Thursday, May 7, 2009

A Long But Not Particularly Interesting Tale

Some of you may have noticed a fall-off in activity on this blog as of late. I'm going to 'fess up as to why.

Readers may recall that about the middle of last summer I found myself embedded in the Consulting Project From Hell--a project that ran months over schedule, with co-workers failing to deliver their goods on time, agencies not providing promised data, the failure of a long-relied-upon software tool (which had to be rewritten from scratch by Yours Truly), and a series of other disasters too plentiful to enumerate lest we never reach the end of this paragraph.

By the time I reached London for the final presentation (and for the serendipitous MNW get-together at Len Tyler's home), I was something of a wreck. I'd gained weight, felt terrible, wasn't sleeping well, couldn't think straight. Tended to wake in the night with a panicky sense of doom.

Now, I've been through the consulting meat grinder many a time, and I knew that it might take some time to recover. But this time, recovery didn't come. Month after month I staggered through through each day doing the minimum necessary.

Then, in February, after I sprained my ankle, a visit to the urgent-care center revealed that I had high blood pressure. Not just any high blood pressure, mind you: I mean serious, hypertensive-crisis, call in the paramedics sort of high blood pressure. To be precise, my first measurement was 185/111; and, sitting there in the urgent care center, while the staff unhelpfully told me how dangerous this was and that I needed to "relax immediately!" it proceeded to climb as high as 221/120. Fun, huh?

Now, I've had my blood pressure creep up to borderline (like, say, 138/94) before, though this is complicated by the fact that I have 'white-coat syndrome.' (That is, having my blood pressure taken raises my blood pressure. It's a sort of Heisenberg Uncertainty Principle, where the process of observing the state of an object alters the object's state.) All I'd ever needed to do was drop a few pounds, get some exercise, and stop living in hyperdrive.

This time, however, things were different. First of all, I had a sprained ankle, which somewhat limits exercise options. Second, they wouldn't let me leave the hospital without starting me on blood pressure medications. And, third, I couldn't downshift: my stress hormones stayed elevated , and I walked (or rather hobbled) around every day in a state that varied from low-level anxiety to downright panic.

Of course, no blood-pressure drug is without its side effects, and, in my hypervigilant state, all of the achy, dizzy feelings from the drug suggested to my subconscious that something was truly, deeply, horribly wrong with me. (Did I mention that some psychologists who study panic disorders have concluded that the number-one risk factor for developing ongoing problems with panic and anxiety is "a creative or imaginative personality"? Writers beware.)

I couldn't get much exercise, but at least I could lose some weight. Even without much exercise, this was easy enough, as I was so anxious that it was difficult to eat. But my blood pressure stayed high, in the 160s/100s. After a month, my doctor decided the ACE inhibitor wasn't enough. He doubled that dosage, started me on a beta-blocker, and threw in a diuretic.

Now, some people love beta-blockers. For most people, they have an anti-anxiety effect; they are the big underground drug in the performing-musician circuit, as they tend to manage stage fright. When you see a classical violinist perform a solo in front of a big audience, you are probably looking at someone taking a beta-blocker. (Pianists are less prone to use them, for some reason. I guess violinists are just more flighty by nature.)

I am not one of those people who love beta-blockers. I am one of those people who gets pain all over their body from beta-blockers, plunges into deep depression, has feelings that they are going to die, and has moments where death seems like a damned good idea. But I couldn't face up to discussing this with my doctor, as I knew he'd send me in for a gazilllion more tests, and immediately switch me to some other Frankenstein medication.

So I stopped without telling him. I know that's against the rules, but I felt better immediately. (And, guess what? My blood pressure didn't change.)

It was now about the start of April. I set about looking for another doctor, and, with my ankle more-or-less healed, was able to limp back to yoga class.

Over the years, I've done a fair amount of Bikram Yoga. For those not familiar with the system, it's a strenuous sequence of postures done in a room heated to about 105 F (that's about 41 C) and 40%+ humidity. This is a bit uncomfortable under the best of circumstances. In my condition, it was simply awful. For the first couple of weeks, I could only do every-other posture, simply standing in between and trying to calm my heart and steady my breathing.

Doing Bikram Yoga while on blood-pressure meds is quite an adventure. Not only do the drugs make you dizzy--which is a problem if you are in, say, Dandayamana dhanurasana, the standing bow--but it's easy to lose a couple of liters of sweat per class. If you're already on a diuretic, this pushes your daily water needs to ridiculous extremes. (Some days I was drinking in excess of five liters of water just to stay hydrated.)

But the system has a powerful effect on blood pressure. Even in the first few sessions, it wasn't uncommon for me to head into class at 155/98 and to emerge from the showers two hours later at 110/80. In the last two weeks I've done Bikram classes every day, and my blood pressure an hour after class averages 99/67. It does its best to climb back up later in the day, but in the same way it seemed to get 'stuck' up too high from stress, now it's showing signs of getting stuck down low. Of course, losing more than 30 pounds might have something to do with it, too.

