Healthy Obsessions The Adventures of a Mild Obsessive Compulsive

Author Archives: Diana

I'm Not the Only One (Five Links)

Currently feeling overwhelmed with some family medical news, which I’m not able to discuss publicly yet. In a week or two. Instead, some links I’ve found interesting.

The Data Driven Life: An article from Time Magazine that’s about me. Or people very like me. It’s about the obsession with tracking, the usefulness and the pitfalls. A friend mentioned the meet-ups sponsored by QS to me some time back, and I’d been meaning to check one out right around when my kidney infection hit in January.

A history of BMI : Great links. Lovely research. Makes me happy. This says pretty much everything I’d want to say. BMI is not an accurate indicator of health, or actual overweight. Body measurement, skin calipers, and hydrostatic weighing are far more accurate. I’ve been tracking body measurements for a while, and will no doubt post that spreadsheet in the future.

I found this via Jim Hines’ blog, where he posts about BMI and weight issues using himself, and his BMI. He also links to the Illustrated BMI from a few years back, which I loved then and still love now. I have a few friends in the accompanying Flickr photo set.

Utility Belt! A friend recently gave me this as a gift, after learning I’d been lusting after it for a year. I got mine in black. If I am very clever, I will eventually manage to get a picture of me wearing it.

Meeting a New Doc Today

Seeing a new doc today. Feeling a bit stressed about it.

For years, when I told my doctors I thought something was wrong, they told me I was wrong. That I was perfectly healthy and maybe I was just depressed.

Fast forward to this past September and the double diagnostic whammy of Sleep Apnea and PCOS. Nothing wrong, my ass. (Actually, there’s nothing wrong with my ass – it’s one of the few body parts with which I’m completely happy).

Any rate, even though I’m going in to see this new doc with those two diagnoses in hand, with a referral from my primary care doc, and with an unquestionably positive Celiac screening test… I’m bracing for getting brushed off. Bah.

So, I’ve been reorganizing my Medical Info Binder. It seems like one of the few productive (and at least not destructive) things I can do with the excess worry-energy. Wanna see pics? I’m so ridiculously proud.

Medical Binder of Massiveness

Interior - With Tabs

Page one is a list of current diagnoses and medications (mostly blurred out for practicality reasons).

The tabs are for the different years. Thanks to the combination of my OCD and my Dad’s OCD, I have medical records going back to 1986. They aren’t all in here, and there are a few years that I didn’t keep track of. But it’s still pretty thorough.

And… it functions kinda like a safety blanket. Or magical armor. Or at least something to occupy my hands.

Fighting the FSA

Hah, my obsessive compulsive record keeping is not useless! (AKA, screw you FSA, and your little dog, too).

My FSA (Flexible Spending Account) is notorious (at least in my experience) for trying to deny payment. Last year they attempted to deny 12 claims, and successfuly denied an additional three – apparently they don’t think chiropractors count as medical expenses. The other claims? Doctor visits.

This year, they’ve tried to deny eight or so. The latest was the bill for my kidney infection treatment. So, I called them and my HR rep called them. Their answer? The receipt the hospital sends them is nonstandard. Only receipts the pharmacies send them are ever okay. Let me replay part of the conversation here:

Me: So, you’ll only deny hospital and doctor visits?

FSA chick: Yes.

However, if I send them an itemized bill (or Explanation of Benefits from my insurance company) they will approve the expenditure. It seems likely that they’re banking on most people either not caring enough to deal with the hassle or not keeping copies of their medical bills and receipts. However, I care. And I keep copies (of course I do – duh).

So I printed out my form letter (this happens so frequently, it seemed like a good idea to create a form letter) and faxed off a copy of my EoB to my FSA administrator.

I’m always filled with this feeling of righteous vengeance when I do this. Not that the FSA particularly cares, or that they’re likely to notice the scornful way I punch in their fax number. But I find it satisfying.

And here’s a handy dandy FSA calculator for figuring out how much it might save you. That is, assuming you want to delal with the hassle.

Sleep Apnea, A Family History (and Rant)

Technically, no one else in my family has ever been diagnosed with Sleep Apnea, but I’m pretty sure I’m not the first to have it.

What I’m about to say will no doubt provoke my father into an argument (one we’ve had before). But.

