MY ADDICTION TREATMENT

GENERAL OVERVIEW

If you have read my post on addiction, you may be interested to read about my experience in rehab.  Though it has been many years but I still have vivid memories of my experience there. 

It was a 28 days program at the treatment centre.  If you have seen the movie called 28 DAYS starring Sandra Bullock which is my favourite movie about addiction, you would have some idea of the concept of such treatment centres.  28 days might seem very short but for me, it seemed like an eternity and the amount of things that happened during this period were unbelievable.  I have seen the effects of addiction resulting in bipolar, schizophrenia, hysteria, verbal abuse and some really bizarre behaviours.  It was really an eye opener for me.

The drug of choice for addicts seeking treatment at the centre includes heroine, alcohol, gambling, sex, overeating and some other types of drugs.  Heroine was the most popular followed by alcohol.  Cross addiction was also very common.  It means being addicted to more than one drug.  I learnt that drugs and alcohol has different effects on different addicts.  If the drugs or alcohol makes the addicts very active, then they will have problem sleeping and so they will consume sleeping pills. On the other hand, if the drugs or alcohol acted as downers for the addicts, I learnt that some will resort to caffeine to keep themselves awake the next day for work.  There was one alcoholic who was also addicted to caffeine because she consumed huge amounts of coffee to keep herself awake at work.  And she eventually suffered a severe headache as the withdrawal symptom.  

There was one person who was addicted to alcohol and gambling.  He told me that when he was gambling, he also consumed lots of alcohol.  After that, he was so high that he can't remember what happened before he collapsed.  When he woke up the next day, the first thing he did was to check his ATM receipts and was shocked to find out that he had made several withdrawals.  Another addict with overeating disorder will spend a lot of money on junk food and alcohol and consumed everything at one go.  Then she will poke her fingers to the back of her throat to make herself puke.  This action resulted in multiple scars on her fingers.   I met another addict who was a doctor and he relapsed after 20 years which just goes to show that no one is exempted from relapse.  He was addicted to heroine and because of his job, he had access to the drug.  It just took one moment of vulnerability for the relapse.  I also learnt from one sex addict that he would comb the streets every night in his car looking for hookers. He was also addicted to gambling and he already had a fiance. 

Many incidents happened at the centre.  One addict became hysterical.  Another addict who also has bipolar would just suddenly burst out in verbal abuse and seemed capable of beating someone up. So because of the danger that he could cause to others, he was kicked out from the centre.  Some addicts were forced to be admitted into the centre by their families thereby causing lots of denial and behavioural problems.   There were also incidents of some runaways, some who smuggled drugs into the centre and some who literally just checked into the centre for some sort of holiday or break without serious thoughts of recovery. 

I cannot forget one middle aged lady who was always dressed in a prim and proper manner.  She was so arrogant, rude and defencive.  I found it amusing that she always claimed that she is not an addict and that she does not need any help.  She said that the only reason she came to the centre was that she was forced by her children.  She also claimed that she was clinically depressed and that anti depressants were her saviour.  One day, when we had a lecture on depression, she openly disagreed with the lecturer that drugs can cause depression.  She took it so personal and ended up arguing with the lecturer and subsequently, walked out of the room.  She hated everyone.  She even told me directly that she did not like me because I was bold enough to speak up about her untoward behaviour in group.  Well, I did not have to get angry with her for long as she was thrown out of the centre.

There were just too many other incidents and experiences to describe here.  But despite all the things that happened in the centre, life goes on.  We have a strict program to follow under the supervision of the nurses and counsellors who were recovering addicts and they were excellent at their job.

OSTEOARTHRITIS

Osteoarthritis (OA) is the most common joint disorder affecting mostly weight bearing joints such as hips, knees, ankle and foot.  The problem starts with the deterioration of the cartillage which is a firm, rubbery tissue that cushions our bones at the joints and allowing bones to glide over one another.  When the cartilage  deteriorates, the bones rub together causing pain, swelling and stiffness.  Eventually, this will cause bony spurs to be formed around the joints and subsequently, the ligaments and muscles around the joints become weaker and stiffer.

