Medical Procedures: What It’s Like to Have an MRI (with contrast)

The first MRI (magnetic resonance imaging) I ever had was a cerebral MRI in a foreign country.  I hadn’t been in the country very long, and didn’t speak much of the language.  I also didn’t know much about the procedure.  All I knew is these people with whom I could barely communicate were going to look inside my head.

The MRI was state-of-the-art – a small, donut-shaped open MRI machine:

The nurse, however, was another story.  She had no bedside manner, or rather, her bedside manner was very stern and unyielding.

My referring physician had requested an MRI with contrast, which means “dye” was injected into my veins through an IV.  The dye helps the radiologist see certain areas more clearly.

After the nurse inserted the IV and began administering the contrast, I felt a burning sensation in the arm in which she had placed the IV.  I was concerned that I might be having an allergic reaction to the dye, because I had read that was possible.  I asked the nurse if the burning sensation was normal (I rather doubted that it was).  Once she understood my question (it took several attempts, due to the language barrier), her response was “That is not possible.”

It has been over 15 years since this experience, and I still remember it vividly.  I am in a hospital gown in a cold room in a foreign country, and I am having what seems to me to be an abnormal response to this medical procedure, and all the nurse will say is “That is not possible.”  I asked again.  Again she responded “That is not possible.”  I started to get excited:  “It must be possible, because it is currently happening TO ME!”  

I could not believe that I might die of a routine medical procedure because the nurse refused to acknowledge my reality.  I had driven myself to the procedure, and I wondered how long it would take before anyone figured out what had happened to me.

I continued to express to the nurse that I thought I might have a problem and I was not satisfied with her answer.  Finally she snapped, “The only way that would be possible is if I had missed the vein, and I did not miss the vein!”  Case closed, as far as she was concerned.

I finally decided I would either die or I wouldn’t, but I didn’t seem to have any control over the outcome.  So I made my peace with it, and continued on with the procedure.

I was given ear plugs, because the machine can be loud.  After I inserted the ear plugs, I laid back on the patient table, someone tucked a foam wedge under my knees for comfort and placed a thin blanket over me for warmth, fastened a basket-type device around my head (see image at beginning of post), and I was eased into the MRI “donut.”

I don’t remember much from that first MRI, except that it didn’t seem that bad, and it was over fairly quickly.

I didn’t die from an allergic reaction to the dye, obviously.  But I was correct that the burning sensation was not normal.  Miss “That is not possible” was wrong.  As it turned out, she had not missed the vein – she had gone completely through it.  I figured this out the next day, when I woke up with a huge black & green bruise on the inside of my elbow, surrounding the IV site.

Presumably enough dye reached my brain for the radiologist to get adequate images, since my doctor was given results, and I didn’t have to re-do the procedure.

Since then, I have had several more MRIs – a few more looking at my brain, and ones looking at my hand/wrist, elbow, and shoulder.

Here’s what I’ve learned about MRIs:

There is a wide variety of condition of equipment and pleasantness of experience.  The “donut” open MRI was the nicest equipment I have experienced.  Many facilities do not have them, or only use them for certain patients (obese, claustrophobic, etc.).

The nicest facilities now have headsets for the patients to wear during the procedure, and will play your choice of local radio stations or even subscription radio (Sirius XM, etc.).  Time passes more quickly when you are listening to your favorite jam.

The worst experience I have had was at a military facility.  The MRI was in a trailer in the parking lot – it was on loan from the VA.  Yes, I had to walk across the parking lot in my hospital gown to get to the trailer.  The machine was small, so the table that I laid on was narrow, and the machine opening was tight too.  That’s the closest I’ve come to feeling claustrophobic in an MRI machine.  The machine was old and VERY LOUD.  There was no music.  No headsets.  Only ear plugs and disappointment.  And a lot of vibration.

The MRI machine cycles through various “runs.”  In most facilities, the technician will talk you through the procedure while it is happening, informing you when the next run is starting, and how long it will last.

You have two-way communication with the technician at all times.  You also have a “panic button” in your hand that you can press at any time if you want to disrupt the procedure and get immediate assistance.

The machine makes noises at different frequencies and volumes during the different runs.  Some runs are quieter and less noticeable.  Other runs are loud, and you can feel the vibration in your body.  Some feel like thuds.  It doesn’t hurt, but some runs are louder and less pleasant than others.

The contrast agent (“dye”) does not normally burn.  You usually can’t feel it at all.  Sometimes it might feel a little cold initially.  Sometimes you might get an odd taste in your mouth (kind-of metallic).  Side effects are rare, but can happen.

In my opinion, cerebral MRIs are the easiest, because all you have to do is lie on your back and not fall asleep.  (Some people might not agree, as a cerebral MRI guarantees that your head must be inside the machine, whereas if they are imaging your arm or leg your head might not have to be inside the MRI machine, which is less claustrophobic of an experience.)

NOTE: It is very important that you not move while the MRI is being conducted.  Moving can blur the images, and the procedure or portions of the procedure would then need to be repeated to get clear, accurate images.  This is also the reason that the body part to be imaged is typically placed in a surrounding device to help stabilize it.  This is also the reason you cannot fall asleep, as you might move in your sleep.

For me, the MRI of my shoulder was no big deal.  The wrist and elbow were more memorable.

In order to get the images they needed of my elbow and wrist, I was required to lie in less comfortable positions.  Although the techs propped me on various pillows and foam wedges to hold my body in the position they needed, my muscles started to fatigue during both of these MRIs.  I was trying to prevent my wrist and arm from shaking, but the muscles became so fatigued that I was unable to prevent the muscle tremors by the end of the procedures.

In particular, for the elbow MRI, I was positioned with the injured arm straight out above my head, in front of me, like Superman’s flying position.  For this procedure, I laid on my belly, rather than my back.  Despite my best efforts, I could not keep my arm from shaking by the end of that procedure, although the tech said the images came out ok.

