Saturday, August 24, 2013

Here We Go Again Part 7

On July 23, I took my first dose of Armour and felt no different, but I didn't expect I would, since the thyroid is a slow reactor.  I didn't develop a curly tail or floppy ears, either, at least not yet.  But who knows, I could sell tickets.

We went back to work getting ready for the garden walks and the party.  Day by day I was starting to feel worse.  The headache was getting stronger and my heart seemed to be beating harder, and my moods?  Well, I could (and did) cry over just about anything.  Drama Queen, I'd chide myself, you're nothing but a DQ. 

I saw a t-shirt the other day on a guy at a rock concert that read :

Cancel my subscription.
I'm tired of your issues.

The people around me NEED this T-shirt.

I'd read online, yes, there I go again, reading.....that the transition from Synthroid to Armour is a little tricky sometimes and one of the mistakes made by doctors and patients is not raising the dose high enough, soon enough.  By August 10, about two and a half weeks on the new med, I was really starting to feel downright awful, but the adrenaline rush of getting ready for the big day kept me going.

We got through the party and it was a beautiful day.  There were some funny things that happened that day, and I do fully intend to finish the booyah post just as soon as I'm done bellyaching about this.  (That is, if I ever do get done bellyaching about this.)

The day after the party was also busy, we had to clean up and then there was a family reunion to go to and more garden guests and finally, the following Monday, I had a chance to slow down.  I didn't have much of a choice about the slowing down part, my body was doing it for me.  I was dizzy, my heart was pounding like a jackhammer, and the headache was now what I guess qualifies as a migraine for it was Incredibly Bad.   

This past week has been a blur.   I did have to sub for our exercise class leader at church twice and really did a bang-up job at that.   I told the ladies about my dilemma and they understood.  I went through the motions with the exercise but that was all.  I even had issues working the DVD player, it is amazing what a low thyroid can do to your motor control and logical thinking.

Other than exercising at church and watching the town repave our road, the time was spent mostly in my chair, down and out, hearing Dr. N's words, "You're not going to feel any better," echoing in my ears.  That was when I decided to start writing this epic saga.  I couldn't do much else.  And when I'm low, the stinkin' thinkin' creeps up on me, around and around I go.

Here I went and fought the good fight to be put on the new med and now look at me.  The doctor has the right to say, "I told you so."

I feel like a little kid who has begged his mother to let him eat an entire bag of candy and then suffered the consequences his mom warned him of.   Talk about a kick in the backside.   I had let optimism creep in, and see where that got me?  Pride goeth before the fall and all that.  My pride is definitely gone, so much for being my own advocate.

 I got the prize and now I'm miserable.   Self-pitying fool.  This isn't the way the story is supposed to go.  I'm supposed to be feeling fantastic and dashing about like I've just found the Fountain of Youth.  Sheesh, I need a shower, that much is certain, but there won't be any dashing going on anytime soon. 

  I remembered Dr. N said, "How did I know it was my thyroid causing the symptoms?"  It could be something else.  What if I was now going hyperthyroid instead, maybe this dose is too high instead of too low?  Or maybe it isn't the thyroid after all.  Had I arrogantly diagnosed myself when it was something else more sinister in the wings? 

I called two of my friends, Nancy and Patti.  Both of the dear ladies listened to my tale of woe in turn for hours.  I am ashamed to admit, It Was All About Me.  Just like these blog posts.  Me. Me. Me.  I'm such a bad friend/blogger.  Ann was spared the drama because she had left the week before to go on a vacation with her sister, so she was safe from my whining in far-away Canada.  Talking it all out sure did help keep me sane, though.  I have wonderful friends. 

Then out of the blue, I remembered talking to a girl I went to high school with about thyroid issues and joint pain and all the hormone stuff over four years ago, at our thirty-fifth class reunion.  She and I hadn't socialized in school much, we didn't have the same classes, but she had heard me griping to someone (imagine that?) about the thyroid stuff and wanted to talk to me.  There was loud music playing and it was hard to hear each other, but I did remember her telling me about a place where they did hormone saliva testing and a nurse practitioner who specialized in treating hormone imbalances.  I hadn't heard about this before.  She told me she had been going for two years and felt wonderful.  She encouraged me to have it done, too. 

I don't know why I didn't go right away.  Money is always the big concern, and a lot of the testing is fairly expensive, so I thanked her and told her I'd keep in touch.  Ok, it 'only' took me another four years of thyroid madness and  being brought to my knees by finding what I thought was going to the answer only to find out it wasn't before I called this friend again last Monday.

"You know, I have often thought of you and wondered if you went to see *Mandy."  (*I'm changing the names here, in case this doesn't work out.)   "How are you doing?"

I told her.  She told me she has been a patient of Mandy's clinic for six years now and said, "What are you waiting for?  Make the appointment, you'll feel better, I'm sure of it!" 

I felt hopeful,  maybe this is the missing piece.  I called the clinic and was told the first step of becoming a patient was to attend an introductory seminar of three hours and then I would be offered the chance to purchase a saliva test kit to take home and, well, basically spit in.  Then, two weeks after the test is done, the results would be sent to the clinic and I would then be contacted to make an appointment which is 90 minutes long.  (90 minutes?  Wow, I can't remember many appointments with any health professional lasting even 9 minutes.)  My friend had told me the consultations are amazingly comprehensive, she said it was truly life-changing. 

The only problem was help from Mandy and the Women's Clinic was at least two or three or more, depending on her case load, weeks away.  Can I last that long?  I made the appointment for the seminar on Tuesday night, anyway.  Baby steps to recovery, Karen. 

 Finally I was down to my last Armour pill of the thirty day prescription and even though I felt like dirt warmed over, I had it refilled.  Despite the fact I was supposed to wait six weeks before a recheck of the TSH, I called the doctor's office.  I told the nurse my symptoms, that I was fully aware it was a bit early to recheck my levels, but I was fully aware I was in trouble. 

"Well, traditionally we would want you to wait another two weeks before we recheck," the nurse hesitated.

"I can't wait another two weeks," I said, "Trust me on this. I need a TSH test."  My voice has, for some reason, dropped at least an octave, I sound like a breathless Greta Garbo.  It's creepy.  Truly.

She checked with Dr. N and called me back the next day, I was to go in for another TSH test.  In the meantime I attempted to make my own arrangements to try to get the bloodwork done, but the lab said their hands were tied, they would have to wait until they received orders.  Such a head game.  Such a head ache.  Ouch.

This was last Tuesday.  I was in a panic.  The doctor's office was on the far side of town and I'd have to drive in rather heavy traffic to get there.  But I couldn't stop crying for very long and the bouts were very unpredictable.  Sort of like what you're supposed to do if your clothing catches on fire, I would just Stop, Drop and Cry.  After sobbing awhile, I'd feel weaker and a little mental relief, but not for long. 

Along with the tears and flapdoodle, I had no energy whatsoever and my Clumsy Meter was off the charts.  I was dropping stuff and my reaction time was way off.  How was I going to get to the lab for the blood test?  And where is the place, anyway?  I was on Mapquest, trying to figure out a route while mopping up my tears when Carl called from work.  There was no way he could get off of work on such short notice.  I was between breakdowns at the moment and assured him I'd be fine, don't worry, I'll figure something out. 