One of the reasons that caused OA is that it runs in the family.  Well, this is certainly true in my family as my parents and a majority of my siblings have OA.  Obesity is another factor that leads to OA due to the burden of the weight on the joints.  So I guess I have a combination of both.  Other factors include injuries from sports, jobs that require a lot of standing, squatting and lifting, direct impact on the joints such as football, basketball or any other sports that have jerky movements.

Pain, swelling and stiffness are the most common symptoms in OA.  Most people will experience morning stiffness and stiffness after a period of sitting, standing, walking or exercise.  During the early days of OA, after a good night's rest, my knees would feel better the next day.  As the condition got worse, I have to rest and take pain meds as well for relief.  I also experienced tenderness when pressure is applied to areas around my knees and legs.  Towards the advanced stage of the joint damage, I suffered the pain and stiffness even when I wasn't moving.  Pain medication doesn't work anymore and it affected my movements and sleep tremendously. 

In the past, I have tried arthritis cream, medicated plasters, massage and injection of artificial joint fluids which gave me a temporary relief of the pain.  I have heard about acupunture and some non-invasive treatments but I have not tried any of them.  However, I have tried treatments by one qi qong master and it was quite good particularly for blood circulation. I have also taken supplements like glucosamine and chondroitin sulfate.  From time to time, I had to take pain medication as well.  These were all helpful to me for pain relief until my OA progressed to a severe stage, then I found that nothing works anymore.

X-ray is the best way to know the extent of joint damage.  My Orthopaedic Surgeon (OS) said that there are 5 stages for joint damage, 5 being the end stage.  My joints were at stage 4 when I had my TKR and the pain was already unbearable for me.  So I can't imagine how one can reach stage 5.  Knowing the extent of our joint damage is a good thing because we can be more prepared and take necessary action such as changing our lifestyle.  This is an area I feel that some of us would hesitate to do.  Its like we are in a state of denial and not knowing the truth is better as it would not require any change.  I have been a culprit of this until I realized that I have to face the reality and do something about it. 

During the initial period of my recovery from sleeping pill addiction, I changed my lifestyle.  I started to exercise and eat healthily.  Some people think that with OA, we should not aggravate it by doing exercise.  In fact, some will try to avoid walking too much just to preserve their knee condition.  But the reality is that if we dont exercise or be active, we lose our range of motion and our joints will deteriorate even faster.  I find that whether I exercise or not, the pain and stiffness are still there.  So it would be more beneficial if I exercise as it improves joint movements and at the same time, I feel healthier, happier and have a positive mindset which really helped me to manage the pain better.  I was surprised that besides my regular exercise, I would gate crash running competitions which my children and sister participated in, just by walking after everyone has taken off.  I have walked from 5 to 7 km in such competitions which is something that I have never done before.  Even though my knees would end up so sore, stiff and painful but the sense of achievement I get when I reached the finish line makes it all worth it.  All these physical exercises kept me motivated and actually helped me to last about 10 years before I had my bilateral TKR.

The key is that when pain meds and all of those non-invasive treatments doesn't work anymore and we continue to be in a great deal of pain and stiffness, then it is time to consider TKR.  TKR requires a lot of courage and I realized that it is hard to overcome the fear for a lot of people.  After my experience with TKR, I have great admiration for elderly people who have gone through TKR.  They would have faced more challenges and difficulty than younger people but inspite of that, they overcame all of it.  They might have taken longer in rehab too but in the end, they still get to enjoy the benefits of a successful TKR.  So in order to make a change for ourselves, we need to let go of the fear.  Because ultimately, the change will give us pain free knees and a better quality of life.

Here are pictures of a normal joint and a joint affected by OA obtained from the internet.



