This is Part 3 of a 3-part blog post series regarding events leading to a second Total Knee Replacement (TKR) surgery, taming surgery anxiety, and post-surgery recovery. Part 1 is about the decision to have surgery and you can read it here. Part 2 is all about taming surgery anxiety once you make that decision. Read about my first TKR here.

And Part 3 gets down into the weeds about the recovery process.

If you want a quick overview, here are my three takeaways about my second knee replacement surgery:

• Be proactive before surgery. Communication with the Anesthesiologist before the surgery is crucial to your recovery! The anesthetizing meds they give you during surgery affect how quickly you start to recover. If you’re sick from those meds, constantly nauseous, and severely constipated, your body can’t focus on healing from surgery! Coming out of surgery without complications of anesthesia means you’ll hit the ground running. Every doctor’s appointment you have pre-surgery, ask them (even if it’s your dentist) for their advice regarding surgeries.
• The more surgeries you’ve had, especially if they’re close together, the more tolerance you build up to opiate pain medications. You might react differently to them each time. It becomes very tricky to maintain pain relief on as little medication as possible, but the meds are critical for you to tolerate PT and get that joint moving ASAP. An exit plan to get back off the meds quickly, without withdrawal symptoms, is also important. Your doctor’s job is to give you the meds you need, but also to get you back off of them, safely, when the time is right.
• Surgeries are never complication-free. Medically speaking, they probably are, but the effect on your life, your caretaker, friends, and family always produces unexpected side effects.

In the Weeds – Day of Surgery

On surgery day, I had a long talk with the Anesthesiologist. I was forthright with him about the problems I experienced with prior surgeries (see New Year New Knee and How A Total Knee Replacement Led to an Emergency Appendectomy). He explained that the approach to anesthesiology for an appendix and knee is different because the appendix is done laparoscopically. Unlike a knee surgery, gas is pumped into your abdomen, which causes complications you don’t have with a joint replacement. He also offered a Scopolamine Transdermal Patch (scope patch) for the nausea that plagued me in both surgeries. I’m susceptible to motion sickness and have Meniere’s Syndrome which affects balance. I gladly accepted the Scope patch!

In the weeks leading up to the surgery, I had appointments with both my GP and my Functional Medicine doctor. I talked with both about my anxiety for this surgery and they had great suggestions to help me out including reminders to take Colace Plus immediately upon starting opiate pain meds to battle the constipation and to use both laxatives and enemas without hesitation if needed. Colace Plus is a stool softener, with an herb that promotes bowel motility. I was reminded to supplement with magnesium as soon as tolerated after surgery to help with regular bowel movements. I found a Magnesium/Vitamin C powder from Life Extension that I decided to try before I resort to an OTC laxative which can be pretty harsh on the system. 

The surgery was quick and routine. I stayed one night in the hospital and gladly headed home the next day. I’m already feeling better than last time because I’m not nauseous. Thank you Scope patch!

Week 1

I have prescriptions and instructions to take the following meds at home:

• Oxycontin – pain
• Hydrocodone – pain
• Methocarbamol – muscle relaxer
• Celebrex – anti-inflammatory
• Zofran – anti-nausea
• Baby Aspirin – blood clot prevention

To keep opiate side effects limited, I decided to try not taking OxyContin along with the Hydrocodone. Like my previous surgery, PT starts right away and the first session was horrible. The pain was bad and I only did four exercises. I thought I was going to pass out! Even icing was painful. After PT, I decide I need more pain relief, so I get the Oxycontin filled.

The first night on Oxycontin, I slept like a baby. But after the first dose, the nausea starts back. The smell of food makes me feel sick even though I’m hungry. Although I slept well the first night, the meds quickly start preventing good sleep throughout the following weeks.

