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Urgency Oct-Nov-Dec 2016

This is a menu of the topics on this page (click on any): October 25, 2016    October 31, 2016    November 2, 2016    November 3, 2016    November 4-6, 2016    November 9-11, 2016    November 12-18, 2016    Nov 21-23, 2016    Nov 24-Dec 6, 2016, trying to give up sleeping pills.    Dec 7, 2016, ASSESSMENT    Dizziness Test    Daily reports December    Five Month Assessment   .

\These are notes on my recovery from knee surgery & the side effects of it & it's medicenes & it is the foundation of a strategy by which I hope to resume a normal productive life. (updated 1/ 5/17 14:02)

    BACKGROUND
  1. In my past I've usually not had trouble sleeping or staying balanced and focussed.
  2. I had knee surgery (to attach the top two quadplex-muscles to their knee tendons) on 8/4/2016 and have been trying to recover since.
  3. Conclusions from talk with my primary physician Dr. Roy Bassett on 10/20/2016
    1. My condition is frequent dizziness, lack of presence of mind & focus, and anxiety (especially when worrying about lack of sleep & other stuff)
    2. Been taking 10mg Ambien nearly every night from 8/4-10/20; now try cutting them in half & see how 5mg works.
    3. 5mg worked good the night of 10/21 except I woke early as usual, felt pretty good during the day.
    4. (Same experience 2nd night 10/22, woke up at 3:30am and struggled to sleep or rest til I got up at 5:00 am. Felt tired all day.)
    5. (It seems I wake up at 3:30 or so each morning and have little or no ability to resume sleep. And I am simply not getting enough sleep & rest.)
    6. I must avoid new challenges, my plate is full
    7. Slow down, resist doing things quickly or fast, make myself (my life) smaller to fit my possibities.
    8. Xanax for anxiety is NOT A GOOD IDEA
    9. Physical Therapy is very important and I must have skilled guidance as I have with Elvis
    10. CPAP machine is very important and I must use it right
    11. Dizziness is helped by swimming and walking exercise & it is a good sign that I never feel dizzy when swimming since I roll my head every stroke
    12. Study Sleep Hygiene, a very important subject for me
    13. Dr. Roach says "Most people get good results from non-drug treatments, such as sleep hygiene, relaxation training and cognitive therapies."
    14. "For people who have really tried these and have not had success, I (Dr.Roach) recommend seeing an expert in sleep medicine to determine the least dangerous medication treatment."
    15. I must avoid electronic devices for 2-3 hours before sleep, even a moment of exposure can be bad (vibration, rays, & light)
    16. I have a tendency to slump when standing or sitting, I must strengthen my inner voice to remind me of this and I must change my behavior.
    17. Maintaining these notes is like "work": it gives meaning to my life including the satisfaction of doing something well, & maybe it will help my healing.
    TAKING CHARGE OF LIFE
  1. Nancy urges I learn about meditation, and Elizabeth Pankey-Warren might be very good help for me.
  2. Dmitri on 10/21/2016 said one must encourage & strengthen the inner voice that makes you do things right (listen to your gut)
  3. Your body must tell you when things are not right whether you are swimming or working with resistence machines or seeking good posture.
  4. 20161024 Mon SLEEPSUCCESS : cut Ambien in half for 5mg + 1 Melatonin 3mg, swam half mile at 2:00 pm & back extensions, Jesus Prayer, CPAP, happily in bed 9-5:50, mostly asleep 9:15-5:15, up 8-10 times to pass urine

October 25, 2016

This page is on the internet ( www.vivaboca.net/notes/urgentoct2016.htm ) and the links can be clicked & seen if one views it there. In my history I have now and then had trouble peeing and had a couple of visits with Dr. Scott Dudak for it 10 or so years ago. On 8/4/2016 I had knee surgery to reattach two quadplex muscles to their tendons. Recovery has been very difficult. The knee surgeon prescribed Ambien and I took 64 pills til I quit them starting on the night of 10/25/2016. A complete list of my medications is available by clicking on this link. I saw Dr. Dudak on 9/21/2016 and was helped as he prescribed Finasteride 5 mg tablet 1 by mouth every day (for 6 months, then my prostrate will have shrunk). Lying in bed awaiting sleep was very difficult (creating great anxiety) til my wife suggested I learn about meditation and now I am able to handle the time awaiting sleep better. Focussing on the breath I interpret the wait as meditation rather than yielding easily to anxiety. My problem is that I get up to pee 8-10 times each night and that makes it very difficult to get useful sleep. I have measured the amount I pee at night and it is typically 1 ounce. I am exercising w/ Physical Therapy and swimming lots but that is not sufficient to solve my sleep problem. And I notice that if the need to pee that one ounce is evident as I walk to swim it does not effect me while I swim my half mile. A non-urgent need for urination daytime is OK because the pressure is more easily ignored and release is convenient. My brother (a family physician) says urologists have ways to modify the prostate to solve my problem, and I am wondering if that or something else might help. I have an appointment on 10/31/2016 Monday 1pm with Urologist: Dr. Scott Dudak, 9325 Glades Road, suite 101, Boca Raton, ph-561-482-8111, fax 561-451-1768
  1. 20161026 WedAM SLEEPSUCCESS : NO AMBIEN 1st night ; interpreted sleep effort as meditation so was not unhappy ; rested 10pm-6:10am ; peed 8-10x ;
  2. best sleep position for me is on stomach with head looking right w/ CPAP and with pillow scrunched down under head to make it linear with spine & with right leg in front. This position is very comfortable for sleep but not easily changed and it is difficult to scratch if I itch somewhere.

