol are good pain meds but there isn't a pain med yet invented that will manage the pain of bone-on-bone arthritis. I've always said, the first scientist to come up with a med that will do that will get a Nobel prize for services to mankind!

As a matter of interest, can you tell me the dosage of each of those meds you are taking? What mgs does it say on the box or bottle?
 
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Knitter4444

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I totally understand the problems with insurance. You cannot be denied any longer for pre-existing conditions. Does your state have an exchange plan under "Obamacare"? Have you looked into that?

Have you looked into Medicaid?
I don't usually ask people to private message me, but since we need to talk finances to help you, I am happy to take a private message.

I am large also. And weight was never an issue as far as my surgery from any of the 6 surgeons that I visited to get second, third etc opinions for my knee replacements and afterwards, the hip. I think I would have felt better at a lighter weight trying to do the PT but it probably didn't hold me back.
Please do not give up. We are a terrific community (more like a family) so lean on us and ask.

One of the side benefits of this board, is that you are actually keeping a diary. I look at mine occasionally to see where I have come and to see all the support that I have received (and hopefully given) when I get "those" days.

I hope to hear from you.
 
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sherrymorss60

sherrymorss60

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Josephine
Thank you for your reply. Yes, I am totally stressed out about this and not knowing what I should do. To answer your questions, I am 5' 4" tall. The diclofenac is 75 mg and the tramadal is 50mg. I take the diclofenac at about 7:30 before I go to work and the when I get home at 5:00. I take the tramadal only when the pain gets intolerable. I am concerned about how long my stomach is going to tolerate all these meds. I'm just concerned about how someone my size copes with having this surgery and recovery. My regular doctor is recommending I have the surgery sooner rather than later because he said I will be in worse shape if I wait until I'm totally immobile.
 
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sherrymorss60

sherrymorss60

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Knitter
Thank you for your input. I did check into the Obamacare options when it was open enrollment. The price I received from their offer was $900 a month. The problems are my weight being 373 pounds and my age. At this point I wonder if I wouldn't be better off paying the $900 a month until I qualify for Medicare. That would probably be less expensive than the surgery. But will the insurance company claim that's insurance fraud if I sign up for their insurance knowing full well I need an expensive surgery and intend to cancel once I can qualify for Medicare? I don't qualify for any Medicaid programs because I do make too much money for that. When I retire, I will be on social security, but I do have a retirement fund and equity in my home that disqualifies me from any state programs. Don't get me wrong, I'm not asking the government for a hand out while I have a big nest egg in the bank or some fancy house I can get a second mortgage on. The small amount I have in the bank is all I have to carry me through my retirement years. The only thing I can do is try to make payments after having the surgery. I can't even get any idea of how much the surgery might cost. Any way, thank you again for your concern and warm welcome to the forum.
 

Bumpa

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Just a little more information regarding the downsides of a high BMI and an active sport hobby - not that many of us older folk partake in agressive active sports!
High BMI, intensive physical activity increased risk of knee replacement
Patients with osteoarthritis who had high body mass index and performed intensive physical activity at work experienced a higher risk of having a knee replacement, according to study results.
http://www.healio.com/orthopedics/k...l-activity-increased-risk-of-knee-replacement
 

Josephine

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I am 5' 4" tall
At 373lbs that gives you a BMI of 64 which, by any measures, is pretty high. However, I have nursed people after TKR who had a BMI of 66 (weighed in a 420lbs and 5' 7" tall). As far as I knew they all did extremely well, healed well and were discharged according to the usual protocol which in those days was around 5 days. So I don't think you'll have much to worry about.
The diclofenac is 75 mg and the Tramadal is 50mg. I take the diclofenac at about 7:30 before I go to work and the when I get home at 5:00. I take the Tramadal only when the pain gets intolerable.
That's not a good way to take them. In order to keep the pain managed, you need to take something more frequently than twice a day. Diclofenac can be taken three times a day and you'll probably find it better to take 2 Tramadol. You could also take Tylenol 1,000mg up to for times a day.
I am concerned about how long my stomach is going to tolerate all these meds.
But first you are right to be concerned about this. Not with the Tramadol or the Tylenol but with the diclofenac. Read this for a really good explanation NSAIDs, acetaminophen (Tylenol, paracetamol) differences and dangers
 
