Wednesday, October 31, 2012

stage 3/4/5 update: crash & burn

Crash by Images by John 'K', on Flickr
Crash by Images by John 'K', on Flickr

This is a bit of a long story; the summary is I had a major adrenal crash, likely due to too much detoxing, and thus temporarily ceased GAPS. Up until the crash, I was enjoying the food just fine, and my deterioration was gradual and didn't seem extreme, so I just puttered my way through stages 3, 4 and 5 until BOOM!

stage 3 food

Stage 3 adds avocados, pancakes made from nut butter, eggs & squash, scrambled eggs and fermented vegetables.

I added avocado with enthusiasm, as it's a favorite.

I will write another post about prepping nut butters and meals later, but I wasn't crazy about the pancakes overall and only did them a few times.

I was quite pleased to add the fermented veggies as opposed to just the juice.

I didn't care about scrambled eggs. I was so incredibly enthusiastic about soft-boiled eggs! I haven't had them since childhood, and was just loving the heck out of them. I have my method perfected, so the white is cooked entirely through, just the outside of the yolk is slightly cooked, and the rest is completely yummy. So I wasn't very interested in scrambled eggs, nor the GAPS-pancakes as I just wanted soft-boiled eggs.

My other fond childhood food that came back was yogurt & honey. As an adult, I mix plain yogurt with fruit and usually a bit of sugar-free DaVinci syrup of one flavor or another. The DaVinci syrups, being entirely chemical and having no food value whatsoever are completely illegal on GAPS. And at this stage, fruit remains illegal too. But just a cup of plain yogurt, mixed with a tablespoon of raw honey, is utterly scrumptious. Maybe a lot of this is due to the whole childhood memory thing, but this became my go-to snack in stage 3.

I enjoyed a pumpkin custard a great deal during this stage also.

Stage 3 recipes will be posted shortly.

stage 3 reactions

When I updated about stage 2, I emphasized the issue I was having with brain fog. This continued through stage 3.

Another thing that occurred was Steve told me I smelled funny over the past few weeks, though not right when he was telling me. I asked him to smell some acetone and he said that wasn't it. I was keeping the carbs up to prevent ketosis, but did a quick check with Ketostix and wasn't in ketosis.

He said it smelled like a wino, but NOT like alcohol. We had a bottle of vodka, so I had him check that.

This is the problem with being married to a non-chemist, something smells funny, but he can't say what. I discussed with my home health aid and she hadn't noticed anything. I chalked it up to detox, as I'd already decided the brain fog was most likely a detox reaction. I took more detox baths, often using both the baking soda and Epsom salts.

I began to be slightly constipated, not badly as when I had reverse T3 issues, but I wasn't going real regularly. This struck me as rather strange as the things I know "help" this include fiber and fat, and when your primary diet is boiled meat and veggies, you're getting a LOT of both. Meanwhile, the only time I've had the opposite problem is when I first started on ThreeLac, so the continual increase of probiotic foods and supplements ought to help things move along also.

Partially as a result of the brain fog, I became more withdrawn. I didn't much want to talk to people. I also didn't want to post, or do Facebook, G+ and Twitter things.

My sleep schedule became somewhat wonky as well. And I found myself feeling grouchy a lot.

A couple times, I had a wave of nausea, but I napped and it went away.

stage 4 food

Stage 4 adds roasted and grilled meats, olive oil, vegetable juice diluted with water or whey, starting with carrot juice and adding celery, lettuce & mint juices and non-sweet baked goods made from nut flours/meals, eggs, shredded squash and fats.

The most exciting thing to me about stage 4 was that my meats could be browned now! The first day, I had uncured bacon, made with all GAPS-legal ingredients, for breakfast to celebrate. YAY! Thereafter, I continued with soft-boiled eggs and yogurt because I like them.

As with the nuts in stage 3, I will post about my juicing experience separately at a later date. I eventually defaulted to a medium carrot, a stalk of celery, a handful of lettuce and a quarter of an apple to yield about 3-5 oz juice daily.

I was also eating a nice batch of mild Italian sausage, bell peppers, onions and garlic with EVOO over top and my ever-present soft-boiled eggs were sopped up with almond meal muffins (recipes to come).

