Medical Procedures: What It’s Like to Have Medical Botox Injections

In my experience, this was one procedure it was best not to think too much about ahead of time: having a 30 gauge needle stuck repeatedly into your head in order to inject multiple doses of neurotoxin.

Most people think of Botox as a cosmetic procedure that reduces wrinkles.  But Botox is used medically to treat several conditions, such as repetitive neck spasms (cervical dystonia) and chronic migraines.  Botox injections work by weakening or paralyzing targeted muscles or by blocking specific nerves.  Although scientists still don’t know exactly how Botox works for chronic migraines, according to The Migraine Trust:

A recent US study by Rami Burstein et al using animal models suggested that botulinum toxin inhibits pain in chronic migraine by reducing the expression of certain pain pathways involving nerve cells in the trigeminovascular system…

Unlike many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscles.

In my case, the Botox injections were prescribed to treat chronic migraines (more than 15 headache days per month) which had not responded to any prescribed medications.

Since I was a bit apprehensive, I did research prior to the procedure, and watched several YouTube videos about the procedure, which made me think a little too much about needles going into my scalp and face.

I couldn’t find a good video that demonstrated the procedure for patients – most of the videos are either commercials for the product, technical demonstrations for healthcare professionals, or patients talking about their experiences.  This video is a technical video produced for healthcare professionals, but it gives you a good idea of the procedure:

My treatment began with me lying on my back on the examination table, and receiving injections in my forehead, temples, and scalp.  After that portion of the treatment was done, I was asked to sit in a chair and put my head on a pillow on the exam table.  (My arms were crossed, and my head was resting on them, like in the elementary school game of  Thumbs up, 7-up.)

While I was sitting in the chair, injections were administered to my scalp and trapezius muscles.

Unlike in the video, my provider did not use ice packs to numb the injection sites.  Some of the injections stung a bit as the Botox went in, but they didn’t hurt as much as some of the patients on YouTube had said they would.  Also, some of the injections were more painful than others.  For me, the injections in my left temple and behind my left ear were the most painful.  That’s the side on which I get most of my migraines, so the nurse practitioner figured those nerves were hyper-sensitive.

One of the injection sites on my face bled onto the pillow a little bit when I was getting the injections to the back of my scalp, and the injection sites were a little bit red and swollen for about an hour after the injections, so I kind-of looked like I had hives (or bee stings?).

But the staff was very careful to follow sanitary procedures, including cleaning the sites with antiseptic and treating the site that bled with clean gauze.

Also, I had no negative reactions to the Botox, so it turned out to not really be a big deal at all, and my apprehension was for nothing.

The entire procedure took about 20 minutes, and the effects should last for about 3 months.  Botox injections are not a cure for migraines – they are a treatment, meaning that they don’t fix what’s wrong; they only treat the symptoms.  If the injections work to lessen my migraines, I will have to continue getting injections once every three months for the rest of my life.

After injections, results are typically felt within 3-4 days.  However, studies show that most people do not experience the full effect until 6 months of treatment, which would be after the second or third series of injections.

If individuals have not responded by two to three treatment sessions it is generally considered that the individual is a non-responder.

(In other words, like other treatments, Botox for chronic migraines doesn’t work for everyone.)

Potential Side Effects of Botox treatment: Pain, swelling, or bruising at the injection sites.  If the person administering the shots isn’t careful to avoid certain muscles, you could have a drooping eyelid – or be unable to hold your head up – until the Botox wears off.

NOTE: Even though the injection sites might feel a little weird (slightly swollen, numb), it is very important not to rub the injection sites, as this can cause the toxin to spread outside of the designated areas.

[For more information on Botox, see this 2009 New York Times article.  Note that Botox has been approved for chronic migraine treatment subsequent to this article.]

Have you had medical Botox injections?  What was your experience with them?  Please comment below.

Update: One week after Botox

Still having debilitating migraines, but I’ve started to feel a little bit better.  Still very light-sensitive.  Less motion in my forehead muscles – can still make a Spock eyebrow, but the eyebrow doesn’t go as high.  Slight furrow when I frown.  Shoulder tension noticeably reduced; able to activate shoulder muscles that had been constantly tense.  Puffy eyes.

Update: Two weeks after Botox

Still having debilitating migraines, but also a few productive days.  Still very light-sensitive.  Very little motion in forehead muscles – can’t make a Spock eyebrow anymore.  Almost no motion when I frown or try to look surprised.  Shoulder tension noticeably reduced, with better range of motion of shoulder muscles.  Eyes still very puffy – but not drooping.

Update: ~ Nine weeks after Botox

My provider had informed me that, for some people, the effects do not last the full 12 weeks.  For these people, he said, Botox wears off a week or two before the next treatment.  For me, the Botox wore off 2 1/2 to 3 weeks before my next treatment.  My migraines returned with a vengeance, like they were making up for lost time.  While I appreciated the reduction in migraine symptoms and migraine frequency for nine weeks, having them return and knowing there’s nothing I can do about it for nearly three weeks until the next scheduled treatment sucks.

[The FDA approved Botox for migraine treatment at a 12 week interval, so even if it doesn’t last the full duration, the provider cannot shorten the interval.]

Guest Post: Slow Down! You Eat Too Fast!

[This is the next post in the guest series from Dave Banko on healthy diet and lifestyle.]

I remember being scolded as a boy for ‘inhaling‘ my food and not chewing it.

In basic training, the instructors would count our chews and slow down our caloric intake in other ways, but, when you only had 15 minutes to eat and it was taking too long, that changed to “Down as much as you can in the last 5 minutes!”  Needless to say, I ate too fast and this didn’t help my weight.

Having lived and traveled extensively in Europe, I’ve noticed this is a major difference between the European and the American culture.  The American culture is very “results-oriented” and this seems to apply to nearly every aspect of life, not just business.

I remember going to a restaurant in London for the first time.  What stood out for me was the space between tables (the owners weren’t trying to maximize how many people fit in the room) and no one pressured us to leave after we’d been there a few hours (not worried about increasing turnover).  I came back to the US and went to dinner at a restaurant where we took our time and noticed the table next to us turned over 3 times while we were there and the waitress was pressuring us to pay the bill and leave.

Slowing down your eating is a major recommendation of the ‘What’s the Right Diet for You?’ program.  

