REFLECTIONS OF 2012

         

Yea, tis the season to be jolly!   Its the best time to go to the malls and snap, snap, snap. Look at the colorful pictures that my daughter, May helped to snap.  Christmas spirit is everywhere and its the happy time.

This year has flown by so quickly for me.  It has been 20 months since I had my bilateral TKR and 7 months since I started this blog.  One thing's for sure, I haven't counted time as much as before.  During my early recovery, I have always wondered when will all this be over.  I used to be envious of people who have been out of TKR for years but look at me now, in another few months, I will be hitting my two year mark. So it just goes to show that everyone will get there, its a matter of time.

About two months ago, I experienced pain along the side of my right knee and down the leg.  I felt pain when I put pressure on my knee and when walking up the stairs.  Naturally, I was worried and started to think about what I had done to have caused this.  The first thing that came to my mind was whether there was anything wrong with the implant. Then I started to notice a small lump at the front of my right knee.  So I consulted my OS and it was a relief to hear that the pain was caused by a pulled ligament and nothing serious.  With one week of anti-inflammatory medicine, the pain was gone.  He suspected that the lump is probably a blood clot and nothing to worry about.  Its a relief that the lump has gotten a lot smaller and not so noticeable now so I'm not worried about it anymore. 

About two weeks ago, I spoke to a friend's friend on the telephone.  She had TKR on one knee last April which was thirteen days earlier than mine and it was at the same hospital as mine too.  She complained that even though she does not have pain anymore in the knee but she still feels the numbness around the surgical scar.  I told her that I still have that too and that its normal because one nerve at the front of the knee had to be cut in order to gain access.  I explained to her that its very hard for the OS to join back the nerve therefore, the numbness may end up being permanent.  Then I asked her when she plan to do the other knee and she said that she might not do it anymore.  I asked her why and she said that her TKR knee doesn't feel natural with the numbness.  Then I asked her whether her knee felt natural before TKR and she said obviously not.  In the end, she admitted that she was scared of going back to do the other knee and that she was envious of me having done both of my knees at the same time.  You see, this is a classic example of some people who ended up with one good knee because the fear of going back to do the other is too great.  Anyway, I gave her some encouragement and hopefully, she will gain the courage to do the other knee.

Some experienced TKRers have said that they do forget that they have TKR knees.  I felt encouraged listening to such feed backs but until today, I have not reached there yet.  At times, I do forget especially when I am focused on doing something.  But at other times, I am reminded of them with the clunking sensation (caused by friction between metal and plastic).  Maybe I tend to be quite observant of my knees too. On top of that, I still have the stiffness, tightness and numbness at the surgical scar.  My range of motion is at 120 degrees which is the same as before TKR.  However, the good news is that I feel great.  I don't have pain in my knees and I can sleep well. I can walk very fast.  I can run up and down the stairs.  I can do all my exercise movements.  I can go shopping for quite a long period.  And I can go for holiday trips.  In other words, I have my life back!

To be honest, I did not know much about OA and TKR before my surgery than I do now.  I used to think that after TKR, everything would be back to normal.  Its obviously not true but maybe so for a  small minority of people.  It all depends on how much damage have been caused by OA. With the knowledge that I have gained, I know that OA has caused permanent damage to my body.  My range of motion and stiffness have been greatly affected by the damage of muscles and ligaments.  The tightness and numbness are caused by the TKR surgery and they are very likely to become permanent.  But the most important factor is that TKR has removed the pain in my knees and gave me my life back.  So all the other sensations that I am still feeling is nothing compared to what I have now.  They do not impair my overall function.  I can only blame myself for my ignorance about OA and for delaying the surgery.  However, looking at the bright side, this experience has given me a passion for sharing my experience, doing research on arthritis and TKR and writing this blog in order to create awareness and help to inspire those who are battling the same problems. 

Some of you may have noticed that I wrote about the importance of pH balance and alkaline diets in my earlier posts. I have been consuming more alkaline water and food on a daily basis.  Actually, I have been drinking 2 to 3 litres of alkaline water for more than a year now and it includes calcium ion powder, lemon and baking soda.  However, I realised that I don't consume enough of greens and fruits.  But now, I am consuming tons of it through my green smoothies everyday.  I have been doing this for a few months now and  I noticed that my immune system is better and my acid reflux problem has improved.  I do believe that an acidic body causes lots of medical problems including inflammatory diseases such as arthritis.    And I cannot take for granted that after my bilateral TKR, other parts of my body would not be affected.  In fact, some parts have already been mildly affected. Thus, something has to change.  I am hoping that by consuming more alkaline water and green smoothies, adopting a healthier eating habit and regular exercise may help to reverse or prevent more damage due to arthritis.  Overall, I am happy with my progress and feel blessed with this medical miracle of TKR.  And I certainly hope that I will continue to be inspired to write more posts in 2013.

To wrap up this year, here's wishing everyone "Merry Christmas and Happy New Year!  May the new year bring you lots of good luck, good health and the courage to change the things that you can.






With daughter, May

WHEN IS THE RIGHT TIME TO DO TKR?

This is a very common question being asked in TKR forums.  In fact, I noticed that some people joined such forums for months or years before they even schedule their TKR surgeries.  I believe that these people know  they have a problem but they wish to find out in detail before they make a decision.  Well, it's good to learn as much as possible in order to be more prepared.  However, if learning more is going to put you off, then it may not be a wise thing to do.  In such instance, I would suggest that you just learn enough to help you make a decision and make necessary preparations before the surgery.  After all, you have plenty of time to learn more during recovery which is quite a long process.