I hung up with Carl, and had another crying jag as I stared at the map online.  Green Bay has been undergoing massive road reconstruction the last few years and with the new roads have come the new traffic circles, or Roundabouts as they call them up here.  I don't mind the single lane roundabouts too much, but the two and three lane ones throw me for a loop even when I'm feeling good.   They are also installing new flyover roads over the freeways and it is a real mess figuring out how to get from Point A to Point B. 

I wasn't sure if there were detours involved, I wasn't sure how many (if any) roundabouts were enroute, I wasn't sure where the place was, and I wasn't completely sure what day I was on.  This prompted another crying jag.

 Joel called me on his lunch hour right as my jag was in progress, poor fellow.  I hadn't heard from him for a few days, so I imagine he was wondering what in the world was happening now.

"Hi, how are you feeling?"

"Oh, hi," Sob sob, "I'm not feeling too good right now," hiccup, hiccup.  "I'm trying to figure out how to get to the lab for blood testing.  Do you know how much road construction is in that area?  Do you remember how to get there?  I'm on mapquest, and I think I remember, but I'm not sure."  Sniff, sniff.

"I don't think there's any road construction in that area.  But are you even fit to drive?" Joel asked.

"I don't know, I think so, maybe," I said.  "Dad's tied up at work, and I can only get in for a 2:30 appointment."  I finally stopped bawling, gosh I was ashamed of myself.   "Ok, I'm better now, I can do this thing. Don't worry, it'll be fine.  So how have you been?"

"I have to go back to work, so just take it easy, ok?" Joel said.  "I love you."

"I love you, too," I said, and after I hung up you all know what I did.  I felt as helpless as a newborn kitten.  Pass the tissues, please.  My dog Pudding was licking my feet and making anxious noises.  She didn't like the noises I was making either.  Petting her dear little head was a comfort. 

This will never do.  I have to get hold of myself.  I got a drink of water and went back to the map again and laid out my course.  Normally in a situation like this I wouldn't be as much of a coward; I'd be scared, because I don't like driving in traffic, but I wouldn't be paralyzed.  Boy, I was a sad sack. 

The phone rang again.  "I will be there to pick you up by 2," Joel said.

"What? No, Joel, don't do that, you'll get in trouble with work."

"I will be there at 2." Click.

Oh, I felt guilty, relieved, thankful, blessed and back to guilty all in one rush.  My good ol' negative self talk was back in a flash along with the tears, 'Now you're dragging your sons into this mess.  Wow.  Great work, Mom.  You're not even out of your 50's yet and you're making your children haul your behind around.'  I hate that voice in my head, and I let it live there for free, on top of it all.  It serves no purpose whatsoever, and needs to be evicted.   

Joel collected his Maternal Unit and drove me to the lab promptly at 2.  He'd left work several hours early for this, and I still can't thank him enough.  Would I have made it there on my own?  Probably.  But who knows?  Joel said he couldn't live with the thought of an accident happening that may or may not have been my fault if I was driving.  I alternated between expressing my gratitude and falling apart on the twenty minute drive.

The lab/nurse practitioner guy, Mike, greeted me cordially and took me in the exam room to draw my bloodwork.  He was the same guy I talked to about the Armour and switching meds, and he has a surprisingly good memory.

While he was getting the procedure ready, we started talking about what was going on with me and though he was showing the appropriate amount of concern, I kind of suspect he didn't truly believe my thyroid was the problem either. 

"When I was in medical school, there wasn't much support for Armour," Mike said.  "In fact, I have to admit, we were told it was not something any doctor should prescribe any more.  I can prescribe medications, but like most other doctors I know, I  prefer to send you along to someone else if you want to use Armour.  It's just what we were taught.  I'm not saying the med is no good, but if you're not feeling well, I guess that's a foregone conclusion."

I didn't say anything.  I know. They told me so.

"Once you get your levels back, at least you'll know if it is the thyroid, even though it is kind of early on," he said.  "But you might have to make an appointment with your doctor anyway to rule out something else more serious, because I think it's pretty rare to have a reaction so quick.  Did you ever think of switching to a different doctor?  Or maybe trying an antidepressant?"

I was seated with the rubber band around my bicep while he was locating a vein to attack.  My eyes were tearing up and threatening to run over again, when suddenly, I laughed out loud.

"What a novel idea!  A different doctor!  An antidepressant!  A second, third, fortieth opinion!! Yes!  Duh, why didn't I think of that?!" 

By now I was crying and laughing at the same time, which I know startled him.

"Well, I was wondering about that," he said, "Sometimes you need to explore other avenues and not just assume your thyroid is the culprit.  Have you ever seen an endocrinologist?"

How long you got?  I rattled off the list of doctors I'd seen, the Good, the Bad and the Polar Bear Ugly Variety and he was a bit stunned. 

"If you had a couple of good doctors in there, why didn't you continue seeing them?"

 Fair question.

"Because they moved away to other states," I said.  "And I certainly hope I was not the cause of their middle of the night flights from Wisconsin, either."

Mike chuckled and said, "Are you sensing a pattern here?"

 By now, I'm actually laughing, this was pretty funny.  But hopefully not true.  Ya think?

"So do you think that somewhere in say, Montana, there are a bunch of former doctors hiding out in the mountains sitting around a campfire eating beans and mourning their lost practices?" Mike asked.

"Yes, that is a distinct possibility.  Can't you just hear them talking,  '"The only reason we're all here is due to  Crazy Karen, the Thyroid Patient in Wisconsin."' 

 I can see it now, maybe there is a Retreat Center and a huge support group for all the doctors I have ruined in the last twenty years.  Their meetings would be anonymous, of course.  "Hi, My Name Is Dr. E and I am a Ruined MD."  They could have t-shirts made too,

I Didn't Survive Crazy Karen's Thyroid Disorder

I could hear Joel chuckling in the waiting room.  I'm sure he wondered at that point why he had to drive me in because, after all I was laughing, and so was Mike.  But then again, maybe not.  I guess they call this sort of thing 'rapid-cycling' in the mental health community.  Laughing and crying all at the same time?  Is that a good thing?

 I was told once that truly insane people never question their own sanity, they simply believe everyone else is nuts.  Maybe I am going downhill more than I think, but so far, the only people I believe are truly nuts are half of the doctors I've ever dealt with.

So, not to drag this out any longer, here's what I did next:

I said goodbye to the Lab/NP Mike.  He promised results of the test in 24 hours.

Joel took me to Carl's work so I could catch a ride home and after thanking him profusely, he went on about his day.   David works at the same place as Carl, and he gave me a hug, too, before we parted.  I am so well and truly blessed to have these men in my life.

Carl and I went home, ate some supper and drove back to Green Bay for the 'Well Woman' seminar.  Carl couldn't attend because this was strictly for women, so he dropped me off at 5:30 and went to fly kites with Dave and a co-worker at a nearby park.  At least he was having a little fun, I hate to make others suffer for my goofy issues.

My head felt like a time bomb and my heart was hammering, but the lone woman I was seated next to didn't seem to hear it, so I relaxed a little.   Slowly the chairs filled up with women of all ages, some with their older mothers and some alone,  and then at 5:30PM Mandy started the meeting.

Despite having the Headache to End All Headaches and feeling sick, I was riveted to her talk.  I think (and hope and pray) I may be on to something here.  The meeting didn't end until 9PM and it was the fastest I have ever had time go in a situation like that.  I bought the kit for $258 and took it home with me.  I know it's expensive, but what other alternative can I try at this point?  I've already completed all the steps and by this Thursday, the kit was back on it's way to the lab for testing.  I hope I did all the steps right.  I hope there's no problem with the shipping.  I hope I hear from Mandy soon........I'll keep you posted on this.

