Is this our business? Or should we just walk away? WWYD?

[shovetheholly]

This is a bit of an update of an older thread.

The backstory: FIL is afraid of surgery. He needs a standard knee op. He's now backed of having this twice at the pre-op stage. He is a very controlling person, and part of the fear seems to be associated with this loss of control.

FIL walks literally bent at a 90 degree angle, grasping a stick in front of him. His spine is now deformed after years of doing this, and he's had one vertebra break under the strain already. I honestly haven't seen ANYONE else walk like this these days - it looks like a big spider. It is getting worse with every passing month.

He's struggling to clear any chest infection he has - he gets a cold and coughs for months and months. I suspect he can no longer properly ventilate parts of his lungs.

He has heart problems already (a stent has been fitted) and his inability to do much in the way of exercise is not going to be doing this any good.

He flat refuses to get a blue badge or a mobility scooter. Yet his walking is becoming slower and slower. It's all having a terrible impact on MIL who is fit and active and able to stride up hills with gay abandon, but who is now reduced to crawling alongside him.

He loves to drive, but I don't know how long he'll be able to do this with the knee problem. He has already been told he has to stop every couple of hours because of a DVT danger.

He is depressive and anxious, and declining mobility isn't helping this.

He refuses to engage in meaningful conversation about these issues, and clams up or changes the subject when this is raised.

So my question is: what should our reaction be? How much should we hassle him about his decision not to have this op?

I am very aware that it's his body, his decision. I would be horrified at the idea of anyone being forced into an operation when they weren't comfortable with it. On the other hand, his fears about the surgery really don't have any rational basis and we are genuinely concerned about the implications of his not having it for his quality of life long term.

I genuinely wouldn't mind walking away with an airy "On your head be it". DH is more concerned about his mother and wants to apply pressure.

WWYD?

My mums friend has stents in her heart and had a spinal block for both her knee reaplacements...

wolfiefan - He's been told he is a suitable candidate, twice. MIL attends appointments, and says that they think the spinal issues will require physio after the op, but that his posture ought to improve a bit and driving will also be better. The first time he backed out on the morning of the surgery, the second time he didn't even make it to the pre-op.

whereyouleftit - that's REALLY useful information, thank you. I cannot believe that no medical professional has raised this with him, so it could well be that he's avoided telling us about this because he doesn't want crutches. I will raise it. In terms of a reward for being infirm, that's an interesting question. I'm inclined to say not. MIL tends to do everything around the house, but I think that would happen anyway since they seem to have quite old-fashioned gender relations. He used to love walking a lot, and now he can't do that any more, and he also risks losing his ability to drive. I would have thought those things would have outweighed the risks of the op, but apparently his fear is stronger. (It is real terror, not just a bit of nerves).

topetoe - yes, the op isn't under a general, it can be done under a spinal anaesthetic - but he's still afraid of dying for some reason!! I take your point about the op worsening things, but it's true of any surgery that it can go wrong or be ineffective. Just part of the risk you take, as you say.

badders - yes, I am honestly inclined to say "What can we do?" .

Were the hospital aware of the anxiety before he attended for the op - was it explained to them at the pre-op stage? Could a plan be made, with back-up from his GP, where they give him something to relax him at an earlier stage than before? He won't be the only anxious/phobic patient they have helped, so there should be options available to help him through the op he needs.

If he has been bent double for years a knee operation won't correct his back. If driving is all he has left and the possibility of not being able to drive after the OP, this might also be part of his decision making process.

At the end of the day we are talking about an adult with full mental capacity. His choices should be his own.

Only he can make these decisions.

ordinarily - interesting question. I do not believe they would have communicated it with any clarity or honesty and I am certain the hospital wouldn't have heard about the depth of it. PIL are not good at expressing emotion at any time. But according to MIL, FIL was literally sitting staring at the wall in a non-functional state 10 DAYS beforehand! So it's not just a question of a bit of sedation before the op to settle him. I reckon he might need some combination of counselling and maybe hypnotherapy plus meds if he were to go for it again. Since he's bottled out, he gets kicked off the waiting list for at least 16 weeks now, so we have a while to consider.

Another one here who doesn't understand why a knee problem means he walks at a 90 degree angle - I just can't see how that takes any weight off the knee. Are you sure that the back problem didn't begin before or at the same time the knee problem did?

Frankly, I would tell him that he's crippling himself over his irrational refusal to have his knee fixed and YOU won't be the ones to do everything for him when he does.

I feel sorry for his wife. Is she likely to leave if he won't help himself? 7 years seems like an awfully long time to stay in situation that continually worsens due to deliberately poor choices.

It's hard to explain. Most people lean sideways onto a stick, right? But he leans forward, with the stick in front of him, taking the weight off the knee and putting it on his arms. But because the stick is then a good foot and a half in front of him, he has to bend his back and walk at an angle. This angle has got more and more pronounced, I guess because he's putting more and more weight through his upper body?

I am not a physiological expert. I'm not sure if this is clear! Hope it makes sense!

(I should add, I think this posture also might prevent him from bending the knee? But it's really hard to tell because he wears quite baggy trousers and I'm not very experienced at analysing body movement so I am not sure what to look for)

"He's now backed of having this twice at the pre-op stage."
OP, can you clarify what you mean by pre-op? Is this the 'immediately before entering the theatre to be anaesthetised' point, or going into the hospital to get his medical history looked over, BP taken and booked onto the physio class to be taught what exercises he needs to do before/after the operation and how to use crutches?

whereyouleftit - By pre-op, I mean the appointment a week before you have the op where a nurse weighs you and assesses your medical history and does an ECG and asks you lots of questions about your health.