Normal Joint

Arthritic Joint

MY ADDICTION LIFESTORY

I used to sleep like a baby before I developed Osteoarthritis (OA) in my knees.  However, after suffering from knee pain for some time, I started having sleep problems.  Not only was I disturbed by the pain in the knees but also the stiffness when I sleep.  So I started to take sleeping pills and it seemed to solve my problem.  The next day I would wake up after a good sleep and my knees would feel better already.  Then the pain and stiffness comes back after moving about the whole day.  Initially, the sleeping pill seemed like a wonderful solution.  But after a period of time, I had to consume more and more to get the same effect.  Eventually, I became addicted to it.

In the past, I wasn't active especially during the years when I had to take care of my children while having a full time job.  When I had OA, I naively thought that I should not move too much so that the condition of my knees would not be aggravated.   During my active addiction with sleeping pills, I became depressed and isolated.  I put on so much weight that my belly looked like I was 6 months pregnant.  I started to lose my mind as I could not think straight nor make any simple decisions.  Then I started having symptoms like seeing dots on the television screen.  I started to panic and decided to stop consuming the pills.  During this time, I had already stopped working and started to go to the gym thinking that I needed to do something healthy.  The day I stopped taking the pills, I went to the gym and I had a seizure attack at the car park and collapsed beside my car.  I was rushed to the hospital and when I woke up, my family members were there.  I was told that I had a seizure and the doctor had calmed me down with some Valium.  I was so fortunate that nothing happened except that my shoulders were hurt due to the fall.  So I stayed at the hospital for observation and was discharged after two nights.

After 3 months, I relapsed.  This time, it was worst.  Within a short period of time, I was consuming a high dosage of the sleeping pills and I started to develop all the same symptoms.  My husband was suspicious of my addiction and I finally confessed to him and gave him all the pills that I had in my possession.  In fact, he was worried about me just giving up totally instead of gradually.  That night, I had a seizure again on my bed and my husband saw the whole episode which left him scarred for some time.  My sisters helped to call an ambulance and I was rushed to the hospital again.  After some medical tests, the doctor told me that I had elevated sugar, cholesterol and blood pressure.  I knew something had to be done but I was lost.

After I was discharged, my family intervened and they found a treatment centre overseas as there wasn't any locally.  I agreed to go there and totally surrendered myself.  Going to this treatment centre was the best decision ever.  It saved my life.  I began to understand my addictive behaviours and also found that the root cause of my problem was due to my knee pain.  I also discovered that when a person consumed a high dosage of sleeping pills and stopped suddenly, the body will experience a seizure which is the withdrawal symptom.  And that was what happened to me. 

During my treatment, a program was drawn up for me. It was based on a NA 12 steps program. There were lots of lectures, family/group counselings, self improvement, relaxation activities etc.  I had to do a brisk walk every morning and was put on a low fat diet.  It was very tough initially because I was so unfit and overweight.  But I improved gradually and in the end lost quite a bit of weight.  My belly was gone and my health conditions improved tremendously.  There was one day, when we hiked up a hill which was quite tough but when we reached the top, there was a huge rainbow across the sky.  All of us just stood there to suck up the whole environment.   Just then, an overwhelming emotion struck me.... I felt so great to be alive! 

During the 28 days at the treatment centre, I learned so much and graduated with flying colours. My sister in law even brought a tape for my farewell at the centre and the special song was called "Wish me luck and wave goodbye to me".  I think its from the thirties but it was so apt.  So the next step my Counsellor said was for me to decide which road I want to take - road to recovery or relapse?  Of course, I chose the road to recovery because without recovery, I would lose everything that is important to me.    You know, I realised that one of the best thing during my early recovery was to have my mind back.  You can imagine the relief I felt after what my mind has gone through.  And there is one celebrity who summed it all up by saying ... "Of all the things I lost to addiction, I miss my mind the most".

BOW LEGS & KNOCK KNEES

Do you know that children up to a few years old have some degree of bow-leggedness?  They do and its due to the time they spent in the cramped space in the womb.  Usually, babies have a bigger space between their knees and the soles of their feet face each other.  When they start to walk, they may appear to be bowlegged.  However, it gradually straightens after they can walk steadier and the legs begin to bear their weight.

