Recently I had lunch with a beloved friend who has had to give up a few things as she has aged. Running five miles a day, for one.
Always an athlete, hiker, biker, active beyond active, my buddy Lisa and her partner Craig own a small second solar home in what’s known as South Park in the high country south of Denver. That area, blessedly free of development, allows them acre after acre of free space to wander, hike, or just sit and watch the clouds, which sometimes suffices when long hikes prove challenging.
But Lisa, who’s in her mid-sixties, stays in motion.
Lisa’s always had a cranky knee. And she’s always been a skier. A lover of berms and bumps, her great love of the outdoors has marked her lovely face with the kind of reddish glow that you see in alpine dwellers. She sports the crinkled grin of someone who smiles and laughs a lot. Which of course is why I love her.
That cranky knee got replaced two years ago.
New joints, new life
The other thing that’s different is her hip. Years ago she was in a car accident which left her with one leg three inches shorter. That discrepancy has cost her years of pain, but that has never slowed her down. Once she qualified for a replacement hip, she got that, too. Now she’s several inches taller, and she no longer lurches when she walks. It’s taken a long time for her to feel tall, even, and balanced. Decades of leaning to one side are done. It’s like having a brand new body in her mid-sixties. A new lease on life indeed.
Lisa can no longer distance run, nor can she pop those berms and bums. However, she still skis, hikes and moves. Sitting around watching television isn’t on Lisa’s schedule. This is one reason why Lisa’s joint replacements are going to be successful.
About a million joint replacements are done every year with many of the recipients, like Lisa, over fifty. As the procedures become more efficient, this number is expected to rise to four million in the next two decades.
There are several challenges with this.
On one hand, joint replacement for someone like my friend Lisa is a slam dunk. She’s slim, active, energetic. Those new joints are going to keep her in the game for decades to come.
For another friend of mine, whose knees are also shot, is not a good candidate. He’s the same age, but at least 350 pounds. His knees are damaged because of a lifetime of obesity.
New Knees Aren’t a Guarantee of a New Life
While the research shows that a fair percentage of morbidly obese people can manage well with knee replacements, they aren’t a guarantee of weight loss. Those who lose weight before the procedure or others, like Lisa, who are active already and of a reasonable weight, fare far better.
Joint replacement is becoming far more common not only for those who are active, but even more so as obesity becomes a norm, rather than the exception. Decades of extreme wear and tear on the hips and knees carrying vastly more weight than the body is designed to manage simply tears the joints apart.
And it’s not cheap. Currently a knee replacement can run upwards of $20,000, not including hospital costs, drugs and physical therapy. Not only that, there are big questions, as we head into a future where the nearly half of America is expected to be seriously obese by the year 2030, about whether joint replacement in the morbidly obese is even viable. http://healthland.time.com/2012/05/07/fat-forecast-42-of-americans-could-be-obese-by-2030/
Aging and Joint Repair
Lisa pointed out what so many of us still have to juggle even in our sixties: we’re still working, we still have families which might now include grandkids. Importantly our bodies might harbor old injuries or sport new parts or replacement parts that create limitations on what’s possible. This is particularly true if we’ve been very active in our youth. We become walking weather vanes.
Just ask us. “Yeah. Big storm coming in….about two hours. It’s in my knees.”
However she also told the story of a skydiver who was paralyzed by one bad jump. Then he spent one year in bed, but did focused isometric exercises every single day. At the end of that year he was able to get up and walk away. For most folks, being paralyzed would have indicated it was time to toss in the towel. Not for this guy. And that was her point. A replacement knee or hip or various injuries can slow us down. They don’t need to spell “give up.” However this just isn’t true for everyone.
My buddy Bill, with the bad knees and the extra 180 pounds, lives in England. He isn’t likely to get those knee replacements. He’s already been waiting for many years, and the older he gets the less likely it is he’ll have the surgery. This in part because he won’t change his habits. Won’t lose weight. So the doctors in his health care system are making the necessarily tough choices about serving more viable candidates who in fact will do the work, and ensure that the new joints remain viable.
I love Bill, and I would like to see him in less pain. By the same token I absolutely understand the British argument that it makes no sense to perform expensive surgery on a recalcitrant patient for whom the long-term prognosis isn’t good. He’d likely to need new replacements in a few years. That’s a burden on everyone else- and in a socialist health care systems, the needs of the larger population have to be taken into account.
