Wednesday, December 8, 2010

Pass It On

This weeks doctor's appointment was a visit like none I have had before. It was not what I expected although I had planned to fill my allotted time and even had some back burner items I was saving for another day that I did not need to talk about today. I ended up having an extra long visit with my doctor and not necessarily because we were talking through my questions.

The appointment started off very plainly, but I think I caught her off guard when I simply asked her how she was doing. She was tired and was going to have rounds again that night. She had already worked through the weekend and for some reason, had to work the extra night.

This actually compelled me to talk about one of my back burner items as it was too perfect of a scenario to let pass. To give you a little background, my doctor is also a Migraineur and has told me on previous occasions that stress is her biggest trigger. That never sat well with me although I had never challenged her on it before because of other things going on and lack of time, but I have wanted to talk to her about it for a while and couldn't let this opportunity pass.

I said I was sure that it was probably very stressful to work rounds like that. She nodded. I mentioned that this was the time that she needed to be careful about her own Migraines. She immediately confessed that she had a killer Migraine on Sunday which would just not go away. I couldn't refrain from asking about her typical Migraines and how this one was different. I know, this was a little role reversal, but I was curious and couldn't believe she was answering me. Next time, I'll have to ask how she treated herself. That should be interesting especially since she was working, but I really wanted to stay on my course.

Next I bluntly said that I did not believe stress was a trigger, but an exasperating factor. She tilted her head and smiled the way she does. I continued that even the International Headache Society took it off of their trigger list and moved it to an exasperating factor; that stress could make you more susceptible to your other triggers. She nodded again.

I continued by asking her when she is on call or doing rounds, does she lose a lot of sleep? Is she staying hydrated and drinking enough liquids? Is she eating right? She said she didn't get enough sleep, she would quickly grab crackers whenever she saw them instead of eating anything real and I could see her calculating everything I was saying.

I never got to give her the analogy of stress and catching a cold which I believe really would have driven the message home. Teri Robert gives a great example of this analogy in her Is Stress a Migraine Trigger? article. She says when we're stressed, we're more likely to "catch a cold." It's not stress that causes the cold; it's the cold virus. The stress just makes us more vulnerable to the virus. I think my doctor picked up on what I was saying without completing the analogy, but I may bring it up again in a future visit.

The other part of my appointment had to do with the elimination diet. The last time I saw her, I had just started the diet, but had not added any foods back in yet. She was still very curious about the elimination diet and during my last visit, had pseudo challenged me to convert her into becoming a bigger believer of the elimination diet. I have shared with you one of my graphs, but I have since put together another one and went over both graphs with my doctor.

The brown lines are from my first ediet while the gold lines are from my second elimination diet.

The first graph shows the first six weeks of each ediet while the second graph shows the first six months of the first diet and first three months of the second diet.

You can't really do a weekly compare after you start adding back in new foods because of the weeks you introduce a 'bad' food. You can see an example of that in week five of the first elimination diet. For me, I believe it takes a few weeks to clean out my system, but during the second diet, I had unavoidable triggers during each of the first four weeks.

I explained my diets and comparisons to my doctor as we looked through both charts. We thought the monthly chart was interesting where it shows the same slope down on both diets during the first two months and then how the end points were virtually the same during after the third month.

She kept asking how do you know what to add back, when do you add it back and how. She was genuinely interested in the answers I was giving and kept asking more questions. My first thought was why wouldn't she have looked into some of this already, but she had mentioned during my last visit that she thought the best way to find food triggers was basically by discovery. I think I have convinced her that the discovery method would not work at least for me.

I wanted to answer as many questions as I could for her. During the first visit I had with her, she said that eighty-five percent of her practice is with headache and Migraine patients. I feel the best way I can Pass On all of the information I have learned is to give it to a willing participant, especially a doctor who can Pass It On through her practice as she sees fit. I don't know if she is a total convert yet, but I will get her there. She did say she wants me to continue with the elimination diet; that she sees it is definitely working for me.

I went on to tell her how I started adding foods back in and why I chose a tomato as my first item. Since the tomato is simple, with no additives and the base to so many other foods, I felt it was perfect to add in at the beginning of the diet. We went over the Thanksgiving holiday food add ins and why my last food to add in was an orange. I want to do oranges carefully because of the reaction I had to a sip of OJ (half of my face went numb) one week into the elimination diet. So far, I seem to be doing well with the simple orange and explained how I plan to work my way up to our regular OJ.

I don't do everything this carefully, but things that I have reacted to need to be treated a little more delicately. For me, this is where the elimination diet can take a long time, but is well worth it in the end. She seemed to understand what I was saying and I also explained that I may need to breakaway from oranges for a little while to get ready for some Christmas foods. It is not easy to do the elimination diet the way that I do it. There are easier ways, but I think this is the best way for me and I have gotten my doctor to see this especially since she told me to continue doing the elimination diet since it definitely seems to be working for me.

You can see that these two areas of my visit this week were really filled with a lot of questions, mostly by my doctor. You can also see why my appointment took a little longer than usual and went over my allotted time. I also had other questions I needed to go over with my doctor which successfully included changing my rescue medication.

I really thought the visit went well. I hope she felt the same way and I believe she will pass on some of this information to other patients who could benefit from either doing their own elimination diet or trying to identify and manage their triggers better when they are in stressful situations.

I am grateful for all of the on-line help I have received from others which helped me to learn the information I have around Migraines that I want to Pass It On in any way that I can. Thank you.



WinnyNinny PooPoo said...

Love the graphs! I'm a number person too!

I think most of her patients aren't as methodical with their diets as you have been. Thanks for sharing the thought behind the process!!!

Teri said...

Wow! Sounds like a great visit. You're really learning a lot AND getting better and better at sharing it. I'm really proud of you!

MigrainePuppet said...

Winnie - I love numbers too. During this visit, my doctor told me I should have been a statistician. I actually have one graph that goes back to Jan 2007!

I have never dieted outside of the elimination diet. I don't want to do it any more than I have to so I feel the more methodical I do it, the better off I will be. Unfortunately, I felt I had to do it this second time, but do feel like it is worth it again. I suspect that I am going to find I am sensitive to more preservatives. I'm not sure what I'm going to do yet if I'm right.

Thank you for everything you share and everything I have learned from you!

MigrainePuppet said...

Teri - I really enjoyed that visit. I like to share information especially when they want to listen, learn and ask questions. I am finding that my mind is a little clearer while off many foods.

Every week I find it tough with what to add back. I need more variety, but more than finding a 'bad' food, I don't want to go back into the fog. This was a big problem I had before going to my doctor visits before. I would always 'treat' myself to a coffee. This would put me into a fog and make me stick to my agenda where it would be hard to think on the fly. Unfortunately, it's not all about foods, but I'm working on each area.

Thank you for sharing your Migraine information. You have enabled me and many others to Pass It On too.