The procedure typically takes about 45 minutes.  Afterward, the tech will typically check the images to see if any runs need to be redone.

Bottom line:  MRIs are loud, but the procedure isn’t a bad experience.  They are not painful.  I have never felt claustrophobic, although I came close in the tiny, old military MRI machine.  If you are claustrophobic, make sure you are referred to a facility that has an open MRI machine and has experience with claustrophobic patients.  Also, you can get a mild sedative if you need one to help you get through the procedure.

[If you think you will need a sedative, make sure you bring a wingman/battle buddy to drive you home.]

It is very rare to have an allergic reaction to the contrast agent.  The pre-procedure paperwork will explain the type of agent used and possible side effects.  If you have any concerns, discuss them with your referring physician or with the MRI facility staff.

You can resume your regular activities upon completion of the MRI – it’s not a procedure that requires recovery time afterward.

Don’t worry that you will get a nurse like I had for my first MRI – “That is not possible.” 🙂  Every tech I have had in the US has been very helpful, very knowledgeable, and most of them have been very reassuring.  They know the procedure can be a bit intimidating for many people, and they typically go out of their way to make it as pleasant as possible for you.

Not Mission Capable: Why I Have No Post This Week

I wish I could tell you there is no post this week because I have been hiking in the Rockies and enjoying the flare of golden aspens before winter comes.  Or because I have been scuba diving in the South Pacific.  Or because I have been traveling the world sampling exotic cuisines and learning about diverse cultures.

However, the reality is I am just sick and tired this week and feel too crappy to write a post.

The reality is that I don’t have the energy to leave the house, and I’m currently on a very restrictive diet that my allergist has assigned to help us determine my food allergies.

A friend, and fellow vet, sent me this video clip illustrating how crappy 2016 has been and it got me thinking…

So far, this year, I have seen the following medical specialists:

  • several PCMs
  • an orthopedic surgeon
  • several anesthesiologists & a CNA
  • an occupational therapist
  • a physical therapist
  • a neurologist
  • an allergist
  • a dermatologist
  • several radiologists
  • an optometrist
  • the NP who administers Botox shots
  • a PA in the VA wrist clinic
  • and various medical assistants (LPNs etc.)

I have had numerous diagnostic medical procedures:

  • an EMG/CNS
  • 2 MRI/arthrograms (elbow & wrist)
  • 1 cerebral MRI
  • numerous x-rays (elbow & wrist)
  • a cardiac ultrasound (echocardiogram)
  • 2 allergy skin tests (skin prick and injection)
  • numerous blood draws
  • a 24-hour urine collection analysis

And I have had the following treatments:

Once again, I am tired to the bone.  It has been a long year, filled with poor health and weekly medical appointments, new medications with complicated regimens, numerous corrections of Tricare billing errors, and several rejected requests for therapeutic medical devices.  This is also the year I discovered that I have multiple allergies (I didn’t know I had any),  and these allergies require that I make significant diet and lifestyle changes.

On the bright side, I *do* finally feel that I am getting better quality of care.  I am slowly building a team of competent medical specialists to diagnose and treat my health issues.  I am learning how to get rid of the incompetent ones.  Spousal Unit and I are learning how to navigate the treacherous Tricare healthcare system more effectively.  I am getting diagnoses that explain my symptoms, and I am getting treatment to reduce my symptoms and hopefully address the underlying causes.

I tell myself to frame the situation positively.  Instead of telling myself I am broken, I tell myself I am healing.  Both are true.  But I choose to focus on a positive future, rather than a negative one.  I believe this will help me get better.

2016 has been a crappy year, full of debilitating health problems.

But I am healing.

Guest Post: The Importance of Sleep to Health and Weight Loss

I had been thinking about this one for some time, and then I saw the following blog post: Does Sleep Deprivation Really Impact Weight Loss?  The obvious answer being, ‘ Yes,’ and it covered nearly everything I was planning to write about, so I highly recommend clicking on the link to this post.

I’ve already talked about the poor food choices we tend to make when tired.  As I am now tracking my daily calorie intake, sleep, and weight the next morning, I’ve also personally noticed 2 nearly identical days of food intake and the next morning one will have a positive effect on my weight, and the other negative – the only real difference was having a good night sleep.

Another interesting study looked at eating late at night.  Your body starts releasing fat into the blood stream about 1 hour before your normal bed time, and does so continuously overnight.  This is to keep the cells nourished while you sleep.  So eating right before bed can not only give you funky dreams and heart burn, but go straight to fat.

Your body saves extra fuel in the blood stream as fat.  If you are eating at a time when your body naturally releases fat, you create an overload which goes right back on as fat.

Everyone’s cycle is different, so I can’t give you a rule to stop eating by a certain time.  I’m a morning person, so I found it is important to me to eat fairly early in the day and stop fairly early.  I try to stop eating food (and drinking any alcohol) by 6-7pm in the evening (yes there are special occasions when I don’t follow this).  My wife however, is a night owl, and she usually eats breakfast later in the morning, and stops eating later in the evening.

I found it surprising how many more calories I can consume and still lose weight, when eating good healthy foods, in the right combinations, at the right times of the day, and getting a good night sleep.

We all know far too well how the negative cycle works. Doing the right  things help get you into a positive cycle of feeling good, making good decisions, sleeping well, and maintaining a healthy weight.

Good luck! If you have any questions or comments, feel free to email me at daveb.uk@hotmail.com.  [Crew Dog: Or comment below]

Crew Dog and the Case of the Faulty Health Paradigm

A paradigm is a model or example of something, or the framework or mindset we use to understand or make sense of things.  When we subscribe to a paradigm, it often means that we choose to see things in only that way.  What do you see when you look at the picture above?  Can you see it in more than one way?*

Often, in business, we hear people talk about a paradigm shift, which means accepting a new way of looking at or thinking about things.  The opposite of a paradigm shift is paradigm paralysis, which is “the inability or refusal to see beyond the current models of thinking.”

