Knee Replacement 12: The Pain Plan

It’s three weeks after my first knee replacement surgery—the days are already ticking down toward my second—and by most measures, I’m doing fine. I’m up to 120 degrees of flexion, and I can just about straighten my leg now. I’m able to get all the way around a pedal stroke on the Peloton in the basement, which is a great boon to my mental well-being, and I’m even able to wobble around without crutches.

But I’m completely failing in one area: pain management.

The OxyContin they prescribed does nothing to ease the pain. It doesn’t put me to sleep or even make me relaxed. Instead, it makes me feel like I have COVID. You remember, the body aches and so much lethargy that turning the channel with the remote was all the workout one could handle? That’s pretty much what the oxy makes me feel like.

My doctor, Eric Heiden, had told me that he hadn’t touched any narcotics after his double knee replacement (which he’d had done at the same time). If he could gut through double the pain I was now having, I figure that I can get through one replacement without the aid of opioids.

So, I decide, I’m not taking the oxy. The bottle stands on the kitchen counter, but I leave its frustrating push-and-twist lid unpushed. And I suffer through nights of writhing pain. Soon thereafter, Claudia, my visiting physical therapist, a wonderful woman with a gift for listening, mentions that she’s puzzled.

You seem to be suffering a lot more than most of my patients, she says.

So, I tell her how the oxy makes me feel and my decision to go cold turkey. This news occasions a deep frown and some clearly not-on-board head shaking. While she allows that oxy doesn’t work the same for everyone, rarely has she heard of anyone experiencing it in the way I report.

This is not the first time I’ve heard that.

Opioids had never been my friends.

I once broke my leg in four places in a skiing crash in Wanaka, New Zealand. At the time, Wanaka didn’t have much for medical facilities, and in order to make the drive over to Queenstown in the back of a station wagon a bit more tolerable, they shot me up with morphine. By triggering the brain's reward system, morphine’s mission is to release dopamine and a powerful sense of pleasure and well-being. At the very least, it’s supposed to give you a relaxed and dopey feeling.

What some would call a wicked good buzz. But in me, the morphine failed to accomplish its mission. Instead, there in the back of the station wagon, I became highly agitated, and a loud voice began selling me a solution: open the back door, jump out, and end it all.

Not what anyone would deem a wicked good buzz.

The voice was just in my head, but that didn’t diminish its authority. It scared the hell out of me. Not ready to buy the proposed final solution, I didn’t jump, but I did arrive at the conclusion that I must be wired differently than most when it comes to narcotics. Although that was more than thirty years ago, apparently, my neural pathways haven’t reconfigured.

I suggest to Claudia that my strange reaction might have something to do with being a redhead, a notion that she considers and quickly dismisses. Although I am sure that there is something to this—there have been studies that confirm that people with the MC1R gene, which is associated with red hair, require higher levels of anesthesia—I don’t press it because she’s already asking the sensible next question: have you ever taken anything that has worked to reduce the pain?

I tell her, yeah, and confess to years of ibuprofen abuse. In the past ski season, there were days when I took 1,600 milligrams of the stuff in order to be able to make turns without excessive pain.

I know it was a bad idea, I tell her, but it allowed me to ski with my kids, and for that, I’ll do almost anything.

While Claudia smiles at the sentimentality of this statement, the 1,600 mg detail occasions even more frowning and head shaking. Apparently, ibuprofen can thin the blood by inhibiting platelet production, which is needed for clotting (and a subject I learned way too much about in the previous year). Poor clotting increases the risk of internal bleeding. Not something you want. Ibuprofen also blocks some enzymes that are involved in bone formation and healing. Another bodily function that you don’t want to mess with. The final knock against Ibuprofen? It screws up your stomach. Ulcers, digestive tract bleeding, that kind of fun. So, ibuprofen is off the table for now.

I tell Claudia that I do remember taking Vicodin after an ACL reconstruction surgery in Vail. And while I can’t recall any voices proposing final solutions, I also can’t remember if it worked to relieve the pain. She says it’s worth a try and suggests asking Dr. Heiden to prescribe Vicodin instead of OxyContin. So I do, and he does, and that very day, I gimp up to the pharmacy window in the corner of a nearby grocery store, where the smiling pharmacy tech says my order is ready. And then he hands me a bottle of oxy.