Experiment

Day 1: The researchers gave each participant a hamburger for lunch then secretly timed them.  All of them ate their hamburgers in less than 5 minutes, some in less than 2 minutes.  The researchers then asked for feedback and nearly all participants were still hungry.  Some said it was like a snack and they could easily eat another.  Then the researchers took blood samples, which showed that the hormone telling the participants’ brains they were full was low.

Day 2: The researchers gave each participant another hamburger of the same size and calorie content, but required them to take 30 minutes to eat it.  To help, the researchers had the participants sit down and use a knife and fork.  At the end of the 30 minutes, they again asked for feedback.  All of the participants felt full!  While some said they could eat more, they no longer felt hungry and were able to stop after one hamburger.  The blood samples supported this as the hormone levels were doubled!

After changing *what* I ate, the next big challenge was *how much* I eat and this information alone was very helpful.  I put this to the test myself and couldn’t believe the difference.

In my 2nd blog post, I spoke about the French Paradox.  How can the French (and I’ve seen this in other European countries like Spain, Italy and Germany) eat rich fatty foods and still stay thin with low cholesterol and heart disease?  They eat small portions over extended periods of time, so their bodies can process it properly.

To them, food isn’t something to conquer, ‘Man vs Food,‘ but part of an event to be enjoyed with friends.

Here are a few of the techniques I use to slow down when I eat:

  • Sit down to eat. If you are standing, or are in an uncomfortable position, you will be more inclined to rush eating.
  • Take a sip of water or other drink in-between bites. If alcohol, alternate alcohol and water, as alcohol adds calories too.
  • Have your meal with someone and engage in conversation during the course of your meal.
  • Cut your food into small pieces.
  • Chew your food thoroughly before swallowing. As your mouth includes digestive enzymes, this also helps digestion and fully processing the nutrients in your food.
  • Try to spread out your meal. When I’m at home, instead of having my meal all at once, I’ll spread it out over an hour or two.  For example, for breakfast, I’ll start with a large glass of water with lemon, then have a 150g container of full fat natural yogurt.  About 15 to 30 minutes later I’ll have some fruit, usually some berries like blueberries or strawberries.  Another 30 to 45 minutes later, I’ll have my 2 eggs.  I’ll have also had another full glass of water with lemon, and tea without sugar during my meal.  I’ve now had about a 450 calorie breakfast over 90 minutes and don’t feel hungry at all.

Unfortunately, we can’t always take the time to slow down.  In those times, you will need to use your will power to remind yourself you have consumed enough food and your body doesn’t need more, even if you still feel hungry.

As always, feel free to contact me at daveb.uk@hotmail.com if you have any comments or questions not already covered.  [Crew Dog: Or comment right here! 🙂 ]

Health Hack: Evening Checklist

It’s easier for me to run my nightly health and hygiene routine without needing a checklist, since I’m a night owl, not an early bird, and since there’s less to the night routine.  However, on a bad day all bets are off.

So, in the interest of symmetry, and since early birds (or off-their-game night owls) might find it helpful to use checklists at night when they’re tired and thinking less clearly, I have also created an Evening Health Checklist:

Evening Health Checklist – One Sick Vet

Again, feel free to print it out and use it, or create your own.

What will you do to hack your health today?

[In case you missed it, the Morning Health Checklist is here.]

Guest Post: Setting Weight Loss Goals

[The next post in Dave Banko’s guest series on healthy diet and lifestyle.]

Setting challenging but achievable goals is important in all aspects of our life, and weight loss is no different.  

When I started, I set the goal for myself to lose 100 lbs in a year. Even though I had never lost more than 15 lbs on any previous diet, I set this goal based on several factors:

  1. I wanted to give the new program a full year and, based on a weekly goal of losing 2 lbs a week, 100 lbs in a year seemed reasonable.
  2. I saw several middle-aged celebrity men who lost 100 or more lbs with diet and exercise (not with surgery).
  3. I also had 2 colleagues at work who recently lost a significant amount of weight, one of whom lost 100 lbs.

The example of friends and public figures achieving this gave me hope!  Although I haven’t been successful before, it has been done, and so I should be able to do it.

I hope sharing my story will inspire you that you can do it too!

100 lbs is daunting, especially having never lost more than 15 lbs before.  After initially setting this end target, I went back to set short and intermediate goals.

Rather than focusing on the end target, I knew if I focused on the short-term goals, the intermediate and end goals would come.

My friend’s Facebook group agreed we would do a weekly virtual weigh-in on Friday or Saturday.  To avoid embarrassment, we wouldn’t report actual weight, but just how many lbs up or down from the previous week.

Even though this was voluntary, it did apply a level of peer pressure to want to be able to report a positive result.  (You could lie of course because no one actually observed your weigh in, but the only one you’d be hurting is yourself.)

I found this combination of reasonable short-term goals, support, & accountability to both my family and a group of others on a similar journey very helpful.

There were some who opted not to do this, and none of them reached their goals.  Not everyone who set goals and reported regularly achieved their goals as quickly as they wanted, but it did help them keep going in the right direction.  The group also offered nothing but encouragement, celebrating our achievements with us and lifting us up when we were struggling.

Although group support is the primary strategy of ‘Emotional Eaters,’ I highly recommend it for anyone wanting to make a significant long-lasting lifestyle change.

I tracked my weight weekly and celebrated my intermediate successes.  Every time I reach a 0 (350 lbs, then 340, then 330 and so on) it felt like crossing a minor milestone.

Then crossing the BMI index: I started at 45, and going below 40, from very obese to obese was huge for me.  Then again, when I went below 30 from obese to overweight.

Finally, I also celebrated loss by body weight %, starting at 10% of my starting body weight lost, 20%, 25% and so on.

This may sound like a lot of celebrating, but for those of you who, like me, struggled for so long, seeing real progress is something to celebrate!

The ‘What’s the Right Diet for You?’ program succeeded so well, I decided to extend my end goal from 100 lbs in a year to 150 lbs total taking me back to what I weighed on active duty.

I reached the 100 lbs lost mark after 7 months.  I’m currently about 10 lbs from the end goal.

These last few lbs have been much harder.  I set weekly targets at just 1/2 lb per week and don’t meet this target every week, but I keep working towards it.  I am thrilled with what I achieved and how I feel, so I won’t let missing the short-term targets get me down.  Having the target, though, helps me stay focused until the day comes when this new eating lifestyle is so ingrained I no longer have to think about it.