I was stuck in a paradigm, or suffered from paradigm paralysis about an aspect of my health for many years, and it basically took a whack upside the head (figuratively speaking) to make me change that paradigm.

The paradigm I was stuck in was this: I don’t have allergies.

I never had any health problems when I was growing up.  I was blessed with excellent health until my mid-thirties.  I didn’t wheeze and sneeze like the people in the allergy commercials.  Surely I didn’t have allergies.

Not only did I believe that I had no allergies, but the one time I went to a (military) doctor because I wasn’t feeling well and I described my eyes as “itchy” the doctor quickly reprimanded me to never say that, because itchy eyes were a symptom of allergies and aircrew could not have allergies.  Since I didn’t want to lose my aircrew status, I never again described my eyes as itchy.

Years later, I started having very concerning symptoms.  I suddenly developed vertigo, which was quite alarming.  I was sitting in a chair reading when, out of nowhere, it felt like I did a front cartwheel.  My inner gyros completely tumbled.  I felt like I had moved violently, even though I hadn’t moved at all.  I dropped my book, grabbed the arms of my chair, and tried to figure out what the heck had just happened.

As it turned out, it took quite a while to figure that out.  I saw lots of specialists during that time.  I had diagnostic tests to rule out brain tumors, inner ear tumors, and…allergies.  The allergist administered a skin prick test, left me sitting in the waiting room far too long, and had trouble reading the results on my arm.  I, of course, didn’t think I had any allergies, and wasn’t expecting them to find anything during this test.  I had noticed one area on my arm react strongly, but the allergist smugly informed me that that particular area had been the control – it was pricked with histamine.  Of course I had reacted to that, I was told disdainfully.

The allergist peered at my arm, ran their fingers over and over the area, and finally pronounced that I was probably allergic to birch trees and penicillium mold.  I asked if that meant I was allergic to penicillin (it runs in my family).  The allergist said it was possible.  [I learned many years later that being allergic to penicillium mold *does not* mean you will be allergic to penicillin the antibiotic.]**

I asked about the allergy to birch trees, and was told to just avoid being around them.  I was given no other information or guidance.***  I decided the allergist wasn’t very competent, and went on with my life.

Next I developed frequent excruciating headaches.  Eventually the headaches and the exclusion of other causes led to a diagnosis of migraines and migraine associated vertigo.

I began to learn about migraine triggers – things that can contribute to having a migraine, such as barometric pressure changes; bright, flashing, or fluorescent lights; and foods.  People with migraines have reported that they were more likely to have migraines after eating certain foods, although not everyone responds to all of the same foods.

Known culprits are red wine; aged cheeses; processed meats; chocolate; citrus fruits; and foods containing MSG or aspartame.  (There are more, but these are some of the biggest culprits.)

I started eliminating many of these foods from my diet, and my symptoms abated somewhat.

During this time, I had also developed a perpetually stuffy nose that seemed to get worse prior to and during a migraine.  I saw an ENT, and was diagnosed with chronic sinusitis.  For years afterward, whenever I mentioned to a new doctor that it seemed to be linked to the migraines, I was told that stuffy nose was not a migraine symptom, and the doctor ignored that symptom.

Fifteen years after my trip to the allergist, I had an allergic reaction to a medicine (Chlorhexidine) I was administered in a hospital.  Since Chlorhexidine is an antibiotic that is widely used as an antiseptic and disinfectant in medicine, dentistry, and  in pharmaceutical and cosmetic products, I figured I’d better see an allergist to discuss how I was going to avoid Chlorhexidine for the rest of my life.  I also wanted to know if I was allergic to any other antibiotics, since I still didn’t know whether I was allergic to penicillin or not.

This allergist was very thorough, and asked me a lot of diagnostic questions.  We discussed my Chlorhexidine allergy.  And then he said, “You probably also have a mold allergy.”

Here’s where the paradigm paralysis makes me look pretty stupid.  Even though I had been diagnosed with an allergy to penicillium mold, and even though I had known for years that I was sensitive to mold in my environment (moldy basements, moldy government buildings, water-damaged areas in homes), it had never occurred to me that I was *allergic* to mold (because I don’t have allergies).

I didn’t even know that mold was a common allergen.

I told the allergist that I had never even considered that I might have allergies, because “aircrew don’t have allergies.”  He laughed, and said, “At least, not until after they’ve retired, right?”

My new allergist gave me a mold elimination diet to follow, for diagnostic purposes.  It sounds crazy, ‘cuz we don’t go around knowingly eating mold, right?  Well, actually…  That penicillium mold I’m allergic to?  It’s used to create Brie and Camembert cheeses.  Two of my favorites, that I started eating right around the time my migraines became frequent and have been eating ever since – because the first allergist *never told me* I should stop eating them!

Penicillium mold is also used to create “veiny” cheeses, including Roquefort, Blue, Gorgonzola, Stilton, etc.  While I ate these cheeses much less frequently, I did like to have Gorgonzola (often found in four-cheese blend) on my pasta.  Fortunately, these cheeses  were all categorized as “aged” cheeses, which I had eliminated from my diet early on because they are known migraine triggers.

Back to the mold elimination diet: Anything pickled, fermented, cured, aged, or cultured contains mold.  Dried products (fruit, nuts, coffee, tea) may also be contaminated with mold.

The cultured yogurt that I was eating because it contained “good” bacteria and was good for my health – was making me sick.  Before I began the mold elimination diet, I ate yogurt for breakfast one last time and my nose got so stuffy that I had to breathe through my mouth.

After three days on the mold elimination diet I could breathe better than I had in fifteen years.

After two weeks on the mold elimination diet, I felt better than I had in many years.  My energy level was much higher, and the incidences of “brain fog” were much lower.

