For Your Health – Check Yourself Before You Wreck Yourself

healthWhy am I so tired all the time?

That’s the single question I never really thought to ask myself over the course of the past five years. This post is a bit of a first for me as I typically write technical content, but recent events practically demand I open up a little with my readers and talk about things that are typically uncomfortable for devout engineers to talk about. Namely, our health, and how we need to start taking it seriously as a community. I’d like to start with some positivity before we dive head first into the less glamorous implications of working in an ops / systems engineering role. Then we’ll circle back to this question.

This Job Can Be Pretty Nice

Being a professional operations / systems engineer has some seriously amazing perks. Here are the few I can think of off of the top of my head:

  • I get to work out of my house. This is a very recent change for me, and frankly I can’t see myself ever going back to an office full-time. I get a ton more work done in less time than I would in an office, and I feel freer than ever to do the best work of my career in an environment I custom designed for my own personal use.
  • I get paid exceptionally good money to do something that I genuinely enjoy. Notice I don’t say love. I love my wife, but I enjoy working with technology. It took me some maturing and some work experience to realize this really is for the best. Truly loving something probably means that you are willing to sacrifice your well-being for it if need be. I think the best rule of thumb is to reserve love for the people who matter, while pouring enthusiasm into ones work.
  • I get to hang out with amazing people (and some really big players in my field) who share in my interests at a meetup group I co-founded and organize, Bucks County DevOps.
  • I get the satisfaction of taking ownership of my infrastructure and taking out my undiagnosed, but surely present obsessive compulsive tendencies on it. Say it with me, “every server, every file, every container in it’s right place”. I possess an arguably insane attention to detail, and this is something that pays dividends when crafting a well-organized, well-documented infrastructure.
  • I get to manage this site and share my knowledge through thoughtfully written tutorials. Some bloggers/authors seem to pump out content without much thought, but there is an inverse correlation between quality and quantity and I prefer quality. I find it rewarding when I get an email notification that someone read and is now commenting on something I’ve written. That’s why I make it a point to try to respond to every comment posted here.

Obviously all of these things are pretty awesome. That said, I would be remiss if I didn’t mention the caveats of working in ops / systems engineering. I’ll do the best I can to talk about these caveats without rambling.

Stop Whining

For a large part of the last five years, there has been one constant in my professional life. I’ve been a member of an on-call engineering paging rotation. For the uninitiated, this means when the infrastructure or application I’m charged with maintaining has problems, I get notified via a service like PagerDuty, and I need to respond and ultimately triage or fix the issue. Ultimately, it sucks. A lot. I wish there were a better way to describe it, but simply saying “it sucks a lot” sums it up quite nicely. There are myriad ways I’ve employed to help decrease the number of alerts that my team receives:

  • Setting monitoring thresholds to reasonable levels so that my team doesn’t get alerted on things that don’t really matter.
  • Tweaking checks so that there are less false positives so that my team doesn’t get alerted on things that aren’t even actual problems.
  • …and of course, fixing common issues with long-term solutions to eliminate the real problems that become nagging issues requiring manual fixes.

The issue here is, even if a dependable engineer isn’t actively being paged on their cell phone due to an issue, their mind begins to operate like that of a lightly-napping cat, one eye open at all times watching for anomalous movement in the reeds. And that’s the best case scenario. At worst, a dependable engineer will experience many long nights spent whispering four letter words to themselves (so as to not wake their significant other or housemates) while completing tedious tasks such as the manual deletion of log files from a server with a disk that is filling due to a misconfigured (or not configured) logrotate. It’s the kind of menial work that over time can make you feel like somewhat of a digital janitor, barely awake while the world sleeps, cleaning up messy things so that the rest of the folks who depend on your infrastructure do not have to deal with the repercussions of it collapsing in the wee small hours of the morning.

The point is that unfortunately, many engineers wear the lack of sleep that comes with our responsibilities as some sort of twisted badge of honor.

