Thursday, August 22, 2013

Here We Go Again Part 3

Before I knew it, I was sitting before the desk of an actual psychiatrist.  Carl had driven me into the appointment and was seated in the posh waiting room.  He was not allowed to accompany me.  Curiously, I felt no shame, despite the fact our family had no use for any doctors, much less 'head shrinkers', as Dad called them.  Up until I was expecting Joel, I had only been to see a doctor a few times in my life.  Running to doctors was seen as a sign of weakness and of course, expense played a part in it, too.  It seemed surreal that I was seeing a Psychiatrist, I mused, wow, I've gone and done it now.

Dr. T was a young man, very professional-looking, and who was almost swallowed up by his immense black leather chair.  He asked me how I was feeling and of course, right on cue, the tears started to flow.  Anytime anyone genuinely asks me about my emotions when I'm low, I'm still the exact same way.  Very damp.  Normally, I'd try to hide the fact I was crying, but I was so down in the dumps, I didn't care anymore.

He took a short history of my life, asking general questions for about ten minutes, and then asked, "Have you ever had your thyroid checked?"

"My thyroid?  No, I don't think so," I said. I had no idea of what the thyroid was, what it did, or where it was located.

"Why don't we start there, then," he said, and grabbing a prescription pad, he swiftly scribbled a few lines on it and handed it to me.

"This is an order for bloodwork, and I want you to go to any clinic or hospital and have it done.   You won't need an appointment.  Once we get your results back, we will take it from there," and with a firm handshake and a smile I was out the door with my orders. 

Carl drove me to some hospital, I don't remember which one, and we had the blood work drawn.  My mother was watching Joel and David for us, and Carl decided to take my mind off my problems and took me for a long ride in the country.  We ended up on the lakeshore, and I remember sitting on the sand watching the waves of Lake Michigan gently lapping the beach.  I was so tired, but almost at peace since I felt we'd finally taken some action. 

When we arrived home a few hours later, Mom informed us the psychiatrist had called the house.  I was to call him back as soon as possible.   When I reached Dr. T, he was very excited.

"I think I've found your problem," he said, "your TSH (thyroid stimulating hormone) levels are extremely elevated.  I'm not sure this number is right, so I want you to have the blood work repeated today.  If it comes back the same, no wonder you feel like you do!  This is the highest TSH number I have ever seen."

I went back to town one more time, had the lab test redone and yes, indeed, it was true.  I had a TSH of well over 100.  (I have the old lab results around here somewhere, at the time I didn't realize it was a big deal.)  Normal levels for thyroid hormone at the time were from 0.3 to 6.0 which has been lowered now from 0.3 to 3.0.  So to say I was profoundly hypothyroid was an understatement.  I was right up there for induction into the Guinness World Book of Records. 

Dr. T was amazed I was still walking around.  "Do you get up at all during the day?  Or do you stay in bed?"

I said with two young children to care for, I was definitely getting up, though it was kinda tough.

"I'm amazed you're still functioning at all," he said.  "What the results mean is your thyroid is not working.  Thyroid is responsible for metabolism and energy; indeed it is the gas pedal for the body.  And you have had these symptoms for years?  I cannot believe your GP never picked up on this."

Yes, it was unbelievable, wasn't it.

Dr. T wrote out a starter prescription for one month of a strong dose of Synthroid for me along with a hefty dose of Prozac to try to get me out of the hole I was in much faster.  He also offered Klonopin, a sedative, and anything else I wanted from the pharmacopeia.

"Do you want me to refer you to an endocrinologist, or do you want to go back to your primary care doctor and see if he can treat you correctly?  I wouldn't have a problem referring you to a very capable endo here in town.  It just seems to me your doctor should have checked for this a long, long time ago.  There was no need to suffer this long."

Again, why did I say, no, I'll take this new problem to Dr. H?  No need to refer me to another specialist.  Why?  Because of our insurance and the HMO's that were in place at that time.  The psychiatrist wasn't a covered expense, and I doubted the endocrinologist would be in network, either. We couldn't afford all these fancy doctors, so I opted to trot back to my GP, Dr. H.

