Dave X
Dave has knee pain, angina, high blood pressure and foot pain. At his appointment with a knee surgeon, he was given a choice about what to do next. Dave decided to hold off on having joint replacement surgery, but appreciated the “safety net” that he could get a referral straight back at a later date. At the moment, Dave’s focus is on his wife’s health and on managing some of his other health concerns.
Dave is a retired factory supervisor, and continues to work a part-time gardener. He is married, and has children and grandchildren. His ethnicity is White British.
More about me...
Dave has knee pain which has been gradually getting worse over the years. Although he’s in pain, he tries not to take pain-killers. Dave also has angina which causes breathlessness and he takes medications for this. Besides “achy joints”, Dave feels “perfectly fit as a flea”; however, he says the dangers of high blood pressure were brought home to him when his wife’s friend had a stroke. Dave is passionate about gardening and works part-time as a gardener. He has made his own garden “easy to manage […] with old age in mind”. He also gets a lot of foot pain; he and his doctors think it’s due to the types of work he’s done, including being “stood in the factory all day long on a concrete floor”.
About five years ago, Dave had steroid injections in each knee by his GP. These injections were repeated twice more over a couple of years. The most recent time, the GP agreed to refer him about surgery. Dave went to a local hospital for x-rays, to fill in some forms, and talk to a non-surgical healthcare professional. The forms included questions about the activities he could and couldn’t do. Dave found them tricky to answer because he can still do the activities, but it is very painful. This appointment was just before lockdown and, for personal reasons, he told them that he wasn’t ready yet to think about surgery. He was pleased though that he would be kept on a list, which would speed up the process when he was ready. Without Dave prompting it, he then received another letter about an assessment. It was unclear to him if this would be re-doing the same tests, or if it was a different type of appointment. He was offered to go to a different hospital but decided to stay with a nearby one that he was familiar with.
At the appointment, Dave had more x-rays taken and was told by a surgeon that “both my knees qualify for replacement. It’s just a question of the ‘when’ really”. The surgeon gave him a choice about what to do next. Dave felt that there were too many downsides to recovering from surgery and that he would rather carry on as normal. He says his own health conditions are not a big factor in his decision about surgery, but his wife has been unwell and experiencing night terrors, so Dave didn’t want to be away overnight from her or laid up whilst recovering. The surgeon said that if Dave wants to reconsider knee replacement surgery, he can get a referral straight back to the surgeon and this would save him going through other processes and tests again.
Since deciding not to have knee surgery, Dave has started playing table tennis again and he has also lost some weight. He says his knees are the same as they have been for the last 3 years; they hurt, but don’t lock or give out. At the moment, Dave’s focus is on his wife who has ongoing night terrors and on managing some other health concerns which he has had recently. This includes a burst blood vessel in his eye related to high blood pressure for which he’s had changes to his medications. He has ongoing prostate problems but cancer has been ruled out, as have concerns that his wife may have early onset Parkinson’s disease. Dave is also having a problem with his hip and his right thumb joint. He had a steroid injection in his thumb a few months ago and would like another, but he isn’t currently considering this treatment for his knees as “I don’t like to bother them [the GPs] too much” or “ask for too much”.
Dave is really pleased with the outcome from the appointment with the surgeon and his decision not to go ahead with surgery at the moment: “it allowed me to carry on as I was but with a feeling that there was a safety net that if it gets really bad I could, through my GP, contact [the orthopaedic] department and [the surgeon], and have it done”. He hopes he can manage for a while longer but, if he gets to a point where he “can’t put up with this anymore”, then he will think again about surgery. Dave thinks that if he got to a point of using pain relief tablets every day, then he would “rather have the surgery”.
Dave X tried “to resist” taking painkillers for his knee. He didn’t want to become reliant on them and take them on top of his angina and blood pressure medication.
Dave X tried “to resist” taking painkillers for his knee. He didn’t want to become reliant on them and take them on top of his angina and blood pressure medication.
Do you take painkillers either for the pains you’ve got in your feet or the knee pains that you get?
No, I try to resist it as absolutely as much as I can. There’s only been an odd couple of occasions where I’ve took painkillers. But yeah, I don’t wanna be starting that really.
But they, as I said before they just hurt, they don’t touch wood, they don’t give out or lock or anything nasty like that. They just hurt.
I don’t take painkillers for them. No, I, you know, I take enough tablets for my angina and all that I don’t take, I can’t be taking, you know, painkillers for my knees as well, you know. Not unless, like I say, unless it got absolutely excruciating, in which case, I’d want the surgery then, you know.
Oh yeah, obviously pain relief, you know, but to be honest if I had to be on pain relief all the time for my knees, I’d rather have the surgery I think if it got to that point.
I wouldn’t be keen, I wouldn’t be keen on taking you know, permanent pain relief for my knees. You know, I’d rather have the surgery if it got to that point.
Dave X’s GP put him onto the knee pathway where he saw an Extended Scope Practitioner who assessed his knee problem.
