Dad wants to get his knees done. What do I need to look for and toward?

I truly feel for you and your family. My father in law was prepped and on the table for hip replacement and it was canceled due to a heart concern. They ended up saying the wouldn't touch him until he had his heart valve replaced. He had never experienced heart trouble in his life. (he was 82) His hip was so bad that he went ahead and had the valve replaced. That surgery was so hard on him that he was never really felt the same after that. 3 months later, they did his hip. Long story short, he was a man who felt great except for his hip and he didn't have a good day for the rest of his life. He told the doctors he would sign anything if they would go ahead, but they wouldn't. You can't force the issue. It is what it is.

I have found that there are a couple of phrases that apply to nearly everything in my (caregiving) life. One is, "It is what it is." and the other is "You do what you have to do."

Usually one or the other gets me through any event.

The reason dad moved in is due to he is a country song, "doesn't do lonely well". Plus there was no money. I was and still am watching his finance (he pays his bills now on his own, I just keep an eye out). On his own I was watching his money and he was one month away from being deep in the red. He was running his business (not well) so it was imperative I had to shut everything down. Mom ran the money and when she died so did her income. He has just enough to live on with me just to pay his medical, life and car insurance. I cover the living expenses (my house) my sister covers his phone. All he has is SSI. No pension and no savings. I liquidated everything else (I cleaned out the house divided up everything in the family and moved his stuff in with me). As far as his living on his own forget it. While he ran a business supported us very well, built houses etc. I am finding it odd that he is complacent for things to be done for him. Almost king like. Mom did everything around the house, daily chores cooking (unless he wanted to make something fancy, then mom cleaned up), cleaning finance etc. He moved in sat right down and expects to be waited on. He has told my wife that he never says "thank you"...... oh that pisses me off! My mother raised me better as did his! Once in a while I get one or "good meal" only after being prompted. He was taken care of as a child (at 14) when his mom died. All the relative doted on him. It is just the little things. And now he expects me to take care of him after the knee surgery. He is trying to push it up for January February! we get like a 100 inches of snow a year here! I will be house bound and a nurse! I have to talk with the doctors. I am not cut out for this. I tried to talk with my sister but she just fluffs it off. As far as sibs forget them I'm on my own. I am trying to get him out to be with other seniors but he is dragging his feet, I took him to church to introduce him to people and hopefully he will go to the senior coffee this week. I cant be the entertainment, driver, everything else!

Dad's are so hard headed, aren't they? They will be the DAD and you will be the kid until they die, no matter how old you are. I'm sure you're doing the best you can do. I wish I lived in west Texas where you could see your dog for 3 days! Dallas is one big parking lot, but at least it isn't Houston, which is worse. That's why I said you drive for an hour to get across town. I've never been to New England, maybe I will get to travel someday.

I do think that women do better on their own than men do, so I totally understand his wanting to live with you. Take some pictures outside your upstairs office window, enlarge them and hang them on the walls of the basement. Poor substitute, I know. Gosh I wish I had a basement.

Maybe just a recumbent exercise bike in his room would be a start. It can't hurt the knees, only help, and the hips too. Put it in front of the TV or the window for something to look at while he cycles. Get two and have races! Nobody likes to exercise alone for very long, they'll give it up. An aerobics video with a pretty girl leading the steps might even do it. Could you get Wii or some other game machine that makes you get up and move???

Well, you know what? Not everyone is cut out to live together. Look for an Independent Living apartment where there is an active social life and maybe he'll surprise you. We have tons of those 55+ communities around us, they are the new big thing right now. Golf, trips to the casinos, lunches and shopping trips, arts and crafts, all kinds of social activities. Makes me want to move to one.

I get it, after mom died he moved in for a varity of reasons. First he doesnt do lonely well, his mom died when he was 14 (moms mother too, same block). he married at 17 so hes never been really alone. Mom did everything around the house. He provided well and fixed everything. He wasn't taking care of the house or himself and he was running out of money and he was running a construction company full time at 78 but not doing it well. Plus I was the one responsible 7 hours away (sister 5 hours and brother 2 minutes, that is another story). Money was the biggest issue. I have some medical training so I can handle the small stuff. While an hour in Texas is not much (been there, you can watch your dog run away for 3 days) New England is much different. Plus no regard for my ruining a business or anything else. I get it I have to be the hard one. I try but he does what he wants unless I come down on him. He is lonely and has nothing to do. I can't be his social outlet, I have tried but I can't get him to go to a gym let alone he will need rehab and exercise, I wont be his valet. He thinks this will be the fix all. I'm just frustrated. Today I walked by his living room (my former office) and he said "it is so pretty outside just like a New England post card, you should see what I am seeing from here"! Yeah, it WAS my office and now I'm in the basement! Maybe I am just getting tired.... I will see what his doctors have to say in January, I guess I will have to go with him to get answers. Don't get me wrong I love my dad and glad he is here so I don't have to worry as much but I wish he'd listen to a little I have to say. I will do more research.

