Ibuprofen & drowsiness: Well, duh.

[Nords]

For the last year I've been "recovering" from the effects of two torn ACLs followed by repeatedly overstressing the remaining knee ligaments. I use quotes because mobility is quickly hampered by swelling, there's little stability, the knee's surrounding muscles atrophy very quickly, and the physical therapy is almost as bad as the injury. A year later I can do squats again and I'm popping up on my longboard instead of creaking up like Frankenstein. From here the recovery depends on more squats with more weights, lots of hamstring, adductor/abductor, & ITB stretches, and not putting too much lateral stress on the knees too quickly. I can almost go down steps without using a handrail. In another six months I may be able to squat down to my heels again and get up without using my hands. In another year I may be back to single-leg squats like in my 30s. Kids, take care of your knees and don't try to stretch your joints like a Chinese acrobat.

None of the physical therapy really works until the swelling goes down, and that requires anti-inflammatories. Lots of 'em. At one point I was taking 800 mg of ibuprofen 3x daily for over three months, and the orthopedic surgeon said that if it didn't work then he had a whole pharmacy of alternatives. The idea is to avert the body's tendency to pump fluid into the knee while I'm rebuilding stability & strength.

During this time I was surprised at how slowly I'd recover from the "activities of daily living". I expected tae kwon do to be tough, especially with a couple pounds of knee braces on each leg. But I'd also be crapped out after surfing, heavy yard work, or even a long evening walk. This just didn't seem right for a 46-year-old who's eating healthy, taking supplements, and not subject to job-related stress. I didn't analyze it, though, just writing it off to rehab and to "getting old sucks".

Until yesterday. I haven't used ibuprofen for a month but I hauled a lot of mango branches on Tuesday, worked hard on Wednesday-night tae kwon do, and woke up pretty sore on Thursday. So I took 800 mg as soon as I got up and another 800 mg eight hours later.

I was hammered. We're talking six-pack-of-beer-before-lunch immobilized. I zonked out at 10 AM for a couple hours, woke up exhausted, stumbled around for a couple more hours, and dozed off in the recliner for 30 minutes. Usually that type of behavior totally ruins my sleep at night but I slept over eight hours and still woke up groggy. Sure enough, there's a "drowsiness" warning in the ibuprofen supplemental info. I never even thought that could be the culprit.

Now I'll pay more attention to the timing. At this stage in my rehab I can get by on taking it after tae kwon do (which should lead to a very good night's sleep) and a compression-wrap icepack during the day. I don't think I'll be using ibuprofen so much during the day anymore.

Once again I proved to myself that excessive fatigue is not just a symptom of aging. If you're tired all the time, look for a problem! I'll pay more attention from now on and this time I really mean it.

So next it's back to the orthopedic surgeon for another anti-inflammatory. Any recommendations?

 

[Texas Proud]

Wow....

Sorry to hear about all the problems.... I guess my slipped disk in my lower back that gives me a sharp pain every once in awhile is not looking so bad....

 

[Rich_by_the_Bay]

Fatigue is not generally reported with ibuprofen as being any different from placebo. That said, there are always idiosyncrasies in how people react to various medications. I'd be inclined to look elsewhere for why you were so bushed.

If it persists, you ought to have your blood count checked. That much ibuprofen for that long can lead to digestive bleeding and anemia. Now that can cause fatigue. As far as NSAIDs go, ibuprofen is probably as safe and effective as any.

 

[Nords]

Fatigue is not generally reported with ibuprofen as being any different from placebo. That said, there are always idiosyncrasies in how people react to various medications. I'd be inclined to look elsewhere for why you were so bushed.
If it persists, you ought to have your blood count checked.

Good point, I'll add it to the "annual checkup" list...

 

[Martha]

I hauled a lot of mango branches on Tuesday

How can you tell if a Mango is ripe? We buy them and just guess. Most are wonderful but sometimes they are woody or not as sweet as the great ones.

 

[Nords]

How can you tell if a Mango is ripe? We buy them and just guess. Most are wonderful but sometimes they are woody or not as sweet as the great ones.

Believe it or not, that's why we're hauling all the mango branches-- or we'd have a pickup-truck full. We can almost see through the tree again!

You're supposed to pick a mango the day before the birds get to it. I've had mango (hiding in the top of the tree) that were nothing more than a skin shell around a seed, carefully pecked out from a single hole by birds that hollowed their way through.

So we pick them when they're turning yellow (with just a hint of red) and let them ripen on the counter. At the store you can probably pick them when they're mostly yellow & red. They're not ready when they're hard, they're still good when they're soft, but when they get black spots then they're turning rotten. This website has a series of step-by-step photos for cutting, but we just slice wedges away from the seed and eat them like watermelon.

