This is Part 1 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. Read about my first TKR here.
In the days leading up to the surgery, all I can think is – Am I a masochist? Why am I doing this?
Again?
Joint replacements aren’t required. This is elective surgery.
If you have bone-on-bone joints, nothing else is going to go wrong. You won’t suddenly wake up unable to walk because you have no cartilage. Pain will limit your mobility, but your leg won’t fall off because you walked all day on a painful knee. Mechanically, your body will still function.
Bodies Adapt
Your life isn’t in imminent danger if you don’t have joint replacement surgery.
No one dies from arthritic joints.
You can make the argument that death can come secondarily to arthritis.
If you fall because of an unstable, arthritic joint, that can certainly lead to an early death.
If you’re unable to move (exercise) because of the pain from arthritic joints, that can cause obesity and wasting of muscles that can lead to death.
But just because your joint is completely worn away by arthritis, your life is not threatened.
Elective joint replacement wouldn’t even exist if it weren’t for one thing…
Pain.
Some people have no pain even with complete stage four, bone-on-bone arthritis. No pain!
Unfortunately, I’m not one of those people. But with one foot firmly planted in the conventional medical space and one foot exploring alternative medicine, I want to believe that I can prevent surgery.
My doctor, being a surgeon, told me it’s inevitable, but thought I had a few years before surgery was necessary. The left knee looked bad, but not completely deteriorated.
I was doing a respectable job with it too. I exercised, strengthening the muscles to support the joint even with all the cartilage consumed by osteoarthritis. My mission was to beat the progression of the disease with a great workout program, nutrition, motivation, and pure grit that would allow me to live with a level of pain that was tolerable. I did everything I could to avoid knee surgery number two.
That was the plan.
But then the pain happened, and it came on swiftly, fiercely, and relentlessly.
The Replacement Saga – Pain Episode #1
When pain episode number one happened, my doctor informed me that the knee had gone south quicker than anticipated and I had to decide when to have surgery.
You’d think this would be an easy decision for me, with one TKR under my belt a year ago. Either it was a good choice or not.
Decision made…but was it?
Was my first knee surgery a good decision?
Yes.
One and a half years later, I can finally say yes. I’ll continue to get stronger because of the knee replacement and I’ll be able to do the things I love — mainly gardening, hiking, traveling, and being outdoors for the rest of my life — because of that decision.
The only downsides for me, now that the recovery is over, are a scar, a weird sensation on the prosthetic, difficulty kneeling on the artificial knee, and a lifetime of taking antibiotics before dentist appointments. Minor inconveniences, far offset by my new quality of life.
Why don’t I want to have a second knee surgery?
The stubborn part of me held onto the idea that I could work through this pain episode and still avoid surgery. You might ask, with all the benefits, why wouldn’t I just replace it?
Because I know what’s involved.
I know it’s arduous work and severely disrupts the things I want to do. It’s especially demanding work for my spouse, who is my caregiver and even more severely disrupts his work and leisure time.
I know there are always risks with any surgery and the last one caused some serious reactions to the pain medications that I don’t want to experience again. And there’s always the possibility of other risks that I didn’t experience last time.
And there’s that pesky bad surgery experience I had 6 months post-TKR with an emergency appendectomy. That’s causing a lot of surgery anxiety (more on that later).
Eventually, the severe pain of episode 1 subsided, and I was back to thinking I could conquer this knee problem without surgery.
We went ahead and booked our dream vacation to Italy for nine months out and I worked hard at getting that knee ready for all the stairs and sightseeing.
Cue Pain Episode #2
This pain was much more intense and debilitating than any I’d experienced with the first knee. Now I feel like I’m under immense time pressure. If I scheduled surgery now, I’d have time to completely rehab the knee with a little time left to focus on strength training for stairs. If I didn’t schedule now, I’d lose that envelope of time and spend the next nine months wondering if I was strong enough and worrying about having a major pain episode on my vacation.
I decided I had to go ahead and schedule the surgery with the caveat that I could still cancel if I decided it wasn’t warranted. I continue to work my plan, except when in severe pain, and I start feeling much stronger.
As the memory of the severe pain fades into the background and I see a lot of gains in my strength, I really start questioning my decision to schedule surgery.
Saying yes to something you don’t want to say yes to is hard
I’m volunteering myself for suffering and putting myself in harm’s way.
And the anxiety this is causing is tearing me apart emotionally.
I can’t continue to live in dissent with myself. With the option to call and cancel the surgery on the table, the daily battle of whether to have surgery creates incredible inner conflict. this went on for weeks until…
Pain Episode #3
This one put me over the top. The pain seemed to be here to stay and nothing I could do, or take was providing relief. The Fixer was tired of having empathy for me! Even though he knew what would be required of him (at his busiest work time of the year), he was tired of watching me try to work through the pain. My kids were tired of the ups and downs of my pain. And I finally had to realize that mine wasn’t the only life being affected by this. Everyone agreed that surgery was inevitable and the sooner the better.
But I had to get my stubborn brain on board with the decision. I had to stop this eternal argument that wasn’t serving any purpose. Indecision was torturing me and everyone around me.
So, I finally said “enough”. There is no argument anymore. I’m having surgery. And when my brain wants to produce all the reasons I shouldn’t, I don’t let it go there. I’m having surgery. Period.
How to Make the Decision to Have Joint Replacement Surgery
Will your doctor decide when you need a joint replacement surgery? No.
You’re the only one who can answer that question. How do you know?
Ask yourself one question – Is the pain you’re experiencing from the joint worse than the temporary pain and risks of surgery?
It’s not just physical pain. You must consider the emotional pain too. Living with an unreliable load-bearing joint causes a lot of anxiety because you never know if you’re going to be able to live up to obligations. That leads to making as few obligations as possible which means leading a diminished life.
You’ve certainly reached the threshold if you’re contemplating the futility of a life lived with the current level of pain and discomfort.
When you feel like pain is your destiny, every arthritis twinge of pain in your hands, elbows, hips, etc. can quickly take you to a dark place.
So, second knee surgery #2, here we come (and I do mean “we” because surgery is never about one person).
Am I unhappy about this? Am I disappointed with my results? Yes. But all that exercising will benefit my recovery as I’m much stronger going into this surgery than I was previously.
I don’t have anxiety about whether to have the surgery, because I’m not allowing myself the argument anymore, but I do still have a lot of surgery anxiety.
My logical brain knows all the reasons why this surgery won’t be the same as last time and it certainly won’t be a horrible experience like I had with the appendix. I keep repeating this to myself, but it’s not calming me down.
The flying monkeys in my brain keep screeching at me that surgery is bad.
I Need Some Surgery Anxiety Tools
I finally realized that I have some great tools already developed. The Pillars of Strength for managing arthritis will also help me manage my surgery anxiety.
If you’ve made the decision to have a total joint replacement, but have anxiety about the upcoming surgery, then read Part 2: Taming Surgery Anxiety.
In Part 3, Second Surgery Summary, I’ll evaluate my surgery and recovery.
Spoiler Alert!
It didn’t go as I expected!
