Posts Tagged ‘Medicine’

The Thinker

Sometimes you have to be your own doctor

2012 ends for me with some positive health news. Problems I have been chasing for years appear to be on their way to resolution, or are at least in remission. The bad news is that despite the many physicians and specialists I have seen, overall I have had to become my own doctor. Such is the world of chasing annoying medical problems for middle-aged people like me in the 21st century.

The one physician I cannot complain about is my primary care physician, who is on the ball, at least about problems he can easily figure out, like my high cholesterol. I have been on a variety of statins, first Lipitor before it went generic, then Simvastatin because it was generic. My physician was on the ball enough to order me to get regular blood work after I switched drugs. It detected that the Simvastatin was causing muscle deterioration, so much so that if it had gone on much longer I would have ended up in the hospital. He saved my insurance company and me thousands of dollars and me from a potentially life threatening condition. So now I am back on Lipitor, which is now generic, with the only yellow flag being an increase in a liver enzyme, something that can happen when you are on Lipitor.

I have also been chasing my painful sciatica. Sciatica is a particularly baffling condition since there are so many possibilities for its root cause. Having it meant that sitting was painful and brought burning sensations down the back of my thighs. I’ve been dealing with it for years and have gone so far as to consider solutions like standing desks. Pretty much everything I have tried brought no permanent relief. When no relief was in sight despite seeing orthopedic surgeons and chiropractors, I ended up on the Internet. It seemed there were two possibilities: a herniated disk or piriformis syndrome. The latter seemed more likely and it occurs when the piriformis muscles in the leg constrict nerves exiting the spinal column. After a lot of traction at my chiropractor’s office and releasing pressure on the piriformis muscle it seemed to go away. Then like a doofus I thought it was gone for good, and stopped getting traction, only to have it come back with a vengeance. What works now is more traction, but this time getting it regularly so my L5 joint does slide back into a position so that it presses against the spinal nerve again. I am getting traction every three weeks now. I also have a special ergonomic chair at work that does not put pressure on L5, like many supposedly ergonomic chairs too, including Aeron chairs due to the drop at the back of the seat. The sciatica is not completely gone but most days I don’t notice it. Moreover, it looks like regular traction will keep it in remission and the key is to keep coming back for more traction at regular intervals.

I also have large feet and consequently a lot of foot related issues. These were originally numbness in the feet. My foot issues got more acute with a recent recurrence of plantar fasciitis on the left foot. Plantar fasciitis typically manifests it out as a burning feeling on the souls of your feet, although this time it was at the heel of the foot. This is a condition occurs when tendons are torn in the feet and it takes months to heal. So I have been wearing running shoes with lots of cushion in the heels. Four months later it is not quite gone, but it is nearly gone.

What to do about all the numbness in my feet? I had seen neurologists and confirmed neuropathies. My podiatrist speculated that my varicose veins might cause them. I had the veins removed on the right leg, where the problem was more acute, but it did not solve the problem. At one point I spent four weeks in a boot that immobilized my foot because the joint pain became excruciating. I was beginning to wonder if I would be better off without my feet. The metatarsal bones in my feet felt like they were not where they should be. Had something broken and moved out of alignment? Eventually my podiatrist agreed to have an MRI done of my foot. Everything was exactly where it should be, which would be good news except for the occasional excruciating pain. One thing that was noticed: muscle atrophy in the feet. So I was sent to a physical therapist and spent weeks trying to regain my balance and strengthening the muscles in my feet. With more muscle mass in my feet, my condition began to clear. It appears if I had done this to start with, I would have avoided years of pain and consultations. No one had the ability to figure it out, and it never occurred to my podiatrist to test the strength of the muscles in my feet. Moreover, the sciatic nerve cascades down into the feet. It is likely that sciatica contributed to the problem.

It seems like an informed and inquisitive patient is the key to solving these chronic problems, because our physicians for the most part can’t seem to properly diagnose these more complex issues. I found that pain is a pretty good motivator for action, but I feel frustrated because I had to piece it altogether, as well as prompt my physicians to get tests that I thought I needed.

Obviously, it shouldn’t be this way. However, I am at a loss on how to improve our health care system so that these probably typical experiences that I had are faster to get properly diagnosed. Whatever medical training our medical specialists are getting, it seems insufficient. They are good at seeing trees, but not so much the forest.

 
The Thinker

Life under the mask

There are things in life that really, really suck, like finding out you have terminal cancer. Then there is stuff that really sucks, like losing your job. There is also ordinary stuff that sucks, like missing a connecting flight. Then there is stuff that you wish you could say sucks but you might get a reputation for being whiny for saying it sucks. For those of you who suffer from sleep apnea and are having treated it the typical way (by trying to sleep with a mask over your nose and/or mouth while mechanically pumped air zooms down your windpipe), you will relate to my opinion that the experience really sucks.