When the crop is really heavy you're supposed to pick some of the green ones, slice them into wedges, and pickle them (any pickle juice will do) with li hing mui powder. Yummy but lots of work...

 

[califdreamer]

Fatigue is not generally reported with ibuprofen as being any different from placebo. That said, there are always idiosyncrasies in how people react to various medications. I'd be inclined to look elsewhere for why you were so bushed.

If it persists, you ought to have your blood count checked. That much ibuprofen for that long can lead to digestive bleeding and anemia. Now that can cause fatigue. As far as NSAIDs go, ibuprofen is probably as safe and effective as any.

Without going into all the details, I experienced a period of chronic fatigue in mid-2006. I got especially tired during and after taking a warm shower. It got to the point where I was having to kneel down in mid-shower because I felt so tired. Told the doc about all this, he had me get blood count taken and, sure enough, I was down to about 1/3 normal blood level. Apparently, a warm shower draws blood toward the skin and away from vital organs and essentially shuts you down if you're low on blood. I was absolutley shocked when I found out. The docs and lab people were amazed I was functioning at all. I was ordered to go immediately to hospital for transfusion. Culprit was digestive bleeding.

 

[MikeD]

I was ordered to go immediately to hospital for transfusion.

Man, oh, man, does it feel great to just have had a transfusion, or what?

I had very low red blood cells due to kidney failure and had to get a transfusion (two units - I don't know what that means) to be able to stay concious while standing or sitting. Afterwards I went jetskiing. It only lasted about a week, though. Very interesting experience.

Mike D.

 

[Nords]

If it persists, you ought to have your blood count checked. That much ibuprofen for that long can lead to digestive bleeding and anemia. Now that can cause fatigue. As far as NSAIDs go, ibuprofen is probably as safe and effective as any.

Without going into all the details, I experienced a period of chronic fatigue in mid-2006. I got especially tired during and after taking a warm shower.
Culprit was digestive bleeding.

Man, oh, man, does it feel great to just have had a transfusion, or what?

OK, now you guys are just scaring me. I'm going, next couple weeks, I swear...

 

[Rich_by_the_Bay]

OK, now you guys are just scaring me. I'm going, next couple weeks, I swear...

Sorry, Nords. While you're at it, have your kidney function blood test checked, too (creatinine).

PM me if I need to calm you down . But seriously, these are reasonable precautions for anyone on that much ibuprofen or similar drugs, in my opinion.

 

[Nords]

Sorry, Nords. While you're at it, have your kidney function blood test checked, too (creatinine).
PM me if I need to calm you down . But seriously, these are reasonable precautions for anyone on that much ibuprofen or similar drugs, in my opinion.

No worries-- just the anticipatory thrill of combining it with the prostate exam and the 12-hour fast for the cholesterol test. And if I'm really lucky maybe they'll be giving away free colonoscopies!

 

[califdreamer]

No worries-- just the anticipatory thrill of combining it with the prostate exam and the 12-hour fast for the cholesterol test. And if I'm really lucky maybe they'll be giving away free colonoscopies!

Ain't middle age great?

 

[Rich_by_the_Bay]

No worries-- just the anticipatory thrill of combining it with the prostate exam and the 12-hour fast for the cholesterol test. And if I'm really lucky maybe they'll be giving away free colonoscopies!

Hey - you think it's fun from this end?

 

[Alan]

No worries-- just the anticipatory thrill of combining it with the prostate exam and the 12-hour fast for the cholesterol test. And if I'm really lucky maybe they'll be giving away free colonoscopies!

About 10 years ago the company doc suggested I have a routine proctoscope check-up. I think I was 43, healthy enough, but it was free so what the heck.

After the proctoscope (telescope with a flashlight on the end I think - no drugs either) the urologist said he could see a polyp so he wanted me back for a colonoscopy. The next week I was back, and while I was drugged I was awake and watched the procedure through the TV screen. When he finished I said that I didn't see anything. He confirmed that all was clear and that what he had seen the week before was a shadow cast by a natural fold in the colon. He then said that I had an exceptionally long colon and his instrument couldn't get all the way around, so he was calling downstairs to have me go down for a barium enema scan. (can't remember the name of the procedure but it was awful).

Didn't mean to move off topic, but the mention of a free colonscopy gives me the willies

 

[Nords]

Hey - you think it's fun from this end?

I guess that would depend on who's paying whom...

After the proctoscope (telescope with a flashlight on the end I think - no drugs either) the urologist said he could see a polyp so he wanted me back for a colonoscopy. The next week I was back, and while I was drugged I was awake and watched the procedure through the TV screen. When he finished I said that I didn't see anything. He confirmed that all was clear and that what he had seen the week before was a shadow cast by a natural fold in the colon. He then said that I had an exceptionally long colon and his instrument couldn't get all the way around, so he was calling downstairs to have me go down for a barium enema scan. (can't remember the name of the procedure but it was awful).

