The fruits of freedom

Across mostly red states, Republicans are noisily celebrating their freedom. Only one freedom seems to matter at the moment: freedom from taking the covid-19 vaccine, a freedom that hasn’t been denied them so you wonder what the fuss is all about.

It’s unfortunately quite clear that they want to extend this freedom to plenty of others in their states, whether they particularly want it or not. Dr. Michelle Fiscus was until this week was the medical director for vaccine-preventable diseases and immunization programs at the Tennessee Department of Health. She was fired for excelling at her job, which apparently included trying to get teenagers and children vaccinated.

We’re seeing the results of all this “freedom” right now, mostly in red states, as covid-19 infections start to spike again, almost exclusively among the unvaccinated. No surprise, those infected are mostly acquiring the newer delta variant of the virus, which is much more infectious than earlier versions. Most of these states have no mandates to wear masks either, making it straightforward for the virus to spread widely in these communities.

In Springfield, Missouri patients are being offloaded to other hospitals as it’s getting hard to treat all these cases locally. Another covid-19 wave is obviously arriving, mostly in red states, but most states are seeing increases. It’s just that in bluer states, it’s more manageable, as more people are immunized. In Missouri, mostly unvaccinated people should be celebrating their “freedom” as they try to hold on to life while hooked up to hospital ventilators. Take that, big government!

But I’m celebrating real freedom. Real freedom gives me more choices to do what I want to do when I want to do it, and do it with reasonable safety. That’s because I’m fully immunized against covid-19. I’m immunized against a whole lot of other stuff too, as my doctor makes sure I’m up to date on my shots including (a sign of age) a shingles shot. My blood stream is teeming with antibodies to attack likely flus as well as lots of other preventable diseases.

How are we celebrating? Well, my wife is off to Las Vegas tomorrow, where cases are rapidly rising. Yesterday, over eight hundred new covid-19 cases were reported in Nevada. She and her friends are immunized though so she’s pretty safe to meet with her friends at an off-strip hotel. Everyone coming is vaccinated. She’ll have to wear a mask on the plane and while in airports, but otherwise she is minimally inconvenienced.

To me it’s still a bit novel to walk around most of the time without a mask. I do this confident that I now have a very low risk of acquiring covid-19 but I’m mostly outdoors anyhow where it’s not a problem. When in stores I’m mostly unmasked too, as are most shoppers. I keep a spare mask in my car in case I need it, and I do need it from time to time. A recent visit to the doctor to treat a UTI required me to wear a mask. But mostly I breathe the fresh air again and do it with confidence. My vaccine has a ninety percent efficacy rate, so should I acquire the disease it is likely to be mild and it’s very unlikely I’ll end up in a hospital and on a ventilator.

We’ve also got trips planned, principally a New York City theater trip in September. We’ll probably have to wear masks during performances, but again we can go confident that we won’t get infected and enjoy some fine Broadway shows, one of our true passions. These shows are returning because the state and the city got vaccination rates up high enough where herd immunity may be within reach. This was the holy grail the anti-vaxxers we shooting for. They just were hoping that enough others would get the vaccine so they wouldn’t have to. Unfortunately, politicians like Florida Governor Ron DeSantis have convinced a whole lot of other people not to get vaccinated too, making it out of reach there. I hope they are enjoying their “freedom”. I’m enjoying mine, because it’s real.

I’m hoping one of these days it will occur to some of these people that government can actually expand freedom. Freedom from dying from preventable diseases doesn’t just happen. The private sector doesn’t decide to create the vaccines needed to keep from dying from these diseases. It’s a role only government can take on. In reality, most freedom means nothing if you don’t first enjoy good health.

Consequently, these “freedoms” being enjoyed in principally red states are anything but. If anything, they are anti-freedoms. The more who practice this “freedom” the less the rest of us can enjoy actual freedom, because we often bear the cost of their reckless selfishness.

I’ll be enjoying two shows on Broadway in September, and the city too. Most likely I won’t be hunting for a hospital with respirators and oxygen, as many people in and around Springfield, Missouri and many people in principally red states will be doing instead.

Give me a mask, please

So after months of waiting, I get my first covid-19 shot tomorrow.

