Post Surgery Week 11: Anatomy of a Sleepless Night

Sunday., August 4

It’s 1 a.m., and I am wide awake.  My knee hurts, and my entire left leg aches.  I can’t get comfortable;  I turn this way and that, but it seems that every position I try results in painful pressure on my knee, no matter what I do with the pillows that I use to cushion my knee.  Ed is sleeping soundly as I go downstairs to get an ice pack.  It helps, but just a little.  I doze a little, but then I’m wide awake again.  I get up, go into the bathroom, take the ice pack off, slather my knee with CBD lotion, and start to cry.  I’m thinking that I don’t know how to handle this.  I don't know if I can get through this:  all this pain, all these sleepless nights.  When will it end?  I climb back into bed, and my crying wakes Ed enough that he hugs me, then he’s back asleep.  And I’m back wide awake, not knowing what else to do.

It’s 2:02 a.m., and I decide to take a Tramadol.  I haven’t taken one of these in weeks;  it was a mother getting it out of my system, but what else can I do?  I try to reassure myself that I’m only ten weeks post-surgery, and it’s okay to take pain meds. 

On Thursday, Heather gave me a new prescription for a painkiller called gabapentin.  She had diagnosed the screwdriver-in-the-side-of-my-knee as bursitis in a phone call late Wednesday afternoon.  She told me that there are several small bursa in the knee, and one exactly in the spot (inside face of the knee, below the joint) where I described my pain.  Heather said that the bursitis is very common, and she teased me with the promise of a cortisone shot - something she said she could do as soon as I came in to see her.

But when I went to see her Thursday morning, she had consulted with Dr. Miner, and they decided against the cortisone shot.  Cortisone can thin tissue, and since my tissue around that particular bursa is already very thin, it just didn’t seem like the best idea.  Instead, she wrote me a prescription for gabapentin.  She told me that it should help me sleep, but that it might make me loopy and hungover.  I picked up the new drug at the pharmacy later that day, and read the list of side effects.  Dang.  Not a good thing to do if you actually want to take the drug.

Because I had an early PT session at Blue Sky Friday morning, I decided against taking the gabapentin Thursday night.  I wanted to be able to drive safely - drug free - to the appointment.  Somehow I made it through that night, and got to my PT appointment a few minutes early.  There were several other people waiting in the reception area when Karen came to take me back to the treatment rooms.  “How are you doing?” she asked.  My answer:  “I’m ready for this knee to stop hurting is how I am”.  The people waiting in the reception area all laughed.  I wished that I found it as funny as they did.

Karen worked on my extension, and gave me some new stretches to do.  She found a tight muscle (my adducter) that she thought might be contributing to the bursitis, and worked on it.  The stretching is intended to lengthen the muscle in order to take the pressure off the tendon that attaches near that bursa.  Then she gave me time on the reformer, and we spent most of that time doing more stretches. I left the PT session feeling good about the progress I’m making.

But by Friday afternoon, the stabbing pain returned.  By 8 p.m. Friday night, I gave in and tried one of the new pills.

It dulled the pain, and helped with sleep, but oh, my, I had weird dreams.  Elton John showed up at a company meeting, and he and I ended up sitting next to each other on the floor at the back of a conference room when there weren’t enough chairs for everyone.  He and I had a nice chat about how much fun it is to sit at a piano and noodle out sounds until you find something that works.  And then I was late for a meeting, and I took off running down a hall until I remembered that I couldn’t run because of the knee surgery.  So they weren’t horrible dreams.  But, as promised, I woke up woozy and feeling hungover.  Ed was alarmed at how cranky I was, and how I was even more grumpy than before.  I decided that maybe this wasn’t the drug for me.

Which is how I decided, at 2 a.m. Sunday morning, to try going back to the Tramadol.  But now it’s 2:32 a.m., and I’m back in bed, still not sleeping, still with the aching knee.  And now I’m dealing with an upset stomach.  I had forgotten that you need to take Tramadol with food.  We had an early dinner, so my 2 a.m. Tramadol dose was on an empty stomach, and I’m thinking I might throw up if I don’t get some food in my gut quickly.  So I go back to the kitchen and have a few bites of the last of the banana bread that Ed made this past week.  I’m afraid to lay back down until the nausea has passed, so I try to do a blog post, but the Tramadol is doing its thing, and I’m getting fuzzy around the edges.

At 3 a.m., I shut down my laptop, stumble up the stairs once again, and crawl back into bed.  Pain is a night stalker, and even with the Tramadol, my knee is still hurting.  My head feels off because of the drug, and my entire left leg still aches.  I watch the clock slowly tick by the minutes.  Now it’s 4 a.m., and now it’s 5, and it’s going on 6.  Will this night never end?

At 7:30 a.m., the sun and the birds wake me.  My head is woozy from the Tramadol, but at least my knee pain is manageable.  It still hurts, but tiredness wins out, and I close my eyes to try to squeeze another hour or so of sleep before we get up and go to what serves as Sunday morning church for us:  the live music at Keith’s Coffee Bar.  

Shortly after 10 a.m., we walk into Keith’s.  This is only the second week that I’ve been able to make the walk - roughly 7/10ths of a mile - since surgery.  I try to remember that this is still a big win, to be able to get here on foot, even if my knee does hurt walking today, and even if I feel loopy and fuzzy.  We have lots of friends in the crowd of regulars, and they all greet us, and ask after the state of my knee.  What can you do?  Complain ad nauseam?  That doesn’t seem to do much to help things improve, so instead, I just try to smile and say “it’s getting better, little by little, with some ups and downs”.  What’s the saying?  Fake it until you make it, or something like that?  Somebody comes up and tells me that they were happy to see me walk in without limping.  Really?  I thought for sure that I was gimping along, so maybe things are really getting better.

Ed and I leave Keith’s early so we can walk home in the bright sunlight, and we can do some maintenance on the ice machine, and then I’m back on the couch, loving the feel of the ice water wrapping my knee, waiting for the fuzziness to pass, wishing I could nap.   When sleep doesn’t come, I grab my laptop and work to finish this post.  I’ll try to hold on to all the positive thoughts that I can, even as I dread the next night, when the pain monsters come crawling out of the dark again.