Sleep is for the Strong

For a very brief time I worked with an engineer who concluded that he did his best work between the hours of 1am and 5am. And so it was, for the five months he was with my company before getting himself fired for not showing up in the morning, I would wake up to pages of systems being down because he was “experimenting with the network”. When I’d sign into chat and see he was the only person signed in, instead of “whoops, sorry man, I’m going to go to sleep like a normal human being”, I’d instead be met with a snide “Whatever, sleep is for the weak”. This is an extreme example of a person exhibiting pride in their own act of self-destruction, but the alarming part is that this backwards mentality is common in the ops / systems engineering community.

What’s the Point?

I outlined the points above so that there would be some context for the next section, where I bring it all back to the topic of how as engineers, we should be putting the same amount of care into our own health as we do into the health of the various systems we manage. We spend countless hours writing checks, collecting and analyzing metrics, and tackling difficult engineering problems, but we neglect our bodies both actively, by eating and drinking unhealthy things that can barely be considered “food”, and passively, by not going to routine checkups or paying attention to the sometimes ambiguous alerts our built in monitoring systems give us about the state our bodies are in.

A Pain in the Neck

In the spring of 2014, a lot of exciting changes were taking place in my professional life. I had a new job, with new responsibilities that were more tailored to my experiences as a seasoned systems administrator. The weather was warming up, the flowers were blooming, allergy season was in full swing, and it was also around this time that I started experiencing what can only be described as a feeling of tightness in my throat, along with rib pain and a general aching in my muscles. I just felt drained and tired all the time. At first I thought it was just the professional changes I was going through. I logically reasoned that it was likely just stress catching up with me, and it’d pass. Of course I’d feel this way, who wouldn’t after three years of sleepless nights responding to issues on production application servers? I just needed to finally relax and enjoy the fact that I was on a new team with new and exciting technical challenges to tackle, and the old problems were just that, old problems that I could learn from by way of a figurative rear-view mirror. I set my eyes on the exciting road ahead and as always, looked positively toward the future, with the expectation that the transient stress would pass, and I’d feel better in short order.

It’s Summer and This is Still a Thing… Why Is This Still a Thing?

Around June of 2014 I noticed I felt the same way, so I went to my primary care physician who said the tightness in my throat was called “globus pharyngeus” or “globus hystericus”. His explanation for the rib pain was that I was stressed and this was manifesting itself as muscle tightness. His explanation for the tiredness was that paging was cutting into my sleep, causing a sleep deficit.  He explained that some of my symptoms were likely psychological in origin, and would resolve on their own. I just needed to be more patient (see what I did there?). Like any good patient, I took my doctor’s advice. He gave me a muscle relaxer called cyclobenzaprine to take before bed every night and said it’d help relax the muscles. The main effect of this pill was that I experienced something more akin to time travel than sleep, but ultimately there was no change in my symptoms for the better. It was almost autumn, and I started to become worried. The throat tightness persisted, and my rib pain was still just as intense as when I first noticed it.

Be Your Own Advocate

I went back to my primary care physician and explained that my symptoms had not gotten any better. His new hunch was that I was likely experiencing heartburn, so he prescribed acid reflux medicine that I was to take every day, twice a day. I reluctantly went home and started on this medication. It seemed logical enough, pain in my ribs coupled with symptoms in my throat seemed to jive with the notion that this could be related to heartburn. The only problem was I didn’t feel any heartburn. It didn’t add up. Despite this, I took my doctors advice, and for a few weeks took the acid reducing medicine he prescribed.

He also suggested chiropractic manipulation, something I’m very leery of. It’s not very often you’ll hear a doctor recommend a chiropractor, but mine did for some reason. You’ll notice chiropractors like to talk about how they promote wellness. The use of this word is a red flag for potential snake oil. Personally, I consider it a potentially dangerous form of “pseudo-healthcare”, but I went along with his suggestion anyway and saw a local chiropractor, who during my first visit tried to get me to sign up for a 6 month “wellness” program. He had posters on his wall talking about channeling energies. No surprises there. I got in and got out of that office as soon as I could.