 

In my case, I have to admit that I did not know much about TKR except way after my surgery.  I was in denial for some time but I knew that I had hit rock bottom when the pain became unmanageable.  Then I went running to my OS to fix the problem.  I was told that I needed a bilateral TKR because I was already bone on bone in both knees and it had resulted in joint damage.  Without any hesitation, I immediately scheduled a surgery which was only about  a few weeks away.  At that time, I was helping my daughter to organise a charity event so I fixed the date right after the completion of the event.  I'm glad I did that as I did not have to go through the anxiety of waiting.  Though I had to move around in great pain but it was the excitement of the preparations and adrenalin from the success of the event that kept me motivated.  To be honest, I could not wait to get over with the surgery as I have endured enough.  It was only early this year that I started to join TKR forums and learnt so much from fellow TKRers. 

It's quite common to see some people who are happy to have finally scheduled their TKR surgeries but subsequently, begin to question whether they have made the right decision.  Most of the time it's because they suddenly experienced less pain in their knees and they begin to feel that their condition is not as bad as what other people are experiencing.  Actually, this is a sign of nerves and its perfectly normal.  Its also quite common to see some people who keeps questioning whether they are the right candidates for TKR because their pain is not as severe as what they see others experiencing.  Since then, I have learnt that  sometimes an x-ray can show very bad damage but the person does not experience much pain.  On the other hand, there are cases where the x-ray showed little damage but the person has extreme pain.  This is quite puzzling and  even some medical professionals find it hard to explain to their patients.  However, these people do admit that while they do not have severe pain but they walked with a limp, have bad posture,  experience pain when climbing up and down stairs, have restrictions in carrying out certain activities,  have limited range of motion etc. So the question remains when is the right time to do TKR?

I know its hard to pin point a certain time.  But some people have said that they knew its time when:-

1. they felt that enough is enough
2. they are unable to do the things they love
3. nothing works anymore
4. there is no quality in their life
5. they are merely existing and enduring life

Well, here's something that can help you to determine whether its time for you to do a TKR.  Just answer the following questions honestly:- 

1. How long can you walk and stand without pain and stiffness?
2. Are you limping when you walk?
3. Do you have a bad posture with aches and pain?
4. Are you able to climb up and down stairs normally without pain?
5. Are you able to do daily chores without restriction and pain?
6. Are you able to go shopping and holiday trips?
7. Are you able to do any exercise or play any sports?
8. Is the knee pain affecting your sleep?
9. Are you having bow legs or knock knees?

If you score poorly on the above questions, then the answer is obvious.  We do not have to just endure life.  We are supposed to have a better quality of life.  TKR is a medical miracle that allows us to gain back our life and it is one of the most highly successful surgery.  In fact, many people including myself waited too long to do TKR and as a result, suffered more damage from OA (refer post on OA still exist after TKR?).  And after finally having gone through TKR and enjoying an  active lifestyle with pain free knees, this is what most of us said  "WHY DID I WAIT SO LONG?"

GREEN SMOOTHIES & ARTHRITIS

In my earlier post on pH balance, I mentioned that its important to consume more alkaline food and water in order to have a healthy pH balance as it helps our body to function properly and prevent diseases including arthritis.  Alkaline food include most fresh fruits and green vegetables.  But how many of us actually consume lots of fruits and leafy greens in particular on a daily basis?  If I look at our diet today, I think most of us will not score well on this.   

Recently, I read a book called "The Body's Natural Instinct" by Professor Chang Jia Rui, M.D. who had researched the body's natural instincts for over 20 years.  He said that "If we all know how to improve our diets, and were willing to consume more green vegetables and drink a large amount of water, illness would automatically disappear".   He also said that "No matter what kind of illness you suffer, it is caused by one single factor, and that is acidic toxins". 

According to the US Department of Agriculture (USDA), the dietary guidelines report stated that "greater consumption of fruits and vegetables is associated with a reduced risk of stroke and perhaps other cardiovascular diseases, with a reduced risk of cancers in certain sites (oral cavity and pharynx, larynx, lung, oesophagus, stomach, and colon-rectum), and with a reduced risk of type 2 diabetes (vegetables more than fruit).  Moreover, increased consumption of fruits and vegetables may be a useful component of programs designed to achieve and sustain weight loss".

All these information really emphasises the need for us to consume more fruits and leafy greens.  Now I'm sure most of you would be asking "but how much is enough?" According to the USDA, the recommendation is 5 to 12 servings a day or 2.5 to 6.5 cups a day depending on calorie needs.  But as a general rule, the more fruits and leafy greens we consume, the better.

A very good alternative to increase the consumption of fruits and leafy greens is to make green smoothies.  Green smoothies was actually created by Victoria Boutenko in 2004.  Since 1994, she and her family were faced with numerous health problems such as obesity, juvenile diabetes, hyper thyroid, chronic fatigue, arrhythmia, chronic rheumatoid arthritis, asthma and allergies.  When medical doctors did not leave them with any chances of recovery, she began researching nutrition and even studied what wild chimpanzees ate because they share with humans 99.4% of genes and have extremely high natural immunity against aids, hepatitis C, cancer and other diseases .  She was surprised to discover that Chimpanzees ate 40% of greens and it was also observed that when they ate a fruit, they would wrap a leaf around it like a sandwich.  She became convinced that greens are the most important food for humans.  She also discovered that in order to get the nutrients, the leafy greens have to be broken down to the tiniest pieces preferably down to the molecules.  In simple words, we need to chew our greens to a creamy consistency in order to get the benefits.  And in order to digest the released minerals and vitamins, hydrochloric acid in the stomach has to be a very strong pH between 1 and 2.  This is something that is not easy to achieve and therefore, she came up with the idea of blending fruits and leafy greens into smoothies which eventually helped her and her family to fully reverse their symptoms and regain vibrant health.  However, it must be noted that she and her family are also on a 100% raw vegan diet and they do exercise regularly.