In 1990, one of my uncles mysteriously died. He was 38, seemingly hale and healthy. No one, at the time, could figure out the cause. All we knew was that during his sleep, he cried out and accidentally struck his wife. By the time she was fully awake and realized something was wrong, it was too late. She called for help, but the ambulance arrived far too late to do anything. The only theory the coroner had was that it was some sort of heart failure.

Sixteen years later another uncle cried out in his sleep, waking his wife. Her cry for help reached their son, who performed CPR while she called for an ambulance. This time, the ambulance arrived in time. It was cardiac arrest, in an otherwise hale and healthy man.

In the hospital, right after the attack but never again repeatable, my uncle evinced a heart arrhythmia. A prolonged QT, somewhat rare and unusual in that it strikes only during sleep. Very simply, that means that his heart took too long between beats.

My father may be right, and Sleep Apnea may have nothing to do with it. But. Sleep Apnea is known to cause cardiac arrest. Sleep Apnea is even known to cause not just heart arrhythmias, but also a prolonged QT.

“After adjustment for age and body mass index, the odds ratios were diminished but still remained significant: Sleep clinic OSA patients had a 2.6-fold greater risk of long QT syndrome than controls, while OSA patients from the general population were at 2.3-fold increased risk.”  – Jancin, Clinical Psychiatry News.

Then let us look at the other comorbid conditions:

Comorbid Conditions for Sleep Apnea

Each condition listed on that graph has enough supporting evidence to be included in the general sleep literature (although “pacemaker” is really more a treatment than it is a condition). But that graph, while lovely and useful (snagged from ResMed) is not absolutely comprehensive.  It can’t be, because 1) it only addresses men, and 2) there are new developments that haven’t yet been accepted into the cannon. We also have evidence of links to Ischemic Stroke, GERD, PCOS, and Metabolic Syndrome.

Let’s be clear here. Correlation does not necessitate causation. Just because two conditions often show up together does not mean that one causes the other. Many of those correlations are still under study, although some (like the one with PCOS) have enough substantiation to be widely accepted.

Then there are the other standard signs (not conclusive on their own, but alarming when taken in conjunction) like snoring, trouble sleeping, frequent wakings, and fatigue (though don’t ever tell a doctor you have fatigue, they seem to think that translates directly to “depression” or “hypochondria”). To my mind, the presence of any of those serious conditions is good enough reason for someone to get a sleep study. Combine them with each other or any of the other signs… yeah. Get thee to a sleep doc.

Back to my family. All on my mother’s side of the family we have: sudden death during sleep, cardiac arrest, heart arrhythmia (specifically prolonged QT), GERD, ischemic strokes, frequent wakings, trouble sleeping, snoring, fatigue, and –if we’re counting me– PCOS and… wait for it… wait for it… SLEEP APNEA.

Sounds like a party, no?

I may be emotional about this issue (all right, I’m definitely emotional about it). But that doesn’t change the fact that within that one branch of the family we have  10 of the conditions known to be linked to sleep apnea — in addition to Sleep Apnea itself. My mom alone has six of those conditions. Six.

There is no way I am the only one.

Edited to add: Oh, ya. And one of my maternal cousins has a Sleep Apnea diagnosis, too. There are at least two of us in my generation.

(Continually Updated List of References)

The Posting of Recipes (Gluten Free and Other)

I’ve had a few people ask for recipes in response to some of my recent facebook posts, and so I shall do something I never really thought I would. I shall post recipes, with a few caveats:

  • I will only post recipes that are my own, are public domain or creative commons, or that I have changed so much that they would be considered new recipes.
  • I won’t post recipes from cookbooks, because, aside from the issues of copyright or intellectual property, I like encouraging folks to buy good cookbooks. The more gluten free cookbooks that sell, the more that will get published. The more that are published, the easier it is for my family to find holiday presents (I am apparently hard to shop for).
  • I will, however, link to cookbooks and online recipes, and provide reviews of those.

With that, I give you:

Gluten Free Croissants (from the excellent Gluten Free Gobsmacked)

My Results:

9 small servings made (out of 36)
75 – 120 calories each
(not including filling)

I must note that I actually do not like croissants. I have never liked croissants. That said, I love this recipe.

The thing with most gluten free recipes is that they often turn out denser than the original gluten-full version. In this case, that worked to my advantage. This recipe is insanely rich and makes a brilliant pastry.

