Ohhhh, My Aching (Blank)

My back has starting to hurt me, but my feet and legs have been aching for years. LOL.

I've been an ER nurse for about 20 years and constantly being on my feet for 12 hours is getting a little too much for me.

Maybe time for a clinical job? LOL.

I was told by an orthopedic surgeon, that I've walked off the fat pads from the "balls" of my feet! No more high heels for me (at age 70)! We're lucky to be living at a time when good footwear is available. I'm looking forward to the "Sketchers'" rounded "exercising" soles. When I went to the outlet of that manufacturer's products here, I was amazed that other styles of their shoes cost almost $50. Children's itty bitty copies were close to $30.!

When my back "went out" at your age (20 years ago), I saw an acupuncture doctor for 2-3 visits weekly, during the acutely painful time, then once a week for a few years. That wasn't covered by my health insurance. However the "network" chiropractic sessions I had simultaneously, were covered, and my back wasn't jerked into luxation (? from subluxation), the doctor said that when it was ready, it would just slip into place. She hardly touched me, and it did! However there was lots of spontaneous crying...... It's an amazing process wherein a lot of the emotional woes I had "on my back" were relieved. My back adjusts itself painlessly now. I'm so glad that I had all that work done. It was originally treatment, but has also prevented further pain, and my posture is better.

Isn't that just typical of mothers, to work through our pain without stopping to have it treated? I remember those days, and how much I wanted to see my children after work - so much so, that I didn't want to delay getting to them, to have treatment for my ills. Sure, I'd leave work to get them to the doctor when it was necessary, and not consider my own needs!

It's time that we considered ourselves worthy of care! The expense, time, etc. involved stops us, but we do everything we can for others. 25 years ago, I had 3+ pitting edema in my lower legs 25 years ago, and my doctor ordered diuretics. They work as long as I remember to take one each morning (again putting other things first sometimes). They have prevented HTN, too!

I hadn't known about the interior venous structure that has "valves" that help blood return to the heart from the LEs, and how they wear down in later life...... Now that I'm 70 and my children are grown, I appreciate the preventive care I was given, which many women don't get.

Avail yourselves of preventive measures, now, fellow nurses! Your bodies will thank you later.......oh, and keep your feet higher than your hearts, whenever you can. Have you heard that "nurses never stand when they can sit, and never sit when they can lie down"?

Lois,
I'm already having a tough time being on my feet for 12 hours and some days more. I get awful swelling that hurts my ankles. What's your advice? I can't do diuretics b/c I'm pregnant. I was using these weak compression stockings, but they're not really working. Maybe a bit more compression?

Several things cause leg and foot swelling, especially when you're pregnant. The first and most obvioius thing, is the expanding abdomen, which puts pressure on your LEs' blood vessels. It's harder to get the return flow of blood (more volume of plasma, not blood cells) when you're pregnant)back to the heart for oxygenation, yet it must. So it does this magic act of returning the blood cells along with some fluid, but leave a lot of fluid (plasma) behind. That's called "stasis". The very worst thing for that would be to further block the return flow of blood, by using stronger "support" hose that bunches at the groin and/or ankles. If your weight gain and/or prepregnancy weight was abnormally high, that could add to your problem.

As you know, you can check on just how much fluid stayed in your legs, by pressing (gently), from top of your feet, to below your knees. If there's an imprint of your finger when you take it away each time, that "pitting" edema requires action. Unfortunately, that action is more inaction time (although you do need to move your legs around to help circulation). You'll have to inform your doctor if its 2+ or more. When that problem becomes sever, you may need a "leave", or working 5, 4 hour days (a drag if you work 3, 12 hour shifts, weekly). It beats bedrest and no work, however........

So when you're charting, find a chair that has a springy back, and adjust the knob so it will slightly recline (that relieves groin pressure). When you sit in that chair, you can exercise your abdominal muscles by leaning forward to write in the chart (rounding your back like cats arch theirs), then slowly go back to rest your upper body on the back of the chair while you think about what else you need to write. When you do that, it's best to have a few thick 'phone books or one of those step things that short patients use to get back into their beds, under your feet, so your knees are separated and are above your hips.

