Saturday, July 10, 2010

NO NEW KNEES FOR YOU!! unless I can amputate your stomach first

Hello Friends,

My mom and I are hanging out with an old family friend tomorrow who lives in Florida, She and my mom are both in their mid 60's.

This friend, who for the purpose of this post I shall call judy, weighs between 300 and 400 pounds. She also has arthritic knees and while I am not 100 % up on the details of her situation, I will describe them as I understand them. I will get very clear on the details tomorrow as we have plans to hang out all afternoon.

Here is the deal. The doctors wanted her to loose weight before they replace her knees, So they advised her to have the lap band procedure. She did this about two years ago. If she lost any weight, she gained in back. So the knees are still not replaced and she lives with horrible pain.

I assume they went to adjust the lap band to force it to work and get her to loose weight and guess what? They cannot find the device. I never heard of that before. It is not around her stomach and they cannot locate it. So guess what the docs are gonna do now. After the lap band failed. They are still not going to do the operation to replace her knees because surgery is too risky at her weight. What they are going to do is amputate her stomach with a full gastric bypass and while they are in there, they hope to find the dislodged lap band device. Apparently the risks of this surgery is acceptable. It just seems so very wrong that the Doctors are willing to risk her life this way.

I feel horrible for her. Worse is that in the few times that I have spoke about fat acceptance with her, she has been completely unreachable.

I am going to try to reach her again tomorrow. Surely folks in our community can understand the injustice of doctors refusing to provide the pain relieving knee replacements but encouraging the life threatening stomach amputation. Further, we have the insight to understand how someone like my mother's friend Judy could agree with the doctors about the bypass surgery before the knee surgery.

I anticipate my discussions with Judy falling on deaf ears tomorrow. I am sick with sadness about this.

Please friends, send me your good vibes to my brain so what I say tomorrow to her has value.

14 comments:

  1. I hope your friend gets the relief she needs. Below is a snippet from a page about total knee replacement surgery and why the doctor(s) would want your friend at a lower weight pre-surgery.

    Finally, it is less likely to have good long-term outcome if the patient's weight is greater than 200 pounds. Excess body weight simply puts the replaced knee at an increased risk of loosening and/or dislocation.

    A similar risk is encountered in younger patients who may tend to be more active, thereby adding trauma to the replaced joint.


    The information came from here: http://www.medicinenet.com/total_knee_replacement/page2.htm

    My mother suffered from severe rheumatoid arthritis for over 40 years and had multiple joint replacements and joint surgeries before her death in 2006. So I can empathize with your friend. I hope she gets her relief soon. No one should have to suffer with debilitating joint pain.

    ReplyDelete
  2. I feel very lucky that I've been able to control my arthritis with exercise.

    ReplyDelete
  3. But, orange, it doesn't sound like the doctors are primarily concerned with the possibly lesser chance of success post surgery. At least as described here, they are worried about the risks of the surgery itself on a fat woman, WHILE AT THE SAME TIME recommending she have risky surgery. This is not the first time I've encountered this attitude. Somehow the risks of surgery magically disappear when it's WLS.

    And as for the lesser chances of success over 200 pounds, that may well be true. However "statistically less," particularly without any numbers attached, is dangerously broad and vague. It could, and probably does, mean very little in the case of any particular individual. Especially an individual who is already suffering. "Less" doesn't mean "none," and if surgeries were only performed when there was a %100 chance of a successful outcome, they would never be performed at all.

    And as for 200lbs in particular as a number--that is not very high at all if considering men as well as women. I can't provide documented evidence of this, but I have a hard time believing that a non-fat man of over 200lbs would be told to lose muscle weight for the sake of a knee replacement, even though joints don't react differently to carrying fat, muscle or bone weight.

    The idea is that the muscly man is "normal," and therefore the extra risk in outcomes is acceptable, it's just part of the package, like being male, or older than 60, or whatever. He shouldn't be asked to change, even if it might "statistically improve" his chance of good results. A fat man or woman, on the other hand, is deviant and that changes everything.

