I Miss the Old Market Street Pharmacy ~ Or how I got yelled at

There was one thing that John Stimac would never do, and that was yell or get mean with you. He was the owner of The Market Street Pharmacy that now in its spot is some icky looking restaurant with a Monkey in title. It was one of the last Mom and Pop Pharmacies in Seattle before he retired and closed shop.

Now that I have a lot of prescriptions because of this whole Insulin Resistance, Metabolic Syndrome, PCOS stuff, I am using the QFC just a block down from me at the moment. Some sort of wires got crossed on my last doc visit.

Someone did not call in and order more refills on some of my prescriptions. So two of them had no refills when I called on Monday night to get them refilled. The automated thing asked me if I wanted the pharmacy to contact the Doctor to get them authorized. I said yes. It told me to call back two days later to confirm the prescriptions were being filled.

So I called today. They had not been filled. In fact, they had not even made contact with the doctor. They had faxed the request and had not heard back. What if they had not received the fax? I run out of pills after tomorrow. Might not be a big deal to you, but my Doc's office is only open Monday through Thursday.

So I explain the situation. They get the Pharmacist on the phone. He gets all mad and grumpy with me. I tell him I would have done something if I had known there was a problem with getting in contact with the doctor. But no one contacted me. I told him I was a teacher in back to work meetings and prep the last two days and was only following directions. He finally acquiesced and is going to give me an emergency prescription through Tuesday, but he basically threatened me and demanded the doc get a hold of him after the holiday.The nurse at my doc's office has several frantic emails from me. He is great and I know will take care of it. The nurse probably thinks I am kinda freakzoid now too.

This is all lamesauce.    

Stubborn Personified Medically

For better or for worse, I am not one to back down. That is sometimes labeled as stubborn. As long as it is monitored and kept in check, I don't think it is necessarily a bad trait. But when it comes to medicine and health, having a stubborn or persistence problem is a real pain.

You might be thinking the results of my latest six week blood test was all doom and gloom. Well that is not the complete case. Let's start with the good:

-Glucose Levels continue to be normal range and excellent
-Blood Pressure best yet. Keep meds the same
-Cholesterol panels still good
-Thyroid OK. Keep same meds
-Liver and Kidney functions are good ~ this is really important because of all the medicine and supplements I am taking.
-B12 is perfect. Keep taking same dose of supplement 

Now for the semi OK news. At first, this will seem like Kermit the Frog, throw your hands up in the air, and scream news, but then, let me explain: 

-Weight has seemed to stabilize and has even slightly decreased.  

I know what you are thinking. This is what your regular doc was so perplexed about in the first place, so actually loosing a little weight is super good. Well my specialist doc thinks this is from the drug Topiramate. If you remember from an earlier post, this is a drug that triggers a receptor in the brain and then works with your digestion (smoking can sometimes trigger the same receptor a little bit ~ But smoking is really really bad). To really deal with the Metabolic Syndrome we need to tackle what has not been really been conquered yet. Now for the not so good: 

-Insulin Resistance is very strong
-Leptin resistance is still ongoing
-Testosterone is elevated and Estrogen levels are low due to PCOS and insulin resistance

Oh yes! A new diagnosis! Many ladies with Insulin resistance also have Polycystic Ovary Syndrome (they are not sure which one causes the other). You may remember I was taken off birth control 12 weeks ago because my doctor believed I had it, but birth control is used to treat the condition (wow! This drug used for something other than non-pregnancy!). The results are positive. Boo.

So what is next? We are upping the Topiramate a little bit because that does seem to be working. We are leaving all other meds the same. I had a lot of trouble with Metformin causing an upset tummy/digestion with the added morning doses. So my doc wanted me to try and take more with my evening meal; three and maybe four pills because I had no troubles with the dinner pills. She said it did not matter taking all at once. Well, I have been taking three pills for a few days and all seems good. I will take four pills on Monday.