Finally, I realized each day is a new day. It hasn’t all been success. I have had days when I over-ate and even binged. I’ve missed targets. But I know the plan works. When I stick to it, I see the results. So when I have a bad day, I don’t beat myself up about it. I start fresh the next morning; it’s a new day! 🙂

As always, please contact me at daveb.uk@hotmail.com with any questions or comments.  [From Crew Dog: Or comment right here at One Sick Vet 🙂 ]

Managing Your Own Healthcare: How Many People’s Jobs Do I Have to Know How to Do?

My personal Tricare experience: I have received several years of harmful care, after decades of inadequate care, from Tricare.

Recently, my soon-to-be-former PCM defended his negligent/health-threatening care by telling me that I had not been aggressive enough in managing my own care.  I countered that aggressively managing one’s own healthcare is very difficult when one has a chronic debilitating condition (especially a condition that affects one’s cognitive abilities).

But today I’m having a good day, abilities-wise, so let’s talk about fighting fire with fire.  You want me to aggressively manage my own healthcare?  Look out, buddy, you just summoned a pissed-off veteran, and you’re about to regret it very, very much.

A friend of mine has a saying about dealing with others, especially those who work in any area interacting with clients/customers.  When encountering roadblocks in daily life having to do with the ignorance, apathy, or incompetence of others, my friend asks exasperatedly, “How many people’s jobs do *I* have to know how to do???”  (Meaning, since you can’t do your job correctly and give me the information and assistance I need, I will have to learn all of the information, procedures, laws, regulations, etc. myself in order to get the result I need.)

We have decided that the answer to this question is “ALL of them.”

ALL of the People.  ALL of the Jobs.

To be fair, there are some *awesome* people in this word who like their jobs, know how to do their jobs well, and like helping others.  When these magical unicorns cross your path, you do whatever you can to make them stay in your life, and you let them know how appreciated they are.

For the Non-magical-unicorn days, which is most of them, you learn how to do ALL the jobs.

Alright, soon-to-be-former PCM, you want me to aggressively manage my healthcare?  You got it.

Today I visited a Tricare Patient Advocate.  I walked in to the largest MTF near me, went to the information desk, and asked for the Tricare Patient Advocate and they hunted around until they found one, who came out and spoke to me face-to-face.

[I had previously located a Tricare Patient Advocate email address for a local advocate.  I emailed in November, and am still waiting for a response over five months later.  (Not the same advocate as the one I spoke to today.)]

The Patient Advocate gave me the contact information for the DoD’s Interactive Customer Evaluation (ICE).  I am going to contact ICE and provide “customer evaluation” on the negligent care I have been receiving, such as waiting 27 months for an MRI/Arthrogram of my wrist, even after I specifically told my soon-to-be-former PCM that my shoulder orthopedic surgeon suspected that I could have a torn ligament in my wrist, and then requested that my PCM submit a referral for an MRI and Arthrogram, which he did not do.

I will tell them that I gave up on ever receiving the care I needed from Tricare, and instead requested an MRI/Arthrogram from the VA, which I received within 6 weeks and which confirmed that I have *two* torn ligaments in my hand/wrist.

There are a few other things I will discuss with ICE about the inadequate care I received from this PCM…

But, next, after speaking to the Patient Advocate and confirming that my PCM did submit a request for referral to a wrist orthopedic surgeon after I confronted him with the results of my (VA) MRI/Arthrogram, I went home to aggressively manage my referral.

I called my Tricare region’s customer service number.  I never reached a human being. (ALL of the People. ALL of the Jobs. ALL of the Computers?)  I chased menu options long enough (15-20 minutes) to figure out that I would not get the level of information I needed from a machine.

So I bit the bullet and created an account on my region’s Tricare website.  I had been avoiding creating an online Tricare account, given the government’s track record on protecting personal information.  I don’t want my health information compromised.

But I needed access to the information, which I got after I created my account.  I was able to see the referral letter and, most importantly, the authorization number.

There are several useful pieces of information on Tricare referral letters.  If you keep reading past the name and contact information of the healthcare specialist to whom you have been referred, you will see this sentence: “This authorization is valid for the dates and service codes that follow on the back page.”  Keep reading until you reach the dates and service codes.  Make sure that your treatment takes place with the date range, and that you do not receive any treatments that were not authorized, or you will have billing problems with Tricare (as in, they may refuse to pay).

If you keep reading past that section, you will see a section titled “If You Would Like to Choose a Different Provider.”

Did you know that if you are not referred to an MTF, but are instead deferred to network, you can choose to see *any* in-network provider of the same specialty?

Also, as per the referral letter, “if your authorization number begins with a 7, you do not need to notify us of a change in provider.”

[Authorization numbers can also begin with a 4, in which case, you *do* have to get prior authorization to switch providers.]

***CAUTION: “You may not switch providers if you have already begun seeing a provider for the service authorized in this letter.”

Armed with that information, and all of the research I had done on orthopedic wrist and hand surgeons since my (very-belated) diagnosis, I called the office of the in-network surgeon I had selected, and scheduled an appointment for later this week.

This probably shaved several weeks off my wait-time, instead of waiting for the referral letter to come in the mail and then trying to figure out how to change providers.

The Patient Advocate also gave me advice on how to switch to a different PCM, given the current constraints of the system (patients being forced to use PCMs at MTFs only; no network PCMs; MTFs not accepting new patients due to being over-capacity).  We decided it would be best to remain with my soon-to-be-former PCM until the wrist/hand surgery is complete, so as not to cause hiccups in the system.  But I will be switching to a different PCM and a different MTF as soon as that is complete.

Meanwhile, I continue to receive excellent care for my other health issues from the local VA facility.

As far as resolving my issues with Tricare, I followed the chain-of-command, as well as rules of common decency.  I tried resolving my inadequate healthcare issues first with my PCM, who got defensive and hostile.  Then I went to the Patient Advocate.  Next I will file an evaluation with ICE.  I will also be completing an Army Provider Level Satisfaction Survey (APLSS).  If I still don’t receive a satisfactory resolution, I will continue to pursue the matter (on the days my health permits me to battle).

I have no illusions that my PCM will change his methods as a result of these actions.  He is impervious to feedback, and I’ve seen much worse healthcare providers remain in the military healthcare system, sadly.

