My Summer Phucket List

My summer bucket list is really a Phucket list.

• Walk the dog in the backyard twice a day.  Phucket, I’ll just let him out the door.
• Go to bed by 10pm.  Phucket, I’ll just read R.F. Kuang fantasy novels past midnight.
• Avoid after-supper treats.   Phucket, I’ll eat all the ice cream, cookies and chocolate I want.

Isn’t the trifecta of a healthy lifestyle to get a good night’s sleep, exercise and eat healthy foods in moderation?  If so, then my Phucket list is more like a death wish.

I blame all this on the lack of impulse control brought about by the Effexor I started taking in September.  It’s time for another visit to the doctor.

What’s the worst side effect you've experienced?

Mood Enhancers

Last year I struggled with forgetfulness, fatigue, brain fog and an overwhelming sense of hopelessness.  I got in quickly for a neuropsychological exam, which resulted in a diagnosis of Major Depressive Disorder and ruled out any kind of cognitive decline.

I had already been taking Nuvigil and had been using a CPAP machine to reduce the number of apnea events I’d have every night.  But that wasn’t enough.  So I started Effexor¹ and Cognitive Behavior Therapy (CBT)².

About six months later I noticed that the sense of hopelessness was gone, and my mood was much improved.  Why?  Was it just the Effexor?  Was CBT helping?  Was there something else that I did to bring about change?

I decided to make a list of all interventions:

• Mindfulness – Staying in the Moment
• Caring for Pets
• Tending to Houseplants
• SAD Therapy Light, which I call my happy light.
• Avoiding Refined Carbs
• Keeping a Gratitude Jar
• Smiling
• Walks in Nature
• Crisp breeze on my face on a sunny winter day
• Listening to Uplifting Music
• Metallica for a shot of high energy
• “Mood Improve” Probiotic
• Medications, such as Effexor and Nuvigil
• Being creative
• Keeping to a Regular Sleep Schedule and Rising Without an Alarm
• Walking and standing with a perfect posture
• Ice Crystals on a frosty or snow-covered lawn
• Community Support, including Online Groups³

Look for more information on some of these items in upcoming posts.

At first I discounted the role that CBT had in my improvement.  But it turns out that CBT was responsible for a few of the items on this list, especially Mindfulness and the other living-in-the-moment experiences listed above.  In fact, there even is a Mindfulness-Based Cognitive Therapy⁴.

On the other hand, I usually experience good mood in Late Winter and Early Spring.  It’s very possible that my improvement is due to seasonal changes.  Now that we’re beyond Summer Solstice, I’ll be able to test this idea.

What do you do to improve mood?

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¹https://medlineplus.gov/druginfo/meds/a694020.html

²https://en.wikipedia.org/wiki/Cognitive_behavioral_therapy

³Such as https://mysupportforums.org

⁴https://en.wikipedia.org/wiki/Mindfulness-based_cognitive_therapy

2025-11-07 Remove extraneous bracket and tab infront of Metalica. Add ",which I call my happy light."

Depression Follow Up

I actually saw the doctor about my depression.  I use "actually" because I almost never go to the doctor, at least not for an ailment.  Usually the long wait time to see a doctor exceeds the duration of any medical condition that sidelines me.

The appointment didn't go the way I'd hoped.  That's probably because my wife was there with me.

My idea was that the doctor might recommend light therapy (due to the seasonal aspect of my condition) plus exercise and perhaps meditation.  And he did mention light therapy.  But my wife's agenda was that I'd leave the office with a prescription for an SSRI-type anti-depressant.  So that's the direction we took.

It amazes me that despite all the medical screw-ups my wife has experienced, she still puts so much faith in doctors and prescription medication.

In fact, my wife interrupted our non-medication discussions a few times with increasing urgency, insisting that my condition was dire.  I thought she was going to erupt in tears at one point.

So the plan is that I'll take the medicine to make my wife feel better.  As if I already don't do enough shit for her.

Now I really feel depressed.  But I'm hoping the doctor prescribed a placebo.  Do they even do that?

Here's a little SSRI humor for you.  I can't seem to embed it, so I hope you'll make the effort to click on it and watch.: http://jonesnco.com/junk/proloxil.swf

Health Insurance

You can let food be your medicine, but don't expect insurance to cover it.

Likewise, medical research tells us that pets provide their owners with stress relief.  It also tells us that too much chronic stress leads to disease.  But show me an insurance company that will reimburse for pet food and vet bills, and I'll show you a three-legged duck.

The one alternative health care practice that insurance does cover is exercise.  They do this by paying for the cost of joining a gym.  Joining is covered; the monthly fees, however, are not.

What healthy lifestyle choice would you like to see covered?

