Whose rules?

I was at my first visit with a new chiropractor last night and had an interesting discussion about thyroid care.

I’ve been missing out on my regular chiropractic adjustments and therapeutic massage due to some unforeseen problems. First the massage therapist informed me she was changing her practice in a way that wouldn’t work for me, then my chiropractor broke his arm. The end result was that I’ve had no body work since January and was really starting to feel it.

I work at a computer all day long and have a tendency to carry all my stress in my upper back. That means I can get pretty locked up around my neck and shoulders unless I stay on top of things. I recalled that this chiropractic center was just blocks from my house so I went in last week for a therapeutic massage and to make an appointment with the chiropractor. (The massage was very good, although I did have a weird after effect where I felt incredibly cold and dopey for hours after wards; to me that just means that I waited far too long to get some crap worked out of my system.)

But back to the discussion with the chiropractor. She looked at my information sheet and commented on how she was on thyroid replacement hormones herself, then and asked me how I was able to get Armour Thyroid prescribed instead of the usual levothyroxine. And so ensued the conversation that I call “interesting,” but really makes me sort of angry the more I think of it.

This chiro doc said her endocrinologist refused to prescribe Armour for her. She further told me that until she got pregnant, her endo thought that having a TSH level of around 5 was perfectly acceptable; now that she’s pregnant, he said he wanted her TSH lower so he adjusted her meds so her TSH was around 1 and that she was feeling *much* better. (I don’t understand why the pregnancy changes anything, although I frankly don’t understand the endo’s logic in any way.)

I said something to the effect that I just didn’t understand why so many doctors are reluctant to work with their thyroid patients based on clinical symptoms, even if that means increasing dosages or changing formations of meds. “They treat us like we’re heroin addicts or something,” were my exact words, as I recall, and she nodded her head in agreement.

Earlier yesterday I was talking with a colleague and related a bit about the internal medicine doc I was working with about 4 years ago when I was first going hypothyroid, and how she offered me antidepressants for my fatigue and suggested I go to Weight Watchers for my weight gain. It made me angry all over again just thinking about that experience because I *knew* I wasn’t clinically depressed, I was physically ill.

Perhaps I’m a bit touchy around this subject as I’m still working through a period of poor health myself. Endocrine disorders are so tricky since there is a lot of fine tuning that has to happen; and once you get tuned to the point where everything seems to be humming along just fine, stuff can get off kilter again for no apparent reason. Which is where I’m still at.

After my “down the rabbit hole” experience, I had some thyroid tests run and went in to see the doctor to go over my symptoms. We looked at the test results, and she suggested I get back on to Armour again (I had been on a compounded medication for several months while the Armour was unavailable) and that my dosage move a bit higher.

Four weeks later I went in for another blood draw for the standard thyroid panel: TSH, Free T4 and Free T3. After one month on the Armour I was somewhat better, but still struggling with fatigue, especially after exercise. This was not good since it was interfering with my ability to work and to lose some of the weight I had gained back during the past few months.

My test results were discouraging. My Free T4 was still ridiculously low, and we were trying to figure out next steps. The doc wanted me to stay at my current dose of medication for another few weeks then get tested again. She also decided to add in some tests for adrenal function, since low adrenal hormones could also be causing fatigue, too, especially when exercising. Today is my day to run back and forth to the lab to get AM and PM blood draws for my cortisol level, and yet another thyroid panel.

In the meantime, I struggle and muddle through the days and do little to no exercise so I can reserve my strength for working. There’s not much energy left for socializing these days, but I’m actually pretty lucky because at least my doc is listening to me, unlike my poor chiropractor’s experience with her endo.

So I come to the gist of things: who sets the rules about how we achieve and sustain good personal health? It’s almost as if the endo in this case is saying “I don’t care how you feel or what your clinical symptoms are, I get to decide when you’re well.” [Or perhaps “well enough” is the better phrase here.] And why is it OK to push meds when they’re SSRIs, but not when the medication is a hormone essential to daily functioning?

In my talk with a colleague yesterday he noted that my old internal medicine doctor was providing me exactly the correct advice. He pointed out that she had to offer an SSRI or she would have been remiss in providing adequate care.

But that just leads me to another question: why are so many people popping SSRIs these days? Everyone in the U.S. can’t be staggering around in a state of chronic clinical depression, can we?

Maybe I just don’t get modern medicine.