Saturday, June 23, 2012

Lack of Common Sense: Travel Prob #1

I leave soon for a trip. I have two problems with airplane travel. The first one is having to keep my medication cool. I will deal with that soon. But I tried to tackle the second one a week ago. I have to inject said medicine with pen needles.

I am supposed to dispose of these needles in a proper manner. That means having my very own Sharps container. What is that? Well it is that hazardous waste container you usually only see at the docs office. I have my very own right now. It is a 3 quart version. It was the smallest my QFC had available for purchase.

So I went to another store that I frequent sometimes to and from work. I never get prescriptions from their pharmacy and thought I would ask their advice on how to get a smaller Sharp's container. They said they could only order a 1 quart container. My pen needles are only about 3 centimeters by 3 centimeters. I don't need to travel with such a large container. And that takes up a ton of space for a carry on. And you are supposed to travel with all your meds and supplies with carry on.

I got home and checked online. Sure enough. There is nothing smaller than a Quart that is hazardous waste appropriate. At the pharmacy, I asked what they suggested. The guy said, If I was your friend and not your pharmacist, I would tell you to take an old prescription bottle and store them in there until you get home and then put them in your Sharps container.

I am going to pretend he was my friend and do this. But if I had money, I would create my own Sharps travel product. There are enough travelers in the world that would benefit from something like this that is cheap. I am just flabbergast there is not a container already out there. Sheesh!  

Saturday, June 16, 2012

And I Thought I had it Bad

One of the most demoralizing things that happened in the last year was after I completed my first half marathon and was starting training for my second half marathon. It was actually the tipping point for my general medicine doc to send me to specialists (so I guess it had a silver lining). It was the fact that I had gained 30 pounds.

A little back story. I do not weigh myself anymore. Only once since I stopped figure skating have I attempted to do so and it was as bad as when I was figure skating. I become obsessed. How low can I get the number to go? When I figure skated, we had weekly weigh ins. They were horrible events where you stepped on a scale in front of a whole group of people in a little leotard. I have numerous little tales about abuses that went on during these weigh ins that I think I will keep to myself.

But back to my 30 pounds gained story. I was completely shocked when she gave me this news. I knew I had not lost as much weight as I thought I would with all the training and cutting of food, but never had I thought I had gained weight. I was eating so little at that moment, I did not think I could cut anymore food without getting a completely light-headed feeling that makes you almost feel like you could pass out. That gives you an idea of how much I could cut food out of my life.

Fast forward to meeting with my Metabolic Doctor and relaying these events to her. Once I got through the whole story with a few more details, she started chuckling. Not the reaction I would expect from someone who is an expert in this type of field. And she had been so sensitive before. And then she said, "You think you have it bad? I have another patient who was sent to me because she was training for an Iron Man competition and gained 80 pounds."

Well that pulled all the wind out of my self pity sails. I can only imagine how frustrating that would feel. It is easy to be down in the dumps when you see no one around you having the same troubles you have. Leave it to the doc to give you some perspective!

Capt Mel

Friday, June 15, 2012

12 Week Check up! Insulin Resistance Factor

Tuesday was my 12 week checkup, but 'all things work' has consumed my time. First piece of news is that nothing is bad. And that is really good news. So here is the updated list of info after 12 weeks of treatment:

- My Cortisol is much lower (this is good)- This improves metabolism a tiny bit, but also helps reduce excess fluid retention. 

-Reproductive hormones look OK, but still need to monitor in next few months and watch for PCOS.

-Fasting Glucose best yet and average glucose in normal range (no where near pre-diabetes). This is very very good!

-Vitamin D is getting much better

-B12 and K are very good

-iron levels are much better

-Thyroid is good

- Blood Pressure is a little better

-Insulin resistance is very strong. Test results are showing a need for aggressive medication to untangle the kinks in metabolic machinery. (This is the not so good part of the results). 

First, let's go back and investigate Insulin Resistance because people have no clue what it is all about (and don't worry, I will attach my resource links as endnotes because I don't plagiarize). Wikipedia gives us a nice overview. It is a physiological illness where insulin (a hormone) is less effective at lower blood sugar levels. Seems simple on the surface, but how is it different than diabetes?  Well Type 2 deals with insulin deficiency (which if insulin resistance is left untreated over time can turn into Type 2 Diabetes, and Type 1 deals with the body not being about to produce insulin.

