Saturday, August 24, 2013

Here We Go Again Part 6

We were running pretty hard with the work around here in June, sometimes ten to twelve hours a day.  (And night.)  Carl and I decided we were going to put good ol' Aaargh as top priority, you may remember.  Well, that was the plan, and still kinda is.  We have a scary garden schedule for 2014......

But first, we had the August tenth garden walk and booyah party in the offing, too, and though we were making fairly good progress with the work, I was feeling more and more frazzled.  Carl was feeling the effects of my frazzlization (new word there) because I was nagging more. (Remember the lawn mower?)   And sleeping less.  And aching a lot.  Ick.

On July 22, I had a doctor's appointment with Dr. N.  I hadn't seen her for a full year, and this was a   prescheduled visit for my annual physical.  The protocol for managing hypothyroidism is usually to leave you on your current dose of medication for up to six months or even a year without a recheck of the TSH if you have no outward signs of needing a change.  When you change medication dosages, though, you are supposed to wait six weeks and then have the TSH rechecked.  If it looks 'within range' (and you all know by now how I hate those words, along with 'normal') most doctors will tell you, "See you next year."

Next year was here.
I had my lab work done in advance by an independent lab through our insurance plan.  The cost is much less than using the doctor's office, but the hours are funky, from 2PM-6PM four days a week.   The nurse practitioner who drew the blood can also treat minor things and is, in my opinion so far, quite competent.  I had a discussion with him about thyroid medication and he too said he knew of no one who prescribed anything other than Synthroid or the generic equivalents.  He'd never heard of Thyrolar, the synthetic T3/T4 I had been on a decade earlier, but he had heard of Armour.

 "Isn't that made out of cow glands or something?"

"No, pig glands, actually."

I should have said Elephant Glands.  Or Eye of Newt Glands.  Or Unicorn Glands. 

"Oh, yes, now I remember.  Well.....that's not a very good medication, is it?  Why would you want to be put on that?"

I listed my reasons, I don't know why, I guess I just like to hear myself babble.  

When he glazed over, I came to a stumbling stop, because I realized it didn't really matter, he wasn't going to prescribe Armour either.  

He said, "To be fair, I think most doctors don't feel that using a medication made of dried up pig glands is the treatment of choice when the modern synthetics are superior.  You have to admit, it doesn't sound very feasible."

 He did wish me luck with my ongoing crusade, though.

Whenever doctors wrinkle their nose in disgust at my request to try Armour and say, "Do you know what that medication is made from?"  I wonder how many times they have prescribed Premarin, which is an estrogen hormone made from the urine of pregnant mares.  (Pre-gnant Mar-e urIn)  How's that for gross?  And if you ever delve into the manner in which the poor mare's urine is collected, you'll be mortified.  

I received my lab results in the mail, so I knew before I got to the doctor's office the reason I wasn't feeling fantastic was because my TSH was now 2.4.  Yes, that is still well within range; 3.0 being the upper limit before treatment is deemed necessary, but it is also double my normal comfort range of less than 1.0.

No wonder I was feeling yucky and the headaches were getting worse.

Carl went along with me to the doctor's office straight from work.

And now you can be a fly on the wall, too.

Here we go:

Dr. N's nurse took my blood pressure, which was elevated, but you see, I was here on a mission. I  was going to try One More Time to address this thyroid thing.  And that makes me nervous.  Because I go in with high hopes, well, okay, a smidgen of a hope, that this time things will be different. 

"You're here for your annual physical, right?" the nurse asked as she returned the blood pressure cuff to the drawer.  "Do you want him to be in the room for the pap procedure, or.......?" and she looked pointedly at poor Carl, sitting there in his work uniform and steel toed shoes. 

"He's seen it all by now," I joked.  "I'd rather he stayed."

"All right, that's fine.  Here's your gown, here's your paper napkin for your lap, and doctor will be with you shortly."

So we waited.  I was wired.  I sat on the table and did some deep breathing.  "Don't blow this, don't cry, don't be dumb," I thought out loud.

Carl was very supportive, "It will be fine, don't worry."

Dr. N came in, right on time, looking very nice in her lab coat.  She is a very attractive woman.  I hated to make her angry.

She sat down to look at her notes and asked me the usual question, "How are you feeling?"

"Not too good."

"I"m sorry to hear that," she said, as she paged through my most recent bloodwork results.  "What symptoms are you having?"

I rattled them off and then said, "I see my TSH is up to 2.4.   I usually start to feel unwell once it is over 1.0.   I guess I wasn't surprised to see it was higher this time."

"Well,  2.4 is still well within the range of the TSH, you're falling right in the middle, and that's not a bad place to be," she said.

I countered, "It may not look bad on paper, but it feels bad in person."

"What makes you think your thyroid is causing your symptoms?  There could be other reasons, for instance, your cholesterol isn't great, and neither is your blood pressure.  Your other blood counts are normal, though.  And I see you weren't fasting when the labs were drawn for the cholesterol, so we will recheck that at a later date when you are fasting.  But I suspect you're still going to have an issue there."

I took a deep breath.  There's a lot riding on this encounter and I have a very short amount of time.

"I think my thyroid is causing the problem because  of my 22 year history of being a thyroid patient. I've had bouts of this over the years, and it certainly feels the same."

We're coming up on the 23rd anniversary of my very first diagnosis this fall.  Maybe we should throw a party....but I didn't say that out loud.  Keep it light, I said to myself, we don't want to be judged insane or intractable.

"I see," she smiled slightly, "But many things can cause your symptoms besides the thyroid.  2.4 is not that high of a TSH.  I wouldn't find that capable of producing symptoms."