I don’t know if it’s the combination of all the meds or just the opiates, but I start having a lot of side effects:

• Disturbed sleep – I start experiencing an odd effect of talking in my sleep, but I can’t tell if I’m asleep or awake! I try to stop myself from talking and can’t. I also keep trying to grab something. It feels like trying to hold onto water. It’s like I’m desperately trying to communicate but can’t make the words come out. I drift in and out of sleep and have bad dreams. I wake up very disoriented. I’m sleeping in disturbed increments rather than through the night.
• My mouth is really dry and I want water all the time.
• I’ve started trembling like I’m cold – but I’m not. And then my surgical leg muscles seize up.
• I have a numb, tingling sensation in my fingers.

Walking with the walker, PT exercises, and showers make me feel better.  I know the sooner I can bend this knee the better off I’ll be, but it barely moves.

I take Zofran to battle the nausea. I’m finally able to eat after a few days and I start on magnesium to help with constipation.

I’ve been propping myself up a lot in bed both at home and while in the hospital and I’m surprised how quickly the skin on my elbows has gotten really rough with sores. I need to be proactive about treating that so it doesn’t get out of hand.

Also, the tendonitis and arthritis in my elbows are flaring from using the walker. I want to transition to the cane ASAP.

Towards the end of week one, my knee is swelling horribly and I’m taking all the meds prescribed to try to get myself feeling better. I’ve been wearing the compression hose they gave me at the hospital per instructions and it should be helping to prevent swelling, but it’s not.

Five days in and I’m in a lot of pain. The swelling makes it too uncomfortable to sleep. Finally, I decide that the darn compression hose is just too tight so I took it off. My leg was like a sausage in a casing. That night, with the help of some lidocaine patches on my now aching back, I finally sleep a little.

I wake up wondering if it’s possible for my skin to explode! I lightly dry brush the whole leg and walk to get the circulation going. Ice, dry brushing, and short walks help, but I’m getting concerned about the swelling.

My daily goals for week 1 are simple: Do PT, poop, and shower! I’d like to add sleep to that list, but of all the tasks, it seems the most unobtainable right now.

The next night I try sleeping with my foot propped on a wedge. Not the comfiest, but it let me sleep and reduced the swelling, but then it gets bad again. I’m starting to feel groggy and headachy. I  decide I have to stop taking the Oxycontin if I can. It seems like it’s causing a migraine (which I experienced after my first TKR). I found a larger compression hose that was stretched out from the first surgery and managed to put it on my sausage leg. I know I need to wear compression hose, but the one they gave me at the hospital was too tight. Hopefully, this one will do the trick.

Week 1 takeaway: I feel like I have about 10 minutes out of every hour that I feel ok. Question everything – don’t make assumptions based on prior surgery experience.

Priorities: Combat nausea, bowel movements, and sleep issues. You can’t get on with rehabbing the knee properly if you feel awful.

Thankful for: My bathroom remodel! The easy access to my spa-like shower lets me indulge in long hot showers and helps me feel better.

Difference between this surgery and first: Experience to know what to say to the anesthesiologist.

Week 2

On the anniversary of week 1, I wake up feeling less groggy because I didn’t take the Oxycontin. Glad to be off it. But I’m in a bad mood. I don’t want to go to PT which is silly because I feel better afterwards. The Magnesium/Vitamin C powder is working well as a laxative and I’m glad I don’t have to take the harsher OTC laxative. I’m getting nauseous on car rides, but I keep the dissolvable Zofran tablets at hand so by the time I arrive at PT I’m ready to work. The surgical bandage came off and the incision looks great.  After exercising they put me in a compression boot and that feels great. Time for lunch, ice cream, and a nap!

I put fresh sheets on the bed today. I probably overdid it, but I’m so happy to want to do things instead of being groggy!

Next day – Yup I overdid it. Had a searing pain last night. As all the anesthesia and pain meds from surgery begin to wear off, the trauma of what’s happened sets in. My body’s been through a lot and I need to respect that. I feel better after moving around a little, but the 4 o’clock witching hour comes and I’m bad again.

My flexion goal at PT is 90 degrees and I’m at 70 right now. My knee is still very tight and my legs are restless at night.

On the way home from PT this week, I had a bad experience. I was in severe pain in the car. I felt like I was in pain shock by the time I got home. I was shivering and got my meds asap and iced in the chair.  I was okay once meds kicked in, but It’s a long drive to PT and I need to be able to get comfortable in the car. 

