What I learned from 2 days in the hospital

[REMINDER TO FIRST-TIME VISITORS: Be sure to read the oldest posts first. The later posts, including this one, deal only with minor details. Start with the first post, which describes the problems I faced, and then read at least the second post, which describes my special diet as a solution.]

Friday evening about 7 pm, I sneezed and had a stab of chest pain. There was no follow-up pain. At 1 am I woke up with excruciating chest pain, right side. I recognized the symptoms: collapsed lung. (I have had 16 earlier pneumothoraces, through 47 years.) I grabbed my hospital bag and cabbed to the hospital (Good Samaritan, Portland).

I was treated respectfully and competently by every person in their huge staff: physicians, nurses, physician assistants, radiology experts, and all their assistants.

Here is what I learned or confirmed from earlier experiences:

GENERAL
- Always have a hospital bag packed, including a novel or two for the long, boring hours, and a list of contact phone numbers.
- Discuss issues with the medical people, to attain at least general clarity, remaining willing to compromise between their caution (stay longer) and my eagerness to leave (to cut my costs and get back to work).
- My lifestyle has paid off: Doctors found no sign of heart disease, cancer, kidney problems, liver problems, or any of the other many problems that their older patients usually have. (In the section of the hospital where I was, all the patients were gray haired; perhaps this was a Medicare wing.)
- When I don't exercise, I need very little sleep. That was good because I was so wired up and tubed up that I could barely roll over; sleep was very difficult.
- The physicians and nurses were surprised to meet a 65-year old patient who uses no pharmaceuticals. (My roommate -- who had acid reflux, heart disease and other problems -- was taking six medications daily before he needed to come to the hospital for his latest emergency [mass sweating, nausea, fainting].)

WEIGHT
- As a result of following my subset of the McDougall Program (fruit, vegs, and starchy roots), with 100% compliance, I have become technically underweight (BMI of 17, the lowest of my adult life). I was shocked at how little I weigh (when I entered the hospital, 124 lbs at 6 ft; 121 lbs when I left.) now compared to the last time I was weighed (about 135 lbs, several years ago).
- Despite being technically underweight, I have been fully functional and the hospital staff found no evidence (from blood tests, CAT scans, x-rays, interviews) of malnutrition or other problem.
- I will need to concentrate on boosting my weight by 10 lbs or so -- perhaps with increased sugar consumption and with avocados, olives, and so forth. Or I might add oil -- cod liver oil, flax seed oil, and olive oil -- at every meal. (That is not compliant with the McDougall Program recommendations, but is much less expensive than buying avocados and olives.)

FOOD
- Even from the beginning, during admittance, be very polite, clear, and assertive about dietary requirements: "Give me only fruit (any kind), vegetables (any kind), and potatoes." Simple and clear and easy for them to write down. Do not say "vegan" or "vegetarian" or similar terms, because they are too vague or confusing to most people.
- By explaining to the nurse on duty (12-hour shifts) what I wanted to eat, I received what I wanted. I tried to always make it easy for the people working in the kitchen (who are about three links removed from the patient). Keep it simple. Don't be picky. Always use the word "plain." Order whole foods, though I found I didn't need to use that word (which is confusing to most people).
- By keeping my requests simple and easy to fill, I got nutritious and delicious food at every meal; Two baked potatoes; two servings of green beans; a "fruit plate" (a mound of diced fresh fruit, such as apples, oranges, melons, grapes); half a cup of olives; and water. The amount of food was large. Even I --and I have a big appetite -- could barely eat it all.

All things considered, my brief hospital stay was positive -- as confirmation of the McDougall program lifestyle.

An expanded anti-itis diet?

[REMINDER TO FIRST-TIME VISITORS: Be sure to read the oldest posts first. The later posts, including this one, deal only with minor details. Start with the first post, which describes the problems I faced, and then read at least the second post, which describes my special diet as a solution.]

STATUS REPORT. My skin continues to improve. It is becoming thinner, free of itching, and very slightly oily (not chalky). It remains very sensitive to abrasion. E.g., shaving (with an electric, rotary shaver) still causes inflammation and subsequent peeling if I press too hard or if the razor becomes hot. I continue to be pain-free (no arthritis, tendonitis, or bursitis, except for occasional muscle pains due to posture problems. (My right shoulder still slopes down, but I am working on correcting that.)

EXPANDED DIET. 1. In the meantime, using the standard test, I have reconsidered a few foods that had given me unclear results in earlier tests. I can now regularly eat dried figs and canned tomatoes (diced). I had avoided both because of the prevalence of seeds which I could not conveniently remove.