    As for talking to your friend--I wish you the best for your conversation. I have had much better luck talking to thin people about FA, myself. Fat people are often (I know I sure was) heavily invested in the hope they will be able to lose weight and/or negative beliefs about how bad they are for being fat. I found (sometimes still do find) those negative beliefs very tenacious.

    But there is hope--I'm proof. The first people who talked to me about FA got laughed at, argued with, pitied and scorned for their trouble. But the idea snuck into my brain nonetheless and slowly built a home for itself.

    ReplyDelete
  4. Orange, Living and Elizabeth, thank you for your responses. I feel a little better having gotten a little sleep. All I can do is give "Judy" the information and hope that she can use it to help herself. As far as stats and weight recommendations, I am clear on why the Doctors choose the data that supports their beliefs... I just hope I can shine some light on the data and the fact that she has already had on RESULTLESS WLS.... NO wait a minute... she does have a foreign body floating around somewhere inside her unable to be located by the doctors that put it there,,,, she does have the information that she doesn't keep the weight off and her digestion is so screwed up that she has to eat a very restricted diet.... Thanks God I found all of you before the stomach amputating barbarians convinced me to maim myself.

    You know I am thinking now, that there are those in our community who have chosen to have these procedures and may have had positive results. I am very upset right now about this however, I am actually in support of everyone's freedom to choose for themselves although I believe it should be from an informed place always.

    ReplyDelete
  5. I'm over 200 pounds and also (relatively) young and active, and I had a hip replacement a year ago. It was very successful. I was back at work 2 weeks after the surgery and now I sometimes forget it's there. I can bike and do NIA, and I can finally run short distances again. My doctor told me not to go back to playing squash, but physically, I could. The doctor's obviously proud of his work, and when I go back for checkups, I'm always the only one without a limp. Even the other people who are fairly young (and both of the ones I've seen are thin) don't seem to have recovered as quickly and completely.

    The new hip has never dislocated, in spite of the fact that I keep trying to increase the range of motion in the joint and wasn't all that careful about following the rules early on. I assumed that was because all the muscle tissue around the new joint was helping hold it firmly in place. In other words, I think my size may be positive in that regard. I can even cross my legs at the knee without any pain or difficulty.

    When I asked the doctor how many years he thought it would be until I'd need a second hip replacement, he said he thought this one would last indefinitely. He says that bone has grown in very solidly around both the ball and socket, and that it looks great. I can't help but think that this might be related to the fact that I eat a nutritious and adequate diet. (WLS causes nutritional deficiencies that could interfere with recovery.)

    I can understand how being heavier could cause a joint to wear out sooner than it would otherwise, and I can understand why have to cut through additional tissue would make the surgery more difficult for the doctor. Believe me, that would have been an issue with my surgery. I'm pear-shaped, and the doctor had to cut through the thickest part of my hip. I had a 14" incision and I evidently bleed a lot during the surgery. I ended up needing a blood transfusion. But, I asked the doc for a sturdy new hip (told him that I was likely to remain both heavy and active), my recovery was really fast and smooth, and now he thinks the new hip might last longer than average. Oh - and the incision healed quickly, too.

    So, in my case, weighing over 200 pounds does not seem to have been a problem. My weight was never mentioned by the surgeon, either. I asked about it, but he brushed it off.

    ReplyDelete
  6. I'm over 200 pounds and also (relatively) young and active, and I had a hip replacement a year ago. It was very successful. I was back at work 2 weeks after the surgery and now I sometimes forget it's there. I can bike and do NIA, and I can finally run short distances again. My doctor told me not to go back to playing squash, but physically, I could. The doctor's obviously proud of his work, and when I go back for checkups, I'm always the only one without a limp. Even the other people who are fairly young (and both of the ones I've seen are thin) don't seem to have recovered as quickly and completely.