Anyway, I was still waiting on the TSH test results.  I called Mike the following day and he said, "Nope, sorry Karen, nothing here yet, but I'll tell you what, I'll call you before I leave here at 6PM either way, ok?"

At 5:45PM, Mike called. 

"I had to call the lab to get the results, so your doctor doesn't have this yet, but your TSH is 12.5.  I guess you were right when you suspected the thyroid."


Wow, I was right for once.  I was so relieved to hear it was the thyroid.  I can't tell you how relieved. Maybe this is just a matter of getting the dose right.

12.5 isn't as high as my all time record of over 100, but it is a whole bunch higher than my normal 1.0 and definitely higher than 3.0!  I was only out four weeks, not six.  If I could have stuck it out for six weeks, I'm sure I would have had a much more impressive number, and you MUST remember, the Numbers are ALL that is important in this Sick Game.

I had just refilled my medication, and without hesitation, I took another half of a pill.  I know this is without doctor's supervision, but remember my research?  The biggest mistake found by fellow thyroid patients was the failure of the doctor to know that the starting dose shouldn't be held for too long (they say for no more than two weeks, and my symptoms certainly back up their anecdotal evidence) or the patient's symptoms would become much, much worse.  Then what typically happens is the patient goes back to the doctor complaining of feeling awful and they are told the Armour is to blame, we told you it was inferior, time to get back on the synthetic again.  Can you see the heartbreaking loop here? 

Armour has been around since the 1890's, which was way before the TSH test came into existence.  The way it was dispensed back then was upping the dosage gradually while watching for the ill person's symptoms to abate.  When a person felt truly well, they knew they had the right dose. 

Despite some doctors habits of warning me of the dangers of taking too much thyroid medicine and having a much too suppressed TSH number and going hyperthyroid, I have a question.   Why, why, why would any hypo patient want to overmedicate and become hyperthyroid?  The symptoms are similar and just as miserable.  I can't imagine anyone who has suffered from either of these two insidious conditions jumping at the chance to trade places.

We Simply Want To Feel Well. 

With just another half pill, my headache subsided in under an hour.  Again, what a relief, I can't tell you what it's like to have that pain gone for awhile. 

The doctor's office called me on Friday.  The nurse said I should increase my meds to the next level.  To be fair to Dr. N, I was surprised she didn't advise me to go back on my Synthroid.  This is a feather in her cap. 

"Doctor wants you to reschedule for TSH lab work on October 2."

So this is where I'm sitting now. I've increased my dosage to the next level per doctor's orders and am now waiting for the thyroid to respond.   October 2 is a long six weeks away, though.   My headache is still there slightly and my heart isn't as bad as it was, but I'm not feeling fantastic yet.  My energy levels are kaput. The crying jags have all but stopped, though, and that's another big relief.  Research tells me I am still at a low dose yet, so we'll see.......I'm not going to wait around to get worse, no sirree.  Someone, somewhere will be hearing from me.  (Yeah, like that does any good, ha.)

With any luck at all, I might have my first appointment with Mandy and the Well Woman Clinic before October 2, but who knows?  A lot of things could come up, but oh, how I hope it's sooner than later.   I forgot to mention, Mandy is a hypothyroid patient herself and believes Armour is superior to synthetic T4 meds AND she believes in optimizing her patients on their medication, whether they are on Synthroid or Armour.   She said, "While the TSH test is a good test, it is certainly not the ONLY test we use here, so if your doctors have told you you're 'normal' and you beg to differ, we can help you every step of the way." 

Oh, I hope so! 

I thank all of my wonderful friends, the near and dear ones and the far and wide ones, for putting up with this Woe Is Me Fest.  

I am truly blessed.

And now, I must get off my behinder and find a lawn mower.

At least I can do that sitting down. 

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.

Friday, August 23, 2013

Here We Go Again Part 5

As sad and crazy as it seems, there is of course more to this tale.  I'm sure I've lost 99.9% of my readers by now.  I know this is supposed to be a gardening stained glass quarry blog, I truly do, and I promise some day it might be again. 

But not right now.  

I was lying in bed early this morning with the ol' sleep apnea mask squawking since I didn't have it adjusted correctly and got to thinking about these last posts.  I have debated deleting all of them, this whole shebang smacks of self-pitying TMI (too much information) and yet, I feel driven to get it in writing.  Some people want their parking validated, well, boo hoo,  I want my feelings validated.  Reading back through what I've written so far, I can't help but shake my head.  Look at that, I'm validating myself. 

And, still lying in bed at 8AM, because I still feel lousy, I recalled even more Close Encounters of the Thyroid Kind.  (Hmmm...that is a catchy title for a book that only thyroid patients would read, should I write it?  Never mind, I already am.  War and Peace will end up having less pages than this.) 

Hard to believe, but I had forgotten about some of the other doctors I'd seen.  There was this one, and that one, and oh, yeah.....THAT one, I remember him all too well. 

The most frustrating part of the whole ordeal so far has been the realization that so much of it was completely unnecessary.  I do have to take the blame for not advocating for myself more assertively.  It has taken me years to find my voice, and I'm still not great at it.  There is still that part of my personality that wants to people-please and craves acceptance, but let's face it, when you're a thyroid patient, you have to be one Tough Mudder. 

Unfortunately, being tough with other people doesn't come naturally to me.  I am always tough on myself, which is yet another character defect.  I know I put myself down continually, even in my own head, and that's a survival mechanism from childhood best left in the dust.  Better to call myself stupid than have someone else say it first.  It hurts less coming from me.  A narcissist I am not. 

My father passed away in 2001.  I miss him terribly at times, but, and this may sound callous and reprehensible, it has been a relief, too.  While I was a patient of the wonderful Dr. E, I confided in him how life with my father was difficult.  A check of Dad's thyroid panel turned up nothing significant, so I guess whatever disorder he suffered from wasn't thyroid disease.  I was 43 when he died and up until that time, I had a lot of stress dealing with him on a daily basis since we live next door to each other.  Thankfully, the last year of his life was a bit easier; he'd suffered a series of slight strokes they think, and his personality mellowed quite a bit.  True, he didn't know me or my mother most of the time and he needed constant supervision (imagine a three year old with access to car keys) but he was less angry.   I used to take him for car rides and he would hold my hand.  He probably had no idea who I was, but I remember those times fondly.  When he lost his balance on a staircase and struck his head at the age of 88, it was all over so fast.  He passed away less than ten hours later.  Mom and I were free.

So, where was I?  Oh, yes.  I was back at Square One in 2011.  Having just left the hospital in 2010 due to another medical mishap and acquiring and fleeing from the Mean Polar Bear Doctor (yes, she has her own post dedicated to her, the b...., ok, diva)  The Polar Bear Doc had insisted I go on statins, and I had absolutely dreadful side effects of sore muscles and lowered stamina and took myself right back off.  I was told I will suffer untold heart problems and an early death.  Ok.  You warned me.  But until then:

Could I please try Armour?   If not, could I please have my synthetic medication increased to lessen my symptoms?  Would you please check more than just the TSH level?  What about the T3 and T4 levels?  What about the reverse T3 and T4 levels?  How about my hormones? 

This brought on more doctor-y wrath. 

I read too much.

I don't have a degree.

She's the doctor here.

