I’ve shared before some of the major medical events in my
life before (*1, *2, *3). But life contains not only these types of major
events, but small events (adjustments) as well. I’ve had three of them during
the past six months that have had some impact on my life – and will continue to
have going forward.
Wearing a CPAP
During the COVID-19 pandemic, many of my medical
appointments were via telemedicine. One of them was my annual visit with my
cardiologist. One of the things that he believes is that there are a lot of
connections between the various medical issues that people have and that
adjustments to one of those issues can impact others. Based on my medical
history and some questions he asked during that meeting, he wondered if I would
be willing to participate in a sleep study. I agreed and he arranged for the
equipment to be delivered to our home.
Sleeping with a small microphone near my mouth (to record
breathing and snoring noises), and a finger “cuff” (to record blood oxygen
levels, pulse, etc.) is an interesting experience. I did this for 3 nights,
then mailed all the equipment back. The determination was that I had very mild
sleep apnea (and which was confirmed by my wife that I do not snore nearly as
much as I did many years ago). My cardiologist called a few days later and
recommended that I consider using a CPAP machine (which would be covered by my
Medicare insurance). I agreed to follow his recommendation.
The technology in the latest machines is quite amazing. Besides
being able to give different pressures (or even ramping up the pressure
gradually), it can preheat the moisture it puts into the delivered air, etc. It
also has cell phone technology built into it that sends the daily results on
usage back to the company which supplies the unit (I hesitated allowing this
type of intrusive technology into the house, but eventually decided it was
acceptable).
Based on an online questionnaire from the company that I
filled out first, their recommendation was for a standard nostril feed rather
than a mask which would cover both the nose and mouth. Because I have always
been a mouth-breather, they also recommended a chin strap that would keep
pressure on my chin and keep my mouth closed (it’s a light pressure so you can
still open your mouth if needed, but when the muscles are relaxed in sleep your
mouth stays closed).
It took a few weeks to get used to everything (and they require
at least 4 hours 70% of the nights in a 30-day period before Medicare will
reimburse them). But now I’m using the machine nearly every night for anywhere
from 4-8 hours (I often take it off after I get up for my early morning
bathroom run).
There are two main benefits. One is that whatever low level
of sleep apnea I had is now gone – and that’s what my cardiologist was seeking
to change since that relieves any possible strain on my heart. But the other is
that since I am no longer a mouth breather during the night that my oral health
has improved. I used to take a nightly Therabreath tablet that would
keep my mouth from getting dry while I slept as mouth breathing had a negative
impact on my gums and contributed to periodontal disease. Now with my mouth
always closed my gums don’t dry out. And since I breathe through my nose at
night, I’ve noticed that I tend to breathe that way during the day as well.
Double benefit!
Intermittent Fasting
In late summer I had a second cardiologist visit so that
they could conduct an EKG to monitor the health of my heart (something you can’t
do during a telemedicine visit). As we talked afterwards – I appreciate the
personal level of care that he gives – he mentioned some of the other life
factors that he considers as having an effect on one’s overall health and thus
on one’s heart health. One that he was particularly keen on was called “intermittent
fasting” (IF). He talked about all the other diet routines – Weight Watchers,
Atkins, Jenny Craig, Noom, etc. – but he likes IF because it does not require
any particular change in foods eaten, special purchases, etc.
That appealed to me, because unlike many individuals my age
who have some control over what foods they buy, we eat together as a family
with our daughter and four growing grandsons. The pattern that my cardiologist
uses is to do IF three days a week (M, T, Th) and keeping eating to just an 8-hour
window (11am-7pm) on those days.
I starting doing the same the week after my visit, but
quickly found that my body was strongly objecting to this pattern. I’ve always
been taught that breakfast is the most important meal of the day and I have
either a bowl of cereal or a few pieces of toast each morning. Skipping those
and not eating until lunch time played havoc with my system – my stomach was
growling, I started having a consistent headache, and I was out-of-sorts all
morning trying that pattern. After less than two weeks I knew that I could not
follow his example.