I am so glad that I started to make green smoothies for myself and my family as it is really helping us to consume a healthy amount of fruits and leafy greens  You will be surprised that it is so easy to make and very pleasant to drink because the taste of the greens is actually masked by the fruits.  You can go to Incredible Smoothies to read about all the excellent information on green smoothies and recipes.

The health benefits of consuming green smoothies indicated by Incredible Smoothies include the following:-

• Increased consumption of fruits and vegetables (particularly greens)
• Easy digestibility and Nutrient Assimilation
• Rich with chlorophyll
• Alkalising
• Antioxidants
• Increased energy
• Mental clarity and focus
• Increased fibre intake
• Clearer skin
• Natural weight loss
• Reduce cravings

We can use any leafy greens for making green smoothies.  I have tried spinach which gives the most pleasant taste for the green smoothies so its easier to start with.  Bok choy, lettuce and any other local greens can be used too.  I have also tried watercress (sai yong choy) which has a strong flavor and bitter taste but it has powerful nutrients.  Other greens which you can use (if available in your market) include kale, swiss chard, collard, dandelion, turnip, beat and parsley.  It is also best to rotate the greens in order to enjoy the variety of nutrients. The general nutrients of leafy greens include potassium, dietary fibre, folate, protein, vitamin A, C, K, calcium and iron. I also added cucumber to my smoothies as it has powerful nutrients.  According to Naturalnews, cucumber helps to control blood pressure, aids in weight loss and digestion, reduce cholesterol, promotes joint health, relives gout and arthritis pain.  It also contains a hormone which is needed by the cells of the pancreas for producing insulin which has been found to be beneficial to diabetic patients.  For arthritis, we can also add 1 teaspoon of turmeric, 1/2 teaspoon of cinnamon powder and one chunk of fresh ginger into the green smoothies as these ingredients have anti inflammatory properties and promotes blood circulation.  In fact, most leafy greens have anti inflammatory properties.

As for fruits, we can use apples, bananas, oranges, lemons, watermelon, pears, papayas, grapes, strawberry, mangoes etc.  The general nutrients of fruits include potassium, dietary fibre, protein, Vitamin A, C, calcium and iron.  However, for diabetics, it is recommended that you use more greens and choose fruits that are lower in sugar.  You can refer to WH Foods for more detailed information on the nutrients of fruits and vegetables.

The ratio for making green smoothies is 40% greens and 60% fruits but you can slowly work up to 50/50.  Sufficient water should be added.  I am using coconut water because of its excellent nutrients and sweetness.  I usually make a large batch of green smoothies and leave it in the fridge and it would be finished within a day. Each of us drinks around 2 to 3 glasses a day.  According to Victoria Boutenko, the green smoothies can be kept fresh within 2 to 3 days in the fridge probably because of the large quantities of antioxidants in the fibre.  Of course, if you can drink the green smoothies fresh from making, that would be ideal.

Now all we need is a blender to make the green smoothies.  In the picture you see below, I tried my sister's high end powerful blender to make the green smoothies.  It was excellent - very smooth.  To be honest, right now I am using a cheap blender which my husband won from a golf competition but it still works well - probably takes a little longer to blend.  But it still serve its purpose.  Maybe when it has done its time, then I will consider upgrading to a better one. 

So what are we waiting for?  Lets start making some green smoothies!  Still not convinced?  Perhaps  the picture below showing my daughter, May and nieces, Jess and Sue-Ann enjoying their green smoothies will convince you to start making those yummy and healthy green smoothies.

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pH BALANCE & ARTHRITIS

I recalled reading from somewhere that arthritis can be caused by high acidity in the body.  I knew that acidity has something to do with our pH level but I never really paid much attention to it.  In fact, I am not even  aware of the implication of the pH level indicated in my medical test reports.  So I embarked on a research to gain more understanding and I found that an imbalanced pH can actually affect our health.  I got even more interested when I read that an imbalanced pH not only can cause arthritis but osteoporosis, kidney ailments and a host of other diseases.  According to Wellness Watchers MD, pH imbalances can cause accelerated aging, demineralization, fatigue, impaired enzyme activity, inflammation which leads to inflammatory diseases such as arthritis and organ damage.  It can also cause proliferation of harmful microorganisms which can lead to cancer.  

I find it interesting that pH imbalances can cause inflammatory diseases such as arthritis.  Could this mean the same as what was suggested by Stanford University School of Medicine's study that "osteoarthritis is in great part driven by low-grade inflammatory processes"? (see post on OA still exist after TKR?).  If this is the case, I wonder why there is a lack of awareness on the importance of pH balance.

So what is a pH balance?  pH stands for potential of hydrogen and it is a balance between acidity and alkalinity in our body which is referred as Acid-Base Balance.  It is not easy to create a normal pH balance in our body due to all the acid-forming foods in our diet, exposure to toxins and high stress levels.  As a result, many people suffer from over-acidification.  A high alkaline level means that there is excessively low acidity in the body.  However, most people with imbalance are usually too acidic and this has been claimed to cause many degenerative diseases.  But too much of alkalinity is also not a good thing as it can lead to other serious health problems.  Therefore, we need to have a healthy pH balance to ensure proper function of organs.