 Up to this point I had no idea what a thyroid gland did nor why I needed one. I started reading everything I could get my hands on from the local library.  Wow, this really did explain everything.  As time went on, the meds started to help, and I was amazed at how much better I felt. 

When I saw Dr. H six weeks after being on the antidepressant and the thyroid med, he was shocked.

"Why didn't you tell me you were depressed?  I can write a prescription for antidepressants for much less of a cost than a psychiatrist," he chided.

I told him I'd mentioned it before, but he once again acted like he never heard me. 

"Well, I'll refill your meds, and we should probably schedule a recheck of your TSH in say, six months.  Be well!" and he sailed out the door.

I continued seeing the psychiatrist for about a year.  The visits were ok, and I was indebted to him for discovering my thyroid problem, but there was no classic counseling going on.  I didn't lie down on the couch while he asked me about my problems and tried to stay awake.  Instead it was very cut and dried, I presented myself at the office every four weeks, he asked how I was doing, I said, ok, I guess (at this point, did I know what normal was? In fact, I still don't know, ha) and in less than fifteen minutes I was back in my car in the parking lot.

He did do a lot of tweaking with my antidepressant in that year, though.  Every time I came in, I would see him drinking from a new coffee mug with yet another drug name emblazoned on the side and he would invariably ask, "How do you think the Prozac is doing for you?  Why don't we switch you to (whatever name of the drug was on the side of this mug) now."

I had no idea  what to say, so I meekly agreed, and changed antidepressants in midstream.  My symptoms weren't worse, I felt pretty good, but pretty weird sometimes too.

The psychiatrist did eventually send me to a psychologist so I could talk about my problems.  She was a nice lady and since I'd never had a complete stranger ask me anything about my life and look interested, I went.  I could only afford a few sessions with her, though, and found it helpful.

Hypothyroidism is generally considered to be an easy fix by most doctors.  Figure out the correct dosage to keep the TSH levels in the range and the patient should feel better.  When I first started on medication, the upper TSH limit  was at 6.0 but later on, it was lowered to 3.0.  I felt sort of good for a few years, but there were always lingering symptoms; the numbers on my labwork for cholesterol didn't look all that great, and of course, the weight was always an issue.

My thyroid numbers had a mind of their own and bounced around quite a bit from high to low.  Unfortunately, it takes about six weeks before the drug takes full effect at any dosage, which is quite a time frame to wait.   So, on it went, raising and lowering medication back and forth for years.

I felt much better than I had when I was untreated, but as time went on, the blood pressure numbers climbed, too.  I began to have headaches again and muscle aches, my weight wasn't budging and I felt rather numb all the time.

By 1999, six years in, I was starting to do quite a bit of research on my own and once the internet became an option, I found a whole bunch of people who were also thyroid patients.  And I found out that there were other options out there for treatment that I'd never heard of.  I had a talk with Dr. H when my blood pressure began to soar.  I asked him if maybe my thyroid medication wasn't adequate, maybe we should be aiming for a lower TSH number.  This went over like a lead balloon. 

No, I was adequately treated, he told me, and there would be no need to tweak the medication to suppress my TSH any lower.

 I told him I'd been reading studies that indicated patients on thyroid meds often felt better closer to the lower end of the range.

He told me it was time for a new antidepressant, a statin, and a new high blood pressure med.

I said I'd read if the thyroid was adequately treated, many of these problems could be resolved, and that many patients had done much better on a natural dessicated thyroid drug called Armour.  Could I try it and see if it would work?

He scoffed at that idea.  There was no way he would prescribe an inferior, outdated medication from the 1890's made from ground up cow's thyroid glands when the synthetic hormone replacement was far superior. Why would I even question his authority on this matter?  Had he ever steered me wrong as a doctor?

Ah, let's see.........I was ready to list the ways he had failed me over the years but before I could say another word, he told me "Trust me, I'm the doctor and I know what is best for you."

I said, "But I just want to feel better.  All I'm asking is for a change in medication," but before I was finished speaking, he was packing up his stethoscope.

"If you persist in this, then our doctor/patient relationship is over," and with that he left the exam room.

I sat there, stunned.  Okey dokey.

 I didn't fire him.

He fired me.

1 comment:

Alison said...

Looking forward to the next installment. Wish I could be right there to give you hugs.