The best I can hope for is:

  1.  To insist I get the care I need for my health conditions and injuries
  2. To insist the providers of this care are highly competent
  3. To hold this PCM accountable for his negligent care by reporting it
  4. To provide helpful information to others who are dealing with similar situations

I suspect by the time I am done, my soon-to-be-former PCM will regret having ever told a pissed-off veteran to be more aggressive about their healthcare.  Mischief, I mean Healthcare, Managed!

Guest Post: Starting the Right Diet for Me

[Dave Banko continues his guest post series on healthy diet and lifestyle.]

The host of this blog, Crew Dog, wrote an excellent article posted on 9 February 2016 about the ‘What’s the Right Diet for You?’ program put together by doctors, nutritionists and dietitians from Oxford and Cambridge Universities in England. As mentioned in my first post, I watched this program just as I was starting my latest ‘diet’ and the comprehensiveness of the program along with the science behind their recommendations impressed me.

Of the 3 over-eating categories, Constant Craver, Emotional Eater, and Feaster, I was clearly a Feaster. I love food, and once I start, I don’t stop until I am literally stuffed. I no longer know what it feels like to be full.

A number of things could have led to this. Everyone in my family is overweight, so there may be a biological predisposition. I also learned to eat very fast growing up, and in the military, which bypasses the response time for your stomach.  I wanted to get my money’s worth at ‘all you can eat’ buffets. And it’s just common courtesy when you are a guest and you enjoy the host’s food to have seconds (or thirds). I suspect all of these thing got me to this place, but now how do I get out of it?

The plan for the ‘Feaster’ is have a ‘high protein low glycemic index (GI)’ diet.

High protein’ doesn’t mean I should have an all meat or protein-based diet, but rather a higher ratio of protein than a general diet.

Low GI‘, doesn’t mean low carb. It means the carbohydrates I eat should have a low glycemic index.

The glycemic index is how quickly the carbohydrates are metabolized. A lower GI (below 55) metabolizes more slowly, prolonging the release of glucose and insulin into the blood stream.

High GI foods shock your system with a rush of glucose into the blood stream requiring a spike in insulin levels to accommodate. Too many spikes over a prolonged period of time reduces your body’s ability to respond and results in diabetes.

Low GI Foods High GI Foods
Hummus Cornflakes
Beans/Legumes Sugar
Whole Grains White (Processed or Refined) Grains
Whole Grain Breads White Bread
Pasta White Potatoes

So I cut sugar and eliminated processed/refined grains except on my cheat days on the weekend, but then still keeping them to small portions. I also made sure I added some form of protein to every meal.

The protein combined with the low GI foods helps me feel satisfied for longer.

I no longer could depend on my body to tell me when I was full, but by adjusting the foods I ate and the ratio, I would feel satisfied with less and it would sustain me for longer periods before I’d feel hungry again.

I didn’t stop there though. Just because I was a ‘Feaster’ didn’t mean I couldn’t learn something from the ‘Constant Cravers’ and the ‘Emotional Eaters’ too.

Constant Cravers were recommended to implement the 5 and 2 diet, so I skipped dinner 2 nights a week. Emotional Eaters were recommended to join a support group, so I joined the online Facebook Group my friend started to encourage each other in our weight loss and fitness goals.

I put the whole program together and the results were over 130 lbs lost in 13 months.

My routine looked like this:

  • Sunday to Thursday, strict adherence to the eating program using food I like to eat.
  • Tuesdays and Thursdays as my ‘fast’ days skipping dinner.
  • Friday and Saturdays are my cheat days. (after our virtual weigh-in for our Facebook Group on Friday mornings)

On my cheat days I would enjoy some of the higher GI foods I avoided during the week, as well as wine and ice cream, but I still would not go crazy on portion sizes.

During the week, my plate would look like this:

½ fruit and veg, ¼ complex carbs, and ¼ meat or other protein source

At this stage you may ask, “What about exercise?”

One of the points stressed in the program is that exercise is beneficial to overall health and fitness but, to lose weight, the #1 factor is diet.

I can bear witness to this, as numerous times I started weight loss programs with exercise. In 6 to 9 months I might lose 10-15 lbs, but I didn’t control my diet. Then something would happen and I’d have to stop exercising. Because I didn’t control my diet, as soon as the activity ceased, I put on the weight plus some as I was eating more because I was hungrier from the physical exercise.

I did add exercise into my routine, but I followed the program’s advice and kept my primary focus on my diet.

I will expand on the details of my routine and how it evolved over time, as well as tips and food tidbits I picked up along the way, in subsequent posts.

For now, I have one final piece of advice to include in this post – Start Small!

You can’t sustain a crash diet, nor is it healthy for you. Also, if you would have told me before I started that I’d be satisfied eating as little as I do today (now I aim to consume 1800-2000 calories per day in a healthy balance) when at the time I must have been consuming 4000-5000 calories per day, I would have thought you were crazy. And I would not have been able to sustain that big of a drop.

Small changes will have an affect! If you reduce the foods that aren’t helpful and increase the ratio of the good foods while starting to decrease the overall portions, you will lose weight!

After a while, your body will adjust to the reduction and your weight will stabilize – the dreaded plateau! That’s the time to make another round of adjustments.

Let me give you an example. I was working in a city and because I was being reimbursed for lunch, I would go out to buy something every day. I found a great little shop that used whole grain breads and natural ingredients in their sandwiches and fantastic soups.

When I started, I would order a large soup, a large sandwich, a dessert and a diet coke. The first thing was to cut dessert and the diet coke (more on that coming later as well). After a while, I then reduced my sandwich from a whole to a half, later eliminating the sandwich altogether. My lunch calories started around 1500 and ended up being 300-400 (with the piece of whole fruit the office provided). The transition from 1500 to 400 calories for lunch took 6-9 months.

Remember Rule #1 – This is a healthy eating lifestyle, not a diet!

Habits take time to break and to form new ones.

Good luck and feel free to contact me at daveb.uk@hotmail.com if this has helped you or if you have specific questions not yet addressed.

 

Medical Procedures: What It’s Like to Have an Echocardiogram (with “Bubble Study”)

Some things are scary.  Like when your healthcare provider refers you for a procedure that involves bubbles injected into your veins and flowing through your heart.

I told my PCM the thought of it kind of freaked me out.  She said it was perfectly safe.  Just a routine procedure.  No big deal.

So I went home and researched the procedure.  I found an article from a reliable source that explained the procedure simply and thoroughly and assured patients that “The bubble study is extremely safe.”

