The War on Drugs

“Just say no!”

– Nancy Reagan

Because I’ll never have a debilitating addiction and uplifting recovery to chronicle (well, unless I pull a James Frey), the Pulitzer is probably beyond my reach. So here’s my stab at the next closest thing: the “struggle” to wean myself off painkillers. James Earle Jones agreed to provide the voice-over to this introduction to lend some seriousness to the blog post.

With Green Day’s “Time of Your Life” (aka the Seinfeld finale song) in the background (the Foo Fighters’ “Best of You” is on-deck), envision me seated in front of the fireplace, a blue-and-grey sweater covering an un-tucked white dress shirt atop dark brown corduroy slacks, stroking a not-so-well-kept beard, with an earnest gaze some might mistake as forlornness, sharing heartfelt thoughts to a living room gathering of my devoted Jim’s Bionic Knee audience. And yes, I realized I just described the stereotypical “hip” male college English professor at a coffee shop poetry reading, minus the tweed jacket and secret stash of marijuana, of course. Don’t think any less of me. I’m just trying to set the right tone for this blog entry.

(Real quick: Mom/Dad, don’t worry. This is just material for my blog. I have as much as chance of becoming a vicodin addict as I do winning the NBA Slam Dunk Contest).

To me, drugs are necessary evils. People can tolerate only so much pain. Without drugs, injured people can’t function properly, and instead would spend their days screaming like inmates at an insane asylum. If I didn’t take drugs that first week after surgery, I’m pretty sure I would’ve called my kids all sorts of parentally incorrect names. Can you imagine the lifetime of emotional scars inflicted upon my children if, drug-free, I had screamed, “Hey dumbass! Nobody fucks with Daddy’s nap time!” Yeah, me neither.

The dangers of using drugs to manage pain, of course, are well-known – they lead to addiction. Think Brett Favre. Or perhaps prostitution in Malaysia, but I don’t want to go there. Besides, I don’t like Asian food.

There’s always going to be some level of pain during any surgical recovery, so patients have a ready justification. Ouch! My knee hurts. Hand me that vicodin and a glass of water, please. But at some point people must ask, does the pain hurt that bad? Do I really need the pills? There’s a thin line between necessity and dependence.

People can’t remain on drugs forever, however. Well, at least those who don’t want to live like Bubbles from The Wire. It’s not good for the body or the mind, and the further down the road of numbness folks travel, the tougher it becomes for them to stop the journey. And, as I learned, before you can slay the vicodin dragon, you’ve first got to make the pain tap out. Realistically, there was almost no chance I would get addicted to the painkillers, yet the fear of addiction accompanied every pill I swallowed.

(Alrighty now. How’s that for some seriousness? Ok. Back to the story.)

During the scope to harvest my cartilage for cloning, I took one 7.5mg vicodin right before leaving the surgery center. I also might’ve taken half of a pill later that night to help me sleep, more as a pre-caution than anything. I didn’t want to wake up in the middle of the night randomly screaming vulgarities like the chef at Larry David’s restaurant. I might wake up the kids, after all, and then Christina would really make sure I was in pain.

Luckily, my knee didn’t hurt after the scope, so I never had a continued need (or excuse, depending on your perspective) for meds. The second surgery, however, posed a different challenge. The difference in severity between the two procedures is impossible to overstate. It’s like the difference between Major League Baseball and Little League. I knew beforehand my leg was going to hurt. Badly. Before going under the knife the second time, I read several diaries by recovering ACI patients. Lots of them were X-games athlete-types or ex-military, and they readily confessed to extreme amounts of pain. One former marine passed out the first time he tried to get out of bed. A member of the Green Berets, I am not. I’m relatively athletic, but let’s just say there’s a reason I’ve never entered a Tough Man competition.

For the second surgery, my surgeon prescribed a more powerful vicodin, 10mg. I could take two pills every 4-6 hours. On day one, I was like clockwork. As it turns out I really didn’t need any pills that first day, because the femoral nerve block prevented all pain until the following morning. Of course, I didn’t know when the nerve block would end, and I wanted to “stay ahead” of the pain.

Day 2 arrived with a vengeance. Not only did the nerve block wear off, but it was the first time I “felt” the pain. The first twangs are the most difficult to handle, because the body has yet to assimilate the pain. Every sensation is new, and thus heightened. I eventually learned that pain is largely a matter of controlling expectations. Once you experience the pain, you know what to expect, and therefore can adjust your tolerance levels accordingly. If managed correctly, each burst of pain should hurt a little less than the previous one. The trick, of course, is to control the pain before it overwhelms you.

