Friday, November 7, 2008

Believing in the Expert Opinion of Others

Well, the results of my sleep study are in. According the the records created by the many electrodes, microphones, and other monitoring devices that took a highly experienced technician one full hour to place all over my body--my head, face, throat, chest, back, abdomen, and legs--I have PLMS (periodic limb movement syndrome) and sleep apnea.

I already knew I had sleep apnea. The surgeon who screwed my broken wrist back together told me that. And my husband and mother--anyone who has had to sleep near me--confirmed it by witnessing/withstanding my snoring, moaning, and gasping.

Clinical results? I stopped breathing 54.9/hour, and my oxygen intake got as low as 69%.

But the PLMS caught me by surprise--and frankly, disbelief. According to the electronic records, I have muscle movements 86.5 times an hour. The doctor (board certified in sleep medicine/pediatrics/psychiatry/neurology) told me that it was the worst case he'd seen in 15 years. Hmmmmm. How can my legs or body be moving more than once a minute without me or my husband knowing it?

I expressed my doubts (I'm no wall flower in the doctor's office!). I told Doctor that I was aware of how restless I was that night in the sleep lab. I thrashed. I accidentally pulled the wires off my legs. I tapped my foot to help me relax and go to sleep--an old standby habit from my childhood.

He basically rolled his eyes and started shaking his head "no" before I could even finish. "We can tell when you're thrashing," he said. These periodic limb movements are " rhythmic," following a pattern. A kind of muscle twitching that we may may not notice but that keep me from deep sleep.

His rationale for treating it was that unless it was addressed, I would be less compliant with the CPAP required to treat the apnea. (He was this firm about it, no "likely"s or "maybe"s.) He claimed the restlessness and lack of deep sleep the PLMs caused would make me more likely to pull off the CPAP without knowing it or wake up and be unable to get back to sleep. (And I do have symptoms that I feel strongly about getting rid of when it comes to the apnea--so I have clear incentive to be compliant.)

His treatment was to prescribe a form of dopamine--a neurotransmitter in my brain. He said (as did the pharmacist, as did the doctor I work for) that it had relatively no side effects--short or long term. And it's cheap.

Course, Hubby & I looked it up. No drug is free of potential side effects. In fact, the one right on the bottle says it could cause a change in color of sweat and urine--red, brown, or black. Wouldn't that be fun to explain in the gym?

And, I take an antidepressant now (the only drug I take) and depression is one of the potential side effects (well that and schizophrenia and suicidal thoughts. . . so point out if you notice these things, will ya??). Two drugs that play with the chemicals in my brain.

So what's my point you're wondering. . .

The point is, this is the first time really in my life that I am being prescribed drug for symptoms that I'm not conscious of. So I find myself having to rely totally on the expert opinion of someone else that a) the symptoms exist and b) they are worthy of treatment.

All kinds of people have to do this. Everyone with high blood pressure or high cholesterol, for instance. These conditions lack visible symptoms. I argue with my mom all the time that she CANNOT know that her blood pressure isn't really high.

But it's a weird place to be in, none the less. And I basically believe in the medical system.

My day job is for a well known consumer health site, and I've been a health editor and manager for 20 years. I've written and edited articles about how to work with your doctor, vet your doctor, look up your own health info.

I also know many doctors personally, so I know they are human. Some are smart and some are not. Some know what they don't know, and well, others don't. They make mistakes. They get tired. They don't like some people just like I don't like some people. And it's super, super clear to me that doctors all don't come up with the same answer when faced with the same data. And the ones with the strongest opinions aren't always right.

But still. . . I typically trust doctors more than I trust my own ability to figure it out. And I still trust doctors more than alternative health folks in the natural health stores or with less formalized training. And I mostly trust my ability and my resources to check something out if it feels wrong.

Still, it's an oddity for me to trust what I don't see or feel for myself. And though some others close to me my disagree. . . I am more likely swayed by logic than emotion or an appeal to have faith.

So all this analysis of my beliefs makes me want to share one of my favorite things--This I Believe on NPR.

This I Believe is a radio program on public radio where people read the essays they've written on what they believe. I typically find them quite well written, often thought provoking, and sometimes moving. You can get free podcasts of them.

Here are links to a few that especially "speak" to me. You can read them from these links or click the "Listen Now" button, which I highly recommend. (They are short.) Hope you enjoy them too.

Learning True Tolerance, Joel Engardio
What Is the Value of a Human Life, Kenneth Feinberg
There Is No Such Thing as Too Much Barbecue, Jason Sheehan
There Is No God, Penn Jillette

[Tisha: Thank you for "back stalking" my blog and reminding me what I had decided I needed to do when I felt self-pity like I expressed in yesterday's blog. You took me back to my blogging beginnings and my application of "mindful keening," for which I am grateful. Your support and kind words mean a lot!]


  1. Well, I'm glad that you finally found an answer. I know how difficult it can be to sit in wonder... I'm sure that the right thing will happen, but I will keep you in my thoughts and prayers anyway! ;)

  2. It sounds like you're making the right choice, and for the right reason. You know have apnea and you want to address it, and that means you have to do all you can to make the treatment effective. And you have talked with others about the drug you're going to take. That's good. You might want to talk to your own family doctor too, though, to get a second opinion. In the meantime I hope the drug works for you. I know I'm glad I'm taking pills for my blood pressure. And thank you for the link. I'm going to have to get an ipod so I can download some of these.


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