New meds today, and new diet

So, the propranolol is out. Low blood pressure, brain fog, nausea, all of it not good.

Now I will be taking topiramate daily as a preventive, and have ketorolac and metoclopramide to take as needed if I feel a headache coming on. So, maybe my next trying-to-take-the-subway exposure therapy adventure, I will take those beforehand just in case. Pharmacist said if none of this works I should be able to convince my benefits to pay for qulipta, since I will have tried so many things, or another one to consider is triptans, e.g. sumatriptan. Typing this all out so I remember later. I found coming back to this blog helpful to notice how things went downhill after starting propranolol.

Meanwhile, I also apparently have high cholesterol. Not crazy high, but elevated enough that I should start thinking about diet. So, according to Harvard:

What foods lower cholesterol?

Certain foods help to keep your cholesterol levels in check. These foods lower cholesterol in various ways:

• oats
• barley and other whole grains
• eggplant and okra
• nuts
• vegetable oils
• apple, grapes, strawberries
• foods fortified with sterols and stanols
• soy
• fatty fish
• fiber supplements.

Noted. I can do that. But:

Here are 4 foods you’ll want to avoid if you have high cholesterol:

1. Red meat. Beef, pork, and lamb are generally high in saturated fat. Cut of meat like hamburger, ribs, pork chops, and roasts are highest in fat. You don’t have to avoid meat entirely, just eat it only on occasion. Limit yourself to the recommended 3-ounce portion size and stick to leaner cuts like sirloin, pork loin, or filet mignon.

Better yet, replace meat with proteins that are lower in saturated fat and cholesterol, like skinless chicken or turkey breast, fish, and beans.

2. Fried foods. Foods that have taken a dip in the deep fryer, like chicken wings, mozzarella sticks, and onion rings are among the worst when it comes to cholesterol. Frying increases the energy density, or calorie count of foods.

If you love the crunch of fried food, use an air fryer and toss your food in a little bit of olive oil. Or bake foods like potato wedges and chicken at a high temperature until they're golden brown.

3. Processed meats. Hot dogs, sausage, and bacon use the fattiest cuts of red meat, and therefore tend to be high in cholesterol and saturated fat. Bacon and sausage made with turkey or chicken might seem healthier, and they are somewhat lower in cholesterol than the red meat versions, but they're not cholesterol-free.

4. Baked goods. Cookies, cakes, and pastry are often made with large quantities of butter and shortening, making them high in cholesterol. You don’t have to give up dessert entirely, just make a few substitutions. When you bake, use applesauce or bananas in place of butter. Or have low-fat frozen yogurt topped with berries for dessert.

Noooooo!!! For one thing, I need red meat for the iron. I guess I should look for iron-rich fish? Baked goods are absolutely part of my identity and a huge comfort. I will try, obviously, but it’s easier with my kiddo not around (when they’re visiting, there are always chips and ice cream around, somehow). Will try to build some good habits before they’re back for the summer. I’ve already made the switch to fat-free greek yogurt, aka wallpaper paste. Will see what else I can do.

So wrecked.

Feeling some kind of a way but maybe it’s just because I’ve been feeling off all week. 

Part of it is stomach upset from the junk food lunch we had on the weekend. 

Part of it is the looming six-month anniversary of my tumble, coincidentally also my birthday. 

I thought I would be better by now. 

Last fall, six months was the longest I thought it could take. At the beginning of this year, 31 March was one of the dates on my LTD letter and I sort of mentally noted it as “will be better by then.” 

Now those dates are coming soon and filling me with anxiety. 

Part of me is frantically thinking, “What else can I try?” I still haven’t called the osteopath my friend recommended (I’m honestly unsure what osteopaths even do). I had the idea the other day of seeing a speech-language pathologist since it seems to be speech where my cognitive difficulties really overwhelm me. I had the idea this morning to try Improv classes to “work those muscles.” Why didn’t I think of that months ago? (Answer: I wasn’t capable of thinking months ago.)

I am typing all this from the waiting room of my doctor’s office, to follow up on some bloodwork results, anx probably get another lab req.

And wondering: 

Do I tread extra carefully now so I don’t mess up my progress as I approach the finish line?

Or do I go hard, to guarantee that I will be either 100% better or 100% obviously not when 31 March rolls around?

So this is why I feel like crap

Update from the exam room, my blood pressure is low even for me! No wonder I was feeling pooped climbing stairs on my way here from the gym. 