You've encapsulated my feelings about the entire process.

And you've given this board so many free punchlines that I don't know where to start!

 

[dumpster56]

For the last year I've been "recovering" from the effects of two torn ACLs followed by repeatedly overstressing the remaining knee ligaments. I use quotes because mobility is quickly hampered by swelling, there's little stability, the knee's surrounding muscles atrophy very quickly, and the physical therapy is almost as bad as the injury. A year later I can do squats again and I'm popping up on my longboard instead of creaking up like Frankenstein. From here the recovery depends on more squats with more weights, lots of hamstring, adductor/abductor, & ITB stretches, and not putting too much lateral stress on the knees too quickly. I can almost go down steps without using a handrail. In another six months I may be able to squat down to my heels again and get up without using my hands. In another year I may be back to single-leg squats like in my 30s. Kids, take care of your knees and don't try to stretch your joints like a Chinese acrobat.

None of the physical therapy really works until the swelling goes down, and that requires anti-inflammatories. Lots of 'em. At one point I was taking 800 mg of ibuprofen 3x daily for over three months, and the orthopedic surgeon said that if it didn't work then he had a whole pharmacy of alternatives. The idea is to avert the body's tendency to pump fluid into the knee while I'm rebuilding stability & strength.

During this time I was surprised at how slowly I'd recover from the "activities of daily living". I expected tae kwon do to be tough, especially with a couple pounds of knee braces on each leg. But I'd also be crapped out after surfing, heavy yard work, or even a long evening walk. This just didn't seem right for a 46-year-old who's eating healthy, taking supplements, and not subject to job-related stress. I didn't analyze it, though, just writing it off to rehab and to "getting old sucks".

Until yesterday. I haven't used ibuprofen for a month but I hauled a lot of mango branches on Tuesday, worked hard on Wednesday-night tae kwon do, and woke up pretty sore on Thursday. So I took 800 mg as soon as I got up and another 800 mg eight hours later.

I was hammered. We're talking six-pack-of-beer-before-lunch immobilized. I zonked out at 10 AM for a couple hours, woke up exhausted, stumbled around for a couple more hours, and dozed off in the recliner for 30 minutes. Usually that type of behavior totally ruins my sleep at night but I slept over eight hours and still woke up groggy. Sure enough, there's a "drowsiness" warning in the ibuprofen supplemental info. I never even thought that could be the culprit.

Now I'll pay more attention to the timing. At this stage in my rehab I can get by on taking it after tae kwon do (which should lead to a very good night's sleep) and a compression-wrap icepack during the day. I don't think I'll be using ibuprofen so much during the day anymore.

Once again I proved to myself that excessive fatigue is not just a symptom of aging. If you're tired all the time, look for a problem! I'll pay more attention from now on and this time I really mean it.

So next it's back to the orthopedic surgeon for another anti-inflammatory. Any recommendations?

Did you have the ACLs repaired?

Moderator edit: quote fix.

 

[Nords]

Did you have the ACLs repaired?

No way.

"Life without the ACL"

I've spoken to over a dozen people in their 30s to 60s, with ACL surgery from 1-20 years ago, and every one of them says that their repaired knee is worse than their damaged knee. In some cases the surgery (or its complications) made things worse.

Interestingly the orthopedic surgeon didn't see the solution in terms of surgery. He said "Well, unless you're going to the Olympics, if you're going to keep doing tae kwon do then I'm just wasting my time." I'm sure he just had my best interests at heart, too.

It didn't help that I went five years (including two years of tae kwon do) without even knowing that I'd torn my ACLs. I'm not sure that there's anything to graft a transplant onto.

It's been a year since my last tae kwon do injury. I've been doing rehab for about eight months and I'm getting stronger all the time, however slight & frustrating the progress may seem at times. In January I strained my left knee ligaments again hauling mango branches but that was my own stupid fault and now I wear a brace on that leg when I'm carrying heavy loads. (The hauling was injury-free last week.) As long as I spend the rest of my life going straight ahead, or wearing orthopedic braces for harsh lateral moves, the trauma & rehab is considered to be worse than the injury. I'm probably never going to dunk a basketball or win my age group in the Ironman or cut it as a samba dancer, but I'm learning to live with that...

Of course I'm not going to get away completely unscathed. Years of Navy workouts & ACL ignorance have messed up all four of my knee meniscii to some degree. I can't completely straighten (lock out) my left knee so unless things resolve themselves (it happens) I may have to have the loose cartilage scraped out. But that's just "minor" bodywork and it isn't necessary yet.