No More Tobacco at CVS

CVS pharmacy recently announced that it intends to stop selling cigarettes starting October 1, 2014¹.  This announcement comes out just over fifty years after the US Surgeon General released its report that linked smoking with disease².

A pharmacy is a place where people who are sick obtain products that are supposed to make them well.  So it's ironic that pharmacies also sell products that are known to make you unwell.

Tobacco is just one example of such a product.  But consider sugar.  Although the Surgeon General hasn't mandated the labeling of sugar-laden products with health warnings, it does state that "...eating healthy means ... limiting intake of ... added sugars."³

Sugar can be found in some form in every drug store.  It's in the candy isle, of course.  And in the soda aisle.  Some larger stores might harbor it in the freezer case in the form of ice cream and other frozen desserts.  Then of course the seasonal isle erupts with candy right after Labor Day with Halloween candy, which transforms into Christmas candy on November 1, then into Valentine's candy in January, and ultimately appears in a majestic fanfare as Easter candy at various times in Spring.  Come Memorial Day, sugar goes on a much needed vacation, at least until it becomes fashionable to eat candy for Independence Day.

Eventually CVS will find it necessary to eliminate candy from its stores once it realizes that selling candy "...is inconsistent with our purpose – helping people on their path to better health."¹  It might take CVS another fifty years to reach that conclusion, although without the profits from tobacco sales to keep it afloat, CVS might not be around that long.

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¹ https://cvshealth.com/newsroom/press-releases/cvs-caremark-stop-selling-tobacco-all-cvspharmacy-locations
² https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf
³ https://www.hhs.gov/fitness/eat-healthy/dietary-guidelines-for-americans/index.html

2020-02-29 SPG -- Updated broken links in footnotes.

Epic Sinus Infection

I'm just getting over a sinus infection.  I first noticed it on the morning of Wednesday, November 28, as I readied myself for an appointment at the dentist.  But I think the trigger occurred on Sunday October 7, when I inhaled a cloud of dust from a bale of moldy hay at a local farm.  In fact, on Sunday afternoon and into the night, I had more and more trouble breathing.  I experienced the worst case of asthma ever, and I went in for a breathing treatment at the walk-in clinic.

I brushed off the sinus infection thinking that with my low-inflammation diet, herbal remedies, neti pot, steam treatments, Reiki and over-the-counter decongestants that I could recover without medical intervention.  But after a while not even the Sudafed could open my nasal passages, so steam and neti pot became futile.

My condition worsened while off from work for Christmas.  And I was surprised.  I had expected to improve once we had a nice layer of snow to seal off the mold from leaf decay.  It was the waves of throbbing head pain that clinched it.  Not wanting to start 2013 sick, I decided to finally visit my Primary Care Physician (PCP) on New Years Eve Day.

He prescribed Ceftin and recommended Mucinex and steam treatments.  I discontinued the Sudafed.  It wasn't working, and it would only increase my borderline high intraocular pressure (glaucoma).  Very soon I started to improve.  The headache was gone within several hours.  I was thrilled with every wrinkled, dense, yellowish-green booger I could dislodge.

But after four days I stopped improving, reached a plateau, and thereafter slowly got worse.  With one day's dose of Ceftin remaining, I called the doctor and explained the problem.  He responded with a prescription for Medrol and Levaquin.  Yes, this was what I needed.  I've been through this once before, and the combination of a systemic steroid and powerful antibiotic (plus a steroidal nasal inhaler) restored me several years ago.

I'm on Day Four of the six-day course of Medrol and ten-day antibiotic.  If I were to just stay as well as I am now, I'll be happy.

I 've heard from others in my circle who are also battling their own sinus infections.  One theory for this confluence of illness is that mold developed here in the Northeast from the flooding from Hurricane Sandy and aggravated many.

How has your health been in 2013?

Is It Selfish To Choose A Life Without Prescribed Medications?

This is in response to the post on Blogher, "Is It Selfish To Choose A Life Without Prescribed Medications?" as well as some of the comments that follow it.

Consider the following scenario:
An individual with a history of allergies, including cat dander, has been prescribed two different inhalers to control asthma.  The patient has also reported effects from eating certain foods, but the allergist refuses to test for food-related allergens.  The patient pays attention to the effects of foods on his own.  After a few years of conscientiously using the inhalers, the patient finds out about a Naturopathic Doctor who has been able to "cure" patients of their allergies.  After consulting with this new doctor, the patient undergoes the recommended diet plan and supplement schedule.  After only one week, the allergy symptoms have improved remarkably.  About six months later, a cat is introduced into the household with no adverse effects.  A few years go by with good results except for some difficultly breathing in the fall when not adhering to the diet.  The patient now shares a home with four cats and one dog.  One fall day, the patient is working outside in the yard and inadvertently inhales a dense cloud of dust from a moldy pile of grass clippings.  Later that night, his breathing is labored even though he self-medicates with Benedryl and Sudafed.  Finding no over-the-counter rescue inhaler, he decides to go to the walk-in clinic for a breathing treatment.

