Starting over, starting now

I feel sometimes like I have started from scratch a dozen times since last fall.

Today’s new start is new meds, cholesterol diet, and trying some faux-work experiments (aka work conditioning lite). I am nearly done my Insomnia CBT course and sleeping a lot better, so maybe if the new meds work I’m ready for it? Having my blood pressure back and bloating (from previous meds) gone makes me feel so much better.

Started the morning by going to the gym (determined to make 30 days this month, not giving myself an excuse miss it), then a breakfast of all the omega-3s, and CBT-i. Next is a volunteer usher shift (my second!) which is my faux-work for the day. Early dinner (lentils, kale, butternut squash), then going downtown to watch the Oscars at the Lightbox (I will not be staying till the end—and as I type this, I’m remembering that I meant to change my ticket to be on the aisle, oops). This will be a chance to both practise subway riding and extended focus. Exposure and endurance.

This week I am planning various tests and work-adjacent things—volunteer envelope stuffing, practice driving, doing my taxes, finishing some stuff that I’ve put off for months (medical complaint against Dr Firdouse, divorce paperwork, various stuff for my kiddo), sewing a garment (I figure that’s a good exercise in project management as well as focus and follow through). Basically, I want to live like I’m working (at a made-up job) on a reduced schedule, and see if I can at least do that, and then grow from there.

I feel like it’s time for me to enter the home stretch, or at least see if I can survive it.

Breakfast of champions

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.

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? 

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. 

The Plan

So I seem to have a pattern of feeling a bit better, overdoing it in some way, and then feeling worse. Every two weeks. I am making progress, but it’s very much two steps forward, one step back. So I’m working on pacing myself a bit better. Hopefully.

First thing is making sure I have light cardio days instead of C25K on the treadmill every day (these would be light days for most normal people, but I am not most normal people). So, using one of the other machines—stationary bicycle or elliptical—and keeping my heartrate in the 110-116 range.

Second thing is building an exposure hierarchy to get gradually used to more.

For example, I have been able to manage a meal at a restaurant and going to the theatre with one other person who can be my point of focus and “sherpa” to get through hubbub and generally keep an eye on me (the incident where I ended up in hospital last month, I had no one person to focus on or look out for me, it was conversations in all directions). On Saturday, I had an early dinner with two friends. Later this month I was invited to a group dinner at a restaurant, which sounds kind of like a nightmare. But maybe book club would be a way to work up to that? There is hubbub, but usually people speak one at a time during the club meeting proper.

Another thing I struggle with is public transit. Streetcars are best. I can handle a bus if I have the right seat and it’s not a crazy route. Subways are the real sticking point. I have managed a Line 1 subway without problems a few times (never at rush hour though obviously) and am working on building my tolerance to Line 2, which is somehow wobblier (I guess due to older trains)? The main thing is avoiding St George station, where too much is going on due to the number of people transferring, and if on the Line 2 platform, I get overwhelmed by the thundering of Line 1 trains overhead on top of the screeching of the wheels on the tracks.

So my transit exposure hierarchy might look something like:

1. Take Line 1 for three stops starting and ending at quiet stations in off-peak hours (e.g. Dupont to Museum)
2. Take Line 1 for six stops starting at a quiet station and ending at a busy station in off-peak hours (e.g. Dupont to Osgoode)
3. Take Line 2 for three stops starting and ending at quiet stations in off-peak hours
4. Take Line 2 for six stops starting at a quiet station and ending at a busy station in off-peak hours
5. Take Line 1 for six stops starting and ending at a busy station in off-peak hours
6. Take Line 2 for six stops starting and ending at a busy station in off-peak hours
7. Transfer at Spadina station in off-peak hours
8. Transfer at Bloor/Yonge station in off-peak hours
9. Transfer at St George station in off-peak hours (Line 2 to Line 1)
10. Transfer at St George station in off-peak hours (Line 1 to Line 2)

And then repeat the whole thing but at rush hour.

That’s the exposure part of exposure therapy. The therapy part might look like having “rescue” options for managing stress during the exposure, like grounding exercises, techniques like havening, noise-cancelling headphones with soothing music, or bringing a journal to write out impressions during the ride; and honouring that this is hard work by rewarding with self-care treats (my go-to being hot chocolate and an almond croissant). 

I should look through my old therapy notes to see what else I can add here.

Anyway today’s exposure adventure is my first volunteer usher gig since the start of October (five months ago)! It’s at a theatre that is very close to home (a five-minute direct bus ride, I could walk there if I want), and has a straightforward set-up (unlike, say, Crow’s, where the layout changes with every production and there’s a lot of traffic management). Thinking I’ll make myself some hot chocolate to bring. I can feel my anxiety rising just thinking about it! But hopefully it will be an easy enough test to my system that I will pass with flying colours. 

And then, a few days’ rest, and on to the next!