I also don’t think it’s a coincidence that the mold elimination diet prohibits me for eating every food that is a known migraine trigger.  I am currently exploring the possibility that my migraines are linked to this underlying allergy.  [Update: see this Migraine diet]

I have subsequently returned to the allergist for two rounds of testing: skin prick and injection (blog post to follow).  Of the identified 100,000 types of mold (there are 1.5 million, but many are unidentified), there are allergy testing samples for 15 types.  I reacted to Penicillium and Aspergillus, which are both common indoor molds.

My allergist tells me that it is less common to do allergen elimination diets these days, particularly for something like a mold allergy.  In fact, it’s hard to find much information about mold elimination diet on the internet (see below).  I’m glad I happened to get an allergist who had this in his “bag of tricks,” because this diet has already had a radical impact on my health.

Are there assumptions or paradigms about your health that might be false?  If you are dealing with a chronic health condition and you haven’t had success treating it, it may be time to go back and challenge previous assumptions and paradigms.  After all, I “knew” I didn’t have allergies…

*This is a classic perception image.  You might see a duck facing left or a rabbit facing right.  Many people have trouble being able to see both, or switching from seeing one to seeing the other.

**NOTE: For more information on Penicillium mold, and supporting data that “hypersensitivity to Penicillium mold bears no relationship with hypersensitivity to the antibiotic Penicillin,” see this article.

*** My new allergist informed me that if you are allergic to birch trees, you may have cross-reactions to certain foods, including celery, apples, or carrots.

NOTE: For more information on mold in general, see these Centers for Disease Control (CDC) FAQs.

NOTE: For more information on mold allergy, see this page on the Asthma and Allergy Foundation of America website or this page (and associated pages) on the American Academy of Allergy, Asthma & Immunology website.

NOTE: For more information on the mold elimination diet, see this example.  [This is not my allergist or ENT and I am not endorsing this practice or being compensated by them in any way.]

P.S. – Have I had a mold allergy my whole life, and just didn’t know it?  Or did it develop in adulthood?  I don’t know.  Either is possible, although adult-onset seems more likely, given the lack of symptoms prior to my thirties.  Here’s a good article on adult-onset allergies and asthma.  [Again, this is not my allergist and I am not endorsing this practice or being compensated by them in any way.]

Guest Post: Breaking Through the Weight Loss Plateau

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

My new diet is off and running. I’m disciplined and start losing weight. A couple of weeks in, and my weight loss starts to slow down, then stops all together even though I’m still doing what I did at the start.

Frustration sets in, and this is where many people quit.

Why?! I’ve hit the plateau!

This happened to me time after time.  I worked so hard, and only lost 10-15 lbs.  Months would pass, and I couldn’t get any further.  Eventually something would happen and I’d stop. I couldn’t get past the plateau.

Over time, with repeated trying, hitting the plateau, and not being able to break through, I became depressed and didn’t think it was possible to lose weight. When trying again this time, I set the goal of losing 100 lbs in a year, but given my past experience I didn’t really believe it was possible.

The ‘What’s the Right Diet for You?’ program, though, explained what the plateau was and how to break through it.  This time I was ready and armed with new information, and blew through each plateau as they started to happen!

What is the plateau? Here’s a link to a dietician’s explanation about a plateau. To try to explain it in simple terms, your body adapts to the changes made and your weight loss levels out.

I started off weighing more than 350 lbs, and let’s assume (I wasn’t measuring at the time, so I don’t know for sure) I was consuming 5,000 calories per day to maintain this weight. I start dieting, cut my intake to 4,000 calories per day and start losing weight.  At 350 lbs, my body needed the 5,000 calories per day just to maintain.  Since I reduced the intake to 4,000 calories per day, my body will start burning fat to compensate for the difference.  However, as I lose weight, my body no longer needs as many calories to maintain the lower weight, and at some point the weight loss will level out as I reach the point where my body only needs 4,000 calories per day to maintain itself. (You can probably insert a nerdy mathematical decreasing returns graph here.) 🙂

So what do I do? Cut further… go from 4,000 calories per day to 3,500 calories per day. When I reach the next plateau, I cut further again.

As long as I have fat reserves, I know my body has all the energy it needs and I can cut further.

What I don’t want to do is cut so far my body goes into starvation/fat preservation mode or is unhealthy because I’m not getting the basic nutrients I need.

The recommended average intake for a man is 2,500 calories per day (minimum 1,500 calories) and a woman is 2,000 (minimum 1,200 calories). This average has a wide variation, however, based on age, body size, activity level, etc. You really need to measure and experiment for yourself to find out what your value is.  I found mine, once I went below 250 lbs, to be around 2,200 calories per day, and, at this moment, as I am working on the last 10 lbs, I set myself the target to stay within 1,800 to 2,100 calories per day.

You might feel like you’ve cut really hard, well below the recommended value, and you’re still not losing weight.  Here are my recommendations:

  1. Did you cut as far as you think you did? If you aren’t tracking what you eat, you may not think you are eating a lot but would surprise yourself by how much you really are. In August 2015, I finished a project at a customer site and started working from home. I had already lost 100 lbs, and was doing well. After a week, I stopped losing weight, and, in fact, started to gain weight. How could this be? I was following my diet and hardly eating anything. This is when I downloaded My Fitness Pal and started tracking what I was eating. To my surprise, I was consuming much more than I thought. It was too convenient at home to have a bite of this and a bite of that, even good food. My calorie consumption had gone up, and my weight was climbing accordingly. I had to discipline myself to track EVERYTHING I was eating at home to get a handle on this. As soon as I did, I got my diet back on track. Another possibility is that you are having nice low-calorie healthy meals like salads, but the salad dressing you are using is so packed with sugar, unhealthy fat, and empty calories it completely outweighs the benefits of the salad.
  2. Did you cut too far and put your body into starvation mode? Remember, we need to consume a healthy minimum of nutritionally balanced food to kick-start our metabolism into burning fat for the excess energy we need.
  3. Are you drinking enough water? We need water to flush the toxins out of our systems, to properly use the nutrients we are taking in, and to release the fat into our blood stream for use. Be sure you are drinking enough water throughout the day.
  4. Adjust your ratios and the nutritional benefit of what you are eating. We need a balance of protein, complex carbs, fiber, fruits, and vegetables, but our body chemistries are all a bit different, so what may work for me won’t work for you quite the same way. This is fine tuning and will come into play more as you work off the last few pounds.
  5. Add or change your exercise regime. Exercise helps improve fitness and burn calories. We need to be careful about exercise when using it for weight loss however (see my previous post on this). Adding or changing your exercise regime while controlling your diet is another way to change the status quo and break through a plateau.

