Weighty Matters

Hi, Everyone. I haven’t kept up with my blogging recently. I plead exhaustion. Recovery from knee replacement surgery is hard work and there have been some other issues effecting me too.

All in all things are good. I am able to drive myself again, which is a huge boost. It feels great to have my independence back. It’s also made it easier for me to return to work on site if not for full eight hour days. I can go where I want, when I want and this makes me feel much more efficient and less needy.

I worry less when I can be at work. Even though there are many things I can do remotely from home, it just isn’t the same as being present with my co-workers, able to easily dial an extension or walk down the hall to consult, etc.

The downside is that I am not able to stretch out on a couch anywhere or take a nap when I need to. Oh, those naps are important. For the first four weeks, even with the stronger medications, I could not sleep through the night. Without fail, a couple hours after I fell asleep, pain would wake me up. Then I’d need to ice my leg, sit up for a while, and give my body time to settle down again before I could fall back to sleep.  These interrupted nights really drained my energy during the day. I treasured the ability to nap and restore when I was home every day.

Last weekend, I finally saw a shift where the pain episodes lessened in both intensity and frequency. I got two great nights of sleep in a row! I noticed that I was easing off of the strongest of the pain medications and eventually also reducing the number of times I relied on the second strongest prescription. Most of the time I could get by with the extra strength acetaminophen the surgeon recommended. This made me very happy.

Then something strange happened. This might venture a little into the “too much info” category, so don’t say I didn’t warn you.

The night after my two great nights of sleep, I was woken up about every hour to an hour and a half by the need to pee. Six times a night, no lie! I couldn’t figure it out. I wasn’t drinking gallons of water during the day or having any liquid at all after 7 or 8 at night when I finished a cup of herbal tea. This made no sense and, after four straight nights of it I was so sleep deprived that it made even less than no sense. I was like a zombie yesterday at work.

I Googled the issue very specifically. Don’t laugh but you actually can find suggested pages in answer to the search sentence of “Increased urination at night after knee replacement surgery”. I found a couple of forums where other people who’d had joint replacements complained of the same thing. Nobody had an answer or a reason, but at least I wasn’t alone. I also spotted a couple of references to a connection between increased urination and discontinuing opioid use.

I called my primary care physician and got in the next morning for a urinalysis. I may be one of the few people in history to be disappointed over not having a urinary tract infection. Sadly, after a lengthy discussion, the doctor didn’t have any concrete suggestions either. I was offered a prescription for overactive bladder, even though I wasn’t having the problem during the day. She also suggested an ultrasound just to make sure that structurally nothing was going on. I asked if I could wait a few days to see if the issue resolved and she agreed.

Have I mentioned before that my wonderful sister-in-law is an adult primary care nurse practitioner and has been for more than 30 years? Honestly, there isn’t a medical professional that I trust more than her so I texted her about what was going on. She did some research and sent me a great and thorough article on nocturia. We then talked at length last night. She agreed with my plan to give it a few days and see if it resolved. We talked about the possibility of an opioid connection. She did some more research and texted me today that she saw several references.

So, that is my current theory.  If this is the root of the problem, then the longer I’m off the stronger meds, the more the situation should resolve. Last night was already a little better. I only woke up four times instead of six. It’s now been 48 hours since I’ve had anything other than acetaminophen. Hopefully, this means that I’ll sleep even better tonight!

In the midst of all this, my physical therapy efforts continue. This week’s sessions were brutal. I freely admit that I felt like a big baby on Monday because I yelped a few times when the therapist was manually manipulating my leg, pushing and pulling on it to straighten it even more. I’d like to pretend that I was sweating but, to be honest, those were tears leaking out of my eyes.  I actually felt kind of down about it because I pride myself on not being a wimp. I felt a lot better at Wednesday’s session when the therapist told me that he’d worked my leg extra hard or, in his words, “beat you up pretty hard last time.”

With extreme effort, I can make the knee flexion goal.  It requires some interesting positioning and pushing, but I get there. As far as the straightening, I’m really close to goal as long as the therapist is pushing down on my leg. Unfortunately, I have not yet reached the point where I can straighten it as far as I want to and keep it straight on my own. Close. Oh so close with effort, strain and pain, but not there yet.