It's been a little bumpy getting here. My previous doctor was utterly uninterested in lifestyle changes like weight loss, better nutrition, dietary supplements, or exercise--with the exception of telling everyone to cut sodium. I was dubious about cutting sodium, but followed his instructions...and, as anyone might expect, passed out after a Bikram class. (My sodium intake was down to about 700 mg per day, as opposed to a typical intake of about 5,000 mg per day, or a low-sodium-diet intake of 2,300 mg per day. Since you lose about 1,400-2,200 mg in a single Bilram class--or in a 90 minute run on a hot day--cutting sodium while exercising is one of the most dangerous things you can do.)

I still have a touch of white-coat syndrome. Nonetheless, my doctor's-office numbers are looking better, too:

Feb 17-- 185/111
Mar 25-- 171/104
Mar 27-- 160/98
Apr 27-- 126/76
May 4-- 130/82

Of course, at home my blood pressure is running well below those doctor's-office numbers.

That May 4th reading was on a visit with my new doctor, who is superb. He congratulated me on quitting the beta blocker on my own initiative, took me off the diuretic ("No one exercising 90 minutes a day needs to be on a diuretic, and no one doing anything whatsoever in 105-degree heat needs to be on a diuretic"), told me to eat a normal amount of salt ("Only ten percent of people are salt-sensitive, and even in them all you achieve by cutting salt is to knock two to four points off their blood pressure"), and said that he wants to see me in a couple of months to see if we can discontinue the medication entirely. Meanwhile, "keep doing what you're doing."

I like this doctor, and like him all the better for citing a research paper that was published just three weeks ago. The doctors I've worked with in the past never seem to keep up with medical research, and most of them seem to have lost all semblance of scientific curiosity. It's nice to see someone whose mind is still alert, and who is willing to question fashionable dogma as in the case of Killer Salt. (Despite the anti-salt recommendations of the AHA and other organizations, scientists are by no means all in agreement on the topic of limiting sodium intake. If you're interested, read Michael Alderman's editorial on the topic--or if you want to see the real science, read his excellent review article.)

I had a point here. Where'd it go? Oh. Yeah. My point was, I've been a disaster for several months, and in recent weeks I've been so focused on what's going on inside my body that I can barely think about anything else. But things seem to be settling down, and it looks as if I'm going to be able to rise from the grave and stalk the night once more, eating the brains of the living. On Saturday, though, we're off to Hawaii for a couple of weeks, so many of my posts may be those ditzy sorts of things you get from people on holiday. You may want to glance at the titles, wince, and quickly click the BACK button on your browser.

And, oh, yeah...I was supposed to be writing a book, wasn't I?


Anonymous said...

Nice to have you back, David. And it's good that you've said "No!" to the conveyor belt of pills. A goodly portion of diabetes patients could stand to take note of your story. The two best things that people can do TODAY to vastly improve their health is eat better and move their bodies.

It really is that simple.

Janet said...

You know we love you if we read a post with a killer title like that. You obviously need to turn your analytical mind to title selection. ;o)

Sorry you've had such a rough ride, and glad to hear that things are getting better. Take care of yourself and don't worry about blogging. You have no moral obligation to keep us entertained, although in your case, it is more a case of getting us thinking. (Of course, for geeky types, that is pretty much synonymous with entertainment.)

Tim Stretton said...

Glad to see you back on track, David. I'd put your absence down to getting lost in a particularly esoteric POV study...("unreliable fourth person plural", perhaps).

Matt Curran said...

Hi David

It's fantastic that you're back on the blog, but more so that you're feeling well with it.

The ever quotable Stephen King once said in an interview that his key to success was that he stayed married, loved his children and stayed healthy. It's perhaps an over simplification of success, sure, but there are some truths to it. And better still you're doing all this without having to pump yourself with drugs.
Hopefully now that you're physically fitter, the mind will follow (not that it really needs to... you've already shown in recent months that despite feeling a bit crap, your mind is sharper than most). Here’s to a classic follow-up to Shock and Awe…

David Isaak said...

Hey, Rob--

Yeah, but they make it awfully hard to Just Say No. Most of the medical profession try to scare you into doing what they want. And by law they hold most of the keys to the kingdom--you can't get the blood tests and diagnostics unless they give the nod.

This system is broken.

David Isaak said...

Hi, Janet--

Yeah, my publisher would agree--titles aren't my strong point.

Geeky? Us? And here I thought we were pretty much the Lingerie Model crowd...

(Well, I suppose I shouldn't assume there aren't geeky lingerie models.)

David Isaak said...

Hi, Tim--

Fourth person? Maybe I ought to move straight on to that, because it's hard to find good generalizations about third person. There's too damn much of it.

David Isaak said...