But knowing that I wanted to do something, I instead just
stopped any snacking after supper (I often had a small dish of ice cream in the
evening), cut back having seconds at supper, and thus established a 12-hour “fast”
that I was able to do seven days a week instead of an 18-hour fast three days a
week. My body was able to tolerate this and I’ve stuck with it for about 3
weeks now. I’ve since learned that this is not unusual (*4, *5), In fact, one
quote in (*5) is “Some may find that a 12-hour fasting window is all they can
do without major discomfort. … For beginners, start with 12 hours and build up from
there.”
I have not yet taken off a lot of weight – only two pounds
in three weeks. But I don’t have extravagant goals either – if I can take off
just 20 pounds over the next year that’s all I really need. That’s a far cry
from a friend of mine who has used Noom to take off 40 pounds in just 27 weeks,
but that’s fine.
However, I have also noticed some progress in other areas,
in particular my blood sugars (I do a finger-stick every morning since I’m
mildly diabetic) is down a consistent 20 points since I started doing this. It’s
still higher than I’d like it to be, but I’m willing to take it slow and easy
since that will be more sustainable in the long run.
Medication Adjustments
I also appreciate my current primary care physician. Unlike
my two prior PCPs who were my age and retired so I had to find someone else,
she is pretty aggressive in making sure that I am healthy. Earlier this year
she added a CBC (Complete Blood Count) to my periodic blood work. There were no
recommendations based on the first one, since she wanted to see a pattern, but
she was interested in seeing the results from the second one several months
later. There are 21 different items measured in a CBC – and 20 of them were in
the normal range (great news!). The one that was out of range was my platelet
count which was in the 85-95 (thousand platelets per cubic millimeter of blood)
range when “normal” is 140-350. Accordingly, she scheduled me to see a hematologist
for further review and recommendations.
I saw him a few weeks ago. He indicated that platelet counts
in the 90 range, while lower than average, are generally not an issue. As the count
continues lower, there are certain things that cannot be done (for example,
below a certain level they will not perform any brain surgery due to the risk of
uncontrolled bleeding, below another level they will not perform open-heart
surgery, etc.). But he wanted to perform other tests to see if they could
determine the cause of the lower-than-average count.
All the initial tests (which they do right in the office)
did not identify anything, but as he reviewed my medication list, he noted that
I have been taking Zetia (ezetimibe) for the past few years. He was aware of
some recent studies where ezetimibe was indicted in cases of thrombocytopenia
(low platelet count), including one in a 72-year old man (*6) – gee, that age
sounds familiar!
He has scheduled me for a few additional tests in October
before I see him again later that month. But in the meantime, I contacted my
PCP to get her permission to suspend taking ezetimibe for the next two months
to see if that solves the problem. I’ve been taking the ezetimibe for about two
years as a cholesterol-lowering drug. It has lowered my total cholesterol from
about 140 to 90. But since 140 is still a reasonable value (should be less than
200), we feel that we might be able to do without it.
Results still to be determined, but if my platelet count goes
back up to normal range and my cholesterol stays in range, then I’ll be able to
take one less medication. The interactions and side effects of taking multiple
medications is a complex topic and I’m glad that there are medical
professionals to help navigate this area.
Notes:
*1 - https://ramblinrussells.blogspot.com/2017/03/surviving-kidney-stone.html
*2 - https://ramblinrussells.blogspot.com/2017/02/surviving-heart-attack.html
*3 - https://ramblinrussells.blogspot.com/2017/05/scenes-from-my-hospital-bed.html
*4 - https://www.popsugar.com/fitness/Intermittent-Fasting-Mistakes-43992178
*5 - https://www.eatthis.com/intermittent-fasting-results/
*6 - https://pubmed.ncbi.nlm.nih.gov/18252832/