Most sucky experiences though are transitory. Using a CPAP (continuous positive airway pressure) or BPAP (bi-way positive airway pressure) machine while sleeping is the way those of us with sleep apnea should sleep for the rest of our lives. The result of not using it could be, not to mince words, deadly. When you have sleep apnea, your lungs decide to shut down while you sleep, causing carbon dioxide buildup and increased blood pressure. This can cause various heart ailments including heart attacks, blocked arteries, strokes and maybe waking up dead.

So it is truly remarkable that given the potentially deadly consequences, so many patients prescribed a CPAP or BPAP simply stop using it. They’ll take their chances with sleep apnea and sudden death, thank you very much. Because when you have to do something annoying for eight hours when you crave uninterrupted sleep, your CPAP or BPAP (a branded version of a BPAP is a BiPAP) is going to feel more like an enemy than your friend.

Is there no pill I can take? Alas, none is available, and it appears there never will be one either. No pill and your remaining choices are chancy at best. If you are very overweight or obese, sometimes losing the weight will cause the sleep apnea to go away. Or not. In my case, I am not a whole lot overweight, so the sleep doctor doubts it will do much good. Even so I may give it a try. Trying to sleep with my BPAP is so annoying it may be worth taking off that weight and more and hope for the best. Then maybe I can fully sleep again.

There is also a dental appliance you can try. My brother, who also suffers from sleep apnea, tried it to bad effect. He may need orthoscopic surgery to correct his jaw alignment. You can also have your uvula, tonsils, adenoids and some throat tissue removed. Even with all that radical surgery, it only cures sleep apnea about a third of the time. And it is quite expensive, painful and could have side effects.

Of course, the reason you use a CPAP or BPAP is to get sleep you are not getting, the vital REM (rapid eye movement) sleep that makes dreaming so vivid. In my case two sleep studies confirmed I got no REM sleep at all. Presumably I am at least getting some of it now. However, my BPAP is hardly conducive to sleeping. Let me count just some of the ways:

  • Your mask probably won’t seal very well. Cleaning the mask nightly helps by removing oils from your skin that accumulate on the mask’s seal. To really get a good seal you have to lock the mask down. This means pulling the mask’s head straps quite tight and locking down the screw that connects the mask with your forehead. This in turn means indentations on your forehead in the morning and maybe a headache. You do this to avoid the whistling noise that results when the extra pressure from your machine finds a way to escape. In any event you, try a little of this, a little of that and at least in my case it never seals perfectly. In my case, with every breath some cold air hisses out near the bridge of my nose and that keeps me awake.
  • Even if you think your mask is sealed, it will start whistling in the night. This is because the machines are usually programmed to start off at a low level, hoping you fall asleep before it really cranks up the air pressure. It needs to do this to keep the windpipe open. This whistling will usually wake you up. You will probably reach for the button on the machine that turns the air pressure down a bit, but it will be back at full pressure in an hour or so.
  • If your nose is disjoint because it was broken, like mine, then the top of the mask won’t seal well. Worse, it irritates the bridge of the nose. When I complained I was sent a jelly-like piece of plastic that is draped over the bridge of the nose. It definitely helps but is hard to get on correctly, because you have to tip your head up while you try to don the mask, so the plastic won’t fall off.
  • When you sleep, you expect your body to relax. It should be natural for your breathing to slow down. Not with your machine on. Your lungs expand and contract, sometimes like you are in a brisk walk. That does not stimulate sleepy feelings.
  • The mask feels claustrophobic. Particularly if you sleep with your mouth open, you will breathe out warm air from your body into the mask and thus on your face. Had I grown up in a tropical climate, maybe this would feel okay, but it feels weird instead.
  • With the BPAP machine that I use, the cycle varies. As you exhale the pressure drops. The machine doesn’t necessarily get the cycle right. So you either feel like you are breathing too much or, worse, that you are not breathing enough. Particularly if you rise to go to the bathroom, then reconnect the mask to the machine, and the machine restarts at a low level, you may feel like you are not getting enough oxygen, and it’s hard to suppress the shortness of breath feeling. Which means, you stay awake and feel a bit panicky.
  • You both hear and feel your breathing. The mask amplifies your breath. The mask itself expands and contracts a bit while I breath, making a crinkling noise and potentially unsealing the mask. This also means that if you do get to sleep you might sleep through your alarm because you won’t hear it. Instead, you will be listening to yourself breathe.
  • Since you are tethered to the machine with a hose, the hose is a constant distraction while you shift in bed. So you spend a fair amount of your rest time pushing the damn hose out of the way.

I hope I can get used to it. I’ve talked with other sleep apnea sufferers who say they have, but I imagine it takes years, if it happens at all. After thirty days of use my sleep doctor will look at the metrics collected by the machine and adjust my settings. I sure hope she will drop the pressure a notch or two. It seems excessive at 3 AM.

Using a CPAP or BPAP is really like spending every night in an iron lung. It may be that an iron lung is really what we sleep apnea sufferers need to get a decent sleep, providing we can fit a bed inside one. An iron lung however is likely prohibitively expensive, and it’s doubtful your spouse wants you sleeping in one. So it’s a CPAP or BPAP instead.

