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.    

More Loathing in the Mornings

I never have been a morning person.

That is quite a laughable statement because has a competitive figure skater I would be up at 4am to get ready for figure-eight practices and such before school.

As a teacher, I have to get up early for evil start times and to get work done.

While my system has seemed to adjust some to the morning thyroid medicine and shots, mornings still seem a tad worse. Especially early mornings.  I know I am only on day three of 4:30am wake-up, but it feels like it is going to be real difficult.

The only positive is that with long work days, I have actually started to feel a little bit hungry at times and food has not seemed so gross. The silver lining right! :-)

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

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!

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

Yes! It is a Snack

I am not sure if it is because I have been telling people about my medical conditions or it is because my new eating habits are just noticeable, but the comments I have been receiving about my eating is mostly amusing.

First, I have to have snacks. Think about this. You have an appointment (let's say a sporting event) at 2pm. You sleep in, and finish breakfast at 10:30am. Set your clock for three and a half hours later. That puts you at 1:30pm. You have one more hour before you need to eat something. That means you have to have a snack at that event.

So, I keep snacks in my purse. I have nuts, freeze dried fruit, and Zone bars. I am not a big fan of the energy bar, but it has a lot of protein and I need to keep a good protein/carb combo. I pull something out of my purse, and I snack. This has gotten me some funny looks. I also need to eat within the first hour of waking up. That can put a real tight squeeze on my time. I have to get up and take my thyroid medicine and my victoza shot. I have to wait at least 10 minutes before I can eat anything. I have to get dressed and make breakfast or get breakfast. It is a time crunch sometimes.

I also don't think people realize what will happen if I miss my 3-4 hour eating window. It is not pretty. The other day, I had a funny work schedule and I sat down to eat lunch at about 4 1/2 hours after my last meal. I started to feel funny as I ordered my food, I ate, and it was good, but afterwards, my body wanted to just crash. I went home and slept for 2 hours. When I stick to my 3-4 hours eating time schedule, I feel way more even keel and not very tired.

I have also started to notice some interesting comments by non-believers of my medical problem. I am using the word non-believers specifically with a religious type connotation. Not picking on a particular belief or non-belief, but some people have a fanaticism with their beliefs, and they can not for once maybe question their perspectives.

For example, let's look at a Christian and a hardcore Atheist. Both will try and prove the other wrong. Both will refuse to listen to one another. The Christian disregards anything (even evidence) the Atheist has to say because he is going to hell for being godless. On the other hand, the Atheist does the same exact thing and will not listen to any information the Christian has because the he believes in magical make-believe fairy tales. Either way, this can become a vicious cycle where each will begin to resent each other.

While I hope that my relationship with some people do not turn into such a heated battle, I am forced to acknowledge that there are some pretty smart people who think my doctor is bogus. They are actually ignoring scientific evidence and calling it false. They don't believe that a person's body can get so screwed up that it will do many things (one of them creating obesity even with little food and lots of exercise). So now I hear little snide comments like, "Cheese has a lot of fat you know." I usually just say, yes, but not all fat is equal and cheese has protein. I need to eat a lot more protein than I ever had. I refrain from nasty counter remarks.I also like the comments about eating more fruits and veggies. Now, they are good for you, but fruit is almost exclusively carbs and that is not the end all be all. I am working toward better health all around.

So why am I getting these comments. Because I will not cater to people who believe in food diets and lots of exercise. I have tried that all my life and it has not worked. When someone tries to bring this up, I shut them down. So, they have to try and convert me in other ways (hence the snide comments). I have a doctor who has been in the field for over 20 years and has data that is positive about my treatments. I can not change someone's belief, but it is frustrating to not only to be disregarded, but to actually have someone think what I am doing will not work. that it is just make-believe. When I mention a side effect, I get scoffed at like I am an idiot for blinding following an evil ne'er do well. Even though I have told these people that it is a 3-4 year plan, they question why they have not seen any noticeable results in 9 weeks. They don't care to hear about my internal non-visible results. Is it because they loath fat people or is it something else?

Until the results outwardly start showing, and then I can throw the results in their faces, I will continue to eat my snacks!

Capt Mel

Proof is in the Pudding

As I start to push back on people's beliefs about obesity, some people get huffy. The best one I've gotten so far was someone saying that maybe I was just not as active as I thought. I had convinced myself (i.e they mean lying) that I was doing more than I believed. And then, along with that, maybe I eat more than I think (I wish my nutritionist was there for that one). So if I really just watched my portion sizes and exercised more, I would not need medicine and all this doctor stuff.

Unfortunately for this person (and the others thinking, but keeping their mouths shut), I do have data to support my claims. In April of 2011, I bought the Fitbit: http://www.fitbit.com/. What I like about these folks is that they do not claim you have to become an iron man to stay fit. They believe if you can average 10,000 steps a day/70,000 steps a week, you can be a healthier person. The device is small and you can wear it on your bra strap. This is great for me because I swore off wrist watches on June 1, 2005.

