Friday, May 29, 2009

NUCCA? Whazzat?

Alas, another post that is only peripherally, and by your indulgence, related to the subject of writing.

Before our little jaunt to Hawaii, I thought my blood pressure was under control. Mornings it tended to be about 124/82; after yoga, this dropped to about 105/70 and tended to stay there for the rest of the day.

That changed in Hawaii, and for no discernible reason. Although a good yoga session in Honolulu still dropped my blood pressure an hour or two later to about 95/60, at odd moments earlier or much later in the day, it might go higher, up into the 140s/90s. And, on the night before we came home, it went very high indeed. We're not talking Dow-Jones-Industrials sort of high; but we're definitely talking numbers that, were they IQ scores, would get you into MENSA no questions asked.

This weirdness has persisted. Yoga invariable puts it below 105/70, but at other times I can get measurements as high as 170/105. There appears to be no particular pattern--although, of course, having something stressful happen will make it rise sharply. For example, yesterday I came home from a morning yoga class with a blood pressure of 91/53; after responding to a particularly upsetting e-mail, it had jumped to 165/100. (Unfortunately, the reverse is not true; relaxing doesn't necessarily make it come down.)

One decision I've made is not to read any e-mails I don't absolutely have to read. Another is that I have decided to drop out of my annual writing retreat in Palm Desert. This was wrenching; it's one of my favorite events of the year, and I look forward to it every summer. But things are so damn strange with me physically at the moment that I'm simply not up to it.

(There, see? I talked about writing. Sorta.)

This "labile" blood pressure is considered a very bad sign; but, then, it's usually seen in the latter stages of heart failure, which is certainly not what is happening to me. It's more than a little baffling--and would continue to be disturbing even if I manage to coax my blood pressure into the nice stable pattern I had before my recent unrelaxing vacation.

In searching the web for information, I came across a technique called NUCCA that has normalized blood pressure in a number of people. Now, as a Californian native, I know about "YUCCA," a large spiny flowering member of the agave family (and, weirdly enough, technically a sort of lily). But "NUCCA?"

As it turns out, NUCCA is the National Upper Cervical Chiropractic Association, a group that specializes in adjustments of the cerivcal spine, and, in particular, the so-called Atlas vertebra that supports the head where the brainstem narrows down into the spinal column.

It seems that a Chicago doctor had been sending a number of his patients to a NUCCA chiropractor for various kinds of pain, and he noticed that the patients who suffered from high blood pressure came back with their blood pressures substantially reduced and sometimes normalized. (He had to take a number of then off of their medications.)

This doctor contacted a the director of the Hypertension center at the University of Chicago, and together they proceeded to conduct a well-designed, double-blind study where neither patients nor doctors knew whether the NUCCA chirpractor on the research team study had given the patient an actual adjustment or a sham adjustment. The results were stunning, and also unassailable--despite the medical prejudice against chiropractic, the results were published in a majore medical journal and now seem set for a wider-scale trial.

"Is it going to be for everybody with high blood pressure? No," the lead researcher said. "We clearly need to identify those who can benefit. It is pretty clear that some kind of head or neck trauma early in life is related to this."

Well, as it happens, I am a survivor of pretty major neck trauma. When I was 17, I took a fall from a building that left me with a broken collarbone. The collarbone was treated, but the damage to neck was ignored. The disc between two of the cerivcal vertebrae was crushed so completely that the two vertebrae fused together, and the vertebrae directly above and below them aren't much better off. (I'm probably an inch shorter than I was when I was 17.) Doctors wince when they look at my x-rays.

This has been a source of ongoing pain in my shoulder, my back, my neck, and my left arm, and not just mild pain, either; but you can get used to pretty much anything. I wasn't worried about the pain, but I was hoping that NUCCA could do something about my fluctuating blood pressure.

Pamela, always the scientist, was somewhat excited by the idea, noting that the odd way my blood pressure fluctuated, and the fact that it responded so strongly to aggressive yoga (but almost not at all to other aerobic exercise) suggested a problem that was mechanical rather than chemical in nature. So, off I went in search of a NUCCA adjustment.