Should the insurance company pay for the breathing treatment?  One could argue that if the patient had been taking the prescribed medication, the breathing treatment would be unnecessary.  Another could argue that by carefully seeking alternative treatment, including diet changes, the patient has saved the insurance company the cost of years of medication, which more than offsets the cost of this one treatment.  Who's right?

How about this:
At a wellness visit, a primary care physician advises his otherwise healthy 35-year-old patient of "dangerously" high cholesterol.  The patient says he will alter his diet in order to try to reduce it.  At the next visit, the doctor finds that the cholesterol has lowered several points but is still way above the upper limit of 200.  The patient agrees to take a statin drug to lower the number.  After three months, the patient's cholesterol has been lowered successfully, but liver enzymes are off, so the doctor adjusts the medication.  After one more adjustment, the blood tests indicate an acceptable level of both cholesterol and liver enzymes.  After a few years, the patient seeks the advice of a Naturopathic Doctor for fatigue, brain fog, weight gain and increased appetite.  The doctor implicates metabolic syndrome (the patient does have a family history of diabetes) and suggests that the patient discontinue the statin medication, which can result in insulin resistance as well as  weak and damaged muscles (including the heart muscle) even though blood tests do not show the damage.  The patient goes on a special lo-carb, anti-inflammatory diet as advised by the doctor.  The diet is intended to address the fatigue and brain fog, but because it will promote a much lower insulin response, it should also prevent arteriosclerosis.  After one week, the patient notices remarkable improvement.  The brain fog is gone, and he's quickly gaining strength at the gym.  Further along, he notices that he awakens refreshed in the mornings, his elbow and knee pain is gone and he has almost no allergy symptoms.  However at his recheck he finds that his cholesterol has returned to its "dangerously" high level.  The new doctor says not to worry about this.  The LDL is high, but other risk factors, such as triglycerides, HDL, C-reactive Protein, are all good, and there are no symptoms of heart disease.  Besides, high cholesterol on its own isn't correlated with heart attack, and statins are remarkably ineffective at preventing heart attack while they promote diabetes.

If this individual should require a stent or bypass surgery, should the insurance company pay for it even though the patient ignored the advice of his PCP?  If the patient should die of something unrelated to a heart condition, can his life insurance company refuse payment on the grounds that the client changed his treatment plan?  Suppose the patient continued the statin and wound up with diabetes.  Can the patient sue his PCP, the AMA or the drug manufacturer?

Amazing Quotes From "Zoobiquity"

Some animal intestines perform an amazing trick. They expand and contract like accordions. This may not sound all that impressive, but its effect on weight can be profound. It allows the body to absorb varying quantities of calories from the same food, depending on the task at hand.

The mechanism is simple: a ribbon of muscle running the length of the intestine allows it contract and expand. When guts are clenched, they’re shorter, tighter and smaller. When relaxed, they’re elongated.

When intestines are in the longer, stretched-out mode, they expose more surface area to the food passing over them. This allows the cells to extract more nutrients and, therefore, energy. When the intestines shrink back to their shortened state, some of the food passes by essentially unused.

Could a similar accordion-like lengthening and shortening in human intestines underlie some unexplained weight gain in our species? ...there are intriguing clues. Our intestines are also lined with smooth muscle. And we know from autopsies that human intestines are some 50 percent longer after death, when smooth muscle control is no longer exerted. Perhaps, during life, dynamic muscle activity allows the human intestine to vary its calorie-absorbing length in response to medications, hormones, and even stress -- factors frequently pointed to when weight inexplicably increases even when a patient isn’t eating more. Many common drugs cause undesired weight gain through unclear mechanisms. It’s intriguing to consider whether smooth muscle effects of these drugs contribute to ... intestinal stretch leading to greater calorie absorption and weight gain.

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Psychiatrists studying eating disorders note that bulimic binge eaters rarely overconsume protein or leafy greens.  ...they focus their eating sprees -- sometimes with obsessive intensity -- on sugars and simple carbohydrates.

In the Yale study [of grasshoppers exposed to predatory spiders], the insects’ food choices were driven by external factors beyond their control, in other words, the ecology of fear.  In the presence of a predatory threat, they chose foods that would accelerate a lifesaving escape.  These animals provide an underexplored possible context for a human binge eater’s food choices.  They suggest an evolutionary origin.  A stressed person’s decision to forgo the chicken breast and vegetables in his lunch box and consume candy bars instead can seem pointless, weak and even self-destructive.  But knowing that some nonhuman animals prefer high-sugar foods when they’re fearful could help a human stress eater better understand his own candy binge.  While he knows it’s unhealthy for his waistline, blood sugar, and molars, the impossible-to-resist impulse may spring from a hardwired response to threats that for eons has saved animals’ lives.