The reflux medicine and chiropractic manipulation provided no benefit, and by November I was getting concerned. The throat tightness was increasing in intensity, and though my rib pain had started to subside only slightly, I was beginning to experience upper back pain. I started to get very worried, enough so that I changed doctors as I didn’t feel I was getting results from the doctor I was seeing. At this appointment, I was told to try taking more reflux medicine, so I did, for a while.

Let’s Fast Forward Shall We?

As you probably guessed, the fact that I’m sharing this story means it’s noteworthy. I went through the Christmas holiday in 2014 with the same rib pain and throat tightness sensation that had been plaguing me for months, and I had convinced myself that the doctors were right, and that it was all in my head and manifesting as the fabled “globus” sensation. Then came February 2015, when I started having a hard time swallowing. I felt a clicking in my throat and what can only be described as a pressure in my neck, so I scheduled yet another appointment with my doctor, and he was prepared to send me on my way with a prescription for antidepressant medication, which I didn’t like at all. This problem was physical. I could feel it getting progressively worse. I suggested maybe my thyroid could be the source of my problems.

“Enlarged thyroid isn’t something a male at your age experiences. It’s more common in women than men, 7 to 1.”

“Can you check anyway, just for my peace of mind?”

At this point the doctor sighed as if to say “I’m the doctor, you’re not” and reluctantly felt my thyroid and conceded that maybe it felt “a little” enlarged.

He seemed more interested in pushing antidepressants than actually diagnosing and treating a physical problem, and he was convinced that this was globus pharyngeus / globus hystericus, and therefore psychosomatic in nature. At my insistence, he prescribed a thyroid ultrasound.

The Proof Arrives

A week later, my ultrasound results were in and what they showed was undeniably the cause of all of the symptoms I’d been experiencing, including my muscle pain in my ribs.

I had an enlarged thyroid with multiple nodules that are suspicious for a variety of reasons, which I won’t bore you with. The point is, I needed to get biopsies done to ensure these nodules weren’t cancerous, and I experienced what were no question three of the most stressful weeks of my life waiting for those biopsy results, which were thankfully good. After multiple blood tests, a diagnosis was finally reached: I have hypothyroidism, a multinodular goiter (that means a larger-than-normal thyroid gland with fun things growing in and on it), and Hashimoto’s Thyroiditis, a congenital autoimmune disease that causes my immune system to essentially go haywire and attack my own thyroid gland.

How it works? We all have a pituitary gland in our brain, and that gland monitors levels of certain hormones in our bloodstream. In the case of an underactive thyroid, not enough hormones are present, and the pituitary gland signals to the thyroid that it needs to work harder. The result is that an underactive (hypo) thyroid will grow larger and larger, never to meet the demanded levels of thyroid hormones. It’s basically a bug caused by a positive feedback loop built right into the human body. Over the course of about a year (likely longer asymptomatically), my thyroid grew until I was actually able to feel it compressing my larynx. It wasn’t reflux, it wasn’t globus, it wasn’t muscular, and it wasn’t (entirely) caused by the lack of sleep due to years of being on an on-call paging rotation. The hypothyroidism that comes with Hashimoto’s Thyroiditis was the source of all of my muscle pain and fatigue. The solution? One synthetic thyroid hormone pill a day. It’s been about a month since I’ve started taking synthetic thyroid medication, and I’ve noticed the following:

  • The throat tightness is slowly going away. I can’t even feel it as I write this. This means my thyroid is shrinking. This is good.
  • My muscle pain has changed from a dull throbbing pain to that feeling you get the day after a really intense workout. This indicates to me that my muscles are finally relaxed and are repairing themselves. It’s a good pain, if that makes sense.
  • I have more energy than I’ve had in years, and I now fully realize just how fatigued I actually was for months, even years. I wake up in the morning with energy. I’m noticeably more focused at work. I’m able to help out around the house and do my fair share of chores without feeling completely drained. I’ve lost a ton of weight too! Life just feels better in general. All without using antidepressants, stomach medication, or muscle relaxers.