I also discovered the BEST warm beverage during this time. One night as I sat at the kitchen table, I had 2 coffee cups in front of me, one for coffee and one for chicken broth. I got up intending to get more chicken broth, but Steve was talking to me as I did so, and I got distracted and added coconut cream to my cup. I briefly considered dumping the cup and then remembered... someone had posted an awesome Thai soup recipe with a coconut milk/chicken broth base on Facebook that day. So I decided to try chicken broth with coconut cream and with the addition of a bit of sea salt, this was the MOST awesome warm drink I ever had! If it only had caffeine, it could replace coffee entirely.

I also invented the yummiest method of eating pumpkin or winter squash yet - hash browns (recipe to come).

stage 4 reactions

A few days into stage 4, my brain fog lifted and I was able to think clearly again. I realized many of my symptoms might be related to adrenal or reverse T3 issues and I began tracking my temperature.

The method for tracking temperature to ascertain adrenal and thyroid health was developed by Dr. Rind. Basically, you measure your temperature 3 hours after waking, 3 hours later and 3 hours later again, then take the average of those 3 temperatures for the day. Average temperatures day-to-day should not vary much if adrenals are in good shape. Basically, the averages should be within 0.2 degrees of each other if cortisol rhythm is normal. And if thyroid is in decent shape, you ought to be hitting 98.6 every afternoon.

Tracking your temperature implies that one is awake at the same time each day, which becomes tricky when sleep is disordered due to adrenal issues.

About sleep... I have always been a night owl and have never been a morning person unless copious amounts of coffee were involved. When Steve and I drove a truck as a team, I took the midnight-to-noon shift. This is how I am. But if I force myself to a schedule, I can sleep at night and be awake during the day. Though I've been unemployed a long time, I mostly try to stay to a normal schedule so as to be awake when my home health aid is here, have evenings to spend with hubby when he comes home from work, etc.

However, when my sleep is disordered due to adrenal issues, this doesn't work. What happens with an adrenal-related sleep-disorder is that you never have enough cortisol in the morning, when you need a large dose to wake up. So mornings are very groggy. But coffee or no, because you can't make enough cortisol for the rest of the day either, the grogginess continues throughout the morning and afternoon. And because you are low cortisol, all day, your pituitary puts out more and more ACTH, to nag your adrenals to get on the ball and make some freaking cortisol already. So all this nagging is going on all day, and your adrenals are trying, but can't keep up with normal requirements. However, the cortisol requirements in the evening are much lower, so suddenly around 5 or 6 PM, your adrenals CAN respond to the ACTH, and they do so with a vengeance. Because the requirement is so low at that time, the adrenals can meet and even exceed the requirement. And suddenly, you are wide awake, because you have much more cortisol than you are supposed to have at that hour.

Normal fixing of this problem doesn't work. You can make yourself go to bed at 9 or 10 PM, but you wake repeatedly, sometimes for an hour or more, throughout the night. Thus you can lie in bed for 8-10 hours, but are lucky to get 3-4 hours sleep. And suddenly, around 4 AM, you're not just tired, but sleepy too.

Now you have one of two decisions to make. You can decide to stay up through the day in hopes you'll be tired enough to sleep that night, or you can nap during the day. If you stay up, you're groggy and unable to focus, so can't think much anyways, so the day is a loss. If you nap, you can recover and be WIDE AWAKE when your cortisol kicks in at 5 or 6 PM. But it doesn't matter whether you nap or not, you may be able to be TIRED at a normal bedtime, but you won't be SLEEPY. So you'll be up all night anyways.

So deciding when to measure your temperature when living with this is a tad tricky. My method was to just powerhouse through, decide to take temperatures at 10 AM, 1 PM and 4 PM, set alarms to remind me or wake me, and just do it.

Normally, you use temperatures to TRACK your treatment, and the very fact that you are taking cortisol with a diurnal rhythm helps the sleep disorder. So you have the hormonal support to powerhouse through forcing yourself into a normal sleep schedule. But I was trying to track while my sleep was disordered, to get a feel for whether or not I should test in the first place.

See, the thing is it costs around $100 at the cheapest place to do a diurnal saliva cortisol test (though I can do it through the mail, so it is at least convenient). To test for rT3, you need a blood draw and to do both an rT3 and FT3 as it's the ratio of the two that indicative of a problem; the nearest place that allows self-ordered labs is over an hour drive away and costs about $140. And I've been disabled and out-of-work for years, so don't particularly want to drop $250 on tests if I can avoid it.

So I wanted to track temperatures to decide what to test, but my tracking was rather inconclusive. No, my results were not stable, but because my sleep was so disordered, it might not be expected to be stable.