Here’s a blog post from My Fitness Pal with additional tips for breaking through the plateau.  [Hint: think of plateau-busting as troubleshooting.]

Plateaus are natural and will happen as your body adjusts to your new eating lifestyle. When you understand them, YOU CAN BREAK THROUGH THE PLATEAU! Breakthrough simply requires another change, further tuning your diet. You can do this!

Good luck! As always, feel free to contact me at daveb.uk@hotmail.com if you have any questions or comments.  [Crew Dog: Or comment below.]

 

Health Hack: What Does “Take On An Empty Stomach” Mean?

So, for the first time, I was prescribed a medication that had the instructions “Take on an empty stomach.”

I was aware such medications existed, but I’d never been prescribed one before so I’d never given those instructions much thought.  But, now, I started wondering – what exactly does that mean?  HOW empty?

I mean, I could take one dose in the morning when I first wake up but then how long do I have to wait before I can eat?  And what about the *other* doses I have to take throughout the day?

And does empty only refer to food, or does water or other drinks count too?  So many questions!

Turns out, it’s not as straightforward as you might think.

Even the “expert” medical websites don’t agree.

After reviewing multiple health websites, I decided I was probably safe waiting one hour after I took the medication before eating, and waiting two hours after I ate before taking the medication.  But I didn’t know for sure.

Turns out, some medications are particularly finicky.  Hopefully, if you are taking one of those, your doctor or pharmacist will give you detailed instructions.

The National Institutes of Health asserts that “on an empty stomach” means you should take these medications either 2 hours before eating or 2 hours after eating.

And what about beverages?  There’s even *less* information to be had about that.  A few sites mention “plain water” as being ok, in moderation. But it appears that there is no “blanket” advice on beverages.  Medications  vary widely, and some medications interact with certain drinks – grapefruit juice being a well-known example.  Milk can also interfere with absorption.  And hopefully everyone knows that many medications don’t mix with alcoholic drinks.

I eventually looked up my specific medication on the Mayo Clinic website, and learned that I could take it with water or fruit juice (8 ounces for adults).  This website also confirmed that 1 hour before meals or 2 hours after was correct for this medication.

Bottom Line: You should discuss specific instructions for taking medications with your doctor or pharmacist.  The Mayo Clinic website (see above) can also provide useful information.  A broad rule of thumb is 2 hours before or two hours after eating.  Taking your medication with plain water (up to 8 ounces) should be fine (but I am not a doctor or a pharmacist, so this information is for educational purposes only).

Finally, I leave you with a commentary, written by a medical professional, on how ludicrous these medication instructions can become.

WARNING: Food and medications can interact, which could make the medications less effective or could cause adverse side-effects.  See this FDA pamphlet for more information on Food-Drug Interactions.

Guest Post: Warning about ‘Healthy’ Food Labels

Low Fat! No Fat! High Fiber! High Protein! All Natural! Organic! Free Range! Zero Trans Fat! Sugar Free! No Sugar Added! Low Carb! Multigrain! Light! Cholesterol Free! Made with Real Fruit! [Follow link for more information on food label claims]

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

Buyer Beware!!!

There is very little regulation on the claims companies make about food products, and advertisers push it to the limits! Let’s face it, they are trying to make their product stand out from the others.

I no longer purchase anything based on the marketing slogan. When I shop, I read the labels and purchase whole food products with natural ingredients and as few chemicals and preservatives as possible. Don’t believe the slogan on the label until you do your research.

While I’m on the subject, also beware of fad diets like detox, liquid, no-carb, etc.  Any diet that demonizes one or more particular food groups is unbalanced and will force you to compensate with expensive alternatives.

As an example, ‘gluten-free’ is the rage where I live with many people believing they need to eat ‘gluten-free’ to be healthy.

Gluten is a composite protein found in many grains, such as wheat, rye, and barley. There is an autoimmune disease called coeliac which affects about 1% of the population. Coeliac (spelled “celiac” in the US) causes the body to react to gluten by triggering a serious autoimmune response which can damage many parts of the body.  If you have this disease, consuming gluten is dangerous and you need to seek out gluten-free products.

If you don’t have coeliac, gluten sensitivity, or a wheat allergy, you can consume gluten without problem. In fact, going gluten free if you don’t have coeliac can result in serious nutritional deficiencies.

‘Gluten-free’ products are being advertised as ‘healthier’ than regular products. The influence is so strong, I had someone who didn’t have enough food to eat come into the food bank where I volunteer and ask if she could have ‘gluten-free’ products because she was trying to eat healthier. She didn’t have coeliac and was surprised (and relieved) when I explained to her what it was. Believe or not, there is even a company promoting ‘gluten-free’ water, which is ridiculous considering there is no grain in water to begin with so all water is naturally gluten-free.

The same applies to other food allergies, like wheat, nuts, etc. These medical conditions are serious. If you have a food allergy and consume products containing them, the results can range from minor discomfort to death. The fact that products for these conditions are being advertised and labelled is a huge benefit to people with these conditions.

But, if you don’t have the condition, you don’t need to seek out these products in the name of being ‘healthy.’ Instead, eat a good balance of real food.