However, if the bowleggedness remains after the child has grown up, then it becomes a deformity.  There are a variety of reasons for such deformity which includes Blount's disease, improper nutrition, sickness such as rickets caused by vitamin D deficiency, physical trauma etc.   Eventually, this will lead to difficulty in walking and early onset of arthritis.  One of the long term effects of Osteoarthritis (OA) in adults is bowlegs (vargus) or knock knees (valgus). 

 

When the surface of our joint is damaged due to the deterioration of cartilage, there is imbalance in the joint.  To describe it in another way (a very good analogy given by a medical professional), it is like 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. This is exactly what happens to our knee joints.  The imbalance will cause deformities depending on which side the joint leans over.  If it is on the lateral side, it is called bow legs and on the medial side, it is called knock knees. 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.

My friend who had a bilateral TKR a few years ago used to have normal legs until she had OA.  Eventually, her OA worsened until her legs became seriously bowlegged leaving her with a great deal of pain and difficulty in walking.  As a last resort, she gathered her courage to go through a bilateral TKR.  In such a situation, both knees would have to be done at the same time otherwise, the operated leg would be longer than the other making things more difficult.  After TKR, both her legs were straightened and she is pain free from the knees and enjoying a better quality of life.  However, because of the delay in surgery, the damage has greatly affected her range of motion.

When I consulted with my Orthopaedic Surgeon (OS) about TKR, I was told that I have knock knees.  I thought my legs looked very straight but apparently, it is not normal.  He explained that normal legs have a certain degree of curvature from the knees downwards.   When I went back to look at my x-ray, I observed that the cartilage loss was in the medial side so it explains the knock knees.  And so my OS corrected the alignment of my legs during TKR.  Actually, I felt strange with the new alignment as both my feet could not touch each other when I stand now maybe its due to my fat knees.  I still feel strange looking at my legs in the mirror but my OS said that they are normal now, so I had to believe him.  Guess it takes some time to get used to it.

It is important to know that if we wait too long to seek treatment for OA especially if it has already resulted in bowed legs or knock knees, we will be left with a lot of damage caused by OA and there may be insufficient quality of bones to hold the implants.  So again, the earlier we seek treatment, the better.

Here are some pictures obtained from the Internet showing the x-ray and pictures of an elderly woman with bow legs due to severe arthritis before and after bilateral TKR.   What an amazing transformation!  Her courage is really admirable considering that she did this in her 70s or early 80s.  I hope this is a good inspiration to the rest of us.

X-ray of a bowed leg before & after surgery

 

 



Bowed legs before surgery

 

 

 

 



Legs after surgery

SWELLING & STIFFNESS

Pain, swelling and stiffness are symptoms that all of us suffer from when we have Osteoarthritis (OA).  The degree may vary depending on the severity of the OA.  When the cartilage wears off, the bones rub together causing pain, swelling and stiffness.  As a result, bony spurs may form around the joints and the ligaments and muscle
s around the joints become weaker and stiffer.  This causes a lot of pain and stiffness.  My joints pre-op had developed quite a number of bony spurs which my OS pointed out from my x-ray.  So you can imagine the degree of pain I suffered from the grinding of the bones and the 'poky' spurs.

Before TKR, I experienced stiffness after prolonged sitting, standing and walking.  Sometimes, I do experience morning stiffness too.  After TKR, I experienced stiffness during early recovery due to the swelling of the knees.  This is normal and will reduce after some time.

Swelling is caused by fluid.  When our knees have gone through a trauma especially after the surgery, our body will automatically send blood to our knees to protect and start the healing process.  With blood comes fluid which is also called lymph.  The excessive fluid may get trapped at the knees because there is insufficient space, like the pipe is too small to flow through.  That's why the knees are swollen.  So if we overdo physio therapy (PT) exercises, it will cause more swelling and stiffness.  PT is necessary but it should be done gently up to the point of discomfort and not up to the point of pain.  With pain, usually comes swelling and with swelling, we will naturally get stiffness.  And this will cause our knees to be stuck and they cannot bend.  That is why we are advised to ice and elevate our legs in order to reduce the swelling.