I’d like to say it was easy, but it was just the opposite. I did discover that if you are determined enough, it is possible. It just meant some compromises. In my case, it meant compromising my sleep. I’m still on the waiting list for the Massachusetts mass vaccination sites, but there are a limited number of CVS drug stores where you can get the shot. The problem is if you go to their website to book an appointment, it will always say there are no appointments available. But from friends and neighbors I learned that they open up new appointments between 3 AM and 3:30 AM. It’s not all CVS stores.

Here’s where it helps to be an older male. Our prostates will naturally wake us up in the middle of the night anyhow. Of course at 3 AM while awake, you are not generally able to focus on a task more complicated than emptying your bladder. But with my tablet computer while sitting on the john, I could scan the list of CVS sites provided by the state. Since my wife has two co-morbidity symptoms, she had priority. After fifteen minutes of trial and error I found a CVS in Chicopee and got her an appointment there. The next night I tried again for myself with no luck. But the third night was the charm. Tomorrow at 11 AM I expect to get the first dose of the Moderno vaccine at this same CVS in Chicopee, about a half hour drive in Hampden County. Welcome to our modern world.

But it may be the beginning of the end of this madness. Just today the Centers for Disease Control and Prevention said that traveling is fine two weeks after your second shot. I doubt I’ll be on the first plane to Hawaii, but maybe the second one. Living in Hampshire County is fine but at this point I … want … out … of … here!

But I have the feeling that we’re still quite far from the end of this. You would think after three waves of covid-19 people might have learned something from it all. But, no, we’re Americans, which means huge portions of us are either too desperately poor to do much about it or, most likely, figure they are immortal. It’s often the young people that are the most reckless, so of course they flocked to Miami Beach and rubbed a lot of shoulders, and now a fourth wave is building across the country, which seems to be affecting younger people more this time. The stupid compounds on the stupid. About a fourth of the country says they won’t get a shot. If they’re serious, that means we can kiss the idea of herd immunity goodbye … and that’s the very reason a lot of these people were out maskless in the first place … supposedly to bring about herd immunity!

It sure appears they’d like to get there via unnecessary deaths than through vaccinations. That’s because at least some of them are anti-vaxxers, which essentially means they refuse to believe in science. Others are convinced tiny microchips from Bill Gates are in the serum, so the government can track us or make us communist or something. It all doesn’t make any sense, but to these people the very fact that it doesn’t make any logical sense means they are probably right. America: the land where freedom means you have the right to be as stupid as you want and where civic virtues does not extend to doing your part to keep preventable illnesses from spreading.

Indeed, the evidence is pretty widespread that American is rapidly dumbing down. Sixty years ago we were anxious to down sugar cubes to avoid polio. Vaccine exemptions were not a thing; parents could go to jail if they didn’t get their kids vaccinated. Sixty years ago science was cool and patriotic. We looked up to scientists. Now we don’t accept any science that conflicts with our biases and political philosophies. The only good thing from all this vaccine hesitancy is that those with this trait are self-selecting themselves to be wiped out. Darwin would be amazed that people would choose their own natural selection.

Well, not all of us. I’m the product of a nurse and an engineer. My Dad was left-brained to the max, my Mom spent a lot of time scrubbing with disinfectants and tracking our vaccinations to make sure we survived to adulthood. It naturally rubbed off on me and my siblings. The mere idea of not following the recommendations of medical professionals and scientists was not only absurd, but was obvious lunacy. We knew medicine was not an exact science and were comfortable with advice evolving at covid-19 was better understood. The virus continues to evolve, making it likely that we’ll be getting annual booster shots, at least.

Unsurprisingly, the virus unfolded largely the way the experts predicted. Trump scoffed at the idea of a half million Americans dead of covid-19. We passed the milestone and have hardly tallied the last casualty. We endured more than a year of stupid leadership by stupid people. Unsurprisingly, about the time we got rid of the last president, things started to improve in a meaningful way. After four years of doing pretty much everything completely counterproductively, we have a government determined to work with nature and reality rather than deny it.

At least some Americans are waking up from their dogmatic stupors. Vaccination rates are rising and the number of people saying they will never get a vaccination is declining. I’m quite confident Bill Gates won’t be controlling me via a tiny microchip after my vaccination tomorrow.