October 31, 2016

Tired lots in the daytime, need naps, swimming also seems to help. Often feel dizzy when standing up or walking. Knee feels weak, not able to easily climb stairs normally. Easily forget things. Dr. Dudak did not feel he should do more to try to help me, saying my primary physician should lead how we deal with issues of sleep, dizziness and P.T. Dr. Dudak said he'd see me in 6 months. (4/24/2017 1:00pm)

November 2, 2016

I have 16 exercises in my P.T. program now and I did 12 of them on 11/1/2016. At the end of the day and on the next day I was tired and my knee hurt.

Dr. Harry is surprised that Ambien was used so extensivly for me saying he'd more often heard of Tylenol PM being used to help sleep after surgery with minimal side affects. He urged these:

  1. Avoid electronic devices in the two hours before bed.
  2. Take a 30 minute walk to help relax before bed, and generally do things to bring relaxation.
  3. Take a 3 mg Melatonin 30 minutes before bed.
  4. Take a hot bath with 3-4 handfulls of Epsom Salts before bed.
  5. He said 10:00 pm or 10:30 pm are optimal times to go to bed to best preserve the Circadian Rhythm.
He felt that power naps of 15-20 minutes during the day are OK. I will follow his advice as I prepare for bed on Wednesday evening 11/2/2016. I have an appointment on 2016/11/03 Thu 9:30am with my primary physician Dr. Roy Bassett, 561-865-1720 .

November 3, 2016

Dr. Bassett feels I am on good course. Says might stop Melatonin & start half a pill of Tylenol PM, try whole pill if that does not work. Wrote RX for Trazodore 50mg if Tylenol does not work. Nap til 1:45 pm. Going to bed with 1 full capsule of Tylenol PM at 10:10pm on 2016/11/03. Awoke at 7:54am after intermittent sleep that was better than the prior 3 days. Lots of trouble emptying bladder during the night, but still sleep episodes were easier to get than in the prior 3 days.

November 4-6, 2016

Swam today & saw Dr. Harry. Worked on "FolderLibs1Drive". Two attempts at naps today did not work. Cut in half four Tylenol PMs and have taken 1 half capsule for tonite (11/4) replacing Melatonin. I expect to continue taking 1 half capsule of Tylenol PM and no Melatonin from now til this is reconsidered. Also today (11/5) I worked out on 5 machines and found myself quite sore from my heavy machine workout on 11/1. Waking in the AM of Sunday 11/6 I felt I had had a pretty good night (on a half capsule of Tylenol PM). Will try again tonite and report on waking 11/7. I still frequently feel some dizziness during the daytime.

November 9-11, 2016

On waking in the morning of 11/9/2016 I was very happy to have had the best night's sleep in a long time. (11/7-8 was not so good.) Still taking half a capsule of Tylenol PM each evening and exercising. My main concern in the last couple of days is that my knee which had surgery feels distinctly swollen & warm to the touch & I have not noticed this before. I don't think it is because of wrong or too much exercise, so I need to get some medical or PT advice on this. Liza who works with Elvis in PT says what is happening with my knee is normal and should pass in a few days or a week. It is worrisome that I am still somewhat tired, dizzy, confused and cognitively impaired in the daytime, presumably due to the Ambien (which I used for two months starting 8/4 & fully winding down on 11/2) but whose effects I have not yet escaped from. There must be a way to get medical assistance to escape the recurring dizziness and related symptoms which I assume are from the Ambien. On Nov 11 I report having had a good night in that I slept quite a bit though I still had to get up every hour to pee. Peeing was mostly successful and I seemed to go back to sleep pretty quickly. Half a capsule of Tylenol PM might prove to work well at night. I am not finding myself able to take naps in the daytime these days. My right knee remains slightly swollen, warm and sore and I still get several warnings every day that feel like a possible imminent collapse of my knee. I am ready to resume physical therapy and hope to add a couple of upper body routines so protect my shoulders and neck from my sleeping on my left side.