The Moral of the Story (TL;DR)

To recap: For six months I’d been walking around with a multinodular goiter that is getting progressively worse, while my doctors have misdiagnosed and prescribed (or tried to prescribe):

  • Misdiagnosis: Stress – Treatment: Muscle relaxers
  • Misdiagnosis: Acid-reflux – Treatment: Acid reducer medication
  • Misdiagnosis: Spinal issue – Treatment: Chiropractic manipulation
  • Misdiagnosis: Anxiety / Psychological – Treatment: Antidepressants (which I’m so glad I rejected)

I realize the details around how this unfolded are unique to me, but the overarching lesson is not, and I think it’s one worth speaking out about. Ultimately, the issue I’m trying to drive home here is that as systems engineers, it can be easy for us to get so busy with the messages our infrastructures are sending us that we neglect the messages our bodies are sending us every day.

Even if we don’t ignore these messages and we go to see our doctors, it’s easy for us to be lazy patients and not follow through and question their conclusions. We’re engineers. It’s in our makeup to want to research and learn about problems so that we can effectively solve them. Too many primary care physicians in America seem to be quick to write prescriptions treating symptoms instead of the source of said symptoms. It’s up to us to be our own advocates and stand up for our health. Doing the best work we can actually depends on it. You can’t do meaningful work if you aren’t healthy in mind and body.

I’m happy to have shared this story with you. If you have any questions, I’ll do my best to answer them in the comments, but please understand due to the personal nature of this post, I might hold back a little more than usual to maintain some privacy around the nitty-gritty details of my experience. As always, I hope this post is useful to you in some capacity. For your health.

Michael is the creator and main author of the Smalley Creative Blog. He is a guy who enjoys technology (particularly open source), educating people about technology, and working with people who enjoy technology as much as he does. Follow him on Twitter @michaeljsmalley.

3 comments: On For Your Health – Check Yourself Before You Wreck Yourself

  • They have a saying in medical school, “when you hear hoofbeats, think horses, not zebras”.
    Unfortunately, you went to multiple physician visits with –literally– a pain in your neck, and they thought “another horse, pump him full of benzodiazepines and SSRIs and keep him moving… next… meter’s running…”. It’s become more akin to DevOps, and that famous CERN paper, we are cattle not pets. If you can’t numb us into being sheeple with EtOH and local sports teams, then we should be shot. Don’t waste the resources in healing, not with so many members of the herd to take care of… individuals are drag on the system, friction, the server that just won’t behave. Next time, standby for sudo init 0
    I’m glad you are doing better, despite the system, and the fact that we are so busy oiling the cogs of capitalism with our blood that we forget to sleep. Keep on truckin’
    *descends soapbox*

    • Thanks for taking the time to read and comment. This is by far one of the best comments I’ve ever received, and I appreciate the kind words. Things are still going smoothly for me, so I’m glad I was persistent with our healthcare system. I’m totally going to steal that “oiling the cogs of capitalism with our blood” line. I’m not sure which is scarier — that we’re descending exponentially deeper into an Orwellian dystopia, or that people are completely and blissfully ignorant of that fact.

      • Hi Michael, Thank you for the kind words about my comments, and steal all you want, it’s open season on intellectual property as far as I’m concerned.

        I have been thinking about your last statement a lot. The fact that we are becoming a dystopia is scary, the fact that people don’t know is scarier, but I think the scariest thing is that so many people just accept this as an inevitability. We just shrug, all of us, and say “well there goes my 1st, 4th, or 5th amendment rights, they were fun while they lasted.” The lack of concern by the people who see it happening is the most frightening. thing to me. And I’m not innocent of this. Meh, another of our rights down the toilet. If there isn’t some type of action or mobilization, then we are going to in that world of “thoughtcrimes” and “two minutes of hate”. Every project that is built to “ingest everything and find bad guys” is double-edged.

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