"True," I said, (remember this is a Numbers Game) "2.4 is within range, but I have historically felt better at around 1.0.   And I have felt like this before.  This isn't the first time around the Thyroid Block for me."

Oh...careful, careful.  I could feel the blood pressure rising more, my face was flushed.  Settle down, too early in the debate to lose it now.  I must tread lightly.

Dr. N sighed.  Before she could say something, I jumped in again.

"I know we have discussed this at my first visit, but I'm here today asking if I could please try Armour instead.  I've read a lot of information online and have talked with other people who have had good results with it instead of Synthroid."

She sighed again.  I sat there in my flimsy backless gown with my feet dangling off the exam table, trying to look dignified.  

"I have a problem with patients who hear about or read misinformation online and then second-guess doctors who have medical degrees," she said.

Ooops, hit a nerve.  Time to regroup.

I could have said, "I have a problem with doctors who hear or read misinformation and then second-guess patients who have the disease in the first degree."

 But I didn't say that, since she hadn't started to pack up her stethoscope yet.

Carl jumped in, "She did feel much better on Thyrolar when it was available, and that was a T3/T4 medication, similar to Armour."

"Armour is a very old medication and not the drug of choice to treat hypothyroidism," she stated.  "Did you know it is made of dessicated pig glands?"

Hey, she gets two points for actually knowing what animal it comes from.

"Yes, I know what it is made from.  And I know it is an old medication.  I would like to try it and see if it will work for me.  The only way I will ever know is if I try, right?"

"Armour is very hard to titrate; it is difficult to get a consistent batch of the medication since it varies so much in strength," she said.

"Synthetic levothyroxine has had recalls, too, due to inconsistency of strength," I said.  (She knew I was right about the recalls, and didn't deny it.  I hadn't found any evidence that Armour had potency issues, but I knew going into the debate this topic would come up.)
I've heard these arguments every time I talked to a doctor about Armour.  First there is the nasty origin of the med, then it's the supposed variation in the strength of the dosage, followed by how hard it is to regulate in the human body, and wrapped up in the neat little package of:  It's All In Your Head.

And here it comes:

Dr. N said, "I suspect most patients simply 'think' they feel better on Armour.  There is the placebo effect to take into account.  There have been studies done where people were given Armour, Synthroid or a placebo, and it turned out the vast majority of them felt much better on the synthetic levothyroxine."

I'll have to do some more digging for that study, because I wasn't able to find it in my research.

  I didn't want to let this stop me.  This was such a tense time, almost like a chess game or Battleship.  Just once I'd love to yell out, "Checkmate! instead of whimpering, "You Sank My Battleship!"

"I've been told before my problems are all in my head," I said.  "But, I repeat myself again-- how would I know unless I try?   I have been on Synthroid for 22 years, and frankly, I think I've given it a fair chance, don't you?  As I see it, this isn't an all or nothing situation, if I try the Armour and it doesn't work, I can always go back to the Synthroid, so what do I have to lose?"

 I could have told her I'm losing a lot of hair already and my voice and my sanity, patience and persistence by this point, but I waited for her to make the next move.

She said, "You mentioned depression issues, have you ever considered an antidepressant?"

"Yes, I've done more than considered them, I've been on a slew of them in the past and I've come to the conclusion that they are simply numbing agents.  Look at it this way:  If I go to the dentist with a toothache and he finds a cavity, he doesn't send me home with a supply of Novocaine and tell me to 'Use as necessary'.  He fills the tooth, stopping the decay.  I don't feel well when my TSH levels are elevated, so why send me home with an antidepressant instead of trying to fix the cause of the problem which is an undertreated thyroid?"

Oh boy, I'm on a roll now and she's not looking too happy.

I went for broke, use it or lose it:

"I wonder how Armour can even stay in business, no one will prescribe it."

"I didn't say I wouldn't prescribe it," she said, "I have other patients on Armour."

Wow, really?  I was amazed by that, seeing how this wasn't going well.

"I will prescribe it for you if you insist, but I warn you, you won't feel any better on it.  There is no exact comparison dose between levothyroxine and Armour and it will take some time to figure out what dose you need.  This isn't going to be an easy fix."

We had gone over the time needed for my pelvic exam, so she did the usual listening to the heart, checking the ears and eyes, stick out your tongue and say 'ah' and said we'd worry about the pap test next year. 

So it turned out that after 22 years, I finally got my way. I had my prescription in hand and handled it like it was spun glass.  We went to the pharmacy and wonder of wonders, they had it in stock for a mere five dollars.  I used to catch a lot of flak from the pharmacists when I was on Thyrolar because they had to order it in for me special.  See, I'm always being a pain.

Carl was happy, maybe now we'd be getting somewhere and my thyroid troubles would be over.

But the doctor's words of warning haunted me, "You're not going to feel any better on it."

She had that right.


FlowerLady Lorraine said...

Oh my, I don't like the sound of those last two sentences.

--But the doctor's words of warning haunted me, "You're not going to feel any better on it."

She had that right.--

And, you've left us hanging once again dear lady.

I do hope you and Carl have a nice weekend ~ FlowerLady

Pamela Gordon said...

Oh dear. That last sentence has me wondering. I'm enjoying this. You have a good memory about your conversations. I'd forget everything about the conversation. Waiting for the next instalment. Hugs. Pam

Alison said...

Oh No! No, no, no. I did a little power fist pump when I read that she agreed to it. You really know how to leave us in suspense.

"Easy fix?" Like being miserable on Synthroid for however many years HAS been an easy fix?