Hi, Matt--

'A bit crap' is one of those British understatements that I so prize. I think I'll start using it myself.

(Actually, as it turns out my new doctor is British. I don't know how he came to be in Long Beach, California, but I'll squeeze the story out of him one of these days.)

Staying healthy and keeping up solid relationships is certainly important--or, at any rate, their opposites provide massive distractions. What's amazing about King is that he stayed relatively healthy despite all the booze and huge bags of Peruvian Marching Powder. The man must have an iron constitution.

Jeremy James said...

When you were quiet I assumed you were busy writing the next novel. Very inspiring post! Glad you're back and in better health. I'm thinking I could use some yoga.

David Isaak said...

Hey, Jeremy--

Last time I checked, you were about the healthiest guy I know. I assume that hasn't changed?

In any case, though, if you haven't done any Bikram, you might get a kick out of it. It's a pretty killer routine that can trach just about anybody (largely because you are working at your edge no matter what your skill level).

I actually used to go to the San Diego school near Old Town (Jim and Emma's first school). But I understand there's a studio in La Jolla now, too, somewhere on Pearl St...

suroopa said...

Glad yoga helped. I am surprised how easily you can roll off a sanskrit word from the tip of your tongue. Clearly yoga is taught well, explaining the posture and why it helps. Will now look forward to your blog and next novel! Very best.

mags said...


ENJOY Hawaii. Take a silly sunset cruise on a pink catamaran, wear a lei, learn the hula ... eat mahi-mahi and take surf-boarding lessons, and most of all, take a break from stress. There'll be plenty more where that lot came from, so don't worry about the supply running low while you're gone!


Jen said...

You'd love my doc. She's the "anti-House." If you get better, she's happy, and she's not all that interested in what you were sick with or whether the drugs or the behavioral changes had the most impact. Plus, she gives me samples of an antidepressant I don't take so I can pass them on to someone I know who doesn't have insurance and needs the stuff. This is probably all kinds of illegal but I don't care.

Joan would agree with you about the parade of pills, by the way. She is diabetic and she turned down a drug for neuropathy by saying "I'm already on four prescription meds and that's the limit. If I'm going to take another one, one of the first four has to go." That was good enough for the Anti-House.

Alis said...

"some psychologists who study panic disorders have concluded that the number-one risk factor for developing ongoing problems with panic and anxiety is "a creative or imaginative personality"?"
Nice to have confirmed what I'd already decided off my own bat! And I have 'white coat syndrome' too. Just sitting in the doctor's waiting room makes me feel ill.

Sorry you've been through the mill, David - like Matt I assumed you were bashing out some deathless prose - but really glad that things seem to be responding to your taking matters into your own hands.
And hooray for the good Brit doctor!

Creative A said...

No need to apologize. We're just glad you're doing a little better. And I've got to second Megs - go enjoy your trip to Hawaii! You need it. :)


Frances said...

(Belated ) welcome back, David. So glad things are improving. Actually (and I'm a nurse, so should probably know better) I've never really understood the salt thing. Since the body is pretty good at getting rid of things it doesn't need, I'm sure it must do the same for excess salt. Makes sense, doesn't it?

David Isaak said...

Hi, Suroopa--

Yes indeed, a limited amount of specialized Sanskrit is at my command. Such as "dandayamana bikhaptadpada pachimottanasana" (which I believe is literally "standing separated-feet far-western posture" or some such).

That's the sort of phrase that comes in handy in a very circumscribed are of life, though...


David Isaak said...

Hi, Mags--

Well, I did not a lick of work in Hawaii. Saw a lot of old friends and tromped around the volcano. Who says I can't take advice?

David Isaak said...

Hi, Jen--

Sounds like you've been blessed in your doctor. (I have high hopes for my new one.)

Four meds is indeed too many; and I always think that the goal of treatment always ought to be some strategy that leads to zero meds...

David Isaak said...

Hi, Alis--

Great, huh--a whole new way for writers to be mentally disordered.

Choosing a new doctor is a sketchy process; you can't really get the gist of the person's approach from what their bio says about them. So the fact he was a Brit did in fact enter into my decision; I hoped that meant he might ot have consumed any of the Kool-Aid his colleagues had been drinking!

David Isaak said...

Thanks, Creative! (and good to see you.)

David Isaak said...

Hi, Frances--

Yeah, the salt thing doesn't actually appear to make much sense...and when you read the broader research papers on the topic, the evidence points both ways.

Why it has been so widely embraced is a mystery...

Jake Jesson said...

Very interesting post, David, despite the deprecatory title. I'm glad to hear you're feeling better, even if I had no idea you were in need of it. Hope you're enjoying Hawaii, and I (and, I'm sure, the rest of your readers) hope to hear from you again soon!

cruise deals said...

Without a doubt - A vacation in Hawaii may fix the sodium level in your blood :) worth a try…