The first time he backed out literally just hours before actual surgery. This second time he didn't even make it to the pre-op a week beforehand.

I really think you just have to let this go tbh.
If he has MH issues it's not going to suddenly get better overnight....and I'm assuming he refuses meds for that too?
Just have the convo with your Dh and mil (if poss) and make clear what you are prepared to do (or not do)
Sadly all too often it is the female of the family that shoulders the care burden (and I speak from experience....)

Well, at least second time around he won't have wasted too much NHS resources.

If he won't countenance the op, how do you think he would take a suggestion that he goes to a physio? They can't fix his knee, but they can advise on how to maximise his mobility. Get him off his stick (which must be too short for him to end up walking like that) and on to crutches, how to use them properly, what exercises he should be looking at to minimise the harm he's doing himself. I'm not qualified, but the description you've given of him all bent over, I'd think he'd be weakening his core and spinal muscles. I'd suggest going private, he'd probably only have to see them once or twice, it wouldn't be too expensive.

Badders - it will fall on MIL as we live 5 hours' drive away. I think DH is very afraid of the effect on her (she's not had an easy time of late) and wants to help for this reason - I'm more of your mind that there's not much we can do as it is ultimately his choice. MIL is hale and hearty and is frankly missing out on a lot because of this problem. But it's really up to her as his wife to exert pressure and get him the help that's needed - she's not a shrinking violet. I fear that there might be things that are not 'on show' in their relationship that might explain why she doesn't do this, despite being loud and confident in other departments, but this is conjecture.

😞 it's often the way, sadly.
What about your Dh having a word with your mil about how to help her?

I think this is going to be a difficult issue for him if he really fears this operation. Although it is often done routinely these days it is still major surgery with weeks if not months of pain and rehab afterwards. If he is not the sort of person who would cooperate well with the post-op physio etc then he may not achieve a lot of benefit from having major surgery.

For my mother it was a huge mistake to have a knee replacement - she ended up having to have a general anaesthetic as she couldn't/wouldn't lie with her spine in the correct position for the spinal, the pain medications exacerbated her early dementia and despite huge efforts of the NHS with 3 months of home visits from physios, OTs and nurses she refused to make any real effort with the exercises so never achieved improved mobility and had less mobility post-op than pre-op. She died less than 2 years later

If they believe that he would be able to straighten his back with better walking he may be able to improve his gait with intensive physiotherapy. improve

whereyouleft - You've been really helpful, thank you so much. I think he has seen a physio briefly as part of the pre-op process (he had to do some exercises, something about preventing DVT before the op?) but either the sticks weren't raised, or they were and he hasn't passed that on because he doesn't want crutches. Either way, thanks to you, we can now ask some questions about his walking apparatus!

I can't find a picture on the internet of what it looks like. The best way I can describe it is that he is a squarish shape. Whereas most humans don't take up much space horizonally - we are quite vertical - he is very horizontal, like a spider. His legs go up. His body bends at something between 45 and 90 degrees. His arm is out in front of him, and the stick is a good distance from his legs. The sticks shake with the weight he puts through them.

I would think the way forward is to just leave him to it. You say MIL is fit and active -- is she passing up opportunities to be out doing things so she can be his nurse? She shouldn't. She should do things without him and stop talking about the OP. Maybe once a month or so say "I'd be glad to go back to see about your knee if you feel ready to do something about it." But everyone coaxing him doesn't seem to be helping. Time for tough love.

By and large, a stick is for balance, if you need to take your weight on your arms then you are far better off with crutches. I'd also bet he holds the stick on the side of his bad knee, when you actually need to use the stick on the opposite side to take the weight off the bad knee.

Does your fil know anyone who has had the same operation that could put his mid at ease ? Perhaps him
Talking to someone would help x

Do you think your fil would use a 4 wheel walker/rollator? It might help him improve his gait by putting equal weight on both feet. My own physio has worked a lot on this aspect - even though my case is not an ordinary knee replacement

I remember your previous thread and my advice is broadly the same - waste less time on trying to convince your FiL to have the op and instead get your dh to concentrate his efforts on emancipating your MiL. She needs to start leaving him at home whilst she goes and does active stuff.

I think those of you saying to focus on MIL have a good point.

I don't really "get" their relationship, by which I mean that I think there are subterranean things going on that are not out in the open. MIL is a very confident, assertive person when it comes to anyone else except FIL, with a tendency to ignore/bulldoze other people and their feelings. I am starting to realise that this is because she has had to become a person like this to deal with FIL. Being with someone who is constantly both negative and anxious is exhausting and he will also, in the wrong mood, niggle away at her with passive-aggressive comments and criticisms. DH can remember him slapping her in front of him when they were younger, and I'm guessing that the one time it happened in front of the children was not the only time it is likely to have happened.

They don't relate to anyone on an emotional level, so it's impossible to have an emotional conversation with them. Perhaps it's best for us to focus on the practical things she can do to get time/space/activity away from him. They do everything together at present, so a constriction in his mobility is cramping her style.