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I’ve gotten a lot of requests for more information since Twittering about the new diet my vestibular specialist has put me on, so I thought I’d try to summarize it here for everyone who is interested.

My particular vestibular disorder, Menieres Disease (aka endolymphatic hydrops) is caused by excess fluid in the inner ear’s hearing and balance structures. Normally these structures are independent of the body’s fluid system, but in Menieres Disease the independent fluid control is lost, causing fluctuating fluid volumes and concentrations in the inner ear, which in turn causes pressure, tinnitus, dizziness/imbalance, and loss of hearing.

For years, people with Menieres have been told to go on low sodium diets. Increased sodium means increased fluid retention, as we all learned in high school biology. But in nursing school physiology I learned that the body regulates sodium balance in the kidneys, so I knew that although eating too much salt would definitely cause increased volumes, eating less salt would, at least to some extent, just mean my body would excrete less of it in order to keep things balanced. Nevertheless, once I had cut back on sodium, I could cause instant symptoms of dizziness and vertigo just by eating something that was too salty, so I could definitely tell it had an effect. As a result, I have spent the last 10 years or so carefully avoiding foods I knew have more sodium than I can tolerate.

Last month, I started seeing a new vestibular specialist. My symptoms have been pretty well controlled, but my previous specialist retired about 3 years ago, and I figured it was probably about time to have a checkup. My new doctor explained to me that the fluid volumes in my inner ear are governed by the overall chemical / hormonal / electrolyte balance of the body fluids as a whole. The driving factor behind that overall balance is not sodium, but insulin.

The key to symptom management, as well as minimizing the permanent damage being done to the inner ear and even trying to restore some function, is managing the level of insulin in the blood and trying to keep it as steady as possible. The more consistent my insulin levels are, the less fluctuation there will be in the fluid volumes in my inner ears.

The diet he wants me to follow (and this is the sobering part: FOR THE REST OF MY LIFE!) is based on the Zone Diet. Where the Zone Diet uses 3 meals and 2 snacks per day, however, this version uses 6 equal small meals evenly distributed throughout the each day. The first one is to be eaten within an hour of waking up, and the last one before bedtime is the most important one, because of the long gap before the next meal.

Each meal consists of the same proportions of protein, carbohydrates, and fats. Carbohydrates, as probably everybody knows, increase the level of glucose in the bloodstream, which causes a corresponding rise in insulin levels. Protein causes the release of glucagon, which regulates insulin levels. And fats control various hormones that also work to keep insulin levels controlled. So the whole point is to balance intake in order to keep insulin at a relatively steady level.

At the Zone website there are lists of “Zone food blocks.” There are three types: a protein block contains 7 grams of protein; a carbohydrate block contains 9 grams of carbs (not counting fiber), and a fat block contains 3 grams of fat. There is also a “body fat calculator” that tells you how many “blocks” per day you should consume. I’m supposed to eat 12 blocks per day of each of the 3 types, so with 6 meals, that’s 2 blocks of each type per meal. I’m to eat every 2-3 hours, never going more than 5 hours between meals during the daytime.

The approach that the nurse recommended to me is to make lists of the foods I’m interested in in each of the 3 lists, stockpile those foods, and as much as possible, have them pre-prepared in block-sized portions. Then I can just mix and match for each meal. For the first 4 weeks, I’m not supposed to eat from the “less favorable carbohydrates” list, so that means the only grain I’m allowed to have right now is steel cut oats. Fortunately, that’s my favorite breakfast.

I’m also supposed to carry “emergency food.” One stick of string cheese is one protein block, and they don’t have to be refrigerated. One apple is two carbohydrate blocks; you can get your hands on an apple just about anywhere. Applesauce also comes in single-serving containers, and one of those is one block. Fat is easy - three almonds is one block. There are also Zone Balance bars and another brand called Balance Bare that have the right proportions and amounts for one 2:2:2 meal. And 6 ounces of 2% milk is a perfect 1:1:1 food, so in a pinch I can drink a half glass of milk and go a little longer before my next meal.

Besides the protein : carb : fat ratios, there are some other things that I have to monitor in my diet. Splenda and stevia are the only sweeteners I can use — all of the others can affect glucose levels. Caffeine increases insulin secretion, so ideally I should avoid it, although for people who just have to have a cup of coffee in the morning, my doctor says to do it consistently — the same amount at the same time every day. MSG is also to be avoided, as are aspirin and all other non-steroidal anti-inflammatory drugs. (I will have to ask again what the reason is, because I’ve already forgotten, but they do something that affects fluid balance in the inner ears.) And I’m supposed to drink a minimum of 64 ounces of water per day, evenly spaced throughout the day.

