Thursday, October 24, 2013

Things Are Looking Up

One of our favorite places since dating days, Keller Lake Park, Waupaca County WI
Last week Friday Carl and I went for a new patient consultation with Dr. Z, my latest in a long line of medical professionals.  We had to drive seventy miles to visit his practice and though the day was overcast, the scenery was beautiful.  We arrived in his office an hour and twenty minutes later and he greeted us at the door with a firm handshake.   I was given a questionnaire to fill out and when I was finished we were ushered into his office.
More scenery from our trip

I handed him my lab tests from January to September and as he paged through them he asked me questions.

"Why are you seeing me now if you're a patient of Well Woman?" he asked.

"I have nothing against the clinic," I said, "but when the NP saw the low TSH numbers on my lab results, she more or less panicked.  She felt with a TSH so low, I must be overmedicated and didn't feel comfortable treating me.  She felt she should refer me to someone else, but she didn't have an idea of who to refer me to.  She did reluctantly raise my dose last week, but she wasn't sure it was the right thing to do.  I'm not feeling very well, so I thought I'd better seek out another doctor."

 Dr. Z asked,  "How did you hear about me?"

I told him I'd spare him the long convoluted tale of 'a friend of a friend of a friend' and he smiled. 

And then he said something completely amazing.

 "Tell your NP you don't care if your TSH is suppressed."

I blinked, did I hear right?  ( Does he know how many doctors I have longed to say that to?) 

"The only numbers we need to concentrate on are your Free T3 and T4, and you have plenty of room to raise in medication, in fact, you're just barely in range.  I see no problem with increasing your meds," he said.  "TSH is a pituitary marker, not a good indicator of thyroid levels.  I prefer to treat patients by their symptoms, not by numbers on a lab report."

Wow.  Could it be I've finally found my Dr. Santa Claus? 

I said, "I've asked doctors for years about taking Armour or another T3/T4 med, but was never successful until July.  Now I'm wondering if I made a big mistake since I have to admit the last few months have been awful.  Maybe Armour just isn't for me?"

"You didn't make a mistake, I believe Armour or Naturethroid are superior drugs to synthetic T4.  It appears you haven't reached an optimal dose yet.  There are other things that we can check into also such as your adrenal function, other hormones, diet.  I see you've only recently started hormone replacement therapy and there are some things I would do differently if I were your physician.  You are on some good vitamin supplements, though.  Would you want to see me for your thyroid only, then?"

"If you are willing, I'd rather see you for all of the above and then some," I said. 

Dr. Z has seventeen years of experience as an emergency physician, along with ten years of treating people like me at his private clinic.  Though I'm obviously no expert on thyroid, everything I've read on online forums and the endless medical studies I've researched matches up with his philosophy so far.  He said his passion lies in treating thyroid disease, hormone imbalances and other metabolic mishaps.  Hallelujah. 

He ordered more lab tests for me through my local friendly lab technician which saved us a lot of money.  I am scheduled for my first official appointment with him early next week when, hopefully, the lab results will be back in.  Dr. Z told us he is willing to have phone consultations with me in the future, too, instead of driving so far; he said he didn't want us to drive seventy miles when the roads are bad in the winter.  I thought that was remarkably kind of him.  So, it's a done deal.  He sent us on our way back home with another hearty handshake and told us to drive safely.  

After we left his office, we climbed into our car and simultaneously breathed a sigh of relief.  It's nerve-wracking seeing one doctor after another and as you all know by now if you've read my dismal past medical history, most of the time their attitudes are not fantastic, at least not when I'm involved.  (Can I ever forget the Polar Bear?  Shudder.)   It's true I don't know how this will turn out, but at least Dr. Z is the most enlightened doctor on thyroid issues I've seen to date.  