Yes, I’m a little frustrated. The female therapist is a little more nurturing than the male practitioner. When he tells me that I’m a little behind schedule, she tells me to focus on the progress and improvement I’ve made since last week. She’s also the one who reminds me that my knee is still healing. At least today he also said that my leg is straighter tha it was and that my knee was bending and performing better when I was on the bike. They both remind me to keep doing exercises at home and to keep pushing myself. All three of us are in agreement on those points.

So, the week ahead is more of the same. Work, therapy, exercises. Keep moving with determination and effort to the eventual goals. At this point, the straightening of my leg is probably “good enough”, but that’s not really good enough for any of us. We want me to be the best that I can be.

I’m a few days shy of the fourth week anniversary of my knee surgery. Yes, I’m seeing improvement. My mobility is pretty good, my pain is reduced most of the time and I’m confident that I can return to driving. I’m not 100% by any means but the improvement definitely increasing.

I still have periodic episodes of pain in other parts of my leg. I believe these episodes are related to how active I might have been in the 12-24 hours prior. Saturday I went to Tai Chi class. Even though I only did Tai Chi from the chair, I then went to friends’ for lunch (up a flight of stairs), then did a little shopping.  That same night, I had a function to go to and I know that I was on my feet walking around for more than an hour before sitting down to dinner. On Sunday, the ache and throbbing in my glute and down the side of my leg were significant. I took it easy all day so last night and today are completely different.  My massage therapist can help with the rest of the leg so I have an appointment scheduled with her tomorrow.

At this point, I think I can reclaim more of my independence. I spoke to my physical therapist about it and he gave me a great suggestion. He said that before I actually drive anywhere I should sit in my car with it not on and practice moving my foot back and forth between the accelerator and the brake to test how it feels and my reaction time. I did that for a few minutes yesterday and it felt pretty good. So, I turned on the car and just drove up and down my quiet street. I even practiced jamming on the brake to see how my knee felt and it was fine.

My final test will be this afternoon. I’m still accepting a ride to P.T. from a neighbor. Then, after I get home from having put my leg through a lot in therapy, I’m going to do the same assessment in my car. If I feel that I can drive even after my leg has worked and is tired, then I will feel confident driving.

My caveat will be that I will not drive if I’ve taken a stronger pain killer. Under the influence of a narcotic pain med, I would be too worried about my cognitive reaction time and reflexes to risk being behind the wheel. If I’m only on acetaminophen, I should be fine. I’m already taking the stronger prescriptions far less frequently than I was in the beginning, which is another sign of my continuing recovery.

I plan to go into work tomorrow, Wednesday and Friday for half days and then again for a couple of hours to take care of a special project on Saturday.  This will help me ease back in so that I can get back to work closer to full time next week.

On other fronts, I’m still doing really well with my food intake. I have definitely noticed that as I cut back on the narcotics, my appetite began to increase. I’m aware of it and alert for it, so that I can be prepared. It doesn’t matter if I get hungrier as long as I don’t start making inappropriate choices. I’m so pleased that I’ve lost weight every week since my surgery which is a longer trend than I’ve experienced in quite some time. I want to build on this trend, keep going and, finally/eventually reach my goal weight.

After my mini-meltdown at the beginning of the week, I’ve had steady improvement in my mood and my physical recovery.  Last night I had the best night of sleep that I’ve had since the surgery. (Monday was the second best sleep.) It’s amazing how good rest can help the other aspects of your life balance out.

After the painful effort of Monday’s therapy, my leg felt looser and more flexible on Tuesday. At Wednesday’s session, we pushed hard again and gained additional improvement. I’m ready to go at it again tomorrow and have been working on my exercises at home.

My emotions evened out and I got over the strong desire to weep and feel sorry for myself. I tried to focus on the positives to help my mindset. I didn’t want to invalidate the things I was feeling, but I didn’t want to wallow in them either.

I also received some great suggestions from readers here and some friends on how to address that other physical issue. Thankfully, efforts in that area are working, too!

Today I had a little pampering with a manicure and pedicure. Right after that, I walked next door to the acupuncturist’s office for a terrific treatment. With that boost, I then went into work for a few hours. I’d told myself all week that I would do so and I am so glad that I was feeling up to it.