I used it to make cheese turnovers and, I will admit, one chocolate turnover. Simransmiles, who told me about this recipe in the first place, used it to make an apple turnover. I suspect it would also make great hamantaschen, if I can ever remember when Purim is.

Tonight, I intend to experiment with it to make tyropita. If I am very clever about it, I will manage to take a decent picture of the results. In the meantime, here’s a semi-decent picture of a turnover (taken with my iPhone and missing a bite):

The Last Turnover (approx. 2 inches long)

Tips & Tricks:

Upon first glance, I was intimidated by the process, but it’s actually a lot less hassle than I’d feared.

  1. Plan to make the dough on one day and do the rolling and baking on another. In addition to letting you chill the dough overnight, it also makes each step feel simpler.
  2. When the dough warms (which it will do while you’re rolling it) use an ice pack on top of the upper layer of parchment paper. Just don’t leave the ice pack so long that condensation begins to gather and wet the parchment paper.
  3. Be okay with getting butter on your hands. Although I froze the butter both before and after grating it, it clumped up and I had to break the clumps into smaller pieces for rolling out the dough. (This may also be due to freezer suckage, so YMMV).
  4. If you have a food processor, and it has a grater attachment, use it. It is a blessing.
  5. For the flour mix, I used Arrowhead Mills Gluten Free All Purpose Baking Mix, which worked just fine.
  6. I suspect you can make these more properly croissantish if you role the dough thinner than I did.
  7. Each quarter of the dough should be approx. 700 calories, taking into account the rice flour and grated butter used during rolling. I overdid with the grated butter on that first batch, which is why I put in a range above.

Writer-Girl Utility Belt (Crafting)

Batman's utility belt.

I’ve always envied Batman. Not because of the cool costume, or the mansion, or the Boy Wonder (definitely not because of the Boy Wonder) or even because of Alfred (though he’s pretty nifty). It’s the belt.

Because the belt seems to carry just as much as Mary Poppins’ carpet bag, but is way more stylish. Believe me, I have far too much stuff I carry with me and a utility belt would be a blessing.

A few years ago, simransmiles and I made ourselves writer-girl utility belts. Awesome writer-girl utility belts. They were her brainchild, and produced primarily by her sewing skills, though I did some of the grunt work. We made them out of thrift store finds, and designed them to sit just above the hips. I don’t have any pics of me wearing mine, but I do have a pic of Sim in hers:

Sim wearing her writer-girl utility belt.

We made them in a V shape, which was more flattering for our girly curves than a straight across belt would be. I tended to wear the V in the front, while  Sim tended to wear it on her hip. Both ways looked fine.

The main body of the utility-belt is made out of a corduroy skirt. Then notice the buttons? Since buttons are notoriously hard to do on your own, we took that part from a pair of button-fly jeans. That portion is actually upside down and forms the center of the V.

We cut the flap that normally covers the buttons and folded it back, lining it with a decorative fabric and sewing it down to make a pocket for pens. As you can see, it fit two pens.

The two pockets on either side of the buttons came pretty naturally from sewing the jean to the corduroy. Both pockets were the perfect size for holding a smaller moleskine notebook. They also fit phones/mp3 players easily. Although stuff could get a bit jumbled up. I found that the edge where the pocket met the corduroy was the place that most frequently needed repair.

The belt laid out flat.

Sim found a pouch she liked and sewed that onto her belt. It easily fit a paperback novel or a normal size moleskine journal (have you guessed that we’re both fond of moleskines?). I ended up deciding not to do that.

That blueish fabric you can see forming the extra trim on Sim’s belt came from a cloth napkin. As you can see, you can hook carabiners on it. In this picture Sim also has her utility knife hooked on it.

My version of the belt was all in black (of course) and we used a black cloth napkin to create the trim on mine.

We both wore those belts until they fell apart. I still have mine, tossed into the trunk of my car in case I someday got around to mending it again, although, honestly, it’s probably too far gone for that.

So, for now, I dream about utility belts. And obsessively research them online.

The Elimination Diet

The Elimination Diet is by far the hardest, and most effective, diet I’ve ever been on.

The point of the diet is to isolate food sensitivities and allergies (not the same thing). And it is brilliant for doing that. It also, as a side effect, is brilliant for weight loss.