My temps did get relatively high regularly, almost all temperatures were over 98, though I didn't hit 98.6 each day. But when my rT3 was really bad before, my temperatures never went over 98, and even rarely over 97, so an rT3 problem seemed unlikely, at least I certainly didn't have an rT3 problem as bad as before.

Meanwhile, other than the brain fog which seemed lifted except when I was groggy from the sleep weirdness, my symptoms from stage 3 continued: grouchiness, withdrawal and constipation worsened. In addition, my chest pain, a remnant of my surgery, returned. I also began feeling pretty darned tired. And the waves of nausea reoccurred a few times.

stage 5 foods

Stage 5 adds cooked apples, raw veggies (starting with cucumber and the soft bits of lettuce) and fruit juices added to the vegetable juice (except no citrus). For me, this was less exciting than the addition of grilled and roasted meats in stage 4.

After my morning juice, breakfast was soft-boiled eggs, pumpkin hash browns and an almond meal muffin. My home health aid and I had made a stockpot of Italian sausage soup, and I had this with a small salad for lunch. Dinner was the carnitas I'd made from the other half of the pork shoulder I'd made pulled pork from in stage 2 along with crockpot stewed apples. All utterly yummy, quite satisfying, and filled in with yogurt and honey and/or chicken broth with coconut cream and sea salt for snacks.

Again, all recipes will be posted in the near future.

stage 5 reactions

I had stopped tracking temperatures because I had decided it was too inconclusive with my badly disordered sleep. I just flat out needed to do a diurnal saliva test ASAP.

Because I had an appointment with the nurse practitioner at my endocrinologist's coming up, I decided to postpone doing the test until I asked her, as if she prescribed it, my insurance would pay for it and save me $100. If she would not prescribe it, I'd do it myself.

This was my decision, I did NOT want to go off GAPS, as I had hopes for GAPS fixing up my T2 diabetes. Besides which, I was really satisfied with the food, felt nourished by all the soups and broth, was keeping carbs and calories up, I just didn't see any reason to stop GAPS. The only thing I was craving was cheese and I only had a week or so before I could try that.

I thought this through one afternoon while soaking in my Epsom salt/baking soda bath, and that evening while grocery shopping, discussed it with my home health aid, and later when he got home from work, with my husband.

This was a Friday and my appointment was the following Tuesday, so I didn't have long to wait.

Saturday October 27 - the crash

This next bit may be too much information. You have been warned.

Steve had thrown out his back on Friday, and took the cat to the vet on Saturday morning, futzed on the computer most of the day with heat packs on his back, then went to bed early.

I spent the day doing cooking stuff, drying apples, processing my last two neck pumpkins, etc. I had a nice dinner, cooked some uncured bacon, then fried burgers and a diced onion in the grease, and topped it all with a couple soft-boiled eggs. I planned to try to get to bed before midnight myself as my home health aid arrives Sunday morning and we do most of the week's cooking then. But the pain in my chest was pretty bad, so I decided to take a Percocet around 11 PM because no chance I'd be sleeping with this pain. This was the first time I'd taken one in months; last time was for a mammogram.

After that, I sat down in front of my computer to waste some time while waiting for the pain to subside and suddenly felt nauseous and... just horrible. Utterly, massively horrible. I recognized the feeling immediately, this is how it felt when I ran out of cortisol and "crashed". I no longer wondered if I had low cortisol, the symptoms are vague, but THIS feeling was anything but vague, it was very specific and I hadn't felt it in years.

I immediately took 10 mg hydrocortisone.

The WORST thing when you have low cortisol is to experience any type of stress. Your adrenals then kick out a pile of adrenaline, the flight-or-flight hormone. So... probably, I shouldn't have put my head down on my desk and started weeping, upset that I felt this way. Cause then the adrenaline rush kicked in and my brain went crazy.

Thoughts racing, and as each stupid thought appeared, I countered with a rational one. And I kept reminding myself, this is just adrenaline. It will go away in a few minutes, once the cortisol kicks in, I'll be fine.

Once I was relatively calm, I decided to go to bed. That might sound strange, but sleeping until nausea passes is a strategy that has worked for me many times before. So I got in bed, a bit shaky, nauseous, but thinking I'd be fine by morning.

And then I RAN to the tub, the closest place to puke. And I puked and puked and puked.


We have an extended shower wand, and it was actually sitting in the tub rather than on it's hook, so I reached over and turned the cold water on to begin rinsing the tub.