The level of pH is measured on a scale of zero to 14.  The lower the pH, the more acidic.  The higher the pH, the more alkaline.  The neutral pH is 7 and 7.4 is considered to be a healthy pH level which is slightly alkaline.  The pH in our blood is the most important in order to ensure proper body functions.  However, to measure the pH of blood is not so convenient as we need to visit our doctor to get our blood drawn to do a venous plasma pH test.  So an alternative is to test our saliva and urine pH as it is very convenient.  It may not be as accurate as the blood pH test but it is a good indication.  This can be done with pH test strips or digital pH meters which  can be purchased from pharmacies.  It is best to do the test upon waking up in the morning and before taking our breakfast.  Do this for several days to get an average result.  If the test is done at other time of the day, it should be at least two to three hours after eating a meal. 

Ideally, we should try to achieve a more balanced pH in our body by consuming more Alkaline Food which includes most fresh fruits and green vegetables.  Dairy foods, meat, bread, chocolate, alcohol, carbonated drinks, certain teas and coffee are very acidic.  As an alternative, drinking alkaline water will help to increase our pH level. Water accounts for up to 75% of our body thus, the fluid intake greatly affects the pH of our body. Unfortunately, most of the water we consume are acidic.  Therefore, drinking alkaline water will help to balance the pH level.  Alkaline water has a pH value between 9 and 11 on the pH scale so it is very effective for developing an ideal pH of 7.4.

OVERCOMING JOINT REPLACEMENT SURGERY

In order to create awareness on total knee replacement, I certainly welcome any contribution of relevant articles from guest writers.  So here's a post contributed by Drugwatch which is dedicated to informing you about seemingly safe, doctor-prescribed drugs and medical devices that could negatively impact your health and life.  I am sure you will find the information useful.

 

 

 

 

Overcoming joint replacement surgery requires a bit of patience and diligence. While knee and hip replacement procedures have come a long way in the past couple of years, bone and joint health should be prioritized to keep joints healthy, mobile and strong. It's important to pay particular attention to the tissue surrounding the joint, as there can be complications associated with replacement surgeries. Some of the major medical device manufacturers have had to recall their latest innovations due to malfunctions and associated health risks, including metallosis and osteolysis.

Anyone who has had a knee or hip replacement should be informed of potential health risks to be aware of complication-related symptoms.

Recovering after Surgery

For the first two to four weeks after joint replacement surgery, patients will need to adhere to strict post-operative guidelines from their doctor. This will involve rest, heat/cold therapy, prescription and/or over-the-counter medications and physical therapy. However, once the post-operative period has ended, it is up to the individual to continue a lifestyle that supports healthy bones and joints, and also the exercise required to maintain strength, mobility and balance.

·   Diet. Eating a well-balanced diet is especially important for anyone recovering from replacement surgery. Not only does the body require a nutritious diet to nourish bone and joint tissues, it is important to maintain a healthy weight to remove additional strain from compromised joints. Even a loss of 15 pounds or so can make a difference in recovery and can help prevent further injury. Dietary supplements can also help. Patients should ask their doctor about recommended supplements for bone/joint health such as, Vitamin D, Calcium, Magnesium, Chondroitin sulfate, Glucosamine and SAMe

 

·   Exercise. It is imperative that joint strength, range of motion and flexibility are maintained to prevent the risk of further injury. In most cases, individuals can assume their normal activities, with minor modifications. An emphasis on exercises that include both weight-bearing activities - to increase bone density - and movement-bases exercises - to increase range of motion and balance, is important. In cases where there are more severe restrictions on movement, patients can use a theraband for resistance and range of motion exercises. These exercises can be done while standing, sitting or lying down. It can also be beneficial for family members to learn how to guide assisted exercises if necessary.

 

·   Anti-inflammatories. Using anti-inflammatories as prescribed can help to alleviate pain and inflammation, which facilitates the body's healing process. Always check with a doctor before taking any new medications.

 

·   Orthotic inserts. It is a good idea to have custom orthotics made. Custom orthotics help to compensate for an unusual gait, differing leg lengths or unusual foot anatomy that may place strain on joints. Even the slightest adjustments can provide support to muscles, bones and joints, alleviate pain and prevent further damage.

The better patients take care of themselves after joint replacement surgery, the less likely they will be to require further surgeries.

Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.com.

ADDICTION LIFE STORY 1

INTRODUCTION

As you know, the purpose of this blog is to raise awareness and provide inspiration to those battling the same problem. One of the ways to inspire others who are still battling the disease of addiction is by sharing life stories of recovering addicts.  This is also very therapeutic and freeing for the recovering addict himself.  So far, I have already posted on my experience with the following posts:-

 

·         Addiction

·         Addiction Rehab
·         Addictive Behavior

 

Now I am inviting other recovering addicts to share their life stories here.  I am also planning to invite family members of recovering addicts to share their stories.  It would be interesting to hear their side of the story.  If any of you readers know of any recovering addicts who have an interesting story to share, please feel free to email me.  Please read along and help to spread the awareness to people whom you know can benefit from it. 

Let’s introduce you to my first guest writer, Kevin who is a recovering addict. He is 34 years old and has been clean for 4 years plus now.

 

LIFE STORY BY KEVIN

 

HOW IT ALL STARTED?

