Sunday, June 24, 2007

Pain and Fear

I've dealt with fear most of my life. Chronic fear is called anxiety. The best diagnosis so far for my decades long struggle with anxiety (and sometimes, depression), has been Obsessive Compulsive Disorder. Fear exacerbates "real pain" and can even make pain appear in the absence of any organic cause (i.e. the "it's all in your head kind of pain").

Having total knee replacement supplied plenty of the "real pain" sort of pain. I knew going into the surgery that my pain would be difficult to manage with opiates because I have been using that strongest class of pain medication to daily just to cope with the chronic arthritis pain. Since I had the arthroscopic surgery on March 2 that did not go well, I had been using even more of the opiates.

Tomorrow will be the second week anniversary of my surgery. I spent four days in the hospital right after the surgery and went back for another four or five days after my recovery at home proved too painful and difficult. Here is a description I wrote for a friend:

Stabilizing the pain meant going to ever higher levels of narcotics. A 5 milligram oxycodone tablet would be typical of what you are given following minor surgery such as having your wisdom teeth removed. You might be prescribe one or two tablets every four hours as needed for pain. So you would max out at about 12 tablets/day. That is how much I was taking just before my June 11 surgery.
By the time I was released from the hospital the first time, I was taking the equivalent of 32 tablets each day. However, I never really got control of the pain and became increasingly dysfunctional during my few days at home because the pain made it very difficult to do my physical therapy exercises and to pass the time by reading, etc. I just couldn't concentrate..

Finally the night of Father's day, I barely slept at all. I tossed, turned, moaned, and the minutes ticked by very slowly. I struggled all day Monday, until I found myself writhing in pain and crying out during an afternoon trip to get my blood thinning medication checked. The blood lab nurse insisted that we get me to a doctor right away. It took a couple of hours and a lot of pain, but eventually I was settled into a hospital bed and full of morphine on Monday night, June 18. The doctor adjusted my oral medications until I was able to use them and not use the morphine pump at all. However, now my daily dose is the equivalent of 72 of those 5mg oxycodone tablets each day.

Most of the past couple of weeks my memory and ability to read or write has been all messed up by the pain and the medications. It is just the past few days that have gotten better. So I know that you visited a time or two and please believe me when I say that it meant a lot to me. However, my memory of the visits is sketchy. I know that at times I was falling asleep while folks were talking to me.

The nurses became very alarmed a couple of times when my breathing rate slowed to 6 breaths per minute while resting or sleeping. This is considered to be in danger zone and possibly leading to death. However, an oxymeter was used regularly to check my blood oxygen levels. They were always excellent even during very slow breathing. I have also had trouble with episodes of extreme OCD anxiety symptoms. It made life tough on the nurses and very tough on Barbara. I get all panicky and rigid about small thing like how my books, glasses, medicines, etc. are arranged. The episodes are bad and I think they cause other people to feel like they are walking on egg shells around me.
This deal of retiring and having major surgery simultaneously does complicated things. Too often I strayed into thinking such things as " I worked 33 years to get to this!"
or "Shit, I missed my peak. It is all down hill from here on out.". Kind words from a friend really help me battle off those particular lying spirits.


I am sorry I haven't posted much or commented much lately. I have struggled with poor concentration and blurred vision. Plus I suspect my intellectual capacity is severely impaired.

I am gradually getting better. Assuming I continue to recover, I hope to be writing a lot more soon. Mean while, any and all prayers are appreciated.
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