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The dozens of
letters, phone calls and e-mail messages I've received since writing my recent
columns on total knee replacement and pain management reveal that I struck a
Some readers chastised me for scaring potential patients away from this surgery,
which, when healing is completed, can greatly enhance quality of life. But many
others praised me for "telling it like it is" about an often painful and
difficult recovery that surgeons don't warn patients about.
Clearly I've not been alone in having prolonged, debilitating postoperative pain
that was not adequately treated.
Obviously, many people have had total knee replacements without experiencing the
kind of pain I suffered.
I knew going into surgery that a friend 10 years my senior had both knees
replaced at once, as I did, and was dancing after four weeks. I could not walk
down stairs using both legs at nine weeks after surgery despite prompt and
intensive physical therapy. Another friend, a woman in her 80's, said she had
almost no postoperative pain.
An Ohio man who had both knees replaced at age 77 wrote: "After surgery, my pain
was very tolerable, and I took minimal pain medication. I now walk everywhere,
miles, over hill and dale, all without pain, and I'm hoping to return to the
tennis court. I would encourage those who need knee replacement to 'go for it,'
even both knees at the same time."
Since I entered surgery slender and in top physical condition, I expected a
similar recovery experience, and my surgeon reinforced that expectation.
Who can explain
it? Not me or my surgeon.
A Patient's Right to Know
To those readers who fear that I unduly frightened some prospective knee
replacement candidates away from this life-enhancing surgery, I must say that
was neither my intent nor my message.
My message was that whatever procedure a patient faces, full disclosure is
imperative. People have a right to know what they may encounter, not just what
the surgeon hopes will happen.
An orthopedic surgeon called after reading my article to say that he tried to
fully inform patients who asked about knee replacement.
As a result, he said, he scares some people off, and the chief of surgery at his
hospital has complained that he does not do this operation often enough.
This is outrageous, and just reveals the monetary motives behind much of modern
medicine. The patient be damned; just bring in the bucks.
So here's the good news: at 10 weeks post-op, I insisted that the surgeon take
another look at me because I was convinced - as I had been for weeks - that
there was something wrong with my right knee.
The left, the most severely afflicted with arthritis going in, was at last
healing nicely, but the right continued to keep me tied to potent painkillers.
As it turned out, I had tendinitis, a seriously inflamed tendon across the
outside of the knee cap that was aggravated with every bend of that knee. All it
took was a shot of cortisone to bring relief and get the healing process back on
track.; I just wish that my weekly complaints of disabling pain in that knee had
been acted upon much sooner.
The day after the shot, I was able to walk half a mile each way to my local Y
and resume my daily swim. In just four days I was swimming three-fourths of a
mile and feeling almost fully human again.
Yes, I still take medication, but much less than before, and I still have to
rest from time to time. But I now anticipate the day when I can resume riding my
bicycle and walking around the park, hiking and ice skating with my friends.
I am certainly not alone in wishing I'd been prepared for a difficult recovery.
A Need for Planning
Here's what one reader who had total knee replacement wrote: "I wish I had known
how incapacitating the recovery period would be so that I could have planned
accordingly. It would not have changed my resolve to have the procedure - only
my planning for its aftermath."
Is this too much to ask of the medical profession?
I had set aside six weeks to recover and done all my work in advance for that
period, only to find that I needed twice the time to return to normal daily
activities, including getting to the subway, on it and off it.
Another surgeon wrote to me about doctors' fear of legal action over prescribing
narcotics. Yes, the government has unfairly attacked some pain management
specialists who treat dozens of patients with chronic pain.
Dr. Jennifer P. Schneider, the author of "Living With Chronic Pain," has
testified on behalf of such doctors who were unjustly accused of feeding the
habits of drug addicts.
An Uprising Overdue
This is hardly the case, and a mass uprising by doctors and patients in support
of legitimate pain treatment is overdue.
It is also not true that pain patients get hooked on narcotics, craving ever
greater doses of them. Addicts get hooked; pain patients need increasing doses
only when their pain worsens, as often happens to those with advanced cancer.
And as Dr. Laura Lewis Mantell of New York wrote to me, "The use of opioid
analgesics (narcotics) need not be avoided out of concerns that addiction will
ensue, because the incidence of addiction arising out of postoperative exposure
to opioids is negligible. "When faced with the kind of pain I experienced,
doctors must treat it properly and not act like frightened children when it
comes to prescribing narcotics, by far the best drugs for dealing with severe
A narcotic like OxyContin is not abused by pain patients but by drug addicts. I
feel no euphoria, just pain relief, and I'm having no problem weaning myself off
it now that I am in much less pain.
The American Academy of Pain Medicine, the primary organization for physicians
who treat pain, is alarmed by the interim policy statement issued by the United
States Drug Enforcement Agency, which threatens to make it even more difficult
than it now is for legitimate physicians to prescribe adequate pain relief for
Undertreatment of pain is already a public health crisis and the government
should act to improve the situation, not make it worse.
Undertreated pain destroys lives. As one young woman put it in an e-mail
message: "The effect of pain had an insidious effect on my life, my outlook, my
well-being and my relationships in every sphere of my life. Pain is a funny
thing. Unless you're the one feeling it, it's basically meaningless."
The time is long overdue to instill empathy, not fear of persecution, into the