And the rational part of my mind believed them.  But some other, irrational, part of my mind kept thinking of all the TV shows in which the villain kills someone by injecting an air bubble into their IV.  (Medical personnel hate Hollywood for this, by the way.)

I’m not the type to worry about things and get anxious, so I didn’t spend the days between the doctor’s visit and the bubble study obsessing about it.  But I didn’t sleep very well the night before, and I was pretty anxious on the ride to the hospital.  I did breathing exercises to try to relax, and, of course, cracked dark jokes about things Spousal Unit needed to know in case I didn’t survive.  (Not sure Spousal Unit appreciated that.)

What ultimately helped me relax was talking to the tech who performed the bubble injection part of the procedure.  She told me three reasons not to worry:

1) The saline solution is being injected into a vein, not an artery, and therefore there is less risk;

2) The bubbles are very small, and could not block a vein;

3) The bubbles go through your heart to your lungs, and your lungs handle them just like they handle every other gaseous fluid (bubble).  That’s what lungs are made for.

In other words, your body knows what to do with the bubbles, and it’s no big deal.

That’s when the rational part of my mind won, the irrational part of my mind stopped freaking out, and I relaxed.  More breathing exercises helped me release the tension as well.

So, what exactly *is* an echocardiogram?  It’s basically just an ultrasound of your heart.

Most of us have seen an obstetric ultrasound on TV, where the technician looks at a pregnant woman’s fetus in the womb.  The technique for an echocardiogram is pretty much the same – sound waves are used to get images of your heart.

But unlike an obstetric ultrasound, where the woman lies on her back, for a cardiac ultrasound you lie on your left side.  This helps the technician get a better image of your heart.

My technician explained to me that the ultrasound cannot get images through your bones, so they have to manipulate the wand around all the bones in your chest, like your sternum (breastbone) and ribs.  The ultrasound also cannot get images through air, so they have to avoid your lungs as well.

Since your heart is already off-set to the left of your chest, lying on your left side allows the heart to fall a bit further left, away from your sternum.

So, you take off your shirt and put on a hospital gown (open to the front), and the technician attaches some electrodes to your chest with sticky patches so they can monitor the electrical currents of your heart.  (For a good overview of the entire procedure, see this Mayo Clinic article.)  Then you lie down on your left side, and move your left arm up near your head.

The technician lubes up the wand (a.k.a. probe or transducer) and moves it around on your skin until they can get clear images of your heart.  (The gel helps improve the conduction of the sound waves, and makes sure there’s no air between the wand and your skin.)

Since they are dodging your bones and your lungs, the wand can wind up feeling like it’s trying to dig under your ribs as the technician attempts to get the clearest image, which can be a bit uncomfortable.  It’s not really painful, just a bit…insistent.  This is another time when the breathing exercises can come in handy.  Although it was rather uncomfortable a few times, I didn’t have any bruising afterward.

The technician takes a series of images from multiple angles, so they move the wand around and dig it in to new uncomfortable places to get the various images.  This may cause them to re-apply more gel as well.  My technician also asked me to take a deep breath, hold it, and exhale at various points in the procedure.  (She only forgot to tell me to resume breathing once.)

I appreciated that the technician explained to me what she was doing as she was doing it, and didn’t mind me watching the monitor as she was working.  An echocardiogram allows you to see the heart beating, and the heart valves opening and closing, and it’s fascinating to watch.

I particularly enjoyed watching the Doppler portion of the procedure:

The first part of the procedure took about 20-25 minutes, and then it was time for the Bubble Study (a.k.a. saline contrast study).  My PCM ordered a bubble study because she wanted to determine if there was a hole in my heart.

In a normal heart, the bubbles that are injected for the test enter the right side of the heart through the vein and then go through to the lungs and are removed from the bloodstream before the blood circulates to the left side of the heart.  If there is a hole between the right and left sides of the heart, the technician can see the bubbles flow through the hole to the left side, where they don’t belong.

Don’t Panic!  The bubble study is less freaky than it sounds.  Nothing is injected directly into your heart.  (Also, if you do have a hole in your heart, and the bubbles leak though to the left side, it’s ok.  Your body will still process the bubbles safely.)

A second technician came into the room, we had the conversation about bubbles and why they aren’t dangerous, and she inserted an IV line into my right arm (since I still needed to lie on my left side for the procedure). The IV line had a valve, so that the tech could start and stop the flow of the saline contrast solution.

The second tech told me that at several points during the bubble study, I would need to do a valsalva maneuver, but she described it as “the way you would bear down during a bowel movement”.  Well, that’s not the way I learned to do a valsalva maneuver during aerospace physiology, so we had a conversation until I figured out that what they *really* wanted was an anti-G straining maneuver (except they wanted me to hold my breath during the maneuver, and not exhale in a big gust when they told me I could exhale).

With that cleared up, we proceeded with the bubble study.  The first technician would signal that she was ready, the second technician would release a stream of bubbles into the vein near my elbow, and they would tell me when they wanted me to do the straining maneuver.

Then we would watch the stream of bubbles rush into my heart.  The bubbles appear white on the monitor, and they are very obvious.  Sometimes the second tech would massage my arm a bit to help the bubbles flow faster or something.

The saline bubble solution felt a little bit weird when it first went into my arm, but then I didn’t feel it anymore.  The first batch of bubbles felt weird when it entered my heart – my heart seemed to flutter a little bit.  But it didn’t hurt, and I didn’t feel it with the subsequent bubble batches.

We repeated the sequence four or five times, until there was no more saline solution, and the first tech was satisfied that she had all the images she needed.  They were both very impressed with my straining technique. 🙂

Then the second tech removed the IV line, the first tech removed the electrode sticky pads, and they left me to wipe the gel off my chest and get dressed.

The whole procedure took about an hour, and I had no residual effects.  Turns out, the bubble study really *was* no big deal.

Also, since having a hole between the two sides is congenital (something you’re born with), I’ll never have to have this procedure again.  Once they’ve determined whether the hole is there or not, that doesn’t change and you never need to check again.

TL;DR:

Tired to the Bone

Tired Dog

I try to be optimistic and proactive about my health.  But some days I’m just tired to the bone.

Last week I had three medical procedures.  One was a new treatment, and two were diagnostic.  It may take days, weeks, or months before we know if the new treatment is having an effect.  So I wait…

Meanwhile,

The diagnostic procedures revealed that I have been correct for the past 2+ years that there is something wrong with my wrist.