I have four sisters. My father passed away about 3 years ago of throat and nose cancer while I was still in the center and I live with my mother now. My dad is a strong will person cause he battle and survive for more than twelve years on liquefied food after he had gone through his radio and chemotherapy. The doctor said he should be dead in within five years because people would naturally give up. Anyway, when I was young, my parents sent me to live with my aunt. I was always bullied by my two elder cousins there. At age six, I went back to stay with my parents and sisters. My parents would very often send me to a temple nearby for most of the day. At the temple, I would just follow whatever activity they have there. My parents did not show me any love and affection because we were poor and they need to earn for the family. My sisters are also not close to me. So there were not much communication within my family and most of the time, I was left alone. I hardly see my sisters or spend time with my parents and there is not much communications. So I came from a dysfunctional family.

 

At 14 years old, I started smoking, drinking and using drugs. The first feeling of "high" I got from the drug was the most amazing moment. I have been chasing to get the same feeling ever since which in fact you will never get back that first high. (But at that time I never knew that so I just kept increasing my dosage). My attendance in school was very poor but I always manage to get away with it. I was also quite popular in school and could even convince other students to give me money and I would use it to buy my supply and booze. I have quite a number of girlfriends but most of them did not last because I was never serious with them. When I was 15 years old, I finally manage to court this girl who lives near my place and I kind of knew her when I was twelve, and fell head over heels in love with her. She was very encouraging and always telling me that education is important. She is the 9A's type while I am the bump type. My relationship with her got very serious but after two years, she dumped me. I was heartbroken and fell into depression. I committed suicide by cutting my wrist at home but my father came home in time and saved me.

 

My drug use slowly became more rampant but still under control. When I turned 18, my friend asked me to join him to work. While I was working there, a customer noticed me and offered me a job to work with her company. I hesitated at first but later decided to accept the job after the third offer. So I joined this firm and was given free lodging at the company premise. I continued to use drugs while I was working. There was never a day that I have worked without the influence of drugs. (Not a day I was sober). I was naive to think that I was not an addict because I have a job and I could still function. I never admitted I was a junkie because I have a professional job and basically living in denial. I hardly go back to visit my family even though my boss would encourage me to do so. My boss and her husband were very kind people and they gave me a lot of support and encouragement. I often wonder whether they were aware of my drug use.

 

Every day after work, I would isolate myself in my room. Even when my boss holds a gathering with friends or family members at the company premise, I would only come down to eat and then disappear into my room. My room was my sanctity where I would be lost in my own world, my sanctuary, my higher state of ecstasy, and my play station. I drank a lot of cough syrup and build up a lot of tolerance so I needed sleeping pills to knock me off and I also experimented with all sorts of drugs. As my lodging and food were provided, my salary was literally paying for all my drug supply. So basically I was working for my drugs.  I tried heroine but did not like it. I actually love my drugs so much because my work performance was great and every client wanted me to handle their event and that kinda made me wanna use more. My dosage kept increasing.

 

After eight years later I finally got fed up and wanted to quit but I can't and the side effect was that I was so depressed, cause the type of drugs I'm using is a downer. So I started to take anti-depressant pill and also anxiety pills and nothing helps and that is when my situation had gone bad. And I was suicidal. My bosses have to keep bringing me to different clinic to sow up the slashes on my wrist and also the stab wounds cause I stab and cut myself.

 

I started to become unmanageable due to all the side effects of the drugs. I could not wake up in time to go to work but my performance was not affected as long as I'm using it. I crashed a few cars as I would suddenly black out while driving. I suffered from bowel problem and could not stop purging so my boss rushed me to the hospital one day. Apparently, it was due to the constant high dosage of cough syrup. Then I started to have hallucinations. There was one day when my colleague found a trail of blood from my room to the kitchen downstairs. They discovered that I had cut myself. Before that I committed suicide many times but they did not take my situation seriously. For I have given up hope on living, I was a living dead at that time. That was a wakeup call for my boss and they decided to intervene to help by checking me into a treatment center and even paid the fees for me. After 28 days, I found that I did not learn anything and when I came out, I relapsed. I checked into the center again but still did not learn anything and relapsed immediately after I got out. My addiction became worse despite all the encouragement given by my boss and her husband. They finally gave up and kicked me out of the company and I had to rent a room to live in because I could not go back to my family in this condition. And at that moment my hell begin, I started to use crystal meth, ketamine, erimin, ecstasy, weeds and hashish just to destroy myself and to get high. Just like how a woman will mix and match their clothing that’s what I did with my drugs - to amplify the effects and to experience euphoria.

ADDICTIVE BEHAVIOUR

Although my addiction to sleeping pills was due to my knee pain, I realize that I also have an addictive behaviour. When I fell sick in the past, I would very often request the doctor to prescribe me with a heavier dose of medicines and for a longer period. My excuses were such as "I have an important meeting to attend" or "I have to go on a business travel" or something else. If I need to travel overseas for work, I will worry about sleep, so I will always carry sleeping pills with me. Even if I self-medicate for a common cold or flu, I will tend to take a few more tablets than required. In the case of shopping, I felt instant gratification for buying something nice and expensive but it may not necessarily be something that I need. These are typical patterns of an addictive behaviour. And my knee pain was just the trigger for me to fall into a full blown addiction to sleeping pills.

WHAT IS AN ADDICTIVE BEHAVIOUR?