On the upside, I had a visitor this week and got a much-needed social break. I’m sitting up more instead of in a recliner, which is okay as long as I have meds. Sleeping at night continues to be a problem. My legs are so restless. I feel like I’m crawling out of my skin.  I’ve started feeling like The Fixer is really tired of all this. I’m sure he is, but he doesn’t complain. It’s almost like the meds are causing a mental problem for me. Sort of a paranoia. I keep worrying that he’s very unhappy with the situation.

I want to be off the walker already. It’s hurting my wrists. With the walker, I can do an exaggerated walk motion that gives good range of motion. When I try to switch to the cane, I walk stiff-legged.

Week 2 Takeaway: Even if you’re feeling better, respect the trauma you’ve been through, and don’t push too hard.

Priorities: Remember your mantra, my job right now is to heal, not worry about anyone or anything else.

Thankful for: The Fixer who’s a great caregiver!

Difference between this surgery and first: I seem unable to calm my legs. I’m very restless.

Week 3

Things that brought comfort last week — my ice machine and sitting in the recliner — don’t seem to work now.  I can’t sit upright at a table for long, but sitting in the recliner makes me antsy.

Flexion is 80 this week. I still have a lot of pain and it doesn’t feel like I’ve made progress.  My stomach is starting to feel bloated and gassy.  I’m having regular bowel movements unlike the constipation from the first surgery, but my stomach just feels full and yucky. 

Seems like I’m having trouble regulating my temperature. Like hot flashes. I’m burning up on the inside, but I know it’s not hot.  There’s no fever or anything alarming I just feel uncomfortably hot. I need to get back on my hormones regularly, but I’m avoiding taking pills because of the stomach discomfort caused by all the prescription meds. Compared to the two-week mark of my first surgery, things seem much better, though. I’m not miserable, but I’m not necessarily happy either.  I’ve hit the doldrums of just wanting it all to be finished. 

I want to get off meds, but I know I can’t yet. I’m in too much pain. I need to feel good so I’ll do exercises and heal and rest, but I think the meds are preventing good sleep. I’m feeling a little crazy!

I want to get on with life but can’t yet. I need distractions, but it’s hard to sit at a table or desk and do things. I might try to cook something this week. Standing is the easiest thing to do, but it wears your knee out. 

I don’t know if it’s the drugs, but like last time, I’m in a phase of having macabre thoughts. I think about what if I couldn’t have knee surgery. What if I didn’t have insurance, or I had a labor job where I wouldn’t get paid if I took off for surgery?  What if I was in a war-torn country and/or imprisoned?  What if I couldn’t get pain meds because my town was bombed?

Dark thoughts, but it does remind me to be grateful and put up with the discomfort of surgery. I try to focus on the garden and nature. 

I’m so lucky to have this beautiful patio all around my house and plants surrounding me. 

We had a Carolina wren mama build a nest on the patio and the babies fledged this week! I saw them practicing their flight from tree to patio. I’m glad the dogs didn’t see them!

Lots of sleepless nights and feeling like I’m getting a migraine again. A deep dull ache in my hip at night while trying to sleep. I wish we’d gotten that new mattress before the surgery! Took a migraine pill and slept in the recliner for a bit. 

I woke to a super sore calf. It’s a PT day and they had me see the Nurse Practitioner. It was decided I should have an ultrasound to make sure there was no blood clot. Waited forever and the Fixer really needed to get back to work! But thank goodness got the all-clear. The NP suggested gabapentin for the restless legs and nerve pain. I don’t want to take another med, but really want some relief.  So now I’m on:

• Hydrocodone – pain
• Gabapentin – nerve pain
• Methocarbamal – muscle relaxer
• Celebrex – inflammation
• Baby Aspirin – blood clot prevention
• Colace – stool softener
• Zofran – as needed for nausea
• Magnesium powder and supplement – regularity

No wonder I don’t want to take my supplements and hormones! I’m taking pills all day!