    The new hip has never dislocated, in spite of the fact that I keep trying to increase the range of motion in the joint and wasn't all that careful about following the rules early on. I assumed that was because all the muscle tissue around the new joint was helping hold it firmly in place. In other words, I think my size may be positive in that regard. I can even cross my legs at the knee without any pain or difficulty.

    When I asked the doctor how many years he thought it would be until I'd need a second hip replacement, he said he thought this one would last indefinitely. He says that bone has grown in very solidly around both the ball and socket, and that it looks great. I can't help but think that this might be related to the fact that I eat a nutritious and adequate diet. (WLS causes nutritional deficiencies that could interfere with recovery.)

    I can understand how being heavier could cause a joint to wear out sooner than it would otherwise, and I can understand why have to cut through additional tissue would make the surgery more difficult for the doctor. Believe me, that would have been an issue with my surgery. I'm pear-shaped, and the doctor had to cut through the thickest part of my hip. I had a 14" incision and I evidently bleed a lot during the surgery. I ended up needing a blood transfusion. But, I asked the doc for a sturdy new hip (told him that I was likely to remain both heavy and active), my recovery was really fast and smooth, and now he thinks the new hip might last longer than average. Oh - and the incision healed quickly, too.

    So, in my case, weighing over 200 pounds does not seem to have been a problem. My weight was never mentioned by the surgeon, either. I asked about it, but he brushed it off.

    ReplyDelete
  7. In an effort to be wonderfully thin, I went on Weight Watchers and exercised like a crazy person. Well, I went from 345 to 192 and my weight loss came to a complete and total standstill - so, I ramped up the exercise and lowered my points again.

    In the process of trying to fit the norm of society, I wore ALL the cartiledge out of both of my knees. I had to have double knee replacements when I was 44 years old. By then, I had gained a great deal, if not all of my weight back. This was due to the fact that I had to stop exercising because of the debilitating pain in my knees. Let me tell you, it is AGONY!

    Okay, I had a wonderful doctor - Donald Dewey in Tallahassee, Florida. He is absolutely awesome. He moved to Pensacola, FL, but I would travel if I needed him. He was my surgeon.

    Here's what we did: first of all, I had to have every other knee procedure known to man BEFORE they would do the surgery. This is because the insurance company will not pay for a person my age to have replacements unless all other avenues have been tried.

    So, after that was done....we set up the surgery. Dr. Dewey used extra-long, extra-strength titanium replacements. They are much longer and bigger than your average replacement knee joint. I'm praying they're much stronger and last a very long time too.

    He did the surgery one knee at a time - the first one and then the second one three days later. This is so there are no problems during the surgery. Heavier people do have issues with anesthesia, their lungs, etc. So, that was how he handled that issue.

    I am not going to say this whole thing was easy - it seriously was not. It hurt pretty badly. BUT, after 1-1/2 weeks in the hospital and three weeks in rehab, I was home with my family with a home rehab person coming once per week. I did my exercises religiously and I healed.

    I feel SO MUCH better! There is no pain. I have occasional bouts of stiffness and it scares me a little bit - like what if they go bad already because I'm still fat. But, I try to get exercise and take care of them.

    This procedure may have to be redone and I really don't want to do it again, but I will. The benefits FAR outweigh the agony of the knees being arthritic.

    Now, I have to say....I do not agree with them trying to make your friend lose all that weight and doing dangerous procedures on her before they do her surgery. She obviously was not made to be a thin person - it's not in the genes. So those doctors should be trying to deal with who and what she is right now. As for losing a device inside of her body, she needs to report the doctors right away. That is not right. She also needs to find new doctors. Please encourage her to get a second opinion before they end up completely screwing her up. I wouldn't let them remove my entire stomach. What the hell is that? That surgery could kill her. I really pray that she doesn't let them do that to her.