More than two years ago I fell violently on a wet ceramic tile floor.  Ever since, I have been telling doctors and therapists that I have pain and malfunction in four areas: my scapula, my shoulder, my elbow, and my wrist.

Although my doctor ordered x-rays immediately after the fall, once those came back negative for broken bones she refused to send me for additional imaging (MRI/arthrogram).  Nearly one year later, after I had “failed to progress” in physical therapy, my doctor finally sent me for a shoulder MRI/arthrogram, which revealed that my labrum was severely torn and would not heal without surgery.

By that point, nearly one full year after the injury, I was in severe pain and could barely do my job.  Some days I left work early due to the pain, and I wasn’t getting much sleep either.  I could sleep in one position on the couch, surrounded by pillows that held my shoulder in the least-painful position, but if I shifted in my sleep the pain would wake me up.

I was taking a strong NSAID and a narcotic, but that wasn’t enough to control the pain.  I was getting pretty desperate for relief.  For months I requested that my doctor refer me for pain management, but she refused.

Fortunately, once I received the diagnosis of the torn labrum (a.k.a. SLAP tear/SLAP lesion) things happened a little more quickly.

The story of how I selected my orthopedic shoulder surgeon is a saga for another post.  But once I had authorization to receive care from him, I was able to see him a few days later (one month after the MRI).

At this point, I was desperate for relief, and I didn’t care if it cost me my job.  I told the nurse I would take the first available surgery slot, and asked her to look for cancellations.  She found a cancellation for the following week, which gave me just enough time to stop taking all medications, vitamins, and supplements and get them out of my system so they didn’t interfere with the surgery or the recovery.

I told my boss that I was having surgery the next week, and would probably be out for at least 6 weeks since I couldn’t drive with my arm in a sling.  Although I was an hourly worker, and would not get paid while I wasn’t working, they didn’t fire me.  They told me to get the help I needed and come back when I was better.

I had the surgery, and it was successful.  The surgeon discovered that my labrum was completely severed, and he had to trim it, re-attach it, and anchor it to the bone.  However, the biceps tendon was not torn, and the rotator cuff was not damaged either.

Even immediately post-surgery, the pain level was so much lower than before the surgery.  I was able to stop taking narcotics after about two days.

I started physical therapy seven weeks after surgery.  My surgeon wanted to give the labrum plenty of time to reattach to the bone and form a strong connection.

We noticed in physical therapy that I was still having pain and malfunction in the scapula, elbow, and wrist.  My doctor and physical therapist wanted to give it some time, to see whether this would shake out as physical therapy re-trained the muscles to function as they had before the fall.

My surgeon said that if the pain and swelling in my hand and wrist had not gone down in three months, I should probably see an orthopedic wrist surgeon, as I might have a tear in my triangular fibrocartilage complex (TFCC).

Then a whole lot of life happened.  Moved twice.  Different states. New PCM.  New PCM refused to refer me for MRI/arthrogram of wrist, which was still discolored, swollen, weak, and painful, but did refer me to a new physical therapist.  Physical therapist wanted to try treatment first, but after I “failed to progress” with elbow and wrist function, PT agreed it was time to get diagnostics and see an orthopedic specialist.

Meanwhile, I had finally gotten my VA disability claim processed, and after a seven month wait for an appointment had finally seen a VA PCM.  Since I had not been able to get my Tricare PCM to follow-up on the wrist, I asked my VA PCM to treat it.  She sent me for x-rays immediately following our appointment.  The x-rays showed my ulna was mis-aligned.

Less than two weeks after I saw my VA PCM for the first time, I had EMG and CNS procedures to determine if there was permanent nerve damage in my left arm/hand, and to determine whether the problem was due to a pinched nerve in my neck.

A few days later, I had an appointment at the VA hand clinic.  The x-rays had indicated a problem in my wrist, and the examination at the hand clinic confirmed it, so the hand clinic referred me for a wrist MRI/arthrogram.  FINALLY!

Three weeks later I had the MRI and arthrogram (post pending).  It was more than two years since I had been injured, and more than a year since the shoulder surgery.

The arthrogram revealed not only that I have a TFCC tear, but also that I have a scapholunate (S-L) teartwo torn ligaments in my wrist.

Initially, I was happy to finally have diagnostic evidence to support the injury claims I have been making for the last two-plus years.  And I was excited by the possibility that I could get the ligaments repaired and finally begin to heal.

But today I am just tired to the bone.  I have to find a new orthopedic surgeon in the state where I now live.  Someone I can trust to work on my wrist – a very delicate and complex part of the human body.  Someone in either the Tricare or the VA system.  And I have to get authorization 1) to consult with them and 2) to have surgery, if necessary.

Plus, I still don’t know whether I have a torn ligament or ligaments in my elbow.  My physical therapist thinks that I do.  But I haven’t been able to get Tricare or the VA to send me for diagnostics of my elbow yet.

On a better day, I will conduct more research on orthopedic wrist surgeons, and I will fight to get the referrals and the treatment that I need.  On a better day, I will take positive action to resolve this injury.

But today I am tired.  Today I will rest and regroup, so that I can resume battle recharged and equipped with knowledge.

Bottom Line:  It’s ok to be tired.  We all need rest.  We all need self-care.  Resting does not mean we are weak.

Lessons Learned:

  1. Keep fighting until you get the care you need.  There will be good days and there will be bad days, but you deserve to be heard and to be treated.
  2. You don’t have to go it alone.  Get a Patient Advocate, Case Manager, or lawyer to assist you.
  3. “If you haven’t got your health, you haven’t got anything.”  I delayed my first round of physical therapy because I was busy with work and school.  If I had “failed” PT sooner, I probably would have gotten my shoulder MRI sooner and my shoulder surgery sooner.  I wish I had made my health more of a priority sooner.  Problems don’t go away when you ignore them.
  4. Learn the administrative procedures.  HMOs typically have set procedures for dealing with illness, injury, etc.  PCMs have to follow the sequence when treating patients.  Even though I knew I needed shoulder surgery, I had to “fail” PT first.  It will do you no good to try to pre-empt procedures – you won’t get authorization to do things out of sequence.  So find out the sequence and get it done so you can get to the end-state you need.
  5. Trust your gut.  Various healthcare providers gave me various ideas on what might be causing my symptoms – only one of them was (partially) correct.  I knew from the beginning that something was wrong with my wrist and that I needed imaging to find out what it was.  You know your body better than anyone else.  If you know something is wrong, keep demanding treatment until it’s fixed to your satisfaction.
  6. Watch out for wet freaking ceramic tile floors!  Or any other slip, trip, or fall hazard – you don’t want to jack yourself up like I did.