2. Helena Kloosterman, who is neither a nutritionist nor a physician, has provided a short list of foods, rated for Potential Renal Acid Load (PRAL), a subject I have discussed elsewhere. Her list is based on calculated values, not laboratory results. Consequently, I have been reluctant to even test (one serving per meal, six meals in a row) some of the foods she says are alkaline-producing. The list, accompanied by a formula for the calculation of PRAL, appears on her weblog, Bitter Poison, here:

http://www.bitterpoison.com/archive/calculate-acid-alkaline-with-pral-formula/

Most of the foods rated as alkaline-producing in her list are not surprising: fruits and vegetables. Others were a surprise. For example, from my own tests of corn, oatmeal, rice, and wheat, I had tentatively generalized that all grains (indeed nearly all seeds of all kinds) were acid-producing and therefore to be avoided. (Production of an acid condition, in the kidneys, is not the cause of my inflammatory problems, apparently, but it has been an infallible "confounder" or "co-incident" indicator or "proxy" predictor of inflammation.)

Kloosterman's calculated list shows the grain quinoa (pronounced "KEEN-wah" or "key-NO-ah") to be alkaline-producing. I hesitantly bought a 26 ounce (737 gram) bag of quinoa from a chain grocery store (Fred Meyer, Kroeger) that carries Bob's Red Mill products. I ran the standard test and got no adverse reaction in the skin on my face. I now eat it regularly, about one serving per day, on average, while continuing to eat most of my starch (the core of my meals) from "roots" (potatoes, sweet potatoes, rutabagas).

The fact that at least one grain is (slightly) alkaline-producing, and thus okay for me to eat, does confirm one pattern: There are exceptions in almost every category. For example, generally beans, nuts, and grains (all seeds) are acid-producing; however, green beans (string beans), hazelnuts (Filberts), and quinoa are exceptions to their categories.

Kloosterman's list also shows some beans -- such as pinto beans -- as being alkaline-producing. I have doubts about that listing, but perhaps someday I will test them.

Last dermatitis stopped!

[REMINDER TO FIRST-TIME VISITORS: Be sure to read the oldest posts first. They describe the "-itis" problems I have faced and the main solution. The later posts, including this one, deal with details.]

As I explained in my oldest post, a series of "itis" (inflammation) problems have appeared during the last 47 years of my life. Four were skin problems (eczema, rosacea, scleroderma, and seborrheic dermatitis). My "anti-itis diet" (which I now humorously call the "prelithic diet") has stopped the arthritis, bursitis, tendonitis, iritis, colitis, and three of the four dermatitis problems.

I discovered recently in talking to my dermatologist that the cause of my fourth skin problem, seborrheic dermatitis, is unknown. (Stress, which is notoriously difficult to measure and track, is one suspect, either in the emotional form or the immune-system form.) Not surprisingly, there is no cure for it.

Apparently the sebaceous glands produce too much oil. The extra oil makes the skin scale--making the skin look chalky and dry. Itching accompanies the scaling, and the skin is very vulnerable to abrasion (which causes redness, swelling, itching, and peeling). Rubbing from an electric razor, a hat brim, or a large, stiff collar are examples of abrasion. I have not been able to shave with an electric razor for many years. (I have been using a hair trimmer set at the lowest setting, on my face and scalp.)

Last week, my dermatologist suggested a treatment program that has eliminated the symptoms. Following is the program, but be sure to consult your own physician. Your situation may be different. I am naming the particular brands I use, but there might be others equally effective.

FACE: Daily, apply a small amount (perhaps one-third teaspoon) of Hydrocortisone Lotion, USP 2.5%, Qualitest, available by prescription. Use it like a moisturizer. A little goes a long way, covering all of my face and front upper neck, that is, all the areas that had rough patches from scaling skin. I apply it about 15 minutes after taking a shower in the morning, when my skin is clean and dry. (I have not used plain soap on my face for fifteen years, but it was very irritating to my skin problems.) The prescription suggests applying it twice daily for the first week and then once daily after that. How long will I need to use it? Perhaps forever, if the purpose is only to suppress symptoms. I may experiment with cutting back the frequency, after a few weeks.

SCALP 1: Every night before bed, apply--throughout the scalp but especially in scaly areas--a small amount (perhaps 1 teaspoon total) of Fluocinonide Topical Solution, USP, 0.05%, 60 ml, TEVA Pharmaceuticals. This application is easy for me because my hair is extremely short. The nurse who told me how to use it has long hair; She said she soon learned to use the squeeze bottle to apply it efficiently and then use her fingers to spread it around the scalp.