[Crew Dog: To summarize what Dave is saying – Don’t buy into the hype and confusion of food labels.  Think about what the food advertisers are saying and whether it makes sense – even if a cookie is low-fat, it isn’t healthy fuel for your body.  Don’t pay extra for things you don’t need (like gluten-free water) just because advertisers slapped faddish buzz words on the packaging.  It may seem like a lot of work to eat healthy, but it doesn’t have to be.  Just eat non-processed foods in their natural state (fruits, vegetables, nuts, seeds, meat, fish) or foods with a few simple ingredients.]

As always, feel free to contact me at daveb.uk@hotmail.com if you have any questions or comments, and good luck!  [Crew Dog: Or comment below.]

Things I Never Knew Before I Had a Debilitating Health Condition

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When I began living with a chronic health condition, I thought I was learning what it was like to not be perfectly healthy.

After years of having excellent health, I was starting to understand physical limitations (I thought).

I was more sympathetic of others who had dietary restrictions (and I was grateful when other people were sympathetic of my dietary restrictions).  I was more aware of physical limitations, and therefore more sensitive to people who have them and ways to make environments more accessible to folks who are differently-abled.  I thought my health condition was making me a better person by making me more aware of others’ realities.

Then my health condition became debilitating, and I learned there was a big difference (at least in my case) between chronic and debilitating.

With a chronic health condition I could still live a fairly normal life, with some restrictions and modifications.  With a debilitating health condition, I rarely leave the house, except to go to doctor’s appointments.

When my health condition became debilitating, I learned there was still a lot I didn’t know about physical limitations and other people’s realities.

In the hopes that others might get a better idea of what it’s like, I made a list of things I never knew before I had a debilitating health condition:

I never knew I would choose to stay home and miss an opportunity to socialize because it was too much work to figure out what clothes to wear in public.

I never knew there would be days (weeks?) that I didn’t have the energy to change out of my pajamas.

I never knew how exhausting it could be to take a shower.

I never knew I could lack the energy to prepare a simple meal like scrambled eggs.

I never knew that some foods could be too exhausting to eat, and that some days all I would have the energy to eat would be foods like soup, apple sauce, macaroni & cheese, or ice cream, that require minimal processing.  (Easy to prepare, easy to chew, easy to digest.)

I never knew that I wouldn’t be able to deal with phone calls, and I would just let them go to voice mail, which I would delete every few months when I got tired of the icon blinking at me.

I never knew that it could take too much energy to sit up, so I’d have to lie on the couch instead.

I never knew that leaving my house to go to a doctor’s appointment, to socialize, or to run an errand could take so much out of me that it could take days to recover.

I never knew that I could be so exhausted that I wouldn’t have the energy to fight for my health – that I would ignore incorrect bills or live with health problems rather than fight with the system to correct these things, because I didn’t have any fight left in me.

I never knew that when I got this ill none of my friends would notice, and  I would become more and more isolated.

Call to Action: If you have a friend with a debilitating health condition, don’t let them fall through the cracks!  Ask yourself, “When is the last time I saw/heard from this person?”  Everyone gets busy, and it’s easy to go a while without contacting your friends, especially if they don’t answer their phone.

Texts, emails, or Facebook messages are a great way to keep in touch with a friend with a debilitating health condition.

Other ways you can help your friend: Ask them if there’s something you can pick up for them while you’re out running your errands.  Saving them a trip to a store can be a great kindness.  Or bring by something for them to eat that they don’t have to prepare themselves (microwave meal, home-cooked, deli, take-out – anything that is easy and within their dietary restrictions).  Even fresh fruit or a veggie tray is a great treat for someone who doesn’t get to the store very often.

Finally, make some time to visit your friend (please coordinate with them first – they might not be dressed!).  They probably won’t have the energy for a long visit, so stopping by wouldn’t take much of your time, but they would most likely appreciate the company.

Debilitating health conditions can be isolating and can lead to depression – Be a good Wingman/Battle Buddy and keep an eye on your friend.  They may not be able to help themselves.  Don’t let them fade away.

What It’s Like to Have an Allergic Reaction Pre-Surgery

It’s been pretty quiet on this blog lately.

Have you heard the saying that flying consists of hours and hours of boredom interrupted by moments of sheer terror?

Well, let me tell you about the time I was waiting for anesthesia prior to surgery, but I developed an allergic reaction and the surgery was cancelled…

[Image of allergic contact dermatitis from Google Images]

So far I’ve had two surgeries, both of which were Tricare referrals to civilian facilities.  This was to be my first surgery at a VA hospital.

The contrast between civilian and VA facilities and experiences was interesting, but I’ll save that for another post.

I will say, though, that the military “hurry up and wait” dynamic is alive and well at this VA facility.  That may have saved my life.

Every stage of the process at the VA hospital felt slow and inefficient.  There was a whole lot of waiting.  And communications could have been better as far as what would happen during each stage of the process.

One thing that was well communicated, however, was the pre-surgery cleansing process.

I was given a nifty hospital gown and robe, a pair of no-slip hospital socks, and some antiseptic body wipes, and was escorted to the bathroom.  Once there, I was directed to follow the cleansing protocol on the wall chart using the antiseptic wipes and I was left to accomplish the task.

There were three packages, each of which contained two wipes.  The wall chart showed a body with six defined zones and directed me to use one wipe for each zone, in a prescribed sequence.  Excluding the head and genitals, I was to start at the neck and wipe my entire body with the antiseptic wipes.  The chart spelled it all out: use the first wipe to clean the neck, shoulders, and chest; use the second wipe to clean the arms and hands; etc.  When I had completed wiping down my body with the antiseptic wipes, I let it air dry as directed.  (The antiseptic was supposed to remain on my body, rather than being rinsed off.)

After having completed the pre-surgery cleansing protocol as directed on the wall chart and donning my nifty gown, robe, and socks, I returned to my hospital bed and waited.  And waited.  I could feel the residue from the wipes on my body – it felt tacky.  I remember commenting that I hadn’t had to do this cleaning procedure for either of my previous surgeries.  We assumed the VA was being ultra-cautious about infections.

