Weighty Matters

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Five Weeks and Counting

on April 21, 2017

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.

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