Come on, you knew there had to be a follow up coming sometime.
Pain. As I’ve said, I suffer from migraines. I’m pretty good at dealing with the pain (or suffering through it) because I’ve had a lot of practice. I know that having migraines has messed with both my pain and drug-relief tolerances but I still manage. I had no idea, however, just how badly my internal system’s pain recognition/response/tolerance had been corrupted — until I had knee surgery.
On 11 April of this year, I had some arthroscopy done on my right knee to repair, or more correctly clean up, a torn medial meniscus. Not a huge deal, 45 minute day-surgery, please show up at 9:45am and oh yeah, don’t eat or drink anything for 12 hours beforehand. Not the best plan for a migraine sufferer but whatever. I show up, my BFF with me, register and wait. Or was it wait and register? And then wait. And wait. By the time they called me into the back to start an IV it was past 10:30 and my head was pounding. The nurse thought that hunger and dehydration were probably playing a big part in that headache; she had an order for Tylenol on file for me pre-op so she gave me two extra strength right away, with a sip of water. She thought my blood pressure was a little high but attributed it to nerves and the headache. No worries. Hooked up the fluid IV and sent me back out to wait with the rest. And wait. My friend was kind enough to massage my shoulders and neck and the Tylenol started taking effect. Great! Coming up on my scheduled surgery time of 11am and and the pain was lessening. Well, 11am came and went. Turns out my surgeon was two surgeries behind schedule — by the time the scrub nurse came to get me at about 1:30pm the headache was back. When this nurse asked “How are you doing?” I’m sure she wasn’t expecting my reply of “I’m starving, my head is killing me and I’m pretty damn cranky!” She laughed, took to me to the OR, introduced me to the anesthesiologist and they put me under.
When I awoke in recovery, another nurse asked “How are you feeling?” and I told her my knee hurt. She gave me some morphine in the IV, checked my vitals and went off to see someone else. I checked my vitals and noticed that my blood pressure was going up. And my knee hurt. The nurse came back, I asked her if my blood pressure was supposed to keep going up, she asked if I had high blood pressure, I said no but my knee was really throbbing. She said well it was high when you came in and I said I had a migraine and my knee hurts. She gave me an Oxy IR caplet and suggested I speak to my family doctor about my blood pressure. So now I had morphine in my drip and an instant release opioid in my stomach. My blood pressure kept going up (to about 168 over I don’t remember) and also, my knee was killing me! The nurse came back around, asked about my pain, which nothing had touched so far and gave me Fentanyl through the IV. 50-100 times more potent than morphine, they say. I asked her when it was supposed to take effect and she thought I was kidding. My blood pressure was still high but not climbing, my pulse ox alarm was going off (thanks to the opioids) and my knee hurt. I told her, “Well, I can feel it in my head, I’m feeling a little loopy, and I can tell that my breathing is reeeaallly slowing down, but it hasn’t touched the pain in my knee.” She told me to keep taking deep breaths, and also that she couldn’t give me anything else. I think she was happy when they were finally able to move me from recovery to post-op. The post-op nurse took my blood pressure, asked if they hadn’t given me anything for pain (!!??!!) then looked at the chart and said “Wow!” She figured something had to take effect soon. By the time I left post-op about 45 minutes later the pain wasn’t too bad and I was okay walking out to the truck using one cane. My BFF dropped off my prescription for Tylenol 3s, drove me home and got me settled.
Friday night, Saturday, Sunday, Monday morning …. all not too bad. I had a bit of swelling, a little bit of pain that was easily controlled by the Tylenol 3s and sometimes even only regular Tylenol. I was up and down off the couch, up and down stairs, and able to do all of the exercises that had been prescribed for post-op “do-it-yourself” physio. No problems. I was up, making dinners and snacks and stuff (when my BFF wasn’t over) while HardWorker was at work. BoyGenius understood that he would have to stay at school for lunch for at least the first week and another friend offered to come pick him up every morning. It was all good. Although ….
There was that pain that started to come up in my quadriceps muscle on Monday afternoon. By Tuesday I was having a hard time getting the exercises done, and had to use two canes instead of one. After being on my feet for about 20 minutes in the morning, getting lunch and snacks ready for school, I had to quickly sit before falling over, then remove myself to the bathroom to throw up. Same thing on Wednesday morning, by which time I was completely unable to even attempt any physio. Where I had been able to survive the pain over the weekend with mostly just regular Tylenol, I was now taking the maximum dosage of the Tylenol 3 at the minimum interval and not getting any relief. I called the surgeon’s office, was asked if I might have strained the muscle, where was the pain, and could I do certain movements and tests. I could manage (just barely) what was asked of me so they figured there was no blood clot or infection, suggested that if it didn’t get better or indeed worsened I should go to the ER. By this time I was able to offer a fantastic description of my pain: a searing hot poker stabbed right into my quad just above the knee, slightly to the left side, and an ever tightening band of fire around the leg, also above the knee. I was advised to keep resting, keep it elevated and keep icing it. That evening, HardWorker noticed a huge blue and purple bruise on the outside of my thigh, about 6 inches long and 3 inches wide. I hadn’t seen it before. Hmmmm.