The Gabapentin finally helped me sleep, but I had weird dreams. I didn’t feel better on awakening, just groggy and in a medication fog. 

I attended a friend’s party at the end of the week. I refused to go with a walker though. It felt good to get out and socialize a little, although, I couldn’t get comfortable whether I stood or sat.

By the time we were walking to the car, I felt very wobbly. It may have been a bit of a push to attend a party but I’m glad I did. The Fixer helped me to the car and back at home I went back to the walker for a few more days.

Week 3 takeaway: The medications seem to have a negative effect both physically and mentally.

Priorities: Sleep!

Thankful for: Great medical insurance and care.

Difference between this surgery and first: I know this won’t last forever.

Week 4

I want to be driving so The Fixer can get back to his own schedule! I know I can’t yet, but I feel like my knee could do it since I don’t use the left leg for driving, but all the meds are the problem. I’m still getting nauseous in the car. If I was driving, I wouldn’t get sick.

My days revolve around PT now. Twice a week it’s an outing for me and a major event.

I’m using the cane but afraid I might fall with this dizzy head. Flexion has improved quite a bit to 94 degrees.

The nausea is making me miserable. I’m afraid it’s all the meds, so I decide to stop the Methocarbamal – the muscle relaxer. But I can’t get comfortable at night and go back and forth from bed to recliner. 

My daughter came over and I had her take me out in the car for a few errands. That gave The Fixer a break and I enjoyed some girl talk. 

I’m plotting out my exit strategy for the rest of my meds. Hopefully, I can execute this plan.

We bought a new mattress! Hopefully, this will help me sleep. It will be delivered tomorrow. We went to a restaurant afterward. It was so nice, but uncomfortable! I’m still not sitting upright at a table well. But it was nice to pretend life was back to normal!

Week 4 takeaway: Plan how you’ll taper off medications but be flexible

Priorities: Get nausea under control.

Thankful for: A new mattress!

Difference between this surgery and first: Learning to ask others to help and give my caretaker a break.

Week 5

PT flexion is 92ish and I still can’t do a full revolution on the bike — just rocking back and forth. I’m still not sleeping great. The new mattress has helped with hip pain though. I’m up reading a lot in the night.

Doldrums! I sound like a broken record but I’m so tired of being in limbo. I can’t quite do things but my mind has a million things to accomplish. I still can’t even sit at the table for more than a few minutes at a time. 

I have to remember that less than 6 weeks ago they were using power tools to take my leg apart and reassemble me! Patience.

I did 5 minutes on the elliptical at home. Not quite the same as a bike revolution but it will help get a better range of motion.

I had one day of gardening cleanup and I realized I’d walked over 10k steps. I don’t even know how that happened! I’m encouraged that things are improving.

I really like how the Hydrocodone makes me feel and that’s kind of scaring me. I don’t feel high, I just feel good. My outlook on life is better. I feel like doing things. I’m willing to work on projects. 

I see the doctor next week for a follow-up on my progress.

Week 5 takeaway: Starting to worry about opiate dependence.

Priorities: PT and getting that knee to bend.

Thankful for: Progress and a garden to take my mind off things.

Difference between this surgery and first: I feel like the drugs are having a different effect on my mental health

Week 6

There’s too much scar tissue!

That’s what the doctor’s saying. It’s preventing me from reaching my flexion goals. I seem to be stuck in the low 90s. He says if I don’t get to 105 in two weeks, they’ll do a Manipulation Under Anasthesia (MUA).  

This is just as it sounds, an unpleasant procedure that puts you back in the operating room. They put you under anesthesia, and force your knee to bend and break up the scar tissue.

I’m determined not to let this happen, but it means staying on Hydrocodone diligently so I can exercise my knee harder.

My drug exit plan has been thwarted by the inability of my knee to bend. I’ve gotta get this fixed because I am not doing the MUA! I don’t feel like I can tolerate more anesthesia and more drugs. 

The good news is he says I can drive as long as the meds aren’t making me feel impaired. 

Week 6 takeaway: We have ways of making you bend!

Priorities: Bend my knee!