Marcelle Pick (OB/GYN NP) also has a nice explanation of Insulin Resistance. She talks about if insulin spikes too often by high carbs than your cells and brain will prevent and decrease the amount of insulin receptors. And then "eventually, this prevents glucose from getting into your cells, leading to high blood sugar and depriving your cells of the energy they need to function. This is why many women with insulin resistance experience carbohydrate cravings, fatigue and weight-gain — their cells are literally starving for energy, even when plenty of glucose is available in the blood" (Women to Women). Unfortunately, what she fails to address is other factors that can cause insulin resistance besides just having a lifestyle of unhealthy food and no exercise. Doctors have known for over 20 years there are also genetic factors, environmental factors, and even lack of food, and extreme exercise factors that can cause insulin resistance. Maybe I will save the stuff I have been told about starvation and your mind choosing not to burn energy, but to store fat for a later blog. I hope that helps with insulin resistance.

So what is on the docket for my next 6 weeks (18 weeks of treatment)?

1). Step up treatment approach for insulin resistance
-Add Topiramate (have an interesting story on this drug and Pharmaceuticals and diet pills from the 1970s for a later time).
-This helps lower a NPY neurotransmitter that signals starvation and directly slows the metabolism.   

2). Keep increase Victoza to maximum dosage in next 2 weeks. This is the hardest to do because every increase causes nausea for me until my body is used to it. 

3). Keep my Metformin the same until Victoza to maximum level then 1 week later start adding in a morning dose. 

4). Reduce B12 from 3,000 IU to 2,000 IU daily

5). Reduce Vitamin K from 4,000 IU to 3,000 IU daily

6). Don't change anything else. So keep taking a multi-vitamin, 10,000 IU of Vitamin D, 1,200 IU Omega 3, prescription Iron supplement, Blood Pressure med, and Thyroid Med daily. 


And modifications will probably happen again. Most of the 6 week checkups are to find out what is working and what needs modification. While the Victoza is definitely helping with my digestion of food, if we can't get it to start helping the insulin resistance, we have another med I will have to try. Breaking the insulin resistance is what is going to be the trickiest, but is what will start having me loose weight (which I know some people are waiting for with bated breath). 

It is funny. When someone has a broken arm and is in a cast, no one ever states, "well, it doesn't look like it is being fixed," or right after it is taken out of the cast someone usually does not bellow out, "Oh my, your arm does not look that healthy!" But something my doctor and I talked about is how to deal with naysayers who don't believe I am sick. It is hard when my only improvement has been internally and not externally. Even though I have said from day one that this will take 3-4 years to work out, they think they will see some kind of miracle weight loss over night. This is not the first time my doc has had this conversation. It is one she has had to have time and time again with her metabolic syndrome patients that have obesity as a symptom. Believe it or not, she has metabolic syndrome patients that are not obese, but have a symptoms I thankfully do not have: high cholesterol and clogged arteries.  And that is something to be thankful for! 

Until next time... when I will have lots of funny tales and anecdotes, 

Capt Mel

Thursday, June 7, 2012


Next Tuesday, I have my 6 week check in with my doctor. I had my blood draw this last Monday and in total, I will have had 12 weeks of treatment. I must say, many of the things that I was told would happen have come to fruition. I first I had a burst of energy, but now, while I am not exhausted, but definitely tired at the end of the day.

I am still having trouble in the morning with my medicine. I wonder if this will stay the same or get better. I am within .2ml of where I am supposed to be with my injection medicine, but I rarely find relief with the nausea in the morning. I am also supposed to add metformin back into my morning dosage once I am at 1.2ml of victoza.

But, this statement is not one of wanting to call uncle. There are too many positive signs with my treatment. If you ever read the literature you get with your prescriptions, many times it has a statement that is similar to this: Remember your doctor believes this treatment will have more positives outcomes than the negative side effects.

But it is not easy. I am looking at 208 weeks of treatment. I will only have 12 under my belt. And some of my anticipation has to do with my visual appearance. I can't help but be a tad self consciousness. While I don't think I have gained any weight (unlike the first 6 weeks), I don't feel like I have had any significant weight loss. It feels weird to tell people I have to eat a meal. It could be just my own guilt, but I think people are more comfortable (or less judgmental) when they are around fat people who do not eat. I will persevere.

So cross your fingers, hope for the best, and maybe there will be some positive results!

Capt Mel