Healthy Obsessions The Adventures of a Mild Obsessive Compulsive

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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.

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 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