Now, not just any chiropractor can do this sort of adjustment. NUCCA is a very narrow, very precise set of techniques that has little connection with what people think of as chiropractic. They don't twist or shove, and above all the NUCCA techniques don't call for popping or cracking joints. Instead, a NUCCA practitioner takes a number of x-rays and then does a rather arcane series of calculations to determine how the bones in the neck (especially the all-important Atlas vertebra) need to be moved to return the body to alignment--and also to remove the pressure of the Atlas on the spinal cord.

As expected, my x-rays were a bit of a horror show. My Atlas was not only tilted but also revolved around my spinal cord; viewed in an x-ray looking down through the top of my head, you could almost see it pinching in on my brainstem. Nice.

The adjustments themselves are truly odd. You lay on your side, with your head supported on a strange little bench that can be cranked up and down to presie angles, and the doctor bends down over you and, well, sort of uses the edge of his hands to fiddle with your ear and jaw. Over and over again. What he in fact is doing is making small movements to lever your vertebrae relative to you skull, sort of as if he's "tapping" things back into place.

That part, at least, works. Even though it feels as if little has been done, the second set of x-rays show how much everything has moved. And my adjustment was unusually successful in terms of realignment.

Now the questions are 1) Will it have the desired effects? and 2) Will it stay adjusted?

Unlike most chiropractic work, this isn't designed to be a treatment that is repeated over and over; ideally it is a one-time adjustment that puts everything back where it ought to be. So I have to be very careful about my movements fro a few days, so as to let the body adjust and hopefully lock all the bones into their new positions. Unfortunately, this also means no yoga! (Ack! I'm going to have a hypertensive crisis!)

It's too early to tell if this will affect my blood pressure, since this takes time. But the effect on my arm, neck, shoulder and back has been dramatic. At one point last night, I woke up feeling strange. That strange feeling was being pain-free for the first time in almost four decades. It didn't last; I have some midl discomfort as I sit here typing this, but the intensity of pain has dminished by at least 80 percent, which is no small matter.

I am, however, afraid to take my blood pressure. Especially when I'm looking at three days without yoga. If you hear a loud BANG! it's probably my head exploding.

Monday, May 25, 2009

When Symbolism Invades Daily Life

Well, rather opaque symbolism.

Here's the deal. A couple of years back, on a hot summer afternoon. various members of my family were over hanging out at the pool, doing family-summer-afternoon sorts of things.

Pamela heard a rustling back in the bushes by the rear wall of our yard. When she investigated, she found it was a baby crow, and when she tried to coax it out of the bushes, said baby crow made a mad rush around her and flung itself into the swimming pool.

Pamela, being the sort of person she is, followed the crow into the pool, and before a crowd of spectators that now included two cawing crow parents, we managed to effect a rescue that ended with the baby crow perched on my shoulder.

We have pet birds--a pair of cockatiels--though I must say they are rather less imposing than a fledgling crow. I admit that having two sets of large claws clinging to my upper trapezius muscle was unnerving, and even a young crow has a rather wicked scythe of a beak that it isn't relaxing to have poised near one's unprotected eyeball.

Nonetheless, we knew something about birds, and something about wet birds in particular. Barring the possible exception of waterfowl, what is it that a sopping bird wants most?

To be blow-dried.

We discovered bird blow-drying on a cold Seattle evening when one of our cockatiels insisted on jumping into the shower with us and then sat there shivering afterwards. Since this seemed like a recipe for overnight death, we tried gettting out the blow dryer...

She loved it. Sat there on my shoulder and leaned into the hot breeze with eyes shut tight in birdy bliss. Birds love being blow-dried, and it is entirely possible that the purpose of evolution all along has been to create a species that could construct blow dryers to serve the needs of some yet-uncreated Birdie Master Race.

So we blow-dried (blew-dried?) the crow. And, like our cockatiel, the crow treated the loud, roaring electrical device as if he had been waiting for us to get around to it.

My sister had her young son along with her, and amongst all the toddler impedimenta had brought some cooked chicken. Peeled off in long wormy strips, this morphed nicely across species into a crow snack.