Eventually I was taken back to some kind of a surgical staging area.  The nurse anesthetist put in an IV line, and I had pre-surgery conversations with a nurse, the nurse anesthetist, the anesthesiologist, and my surgeon. Again there was more waiting around than I had experienced prior to previous surgeries.

The nurse anesthetist returned and said it was time to remove my robe.  As she assisted me in getting the robe off of my shoulders (while I was propped up in the hospital bed), she exclaimed, “Your back is really red and splotchy!”  This got the attention of the nearest nurse, who came over, looked at my back, and agreed it didn’t look normal.

They asked me questions:  “Do you have a history of eczema?” [No]. “Do you have a history of hives?” [I don’t think so].  “Is it spreading?”  I could feel that my face and neck were getting more and more flushed.  I could tell when the hives spread up my neck, although I couldn’t see them.

They started looking at the rest of my body, asking questions while they looked under my gown and folded back my blanket:  “Is it on your chest?” [Yes].  “Is it on your abdomen?” [Yes].  “Is it on your arms?” [A bit].  “Is it on your legs?” [Not yet].

Once they determined that I was probably having an allergic reaction, they started asking lots of questions: “Does it itch?” [No]. “Does your tongue feel swollen?” [No].  “Stick out your tongue and let me look at it.”  “Are you having any trouble breathing?” [No].  Other medical staff came and went, looking at the situation and asking questions.

At some point the nurse anesthetist went and got Benadryl (an antihistamine) and started administering it through my IV.  Then they started trying to determine the cause of my allergic reaction.

It was pretty clear to me that it must be the antiseptic wipes.  But the pre-surgery cleansing protocol had apparently been instituted fairly recently, and not many people in the pre-surgery staging area seemed to know about it.  I explained it to person after person.

Finally one or two people who were aware of the new cleansing protocol got involved.  A consensus was reached that I was having an allergic reaction, as evidenced by allergic contact dermatitis and hives (urticaria), and that it was caused by the antiseptic wipes.

A decision was made to delay my surgery while they monitored my condition.  The nurse anesthetist was prepared to administer steroids if necessary.  The patient who was scheduled after me was moved up to my surgical time slot.  I started to feel light-headed and buzzed from the Benadryl.  A nurse told me that my blood pressure was “slightly high.”  When I asked her “How slightly?”, she responded “185/99.”

I was informed that the hospital was tracking adverse patient reactions to the new protocol.  Someone sent for the Chief Surgeon, who came and looked at me, asked me a few questions, proclaimed that I was manifesting a classic dermatologic allergic reaction, and told me he was sorry I was having this negative reaction and that it would be logged.

I was also informed that this allergy would be added immediately to my VA medical records.  The substance to which I reacted is Chlorhexidine.  In the wipes, it was a 2% Chlorhexidine Gluconate solution.  I was told that Chlorhexidine reactions were rare, but could be severe.

The anesthesiologist suggested that I have a shower to wash off the antiseptic.  No one responded to his suggestion, although a nurse went and got a wet wash cloth and proceeded to wipe down my back and part of my neck.

The rash/dermatitis/hives seemed to stop spreading in response to the Benadryl.  My blood pressure also started coming down.  My surgeon, who had been monitoring my situation, returned and informed me that he had decided to cancel my surgery and re-schedule it for another day.

Initially I was disappointed by this decision, since I wanted to get the condition I needed surgery for dealt with, and because I would have to go through the surgical preparation logistics all over again.

But after I got home and started feeling better, I researched Chlorhexidine reactions and found multiple medical journal articles describing patients with Chlorhexidine reactions having anaphylactic reactions* under anesthesia, either in pre-op or during surgery.  Then I was very grateful for my surgeon’s caution.

(And for the inefficiency of the hospital staff.  Had my surgery started on time, I might have been under anesthesia when my allergic reaction manifested.)

Additionally, I was warned that my symptoms could return (presumably after the Benadryl wore off).  It would not have been good for my symptoms to get worse or to return while I was under anesthesia.

After monitoring, and the return of my blood pressure to an acceptable level, I was permitted to go home, with the caution to continue to monitor my symptoms and to get help if the symptoms returned/got worse and I started to have trouble breathing.

[I insisted on a shower before leaving the hospital, to remove the offending substance from my skin, however no shower was available, so I was given wash cloths and towels, and escorted to a bathroom to clean up in the sink.  I washed myself as best as I could, and took a complete shower after I got home.]

I did have symptoms again at home the next day, which I treated with an OTC antihistamine and an NSAID.  Had my symptoms gotten worse, I would have called 911 or driven to the emergency room.

I am still waiting to re-schedule the surgery…

BOTTOM LINE: The VA has a new (as of April 2016) pre-surgery cleansing procedure which consists of using 2% Chlorhexidine Gluconate body wipes.  Some people, like me, are allergic to Chlorhexidine.  Chlorhexidine is also used in hospitals in catheters, antimicrobial skin dressings, and antimicrobial surgical mesh, among other things.  It is also used sometimes to sterilize medical equipment.  If you are allergic to Chlorhexidine, be VERY, VERY cautious in a medical setting and make sure all of your healthcare providers know.

Chlorhexidine is also used in dentistry, in certain mouthwashes and rinses and in certain dental procedures, so be cautious there as well.

WARNING:  If you are allergic to Chlorhexidine, you should be aware that it is an ingredient in many products besides pre-surgery antiseptics.  Please see this website for other products (including everyday household products) which may contain Chlorhexidine.

NOTE: Prior to this incident, I was aware that my skin was sensitive to some laundry detergents (they make my skin itch) but I had never had an allergic reaction, nor had I been diagnosed with any allergies.  I had no idea I would have an allergic reaction to the antiseptic wipes.

*NOTE: An anaphylactic reaction/response is a severe allergic reaction.  The most dangerous anaphylactic reaction is one in which the airway is compromised due to swelling of the mouth, tongue, throat, and/or lungs.  For more information on anaphylaxis, see this Mayo Clinic website.

