Making decisions about knee replacement as an older person with multiple conditions

I knew I’d had to have a knee; I mean because the way my leg was it’s obvious that I mean there was something wrong with the knee: it’s permanently swollen from the ankle up to the waist near enough.

And the knee, you can tell there’s something wrong with the knee because of the way it is.

So, I knew that was the case; I didn’t think I’d have to wait that long. Like I said to you before, if it was half a knee, it got to be cheaper the full knee, but the longer it goes on, the worse my knee’s going to get.

So instead- he said it’s bone to bone at the moment, it’s going to be a full knee, which perhaps is more expensive, it’s a bigger operation, I don’t know.

So, I mean to me I get- well, look, we all know enough in the papers about the waiting lists and so forth. But again, you see people who had it done and you- "oh, it hasn’t worked, I’m going to go back and have it done again." And you see people- a friend of mine he’s going to have a hip replacement, he’s been waiting about two years, and he went to [city] or somewhere and went private, but on the National Health.

But some people seem to get-, [sighs] oh, I don’t know, I mean, I’ve just got to carry on the way I’m going, I presume.

But as I said, I do worry living on my own and having this giddiness and then having trouble with the knee as well.

It’s a fairly routine sort of situation, something they’re dealing with all day every day and nothing unique about my knees really for people my age.

And so, obviously, I asked - I didn’t bother him too much about what when and why - but I said “I’m bound to ask the question when do you feel you can operate on my knees?” And he said “Well, the best guarantee I can give you at the moment is I’ll try and get it done before you’re a hundred years old.”

And the nurse fell about laughing and I, you know, I mean to be quite honest even my subsequent calls to them, just you know, I don’t pester them every day there’s no point, we all know the situation.  But I did - I guess I asked the question after three months and I asked the question after about six months, something like that. And they have absolutely no idea at this moment in time when my knee operation could take place.

And I didn’t pursue it or pressurise them in any way, there’s simply no point because you know, I think we have to recognise that we’re just a name to them. You know, your turn will come round one day, eventually.

Yes, you don’t actually speak to the consultant of course, you speak to the appointment secretary and my guess is they’re being bombarded by calls because the list is enormous now I, I do know that.

And she was quite reasonable but fairly abrupt on the last occasion I spoke to her - “We can’t, we cannot tell you when you’ll be seen you’re in the list you will be contacted you know, when we can provide you with an appointment but it won’t be for some considerable time and I can’t give you a date at the moment.”

Since they introduced that extra tablet, the swelling has stayed down so no, it’s just about the same really, so I’m pleased to say it’s nice to be able to say that it hasn’t got worse. I’m very pleased about that because I still might have to wait at least another 18 months, because he said two years, and that was back in October, was it, or December when I saw him?

He said it would be another two years, so at least I’ve done another six months and it’s still about the same, so that’s not too bad.

What would not coping look like, what would that involve do you think?

Well, it would involve me not being able to walk my dog, or not being able to actually do the lawns, or whatever, you know? It would be- and I- [sighs] I’d grumble at lesser things, but I wouldn't do anything about it if you see what I mean?

It would have to be that, I’m literally near enough housebound, not being able to use my legs at all, that- you know, my knee at all, then I would have to complain.

Anyway, in the meantime I hadn’t been feeling great, and I had been to the doctor about several things, and it had been decided after me having - or rather after the doctor using the stethoscope and so on - my area where I had the mitral valve repair in 2016 -  it was decided that I should have an echocardiogram.

Now, you could say that was unfortunate, because what it meant was that the hospital, - the new hospital - then wanted to wait for that to happen. And of course that gradually was moving towards the Christmas period.

Trying to get some idea of how long that was going to be for an NHS appointment for that, and then when it seemed it was going to be almost as long as the time I’d been on for my knee - which by now was a year.

So I went through my insurance and got an appointment through [private hospital]. That sounds alright, except as I say it was coming up to the Christmas and New Year period so you know nothing happened terribly quickly.

But I have now had it, the result of that has gone off to the new hospital, I have spoken to them and checked that it was sent direct to them by email - as I had asked.

And the young woman I spoke to said yes, she went straight into her email and there it was and she said, “I’ll print it off straightaway and I’ll take it straight down to the anaesthetist.”