    Please let us know what happens. I am very concerned for your friend. She needs to find a caring doctor that is knowledgeable with joint replacements for heavy people. If you live around Florida - try to find Dr. Donald Dewey. He is fabulous and caring!

    ReplyDelete
  8. My husband just his left knee replaced in December. He's 5' 10" and weighs 250 lbs and his surgeon didn't have a problem with his weight at all. We were told after the surgery that they had to use the largest joint replacement they had because my husband has huge bones, and even then, they had to shave the bones to get the joint to fit. He still has some pain, but nothing like it was before the replacement (and I'm assuming it's from the bone growing around the metal joint).
    I've never understood surgeons who think doing joint replacements on fat people is too dangerous, but it's not too dangerous to surgically alter a working digestive system (the cognitive dissonance in that just burns).
    I weigh 380 lbs and have arthritis in my knees, and at the age of 56, I'll be looking at replacements one of these years. I fully intend on using the same surgeon who did DH's surgery (hell, even the ortho doctor I see now says he doesn't see why I couldn't have my knees replaced at my weight if I needed to have it done). I think it all depends on the surgeon.

    ReplyDelete
  9. I hope that even if it seems like it's falling on deaf ears that maybe, later that night when she's laying in bed, it just suddenly sinks in. Above all though, I would assure her that she's worth far too much and is far too loved to risk her life without a second opinion, if nothing else. Sorry, friend, to hear about "Judy" and hopefully the outcome will positively surprise us all. =0)

    ReplyDelete
  10. It's a heartbreaking situation Ivan, that's for sure.

    I will send up a prayer that the right thing comes to pass for her, that she is free of pain AND weight stigma asap.

    ReplyDelete
  11. Ivan, this is absolutely mindblowing! She got the damn lap band and they lost it?! And now they want to amputate her stomach and won't even do the knee surgery! I hope she finds different doctors AND talks to a med mal attorney. I am so sorry for your friend. They're treating her more like a lab rat than a human being.

    She is lucky to have you in her life, even if it's falling on deaf ears for now. Sending you both lots of love.

    (By the way, no more than an hour ago I was re-reading Ask & It Is Given and thinking of you.)

    ReplyDelete
  12. Any update on your friend? This story is really bothering me, as I think her doctors are doing the wrong thing for her. Please let us know what has been decided.

    ReplyDelete
  13. Well I had my visit with our family friend. I found out that my mother had all bad information about what was going on with "Judy". It was true that the lapband has disappeared.

    It turns out that Judy had one knee replaced at the same time as the lapband surgery a few years ago and had the second knee replaced about a year after that. Judy has very bad arthritis and the paid has increased on her knees to the point where the doctors are doing the bypass to address the knee pain.

    She lost very little weight with the lapband. She thinks the bypass will help her lose weight.

    When I asked judy about building up her strength in the pool and how that would be easier on her joints, she looked at me and said, "I won't get into a bathing suit."

    Judy feels like this is her ticket to being able to be more physically active, She wants to move around more without pain and her doctors have her believing that loosing wight is the only way for her to find relief.

    She is not in the predicament that I thought she was is but she still is going to have her stomach amputated in the hopes of losing weight so she can be in less arthritic pain. She is convinced that this is her only option.

    I wish nothing but the best for her and I hope she doesn't have horrible side effects from this surgery. I still feel sad about her not being willing to get into a bathing suit. I still feel bad about her choice to have the surgery.

    I do honor her right to make this decision for herself.

    ReplyDelete
  14. Well, everyone does have that right - so, it is her choice. I can understand her feelings about the bathing suit, but there are places that hold water exercise programs for people like us - where it really doesn't matter what you look like in a bathing suit!

    I don't know what to say about the surgery, but again it's her choice. It sure is a radical one. Sometimes when a person is in extreme pain and feels there is no way out, they will do more drastic things if they feel it will offer some relief. Sometimes weight loss isn't the answer...it's just the first thing the doctors address because they can see it.

    Well, keep us posted if you would!

    ReplyDelete