Addictive behaviour is defined as one which is characterized by or susceptible to addiction. There is no single set of characteristics that fit all addicts but there are some shared similarities with different addicts. These are some common characteristics of addictive behaviours:-

· Low self esteem                                   · Compulsiveness

· Obsessiveness                                      · Need instant gratification

· Perfectionist                                         · Insecurity

· Depression or anxiety                          · Loneliness

· Aggressiveness                                    · Lack of self-control

· Lack of love and affection                   · Self-destructive

· Impatience                                           · Co-dependent

People with addictive behaviour do not necessarily mean that they will be destined to develop an addiction problem. Some of them still are able to make positive life choices. However, they must become more aware of the potential dangers of addiction.

WHAT IS ADDICTION?

Addiction is defined as a means "to devote or surrender oneself to something habitually or obsessively; behaviour that impairs the performance of a vital function, a harmful environment." Addiction causes you to lose your sense of balance and rationality. Beneath all addictions is a longing for immediate gratification - to feel good, powerful, worthy of admiration, problem free and an insistence on ignoring the long-range self-destructive implications of the behaviour. In simpler term, addiction is an out-of-control habit.

WHAT CAN WE BE ADDICTED TO?

A person can become addicted, dependent or compulsively obsessed with anything. It can be broken down as:-

Psychological addiction such as work, shopping, exercise, video/online games, gambling, sex, eating disorder etc.

Physical addiction such as drugs and alcohol. This occurs when the body has to adjust to the substance by incorporating the substance into its "normal" function. This state creates the conditions of tolerance and withdrawal. Tolerance is the process by which the body continually adapts to the substance and requires increasingly larger amounts to achieve the original effects.

Withdrawal refers to both physical and psychological symptoms that people experience when reducing or discontinuing a substance the body had become dependent on. Symptoms of withdrawal generally include but are not limited to anxiety, irritability, intense cravings for the substance, seizure, nausea, hallucinations, headaches, cold sweats and tremors.

Most physical addiction also has a psychological addiction. For example, an alcoholic who has not used alcohol for years may still crave a drink. This is referred to as a "Dry Drunk" syndrome. Normally, recovering addicts require a lot of help such as an established program, support groups, counseling, behavioural therapy etc. However, in such instance, the addict simply stopped drinking without any proper help, understanding of addiction, issues involved etc. Therefore, the addict remains emotionally disturbed, mentally unstable and vulnerable to relapse.

WHAT ARE THE SIGNS OF ADDICTION?

Some people ask "Can I be physically dependent on prescription medicines and not have an addiction?". The answer is "yes". If you depend on sleeping pills to sleep or pain killers to control pain but you can keep it within a low dosage, you do not have an addiction yet. But if you are told by your doctor to reduce the amount of the pills you are taking, your body will probably react by giving you very vivid dreams or you may toss or turn and be unable to sleep for a few nights. This is because your body has already become physically dependent to some degree on the pills and is reacting to the loss of the medication. So as long as you can control your choices, you are not addicted but you are at risk.

Some people use recreational drugs over the weekend. They can still keep control over how much and how often they use them. Many people can regularly drink limited amounts of alcohol too. The problem is that many people gradually lose control over how much they use and are overcome by the increasingly strong desire to consume more and more. Sometimes, a certain crisis such as an emotional trauma due to relationship, work, health, financial problem etc. can trigger a full blown addiction. In my case, it was the knee pain.  Here's a link to a real life example as a point of reference.   

http://www.thatslife.com.au/Article/Real-Life/Real-Life-Stories/I-was-an-alcoholic

Most people who are addicted to certain substances are very aware of their addictions and even the harms caused by the addiction but keep doing it anyway. This is because they feel they cannot cope without the addiction and they are avoiding having to deal with the real issues. It is only when a crisis happens and the substance is taken away completely, then the person goes into withdrawal and cannot cope. The most obvious sign of addiction is when the addict's life has become unmanageable.

OA STILL EXIST AFTER TKR?

This question has been on my mind for some time now and I have been searching for an answer.  Some medical sources says that OA is no longer present after TKR based on the common understanding that it is not an actual disease but a wear and tear condition.  However, there has been a recent study by Stanford suggesting that OA is a degenerative disease resulting from inflammatory process, not just  wear and tear (see link below).  Perhaps this explains why more and more younger people are diagnosed with OA. This development offers hope that someday this condition may be preventable. Therefore, I remain puzzled whether OA still exist after TKR but I do hope to find a definite answer someday. Whatever it is, the end result is still joint damage.

http://www.med.stanford.edu/ism/2011/november/osteoarthritis.html

Meanwhile, assuming that OA is no longer present, why do I still have the stiffness after prolonged sitting, standing and walking which feels the same as before TKR?  Apparently, this is due to the damage caused by OA.  Frankly, I have been quite ignorant of the damages that can be caused by OA in the long run.  I thought that after TKR, apart from the pain, all the stiffness, aches and tenderness would be gone and range of motion would be restored.  However, after 18 months now, I still have the same range of motion and stiffness. And some areas around the knees and legs still have the same tenderness.  The most logical explanation that I can think of is that OA has caused some permanent damage to my body.  Only recently I found out from some joint replacement medical professionals that the stiffness we still experience after recovery from TKR is due to the damage from OA.  

When our cartilage deteriorates, the bones rub together when we walk thereby causing a lot of pain and damage on the joint surface.  Eventually, spurs will be formed due to the damage of the joints.  These bony spurs might look tiny but they can cause a lot of pain.  It can also get dislodged somewhere in the body.  I know of someone whose spur from the knee joint surface got dislodged in her thigh muscle.  She suffered a lot of pain and eventually, got it removed through surgery. The spur actually caused some torn muscles.