New Girlfriend

"Mitzy got her hair highlighted!" I announced, returning home from the drug store with a cornucopia of my wife's medications. Mitzy is the pharmacy manager.

"Oh, is she your new girlfriend, now?" my wife asked casually.

"Yes. Well, you know. I go to the drug store so often, I see her more than I see you," I explained.

"That's nice, dear. I'm glad you're happy," she said, taking the package of meds from me and dumping them out onto the counter.

"Hey, is there a love note in there for me?" I asked with mock breathlessness.

"Oh yes! As a matter of fact there is!"

"Really!"

"Yes! It's from Darren. He's had his eye on your for a while, now."

"Ugggh."

On Finding (and Keeping) a Pain Management Doctor

Five days ago, Jenny Ryan posted the following Tweet:

Has anyone here ever seen a pain management specialist? If so, do you have any advice on how to find one, what to ask, etc.?

This is my response:
Pain management doctors (PMDs) purposely try to avoid calling attention to themselves lest they attract drug seekers, fond of self-injury, carrying altered prescriptions. But you can ask for referrals to PMDs at the usual places you'd find folks who are familiar with drugs: your PCP, health insurance providers, support groups, and your local high school parking lot.

Your PMD will refuse to call in prescriptions for you. And every prescription he/she will write will have no refills, even though he will go on vacation when a refill is needed and forget to tell you. He/she has no idea how you will react to a certain med, so some experimentation is in order initially. The dose is intended to "manage" pain, not cure it, and PMDs tend to think that pain at 5 or below is good.

You must be a delightfully compliant patient, with an alert yet relaxed disposition. During your appointments, you should endeavor to make good eye contact and resist the urge to glance furtively at your watch or the window or especially the cabinet that houses the drug samples. Suppress all nervous tics, hand wringing, rocking, scratching, tapping, shaking, etc. Otherwise you will be suspected of an addiction.

It's okay to ask for a specific drug. But when the PMD mentions the name of a drug, "Vicodin," for example, it's not a good idea to respond with, "OOOh yeah, that's good stuffcanigetthatpleaseohpleaseohplease!" Perhaps you should not bring your husband with you.

Some of this is in jest, but not all of it.

One last thing. My wife despises her PMD.

Your Choice: Rocks, or a Dull Blade

"Would you rather die by having your head struck by rocks, or by having your head cut off with a dull blade?" asked my wife.

This was in response to my asking which was worse: her pain, or the nausea caused by the pain med.

She had suffered from nausea since May 29. We only recently figured out that the nausea was a side effect of the opioid that she started in February, an opioid that brought pain down from 6 - 8 to 1. After multiple visits to her primary care doctor, and referrals to a rheumatologist, an endocrinologist, and a gastroenterologist, each one involving either a blood draw or an endoscopy (and a one-week wait plus a co-pay), the answer was to simply stop taking a medication.

Yet it's not so simple. Now off the pain med, her nausea was indeed gone, but the pain was back. And the Pain Management doctor was away on vacation with no backup.

To me, it seemed a no-brainer -- I'd endure nausea to get rid of that much pain. But apparently the nausea is severe enough even to wake her from a deep sleep.

"Rocks" I answered, thinking that a severed neck was just too invasive for me at this time in my life.

"Well, that's the pain that I have to experience for the rest of my life."

"Maybe you could go back on the nauseating med just until the doctor comes back. It probably won't make you nauseous right away."

"And that Dickwad of a doctor went on vacation leaving me without enough pain meds."

It is said that there are times when it's important to just listen and not try to offer solutions. This was definitely one of them.

Your Sleep Has Been Delayed

"Your sleep has been delayed." Imagine hearing that as if it were announced in an airport. That's how I'm imagining it, anyway.

I'd be sleeping now. But an hour and a half ago my wife told me that she was having trouble swallowing. Turns out she just took a new-to-her med, Trazodone, to help her sleep through the night. The idea here is that maybe her extreme fatigue is due to her inability to get a full night's sleep.

Ironically, one of Trazodone's more common side effects is dry mouth, which is also a huge problem for folks with Sjögren’s Syndrome, which she may (or may not) have. And excessive dry mouth can lead to difficulty swallowing.

Another thing that can cause difficulty swallowing is swelling of the throat due to an allergic reaction, which, as you might imagine, requires immediate medical attention. My experience is that it's easier to seek immediate medical attention when you're awake.

Hence, the delayed sleep and a time-wasting post about it.

Anyway, she's sleeping now. I don't have to check on her breathing -- the snoring says it all.

Good night!