And if I don't like it, don't let the door hit me on the ass on my way out of the exam room.

There I was, a hapless, hypothyroid wanna be Armour junkie,  back out on the streets once again, looking for help in all the wrong places.
And yes, what about my hormones?  Through all these years of struggling with the thyroid, I often wondered if my other hormones were out of whack, too.  I remember asking at least six doctors or more about my PMS issues and low libido, but was told I was a 'normal' perimenopausal woman.  I was to keep track of my symptoms during my menstrual cycle back then and after a year, they would look into it.  I blinked at one doctor and told her I didn't need to keep track of my symptoms, I had them all memorized by heart. 

"This is normal for perimenopause," I was told.  "We just have to take what comes and learn to deal with it."

And later, much later,

"This is normal for menopause."

(WHY am I never considered 'normal' when I ask for a different thyroid medication??  Anyone have an answer for that question?) 

So many doctors have all told me my problems are in my head. 

I need psychiatric help.  (Check.)

I need an antidepressant.  (Check x five or six different kinds.  And gained weight.)

I need a statin.  (Check, ouch.)

I need a beta blocker (because my heart pounds when my thyroid meds are too LOW, yes, that happens to hypo's too, not just hyperthyroid patients)  (Check, did the betas and ACE inhibitors, gained more weight)

I need migraine medication. (Declined that.  But I do have horrendous headaches when hypothyroid.)

I need blood pressure medication.  (Check, three or four of them were tried.  I am currently not on any.)

I need to keep my mouth shut when yet one more doctor tells me that I don't know what I'm talking about when I gently suggest and then tearfully insist that the thyroid is very, very possibly at the core of all of the above and then some. 

And heaven forbid if I become demanding, there will be a ride to the Loony Bin in my near future.  The little white men in their little white coats, coming to take me away, ha ha hee hee.

Ok, 2011 and I was looking for another DO (Doctor of Osteopathy) since I had good luck with Dr. E ten or eleven years prior.  I found the one I currently have, Dr. N, who is a pleasant-enough younger lady doctor, but who is underwhelmed by my persistence about getting my thyroid adequately treated.  She wasn't interested in prescribing Armour, either, and kept me at the same dose of Synthroid while still a bit leery of my TSH being 1.5 by then.  (It was creeping up.)  She felt that number was bordering on too low, my cholesterol and weight numbers were too high, but took my word for it when I said I would do my best to get healthy in other ways.  Just give me a year, I pleaded.  I didn't want to antagonize her, she seemed fairly reasonable, and let's face it, where can I go next?  I'm running out of options. 

Maybe I am crazy.  

So, I sat myself down and did a personal inventory.  Many of my health habits weren't great.  I was overeating, this I knew.  It hurt to admit it, but there it was.  I took the Polar Bear's advice about the exercise, ok, I was going to do this thing, and from January 2012 to now I've managed to maintain a weight loss of forty pounds.  I'm still a long way from where I need to be on the BMI charts, which would be at least forty pounds more.

I took up the weight lifting with a vengeance right up until gardening season this June, lifting as heavy as possible three days a week, alternating with aerobics four days a week.  Not a day goes by I don't get in excess of 10,000 steps and some days, twice that.  I took up the Exerstriding and credit much of my firming up to that alone.  I joined a calorie counting website and spent exhaustive hours on online research reading up on resting metabolic rates, basic metabolic rates, activity levels and calories required to lose weight. (That's why I wasn't posting much, I was reading, reading, reading.)

  And exercising.

 I bought a food scale.  Everything I eat is measured and weighed, and there have been significant changes to my diet.  We eat home cooked meals as clean as possible, quality grass-fed beef from a friend's farm and eggs from the Girls in the coop here.

You'd think I'd be a Skinny Minnie by now, wouldn't you?  How big am I?   I'm 5' 9" tall and still a size 14/16, depending on the cut of the clothes.   And as of yesterday, I am still just over 200 pounds. 

Say what??  Did I just put that in print?  

Yeah, I did.  Because I think it proves something.

 I know my thyroid is not being adequately treated. 

Years ago, I saw someone on one of the thyroid forums had coined an acronym for TSH.  They said it stood for, 'Try Something Harder'. 

Try Something Harder. 

That's what the Polar Bear and just about every other doctor has told me over the years.  I wasn't working hard enough.  I didn't want it bad enough.  No pain, no gain.  There is no way I will ever find a doctor who will believe me about my thyroid status, so I guess I had to face it, this is all my fault.

Ok, let's hit the kettlebell workouts, and HIIT (high intensity interval training) along with Callanetics and of course, Leslie Sansone.  Lift heavy or go home.  I never did get into P90X or any of the 'Insanity' workouts since I do still have to work in the gardens here and couldn't afford to cripple myself entirely.  I did make it through the New Rules of Lifting for Women, which is a rigorous program I still plan to revisit, albeit with some modifications.   I still attend the aerobics class at our church twice a week, too.

 I've been told I look better than I actually weigh, if that makes any sense.

 I can't see much difference.

And by June of this year, I was feeling the effects of what I assumed was too much exercise.  Yes, I had more stamina, but I woke up each morning feeling like I'd been in a car accident.  My muscles weren't recovering from the weight lifting.  It is normal to have DOMS or delayed onset muscle soreness, after strenuous exercise, but this was a lot more than that.  My joint pain has never really decreased, but again, Fake it Til You Make It, or in my case, Break It.  I brushed it off as just the additional wear and tear of running this crazy garden here on top of the exercise, and decided I would take a hiatus from lifting heavy until fall.  I kept up with all the other exercise, though.

Fast forward to the 'What Have We Been Doing" series I was writing before this drivel hit the blog, and I can tell you this, what I was doing was going downhill.

  It was getting scary.

Here We Go Again Part 4

 I apologize for going on and on about this topic, but out of sheer frustration, I've decided to keep going.  Maybe there are some other people out there who can relate.

I've been told hypothyroidism is very common, so wouldn't you think the treatment would be simple?  Oh, if it was only that easy. 

Being a thyroid patient can be a frustrating thing.  It's a Numbers Game.  The most important number to most general practitioners and endocrinologists is the much revered TSH level.

The TSH test measures the levels of TSH or thyroid stimulating hormone that is made and released by your pituitary gland. Your pituitary can sense whether there is enough thyroid hormone in the bloodstream, and it releases TSH when it detects insufficient thyroid hormone.

 I don't pretend to understand most if any of the scientific study and research, but I am really, really familiar with the good ol' TSH as it relates to my well-being.   Dr. H was a slave to the TSH number, keeping my numbers on the high end of normal which kept my symptoms at the low end of 'I don't feel horrible, but I don't feel good'. 

 And once we owned a computer, I found out I was definitely not alone with my frustration.  There are several websites dedicated to the topic, Stop The Thyroid Madness is one, and an outstanding patient advocate I've learned much from is Mary Shomon.  I've joined online forums and have met many other people all going through essentially the same thing.  We're all, in Ms. Shomon's words,  'sticking our necks out' looking for better medical care and freedom from the rigid TSH regime.   There are scores of us searching for enlightened doctors.

After Dr. H bid me adieu, I was on my own, looking for a new physician.  I think it was 2000 by then.  (The year, that is, not the number of doctors I went through.)  I had one refill of medication left, and no idea where to start, but at least I had thirty days.  As luck would have it, I took my father to see his physician one day and he invited me to come into the exam room to discuss Dad's health.