As for sodium, it’s to be avoided in large amounts. Like everything else, my meals should contain similar amounts of sodium — but the plan is to titrate me back up to within the ADA recommended 2000-3000 mg daily consumption range. Oh, and I’m supposed to eat a 1:1:1 snack 20 minutes before exercising.

It’s actually been kind of fun creating my meals, since I’m not cooking for a family any more, which means they can be as weird as I want. I’ve loaded the freezer with frozen protein servings (turkey sausage, chicken breasts, etc.) and frozen fruits, stocked the fridge with boiled eggs, tofu, apples, oranges, kiwi, and Mozzarella cheese, and stashed single-serving containers of salmon, tuna, sardines, and different flavors of applesauce in the pantry.

For breakfast today I ate 2 links of turkey sausage, and 2/3 cup of steel-cut oats with Splenda and 2/3 tsp of butter. I could have had 1/3 cup of oatmeal and mixed in 1/2 cup of blueberries instead — maybe I’ll do that tomorrow. I had a Balance Bare bar for one of my meals, and it was actually quite tasty. My latest meal was 3 oz. of canned salmon, 1/4 cup hummus, 1 kiwi, and 6 almonds.

I’m also expected to keep a diary of the foods I eat every day, what time I ate them, what time I noticed feeling hungry, my fluid intake, and my symptoms. That way, over time we’ll be able to fine-tune my diet to my needs. My diary is also supposed to show the barometric pressure each day — that’s the wildcard in the equation; it’s the one thing that can’t be controlled. (I still have to go buy a barometer.)

I’m the least-regimented person on the fact of the planet, but I’m determined to make this work. Wish me luck! Better yet, join me; then we can share ideas for making it painless and fun!

1. I was in labor for two months with my 3rd child (which probably explains why I don’t have a 4th). I went into premature labor at 24 weeks on August 4, 1986. My due date was November 28. The doctors didn’t hold out much hope, and despite using every tactic in their arsenals they never could stop the contractions completely. They did, however, manage to slow the progress of my labor for 8 long weeks, which gave Rusty time to get big enough to survive. (If you medical sorts are ever curious about what it feels like to spend a month on IV magnesium sulfate, drop me a line. It’s been a while, but it’s not something one tends to forget!)
2. In my 48 years I’ve had 29 different addresses in 8 US states and 2 countries. The longest I’ve ever lived in one residence is 5 years. For much of my childhood I lived in a tiny Japanese farming village and roamed the countryside with my Japanese playmates watching the tea, rice, pig, and silkworm farmers, weavers, and carpenters work at their crafts. As a result of my gypsy lifestyle and exposure to a variety of settings and cultures, I can fit in just about anywhere and am quite comfortable with change. I get bored if things stay the same for too long, rarely plan my life very far ahead, and tend to be somewhat spontaneous, such as going to the animal shelter to put up a “lost cat” notice and coming home with a great Dane. But that would be another “thing,” and I’ve already got the requisite seven, so I’ll just move on.
3. I’ve had a movie made about me. It all started when my husband Jeff found something something very cathartic and personal that I had written in private and decided, without my knowledge, to share it with the entire world. This resulted in it being published in the newspaper, where the movie-maker found it. It eventually became a short film called A Simple Smile. For the whole story, see my post The Accidental Op-Ed. (Fortunately, I love my husband very much and was therefore able to refrain from killing him on the spot.)
4. Physical oddities: At 6′2″, I am quite tall for a woman, but I’m by far the shortest of our 4 siblings (photo evidence). Both of my talo-calcaneal joints are congenitally fused. With all my fingers extended, I can bend my pinkies without moving my other fingers. (My dad & brothers can all do this with their left hands, but not their right. My mom can’t do it at all.)
5. I built the world’s first website about sugar gliders in 1994, mostly to teach myself HTML. (Its final iteration has been archived at http://www.sugarglider.com/archives/ruth/). In its second year it earned a Yahoo! “Cool Site of the Day” award. Of course, since there were only about 27 websites back then, that wasn’t nearly as impressive an achievement as it would be today.
6. I played volleyball my senior year in high school, but having never been a terribly athletic sort, I mostly sat on the bench. My shining moment of the season was when an opposing team’s coach complained that our court was missing a regulation line 6 feet behind the serving line, and, as no tape measure was handy, I was summoned to lie on the floor in front of a gymnasium full of spectators to measure for placement of a temporary line.
7. I once won a trophy in an archery tournament that I attended as a spectator. At least, I had intended to be a spectator. A member of the Texas A&M women’s archery team became ill at the last moment, and without a replacement they didn’t have enough players to compete. I was hurriedly outfitted with borrowed equipment and, with much one-on-one personal coaching, managed to shoot well enough (for two long days and with screaming muscles unaccustomed to such uses) to supplement the scores of the 4 real team members so they could keep their first place spot. I was on the team by default after that. I won several more trophies, due more to the excellence of my teammates than any stellar ability of my own. When my nock locater slipped at one subsequent (outdoor) tournament, however, I did become the only member of the team to ever “Robin Hood” in the dirt. My first arrow flew over the target and landed in the field some 30 yards beyond it. My second arrow also flew over the target, and neatly split the first one in two.