I went on the Elimination Diet in November of 2008 as a result of a visit to the Crazy Docs. And when I say crazy here, I don’t mean they were psychiatrists. They were nutritionists and they were very eccentric. Hence, the Crazy Docs.

A friend had recommended them to me, saying they’d helped her with problems similar to the ones I was having at the time: fatigue, brain fog, and sudden weight gain. Add in, in my case, constant allergic rhinitus, hormonal irregularities, and frequent bronchitis. Sounds like a party, no?

Their answer was the  modified Elimination Diet. Their suspicions was gluten sensitivity, or full blown Celiac Disease. I did not realize, at the time, that this was actually their answer to everything. In my case, it turned out they were right. (I will talk more about Celiac Disease and gluten sensitivity in a future post).

Gluten, however, was not the only thing we were taking off the menu. No dairy, no eggs, no sugar, no vinegar, no citrus, no soy…  Here’s The List of Noes:

Everything that's not allowed on the diet.

That’s a pretty big list of things you can’t eat. Add in the complication of eating out, and you’re totally (pardon my language) screwed. Citrus, for example, is problematic. A surprising number of people don’t realize that lemons are citrus. Vinegar is in most condiments: mustard, ketchup, mayo, salad dressing. And try finding a satisfying dessert that fits that list. It’s not impossible, just hard.

The Elimination Diet doesn’t stay that limited forever. The idea is to do it strictly for two weeks and then slowly start reintroducing foods. Each reintroduction takes three days. The day you eat the food and then two days following for it to get fully out of your system. If you have any problems, and I mean any, while testing a food, that food needs to be retested. Dairy shouldn’t be reintroduced until you’ve been on it for several months (I waited six months, and man was I happy to have it back). Gluten is last of all.

It took me months to reintroduce all of those foods. And, honestly, I fudged on the last few. During that time, I lost nearly 20 pounds. In part because my food choices were significantly healthier, in part because there were so few foods I could eat. I did find some decent substitutes. Pure Decadence has a great coconut milk, agave sweetened, mango flavored ice cream.

Pile o' death.

I also learned even the Modified Elimination Diet wasn’t actually limited enough. Mind you, thanks to the limited types of foods I could eat, it was a lot easier to isolate the real problems. Like tomatoes and potatoes. Turns out they give me eczema. Brussel sprouts = migraines. And anything with capsaicin is inimical to my existence. I am allergic to capsaicin. I just always avoided it instinctively, and never had much. I thought I was breaking out for quite possibly years. Turned out it was hives from spicy peppers and their kin. (For some reason, almost every guy I’ve dated seriously over the last seven years has really, really liked capsaicin).

Ironically, aside from the gluten, everything I reacted to was actually on the list of allowed foods. If you’re interested, here’s a detailed list of the foods on the diet, including an annotated version on the second page: The Elimination Diet.

The Elimination Diet  improved my health. A lot.

(Addendum: There are food sensitivity tests out there that are certainly easier. However, the jury is still out as to the effectiveness of most of them.)

Putting the FitBit to Bed: Sleep Tracking

Some people apparently use it like this. And then wonder why it slips out.

To use the fitbit for sleep tracking, you slip it into the wristband that comes with it. In this picture (which I snagged from the engadget review) you can see the band and the fitbit. Do not wear it this way. It may look pretty and snazzy like this, but the fitbit will slip right outta there. (Enough reviews complain about this problem that it’s worth noting). Do the smart thing, slip the fitbit all the way inside the band. You won’t be able to see it anymore, but it won’t slip out.

You wear the band on your non-dominant hand. I don’t know why they specify the non-dominant hand, but I’m willing to accept that there’s a reason for it.

When you’re ready to sleep, press down on the button for several seconds until the word Start pops up. Do the same thing in the morning until the word Stop pops up. If you forget, it’s okay. You can add in sleep times manually on the website, too.

So far as I’m concerned, the sleep tracking is the most useful function of the fitbit.

On its own, the fitbit cannot give you conclusive information about your sleep. It can’t tell you if you have DSPS, or Sleep Apnea, or Restless Leg Syndrome. But it can tell you if your sleep is disturbed, which could indicate any of those conditions. Or could indicate that your cat likes jumping on your stomach at 2 am with claws extended.