A day of contrasts

Of all kinds, literal and figurative. 

I started yesterday feeling awful. Post-concussion nausea? Straight-up stomach cramps? Seemed to be the latter; I blame the “boneless wings” I had for lunch on Sunday (restaurant chosen by a relative). All day I had cramping and stabbing pains off and on, that had me looking up “spleen pain” to see if I was actually dying. 

I did force myself to go to the gym regardless; being a light cardio day I told myself I could leave early if I wanted. And this is dumb, but I knew I was due for an “award” for a 12-week attendance streak. I am like a kid with a sticker chart! Silly, but it does motivate me.

I am on fire!

Then I went home to clutch my belly for a while longer. Waah.

I had a couple of late afternoon appointments that I had been looking forward to, but worried my upset stomach would keep me from. Nevertheless, I soldiered on.

First was an orientation at the neighbourhood secret sauna.

The neighbourhood oasis 

You’d never guess from the outside, but a nondescript building in my neighbourhood is actually a gorgeous little sauna. 

I’ve long enjoyed contrast therapy, and for the past five or so years have been a semi regular at the Banya in Mississauga. I go with a friend and we spend the entire day there. I had been longing to go, but worried I wouldn’t be able to handle it. Anecdotally, I’ve heard both good and bad things about contrast therapy for people with post-concussion syndrome. I asked my doctor at the Toronto Concussion Clinic and they said, “It depends.”

Temperature regulation is a function of the autonomic system—all the stuff your brain tells your body to do without you really being aware of it. Balance is also under the autonomic system. So if you’re really pushing your autonomic system with one task—temperature regulation—it may not have the juice left for another—balance.

I reeeeally wanted to go to Banya, but I didn’t want to say to my friend, “Hey, drive me across the city to this place that costs $60 but maybe I won’t feel well and I’ll need you to drive me home after twenty minutes.” Then, I found out about a new sauna in the neighbourhood that’s more poshy-posh but I could walk there (and get home easily if need be), and we started talking about when we could go there. Then, I found out about the secret sauna, and booked the orientation.

It felt great! 

I was anxious about feeling off-balance—imagine falling into the coals?!—and whether I would be able to manage the cold plunge. I did have an experience at Banya a couple of years ago where I got the shakes and needed my friend to bring me tea and warm towels to use as a blanket while I lay on a sofa to recover. But I was okay! Got in and out without a struggle, although I barely stayed in for a moment.

I felt exhilarated after! And ready to go to my next lil appointment a brisk fifteen-minute walk away.

Part of me of course is thinking, “Wow, this is it! I have found the cure! A few more sauna trips and I’ll be fully recovered!” But another part of me remembers that I felt that way for about two days after reading Sarah Polley’s book, and apparently having a few good days and feeling inspired is not a guarantee of anything.

So far today, I feel okay (the day-after-feeling seems to be my litmus test for a lot of things). I was going to do a “practice workday” experience today (two hours of stuffing envelopes at a theatre in my neighbourhood) but just got notice that was cancelled. Maybe I’ll try the next step in TTC exposure therapy instead? 

Just noticing…

… that I’m making a lot more entries here this week, but they’re mostly about anxiety and balance issues. Since I started propranolol. Maybe it’s not so good for me? Woke up today with an “upset stomach” and wondering what I ate to trigger that, and then remembering that nausea is one of my concussion symptoms. I think this one might actually be my stomach though? 

Exposure

I was just looking at my exposure therapy plans and fleshing out the details looking at the TTC website. For example, my next step says, “Take Line 1 for six stops starting and ending at a busy station,” but how to do that? How to get to a busy station, how to get home from a busy station? Which routes are currently changed (e.g. Spadina streetcars were replaced by buses for a while, is that still happening?)

Looking at the service updates page, I noticed an item on the long-awaited Eglinton Crosstown line, and looked at the map. There’s a stop at Kennedy, near the Rama Gaming House where I had my fall. RGH is definitely a place I’ve thought of as a peak-stimulus spot on the exposure hierarchy. Lights and noise and a general sense of guilt… how would I work up to going someplace like that?

And just thinking about it, I tear up.

A little panic, a little fear. Could I go there? Just to walk in the door, look around, and then skedaddle off for a saving treat? I would need someone to go with me, who would go with me? 

Just thinking about it makes me cry.