I have been experiencing some nasty lady trouble with PCOS, but I can't go back on birth control with treating Metabolic Syndrome. Well I could have a few months ago, but the FDA took all estrogen only birth control off the market for a while (I will go into this outrage in another post ~ Losers). So she is having me try a supplement called Inositol. There are two types. The one to try and help PCOS is the myo form. I am supposed to take 1000mg, but Super Supplements only had a pill form of 750mg. My doc thought they would have a powder. They were sold out of a powder that came in 500mg packets, but they were not sure if it was the myo form.

The last little potential hiccup (more of a pain in the butt for me) has to do common colds. One of my cabin mates on the cruise got a common cold during our trip. In turn, all the other cabin mates got a cold when we got back. Well, I am not allowed to take any over the counter cold or pain medicine through treatment. It is very bad for your blood pressure and even your liver. If things get uber bad, I can once during the cold take Afrin and maybe one other time at night take a 'drowsy' formula that does not have sudafed. But that is only as a last resort. As a teacher and former science museum employee, this is a sad state of affairs. Cold medicine has my been my trusty companions through the years. But I survived this cold and can survive others. So far, this has been the only cold in 8 months I have gotten since I have started treatment. I will keep my fingers crossed.

There is possible light at the end of the tunnel. We are making slow progress, but the concern is money, time, and what happens if there is a set back. I.E. something happens to me and I get put on Prednisone and gain weight. But there are some human studies being wrapped up that if all safeness is shown, could be a green light for me in six weeks. We talked a very long time about this and I am sure we will talk more if it is a go.

Capt Mel

The Waiting Game

I just finished 18 weeks of treatment and had my third blood test. But it takes at 8-10 days for the results to come back. That is right in the middle of my vacation, so I won't see my doctor for another week and a half.

Is this really a big deal? No. But I am anxious to see if our changes in treatment have really started to work on fighting the insulin resistance. A couple of negatives have happened with this round of medicine tweeking.

The first one is loss of appetite. I was warned that some of the medicine would could cause me not to have any appetite, but it has gotten really bad. Especially with some of the heat we have been experiencing. It is not a matter of just fixing something, and once I am eating, everything is ok (like before). Food has actually been gross. So making the eat goal of every 3-4 hours has been nightmarish. I did have a meeting with my nutritionist and we got some strategies to try and work through some things. More of a brainstorming session on foods that were more liquid in nature.

The second one has to do with my stomach. The Doc wanted to increase my Metformin again. I had been only taking it with my large meal in the evening, but she wanted a morning dose too. About a week into that, I started to get some digestive trouble again. Nothing like to where I was before I started treatment. It is a small annoyance, but it is there.

So that leaves me playing a waiting game. Until we can see the results, there is nothing to do, but stay the course. If we are seeing huge results, I can deal with these minor side effects. But if we don't, we have already discussed some other medicine routes, and we may need to look at those. Let the Wait Begin!

Capt Mel

Is It the Heat? Is it the Meds? A Cold?

A few weeks ago, I was in WA, DC and while it was not the hottest degrees I have ever been in, it was the highest temps and humidity I have ever experienced. I seemed to do OK, but by the end of the week, I started to have some stomach symptoms that could have been one of three things:

1. Heat getting to me
2. Effects of upping my medication in certain areas
3. I caught some sort of illness

I got home and I rested for a couple days, and I seemed to get better. But of course, with treatment, comes changes in medication again and Seattle weather got hot (for Seattle weather), and my stomach got upset again. So the three things were all options again.

The other thing I have been discovering with the hotter temps is that I have absolute zero appetite to eat. And that is a really really bad thing. Even trying to force food down is awful. I actually start to feel gag reflexes. For all this medicine to work, I need to be eating.

Luckily, I had an appointment scheduled with my nutritionist and we brained stormed some ideas. Smoothies are actually an OK option with a protein pack. But I have nothing at home to make smoothies, and I have no desire to spend money buying something. Especially when I might be having to downsize soon. But other things like yogurt and cottage cheese and even more snackie things have seemed to help some. Meeting people for lunch has helped quite a bit as long as I can eat slowly.