This is what a good night looks like for me.

Each pink spike in the graph above indicates a time when I moved around while trying to sleep. It doesn’t necessarily mean that I fully woke up each time, just that my sleep was light enough, or disturbed enough, at that point that I moved. At a sleep lab they’d call that an arousal (which is nowhere near as fun as what I usually mean when I use that word). When you’re in a deeper sleep phase, you don’t move around much.

This particular graph is from last Wednesday and indicates a very good night for me. I had 17 brief arousals, and managed to get over eight hours of sleep. I also was asleep at a decent time, which is an issue for me (remember my prior post about charting sleep?).

And here’s a bad night.

A bad night.

You can see that I was a lot more restless that night (Sunday). I still woke up 17 times. But I stayed awake, or aroused, a lot longer. And as I said earlier, not aroused in the good way. I totalled six and half hours of sleep, although I was in bed for 13 hours. This is incredibly useful information; I wish to heck I’d had this info when I was a teenager getting nagged for sleeping in so late on weekends and being zoned out in morning classes (8am Italian was excruciating).

If I’d known how bad my sleep was, I might have been able to do something about it. Or my father (the pediatrician) might have.

You see, I have sleep apnea. Want to know what the difference between those two nights is? The good night, I used my CPAP. The bad night, because of congestion, I didn’t use my CPAP.

See what I mean about that sleep tracking being useful? On its own, the fitbit doesn’t tell me I have sleep apnea. But it does tell me when I’m having trouble sleeping. And these results are consistent enough for me to say that my CPAP definitely makes a difference.

Hours of sleep in March.

Here you can see how much sleep I actually got this month. Not how much time I spent in bed trying to sleep, but how much sleep. This is a key distinction.

You can also see how frequently I wake up during the night. There’s a huge variation there. Some of that correlates with how long I spent in bed (if you’re only in bed for four hours, you’re going to wake up fewer times than you would in eight). But there are other potential factors as well.

Times awakened.

This data can help me figure out if the nights I take a decongestant are, overall, better. Or worse. Or no different from other nights. Likewise with taking Ambien. Or with exercising before bed. Or having a glass of wine before bed. Or changing my diet. Or any other variable I care to examine.

Fitbit Ultra

OCD Dream Gear: The Fitbit

Three FitBits, all in a row.

Adorable, isn’t it? I have to admit, the form factor was a big part of the attraction.

In some ways, the Fitbit is a really fancy pedometer. It has an accelerometer in it, much like what you’d find in a wii controller. It is particularly suited for walking, running, hiking, jogging, and sitting still. (Yes, knowing how much time you spend sitting on your butt is actually useful). It can also track your sleep to some extent; I’ll talk about that in another post.

The form factor and the online interface were the real selling points for me. The fitbit is sleek and subtle. It’s built like a belt clip, but because of how small it is, I can wear it on my bra. Which is mostly where I wear it.

I already knew that I was pretty sedentary, but the fitbit visually presented that information in a way that motivated me to get off my butt and move around more, which means it’s doing its job as a fitness aid.

Here we have an overview of my typical workday after using the fitbit for several months. Each colored line indicates calorie burn, which indicates activity. You can see a few spikes during the night, which indicate times I moved around a lot or got out of bed. Then, you can see some pretty consistent blue activity (blue meaning low level) as I started my day. The big orange and red spikes indicate my lunch time walk, when I was more active and therefore burning more calories. It’s a very simple, and therefore very useful, visual.

Above the graph, you can also see how many calories I burned (logged by the fitbit itself ) and how many I ate (logged manually by me). Again, very useful. I don’t actually manually log every single thing I eat on the fitbit site. The interface is a little cumbersome for me, and it requires me to remember and enter whatever I ate the next time I’m near my computer. I use LoseIt on my iPhone throughout the day and then just enter the summary of my calories  into fitbit’s interface in the evening.

Activity Log, complete with pie chart!

There’s also an activity log that records the number of steps and miles and shows you the same info as above in pie chart form. Useful, but I like the graph from above better. (Click to enlarge if you’d like to see it more clearly).

If you participate in an activity the fitbit isn’t good at logging, like weight lifting, you can add that manually and the software will provide a “standard” calorie burn for that.

Intake vs Burn. My other favorite graph.