Will I ever go to Bike Rave again? Will I ever even ride a bicycle?

How is this even happening?

Sometimes it just seems insane that I was transformed in the blink of an eye from someone who was out six nights a week, biking across the city to the theatre and Midnight Madness events that end at 2am while at the same time working at a day job. Seriously, in September I’d leave home at 8, bike to work (often arriving early, first person in the office), go on a group social ride after, and then see a show at 9:30—that was a Monday.

Funny, I remember thinking during pandemic lockdown—how is this happening? And then after things were back to normal—did that really happen? Was it all just a dream? 

I hope I get back to normal again. I hope there comes a time when I look back on these dark months as a wacky anomaly—“Remember the winter that I didn’t leave the house? That was so weird!”

I really need to believe that can happen.  

Ow my brain

Just making a note to self that I have a headache coming on. Left side. Didn't get great sleep last night; kiddo came home from uni and with the train schedule it’s a quarter to eleven when they get here, and they were still yapping when I said, “I love you but I gotta go to bed,” an hour later. We went to Freshco this afternoon (note to self: I need to try exposure to a different grocery store to see how I do), and I had that “power drop” feeling I get in the summer when it’s too hot/humid. Just finished a mug of green tea so I shouldn’t be dehydrated. So tempted to doze, or try to.

Oh, and tomorrow is daylight savings, aka goodbye morning sun. Waah.

Oh and I almost forgot, I’ve been really stumbly today, too. Just staggering around and bumping into things. 

Is it me, or…

So I started a new migraine medication this week, propranolol.

Previously, I had been taking amitriptyline for migraine prevention, with mixed results (maybe it would have been worse without? But I did have that nasty incident that drove me to ER). A friend suggested I ask my doctor about Qulipta. My insurance wouldn’t approve Qulipta until I “failed” two other medications. So amitriptyline was one, and propranolol will be two—or maybe it will just work and I can stay on it?

Here’s the thing with propranolol—the side effects include lowering heartrate and blood pressure. For most people, that’s a win. As someone with low blood pressure normally, it makes me a lil nervous. I already have issues with feeling lightheaded if I stand up too quickly, and now we’re doubling down on that? Hmmm…

My first treadmill run the day after starting it went really well. It was the first day of week 5 of Couch to 5k, which feels like a bit of a jump from week 4 (week 5 feels like a bit of a jump every day). I was pleased at how manageable it seemed, and noted also that my peak heartrate wasn’t as high as it had gotten two days prior when I was finishing up week 4. Meds, maybe? 

Today, though, I just felt off. My skin felt prickly? Or almost pins-and-needles but not quite? I repeated day 1 (5 minute jog, 3 minute walk, 5 minute jog, 3 minute walk, 5 minute jog) instead of progressing to day 2 (8 minute jog, 5 minute walk, 8 minute jog) because 5 minutes of jogging felt like I was really pushing it. Afterwards, my skin was super blotchy—really flushed in some areas (face, chest), really pale in others (neck). 

Blotchy!

So, I thought maybe I should look up the side effects (up till now, I’ve only known what the doc and pharmacist told me). Here we go…

From Migraine Again:

Propranolol is a beta-blocker medication developed in the 1960s to treat chest pain and high blood pressure… By blocking adrenaline, propranolol slows your heart rate, lowers your blood pressure, and reduces the dilation of peripheral blood vessels (is that where the blotchiness came from?)… Propranolol may also reduce stimulation of the trigeminal nerves in the head, which contributes to the migraine process… Common potential side effects of propranolol include:

• Dizziness or lightheadedness
• Drowsiness
• Fatigue
• Nausea (hmm, my tummy has been off lately)
• Exercise intolerance (ah, maybe that’s it)

Some readers reported intolerable side effects:

“I tried it, but it made me feel spaced out, I couldn’t concentrate, and my brain was always fuzzy—I’d rather have a migraine!”—GW (I am definitely spaced out, but I was already kinda spaced out, so…) 

“It did nothing to prevent migraine and gave me horrendous, vivid nightmares. I would not recommend it.”—MLA (not nightmares, but I have had difficulty sleeping and some vivid dreams!)

I was worried about having a “hangover” effect after last night’s struggles, but not doing too badly today (although I did almost start crying for no apparent reason on the way home from the gym). So maybe it’s helping with the anxiety too, which it is also supposed to do?

Guess just have to wait and see; often side effects go away as the body gets used to things.