When the surface of our joints are damaged, there is imbalance in the joint.  To describe it in another way (a very good analogy given by a medical professional), just imagine a camping tent. A tent is held by poles (bones) and guy ropes (muscles and ligaments) and pegs in the ground (their attachment on the bones).  If the surface upon which they depend on stability becomes out of balance, then the whole structure will lean over.  When this happens in our knee joints, the imbalance will cause deformities such as bow legs (lateral side) or knock knees (medial side).  And this state of collapse causes the muscles and ligaments to become slack and tight.  Eventually, the muscles and ligaments become inflamed, sore, tight and painful.  The function of ligaments is to attach bones to bones and give strength and stability to the knee as the knee has very little stability.  Ligaments are strong tough bands that are not particularly flexible (see picture below obtained from internet).  Once stretched, they tend to stay stretched and if stretched too far, they snap.  Therefore, the damage done to muscles and ligaments as the arthritic process develops carries over post TKR.  So this explains why we still have stiffness after TKR. 



Normal knee anatomy

Now what about all the limping and bad posture when we walk due to our arthritic knees?  This can cause problems to our body in the long run particularly back and hip problems.  OA can also cause Baker Cyst and Posterior Tibial Tendon Dysfunction which affects the ankles and feet.

During TKR surgery, we have trauma caused to soft tissues and major muscles. This will cause severe inflammation on the entire area of the knee joint.  The muscles and ligaments will be sore, tight and inflamed and we will have rubber band sensations, aches and pains, tense and tight episodes, reaction to weather change etc. So all these sensations are caused by the trauma to the soft tissues, muscles and ligaments which should settle down or reduce after a period of time.

While TKR gives us a new functioning knee and pain relief but it does not remove the damage caused by OA.  This is something that we really need to consider if we decide to delay surgery.  I think the point now is not how long we can tolerate the pain but rather how much damage we will cause to our body if we choose to delay the surgery. 

Despite all these information, I don't think people are going to run to do TKR.  TKR is a major challenge for most people.  There are many people who would rather suffer or be wheelchair bound than do TKR.  The fear is too great and I think it is largely due to a lack of courage and understanding about OA and TKR.  Of course, there is also the concern of doctors tyring to delay TKR as long as possible due to age factor and revisions required.  I thought that when I did my bilateral TKR at age 50, I was rather young.  But I am finding that more and more younger people who suffer from severe arthritis are willing to do TKR in order to gain a better quality of life. 

So even though I still have the stiffness, it is something that I can live with and it does help if I do a lot of stretching. I am grateful that I still have a reasonable range of motion that does not impair my overall function.  And I am most grateful that I did my bilateral TKR as it has enabled me to lead an active life with pain free knees. 

NUMBNESS

It's normal to have some numbness around the front and outer side of the knees following TKR.  This is due to nerve injury during surgery which can result in a decrease or loss in sensation either temporarily or permanently.  Feeling of numbness, tingling or burning sensation are indications of nerve injury or damage.

A nerve is an enclosed, cable-like bundle much like an electrical cable with lots of fine wires.  Each nerve is a cord like structure that contains many axons (nerve cells).  These axons are often referred to as fibres.  Within a nerve, each axon is surrounded by a layer of connective tissue called the endoneurium.  The axons are bundled together into groups called fascicles, and each fascicle is wrapped in a layer of connective tissue called the perineurium.  Finally, the entire nerve is wrapped in a layer of connective tissue called the epineurium (see picture of nerves anatomy below obtained from internet).

Anatomy of Nerves

Nerves are fragile and can be damaged by pressure, stretching or cutting.  Injury to a nerve can stop signals to and from the brain, causing muscles not to work properly and a loss of feeling in the injured area.

There is a nerve called saphenous that comes down the inside of the thigh and on into the calf.  It has a small branch called the infrapatellar branch that goes across the front of the knee and provides sensory input from the skin in that area.  This nerve branch is in the path of the incision so it is necessary to cut through it to gain exposure to the knee during TKR surgery. 

When a nerve is cut and the ends are sutured together, the axons within seek to grow out to their opposite numbers and join up again.  In this arduous task, some might succeed but a majority of them don't and they end up lost and just die off.  During TKR surgery, the nerves are roughly approximated as the wound is sutured without much accuracy.  So whether you have any return of sensation depends on your luck.  Some people are fortunate enough to have complete return of sensation while others may only have some return.  And there are some who are unfortunate enough to have no return of sensation at all so the numbness becomes permanent.

There are several major blood vessels and nerves around the knee but they are rarely injured during TKR.  However, a minority of people may experience more severe symptoms from nerve injury post TKR including feeling of ankle weakness when lifting up the foot, dragging toe when trying to walk or numbness on top of the foot.

It is common to have a feeling of pins and needles during the recovery process. While this can be uncomfortable, it will pass and is a sign of recovery.  I have observed that it is quite common to have reduction in the numb spot which then becomes permanent. However, there is a small minority of people who have complete return of sensation.  Personally, I don't think I will be one of those lucky ones as after 17 months, I still have the numbness.  Although numbness can cause a strange sensation, the most important thing is that it does not impair our overall function. 

As for me, it's not an issue living with the numbness as it does not bother me nor does it affect my function.  If I can live with the stiffness, this is nothing compared to it.  In fact, I consider both of them a very small price to pay for my two pain free knees.

DEPRESSION POST TKR

Depression may be described as feeling sad, blue, unhappy, miserable or down in the dumps.  Most of us may have experienced this before for short periods particularly after certain incidents or a major surgery.