Evening approached all too fast, closing our window of opportunity to reunite the crow with his parents. With the baby crow at last warmed up and fed, we took him outside. His parents flew back and forth above us, calling out, and we placed him atop a wall. They cawed for him to join them, and somehow, in the gathering dark, finally encouraged him to flap up and join them in a tree. Meanwhile, we humans all retreated into the house and patted ourselves on the back for a job well done.

A few days later, the crows were back. The parents stayed well away, but Crow Baby, now a bit more skilled in the skies, flew down and perched low on our roof, calling to us. He wasn't in need of blow-drying, so we brought out some food, and as soon as we backed inot the house, he swooped down on it and ate greedily, no doubt pleased at how well he'd trained us.

That's how we acquired a rather demanding resident crow. He comes when he hears the back door open, or even swoops past us, bitching about our tardy serivce, if we go out the front door and haven't yet fed him. And eventually he showed up with a mate; and at least once a year and sometimes twice, he now shows up with a two or three clumsy babies, all calling out to be fed. (What happens to these babies in the longer term I don't know. It seems that by now we'd have a flock of twenty-some crows, but it seems that at some point the youngsters get the boot.)

My, you're saying, what a charming story--or, perhaps, What the hell does that have to do with anything? Well, if you'll stop fidgeting and drop your gum in the wastebasket, I'll continue.

We have a huge chimney attached to our house, the sort of thing a Californian looks at and, inspired by its soaring height, says to himself, Lordy, it's going to cost a fortune when that thing goes down in an earthquake. Why we have fireplaces in Southern California in the first place is an unanswered question, much less the two fireplaces attached to this massive brick tower; but I didn't design the place. (From the looks of it, it was designed on Cape Cod about 300 years ago. It has gables and such.)

The crows like the chimney--it's both high and isolated. Plus you can cary nice bits of roadkill up there and crack the bones open against the mortar.

If you're an adolescent crow, you can also lose your balance and fall down the chimney. One day we heard this odd metallic banging. When it persisted, we peeked into the living room to find a young crow in the fireplace jumping and pecking at the firescreen in an effort to get out. We opened the back door, pulled the screen aside, and watched with some trepidation as he took flight toward the interior of our house and then, neat as you like, swooped about and whooshed out the back door just as if he'd been planning the whole display.

A day or two after we returned from our recent vacation, the crows--who brought off a clutch of three babies in our absence--were in an uproar, swooping around and cawing, and apparently dive-bombing the neighbor's dog. (They aren't quite large enough to carry the dog off and eat it. Unfortunately.)

The source of all this ballyhoo turned out to be another baby crow down the chimney. But this time the bird hadn't toppled all the way into the fireplace. There is a space back behind the flue door--a deep sort of trough that reaches down a foot or two behind the back wall of the fireplace. And in this trough there is, for unknown reasons, a hand-high gap in the brickwork which is perfect for a crow, or, I suppose, for any animal that can scrunch down into a hand-high ungraspable packet, to hide.

The entrance to our flue is quite narrow front-to-back. As it turns out, it is so narrow that when I kneel in the fireplace and try to reach up the flue, my arm makes it just to mid-bicep. So it fell to Pamela, who has rather daintier arms than I, to achieve a rescue, which she mamaged over the next ninety minutes (while I figdgeted and scratched and offered no-doubt invaluable advice.) I won't describe all the machinations, though I will note that a part of our rescue strategy involved pushing nearly all of our supply of towels into the weird trough so as to raise the floor, and then harrying the crow out onto the terrycloth platform.

After we finally managed to net the little bastard, he stood on my arm as if there wasn't much unusual. I suppose that from family legend he was expecting chicken and a blow-drying, but instead we took him out to his parents, and after he regained his bearings, he flew off and the five of them finally shut the hell up for the day. (One thing for sure: we need to put acreens over the tops of the damn chimneys.)

Now, if one put this sequence of events in a novel, it would mean something. Especially as it involves black birds. (And as it happened three times. The Goldilocks formula means that we have reached completion. Or, as Auric Goldfinger observes to James Bond, Once is happenstance, twice is coincidence, three times is enemy action. Three isn't just a crowd, it's a sort of storytelling touchstone.)

But what the heck does something laden with this sort of symbolism mean in real life?

And who is the protagonist? Me? Pamela?

The Crow?

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?