Thankful for: Being cleared to drive.

Difference between this surgery and first: A lot more scar tissue and the threat of MUA.

Week 7

I work hard on flexion, doing my PT exercises religiously. It’s up to 100 now. I can really feel and see the lumpy scar tissue under the skin, but it seems to be breaking up some.

I started having problems getting my Hydrocodone. One week the pharmacy I was using was out of it, so I asked them to switch to a pharmacy that had some in stock. This set off a chain of ridiculous problems for the next three weeks trying to get the meds filled.
Because it’s an opiate, the doctor writes a new prescription every week.  

I hate this. I hate being on the meds and I hate that I’m loving how good they make me feel. I’m grumpy as they wear off and I immediately feel relief and I’m chatty and smiling when I take them. I’m desperate that the pharmacy work this problem out so I can continue to push the knee to bend. I feel like I’m the problem patient. I’m hoarding the pills in case I can’t get them filled in time, but I’m supposed to be taking them every four hours so I can tolerate bending my knee. It seems like this will never end.

Week 7 takeaway: Always get your refills done on a Monday – if there are any problems, they can be fixed before the weekend.

Priorities: Get the prescription problem solved!

Thankful for: Small improvement in flexion.

Difference between this surgery and first: Problems getting meds filled — I feel like an addict.

Week 8

Still feel like Dr. Jekyll and Mr. Hyde with the Hydrocodone. I did some research and what I didn’t realize is that it affects your Dopamine. So of course I immediately feel great when I take them and crash when they wear off!

The doctor told me that recovery from second surgeries is often harder because you build up a tolerance to the opiates and you have to take more to get the same relief.

That’s another good reason to avoid surgeries when possible!

I also realize I’m catastrophizing, which is another opiate side effect. So all this feeling like I’m not getting better and my recovery isn’t going anywhere has a lot to do with the meds and not reality.

I read my journals from the prior surgery and in comparison, I’m pretty much at the same place now as I was then. The ups and downs are all normal. This helped me to realize it will all be okay. 

I’m finally at 107 flexion at the end of the week! I will start tapering off the meds and working harder at PT. I’ll try taking Extra Strength Tylenol in place of Hydrocodone when possible.

Week 8 takeaway: Normalize your experience.

Priorities: Remind yourself that there will be a day when all this is in the past.

Thankful for: Reaching my flexion goal so the threat of MUA is gone.

Difference between this surgery and first: I have a written journal of my first surgery to compare with and even though it seems like I’ll never get better, I know firsthand that I will.

Weeks 9-12

Continued PT through 12 weeks and now it’s time to start my own program. I still have a lot of scar tissue in about a two-inch band on either side of the surgery site. Bending is still stiff, and I have some pain on the inside of my knee, more prevalent at night when trying to sleep on my side. There’s still some swelling. I can feel it stiffening up if I don’t give it a good stretching in a full range of motion. 

I’m having more days that are good than bad. But there are still bad ones and that’s okay. I’m still struggling with sleep issues and I’m tapering off the Hydrocodone. 

My stomach isn’t back to “normal” but it’s better.

I’m so ready to be back to me again and I’ll continue to work on that but my knee is still the priority.

Week 9-12 takeaway: There’s still a lot of work to be done before you’re back to you.

Priorities: Stop all prescriptions meds

Thankful for: More good days than bad.

Difference between this surgery and first: My PT team sent me home with a plan after the first surgery, and this one didn’t. But I know what needs to be done and I know I won’t feel completely healed for up to a year.

Now that I’ve reached 12 weeks, my knee is much stronger.  I still have pain and stiffness, but as I increase my strength training that will improve.

My sleep has improved so much and I’m back on all my hormone replacement meds and supplements.

My focus is on getting in back in shape for the next gardening season.

But before that, I have a more pressing need and that is to get in shape for traveling!

Our trip to Italy is coming up in just a few months and I don’t have much time to get myself ready for hours of flying, days of sightseeing, and lots and lots of stairs!

I need a way to get myself fit and ready to travel, fast! But, I have a plan to get me Fit4Italy in no time!