Need medical advice for family member....

[Miss Mary]

Here's are the facts folks:

- My 80 year old mother has a torn ligament in her knee.
- Went to Primary, who referred her to Ortho doc.
- Ortho doc took x-rays and ordered an MRI.
- MRI confirmed it's a torn ligament.
- Ortho doc strongly suggested surgery so this doesn't go into arthritis.
- Ortho scheduled her for out-pt orthoscopic surgery Oct. 14.
- After surgery, she's to stay off of it for 48 hours, using a walker to get around a minimal amount.

Please tell me there are red flags going up in someone's head?!!! Thru-out this whole process (appts., x-rays) huge red flags have been going up in my head. My mom is in poor health to start with: at least 70 lbs. overweight, angiogram this past year revealed some heart blockage, on Lipitor for that, on 6 various other meds, has emphasema and asthma, wheezes going up and down stairs, lives in an apt. with 6 steps up to it. She's not at an assisted living facility yet (my family has discussed this for down the road, but Mom wants to still be independent). My mom is inactive, content to stay home and watch TV and/or talk on the phone to friends. Finally, I need to add one more detail and I hope you all won't think less of me - my mother looks at any potential medical procedure or surgery as an attention getter (expecting attn., flowers, candy, cards, etc.). In other words, for at least 7 years now she's been looking for something terminal to dwell on and every time she's faced with a new medical concern, it usually turns out fine. Best example is she's had two angiograms in the past 7 years, no angioplasty needed either time. Both times came out with meds only - almost unheard of I'm told.

I consulted with a nurse in my husband's family. She said she herself has a torn knee ligament and it's painful, but she's avoiding surgery at all costs. When I explained the entire situation, she said we should all question why surgery is recommended on an 80 year old patient, one that's in poor health to start with. She also added that even though this is out-pt surgery, there are risks involved and she's seen way too many geriatric patients come out of simple surgeries like this and end up in nursing homes in the end.

I have two calls into my brothers but in the meantime I was hoping someone would have an opinion. Dennis, you come to mind! I know you're avoiding back surgery at all costs and have put that off until you absolutely must have it some day.

Thanks in advance everyone!

Mary

PS - I forgot to add, my husband's family knows about surgery risks. His mother suddenly died from internal bleeding after heart surgery. She was expected to make it and with a good recovery too. His brother developed a clot after open heart valve surgery, that traveled to his heart. He had a massive stroke as a result. So add these two tragic examples to the info I gave you and you can see why I'm concerned!

[GalvestonDuck]

Well, now, since my bestest bud is a geriatric PT, I'm gonna address your issue with her. I'll get back to you with an answer as soon as we talk again. She's already gone for the day and it's her hubby's night off so...you know...I'm not gonna call them. But I'm sure I'll talk with her in the morning.

[azsnowman]

For what it's worth......taking into consideration her age, her other health problems, is this surgery worth taking a risk? I honestly have to say no. Don't want to sound crude, rude or nuthin' like that but really, like I said, taking ALL the factors that you mentioned into consideration, I don't see any benefits. #1. The arthiritis can be controlled with meds. #2. Her age plays a HUGE roll and with her heart condition????#3. Last but NOT least, does she have good insurance? The reason for the question, most doctors I've met, talked to are JUST in it for insurance money, sound crude? Yes, it is but let's face the facts here, the surgery MIGHT, MIGHT be a success, but does putting your mother through the pain, recovery AND the chance of the anesthia (sp) affecting her already compromised pulmenary system outweigh the final outcome?

Dennis

[Miss Mary]

Thank you Dennis!!! Hugging you.....no you were not being crude or rude. I was hoping you could read between the lines here. I don't want her to have surgery that may be easily avoided with meds, as you suggested. She does have good insurance, Medicare but an additional supplement she has from her job years ago in the Archdiocese of Cincinnati. She's never had to ask my brothers or me for help with bills or copays. I think most of her bills are covered. However our insurance is the pitts these days so if a doctor said - well you could have surgery - I'd be asking what can we do instead of surgery. You see with my mom she seems quite willing to not even think in that direction. Yes she has her wits about her but has always thought in wacky ways....not always thinking as a reasonably sound person would. No demensia (sp?) or anything like that going on, just an older woman who's easily talked into things. I'm wondering if this surgeon isn't in it too for the money. Hate to think that way but how else can I think tonight?