 Dr. E was a Doctor of Osteopathic medicine, or DO, for short. Now here was a doctor who truly believed in family medicine for he knew my mother's name and remembered things my folks had told him from previous visits.  This was a doctor who probably would have remembered my pet cat's name; he was very caring. 

As a result of chatting with Dr. E at my father's appointment and incidentally bringing up my doctorless state and my thyroid struggles, his eyes lit up.

"I'd like the chance to be your physician.  Thyroid issues interest me."

Done deal.

Dr. E ended up being the answer to my prayers.  He was very knowledgeable on hypothyroidism,  and also open to new information along with being very willing to treat my symptoms by adjusting the medicine.  And speaking of medicine, he wasn't able to get Armour at that time, but he did prescribe a very similar med for me right away, one that contained both T3 and T4, not just synthetic Synthroid which is a T4 only medication.  Those were the best years of my life as a thyroid patient.  I started to feel truly well.

Imagine my dismay when a short two years later, Dr. E announced he and his family were moving to another state.  Now I had to find yet another doctor.

His interim replacement was a semi-retired MD who immediately refused to refill my prescription for the T3/T4 drug.  He took one look at my TSH levels from the lab work and said I was overmedicated on an inferior, antique drug and prescribed Synthroid again at a lower dose.

I protested, it had taken Dr. E and I some time to figure out the optimal levels for me, and I knew lowering the numbers and changing back to Synthroid wasn't going to work.    Synthroid is a good drug for many people, I'm sure, but it wasn't the gold standard for me.  I did better on the T3/T4 combination.

I told the temporary doctor I didn't want a change in dosage or medication since I knew I felt much better on what I was currently on.

"You'd feel better if I prescribed you cocaine, too, but I'm not about to.  Your TSH numbers are much too low; I think you're just looking to lose weight."  (I am not making that up, he really did snarkily say I'd feel better on cocaine.  Sarcasm was his strong suit.)

I was devastated.  Dr. E's former nurse told me to wait it out until a new replacement doctor could be found and maybe things would change.  I went back on the Synthroid and slowly started to slide back to feeling unwell again. 

A new doctor was hired for the practice, but no help would be forthcoming from him.  He didn't like the look of my cholesterol numbers, but he didn't like the idea of statins, either, and said he felt since I had no other risk factors, it was up to me.  I declined the statin therapy.  He, too,  would not prescribe Armour and the T3/T4 drug I had been on was no longer available.

 I got the same song and dance I'd had before, Armour was inferior, old-fashioned and made from ground up sheep thyroid.  Interesting how every doctor had the same rhetoric on the drug, but the animal it originated from continually changed.  (Armour is actually made from dessicated pig's thyroid glands.)  

I was kept on Synthroid and my TSH was held at the upper end of normal.  I wasn't feeling very well, but there was no budging from the doctor, nope, you're adequately treated according to the TSH levels.  Case closed.

I moved on in search of another good thyroid doc.  

Friends gave me recommendations, but usually I couldn't get in because their practices were booked solid or I found out they wouldn't treat the thyroid any differently either.  All I had to do was mention the word 'Armour' and they looked at me like I was an idiot.

 No way, lady.  Not gonna prescribe that stuff.

 I saw a doctor for about a year who refused to show me my lab test results until I demanded them.  I knew I hadn't been feeling well again, and when I saw the TSH level of 5.6, I was stunned.  I asked him why in the world was my TSH so high?  Historically, I felt my best at 1.0 or slightly below.  He said my current 5.6 wasn't high at all since years ago, 6.0 was the standard, and I was still below that number.

Wow.  The new standards had been set to 3.0 being considered the upper limit years prior, and I told him so.  Yes, he knew that, but he personally thought 3.0 was much too low of a number and preferred to keep his patients near 6.0. 

Wow, again.  Great idea, keep 'em coming back to see you because they feel awful.

"Would you like to try the newest antidepressant?"

No, in fact I would not.  I had weaned myself off of them when I was on the T3/T4 medication and hadn't felt a need to use them any longer.  Ten years was long enough. 

Next!  Time for a new doctor.

Meanwhile, back in the online thyroid communities, patients were still singing the praises of feeling so much better on Armour.  Not everyone, to be sure, there are still many people who feel just fine on Synthroid, especially if the doctor is willing to work with the patient to find the perfect level.  Not many doctors will do this, because if the medication is too high, it can push a patient into hyperthyroidism which is also not a good thing.  There is a fine line between too much and not enough and most doctors like to err on the side of caution.  I guess I don't blame them, once again due to lawsuits, but far too many people like myself are chronically under-treated and left with lingering symptoms of varying degrees.  I was jealous of those who were able to obtain Armour. 

Finally, I found an endocrinologist whose practice was about fifty miles away.  His nurse said he was open to working with patients on optimizing their treatment.  I found he wasn't open to prescribing anything but Synthroid, but if he was willing to tweak the dosage, well, it was better than nothing.  He was a doctor who did order the TSH tests, but didn't necessarily go by just a number on a piece of paper.  If I told him I didn't feel well,  he was willing to increase or decrease dosage at my discretion.

We had a true doctor patient partnership with the respect going both ways, but nothing good lasts forever.  A year later, his wife was transferred to another state and I was stuck looking for yet another MD.

So there you have it, this leads me back to 2010 and my experiences with the clueless Nurse Practitioner who sent me for a ride in an ambulance and a no-expenses paid night at the local hospital.  That was expensive and truly not fun.

Then, on this list of who's who in my dysfunctional wellness quest, let us not forget the Polar Bear MD of 'Walk 10-15 Miles a Day Fame' who came recommended from a cousin of mine (so far, she was one of a kind, thank goodness) and then yet another endocrinologist who seemed really bored with his job.  He was also a strict devotee of the Magical TSH range, sorry, if you don't feel good at the Magical, Mystical TSH number plucked from the Air, too bad, so sad.  He eventually left his practice, too.  I cannot even recall his name.  I'm sure he can't recall mine, either.   Marge...was it Marge? 

For those of you keeping score, stay on your toes, there may be a quiz later.

I was also sent to a rheumatologist who chewed me out for wasting his time since I wasn't a candidate for that disease.  He did manage to diagnose my sleep apnea, however.

 I didn't have rheumatoid arthritis, thank goodness, but he figured out I snored and it turns out sleep apnea can bring on symptoms of arthritis. 

I'm still waiting for my somnologist (sleep doc) to fix my thyroid.

Or finish Castle Aaargh.

Either one is a challenge.

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.

Here We Go Again Part 2

When we last left this saga, I did indeed go back to Dr. H.  To this day, I regret that decision.  His demeanor at my visit the next day was one of joyous frivolity, gosh, wasn't I happy that I had such good results?

Never once did he apologize for his part in this error, but he did place blame where he felt it was entirely due, onto the hapless ultrasound technician, who 'didn't have adequate training' and who was clearly 'inept'.  She was going to be given a firm reprimand and/or lose her job if he had anything to do with it.

"I can only diagnose with the tools I have at hand, and the ultrasound measurements the technician provided clearly showed the fetus to be at 12 weeks gestation.  Therefore there is no error on my part, you understand," he said, with a broad smile on his face.   "Now we can move forward and retest again in a few weeks."

I told him there would be no need, since my new friend, the Ob-gyn, Dr. S. assured me that his office would handle the next test.  This took Dr. H aback a bit, his puffed up attitude slipped ever so slightly and he said he was a bit saddened to hear this, but if I felt it was absolutely necessary to involve Dr. S, he would be fine with my decision.