OTOH UH has done a lot of ACL surgery in the last few years with their women's basketball & volleyball teams. And it's so bad on some college football teams that the linemen are issued orthopedic knee braces from the very beginning.

 

[dumpster56]

Good!

I also have a torn ACL and never would have the surgery. I have spent years strengthning the muscles around the knee. It has worked. Now I tend to stay away from the cutting movements. I watch out while playing tennis, or Basketball. The sking is well done. Running is a breeze. The surfing you do might give you all kinds of trouble due to the constant bending of the knees and the weight transfer. I see how the ibuprofin will cut down on the swelling I love the blue advil liqual gels, but I to worry about GI bleeding. Along with being on asprin a day for the heart.

Keep using the braces.

I have found that the constant movement of the knee will grind down the lose cartilage and the pain will tend to subside. Almost like a pebble in the shoe, at some point it might either grind down to nothing or make you crazy enough to get the knee scoped.

good luck.

Al

By the way when I take the advil after 10pm at night I sleep like a stone. Maybe you are on to something! I always thought by that time I was tired and fell asleep, but you post has got me thinking, When I had to take 1200 a day for 8 weeks when I had pericarditis I was dog tired. Interesting. Time for some research.

 

[Buckeye]

Aren't there stories about football players shutting down their kidneys taking regular high normal (800mg several times per day) doses of ibuprofen? If those big guys can't deal with it, I know I can't so I take take only limited doses on rare occasions.

 

[cute fuzzy bunny]

Its not the ibuprofen thats making you sleepy.

Yer old!

Welcome to the club. I took a 3 hour nap the other day. My nap history so far has been 45 minutes to an hour once or twice a year when exhausted and/or deathly ill. Oddly, I was very grumpy when I woke up. Confirmed by the wife.

 

[spideyrdpd]

I have had patients that swore that Ibuprofen made them drowsy. I just wonder if like Rich says they were drowsy for other reasons and blamed the medication.
Have you tried the glucosamine . I know its for arthritis but again people swear by the stuff.

CFB
Naps are healthy and are to be encouraged. Except of the grumpy part.
Rob

 

[dumpster56]

I have had patients that swore that Ibuprofen made them drowsy. I just wonder if like Rich says they were drowsy for other reasons and blamed the medication.
Have you tried the glucosamine . I know its for arthritis but again people swear by the stuff.

CFB
Naps are healthy and are to be encouraged. Except of the grumpy part.
Rob

I figured since I run 10+ miles a day that everything hurts at times, knees ankles, lower back so when I take the advil and the pain goes away well I am comfortable.= sleep NO?

 

[Nords]

I may get old but I refuse to grow up!

Have you tried the glucosamine .

I've watched glucosamine/MSM make arthritic polo ponies scamper around like colts, but I haven't seen any benefits in me or any other humans. I'll wait for a good double-blind study before I start shelling out for those supplements.

I think I'm doing enough and maybe too much already-- 400 IU vitamin E, 500 mg vitamin C, 500 B12, 50 mcg coenzyme Q10, fish oil, and a multi-mineral/multivitamin.

 

[cute fuzzy bunny]

I may get old but I refuse to grow up!

Neener neener NEENER!

I think I'm doing enough and maybe too much already-- 400 IU vitamin E, 500 mg vitamin C, 500 B12, 50 mcg coenzyme Q10, fish oil, and a multi-mineral/multivitamin.

I keep seeing more and more about overdoing certain vitamins and minerals, and that most people get all they need from their diet. I keep taking a basic 100% of everything, no iron, multivitamin/mineral tab, which I forget about 1/3 of the time. I'm dabbling with the fish oil since my doctor freaks out about my triglycerides being so high, although my LDL and HDL are fine...an odd genetic thing since my dad and grampa had it as well. My dads 73 and healthy as a horse and my grampa lived into his late 80's despite smoking with asthma and smearing bacon fat on his toast to go with his eggs and bacon every morning.

Cant say I appreciate the raw sardine burps for 2 hours after taking it though.

 

[Rich_by_the_Bay]

I may get old but I refuse to grow up!
I've watched glucosamine/MSM make arthritic polo ponies scamper around like colts, but I haven't seen any benefits in me or any other humans. I'll wait for a good double-blind study before I start shelling out for those supplements.

I think I'm doing enough and maybe too much already-- 400 IU vitamin E, 500 mg vitamin C, 500 B12, 50 mcg coenzyme Q10, fish oil, and a multi-mineral/multivitamin.

Latest meta-analysis (Reichenbach et al, Ann Intern Med, 146:8 ) shows no benefit for osteoarthritis of the knee or hip from chondroitin.

To each their own.