Carl and I took the long way home that day and ended up at one of our favorite haunts, Keller Lake Park.  We discovered this park the third year we were married when we went on a 'County Park' tour thirty-two years ago.  (How time flies.) This is our favorite time of year to go to parks since they are usually devoid of people now that summer is over.  We arrived there around 4PM and walked hand in hand along the winding road which goes around the lake.  As we walked we discussed the doctor visit.  We're both a little afraid to become too optimistic because past experiences have taught us a thing or three, but we'll see how this goes.

The 19 acre lake is formed by a small dam on the Pigeon River

I don't know if Dr. Z has already worked magic on me or what, but since last week Friday, I've been feeling a lot better.  The incessant chest pressure and pain has almost completely subsided--for awhile I felt as if I had a fence post lodged in my sternum, oh it heart has stopped banging around (it's still beating, thank goodness, just not as Loud) and my joint pain has decreased.  My fatigue has also lessened to the point where I was able to get some yard work done over the weekend and if the weather would cooperate, I think I could see myself getting more accomplished.  I imagine the change has come about because the new dose of thyroid meds Mandy prescribed are finally taking effect two weeks later.  Thyroid disease is very slow to respond to medication, there's no instant relief from symptoms, unfortunately.

The road goes over the small dam which holds back the Pigeon River to form Keller Lake.  Love the cut granite stonework, probably done by the Civilian Conservation Corp years ago.  

The other side of the bridge, Pigeon River flowing free.
There are large granite outcroppings in the park which inspired us to use rock in our garden. 
Ferns and moss clinging to the stone.
Another beautiful outcropping, Mother Nature has us beat on rock placement every time.

I'm sure there will be all sorts of things I'll have to work on with Dr. Z.  He confirmed Mandy's diagnosis of Hashimoto's thyroiditis, which is an autoimmune disease, and unfortunately, probably not limited just to thyroid destruction.  He said that flareups will happen over time and when they do occur, more of my thyroid will be destroyed which will then necessitate a raise in thyroid medication until the gland is finally finished off and then I will be completely dependent on meds to survive.

 He does feel there are steps I can take to improve my health and cut down on the flareups.  Let me admit right now, that though I want to be as healthy as possible not all of the changes are going to make me jump for joy.  He'd like to have me try a 90 day elimination diet to see if any of my symptoms lessen with the removal of certain foods.  Mandy had also recommended that route, too, in her seminars.  I have a few friends and people on the thyroid forums who have removed all gluten, sugar, dairy and meat from their diets with varying degrees of success, though none of them 'cured' their thyroid disease.  In some cases, they've felt better, in some cases, worse, but I guess it can't hurt to try.  (Much.) 

 Interestingly, when I told him my worst bouts have always been in the late summer and early fall, he said it is quite common.  There has been some research into whether the changing temperatures in our crazy part of the world have anything to do with it since in Wisconsin we can go from 90+ degrees to -25 in a few months time, not to mention the lack of sunlight, too.  Some studies cite the wide fluctuation in temperatures can cause a strain on the metabolism which can worsen thyroid conditions.  I can vouch for that.

 The problem with autoimmune diseases are the misery they cause throughout the body, incurring amongst other things, joint pain and arthritis which of course, led to the 'fibromyalgia' diagnosis the Polar Bear snottily threatened to label me with.  Don't get me wrong, I believe fibromyalgia is a very real problem, but as it relates to thyroid disease, I think it's mostly a case of under-treated thyroid function.  The ol' Polar Bear made me feel as though I were in need of a psychiatrist and not a doctor. 

The general consensus I have gleaned from countless hours of reading whatever I could find on thyroid disease is that there are a multitude of undiagnosed thyroid patients out there.  And most of those who have been diagnosed have been mismanaged by (hopefully) well-meaning, overworked doctors who were sadly taught to see thyroid disease as an 'easy to fix' problem.  

How many times haven't I heard, "You can't blame your thyroid for (fill in the blank).  You're medicated.  It's not your thyroid."

Really?  Pull the other one.