November 12-18, 2016

I'm now finding that with Tylenol PM & meditation techniques to manage my mind I am able to get thru the night without the anxiety that used to hurt me. So it is not a sound sleep, but it is a resting state. I do still have to get up to urinate 8 or 12 times a night, but I am usually able to return to my resting state fairly easily. My concern is that I am not getting a good sleep and so each day I have the dizzyness & tiredness that limit me. My brother, Dr. Bob House, suggests I try a full capsule of Tylenol PM for a few days or a week and if needed then try the trazodone Dr. Bassett prescribed in case the Tylenol PM does not work adequately. He says each sleep aid needs to be used for a few days or a week and that I need to take notes on how each works so I can sensibly draw a conclusion on a sleep strategy for me. Monday Nov 14 am, took full capsule of Tylenol PM last night and resting state was better and easier to get to. Don't know yet whether my days will get better or not. I am troubled by strange condition in my throat that has been developing over the couple of weeks. I have frequent throat irritation that Hall's cough drops do not help and my voice is strange. The following get importance from visit with Dr. Bassett (2016/11/14).
  1. Azithromycin Tablets USP 250 mg 9 (a full dose of antibiotic therapy in Just 5 doses) and which keep working on days 6 thru 10. Day 1=11/14/2016.
  2. MethylPREDNISolone Tablets, USP 4 mg Steroid (21 tablets) (limit alcholol use while taking this drug, daily alcohol use is risky) OmerY Ulku 11/14/2016. Day 1=11/16/2016.
  3. continue 1 capsule of Tylenol PM each nite
  4. sleep specialist, probably in Miami, or U of Miami
  5. orthopedist, Holy Cross, Dr. Delgado-Garcia
  6. next appointment with Dr. Bassett: 11/28/2016 & 12/28/2016 2pm per Sandy Strauss
  7. Sue Graves & Denise Merrill, FAU Department of Exercise_Science_&_Health_Promotion, http://www.coe.fau.edu/academicdepartments/eshp/
Another full capsule of Tylenol PM for the 3 nights ending in AM of 11/15-16-17/2016 got similar result. The Tylenol got me thru the night but during the next day I was tired & weak, not strong, not refreshed & not effective. I hope the Azithromycin and MethylPREDNISolone tablets I am now taking will make a difference.

Nov 18, Friday AM. Last night was my best night's sleep in a very long time. 10pm-6:45 am in sleep or deep resting state except for 8 or so times to pee all of which were successful and included easy return to sleep or resting state. Monday I resume with my PT coach and top priority will be to deal with the continuing discomfort and fear from my right knee.

Nov 21-23, 2016

  1. Nov 21 am: I THINK I MIGHT HAVE SLEPT THRU THE NIGHT WITHOUT HAVING TO GET UP TO URINATE. IF SO, IT IS A FIRST IN A LONG TIME AND IS A WONDERFUL IMPROVEMENT.
  2. Nov 22 am: Shared bottle of wine and did not get good night's sleep.
  3. Nov 23 am: Pelegrino soft drink and did not get good night's sleep. Today I have the ususal dizziness, clumsiness, knee pain, & loss in mental acuity.
Top priorities for me now are
  1. to review my stats to learn if I have low blood pressure. Internet research says that might be a cause of my dizziness. Andy has agreed many times to give me a copy of my stats, but I've not been insistent enough in asking for them as she has not given them to me. That is high priority now. I want to see not only recent stats but also past points in time to see if there has been change since my dizziness has come upon me in the past few months.
  2. And to make progress on Physical Therapy as my knee is still sore and worrisome and P.T. assistance has lacked insurance authorization. I have an appointment at The Training Room with Elvis today at 2:00 pm.

Nov 24-Dec 6, 2016, trying to give up sleeping pills.