SCALP 2: With a medicated shampoo, wash scalp (not the face) every morning. (Be sure to leave it on for a few minutes before washing it off.) Rotate the daily shampoo among the following five medicinal shampoos. I assigned each to a day of the week, for simplicity's sake (and I wrote the day on the bottle with a bold felt pen).
- 1. Monday: Prescription Ketoconazole shampoo, 2%; Perrigo.
- 2. Tuesday: Over The Counter (OTC), RiteAid "Dandruff Classic Clean" shampoo, containing pyrithione zinc 1%.
- 3. Wednesday: OTC, RiteAid "Therapeutic Shampoo," containing coal tar, 2.5%.
- 4. Thursday: OTC, RiteAid "Dandruff Shampoo," containing selenium sulfide, 1%.
- 5. Friday: OTC, Neutrogena T/Sal Therapeutic Shampoo, containing salycylic acid, 3.0%.
- Saturday: repeat shampoo from Wednesday.
- Sunday: repeat shampoo from Thursday.

With this approach, the scalp condition is medicated by a series of active ingredients in the hope that at least one of them will reduce the symptoms. Perhaps the various shampoos work individually to reduce different aspects of the symptoms. I do not know.

What I do know is that the treatment program outlined above works for me, and after only about five days of application. (My doctor cautioned me to continue even if the symptoms disappeared.) For the first time in 47 years, I am symptom-free!

This is not a cure, but it is a way, if applied regularly, to eliminate the symptoms.

I am very glad I live in a country that still has a little freedom of choice for doctors and patients.

Burgess Laughlin
The Aristotle Adventure

Allergic reaction to grapefruit: Scleroderma

[REMINDER TO FIRST-TIME VISITORS: Be sure to read the oldest posts first. They describe the "-itis" problems I have faced and the main solution. The later posts deal with details.]

About five years ago, I was in my worst condition. All the inflammatory problems were in full bloom. In addition to the arthritis, bursitis, tendonitis, iritis, and colitis, I had a bouquet of skin problems (dermatitis). Over the years, the eczema and the rosaca have faded away, almost completely. As they disappeared, another problem came to the forefront: In the caliper region between the nose and mouth, on each side, a thick, red section of skin appeared. The top layer of that area was very dry and cracked like a tiny mosaic. These symptoms came and went on their own schedule, and I could not find any correlation between this condition and my other skin problems.

Provisionally, I now know that the condition was scleroderma. The cause appears to have been a plain allergic reaction (possibly independent of the leaky-gut problem) to grapefruit. I was eating a lot of grapefruit (inexpensive, tastes good, easy to prepare and store). As soon as I stopped eating grapefruit, the problem began to fade. Now, two weeks after beginning this new experiment, the thickness has diminished by half, the redness is fading steadily, and the cracking is almost gone. I have hope that the condition, now requiring little attention from me, might go away completely.

My skin, all over my face and neck, still remains extremely sensitive to abrasion. I never wear a hat, I must frequently adjust the position of my eyeglasses on my nose so that the skin underneath the support pads will not thicken, and I must be very careful not to let a blanket rub against my face when I am sleeping. Still, I would say my skin problems are more than 99% gone, in terms of how much attention they require.

Working on the possibility that my allergic reaction might arise from all citrus fruit, I am now avoiding oranges and tangerines as well as grapefruit. Perhaps in a month or so, I will test oranges and tangerines individually, using the standard test Dr. McDougall has described for his Elimination Diet.

So, now my general rule of foods that I can eat is: Any root, any vegetable, and any fruit (including gourds) except citrus fruit and those fruits, like figs and tomatoes, which contain a lot of seeds. (I eat no animal products, except honey; and no foods made from seeds.)

Burgess Laughlin
The Aristotle Adventure

Final Problems

What I have learned over the last few years is that the symptoms of my inflammation problems disappear when I follow my anti-itis diet, making no exceptions whatsoever.

I eat only fruit, vegetables, roots, and gourds. I exclude from my diet (1) all animal products and (2) all plant foods made from seeds (beans, peas, nuts, grains, and conventional seeds such sunflower).