The other good news is another 6 weeks is almost up and I have my blood draw bright and early Monday morning. I won't get the results until I get back from a vacation, but I am hoping we have some progress, and even if we don't, I know my doctor has some plans for a different route. I don't have to do any changes in what my current med setup is until then. So I have plenty of time to get my body used to this current med setup, So there should be no issues for my vacation! That is a relief!

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!  

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

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. 

Phew. 


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

http://en.wikipedia.org/wiki/Insulin_resistance
http://en.wikipedia.org/wiki/Diabetes_mellitus
http://www.womentowomen.com/insulinresistance/default.aspx

The Travel Conundrum

I was out of town this past Thursday through Sunday. It was the first travel I have done since the starting of all my medications. So this involved several new steps.

First, I had to make sure I had some supplemental food sources. I brought along bananas and Cliff Bars because I was not sure if a store was close to my hotel and what would be available between 7am and 8am (right before I had to start trekking to the Convention Center). Sure enough, they came in very handy in the morning and I was able to get my carb/protein combo I needed.

Second, I had to figure out how to travel with my my injection supplies. Luckily, I was carpooling the 300 miles and not flying. I still need to figure out the flying stuff soon. My local grocer/pharmacy said they were selling me a travel sharps container* for pen injection needles, but I found out too late it was a one time use for a larger needle.

*Sharps containers are those red (or white) Hazardous Materials containers you usually see at the doctor's office.

Why did I need a travel sharp's container? Well the one I have is HUGE and I did not want to pack it. I had to though, and it worked out alright. When we got to the hotel, I was shocked to see that I did not have a micro fridge. I have to keep my injection medicine cold. First, I filled up the ice bucket with some ice and put the meds there. I called the main desk feeling quite foolish about asking my question. I told them my meds needed to be refrigerated, and the response was they would be right back up with a medical frig.

So then I was curious about what a medical frig looked like. It was nothing special. Just a micro fridge. but it did the job I needed it to do.

Lastly, conferences can be very long, and many times, healthy (non fast food) choices are not near convention centers. While there were a couple healthy choices in the little food kiosk, I will not pay $3.25 for a Yoplait Yogurt. They are not even that healthy. So food was tricky sometimes. I need to eat every 3-4 hours with a carb/protien combo and that was hard. I had to miss a little bit of business I wanted to hear because I had to get food during one session.

This all should not sound like a big deal, but next time you are at an extended conference,business meeting, or day long class, I want you to set your alarm to ring ever 3.5 hours and see how difficult it can be to stay on a schedule. Try to pack lightly when you have to carry a sharps container, meds for 4 different times of the day for 4 days, alcohol wipes, and meds you need to keep cold, and see how difficult small packing can become. Add on that packing some of your own food. The one saving grace was that because there was an odd number of girls, I was the lucky girl this time and had a room to myself. I did not feel so self conscious about injecting myself each morning. I know my trips coming up will not be the same, but I feel more prepared.

I guess the lesson this time would be to not judge folks who seem to be traveling with some excessive baggage.There might be a very good reason why they have 2-3 bags!

Capt Mel

Let's Get Everyone Scared of Fat

As I was trying to shop for my groceries today, I was horrified by a magazine on the rack. I didn't pay much attention to which one (It was Newsweek or something like that). And the premise of the main pic and title was shock and awe scare tactics.

The photo was of a cute little baby boy and the title said something like "In 20 years, he will be 300 pounds."

What an awful article. I wanted to yell out, "No he won't if you get the proper medical care! He is probably insulin resistant and just needs treatment." But you never hear that from people or the doctors. Is fat the new group we persecute and ignore? Are we scared to fight the diet establishment because it is such a money maker?

In the last 12 weeks, I have learned so much more about hormones and digestion and brain chemistry. But you can't just find this stuff on the internet. All you see on the first many pages is stuff about just loose weight. Eat less, exercise more.

People.... this is a failing solution. It is like saying a broken arm happened just because you were clumsy. It doesn't fix the broken arm. There are doctors out there that can help and if you are overweight or over exercising to try and keep weight off, you need to get tests done!