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HADAR

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My first time on one of these forums. I joined as I like Sherry am just on 5' and weigh 78kg.
I am having a hip replacement on the 9th September and am terrified as well.
Being overweight I searched for the best procedure to have for this problem I am having the anterior
HR.Anyone who has had this type of procedure. Let me know.Thanks & glad to know you all Hadar
 
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sherrymorss60

sherrymorss60

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My doctor said he would prescribe more of the tramadal if I need it. He doesn't like to prescribe to many of anything in case it doesn't work and then it's a waste of money. I think I will up my medication to be more comfortable and continue with the weight loss program. If I can, I would still like to postpone surgery until I retire on February 25th. I'm so glad I found this forum. Thank you to those who have replied.
 
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sherrymorss60

sherrymorss60

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My first time on one of these forums. I joined as I like Sherry am just on 5' and weigh 78kg.
I am having a hip replacement on the 9th September and am terrified as well.
Being overweight I searched for the best procedure to have for this problem I am having the anterior
HR.Anyone who has had this type of procedure. Let me know.Thanks & glad to know you all Hadar
Hafar it sounds like you and I are kind of in the same boat. I will be keeping you in my thoughts and prayers as your surgery date approaches.
 

Knitter4444

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We are so glad that you have found this great family.
No, it is not fraud at all. When you turn 65, you have to go on Medicare. But your group health plan could become your secondary.
I totally understand the financial difficulties. Be careful when you choose a plan when open enrollment comes up.
The less the premium the highter the OOP (OUT OF POCKET). I will help you when its time if you would like.
 
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Knitter4444

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This surgery is expensive. You want to have insurance and you can drop it after the surgery if you need to.
To give you an example.. My BTHR was about $8500 just for the surgeon. Medicare approved about $1800 and between Medicare and my secondary I paid $0. The dr had to write off the difference between the $8500 and $1800.
But there is the hospital charges, the anesthesiologist, all the preop testing before and maybe rehab and PT so if you can manage the insurance premiums for a few months it would be better. Hope this gives Yes, I understand somewhat if an idea. I don't remember what the hospital was.. My rehab facility was about $32000 for 2 weeks.. More for my one hip as I was there for 3 weeks so its not just about the surgeon and his/her charges.
 

Jamie

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My first time on one of these forums. I joined as I like Sherry am just on 5' and weigh 78kg.
I am having a hip replacement on the 9th September and am terrified as well.
Being overweight I searched for the best procedure to have for this problem I am having the anterior
HR.Anyone who has had this type of procedure. Let me know.Thanks & glad to know you all Hadar
@HADAR....welcome to the forum! Why don't you start a thread of your own where we can more easily chat about your particular situation. Please feel free to post on anyone's thread when you want to make comments about their posts.
 

Jamie

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@sherrymorss60....when you looked into the exchange, did you check to see if you qualified for a subsidy under the program? That might be an option available to you if your income levels are appropriate to qualify.

Otherwise, I agree with knitter4444 that you will probably be better off carrying the insurance for a period of time until you can get this surgery done. You really don't want to try and wait and risk having additional problems because you delayed.
 
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sherrymorss60

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Jamie no I didn't check into any subsidy. When I was finally able to get on and get a price quote, I was so discouraged I just gave up on it.
 
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sherrymorss60

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Knitter that would be great if you can help me when the open enrollment period comes up again. From what I have found on the web, the next period starts November 15. What I read said that was for coverage starting in 2015. Do you know when the coverage would start then? Would I start paying in January and have coverage then?
So if I kept that insurance when I qualify for Medicare, would the insurance premium likely go down?
 
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