It was so good to be on the grounds again to see my work-family and, of course, the dolphins. I was so happy, I got weepy for a few minutes. After visiting a little, I went into my office and dug into some projects. It felt great to be there. Even though I have been doing some work at home, it isn’t the same feeling as being in the office, focusing, with all of the tools and information I need around me.

That said, after four hours when 5 p.m. rolled around, I was ready to leave. Although I didn’t fall into a nap when I got dropped off at home, I knew that my body was ready to take it easy for the rest of the night.

Thank you everyone for your support and encouragement. They helped me get through the rough spot, process, and keep moving forward.

If you don’t want to read a post that mostly includes me whining, I’ll understand.

If you’re still here, well, you were warned. I’m sorry, everyone. I’m doing my best to keep up a good, strong, fighting spirit during my recovery. For the most part, I’m succeeding, I think. Today, however, I’m just not feeling it. Instead I’m feeling the pain, the frustration and the sleep deprivation.

It is all well and good for me to understand that I have to keep pushing myself in physical therapy. If we don’t keep forcing the muscles, tendons and other parts of my leg, I will not achieve the straightness, extension and flexion I desire. These things were compromised from years of a degenerating knee. Improvement is a challenge. I know all of this intellectually but, damn it, in today’s therapy session the pain and effort got to me. I wanted my leg to just. be. better. Right then and there I wanted it to be where I know it will be eventually. I resented every repetition of every exercise, even while I was striving my hardest to push, to press, to straighten, to bend.

I didn’t whine audibly, although I did cry out a couple of times when the therapist was physically manipulating my leg. I refused to give up or ask to stop. Instead I dug deep, told myself to suck it up and kept working, kept pressing, kept going for more. My therapist said that we made progress and that my leg was straighter at the end of the session. I’m glad he could see it because I couldn’t, and I couldn’t feel anything but tired and sore.

After that I went to my massage therapist to see if she could help me with the nightly problem that is creating my sleep deprivation. Every night, I fall asleep and then a couple of hours later a persistent, annoying, powerful ache wakes me up. It starts in my right glute, travels down my leg, often crosses over the quads and can go down into my calf and shin. It doesn’t matter that I take a pain pill before I go to bed and have even been using a sleeping pill on the suggestion of my surgeon. Once the ache wakes me up, I’m then up for two to three hours. I come out into the living room and try shifting lots of positions to find one where I’m more comfortable.  Depending on what temperature I think will feel better, I either warm up the heating pad or use the ice machine cooling contraption.

I’m worried about taking pain pills too close together so I hold off as long as possible to the right time before I take another dose.  That’s all well and good, but it takes a while for the medication to get into my system and help.  Sometimes I just give up on the idea of going back to sleep and just start doing stuff around the house, banking on getting in naps during the day.  Even though I can take those naps, the interrupted sleep really throws me off mentally and emotionally.

I’m tired of it. I want a good night’s sleep. I resent the pain.

Look, I knew to expect a period of pain, intense pain, after surgery. I just honestly thought that I would be experiencing significantly less by this point. Maybe I am.  No, probably I am, but it just doesn’t feel like it today.

The massage therapist worked on me for an hour. She doesn’t just do tissue massage, but instead feels for the nerves, the circulation, the muscles and how everything connects and affects the other parts of my leg. I believe that I started to experience some relief and she confirmed better blood and energy flow so, I am cautiously hopeful that tonight will be better.

She and I are friends and have know each other for several years. Because of that, I felt comfortable discussing another complaint. If you watch television much, you’ve probably see ads with people talking about opioid related constipation. Folks, that’s not something created by pharmaceutical companies. It’s a real thing and it sucks. I do not want to call my doctor and ask for yet another prescription medicine. Instead, I’m trying to correct the problem with a special herbal tea, prunes and, today, my letting my massage therapist work on some of my internal organs too. Please, let’s all be hopeful.

I got home from my appointments and experienced a big, emotional let down.  I’m just tired of hurting, not sleeping, being constipated and everything else. Tonight, it’s all getting to me and I think I may even need to indulge in a good cry to let everything out.

Tomorrow, I’ll pick myself up and get back in the game but tonight, I needed the whine. Thanks for listening.