It can record up to seven days of activity before having to be charged, and it syncs with your computer without having to put it on the charger. You can even wear it at night and it will record your sleep. You can also enter in your food. There is a new scale to measure body weight and mass. But since I don't weight myself (and you really should not either), I don't know too much about that.

So I have data. Boat loads of data. Over a year of data. So take a look:

Life Time Distances starting from April 17, 2011:

April 30, 2011 = Earned a total of 50 miles since purchase
June 17, 2011 = Earned a total of 250 miles since purchase
August 29, 2011 = Earned a total of 500 miles since purchase
October 26, 2011 = Earned a total of 750 miles since purchase
December 20, 2011 = Earned a total of 1,000 miles since purchase 

As of this writing post, I have earned 1,540.5 miles since purchase. Another official data point will be recorded when I hit 2,000 miles. I will help you with some of the math:

I earned 1,000 total miles in 247 days. That is an average of 4 miles a day, every day. 
Since December 20, I have averaged 3.4 miles a day (remember I am on exercise restriction). 

I know my average will start to go down even more because of promising to keep close to under the 10,000/70,000 average, but it goes to show you that I am no lazy oaf. In fact, my numbers are a tad inaccurate because there have been days I have failed to wear the fitbit, it doesn't record biking accurately (though I have done little of that) and it doesn't account for swimming (not water proof). There was a week in May 2011, where my fitbit encountered a crushing accident and it took me that long to replace it. Also, in July 2011, I did not take my fitbit to Hawaii and we did a lot of walking, etc there. I also question the accuracy when I am curling because I slide on my slider a lot and I don't think it counts that correctly. In late October 2011, I suffered my first curling injury and tore a muscle on the front of my right calf. I did a half marathon on a torn muscle.

So again... with this little of data, do you still want to question my activities levels? I am not some lone weirdo medically. I am pretty tenacious and like to be active, but there are lots of people like me. We are shamed into silence because of fat jokes and criticism about fat people just being lazy and eating lots of food. Though we are reassured that is not us because of the acquaintance factor. 

Maybe proof is not in the pudding, but in the data because I eat so little pudding! :-) 

Capt Mel    
 
 

The Ying and the Yang of Treatment

I envy the people who can take any type of medicine and not have any of the side effects. Though I have to say, through most of my life, most medicines I had to take (and usually in the short term) did not really have horribly negative effects. The worst I could say was that they didn't necessarily make me feel good. I could never understand why people got so excited to hear I had some powerful pain killer for something or other because it did not make me feel good to take. It just took away the pain. 

But now with Metabolic Syndrome, Insulin Resistance, and a whole other slew of things, I have tons of meds and supplements to take. And while the results seem to be better than the side effects, it still can be pretty icky and put you in a bad mood. 

While I am still on Metformin in the evening, I am not taking it in the morning because about 5 weeks into initially taking it, I got horrible nausea in the morning and even threw up a couple of times. I found out that it was creating an acid reflux effect. I had never had acid reflux before. Or at least not so bad as to make it noticeable. So instead of trying to give me another med to counter act that, I am on a new med in the morning and will hopefully be able to add a morning dose of Metformin .

What the doc did add was something called Victoza. The huge downside to this is that you have to inject the stuff. It really doesn't hurt, but it is awkward. If you don't pinch really hard and continue pinching while injecting yourself, you get this icky bruise. From a pen needle no-less.I have a couple places where I am bruised.

And unfortunately, the second day of taking it, I got nausea. We are not sure if it is just a side effect until my body gets used to it or something I will have to live with. The first thing I was told to do by the nurse was to move from injecting in my stomach to injecting in my upper thigh. I had only a tiny bit of nausea yesterday and today almost zero. So I am thinking of trying the stomach one more time tomorrow. It is completely awkward to inject in the upper thigh spots.

The nausea is weird too. It is not from the belly when you have an upset stomach virus or a bad hangover. This literally starts in your lower throat. And you have to hack and gag. You can't control it. Eventually you have a bout of retching. But it is all within a five minute period. Within another five minutes, you feel OK. It is the oddest thing. 

But there is nothing like feeling alive. Even if I have to go three to four years with morning nausea, I will do it. I am feeling better. It is hard to describe the idea that you don't have to just lie down and sleep. Or exhaustion from doing nothing.

Of course, the last thing I need to see happen is loss of weight. This is the first time since I was five years old, I have not actively been trying to train/exercise a lot to lose weight or do something specific. I have promised my doctor that I will try not to go over 10,000 steps in one day or 70,000 steps in a week. That averages to almost 5 miles a day. Now most people will read this and have their jaws drop, but you can see how much I was doing. I remind folks that I gained 30 pounds training extensively for a 1/2 marathon and eating only about 800-1000 calories a day. And when I can start biking again (my right hip is still wonky, but getting better since inflammation in all my muscles is going down), I have to limit my mileage. At first I can only do like 10 miles and then only 20 miles. In the summer of 2006, I was biking 75-100 miles a day.

The Ying and Yang of Western medical treatment. I will keep plugging along and will hopefully see some amazing results!

Capt Mel