Saturday, September 22, 2012

Day 98 - the fatigue and fog abate a bit

If this were twitter instead of a blog, the last two days' worth of entries would consist entirely of things like "I had noodles and tomato sauce for lunch," "just won a game of solitaire," "Maggie is cute. LOL." I am feeling a little bit more insightful today than the last two days. You'll probably get something more like "I had noodles and tomato sauce for lunch. It was good."

I actually felt a whole lot better today than yesterday and was able to go to the beach for a little walk with Terry which was really fabulous. The weather was gorgeous; I left my outer coat in the car although most people were in T shirts or wetsuits in the case of the surfers. I was able to walk for maybe a mile and was not even too tired at the end. This seems like real progress although I suspect that there are some very tired days ahead still as my counts continue dropping. I did not have to do any intellectually challenging things like talk on the phone to strangers today although I was able to order Ellie's takeout from Las Olas without incident. This makes me think my intellectual status is probably OK. I bought some books in the mail and it turns out one was intended to be a book of poetry for high schoolers. I was able to understand the first few poems so I am probably functioning at at least a ninth grade level. I was also able to understand (I think) the most recent JAMA (see below; you be the judge) and the most recent NEJM.

Last night, again, I slept about eight hours without interruption which was extremely welcome. I woke feeling refreshed and took two or maybe three little naps today--they seem to be getting shorter and not as deep. It all reminds me of what babies/toddlers do as they get older and consolidate their sleep from lots of medium length naps to longer at night and several naps to even longer at night and shorter, fewer naps to eventually all at night. Perhaps I am recapitulating my sleep history.

For sure, the highlight of my day was going to the beach or maybe it was lying on the couch, half asleep while the dogs rested, Tommie read, Ellie played on her computer and Terry froze a bunch of soup in the next room. Half awake, listening to Terry's noises, just barely aware of Ellie's swinging leg, Tommie's wiggling foot, the sun on Maggie's muzzle, the way Kita was snuggled into Maggie's bed. Delicious.

Let me summarize the most recent journals for you to save you the time. The NEJM has a nice clinical problem solving article which I would recommend. It's not something I think any of us is likely to see, but I would have missed it (but that's why it's a team effort; I would have gotten a neuro consult and they would have gotten it--which is exactly how it played out). It's one of those completely treatable zebras that make a great recovery if you think of it and treat for it.

The most recent JAMA is devoted to obesity research and commentary. I am not such a big fan of obesity research because my suspicion is that a lot of what we "know" about obesity is actually false, beside the point or only relevant in some cultures at some times. That said, I read the whole journal--more or less--and paid attention. The article that I thought was the most interesting was one of the last ones. The idea was that the researchers gave a bunch of people with obstructive sleep apnea (OSA) lap band surgery and then repeated their sleep studies to see how much their OSA improved. The subjects lost about 25% of their excess weight and their OSA was about as severe as it had been before. This is totally fascinating to me because, in general, OSA responds so well to weight loss--or at least that's the common belief; no one has actually done pre- and post- surgery sleep studies before. You might posit that the subjects did not lose enough weight to affect their OSA (people don't lose as much weight as quickly with lap band compared to gastric bypass), but you would still expect at least a trend towards people with more weight loss improving more and that is not what happened. This probably means that OSA is a heterogeneous disease (with many different causes or maybe even several actual diseases lumped in together with the same name because we can't tell them apart yet), that there was something wrong with the study, that OSA is much more complicated than we thought or perhaps some combination of the above.

Another article shows that people who have gastric bypass surgery (in Sweden) end up costing the health care system about the same over the next twenty years as people who start at a similar size, consider the surgery and then don't have it. People who do the surgery cost more up front and less twenty years later, especially in meds for chronic conditions (mostly diabetes). This will be interesting to watch play out over the next twenty years as it can take a long time for diabetes complications to wrack up. I wonder what effect the U.S. tendency to turn insurance on and off over a person's lifetime might have on this and also if it would play out differently in the U.S. because people tend to have private insurance for the first forty years of their adult lives and then public insurance.

As a side note on obesity, my daughter's middle school does not have a bike rack. It is also not safe to ride your bike or walk to school (kids who live less than half a mile away are bussed in) because there are no shoulders on the road leading to it. I think if we were really interested in health or perhaps if we really understood health, we would be running our communities differently. Just sayin'.

For tomorrow, I am going to hope that I feel as good again as I do today. I hope your tomorrow is as good as today was and, if today wasn't your best day, I hope tomorrow improves.

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