Official “7 Things” Meme Rules:

1. Link your original tagger(s), and list these rules on your blog.
2. Share seven facts about yourself in the post — some random, some weird.
3. Tag seven people at the end of your post by leaving their names and the links to their blogs.
4. Let them know they’ve been tagged by leaving a comment on their blogs and/or Twitter.

Tagged By:

Thinking I was about to be tagged for this meme, and knowing that after this weekend I wouldn’t have time to blog for at least the next month, I dutifully prepared my entry ahead of time. As it turned out, the friend I thought was going to tag me was merciful and chose 7 others. But by then I’d already gone to all the trouble of writing the post, and I’d hate to think I wasted a perfectly good free afternoon this close to the beginning of the semester. So I’ve decided to publish my post anyway, and credit Felicity with the tag, in hopes the meme gods will be merciful to her for flaunting their rules and not tagging anyone.

Tag, You’re It:

• Jeff
• Etmorpi
• ByGolly
• Greystork
• Weasel
• Rasama
• Enrico

One of my responsibilities as a psych nurse is patient education. I help my patients learn coping skills, teach them about their medications and how they work, and help them find ways to change the thoughts and attitudes that keep defeating them. It’s not a one-way street, though; my patients teach me, too. They show me new ways to look at the world; they teach me honesty and transparency, and about the resilience of the human soul. Once in a while, one comes along who teaches me more than I have to offer in return.

Jerry* was one of those. He had a mental illness that included psychotic symptoms, and was back in the hospital for a medication tune-up. He was very interested in the new medications the doctor wanted to try, and what their effects would be, so we were going over his medications together. One of them, naturally, was an antipsychotic. When I explained that it would help to diminish the voices, Jerry looked alarmed. “Oh, I don’t want the voices to go,” he told me. “It’s too lonely without them!”

I’m sure I seemed surprised, since that’s not how most of my patients feel about their voices. Jerry began to explain to me how, in the beginning, the voices had been horrible, nagging, taunting, threatening things; much more typical of the voices many psychotic patients experience. But Jerry had found a way to deal with them. “You have to get right with yourself,” he told me. “Every little thing you’ve ever said or done that you feel bad about, anything you don’t like about yourself, all the things that have happened to you that you still think about. Those are handles they can hold on to you with.” He talked about how he had searched out, one by one, every bit of the past he had been holding on to, and had worked through each thing in whatever way he needed to in order to finally come to terms with it, make peace, and let it go. He had dealt with his own flaws and shortcomings the same way, learning to accept himself in spite of them. “You have to just get over it,” he explained, “that way you get rid of all the handles for them to grab on to, and they can’t hurt you any more.”

But that hadn’t been the end of it, for Jerry. Once the voices had nothing left to taunt him with, they changed tactics and began to threaten him. “I was afraid all the time,” he told me. “They were always telling me horrible things they were going to do to me. It was a nightmare.” He paused for a moment, then continued. “But then I realized they never actually did anything. They just talked about it. So one day I had enough, and I sat down on the ground and told them, ‘Okay, if you’re going to do something to me, then do it! Right now!’” He waited for a long time, he said, but nothing happened, and so he knew the voices couldn’t really hurt him. After that he wasn’t afraid of them any more.

“So then they started changing,” he told me. “They would say things to help me, or to make me laugh. Now they’re like my friends. I’m okay with them, and they’re nice to me, and when they’re not there, it’s just…it’s so quiet, and lonely. I’m used to having them around now; I don’t want them to go away.”

We all have “voices” in our heads, audible or not…voices of self-criticism, doubt, guilt, and fear; voices of the people in our lives who have wounded us, hurtful things we save in our memories and replay over and over to make ourselves miserable. While for most of us the voices are silent and imaginary, for people like Jerry they are audible and real. Yet he was able, despite that much greater challenge, to come to terms with his own failings and learn to accept himself for who he was, to let go of the past and its hurts and failures, and choose to move forward. Once he had made peace with himself, he then faced and conquered his worst fears, even though they were much more tangible and real than most of us can even imagine.

I came away from that encounter both awed and humbled. For someone who is really pretty severely mentally ill, Jerry showed an amazing amount of insight, not to mention plain old common sense. Even those of us fortunate enough to have healthy brains and fairly normal lives could stand to learn a thing or two from him, I think.

* The patient’s name and other identifying details have been altered to protect their privacy.