Indoor Air Quality – How I Made the Air I Breathe Healthier By Using NASA Research

Some of you may be wondering why I said in my first post that I’d rather have house plants than an air purifier.  I chose house plants because they do not use any energy other than sunlight, and because my research did not convince me that air purifiers were significantly better than houseplants.  Thus, I preferred the cheaper, more natural option.

What I said in the previous post:

To me, [naturopathic self-healing] means utilizing evidence-based natural solutions when possible, such as using house plants to improve the quality of the air in my house, rather than buying an air purifier.

The Spousal Unit and I had talked for years about getting an air purifier.  We thought that putting an air purifier in the bedroom would help us get better sleep.  I had read blogs and websites written by asthmatics and allergy sufferers who highly recommended air purifiers with HEPA filters, and they were pretty persuasive.  The only thing holding me back was the price – $500+ for a one-room HEPA filter air purifier.

“Maybe I could start with something less expensive,” I thought.  “What about those Himalayan salt lamps?”  According to the advertisements, a Himalayan salt lamp “works as an air purifier by emitting negative ions into the air.”  And they retail for $25-$30 for a smaller lamp.  So I did some research.  Unfortunately, I found that Himalayan salt lamps do not emit negative ions in a large enough quantity to have an actual effect on your indoor environment.  For a thorough examination of Himalayan salt lamps, I recommend this post over at A Breath of Reason blog.  Bottom line: they don’t improve air quality.

Ok, what about beeswax candles?  They are also touted as being good for air quality because they release negative ions.  Nope, Skepticcystic over at A Breath of Reason debunked beeswax candles too.  (See this post.)  According to her research, not only do beeswax candles not release stable negative ions, but there is no scientific evidence that beeswax is healthier to burn than other types of wax.  So, although some would argue that you should avoid the phthalates in artificially scented candles, the type of wax  a candle is made of doesn’t appear to make a difference to indoor air quality.  Bottom line: Regardless of what they are made of, burning candles does not improve indoor air quality.

So back to air purifying machines…

For a practical overview of air purifiers, check out this article from ConsumerReports.  For example, ConsumerReports suggests:

“Before you buy an air purifier, try some simple, common-sense steps to reduce indoor air pollution. Begin by vacuuming often, banning smoking indoors, minimizing use of candles and wood fires, and using exhaust fans in kitchen, bath, and laundry areas.”

As the article continues, various claims made by air purifier companies are tested.  ConsumerReports cautions that ozone-producing air purifiers are actually harmful to your health and should be avoided, particularly if you have allergies or breathing problems.  This is confirmed by the American Academy of Asthma Allergy & Immunology:

There is no debate about the negative effect of ozone…with the FDA concluding there is no place for ozone in medical treatment.” (See article here.)

For more information on the pros and cons of air purifiers, read this article from the New York Times, in which Steven Kurutz, an allergy sufferer, tested six popular air purifiers.  Here are a few excerpts from his article:

“For all their high-tech wizardry (some claim to be able to eliminate particles 0.3 microns in size and smaller), air purifiers occupy the same category as faith-based wellness products like nutritional supplements.”

And,

“Over the years, the Federal Trade Commission has taken action against several makers of air purifiers, including brands like Honeywell and Oreck, for unsubstantiated allergy-relief claims or for advertising that their devices removed virtually all impurities from the indoor air people breathed.”

According to ConsumerReports’ deputy home editor, Celia Kuperszmid Lehrman, whom Kurutz interviewed for the article,

“The first thing you need to know about an air purifier is that most people don’t need one.”

However, some doctors do recommend air purifiers for their patients, particularly children who suffer from asthma.  So, if you have asthma or allergies (or both), talk to your doctor about whether an air purifier would be beneficial for you.

According to the American Academy of Allergy Asthma & Immunology:

There is no definite evidence of filtration clinically benefiting patients with allergic disease, but this may be the result of the studies being of insufficient durations to prove benefit.   The best review of the topic is by Sublett et al in 2010, a report of the Indoor Allergen Committee of the American Academy of Allergy Asthma and Immunology.” (See AAAAI article here.)

The Bottom Line for Air Purifiers: The different things you may be allergic to (dog allergens, cat allergens, mite allergens, mold, pollen, etc.) have different-sized particles.  You will see the most benefit if you select an air purifier that is designed to filter the particle size of the allergen that most affects you.

Conclusion from the Sublett et al report:

“As far as optimal choice of cleaning devices, initial cost and ease of regular maintenance should be considered. Portable room air cleaners with HEPA filters, especially those that filter the breathing zone during sleep, appear to be beneficial.

For the millions of households with forced air HVAC systems, regular maintenance schedules and the use of high-efficiency disposable filters appear to be the best choices.

However, further studies and research in this area are desirable to make more definitive recommendations in the role of air filtration on improving disease outcomes.”

Ok, so I could buy an expensive HEPA filter air purifier for my bedroom, which might help us sleep a bit better.  Are there any other options?

That’s when I remembered that house plants help improve indoor air quality.

Most of us learned in school that plants breathe in carbon dioxide and breathe out oxygen (roughly speaking), which is great for humans because we breathe in oxygen and breathe out carbon dioxide.  So having plants in the house helps increase the oxygen level in the air and decrease the carbon dioxide level.  But indoor plants can do more than just produce oxygen.

NASA published research in 1989 which demonstrated that house plants help reduce indoor air pollution.  Due to the energy crunch in the 70’s, buildings became more air-tight to reduce energy costs associated with escaping heated or cooled air.  But then occupants began developing health problems, and researchers determined that decreased air flow in buildings led to higher concentrations of carbon dioxide and volatile organic compounds (VOCs) in the indoor air.

Three of the VOCs NASA focused upon in its research were benzene, tricloroethylene, and formaldehyde.  These chemicals pose various health hazards that range from skin and eye irritation to headaches, asthma, and cancer (pp. 3-5).  Assuming we’d like to avoid these health hazards, what can we do to reduce the levels of these chemicals in our homes?