Let us reflect........
  This post is going far too long again, but upon reflection, things come to mind.   I'm certain my thyroid disease has been under-treated for many years, and after comparing notes with people near and far,  I know I'm not alone.  And that's a real tragedy.  There are more and more patient advocate groups forming with hopes of changing the status quo on thyroid treatment, and I have high hopes our voices will be heard.  The current medical school teachings and more importantly, attitudes, have to change. 

And finally,  I can't blame it all on doctors..... I admit I have to take an active part in improving my own health through diet and exercise.  No one can force me to eat more nutritiously or exercise more, and much of my health status does come down to the decisions I make every day.  Since New Year's Day 2012, I've stuck to my guns with the ol' diet and exercise routine faithfully.

 But I have read that excessive exercise isn't good for thyroid patients either, for if it becomes too intense (think of the Biggest Loser and those poor contestants passing out and throwing up) cortisol levels can be raised which defeats the purpose of exercising like a crazy person.  To this day, I've never watched a full episode of the show.  It makes me very uncomfortable to see people go through such torture. Can you imagine what they must feel like after their first day on the 'dreadmill'?    This isn't a sustainable lifestyle change for anyone, at least in my opinion.   But I know it's what passes for entertainment and the more drama, the more 'entertaining', though for the life of me, I really, really, Really don't enjoy watching people toss their lunch.

 And I wonder how many of those contestants have undiagnosed/undertreated thyroid problems?  Just sayin......

With a little luck, maybe this time things will keep improving. 

It certainly has been a long road to recovery.


FlowerLady Lorraine said...

Oh dear Karen ~ I hope Dr. Z will be able to help you and it sounds very positive that he will. He also sounds kind and considerate which is a blessing in the medical field. More human than thinking they are mini gods. JMHO. :-)

What lovely photos of the park at this time of year. I really loved the reflections photo. The granite work on the bridge was very nice too.

I am glad you are feeling better and hope you continue to do so.

Love and hugs ~ Rainey

Pamela Gordon said...

Karen, this sounds like very good news for you and your health problems. I hope it all works out and you will soon be feeling 'normal' again! Your photos of the lake and river are so gorgeous. What brilliant colour! Take care and God bless you.

Alison said...

Oh, Karen! Do I dare to hope you are on the road to recovery? Your post brought tears to my eyes, tears of joy and relief. The elimination diet is going to be hard, but I'm sure you know that. I've cut out sugar and gluten, and I went for a couple of months without dairy, and it is HARD. But you can do it. I know it was hard to keep looking and hoping for the right doctor. Maybe now you can put that motivation into changing some eating habits. (I hope that was helpful advice and encouragement, and not seen as criticism.)

Alison said...

BTW, if you want recipes, I have lots!

africanaussie said...

Oh I am so glad to hear that you have found a doctor who you can relate to. I loved that reflection photo, and the thought of you and Carl walking hand in hand made me smile. I am sure that having such a loving husband by your side will be a real blessing as you continue on this journey. Have you heard of Sara Wilson - I just read the same word hashimotos on her blog this week.. there might be some good recipes and advice there for you. Take care and hope your health continues to improve.

Karen said...

FlowerLady, thank you. I'm certainly hoping I can get things straightened out very soon. Dr Z doesn't act all high and mighty, at least not yet. But you know my track record, if anything can happen it probably will. Trying to stay positive!

Pamela, thank you. We're always drawn to that particular park when we're in the area. It was so peaceful that day, we had it all to ourselves.

Alison, thank you for your words of encouragement. I so appreciate it! I know you have successfully transitioned to more healthful eating and believe me, you'll be hearing from me when I get going on whatever diet protocol he wants me to try. We'll see how the first actual appointment goes. I do have hope again, but I also hope I'm not blindsided one more time. Thank you for thinking of me, I am so blessed.

Karen said...

africanaussie, having Carl put up with me through this long drawn out ordeal has been about the only thing keeping me going. And also kind people like you who haven't fled this blog for good since all I do is talk about thyroid, lol. I have visited Sarah's blog and it is very good, I've been reading it ever since you told me about it. Thank you so much for that link.