 I could tell he wasn't 'fine' with it, in fact I know the very thought Dr. S was going to be basically supervising this pregnancy was a decided thorn in his side. After the chewing out Dr S had given Dr. H over the phone in my presence, I could tell his fake veneer of confidence wasn't as perfectly polished as before.

I would have had more respect for him as a physician and as a person if he would have apologized to me for his mistake instead of passing the buck to the ultrasound tech.  I know doctors are constantly at risk of being sued for malpractice and part of the reason our health care system is so exorbitantly priced is due to the lawsuits and the insurance doctors must carry to protect themselves financially.  But a simple and sincere apology would have done a much better job of soothing my anxiety than his arrogant placing the blame on someone else.  After all, if Dr. S could simply look at me and believe my account of my due date, why couldn't Dr H have listened in the first place when I repeatedly told him I was only two months along?

Oh, well.  I know.  Let it go.  And I did.  Thankfully, the pregnancy went along smoothly, though in the back of my mind, doubt lingered.   On the last day of June, 1990, David made his entrance into the world.  Like all new mothers, I counted each precious finger and toe and sobbed with relief that he was finally here, safe and sound and perfectly healthy. 

A different doctor had attended the birth, since Dr. H was on vacation.  I wasn't sad about that.  By this time I had been seeing Dr. H for four years, both as my general practitioner and Joel's doctor, too.  I know doctors see a lot of people in their practice, but wouldn't you think they would kinda sorta remember faces just a wee bit, or at least check the chart before they come into the hospital room?  I mean, I don't expect the man to remember what my pet cat's name is or anything, I'm not that silly.

But the morning David was born, Dr. H appeared on his rounds.  He came into the room, all smiles, and congratulated us on our new bundle of joy.

"Marge, congratulations!  Let's see the new baby!  Sorry I missed your delivery, but I hear it went just fine.  And I cannot get over how good you look for being a first time Mom!"

Um, well, I wasn't a first time mom, he'd been seeing me as my GP for five years and Joel for four years, but I thought, ok, he's a busy guy, I guess.  I did tell him my name wasn't Marge and this was Baby Number Two but he didn't really seem to hear me.  

I wasn't depressed after Dave's birth, which was a blessing. I was very, very tired, but then who isn't at that time?  Dr. H came back one more time the next day before we were discharged from the hospital and wouldn't you know, he still called me by the wrong name and once again, complimented me on my composure as a first time mother.  Carl was there with little four year old Joel, too.  Carl looked at me quizzically but I didn't attempt to correct him again.

All you can say is, "Oh," and let it go.

Things went along swimmingly for a few months but the fatigue was ever-present.  Dave was a very easy baby to care for, almost too easy, for he slept through the night nearly a month after coming home.  I was getting adequate rest, but upon waking every morning I felt as if I'd never slept at all.  I was anxious, moody, and depressed.

After two years,  I was feeling awful.  I talked to Dr. H about my symptoms one more time which in the previous two yearly physicals were still brushed off as new mom-itis.  I had two young children, of course I'm tired, try relaxation, etc.  You're normal.  All your blood tests look fine, except for my cholesterol levels, which were borderline.  Here is a new low-fat diet.  And I should lose weight. As for the depression, maybe you just take life too seriously. Would you like to start on an antidepressant? 

I declined.  Ok, I just had to get myself in hand and start watching my diet.  I can do this. 

But I couldn't.

I was well aware I wasn't a Special Snowflake and that other people had it much harder than me, I wasn't holding down a full-time job or running marathons, but I felt completely overwhelmed by everything.  My emotions were all over the place, from high to low, I was so miserable.  I knew it was getting worse when I couldn't summon up any enthusiasm for anything, even gardening. 

Carl and I had been  attending the local garden walks for years and always looked forward to seeing the beautiful yards on display.  But I was now in a spot where I didn't really want to leave the house anymore.  I had horrible, panicky feelings and the only place I felt safe was home.   I told Carl I didn't think I could handle going on the annual garden walk that year, but he encouraged me.  I know he was worried and I felt guilty for letting him down, so we went.  It was a hot day in July and I could barely walk down the street.  I felt so useless.  I was only 34 years old and creaking along like a little old lady. The headaches were now with me twenty four hours a day.

The last straw was ironically, at the Hamburger Parade in our little town of Seymour in August of 1992, a few weeks after the garden walk.  We were seated in our favorite spot on Main Street and both six year old Joel and two year old Dave were having a good time watching the floats and tractors going by. 

Out of the blue, I started to cry.  Not loud wailing or anything, but the tears started to fall and I could not stop them.  My greatest fear was coming true, I was losing my mind in public.  I made an excuse to Carl, told him to finish watching the parade with the boys, and beat a retreat to the car.  There I sobbed uncontrollably over nothing.  I was so sick and tired of being sick and tired. 

When we got home, I still couldn't stop crying.  Carl and our little boys were worried, my mother came down to see me and was scared, too.  Even my father came in the house to talk to me, and for the life of me, I couldn't pull myself together.  I loved my dad, but I feared him, too, and he hated to see any show of emotion.  His mantra my entire childhood was, "Stop your crying or I'll give you something to cry about," so at a young age I learned to stuff any display of emotions, especially negative.  But there I sat, a 34 year old woman, bawling in front of my father who was thoroughly disgusted. 

"What is wrong with you?" he asked, highly exasperated. 

"I don't know," I blubbered. 

"Well, there must be something wrong, stop that right now!  You don't want people to think you're a nut, do you?  What are you bawling about, anyway?"

I cried harder and shook my head.  I had no idea what was wrong with me and no words to express the feelings. 

Dad left in disgust, shaking his head in derision.   I was now in the dog house with him, too.

I was amazed at my bravery in his presence, and yet also more worried than ever for my sanity.  I hadn't stopped crying even though I was commanded to.  There must really be something wrong with me.

 Dad had issues with depression of his own, though we never talked about it.  He medicated his demons with alcohol, but his mood swings were wide and rapid.  I saw alcohol as a blessing, not as a curse.  He was usually always jolly when he was drinking.  It was the sobriety that was hell.   I spent my childhood walking on eggshells around him, gauging his mood to see how I should act and feel.  He had a violent temper but what was worse was his usage of the Silent Treatment to punish my mother and me. 

Dad could go silent for up to and over a week or more, acting hurt and stiff, pretending we did not exist.  As a kid, I had no idea what I'd done wrong, and tried to win his affection, but the rejection was cold and swift.  I learned at a very young age to walk a wide berth around him when he was in a mood.  Sometimes, he would talk to my mother but not to me.  That was the worst, because being completely ostracized was pure pain for me.   My mere presence in his vicinity when he was angry with me rankled him, his body posture and abrupt leaving a room if I walked in was horrible.  As I grew older, I still had to work with him on the farm when he was giving me the cold shoulder, and there were times he put me in physical danger due to his contempt.  I felt abandoned over and over again.  He never got over his use of the Silent Treatment, either, carrying on with it for the rest of his life. 

 I grew up to become a humongous, anxiety-ridden People Pleaser and true chameleon as a result, always trying to be accommodating and pleasant, but also very shy.  I made it a habit to stay in the shadows and the background, hoping against hope that no one would notice me.  If someone stepped on my toe by accident, I apologized to them, because it was obviously my fault my toe was in their way.  To this day, there are still people I graduated high school with who didn't even remember seeing me in school.  I guess that's why Dr. H called me Marge?  See, I was doing a good job being a chameleon.   I did a lot of roaming around the farm at night after dark.  Darkness has always felt like a comforting cloak to me.  No one can see me, no one can criticize. 