As NASA points out, “The first and most obvious step in reducing indoor air pollution is to reduce off-gassing from building materials and furnishings before they are allowed to be installed.” (p.2)

The best way to reduce chemical indoor air pollution is to choose lower-VOC or zero-VOC options for furnishings, floorings, and other elements inside your home (wall paint, flooring glues, shower curtains, etc).  That way, you’re bringing less VOCs into your house to begin with.  (There are lots of good articles about this on the web; I encourage you to Google-Fu them.)

In addition to reducing VOCs by using less-toxic cleaning supplies, lower-VOC paint, etc., we figured “If it’s good enough for NASA, it’s good enough for us,” and bought houseplants – lots of houseplants.

Before I bought the plants, I did an online search and found many helpful articles.  This article at Lifehacker.com has a graphic of various houseplants and the chemicals they filter best.  And since houseplants have not fared well at my house in the past, I also read articles, including this one, on low-maintenance, hardy houseplants.  See this article for a good overview of the benefits of houseplants, including how many you need per room/ per square foot.

In the end, I decided to buy plants that didn’t have runners that would wind up all over the house (I’m looking at you, golden pothos).  I found a local nursery and selected plants for various rooms based on the available sunlight in those rooms, the amount of available space, and what looked good to me.  Be sure to check how big each plant typically grows, so you don’t buy ones that will outgrow the space you bought them for.

For the bedroom, I selected a snake plant (a.k.a. mother-in-law’s-tongue; see picture at top of post) because they are one of the only plants that continue to take in carbon dioxide and give out oxygen at night.

So far, it’s been about six months and none of the houseplants has died.  In fact, nearly all of them are thriving.  It’s hard to say whether our indoor air quality has improved, since we don’t have a way to test it.  But at least we know that science is on our side, and we didn’t waste our money on air purification myths like beeswax candles or salt crystal lamps.

CAUTION: Many low-maintenance houseplants are toxic to dogs, cats, and sometimes children if they chew on the plants.  If this is likely to happen in your home, make sure you know which plants are toxic, and put them where pets or children cannot reach them.

 

 

Guest Post: A Diet for Everyone

 

[Here’s another in the series of healthy eating and lifestyle posts from Dave Banko.]

Shortly after I started eating more healthily, another TV program aired called, “50 of the World’s Best and Worst Diets.” Countries were ranked by average lifespans, rates of obesity, and other health issues, then related to their diet and lifestyle. The results are fascinating!

Worst Countries

#50 – Marshall Islands

  • Health – Highest death rate from diabetes
  • Diet – White (refined) rice, tinned [canned] vegetables, and high-fat processed meats

#49 – Russia

  • Health – ¼ of men die before age 55, high rates of liver disease, alcohol poisoning and car accidents
  • Diet – High consumption of Vodka

#44 – Mexico

  • Health – 1/3 of the population is obese
  • Diet – Lots of soft drinks and processed calories, lack of fresh and natural foods

#43 – USA

  • Health – High diabetes and obesity
  • Diet – Super-sized portions with processed food and cheap sweeteners like corn syrup (fructose)

#38 – Australia

  • Health – Fastest growing rate of obesity
  • Diet – Plenty of Meat and Beer!

Best Countries

#13 – South Korea

  • Health – Lowest obesity rate
  • Diet – Lots of fresh fish and lots of vegetables and fermented foods

#10 – Netherlands

  • Health – Tallest people in the world
  • Diet – Lots of milk and milk products!

#8 – France

  • Health – Low levels of cholesterol and heart disease
  • Diet – Red wine, cheese, high saturated fat dishes!

#7 – Kuna Indians

  • Health – Lowest levels of cardiovascular disease and blood pressure
  • Diet – Lots of chocolate (up to 5 cups a day) in combination with plantains, coconuts and fish

#5 – Japan

  • Health – longest life expectancy for women
  • Diet – Rich in vegetables and fish

#3 & 2 – (Greece & Italy)

  • Health – Long life span
  • Diet – Rich in legumes, fruit, vegetables, fish, olive oil, wine, dairy, pasta, whole grain rice, and red meat

#1 – Iceland

  • Health – Longest overall average life span
  • Diet – fish, red meat and dairy from grass-fed animals, and few fruits and vegetables

Why is this important? Diet information is about as confusing as it gets, fat or no fat, all meat or vegetarian, carbs or no carbs. If you look at these best diets in the world, it seems to only add to the confusion.

  • How can the best diet in the world include few fruits & vegetables?
  • How can the French have such low levels of cholesterol and heart disease with a diet loaded with high saturated fat?
  • Who got excited when they saw #7 was high in chocolate?!

The facts are:

  • Icelanders eat the fresh produce from the land and sea with little processing.
  • The French consume rich food, but in small portions and take their time – enjoying life.
  • The Italians eat pasta with every meal, (made from complex carb flour) even when dieting, with lots of fresh, simple ingredients and small portions.

Most of the diet plans out there were put together as something that worked for someone else. But it wasn’t mine, or what I like to eat.

Recipes are helpful, but need to be adapted to what you like to become a healthy eating lifestyle you can sustain.

There are general principles to follow:

  • Avoid or minimize: sugar & sugary products, processed foods, foods with lots of chemicals, and refined foods
  • Reduce portion sizes – This goes without saying as the curse of our own abundance in a super-sized or ‘all you can eat’ culture.

The countries with the worst diets overindulge in less-healthy food and empty calories.

  • Balance & variety – our bodies need lots of different nutrients for health. I’d be wary of any program that eliminates or focuses on any one food group.
  • 80/20 rule – ‘I adhere to the 80/20 rule. I eat healthily 80 per cent of the time, and that leaves me free to eat what I want for the remaining 20 per cent. And those cheat meals taste so much better when they are a treat rather than the norm,Bear Grylls. I follow this myself, relaxing my program on the weekends to have some ice cream, mashed potatoes, or other treats which I avoid during the week.

I’ll share more about the principles and specific techniques in future posts.

For now, pick a balanced program closest to the type of food you generally like to eat, and use it as your starting point. But don’t be afraid to experiment and adapt it to what you like and what works for you.

Until next time!

Dave Banko

P.S. – In case you were interested, here’s the link to the countries in the middle.

[Note from Crew Dog: Looking for a diet starting point, but don’t have time to read all of the “What’s the Right Diet for You?” information?  Start with the guidelines in this article.]