An Uncertain Future
I’ve been seriously fat. Unless you’ve battled that particular war, it is well nigh impossible to have empathy for those who also struggle with their weight. For people who have metabolisms that keep them perpetually thin, it’s extremely easy to be judgmental and call heavy folks lazy. That’s just not always the case. There are are multitude of factors involved with obesity. It’s not as simple as get your butt outside and run the block, and stop eating so much. There is still a great deal of prejudice and misinformation about why folks get fat, why they stay fat, and why the cycle is so vicious. While a lack of exercise and poor food choices most certainly are factors, those aren’t the only reasons people get heavy. We need a great deal more thoughtful research to come up with answers to more of the variables. This isn’t an option. It’s an imperative, because the whole world is getting fatter.
Organ Transplants to the Most Viable Candidate
Along similar lines, a good friend of mine at my gym is missing workouts to spend evenings at the hospital with a friend whose organs are failing. Day by day: liver failure, kidney failure. Brandon reports the latest disaster. This young man, whom Brandon has known all his life, represents the life that Brandon nearly chose himself: decades of extreme drug and alcohol abuse.
The other night, Brandon, who is today the picture of health, reported that this young man, barely forty, no longer recognizes anyone. Once a bright, witty, intense kid, his organ failures have made him a ninety-year-old man.
“There but for the grace of God go I,” said Brandon. He had done his fair share of drug and alcohol abuse, which had cost him his marriage. What saddens him is Brandon’s family. The kid never had a chance. Alcoholic, drug-abusing parents, a sister on crack, a brother on heroin.
This kid won’t get new organs. The doctor told Brandon that when they assessed his chances of survival, they also took into account his family. His living conditions. The chances that the hugely expensive and complex surgery would be worthwhile.
It isn’t. That liver, those kidneys will be going to someone who has a better shot at survival, and thrival. This drug-ravaged young man will be dead in just a few days.
A Very Real Potential Future
It is entirely possible, given the cost of joint replacements, that in a future healthcare system such decisions may also be made for those of us who are morbidly obese. Fundamental changes to our healthcare system are inevitable. At some point, the burden to treat those who do not choose to help themselves becomes untenable.
My dear friend Bill is crippled for life. The British healthcare system is not set up to serve people like him. I know him well enough to know that in his situation, it was all about choices. That’s heartbreaking, but Bill is where he is because of who he chose to be.
As we increasingly become a nation crippled by obesity, diabetes, cancer and many other illness brought on by bad food, poor choices, lack of exercise and a host of other issue brought on by pollution, lead in our food (including protein powders that athletes use, I might add), lead in our water (thank you, Michigan politicians) we may be facing a bleak future. A future in which an overburdened health care system may have to make more decisions about who is deserving. And that may not be you. Or me. Or someone else we love.
Right to Life
There looms in this possible future an entirely different kind of Right to Life. Far from being only about fetuses, this concerns those of us who cripple ourselves or are crippled by our environment to the point where life itself, forget quality of life, may be determine by heroic measures that an overly-strained health care system can no longer justify.
The potential for this is very real. America already spends more per capital on health care than any other nation- close to $10,000 (https://www.npr.org/sections/goatsandsoda/2017/04/20/524774195/what-country-spends-the-most-and-least-on-health-care-per-person).Yet we are 11th in standing in terms of the quality of that healthcare compared to other rich nations. This doesn’t bode well either for us as individuals or for the healthcare system that was once the best in the world. No matter what kind of healthcare system you support, socialized, single-payer, something else, makes no difference. The numbers speak volumes about where we are headed with our health, the attendant costs, and the inevitability of wicked-tough choices up ahead.
At some point we simply cannot skate along assuming that some new pill or some new magical procedure will make us all better. That’s fantasy thinking in a world full of very tough realities.
Is there an answer? If there is, it’s be like Brandon. Be like Lisa. If your health is trending down, do everything you can right now to stem the tide. Take your health in hand as much as possible and don’t bank on getting new joints if yours fail due to obesity. Don’t count on brand new organs if yours fail due to opiate abuse and a lifetime of drinking. Because those healthy organs are going to be increasingly rare, and those joints are probably going to go to viable recipients.
You most definitely want that to be you, when and if you never need them. The alternatives simply aren’t acceptable.