So that’s where I am now. I don’t know what they’re thinking about the result, and therefore you know whether they’re going ahead with the admission.

Unfortunately, before I've had the chance to get my knee operated, my heart problem’s overtaken me, and I've had three heart attacks and had to have a triple bypass, which has been very successful from the point of view of supplying my heart with blood through the main arteries, but still the smaller vessels aren’t receiving a very good flow of blood, so I'm still left with residual angina, which if left untreated, then develops into another heart attack, so, I'm pretty dependent on this-, my spray, my GTN spray. I am improving steadily after the surgery, and slowly getting back to some kind of normality.

Yes, unfortunately they used a long saphenous vein in my left leg to make the new arteries for my heart, but that site got infected, and subsequent to that was- I had to go back to theatre and have the site all debrided.

So, getting my leg to heal has been rather a long process as well; it’s still getting dressings on it at the moment. They used an interesting machine called a ViPAC [VAC] which is a suction system that they put into the wound and it sucks away all the detritus and any sort of nasty tissue.

You have to carry round a little pack with you, but it’s a very clever system, and then it certainly healed the wound up beautifully. And I'm hoping in a couple of weeks to be dressing-free [chuckles].

Oh, bless you, so you've got sort of ordinary dressings now, you don't have to have that kind of machinery? No?

I don't have to have the pack, I've had it off for about 10 days now. It’s lovely, because it did interfere with sleeping, having to have these little battery-powered systems with you all the time.

Oh goodness. And you said it was your left leg where the veins had become infected, and that’s also the leg that you've got your joint problems with, I think?

It is, yes, it is.

Goodness, that must have been difficult.

I don't know if it’ll affect the surgery, I'll have to ask him next time I see him.

And can I ask about the times that you have seen the knee surgeon? I think when we last spoke, you were due to see him the next day, in late March of this year?

Yes, unfortunately I had to cancel that clinic.

Oh no, oh goodness, okay.

[chuckles] Yes, so I haven’t seen him, with being ill. But just he wrote me a little note saying that obviously because of my health, he was putting everything on hold.

At the moment I suppose you've got quite a lot of health concerns going on - wwhat is sort of the placing for your knee problems in relation to that? I can imagine that it’s sort of dropped down in terms of your priorities for the time being?

It has rather, yes it has. I mean obviously because I'm not well, I'm not doing as much, so it’s not affecting me as much as when I was more active.

Plus, with the winter and the weather, I'm not getting chance to get out and try and walk, and you know, it-, the weather in itself sort of slowing my recovery down.

Unfortunately, when I was admitted, until this point, I hadn’t actually met the anaesthetist and I’d only had the pre-op a few days beforehand. I don’t know whether it was the first time he saw the cardiogram reading - well I don’t know if it’s cardiogram - but the readings they’d taken of, of my heart - but he didn’t look very happy about that.

I knew already from the last, from about six years ago when I had my first knee done, I knew that I had an atrial fibrillation, but obviously I’m six years older than when I had that done, and ever since that was discovered I’d been on warfarin, but obviously I’d come off the warfarin for, to have the operation some five days earlier.

I, and the anaesthetist listened to my heart and he went away to consult with the consultant, and they came back and explained that they wouldn’t feel happy going ahead with the operation until I’d been seen by a cardiologist. Just to clear it that I was, you know, it wasn’t something which - well the heart -  if there was a further problem with my heart - they used the word ‘heart murmur’ - and they said they wanted me to see a cardiologist first.

Well, I managed to see the cardiologist this week, and I haven’t had an echocardiogram, which is what the anaesthetist and consultant wanted, but I’m going to have that in four days’ time. So that’s all, all booked.

But the cardiologist said that I don’t, I had a heart murmur, and this probably needed some monitoring in the years to come, but that he didn’t think that this was any reason not to go ahead with the surgery. So, I’m hoping that once I’ve had the echo- ECG, it’s called, isn’t it? That once I’ve had that then I’ll be able to be on the list to have my knee done.

But - unless this ECG throws up something - which I don’t think it will - but something different or something more serious than the cardiologist was able to hear, then he didn’t think there should be any reason why my surgery, knee surgery couldn’t go ahead.