The second shot is scheduled for May 1, which means on May 15 I’m largely out of covid-19 jail. I still won’t be able to do everything. There is maybe a ten percent chance I can still acquire the disease, but it won’t hospitalize me or kill me. It’s possible one of the variants could sneak in somehow. As I said, there is no guarantee. There are simply improving probabilities that it can be avoided or its impact lessened if acquired. I’ll probably still wear a mask a lot of the time I am in public. We may start eating in restaurants again, but we’ll keep the masks on until the food is served and put them on shortly afterward.

I’ve come to appreciate the value of the low-tech mask. If Americans had brains, they would use this opportunity to use masks routinely during the cold and flu season. The flu largely didn’t happen this year, thanks to all the masking. While I was aware a lot of illness was transmitted in the air, I can now clearly see the link and the virtues of wearing masks. It’s no longer that big a deal.

I just wish most Americans could embrace the idea that rather than limiting freedom, using masks allows freedom not just for you, but for everyone else too.

God won’t save you from COVID-19, but science might

Everyone’s feeling out of kilter these days. Most of us are feeling somewhat scared too.

It’s reasonable to expect that in the weeks ahead we will feel more scared, as the COVID-19 crisis gets much, much worse. When people we know, particularly family and celebrities, are felled by the disease we’re going to be looking for escape from this hell. For some it will be from a bottle of booze. For many perhaps it will come by praying to God that you or people you know will be spared.

There is nothing wrong with either prayer or meditation. Both have proven mental health benefits. It helps us feel connected to the larger world and helps many find solace in difficult times. Whether God saves you or not you’ll never know for sure, but science can probably save you, if you pay attention to what scientists and medical professionals are telling you to do and follow their advice. If God has a higher power at work, it’s the power of science.

What we are experiencing in 2020 is hardly new to mankind. Aside from the many wars mankind has endured over the years, natural disasters and pestilence have been periodic killers too. It’s been a while though since we’ve seen a pandemic, so it’s new and very frightening. In my 63 years, I don’t think we’ve had a proper pandemic here in the United States. Still, what we are going through now is hardly unplowed territory. Since the early 1980s we have been dealing with HIV and its AIDS disease. We’ve made progress but most of the progress has come through boring things like monogamy and practicing safe sex.

The religious among us seem to be in two camps on COVID-19. Some see it with the frame they gave to AIDS and HIV: God is punishing us for all our rampant sinning. Then there are others, like Jerry Falwell Jr., who swallowed the Republican KoolAid and reopened Liberty University after Spring Break. I’m guessing he figured his students were too godly to get COVID-19.

Falwell should be practicing penance at the moment, but if he’s not his students are. Some are likely to pay with their lives. For many younger people, catching the disease is no walk in the park. It will kill them. Heck, it killed the guy who first discovered the disease and tried to get the Chinese government to do something about it. Instead, he was punished. He was 33 years old.

I was on a cruise this month. Fortunately, no one was infected on the cruise. Two weeks later we show no signs of the disease, but while on the cruise we were meticulous about regularly washing our hands. The cruise line was meticulous about squirting our hands with sanitizer when we went to eat too. Before the cruise we spent a night at a Rodeway Inn in Fort Lauderdale, Florida. Eating their free breakfast in the morning, someone on the P.A. system was saying the way to fight the disease was to stop listening to the liberal news media.

He should have listened. There’s no more cruising going in and out of Fort Lauderdale and won’t be for a long time. He’s probably one of much of the hotel staff that’s been laid off because of the disease, made much worse because their Republican governor Ron DeSantis put profits over public health, doing much to spread the disease as spring breakers brought it back home. Florida still lags other states in keeping its populace at home. Maybe he’s figuring that God will save them.

God’s not coming to his rescue. He didn’t come to Jerry Falwell Jr.’s rescue and he won’t be coming to your rescue either. I can say it’s because God doesn’t exist, which is likely, but I can’t prove it. What I can say is that with if God exists, its a removed and impersonal god, that shows no interest in your life in particular. It didn’t keep people from getting the plague either. Even back then though the smarter ones inferred that it had a lot to do with people being clustered closely together. Today, others like my friend Tom are using the same strategy: flee to the country and hope to ride it out there. You can also do what health care professionals are telling us to do. That’s what we’re doing.