So there I was, a blubbering mess.  I felt like such a self-pitying fool, I had a good life, there was no reason to be depressed.  I was certain it must be a mental illness.  Knowing I wouldn't get anywhere with Dr. H, I finally located the number in the Yellow Pages for the Crisis Center.   I have had no experience before or since with any Crisis hotline, but I figured what did I have to lose?  My mind was already well on it's way down the road.

I remember the conversation so well, the lady on the other end of the phone was wonderful.  She asked me my name and through my stuffed up nose and recurrent breakthrough sobs, I managed to spell it for her.  She asked me what was wrong.

"I don't know.  I'm at the end of my rope.  I can't stop crying, I don't feel like life is worth living."

"Are you suicidal?" she asked.  "Have you had thoughts of harming yourself?"

For some reason, this question struck me as funny (I told you I was losing my mind) and I half-heartedly laughed.

"Yes, I have had thoughts of ending it all," I said, "but the effort involved in finding a way to actually kill myself seems like way too much work right now.  I'm just too tired."

She seemed to take heart at that statement, and asked if there was anyone else there with me.  Carl talked with her and assured her I wouldn't be alone until they could see me the next morning. 

"We're setting up an appointment for you to meet with a psychiatrist, Dr. T at 8:00AM tomorrow morning.  I am sorry this is happening to you, but once you see him, I guarantee you, you'll feel SO much better, dear," the lady said.  "If you are feeling worse and don't think you can make it through the night, please call 911.  We look forward to seeing you tomorrow."

I wasn't sure.

Wednesday, August 21, 2013

Here We Go Again

I am interrupting my scheduled What Have We Been Doing Part 5 programming to bring you all this recent news flash:
I Feel Awful.

For those of you who really don't want to hear my sad tale of woe, I don't blame you....I don't either.  But I'm still going to write about it because it makes me feel better.  
Sort of.

Yes, Chronic Karen is back on a hypothyroid-induced roller coaster.  Some people call roller coasters 'thrill rides'.  Well, that may be, but so far I haven't had any fun on this ride.  

At all.  None.  Zip. 

And I really don't want to end up where I was in 2010 being hauled down the highway riding backward in an ambulance, either.  I've learned my lesson; I won't be tossing around vague questions about heart health that nervous practitioners take seriously.  Because when you're strapped to a gurney in the back of that truck and the siren is wailing, well, it's a little too late.  

(If you are unfamiliar with that episode and provided you are interested, I refer you to this post from 2010:  Karen Gets Taken for a Ride )

Why am I posting about my aches and pains?  Well, mostly because I can't do much else right now.  I'm so bone tired.  My head ache is unbelievably bad.  My joints hurt.  My heart bangs around like a crazy moth trying to get to a porch light.  I'm weak.  And I cry.  No, wait, I'll take that back, I don't just cry, I Weep.  Profusely.  My eyes are so sore they are mere slits.  And then just as suddenly, I can find the humor in the whole situation and laugh which makes me wonder for my sanity.  My sense of humor is about the only thing keeping me going right now.  God help me when that goes.

As I sit here writing this, I'm waiting for the results of blood work drawn yesterday afternoon.  I hate waiting. 

So I will write.   Maybe some of you can relate to my experiences.  My hope is not many of you, though.  It's no fun, is it?

I was first diagnosed with hypothyroidism way back in 1992.  Our youngest son David, was two years old, Joel was six and Carl and I were 32.  I was having horrible trouble with headaches, insomnia, joint aches, crushing fatigue, full-blown crying jags, hopelessness, despair, and weakness.  My weight was going up at a steady rate and my hair was falling out.  My hands and feet were always cold, but curiously, hot weather nearly incapacitated me.  I would feel faint and nauseous in the hot sun.  My feet, especially my heels, were so sore it felt as if bones were broken.  After sitting for a little while, walking the first five feet or so was pure agony, I felt like Dorothy from the Wizard of Oz forgot to oil the Tin Man.  I swear I could hear the joints creaking.  

I did have a doctor in those days.  As I've written before, I have not had great luck with doctors over the years.  I suspect it is because I have a fear of authority figures.  Well, maybe not a fear, per se, more like an unhealthy respect for people who are supposedly professionals and 'In Charge'. 

 Doctors, in their lab coats and with stethoscopes, always intimidate me.  I know this goes way back to my childhood and mental abuse, so when I can think things through rationally, I can see where I play my own part in setting up authority figures as little 'gods'.  Far too often in the past I have given people the power that rightly and justly belongs to me.  And apologized to them for troubling them with my problems which were obviously all in my head, to boot.

Case in point, the early undiagnosed thyroid problem.  I had a whale of a post-partum depression at age 28 with our eldest son, Joel.  Baby blues are normal, they say, and the doctor at that time brushed it off as just that, baby blues. 

"It's due to your fluctuating hormones, once you get through the first month, you'll be all better," the doctor said.  But since I had to have two blood tranfusions due to a forceps delivery, the doctor did look at my iron levels and prescribed a supplement or, in his words, "It would take me a long time to crawl out of the mental and physical hole" I was in. 

When they handed me baby Joel in the hospital for an attempt at a 3AM feeding, the tears would not stop flowing.   I was an emotional wreck.  Through my tears I whispered, "Oh, you poor, poor baby.  All you have is me to take care of you and I don't know what I'm doing." 

 I tried so hard to keep it together, but just couldn't.  I wanted to breast feed  but try as I might, it wouldn't work.  One of the nurses was genuinely concerned about my mental state and I do remember her asking the doctor if there was a possibility it was more than just the blues.  No, it was decided that the low iron level and the postpartum was the cause.  Just take your iron and relax.  Congratulations, you are a New Mom!  This should be a Happy Time.  And it should have been.  We had a healthy, beautiful son, what more could we ask for? 

We went through a nightmare after we got home from the hospital.  I couldn't stop crying, my milk supply was non-existent.  Joel was crying, I was crying, Carl was frantic.  God bless Carl, he was a saint.  He had taken off two weeks of work to ease our transition into parenthood and was just as sleep deprived as I was.  I pumped what little milk I had and we attempted to feed our baby with a bottle as he could sense my anxiety and refused to latch on.  I felt like a complete and utter failure.  We eventually switched to formula.  (But I did use cloth diapers to save money.)

I had worked full-time at an insurance company for the first ten years of our marriage and had worked right up until the day I delivered.  I intended to become a stay-at-home mom for we were now at a financial place that wasn't too bad; our house was nearly paid for and we had a small nest egg.  Still living on one paycheck has it's scary times, but we know how to stretch a buck.  What I'm saying is we don't lead a lavish lifestyle.  Once Carl went back to work, I had a very hard time with the anxiety of being home alone with an infant.  I'd never changed a diaper in my life; never babysat.  Yeah, I was green as grass and profoundly depressed.

About three weeks after Joel was born, work called me and asked me if I wanted to come back full-time.  The thought was tempting.  I wasn't feeling much better, and I was lonely.  My mom would come down to see me once or twice a day but my father was not happy about it because that meant she left him home alone so her blessed visits were always fraught with anxiety and tension.  I would simply try to wish the hands on the clock forward to 4PM when Carl would come home.  