1. Causes? What I don't understand is what those two groups have in common, if anything.

a. Thanks in part to DianeR in the McDougall Discussion forums, I have uncovered one possibility, but remember that I have no scientific training, so I am flying blind here. Apparently, what the two groups of foods have in common, that might also be a cause of leaky-gut symptoms, is that they both contain a high level of either of two amino acids: cysteine and methioline. Both of these amino acids apparently are high in sulfur. I do not know if the problem is the sulfur as an element or the particular sulfur-laden amino acid molecules as a whole.

b. Further, if my problem is truly a "leaky-gut," then does that mean that these two amino acids appear to my immune system to be an invading virus, which my immune system then attacks, thereby setting off a chain-reaction of effects leading to inflammation symptoms? I do not know.

c. Last, seemingly many of the foods I can eat (such as fruits, vegetables, roots, and gourds) are generally low in fiber compared to plant foods I cannot eat (such as grains, legumes, and nuts). Is that general (but not invariable) pattern a coincidence? Or does the fiber in acid-producing plant foods (grains, legumes, nuts) add to or accompany other elements that cause an immune system reaction? The fiber discussed here is, I understand, technically called "dietary fiber," a misnomer that actually names fiber which normally passes all the way through the gut and is not digested. Could it, in my case, be partly passing through the holes in my intestine and triggering a reaction? I do not know.

2. Cure? The second major question I have not been able to answer is whether leaky-gut syndrome can be cured. I know that careful diet management can practically eliminate symptoms. What I would love to do is solve the problem. Can that be done? I do not know.

Specifically, do the holes in the intestine gradually close up by themselves as time passes? I do not know.

When my budget allows, my next step will be to hire a physician, physiologist, or other researcher to help me find answers (if there are any).

Burgess Laughlin
http://www.aristotleadventure.com

Addendum H: Fiber Problems

LOW-FIBER PROBLEM SOLVED. With few exceptions, my anti-itis diet includes only foods low in "dietary" fiber, compared to oats and beans, for example.

Some alkaline-producing foods are relatively high in fiber compared to potatoes. Examples of relatively high-fiber foods, that are still PRAL-acceptable, are parsnips, pumpkin (but not all other winter squashes), and artichoke hearts (which I buy quartered, in cans). Such foods -- plus high-fiber or otherwise laxative fruits (prunes, cherries, berries) -- help speed passage of food through the gut. Also, I am learning to make soups and sauces from pumpkin (with garlic and lemon juice, for example).

OAT BRAN caused a rosacea/eczema type reaction on my skin when I tried the standard test (1 teaspoon/meal, for 6 meals in a row). I suspect that other forms of bran (rice, wheat) would produce the same result. Is the bran in grains a big part of what makes them acid-producing? I don't know, but I intend to continue avoiding all grains -- even white rice, the least acid-producing of all the grains.

Burgess Laughlin
http://www.aristotleadventure.com

Addendum G: Proteins

GETTING SUFFICIENT PROTEIN ON THE ANTI-ITIS DIET. When adopting this diet, the first myth to toss aside is the myth that you can't get enough protein unless you eat meat, dairy, or at least a lot of beans. As Dr. McDougall and various researchers have shown, protein requirements are very small, as little as 35 grams per day, assuming you are getting sufficient calories (so your body doesn't burn up your own protein to make up the deficit) and assuming you are getting sufficient variety of amino-acids (proteins). Pregancy, recovery from major surgery, and a massive body building program might double the requirement.

The second myth to set aside is the myth that plant foods don't provide "complete protein." They do. Potatoes are an example. You can get all the protein you need from potatoes. Add fruit and vegetables and you will get plenty of protein in both quantity and variety. (An assumption here is that you have a healthy appetite.)

Those are my conclusions. I am a layman. I rely on the testimony (related to my own experiences) of individuals I trust as sources. For a start on exploring these issues, see Dr. McDougall's articles on protein, in his newsletter. For instance:
http://www.drmcdougall.com/misc/2007nl/apr/dairy.htm and
http://www.drmcdougall.com/misc/2004nl/040100.htm

PROTEINS AS A CAUSE? When I saw the first results of my food testing, I wondered if all proteins might be the cause of my inflammation problems. However, further testing indicated that, for me, proteins in alkaline-producing foods do not cause flare-ups, even when eaten in normal quantities at every meal during the six-meal test.

I know now that alkaline-producing foods, as shown in the PRAL list, must be my only source of protein. To make sure I get all the different kinds of proteins (amino-acids) required for health, I try to eat a very wide variety of fruits, vegetables, starchy roots and starchy gourds.

Burgess Laughlin
http://www.aristotleadventure.com