Shawn - thanks in advance for any info you can send my way. And I just knew you'd respond!

Thanks you two.

Mary

[coriolis]

Mary, what a wrenching time this must be. I have my opinions, similiar to what Dennis said. At the same time, there's a guilt trip waiting to happen, that you didn't do EVERYTHING that you could. We have a similar time bomb ticking with my mother-in-law that lives with us. Her diabetes has started attacking her feet. Her primary care physician already mentioned the possibility of amputating her legs, but isn't pushing it. My wife decided that it's not going to happen. At best it would buy some time, but it would cause many more issues, even if she made it through the surgery. Would your mom's arthroscopic surgery require follow up physical therapy? Would she follow through with it? Would she have a desire to do the work to get better? It sure burns me to think that the doctors might be pushing it for the money. I guess that since that's what they do, that's what they want to do. Did you have a heart to heart talk with her primary care physician? He/she doesn't have as much of a stake in it. Finally, how does your mother feel about it. Did anyone tell her flat out what the risks and probabilities are? Is she motivated to do her part of the work? Did you do any internet surfing for more information?

At 45, it's easy for me to say now, that I'd want to leave this world with some dignity, without becoming a pin cushion, but when I'm in that position, I wonder if I'd think differently. I guess I'm not really saying to do one thing or the other, but I'm trying to relate to all the things that must be going through your mind.

[Miss Mary]

Searching on the internet is good advice Ed. I looked it up over at WebMD but didn't find much. I'll have to give it another serious try tomorrow. My mother has always been difficult to handle so that's part of what's going thru my mind - what will she be like after the surgery? If her recovery isn't as easy or swift as she thinks it will be, what then? You see my mom has two sides. One for her family and one for the rest of the world. My one brother just wants to relocate....the other is very dependable. Both will be there if I need them. But being the only daughter a lot falls upon my shoulders. And all of us have said, under no circumstances will she ever live with any of us. My gosh, we'd all be divorced in no time if that happened. And this is my second marriage!!! So you sure have MY respect inviting your mother-in-law into your home Ed. But then again, maybe she's like my mother-in-law was, God rest her soul - nearly a saint, a joy to be around. My heart goes out to you and your wife for what you may have in store down the road. Amputation isn't to be taken lightly and I can understand why your wife is putting it out of her mind. Easier to deal with that way.

I do want a heart to heart talk with her primary doc. He's been her doctor for at least 10 years. I've taken her for a few appts. over the years but hardly know him. You see another aspect to this is my mom RUNS to doctors so she has a slew of friends all lined up for the next concern.....I've honestly been off the hook since I live 30 minutes away.

Thanks for your input though - it's very much appreciated.

Mary

[breeze]

Oh, Miss Mary, my specialty is neurology, so, I'd better stay
out of this one! I do understand the PCP sending her for an
Ortho consult, and Ortho is going to do their tests to peg an
absolute diagnosis or a "rule-out". Since the diagnosis was
confirmed, I do hope and pray for an accurate decision and
recovery, and my prayers go out for your Mom!

[Stephanie]

I know Marty has had orthoscopic surgery on his knee ( and an ACL that needed surgery). The orthoscopic surgery isn't that invasive, but we are talking a 30 year difference in age between the two. I'd be just as concerned, but if she's still able to get around without the surgery and the arthritis can be helped with meds, I'd say no surgery as well.

Keep us updated as to what is happening with her!

[Miss Mary]