On a different tack here, why did he move in with you after his wife's death? Were there reasons he couldn't live alone and continue to work? Your words "very active working". I'm 100+ lbs. overweight and have bad knees, but that wouldn't keep me from living alone. Loneliness might, but I don't think I'd move in with my kids if I could stay in my own home.

I'm just thinking, maybe he doesn't have much else to do or think about except the pain in his knees. Maybe for the first time, he has the time to have surgery, since he's not working. I'd certainly want the best doctor to do any surgery on me or mine. And here in Texas, an hour is nothing to drive. Gosh, with traffic, that's just the other side of town!

Babalou is right. Dad is being a Bully. So you Bully back, you draw the line in the sand and say "Unless you lose 50lbs and start PT NOW, I am not lifting a finger. And if you can't PASS rehab you will be in a Nursing Home." Find your inner Nurse Ratched.

No, dad is going to rehab. Because no surgeon is going to touch a patient who is refusing rehab before the surgery even starts. I would not inflict him on my spouse.

I don't mind that he has to have them done, it's just the way it is presented, "I'm going to have them done by the best in the country and you will have to take care of me". No regard to me or my wife. My house is a 2 story colonial with the access from the basement level or us a 75 long walkway to the front door w many steps. His bedroom and bath are of course on the second floor. We discussed adding a $100,000 addition but that stopped right there. Either way I gave over a year to may parents when mom died, managing moms funeral, running every 3 weeks through 5 states back and forth, every day on the phone and every day managing finances and moving plus I managed the entire move for him to my home and closing up the house and getting rid of most of his and moms stuff (divided up amongst the family with his permission). 3 years ago I managed my sister in laws death and disposal of her home (brain cancer) and my wife's brother being put in a home (at the same time) and I still manage him 1800 miles away (albeit on the phone but a year of back and forth to Texas). I am just getting tired and don't need another crises. My siblings have got off scott free. My sister did do the medical issues when she lived close by but she is a nurse and she did not have to tend to them every day or live with them, hers was mostly advice. Sorry just ranting here I guess. I appreciate all the advice. I will check w the Dr.s. I hesitate to call my sister because she will have one answer from dad and one from me both different and she will tell me what to do and stand back so I wont even bother. I don't talk to my brother any longer after the way he treats my dad and there is a long history with me and him that is just now coming to the surface anyway.

Brilliant, comprehensive account DG, thank you - though even the thought of having both knees done at once made my head swim! Horrifying idea.

I have had both of my knees replaced, so I know what to expect in that department, although everyone's recovery is different. At your father's age and with his general state of health, the doc may say no way. Medicare may not be willing to pay for it. I know my doc (and the anesthesiologist) made me jump through a lot of hoops before we scheduled my surgery, and I'm relatively young.

My father needs to have both knees replaced and the doc said at his age, no way, even though he is in good health for his age (80's). I've been told that under Obamacare, Medicare is less likely to want to pay for it, so they make the decision for you. If the doc is willing to do it, and Medicare will pay, you DEFINITELY need to have him go to a good rehab center afterward for physical therapy. Medicare will pay for 100 days as long as he is getting PT and is showing improvement. Anything they don't cover, his supplemental insurance should. Be sure you understand the limitations before he has surgery.

As for the actual TKR, keep in mind this is MAJOR SURGERY! It is somewhat dangerous, and it is VERY painful. This is another reason he should go to a rehab center afterward, and not try to recover at your house. He will be on pain meds and it will be difficult for him to stand up, and also to walk, even with a walker. That said, you may find that in as little as 3-4 weeks he is able to walk without a walker, depending on how good the PT is.

Do not decide to have both knees done at once because you think it will be better, cheaper, etc. Having both knees done is twice as dangerous to someone your father's age, because he'll be in surgery twice as long. It also makes recovery harder because while the new knee is recovering, you don't have the old knee to fall back on. It might sound strange, but I could hardly walk when I went in to have my first knee done. After the surgery the new knee hurt so much I couldn't feel any pain in the other knee. Then as the new knee got better and better, the other knee pain kicked back in.

Don't know if any of my rambling is helpful to you. Getting my knees replaced was the best thing I've done in years! I have my life back!

I advise my friends to prepare for TKR by building strength in their quadricep muscles and their hamstrings. Simple leg lifts that your dad can do laying in the bed will help with this. If you have an exercise bike, or access to one, that is great, non-impact exercise for your knees, and would help him build strength. This is important because it will help him whether he has the surgery or not.

Good luck!