Some TKRers have seeked treatment to reduce swelling by doing a lymph drainage therapy which they found to be beneficial.  This is done by a professional massage therapist and there is a link below here to one website recommended by one of my TKR forum member.

I also have the feeling of a tight band around the knees.  I learnt that it is caused by scar tissue.  Apparently, when our OS cuts open the knee, he has to undercut the skin and superficial structures from that centre line to each side of the knee in order to get good access all round the bones.  Part of the healing process is when those flaps reattach themselves to the main body of the leg.  This healing creates a thin layer of scar tissue across the front and sides of the knee.  Scar tissue is not flexible compared to normal tissue so that's why it feels like a tightness or band across the knee especially if there is swelling and also during normal activities later on.  It seems that it will gradually reduce in size and thickness over a period of time up to a point when we might not feel the sensation anymore.

After more than a year, I still have the same stiffness after prolonged sitting, walking or standing.  I discovered that most members from the my TKR forums have the same experience with stiffness.   I often wonder why we still experience stiffness after many months of recovery as I do not have swelling even at 3 months after surgery.  Apparently, all the damage caused to the ligaments and muscles during the  progression of the arthritis process actually remains after TKR.  That's why we still have the stiffness.  Some studies have shown that:-

1.   Some people seem to make more scar tissue than others which causes stiffness.

2.   If the patient have stiffness before surgery, then it is more likely to have stiffness after surgery.

So TKR may give us pain free knees but it cannot remove the damage caused by OA.  It's the same case like my friend who went through a bilateral TKR and was able to get her bow legs fixed but her range of motion had been greatly affected due to the damage caused by OA. In order to prevent more damage from OA, we should consider doing TKR earlier. 

Anyhow, I can live with the stiffness as I have done that for many years during my OA days.  The most important thing is that I have two pain free knees and my overall function is not impaired.  And I am grateful that I can still lead an active life.

Here's the link for you to check out on lymph drainage therapy.

http://www.fortcollinslymph-massage.com

TKR FORUMS

I discovered two TKR Forums which are extremely helpful and interesting.  I wish I had discovered them before my bilateral TKR.   These forums are similar to support groups and the members are so friendly and would not hesitate to answer questions and motivate each other. 

Its important to have adequate knowledge of TKR before we go for the surgery.  This is to ensure that we know what to prepare before surgery, what to expect during recovery and what is the period for recovery.  This way we can have a realistic expectation.  Believe me, I have come across a lot of people who have unrealistic expectation of their recovery  as they think they can fully recover and go back to work in 4 to 6 weeks' time.  And then they start to panic when they do not see much progress or may even experience a set back in their recovery.  So it is better to have sufficient information and learn from other people's experience.  There are lots of information in the internet about TKR either through medical websites, individual blogs or community support groups.  Joining a community support group is highly beneficial. There is nothing like learning from other people's experience as they have been there and done it.   The last thing you want to do is to listen to people who have not done TKR before. 

 

BoneSmart is one of the forum that I have joined and it consist of members from all over the world.  This forum is quite large in terms of membership but they are very well organized and very interesting.  And some of the forum administrators have joint replacement medical background.  This forum is set up in two sections, one for pre-op and the other for post-op.  This is the most interactive forum that I have come across.

The other forum that I have joined is Delphi Forum (Joint Replacement) which is hosted by Robyn Mayhall who had TKR in both knees at age 27 and 28 years respectively due to rheumatoid arthritis.  This is a smaller forum but also very well organized, interesting and fairly interactive. 

 

If any of you are considering doing a TKR or are in recovery after TKR, you can join these forums for free.  You will feel very welcomed when you first post an introduction about yourself.  Check out their links here:-

http://www.delphiforums.com

http://www.bonesmart.org