Hi to everyone.

I have had rheumatoid arthritis and small fiber peripheral neuropathy for almost 5 years now and had been on disability for almost 4 years. My RA is in a medicated remission for a year and my neuropathy pain is finally basically under control with 4500 mg/day of gabapentin, 175mcg/every 2 days with the fentanyl patch and amitriptyline 50 mg each night. I also have been taking many supplements for about a year.

I talked my neuro into referring me for physical therapy as I need to get back to work as soon as I can. Cannot afford to live on SSD and cannot stand to be home alone since my husband died 8 months ago. I have had to use a cane to walk for the last 3 years as my left leg had become very weak.

I started using the treadmill in my apartment gym at only a 2.0 level for the last 2 weeks and I started physical therapy this past week. The Sunday before my first pt visit, I went out with some friends and before the end of the night had swelling in both feet and ankles. This is a new symptom for me. My therapist noticed all the swelling in my first appointment on Monday and suggested an exercise I could do to help. He didn't seem too concerned. I told my therapist about my using the treadmill and he made it my homework to continue to do so.

The only medication changes I have had were both last week. My neuro put me on 20mg/day of prozac for depression and my internist increased my levoxyl from 150 to 175mcg when my thyroid test came back 7.48.

I was wondering if the medication changes or the exercise could have led to the sudden swelling. I have had it all week now. I would appreciate all input.

Thanks. Cat

I need to make a correction to my medications listed above. My Fentanyl patches are 125mcg every 2 days.

Both opiates and gabapentin cause edema.

Low thyroid also... your med increase won't kick in for a week or two and then will be small and slow. Make sure you are taking that thyroid on an empty stomach with no calcium present.

Make sure you are getting enough water, and try elevating your feet after the work out.

Sometimes edema is minor and sometimes not. You have 3 factors predisposing to edema situations.

What supplements do you take? Can you list them?

Also make sure you get a good check up... cardiac and renal next visit to the doctor.

Cardio exercise increases blood flow, so you may have swelling in the feet from that...meaning the return is slower than the delivery of the blood to the feet.

Hi when I walk a lot I swell a lot. I think it is from inflamation. Even after a busy day my shoes are so tight and ankles are very swollen. I am not familiar with the side effects of those meds but I do think some meds can cause swelling as well. Hope you feel better

Thank you, mrsD and Daniella for your replies.
This is going to be a novel, so please bear with me.

mrsD, I have been taking fentanyl and gabapetin for almost 5 years and have never had swelling before. That is why I am so concerned. Swelling is worse on my left side which is my weak side and why I use a cane. I do take my thyroid med, B-12 & acetyl-l-carnitine in AM as soon as I get up on an empty stomach.

I just had a check up with my internist, complete with lab work, mammo & bone density scan. The only things amiss are my thyroid (hypo) at 7.48 and my cholesterol at 330. The 330 comes after stopping my statin 5 months ago. Doctor will allow just diet and exercise at this point.

I will see my rheumy on Monday & he will have have blood results as he always does blood work for liver, renal, etc every time I see him every 2 months.

Here is my list of all medications, vitamins and supplements for your review and comment:
gabapentin 1500mg 3 doses per day
Amitriptyline hcl 50mg 1 at bedtime
hydrocodon-acet 10-500 for breakthru pain as needed 3 times a day max
levoxyl 175mcg 1 per day
fentanyl patches 125mcg/hr change every 48 hrs
enbrel 50mg 1 injection per week
fluoxetine hcl 20mg 1 every morning

Now the good stuff:

methyl B-12 5000mcg 1 first thing in AM empty stomach
D3 5000IU 1 a day
benfotiamne 150mg 2per day
chelated magnesium (glycinate) 200mg 1 per day
ester C 500mg 1 per day
Melatonin 5mg 1 at evening
coQ10 100mg 1 per day
r lipoic acid 100mg 1 per day
acetyl l-carnitine 250mg 2per day on empty stomach am & pm
osteo biflex 1200mg 2 per day
grapeseed extract 100mg 2 per day
centrum silver ultra womens formula multi vit 1 per day
neptune krill oil 1000mg 1 per day
suntheanine l-theanine 150mg 2 per day

I have basically been bed bound and inactive for last 4 years until last August when my husband got sick and died. Is my body in shock from all this exercise all of a sudden after being inactive for so long?

After a week I still have the same swelling in ankles and feet, but I continue to exercise on my own and go to PT. The swelling occured before I started the PT and was just using the treadmill on my own. I did get new shoes: Sketchers shape ups. I hope you can help me and thank you for your interest in me.
Cat

When your thyroid is low, the cholesterol will go up.

It is one sign of hypothyroidism.

