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?