It’s human to be scared by all of this. For most of us it will be one of the major events in our lives, and a shared world trauma. Some of us cope with stress better than others. Religion is supposed to give us ways of coping with this kind of stress in particular. If so, I don’t see much evidence that it’s working. Part of the stress of the religious is their cognitive dissonance. They know what their religion is telling them is crap, but they can’t admit it to themselves.

The successful people are going to acknowledge that it is crap and move on. This is not to say that religion is necessarily bad, but certain flavors of it can be quite toxic, and a lot of religious Americans are in this camp. Most are evangelicals. If we are at the first stages of Armageddon, it’s going to be sending many more of these Christians to early graves. Of course, a lot of us less religious folk will be felled by it too. But fewer of us will because we will largely heed the advice scientists like Dr. Fauci are giving us.

To me, following their advice is something of a balm because it’s likely to actually work. It may also be my nature, but although concerned I am markedly happier than most of the people around me. It comes not through choosing ignorance, but learning what works to keep from getting infected and then doing it scrupulously. I’ve learned there are ways to be less afraid of COVID-19 and things you can still do an enjoy to give you pleasure and meaning.

Here’s some of what I’m doing. You might want to see if these strategies work for you too:

  • I stay mostly indoors
  • I keep surfaces I touch clean with appropriate disinfectants
  • When I go out shopping, I am careful. I bring sanitary wipes, stay calm, and keep a social distance. Since I am age 60+, I take advantage of special shopping hours for us more at-risk people.
  • I mostly succeed in not touching my face
  • Some face touching will happen anyhow. So I try to wash my face with soap and water once a day too. Keeping it clean means if I touch it I probably won’t get infected if I then touch my mouth or a mucus membrane.
  • I wash my hands periodically throughout the day, with soap and water, at least for twenty seconds, being very thorough to clean all surfaces
  • I try to get outside once a day and take a walk. Walking is quite safe if you maintain a social distance. There are parks and trails nearby. Seeing people makes me feel connected to them. The fresh air and sunshine feels good too. Hearing the birds and feeling wind on my face makes me feel alive.
  • When the weather permits, I open up the windows and enjoy the fresh air. There’s no coronavirus in the air unless someone coughs on you. Outdoor air is likely healthier than indoor air anyhow.
  • I keep busy doing stuff: consulting when it is available, indulge in my hobbies and try not to obsessively watch the news. Watching Star Trek Picard was a great distraction.
  • After going shopping, I wipe surfaces and things I touched, including groceries I brought in if possible. I leave stuff that’s not too perishable in the garage for a few days. And I wash my hands.
  • I count on layers of protection. The most likely way of acquiring the disease is from touching your face and then touching your mouth or nose. I keep both hands and face clean.
  • Realize this is not forever.
  • Chat with friends and family virtually. Be positive but realistic. Encourage them that by doing sensible things they are likely to be survivors.

In one way we are lucky: our finances won’t be stretched by this crisis, so that’s a huge relief. Most of you won’t be so lucky, but you will get some relief from the government. Hopefully it will let you ride the financial impacts for a while without feeling like you are in a financial crisis too.

By doing these things, you are also being virtuous. In addition to hopefully putting yourself in a healthier space, you are also helping society. You are helping to cut the transmission of the disease so others can survive it. You are making things less stressed for our overtaxed healthcare workers. Your actions may be boring, and make you feel lonely, but it’s vital. Staying at home helps not only you, but everyone.

Keep praying to God if that gives you comfort. We know what kills people now when pandemics occur. In the past, we didn’t know so we attributed it to the supernatural. Trust that God revealed science for a reason, and that it wants you to place your trust in our scientists. One to 3 percent of us who get the disease won’t survive it, but most of us will, but only if we stop doing the stupid stuff.

Stay safe and stay positive. This won’t last forever.

Anti-vaxxers – Lock ’em up

It’s nice to get some validation that you were a good parent. The latest was a tweet from my 29-year-old daughter publicly thanking her mom and me for getting her vaccinated. She was watching a documentary on rubella that scared the crap out of her until she realized that we had vaccinated her against it.