It is quite common for people to have feelings of depression after TKR which is a major surgery.  This usually happens during early recovery.  Symptoms experienced includes crying, anxiety, fear etc. Some people may even feel a sense of regret of having done the surgery or they may be convinced that things are not going to get any better.  These are typical negative thoughts which actually contribute to the depression.

Some people may even have depressive feelings before surgery. This may be due to the shock of finding out that we need TKR. So we either get into a denial stage and procrastinate or we decide to do the surgery. Even if we do decide to do TKR, we may feel very anxious with the waiting period.

From my TKR forums, I have come across many people saying that they felt depressed during early recovery.  Some would just burst out crying non stop and some just felt down in the dumps.  Personally, I did experienced it for a brief period.  Mostly, I felt depressed about the negative comments from certain family members due to their lack of understanding.  I also felt lonely when my husband and children either left to work or school and all the down time made me miserable.

There are a variety of factors that contribute to such depressive feelings which includes:-

1.     Temporary loss of mobility and feeling confined to the house
2.     Discomfort from pain, swelling and stiffness
3.     Loss of privacy
4.     Loss of independence as we need to rely on others for help
5.    Side effects of medication which may cause some chemical, emotional and physiological 
       changes in the body
6.    Loss of confidence in normal daily activities
7.    Fear of falling down, fear of things not going to improve further etc.
8.    Feeling anxious about how long recovery is going to take
9.    Negative comments from family members or friends due to their lack of understanding
10.  Lack of sleep
11.  Regret doing the surgery
12   Loneliness
13.  Self pity

These feelings of depression during early recovery will usually fade out as we begin to be more active and return to regular activities.

To prevent or minimise depression during recovery, I would like to suggest the following:-

1.   Have adequate knowledge about TKR so that we can be better prepared.
2.   Learn from other people's experience by joining a TKR forum.
3.   Keep a positive mindset.
4.   Reward our self with something that we like even for a small milestone. 
5.   Try to get out of the house even for a while as soon as we are able to as this will lift our mood. 
6.   Educate family members about TKR so they can be more understanding and encouraging.
7.   Family members should provide necessary support and show more care and concern.
8.   Be aware of recovery time so that we do not have unrealistic expectations.

BILATERAL TKR

There are actually two types of bilateral TKR.  One is simultaneous bilateral TKR whereby both knees are replaced during the same surgery on the same day.  The other is staged bilateral TKR whereby both knees are replaced at different times either days or months apart.  For those who only need to replace one knee, its called unilateral TKR.  Lets look at the pros and cons of simultaneous and staged bilateral TKR.

SIMULTANEOUS BILATERAL TKR

Simultaneous bilateral TKR appears to be the most logical thing to do as it involves one surgery, one anaesthesia, one hospitalisation  and one recovery.  It also saves a lot of time and costs.  If both of your knees are equally bad, then you are a candidate for simultaneous bilateral TKR.   Of course, this is not a decision to be made by you alone as it also depends on the recommendation of the Orthopaedic Surgeon (OS).  As this procedure requires a longer surgery and is more demanding on the body, patients who have cardiovascular problems, pulmonary disease or are over the age of 80 are usually advised against a simultaneous bilateral TKR.  Studies have shown patients undergoing simultaneous bilateral TKR have a slightly higher risk of cardiac events and needing blood transfusion.  The risk of complications such as infection, blood clots or pulmonary embolism is the same for both simultaneous and staged replacement.

In my case, I did not hesitate at all to do a simultaneous bilateral TKR as both my knees were equally bad.  As I was only 49+ at that time and relatively healthy, my OS did not have any problem with my decision.  We did not even discuss about any other option.  And I am so glad that I did that because now I have two pain free knees with one surgery.

However, many people worry that replacing both knees simultaneously may pose a problem in recovery as they do not have a good leg to work with.  Yes, during my recovery, I did experienced difficulty in getting up from a chair or toilet bowl due to the weak muscles and the stiffness and tightness in both knees.  It was exhausting as I have to rely on my upper body strength to pull myself up.  So if you have a strong upper body, it would be a great help.  However, walking is not a problem at all.  Eventually, it just got easier and easier when my muscles begin to strengthen.  For more elderly patients, I would imagine that they may take a little longer in recovery but it would still be worth it as they only have to deal with one recovery as opposed to two recovery if they have a staged bilateral TKR.

I have come across a lot of people from my TKR forums who have done simultaneous bilateral TKR and they are so glad they did that and would not have done it any other way. 

STAGED BILATERAL TKR

I understand that some OS does not advocate the practise of simultaneous bilateral TKR.  They prefer to do a staged replacement in order to minimise the risk of complications.  For this reason, I have come across people who did their bilateral replacement within days apart but during the same hospitalisation.   Then there are some who did it within one month apart and some within several months apart.  I have great admiration for these people as they have the courage to go through two surgeries within a short time frame.

For those who are in the high risk group in terms of age and medical condition, the staged replacement appears to be safer than simultaneous bilateral TKR.  These are factors that your OS would consider in order to make the necessary recommendation.

The disadvantages of doing a staged bilateral TKR involves having to deal with two separate surgeries, two anaesthesia, two hospitalisations and two recoveries.  And the time and costs spent would be much more than a simultaneous bilateral TKR.  Additionally, there are people who ended up with one good knee because the fear of going back to do the other one is too great.  So these are factors for those who are suitable candidates for simultaneous bilateral TKR to consider when making a decision.  And you need to find an experienced OS who is willing to do a simultaneous replacement.

Overall, the result of both simultaneous and staged bilateral TKR is the same in terms of pain relief and knee function.