By Thursday morning (6 days post-op) I guess I had gotten used to the pain enough to feel that it wasn’t that bad. Or maybe it was even getting better. I stayed on the couch, not really moving much, so it was bearable. HardWorker got home from work, we had dinner, started watching Coronation Street. I got up to go to the bathroom and never made it back to the living room. I stopped by the front door and told her to take me to the hospital. “Now?” YES. “We just started watching Coronation Street!” NOW. YES. NOW. I told her she didn’t have to wait for me, BoyGenius was okay with waiting at home while she dropped me off and away we went. During my 30-45 minute wait for triage I had almost convinced myself (again) that it wasn’t that bad. Maybe I should just go home. Then it was my turn. History, temperature, blood pressure. Blood pressure. 190/90. Do you have high blood pressure? No, my leg hurts. Are you on medication? No, other than the pain killers that aren’t working for my leg that hurts. For blood pressure? No. Okay, on a scale of 1 to 10, what’s your pain? Just sitting here, doing nothing, about 6. Getting here, 8-9. Attempting to actually do anything that involves leg muscles, 10. Okay, let’s check your BP again. 195/90. No medication? No. Do you even have a headache or anything? My leg hurts. So of course I then had to wait to get to see the surgeon on call and in that wait time I had just about, that’s right, convinced myself that it felt better and maybe I should just leave. Neat, huh? So I get in to see the doctor, paint him the picture of my pain, he sees the bruise remnant and new ones coming up on the inside, asks how many days post-op, agrees I shouldn’t be suffering that pain, explains that I must have had a lot of bleeding during the surgery, which pooled in my thigh (as they tourniquet the leg so you don’t bleed into the surgical field, which I knew) and that my body was now trying to dissipate that blood by pushing it outwards (hence the bruising) through the muscle and tissue, thereby severely irritating the quadriceps (hence the actual excruciating pain) and offered a new prescription to tide me over while the inflammation healed. As we walked to the nurses’ desk so he could write me a ‘script’ (well, I hobbled behind on my two canes), he asked would I like a pill now, before I left? So it can already get in my little system while I’m waiting for my prescription to be filled. YES. THANK YOU. YES. So I take this little pill, which I believe to be a different, higher dosage pain reliever that I’ve never heard of, and call my ride to come pick me up. We drop my Rx at the drug store, I hobble back to my couch and call BFF to to explain the cryptic text I sent her from the ER. Mid-sentence, about 1/2 an hour into the call, I go silent. I listen. I ask “did you hear that?” She says no, HardWorker looks at me like I’m crazy. “It’s like the clouds parted and the angels are singing,” I say. “My pain is GONE.” Seriously. I said that. And that’s what it was like. From one instant to the next. When HW picked up my prescription later that night and I read the little info sheet that comes with the drugs, I started laughing. It said “this drug takes effect in one hour.” It had been almost exactly one hour from the time I took that little pill in the ER to when my pain ceased. Toradol, that’s what it’s called. An anti-inflammatory that is not to be prescribed for more than 5 days. For moderate to severe acute pain. One every 6 hours. Five days only.
I slept that night for 7 hours straight, without moving, on just the one pill that I had taken in the hospital. I started the course of drugs the next morning, was immediately back to one cane and quickly not using any at all. I was able to resume the physio exercises that next morning. I slept 8 hours the next night. The whole thing felt surreal.
So here’s my take on pain. My pain. Not anybody else’s. If you have a certain type of “chronic” pain, your body, your nervous system, your brain, all get used to that pain, to a certain degree. You still feel it, it’s still bad, but you know how it works. You know the ins and outs of it and you know how to deal with it; whether you’re able to manage it or not. I have migraines and other headaches. I have the occasional other ache or pain, but they don’t compare, they’re just incidental. My migraine pain is specific; the whole event has a pattern and the pain itself has its own pattern within that framework. It’s a pounding, a hammering, an on and off of building pressure. You can’t forget it’s there because of the minuscule space in between the hammering. That millisecond of relief before the next slamming of pain into the side of your skull serves two purposes: it maintains the sensation of that pain, keeping it fresh, making it impossible to forget or ignore; it promises hope of cessation of that hammering, you learn to recognize immediately if that space of relief is growing longer, no matter how infinitesimally small the growth may be. I’m used to that pain, I can survive it, even though it may not feel that way when I’m in the middle of it. What happened with this post-operative pain, though, is that it was constant. The “band of fire” that I felt was always there so it didn’t register with me as being as painful as it was. The “searing hot poker” part of it was occasional and acute, so I noticed that. For sure. But in those times when that pain went away, I was not aware that the other pain was even still present. That messed me up. To the point of ridiculously high blood pressure. That would have just kept rising. And the fact that I have migraines made me think, over and over again, that what I did feel wasn’t as bad as I may have thought. I mean, I was upright, so how bad could it be? Chronic pain can make you stupid. In more ways than one.