I’m not sure we deserve plaudits for doing what every parent should be doing, but that many are not. What I would like to do is to make it criminal for parents not to get their kids vaccinated against common communicable diseases. At a minimum, these parents are guilty of child abuse. Maybe their kids would end up in a foster home, but at least their foster parents would get them vaccinated.

Maybe I’m pro-life at heart. I think that kids deserve the right to grow up strong and healthy and with a minimum of unnecessary misery and death. These days, of course, being pro-life means forcing women to carry to term pregnancies, and to not give a damn about the mother and the kids afterward. This is borne out by, well, not caring if they get their kids vaccinated against wholly preventable diseases!

It’s hard to miss the news that there are a lot of bad parents out there, i.e. parents who won’t get their kids vaccinated. It’s not too hard to do it these days because you can claim it’s against your religion or deeply held beliefs or pretty much for whatever reason you want in some states. That’s because states are increasingly reluctant to trample on parents rights. It’s all about freedom or something, i.e. the parents’ freedom to make decisions for their kids, not their kids right to not become a victim to preventable diseases that used to kill millions.

Anti-vaxxer parents have their reasons for not getting their kids vaccinated, but none of them make any sense. For example, there is zero credible evidence that vaccinations cause autism. But even if you grant that parents should decide whether their kids should be able to catch these diseases, they shouldn’t have the right to inflict it on the rest of us. Because that’s what’s going on with these recent measles outbreaks: if almost all of us are not vaccinated, those of us who do catch these diseases can pass them on, sometimes to people who have been vaccinated because there are newer mutant strains of the disease, like measles.

I had measles, chickenpox and mumps as a kid because there was no vaccine available. Fortunately I was young enough not to remember the impact they had on me. While I don’t remember having them, you can bet that when it’s time for my booster shot I’ll happily raise my arm for it. Most recently, I raised my arm for a shingles shot, which is recommended if you are age sixty or over. The doctor didn’t have to ask me. I brought it up, even though my physical was a month before I turned sixty. (I got it about a week after I turned sixty; insurance won’t pay for it before then.) I have friends who got shingles in their sixties and each says that it was the most painful thing they have ever endured. I’m not going to take that chance.

Children of course can’t speak for themselves; it’s a parent’s job to act in their best interest. With my daughter, I got her vaccinated for everything I could legally get away with. She did end up with the chickenpox, but only because the vaccine was not approved at the time. A few months after she got it, the vaccine was finally approved. Tough luck for her. When the HPV vaccine came out though I made sure she got that even though she was a young teen who was not sexually active. It would be up to her if she chose to be sexually active, but most people are at least at some point in their lives, so there was no point in taking chances in getting cervical cancer. In addition, I made sure she was vaccinated against both Hepatitis A and B, also getting both shots for myself. As we’ve done a lot of foreign travel lately, they might have come in handy. I don’t know for sure but I do know I didn’t come down from these diseases. Neither will she.

I doubt any parent intends to be malicious by not vaccinating their kids. They probably think they are doing their kids a favor. What’s really going on though is that they are believing disinformation or not taking the time to truly study the issue. Certain vaccines can actually cause the condition it is supposed to prevent, but only in very rare cases, and it’s virtually impossible in the case of vaccines with dead viruses. In many of these cases, your kid would have a better chance of winning the lottery than getting the disease from the shot.

This is freedom gone amok. Whether we like it or not, we are all part of the same biosphere. We all have to live with each other. We have an implicit obligation to society not to transmit preventable diseases. Thankfully we haven’t had a real pandemic like the 1918 Spanish Flu that killed millions in a very long time, so long that we don’t think it can happen again. It killed an aunt I never met. But we are definitely playing with fire and when it happens, it won’t be just these anti-vaxxer parents kids that will die many miserable and preventable deaths. It will be millions of the rest of us who did our best for our kids but because we allowed boneheaded parents to opt their kids out of vaccines ended up killing millions of the rest of us too.

What these parents are doing to not just their children but also to the rest of us is criminal. It should be treated that way.

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.

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.

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.