I hand it back.

A day later, after phone calls and texts, I’ve procured a bottle of the right medicine: hydrocodone (which is the opioid in Vicodin). Perhaps these little white pills will provide relief, and more importantly, a good night's sleep. That night, I take the prescribed dose and trundle off, hopefully to bed. My optimism is not rewarded; maybe the hydro works a little better, but not well enough to provide more than an hour of sleep at a time.

Now I’m getting desperate, and I wonder about weed.

With the exception of the cool paraphernalia that weed smokers get to play with—the little bat that went in the dugout, the water pipes and hookahs and kaleidoscopic bongs, and even today’s tricky little vapes that I’d watched dudes suck on in a crowded tram without (almost) anyone being the wiser—I’ve never been interested in pot. Sleepy and paranoid and ravenously hungry for Doritos was never how I wanted to go through life.

Certainly not worth sucking in a lungful of smoke.

But all that was a long time ago. My pot-smoking friends report that weed is waaaay better now, dude. And who am I to argue? Not that I could argue anyway; by the day, I’m becoming more dense, further addled. Maybe today’s supercharged THC can bring pain relief where the opioids have failed? I put out a call to the pot people in my life, and within a day, I’m in possession of various Sharpie-labeled Ziploc bags of pastel gumdrops and a few odd little square plastic containers that you have to pinch at the top in order to pull off the lid. There’s even a tin of THC-infused breath mints from the pot shop in Wendover, Nevada.

And so, not looking to get high but rather for healing unconsciousness, I begin nightly weed experiments. I chew the gummies and wait.

First observation: gummies work too slowly. Nothing for an hour. So, I take more. My second observation: my thinking has canted over sideways, and circular arguments for parallel universes present themselves as rational. I’d gladly escape to a parallel universe if only I could find the door in the big plexiglass wall that separates me from a brighter realm.

And no pain relief.

The next night, I try 20mg and imagine I’m watching two people playing jai lai on the other side of the glass. One looks like Travis Kelsey, in full game-day Kansas City Chiefs uniform. The other is an animated character in a helmet with a half-shield and a red M on the crest: Speed Racer. Kelsey, I can understand—I just watched the Chiefs play and he had some notable catches—but Speed Racer? For that vision, I have to give the THC full credit. Summoning Speed and his girlfriend Trixie from half a century away, and those UHF afternoons of rushing away from the school bus to the home of Mikey Davis, whose parents had the first color television console in the neighborhood?

Now that’s impressive.

Maybe I’ve been missing out on something after all. Is it too late to become a burner? Wake-and-bake Bill?

Yeah, probably too late for that. Refocus. That’s not what these experiments are about. They’re about pain relief, and in that regard, the experiment is failing. My leg still hurts. A lot. The weed isn’t taking the pain away; it’s just upstaging it, and the dark curtain of sleep simply won’t descend.

Maybe if I just change perspective? Maybe sleep isn’t all it’s cracked up to be. Maybe I can just go without? Immediately, I hear Warren Zevon’s voice in my head.

…drinking heartbreak motor oil and Bombay gin

I'll sleep when I'm dead

Straight from the bottle, twisted again

I'll sleep when I'm dead

And then I remember that the Excitable Boy is already gone off to his final rest. Checked out at 56. Warren was good at lyrics, but at bad planning.

Back to the beginning.

Like any good American male, I never read directions. Not to the new Sawzall and certainly not to the baggie of drugs that have accompanied me from the supermarket. I promptly throw away the paper pamphlet that had been stapled to the pharmacy bag and never think to peruse the fine print on the little brown pill bottles.

Now, in desperation, I revert to the directions. I actually read the bottle and decide not to attempt to outsmart the experts.

My wife—who has to listen to my moaning and griping and, for her trouble, is probably suffering more than I—is in favor of this approach. I decide I will just take the pills, regardless of how I seem to be feeling. We make a schedule—hydrocodone every six hours, round the clock, and acetaminophen in between doses—and commit to it, even to the extent of setting alarms on our phones for the middle-of-the-night doses. It doesn’t really work, but at least it’s a plan, and sometimes, just having a plan is enough to get through the grind of the passing days.