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).
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/
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