So I, and he, I think they’re all aware that yes, I’m eager to get on with this, and oh - and the really - I was surprised about but very, very delighted, because as soon as when I was admitted, as soon as the consultant and the anaesthetist began to talk about seeing a cardiologist that’s when my heart sank because I thought, ‘Oh dear, if I’ve got to go on a waiting list at the NHS the NHS to see a cardiologist how long is that going to take?’

But the consultant explained to me that this was necessary before they could do the knee surgery and therefore at no extra expense to me, it would be included within the package, that I’d paid for the knee surgery.

So, I would see a private cardiologist and that would be all be paid for. So that was good, otherwise it would have taken a lot longer if I’d had to go onto an NHS waiting list, I think.

On top of that I’ve now got blood pressure problems. My doctor’s- which is fantastic a doctor, I never knock my doctor at all - has given me some pills which I don’t know if they suit me or not.

And on top of that, three weeks ago I woke up Saturday morning and I couldn't get out of bed because the head- my- the whole room was spinning and every time I got up, I just felt uncomfortable, so I stayed in bed.

The following day I dialled 111. I spoke to the doctor, he phoned up and he said, “Looks like you've got vertigo, I’ll give you some pills,” but in the meantime I was sick all day on the Saturday and stayed in bed.

The pills come, they stopped the giddiness and, okay, I felt lazy for about four or five days, on top of that the doctor said to me- I told [him] I was on new blood pressure pills. “Can you do a blood- a heart-" oh, Christ, “a blood pressure test?”  Because I’ve got a machine at home.

Yes, I [told her I] done three tests and they were way, way up.

So, she said, “If I was you, if the giddiness doesn’t go off, phone me back and I’ll get you into hospital,” and I said, “I don’t want to go into hospital if I can help it.”

Anyhow, the pills sorted it, but she said, “Phone your doctor on Monday morning.”

I phoned my doctor on Monday morning and explained the situation and he said, “Well look, Stu, double up on your heart pills, we’ll wait a couple of weeks and we’ll give you a blood test to see if - what harm it’s doing to the rest of your body.” So I think it’s supposed to do something to the kidneys or livers this pill. So, I’ve done that.

But with that and this giddiness, it’s about- you know, getting me really down now because I’m scared to go anywhere near enough, because if I have this spell of giddiness again... And it’s bad enough just being giddy but worse still when you've got a leg what’s playing up as well.

I do worry living on my own and having this giddiness, and then having trouble with the knee as well. I mean it-, when you've been used to doing things and then all of a sudden you can’t do it, you know, it’s frustrating in a lot of ways.

Was it a letter, or they might have phoned up to say would I be willing to go elsewhere, to a private hospital? Which they naturally pay for, because the waiting list is so long, obviously due to Covid. They couldn't give me a date as to when it would be done at the hospital, and so I went to a private hospital in another city.

Well I obviously discussed it with my daughter because she would be the one that was going to look after me afterwards. In fact I asked her when this letter or phone call came to say would I be willing to go to another hospital -  I did have to ask her first because she would be the person that was going to take me, and she just said, “Well, go wherever it is, you know, I will take you.” So to go ahead and not just wait for the [other hospital] to do it.

They were very good there. I suppose I was very lucky that they chose me to go, you know. This little private hospital because a lot of people are waiting longer. Mind you it was my choice that I went there; I could have had it done at the [other hospital] but it would have been a much longer wait.

I think time was the factor you know, that having to wait a lot longer and the pain getting worse, and who knows, if I had to wait another couple of years how much worse it would have been.

I received a telephone call from the hospital saying would I be prepared to go to another hospital to have the operation, as the present hospital that I am under has obviously a long waiting list for obvious reasons. I said yes I would , two alternative hospitals were mentioned, we went through a, a questionnaire on the phone as I was asked if I had a pacemaker, well I have an ICD plus defibrillator, and immediately the conversation then was stopped regarding questions, and I was told well because of that we do think you ought to remain where you are as they do have a heart unit there, and just in case, we believe that you should have this operation only done under conditions where there is a heart or cardiology facility.

I obviously accepted that, and I was told, “Well I’m afraid again it’s where we were trying to trying to shorten the time where you would have the procedure, you’ll now just have to take your turn with the hospital that you are being dealt with presently, being dealt with. I of course accepted that I appreciate the fact that they’re still looking after me and I will just have to be patient.