Dave X’s GP put him onto the knee pathway where he saw an Extended Scope Practitioner who assessed his knee problem.
Well I was, I think I was at the docs and I think it was the last doctor that gave me the cortisone injections and, you know, obviously we, I think we chatted again about replacements and then he said, “Well, now,” he said, “I can’t I can’t refer you now like we used to be able to,” he said, “We have to put you on what’s called the knee pathway and then other people do the referring and so on,” you know, so that was I think that was how I had it, I got onto the knee pathway, you know.
Well, you have to go on this knee pathway before you can get to see a consultant or anything. So, I had to go on a knee pathway. So, I went to our local hospital and had them x-rayed and had to see a lady there and she said, “Yeah you’ve got osteoarthritis in both knees.” And I had to fill out this this lengthy form, you know, with all these, tick this box, that box and another box. But I said to her, “Really there’s little I can tick there,” because I said, “All the questions like ‘Can you get up? Can you sit down? Can you do this that and the other?’” I said, “I’m not gonna lie about it, I can do all that,” and for me luckily they don’t, my knees don’t lock, they don’t give out, they just hurt.
And, she said, “Well you have got osteoarthritis in both knees,” so she said, “You-,” so I had to go to see a consultant at [hospital].
And she, oh of course because of Covid and the lockdown, this is going back, this was not long before lockdown actually. In fact, I think it might have been the month before lockdown, something like that. And she said, “I’ll put you on-, yes you’ve definitely got arthritis”. I told her the same, I said, you know, “They just hurt, nothing more than that they just hurt,” and she said, “Well I’ll put you down on the list,” and so I said that I was a bit reluctant at the time to have it done for one reason or another and so she said, “Well I’ll put you down on the list and should you decide to have it done you can get straight in, your GP can contact-,” oh I mustn’t mention names but the main man sort of speak, “And you could be sort of put on the list, shortlisted if you like.” Yeah.
So, I said, “That’s fine,” I said, “I’m very happy with that actually.”
So that was, I said, “Oh that is brilliant, just what I wanted,” because as I said, I really didn’t want it at that moment in time but I didn’t wanna be taking myself out of the picture completely either, you know, just in case, you know.
Dave X asked to be seen at his local hospital because he trusted them, and getting to a different hospital would be difficult.
Dave X asked to be seen at his local hospital because he trusted them, and getting to a different hospital would be difficult.
I had a, first off, I had a letter to say that they would like me to have an assessment at a different hospital then, I can’t mention names, a different hospital and anyway I said, “Well-” so I rang them and I said, “Look I don’t really wanna go to a different hospital,” I said, you know, “The hospital is,” I said, “That’s a long way away for a start and my Mrs doesn’t drive and also,” I said, you know, “I’ve got total faith in our-, what I call our local hospital,” still a little way from us, but it’s still our local hospital.
And I said I really didn’t want to go to a different hospital” and they said, “No that’s perfectly alright.”
They said, “But it’ll be quite a while before you’ll hear anything again.” But then surprisingly a few weeks later, I did get this appointment at what I call our hospital,” you know.
The surgeon told Dave X that he could have both knees replaced. He wants to postpone having surgery at the moment to look after his wife with her health problems.
The surgeon told Dave X that he could have both knees replaced. He wants to postpone having surgery at the moment to look after his wife with her health problems.
No, it was, I mean he’s very nice, a very nice man and, you know, as I say he was quite hopeful that my knees could go on, you know, quite a while if I was lucky, I suppose. And, I do have to put up with the, you know, with the pain of them, you know, more so when I’ve had a busy day or something like that, you know. But you’ve always, you know, gotta weigh that up against, you know, six weeks laid up after an operation and [wife’s] situation, I [sigh], you know, I would be really reluctant to have to go in hospital and with [wife] gets these bad times in the night, you know.
Wouldn’t be something I’d relish, you know.
Of course. And so, what is the situation at the moment in terms of are you waiting to hear back about a date for surgery or-?
No, no, well the ball’s in my court to request it if I get to the point where I think I can’t put up with this anymore.
Okay.
You know. But as long as I can reasonably keep working which I do and like I say I’ve gone back to play table tennis and well then obviously when I do stuff, I ride my bike, you know, they hurt and that’s it, but then I know that. You know, its choices have to be made, you know.
And that’s, that’s sort of my choice, certainly at the moment, you know.
What with, you know, [wife]’s situation with her night times and you know, I’d be, well I wouldn’t be too reluctant about going in to have it done regarding the Covid because I think they must have got that all planned out fairly well, but obviously it’s difficult times and it’s everything all together, you know, I, it would be really difficult for me to say, “Yes, can I have my knees done?” you know.
I’d have to sort of, I think they’d have to be, deteriorate to the point where they were giving out or locking or something, and then I would have to.
Take the plunge somehow or other, you know.
But until then I’ll probably, if they stay as they are, which they’ve been the same now for oh I’d say they’ve been at this level now for two or three years probably. And I’ve managed to deal with it and do everything I wanna do. And that seems to me to be the best option at the moment.