When I went in for the newborn checkup, I mentioned the terrible depression.  The doctor pooh-poohed it.  Nothing to worry about.  After all, it will take time for the iron levels and my other hormones to stabilize.  

"You're a new mom, that's very common," he replied.  "Try to take time for yourself.  Relax.  Go to a movie."

Ok, I gulped back the tears and tried to smile.  

"See, it's not so bad, now is it?  You'll be fine."

So I stumbled back home and somehow or other poor Joel managed to survive his infancy.  As time went on, I did feel a little better, but it took almost six months before I saw light at the end of the tunnel.

I never felt great, but what I was good at was faking it til I make it, and I Faked On.  What else could I do, there wasn't going to be any help forthcoming.

Then I became pregnant with David four years later.  Everything was ok with that pregnancy until the second month when I started bleeding a bit on a Friday afternoon.  The same clueless doc told me I was probably going to miscarry.  If I hadn't obvious signs of a miscarriage by the following Monday, I was to make an appointment to see him for a D and C. 

Monday came, I had no further bleeding,  and in I went.  I asked him if he could check for a heartbeat.  He looked at me rather impatiently and said, "Well, I think it's a waste of time, but ok."

I searched his face as he wielded the stethoscope and finally he stopped abruptly.  "Well, I'll be.  There is a heartbeat.  Huh."

He gave me a hand up off the table into the sitting position and then announced I was going to have an ultrasound to see what was going on.  I had to wait a few days, drink a whole bunch of water, and then found myself on another exam table with a nervous young girl scanning my barely there tummy with a wand.  Once again, I searched her face anxiously, and though I asked, she said she couldn't say anything.  She did whisper that as far as she was concerned, everything looked normal and finally turned the screen to let me see the baby moving.  I was elated. 

Later on that day, back home, I received a phone call from the doctor's office. "Doctor has reviewed the ultrasound results and has determined you are three, not two months along.  We will be running some blood tests and will get back to you with the results."

I argued that my dates clearly pointed out that I was not three months along, but only two.

"You may think you know your dates, but ultrasound clearly indicates the size of the fetus and through measurements, we know you are truly three months along."

Ok, well, I guess I was wrong.  Huh.

The blood work was done and on New Year's Eve, 1989 I received another phone call from the doctor's office.

"The blood tests reveal your baby has a high likelihood of Down's Syndrome.  Doctor would like you to become educated before you deliver on the topic, so here's a list of reading material to prepare you.  Oh, and Happy New Year!"

I sat there, stunned, and thought I was surely dreaming.  I told Carl the news and went to our bedroom and laid down on the floor.  Then, I got back up again and called the doctor's office right back.  I told them I wanted an appointment right that afternoon, I didn't care it was New Year's Eve.  Somehow, we got in, I'm not sure how, but there we were, sitting in a conference room with a very impatient MD.  I suppose we were keeping him from a cocktail party or something.

"What do you want me to tell you?" he asked.  "Do you want me to guarantee you a healthy child?  I am not God, I cannot do that.  And IF you are here to talk about an abortion, then you will have to find another doctor.  I'm just telling you that the results of the alphafetoprotein test came back conclusive for Down's Syndrome.  We won't know how severe it will be until the child is born, that is, if you carry to term."

Abortion?  What?  Who said anything about that??  It was the farthest thing from our minds and here he's acting like we were demanding a termination of the pregnancy.

This was before the internet, so I had no place to turn for information.  I countered with, "But does it make a difference when the test is run?  Maybe if we rechecked it would be different?"

"No, there is a narrow window of time that we check the alfa-levels and since you are in your third month, this is when it is done.  If we wait too long, the result won't matter. "

I said, "But I still say I'm in my second month," but before I could finish that sentence he shot me down.

"No, I've told you before, the ultrasound test is the definitive test to determine the age of a fetus.  We take careful measurements and there is NO doubt you are in your third month.  Women's cycles and your memories of when your last menses was are faulty.  Science is not faulty.  You could elect to have an amniocentesis done, where we would use a fine needle to remove some amniotic fluid and see what the extent of the problem is, but I don't do that procedure, you'd have to see a specialist."

Through my tears, I told him to bring on his specialist.  I had to wait until January 2, 1990, but I did manage to somehow drive myself to the hospital on a terribly snowy, cold day.  The specialist was a big man, very quiet, and asked me to lie down on his exam table.  He pulled my t-shirt up and stood there for a moment, not saying a word.  He never touched me.

I had been having crying jags for days and was so nervous I was about ready to shake off the table, and this big man's quietly staring at my exposed belly was rather unnerving.

He finally said, "How far along are you?"

"Well, I think two months, but my doctor says three, according to ultrasound results."

"I agree with you," he said.  "You certainly don't look three months pregnant.  Well, we will get you ready for the amniocentesis, and I'll see you when you're ready."

So, I drank the gallons of water they prescribe, ok, it's a quart or three, but seems like an ocean, I don't remember, and then I shakily climbed up on the ultrasound table again.   The specialist came in the room, took one look at the picture the ultrasound tech was displaying on the monitor.  Then he took the wand away from her, did some exploring of his own and stopped.

"Get me Dr. H on the phone," he tersely told the nurse.

While he was waiting for a connection, he turned to me and said, "There is nothing wrong with this baby.  And you are indeed correct.  You are only two months pregnant.  The test was run at the wrong time and that is why the results came back for Down's.  I am so sorry you were put through all of this worry for nothing."

Then this very quiet man became a very loud one when he was handed the phone. 

"I have your patient on the ultrasound equipment at this moment, in preparation for an amniocentesis.  I have one question for you, do you ever listen to your patients?  She is clearly only two months into this pregnancy and has told me, and apparently, you, the same thing before.  But you chose to ignore her wisdom and went ahead and ordered a test a full four weeks early for no good reason. Then she is given devastating news and put through untold stress which, I may educate you with, is certainly not good for either the child or the mother!  I would not blame her if she brings you up on malpractice."

Wonder of wonders, the arrogant Dr. H asked the specialist if he could speak to me.  I was still lying flat on my back with a distended bladder which was very uncomfortable.  And I was crying silently as this conversation was going on from relief and depression and frustration and weariness. This was good news, truly it was.  I was thankful.  But what an emotional drain.

The specialist grumbled, "Dr H. wants to talk to you, do you want to talk to him?"

I took the phone shakily and mumbled hello through my tears.  Dr. H was all apologetic and happy-sounding, gee, isn't this Fantastic News?  And good golly, who knew?  And would I possibly have the time to come and see him tomorrow at his office?  

I said OK. 

Why?  The specialist was shocked to hear me say it. 

"Are you sure you want to go back to see him?  I would take over for him for this pregnancy if you would like."

WHY didn't I say yes to the Nice Specialist? 

Because I wasn't thinking straight.

I asked him, "Is your practice strictly Ob-gyn?"

"Yes," he said.

"I'd have to find another doctor for my four year old son, too," I stammered, and broke down again.  I had to pee really bad by this time, it was Urgent.

The specialist kindly left then, and asked me to stop in at his office after I was dressed.

He once again assured me nothing was wrong, it had all been an error.  He apologized for the ineptness of Dr. H, reminded me I could make an appointment for my next pregnancy checkup with his office and sent me on my way with a warm handshake and a solemn wish for my peace of mind.

And what did I do?

I went back to Dr. H.