We have new news on Tylenol PM (my recent choice for help in sleeping). Diphenhydramine (DPH) is in PM products and "should be avoided in the elderly. Grogginess, drowsiness, confusion, and memory loss have been well described with use of DPH."
On Thurs 11/24/2016 The People's Pharmacy (Joe & Teresa Graedon) reported this quoting Clinical Therapeutics online , Oct. 14, 2016. These are precisely the symptoms I jumped away from Ambien for, so it I fear I must give up use of Tylenol PM as well.
* 1st night (Fri,11/25/2016), as I prepared for bed I took all my medications except I did not take Tylenol PM (or Ambien). Sleep was not easy, but I got thru the night using the meditation tools developed in recent weeks with Elizabeth. The next day (Sat,11/26/2016) included the same "dizziness, clumsiness, knee pain, & loss in mental acuity" I have reported. My intent is to try again for a second night and a third night (11/26-27) so I can discuss this with Dr. Bassett at 2:00pm on 11/28/2016.
* 2nd night (Sat,11/26) without a sleeping pill I slept or rested ok during the night, but next day (Sun,11/27) had symptoms of "dizziness, clumsiness, knee pain, & loss in mental acuity".
3rd night (Sun,11/27) had severe pain in left shoulder so took half an Ambien (leftover) to help me thru the night. Also treated shoulder with ice pack, heating pad, and massager (Panasonic Panabrator II EV221 Matsushita Electric Works Full Body Massager by Panasonic $175). -11/28MonAM swam 1 mile at LAFitness 58? mns
* 4th night (Mon,11/28) no sleeping pill I believe, do not recall quality of sleep, performance next day was as usual. -11/29TueAM swam half mile 30? mns
* 5th night (Tue,11/29) no sleeping pill, to bed 9:13pm, slowly got to sleep &/or resting state w/ meditation skills, awakened 1:30-2:30, then sleep/resting state til 6:30am. Then StG Men's Spirituality Group. Nap from 10:07 to 11:37. -11/30WedNOON swam 2:30-3, before swim had lots of pain in shoulders but swim did not help.
6th night (Wed,11/30) shoulder pain & lots of other distress before bedtime, so took half a Tylenol PM capsule. Lots of pain thru the night plus getting up to pee. Did not feel anxiety thank goodness, but not a happy night. Attempting sleep 11:45pm-6:45 am. On waking felt relief to be getting up. Discomfort in shoulders but not bad pain.
7th night (Thu,12/01) shoulder & neck pain & lots of other distress before bedtime, so took half a Tylenol PM capsule. Room was warmed to 77 degrees with a space heater. Helped by 1 hour massage, 30 minute swim 2:08-2:38pm, and application of Biofreeze Pain Reliever from Mar-J to shoulder/neck area just before bed. GOT HIGHEST QUALITY SLEEP FOR THIS TIME IN MY LIFE 10:15PM-7:00AM GETTING UP TO PEE MAYBE 4 TIMES, WOKE REFRESHED & WITHOUT PAIN, SLEPT ON MY LEFT SIDE. Still felt dizziness & clumsiness when I walked my dog. And my knee is a constantly telling me not to trust it. Dizziness, Clumsiness, Fatigue, Knee warnings, & Loss in mental acuity ("DCFKwLma") persisted throughout the day.
8th night (Fri,12/02) trouble settling in, so took half a capsule of Tylenol PM, worked on computer for a bit, back to bed at 11:30pm.
* 9th night (Sat,12/03) no sleeping pill except Melatonin 3mg, got up 8+ times to urinate, mostly not successful, sleep/rest 9:30-6:15.
*10th night (Sun,12/04) no sleeping pill except Melatonin 3mg, woke 5+ times to urinate & was successful, sleep/rest 11:30-6:30.
*11th night (Mon,12/05) no sleeping pill except Melatonin 3mg, got up 8+ times to urinate, mostly not successful, sleep/rest 10:00-6:00, awoke feeling rested.
*12th night (Tue,12/06) no sleeping pill except Melatonin 3mg, got up 8+ times to urinate, mostly successful, sleep/rest 10:00-7:00, awoke feeling rested.

Dec 7, 2016, ASSESSMENT

  1. Four nights in a row without sleeping pills & 4 nights without in the prior 8 nites, still waking often to pee & successful half the time,
  2. Dizziness, Clumsiness, Fatigue, Knee warnings, & Loss in mental acuity ("DCFKwLma") still persist throughout each day.
  3. Doing good at swimming.
  4. Not getting physical therapy except that which I do myself according to my plan for strength training.
  5. I am deeply troubled that Dizziness, Clumsiness, Fatigue are so bad and they are still persisting (not getting better). Surgery was August 4.
  6. I am deeply troubled that my knee has not gotten any more comfortable since PT began on October 3, 2016 with Elvis.
  7. On Nov 28 Dr. Bassett began the process of issuing a referral for a new physical therapist. It took til 12/22 (24 days) to be able to make an appointment.
  8. I must learn from Tim McGonigil to take charge of finding a good Physical Therapist & pushing to make the program work.
  9. Since Dr. Delgado-Garcia prescribed Ambien for me but did not warn me of the side effects, shouldn't he be helping us find solution for the side effects ?