The most influential factors would be the length of time you’re off doing anything after the surgery because my wife can’t drive.
And also [wife]’s situation in the night time which, with her nightmares, I’d be just worried sick for her, you know. If I wasn’t there, you know.
So, it’s that as well. And it’s a combination of the two, you know, because it would be extremely difficult for us if I was laid up for six weeks twice, you know, with [wife] not being able to drive.
Dave X's surgeon talked about possible risks of knee replacement surgery.
Dave X's surgeon talked about possible risks of knee replacement surgery.
I think they always kind of give you-, and I understand the reading, they give you like the worst-case scenario, as you may be worse off than you were before. Some people experience more pain than they did before they had it done. Can’t kneel or can’t, find difficulty walking or something like that, you know.
I know that’s the way it is with pretty well any surgery isn’t it. They give you the worst-case scenario I suppose, just too well cover themselves I suppose. Can’t say, they can’t sort of say, “You’re gonna be skipping out of here like a two-year-old,” can they, and then you find you’re not [laughs].
But like I say, my experience is overall that, you know, we’ve got a good hospital I think for joint replacement.
And I’ve not come across too many people-, well I’ve not come across any that haven’t been pleased with it. But I have just heard some scare stories from one or two which I take with a pinch of salt in the absence of any evidence of that, you know.
Dave X wants to postpone having surgery at the moment to look after his wife with her health problems.
Dave X wants to postpone having surgery at the moment to look after his wife with her health problems.
And can you tell me a bit about that appointment what was that like and what was discussed?
Oh, it was very good. You know, he said both, basically both my knees sort of qualify for replacement; it’s just a question of the ‘when’ really.
The ‘when’ is always gonna be difficult for me anyway. And he was quite happy, he said “I think your knees could go on for, you know, quite a while.”
He said “You may-” he said “You may never need to have them done,” you know
I said “Well I hope I aint gonna die that quick” [laughs].
[laughs]
No, it was, I mean he’s very nice, a very nice man and, you know, as I say he was quite hopeful that my knees could go on, you know, quite a while if, you know, if I was lucky, I suppose. And, I do have to put up with the, you know, with the pain of them, you know, more so when I’ve had a busy day or something like that, you know. But you’ve always, you know, gotta weight that up against, you know, six weeks laid up after an operation and [wife’s] situation, I [sigh], you know, I would be really reluctant to have to go in hospital and with [wife] gets these bad times in the night, you know.
Wouldn’t be, wouldn’t be something I’d relish, you know.
Of course. And so, what is the situation at the moment in terms of are you waiting to hear back about a date for surgery or-?
No, no, well the balls in my court to request it if I get to the point where I think I can’t put up with this anymore.
Okay.
You know. But as long as I can reasonably keep working which I do and like I say I’ve gone back to play table tennis and well then obviously when I do stuff, I ride my bike, you know, they hurt and that’s it, but then I know that. You know, its choices have to be made, you know.
And that’s sort of my choice, certainly at the moment, you know.
What with, you know, [wife]’s situation with her night times and you know, I’d be, well I, I wouldn’t be too reluctant about going in to have it done regarding the Covid because I think they must have got that all planned out fairly well, but obviously it’s, it’s difficult times and, it’s everything all together, you know, I, it would be really difficult for me to say, “Yes, can I have my knees done?” you know.
I’d have to sort of, I think they’d have to be deteriorated to the point where they were giving out or locking or something, and then I would have to.
Take the plunge somehow or other, you know.
But until then I, I’ll probably, if they stay as they are, which they’ve been the same now for oh I’d say they’ve been at this level now for two or three years probably.
And I’ve managed to deal with it and do everything I wanna do. And that seems to me to be the best option at the moment.
It sounded like the Professor sort of gave you the option, is that right, and then you were able to choose?
Absolutely, yeah.
Oh yeah.
Yeah, I could have said at the time, you know, I could have said, I think I could have said at the time, “Yeah, can you do them please?” Yeah.
But like I say, with all the other things I’ve got to take into consideration, if they go on enabling me to do stuff then, as long as that holds out, that’s what probably I’ll probably what I’ll do, you know.
How did you feel about that outcome at the time?
I was chuffed to bits.
Because it’s, because it allowed me to carry on as I was but, but with a feeling that there was a safety net that if it gets really bad I could, through my GP, contact his department and him and, and have it done.
No, he did say if any, you know, I’ve got all this on, well I guess his records, whatever they do, you know, his records. And he said “If you get a problem with it, you-” if I wanted it sort of done I guess go to my GP and they could refer me straight to [surgeon] who is the team-, well head of knee surgery and hip surgery I think at the Orthopaedic Department of the [hospital], you know.
So that was good, you know, that was result, I was quite pleased, well very pleased really.
That I wouldn’t have to go through all the pathway again, as they call it. Because they’ve got it all on record what I’ve got there and everything, you know.
