By Kari Firestone
Just to recap my posting last summer, after quickly self-diagnosing my swollen and bothersome knee as another in a series of tears, I learned from a real doctor that I needed an entirely new knee. His advice was to postpone the inevitable for a couple of years by giving up running and singles tennis immediately and starting a serious regimen of physical therapy, which I undertook diligently.
Unfortunately, it didn’t work. Even on the doubles court, my buddies had to cover shots that would typically be routine for me. Golf was fine in July, but by August, I couldn’t manage shifting from right to left. By mid-August, I needed to put both feet on each step before moving to the stair below. That was the final straw. However tough the surgery or the recovery, I couldn’t live this way.
Because my knee doctor only does repairs, not replacements, he suggested two capable colleagues. The first told me, in late August, that he was booking patients for February. I replied, “Well, you won’t be booking me.” My friend, who chairs the hospital board, interceded, and the next day I heard about a cancellation at the end of September. I took it.
I told everyone at work, but certainly not my surgeon, that I would be back in the office within a week. Everyone, very kindly, told me how painful the surgery would be and to make sure I got enough pain and sleeping pills for ‘the duration” because I would really need them. OK, I said.
As a veteran of eight prior orthopedic surgeries, I was astounded at how much more “serious” this operation seemed to be than any of my others. Nearly a half-day of pre-op appointments, tons of tests, multiple warnings about my home care arrangements, a walker (A WALKER???), then crutches, home nurses and physical therapy, etc. I decided not to tell the interviewing nurse that I would be home alone during the day because my husband was going to work and didn’t need to watch me watch TV.
So, how did it go? Here’s the good news. I had little pain post-surgery, even though I kept expecting it and occasionally lied just to guarantee I had something in my system if the nerve block wore off. I used crutches the day of the surgery, got dressed, went up and down stairs the next day, and went home a day early. The surgical resident told me that my knee had been a “total mess”, no cartilage and tons of bone shards and commiserated that I must have been in real pain for a long time. I assured him that I hadn’t felt a thing until three months before the procedure and had run the best age-adjusted race of my live less than six months ago. Maybe he just wanted me to feel Herculean.
Four days later, I gave up the crutches. I went to work a week after the surgery for a few hours, with my trusty circulating electrical ice and started the stationary bike on day eight. During the sixth week, I walked over six miles in New York because Donald Trump’s presence caused all of mid-town to be blockaded and, after that, I went back to spinning class.
So what’s the bad news? Two months of sleep deprivation. Maybe I slept two to four hours a night, but not more. I would fall asleep exhausted but wake up ninety minutes later unable to find a comfortable place to put my repaired knee. My surgeon used the same incision from two prior ACL replacements, on the inside of my left knee, but that scar lights up at night and there was no way to ignore it.
During the day I have used enough ice to fill an Olympic skating rink, but at night, the ice, sloshes around and melts. What I missed out in terms of daytime discomfort I’ve made up in spades at night.
I have fallen asleep twice driving to work. Once was at a red light and someone honked at me, assuming I was texting. After the second incident, which was much scarier, I called my surgeon and left a message.
He suggested Melatonin which is basically Tylenol PM with an organic sounding name. It gives me a pounding headache in addition to no sleep. I asked for some sleeping pills. The hospital so very generously prescribed five, let’s count them, sleeping pills when I left a day early, and they were gone. My surgeon declined. I still had half of the short acting narcotics he originally prescribed but they weren’t going to help me sleep all night. Try warm milk the nurse said. We just don’t prescribe habit forming drugs two weeks after surgery.
The likelihood of my causing a serious car accident was infinitely higher than that of my becoming a drug addict. I am furious with all the over-prescribing doctors and overindulging patients who have slammed a door on legitimately needy patients requiring help for an interim basis with pain or sleep. Healthcare professionals must figure out how to provide for their patient’s entire care, not just the mechanical mending. I just wanted to sleep enough to avoid killing myself or someone else and be alert at a job that requires whatever mental acuity I can pull together.
Eventually, I turned to my primary care physician. After we talked about my symptoms, he prescribed ten nights’ worth of the lowest dose long acting pain medication. At CVS, when the pharmacist could not find my name on one of the numerous white bags, she asked me the name of the drug. Following my response, she yelled out “She’s lookin’ for the OXYCONTIN!!!”
Everyone within earshot stopped to stare at me, the drug addict. I felt obliged to tell them all that I had a knee replacement four weeks earlier. Too late; they had already profiled me. Also, too bad, the pharmacist told me. My doc hadn’t used the right prescribing network, which, in the latest of officious “safety” initiatives, isn’t even available for the Harvard teaching hospitals.
Medical marijuana is legal in Massachusetts. A friend who works in health care suggested I try what had worked for her husband after a similar surgery, when he couldn’t sleep. I hadn’t smoked any pot since I was nineteen, after I hit the pool for swim practice early one morning and still felt stoned. I’m willing to try anything. Just give me some decent shut-eye and I’ll say my knee replacement was a huge success.