I think you need to take three steps back. Do some research on what is involved in knee replacement surgery on a site like webs or mayo clinic. Get a predestination of benefit from his insurance company and ask not only about the surgery but the rehab as well. I think you must misunderstand what rehab is. Medicare will cover it if it's ordered by the doctor, 20 days at least IF he's doing the therapy. Bringing him home without rehab would be iin same. My opinion only.

I agree with seeing if he's willing to do any hard work before the surgery, because to recover, he will have to do hard work in rehab after surgery. If he's not willing to do anything now, he won't be willing after surgery and you will have wasted a lot of time and effort, along with his new pain and suffering.

My neighbor did two weeks in rehab after her surgery and my cousin did a week, I think. I went to stay with her for a week after that and she was still not getting around very well. Then she had to go to physical therapy maybe three times a week or so.

Has he had the fluid removed from his knees? He can also do that when he gets the shots. Has he investigated getting the artificial lubricant injected into his knee joints? There's also a cold laser procedure that chiropractors do, but I can't speak to how much (if any) it helps. Accupuncture has also been shown to be of benefit to osteoarthritis in the knee.

He could also go on an anti-inflammation diet, to see if that would help. I guess I'd make him jump through a few hoops (no pun intended!) to see if he's willing to do anything to make himself a better candidate for a good outcome after surgery. If he won't, I wouldn't go out of my way to help him schedule surgery.

At 100 lbs over weight, his heart is taking a real beating. Many surgeons, the really good ones, will say NO unless at least 50 lbs come off and the patient engages in pre-surgical PT. If he really wants the knees done, he has to show some effort. Otherwise it is a total waste of time and money, he will be no better and the prosthesis will fail from dynamic overload.

I'm sure you could find a doctor who would be willing to perform the surgery, but that doesn't make it a good idea. Serious excess weight is going to complicate everything from the actual risks of surgery and anaesthesia to his recovery and beyond; and ironically it is also probably a major culprit in causing the pain in the first place - you only have to consider the extra strain put on his joints.

But I'm not unsympathetic. It's all very well for some lofty outsider to say he needs to eat less and exercise more, but when you're overweight and out of condition it's very hard to do either. Nevertheless. What about getting a personal trainer onto him? See if you can sell it to one of them as an exciting Before & After type career challenge. Maybe bargain with your father, too: if he can get down to such and such, you will be cheerleading when it comes to his surgery. But get *somebody else* to do all the nagging and cattle-prodding and motivating while you stay out of it ready to hand the poor fella a sympathetic cup of green tea (no milk no sugar) when he gets back from his workout.

My ex's father has just had his knees done. He is 90. He has recovered well and the pain is much improved. But this man is fit and active for his age, and the process was still an ordeal. I think you're going to have to get very firm with the message that if your father won't start the hard work now by getting into shape at least a little, then you won't play ball in getting him surgery - because it would be risky and pointless.

Rehab is best way to go after any.medical situation. After his stroke, dad refused to do the physical therapy in the hospital because it hurts. The only way the doctor persuaded him to do it was by threatening him. No physical therapy, NO release from the hospital. He refused rehab after being released. He is now bedridden and absolutely refuses to leave the bed, not even to the wheelchair. By the way, he had a Minor stroke. He could have been back to walking if he was willing to do the hard painful therapy.

While you are looking into the surgery and getting the info on rehab, why don't you have the doctor's office send in a Predetermination of Benefits to the insurance company? Then you will have facts and figures in front of you. As a good start and a sign of expected compliance, perhaps your father could begin to lose weight. It wouldn't hurt to do so now, and would go a long way towards his recovery. You say you have a three story house, where in the house is his bedroom? Hopefully on the first floor.

You say you don't want him to go to a rehab facility after the surgery? Why not? There he will be available for his physical therapy without driving him, they will prepare healthy, low calorie meals, the doctor can attend to him without having to come to his office, he will be with others who are going through the same thing and can cheer each other on. There are so many advantages, especially with winter coming up.

P.S. I definitely think your sister should be involved and take care of your father during this time.

My mother had both her knees replaced within 6 months apart in 2000 (14 yrs ago). Before that, she had the shots and they say "you know when you have to have knee replacements, when you can't take the pain anymore and can't walk". Yes, being overweight just adds to the knee problems. Of course the first step is talking with his doctor. He should direct you as to whether your dad should do this or not. If your dad does have knee replacement it is most crucial (right after the surgery) to do all the exercises they tell you to do in 'rehab' (in or out of the home)! Even though it's painful, it'll help you regain near mobility (bending, etc.)... If you don't do these exercises, you aren't stretching the tendons, etc. in your legs and they can cease up. So this is very important. My mother has done very well with her replacements. I know it's not fun, but at least they can do wonders so that seniors can be mobile again... Perhaps in time, your dad will shed some weight and things will turn out well. It's just the initial surgery that's scary (like any surgery). I hope this helps.... God Bless you and your dad.