Friday, July 12
It’s been seven weeks and a day since my surgery, and the one constant throughout the entire recovery process has been pain. And thoughts about pain. And questions about pain. And efforts to reduce pain. All this attention on pain is, well, a pain in itself.
My knee pain started at least twenty-five years ago. Twenty-five years! It’s impossible to think of a time when I wasn’t at least a little aware of pain in my left knee. The problem wasn’t anything mysterious or out of the ordinary or hard to diagnose. Being knock-kneed (or, as I’m learning more of the medical terms for it, having a “valgus deformity”) combined with arthritis meant that the cartilage on the outside of my knee wore away, and I was left in a bone-on-bone situation. And bone-on-bone is just plain not good.
I have been knock-kneed for as long as I can remember; one of the first docs I saw when my knee was hurting before my second or third marathon took one look at my stance and said, “you have really bad bio-mechanics for running”. He recommended shoe inserts and lots and lots of Advil. I learned to live with the pain. I saw other docs, and I went to lots of physical therapists, and had acupuncture, and I searched like crazy for a magic pill to solve the pain-in-the-knee situation. I got a foam roller. I got a different rolling stick thingy. I did some stretching. (Okay, I didn’t do all that much stretching. I had good intentions.) I sat in ice baths. (Okay, I’m stretching on that one, too. I had good intentions of sitting in ice baths, but was maybe just not stalwart enough. A few ice baths went a long way to convincing me I didn’t really like ice baths so much.) I iced my knee with ice packs. Sporadically. When it hurt a lot, I iced a lot. When it didn’t hurt so much, the ice packs were safe in the freezer. (Mick, my long time boyfriend back many years ago, was a huge proponent of icing, and he was very persuasive in getting me to ice even when I really didn’t want to. Heck, he probably gave my knee an extra year or two.) I made sure to replace my running shoes frequently; at the height of my marathon running years, I would easily go through eight pairs of running shoes a year.
The pain was all - 100% - on the outside of my left knee. It became a regular part of me, just another thing like having blue eyes or being right-handed. Some knee docs said I should stop running, but that option seemed like poking out one of my eyes, so I just accepted the pain. After all, it was never that bad. At least not on a regular basis. The pain would come and go, and between the ice and the Advil and the denial, I could handle it. I got cortisone shots as often as the knee doc would allow. I did hyaluronic acid treatments. I had the knee scoped. I did one round of PRP (Platelet Rich Plasma). I got relief. The relief wore off over time. I looked for more ways to get relief.
I finally started to run less - a lot less. I stopped running marathons. I stopped running races of any kind. Fourteen years of living in downtown Denver and running almost exclusively on concrete caught up to me; I found softer surfaces to run on. Even then I might be running, and the pain would just overtake me. I’d stop and walk for a bit, then start running again when my knee allowed. The pain never went away; it got more intense over time, but at some point it was just there. A part of me that I could accept, just like you accept the crazy aunt in your family.
In February of this year, things changed. My knee had, apparently, reached its limit, and it started to hurt for real. It. Hurt. Like. Hell. Seemingly out of nowhere, my knee started talking to me. Or, as my friend Leann says, it started asking why I was so hard of hearing. It had been talking to me for years, and I’d ignored it, so now it was pumping up the volume. It was screaming.
When you talk to the medical folks, they like to ask you, how bad, on a scale from 1 to 10, is your pain? I’d never really known how to answer that. The pain was never one number; it was a range of numbers too varied to choose just one. But when my knee started talking to me in February, there was no longer any question. It was at a 15. That was when I knew that it was time for a new knee.
Now, seven weeks and a day after the surgery, my knee still hurts. And I’m still getting questions from medical folks. What level is your pain?
Well, that depends. If I’m sitting here on the couch with the ice machine running, it’s maybe at a 1 or 2. But then I might take off the ice and stand up, and it may just yell at me with a 7 or 8. It doesn’t like being in one position for long right now, but it really doesn’t like the transition from being in a fixed position to a different position. This week, I have been working part-time, and my knee really doesn’t like that. Sitting at a desk for any length of time is pretty much pissing it off. I get up, walk around, and it calms down a little. I try to keep it propped up: on a basket, on a pile of pillows, on a big rubber ball. Nothing works very well. I don’t think it’s gonna be happy with me when I am back at work full time.
The pain that took me backwards about four weeks ago was a MoFo. It was a big chef’s knife stabbing me in the outside of the knee. And stabbing. And stabbing. What level is that pain? What does a number matter? The level of that pain when I tried to move my leg with that knife sticking in the side of the knee was horrendous. I tried to move my leg - to get up off the couch to walk, since walking usually helped bring down the pain level - but the message from my brain to my leg muscles got interrupted. There was a circuit breaker, it seems, and that circuit breaker was saying “Nope. No way are we moving that leg. We know it’s gonna hurt more than we can handle. Just. Not. Gonna. Do. It.” Those were the instances where I had to get Ed to come move the leg for me.
You assign the number for that level of pain. I can’t do it.
But things are getting better. The pain comes and goes. On Wednesday, I had a scaled down version of the chef’s knife pain; this time it was a screwdriver sticking me in the outside of my left knee, and at a rate that wasn’t quite as severe as the earlier pain - but not so far behind, either. Ed and I had plans to go out for lunch, and I was in enough pain that he suggested we stay home. But I know that moving helps. Changing environments sometimes helps. Being around people - like our good friends at our local breakfast/lunch place - helps. Anything to get my mind off the pain helps. I iced the painful spot. A bunch. And I slathered CBD lotion on it. A lot. And I massaged it. And talked nicely to it. Took a couple more Tylenol. By mid-afternoon, the nearly-off-the-scale pain was gone.
The pain still wakes me up in the middle of the night. Every night. Sometimes multiple times. That bit is getting old. The pain that wakes me up can be acute, or it can be just one great big ache. Sometimes I can get it under control just by massaging it, and moving it around, trying hard not to wake up Ed. Sometimes I get up and walk around a little, and that helps. Sometimes I go downstairs and get a fresh ice pack. The other night I resorted to more Tylenol at 3 a.m. But at least I didn’t need the Tramadol. Or the Diazepam. So that seems like progress. I’m praying for the morning when I wake up, and realize that I’ve slept through the night.
I know that the pain will eventually go away. Or - more honestly - I pray that the pain will eventually go away. One of the very weird things is that the most frequent pain I have in my left knee right now is almost identical to the pain before the surgery, and before it all got really bad. How do ya like that? Major surgery and trauma to get back to the same place you were a year - or less - ago. One of my friends who has had knee replacement surgery told me that it was a year before he had a day when he didn’t think about his new knee. He didn’t mention the pain, but this conversation was before my surgery, and I suspect he was saving me from a dread that I didn’t need when I was already a little more than nervous.
One day, I’ll walk down the street without pain. Really. I’m holding on to that thought. But I’ve gotten so used to having the pain, I can’t really imagine how that will feel. This pain - oh, so much pain over the years, almost all on the outside of my left knee - has become a part of who I am. Who will I be without it? I’m looking forward to figuring that out.
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