Any exercise needs to be done very slowly, to protract the time you contract and then release muscles, WHILE BREATHING IN SLOWLY AND DEEPLY, as the back rises (just a little)THEN EXHALING AS SLOWLY as it returns to usual flat position). Quick motions are useless, and can do damage to them. As you become more familiar with doing that, it will be easier, and not take as long. Ordinarily the one above is done on the floor, "on all fours", with arching to contract the abdominal muscles, and then making your back flat (not sunken, with your rear high, which can do great harm to the lumbar/sacral vertebrae). Your labor coach/friend needs to watch you do it, with their hand lightly on your back, and if their hand goes below your hips, he/she should say, "STOP!"

By placing your lower bed legs slightly higher than the upper ones (on bricks), while you sleep, will drain the fluid that has accumulated during the day. You should not feel like your food is coming up, or your head gets congested.

Now, last but certainly most important, is to curtail your salt intake, without using salt substitutes that have K. That means eating fresh foods, as canned and frozen food has extra salt. Get used to reading labels to add thye NA content and maintain it at less than 1200 mgm. Cut the amount of salt in recipes by half to 3/4 less than that recommended in the cook book. NEVER ADD SALT TO YOUR FOOD!!!! Precooked food purchased at markets, has a ton of salt, as does restaurant food. All cheese is particularly high in salt, as is seafood that comes from oceans - salt water. That's where most people faulter, as a lot of less expensive dishes require cheese. Seafood can be washed to get some of the salt off it, but not so cheese. As you've probably known, all fish is suspected of having mercury, and must be eaten seldom, while you're pregnant. For some reason, pink salmon (the cheaper kind), has less mercury.

Removing salt from men and women's diets prevents HTN and HD, so it's a good idea to keep it low all your lives.
Drinking more water than usual (at least 8 - 10, 8 OZ. glasses of fluid daily, including juices and tea (not coffee), is also a way of removing salt from your body. Keep a glass full of something, by your bed, desk, favorite chair for watching TV or reading......... along with an ottoman for raising your legs (keep them up, as much as possible).

Lois,

Thank you so much for taking the time to write down all of that information I'm actually printing it out to keep with me at work as a reminder since I forget nearly everything these days. I do think it has been 3+ pitting edema and upon my next visit to the doctor, I am going to tell them. Hopefully the techniques you gave me will help keep the swelling down a bit more!

Katrina

Katrina:

I'm glad you found my post useful. I'm not actively teaching childbirth classes right now, and the information just keeps bubbling up to my fingers (on the keyboard). I'm sure that I drive my pregnant daughter-in-law crazy with my emails, and concerns about her possibly getting the H1N1 flu.

Now, about your concerns. If you are in your 7th month or further along, like 30 weeks, the 3+ edema may portend pre-eclampsia /toxemia. It would be helpful for you to keep track of your B.P., if your appointment with your doctor isn't until next week. It wouldn't be a bad idea to see if you have any protein in your urine (if there are "combistix around, or the lab will give you a few). I hope you work with others who won't get upset by you asking them to check your B.P. If the systolic is above 145, and the diastolic is over 88, it's very important that you call your doctor's office and ask to speak to the nurse or, if there's one there, the nurse practitioner. Proteinuria over 1+ should be mentioned, too. They may want you to come in, to be seen...... within a few hours.

The main early treatment for preeclampsia/toxemia, is rest, with a capital "R" and low salt diet! I hope you have the weekend off...... Learn to knit or crochet, if you don't do that already, and when you look at your fingers, note whether they're swollen. It's also time to take your wedding band/rings off, too. The fingers, and any facial swelling is usually manifested after 30 weeks, with preeclampsia/toxemia; and you'll need to have your B.P. checked then, and tell your doctor/nurse about that as soon as you notice it. If your B.P. is over 160/100, have it taken when you're on yourleft side, lying down. Pressure on the right kidney (from compressing your trunk in a sitting position) can cause BPs to rise more than they actually are.

I used to tell classes, that if you look in your mirror at your face, and that isn't you staring back, it could be facial edema - eyes, nose, lips, cheeks edematous and that can make you panicky. Slowed, "chest" breathing is good for that. A mantra to keep saying to yourself is, "I'm going to be fine", over and over - and believe it!

Keep posting, and let us know how you're doing.

Lois