I didn't have time to pull my hair back and had not grabbed my glasses. I reached up and realized my hair was full of vomit, so wrapped it in a towel. I realized I'd peed a tiny bit, so pulled off my pants and underwear. I left this on top of the rug in front of the tub and staggered to my bed to retrieve my glasses. Then I returned to the tub and realized it was clogged. Bits of bacon, burger and onions were recognizable and floating about. I reached in to retrieve the shower wand and realized the water was GREASY.

I sat down on the rug in front of the tub and began to cry. As the next adrenaline rush hit me, I realized the HC is unlikely to kick in at ALL, as I took it HOURS after the food in the tub.

Meanwhile, my throat burns, my stomach still feels horrid, I have vomit in my hair and in my nose, I NEED A SHOWER NOW and my tub is clogged and I am shaking all over. I began swearing at the top of my lungs, which did not help my throat at all.

Normally, Steve is a light sleeper, so I have no idea how he slept through all this. And I really didn't want to wake him anyways since his back hurt, but I was beaten and needed help.

I calmed myself before I called him. Last time I puked in the middle of the night, it was a heart attack, so I needed my voice calm. I called him repeatedly before he heard me, at which point I was less calm. "Steve, I need help. I am NOT having a heart attack. I just need help."

It was several hours before we got the tub usable, both showered thoroughly, started a load of laundry, and bleached everything.

There were several times I insisted we stop and sit, me due to fatigue, him due to his back. During one of these breaks, we had the following conversation...

Steve: "You are amazingly mad at me."
Me: "I'm not mad. You're helping me."
Steve: "I can see in your face you are biting your tongue, you're really mad."
Me: "I'm having an adrenaline rush. Adrenaline is the fight-or-flight hormone. And I can't run."

This is how you inform your husband that it is NOT a good time to tease you.

I quit GAPS

Once we had recovered from our nocturnal adventures, I decided to drink a diet soda. My default GAPS drink is water with lemon and a touch of stevia, but I couldn't stand the thought of lemon. Nothing acidic was working for me now, with my esophagus burnt halfway down. But I needed something to get the taste out of my mouth.

And surprisingly, I needed to eat. My stomach hurt, and I knew it would keep hurting. And nothing sounded good, so I hit up the saltines.

Sunday morning, when my home health aid arrived, I canceled the cooking session. I sent her to the store to get me lots of ice cream and some Diet Pepsi. I was awake a few hours in the morning and a few in the evening and both times ate GAPS-illegal foods the entire time. I took 10 mg HC in the morning and just slept all day and then all night that night. Disordered sleep was irrelevant, I just needed to sleep and recover.

Monday morning when my alarm went off, I rolled over in bed and felt excruciating pain in both adrenals - and I decided right then to go back on a full replacement dose of HC. For me, that is 30 mg daily. And I'm tracking temps again too.

As I write this, it is Tuesday. Apparently, there was also a hurricane during this, so I rescheduled my endo appointment. We had some hurricane damage, and hubby asked me for some help straightening things, but I wasn't much help. I am considering a Percocet as I write this, as my chest hurts. But it's late afternoon, and I haven't napped today yet. After only one and a half days on a full HC dose, I'm already 90% recovered.

Both hubby and Cristina have asked me, and yes I do plan to go back on GAPS. But not until my temps have been stable a while. And no way I'm doing intro, I'll start back up with full GAPS.

But right now, I can't stand the thought of it. I froze all my chicken broth as the idea is a turn-off now, can't even think about pasta cooked in broth. Besides the piles of ice cream, first to soothe my throat, and then cause... well, it's ice cream, I've eaten French toast with very little butter, grilled cheese, and boxed pasta. Fatty foods gross me out right now. I can't even think about burgers. Or bacon. I did manage a couple soft-boiled eggs today though.

Going low carb OR low calorie for a long period can cause both adrenal and thyroid problems; I know this. But I avoided ketosis and kept my calories up throughout, so it's not that. As I posted at the beginning of my post about my adrenal history, Val always said detox was hard on the adrenals. I'm pretty sure that's what did me in.

So aside from stabilizing my adrenals, before I restart, I'll be carefully rereading the book to minimize detox as I may not be healthy enough to heal very quickly.

Meanwhile, I have lots of GAPS-related stuff to post, all these recipes, my experience with making nut butters and meals, my experience juicing. By the time I get caught up with posting, I'll likely be back on GAPS.