Throughout the initial onslaught of pain, I struggled to last 4 hours between pills, sometimes taking half of a pill at the 2- or 3-hour mark to tide me over. I failed to settle into a pain management rhythm on my second day, and Day 3 brought more of the same. That’s when I tweaked my osteotomy, prompting a panicked call to my doctor. That also gave me a small dose of what prisoners of war experience; I would’ve broken within seconds.

The vicodin failed to provide any meaningful pain relief. I could feel myself getting loopy at times, sort of like suffering a minor concussion. But my knee never stopped aching. I decided to upgrade to the varsity painkiller. Morphine. I think that’s what helped the Asian tricycle rider in Revenge of the Nerds complete the obstacle course.

Christina picked up my morphine prescription. Apparently it’s easier to navigate customs at a Third World country than it is get morphine. Christina had to sign multiple forms at the doctor’s office, and again at the lone pharmacy that carried the drug before receiving the morphine. It wouldn’t surprise me if I pledged my knee as collateral. Between the morphine and vicodin, the street value of our medicine chest reached five figures.

The morphine, surprisingly, didn’t provide any additional relief, though the fog around my brain thickened. Even while resting in bed, I felt like I was on that amusement park ride where the room spins around before the floor drops out. At that point, I mistakenly thought the meds would eliminate all pain, not just dull it to manageable levels. It took 3 full days after the surgery before I established a comfort level with the pain. Finally, the pain no longer dictated how I spent the day. Well, I still spent most my day in bed, but you know what I mean. Though I was somewhat unsure whether the morphine helped, I quickly decided to ditch the highly addictive drug. Besides, morphine gave me a massive headache. This was the moment I realized I could never hack it as a junkie.

After 1 day on morphine, I transitioned back to vicodin. The change caused no noticeable difference in pain management. My pain levels actually decreased, mainly because more days had passed since the surgery, and my tolerance had grown. The next step was to slowly decrease my vicodin usage. I was determined not to lose any more brain cells.

For the next few days, I cut back on my normal dosage, from 2 pills to 1 ½, and from every 4-5 hours to every 5-6 hours. I also stopped taking my 2 or 3am dose so Christina could sleep through the night. The reduced dosage generally worked just fine. However, as I became more “mobile,” I increased the strain on my knee/shin a bit more, thereby upping the pain and making it difficult to wait 6 hours between pills. Ironically, the more freedom I exercised, the greater the pressure to remain dependent on the vicodin. Nonetheless, I gritted through the extra pain. To me, it was a worthy tradeoff for the opportunity to feel “more normal.”

The baby steps to wean myself off painkillers slowly grew further apart. Soon, I lasted 8 hours between meds, and decreased the dosage to 1 pill. Not long after that, I stopped taking any pills during the day. I took only one vicodin first thing in the morning, and another right before bedtime. I didn’t want to play hero, but as my buddy PK once joked, “my body is a temple,” and I don’t want to pollute the temple with unnecessary foreign substances. Well, not unless I wanted to preserve my right to feign ignorance after a positive drug test.

Eventually, I stopped taking vicodin when I woke up, though I still took 1 pill before I went to bed. In other words, two weeks after the surgery I was down to 1 pill/day, and only as a sleep aid. I rationalized I couldn’t afford to reject anything that helped me sleep. Unfortunately, I discovered the nighttime vicodin didn’t help, either. I certainly became groggy about 30 minutes after taking the pill, which allowed me to settle into a relaxed stupor. But I continued to wake up 3-4 hours after I went to bed. After a few days, I stopped taking the vicodin before bedtime. I still failed to get more than a few hours of sleep at a time, but at least I could enjoy the 3am Ginsu Knife infomercials with a clear head.

And here I am, 7 weeks after surgery. I’m officially drug-free, victorious in my battle against vicodin. Or as alcoholic might measure his days, I’ve been sober for 4 weeks, 5 weeks if you don’t count the vicodin nightcaps. I’m even strong enough to stare down the vicodin in the cabinet without being tempted. To paraphrase Vince Vaughn from Swingers, “Jim’s the big winner! Jim’s the big winner!”

Thank you, Nancy Reagan. I couldn’t have done it without you.