I wonder why you are on such a high dose? Did you have Hashimoto's? Or a thyroid surgery? I know patients who have had most of the thyroid removed, who were not on so high a dose as you are. Just asking.

It may be the shoes. Shoes can do terrible things, and have done so to me. So try using another pair for a week and see if that is better. I have been rather skeptical of the Sketchers, myself. They look unstable to me and hard on the ankles. Like one can fall with them if not careful. I don't think a newbie exerciser should try them, until they have improved with exercise etc.

You may be putting on muscle mass on the ankles, so account for that too. Soft squishy type swelling is usually water/edema, firmer stuff is increased tendon density, and or some muscle.

mrsD, I have been on 150 mcg since 2000. While I was still in California. MD just told me that "thyroid was low". This is first thyroid test that has not been in normal range since.

I ran out of thyroid med in Feb. this year with no refills left. I was so busy with other MD appointments and trying to get copay assistance for my fentanyl and enbrel (I am on Medicare) that I didn't see my prescribing internist until April 8. I started back on my regular 150mcg dose until my blood work showed high number and was changed to 175mcg on May 6.

I have never been advised of Hashimoto's and have not had thyroid surgery. My internist does not seem to be too concerned. Are there questions I should be asking him?

With respect to the shoes, that is my bad. I have been wearing the New Balance 550 toners for a few months now and have sung their praises on another thread. Since they felt so good and I wore them all the time I figured I would graduate up to the sketchers and slowly broke them in. I started on the treadmill with the new balance first and changed to the sketchers. My ankles were a little sore but no swelling until a week later. I have switched back to the new balance and still have swelling. My pt guy told me to stay off the sketchers until my balance is good enough to do the treadmill without holding on.

I can't tell if the swelling would be considered soft or firm. There is some give when I poke at it, but it is not absolute mush.

Thank you, Cat

Because thyroid hormone causes increased bone tear down, in the elderly, the recommended limit is not to go above .1 (100mcg) typically if possible. The knowledgable doctors stay around that figure as much as possible because of risk of bone loss in older patients.

The higher doses are rarely used anymore. I have to wonder if you are absorbing it. Or not converting it to active T3 enough in the tissues. But you are taking a multi vit...which would have zinc and selenium in it...which are need to convert.

Some doctors give some T3 when they suspect this. Doses may start at 5mcg a day. The Levoxyl is T4 only... inactive until your body converts it.

About those Sketchers:
I'll tell you a little story... I was in Costco after Xmas and they had the Sketchers on sale on a table near the check out. There was an elderly immigrant guy and his wife, older, from a culture where women don't speak up. I was resting on the demonstration furniture while hubby paid for our stuff. I watched this guy put some male style ones on and teeter around in front of me. His wife was watching him. So I turned to her, and said " I think this is a bad idea for him, because these shoes stress the ankles, and he is an older person, and should he fall or twist, he'd break bones for sure. So she went and told him, and he defiantly looked at me in horror, and boxed them up and proceeded to the check out. She winked at me and said, I agree with you, but he won't listen! Advertising is a powerful thing...convincing everyone to buy these new shoes, so we must be careful of this when we are older, and have "issues".

Now this is me but if someone paid me I would not wear those shape ups. I think one with problems needs a very supportive proper shoe. Even if this is not causing yuor swelling to me they could cause a fall or twist of the ankle etc. Many of us have balance issues as it is. This is my opinion though and everyone is different.
For me when I was in bed full days and then was told by doctors to get moving I did it very slow. I would increase by 5 minutes even in a week or 2 the amount I did. I had tried a different way when I was at Cleveland Clinic where it was extreme pt and I did not think I would make it from the pain. Then it set fear in as well.
I am sorry to ask a question on your post but I know you stated to me Mrs D about neurontin and swelling but then wouldn't the swelling be always? I have swelling always but it sometimes is very extreme so why I ask.
To the OP I am not an expert but some other things has your weather changed cause for me I live in a humid climate but when it gets extreme I am worse. Also with rain. What about your diet? I am trying to work on mine in terms of sugar and salt which is hidden in everything and I did not know that. Also have you tried walking on ground instead of treadmill? Also maybe pool walking as a transition too?
Feel better and hang in there

[QUOTE=It may be the shoes. Shoes can do terrible things, and have done so to me. So try using another pair for a week and see if that is better. I have been rather skeptical of the Sketchers, myself. They look unstable to me and hard on the ankles. Like one can fall with them if not careful. I don't think a newbie exerciser should try them, until they have improved with exercise etc.[/QUOTE]


I bought a pair of Sketchers because in the store they were very comfortable. When I got home, and wore them for a while around the house, I realized they made my balance issue worse. The only shoes I can wear and be comfortable are Birkenstock.