Update - while waiting for my brothers to return my calls, I knew my mom was waiting for me to call. So I was as honest with her as I could be. I said let's be really certain this surgery is necessary and it will make things better for you, not more difficult. She breathed a sigh of relief and said she was glad I was so honest. I told we've seen way too many patients have complications after surgery (death, stroke) to take this so lightly. And get this - her knee is getting better, slowly over time! And another thing, because she was in for her annual checkup a month ago, her primary asked how she was doing overall. She mentioned the sore knee and from there she got referred to an Ortho. Now I know it's painful but part of me thinks if she hadn't spoken up, a surgeon wouldn't have been recommended. Long story short, she agreed to at least my calling her primary tomorrow. I want to hear his opinion. Then if he thinks she absolutely needs this surgery, then we're asking for a second opinion. My mom wasn't even going to ask about post-op therapy until it was over with either! I said whoa, you're used to having your independence, you could be down for months possibly. My brother did call after our talk and he agrees with me 100%. And of course the date for this surgery falls when he and his wife are on vacation in N. Carolina! He said if for no other reason, maybe we can get her to postpone it until he's in town and then we're also hoping she says the pain is gone! Finally, he also suggested searching the internet for this type of surgery - it's actually called arthroscopic surgery, with an a. I pulled up many message board posts from extreme type sports enthusiasts, who had the surgery and were doing well. Of course you know they have to be in tip-top shape, except for the knees to begin with, if they're into hiking, biking, etc. One man said the recovery time surprised him, he wasn't back on his feet as quickly as he thought he'd be. If my mom owned a computer, I'd send her these links. She gathers opinions from everyone she knows so I'm hoping I planted some seeds today. Perhaps some of her close friends will have doubts too. If for nothing else, my concern will just confirm this is necessary.

Marty is the first patient to have had this surgery Stephanie! I'm glad he recovered well. But you're right he was much younger than my mom. And get this both her primary and this surgeon had arthroscopic surgery. They both said they were glad they had it done. Again, I'm sure they're near Marty's age or even younger! I feel like I'm the only one that sees she's 80! If her primary is in tomorrow, I might have some answers before the weekend. I know my mom wants to know what to do here.

Thanks everyone for your replies!

Mary

[george_r_1961]

Mary ANY kind of surgery carries risks. And if the risks outweigh the benefits its just not worth it. The risks with this kind of surgery include blood clots and infection with the former probably the most dangerous since clots can quickly lead to heart attack or stroke. Also the recovery time in a patient that age is long...possibly months, as opposed to a few weeks for someone my age (43). and this long period of forced inactivity can itself lead to complications. I think you are doing the right thing.

[GalvestonDuck]

I talked to Niki and she said basically it's all about quality of life. If not having the surgery would cause your mom to remain in pain and not be able to move around and take care of herself, then she should have it. The biggest concern would be if it caused her to stumble and fall and break a hip. A large percentage of patients who break a hip succumb within the first year -- because they don't recover and rehab like they should and they remain bed-ridden. However, if your mom is not in serious pain and her mobility is not affected, the surgery is definitely not necessary.

[Miss Mary]

George - thanks for your 2 cents worth too. Agree, someone 43 recovering from this type of surgery is very different from someone 80.

Shawn - thanks for your input. Your friend's advice sounds pretty much what her primary said also. I spoke with his nurse yesterday and really unloaded on her. I said well, there's something you may or may not have noticed, my mom can be difficult. She laughed as if to say - that's an understatement! So bottom line is her doctor said he would recommend this surgery only if she couldn't manage or function anymore. And if the pain became so unbearable she couldn't stand it. Well, my mom isn't grounded - she's going out with friends, to dinner, church, prayer meetings, sure she's walking more carefully but she said it is slowly getting better. When I told the nurse this, she said a hrrrmmmmph! I said - exactly! To sum it all up, we now think since my mom was in for a recent physical and he asked how her health was overall, any concerns, she mentioned the knee. And an ortho was suggested. She didn't seek a doctor out only for the knee. She was even getting around back then! Again, when I said this the nurse chuckled. Boy it's a good thing my mom doesn't own a computer....I'd be busted if she read this. Anyway, called my family with her primary's opinion, they all agreed with him. Why risk surgery unless she really needs it. My mom is actually in agreement and muttered to one of my brothers - oh thank you all for taking the time to care about me, talk this over with me, my family is so wonderful....my brother said he just bypassed all of this praise and returned to the topic at hand, possible surgery. Let's just say her primary and his staff are on to her also. I swear I won't be this way when I get older! Told my girls if I ever am they can snap out of my behavior with a simple statement - Mom, you're starting to sound just like Grandma! I hope you all don't think I care, I do. I don't want my mom to put up with a sore knee, needlessly. But thankfully everyone I talked to - immediate family members, my husband's family and my wx board family (that's just what you are!) and good friends like Phyllis - agree with me.

So another medical episode diverted. Thanks for all of your input everyone!

Mary

[Skywatch_NC]

Mary,

Prayers and thoughts are w/ your mother and you guys.

Eric