April 2, 2007

Worse Than The Flu

Here's a little case report, about me, a cautionary tale about working too hard.

I had to go to Chicago for a case. It took three days.  It took a lot out of me.  There was the jet lag, and the work, and skipping meals, and sleep deprivation.   I barely sleep at home, but all I could get in the hotel was 2 hours/night.   I usually drink about 3 cups of coffee (16 oz each-- so I guess that's 6 actual cups)  a day, but with this level of stress and tiredeness I was drinking 4-5.  And, dare I admit it, I took a Provigil.

I could feel myself getting sick on the last day.  Just get through it, I thought.  Sick later.  Work today.  

I got home, exhausted.  The next morning I felt sick, wiped out, achy.  There you go, I said.  I have the flu.  I struggled through work, taking naps when I could.    

As the day progressed, I got worse.  Weakness, tiredness, horrible nausea, headache.  I gagged at the thought of food, but I forced myself to at least drink Gatorade.  Gatorade is the artificially sweetened sweat of male bicyclists.  Every word of that description disgusts me.  I drank the purple one.

Day 2 came, and I was worse, not better.  Not even the same-- much worse.  The headache was ruthless.   The nausea had become motion sickness-- turning my head was a lunar launch.  The arthralgias, bizarrely, had disappeared-- except in my neck, which had become very painful and stiff.  I couldn't turn my head well.  I could barely walk, I could barely think.

I went to work.

The weakness and lethargy had also changed-- into narcolepsy.  It wasn't weakness-- I was drugged.  I fell asleep for only a second at a time, but it overtook me every moment I wasn't active.  Driving.  Watching TV.  Standing at a urinal.  On an elevator.  During phone calls.  I could not stay awake.  Simply closing my eyes would drop me into Stage IV sleep.  I could still be talking, but if my eyes were closed I was asleep.  And what I said was nonsensical.

I was almost helpless.   I took Tylenol.  Motrin.  Tylenol + Motrin.  Nothing.  And I could not stay awake.  The head and neck hurt so much that the only solace was sleep, which I couldn't stop anyway.

What kind of flu was this?  And something worried me: why didn't I have a fever?

By day 3 I had what can only be described as the worst headache of my life.  The nausea was constant. 

Worst. Headache. Of. My. Life.

I rarely get sick, I rarely take pain relievers.  I do 3 sets of 50 push ups a day.  I'm pretty healthy, and I've never been incapacitated.  I only say this as background for my next sentence: I was so sick I could not see. 

Light hurt me, hurt my head.  I could not look at the monitor, or TV.  I wanted to be in a quiet, dark room-- asleep.  With morphine.  And the medical student in me solved the mystery: headache, stiff neck, photophobia, no fever.    I had finally done what I had been threatening to do for so long: I had popped an aneurysm.   I thought: so this is how it ends.

Nausea.  Headache.  Neck stiffness.  Exhaustion.


Oh my God, could I be in caffeine withdrawal?

As soon as I thought it, I knew that was it.  I couldn't believe it.   I'd never felt it before because I'd never not had coffee before.  And that first day back, being a little off, I skipped it-- which made me worse, and then the withdrawal hit.

I made some coffee.  It smelled like battery acid.   I put ice in it and drank it, one cup all at once.  I gagged, twice. 

Within ten minutes, I was 10% better. In 30 minutes, I was 50% better.  In an hour I was 95% cured.  From unable to move, to almost complete cure.


The cure was so total, the reversal so profound, that I actually couldn't remember how sick I was.  I thought I must have been exaggerating.

So my body reminded me.

Four hours later, I started to feel that motion sickness again.  By the fifth hour, I was on the floor again, same stiff neck and headache. And the nausea was worse: the thought of drinking the battery acid again was too much for me. 

But I did it.  And again, an hour later, I was completely cured. 

How "real" is caffeine withdrawal?  Clearly, my own experience takes it out of the theoretical realm.  But what about:

the average coffee junkie when he goes to the hospital? 

the psych patients who smoke 1 or 2 packs a day, 4 or 5 coffees a day, and get admitted on the unit where it's only decaf and a smoke break a shift? 

The case reports of neonates born to heavy caffeine drinking mothers, who went into serious withdrawal.  Three neonates had caffeine in their urine!  Symptoms include irritability, rigidity, hypertonia and hyperreflexia.

And then there are the kids.

What about all those kids who drink a lot of soda-- say, two cans/d (100mg total)--and maybe sometimes they don't get their dose?  One study of such 10year olds found that missing one dose of 100mg made them less alert, had more headache, and performed more poorly on cognitive tasks.  But how many parents (or doctors) would have thought about this? Another study also found kids in withdrawal got little headache, but get more myalgias than do adults. Who is savvy enough to attirbute these subtleties to caffeine?

Has anyone else wondered if the prevalence of ADHD doesn't parallel caffeine use and sleep deprivation, especially in kids (kids don't take naps anymore)?  And remarked that the main treatments are-- stimulants?


Referencing myself: What is the best and healthiest coffee to drink?