Aqua Lung Revisited

Preface

The personal profile on this blog is intentionally abstract. It is my thought that it would be better for readers to gradually form a picture in their heads of who I am by reading the posts. In the long run, I think this would be more honest than anything I would attempt to compose in the form of a biography. Of course this assumes a great deal. One assumption being that anybody reads this tripe and beyond that assumption that I post frequently and honestly enough to provide that kind of picture of who I am. I couldn’t say whether any of those questions are resolved but, really, who gives a !@#$ who I am anyway?

One thing that has most definitely defined who I am is that I have migraine headaches. I have had them since I was a pre-teen. There have been periods where they have waxed or waned in frequency and intensity but they have always been with me and when they are at their worst they are completely debilitating. If they are at maximum intensity I will not be able to function at all beyond moans and writhing. I have several times in my life gone to the emergency room for the shot of Demerol for relief. Prior to the emergence of sumatriptan class of drugs my only other hope was to get in a quiet and darkened place and ride it out. Riding it out often involves peaking with nausea and vomiting. Just as a side note, I have had MRI’s, numerous blood tests, and tried lots of prophylactic medications. All of those meds had intolerable side effects and, at least as long as I was able to tolerate them, no effect on the frequency of the headaches.

Sumatriptan drugs came along in the 1990’s and have allowed me to pharmaceutically intercede before the ’sick’ stage most of the time. I can’t be thankful enough for the advent of these meds. Having the specter of the debilitating variety means every twinge of a headache elicits great fear. That fear has led me to become, in my opinion, hyperactive, pharmaceutically speaking. The sumatriptan drugs are kind of expensive and carefully meted out as far as insurance is concerned.  So, I will often attempt to avert the headache with pain medications first. This includes over the counter variety and some prescription variety as well. Also, on the occasion where the sumatriptan drug doesn’t seem to be doing the job, I will supplement with pain medication.

This cycle has been going on for a decade now. So it is, that in the past year I have been attempting again to root out the cause of the headaches at a deeper level. One potential root cause might have been fleshed out in a clinical sleep study I had done. It appears from the study that I never go into what sleep specialist call stage 3 deep sleep (or was it stage 4 – I can’t recall). The study also revealed what my wife has maintained for sometime and that is that I frequently stop breathing (clinically referred to as ‘apnea’) during sleep. The neurologist who oversaw the study said that the reports from my study look like classical narcoleptic but I do not exhibit any of the classic narcoleptic symptoms. That is to say, I don’t fall asleep while waiting at red lights, watching TV, reading a book, etc. I am tired a great deal of the time, and perhaps the sleep study has revealed why, at least in a clinical sense. So it is that I have been trying to accommodate sleeping with a CPAP machine for some months now. The neurologist also prescribed Ambien. With the ambient, I was able to go to sleep for a couple hours, sometimes three, with the CPAP machine mask on my face. But, invariably, I would wake up and have a kind of claustrophobic reaction to the mask, and take it off and go back to sleep. Sometimes I would go back to sleep easily, other times I would struggle with it. I was, of course, supposed to report these results to my neurologist frequently and additionally I was supposed to send him a credit card like thing from the CPAP machine after 30 days or so that records the ‘back pressure’ from my breathing through the mask. After 30 days (possibly more) of struggling with the mask, I kind of fell into a routine of just relying on the Ambien and not wearing the mask at all.  I am embarrassed to say I never followed up with the neurologist, nor did I ever send in the little card.  I was getting four, five hours of sleep for the first time in I don’t know how long for for a while I was kind of satisfied with that.

But, alas, there has been no great reduction in the frequency of headaches. So, with a little encouragement/reprimanding from the neurologist and my wife I’m making another, more resolved, attempt to sleep with the CPAP machine. This began with a frustratingly pointless appointment with my neurologists (all my fault) and then a visit to the medical supply establishment that ‘leases’ me and the insurance company the machine in the first place.

