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.

Productive and the reverse

Is the opposite of productivity non-productivity? It doesn’t really roll off the tongue. I mean, saying “What a non-productive [fill in the blank…day, meeting, etc.]” is something that sounds sensible, but I haven’t heard lack of productivity referred to as non-productivity; I guess it’s just “lack of productivity.”

Anyway, I’ve been staggering back and forth between these extremes lately, so it seems. First, I’ll tackle the virtuous, productive stuff. I have single-handedly accomplished leaf relocation this year. Well, technically there is still a pile on the patio to be strategically piled on the garden beds, but the leaves on the lawn, driveway, and in the gangway have been cleared up. In the past I was usually able to cajole Mark into helping me, but this year I was on my own. And I did it. Hooray for me!

I’ve accomplished the major garden winterizing tasks, too. I left the broccoli plants in the beds because they are still producing shoots, flowers and leaves. It was amazing to see how the bees were all over the broccoli flowers a few weeks ago. I guess that’s because there was nothing else flowering and they were trying to gather up the last bits of pollen and nectar for their own purposes. I haven’t really been eating the broccoli shoots myself, but the chickens love the leaves and the flowers. This late in the year it’s great to have something green to give them from the garden.

Other than the broccoli bed, though, the rest of the beds are cleared and covered in leaves. I even found time to (finally!) plant the garlic last weekend.

In addition to the broccoli plants, there are some edibles coming out of the garden. I have mint and parsley, which make lovely fresh teas and/or additions to cooking and salads. (My favorite legume, chick peas, dressed with a little lemon juice, olive oil, salt, pepper, and then tossed with some chopped parsley and cubed sheep’s milk feta is a YUMMY salad.) And the chickens are back to laying fairly regularly. I get an egg every couple days, and sometimes 2 eggs. This is the best that can be expected when the days are so short and they’re molting.

Let’s see, what else am I doing that’s productive? Oh, I have been exploring meditation, but I should write a special post about that since it’s been an interesting journey. I’ve gotten my gym schedule back in place: 3 days a week or 4 if I can fit it in.

Despite all this busy work accomplished, I had been feeling lost and rudderless at work, and generally a bit blue. The lack of productivity at work was making me feel guilty, and I was just not sure what to do. Then, in just a few days it all started to turn around.

The chemistry of our bodies is such an interesting and strange phenomenon to figure out at times. And it appears that at least part of what I was experiencing was due to non-optimal thyroid meds.

Since late August I’ve been forced to play with my meds quite a bit. I started to experience the recurrence of some symptoms that I know were due to poor thyroid levels. My joints were started to ache a bit more and I was starting to feel more easily fatigued. I talked to the doctor and we adjusted my meds a bit. Unfortunately, I immediately ran smack dab into the fact that most dosages of Armour Thyroid (the brand of natural, dessicated thyroid or NDT I was taking) was hard to get a hold of. (No one is exactly sure of what the hell has been going on with the company that makes it, and they’re not saying.) I started on the new dosage with the Armour I had on hand, but that was running out quickly.

My only choice seemed to be to switch to a comparable product called Westhroid made by another company. I started on the Westhroid in early September and continued to take it through late October, at which point I had to make a decision about whether I should ask my pharmacy to special order it for me again, or move to another option.

At the time I started the Westhroid, the nurse at my doctor’s office suggested I just *may* consider changing to a compounding pharmacy to have my meds made up for me. I was starting to suspect that the Westhroid wasn’t the best option for me and so I called the nurse to get a compounding pharmacy recommendation and give it a try.

Even though I had about a month’s worth of Westhroid left I started taking the compounded NDT shortly after it arrived at my house via the mail. Being on it a few days was all the convincing I need that this was the right decision for me and that the Westhroid definitely was not an optimal med for me.

My energy levels are back up again, my mood is much improved, and I even have adequate enthusiasm for work again. I still have some work to do in figuring out how to make my job more engaging for me, but I no longer feel like just a blob occupying a chair anymore. I have interest and a willingness to action things again. And my improved mood is helping me not just at work, but throughout my life.

A couple years ago when I first started having issues with my body’s use of thyroid I learned that I really needed to pay attention to what my body is telling me. And this latest experience seals the deal.

Waiting Game

I feel like I’m in limbo, and it’s really weighing on me. Fair warning: I try not to bitch and moan too much here, ’cause we all hear plenty of that elsewhere. I’m making an exception today since I’m so miserable.

Last week, I saw a new internist. The appointment went well, and I left feeling very positive about working with this doctor as a partner. I had prepped for this appointment by spending some time writing down major milestones in my medical history, like surgeries, onset of any sort of physical symptoms, etc. We used this during our conversation and it ended up being very helpful as we looked for patterns and put together a game plan for how to get me feeling better. However, I still had to get some blood tests, and this is why I am in a state of suspended animation now; until we get the labs and diagnostic tests over with, we’re sort of not sure what to be doing right now.

The B-12 situation is one thing that needs to be followed. I had lab orders from the allergist to get those tests run about 5 days after my last B-12 injection. So, I had that blood draw done last Friday. And I’m still waiting for the results.

The internist wants to dig a little deeper around the B-12 situation. She wrote orders for antibody tests for intrinsic factor (yep, that’s what it’s really called) and antiparietal cell antibodies. If I have either of these antibodies present, I have pernicious anemia and will have to take sublingual or injection B-12 regularly.

The other course of action we are taking is testing for thyroid antibodies, to see if my body is trying to destroy my own thyroid: in other words, if I have an autoimmune thyroid disease (Hashimoto’s disease). I have many of the symptoms of hypothyroidism — unexplained weight gain, joint pain and stiffness, fatigue, moodiness, trouble concentrating — and the previous thyroid function tests were either borderline hypothyroid, or on the low end of functioning. With the exception of the weight gain and join pain, the symptoms above could also be due to the B-12 deficiency, however there’s no reason why I can’t have both going on at the same time.

I’m also recording my early morning body temp. First thing in the morning, before I even really rouse or get up, I stick the electronic thermometer in my mouth to take my temp. The internist wants me to do this for an entire month to see if my my body temp averages below 98 degrees. I told her that would be no problem, as even when I am up and about and active my body temp is never as high as 98. So far, the highest my morning temp has been is 97.7. Today it was 97.0 and a couple days ago it was 96.4.

So, all of this busy work to find out exactly what is wrong is good. But I’m still miserable. The past week has been a bad one. I ache a lot. I am tired, tired, tired; I have barely enough energy to get through the day and my home time is spent mainly laying down with a book (’cause that’s all I have the energy for) or sleeping.

I did go to the gym twice this week to work out with the trainer, and have been wiped out in the process. Yesterday I barely made it through the workout; I was getting dizzy and light-headed just doing squats with no weights. Afterward, I spent most of the day in a fog and went to bed at 8:30 (and this was after having taken a nap from 5:30 to 7 PM).

I just want to cry half the time because I am so frustrated and miserable. I end up spending most of my precious energy on work (and not even work that I feel is done well), leaving me with none for my personal life. The weather this week has been perfect for outdoor activities (low humidity, pleasant temps), but I barely get to enjoy it. I struggled this morning just to get up and water the veggie garden, which desperately needed it. I want to be out in the yard every day after work tending to my garden: weeding, pruning, dead-heading, etc. I love doing this stuff. But I just don’t have the energy right now. Nor do I even have the energy to sit up and knit in the evenings.

I’m going to get through this and find a way to make it better. I know I will. In the meantime, though…well, it’s rough…that’s all I can say.