So forgive me for venting. Whining is good for my system. And while I realize I am just whining, it really sucks.

 
The Thinker

Aging: this ride is not an E ticket

Another birthday rolled in today. Curiously, what also came in my mailbox on my birthday was my new drivers license. Before I shredded my old license I looked at its picture, taken ten years earlier. Comparing the two photos was rather shocking. I was ten years older and I looked ten years older. Maybe I looked older.

Drivers’ license pictures have this knack for making you look old and/or ugly. The DMV gloriously succeeded with me, making me scrunch down to get into the camera’s frame. The new photo is in black and white, which by itself is guaranteed to make you look older. It also gives prominence to my receding hairline, something I had not noticed before. I seem to be developing a sag under my chin. Perhaps its worst feature is the dark looking circles under my eyes, something I never see when I look in the mirror, but which a black and white picture adds. I look grandfather-like, sort of like Grandpa from The Munsters. The horror!

It’s a brave new world that I inhabit as I cross a boundary in time between my lower fifties and my upper fifties. In the novel Brave New World, it seemed everyone was on an antidepressant known as soma, which made life feel blissful. Thankfully, I am not on an antidepressant but slowly over the last ten years my medicine cabinet expanded with a host of prescription medications. In order to keep my aorta from getting too big I am on two heart medicines: Flecainide and Simvastin. (The men in my family have enlarged aortas, an effect of Marfans-like symptoms.) To control cholesterol, I am on a statin, specifically Simvastin. To reduce high triglycerides, I was put on a pricey drug that is encapsulated in fish oil called Lovaza. Then there is the nasal spray (Nasonex), which seems to help with the chronic stuffiness and nasal discharge. Plus there is one optional medicine: Terbafine, which is supposed to kill toenail fungi.

So I take six prescription medicines in all, plus a couple of supplemental ones if I need them, including a muscle relaxant for the sciatica. And speaking of supplements, I take a daily Vitamin D supplement because we middle aged people just don’t absorb much of it naturally, no matter how much time we spend in the sun. There is also a silver multivitamin, because I’m over fifty. There are also fiber capsules to make certain things move more predictably. I also take a baby aspirin to reduce the likelihood of blood clots as well as a daily Zyrtec, which I may give up.

Here is a list of the medicines I took at age twenty: nothing. I didn’t need any but that’s because my body mostly worked like clockwork back then and, of course, I had no health insurance. Now, it gets crankier and I feel creakier, resulting in really annoying conditions like sciatica and numerous trips to my chiropractor. All this plus you try to exercise as much as you can with a sedentary job and mind your doctors’ insistent urgings (only partially successfully) to refrain from all the foods you enjoy and eat all the stuff that vegans love but leave you taste deprived.

However, nothing says “old” better than using a BiPAP machine. A BiPAP machine is a close cousin to a CPAP machine, and is used by the millions of Americans like me with sleep apnea. After two sleep studies, the doctor of sleepology sort of knows what’s going on with me, and she is insistent that every night when I sleep I must wear an ungainly facemask and attach it to my BiPAP. What it does is make my breathing regular while sleeping. Thanks to the power of durable medical equipment it pushes air into my lungs while I sleep, preventing snoring and (hopefully) sleep apnea. If you have sleep apnea, you have lungs that like to sleep along with you. They can’t be bothered to provide all the oxygen you need and will even shut down, until your unconscious brain realizes something is wrong, shoots some adrenaline into your blood and you abruptly start breathing again.  This should wakes you up, although most of the time you are too sleepy to notice. Instead you usually arise in the morning feeling tired and tend to want to nap during the afternoon.

If I had been prescribed a CPAP machine, a steady stream of air would go down my windpipe all night, but that’s not the best fit for an old coot like me. Instead, I get the BiPAP machine, which works with my natural breathing. It knows when I am inhaling and pushes extra air into my lungs in a scientifically controlled and measured manner. To accomplish this I wear a large tightly sealed mask over my face and nose all night. The air is delivered through a sealed plastic hose attached to the BiPAP machine. The mask does not seal perfectly because a couple of years back I broke my nose, making wearing the mask somewhat uncomfortable and with some loss of pressure due to mask leaks. But hopefully while I am tethered to this machine the sleep apnea is gone but at least so far my sleep is not comfortable. I hope that I will get used to it in time. It seems I have no choice. Yet, something must be working, as I run to the bathroom in the middle of the night much less than I used to. I have yet to wake up feeling refreshed like a baby after a night on my BiPAP machine, something I hear happens, but perhaps that is coming.

In any event, all these medicines, minor ailments and durable medical equipment simply reinforce the obvious fact revealed in my drivers license: that I am aging, I know it, people who know me know it, and that the black and white camera at the DMV has documented it in its database and on my license. A much different future than my youth awaits. I’d best settle in for the ride. It sure won’t be an E ticket.

 

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