Medical Supply

I went back to this establishment today to be refitted with a new mask in the hopes that I will sleep through the night, reap the benefits of improved oxygen saturation, and be headache free (loaded with energy would just be bonus). The company was chosen by my insurance company. I will not recount here the amazingly brainless choices made by most insurance companies but lets just say this is no exception to that rule. It is nearly 30 miles away from where I live. It operates in a ‘business’ park of small garage style warehouses. It looks more like a place you’d get your car windows tinted than a medical supply. A youngish girl greeted me from behind a cheap and fairly messy metal desk with a computer on it. She looked on the computer and said it appears I was there to get a different mask. I said something to the effect of, appearances can be deceiving but in this case she was correct. She never paused a moment to acknowledge my philosophical and witty reply.  I should have known then, anything remotely conversational would be a waste of time. I sat at a chair across the desk. She explained that I could choose between two masks different from the one I was currently using. The current one straps around my head like a military issue gas mask, but only covers my nose. The choices were one that covers mouth AND  nose, and a “nasal canular” which fits under your nose and into your nostrils. Since claustrophobic reaction to the current mask is the reason I was there, I opted for the latter. If it had a breathing regulator for your mouth it would look like some of the early ‘aqua lung’ SCUBA apparatus. She launched into a spiel about its operation and fitting with as little eye contact as possible. While still giving the spiel she stood and moved beside the desk so I could see as she showed the adjustments of straps and hoses for the mask. The girl giving the spiel was twiggishly thin but she didn’t appear fragile. On the contrary, I got the sense that she might be kinda tough. She wore no makeup that I could tell. Her nails were slightly long but not manicured. She was standing in front of me and I was sitting so it was like she was doing a card trick or puppet show in front of me.  I could watch the show, or look her in the face, but not both at the same time.  I became distracted by watching her thin arms and long fingers manipulate the mask. I was reminded of my mother. She was also thin like this. In fact I have my mother’s thin forearms. Even at 165lb, I cannot wear a men’s watch to this day because my wrists are so narrow. I commented to her that her arms and wrists where small like my mothers. She didn’t acknowledge the remark an iota and barely paused from the script. I considered for a moment that this might be an interesting challenge. I wondered if I could gradually ratchet up the remarks in their absurdity or provocativeness till she would at last tell me to shut the !@#$ up. It occurred to me that other relationships I had with women in the past had been based on this experiment - just extended over a longer time period. After a time, I decided to just let her finish the spiel so we could both be on our way. But I now observed she had an odd tiny spasm to her movements. It was very very subtle. As she shifted her weight from one foot to the other it was like there was an extra and slight bend of the knee. Or as she moved the mask from one hand to the other, the hand releasing would just slightly wave or an elbow would bend unnecessarily. That’s when I started observing her face more and I grew to suspect that she was concentrating very hard to keep on the script without the extra tics affecting her face or speech.  Ocassionally, I saw the slightest twitch of the corner of her mouth.  I was glad I hadn’t elected to go with the experiment. But now, I was hopelessly distracted from the spiel. I can only pray I got the gist of the demonstration and don’t end up putting an eye out as my mother so often predicted would happen.  As I left the office it occurred to me she never told me her name, but that asking now would just be weird.

After the demonstration, she changed out the machine with new air filters and hoses, had me sign some papers, and I was on my way. I went to my car and, as has painfully become my habit, text messaged my wife and work that I was leaving the medical supply place and headed back to the office. Before I started the car to leave I noticed that the demo girl and the only other girl in the office and gone outside for a smoke break. It always pains me to see young and even marginally healthy people smoking. I’m by no means preachy about the subject. I just have witnessed what a toll that habit takes on the body and I don’t particularly mean lung cancer. I always wanna tell young people when they’re smoking, “you won’t be young forever but you might as well make it last as long as possible so put that !@#$ing cigarette out!”. I never do. She was standing and gazing off so stoically though. The other girl was prattling away and she was fixed on the horizon and sucking that cigarette smoke down. I wondered what heavy burdens this waifish girl must be carrying at such a young age to give her this edge. I wondered if the tics had anything to do with it. I wished I could go and tell her everybody should get to stay young as long as possible and I was sorry for the extra burdens she had to carry.  But I didn’t even know her name.