I’d seen this patient a couple times before, but today was the first time that I knew in advance that he would be coming, and I was able to clear my schedule for a full one-hour appointment. The last visit, I just couldn’t figure out why the medications weren’t working, and he was already at about he maximum amount which I felt comfortable dosing. He was struggling from low mood, and even though that was improving, none of my treatments had done anything for the anxiety or the difficulty sleeping.
He had gained some weight, too, and today I had some time to ask more in-depth questions about nutrition and exercise. I know that doctors in America would love to have an hour with their patients, and I know I’m fortunate. Because it doesn’t take me long to figure out one of the roots of the problem. My patient is drinking a big cup of coffee on an empty stomach, right when he wakes up. He might have a bit of toast (or not) then another big pot of coffee mid-morning. Lunch is decently big, but heavy with simple carbohydrates which will give quick energy and cause a sugar low. Not much protein to get him through his busy day as an NGO worker. And then another big cup of coffee, and another and another, with the final and 5th cup of the day not long before bedtime. I know a thing or two about caffeine, as I have to be very careful with my tea habit to not get shakes drinking black tea on an empty stomach, and not having any caffeine after lunchtime. So it’s easy enough to dive in. I can’t say for sure that the coffee is the cause of his problems, but I am nearing certain confidence that cutting back on the caffeine will help the anxiety and insomnia.
Lifestyle changes aren’t easy. I share some information about the power of caffeine on an empty stomach, especially when it comes to anxiety. We discuss alternatives such as decaf or smaller cups, lower-caffeine tea alternatives and higher protein meal options. I know that cutting down on caffeine can lead to headaches and feeling ill, so we talk about that as well. I suggest that caffeine at night could impact his sleep, and he listens as if he’s considered it for the first time.
I know it’s unlikely that everything will change at once, but now that my patient has some information and some achievable goals that he came up with himself, I am confident that he will find improvements which are even greater than more medications could have brought. I let out a sigh of relief, it’s not always that there are root causes easy enough to change like this, especially when it comes to anxiety and insomnia. But I’m optimistic here. I book him for a follow up in 4 weeks, remind him of my email in case he wants to contact me beforehand, and I go home with a little less tension in my shoulders. At least this one patient has a way forward and a hope for remarkable improvement in a short amount of time.
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