Dizziness Test

2016/12/12 Led by Dr. Robert H. House on phone & helped by Nancy, I took a "ice caloric stimulation test" and it produced the same dizziness I have been experiencing (2016/12/12 9-10am). After the test I was quite dizzy and sleepy and I took a 100 minute nap (10:25am-12:03pm) that felt like deep sleep. This was extraordinary since daytime naps do not work very well for me (hard to sleep in daytime). This suggests "vertigo" and that I should get an "epley" evaluation of my (auditory) vestibular system. (inner ear).

Daily reports December

(dates are as of going to bed)
20161207 Wed rested 8:30-6:00
20161208 Thu rested 11:08-6:50
20161209 Fri swam,SR,Morikami,2-3 glasses wine, bedtime 9:30 sleep start normal, but at 3am sleep wretched,LB,slept/rested til 8:30am
20161210 Sat CS Swim Meet: swam 4 events, 2 times were faster than times before 8/4 surgery & 2 times were slower. sleep/rest 10:30-7:00; severe knee discomfort at 4am, ice pack 10 minutes, then resume attempted rest & maybe some sleep til 7am.
20161211 Sun CS Swim Meet: swam 2 events, 6 in 2 days, 4 first & 2 second place ribbons, breastroke very good, sleep-rest 11:30pm-5:30am, nap 6-7am.
20161212 Mon Epley test 9am, 100 minute nap daytime, SLEPT EXCEPTIONALLY WELL 11:15pm-6:45 am, maybe no interruptions 11:15pm-5:30 am.
20161213 Tue slept good 9:45-6:45, woke to pee 6+ times, mostly successful but very small quantity, less dizziness than normal, knee hurts when get out of chair. next day had good nap 11:45am-12:18pm, woke feeling rested, 5:40-6:35pm, all exercise routines at Michael's Body Scenes.
20161214 Wed slept 1:08-7:00am (Thu); then at 8am swam 1000 yards 35:02, nap 12:00 noon-12:15pm
20161215 Thu slept 10:30pm-7am, ok but possibly hurt by a little wine (3-4 oz with dinner), got up to pee 6? times, PT w/Elvis 3pm, nap 5-5:20pm.
20161216 Fri PT*** 3:00pm Elvis, slept/rested 11-7 ok, got up to pee 6? times, swam 1000 32:21.62
20161217 Sat slept ok, probably 10:30-6:00, Sunday dizzy & tired
20161218 Sun PT*** ON MY OWN AT MICHAEL'S AND HOME , 4:00pm Seraphic Fire at St. Gregory's , slept ok, probably 10:30-6:00, Mon dizzy & tired
20161219 Mon 10:45am Dr. Roy Bassett cancelled w/ no new appointment, slept ok, probably 10:30-6:00, Tues dizzy & tired
20161220 Tue PT*** 10:30am Elvis w/ tougher PT,4 oz wine w/ dinner, computer work all day til bedtime, slept/rested good, up 6?x, 10:30pm-7am
20161221 Wed swam 1000 yards 35:32,
20161222 Thu PT*** 10:00am Elvis
20161228 Wed PT with Arturas Placas at Golden Orthopedics (he is excellent & so is his associate Krista Farnes)
20161229 Thu swam 1000 free 32:42 : pace 1:38
20161230 Fri PT with Krista Farnes at Golden Orthopedics (she and Art are excellent)
20170102 Mon swam 1000 free 29:06 : pace 1:27

Five Month Assessment

(1/1/2017 Assessment, 5 Months After Surgery)
  1. dizziness is serious with lots of fatigue, maybe Vertigo. I have not yet seen a neurologist for help, Dr. Andrew Brown said his training did not prepare him to help me (10/10/2016).
  2. lots of congestion, runny nose, sneezing. Dr. Chrzan (2017/01/03) proposes an ENT Dr. for dizziness, let's have him deal with ENT issues as well.
  3. sleep is ok but maybe not deep, must get up to pass urine 6+ times per night. My only sleep specialist was of no help (Dr. David Brodner 10/14/2016).
  4. only Melatonin & exercise are used to help sleep, not using Ambien or Tylenol PM anymore.
  5. lots of discomfort & fear re: my right knee. Need good physical therapy and expect to get it from Golden Orthopedics.
  6. I sleep on my left side with help from BioFreeze for soreness. I hope the BioFreeze is not masking stress & injury and creating future problems.

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