Health Hack: Chia Seeds

Ch-ch-ch-chia!  Lately, eating chia seeds has been all the rage.  But for those of us of a certain age, all we knew about them was Chia Pets (as seen on TV).  Slightly more fun than a Pet Rock (perhaps), a Chia Pet is a terra cotta shape that you soak in water and slather in chia seeds.  When the seeds sprout, your Chia Pet grows fur.  (I don’t know what the deal is with the alligator.  Who ever heard of a furry alligator?)

It never occurred to me that you could eat the chia seeds – it would have been like suggesting you could eat Sea Monkeys.

Flash forward a few decades, and suddenly the health food crowd is eating chia seeds (Salvia hispanica).

Touted as a “super food” by some, chia seeds are relatively high in protein and omega-3 and omega-6 fatty acids.  Many claims have been made regarding possible health benefits of chia seeds but, since this blog is for informational purposes only and I am not a healthcare professional, I leave it to you to do your own research and due diligence.

This article provides an overview, and is a good place to start.

Not much scientific health research has been done on chia seeds yet.  However, according to one journal article, “the historical use of Salvia hispanica suggests that it is safe for consumption by nonallergic individuals. Further rigorous examination is warranted pertaining to the use of Salvia hispanica as a dietary supplement, as well as in the treatment or prevention of human disease.”

If you are skeptical about the health claims being put forth in the popular media about chia seeds, and you want more scientific information, this blog post is just the thing for you.

My Experience: I read that chia seeds grew slimy* when they were reconstituting, and I thought the texture might be gag-inducing off-putting.  (*Apparently the less unappetizing adjective is “gelatinous”.)

In fact, “Chia seeds have the ability to absorb up to 27 times their weight in water,” according to Dr. Rebecca Rawl, from Carolinas Medical Center in Charlotte, N.C.

The articles I read suggested that the easiest way to start eating chia seeds was to mix the chia seeds into something where they could absorb moisture but the texture wouldn’t be noticeable, like yogurt.  So that is how I began eating chia seeds – mixed into yogurt.

To me, chia seeds don’t have a noticeable flavor.  But if they haven’t fully reconstituted they are a bit crunchy, which is fine, as long as you’re expecting it (yogurt, for example, doesn’t typically crunch).  So, if you want them to get good and slimy gelatinous, you have to give them a few minutes to soak up moisture from whatever you’ve mixed them into (or pre-mix them with water).

I currently mix them into a 6 ounce glass of low-sodium V-8 juice (which I season with Tabasco sauce), and wait for them to reconstitute before I drink it.  [Stir well – they tend to clump on the bottom of the glass!]

I have found that I don’t mind the consistency of the reconstituted chia seeds – it reminds me of tapioca pearls.  But a few always get caught in my teeth at the gum line.  So check your teeth before you leave the house…

“Why are you eating this slimy, disgusting seed?,” you might ask.

Good question.

To put it delicately, chia seeds help keep you regular.

Chia seeds are high in fiber*, and the gelatinous coating around the seeds helps them ease through your digestive system.  *“Just 1 tablespoon of chia seeds will give you 19% of your recommended daily fiber.”  It also helps your stool to be “fluffier,” if that makes any sense to you.

In other words:

“Chia seeds are a good source of insoluble fiber. The seeds expand quite a bit and form a gel when they come into contact with water. This gel adds bulk to your stool, which keeps bowel movements regular and helps prevent constipation.”

Certain medications, like iron supplements or opioid painkillers, cause constipation as a side effect.  Eating chia seeds helps counteract that effect.  Instead of getting dense and compacted, your stool stays more liquid and continues to move through your system.

It’s up to you whether you decide to take them daily, as preventative maintenance for your digestive system, or whether you choose to use them on an “as needed” basis.  They do seem to act relatively quickly, so you don’t have to wait days for the effects.

If you happen to keep an eye on your stool, you can make adjustments as necessary.

“Bottom” line: Many health claims have been made about the benefits of eating chia seeds.  Most of them have not been substantiated by scientific research (although much research remains to be done).  I use chia seeds as a natural means of maintaining regular bowel movements.  They contain only one ingredient, they’re easy to add to my regular diet, and they counteract the constipating effects of some prescription medicines and supplements.

But chia seeds are not for everyone.  See cautions below.

CAUTION:  WebMD lists several possible side effects of consuming chia seeds.  If you have one of these conditions, consult with your health care provider before consuming large or frequent quantities of chia seeds.  

CAUTION:  Some people are allergic to chia seeds.  These individuals should not consume chia seeds.  If you are allergic to sesame seeds or mustard seeds, you may also be allergic to chia seeds.

CAUTION: “If you plan to consume chia seeds or chia seed oil on a regular basis, talk with your doctor. Chia seeds can thin your blood and may affect how medicines such as Coumadin (warfarin) and aspirin work. You may need to avoid chia seeds before surgery.”

CAUTION: Although you can eat chia seeds wet or dry, it is not recommended that you eat a bunch of dry chia seeds and then drink a glass of water.  If you do this, it is possible to have problems with chia seeds lodging in your throat.  People with a history of swallowing problems or esophageal strictures are cautioned to only eat chia seeds after the seeds have fully expanded (same source as previous link).

CAUTION: It is recommended that you not consume more than 3 tablespoons of chia seeds at a time, as this can cause you to visit the bathroom more frequently than you might desire.  According to one source,  the recommended dose for children ages 4 1/2 – 18 is 1 tablespoon per day, although research has not yet established optimal or maximum doses for any age.

NOTE: For an overview of scientific research conducted on the health benefits/side effects of chia seeds, see here.

NOTE:  Nowhere have I found clarification as to whether the suggested doses (in tablespoons)  refers to the dry seeds or the reconstituted (wet) seeds.  I measure approximately 1 1/2 tablespoons of dry seeds into my food or drink and wait for them to reconstitute before consuming them.