I’m not sure this graph even requires any explanation. It’s just lovely. You can see where I didn’t track food intake. You can see where I ate more than I burned. You can see where I burned more than I ate. You can see my average intake and my average burn. This is awesome information. Particularly when matched up against weight fluctuations.

BMI fluctuations over the past month.

That huge intake spike around March 12th was when we took J’s dad out to dinner at our favorite steakhouse; primerib and a baked potato seriously add up.

There are a bunch of other graphs, all of them with useful info. These are the ones I find most helpful. I love that I can see patterns over the last month, or over the last year (once I’ve been tracking that long). I love that I can see the correlation between my exercise, my consumption, and my weight.

I love my fitbit. The information is useful, the step count is pretty accurate, and the physical object itself is unobtrusive and convenient to wear.

Fitbit Ultra

The Weight Loss Quest: How Much OCD is Helpful?

Notice the animals instead of numbers? Maybe I should get this scale instead...

My endocrinologist wants me to lose 50 pounds. Yep, 50.

This presents me with a challenge to figure out how to use my OCD to facilitate weight loss, without letting it get out of control.

Before anyone tells me that I don’t need to lose any weight and I look fine (and thank you if you were going to say that) it’s not about the way I look. It’s about hormones. Insulin, to be specific.

I have PCOS, which means that I’m more at risk than average for diabetes or other insulin related problems. Weight is a big factor there. (I’ll go into more about this in a future post because I have, of course, obsessively researched it).

I do have to say, I think I’d be unhealthy (and damned unattractive) if I lost that much. I also think I wouldn’t have breasts if I lost that much. This would make me sad, as I rather like having breasts.

Me at my current weight. Wearing a pink wig.

The first challenge is figuring out how much I want to lose, instead of obsessing on 50. My endo pulled that number from a BMI chart. My current BMI is 28.2, which puts me solidly in the overweight category, nearing obese. However, I don’t buy into BMI.

In truth, although I weigh 20 pounds more, now, than I did when I got out of college 10 years ago, I’m smaller and stronger than I was then. The same clothing is looser on me now. Which means my muscle density has increased. Which is a Good Thing (TM). However, my BMI is higher.

Personally, I’m thinking 15 pounds, although that leaves my BMI in the overweight category, at 25.8. I’m picking that as my initial goal and ignoring that little obsessive voice that keeps saying, “He said 50. He did say 50, you know. How about 50?”

The next challenge is using my OCD just enough to be helpful but not so much that I’m miserable. As we already know, I’m good at tracking things. So, I’m tracking my intake. I know that if I follow that primrose path too far, I could end up in serious eating disorder territory. I have, luckily, never been in that territory, so for now I’m going to say my obsessive tracking will probably be fine. Thanks to my lovely iPhone, I’m using LoseIt to track my food intake. More later, no doubt, on that.

FitBit

I’m using my FitBit to track my exercise (this is where my Christmas money went – thanks Mom & Dad!). More on this in another post, too.

I’m also walking more.  Last weekend, J and I walked to a party 3 miles away instead of driving. There and back again gave us 6 miles, and two hours of conversation.

The most challenging thing, however, is not looking at the scale. Strange, to say I want to lose weight but then say I don’t want to look at the scale, no?

Thing is, for me, looking at the scale is self-sabotage. If I see that I’ve lost a pound or two, then I feel like I can relax, which means I end up gaining. If I see I’ve gained, or that I’m staying the same, I get discouraged and don’t want to continue. If, on the other hand, I don’t look, I keep eating and exercising according to plan. And the plan is a good one.

But every morning, I feel the absolute need to weigh myself. It’s not optional. I need to. I will stand there, frozen and unhappy, staring at the scale and not stepping on it, knowing I shouldn’t do it, but unable not to. This tends to slow the morning down considerably. Finally, today, I closed my eyes, stepped on the thing, and asked J to look – but not to tell me any numbers. Just to tell me if I was doing all right.

So far, so good.

Here’s an interesting BMI calculator in case you’d like to play with it.a.dir_resource_link{color:#a0a0a0;}[gigya width=”300″ height=”250″ src=”http://www.dietsinreview.com/media/instant-health-snapshot.swf” quality=”high” wmode=”transparent” ] More Diet Resources: Diet Reviews, Healthy Recipes, and Health News